Psoriasis in childhood and adolescence: evaluation of demographic and clinical features

BACKGROUND: The present study was aimed to define the gender ratio, familial occurrence, age of onset, precipitating factors, clinical types, nail and joint involvement of psoriasis in childhood and adolescence in Turkey. METHODS: A total of 61 children with psoriasis under 18 years old were evaluated retrospectively, for age, gender, age of disease onset, family history, concomitant disease, the clinical type of psoriasis, clinical localization, nail and joint involvement and treatment modalities. RESULTS: Of the patients, 23 (37.70%) were boys and 38 (62.30%) were girls. Mean age was 9.28 +/- 4.02 years in girls and 11.18 +/- 3.85 years in boys (9.96 +/- 4.03 years in all children). Mean age at the onset of the disease was 6.81 +/- 4.11 years in girls and 7.03 +/- 4.28 years in boys (6.89 +/- 4.14 years in all patients). In 14 (23%) cases, a positive family history was detected. The most frequent probable triggering factors were upper respiratory tract infections (14.8%) and positive throat culture for A group ss-hemolytic streptococcus (21.3%). Frequency of emotional stress and psychiatric morbidity were 54% and 9.8%, respectively. The most frequent localizations at onset were trunk (44.3%), extremities (54.0%), and scalp (36.0%). Three children (4.9%) had a history of dissemination from psoriatic diaper rash. In total, 51 (83.6%) patients presented with psoriasis vulgaris, eight (13.1%) with generalized pustular psoriasis, and the remaining two (3.3%) with erythrodermic psoriasis. CONCLUSION: The incidence of psoriasis among dermatological patients in childhood and adolescence was 3.8%. The disease tends to appear earlier in girls than boys. The authors suggested that stress and upper respiratory infections are the most important triggering factors in childhood and adolescence psoriasis.     

Does prophylactic sotalol and magnesium decrease the incidence of atrial fibrillation following coronary artery bypass surgery: a propensity-matched analysis

Background  

Atrial fibrillation can occur in up to 40% of patients undergoing coronary surgery.     

Malaria resurgence in India: a critical study

In 1953, the Indian National Malaria Control Programme (NMCP) was started. Encouraged by the results, and the fact that insecticide resistance in vector species may evolve and become an obstacle, in 1958 a control programme was converted to the National Malaria Eradication Programme (NMEP). By 1964, malaria was eradicated from 88% of the area and it was in the advanced stage of spraying in the remaining parts. At that time, focal outbreaks that occurred in 1965 and increased in later years, could not be contained due to the shortages of DDT. As a result, large areas in consolidation and maintenance phases were reverted to the attack phase. Besides, the infrastructure in general health services was not adequate and mature enough to take up surveillance and vigilance. This produced a large number of secondary cases due to the re-introduction and relapse of malaria. Added to this was the problem of urban malaria, the control of which was the responsibility of local bodies. Malaria cases increased in towns, and started diffusing to the rural areas, due to inadequate staff and the shortages of malarial larvicidal oil (MLO). Later, it turned out, that while it was technically feasible to eradicate malaria from 91% of the population, the strategy of indoor spraying of DDT to interrupt transmission did not succeed in 9.0% of the population, despite more than 12-14 years of regular spraying. During the years of resurgence, there was no research support to the programme, so that technical problems were not properly appreciated, understood and tackled. The reservoir of parasites that were present throughout the country started multiplying and spreading to newer areas due to the presence of vectors in high densities. Thus malaria resurged and re-established itself even in areas that were at one time freed from the disease. The analysis of the pattern of malaria resurgence revealed that malaria outbreaks preceded the true problem of insecticide resistance. It is noteworthy to mention that malaria resurgence occurred in towns where the control measures were non-insecticidal and in regions which were not under the influence of insecticide-resistant vectors. The study also revealed that resurgence occurred before the introduction of high-yielding varieties programme in the country, and had no relationship to either the cotton or rice growing or intensive agriculture.     

CT19PTRICUSPID VALVE REPAIR IN ‘TORRENTIAL TRICUSPID REGURGITATION’ FOLLOWING PERMANENT PACEMAKER LEAD EXTRACTION – A CASE REPORT

Introduction Traumatic tricuspid regurgitation secondary to blunt chest trauma has been reported in literature. We report our experience with a case of ‘Torrential Tricuspid Regurgitation’ following permanent pacemaker lead extraction which was successfully treated with tricuspid valve repair and annuloplasty. Report A 67 year old woman was treated for Sick sinus syndrome with permanent pacemaker implant. She had three generator changes for end of life and repositioning.Erosion of generator, led cardiologist to plan lead and generator extraction with the surgical backup. During lead extraction a small piece of papillary muscle was avulsed. The patient remained hemodynamically stable in the theatre. However in ward she developed right sided cardiac failure not responding to conservative therapy. A transthoracic echo (TTE) revealed torrential tricuspid regurgitation with a freely mobile posterior leaflet with attached chordae and avulsed papillary muscle.During surgery the tricuspid valve was successfully repaired and transesophageal (TOE) images showed trivial to mild tricuspid regurgitation at the end of repair procedure. Additional procedure also included ligation of both atrial appendages and implantation of epicardial leads and pacemaker. Patient made good recovery from operation. Conclusion To the best of our knowledge this is first report of repair of tricuspid valve in ‘Torrential Tricuspid Regurgitation’ following pacemaker lead extraction. We share our experience with tricuspid valve repair technique and annuloplasty.