Introduction Scabies is a highly contagious skin disease caused by an ectoparasite mite called Sarcoptes scabiei. Ivermectin and permethrin have been commonly used for the treatment of scabies. However, topical ivermectin has been compared to other treatment modalities to a lesser extent. Objective This study aimed to compare the efficacy of topical ivermectin versus topical permethrin in the treatment of uncomplicated scabies. Methods 354 patients with scabies attending the dermatology outpatient department of Pak Emirates Military Hospital Rawalpindi were enrolled. Patients were divided into two groups randomly. The first group and their family contacts received 1% ivermectin lotion whereas the other received 5% permethrin lotion. Patients were evaluated at the end of the second and the fourth week. Results At the end of the second week, initial follow-up showed that 97 out of 159 patients (61.0%) in the ivermectin 1% group, and 107 out of 159 patients (67.3%) in the permethrin 5% group had achieved clinical cure (P=0.24). On the final follow-up at the end of Week 4, the cure rate amounted to 85.5% (136 of 159 patients) in the ivermectin group and 89.9% (143 of 159 patients) in the permethrin group. Differences among both groups remained statistically insignificant (P=0.23). Conclusions The use of ivermectin 1% versus permethrin 5% as topical therapy showed almost identical results for the treatment of uncomplicated scabies. Side effects were minimal and there were no significant differences observed in patients with regard to compliance among both the groups.
As more and more patients seek treatment for increasingly complicated and cosmetically challenging skin cancers, Mohs Micrographic Surgery (MMS) is now exceedingly in demand. Training in MMS could help dermatologists improve patient outcomes allowing them to handle complex lesions safely and efficiently and hence, provide the best possible care. As a result, there is an urgent need to train additional dermatologists in Mohs Surgery in order to meet the huge demand for dermatologists with imperative expertise, specifically in this field.
Hairy cell leukemia (HCL) is a rare B-cell lymphoproliferative disorder. Patients typically present with cytopenia and splenomegaly. We describe the case of a 78-year-old patient with refractory HCL who acutely developed a cystic lesion on the back while receiving moxetumomab pasudotox therapy. Biopsy of the lesion revealed the presence of adenocarcinoma, which prompted a detailed evaluation resulting in a diagnosis of stage IV gastric cancer. Nevertheless, to establish any association between moxetumomab pasudotox therapy and secondary cancer development, a satisfactory number of studies need to be conducted.
Schmidt's syndrome constitutes Addison's disease in conjunction with autoimmune hypothyroidism or type 1 diabetes mellitus. It has misleading symptomology and an unclear order of presentation of symptoms. This often results in missed and late diagnosis. Chronic kidney disease is a rarely reported phenomenon in Schmidt's syndrome. Multiple factors may have the potential to cause renal failure, such as Addison's disease and/or hypothyroidism, the understanding of which is still evolving. A 45-year-old gentleman who is a known case of Schmidt's syndrome presented to us with fatigue, anorexia, and weight gain. Further evaluation revealed a picture of chronic kidney disease. We would like to alert fellow peers of this potential complication and the importance of screening as well as timely diagnosis.
BACKGROUND: Melasma is a very common skin problem that is much more prevalent in women. In our society, it results in many psycho-social implications and eventually leads to an impaired quality of life. Many treatment modalities have been developed for it. However, in recent years resistant forms of melasma have emerged that are unresponsive to the usual first line treatment options. Thus, this study is being conducted to explore new treatment modalities for this disease by using micro-needling with vitamin C and tranexamic acid. METHODS: Thirty patients participated in this non-randomized clinical trial including 11 males and 19 females. All patients received Tranexamic acid via micro-needling on right side of the face and Vitamin C on the left side. A total of three biweekly sessions were performed. Patients' response was evaluated at week 2, 4 and 6 on the basis of Physician Global Assessment, Patient Global Assessment, modified Melasma Area Severity Index and clinical assessment. Paired sample t-tests were used to calculate the difference in the means of two groups at 2, 4 and 6 weeks and p-value of <0.05 was considered significant. RESULTS: After first session, there was more improvement observed with tranexamic acid. At the end of 6 weeks, modified Melasma Area Severity Index, Physician Global Assessment and Patient Global Assessment showed significant improvement with both tranexamic acid and vitamin C. However, the difference between them was not statistically significant (p>0.05). CONCLUSIONS: Both Tranexamic acid and Vitamin C are potent therapies for melasma as an adjuvant to micro-needling.
Melanosis , Tranexamic Acid , Ascorbic Acid/therapeutic use , Female , Humans , Male , Melanosis/drug therapy , Quality of Life , Tranexamic Acid/therapeutic use , Treatment Outcome
Human induced pluripotent stem cells (hiPSCs) are a promising approach to study neurological and neuropsychiatric diseases. Most methods to record the activity of these cells have major drawbacks as they are invasive or they do not allow single cell resolution. Genetically encoded voltage indicators (GEVIs) open the path to high throughput visualization of undisturbed neuronal activity. However, conventional GEVIs perturb membrane integrity through inserting multiple copies of transmembrane domains into the plasma membrane. To circumvent large add-ons to the plasma membrane, we used a minimally invasive novel hybrid dark quencher GEVI to record the physiological and pathological firing patterns of hiPSCs-derived sensory neurons from patients with inherited erythromelalgia, a chronic pain condition associated with recurrent attacks of redness and swelling in the distal extremities. We observed considerable differences in action potential firing patterns between patient and control neurons that were previously overlooked with other recording methods. Our system also performed well in hiPSC-derived forebrain neurons where it detected spontaneous synchronous bursting behavior, thus opening the path to future applications in other cell types and disease models including Parkinson's disease, Alzheimer's disease, epilepsy, and schizophrenia, conditions associated with disturbances of neuronal activity and synchrony.
Renal cell carcinoma (RCC) is a common malignancy in elderly males. Metastatic spread of this cancer is not an uncommon occurrence, even after nephrectomy. Lung, bone, liver, and brain are the most frequently involved sites. Such a type of presentation mostly occurs within five years after nephrectomy however, cases have been reported later as well. Here, we report a case of metastatic renal cell carcinoma that presented in the form of a lung growth 28 years after nephrectomy. This highlights the importance to consider relapsed metastatic renal cancer in the differential, even decades after its surgical removal.
BACKGROUND: Psoriasis is a non-communicable, long-lasting disorder of the skin comprising various immunological inflammatory changes. Increasing evidence suggests that psoriasis is closely related to multiple organ systems, potentially arising due to underlying co-morbid conditions such as diabetes, hypertension, dyslipidaemia and obesity. Aim of this study was to know the frequency of metabolic syndrome in psoriasis patients. METHODS: This cross-sectional study was conducted from May to November 2020 in a Tertiary-care hospital. Eighty patients diagnosed with psoriasis were selected using non-probability consecutive sampling. Informed written consent was obtained from each patient and a questionnaire was filled. Blood pressure, waist circumference, body surface area covered by psoriasis, Psoriasis Area Severity Index were recorded on initial visit. Fasting blood sugar, serum triglyceride and HDL cholesterol levels were advised. Patients were diagnosed to have metabolic syndrome if ≥3 out of 5 criteria for the modified version of National Cholesterol Education Program Adult Panel III were met. RESULTS: There were 62 male and 18 female patients. A total of 39 patients (48.8%) met the criteria for metabolic syndrome. Amongst these, 26/62 (41.9%) males vs 13/18 (72.2%) females fulfilled the criteria. The mean BMI of males was 26.0 while those of females was 28.3, comparison of which demonstrated a noteworthy difference (p=0.04). A statistically significant (p=0.038) positive correlation (r) of 0.233 was observed between body surface area and BMI. CONCLUSIONS: Metabolic syndrome is seen frequently in patients of Psoriasis. Female patients have a significant frequency of metabolic syndrome and tend to have a higher BMI than males.
Metabolic Syndrome , Psoriasis , Adult , Body Mass Index , Cholesterol , Cross-Sectional Studies , Female , Humans , Male , Metabolic Syndrome/complications , Metabolic Syndrome/epidemiology , Psoriasis/complications , Psoriasis/epidemiology , Risk Factors , Waist Circumference
Lichen planopilaris (LPP) is characterized by chronic cicatricial alopecia that is lymphocytic in nature. The underlying pathophysiology of LPP is not well understood. Failure of therapeutic management occurs quite often resulting in significant psychosocial stress on the patient when they are unable to prevent further hair loss or reverse it. Although the occurrence of LPP is rare, it is especially seldom observed in the pediatric population. Herein, we discuss a case of a nine-year-old child who was recently diagnosed with LPP.
Ischemic stroke is a rare phenomenon in young adults. A complete workup for hypercoagulable and myeloproliferative disorders is a cornerstone of evaluation. Essential thrombocytosis is a chronic myeloproliferative disorder that primarily involves platelets. It may remain undiagnosed in patients and subsequently present in the form of ischemic stroke. The management of this disorder is complex and often involves cytoreduction therapies. The initiation of these drugs in such patients may lead to unnecessary adverse effects and complications. This case report is an attempt to highlight an underappreciated cause of stroke when assessing young individuals.
Coronavirus disease 2019 (COVID-19) is a respiratory disease that has been reported to have a wide array of extrapulmonary manifestations. Our knowledge regarding this virus is constantly evolving, and new literature is being published every day. Children usually have a mild severity of COVID-19 infection. A variety of skin lesions have been documented in this disease. Similarly, our 18-month-old patient who was diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection had mild symptoms, but three days later he presented to the hospital with the development of urticarial lesions followed by angioedema. In this case report, we have attempted to highlight a possible association of angioedema and urticarial with coronavirus infection. Physicians should be aware of this association and should always inquire about symptoms of respiratory illness (SARS-CoV-2) while dealing with patients in whom a specific trigger for angioedema/urticaria is un-identifiable.
