Clinicoetiological study on vaginal discharge among sexually active women attending a tertiary center in North Kerala, India.

Background: Vaginal discharge is a common complaint among women attending the sexually transmissible infections (STIs) clinic and is a cause for concern and mental distress. It can be attributed to physiological or pathological causes. This study aims to understand the prevalence of various etiologies of vaginal discharge, which would help frame health policies based on local needs. Objectives: (1) To estimate the prevalence of discharge per vaginum among sexually active women attending the STI clinic at a tertiary care center during a 1-year period, (2) To identify the organisms causing vaginal discharge, (3) To have a clinicoetiological correlation of the cases, and (4) To identify the subspecies of Candida causing vaginal candidiasis. Materials and Methods: A total of 126 patients with vaginal discharge attending the STI clinic at a tertiary care center were included in the study. A detailed clinical history, physical examination of the external genitalia, and vaginal examination were done on each patient. Five swabs were taken from the posterior fornix and lateral vaginal wall for evaluation of the organisms. Results: The mean age of the study population was 31.51 ± 7.9 years. Vulvovaginal candidiasis (VVC) was found to be the most common cause of vaginal discharge, followed by bacterial vaginosis, mucopurulent cervicitis, herpes genitalis, and trichomoniasis. The most common species of Candida was found to be Candida albicans. Conclusion: Even though VVC still remains the major cause, other viral infections like herpes significantly contribute. Vaginal discharge is an important indicator of women's reproductive health and its detailed evaluation helps identify the prevalence of various STIs in the community.

Squamous cell carcinoma on a syphilitic gumma: A unique presentation.

Gumma is a characteristic lesion of tertiary syphilis that is rare nowadays, but still rarer is squamous cell carcinoma (SCC) arising from it. A 74-year-old male presented with throat pain and nasal twang with a past history of genital ulcer. Examination revealed a well-defined ulcer with a perforation of 1.5 cm over the hard palate with induration and nodularity at the margins. This patient also had leukoplakia over the ventral aspect of the tongue. His treponema pallidum hemagglutination assay was positive, and biopsy revealed well-differentiated SCC from the lesion over the palate and leukoplakia with dysplasia from the lesion over the tongue. Patient is on treatment from radiotherapy. To conclude, this is a unique presentation of syphilitic gumma with palatal perforation with SCC and syphilitic leukoplakia with Ca in situ over tongue. Thus, serology for syphilis should be done in all patients with SCC of the oral cavity.

Pyoderma gangrenosum in association with microscopic colitis, idiopathic hypereosinophilic syndrome, selective IgE deficiency and diabetes mellitus.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown aetiology. We report a 27-year-old male patient with diabetes, who presented with a nonhealing ulcer on the left leg, pruritic hyperpigmented papules distributed over the trunk and limbs, and chronic diarrhoea. He had eosinophilia, low haemoglobin and serum IgE levels, and raised erythrocyte sedimentation rate. Histopathology of the leg ulcer was consistent with the diagnosis of PG, while the histology of the hyperpigmented papule revealed tissue eosinophilia. Subsequent evaluation was conclusive of the diagnosis of PG, idiopathic hypereosinophilic syndrome (IHES) and selective IgE deficiency. Dexamethasone pulse therapy achieved resolution of the ulcer and reduction in the eosinophilia. Further evaluation for the persistent diarrhoea led to a diagnosis of lymphocytic colitis (LC), which responded to budesonide. To our knowledge, the association of PG with IHES, selective IgE deficiency or LC has not been previously reported.

Delineating the effects of anodal transcranial direct current stimulation on myoelectric control based on slow cortical potentials.

Active cortical participation in rehabilitation procedures may be facilitated by modulating neuromuscular electrical stimulation (NMES) with electromyogram (EMG) and electroencephalogram (EEG) derived biopotentials, that represent simultaneous volitional effort. Here, the ability of the nervous system to respond to intrinsic or extrinsic stimuli by reorganizing its structure, function, and connections is called neuroplasticity. Neuroplasticity is involved in post-stroke functional disturbances, but also in rehabilitation. Beneficial neuroplastic changes may be facilitated with an adjuvant treatment with non-invasive brain stimulation (NIBS). This paper presents the results from a motor cortex anodal tDCS-EEG/EMG study in healthy volunteers. We investigated slow cortical potentials (SCP) during self-initiated movements. In this preliminary study, we found that anodal tDCS increased baseline-normalized post-tDCS mean power in the Theta band (4-8 Hz) of resting state EEG (60.71% vs. 8.36%; p<0.01), and decreased the slope of post-tDCS SCP from motor task-related EEG (-6.43 au/sec vs. -4.86 au/sec; p=0.021) when compared to sham tDCS. These preliminary results are discussed based on an accumulator model for spontaneous neural activity which postulates that a decision threshold applied to auto-correlated noise­in this case the output of a leaky stochastic accumulator­can account for the specific shape of the SCP prior to movement. We postulate that the anodal tDCS facilitated change in the slope of SCP may be related to the reaction times during a cued movement task since our prior work showed that anodal tDCS decreases the delay in initiation of muscle contraction and increases the delay in termination of muscle activity.

Psoriatic arthritis with acral lentiginous melanoma: role for methotrexate?

A 50-year-old male with psoriatic arthritis since 20 years and on methotrexate since 12 years developed an asymptomatic black patch over his right sole of two years duration. On examination, patient had scaly plaque over the body and extremities with severe mutilating arthropathy of distal joints. There was a hyperpigmented patch over the right sole with surface and color irregularities. A possible diagnosis of acral lentiginous melanoma was made which was confirmed by biopsy. Methotrexate can induce malignancies due to immunosuppression. Here, we present a patient of psoriatic arthritis on long term methotrexate developing malignant melanoma.