Efficacy of narrowband ultraviolet B phototherapy with needling in patients of vitiligo

Objective: To determine the efficacy of narrowband ultraviolet B therapy [NBUVB] with needling in patients of vitiligo

Methods: A total of 100 cases were included in this study. In each patient a patch of 15 to 5 cm diameter skin area was selected as a target lesion for the study. Needling was done on the whole patch with a disposable insulin syringe, from the pigmented margins or the islands in the vitiliginous patch. After the procedure, the whole patch was subjected to NBUVB. The repigmentation was assessed according to 5-grades scale. Results: Out of 100 patients of vitiligo, 45% males and 55 % females, treated with NBUVB with needling, 58% patients showed grade 4 response i.e. 75% or more repigmentation

Conclusion: Narrowband UVB with needling is an effective, useful and well-tolerated therapy for treatment of vitiligo

Frequency of dyslipidemia in patients with psoriasis

To determine the frequency of dyslipidaemia in psoriatic patients. A cross-sectional study was carried out in the Department of Dermatology, Jinnah hospital, Lahore for the duration of six months. A total of 120 patients suffering from psoriasis, of any severity, belonging to either sex and with age between 15-70 years were included in the study. All patients in the study were investigated for total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins after 12-14 hours of overnight fasting. The mean age of the patients was 38.59 +/- 13.86 years. There were 78 [65%] male and 42 [35%] female patients. The mean duration of psoriasis was 5.46 +/- 4.49 years. The mean PASI score was 14.98 +/- 8.95. There were 67 [55.8%] patients having dyslipidaemia and 53 [44.2%] patients had normal lipid levels. 34 [28.3%] patients had raised total cholesterol [>200mg/dl], 32 [26.7%] raised low-density lipoprotein-cholesterol [>130 mg/dl], 44 [36.7%] hypertriglyceridemia [>150mg/dl] and 35 [29.2%] patients had reduced high-density lipoprotein-cholesterol [> 130 mg/di], 44 [36.7%] hypetriglycerideia [> 150 mg/d] and35 [29.2%] patients had reduced high-density lipoprotein-cholesterol levels [< 40 mg/dl] it is concluded from this study that patients of psoriasis have a high incidence of dyslipidaemia, as it was found in 55.8% of psoriasis patients

Herpes zoster in children

To study the epidemiology and clinical features of childhood herpes zoster. The study was carried out from March 2008 till February 2012. Forty two cases of herpes zoster in children less than 12 years of age were enrolled from the outpatient departments of Lahore General Hospital and Jinnah Hospital Lahore. Patients were subjected to detailed history, physical examination and relevant investigations. Out of 42 patients with herpes zoster, 57.1% were males and 42.9% were females. The mean age was 8 years with an age range of 18 days to 12 years. In most patients a single dermatome was involved [69%] and thoracic dermatome was involved in the majority [40.4%]. The most common symptom was pruritus in 52%, followed by pain in 12%. A positive history of previous exposure to varicella was present in 31% patients only, and out of these 61% were exposed before the age of two years. Six patients gave history of chickenpox in mother during pregnancy. Majority of patients i.e. 83.3% showed no evidence of immunosuppression on history, examination and investigations. Three patients were anti-HCV positive [7.1%], two [4.6%] had tuberculosis, one [2.3%] patient was taking steroids and one [2.3%] was diagnosed as leukemia. Most of the children with herpes zoster had no obvious evidence of immunosuppression. History of previous exposure to varicella was found in only 31% with majority being exposed below two years of age. Herpes zoster is a relatively mild disease in children with pruritus being the main symptom in 52% and pain occurred in only 12% of cases.

Necrolytic acral erythema: an unusual cutaneous presentation of hepatitis C virus infection

Necrolytic acral erythema [NAE] is a newly recognized dermatosis which has been regarded as early cutaneous marker of hepatitis C virus [HCV] infection. It presents as a well demarcated, dusky, symmetrically distributed erythematous to violaceous eruption with marked hyperkeratosis and lichenification associated with pruritus or burning on the dorsal aspects of feet extending to the toes. It shows clinical and histopathological resemblance to other necrolytic erythemas. We report a case of a-55-year-old woman with itchy hyperpigmented papules and plaques on the feet for the last 6 months. Histopathology showed the features of necrolytic acral erythema

Cutaneous manifestations in patients of dengue fever

To observe the spectrum of cutaneous changes in patients of dengue fever. The study was carried out from April 2010 till October 2011. Three hundred cases of dengue fever were enrolled from the outpatient and inpatient departments of Jinnah Hospital, Lahore. Patients meeting the inclusion criteria were subjected to detailed history, physical examination and relevant investigations. The data was recorded on a pro forma and later analyzed. Out of 300 patients with dengue fever, 67.3% were males and 32.7% were females. The mean age was 35 years with an age range of 2 to 80 years. Cutaneous manifestations were present in 65% of patients. Commonest skin manifestation was pruritus which was present in 69.2% patients. This was followed by burning of extremities which was present in 64.6% patients. A skin rash was present in 42.9% patients. This rash was macular in 31.7% and papular in 11.2% patients. A petechial eruption was seen in 20% patients, while ecchymosis was seen in 13.8% patients. Mucosal involvement was seen in 40.66% patients. Skin manifestations are a common feature of dengue fever and were seen in 65% of our patients

Frequency of mucocutaneous manifestations in HIV positive Pakistani patients

Mucocutaneous manifestations are commonly observed in HIV patients. These range from various opportunistic infections, inflammatory dermatoses to neoplasms and drug reactions. To observe the nature and frequency of mucocutaneous manifestations in patients of HIV, with or without antiretroviral therapy and their correlation with CD4 cell counts. The duration of study was one year, starting from July 2009 to July 2010. The patients were enrolled from the HIV clinic and inpatient departments of Jinnah Hospital Lahore. Patients meeting the inclusion and exclusion criteria were subjected to a detailed history and clinical examination. Investigations were carried out where required. Treatment profile was also noted. The data was recorded on a pro forma and was analyzed later. A total of sixty two patients were enrolled in the study. There were 49 [79%] males and 13 [21%] females. The age range was 4 to 58 years. Cutaneous manifestations were seen in 51 [82%] patients. The most common cutaneous findings were fungal infections seen in 33.87% patients, followed by viral infections [29.03%], xerosis [22.58%] and bacterial infections [12.9%]. Less common manifestations were photosensitivity, scabies and hyperpigmentation. CD4 cell count was found to be more than 455xl0[9]/ in 22 patients while it was less than 455xl0[9]/in 40 patients. Skin manifestations were found in 19 [86.36%] patients with a high count and in 33 [82.5%] patients with a low count. Cutaneous manifestations are commonly seen in patients of HIV infection

Cornelia de Lange syndrome - a cause of hypertrichosis in children: case report and review of literature

Cornelia de Lange syndrome is a rare developmental disorder characterized by hypertrichosis, low intelligence, delayed milestones and skeletal and dental abnormalities. Gastroesophageal dysfunction, ophthalmologic, cardiac and genitourinary anomalies, learning difficulties, and mental retardation may be present in severe cases. We report a case of this syndrome who presented for laser treatment for the problem of hypertrichosis, and on examination other features of the syndrome were noted

Werner syndrome: a case report and review of literature

Werner's syndrome is a rare inherited disorder characterized by short stature, sclerosed skin, cataract and premature aging of the face. The disease involves multiple systems of the body and some of the abnormalities may cause life threatening complications such as myocardial infarction and malignancy. We report a case of this rare disorder

Patient satisfaction and merging of small hospital

The first merging of small hospitals into a large one came into existence in January 2005 in county Louth. As a result the surgical departments of Louth county hospital Dundalk and Our lady of Lourdes hospital Drogheda Ireland were combined. Two hospitals are at less than half an hour drive and situated North-eastern region of Ireland. To assess the impact of joining two departments of surgery in two different hospitals along with the patient's reaction after such arrangements were made. review of literature. Louth County Hospital Dundalk Ireland. One year Following review of literature it was decided to explore the experience of patients who were treated in Louth County Hospital Dundalk one year after merging of two departments of surgery. Randomly 20% of patients treated in Louth County Hospital were included in a telephone survey. These patients were under care of all consultant surgeons. The patients were asked about their experience in Louth hospital. Also impact of joining surgical departments on waiting list was explored. Out of 1310 patients, 20% of patients treated in Louth Hospitals were included in the survey. The age of the patients varied from 15 to 67 years. 57% of the patients were female and the remainders were males. It was found that 93.5% of patients were happy to travel to Dundalk and 96.5% were satisfied with the facilities there as well. Furthermore 96% said that they would be happy to have surgery in Dundalk if they ever needed it in the future. 6% of patients were dissatisfied with services in Louth County Hospital, Dundalk. The improvement of quality processes in healthcare is of constant concern to communities throughout the world. The results have clearly demonstrated that restructuring of services can work well and be acceptable to patients once hospitals are prepared with relevant resources in place

Prevalence of smoking, alcohol, and comorbid conditions in psoriasis

Numerous studies suggest a link between cigarette smoking and alcohol. Psoriasis is associated with comorbid conditions like diabetes, hypertension, and metabolic syndromes which have a major impact on severely affected patients. To study and assess frequency of smoking, alcohol, and comorbid conditions in patients of psoriasis. One hundred and four psoriatic patients fulfilling the inclusion criteria, were included in the study. Detailed medical history and examination of the patients with particular emphasis on the onset, distribution, and nature of psoriasis was carried out. History of smoking and alcohol intake was specifically looked for along with known history of other medical ailments. Diagnosis of psoriasis was clinical. Out of 104 patients 58% were males and 42% were females. Mean age was 34.8+14.71 years. Most of the patients had generalized type of plaque psoriasis. Among all, 26.9% were smokers. History of alcohol intake was found only in 2.9% of patients. Comorbid diseases noted were hypertension and diabetes present in 11.6% and 5.8%, respectively. 3.9% were positive for hepatitis C virus. In our study, smoking was associated with severity of disease and mean PASI scores directly correlated with the number of pack years. Data regarding alcohol are still scanty and larger number patients is required to establish or refute an association. Comorbidities in psoriasis may need careful assessment and early treatment

Role of systemic steroids in the outcome of Stevens-Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome [SJS] and toxic epidermal necrolysis [TEN] are cutaneous adverse reactions which usually develop as a result of drug therapy. The role of systemic steroids in the treatment of SJS and TEN is debatable. To see the clinical outcome of patients suffering from SJS or TEN, treated with or without steroids. Forty patients of SJS and TEN were enrolled from the inpatient department of Jinnah Hospital Lahore. Clinical data were recorded on a pro forma. Clinical outcome of patients treated with or without steroids was recorded and analyzed. A total of forty patients were enrolled in the study. Twenty nine patients were suffering from SJS and 11 were suffering from TEN. Twenty three patients of SJS [79.31%] were treated without steroids. Two patients died [8.7%] and twenty one [91.30%] recovered. Six patients were given steroids [20.68%], out of these 2 [33.3%] died and 4 [66.76%] recovered. There were eleven patients of TEN, four [36.37%] were managed without steroids, one expired [25%] and rest of the three [75%] patients recovered. Seven [63.63%] patients were given steroids, three [43.86%] patients expired while four [57.14%] recovered

aetiological study of moderate to severe hirsutism

Hirsutism is a common disorder of females. Most cases are idiopathic, however some studies claim polycystic ovarian syndrome to be the commonest cause. The objective of the present study was to evaluate the etiology of moderate to severe hirsutism and to devise a rational diagnostic approach in these patients depending upon age, severity of the problem and other clinical findings. Seventy four consecutive patients with moderate to severe hirsutism [i.e. Ferriman and Gallwey score of 7 and above] were enrolled and recorded on a standard Proforma. All patients were assessed clinically with particular emphasis on signs and symptoms of virilisation. Hormonal investigation as well as abdominal and pelvic ultrasonography for adrenals and ovaries was done in all patients. Of the 74 patients 35 [47.3%] were labeled as idiopathic hirsutism, while 33 [44.6%] were diagnosed as polycystic ovary syndrome. Other causes identified were hypothyroidism [4%], Cushing"s syndrome [2.7%] and congenital adrenal hyperplasia [1.3%]. Majority of patients belonged to the age group 21-25 years. The commonest cause of hirsutism in our study was idiopathic [47.3%]. This was followed by PCOS which accounted for 44.6% of patients