An open randomized comparative study of oral itraconazole pulse and terbinafine pulse in the treatment of onychomycosis.

BACKGROUND: Onychomycosis is a recalcitrant disease of the nails caused by dermatophytes, yeasts, and molds. AIMS: To compare the clinical efficacy of oral itraconazole pulse therapy and oral terbinafine pulse therapy in onychomycosis. METHODS: A randomized single-blind clinical comparative study was undertaken on 120 patients of onychomycosis during the period March 1999-February 2002. Sixty patients were randomly assigned to receive oral itraconazole 100 mg, two capsules twice daily for seven days a month and the other group of sixty patients received oral terbinafine 250 mg, one tablet twice daily for seven days every month. Four such monthly pulses were administered for each drug. The patients were evaluated at 4-weekly intervals till sixteen weeks and then at 24, 36 and 48 weeks. RESULTS: We observed a clinical cure rate of 82% and mycological cure rate of 90% in the group of patients treated with itraconazole while the group with terbinafine showed clinical and mycological cure rates of 79% and 87% respectively. This difference was not statistically significant. CONCLUSIONS: Both oral itraconazole and terbinafine are effective in the treatment of onychomycosis when administered in the pulse dosage form. Terbinafine is more cost effective while itraconazole has a broader spectrum of antimycotic activity.

Itraconazole pulse therapy in onychomycosis.

A prospective study of 30 clinically and mycologically diagnosed cases of onychomycosis was carried out for a period of twelve months from May 1996 to April 1997. Itraconazole pulse therapy was given for the 1st week followed by 3 week drug-free period, for 1st 3 months for the finger nail cases and 4 monthes for finger nail + toe nail and toe nail cases. Patients were evaluated at baseline, week 4, week 12, week 16, week 24, up to 12 months and assessed as cleared or markedly improved with clinical and mycological success. The result of our study is very much encouraging. It suggests that the use of itraconazole pulse therapy will maintain the continuous treatment efficacy and is cost effective than continuous therapy.

Amyloidosis in leprosy.

Fourteen hundred and forty five biopsied tissues of various organs including liver, skeletal muscle, kidney, lymphnode, larynx and skin from 1222 patients of leprosy obtained during the last 10 years have been examined histopathologically to study various types of pathological lesions. These patients ranged in age from 7 years to 72 years and the duration of illness varied from less than one year to twenty years. Although the presence of lepromatous granuloma, AFB in varying proportions, and some nonspecific lesions have been observed in them, but amyloidosis was not detected in any of them. This finding is discussed in view of the observations of other authors of different parts of the world in this connection. Consumption of mainly vegetarian diet in our population and that of meat in Western population has been suggested to be the probable cause of the difference of amyloidosis observed in the two groups of people.

Amyloidosis in leprosy

Fourteen hundred and forty five biopsied tissues of various organs including liver, skeletal muscle, kidney, lymphnode, larynx and skin from 1222 patients of leprosy obtained during the last 10 years have been examined histopathologically to study various types of pathological lesions. These patients ranged in age from 7 years to 72 years and the duration of illness varied from less than one year to twenty years. Although the presence of lepromatous granuloma, AFB in varying proportions, and some nonspecific lesions have been observed in them, but amyloidosis was not detected in any of them. This finding is discussed in view of the observations of other authors of different parts of the world in this connection. Consumption of mainly vegetarian diet in our population and that of meat in Western population has been suggested to be the probable cause of the difference of amyloidosis observed in the two groups of people.

A histopathological study of lymphnodes in 43 cases of leprosy.

Eighty cases of leprosy including 60 cases of lepromatous type and 20 cases of tuberculoid type, during the period of 1974-75, have been examined for evidence of lymphnode enlargement. Of the 52 cases of enlarged lymphnodes, lymphnode biopsy was done in 43 cases including 38 cases of lepromatous type and 5 cases of tuberculoid type. The lymphnodes have been studied for evidence of any pathological changes and presence of acid-fast bacilli. In cases of lepromatous leprosy, lepromas and acid-fast facilli were seen in 92.2 per cent of the cases and patchy fibrosis was noted in 23.6 per cent of the cases. No amyloid could be demonstrated. In cases of tuberculoid leprosy, only non-specific reticular hyperplasia was noted. No specific granuloma or acid-fast bacilli could be demonstrated. The findings have been described in detail and discussed in the light of previous published data.

Skin Lesions (non Neoplastic and Non Hansen Disease) in Jabalpur Area.

The paper deals with 588 cases of skin diseases studied histopathologically between 1968 and 1974. Neoplastic and Hansens's diseases have not been included in this study. The diseases have been studied with emphasis on their incidence, types and clinicopathological features. Psoriasis, lichen planus, vitiligo, chronic dermatitis, eczema, lupus vulgaris, mofluscum contagiosum etc. are reported in this paper. The results are presented and discussed.

A histopathologic study of renal biopsies in fifty cases of leprosy.

Renal biopsies from 50 cases of leprosy, including 45 cases of lepromatous and 5 cases of tuberculoid, have been studied in detail histopathologically with special reference to any specific leprosy lesion such as the presence of leproma or granuloma, the presence of acid-fast bacilli and the occurrence of amyloid deposit. Leproma or granuloma, acid-fast bacilli and amyloid deposit could not be detected in any of these cases. Pathologic features of nephritis of various types were seen in only 40% of cases. Similar observations made by previous authors have been reviewed. The question is raised as to why kidney tissue should escape from developing specific leprosy lesions in either type of leprosy when other tissues such as liver, striated muscles and lymph nodes are known to develop such lesions. A greater immunologic resistance of the renal tissue to lepra bacilli or local physiochemical factors which may render renal tissue an unfavorable site for the settling and multiplication of lepra bacilli are considered as possible related factors.