RESUMEN

Melasma is a chronic acquired dysfunction of melanogenesis characterized by dark brown irregular macules on skin. Genetic predisposition, pregnancy, sun exposure, and hormonal therapy are common risk factors. Prevalence of melasma is variable, ranging from 5% to 46%. This study aimed to assess the severity and potential risk factors of melasma in a tertiary care setting. An analytical cross-sectional study was conducted on patients with melasma visiting dermatology department of a tertiary care center in Nepal. Nonprobability consecutive sampling was adopted. Severity of melasma was assessed using the Modified Melasma Area and Severity Index score. Data analysis was performed using the Statistical Package for the Social Sciences, version-23. Bivariate analysis was done by using Student t test/Mann-Whitney U test, or Chi-square/Fischer exact test for continuous and categorical variables, respectively. The overall median Modified Melasma Area and Severity Index score was 5.40 (3.60-6.75). Most patients (168, 88.42%) had mild melasma. The severity score was significantly higher in older age (P = .024), women having parity more than 3 (P = .014), centrofacial pattern (P = .024), and patients having dermatological comorbidities (P = .014). Severity was significantly lower in those who used cosmetics at home. Moreover, the use of digital screens was not associated with an increase in melasma severity. Most of the cases had mild melasma. Severity was significantly associated with age, parity, pattern, practice of cosmetic use, and presence of dermatological comorbidities.

Asunto(s)

Melanosis , Índice de Severidad de la Enfermedad , Centros de Atención Terciaria , Humanos , Melanosis/epidemiología , Estudios Transversales , Femenino , Adulto , Centros de Atención Terciaria/estadística & datos numéricos , Factores de Riesgo , Masculino , Nepal/epidemiología , Persona de Mediana Edad , Adulto Joven , Factores de Edad , Adolescente

RESUMEN

INTRODUCTION AND IMPORTANCE: Traumatic diaphragmatic injury (TDI), although rare, is associated with high mortality and morbidity and timely recognition is important. CASE PRESENTATION: We present a case of a 44-year-old male who fell from a three-story building and presented with complaints of shortness of breath and chest pain. On examination, his chest compression test and extended focused assessment with sonography in trauma (E-FAST) were positive. Chest X-ray showed loss of diaphragmatic contour, fracture of fifth to eleventh ribs on the left side, and opacities in the left hemithorax. Contrast-enhanced computed tomography of chest, abdomen, and pelvis showed bowel loops over the left hemithorax with grade 1 splenic injury. A diagnosis of ruptured diaphragmatic hernia with grade I splenic injury was made and emergency primary repair of the diaphragm was done via thoracotomy. DISCUSSION: Clinical diagnosis of TDI is difficult and can be misdiagnosed as a pneumothorax. In addition, the subtle presentation can often be missed. CT scan of the chest and abdomen is the imaging of choice to reach a diagnosis. Once diagnosed, emergency surgery via laparotomy or thoracotomy is mandatory. Delay in diagnosis can have a fatal consequence or delayed complications which have high mortality. CONCLUSION: Diaphragmatic injury should be suspected in all blunt thoracoabdominal traumas, and the presence of this injury should be excluded to prevent late complications. Timely intervention can provide excellent outcomes.