Docstoc

S Sikder Slide anaemia

Document Sample
S Sikder Slide  anaemia Powered By Docstoc
					WELCOME
     Management of
      Arsenicosis

Dr.Md.Shahidullah Sikder
Haider Jahan
Dr.Hasibur Rahman
   Bangladesh
              Introduction:
   Arsenic contamination of under
    groundwater has raised much concern
    due to its high potential to cause
    adverse health effects ranging from
    skin lesions to cancers of various
    organs.
   There is no specific treatment
    available for Arsenicosis but there are
    some measures available for
    symptomatic management.
   It is very essential to find out an
    appropriate treatment regimen of
    Arsenicosis.
    Subjects & Methods:
   750 patients selected randomly having suspected skin lesions of
    Arsenicosis during the period of January 1996 to July 2005 at
    dermatology department of Banghabhandhu Sheikh Mujib Medical
    University (BSMMU),Dhaka, Bangladesh.
   Thorough clinical examination and relevant laboratory
    investigations were done.
   Different modalities of treatment were applied among the
    different group of arsenicosis patients in different periods.
   Along with avoidance of drinking arsenic contaminated water
    different regimen of treatment have been applied like : (i)
    Topical use of salicylic acid (5% to 30%). (ii) Systemic oral use of
    vitamin ACE, (iii) Oral use of spirulina with other nutritional
    supplement (iv) Cryotherapy for hyper keratosis, (v) Combination
    of topical application of salicylic acid with oral vitamin & other
    nutritional supplement.
   The out come of the investigations & treatment was recorded
    properly.
   Rain drop
    Pigmentation
    with arsenical
    punctate
    keratosis
•Malnutrition with
diffuse
hyperpigmentation
in chronic
arsenicosis patient
Warty Hyperkeratosis in the palm
  Warty Hyperkeratosis &
Pigmentation on the Palm &
           Sole
Unilateral leg oedema in chronic
       arsenicosis patient
Chronic liver disease in chronic
     arsenicosis patient
Bowen’s disease in chronic
   arsenicosis patient
       in the sole
Cutaneous malignancy in chronic
      arsenicosis patient
Result:

                  Table # 01
                  Dermatological Manifestation:

Sl.No.   Presentation                      No. of     Percentage of
                                           Patients   Patients


01.      Pigmentary changes                750        100%
         Raindrop pigmentation/Diffuse
         pigmentation
02.      HyperKeratosis                    600        80%
         i)    Discrete warty lesion in
              palm & sole
         ii)   Fissure/crack in Palm &
              Sole.
         iii)  Diffuse Hyperkeratotic
              lesion in the sole & palm.


03.      Palmoplanter hyperhydrosis        15         2%

04.      Skin malignancy                   15         2%
                             Table # 02
                       Systemic Manifestation:

Sl.No   Parameters                No. of Patients   Percentage of
                                                    patients
01.     Anaemia                   675               90%

02.     Weakness                  675               90%

03.     Anorexia                  675               90%
04.     Weightloss                600               80%
05.     Difficulty in breathing   150               20%
06.     Conjunctival conjestion   90                12%
07.     Cramps in legs with       150               20%
        asthenia
08.     Peripheral neuropathy     23                3%
09.     Hepatomegaly              18                2.4%
10.     Cardiomegaly              9                 1.2%
                       Table # 03
      Results of topical use of Salicylic acid:




Sl.No.   Parameter     Improvement No Change   Reduced
01.      Pigmentary    10%          85%        5%
         change
02.      Hyperkeratosis 90%         5%         5%
                           Table# 04
 Result of oral use of Vitamin AEC( Anti-oxidant Vitamin) on the
                    following Manifestations:



Sl.No.   Parameter        Improvement    No Change     Reduced


01.      Pigmentary       60%            35%           5%
         Change
02.      Hyperkeratosis   10%            85%           5%
03.      Weakness         80%            15%           5%
04.      Anorexia         80%            15%           5%
05.      Anaemia          70%            20%           10%
06.      Weightloss       70%            20%           10%
07.      Breathlessness   70%            20%           10%
                           Table # 05
      Result of using spirulina & Nutritional Supplement:




Sl.No.   Parameter           Improvement No Change   Reduced

01.      Pigmentary Change   70%         25%         5%

02.      Hyperkeratosis      10%         85%         5%
03.      Weakness            90%         5%          5%
04.      Anorexia            80%         15%         5%
05.      Anaemia             80%         15%         5%
06.      Weightloss          75%         20%         5%
07.      Breathlessness      75%         20%         5%
                         Table # 06
          Result of application of Cryotherapy for
                      Hyperkeratosis:




Sl.No.   Parameter     Improvement    No Change   Reduced


01.      Hyperkeratosis 90%           2%          8%
                       Table # 07
Use of Combination therapy of Topical Salicylic acid with
      oral Vitamin & other nutritional supplement:


Sl.No.   Parameter           Improvement No Change   Reduced


01.      Pigmentary Change   90%         5%          5%


02.      Hyperkeratosis      95%         0%          5%
03.      Weakness            90%         5%          5%
04.      Anorexia            80%         15%         5%
05.      Anaemia             80%         15%         5%
06.      Weightloss          75%         20%         5%
07.      Breathlessness      75%         20%         5%
              Discussion
             & Conclusion:
   Management of arsenicosis is a complicated issue
    which needs options of safe drinking water,
    appropriate topical & systemic medication.
   No single medication is available to treat a fully
    developed arsenicosis patient satisfactorily.
   In spite of avoidance of arsenic contaminated water
    & treatment with available medications some
    patients are detoriating.
   Early diagnosis of arsenicosis & combination
    therapy may save many of the victim.
Thank You

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:8
posted:1/16/2011
language:English
pages:23