Comparison of oral itraconazole versus topical clotrimazole in treatment of pityriasis versicolor

Objective: To compare the efficacy of single dose of oral itraconazole 400mg with 1% topical clotrimazole in the treatment of pityriasis versicolor

Study Design: Randomized controlled trial.

Place and Duration of Study: Dermatology department, Military Hospital Rawalpindi, from Jun 2015 to Dec 2015

Material and Methods: A total of 60 patients of pityriasis versicolor fulfilling the inclusion criteria were selected from dermatology OPD after written informed consent and approval from the hospital ethical committee

Patients were divided into two treatment groups using random numbers table. Group A received single dose of itraconazole capsule [400mg] and group B received 1% clotrimazole cream twice daily application for 2 weeks

Patient evaluation included detailed history, clinical examination and direct microscopy of skin scrapings for fungal hyphae at the baseline, at the end of 2[nd] and 6[th] week of treatment. Efficacy of treatment was assessed on the basis of clinical and mycological cure

Results: At the end of 2 weeks of treatment, clinical cure was seen in 23 [76.6%] and 29 [96.6%] patients [p=0.05] and mycological cure in 20 [66%] and 26 [86.6%] patients in group A and B respectively [p=0.06]. At follow up [end of 6 week] 21 [70%] and 28 [93.3%] patients were cured clinically [p=0.02] while 18 [60%] and 27 [90%] patients were cured mycologically [p=0.007] in group A and B respectively

Conclusion: Topical clotrimazole [1%] was found more effective than single dose of oral itraconazole in the treatment of pityriasis versicolor

Diagnostic accuracy of slit skin smears in leprosy

To determine the diagnostic accuracy of slit skin smears in clinically suspected patients of leprosy using histopathology as gold standard. Validation study Study was carried out at Rawalpindi Leprosy Hospital, Dermatology Department Military Hospital [MH] and Armed Forces Institute of Pathology [AFIP], Rawalpindi from 18[th] August 2012 to 18 Feb 2013. Appropriate technical and ethical approval for the study and patient consent were obtained. All suspected patients of leprosy of any age and either gender having typical hypo-aesthetic or anesthetic, erythematous or hypo-pigmented scaly skin lesions on any part of body were included in this study. All patients who have already received treatment for leprosy, patients with pure neural leprosy, patient not giving their consent for skin biopsy and patients with lepra reactions were excluded from this study. Forty eight patients fulfilling the inclusion criteria were included in the study. Sample size had been calculated by using WHO sample size calculator taking confidence level 95%, absolute precision required 14% and anticipated population proportion 40%. Non-probability consecutive sampling technique was used to collect sample. The results of the study revealed that out of 48 clinically suspected patients of leprosy skin biopsy confirmed the diagnosis in 34 patients [70.8%] and the slit skin smear had diagnostic accuracy of 68.75% with sensitivity 55.8% and specificity and positive predictive value of 100%. Study suggested that although slit skin smears are rapid and inexpensive method of diagnosis but their diagnostic accuracy is low

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

Frequency of anti thyroid peroxidase antibody in patients of vitiligo

The objective of this study was to compare the frequency of anti thyroid peroxidase antibody in patients suffering from vitiligo with healthy control group.Type of Study: Case control study. Dermatology Department, Military Hospital, Rawalpindi, from 20th March 2010 to 20th July 2011. Fifty clinically diagnosed patients of vitiligo, age >/= 18 yrs and both genders with no history of thyroid disease, past or current use of drugs for thyroid disorder or thyroid surgery were included as cases [Group A]. Fifty healthy individuals with no evidence of vitiligo or thyroid disorder on history and physical examination and with no family history of vitiligo, matched for age and gender with cases, were included as control [Group B]. Serum anti thyroid peroxidase [anti TPO] antibodies were measured using enzyme linked immunosorbent assay [ELISA] in both cases and control. Eight [16%] patients in Group A were anti-thyroid peroxidase antibody positive and forty two [84%] patients were negative while one [2%] patient was anti-thyroid peroxidase antibody positive in Group B and forty nine [98%] patients were negative [p = 0.001]. Anti TPO antibody is significantly more common in patients of vitiligo as compared to general population

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

Comparison of clinical and sonographical findings of Achilles tendon involvement in newly diagnosed and established cases of psoriasis

To compare the clinical and sonographical findings of Achilles tendon involvement in newly diagnosed [disease duration <6 months] and established psoriatic patients [disease duration >5years]. This cross-sectional, comparative study was carried out in Departments of Dermatology and Radiology, Military Hospital, Rawalpindi, over a period of six months. 70 patients of psoriasis were divided into two groups comprising 35 patients in each. Group I patients were newly diagnosed cases while group II included the established psoriatic patients. All patients with clinical and histological evidence of psoriasis were included. Patients with history of osteoarthritis, rheumatoid arthritis or foot trauma were excluded. Detailed history and complete clinical examination was carried out as per pro forma. The condition was considered symptomatic when there was tendon swelling, pain, tenderness or functional impairment. Ultrasound of Achilles tendon was done, keeping patient in prone position by using Pro Sound SSD 5500 Toshiba ultrasonographic machine with high frequency probe [7.5MHz] to assess findings of Achilles tendon in psoriatic patients. Fibrillar tendon structures, tendon thickness, peritenon, and bursae were evaluated. On clinical assessment 1 [2.8%] patient in group I and 5 [14.3%] patients in group II had Achilles tendon involvement. On ultrasonographic assessment, 3 [8.5%] patients in group I and 15 [42.8%] patients in group II showed involvement of Achilles tendon [p <0.05]. Achilles tendon involvement occurs in significant number of patients with long standing psoriasis as compared to newly diagnosed cases. It also revealed that enthesitis progresses with the duration of disease

Mucosal lichen planus simultaneously involving oral mucosa, conjunctiva and larynx

Lichen planus is an autoimmune disease that typically involves skin and the mucosa of the mouth and genitalia. The involvement of conjunctival and laryngeal is rare. A young patient presented with hoarseness of voice, oral ulcerative lesions and symblephron. Mucosal biopsies [buccal mucosa and supraglottic area] revealed the diagnosis of lichen planus and he was managed accordingly. Although oral lichen planus is frequently reported but simultaneous involvement of oral, ocular and laryngeal mucosa has not been reported earlier

Efficacy of rifampicin in eradication of carrier state of staphylococcus aureus in anterior nares with recurrent furunculosis

To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state. Quasi-experimental study. Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005. Patients and The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily [depending on the body weight] for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures. Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 [57.5%], while in group II the carrier state was found in 8 [20%] individuals [p <0.001]. Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive [p<0.001]. These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection. Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection

Urethral discharge in men - risk assessment and evaluation of syndromic management

Sixty two patients presenting with urethral discharge were enrolled in the study. The high risk sexual behaviour in these individuals was assessed through standardized, anonymous, self completed questionnaire. The WHO algorithm for the syndromic management of urethral discharge in men was applied to these patients. The questionnaire was completed in full by 45[73%] and partly by 8[13%]. The high risk factors included paid sex or casual sex, and lack of condom use. According to the algorithm, 59 cases with clinically confirmed urethral discharge received the treatment, 55 individuals completed the follow up and 53 [96.3%] were clinically cured. The sensitivity of algorithm was 100% and its Positive Predictive Value was 97%. We conclude that high risk sexual behaviour exists in our population and syndromic approach in the management of men with urethral discharge is effective, acceptable and affordable. Its implementation particularly at the primary healthcare settings could have major impact in the control and prevention of sexually transmitted infections

Antiretroviral therapy for HIV infection

The global epidemic of Human Immunodeficiency Virus infection continues to expand. The advent of new antiretroviral drugs has shown substantial improvement in patients life expectancy and quality of life. The aim of therapy is complete suppression of viral replication. The reduction of plasma HIV RNA to below the level of detection of a sensitive assay is viewed as the optimal treatment response. Several randomized clinical trials have conclusively demonstrated survival benefits associated with various combinations of antiretroviral drugs. At present most effective and reliable way of preventing HIV induced immune damage is to use two nucleoside reverse transcriptase inhibitors in combination with a Protease Inhibitor. Such combinations are now widely considered to represent the current standard of antiretroviral care