Zinc deficiency in patients with persistent viral warts

To determine the association of low serum zinc levels with persistent, progressive or recurrent viral warts. A comparative study. Dermatology outpatient department of Combined Military Hospital, Abbottabad in collaboration with Department of Chemical Pathology, Army Medical College, Rawalpindi, from June 2006 to May 2007. Seventy five patients having warts of more than six months duration, more than 10 in number, who either not responded to or had recurrence after previous treatments for viral warts and not having other chronic dermatological or systemic illness were included in the study after informed consent. Seventy five age and gender matched healthy individuals were taken as control. Serum zinc analysis was carried out by atomic absorption spectrometry using Perkin elmen [USA] apparatus. Independent sample t-test was used to compare mean zinc levels in microgram/litre with significance at p<0.05. Age of the patients as well as controls ranged from 12-65 years with a mean of 25.88 +/- 8.90 years. Serum zinc level was low in 42 [56%] patients and 24 [32%] controls [p=0.003]. Among the patients, serum zinc level ranged from 695-1090 micro-gram/litre with a mean of 804.38 +/- 100.60, whereas the level ranged from 690-1100 microgram/litre with a mean of 836.17 +/- 91.04 among controls [p 0.044]. Zinc deficiency is associated with persistent, progressive or recurrent viral warts in the studied patients. Randomized controlled trials with careful dose adjustment of oral zinc sulphate may be helpful to formulate guide lines to manage such patients

clinicopathological study of urethritis in males

To determine the etiology and frequency of different types of urethritis in adult males. A case series. The Dermatology Department of PNS Shifa Hospital, Karachi, from June 2004 to December 2007. One hundred male patients having complaints of urethral discharge and dysuria reporting in the skin OPD were included in the study. Patients who had received systemic treatment for their complaints and those who had other systemic infections were excluded. A detailed history including history of sexual contact was taken. Dermatological examination including examination of external genitalia was also performed. All these patients were subjected to complete physical examination, complete urine examination, urethral pus for gram staining and culture, endo-urethral swab with urethral loop for seeing Chlamydia antigen by fluorescent microscopy, cultures for ureaplasma and Wet mount specimen microscopy for trichomonas along with HIV [serum ELISA] test. Non-gonococcal urethritis was diagnosed on the presence of more than five polymorphonuclear leucocytes per high power field in at least five fields of Gram stained urethral smear, in the absence of Gram negative diplococci. The mean age was 29.2 +/- 5.8 years. Seventy [70%] cases were diagnosed as gonococcal urethritis and 30 [30%] cases as non-gonococcal urethritis [NGU]. History of illicit sexual exposure was available in 25 [25%] patients. The interval period between initiation of symptoms and reporting of patient in gonococcal urethritis was 4 to 30 days [mean 12.8 days] and 4 days to 2 months [mean 20.7 days] in non-gonococcal urethritis. The patients with gonococcal urethritis presented with purulent discharge in 66 [84%] cases, and dysuria in 49 [70%] cases. In the NGU group, 25 [80%] cases had mucoid discharge and 18 [65%] had dysuria. in 70%, Neisseria gonorrhoeae was isolated, Chlamydia trachomatis in 16%, ureaplasma in 8%, and Trichomonas vaginalis in 4%. No organism could be detected in 2% cases. HIV test was negative in all cases. Gonococcal urethritis was the commonest urethritis seen followed by Chlamydia infection in the studied group of adult males

Second opinion in pathology of lymphoid lesions- an audit

Errors in medical practice remain under intense scrutiny because of their human costs in terms of disability and suffering. Second opinion in histopathology is a safeguard against misdiagnosis before instituting major therapeutic endeavor. Lymphoid lesions are peculiar for their diagnostic evaluation as they require ancillary techniques and expertise in most cases. This review was undertaken to assess the magnitude of diagnostic discrepancies in lymph node lesions of surgical pathology. Forty cases of lymph node lesions initially reported from different centres and referred for second opinion during the year 2005 were included in the study. Special stains and immunohistochemistry were applied and initial diagnosis was compared with the review diagnosis. The discrepancies were divided into different categories keeping in view the implications on patient management. Of the 40 cases included in the study, there was agreement with the initial diagnosis on review in 11 cases. There was discrepancy between the initial and review diagnosis in 29 cases. Review is a sensitive and effective method for quality control and to identify areas of disagreement. Mandatory second opinion is a good policy in patient management where crucial therapeutic decisions are involved. It is highly suggested in cases where the histpathologist initially reporting the case does not have requisite ancillary techniques like immunohistochemistry