Development of Skala Kepuasan Kaunseling Mandatori

@#Introduction: Mandated counselling is usually associated with forced participation. Therefore, there is considerably higher likelihood of involuntary participation resulting in client’s dissatisfaction toward the counselling session. However, there exists literature that shows satisfaction and positive outcomes among mandated clients. Mandated counselling is widely practised, especially in the case of Malaysia. Thus, an instrument to measure client’s satisfaction was developed to capture the client’s perception, attitude and factors that contributed to the mandated counselling satisfaction. Methods: The respondents involved in this study were adolescents in rehabilitation centres under the supervision of the Department of Social Welfare (Jabatan Kebajikan Masyarakat) aged 13 to 19 who had attended mandated counselling at least twice. The study was divided into four phases. Initially, in the first phase, the items were developed based on themes narrated by mandated clients and from the counsellor’s perspectives. Next, the initial measurement developed was tested to identify dimensions conceptualized in the instrument. Then, the reliability of the instrument was tested. In the final phase, a confirmatory factor analysis was conducted to confirm the model. Results: Findings showed a 52% of total variance was explained in the exploratory factor analysis, with an internal consistency of .919. The findings also showed a 16-item measurement with four dimensions: (a) alliance-system; (b) counselling efficacy; (c) therapeutic change; (d) counsellor-counselling effect. Conclusion: : In summary, this study had identified significant factors essential in influencing satisfaction of mandated counselling clients in the Malaysian context. It is thus beneficial for counselling practitioners in their counselling work involving mandated clients.

Exploring the Determinant of Pre-Pregnancy Care Services Usage among Reproductive Ages Women in Kedah, Malaysia

​In Malaysia although mortality rate among women of reproductive ages has reduced over the years, the reduction has been stagnant for the past ten years. In order to achieve the 5th Millennium Development Goal, several measures need to be taken including a proper implementation of pre-pregnancy services in this country. This study explores the awareness, intention and usage of pre-pregnancy care (PPC) services and its determinant among women of reproductive ages in Kedah, Malaysia. This is a qualitative study, which consisted of a focus group discussion (FGD) among women in the ages of 18 to 45 years old from all ethnic groups who attended four government clinics in the state of Kedah. The mothers were chosen through purposive sampling from twelve districts that were selected through a multistage random sampling. A semi-structured questionnaire was utilized during the FGD. The results from the FGD were recorded verbatim and thematic analysis was finalized once saturation of information from respondents was achieved. These are two themes was identified, namely personal reasons and reasons of service and there are several subthemes under two main themes. Under the Personal reason themes, the subthemes including awareness and intention to used the services, knowledge, perception, social support and history of medical illness. While under pre-pregnancy care services themes, the subthemes including the promotion of the services, the communication relationship with the health staff, the waiting time and also the accessibility of the service. As a conclusion, there is still part of society who was unaware of pre-pregnancy services and its importance in reducing maternal mortality rate as well as producing good pregnancy outcome. Information and knowledge on pre-pregnancy care services should be disseminated among community members through various means including roadshows and pre wedding workshops.​

Role of serum procalcitonin in sepsis

Objective: Role of serum procalcitonin in sepsis

Study Design: Descriptive / Cross sectional study

Place and Duration of Study: This study was carried out at the Mamji Hospital Karachi from January 2013 to July 2014

Materials and Methods: The adult patients presented with short duration of fever, altered consciousness, bed sores, cough, increased frequency of urine, diarrhea and vomiting and abdominal pain. ESR, CRP and serum procalcitonin level were sent simultaneously with blood, sputum and urine cultures. The study was conducted in Mamji Hospital F. B. area, data was recorded in a preset proforma. The features like biodata, symptoms/signs, biochemical test and cultures reports were shown in tables. The data was analysed on SPSS version 15

Results: In this study total cases were 33. Males were 19[55%] and 14[45%] were females. The mean age was 47 +/- 19. With the age range from 28 to 68 years. Males were slightly more than females. The patients were divided into two groups according to the level of procalcitonin. Group I were those with raised procalcitonin level > 0.5 and group II were those with procalcitonin level < 0.5. The ESR and CRP were raised in every case. In Group I total number of cases were 27, pneumonias 06 cases, UTI06 cases, bacterial meningitis 05 cases, bacterial dysentery 05 cases, skin infection 04 cases and septic arthritis 01 cases. In group II total cases were 06, 02 cases were viral one is cytomegalovirus and other is Epstein-Barr virus, 01 cases was connective tissue disease and was diaganosed as systemic lupus erythematosus 01 case was wegner's granulomatosis, 01 case was bronchogenic carcinoma and 01 was peripartum cardiomyopathy. The culture report showed 08 cases were E coli, 6 cases were pseudomonas aeroginosa, 5 cases were staphylococcus aureus, 3 cases Enterobacter 03 cases and streptococcus pneumonia 02 cases

Conclusion: In cases with fever the early detection of high serum procalcitonin level will clearly differentiate between inflammatory conditions caused by bacterial rather non bacterial conditions

Beyond the liver! extra hepatic manifestations: assessment of frequency and risk factors among hepatitis b and c related chronic liver diseases

Objectives: The study aimed to determine the frequency and risk factors for Extra Hepatic Manifestations among patients with Hepatitis B and C related Chronic Liver Diseases

Study Design: Cross Sectional Study

Place and Duration of Study: This Study is conducted at the Department of Medicine [Both indoor and outdoor patients] of Civil Hospital, Karachi from 2012 to 2016

Materials and Methods: In this study of 548 patients, who were positive for HBV or HCV, fulfill the selection criteria and were suffering from Chronic Hepatitis, Cirrhosis or HCC were examined for Extra Hepatic Manifestations clinically and if required appropriate tests were done to confirm the diagnosis and finding. Frequency and risk factors were determined for extra hepatic manifestations. Test of statistical significance were applied where p value of <0.05 was considered to be statistically significant cut-off

Results: Majority of patients 432 [78.8%] were HCV Positive and 116 [21.2%] were found to be HBV positive. Overall frequency of extra hepatic manifestations was found to be 54.7 %. Patients with chronic hepatitis C and B. The Extra Hepatic Manifestations of 60.6 % in HCV and 32.8% in HBV respectively. Diabetes Mellitus [DM] is the most common extra hepatic manifestation found in both, chronic HCV [19.0%] and chronic HBV patients [5.2%] whereas hypertension is the second commonest extra hepatic manifestation among HBV patients [12.1%]. Disease duration > 5 years, age> 45 years, Viral PCR, Raised ALT and Hepatocellular Carcinoma associated with chronic HCV and HBV were found to be significant risk factors for extra hepatic manifestations

Conclusion: Extra Hepatic Manifestations are more common in HCV associated liver diseases than HBV. Diabetes and hypertension are the main extra hepatic manifestation among HBV and HCV positive patient. Disease duration > 5 years, age> 45 years, Viral PCR, Raised ALT and HCC associated with chronic HCV and HBV were found to be significant risk factors for Extra Hepatic Manifestation

Intracerebral hemorrhages as an atypical radiographic presentation of herpes simplex encephalitis on CT scan: an analysis of 23 patients

To find out the effect of the atypical presentation of herpes encephalitis in the form of intracerebral Hemorrhage on the morbidity and mortality of patients. It is basically retrospective study conducted at radiology department Dow University of Health Sciences Civil Hospital, Karachi from 2009 to 2011. Total numbers of patients presented with clinical diagnosis of encephalitis were109 and underwent CT scan plain and post contrast study. Physical diagnosis was based on fever, fits and altered level of consciousness. Laboratory diagnosis was based on pleocytosis with predominant lymphocytes, low glucose and high proteins and confirmation by polymerase chain reaction test [PCR] and empirical use of acyclovir. Total cases presented with clinical diagnosis of viral encephalitis and presented as hypo density with focal edema on CT scan were 109, out of which 23 cases presented with intracerebral hemorrhages. Hemorrhagic encephalitis was found in 21% of the cases. On plain CT scan brain, five cases showed isolated bilateral basal ganglia and thalamic hemorrhages. In seven cases bilateral temporofrontal region showed hemorrhages. Nine cases showed unilateral temporoparietal region [six cases were on right side and three cases were on left side] hemorrhages and in three cases unilateral right frontoparietal and basal ganglia hemorrhages were found on CT scan. In five cases leptomeningeal enhancement was associated with bilateral temporoparietal encephalitis. Hemorrhage size ranged from 2-5 cm. In nineteen cases, post contrast enhancement was seen in areas of encephalitis. In appropriate clinical setting of encephalitis with CT SCAN diagnosis of intracerebral unilateral or bilateral hemorrhages and post contrast enhancement with CSF positive criteria for viral infection, diagnosis of herpes encephalitis should be on top of differential diagnosis. An early use of acyclovir without waiting for further tests can save the life of patients and significantly reduce the mortality and morbidity of patients

Early computerized tomographic scan in mild pancreatitis may be deceiving: an experience of tertiary care hospital

To assess the justification of Computerized Tomographic [CT] scan for the diagnosis of acute pancreatitis at early stage and its impact on mortality and morbidity of patients. It was a retrospective study conducted at Radiology Department Dow University of Health Sciences from April 2009 to August 2011. Patients were diagnosed as acute pancreatitis both clinically and radiologically. Severity of acute pancreatitis was clinically assessed by Ranson's criteria and radiologically by Balthazar CT Grading and CT Severity Index. Fourteen of the total 131 included patients underwent early CT scan at 4-12 hour after start of symptoms of abdominal pain and vomiting and were normal radiologically[10.68% out of total 131 patients presented with acute pancreatitis. These patients revisited at 24-36 hours, with severe epigastric pain and on follow-up CT scan on re-admission, two patients showed intra and peripancreatic collections, swollen pancreas with peripancreatic fat necrosis without necrotizing pancreatitis [Balthazar Grade-E] and moderate pancreatitis according to CT Severity Index[four points]; Three patients had 30% pancreatic necrosis with Balthazar grade-E changes and according to CT Severity Index moderate pancreatitis[2+4=6]; Two patients had 30-50% necrosis and rated as Balthazar Grade-E and labeled as severe necrotizing pancreatitis according to CT Severity Index[4+4=8]; while Seven patients showed severe necrotizing pancreatitis with >50% of pancreatic necrosis according to CT Severity Index[6+4] along with Balthazar Grade-E pancreatitis[6+4=10]. Patients with severity index of 10 had 100% mortality. Early CT scan has very little role in diagnosing and determining severity of disease or in predicting prognosis of patients.

Antibacterial effect of camellia, juglans, and hippophae spp. on methicillin-resistant strains of s. epidermidis and S. hemolyticus in urine samples

To investigate the antibacterial activity of Camellia sinensis, Juglans regia and Hippophae rhamnoides extracts on methicillin-resistant strains of Staphylococcus epidermidis and Staphylococcus hemolyticus. Coagulase negative staphylococci [CoNS] which were once considered avirulent and usually contaminants when isolated from urine samples are becoming increasingly recognized as agents of clinically significant nosocomial infections. These pathogens are also steadily becoming resistant to conventional antibiotics available as well as combination drugs, highlighting the need for alternative or synergistic natural antimicrobial products that are effective, inexpensive and non-toxic. 300 urine samples from hospitalized patients with indwelling catheters were tested for CoNS. Methicillin resistant strain of S. hemolyticus and methicillin resistant strain of S. epidermidis were found amongst others using standard microbiological procedures. Identification was done by API-staph and 16S rRNA gene sequencing using ATCC cultures as control. The antibacterial activity of aqueous extracts of green tea leaves [Camellia spp.], dandasa: dried bark of the walnut tree [Juglans spp.], and sea-buckthorn berries [Hippophae spp.] were investigated on the CoNS isolates, in duplicate, using Microtube-dilution method for Minimum Inhibitory Concentration [MIC] estimation. Amongst the CoNS isolated, 19% were S. epidermidis and 15% were S. hemolyticus. Methicillin resistance observed was above 60%. Of which, 51% of the S. epidermidis strains and 89% of the S. hemolyticus strains were found to be sensitive to the tested extracts. The average MICs of extracts for the S. epidermidis were found to be 1250 microg/ml for green tea, 312.5 microg/ml for Dandasa and 156.25 microg/ml for sea-buckthorn. S. hemolyticus strain, however, showed the average MICs of 625microg/ml for green tea, 2500microg/ml for dandasa and 39.06 microg/ml for sea-buckthorn. Our results indicate that extracts of green tea leaves, dried bark of walnut tree, and sea-buckthorn berries may contain compounds with important therapeutic activities, encouraging further study

Dietary misconceptions in Pakistani diabetic patients

To find out prevalence of various myths regarding diet of diabetics in local population. This was a cross sectional study conducted at diabetic clinic and medical OPD in Civil Hospital Karachi from January 2008 to December 2008. A total of 409 diabetic patients of either gender, age 18 or above who had given the consent were randomly selected. A pretested semi structured questionnaire regarding sociodemographic profile and various dietary myths regarding diabetes were used to get information from the study group. Out of 409 diabetic subjects 207 [50.6%] were male. Average age was 51.6 +/- 10.4 years. Most of the participant 397 [97.1%] were type 2 diabetics. Large number of subjects 83 [20.3%] were either illiterate or had had primary schooling 112 [27.4%]. Most of the participants 256 [62.6%] never received any diabetic education. Majority of study subjects 348 [85%] believed in special diet for control of blood sugar level while large proportion of study population 335 [81.9%] did not use underground vegetables and same number of participants had strong belief in bitter vegetables as natural remedy. Forty one percent study subjects had myths regarding fruits while 301[73.5%] said that rice is prohibited. Study population who believed in special diet showed significant p-value [<0.005] when compared with those who did not. Similarly the group that had received diabetic education showed significant p-value when compared with those who did not. A large number of diabetic patients especially those who never received any diabetic education have strong dietary misconceptions

Vitamin-D status in a population of healthy adults in Pakistan

To determine the prevalence of hypovitaminosis D and its predictors in healthy adult Pakistanis. This study was conducted at various hospitals in Karachi from April 2007 to September 2007. In this study 244 healthy adults 16-62 years of age, visited hospital as an attendant of the patients and fulfilled the inclusion and exclusion criteria has been enrolled. After taking written consent a questionnaire regarding age, gender, occupation, duration of sun exposure, area of skin exposed, type of residence used, clothing and dietary habits were recorded. Serum 25-OH Vitamin D3 levels were determined by electrochemiluminescence method and Vitamin D deficiency was defined as a level <20micro g/ml. serum calcium. Phosphorus and Alkaline Phosphatase were also measured in all of these subjects. Among 244 subjects ranging from 16-62 years, 193[79%] were female. Subjects were predominantly married [72%], mostly residing in apartments [47.5%] and most of them [41 .8%] only exposed their face and hands while outdoor. Duration of sun exposure in majority was 1 -2 hour /day [42%]. Majority used clothes of variable colour [72%] and fabric [41%]. One hundred and eighty six [76.2%] subjects had deficiency of Vitamin D and significantly correlated with duration of sunlight exposure, large area of skin exposed, vitamin D in diet consumed and colour of clothes worn. Vitamin D was significantly correlated negatively with serum Phosphorus and Alkaline Phosphatase whereas serum calcium correlated positively. Prevalence of hypovitaminosis D among healthy Pakistanis is high and duration of sun exposure is the most common predictor of hypovitaminosis D

Clinical profile and management outcome of diabetic foot ulcers in a tertiary care hospital

To determine major risk factors and management outcome of diabetic foot ulcers in order to prevent amputation. Cross-sectional descriptive study. Study was conducted at the Department of Medicine, Civil Hospital Karachi, from January 2005 to December 2006. One-hundred and sixteen consecutive diabetic patients, with foot ulcers of Wagner's grade 1 to 4 were assessed at baseline for demographic information, detailed history, neuropathy, peripheral pulses and frequency of diabetic complication. Glycemic control was determined on the basis of HbA1c levels. Appropriate medical and surgical treatments were carried out and patients were followed-up until healing or for 6 months as end point of study. Outcome was recorded as healed, incomplete healing and amputated. A majority of subjects had type 2 diabetes [95.7%] with male predominance [66%]. The mean age was 54.29 +/- 7.71 years. Most of the patients were overweight, hyperglycemic and had diabetes > 10 years duration. Neuropathic ulcers were found in 91 [78.4%] patients, while rest of the 25 [22.6%] had neuroischemic ulcers. Wound cultures revealed polymicrobial organisms. Foot ulcers of 89 [77.7%] patients healed without amputation and 17 [14.7%] patients had minor or major amputations. Long-duration of diabetes, poor glycemic control and type of foot ulcers had effect on prognosis [p<0.05]. Effective glycemic control, optimal wound care, aggressive medical management and timely surgical intervention may decrease disabling morbidity with better outcome of diabetic foot ulcer

Diabetic ketoacidosis - a study of 67 episodes in known type 1 and type 2 diabetic patients

Review and describe the clinical characteristics and outcomes of Diabetic Ketoacidosis [DKA] in type land type 2 Diabetic patients. We reviewed the medical records of all patients with a diagnosis of DKA in known diabetics and followed their clinical course and outcome. We classified patients as "type 1" and "type 2" diabetes mellitus based on their treatment history. DKA with recent onset of diabetes excluded because of uncertainty of type of diabetes. We compared the groups for precipitating factors, clinical characteristics and outcomes. Sixty-seven patients fulfilled criteria for inclusion in the study. Of 67 patients 44 [65.7%] were male. Twenty [30%] patients had type 2 diabetes. Mean age of type 1 diabetics was 21.6 +/- 6.lyears while type 2 Diabetics were older and had 48.7 +/- 9 years mean age. Body Mass Index [BMI] and duration of diabetes were greater in type 2 Diabetes. A history of prior DKA was noted in 28 patients and all of them were type 1 Diabetics. Infections were the most common precipitating factor in total [41.8%] but in type 2 Diabetes noncompliance was the main precipitating factor. There were 8 deaths in total and mortality rate was apparently higher in type 2 Diabetes. DKA could frequently complicate type 2 Diabetes contrary to belief and carries relatively high mortality

Hepatotoxicity with antituberculosis drugs: the risk factors

To assess the severity and frequency of hepatotoxicity caused by different antituberculosis [ATT] drugs and to evaluate whether concurrence of risk factors influence the antituberculosis drug induced hepatotoxicity. This prospective cohort study was conducted in Medical Unit-V and OPD department of Civil Hospital Karachi from July 2004 to July 2005. A total of 339 patients diagnosed of active tuberculosis infection with normal pretreatment liver function were monitored clinically as well as biochemically. Their data were collected on proforma and patients were treated with Isonized, Rifampicin and Pyrazinamide. Duration after which derangement in function, if any, occurred and time taken for normalization was noted. Treatment was altered as needed, with exclusion of culprit drug. Finally data was analyzed by SPSS version 10.0. ATT induced hepatotoxicity was seen in 67 [19.76%] out of 339 patients. Females were more affected as compared to males [26.3% vs. 19.7%]. BMI [kg/m2] of 91% of diseased group were less than 18.5 [p<0.01] most of them were anemic having low albumin level suggestive of lean body mass. Hepatotoxicity was more severe in AFB smear positive patients. Concomitant use of alcohol, paracetamol and low serum cholesterol were proved as predisposing factors. Isoniazid [37 patients [55.21%], p<0.01] was the main culprit followed by Rifampicin [23 patients, 34.21%] and Pyrazinamide [7 patients, 10.5%]. Most of the patients [61%] developed the hepatotoxicity within two weeks of starting antituberculosis therapy with mild to moderate alteration in ALT and AST. ATT-induced hepatitis is significantly more frequent and more severe in patients with hepatotoxicity risk factors

Falciparum malaria: various presentations

This study was conducted to evaluate the modes of clinical presentations of falciparum malaria. Descriptive study. Medical Unit 5, Civil Hospital Karachi and Ankle Sria Hospital Karachi from August 2003 to December 2005. A total of 348 patients admitted with fever were screened with peripheral blood smear for malarial parasite. One hundred and twenty two patients were smear positive. One hundred and eight were positive for plasmodium falciparum, which were included in this study. Eleven patients were positive for plasmodium vivax and three patients had co-infection with plasmodium falciparum and P.vivax which were excluded. Critically ill patients were given injectible Quinine sulphate, rest of them were given either Halofantrine or Artemether orally. Out of 108 P. falciparum smear positive patients, males were 74 [68.51%] and females were 34 [31.48%]. Fever was present in all patients. Jaundice was observed in 39 [36.11%], vomiting in 32 [29.62%], abdominal pain in 23 [21.29%], altered state of consciousness in 26 [24.07%], diarrhea in 9 [8.33%], cough in 8 [7.40%] and seizures in 2 [1.85%] patients. Out of 108 patients 22 [20.37%] patients presented with cerebral malaria, 8 [7.40] with picture of respiratory tract infection, 9 [8.33%] patients presented with acute gastroenteritis, 9 [8.33%] with acute abdomen simulating the picture of acute pancreatitis but serum amylase and ultrasound abdomen excluded the diagnosis of acute pancreatitis. Six [5.55%] presented with the picture of acute hepatitis and 4 [3.70%] presented with fulminant hepatic failure with raised serum ammonia levels and hepatocellular jaundice with negative viral markers for hepatitis B, C and E. Three [2.77%] patients presented with a picture of acute renal failure. Apart from these, many patients were seen with various presentations of acute abdomen, clinical picture of lower respiratory tract infection, acute hepatitis with Fulminant hepatic failure being notorious. Falciparum malaria should be considered as a possibility in all febrile patients even with various presentations for malaria

Various methods to detect Helicobacter pylori and their respective yield

This is a prospective study carried out in 100 cases with the aim to see various methods available to detect H. pylori and their respective yield. Further to select which of the two methods if combined together give the best/highest yield. Department of Medicine Dow University of Health Sciences [DUHS] and Civil Hospital, Karachi. In this study 100 patients were selected coming to Gastrointestinal Clinic of Medical Unit - 5, Civil Hospital and DUHS, Karachi, for various dyspeptic symptoms and were suspected to be suffering from acid peptic disease. Multiple biopsy specimens [six] were taken for the study:-First two samples were directly inoculated into culture media. The third specimen was immerse directly into the helicourease gel for detection of H.pylori. The three biopsy specimens were preserved in the formalin for histological examination and for special staining to detect H.pylori. Finally l0cc blood was drawn to detect both quantitative and qualitative antibody titer for H.pylori. All the tests for detection of H.pylori were performed on these 100 patients and it was found that Enzyme Linked Immunosorbent Assay [ELISA] 82% [Quantitative], H. Flex 72% [Qualitative], Histology 66%, Helicourease test 52%, Culture 46% and ELISA and Histology combine74% positivity. Serological detection on IgG antibodies to H.pylori is found to be highly reliable for the diagnosis of H.pylori infection, because of its non-invasiveness, easy and quick to perform its reliability had made it to replace the invasive procedure as a primary diagnostic test. It is observed that if ELISA and histology are combined together give the highest yield, as histology is the most confirmative procedure to identify the active invasion of the organism into the substance of tissue

Serum uric acid levels in female patients of ischemic heart disease

To find out possible relationship between serum uric acid and incidence of ischemic heart disease. Comparative study of serum uric acid in 30 patients of IHD with 11 age and body mass index matched control subjects. Basic Medical Science Institute, JPMC, Karachi. Serum uric acid was found to be significantly high [P<0.001] in hypertensive with ischemic heart disease and in hypertensive. The mean values were also found to be high in normotensives with IHD but the difference was statistically non-significant. Serum uric acid levels is strongly related to incidence of ischemic heart disease

Acneiform Eruptions: a Hazard of beauty creams

Adolescent and post adolescent females visit Dermatologist frequently with white comedones and inflamed papules, situated mainly on cheeks and forehead. Most of these patients admit to development of these lesions after the use of a beauty cream, applied to improve their complexion. The objective of this study was to establish the incidence of skin lesions following the use of beauty creams, duration of use, frequency of application, distribution of lesions, types of lesions, and the source/advice about the use of beauty creams. This is a prospective study which lasted four months and was conducted in the Dermatology OPD of Abbasi Shaheed Hospital [Karachi Medical and Dental College]. The subjects underwent a thorough clinical history and dermatological examination regarding type and distribution of lesions. They were asked to identify the products [beauty creams and the steroid preparation] used. Those who could not identify the preparations were excluded from the study. All those patients who had any sort of lesions on the face prior to the use of the beauty cream were also excluded. Fifty patients were enrolled in the study which were divided into two groups group- A which used beauty cream alone [15 patients], and group -B which used beauty cream with an admixture of a steroid [35 patients]. Acneiform eruptions were commonly seen in both groups 30% in group A and 70% in group B. The average duration of application was 3.7 months in group A [range 1-6 months] and 2 months in groups B [range 1-4months]. Most subjects used single night time application. The predominant lesions were white comedones [100% in both groups] and inflammed papules [100% in group B and 53.3% in group A]. Macular erythema and telangiectasia were [34.2% and 28.5% in-group B] and [26.6% and 0% in-group A]. The cheeks and forehead were universally involved in all patients [100%] and chin in [17% group B and 26% in-group A]. Majorities of the subjects belong to the middle and low-income families. Acneiform eruption developed in 30% of subjects using beauty creams alone and 70% of subjects who mixed steroids in their beauty cream

Oral candidal carriage in young insulin dependent diabetics.

Fifty patients with insulin-dependent diabetes mellitus (IDDM) in the age group of 5-20 years were assessed for oral candidal carriage state and other related oral manifestations. The control group showed 16% Candida carrier state, whereas the IDDM group showed 92% candida carrier state. The candidal count was significantly higher in the IDDM group. Other associated oral manifestations like dry mouth, burning sensation, and painful fissures were also observed in the IDDM subjects.