Experimental Study on Cementless PET Mortar with Marble Powder and Iron Slag as an Aggregate.

There has been an increase in plastic production during the past decades, yet the recycling of plastic remains relatively low. Incorporating plastic in concrete can mitigate environmental pollution. The use of waste polyethylene terephthalate (PET) bottles as an aggregate weakens properties of concrete. An alternative is to use PET bottles as a binder in the mortar. The PET binder mixed with sand results in weak mortar. Marble and iron slag can enhance PET mortar properties by preventing alkali reactions. This study examines the mechanical and durability properties of PET mortar with different mixes. The mixes were prepared as plastic and marble (PM); plastic and iron slag (PI); plastic, sand, and marble (PSM); plastic, iron slag, and marble (PIM); and plastic, sand, and iron slag (PSI). PM with 30-45% plastic content had increased compressive and flexural strength up to 35.73% and 20.21%, respectively. PI with 30-35% plastic content showed strength improvements up to 29.19% and 5.02%, respectively. However, at 45% plastic content, strength decreased by 8.8% and 27.90%. PSM, PIM, and PSI specimens had nearly double the strength of ordinary Portland cement (OPC) mortar. The durability of PET mortar in chemical solutions, mainly 5% HCl and 20% NaOH, indicate that mass decreased after 3, 7, and 28 days. All specimens showed good resistance to HCl and NaCl solutions compared to OPC mortar. However, its resistance to NaOH is low compared to OPC mortar. PET mortar without cement showed higher strength and durability than cement mortar, making it suitable for paver tiles, drainage systems, and roads.

Quality of Life Index in Patients with Vitiligo.

OBJECTIVE: To ascertain the quality of life (QoL) impairment among the Pakistani population with vitiligo and to determine the relationship between sociodemographic and clinical characteristics. STUDY DESIGN: Cross-sectional study. Place and Duration of the Study: Dermatology Outpatients at the Aga Khan University in collaboration with outpatients of seven tertiary care hospitals of Sindh, Punjab, KPK, Balochistan, and AJK to collect data from March 2015 to April 2019. METHODOLOGY: All clinically diagnosed patients of vitiligo, who signed consent and assent forms, were included in the study. A validated 25-item, QoL scale for vitiligo was used. Socio-economic status of the patients, clinical assessment of the disease and patients' engagement in social and domestic lives was noted. RESULTS: Five hundred and seventy-three patients were enrolled in the study, having mean age 29.8 ± 16.2 years. In 306 (53.4%) males and 267 (46.65%) females; 21.8% were below 18 years. Mean vitiligo QoL index was 38.4 ± 11.8. Patients of vitiligo with disease duration 5-10 years, those affected on exposed parts, more than five body sites, rapidly progressing disease and of female gender had a higher impairment of quality of life. These scores were found significantly higher as compared to other levels of these parameters (p<0.05). CONCLUSION: Patients with vitiligo experience low self-esteem. The disease adversely affects their quality of life. The authors recommend the use of disease-specific instruments to assess the quality of life which enables the treating physician to devise best possible management plan individually. KEY WORDS: Vitiligo, Quality of life, Pakistan, Vitiligo life quality index.

Impact of acne on quality of life in young Pakistani adults and its relationship with severity: A multicenter study.

OBJECTIVES: The current study aimed to determine the effect of acne vulgaris on quality of life of young adults and to assess the correlation between acne severity and impairment of quality of life (QOLI). METHODS: In this multi-center cross-sectional study, 163 young adults with acne vulgaris were assessed for severity and quality of life impairment between December 2016 and May 2017 at three tertiary care hospitals. Cardiff Acne Disability Index (CADI) was used to assess the quality of life while the severity of acne measured by Global Acne Grading System (GAGS). Data were collected on standardized forms, with CADI, GAGS scores, and sociodemographic data and analyzed using SPSS version 9. The quantitative variables were presented as means, median and qualitative variables expressed as frequency and percentages. P-value ≤0.05 was considered as statistically significant. RESULTS: Out of 163 patients enrolled in this study, the mean age was 21.6 ± 4.9 years and 124 were females and 39 males. In mild QOLI, 56 (87.5%) cases were affected with mild, 11 (13.4%) with moderate and 1 (1.5%) case had severe acne. While, in moderate QOLI, 8(12.5%) cases were of mild, 60 (73.2%) were moderate and 6 (35.3%) cases affected with severe acne. The severe impairment of QOL noted in 11 (13.4%) moderate and 10 (58.8%) severe acne cases. The relationship between sex was statistically significant, (P<0.001). The result showed significant correlation between severity of acne vulgaris and the quality of life impairment of these patients (P<0.001). CONCLUSION: This study showed significant correlation between acne vulgaris and quality of life impairment. Cardiff acne disability index has proven to be a reliable tool to assess the quality of life. It is recommended to be used routinely in dermatology clinics to provide tailored treatment to individuals because mild disease may be disproportionately distressing for patients.

Analytical study to find the impacts of using a mobile phone on driver's inattentions while driving - A case study of Lahore.

The road traffic injuries are one of the leading cause of death in children and young adults according to the World Health Organization (WHO). The risk of a crash increases approximately four times for drivers using mobile phones during driving. This study investigates the importance of different factors affecting the driver's choice to use mobile phones for conversation during driving in Lahore, Pakistan. A questionnaire survey was conducted to check the tendency of mobile phone usage during driving from different locations of the city. Participants were asked to indicate frequency, risk, importance and emotionality of ten different conversations. A Structural Equation Model (SEM), similar to a previous study, conducted in Beijing, was developed for the frequency of calling and texting during driving with perceived risk of calling and texting, perceived importance and emotionality as predictors. The frequency of different conversations shows that perceived importance of the call mainly influences the driver's choice to make a call during driving in Lahore. The result of the model show that perceived risk has a significant negative effect on driver's decision to call or text in Lahore, similarly to Beijing. The results also indicates that drivers prefer calling on mobile phones in comparison to texting during driving in Lahore.

Prevalence of Clinical Spectrum of Cutaneous Adverse Drug Reactions in Patients Presenting at a Tertiary Care Hospital in Pakistan.

INTRODUCTION: Cutaneous adverse drug reactions (CADRs) are the most common adverse drug reactions reported in the literature. CADRs have resulted in disabling infirmities during hospitalization and complications following outdoor drug therapy. The pattern of CADRs and the responsible drugs usually changes with the introduction of newer drugs and evolving clinical practices. Moreover, several international studies showed variable prevalence, emphasizing the need for local data in light of different socioeconomic and demographic practices. Therefore, the purpose of this study is to evaluate the prevalence of adverse cutaneous drug reactions and identify the clinical spectrum and any potential risk factors. METHODOLOGY: The current study is a descriptive cross-sectional study conducted at Aga Khan University Hospital, Pakistan. One hundred ninety-three patients who met the study inclusion criteria were included. Data were collected from patients on a proforma after taking informed consent. Quantitative data were presented as simple descriptive statistics giving mean and standard deviation, while qualitative variables were presented as frequency and percentages. Effect modifiers were controlled through stratification to highlight the effect of these on the outcome variable. The post-stratification chi-square test was applied and the p-value of ≤0.05 was statistically significant. RESULTS: A total of 193 patients who had cutaneous adverse drug reactions were included in the study. The mean age in this study was 47.78±8.33 years. One hundred eight (56%) were male and 85 (44%) were female. Out of 193 patients, 135 (69.9%), 50 (25.9%), 24 (12.4%), 12 (6.2%), 20 (10.4%), 11 (5.7%) and six (3.1%) had maculopapular rash, acneiform eruptions, Stevens-Johnson syndrome, erythema multiform, urticaria, fixed drug eruptions and toxic epidermal necrolysis, respectively. CONCLUSION: CADRs are a common clinical presentation and awareness and knowledge about their diagnosis and prevention is important. It can be assumed that in our local setup, the clinical trends and medications causing ADRs are strikingly similar to those found in other countries. Physicians commonly come across these cases and they should be well aware of the clinical spectrum of skin reactions to enable early diagnosis and management.

Bilateral Systematised Epidermolytic Epidermal Nevus: A case report.

Verrucous epidermal nevi (VEN) are benign congenital hamartomas consisting of keratinocytes. Histological examination mostly exhibits hyperkeratosis, acanthosis, papillomatosis and, rarely, the features of epidermolytic hyperkeratosis (EHK). We report a case of a 6-year-old boy who presented at Aga Khan University Hospital, Karachi, Pakistan with bilaterally symmetrical linear epidermal nevi following Blaschko's lines and showing epidermolytic hyperkeratosis on histology. The patient was treated with topical keratolytics and emolients which led to considerable improvement. To the best of the authors' knowledge, this is the first report of VEN from Pakistan.

Lepra reactions: A study of 130 cases from Pakistan.

OBJECTIVE: To determine the occurrence and characteristics of lepra reactions in leprosy patients. METHODS: The retrospective study was conducted at the Marie Adelaide Leprosy Centre, Karachi, and comprised data of patients admitted between January 1, 2013, and December 31, 2015, for the management of lepra reactions. Data was noted on a detailed proforma and was analysed using Microsoft Excel and applying chi-square test. RESULTS: Of the 130 cases, 95(73%) were males and 35(27%) were females. Mean age at onset of the first episode was 39±14 years. Borderline lepromatous was the most common classification 76(58%), with 40(53%) of them having type 1 reaction as the first episode and 36(47%) having a type 2 reaction Risk factors associated with recurrence were skin lesions, fever, lymphadenopathy and type of reaction (p<0.05). CONCLUSION: Healthcare providers need to be aware of the clinical manifestations of lepra reactions in order to diagnose them early.

Cyclosporin in dermatology: A practical compendium.

Cyclosporine A (CYA) belongs to calcineurin inhibitor family, which has the ability to selectively suppress T cells. Owing to its immune-modulatory effects, it had been in use for graft vs host diseases and organ transplant rejection for many years, but in dermatology, it was first approved for use in 1997 in the treatment of psoriasis. Other off-label indications for skin diseases include atopic dermatitis, chronic spontaneous urticaria, lichen planus, pyoderma gangrenosum, alopecia areata, granuloma annulare, and several others. A thorough search of Medline-PubMed database, Google Scholar, and Uptodate was performed for evidence-based and peer-reviewed information. We have summarized the use of cyclosporine in dermatological diseases with respect to its, dosage, safety considerations, and monitoring guidelines. Furthermore, brief overview of its pharmacology, drug interactions, use in pregnancy, and lactation has been discussed. Despite of its common adverse effects like nephrotoxicity and hypertension, cyclosporine offers good safety profile when used in skin diseases. Decision to start cyclosporine therapy is individualized and it should be based on analysis of risk vs benefit. Nevertheless, CYA is preferred over other immunosuppressants in dermatology because of early therapeutic response and less myelosupression. This article offers concise but detailed summary of this beneficial immune-suppressive agent in skin diseases.

COVID-19 Pandemic & Skin Care Guidelines for Health Care Professionals.

The Novel corona virus is bringing multiple challenges for health care professionals. Skin is the biggest organ and the first line of defense against different infections and external factors. Being the front line warriors, health care professionals are susceptible to various skin conditions due to prolonged use of personal protective equipment. These adverse skin conditions are redness, irritation, itching, contact dermatitis, and aggravation of underlying skin conditions like seborrheic dermatitis and acne vulgaris. In the current global situation, the potential incidence of such adverse dermatological effects does not in any manner cause the HCPs to deviate from the strict specific precautionary hygiene rules. These skin problems are manageable with the few precautionary measures. This article explores the different skin conditions that result from personal hygiene measures and usage of protective gear and will suggest some practical advice about how to manage and protect from these different adverse skin conditions.

Frequency of depression and anxiety among patients with chronic spontaneous urticaria visiting a tertiary care hospital in Karachi, Pakistan.

OBJECTIVE: To determine the frequency of anxiety and depression among chronic spontaneous urticarial patients presenting at a tertiary care hospital. METHODS: The prospective, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from February to August 2015, and comprised patients diagnosed with chronic spontaneous urticaria at the dermatology clinic. All the participants were assessed for anxiety and depression using Aga Khan University-Anxiety Depression Scale. Data was collected in face-to-face interview using a structured questionnaire. The association of the condition with different characteristics were calculated after stratification for age, gender, occupation and monthly income. SPSS 19 was used for data analysis.. RESULTS: Of the 146 study participants, 84(57.5%) were males and 62(42.5%) were females. The overall mean age was 39±15.6 years. Of the total, 39(26.7%) had depression and anxiety. Depression and anxiety were more frequent among patients with a positive family history of mental disorders (p=0.02). CONCLUSION: Anxiety and depression were found to be considerably common among chronic spontaneous urticaria patients, with patients having a positive family history for mental illnesses particularly vulnerable.

Factors associated with onychomycosis in nail psoriasis: a multicenter study in Pakistan.

BACKGROUND: Treatment of psoriatic nail disease is challenging, and dystrophic psoriatic nails can get secondarily infected with fungi. METHODS: This 2-year, matched case-control study was conducted at three tertiary care centers of Karachi, Pakistan. Data were collected from patients with nail psoriasis as cases with age- and gender-matched controls. A detailed questionnaire was filled for all study participants. Nail Psoriasis Severity Index (NAPSI) scoring tool was used to assess dystrophy. Fungal infection was inferred by nail clippings for fungal hyphae and culture. RESULTS: Among 477 participants, 159 cases and 318 controls completed the study. Their mean age was 44 years, and one-third were female. Fungal culture positivity was statistically significant in cases as compared to the control group (P < 0.001). The most frequent species identified was Candida parapsilosis in both cases and controls. Body mass index, NAPSI scoring, socioeconomic status, elevated diastolic blood pressure, smoking status psoriasis among first-degree relatives, and longstanding disease of more than 10 years were significant factors in univariable analysis. Multivariable logistic regression identified independent factors like low to middle socioeconomic status, history of psoriasis in first-degree relative, current smoker, and obesity. CONCLUSION: We found nearly one-third of the psoriatic patients with nail involvement having concomitant fungal infection. We emphasize that nail clipping for fungal smear and culture should be advised to those patients with coexisting factors found significant in our study results. This opinion can be incorporated in psoriasis management guidelines for improving treatment of psoriatic nails.

Neonatal Purpura Fulminans, a rare genetic disorder due to protein C deficiency: A case report.

Neonatal Purpura Fulminans is a rare and fatal disorder associated with perivascular haemorrhage and disseminated intravascular coagulation. Early clinical recognition, timely investigation and treatment is utmost important. A 6 days old baby boy was brought to emergency with blackish ulcers all over the body. Initially these were over the feet and scalp but later appeared on the abdomen. On examination, child was vitally stable, mildly icteric and had multiple erythematous large bullous blackish lesions on scalp, lower abdomen, perineum, back and soles. Neonatal reflexes and systemic examination was normal. Laboratory investigations showed normal CBC, PT/APTT and Protein S level while Protein C and Antithrombin III levels were low. Neonatal Purpura Fulminans is a life threatening condition and family screening is also mandatory for early recognition of disease in the siblings.

Clinical types of tinea capitis and species identification in children: an experience from tertiary care centres of Karachi, Pakistan.

OBJECTIVE: To study the clinical types of Tinea Capitis and identify species in children reporting to two tertiary care centres of Karachi, Pakistan. METHODS: The descriptive, cross-sectional study was conducted at the Dermatology Outpatients' Department, PNS Shifa Hospital and the Institute of Skin Diseases, Karachi, from January 1, 2008 to December 31, 2009. It comprised 202 children with clinical diagnosis of tinea capitis, confirmed by skin scrapings, showing fungal hyphae and spores in 10% potassium hydroxide on direct microscopy. Wood's lamp examination was carried out and the scrapings were cultured on Sabouraud's agar. A detailed dermatological examination was performed for evidence of fungal infection elsewhere in the body. SPSS 19 was used for data analysis. RESULTS: Male-to-female ratio was 1.1:1 and age ranged from 1 to 14 years.The commonest clinical type gray patch was observed in 71 (35.1%) of the patients, black dot in 63 (31.2%), kerion in 50 (24.8%), favus in 10 (5.0%), diffuse pustular in 6 (3.0%), and diffuse scale in 2 (1.0%) patients. The most frequent species grown on culture was Trichophyton (T). Soudanense, followed by T. Tonsurans, T. Schoenleinii, and T. Mentagrophytes respectively. CONCLUSION: Most of the patients of Tinea capitis presented with gray patch and black dot variety. The most common species identified by culture was Trichophyton Soudanense. Disease was equal in both gender and predominantly affected the population belonging to low and middle socioeconomic class.

Multiple autoimmune syndromes associated with psoriasis: a rare clinical presentation.

Autoimmune diseases are known to have association with each other but it is very rare to see multiple autoimmune diseases in one patient. The combination of at least three autoimmune diseases in the same patient is referred to as multiple autoimmune syndrome. The case we are reporting features multiple autoimmune syndrome with five different conditions. The patient had type 1 diabetes mellitus, autoimmune hemolytic anemia, systemic lupus erythematosus, vitiligo, and psoriasis. Psoriasis has rarely been reported previously under the spectrum of autoimmune syndrome. Although the relationship of autoimmune conditions with each other has been explored in the past, this case adds yet another dimension to the unique evolution of autoimmune pathologies. The patient presented with a combination of five autoimmune diseases, which makes it consistent type three multiple autoimmune syndromes with the addition of psoriasis. The current case is unique in this aspect that the combination of these five autoimmune disorders has never been reported in the past.

Cryptococcal meningitis with secondary cutaneous involvement in an immunocompetent host.

Cryptococcosis is a potentially fatal fungal disease caused by variants of Cryptococcus neoformans species.  The respiratory tract is the usual portal of entry, with a peculiar predilection to invade the central nervous system.  The skin can be secondarily involved in disseminated infection or be exceptionally involved as primary cutaneous infection by inoculation.  The disease is mostly seen in immunodeficiency states.  The diagnosis is frequently unsuspected in immunocompetent patients. We report a case of disseminated cryptococcal meningitis in an immunocompetent young adult. The cutaneous eruption prompted the accurate diagnosis.  The patient, a 20-year-old female, had fever, cough, headache and intractable vomiting for the past two months and was being managed as a case of tuberculous meningitis. Two weeks after starting antituberculous treatment she developed umbilicated papules on the head and neck region. Necessary laboratory workup identified C. neoformans in cerebrospinal fluid (CSF) and skin specimens.  The titers of cryptococcal antigen were measured in CSF and serum for diagnostic and prognostic purposes.  Anti-fungal treatment resulted in regression of the cutaneous lesions and resolution of systemic complaints. The case highlights the need for high degree of suspicion, especially in healthy young adults, in the diagnosis of cryptococcosis. The cutaneous eruptions can be the first manifestation or a diagnostic clue of enormous significance.

Frequency and clinical variants of specific dermatoses in third trimester of pregnancy: a study from a tertiary care centre.

OBJECTIVE: To determine the frequency of patients with dermatoses in the third trimester of pregnancy and to identify various clinical types of dermatoses in the third trimester. METHODS: The study was carried out at the Department of Dermatology and the Department of Gynaecology & Obstetrics, PNS Shifa Hospital, Karachi, from January 2 to July 1, 2008. Two hundred pregnant women in their third trimester were included in the study. The diagnosis was based on history, clinical examination and relevant investigations. Patients with physiological dermatoses and dermatoses which flare up during pregnancy were excluded. A comprehensive pro-forma was used to evaluate different dermatoses. Skin biopsy for histopathology was also done where necessary. RESULTS: The age of the study population ranged from 17 to 36 years (mean = 27.3 +/- 4.86). Five (2.5%) patients had prurigo of pregnancy, 4 (2%) had dermatoses associated with Intrahepatic Cholestasis of Pregnancy (ICP), 3 (1.5%) patients had polymorphic eruption of pregnancy, and 1 (0.5%) patient had pruritic folliculitis of pregnancy. No case of pemphigoidgestationis was observed. CONCLUSION: In the study, 6.5% patients presented with specific dermatoses. Prurigo of pregnancy was the commonest condition. Polymorphic eruption of pregnancy was more common in primigravida, while dermatoses with intrahepatic cholestasis was seen more often in multigravida.

Efficacy of itraconazole versus fluconazole in vaginal candidiasis.

OBJECTIVE: To compare the efficacy of fluconazole 150mg single dose and itraconazole 200mg twice for one day in the treatment of acute vulvovaginal candidiasis. METHODS: The study was carried out at the Department of Dermatology, PNS Shifa Hospital, Karachi, from March, 2008 to February 2009 and comprised 60 women with clinical and mycological diagnosis of vaginal candidiasis. Diagnosis was based on history, clinical examination and relevant investigations. The women were divided into two equal groups. After initial assessment, Group 1 was treated with capsule fluconazole 150mg stat, and Group 2 with capsule itraconazole 200mg twice for one day. They were assessed clinically for cure and relapse on day 7 and 21 respectively. All findings were recorded in the proforma. Data was analysed using SPSS 12. RESULTS: The overall clinical evaluation showed 70% (n = 21) cure rate with itraconazole and 50% (n = 15) with fluconazole. In Group-1, 7 (23.33%) and in Group-2 8 (26.6%) showed some improvement, while 2 (6.66%) in Group 1, and 7 (23%) in Group 2 failed to respond. Relapse was observed in 9 (28.5%) and 16 (53%) of the cured cases in Group 1 and Group 2 respectively. CONCLUSION: Itraconazole was found to be more effective in the treatment of vulvovaginal candidiasis compared to fluconazole with high cure and low relapse rate.