A Case Of Chemical Leukoderma Effectively Treated With Punch Graft Surgery

Chemical leukoderma is a hypomelanotic disorder due to destruction of melanocytes or inhibition of melanogenesis secondary to application of harmful chemicals household or industrial. It can be easily diagnosed clinically by a positive history of frequent exposure to a depigmenting agent at the site corresponding with the pattern of the object applied. It has a psychosocial significance because of the dyspigmented presentation of the disease which often simulates other conditions associated with social stigma, like leprosy or vitiligo. Here, we report a case of thirty year old female with chemical leukoderma who presented to us with depigmented patches over forehead (bindi leukoderma) and dorsae of feet (footwear dermatitis) caused by application of sticker bindi and wearing of rubber footwear respectively. Complete repigmentation was observed after treatment with topical corticosteroids and melanocyte transfer surgery.

Elevated Body Mass Index Is Associated with Secondary Hypogonadism among Men Presenting to a Tertiary Academic Medical Center

PURPOSE: To characterize the population of hypogonadal men who presented to a tertiary academic urology clinic and evaluate risk factors for primary vs. secondary hypogonadism. MATERIALS AND METHODS: We evaluated all men with International Classification of Diseases-9 diagnosis codes R68.82 and 799.81 for low libido, 257.2 for testicular hypofunction, and E29.1 for other testicular hypofunction at a tertiary academic medical center from 2013 to 2017. We included men who had testosterone (T) and luteinizing hormone (LH) drawn on the same day. We classified men based on T and LH levels into eugonadal, primary, secondary, and compensated hypogonadism. Risk factors including age, body mass index (BMI) over 30 kg/m2, current smoking status, alcohol use greater than 5 days per week, and Charlson comorbidity index greater than or equal to 1 were investigated and measured in each group using the eugonadal group for reference. RESULTS: Among the 231 men who had both T and LH levels, 7.4%, 42.4%, and 7.4% were classified as primary, secondary, and compensated hypogonadism, respectively. Only elevated BMI was associated with secondary hypogonadism compared to eugonadal men (median BMI, 30.93 kg/m2 vs. 27.69 kg/m2, p=0.003). BMI, age, comorbidities, smoking, or alcohol use did not appear to predict diagnosis of secondary hypogonadism. CONCLUSIONS: Secondary hypogonadism appears to be the most common cause of hypogonadism among men complaining of low T and decreased libido at a tertiary academic medical center. Secondary hypogonadism is associated with elevated BMI and therefore obesity should be used as a marker to evaluate men for both T and LH levels.

INTRAOSSEOUS LESION OF PHALANX: TWO SIMILAR CASES BUT NOT THE SAME

@#Intraosseous lesions at phalanges are rare. They frequently present with pain and swelling. Fortunately, the majority of the lesions are benign. However, some lesions are destructive and early interventions are required. We report two cases of similar presentations of swelling and discomfort at the little finger for six months. The lytic lesions involved the whole middle phalanx with cortical breach sparing the joints. A provisional diagnosis of osteomyelitis was made, although unlikely. Bone biopsy was performed early to plan for definitive treatment and surgery. Patient 1 was diagnosed for intraosseous gout whereas Patient 2 for epithelioid hemangioma. Both were benign destructive bone lesions. Thus, we counselled the patients for curettage of lesion, bone grafting and spanning external fixation in view of extensive lesion. Patient 1 defaulted treatment. Patient 2 had an uneventful surgery. She regained her grip strength. In two years follow up, there was no evidence of infection, recurrence or malignant transformation.

Evaluation of Arterial Pulse Amplitude Ratio and Valsalva Ratio in Different Age Groups.

Aims: To construct normal values of Valsalva ratio for heart rate responses during Valsalva maneuver (VM) and arterial pulse amplitude ratio as reference values for different age groups, and to investigate the effect of aging alone , without , the presence of risk factors, on autonomic nervous system. This is a case control study, performed in Marjan teaching hospital, in Hilla city, from February 2012 to June 2012. Methodology: 40 subjects were included in this study, all were healthy males, group 1 (G1) mean age 28.3±9.7 years, group 2 (G2) mean age 48.4±7.1 years. Strips of lead II of ECG were recorded during performance of VM for calculation R-R intervals and measurement of blood pressure during phase I and phase II by mercury sphygmomanometer. Calculation of Valsalva ratio for heart rate and arterial pulse amplitude ratio for both groups were done. Results: The systolic and diastolic blood pressures of G2 were significantly higher than values of systolic and diastolic blood pressures of G1 at phase I and phase II of VM (P=0.05). Pulse pressure for the two groups at phase I (G1:51±11, G2: 53±13mmHg) and phase II (G1:41±5, G2:41±3.99) of VM were not significant (P>0.05). Valsalva ratio for G1 was (1.5±0.3) and for G2 was (1.39±0.29), pulse amplitude ratio for G1 was (0.80±0.19) and for G2 was (0.77±0.19). There were no significant differences between the two groups (P>0.05). All values were expressed as mean±SD. Conclusions: The results showed that the autonomic nervous system is intact in the older group. The aging process, without the presence of risk factors, does not affect the autonomic nervous system.

Successive objective long-case assessment as a driver of clerkship learning – Evaluation through perception questionnaire

Background: Clinical clerkship in a busy hospital environment forms an important part of undergraduate medical training. Regular objective assessment of this activity with feedback would be expected to improve outcome. Methods: We implemented fortnightly clinical assessments using modified OSLER (Objective Structured Long Examination Record), and over a 6-week clinical rotation. Modifications included provision of individualized feedback. The assessment process was evaluated by both students and teachers via a questionnaire measuring their perceived educational impact, feasibility and acceptability. Results: Students agreed that the patient spectrum was appropriate and fair, resulting in improved history taking and presentation skills (96.6%), clinical examination skills (89%) and clinical reasoning skills (90.7%). It was graded to have helped learning “tremendously” and “moderately” by 64.7% and 32.8% of students respectively. Perceived improvement was attributable mainly to the repetitive nature of the assessments since only 63% of students were provided with feedback. 96.6% of students and 94.1% of assessors perceived the format created a stressful but positive learning environment. 52.9% of assessors agreed that the exercise consumed significant time and resources but 88.2% rated it as manageable and supported its continuation. Conclusion: Frequent and regular in-course clinical assessments with emphasis on individual feedback is feasible, acceptable and has significant positive educational impact.

Thoracic epidural anesthesia attenuates hemorrhagic-induced splanchnic hypo-perfusion in post-resuscitation experimental hemorrhagic shock.

The purpose of present study was to assess the effects of thoracic epidural anesthesia on splanchnic perfusion, bacterial translocation and histopathologic changes in experimental hemorrhagic shock in short-tailed macaques (Macaca nemestrina). Sixteen Macaca nemestrinas were randomly assigned to one of two groups i.e. the lidocaine group (n = 8), receiving general anesthesia plus lidocaine thoracic epidural anesthesia; and the saline group (n = 8), receiving general anesthesia alone as control. Hemorrhagic shock was induced by withdrawing blood gradually to a mean arterial pressure (MAP) of 40 mm Hg, and maintained for 60 minutes. Animals were then resuscitated with their own blood and ringer lactate solution (RL). After resuscitation, epidural lidocaine 2% was given in the lidocaine group and saline in the control group. Resuscitation that was performed after one hour hemorrhagic shock, with hemodynamic variables and urine output returned to normal, revealed there was no improvement of splanchnic perfusion. PgCO2, P(g-a)CO2, and pHi remained in critical value and tended to deteriorate in the saline group. Contrast to saline group, splanchnic perfusion in lidocaine group tended to improve. This condition was supported by the finding of less bacterial translocation and better histopathologic changes in lidocaine thoracic epidural anesthesia group than in saline group. This study concludes that lidocaine thoracic epidural anesthesia attenuates splachnic hypoperfusion in post-resuscitation hemorrhagic shock in Macaca nemestrina.

use of different media in the isolation and maintenance of campylobacter jeiuni from children with diarrhea

Among a total of [105] samples collected from childern suffering from bloody or mucoid diarrhea, 11 [10.5%] isolates were diagnosed as Campylobacter [C.] jejuni, of which 2 [82%] were identified as Biotype 1, and 2 [18%] as Biotype 2, In the primary isolation procedures, Campylobacter blood-free selective medium [CBFM] was superior to skirrow's [SM] and Preston's [PM] media. Regarding the enrichment maintenance and viability of campylobacters, a newly prepared medium, the Columbia Biphasic medium [CBM] was superior to Brucella broth [BB], nutrient broth No. 2 [NB2] and fluid Thioglycollate medium [FTM]

Perspectivas de recuperaçäo do lesado medular / Perspectives of recuperation of spinal cord injuries

Ao contrário da grande capacidade de regeneraçäo observada em nervos periféricos, a do tecido nervoso central adulto é mínima após trauma. Apesar dos rearranjos sinápticos subseqüentes ao trauma, lesoes medulares resultam em déficits permanentes. Intervençöes no micro-ambiente neuronal säo necessárias para promover regeneraçäo e proteçäo de neurônios medulares lesados.

Effect of medroxy-progesterone acetate on the rat's lingual salivary glands [histological and histochemical study

The aim of this work was to detect any histological or histochemical changes that might occur in the rat's lingual salivary glands as a result of use of this long acting injectable single hormone contraceptive drug. Twenty adult female albino rats were utilized in this study. They were divided into two equal groups [control and experimental]. Rats of the experimental group were injected intramuscularly acetate [Depoprovera] every 3 esterases cycles for 3 months, while those of the control group were injected with a vehicle. The results of this study revealed on anabolic effect on the lingual salivary glands of the Depoprovera administered rats. This was manifested in the form of apparent increase in the size of the acini with dilatation of the striated and excretory ducts which were engorged with secretory material. Dilatation and congestion of the blood vessels as well as, a noticeable increase in the course of the stromal collagen fiber bundles, in both glands. However, a marked increase in the reaction intensity of glycogen, mucosubstances and total proteins in both acinar and ductal cells of the studied gland of the experimental group, in comparison to those of the control one, was observed

Psycho-social aspects of children and adolescents with diabetes.

The diagnosis of diabetes mellitus, a life-long disease with many possible complications, has a dramatic impact upon the entire family, precipitating a state of "shock". The psychological problems in diabetes should be divided in 3 periods: at diagnosis (other diseases or tension existing in the family and not related to diabetes, socio-economic state); initial adaptation period (acceptance to be "different", adjustment to rules of control such as daily injection of insulin, self blood glucose monitoring or urine testing, changing of nutritional habits, etc.), and long term coping (self-image, family dynamics, social activities, school achievements, vocational rehabilitation and continuing compliance. Counselling of the psychological problems is an ongoing need and is best delivered when the treating team included psychologists and social workers.

Changes in the submandibular salivary glands and gingiva of the rat following chronic toxicity to thallium sulfate with special reference to hepatic afftection

Forty five adult male albino rats were divided into two groups. Group I composed of 3 rats and were treated with a daily oral dose equivalent to 1/20 LD50 of thallium sulfate for 10 weeks to study the effect of chronic toxicity to this rodenticide on the submandibular salivary gland, gingiva and liver. Group II composed of 15 rats and served as controls. Chronic toxicity to thallium sulfated in major histochemical and ultrastructural changes in the organs and tissues under investigation where there was a marked reduction in the amount of glycogen and protein while there was an increase in RNA and glycos aminoglycans, however the later was decreased in hepatocytes of the treated fats. Ultrastructurally the submandibular salivary gland secretory cells, x surface epithelium and fibroblasts of the lamina propria of the gingira as well as the hepatocytes presented toxic deposition of electron dense granules of thallium with marked reduction in the nuclear chromatin, number of mitochodria, Golgi bodies as well as the secretory granules, increase in the rough endoplasmic reticulum of low electron density was found. Hepatocytes presented collection of fat globules, abnormal figures of electron dense material and vacuolization. Dilatation of the bile canalicului and narrowing of blood sinusoids were also detected