Role of transdermal testosterone gel pre-treatment on IVF outcome: a prospective randomized controlled trial with active control

Background: Dealing with poor ovarian responders is the newest challenge for the present-day reproductive physicians. Androgens are said to increase pregnancy outcomes due to enhanced oocyte retrieval in poor responders. The aim of the study was to measure the effect of transdermal testosterone gel in women with unexplained poor ovarian response.Methods: It was a prospective randomized controlled trial with active control conducted at ART centre, department of obstetrics and gynaecology, AIIMS, New Delhi from August 2017-August 2018. Seventy women with previously failed IVF/ICSI who had ≤5 oocyte retrieval in previous cycle having normal ovarian reserve with normal or low testosterone levels were randomized. Study arm (N=35) received testosterone gel pre-treatment whereas the control arm (N=35) received standard treatment. GnRH antagonist stimulation protocol was followed. The number of oocytes retrieved and pregnancy outcomes were studied.Results: Of the 70 women in the study, the number of oocytes retrieved was significantly higher (6.5±5.8 vs 3.1±2.1; p=0.002), cycle cancellation rate was lower (8.6% vs 22.9%; p=0.094), implantation rate (8.2% vs 2.6%; p=0.228), clinical pregnancy, ongoing pregnancy, live birth rates (14.7% vs 2.9%; p=0.092) and take home baby rates (17.6% vs 2.9%; p=0.049) were higher in testosterone group compared to controls. One woman in testosterone group developed mild OHSS.Conclusions: The study shows that transdermal testosterone gel is found to improve oocyte retrieval significantly in unexpected poor responders, although there was not a significant improvement in pregnancy outcomes. Hence further studies are of utmost importance to establish the effectiveness of the gel

Trigeminal trophic syndrome

Trigeminal trophic syndrome (TTS) is a rare cause of facial ulceration, consequent to damage to the trigeminal nerve or its central sensory connections. We reporta case of TTS in a 48-year-old woman with Bell′s palsy following herpes zoster infection. The patient was treated and counseled. There hasnot been any recurrence for 1 year and the patient is being followed-up. The diagnosis of TTS should be suspected when there is unilateral facial ulceration, especially involving the ala nasi associated with sensory impairment

Subcutaneous granuloma annulare in a child: A rare presentation

We present a rare case of subcutaneous granuloma annulare (SGA) of the palm in a 3-year-old girl disappearing on removal of a SGA of the dorsum of foot. Though GA is more common in children, subcutaneous type is rare and poses diagnostic difficulty. Very few cases of SGA over the palm have so far been reported. Disappearance of SGA of the palm following removal of a nodule from the foot represents remote reverse Koebner′s phenomenon

The scope of teledermatology in India

Telemedicine describes the application of information and communication technologies in the entire range of functions that involve the health sector. Several medical and surgical specialties utilize tele-consultation. Dermatology is the best clinical specialty in the use of communications technology because of its inherently visual nature in both diagnosis and follow-up, which makes it easily applicable to virtual medicine. Teledermatology embraces great potential for revolutionizing the delivery of dermatologic services to remote and distant locations by means of telecommunications and information technology. It encompasses consultations between a patient (and the primary healthcare provider) and a dermatologist for diagnosis and management advice. Teledermatology also covers dermatological education for health professionals and for consumers. Teleconsultations reduce time and increase the chances of access to one or more consultants as the patient or referring doctor desires, irrespective of the distance between the two. Its usefulness in the field of surgery and aesthetic surgery is immeasurable as there are only a few experts in the field of aesthetic surgery available currently in comparison to the dermatology population and the ever growing awareness and demand of the patients towards aesthetics. As the field of teledermatology is advancing in leaps and bounds the day is not far off when an aesthetic surgeon will be able to perform his skill from his own office on a patient in a distant locality with the help of a qualified and trained assistant. By adopting high-tech medical communication, high-performance computers, high-resolution cameras, and fiber-optic equipment′s the entire world shrinks

Xeroderma Pigmentosum With Squamous Cell Carcinoma Of The Skin And Tip Of The Tongue

Xeroderma pigmentosum (XP) is a rare heterogeneous group of disorders with a high incidence of cutaneous malignancies. However, malignancies of the mucosa are rare. We report a case of XP in an eight-year-old boy who developed squamous cell carcinoma (SCC) of the tip of the tongue within a short period of two months. Biopsy from the lingual growth and a papule from the face showed SCC. We report this case for its rarity and for rapidity with the tongue cancer developed

Histology of psoriatic erythroderma in infants: Analytical study of eight cases

Background: Erythroderma in infants is a rare condition of varied etiology. Psoriasis is now emerging as the most common cause of erythroderma in infants. Early diagnosis of the etiological cause much depends upon the histological confirmation, which is essential for an early and appropriate treatment. Aim: It was aimed to study the histological findings in psoriatic erythroderma in infants. Materials and Methods: A total of 8 infants up to 1 year of age presenting with erythroderma, clinically suspected to be of psoriatic etiology attending private clinic were included. After detailed history taking and astute clinical exam, all of them were biopsied. In case 6, with a positive family history of psoriasis and asthma in parents, biopsy was taken from two sites. The histological findings of all nine biopsies were studied and analyzed. Results: Histology of all eight children showed psoriasi form pattern with acanthosis (AC) and dilated papillary capillaries (PC). Spongiform (SF) pattern was seen in the second biopsy (6b) of child with features of both psoriasis and atopy. SF pustule of Kogoj or Munro′s abscess was not seen in any of them. Conclusion: Regular AC and PC dilatation were the consistent histological findings observed in infants with erythrodermic psoriasis. These were the early findings observed in younger infants. Co-existence of psoriasis with atopic dermatitis may indicate a common pathogenic mechanism or an immunogenetic spin-off

Ulcerated infantile haemangioma of leg successfully treated with propranolol

Infantile haemangioma (IH) frequently requires no intervention. Eighty percent of IHs are focal and solitary. Fifteen percent of cutaneous haemangiomas occur on the extremities. A large size or a specific location or both may carry complications such as ulceration which is one of the main complications, and active treatment is usually required to manage pain, potential scarring, and occasionally, bleeding and infection. Oral propanolol is used in the treatment of IH and is found to be an effective treatment for complicated IH, replacing systemic corticosteroids as first-line therapy. Recommendations for instituting treatment with propranolol in infants differ among different specialties and academic centres. We report an infant with ulcerated IH of leg who responded dramatically to treatment with propranolol in 4 months