Variant Cutaneous Manifestations of Extra Pulmonary Tuberculosis

Background: Ulcers and surgical wounds not healing well andexpectedly are common problems among patients in countrieslike us. Ulcers may develop spontaneously or following apenetrating injury. Wounds not healing well are commonamong poor, lower middle class and middle class people.Postsurgical non-healing wound or chronic discharging sinusesat the scar site are also common in that class of people.Suspecting malignancy or tuberculosis in these types ofwounds we have sent wedge or excision biopsy for theseulcers in about 500 cases and found tuberculosis in 65 cases.In rest of the cases histopathology reports found as nonspecific ulcers, malignant melanoma, squamous or basal cellcarcinoma, Verruca vulgaris.Objectives: To find out the relationship of tuberculosis withchronic or nonhealing ulcers.Methods: This is a prospective observational study conductedfor patients coming to our chambers, OPD of a district generalhospital and Shaheed Suhrawardy Medical College Hospital,Dhaka.Results: Mean age of the study subjects were 28±2. Amongthe study subjects nonspecific ulcer or sinus tracts were foundin 418 (83.6%), tuberculosis in 65 (13%), Malignant melanoma7 (1.4%), Verruca vulgaris 5 (1%), squamous cell carcinoma3(0.6), basal cell carcinoma 2 (0.4%). Biopsy done only forvery suspicious ulcers or wounds.Conclusion: With this very small sample size it is difficult toconclude regarding incidence of cutaneous involvement ofextra pulmonary tuberculosis, but every clinician should think ofit in case of suspicious non healing wounds, ulcers andprolonged discharge from a surgical incision site.

Asthma control among asthmatic patients: a single center study

Background: Asthma, when uncontrolled is a crippling condition and due to increasing allergens, the patients are increasing in number worldwide

Objective: To determine the level of asthma control in southern Punjab and impact of education level, habitat and gender on it

Subjects and Methods: This cross sectional study was conducted in the outpatient consultant's clinic, Bahawal Victoria Hospital, Bahawalpur, from 1[st] February to 30[th] September, 2011. All the patients diagnosed as having asthma by the physicians, were interviewed about the control of asthma. The data was collected on a questionnaire that included questions on the level of control of asthma and other related variables. Data was entered and analyzed by SPSS version 10

Results: A total of 768 patients were included in study, out of which 75% were having poorly controlled asthma. There were 224 [29.2%] females and 544 [70.8%] males. Fifty percent patients were of young age group. Middle age and elderly were 37% and 12% each. In the patients of urban area 61.53% were educated while from rural area 38.46% were educated. Among poorly controlled asthma group 320 [55%] were from rural area and 256 [44%] from urban area. In poorly controlled group 32 [5.55%] were on no treatment. Hundred percent of partially controlled and well controlled were having physician prescriptions. In well controlled group 64 [66.66%] were young. In poorly controlled group 288 [50%] were young. In well controlled group 100% were educated while in poorly controlled group 288 [50%] were uneducated. In poorly controlled group 32 [5.55%] were on no treatment while 544 [94.44%] were on some medications with prescription. In fully controlled group 100% patients had prescription

Conclusion: Asthma control is mostly poor in rural areas of Southern Punjab and almost half of the patients are uneducated, and young

Hyperuricaemia and the risk of ocular complications in tuberculous patients during therapy

Objective: To determine the risk of ocular complications due to hyperuricaemia in tuberculous patients during therapy. Material and Methods: The study was canducted in chest ward and eye ward BVH, Bahawalpur in collaboration with Department of Chemical Pathology, QMG, Baharvalpur from July 2009 to July 2011 One thousand and fifty tuberculous patients [850 males and 200 females, aged 18 - 70 years] receiving four standard drugs i.e; rifampicin. pyrazynamide, ethambutol, and isoniazid, were included in the study. Approved and fixed dose combination of four drugs of proven bio equivalency was used Serum uric acld and creatinlne levels were estimated on fujly automated chemistry analyzer SELECTRA-XL [Merck Diagnostics] using Merck reagents. before the commencement of treatmenl. Ophthalmic examination of all the patients included in the study was also done by funduscopy and on slit lamp before starling therapy. At 8-1 2 weeks after commencement of therapy serum uric acid and crealinine levels were measured along with fundoscopic and slit lamp examination on all patients under srudy subjects to diagnose any ocular complication by an ophthalmologist. Results: All patients study subjects had hyperuricaernia [mean=9.60 mg/dl +/- 3.4 SD] and ncrmal creatinine. Syrnploms of visual blurring from the corneal haze or foreign body sensation due to epithelial breakdown were found in 86% of study subjects. Uveitis was found in 2 percent of the patients. Scleritis and Episcleritis was seen in 4% of the patients. Corneal deposits of urates were found in 0.5% subjects whiie conjuntiual urate crystals were found in 8.5% of the subjecls Conclucian: Hyperuricaemia is an important risk factor for ocular complications and starts almost after 8-12 weeks of cornmcncement of antituberclosis treatment. If it is left undiagnosed, sight-threatening effects can occur

Evaluation of the relative efficacy of an allograft used alone and that in combination with simvastatin in the treatment of human periodontal infrabony defects - a clinical and radiological study

Simvastatin has been found to cause increased bone formation in vitro and in animal studies. However, its effect on periodontal reconstruction in humans is yet to be determined With this study an attempt was made to evaluate the effects of a combination of simvastatin drug with Demineralised Freeze-Dried Bone Allograft [DFDBA] and also to compare the efficacy of this combination with that of DFDBA alone in the treatment of human periodontal defects. Fifteen patients with almost identical bilateral 2-walled or 3-walled infrabony defects were selected. Defects on the right side [Group A] were treated with the placement of DFDBA alone while those on the left side [Group B] were treated using a combination of DFDBA and a 10-8 M solution of the drug simvastatin. Two clinical parameters namely probing pocket depth and clinical attachment level and one radiographic parameters namely infrabony defect depth were measured preoperatively and 12 and 24 weeks postoperatively. DFDBA alone as well as the combination of DFDBA and simvastatin resulted in a highly significant mean reduction in probing depth, gain in clinical attachment level, and linear defect fill. The values of mean changes in parameters were significantly greater with the drug-graft combination in comparison with the graft alone. Combination of DFDBA with a solution of simvastatin leads to significantly greater reduction in probing depth, gain in clinical attachment level, and linear defect fill than when the graft is used alone in the treatment of human periodontal infrabony defects