Orofacial and systemic manifestations in 212 paediatric HIV patients from Chennai,South India

International Journal of Paediatric Dentistry 2010; 20: 276–282 Background. Lesions in the mouth and in other tissues and organs (oral and systemic lesions) in paediatric HIV infection are diverse and show differences in clinical presentation and severity from that of adults. Very little data exist for oral lesions in paediatric population in India. Aim. To document and study oral and more widespread lesions in paediatric HIV seropositive patients. Design. A cross‐sectional study. Setting. Paediatric HIV seropositive patients at tertiary centers: Ragas Dental College and Hospital and YRG CARE, Chennai, India. Patients and methods. Two hundred and twelve paediatric HIV patients aged 0–14 years seen over a period of 1 year were included in the study. Clinical history, oral and systemic examinations were recorded by qualified dental surgeons and physicians. Results. One hundred and thirty‐two patients had oral lesions ranging in number from one to three. Oral lesions included oral candidiasis (OC) (56.1%), gingivitis (10.8%), oral pigmentation (6.1%), depapillation of the tongue (5.7%), ulcers (4.2%), and oral hairy leukoplakia (1.4%). The most common systemic lesion observed was nonspecific lymphadenopathy (74.1%) followed by pruritic eruptions (53.8%), measles (51.4%), and tuberculosis (TB) (49.1%). Thirty‐three (26%) patients were not immunosuppressed, 74 (58%) were moderately immunosuppressed, and 20 (15%) were severely immunosuppressed. Oral lesions exhibited positive correlation with lesions in other parts of the body. Conclusion. Oral lesions are a common feature in paediatric HIV infection. Their management is vital to improve the quality of life of the infected children.     

Tricorporal priapism postradical cystoprostatectomy: First sign of recurrent urogenital malignancy

Priapism usually involves the whole length of a corpus or two corpora. Rarely is priapism segmental, especially proximally, and seldomly does it involve all three corpora. The causes of priapism are varied, but priapism due to solid malignancy is an extremely uncommon entity. The usual malignancy is urogenital. The disorder is frequently a manifestation of extensive pelvic extension of the primary disease; less commonly, it is associated with pelvic recurrence after seemingly curative surgery. In cases of malignant recurrence, priapism is rarely the first sign of such recurrence. We report a case of proximal tricorporal priapism, secondary to penile metastasis of a bladder malignancy postradical cystoprostatectomy. In this case, priapism was the first sign of disease recurrence and occurred in the absence of pelvic recurrence. This is the first such report of which we are aware.     

Electrocardiographic Patterns and Results of Radiofrequency Catheter Ablation of Clockwise Type I Atrial Flutter

Clockwise Rotation of Atrial Flutter. Introduction: Counterclockwise right atrial propagation is usually observed in common atrial flutter, but little is known regarding flutter with clockwise right atrial rotation. The aim of this study is to describe the ECG characteristics and results of catheter ablation of atrial flutter with clockwise right atrial rotation.
Methods and Results: Among the 38 patients with type I atrial flutter in this study population, right atrial impulse propagation was counterclockwise in 20 and clockwise in 8. In the remaining 10 patients, both clockwise and counterclockwise patterns were seen. Clinical and ECG parameters associated with clockwise flutter were compared to those of 28 cases of counterclockwise atrial flutter. Ablation was performed in 11 of 18 cases using a technique identical to that used for counterclockwise flutter. A classical "sawtooth" pattern of the flutter wave was observed in 28 of 28 counterclockwise and 14 of 18 clockwise flutter. A shorter plateau phase, a widening of the negative component of the F wave in the inferior leads, and a negative F wave in V₁ were the most consistent findings in clockwise flutter. Coronary sinus recording always showed septal to lateral left atrial impulse propagation. Ablation was successful in 11 of 11 cases of clockwise flutter in whom this procedure was performed, with 9.5 ± 11.6 radiofrequency pulses delivered between the tricuspid valve and the coronary sinus ostium (n = 5) or the inferior vena cava (n = 5), and in the proximal coronary sinus (n = 1). After a follow-up of 46.6 weeks, two recurrences of clockwise flutter were encountered, which were successfully treated with a second session.
Conclusion: Contrary to commonly accepted concepts, clockwise rotation of atrial flutter Ls not an infrequent phenomenon and can mimic counterclockwise rotation. It can also be successfully ablated by radiofrequency pulses.     

Incidence and Significance of Early Recurrences Associated with Different Ablation Strategies for AF: A STAR‐AF Substudy

Early Recurrence in STAR‐AF. Background: Early recurrences of atrial tachyarrhythmias (ERAT) are common after atrial fibrillation (AF) ablation, and predict late recurrences (LR). We sought to determine the impact of different ablation strategies on ERAT and LR. Methods and Results: The STAR‐AF trial randomized 100  patients with paroxysmal or persistent AF to ablation of complex fractionated electrograms (CFAE) alone, pulmonary vein isolation (PVI) alone, or combined PVI + CFAE. Patients were followed for 12  months. ERAT was defined as any recurrence of AF, atrial tachycardia, or flutter (AT/AFL) >30 seconds during the first 3  months of follow‐up. LR was defined as any recurrence of AF/AT/AFL >30 seconds 3–12  months post. Forty‐nine patients experienced ERAT. The index ablation strategy was the only independent predictor of ERAT on multivariate analysis (HR 2.24 PVI vs PVI + CFAE; and HR 2.65 CFAE vs PVI + CFAE). Fifty‐two patients experienced LR. The presence of ERAT (HR 3.23), the use of antiarrhythmic drug (AAD) in the first 3  months postablation (HR 2.85), and the index ablation strategy were independently associated with LR (HR 3.42 PVI vs PVI + CFAE; HR 4.72 CFAE vs PVI + CFAE). Thirty‐five of 49 (71%) patients with ERAT and 17 (33%) of 51  patients without ERAT had LR (P  < 0.0001). Among patients with ERAT, increased left atrium size (HR 1.08), the use of AAD in the first 3  months postablation (HR 2.86) and the index ablation strategy were independently associated with LR (HR 4.77 PVI vs PVI + CFAE; HR 4.45 CFAE vs PVI + CFAE). Conclusion: ERAT is common following AF ablation and is strongly associated with LR. Although CFAE ablation alone results in higher rates of early and LR, the addition of CFAE to PVI results in increased long‐term success without an increase in ERAT. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1295‐1301, December 2012)     

MUDI-CHOOD: AN UNUSUAL TROPICAL DERMATOSIS

Mudi-chood is an unusual dermatosis seen in India. It affects the nape of the neck and the exposed part of the upper back in girls and young women. It is characterized by mildly pruritic pigmented papular lesions. It probably represents the comedogenic activity of various oils applied to the hair, which is aggravated by the typical climatic conditions. We present three cases of mudi-chood.