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Purpose: Healthcare personnel (HCP) are at high risk of facing violence globally. Their sanctity and respect are threatened by violence in healthcare settings. Mostly, this occurs at the hands of patients and community members. This study explores the reasons for disrespect and violence against HCP by patients and community members in selected communities of two provinces of Pakistan. Design/methodology/approach: A qualitative study design was applied to develop an understanding of the processes that explained the community member's perception of disrespect and violence. A total of 12 focus group discussions (FGDs) with 11 community members on an average in each focus group and eight individual in-depth interviews (IDIs), each lasting for 40--50 min were conducted with community members. Data were analyzed thematically and guided by phenomenology. Findings: The study found that community members perceived HCP as "angels on duty." However they justified the anger of offenders as a result of shortcomings on the part of HCP and the healthcare settings. Furthermore, they blamed the chaos and ongoing crisis due to illiteracy and corruption within the society with existent poverty as triggers of violence and disrespect. Community members emphasized the role of media and labeled it as the game changer in building the image of HCP. They further stressed upon building competencies of the HCP and bridging the gap between HCP and communities to enhance respect and decrease violence on HCP. Practical implications Disrespect and violence against HCP can be minimized through improving competencies of HCP. Furthermore, media should play a positive role in safeguarding the rights of HCP and building their image. A holistic approach is suggested whereby all stakeholders should be actively involved in promoting awareness and respect for HCP. Originality/value: Community members' perceptions have been taken into account, which is a unique and novel approach towards building inclusive communities.

Objective: To study the pattern of skin diseases in our population with respect to different age groups, gender and seasonal variations. Study Design: Observational Retrospective study. Setting: Department of Dermatology, Lahore General Hospital, a tertiary care referral hospital situated in second big city of Pakistan i.e Lahore. Period: July 2021 to June 2022. Methods: A total of 65284 patients presenting to skin OPD were studied. Demographic details were noted and diagnosis was made after detailed history, examination and appropriate investigations like scraping or smears. Data was analyzed for various age groups, gender distribution and effect of variables on diagnosis. Results: Out of 65284 patients, 38 %were male & 62% were female. Most of the patients (43%) were in age group of 21-40 years. Scabies was the most prevalent dermatosis and affected 27% of study population. Three most common dermatosis were tinea, scabies and acne. The maximum number of dermatosis was seen in the months of summer. Conclusion: Infectious diseases pose a major burden to skin health of most of the population suffering from dermatological problem. Fungal infections and scabies are treatable but very common diseases contributing in burden of dermatological disorder in population presenting to hospitals. [ABSTRACT FROM AUTHOR]

Modulatory effects of serotonin (5‐Hydroxytryptamine [5‐HT]) have been seen in hepatic, neurological/psychiatric, and gastrointestinal (GI) disorders. Probiotics are live microorganisms that confer health benefits to their host. Recent research has suggested that probiotics can promote serotonin signaling, a crucial pathway in the regulation of mood, cognition, and other physiological processes. Reviewing the literature, we find that peripheral serotonin increases nutrient uptake and storage, regulates the composition of the gut microbiota, and is involved in mediating neuronal disorders. This review explores the mechanisms underlying the probiotic‐mediated increase in serotonin signaling, highlighting the role of gut microbiota in the regulation of serotonin production and the modulation of neurotransmitter receptors. Additionally, this review discusses the potential clinical implications of probiotics as a therapeutic strategy for disorders associated with altered serotonin signaling, such as GI and neurological disorders. Overall, this review demonstrates the potential of probiotics as a promising avenue for the treatment of serotonin‐related disorders and signaling of serotonin. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of Chemical reconstruction of skin scars (CROSS) with 50% TCA peel and Microneedling in acne scars in the treatment of acne scars. Methods This trial was carried out from 15th March to 14th September 2022, at Outpatient Department of Dermatology, Services Hospital, Lahore. Patients of both genders and 18 to 50 years of age, who had grade 2 to 4 acne scars were enrolled. Their acne scars were graded by Goodman's Qualitative Acne Scarring Grading System. Paper lottery method was used to randomly divide them into 2 groups. Group A patients received 50% TCA peel whereas in Group B, patients were treated with microneedling with dermapen. Follow-up was done one month after the last treatment session and the response was recorded. Excellent response was labelled if patient's acne scars reduced by two grades, good response if one grade was reduced and a poor response was no improvement. Efficacy was considered as good or excellent response. Results A total of 84 patients were enrolled. The mean of the ages of patients in group A was 33.21±7.22 years and in group B was 32.12±6.59 years. Majority of the patients 60 (71.43%) were between 18 to 35 years of age. Out of 84 patients, 73 (86.90%) were females and 11 (13.10%) were males with female to male ratio of 6.6:1. Efficacy of Group A (50% TCA peel) was noted in 31 (73.81%) patients while in Group B (microneedling with dermapen) was seen in 39 (92.86%) patients (p-value = 0.019). Conclusion We concluded that microneedling with dermapen was more efficacious in the treatment of post acne facial scars than chemical reconstruction of scars (CROSS) with 50% TCA peel. [ABSTRACT FROM AUTHOR]

Background Lichen planus (LP) is a chronic inflammatory disorder that affects skin and/or mucous membranes. It is a T-cell-mediated inflammatory disorder which causes lipid metabolic aberrations and is associated with increased risk of cardiovascular diseases. Objective To assess the prevalence of dyslipidemia in patients of lichen planus which presents to the Dermatology Department at a tertiary care setting. Methods In this cross sectional survey, 80 cases of lichen planus were included after clinical and histopathological confirmation. Presence or absence of dyslipidemia was confirmed by fasting lipid profile. Patients taking lipid lowering drugs, patients of diabetes, hypothyroidism (TSH >4.2mIU/ml), hypertension or ischemic heart disease, patients with BMI more than 30 kg/m², patients with family history of dyslipidemia and early cardiac death, were excluded. Stratification of dyslipidemia with regards to age, gender and area of involvement was carried out. Results There were 47 (58.8%) males and 33 (41.2%) females. Mean age of the patients was 39.00±11.76 years. Cutaneous lichen planus was seen in 32 (40%) patients, mucosal in 28 (35%) patients and both (cutaneous and mucosal) in 20 (25%) patients. Dyslipidemia was present in 48 (60%) patients. Stratification of dyslipidemia with regard to age and gender was not significant but with regard to mucosal and cutaneous involvement was significant. Conclusion Lichen planus is significantly related to dyslipidemia according to this study. Therefore meticulous screening for dyslipidemia is needed in patients of LP. [ABSTRACT FROM AUTHOR]

Background The location of infraorbital and supraorbital foramina is critically important for avoiding iatrogenic nerve damage during surgery or cosmetic procedures on the mid-face. This study aimed to conduct the morphometric analysis of infra orbital and supraorbital foramina in dry human skulls in Pakistani population. Objective To evaluate precise anatomical position of infraorbital foramina in reference to supraorbital foramina in adult human skulls. Methods Out of 40 skulls, 35 met the criteria of selection. Measurements were taken three times and mean was calculated to increase accuracy. Mean and standard deviations, median, range and mode were calculated and analyzed using SPSS ver. 27.0. Results The mean vertical and horizontal distances of IOF on right side were 43.2±2.5 (SD) mm and 3.7±2.7 (SD) mm respectively. The mean vertical and horizontal distances of IOF on left side were 43.2±2.7 (SD) mm and 3.46±1.8 (SD) mm respectively. Conclusion The study adds information to the literature concerning morphometric value of infraorbital foramen in view of racial variations. [ABSTRACT FROM AUTHOR]

Objective To determine the frequency of nail changes in patients of psoriasis to Dermatology Department of Services Hospital, Lahore. Methods It was a cross-sectional survey conducted in the Department of Dermatology, SIMS/Services Hospital, from September 2022 to March 2023. 80 patients of psoriasis were enrolled. Detailed history and examination for psoriasis was done. All patients underwent evaluation for nail changes (as per operational definition). The presence/absence of nail changes was recorded on a pre-designed proforma (annexure). Results In this study, mean age of patients was 27.24±4.57 years, 59 (73.8%) were male whereas 21 (26.3%) were females, 55 (68.8%), moderate in 17 (21.3%) and severe in 8 (10%) of the cases. Descriptive statistics of nail changes of patients in psoriasis shows 72 (90%) had pitting, 64 (80%) had Onycholysis, 24 (30%) had Splinter Haemorrhage, Oil Drop Discoloration in 71 (88.8%) and Subungual hyperkeratosis in 64 (80%) of the cases. Conclusion We found pitting as the leading nail change in psoriatic disease followed by Oil Drop Discoloration and Onycholysis. Psoriasis can significantly impair a patient's quality of life. Nail changes can significantly affect cosmetic concerns of the patients and need to be addressed adequately and timely. [ABSTRACT FROM AUTHOR]

Objective To evaluate the efficacy of platelet rich plasma in patients of androgenic alopecia attending the dermatology department of a tertiary care hospital in Lahore. Methods This descriptive case series was conducted at the Department of Dermatology, Services Hospital, Lahore over six months. 77 patients of both genders, aged between 18-45 years who presented with androgenic alopecia were enrolled and treated with injection of platelet rich plasma. Outcome was assessed in terms of improvement in hair quality and thickness by patient selfassessment questionnaire on a linear analogue 2 scale of 5-26 scores. Treatment was labelled effective if the score was less than 12, four weeks after the completion of all 4 sessions. A written informed consent was taken from each patient. Data was entered and analyzed using SPSS version 21. Results The mean age of patients was 29.2±9.2 years. Majority (n=51, 66.2%) of the patients were aged under 30 years. There were 52 (67.5%) male and 25 (32.5%) female patients with a male to female ratio of 2.1:1. 31 (40.3%) patients had Grade-II while 38 (49.4%) patients had Grade-III alopecia. Only 8 (10.3%) patients had Grade-IV alopecia. Platelet-rich plasma treatment was effective in 65 (84.4%) patients as per operational definition. There was no statistically significant difference in the frequency of efficacy across various age (p-value=0.972) and gender (pvalue= 0.944) groups. However, it decreased insignificantly with increasing grade of alopecia; Grade-II vs. Grade-III vs. Grade-IV (87.1% vs. 84.2% vs. 75.0%; p-value=0.701). Conclusion Platelet-rich plasma therapy was found extremely effective in patients of mild to moderate androgenic alopecia which along with cost-effectiveness, simplicity and safety of procedure advocate its preferred use in future practice. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness and safety profile of glycolic acid peel combined with microneedling versus 35% glycolic acid peel in the management of acne scars. Methods This study was conducted from 27th September 2021 to 28th March 2022 at Outpatient Department of Dermatology, Services Hospital, Lahore. Patients of either gender, having acne scars of grade 2 to grade 4 were included. After written informed consent, they were divided randomly into two treatment groups. Patients in Group A were treated with 35% glycolic acid peel combined with microneedling while Group B was received 35% glycolic acid peel only. All patients underwent six treatment sessions at two weekly intervals. They were called for follow-up one month after the last treatment session and treatment response was noted. 'Treatment response' or efficacy was defined as Excellent response (reduction in two grades of scars), Good response (reduction in one grade) or Poor response (no reduction in grade of scars). Safety of treatments was assessed by side effects reported by patients and observed on examination. Results Out of 60 patients, 51 (85%) were women and 09 (15%) were men with a ratio of 5.7:1. They were divided equally into two treatment groups. Group A patients had a mean age of 32.43±6.91 years while it was 33.27±7.24 years in group B patients. Majority of the patients (58.33%) were between 31 to 45 years of age. Efficacy of Group A (glycolic acid peel 35%, combined with microneedling) was seen in 29 (96.67%) patients whereas it was observed in 22 (73.33%) patients (p-value=0.011) in Group B. Two patients in combination group reported postinflammatory hyperpigmentation, rest of the patients reported improvement in tone and texture of skin. Conclusion This study concluded that use of glycolic acid peel 35% combined with microneedling is more effective treatment option in acne scars versus the peel alone. Patients in both the groups reported improvement in the quality of skin with a relatively good safety profile. [ABSTRACT FROM AUTHOR]

Objectives: To assess the prescribing practice of obstetricians and gynecologists (OBGYN) regarding Menopausal Hormone therapy (MHT) for menopausal females and assess the knowledge regarding indications for prescribing MHT and identify the barriers to HRT. Methods: This was a cross-sectional study conducted from May 2021 to December 2021. The participants were OBGYN experts (MCPS, FCPS, MRCOG) and senior experts. The tool was formulated after looking at contemporary literature and then validated by experts for face, content and construct validity. It was piloted and hence fourth given to study participants after approval by IRB of JSMU. Data was analyzed by SPSS version 22. Mean and Standard Deviation of categories in Likert scale were calculated. Results: Majority of the participant gynecologists prescribed HRT for Hot flushes and vaginal dryness having the highest mean scores nearing 4 on a Likert scale of (1-5). The prescription for other menopausal symptoms was observed to be less. The highest score for category of women in whom hormone therapy is specifically justified was “Premature ovarian failure” (4.37) followed by “Hysterectomy with bilateral oophorectomy before the age of 50” (4.23). Conclusion: Pakistani gynecologists are more cautious in their management strategies concerning MHT. Most of the gynecologists showed good and up to date information while prescribing MHT however knowledge for preventing fractures, alleviating anxiety/depression and weight gain was less among the gynecologist of Pakistan. We recommend refresher courses and online webinars for updated information on menopause and its management. [ABSTRACT FROM AUTHOR]