A prospective multicentre study evaluating the performance of the modified simple biliary atresia scoring system in predicting biliary atresia.

PURPOSE: Early diagnosis of biliary atresia (BA) is critical for best outcomes, but is challenged by overlapping clinical manifestations with other causes of obstructive jaundice in neonates. We evaluate the performance of the modified Simple BA Scoring System (SBASS) in diagnosing BA. METHODS: We performed a prospective, cross-sectional study on infants with cholestatic jaundice (June 2021-December 2022). Modified SBASS scoring was applied and compared to the eventual diagnosis (as per intraoperative cholangiogram (IOC) and liver histopathology). The score (0-6), consists of gall bladder length < 1.6 cm (+ 1), presence of triangular cord sign (+ 1), conjugated bilirubin:total bilirubin ratio > 0.7(+ 2), gamma-glutamyl transferase (GGT) ≥ 200 U/L (+ 2). RESULTS: 73 were included: Fifty-two (71%) had BA. In the non-BA group, 6 (28%) had percutaneous cholangiography (PTC) while 15 (72%) had intraoperative cholangiogram (IOC). At a cut-off of 3, the modified SBASS showed sensitivity of 96.2%, specificity of 61.9% and overall accuracy of 86.3% in diagnosing BA. Area under receiver operating characteristic curve was 0.901. GGT had the highest sensitivity (94.2%), while triangular cord sign showed the highest specificity at 95.2%. CONCLUSION: The SBASS provides a bedside, non-invasive scoring system for exclusion of BA in infantile cholestatic jaundice and reduces the likelihood of negative surgical explorations.

ELECTIVE PERCUTANEOUS CORONARY INTERVENTIONS--A COMPARISION OF EFFICACY OF CLOPIDOGREL AND PRASUGREL.

BACKGROUND: Percutaneous coronary interventions are almost always preceded by the loading dose of platelets inhibiter drugs such as clopidogrel or prasugrel and followed by maintenance therapy to decrease the mortality and morbidity due to stent thrombosis. This study was conducted to compare the efficacy of clopidogrel and prasugrel for inhibiting platelet aggregation among patients undergoing elective percutaneous coronary intervention. METHODS: This randomized controlled trial study was done in Department of Cardiology, Postgraduate Medical Institute Govt. Lady Reading Hospital Peshawar. A total of 148 patients were randomly allocated to either group-A containing 74 patients using clopidogrel or group-B containing 74 patients using prasugrel RESULTS: Group-A had 55 (74.3%) male and 19 (25.7%) females while group-B had 56(75.7%) males and 18 (24.3%) females (p=0.85). Mean age was 54.9 +/- 11.2 years in group-A and was 57.7 +/- 8.7 years in group-B (p=0.09). Mean body weight was 71.8?6.4 Kg in group-A and 70.8 +/- 6.3 Kg in group-B (p=0.35). Mean Baseline platelet aggregation before drug administration was 10.43 +/- 1.9 ohm in group-A while 10.12 +/- 2.2 ohm in group-B (p=0.36). Mean Follow up platelet aggregation 6 hours after drug administration was 5.88 +/- 2.9 in group-A while it was 3.47 +/- 1.8 ohm in group-B (p=0.001). Mean Difference between basal and follow up platelet aggregation +/-SD was 52.9649 +/- 24.77 in group-A while it was 82.25 +/- 14.34 in group-B (p=0.001). 63(85.15%) of group-A had inhibition of platelets aggregation >10% as compare to 72(97.3%) of group-B had inhibition of platelets aggregation >10% (p=0.009). CONCLUSION: Prasugrel is more efficacious than clopidogrel in term of inhibition of platelets aggregation.

FREQUENCY OF ABDOMINAL OBESITY AND ITS ASSOCIATION WITH DIABETES MELLITUS AMONG PEOPLE OF PESHAWAR.

BACKGROUND: Increased body weight is a major risk factor for the metabolic syndrome which is a cluster of coronary heart disease risk factors, like: hypertension, diabetes mellitus and dyslipidaemia. This study was conducted to determine the frequency of abdominal obesity and diabetes mellitus in the population of Peshawar and association between them. METHODS: This was a cross sectional study, performed by the Cardiology Department, Lady Reading Hospital Peshawar, in the population of Peshawar. All participants were interviewed in detail regarding known risk factors for coronary artery disease. Waist circumference (≥102 cm in male and ≥88 cm in females) was used as the surrogate marker for abdominal obesity in already diagnosed patients of type-2 diabetes mellitus. RESULTS: A total of 2548 individuals were included, 71.1% were male. Mean age was 37.94±12.59 years. Mean waist circumference was 90.25±13.45cm in males and 90.52±12.52cm in females. Diabetes was present in 4.4% of the participants and abdominal obesity in 56.6% Among the male, abdominal obesity was present in 39.4% and diabetes in 2.9%. Out of 39.4% males with abdominal obesity, 2% were diabetic. Out of 38.6% males with no abdominal obesity, 0.9% was diabetic. Amongst the total 559 (21.1%) female subjects, 17.2% were having abdominal obesity and 1.4% was diabetics. Among 123 (4.8%) females with no abdominal obesity, 0.1% was diabetic. A positive association was established between abdominal obesity and diabetes mellitus with a significant p-valve (<0.05). CONCLUSION: Abdominal obesity is more common in the local population of Peshawar and associated with type-2 diabetes mellitus.

Capital structure determinants across sectors: Comparison of observed evidences from the use of time series and panel data estimators.

This comparative study is an attempt to explore the determinants of capital structure for Malaysian firms listed in various sectors level. Within the framework of traditional and moderate dynamic capital structure theories, the key determinants such as fixed assets, current assets, return on equity, size, earning per share and total assets are tested in relation to the debt-equity ratio. The large-scale study entails data collected from 551 listed firms of Bursa Malaysia main market over 12 years period i.e. 2005-2016. Notably, this study combines Time Series econometrics with Panel Data analysis to enhance methodological robustness. Moreover, the comparative analysis approach is designated to recognize the most persistent capital structure determinants. In the first place, the Multiple Regression analysis (MRA) is selected as a baseline estimation method. Subsequently, the Auto Regression Distributed Lag model (ARDL), the Panel Data Static models, and Dynamic model via the Generalized Method of Moments (GMM) are employed to identify the capital structure determinants for the firms listed at Bursa Malaysia. The outcomes are surprising and indicate that the entire market is primarily controlled by the studied determinant total assets, which is significant in both construction and property sectors through MRA, ARDL, and GMM analysis. Technically, the significant role of tangibility and the existence of speed of adjustment across sectors imply that the Dynamic Capital Structure is the most prominent among all, followed by the Dynamic Trade-off theory.

Effects of MAP4K inhibition on neurite outgrowth.

Protein kinases are responsible for protein phosphorylation and are involved in important intracellular signal transduction pathways in various cells, including neurons; however, a considerable number of poorly characterized kinases may be involved in neuronal development. Here, we considered mitogen-activated protein kinase kinase kinase kinases (MAP4Ks), related to as candidate regulators of neurite outgrowth and synaptogenesis, by examining the effects of a selective MAP4K inhibitor PF06260933. PF06260933 treatments of the cultured neurons reduced neurite lengths, not the number of synapses, and phosphorylation of GAP43 and JNK, relative to the control. These results suggest that MAP4Ks are physiologically involved in normal neuronal development and that the resultant impaired neurite outgrowth by diminished MAP4Ks' activity, is related to psychiatric disorders.

Foot plantar pressure measurement system: a review.

Foot plantar pressure is the pressure field that acts between the foot and the support surface during everyday locomotor activities. Information derived from such pressure measures is important in gait and posture research for diagnosing lower limb problems, footwear design, sport biomechanics, injury prevention and other applications. This paper reviews foot plantar sensors characteristics as reported in the literature in addition to foot plantar pressure measurement systems applied to a variety of research problems. Strengths and limitations of current systems are discussed and a wireless foot plantar pressure system is proposed suitable for measuring high pressure distributions under the foot with high accuracy and reliability. The novel system is based on highly linear pressure sensors with no hysteresis.

Serum-Based lncRNA ANRIL, TUG1, UCA1, and HIT Expressions in Breast Cancer Patients.

Breast cancer is a heterogeneous disease and is the most common and prevalent form of malignancy diagnosed in women. lncRNAs are found to be frequently dysregulated in cancer, and its expression plays a critical role in tumorigenesis. The study included 100 histopathologically confirmed, newly diagnosed untreated patients of invasive ductal carcinoma (IDC) of breast cancer patients and 100 healthy subjects. After blood collection, the serum was separated and total RNA was extracted, cDNA was synthesized using 100 ng of total RNA, and lncRNA (ANRIL, TUG1, UCA1, and HIT) expression was analyzed. Increased ANRIL (3.83-fold), TUG1 (7.64-fold), UCA1 (7.82-fold), and HIT (3.31-fold) expressions were observed in breast cancer patients compared to healthy controls. Relative expression of lncRNAs UCA-1 (p = 0.010) and HIT-1 (p < 0.0001) was significantly elevated in patients with advanced breast cancer stage compared to those with early-stage disease. While lncRNA TUG-1 expression was found to be higher in patients with early-stage tumors than those with advanced-stage tumors (p = 0.06), lncRNA ANRIL showed increased expression in patients with PR positive status (p = 0.04). However, we found a significant difference in lncRNA HIT expression in HER-2 positive breast cancer patients compared to HER-2 negative breast cancer patients (p = 0.005). An increase in the expression of serum lncRNAs ANRIL (p < 0.0001), UCA-1 (p = 0.004), and HIT (p < 0.0001) was observed in the distant organ metastatic breast cancer patients. In the ROC curve concerning lymph node involvement, the sensitivity and specificity of lncRNA HIT were 68% and 58%, respectively (p value = 0.007). In the ROC curve w.r.t. stages of disease, the sensitivity and specificity of lncRNA HIT were 80% and 50%, respectively (p value < 0.0001). Better sensitivity and specificity were observed for lncRNA HIT (sensitivity 91% and specificity 78%; p value < 0.0001) and ANRIL (sensitivity 70% and specificity 60%; p value < 0.0001) w.r.t distant organ metastases.

Factors influencing the practice of Smoking Cessation Assessment and Management among Primary Care Doctors (SCAAM-DOC) in three districts of Malaysia.

BACKGROUND: Smoking prevalence remains high in Malaysia. Primary care doctors have a good opportunity to motivate the smokers to quit smoking in view of the accessibility of primary healthcare clinics to the public. The objective of this study was to determine the practice of smoking cessation management among primary care doctors and its associated factors. METHODS: A cross-sectional online survey was carried out among 383 medical officers and interns in all government primary healthcare clinics in the district of Petaling, Klang and Hulu Langat from June to August 2020. All doctors were involved in the care of patients for smoking cessation. The knowledge, attitude and practice of smoking cessation management were assessed using a 17-items validated questionnaire which covered the components of 5As (Ask, advise, assess, assist, arrange) and 5Rs (Relevance, risk, reward, roadblocks, repetition). The management of pre-contemplation phase included the components of ask, advise, assess and 5Rs. The management of the contemplation phase included the components of assist and arrange. RESULT: The majority of the respondents had poor score of knowledge (62.4%); attitude (58%) and practice (pre-contemplation management:50.9%; contemplation management:75.7%). Using multivariate logistic regression analysis, the significant factors associated with the poor practice of smoking cessation management in the pre-contemplation phase were poor (OR = 2.14, 95% CI 1.11-4.12, p <0.01) or moderate knowledge (OR = 2.50, 95% CI 1.19-5.26, p<0.01), poor attitude (OR = 2.16, 95% CI 1.39-3.37, p<0.01), lacks smoking cessation banners, brochures and leaflets in the clinic (OR = 2.01, 95%CI 1.26-3.19, p<0.01) and lack of nicotine replacement medications (OR = 2.27. 95%CI 1.27-4.06, p<0.01). No significant factors were shown associated with the practice of the contemplation phase. CONCLUSION: The majority of primary care doctors had poor knowledge, attitude and practice of smoking cessation management. Factors that had increased the odds of the poor practice of smoking management at the pre-contemplation phase were poor knowledge, poor attitude, and insufficient organizational support for health promotion materials and nicotine replacement medication.

Phytochemical Screening, Antioxidant and Antifungal Activities of Aconitum chasmanthum Stapf ex Holmes Wild Rhizome Extracts.

Aconitum chasmanthum Stapf ex Holmes, an essential and critically endangered medicinal plant from Kashmir Himalayas, was studied for its antioxidant and antifungal properties. The shade-dried powdered rhizome was extracted sequentially with hexane, ethyl acetate, and methanol. These subsequent fractions were evaluated for total phenolic content (TPC); total flavonoid content (TFC); antioxidant assays, such as 1,1-diphenyl 1-2-picryl-hydrazyl (DPPH); ferric-reducing antioxidant power (FRAP); superoxide radical scavenging (SOR); hydroxyl radical scavenging (OH) and antifungal activity using the poisoned food technique. Highest TPC (5.26 ± 0.01 mg/g) and TFC (2.92 ± 0.04 mg/g) were reported from methanolic extracts. The highest values of radical scavenging activities were also observed in methanolic extracts with IC50 values of 163.71 ± 2.69 µg/mL in DPPH, 173.69 ± 4.91 µg/mL in SOR and 159.64 ± 2.43 µg/mL in OH. The chemical profile of ethyl acetate extract was tested using HR-LCMS. Methanolic extracts also showed a promising inhibition against Aspergillus niger (66.18 ± 1.03), Aspergillus flavus (78.91 ± 1.19) and Penicillium notatum (83.14 ± 0.97) at a 15% culture filtrate concentration with minimum inhibitory concentration (MIC) values of 230 µg/mL, 200 µg/mL and 190 µg/mL, respectively. Overall, the methanolic fractions showed significant biological potential, and its pure isolates might be used to construct a potential new medicinal source.

Solubility and Dissolution Enhancement of Dexibuprofen with Hydroxypropylbetacyclodextrin (HPßCD) and Poloxamers (188/407) Inclusion Complexes: Preparation and In Vitro Characterization.

The objective of this study was to improve the dissolution and solubility of dexibuprofen (DEX) using hydroxypropyl beta cyclodextrin (HPßCD) inclusion complexes and also to evaluate the effect of presence of hydrophilic polymers on solubilization efficiency of HPßCD. Three different methods (physical trituration, kneading and solvent evaporation) were used to prepare binary inclusion complexes at various drug-to-cyclodextrin weight ratios. An increase in solubility and drug release was observed with the kneading (KN) method at a DEX/HPßCD (1:4) weight ratio. The addition of hydrophilic polymers poloxamer-188 (PXM-188) and poloxamer-407 (PXM-407) at 2.5, 5.0, 10.0 and 20% w/w enhanced the complexation efficiency and solubility of DEX/HPßCD significantly. Fourier-transform infrared (FTIR) analysis revealed that DEX was successfully incorporated into the cyclodextrin cavity. Differential scanning calorimetry (DSC) and X-ray diffractometry (XRD) revealed less crystallinity of the drug and its entrapment in the cyclodextrin molecular cage. The addition of PXM-188 or PXM-407 reduced the strength of the DEX endothermic peak. With the addition of hydrophilic polymers, sharp and intense peaks of DEX disappeared. Finally, it was concluded that PXM-188 at a weight ratio of 10.0% w/w was the best candidate for improving solubility, stability and release rate of DEX.

Assessment of left ventricular systolic and diastolic function by tissue Doppler imaging after acute myocardial infarction.

OBJECTIVE: To evaluate left ventricular systolic and diastolic function by Tissue Doppler imaging after acute myocardial infarction. METHODS: It was a hospital based, prospective descriptive study, from 1st July 2010 to 31st Dec. 2010. Total of 200 patients having acute myocardial infarction underwent detailed tissue Doppler imaging (TDI) echocardiographic examination for evaluation of left ventricular systolic and diastolic function on day 3, in echocardiographic section of Govt. Lady Reading Hospital, Peshawar. Peak systolic (Sm), peak early diastolic (Em) and peak late diastolic (Am) velocities were recorded at 4 different sites of the mitral annulus. The ejection fraction and pulse wave TDI diastolic parameters were also recorded. Using SPSS version 16 data was analysed, frequencies and Mean +/- SD were determined for categorical and numerical variables, respectively. A p-value < or = 0.05 was considered significant. RESULTS: Total study sample was 200 patients having acute myocardial infarction (MI). The sample was divided into 4 groups, i.e., anterior MI, inferior MI, septal MI, and lateral MI. There were 122 men and 78 women and the mean age was 42 +/- 5 SD. There was a marked reduction in Sm velocity at mitral annulus, especially at the infarction sites. The mean peak systolic velocity from 4 mitral annulus sites was well correlated with ejection fraction (p = 0.0001). Similar to systolic velocities, Em velocity was also reduced, especially at the infarction sites. The mean peak early diastolic velocity from 4 mitral annulus sites was well correlated with ejection fraction (p = 0.0001). The mean Em velocity was correlated well with isovolumic relaxation time (IVRT). There was no correlation between mean Em velocity and deceleration time (DT). CONCLUSION: Tissue Doppler Imaging is a reliable, accurate and easily reproducible modality of echocardiography. The reduced peak systolic velocity and reduced peak early diastolic velocity seems to be an expression of regionally reduced systolic and diastolic functions, respectively. While the reduced mean systolic velocity and reduced mean early diastolic velocity from 4 mitral annulus sites are expressions of globally reduced systolic and diastolic functions, respectively and were correlated well with the ejection fraction.

Prevalence of SARS-CoV-2 antibodies in the Palestinian population: A primary health center-based cross-sectional study.

This study aimed to assess the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) total antibodies in the north, middle, and south regions of West Bank and the prevalence of SARS-CoV-2 specific antibodies (IgA, IgM, and IgG) in the Palestinian population. This was a cross-sectional study. The serological and epidemiological data of 1269 persons were assessed. Participants were selected randomly among primary health care center attendees in Palestine between November 1, 2020 and December 31, 2020. All serum samples were tested for total antibodies using an enzyme-linked immunosorbent assay (ELISA) test. IgM, IgG, and IgA-specific antibody titers were measured using ELISA. The overall prevalence (with 95% confidence intervals [CIs]) of SARS-CoV-2 total antibodies and specific antibodies were estimated. A multivariate regression model was used to assess the predictive factors for SARS-CoV-2-specific antibodies. The overall seroprevalence of SARS-CoV-2 antibodies was 24·0% (95% CI, 21·7%-26·5%). Seroprevalence was significantly higher among people living in south West Bank (adjusted Odds ratio [aOR], 2·22; 95% CI: 1·58-3·11), people who had COVID-19 symptoms (aOR, 3·92; 95% CI, 2·83-5·43), people with a COVID-19 contact history (aOR, 1·44; 95% CI, 1·03-2·03), patients with hypertension (aOR, 1·57; 95% CI, 1·06-2·33), and non-smokers (aOR, 0·47; 95% CI, 0·31-0·72). A total of 171 blood samples from SARS-CoV-2-positive patients were chosen at random for additional serological testing. Specific IgM, IgG, and IgA antibodies were positive in 14·0% (95% CI, 9·2%-20·2%), 88·3% (82·5%-92·7%), and 42·1% (34·6%-59·9%) of the samples, respectively. SARS-CoV-2 antibodies were common among PHC center attendees and were significantly associated to sex, smoking, and COVID-19 contact history. However, considering that almost three-quarters of this population remains susceptible, maintaining public health measures and encouraging access to immunization is critical in protecting this population.

5-Hy-droxy-7-meth-oxy-2-methyl-4H-chromen-4-one from Dysoxylum macrocarpum (Meliaceae).

Both independent mol-ecules in the asymmetric unit of the title compound, C(11)H(10)O(4), are almost planar (r.m.s. deviations = 0.011 and 0.033 Å). In both mol-ecules, the hy-droxy group is intra-molecularly hydrogen bonded to the ketonic O atom. The independent mol-ecules are stacked alternately along the a axis, with the centroids of their chromene ring separated by distances of 4.490 (1) and 3.621 (1) Å.

14-De-oxyxyloccensin K from Chisocheton ceramicus (Meliaceae).

The title limonoid 14-de-oxyxyloccensin K, C(27)H(34)O(7), isolated from Chisocheton ceramicus (Meliaceae), features an oxygen linkage between carbon-3 and carbon-8 along with a tetra-hydro-furyl sub-unit. The six-membered rings adopt chair configurations and the tetra-hydro-furyl sub-unit has an envelope shape.

Prevalence of diabetes mellitus among obese and non-obese patients with coronary artery disease.

BACKGROUND: Globally, obesity is now recognised as an epidemic. The degree of obesity is proportional to the rate of development of cardiovascular diseases, hence, resulting in a dramatic increase in morbidity and mortality. Apart from obesity, diabetes mellitus is another well recognised risk factor contributing to coronary artery disease. The precise prevalence of obesity-related diabetes varies with age, race and gender; and is yet unknown in our population. We therefore, carried out this study with the aim to determine the prevalence of diabetes mellitus in obese and non-obese patients with diagnosed coronary artery disease. METHODS: This hospital based cross-sectional comparative study was conducted in Cardiology Department of Postgraduate Medical Institute, Lady Reading Hospital, Peshawar, from 15th March 2005 to 30th May 2006. A total of 200 patients with diagnosed coronary artery disease were enrolled, 100 were classified as obese and 100 as non-obese. RESULTS: Among these, 139 patients were male and 61 female. A total of 88 were found to be diabetic, 54 of these were obese and 34 non-obese (p = 0.004). CONCLUSION: Diabetes mellitus was significantly more frequent among obese patients with coronary artery disease as compared to non obese patients with coronary artery disease.

Frequency of pericardial effusion in patients with first myocardial infarction and its effects on in-hospital morbidity and mortality.

BACKGROUND: Pericardial effusion (PE) is not an uncommon finding in serial echocardiographic evaluation of patients with AMI, especially when infarction is anterior and extensive. The objective of this study was to determine the frequency of pericardial effusion after first myocardial infarction and its effects on in-hospital morbidity and mortality. METHODS: This descriptive study was performed in the Department of Cardiology, PGMI, LRH Peshawar, from July 2007 to December 2007. Main outcome measure was frequency of pericardial effusion. RESULTS: Out of 200 patients with first acute myocardial infarction (AMI), mean age was 56 +/- 18 (28-90 years). Majority of patients (31.5%) were in the age range of 51-60 years. Males were 65.5% and 34.5% were females. Pericardial effusion was found in 4.5% patients on day 0, in 12.5% patients on day 2 and in 15% patients on day 4. Left ventricular failure was documented in 19 (9.5%) patients without and 42 (21%) patients with pericardial effusion (p<0.05%). Cardiogenic shock was reported in 5 (2.5%) patients without and 16 (8%) in patients with pericardial effusion and mitral regurgitation was found in 3 (1.5%) patients in each group. Death was recorded in 1 (0.5%) patient without pericardial effusion and was 1.5% (n=3) in patients with pericardial effusion. CONCLUSIONS: Pericardial effusion was seen in one third of the patients with first acute myocardial infarction. In acute phase of myocardial infarction, the chances of development of pericardial effusion increases as the time passes. Left ventricular failure was the commonest in-hospital morbidity followed by cardiogenic shock and mitral regurgitation. In-hospital mortality was more in patients with pericardial effusion.

Giant bladder uric acid stone with a history of prolonged sun exposure and high protein diet in North Moluccas: Case series.

INTRODUCTION: Giant bladder uric acid stone cases that have more than 4 cm in diameters and weighing more than 100 g are considered rare. PRESENTATION OF CASES: At the end of 2019, two men presented with chronic lower abdominal pain since five years ago. Abdominal radiography found a giant opaque mass inside the bladder. Open suprapubic cystolithotomy was performed by a general surgeon. Both giant bladder stones were extracted and measured approximately 11 × 7 × 6 cm and 500 g in weight. More than 80 % of stone composition was uric acid. Neither of the patients developed severe complications after the procedure. DISCUSSION: Our patients had a history of prolonged sun exposure related to occupation and high protein intake. Benign prostatic hyperplasia as a major underlying cause for stone formation was not found in the digital rectal examination. Prostatectomy was not performed. Uric acid stone is common in Southeast Asia, with a multifactorial pathogenesis. CONCLUSIONS: Open suprapubic cystolithotomy is the best method to extract giant bladder stones in limited settings in the rural areas of Indonesia. It was likely that the most important factors associated with the stone formation were the climate and dietary habits. The findings showed that pathogenesis of bladder stone formation and particularly, uric acid bladder stone is still not clearly understood.

Applications of Lasers in Refractory Periodontitis: A Narrative Review.

OBJECTIVE: The purpose of the study is to evaluate the various lasers in dentistry and to investigate if it can be used for treatment of refractory periodontitis. METHODS: The study followed partially the PRISMA guidelines as it is a narrative review. A number of articles were selected from a period of 1980 to 2020 from databases, PubMed, PubMed central, Cochrane and Scopus. Articles related to the effects of lasers on periodontitis both refractory and aggressive were investigated. RESULTS: After reviewing the literature, 70 articles were found, related to application of lasers in periodontal diseases. Out of the 70, 11 articles pertained to the effect of laser for the treatment of Refractory and inflammatory periodontitis. 5 articles related to experimental animal models, one pertaining to in-vitro and six studies related to in-vivo in human cohorts. DISCUSSION: It was found that lasers if used in controlled parameters by incorporating laser assisted treatment such as Photodynamic therapy and low level laser therapy can be of use as an adjunct therapy for treatment of refractory periodontitis. The use of different wavelengths in the initial and maintenance phase of periodontal disease plays a positive role. The presence of in-vitro and animal model studies is one of the limitation to this study. The available studies have shown marked reduction in inflammation and better clinical and microbiological parameters. The drawback of this study is the limited literature involving laser management for refractory periodontitis in human cohorts. CONCLUSION: Different wavelengths of laser and choice of laser assisted periodontal treatment plays an important role in the overall progress and prognosis of periodontal disease activity.

In silico study of glenoid perforation during total shoulder arthroplasty: the effects on stress & micromotion.

Glenoid perforation is not the intended consequence of the surgery and must be avoided. The analysis on biomechanical aspect of glenoid vault perforation remains unknown. The purpose of this study is to determine the impact of glenoid perforation towards stress distribution and micromotion at the interfaces. Eight glenoid implant models had been constructed with various size, number and type of fixation. A load of 750 N was applied to centre, superior-anterior and superior-posterior area. Implant perforation had minimal impact on stress distribution and micromotion at the interfaces. However, cement survival rate for implant without perforation was the highest with a difference of up to 37% compared to other perforated models. Besides that, implant fixation and high stresses at the implant had more of an impact on implant instability than implant perforation. As a conclusion, glenoid perforation did not influence the stress distribution and micromotion, but, it reduced cement survival rate and increase the stress critical volume.

Diabetic retinopathy screening barriers among Palestinian primary health care patients: a qualitative study.

PURPOSE: Diabetic Retinopathy (DR) screening among Palestinian diabetic patients is limited. To improve the care of our patients, we explored the barriers to DR screening with a qualitative study. METHODS: Three focus groups were conducted in the northern West Bank. Patients noncompliant with DR screening were recruited from Primary Health Care clinics. Questions were adapted from similar published studies. Informed consent was obtained and group discussions were audio recorded, transcribed, and analyzed for themes by three researchers. RESULTS: Most patients reported financial barriers including the costs of the exam and additional treatments, and transportation to the referral clinic. System related issues were the difficulty of getting appointments and long wait times due to inadequate numbers of ophthalmologists or screening facilities, and physicians failing to recommend screening. Personal concerns related to patients having other priorities, fears about the results, and the negative experiences of family members. Finally, cultural aspects included the stigma of wearing glasses and not doing a test for a condition without symptoms. CONCLUSIONS: Barriers to completing retinopathy screening are multidimensional with financial, personal, educational, health system, and cultural factors. These should be taken into consideration by policy makers in order to increase the uptake and quality of service.