ABSTRACT
Background: There is paucity of research based information regarding the dermatology learning needs and their fulfilment in primary care physicians
Objective: To determine skin diseases burden in the community AND adequacy of preparedness of Primary Care Physicians to deal with skin diseases
Methodology: This was a cross sectional study conducted from 1[st] January 2015 to 31[st] December 2016 at Dermatology Outpatient Department of Sheikh Zayed Medical College/Hospital [SZMC/H], Rahim Yar Khan, for burden of skin diseases and feedback from Primary Care Physicians of both SZMC/H and Primary Health Care setups [BHUs and RHCs] of District Rahim Yar Khan regarding adequacy of their preparedness to deal with skin disease patients. Records from a tertiary care teaching hospital was sought from OPD to assess skin disease burden and Primary Care Physicians from tertiary care hospital and BHU and RHC of district were surveyed regarding content AND teaching adequacy of undergraduates through their dermatology curriculum. Data was entered and analyzed by using SPSS version 20
Results: A total of 356 doctors participated in this study. Of these 233 [65.4%] were males. It was found that 10% of patients attending OPD in Sheikh Zayed Hospital [A tertiary care teaching hospital] suffered from skin disease. Frequencies of "Common skin diseases" in the community were; eczema 12.9%, scabies 10.8%, fungal infection 9%, bacterial infection 8% and acne 7%. Of all participants, 274 [77%] reported that <10% of their patients suffered from skin disease and only 30 [8.4%] of them were fully confident while treating skin disease patients and only 36 [10.1%] reported that most of their patients were cured. It was noted that 145 [40.7%] participants could name only 1-3 of the common skin diseases in the community, 182 [51.1%] named 4-6 while only 12[3.4%] could name 7 or more and 17[4.8%] had no knowledge of even a single common skin disease in the community. Only 92[25.8%] participants rated that their undergraduate training was adequate while 264[74.2%] rated it to be inadequate
Conclusion: This study concluded that primary care physician were not adequately prepared for managing common skin diseases during their undergraduate training. Appropriate exposure and adequate teaching in dermatology throughout undergraduate medical curriculum is essential because skin presentations manifest throughout all aspects of medicine, and most often dermatological problems are dealt with exclusively by non-dermatologists
ABSTRACT
Background: tinea capitis is an important skin infection in children. Terbinafine has been used as preferred drug but increasing number of resistance and side effect profile suggests search to find another drug with better efficacy and safety
Objective: to compare the efficacy and safety of terbinafine and Itraconazole in tenia capitis
Methodology: it was a randomized control trial on 120 cases of tenia capitis diagnosed on the basis of five clinical signs and symptoms [erythema, desquamation/scaling, papules, pustules and pruritis] which were rated on four point scale [0-absent, 1-mild, 2-moderate, 3-severe] summed as total signs and symptoms score [TSSS] and a positive KOH microscopy and were divided into two equal groups A and B. Group A was treated with terbinafine at a dose of 62.5 mg for children less than 20 kg, 125 mg for 20-40 kg and 250 mg for above 40 kg. Group B was treated with Itraconazole and dosage was as follows; 10-19 kg 50 mg/day, 20-40 kg 100mg/ day, more than 40 kg 200 mg/day. This study was carried out from 1[st] January to 30[th] June 2016, at department of Dermatology, Sheikh Zayed Hospital, Rahim Yar Khan. These cases were then followed at weeks 02, 04, 06 and 08 and assessed on the basis of KOH microscopy and TSSS score. Negative microscopy and zero TSSS were labeled as cured and parents were also asked about any side effect and tolerability. The data was entered and analyzed by using SPSS version 16
Results: there were 60 cases in each group. Group A has 29 males and 31 females while Group B has 34 males and 26 females. Cure was seen significantly higher in Group B where it was in 86.67% as compared to Group A with 68.33%. [p value 0.01]. There was again significant difference seen when they were compared in terms of cure time where 58.34% of cases in group B were cured by 6 weeks as compared to 40% in Group A. [P value 0.03]. There was no significant difference in terms of side effect profile [p= 0.45] while it was again significantly better in terms of tolerability with Itraconazole [p= 0.02]
Conclusion: intraconazole has better care and safety profile as compared to terbinafine in treatment of Tenia Capitis