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td{ vertical-align: top; } RESUMEN La insuficiencia cardiaca (IC) es la principal causa de hospitalización en los países desarrollados. A pesar de las mejoras en el diagnóstico y las terapias, una proporción importante de pacientes con IC aún persisten muy sintomáticos o con pobre calidad de vida. La mayoría de estos pacientes, además, no son candidatos a trasplante cardiaco ni a asistencia ventricular de destino. Así pues, existe una necesidad clínica no cubierta de tratar a este creciente subgrupo de pacientes. Los nuevos dispositivos percutáneos para IC son una opción de tratamiento para mejorar los síntomas y la calidad de vida de estos pacientes. Los primeros estudios en humanos con estos dispositivos han mostrado unos resultados prometedores en términos de factibilidad, seguridad e integridad de los dispositivos. No obstante, todavía hay pocos datos sobre su eficacia. En esta revisión nos centramos en describir las características, las ventajas y los inconvenientes, así como las evidencias, de los 3 tipos principales de dispositivos percutáneos para la IC, con especial énfasis en la base fisiopatológica subyacente que justifica su diseño: los dispositivos de derivación interauriculares, que pretenden descomprimir la presión de la aurícula izquierda y así evitar el edema pulmonar; los dispositivos de ventriculoplastia, que restauran físicamente el ventrículo izquierdo en situaciones de mal remodelado ventricular; y los dispositivos de modulación del flujo cardiorrenal, diseñados para mejorar la diuresis en situación de IC aguda descompensada con síndrome cardiorrenal asociado.

td{ vertical-align:text-top;} ABSTRACT Heart failure (HF) is the leading cause of hospitalization in the Western world. Despite improvements in diagnostic tools and therapies, a substantial number of patients with HF still remain highly symptomatic, with a poor quality of life. Most of these patients are ineligible for heart transplantation or left ventricular assist device placement, which underscores an unmet clinical need in this population. Novel device-based HF therapies represent therapeutic options for these patients to improve their symptoms and quality of life. First-in-man studies showed promising results in terms of feasibility, and device performances. However, there is still scarce data regarding efficacy. In this review, we focus on the pathophysiological rationale, emerging data, concerns, and future perspective behind the 3 most studied type of device-based HF therapy: interatrial shunt devices, designed to decompress the left atrium and prevent pulmonary edema; ventriculoplasty devices, designed to physically restore the left ventricle in patients with maladaptive left ventricular remodeling; and cardiorenal flow modulator devices, designed to improve diuresis and renal function in acute decompensated heart failure with cardiorenal syndrome.

Introduction: Cutaneous metastases may precede a malignancy and, in other cases, herald the recurrence of a malignancy after surgery. Aim: To determine the significance of cutaneous manifestations in patients with an internal malignancy and to observe the various types of carcinomas in patients attending a dermatology OPD. Methods: This was a prospective hospital-based study undertaken to observe the cutaneous features in a dermatology OPD in patients coming from the oncology department of a medical college. Results: The commonest malignancy in males was a lung carcinoma, observed in 5.50% of the patients, followed by a prostate carcinoma, observed in 4.58% of the patients, an esophagus carcinoma, observed in 4.12% of the patients, and a penis carcinoma, observed in 2.29% of the patients. Specific cutaneous manifestations included cutaneous metastatic infiltrates, observed in 5.04% of the patients, and carcinoma erysipeloides, observed in 1.37% of the patients. Discussion: Skin metastases may herald the recurrence of a malignancy after treatment and usually indicate a poor prognosis.

Tailings deposit of San Andrés Benefit Concession, located in La Libertad, Peru, stores tailings in two integrated deposits, one for flotation tailings and the other for cyanidation tailings; the storage is done by the central axis method. The purpose of this study was to determine the physical stability during the operation phase, aimed at controlling the quality and quantity of tailings; the height and slope angles of the main dike; to keep water mirror away from the dike; to conserve the difference between the crown of the dike and the level of the water mirror over a minimum height of 2 m (free edge); and detecting deformations or settlements, abnormal leaks in the dike or cracks presence. Results of the safety factors for both tailings deposits, showed higher values than the minimum safety factors required by current legislation, so it is concluded that both structures are physically stable, both in static and pseudo-static conditions.

Introduction: Scars are psychologically distressing for the patients and have an impact on the quality of life and self esteem of the patients. Scar revision is an aesthetic skill which is mastered by plastic surgeons and encroached now by dermatosurgeons. Scars on the face are aesthetically unacceptable and various techniques have been improvised for making a scar aesthetically acceptable. Various types of techniques are used for scar revision like W plasty, Z plasty and VY plasty. Aims: To see the efficacy of various scar revision techniques including Z plasty, VY plasty and W plasty in 30 patients with disfiguring scars. Methods: We selected twenty patients of disfiguring scars for the study. The scars from various causes including trauma and burns were included in our study. Various techniques of scar revision include Z plasty, W plasty and VY plasty were performed according to the type and site of scar. Results: Male: female was 1.5: 1. The scar revision surgery yielded excellent results with minimal complications including haematoma formation, secondary infection and delayed healing seen in 5% patients each. Regarding the efficacy of scar revision, excellent improvement was seen in 60% patients, moderate improvement was seen in 30% patients and mild improvement was seen in 10% patients. Conclusions: Dermatologists can employ a number of surgical scar revision techniques. While some are better suited to treat specific types of scars, they can be used in combination with each other or with adjunctive therapies to achieve optimal results.

Platelet rich plasma is a promising therapy in dermatology and aesthetic medicine. In this article we will discuss the pros and cons of platelet rich plasma (PRP) and the usage of PRP in aesthetics. PRP is especially used for conditions like facial and neck rejuvenation, fine lines and wrinkles, abdominal striae and facial scarring.

P- Phenylenediamine is an oxidative chemical that is frequently used as a permanent hair-coloring agent. It is added to henna to increase the intensity and longevity of the tattoo and expedites its drying time. Henna itself is a greenish brown vegetable coloring made from the leaves of Lawsonia inermis and rarely causes allergic contact dermatitis. The addition of PPD causes the contact sensitization to black henna. Serious adverse skin reactions to permanent hair dyes and temporary black tattoos have been reported. As temporary tattoos have become fashionable among adolescents, the risk profile for p-phenylenediamine (PPD) sensitization of the population has changed simultaneously with an increasing use of hair dyes in this age group. With increased popularity of body art such as body piercing and tattooing, an increase in temporary henna tattoos has also occurred. Although the appeal of non-permanence exists for henna tattoos, dermatologists have begun to see numerous cases of allergic contact dermatitis linked with a certain type of henna. We selected 50 patients using hair dye and henna for our study. Patch testing was done in all the patients using Indian standard series of antigens. Regarding to the side effects to hair dye and henna and itching was the commonest symptom seen in 16% patients, erythematous scaly plaques were seen in 10% patients, vesicular reactions were seen in 6% patients, angioneurotic oedema and contact urticaria was seen in 4% patients each and anaphylaxis and keloidal reaction was seen in 2% patients each.

Introduction: Integrated counseling and testing (ICTC) for HIV is a cost-effective intervention in preventing the spread of HIV transmission and is an integral part of HIV prevention program, which provides an opportunity to learn and accept the HIV status in a comfortable, convenient, and confidential manner. Material and Methods: A retrospective study of 3600 attendees visiting the ICTC centre from April 2010 to April 2011was undertaken. The study included 3600 attendees who came either voluntarily or referred by various department of this institute. Dominant reason for visiting ICTC was the history/presence of high risk behavior (HRB). Results: 60% indulged in heterosexual route; other HRB including men having sex with men or MSM were 5% and injecting drug users or IDU) were 15%. There were more positive among males, 21-40 years of age group, those living singly, unmarried, divorcee, widow(er) and separated. Similarly positives were more amongst illiterates, less educated and those engaged in unskilled and semi skilled jobs. Adolescent students (>14 years) accounted for one-fifth of the total positives. Direct walk in clients were more positive compared to those referred by doctors. Overall sero positivity was 4.8%; high in males, 21-40 years age, unmarried and divorcee etc. Conclusions: Sero prevalence decreased with improvement in education and also with improvement in job nature. It was also high in those living alone compared to those staying with their family.

Introduction: Cicatrical alopecia occurs in otherwise healthy men and women of all ages and is seen worldwide Material and Methods: A study of 40 patients was conducted to study the clinical variants and histopathology of cicatricial alopecia. Results and Discussion: n our study, it was seen that maximum number of cases of cicatrical alopecia were of LPP (27.5%) followed by 25% of DLE, 20% patients had pseudopelade of Brocq, SLE was seen in 5% cases followed by Scleroderma, dermatomyositis, Keratosis follicularis spinulosa decalvans, aplasia cutis, kerion, follicular mucinosis, pemphigus, dissecting cellulitis of scalp/ pyogenic folliculitis and acne keloidalis nuchae in 2.5% cases each. Regarding the morphology of lesions,epidermal atrophy was seen in 90% patients, erythema was seen in 55% cases, follicular pluging was seen in 40% patients, telangiectasias in 27.5% patients, diffuse scaling in 25% patients and mottled hyperpigmentation was seen in 20% patients. In our study, commonest histopathological feature of alopecia was perifollicular fibrosis seen in 65% patients, basal cell vacuolization was seen in 52.5% patients,perifollicular lymphocytic infiltrate were seen in 50% patients, epidermal atrophy seen in 35% patients and hyperkeratosis was seen in 20% patients.

Introduction: Topical dobesilate offers the potential for treatment of plaque psoriasis without atrophy or other local side effects associated with the use of topical corticosteroids. Fibroblast growth factor (FGF)-mediated pathways participate in many of the cellular events implicated in the pathogenesis of psoriasis. Thus, targeting FGF signals may be potentially therapeutic. Aims: To study the efficacy of topical calcium dobesilate for the treatment of 50 patients of limited plaque psoriasis. Methods: For the present study, fifty clinically diagnosed cases of psoriasis with limited number of plaques ( 0.05).

Introduction: The Sexually transmitted diseases (STDs) are a global health problem of great magnitude. The pattern of STDs differs from country to country and from region to region. The increased risk of the transmission of HIV is known to be associated with the presence of sexually transmitted diseases (STDs) and despite the presence of the National STD Control Program in India the number of people with STDs remains high. Aim: The aim of our study was to study the profile of patients in a STD clinic in North India and to study various sexually transmitted infections in both male and female patients. Material and Methods: A prospective study of the patients attending STD clinic in a district hospital in North India from December 2009 to December 2012 was done. A total of 2700 patients attending the STDclinic in three years from December 2009 to December 2012 were taken up for the study. Results: The commonest sexually transmitted infection in males was herpes genitalis (30%) followed by 20% cases of genital warts. 10% patients had gonorrhoea, genital molluscum contagiosum, syphilis and genital scabies each and 5% patients had nongonococcal urethritis. Only 5% of the total patients had chancroid, donovanosis and LGV. The commonest sexually transmitted infection in females was vaginal discharge seen in 40% patients, lower abdominal pain in 20% patients, herpes genitalis in 15% patients followed by 20% cases of genital warts and syphilis each. Genital molluscum contagiosum was seen in 5% patients only. Conclusions: The treatment of STD’s is important as both non-ulcerative and ulcerative STDs increase the susceptibility to or transmissibility of HIV infection and as such, an increase in STD prevalence as revealed by clinic attendance in this study was bound to facilitate the spread of HIV/AIDS. Perhaps it is high time health planners adopted a more aggressive and result oriented HIV/AIDS/STD awareness campaign strategy.

Introduction: Acrodermatitis enteropathica (AE) is a disorder of zinc metabolism that occurs in one of two forms: an inborn (congenital) form and an acquired form. The inborn form of AE is a rare genetic disorder characterized by intestinal abnormalities that leads to inability to absorb zinc from the intestine. The lack of zinc presents, characteristically, as skin inflammation with pustules occurring around the mouth and/or anus, diarrhea.Aims: To study the efficacy of oral zinc therapy on thirty patients of acrodermatitis enteropathica.Methods: Thirty clinically diagnosed patients of acrodermatitis enteropathica were taken for the study. The criterion of diagnosis of this condition was the clinical picture of symmetrical vesiculo-pustular dermatitis, in upper and lower limbs and periorificial regions.Results and Discussion: In our study maximum (50%) patients were below 1 year of age, 33.3% patients were between 13-24 months of age, 6.66% patients were between 25- 36 months and 37- 48 months each and 3.33% patients were between 49- 60 months of age. Nail changes were seen in 60% children. Also, it was seen that perioral area was the commonest (86.6%) site involved, followed by anogenital area in 80% patients, palms and soles were involved in 66.6% patients, arms in 46.6% patients and legs were seen in 40% patients. Regarding clinical features, dermatitis was seen in 100%patients, alopecia was seen in 40% patients, diarrhea in 60% patients and mental disturbances were seen in 30 % patients.

Introduction: Tinea capitis is a superficial fungal infection of scalp and hair caused by various species of dermatophytes. The incidence of Tinea capitis varies from country to country and region to region.Material and Methods: tract Fifty patients from the preschool going population were selected for the study.Results and Discussion: Clinical presentation of disease revealed that black dot to be the commonest (32%) followed by grey patch (28%), kerion (20%) and favus type was the least (1%). Direct microscopy of hair in KOH preparations revealed that all clinically suspected patients of Tinea capitis had endothrix type in 56% of cases and ectothrix type in 44%.

Introduction: Psoriasis is a genetically determined chronic disease of skin in which a number of biochemical alterations take place during its course. The main objectives of our study were to calculate various biochemical parameters in psoriasis correlate them clinically. Materials and Methods: An attempt was made to detect the biochemical changes during its exacerbations. Fifty biopsy proved psoriasis patients were selected. Clinical examination and the various biochemical tests were performed at the time of enrollment and at the end of eight weeks of treatment. Results: Hyperurecemia was seen in 16% patients and hypocalcemia was seen in 10 % patients and hypoalbuminaemia was seen in 56% patients. Conclusion: With improvement of clinical picture, a shift of biochemical values towards normal was recorded.

Certain dermatoses are specifically seen in pregnancy or postpartum period. It is therefore important for the clinicians to recognize and treat these cutaneous disorders to minimize maternal and fetal morbidity. The commonest pregnancy related dermatoses was polymorphic eruption of pregnancy seen in 22% patients, prurigo of pregnancy was seen in 7% patients, pemphigoid gestationis was seen in 3% patients, pruritic folliculitis of pregnancy was seen in 2% patients and intrahepatic cholestasis was seen in 1% of patients. It was seen that the skin disorders were commonest in the third trimester (60%), followed by 31% patients in second trimester and 9% patients in first trimester.

Non-venereal dermatoses of female external genitalia include a spectrum of diseases with varied etiology. The most common non-venereal dermatoses in males were scrotal dermatitis seen in 16.6% patients, vitiligo was seen in 14.3 % patients, fixed drug eruption ,scabies and pearly penile papules were seen in 10% patients each. Sebaceous cyst, tinea, psoriasis and lichen planus was seen in 6.6% patients each. Balanitis xerosus obliterans, squamous cell carcinoma and verrucous carcinoma and achrochordon were seen in 3.3% patients each. The most common genital dermatoses seen in females were lichen sclerosus (15%), vitiligo (15%) and vulval candidiasis in 15% cases. Other non venereal genital dermatoses in females were lichen simplex atrophicus (10%), bartholin cyst (10%), tinea (10%), psoriasis (10%), vulval lymphoedema (10%) and achrochordon in 5% patients.

Sutures are a very important component of dermatosurgery. During the three years post graduate curriculum in dermatology, hardly any kind of dermatosurgery or aesthetic dermatology is taught. Aesthetic dermatology is usually not practiced in the medical colleges. But their are some basic surgical techniques, which every dermatologist ought to know. The technique of closing wounds by means of needle and thread is several thousand years old [1].

Introduction: There is a high prevalence of leprosy in certain areas of our country. The main problem with leprosy is the prevalence of disability in untreated patients. Aims: To know the clinical profile of leprosy patients and to find out the risk factors for disabilities. Methods: A retrospective study of 10 years was conducted from April 2003 to March 2014 was conduced. Results: There were 137 MB (75.6%) and 44 PB (24.4%) cases. There were 35 (19.33%) MB patients with disability and 5 (2.76%) PB patients with disability. There were 5 cases (2.7%) with childhood leprosy. The percentage of defaulters was 9 (4.97%). The Patients were grade II disability were 19.4% and patients with grade I disability were 2.8%. Regarding the nerve involvement in leprosy, ulnar nerve was most commonly involved in 45 (24.86%) patients, lateral popliteal nerve in 20 (11.04%) patients, posterior tibial nerve in 15 (8.28%) patients and median nerve was involved in 12 (6.62%) patients. Conclusions: The multibacillary patients are more susceptible to neuritis as compared to the paucibacillary patients. The occurence of neuritis is a significant risk factor for disabilities in leprosy. Early diagnosis and treatment is important to reduce the load of infection.

Introduction: Previous studies from India concluded that the incidence of cutaneous tuberculosis has fallen from 2% to 0.15%, whereas more recent reports suggest that cutaneous tuberculosis is again becoming more prevalent. Aims: To study the patterns of clinical presentation of cutaneous tuberculosis, to correlate them with histopathology, Mantoux reactivity and BCG vaccination status in the north-west region of Punjab. Methods: Analysis of the records of patients with cutaneous tuberculosis who attended the hospital between Jan 2009 to Dec 2012. Results: A total of 36 (0.02%) of dermatology patients had cutaneous tuberculosis. The type of cutaneous tuberculosis in decreasing order of incidence was lupus vulgaris 16 (44.44%) followed by tuberculosis verrucosa cutis 10 (27.77%), scrofuloderma 7 (19.44%) and tuberculids 3 (8.33%). There were no cases of erythema nodosum or miliary tuberculosis. Multiple sites were involved in 17 (47.22%) patients. Face and neck were the most common sites affectedMost of the patients (52.77%) presented with single lesion. Active tuberculosis in other organs were observed in 8 (22.22%) patients. Mantoux test was positive in 23 (63.88%). BCG scar was present in 23 (63.8%) patients. 29 cases (80.55%) showed characteristic histopathological changes of cutaneous tuberculosis. Conclusions: The incidence of cutaneous tuberculosis in the present study was found to be 0.02% which is far lower as compared to previous reports. Reason for this observation could be the effective implementation of the National Program for tuberculosis at primary and secondary level leading to early diagnosis and treatment, hence lesser number of cases reaching to a tertiary center. This study also depicts the histopathological correlation evident in 80.55% of the histopathological specimens which is highly significant.

Psoriasis is a chronic recurrent papulosquamous disorder characterized by epidermal hyperplasia. The management of psoriasis can be challenging. Although, there are many therapeutic modalities available but still there are no clear cut guidelines regarding the usage of different modalities depending on the severity of psoriasis evaluated by PASI score. Taking this into consideration, a randomized controlled trial was undertaken to clinically evaluate different therapeutic modalities in psoriasis by PASI scoring. We selected fifty clinically diagnosed cases of psoriasis and confirmed by histopathology. The patients were put on different modalities depending on the psoriasis area and severity index score (PASI score) and all the patients were followed up to 24 weeks for any relapse.

Onychomycosis or fungal infection of the nails is a common disease, especially in older persons. A mycological study of onchomycosis was undertaken in 75 patients. The nails were judged to be infected by their clinical appearance. There were a total of 75 suspected cases of onychomycosis. Of these 75 cases 22.6% were positive by direct microscopy and 33.3% were culture positive. Of these 75 cases, 18 were males (24%) and 57 (76 %) were females, male to female ratio being. The commonest age group was 31-40 years followed by 21-30 years. The finger nails were more frequently involved. i.e. 45 (60 %), followed by toe nails 30 (40 %) and both in 18 (24%) cases. Ratio of finger nail to toe nail infection was 1.5:1. Distal and lateral subungual onychomycosis (DLSO) was the commonest clinical pattern (76%) followed by total dystrophic onychomycosis (18.66%) and then superficial white onychomycosis (4%) and proximal subungual onychomycosis (1.33%). The most common fungal isolates were dermatophytes of which 44% were Trytophyton rubrum, 4% were Trytophyton mentagrophytes. Non dermatophyte moulds constituted 16% of the fungus isolates. Onychomycosis was found to be the commonest in housewives (52%), followed by serviceman / businessman (32%) followed by farmers (8%) and labourer and student 4% each.

Nails act as a window to diagnosis of skin diseases. Various dermatosis affect the nails and the severity of the skin disorder is reflected in the nails. Nail changes are seen in various dermatosis like psoriasis, lichen planus, onychomycosis, collagen vascular disorders, vescicobullous disorders and other papulosquamous disorders. We will discuss in detail regarding nail changes in various dermatosis.

Hirsutism is the presence of terminal hairs in a male-like pattern in females, due to elevated male hormone levels. Females with hirsutism are often overweight and have metabolism disturbances as insulin resistance and impaired glucose tolerance. We selected fifty patients of hirsutism from the department of dermatology for the study. A thorough physical examination with specific emphasis on signs of virilization (including frontal baldness, loss of female body contours, increased muscularity, acne, clitoromegaly, and atrophy of breast) was done in all the patients.

The cutaneous manifestations of diabetes mellitus are varied. We conducted a study of fifty patients having diabetes mellitus coming from the department of dermatology and medicine. The commonest cutaneous feature of diabetes were pyodermas seen in 40% patients, dermatophytosis seen in 36% patients, pruritis diabetic thick skin seen in 20 % patients, diabetic dermopathy seen in 16% patients, diabetic bulla and rubeosis seen in 8% patients each and meralgia paraesthetica and diabetic foot seen in 4% patients each. About the associations of diabetes mellitus, achrchordons were seen in 8% patients, vitiligo and perforating dermatoses were seen in 6% patients each, granuloma annulare, eruptive xanthomas, acanthosis nigricans, necrobiosis lipoidica and oral lichen planus were seen in 4 % patients each and xanthelasma was seen in 2% patients.

Introduction: Lichen planus is considered to be rare in children. However, it does not appear to be uncommon in Indian subcontinent. Aims: The study was undertaken to analyse the clinical profile of childhood lichen planus. Material and Methods: We selected 30 children with LP for the study. The children selected were below the age of 14 years of age. Results and Discussion: In our study, it was seen that that the maximum onset of disease was between 5-9 years of age and mean age of children with LP was 6.8 years. The commonest type of LP in children was classical LP seen in 60% children, followed by actinic LP in 20% children. LP hypertrophicus and linear LP were seen in 10% patients each. Nail changes were seen in 10% patients.

Everyone dreams of a beautiful and flawless face but true beauty is God given gift. Plastic surgery and various filler techniques can just highlight certain features and are just the temporary procedures. Features that further enhance the attractiveness of a beautiful face are the hair, skin, and teeth. These areas are the easiest to routinely enhance. There are many methods of facial sculpting including botulinum toxin, fillers and various other invasive plastic surgery techniques.

The coexistence of psoriasis and vitiligo is rare. We describe a case report of a 58 year old female patient who developed typical psoraiatic plaques covering completely or partly the vitiliginous areas of her skin. Her psoriasis was strictly limited to the vitiliginous patches with no involvement of the normal skin. Strict anatomical coexistence of both diseases is extremely rare and suggests a casual mechanism, possibly due to a koebner phenomenon but genetic and environmental factors may also be involved.

There are various medical and surgical modalities for the treatment of vitiligo. Surgical modalities are used in the patients who fail to respond to medical therapy. We selected thirty patients of stable vitiligo from the department of dermatology for the study. The patients were divided into two groups of 15 patients each. In Group I patients application of 100% TCA was done on the vitiliginous sites and in Group II patients 88% phenol was applied on the affected sites. Comparing the results of repigmentation in both the groups it was seen that marked pigmentation was seen in 66.6% patients in the TCA group and 80% in the Phenol group. Moderate pigmentation was seen in 13.3% patients in both the groups and mild pigmentation was seen in 20% patients in the TCA group and 6.6% in the Phenol group.

Introduction: Kimura’s disease is a benign, but locally injurious disease with a marked predilection for the head and neck. Case Report: We present two cases of this rare disease. Discussion: Of uncertain aetiology, its tendency to present as a discrete, enlarging mass with associated lymphadenopathy makes it a condition of interest to clinicians who see head and neck pathology. Although rare, there are increasing numbers of reports of the condition and it should become part of the standard differential diagnosis.

Alopecia areata is a common condition with patchy non scarring hair loss. We report a case of an 11 year old male child with localized patch of hair loss on the frontoparietal region of the scalp since one year. It was a widespread extensive patch of hair loss covering more than 40% of the scalp. On hair shaft microscopy, numerous exclamation mark hairs were present. The patient was put on topical tacrolimus and topical corticosteroids but no response was seen. Since the child was recalcitrant to treatment, methylprednisolone 500 mg/day on three consecutive days in a month was given. After six months 80% regrowth was seen over the affected area of the scalp.

Infantile psoriasis is a benign disease. Systemic features are rare and spontaneous remission occurs. There is a hazard of viral infection particularly in steroid treated children. Psoriasis in infancy is often more therapeutically challenging than atopic and seborrheic dermatitis. We report a case of nine month old infant treated with topical calcipotriene for infantile psoriasis who experienced greater benefit than he had with standard corticosteroid medications.

An in growing toenail develops when the proper fit of the nail plate in the lateral nail groove is altered. We selected 30 patients of ingrowing toe nail for the study. The patients were divided into two groups of 15 patients each. In group I patients, nail avulsion with chemical matrictectomy with 88%phenol was done. In group II only nail avulsion was done. In group I patients the surgical success rate was 98% and in group II, the surgical success rate was 86.6%. No patient complained about the cosmetic appearance of toe nail after the operation.

The concept of beauty has acquired new dimensions due to the increasing awareness in general public about the aesthetic procedures. The problems between the patient and the cosmetologists arise when the patients expectations become very high and unrealistic. The classical concept of doctor – patient relationship born in the golden days of family physicians has undergone drastic change due to dramatic advancement in medical technology, availability of sophisticated imaging system, high tech electronics and preponderance of new diseases. However, the accountability of the doctors under the law of professional negligence has emerged as a debatable issue among the medical fraternity all over the country after the enactment of the consumer protection act, 1986, which has not only changed the law of medical negligence1, but created an inexpensive and speedy remedy against medical malpractice.

Background Nevus sebaceus (NS), otherwise designated as 'organoid nevus', involves proliferative changes of the sebaceous glands, sweat glands, and the hair follicles. It displays a range of appearances, depending on the lesion's age. Aims To study the clinical features along with histopathological study of 20 cases of nevus sebaceus. Methods We selected 20 cases of nevus sebaceous for the study. Results Clinically,verrucous plaques were seen in 60% patients, papules were seen in 25% patients and patches were seen in 15% patients. All of them showed abortive/immature hair follicles characterized by cords of undifferentiated, basaloid cells resembling the embryonic stages of hair follicle. Conclusions To conclude, NS is an organoid nevus, i.e a hamartoma consisting of various elements indigenous to the organ and not merely the sebaceous units.

Carcinoma erysipeloides (CE) is a relatively rare variant of cutaneous metastasis more often observed in breast cancer than in other carcinomas in women. Clinically, it appears as a well-defined, warm and tender inflammatory erythematous plaque, thus mimicking Erysipelas, Cellulitis or post mastectomy complications of lymphedema and acute radiation dermatitis. We report a case of CE in a women previously treated for infiltrating ductal carcinoma by modified radical mastectomy, chemotherapy and radiotherapy. An early and accurate differential diagnosis of this disease gives the opportunity to diagnose and halt the systemic spread of the cancer.

Lichen Planus actinicus (LP actinicus) is a variant of lichen planus often confined to individuals in tropical and subtropical regions. The lesions involve sun-exposed areas and are characterized by well-defined nummular patches which have a deeply hyperpigmented centre surrounded by a hypopigmented zone. It mainly involves teenagers with an Asian racial profile. We report a rare case of a 10 year old male child who reported to the department of dermatology with multiple annular pigmented patches on the face, forearms and shins which developed slowly over a period of one year.

Objective: On January first, 2020, the Institutes of Legal Medicine and Forensic Sciences (IMLCF) began to inform the causes of death directly to the National Statistics Institute (INE) through a web application (IML-Web). The objective of this study was to evaluate the impact of the implementation of this application on the quality of the data collected., Methods: A descriptive study using deaths data with judicial intervention that occurred in Catalonia was carried out. The data of the period 2015-2018 and 2019 was compared with 2020. The percentages, with confidence intervals, of the causes of death that were not specific, according to different classifications, were calculated on the total of cases by period and territory., Results: The total percentage of non-specific deaths had decreased, not significantly, by 1.6 points between the period 2015-2018 and 2020. The same indicator between 2019 and 2020 had decreased by 13.4 points. The percentage of non-specific deaths from external causes showed significant drops between both periods and 2020. In general, the indicators displayed territorial differences., Conclusions: The roll-out of the IML-Web implies, compared to 2019, an improvement in the quality of the data. On the other hand, compared to the period 2015-2018, the data show a similar level of quality. Generally, it is assessed that the information provided by IMLCF of Catalonia through the IML-Web is accurate, but still has room for improvement.

Objectives: To analize results and late complications in patients with vesicoureteral reflux, treated by endoscopic treatment and with several substances., Methods: In a long bibliographic review we analize results, recurrences and late complications with this treatment using different substances., Results/conclusions: In spite of the prescribed substance, VUR may recur several years after treatment. These cases are of low grade and most disappear after a new session of ET VUR can also appear in the other side, not knowing in fact why this happens. Grade IV -V reflux, and also VUR secondary to organic and functional pathology, can be resolved by endoscopic treatment, although the percentage of good results is lower. Parents have to be informed, in detail, of the three therapeutic options for reflux, (medical, endoscopic, and open surgery), and participate in the final decision. Parents use to prefer ET. According to the number of patients treated by ET and the number of follow-up years that possible side effects have been observed, most authors consider that ET is a safe treatment, and it is currently the treatment of choice for patients with reflux.

Objective: To detect the possible differences in risk of mortality of the population aged 65 and over in Health Area 11 of the Community of Madrid and to explore their relationship with economic factors., Design: Observational, retrospective, and ecological-style study., Setting: Districts and boroughs in Health Area 11 of the Community of Madrid, Spain., Participants: People aged 65 and over., Main Measurements: The analysed variable was the total deaths occurring in the study population during the period 1996-2001. The standardized mortality rate (SMR) was calculated. As a social/economic indicator, mean available income, stratified in 3 groups, was used. The statistical method used was Poisson regression., Results: The mortality rates oscillated between 37.33 and 91.54 deaths for every thousand inhabitants (SMR ratio, 2.47). In urban areas, in men with level 2 income, mortality was 16% less (P=.0406) than the reference group, whereas in high-income men it was 20% less (P=.0042). In women the rate was about 8% less, though this did not attain statistical significance (P=.3039). The relationship in semi-rural areas was not demonstrated., Conclusions: The existence of inequalities in the mortality of the population aged 65 or over was demonstrated. There was an inverse relationship between mean available income and mortality in urban areas.

Background and Objective: Our objectives were: To estimate the prevalence of postpartum depression (PD) by two evaluation methods: Structured Clinical Interview for DSM-IV (SCID), and self-report Edinburgh Postnatal Depression Scale (EPDS), and to identify the EPDS cut-off to provide an unbiased estimation of PD prevalence., Patients and Method: We report data from all women (n = 1191) attending to postnatal routine checking visits at six weeks postpartum during one year in the Gynaecology and Obstetrics Department of the Hospital Clínic of Barcelona (Spain). A two-stage method was used. In the first stage, all women selected completed the EPDS. In the second stage, all women with an EPDS score >= 9 (probable PD cases) and a randomized sample of 16% with a score < 9 were evaluated by a psychiatrist using the SCID interview to establish a psychiatric diagnosis of major and minor depression. 402 postpartum women were offered the SCID interview; 68 of them refused to participate., Results: The prevalence of depression according to the SCID interview was 10.15% (CI 95%, 8.43-11.87). The prevalence of major depression was 3.6% (CI 95%, 2.55-4.67) and it was 6.5% (CI 95%, 5.14-7.95) for minor depression. An EPDS cut-off of 11/12 provided an unbiased estimation of the postpartum depression prevalence rate., Conclusions: Our results justify the need to use different EPDS cut-offs. A cut-off of 10/11 is effective for identifying the population at risk and a cut-off of 11/12 is useful to estimate the prevalence in epidemiological studies.

Introduction: Infantile hypertrophic pyloric stenosis (IHPS) consists of hypertrophy of the muscular layer of the pylorus. Its etiology is still unknown. In the last years only few jobs that studied the extracellular matrix (ECM) in the muscular layer in the IHPS have been reported. Our aim was to investigate the expression of two ECM molecules: chondroitin-sulfate proteoglycan (CSPG) and fibronectin (FN), and fibroblasts., Material and Methods: Full-thickness muscle biopsy specimens were obtained from 33 IHPS patients at pyloromyotomy and 12 controls. Indirect immunohistochemistry was performed using CSPG, FN and fibroblasts monoclonal antibodies. The results were showed by a semiquantitative scale as follows: strong (++), moderate (+), weak (+/-), and absent (-)., Results: We demonstrated that the CSPG immunoreactivity was localized in the connective tissue septa and the expression of FN molecules in the pericellular space. Both molecules were significantly the increased in the muscle layer of the pylorus with IHPS in relation to control pylorus. We also demonstrated a marked increased expression in the number of fibroblasts in the muscle layer of the pylorus with IHPS. Even-though the most striking increase was localized in the septa, we also observed great number of fibroblasts amongst the smooth muscle cells., Conclusions: We suggest that IHPS is characterized, not only by the muscle layer hypertrophy, but also by the increase of several ECM molecules, such as CSPG and FN. We also think that the increase of fibroblast could explain the higher expression of both ECM molecules in the muscle layer of pylorus in IHPS.