Frequency of etiologies of acute kidney injury in Faisalabad and surrounding districts

Background: To find out the causes of Acute Kidney Injury (AKI) in population.Methods: A total of 150 patients were enrolled from medical, surgical, gynecology and obstetrics units of Allied Hospital and Madinah Teaching Hospital, Faisalabad, Pakistan. History, physical examination and investigations were recorded on specially designed proforma. Patients were evaluated to find out the etiologies of AKI. All patients were subjected to urine analysis, complete blood count, blood biochemistry (urea, creatinine, electrolytes, uric acid, calcium and phosphorus) and ultrasound scan of the abdomen and pelvis. Renal biopsy, immunological assays, such as hepatitis B surface antigen, anti-hepatitis C virus antibody, complements level, antinuclear antibody, anti-double-stranded DNA, anti-neutrophil cytoplasmic antibody and anti-glomerular basement membrane antibody were performed in selected cases.Results: Male (36%) and female (64%). Pre-renal AKI was most common and was reported in 80 patients (53.33%). Intrinsic Renal azotemia in 56 patients (37.33%). Post renal azotemia in 14 patients (9.33%). Among 80 patients of prerenal AKI, hemorrhage in 45(56.25%), gastroenteritis in 16(20%), sepsis in 8(10%), cardiac diseases in 4(5%), hepatorenal syndrome in 3 (3.75%), peritonitis in 2 (2.50%) and burns in 2(2.50%) were the main causes of Pre-renal AKI. Among 56 patients of intrinsic renal AKI, 40(71.4%) had acute tubular necrosis (ATN), 12(21.4%) with multifactorial causes and 4(7.14%) were found to have glomerulonephritis. Among 14 patients of post renal AKI, 6(42.9%) were having calculi, 6(42.9%) were to have enlarged prostate and 2(4.3%) were having stricture urethra. In this study, contribution of obstetrical, medical and surgical etiologies were recorded as 40%, 36% and 20% respectively.Conclusions: In contrast to study reported from neighbouring country, this study shows rather increase in pregnancy related AKI.

Effectiveness of electric toothbrush as vibration method on orthodontic tooth movement: a split-mouth study

Abstract Objective: To investigate the effects of application of vibratory stimuli, using an electric toothbrush, on the rate of orthodontic tooth movement during maxillary canine retraction. Methods: A split-mouth study was conducted in 28 subjects (mean age = 20.8 years; ranging from 18 to 24 years) whose bilateral maxillary first premolars were extracted with subsequent canine retraction. On the Vibration side, light force (100 g) was applied to the canine for 90 days, in combination with vibratory stimuli provided by an electric toothbrush; only orthodontic force was applied to the canine on the non-vibration side. Amount of canine movement was measured monthly. Related to electronic toothbrush usage, a diary was provided to each patient for recording discomfort during experimental period, having 100-mm visual analogue scale (VAS). The paired t-test was used to assess the differences in amount of tooth movement between canines of the vibration and non-vibration sides. Results: The amount of tooth movement was similar for canines on the vibration side and on the non-vibration side (mean 0.81 ± 0.10 mm and 0.82 ± 0.11 mm, respectively, p> 0.05). Plaque accumulation was minimal in any subject throughout the study. No subject reported discomfort as a result of using the electric toothbrush. Conclusions: This study demonstrates that application of vibratory stimuli using an electric toothbrush, in combination with light orthodontic force, do not accelerate orthodontic tooth movement.

Resumo Objetivo: investigar os efeitos da aplicação de estímulo vibratório, usando escova elétrica, sobre a taxa de movimentação dentária ortodôntica durante a retração dos caninos superiores. Métodos: um estudo de boca-dividida foi realizado em 28 pacientes (idade média de 20,8 anos, variando entre 18 e 24 anos) cujos dois primeiros pré-molares superiores foram extraídos, com subsequente retração dos caninos. No lado Com Vibração, uma força leve (100g) foi aplicada no canino durante 90 dias, em combinação com o estímulo vibratório gerado por uma escova de dentes elétrica; enquanto os caninos do lado Sem Vibração foram submetidos apenas à aplicação da força ortodôntica. A quantidade de movimentação dos caninos foi aferida mensalmente. Quanto ao uso da escova de dentes elétrica, diários foram fornecidos aos pacientes para que esses anotassem, em Escalas Visuais Analógicas (EVA) de 100 mm, o desconforto sentido durante o período experimental. O teste t pareado foi utilizado para avaliar as diferenças na quantidade de movimentação dos caninos nos lados Com Vibração e Sem Vibração. Resultados: os valores da movimentação dentária foram semelhantes nos lados Com Vibração e Sem Vibração (médias de 0,81 ± 0,10 mm e 0,82 ± 0,11 mm, respectivamente, p> 0,05). O acúmulo de placa dentária nos pacientes dessa amostra foi mínimo, ao longo de todo o estudo. Nenhum paciente relatou desconforto durante o uso da escova elétrica. Conclusões: o presente estudo demonstrou que a aplicação de estímulo vibratório usando uma escova elétrica, associada a forças ortodônticas leves, não foi capaz de acelerar a movimentação dentária ortodôntica.

Phenotypic and metabolic dichotomy in obesity: clinical, biochemical and immunological correlates of metabolically divergent obese phenotypes in healthy South Asian adults

<p><b>INTRODUCTION</b>Metabolic heterogeneity among obese individuals is thought to translate into variations in cardiovascular risk. Identifying obese people with an unfavourable metabolic profile may allow preventive strategies to be targeted at high-risk groups. This study aimed to identify clinical, biochemical and immunological differences between insulin-sensitive and insulin-resistant obese subgroups, to understand the population-specific pathophysiological basis of the adverse cardiovascular risk profile in the latter group.</p><p><b>METHODS</b>Cardiovascular risk indicators, including anthropometric parameters, blood pressure, acanthosis nigricans area, and related biochemical, endocrine and inflammatory markers, were determined in 255 healthy South Asian volunteers aged 18-45 years, with a 2:1 ratio of obese/overweight to normal-weight individuals. Lifetime atherosclerotic cardiovascular disease (ASCVD) risk was also calculated.</p><p><b>RESULTS</b>Body mass index (BMI) and insulin sensitivity-based tertiles independently showed incremental trends in waist-hip ratio, skinfold thickness, acanthosis nigricans area, blood pressure, serum lipids, hepatic enzymes, adipokines, inflammatory markers and ten-year ASCVD risk. The anthropometric, biochemical and inflammatory parameters of obese insulin-sensitive and obese insulin-resistant groups differed significantly. Extreme group analysis after excluding the middle tertiles of both insulin resistance and BMI also showed significant difference in anthropometric indicators of cardiovascular risk and estimated lifetime ASCVD risk between the two obese subgroups.</p><p><b>CONCLUSION</b>Obese insulin-sensitive individuals had a favourable metabolic profile compared to the obese insulin-resistant group. The most consistent discriminative factor between these phenotypic classes was anthropometric parameters, which underscores the importance of clinical parameters as cardiovascular risk indicators in obesity.</p>

Antimicrobial and antiurease potential of diorganotin [IV] schiff bases

Six new diorganotin [IV] Schiff bases, [[CH3]2SnL] [I], [[C2H5]2SnL] [II], [[n-C4H9]2SnL] [III], [[C6H5]2SnL] [IV], [[CH2C6H5]2SnL] [V] and [[n-C8H17]2SnL] [VI] where L = N-[5-bromo-2 oxidobenzylidene]phenylacetohydrazide, were synthesized and characterized by elemental analysis, FT-IR, multinuclear NMR [1H, 13C] and UV-visible spectroscopy. Spectroscopic studies indicate coordination of ligand to the diorganotin [IV] moieties via ONO donor sites generating a pentacoordinated tin center. The synthesized compounds were tested in vitro for antibacterial activity against Klebsiella pneumonia, Salmonella typhimurium, Escherichia coli, Aeromonas, Staphylococcus aureus, Vibrio cholerae, Pseudomonas aeruginosa, Shigella flexneri, and in vitro antifungal activity against Aspergillus nigar, Fusarium solani, Aspergillus fumigatus and Alternaria species. All the compounds were also screened for antiurease activity

Attenuation of palmitate induced insulin resistance in muscle cells by harmala, clove and river red gum

The present study aimed to decipher the mechanism of action of selected anti-diabetic plants extracts on palmitic acid mediated insulin resistance in muscle cells. Our results showed that extract from Peganum harmala seeds, Eucalyptus camaldulensis and Syzygium aromaticum leaves, showed significant antioxidant activity. We found that these extracts were able to affect stress signalling by reducing p-38 MAP kinase phosphorylation. They also reduced phosphorylation of substrate for insulin receptor [IRS] at serine residues and increased its phosphorylation at tyrosine residues and also enhanced PKB phosphorylation. Glucose uptake was also enhanced in muscle cells after treatment with these extracts. Extracts from Lantana camara, Psidium gujava fruit and different parts of Cassia alata did not affect FFA mediated down-regulation of insulin signalling. The study conclude that seeds of Peganum harmala and leaves of Eucalyptus camaldulensis and Syzygium aromaticum enhanced insulin signal transduction and glucose uptake in muscle cells via reducing oxidative stress. As a result, these herbal extracts may be considered useful to protect from insulin resistance

Assessment of periodontal status of miswak and toothbrush users from karachi. a comparative study

Objective: The purpose of this study was to assess the periodontal status of miswak and toothbrush users of Karachi

Study Design: Observational / Descriptive / cross sectional study

Place and Duration of Study: This study was conducted in the OPD Department, Jinnah Medical and Dental College Karachi from 02.05.2015 to 30.09.2015

Materials and Methods: Participants of the study include the students of Madrasah Islamia and patients presenting to OPD of Jinnah Medical and Dental College Karachi for routine dental checkups. We chose purposive sampling for the study. Subjects were selected on the basis of their use of miswak [Group A], use of toothbrush [Group B] and use of Miswak and Toothbrush [Group C]. Each subject was examined using CPITN probe to evaluate gingival bleeding, dental calculus and probing pocket depths of the selected surfaces. Selected surfaces were lingual surface of mandibular anterior teeth and buccal surface of maxillary posterior teeth

Subjects who did not consent to participate in the study were excluded from the study. SPSS version 20 was used for data analysis

Results: In group A 40% participants had calculus, 50% had less than 3mm pockets and 20% had more than 3mm pockets. 30% had no gingival pocketing. In group B [brushing only] 4% subjects had calculus and 96% had less than 3mm pockets. In group C [miswak plus toothbrush] 40% had calculus and less than 3mm pockets and 10% of subjects had more than 3mm pocket depth. 50% had no pockets at all. Gingival Bleeding was demonstrated in all groups with Miswak users being 30% and tooth brush users and tooth brush plus miswak users being 10 % each

Conclusion: The periodontai status of all 3 groups was found to be satisfactory but examination revealed that the users of toothbrush only [group B] possess healthier periodontal tissues

Self-reported anxiety of dental procedures among dental students and its relation to gender and level of education

Objectives: The study aimed to identify the dental procedures that elicit the highest level of anxiety by various dental procedures and to determine the correlation of anxiety with students' gender and varying perceptions of anxiety across years of dental education

Methods: This cross-sectional study was conducted at Sardar Begum Dental College, Peshawar, Pakistan during June 2014. The Corah's Dental Anxiety Scale [DAS] was distributed to all students. This instrument had 26 items examining the anxiety levels experienced for different dental procedures. Options ranging from 1 to 4 were provided for every item, where 1 represented low anxiety and 4 represented the highest anxiety

Results: The overall response rate was 67.3% [n = 101; 64 females and 37 males]. Among the top five dental procedures eliciting the highest anxiety levels, females were found to be more anxious than males for all procedures [fear of injection/needle, root canal treatment, extraction, and application of cold air] except the need for further treatment. Pre-clinical students [1[st] and 2[nd] year] were found to be more anxious than clinical students [3[rd] and 4[th] year]. Significant differences [p < 0.05] were found for three procedures: rubber dam placement, inability to stop dentist, and impression taking. Clinical students reported high anxiety for the latter, and pre-clinical students reported higher anxiety for the former two procedures

Conclusions: Higher anxiety levels were reported by females and pre-clinical students than their respective counterparts. Educational sessions and graded exposure therapy at an initial stage of dental educational training may decrease the anxiety associated with dental procedures

review of the effect of various ions on the properties and the clinical applications of novel bioactive glasses in medicine and dentistry

Bioactive glass is a novel material that dissolves and forms a bond with bone when exposed to body fluids. Bioactive glasses are silicate-based, with calcium and phosphate in identical proportions to those of natural bone; therefore, they have high biocompatibility. Bioactive glasses have wide-ranging clinical applications, including the use as bone grafts, scaffolds, and coating materials for dental implants. This review will discuss the effects of ions on the various compositions of bioactive glasses, as well as the clinical applications of bioactive glasses in medicine and dentistry

Small eyes big problems: is cataract surgery the best option for the nanophthalmic eyes?

Nanophthalmos refers to an eyeball of short axial length, usually less than 20 mm which leads to angle closure glaucoma due to relatively large lens. Intra-ocular lens extraction relieves the angle closure in nanophthalmos. Cataract surgery in a nanophthalmic eye is technically difficult with high risk of complications such as posterior capsular rupture, uveal effusion, choroidal haemorrhage, vitreous haemorrhage, malignant glaucoma, retinal detachment and aqueous misdirection. Various options are explained in the literature to perform cataract surgery in nanophthalmos, like extracapsular cataract extraction with or without sclerostomy; small-incision cataract extraction by phacoemulsification which not only helps maintain the anterior chamber during surgery but also reduces the incidence of complications due to less fluctuation of intraocular pressure [IOP] during the surgery. Cataract surgery deepens and widens the anterior chamber angle in nanophthalmic eyes and has beneficial effects on IOP in eyes with nanophthalmos but is associated with a high incidence of complications

Amalgam waste disposal in dental hospitals of Peshawar

The study was done to find out the methods for dispensing the dental amalgam and its disposal in three dental teaching hospitals of Peshawar according to American Dental Association [ADA] Standard and International Standard Organization Standard [ISO]. A specially designed questionnaire was sent for this study. The results showed that none of the dental teaching hospital in Peshawar follows the ADA and ISO standard for the disposal and recycling the amalgam waste. Only 9% claimed using the chair side traps and install amalgam separator at chair side, 64% used the hand mixing alloy / mercury procedure. Number of amalgam fillings done and removed by three dental hospitals per month were 2027 and 267 respectively. It was concluded that total amalgam waste Was 3.204 kg in three dental hospitals in one year, and proper measures should be taken for the dispensing and disposal of amalgam

case of atypical idiopathic choroidal effusion syndrome

Uveal effusion syndrome is characterized by annular ciliochoroidal detachment, shifting non-rhegmatogenous retinal detachment, unremarkable inflammation in the anterior eye segment and normal intraocular pressure. A 36-year-old Caucasian hypermetropic male presented in the eye casualty with a week history of curtain like effect in front of his left eye associated with worsening of vision and flashing lights. Left fundus examination revealed retinal detachment with smooth shaped elevation superonasaly and detached retina inferiorly confirmed on ultrasound B-scan with no tobacco dust in the anterior vitreous. Diagnosis of uveal effusion syndrome was made. Lamellar sclerectomies in the two quadrants were performed. Fourteen months postoperatively, the left eye choroidal effusion gradually settled down and at 18 months the retina flattened. Early diagnosis, close follow-up, and appropriate management are mandatory to improve or maintain visual function in such patients

Comparison between loss variance of tendency-oriented perimetry and normal strategy perimetery using octopus 32 program

To compare the values of loss variance [LV] obtained by a faster strategy- Tendency oriented perimetry [TOP] with those obtained by a standard stair casing strategy i.e. normal test strategy using OCTOPUS 32 program. Cross-sectional comparative study. Eye Department of Military Hospital Rawalpindi from February 15, 2007 to October 10, 2007. A total of 61 eyes were included in the study. Thirty with normal ocular examination and 31 with ocular pathologies producing visual field defects. Each eye was analysed with the normal [stair casing] test strategy and TOP strategy using 32 programs on Octopus 311 perimeter. LV was compared for two strategies. There was statistically significant difference between LV obtained from TOP and Normal strategy [p = 0.001]. TOP strategy tends to obtain fields with less pathological results especially for the calculation of the extent and depth of each scotoma in comparison with the normal strategy

Factors effecting the mechanism and forces involved in denture retention

Denture retention is a very multifarious phenomenon and difficult to understand. Various attempts have been made to explain it, for the past two centuries. However, there is still a contradiction and confusion in understanding of the subject. An attempt has been made, to highlight the mechanism, factors and different forces that are involved, directly or indirectly, in giving retention to the denture. The denture retention is attained by the combination of various techniques involved and none should be ruled out, as each has its own importance. Further research is needed for the explanation and better understanding of this complex procedure

Non invasive assessment of liver fibrosis in chronic liver disease

Background: Chronic hepatitis C [CMC] infection leads to necroinflammation which causes fibrosis and ultimately cirrhosis in 20% of cases. Liver biopsy is recommended for assessment of hepatic fibrosis and is thought to be the gold standard. Recurrent bouts of hepatocellular necrosis in CMC infection cause episodic rise in aminotransferases especially alanine aminotransferase [ALT]. ALT levels decrease as fibrosis advances and AST levels tend to exceed ALT. This results in increase in AST/ALT ratio >1.0, which can be used as non-invasive marker of hepatic fibrosis and cirrhosis, thus reducing the number of liver biopsies performed in patients with AST/ALT ratio >1.0

Objectives: To assess the accuracy of serum aminotransferases [AST/ALT] ratio for determining the severity of hepatic fibrosis in patients with chronic hepatitis C, considering histopathological findings as gold standard

Study Design: Cross sectional survey

Setting: Medical unit 4, Services Institute of Medical Sciences [SIMS]/ Services Hospital, Lahore

Duration: The study was completed over a period of 6 months; from 15th October, 2008 to 15th April, 2009

Subject and Methods: Seventy HCV positive with detectable RNA by Polymerase Chain Reaction, fulfilling the criteria were selected. AST and ALT levels were measured in [IU/L]. Upper limit of both AST and ALT was taken as 40 IU/L. AST/ALT ratio was calculated as under; AAR = AST [IU/L], ALT [IU/L] All these patients also underwent percutaneous liver biopsies and then histopathologist staged biopsy for fibrosis according to Ishak/Knodell criteria

Results: AST/ALT ratio of more than 1.0 was associated with severe fibrosis/ cirrhosis [F4- f6]

Conclusion: Study showed that AAR more than 1.0 has significant association with severe fibrosis and identifies CMC patients with marked fibrosis/ cirrhosis, and its application can decrease the need for performing liver biopsies for staging

Efficacy of pre-operative injection Mitomycin-C in prevention of pterygium recurrence

To determine the recurrence rate of pterygium with four weeks preoperative injection mitomycin-C using bare sclera technique. An interventional case series. This ongoing study was started in November 2005 at eye department of combined military hospital Kharian, Pakistan. Ninety one eyes of 87 patients have been so far enrolled in the study. Cases between 20 to 50 years of age, of either sex, with primary and recurrent pterygia were included. The subjects were first given 0.1 ml injection mitomycin-C 0.15 mg/ml into the body of pterygium. Four weeks later, pterygium surgery was performed using bare-sclera technique. The subjects are being followed up for at least one year to detect any recurrence. Out of 91 cases, 16 [17.58%] cases have been followed up for 12 months, 19 [20.87%] for 9 months, 21 [23.07%] for 6 months, 17 [18.68%] for 3 months and 18 [19.78%] for less than 3 months. Recurrence has not been encountered in any of these cases so far. Initial results show that pterygium surgery with pre-operative injection mitomycin-C appears to be an effective form of treatment for prevention of pterygium recurrence. Further follow up and multi-centric studies are required for final conclusion

Myocardial ischaemia and reperfusion injury: reactive oxygen species and the role of neutrophil

A growing body of evidence suggests that oxygen radicals can mediate myocardial tissue injury during ischaemia and, in particular, during reperfusion. This review focuses on the role of neutrophil as a mediator of myocardial damage. Upon reperfusion, neutrophils accumulate and produce an inflammatory response in the myocardium that is responsible, in part, for the extension of tissue injury associated with reperfusion. It has shown that the inhibition of neutrophil accumulation and adhesion is associated with decreased infarct size. This strongly suggests that myocardial cells at risk region undergo irreversible changes upon reperfusion and accumulation of neutrophils. Several pharmacological agents [ibuprofen, allopurinol, prostacyclin, and prostaglandin E analogues] protect the myocardium from reperfusion injury. In addition, the mechanisms by which these agents act and directions of research that may lead to therapeutically useful approaches are also discussed in this review