Timely diagnosis and inpatient care has important implications on appropriate treatment, duration of hospital stay and patient outcome.
The early diagnosis and treatment of ocular disease to prevent morbidity and mortality of patients with human immunodeficiency virus (HIV) is of paramount importance. Since the advent of highly active antiretroviral therapy (HAART), the incidence of ocular complications of HIV has decreased and their manifestations and natural course are also modified. This has been observed in the face of emerging immune recovery, which per se has brought new difficulties in the process of diagnosing and management of the ocular disease. Conditions such as immune recovery uveitis could affect eyes with history of opportunistic disease with a potential to cause vision loss; with this regard, differentiation of the inflammatory process from infective causes is essential. The other sexually contracted diseases are also to be included in this complex picture because of their contribution to the clinical picture and also sharing common routes of transmission with HIV. There is very little doubt that visual deterioration would further deteriorate the already compromised quality of life of this group of patients. In this review, authors wish to provide evidence available in the medical literature around the visual health issues in HIV-infected patients and raise awareness towards the changing pattern of the ocular disease in the HAART era.
Background. Advanced stage primary cutaneous malignant melanoma (PCMM) has a high mortality. PCMM may affect any area of the skin, including the nail apparatus (malignant melanoma or subungual melanoma). Although nail apparatus malignant melanoma (NAMM) is rare, delayed diagnosis carries a poor prognosis. Aim. The primary aim was to study the range of nail presentations and identify key patterns to aid in differential diagnosis. A secondary aim was to quantify the number of patients requiring surgery, indications for biopsy, and the incidence and characteristics of NAMM.Methods. This was a prospective study of all referrals with nail apparatus pigmentation to a weekly dedicated melanoma screening clinic over a 6-month period.Results. In total, 2246 patients were included. Of the 38 patients referred with nail pigmentation, 1 (2.6%) was diagnosed with NAMM and involved a fungating amelanotic lesion of the right hallux. The remaining patients were diagnosed with subungual haematoma (20/38; 52.6%), viral wart (2/38; 5.4%), acral fibrokeratoma (1/38; 2.6%), myxoid cyst (3/38; 7.9%), fungal nail infection (4/38; 10.5%), Pseudomonas nail infection (1/38; 2.6%), benign linear pigmentation (2/38, 5.3%), Bowen disease (1/38, 2.6%), psoriatic nail changes (2/38; 5.3%) and matrix malalignment (1/38; 2.6%). Of the eight patients (21.1%) who required surgery, five had a biopsy taken and three underwent surgery. Only 14 cases were followed up by Dermatology. NAMM accounted for 0.7% of all melanomas diagnosed. Conclusion. We illustrate the wide range of diagnoses for pigmented nail presentations and highlight the late presentation of advanced disease in a patient presenting with NAMM.
The aim of this study was to compare the effects upon marginal leakage of a number of dentine bonding agents when used with a posterior composite resin, Occlusin, after storage for periods of up to 2 years. The bonding agents used were Gluma, Scotchbond, Topaz and an experimental material. The results were compared with a glass ionomer, Chemfil II. Class V cavities with or without a bevelled cavo-surface margin were prepared in the buccal surfaces of extracted premolar teeth. Following restoration, the teeth were stored for periods of up to 2 years and then thermally cycled. Marginal leakage was subsequently demonstrated using a radioactive isotope containing 45Ca, and an auto-radiographic technique. Image analysis was used to determine the total amount of linear leakage for each specimen. The results showed that some leakage occurred for all materials at each time interval. The bevelled design of cavity allowed significantly less leakage than the unbevelled cavity. Overall, there was little difference between the various dentine bonding agents. The glass ionomer restorations showed significantly less leakage than the composite resin and dentine bonding agent combinations in unbevelled cavities.
The pulpal reaction associated with a composite resin alone and composite resin used in conjunction with two dentine bonding agents was studied. Class V cavities were prepared on the labial surfaces of the canine teeth of 18 male ferrets. After acid etching of the enamel margins, the cavities were restored with either a composite resin alone or in combination with one of two dentine bonding agents, Scotchbond and Gluma. One cavity in each animal was filled with Kalzinol as a control. The animals were killed after 7, 14 and 28 days. After histological processing, the pulpal changes were assessed qualitatively and quantitatively according to standard criteria. There were variations in the pulpal response at all time intervals. The responses to the two dentine bonding agents were similar to those found with composite resin alone. No pulpal inflammation was observed in the control teeth. Gram-positive micro-organisms were identified at the interface of restoration and cavity wall, or within the dentinal tubules in virtually all cases in which pulpal inflammation was observed.
We present a case of carcinoma en cuirasse as a presentation of advanced lobular breast carcinoma. On further investigation, she was found to have metastasis to her liver and bone. We report this case to highlight the phenomenon of cutaneous metastasis. It is important to consider this diagnosis as an initial manifestation of breast cancer, but rarely, it can also be associated with other adenocarcinomas, for example, carcinoma of lung, kidney or gastrointestinal tract.
The aim of this study was to compare the effects upon marginal leakage of a number of dentine bonding agents: Gluma, Scotchbond, Topaz and an experimental material when used with a posterior composite resin, Occlusin. The results were also compared with composite used without a dentine bonding agent and with a glass ionomer, Chemfil II. Class V cavities with or without a bevelled cavo-surface margin were prepared in the buccal surfaces of extracted premolar teeth. Following restoration, the teeth were stored for periods of up to 3 months and then thermally cycled. Marginal leakage was subsequently determined using a radioactive isotope containing 45Ca, and an autoradiographic technique. Image analysis was used to determine the total amount of linear leakage for each specimen. The results showed that some leakage occurred for all materials at each time interval. The bevelled design of cavity allowed significantly less leakage than the non-bevelled type. The use of dentine bonding agents did not improve the marginal seal of the composite restorations, and the glass ionomer restorations showed significantly less leakage than the composite resin and dentine bonding agent combinations.
The most important aspect of management in these cases is immediate withdrawal of the suspected agent, because small pustules in a localized patch may progress to a more generalized pustular rash. 5 Treatment is supportive, and because of the self-limiting nature of the disease, no specific treatments are usually needed. However, topical or systemic corticosteroids can be used to hasten resolution. 2 We discontinued enoxaparin for our patient, and prescribed topical corticosteroid (betamethasone) cream to be used twice daily. The pustules resolved rapidly over several days.In conclusion, we present a case of a woman with a cutaneous drug reaction consistent with ALEP that occurred after enoxaparin. This case highlights enoxaparin as a novel causative agent for this type of drug reaction.
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