The retromandibular transparotid approach vs. retromandibular retroparotid approach for the mandibular condyle: our clinical experience

Aim: The mandible is regarded as a frequently fractured bone in patients who present with maxillofacial trauma accounting for almost 15.5% to 59% of all facial fractures. Managing condylar trauma has remained to be a point of contention amongst experts, regardless of the advances in surgical modalities and methodologies, and the treatment plan is often determined by the preference and the experience of the surgeon. There exist various approaches in the literature, each with its own specific benefits and drawbacks. With this study, we aimed to evaluate the prevalence of post-operative complications in patients who experienced ORIF by means of the retromandibular approach, by comparing the outcomes of one group having undergone transparotid surgery, with another that underwent retroparotid surgery. Methods: An experimental trial was undertaken. Convenience sampling was done from among the cases of condylar neck and base fracture visiting the department of OMFS, Dow University of Health Sciences from January 2017 to December 2019. An overall 26 patients were divided into 2 groups of 13 members each; one was managed using Open Reduction Internal Fixation (ORIF) by means of a retromandibular transparotid approach while the other group was treated with ORIF by means of a retromandibular retroparotid approach. A 6 month follow-up was done to assess range of active motion, occlusion, and complications such as deviation/deflection, neural injury, infections, sialocele, salivary fistulae and Frey's syndrome in both groups. Results: There was no statistically significant difference between the two groups in terms of inter-incisal opening, right and left lateral movements, or protrusion. One patient in the retroparotid group had deviation on mouth opening (7.69%), while one in the transparotid group reported with infection (7.69%), and 2 developed post operative seromas (15.38%). None had persisting facial nerve palsy at 6 months. Conclusion: We find no significant disparity between the 2 approaches at a follow-up of 6 months; therefore, the primary determining factor for selection of either technique is surgeon preference and appropriate case selection

management of glycemic control in associated disorders

Glycemic control is a very useful parameter for the prevention of the chronic metabolic diseases complications such as diabetes, metabolic syndrome, cardiovascular and kidney disease. Glycemic control management among chronic metabolic diseases has been an area of active research from the past decades. The glycemic index specifies that how fasting blood glucose level is elevated after consuming a high carbohydrate-containing diet. The metabolic studies among the human populations showed that glycemic index is directly related with different chronic metabolic diseases. The sturdiest associations are suggested that the low caloric diet consumption can prevents metabolic complications. Primary and tight glycemic control is compulsory to prevent and reduce the development of vascular complications in individuals with chronic disorders. The aim of this review was to provide a practical guideline on the bases of the survey of the related key studies which had reflected the clinical guidelines and current perspectives related to glycemic management. The objective of this review is also to investigate the interventions, related to glycemic control in patients with diabetes, metabolic syndrome and cardiovascular diseases. In conclusion, we can say that multidisciplinary management of glycemic control are powerful measure for the prevention of metabolic diseases complications, providing necessary support for reducing in economic burden of chronic metabolic diseases

Resistance patterns among multidrug-resistant tuberculosis patients: a multi-center study from Pakistan

Background: the high burden of multi-drug resistance tuberculosis [MDR TB] is a matter of great concern. The increasing resistance to anti tuberculosis drugs has been the area of growing concern and are posing threats to TB control. The aim of this study was to evaluate the drug resistance patterns for the first line and second line anti-Tuberculosis drugs in multiple drug resistant tuberculosis [MDR-TB] patients

Method: the study was retrospective, observational, employing purposive, non-random sampling technique for data collection conducted at the TB Clinic- of the different healthcare centers in the provinces of Pakistan Sindh and Baluchistan from December 2010 to May 2016. All bacteriologically confirmed TB patients who were found to be Rifampin Resistant [RR] on Genotypic drug susceptibility testing [GXP], or detected to be drug resistant on phenotypic Universal drug susceptibility testing were enrolled into the study

Results: out of total 3776 patients, 96.3% were resistant to Rifampicin and 94.7% were resistant to Isoniazid. 25.5% isolates were resistant to all five first line drugs. Resistances against Pyrazinamide and Ethambutol was 54.2% and 51.6% respectively. 36.3% patients were resistant to Fluoroquinolones [FQ], 9.7% were resistant to Ethionamide [Eto] and 4.1% were resistant to both FQ and Eto. 33.5% patients were MDR plus resistant to FQ. However, the resistance to both FQ plus Aminogycosides was quite low, 2.7%

Conclusion: the drug resistance rates are quiet high in MDR-TB for both first line and second line drugs. The standardized MDR TB regimen needs to be updated, based on the prevalence of drug resistance patterns in the community for the effective management of drug resistant TB

Interplay between cholesterol, SREBPs, MicroRNA-33 in dyslipidemia

Dyslipidemia is characterized by elevation of plasma cholesterol, triglycerides [TGs] or both, or a low high-density lipoprotein-cholesterol [HDL-C] level that contributes to the development of insulin resistance, Diabetes mellitus type 2 [DM2] and atherosclerosis. Dietary fat and cholesterol, genetics and other risk factors are responsible for producing variations in the lipids. The cholesterol plays a major function in the body, cholesterol homeostasis mechanism is regulated by the sterol regulatory-element binding proteins [SREBPs] and firstly introduced by Brown and Goldstein. The SREBP transcription factors act coordinately with their intronic microRNAs [miRNA-33a / miRNA-33b] to regulate both fatty acid and cholesterol homeostasis. Recently, multiple studies described microRNA-33a and SREBP2 cooperation for cholesterogenic transcription to improve intracellular cholesterol levels; suggesting that therapeutic approach of miR-33 targeting antisense would imperative for reverse cholesterol transport from atherogenic macrophages, as a result reduce atherosclerosis

Vitamin thiamine and glucose homeostasis in alloxan induced diabetes mellitus

Objective: valuating the vitamin B[1] [thiamine] on glucose homeostasis and Glycosylated hemoglobin A1 [HbA1c] in Alloxan induced diabetic rat model

Study Design: Experimental study

Place and Duration of Study: This study was conducted at the Animal House, Isra University Hyderabad from September 2014 to March 2015

Materials and Methods: 60 adult albino rats were divided into four groups; Group 1. Controls, Group 2. Rats receiving thiamine added diet, Group 3. Diabetics rats on normal diet and Group 4. Diabetic rats receiving thiamine added diet. Alloxan [120 mg/kg] was introduced intraperitoneally to induce diabetes. Vitamin B1 was given orally at 1.6 g/kg body weight for 12 weeks. Venous blood was taken from tail vein by small bore cannula at the baseline and after 12[th] week. Blood glucose and HbA1c were detected at baseline and after 12[th] week. Data was saved in proforma and analyzed on SPSS 22.0 using paired student t-test at 95% confidence interval

Results: Blood glucose and HbA1c levels were found statistically significant in groups 1 vs. 3 [p=0.0001], 1 vs. 4 [p=0.0001], 2 vs. 3 [p=0.0001], 2 vs. 4, [p=0.001] and 3 vs. 4 [p=0.024] at the end of experiment period. Significant improvement in blood glucose and HbA1c was noted in the vitamin thiamine treated rats

Conclusion: Vitamin thiamine improved the blood glucose homeostasis and reduced Glycosylated Hemoglobin A1 effectively in experimental rats. It is recommended to supplement diabetic subjects with vitamin thiamine

Treatment of mycosis fungoides with total skin electron beam therapy using modified stanford technique

A retrospective review of three patients with mycosis fungoides treated with total skin electron beam therapy, from the year 2007 to 2009, at the Oncology department, Ziauddin University Hospital

Evaluating the correlation between histopathological patterns of oral squamous cell carcinoma, age and site

The objective of this study was to provide a baseline data on the pattern of oral squamous cell carcinoma in Karachi and to find a correlation between the clinical patterns of oral squamous cell carcinoma with age and site. The retrospective cross sectional study was conducted. The patients of oral squamous cell carcinoma were examined from January 2007- December 2010 at oral maxillofacial department, Darul Sehat Hospital Karachi. All retrievable case files were obtained and necessary data were extracted regarding age, gender, site and histological type. All cases were clinically examined and provisionally diagnosed. Biopsy was taken from the lesions and tissues were fixed in 10% buffered formalin and submitted to histopathologic department for histological confirmation. 62% of males and 38% females were diagnosed with squamous cell carcinoma. 30% were observed in age group of 41-50 years old. 45% of squamous cell carcinoma were on buccal mucosa. Correlation between the 2 variables i.e., site to histological type and age to histological type was found to be statistically significant. Level of significance was set at 0.05. However, the strength of association was weak between the selected variables. OSCC was most common of all oral malignancies of which most were in the older age group. Serious thought should be given to prevention and early detection

Efficacy of peripheral streptomycin injection in the treatment of idiopathic trigeminal neuralgia

To evaluate the efficacy of peripheral streptomycin injection in relieving the pain of idiopathic trigerninal neuralgia. Quasi experimental study. Oral and Maxillofacial Surgery Department, Armed Forces Institute of Dentistry Rawalpindi, from 1[st] June 2006 to 31[st] December 2007. Thirty patients of idiopathic trigerninal neuralgia were selected. They received five consecutive injections of streptomycin Ig in 3 ml of 2% Lignocaine [Septodont] with 1: 100,000 adrenaline at one week interval. Follow up was carried out at one, two and six months after the last injection. Age ranged from 15-78 years [mean 44.67]. Male to female ratio was 1:1.14. Right side of the face was involved in 70% and left side in 30% cases. Mandibular division of trigeminal nerve was involved in 43.3% and maxillary division in 40% of the cases. In the rest both maxillary and mandibular divisions were involved. Pain was significantly decreased from baseline to 1 month [p < 0.001]. The level of pain was increased a bit but the increase was significant at two months [p = 0.006] and at 6 months [p = 0.020]. Best treatment modality for this devastating disease is yet to evolve. Within the confines of the study it can be stated that efficacy combined with low post treatment morbidity makes streptomycin a useful treatment option

Protective effect of vitamin E [alpha tocopherol acetate] on diclofenac-induced nephrotoxicity in young albino rats

To determine the preventive role of Vitamin E on renal parenchyma after given of Diclofenac Sodium in young albino rats. Experimental study. This study was carried out in the Department of Anatomy Baqai Medical University and Muhammad Medical College. Mirpurkhas from June 2011 to November 2011. 30 young albino rats were taken. They were divided into three groups: A, B and C. The animals in group-A given normal saline 10 ml/kg per day. Group-13 received diclofenac sodium 2 mg/kg per day and group-C receives diclofenac sodium 2mg/kg/day dissolved in distilled water with vitamin-E 2 mg/kg/day dissolved in olive oil administered half an hour before the diclofenac sodium by feeding tube per day for 2 weeks. On day 15 all animals were sacrificed with deep ether anesthesia. Their kidneys were removed, fixed in 10% formalin, Representative blocks were taken and embedded in liquid paraffin. For routine histological examination 5 pm thick section cut by niicrotome and stained with HandE, PAS and silver methenamine Renal histology was done under- light microscope to see the proximal and distal tubular diameter and count. No significant [PT0.05] changes were observed in the histopatholov of kidney tissues of the groups A and C rats. The group B significantly [P<0.001] affected the histopathology of kidney. It may be concluded that diciofenac sodium produces changes in kidne, which may be attributed to ischaemia induced by inhibition of prostaglandin synthesis resulting in tubular necrosis in young albino rats simultaneous administration of vitamin-E partially protect the morphological and histological changes induced by diclofenac sodium

Immunological study of type 2 diabetic patients with periodontal disease

To evaluate the IgA, IgG and IgM levels in the serum samples of type 2 diabetic and Periodontal patients of the Peshawar area having different life style set up. Case control study. This study was carried out on subjects who fulfilled our criteria and agreed to participate in the study were included. They were residents of Peshawar area and visited OPDs of Khyber College of dentistry, Peshawar during July, 2012 to June, 2013. Among 120 participants, 30 were healthy, 30 were with periodontitis, 30 had diabetes and the remaining 30 had both diabetes and periodontitis. All of them had at least 20 natural teeth. Diabetic patients had the disease history minimum of five years while the periodontal patients had clinically confirmed the disease. Blood samples were collected from each of the participant and immunoglobulins A, G and M were measured. The observed data were analyzed accordingly through standard statistical methods. Male patients were found more as compared to females [ratio 1: 0.87] in the two diseases. The age range was 35 to 54 years with the mean 44 +/- 5. As per HBA1C results; 40% had good control of diabetes, 26% moderate while in 34% control was poor. Immunoglobulin A and G levels were found significantly higher [p < 0.05] in the three disease groups as compared to control group. Whereas the concentration of IgM was not changed by the said diseases. Besides, the gender has no influence on the levels of the three immunoglobulins. The IgG levels increased with the increase in severity of the Periodontitis disease. While IgA showed slight decrease with the increase in clinical grades of the Diabetes disease. The result of the current study indicates the role of humoral immune response in the two mentioned diseases. The higher levels of immunoglobins particularly IgA and IgG might be due to protective mechanism against the weak immune response and the increased bacterial challenge in diabetes and periodontitis

Histopathological patterns of oral squamous cell carcinoma

The objective of this study was to provide a baseline data on the pattern of oral squamous cell carcinoma in Karachi. The retrospective cross sectional study was conducted. The patients of oral squamous cell carcinoma were examined from January 2007- December 2010 at oral maxillofacial department, Darul Sehat Hospital Karachi. All retrievable case files were obtained and necessary data were extracted regarding age, gender, site and histological type. All cases were clinically examined and provisionally diagnosed. Biopsy was taken from the lesions and tissues were fixed in 10% buffered formalin and submitted to histopathologic department for histological confirmation. 62% of males and 38% females were diagnosed with squamous cell carcinoma. 30% were observed in age group of 41-50 years old. 45% of squamous cell carcinoma were on buccal mucosa. OSCC was most common of all oral malignancies of which most were in the older age group. Serious thought should be given to prevention and early detection

Adrenocortical oncocytoma

Adrenocortical oncocytoma is an exceedingly rare pathological variant of an adrenal neoplasm. The pathogenesis of oncocytic neoplasms is poorly understood. Females have been reported to be affected 2.5 times more frequently than males, and left-sided lesions are more common than those on right side. This case describes a 20 years old female with right lumbar pain. She found to have a right adrenal gland mass measuring about 6 x 5 cm. A computed tomogram showed hypodense mass lesion 6 x 4.2 cm involving right adrenal gland. Differential diagnosis of non-functional adrenal adenoma was made. A laparoscopic right adrenalectomy was performed using the 3-ports lateral transperitoneal approach. Histopathology showed adrenocortical oncocytoma of adrenal gland

Assessing the effectiveness of evidence based practice course on clinical practice of physiotherapy students using objective structured clinical examination [OSCE]

To assess the effectiveness of the EBP course on clinical practice of graduate physiotherapy students using OSCE stations. Thirty students of post graduate physiotherapy participated in an EBP course workshop of 30 hours [5 days] in Mangalore, Karnataka, India. The EBP course was designed to teach core EBP knowledge and skills based on the EBP 5 step model. EBP OSCE tool was developed and applied to test the effectiveness of EBP course. The inter-rater reliability of OSCE tool was good [ICC = 0.98, 95% CI: 0.93 to 0.99] and highly acceptable Internal consistency [Cronbach's alpha = 0.99] reflects how consistently different OSCE station measure the unified construct, i.e., EBP clinical skills. Before the EBP course, the participants had a mean score of 39% overall, Post course evaluation, the mean percentage of student's performance increased to 69%, indicating 30% improvement with significant improvement at each EBP OSCE stations [p < 0.001]. Short EBP course delivered in workshop mode was effective in improving EBP knowledge and skills of graduate physiotherapy students. This study demonstrated the use of OSCE to test the EBP knowledge and skills in different clinical vignettes

Cytoprotection of heat - induced splenic tissue by cyanocobalamin in albino rats

To evaluate the cytoprotective role of the Cyanacobalamin on the detrimental effects of heat -induced stress on splenic tissue. An Experimental study. Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from January 2010 to April 2010. Forty five Albino rats [180-200 grams] were selected and divided into group A [Control], group B [Heat - induced] and group C [Protective] Each group was further subdivided into three subgroups, based on the period of the study. The animals of the subgroups B and C received heat and the temperature was set at 42 C for six hours daily. Group C [Cl, C2 and C3] animals were protected with Cyanocobalamin [BETOLVEX] at the dosage of 0.8 mg/ kg of body weight intraperitonealy, two hours before heat induction. Then animals were sacrificed according to their time duration, spleens were removed and fixed in alcoholic formalin for 24 hours .Then tissue were processed in ascending strengths of alcohol from 70 to 100%,cleared in xylene, infiltrated and embedded in paraffin. 5 micron thick sections were stained with haemotoxylin and eosin and e. Blood samples were collected in EDTA K3 containing vacutainers for the hormonal assay of plasma ACTH level. in group B animal's heat-stress alters the immunoarchitecture of the spleen; size of all comportments of the white pulp reduces with the appearance of the tingitble body macsophages and individual apoptotic cells and free apoptotic bodies. This group also shows significant increase in plasma ACTH levels. Whereas the splenic architecture and plasma ACTH level in group C animals return to normal by the cytoprotective effects of the Cyanocobalamin. The current study demonstrates the beneficial effects of the Cyanocobalamin to alleviate the detrimental effects of the heat-stress on the immune organs

Anti-stress Role of Cyanocobalamin in Heat- induced Weight Loss in Albino Rats

To determine the deleterious effects of heat-stress on the body weight and to evaluate the anti - stress role of the Cyanacobalamin. An Experimental study. Department of Anatomy, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi from November 2010 to February 2011. Forty five Albino rats [180-200 grams] were selected and divided into group A [Control], group B [Heat - induced] and group C [Protective]. Each group was further subdivided into three subgroups, based on the period of the study. The animals of the subgroups B and C received heat and the temperature was set at 42 C for six hours daily. Group C [Cl, C2 and C3] animals were protected with Cyanocobalamin at the dosage of 0.8 mg/kg of body weight intraperitonealy, two hours before heat induction. All the animals were weighed before the commencement of the study. Blood samples were collected for the hormonal assay of plasma ACTH level. Heat -stress and its consequences significantly decrease the body weight in group B animals. It could be due to hyper activation of the HPA and is and resultant ACTH corticosterone secretions causecatabolism of muscle and other bodily proteins. The prophylactic use of Cyanocobalamin group C animals by its cytoprotective of and anti-apoptotic role significantly increase the body weight and restore ACTH secretions near to normal. Findings of the current study conclude that Cyanocobalamin is beneficial to alleviate the detrimental effects of the heat-stress

Captain of all these men of death - tuberculosis remains the commonest diagnosis - two years experience of bronchoscopy at Shaikh Zayed hospital, Lahore

A retrospective study of two years duration was conducted at the department of Pulmonology, Shaikh Zayed Hospital, Lahore, Pakistan to review our experience with bronchoscopy. Data was collected from145 patients who underwent bronchoscopy for different diagnostic and therapeutic indications. The study participants were having ages between 13 and 93 years. There were 85 male and 60 female patients. Bronchoscopy was performed for diagnostic purposes in 124 [85%] patients, for therapeutic purposes in 9 [6%] patients and for surveillance of airways in 13 [9%] patients. Bronchoscopy remained diagnostic in 74.19% patients. Tuberculosis was the commonest diagnosis in 34.6% patients followed by malignancy which was diagnosed in 16.1% patients. In 82% patients there was no complication during procedure, while mild haemoptysis occurred in 11.72%, 5.5% had wheezing [bronchospasm], 4.1% developed low grade fever and 1 patient died due to respiratory failure. It was concluded that bronchoscopy is found to be a useful procedure and can be used safely for diagnoses and treatment of different respiratory diseases

Urolithiasis in male patients: a pilot study on the ethnic differences and clinical profile

The association between ethnicity, age, clinical profile, stone size with type of ureteric stones among male patients with urolithiasis was studied. Male patients above 18 years with lower ureteral stones size < 10mm attending outpatient department of Urology, GMC hospital, Ajman over a period of one year were included. Ethical approval obtained from Institutional Ethics Committee. Data was retrieved from the case record form which included socio-demographic variables [age, nationality], clinical profile [ureteric colic, duration of pain, other complaints, laboratory investigations [type of stone, stone size]. Descriptive and inferential statistics were performed with SPSS version 20 and p values < 0.05 considered significant. 185 male patients were included. Mean age was 41.5 [7.3] years, range [22-71] years. Of the total, 81[43.8%] patients were of Asian ethnicity, 81[43.8%] Arab and 23 [12.4%] were of other ethnicity. Most patients [95.1%] reported with ureteric pain. Only 49 [26.5%] had family history of stone disease with majority being first degree relation. Data on type of stone was available for 90 patients; of which, 21 were calcium oxalate monohydrate, 33-calcium oxalate dehydrate, 24-uric acid and remaining 12 other form of stones. Uric acid stone was common among Asians and calcium oxalate-dehydrate among Arab ethnicity. Among those with family history calcium oxalate monohydrate and uric acid stones were common compared to other types. Average age for different types of stone was 38.3, 41.6, 39.4 and 42.8 years respectively for calcium oxalate monohydrate, calcium oxalate dehydrate, uric acid and other types. Uric acid stones were more prevalent among Asians and calcium oxalate-dehydrate stones among the Arabs. Further studies among multiethnic population focusing on detailed dietary pattern and stone analysis can be conducted

Effects of Khat chewing and other factors in the control of hypertension among treated patients attending private clinic

The aims of the study to determine the blood pressure control and the risk factors of poor control stressing on Khat. 209 hypertensive patients were included in study. They were 105 males and 104 females. Sampling was convenient that any patient attending the clinic and followed regularly was included. Blood pressure [BP] was recorded, three times at each session and the mean was calculated. Three sessions were/at an interval of at least one month and the average BP was calculated. A record of BP of 140/90 or less was taken as control and any value above was uncontrolled all variables were recorded in a questionnaire filled for that purpose. The data was collected and analyzed using SPSS program. 209 hypertensive patients were included with equal male female ratio, mean systolic BP was 150 +/- 20 mmHg, while the mean diastolic BP was 89 +/- 12 mmHg. The mean age was 54 +/- 10 years. 35.9% had controlled BP, compared with 64.1% uncontrolled. Khat chewing non drug compliance, lack of exercise, regular salt intake, low educational level and weight gaining were associated with poor BP control with statistical significance. There were no significant differences in the sex distribution, residence, marital status, smoking, type of antibypertensive drugs used and interfering medications, between controlled and non controlled hypertensive patients. There was low control rate among our hypertensive patients. Drug compliance should be improved, health education, avoidance of Khat. and exercise should be encouraged, as well as salt and weight reductions, in order to improve hypertension control

Comparison of placentae from hypertension associated pregnancies and normal pregnancies

Objectives: this study was carried out to compare the placentae from hypertension associated pregnancies and normal pregnancies

Design: comparative study

Setting: Isra University Hospital Hyderabad Sind

Method: eighty full term placentae were collected; 40 from normal and 40 from hypertensive pregnant women. Gross features of placentae were noted and then stained for their microscopic features. Birth weight and Apgar score of the newborn were recorded

Results: the weight and surface areas of placentae were significantly low in the hypertensive group whereas thickness of placenta and number of cotyledons were almost same in hypertensive and control groups. Microscopically increased number of syncytial knots, chorionic villi with excessive collagen was observed in placentae of hypertensive women. In hypertensive group birth weight of neonates was significantly low than control group while difference in APGAR score between two groups was statistically insignificant

Conclusion: hypertension during pregnancy is associated with remarkable changes in the placentae