A study on satisfaction level among patients attending sexually transmitted infections clinic.

INTRODUCTION: Patient satisfaction has become a favourite debate for enhancing quality of OPD services, however it still needs a lot of improvement for the better delivery of health care services. AIM: The aim was to study the satisfaction level among STI (Sexually transmitted infection) patients regarding quality of care and services provided in STI clinic. MATERIALS AND METHODS: The present study was a cross sectional study conducted on 88 patients with ages ranging from 16-65 years attending STI clinic at the department of Dermatology, Venereology and Leprology of a tertiary care hospital in Gujarat, India from December 2016 to april 2017. An effort was made to bring into focus significant areas to target for improvement. Satisfaction was assessed using 13 questions modified from patient satisfaction questionnaire by Wirral Community NHS Trust.Patients were asked to give rating to these questions. Likert's 5 point rating scale was used. RESULTS: It was noticed that total satisfaction in present study was 82.9%. Most of the questions of patient satisfaction were statistically highly significant (p <0.0001). CONCLUSION: Overall patient satisfaction with services provided at our STI Clinic was high (93.2%) except length of waiting time (<30 minutes), waiting area & other amenities of the hospital.

Sexually transmitted infections and human immunodeficiency virus coinfection: Scenario in Western India.

CONTEXT: Sexually transmitted infections (STIs) have a well-established synergistic relationship with human immunodeficiency virus (HIV) infection. Coinfection with HIV and STI can increase the probability of HIV transmission to an uninfected partner by increasing HIV concentrations in genital lesions, genital secretions, or both. Concurrent HIV infection alters the natural history of the classic STIs. AIMS: The aim was to study the current scenario of STIs with HIV co-infection, and to recognize different manifestations of STIs than the classical presentation in people living with HIV/AIDS (PLHIV). SETTINGS AND DESIGN: It was an open, cross-sectional, descriptive study carried out in the setting of state government hospital with attached antiretroviral therapy referral center. SUBJECTS AND METHODS: The sample size of the study was duration based (30 months). INCLUSION CRITERIA: All PLHIV presenting to the department of dermatology with STIs were included in the study. EXCLUSION CRITERIA: Non-STI causes of genital ulceration were excluded in the study. RESULTS: The study includes total (n = 484) patients living with HIV/AIDS, prevalence of different STIs was in the following order, herpes simplex virus infections 24.17%, human papillomavirus infections 8.88%, molluscum contagiosum 7.43%, secondary syphilis 4.33%, gonorrhea 1.85%, chancroid 1.44%, and granuloma inguinale 0.41%. Of all the patients with herpes simplex virus infections, 45.6% (n = 57) had multiple recurrences (>6/year). The incidence of mixed STI was 17.29% in the present study. CONCLUSIONS: The study represents decreasing trends in bacterial STIs and the rise of viral STIs. Atypical presentations of classic STIs were more frequent than non-HIV-infected individuals.

Huriez syndrome with superadded dermatophyte infection.

Palmoplantarkeratodermas (PPKs) are a heterogeneous group of hereditary and acquired disorders with underlying gene defects, and characterized by hyperkeratosis of palms and soles with or without other ectodermal and systemic abnormalities. Huriez syndrome is a rare autosomal dominant transgradient type of PPK with high frequency of squamous cell carcinoma in the affected skin. We hereby describe a case of a very rare autosomal dominant PPK in a 40-year-old male patient presenting since birth with PPK extending onto the dorsal aspects of hands and feet with peeling of the skin. The complaints were associated with sclerodactyly, hyperhidrosis, and nail abnormalities. Also superadded dermatophyte infection was observed involving abdomen. No history of loss of any digit. No mucosal, dental, or any systemic involvement was present. No sign of malignancy was noted. Baseline investigations, including ultrasonography of abdomen were normal. Histological findings were nonspecific with only orthohyperkeratosis and acanthosis. Diagnosis was mainly done on clinical grounds. The patient is better with oral retinoids and topical emollients and keratolytics along with antifungal treatment for dermatophyte infection. He is under follow up.

Evaluation of Various Therapeutic Measures in Striae Rubra.

BACKGROUND: Striae are linear atrophic depressions that form in areas of dermal damage in the skin. As on date, no consensus or protocol exists for the treatment of stria rubra. Topical retinoids, chemical peels, microdermabrasion, radiofrequency, photothermolysis, intense pulsed light and lasers are some of the modalities used. AIMS AND OBJECTIVE: To compare the efficacy of various therapeutic modalities in striae rubra. METHODS: This prospective cohort study comprised of a total of fifty patients from August-2012 to October-2013 in a tertiary care center in Western India, Gujarat having striae rubra. They were randomly divided into five groups of ten patients each. Patients were evaluated on the basis of visual assessment, both by doctor as well as the patient. Group I was given topical tretinoin (0.1% w/w) gel applied once at night, Group II-microdermabrasion (MDA) combined with trichloroacetic acid (TCA) (30%) peel, Group III-mesotherapy, Group IV-Q-switched Nd: YAG laser, and Group V-combination treatment of microdermabrasion, salicylic acid peel and retinol (yellow) peel. Patients were treated at an interval of 15 days for 2 months and then at monthly intervals. Objective assessment was done at 2(nd) month, 6(th) month, and at the end of 1(st) year. RESULTS: Patients in Group I treated with topical tretinoin showed the least response with 80% (8) of them showing minimal clinical improvement (0-25%) as compared to patients in Group V in which 60% (6) patients showed moderate clinical improvement (50-75%). While majority of the patients in Group II, III, and IV showed mild clinical improvement (25-50%). CONCLUSIONS: Striae rubra is a common cause of concern for adolescent population. Combination treatment with microdermabrasion, salicylic acid and retinol yellow peel gave superior results as compared to other therapeutic options. Mild to moderate improvement was seen with Nd: YAG laser, mesotherapy and MDA + TCA whereas minimal improvement were seen with topical tretinoin.

Senile hemangioma of the lips.

A venous lake, sometimes referred to as senile hemangioma of the lips is usually a solitary, non-indurated, soft, compressible, blue papule occurring due to dilatation of venules. It is commonly found on sun-exposed surfaces of the face and ears. We describe a 46 year-old male who presented with this clinical picture on the lower lip.

Case reports of incontinentia pigmenti in males.

Incontinentia pigmenti is an X-linked dominant disorder, which is fatal in males, and majority of cases reported are in females. Here, we report 2 cases of males with incontinentia pigmenti. Case 1 has progressed through the classical stages of IP, giving history of vesicular and verrucous lesions and has presented with hyperpigmentation in whorled pattern. Case 2 has vesicular lesions in a linear distribution on the legs along with classical histopathological findings.

Penile pyoderma gangrenosum successfully treated with topical Imiquimod.

Pyoderma gangrenosum(PG) is a rare ulcerating inflammatory neutrophilic dermatosis. Genital involvement has been rarely reported. We report such a case of 24- year- old, male patient living with HIV/AIDS(PLHIV) who presented with progressive genital ulceration, not responding to oral antibiotics and aciclovir, gradually increasing in size over 15-18 months. Repeated biopsies showed acute on chronic inflammation. The lesion partially responded to oral and topical corticosteroids but soon increased in size after tapering the dosage of the steroids.Then patient was given Imiquimod 5% cream to be applied over the lesion once daily for 2-4 weeks. Lesion cleared completely in 4 weeks and is in remission since last 6 months. The case report highlights the successful use of topical Imiquimod 5% cream in the treatment of penile PG.