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Objective: The study aims to ascertain the degree of felt stress among parents of cerebral palsy patients at HIT and POF Hospitals. Study Design: Cross-sectional. Setting: Department of Pediatrics, HIT & POF Hospitals. Period: February 2022 to May 2022. Material & Methods: The study was approved by IRB of HITEC-IMS under approval number HITEC-IRB-22-2021. Using the purposive sampling method, the study included CP children aged 3 to 10 and caregivers who had experienced stress for three consecutive months. The total score was determined using Sheldon Cohen's perceived stress scale. Scores between 0 and 13 were classified as low perceived stress, 14 to 26 as moderate, and 27 to 40 as high felt stress. Results: Children with the spastic form of CP made up 50% of the population, while those with the dyskinetic ataxic and mix types made up 16%, 8%, and 5% of the total. 66 percent of the children were under 5, 22 percent were between the ages of 6 and 10, and just 12 percent were under 3. With level 4 on the second, the GMFCS level of 3 was the most prevalent. The parents’ average age was 31±7.2. Respondents' average stress score was 18.03±8.8. Conclusion: Parents of CP children experience moderate to high levels of stress that are significantly influenced by the employment status of moms and family income. Parents must be stress-free in order to raise children with poor health.

Objective: To assess the sleep quality among medical students, comparing their sleep cycles during physical and online studies along with other factors associated with sleep patterns. Study Design: Cross-sectional Questionnaire based survey Place and Duration of Study: Department of Community Medicine, HITEC Institute of Medical Sciences Taxila from 1st January 2020 to 31st March 2020 Methodology: One hundred and forty seven students were surveyed in a time period of 1 month. The questionnaire included PSQI Pittsburgh Sleep Quality Index and other clinically validated questions. Students with known sleeping disorders were excluded from this survey. Results: There were 81 (55.1%) females and 65 (44.2%) males with mean age 20±1.4 years. Out of these 94(63.9%) were classified as “Poor Sleepers” and only 53 (36.1%) were “Good Sleepers”. Poor sleep quality was associated with female gender (p

Objective: To observe association of Melasma with serum Iron and complete blood count indices Study Design: Case-control cross-sectional study Place and Duration of Study: Department of Dermatology, HIT Hospital Taxila from 1st May 2021 to 1st October 2021 Methodology: Fifty seven females having melasma were taken as cases and 48 non-pregnant females without melasma as control between 12-50 years of age. Women with pregnancy, history of cardiac or thyroid disease and usage of hormone therapy, phototoxic drugs or anti-convulsant drugs were not included. History and examination was done by a dermatologist. Modified MASI (m Melasma Area and Severity Index) score was used for assessing severity of melasma. Blood samples were collected and send for serum Ferritin level, TIBC and Complete blood count in both groups. Results: The mean age of females were 35±7.4 years, and 48 female patients with no melasma were selected as controls with mean age of 25.7±8.4 years. We also analyzed the effect of different hematological and general factors on mMASI score within group of melasma patient but again found no statistically significant effect of any of these on MASI score. Conclusion: There is no direct association between melasma, serum iron levels and blood indices. Keywords: Melasma, Serum ferritin levels, Complete blood count

Background: Newborn skin undergo various stages of developmental changes after birth in order to adapt to challenging conditions of extrauterine life. Many dermatoses though appearing challenging could actually be momentary or physiological undergoing rapid involution, therefore, a vital knowledge of neonatal skin biology is essential for all dermatologists. Aim: To study the clinical pattern of various dermatoses in neonates and their diagnostic value. Study design: Descriptive cross sectional study Place and duration of study: Department of Paediatrics, HIT Hospital Taxila from 1st April 2021 to 30th September 2021. Methodology: One hundred neonates within first 72 hours of life regardless of gestational age, sex and mode of delivery were selected. Neonates kept in intensive care unit were not included, as the chances of infection and sepsis are more in them. A detailed history was taken. Dermatological examination of all the neonates was done thoroughly in broad day light to accurately define the morphology of skin lesions. In all instances, the diagnosis of skin lesion was exclusively based upon the clinical impression. Results: There were 42 (42%) males and 58 (58%) females. 74% were full term and 26% were preterm,79% had normal birth weight (2.5-3.5 kg) and 21% had low birth weight (

Background: Since beauty standards have widely change over the last few decades, women feel self-conscious about having unwanted hair that leads to low self-esteem and some develop depression. Although hirsutism can be emotionally distressing, it can be treated. Females have a lot of pressure to undergo painful procedures of hair removing like plucking, treading and creams that can temporarily remove or reduce the visibility of unwanted facial and body hair. In the past two decades of digital technology, lasers have modernized their use in the treatment of many skin conditions including hirsutism. As intense pulsed light is economical and more cost effective, it can be a more suitable option for those who cannot meet the high expenses of laser treatment. Objective: To evaluate the efficiency of intense pulsed light in females with hirsutism. Study Design: Place and Duration of Study: Department of Dermatology, HIT Hospital Taxila from 1st October 2020 to 30th September 2021. Methodology: Sixty patients of idiopathic hirsutism more than 15 years of age were enrolled. Both the history and examination were done. Diagnosis of idiopathic hirsutism was made on clinical examination using and necessary investigations. Those who had photosensitivity, hormonal therapy or hormonal disturbance, infertility, white hair hirsute, pregnancy, and history of keloid or hypertrophic scar were excluded from the study. Treatment was given for six sessions, with one month apart. Parameters of IPL were adjusted according to (Fitzpatrick) skin type, the density of hair, and fluency, the fluence will be increased subsequently depending upon the response of the patient. Post treatment, participants were evaluated and a 4-point scale was used to grade the results. Patients were told to revisit after 6 months to assess the regrowth of hair on face. Conclusion: Intense pulsed light is the cheap, effective and safe option for hirsutism that a third world country like ours needed where the socio-economic status is relatively low. Keywords: Idiopathic hirsutism, Intense pulsed light (IPL), Fitzpatrick skin type

Aim: To find out association of herpes zoster and changes in disease course like incidence of post-herpetic neuralgia with Covid-19 vaccination. Study design: Cross-sectional, observational study. Place and duration of study: Outpatient Department of Dermatology, CMH and PEMH Rawalpindi from 1st January 2021 to 30th September 2021. Methodology: Seventy three patients presenting with herpes zoster selected by convenience sampling after their verbal and written consent. Demographics, Covid-19 vaccination history, type of vaccination, dermatome effected, co-morbids and presence of post herpetic neuralgia were recorded in them. Results: Mean age of participants was 48.09±15.73 years with 50 (68.5%) were males and 23 (31.5%) were females. 33 (45.2%) were vaccinated and 36 (49.3%) were non-vaccinated against covid-19. Maximum patients were vaccinated with Sinopharm i.e. 19(57.6%).8 (24.2%) patients developed the lesions after first dose and 25(75.8%) after 2nd dose of vaccination. Conclusion: Herpes zoster risk is increased with covid-19 vaccination. Key words: Herpes Zoster, Covid-19 vaccination

Background: Hirsutism is a medical condition characterized by presence of excessive terminal (coarse) hair among females in androgen-dependent areas. psychological well-being of females is negatively influenced by hirsutism. Poly cystic ovarian syndrome (PCOS) is the most common cause of hirsutism. However, hirsutism is found to exist without any underlying cause and is known as idiopathic hirsutism (IH). Studies have shown correlation between skin type and hirsutism among PCOS cohorts; however, no such relationship is known to exist between skin type and idiopathic hirsutism. Objective: To determine association between skin type and idiopathic hirsutism. Study Design: Case control study Place and Duration of Study: Department of Dermatology, HIT Hospital Taxila from 1st March 2019 to 29th February 2020. Methodology: 118 cases and 133 controls were included in study after informed consent. Skin type was determined by Fitzpatrick skin type (FST) rating scale ranging from I to IV. Modified Ferriman-Gallwey (mFG) visual four-point scale was used to quantify hirsutism into mild, moderate and severe. Results: Mean age of cases and controls was 31.01±9.5 years and 28.01±9.7 years respectively. Seventy four (62.7%) of cases and 88 (66.2%) controls had type III skin type. Eighty (67.8%) had mild (8-15) hirsutism. Statistically insignificant (P

Background: Melasma is hyper-pigmentation of skin, usually seen in young female adults, and previous studies have established substantial psychosocial burden associated with this disease. Aim: To measure the frequency of depression in melasma patients and its correlation with severity of melasma Study Design: Descriptive cross-sectional study. Place and duration of study: Dermatology OPD, HIT Hospital Taxila from 1st January 2021 to 31st August 2021 Methods: One hundred consecutive patients of melasma diagnosed by a skin specialist were enrolled. Elderly patients aged >60 years, those with previous psychiatric disease or chronic illnesses and on long term streroids were not included. After getting written informed consent, enrolled patients were screened for depression using Patient Health Questionnaire 9 (PHQ-9) Results: There were 17 males and 83 females. The mean age was 41.5±8.14 years. On MASI scale for assessing severity of melasma, 38 patients scored mild, 51 scored moderate and 11 scored severe. Using Patient Health Questionnaire 9 (PHQ-9) in patients with melasma, 18 patients didn’t have depression, 38 had mild depression, 31 had moderate depression, 6 had moderately severe depression and 7 had severe depression. Conclusion: The frequency of depression is quite high in patients suffering from melasma. It indicates a need for prompt diagnosis, appropriate intervention at correct time to ensure patient’s compliance to therapy to improve his disease outcome. Keywords: Depression, Melasma, Frequency

Background: Psoriasis is a recurrent disfiguring skin disease, associated with abnormal lipid metabolism and with high occurrence of cardiovascular complications. This linked to the extent of disease, as it is often seen in those patients who have larger body areas involved with psoriasis. Objective: To estimate frequency of dyslipidemia in psoriatic patients and to determine the frequency of dyslipidemia in psoriatic patients based on the severity of disease. Study Design: Cross-sectional study Place and Duration of Study: Department of Dermatology, Fauji Foundation Hospital Rawalpindi from 1stMarch 2017 to 30th September 2017. Methodology: One hundred and fifty cases were enrolled. All cases were enrolled and 3ml of blood was collected following 12 hrs of fasting for determination of lipid profile. Blood sample was sent to the Hospital laboratory and reports were verified by senior pathologists. Severity of psoriasis was determined according to PASI score. Results: Age of participants was between 18-60 years with mean 38.88±12.26 years and 29 (19.33%) male and 121 (80.67%) female cases. According to severity of disease, 50 (33.3%) cases had mild, 70 (46.7%) had moderate and 30(20%) cases had severe Psoriasis. The mean cholesterol, triglycerides (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL) was 12.91 ± 2.17, 8.93 ± 2.90, 5.0 ± 2.28 and 1.98 ± 0.31 respectively. There were 100(66.7%) cases who had dyslipidemia and 50(33.3%) had normal lipid profile. Conclusion: Frequency of dyslipidemia is very high and is associated with severity of psoriasis. Keywords: Psoriasis, Dyslipidemia, Lipid profile and Cardiovascular disease.

Background: Serum ferritin is a good indicator of quantifying the risk of hair loss among women. Iron lead to low serum ferritin level; therefore, a low serum ferritin level can precisely point toward iron deficiency. Objectives: To determine the mean serum ferritin levels in female patients with androgenetic alopecia. Study Design: Descriptive cross-sectional study Place and Duration of Study: Department of Dermatology, Fauji Foundation Hospital, Rawalpindi from 2nd October 2018 to 1st April 2019. Methodology: One hundred female patients with androgenic alopecia of all ages after puberty were included. Patients with scarring and other non-scarring alopecia, who had taken iron, vitamin B12, folic acid or multivitamin supplements, anticoagulants, anti-thyroid drugs, antimitotic drugs and oral contraceptives were excluded. After aseptic measures,5 ml of venous blood was drawn, into sterile and disposable plastic syringes. Serum ferritin was measured by enzyme immunoassay (EIA) test, based on sandwich ELISA. Results: Mean age was 33.94±6.29 years and 65 (65.0%) of patients ranged from 36 to 50 years. Average duration of disease was 6.25±2.43 months. Mean weight was 58.77±9.17 kg. Mean serum ferritin levels in female patients with androgenetic alopecia was 33.10±42.99ng/ml. Conclusion: Serum ferritin levels in female patients with androgenetic alopecia are low. Keywords: Androgenic alopecia, Serum ferritin levels

Objective: This study was designed to evaluate the prevalence of depression in females with primary infertility at a tertiary care hospital in Rawalpindi and identify the factors associated with the condition. Study Design: Descriptive Cross-sectional study. Setting: Infertility Clinic of the Department of Obstetrics and Gyanecology, Benazir Bhutto Hospital, Rawalpindi. Period: February to August 2016. Material & Methods: Females between the ages of 18 and 40 years with primary infertility were included in the study. The presence and severity of depressive symptoms were assessed using the Hamilton Rating Scale for Depression (HAM-D). Socio-demographic details and clinical information was collected on a pre-designed proforma. Results: A total of 102 females were included in the study. The mean age of the patients was 31 years with a STD of ± 4.3 years. 78.4% (n=80) patients were suffering from depression on the basis of HAM-D scores. 18 (17.6%) had mild depression, 34 (33.3%) had moderate depression, 20 (19.6%) had severe depression and 8 (7.8%) patients had very severe depression. An analysis of the socio-demographic factors showed that a majority of the females were educated, housewives and living in extended families. The frequency of depression was significantly associated with a low monthly household income (p=0.046). Conclusion: A high proportion of females with primary infertility suffer from depression. Screening for psychiatric illnesses should be part of the standard evaluation of these patients. Early detection and timely psychological intervention can lead to a significant reduction in long-term morbidity.

Objective: To observe the prevalence and association of idiopathic hirsutism with obesity Study Design: Descriptive cross-sectional, case control study Place and Duration of Study: Dermatology Clinic, Heavy Industry Taxila Hospital Taxila from 1st July 2020 to 31st December 2020. Methodology: Two hundred and fifty female patients and age between 12 to 50 years were enrolled. The complaint of hirsutism while their work up for secondary causes of hirsutism was negative were labelled as idiopathic hirsutism as cases and their age and gender matched healthy attendants were taken as controls. Both cases and controls were checked for body mass index and Ferriman Gallwey (FG) scores. Results: Idiopathic hirsutism was found significantly prevalent and increased body mass index was statistically significantly associated with the idiopathic hirsutism in females. Mean age of idiopathic hirsute cases was less than 30 years. So younger females were found to be more prevalent having hirsutism with increased body mass index. Mild to moderate hirsutism was frequently observed in overweight and obese females, however severe hirsutism was rarely observed. Conclusion: Idiopathic hirsutism is prevalent and associated with obesity in our females, so obesity management should also be addressed through referrals in derma clinics where hirsute obese/overweight female have reported. Keywords: Obesity, Hirsutism, Body mass index (BMI), Hirsutism, Excessive hair growth

Objective: To investigate the experience of timely thesis completion by the graduates of the Master of Health Professions Education (MHPE) program in Pakistan.Study Design: Qualitative interpretative study design.Settings: Riphah University Islamabad and HITEC-IMS Taxila.Duration: May 2018 to June 2019.Materials and Methods: Data was collected by semi-structured interviews. All interviews were carried out in person. Detailed notes were taken, and conversations were audio-recorded. Three authors analyzed data independently using iterative thematic analysis. Inconsistencies were resolved through discussion.Results: Two major themes out of five were identified: Intrinsic attributes of the graduates and the role of the supervisor. including sub-themes of intrinsic motivation, self-regulation, age of the participant, supervisor-trainee relationship, supervisor’s availability, supervisor’s commitment, personality traits of the supervisor. Periods of face-to-face contact sessions were considered to increase internal motivation during which participants believe to have greater self-regulation. Positive relationship with a committed supervisor who was readily available and had a friendly, yet professional attitude aided in the completion of the thesis on time while a supervisor lacking these traits posed challenges for the graduates.Conclusion: Several factors were identified which influenced thesis completion among the graduates of MHPE in Pakistan. The five major ones consisted of the following, 1) Research Project-Related Problems; 2) Support System; 3) Supervisor Guidance; 4) Attributes of the Researcher; 5) Conducive Research Environment. These results can help influence policies to evaluate and improve this program.