Effectiveness and safety of oral acyclovir 1 g twice a day for 3 days in the management of genital herpes.

CONTEXT: Acyclovir is the most commonly used drug in genital herpes; however, with existing acyclovir regimens, the drug needs to be taken five times a day which is inconvenient for patients. AIMS: The aim of the study was to evaluate the efficacy and safety of oral acyclovir 1 g twice a day for 3 days in genital herpes. METHODS: The patients of genital herpes were treated with oral acyclovir 1 g twice a day for 3 days and followed up after day 3, 5, 7, and 10 to determine the response to therapy. The response was assessed by physicians' assessment of percentage healing of the ulcer and mean healing time as well as patients' assessment of improvement in the Visual Analog Scale (VAS). RESULTS: Twenty-three patients of genital herpes were recruited of which 21 (91.3%) had recurrent episodes, whereas 2 (8.7%) patients had first episode. One patient was lost to follow-up and 22 were analyzed. Complete healing of ulcer was seen in 9 (40.9%), 17 (77.27%) and 20 (90.90%) patients after day 3, 5 and 7 following the treatment respectively, with a mean healing time of 4.91 ± 2.16 days. The mean healing time of recurrent disease was 4.67 ± 1.87 days. Complete improvement in VAS was seen in 9 (40.9%), 21 (95.45%) and 22 (100%) patients after day 3, 5 and 7 following the treatment respectively, with a mean time for complete improvement being 4.27 ± 1.16 days. There were no significant side effects of therapy. CONCLUSION: Acyclovir 1 g twice a day for 3 days is an effective treatment for genital herpes with advantages of comparable healing time and convenient dosage schedule.

Ultrasound liver elastography for the detection of liver fibrosis in patients with psoriasis and reactive arthritis on long-term methotrexate therapy: A cross-sectional study.

BACKGROUND: Long-term low-dose methotrexate therapy is associated with liver fibrosis. Although liver biopsy is the gold standard for detecting fibrosis, it is an invasive procedure associated with morbidity and mortality risks. Hence noninvasive imaging techniques such as transient elastography (TE) and shear wave elastography (SWE) have been studied to measure liver stiffness. AIMS: To assess the utility of TE and SWE in detecting fibrosis in patients with psoriasis and reactive arthritis on long-term methotrexate therapy. METHODS: A cross-sectional prospective study was undertaken on 54 patients with psoriasis and reactive arthritis who had received ≥1.5 g of methotrexate. Various clinical and biochemical [fibrosis 4 index (FIB4), aspartate-transaminase-to-platelet ratio index (APRI)] parameters were calculated and liver stiffness measurement (LSM) was done with TE and SWE. The degree of steatosis was measured using controlled attenuation parameter (CAP). Liver biopsy was done when indicated and was interpreted by a pathologist blinded to clinical and imaging results. RESULTS: Fifty four patients with a mean age of 40.3 years and a male-to-female ratio of 5:1 were included. The mean cumulative methotrexate dose was 3.04 g. The median FIB4, APRI, and gamma-glutamyl transpeptidase-to-platelet ratio values were 0.75, 0.23, and 0.15, respectively. The median LSM for TE and SWE was 5.3 and 7.32 kPa, respectively. SWE and TE showed a weak positive correlation (r = 0.26, P = 0.053). The mean CAP was 217 dB/m (area under the receiver operating characteristic = 0.70). In the 19 of 26 cases whose liver biopsies could be assessed, only 4 (21%) showed F1 fibrosis (Ishak staging). The median LSM on SWE was significantly higher in patients with a cumulative methotrexate dose ≥ 4 g when compared with those with a dose <4 g (9.85 vs 7.1, P = 0.02). Other parameters did not correlate with TE and SWE. LIMITATIONS: The small sample size and the low number of cases with significant fibrosis on histopathology were the major limitations of this study. CONCLUSION: Histologically detectable LF is uncommon in patients with psoriasis and reactive arthritis on long-term methotrexate therapy. Both TE and SWE are good at detecting the absence of fibrosis in these patients. In our study, SWE and TE values did not correlate with clinical, biochemical, or histopathological parameters.

Urethrocutaneous fistula: a rare presentation of penile tuberculosis.

A man in his 50s presented with two urethrocutaneous fistulae with intermittent dribbling of urine from the opening of fistula on the surface of glans penis. A skin biopsy from indurated margin of fistula was suggestive of fibrosing granulomatous reaction. Anti-tubercular therapy was given with a diagnosis of penile tuberculosis and there was 50% improvement within two months of treatment.