Prevalence of Misconceptions and Myths Regarding Oral Health Among Medical and Dental Students in Peshawar, Pakistan.

Background The aim of study is to assess the prevalence of dental myths and misconceptions among the students of medicine and dentistry in Peshawar, Pakistan, and to gauge the quality of dental education, knowledge, and awareness. Methods A cross-sectional descriptive study was conducted on the current students of medicine and dentistry at Rehman Medical College, Rehman College of Dentistry, Gandhara University, Khyber Medical College, and Khyber College of Dentistry. They were questioned regarding their beliefs in dental misconceptions and myths prevalent in Peshawar, Pakistan. Results The sample comprised 400 undergraduate students, of whom 47.5% (190) were males and 52.5% (210) were females. The most held beliefs were that eating sugar does not affect teeth as long as one brushes twice a day (46%), brushing right after a meal is better for teeth (70%), and the extraction of baby teeth does not matter as they are going to be replaced by the permanent teeth in any case (38%). Most of these misconceptions had a significant association with the field of study. Conclusion The issue of myths and misconceptions regarding dental health and care is widespread, even in the academic community. This should be of significant concern to the relevant authorities, and adequate measures must be taken to dispel such false information.

Drying kinetics and economic analysis of bitter gourd flakes drying inside hybrid greenhouse dryer.

In this study, a heat storage-based hybrid greenhouse dryer has been developed and analysed for drying bitter gourd flakes under the climatic condition of Ranchi, India. Proposed heat storage-based hybrid greenhouse dryer consists of a solar air heater with a 2.12-m2 area, greenhouse dryer and DC fan to induce and force the air. The significant objective of the present study is to analyse the drying efficiency, drying kinetics, property analysis, economic analysis, embodied energy and CO2 mitigation of the hybrid greenhouse dryer for drying of bitter gourd flakes. An experiment was performed simultaneously on proposed system and open sun drying for the proper comparative analysis. Moisture contents reduced from 88.14 to 10.14% in 6 h in proposed dryer and 88.14 to 11.01% in 15 h for open system. Thus, significant drying time is reduced in proposed system by 8 h as compared to open system. Environmental impact analysis shows that the energy payback time was found to be 0.4907 years only. Cost of the proposed system dryer is 22664.30 INR. The total embodied energy is found 1591.07 kWh and earned carbon credit ranges from 16844.76 to 67379.05 INR, while CO2 mitigation was 46.28 tonnes for 35 years of expected lifetime. Seven standard mathematical models for drying of bitter gourd flakes were studied. Ahmad and Prakash model was found to be the best as compared to other models. The metal contents of dried bitter gourd flakes were also examined. Bitter gourd dried in proposed dryers possesses superior metal content as compared to open systems. Impact analysis demonstrates that the hybrid greenhouse dryer is more suitable for reducing post-harvest loss with environmental sustainability.

Hemoglobin Titusville: a rare low oxygen affinity hemoglobinopathy.

The relevance of this case lies in the extensive diagnostic workup that can be avoided with proper laboratory evaluation of relatively unsophisticated tests.

Resorbable Plates Prevent Regression in Pediatric Mandibular Distraction Osteogenesis.

BACKGROUND: Mandibular distraction osteogenesis is an important technique to correct the pediatric hypoplastic mandible. Regression of the mandible after distraction continues to be a challenge, with some studies reporting up to 22% to 56% decrease toward predistraction length in the first year. We hypothesize that a resorbable plate placed after removal of the distractor will provide additional stability to newly formed bone, allowing further time for consolidation and minimizing regression. METHODS: This is a retrospective review of neonatal and pediatric patients between 2010 and 2015 who had mandibular distraction osteogenesis performed by the senior author (D.J.). Five patients, including 1 control and 4 intervention subjects, who had preoperative, postdistraction, and follow-up imaging were evaluated. Mandibular distraction was performed via internal devices (KLS Martin, Jacksonville, Fla) and followed by a consolidation period of 6 to 8 weeks. At the second operation when the distractors were removed, the intervention group had a SonicWeld Resorbx (KLS Martin) resorbable plate placed across the bone regenerate. A digital imaging and communications in medicine viewer was used to create a 3-dimensional reconstruction of each of the computed tomography scans and measurements of the mandible were made in the lateral cephalometric view. We then determined distraction distance, regression distance and percent regression. RESULTS: The average mandible distraction distance was 8.2 mm for the control group, and 9.9 mm for the intervention group (range, 6.7-12 mm). The average distance that the mandible regressed after distraction (regression distance) was 2.7 mm for the control group, and 0.5 mm for the intervention group (range, 0.2-0.9 mm). The average percent regression was 32.9% for the control group, and 5.1% for the intervention group (range 1.8 to 7.5%). CONCLUSIONS: The results of this study suggest that resorbable plate placement after removal of distractors helps prevent regression in pediatric mandibular distraction osteogenesis. The improvement was readily apparent both radiographically and clinically.

Chronic Lymphocytic Leukemia and the Side Effects of Therapy: 2017 Review.

In recent years, the choice of therapies for symptomatic Chronic Lymphocytic Leukemia (CLL)/Small Lymphocytic Lymphoma (SLL) have grown exponentially, with no single agreed upon standard first-line therapy. The choice of therapy is often dictated by goals of care, patient characteristics and tumor genetic abnormalities. The goal of this article is to familiarize the primary care provider with some of the most commonly used therapeutic modalities with attention to the side effect profile of these regimens.

Clinical evaluation and surgical options in acetabular reconstruction: A literature review.

The purpose of this paper is to review the clinical indications for acetabular reconstruction in patients with underlying peri-prosthetic segmental and cavitary defects, evaluate steps in pre-operative planning, and present the American Academy of Orthopaedic Surgeons (AAOS) and Paprosky classification systems to categorize acetabular defects. We also present a review of the current surgical techniques to reconstruct the acetabular socket which includes a cementless acetabular component with morselized bone, structural allograft, jumbo and oblong cups, reinforcement rings, bone cages, custom triflange acetabular constructs, and trabecular metal components.

WITHDRAWN: Porous Metal Augments Show Excellent Mid-to-Long Term Survival in Complex Acetabular Reconstruction.

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Vibrio parahaemolyticus Induced Necrotizing Fasciitis: An Atypical Organism Causing an Unusual Presentation.

Background necrotizing fasciitis (NF) represents a life-threatening bacterial infection characterized by a rapid necrosis of deep subcutaneous tissue and facia underlying the skin. Despite its lethal nature, NF occurs infrequently, leaving many physicians unfamiliar with the disease process, common pathogens, and treatment strategies. Here we present a case of NF caused by an unlikely organism, Vibrio parahaemolyticus. We highlight the innocuous nature of initial presentation and the potentially devastating sequela.

Atypical Presentation of Prostate Cancer and the Workup of an Adenocarcinoma of Unknown Primary.

Prostate Adenocarcinoma is one of the most commonly diagnosed cancers in the United States, with a prevalence of around 2.4 million. Patients with this disease commonly present with urinary frequency and hesitancy, nocturia, and dysuria secondary to tumor enlargement. We present the case of a 60-year-old man with multiple-site biopsy proven metastatic prostate cancer that presented with neither urological or bone related signs or symptoms. His findings were rather atypical; they included dyspnea, pancytopenia, nausea, and chills. We then detail how we narrowed our diagnosis through a systemic process of elimination, and review the general workup of an adenocarcinoma of unknown primary in a male patient.

Glycated haemoglobin--a marker and predictor of cardiovascular disease.

Glycated haemoglobin is formed by simple chemical reaction between haemoglobin and blood glucose. It represents a reliable and moving average of blood glucose over preceding three months. In 2009 the International Expert Committee recommended the use of HbA1c to diagnose diabetes with a cut-off of 6.5%. Studies have shown that HbA1c even in the range of 5.5% to 6.5% poses considerably high risk of morbidity and mortality due to cardiovascular disease. HbA1c as a test is important because about 220 million people have diabetes and with increasing life expectancy and emergence of type 2 diabetes in children makes it even more important. Each 1% increase in HbA1c poses 15-18% relative risk of cardiovascular disease in T1DM and T2DM respectively. CVD is a major cause of death and disability among diabetes patients and glycated haemoglobin itself is proportionately linked with excess CV morbidity and mortality. UKPDS-35 demonstrated 14% reduction in the incidence of acute myocardial infarction with only 1% reduction in HbA1c in T2DM patients. The DCCT reported significant reduction in retinopathy and nephropathy in T1DM, the follow up trial EDIC demonstrated 42% reduction in CVD with intensive reduction of HbAlc. This review is written to remind ourselves of the importance of this simple test which can predict early CV mortality in patients without prior CVD and poor prognosis in established cardiovascular disease. In a country like ours, Pakistan; where diabetes is prevalent with poor health awareness and limited resources, a test like HbA1c which costs Rs, 500.00 twice a year should be considered a cost effective way to avoid the long term diabetes complications, which once start unfolding put enormous burden on already stretched healthcare resources which could easily be avoided by intensive control of diabetes.

Glycated haemoglobin; past, present, and future are we ready for the change.

Glycated haemoglobin has been in use to monitor control of blood glucose in diabetic patients for about three decades. It provides an average blood glucose level during preceding 10-12 weeks. It is a very convenient blood test, can be done in any clinical setting regardless of prandial state. There were thirty different laboratory methods available to measure glycated haemoglobin with significant variability of results on same sample. IFCC developed a new reference method to measure the glycated haemoglobin, and the method is accepted world wide as only valid anchor for the measurement of HbA1c. In 2009 International expert committee recommended the use of HbA1c to diagnose diabetes with a threshold 6.5%. IFCC recommended the use of a new unit, i.e., mmol HbA1c/mol of total haemoglobin in place of percentage. Meanwhile a trial was conducted to find out relationship between average blood glucose and glycated haemoglobin, and a linear regression equation was developed to measure average blood glucose from HbA1c. Using the equation one can calculate average blood glucose from glycated haemoglobin in mmol/mol. This average blood glucose will be reported as "eAG" (estimated average glucose) and it will be used to monitor glucose control as eGFR (estimated glomerular filtration rate) is used to monitor renal function in chronic kidney disease patients. How easy or difficult would it be to abandon a term and a unit, in use for three decades and introducing a new unit (mmol/mol) and even a new term (eAG); only time will tell. Health professionals will need to familiarize with new term and units, they will also have to spend more time with their patients to educate them about new developments.

Ethanol enhances carbachol-induced protease activation and accelerates Ca2+ waves in isolated rat pancreatic acini.

Alcohol abuse is a leading cause of pancreatitis, accounting for 30% of acute cases and 70-90% of chronic cases, yet the mechanisms leading to alcohol-associated pancreatic injury are unclear. An early and critical feature of pancreatitis is the aberrant signaling of Ca(2+) within the pancreatic acinar cell. An important conductor of this Ca(2+) is the basolaterally localized, intracellular Ca(2+) channel ryanodine receptor (RYR). In this study, we examined the effect of ethanol on mediating both pathologic intra-acinar protease activation, a precursor to pancreatitis, as well as RYR Ca(2+) signals. We hypothesized that ethanol sensitizes the acinar cell to protease activation by modulating RYR Ca(2+). Acinar cells were freshly isolated from rat, pretreated with ethanol, and stimulated with the muscarinic agonist carbachol (1 µM). Ethanol caused a doubling in the carbachol-induced activation of the proteases trypsin and chymotrypsin (p < 0.02). The RYR inhibitor dantrolene abrogated the enhancement of trypsin and chymotrypsin activity by ethanol (p < 0.005 for both proteases). Further, ethanol accelerated the speed of the apical to basolateral Ca(2+) wave from 9 to 18 µm/s (p < 0.0005; n = 18-22 cells/group); an increase in Ca(2+) wave speed was also observed with a change from physiologic concentrations of carbachol (1 µM) to a supraphysiologic concentration (1 mM) that leads to protease activation. Dantrolene abrogated the ethanol-induced acceleration of wave speed (p < 0.05; n = 10-16 cells/group). Our results suggest that the enhancement of pathologic protease activation by ethanol is dependent on the RYR and that a novel mechanism for this enhancement may involve RYR-mediated acceleration of Ca(2+) waves.