ABSTRACT
Objective: To compare the efficacy of oral zinc sulfate [ZnSO4] with intramuscular meglumine antimoniate [MA] in the treatment of cutaneous leishmaniasis
Study Design: Randomized controlled trial
Place and Duration of Study: Dermatology Department, Military Hospital, Rawalpindi from 1st May 2013 to 1st Jan 2014
Material and Methods: Eighty patients of cutaneous leishmaniasis from dermatology OPD fulfilling the inclusion criteria were selected after informed consent and permission from Hospital Ethical Committee. Using simple randomization patients were assigned into two treatment groups. Group A received oral zinc sulfate in a dose of 10 mg/kg/day during 45-day period in three divided doses, and group B received systemic MA [glucantime] 20 mg/kg/day intramuscularly for 20 days. The size and induration of lesions was measured by ruler and palpation respectively. Patients were followed up till the end of treatment. Three patients were excluded from the study due to discontinuation of treatment. Acceptable cure indicated efficacy at the end of treatment duration
Results: In group A 14 [35.9%] patients had moderate improvement followed by total clearance in 12 [30.8%] patients. In group B, majority of the patients i.e. 26 [68.4%] patients had total clearance followed by moderate improvement in 9 [23.7%] patients. Group B had significantly better response as compared to group A. Efficacy of the drug was significantly higher in group B as compared to group A [p = 0.001]
Conclusion: Oral zinc sulfate 10mg/kg is not better than intramuscular MA in treatment of cutaneous leishmaniasis but can be considered as a treatment option if MA cannot be used
ABSTRACT
To determine the efficacy of combined treatment with narrowband ultraviolet B phototherapy [NB-UVB] and topical tacrolimus in comparison with NB-UVB alone with placebo control in the treatment of vitiligo affecting face and neck. We included 60 patients with vitiligo affecting face and neck with or without involvement of the rest of body, in this randomized, double-blind, placebo-controlled trial. The patients were randomly allocated in two groups as A and B. Topical 0.1% tacrolimus ointment was given for vitiligo patches twice daily in group A, while placebo ointment was given to be applied in similar way for vitiligo patches in group B. Tri-weekly NB-UVB for depigmented areas with starting dose of 0.1J/cm2 with increment of 10% at every visit was given to the patients in both groups. Percentage of depigmented patches was calculated at the baseline, 1, 2 and 3 months. All patients completed the treatment period of 3 months. The mean response at the end of the 3rd month revealed excellent response [>75% repigmentation] in 16 [53.3%] patients in group A and 9 [30%] patients in group B. Good response [50-75% repigmentation] was seen in 11 [36.7%] in group A and 12 [40%] patients in group B. Moderate response [25-49% repigmentation] was shown by 3 [10%] patients in group A and 5 [16.7%] patients in group B. None of the patient showed poor response [<25% repigmentation] in group A, however 4 [13.3%] patients showed poor response in group B. Comparison of efficacy in both groups show excellent and efficacious response in 16 [53.5%] of patients in group A and in only 9 [30%] of patients in group B [P <0.05]. Combined treatment with NB-UVB and topical 0.1% tacrolimus ointment in comparison with NB-UVB with placebo control in the treatment of vitiligo affecting face and neck is more effective
ABSTRACT
Workplace-based assessments [WPBAs] refer to the assessment of working practices based on what doctors actually do in the workplace and is predominantly carried out in the workplace itself [PMETB, 2007]. WPBAs should be recognized as a series of essential educational events along a learning trajectory. WPBAs are an essential part of an assessment system alongside traditional examinations. The primary purpose of WPBAs is to provide constructive feedback to the trainees. The trainer is required to identify trainees not progressing along their structured learning plan so that early remedial action can be initiated. An understanding of the acceptable level of clinical competence required for a particular stage of learning is essential. This will ensure that the patients are safe during training through appropriate supervision and assessment. Stakeholders [trainers, trainees, managers, patients] should actively be involved in the development and implementation of the programme to ensure transparency and understanding of the process