Comparison of efficacy of spironolactone plus oral contraceptives with metformin in patients of PCOS with hirsutism

Objective: To compare the efficacy of spironolactone plus oral contraceptives with metformin in treatment of hirsutism among patients with polycystic ovarian syndrome [PCOS]. Study Design: Randomized controlled trial. Place and Duration of Study: Dermatology department, Military Hospital Rawalpindi, from Jan 2016 to Jul 2016

Material and Methods: A total of 84 women with PCOS and hirsutism with ages ranging between 16 and 50 years were included in the study. Patients with hirsutism due to etiologies other than PCOS like idiopathic hirsutism, Cushing syndrome or late-onset congenital adrenal hyperplasia were excluded. Random allocation of treatment was done, those reporting on even dates were enrolled in group A and those reporting on odd dates were placed in group B. Group A received oral tablet spironolactone 50mg twice a day along with combined oral contraceptive pills [cOCPs] containing levonorgestrel 0.15mg / ethinyl estradiol 0.03mg daily as combination therapy for 6 months, while group B received oral metformin 500mg twice daily for 6 months. Hirsutism scores were determined according to the modified Ferriman-Gallwey [mFG] scoring system [attached as annexure A] and 50% reduction from the baseline was considered effective therapeutic response

Results: The mean age of patients in group A was 32.83 +/- 8.28 years and in group B was 32.57 +/- 8.21 years. The mean duration of disease in group A was 18.84 +/- 7.26 months and in group B was 18.04 +/- 7.11 months. Efficacy in group A was observed in 29 [69.05%] patients while in group B it was observed in 17 [40.48%] patients

Conclusion: The efficacy of spironolactone plus cOCPs combination therapy is better than metformin alone in the treatment of hirsutism among patients of PCOS

Study of efficacy of Hypofractionated Radiotherapy 8 Gray in single fraction in Palliation of pain secondary to bone Metastasis

Objectives: To determine the efficacy of hypo-fractionated radiotherapy 8 Gray in 1 fraction for palliation of pain secondary to bone metastasis

Study Design: Quasi-experimental study

Place and Duration of Study: Oncology department, Combined Military Hospital, Rawalpindi, Sep 2012 to Nov 2013

Patients and Methods: Forty three patients were included after permission from concerned authorities and Hospital Ethical Committee. OPD registration numbers, name, age, gender, Eastern Cooperative Oncology Group [ECOG] performance status [PS], diagnosis of primary malignancy along with histopathology and sites of skeletal metastasis were recorded. Radiotherapy 8 Gy in 1 fraction was administered using 6MV [mega voltage] Primus Linear Accelerator with 2-2.5 cm margin around the gross disease at the Oncology department, CMH Rawalpindi. Pain score was recorded using visual analogue scale on the day of administering radiotherapy [day 0] and thirty days [day 30] after radiotherapy to assess response to treatment

Results: There was a statistically significant [<0.001] improvement in the scores of pain with treatment at day 30. Thirty four out of forty three patients [86 percent] showed an improvement in pain score

Conclusion: Based on our results hypofractionated radiotherapy 8 Gy in 1fraction is an effective modality in the palliation of pain secondary to bone metastasis

Comparison of efficacy of combination of 2 percent Ketoconazole solution wash and topical 1 percent clotrimazole with topical 1percent Clotrimazole alone in C

Objective: Comparison of efficacy of combination comprising 2 percent ketoconazole solution wash plus topical 1 percent clotrimazole versus topical 1 percent clotrimazole alone in management of patients with Pityriasis versicolor

Study Design: Randomized controlled trial

Place and Duration of Study: Dermatology department, Pak Emirates Military Hospital Rawalpindi, from Oct 2016 to Apr 2017

Material and Methods: Sixty patients of Pityriasis versicolor, both male and female were included in study. Diagnosis of Pityriasis versicolor was made clinically and confirmed microscopically by examining skin scrapings for fungal hyphae. Patients with concomitant systemic illnesses or those who had received anti-fungal in last three months were excluded from study. Random number tables were used to allocate patients to the two treatment groups. Group A received 2 percent ketoconazole shampoo twice per week for four weeks plus topical 1 percent clotrimazole twice daily application for 2 weeks. Group B received only topical therapy with 1 percent clotrimazole cream applied twice daily for 2 weeks. Assessment of treatment efficacy was done by clinical examination of patient and microscopy of skin scrapping for fungal hyphaedone at baseline and at end of study [4 weeks of treatment]. A negative clinical examination and negative skin scrapping for fungal hyphae was considered effective therapeutic response

Results: In group A, the mean age of patients was 29.76 +/- 8.89 years and in group B was 27.67 +/- 10.46 years. Efficacy in group A was observed in 22 [73.33 percent] patients while in group B in 14 [46.67 percent] patients

Conclusion: Combination of 2 percent ketoconazole solution wash plus topical 1 percent clotrimazole was found more effective in treatment of patients with Pityriasis versicolor as compared totopical 1 percent clotrimazole alone

Comparison of oral itraconazole versus topical clotrimazole in treatment of pityriasis versicolor

Objective: To compare the efficacy of single dose of oral itraconazole 400mg with 1% topical clotrimazole in the treatment of pityriasis versicolor

Study Design: Randomized controlled trial.

Place and Duration of Study: Dermatology department, Military Hospital Rawalpindi, from Jun 2015 to Dec 2015

Material and Methods: A total of 60 patients of pityriasis versicolor fulfilling the inclusion criteria were selected from dermatology OPD after written informed consent and approval from the hospital ethical committee

Patients were divided into two treatment groups using random numbers table. Group A received single dose of itraconazole capsule [400mg] and group B received 1% clotrimazole cream twice daily application for 2 weeks

Patient evaluation included detailed history, clinical examination and direct microscopy of skin scrapings for fungal hyphae at the baseline, at the end of 2[nd] and 6[th] week of treatment. Efficacy of treatment was assessed on the basis of clinical and mycological cure

Results: At the end of 2 weeks of treatment, clinical cure was seen in 23 [76.6%] and 29 [96.6%] patients [p=0.05] and mycological cure in 20 [66%] and 26 [86.6%] patients in group A and B respectively [p=0.06]. At follow up [end of 6 week] 21 [70%] and 28 [93.3%] patients were cured clinically [p=0.02] while 18 [60%] and 27 [90%] patients were cured mycologically [p=0.007] in group A and B respectively

Conclusion: Topical clotrimazole [1%] was found more effective than single dose of oral itraconazole in the treatment of pityriasis versicolor

Efficacy of clarithromycin in pityriasis rosea

To determine the efficacy of clarithromycin in the treatment of Pityriasis Rosea [PR]. Double blind randomized controlled trial. Dermatology OPD, Military Hospital, Rawalpindi, from July 2008 to July 2009. Patients aged above 10 years, diagnosed with PR, were randomly assigned to two groups of 30 each to receive either clarithromycin or similar-looking placebo for one week. Neither the patient nor the treating physician knew to which group the patient belonged. Patients were assessed at 1, 2, 4 and 6 weeks after presentation and compared for complete, partial or no response. Among the 60 patients, no significant difference was found between the two groups at 2 weeks after presentation [p = 0.598]. In the placebo group, complete response was seen in 20 [66.7%], partial response in 3 [10.0%] while no response was seen in 7 [23.3%]. In clarithromycin group, there was complete response in 23 [76.7%], partial response in 3 [10.0%] and no response in 4 [13.3%] patients. Clarithromycin is not effective in treatment of pityriasis rosea

Frequency of pigmented birthmarks in newborns of various ethnic groups of Pakistan

To determine the frequency of various types of pigmented birthmarks in neonates of different ethnic background born at PNS Shifa, with in 48 hours of birth. Descriptive Cross sectional study Department of Dermatology and Department of Obstetrics, PNS Shifa, Karachi. The study was conducted for six months, from 1st March 2008 till 31st September 2008. Patients and Two hundred newborn children of both sexes, born by any mode of delivery and belonging to different social classes and ethnic groups, in their first 48 hours of life were recruited. Each baby was physically examined, after taking consent from the mother, so as to assess the type, colour and distribution of the pigmented birthmark. All demographic features were recorded in a proforma and a digital photograph of each baby with a pigmented birthmark was also taken. Pigmented birthmarks observed included Mongolian blue spot, caf‚-au-lait macules and congenital melanocytic nevi. Among the ethnic groups these nevi were more prevalent among groups with darker skin colour and black hair. Mongolian blue spot are the commonest pigmented birthmarks observed followed by caf‚-au-lait macules and congenital melanocytic nevi