Outbreak of cutaneous leishmaniasis in Somniani, Balochistan - implementation of preventive measures for deployed personnel of armed forces

To evaluate the number of cutaneous leishmaniasis [CL] cases reporting from Somniani between years 2001 to 2005 and to explore the preventive measures being used against sandfly bite. This observational study was conducted at the dermatology department of Combined Military Hospital, Malir Cantonment, Karachi from January 2001 to December 2005. Between year 2001 and 2005, suspected cases of CL reporting from Somniani, Balochistan were identified, evaluated, diagnosed and included in this study. Diagnosis was based on clinical examination, slit skin smear for detection of Leishman-Donovan [LD] bodies and skin biopsy for histopathology. Patients were then asked to fill a structured, anonymous, self-administered and close ended questionnaire which included questions about the use of various preventive measures against cutaneous leishmaniasis. A total of 108 patients were diagnosed as CL from Somniani during the study period. The peak was seen in year 2004 [n=58] which coincided with increased troop activity in the area. Nodulo-ulcerative lesions were the commonest mode of presentation. Skin biopsy for histopathology was the most effective method of diagnosis. Overall only 28% personnel were using preventive measures against sand fly bite. Only 15% personnel had disease awareness. Lack of application of preventive measures and knowledge of disease were the reasons for increase in CL cases

Efficacy and safety of oral dexamethasone pulse treatment for vitiligo

Results of previous studies on efficacy and safety of oral corticosteroid pulse treatment for vitiligo are inconsistent. The objective of this study was to assess the efficacy and safety of oral dexamethasone pulse treatment in a cohort of Pakistani patients. This is a descriptive study. Thirty patients with vitiligo were included in the study. Of these, 21 had progressive disease and 9 had stable disease. The patients were given weekly pulses of dexamethasone on 2 consecutive days every week followed by 5 days off treatment for a maximum of 24 weeks. Clinical response and side effects were evaluated at monthly intervals. Plasma cortisol levels were also monitored. After a mean treatment period of 16 + 4 weeks, progression was arrested in 18 [85.7%] of 21 patients with active vitiligo before the study. Overall, repigmentation was noted in 14 [46.6%] patients at the end of 24 weeks. The extent of repigmentation varied from less than 25% [slight] to 51% to 75% [marked]. Twenty [66.6%] patients reported one or more side effects. Plasma cortisol values were markedly decreased 24 hours after the second dose of each pulse but returned to baseline before the next dexamethasone pulse. Oral corticosteroid pulse therapy is an effective treatment modality to arrest progressive vitiligo but is only moderately effective in inducing satisfactory repigmentation. Treatment associated side effects are frequent but reversible; however, sustained suppression of endogenous cortisol production does not occur with pulse regimen