Comparison of efficacy of oral fluconazole with intramuscular meglumine antimoniate in treatment of cutaneous leishmaniasis

Objective: To compare the efficacy of oral fluconazole with intramuscular meglumine antimoniate in patients of cutaneous leishmaniasis

Study Design: Randomized Control Trial

Place and Duration of Study: Study was conducted from 1[st] January 2013 to 30[th] June 2013, at Dermatology department, Military Hospital, Rawalpindi

Patients and Methods: Eighty histopathologically diagnosed patients of cutaneous leishmaniasis were selected. Patients were randomly allocated into two groups. Group-A was given oral fluconazole 200mg/day for six weeks. Group-B was given intramuscular meglumine antimoniate 20 mg/kg/day for 21 days. Status of each lesion was regularly documented and efficacy of drugs was measured at the end of three months. The drug was considered efficacious if there is more than 75% regression in size and induration of lesions

Results: Clinical efficacy was seen in 70% [n=28] in Group-A and 92.7% [n=37] in Group-B at end of three months. When compared by Chi-square test, these results were found to be statistically significant with pvalue 0.010[< 0.05]

Conclusion: Efficacy of Intramuscular meglumine antimoniate is better than oral fluconazole in treatment of cutaneous leishmaniasis

Clinical audit on treatment of mucosal and multiple cutaneous leishmaniasis lesions with pentavalent systemic antimony

Cutaneous leishmaniasis is a parasitic disease spread by the female sandfly occurring throughout the Americas from Texas to Argentina, and in the Old World, particularly the Middle East and North Africa. The condition is diagnosed every year in travelers, immigrants, and military personnel. The treatment mainstay is pentavalent antimony [e.g., sodium stibogluconate]. Not all patients require treatment; many lesions heal spontaneously. The treatment is usually indicated in mucosal, mucocutaneous and multiple active cutaneous lesions. 30 patients of cutaneous leishmaniasis were included from the dermatology ward. The method of data collection was retrospective. The basis of proposal was local guidelines. The audit type was process. The standard set was "100% patients with mucosal and multiple cutaneous leishmaniasis lesions should be treated with pentavalent systemic antimonials"

Workplace-based assessments: the right time to start

Workplace-based assessments [WPBAs] refer to the assessment of working practices based on what doctors actually do in the workplace and is predominantly carried out in the workplace itself [PMETB, 2007]. WPBAs should be recognized as a series of essential educational events along a learning trajectory. WPBAs are an essential part of an assessment system alongside traditional examinations. The primary purpose of WPBAs is to provide constructive feedback to the trainees. The trainer is required to identify trainees not progressing along their structured learning plan so that early remedial action can be initiated. An understanding of the acceptable level of clinical competence required for a particular stage of learning is essential. This will ensure that the patients are safe during training through appropriate supervision and assessment. Stakeholders [trainers, trainees, managers, patients] should actively be involved in the development and implementation of the programme to ensure transparency and understanding of the process

Clinical audit: Baseline investigations for intramuscular meglumine antimoniate in cases of cutaneous leishmaniasis

To see if the baseline investigations for intramuscular meglumine antimoniate in cases of cutaneous leishmaniasis were being carried out in accordance to our local guidelines. 30 case records of patients with cutaneous leishmaniasis were randomly selected from our dermatology ward. These records were reviewed to see if the pre-therapy investigations for meglumine antimoniate were carried out. The method of data collection was retrospective. The result showed 100% compliance with our local guidelines in the analyzed cases. Our audit showed 100% compliance

Clinical audit: a simplified approach

A clinical audit measures practice against standards and performance. Unlike research which poses the question, "what is the right thing to do?" clinical audit asks are we doing the right thing in the right way? An approach for understanding a clinical audit is provided. A basic clinical audit example of a case note audit is presented. A simplified template to help the beginners is included