Outcome of CROSS technique with 100% trichloroacetic acid in the management of atrophic icepick acne scars

Objective: to assess the outcome of CROSS technique with 100% trichloroacetic acid [TCA] on atrophic icepick acne scars

Methods: it was a quasi-experimental study held at dermatology department, Sir Ganga Ram Hospital, Lahore on 20th November 2013 till 19th April 2014. A total number of 60 patients were included in this study. There were 40 female [66.7%] patients and 20 male [33.3%] patients. After informed consent, four sessions of 100% TCA focal application on atrophic icepick acne scars by CROSS [chemical reconstruction of skin scars] technique were done at two weekly intervals and final outcome was assessed at three months after the last session

Results: in our study 41.7% patients showed excellent [>70% reduction of acne scars] response, 45% patients showed good [51-70% reduction of acne scars] response, 13.3% patients showed fair [30-50% reduction] response and no patient showed poor [<30% reduction] response

Conclusion: chemical reconstruction of skin scars [CROSS] technique with 100% TCA is a safe, minimally invasive and cost-effective technique for the treatment of icepick acne scars

Clinical spectrum of pediatric dermatoses at a tertiary care unit

Objective: To determine the clinical spectrum of pediatric dermatoses at a tertiary care unit

Methods: Three hundred and fifty cases aged up to 12 years, presenting to dermatology unit I, Jinnah Hospital, Lahore with skin diseases were enrolled over a period of 6 months. Detailed history and physical examination were done to diagnose the skin lesions. All the information was collected on a specially designed proforma

Results: A total of 350 children with skin diseases, 186 [53.1 percent] males and 164 [46.9 percent] females were seen. The mean age of patients in the study was 4.18+/-2.97 years. Infections and infestations were the common dermatoses seen in 158 [45.1 percent] and 105 [30 percent] children, respectively. Eczema was present in 79 [22.6 percent] patients and diseases of sweat gland in 8 [2.3 percent]

Conclusion: Infection and infestations were seen as the most common pediatric dermatoses

Lactic acid peeling in the treatment of epidermal melasma

Objective: To determine the efficacy of lactic acid peeling in the treatment of melasma

Methods: This quasi- experimental study was carried out at department of Dermatology, Sir Ganga Ram Hospital, Lahore. A total number of 40 patients, with age ranging from 20-50 years were included in the study. All patients were female except 2. All patients underwent lactic acid peeling sessions at 3 weekly intervals for a total 6 sessions. The severity of melasma was assessed by MASI score. Efficacy was based on mean decrease in MASI score at baseline and MASI score three weeks after the completion of treatment

Results: Mean of MASI scores of all these subjects at baseline was 12.62, and the mean MASI score recorded at the final follow-up was 6.30. Mean decrease in MASI scores was 6.32

Conclusion: Lactic acid peeling is effective in the treatment of epidermal type of facial melasma in Asian skin

Histopathological analysis of skin biopsies in a tertiary care setting

Objective: To determine the spectrum and frequency of skin diseases on the basis of histopathology

Methods: 152 skin biopsy specimens were received during a period of one year. They were processed routinely and findings recorded. Relevant demographic data as well as clinical findings were also noted. After diagnosis, the cases were divided into seven groups, viz, eczema-dermatitis, papulosquamous disorders, infectious disorders, blistering disorders, neoplastic lesions, degenerative diseases and miscellaneous lesions. Results were analyzed using percentage frequencies, Fischer's exact test and student's t test as appropriate

Results: The age range of patients was 5-81 years with mean being 37.59 +/- 17 years. Majority of biopsies were from male patients [55.3%]. Papulosquamous disorders were the most common group with a frequency of 46.7%. Second most frequent skin disease groups were eczema -dermatitis and blistering disorders, each accounting for 12.5 % of all biopsies. Neoplastic lesions constituted 10.5% of the lesions, with benign and malignant lesions presenting at the average ages of 47 and 43 years respectively

Conclusion: The average age at presentation was close to that reported by other researchers from this region. The greater number of male patients is at variance from most other reported studies. The difference was statistically highly significant [p=0.0031]. The frequency of different diagnostic groups was unique in some respects and conformed to other studies in others. The most striking was the statistically significant difference in age of presentation of patients with malignant neoplasms. This highlights the need to raise awareness in public about the possible precautionary measures that need to be taken, in this region with high levels of exposure to sunlight

Plasmapheresis: an effective treatment in patients of toxic epidermal necrolysis: case report of two patients

Toxic epidermal necrolysis [TEN] is an acute, life-threatening cutaneous drug reaction that predominantly involves the skin and mucous membranes. It is a rare disorder and treated as a medical emergency, due to its fatal outcome. The principles of management include immediate removal of culprit drug[s], supportive management and specific drug therapies or procedures, of which plasmapheresis is one treatment modality. We report two patients of TEN, being successfully treated with plasmapheresis, proving it to be a life saving treatment modality

Exposure of dermatology postgraduate trainees to different learning resources and procedural skills in Pakistan

Objective To determine the learning resources and procedures used for dermatology postgraduate training in Pakistan

Methods Trainees from different centers accredited for dermatology postgraduate training in Pakistan were approached. A pre-designed proforma was filled by 100 dermatology trainees of FCPS, MCPS and MD programs

Results Hundred percent trainees followed Rook's Textbook of Dermatology as a major learning resource. The most commonly read journal was Journal of American Academy of Dermatology. Scientific conferences had been attended by less than 50% students. Most of the students were participating in clinical case discussions, while clinical slide sessions and histopathology sessions were not being attended by all. Most commonly learnt diagnostic procedure was fungal scraping [92%], least common was immunofluorescence [16%]. Out of various therapeutic procedures, electrocautery was being performed by 100% students while dermal fillers and botox injections by none

Conclusion There is a wide variation in exposure of dermatology residents to various learning resources and procedural skills across different teaching units of the country. The most lacking part of training highlighted in this study is the aesthetic or cosmetic aspects of dermatology

Anogenital ulceration; an unusual presentation of mixed connective disease

Mixed connective-tissue disease [MCTD] is an autoimmune disorder with overlapping clinical features of systemic lupus erythematosus [SLE], scleroderma, and myositis, with the presence of antiUl-ribonucleoprotein [RNP] antibody. We report a case of a male patient with unusual clinical presentation of the condition

Case of bullous pyoderma gangrenosum in a child

Bullous pyoderma gangrenosum is an atypical variety of pyoderma gangrenosum characterized by rapidly evolving vesicles or bullae that later rupture to form ulcers, commonly associated with underlying hematological malignancy. Various therapeutic options are available, including corticosteroids and other immunosuppressive agents. We present an eight-year-old boy having recalcitrant bullous pyoderma gangrenosum treated successfully with thalidomide

To explore the relationship and difference of life satisfaction and emotional expressivity among adolescence in joint and nuclear family

Objectives: The aim of present study is to investigate and examine the relationship of emotional expressivity and life satisfaction between male and female. Further, the study also examines gender differences of perceived life satisfaction and emotional expressivity and comparison between nuclear and joint family system among the respondents were also investigated Sample of the study consisted of n=30 of early adult, aged 19-25 drawn from university in Faisalabad. Study Design: Cross-sectional study. Place and Duration of Study: The sample was taken from GC University and different areas of Faisalabad. The duration of study was from August 2015 to November2015

Methodology: The Diner's Life Satisfaction Scale and The Ann M. Kring, David A Smith and John M. Neale Emotional Expressivity Scale used to check out the effect of emotion in this study. The results indicated that there would be significant relationship on emotional expressivity and Life satisfaction between male and females. We used correlation research design. Use of SPSS to find the results. The study result that is based on small sample can be generalized on large population which can build positive approach in people toward their future life

Results: In this study used the correlation research design for measuring in which degree the both variables are correlate to each. Otherwise study consisted on a sample of N= 30 participants which are divided in sub sample n= 15 male and n= 15 female. In this study used SPSS 3[rd] version for analysis the result and collection on data. Results shows that there was positive relationship between expressivity and life satisfaction [r= .522* with M= 60.42 and SD= 11.85] for emotional expressivity scale and M= 60.12 and SD= 11.20 for life satisfaction scale] therefore, the hypothesis was accepted which states that expressivity is positively related with life satisfaction while there was no difference in the level of life satisfaction and emotional expressivity between the two sexes

Conclusion: Thus, it can be concluded from the above discussion that is positive relationship between life satisfaction and emotional expressivity. It also concludes that male and female are living in same environment they both are equal on life satisfaction and Expressivity of emotions. The environmental factors are equally affected on their life satisfaction and Expressivity of emotions

Necrolytic acral erythema: a rare entity

Necrolytic acral erythema [NAE] is a rare but distinct clinical entity. It is one of the necrolytic erythemas that presents with itchy well-defined, dusky, erythematous to violaceous papules and plaques on acral areas

We report a case of a 50-year-old woman with 8-year history of itchy hyperpigmented papules and plaques on dorsum of both feet. Later, she developed similar lesions on both hands along with hemorrhagic blisters and purpura

She was found to be a hepatitis C virus [HCV] positive case. Histopathological findings were consistent with necrolytic acral erythema. She was treated with topical tacrolimus, oral zinc and cetirizine, and referred to medical outpatient department for treatment of HCV infection i.e. interferon and ribavirin

To measure the level of depression among working and non working married women

Objective: the aime of present study is to investigate and examine the perceived level of depression among working and non-working married women. Sample of the study consisted of 50 working married women and 50 non-working married women. It holds great significance to understand the difference of level of depression among working and non-working women in order to identify the causes and make endeavors to rectify these causes

Study Design: cross sectional study. Placed Duration of Study: The sample was taken from MHT hospital, Lahore Grammar School and different areas of Faisalabad. The duration of study was from November 2014 to April 2015. The investigation was to examine the perceived level of depression among working and non working women. It holds great significance to understand the difference of the level of depression among working and non working women in order to identify the causes and make endeavors to rectify these causes BDI Scale was administered individually on a sample of N=100 women' n= 50 working and n=50 non-working women from MTH hospital, Lahore grammar school and different areas of Faisalabad. Oral as well as written information was given to the participant

Results: results presented in the table indicate that there is highly significant correlation between the two measures. The table also suggests that the correlation of BDI [Beck Depression Inventory] [t=2.30,df=148 **p<.001]. It indicates that if depression is high in working married women then non- working married women. Our hypothesis regarding this relationship is supported, which implies that higher the depression in working married women then non-working women

Conclusion: thus, it can be concluded from the above discussion that there are differences in the western countries and Pakistani regarding depression. The findings of the study indicate that working married women have to face more difficulties in their lives like they experienced more depression as compared to non-working married women. It concludes that on some aspects working married women cannot contribute significantly for the well being of their family. Their attention diverted because of working in two situations. They cannot give proper attention to their marital lives and this causes depression

Anxiety life interference and self concept of slow learners

Objective: The study was designed to assess anxiety and its interference in life of slow learners, their self concept and find out relationship between anxiety and self concept

Study Design: Descriptive Case Series

Place and Duration of Study: The study was conducted from March, 2012 to October, 2012 in Government Special Education Institute for Slow Learners, Jhang

Method: Sample [N=54] was comprised of children, drawn from Government special Education Institute for Slow Learners, Jhang through purposive sampling technique. Participants were identified as slow learners on the basis of Mental State Examination [MSE] and Raven's Colored Progressive Matrices [CPM]. The test booklet comprised of three instruments including, Informed Consent Form, Children Anxiety Life Interference Scale [CALIS] and Self-Perception Profile for Children [SPPC]. Descriptive analysis and Pearson Correlation coefficient was used to analyze and make inferences from the data collected from sample by using SPSS version 13

Results: Descriptive analysis showed that slow learners [M=25.54, SD=6.59], N=54 on anxiety scale and [M=62.80, SD=11.38], N=54 on self perception profile as Athletic Competence [M=13.96, SD=3.13], Conduct [M=12.15, SD=2.45], Peer Acceptance [M=13.37, SD=3.13], Physical Appearance [M=12.72, SD=1.88] and Scholastic Competence [M=10.76, SD=2.39] that indicate negative self concept with moderate level of anxiety and correlation [**P<0.01] of anxiety life interference and self-perception profile

Conclusion: Slow Learner Children have moderate level of anxiety and negative self concept

Treatment seeking behavior in patients suffering from melasma

Introduction: Melasma is a common hypermelanosis that typically involves sun exposed areas in the face. Genetic, hormonal and UV radiations are important factors in its pathogenesis. Usually patients with melasma seek medical advice late after they have made their skin worse. So awareness regarding treatment of melasma is needed

Objective: To determine treatment seeking behavior in patients with Melasma

Study Design: Descriptive case series

Setting: Dermatology department of DHQ, Allied Hospital Faisalabad and Sir Ganga Ram Hospital Lahore

Methodology: By using non-probability consecutive sampling 104 individuals having melasma age ranges from 18-47 years of both gender were included. Questions asked from the patients regarding their treatment attitude included contact with doctor, self medication or any remedy, level of education and living background

Results: Out of 104 patients 103[99%] were females and 1[1%] male with mean age was 30.13 +/- 7.71. 26[25%] consulted skin specialists in public sector hospitals. 26[25%] patients used self medication. 17[16.3%] patients took no treatment. 13[12.5%] patients took advice from beauticians. 10[9.6%] patients consulted skin specialist in private sector hospitals.6 [5.8%] patients took advice from general practioners. Of 104 patients 89[85.6%] patients did not use any sunscreens as part of treatment. Out of 79[76%] patients who belong to urban area 21[26.6%] patients first consulted skin specialist in public sector. Regarding education 7[38.9%] illiterate and 5[41.7%] intermediate patients used self medication, 3[42.9%] primary educated patients did not consulted to any one, 6[33.3%] middle passed patients consulted beauticians, 6[26.1%] matriculate and 4[44.4%] graduate patients consulted skin specialist in public sector while 5[29.4%] post graduate patients first consulted skin specialist in private sector

Conclusion: Based on the knowledge obtained from the patients, it was observed that patients having melasma have no idea about the disease and whom they should consult after appearance of melisma

Frequency of sensitivity to Parthenium hysterophorus in patients with chronic extensive eczematous eruption

Eczema is a pruritic skin disorder of exogenous or endogenous nature. Allergic contact dermatitis is of exogenous nature and can be caused by many allergens including plants. In this quasi-experimental study, 50 patients presenting with extensive eczematous eruption were enrolled. They were patch tested with fresh crushed extract of flowers of Parthenium hysterophorus. Three patch test readings were taken at 48 hours, 72 hours and 120 hours. Patch test readings were read according to ICDRG criteria. Forty four [88%] out of 50 enrolled patients were male while 6 [12%] were female with male to female ratio of 7.3:1. Average age of the patients was 56.8 years with S.D +/- 12.6 years. Fifty four percent of enrolled patients showed positive patch test reactions to fresh crushed extract of flowers of P. hysterophorus with a male to female ratio of 5.7:1. P. hysterophorus is a leading cause of extensive eczematous eruption of exogenous type in a specific group of patients

Relationship of self-esteem and body esteem with social anxiety among psychiatric patients

Objective: The study was designed to demonstrate the relationship of self-esteem and body-esteem with social anxiety among psychiatric patients and to explore the split up of participants as per gender

Study Design: Cross Sectional Study

Duration and the Place of the study: The study was conducted from July, 2010 to Jan, 2011 in Outdoor of psychiatry department DHQ hospital Faisalabad

Patients and Methods: This comparative study was carried out as per inclusion and exclusion criteria. Mild to moderate patients of psychiatric disorders [anxiety disorders, mood disorders, somatoform disorders and drug dependence] were included in the study and patients who had severe psychotic features and psychotic illness such as schizophrenia were excluded from study. A sample of 201 patients of psychiatric disorders was collected which comprised of 90 males and 111 females through purposive convenient sampling technique. The test booklet comprised of three instruments including, The Liebowitz Social Anxiety Scale, Rosenberg Self-Esteem Scale, The Body Esteem Scale, informed consent form and demographic variables form. To diagnose the patients with psychiatric disorders, the diagnostic criteria of DSM IV[TR] were employed

Results: Results showed that there is negative relationship between social anxiety and self- esteem among psychiatric patients. Correlation is significant at the P<0.01 level. Self-Esteem and body-esteem have positive relationship among male psychiatric patients P<0.01. Self-Esteem and bodyesteem also have positive relationship among female psychiatric patients P<0.01. Result showed that there was insignificant correlation between social anxiety and body-esteem among male psychiatric patients P=ns. Social anxiety and body-esteem have significant relationship among female psychiatric patients P<0.01. Female psychiatric patients have high level of social anxiety M=76.89, SD=15.65, than male psychiatric patients M=68.39, SD=19.65, where t=-3.417, df=199, P=0.0005. There is non significant difference on self esteem scale between female psychiatric patients M=9.57, SD=2.65 and male psychiatric patients M=9.27, SD=2.49, where [t=- .822, df=199, P=0.206

Conclusion: Female psychiatric patients have high level of social anxiety as compared to male psychiatric patients. Self-esteem and body esteem have positive relationship among male psychiatric patients as well as female psychiatric patients. There is no significant difference on self esteem scale between female psychiatric patients and male psychiatric patients. In clinical practice it is suggested that clinicians should take into account co morbidity of social anxiety, self esteem and body esteem in psychiatric patients when planning treatment approaches

Social anxiety among depressed and non depressed people

Objective: The study was designed to assess and compare the social anxiety among depressed and non depressed people and to explore the split up of participants as per gender

Study Design: Comparative Study

Duration and Place of Study: The study was conduced from February 2010 to April 2010 in Outdoor of psychiatry department DHQ Hospital Faisalabad and Bahauddin Zakariya University Multan

Patients and Method: This comparative study was carried out as per inclusion and exclusion criteria. Mild to moderate patients of depression were included in the study and patients who had depression with psychotic features were excluded from the study as per purposive sampling technique. For non depressed people, students were included in the study whereas working people were excluded as per convenient sampling technique. Sample [N=90] was comprised of 45 patients of depression and 45 non depressed people as control group. Sample of patients with depression [20 males and 25 females] were drawn from Department of Psychiatry and Behavioral Sciences, Divisional Headquarter Hospital, Faisalabad through purposive sampling technique. Sample of control group [20 males and 25 females] was drawn from Bahauddin Zakariya University, Multan through Convenient Sampling Technique. To diagnose the patients with social anxiety and depression, the diagnostic criteria of DSM IV TR and Liebowitz Social Anxiety Scale were employed while demographic variable such as gender was recorded on a demographic sheet. Independent sample t-test was used to analyze and make inferences from the data collected from sample by using SPSS version 10

Results: Results showed that patients of depression have higher level of social anxiety [M=89.00, SD=12.79] as compared to non depressed people [M=21.71, SD=17.53], where t [88] =20.803, p=0.001, N=90 on the scale of social anxiety. Female patients of depression [M=79.85, SD=9.16] as compared to male patients of depression [M=96.32, SD= 10.38], where t [43] = 5.568, p=0, N= 45 which indicated that there is a significant difference on social anxiety scale among female patients of depression and male patients of depression. Another finding indicated that female patients of depression [M=96.32, SD=10.38] and non depressed females have [M=96.32, SD=10.38], where t [48] = .000, p=0.5, N=50 which indicated that there is no significant difference on social anxiety scale among female patients of depression and non depressed females. Results also showed that male patients of depression [M=79.85, SD=9.16] and non depressed males have [M=8.40, SD=8.40], where t [38] = 26.250, p=0, N=40 which indicated that there is highly significant difference on social anxiety scale among male patients of depression and non depressed males

Conclusion: Depressed people have higher level of social anxiety comparatively non depressed people and as per gender, female patients of depression have higher level of social anxiety comparatively male patients of depression as told by this study and other studies as well, so depressed people and their families should educate about their illness and their treatment and increase contacts to build up confidence in a better way

Cutaneous manifestations in 1000 Pakistani newborns

Cutaneous manifestations are commonly seen in neonates. Benign dermatoses in newborns must be distinguished from more serious, life threatening disorders with cutaneous manifestations. To determine the frequency of various dermatoses i.e. physiological and pathological among newborns up to 96 hours of age. 1000 full-term neonates were enrolled from labour rooms and pediatric nursery of Jinnah hospital, Lahore and were evaluated for cutaneous manifestations. All the relevant data regarding history, clinical examination and investigations were recorded and analyzed. Out of 1000 neonates, there were 469 boys and 531 girls. Their mean age was 72 hours [6-96 hrs]. Cutaneous manifestations were present in 94% of babies and 82.5% babies had more than one manifestation. The most common dermatoses were Mongolian spots [63.2%], Epstein pearls [47.8%], sebaceous hyperplasia [44.8%], miliaria [12.8%], hypertrichosis [12%], erythema toxicum neonatorum [12%], salmon patch [12%] and impetigo [11.4%]. Uncommon manifestations included desquamation 8.5%, omphalitis 8% and birth trauma [7.7%]. Rare dermatoses were hemangiomas [3.5%], cafe-au-lait macules [2.6%], congenital melanocytic nevus [2.4%], acne neonatorum [0.9%], preauricular skin tag [0.4%], cutis marmorata telangiectatica congenita and collodion baby in [0.1%] each. Cutancous manifestations one are frequent in newborns

Life events and depression

A sample of 200 depressed patients [100, males, 100 females was matched on socio demographic variable with an equal number of control subjects. The frequency of occurrence of life events in the 12 months immediately prior to onset of depression was compared with a compared with a comparable twelve-month period in control population. Results of this controlled comparison indicated a general excess of life events prior to the onset of depression. Analysis of different categories of events showed that event involving finances affects patients more which is 61%in case of males, 73% in females, next event hit more our patients is job problems which is 37% in males and 4% in females. Third life event is relationship difficulties, which are more in females 54%, and 26% is males. Illness life event affected 14% males and 21% females. The legal issues affected 13% males and 5% in females. The last life event separations/ deaths affected more females which is 23% and 6% males; these findings supports the importance of life events in genesis of depression. The methodological limitations of life events research like measurement difficulties, reliability of the measures, selective recalls while reporting and selection of events in questionnaire or interviews also need consideration. Field needs to more towards exploration of underlying mechanism and interaction with other factors

Characteristics of psychiatric hospital absconders

Absence of patients without leave is common in Psychiatric hospitals, and causes anxiety to staff, relatives and the lay public. This study attempted to identify the characteristics of patients absconding from Mental Hospital Lahore over one year. Absconders were predominantly male, young, compulsorily admitted, and discharged with a diagnosis of schizophrenia. They tended to single, had many previous admissions, and a longer total length of stay and the police were more often involved in their admission. Reasons for absconding and the implications for management of newly admitted psychiatric patients are discussed

Efficacy and safety of quasi-continuous, frequency-doubled Nd:YAG [532nm] laser therapy of port-wine stains

The quasi-continuous, frequency-doubled neodymium yttrium aluminum garnet [Nd:YAG] 532nm laser has been used for the first time in the treatment of port-wine stain [PWS]. To determine the efficacy and side effects of quasi-continuous Nd: YAG 532nm laser in the treatment of PWS. Twenty patients were enrolled in the study. The site and colour of PWS were recorded and assessed subjectively and by photography both before and after treatment. The patients had test areas treated and followed up after four weeks. Maximally eight treatments were given on any one site or until >75%improvement occurred. Final evaluation was done one month after the last treatment session on a four-point scale. Twenty patients were treated, age range 15-35 years wit 14 females. All the patients had PWS in the head and neck region and achieved >25%improvement.Patients underwent a mean of 7.55 treatment sessions. Overall, fifteen [75%] showed 75-100%improvement. The side effects seen in the study were hyperpigmentation in 65%cases, textural changes in six [30%] and eczematization after laser therapy in four [20%] of patients. Other complications included intraoperative hemorrhage and pyogenic granuloma-like lesions that occurred in two cases [10%] each. We have shown that frequency doubled Nd: YAG 532nm is effective and safe in the treatment of PWS