A Rare Case of Patella Rotational Dislocation and Incarceration in Femoral Condyle Fracture: A Case Report

@#This is a rare case report of medial femoral condyle fracture with irreducible incarcerated patella dislocation. Following the literature search, only a few cases have been reported in the literature. In this case, the patient had undergone open reduction and screw fixation of the femoral condyle, augmented with a distal femoral locking plate (LCP). Postoperatively patient was immobilised with an above knee backslab for a month. After removing the backslab, physiotherapy was commenced to improve the range of motion and strengthening the quadriceps muscle. After 18 months of follow-up, the patient recovered well with a satisfactory bone union, no episode of patella dislocation, full weight bearing with an acceptable range of motion of his left knee about 0° to 90°. He could squat, climb stairs, and walk without any walking aid and returned to work as a food deliverer.

Comparison of efficacy and safety of two dosing of oral methotrexate in patients with moderate to severe plaque psoriasis

Background: Methotrexate has been widely used as an effective systemic therapy for psoriasis. Retrospective data showed efficacy rate of 70-80% but recent RCTs using PASI 75 as primary endpoint showed wide variations in efficacy. Different dosing regimens for methotrexate may explain this variation. Objectives: To compare the efficacy and tolerability of two different dosing regimes of oral methotrexate in patients with moderate to severe plaque psoriasis. Methods: A prospective comparative study was conducted from October 2009 to June 2010. Patients with moderate-to-severe plaque psoriasis were randomized to receive either a ‘step-up dose’ regime (starting dose 7.5mg) or a ‘step-down dose’ regime (starting dose 20mg) of oral methotrexate for 16 weeks. The primary efficacy endpoint was PASI 75. Tolerability and safety were assessed. Results: Forty patients received oral methotrexate with equal numbers in each arm. After 16-week, 55% (11) of patients in ‘step-up dose’ group and 65% (13) of patients in ‘step-down dose’ group achieved PASI 75 (p > 0.05). Significantly higher number of patients in ‘step-down dose’ group achieved PASI 75 at week 4 and week 8 (p < 0.05) compared to ‘step-up dose’ group. One patients from ‘step-down dose’ group discontinued study prematurely due to adverse effect but no significant difference in rate of adverse events was noted. Conclusion: There was no significant difference in efficacy between both regimes at the end of 16 weeks but significant efficacy was observed in patients on ‘step-down dose’ regime as early as week 4. The side effect profile and tolerability were similar.

Local experience on the use of Methotrexate in the treatment of Psoriasis in Hospital Sultanah Aminah, Johor Bahru

Introduction The efficacy of methotrexate in the treatment of psoriasis is well established. However, high-quality data concerning its efficacy and side effects are sparse. The initial administration dose differs among various centres. In Hospital Sultanah Aminah, Johor Bahru, methotrexate is initiated at a starting dose of 0.3mg/kg body weight weekly and is continued until significant clinical response before being tapered to the lowest maintenance dose. The aim of this study is to determine the profile of our local psoriasis patients treated with methotrexate, their response to treatment, their tolerability and the side-effects experienced. Methods This is a retrospective study of all patients who were on methotrexate from January 2005 to December 2008 at the Department of Dermatology, Hospital Sultanah Aminah, Johor Bahru. Results Out of a total of 128 patients, 111 were started on an initial dose of methotrexate of between 15mg/week to 25mg/week. The mean age was 43 years old. 56.8% (63) were males and 43.2% (48) females. The mean body weight was 66 kg, ranging from 39 kg to 103 kg. Methotrexate was indicated for moderate to severe psoriasis in 77.5% (86), psoriatic arthropathy in 7.2% (8) and 15.3% (17) for both indications. Methotrexate was started as a first line in 57.7% (64) of patients, whereas, 19.8% (22) had received phototherapy, 14.4% (16) acitretin and 7.2% (8) cyclosporine in the past prior to being given methotrexate. Good response was noted in 79.3%, (88) of patients, 17.7% (19) moderate and 2.7% (3) had a poor response. Side-effects were noted in 19.8% (22) of patients within the first 6 months, 12.6% (14) due to raised liver enzymes, 3.6% (4) to bone marrow suppression, 2.7% (3) to gastro-intestinal symptoms and 0.9% (1) to central nervous system symptoms. Methotrexate was stopped due to adverse events in 15.3% (17) of patients. Conclusion Methotrexate is effective in the treatment of psoriasis but is limited by side effects, especially raised liver enzymes. However, most of the side effects are mild and reversible on stopping the drug.

Aplasia cutis congenita secondary to maternal exposureto carbimazole during pregnancy. A case report

Aplasia cutis congenita (ACC) is a rare anomaly presenting with absence of skin. It was first reported by Cordon in 1767. About 70% of cases manifests as a solitary defect on the scalp, but sometimes it may occur as multiple lesions. The lesions are typically well demarcated, non-inflamed, and they range in size from 0.5cm to 10cm. ACC may be circular, oval, linear, or stellate in configuration. At birth, lesions may appear as scars or ulcers1. They may appear as parchment-like scars with alopecia. Most lesions occur on the scalp vertex just lateral to the midline, but defects may also occur on the face, the trunk, or the limbs, sometimes symmetrically. The depth may involve only the epidermis and the upper dermis, resulting in minimal alopecic scarring, or the defect may extend to the deep dermis, the subcutaneous tissue, or rarely the periosteum, the skull, and the dura. ACC is most often a benign isolated defect, but it can be associated with other physical anomalies or malformation syndromes. Frieden classified them into 9 groups based on the number and presence or absence of other anomalies1. Nearly 86 percent belong to the first group with a solitary lesion. We report a case of Aplasia Cutis Congenita secondary to maternal exposure to carbimazole during pregnancy.

Cutaneous Sarcoidosis Mimicing Tuberculoid Leprosy

Sarcoidosis is a chronic systemic disorder of unknown etiology, characterized histopathatologically by non-caseating, epithelioid granulomatous infiltration in various organs.1,2 Cutaneous sarcoidosis is also known as a dermatologic masquerader because the lesions can exhibit many different morphologies.3 We report a patient who was initially diagnosed as having tuberculoid leprosy based on histological findings. He was treated with multi-drug therapy for 18 months without clinical improvement. In addition, he had left panuveitis and mediastinal lymphadenopathy.

An unusual case of naevus of Ota and Ito associated with port wine stain

Naevus of Ota is a dermal melanocytic pigmentary disorder that affects predominantly females. It occurs most frequently in Asian populations. Its association with naevus of Ito and a port wine stain is very rare. We report a rare occurrence of these three conditions in a male patient.