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Objective: As populations age globally, there is an increasing prevalence of dementia, with an estimated 153 million living with dementia by 2050. Up to 70% of people with dementia experience dementia‐related psychosis (D‐RP). Antipsychotic medications are associated with many adverse effects in older people. This review aims to evaluate the evidence of non‐pharmacological interventions in managing D‐RP. Method: The search of Medline, EMBASE, Web of Science, CINAHL, PsycINFO, and Cochrane included randomised controlled trials that evaluated non‐pharmacological interventions. Data extraction and assessment of quality were assessed independently by two researchers. Heterogenous interventions were pooled using meta‐analysis. Results: A total of 18 articles (n = 2040 participants) were included and categorised into: sensory‐, activity‐, cognitive‐ and multi‐component‐orientated. Meta‐analyses showed no significant impact in reducing hallucinations or delusions but person‐centred care, cognitive rehabilitation, music therapy, and robot pets showed promise in single studies. Conclusions and Implications: Future interventions should be developed and evaluated with a specific focus on D‐RP as this was not the aim for many of the included articles. [ABSTRACT FROM AUTHOR]

Background: The evaluation of degree of liver fibrosis is an important prognostic factor in the management of NAFLD patients. Noninvasive risk stratification is needed to triage individuals with advanced fibrosis for optimal treatment and surveillance. Objective: To find the frequency of fibrosis in NAFLD patients using multiple non-invasive tests and to match the performance of noninvasive tests in diagnosing liver fibrosis. Methods: An observational study done in Out-patient Clinics of National Institute of Liver and GI diseases (NILGID), Dow University Hospital from January 2021 to January 2022. All consecutive NAFLD patients during the study period were enrolled. Liver fibrosis was assessed in each patient with non invasive scoring including APRI score (AST to platelet ratio index), AST/ALT ratio, NFS (NAFLD fibrosis scores) and FIB-4. Results: 322 patients (mean age 44.84 ±10.94 years) were included. The mean values for ALT and AST levels were 40.67 ± 31.69IU/L and 31.85 ± 22.60 respectively. The best diagnostic accuracy was observed with FIB4 score having AUROC of 0.904. A robust correlation was observed between APRI index and FIB-4 score (r = 0.734, p-value < 0.01), and between FIB-4 score and NFS score (r = 0.700, p-value <0.01). Whereas correlation of APRI index with NFS score was moderate (r=0.394), and with AST/ALT ratio was weak (r = 0.201). Conclusion: Noninvasive markers, FIB4 and NFS score demonstrate a dependable ability to diagnose and rule out liver fibrosis, which proves to be an economical approach in management of patients with NAFLD. [ABSTRACT FROM AUTHOR]

Background Tinea corporis and Tinea cruris is one of the chief infection seen in dermatology clinics affecting every age and gender. The rapidly rising prevalence of superficial fungal infection in our population warrants mycological analysis to establish any change in the causative dermatophytic specie responsible for ticking up the number of the cases. Objective To isolate and identify the fungal species in patients of recalcitrant tinea corporis and/or tinea cruris attending tertiary care hospital in Karachi. Methods This Cross-sectional study was conducted in the Outpatient Department of Dermatology, Dow University Hospital, Karachi, Pakistan from 11th April 2022 till 10th October 2022. It comprised of 60 patients who had either received one complete course of oral antifungal treatment and had responded poorly to the therapy (identified on the basis of clinical response) and had a recurrence of disease after cure. The skin scrapings were collected from these patients and then microscopy and cultures were performed. Results Out was 60 patients of Recalcitrant Tinea Corporis and/or T. cruris KOH mount was positive in 43 (71.6%) patients and the culture isolated and identified the causative species in 53 (88.3%) patients. T. Tonsurans account for about 33.3% of the cases followed by T. Mentagrophytes accounting for 15% of the patients. In 11.6 % of the patients isolated specie was T. Rubrum. Conclusion Rise in the number of recalcitrant dermatophytosis could possibly due to change in the species causing dermatophytosis. Mycological analysis can help in identifying such species and facilitate in the treatment of these patients. [ABSTRACT FROM AUTHOR]

Eccrine Spiradenoma (ES) is an uncommon tumor of eccrine sweat gland. It usually presents as a solitary, painful nodule located over trunk and proximal limbs. Multiple ES is a rare phenomenon, comprising less than 2% of all cases. We report a case of middle-aged female presented with multiple, painless tumors of varying morphology located in linear and zosteriform distribution diagnosed as ES. Prompt diagnosis of ES is pivotal due to risk of life threatening malignant transformation. This article highlights the rare presentation of ES and a brief review of this disease. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine the frequency of nail changes in Psoriasis Vulgaris patients and to document the patterns of these nail changes in patients reporting to Civil Hospital Karachi (a tertiary care hospital). METHODOLOGY: This cross-sectional study was carried out at Dermatology Department - Civil Hospital Karachi from January 2017 - June 2018. The study included 100 clinically diagnosed cases of Psoriasis Vulgaris of either sex. The patients were enrolled irrespective of age, family history, duration and severity of disease. These patients were either admitted in ward or presented in OPD of Civil hospital Karachi. A detailed dermatological examination of these patients was carried out. The results were recorded in preformed pro-forma. RESULTS: The study concluded that out of a total of 100 patients of Psoriasis Vulgaris, there were 54 (54%) males and 46 (46%) females. 79 (79%) patients had nail changes while remaining 21 (21%) had normal nails. Nail ridging was found in 75 (94.93%), pitting in 70 (88.6%), discoloration in 70 (88.6%), onycholysis in 60 (75.94%), subungual hyperkeratosis in 56 (70.88%) of patients. Other nail findings included paronychia, twenty nail dystrophy, Beau's lines, longitudinal melanonychia, shiny nails and splinter hemorrhages. CONCLUSION: Nail changes are common Psoriasis Vulgaris. Nail ridging, pitting, discoloration being the most common. Other findings included onycholysis, oil drop sign, subungual hyperkeratosis, paronychia, twenty nail dystrophy, beau's lines and splinter hemorrhages. [ABSTRACT FROM AUTHOR]

Objectives To determine the frequency of superficial fungal infections in renal transplant recipients. Methods This cross-sectional study was conducted in the outpatient clinic, Department of Dermatology, Dow University of Health Sciences & Civil Hospital Karachi. Patients of 20-60 year of age undergone renal transplant 3 to 12 months back were enrolled while patients with diabetes were excluded from study. Patients were evaluated for the presence of superficial mycoses. Skin scrapings and nail clippings were collected mycologic evaluation. Results A total of 62 patients were enrolled. The mean age of enrolled patients was 39.9±10.3 years and 37 (59.7%) were male. The mean duration of transplant was 7.6±2.9 months. 23 (37.1%) were on steroids. Fungal infections were documented in 38 (61.3%) patients. Of 38 patients, 19 (50%) had candidiasis. Stratified analysis showed fungal infections to be similar in ≥40 or <40 years of age (63.6% v. 58.6%), female and male (64% vs. 59.5%); duration of transplant <8 or >8 months (63.9% vs. 57.7%) and those who were on steroids (69.6%) or other drugs (62.5%). Conclusion It is concluded from this study that patient's undergone renal transplant has increased frequency of fungal infection. [ABSTRACT FROM AUTHOR]

Treatment of psoriasis and its variants with concomitant hepatitis C virus (HCV) infection is complex. The treatment options are limited because the immunosuppressive drugs used for managing severe psoriasis are mostly associated with end-organ damage particularly hepatotoxicity. On the other hand, Interferon therapy has the potential to exacerbate psoriasis and psoriatic arthropathy. There is emerging data regarding the use of etanercept, a TNFα inhibitor in such cases. Though its cost and availability limits its use; but when combined with Interferon therapy and ribavirin for HCV, it has shown good results. Here, we report a case of 28-year male, suffering from erythrodermic psoriasis with arthropathy and concomitant HCV infection, who was successfully treated with etanercept and pegylated interferon and ribavirin. Pegylated interferon was given for 6 months and etanercept for 8 months. At the end of the therapy, not only the patient's polymervese chain reaction (PCR) for HCV became undetectable, but his erytherodermic state also improved.