COVID-19 pandemic & skin care guidelines for health care professionals

The Novel corona virus is bringing multiple challenges for health care professionals. Skin is the biggest organ and the first line of defense against different infections and external factors. Being the front line warriors, health care professionals are susceptible to various skin conditions due to prolonged use of personal protective equipment. These adverse skin conditions are redness, irritation, itching, contact dermatitis, and aggravation of underlying skin conditions like seborrheic dermatitis and acne vulgaris. In the current global situation, the potential incidence of such adverse dermatological effects does not in any manner cause the HCPs to deviate from the strict specific precautionary hygiene rules. These skin problems are manageable with the few precautionary measures. This article explores the different skin conditions that result from personal hygiene measures and usage of protective gear and will suggest some practical advice about how to manage and protect from these different adverse skin conditions

Malignant and non-malignant causes of hypercalcemia: A retrospective study at a tertiary care hospital in Pakistan

Background: Hypercalcemia is a common electrolyte abnormality presenting with a variety of symptoms. The common causes are primary hyperparathyroidism and malignancy associated with hypercalcemia. However, iatrogenic hypercalcemia with the overzealous use of vitamin D has now emerged as another important cause of hypercalcemia over the past decade.Objective: This study aims to evaluate the causes of hypercalcemia, management strategies, and outcomes in patients admitted with hypercalcemia in a tertiary care hospital. Method: It is a retrospective study done at Aga Khan University Hospital (AKUH), Karachi after taking approval from the ethical review committee (ERC). Data were gathered about all patients admitted from 1st January 2008 to 31st December 2018. A total of 1142 patients were included in the study and their calcium levels were noted. Along with demographic details, data pertaining to their diagnosis and all investigations done to evaluate the causes of hypercalcemia were noted in a pre-defined questionnaire.Results: A total of 814 patients having hypercalcemia were included in the final analysis and their mean age was 60.8 ± 14.1 years. Male and female patients were 45.4% and 54.6%, respectively, and their mean hospital stay was 6.2 ± 5.8 days. The most common cause of hypercalcemia was malignant solid tumors (49.1%), followed by hematological malignancy (16.5%), hyperparathyroidism (10.9%), definite vitamin D toxicity (8%), chronic kidney disease (4.9%), chronic granulomatous diseases (4.7%), and probable vitamin D toxicity (3.5%). The oral cavity carcinoma (17.7%) was the most common solid tumor associated with hypercalcemia. Amongst hematological malignancy, multiple myeloma (14.4%) was the most common one. Out of 814 patients admitted with hypercalcemia, 601 (74%) patients recovered from hypercalcemia, while mortality was observed in 129 (16%) patients. Of those who expired, 110 (85.3%) had malignancy either solid tumor or hematological.Conclusion: Malignancy is the most common cause of hypercalcemia in admitted patients. The knowledge of hypercalcemia\u27s causes is of great importance so that targeted investigations can be done. Not only will it minimize the cost burden and shorten the hospitalization of patients; it will also help the physicians to decide the appropriate management accordingly. Moreover, vitamin D toxicity was also observed in a significant number of patients which highlights the common practice of using higher doses of vitamin D by physicians

Follicular thyroid carcinoma in a developing country: A 10-year retrospective study

Background: The most common endocrine tumor is thyroid cancer. Follicular thyroid carcinoma (FTC) accounts for 5-10% of all thyroid cancers. Patients with FTC frequently present with more advanced diseases and a higher occurrence of distant metastases because of the propensity of vascular invasion. FTC is mainly treated with surgery while radioactive iodine (RAI) therapy is the main adjuvant therapy according to the American Thyroid Association guidelines.Methodology: This was a retrospective observational study of FTC patients aged 18 and above conducted at a tertiary care hospital in Karachi from January 01, 2010 to December 31, 2019.Results: A total of 404 patients with thyroid carcinoma were sorted, of which 40 (10.1%) were FTC cases. Overall, 50% of the patients were in the age group of 41-60 years, and the female-to-male ratio was 1.5:1. The majority of patients (60%) presented with neck swelling, followed by bone and lung metastasis in 20% and compressive symptoms in another 20%. On fine needle aspiration cytology (FNAC), 50% had Bethesda category III-IV nodules while 10% had Bethesda category II. Overall, 50% had a total thyroidectomy while 50% had a lobectomy followed by a completion thyroidectomy. On histopathology, 23 (57.5%) patients had minimally invasive FTC while 17 (42.5%) had widely invasive FTC. A total of 17 (42.5%) patients had received RAI 30-100 mCi while 10 (25%) received more than 100 mCi.Conclusions: FTC can present with both local or metastatic symptoms. The atypical presentation of metastatic FTC should be considered, diagnosed, and managed early to limit mortality and morbidity. Ultrasound is the best diagnostic investigation of choice followed by FNAC. Surgery is the mainstay of treatment and should be followed by RAI in select cases. Thus, understanding the trend of FTC and proper planning and utilization of the resources will help developing countries in effectively treating the FTC

Impact of acne on quality of life in young Pakistani adults and its relationship with severity: A multicenter study

Objectives: The current study aimed to determine the effect of acne vulgaris on quality of life of young adults and to assess the correlation between acne severity and impairment of quality of life (QOLI).Methods: In this multi-center cross-sectional study, 163 young adults with acne vulgaris were assessed for severity and quality of life impairment between December 2016 and May 2017 at three tertiary care hospitals. Cardiff Acne Disability Index (CADI) was used to assess the quality of life while the severity of acne measured by Global Acne Grading System (GAGS). Data were collected on standardized forms, with CADI, GAGS scores, and sociodemographic data and analyzed using SPSS version 9. The quantitative variables were presented as means, median and qualitative variables expressed as frequency and percentages. P-value ≤0.05 was considered as statistically significant.Results: Out of 163 patients enrolled in this study, the mean age was 21.6 ± 4.9 years and 124 were females and 39 males. In mild QOLI, 56 (87.5%) cases were affected with mild, 11 (13.4%) with moderate and 1 (1.5%) case had severe acne. While, in moderate QOLI, 8(12.5%) cases were of mild, 60 (73.2%) were moderate and 6 (35.3%) cases affected with severe acne. The severe impairment of QOL noted in 11 (13.4%) moderate and 10 (58.8%) severe acne cases. The relationship between sex was statistically significant, (P\u3c0.001). The result showed significant correlation between severity of acne vulgaris and the quality of life impairment of these patients (P\u3c0.001).Conclusion: This study showed significant correlation between acne vulgaris and quality of life impairment. Cardiff acne disability index has proven to be a reliable tool to assess the quality of life. It is recommended to be used routinely in dermatology clinics to provide tailored treatment to individuals because mild disease may be disproportionately distressing for patients

Frequency of depression and anxiety among patients with chronic spontaneous urticaria visiting a tertiary care hospital in Karachi, Pakistan

Objective: To determine the frequency of anxiety and depression among chronic spontaneous urticarial patients presenting at a tertiary care hospital.Methods: The prospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from February to August 2015, and comprised patients diagnosed with chronic spontaneous urticaria at the dermatology clinic. All the participants were assessed for anxiety and depression using Aga Khan University-Anxiety Depression Scale. Data was collected in face-to-face interview using a structured questionnaire. The association of the condition with different characteristics were calculated after stratification for age, gender, occupation and monthly income. SPSS 19 was used for data analysis..Results: Of the 146 study participants, 84(57.5%) were males and 62(42.5%) were females. The overall mean age was 39±15.6 years. Of the total, 39(26.7%) had depression and anxiety. Depression and anxiety were more frequent among patients with a positive family history of mental disorders (p=0.02).Conclusion: Anxiety and depression were found to be considerably common among chronic spontaneous urticaria patients, with patients having a positive family history for mental illnesses particularly vulnerable

Frequency and clinical variants of specific dermatoses in third trimester of pregnancy: a study from a tertiary care centre

OBJECTIVE: To determine the frequency of patients with dermatoses in the third trimester of pregnancy and to identify various clinical types of dermatoses in the third trimester. METHODS: The study was carried out at the Department of Dermatology and the Department of Gynaecology & Obstetrics, PNS Shifa Hospital, Karachi, from January 2 to July 1, 2008. Two hundred pregnant women in their third trimester were included in the study. The diagnosis was based on history, clinical examination and relevant investigations. Patients with physiological dermatoses and dermatoses which flare up during pregnancy were excluded. A comprehensive pro-forma was used to evaluate different dermatoses. Skin biopsy for histopathology was also done where necessary. RESULTS: The age of the study population ranged from 17 to 36 years (mean = 27.3 +/- 4.86). Five (2.5%) patients had prurigo of pregnancy, 4 (2%) had dermatoses associated with Intrahepatic Cholestasis of Pregnancy (ICP), 3 (1.5%) patients had polymorphic eruption of pregnancy, and 1 (0.5%) patient had pruritic folliculitis of pregnancy. No case of pemphigoidgestationis was observed. CONCLUSION: In the study, 6.5% patients presented with specific dermatoses. Prurigo of pregnancy was the commonest condition. Polymorphic eruption of pregnancy was more common in primigravida, while dermatoses with intrahepatic cholestasis was seen more often in multigravida

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

Infants-feeding practices and their relationship with socio-economic and health conditions in Lahore, Pakistan

Background: Pakistan, has high infant mortality rate. Among every 1000 live births 0.76% becomes the victim of death due to malnutrition and fatal infections. Therefore, feeding modes and practices may serve as important factors for assessment of an infant's growth and nutritional status. This study was designed to assess the exclusive breast feeding rate, frequency of diseases during breast feeding, status of breast feeding along with weaning, level of education, occupation and socio-economic status of parents.Methods: In the descriptive and cross-sectional study, a total of one hundred (100) infants were included. The sampling technique was non-probability convenience sampling. This study was conducted at vaccination centers and children clinics in different hospitals in city of Lahore -Pakistan.Results: The results showed that 67% of the mothers exclusively breastfed their babies. 64% of the mothers had knowledge of exclusive breast feeding. The practice of breast feeding was found as 81% while artificial feeding was practiced among 19% of the mothers. Majority of the mothers started weaning their babies at the age 4 (31%) and 6 months (32%) whereas 28% mothers started after 6 months. 54% of mothers continued breastfeeding along with weaning. 72% of the mothers were aware of the importance of colostrum.Conclusion: Maternal education and women's employment have been found major determinants for breastfeeding. The result indicates that in Pakistan, mothers receive counseling on breast feeding which is quite satisfactory and feeding practices of infants are found as better in Pakistan

Last Decade of Dengue – and the Next One

AbstractBackground: Before 1970, only 9 countries had dengue. Until 1998, there were 1.2 billion dengue infected cases in 56 different countries around the globe. To date it is prevalent in all of 6 WHO regions. Mortality rate is thought to be 2.5% as it varies from country to country. These figures are not surely depicting exact situation as many cases from most parts of the underdeveloped and developing countries go unreported due to number of reasons but one thing is sure that it is on accelerating note.Methodology: In this study, total number of dengue victims around the globe from year 2000-2009 was estimated. Data were collected from World Health Organization (WHO), different health and country specific emergency dealing agenciesand hospitals. We have shown dengue statistics in annotated maps of international regions where dengue has affected in certain.  In a country specific (Pakistan) study we have determined most vulnerable population group among society, their age, gender and immunological profile against dengue virus. Moreover, most prevalent serotype of dengue virus is determined by surveying the current data.Results: It is estimated that there were 24,956 lives lost world wide during 2000-2009 as a consequence of dengue infection (DF/DHF/DSS) with an average CFR of 0.24%. These figures are approximate as we have not included the unauthentic source figures from non-reporting (to WHO) countries or not having an official database. A total of 10,178,624 clinical cases had been reported during that period with highest share of Americas of 6,586,785 cases.Conclusion: Our estimate suggests that number of dengue cases got elevated in first decade of 21st century but death rate is not that higher as 2-2.5% which is estimated. Dengue is spreading and finding novel places as temperature and travelling is getting increased

Translating knowledge for action against stroke – using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke)

Participant timeline. (DOCX 48 kb