Efficacy of trichloro-acetic acid peel alone versus combined topical magnesium ascorbyl phosphate for epidermal melasma

Objective: To compare the efficacy in terms of reduction in melasma area and severity index [MASI] score by more than 10 of a combination of 20% trichloro-acetic acid peel plus 5% topical magnesium ascorbyl phosphate versus 20% trichloro- acetic acid peel alone in the treatment of epidermal melasma

Study Design: Randomized controlled trial

Place and Duration of Study: Department of Dermatology, Lady Reading Hospital [LRH], Peshawar, from May 2012 to May 2013

Methodology: Patients aged 18-65 years, with Fitzpatrick skin type III-V were divided into two equal groups having 74 patients each. Detailed history was taken and Wood's lamp examination done to rule out mixed and dermal melasma

Melasma area and severity index [MASI] score was calculated for every patient. Priming was done for all patients with tretinoin cream applied once daily at night for 2 weeks, and to use a broad spectrum sun block cream before sun exposure

Patients in group A were subjected to combined treatment, i.e. trichloro-acetic acid peel 20% [weekly] plus magnesium ascorbyl phosphate cream [applied once daily], while patients in group B were subjected to trichloro-acetic acid peel 20% [weekly] alone. Treatment was continued for 6 weeks. After completion of treatment, MASI score was recalculated

Proportion of patients with significant MASI score reduction was compared using chi-square test with significance at p < 0.05

Results: Male and female patients were 11 [14.9%] and 63 [85.1%], respectively in group A, whereas 13 [17.6%] and 61 [82.4%] in group B. The mean age in group A was 30.28 +/- 8.08 years, and 29.36 +/- 6.84 years in group B. Significant MASI score reduction in group A was seen in 60 [81.1%] patients and in group B 49 [66.2%, p= 0.040]

Conclusion: Combination of trichloro-acetic acid peel and topical magnesium ascorbyl phosphate cream was significantly more effective than trichloro-acetic acid peel alone in treatment of melasma

Juvenile hyaline fibromatosis

Juvenile hyaline fibromatosis is a rare, autosomal recessive disease. We report a 4-year-old female born of first-degree consanguineous marriage, presenting with gingival hyperplasia, nodular swellings involving the both pinna and right ankle joint. She had contractures of elbows, knees and shoulder joints, restricting the movements of these joints. Cutaneous examination revealed erythematous papules and plaques involving the nape of neck and the perianal region. Histological examination revealed deposition of PAS positive amorphous eosinophilic hyaline material with scattered intervening fibroblast like cells resembling chondroid cells. The patient was diagnosed as a case of Juvenile hyaline fibromatosis based on characteristic clinical and histopathological findings

Management of supracondylar fracture of humerus in children by close reduction and immobilization of the elbow in extension and supination

A Supracondylar fracture of the humerus is the most common fracture in children around the elbow and is also called first decade injury. If not treated properly it may lead to disability due to elbow stiffness, and sequel of neuro-vascular injuries like Volkmann ischemic contracture etc. This study was undertaken to determine the outcome of close reduction and immobilization of the elbow in extension and supination in displaced supracondylar fractures of the humerus in children. This Quasi-experimental study was conducted in the Department of Orthopaedics, Postgraduate Medical Institute, Lady Reading Hospital Peshawar, from January 2007 to December 2007. The inclusion criteria was Gartland Type III [completely displaced] supracondylar fractures of the humerus and the exclusion criteria was open or closed Gartland type-III fracture associated with neurovascular injury. Close reduction under general anaesthesia was done and the elbow was immobilized in extension by the application of 2 plaster slabs according. The follow up is based on the overall rating using the modified Flynn global criteria. Out of 70 cases, in 56 cases [80%], reduction was acceptable; while in 14 cases [20%] it was unacceptable. Those with unacceptable reduction, 2nd attempt of close reduction were done but only eight were successful and the other six children required open reduction and internal reduction. Those with acceptable reduction went in to union with the carrying angle +/- 5 of the contra-lateral side and full range-of-motion. Excellent result were achieved in 35 cases [50%], good in 15 cases [21.43%], fair in 4 cases [5.71%] and poor in 6 [8.75%] patients. The extension method of close reduction and immobilisation with two slabs is safe method and give better cosmetic results in uncomplicated type III injures as compared to the flexion method

Preventive role of zinc chloride against toxicity of ciprofloxacin on the growing cartilage of wistar albino rat litter

To assess the preventive role of zinc chloride on toxicity of ciprofloxacin administration in wistar albino rat litter. It was a Prospective experimental study. The study was carried out in the department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, Pakistan during March 2002 to February 2003 one year study. Ciprofloxacin and zinc chloride were administered to newly born albino rat litters separately and simultaneously at a dose of 20 mg/kg body weight and 1200 micro g/Kg body weight respectively, intraperitonealy twice daily from 1-14 day after birth. The animals were sacrificed by deep ether anaesthesia. The fore and hind limbs were dis-articulated from the axial skeleton, soft tissue was removed and bones were fixed in 10% buffered formalin. Decalcification was done in 10% nitric acid and 10% formic acid changes. After paraplast embedding, 4 micro m thick longitudinal sections of proximal and distal ends of long bones were cut by a rotary microtome. Routine staining with haemotoxylin and eosin was performed. Histomorphometery was done to measure the thickness of epiphyseal cartilage and was compared with similar values of the control animals. The results were statistically analyzed to evaluate the significance. Our study revealed that ciprofloxacin administration in new born albino rat litter decreased the width of epiphyseal growth plate cartilage by 13.7 +/- 0.42 micro m, 10.43% in humerus and 6.6 +/- 1.2 micro m 4.72% in femur as compared to control, whereas, simultaneous zinc chloride administration restricted the decrease to 1.27 micro m +/- SD in humerus and 2.05 micro m +/- SD in femur. Simultanous zinc chloride administration minimized the epiphseal cartilage damage induced by ciprofloxacin in Wistar albino rat litter

Inherited dyslipidaemic disorders contributing to coronary heart disease

Lipoprotein [a] [Lp [a]] is an established independent risk factor for premature myocardial infarction [MI]/coronary artery disease [CAD]. The study was conducted to determine the value of Lp [a] in prediction of CAD or MI in the offspring at risk. A total of 160 subjects were investigated. Serum Lp [a] was measured by ELISA, serum total cholesterol, triglycerides [TG] and HDL-Cholesterol by enzymatic colorimetric methods using standard kits. Differences in levels of total Lp [a] and cholesterol were observed between patients and controls. Both Lp [a] [16.23 +/- 1.95 mg/dL] and cholesterol [175.00 +/- 7.60 mg/dL] of group A [patients] were higher than the corresponding controls. However an opposite trend in results was noted for serum HDL-Cholesterol in patients vs. controls. Persons found to have elevated levels of Lp [a] should focus on controlling the known modifiable risk factor for heart disease, especially smoking, hypercholesterolemia, obesity, hypertension and sedentary life style

Comparison of lipoprotein [a] and serum cholesterol in offspring of patients diagnosed as myocardial infarction

The value of lipoprotein [a] [Lp[a]] in the prediction of coronary artery disease [CAD] or myocardial infarction [MI], is an established independent risk factor for premature MI. This study was conducted to diagnose offspring at risk. Material and A total of 120 subjects were investigated. Serum Lp [a] and total serum cholesterol were measured by ELISA and serum cholesterol by enzymatic colorimetric [CHOD-PAD] method using standard kits from Spincreact, Spain. Differences in levels of total Lp [a] and cholesterol were found between patients and control. Both Lp [a] 16.23+1.99 mg/dL and cholesterol 175.0+7.63 mg/dL of patients were higher than the controls. Lp [a] is a strong lipid variable predisposing to CAD