Clinical Analysis of Complete Denture Satisfaction Factors: Dentist and Patient Perspective

Background: The dilemma of patient satisfaction vs. non-satisfaction with dentures is another never-ending debate in dentistry. The fabrication of optimal dentures is possible with appropriate prosthetic laboratory techniques along with patients’ anatomic and physiologic requirements assessed by a dentist. Objective: The purpose of this study was to evaluate the patient’s priority and mean satisfaction scores of the patient and dentist during complete denture therapy. Material and methods: After selecting the subjects based on decided inclusion and exclusion criteria, the patients were asked to fill the proforma with VAS. The proforma contained a questionnaire divided into 3 parts which need to be filled by both the patients and the dentist, independently. The patients rated their dentures using a scale ranging from 1-5 (5=very satisfied; 4=satisfied; 3=neither satisfied, nor dissatisfied; 2=dissatisfied; 1=very dissatisfied), and a dentist rated the quality of the denture and the denture-bearing area. Results: According to the patient’s priority the majority of the patients preferred mastication (47%). The highest mean dentist satisfaction score was concerned with the extension of a denture (0.97 ± 0.28). There was no statistically significant difference with age and gender for mean denture assessment, aesthetic, phonetics, mastication and comfort satisfaction score (p>0.05). However, the employed patients have aesthetic, phonetics and mastication satisfaction score higher than unemployed patients and the relationship was statistically significant (p<0.05). The educated patients have mean phonetics satisfaction score higher as compared to uneducated patients and the relationship was statistically significant (p<0.05). Conclusion: Majority of the patients was concerned with better chewing function with their dentures. Age and gender do not affect patient satisfaction. However, employed patients were less satisfied with their dentures as compare to unemployed patients. In addition, patients who were educated had better phonetics with their dentures as compare to uneducated patients. Strong dentist-patient communication is necessary to be able to satisfy a patient.

Study of erythrocytes as a novel drug carrier for the delivery of artemether

Resealed erythrocytes have been explored in various dimensions of drug delivery, owing to their high biocompatibility and inability to initiate immune response. The present research was designed to evaluate the drug delivery potential of erythrocytes by loading a hydrophobic anti-malarial drug, Artemether. Three different loading techniques were applied to achieve maximum optimized drug loading. A HPLC method was validated for drug quantification in erythrocytes. The relatively high loading was achieved using hypotonic treatment was 31.39% as compared to other two methods. These, drug loaded erythrocytes were characterized for membrane integrity via ESR showing higher ESR values for drug loaded cells as compared to normal cells. Moreover, microscopic evaluation was done to observe morphological changes in erythrocytes after successful loading which showed swollen cells with slight rough surface as compared to smooth surface of normal cells. Drug release was studied for 8 h which showed more than 80% release within 3-7 h from erythrocytes treated with different hypotonic methods. Overall, the study revealed a potential application of erythrocytes in delivery of hydrophobic drugs using hypotonic treatment as compared to other methods.

Discord Between the Facial and Maxillary Midline and Intermaxillary Midline Among the Population of Asir, Saudi Arabia

Abstract Objective: To determine the proportion of Saudi population in the Asir region that displayed discordance between the facial and maxillary midline and intermaxillary midline, to form an informative guideline for esthetic rehabilitation of patients. Material and Methods: We evaluated 2418 Saudi citizens using positioning guides of the orthopantomography machine to record the relationship of the dental midline to the facial midline. The relationship of the maxillary midline to that of the mandible was observed clinically, and diagnostic mounting of particular cases was performed for confirmation. The examination was carried out by four trained observers (two dentists and two radiology technicians) to overcome the parallax effect. The cases with disagreements were repeated. The record was grouped into (1) coincidence, (2) deviation of the mandible to the right, and (3) deviation to the left. The relationship between facial-dental midline concordance and intermaxillary concordance was assessed using the Chi-squared test Results: Facial and maxillary midline did not coincide in 42.5% participants, whereas intermaxillary midline discordance was observed in 51.5%. Among those exhibiting discordance, 57% had right discordance and 43% had left discordance Conclusion: A significant proportion of the population displayed discordance between the facial-maxillary midline as well as the intermaxillary midline. The female population showed not only a higher number of intermaxillary discordance than males but also a significant number of intermaxillary discordance towards the right.

Depletion of apomorphine induced behavioral sensitization in rats treated with escitalopram

Apomorphine is a classical psychostimulant and used throughout the world as prescribed medicine. Despite of their therapeutic effects, use of psychostimulants is restricted because some psychosis and impulse control disorders are the consequence of their long term use. Studies suggest that serotonin [5-Hydroxytryptamine; 5-HT] has a critical role in psychosis and drug abuse. Center of the present article is to assess the impacts of serotonin in the easing of misuse potential; the sensitization prompted by recommended psychostimulant apomorphine. We researched that whether Escitalopram can weaken apomorphine instigated behavioral sensitization. Rats treated with Escitalopram [10 mg/kg] daily for 7 days followed by apomorphine injections [1mg/kg] for next 7 days. Apomorphine increased motor activity after single injection and repeated injections produced a progressive sensitization of motor activity. Whereas, in rats pretreated with Escitalopram apomorphine induced behavioral sensitization did not occur. In this article, from the results of this study it is concluded that apomorphine induced behavioral sensitization was smaller in rats pretreated with SSRIs. It might be due to the desensitization of somatodendritic 5-HT-1A receptors

Biochemical, Nutritional and End Use Perspectives of Wheat Grass as Potential Dietary Supplement

Wheat grass being substantial cereal grass crop in the world; copious source of nutrients with noteworthy nutritional and therapeutic value. The research, wheat grass was grown in indoor trays and then used as powder and in drink. The objective were to use the wheat grass to formulate a suitable processing procedure for wheat grass powder (WGP) enriched food products. Both raw WGP and cookies were analyzed for total dietary fiber (TDF), soluble dietary fiber (SDF), insoluble dietary fiber (IDF), total phenolic content (TPC) and antioxidant activity. Drink was analyzed for pH, viscosity and total soluble solids (TSS). WGP addition showed a significant effect on mixographic (peak height and peak time) and farinographic studies; water absorption, arrival time, dough development time (DDT) and mixing tolerance index (MTI). The cookies prepared using different levels were generally accepted by sensory panelists of the department but 3% substitution level of WGP have high acceptability. Moreover, on the basis of physicochemical and sensory attributes, 10% supplementation level of wheat grass in drink was best making it a nutrient enriched food source.

Sharing the experience of management of neonates with maternal premature rupture of membranes

Background: Neonates with the maternal premature rupture of membranes are commonly encountered in the clinical practice. The condition has an important implication for the management of neonates, as it is associated with certain risks of morbidity and mortality. The management varies among the physicians. The study aimed at evaluating out the neonatal outcome of the existing condition with institutional practice

Methods: The study was conducted at King Khalid Hospital, Al Majmaah KSA from August 2016 to August 2017. Two hundred neonates born to mothers with premature rupture of membranes were evaluated, monitored and treated in neonatal unit. Septic screening was done in all the neonates and empiric antibiotics were started for all the neonates. Maternal risk factors were taken into consideration. Neonatal outcomes were considered in all cases

Results: There were 111 male and 89 female neonates. Most of the cases were term prom while 68 cases were pre-prom. Most commonly associated complication was feeding intolerance found in 16% of cases. Only two neonates had a positive blood culture for group B streptococci. Maternal high vaginal swab yield group B streptococci in 17 cases. Sepsis developed in three cases. One hundred and ninety eight neonates were discharged home while one patient died of severe sepsis

Conclusion: PROM is a common clinical entity that requires careful handling of the neonates to prevent the mortality and morbidity. With prompt treatment, the outcome can be significantly improved

Attenuation of apomorphine induced behavioral sensitization in rats pre-treated with tryptophan

Psychostimulants substances, some of which are abused by humans, are generally believed to produce sensitization effects when they are repeatedly administered to animals. Apomorphine, a non-narcotic derivative of morphine, having agonistic property for dopamine in order to produce psycho stimulant-like effects. Meanwhile, chronic administration leads to behavioral sensitization. Therefore, present study destine to produce desensitization in animals by the repeated administration of tryptophan [100 mg/kg], thereafter treated with apomorphine [1.0 mg/kg] to observe the intensity of sensitization in rats pre-treated with tryptophan. Apomorphine on acute administration known to increase motor activity whereas repeated treatment of apomorphine initiates the sensitization of motor behavior. It is expected that the intensity of apomorphine induced sensitization would be affected in tryptophan-treated rats. Present study provide the clear-cut evidence that chronic treatment of apomorphine arouses the motor behavior of animals in both novel and anxiolytic model over the saline treated animals, whereas hypo locomotive behavior was seen in animals pre-treated with tryptophan, provides the evidence that preliminary treatment of tryptophan perturbs the apomorphine induced sensitization in animals. The discoveries present an inventive methodology for amplifying the remedial utilization of apomorphine and traditional psychostimulants

Experience of peritoneal dialysis in renal failure in children

Objective: To determine the course and efficacy of peritoneal dialysis in children presenting with renal failure

Study Design: Quasi experimental study

Place and Duration of Study: The study was conducted at the Nephrology department of Children's Hospital and Institute of Child Health Lahore from Feb 2007 to Feb 2008

Material and Methods: Forty children diagnosed with renal failure at the Nephrology department of Children's Hospital and Institute of Child Health, Lahore were evaluated for the efficacy of PD, duration of PD and the associated complications

Results: There were 55% cases of acute renal failure and 45% cases of chronic renal failure. The mean duration of PD was 3.8 days. About 75% of all the patients improved with PD. The mortality rate was 22.5%. Leading complications were Catheter-related [leakage/blockade] and peritonitis

Conclusion: We concluded that peritoneal dialysis is lifesaving procedure which improves the acute metabolic derangements of renal failure in children. It is associated with certain complications but the benefits outweigh the complications

Association of serum ferritin and CRP levels with development and severity of diabetic retinopathy

Background: Diabetes mellitus is a global health issue. Chronic hyperglycaemia induces endothelial dysfunction and metabolic derangements which are postulated to be the cornerstone for the pathogenesis of diabetic microangiopathic complications. The interplay of oxidative stress, endothelial dysfunction and inflammation in this regard has led to investigation of role of inflammatory biomarkers as adjuncts to routine diagnostic testing. This study was designed to elucidate the association between serum ferritin and high sensitivity CRP levels and diabetic retinopathy

Methods: The study was carried out at Department of Physiology and Centre for Research in Experimental and Applied Medicine [CREAM], Army Medical College, in collaboration with Armed Forces Institute of Ophthalmology, Rawalpindi for a period of one year. A total of 90 subjects were recruited into three equal groups; healthy subjects, diabetics and patients with diabetic retinopathy. Serum high sensitivity C-reactive protein [hs-CRP] was estimated by Enzyme Immunoassay [EIA] and serum ferritin levels were carried out by enzyme linked immunosorbent assay

Results: The mean age was 48.50+/-5.32, 50.90+/-3.83 and 50.83+/-3.54 years respectively. Insignificant differences in height, weight and BMI were found across the groups. Highly significant difference was noted in the mean CRP levels in normal subjects. The mean ferritin levels were also found to be significantly different. Univariate multinomial regression revealed that variance in CRP levels could account for 91.1% of variance in status of patients and that in ferritin levels could account for 96.7%

Conclusion: These prognostic markers correlate well with diabetic retinopathy and have an independent predictive ability as well. This may in future be inculcated into screening and surveillance of diabetic microangiopathic complications

Frequency of early remodeling of left ventricle and its comparison between patients with stroke volume >97 Ml versus patients with stroke volume <97 Ml after aortic valve replacement for severe aortic regurgitation

Objectives: To evaluate the frequency of early remodeling in patients of severe aortic regurgitation after aortic valve replacement and to see the incidence of early remodeling in patients with stroke volume >97 ml versus < 97 ml before aortic valve replacement

Method: This was a prospective comparative study conducted from August 2013 to December 2014 in a tertiary care hospital. Fifty seven [57] patients of isolated chronic aortic regurgitation were included in this study. SPSS v23 was used for data analysis. Independent sample t-test was used for analysis of continuous variables and chi-square test for qualitative variables

Results: Out of fifty seven patients, early remodeling occurred in 34 [59.64%] patients after surgery. The mean pre-operative stroke volume of patient in whom remodeling occurred was 110.3 +/- 9.66 ml while mean pre-operative stroke volume of patients who did not undergo remodeling was 86.65 +/- 7.63 ml. There were 28 [82.4%] patients with stroke volume >97 ml in whom Remodeling occurred where as in patients with stroke volume <97 ml remodeling occurred only in 6 [17.6%] patients [p value 0.004]. There was no inhospital mortality

Conclusion: There is an association between stroke volume and early LV remodeling after Aortic valve replacement. Stroke volume >97 ml is a good predictor of early LV remodeling

Apomorphine induced conditioned place preference and sensitization is greater in rats exposed to unpredictable chronic mild stress

CNS stimulants are the class of the drugs that may be used to get relief from depression. Apomorphine is a D1 and D2 receptor agonist with a CNS stimulatory effect used for the treatment of Parkinson's disease is also abused. Although many drugs of abuse produce tolerance and dependence. Long term use of pshycostimulants produce reverse tolerance described as sensitization. These drugs also have a number of other beneficial effects but their therapeutic use is limited because of abuse potential. Conditioned place preference [CPP] test is used to monitor the reinforcing effect of drugs of abuse. Stress is an important factor that precipitates and potentiates addictive effects of different drugs of abuse. The present study was designed to investigate the addictive effect of apomorphine [1mg/kg] in rats previously exposed to repeated unpredictable chronic mild stress for 10 days [animal model of depression]. Results from present study illustrate that unpredictable chronic mild stress potentiates the reinforcing effects of apomorphine as the number of entries and the time spent in the CPP compartment associated with drug administration is increased. Motor activity was taken as a parameter for behavioral sensitization which is induced by repeated administration of apomorphine, monitored as the number of cage crossings in light compartment of the CPP apparatus, also increased

Gastroprotective effects of cuscuta reflexa on aspirininduced peptic ulcer

Background: Gastroprotective effects of cuscuta reflexa may be considered as alterative to many currently used anti peptic ulcer drugs

Objective: To explore the in-vivo gastroprotective activity and antiulcer potential of crude extract of the indigenous medicinal plant, Cuscuta reflexa, belonging to the plant family 'Convolvulace

Methodology: This experimental study was conducted from 1[st] March to 1[st] July 2015 at faculty of pharmacy and alternative medicine, Islamia Universty Bahawalpur. The antiulcer activity of Cuscuta reflexa [Cs.Cr] was investigated in aspirin-induced ulcer models. Wistar Albino rats were divided into six groups, each consisting of six animals. Control and intoxicated groups received normal saline at the dose of 8 ml/kg, standard group received Cimetidine [100 mg/kg] and the test groups received three different doses [30, 100 and 300 mg/kg] of Cs.Cr oraly individually for seven days, with subsequent administration of aspirin [200 mg/kg oraly] for two consecutive days. At the end of the experimental period, rats were anaesthetized and sacrificed. The stomach was removed and incised to collect the gastric juice for determination of pH and acidity. The stomach from each group was evaluated for ulcer index and percent protection. Afterwards, stomachs were weighed and samples preserved in 10% formalin for histopathological studies. Acute toxicity studies were also performed in mice. The extract [Cs.Cr] was also analyzed phytochemically for the presence of various secondary metabolites

Results: Oral administration of the crude extract of Cuscuta reflexa [Cs.Cr] exhibited dose-dependent [30-300 mg/kg] significant protection [p<0.05] in the Aspirin-induced peptic ulcerated animals. The extract, Cs.Cr, was found to be safe up to the dose of 10 g/kg in mice. Phytochemical analysis showed the presence of several metabolites like glycosides, flavonoids, saponins, terpenes and tannins in the crude extract of the plant

Conclusion: The results of the study clearly showed that Cs.Cr possesses gastroprotective potential and caused the reversal of peptic ulceration which justify the traditional use of the plant in several gastric ailments like hyperacidity, gastro-esophageal reflux disease and ulcer. However, further investigations are needed to explore the exact mechanism[s] responsible for protective effects of the plant

Unpredictable chronic mild stress induced behavioral deficits: a comparative study in male and female rats

Stress is an important precipitant factor for depression. Changes in various body systems that occur in depression are similar to those observed in response to stress. Chronic stress may alter behavioral, neurochemical and physiological responses to drug challenges and novel stressors. Unpredictable chronic mild stress [UCMS] also produces alteration in the serotonergic [5-HT; 5-hydroxytryptamine] neurotransmission. Unpredictable chronic mild stress [UCMS] could be used as an animal model of depression. Neurochemical and behavioral effects of UCMS can be reversed by antidepressant agents, suggesting an important role of serotonin. In rodents, UCMS can elicit depression-like symptoms. The objective of the present study was to evaluate and compare the behavioral deficits induced by chronic mild stress in male and female rats and finding out the vulnerability of the two groups. Male and female rats exposed to UCMS exhibited a significant decrease in cumulative food intake as well as in growth rate. Loco motor activity in home cage and open field was also decreased. Results may contribute to our understanding of the interaction between stress and behavioral functions have to depressive disorders

Coincidence of facial midline with dental midline

The objective of the present study was to determine the role of facial mid line as a guide for positioning maxillary dental midline for Prosthodontic patients during fabrication of prosthesis. Furthermore the study will help in indicating character as well as perception of discrepancies between dental and facial midline among Pakistani population. The study was carried out within population of Baqai Medical University Karachi, Pakistan from Jan2013 to June 2013. A total of 500 dentate patients with the age range 18 to 30 years were selected randomly. No fixed proportion was proposed. The patients having permanent dentition from 2nd molar to 2nd molar in maxillary arch were included .However patients having midline diastema, orthodontic treatment, or any cranio-facial anomaly were excluded. The patients were observed to check if the maxillary dental midline coincides with the facial midline. The facial midline was examined by marking points between nasion till pognion including centre of philtrum with the help of scale or dental floss. The results of the present study showed that 82.8% patients had their maxillary dental midline coinciding with facial midline. Therefore it was concluded that the Facial midline can be taken as reliable guide in establishment of maxillary dental midline among Pakistani population

Determination of lower facial height through mandibular morphology using lateral cephalometery

The objective of the present study was to correlate the mandible morphology and lower facial height in occlusion through lateral cephalographs. Moreover the cephalometric measurements can be used as records for future complete dentures fabrication. It is a descriptive study and was carried out at the Prosthodontic Department of Lahore Medical and Dental College, Lahore from July 2011 to January 2012. A total of 120 completely edentulous patients of both genders were selected and the age ranged 35 years and above. Demographic data and informed consent of all the patients were taken. The patients with the facial asymmetry, acquired and congenital orofacial deformity were excluded from the study. All those patients not willing to undergo radiography were also not included. The cephalographs of each patient was carried out after the insertion of the complete dentures. The Rickets cephalometric analysis was used to analyze the mandibular shape by [gonial angle] and the mandibular arch. The lower facial height in occlusion was measured by three angles [superior, median, inferior]. The results of the present study showed that there is a positive and a strong correlation between mandibular gonial angle with all the three angles determining the lower facial height. Furthermore the median and inferior angles were found to be having significant correlation with the mandibular arch angle. The regressions for gonial angle [Gonial = 103.527+0.466 [inferior] and for mandibular arch angle [arch =30.519-0.271[superior] +0.227 [inferior] were statistically significant. It was concluded that the mandibular morphology can be used to evaluate the lower facial height in occlusion in the Pakistani population and is complementary to the routinely used methods for the complete denture fabrication

Etiology and treatment of midline diastema: a review of literature

Midline diastema can be physiological, dentoalveolar, due to a missing tooth, due to peg lateral, midline supernumerary teeth, proclination of the upper labial segment, prominent frenum or due to a self-inflicted pathology by tongue piercing. The treatment involves observation and follow up, active orthodontic tooth movement, combined orthodontic and surgical approach, restorative treatment and Mulligan's technique of overcorrection. Hand and electronic searching was done for 55 articles for this review of literature. Midline diastema is common dental anomaly having multiple causes and various orthodontic and surgical options for management. Midline diastemas require proper diagnosis and timing for better care of patients

The Outcomes of Pars Plana Vitrectomy without Tamponade for Tractional Retinal Detachment Secondary to Diabetic Retinopathy

Objectives: The objective of this research was to evaluate the outcomes of pars plana vitrectomy (PPV) without the use of an ocular tamponade in patients with tractional retinal detachment (TRD) secondary to proliferative diabetic retinopathy (PDR) presenting to Bahawal Victoria Hospital, Bahawalpur, Pakistan. Methods: This was an interventional study conducted at the Department of Ophthalmology, Bahawal Victoria (B.V.) Hospital, Bahawalpur, Pakistan, from July 2011 to July 2012. A total of 75 patients (84 eyes) with TRD secondary to PDR were treated by PPV without using an ocular tamponade. All patients included in the study had a TRD secondary to PDR but did not have or develop retinal breaks before or during the study period. The surgical procedure included a PPV combined with the removal of the tractional retinal membranes and the application of endolaser photocoagulation to the retina. The mean follow-up period was 12 months. Results: The study included 75 patients (84 eyes). Among these, 40 patients were females and 35 males. Successful retinal reattachment was observed in 78 of the operated eyes (92.8%). In these patients, the retina remained attached until the end of the 12 month follow-up period. Improvement in best corrected visual acuity (BCVA) was seen in 63 eyes (75%). The visual acuity remained unchanged in nine eyes (10.7%). Mean improvement in BCVA was 2.00 ± 1.24 at baseline to 1.24 ± 1.22 (P = 0.010) at the end of the follow-up period. Conclusion: In the absence of retinal breaks, a TRD secondary to PDR can be successfully treated and improved by PPV without the use of an ocular tamponade.

Proparacaine; Efficacy as a topical anesthetic in pterygium surgery

To evaluate the efficacy of proparacaine 0.5% as a topical anesthetic in pterygium surgery. Quasi-Experimental study. Eye Unitll, Bahawal Victoria Hospital, Bahawalpur, from December 2010 to April 2011. Thirty patients affected by primary pterygium undenwent pterygium excision under topical anesthesia using proparacaine 0.5% eye drops. Pterygium excision was performed along with dissection of the degenerative conjunctival tissue, scraping of the corneal surface with surgical blade N0.15, meticulous dissection of the underlying Tenon's capsule, preparation of a free conjunctival graft from the superotemporal sector of healthy conjunctiva, and positioning of this graft to the area of bare sclera using 6/0 vicryl suture. Computer software SPSS [version 10] was used to analyze the data. Results were considered statistically significant at p<0.05. lt was possible to perform all the procedure under topical anesthesia using 0.5% Proparacaine eye drops without a need of supplemental subconjunctival or peribulbar anesthesia. Pain reported by the patients, recorded by a Visual Analog Scale [VAS] with 0-4 grades, and was mild to moderate during the entire surgical procedure. Topical proparacaine 0.5% is a safe and effective anesthetic in pterygium surgery. The long lasting anesthesia with this agent permits performing the surgical procedure with low pain felt by the patients with a resultant low surgical invasivity anda short duration of surgery.

Temporomandibular disorders

Temporomandibular joint has been a subject of intense debate and interest for researchers since long. Temporomandibular disorders are one of the most intriguing and controversial subject in the world of dentistry. This study reviews the possible etiological factors and the management protocol for these disorders. The key to successful management is an appropriate diagnosis, for alleviating pain and restoring physiological functions. The choice of treatment provided to the patient depends on the degree of the problem. On time referral to an oral and maxillofacial surgeon is essential for the treatment of temporomandibular disorders to avoid complications

Effects of pterygium excision on corneal curvatures

To determine the difference in mean corneal curvatures before and after pterygium excision, by using automated refraction and keratometry. This quasi-experimental study was conducted at Eye Unit-1, Bahawal Victoria Hospital, Bahawalpur, from March 2010 to August 2010. Thirty patients with primary pterygium were analyzed before and after pterygium surgery for corneal curvature changes. Automated refraction and Automated keratometry were used to calculate the cylindrical error and the corneal surface power respectively. The mean and standard deviation were calculated for the corneal curvatures and the refractive cylinder before and after the operation. Paired sample t-test was used to compare the corneal curvatures and refractive cylinder before and after pterygium excision. P-value<0.05 was considered significant. The preoperative cylindrical error decreased from 4.32+ 1.88 D to 2.11 +1.96D postoperatively. Similarly, before surgery, the keratometry readings were 43.71 + 1.12 D in horizontal meridian and 44.94+ 1.41 D in vertical meridian. One week after the pterygium surgery these values were 44.45+0.85 D in horizontal meridian and 45.23 + 0.78 D in vertical meridian. Pterygium excision brings a statistically significant change in corneal curvatures which leads to a decrease in cylindrical correction needed. This causes an improvement in subjective visual acuity in patients who have undergone pterygium surgery