Necrolytic acral erythema: an unusual cutaneous presentation of hepatitis C virus infection

Necrolytic acral erythema [NAE] is a newly recognized dermatosis which has been regarded as early cutaneous marker of hepatitis C virus [HCV] infection. It presents as a well demarcated, dusky, symmetrically distributed erythematous to violaceous eruption with marked hyperkeratosis and lichenification associated with pruritus or burning on the dorsal aspects of feet extending to the toes. It shows clinical and histopathological resemblance to other necrolytic erythemas. We report a case of a-55-year-old woman with itchy hyperpigmented papules and plaques on the feet for the last 6 months. Histopathology showed the features of necrolytic acral erythema

Copper-t presenting as vesical calculus

Intrauterine contraceptive devices [IUCD], in various forms have been in use since the time immemorial. Perforation of the uterus and migration of IUCD to adjacent structures is not an unusual occurrence but their intra vesical migration with secondary stone formation is a unique complication. We present an interesting case of a 3 5 years old lady who met with this complication. This lady had intrauterine contraceptive device [Copper-T] placement 9 years back and a few days earlier presented to us with lower urinary tract symptoms. She underwent ultra-sonographic scan and stone bladder was detected as the cause of her symptoms. Open cystolithotomy was performed and a T-shaped vesical calculus retrieved

Methods of circumcision practiced in central Pakistan and their complications

Background: circumcision is the most common surgical intervention performed in non-medical settings. It is the most common but neglected procedure in our country. Barbers, quacks and other non-qualified persons perform circumcision by their own methods without proper sterilization and without knowing the consequences

Objectives: the objectives of our study were to determine different methods of circumcision and outcome of these methods in central Pakistan

Patients and Methods: this was an observational study conducted by the Department of Pediatric Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. A total of 600 cases were included in this study and information was recorded on a pre-designed Performa. Attendants/parents having the best knowledge regarding circumcision of the child were interviewed. Related clinics were contacted to determine the methods of circumcision and sterilization techniques, where found necessary

Results: out of 600 cases 157 [26.17%] were circumcised in the 1st month of life [mean age: 10+/-3.5 days], 92 [15.33%] in first year [mean age: 7+/-2.4 months] and 351[58.5%] between one to twelve years of age [mean age: 6+/-2.33 years]. Regarding the personal who performed circumcision 110 [18.33%] cases were circumcised by the barbers, 139 [23.17%] by quacks, 210 [35%] by General Practitioners [GP] and 141 [23.5%] by surgeons [General and Pediatric Surgeons]. Regarding the methods of circumcision, bone cutter method was the commonest, 307 [51.17%], whereas, only 60 [10%] cases were circumcised by plastibell technique. Complications were more with barber method and less with plastibell technique. Under circumcision [too less prepuce is removed] is the commonest complication with barber method. Out of 110, the 11 children [10%] were under circumcised. In bone cutter method, out of 307 cases, 15 [4.87%] were under circumcised. No case was under circumcised with plastibell or open method. With barber method 06 cases [5.45%] got infected. They consulted doctors and were cured with antibiotics. Three [0.977%] cases were infected with bone cutter method. Bleeding occurred in 10 patients after bone cutter method and stitching was done. There was no bleeding with plastibell or open method

Conclusion: our study showed that a big proportion [41%] of male children are still getting circumcised by unskilled [quacks and barbars] operators and commonest method of circumcision was bone cutter method. There is a dire need to educate the people regarding age, methods of circumcision and their possible complications