Objectives:To find out the frequency of Alzheimer’s and Vascular dementia in the elderly patients.Methods:This cross sectional descriptive study was conducted in Department of Medicine, Ziauddin Hospital Karachi from 1st October 2013 to 31st March 2014. Patients with symptoms of dementia for more than 6 months duration, and Mini Mental State Examination score <24 were included in this study. Patients who fell in category of dementia were assessed for duration of symptoms. Patients underwent CT scan of brain. Patients with generalized atrophy of brain on CT scanning of brain were labeled as Alzheimer’s dementia, while patients with ischemic or hemorrhagic stroke on CT scan of brain were labeled as vascular dementia.Results:Four hundred twenty two patients were included in this study. There were 232 (54.98 %) male and 190 (45.02 %) were female. The mean age ± SD of the patients was 72.58±5.34 years (95% CI: 72.07 to 73.09), similarly average duration of symptoms was 10.14±2.85 months. About 18.96% of patients were illiterate, 32.23% were matric, 28.44% were intermediate and 20.33% were graduate and post graduate. Hypertension and diabetes were the commonest co-morbid i.e. 81.3% and 73.7%, hyperlipedimia and smoking were 38.2% and 45% respectively. Frequency of Alzheimer’s disease and vascular dementia in the elderly was observed in 3.79% (16/422) and 2.61% (11/422) cases.Conclusion:A good number of patients, 27 out of 422, in this hospital based study were suffering from Alzheimer’s disease and vascular dementia. Early detection and prompt treatment can reduce the burden of the disease in our population.

Objectives: Mammary duct ectasia, a benign condition of breast is a diagnostic challenge both for surgeon and histo-pathologist. Duct ectasia is commonly encountered in clinical practice and its histo-pathological spectrum needs to be studied in detail in our patients. Study Design: Descriptive cross sectional study. Setting: Sir Syed College of Medical Sciences Karachi after ethical approval. Period: 24 months from June 2016-June 2018. Material & Methods: Total 104 female patients (>18 years) were included after informed consent. Patients presenting with lump in breast, breast pain, tenderness or nipple discharge were screened by ultrasound breasts or mammography. Pregnant women, patients having high grade fever, hematological abnormalities, coagulopathy, axillary lymphadenopathy, papilloma of nipple, galactocele, lactating mothers and those with past history of malignancy were excluded. Only those cases were included that had diagnosis of duct ectasia on ultrasound breast. Cone excision (Hadfield’s operation) was performed after pre-requisites and histo-pathological findings were documented. Patients were kept admitted under observation for minimum 24 hours and then followed up with histo-pathology report. Results: Amongst 104 cases, mean age was 41+6.35(range=30-50) years. The mean duration of symptoms was11.6+5.76 (range=1-24) months. 72(69%) women were married and 32(30.8%) were unmarried. As per histo-pathology report duct ectasia was found in 102(98%), hyperplasia in 61(58.7%), metaplasia in 41(39.4%) and atypical cells in 2(1.9%) samples. Conclusions: Current study demonstrated final outcome of metaplasia in thirty nine percent cases with initial clinical and sonographic diagnosis of duct ectasia. This suggests the triple technique evaluation (i.e. clinical assessment, ultrasound breast/mammography along with histo-pathological assessment) to identify cases with metaplasia. The high risk cases should be frequently followed with clinical assessment and imaging along with BRCA 1 & 2 gene for timely detection and intervention of breast malignancy.

BACKGROUND: Acne Vulgaris is a frequently seen dermatological condition having physical and psychosocial implications. Current study aims to assess Quality of life (QoL) in acne patients and study the associated risk factors. METHODOLOGY: This descriptive cross sectional study was conducted in 6 months duration at Dept. of Dermatology, Rawal Institute of Health Sciences Islamabad after ethical approval. Total 205 cases of acne (age>12 years) were included. Patients with severe systemic illness and endocrine disease were excluded. Global Acne Grading Scale (GAGS) was used to grade acne as mild, moderate or severe. Quality of life assessed by Cardiff Acne disability index (CADI) with outcome as no impairment, mild impairment, moderate impairment or severe impairment. Data analyzed via SPSS version 17 withChi-square test applied for significance. The p-value <0.05 considered to be statistically significant. RESULTS: Among 205 acne cases (24% males and 76% females), mean age was 25+5.7 (14-36) years. As per GAGS score; mild acne was present in 45.4%, moderate acne(44%), severe acne (8.35%) and very severe acne (2.4%). As per CADI score, there was no impairment in 7.3%, mild impairment (19.5%), moderate impairment (61%) and severe impairment in (12%). The impaired QoL was found to be associated with gender, socioeconomic class, education, acne grade, obesity and use of alternative medicine (p<0.05). CONCLUSION: Acne vulgaris significantly impairs QoL in adolescents to varying degrees. Higher grade of acne, female gender, obesity, illiteracy and poverty are the proposed risk factors for impaired QoL in acne cases. Early identification of acne cases at risk of impaired Qol may be helpful to take QoL measures like counseling and psychological intervention in parallel with medical management. This may improve the social and psychological wellbeing of acne cases.

Objectives: Global COVID-19 epidemic has been therapeutic challenge. Convalescent plasma is observed to improve clinical outcomes. This research aims to study whether convalescent plasma therapy reduces the mortality and duration of hospitalization in moderate to severe Covid. Study Design and Setting: This interventional study was conducted after ethical approval at RIUT COVID-19 center from1stJune-30th Nov 2020. Methodology: Hundred Covid patients included; Total 100 hospitalized adult SARS Cov-2 PCR positive with moderate to severe disease who agreed for convalescent plasma transfusion were included. Fifty in plasma transfusion group and fifty in conventional therapy group. Those with contraindications for plasma transfusion, delayed presentation, indoor stay <5 days were excluded. Convalescent plasma was obtained from donors with prior documented SARS CoV-2 infection meeting donor eligibility criteria. 50 cases received convalescent plasma and50 received conventional therapy. Hospital stay and outcome documented. Results: Amongst 100 Covid cases; 44 females and 56 males; mean age 57.88+11.95 years, 74% had moderate covid and 26% severe. Fifty cases received conventional therapy for Covid and 50 received plasma transfusion. Both groups comparable for gender, age, smoking, obesity, and disease severity. Invasive ventilation administered in 25% and was associated with mortality (p=0.004). Mortality observed in 29 cases; 20(69%) in plasma transfusion group Vs. 09(31%) in conventional therapy group (p=0.015). The hospital stay was comparable between two groups The relative risk ratio was 2.22 with 95% CI (1.12-4.39). Conclusions: There was no therapeutic benefit in Covid patients treated with convalescent plasma as compared to conventional treatment

Objectives: To study the cutaneous manifestations in elderly and their association with gender. Study Design: Cross Sectional study. Setting: Sir Syed Hospital Karachi. Period: Jan 2016 to Jan 2018. Material & Methods: Total 217 geriatric cases (>60 years; both genders) were included from outdoor dermatology clinic. The previous pregnancy, lactation, severe systemic disease and drug induced skin changes were excluded. The association of skin manifestation with gender was analyzed by Chi-square test with significant p<0.05. Results: Among 217 cases, there were 126(58%) females and 91(42%) males. Mean age was 69.3+4.99 years. Wrinkling was seen in 92%, skin laxity in 54.8%, xerosis (43%), dryness (65%), sagging (46%), pigmentation (37%), eczema (25%), sparse hair (21%), skin atrophy (19%), tinea (13%) and LSC (10%). While  herpes zoster, psoriasis, onychomycosis, tinea corporis ,asteotic eczema in 7%. Folliculitis 6%, scabies and bullous pemphigoid seen in 5%, while lichen planus, actinic elastosis, BCC, Prurigo nodularis in 3%. Cellulitis, pediculosis, Seborrheic Dermatitis and contact dermatitis were seen in 2% followed by 1% cases of warts, candidiasis, photodermatosis and SCC seen in our study. Folliculitis (6%) was the most frequent bacterial infection followed by impetigo (0.9%). Herpes zoster (6.5%) was frequent among viral infections followed by warts (0.9%) and HSV-1 (0.9%). Tinea (13.4%) was most frequent fungal infection followed by onychomycosis (7%) and candidiasis (0.9%). Scabies was most common parasitic infection (4.6%) followed by pediculosis (2.3%). Eczema seen in 24.8%. The benign dermatosis, Actinic elastosis was frequent (3.2%), stucco keratosis 4(1.8%), Keratoacanthoma (0.9%). Amongst malignancies, BCC was common (3.2%), followed by SCC (1.4%). 5% Bullous Pemphigoid cases were found. The psychocutaneous disorder included LSC (10%), prurigo nodularis (2.8%) and neurotic excoriation (0.9%). Wrinkling, sagging, dryness of skin, actinic keratosis, actinic elastosis was found to be associated with female gender, however cellulitis, squamous cell carcinoma and asteatotic eczema with male gender. Conclusion: Geriatric population is facing multiple dermatological concerns. Contributory factors being the natural aging process, exposure to UV radiation, pathogens, dryness, humidity, temperature and chemical irritants. Female geriatrics are prone to wrinkling, sagging, dryness of skin and male geriatrics to basal cell carcinoma. There is need to address the skin problems in elderly for better quality of life in geriatrics.