Prevalence Of Sunscreen Usage And Perception About Sun Exposure And Sunscreen: A Lower-Middle-Income Country's Perspective.

Sunlight is required for vitamin D synthesis but is also responsible for various adverse effects on human skin, including photo aging, sunburn, and skin cancer. To avoid this, regular use of sunscreens is recommended. The aim of the study was to evaluate the knowledge of a subset of our local population about exposure to sun and assess the attitude about the importance of sunscreen usage. This prospective cross-sectional study was conducted at the dermatology outpatient clinic using a predesigned questionnaire filled by the participants. A total of 200 patients were selected, out of which 135 were females and 65 were males. Forty-nine percent of the participants claimed to use sunblock; however, the majority (54%) used it only occasionally. Fifty-one percent of the participants were not aware that exposure to sun can cause darkening of the skin but more than 100(50%) were aware that this exposure has multiple side effects on the skin. It was also observed that participants had good knowledge about the side effects of sunblock. The study results concluded that participants have good perception of the effectiveness and side effects of sunscreen, most of them used it occasionally. It necessitates the need for a health education programme.

MASKNE - Prevalence and association of causative factors during Covid-19 pandemic at a tertiary care hospital of Karachi.

OBJECTIVE: To assess the prevalence of mask acne in general population and healthcare workers, and the association of acne breakout due to mask-wearing with different factors. METHODS: The prospective, cross-sectional study was conducted from January to April 2022 at the Dermatology Department of Aga Khan University Hospital, Karachi, and comprised patients of both genders of all ages who received acne treatment during the period. Data was collected using a self-designed questionnaire having Cronbach's alpha value 0.789 which was filled by the subjects. Data was analysed using SPSS 19. RESULTS: Result: Of the 200 subjects, 152(76%) were females and 48(24%) were males. The overall mean age was 25.50±8.49 years. There were 122(61%) non-healthcare workers and 76(38%) were healthcare workers. Acne was prevalent in 157(78.5%) participants, and, of them, 123(78.3) were females. Significant association of acne breakout due to mask-wearing was found with regular mask change habit (p<0.001) and past history of acne (p<0.01). Participants who wore mask continuously for 6 hours or more came up with more complaints of acne (p<0.05). CONCLUSIONS: Prolonged and continuous use of the same mask for 6 hours or more could lead to acne eruption.

Analysis of differential gene expression of pro-inflammatory cytokines in the nasopharyngeal milieu of mild & severe COVID-19 cases.

INTRODUCTION: A subset of individuals with COVID-19 can suffer from a severe form of the disease requiring breathing support for respiratory failure and even death due to disease complications. COVID-19 disease severity can be attributed to numerous factors, where several studies have associated changes in the expression of serum pro-inflammatory cytokines with disease severity. However, very few studies have associated the changes in expression of pro-inflammatory changes in the nasopharyngeal milieu with disease severity. Therefore, in the current study, we performed differential gene expression analysis of various pro-inflammatory cytokines in the nasopharyngeal milieu of mild & severe COVID-19 cases. MATERIAL AND METHOD: For this retrospective, cross-sectional study, a total of 118 nasopharyngeal swab samples, previously collected from mild and severe (based on the WHO criteria) COVID-19 patients were used. A real-time qPCR was performed to determine the viral loads and also evaluate the mRNA expression of eight cytokines (IL-1, IL-2, IL-4, IL-6, IL-10, IFN-γ, TGF-ß1, and TNF-α). Subsequently, an unpaired T-test was applied to compare the statistical difference in mean expression of viral loads and each cytokine between the mild and severe groups, while the Pearson correlation test was applied to establish a correlation between disease severity, viral load, and cytokines expression. Similarly, a multivariable logistic regression analysis was performed to assess the relationship between different variables from the data and disease severity. RESULTS: Out of 118 samples, 71 were mild, while 47 were severe. The mean viral load between the mild and severe groups was comparable (mild group: 27.07± 5.22; severe group: 26.37 ±7.89). The mRNA expression of cytokines IL-2, IL-6, IFN- γ, and TNF-α was significantly different in the two groups (p<0.05), where the Log2 normalized expression of IL-2, IL-6, IFN- γ, and TNF-α was found to be 2.2-, 16-, 2.3-, and 1.73-fold less in the severe group as compared to the mild group. Furthermore, we also observed a significant positive correlation between all the cytokines in the severe group. The multivariate analysis showed a significant relationship between age, IL-6, and disease severity. CONCLUSION: This decreased expression of certain cytokines (IL-2, IL-6, TNF-α, and IFN-γ) in the nasopharyngeal milieu may be considered early biomarkers for disease severity in COVID-19 patients.

Telemedicine During a Pandemic: Challenges, Opportunities & Way Forward at a Tertiary Care Hospital.

Telemedicine is utilized to deliver health care services remotely. TM gained popularity as a result of pandemics, it can help the patients to get required medical care while sitting in the comfortable environment of their homes. In the future, it will continue to be used as a convenient, cost-effective patient care modality. This cross-sectional study was conducted in a tertiary care hospital, the objectives were to identify challenges faced by physicians during teleconsultations, recognize the opportunities and strengths of this modality during pandemic in a lower-income country. The self-made questionnaire was filled through an online medium and responses were recorded on a five-point Likert scale. A total of 83 participants were enrolled in this study. Most of them were Associate professors (29.8%), Assistant professors (26.2%), the ratio of the females was (52.4%) greater than males (47.6%). 46 (54.8%) lie between the age group 30-40 years. Pediatricians and senior instructors faced more difficulty in using telemedicine. The ones having clinical experience of less than 15 years or categorized in the age of 50-60 years faced challenges while using this modality. During the current pandemic, situation telemedicine is the only glimmer of light to provide better quality health care. Telemedicine is an innovative strategy and it is important to understand the perception of physicians about it. Incomplete and inadequate infrastructure and attitude of the physicians are the main obstacles toward successful implementation of telemedicine. Successful installation and deployment of this technology require a complete grasp of the process among physicians.

Assessment of topical steroid phobia in dermatology patients, a cross-sectional study from an urban area of Pakistan.

BACKGROUND: Topical corticosteroid (TCS) phobia is a fear of steroids, most prevalent among the general steroid users, the origin of anxiety and fear about steroids is still unclear. Although multiple studies have been using the validated TOPICOP© scale to assess the scores of steroid phobia in various skin disorders. OBJECTIVES: The aim of the study was to analyze the steroid phobia among users of topical corticosteroids and also to assess the association between demographical characteristics and TCS phobia. METHODS: A cross-sectional survey was conducted to evaluate the belief and perspectives of TCS in a large range of patients of both genders of all ages. Patients presenting in dermatology clinic with any dermatological complaint, who were being treated or currently on topical steroids were included. TOPICOP© scale was used to assess the topical steroid phobia. RESULTS: A total of 221 topical steroid users were selected for this study, among them 56 (26.7%) were male and 162 (73.3%) were female. The median of global TOPICOP score was 18% and CI 22-12%, S.D: 6.23. The median score of knowledge and beliefs was 7%, (IQR: 9-4%), S.D: 3.33, while fear showed median 5% (IQR: 7-3%), S.D: 2.24, and 6% (IQR: 8-4%), S.D:2.4 for behavior 96 (43.4%). Patients who were not well aware of steroids but still afraid of using steroids. 112 (50.7%) acknowledged the non-adherence to treatment. CONCLUSION: Steroid phobia is more prevalent among uneducated users of topical steroids than among those who are knowledgeable and literate. Healthcare practitioners should counsel their patients about steroids use and related concerns, rather than addressing the issue that is causing fear in patients.

Prevalence of Clinical Spectrum of Cutaneous Adverse Drug Reactions in Patients Presenting at a Tertiary Care Hospital in Pakistan.

INTRODUCTION: Cutaneous adverse drug reactions (CADRs) are the most common adverse drug reactions reported in the literature. CADRs have resulted in disabling infirmities during hospitalization and complications following outdoor drug therapy. The pattern of CADRs and the responsible drugs usually changes with the introduction of newer drugs and evolving clinical practices. Moreover, several international studies showed variable prevalence, emphasizing the need for local data in light of different socioeconomic and demographic practices. Therefore, the purpose of this study is to evaluate the prevalence of adverse cutaneous drug reactions and identify the clinical spectrum and any potential risk factors. METHODOLOGY: The current study is a descriptive cross-sectional study conducted at Aga Khan University Hospital, Pakistan. One hundred ninety-three patients who met the study inclusion criteria were included. Data were collected from patients on a proforma after taking informed consent. Quantitative data were presented as simple descriptive statistics giving mean and standard deviation, while qualitative variables were presented as frequency and percentages. Effect modifiers were controlled through stratification to highlight the effect of these on the outcome variable. The post-stratification chi-square test was applied and the p-value of ≤0.05 was statistically significant. RESULTS: A total of 193 patients who had cutaneous adverse drug reactions were included in the study. The mean age in this study was 47.78±8.33 years. One hundred eight (56%) were male and 85 (44%) were female. Out of 193 patients, 135 (69.9%), 50 (25.9%), 24 (12.4%), 12 (6.2%), 20 (10.4%), 11 (5.7%) and six (3.1%) had maculopapular rash, acneiform eruptions, Stevens-Johnson syndrome, erythema multiform, urticaria, fixed drug eruptions and toxic epidermal necrolysis, respectively. CONCLUSION: CADRs are a common clinical presentation and awareness and knowledge about their diagnosis and prevention is important. It can be assumed that in our local setup, the clinical trends and medications causing ADRs are strikingly similar to those found in other countries. Physicians commonly come across these cases and they should be well aware of the clinical spectrum of skin reactions to enable early diagnosis and management.