No abstract

Background: Melasma is a very common skin problem that is much more prevalent in women. In our society, it results in many psycho-social implications and eventually leads to an impaired quality of life. Many treatment modalities have been developed for it. However, in recent years resistant forms of melasma have emerged that are unresponsive to the usual first line treatment options. Thus, this study is being conducted to explore new treatment modalities for this disease by using micro-needling with vitamin C and tranexamic acid. Methods: Thirty patients participated in this non-randomized clinical trial including 11 males and 19 females. All patients received Tranexamic acid via micro-needling on right side of the face and Vitamin C on the left side. A total of three biweekly sessions were performed. Patients’ response was evaluated at week 2, 4 and 6 on the basis of Physician Global Assessment, Patient Global Assessment, modified Melasma Area Severity Index and clinical assessment. Paired sample t-tests were used to calculate the difference in the means of two groups at 2, 4 and 6 weeks and p-value of <0.05 was considered significant. Results: After first session, there was more improvement observed with tranexamic acid. At the end of 6 weeks, modified Melasma Area Severity Index, Physician Global Assessment and Patient Global Assessment showed significant improvement with both tranexamic acid and vitamin C. However, the difference between them was not statistically significant (p>0.05). Conclusion: Both Tranexamic acid and Vitamin C are potent therapies for melasma as an adjuvant to micro-needling.

No abstract

Objective: To check the motivational factors behind the usage of skin lightening creams and users’ awareness in our setup by constructing a validated questionnaire. Study Design: Cross-sectional study. Place and Duration of Study: Outpatient Department of Dermatology, Combined Military Hospital Rawalpindi, from Oct to Nov 2020. Methodology: Two fifty patients who were using skin-lightening creams (SLC) were recruited after the informed consent. Questionnaire was made following seven steps as mentioned in AMEE (Association for Medical Education Europe) guide 87. Data was analyzed by SPSS version 21. Reliability was be checked by Cronbach@. Descriptive statistics of responses including frequencies and percentages were calculated. Exploratory factor analysis of questionnaire was made. Results: Skin lightening cream users had age range from 16-56 years, majority 190 (76%) were females. Out of 158 (63.2%) were married, 180 (72%) well educated and 146 (58.4%) had Fitzpatrick skin type 3-5 predominate. Cronbach alpha of our questionnaire was 0.802. The 5-point likert scale was used to record users’ perceptions in the domains i.e., motivational factors, awareness about product and intentions. Majority, 89 (35.6%) used the product on social media recommendation. Out of 201 (80.4%) developed side effects with telangiectasia and skin thinning being the commonest ones. Out of 88 (35.2%) were using other skin whitening practices besides these creams. Conclusion: False perceptions about fairness and lack of user’s awareness govern the skin lightening practices in our society resulting in increased usage and side effects experienced by users. A mass educational awareness program regarding “skin lightening.........

BACKGROUND AND PURPOSE: Third and fourth branchial apparatus anomalies are rare congenital anomalies. The purpose of this study was to investigate imaging features of these lesions on fetal MR imaging in comparison with lymphatic malformations, the major competing differential diagnosis in these cases. MATERIALS AND METHODS:A retrospective review of our institutional fetal MR imaging database between 1997 and 2019 resulted in 4 patients with confirmed third and fourth branchial apparatus anomalies and 14 patients with confirmed lymphatic malformations. The imaging features were reviewed by consensus, and the Fisher exact test was used to evaluate statistically significant differences between these 2 populations.RESULTS: Four cases of third and fourth branchial apparatus anomalies were imaged at 29 weeks 1 day (range, 23 weeks 1 day to 33 weeks 4 days). All 4 cases demonstrated unilateral, unilocular cysts without reduced diffusion or hemorrhage and a medially directed beaked contour that tapered between the spine and airway at the level of the piriform sinus. Compared with 14 cases of fetal lymphatic malformations imaged at 27 weeks 6 days (range, 21 weeks 3 days to 34 weeks 6 days), third and fourth branchial apparatus cysts were significantly more likely to be unilocular (P , .005) and to have a medially beaked contour (P , .005). The combination of features of unilateral, unilocular, and medially beaked contour was observed only in the fetuses with third and fourth branchial apparatus cysts (P , .001). CONCLUSIONS:The presence of a left-sided unilocular cyst with a medially beaked contour tapering at the level of the piriform sinus suggests the diagnosis of third and fourth branchial apparatus anomaly. Accurate diagnosis in the prenatal period allows proper counseling, genetic work-up, and treatment, potentially sparing patients from recurrent infections and associated morbidity.

BackgroundLimited data are available on the efficacy of platelet-rich plasma (PRP) and microneedling versus PRP alone. In this study, we aimed to compare the efficacy of PRP and microneedling with PRP alone in androgenetic alopecia (AGA). MethodologyThis prospective, randomized, interventional study was conducted in Pak-Emirates Military Hospital, Rawalpindi, from September 2020 to December 2020. In total, 60 individuals suffering from AGA of up to Hamilton-Norwood grade 4 were randomly assigned to two groups, namely, PRP+microneedling versus PRP alone. A total of three sessions, each one month apart, were offered. Pre and post-intervention photographs, hair count (/cm 2 ), hair-pull test, and physician's and patient's perception of hair loss were recorded. The data were statistically analyzed. ResultsA greater proportion of patients in the microneedling group achieved a negative hair-pull test and improved perception of hair loss compared to the PRP-alone group (82.1% vs. 51.9% and 88.0% vs. 73.9%, respectively). The percentage increase in mean hair count in the microneedling group (24.53 ± 9.49%) was significantly higher than the increase in the PRP-alone group (17.88 ± 10.15%) (p = 0.011). For grades 2 and 3 hair loss, microneedling+PRP caused a much greater increase in hair count than PRP alone. This difference was less pronounced for Norwood grade 4. No notable side effects were noted in any patient. ConclusionsCombined PRP and microneedling is more efficacious than PRP alone in patients with AGA up to Hamilton-Norwood grade 4.

Objective: To analyze the motivation and psychological well-being to perform duties during the COVID-19 pandemic among the dermatology residents. Study Design: Cross-sectional survey. Place and Duration of Study: Dermatology Department, Combined Military Hospital, Rawalpindi, from Mar to Sep 2020. Methodology: A total of 155 dermatology residents were included in the study. Health care provider motivation scale (HCPMS) was used through online Google Doc due to lockdown. Secondary data was also generated from Google scholar, newspapers, journals, reports and the literature review. Results: We analyzed the impact of COVID-19 on motivation and psychological well-being. The result showed that the COVID-19 pandemic has an adverse effect on motivation due to anxiety (31%), stress (23%) and depression (27%) among dermatology residents. There was statistically significant relationship between decreased motivation and increased stress levels and depression among dermatology residents performing COVID-19 duties (p<0.001). Conclusion: Due to extra duties in the COVID-19 pandemic, the motivation and psychological well-being were severely affected among dermatology residents.

No abstract