Pharmacological studies of Adhatoda vasica and Calotropis procera as resource of bio-active compounds for various diseases

Adhatoda vasica and Calotropis procera species were investigated as a resource for new diverse pharmacological agents including B complex, individual total phenolic compounds and antioxidants for curing and treatments of many infectious diseases in human through advanced analytical methods. These plants are abundant in Khyber Pukhtoon Khawa, Pakistan as well as in all over the world and famous for their unique medicinal importance. These herbaceous species are so far used for animals curing while current exploration of these species showed that these species are a precious resource of various compounds which can be employed in the formation of different drugs. The results showed that the leaf and flower extracts of Adhatoda vasica and leaf extract of Calotropis procera contained higher contents of bioactive compounds. The chemical analysis of the samples resulted in higher values of total phenolic compounds [71.32mg GAE/g], total antioxidants [651% DPPH inhibition], the enzyme catalase [4716Mug/g], ash content [16.72%] and pH values in the Calotropis procera, whereas the total carotenoids [1987mg/100g], the enzymes, superoxide dismutase [4566Mug/g] and peroxidase [1322Mug/g] were higher in leaves of Adhatoda vasica. The flower extract of the Adhatoda vasica was rich in the flavonoids [0.87mg/100g] and organic matter [89.99%] as compared to Calotropis procera. The obtained data for each parameter was interpreted by applying Complete Randomized Design [CRD] along with factorial arrangements. The mean comparison was performed using LSD test at 5% probability level. The presence of these phytochemicals may lead to the conclusion that these herbal plants have the potential for formation of new drugs and can be used as herbal medicine for treatment of different cancer and viral diseases. These compounds are also useful in the treatment of the tumor

Non-vascularized autogenous bone grafts for reconstruction of maxillofacial osseous defects

Objective: To determine the outcomes of non-vascularized bone grafts for reconstruction of maxillofacial defects. Study Design: Case series. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from January 2013 to December 2015

Methodology: Descriptive analyses of 30 patients, who underwent maxillofacial reconstruction with non-vascularized bone grafts, were conducted. The demographic information, diagnosis, and type of graft harvested to reconstruct the defect were statistically analyzed. Outcomes of reconstruction with non-vascularized bone grafts were analyzed in terms of mouth opening, success of dental rehabilitation, and postoperative complications, i.e. surgical site infection and hardware loosening

Results: A total of 30 patients ranging from 8 to 60 years [33.57 +/- 14.74 years] had maxillofacial defects reconstructed mostly due to gunshot injuries, followed by post-resection defects. Overall 15 cases [50%] were reconstructed with iliac crest cortico-cancellous bone graft, 11 cases [36.7%] with rib; while in four cases [13.3%], costochondral graft was used for reconstruction. In 26 cases [86.7%], graft was found to be successful. In three cases, re-operation for onlay bone graft was required to provide optimal dental rehabilitation; while in just one case, postoperative surgical site infection was observed

Conclusion: Non-vascularized bone grafts provide a reasonable and effective modality for reconstruction of maxillofacial defects

Knowledge and attitude of patients towards dental implant at armed forces institute of dentistry, Pakistan

Objective: Assessment of the patient knowledge and attitude towards dental Implants at a tertiary care dental hospital

Study Design: A cross sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi from Jan 2014 to Jun 2014

Material and Methods: A survey was conducted on 150 partially dentate male and female patients having age 20 years and above using a self-explanatory questionnaire. Completely dentate and edentulous patients were excluded in study. Age and gender of the patients were noted. Data were analyzed using SPSS 17.0. Frequencies of age, knowledge, sources and limiting factors were calculated

Results: Sixty percent of the patients were aware of dental implants. Dentists were the main sources of information regarding the dental implants followed by friends and relatives. A majority of patients [65%] had objection on the cost of implant therapy. Major disadvantage and deterrent to implant therapy were cost and surgery

Conclusion: The study showed that most of the patients were aware of dental implants. Dentists and electronic advertising media plays an important role in educating patients about dental implants. Cost was a major limitation in provision of dental implants

Weight loss due to maxillomandibular fixation in mandibular fractures

The aim of this study was to calculate extent of weight loss [in kilograms] due to Maxillomandib-ular fixation in patients after trauma. Study design was prospective observational study. The study was conducted in Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi from February 2014 to July 2014 over a period of 06 months. A total of 30 patients with only mandibular fracture were included in the study. Out of these 30 patients 27 patients were males and 03 patients were females. All patients were treated with Max-illomandibular fixation for 04 weeks. Weight of the patient was noted pre-operatively, 1st week post operatively and 4th week post operatively. Data was analyzed using SPSS version 20. The study included 30 patients with mean age of 36.67 [SD +9.743] out which 90% were male and 10% were female. The overall weight loss sustained by patients in this study was 6 kilograms [kgs] at the end of first week post operatively and 5kilograms [kgs] at fourth week post operatively when compared with their weights before surgery. Within the limitations of this study, significant weight loss was observed at the first week post operatively among all patients

Assesment of recurrence of odontogenic keratocysts treated with different surgical modalities -nine years follow up of disease

The purpose of this study was to determine the Recurrence rate of odontogenic keratocysts [OKC] and association of recurrence with various surgical modalities. It was cohort analytical study. Eighty-two odontogenic keratocysts cases treated at Oral and Max illofac ial department Armed Forces Institute of Dentistry, Rawalpindi farmed the study subject, and were followed for a period of 9 years from 2004 to 2013. Recurrence ofOKCs were evaluated from 1-9 years after surgical treatment by clinical and ra-diographic means and correlated with various treatment modalities. The most frequent site affected by OKCs was the posterior mandible including body, angle and ramus. Patients were followed for recurrence. 16 patients were lost to follow up and this journal was 14 cases of recurrence out of 66 were treated with varying modalities [21.2%]. Patients treated conservatively with marsupialization or enucleation alone demonstrated higher recurrence rates [100% and 50% respectively]. Odontogenic keratocyst is an aggressive cyst associated with high recurrence. Surgeons should decide on various modalities as per requirement of the case. Although resection carries least risk of recurrence, it should be limited to recurrent and aggressive OKCs. The outcomes of enucleation combined with peripheral ostectomy and chemical cauterization is reasonably acceptable

Assessment of OPD patient's satisfaction with health care services at Al-Nafees medical hospital

Objective: To determine socio-demographic profile among the OPD patients and the overall satisfaction level of the patients utilizing the OPD

Study Design: A descriptive cross sectional study

Place and Duration: Conducted in OPD of Al-Nafees Hospital Islamabad from 12th January -12th March 2015

Methodology: Through convenient sampling a closed ended structured questionnaire was employed to collect the quantitative data. OPD patients aged 18-64 who showed willingness to participate were included in the study. Indoor patients, patients below 18 and above 64 and those who were not willing were excluded

Results: The study was conducted on 209 patients. Overall satisfaction level of patients with the OPD health services was 86.2%. Satisfaction level was found to be more in females than males. 42.6% had a family income of >15000 Rupees but satisfaction level with OPD services was same among respondents falling in different categories of family income. Patients with primary level of education were more satisfied. 41.1% waited 15-30 minutes for the examination by the doctor. 89% of the patients were satisfied from the registration staff. 73.3% were satisfied with doctor's service. The satisfaction level from the nurses was 64.6%. 63.3% were satisfied from the services provided by the pharmacy. 63.2% said that the medical expenses were affordable. 88% of the patients agreed upon the cleanliness of the building of the hospital and 77% stated that that signs and boards were easy to follow

Conclusion: In the current study it was found that majority of respondents were highly satisfied with the OPD services offered at Al-Nafees Hospital. Patients were satisfied with the behavior of registration staff, Physicians' communication skills, waiting time for examination, nursing care, pharmacy services and logistic arrangements

To identify the factors affecting the risk of recurrent febrile seizures in saudi children

To identify the risk factors of recurrent febrile seizures [FS] in Saudi children in a Northern Province of Hail in Saudi Arabia. Descriptive prospective study. Pediatric department, King Khalid Hospital Hail, Kingdom of Saudi Arabia from 01 October 2010 to 30 September 2011. A total of 132 children [age ranges from 03 months to 60 months] were included in the study, while they were admitted with the diagnosis of FS during the study period, in the Pediatric department of the King Khalid University Hospital, Hail. A predesigned study proforma was utilized for data collection. All the children included in the study were followed for a period of 01 year after discharge from the pediatric ward for any recurrence of FS. During the study period 132 children were admitted for FS, the mean age of children in our sample was 16 months. There was a preponderance of male children. Among the causes of fever, mostly 63 [47.73%] had symptoms of viral prodrome. Recurrent febrile seizure was found in 46 [34.85%] children. There was a statistically significant association between low temperature at onset of seizure and recurrent FS in 65.22% cases p-value= 0.001]. Similarly, the association of duration of fever [

Prevalence of social myths and taboos related to dental health among general population of Rawalpindi - Pakistan

It was a descriptive cross-sectional study conducted in 2010 to explore various misconceptions and taboos about dental health to see their prevalence in the community and to assess their effects on general dental health. The survey was carried out using convenient sampling technique of 300 adults. A Questionnaire in Urdu language consisting of ten close-ended questions regarding most common myths related to dental health in the community was used. SPSS version 16 was used for data analysis. Most of the respondents were found strong believers of various myths irrespective of their qualification level. The results of this study shows that general population of Rawalpindi believes in various myths regarding teeth and their health which results in poor dental health. This might be due to lack of knowledge about the dentition, dental health and its importance

Correction of facial asymmetry associated with unilateral hypoplastic mandible with monobloc distraction osteogenesis in adult

Facial asymmetrey can be corrected by bimaxillay orthognathic surgery and distraction osteogenesis. We report a case of facial asymmetry which was corrected using monobloc distraction osteogenesis. A monobloc was created using an osteosynthesis fixation device from the zygomatic buttress to the mandible, LeFort I osteotomy was combined with mandiular angle osteotomy and the bloc was distracted using uni-directional distractor

Knowledge, attitude and practice [KAP] about malaria among inhabitants of a slum area of Karachi

To assess the KAP regarding malaria among inhabitants of slum area of Karachi. A community based comparative cross sectional study was conducted in a slum area of Karachi i.e. Arafat town, for a period of seven months from Oct 2011 to April 2012. Total 151 inhabitants of Arafat Town were included and interviewed by trained Lady Health Worker using structured questionnaire, comprising of three components i.e. KAP about malaria. Individuals who scored more than 70% were labeled as having satisfactory KAP. Proportions of score regarding KAP were compared with one another and also with demographic variables by using chi-square test. Most of the participants were married female, having mean age of 33.87 +/- 7.5 years. Large proportion [97%] of sample had satisfactory attitude as compared to knowledge [50%] and practice [59%]. Difference in knowledge and practice was found to be significant [p=0.040]. Inhabitants of Arafat Town, had positive attitude towards prevention of malaria, but their levels of knowledge and practice were found to be low, may be due to low literacy rate or poor socioeconomic condition or both. Prompt interventions are required to enhance their knowledge and practice and thus ultimately would reduce the burden of malaria

Bioresorbable versus titanium plates for mandibular fractures

To compare bioresorbable plates with titanium plates for treatment of mandibular fractures. Randomized controlled trial. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry, Rawalpindi, from January to December 2010. Patients with mandibular fracture were randomly divided in to two groups. The control group received titanium plates while the experimental group received the bioresorbable plates. All the procedures were carried out under general anaesthesia using standard surgical techniques. Frequency of plate/screw breakage or loosening, development of infection, malocclusion, malunion, wound dehiscence, the need for hardware removal and any other technical difficulties were compared between the two groups using chi-square test with significance at p < 0.05. A total of 34 patients were included in the experimental group where 53 resorbable plates were applied. The control group consisted of 35 patients and received 52 titanium plates. The mean age in the experimental group and the control group were 31.35 +/- 11.16 years and 34.31 +/- 10.69 years respectively. Breakage of 16 screws and 03 plates was seen in the experimental group while no screw or plate broke in the control group. The results showed significant association of screw breakage with resorbable plates and plate removal with titanium plates. Bioresorbable plates can be used as an alternative to titanium plates in mandibular fractures but with caution. They are a good means to stabilize fractures in patients where growth retardation and hardware removal may be a consideration

Identification of sulfamoylbenzamide derivatives as selective cathepsin D inhibitors

Aspartic proteases play very important role in post translational processing of proteins and several of them are essential for organism's viability. Here we present the enzyme inhibition activities of different Sulfamoylbenzamide derivatives against two aspartic proteases cathepsin D and plasmepsin II. Cathepsin D is an aspartic protease that degrades proteins at acidic pH in the lysosomes, or extracellular matrix. It is overexpressed by epithelial breast cancer cells and hence hyper-secreted. On the other hand plasmepsin II is an essential enzyme of Plasmodium falciperum. Cathepsin D and Plasmepsin II are pivotal drug targets for treatment of breast cancer and malaria respectively. Virtual screening of Sulfamoylbenzamide compounds followed by enzyme inhibition assays revealed these compounds as selective Cathepsin D inhibitors while inactive against Plasmepsin-II. IC[50] values of five Sulfamoylbenzamide compounds tested are in range of 1.25-2.0 microM. N-[3-chlorophenyl]-2-sulfamoylbenzamide is identified as the most potent of all tested Sulfamoylbenzamide compounds with IC[50] 1.25 microM. It was also noted that the docking score of theses compounds was better in case of Cathepsin D as compared to Plasmepsin-II. Docking score ranges from -29.9 +/- 1.16 to -35.1 +/- 0.13 in case of Cathepsin D, while from -24.0 +/- 0.10 to -29.5 +/- 0.10 in case of Plasmepsin-II

maxillofacial trauma management trends at Armed Forces Institute of Dentistry, Rawalpindi

The aim of this study was to evaluate and analyze current trends in the management of trauma in patients presenting to oral and maxillofacial surgery department of Armed Forces Institute of Dentistry. Rawalpindi from Jan 2008 to Dec 2010. In this retrospective study, data of 613 patients with maxillofacial fractures treated at oral and maxillofacial surgery department, Armed Forces Institute of Dentistry was reviewed and analyzed. The main parameters recorded were gender, pattern of facial bones fracture and treatment modality of fracture. Out of these 613 patients, 564 [92%] were males and 49 [8%] were females with a male to female ratio of 11.5:1. The mandible was the most common bone to be fractured, with 307 fractures [50.1%], followed by 116 fractures [18.9%] of zygomatic bone, 83 fractures [13.5%] of maxillary bone, 64 patients [10.5%] had panfacial trauma, 26 [4.3%] were having nasal fracture while Naso-orbito-ethmoid fractures [NOE] were seen in 15 [2.4%] cases. The management of the injured face has undergone major changes, outcomes are considerably better than 30 years ago as more comprehensive assessment and management is now possible

Distraction osteogenesis for correcting maxillo-mandibular deformities

To determine the effectiveness of distraction osteogenesis [DO] for correcting maxillofacial deformities. Case series. Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from June 2008 to November 2010. Patients with diverse maxillofacial deformities were selected for the study. In all cases, intraoral distractors were used. Mandibular osteotomies were done using submandibular incision and maxillary osteotomy was done using standard vestibular incision. In paediatric patients, DO was started on third postoperative day while in adults, a 7-day latency period was followed. Distraction was carried out at a rate of 0.5 mm twice daily [1 mm/day]. Distractors were removed after a consolidation period of 2 months. A total 7 cases were operated for DO. Out of these, 3 were males and 4 females. The age ranged from 2-24 years [mean 12.57 +/- 9.48 years]. Five patients had their deformity owing to temporo mandibular joint [TMJ] ankylosis, one had congenital micrognathia and one patient had skeletal class-III deformity. Five patients underwent mandibular DO, one underwent maxillary DO and in one case simultaneous maxillo-mandibular DO was carried out. Amount of distraction varied from 9.0 mm to 19.2 mm [mean 15.04 +/- 4.33 mm]. Mean follow-up was 18.14 +/- 5.39 months. Distraction osteogenesis can be employed satisfactorily to correct diverse maxillofacial deformities like retrognathia, facial asymmetry and skeletal class-III

Total thyroidectomy for multi - nodular goitre

To assess the efficacy and safety of total thyroidectomy for benign multi-nodular goitre. Descriptive study. The study was conducted in the Department of General Surgery, Combined Military Hospital Kharian from January 2004 to December 2008. A total of 66 patients with bilateral benign multi nodular goitre [61 females and 5 males] underwent total thyroidectomy. Sixty two cases were euthyroid while 4 had hyperthyroidism Surgical dissection techniques involved identifying both recurrent laryngeal nerves through out their course, securing of parathyroid glands with their intact blood supply and ligation of inferior thyroid artery branches close to the thyroid capsule. All the patients were evaluated post operatively for signs of recurrent laryngeal nerve injury and hypoparathyroidism and other complications. All patients were put on thyroxin replacement therapy post-operatively and were followed for 9 to 12 months. There was no injury to the recurrent laryngeal nerves. One case of injury to external laryngeal nerve was found. Transient hypocalcaemia occurred in 4 patients without permanent hypoparathyroidism. All cases of transient hypocalcaemia recovered fully within 3 months. Four patients had occult malignancy diagnosed post-operatively on histo-pathology. In experienced hands total thyroidectomy is an effective and relatively safe operation for benign multi-nodular goitre and its complication rate is same as that of a sub-total thyroidectomy

Aetiology and pattern of dentoalveolar injuries in patients at armed forces institute of dentistry, Rawalpindi

To determine the aetiology and pattern of dentoalveolar injuries in patients presenting to oral surgery department of Armed Forces Institute of Dentistry, Rawalpindi. Cross sectional study. Oral Surgery department, Armed Forces Institute of Dentistry, Rawalpindi. September 2008 to August 2009. One hundred and thirty eight consecutive patients presenting to oral surgery department with dentoalveolar injuries irrespective of the age and gender were included in the study. Edentulous patients, patients with only soft tissue injury and patients with other maxillofacial injuries but no dentoalveolar injury were excluded. The included patients were asked about the cause of injury and the pattern of injury was noted clinically. This information was collected on specially designed proformas. All injuries were classified according to Andersean's classification. Out of these 138 patients, 111 [80.4%] were males with a male to female ratio of 4.1:1. The age ranged from 2-65 years with a mean age of 21.22 years. RTA was the most common cause of injury and was seen in 58 [42%] patients. Followed by fall noted in 52 [37.7%] patients. Other causes observed were contact sports in 7 [5.1%], violence in 4 [2.9%] and work place accident in 7 [5.1%] patients. Regarding pattern, the most common type of injury was avulsion and subluxation followed by crown fractures, luxation, root fractures and tooth displacements in various directions. Males especially the young lot was more affected by dentoalveolar trauma. RTA and fall remain the main causes of these injuries in our population. Avulsion, subluxation and luxation were the most common patterns of trauma observed. Maxillary incisors were the most commonly affected teeth in these traumatic episodes

Etiology and pattern of swellings in mandible and maxilla

To determine the etiology and pattern of swellings in the mandible and maxilla. A descriptive study. This study was conducted at Oral and Maxillofacial Surgery Dept, Armed Forces Institute of Dentistry Rawalpindi for two years from December 2004 to December 2006. Three hundred and fifty patients with swellings in the jaws reporting to AFID were included in this study. After history, clinical examination and radiographic evaluation, patients were registered. All patients whether admitted to hospital or treated as outdoor patients in oral surgery clinic were included. Swelling of the parotid region, nasal and para nasal sinuses and neck were not included. In majority 131 [37.42%] the patients were of age between 21 to 30 years [mean 25.5 years]. Males were affected more than females with ratio 1.3:1. The most common swellings found were inflammatory which accounted for 138 cases [39.42%] due to odontogenic reasons i.e. caries and non vital teeth. The most frequent site involved was mandible which accounted for 202 cases [57.71%]. In 111 cases [31.71%] the treatment modality used was incision and drainage followed by antibiotics. Caries and non-vital teeth were cause of the most common inflammatory swellings. The predominant site of swellings was the mandible. Every person must visit a dentist for oral examination six monthly so that early lesions in mandible and maxilla can be detected and treated more conservatively

Correction of airway obstruction in congenital micrognathia by mandibular distraction osteogenesis

Varying degrees of upper airway obstruction is almost universally present in patients of congenital micrognathia which needs to be corrected as early as possible. This allows appropriate feeding and growth and prevents long-term complications such as pulmonary hypertension and cor pulmonale. We report the case of a tracheostomy-dependent, 4-year-old child with congenital micrognathia who was treated with mandibular distraction osteogenesis. This is the treatment of choice for surgical correction of mandibular hypoplasia and for the challenging airway management in infants. Once a bone length of 2 cm was achieved through distraction osteogenesis, the child was completely relieved of respiratory obstruction and tracheostomy tube was removed through the process of decannulation

Distraction osteogenesis of a unilateral hypoplastic mandible

Distraction osteogenesis [DO] is a surgical process in which two bony segments are gradually separated so new soft tissue and bone will form between them by applying tension through a fixation device. There are three phases to this process: latency phase, distraction phase, and consolidation phase. The technique was originally applied to long bones but in recent years the method has been adapted for use in maxillofacial surgery. Distraction osteogenesis is a new variation of more traditional; orthognathic surgical procedures which can be applied for the correction of dento-facial deformities and syndromes of the jaws, treating upper airway obstruction in paediatric patients with mandibualr retrognathia, due to tongue collapse and physical obstruction in the hypopharangeal region. It is an effective and powerful reconstructive surgical technique, which can be performed safely without the need of bone graft or blood transfusion. We present treatment of a child with severe facial asymmetry after unilateral TMJ ankylosis corrected by distraction osteogenesis