Determination of Bergenin in Different Parts of Bergenia ciliata using a Validated RP-HPLC Method

Bergenia ciliata (Family: Saxifragaceae) is a folklore remedy for the treatment of various ailments in Asian countries. Bergenin (1) has been isolated as an active constituent in many studies, however, the amount of bergenin has not been determined in all parts of the plant. A simple RP-HPLC method was developed to determine the amount of bergenin in methanol extracts of leaves, rhizomes and roots of the plant. Separation was achieved on an Agilent Eclipse XDB-C18 column maintained at 25 o C using isocratic solvent system (water: methanol: acetic acid; 62.5:37:0.5 v/v/v) adjusted at pH 2 0 at a flow rate of 1.0 mL/min. and detected at 275 nm. Correlation coefficient (0.9952) showed linearity of concentration (5-200 μg/mL) and response. The values of LOD (0.00947 μg/mL) and LOQ (0.02869 μg/mL) indicated that method was sensitive. The recovery of bergenin was 99.99-100% indicating accuracy of method. The methanol extract of rhizomes contained higher amount of bergenin (19.4%) than roots (9.2%) and leaves (6.9%). It is concluded that methanol extract of rhizomes is a better source of bergenin than other parts of the plant. The findings are useful for standardization of bergenin containing extracts and herbal preparations.

Congenital hyperinsulinism: 2 case reports with different rare variants in ABCC8

Congenital hyperinsulinism (CHI) is a rare glucose metabolism disorder characterized by unregulated secretion of insulin that leads to hyperinsulinemic hypoglycemia (HH). Most cases are caused by mutations in the KATP-channel genes ABCC8 and KCNJ11. We report 2 patients that experienced severe HH from the first day of life. Patient 1 developed midgut volvulus after initiating diazoxide and required intestinal resection. He was subsequently managed with a high-dose octreotide and glucose-enriched diet. Consistent with diffuse type CHI by 18F-dihydroxyphenylalanine positron emission tomography-computed tomography, genetic testing revealed a homozygous ABCC8 variant, c.1801G>A, p.(Val601Ile). The rare variant was previously reported to be diazoxide-responsive, and the patient responded well to diazoxide monotherapy, with clinical remission at 2 years of age. Patient 2 responded to diazoxide with spontaneous clinical remission at 15 months of age. However, an oral glucose tolerance test at 7 years of age revealed hyperinsulinism. Genetic testing revealed that the proband and several seemingly healthy family members harbored a novel, heterozygous ABCC8 variant, c.1780T>C, p.(Ser594Pro). Genetic findings identified previously unrecognized HH in the proband’s mother. The proband’s uncle had been diagnosed with monogenic ABCC8-diabetes and was successfully transitioned from insulin to glibenclamide therapy. We report findings of intestinal malrotation and volvulus occurring 2 days after initiation of diazoxide treatment. We also report a novel, heterozygous ABCC8 variant in a family that exhibited cases of CHI in infancy and HH and monogenic diabetes in adult members. The cases demonstrate the importance and clinical utility of genetic analyses for informing and guiding treatment and care.

Congenital hyperinsulinism: 2 case reports with different rare variants in ABCC8

Congenital hyperinsulinism (CHI) is a rare glucose metabolism disorder characterized by unregulated secretion of insulin that leads to hyperinsulinemic hypoglycemia (HH). Most cases are caused by mutations in the KATP-channel genes ABCC8 and KCNJ11. We report 2 patients that experienced severe HH from the first day of life. Patient 1 developed midgut volvulus after initiating diazoxide and required intestinal resection. He was subsequently managed with a high-dose octreotide and glucose-enriched diet. Consistent with diffuse type CHI by 18F-dihydroxyphenylalanine positron emission tomography-computed tomography, genetic testing revealed a homozygous ABCC8 variant, c.1801G>A, p.(Val601Ile). The rare variant was previously reported to be diazoxide-responsive, and the patient responded well to diazoxide monotherapy, with clinical remission at 2 years of age. Patient 2 responded to diazoxide with spontaneous clinical remission at 15 months of age. However, an oral glucose tolerance test at 7 years of age revealed hyperinsulinism. Genetic testing revealed that the proband and several seemingly healthy family members harbored a novel, heterozygous ABCC8 variant, c.1780T>C, p.(Ser594Pro). Genetic findings identified previously unrecognized HH in the proband’s mother. The proband’s uncle had been diagnosed with monogenic ABCC8-diabetes and was successfully transitioned from insulin to glibenclamide therapy. We report findings of intestinal malrotation and volvulus occurring 2 days after initiation of diazoxide treatment. We also report a novel, heterozygous ABCC8 variant in a family that exhibited cases of CHI in infancy and HH and monogenic diabetes in adult members. The cases demonstrate the importance and clinical utility of genetic analyses for informing and guiding treatment and care.

Argemone mexicana extract alleviates gastrointestinal disorders by stimulating muscarinic receptors and blocking voltage-gated L-type calcium channels

Objective: To investigate the pharmacological potential of Argemone mexicana in treating constipation and emesis by using in vitro and in vivo models. Methods: The spasmogenic and spasmolytic effects were evaluated on isolated rabbit jejunum fragments loaded in a tissue organ bath. The response was recorded with an isotonic transducer attached with Power Lab Data Acquisition System. The laxative and antiemetic activities were assessed in BALB-c mice and poultry chicks challenged with carbamylcholine and copper sulphate stimulated emesis, respectively. Results: The total phenolic and total flavonoids contents of the extract were (267.75 ± 5.77) mg GAE/g and (73.86 ± 6.01) mg QE/g, respectively. Argemone mexicana extract exerted spasmogenic effect on isolated rabbit jejunum segments with an EC50 value of 0.016 mg/mL, which was blocked by atropine (0.3 μM). Argemone mexicana extract exerted spasmolytic effect in atropine treated jejunum fragments with an EC50 value of 2.185 mg/mL. Furthermore, Argemone mexicana extract relaxed potassium (80 mM)-induced contractions (EC50: 9.07 mg/mL), similar to a standard drug verapamil. The calcium channel blocker activity was confirmed by a rightward shift of concentration-response curve of calcium in the presence of Argemone mexicana extract (1-5 mg/mL) and verapamil (0.1-1 μM). In addition, the extract increased the distance travelled by a charcoal in the gastrointestinal tract and exhibited antiemetic effect on copper sulphate induced emesis in chicks. Conclusions: Argemone mexicana shows cholinergic agonist and calcium channel blocker activities, as well as antiemetic effect. It may be used as a potential agent for treating gastrointestinal disorders.

Argemone mexicana extract alleviates gastrointestinal disorders by stimulating muscarinic receptors and blocking voltage-gated L-type calcium channels

Objective: To investigate the pharmacological potential of Argemone mexicana in treating constipation and emesis by using in vitro and in vivo models. Methods: The spasmogenic and spasmolytic effects were evaluated on isolated rabbit jejunum fragments loaded in a tissue organ bath. The response was recorded with an isotonic transducer attached with Power Lab Data Acquisition System. The laxative and antiemetic activities were assessed in BALB-c mice and poultry chicks challenged with carbamylcholine and copper sulphate stimulated emesis, respectively. Results: The total phenolic and total flavonoids contents of the extract were (267.75 ± 5.77) mg GAE/g and (73.86 ± 6.01) mg QE/g, respectively. Argemone mexicana extract exerted spasmogenic effect on isolated rabbit jejunum segments with an EC50 value of 0.016 mg/mL, which was blocked by atropine (0.3 μM). Argemone mexicana extract exerted spasmolytic effect in atropine treated jejunum fragments with an EC50 value of 2.185 mg/mL. Furthermore, Argemone mexicana extract relaxed potassium (80 mM)-induced contractions (EC50: 9.07 mg/mL), similar to a standard drug verapamil. The calcium channel blocker activity was confirmed by a rightward shift of concentration-response curve of calcium in the presence of Argemone mexicana extract (1-5 mg/mL) and verapamil (0.1-1 μM). In addition, the extract increased the distance travelled by a charcoal in the gastrointestinal tract and exhibited antiemetic effect on copper sulphate induced emesis in chicks. Conclusions: Argemone mexicana shows cholinergic agonist and calcium channel blocker activities, as well as antiemetic effect. It may be used as a potential agent for treating gastrointestinal disorders.

Determination of Bergenin in Different Parts of Bergenia ciliata using a Validated RP-HPLC Method

Bergenia ciliata (Family: Saxifragaceae) is a folklore remedy for the treatment of various ailments in Asian countries. Bergenin (1) has been isolated as an active constituent in many studies, however, the amount of bergenin has not been determined in all parts of the plant. A simple RP-HPLC method was developed to determine the amount of bergenin in methanol extracts of leaves, rhizomes and roots of the plant. Separation was achieved on an Agilent Eclipse XDB-C18 column maintained at 25 o C using isocratic solvent system (water: methanol: acetic acid; 62.5:37:0.5 v/v/v) adjusted at pH 2 0 at a flow rate of 1.0 mL/min. and detected at 275 nm. Correlation coefficient (0.9952) showed linearity of concentration (5-200 μg/mL) and response. The values of LOD (0.00947 μg/mL) and LOQ (0.02869 μg/mL) indicated that method was sensitive. The recovery of bergenin was 99.99-100% indicating accuracy of method. The methanol extract of rhizomes contained higher amount of bergenin (19.4%) than roots (9.2%) and leaves (6.9%). It is concluded that methanol extract of rhizomes is a better source of bergenin than other parts of the plant. The findings are useful for standardization of bergenin containing extracts and herbal preparations.

Impact of body mass index on survival outcome in patients with differentiated thyroid cancer / Impacto do índice de massa corporal sobre o desfecho de sobrevida em pacientes com câncer diferenciado de tireoide

Abstract Introduction Increased body mass index is known to be associated with the high prevalence of differentiated thyroid cancers; however data on its impact on survival outcome after thyroidectomy and adjuvant therapy is scanty. Objective We aimed to evaluate the impact of body mass index on overall survival and disease free survival rates in patients with differentiated thyroid cancers. Methods Between 2000 and 2011, 209 patients with differentiated thyroid cancers (papillary, follicular, hurthle cell) were treated with thyroidectomy followed by adjuvant radioactive iodine-131 therapy and thyroid-stimulating hormone suppression. Based on body mass index, patients were divided into five groups; (a) <18.5 kg/m2 (underweight); (b) 18.5-25 kg/m2 (normal weight); (c) 26-30 kg/m2 (overweight); (d) 31-40 kg/m2 (obese) and (e) >40 kg/m2 (morbid obese). Various demographic, clinical and treatment characteristics and related toxicity and outcomes (overall survival, and disease free survival) were analyzed and compared. Results Median follow up period was 5.2 years (0.6-10). Mean body mass index was 31.3 kg/m2 (17-72); body mass index 31-40 kg/m2 was predominant (89 patients, 42.6%) followed by 26-30 kg/m2 seen in 58 patients (27.8%). A total of 18 locoregional recurrences (8.6%) and 12 distant metastasis (5.7%) were seen. The 10 year disease free survival and overall survival rates were 83.1% and 58.0% respectively. No significant impact of body mass index on overall survival or disease free survival rates was found (p = 0.081). Similarly, multivariate analysis showed that body mass index was not an independent prognostic factor for overall survival and disease free survival. Conclusion Although body mass index can increase the risk of thyroid cancer, it has no impact on treatment outcome; however, further trials are warranted.

Resumo Introdução Sabe-se que o aumento do índice de massa corpórea está associado à alta prevalência de câncer diferenciado de tireoide; entretanto, os dados sobre seu impacto no desfecho de sobrevivência após tireoidectomia e terapia adjuvante são escassos. Objetivo Objetivou-se avaliar o impacto do índice de massa corpórea nas taxas de sobrevida global e sobrevida livre de doença em pacientes com câncer diferenciado de tireoide. Método Entre 2000 e 2011, 209 pacientes com câncer diferenciado de tireoide (papilar/folicular/de células de Hurthle) foram tratados através de tireoidectomia, seguida de tratamento com iodo radioativo-131 adjuvante e supressão de hormônio estimulante da tireoide. Com base no índice de massa corpórea, os pacientes foram divididos em cinco grupos; (a) < 18,5 kg/m2 (baixo peso); (b) 18,5-25 kg/m2 (peso normal); (c) 26-30 kg/m2 (sobrepeso); (d) 31-40 kg/m2 (obesos) e (e) > 40 kg/m2 (obesos mórbidos). Várias características demográficas, clínicas e de tratamento e toxicidade associada e desfechos (sobrevida global e sobrevida livre de doença) foram analisadas e comparadas. Resultados O período médio de acompanhamento foi de 5,2 anos (0,6-10). O índice de massa corpórea médio foi de 31,3 kg/m2 (17-72); o índice de massa corpórea de 31-40 kg/m2 foi predominante (89 pacientes, 42,6%), seguido por 26-30 kg/m2, observado em 58 pacientes (27,8%). Observaram-se 18 recidivas locorregionais (8,6%) e 12 metástases distantes (5,7%). As taxas de sobrevida livre de doença e sobrevida global de 10 anos foram de 83,1% e 58,0%, respectivamente. Não foi encontrado impacto significativo do índice de massa corpórea nas taxas de sobrevida global ou sobrevida livre de doença (p = 0,081). Da mesma forma, a análise multivariada mostrou que o índice de massa corpórea não foi um fator prognóstico independente para sobrevida global e sobrevida livre de doença. Conclusão Embora o índice de massa corpórea possa aumentar o risco de câncer de tireoide, ele não tem impacto no resultado do tratamento; contudo, outros estudos são necessários.

Determination of waiting time in patients visiting general male and female outdoor clinics

Objective: To determine waiting time of patients visiting general male and female outdoor clinics of 01 Mountain Medical Battalion, Bagh

Study Design: Descriptive cross sectional study

Place and Duration of Study: The study was carried out at 1 Mountain Medical Battalion Bagh, from Dec 2016 to Feb 2017

Material and Methods: One hundred and ninety patients selected out of all patients visiting general male and female outdoor clinics during working days were included in this study. Lottery method was used to select ten patients daily in the study period and these were then scrutinized to include those fulfilling the inclusion criteria. Waiting time to get registered, consultation and total waiting time was noted. Data collected was entered and analyzed using Statistical Package for Social Sciences (SPSS) version 17; Independent sample t-test was used to compare means between samples with the level of statistical significance set at 5 Percent (p<0.05)

Results: Waiting time to get registered for female patients was 7.24 +/- 4.42 minwhile for male patients it was 8.64 +/-5.30 min. Waiting time for consultation ranged from 15.15 +/- 10.50 min for female and 16.25 +/- 9.89 min for male patients. Total waiting time was 22.04 +/- 11.75 min for female and 24.93 +/- 12.06 min for male patients. Out of all patients, 83.33 Percent females and 87.5 Percent male patients were seen within 30 minutes after being registered

Conclusion: Majority of patients visiting general outdoor clinics were seen within 30 minutes of their registration which is close to the international standards. There is need to further improve waiting time of patients to increase patient satisfaction. The difference of waiting time was insignificant between male and female patients

Appendiceal duplication presenting as acute Appendicitis

Anomalies of appendix are a rare and are usually discovered incidentally during surgery. A 23 year old female was operated for acute appendicitis and per operatively two appendiceal lumen were found. Appendiceal duplication should be kept in mind in patients presenting with acute appendicitis especially when appendix is found non inflamed and in cases where patient has previous history of appendicectomy and presents with signs and symptoms of acute appendicitis

Prehypertension and hypertension in medical students of northern border university in Arar, Saudi Arabia

Aim of the work: hypertension is the commonest cardiovascular disorder. Prehypertension in adolescents and young adults is a risk factor for developing hypertension in later years of life. The objective of this study was to determine the prevalence rate and risk factor associated with prehypertension and hypertension in the medical students of Northern Border University in Arar city, Saudi Arabia

Methods: this crosssectional study included 232 students. The study subjects were selected by systematic random sampling method. This study included 232 medical students [136 male and 96 female]. The study period was from 1 March to 31 May 2017. Students were given a predesigned and pretested questionnaire to collect the relevant data

Results: Fifty [52.1%] of females and 58.8% of males were pre-hypertensive and 1.5% from males were hypertensive. Family history of hypertension was positive in 66.7% of hypertensive or prehypertensive students [P<0.05], 18.2% were obese [P<0.05], 9.1% of hypertensive or pre-hypertensive students were diabetic [P>0.05], 31.8% were smokers [P>0.05], 10.6% were drug addicts [P>0.05], 18.2% only performing muscular exercise [P>0.05], 62.1% consume >5g salt /day [P<0.05]and 40.9% of them spent 2-5 hours in front of TV, Computer or mobile [P>0.05]

Conclusion: in medical students of the Northern Border University, 52.1% of females and 58.8% of males were pre-hypertensive and 1.5% of males were hypertensive. Risk factors included obesity, family history, sedentary life and excess salt intake. So health-care providers should recognize the increased risk of prehypertension and hypertension and should seek to identify and manage the modifiable risk factors in those students

Development and validation of a stability-indicating RP-HPLC-FLD method for determination of 5-[[4-chlorophenoxy] methyl]-1, 3, 4- oxadiazole-2-thiol; A novel drug candidate

The present study describes the development and validation of a simple high performance liquid chromatographic method for the determination of a novel drug candidate, 5-[[4-chlorophenoxy] methyl]-1, 3, 4- oxadiazole-2-thiol. The stability-indicating capacity of the method was evaluated by subjecting the compound's solution to hydrolytic, oxidative, photolytic, transition metal- and thermal- stress. The chromatographic separation was achieved over a C18 column [Promosil, 5 microm, 4.60 × 250 mm], maintained at 25°C, using an isocratic mobile phase comprising a mixture of acetonitrile and acidified water of pH 2.67 [1:1, v/v], at a flow rate of 1.00 mL/min and detection using a fluorescent light detector [excitation at 250 nm and emission at 410 nm]. The Beer's law was followed over the concentration range 2.50-50.00 microg/mL. The recovery [98.56-100.19%, SD <5%], intraday accuracy and precision [97.31-100.81%, RSD<5%] and intermediate accuracy and precision [98.10-99.91%, RSD<5%] indicated that the method was reliable, repeatable, reproducible and rugged. The resolution and selectivity factors of the compound's peak from the nearest resolving peak, particularly in case of dry heat and copper metal stress, were found to be greater than 2 and 1, respectively, which indicated specificity and selectivity. The compound was extensively decomposed in alkaline-hydrolytic, oxidative, metal- and dry heat- stress. However, the compound in acidic and neutral conditions was resistant to photolysis. The results of the present study indicate that the developed method is specific, selective, sensitive and suitable, hence, may be used for quality control, stability testing and preformulation studies

Evaluation of hospital management system at combined military hospital Peshawar

Objective: To evaluate HMS in terms of its user's satisfaction, time management, data retrieval, record keeping and confidentiality of medical records

Study Design: Cross sectional study

Place and Duration of Study: Combined Military Hospital [CMH] Peshawar, from 1[st] Nov 2013 to 30[th] Apr 2014

Material and Methods: All doctors using hospital management system [HMS] for more than six months in CMH Peshawar were included in this study by means of non probability convenient sampling. This made a total sample size of 71. A questionnaire was filled regarding satisfaction, time management, data retrieval, record keeping and confidentiality of medical records and results analyzed

Results: Out of total 71 participants, 25 [35.25%] were satisfied and 46 [64.75%] were not satisfied with the use of HMS. Increase in time per patient was observed in 60 [84%]. Out of total respondents, 57 [80%] found HMS as useful tool for data retrieval and 25 [35%] stated that manual record should be retained along with electronic records. Concerns regarding confidentiality of record was shown by 21 [30%] of the participants

Conclusion: A significant percentage of doctors were not satisfied with the use of HMS. Its use leads to increase in time spent per patient. However, most of the participants of the study found HMS efficient tool for data retrieval, record keeping and confidentiality of medical records

Association of [hypovitaminosis v] with persistent non-specific musculoskeletal pains

Objective: The study was conducted in Pakistani population to find association of vitamin D deficiency with persistent non-specific musculoskeletal pains by comparing with pain free controls

Study Design: Case control study

Material and Methods: Patients aged 12 years or more presenting to Medical OPD with persistent nonspecific musculoskeletal pains for more than 3 months were selected as cases, while healthy individuals served as controls

Results: A total of 60 cases [patients with persistent non-specific pains] presenting to medical outpatients department at Military Hospital Rawalpindi and 60 controls were studied. Mean age of cases was 43.9 +/- 14.0 years and amongst controls were 33.2 +/- 17.8 years. Mean serum vitamin D level of 32.8 nmol/L was reported in cases whereas mean serum vitamin D level amongst controls was 26.7 +/- 17.8 nmol/L. Hypovitaminosis D amongst cases and controls was 86.6% and 95% respectively. The proportion of vitamin D deficiency did not differ significantly as compared to controls. There was non-significant difference in proportion of deficiency amongst cases and controls

Conclusion: Overall there was no association between persistent non-specific musculoskeletal pains and vitamin D deficiency

Fanconi Bickel Syndrome with Hypercalciuria due to GLUT 2 Mutation.

Background: Fanconi Bickel Syndrome is a rare, autosomal recessive, disorder of carbohydrate metabolism. Presence of hypercalciuria is rare. Case characteristics: 4.5-years-old boy presented with growth failure, hepatomegaly, rickets, fasting hypoglycemia with postprandial hyperglycemia, fanconi syndrome and hypercalciuria, Outcome: A rare mutation in GLUT-2 gene suggestive of Fanconi Bickel Syndrome. Message: Fanconi Bickel Syndrome may present with hypercalciuria with proximal renal tubulopathy along with fasting hypoglycemia and postprandial hyperglycemia.

Rectovaginal fistula as a result of coital injury

Rectovaginal fistula following sexual intercourse is rarely reported. It is a social stigma; and without adequate treatment and social support, the patient may end-up in isolation. A thorough knowledge of the problem and management is essential for successful outcome. We report a case of low rectovaginal fistula in a newly married female managed trans-vaginally with prior defunctioning colostomy

Endoscopic transnasal dacryocystorhinostomy: our experience and case series analysis

Background: This study aims to describe our surgical technique and results for endoscopic transnasal dacryocystorhinostomy for the blocked nasolacrimal passage in patients presented in the department of Otolaryngology and ophthalmology at a tertiary care center

Methods: A consecutively presenting case series of blocked nasolacrimal passage were selected for transnasal endoscopic dacryocystorhinostomy. Bone removal done by cold instruments and the drill was used to remove the bone over the superior aspect of the sac. Medial wall of the sac was removed to marsupialize the sac in the nasal cavity. Septoplasty was done in 13 patients [17.10 %]. The specific surgical approach with or without septoplasty and the use of endolight was discussed. Postoperative follow up including endoscopic examination and results are documented

Results: A total of 76 cases were included. Mean age was 37.32 [range 6-76]]. An endolight was used in all cases to localize the site of nasolacrimal sac72 cases [94.74 %] have successful outcome in terms of relief of symptoms, whereas 4[5.26 %] cases had persistent epiphora. Revision procedure were done and 3[3/4, 75 %] cases had successful outcome. The overall success rate in our series of primary and revision ETDCR is 98.68 %

Conclusion: Endoscopic transnasal dacryocystorhinostomy is an effective treatment for nasolacrimal duct obstruction. Use of the endolight to localize and the power drill to expose the sac and septoplasty; contribute to the ultimate surgical success

Comparison of pain score after giving diclofenac sodium versus nalbuphine in patients undergoing ESWL: our experience in SIMS/ SHL

Abstract: Treatment of urolithiasis has been revolutionized with the introduction of extracorporeal shock wave lithotripsy [ESWL] due to its simplicity, non-invasive nature, efficacy, and minimal morbidity. Pain experienced during ESWL is considered to be multifactorial including type of lithotripter used, frequency, voltage, age, and sex of patient. Various analgesic agents including opiods, nonsteroidal anti-inflammatory drugs, local anesthetic agents and a number of combinations have been used during extracorporeal shock wave lithotripsy by various techniques

Objective: Compare the mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy. Study Design: Randomized control trial study Setting: Department of Urology SIMS/SHL Lahore Period: 01.12.2012 to 01.05.2013

Methods: Total number of 150 [75in each] patients were included in two groups [Diclofenac sodium group A SD 3.28+ 0.18, Nalbuphine group B SD 4.11 + 1.69]. Inclusion and exclusion criteria strictly followed. Detailed history including [age sex address], informed consent, labs, bleeding profile, RFT, X-rays KUB, USG, IVU, and pregnancy test checked. Patients divided in two groups by lottery method. Injection Diclofenac sodium given deep intramuscular, while Nalbuphine HCL intravenous. Both groups were observed pain during ESWL. Data was analyzed by using SPSS version 10, SD, P value calculated

Results: A total of 150 [75 in each group] cases were enrolled after fulfilling the inclusion/exclusion criteria, majority of the patients in both groups were between 41-50 years i.e. 33.33%[n=25] in Diclofenac sodium group and 32%[n=24] in Nalbuphine group, mean and SD was calculated as 35.98+3.54 in Diclofenac sodium and 37.32+3.83 years in Nalbuphine group, 58.67%[n=44] in Diclofenac sodium and 52%[n=39] in Nalbuphine group were male while 41.33%[n=31] in Diclofenac sodium and 48%[n=36] in Nalbuphine group were females, mean pain score after giving diclofenac sodium versus nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy was recorded as 3.09+0.54 in Diclofenac sodium and 4.93+0.79 in Nalbuphine Group, p value was computed as 0.05

Conclusion: We concluded that on comparison of mean pain score after giving Diclofenac Sodium versus Nalbuphine in patients undergoing extra-corporeal shock wave lithotripsy, significant low pain score was recorded in patients treated with Diclofenac Sodium which may be used in future to control the pain

Impact of malocclusion on quality of life in a group of adults

Malocclusion has a negative impact on oral health related quality of life. Orthodontists in routine have focused on the clinical-centred measures of outcome for orthodontic treatment, but now, attention to patient-based assessment has greatly increased in dental research. The purpose of study was to determine oral health-related quality of life in adults with mal-occlusion and its relationship with perceived oral health status and satisfaction. This crossectional study was conducted at orthodontics department, de'Montmorency College of Dentistry, Lahore from January 2015 to May 2015. The sample comprised of 100 adults [34 males and 66 females] with age range of 18 - 25 years and willing to participate in the study. The oral examination was done by three examiners to assess severity of malocclusion according to Dental Aesthetic Index [DAI]. Information regarding oral health-related quality of life was collected by using a self-administered questionnaire. The results of study showed that males have highest Oral Health Impact Profile related to psychological problems followed by social and physical impacts whereas in females the highest impact profile was observed on social impacts followed by physical and psychological impacts. Body Satisfactory Scale was almost double in females as compared to males. Mean values from grade 1 to IV DAI for females were non- significantly increased as compared to males. It was concluded that most common Oral Health Impact Profile of malocclusion was psychological and social followed by physical discomfort in males whereas females show highest impact profile on social followed by physical and psychological impacts