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Nature is the best teacher and reconnects the mechanically lost man with originality. Considering the fundamental role of nature in the nurture of mankind, this study aims to emphasise the need for green spaces within the urban metropolis for improved lifestyles and a sustainable environment. The conditions of the United Nation Sustainable Development Goals (UN-SDG) necessitate a cleaner environment, clean air, water and sanitation. The quantitative research proposes jogging track, artificial forest implementation and recreational facilities along with the treated Malir river water sections. For this research, a questionnaire-based analysis is conducted. This study proposes a notion of urban forest recreation for the citizens, dwellers and monetary contribution for maintaining such facilities based on the quantitative analysis of the collected data. As a result, the analytics of the survey reveals that people would welcome the use of such options for recreation. According to the data received, the respondents ponder that these green places could enhance their quality of life with a preference for sharing green space with their family and friends and also increase some soothing hobbies in urban areas. Most respondents prefer urban forestry supporting water sports, boating and fishing areas in Karachi. The feasibility of the proposed model is ensured with critical analysis and assessment of public income for Tax, preferences of green places assessment, use of recreational areas, and willingness to pay for entry in the green area.

All living things, including people, plants, animals, and, in fact, all of God's creatures, need to connect with one another to maintain their life cycles. They are constrained inside their predetermined realm and have several methods to interact with one another. Technology becomes more engaged in communication over time, and human productivity rises as a result, such as when signals are converted into understandable communications. Since people desire to be involved in whatever they do, Radio Frequency (RF), a form of electromagnetic wave technology, has been developed for communication. RF-based communication technology makes life easier for people, but the exponential growth in demand for the technology has led to high levels of engagement with communication devices—something that is undoubtedly harmful to people and other living things. The participation and prolonged use of RF devices expose people to more live things that have an impact on their health and the environment. In this study, we will assess the direct and indirect effects of heavy electromagnetic pollution on the ecosystem and the health of living things. The Pakistan region has been chosen since it is among the world's most densely inhabited regions in terms of sample size. When Metaverse is made available to everyone, especially in Pakistan, the metaverse starts generating electromagnetic radiation, which will have a significant influence on electromagnetic pollution, although no research has been able to demonstrate the relationship in comparison to the metaverse.

This study aims to check the effect of job demands on employees' burnout and job resources on employees' work engagement with the moderating role of psychological ownership. Moreover, the direct and mediating role of burnout and work engagement in adaptive job performance. Data were collected through a survey questionnaire from a total of 311 four and five-star hotel employees and structural equational modeling was employed to test the hypotheses. The findings demonstrate the positive relation of job demands with burnout and job resources with work engagement. Furthermore, burnout has a direct negative as well as mediating relation with adaptive job performance whereas, work engagement has a direct positive as well as mediating relation with adaptive job performance. Lastly, the study has also found that psychological ownership weakens the relationship of job demands and employees’ burnout whereas, it strengthens the relationship among job resources and employees’ work engagement. Theoretical and practical implications are also discussed.

This paper introduces an abridgment of solid waste conditions and their management issues in Karachi. Approach that can be usedto reduce the municipal waste and the management of solid waste produced by the residents of Karachi city is Zero Waste Strategy. Zero waste strategy is a focused approach of conserving all the resources. This approach is beneficial by means of responsible production, valuable consumption, reuse and recovery of product, packaging and materials without burning and with the least discharge to air, water or land that cause an adverse effect on our environment and human health. The budget allocated by governmental bodies for solid waste management is adequate but not allocated properly to the local bodies. Bin services are provided throughout the city is enough but the locations selected for this purpose are not appropriate. Zero waste strategy (ZWS) helps to reduce the solid waste by providing a proper route, with an appropriate recycling plan, adequate management of resources, and public behavior related to solid waste. The research concludes by proposing zero waste strategy (ZWS) as an effective solution of highlighted issues for the management of solid waste in Karachi city. The current research is entirely unique and could affect the society in value-added manner.

This paper presents the development of low-cost and robust industrial IoT based data acquisition system primarily focused on domestic manufacturing industries striving to achieve goals and benefits of “Industrial 4.0”. This proposes aims to promote DAQ System integration in traditional manufacturing process of the small and mid-sized industries of Pakistan with limited capacity of investment. Proposed method comprises of Arduino and it’s IoT features for Data Collection, along with a self-developed PC based Centralized Software for Collection of Data, Graphical User Display and Storing collected Data in Local SQL Database. PC based Software replaces requirement of multiple software in case of traditional low-cost DAQ systems, like OPC Software for collecting data from industrial hardware, Java or PHP based any GUI and SQL Data storage. The analysis of work is done with the help of the Message Queue Telemetry Transport (MQTT) protocol. This project will be in further stages evaluated to add features of Supervisory Control, along with Data Acquisition hardware with minimum increase in cost and further upgrading PC Software to add more features of Industry 4.0, as compared to costly commercial solutions available in the market. A machine learning algorithm, k-nearest neighbors algorithm has been used to classify sensitive and non-sensitive data for improvising cloud security. K-Nearest Neighbors is also called KNN algorithm which is supervised machine learning classifier.

This paper aims to transform tidal energy into rotation energy for electricity generation and in the course evaluating sea parameters. This is accomplished by integrating the Internet of Things with tidal energy off the coast (and in a home environment), which further enhances the capabilities of this prototype project to remotely monitor sea-like parameters to enable energy production using tidal energy. As South Korea is transducing tidal energy with a total installed tidal power capacity of above 500MW, Pakistan and Middle Eastern countries can benefit from its vast coastal line. This paper proposes a sustainable design that makes the turbine rotate at high speed. A vertical design is chosen, which is bi-directional. The design of the turbine consists of 3 blades, each occupying a 2 square feet area supported by an iron-rod frame. During the experimentation, an average voltage of 5V was generated, whereas the speed of the turbine generated was 75 RPM. It is the first known attempt of its kind supported by indigenous resources. It is proposed that this type of prototype can be scaled, to the coast to produce electrical energy to meet the energy production needs of the region.

This is a review paper on the idea of cloud computing which is evolved from the era of internetworking. Subsequently the highlight includes classification of cloud computing, comparison of public versus private cloud infrastructure. We further the concept of SaaS and PaaS where we set in note for future work. We finally conclude with some of the salient characteristics of networks on the cloud.

Conventional buildings consume large amounts of energy and are the source of greenhouse gas emissions contributing to climate change. The shortage of green buildings in Pakistan have been said to be due to shortage of knowledge of the benefits of essential green building materials and the absence of a regulatory framework. The study is qualitative and quantitative and is divided into two parts. This review paper focuses on awareness in the Pakistan's local construction market concerning green buildings through a survey questionnaire. Data collection procedure consists of 60 questionnaires related to green building construction awareness and priorities within Karachi's construction sector. Also, a focus group and personal interviews conducted with at least 5 professionals working in local construction projects are analyzed. The research questions formed from detailed literature review were analyzed and found that energy conservation, environmental/resource conservation and improving indoor environmental quality are major driving factors for green building development. Similarly, there is a lack of knowledge of green construction methods and regulations and lack of support from the government. This has been found as the major barrier in going towards green construction. We recommend policy directions towards this end and elaborate points of concern to the authorities.

Background All scoring systems used in Alopecia Areata (AA) focus mainly on scalp and cannot assess the severity or treatment response when AA involves the beard hair, eyebrows, or eyelashes. Aim This study describes and assesses the reliability of a new scoring system "Alopecia Areata Severity Index" (AASI) for measuring the severity of AA of scalp, beard, and upper face. Methods Scalp hair, beard hair, upper face (eyebrows and eyelashes) were individually assessed and the severity of AA was scored from 0 to 100 (0-50 in case of upper face). AASI score was then calculated as a sum of all these individual scores as AASI = AASI (scalp) + AASI (upper face) + AASI (beard)+. To test the inter-observer reliability of AASI score, 25 patients with varying severity of AA were scored by 4 trained dermatologists. Repeat scoring was performed after one week to test for intra-observer reliability. Results Excellent inter-rater, as well as intra-observer reliability, was observed with Chronbach's alpha value of 0.999 (CI = 0.989-1.000). The intra-observer correlation coefficient with average measure was 0.999 (CI = 0.990-1.000) with statistically significant F test Conclusion AASI score is a reliable scoring system to assess the severity of AA in patients with involvement of one or more areas of the body. Limitations Sample population belonged to single ethnic group.

Melasma is a common dermatosis, presenting as ill-defined light to dark brown pigmentation of photo-exposed areas, most commonly the face. Its exact prevalence is unknown, but it is commoner in intermediate skin phototypes and women of reproductive age. Its treatment and monitoring have significance due to its chronic recalcitrant history and psychosocial impact. Various indices and tools like the melasma area and severity Index (MASI), melasma severity index (MSI), and Melasma Quality of Life Scale (MELASQoL) have been formulated for measuring severity and treatment response. In this review, particular emphasis has been laid on melasma's epidemiological and clinical aspects and its assessment and scoring.

Topical steroid damaged face (TSDF) is an entity caused by unsupervised and prolonged use of topical corticosteroids (TC) on the face. There is currently no definite treatment that can partially or completely reverse the changes seen in the facial skin in TSDF. Platelet rich plasma (PRP) is a biological product that is obtained from autologous centrifuged blood and it contains multiple growth factors for the skin and other body tissues. PRP has been employed as a treatment option in patients with steroid induced rosacea. We hereby report the results from 34 cases of TSDF who had been treated with PRP at our institute. Retrospective analysis of the data and digital photographs of these cases was carried out in October 2021 and the data analysis revealed a significant therapeutic benefit in most of the cases with excellent results in 76% (26/34) cases. Improvement was noticed after the first session only in majority of cases and in all the clinical parameters in the study patients. No adverse effects were reported in any patient in this series.

Objective: Polycystic ovary syndrome (PCOS) is one of the most common reproductive, endocrine and metabolic disorders in premenopausal women. Even though the pathophysiology of PCOS is complex and obscure, the disorder is prominently considered as the syndrome of hyperandrogenism. C-Terminal binding protein 1 antisense (CTBP1-AS) acts as a novel Androgen Receptor regulating long noncoding RNA (lncRNA). Therefore, the present study was aimed to establish the possible association of androgen receptor regulating long noncoding RNA CTBP1-AS with PCOS.Methods: A total of 178 subjects including 105 PCOS cases and 73 age-matched healthy controls were recruited for the study. The anthropometric, hormonal and biochemical parameters of all subjects were analysed. Total RNA was isolated from peripheral venous blood and expression analysis was done by quantitative real time PCR (qRT-PCR). The correlation analysis was performed to evaluate the association between and various clinical parameters and lncRNA CTBP1-AS expression.Results and conclusion: the mean expression level of CTBP1-AS was found to be significantly higher in the PCOS women than in the healthy controls (-lnCTBP1-AS, 4.23 ± 1.68 versus 1.24 ± 0.29 p

Excimer light (EL) and targeted UVB (TUVB) devices have been used successfully in repigmenting vitiligo. To compare the repigmenting efficacy and safety of EL with TUVB device in vitiligo. The study was conducted retrospectively on patients of vitiligo who had received either EL (Group A) or TUVB (Group B) from year 2015 to 2020. Data pertaining to 40 such age and sex matched patients from each group was retrieved with almost similar sites of involvement. Only patients whose phototherapy sessions had been given twice weekly for minimum of 30 sessions or until 90%-100% repigmentation were included in the study. The study was retrospective in nature and the principles outlined in the Declaration of Helsinki were followed during the study. The primary endpoint compared between the two groups was the extent of repigmentation achieved on different sites of body and adverse effects from treatment. Secondary endpoints compared included total number of doses, cumulative dose needed for complete repigmentation and number of doses needed for onset of repigmentation. There were 82.6% responders in Group A and 76.3% in Group B who had achieved at least 50% repigmentation. Excellent response (75%-100% repigmentation) was achieved in 68.1% lesions in Group A and 46.4% lesions in Group B. Patients in Group A needed less number of doses (13.75 vs. 19.37) and less cumulative dose (6.14 vs. 7.69 J/cm2 ) to achieve complete or near complete repigmentation. Adverse effects were negligible in both groups. Targeted phototherapy with EL demonstrated better repigmenting efficacy than TUVB in vitiligo.

Over several decades, topical corticosteroids (TCs) have been used in the treatment of various dermatoses such as psoriasis, contact dermatitis, and eczema, among others. The TCs act by reducing inflammation and irritation after topical application. The therapeutic effect of TCs is bestowed through their diverse biologic properties such as anti-inflammatory, antiproliferative, vasoconstrictive, and antimitotic activity, and its role in the reduction of lymphocyte reactivity, modulation of Langerhans cell expression, cellular and lysosomal membrane stabilization, reduction of recruitment of neutrophils and monocytes, reduction of mast cell density and reactivity, and sensitization of immunoglobulin E. Clobetasol propionate (CP) 0.025% is a class I TC available as a cream formulation. The cream formulation contains half the concentration of conventional CP (0.025%), without the loss of therapeutic potency. The lack of additives such as penetration enhancers (propylene glycol) further prevents cutaneous microbiome alteration. This comprehensive case series covers the potent efficacy and safety of ImpoyzTM (CP) Cream 0.025% in the management of various dermatological disorders.

The ability to sustain communication between nodes as per Industry 4.0 standard within the waterways is still not mature enough. It is prudent to make use of natural resources that are abundantly found in the form of strong wind (wind energy) and underwater tidal waves generation (tidal energy). Climate change and environmental sustainability are now becoming more important for a sustainable smart world. This is discussed in detail along with the decentralized mode of crop management. In this chapter, it is shown that energy efficiency can lead to the selection of different system models for the internet of underwater things (IoUT) where systems are sustainable and can tap previously unexplored resources. This resource is useful as a reference to further explore IoUT and green energy harvesting techniques.

Segmental vitiligo (SV) is considered to be relatively less responsive form of vitiligo to medical treatment. While excimer light (EL) has shown great promise in treating localized vitiligo especially on face and neck, its efficacy in SV is not reported so commonly. We conducted a retrospective study on patients of childhood SV who had received EL therapy from January 2016 to December 2018 at our institute. Data of all such cases who had received at least 10 doses of EL treatment or achieved complete repigmentation were selected for analysis. Records of 26 children with SV satisfied the selection criteria. Excellent response (75% repigmentation) was documented in 65.4% (17/26) patients with 7.7% (2/26) patients showing partial (50%-75%) repigmentation. Response to treatment was seen to correlate inversely with the duration of SV. Patients with SV of6 months reported better results with all 10 cases achieving complete or near complete (75%) repigmentation. In contrast, only 44% patients (7/16) with disease duration of6 months were seen to have achieved75% repigmentation.

The delivery of healthcare in remote rural areas is a global phenomenon. Using digital governance, a discretized cluster of node relaying time-sensitive, and reliable data, life-critical health services can be ensured. Here tactile internet-based internet of things (IoT) and its variant internet of medical things (IoMT), as well as tactile internet, is introduced. Its relationship with 5G is explored. A model for e-health implementation using unmanned autonomous vehicles (UAVs) in the backhaul is presented. The link is analyzed over fiber optics, satellite, and 5G network in terms of latency and reliability: the crucial metrics for robotic surgery. It is also shown that 5G implemented in Italy, Zimbabwe, and Cooks Island have supported mobile hospitals in rural regions. Hence, induction of 5G networks is a feasible approach. Finally, a critical review of expected future technologies including telematics is presented. Hence, tactile internet-based robotic surgery can reduce the digital divide.

Laser hair removal since its availability has been primarily used for aesthetic purposes. Over the years, it has emerged as an important therapeutic modality in various dermatological and surgical disorders, both as an adjuvant and as a monotherapy. Depending on the skin type, all laser hair removal systems have been used with good results and minimal complications. We hereby review the diverse range of unconventional indications of laser hair removal.

There are limited treatment options available to control the progression of vitiligo and most of these treatment options carry the risk of both short-term as well as long-term adverse effects. Apremilast has emerged as a promising treatment option in psoriasis and many other cutaneous disorders. We report herein the successful use of oral apremilast therapy in controlling the progression of adult onset vitiligo in 13 patients. The patients had not responded to other systemic treatments earlier. In addition to the control of progression, eight patients (61.5%) showed some evidence of repigmentation after apremilast therapy. Gastrointestinal adverse effects and headache were the commonest adverse effects reported that led to cessation of treatment in two cases.

Long-term monitoring of Indus River Dolphin (IRD) is critical to enable and make informed decisions on current habitat. However, existing literature on underwater acoustic sensor network (UASN) based sensing and activation is limited. Most recently canal entrapment has lacked to recover 2–7 dolphins per year. Coupled with the need to conserve energy, this paper introduces IRD Habitat Monitoring System (IRDHMS). IRDHMS aims to monitor IRD in different phases using energy-aware mechanism. It performs detection and generates automated response based on speed and location of animal species. The proposed model effectively monitors IRD within sensing boundary, minimizes observation cost using in-situ processing and reusing existing infrastructure. It also aims to perform as acoustic guide to prevent dolphin from being entrapped in artificial canals also referred to as canal entrapment. This paper is the first known attempt on prevention of canal entrapment using energy-aware sense and react mechanism as applied on Indus Blind Dolphin as an extended cellular based acoustic sensor network. In energy-awareness perspective, results show that IRDHMS performs better as compared to conventional networks by conserving approximately 6.5% energy per click frame.

Background Lasers and potent topical corticosteroids are used as therapeutic options in hypertrophic burn scars. Objective To assess the therapeutic effect of fractional CO2 laser resurfacing in combination with potent topical corticosteroids on hypertrophic burn scars in pediatric age group. Methods Ten children (5-12 years) with postburn hypertrophic scars were treated with 3 to 5 sessions of fractional CO2 laser resurfacing at 1-month intervals, and triamcinolone suspension was applied immediately after each laser session. Patients were also instructed to apply clobetasol propionate gel for 1 week after each laser session. Response to treatment was assessed using Vancouver Scar Scale (VSS) and Physician Global Assessment (PGA). Tolerability for the procedure and adverse effects were also assessed. Results Laser sessions were well tolerated under the effect of topical or local anesthesia. At the time of final assessment, there was mean reduction of 4.2 (range: 2.8-7) in VSS. Reduction of VSS by ≥4 points was observed in 8 of 10 cases, whereas PGA revealed excellent response in 6 of 10 cases. No significant adverse effects were reported by any patient. Conclusion Fractional CO2 laser resurfacing in combination with potent topical steroids leads to significant therapeutic benefits in children with postburn hypertrophic scars.

Conventional and advance technologies are available for laser hair removal. Complete and permanent hair reduction is not yet possible by treatment with lasers. Ideal patient for any conventional laser hair removal treatment is one who has thick, dark terminal hair, light skin and normal hormonal status. Factors that contribute to variable outcomes in laser hair removal can be broadly divided into patient related ones and the technology related ones. Skin type, hair color, thickness and density, degree of tan, hormonal dysfunction etc., constitute the patient related factors. The wavelength, fluence, spot size and pulse duration of the laser system are the technology related factors. There are some patients who respond variably, unpredictably or poorly to laser hair removal despite ensuring that indication for treatment is appropriate with adequate parameters of the laser system. This article reviews various patient related and technology related factors which lead to variable-to-poor outcomes in laser hair removal; and various challenges and limitations of laser hair removal technology in patients with dark skin types.

Background: Currently, the standard protocol regarding the performance of procedures on patients receiving or having recently received isotretinoin (13-cis-retinoic acid) states that the procedures should not be performed. The recommendations in standard books and drug insert require discontinuation of isotretinoin for 6 months before performing cosmetic procedures, including waxing, dermabrasion, chemical peels, laser procedures, or incisional and excisional cold-steel surgery. These recommendations have been followed for over two decades despite little evidence for the stated increased risk of scarring. Objective: The Association of Cutaneous Surgeons (I) constituted a task force to review the evidence and to recommend consensus guidelines regarding the safety of skin procedures, including resurfacing, energy-device treatments, and dermatosurgical procedures in patients with concurrent or recent isotretinoin administration. Materials and Methods: Data were extracted from the literature through a PubMed search using the keywords “isotretinoin,” “safety,” “scarring,” “keloids,” “hypertrophic scarring,” and “pigmentation.” The evidence was then labeled and circulated to all members of task force for review. Results: The task force is of the opinion that there is insufficient evidence to support the current protocol of avoiding and delaying treatments in the patient group under consideration and recommends that the current practice should be discontinued. The task force concludes that performing procedures such as laser hair removal, fractional lasers for aging and acne scarring, lasers for pigmented skin lesions, fractional radio-frequency microneedling, superficial and medium-depth peels, microdermabrasion, dermaroller, biopsies, radio-frequency ablation, and superficial excisions is safe in patients with concurrent or recent isotretinoin administration.

Carcinoma en cuirasse is a specific clinic-morphological type of cutaneous metastasis that has been described with internal malignancies of the breast, lungs and gastrointestinal tract. We describe herein a case of carcinoma en cuirasses arising from an operated Carcinoma of rectum in a 55 year old female.

Melasma is one of the most common hyperpigmentary disorders found mainly in women and dark-skinned patients. Sunlight, hormones, pregnancy, and genetics remain the most implicated in the causation of melasma. Although rather recalcitrant to treatment, topical agents such as hydroquinone, modified Kligman's Regime, azelaic acid, kojic acid, Vitamin C, and arbutin still remain the mainstay of therapy with sun protection being a cornerstone of therapy. There are several new botanical and non botanical agents and upcoming oral therapies for the future. There is a lack of therapeutic guidelines, more so in the Indian setup. The article discusses available evidence and brings forward a suggested treatment algorithm by experts from Pigmentary Disorders Society (PDS) in a collaborative discussion called South Asian Pigmentary Forum (SPF).

In this paper we introduced a new type of terminal block of energy meter as a way to prevent energy theft for K-Electric. K-Electric is a vertically integrated utility based in Karachi, Pakistan responsible for all energy generation, transmission and distribution within the boundary of Karachi, Hub and Parts of Baluchistan. This piece of hardware is designed to overcome the flaw associated with the old terminal block which is being used in energy meters from decades. The first flaw of old energy meter terminal block is that it does not produce any hindrance to any adversary who attempts to tamper the meter. The second flaw is that the construction of the old terminal block contains many contact points i.e. 6 contact points for every phase in total, for single phase meter there are 12 contact points situated in the terminal block and for three phase meter the count rises to 24 contact points, any loose connection between any two contact parts results in the burning of energy meter. By tampering we refer to shunt type tampering, which is the most common method to make energy meter register less energy flow. There are further tampering techniques that are being carried out for registering fewer energy consumption by the utility. We carried a survey of data of a utility company that shows 16% of energy loss is due to shunt type tampering. Further in this study we also found that faults related to terminal block accounts up to 48% of total faults carried out by energy meter being on site. Precise energy accountability is every utility's key goal and objective. It is one of the major factors in evaluating efficiency of a utility like K-Electric. The challenges faced by the utility to reach its goal are exemplified by the unaccountable energy consumed by the public. This paper hence addresses a possible solution to prevent the economic and social losses associated with introduction of Smart Grids in Southern Pakistan.

BACKGROUND Ultrathin skin grafting (UTSG) is a tissue grafting technique used in resistant stable vitiligo. OBJECTIVE To assess long-term follow-up results achieved with UTSG in vitiligo. METHODS Over a span of 8 years, a total of 415 patients with stable vitiligo were treated with UTSG at the authors' institute. Retrospective analysis of results achieved in these patients was performed, and primary end points assessed included the extent and quality of repigmentation achieved and adverse effects from the procedure. Results were correlated with the site, morphological type of vitiligo, duration of stability, postprocedure treatment used, and the age and sex of the patient. RESULTS Follow-up results were available with 554 lesions in 370 patients. Excellent response (≥90% repigmentation) was documented in 78.9% (437/554) lesions whereas 8.67% (48/554) lesions demonstrated poor results. Pigmentation was retained in >98% (112/114) cases over 4-year follow-up. The commonest adverse effect noted was "perigraft halo" in 12.3% (68/554) lesions. Site and morphological type of vitiligo as well as the postoperative use of phototherapy showed statistically significant correlation with response. Age and sex of the patient and duration of stability beyond 1 year did not influence the outcome. CONCLUSION Ultrathin skin grafting provides long-term beneficial results in stable resistant vitiligo.

Q-switched (QS) lasers are used for depigmentation in universal vitiligo, but there is limited data on long-term results after laser treatment. This study was conducted to assess the safety and long-term follow-up results of QS Nd:YAG laser treatment in combination with need-based topical depigmentation therapy for universal vitiligo. A retrospective study was performed on patients with universal vitiligo who had received QS Nd:YAG laser treatment from 2010 to 2013. All patients were contacted and called for follow-up. Patients who reported were assessed clinically and information regarding adverse effects and relapse (repigmentation) in the follow-up period were obtained. Any need for topical depigmenting creams or other interventions and overall satisfaction to treatment were also documented. Records of 34 patients were retrieved, out of whom 28 cases reported for the follow-up visit. Duration of follow-up ranged from 2 to 5 years (mean, 2.78). No long-term adverse effects were reported and the majority of patients were highly satisfied with treatment. Satisfactory results with >90% clearance of pigment was reported by 89.3% (25/28) of patients, out of whom 72% (18/25) had retained the therapeutic effect with the use of sunscreens with/without intermittent topical depigmentation therapies. In seven cases, partial to complete relapse was observed. QS Nd:YAG laser is an effective tool for treating residual pigmentation in universal vitiligo, and the therapeutic effect can be maintained in most cases with regular sunscreen use and need-based topical therapies.

Monilethrix is a rare genetic disorder of hair characterized by beaded appearance of the hair shaft leading to hair fragility and patchy dystrophic alopecia. In this disorder, the hair shaft has alternate widenings (nodes) and constrictions (internodes) that lead to fracture of hair shaft and varying degree of alopecia. We report an eight year old Kashmiri boy who presented with diffuse hair loss since infancy. As monilethrix is a rare disease entity which prompted us to report this case.

Background: Narrowband ultraviolet B (NB-UVB) therapy has emerged as one of the most favored treatment options in patients with generalized vitiligo. The aim of combining topical agents is to improve the efficacy of NB-UVB in causing repigmentation in vitiligo. Aims and objectives: The present study aims to study the effect of combining topical tacrolimus to NB-UVB therapy in causing repigmentation in vitiligo lesions. Methods: This prospective single-blind study was performed on 80 patients of generalized vitiligo above 12 years of age who had symmetrically distributed vitiligo lesions on the face, trunk or limbs. The patients applied topical tacrolimus 0.1% ointment twice daily on selected symmetrically distributed lesions on the left side of the body. No topical agent was applied on the corresponding lesions on the right side. The patients also received whole-body NB-UVB exposure three times every week on non-consecutive days according to a set protocol. Lesions selected for the comparison analysis were photographed serially and assessed by a single-blinded observer for the extent or repigmentation achieved. The extent of repigmentation achieved was calculated on the basis of VASI scoring. The time taken for the initial repigmentation to start, the overall repigmentation achieved as well as any adverse effects were noted down and compared between the selected lesions on the two sides. Results: Seventy-four patients with 234 symmetrical vitiligo lesions were available for comparison analysis at the end of study period. The mean repigmentation achieved on the left-sided study lesions was approximately 71% (VASI score of approximately 4.0) as compared with 60.5% on the symmetrically distributed right-sided lesions (VASI score of 3.4). Moreover, the repigmentation started earlier on the study lesions on left side than on the right-sided ones. No significant adverse events were reported with the combination treatment. Conclusions: Addition of topical tacrolimus increases the extent of overall repigmentation achieved with NB-UVB therapy in vitiligo and also reduces the cumulative NB-UVB dose needed to achieve a therapeutic benefit in affected patients.

Rosacea is a common inflammatory skin disease affecting the face usually in middle-aged individuals. The disorder is associated with a lot of psychological impact on the quality of life of the affected patient. Treatment options for this skin disease range from topical treatment options to systemic agents and even lasers. This paper will review the current and some of the upcoming treatment options for this chronic skin disease.

Background: Melasma Area and Severity Index (MASI), the scoring system in melasma, needs to be refined. Aims and Objectives: To propose a more practical scoring system, named as Melasma Severity Index (MSI), for assessing the disease severity and treatment response in melasma. Materials and Methods: Four dermatologists were trained to calculate MASI and also the proposed MSI scores. For MSI, the formula used was 0.4 (a × p 2 ) l + 0.4 (a × p 2 ) r + 0.2 (a × p 2 ) n where "a" stands for area, "p" for pigmentation, "l" for left face, "r" for right face, and "n" for nose. On a single day, 30 enrolled patients were randomly examined by each trained dermatologist and their MASI and MSI scores were calculated. Next, each rater re-examined every 6 th patient for repeat MASI and MSI scoring to assess intra- and inter-rater reliability of MASI and MSI scores. Validity was assessed by comparing the individual scores of each rater with objective data from mexameter and ImageJ software. Results: Inter-rater reliability, as assessed by intraclass correlation coefficient, was significantly higher for MSI (0.955) as compared to MASI (0.816). Correlation of scores with objective data by Spearman′s correlation revealed higher rho values for MSI than for MASI for all raters. Limitations: Sample population belonged to a single ethnic group. Conclusions: MSI is simpler and more practical scoring system for melasma.

Introduction: Intradermal steroid injections are used as treatment option in resistant alopecia areata. However, it is difficult and quite painful to treat large areas of alopecia with this modality. Objective: To assess the efficacy and safety profile of a combination of fractional carbon dioxide (CO2) treatment followed by topical corticosteroid application in resistant alopecia areata. Materials and Methods: Ten cases of resistant alopecia areata who had not responded to multiple treatment modalities were treated with fractional CO2 laser followed by topical application of triamcinolone spray (10mg/mL) on the resistant lesions. Patients received 4–8 sessions that were repeated at an interval of 3–4 weeks. Response to treatment was assessed on a quartile physician assessment scale and labeled as excellent (>75% regrowth), good (50%–75% regrowth), fair (26%–50% response), and poor (

Background: Chronic autoimmune urticaria (CAU) is one of the most challenging therapeutic problems faced by a dermatologist. Recently, weekly autologous serum injections have been shown to induce a prolonged remission in this disease. Aim: To evaluate the efficacy of repeated autologous serum injections in patients with CAU. Materials and Methods: Seventy patients of CAU were prospectively analyzed for the efficacy of nine consecutive weekly autologous serum injections with a post-intervention follow-up of 12 weeks. Total urticaria severity score (TSS) was monitored at the baseline, at the end of treatment and lastly at the end of 12 weeks of follow up. Response to treatment was judged by the percentage reduction in baseline TSS at the end of treatment and again at the end of 12 weeks-follow-up. Results: Out of the 70 patients enrolled, 11 dropped out of the injection treatment after one or the first few doses only. Among the rest of 59 patients, only 7 patients (12%) went into a partial or complete remission and remained so over the follow-up period of 12 weeks. Forty patients (68%) did not demonstrate any significant reduction in TSS at the end of the treatment period. Rest of the 12 patients showed either a good or excellent response while on weekly injection treatment, but all of them relapsed over the follow-up period of 12 weeks. Conclusion: Autologous serum therapy does not seem to lead to any prolonged remission in patients of CAU.