A Rare Case of Acrodermatitis Enteropathica in a One Year Old Child.

Acrodermatitis enteropathica (AE) is a rare autosomal recessive disorder caused by zinc deficiency.[1] It can be classified as primary zinc deficiency, genetically based zinc deficiency (classical, AE, acquired zinc deficiency of lactogenic origin), and acquired secondary zinc deficiency.[2] Genetic zinc deficiency is associated with the defects in two zinc transporters, of which one is involved in intestinal zinc uptake ZRT- and IRT-like Protein-4 (ZIP), causing classical and AE. The other is responsible for zinc secretion in breast milk zinc transporter-2 (ZnT) resulting in zinc deficiency of lactogenic origin.[3] Here, we have discussed and reviewed the clinical aspects and probable role of zinc transporters in the manifestation of AE.Acrodermatitis enteropathica (AE), manifests as acral and periorificial dermatitis, alopecia, intractable diarrhoea, and failure to thrive. It is classified as primary zinc deficiency, genetically based deficiency, and acquired secondary deficiency. We hereby report a case of genetically based AE in a one year old child. After reviewing the literature, we have also emphasized the possible role of genetics in the manifestation of AE

A Rare Case of 10-Year-Old Glomus Tumour with Excellent Response to Surgical Excision

Glomus body is an arteriovenous anastomosis located mostly in the finger nailbed and has a role in thermoregulation. Glomus tumour is a rare benign hamartoma, comprising of vascular spaces (the Sucquet-Hoyer canal) internally lined by endothelium and externally surrounded by glomus cells, arising from the glomus body at arterial end. 1,2 Wood first reported it in 1812.1 Most of the glomus tumours are small, benign neoplasia located in the dermis and subcutaneous tissue of the extremities.3 They can vary in number from being solitary most often or multiple in few cases. They can develop in any part of the body. They account for 1-5% of all hand tumours. They are most commonly seen in middle age women. One such rare case of glomus tumour of 10 years duration is reported here.

A Rare Case of Herpes Zoster Ophthalmicus Secondary to Methotrexate Induced Immunosuppression.

Herpes zoster ophthalmicus (HZO) is defined as herpes zoster (HZ) due to involvement of the ophthalmic division of the fifth cranial nerve.1 It is the second most common type of herpes zoster, after thoracic zoster. Herpes zoster affects about 20% of the world's population at least once in their lifetime, with nearly 20% of these showing an ophthalmic involvement.2 It is estimated that 1 million adults in the USA are afflicted with herpes zoster every year. The risk of developing herpes zoster increases considerably with age, reaching 50% in those aged 85 or older. Advanced age and dysfunctional cell-mediated immune responses are two well-established risk factors for varicella zoster virus reactivation. Other risk factors, such as female gender, Caucasian ethnicity, diabetes mellitus, psychological stress, mechanical trauma, heavy metal exposure, as well as family history, have also been postulated. It causes debilitating pain, neuropathy and inflammatory complications.3

Sonourethrogram in comparison with retrograde urethrogram in evaluation of male anterior urethra

Objective: Imaging of anterior male urethra is usually done using retrograde urethrogram, which utilises radiation. This study utilises high resolution ultrasound which is radiation free and helps to understand urethral pathologies like strictures, chronic urethritis etc. This study also compares the utility of sonourethrogram with retrograde urethrogram and provides the advantages of using sonourethrogram. Also establishes the drawbacks of using sonourethrogram over retrograde urethrogram. Material & Methods: This study was done on 60 patients, came with different complaints like difficulty in micturition, obstructed urinary stream, pain in penis, increasing frequency of micturition and referred to us for retrograde urethrogram. Patients were examined with high resolution ultrasound with due permissions. Results are compared with findings of retrograde urerthrogram. Results: Out of 60 patients, 59 had strictures shown in retrograde urethrogram either in penile, bulbar or membranous parts. Only one patient had membranous urethral stricture in retrograde urethrogram which was not shown in sonourethrogram. All other patients have shown strictures in sonourethrogram. One patient had penile urethral calculus shown in both sonourethrogram and retrograde urethrogram. Conclusion: Sonourethrogram is equally effective as that of retrograde urethrogram especially in anterior urethral strictures. However, it underestimates or less useful in evaluation of posterior male urethral pathologies. Sonourethrogram is easily available, cost effective technique that uses no radiation in the evaluation of male urethra. It is equally effective compared to retrograde urethrogram in the evaluation of male anterior urethral strictures. Periurethral pathologies like fibrosis are better evaluated with sonourethrogram than with retrograde urethrogram. It is also important in the surgical planning and approach.

Molecular cloning and subcellular localization of six HDACs and their roles in response to salt and drought stress in kenaf (Hibiscus cannabinus L)

BACKGROUND: Histone acetylation is an important epigenetic modification that regulates gene activity in response to stress. Histone acetylation levels are reversibly regulated by histone acetyltransferases (HATs) and histone deacetylases (HDACs). The imperative roles of HDACs in gene transcription, transcriptional regulation, growth and responses to stressful environment have been widely investigated in Arabidopsis. However, data regarding HDACs in kenaf crop has not been disclosed yet. RESULTS: In this study, six HDACs genes (HcHDA2, HcHDA6, HcHDA8, HcHDA9, HcHDA19, and HcSRT2) were isolated and characterized. Phylogenetic tree revealed that these HcHDACs shared high degree of sequence homology with those of Gossypium arboreum. Subcellular localization analysis showed that GFP-tagged HcHDA2 and HcHDA8 were predominantly localized in the nucleus, HcHDA6 and HcHDA19 in nucleus and cytosol. The HcHDA9 was found in both nucleus and plasma membranes. Real-time quantitative PCR showed that the six HcHDACs genes were expressed with distinct expression patterns across plant tissues. Furthermore, we determined differential accumulation of HcHDACs transcripts under salt and drought treatments, indicating that these enzymes may participate in the biological process under stress in kenaf. Finally, we showed that the levels of histone H3 and H4 acetylation were modulated by salt and drought stress in kenaf. CONCLUSIONS: We have isolated and characterized six HDACs genes from kenaf. These data showed that HDACs are imperative players for growth and development as well abiotic stress responses in kenaf.

prevalence of stress among medical students and its effects on academic performance in the Kingdom of Saudi Arabia

Background: A definition of stress is anything that can disturbs the normal individual's mental or physical wellbeing. Medical school is known to be stressful branch in higher education and requires a lot of effort. In fact there is an increase in the incidence of stress between medical students. Young students are more liable to develop stress due to the high competitive field of medicine

Aim of Study: the study is to explore the prevalence of stress among medical students and its effects on their academic performance in the Kingdom of Saudi Arabia

Methods: A cross sectional study was conducted in under graduate medical students and interns at Faculty of Medicine in the kingdom of Saudi Arabia, a quota sampling was used. The questionnaire was validated, self -administrated with a Kessler Psychological Distress Scale [K10] used to conduct the data

Results: In total, of 1900 students and interns, 29.5% were males, 70.1% females .The prevalence of stress among undergraduates 82.1% and interns 17.1%, the prevalence of severe stress was in the undergraduate female 84.6%. According to the results the proportion of female who had stress was higher 70.1%than their counterpart males 29.5%. The prevalence of stress was highest among fourth year students 21.1%, and first year 4.8% showed the lowest .There was a high association between a study year and level of stress p >[0.00] There is high association between studying medicine and developing symptoms of stress[ p value 0.001]. Most of the 60.6% of the participants developed symptoms related to exposure to stress, most common symptoms were gastrointestinal [67.19%].There is significant association between marriage and stress [p vale 0.19].There is no association between work and stress [p <0.132].There is no association between martial statues and stress [p value<0.386]

Conclusion: The main result in this study shows high prevalence of stress among medical students in Kingdom of Saudi Arabia compared to others studies .The Level of stress is more among the female students compared to the male students. The main causes of stress are related to hours of sleep, hours of studying and marriage

Color stability evaluation of different provisional materials immersed in beverages

Objective: the aim of the study is to evaluate the surface topography [Polished vs. Non-polished] and color stability of different provisional materials: 1] Bis-acryl Composite [System C and B - IvoclairVivadent]; 2] Bis-acryl Composite [ProTemp IV - 3M ESPE]; 3] Bis-acryl Composite [Success CD - Promedica]; 4] Polymethyl Methacrylate [Trim II - Bosworth]; and 5] Light-cure Polymethyl Methacrylate [UniFast TRAD - GC Europe] immersed in commonly used beverages

Material and Methods: the color change value of each specimen after immersion in different beverages i.e. 1] Coffee with artificial saliva; 2] Tea with artificial saliva; 3] Cola with artificial saliva; 4] Apple juice with artificial saliva; and 5] Saline with artificial saliva was measure using spectrophotometer with CIE LAB system before and after immersion at 2 days, 1, 2 weeks, and 1 month

Results: proTemp IV was found to be the most color stabile material, followed by System CandB, Success CD, Trim II, and UniFast TRAD respectively. It was found that coffee had the most staining ability, followed by tea, cola, and apple juice

Conclusion: bis-acryl composites showed the highest color stability values [ProTemp IV, System C and B, and Success CD], followed by Polymethyl Methacrylate [Trim II], then light cured polymethyl methacrylate [UniFast TRAD]. Polishing decreases the color changing values of the provisional materials. Coffee had the most color changing effect

Morbidity and mortality of corrosive injury of esophagus: a study of 50 cases

Objective: To evaluate the morbidity and mortality of corrosive injury of esophagus. Introduction: Corrosive ingestion, mostly accidental in children and with suicidal or deliberate self-harm intention in adults, still remains a prevalent condition in developing countries. It is relatively common among the illiterate people having poor socioeconomic condition residing in the rural areas. It poses a great challenge to the otorhinolaryngologist from management point of view. Study design: Descriptive study. Place and duration of study: This study was conducted in the department of ENT and Head and Neck Surgery, Allied Hospital [PMC] Faisalabad during a period of two years from November 2013 to October 2015

Patients and Methods: Fifty patients with history of corrosive ingestion were included in the study. All patients were admitted in the ENT department and thoroughly investigated regarding history, physical examination and investigations according to a written proforma. Inclusion criteria: The patients of either sex ranging from 3 years to 60 years, having history of corrosive ingestion and giving written consent for any surgical intervention and regular follow up were included in the study. Exclusion criteria: Patients having age below 3 years and above 60 years, patients with malignant stricture, peptic stricture and not giving written consent for surgical intervention and regular follow up were excluded. Data analysis: SPSS software version 20 was used to analyze the data

Results: Out of 50 patients, 16% were males and 84% were females ranging from 3 years to 60 years. Thirty one patients [62%] were from rural areas while 19 patients [38%] were urban dwellers. Forty one patients [82%] took acid whereas 9 patients [18%] took alkali. Eleven patients [22%] reported early within first three days of corrosive intake while 39 patients [78%] reported late. Two patients out of 50 were received in very serious condition with respiratory distress and shock who died despite of emergency treatment. Endoscopic examination of 48 survivors showed grade I corrosive injury in 6 patients [12.5%], grade II injury in 30 patients [62.5%] and grade III injury in 12 patients [25%]. Forty two patients were found to develop esophageal strictures. Thirty four patients [81%] out of 42 had single stricture while 08 patients [19%] had multiple strictures who were referred to general surgery for further management. Treatment: Patients having minor burns were successfully managed conservatively and no stricture was found in 6 months follow up period. Patients with single stricture were managed with endoscopic dilation with good results while patients having multiple strictures of esophagus were referred to general surgery for further management

Conclusion: Stricture formation in the esophagus and resulting dysphagia is more frequently seen in those patients who present late after corrosive ingestion. Moreover endoscopic dilatation of corrosive induced strictures with gum elastic bougies is quite safe and effective procedure to relive dysphagia although repeated sessions of endoscopic dilatations are often required

A Prevalence Study on Myopia Among School Going Children in a Rural Area of South India.

Introduction: Myopia or short sightedness is a type of refractive error in which parallel rays coming from infinity are focused in front of retina when accommodation is at rest. It is a vision condition in which close objects are seen clearly, but objects farther away appear blurred. Myopia occurs if the eyeball is too long or cornea has too much curvature. Myopia is a common vision condition affecting nearly 30% of population. It occur more frequently among school children aged between 8 and 12 years. Because the eye continues to grow during childhood, it typically progresses until about age 20. Aims and objectives: This study aimed at finding the prevalence of myopia among the students aged 10-12 years of a school in a rural area of Kollam and the influence of environmental factors, indoor activities like reading, computer games and outdoor activities and genetic factors in development of myopia. Materials and methods: Study population included students of a nearby school. Students of age >10 years were considered, so students of 5th, 6th and 7th standard students were selected. Each of the division was considered as one strata and simple random sample of clusters had been selected from each standard. All the students of the selected division were selected to sample. Thus, a total of 68 students from that school were taken for the study. The study setting was in a rural area in Kollam district of Kerala. Results: Snellen’s chart along with unilateral vision blinders were used for evaluating vision. Details of factors influencing were obtained using a pretested questionnaire in a pilot study. The prevalence of myopia in school children of rural community in Kollam was found to be 51.47% in which a group of hidden myopic of 43.1% were discovered.

Women, The victim of Modern forms of Terrorism– An Introspection.

Alas! Where gone the days when women held a high place of respect in the society as mentioned in Rigveda and other religious scriptures. Bulk of literature can be written about the status of our women and their heroic deeds from Vedic period to modern times. Terrorism in this part of the world usually means bombs exploding or hotels burning. Our news papers, news channels and T.V. programmes are flooded with the new, more potential, emerging form of terrorism (violence) against the half of the world. This paper makes an attempt to analyze the violence and atrocities against the women or this new emerging form of terrorism. The growing incidence of flinging acid on a woman‟s face, female foeticide, gang rape, eve-teasing question the Indian sensitivity for women. Of all the rich G20 nations, India has been labeled the worst place for a woman. The question is why such social evils. The traditional and conservative attitude on the part of parents and moral erosion and romantic relationship on the part of young generation have contributed in making India a place of hell for women. Even some religious preachers unfortunately using Religion as a platform have left no stone unturned in making the situation more startling like self- styled Gulzar Peer from crown of India, Kashmir which was once called Resh Waer.Can we afford a society without women? This paper attempts to highlight the deadly consequences of this terrorism and the role of Education, NGO, Religious preachers in developing a global village where women are viewed as equal and valuable partners in society, thereby bringing back the lost status of women.

Agenesis of right diaphragm in the adults a diagnostic dilemma.

Diaphragmatic agenesis is the most extreme form of congenital diaphragmatic defect, and it may be unilateral or bilateral. Diaphragmatic agenesis is a rare diagnosis, typically made early in infancy and is generally associated with other genetic anomalies, especially anueploidy syndromes. It is associated with a high mortality, if not treated in infancy. However, a few patients have survived till adulthood. In this report, we describe the case of an adult female who presented with progressive shortness of breath during third trimester of pregnancy with complete agenesis of the right side of the diaphragm. A new diaphragm was created using polypropylene mesh after which she improved symptomatically and the lung showed good expansion.

Pathogens and their antibiotic sensitivity patterns in community acquired bacterial infections of skin

Background: Common infections of the skin are mostly treated empirically depending upon the personal habits or promotional efforts of the pharmaceutical industry. Scientific approach to the treatment of such infections would be either to treat the infections definitively based on the culture and sensitivity results or at least on evidence based treatment

Objective: To determine the pathogens involved and their sensitivity patterns in common skin infections in a tertiary care hospital

Subjects and Methods: This cross sectional study was conducted in Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, over a period of three months from 1[st] September to 30[th] November, 2013, involving a total of 135 subjects suffering from various common bacterial infections of skin. Their pus or blister fluid samples were taken and cultured in blood agar or Macconkey's agar to determine the pathogens involved and their antibiotic sensitivity patterns by disc method. The data was entered and analyzed by using SPSS version 15

Results: The dominant bacteria causing skin infections remain Gram Positive cocci [37.8%] followed by Gram Negative Rods [26.7%]. The most sensitive antibiotic was found to be Amikacin [20.7%], followed by sulzone/cefoparazone [19.2%], ciprofloxacin [14%], linezolid [14%] and azithromycin [9.6%]

Conclusion: From the present study, it is concluded that Gram positive cocci continue to remain the most common pathogen in bacterial infections of the skin, followed by Gram Negative Rods. Most of the pathogens were sensitive to Amikacin followed by sulzone/cefoparazone combination, ciprofloxacin, linezolid, azithromycin, levofloxacin. The results of this study emphasize the need for checking the indigenous sensitivity patterns of the pathogens and accordingly modify our empirical prescription of the antibiotics based on such studies

Multicentric calcified trichilemmal cysts with alopecia universalis affecting siblings.

Trichilemmal cyst, also known as "pilar cyst," is a benign cyst containing keratin and its breakdown products with a wall resembling external root sheath of hair. It occurs mostly in females as a solitary firm nodule over scalp. Occurrence of multiple trichilemmal cysts in areas other than scalp is extremely rare. We are reporting a case of a 40-years-old female who presented with multiple calcified trichilemmal cysts in multicentric distribution associated with alopecia universalis. Similar complaints were present in elder sister of the patient, indicating a genetic background. Multicentric distribution of trichilemmal cysts, calcification, familial occurrence, and association with alopecia universalis seen in our case are all rare and intriguing features.

Application of LC-MS/MS for quantitative analysis of glucocorticoids and stimulants in biological fluids / 药物分析学报

Liquid chromatography tandem mass chromatography (LC-MS/MS) is an important hyphenated technique for quantitative analysis of drugs in biological fluids. Because of high sensitivity and selectivity, LC-MS/MS has been used for pharmacokinetic studies, metabolites identification in the plasma and urine. This manuscript gives comprehensive analytical review, focusing on chromatographic separation approaches (column packing materials, column length and mobile phase) as well as different acquisition modes (SIM, MRM) for quantitative analysis of glucocorticoids and stimulants. This review is not meant to be exhaustive but rather to provide a general overview for detection and confirmation of target drugs using LC-MS/MS and thus useful in the doping analysis, toxicological studies as well as in pharmaceutical analysis.

Effect of different ferrule designs on the fracture resistance and failure pattern of endodontically treated teeth restored with fiber posts and all-ceramic crowns

OBJECTIVE: This study investigated the effect of different ferrule heights on endodontically treated premolars. MATERIAL AND METHODS: Fifty sound mandibular first premolars were endodontically treated and then restored with 7-mm fiber post (FRC Postec Plus #1 Ivoclar-Vivadent) luted with self-polymerized resin cement (Multilink, Ivoclar Vivadent) while the coronal section was restored with hybrid composite core build-up material (Tetric Ceram, Ivoclar-Vivadent), which received all-ceramic crown. Different ferrule heights were investigated: 1-mm circumferential ferrule without post and core (group 1 used as control), a circumferential 1-mm ferrule (group 2), non-uniform ferrule 2-mm buccally and 1-mm lingually (group 3), non-uniform ferrule 3-mm buccally and 2-mm lingually (group 4), and finally no ferrule preparation (group 5). The fracture load and failure pattern of the tested groups were investigated by applying axial load to the ceramic crowns (n=10). Data were analyzed statistically by one-way ANOVA and Tukey's post-hoc test was used for pair-wise comparisons (α=0.05). RESULTS: There were no significant differences among the failure load of all tested groups (P<0.780). The control group had the lowest fracture resistance (891.43±202.22 N) and the highest catastrophic failure rate (P<0.05). Compared to the control group, the use of fiber post reduced the percentage of catastrophic failure while increasing the ferrule height did not influence the fracture resistance of the restored specimens. CONCLUSIONS: Within the limitations of this study, increasing the ferrule length did not influence the fracture resistance of endodontically treated teeth restored with glass ceramic crowns. Insertion of a fiber post could reduce the percentage of catastrophic failure of these restorations under function.

Fetal varicella syndrome.

Fetal varicella syndrome is a rare condition of the newborn, presenting with cutaneous scars, limb defects and ocular and central nervous system abnormalities. It is due to varicella or zoster developing in the fetus following maternal varicella infection during early pregnancy. We are reporting one such patient who presented with a linear, depressed, erythematous scar over the left forearm and axillary fold, with a history of maternal chicken pox during the first trimester of pregnancy.

Kartagener's syndrome and acute appendicitis

Kartagener's syndrome is a combination of situs inversus totalis, sinusitis and bronchiectasis. Left sided appendicitis can present with problems in diagnosis and during surgery. We present here a case of Kartagener's syndrome and left sided appendicitis successfully managed in a peripheral hospital in Bahawalnagar, Pakistan

Protocol-guided phase-1 cardiac rehabilitation in patients with ST-elevation myocardial infarction in a rural hospital

Phase-1 Cardia Rehabilitation [CR] is an important part in the treatment of patients with ST-Elevation Myocardial Infarction [STEMI]. Lac of literature in the rural Indian setting led to the design of this study. Secondary care rural hospital, non-randomized experimental study. Fifteen historical controls and 15 prospectively enrolled patients between January 2007 and December 2007. The prospectively enrolled patients received the phase-1, exercise-based, protocol-guided CR. At discharge, the six-minute walk test [6MWT] distance, Borg's Rating of Perceived Exertion [RPE] after the 6MWT, time to return to baseline parameters after the 6MWT, and complications were assessed. Independent t-test and the Mann Whitney test. Statistically significant [P< 0.01] differences in rating of perceived exertion [RPE] and time to return to baseline parameters post the 6MWT were seen in the experimental group [2 vs. 4 and 5.47 vs. 7.93 minutes, respectively]. No significant changes in the 6MWT distance between the groups were noticed [470+151.76 m and 379 +170.70 m, respectively]. No adverse events during the 6MWT and the phase-1 CR were observed. Protocol-guided, phase-1 CR produces a much faster return of heart rate and blood pressure to baseline following the 6MWT, without producing a great rise in the RPE during the 6MWT, which suggests a training benefit among these patients. The 6MWT can be safely administered in this rural population. However, larger studies will be required to validate these results