slit-skin smear an alternate to histopathology in the diagnosis of cutaneous leishmaniasis?

To determine how effective is slit-skin smear as a diagnostic test in comparison with the histopathology. This was a validation study, carried out in Combined Military Hospital [CMH] Kohat from 1st September 2011 to 30th June 2012. The study population was the patients who were clinically diagnosed as cutaneous leishmaniasis. Slit-skin smears were performed in all and a biopsy was sent for histopathology. The results were analyzed by cross tabs and chi square test. A total of 50 patients were included. They were all adult males. Leishman-Donovan [LD] bodies were seen in histopathology slides in 31 patients [62%] and were not detected in 19 patients [38%]. The slit-smear showed LD bodies in 18 smears [36%] and negative in 32 smears [64%] [p=0.048]. Histopathology is statistically superior investigation than slit-skin smear in the diagnosis of cutaneous leishmaniasis

Sensitivity and specificity of BerEP4 immunostaining in basal cell carcinoma cases in Asian skin

To evaluate the BerEP4 stain positive cases of basal cell carcinoma in our population [BCC]. A non-interventional descriptive study. Military Hospital and Armed Forces Institute of Pathology [AFIP] Rawalpindi from 1[st] January 2009 to 31[st] August 2009. Patients who reported to the skin department of Military Hospital Rawalpindi with clinical impression of BCC were biopsied. Only those cases which were easily diagnosed on Haematoxylin and Eosin [HandE] were included. All such sections were then subjected to BerEP4 immune marker and the intensity of staining was noted. In addition, 11 cases of straight forward squamous cell carcinoma [SCC] were also stained with BerEP4, which served as controls. The study group [BCC cases] included 17 males [59%] and 12 females [41%], who were histologically diagnosed as BCC. All such cases were subjected to BerEP4 immune staining. All the tumors showed positive staining, the intensity/staining pattern was however variable. Twenty-two out of twenty-nine cases showed diffuse [75.9%], while 7 out of 29 cases showed partial [24.2%] staining; irrespective of the histological subtype and site of tumor. All the SCCs were negative for BerEP4 staining. BerEP4 was positive in 100% of the cases. Its intensity was however variable. Nevertheless, it must be used with confidence in all difficult to diagnose cases of BCC, especially when it is difficult to differentiate from SCC

Miltefosine in treatment of old world cutaneous leishmaniasis in Pakistan

To evaluate the efficacy of miltefosine in the treatment of cutaneous leishmaniasis Uncontrolled, open label, quasi-experimental study Place and Duration of Study: The study was carried out in Military Hospital Rawalpindi and five other Army Hospitals from Jan 2006 to Aug 2006. This study was dome to investigate the efficacy of treatment of cutaneous leishmaniasis patients with oral miltefosine in doses of 2.5 mg/kg/day at 6 centers in Pakistan. The study was conducted among 90 hospitalized adult cutaneous leishmaniasis patients. All patients completed the full 28-days treatment course. The study revealed excellent response in 32[28.8%], good in 38[34.4%], fair in 17[15.3%] and poor in 3[2.7%] patients. Treatment-related adverse events were transient rise in ALT [95%], followed by myalgia [33%], arthralgia [15%], nausea vomiting [12%], bad oral taste [2%], testicular pain [4%], cough [2%], conjunctivitis [2%] and fever [1%]. All theses side effects were transient and settled on discontinuation of medication. Compliance was good The use of oral miltefosine in doses of 2.5 mg/kg/day is effective and well tolerated in old world cutaneous leishmaniasis

Fatal hemorrhagic chickenpox in a case of acute promyelocytic leukaemia

Chickenpox is a viral infection caused by varicella-zoster virus. The infection is rather benign in nature, but in patients with impaired immunity it may result in fatal complications like haemorrhagic chickenpox. The case below is an association of the above complication of chickenpox in a patient suffering from acute promyelocytic leukaemia

Role of correct dose of zinc sulphate in the treatment of acrodermatitis enteropathica in two siblings

Acrodermatitis enteropathica is a rare autosomal recessive disorder, caused by impaired absorption of zinc from gastrointestinal tract and results in several physical and psychological effects. It typically causes perioral and perigenital eczematous rash. The disease is treated by zinc sulphate powder but while calculating the dose of powder, due attention is not given to the amount of elemental zinc per mg of zinc sulphate powder, resulting in slow and incomplete response to the treatment

Granuloma faciale: an unusual presentation

Granuloma faciale is a rare skin disorder, characterized by asymptomatic cutaneous nodules on the face without any systemic manifestations. The disorder mainly affects middle-aged Caucasian males. One such case occurring in a young unmarried lady of 'Pathan' descent is presented here. The presentation was unusual due to the history of frequent swelling, redness and heat in her nodules without any known stimuli and spontaneous regression of the nodules to the original size in a few hours. The patient was treated with a combination of cryotherapy and intralesional corticosteroids with excellent results

Efficacy of rifampicin in eradication of carrier state of staphylococcus aureus in anterior nares with recurrent furunculosis

To compare the frequency of detection of Staphylococcus aureus carrier state in anterior nares of the patients suffering from recurrent furunculosis with the normal population and to determine the efficacy of rifampicin in eradication of the carrier state. Quasi-experimental study. Skin Department of Combined Military Hospital, Peshawar and Multan, from March 2004 to December 2005. Patients and The study consisted of 80 individuals. They were placed in two groups. Group I comprised of 40 patients suffering from recurrent furuncles and group II included 40 healthy adults, kept as controls. Nasal swab was taken from the individuals belonging to both the groups, when they first reported to skin OPD. The patients who were suffering from furuncles were treated with co-amoxiclav 375 or 625 mg three times a day. The patients in whom S. aureus carrier state was detected were again divided into two groups. Group 1 was prescribed rifampicin 450-600 mg daily [depending on the body weight] for 10 days, while the group 2 was not offered any treatment. After this course, a second nasal swab was taken and submitted for cultures. Among the 40 patients belonging to group I, S. aureus carrier state was detected in 23 [57.5%], while in group II the carrier state was found in 8 [20%] individuals [p <0.001]. Among the 13 patients who received rifampicin, 10 got cured of carrier state, while in 3 patients nasal swab was still positive after a course of rifampicin. In 10 patients, who were not offered any treatment, the nasal swabs remained positive [p<0.001]. These patients were followed-up in skin OPD for another 3 months, and did not develop any recurrence of the infection. Nasal swab for detection of S. aureus carrier state should be done in all patients of recurrent furunculosis. If the nasal swab culture is positive, then as the infection gets cured, the patients should receive a course of rifampicin for 10 days. This may eradicate the carrier state in majority of cases and prevent the recurrence of the infection

Honey compared with 1% silver sulfadiazine cream in the treatment of superficial and partial thickness burns

To assess the efficacy of honey compared with 1% silver sulfadiazine cream as a burn dressing for the treatment of superficial and partial thickness burns covering less than 15% of the body surface. In a randomized comparative clinical trial, carried out at the Surgical Department, of Combined Military Hospital, Bahawalpur, from September, 2002 to August, 2003, 50 patients were selected for the study. They were randomly assigned to two groups. Each group contained 25 patients. Patients in group-I were treated with pure honey which was applied once daily after the wound was cleaned with normal saline. Patients in group-II were similarly dressed with a layer of 1% silver sulfadiazine cream once daily. The effectiveness of the two modalities of treatment was judged on the basis of time taken for the wounds to heal, to be relieved of pain and to get sterile. In group-I [treated with honey], 52% of the patients had all the burns healed after 2 weeks and 100% got cured after 4 weeks. In group II [treated with 1% silver sulfadiazine], 20% of the patients had their burns healed after 2 weeks, 60% after 4 weeks and 100% by the end of 6 weeks of the treatment. As regards pain relief, all the patients of group-I were relieved of pain after 3 weeks of the treatment. On the contrary it took 4 weeks for all the patients of group-II to be free of pain. Lastly, it took 3 weeks and 5 weeks for positive swab culture from the wound to get sterile with honey and 1% silver sulfadiazine cream, respectively. With all the three criteria used to compare the effectiveness of the two modes of burn wound treatment, honey was found superior to silver sulfadiazine

Frostbite in gangrene; role of classification

The objective of this study is to determine if classification of cases of frost bite in 1st, 2nd, 3rd and 4th degree have any predictive value on the future complications e.g. skin necrosis and gangrene. A non-interventional and descriptive study. The study was carried out at the Surgical Department, of Combined Military Hospital Gilgit from January 2002 to February 2005. All the patients who reported to the hospital with frost bite were admitted and enrolled in the study. The local examination of wound was done and all the physical signs were recorded, The frost bite was labeled according to the severity from 1st to 4th degree in accordance to the specified criteria. All the patients were placed on a standard treatment protocol comprising of injection of Benzyl Penicillin 10 lac U x 6 hourly, injection of Heparin 5000 IU s/c x 6 hourly and tablets Ibuprofen 400mg x 8 hourly for 5-7 days. The condition of wound was assessed daily till 8 weeks after admission. The end point of medical treatment was a clear demarcation of dry gangrenous and viable tissue, or the formation of moist gangrene or infection in frost bitten area which was spreading proximally. Once this condition was reached the patients were planned for amputation surgery. Total numbers of patients included were 96. Among them 33 had 1st degree, 37 had 2nd degree, 16 had 3rd degree and 10 had 4th degree frost bite. All the 33 patients of 1st degree frost bite recovered well and were discharged from the hospital without any surgical intervention. 16 patients among the total 37 who sustained 2nd degree frost bite developed superficial ulcers over the skin. These patients required regular wound dressings and recovered well by 6 weeks of treatment without any limb loss. 7 out of total 16 patients of 3rd degree and all the 10 patients of 4th degree frost bite developed gangrenes. They were observed till 8 weeks and after that they underwent amputations. In accordance to the results it is concluded that most of the patients who had r degree of frostbite and all the patients who sustained 4th degree frost bite developed gangrene by 8 weeks of hospitalization despite of the treatment. None of the patient of 1st and 2nd degree frostbite developed gangrene. Hence the initial assessment of a patient was very useful in predicting the chances of development of gangrene

Recent advances in the management of tuberculosis

The importance of tuberculosis in Pakistan and other underdeveloped countries cannot be over emphasized. Despite inclusion of BCG vaccination in the EPI program and availability of the anti-tuberculosis medicines at affordable prices, tuberculosis is still the number one cause of prolonged morbidity. The emergence of Human Immunodeficiency Virus and multidrug resistant tuberculosis has added another dimension to an already complicated situation of tuberculosis globally. In response, vigorous efforts have been made to stratify the patient population and streamline the treatment of various categories of tuberculosis patients

Cutaneous vasculitis

Vasculitides constitute a heterogeneous group of inflammatory disorders involving walls of blood vessels of integument and viscera. Depending on the size of blood vessels affected and organs involved, different subsets can vary in clinical presentation, histopathology, laboratory markers, treatment and prognosis. The present review focuses on recapitulating the vasculitides involving skin in a tabulated form

Fine needle aspiration cytology versus histopathology in the diagnosis of cutaneous leishmaniasis in Pakistan

To compare FNAC with histopathology as an alternate method of diagnosing cutaneous leishmaniasis. Comparative study. The duration of the study was from August 2003 to April 2004 at CMH, Peshawar. A total of 40 patients were included in this study. They were referred from various areas of North-West Frontier Province. FNAC and skin biopsy was performed on every patient. Haematoxylin and eosin [H and E] stain was used for both procedures. The study group included 39 males and one female, their age ranging from 8-60 years with a mean age of 31.97 years. Detection of LT bodies was considered as a single criterion of the positive result. Histopathological examination was able to diagnose 14 out of 40 patients [positive yield of 35%], while FNAC picked up 11 out of 40 patients [positive yield of 27.5%]. FNAC is easier, less painful and more cost-effective than the conventional skin biopsy. The high sensitivity and specificity eliminate the need for other time-consuming and invasive procedures. However, if LT bodies are not detected then any further comment cannot be made regarding the diagnosis and it is necessary to perform skin biopsy

Unilateral tuberous sclerosis complex

Tuberous sclerosis is a rare genetic disease of autosomal dominant inheritance, associated with hamartomata formation in several organs and various skin findings. A case of young male is presented here with multiple fibromas on right side of his face, peri-ungual fibromas in right index and middle fingers and right second toe, a small shagreen plaque over right lower back and multiple, ill-defined hypopigmented patches over his right side of the trunk and right buttocks. Fundoscopic examination revealed retinal phacomas on right side. CT-scan brain showed right-sided paraventricular calcification

Diagnositc yield of various traditional laboratory investigations in the diagnosis of cutaneous leishmaniasis

Leishmaniasis is a tropical protozoal infection endemic in certain areas of Pakistan. The clinical diagnosis of disease can be confirmed by various laboratory investigations like direct microscopy, culture, Leishmanin test and newer serological tests. To determine the diagnostic yield of Leishmanin test, direct microscopy and leishmania culture in the diagnosis of cutaneous leishmaniasis in Pakistan. Patients and methods In this observational study conducted at the Skin Department, PNS Shifa and DESTO Laboratories, Karachi, 40 patients were included. Leishmanin test, direct microscopy and leishmania culture was performed on all these patients. Leishmanin skin test was positive in all the 40 patients [100%], direct microscopy of the smear in 28 patients [70%] and Leishmania culture in 32 patients [80%]. Traditional methods of diagnosis have a high yield of positivity in the diagnosis of cutaneous leishmaniasis

Furuncular myiasis by Tumbu fly

To study cases of furuncular myiasis by tumbu fly [Cordylobia anthropophaga] among Pakistani troops in Sierra Leone, Africa. Design: Observational study. Place and Duration of Study: Pakistani troops in Sierra Leone, Africa. The duration of the study was 1 year, from July 2001 to August 2002. Subjects and Two hundred and forty-eight cases of furuncular myiasis were observed among Pakistani soldiers. All the patients were male. The lesions were treated by removal of the larva followed by twice daily application of an antibacterial ointment. The extraction was done by injecting 2% xylocaine over the base of the nodule. Care was exercised in not damaging the larva while extracting. The ages were from 22 to 43 years. Mean age was 29.42 years. The patients presented with a solitary lesion [178 out of total 248 cases, 71.8%] or multiple lesions [70 out of 248 cases, 28.2%]. The lesions were almost always on the non-exposed parts of the body [239 cases out of total 248 cases, 96.37%]. One case presented with a lesion on the face and 8 cases had lesions over dorsum of hands or feet. This disease is common in tropical Africa. The knowledge of the disease, its management and prevention is necessary for all the individuals who are planning to visit tropical Africa

Efficacy of allopurinol compared with pentostam in the treatment of old world cutaneous leishmaniasis

To compare the efficacy of allopurinol, a uricosuric compunde antimony compounds. Design: Randomized comparative clinical trial. Setting: Skin department, PNS, Shifa, Karachi. Subjects and Forty patients suffering from old world cutaneous leishmaniasis were randomly divided in two groups of 20 patients each. The diagnosis was confirmed by direct microscopy of the smear or leishmania culture. The first group received pentostam injection and the second group was given zyloric [allopurinol] tablets. The duration of treatment in both groups was 2 weeks. At the end of the study 70% of the patients on allopurinol and 85% on pentostam got cured. There was no significant side effect noted in either of the two groups. Allopurinol is quite an effective drug for the treatment of cutaneous leishmaniasis in Pakistan