Role of Probiotics in Patients with Allergic Rhinitis: A Systematic Review of Systematic Reviews

Abstract Introduction Allergic rhinitis (AR) is estimated to affect up to 30% of the world population. With the rise in cases, newer treatment modalities have been explored. Probiotics have shown to reduce symptoms of AR and improve quality of life. A few systematic reviews have been published aiming to assess the role of probiotics in AR. Objectives To consolidate the recent evidence with an overview of systematic reviews by extracting data regarding subjective outcomes (from quality of life questionnaires, the Total Nasal Symptom Score, the Total Ocular Symptom Score, the Daily Total Symptom Score, the incidence of AR, and the Rhinitis Total Symptom Score) and objective outcomes (levels of antigen-specific immunoglobulin E [IgE], total IgE, interleukin 10 [IL-10], interferon gamma [IFNG], eosinophil, and the T helper 1/T helper 2 [Th1/Th2] ratio). Data Synthesis We conducted a literature search on the PubMed, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, and Cochrane Library up to April 14, 2020. The qualitative assessment was performed using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR-2) tool. A total of 419 titles were screened, and 3 systematic reviews met our eligibility criteria. Probiotics in the treatment of AR have been shown to improve quality of life, the total nasal and ocular symptom scores, the daily total symptom scores and Th1/Th2 ratio. No difference was ascertained for rhinitis total symptom score, and the rates of antigen-specific IgE, total IgE, IL-10, INFG and eosinophil. Conclusion The present review showed that there is considerable evidence that probiotics are useful in the treatment of AR. Further randomized trials targeting the limitations of the currently-available evidence can help ascertain the usefulness of probiotics in cases of AR.

In Vitro Microscopic Evaluation of Metal- And Zirconium-Oxide-Based Crowns' Marginal Fit

ABSTRACT Objective To evaluate the marginal adaptation of computer-aided designing and computer-aided machining (CAD/CAM) fabricated cobalt-chromium and zirconium-oxide-based ceramic crowns compared to those produced by a conventional method. Material and Methods The study consists of three groups; 45 crowns fabricated from cobalt-chromium (CAD-CoCr) and 45 crowns manufactured from zirconium CAD/CAM technology (CAD-Z), and 45 control (C) which consists of conventional metal-ceramic crowns. The marginal discrepancies in vertical dimensions were assessed utilizing a microscope in four surfaces (mesial, distal, vestibular, and oral) for each crown. On completion of the microscopic evaluation, multivariate analysis of variance (MANOVA) was used to study the difference in the four surfaces, considered altogether. Two-way ANOVA revealed the effect of three systems used for gap measurements of each landmark. The differences observed were considered significant at p<0.05. Results There were no differences in the four surfaces revealed by АNOVА in the three groups when considered altogether. Two-way ANOVA of each surface discovered no differences among all groups as well. Conclusion The CAD/CAM crowns revealed a comparable and satisfactory marginal adaptation compared to conventional metal-ceramic crowns.

Formulation, Optimization, in vitro and in-vivo evaluation of levofloxacin hemihydrate Floating Tablets

Abstract The objective of the present investigation was to design, optimize and characterize the gastro retentive floating levofloxacin tablets and perform in-vivo evaluation using radiographic imaging. The floating tablets were prepared by using polymers i.e hydroxy propyl methyl cellulose (HPMC-K4M) and carbopol-940 individually and in combination by nonaquous granulation method. All the Formulations were evaluated for swelling index (S.I), floating behavior and in-vitro drug release kinetics. The compatibility study of levofloxacin with other polymers was investigated by FTIR, DSC, TGA and XRD. Results from FTIR and DSC revealed no chemical interaction amongst the formulation components. The optimized formulation (F11) showed floating lag time (FLT), total floating time (TFT) swelling index (S.I) of 60 sec, >16h and approximately 75 %, respectively. Moreover, F11 showed zero order levofloxacin release in simulated gastric fluid over the period of 6 h. X-ray studies showed that total buoyancy time was able to delay the gastric emptying of levofloxacin floating tablets in rabbits for more than 4 hours. In conclusion the optimized formulation (F11) can be used for the sustained delivery of levofloxacin for the treatment of peptic ulcer.

Comparative anthelmintic efficacy of Arundo donax, Areca catechu, and Ferula assa-foetida against Haemonchus contortus / Eficácia anthelmíntica comparativa de Arundo donax, Areca catechu e Ferula assa-foetida contra Haemonchus contortus

Abstract In the present study, anthelmintic activities of Arundo (A.) donax L., Areca (Ar.) catechu L., and Ferula (F.) assa-foetida L. were determined. Leaves of A. donax L., latex of F. assa-foetida L. and seeds of Ar. catechu L. in different solvent fractions were subjected to in vitro (egg hatch assay; EHA, and adult motility assay; AMA) and in vivo (faecal egg count reduction test; FECRT) tests of anthelmintic activity using Haemonchus contortus model. In the AMA, crude aqueous methanol extracts (CAME) and ethyl acetate fractions of F. assa-foetida at 10 hr post-treatment showed maximum mortality of H. contortus at 12.5-50 mg mL-1. In the EHA, CAME of F. assa-foetida was identified as a potent ovicide based on its low LC50 (16.9 µg mL-1), followed in order by Ar. catechu and A. donax. Results from the FECRT also showed the extract of F. assa-foetida L. to be more effective than those of Ar. catechu L. and A. donax L., against the gastrointestinal parasitic nematodes. Chloroform and ethyl acetate fractions showed better anthelmintic activities against the adult worms in vitro, while CAME of these plants were better than their crude powders in vivo. It is recommended to document and investigate indigenous knowledge of possible medicinal plants to plan scientific trials that may justify their endorsement.

Resumo No presente estudo, as atividades anti-helmínticas de Arundo (A.) donax L., Areca (Ar.) Catechu L. e Ferula (F.) assa-foetida L. foram determinadas. Folhas de A. donax L., látex de F. assa-foetida L. e sementes de Ar. catechu L. em diferentes frações de solvente foram submetidos a testes in vitro (teste de eclosão de ovos, EHA e ensaio de motilidade em adultos, AMA); e in vivo (teste de redução da contagem de ovos fecais, FECRT) de atividade anti-helmíntica, usando-se Haemonchus contortus. Na AMA, extratos aquosos brutos de metanol (CAME) e frações de acetato de etila de F. assa-foetida. Dez horas pós-tratamento, apresentaram mortalidade máxima de H. contortus em 12,5-50 mg mL-1. No EHA, CAME de F. assa-foetida foi identificado como um ovicida potente baseado em seu baixo LC50 (16,9 µg mL-1), seguido em ordem por Ar. catechu e A. donax. Os resultados do FECRT também mostraram que o extrato de F. assa-foetida L. é mais eficaz do que o de Ar. catechu L. e A. donax L., contra nematoides parasitas gastrointestinais. As frações clorofórmio e acetato de etila mostraram melhores atividades anti-helmínticas contra vermes adultos in vitro, enquanto o CAME dessas plantas foi melhor do que o pó bruto in vivo. Recomenda-se documentar e investigar o conhecimento indígena de possíveis plantas medicinais para planejar ensaios científicos que possam justificar seu endosso.

Role of Fine Needle Aspiration Cytology in the Diagnosis of Parotid Gland Tumors: Analysis of 193 Cases

Abstract Introduction Parotid gland tumors include a wide variety of inflammatory and neoplastic diseases. The majority of these tumors are benign (80%), which usually require superficial parotidectomy, while the incidence of malignant tumors is lower (20%), requiring more radical surgery with or without neck dissection. The diagnosis cannot be established on the basis of clinical history and simple physical examination and requires complementary diagnostic methods. Fine needle aspiration cytology (FNAC) guided by ultrasound is a widely used diagnostic tool to evaluate parotid swellings. Objective To determine the sensitivity, specificity, positive and negative predictive values and diagnostic accuracy of FNAC in the diagnosis of parotid gland tumors. Methods A retrospective chart review of 193 patients who underwent preoperative FNAC and parotidectomy at the Aga Khan University Hospital, Karachi, Pakistan, from the period of January 2000 to December 2015 was performed. Results Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, the mean age being 48.21 and 43.76 years old, respectively. The mean duration of the symptoms was 41.33 months, and the most common symptom was preauricular swelling present in all patients, followed by pain, which was present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). Fine needle aspiration cytology was performed preoperatively and the results were compared with the final histopathology, which showed sensitivity of 88.9%, specificity of 97.9%, positive predictive value of 93%, negative predictive value of 96.7% and diagnostic accuracy of 95.8%. Conclusion Our results suggest that FNAC is relatively an accurate method for preoperative diagnosis of parotid swelling and can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis.

Intraoperative Use of Analgesics in Tonsillar Fossa and Postoperative Evaluation with Visual analogue Scale Scores-A Prospective, Randomized, Placebo-Controlled, Double-Blind Clinical Trial

Abstract Introduction Posttonsillectomy pain results in significant morbidity to the patients. There is a disagreement in the literature regarding the use of local anesthetics during tonsillectomy. The aim of this placebo-controlled, double-blind study is to evaluate the effect of peritonsillar administration of local anesthetics. Objective To evaluate the role of intraoperative use of analgesics in tonsillar fossa and postoperative evaluation with visual analogue scale (VAS) scores in achieving pain relief after tonsillectomy procedure Methods In this study, 180 patients were randomized to 1 of the 6 groups: bupivacaine infiltration, lidocaine infiltration, normal saline infiltration, bupivacaine packing, lidocaine packing, and normal saline packing. Pain caused by speaking, swallowing, and on rest was assessed using VAS at 4, 8, 12, 16 hours, and at discharge. Results Significant analgesia was obtained in patients who received bupivacaine infiltration and packing compared with placebo (p < 0.05). The majority of the study subjects had no postoperative complications, and patients receiving bupivacaine infiltration required less additional analgesics in the first 24 hours after surgery. Conclusion We advocate the use of bupivacaine infiltration or packing immediately following the procedure to achieve adequate postoperative analgesia.

Prevalence and future prospects of HIV in Pakistan

In Pakistan, 1.5 million people are living with HIV and only 8% of them are receiving antiretroviral therapy. Moreover, the number of newly reported cases of HIV have increased to 30% and it has caused 78% deaths of the HIV infected patients since 2010. More than eight outbreaks have been reported in different area of Pakistan in past two decades, Gujrat-a city of Punjab is one of them. Recently, a medical practitioner in the civil hospital of Gujrat referred 905 cases which were suspected on the basis of symptoms-rapid weight loss, extreme tiredness, prolonged swelling of lymph glands, mouth sores. HIV-ELISA test was performed for suspected cases and 17.5% cases were reported HIV positive. Female percentage (58%) was higher as compared to the male (42%) with HIV positive cases. Study participants were categorized into different age groups and the HIV was highly prevalent in the individuals with 30-39 years of age (38%), 23% in age group III with (20-29 years). However, 4% cases were less than 10 years of age. Overall, 17% HIV positive cases in a small town of Gujrat are an eye opener to the incidence and prevalence of HIV. Stringent actions are required in collaboration with federal and provincial agencies to control the HIV spread.

Facial antibioma formation: a case report

Odontogenic infections are associated with a variety of microorganisms. antibiotics are commonly used for the management of various dental infections and have a proven role in decreasing morbidity and mortality caused by infectious diseases. the frequent and over usage of antibiotics has been associated with a number of consequences such as the selection of drug resistant strains, and the formation of antibiomas. antibiomas are characterized by the formation of a localized pathology surrounded by thick fibrous tissues in response to long term antibiotics use. an established antibioma is characterized by a tough fibrous swelling accompanied by painful or painless swelling, intermittent fever and constitutional symptoms. in this article, we are reporting the case of a facial antibioma formed due to prolonged use of antibiotics prescribed for a residual periapical infection following endodontic treatment. in addition, the association of using antibiotics in this context is discussed.

A Retrospective Analysis on the Cystic Echinococcosis Cases Occured in Northeastern Punjab Province, Pakistan

A retrospective study was performed to report the case occurrence of cystic echinococcosis (CE) in three hospitals of north-eastern region in Punjab Province, Pakistan. We reviewed retrospectively the clinical records of patients in 4 hospitals which were diagnosed with CE during 2012–2017. A total of 198 cases, 82 (41.4%) male and 116 (58.6%) females were detected as CE. The most Highest incidence was revealed in.... 21–30 years-old group (24.2%) followed by 41–50 (22.7%), 31–40 (16.2%), 11–20 (13.6%), 51–60 (8.1%), below 10 (5.5%), over 71 (5.1%) and 61–70 year-old group (4.5%). CE was detected in various organs of infected individuals. However, most of CE cases were detected in the liver (47.4%) and lung (18.6%). The present study indicated that CE is more or less prevalent in surveyed areas and one of the most important public health problems in Punjab Province, Pakistan.

Regenerative Potential of Platelet Rich Fibrin (PRF) for Curing Intrabony Periodontal Defects: A Systematic Review of Clinical Studies

Platelet-rich fibrin (PRF) has been used in regenerative medicine and dentistry. Recently, its use has been advocated for regenerative periodontics and wound healing. The randomized control trials have assessed the regenerative efficacy of the PRF for restoring intrabony periodontal defects.The objectives are to critically analyze and appraise the currently available literature, focusing on the use of PRF in regenerating periodontal bone defects. An electronic search was conducted (PubMed/MEDLINE, Google Scholar, ISI-WOS). Various combinations of following keywords were used: ‘ platelet-rich fibrin’, ‘ intrabony’, ‘ periodontal’, ‘ bone defect’ and ‘ guided tissue regeneration’.Asecondary search was conducted by analyzing the reference lists of the articles obtained in initial search. The final search resulted in 13 randomized controlled trials being included. Inmajority of studies, PRF resulted in better clinical/radiographic outcomes than open flap debridement and augmented therapeutic effects of bone grafts. The combination of bovine bone substitutes and PRF resulted in better performance compared to alone. Similarly better outcomes were observed while using PRF in combination with nanohydroxyapatite, metformin and demineralized freeze-dried bone allograft. It can be concluded that PRF produces better outcomes than open flap debridement alone and augments the regenerative effects of bone substitutes.

Effect of cellulose acetate phthalate and polyethylene glycol on physical properties and release of theophylline from microcapsules

ABSTRACT The present study describes the development of theophylline microcapsules by a non-solvent addition method and the effect of plasticizer addition on microencapsulation. The release was studied in distilled water and the data were analysed by various mathematical models for determining the mechanism of release. Prepared microcapsules were found to be spherical, free flowing and having more than 80% entrapped drug. The polymer - cellulose acetate phthalate and plasticizer - polyethylene glycol was considered to be affecting the properties of microcapsules including drug release (time for 50% drug release, T50). The formulation with the highest proportion of polymer and without plasticizer (F3) showed the slowest release with T50 = 4.3 h, while the formulation with lower proportion of polymer and 20% (w/w) plasticizer (F13 &14) showed the fastest release of drug with T50 values of 1.2 h and 1.3 h, respectively. The drug release from most of the formulations was found to be following Higuchi model. It is concluded from the results of the present study that cellulose acetate phthalate significantly affects the sustained release of the drug in water, whereas the addition of polyethylene glycol slightly enhances the drug release.

RESUMO O presente estudo descreve o desenvolvimento de microcápsulas de teofilina pelo método sem adição de solvente e o efeito da adição de plastificante na microencapsulação. A liberação foi estudada em água destilada e os dados foram analisados por vários modelos matemáticos para determinação do mecanismo de liberação. As microcápsulas preparadas mostraram-se esféricas, livres de corrente e com mais de 80% de fármaco encapsulado. O polímero - ftalato de acetato de celulose e o plastificante - polietileno glicol - afetaram as propriedades das microcápsulas, incluindo a liberação do fármaco (tempo para liberação de 50% do fármaco, T50). A formulação com a maior proporção de polímero e sem plastificante (F3) se mostrou como a de liberação mais lenta, com T50 = 4,3 h, enquanto as formulações com menor proporção de polímero e 20% de plastificante (m/m) (F13 &14) apresentaram a liberação mais rápida do fármaco, com T50 de 1,2 h e 1,3 h, respectivamente. A liberação do fármaco para a maioria das formulações seguiu o modelo de Higuchi. Concluiu-se, dos resultados do presente estudo, que o ftalato do acetato de celulose afeta significativamente a liberação controlada do fármaco em água, enquanto que a adição de polietileno glicol aumenta ligeiramente a liberação do fármaco.

Skeletonization of left internal mammary artery in coronary artery bypass grafting

Objective: To compare mean per-operative flow capacity between skeletonized and pedicled left internal mammary artery [LIMA] in patients undergoing coronary artery bypass grafting [CABG] surgery

Study Design: Randomized control trial

Place and Duration of Study: Department of Cardiac Surgery, Armed Forces Institute of Cardiology and National Institute of Heart Diseases [AFIC-NIHD], Rawalpindi, Pakistan from February to August, 2013

Methodology: Patients undergoing CABG for coronary artery disease, under 80 years, excluded by the exclusion criteria; and fulfilling the inclusion criteria were randomly assigned to two groups of 70 each. One group underwent skeletonized and the other underwent pedicled technique of LIMA harvesting. Free flow was checked just before anastamosis of each LIMA to the LAD, manually in blood flow in ml per minute during cardiopulmonary bypass by allowing it to bleed into a 100 ml container over 20 seconds. A specialized proforma was used to record the age, gender, weight, disease, type of IMA used, and free flow of the IMA. Data was analyzed using SPSS 18

Results: The mean age of the patients was 57.16 years in 40 patients, ranging from 36 to 75 years. Disease pattern analysis showed 5%, 10.7% and 84.3% single, double and triple vessel coronary artery disease, respectively. There was significantly higher free flow in the skeletonized group than the pedicled group [p=0.04]

Conclusion: Skeletonized IMA had superior flow to pedicled IMA in addition to its traditional proven advantages, which justifies its further use as a conduit for myocardial revascularization

Pharmacoeconomical evaluation of prescribing trends and prescription cost analysis of anti-diabetic drugs in the United Kingdom

This study deals with the pharmacoeconomical evaluation of the prescribing trends and prescription cost analysis of anti-diabetic drugs in UK from 1999-2015. The trend and cost estimation have been performed by the help of prescription cost analysis [PCA] data provided by National Health Service [NHS], UK. In addition to PCA, the trend of prescribing new drugs developed for type-II diabetes has also been studied. A dramatic increase in cost and number of diabetic drugs dispensation has been observed. The total number of diabetic prescriptions from 1999 to 2015 has significantly increased from 1,01,70,700 to 4,17,92,000 while the rise in total cost during the same period is found to be from pound 13,66,13,200 to pound 74,71,36,500. The largest proportion of cost was spent on insulin until 2013 followed by oral hypoglycemic agents, in spite the fact that they were three times more prescribed than insulin. However, in the last two years, the cost of oral hypoglycemics has superseded insulin. Biguanides [metformin]were the highly prescribed drugs among oral hypoglycemic followed by sulfonylureas and thiazolidinones. The relatively two new groups of drugs i.e. glucagon like peptide-1[GLP-1] mimeticsand dipeptidyl peptidase [DPP-IV] inhibitors are comparatively more expensive than the conventional anti-diabetic drugs but still a rise in their prescribing has also been noted from the year 2007 and onwards. A decrease in prescribing of alpha glucosidase inhibitors has been observed. It is concluded that the prevalence of diabetes is constantly increasing with the passage of time and it would be a great challenge in future to control it due to aging and high obesity rates in UK

Epidemiology of polio virus infection in Pakistan and possible risk factors for its transmission

End Polio Pakistan program still has to overcome many hurdles; unfortunately on 8th February 2016 first polio case of the year has surfaced in Karachi. It seems that battle against polio demands little bit more conviction and motivation. WHO has set a goal of polio eradication in Pakistan till 2018, in order to evaluate the success of this target; polio eradication campaign in Pakistan has been analyzed in different perspectives. Our analysis indicated that major obstacles in eradication are low literacy rate, poor health infrastructure, lack of planning, natural disaster, economic crisis, counter insurgencies and almost no protection for polio health workers. WHO has allocated new funds to tackle this problem, now there is a need to spend this money more effectively; with proper planning and honest deployment of funds.

Epidemiology of polio virus infection in Pakistan and possible risk factors for its transmission

End Polio Pakistan program still has to overcome many hurdles; unfortunately on 8th February 2016 first polio case of the year has surfaced in Karachi. It seems that battle against polio demands little bit more conviction and motivation. WHO has set a goal of polio eradication in Pakistan till 2018, in order to evaluate the success of this target; polio eradication campaign in Pakistan has been analyzed in different perspectives. Our analysis indicated that major obstacles in eradication are low literacy rate, poor health infrastructure, lack of planning, natural disaster, economic crisis, counter insurgencies and almost no protection for polio health workers. WHO has allocated new funds to tackle this problem, now there is a need to spend this money more effectively; with proper planning and honest deployment of funds.

Reproductive health issues of mothers; a study in Faisalabad

In Pakistan maternal mortality rate is very high as compared to other low income countries. Maternal mortality rate in Pakistan 260/100,000 is the highest in South Asia. In developing countries one woman dies in sixteen from pregnancy related diseases

Objective: This study was aimed to explore reproductive health issues of mothers in Faisalabad

Study Design: A sample of 200 respondents was obtained from Faisalabad city through multistage sampling technique

Period: 2013-2014

Setting Area: Urban Area of district Faisalabad

Material and Method: Uni-variate [frequency distribution and percentage] and Bi-variate analysis [Chi square and Gamma Statistics] was carried out

Results: It was found that antenatal and postnatal care utilization services were poor. Majority of the respondents 79% got at least one antenatal care service but only more than one third 34% got the four recommended checkup during pregnancy. It was also investigated that only 60% women got postnatal visits and only 18% deliveries took place at homes. Two third of the respondents 66% had the positive attitude towards the contraceptive methods for birth spacing. The bi-variate analysis shows that age [p=.003], education [p=.013], income [p=.001], type of family [p=.002] were significantly associated with the positive attitude towards the contraceptive for birth spacing

Conclusion: It is suggested that mothers should be aware of the importance of antenatal and postnatal recommended visits to overcome the reproductive health issues through LHW's visits mass media compaigns and easy assess towards the health care centers

Evaluation of root canal morphology of maxillary molars using cone beam computed tomography

The success of endodontic treatment is based on cleaning and shaping of the root canals. The root canals have complex morphology and wide individual variations. The objective of this study was to analyze root canals morphology and existence of extra canals in maxillary molars in Saudi subpopulation. Freshly extracted maxillary first molars [n=100] were included in this study. All teeth were examined for morphology of roots, root canals and apical foramen by Cone Beam Computed Tomography [CBCT]. The root canals configuration was classified using Vertucci's classification. The majority of maxillary first molars [94%] were having three distinctly separated roots and 6% had four roots. Palatal and distobuccal roots were observed to contain one root canal [100%] and Vertucci's type I configuration. The mesiobuccal root had one [29.4%; type I] or two canals [70.6%; type II, III or IV]. The occurrence of second canal in the mesiobuccal root of upper first molar is very much likely [>70%]. The mesiobuccal roots are more likely to have Vertucci's type I or II configuration [>76%]. The palatal and distobuccal roots always have a Vertucci's type I canal configuration

Evolving medical and dental education system in Pakistan

Medical science is the backbone for treatment and the foundation for understanding human diseases. Standardization and organization of medical and dental education is required to accomplish goals towards achieving excellence in professional practice. The aim of this publication is to explore the current status of educational system in medicine and dentistry in Pakistan and possible channels for improvement. Medical and dental educational system for undergraduate as well as postgraduate level must comprise of continuing professional developmental sessions both for students and teachers. There is also a concomitant need of well discerned educational system which helps to manage trainee's induction, their curriculum assessment, and examination process. In addition, activities such as keeping the entire medical and dental education system under continuous circle of evaluation in the form of feedback and effective communication are essential at periodic academic stages. An interactive session at multiple levels and its valid quantified evaluation is constantly required to assess the progress of ongoing educational system. A well oriented process of decision making involving syllabus, professional annual examinations, re-certification examinations and licensure requirements must be comprehensively established