Common Clinical Pattern Research Articles

The clinicoaetiological, hormonal and histopathological characteristics of melasma in men.

Melasma is relatively uncommon in males, and there is a paucity of data on male melasma, including its clinical pattern, triggering factors, endocrine profile and histopathological findings. To characterize the clinical findings and aetiological factors, including hormonal and histopathological features, of male melasma. Male patients with melasma and age- and sex-matched healthy controls (HCs) were recruited. Demographic profile, risk factors, clinical pattern and Wood lamp findings of patients were recorded. Sera were obtained from patients and HCs to determine hormone levels. Biopsy specimens were obtained from lesional and adjacent nonlesional skin. In total, 50 male patients with melasma and 20 HCs were recruited into the study. Mean age of patients was 27.58 ± 4.51 years. The most common clinical pattern of melasma was malar, which occurred in 52% of cases. Positive family history was present in 16% of patients, while 34% had disease aggravation with sun exposure and 62% used mustard oil for hair growth and/or as an emollient. Wood lamp examination revealed epidermal-type melasma in 54% of patients. There were no significant differences in hormone levels between patients and HCs. Histologically, epidermal melanin, elastotic degeneration, vascular proliferation and mast cells were more pronounced in lesional compared with nonlesional skin. Absent to weak expression of oestrogen receptors, progesterone receptors and stem cell factor was observed in lesional skin. Ultraviolet light and mustard oil are important causative factors in male melasma. Although stress and family history may contribute, hormonal factors possibly have no role. Quantitative analysis of immunohistochemical markers would provide insight in understanding the pathogenesis of melasma.

Epidemiology of dermatomycoses in Kerman province, southeast of Iran: A 10-years retrospective study (2004-2014).

Superficial and cutaneous fungal infections (SCFIs) are an important public health problem and are common in tropical and subtropical countries. Pityriasis versicolor, dermatophytosis, erythrasma, onychomycosis, and otomycosis are the major diseases associated with SCFIs. The aim of this study was to evaluate the prevalence and causative agents of dermatomycoses over a period of 10 years in Kerman province, southeast of Iran. A number of 1782 subjects, including 1096 females and 686 males, with cutaneous disorders in their skin, nail, and hair suspected to have SCFIs participated in this study. The collected specimens were examined using direct microscopy examination, staining, culture on specific media and PCR-RFLP technique. In total, 617 (34.62%) subjects had SCFIs, of whom 290 (47%) were female and 327 (53%) were male. Identified SCFIs included yeast infections, dermatophytosis, saprophyte onychomycosis, erythrasma, and otomycosis due to non-dermatophytic molds (NDMs). The highest prevalence of dermatomycoses was found among the 41-50-year and 31-40-year age groups. Tinea unguium was the most common clinical pattern of dermatomycoses, and T.mentagrophytes was the predominant agent. Also, Aspergillus spp. were the most common NDMs agents of onychomycosis and otomycosis. This study summarized the epidemiological trends and etiologic agents of SCFIs in a 10-year period in Kerman, southeast of Iran. Consideration of the current epidemiologic trends in the prevalence and knowledge of the exact causative agents of SCFIs may play an important key role towards further investigations, diagnosis, and modification of current treatments.

Motoric Clinical Symptoms in Late Onset Parkinson’s Disease at Dr. Hasan Sadikin General Hospital Bandung

Background : Parkinson’s disease (PD) is a progressive neurological that disorder is characterized by a number of motoric symptoms which are resting tremor, bradykinesia, rigidity and postural disturbance. The main aim in carrying out this study was to observe the motoric clinical pattern in patients with late onset Parkinson’s disease based on age, gender, and staging of the disease. Methods : This was a descriptive retrospective study to 89 medical record of patients with late onset Parkinson’s disease from Neurology outpatient clinic of Dr. Hasan Sadikin General Hospital Bandung in the period January 2010 to January 2013. Total sampling was used to determine the population sample size The motoric clinical symptoms in patients with late onset Parkinson’s disease were classified based on age at diagnosis, gender, and staging of the disease conducted using descriptive retrospective method. Besides, staging was made based on Hoehn and Yarl scale. Results : Overall, 92% of the patients with late onset Parkinson’s disease had resting tremor, and postural instability was less frequently found in 21% of patients. Sixty one men suffered from this disease, 43% were from the age group 60–69, and 32% were in stage III. Conclusions : A majority of patients with the late onset Parkinson’s disease show resting tremor that has the common motoric clinical pattern, followed by bradykinesia, rigidity, and some show postural instability. [AMJ.2017;4(1):11–5] DOI: 10.15850/amj.v4n1.1013

Cutaneous drug reactions notified by ADR monitoring centre in a tertiary care hospital of Bihar

Background: Cutaneous drug reactions are most frequent drug related adverse events which lead to early treatment discontinuations, high treatment cost and leading cause of morbidity and mortality. The aim of this study is to analyze the clinical patterns and offending drugs as well as their causality, severity and preventive strategies.Methods: All adverse drug reactions (ADRs) forms filled from May 2015 to April 2016 were scrutinized and forms with cutaneous drug reactions were analyzed and assessed for causality, severity and preventability.Results: Out of 300 ADR forms, 160 (53.34%) included cutaneous drug reactions. 68 (42.50%) patients were male and 92 (57.50%) were female. Maculopapular rash 58 (36.25%), fixed drug eruption (FDE) 31 (19.37), pruritus 27 (16.87%) and urticaria 19 (11.87%) were the common clinical patterns of cutaneous drug reactions. Most common offending drug classes included antibiotics, anti-inflammatory and steroidal agents. Causality assessment was done by using Naranjo’s algorithm. The result showed that out of 160 cutaneous drug reactions 141 (88.12%) ADRs were probable, 15 (9.37%) were classified as possible; 2 (1.25) doubtful and 2 (1.25%) were definitely related to the drug.Conclusions: The present study shows cutaneous drug reactions are commonly reported at ADR monitoring centre of this tertiary care hospital. Our study suggests that there is a need of intensive monitoring for ADRs in tertiary care hospital for early detection and to ensure the patient safety.

Pharmacovigilance of cutaneous drug reactions: A prospective observational study

Objective: To determine the frequency, severity and morphological pattern of ACDRs and their correlation with various risk factors.Methodology: A prospective, observational study was conducted in Muzaffarnagar Medical College & hospital, Muzaffarnagar Uttar Pradesh from Feb 2013 to Jan 2014 for one year. All patients of either sex and all age groups with suspected ACDRs attending/referred to Dermatology department were included.Results: Total of 90 cases were reported over a period of one year. ACDRs were observed with 0.5% incidence of patients attending OPD. ACDRs were commonly seen in adult age group (mean age 36.93 yrs) and have 3 or more drugs prescribed with equal gender distribution. As per Naranjo Algorithm, maximum number of ACDRs were of Possible type (74%), while 23 cases were of Probable category with female and male preponderance respectively. 71 of ACDRs were Moderate in severity (79%) followed by 11% of mild and 10% of severe category. Most common clinical pattern was Urticaria with 32 cases followed by 24 cases of Maculopapular Eruptions, 9 cases of Acneiform eruptions and 8 of fixed drug reactions and SJ Syndrome. Commonest Drug groups causing ACDRs were Antibiotics (38%) and Antiepileptics (30%).This was followed by NSAIDs induced ACDRs (9%). Phenytoin was the most common drug causing 12 ACDRs followed by 6 with Cabamazipine and Ceftrixone each and 5 cases with ATT.Conclusion: Incidence was low as compare to global incidence; better steps must be needed to strengthen the activity of pharmacovigilance in this state of the country.

Impairment of an atrophic mandible by preparation of the implant cavity: a biomechanical study

An important complication during insertion of implants in atrophic mandibles is the fracture that can be induced by preparation of the cavity. We designed this study to identify which configuration of cavities in the interforaminal region was the least likely to fracture. An electromechanical testing machine was used to measure breaking loads of specifically-designed synthetic models of atrophic mandibles. The implant cavities correlated with the common clinical patterns. Intact atrophied synthetic mandibles broke at a mean (SD) load of 729.48 (59.94) N (control group). Models with four different configurations of cavities fractured as follows: two short, wide cavities (8 x 4.2mm) at a mean (SD) load of 569.17 (67.7) N; two long, thin cavities (15 x2.8mm) at a load of 563.40 (62.0) N; four short, wide cavities (8 x 4.2mm) at a load of 667.01 (71.89) N; and four long, thin cavities (15 x 2.8mm) at a load of 409.50 (43.61) N. Biomechanical findings showed that there was a greater risk of fracture of atrophic mandibular models in long, thin implant cavities with more preparation sites. Each cavity prepared for an implant increased the risk of fracture in an atrophic mandible. The risk of fracture is greatest with long, thin cavities.

A study of adverse cutaneous drug reactions (ACDR) owing to antiepileptics at a rural-based tertiary-care center, Gujarat

Background: Cutaneous reactions are common manifestations of adverse cutaneous drug reactions (ACDRs). It is commonly seen with antiepileptics. Antiepileptics are frequently used for neurological disorders, head injury, etc. So, it is very important to have an in-depth understanding of ACDRs owing to antiepileptics. Aims and Objective: To analyze the spontaneous ACDR with various clinical patterns of drug reactions owing to antiepileptics, the common ACDR owing to antiepileptics, and the most common antiepileptic drugs responsible for it. Materials and Methods: An observational study was carried out from April 2010 to March 2015 in the Department of Dermatology at a rural-based tertiary health-care center after ethical clearance. The study included all the patients with symptoms and signs suggestive of ACDR after intake of antiepileptic drugs. Result: Thirty-four cases presented with antepileptics-induced ACDR. Male and female subjects were found to be equally affected. The common age group affected was 11–20 years. Four patients showed history of ACDR, of which one patient showed history of reaction with the same drug. The commonest clinical pattern was maculopapular rash in 58.8%. Maximum number of patients had >50% body area involvement. Oral mucosa was involved in 17.64% patients. The commonest culprit was phenytoin in 74.41%, followed by carbamazepine in 20.58%. Conclusion: Antiepileptic drugs are very commonly prescribed drugs, and various patterns of cutaneous drug reactions are observed owing to it. The active involvement of a dermatologist for detecting the ACDRs in an initial phase and delivering the awareness regarding the need of reporting the incident could improve the scenario in under-reported hospitals.

Epithelial, non-melanocytic and melanocytic proliferations of the ocular surface.

Ocular surface tumors are commonly encountered by ophthalmologists and ophthalmic pathologists. These tumors have varied clinical manifestations. In this article, we discuss the most commonly encountered non-melanocytic and melanocytic ocular surface tumors, with emphasis on their common clinical features, morphologic patterns, and prognostic factors.

Perineural spread of pelvic malignancies to the lumbosacral plexus and beyond: clinical and imaging patterns.

OBJECT Perineural spread along pelvic autonomie nerves has emerged as a logical, anatomical explanation for selected cases of neoplastic lumbosacral plexopathy (LSP) in patients with prostate, bladder, rectal, and cervical cancer. The authors wondered whether common radiological and clinical patterns shared by various types of pelvic cancer exist. METHODS The authors retrospectively reviewed their institutional series of 17 cases concluded as perineural tumor spread. All available history, physical examination, electrodiagnostic studies, biopsy data and imaging studies, evidence of other metastatic disease, and follow-up were recorded in detail. The series was divided into 2 groups: cases with neoplastic lumbosacral plexopathy confirmed by biopsy (Group A) and cases included based on imaging characteristics despite the lack of biopsy or negative biopsy results (Group B). RESULTS Group A comprised 10 patients (mean age 69 years); 9 patients were symptomatic and 1 was asymptomatic. The L5-S1 spinal nerves and sciatic nerve were most frequently involved. Three patients had intradural extension. Seven patients were alive at last follow-up. Group B consisted of 7 patients (mean age 64 years); 4 patients were symptomatic, 2 were asymptomatic, and 1 had only imaging available. The L5-S1 spinal nerves and the sciatic nerve were most frequently involved. No patients had intradural extension. Four patients were alive at last follow-up. CONCLUSIONS The authors provide a unifying theory to explain lumbosacral plexopathy in select cases of various pelvic neoplasms. The tumor cells can use splanchnic nerves as conduits and spread from the end organ to the lumbosacral plexus. Tumor can continue to spread along osseous and muscle nerve branches, resulting in muscle and bone "metastases." Radiological studies show a reproducible, although nonspecific pattern, and the same applies to clinical presentation.

Equine urticaria: a clinical guide to management

Urticaria (hives) is a fairly common clinical reaction pattern in horses. Although often attributed to allergic causes, several other aetiologies can lead to the manifestation of the condition. A thorough...

Multiple primary melanomas versus single melanoma of the head and neck

Single primary and multiple primary melanomas (MPMs) of the head and neck region may be confused at first glance because of the common clinical and dermoscopic patterns. An inaccurate diagnosis may lead the clinician to a wrong diagnostic and therapeutic pathway because MPMs occurring in familial or sporadic settings are often involved in individual cancer susceptibility. We investigated the clinical, demographic, histological, and survival differences between MPMs and single melanoma occurring in the head and neck region. A retrospective analysis of medical and histologic records from 217 melanomas of the head and neck region was carried out. Malignant neoplasms affecting MPMs patients were also reported. Mutational analysis of specific genes was carried out when clinical data and family history were suggestive for a familial/hereditary setting. Two hundred and five out of 217 (94.5%) patients were affected by single primary melanoma and 12 (5.5%) by MPMs of the head and neck region. Individuals affected by MPMs were distinguished by a significantly higher mutation frequency and a higher prevalence of malignant neoplasms such as renal cancer. Genetic testing showed germline mutations affecting MITF E318K, CDKN2A genes. Our data highlight the importance of strict cancer surveillance in individuals with MPMs and the role of appropriate genetic counseling and testing in selected patients. Finally, personalized clinical and instrumental screening and follow-up strategies should also be based on mutational status. A heightened level of suspicion is required in the clinical management of mutation carriers.

Characterization of cytomegalovirus lung infection in non-HIV infected children.

Cytomegalovirus (CMV) is a prevalent pathogen in the immunocompromised host and invasive pneumonia is a feared complication of the virus in this population. In this pediatric case series we characterized CMV lung infection in 15 non-HIV infected children (median age 3 years; IQR 0.2–4.9 years), using current molecular and imaging diagnostic modalities, in combination with respiratory signs and symptoms. The most prominent clinical and laboratory findings included cough (100%), hypoxemia (100%), diffuse adventitious breath sounds (100%) and increased respiratory effort (93%). All patients had abnormal lung images characterized by ground glass opacity/consolidation in 80% of cases. CMV was detected in the lung either by CMV PCR in bronchoalveolar lavage (82% detection rate) or histology/immunohistochemistry in lung biopsy (100% detection rate). CMV caused respiratory failure in 47% of children infected and the overall mortality rate was 13.3%. Conclusion: CMV pneumonia is a potential lethal disease in non-HIV infected children that requires a high-index of suspicion. Common clinical and radiological patterns such as hypoxemia, diffuse adventitious lung sounds and ground-glass pulmonary opacities may allow early identification of CMV lung infection in the pediatric population, which may lead to prompt initiation of antiviral therapy and better clinical outcomes.

A8.1 NCF1-deficient mice with impaired oxidative bursthave a more aggressive progression of dextran sulfate sodium (DSS) -induced colitis

IntroductionIntestinal Inflammatory Disease (IID) as a primary immunodeficiency depends on mutations in the NADPH oxidase complex, responsible for the production of reactive oxygen species (ROS). One of the most common...

Indications for Gynaecological Consultation by Women at a Rural Outreach Centre in North-Central Nigeria

Aims: To identify the reasons for consultations, the common clinical diagnosis and disease pattern at a rural gynaecologic outreach clinic. Study Design: Descriptive Retrospective Study. Place and Duration of Study: NKST Hospital Mkar-Gboko, Benue state, North-central Nigeria, in seven years (1 April 2005 to 31st July 2012). Methodology: Information from the case notes of patients who attended the outreach clinic over the study period were retrieved and analysed. Majority of the patients came by self-referral. Results: Of the 1,733 women that attended the clinic during the study period, 1,605 (92.6%) women made the inclusion criteria and formed the study population. The age Original Research Article International Journal of TROPICAL DISEASE & Health, 4(6): 696-712, 2014 697 range was 15 to 78 years; mean value of 33.6 +/9.5 year; 78% of the women were ages 21 – 40 years. The mean parity was 2.1 +/2.7and ranged between 0 to 13 children. 68% of the women were para 0 – 2 whilst 18% had parity of 5 and above. The women had 73 reasons and 2,390 presenting complaints, 49.6% of them had multiple presenting complaints (average 1.5 complaints per woman).Most common complaints were inability to conceive, lower abdominal pain and leaking of urine and /or faeces amongst 38%, 11% and 10% of the women respectively. There were 63 disease conditions with 1,793 clinical diagnoses. About 12% of the women had multiple clinical diagnoses. The three leading clinical diagnoses were infertility, genital fistulae and uterine myoma, in 46%, 12% and 10% of the women respectively; followed by sundry other gynaecological disorders (9%) and medical disease conditions (5%) in which hypertension, diabetes mellitus and retroviral diseases were more frequent in that order. Some women (n = 21; 1%) came for second opinion. Conclusion: Gynaecological diseases are diverse and common among women in rural central Nigeria. Inability to conceive, lower abdominal pain and incontinence of urine and or faeces were the three main reasons women sought consultation with the gynaecologist at Mkar. Infertility, genital fistulae, uterine myoma, non-communicable medical disorders and retroviral diseases were leading clinical diagnoses. Extending the services of Gynaecologist to the rural areas in the region may reduce the access gap to women’s health and enhance national development.

Epidemiological pattern of psoriasis, vitiligo and atopic dermatitis in India: Hospital-based point prevalence.

Background:The knowledge of the prevalence of common dermatoses will be useful for optimum use of valuable resources of the country.Aim:The aim of the study is to determine the pattern and prevalence of psoriasis, vitiligo and atopic dermatitis (AD) in India.Materials and Methods:This was a hospital-based study conducted on a single day in one medical college each in four zones of India.Results:The point prevalence of dermatological cases was 9.25%. The point prevalence of psoriasis, vitiligo and AD were 8%, 9.98% and 6.75% respectively. Chronic plaque type psoriasis was the most common (50%) clinical pattern. The most common site of involvement of psoriasis was the palms. Stable type of vitiligo was common which accounted for 65.21%. Lower lip was involved in 75% of mucosal vitiligo. Lower limbs were the most common site of onset of vitiligo. AD was most prevalent in the first decade (40.7%). Personal history of atopy was present in (59.5%) patients. Dry skin was present in 92.5% of patients.Conclusions:Our data correlates with previous hospital-based prevalence studies of psoriasis, vitiligo and AD.

Problem based review: the patient with dizziness on the AMU

Unsteadiness, balance disturbance, and ‘dizziness’ are common presenting complaints on the Acute Medical Unit. This article outlines key components in the evaluation of these problems and describes the most common clinical patterns of dizziness. A case history is used to highlight some key learning points.

Prevalence of Cutaneous Adverse Drug Reactions in Southwest China

An update of the information about the prevailing trend of cutaneous adverse drug reactions (CADRs) is important for clinicians. The objective of the study was to survey the prevalence of CADRs in Southwest China over the past 11 years. The clinical and laboratory data of all inpatients admitted with a diagnosis of CADRs to the dermatology ward of Southwest Hospital during the past 11 years were retrospectively investigated. In the 547 recruited patients, the most common clinical pattern was maculopapular eruptions (n = 277), followed by fixed drug eruptions (n = 84) and acute urticaria (n = 44). In 206 cases with single medication intake, the 3 most common culprit drugs were acetaminophen (n = 44), penicillins (n = 44), and cephalosporins (n = 30). The frequency of urticaria in the elderly (≥60 years old) (n = 117) was significantly lower than that in younger patients (<60 years old) (n = 430) (P = 0.046), whereas erythema multiforme was much more common in the elderly (P = 0.038). As compared with younger patients, allopurinol was the most common culprit drug in the elderly. In contrast to previous studies, our study showed that the prevalence profiles of CADRs in the elderly are quite different from those in younger population. Acetaminophen was the most common culprit drug for total CADRs, which should be alerted as an important public health problem.

Successful treatment of Nocardia pneumonia with cytomegalovirus retinitis coinfection in a renal transplant recipient

Nocardiosis is a rare opportunistic infection, especially seen in immunocompromised patients, including renal allograft recipients. Primary pulmonary infection is the most common clinical pattern and can easily result in disseminated Nocardia infection if treatment therapy is not adequate at the beginning. We report a case of pulmonary nocardiosis associated with cytomegalovirus retinitis in a renal transplant recipient, followed by chronic allograft dysfunction. Our patient was a 50-year-old male renal allograft recipient, with diabetes mellitus and hypertension, who was diagnosed with pneumonia and cytomegalovirus retinitis. High-resolution computed tomography scan of the thorax and bronchoscopy revealed nocardial pneumonia. The patient responded well to ceftriaxone and was later switched to oral minocycline. To our knowledge, this is the first report of a successful treatment of co-infection with Nocardia pneumonia and cytomegalovirus retinitis in a renal transplant patient, with early diagnosis and prompt treatment.

Melanoma cutâneo: estudo prospectivo de 42 casos

A prospective longitudinal study of 42 cases of cutaneous melanoma showed that: 71.2% of patients were between 50 and 79 years of age; 45.1% were male and 54.7% female; most patients (88%) were white; most lesions (54.7%) were located on the trunk (p = 0.039); the most common clinical and histological pattern was the superficial spreading melanoma (52.3% / 26.1%) (p = 0.02); 16 cases (38.1%) were classified as stage IA and 9 cases (21.4%) consisted of melanomas in situ.

Onychomycosis observed in children over a 20‐year period

There are few reports studying the aetiology of onychomycosis in children in Spain. To study childhood dermatophyte onychomycosis, a retrospective study of children was carried out, who were <16 years of age with dermatophyte onychomycosis diagnosed between 1987 and 2007. Of 4622 nail samples from 3550 patients, 218 came from 181 children up to 16 years old. Onychomycosis caused by dermatophytes was demonstrated in 28 (15.5%) cases. Trichophyton rubrum (18 cases) was the most prevalent species, followed by Trichophyton tonsurans (five cases), Trichophyton mentagrophytes var. interdigitale (four cases) and Trichophyton mentagrophytes var. mentagrophytes (one case). Concomitant dermatophytosis at other locations was confirmed in seven cases (25%). Toenail onychomycosis was associated with tinea pedis in five cases. Distal and lateral subungual onychomycosis was the most common clinical pattern. The superficial white type was found in two cases of toenail onychomycosis caused by T. rubrum and T. tonsurans. During the period of study, only 5.1% of all investigated people were children up to 16 years. The prevalence of onychomycosis tended to increase over the years and represented 15.5% of all nail dystrophies in children. Therefore, dermatologists must consider onychomycosis in the differential diagnosis of nail alterations in children and always perform a mycological study to confirm the diagnosis.