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Background and Objective: Causal attributions are reasons given to certain events in life including failure and success. The objective of this qualitative study was to explore the attributions perceived as the cause of failure by post graduate residents, failing the final clinical exit examination of Fellowship of College of Physicians and Surgeons Pakistan (FCPS). Methods: This exploratory study was conducted from July 2021 to July 2022, at Jinnah Hospital, Lahore. Study population was selected by purposeful maximal variation sampling. A total of ten post graduate residents from four specialties, failing in FCPS part two clinical examination were included. After written informed consent, semi structured face to face, in depth interviews were conducted. Data saturation was achieved after eight interviews after which two more interviews were carried out. All interviews were recorded and transcribed verbatim. Thematic analysis of the data was done by synthesizing codes into categories and themes. Results: A total of 17 attributions noted were grouped into five categories namely 'Inadequate exam preparation', 'Personal factors,' 'Exam related factors,' 'Training related factors and 'Luck'. Two main themes of External and Internal factors emerged from these. Common attributions were; lack of effort (8/10), inadequate knowledge (8/10), family commitments (7/10), luck (8/10) and examiner's attitude (5/10). Conclusions: Most of the residents attributed internal, unstable and controllable factors like inadequate knowledge and lack of effort. In addition, external uncontrollable factors of bad luck and harsh attitude of examiners were considered as contributory factors towards failure. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of 1064nm Q-switched Nd:YAG laser in the treatment of Nevus of Ota. Methods This study was conducted in Department of Dermatology, Unit-II, KEMU/Mayo Hospital, Lahore. A total of 100 patients of nevus of Ota (both unilateral and bilateral) with Fitzpatrick skin type III to V were included in this study. Baseline photographs and Pigment area and Severity Index (PSI) score was recorded. All patients were treated with 1064nm Q-switched Nd:YAG laser at fluence of 500-600 V and frequency of 5Hz. A total of 10 sessions at 2 weeks interval were given. Final assessment was done at 4 weeks after last session. Improvement was measured in terms of percentage reduction in baseline PSI score. Results Mean age of the patients was 24.35±5.70 years. There were 15.0% males and 85.0% females. Majority of the patients had duration of lesion > 15 years. Most of the patients presented with skin type IV. 52.0% patients showed more than 50% clinical improvement. Improvement was higher in females (56%) and in patients with skin type III (50%) and IV (60%). Stratification with regards to age and duration of lesion showed no statistically significant difference. Conclusion Fifty two % of patients of nevus of Ota treated with 1064 nm Q-switched Nd:YAG laser showed more than 50% improvement. [ABSTRACT FROM AUTHOR]

Objective To determine the percentage reduction in modified MASI score with combination of microneedling and tranexamic acid in patients of melasma. Methods This descriptive case series involved 66 patients of both genders aged 18-40 years having moderate to severe melasma. These patients were treated by microneedling with tranexamic acid at 0, 4 and 8 weeks. Baseline modified MASI scores at 0 weeks was calculated and outcome was evaluated after 12 weeks in the form of percentage reduction in the initial modified MASI scores, both clinically and photographically. Response was graded as excellent (>75% reduction), very good (50-74%), good (25-49%) and fair (<25%). Results A total of 66 patients with moderate to severe melasma were enrolled. Majority of the patients (53%) showed very good response, 41% had good response, 4.5% had excellent response while only 1.5% patients showed fair response. No serious side effects were noted. Conclusion Microneedling in conjunction with tranexamic acid showed very good response (50-74% improvement) in majority of the patients. [ABSTRACT FROM AUTHOR]

Objective To study the outcome of microneedling combined with 35% focal trichloroacetic acid peeling in post acne atrophic scars. Methods This study was conducted in department of dermatology, unit 1, Jinnah hospital, Lahore. A total of 90 patients with Goodman Baron grade 2, 3 & 4 post acne atrophic scars were included in the study. All patients were treated with microneedling alternating with trichloroacetic acid focal peel via CROSS technique at 2 weekly intervals. Results Combination therapy with microneedling followed by trichloroacetic acid peeling resulted in improvement of 1 grade in 93.3% patients with grade 3 and 4 post acne atrophic scars regardless of the age, gender, duration and type of scar and the baseline grade of scarring. There was statistically no significant difference in the frequencies of improvement across various subgroups of patients based on patient's age (p-value=0.731), gender (p-value=0.461), duration of disease (pvalue= 0.777), type of scar (p-value=0.899) and baseline Goodman and Baron Grade (pvalue= 0.821). Conclusion Combination therapy of microneedling followed by trichloroacetic acid peeling resulted in improvement of 1 grade in 93.3% patients with grade 3 and 4 post acne atrophic scars. [ABSTRACT FROM AUTHOR]

Objective To assess the frequency of steroid-induced hyperglycemia in patients taking systemic steroids (30mg or more of prednisolone or equivalent) for dermatological disorders. Methods We included 150 patients of either sex and with ages between 12 and 70 years in this cross-sectional study, carried out in the department of dermatology, Jinnah Hospital, Lahore for a duration of 6 months. Their baseline fasting blood glucose level prior to the start of steroid treatment was recorded. Patients taking 30mg or more of prednisolone (or equivalent) were followed up after one week of treatment and their random blood sugar levels were checked by the same laboratory on venous blood, to see whether they developed hyperglycemia or not after treatment with steroids. Results Mean age of the patients was 41.83±16.42 years. Ninety-four (62.7%) patients were male while 56 (37.3%) were female. Hyperglycemia was found in 28 out of 150 (18.7%) patients. Conclusion Steroid induce hyperglycemia occurred in 18.7% of the study population. [ABSTRACT FROM AUTHOR]

Objective To determine the learning resources and procedures used for dermatology postgraduate training in Pakistan. Methods Trainees from different centers accredited for dermatology postgraduate training in Pakistan were approached. A pre-designed proforma was filled by 100 dermatology trainees of FCPS, MCPS and MD programs . Results Hundred percent trainees followed Rook’s Textbook of Dermatology as a major learning resource. The most commonly read journal was Journal of American Academy of Dermatology. Scientific conferences had been attended by less than 50% students. Most of the students were participating in clinical case discussions, while clinical slide sessions and histopathology sessions were not being attended by all. Most commonly learnt diagnostic procedure was fungal scraping (92%), least common was immunofluorescence (16%). Out of various therapeutic procedures, electrocautery was being performed by 100% students while dermal fillers and botox injections by none. Conclusion There is a wide variation in exposure of dermatology residents to various learning resources and procedural skills across different teaching units of the country. The most lacking part of training highlighted in this study is the aesthetic or cosmetic aspects of dermatology.Objective To determine the learning resources and procedures used for dermatology postgraduate training in Pakistan. Methods Trainees from different centers accredited for dermatology postgraduate training in Pakistan were approached. A pre-designed proforma was filled by 100 dermatology trainees of FCPS, MCPS and MD programs . Results Hundred percent trainees followed Rook’s Textbook of Dermatology as a major learning resource. The most commonly read journal was Journal of American Academy of Dermatology. Scientific conferences had been attended by less than 50% students. Most of the students were participating in clinical case discussions, while clinical slide sessions and histopathology sessions were not being attended by all. Most commonly learnt diagnostic procedure was fungal scraping (92%), least common was immunofluorescence (16%). Out of various therapeutic procedures, electrocautery was being performed by 100% students while dermal fillers and botox injections by none. Conclusion There is a wide variation in exposure of dermatology residents to various learning resources and procedural skills across different teaching units of the country. The most lacking part of training highlighted in this study is the aesthetic or cosmetic aspects of dermatology.Objective To determine the learning resources and procedures used for dermatology postgraduate training in Pakistan. Methods Trainees from different centers accredited for dermatology postgraduate training in Pakistan were approached. A pre-designed proforma was filled by 100 dermatology trainees of FCPS, MCPS and MD programs . Results Hundred percent trainees followed Rook’s Textbook of Dermatology as a major learning resource. The most commonly read journal was Journal of American Academy of Dermatology. Scientific conferences had been attended by less than 50% students. Most of the students were participating in clinical case discussions, while clinical slide sessions and histopathology sessions were not being attended by all. Most commonly learnt diagnostic procedure was fungal scraping (92%), least common was immunofluorescence (16%). Out of various therapeutic procedures, electrocautery was being performed by 100% students while dermal fillers and botox injections by none. Conclusion There is a wide variation in exposure of dermatology residents to various learning resources and procedural skills across different teaching units of the country. The most lacking part of training highlighted in this study is the aesthetic or cosmetic aspects of dermatology.Objective To determine the learning resources and procedures used for dermatology postgraduate training in Pakistan. Methods Trainees from different centers accredited for dermatology postgraduate training in Pakistan were approached. A pre-designed proforma was filled by 100 dermatology trainees of FCPS, MCPS and MD programs . Results Hundred percent trainees followed Rook’s Textbook of Dermatology as a major learning resource. The most commonly read journal was Journal of American Academy of Dermatology. Scientific conferences had been attended by less than 50% students. Most of the students were participating in clinical case discussions, while clinical slide sessions and histopathology sessions were not being attended by all. Most commonly learnt diagnostic procedure was fungal scraping (92%), least common was immunofluorescence (16%). Out of various therapeutic procedures, electrocautery was being performed by 100% students while dermal fillers and botox injections by none. Conclusion There is a wide variation in exposure of dermatology residents to various learning resources and procedural skills across different teaching units of the country. The most lacking part of training highlighted in this study is the aesthetic or cosmetic aspects of dermatology. [ABSTRACT FROM AUTHOR]

Objective To compare the frequency of patch test positivity to Parthenium hysterophorus by using aqueous and acetone extracts of fresh plant in patients of allergic contact dermatitis (ACD). Patients and methods 115 clinically diagnosed patients of allergic contact dermatitis involving ≥40% of body area were enrolled from dermatology outdoor department. After taking informed consent patch test was performed with aqueous and acetone extracts of fresh plant. Aqueous allergen was prepared in three serial dilutions as 0.1%,1%, and 10% strength. 1% acetone extract allergen was taken as gold standard for comparison as well as positive control while pure aqua was taken as negative control. Patch test results were interpreted according to ICDRG criteria Results 115 patients of ACD consisted of 88 males and 27 females with the age range of 20 to 75 years (mean 42±10.20 years). Patch test showed positive contact sensitivity in 56 (49%) patients with 1% acetone extract, in 52 (45%) patients with 10% aqueous extract, in 44 (38%) patients with 1% aqueous extract and in 13 (11.3%) patients with 0.1% aqueous extract. Irritant reaction was seen in 20 (17%) patients with 1% acetone extract, in 12 (10%) patients with 10% aqueous extract and in 5 (4%) patients with 1% aqueous extract. Conclusion Contact sensitivity to P. hysterophorus can be diagnosed with patch test by applying either aqueous or acetone extracts of fresh plant. Aqueous extract is safe (as it produced less number of irritant reactions) and almost equally sensitive allergen. Thus it can be a readily available alternate allergen for patch test in diagnosing parthenium sensitivity. [ABSTRACT FROM AUTHOR]

Background: The first merging of small hospitals into a large one came into existence in January 2005 in county Louth. As a result the surgical departments of Louth county hospital Dundalk and Our lady of Lourdes hospital Drogheda Ireland were combined. Two hospitals are at less than half an hour drive and situated North-eastern region of Ireland. Objectives: To assess the impact of joining two departments of surgery in two different hospitals along with the patient's reaction after such arrangements were made. Design: review of literature. Setting: Louth County Hospital Dundalk Ireland. Period: One year Methods: Following review of literature it was decided to explore the experience of patients who were treated in Louth County Hospital Dundalk one year after merging of two departments of surgery. Randomly 20% of patients treated in Louth County Hospital were included in a telephone survey. These patients were under care of all consultant surgeons. The patients were asked about their experience in Louth hospital. Also impact of joining surgical departments on waiting list was explored. Results: Out of 1310 patients, 20 % of patients treated in Louth Hospitals were included in the survey. The age of the patients varied from 15 to 67 years. 57 % of the patients were female and the remainders were males. It was found that 93.5% of patients were happy to travel to Dundalk and 96.5% were satisfied with the facilities there as well. Furthermore 96% said that they would be happy to have surgery in Dundalk if they ever needed it in the future. 6% of patients were dissatisfied with services in Louth County Hospital, Dundalk. Conclusions: The improvement of quality processes in healthcare is of constant concern to communities throughout the world. The results have clearly demonstrated that restructuring of services can work well and be acceptable to patients once hospitals are prepared with relevant resources in place. [ABSTRACT FROM AUTHOR]

Cornelia de Lange syndrome is a rare developmental disorder characterized by hypertrichosis, low intelligence, delayed milestones and skeletal and dental abnormalities. Gastroesophageal dysfunction, ophthalmologic, cardiac and genitourinary anomalies, learning difficulties, and mental retardation may be present in severe cases. We report a case of this syndrome who presented for laser treatment for the problem of hypertrichosis, and on examination other features of the syndrome were noted. [ABSTRACT FROM AUTHOR]

Objective To determine the outcome of combination of microneedling with PRP in patients with post acne atrophic scars attending the Dermatology Department in a tertiary care hospital of Lahore. Methods A descriptive case series was performed on a total of 60 patients with post acne scars who fulfilled a predefined inclusion criterion. An informed consent was taken. Relevant information about the patient's demographic data and grade of acne scarring was noted along with baseline photography. All patients were given three sessions of microneedling with PRP at one month intervals, using standard treatment protocol and the scars were graded four weeks after the 3rd session using the same grading system. Photographs were taken at each visit and 3 weeks after the last visit. The effectiveness of treatment was determined as per decided operational definition. Data was analyzed using SPSS version 17. Results Total of 60 patients completed the study, having mean age of 28.65 years. Most of them were females. The effectiveness of treatment in terms of reduction in grade of acne scarring in one or more grades from baseline was observed in 78.33% (47), while in 21.67% (13) treatment was not effective. Conclusion Microneedling combined with topical PRP is effective in treatment of post acne atrophic scars. [ABSTRACT FROM AUTHOR]

The authors discuss the implications of the increasing number of women doctors entering the field of dermatology in Pakistan. They cite factors contributing to the gender shift, including dermatology's compatibility with the family life of a female doctor. They also describe problems associated with patients being examined by the opposite gender.

Objective To determine the efficacy of intralesional vitamin D3 in treatment of plantar warts. Methods Total 65 participants, of either gender, with clinical diagnosis of plantar warts were enrolled in the study after taking informed written consent. In each session, selected wart was first injected with 0.2ml (20mg/ml) lignocaine and then 0.6 ml of intralesional vitamin D3 injection (2,00000 IU) was injected with 27-gauge insulin syringe at the base of selected wart. Total 4 sessions were performed every 2 weeks. All patients were clinically assessed for change in size of wart before the first session, every two weeks for the next four sessions, and then at the follow-up period of two weeks after the last session. The treatment was considered effective if there was complete resolution of wart on inspection and palpation at the end of 10 weeks, as final assessment was done 2 weeks after last injection. Results The patients' average age was 26.69±4.63 years. Out of 65 patients, 57.7% (n=57) were between the ages of 18-30; and 8.3% (n=8) were between the ages of 31-45. There were 26.2 percent females (n=17) and 73.8 percent were males (n=48). Treatment was considered effective on complete clearance of wart. In a total of 65 patients, procedure was found to be effective in fortysix patients (70.8%). Conclusion In our study intralesional vitamin D3was effective in 70.8% patients. [ABSTRACT FROM AUTHOR]

Objective To determine the degree of agreement between clinical and dermoscopic diagnosis in patients of scabies. Methods A total of 210 patients with clinical suspicion of scabies were enrolled in the study. Patients were evaluated in a well lit room and those patients who met the definition of clinical diagnosis were recorded as having scabies. All patients were then subjected to dermoscopic examination of the suspicious areas e.g. interdigital clefts of hands, abdomen and groin. Findings were recorded on a predesigned proforma. Outcome variable was a positive or negative dermoscopic examination. Results Mean age of patients was 16±8.5 years with a range of 1 month to 87 yrs. Among 210 patients 116 (55.2%) were males and 94 (44.7 %) were females. Total of 112 patients (53.3%) were clinically diagnosed as scabies and 98 patients (46.7%) were not. Positive dermoscopic examination was recorded in 104 patients (49.5%) of whom 99 (95.2%) were also positive on clinical examination. Mite head was the most frequently visualized part, in 94.1% of the 104 cases. Negative dermoscopic examination was seen in 106 patients (50.5%) of whom 93 (87.7%) were also negative clinically. Hence 99 patients were true positives and 93 were true negatives. Kappa test was used to assess the difference between the two (K=0.829, P < 0.05). Conclusion The results of this study suggest that there is almost a perfect agreement between the clinical diagnoses and dermoscopy for scabies (K=0.829). [ABSTRACT FROM AUTHOR]

Objective To determine the clinical spectrum of pediatric dermatoses at a tertiary care unit. Methods Three hundred and fifty cases aged up to 12 years, presenting to dermatology unit I, Jinnah Hospital, Lahore with skin diseases were enrolled over a period of 6 months. Detailed history and physical examination were done to diagnose the skin lesions. All the information was collected on a specially designed proforma. Results A total of 350 children with skin diseases, 186 (53.1%) males and 164 (46.9%) females were seen. The mean age of patients in the study was 4.18±2.97 years. Infections and infestations were the common dermatoses seen in 158 (45.1%) and 105 (30%) children, respectively. Eczema was present in 79 (22.6%) patients and diseases of sweat gland in 8 (2.3%). Conclusion Infection and infestations were seen as the most common pediatric dermatoses. [ABSTRACT FROM AUTHOR]

Toxic epidermal necrolysis (TEN) is an acute, life-threatening cutaneous drug reaction that predominantly involves the skin and mucous membranes. It is a rare disorder and treated as a medical emergency, due to its fatal outcome. The principles of management include immediate removal of culprit drug(s), supportive management and specific drug therapies or procedures, of which plasmapheresis is one treatment modality. We report two patients of TEN, being successfully treated with plasmapheresis, proving it to be a life saving treatment modality. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency of dyslipidaemia in psoriatic patients. Methods A cross-sectional study was carried out in the Department of Dermatology, Jinnah hospital, Lahore for the duration of six months. A total of 120 patients suffering from psoriasis, of any severity, belonging to either sex and with age between 15-70 years were included in the study. All patients in the study were investigated for total cholesterol, triglycerides, low-density lipoproteins and high-density lipoproteins after 12-14 hours of overnight fasting. Results The mean age of the patients was 38.59 ± 13.86 years. There were 78 (65%) male and 42 (35%) female patients. The mean duration of psoriasis was 5.46 ± 4.49 years. The mean PASI score was 14.98 ± 8.95. There were 67 (55.8%) patients having dyslipidaemia and 53 (44.2%) patients had normal lipid levels. 34 (28.3%) patients had raised total cholesterol (>200mg/dl), 32 (26.7%) raised low-density lipoprotein-cholesterol (>130 mg/dl), 44 (36.7%) hypertriglyceridemia (>150mg/dl) and 35 (29.2%) patients had reduced high-density lipoprotein-cholesterol levels (<40mg/dl). Conclusion It is concluded from this study that patients of psoriasis have a high incidence of dyslipidaemia, as it was found in 55.8% of psoriatic patients. [ABSTRACT FROM AUTHOR]

Objective The purpose of this study was to determine frequency of positive Hepatitis C virus in lichen planus patients. Methods It was a cross-sectional survey which was carried out from 06-08-2014 to 05-02-2015 at the Department of Dermatology, Jinnah Hospital, Lahore. Total 100 patients of lichen planus were enrolled. Antibody titre of Hepatitis C were measured by enzyme-linked immunosorbant assay of third generation. Results Patients of age between 20-70 years were selected. Mean age was 40.55±14.38 years. Out of total 100 patients, 58 were male (58%) while remaining 42 were female (42.0%). Skin involvement was seen in 96 patients (96.0%), mucous membrane involvement in 21 patients (21.0%) and nails involvement in 8 patients (8.0%). Distribution of patients by type of lesions was as follows: nonerosive mucosal 13%, hypertrophic 80%, annular 1%, follicular 8%, nonerosive palmoplantar 5%, nail lesions 6%, atrophic 9%, erosive mucosal lesions 10%, guttate form 6%, actinic 8% and erosive palmoplantar lesions 1%. Hepatitis C antibody was positive in 23 patients (23.0%). Conclusion We discovered high frequency of positive HCV in lichen planus patients. We need a case-control study on a larger population to clarify our results. [ABSTRACT FROM AUTHOR]

Werner's syndrome is a rare inherited disorder characterized by short stature, sclerosed skin, cataract and premature aging of the face. The disease involves multiple systems of the body and some of the abnormalities may cause life threatening complications such as myocardial infarction and malignancy. We report a case of this rare disorder. [ABSTRACT FROM AUTHOR]

Background Mucocutaneous manifestations are commonly observed in HIV patients. These range from various opportunistic infections, inflammatory dermatoses to neoplasms and drug reactions. Objective To observe the nature and frequency of mucocutaneous manifestations in patients of HIV, with or without antiretroviral therapy and their correlation with CD4 cell counts. Patients and methods The duration of study was one year, starting from July 2009 to July 2010. The patients were enrolled from the HIV clinic and inpatient departments of Jinnah Hospital Lahore. Patients meeting the inclusion and exclusion criteria were subjected to a detailed history and clinical examination. Investigations were carried out where required. Treatment profile was also noted. The data was recorded on a pro forma and was analyzed later. Results A total of sixty two patients were enrolled in the study. There were 49 (79%) males and 13 (21%) females. The age range was 4 to 58 years. Cutaneous manifestations were seen in 51 (82%) patients. The most common cutaneous findings were fungal infections seen in 33.87% patients, followed by viral infections (29.03%), xerosis (22.58%) and bacterial infections (12.9%). Less common manifestations were photosensitivity, scabies and hyperpigmentation. CD4 cell count was found to be more than 455x109 in 22 patients while it was less than 455x109 in 40 patients. Skin manifestations were found in 19 (86.36%) patients with a high count and in 33 (82.5%) patients with a low count. Conclusion Cutaneous manifestations are commonly seen in patients of HIV infection. [ABSTRACT FROM AUTHOR]