Publications by authors named "Naeem Raza"

52 Publications

Comparison Of Efficacy Of Permethrin 5% Cream With Crotamiton 10% Cream In Patients With Scabies.

J Ayub Med Coll Abbottabad 2019 Apr-Jun;31(2):230-232

Department of Dermatology, Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, Pakistan.

Background: Scabies is a common dermatological presentation in Pakistan. Permethrin and Crotamiton both are used widely for treating scabies. As there is no local study available regarding comparison of efficacy of Permethrin and Crotamiton in patients of scabies, current study was undertaken. The objective of the study was to compare the efficacy of 5% Permethrin with 10% Crotamiton in patients of scabies.

Methods: A Randomized control trial was conducted at Dermatology Department, Military Hospital, Rawalpindi. One hundred and sixty patients with scabies (diagnosis made by scraping the burrows to extract mite, larva or eggs and to see under light microscope) were randomly assigned either to Permethrin or Crotamiton group. Patients were followed over for 4 weeks to determine the effectiveness of either treatment.

Results: A total of 160 patients were included in the study with a mean age of 45.49±17.047 years and ranging from 13-65 years. One hundred and one patients (63.1%) were male and remaining 59 patients (26.9%) were female. Treatment was effective in 81.3% patients being treated with 5% Permethrin and 53.8% in 10% Crotamiton group. Comparison of treatment showed superiority of 5% Permethrin over 10% Crotamiton (p=0.001). There was no effect of age and gender on this outcome difference.

Conclusions: Our study concludes that 5% Permethrin cream is significantly superior to 10% Crotamiton cream in treating patients of scabies (81.3% vs. 53.8%, p=0.001).
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July 2019

Unusual skin mass (primary cutaneous mucinous carcinoma).

BMJ Case Rep 2018 Jan 18;2018. Epub 2018 Jan 18.

Department of Pathology, Army Medical College, Rawalpindi, Pakistan.

Primary mucinous carcinoma of the skin is a rare malignant tumour of sweat gland origin. Diagnostic concerns include its deceptively benign appearance in some cases and the difficulty in differentiating it from secondary mucinous carcinoma of skin metastasising from a primary source elsewhere. A case of a 75-year-old man is reported who presented with a slowly growing painless mass near the lateral canthus of the right eye for about 2 years. Clinically, a diagnosis of basal cell carcinoma was made whereas histopathology revealed mucinous carcinoma of the skin. The primary source of the tumour could not be found on detailed physical examination and laboratory investigations. Immunohistochemistry, performed later, was consistent with primary cutaneous mucinous carcinoma.
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http://dx.doi.org/10.1136/bcr-2017-222546DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5775771PMC
January 2018

ASSESSMENT OF PRACTICE AT RETAIL PHARMACIES IN PAKISTAN: EXTENT OF COMPLIANCE WITH THE PREVAILING DRUG LAW OF PAKISTAN.

Acta Pol Pharm 2016 May-Jun;73(3):803-7

The main objective of this study was to assess the practice at retail pharmacies in Pakistan and to compare the same in rural and urban areas. The maintenance of pharmacy and drug inspectors' visit was also assessed. This cross sectional study was conducted in Abbottabad, Pakistan during October-November, 2012. A sample of 215 drug sellers or drug stores was selected by employing convenient sampling method. With a response rate of 91.6%, 197 drug sellers participated in this study. All the drug sellers were male. Overall, 35% (n = 197) of the drug sellers did not have any professional qualification. A majority of the drug sellers were involved in various malpractices like selling of medicines without prescription (80.7%), prescribing practice (60.9%), prescription intervention (62.4%) and selling of controlled substances (66%) without a license for selling it. These malpractices were significantly higher in rural area than that in urban area.
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September 2016

Gorlin-Goltz syndrome.

J Coll Physicians Surg Pak 2014 Nov;24 Suppl 3:S171-3

Department of Oral and Maxillofacial , 30 Military Dental Centre, CMH, Peshawar Cantt.

A 12 years old girl was presented with bilateral swellings on angle and body of mandible. On general physical examination, there were polydactyly and papular lesions on arm. Histopathology of mandibular lesions revealed odontogenic keratocysts. Marsupialization of the cysts followed by enucleation was done. The patient was reviewed every six months and there was no recurrence at the end of two years.
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http://dx.doi.org/11.2014/JCPSP.S171S173DOI Listing
November 2014

Radiofrequency ablation of treatment-refractory gastric antral vascular ectasia (GAVE).

Surg Laparosc Endosc Percutan Tech 2015 Feb;25(1):79-82

Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA.

Gastric antral vascular ectasia (GAVE) is a rare but an important cause of gastrointestinal bleeding and anemia. Endoscopic ablation is usually successful, but treatment-refractory cases occur. We have used radiofrequency ablation (RFA) with the HALO device in these cases with positive results. Nine patients (5 female patients) with refractory GAVE were treated with RFA. Four had GAVE associated with cirrhosis, 4 had renal insufficiency, and 1 had both cirrhosis and renal insufficiency. Patients had received multiple endoscopic treatments before undergoing RFA over a period of up to 2 years (median 4; range, 2 to 15 y). A total of 2 to 6 (median 3) RFA sessions were performed until GAVE eradication. Endoscopic ablation was achievable in all patients. There were no complications of the treatments. Seven of the 9 patients had sustained response to RFA over a median follow-up of 11 months (range, 6 to 21 mo).
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http://dx.doi.org/10.1097/SLE.0000000000000033DOI Listing
February 2015

A patient with low pressure idiopathic intracranial hypertension and multiple cranial neuropathies.

Br J Hosp Med (Lond) 2013 Dec;74(12):696-7

Registrar in the Department of Acute Medicine, Frenchay Hospital, Bristol.

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http://dx.doi.org/10.12968/hmed.2013.74.12.696DOI Listing
December 2013

Real time and accelerated stability studies of Tetanus toxoid manufactured in public sector facilities of Pakistan.

Pak J Pharm Sci 2013 11;26(6):1271-8

National Institute of Health, Islamabad, Pakistan.

Tetanus is an acute illness represented by comprehensive increased inflexibility and spastic spasms of skeletal muscles. The poor quality tetanus toxoid vaccine can raise the prevalence of neonatal tetanus. WHO has taken numerous steps to assist national regulatory authorities and vaccine manufacturers to ensure its quality and efficacy. It has formulated international principles for stability evaluation of each vaccine, which are available in the form of recommendations and guidelines. The aim of present study was to ensure the stability of tetanus vaccines produced by National Institute of Health, Islamabad, Pakistan by employing standardized methods to ensure constancy of tetanus toxoid at elevated temperature, if during storage/transportation cold chain may not be maintained in hot weather. A total of three batches filled during full-scale production were tested. All Stability studies determination were performed on final products stored at 2-8°C and elevated temperatures in conformance with the ICH Guideline of Stability Testing of Biological Products. These studies gave comparison between real time shelf-life stability and accelerated stability studies. The findings indicate long-term thermo stability and prove that this tetanus vaccine can remain efficient under setting of routine use when suggested measures for storage and handling are followed in true spirit.
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November 2013

Multiple disseminated pyogenic granulomas.

J Coll Physicians Surg Pak 2013 Aug;23(8):588-9

Department of Dermatology, PAF Hospital, Sargodha, Pakistan.

Pyogenic granulomas (Granuloma telengiectaticum) or lobular capillary haemangioma are classically described as solitary lesions, occurring in young individuals, usually at the site of previous trauma, with a tendency to recur after treatment. We describe an unusual case of multiple disseminated pyogenic granulomas in an elderly male caucasoid of Pakistani origin in whom more than 400 lesions occurred de novo without any antecedent history of trauma or skin disease, responded well to treatment and showed no tendency for recurrence. Multiple eruptive pyogenic granulomas are probably a rare subset of the disease, which can occur at any age, arise de novo or in association with a skin or systemic disease and do not exhibit a tendency to recur after treatment.
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http://dx.doi.org/08.2013/JCPSP.588589DOI Listing
August 2013

Risk factors for colonoscopic perforation: a population-based study of 80118 cases.

World J Gastroenterol 2013 Jun;19(23):3596-601

Department of Gastroenterology, Geisinger Medical Center, Danville, PA 17822, USA.

Aim: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy.

Methods: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t-test and Pearson's χ² test, as appropriate.

Results: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P-value < 0.1 were checked for inclusion in a multivariable log-binomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy.

Conclusion: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.
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http://dx.doi.org/10.3748/wjg.v19.i23.3596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3691036PMC
June 2013

Clinical pattern of vitiligo.

J Coll Physicians Surg Pak 2012 Jan;22(1):61-2

Department of Dermatology, Combined Military Hospital, Abbottabad.

All new cases of vitiligo reporting to Dermatology Outpatient of Combined Military Hospital, Panu Aqil, were included in the study. Of the 230 patients, 124 were male (53.9%) and 106 were female (46.1%). Males were more commonly affected. The disease affected all age groups. Mean age at presentation was 27.02 + 18.34 years and age at presentation ranged from 5.5 months to 82 years. The mean age at onset was 22.03 + 16.97 years with majority 30.4% (n=70), developing vitiligo in first decade of life. Generalized vitiligo was the most common type (n=132, 57.4%) followed by focal (n=53, 23%) and acro-facial vitiligo (n=16, 7%). Head and neck was the most common initial site of onset (n=100, 43.48%). Koebner phenomenon was observed in 72 patietns (31.3%), family history was present in 64 patients (27.8%) and 16 patients (7%) had associated diseases.
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http://dx.doi.org/01.2012/JCPSP.6162DOI Listing
January 2012

Harlequin ichthyosis in two siblings.

J Coll Physicians Surg Pak 2011 Aug;21(8):503-5

Department of Dermatology, Combined Military Hospital, Abbottabad.

Harlequin ichthyosis is a rare and extremely severe form of congenital ichthyosis. The affected neonates usually do not survive beyond first few days after birth, but several long-term survivals have been noted. The inheritance is thought to be autosomal recessive. It has recently been shown that the vast majority of affected individuals are homozygous for mutations in the ABCA12 gene, which cause a deficiency of the epidermal lipid transporter and result in hyperkeratosis and abnormal barrier function. Prenatal diagnosis is possible. We report a case of a newborn with Harlequin ichthyosis, a product of consanguineous marriage, with a history of similar disease leading to early neonatal death previously in a sibling.
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http://dx.doi.org/08.2011/JCPSP.503505DOI Listing
August 2011

Paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features of multiple myeloma.

J Coll Physicians Surg Pak 2011 Jan;21(1):40-2

Department of Dermatology, Combined Military Hospital Lahore.

Black brown hyperpigmentation of the mucosae, sunexposed skin, palmar creases and frictional sites (Addisonian pigmentation) is characteristic of Addison disease. However, it can also occur as a paraneoplastic manifestation of tumours like bronchogenic carcinoma. Acquired ichthyosis starts later in life and can also be a paraneoplastic presentation. We report a unique combination of paraneoplastic Addisonian pigmentation and acquired ichthyosis as presenting features in a patient with undiagnosed multiple myeloma. To the best of our knowledge this combination of paraneoplastic dermatosis has not been documented before in multiple myeloma. It is concluded that the presence of more than one suspicious dermatosis may be an indicator of being paraneoplastic requiring necessary work-up.
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http://dx.doi.org/01.2011/JCPSP.4042DOI Listing
January 2011

Nutrition in critically ill obese patients.

Crit Care Clin 2010 Oct;26(4):671-8

Department of Gastroenterology and Nutrition, Geisinger Medical Center, MC 21-11, 100 North Academy Avenue, Danville, PA 17822, USA.

Critically ill obese patients require timely nutrition in the intensive care unit. Hypocaloric, high protein nutritional feeding might have a role in critically ill obese patients. Although critically ill obese patients need special medical and nutritional care as do nonobese patients in the ICU, there are some differences in the literature about the initiation, routes, and nature of nutritional support. This article reviews the norms of nutritional care among critically ill obese patients and the differences between these patients and those with a normal BMI.
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http://dx.doi.org/10.1016/j.ccc.2010.08.004DOI Listing
October 2010

Constitutional and behavioral risk factors for chilblains: a case-control study from Pakistan.

Wilderness Environ Med 2010 Mar 22;21(1):17-21.e1. Epub 2009 Dec 22.

PAF Hospital Faisal, Shahrah e Faisal, Karachi, Pakistan.

Objectives: To study constitutional and behavioral risk factors for chilblains in patients at Abbottabad and Sialkot, Pakistan.

Methods: One hundred patients and matched controls completed a single-page, close-ended questionnaire which included demographic data and questions related to possible constitutional and behavioral risk factors for chilblains. Computer program SPSS-10 was used to manage and analyze the data. Risk factors were identified statistically by determining odds ratios and 95% confidence intervals using multivariate analysis.

Results: There were an equal number of male and female respondents in each group. Age of the patients and controls ranged from 2 to 80 years with a mean of 24.51 +/- 16.02. Twenty-six patients and 3 controls had a positive family history for chilblains (odds ratio = 9.33); 42 patients and 14 controls reported a history of constipation (odds ratio = 2.69); 32 patients and 8 controls had a history of either numbness or tingling of fingers or toes (odds ratio = 2.93); 55 patients and 45 controls led sedentary lifestyles (odds ratio = 1.27); 85 patients and 58 controls consumed a low number of cups of tea daily (odds ratio = 3.20); 65 patients and 29 controls frequently washed their hands and/or feet (odds ratio = 4.93); and 56 patients and 33 controls had occasional sun exposure during winter months (odds ratio = 2.08).

Conclusion: Significant risk factors for the development of chilblains for people at Abbottabad and Sialkot included a history of chilblains in first-degree relatives, numbness and tingling sensations of fingers or toes, frequent hand or feet washing, and lower tea consumption during winter months.
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http://dx.doi.org/10.1016/j.wem.2009.12.023DOI Listing
March 2010

Treatment of toxic epidermal necrolysis (TEN) with low dose intravenous immunoglobulin in child.

J Coll Physicians Surg Pak 2010 Mar;20(3):205-7

Department of Dermatology, Combined Military Hospital, Pano Aqil Cantt.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN, Lyell's disease) are severe, episodic, acute mucocutaneous reaction that may be caused by various factors particularly drugs. Treatment is primarily supportive care and there are no specific therapy regimens. Intravenous immunoglobulin (IVIG) has recently been shown to be a useful and safe therapy in paediatric patients with SJS/TEN, though no such case has so far been reported from Pakistan. The authors report the experience with low dose IVIG (0.1 g/kg/day for four consecutive days for treating a 3 years old boy with toxic epidermal necrolysis with favourable outcome without early complications.
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http://dx.doi.org/03.2010/JCPSP.205207DOI Listing
March 2010

Zinc deficiency in patients with persistent viral warts.

J Coll Physicians Surg Pak 2010 Feb;20(2):83-6

Department of Dermatology, PAF Hospital Faisal, Shahrah-e Faisal, Karachi.

Objective: To determine the association of low serum zinc levels with persistent, progressive or recurrent viral warts.

Study Design: A comparative study.

Place And Duration Of Study: Dermatology outpatient department of Combined Military Hospital, Abbottabad in collaboration with Department of Chemical Pathology, Army Medical College, Rawalpindi, from June 2006 to May 2007.

Methodology: Seventy five patients having warts of more than six months duration, more than 10 in number, who either not responded to or had recurrence after previous treatments for viral warts and not having other chronic dermatological or systemic illness were included in the study after informed consent. Seventy five age and gender matched healthy individuals were taken as control. Serum zinc analysis was carried out by atomic absorption spectrometry using Perkin elmen (USA) apparatus. Independent sample t-test was used to compare mean zinc levels in microgram/litre with significance at p < 0.05.

Results: Age of the patients as well as controls ranged from 12-65 years with a mean of 25.88 + 8.90 years. Serum zinc level was low in 42 (56%) patients and 24 (32%) controls (p=0.003). Among the patients, serum zinc level ranged from 695-1090 micro-gram/litre with a mean of 804.38 + 100.60, whereas the level ranged from 690-1100 microgram/litre with a mean of 836.17 + 91.04 among controls (p 0.044).

Conclusion: Zinc deficiency is associated with persistent, progressive or recurrent viral warts in the studied patients. Randomized controlled trials with careful dose adjustment of oral zinc sulphate may be helpful to formulate guide lines to manage such patients.
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http://dx.doi.org/02.2010/JCPSP.8386DOI Listing
February 2010

Lupoid cutaneous leishmaniasis: a report of 16 cases.

Indian J Dermatol Venereol Leprol 2010 Jan-Feb;76(1):85

Department of Dermatology, Combined Military Hospital, Peshawar, Faisal, Pakistan.

Background: Lupoid cutaneous leishmaniasis (CL) is known as the chronic form of CL. However, keeping its clinical presentation in view, there is a need to revisit this form of disease.

Aims: To redefine/describe lupoid CL in view of clinical features.

Methods: It was a case series seen in Muzaffarabad (Pakistan) from Jan 2006 to May 2008. All patients clinically suggestive and consistent with laboratory diagnosis of CL were registered. Patients of all age groups and either sex having cutaneous lesions resembling lupus vulgaris or lupus erythematosus on the face or elsewhere were included in the study. Those having chronic fluctuating/relapsing course or scarring within the lesions were also included. Various demographic features of the patients and clinical patterns were recorded. Descriptive statistics were used for analysis.

Results: Of 254 registered patients of CL, 16 (6.3%) were diagnosed as lupoid CL. None of the patients had scarred lesions. Age ranged from 38 to 75 (55 + 15.11) years and duration of lesions varied from 4 to 32 (14.25 + 07.59) weeks. All patients had lesions over the face. Thirteen (81.25%) had a large solitary plaque extending over the nose and a large part of the cheeks and three (18.75%) had multiple lesions. Lesions were central/nasal in two (12.5%), unilateral/asymmetrical in four (25%) and bilateral/symmetrical in 10 (62.5%). Morphological patterns included erythematous/infiltrated (7), psoriasiform (6), ulcerated/crusted (2) and Discoid lupus erythematosus (DLE)[G1] like (1).

Conclusion: Lupoid CL is not strictly a chronic form of disease, which presents on the face from the very onset and shows no scarring or recurrence.
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http://dx.doi.org/10.4103/0378-6323.58698DOI Listing
August 2010

A clinicopathological study of urethritis in males.

J Coll Physicians Surg Pak 2009 Dec;19(12):772-5

Department of Dermatology, Pakistan Steel Hospital, Karachi.

Objective: To determine the etiology and frequency of different types of urethritis in adult males.

Study Design: A case series.

Place And Duration Of Study: The Dermatology Department of PNS Shifa Hospital, Karachi, from June 2004 to December 2007.

Methodology: One hundred male patients having complaints of urethral discharge and dysuria reporting in the skin OPD were included in the study. Patients who had received systemic treatment for their complaints and those who had other systemic infections were excluded. A detailed history including history of sexual contact was taken. Dermatological examination including examination of external genitalia was also performed. All these patients were subjected to complete physical examination, complete urine examination, urethral pus for gram staining and culture, endo-urethral swab with urethral loop for seeing Chlamydia antigen by fluorescent microscopy, cultures for ureaplasma and Wet mount specimen microscopy for trichomonas along with HIV (serum ELISA) test. Non-gonococcal urethritis was diagnosed on the presence of more than five polymorphonuclear leucocytes per high power field in at least five fields of Gram stained urethral smear, in the absence of Gram negative diplococci.

Results: The mean age was 29.2 + or - 5.8 years. Seventy (70%) cases were diagnosed as gonococcal urethritis and 30 (30%) cases as non-gonococcal urethritis (NGU). History of illicit sexual exposure was available in 25 (25%) patients. The interval period between initiation of symptoms and reporting of patient in gonococcal urethritis was 4 to 30 days (mean 12.8 days) and 4 days to 2 months (mean 20.7 days) in non-gonococcal urethritis. The patients with gonococcal urethritis presented with purulent discharge in 66 (84%) cases, and dysuria in 49 (70%) cases. In the NGU group, 25 (80%) cases had mucoid discharge and 18 (65%) had dysuria. in 70%, Neisseria gonorrhoeae was isolated, Chlamydia trachomatis in 16%, ureaplasma in 8%, and Trichomonas vaginalis in 4%. No organism could be detected in 2% cases. HIV test was negative in all cases.

Conclusion: Gonococcal urethritis was the commonest urethritis seen followed by Chlamydia infection in the studied group of adult males.
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http://dx.doi.org/12.2009/JCPSP.772775DOI Listing
December 2009

Different faces of gastroparesis.

World J Gastroenterol 2009 Dec;15(48):6052-60

Division of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States.

Aim: To test the hypothesis that pain and affect rather than impaired emptying determine symptom severity in patients with gastroparesis.

Methods: Adult patients with documented gastroparesis were enrolled prospectively in a single center and asked to complete the Gastroparesis Cardinal Symptom Index (GCSI), Hospital Anxiety and Depression Scale (HADS), the Short Form 12 (SF-12) as quality of life index, rate pain severity and answer 10 open-ended questions.

Results: A total of 55 patients (44 women) participated. Idiopathic (n = 29) or diabetic (n = 11) gastroparesis and connective tissue disease (n = 8) were the most common underlying causes. Antiemetics (n = 30) and prokinetics (n = 32) were most often prescribed. Seventeen patients used opioids on a daily basis. Nausea and/or vomiting (n = 28), pain (n = 24) and bloating (n = 14) were most commonly listed as dominant symptoms. Patients subjectively attributed symptom improvement to nutritional and dietary therapy (n = 11), prokinetics (n = 11), antiemetics (n = 10) or analgesic agents (n = 3). In univariate analyses, the physical subscore of the SF-12 and HADS, but not gastric emptying delay or symptom duration significantly correlated with disease severity as measured by the GCSI. In multivariate analyses, the combination of vomiting, bloating and depression best predicted the overall impact on quality of life.

Conclusion: The study confirms the importance of pain and affect in gastroparesis, which requires novel approaches to improve more effectively the quality of life in patients with this disorder.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797661PMC
http://dx.doi.org/10.3748/wjg.15.6052DOI Listing
December 2009

Drug induced toxic epidermal necrolysis: two case reports.

Cases J 2009 Sep 9;2:7765. Epub 2009 Sep 9.

Department of Dermatology, Combined Military Hospital, Kohat-75200, Pakistan.

Introduction: Among the various drug induced dermatological entities toxic epidermal necrolysis and Stevens-Johnson's syndrome occupy a primary place in terms of mortality. Prompt recognition of these conditions, immediate drug withdrawal and institution of appropriate treatment plays a vital role in reducing mortality. Drugs are by far the most common cause of toxic epidermal necrolysis, in which large sheets of skin are lost from the body surface making redundant the barrier function of the skin, with its resultant complications. The use of systemic corticosteroids in the treatment of toxic epidermal necrolysis has always been controversial, some consider corticosteroids life-saving while others believe that they increase mortality.

Case Presentation: We describe two cases of drug-induced toxic epidermal necrolysis, a male and a female, both caucasoids of Pakistani origin, one treated without any steroids and the other with them, who made complete recovery without any major complications or sequelae.

Conclusion: The administration of systemic corticosteriods did not cause any major changes in outcome in our cases.
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http://dx.doi.org/10.4076/1757-1626-2-7765DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769368PMC
September 2009

Why dermatology patients are hospitalized? A study from Pakistan.

Acta Dermatovenerol Croat 2009 ;17(2):113-7

PAF Hospital Faisal, Karachi, Pakistan.

In most countries, there are no specified protocols or guidelines for admitting dermatology patients and admission criteria depend on assessment and sometimes the whim of the dermatologist. Although the severity and extent of the disease are the commonest reasons for hospitalizing dermatology patients, sometimes other factors also operate to provide comfort to the patient. This study was carried out to determine the reasons for hospitalizing patients on dermatology beds in secondary care hospitals of Pakistan. A questionnaire comprising patients' demographic data, diagnosis, specific reasons for hospitalization and length of hospital stay was sent to dermatologists of 10 secondary care hospitals in the country. The data received in response were processed and analyzed using the SPSS-10 computer program. A total of 310 patients were included in the study. Patient age ranged from 1 to 87, mean 28.87+/-12.32 years. The severity and extent of the disease (n=122; 39.3%), outpatient treatment failure (n=57; 18.4%) and need for further observation and/or investigations (n=51; 16.5%) were the most common reasons for hospitalizing these patients. Hospital stay of the patients ranged from 2 to 30, mean 9.82+/- 6.43 days. Scabies (n=56; 18.1%), chickenpox (n=52; 16.8%) and eczema (n=41; 13.2%) were the most common diagnoses.
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December 2009

Onset of chilblains in relation with weather conditions.

J Ayub Med Coll Abbottabad 2008 Apr-Jun;20(2):17-20

Combined Military Hospital, Abbottabad.

Background: Chilblains or perniosis is a moderately severe form of cold injury, localized to peripheral parts of the body, which occurs after exposure to non-freezing temperatures and damp conditions. Although inter-individual variations exist with respect to susceptibility to develop chilblains, no study has been carried out in this region to determine the role of different weather conditions either alone or in combination, in predisposing the susceptible individuals to chilblains. The objective of this study was to determine the relationship between weather conditions and onset of chilblains at a moderately cold weather station.

Methods: This study was conducted at the Department of Dermatology, Combined Military Hospital, Abbottabad, from Dec 2004 to Mar 2005. All patients fulfilling the clinical criteria for diagnosis of chilblains were included in the study. These patients were interviewed and examined thoroughly. A specially designed proforma was filled for each patient separately. Meteorological department was contacted for record of weather conditions. Onset of chilblains in each patient was related with weather conditions of that particular month. Computer programme SPSS 10 was used for statistical analysis.

Results: Out of 111 patients, 67 (60.4%) were males and 44 (39.6%) were females. Eighty nine (80.2%), 90 (81.1%) and 90 (81.1%) patients had onset in relation with lower temperature (< 10 degrees C), relatively low atmospheric pressure (< 1500 kpa) and higher relative humidity (> 60%) respectively. There was statistically significant relationship of weather conditions with onset of chilblains when different groups, i.e., elderly and young, males and females, locals and non locals, outdoor workers and those remaining inside most of the time and those having disease of longer or shorter duration were compared.

Conclusion: The cold weather conditions that can be endured by humans depend on combination of the duration and the extent of the exposure, in addition to physiological adaptive changes. However, susceptibility to chilblains increases when ambient temperature is less than 10 degrees C and relative humidity is more than 60%. Elderly, females, outdoor workers and those having chronic or recurrent episodes of chilblains are less tolerant to cold weather and develop the disease under lesser ambient cold.
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August 2009

Presentation of early onset psoriasis in comparison with late onset psoriasis: a clinical study from Pakistan.

Indian J Dermatol Venereol Leprol 2009 Jan-Feb;75(1):36-40

Combined Military Hospital, Kharian Cantonment, Pakistan.

Background: Early onset psoriasis and late onset psoriasis are known to have different clinical patterns in Caucasian population. However, there is paucity of data among Asian patients.

Aims: To compare the clinical presentation of early onset psoriasis with late onset psoriasis in Pakistani population.

Methods: During the study period, participating dermatologists filled a pre-tested questionnaire for each patient with psoriasis on first encounter. The questionnaire incorporated information regarding clinical and demographic features of psoriasis including age of onset, clinical type of psoriasis, nail or joint involvement, and PASI score. Patients were then divided into early onset (age of onset < 30 years, group I) and late onset (age of onset > or =30 years, group II) psoriasis.

Results: Five hundred and fifteen questionnaires were filled and returned for evaluation. There was no statistically significant difference in both groups with regards to gender, family history (P = 0.09), nail (P = 0.69) and joint (P = 0.74) involvement, disease severity (P = 0.68), and clinical type of psoriasis (P = 0.06). No significant difference between disease severities measured by PASI score was observed in the two groups (P = 0.68). Presence of nail involvement was associated with joint disease in both groups (odds ratio 2.8, confidence interval 1.9-4.1).

Conclusion: Patients with early and late onset psoriasis in Pakistani population do not show different clinical and demographic features contrary to the Western patients.
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http://dx.doi.org/10.4103/0378-6323.45218DOI Listing
November 2009

Drug induced linear IgA disease with unusual features: Koebner phenomenon, local insulin sensitivity and annular blister of the nipples.

Acta Dermatovenerol Croat 2008 ;16(4):215-7

Department of Dermatology, Combined Military Hospital, Lahore, Pakistan.

Linear IgA disease is an autoimmune subepidermal bullous disease in which linear IgA deposits are found at the basement membrane zone. It is classically idiopathic but may be drug induced. We report on a patient with drug induced linear IgA disease who exhibited certain unusual and interesting clinical features including isomorphic Koebner response, annular blister of the nipples and local insulin sensitivity. To the best of our knowledge, these clinical features have not yet been reported in linear IgA disease.
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April 2009

Discriminative value of anorectal manometry in clinical practice.

Dig Dis Sci 2009 Nov 18;54(11):2503-11. Epub 2008 Dec 18.

Division of Gastroenterology, University of Pittsburgh, Pittsburgh, PA 15213, USA.

Guidelines recommend anorectal manometry in patients with fecal incontinence and chronic constipation. However, limited evidence supports the utility of manometric testing. We retrospectively reviewed tracings obtained between November 2005 and May 2008. A total of 298 patients (86% women; average age 52 years) were included. The main indications were incontinence (51%) and constipation (42%). Patients suffering from incontinence were older and had lower resting and squeeze pressure compared to continent patients. However, the discriminative power of manometric pressure data was poor, with low sensitivity and specificity. An abnormal straining pattern suggesting dyssynergic defecation was seen in 43% of constipated patients compared to 13% of patients with fecal incontinence. A concordance between manometric patterns and the balloon expulsion test was seen in 72%. The low sensitivity and specificity of manometric parameters does not support the routine use of anorectal manometry in patients with defecation disorders.
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http://dx.doi.org/10.1007/s10620-008-0631-1DOI Listing
November 2009

Dermatosis neglecta in a case of multiple fractures, shoulder dislocation and radial nerve palsy in a 35-year-old man: a case report.

J Med Case Rep 2008 Nov 17;2:347. Epub 2008 Nov 17.

Skin department, Combined Military Hospital, Kharian Cantt, Pakistan .

Introduction: Dermatosis neglecta is an often misdiagnosed and under-diagnosed condition. In dermatosis neglecta, a progressive accumulation of sebum, sweat, keratin and other dirt and debris, occurs due to inadequate local hygiene resulting in a localized hyperpigmented patch or a verrucous plaque. Vigorous rubbing with alcohol-soaked gauze or soap and water results in a complete resolution of the lesion. This is the first case of dermatosis neglecta reported in a patient with multiple traumatic injuries.

Case Presentation: We report a case of a 35-year-old male Caucasian of Pakistani origin, with multiple fractures, neurological deficit and immobility sustained in a fall, leading to the development of dermatosis neglecta of the left hand.

Conclusion: Early and prompt clinical recognition of this condition eliminates the need for aggressive diagnostic and therapeutic procedures.
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http://dx.doi.org/10.1186/1752-1947-2-347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596164PMC
November 2008

Localized lesions in secondary syphilis.

J Coll Physicians Surg Pak 2008 May;18(5):303-4

Department of Dermatology, Combined Military Hospital, Lahore, Pakistan.

The clinical manifestations of secondary syphilis are variable and can mimic many skin diseases, mostly being generalized and symmetrical in distribution. Localized lesions of secondary syphilis are rarely seen in dermatology clinics. We report an unusual presentation wherein a patient had localized lesions over face and soles only. There is a need for increased awareness on the part of physicians to recognize new patterns of syphilitic infection, together with a willingness to consider the diagnosis of syphilis in patients with unusual clinical features.
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http://dx.doi.org/05.2008/JCPSP.303304DOI Listing
May 2008

Millipede burn at an unusual site mimicking child abuse in an 8-year-old girl.

Clin Pediatr (Phila) 2008 Jun;47(5):490-2

Department of Dermatology, Combined Military Hospital, Lahore, Pakistan.

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http://dx.doi.org/10.1177/0009922807310935DOI Listing
June 2008

Trumpet cheilitis in a novice musician.

Arch Dermatol 2008 May;144(5):690-1

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http://dx.doi.org/10.1001/archderm.144.5.690DOI Listing
May 2008

Papulonecrotic tuberculids associated with uveitis.

J Coll Physicians Surg Pak 2008 Apr;18(4):236-8

Department of Dermatology, Combined Military Hospital, Lahore.

Papulonecrotic tuberculids represent an immunological expression of an internal focus of tuberculosis in an individual with a moderate or high degree of immunity. It responds to anti-tuberculosis treatment and is characterized by an eruption of necrotizing papules occurring in symmetrical crops, particularly affecting the elbows, knees, buttocks and face. A case of papulonecrotic tuberculids associated with immune mediated unilateral uveitis is reported in which all investigations were negative for tuberculosis except a strongly positive tuberculin test. There was an excellent response to anti-tuberculosis treatment. The association of immune mediated uveitis with papulonecrotic tuberculids has not been described before.
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http://dx.doi.org/04.2008/JCPSP.236238DOI Listing
April 2008