Comparative efficacy of methotrexate and mini pulse betamethasone in the treatment of lichen planus.

A clinical trial was conducted to evaluate the efficacy of methotrexate and mini pulse betamethasone in the treatment of lichen planus. A total of forty four patients of lichen planus, attending at the department of Dermatology and Venereology, BSMMU, Dhaka, Bangladesh during the period of January 2009 to December 2010 were enrolled in this study. Of them, 23 patients in Group A (case) and 21 patients in Group B (control) were selected. The case was treated with oral methotrexate and the control was treated with betamethasone oral mini-pulse therapy. Efficacy of drugs were measured to assess the improvement of mucocutaneous lesions, to change the colour of the lesions which became violaceous to postinflammatory hyperpigmentation, remission of itching, disappearance of existing lesions and stop appearance of new lession after initiation of treatment at 1st week, 2nd week, 6th week and 12th week. At the end of the present study, it was found that 16(69.6%) patients in cases completely cured the disease, whereas 10(47.6%) patients among the control cured the disease. Data showed that moderate remission was higher among the control 6(28.6%) compared to cases 5(21.7%) and the partial remission was also higher among the control 5(23.8%) compared to cases 2(8.7%). However, the efficacy was better in patients taking methotrexate and it also showed that macular and papular lesion responded well than plaque type lesion. Differences in treatment outcome were seen better in methotrexate group but the difference was not statistically significant.

Adverse outcome of methotrexate and mini pulse betamethasone in the treatment of lichen planus.

The objectives of this study were to compare the adverse outcome of methotrexate and mini pulse betamethasone therapy in the treatment of lichen planus. It was a clinical trial conducted in the department of Dermatology and Venereology, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2009 to December 2010. Forty four patients of lichen planus were included in the study. Patients in Group-A, (n = 23) were treated with methotrexate (10 mg) single morning dose and group-B (n = 21) were treated with mini pulse betamethasone (5 mg) single morning dose on 2 consecutive days during the period of 12 weeks. Adverse outcomes were measured by clinical examination and laboratory investigations during follow up visits. Anemia 3 (14.2%) and edema 12 (57.1%) developed in group-B but none in group-A. In group-B, dyspepsia 15 (71.4%), acne 10 (47.6%), mooning face 8 (38.1%), striae 8 (38.1%) and hypertrichosis 4 (19.0%) developed but none in group-A. Intermittent diarrhoea, headache, nausea and fatigue complained in both groups of patients but the percentage of complaints was higher among group-B compared to group-A. Menstrual abnormality developed in group-B 5(71.4%) but none in group-A. Laboratory investigations showed abnormality in platelet count and SGPT in group-A but none in group-B. The adverse effects of methotrexate on haematological parameter and liver functions were mild and could be prevented by reducing the dose but the adverse effects of betamethasone were unavoidable. The overall adverse effects were less in group-A than group-B. Therefore, methotrexate can be used as an alternative safer option for the treatment of lichen planus.

Comparative efficacy of hydroxyurea and methotrexate in treating psoriasis.

A clinical trial study in the treatment of psoriasis was conducted in twenty three patients. The patients of psoriasis attending at the department of Dermatology and Venereology, BSMMU, Dhaka during the period of July 2009 to May 2010 were enrolled in this study. Eleven patients were treated with oral hydroxyurea (case), belonged to Group A and rest 13 patients were treated with oral methotrexate (control), belonged to Group B. Elements of the Psoriasis Area and Severity Index (PASI) were calculated as main outcome measure at baseline; follow up after 4 weeks and finally at 8 weeks. The mean PASI score for the Group A patients was 17.0±7 and that of Group B patients was 13.8±3. The mean reduction was higher among the Group B patients (11.8±3.5) than the Group A patients (13.5±6.8), but the mean reduction was not statistically significant (p>0.05) between two groups of patients. The mean percentage of decrease of PASI score was found to be high among the Group B patients (84.9±10.4, i.e. 85%) than the Group A patients (77.6±14.0, i.e. 78%), but the mean difference was not statistically significant (p>0.05). Analysis revealed that a statistically significant improvement of psoriasis was observed based on PASI score eight weeks of treatment in both treatment group (p=0.001). There was no statistically significant mean difference was found between Group A and Group B patients in terms of blood hemoglobin, erythrocyte sedimentation rate, WBC and platelet count and serum ALT (p>0.05). The current study showed adverse effects in 7(63%) patients of Group A and 8(66.6%) patients of Group B. In both groups of patients the adverse effects were few and mild in nature. So hydroxyurea can be alternative drug to methotrexate in the treatment of psoriasis.

Changing scenario of transfusion-related viral infections.

OBJECTIVE: To study the changing incidence of blood transfusion-related viral infections consequent to compulsory screening of blood and greater awareness of the problem, over the last five years. METHODS: This is a cross-sectional study carried out at Medical College, Calcutta. Three groups each consisting of 100 subjects were selected for this study. Group A comprised multiple transfused patients who have also received transfusion before 1995. Group B comprised patients who had received transfusions only since 1995. Group C comprised of control patients who have never been transfused. The incidence of HBsAg +ve, anti-HCV +ve and HIV +ve cases were calculated and expressed as percentages and compared using the chi square test. RESULTS: The incidences of HBsAg +ve and anti-HCV +ve cases in the three groups were 20% and 16% in Group A, 7% and 6% in Group B and 4% and 2% in Group C. The difference between Group A and Group B were statistically significant. CONCLUSION: The incidence of HBsAg and anti-HCV positive cases among the multi-transfused has decreased over the last five years.

People living with HIV infection / AIDS - a study on lymph node FNAC and CD4 count.

Between July 1997 and December 2000, 1616 HIV seropositive persons were identified by Western Blot test at the School of Tropical Medicine, Kolkata. Four hundred seventy two (29.2%) of them had generalized lymphadenopathy. CD4 count could be done in only 54 of these 472 subjects (11.4%). These 54 patients, consisting of 40 males (74%) and 14 females (26%) were the subjects of the study. Their mean age was 29.5 years. In all these subjects, FNAC was done from the enlarged lymph nodes (non-inguinal). Reactive hyperplasia was seen in 30 cases (55.5%) whose absolute CD4 count varied between 411-945 cells/microL (median value 670 cells/microL). Evidence of tuberculous lymphadenitis was detected in 22 (41%) with CD4 counts varying between 113 and 422 cells/microL (median value 212 cells/microL). Non-Hodgkin lymphoma was diagnosed in 2 cases (3.7%) with CD4 count 79-113 cells/microL. All patients had evidence of HIV-1 infection, excepting one case of dual infection (HIV-1 and 2).

The utility of waist circumference in assessment of obesity.

The objective of this study was to assess the correlation between waist circumference and waist hip ratio and body mass index. Also to assess if a simple measurement like the waist circumference can be used as an independent indicator for detecting health risk and management. 500 men and 500 women were included in this study from the out patient department and indoor wards of Medical College, Calcutta. Only 7% of the males and 16% of the females had body mass index > or = 25. About 50% of both males and females had waist hip ratio above the desirable range (0.80 for females and 0.95 for males). About 99% of females with, waist circumference > or = 72 cm. had either body mass index > or = 25 or high waist hip ratio > or = 0.80 or both. Similarly 99% of males with waist circumference > or = 80 cm. had either high body mass index > or = 25 or high waist hip ratio > or = 0.90 or both. Waist circumference is simple to assess and can be used as an independent measurement to identify those at risk from either increased body weight or central fat distribution or both.