Frequency and Effect of Cutaneous Manifestations on Quality of Life in Patients with End-Stage Renal Disease Undergoing Hemodialysis.

OBJECTIVE: To determine the frequency of skin manifestations found in end-stage renal disease (ESRD) patients undergoing dialysis, while assessing their effect on the quality of lives of the same patients. STUDY DESIGN: Descriptive cross-sectional study. Place and Duration of the Study: Benazir Bhutto Hospital, Holy Family Hospital, and Hussain Lakhani Hospital, from 12th December 2021 to 13th October 2022. METHODOLOGY: Seventy-three Patients undergoing hemodialysis were enrolled in the study. Skin manifestations were defined as "cutaneous signs and symptoms related to ESRD unrelated to the symptoms resulting from any primary dermatological disorder or other systemic diseases". Data on the skin manifestations of their disease and their effect on patients' quality of life were collected by using a 2-part questionnaire. The first part consisted of demographic details along with the type of skin disorders faced by the patient and the second part of the questionnaire comprised of the dermatology life quality index (DLQI). The data were entered and analysed using the statistical package for social sciences (SPSS) version 23.0. RESULTS: Xerosis and pruritus were most commonly reported (83.7%), followed by nail changes (18.6%) and skin discolouration (16.3%). The median duration of dialysis was 36 (1-180) months and there was no significant increase in skin symptoms with the increase in the duration of dialysis (p=0.082). The median DLQI score was 3 (range:0-10) A significantly higher number of females (n=14) reported associated mental discomfort with their skin symptoms of pruritis as compared to males (n=5, p=0.008). CONCLUSION: Cutaneous manifestations have variable effects on the quality of life of ESRD patients. Adopting a multidisciplinary approach early in the management may help to minimise the mental discomfort of these patients and bring an improvement in their quality of life. KEY WORDS: End-stage renal disease (ESRD), Hemodialysis, Skin manifestations, Pruritus, Quality of life.

COVID-19 and Pakistan: a survey assessing the awareness of patients presenting to the outpatient departments of health care centers.

Background: The coronavirus pandemic is one of the most disastrous calamities of modern times. The outpatient departments of health centers have an important role in the appropriate health education of the patients and their attendants regarding disease prevention and control. Objective: The objective of this study was to help the health authorities in devising an effective strategy of educating the vulnerable population at their point of first contact with a health professional. Methods: This descriptive cross-sectional study was conducted from 2 April 2020, to 17 July 2020, in the Punjab province of Pakistan. Data was entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0. A p-value of less than 0.05 was considered significant. Results: Out of 238, 144 were males and 94 were females and the mean age was 34.53 years. Although television was the most common source of information (51.7%) a significant proportion of the people of Shorkot, i.e., 60.3% relied on word of mouth compared to that of other cities (p < 0.001). Almost 60% of the participants recognized all the symptoms correctly. The majority agreed that wearing a mask was effective in limiting transmission (96.6%) and about 80% of the participants considered the decision of the nation-wide lockdown to be a correct measure. In Shorkot, 32% of the people were against the decision of lockdown, which was significantly higher as compared to people from other cities (p < 0.001). Conclusions: Our study demonstrated encouraging data regarding awareness of the included population in terms of COVID-19 symptoms and preventive measures.

The adverse impact of excessive smartphone screen-time on sleep quality among young adults: A prospective cohort.

INTRODUCTION: Problematic over usage of smartphones has led to various deteriorating effects including poor sleep quality. Screen exposure, especially near bedtime, directly leads to poor sleep quality. We aimed to measure smartphone screen-time (ST) statistics of the participants directly using a smartphone application. Furthermore, we aimed to assess sleep quality using the Pittsburgh sleep quality index (PSQI), and to investigate the association between ST & PSQI. MATERIAL AND METHODS: This descriptive cohort study was conducted among 280 students of MBBS at Rawalpindi Medical University for a period of 1 month (30 days). Physically healthy students who owned Android smartphones were included in the study. Students with diagnosed sleep disorders and students taking sleep medication were excluded from the study. ST was recorded using a smartphone application. Sleep quality was assessed at the end of 30 days using the PSQI questionnaire. Data entry and analysis was done using SPSS v23.0. RESULTS: Total and mean ST were calculated for every participant. The mean screen time of 242 individuals was 147.50±51.09 hours. The mean PSQI score was 6.68±2.3. 65.70% of the participants had a poor sleep quality (PSQI>5). Pearson's correlation revealed that long total ST was associated with decreased sleep quality (R=0.356, p<0.001). CONCLUSION: Our findings are in accordance with previous scientific literature largely based on self-reported ST measurements and affirm that excessive ST deteriorates sleep quality and hence has numerous adverse physical and psychological manifestations.

Physicians' Attitudes Towards Treating Patients in the Context of COVID-19 Pandemic in Pakistan.

Background and objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been the cause of a worldwide outbreak of respiratory illness, which has been declared as coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO). The outbreak has posed a huge challenge to countries around the world and has resulted in a global lockdown. The pandemic has especially overburdened the healthcare sector, resulting in a shortage of personnel and equipment. Along with many other manifestations, it has resulted in stress and anxiety for the physicians as well. Furthermore, many healthcare workers have been reluctant in treating COVID-19 patients. This study aimed to explore the concerns of physicians in the context of the COVID-19 pandemic and to evaluate the reasons for their reluctance to treat the patients. Methodology This descriptive cross-sectional study included 235 physicians from seven hospitals of Pakistan who were actively working amid the COVID-19 pandemic. Data were collected from March 1, 2020, to May 30, 2020, using a structured online questionnaire. Participants were approached via non-probability convenient sampling. Two hundred and eight respondents were included in the data analysis. SPSS Statistics version 23.0 (IBM Corp., Armonk, NY) was used for data entry and analysis. Results A striking 83.7% (n=174) of the respondents expressed their reluctance to treat patients with COVID-19. Concerns they raised included one or more of the following four reasons; lack of proper personal protective equipment (PPE), fear of self-infection, excessive workload, and fear of transmitting the infection to their family members. Of note, 92% (n=161) of the respondents reported a lack of PPE while 74.1% (n=129) reported fear of transmitting the infection to their family members as reasons for their reluctance. The vast majority of the participants reported the need for psychological training to treat the patients' anxiety (95.2%, n=198). Many participants were afraid that their own anxiety might be affecting the quality of care patients were receiving (67.3%, n=140). Hence, most of the participants reported that psychological counseling should be provided (93.3%, n=194). Participants with family members older than 60 years were found to be reluctant to treat patients due to the risk of transmitting the infection to them (69.7%, n=145, p=0.001). Therefore, a major proportion of the participants (96.2%, n=200) felt that the hospitals should provide a place for them to rest and temporarily isolate themselves to avoid coming into contact with their family members. Conclusions We conclude that a major proportion of physicians is reluctant to treat their patients due to multiple factors. The grave situation of the pandemic has taken a toll on their mental health, which could be affecting the quality of care that the patients receive. Their concerns should be addressed to not only provide them with support and improve their working environment but also to ensure that they are fully equipped to provide state-of-the-art care to the patients in these grave times.

Exploring Antimicrobial Resistance in Agents Causing Urinary Tract Infections at a Tertiary Care Hospital in a Developing Country.

Background and objective Urinary tract infections (UTIs) are usually treated with empirical therapy by physicians based on previous knowledge of the predictability of causative agents and their antimicrobial susceptibilities. The objective of this study was to determine the frequency of various pathogens causing UTIs and their antimicrobial resistance profile in patients presenting to the outpatient department (OPD) of a tertiary care hospital. Materials and methods This descriptive cross-sectional study was conducted in the urology OPD of a tertiary care hospital in Pakistan. The study was conducted over a period of six months, and it included 1,000 patients (of ages 12 years or above) who were clinically suspected for UTIs. Patients with comorbidities and immunocompromised patients were excluded from the study. Recipients of corticosteroid therapy or those with a history of intake of broad-spectrum antibiotics in the previous 15 days were also excluded. The modified Kirby-Bauer disc diffusion method was used for determining antimicrobial resistance against various antimicrobials. Results Out of 1,000 tested specimens, 530 (53%) isolates were found to be culture-positive. E.coli was the most common species isolated from the cultures with a prevalence of 77.4%, followed by Klebsiella (6.4%), Enterobacter (6.0%), Pseudomonas (3.8%), Staphylococcus saprophyticus (3.4%), Citrobacter (1.1%), and Morganella (0.4%). Antimicrobial resistance against commonly used antimicrobials was found to be alarmingly high. Conclusion E.coli was the most commonly isolated microorganism from the urine samples of UTI patients. Antimicrobial resistance against UTI-causing organisms is of great concern. The Surveillance of trends of antimicrobial susceptibility pattern for organisms causing UTIs is highly important. Antibiotics should be prescribed according to proper guidelines to prevent increasing antimicrobial resistance.

Dupilumab for Atopic Dermatitis: The Silver Bullet We Have Been Searching for?

Atopic dermatitis is a chronic inflammatory condition of the skin affecting a large number of people worldwide. Historically, this condition has been managed by topical corticosteroids and general skincare measures. The inadequacy of these management strategies has always driven efforts to find better drugs. Dupilumab has been recently approved for the management of atopic dermatitis. It is a human monoclonal antibody that inhibits the binding of key interleukins involved in the pathogenesis of atopic dermatitis, thus blocking the signaling mechanisms and disrupting the disease progression. Dupilumab reduces the severity and associated symptoms of atopic dermatitis. It improves the life quality of patients and reduces the anxiety associated with the disease. Combination therapy of dupilumab and topical corticosteroids is more effective than dupilumab monotherapy. The treatment-related adverse events include headache, injection site reaction, conjunctivitis, nasopharyngitis, and herpes viral infections. Moreover, the simultaneous use of live vaccines with dupilumab is contraindicated. It is also beneficial in the management of asthma, chronic rhinosinusitis, and eosinophilic esophagitis. In this review, we have discussed the clinical efficacy and safety profile of dupilumab in the management of atopic dermatitis.

Assessment of Knowledge, Attitude, and Practices Regarding Self-medication for Acne Among Medical Students.

Introduction Acne is one of the most common skin conditions worldwide. Self-medication for acne is a fairly common practice among medical students. The objective of our study was to identify the prevalence of self-medication and to assess its knowledge, attitude, and practices among medical students. Materials and methods This descriptive cross-sectional study was conducted at Rawalpindi Medical University, Rawalpindi, Pakistan, from January 2019 to June 2019. Data were collected by using the convenient sampling technique. Students were asked to fill a semi-structured questionnaire. Students of all the medical years studying in our university were included in the study. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0 (IBM Corp., Armonk, US). Results Out of 349 students, 244 (69.9%) suffered from acne and self-medication was practiced by 123 (50.4%) acne sufferers. The practice of self-medication was significantly higher in students having acne lesions on the face (52.2%). The most common source of information was reported to be acquaintances (55.8%). Most of the students had knowledge of the dosage of drugs (46.3%) and precautions for their use (41.5%). Sixty-three percent of the students were of the opinion that self-medication is part of self-care. Most of the students read the expiration date on the drug label (88.6%). Conclusion Acne is a highly prevalent condition among medical students and the practice of self-medication among acne sufferers is high. The practice of self-medication and visits to dermatologists were both significantly more common in the students with lesions on the face. The knowledge of students regarding self-medication of acne was not adequate.