Effect of the Irrigation Agitation Technique on Postoperative Pain in Teeth With Symptomatic Irreversible Pulpitis.

Introduction Irrigation of the root canal system is a vital step in endodontic treatment aimed at disinfecting the canal. The efficacy of irrigation can be improved by various irrigation agitation methods. One such novel method of interest is the manual dynamic agitation (MDA) technique. However, the effect of MDA on postoperative pain as compared to needle irrigation (NI) with sodium hypochlorite has been scarcely explored. This study aimed to compare the effects of NI and MDA techniques on postoperative pain in teeth with symptomatic irreversible pulpitis. Materials and methods This quasi-experimental study was conducted at the Department of Operative and Paediatric Dentistry, Fauji Foundation Dental Hospital, over four months after gaining ethical approval. One hundred and sixty-eight participants diagnosed with symptomatic irreversible pulpitis were enrolled in the study through the purposive sampling technique. The participants were divided into two groups based on the irrigation technique used: Group A (NI) and Group B (MDA). Postoperative pain was recorded after six hours, 24 hours, 48 hours, and seven days using the 0-100mm visual analog scale (VAS). The VAS scores were compared using an independent sample t-test. Results Out of 168 participants, 48.2% were in Group A and 51.2% in Group B. The study found that VAS pain scores for Group B (MDA) were significantly lower at six hours, 24 hours, 48 hours, and seven days as compared to Group A (NI), with a p-value less than 0.001. Conclusion This study shows that the MDA technique leads to decreased postoperative pain both immediately after endodontic treatment and a week later as compared to the NI technique. Hence, the use of MDA can aid in controlling postendodontic pain and, therefore, ensure smoother recovery and increased patient satisfaction.

Molecular Genetic Analysis of the Autosomal Recessive Non-Syndromic Inherited Retinitis Pigmentosa.

INTRODUCTION: 90% of visually impaired people live in developing countries. There are various types of vision impairment, but the focus of the current study is retinitis pigmentosa (RP). Up to now, 150 mutations have been reported that are linked with RP. METHODOLOGY: Healthy and affected members from two Pakistani families (RP01 and RP02) segregating autosomal recessive RP were selected for DNA extraction. PCR was conducted, and the amplified PCR products were analyzed using Polyacrylamide Gel Electrophoresis (PAGE) and visualized in the Gel Doc system for linkage analysis. The Gene Hunter 2.1r5 tool in the Simple Linkage v5.052 beta software suite was used to conduct multipoint parametric linkage analysis on the two consanguineous families examined on the 6K Illumina array. Exons and intron-exon borders of all known arRP genes found in homozygous areas were sequenced in the matching probands using a 3130 automated sequencer and the Big Dye Terminator Cycle Sequencing Kit v3.1. The mutation study was carried out using the AlaMut 1.5 program. RESULTS: In both families, linkage analysis was performed using microsatellite marker DIS422 for gene crumbs homolog 1 (CRB1) and microsatellite marker D8S2332 for gene Retinitis Pigmentosa 1 (RP1). Multipoint linkage analysis identifies genomic regions that could potentially contain the genetic defect. In family RP01, only a single peak with a maximal multipoint LOD score of 3.00 was identified on chromosome 1, whereas in family RP02, multiple peaks with multipoint LOD scores of 1.80 were identified on chromosome 8. Analysis of the CRB1 gene revealed a homozygous substitution of glycine for valine (c.1152T>G; p.V243G), whereas the RP1 gene demonstrated that leucine was substituted for proline as a result of cytosine to thymine transfer (c.3419C>T; p. P1035L).  Conclusion: Homozygosity mapping is a powerful method for finding genetic abnormalities that are both precise and comprehensive for identifying harmful variations in consanguineous families. This method is invaluable for providing accurate clinical diagnostic and genetic advice in remote regions of Pakistan while also increasing knowledge about autosomal recessive diseases and the dangers of mixing.

Targeting Anti-Inflammatory Pathways to Treat Diabetes-Induced Neuropathy by 6-Hydroxyflavanone.

It is evident that inflammation and metabolic syndrome instigated by diabetes mellitus can precipitate diabetes-induced neuropathy (DIN) and pain. In order to find an effective therapeutic method for diabetes-related problems, a multi-target-directed ligand model was used. 6-Hydroxyflavanone (6-HF) carrying anti-inflammatory and anti-neuropathic pain potential due to its quadruplicate mechanisms, targeting cyclooxygenase-2 (COX-2), 5-lipoxygenase (5-LOX), and opioid and GABA-A receptors was investigated. The anti-inflammatory potential of the test drug was confirmed utilizing in silico, in vitro, and in vivo tests. A molecular simulation approach was utilized to observe the interaction of 6-HF with the inflammatory enzyme COX-2 as well as opioid and GABA-A receptors. The same was confirmed via in vitro COX-2 and 5-LOX inhibitory assays. In vivo tests were performed to analyze the thermal anti-nociception in the hot-plate analgesiometer and anti-inflammatory action in the carrageenan-induced paw edema model in rodents. The potential anti-nociceptive effect of 6-HF was evaluated in the DIN model in rats. The Naloxone and Pentylenetetrazole (PTZ) antagonists were used to confirm the underlying mechanism of 6-HF. The molecular modeling studies revealed a favorable interaction of 6-HF with the identified protein molecules. In vitro inhibitory studies revealed that 6-HF inhibited the COX-2 and 5-LOX enzymes significantly. The 6-HF at dosages of 15, 30, and 60 mg/kg substantially reduced heat nociception in a hot plate analgesiometer as well as carrageenan-induced paw edema in rodent models. The authors discovered that 6-HF had anti-nociception properties in a streptozotocin-induced diabetic neuropathy model. According to the findings of this study, 6-HF was demonstrated to diminish inflammation caused by diabetes as well as its anti-nociception effect in DIN.

Conductive polythiophene/graphitic-carbon nitride nanocomposite for the detection of ethanol mixing in petrol.

The automobile vehicles must be operated on fuel containing no more than 10% ethanol. Use of fuel having more than 10% ethanol may cause engine malfunction, starting and running issues, and material degradation. These negative impacts could cause irreversible damage to the vehicles. Therefore, ethanol mixing in petrol should be controlled below 10% level. The current work is the first to report sensing of ethanol mixing in petrol with reference to the variation in the DC electrical conductivity of polythiophene/graphitic-carbon nitride (PTh/gC3N4) nanocomposite. The in situ chemical oxidative method of polymerization was used for synthesizing PTh and PTh/gC3N4 nanocomposite. Fourier transform infrared spectroscopy (FT-IR), X-rays diffraction (XRD), thermo-gravimetric analysis (TGA), transmittance electron microscopy (TEM) as well as scanning electron microscopy (SEM) analysis were used for confirmation of the structure along with morphology of the PTh and PTh/gC3N4 nanocomposite. The thermal stability of DC electrical conductivity of PTh and PTh/gC3N4 nanocomposite were tested under isothermal and cyclic ageing condition. The sensing response of PTh and PTh/gC3N4 nanocomposite as a function of DC electrical conductivity were recorded in petrol and ethanol atmosphere. The sensing response of PTh/g-C3N4 nanocomposite in petrol atmosphere was 6.1 times higher than that of PTh with lower detection limit to 0.005 v/v% of ethanol prepared in n-hexane.

Porous Molecular Conductor: Electrochemical Fabrication of Through-Space Conduction Pathways among Linear Coordination Polymers.

The first porous molecular conductor (PMC), which exhibits porosity, a through-space conduction pathway and rich charge carriers (electrons), was prepared through electrocrystallization from Cd2+ and N, N'-di(4-pyridyl)-1,4,5,8-naphthalenetetracarboxdiimide (NDI-py). [Cd(NDI-py)(OH2)4](NO3)1.3±0.1· nDMA (PMC-1) was assembled by π-π stacking among one-dimensional (1D) linear coordination polymers. The NDI cores were partially reduced into radical anions to form conductive π-stacked columns, yielding (1.0-3.3) × 10-3 S cm-1 at room temperature. Moreover, the electrical conductivity was significantly enhanced by removing the solvent molecules from PMC-1, indicating that PMCs are promising as molecule-responsive conductive materials.

Knowledge and beliefs among health care workers regarding hepatitis B infection and needle stick injuries at a tertiary care hospital, karachi.

Hepatitis B virus (HBV) infection is a recognized occupational risk for health care workers (HCWs). This study aimed to assess the knowledge and beliefs of HCWs regarding HBV transmission and needle stick injuries (NSIs). A cross-sectional questionnaire based KAP study was conducted at Civil Hospital, Karachi, during the period of January to September 2006. HCWs were inquired about possible modes of HBV transmission and association with NSIs. Data were entered using EpiInfo 6.04d software. Statistical analysis was performed using SPSS 12.5 software. A total of 343 HCWs participated, and those answered at least 5 correct modes of HBV transmission were considered knowledgeable. Knowledgeable group was more likely to report NSIs (p < 0.006), more vaccinated (p < 0.001) and were also more likely to attend awareness session (p < 0.009). Overall knowledge were inadequate and behaviour and attitude towards clinical practices were found compromised. To reduce the occupational risk, effort should be focused to establish effective infection control program and training of staff.

Randomized controlled trial to improve childhood immunization adherence in rural Pakistan: redesigned immunization card and maternal education.

OBJECTIVE: A substantial dropout from the first dose of diphtheria-tetanus-pertussis (DTP1) to the 3rd dose of DTP (DTP3) immunization has been recorded in Pakistan. We conducted a randomized controlled trial to assess the effects of providing a substantially redesigned immunization card, centre-based education, or both interventions together on DTP3 completion at six rural expanded programme on immunization (EPI) centres in Pakistan. METHODS: Mother-child pairs were enrolled at DTP1 and randomized to four study groups: redesigned card, centre-based education, combined intervention and standard care. Each child was followed up for 90 days to record the dates of DTP2 and DTP3 visits. The study outcome was DTP3 completion by the end of follow-up period in each study group. RESULTS: We enrolled 378 mother-child pairs in redesigned card group, 376 in centre-based education group, 374 in combined intervention group and 378 in standard care group. By the end of follow-up, 39% of children in standard care group completed DTP3. Compared to this, a significantly higher proportion of children completed DTP3 in redesigned card group (66%) (crude risk ratio [RR] = 1.7; 95% CI = 1.5, 2.0), centre-based education group (61%) (RR = 1.5; 95% CI = 1.3, 1.8) and combined intervention group (67%) (RR = 1.7; 95% CI = 1.4, 2.0). CONCLUSIONS: Improved immunization card alone, education to mothers alone, or both together were all effective in increasing follow-up immunization visits. The study underscores the potential of study interventions' public health impact and necessitates their evaluation for complete EPI schedule at a large scale in the EPI system.

Prevalence of multi-drug resistant tuberculosis in Karachi, Pakistan: identification of at risk groups.

Multidrug-resistant tuberculosis (MDR-TB) is a possible threat to global tuberculosis control. Despite a disease prevalence of 263/100 000 population Pakistan lacks information on prevalence of drug resistant TB. Our objective was to estimate prevalence of MDR and associated risk factors in patients with pulmonary tuberculosis in Karachi. Six hundred and forty consenting adult patients were enrolled from field clinics from July 2006 to August 2008 through passive case finding. Prevalence of MDR-TB with 95% confidence interval (CI) was calculated with Epi-Info. Logistic Regression analyses were performed for risk factors associated with MDR. Overall MDR rate was 5.0%, 95% CI: 3.3-6.6% (untreated 2.3%, treated 17.9%). Mean age was 32.5 (+/-15.6) years and there were 292 (45.6%) females and 348 (54.4%) males. Factors independently associated with MDR were: female gender (OR 3.12; 95% CI: 1.40-6.91), and prior history of incomplete treatment (OR 10.1; 95% CI: 4.71-21.64). Ethnic groups at higher risk for MDR included Sindhis (OR 4.5; 95% CI: 1.42-14.71) and Pashtoons (OR 3.6, 95% CI: 1.12-11.62). This study reports an overall MDR rate of 5.0% in our study population. It further highlights the need for MDR prevention through re-focusing Directly Observed Treatment, Short-course DOTS delivery with emphasis on women and certain high risk sub groups.

Determinants of third dose of diphtheria-tetanus-pertussis (DTP) completion among children who received DTP1 at rural immunization centres in Pakistan: a cohort study.

OBJECTIVE: In Pakistan, a high proportion of children fail to complete third dose of diphtheria-tetanus-pertussis (DTP3) after having received the first dose (DTP1). A cohort study was conducted to identify the factors predicting three doses of diphtheria-tetanus-pertussis (DTP3) completion among children who have received DTP1 at six centres of Expanded Programme on Immunization (EPI) in rural Pakistan. METHOD: We analyzed a cohort of mother-child pairs enrolled at DTP1 between November 2005 and May 2006 in the standard care group of a larger randomized controlled trial. Data were collected from mothers on a structured questionnaire at enrollment, and each child was followed up at clinic visits for 90 days to record dates of DTP2 and DTP3. Multivariable log-binomial regression analysis was performed to identify the independent predictors of DTP3 completion. RESULTS: Only 39% (149/378) of enrolled children completed DTP3 during the follow-up period. After adjusting for the centre of enrollment in multivariable analysis, DTP3 completion was higher among children who were < or =60 days old at enrolment [adjusted risk ratio (Adj. RR) 1.39, 95% confidence interval (CI): 1.06-1.82], who were living in a household with monthly household income >Rs. 3000 (US$ 50) (Adj. RR 1.76, 95% CI: 1.16-2.65), and who were living < or =10 min away from EPI centre (Adj. RR 1.31, 95% CI: 1.04-1.66). CONCLUSIONS: Interventions targeting childhood immunization dropouts should focus on bringing more children to EPI centres on-time for initial immunization. Relocation of existing EPI centres and creation of new EPI centres at appropriate locations may decrease the travel time to the EPI centres and result in fewer immunization dropouts.

Impact of infection control activities on the rate of needle stick injuries at a tertiary care hospital of Pakistan over a period of six years: an observational study.

BACKGROUND: Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan. METHODS: At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated; surveillance data from 2002 to 2007 was analyzed and compared with various risk factors. RESULTS: During study period 1382 incidents were reported. Junior doctors sustained highest number of injuries (n = 394; 28.5%) followed by registered nurses (n = 283; 20.4%). Highest number of incidents was reported during blood collection (19%). An increasing trend was observed in the pre intervention years (2002-04). However noticeable fall was noted in the post intervention period that is in year 2006 and 2007. Major decline was noted among nurses (from 13 to 5 NSI/100 FTE/year). By relating and comparing the rates with various activities directly linked with the use of syringes a significant reduction in incidents were found including; hospital admissions (p-value 0.01), surgeries and procedures performed (p = 0.01), specimens collected in the laboratory (p = 0.001) and patients visits in clinics (p = 0.01). CONCLUSION: We report significant reduction in needle stick injuries especially during post intervention study period. This is being achieved by constant emphasis on improving awareness by regular educational sessions, implemented as a quality improvement project.

Redesigned immunization card and center-based education to reduce childhood immunization dropouts in urban Pakistan: a randomized controlled trial.

In Pakistan during 2000-2004, about 11-13% of children who received the first dose of diphtheria-pertussis-tetanus (DPT1) failed to complete its third dose (DPT3). We assessed the effect of a redesigned immunization card and center-based education to mothers on DPT3 completion. We enrolled 1500 mother-child units at DPT1, randomized them to three intervention and one standard care groups, and recorded their DPT3 visits during a 90-day follow-up. In multivariable analysis, a significant increase of 31% (adjusted RR=1.31, 95% CI=1.18-1.46) in DPT3 completion was estimated in the group that received both redesigned card and center-based education compared with the standard care group.

Cryopreservation of Trichomonas vaginalis: a trial of using four different cryoprotectants.

To reach the maximum survival rate of Trichomonas vaginalis after cryopreservation, four substances: dimethylsulphoxide (DMSO), glycerol, egg yolk and horse serum were used as cryoprotectants. T. vaginalis trophozoites, in the logarithmic phase, cultured on TYM-S medium were used. Rapid and slow freezing schedules were followed. Examinations for viable organisms were done after a month duration in liquid nitrogen. Immediate and delayed thawing were tried. Viability scores depended on the presence of live organisms in the thawed parasite suspensions determined by the presence of motile trophozoites under microscopic examination, by dye uptake and by re-suspension of the organisms in fresh TYM-S and watching for parasite growth and multiplication. Rapid freezing protocol failed to cryopreserve T. vaginalis with any cryoprotectant. DMSO was superior to glycerol especially in 10% conc. by slow freezing. Viable organisms were more when the suspensions were immediately thawed without delay.

Compatibility of Biomphalaria alexandrina snails to infection with Schistosoma mansoni after exposure to sublethal concentrations of Myrrh.

The effect of exposing B. alexandrina to sub-lethal dose (LC10 & LC20) of Myrrh, on its susceptibility to infection with S. mansoni miracidia were determined. Starting three weeks post miracidial exposure, cercarial shedding was monitored. No shedding of cercariae were observed from snails treated with LC20. In snails treated with LC10, longer prepatent cercarial and shorter cercarial production periods than those of control group were recorded. The number of infected snails and of shedding cercariae were decreased. The study revealed that sublethal values of myrrh decreased the compatibility of B. alexandrina to S. mansoni infection thus playing an important role in the control of schistosomiasis.

Seasonal distribution of Culicini larvae in Greater Cairo.

Five species of mosquito larvae were encountered in Greater Cairo, Culex pipiens, Cx. pusillus, Cx. perexiguus, Aedes caspius and Culiseta longiareolata. In parts of Qualyoubia G. Cx. pipiens was the most dominant and the least was Cx. perexiguus. In parts of Giza G. Cx. pipiens was the most dominant and the least was Cs. longiareolata. In Cairo G. Cx. pipiens was the most dominant and the least was Ae. caspius. The overall abundance in a descending order was Cx. pipiens (61.74%), Cs. longiareolata (15.56%), Ae. caspius (15.3%), Cx. pusillus (4.0%) and Cx. perexiguus (3.16%). However, in all sites Cx. pipiens were more in December than in August. The difference in number of Cx. pipiens in one hand and all number of larvae collected on the other hand was non significant.

Culicini mosquito larvae in Greater Cairo.

No doubt, there is a marked civilization and modern establishment of housing, agricultural and industrial projects in Egypt. In a survey to evaluate the culicini mosquito larvae in Greater Cairo, five species were recovered. These were Culex pipiens, Cx. pusillus, Cx. perexiguus Culiseta longia reolata and Aedes caspius. The taxonomic features of the larvae were given and illustrated. The results were discussed on the light of previous work carried out in Egypt.

Role of nitric oxide in host defense against Hymenolepis nana infection.

The defensive role of nitric oxide (NO) against Hymenolepis nana was investigated in vivo and in vitro studies. Serum NO levels were increased (P < 0.001) in mice 5 days (cysticercoid stage) and 15 days (adult stage) after H. nana induced oral infection with 1000 eggs/mouse, compared with normal controls. Meanwhile, L-NAME, a NO synthase inhibitor, oral administration in drinking water to infected mice caused a non significant decrease in serum NO levels (P > 0.05) compared with normal controls, and was associated with a significant increase in number of both cysticercoids and adult worms (P < 0.001) compared to that in infected mice 5 and 15 days post infection. In an in vitro study, the NO donor; sodium nitroprusside caused an increased mortality rate of H. nana cysticercoids and adult worms (P < 0.001) compared with controls without NO donor, and this was in a concentration-dependent manner (P < 0.001). Implications of these results are discussed.

The effects of myrrh (Commiphora molmol) on the infected snails of Schistosoma sp. and their egg masses: effect on shedding of cercariae and on snail fecundity.

Myrrh has molluscicidal effect on infected Bulinus truncatus and Biomphalaria alexandrina snails at low concentrations (10 & 20 ppm respectively) after 24 hours exposure. The number of dead-snails increased with prolongation of exposure time. All Schistosoma free cercariae were killed by 2.5 ppm within 15 minutes. One day-old egg masses were more susceptible to the ovicidal effect of Myrrh than the five-day old ones. Both types of eggs were more resistant to the effect of Myrrh than the adult snails, embryogenesis began to stop at 20 ppm and eggs were all killed at 60 & 80 ppm. Shedding of cercariae of Schistosoma mansoni from infected B. alexandrina stopped at 1 ppm and was suppressed at 0.8 ppm. Snail fecundity decreased at 1 ppm.

Mice immunzation using crude Trichinella spiralis antigen.

Four hundred laboratory bred male Swiss strain albino mice, seven to ten weeks old, were experimentally used to determine the effective mode of immunization against T. spiralis infection. In this regard, active immunization using repeated injection of T. spiralis muscle larval antigen was used in comparison with three, commonly used immunosuppressive drugs (Kenacort, Endoxan and Cyclosporin). Also, the minimal oral dose of T. spiralis larvae that can cause the infection was estimated. The use of T. spiralis muscle larval antigen was found promising for vaccination against the spiralis infection. Although Cyclosporin has an immunosuppressive effect, yet it has a direct lethal effect on both adult and larvae of T. spiralis, and being recommended for treatment of trichinosis. The minimal oral dose of T. spiralis larvae that lead to formation of adult worms in the intestine and larvae in muscles was 20 larvae/mouse. Meanwhile, neither adults nor larvae were formed below this dose.