Comparison Of Efficacy Of Miltefosine Versus Meglumine Antimonate In The Treatment Of Cutaneous Leishmaniasis.

BACKGROUND: Cutaneous Leishmaniasis is a morbid condition that generates stigmatization and disfiguring scars. Pakistan is among the ninety-eight countries where cutaneous Leishmaniasis is endemic. Purpose of study was to compare the efficacy of miltefosine and meglumine antimoniate in the treatment of cutaneous Leishmaniasis. METHODS: All patients with cutaneous Leishmaniasis (CL) who met the inclusion criteria were divided into two groups using the envelop method. Capsule Miltefosine 50 mg (2.5 mg/ kg) was given to group A, while intralesional Glucantime injection was given to group B. The treatment's efficacy was evaluated after four weeks and again after eight weeks. RESULTS: Out of 74 patients, 37 patients were included in each group. In group A (miltefosine group), 56.75% were males, and 43.25% were females. In group B (meglumine antimoniate group), 62% were males, while 38% were females (p=0.63). The mean age was 32.81 years±12.09 SD, the mean duration of the disease was 5.4 months±2.3 SD and the mean number of lesions was 2.56±1.33 SD. The efficacy of Miltefosine and meglumine antimoniate (I/L) was 91.9% and 56.75%, respectively (p<0.001). CONCLUSIONS: Miltefosine was more effective than intralesional meglumine antimoniate in the treatment of cutaneous Leishmaniasis (p<0.001).

Efficacy Of Methotrexate Versus Azathioprine In The Treatment Of Chronic Actinic Dermatitis: A Randomized Control Trial.

Background: Azathioprine is first line immunosuppressive agent in treatment of chronic actinic dermatitis. The role of methotrexate has been effective in different dermatosis and it seems reasonable to use it in the treatment of chronic actinic dermatitis. Aims: We sought to compare the efficacy of methotrexate versus azathioprine in treatment of chronic actinic dermatitis. Methods: Patients with chronic actinic dermatitis were randomized to receive methotrexate in group A and azathioprine in group B. The response to treatment in terms of percentage PASI reduction and side effects of medications were assessed 12 weeks follow-up. Results: In group A, the percentage PASI reduction was <25% in 2 (1.19%) patients, 25-49% in 47 (27.9%) patients, 50-74% was achieved by 35 (20.8%) patients while in group B, the percentage PASI reduction of 25% was achieved by 2 (1.19%) patients, 25-49% in 45 (26.7%) patients, 50-74% in 37 (22.0%) patients. More than or equal to 75 percentage PASI reduction was not achieved by any patient in the study. Both drugs were found efficacious in treatment of CAD. A total of 23 (27.38%) patients in group A and 22 (26.19%) patients in group B showed derangement in laboratory investigations during 12 weeks treatment. The limitation of study was inability to do photo-patch test, so patients were diagnosed clinically and biopsy was done in clinically challenging cases. Conclusion: : This study shows that methotrexate is equally effective as azathioprine in the treatment of chronic actinic dermatitis with its added benefits of being cost effective and better safety profile.

PHYTOCHEMICAL ANALYSIS AND CARDIOTONIC ACTIVITY OF METHANOLIC EXTRACT OF RANUNCULUS MURICATUS LINN. IN ISOLATED RABBIT HEART.

Ranunculus muricatus Linn. (RML) have been traditionally used for the treatment of various cardiovascular disorders. The aim of present study was to evaluate their cardiovascular effects in isolated perfused rabbit heart. The methanolic extract of RML was prepared by cold maceration process. The methanolic extract of RML (1 ng to 10 mg) was used to determine the percentage change in force of contraction (FC), heart rate (HR) and perfusion pressure (PP) by using Langendorff's Perfused Heart Apparatus. The PP, FC and HR of isolated rabbit heart were measured by power lab data acquisition system. Moreover, phytochemical analysis and acute toxicity study were also performed. The methanolic extract at the doses from I ng to 10 mg exhibited a significant increase in perfusion pressure and force of contraction. Moreover, the crude extract of RML revealed a significant increase in heart rate at doses from 1 ng to µg. The maximum rise in all the thee parameters was observed at 1 µg and 1 ng, respectively In another study, the melhanoliC extract was tested in the presence of propranolol and verapamil on isolated perfused rabbit heart. The study shown that the increase in HR and FC produced by the plant extracts was significantly reduced in the presence of propranolol whereas PP remained significantly raised even in the presence of propranolol. However, in the presence of verapamil, this increased PP was significantly reversed to a decrease while a significant positive inotropic and chronotropic effects were observed. It is concluded that the cardiotonic activity of methanolic extract of RML might be due certain cardio active chemical compounds. Further studies are needed to isolate these pharmacologically active phytochemical constituents and elucidate their exact mechanism of action.

Malignant solid pseudopapillary tumor of pancreas causing sinistral portal hypertension.

Solid pseudopapillary tumor (SPT) of the pancreas is a rare benign or low-grade malignant epithelial tumor that occurs mainly in young females in second to fourth decades of life. Pathologic and imaging findings include a well-defined, encapsulated pancreatic mass with cystic and solid components with evidence of hemorrhage. We report a 23-year-old female who presented with upper abdominal pain of long duration and epigastric mass on palpation. Multidetector-row CT (MDCT) demonstrated a large well-defined heterogeneous attenuation mass, containing hyperdense areas of hemorrhage mixed with solid enhancing and cystic non-enhancing areas, arising from the pancreatic body and tail. Splenic vein thrombosis was present with dilated splenoportal collateral vessels between splenic hilum and portal/superior mesenteric veins, with dilated vessels seen in the gastric wall, with patent portal vein, compatible with sinistral portal hypertension. Typical imaging features and age and sex of the patient suggested a diagnosis of SPT of pancreas complicated by segmental portal hypertension due to splenic vein thrombosis. Histopathology of the biopsy material was confirmatory.

Intrabiliary rupture of hepatic hydatid cyst: multidetector-row CT demonstration.

Rupture of a hydatid cyst into the biliary tract, also known as cystobiliary communication, is the most common complication of hepatic hydatid cyst. This may lead to obstructive jaundice, pancreatitis, cholangitis, and sepsis with high mortality. Imaging plays an important role in the preoperative diagnosis of this condition which facilitates its management. We studied six patients with rupture of hepatic hydatid cyst into a large bile duct in whom multidetector-row CT (MDCT) suggested the diagnosis. The imaging findings included a single hepatic cyst less than 10 cm in diameter in all the cases; interruption of the cyst wall adjacent to a bile duct signifying cyst-bile duct communication was seen in five patients. The common bile duct was dilated in all the patients, with linear membranes in four and diffuse irregular high dense intrabiliary material observed within the common bile duct in two of them. Intrahepatic ducts were dilated in all the six cases and two patients showed linear dense contents within distended gallbladder. Subcapsular and intrathoracic rupture was associated in one patient each. MDCT demonstration of hydatid cyst in the liver together with a dilated common bile duct and distended gallbladder containing high density hydatid material suggest rupture of the cyst into biliary tree. MDCT enhances demonstration of the dilated common bile duct with hydatid material inside. The diagnosis is reinforced by the demonstration of the cystobiliary communication itself.

Foreign body within sphenoid sinus: multidetector-row computed tomography (MDCT) demonstration.

Trans-nasal sphenoid sinus foreign body is a rare condition. We report a case of trans-nasal gun bullet within the sphenoid sinus with breach of the floor of the sella turcica. A 42-year-old soldier presented a few weeks after a gun battle with a history of headache. The skull x-ray demonstrated a foreign body in the region of sphenoid sinus and sella. Multidetector-row CT with multiplanar reformats demonstrated a bullet within the sphenoid sinus with its tip penetrating into the sella turcica. A few days later the patient coughed up the bullet as it came out spontaneously without any intervention. This is perhaps the unique occurrence of such a foreign body.

Multidetector-row computed tomography in cerebral hydatid cyst.

Intracranial localization is a rare manifestation of hydatid cyst disease (Echinococcosis). It comprises only 2% of cases of Echinococcosis infection even in endemic areas and is predominantly seen in children. Clinical manifestations resulting from raised intracranial tension are nonspecific. Imaging with computed tomography (CT) may suggest the diagnosis preoperatively with reasonable accuracy. Multidetector-row CT (MDCT) with its high resolution multiplanar reformations can demonstrate the relationship of the cyst with adjacent brain structures and thus help in planning surgery. This has a practical utility in places where magnetic resonance imaging is not available. We describe a case of cerebral hydatid cyst in a 13-year-old boy who was diagnosed with MDCT, which helped in planning its surgical removal.

Proteinuria in South Asian children: prevalence and determinants.

Proteinuria in children is a marker of kidney disease and atherosclerosis, both which are known predictors of cardiovascular mortality. Recent evidence suggests that migrant South Asian populations living in the West may be at higher risk of kidney disease than native Caucasians. However, the determinants of proteinuria in South Asian children have not been explored. Previously, we reported ethnic variation in the prevalence of proteinuria in the adult population of Pakistan. However, it is not known whether ethnic predisposition to proteinuria appears during childhood or whether it is acquired later in life as a result of prolonged exposure to undiagnosed diabetes and hypertension. Analyses were based on a subset of data for 4977 children aged 5 to less than 15 years collected as part of the broad National Health Survey of Pakistan, conducted between 1990 and 1994. Proteinuria was defined as a dipstick positive for protein on a random urine sample. Ethnicity was reported as "mother-tongue", which is specific for each of the five major ethnic subgroups of Pakistan: Muhajir, Punjabi, Sindhi, Pashtun, and Baluchi. The overall prevalence (95% CI) of proteinuria in the children was 3.3% (2.7-3.9%). It was 6.2% in Sindhis, 3.6% in Muhajirs, 2.8% in Punjabis, 2.8% in Baluchis, and 1.0% in Pashtuns (p<0.001). In multivariable analyses, proteinuria was associated with greater height (p=0.007), urban dwelling (p=0.03), lower socioeconomic status (p=0.02), and certain ethnicities (p=0.005). The ethnic variation in proteinuria in South Asian children mirrors variation among ethnic groups in adults. This suggests variations in susceptibility or early exposure to causes of chronic kidney disease, rather than long-term exposure to undiagnosed diabetes or hypertension. Further studies are needed to determine factors in early life that may differentially predispose certain ethnic groups to proteinuria.

Prevalence and predictors of smoking in Pakistan: results of the National Health Survey of Pakistan.

OBJECTIVE: We analysed data collected during a nationwide cross-sectional household survey to estimate the prevalence of and identify factors associated with smoking in Pakistan. DESIGN: Population-based, cross-sectional survey [National Health Survey of Pakistan (NHSP) 1990-1994]. METHODS: A population-based survey was carried out in Pakistan during 1990-1994. A nationally representative sample of 18,135 individuals aged 6 months and older was surveyed. We restricted this analysis to individuals aged 15 years or older (n=9442). The main outcome measure was self-reported smoking. Smokers were defined as individuals who reported current smoking and having smoked at least 100 cigarettes or 'beddies' during their lifetime. RESULTS: Overall prevalence of smoking was 15.2% [95% confidence interval (CI), 14.5-15.9%]. It was 28.6% (27.3-29.9%) among men and 3.4% (2.9-3.9%) among women. The highest prevalence was reported in men aged 40-49 years (40.9%). The independent predictors of smoking identified in the multivariate logistic regression analysis included age, male gender, ethnicity and illiteracy. CONCLUSIONS: One out of every two to three middle-aged men in Pakistan smoke cigarettes. Our findings suggest that ethnically sensitive smoking control programmes that include measures for improving literacy rates are needed in Pakistan.