SCORTEN: does it need modification?

BACKGROUND: Toxic epidermal necrolysis (TEN) is a drug induced acute life threatening condition with mortality ranging from about 15 to 60%. A 'severity of illness' score termed as SCORTEN has been developed to predict mortality in TEN cases at the time of admission. It is calculated by giving one point for each of predetermined seven variables, evaluated during first 24 hours of admission. Total score ranging from 1-7 predicts a probability of mortality from 0.03 to 0.90. AIM: A prospective study was conducted to analyze efficacy of 'SCORTEN' in TEN cases to predict mortality during their management. METHODS: All cases of TEN reporting for management to the hospital were assessed using 'SCORTEN' on day one and day five to predict probable mortality, this data was then compared with ultimate outcome. RESULTS: During the study period, we treated 10 cases of TEN, all induced by drugs, patient's age ranging from 03 to 70 years and body surface area (BSA) involvement from 10 to 95%. Three cases succumbed to death. These cases were analyzed with SCORTEN to predict probability of mortality at the time of admission and day five. We encountered some variations from the original study. It was observed that if patients are analyzed with SCORTEN on a daily/alternate day basis, it will serve as a better predictor of mortality. CONCLUSION: Body surface area (BSA) involvement and age probably need more weightage in calculations. Besides malignancy, tuberculosis and pre-existing diabetes also need to be included while predicting mortality.

Keloidal granuloma faciale with extrafacial lesions.

Granuloma faciale (GF) is a rare cutaneous disorder characterized by one to several soft, erythematous to livid papules, plaques or nodules, usually occurring on the face. Extrafacial lesions are uncommon. A 52-year-old lady with multiple asymptomatic, variously sized brownish-black colored, firm, sharply circumscribed plaques resembling keloids on both cheeks and extrafacial lesions on the right arm and the right breast is presented for its unusual keloidal appearance and typical histopathological findings. She failed to respond to oral dapsone 100 mg daily administered for 3 months. Local infiltration of triamcinolone combined with cryotherapy led to only partial flattening of the lesions. All the skin lesions were excised surgically followed by flap transfer grafting on both cheeks. The cosmetic outcome was highly satisfactory.

Diltiazem vs. nifedipine in chilblains: a clinical trial.

BACKGROUND: The treatment of chilblains remains unsatisfactory. Nifedipine in higher doses remains the mainstay of treatment. AIMS: To compare the efficacy of diltiazem with that of nifedipine, and to determine the efficacy of nifedipine in lower doses, 36 chilblains cases were studied. MATERIAL AND METHODS: Group A (12 patients) was treated with diltiazem 60 mg thrice daily, and Group B (24 patients) with 10 mg nifedipine thrice daily till complete relief and then maintained on a sustained release preparation of nifedipine 20 mg twice daily. RESULTS: Two patients in Group A showed complete relief in 7 days, and 3 patients in about 21 days, but in 7 cases there was little or no response. In group B, 21 cases showed 80-90% relief by the fourteenth day. CONCLUSIONS: We conclude that nifedipine remains the drug of choice in chilblains but can be used in a smaller dosage in the Indian population. Diltiazem is less effective in the conventional dose, which may be optimized.

Clinical and bacteriological study of urethral discharge.

A clinics-bacteriological study of 52 patients with urethritis was carried out. All the patients were evaluated clinically and bacteriologically at the beginning and end of the treatment. Majority of the patients belonged to the age group 21-30 years (58%). Incidence of gonococcal urethritis was 65% and Non gonococcal Urethritis (NGU) 35%. The common organisms causing NGU were chlamydia (28%) ureaplasma (11%) and mycoplasma (11%). Neisseria gonorrhoea was resistant to penicillin in (38%), ciprolloxacin in 67, and to noriloxaein in 6% cases. High incidence of HIV positivity was found in gonorrhoea (21%).

Concurrent leprosy and HIV infection: a report of three cases.

Three cases of concurrent infection with HIV and leprosy are reported. One had developed borderline lepromatous leprosy one year after identifying HIV infection, while the other two had indeterminate leprosy and both conditions were identified at the same time in these two patients. All three cases showed satisfactory response to standard antileprosy multidrug therapy.