Smegma in diabetes mellitus

A 37-year-old male patient presented with 1-month history of pain over the bulb of penis during retraction of foreskin. Patient suffered from type 1 diabetes mellitus on poor glycemic control. On examination multiple white patches of 1 mm x 3 mm dimension were observed with pain during retraction of prepuce. Smegma deposition over the glans penis and erythematous areas were revealed while scraping the lesions. The patient, screened for urinary tract infection (UTI) and sexually transmitted disease (STD) including hepatitis B, syphilis and HIV which were negative and complete blood count was normal. Since smegma can be a precursor for genital infections, physicians must scrupulously examine diabetic patients presenting as timely diagnosis and treatment would improve patient´s quality of life. The patient, put on long acting insulin and advised personal hygiene and showed significant improvement during his follow-up visit, 1 month later

Ectrodactyly-lobster claw deformity

Lobster-claw deformity, also called as ectrodactyly is an uncommon congenital presentation occurring in the hand due to longitudinal failure of development of second, third or fourth ray. It occurs in 1 to 4 newborns in 100,000 live births. It occurs mostly due to consanguineous marriage but can also occur in the non - consanguineous marriage. This deformity is usually associated with ectodermal defects, mental retardation, deafness, orofacial clefting and tibial aplasia. A 6-year-old boy was brought to the Department of Orthopedics in a Private Medical Hospital, Chennai, with deformity of left hand since birth. The affected hand had a wide median cleft and, there was deformity of flexion of the ring and index finger with absence of middle finger. The other hand and both feet were normal. On radio-imaging, left hand showed transversely oriented bone between third and fourth metacarpal and phalanges of middle finger were absent except for rudimentary proximal phalanx. No other congenital defects were present other than this. The child was born to non-consanguineous parents with no significant family history. The treatment for this anomaly is complete surgical excision of transverse bone with partial excision of the third metacarpal and apposition of the second and fourth metacarpal by absorbable sutures which leads to a smaller cleft. If required, flexion contracture of ring and index finger will be corrected