Journal Issue: Volume. 9, No. 1 (2010)
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Volume
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Issue Date
2010
Journal Title
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ISSN 2091-0231 eISSN 2091-167X
Journal Volume
Articles
Cutaneous manifestations in senile skin in coastal Goa
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Pavithra, S; Shukla, P; Pai, GS
Abstract
Background Discoveries in medical sciences and improved social conditions during the past few decades have increased human life span thereby leading to an increasing segment of geriatric population.1 Senescence in the skin is a gradual process that ultimately results in the appearance and functional differences that we associate with age.2 The increasing segment of geriatric population are noted to have characteristic group of dermatoses which can be called as geriatric dermatoses. Such dermatoses may be expressed as cutaneous changes intrinsic to chronological ageing. Alternatively there may be other unrelated dermatoses having an altered expression on the geriatric skin.
Aims This study aims to delineate the spectrum of various geriatric dermatoses among the hospital population at Goa Medical College (GMC).
Methods This was a prospective study done over a period of one year in the department of dermatology, Goa Medical College. Patients above the age of 60 years presenting to the dermatological outpatient in GMC, patients referred from other wards were included in the study. A detail history and thorough clinical examination was done of every patient above 60 years who presented with skin complaints. A clinical photograph was taken of the relevant skin changes. Relevant investigations pertaining to the study were carried out to support the clinical findings.
Results Of the 411 geriatric patients above 60 years, males (64.7%) outnumbered females (35.3%). Age group of 65-69 years constituted a maximum (57.9%) number of geriatric patients. Amongst the geriatric dermatoses, wrinkling of skin (99.3%) and graying of hair (96.8%) outnumbered all other findings. This was followed by benign neoplasias (80.5%). Fungal infections (20.7%), eczemas (19.2%), papulosquamous disorders (12.3%), senile pruritus (9.2%), senile comedones (8.5%), fissured soles (6.8%), xerosis and leg ulcers (6.6%) each, pigmentory disorders (5.8%), infestation (4.9%), vesiculobullous disorders (4.4%), senile purpura and immune, rheumatic disorders (4.1%) each. 3 (0.7%) malignant cases were reported. Graying of hair (96.8%) and alopecia (32.55%) were the ageing related hair changes seen. Among the nail disorders, longitudinal ridges (12.6%) was the commonest followed by nail discoloration (10.2%), subungual hyperkeratosis (7.3%), onycholysis (7.5%), onychomycosis and nail distortion (5.8%) each, pitting of nails (5.0%).
Conclusion The skin is marker of systemic disease. With variation of geographical distribution in Goa, most common cutaneous findings are physiological aging signs, benign legions and very rarely malignant cutaneous changes have been seen.
Keywords Ageing; geriatric; dermatoses; intrinsic; chronological; biopsies.
Emerging trends of nosocomial Citrobacter species surgical wound infection: concern for infection control
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Thapa, B; Karn, D; Mahat, K
Abstract
Background Surgical wound infection is a common problem among patients who undergo operation. Several factors play important role in this infection process including endemic nosocomial infection without proper infection control measures.
Objectives To study the occurrence of the pathogens in post-operative wound infections, their antibiotic resistance patterns, and comparison with published reports.
Methods Various specimens obtained from the surgical wound during a period of four months were processed for bacteriological culture in the Department of Microbiology, Kathmandu Medical College, Kathmandu. Antibiotic susceptibility test was performed by Kirby-Bauer disk diffusion test for pathogens isolated. The relevant literatures were searched and compared with the present study.
Results Among 79 culture positive cultures, Citrobacter sp. (n=23) was most frequently isolated from surgical wound infection. Twenty strains were multidrug resistant. In comparison with other studies, this study highlights the emergence multi-drug resistant Citrobacter sp. as a leading cause of surgical wound infection. E. coli, Staphylococcus aureus, Acinetobacter sp., Klebsiella pneumoniae, Pseudomonas aeruginosa, Proteus sp., and Enterobacter sp. were also isolated from 19, 13, 10, 8, 2, 2, and 2 cultures, respectively. More than 50% of these pathogens were resistant to most of the β-lactam antibiotics tested and most of them were multi-drug resistant while these pathogens showed variable level of resistance to fluroquinolones and amino glycosides.
Conclusion The frequent isolation of multi-drug resistant nosocomial strains of Citrobacter sp. in surgical wound infection is a remarkable trend. This pathogen and their resistant genes could be endemic to the institution and can cause difficult-to-treat infection if infection control committee is not revitalized and infection control strategies are not implemented.
Key words Citrobacter sp.; Multi-drug resistant; surgical wound infection.
Comparative study of Methotrexate and Cyclosporine in the treatment of Psoriasis
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Karn, D; Amatya, A; Khatri, R
Abstract
Background Psoriasis is a chronic skin disease characterized by sharply demarcated, erythematous squamous lesions, with an estimated worldwide prevalence of 0 to 11.8%. Methotrexate (MTX) and cyclosporine (CsA) are well known systemic therapies for moderate to severe chronic plague psoriasis.
Objective The aim of this study is compare the efficacy of methotrexate and cyclosporine in the treatment of Psoriasis.
Methods A prospective randomized study was conducting at the Dhulikhel Hospital, KUTH, Dhulikhel during November 2008 to July 2009 with the objective to compare the effectiveness, side effects and cost of MTX and CsA treatment in a context reflecting normal clinical practice.
Results A total of 64 patients (33 receiving MTX and 31 receiving CsA) were enrolled. These patients were followed every week for first month and their PASI score and side effects were recorded at 0, 1st, 2nd and 3rd month interval. In the study, the mean (± S.E) PASI score at base line was 23.34 ± 1.12 for MTX and 21.25 ± 1.07 for CsA group. After 12 weeks of treatment the mean ± S.E PASI score found to be 5.37 ± 0.42 for MTX and 4.56 ± 0.41 for CsA group. The difference in the response between the groups acquired statistically not significance (p=0.160 > 0.05) meaning there is no difference in the effectiveness of MTX and CsA.
Conclusions The efficacy, side effects, ease of administration (once weekly vs. twice daily treatment) and cost, it seems that treatment of psoriasis patient with systemic therapy using MTX is preferable than CsA even though, both have similar clinical efficacy.
Keywords Methotrexate; Cyclosporine; Psoriasis.
Disseminated Superficial Actinic Porokeratosis
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Kumari, S; Mathur, M
Abstract
A Case Report about a rare Geno dermatosis -Dissamenated Superficial Actinic Porokeratosis is presented.
Key Words: Classic porokeratosis of Mibelli (PM); disseminated superficial actinic porokeratosis (DSAP); porokeratosis palmaris et plantaris disseminata (PPPD); linear porokeratosis
Nimesulide induced Stevens- Johnson Syndrome
(Society of Dermatologists, Venereologists and Leprologists of Nepal (SODVELON), 2010) Karunaratne, D; Khatri, R
Abstract
Stevens - Johnson syndrome (SJS) is a severe, episodic, acute mucocutaneous reaction that is most often elicited by drugs and occasionally by infections. We report a case of 29 years old woman who developed Stevens - Johnson syndrome following the ingestion of Nimesulide tablets. Nimesulide is a nonsteroidal anti-inflammatory (NSAID) drug with antipyretic and analgesic properties. To the best of our knowledge there have been no previous reports of SJS induced by the ingestion of Nimesulide in the medical literature. This case highlights the importance of Nimesulide and other NSAIDS as the possible cause of Stevens - Johnson syndrome which needs to be borne in mind by the treating physician in cases of drug reactions.
Key words Nimesulide; Stevens - Johnson syndrome.