Atypical skin manifestation in severe acute chikungunya infection in a pregnant woman: a case report

Introduction Patients with chikungunya virus infection commonly present with fever, skin rash, and severe joint pain. The vesiculobullous rash is rare in adults but common in infants. In addition, septic shock and acute respiratory distress syndrome are rare complications of atypical and severe acute chikungunya infection. Case presentation We report the presence of an 18-year-old Thai female, at 31 weeks gestation, with fever, maculopapular rash, and polyarthritis. The rash later progressed to a vesiculobullous pattern, and she developed septic shock and acute respiratory distress syndrome. Skin biopsy and blood were positive for chikungunya virus RNA. The patient was intubated with a mechanical ventilator and subsequently fully recovered. Conclusion Atypical skin manifestation and severe acute disease is likely due to immune response attenuation in pregnancy. The possibility of progression to severe or atypical disease in pregnant women suffering chikungunya should always be considered.

Effect of COVID-19 on Kawasaki Disease: Decrease Age of Onset and Increase Skin Manifestation

Background Kawasaki Disease (KD) is the most common childhood vasculitis and cause of acquired heart disease for no apparent reason. There is some evidence indicating infectious agents as possible triggers for KD. During the COVID-19 pandemic, vasculitis has been a presentation of COVID-19 in children. We performed this study to assess the association between KD and COVID-19. We evaluated KD hospitalized children during February to September 2020 for COVID-19 (group one) and compared their demographic, clinical, laboratory, and echocardiographic findings with KD patients from the same period time in 2019 (group two). We also compared the same data in COVID-19 positive and COVID-19 negative KD patients in 2020 pandemic period in Shiraz Namazi referral hospital at southwest of Iran. Results Thirty-two patients in group one compared with 44 patients in group two. Sixty-eight percent of group one KD patients were positive for COVID-19 during the pandemic period. KD Age of onset in the group one was lower than group two (4.38 years VS 5.5 years, P-value = 0.044). There was no difference in the demographic, clinical, laboratory, and echocardiographic features of the patients during and before the COVID-19 pandemic (p-value > 0.05). Moreover, Comparing COVID-19 positive and negative the incidence of rash was higher within COVID-19 positive cases (p < 0.05), and coronary artery abnormalities were more prevalent in COVID-19 negative cases (p < 0.05). Conclusion Admission rate of KD was almost similar during the COVID-19 pandemic but 68% of KD admitted patient were COVID-19 positive. Age of onset for KD during the COVID-19 pandemic was lower and skin manifestation was higher than the same period time in last year.

A CLINICAL STUDY TO EVALUATE THE EFFECT OF TOPICAL APPLICATION OF CERTAIN INDIGENOUS DRUGS IN THE MANAGEMENT OF KIKKISA

The woman is the most artistic creation of our creator. She carries pride in her appearance & gains confidence by maintaining her beauty also is equally esteemed about motherhood. For every woman, pregnancy is the most important & pleasurable phase of life, as this is the time she evolves as a mother. This comes with several inevitable changes in her appearance like weight gain, skin changes & whatnot. Kikkisa is one such physiological skin changes of pregnancy. Kikkisa is a skin manifestation in 3rd trimester of pregnancy seen in about 90 % of pregnancies. This is co-related with striae gravidarum presenting as stretch marks on abdomen, thighs and breasts associated with itching, burning sensation, dryness & discolouration. Though not a disease, it does seek a lot of attention for the symptoms are very disturbing to women. Hence, an efficient & easy method was selected in our study for treating kikkisa. Objectives: To assess the effect of the application of raktachandanadi churna with lakshadi taila over the abdomen in the management of kikkisa. Study design:30 pregnant women from 28 weeks of gestation diagnosed with kikkisa were selected & given to apply Raktachandanadi churna with Lakshadi taila over abdomen half an hour before bath for 2 months. Result: After trial, marks became less prominent but not reduced completely. We found an effective reduction in symptoms like itching (93.1%), dryness (95.45%), burning sensation (78.6%), & discolouration (57.6%), without causing any changes in the texture of the skin. Keywords: Kikkisa, Striae gravidarum, Raktachandanadi churna, Lakshadi taila

DUSHI VISHA W.R.T. MODERN SLOW-ACTING POISON AND THEIR SKIN MANIFESTATION

According to Ayurveda, prevention of disease and maintenance of health are more important than the treatment of disease. As given in Ayurvedic Samhitas, a poison is a substance that vitiates the normal functioning of dosha, dhatu, mala. Thousands of harmful toxins are present in our atmosphere (Air, water and earth) that are ingested by human beings on daily basis. As described in our Ayurvedic Samhitas, Dushi Visha is an intake of toxic drugs which is less potent (Denatured) and remains in a dormant state within the body for years together without causing any major harm to the body. As we see in today's era workers working in the lead industry like enamel workers, glass blowers, printing works have typical chronic lead poisoning symptoms such as constipation, tremors, menstrual disarrangements etc. Due to chronic exposure to lead which accumulates in the body and produces its ill effect like Dushi Visha. Arsenic, copper, mercury chronic occupational poisoning also happened due to long exposure of poi- son working in the respective industry. In agriculture, chronic exposure to OPP, OCP, weed killers like parquet, chlorophenoxy acetates, chlorates used to prevent infection in plants, being sprayed by farmers on daily basis, leads to symptoms like dysphasia, oropharyngeal ulcers, coughing, pain in the abdomen, etc. These symptoms resemble Dushi Visha like symptoms. From this article, we may correlate the symptoms of Dushi Visha with the dermatolog- ical manifestation of chronic occupational poisoning and agricultural field exposure to weed killers, which may behelpful to understand the concept of Dushi Visha. We need to realize the health hazardous effects of cumulative poison and its proper time to time prevention as well as its proper treatment. Keywords: Dushi Visha, Skin manifestation, Slow acting poison