Comparison of Three Different Therapies for Cutaneous Leishmaniasis and Identification of the Etiologic Isolates in Isfahan, Iran

Background: In Iran, zoonotic and anthroponotic cutaneous leishmaniasis (CL) are caused by Leishmania major and L. tropica respectively. Despite extensive studies, no effective therapies have ever been reported for CL. The main objective of this research was to determine and compare the three different protocols for treatment of CL patients referring to Skin Diseases and Leishmaniasis Research Center (SDLRC), affiliated to Isfahan University of Medical Sciences, Isfahan, Iran from September 2017 to October 2018. Methods: In a randomized controlled parallel groups clinical trial, 150 selected CL patients who met our inclusion criteria were randomly assigned to one of the three therapy groups: A, intra-lesional glucantime plus 50% trichloroacetic acid (TCA), B, intralesional glucantime and C, systemic glucantime. All patients in the three groups received the complete course of treatment and were followed for 6 months. To identify the etiologic agents, smears from their lesions were prepared and PCR-RFLP was used after parasite culture. Also, clinical characteristics, history of previous involvement, endemic emigration and demographic data were collected. Results: The results showed that the mean value of healing period was 53.12 ± 25.88 (median: 45, IQR: Q1 = 30-Q3 = 77) days in group A, 57.22 ± 44.02 (median: 42.5, IQR: Q1 = 30-Q3 = 60) days in group B, and 73.56 ± 41.08 (median: 71, IQR: Q1 = 45-Q3 = 90) days in group C; the observed differences were statistically significant (P=0.024). There was a significant difference between group A and group C (P = 0.049), and between group B and group C (P = 0.047) in terms of mean healing period. Finally, complete recovery rates of 80%, 62% and 42% were shown in the three medicinal groups of A, B and C, respectively (P = 0.022). Conclusion: In this study, the average duration of lesion healing among the three groups was the shortest in patients with IL glucantime plus 50% TCA treatment regimen. Also, the use of 50% TCA in patients suffering from CL was associated with a significant improvement in the depth of scars, the time and the percentage of recovery, and the low cost of this agent in the treatment of CL.

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Perforator-Based Flap Reconstruction after Melanoma Resection: Evaluation of Oncological, Aesthetic, and Functional Outcomes

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1740925 ◽

2021 ◽

Author(s):

Beniamino Brunetti ◽

Rosa Salzillo ◽

Stefania Tenna ◽

Bruno Brunetti ◽

Mario Alessandri Bonetti ◽

...

Keyword(s):

Functional Outcomes ◽

Locoregional Recurrence ◽

Demographic Data ◽

Exact Test ◽

Significant Difference ◽

Chi Squared ◽

Group A ◽

The Aesthetic ◽

One Year ◽

Group B

Abstract Background Evidence in literature about the best reconstructive approach after melanoma resection is controversial, with some authors advocating that tissue rearrangement flap techniques might hinder the early detection of local relapses. The aim of the present study is to evaluate oncological, aesthetic, and functional outcomes following melanoma reconstruction using pedicled perforator-based flaps. Methods The authors reviewed all patients affected by melanoma treated during a 6-year period. Demographic data, tumor characteristics, and operative variables were evaluated. Locoregional recurrence was assessed with clinical and radiological follow-up. One-year postoperatively patients rated on a 5-point Likert scale the aesthetic and functional outcomes of the procedure. Three blind observers examined preoperative and 1-year postoperative photographs and rated the aesthetic outcome of the reconstructive procedure. Results One-hundred sixty-five patients were treated with wide excision and delayed reconstruction, including pedicled perforator-based flaps in 70 patients (group A) and primary closure in 95 patients (group B). Mean Breslow thickness was 2.972 and 2.189 mm in group A and B, respectively. There was no statistically significant difference in locoregional recurrence (chi-squared test, p = 0.8333; Fisher's exact test, p > 0.9999) between the two groups. Group A reported a higher satisfaction with both the aesthetic (mean rating 4.390 in group A and 4.094 in group B) and functional (mean rating 4.732 in group A and 4.170 in group B) outcomes of the procedure, the latter being statistically significant (p = 0.0006). Conclusion This series suggests that pedicled perforator-based flaps provide optimal aesthetic and functional outcomes in melanoma reconstruction without impairing the locoregional control of the disease.

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Comparative Evaluation of the Embrasure Wire versus Arch Bar Maxillomandibular Fixation in the Management of Mandibular Fractures: Are Arch Bars Replaceable?

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0037-1603453 ◽

2018 ◽

Vol 11 (2) ◽

pp. 118-123

Author(s):

Sanjay Rastogi ◽

Tousif Ahmed ◽

Kolli Giri ◽

Ramakant Dandriyal ◽

Indra B. Niranjana Prasad ◽

...

Keyword(s):

Statistical Significance ◽

Demographic Data ◽

Study Data ◽

Mandibular Fractures ◽

Intermaxillary Fixation ◽

Maxillomandibular Fixation ◽

Arch Bar ◽

Significant Difference ◽

Group A ◽

Group B

The aim of this prospective study was to appraise the role of embrasure wiring in the treatment of mandibular fractures over the arch bar as adjunctive techniques of maxillomandibular fixation (MMF). This study was conducted on 40 patients who were surgically treated for mandibular fractures with accessory use of MMF (embrasure: group A vs. arch bars: group B). All patients were evaluated for demographic data, etiology, and location of fracture. Characteristically, the complications, including wire injury, infection, and malocclusion, were recorded. The data were analyzed using Student's t-test and chi-square test as appropriate. Statistical significance was set at p < 0.05). In this study, data from 40 patients were included. In group A (embrasure wiring), time required for placement of MMF was significantly less than (7.85 ± 0.81 minutes) that in group B, and also there was less incidence of wire prick to the operator in group A than in group B ( p < 0.05). However, in terms of wire prick and malocclusion, no statistically significant difference was noted in groups A and B ( p > 0.05). Patient treated with embrasure wiring intermaxillary fixation had better outcomes especially in terms of time of placement and less incidence of wire prick injury when compared with arch bar.

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Comparison of Intralesional Meglumine Antimonite along withoral Itraconazole to Intralesional Meglumine Antimonitein the treatment of Cutaneous Leishmaniasis

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.35.6.363 ◽

2019 ◽

Vol 35 (6) ◽

Cited By ~ 1

Author(s):

Uzma Bashir ◽

Moizza Tahir ◽

Muhammad Irfan Anwar ◽

Faisal Manzoor

Keyword(s):

Cutaneous Leishmaniasis ◽

Clinical Cure ◽

Statistical Significance ◽

Military Hospital ◽

P Values ◽

Meglumine Antimoniate ◽

Significant Difference ◽

Group A ◽

Oral Itraconazole ◽

Group B

Background & Objective: Cutaneous leishmaniasis (CL) is endemic in developing countries like Pakistan. Pentavalent antimonials are still drug of choice, despite being toxic and intolerable for patients. Second line treatments have been extensively studied but the results of their efficacy are conflicting. This, to our knowledge, will be the first study in this regard. Our objective was to determine if combination of oral itraconazole with intralesional (IL) meglumine antimoniate (MA) reduces the duration of treatment for cutaneous leishmaniasis, as compared to intralesional MA alone. Methods: A randomized controlled trial (single blinded) was carried out from August 2017 till December 2017 on 69 patients who fulfilled inclusion criteria. They were assigned to Group-A or B by lottery method. Group-A patients received IL MA once a week while Group-B received oral itraconazole 200mg, once daily, for six weeks along with similar regimen of IL MA as Group-A. The patients were assessed every three weeks by the blinded assessor till clinical cure was achieved. A follow up visit, two months after clinical cure was done to look for relapse of the disease. Results: Thirty patients in Group-A and 35 patients in Group-B completed the study. At 3, 6, 9 and 12 weeks the patients were assessed for: no, partial or complete response and results of the two groups were compared for statistical significance. The p-values of 0.20, 0.57 and 0.11 at 3, 6 and 9 weeks, respectively, depict that there was no significant difference at any step of assessment between the two groups in terms of healing. The p values of each t test was >0.05 refuting the hypothesis. Conclusion: Combination of oral itraconazole with intralesional MA offered no benefit over intralesional MA alone in the management of cutaneous leishmaniasis in terms of duration of therapy. Abbreviations Used: IL = Intralesional, MA = Meglumine Antimoniate, LD = Leishmania Donovan, CL = Cutaneous leishmaniasis, CMH = Combined Military Hospital. doi: https://doi.org/10.12669/pjms.35.6.363 How to cite this:Bashir U, Tahir M, Anwar MI, Manzoor F. Comparison of Intralesional Meglumine Antimonite along with oral Itraconazole to Intralesional Meglumine Antimonite in the treatment of Cutaneous Leishmaniasis. Pak J Med Sci. 2019;35(6):1669-1673. doi: https://doi.org/10.12669/pjms.35.6.363 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Comparing efficacy of Rifaximin plus Lactulose vs. Lactulose alone in treating Hepatic Encephalopathy

Journal of Rawalpindi Medical College ◽

10.37939/jrmc.v24i4.1418 ◽

2020 ◽

Vol 24 (4) ◽

pp. 339-343

Author(s):

Tanveer Hussain ◽

Misbah Sattar ◽

Sara Mustafa ◽

Uzma Batool ◽

Shafqat Iqbal ◽

...

Keyword(s):

Hepatic Encephalopathy ◽

Local Population ◽

Tertiary Care ◽

Simple Random Sampling ◽

Complete Recovery ◽

Treatment Modalities ◽

Care Hospital ◽

Significant Difference ◽

Group A ◽

Group B

Background: Hepatic Encephalopathy is a syndrome observed in patients with liver cirrhosis. Various treatment modalities are in use for treatment of Porto Systemic Encephalopathy (PSE). Our study aimed to compare the efficacy of Rifaximin plus Lactulose vs.Lactulose alone in treating Hepatic Encephalopathy in local population. Materials & Methods: The study was conducted at a tertiary care hospital recruiting decompensated chronic liver disease(DCLD) patients with PSE. Using simple random sampling, patients were divided in two groups (A & B). Patients in group A received Lactulose plus Rifaximin while group B received Lactulose alone. Efficacy of treatment was assessed as return of the conscious level to pre-encephalopathy state as per clinical examination within 1 week after start of the treatment. Results: A total of 124 patients were included in the study with each group (A & B) containing 62 patients. Frequency and percentage of efficacy among group A (Rifaximin plus Lactulose) verses group B (Lactulose alone) in treating Hepatic encephalopathy was 45 (72.6%) and 32 (51.6%) respectively. Conclusion: The study concluded that there is a significant difference in proportions of patients showing complete recovery from Hepatic encephalopathy treated with Lactulose plus Rifaximin as compared to Lactulose alone.

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Reconstruction of Long Segmental Tibial Bone Defect Using the Bone Transport Compared to Acute Shortening and Re-lengthening : A Retrospective Study

10.21203/rs.3.rs-783176/v1 ◽

2021 ◽

Author(s):

Feiyu Cai ◽

Yanshi Liu ◽

Kai Liu ◽

Chenchen Fan ◽

Xiayimaierdan Maimaiti ◽

...

Keyword(s):

External Fixation ◽

Bone Defect ◽

Demographic Data ◽

Bone Transport ◽

Fixation Index ◽

Fixation Time ◽

Significant Difference ◽

Group A ◽

Group B ◽

Acute Shortening

Abstract Background: Ilizarov technique has been widely used to salvage bone defects. However, treating large bone defects remains a challenge for surgeons. The aim of this study was to compare bone transport with acute shortening/re-lengthening in a series of large tibial segmental defects.Method: A total of 39 patients (29 males, 10 females) with large tibial segmental defects were treated with the Ilizarov technique (Group A: bone transport in 23 cases; Group B: acute shortening/re-lengthening 16 in cases) from March 2010 to December 2018. The mean age was 38.7 years (range24 years to 55 years). The average bone defect size was 8.82 cm (range from 6 cm to 12 cm). The demographic data, operation duration, docking time, external fixation time, and external fixation index were retrospectively documented and analyzed. Complications that occur during the treatment were classified. The clinical outcomes were evaluated by the Association for the Study and Application of the Method of Ilizarov criteria (ASAMI) at the last clinical visit.Result: There were no statistically significant differences (P>0.05) in the demographic data of the two groups. There was no significant difference in operation duration between the two groups. The docking time in group A was longer than that in group B (93.26±19.52 days, 58.44±14.23 days, P<0.001). No statistical significance was obversed for the external fixation time in the two groups (330.87±88.52 days in group A, 321.25±56.67 days in group B,P=0.704). A higher external fixation index was presented in group A (38.32±5.39 days/cm) than group B (35.17±2.14 days/cm) (P=0.033). There was no significant difference between the two groups in ASAMI bone results and functional results (Table 4). Complications were more prevalent in group A (28 complications of 23 patients), while less in group B (7 complications of 16 patients) (P<0.05).Conclusion: Both bone transport and acute shortening/re-lengthening technique can achieve satisfactory clinical outcomes in the reconstruction of long segmental tibial bone defect caused by infection using a monolateral rail external fixator. The acute shortening/re-lengthening can significantly decrease the docking time, external fixation index, and complications compared with bone transport.

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Efficacy of adding Luvos® Healing Earth supplementation to mebeverine in improving symptoms and quality of life of patients with diarrhea-predominant irritable bowel syndrome: A randomized clinical trial

Biomedical Research and Therapy ◽

10.15419/bmrat.v5i10.493 ◽

2018 ◽

Vol 5 (10) ◽

pp. 2776-2783

Author(s):

Marjan Mokhtare ◽

Mohammadreza Asadipanah ◽

Mansour Bahardoust ◽

Arezoo Chaharmahali ◽

Masoomeh Khalighi Sikaroudi ◽

...

Keyword(s):

Quality Of Life ◽

Irritable Bowel Syndrome ◽

Demographic Data ◽

Gastrointestinal Disorder ◽

Young Males ◽

Significant Difference ◽

Group A ◽

Irritable Bowel ◽

Group B

Introduction: Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder. Treatment can improve symptoms and social functioning in the patients. This study was designed to assess the effect of adding Luvos supplementation to mebeverine on improving symptoms and quality of life (QOL) in patients with diarrhea-predominant irritable bowel syndrome. Methods: Eighty patients with diarrhea-predominant IB, ages 18-65, were diagnosed by the Rome IV criteria and randomly assigned to the study. Forty patients (group A) received mebeverine (135 mg) twice a day (bid) plus Luvos®Healing Earth (1 sachet, bid). The other 41 patients (group B) received mebeverine (135 mg) bid for 4 weeks. Basic demographic data, Bristol score, symptom severity score, and QOL questionnaire were recorded at the start and completion of treatment. The data were analyzed by SPSS version 22. Results: Seventy one of the patients (35 and 36 patients in groups A and B, respectively) completed the study. The majority of the patients were young males, unmarried and highly educated. Diarrhea and QOL were both significantly improved in group A when compared to group B (P=0.036 and P=0.028, respectively). We did not find a significant difference (improvement) in abdominal pain or overall symptom score between group A (mebeverine + Luvos) compared to group B (mebeverine alone) (P=0.096 and P=0.071, respectively). Mild and tolerable adverse effects were observed in 2.8% (2/71) of the patients. Conclusion: According to our results, Luvos supplementation is safe, effective and well-tolerated in diarrhea-predominant irritable bowel syndrome patients. Further study with a larger sample size is recommended to evaluate the efficacy of this natural clay-like medicine.

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Тhe efficiency and safety of a dietary supplement used in the treatment of preschool and school children with acute respiratory infections

Medicinski pregled ◽

10.2298/mpns1806180s ◽

2018 ◽

Vol 71 (5-6) ◽

pp. 180-185

Author(s):

Lidija Sagic ◽

Katarina Milosevic ◽

Olivera Ostojic ◽

Anita Agic

Keyword(s):

Physical Examination ◽

School Children ◽

Respiratory Infections ◽

Demographic Data ◽

Acute Respiratory Infections ◽

Mucus Production ◽

Significant Difference ◽

Group A ◽

Group B

Introduction. The aim of this research was to assess the efficiency and safety of a natural product N-acetylcysteine and propolis in the children with acute respiratory infections with increased mucus production and cough. Material and Methods. The research was conducted in the period April 2016 - February 2017 among 145 pediatric patients aged 3 to 14 years with symptoms of acute respiratory infection. They were divided into two groups. Group A - preschool and Group B - school children. The first clinical examination included demographic data, physical examination. filling out the quality of cough questionnaire, and taking nasal and pharyngeal swabs. After a ten-day therapy, physical examination was conducted, quality of cough questionnaire was refilled and swabs were taken. Results. Group A included 73 and Group B 72 children. No statistically significant difference was observed in the incidence of respiratory disease episodes. In Group B children received antibiotics less often. started school at an early age and more children had daily activities in regard to children in Group A. Statistically, both groups of children coughed early in the morning more than during the day. The results of control swab tests were negative in both groups. No side effects were reported in either group. Conclusion. The propolis combined with N-acetylcysteine in a pediatric syrup is a good choice in the treatment of acute respiratory infections in children with accompanied mucus production and cough. The product is efficient and safe for all age groups.

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Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

TAJ Journal of Teachers Association ◽

10.3329/taj.v33i1.49824 ◽

2020 ◽

Vol 33 (1) ◽

pp. 41-47

Author(s):

Mohsena Akhter ◽

Ishrat Bhuiyan ◽

Zulfiqer Hossain Khan ◽

Mahfuza Akhter ◽

Gulam Kazem Ali Ahmad ◽

...

Keyword(s):

Skin Diseases ◽

Close Contact ◽

Randomized Study ◽

Sarcoptes Scabiei ◽

Efficacy And Safety ◽

Common Skin ◽

Group A ◽

The Mean ◽

The Difference ◽

Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47

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DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i4.89 ◽

2019 ◽

Vol 1 (4) ◽

pp. 133-139

Author(s):

Yasser Hamdy ◽

Mohammed Mahmoud Mostafa ◽

Ahmed Elminshawy

Keyword(s):

Right Ventricular ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Early Postoperative Period ◽

Tricuspid Valve Repair ◽

Ring Annuloplasty ◽

Significant Difference ◽

Group A ◽

Group B ◽

The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

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Effect of short-term use of oral contraceptive pills on intraocular pressure

Pakistan Journal of Ophthalmology ◽

10.36351/pjo.v35i3.871 ◽

2020 ◽

Vol 35 (3) ◽

Author(s):

Tayyaba Gul Malik ◽

Hina Nadeem ◽

Eiman Ayesha ◽

Rabail Alam

Keyword(s):

Oral Contraceptive ◽

Childbearing Age ◽

Short Term ◽

Oral Contraceptive Pills ◽

Contraceptive Pills ◽

Time Period ◽

Significant Difference ◽

Group A ◽

Group B ◽

Short Time

Objective: To study the effect of short-term use of oral contraceptive pills on intra-ocular pressures of women of childbearing age. Methods: It was a comparative observational study, conducted at Arif memorial teaching hospital and Allied hospital Faisalabad for a period of six months. Hundred female subjects were divided into two groups of 50 each. Group A, included females, who had been taking oral contraceptive pills (OCP) for more than 6 months and less than 36 months. Group B, included 50 age-matched controls, who had never used OCP. Ophthalmic and systemic history was taken. Careful Slit lamp examination was performed and intraocular pressures (IOP) were measured using Goldman Applanation tonometer. Fundus examination was done to rule out any posterior segment disease. After collection of data, we analyzed and compared the intra ocular pressures between the two groups by using ANOVA in SPSS version 21. Results: Average duration of using OCP was 14.9 months. There was no significant difference of Cup to Disc ratios between the two groups (p= 0.109). However, significant difference was noted between the IOP of OCP group and controls. (p=0.000). Conclusion: OCP significantly increase IOP even when used for short time period.

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