study on clinical presentation of herpes zoster in a district hospital in North India

Objective: To study the clinical manifestations of patients of herpes zoster

Methods: Fifty patients suffering from herpes zoster enrolled in the study. Their demographic data, clinical features, dermatomes involved were recorded

Results: Pain, paresthesia and insomnia were noted in 90%, 50% and 20% patients, respectively. PHN was seen in 80% patients with age more than 50 years. 4[8%] patients were positive for HIV. Thoracic dermatome were the commonest dermatome involved in 40% patients followed by trigeminal nerve in 36%, lumbar dermatomes in 16%, cervical dermatomes in 8% and cervicothoracic and thoracolumbar dermatomes in 4% patients each

Conclusion: Patient education and counselling is very important, so that the patients can identify early eruptions and prodromal signs and symptoms and timely antiviral therapy can be instituted

Etiology and management of leg ulcers - an Enigma

Chronic leg ulcer is defined as a defect in the skin below the level of knee persisting for more than six weeks and shows no tendency to heal after three or more months. Leg ulcers are debilitating and greatly reduce patients' quality of life. The common causes are venous disease, arterial disease and neuropathy. Management of patients with chronic ulcers has to be multidisciplinary and should include detailed history, physical examination, investigations, basic and newer treatment modalities, and educating patients on issues of correct foot care and the importance of seeking early medical advice

Comparative study of dermaroller therapy versus trichloroacetic acid CROSS for the treatment of atrophic acne scars

To compare the efficacy and safety of dermaroller treatment with that of TCA CROSS in acne scars. We selected thirty patients of atrophic acne scars for the study. Group I patients underwent four sessions of dermaroller therapy four weeks apart. Group II were treated with four sessions of TCA CROSS technique four weeks apart. After four sessions of dermaroller and TCA CROSS each, marked improvement was seen in 40% patients in the dermaroller group and in 60% patients in the CROSS group. Moderate improvement was seen in 40% patients in dermaroller group and in 26.6% patients in the CROSS group and mild improvement was seen in 20% patients in dermaroller group and 13.3% patients in the CROSS group. Side effects were mild and infrequent in both groups. Both treatments are equally effective and safe for the treatment of acne scars

study of clinical and biochemical correlation in patients of psoriasis in acute exacerbation

To document various biochemical parameters like serum calcium, uric acid etc. and correlate them clinically. An attempt was made to detect the biochemical changes during its exacerbations. Fifty biopsy proven psoriasis patients were selected. Clinical examination and the various biochemical tests were performed at the time of enrollment and at the end of eight weeks of treatment. There were significant alterations in different biochemical values in patients before and after treatment. With clinical improvement there was shift of biochemical parameters towards normal value. Hyperuricemia was seen in 16% patients and hypocalcaemia was seen in 10% of patients. With improvement of clinical picture, a shift of biochemical values towards normal was recorded.

clinical and histopathological study of nevus sebaceous

To study the clinical and histopathological features of nevus sebaceous [NS]. We selected 20 cases of nevus sebaceous for clinical and histopathological evaluation. Regarding the clinical appearance of lesions verrucous plaques were seen in 60% patients, papules in 25% and patches in 15%. All of the lesions showed abortive/immature hair follicles characterized by cords of undifferentiated, basaloid cells resembling the embryonic stages of hair follicle. NS is a hamartoma consisting of various elements indigenous to the organ and not merely the sebaceous units

Anesthesia for dermatologic procedures and their complications

Local anesthesia [anesthesia] is the reversible loss of sensation in a defined area of the body and is achieved by the topical application or injection of agents that block the generation and/or journey of nerve impulses in tissue. No dermatological procedure is possible without a local anesthetic. Local anesthesia is used in many dermatological procedures and surgical operations. The aim is to minimize pain and suffering and maximize patient comfort. This article provides an insight into the various types of anesthesia for dermatologic procedures and their complications

study on the efficacy of TCA CROSS for the management of acne scars

The purpose of this study was to evaluate the clinical effects of the CROSS method on atrophic acne scars in Indian patients. We selected twenty cases with ice pick scars from the department of dermatology for the study. Focal application of 70% TCA was done by pressing hard on the entire depressed area of atrophic acne scars using a sharpened wooden applicator. After treatment, marked improvement was seen in 60% patients, moderate improvement in 30% patients and mild improvement was seen in 10% patients. Regarding the side effects of treatment, erythema was seen in 15% patients, and stinging was noted in 10% patients and postprocedure hyperpigmentation was seen in none of the patients. CROSS is a safe and very effective single modality for the treatment of atrophic acne scars with no significant complications

clinical and histopathological study of cicatricial alopecia

To document the causes and clinical and histopathological features of cicatricial alopecia. A study of 40 patients was conducted to study the clinical variants and histopathology of cicatricial alopecia. In our study, major causes of cicatricial alopecia were lichen planopilaris [27.5%], discoid lupus erythematosus [25%], pseudopelade of Brocq [20%], systemic lupus erythematosus [5%] followed by scleroderma, dermatomyositis, keratosis follicularis spinulosa decalvans, aplasia cutis, kerion, follicular mucinosis, pemphigus, dissecting cellulitis of scalp/pyogenic folliculitis and acne keloidalis nuchae in 2.5% cases each. Morphological features included epidermal atrophy in 90%, erythema in 55%, follicular plugging in 40%, telangiectasia in 27.5%, diffuse scaling in 25% and mottled hyperpigmentation in 20% patients. The commonest histopathological features were perifollicular fibrosis in 65%, basal cell vacuolization in 52.5%, perifollicular lymphocytic infiltrate in 50%, epidermal atrophy in 35% and hyperkeratosis in 20% patients. Lichen planopilaris, discoid lupus erythematosus, pseudopelade of Brock were the common causes of cicatricial alopecia in the studied population.

study on the surgical treatment of ingrowing toenail with nail excision with chemical matricectomy versus nail excision alone

To compare the results of surgical treatment of ingrowing toenail with nail excision with chemical matricectomy versus nail excision alone. We selected 30 patients of ingrowing toenail for the study. The patients were divided into two groups of 15 patients each. In group I patients, nail avulsion with chemical matricectomy with 88% phenol was done. In group II only nail avulsion was done. In group I patients the surgical success rate was 98% and in group II, the surgical success rate was 86.6%. No patient complained about the cosmetic appearance of toenail after the operation. The technique is easy to perform and is associated with little morbidity and has a success rate of 98%

clinical profile of psoriatic arthropathy

Psoriatic arthropathy [PA] is defined as the association of psoriasis of skin and / or nails with peripheral and / or spinal arthropathy and usually with a negative serological test for rheumatoid factor. 50 psoriatic patients with arthropathy and a negative rheumatoid factor were taken for the study. Commonest type of joint involvement was distal interphalangeal joint seen in 44% patients followed by asymmetric oligoarthritis in 40% patients, arthritis mutilans in 6% cases and sacroiliac joint involvement in 2% cases. Nail involvement was seen in 60% cases. In most cases [56%] it was skin involvement followed by arthritis. Hypocalcemia was seen in 60% patients and hyperuricemia was seen in 14% patients. Distal interphalangeal and asymmetric arthritis are most common types of psoriatic arthropathy. Nail involvement is frequent. Skin disease usually precedes arthropathy

Nail changes in psoriasis - a profile

Nail involvement in psoriasis is quite common and is seen in 50% of all cases. For the present study, we selected 100 patients of psoriasis with nail changes coming from various walks of life. The data was collected and statistical analysis of the data was done. Pitting was the most common finding in psoriasis, accounting for 70% cases. Next most common nail changes were onycholysis in 52% and subungual hyperkeratosis in 40%cases. Discoloration was found in 25% cases followed by paronychia in l0% cases. Splinter hemorrhages were seen in 12% and Beau's lines were observed in 14% cases. Nail changes are frequently observed in psoriatic patients which are usually pitting, onycholysis and subungual hyperkeratosis

clinical and histopathological study of Darier's disease

Darier's disease is an uncommon inherited skin disease transmitted in autosomal dominant pattern characterized by brownish keratotic papules particularly dense in the seborrheic areas of the body, palmar pits and nail dystrophy .The disease is often exacerbated by sun exposure, perspiration and heat. We selected 30 patients of Darier's disease from the dermatology OPD for the study. The histopathological examination was performed in all the patients. Yellow brown crusted greasy papules were the commonest clinical feature seen in 100% patients, cobblestoning of palate was seen in 86.6% patients, palmar pits in 83.3% patients and keratotic papules were seen in 73.3% patients. Regarding the nail changes alternating red and white bands were seen in all the patients [100%] and V shaped nicking at the free margins of nails was seen in 93.3% patients. The histopathological features noted were hyperkeratosis [100%], suprabasal acantholysis [90%], acantholytic cells [86.6%] and corps ronds and grains [83.3%]. Cutaneous changes, clinical and histopathological, in Darier's disease are similar to that described in the literature

Music and its effect on sedative requirements in patients undergoing procedures under regional anaesthesia

The study was carried out to detect the effect of music and elimination of operating room noises on the dose requirement of propofol as sedative in awake patients undergoing urological procedures under regional anaesthesia. Case-Control study. This study was carried out at Departments of Anesthesiology and Surgery, G.G.S. Medical College and Hospital, Faridkot, India. 75 patients who were to undergo different procedures under spinal anaesthesia were randomly divided into three groups: Group I [control group] patients exposed to normal operating room noises; Group II patients with occlusive head phones but no music and Group III patients with occlusive head phones and music of their choice Ramsay sedation score was used to assess the level of sedation, which was maintained at the level of 3 and monitored every 5 minutes. The head phones were removed temporarily to assess the sedation level. The Sedation was achieved with inj. propofol, and total close usedwas noted. As compared to group I [control group], patients of group II and group III showed statistically significant [p < 0.05] reduction in propofol requirement as compared to Group-I [24.52 +4.12 vs 19.80 +4.04 and 18.56 +3.56] to attain the sedation score of 3 on Ramsay Sedation Score. Patients of these groups showed no statistically significant difference in propofol requirement when compared with each other. Group II patients did not hear any music but required statistically significant [p < 0.05] less propofol as sedative as compared to group I. The elimination of ambient and disturbing operating room noises is sufficient enough to reduce the sedative requirement of propofol in anxious awake patients under spinal anaesthesia. Music, as a non pharmacologic adjunct to relieve anxiety may further reduce this requirement

Effects of fatigue after sleep deprivation on cognitive functions in anaesthesia residents

Maintaining vigilance during an anaesthetic is hampered by a variety of factors relating to the patient, working environment and anaesthetist himself. Since fatigue is a common issue in the medical environment, there have been many studies of the effects of sleep deprivation and fatigue on human performance and well being. A review of the literature does not permit us to come to any specific conclusion due to the many flaws/shortcomings in most of the studies, including poor definition of the degree of acute sleep deprivation, lack of assessment of accumulated chronic fatigue, the effects of diurnal variation in performance, motivation and incentives etc. A need was felt to study the effects of fatigue associate with sleep deprivation in anaesthetists. We undertook this study in the anaesthesia residents to assess the effects of sleep deprivation on the mental performing abilities. Department of Anaesthesiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab [India]. Residents of anaesthesia department. We excluded the variables known to affect the outcome. The residents who had used sedatives, alcohol or other similar CNS depressants; those with systemic illness/organic disorder or left handedness were excluded. In this study, fifty residents of anaesthesia were tested under two situations using a battery of cognitive function tests. Group I comprised of residents after their routine day duty [10 hrs, non sleep deprived]. Group II was formed by the same residents after their night duty with less than 4 hours of sleep in the previous 24 hours [sleep deprived]. The results lead us to the following. Fatigue following sleep deprivation adversely affects the psychomotor and cognitive functions of the anesthetist but not the short term