Cutaneous tuberculosis revealing multifocal tuberculosis in immunocompetent patients

Multifocal tuberculosis [TB] is rare. It occurs especially in immunocompromised patients. Association with skin involvement is rarer, and few cases are reported in the literature. The present study reports 7 cases of multifocal TB with cutaneous localization in immunocompetent patients. Cutaneous forms of TB included in this series are: gummas, scrofuloderma, vasculitis TB and lupus TB. The patients had at least two extra skin locations, namely: osteoarticular, lung, pleural, scrotal, muscular, digestive, laryngeal, nodal and splenic locations. These patients had no context of immunosuppression which is uncommon, but should be kept in mind, especially in endemic countries

effect of renal transplantation on uremic peripheral neuropathy

Six uremic patients were electrophysiologically assessed in regard to some of their peripheral nerves before and two times after they had undergone renal transplantation, in addition to eleven normal subjects as control. The latency, conduction velocity and amplitude of the compound sensory and motor action potential were tested for the ulnar and common peroneal nerves of unilateral limbs. The results of the tests done before the transplantation were similar to other studies showing mixed sensory and motor neuropathies of both axonal degeneration and demyelination types, while these results significantly improved two months after the transplantation, yet some of the parameters were still below normal ranges, and this improvement continued in the second assessment six months after surgery. These results indicate that successful renal transplatntation will improve the peripheral nerve function in those patients

Hearing loss in Iraqi divers

Ear problems, particularly hearing loss, in divers are well known and documented all over the world. Studies showed that they form the most common health problems among divers. However, it seems that this problem has never been investigated in the Iraqi divers population. This cross-sectional comparative study is an attempt aims to contribute to the better understanding of the extent and impact of the problem among the local divers and to relate certain risk factors associated with diving. One hundred and eleven divers and 222 non-divers were interviewed regarding this problem and examined audiometerically. Results showed that 45% of the studied divers complained of some sort of ear problems. In a considerable number of them the problem is serious. Audiometer ically, about 50.5% of divers have some degree of hearing loss. There was a significant difference in the prevalence of hearing loss in divers as compared to non-divers. Furthermore, hearing loss problem among divers was more severe than in non-divers and it was mostly bilateral. High frequencies are the ones affected more. The role of certain proposed risk factors was studied with few conclusive findings; these are the association between hearing loss and underwater blast, maximum depth, duration of profession and underwater diving accidents. Further studies and regular check-ups are strongly recommended

[An education programme of asthma in children]

In the aim to improve asthma management in children, we conduct an education programme including 22 children and their parents. All patients are under 15 years of age and at a stable state. They are ages between 3 and 15 years with a mean age of 6 years. The education teaching is in dialectal Arabic language. Giver information concerned physiopathology of asthma, anatomy of the airways, asthma attack symptoms, trigger and methods of their prevention, medication, delivery devices and practice of sport. By a direct and collective method, our education programme resulted in improvement of children and parent's knowledge on asthma and a reduction by half of acute episodes of asthma

Clinical characteristics and sensitisation to common aeroallergens in patients with asthma and rhinitis

Allergic disorders such as asthma and rhinitis are common and their prevalence is rising Differences in climatic and living conditions may modify the disease prevalence. The causes of allergic asthma and rhinitis vary considerably in different parts of the world depending on the type of the allergens present in the environment. We studied the clinical characteristics and causative allergens in patients with asthma and rhinitis. All patients seen in a respiratory allergy clinic with symptoms suggestive of rhinitis and asthma over a twelve months period were invited to participate in a prospective study. A detailed history was obtained, seeking information on the type and duration of symptoms and current treatment. Skin prick test [SPT] to a standard battery of common aeroallergens were performed. The analysis in confined to 109 adults and children who fulfilled the criteria. Common presenting symptoms for rhinitis were rhinorrhoea and sneezing and for asthma; dyspnea, cough and wheezing. Antihistamines were most commonly used [35%] in rhinitis and bronchodilator [54%] in asthma. Overall, skin test were positive to one or more common allergens in 91 [84%]. The rate of sensitization was 88% in asthma and 82% in rhinitis. Dust-mites by far the commonest allergen with 60-70 sensitised. Between 30-40% were positive to pollens, fungi and cat dander. The pattern of sensitization was similar in patients with asthma and rhinitis. Conclusion: Interesting differences were observed in the presenting complaints, treatment prescribed and pattern of sensitization to common allergens form conducted in the western world. This may reflect difference in environmental factors and way of living

study of otomycosis in Karachi

In a multicenter study of 544 consecutive ear-swab referrals cultured during a 9-month period ending June 1999. Staph. aureus [38.6%] and Pseudomonas spp. [28.5%] accounted for 67% of isolates among 10 bacterial species, Aspergillus niger [7.1%] and Candida albicans [3.8%] were two fungal agents also recognized. Subjects clinically suspected of otomycosis presented mainly with chronicity, itching and fullness of ear, sometimes with hearing impairment, otorrhoea and occasionally pain, gender and age were other unidirectional variables did not influence the study. Sterile alginate-tipped swabs of wet discharge of desquamated material from the external auditory canal were examined directly by light microscopy of a smear in 20% KOH, and by paired culture on Sabouraud-Dextrose and Chocolate agar plates incubated at 30°C and 37°C for 1-3 days. Aspergilli were visible in some cases with mycelium in black-gray clumps in the external ear canal, in contrast to Candida, which presented with a whitish discharge

Suppurative otitis in Karachi: an audit of 510 cases

Suppurative disease of the middle ear is a constant challenge for otologists to treat. "Watchful waiting" may be acceptable for a few cases, but possibly all patients with chronic otitis media should receive antimicrobial therapy to minimize mastoid pathologies. Selection of a potentially effective drug, however, in the absence of discharge culture analysis, depends on the regional prevalent microflora. In a multicentre study of 596 consecutive ear-swab referrals processed during a 10-month period ending July 1997. Staph. aureus [40.4%] and Pesudomonas [29.6%] accounted for 70% of isolates among 10 bacterial species. Aspergillus [6.2%] and Candida [3.1%] were additional irritants. However, approximately 14.4% of swabs were culture-negative, suggesting possible other or non-infective aetiology. The finding that pseudomonas was increasingly implicated in recent months warrants tailored drug prescription; moreover, 37.9% of our Staph isolates were beta-lactamase producers and methicillin-resistant, necessitating the choice of "enzyme-stable" antibiotics for first-line use. The high number of gram-negative aerobes isolated from our cases of otitis media casts serious doubt on the role of the nasopharynx as the major contributor to this infective process; an alternate presumption that the faecal-aural route is often involved, seems more practical in our environment

open ended clinical trial of ciprofloxacin in upper respiratory tract infections

Ciprofloxacin is a 4-quinolone derivative with a broad antibacterial spectrum covering gram-negative rods particularly pseudomonas and gram-positive cocci. A clinical trail was conducted in randomly selected 69 patients with upper respiratory tract infections. The drugs was given in oral form in equal dosage on 6 hourly basis [250 and 500 mg]. The response rate was 96.6% with symptoms and signs disappearing by 3rd day in 35 [60.34%] patients, by 5th day in 21 patients [32.6%]. Bacterological profile showed excellent response in all the patients

URTI in Karachi: an appraisal of current isolated and antibiotic therapy

Recent reports in the literature indicate increasing involvement of Pneumnococci, HAEMOPHILUS INFLUENZAE and Klebsiella in community acquired throat infections. This was also our observation in a scrutiny of 576 throat swabs cultured during a 10 month period ending October, 1995. STREP. PYOGENES was isolated in only 6.6% of our cases, and remains 100% sensitive to the pencillins and cephalosporins. However, the possibility that its incidence is higher in deep tonsillar tissue is currently being investigated. Though Amoxycillin, Augmentin and Erythromycin have remained popular drugs for empirical treatment, increasingly, however, oral quinolones are being prescribed, which do not effectively cover pneumococci and are too broad in spectrum for common infected throats. H.INFLUENZAE, which is reported to colonize 25-75% of healthy human mucosa, can cause irritation ranging from uncomplicated pharyngitis to acute laryngoepiglottitis, and should be reported. It is currently resistant to several drugs including penicillin V, Doxycycline, Cotrimoxazole and Erythromycin [upto 97%] due to plasmid-mediated beta-lactamases and altered penicillin-binding proteins. While Klebsiella [15-20%] isolates are in different to several cephalosporins, it was sensitive to Augmentin, as were a majority of our pneumococcal and hemophilus cases. An audit is therefore presented encouraging the prescription of Augmentin, Amoxil and first generation Cephalosporins in uncomplicated URTI, with a macrolide such as Erythromycin, if LRTI symptoms are observed