A Lean Lady With Acanthosis Nigricans and Uncontrolled Diabetes Mellitus.

A 47-year-old Asian Indian woman presented with uncontrolled hyperglycaemia and osmotic symptoms despite multiple oral antidiabetic medications and insulin. She had a history of recurrent oral ulcers, profound weight loss, and intermittent fever for one and a half years before the presentation. She had severe acanthosis nigricans, although her body mass index (BMI) was 14.6 kg/m2. Her blood glucose remained uncontrolled despite very large dosages of intravenous insulin (more than 12,000 units daily). Evaluation for possible underlying collagen vascular diseases and malignancies were negative. Her serum insulin levels were high. She tested negative for anti-insulin antibodies but positive for anti-insulin-receptor antibodies. She improved with a pulse dose of intravenous methylprednisolone but relapsed within one month. A second pulse dose was given following which a complete remission of diabetes and regression of acanthosis was observed. Type B insulin resistance, a rare cause of severe insulin resistance, may respond favourably to immunosuppressive therapy with high-dose methylprednisolone.

Evaluation of Fluorescent Staining for Diagnosis of Leprosy and its Impact on Grading of the Disease: Comparison with Conventional Staining.

INTRODUCTION: Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae). Histopathological examination of skin lesion is the gold standard for diagnosis. We evaluated the possible role of fluorescent microscopy in this direction which is increasingly used for rapid screening. AIM: To compare the efficacy of auramine rhodamine stain with Ziehl-Neelsen and modified Fite-faraco staining in diagnosing M. leprae in tissue sections. STUDY DESIGN: Experimental, cross-sectional and retrospective study conducted for 4 years. METHODS AND MATERIALS: Skin biopsies of sixty clinically diagnosed leprosy patients were stained by Ziehl-Neelsen, Fite-Faraco and fluorescent stain. The presence of the bacilli and the bacillary index was scored for each case. The bacillary index by each staining methods were compared. STATISTICAL ANALYSIS: SPSS v 17 (IBM, New York) used for data analysis. Chi-Square test was used to calculate significance between differences. The p-value of <0.05 was considered as statistically significant. Pearson Correlation (r-value determined) was also used for comparison between groups. RESULTS: Sensitivity of fluorescent stain for indeterminate and borderline tuberculoid leprosies were 100% each. Positivity rates and mean bacteriological index with fluorescent stain was higher (43.3 and 11.5 respectively) as compared to that of Ziehl- Neelsen and Fite-faraco when the bacillary load was less (bacillary index < 3). There was significant correlation between the three staining types at higher bacillary load. There was a higher mean bacillary index with fluorescent stain as well as detection of an additional multibacillary case. CONCLUSION: Fluorescent method is more sensitive than modified fite-faraco method in detecting lepra bacilli in tissue sections especially in cases with bacillary index less than three. With its higher sensitivity, paucibacillary cases could be upgraded to multibacillary thus affecting treatement decisions.

Dyslipidemia in Dermatological Disorders.

Dyslipidemias are one of the common metabolic disorders. A link between dermatological disorders like psoriasis and dyslipidemia has been established in the recent past. Many dermatological disorders could have a systemic inflammatory component which explains such association. Chronic inflammatory dermatological disorders could also have other metabolic imbalances that may contribute to dyslipidemia. Presence of such abnormal metabolism may justify routine screening of these disorders for associated dyslipidemia and other metabolic abnormalities and early treatment of such comorbidities to improve quality of life. Some of the drugs used by dermatologists such as retinoids are also likely to be a cause of dyslipidemia. Hence, it is imperative that the dermatologists obtain scientific knowledge on the underlying mechanisms involved in dyslipidemia and understand when to intervene with therapies. A systematic review of the English language literature was done by using Google Scholar and PubMed. In this review, attempts are made to list the dermatological disorders associated with dyslipidemia; to simplify the understanding of underlying mechanisms; and to give a brief idea about the interventions.

Uncontrolled hyperglycaemia: a reversible cause of hemichorea-hemiballismus.

Hyperosmolar hyperglycaemic state (HHS) an acute complication of diabetes mellitus, can be associated with neurological involvement ranging from seizures, involuntary movements to reversible focal neurological deficits without any structural lesions. We report a 71-year-old woman, a known case of type 2 diabetes mellitus who presented with the sudden onset of hemichorea-hemiballismus. On investigations she had hyperglycaemia and urinary tract infection. Achievement of euglycemia with insulin therapy resolved the involuntary movements completely. This highlights the fact that HHS is an uncommon but easily treatable cause of recent onset unilateral hemichorea-hemiballismus.

Estimation of relationship between psychosocial stress and periodontal status using serum cortisol level: a clinico-biochemical study.

AIMS AND OBJECTIVES: Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. The aim of the present study was to explore the role of psychosocial stress that influences the periodontium with the use of a questionnaire data and serum cortisol level. MATERIALS AND METHODS: In this study 47 subjects, both male and female, were taken and divided into two groups. Group I comprised of 16 chronic periodontitis subjects. Their stress level was evaluated using a standard questionnaire method (social readjustment rating scale). Plaque index (PI), gingival index (GI), periodontal disease index (PDI) and serum cortisol level were also measured. Group II comprised of 31 stressed subjects and their clinical parameters PI, GI, PDI and cortisol level were recorded. STATISTICAL ANALYSIS USED: Spearman's rank correlation coefficient and unpaired 't' test. RESULTS: In group I statistically significant correlation (P<0.05) was found between cortisol and PDI; and cortisol and PI. In group II positive correlation was found between stress, cortisol, PI, GI and PDI. A statistically significant correlation was found between cortisol and smoking. CONCLUSION: Stress may be a contributing factor in periodontal disease.