In a prospective study, 100 cancer patients and their relatives were separately interviewed using a structured interview to examine whether the diagnosis of cancer should be communicated to patients and relatives; the reasons for doing so or not, the emotional reactions of patients and families; any change in the attitude of relatives; behaviour of patients and patient's expectation, on diagnosis, of the course of their illness. The majority of patients, who knew their diagnosis (71%), wanted to be told the truth. The majority of relatives wanted to know the truth themselves (81%) without the patients being told (77%). Patients did show immediate emotional reactions like anxiety and dejection, however they appeared to accept the diagnosis. Findings suggest that in an Indian setting the attitude of family members is more positive. The role played by sociocultural factors in the acceptance of the truth is discussed.
Pachyonychia congenita (PC) is a rare genodermatosis with only 450 cases reported since 1906. It is of two types, type I due to mutation in genes 6a and 16, and 6b and 17 in type II with an autosomal dominant inheritance in both types. A 22 yr old female patient presented in our OPD with hypertrophy of finger and toe nails, palmoplantar keratoderma, oral punctuate leukokeratosis, hyperhidrosis in palms and soles with maceration and malodour since childhood. She had a positive family history with father and grandfather affected but less severely. Microscopy and culture of nail clippings and scrapping were done to rule out fungal infection. On biopsy acanthotic epidermis, parakeratosis, orthokeratosis were seen. No evidence of any associated malignancy was found after thorough workup. She was diagnosed as PC Type 1. She was put on topical steroids and orally on acetretin 25 mg OD. Paring of the nails was done too reduce the thickness of nails & to provide symptomatic relief. She was on a regular treatment for 3-4 months and showed some improvement in the form of reduced palmoplantar hyperkeratosis and reduced oral punctate keratosis but was later lost on followup. She showed no adverse effect to therapy during this period. This case is being reported because of its rarity.
Celiac disease (CD) is an immune-mediated disorder that may be associated with various diseases that share a similar pathogenic immune mechanism. This study reports on the prevalence of various diseases in a cohort of CD patients in northern India. Patients diagnosed with CD based on modified ESPGHAN criteria were prospectively evaluated for associated concomitant diseases. Of the 363 patients evaluated, 207 (57.0 %) were male. The mean age was 19 years. Seventy-one percent of patients presented with typical diarrheal disease, while 29 % presented with atypical nondiarrheal disease. One or more associated diseases were noted in 70 (19.2 %) patients. Liver diseases were the most common association. Portal hypertension was present in 33 (9 %) patients; chronic liver disease was the underlying cause in 17 patients, while noncirrhotic causes were noted in 16 patients. Type 1 diabetes was seen in 13 and hypothyroidism in 11 patients. Other unreported or rarely reported associated diseases were also found in some of the patients. Associated comorbid diseases are common, and may need to be actively screened, in Indian CD patients.
ABSTRACT:Oral mucosal health is an integral part of our holistic well-being. Complete skin examination includes those of mucosa, with oral mucosa being the most readily accessible and amenable to examination. Many dermatological diagnoses have an essential mucosal component with the latter adding to the diagnostic information. Apart from this, oral mucosa may harbour incidental abnormalities which either the patient may not be aware of or seems trivial enough to be given due consideration. These findings may nevertheless be quite important and some may need management too. Few studies in the past have attempted to study epidemiological trends of oral mucosal involvement in dermatology outpatient settings. (1,2,3,4) We studied oral mucosa of patients attending dermatology outpatient department. 51.8% patients had oral mucosal findings with 50.1% being incidental not related to the dermatological diagnosis.
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