Five-Year follow-up of a coronally advanced flap over grafted bone and restorative composite in maxillary recession defect

Periodontal plastic surgery has become a predictable method of managing gingival recession defects. In the current case report, a five-year follow-up of a coronally advanced flap surgery with bone graft along with endodontics and fixed prosthodontic rehabilitation is reported in the maxillary anterior sextant of a middle aged female. The present case demonstrates that deep and wide gingival defects can be treated with coronally positioned surgical flap without a connective tissue graft

A multidisciplinary management approach was adopted in this case that yielded predictable outcome

Comparison of micro-leakage around temporary restorative materials placed in complex endodontic access cavities: an in-vitro study

Objective: To compare mean micro-leakage around 3 types of temporary restorative materials in-vitro, when placed adjacent to permanent restorations [amalgam] in complex endodontic access cavities. Study Design: Randomized controlled trial. Place and Duration of Study: Dental Clinics, Dental Laboratory and Research Laboratory at The Aga Khan University Hospital, Karachi, from January to June 2014

Methodology: After random allocation of 60 teeth into 3 experimental groups, each group had conventional class II cavities prepared and amalgam placed. After 14 days, endodontic access cavities were made in these teeth, followed by placement of Cavit, IRM and CLIP [depth of 4 mm each]. After thermo-cycling and immersion in 0.5% methylene blue dye, the teeth were sectioned mesio-distally and observed under stereoscopic microscope [magnification x4] along 2 interfaces 'a' and 'b' [tooth-temporary restoration and temporary restoration-primary restoration], respectively. Depth of dye penetration was measured in millimeters

Results: IRM was leakiest at interface 'a', cavit had highest dye penetration at interface 'b', while CLIP exhibited least micro-leakage at 'a' and 'b'. The mean dye penetration for Cavit was 0.80 +/- 0.23 mm at 'a', and 2.24 +/- 0.48 mm at 'b'. For IRM, it was 1.82 +/- 0.09 mm at 'a', and 0.44 +/- 0.13 mm at 'b'. For CLIP, the mean dye penetration was 0.43 +/- 0.05 mm at 'a', and 0.32 +/- 0.12 mm at 'b'. The difference in dye penetration observed between the 3 groups at both interfaces was statistically significant

Conclusion: In a complex access cavity made adjacent to a pre-existing amalgam restoration, CLIP exhibits the least micro-leakage, followed by IRM and Cavit

VATS without general anesthesia: initial experience of 18 cases

Background: General anesthesia and selective ventilation has long been the traditional anesthetic approach for video-assisted thoracoscopic surgery [VATS]. However it may not always be necessary or feasible in a certain variety of patients. VATS under locoregional anesthesia and sedation has proved to be a safer and more efficacious alternative to general anesthesia, especially in cases deemed unfit for the latter

Methodology: We retrospectively reviewed medical records of patients who underwent VATS under regional anesthesia/nerve blocks with sedation in three private hospitals from April 2014 to November 2015. VATS are conducted in these hospitals by the same anesthesia team and operated by a single surgeon. Eighteen patients included in the case-series were either considered high-risk for general anesthesia or required minor to intermediate surgery. None of the patients required endotracheal intubation or conversion to thoracotomy during the procedure

Results: Eighteen patients underwent successful VATS under locoregional anesthesia with sedation at our set-up from April 2014 to November 2015. The procedures included pleural biopsies, pleurodesis, empyema drainage, biopsies for mediastinal masses, lung tumors and apical infiltrates, all performed under video-assistance. There was no perioperative mortality or unanticipated ICU admission

Conclusion: VATS under locoregional anesthesia and sedation is a valuable, efficacious and safe alternative to general anesthesia that needs to be incorporated more frequently in the modern anesthesia practice

Ophthalmic injuries in orbito-zygomatic fractures

To assess the frequency and severity of ophthalmic injuries in patients with orbito-zygomatic fractures. A case series. Oral and Maxillofacial Department, KEMU/Mayo Hospital Lahore, from January 2009 to December 2011. Patients with orbito-zygomatic fractures were divided into three groups. Group-1 patients had fracture of floor/medial wall of the orbit [orbital-blow out fracture]. Group-2 had comminuted orbito-zygomatic fractures. Group-3 had simple zygomatic bone fractures. Frequency and types of ocular injuries were determined on each group. There were 296 [260 male, 36 female] patients with mean age of 31.7 years. Group-1 [n = 20] had 28 ocular findings in 12 [60%] patients including diplopia [n = 10, 36%], enophthalmos [n = 6, 14%], and hyphema, vitreous hemorrhage, retinal hemorrhage, choroidal rupture, traumatic mydriasis, and commotio retinae in 2 cases, 7% each. In Group-2 [n = 106], 44 ocular findings were identified in 30 [28%] patients including diplopia [n = 10, 23%], enophthalmos [n = 4, 9%], commotio retinae [n = 10, 23%], reduced visual acuity [n = 6, 14%], retinal hemorrhage [n = 4, 9%] and corneal laceration, corneal abrasion, retinal detachment, traumatic mydriasis, and canthal laceration in 2 cases, 4.5%. In Group-3 [n = 170], 22 ocular findings were seen in 16 [9%] patients included diplopia [n = 10, 45%], enophthalmos [n = 4, 18%], and retinal tear, hyphema, angle recession, and traumatic mydriasis in 2 cases, [9%] each. Ophthalmic injuries are a common complication of orbitozygomatic fractures occurring in about 20% of patients in this study, most frequent in the orbital blow fractures subgroup. Ophthalmology consultation is recommended for patients presenting with midface fractures

Therapeutic effect of carnitine on atorvastatin induced mechanical myotoxicity of gastrocnemius muscles of rats

To Study Therapeutic Effect of Carnitine on Atorvastatin-induced Mechanical Myotoxicity of Gastrocnemius Muscles of Rats. Observational study. This study was conducted at Department of Physiology, University of Karachi, from 21[st] January 2012 to 30[th] December 2013. Present study showed that effect of statin on mechanical properties of gastrocnemius muscle of rats and use of carnitine as prevention of statin induced myopathies. Animals were injected statin for 6 weeks in one group and carnitine to another group along with statin to study the possible therapeutic effect. After treatment period, animals were decapitated and gastrocnemius muscles were isolated. Twitch and tetanus of muscles were recorded in each group. Our results showed that treatment of statin reduced the body weight of animals and increased the resting length [106%] of isolated gastrocnemius muscles. We also observed that force of contraction of both twitch and tetanus in statin treated group were significantly reduced [P>0.0001]. This negative effect of statin on twitch and tetanus parameters of muscle was partially decreased by an additive treatment of carnitine. Thus, carnitine plays a vital role in improving muscle contractile ability caused by statins. Our study demonstrated the potential preventive measure of atorvastatin-induced myopathy using carnitine and its impacts on mechanical function of muscles

Assessing the perception of smile attractiveness in young adults, a pilot study

To assess the perception of dental, art and business students on the importance of smile attractiveness and the understanding on effect of skin tone on tooth shade value as perceived by the 3 groups. It was a cross sectional, analytical study conducted in Art, Business and Dental Schools. Ninety 90 students [3 groups of 30 each]were selected by non probability, purposive sampling. 24 pictures were run in front of the participants as power point presentations. The pictures were of two individual smiles, a male and a female, with changes made to colour of teeth and skin, in Adobe Photoshop. The participants were asked to grade each picture on a rating scale. SPSS 17.0 was used for data analysis. Frequency distribution of all variables was determined. Association of smile attractiveness with gender and profession was determined using Chi-square test. Mean ranks and score [of the 24 pictures] of smile attractiveness as perceived by the 3 groups were compared using Kruskall-Wallis test. Level of significance was set at 0.05. The sample size consisted of 34.1%males and 64.8%females. For the dental group smile attractiveness was very important as opposed to the business and art students. For females, smile attractiveness was more important than their male counterparts. Fair skin with bright and moderately bright teeth rated as the most attractive smile, whereas fair skin with dark teeth rated as the least attractive smile. There is a difference in perception of smile attractiveness between males and females. Art, business and dental students also have different perceptions of smile attractiveness with respect to skin tones and tooth shade values

Teaching and practice of repair of resin composite restorations in dental institutions of Karachi

1.To determine the proportion of dental institutions' faculty teaching repair of composite restorations to dental students [undergraduate]. 2.To evaluate the factors that affect the decision making process of Resin Composite restoration repair. An 11 item questionnaire was presented to the faculty members of all the dental institutions in Karachi. Nine out of ten dental institutions participated in the survey and a total of 38 faculty members from the department of Operative Dentistry filled the questionnaire. About 90% of the respondents stated that composite repair is advisable whereas 70% of the respondents stated that they have performed such type of interventions and have achieved success. Around 40% stated that they teach such procedures to students and60%stated that the course of instruction is at clinical level. 1.The findings of the present study indicate that the teaching of the repair of defective composites has found a place in primary dental degree curricula in almost all the dental institutions in the Karachi. 2.Occlusal relationship and patient's existing oral hygiene appeared to be the most important factors in decision making process

survey of the composite curing units used in the dental institutions of Karachi, Pakistan

To evaluate the light intensity output of the composite curing units used in the dental institutions of Karachi. It was a cross sectional study in which a total of 29 halogen composite curing units were examined. The light intensity output was measured using Cure-Rite meter. A cut off of 300mW/cm was taken as adequate light output. ANOVA and Kruskal-Wallis test were applied. Level of significance was kept at 0.05. The mean light output intensity was 345.2 mW/cm [SD 251.1 mW/cm]. Out of 18 units at undergraduate institutions, 11 had poor light output while 3 out of 11 at postgraduate institutions had poor light output. The condition of light cure unit's casing had a significant association with the light output [p-value of 0.011]. About half of the curing units at the dental institutions have poor light intensity output which may result in an inadequate quality of dental service. This is an alarming situation for the clinicians. As mishandling of the equipment is a leading cause of its poor performance, the external casing of the light cure unit can be taken as a proxy for its light output

Preparation and in-vitro in-vivo evaluation of sustained release matrix diclofenac sodium tablets using PVP-k90 and natural gums

Conventional dosage form is nowadays mostly replaced by sustained release formulation in order to increase drug efficacy and patient compliance. The sustained release properties of the PVP K90 alone and in combination with guar gum, xanthan gum and gum tragacanth were evaluated using diclofenac sodium [100 mg/tablet] as a model drug. Tablets were processed using wet granulation method and evaluated for sustained drug release properties. The drug release from the formulations was studied in relationship with Commercially available Diclofenac Sodium SR, used as a reference tablets and results were expressed as similarity [f1] and differential factor [f2]. The tablets prepared using PVP K90 160 mg/tablet sustained the release of diclofenac sodium for 12 hours. Formulations where the PVP K90 was partially replaced with different gums also sustained the release of drug for 12 hours. The release of the drug from these formulations mainly followed Higuchi model and super case-II and Non-Fickian diffusion. The in-vivo drug release was studied in healthy human volunteers using non-blinded cross over, two period design using Diclofenac Sodium SR Tablets as a reference drug. The relative bioavailability of the formulation containing PVP K90 and gum tragacanth was 0.91. The studies showed that the use of the PVP K90 in combination with gum tragacanth both in-vitro and in-vivo sustained the release of the drug

survey of knowledge of dentists in diagnosing irreversible pulpitis

Dental caries and its sequel pulpitis, is one of the most common complaint with which the patient attends a dental office. The diagnosis of of puplitis involves distinguishing the two types, i.e.; the reversible and irreversible pulpitis, through objective and subjective testing. This process is usually straightforward but can at times be difficult due to anatomical, physiological and psychological factors. The Purpose of this questionnaire based survey was to find out the ability of dentists in diagnosing irreversible pupitis. The study design was cross sectional. Two hundred signle clinical scenario based questionnaires were distributed among 3 dental colleges. Totally 142 questionnaires were received back. Respondents were the clinical staff [consultants, senior registrar residents, demonstrator, house officers and final year students] of the 3 dentil college. The respondents were asked to diagnose the clinical scenario as either reversible or irreversible pulpitis. Most of the participants [81.7%] gave a wrong diagnosis. Worst response was from the final year student category [88.6%] whereas best response was in the resident category [44.4%]. The deference was statistically significant [p<0.05]. The ability of participants in diagnosis the clinical scenario correctly was poor in all categories

Reliability of landmark identification among orthodontic residents using traditional and indirect digital cephalometry

To determine the inter examiner reliability of landmark identification among Orthodontic Residents using Traditional and Indirect Digital Cephalometry and to determine the intra examiner reliability of landmark identification. A cross-sectional study of six months duration done at Orthodontics Department of KMDC. One conventional Lateral Cephalometric radiograph was randomly selected. Study subjects were 8 residents with mean age was 28.8 years, with a range of 27.5 to 31 years. Cephalometeric tracing was done and landmarks S or Sella, N or Nasion A or Point A, B or Point B, Pog or Pogonion, Gn or Gnathion, Go or Gonion, Me or Menton, Or or Orbitale, Ba or Basion, API or apex of upper incisor, APT or apex of lower incisor were identified using traditional method by an Orthodontic consultant and then tracing was scanned and digitized to obtain the Indirect Digital Cepha image. The same cepha was asked to trace by all 8 study subjects. Kappa statistics was applied to see the agreement between the residents for landmarks identification in conventional and indirect digital cephalograph. Results: The study subjects were 8 orthodontic residents [3 males and 5 females]. Residents had excellent agreement for landmark identification on the conventional and the indirect digital cephalogram. The value of agreement for inter-examiner and intra-examiner reliability was found to be 0.80 [CI: 0.71, 0.89] and 0.83 [CI: 0.79, 0.87] respectively. The reliability of landmark identification was good among residents for both the conventional and the indirect digital cephalometery

Frequency of class-III malocclusion reported in dental OPD, Karachi medical dental college

To determine the frequency of Class-III malocclusion reported Orthodontic department in Karachi Medical Dental College, Pakistan. It was a cross sectional study of orthodontic patients. With convenience sampling a total of 384 patients [267 girls, 117 boys] referred to the Department of Orthodontics, Karachi Medical Dental College, were evaluated in this study. The mean age of the patients was 11.86 +/- 3.16 years. There malocclusion were classified from I, II [Div-1 and Div-2 with sub division right and left], and III, and recorded according to angle classifications. Class-III malocclusion was the least common malocclusion present in the major category of malocclusion and found 8.1% of the samples. Class-III malocclusion requires very early treatment then class-II and Class I malocclusion and has totally reverse treatment philosophy. Having the lower frequency of Class-III malocclusion in the population makes doctor to focus more in later age group and puts less burden on health resources as more patients of Class-II and I can be treated using the same resources. The type of malocclusion, also an important factor that affects a patient's motivation to seek treatment

Diagnosis of nasopharyngeal carcinoma on fine needle aspiration cytology of cervical lymph nodes

This study was carried out to see the sensitivity of Fine needle aspiration cytology [FNAC] in cervical lymph nodes in patients of carcinoma of the nasopharynx. This Study was carried at the Department of ENT and Head Neck Surgery of Khyber Teaching Hospital, Peshawar Pakistan from June 2003 to May 2005. Patients between the age of 30 and 70 years were included in the study. 25 patients having cervical lymphadenopathy were selected and divided into two groups A and B. Group A includes 20 patients which were undiagnosed cases of nasopharyngeal carcinoma. Out of them 17 patients have ENT Symptoms and 03 patients have only Cervical lymphadenopathy. Group B includes 05 patients who were post irradiated cases of Nasopharyngeal Carcinoma having detectable cervical lymphadenopathy. Fine needle aspiration was performed with 21 gauge needle attached with 20 ml syringe and smears were prepared. The cellularity in most of the smears was high 96%. Single scattered malignant cells were present in 92% of cases. The oval shaped vesicular neuclei were present in 92% of cases. In group B who had undergone radiotherapy showed one to three prominent nucleoli. FNAC of Cervical lymphnodes is an important diagnostic tool for the diagnosis of NPC, especially in those patients who have no ENT symptoms. It is also helpful in the follow up of post-irradiated patients

Frequency of allergic fungal aetiology of chronic rhinosinusitis

The aim of this study was to find out the frequency of intranasal fungal sinusitis in patients attending a tertiary care hospital in North West Frontier Province [NWFP] of Pakistan. This study was conducted in the ENT department of Khyber Teaching Hospital Peshawar Pakistan from November 2004 to May 2006. One hundred patients with chronic rhinosinusitis [CRS] and 50 healthy subjects as a control group were included in this prospective study. Nasal lavage samples were investigated for the presence of fungus, using new culture technique and histological examination. Epidermal and intradermal hyper sensitivity tests were used to find out fungal atopy. Levels of serum eosinophils, total IgE were estimated in the blood samples. Allergic fungal sinusitis was diagnosed in 13 [13%] patients. Clinical and laboratory parameters of CRS were not significantly different in the groups with and without intranasal fungi. In this study frequency of fungal sinusitis was not as high as expected in patients living in NWFP with CRS. Furthermore, no significant correlation could be found between presence of intranasal fungus and type- I hyper sensitivity in patients with CRS

Frequency of intra cranialcomplications in chronic otitis media

Chronic Otitis Media can lead to intracranial complications, which were more common in pre-antibiotic era as compared to the present antibiotic era. Patients of Chronic Otitis Media with intrracranial complications usually present very late due to ignorance and lack of primary health care. The aim of this study was to investigate, the frequency, mortality and morbidity of intracranial complications of chronic otitis media admitted in Far Nose and Throat Unit of Lady Reading Hospital Peshawar. This study was conducted in Government Lady Reading Hospital Peshawar for a period of two years front October 2001 to October 2003. All the patients diagnosed as intracranial complications of chronic otitis media were included in the study. Result: The total number of patients reporting with intracranial complication due to chronic Otitis media [Unsafe ear] was 20. Meningitis and brain abscess were present in 8 cases each [40%]. In 3 cases [15%] extradural abscess was found while 1 [5%] had lateral sinus thrombosis. Chronic Otitis media is a common disease in our part of the world

survey of urinary bladder injuries in Abbottabad

Background: Injury of urinary bladder is not very uncommon. It has iatrogenic and non iatrogenic causes. This study was designed to determine the pattern, mode of diagnosis and management of urinary bladder injuries presenting at Ayub Teaching Hospital, Abbottabad

Methods: Ten years hospital record of urinary bladder injuries reporting at Urology, Surgical and Gynaecology wards of Ayub Teaching Hospital, Abbottabad was analysed. The cause of injury, associated injuries, diagnostic method and management protocols were analyzed

Results: During 10 years period 260 patients were treated for bladder injuries. The age range was from 5-75 years while there were more males than females. In 35% the injuries were due to RTA, in 20% by a fall from a height, in 10% by a gun shot wound and in the remaining 35% the injury was iatrogenic. Gynaecological procedures were the major cause for iatrogenic bladder injuries

Conclusions: Most of the bladder injuries seen at our hospital are due to road traffic accidents or iatrogenic causes. Both of these factors can be minimized by taking appropriate steps to improve road safety and operative procedure safety respectively

Actinomycosis in neck glands

A middle aged women presented with right submandibular swelling, fever off and on and anemia. Excisional biopsy of the gland showed Actinomycosis. It is a rare disease in the neck. Patient was treated with high doses of parenteral pencillins followed by three months course of oral Doxycyclines. The patient was followed upto six months and she was symptoms free. In this case report the disease is elaborated and literature is reviewed