"Mycetoma" means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.
Objectives: Acanthosis nigricans refers to the velvety, black hyperpigmentation seen in the flexures. It is a cutaneous marker for insulin resistance (IR), some metabolic disorders and rarely malignancy. When secondary to IR, it is asymptomatic, except for the hyperpigmentation. The neck is the most accessible and easiest to grade. Our aim was to identify the predictive value of the grades of acanthosis nigricans in identifying IR, the predictive value of the textures of acanthosis nigricans in identifying IR, and the diagnostic utility of acanthosis nigricans grading in comparison to the laboratory tests.
Settings and subjects:The institutional ethics committee of Sri Ramachandra University approved this study.Three hundred consecutively presenting adults (50 males) with acanthosis nigricans neck were enrolled.Design: History, physical parameters and acanthosis nigricans grades, location and textures were noted. An oral glucose tolerance test (OGTT), fasting serum insulin and homeostasis model assessment of IR (HOMA IR)were carried out. The acanthosis nigricans grades were correlated to establish any association. Thirty obese controls without acanthosis nigricans were included.Outcome measures: OGTT, fasting serum insulin and HOMA IR were the outcome measures studied.
Results:This cross-sectional study revealed that 94 subjects with acanthosis nigricans (31.34%) had IR. Grades III and IV, and textures II and III, were more predictive of IR. Acanthosis nigricans grading was insignificant in the noninsulin-resistant group. Acne (p-value 0.379), hirsutism (p-value 0.12) and acrochordons (p-value 0.415) were not significantly associated with IR.Conclusion: Severe grades and higher textures of acanthosis nigricans are reliable clinical diagnostic tools for IR. The absence of acanthosis nigricans was not associated with IR. Acanthosis nigricans grading is an inexpensive and non-invasive way of identifying pre-diabetes.Peer reviewed.
The purpose of this study was to determine the effect of coconut water feeding in cholesterol-fed rats. Male albino rats were fed tender coconut water and mature coconut water at a dose level of 4 mL/100 g of body weight. Cholesterol feeding caused a marked increase in total cholesterol, very low-density lipoprotein (VLDL) + low-density lipoprotein (LDL) cholesterol, and triglycerides in serum. Administration of coconut water counteracts the increase in total cholesterol, VLDL + LDL cholesterol, and triglycerides, while high-density lipoprotein cholesterol was higher. Lipid levels in the tissues viz. liver, heart, kidney, and aorta were markedly decreased in cholesterol-fed rats supplemented with coconut water. Feeding coconut water resulted in increased activities of 3-hydroxy-3-methylglutaryl-CoA reductase in liver, lipoprotein lipase in heart and adipose tissue, and plasma lecithin:cholesterol acyl transferase, while lipogenic enzymes showed decreased activities. An increased rate of cholesterol conversion to bile acid and an increased excretion of bile acids and neutral sterols were observed in rats fed coconut water. Histopathological studies of liver and aorta revealed much less fatty accumulation in these tissues in cholesterol-fed rats supplemented with coconut water. Feeding coconut water resulted in increased plasma L-arginine content, urinary nitrite level, and nitric oxide synthase activity. These results indicate that both tender and mature coconut water has beneficial effects on serum and tissue lipid parameters in rats fed cholesterol-containing diet.
Sir, A 29-year-old man presented with complaints of progressively enlarging, hyperpigmented lesion over the face of 7 months duration. The lesion had started on the right infraorbital region and progressed to involve the left side of the face. He had been operated on the right side of his face, 1 year ago, for complaints of nasal stuffiness with bleeding, and was not on regular follow-up. He had mild pain on the right side of the face but maintained that he continued his regular cleansing habits. Local examination revealed a well-defined hyperpigmented verrucous plaque of size 15.2 × 5.1 cm extending from the right preauricular
Net LetterHow to cite this article: Vetrichevvel TP, Sandhya V, Shobana S, Anandan S. Dermatosis neglecta unmasking recurrence of carcinoma nasopharynx. Indian J Dermatol Venereol Leprol 2011;77:627.
Desmoglein 1 and 3 are distributed in the outer root sheath (ORS) of the hair follicle. Direct immunofluoresence (DIF) pattern of ORS in cases of pemphigus resembles the DIF pattern of the perilesional skin. We performed a DIF of the anagen and telogen hair ORS in a case of pemphigus and correlated it with the DIF findings of perilesional skin. Telogen hair ORS promises to be a useful tool in performing DIF for the purpose of diagnosis and follow-up in cases of pemphigus
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