Modified Impression Technique of a Custom Made Hand Painted Iris For an Ocular Prosthesis: A Case Report

@#The enucleation of the eye due to variety of causes such as trauma, tumor and severe eye disease or infection has resulted to permanent defect of sight and aesthetic. Defects of the eye may include removal of a part of or the entire orbit which has affected patient’s psychology. Restoring the defect with pre-fabricated or custom-made ocular prosthesis will restore aesthetics and improves patient’s social confidence. This is a case report of construction a custom-made; hand painted iris of ocular prosthesis on a patient with missing left eye due to trauma using modified impression method. The case describes the process of constructing the custom-made ocular prosthesis with modification of impression technique to improve accuracy and fitting. It is aim to highlight the importance of custom-made prosthesis as compared to pre-fabricated ocular prosthesis on its property, fitting to eye socket, hygiene and aesthetic satisfaction.

Health Consequences During Pandemic: A Review

@#COVID-19 pandemic has brought many changes in daily life. The pandemic has affected all populations in the world and lead to WHO calling for the global action to minimize the spread of this infection. Social distancing, work from home and movement control order are some of the strategies implemented to mitigate this infectious outbreak. Health consequences on non-communicable disease, mental health, social crisis among schoolchildren and burnout among healthcare providers have been affected during the pandemic. This review will provide a brief explanation on these health consequences of COVID-19 to the population. Future strategies that can be implemented during pandemic will also be discussed in the review.

Tourniquet practices in orthopaedic surgery: a questionnaire based study

Objective: To assess the level of understanding of operation room personnel for application of tourniquets. Study Design: Descriptive cross-sectional study. Place and Duration of Study: The study was carried out in the department of Surgery, Combined Military Hospital Rawalpindi, from Feb 2013 to Jun 2013

Material and Methods: A previously published questionnaire form with slight modifications was distributed among orthopaedic/plastic/general surgery/anaesthesia operation room staff. The questionnaire comprised 26 questions with total of 56 marks. The answers were taken from the individuals on the spot and forms were marked according to the marking scheme and total score of each individual was recorded. The experience of each individual in his respective specialty was also documented [In years]. The individuals were categorized into their respective specialties. Data was analyzed using SPSS version 21. Mean and SD of numerical variables was calculated and frequency and percentages were presented for categorical variables

Results: Fifty six individuals answering all 26 questions from the questionnaire were included in the study. Out of 56 individuals, 6 [11%] were orthopaedic surgeons, 4 [7%] were plastic surgeons, 14 [25%] were general surgeons, 19 [34%] were registrars in surgery, 5 [9%] were registrars in anaesthesia and 8 [14%] were operation room assistants. The mean score of all the participants was 25.1 [+/- 4.1] out of 56 with minimum of 17 to maximum of 35

Conclusion: The role of tourniquet in the field of orthopaedic surgery has become very significant. As there is no formal teaching to the trainees about its use, there is a need to incorporate its training at the practical level during training

Association Between Il-31 Serum Levels And Other Predisposing Factors With Allergic Diseases In Hrpz Ii And Husm, Kelantan, Malaysia

@#Interleukin 31 (IL-31)is one of the cytokines which appears to be an important regulator of Th2 responses. Previous study has been done to determine IL-31 serums levels in atopic dermatitis (AD). However, the serum levels of IL-31 in allergic rhinitis (AR) and atopic asthma (AA) is not many reported and still unclear. The objective of this cross sectional study is to determine an association between IL-31 and other predisposing factors with allergic diseases in HRPZ II (Hospital Raja PerempuanZainab II) and HUSM (Hospital UniversitiSains), Kelantan, Malaysia. This study involved 70 patients of AD, 70 patients of AR, 70 patients of AA and 70 healthy controls from staffs and people in HUSM.Five milliliters of blood were withdrawn and centrifuged for 5 minutes at 2000 rpm to obtain the serum and analyzed for IL-31 levels by using enzymelinked immunosorbent (ELISA) kits (Human IL 31 Duoset, R&D System). Simple and multiple logistic regressions were used to analyze the association between IL-31 levels and predisposing factors among allergic diseases. The levels of IL-31 and other predisposing factors showed significant associations in smoking status, occupational exposure and area of living for AD and AR, however in AA, the significant association only found in smoking status and occupational exposure. In conclusion, we found that there were associations between IL-31 serum levels and other predisposing factors with AD, AR and AA. The findings can be the pilot study to determine IL-31 levels in allergic diseases in Malaysia.

Factors involved in failure of exclusive breast feeding practices among mothers

Background: Exclusive breast feeding is essential for baby's health

Objective: To determine the factors associated with failure of exclusive breast feeding

Methodology: Study design: Cross - sectional study. Place and duration of study: The study was carried out in Pediatric department of Sheikh Zayed Hospital, Rahim Yar Khan, from 1 July 2015 to 30 June 2016. This study was conducted on five hundred women having infants up to 6 month of age and not on exclusive breastfeeding. A questionnaire was designed and data was collected through interviewing infant's mothers about various risk factors including maternal education, socioeconomic status, maternal employment status, family type, maternal separation, social myths, number of children, mode and place of delivery, maternal systemic illness, maternal breast condition, birth spacing, and counseling for breast feeding. The data was entered and analyzed by SPSS version 16

Results: Our study showed that among mothers having lack of exclusive breast feeding practice, following factors were found including lower socioeconomic status in 51.2%, joint family system 75.8%, male sex of infant in 62.8%, use of water up to 4 months is good in 64%, mother thinking that milk is not good in 29.2% and to familiarize baby to top feeding in 78.4%. Study showed that place of delivery was private clinics in 55.4%, caesarean section in 37.6% of and 73.4% of caesarean sections as mode of delivery took place at private clinics. Pathological maternal breast conditions [engorgement, sore or cracked nipples, abscess] were found in 36.6% and maternal systemic illness in 19.2%. It was found that proper counseling of mothers for exclusive breast feeding was done among 20.8%, at antenatal visits and 37.2% after delivery

Conclusion: Our study showed that among mothers not practicing exclusive breast feeding, most of these belonged to lower socioeconomic status, not employed, living in joint family system, and having social myths like use of water up to 4 months and to familiarize baby to bottle feeding. It was also found that pathological maternal breast conditions and lack of counseling, antenatally and postnatally were also important risk factors

Association Between IL-31 Serum Levels And Other Predisposing Factors With Allergic Diseases In HRPZ II and HUSM, Kelantan, Malaysia

Interleukin 31 (IL-31)is one of the cytokines which appears to be an important regulator of Th2 responses. Previous study has been done to determine IL-31 serums levels in atopic dermatitis (AD). However, the serum levels of IL-31 in allergic rhinitis (AR) and atopic asthma (AA) is not many reported and still unclear. The objective of this cross sectional study is to determine an association between IL-31 and other predisposing factors with allergic diseases in HRPZ II (Hospital Raja PerempuanZainab II) and HUSM (Hospital UniversitiSains), Kelantan, Malaysia. This study involved 70 patients of AD, 70 patients of AR, 70 patients of AA and 70 healthy controls from staffs and people in HUSM.Five milliliters of blood were withdrawn and centrifuged for 5 minutes at 2000 rpm to obtain the serum and analyzed for IL-31 levels by using enzyme-linked immunosorbent (ELISA) kits (Human IL 31 Duoset, R&D System). Simple and multiple logistic regressions were used to analyze the association between IL-31 levels and predisposing factors among allergic diseases. The levels of IL-31 and other predisposing factors showed significant associations in smoking status, occupational exposure and area of living for AD and AR, however in AA, the significant association only found in smoking status and occupational exposure. In conclusion, we found that there were associations between IL-31 serum levels and other predisposing factors with AD, AR and AA. The findings can be the pilot study to determine IL-31 levels in allergic diseases in Malaysia.

survey on current impression techniques and materials used for complete denture fabrication practiced by private dental practitioners in Sindh

The purpose of the study was to evaluate which impression materials and techniques are used by private dental practitioners for fabrication of complete denture in Sindh, Pakistan

In this cross-sectional study, structured questionnaires consisting of 10 questions regarding complete denture impression materials and techniques was prepared and randomly distributed among 150 dentists in Sindh, Pakistan

The response rate was [85%] in this survey. [78%] practitioners used stock metal tray for primary impressions. The irreversible hydrocolloid was the material of choice for preliminary impression by [76%]. Custom tray for final impression by [89%]. Self cure acrylic resins was the most commonly used material for the custom tray fabrication by [92%] Custom tray was made few days prior to make final impression by [82%]. Close-fitting trays was preferred by [75%]. Mucocompressive technique was the most predominant impression philosophy [77%]. The most common materials of Choice for border molding and final impressions were modeling plastic impression compound [90%] and zinc oxide eugenol paste [89%] respectively

Concerns and issues regarding the non-use of latest impression materials and techniques related to complete denture impressions as well as a lack of understanding of the related concepts of participants were observed

Management of lower limb wounds by negative pressure dressings

Objective: To determine the outcome of home-made negative pressure dressings in acute complex wounds of the lower extremity in terms of healing

Study design: Descriptive case study

Place and Duration of study: Department of Orthopaedics and Spine Surgery, Ghurki Trust Teaching Hospital Lahore, from September 2012 to February 2013

Methodology: Patients with soft tissue defects of lower extremity were included. Preoperative size of the wound with Gustilo type IIIA and IIIB was measured and negative pressure dressings were applied. Each dressing was applied for 72 hours. Outcome of the wound was assessed on 9th day after 3 dressings. The quality of granulation tissue and wound healing were noted

Results: A total of 100 patients were enrolled. There were 75 males and 25 females with a ratio of 3:1. Mean age was 32.88 +/- 6.10 year. Seventy percent patients had decrease in size of the wound. Ninety patients developed granulation tissues in the lower limb wounds

Conclusion: Home-made negative pressure dressing was a valuable therapy in the management of acute injuries of lower limb as it resulted in granulation and healing of the wound under challenging conditions

Frequency of three complications [bleeding, laceration of external auditory canal and perforation of tympanic membrane] in patients with aural foreign bodies

To determine the frequency of three major complications of the foreign body in the external auditory canal i.e. the haemorrhage, the laceration and the perforation of the tympanic membrane. Cross sectional study. This study was conducted in the Department of ENT, Bahawal Victoria Hospital, Bahawalpur from 25-12-2012 to 24-09-2013. Total 284 cases that presented during nine months of duration were included in our study. General anaesthesia was used not only when initial attempt under direct visualization was unsuccessful, but also for those having history of previous attempts, and uncooperative patients. 25% of patients developed haemorrhage, 13.8% were having laceration while none of the patient presented with tympanic membrane perforation. Cotton bud was found to be the commonest foreign body [33.7%] and bleeding was associated with it. In this study, the cotton bud was found to be the commonest foreign body in external auditory canal. Use of cotton bud although is easy for cleaning of ears but if it is broken inside the external auditory canal, can cause serious complications like bleeding and laceration as found in this study. Public should be educated about this preventable medical emergency

Study is about the prevalence of the HCV disease and survival of HCV patients with associated factors in the population of district Multan

To find out the significant factors associated with HCV disease and evaluate the impact of these factors on the survival patternof HCV patients in district Multan. The study was conducted in Nishter Hospital of Multan district from 1[st] January 2011 to l[st]October 2012. To see a significant difference between the survival rates of patients with associated factors, non-parametric Cox- proportional hazard model with their graphical results were used. All the patients above 11 years old of both sexes were included in the study. All those who were surviving with HCV diseasewere studied with their associated factors such as age, family history [FH] barber/parlor services, blood group [BG] types weight loss [WL], Gender and drug use were collected from Nishter Hospital Multan. Results indicated that age, blood group types and gender are the most significant factors in the patients who are surviving with HCV disease. It was also observed that survival rate of female patients is high as compare to male patients

HCV; prevalence in the population of district Multan Pakistan

To find out the risk factors associated with HCV disease and evaluate the association of risk factors of HCV disease patient's in the population of Multan District. Experimental study. Nishter Hospital of Multan District. 1[st] January 2011 to 1[st] April 2012. 540 patients with ages 11 to 90 years old of both sexes were included in this study. All those who were surviving with HCV disease were studied with their associated risk factors such as age, family history; barber/parlor services, blood group types, drug use and weight loss were collected. For the data analysis, descriptive and Chi-square analysis are used to determine the association between risk factors and HCV. Results shows that out of 540 patients surviving with HCV, out of which 48% are female and 52% are males. The mean age for male and female was 37 +/- 12.62 and 34 +/- 11.22 respectively. Results showing that blood groups types and age of the patients were significantly related to the HCV survival status at 5% level of significance. The study shows that HCV patients with blood group "O' patients are maximum as compared to other groups. HCV is more common in males as compare to female. Persons who are above 30 years old were more affected with HCV disease. Age and blood group types are the most significant factors in the patients who are surviving with HCV disease

Comparison of accuracy of working length measured by apex locator and periapical radiograph

The aim of this study was to compare the accuracy of working length measured by electronic apex locator andperiapical radiograph. This cross sectional analytical study was conducted at Department of Operative Dentistry, Dental section, Dow International Medical College, DUHS from November 2014 till December 2014. Thirteen teeth with twenty three canals were selected in patients having age between 18 to 60 years, who were advised extraction of teeth due to any reason. Access opening was performed and working lengths of all canals were measured using Kfile with apex locator and periapical radiographs. Access opening was filled with restorative GIC with the files present in canals. Teeth were then subjected to extraction. All extracted teeth were evaluated by sectioning the lower half or lower one third of the apices longitudinally. The distance of the file tip from the minor constriction was measured and recorded. Data were analyzed by using SPSS version 16. Intraclass co-efficient test was applied to see the agreement between the lengths measured with radiograph and apex locator than compared to the actual lengths as noted after sectioning. P-value of <0.05 was considered as significant. The results of the study showed that accuracy of apex locator were 65% [n=15] with the file tip at minor constriction, while 22% [n=5] for periapical radiograph. Thus it is concluded that electronic apex locator is more accurate and reliable then periapical radiograph

Dental anxiety level of patients presenting to operative dentistry department

Dental anxiety is a fear of visiting a dental health care provider for preventive or therapeutic care that leads to deterioration in oral health. The aim of this study was to measure the dental anxiety levels of patients presenting to the Operative dentistry department of Dental Section Dow International Medical College. It was a cross sectional study conducted between December 2014 and February 2015. Norman Corah's dental anxiety scale was used to measure the anxiety levels of patients.1 A questionnaire was developed based on this scale and a valid record of 383 forms was obtained. Amongst 383 patients, 125 were male patients [32%] while 258[67%] were female. Descriptive analysis was performed. Frequencies and cross tab calculations were carried out using SPSS version 20. Among other stressors, dental handpiece stood out as the most frightening. 12% of the respondents replied that they would get extremely anxious, making them feel physically sick while anticipating the use of a dental drill. Result showed that most of the patients [49%] had moderate dental anxiety that could be managed by simple non pharmacological means and counselling. While only 5% and 8% of the patients had high and severe [phobia] dental anxiety respectively. The mean dental anxiety level was 9.35 with Standard Deviation of +/- 3.06. More females had severe dental anxiety as compared to males [9% as compared to 5%]

Knowledge, attitude and perception of dental fraternity towards practice of rubber dam

Rubber dam isolates operating field and makes treatment less invasive and safer for the patient. The aim of this study was to evaluate knowledge, attitude and practice of using rubber dam among different strata of dental fraternity. This cross sectional survey was conducted at Dental section, Dow International Medical College; DUHS from November 2014 till may 2015. Four hundred questionnaires were distributed amongst dental students, house officers and postgraduate trainee. General practitioners and retired dentist were excluded from the study. Three hundred and seventy four questionnaires were returned with over all response rate of 93.5%. Data was analyzed by using SPSS version 20. Statistically there was a significant association between knowledge and designation [p=0.031]. Dentist showed positive attitude towards rubber dam application [p=0.00]. It is concluded that dentists have significant knowledge about rubber dam use, but general reluctance towards it require change in the attitude by improvising regular practice

In vitro interaction of antimicrobial agents in combination with plant extract against multidrug-resistant bacterial strains

Aims: To evaluate the possible in vitro interaction between methanolic extract of root of Adiantumcapillus-veneris and certain known antimicrobial drugs i.e. Oxacillin, Ceftazimide, Cefriaxone, Ofloxacin, Meropenem, Erythromycin, Cefuroxime, Cefoxitin, Cefotaxime and Ampicillin. Methodology and results: The study was carried out against ten bacterial strains (Staphylococcus aureus, S. epidermidis, Salmonella typhi, Klebsiella pneumoniea, Shigella dysentriea, Proteus vulgaris, Pseudomonas aeruginosa, Providencia species, Citrobacter freundii and Escherichia coli isolated from urine, pus and blood samples. Both disc diffusion and well diffusion methods were used to determine antimicrobial activity of plant extract in combination with antibiotics. Antimicrobial sensitivity showed that Meropenem was the most effective antibiotic with zone of inhibition (ZI) of 25-33 mm among all tested antibiotics followed by Ofloxacin (10-26.5 mm), Ceftriaxone (8-20 mm), while Oxacillin showed no activity against almost all bacterial strains. The study showed that most bacterial strains were resistant to most of the antibiotics used, ranging from 20-60%. The methanolic extract (mEXT) of A. capillus-veneris used alone was active against most of the bacterial isolates with maximum activity against E. coli with 16 mm ZI. The study also indicated that there was an increased activity in case of combination of mEXT with antibiotics. The combined effects of plant extract with antibiotics were synergistic against most of the bacterial strains. The mEXT showed maximum synergistic effect with Ceftazimide with ZI of 42 mm followed by Meropenem (40 mm) and Ceftriaxone (28 mm) against multidrug-resistant (MDR) bacterial strains. Conclusion, significance and impact of study: The data suggests that plant extract could be used as alternative to antibiotics. These results give scientific backing that combination between plant extract and antibiotics would be useful in fighting the emerging drug-resistant bacterial pathogens.

Association between baseline parameters and end of treatment response to combination of conventional interferon and ribavirin in patients with chronic hepatitis C

To study the association between baseline parameters and end of treatment response [ETR] to conventional interferon treatment in patients with chronic hepatitis C. This retrospective analytical study was conducted in Gastroenterology department of Lady Reading Hospital Peshawar from January 2012 to June 2012. A total of 222 patients with chronic hepatitis C, on combination of conventional interferon and ribavirin therapy were included in the study who reported with ETR. Various baseline parameters included sex [male vs. female], age [< 40years vs. >40years], weight [<70kg vs. >70kg], viral load [<800000IU/ml vs. >800000IU/ml] and ALT quotient [<3 vs. >3]. These variables were compared with ETR to see for any significant association. Two hundred and twenty two patients were included in the study out of which 94[42.3%] were male and 128[57.7%] were females. 121[54.5%] of the patient achieved ETR while 101[45.5%] failed to achieve ETR. Among various variables tested weight <70kg [59% vs. 43%] and ALT Quotient >3 [70% vs.50%] were significantly associated with ETR with a p value of 0.01 and p value of 0.013 respectively while there was no statistically significant association between other parameters and ETR. High baseline ALT and baseline low body weight are significantly associated with better ETR. Among these weight is a modifiable factor and obese patients should be advised to lose weight before embarking them on anti viral therapy in order to improve their chances of viral clearance

Varying thickness of tide mark in articular cartilage of ageing male undergoing osteoarthritis in Pakistani population

Objective: to study increasing thickness of tide mark in articular cartilage of male with advancing age

Material and Methods: forty samples of articular cartilage of knee joint from male dead bodies of estimated age between 21- 60 years, brought to forensic department within six hours of death and undergoing autopsy within 12 hours of death were collected. The samples were grouped as A, B, C and D depending upon the estimated age. The thickness of tide mark was recorded in different age groups

Results: with advancing age, the thickness of tide mark was increased and highly significant statistically [p-value = 0.000]

Conclusion: as the age advances the thickness of the tide mark increases in articular cartilage of knee joint of male undergoing osteoarthritic changes and such changes are set in about a decade earlier in Pakistani population

Histomorphological study of minor salivary glands in advancing age

Objective: to study age related morphological changes in the minor salivary glands

Material and Methods: thirty five specimens of minor salivary glands were collected from dead bodies of adults, both male and female, brought to the Forensic Department of King Edward Medical University Lahore for autopsy within twenty four hours of unnatural death. Dead bodies with surgical scars on body, lymphadenopathy and enlarged salivary glands were excluded from the study. Autopsy specimens were placed in five groups according to estimated age. Samples were collected, processed and stained with Hematoxylin and Eosin for histomorphometric studies under light microscope for diameter of acini, number of acini, number of intercalated ducts and number of interlobular blood vessels

Results: statistically significant changes in diameter of acini and mean number of acini were observed in different study groups with advancing age [p value = 0.000] while no significant change was observed in mean number of intercalated ducts and interlobular blood vessels

Conclusion: with increasing age mean diameter and number of acini decreases while number of intercalated ducts and interlobular blood vessels remains unchanged in minor salivary glands

Assessment of microleakage of three restorative materials in class V cavities. an in vitro study

To evaluate the marginal microleakage in class V cavities restored with three different restorative materials using dye penetration scoring system. Cross sectional study. This study was conducted at Dental Clinic laboratory, Juma building research laboratory, and Multidisciplinary laboratory, The Aga Khan University, Karachi for a period of six months from April 2008 to September 2008. One hundered and fifty extracted premolars were randomly selected. Standardized class V cavities were prepared and then divided into three equal groups: Group I was restored with composite resin, Group II with glass ionomer cement and group III with resin modified glass ionomers. They were then subjected to thermocycling, immersed in 2% methylene blue dye, sectioned and examined under dissection microscope. Dye penetration for each section was recorded and data was analyzed. Lowest leakage was found in Group I [composite resin] and maximum in Group II [conventional glass ionomer]. Microleakage at gingival margins was significantly more than that at occlusal margins in all groups. Composite resins and resin modified glass ionomers provide a better seal than glass ionomers in class V cavities. All materials show more microleakage at gingival margins as compared to occlusal margins

A rare case of massive systemic embolisation secondary to atrial myxoma- case report

We report a case of a 21 year old girl who presented with sudden onset of abdominal, back and bilateral leg pain, paralysis with unexpected collapse at home. Physical examination was suggestive of acute aortic occlusion. CTangiogram revealed multi-system thrombo-embolic shower. She proceeded to urgent aortic thrombectomy and fasciotomy of the bilateral lower limb. Further investigation revealed atrial myxoma and we report the patient's postoperative progress and eventual transfer to rehabilitation facility.