A Radiographic Study of Prevalence and Location of Enamel Pearls in a Saudi Arabian Adolescent Population

Objective: To determine the prevalence of enamel pearls on panoramic radiographs and to explore any potential correlation between the occurrences of enamel pearls with gender, jaw and tooth involved. Material and Methods: Digital panoramic radiographs of 642 adolescents aging 12­19 years were examined for the presence of enamel pearls. The location of involved tooth in terms of jaw and side and gender were recorded. Statistical analysis was carried out by applying Chi-square tests with the Yates correction. The level of significance was set at 5%. Results: The person prevalence of enamel pearls was 4.82% of patients and tooth prevalence was 0.96%. No statistical significant difference was observed between maxillary and mandibular arches and no gender and side predilection was observed. Most of the enamel pearls were seen in maxillary third molars (4.76%) and mandibular third molars (2.68%), followed by maxillary first molars (2.68%) and mandibular second molars (1.95%). No enamel pearl was observed in any of the anterior teeth or in any of the deciduous teeth. Conclusion: The prevalence of enamel pearls was observed in 4.28% of patients and 0.96% of teeth. They were most frequently seen on molars with no predilection for gender, jaw and side.

Brachdactyly instigated as a result of mutation in GDF5 and NOG genes in Pakistani population

Objectives: Brachdactyly a genetic disorder associated with the abnormal development of metacarpals, phalanges or both which results in the shortening of hands and feet. Mutations in the contributing genes has been recognized with the majority of the investigated syndromic form of brachdactyly. The current study was proposed to examine mutation in NOG and GDF5 genes in a Pakistani family

Methods: Poly Acrylamide Gel Electrophoresis and Polymerase Chain Reaction was used for the genomic screening and linkage analysis to observe the mutation in genes. The samples were collected from Luckki Marwat district, KPK, while the research study was conducted in the department of Biochemistry, Quaid-IAzam University, Islamabad, Pakistan

Results: After survey, family was identified with brachdactyly type A2 and investigated a heterozygous arginine to glutamine exchange in the growth demarcation factor 5 in all the victim persons. Different types of skeletal dysplasia resulted due to mutation in the GDF5 genes. Novel GDF5 genes mutations were reported with distinct limb malformation and sequencing of coding region revealed that the mildly affected individuals were heterozygous while the harshly affected individuals were homozygous

Conclusion: The current study reported the genetic variability and concluded that the Brachdacytyly type A2 and type B2 resulted due to mutation in GDF5 and NOG genes respectively. A new subtype of brachydactyly [BDB2] was instigated as a result of novel mutations in NOG. The mutation has been reported for the first time in Pakistani population and especially in Pushtoon ethnic population

Effects of chromium on testes and protective role of mulberry

Background: The chromium supplements and medicines are used to reduce sugar and boost sexual performance without recommendations. This practice may cause hyperlipidemia and testicular anomalies which can be partially ameliorated by natural phytochemicals of Mulberry [Morus nigra] fruit extract [MFE]

Objective: To determine the protective effects of mulberry [Morus Nigra] against injury on testes caused by hexavalent chromium

Methodology: This experimental study was conducted at DHQ teaching Hospital Sargodha and experimental work was conducted in Sargodha University. Thirty male mice [Mus musculus] were equally grouped as: C; Control, Cr; 50ppm in water ad-libitum [10 days] followed withdrawal for 5days, Cr-M; as Cr group but followed by 0.25mL/12h MFE and sacrificed on 16[th] day. The laboratory work was completed in 3 months. The data was entered and analyzed by using SPSS version 17

Results: Cr[+6] exposure significantly [p < 0.05] reduced sugar but caused hyperlipidemia, atrophy, steatosis, cirrhosis and necrosis in testes. The accumulation of debris with tail-less sperms raise cross sectional area of seminiferous tubules [ST] to generate pressure potential to lyse some ST. There significant [P< 0.001] reduction of Spermatogonia, primary spermatocytes and dislodged parrot beak headed spermatozoa [PBH] /area specifies sperm deformities and infertility, while Mulberry ameliorates such anomalies

Conclusion: Cr contamination in water and food supplementation may produce histpatholgical changes in the testes while Mulberry has rehabilitation and metal chelating capability to recover anomalies

Surgical Site Infection Following Fixation of Acetabular Fractures / 대한고관절학회지

PURPOSE: Acetabular fractures are mainly caused by high energy trauma. Surgical fixation of these fractures requires extensive surgical exposure which increases the length of operation and blood loss as well. This may increase the risk of surgical site infection. Our aim is to evaluate the prevalence of surgical site infections and the risk factors associated with it so as to minimize its chances. MATERIALS AND METHODS: A total of 261 patients who underwent acetabular fracture surgery were retrospectively reviewed. Patients were divided into 2 groups, with or without surgical site infection. Factors examined include patients' gender, age, body mass index (BMI), time between injury and surgery, operative time, estimated blood loss, number of packed red blood cell transfused, length of total intensive care unit (ICU) stay, fracture type, surgical approach, smoking status, patients' comorbids and associated injuries. RESULTS: Fourteen patients (5.4%) developed surgical site infection. Out of 14 infections, 4 were superficial and 10 were deep. The factors that were found to be associated with surgical site infection following acetabular fracture fixation were prolonged operation time, increased BMI, prolonged ICU stay, larger amount of packed red blood cell transfused and associated genitourinary and abdominal trauma. CONCLUSION: In our study, we conclude that measures should be undertaken to attenuate the chances of surgical site infection in this major surgery by considering the risk factors significantly associated with it.

Clinical profile, conventional surgical approaches and the outcome of the surgery in juvenile nasopharyngeal angiofibroma

To study the clinical profile of angiofibroma, various conventional surgical approaches and the outcome of surgery. Prospective, analytical study. This study was conducted at the Department of Otorhinolaryngology and Head and Neck Surgery, Bolan Medical Complex Hospital, Quetta from January2008 to December2012. This study included 31 patients of juvenile nasopharyngeal angiofibroma over a period of 5 years. All patients were treated by conventional surgical approaches following Fisch staging system. Twenty one [21] patients were operated by lateral rhinotomy approach, Three [3] patients by transpalatal approach, five [5] patients by Weber-Fergusson approach and two [2] by Mid-facial degloving approach. The patients were followed up for a period of three [3] years for any recurrence. All patients were male with mean age 15.61 +/- 2.64 years. The patients presented with recurrent epistaxis, nasal obstruction and nasopharyngeal mass apart from other symptoms and signs. Majority of the patients [80.64%] came with stage II and IIIA disease. Lateral rhinotomy approach was used in majority of cases [67.74%]. Recurrence was observed in 5 cases [16.12%]. Recurrence rate was less [one out of 2leases] with lateral rhinotomy approach in comparison with other approaches. In transpalatal route recurrence was observed in two [2] cases out of three [3] cases, while in Weber-Fergusson approach it was one out of five [5] and in Mid-facial degloving it was one out of two [2] cases. Juvenile nasopharyngeal angiofibroma is a disease of male adolescents. The patient most commonly presents with recurrent epistaxis and nasal blockage with nasopharyngeal mass. Surgery is the treatment of choice. Lateral rhinotomy approach gives an excellent exposure for most of these tumours with less chance of recurrence

l Comparison of Efficacy of Topical Ofloxacin and Gentamycin in Tubotympanic Type of Chronic Suppurative Otitis Media

Objectives: To compare the eficacy of 0.3% topical ofloxacin 4 drops thrice daily with topical gentamycin 0.3%, 4 drops thrice daily in patients with active tubotympanic type of CSOM. Study Design: Randomized controlled trial study. Place and Duration of Study: This study was carried out in the Department of ENT and Head and Neck Surgery, HMC, Peshawar from Jan 2012 to July 2012. Materials and Methods: This Randomized controlled trial was conducted, consisting of 134 patients with ear discharge for more than three months which were randomly allocated to two groups each consisting of 67 patients. Patients in group A received gentamycin 0.3% in a dosage of four drops thrice daily, while patients in group B received 0.3 % ofloxacin four drops thrice daily for ten days. Patients were followed for two weeks after therapy for ear symptoms assessment, otoscopy and examination under microscopy. Results: A total of 134 patients of chronic suppurative otitis media were included in the study. Results showed that the rate of resolution of ear discharge [otorrhea] is significantly higher in patients treated with topical Ofloxacin than gentamycin [98.5% vs 89.6%]. [Pc0.05] Conclusion: Topical Ofloxocin is a better choice in management of CSOM than topical Gentamycin in terms of resolution of ear discharge.

Etiological agents of CSOM and its sensitivity pattern

The present study was undertaken with the aim to detect bacteria and fungi as aetiological agent in CSOM and to see susceptibility pattern of bacterial isolates to different antibiotics and to determine the beta lactamase production by the bacterial isolates. Experimental Study. This study was conducted in the department of Microbiology, Basic Medical Sciences Institute, JPMC, Karachi, during the period of August 1998 to February 1999. During this period, 110 patients were seen, of them 62 were male and 48 were female with male to female ratio of 1.3:1. Two swabs were taken from each patients ear, one was put immediately in to Brain Heart Infusion [BHI] broth and the other was inoculated on Sabouraud Dextrose Agar [SDA] slant. BHI was incubated for 2-4 hours and subcultured on blood agar, chocolate agar and MacConkey's agar plates. The Chocolate agar was incubated in 5-10% CO[2] atmosphere in a candle jar and they were incubated for 24 hours at 37°C. SDA slant was incubated for 14 days at 37°C. Isolates were identified by Gram staining and then confirmed by biochemical test. Fungus growth was stained in Lactophenol Cotton blue [LPCB] and identified microscopically. Amongst bacterial isolates gram negative rods [41] and Pseudomonas aeruginosa [45] were predominant. 47 gram positive cocci were seen, of those 37 were Staphylococcus aureus. Fourteen fungal isolates were recovered, all of them were found to be Aspergillus species. Bacterial isolates were tested for beta-lactamase production the drug sensitivity was noted by disc diffusion method on Mueller Hinton agar. Ciprofloxacin and Enoxacin emerged as the most effective antibiotics. Tobramycin also showed good results against gram negative rods and Pseudomonas aeruginosa. Chloramphenicol, Clarithromycin and Minocycline showed good results against Staphylococcus aureus. And other gram positive cocci. Drug sensitivity of the fungi was not done. Micro-organisms showed least sensitivity to Ampicillin and Cotrimoxazole. It is concluded that to achieve the maximum benefits of antibiotics, we must use them with discrimination and with the understanding of microbial population and with the knowledge of their indications and limitations. The indiscriminate, haphazard and halfhearted use of antibiotics and poor follow up of patients causes more harm than good

Role of microlaryngoscopy in the management of laryngeal lesions

1. To evaluate the role of microlaryngoscopy in the management of various laryngeal pathologies. 2. to enlist the various laryngeal lesions causing hoarseness and their presentation. Descriptive study. This study was conducted in ENT, Head and Neck Surgery department, Hayatabad Medical Complex, Peshawar from 1[st] September 2000 to 31st December 2002. A series of 70 patients of laryngeal pathologies were included in this study. A thorough history was taken and clinical examination performed, only relevant laboratory investigations were done. CT scan /MRI was done in selected cases for extension of the lesion like carcinoma to nearby structures so that later if the lesion requires endolaryngeal microsurgical intervention, appropriate and precise excision of the lesion be carried out. Microlaryngoscopy was performed in all cases and for diagnostic purposes biopsy was taken for histopathology. 32.85% of the patients with vocal cord nodules, 17.14% with vocal cord polyps and 4.2% with Reinke's edema were treated with microlaryngoscopy. Laser was used along with microlaryngoscopy for laryngeal papillomas in 11.42% and laryngeal granulomas in 2.8%. Microlaryngoscopy was helpful not only in the diagnosis of small vocal lesions but also in the surgical management of these lesions with good post operative functional results. Microlaryngoscopy plays an important role in the diagnosis of a variety of laryngeal lesions especially in all cases that are examined on indirect laryngoscopy, where diagnosis is not clear or needs biopsy for histopathology, Moreover it has got both diagnostic and therapeutic role in laryngeal pathologies. Therefore the facility and expertise should be provided so that an early diagnosis can be made and late untoward complications can be avoided

Postoperative sore throat after oral surgery under endotrachial intubations; influence of the pharyngeal pack

To investigate the effect of the presence of pharyngeal pack during endotrachial intubations general anesthesia on the incidence of postoperative sore throat. This study was carried out on 60 patients aged 16 to 70 years in the Department of Oral and Maxillofacial Surgery Mayo Hospital Lahore during 20-12-2004 to 19-12.-2005. Patients were randomly divided in to two groups A and B, of 30 each. In-group A, 30 patients were inserted throat pack while in-group B, 30 patients with out throat packs. After induction of anesthesia, size 6.5 to 7.0 mm internal diameter portex endotracheal tubes with cuff were used for females while 7.5 to 8.5 internal diameters were used for males. The presence of sore throat was determined just after recovering from anesthesia and 24 hours after operation. Out of sixty patients, forty-three patients [71%] experienced sore throat after operation. the incidence of sore throat were similar in both groups. There was no statically significant difference with P<0.05. Our results are same as that of other international study. Postoperative sore throat is not related to pharyngeal pack. There is need to further evaluate if the use of smaller sized endotracheal tubes could reduce the incidence of throat complications

Successful treatment of early postinfarction massive ventricular septal rupture and cardiogenic shock

A 65 years old woman presented to the ER with vomiting and severe retro-sternal chest pain for twelve hours. She was extremely dyspneic with a respiratory rate of 32/min, heart rate of 120/min, blood pressure of 70/50 mmHg and 02 saturations of 91% on 15 liters by face mask. She had bilateral crepitations upto mid lung zones bilaterally and had pan systolic murmur and had cool extremities with no pedal pulses. ECG showed massive anterior ST elevation myocardial infarction. An emergent echocardiography showed dilated right ventricle, and a large ventricular septal rupture anteriorly with severely reduced LV function. Patient was intubated, taken to the cardiac catheterization lab. An IABP was placed and on angiography large ventricular septal rupture was identified along with complete LAD occlusion. Median sternotomy was performed and patient was placed on cardiopulmonary bypass. The anterior infracted portion was excised and large anterior VSD was identified. The edges were debrided and then a large 7.5 cm defect in the anterior interventricular septum was identified. A Dacron patch was sewn along the edges of the VSD with interrupted plegeteted ethibond sutures and then the free wall of the LV and RV were brought together with plegeted prolene sutures; thus sandwitching the patch and closing the ventricular free wall also. LAD was grafted with a vein graft. IABP was removed after 48 hours and the patient was extubated. The rest of the hospital stay was unremarkable and patient was discharged home in 10 days

Characteristics and etiology of zygomatic complex fractures

This study aims to determine Etiology and Characteristics of Zygomatic complex fracture [ZMC]. Forty patients of zygomatic bone fracture were evaluated by history, clinical and radiological examination. The most common cause of ZMC fractures was road traffic accident [RTA] 52.5%[n=21], followed by fall 17.5% [n=7], fire arm injury [FAI] 15%[n=6], interpersonal violence [IPV] 7.5%[n=3], occupational trauma and sport injuries 5%[n=2] and 2.5%[n=1] respectively. The most common characteristic of ZMC fractures recorded in this study was flattening of cheek, 92.5%[n=37] and subconjunctival hemorrhage 92.5%[n=37] respectively, followed by abnormal nerve sensibility 90%[n=36],periorbital ecchymosis 87.5%[n=35], epistaxis 55% [n= 18], limited mouth opening 50% [n=20] and diplopia 27.5% [n=11]. The most common characteristic of ZMC fractures was flattening of cheek and subconjunctival hemorrhage, because the zygomatic complex bone is very prominent and easily expose to traumatic forces and subconjuctival hemorrhage can easily occurs even if there is a minor tear of periosteum. The most common cause of ZMC fractures was RTA because of bad road conditions, poor road traffic sense in road users plus seat belt legislation was not enforced in this part of the world

Characteristics and etiology of radicular cyst - a study

Radicular cyst is one of the late sequelae of untreated pulpal necrosis often caused by dental trauma and caries. It develops slowly and gradually but symptomlessly, and involves many adjacent sound teeth endangering their vitality and even prognosis.The objectives of this study were to determine the site, age and sex distribution as well as to know the ratio of trauma to caries in the occurrence of Radicular cyst. Fifty [50] patients were included in study after taking history, clinical examination, radiological findings, aspiration test and biopsy report. 38 cases occurred in maxilla while 12 in mandible with ratio 3.1:1. In maxilla, the offended tooth was anterior in all 38 cases. So the favoured site was maxillary anterior teeth. The peak frequency was in 3rd decade with mean age of 23 years. There was slight male predilection as like other international studies. The ratio of trauma to caries was 4.3:1 in both jaws, 10:1 in maxilla and 1:1 in mandible. The increased ratio of trauma to caries indicates the neglecting attitude of our patients to dental treatment and demands their awareness and education about the untreated dental trauma.This study will help professionals to know the hazards of untreated dental trauma as well as their consequences. It will also help in early diagnosis and management of radicular cyst to reduce its morbidity

Retrospective analysis of 268 cases of fractures of mandible

The purpose of the study was to determine the causes of fractures of mandible, age groups and gender involvement in North West Frontier Province of Pakistan. This study was conducted at Khyber College of Dentistry, Peshawar University Campus from 1[st] January to 31[st] December 2002. 268 patients with mandibular fractures were recorded in this study. The patients age range was from 2 to 70 years

Out of 268 cases of mandibular fractures, 118 patients [44%] were the result of road traffic accidents. Interpersonal violence was responsible for 67 cases [25%] while 43 cases [16%] were due to fall. 35 patients [13%] were found due to gun shot injuries and 5 cases [2%] were due to other injuries.213 patients [79.4%] were male, thus male to female ratio was 3.87:1

Endoscopic removal of the tracheobronchial foreign bodies at a peripheral hospital

To evaluate the use of therapeutic endoscopic procedures for inhaled foreign bodies at a peripheral hospital. Material and This study was conducted from 28th April 2001 till May 2003 at DHQ Hospital Timergara District Dir NWFP. Forty eight patients [34 male and 14 female, age range 7 months -14 years] who underwent endoscopic examination for foreign bodies were included in this study. The endoscopic procedure was performed under general anaesthesia. The most common affected age group was under 3 years. The commonest site in order of frequency was right main bronchus 30 [62.5%] followed by left main bronchus 13 [27.0%], trachea 3[6.3%] and larynx 2[4.2%]. The commonest foreign body was peanut 31[64.6%] followed by whistles 8[16.6%], bean seed 4[8.3%], maize seed 2[4.2%] bead, disposable needle and Chalia [2.1%] each. The success was achieved in 100% cases with no mortality. Early diagnosis and management is essential to prevent morbidity and mortality associated with foreign bodies