Dermatological manifestations of dengue fever

Each year dengue related infections are rising in tropical countries. There is not enough data available on dermatological manifestations of dengue fever. This study was conducted to investigate prevalence and type of dermatological manifestations of dengue fever [DF], Dngue Haemorrhagic Fever [DHF], and Dengue Shock Syndrome [DSS]. A Prospective study was contacted in Department of Medicine, Shaikh Zayed Hospital, Lahore, from 3[rd] Oct to 20[th] Nov 2010. Specific serological tests for DF were done in all 60 patients admitted with suspected diagnosis of DF, DHF or DSS. Forty-eight confirmed cases were evaluated for age, gender, mucocutaneous features and outcome of the disease. Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged 5-68 years with a mean of 31.5 +/- 15.2. DF, DHF and DSS were found in 71%, 19% and 10% respectively. Common dermatological presentations were oral mucous membrane congestion [66.67%], generalised morbiliform rash [64.58%] and eye congestion [64.58%]. Purpuric spots along with mucous membrane congestion, generalised morbiliform rash and eyes congestion was observed in 20.83%, 12.5% and 6.25% patients respectively. All except one patient improved clinically. One patient died of respiratory distress and haemorrhage on second day of admission. Dermatological features are significantly noticeable in dengue fever patients. These may help us in early diagnosis and better management of patients.

Clinical characteristics of patients with dengue fever: report of 48 patients in 2010

Dengue fever is a mosquito born viral disease. It occurs in tropical and sub-tropical areas of the world. Symptoms appear 3-14 days after the infective bite. Mortality can occur in dengue hemorrhagic fever and dengue shock syndrome unless prompt and adequate management is provided. To determine the clinical and epidemiological characteristics along with outcome of patients with dengue fever [DF] dengue hemorrhagic fever [DHF] and dengue shock syndrome [DSS]. Prospective, follow-up study. Department of Medicine, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore from 3rd Oct 2010 to 20th Nov 2010. Specific serological tests for dengue fever were done in all 60 patients admitted with suspected diagnosis of DF, DHF and DSS. Forty-eight confirmed cases were evaluated for age, gender, clinical features and outcome of the disease. Forty-eight out of 60 patients had positive serology for dengue fever. Male to female ratio was 1.09:1. Their ages ranged from 5 years to 68 years with the mean of 31.5 +/- 15.2 years. DF, DHF and DSS were found in 71%, 19% and 10% cases respectively. Common presentations were fever [100%], skin rash [83.33%], myalgia [69.75%], restlessness [66.67%] and rigors and chills [66.67%]. All, except one patient improved clinically. One patient died on second day of admission. Dengue fever, a viral infection is re-emerging as a serious public health problem. Fever, rash, myalgia with rigors and chills were common presenting features

Breastfeeding during month of Ramadan; a community based study

To study breastfeeding practices during month of Ramadan. Descriptive study. It was a community based study in research area of the department of Social ant Preventive Pediatrics, King Edward Medical University/ Mayo hospital, Lahore and was conducted in four weeks, Month of Ramadan 2008/ 1429 Hijri. Total of 734 mothers were present in study area during study period. Among them, 137 lactating mothers with children of age 24 months or younger were interviewed. Most mothers had infants aged 12 months or younger [77%]. Sixty one percent were male. Sixty one percent mothers were older than 25 years of age. Majority were educated upto higher secondary level [66%]. Among infants younger than 6 months of age, 69% were exclusively breastfed. Fifty seven percent mothers were fasting. Among these, most mothers [59%] felt that fasting would decrease the quality of milk. Fifty nine percent of lactating mothers during fast felt thirst, weakness and dizziness [without any other associated medical illness]. Among nonfasting mothers [43%], 61% did not fast due to lactation. Eighty seven percent of the total mothers had the knowledge about relaxation given by Islam regarding breastfeeding during the holy month of Ramadan. Overwhelming majority of breast feeding mothers knew about religious relaxation for fasting during lactation but they preferred to observe it as their religious duty. Majority of lactating women had subjective felling of thirst, weakness or dizziness

Fixed drug eruption and intradermal provocation tests

To determine the role of Intradermal Provocation [IDP] tests in Fixed Drug Eruption [FDE]. Study Design: Quasi-experimental study. Place and Duration of Study: Dermatology Unit, Shaikh Zayed Hospital, Lahore, from August 2004 to July 2006. Methodology: The tests were performed in 96 patients in two stages. At stage I, suspected drugs were given intradermally. Changes at injection site in FDE lesions or any systemic effects were observed. In patients showing no response to IDP, Oral Provocation [OP] was performed [stage II] and its effects in FDE lesions or any systemic effect were observed. The positive response of FDE lesions after IDP and OP were compared with local changes at injection site. Control intradermal tests were repeated in normal persons with drugs and in FDE patients with distilled water on normal skin. At stage I, 46 positive cases had local signs of erythematous indurated nodule with or without hemorrhagic centre, urticarial weal with hemorrhagic centre and erythematous indurated nodule with central vesicle. At stage II, 41 patients had similar local signs. The changes at injection site to those of FDE lesions were compared. Z-test for proportions showed no significant difference between groups [p-value > 0.05]. Control tests were negative. The drug producing erythematous indurated nodule with or without hemorrhagic centre, vesicle or urticarial weal with hemorrhagic centre at injection site was the most likely drug causing fixed eruption

Prevalence of Hepatitis B surface antigen carrier state in patients with Lichen planus-Report of 200 cases from Lahore, Pakistan

To determine the prevalence of hepatitis B surface antigen carrier state in patients with lichen planus. A quasi experimental cross sectional study was done at Department of Dermatology, Shaikh Zayed Federal Postgraduate Medical Institute, Lahore, Pakistan, from April 2003 to March 2005. Two hundred clinically diagnosed cases of LP and equal number of patients with other dermatoses not reportedly associated with hepatitis B virus [HBV] infection [control group] were collected from Skin Out Patient Department. They were screened for hepatitis B surface antigen [HBsAg] by Enzyme Linked Immunosorbent Assay [ELISA]. Statistical analysis was done by using SPSS package version 11. Out of 200 patients of each group, three patients with LP and seven patients from control group were positive for HBsAg. The test of significance for proportions revealed that there was no significant difference [p > 0.1] between two groups. No association between HBsAg carrier state and LP was found in our study

Tropical provocation of fixed drug eruption

To determine the usefulness of topical provocation in the diagnosis of fixed drug eruption, different drugs at various concentrations [2% and 5%] in white soft paraffin were applied on normal or affected skin of 401 patients. Reliable results were obtained with 5% ointment preparations, applied on normal skin. The results were confirmed by peroral provocation, by giving half to full therapeutic dose of the suspected drugs

Drugs causing fixed eruption in children. a study of 31 cases

This is the largest series of fixed drug eruption [FDE] in children ever reported from one centre. Out of thirty five clinically diagnosed cases of FDE, 31 patients were positive to oral provocation tests. Cotrimoxazole was the commonest cause of FDE. Other incriminated drugs were paracetamol, acetylsalicylic acid, phenylbutazone, ampicillin, amoxycillin, tetracycline, metamizole and mefenamic acid. Cross-sensitivity was seen between penicillin derivatives; Polysensitivity with various drugs was observed in 4 cases [12.8 percent]. Cross-sensitivity between ampicillin/amoxycillin and polysensitivity among different drugs are still unreported