Burns in children; early versus late excision and grafting

Burns are among the most devastating of all home injuries with formidable sequelae ranging from considerable physical disability to emotional and mental trauma. Patients of burn require prolonged hospitalization resulting into considerable financial burden on patient as well as the state. Treatment of burns can be made cost effective by early excision and grafting of the burned areas. A randomized controlled study was conducted to evaluate the efficacy of early versus delayed excision and skin grafting in pediatric burns. Out of 80 burned children, 30 underwent early excision and grafting whereas 50 were treated with delayed excision and grafting. Mean percent graft take was 96.67 in early and 88.40 in delayed group. Over all post operative complications like minor graft rejection was found in 26% cases of early and 48% of delayed group whereas major graft rejection was found in 14% of delayed group only. Post operative contractures developed in 8% of delayed group. Mean hospital stay was 13.66 and 37.46 days for early and delayed excision and grafting respectively. Early excision and grafting in pediatric burns is a superior and cost effective to delayed excision and grafting in terms of post operative complications, cosmesis and hospital stay

Oesophageal atresia: role of gap length in determining the outcome

Twenty neonates born with oesophageal atresia and tracheoesophageal fistula over a period of two years were managed and the role of gap length between the two ends of oesophagus on the outcome was studied. Twelve [60%] were males and 8 [40%] were females. Body weight ranged from 2.2 kg to 3 kg. Only 2 [10%] were received within 24 hours of birth. Six [30%] were received within 48 hours of birth, 3 [15%] were 3 days old and 9 [45%] were 6 days old at the time of admission. Gap between the upper pouch and the lower fistulous end of oesophagus was 2cm in 4 [20%], >2cm but 3cm in 8 cases [40%] and >3 cm in 8 [40%] cases. Preoperatively chest infection was found in 16 [80%] cases. Associated congenital malformations were found in 7 [35%] cases. Primary anastomsis of Oesophagus was performed in all the cases. In order to relieve the tension on the anastomosis upper segment circular myotomy was performed in 8 [40%] cases. Post operative survival was 45%. Early postoperative complications among survivors included anastomotic leak in 3 [33%], pneumonia in 2 [22%] and wound infection in 2 [22%] cases. Late complications included gastroesophageal reflux in 7 [78%] and stricture formation in 6 [67%] cases. Major cause of death was sepsis secondary to chest infection. Authors conclude that prognosis of oesophageal atresia-tracheoesophageal fistula is excellent in children born with gap length 2cm. Morbidity and mortality increases proportionately as gap length increases beyond 2 cm

Allergic contact dermatitis: a comparison between atopic and non-atopic individuals

To determine the prevalence of ACD in atopics in comparison to non-atopics in our community. Design: Cross-sectional study. Place and Duration of Study: Departments of Dermatology, King Edward Medical College/Mayo Hospital, Lahore, from May 1998 to July 1999. Subjects and Two hundred and fifty patients, 34 with past or present atopic dermatitis [Group I], 88 with personal or familial atopy [Group II] and 128 non-atopic with contact dermatitis [Group III] were subjected to patch testing with European standard series. The results were interpreted according to International Contact Dermatitis Research Group guidelines. Positive reactions were seen in 50%, 70.4% and 67.8% of patients in the respective groups [p>0.05]. Our results suggest that atopics are equally affected with contact dermatitis as compared with non-atopics and recalcitrant cases of atopic dermatitis should be patch tested to find out aggravating factors

Antenatal diagnosis of beta thalassemia in pregnancy

To evaluote fetal status for B. Thalassemia. During 1994-99, one hundred and twenty women with B thalassemia minor underwent Chorion Villus Biopsy in early pregnancy to determine the fetal status. Aga Khan University Hospital, Karachi. Seventeen pregnancies were found to have B. Thalassemia major, 86 embryos had B. Thalassemia minor and seventeen were Thalassemia free. All the couples were given genetic counselling to make decision regarding management of the current pregnancy affected by B. Thalassemia. During initial phase of this study the undesirable side effects of the trans vaginal procedure in 2 cases were excessive vaginal bleeding and abortion. The sample was obtained after two attempts in these cases

Tinea capitis: a family problem

To determine the frequency of a positive family history of dermatophytosis and the presence of a separate focus of dermatophytic infection in patients with tinea capitis. A prospective, cross-sectional study. A total of 100 patients with mycologically proven tinea capitis were examined, and a family history was taken of dermatophytic infections in family members. Clinical and mycological examinations of index cases as well as of affected family members were carried out. Department of Dermatology, Mayo Hospital/King Edward Medical College, Lahore. Sixty eight patients [68%] had a positive family history of dermatophytosis and 17 [17%] had a focus of dermatophytic infection other than tinea capitis. A family history of tinea capitis or other dermatophytosis is a frequent accompaniment, in patients with tinea capitis. Also, some patients have another focus of dermatophytic infection in addition to the tinea capitis. These factors may serve as course of infection in the patient as well as in the family and community

Cutaneous manifestations of diabetes mellitus: a study from Lahore, Pakistan

To assess the spectrum of cutaneous changes in diabetes mellitus in Lahore, Pakistan. Design; Prospective clinical study with follow up of 4 months. Setting; Medical outdoor and indoor, Mayo Hospital, Lahore. Subjects: One hundred adult patients of any age and either sex suffering from diabetes mellitus. Main outcome measures: Cutaneous manifestations. Of 100 patients, skin changes were found in 96% of patients [P<0.00001]. The most frequent finding was the cutaneous infections [55%]. Other common findings included: tingling and burning of feet [45%], sweating disorders [26%], tartar deposits [24%], gingivitis [22%], diabetic dermopathy [18%], generalized pruritus [15%], localized pruritus [15%] and thickened skin [12%]. Less common manifestations were: nail disorders [11%], skin tags [10%], cherry angiomas [7%], vitiligo [5%], foot ulceration [5%] and burning mouth [5%] Rare features were: insulin complications [3%], xanthelasma palpebrarum [3%], amputation toe [3%], callus and fissures over feet [2%], syndrome of limited joint mobility and waxy skin [2%] and eruptive xanthomas [2%]. Conclusions: There is significantly increased prevalence of cutaneous manifestations in our diabetic patients [p<0.00001]

open, non-comparative study for the evaluation of oral fluconazole in the treatment of tinea corporis, T. cruris, T.pedis

To assess the safety and efficacy of weekly 150mg doses of oral fluconazole for the treatment of tinea corporis/tinea cruris for upto 4 weeks and of tinea pedis for upto 6 weeks. Design: A total of 53 patients with mycologically proven tinea corporis, tinea cruris or tinea pedis [tinea corporis/tinea cruris, n=47; tinea pedis, n=6] were treated with 150 mg weekly doses of oral fluconazole. Patients were assessed clinically and mycologically at baseline, 2 weeks and then weekly till the last dose of medication was administered. Final follow-up was at 28-35 days after cessation of therapy. Settings: Department of Dermatology, Mayo Hospital, King Edward Medical College, Lahore, Pakistan. Clinical cure rate 28-35 days after cessation of therapy was 70% [72.3% for the tinea corporis/ tinea cruris group and 50% for the tinea pedis group], 30% showing moderate to marked improvement. Mycological eradication was seen in 47 patients [88.6%], [91.5% in tinea corporis/tinea cruris and 66.7% in tinea pedis], persistence in 3 [5.7%] [1 patient with tinea cruris and 2 with tinea pedis], and relapse in 3 patients [5.7%] [all 3 with tinea corporis/tinea cruris]. Mild side effects, not requiring cessation of therapy, were seen in 7 patients. Weekly 150mg doses of fluconazole are safe and effective when given for tinea corporis/tinea cruris for upto 4 weeks and for tinea pedis for upto 6 weeks

Pemphigus: epidemiological survival characteristics of 72 patients

From 1st October, 1991 to 30th September, 1992 an observational study was conducted on pemphigus patients presenting to the department of dermatology, Mayo Hospital, Lahore in order to document the epidemiological and survival characteristics. A total of 72 pemphigus patients were recorded. Thirty eight of these were already known to have the disease while 34 were seen for the first time. A majority of patients[76%] were from lower socioeconomic class. Pemphigus vulgaris was the most common type, accounting for 83% of the total patients, with female to male ratio of 4.4:1. Most of the patients were in third and fourth decades of life. Eight patients[11%] complained of exacerbation during summer and three [4%] had history of photosensitivity. In two patients disease relapsed at the site of trauma. Eleven deaths [15% mortality] occurred during this period either due to the disease itself or disease related complications

Randomized, comparative, study of 1% Naftifine cream [once daily] and 1% Tioconazole cream [twice daily] in the treatment of Tinea cruris Naftifine cream [once daily] and 1% Tioconazole cream [twice daily] in the treatment of Tinea cruris

To compare the efficacy and tolerability of 1% naftifine cream [once daily] and 1% tioconazole cream [twice daily] in the treatment of tinea cruris. A randomized, comparative study of 4-week treatment followed by 4-week of wash-out period. Out-patient Clinic of Department of Dermatology, Mayo Hospital, Lahore. Thirty-three adult patients of either sex or age suffering from tinea cruis. Efficacy i.e. response to treatment in terms of clinical improvement and negative mycology and safety i.e. adverse effects. Of 33 evaluable patients, 15 patients were treated with naftifine cream and 18 with tioconazole cream. Isolated pathogens included, Trichophyton rubrum [n=16], Epidermophyton floccosum [n=9], T. interdigitale [n=7] and T. violaceum [n=1]. Final evaluation at 8 weeks showed 100% efficacy in both the groups. both the drugs were well tolerated. Naftifine is equal to tioconazole in terms of efficacy and safety in the treatment of tinea cruris

Potency disorder among pathans

In a working class industrial area of Karachi hundred consecutive Pathans presenting to a family physician with potency disorder were examined. After exclusion of those with structural or drug related conditions, a structured proforma was introduced. Their presentation, associated symptoms and background pointed to masked depression and lack of sex education. Symptoms of anxiety were noticed in 49% and depressive features in 43%. The guilt feelings were reinforced by Hakims and lay literature which stress more on masturbation [79%] and spermatorrhoea [60%] and not extra-marital intercourse [52%] or bestiality [39%]

study of skin disease in Chitral

Two thousand six hundred and twenty five cases were examined in five different villages of Chitral to study the prevalence of skin disease. One thousand nine hundred and three [72.5%] were actually found to have a dermatological problem. Nail disorders [27.8%], pediculosis capitis [15.2%], branding [12.5%], mouth diseases [10.6%], hyperkeratosis [10.2%], cutaneous tumours [7.8%], eczema [6.6%], xeroderma [6.2%], insect bites [6%] and pityriasis alba [5%] were the ten common dermatoses

Study of fixed drug eruptions in Karachi

Thirty three patients with fixed drug eruptions were subjected to provocation tests. Cotrimoxazole was the commonest drug responsible, followed by trimethoprim, Beserol and tinidazole. There was cross sensitivity among sulphonamides. Polysensitivity was recorded with one case each of Ampicillin and Beserol to Cotrimoxazole