Surgical intervention in aggressive ulcerative pyoderma gangrenosum.

Pyoderma Gangrenosum (PG) is a rare, debilitating, and painful disease of the skin. Its aetiology and pathophysiology are not well understood. However, it is known that PG is not bacterial in origin, as previously believed. A significant number of cases of PG report a phenomenon called pathergy, which is characterized by the appearance of new lesions after the application of trauma to the skin. This represents a unique challenge for surgeons in cases that are refractory to medical therapy. The objective of this study is to review past literature and report a case of PG in a 19-year old woman, who presented with recurrence, after undergoing skin grafting one year back. The patient was referred for split thickness skin grafting (STSG) to reduce the psychological and physical morbidity as a result of this disease.

Impact of Graphic Warning Labels on Cigarette Packs in Changing Smokers' Views and Habits: An Opinion Survey.

BACKGROUND: Smoking has become a major issue worldwide. With the advancement in technology, more vulnerable populations, such as teenagers, are also being harmed. One deterrent is the presence of graphic labels on cigarette packs. With this rationale in mind, the objective of our study is to assess the impact of these warning labels on the habits and opinions of smokers. METHODS: A cross-sectional study was conducted by distributing a validated paper-based questionnaire. The sample size was calculated to be 200 using statistical software. The study targeted students of Islamabad, Pakistan, who were studying in twelfth grade and were smokers. The sampling method used was 'snowball sampling'. FINDINGS: 128 (64%) males and 72 (36%) females participated in the study. The mean age of the participants was 17.59 ± 0.51 years. 40 participants reported choosing local brands for cigarettes due to cigarette 'freshness', regardless of presence or absence of a graphic label, which was a new concept. 94% of participants believed that presence of a visual label helped with understanding the harm and 78% believed that the side effects were accurately portrayed. Participants who were more than 17 years of age believed that the graphic label provided a clear description of the consequences of smoking. Similar results were seen in the female participants of the study. CONCLUSION: There is a general consensus on graphic labels altering the opinions of smokers. The presence of these labels is, however, targeting only a specific type of audience and hence, should be expanded for a larger audience.

Lunotriquetral Coalition: An Unusual Cause of Wrist Pain.

Carpal coalition is the fusion of two or more carpal bones in the wrist. This has a prevalence of 0.1% in Caucasian populations, with lunotriquetral coalition being the most common type. The incidence in Asian populations, including Pakistan, is not known. Usually, these fused carpal bones are asymptomatic. However, they can be the cause of undiagnosed wrist pain. We present the case of a 26-year-old female who presented with right-sided wrist pain. On X-ray, she was diagnosed to have a lunotriquetral coalition. We emphasize the role of radiographic imaging in cases of carpal coalition. Most patients are treated conservatively. However, in severe cases, surgical treatments may be considered.

Prevalence of Methylphenidate Misuse in Medical Colleges in Pakistan: A Cross-sectional Study.

Objective To determine the prevalence of nontherapeutic use of methylphenidate as well as to ascertain any benefits, side effects, and other factors associated with this use. Materials and Methods A cross-sectional study was conducted in medical colleges in Pakistan using a self-constructed, validated questionnaire. The sample size was calculated using Open Source Statistics for Epidemiological Health software (OpenEpi web-based open-source program, MIT license), and it was determined to be 400. The type of sampling was cluster sampling. Cronbach's alpha was used to assess the internal consistency of the questionnaire, and it was found to be 0.80. Results Out of the 400 participants, 197 (49%) were male and 203 (51%) were female. The mean age of the participants was 21.02 (±1.54) years. Most of the participants (84%) reported they usually studied 1-3 hours a day, and 149 participants (37%) reported a score ranging from 70 to 80% in exams. Methylphenidate was admitted to be used by 37 participants. Out of these 37 participants, only 10 participants believed they had attention deficit hyperactivity disorder (ADHD). Participants revealed they used the drug to either cope with the anxiety related to their scores or merely as a personal, recreational choice. Methylphenidate was mostly acquired from peers (68%), and peer pressure was found to be a major factor in its misuse. Conclusions Most of the methylphenidate misuse is linked to student underperformance in examinations and an underlying dissatisfaction. The problem is more aggravated when the social influence exerted by other students is taken into account. The side effects of drug usage are found to outweigh the benefits that have been reported.