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Objective: To compare the effectiveness of Methotrexate (MTX) versus Cyclosporine (CyA) in the patients of moderate to severe atopic dermatitis (AD) Study Design: Systematic review and Meta-analysis. Methodology: After formulating our research team and PICO question rationally, a search strategy and literature search were carried out as per Cochrane guidelines. Full-text articles were retrieved after title and abstract screening per our inclusion criteria. The whole search process was documented in the form of a PRISMA flow chart. Team members made and filed data extraction sheets, and qualitative data synthesis was performed. Afterwards, a meta-analysis was carried out, involving a total of 03 randomized controlled trials. Revman was used to process the continuous and dichotomous data collected for our outcomes. RoB 2 was used to assess the risk of bias in the included studies. Grade pro-GDT was used to summarize the findings in the table. Results: Pooled results from 3 RCTs showed that CyA in a 2.5mg/kg dose is better than MTX @0.4 mg/kg/week at 12 weeks in AD. At follow-up, MTX maintains better disease control, i.e., until 24 weeks post-treatment. MTX has a better safety profile than CyA. Conclusion: MTX and CyA are both effective drugs for moderate to severe AD, but they have their pros and cons.

OBJECTIVES To determine the accuracy of the plain chest radiograph in diagnosing interstitial lung diseases (ILDs), keeping a high-resolution CT scan (HRCT) as the gold standard. METHODOLOGY A cross-sectional study was conducted. A total of 75 patients who visited the Department of Radiology department over two years were assessed by prospective analysis of their radiology reports. All the HRCTs and Chest X-ray images were reviewed. Data collected was recorded on a specially designed proforma and entered into Microsoft Excel and SPSS (Version 22.0. IBM Corp., Armonk, NY). Patients with a history of acute exacerbation of symptoms were excluded. RESULTS The median age of the patients was 59 years, with SD 12.2. Chest radiographs detected interstitial lung disease (ILD) in 42/75 (56%).). The chest radiograph’s sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV) were 76%, 84%, 86.3% and 76.7%. A plain chest X-ray's positive likelihood ratio (LR+) was 4.75, while the negative likelihood ratio (LR-) was 0.28. The overall accuracy of CXR was calculated as 78.6%. CONCLUSION Our study concluded that chest X-ray is the ideal initial investigation for diagnosing Interstitial lung disease (ILDS) with an accuracy of 78.6% compared to HRCT.

Objective: To compare the efficacy of Tazarotene 0.1% cream versus Clindamycin 1% gel in treating acne vulgaris. Study Design: Quasi-experimental study. Place and Duration of the Study: Dermatology Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2018. Methodology: One hundred and fifty-four patients of both genders who had moderate acne vulgaris for more than four weeks were divided into two Groups. In both Groups, patients applied one-fourth fingertip unit of Tazarotene 0.1% cream in the evening once daily and Clindamycin 1% gel over the affected area in the morning once daily for 12 weeks. The Global Acne Grading System Score (GAGS score) was used for severity and efficacy assessment. Results: The majority of the patients belonged to 13-25 years of age, i.e., 61(79.2%) and 54(70.1%) in Group-A (Tazarotene 0.1% cream) and Group-B (Clindamycin 1% gel), respectively. The efficacy of topical Tazarotene cream (0.1%) was better than topical Clindamycin 1% gel, and the difference was statistically significant with a p-value less than 0.01. GAGS score

Background: Polygamy stays one of the key themes in a different social order. It is through social practices, convictions and the people’s decisions that individuals choose to be focused on polygamy ways of life. Objective: To highlight the prevalence and associated factors of polygamous marriages among men in Pakistan. Methods: The current study analyzes the secondary data of PDHS (Pakistan Demographic & Health Survey). This survey was done in Pakistan from November-2017 to April-2018. The study selected cases of 3145 men, which were married once or more than once and other factors from obtained data to find association. Statistical software SPSS version 22 was used for data analysis. Results: Data were retrieved from 3145 men but a complete analysis was done on 3070 men (remaining were excluded due to missing data issues). The average age among men was 32 ± 8.6 years. Majority belonged to rural area (55.5%), with high standard education (55.4%), high wealth status (55.6%), and desire for more children (53. 3%), had child mortality issue (52.2%) and had their workplace away from not close to home (52.2%). Out of 3070 men, 51.8% were polygamous. On multivariate analysis, age, residence, education, wealth, desire for more children, child mortality issue and work status were found to be independent predictors of polygamy. Conclusion: Using the PDHS data, we have found that the prevalence of polygamy was 51.8%. However, different socio-demographic factors affecting it showed significance like wealth index, husband work away & husband desire for more children positively contributing polygamous marriages in Pakistani society.

Objective: To compare the efficacy of oral fluconazole and oral itraconazole in the treatment of Pityriasis versicolor. Study Design: Comparative prospective study. Methodology: Total 72 patients of both genders with Pityriasis versicolor were included. Patients were randomly allocated into two treatment groups with 36 patients in each group: group A and group B by lottery method. Patients in group A received Cap Fluconazole 150 mg bi- weekly for two consecutive weeks while those in group B received two doses of 400 mg of itraconazole once weekly for two weeks. Patients were asked to follow-up after 4 weeks skin scrapings for microscopy using 10% KOH mount was done at follow-up. Efficacy was assessed in terms of negative fungal hyphae on microscopy. Results: In this study, age ranged from 18 to 40 years with mean age of 33.52 ± 4.12 years in group A, whereas 35.055 ± 4.18 years in group B. Mean duration of disease was 4.66 ± 1.51 months in group A and 5.27 ± 1.70 months in group B. Efficacy was seen in 77.8% of group A patients as compared to 50% in group B patients (p=0.014). Conclusion: Oral Fluconazole two doses of 150 mg/week (total 300mg/week) for two consecutive weeks was found more effective than oral itraconazole.

Objective: To determine the correlation between glycosylated hemoglobin (HBA1c) and mean platelet volume (MPV) among the patients suffering from type II diabetes mellitus. Study Design: Correlational study. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jun 2018 to Dec 2018. Methodology: A total of two hundred patients with type II diabetes mellitus reporting for the routine follow-up were recruited. They were divided into two groups on the basis of HBA1c levels. Group A had patients with HBA1c level 7%. Mean platelet volume and routine socio-demographic factors were measured and compared in both the groups. Results: Mean duration of diabetes among the patients was 4.28 ± 5.128 years. A total of 163 (81.5%) patients were using the oral hypoglycemic while 37 (18.5%) were on the insulin. Mean platelet volume of patients in group A was 8.16 ± 0.39 while mean platelet volume of patients in group B was 9.34 ± 0.81. Strong correlation of mean platelet volume and glycosylated hemoglobin among the patients in this study (p-value

Objective: To compare the frequency of success of intralesional vitamin D3 versus cryotherapy for management of patients with plantar warts. Study Design: Quasi experimental study. Place and Duration of Study: Department of Dermatology, Pak Emirates Military Hospital, Rawalpindi, from Aug 2016 to Feb 2017. Methodology: Total 60 patients, fulfilling the selection criteria, were included in the study. The patients were randomly divided in two groups by using lottery method. In group 1, Vitamin D3 was injected into the base of the warts after local anaesthetic agent, prilocaine. In group 2, cryotherapy was done by using a high-intensity regimen of one session every two weeks till 6 weeks. All patients were followed-up in Out-Patient Department (OPD) for 13 weeks. After 13 weeks, condition of warts was assessed. In case of complete resolution of warts, the success was labeled. Results: In this study success rate of intralesional D3 was 63.3% and for cryotherapy success rate was 43.3% (p-value=0.121). Stratification of age and gender did not show any statistically significant difference between success rates of both treatment modalities. However patients with history of shorter duration ranging in between 11-15 days showed significant higher success rate for intralesional vitamin-D3 as compared to cryotherapy. Conclusion: Frequency of success of intralesional vitamin-D3 was more than that of cryotherapy for treating planter warts.

Objective: To compare the efficacy of intralesional purified protein derivative (PPD) with conventional cryotherapy in the treatment of cutaneous warts. Study Design: Quasi experimental study. Place and Duration of Study: Dermatology Department, Pak Emirates Military Hospital (PEMH) Rawalpindi, from Jul 2017 to Jan 2018. Methodology: Total number of 60 patients were included in the study through Out Patient Department OPD. All patients were randomly divided in 2 groups by lottery method. Group A patients were given intra-lesional PPD (0.1ml in a single wart or targeting the largest wart in case of multiple warts, procedure was repeated fortnightly) while Group B patients were given cryotherapy with liquid nitrogen (2 freeze thaw cycles 20 sec duration each fortnightly). All patients were followed up after the end of treatment (maximum 6 sessions i.e. 3 months or complete clearance of wart whichever is earlier) and assessment of treatment efficacy was based on the response which was noted after 3 months of treatment. The response was categorized as excellent (no visible lesion), good (50-99% improvement), intermediate (

Objective: Comparison of efficacy of combination comprising 2% ketoconazole solution wash plus topical 1% clotrimazole versus topical 1% clotrimazole alone in management of patients with Pityriasis versicolor. Study Design: Randomized controlled trial. Place and Duration of Study: Dermatology department, Pak Emirates Military Hospital Rawalpindi, from Oct 2016 to Apr 2017. Material and Methods: Sixty patients of Pityriasis versicolor, both male and female were included in study. Diagnosis of Pityriasis versicolor was made clinically and confirmed microscopically by examining skin scrapings for fungal hyphae. Patients with concomitant systemic illnesses or those who had received anti-fungal in last three months were excluded from study. Random number tables were used to allocate patients to the two treatment groups. Group A received 2% ketoconazole shampoo twice per week for four weeks plus topical 1% clotrimazole twice daily application for 2 weeks. Group B received only topical therapy with 1% clotrimazole cream applied twice daily for 2 weeks. Assessment of treatment efficacy was done by clinical examination of patient and microscopy of skin scrapping for fungal hyphaedone at baseline and at end of study (4 weeks of treatment). A negative clinical examination and negative skin scrapping for fungal hyphae was considered effective therapeutic response. Results: In group A, the mean age of patients was 29.76 ± 8.89 years and in group B was 27.67 ± 10.46 years. Efficacy in group A was observed in 22 (73.33%) patients while in group B in 14 (46.67%) patients. Conclusion: Combination of 2% ketoconazole solution wash plus topical 1% clotrimazole was found more effective in treatment of patients with Pityriasis versicolor as compared totopical 1% clotrimazole alone.

We have presented here a Dental anomalies, hypodontia/oligodontia and microdontia in a family which reported to us at Armed Forces Institute of Dentistry Rawalpindi. A father along with his two sons presented to us with complaints of small sized dentition and gaps between teeth. On examination it was found that all three of them had concomitantly occurring hypodontia and microdontia which had functional and esthetic implications. It was then planned to adopt multidisciplinary approach to treat the patients involving orthodontics, restorative dentistry and prosthodontics.