Metabolic Diseases and Associated Complications in Patients with Psoriasis.

BACKGROUND: Psoriasis patients are at increased risk of developing metabolic diseases. Proinflammatory cytokines such as IFN-γ, IL-17, IL-23, and TNF-α,IGF that are increased in psoriasis play an important role in the development of diabetes mellitus(DM), hypertension, dyslipidemia, obesity, insulin resistance and their complications. AIMS: To study prevalence of insulin resistance (IR) using HOMA-IR index in psoriasis patients and its association with severity of psoriasis. To study prevalence of metabolic diseases, macro and microvascular complications of these diseases in psoriasis. MATERIALS AND METHODS: A hospital based case control study was conducted involving 102 psoriasis patients and 102 age and sex matched controls. All patients were analysed for the presence of metabolic diseases and their complications. RESULTS: Mean age of cases was 38.41±16.37 years. Majority of cases(58.8%) as well as controls (55.9%) were males. Prevalence of hypertension, prediabetes, DM, raised TG, low HDL, MetS and IR was 46.1%, 28.4%, 27.5%, 42.2%, 31.4%, 31.4% and 48% respectively in cases as compared to 26.5%, 13.7%, 11.8%, 24.3%, 16.7%, 10.8% and 26.5% respectively in controls. However there was no significant difference in obesity (29.4% vs 21.6%, p=0.2024) and LDL among the cases and controls(14.7 %vs 10.8%,p= 0.4). Prevalence of all the metabolic disorders except LDL was significantly higher in cases as compared to that in controls. Prominent complications noted were retinopathy, neuropathy and CVD. With increased psoriasis severity insulin resistance increased. CONCLUSION: There is a positive correlation of psoriasis with IR and it is associated with increased risk of metabolic diseases and their complications.

Radiological and antroscopic study of maxillary antrum in multibacillary leprosy patients.

Sixty consecutive patients having multibacillary leprosy were examined for symptoms of nasal involvement and sinusitis. A complete ENT examination was carried out of all these patients and they were subjected to radiological examination of paranasal sinuses. Radiological abnormalities of maxillary antrum were found in 15 of 20 cases of lepromatous leprosy, 6 of 26 cases of borderline lepromatous and in 14 cases of mid-borderline leprosy. Localized or generalized mucosal thickening was the most common finding, followed by opacity of maxillary antrum. Radiological abnormalities were confirmed by antroscopy, which is the most appropriate technique for making an accurate diagnosis of maxillary antral diseases. Initially, antral involvement may begin with a localized area of mucol erythema, progressing to a typical granuloma formation and ulceration. The antero-inferior part of the antrum was found to be the most commonly affected region.

Helicobacter pylori and associated histopathological changes in gastric biopsies of patients with leprosy.

Two antral biopsies each from 104 patients of leprosy and 100 controls were studied to find out the prevalence of H. pylori and associated histopathological changes. Sections were stained with hematoxylene and eosin, AB/PAS (Ph 2.5) and Loeffler's methylene blue stains. Infection by H. pylori, inflammation and atrophy were found to be significantly more in leprosy patients as compared to controls (p < 0.01, < 0.005 and < 0.02 respectively). On comparing the histopathological changes in various subgroups of leprosy, H. pylori, inflammation and activity showed a statistically decreasing trend from tuberculoid to lepromatous subgroups (p < 0.05, < 0.001, < 0.01 respectively). Atrophy showed a significant increasing trend from tuberculoid to lepromatous group (< 0.001), it is concluded that despite a low prevalence of H. pylori and associated gastritis in patients with lepromatous leprosy, gastric epithelial damage is more marked due to altered immune response.

Autologous miniature skin punch grafting in vitiligo.

Forty-five sites of stable vitiligo in 32 patients refractory to medical treatment were subjected to autologous miniature skin punch grafting. Main instruments used were skin biopsy punches 1-3 mm in diameter. Donor sites selected were either gluteal region or extensor aspect of the thigh which were not affected by the disease in the past. Most of the grafts changed from brown to black and upper scales desquamated within 10-15 days. Uniform perigraft pigmentation was observed by 1-1½ months and 90% area was covered within 3-4 months. The cases were followed up for six months. Fair to excellent results were observed in 87.5% of the cases.

Pattern of sexually transmitted diseases in Allahabad.

PIP: The distribution of sexually transmitted diseases (STDs) in 1922 consecutive patients of the PG Department of Medicine, MLN Medical College, Allahabad, India, from 1978-1988 is reviewed. 95.3% were male; ages ranged from 4 months-72 years; most were aged 20-29 years old. The STDs found in descending order were chancroid in 33.1%, gonorrhea 21.3%, syphilis 16.7%, genital herpes 13.9%, venereal warts 5.41%, balanoposthitis 3.6%, Donovanosis 3.02%, condyloma accuminata 2.5%, lymphogranuloma venereum 1.46%, and molluscum contagiosum 0.62%. 1.14% were mixed infections. In women secondary syphilis was the most common infection. Men almost always reported prostitutes as the source of their illness, while women always cited spouses: 86% of husbands of infected married women had evidence of STDs.^ieng

A psychosocial study of delusional parasitosis.

Forty eight patients of delusional parasitosis seen during a short span of five years were studied and underlying psychosocial factors were analysed. The findings revealed that elderly, married, and illiterate persons of rural area from lower socio-economic stratum were distinctly more affected. The incidence of the disease was greater during the months of May to August. Majority of them had abnormal personality traits and definite psychiatric illness was present in about one third of the patients. The psychosocial factors associated with the disorders are discussed.

Dermatitis artefacta.

Dermatitis artefacta is an uncommonly encountered condition. This paper presents a case report of two such rare patients. The symptomatology and history of fourteen and sixteen year old males with dermatitis artefacta are described. Possible psychophysiological aetiology of the cases is discussed.

Shoe dermatitis in India.

105 patients with foot dermatitis, seen over a period of 18 months, were patch tested with various shoe allergens. 47 showed a positive reaction to 1 or more allergens. The majority of the cases (37-47) were chrome-positive. Positivity to plastic material was observed in 8, whereas rubber and rubber chemicals accounted for 5 cases. Of special interest were positive reactions to 1,3-diphenylguanidine in 3 and N-cyclohexyl-2-benzothiazolesulfenamide in 2 cases.

Pseudo-ainhum Associated with Spina-bifida Occulta and Hemivertebra.

A 7 year old girl had pseudo-ainhum, spina-bifida occulta, A hemivertebra and focal, neurogical deficit. The disease process was progressive for the last three years leading to amputation of the third digit and formation of constricting bands around -the fourth and the fifth digits of the left foot.

Familial Biphasic Cutaneous Amyloidosis.

A Bengali family had familial biphasic cutaneous amyloidosis in 6 of the 11 members in 3 generations. The propositti developed intense itching, thickening and pigmentation of the skin associated with discrete, brownish black papules bilaterally on the legs, ankles, popliteal fossae and extensor aspects of the thighs. Face, neck, scalp and oral mucosa were spared. There was hyperkeratosis of the palms and soles. None of them had lymphadenopathy, macroglossia, hepatosplenomegaly, neuropathy or gingival hypertrophy.