Radiographic Analysis of Morphological Variations of Sella Turcica in Different Skeletal Patterns Among Saudi Subpopulations.

Background: Size and shape of the sella turcica is considered vital for many radiographic analyses. Objectives: To assess and compare the linear dimensions and shape of sella turcica on digital lateral cephalograms in Saudi subpopulation with different skeletal patterns, age groups and genders. Methodology: A total of 300 digital lateral cephalograms were retrieved from the hospital archive. The selected cephalograms were grouped based on the age, gender, and skeletal types. The linear dimensions and shape of sella turcica were measured on each radiograph. Data were analyzed using an independent t-test and a one-way ANOVA. To test the inter-relationship of age, gender, and skeletal type with the dimensions of sella turcica, regression analyses were used. Statistical significance was set at P ≤ 0.01. Results: Significant differences in linear dimensions between the age groups (P < 0.001) and genders (P < 0.001) were noted. On comparing sella size with different skeletal types, a significant difference was found for all sella dimensions (P < 0.001). The mean length, depth and diameter among skeletal class III were significantly higher than that among classes I and II. On comparing age, gender, and skeletal type with size of sella, age and skeletal type were significantly related to the change of length, depth and diameter (P < 0.001), whereas gender was found to be significantly related only to a change in length of the sella (P < 0.01). For the sella shape, normal morphology was noted in 44.3% of patients. Conclusion: According to the findings of this study, the measurements of sella can be used as reference standards for future studies in Saudi subpopulation.

The Predictors Of Re-Bleeding In Chronic Liver Disease Patients After Endoscopic Variceal Band Ligation.

BACKGROUND: Variceal bleeding is a key and most fatal complication observed in chronic liver disease patients with portal hypertension and is a major contributor to the high morbidity and mortality seen in these patients. Exploring the predictors of rebleeding in chronic liver disease patients is of paramount importance to alter disease course and impact on morbidity and mortality. METHODS: About 50 patients with chronic liver disease who previously had evidence of varices on upper GI endoscopy and had at least one episode of rebleeding after EVBL were included in this study. Patients were assessed for the possible contributors to rebleeding through complete history, clinical examination, coagulation profile and platelet count, ultrasound features (splenic size and portal pressure), and upper GI endoscopic findings (site and grade of varices, red sign). Sample selection was done using non-probability purposive sampling technique and sample size calculated using the standard WHO formula. Data was entered and analyzed using SPSS version 20. RESULTS: In this study, mean age of the patients was 51.34±6.34 years with male predominance (64%). Rebleeding was significantly associated with grade of varices, presence of red sign on upper GI endoscopy, site of varices, splenic size and coagulopathy. CONCLUSIONS: Rebleeding in chronic liver disease patients following EVBL is predicted by grade, extent and site of varices, red sign on upper GI endoscopy, splenic size and coagulation disturbances.

Etiology and pattern of maxillofacial trauma.

INTRODUCTION: Maxillofacial trauma can be limited to superficial lacerations, abrasions, and facial bone fractures. The objective of this study was to determine the etiology, pattern, and predictors of soft tissue and bony injuries. MATERIALS AND METHODS: This study was conducted in the department of maxillofacial surgery Lady Reading hospital Pakistan from Jan 2019 to June 2021. The nonprobability consecutive sampling technique was used for the selection of patients. All patients were assessed clinically and radiologically. The neurosensory examination was done for any altered sensation, anesthesia, or paresthesia. Motor nerve function was also assessed clinically. Data were analyzed using SPSS version 26. The etiology and pattern of maxillofacial trauma were stratified among age and genders using the chi-square test to see effect modifiers. Tests for regression analysis were also applied. P≤0.05 was considered significant. RESULTS: A total of 253 patients meeting inclusion criteria were included in this study. The majority of these patients were males, 223 (88.1%), while only 30 (11.9%) were females. The mean age for the group was 25.4 ± 12.6 years. RTAs were the most common causes of trauma (63.6%) followed by assault (15.0%), falls (11.5%), FAIs (5.9%), and sports (0.4%). The most vulnerable skeletal part was the mandible (22.9%) followed by Zygoma (7.1%), significantly predicted by RTAs. Soft tissue laceration analysis showed a high frequency of multiple lacerations (38%) significantly predicted by FAIs. The frequency of trigeminal nerve injury was 5.5% (14 patients) and that of the facial nerve was 1.6% (4 patients). The strongest association of nerve injury was with firearm injury (47%), followed by road traffic accidents and sports injuries. CONCLUSION: Road traffic accident was the most common etiological factor and mandible fracture was commonly predicted by RTA. Trigeminal nerve injuries were common, frequency of nerve injuries was highly associated with mandible fracture and was predicted by FAI.

Influence of Surgical Flap Design (Envelope and Szmyd) for Removal of Impacted Mandibular Third Molars on Clinical Periodontal Parameters: A Clinical Trial.

The aim of the study was to assess the influence of flap designs (Envelope flap (EF) and Szmyd flap (SF)) for impacted mandibular third molar extraction, on periodontal pocket depth (PPD), clinical attachment loss (CAL) and bone levels (BL) of second molar. Sixty patients indicated for third molar extractions with healthy second molars were allocated into two groups: EF and SF (n = 30). Third molars were assessed for angulation, root patterns, depth of impactions and relation with ramus (Pell and Gregory classification). Extraction of third molars was performed and PPD, CAL and BL around second molars at 0, 3 and 6 month (mon) follow-ups (FU) were assessed clinically and radiographically. ANOVA, Chi-square and Fisher's exact test were employed to compare periodontal factors between EF and SF groups, considering p ≤ 0.05 as significant. Sixty participants with a mean age of 23.22 ± 3.17 were included in the study. Based on angulation, the most common impaction in the EF and SF groups was mesio-angular (EF, 50%; SF, 36.7%). Buccal and distal PPD showed a significant increase (p < 0.001) in both EF and SF patients from baseline to 6 mon. EF patients showed significantly higher distal and buccal CAL (6.67 ± 0.18 mm; 6.91 ± 0.17 mm) and BL (7.64 ± 0.16 mm; 7.90 ± 0.15 mm) as compared to SF patients (CAL, 6.76 ± 0.26 mm; 6.91 ± 0.17 mm-BL, 7.42 ± 0.38 mm; 7.34 ± 0.34 mm) at 6 mon FU. SF showed better soft tissue attachment (PPD and CAL) and bone stability (less bone loss) around second molars compared to EF after third molar extractions regardless of the patient, tooth and operator factors.

Exploring the Effect of Metformin to Lower Thyroid-Stimulating Hormone in Euthyroid and Hypothyroid Type-2 Diabetic Patients.

Introduction Metformin is one of the safest, first-line oral hypoglycemic agents used in type-2 diabetes mellitus patients. This study aims to study the effect of metformin on thyroid-stimulating hormone (TSH) in hypothyroid and euthyroid individuals, as both these diseases have an increased prevalence and coexistence. Method This hospital-based study was conducted in Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/Jinnah Hospital Lahore, Pakistan, from October 2019 to April 2020. One hundred and sixty type-2 diabetic participants, aged 25-60 years and meeting the inclusion criteria were enrolled in the study after informed consent. They were divided into two groups, the hypothyroid group who were already on levothyroxine therapy and had a stable TSH in the normal range, and a euthyroid group who had no thyroid dysfunction. Both the groups were started on metformin therapy for the control of type-2 diabetes mellitus and followed for six months. Their blood samples for TSH and free thyroid hormone (fT4) were drawn both prior to and after the study period. Results Out of the 160 type-2 diabetic patients, TSH levels showed a significant reduction in the hypothyroid patients (2.33 ± 0.70, p < 0.001) with no significant changes in the euthyroid patients (3.87 ± 0.40, p = 0.206) following six months of metformin therapy. However, there was no significant difference in the fT4 levels in either of the groups. Conclusion Metformin has the effect of significantly lowering TSH levels in hypothyroid individuals. However, no such effect was observed in euthyroid patients.

Arthrocentesis For Temporomandibular Joint Pain Dysfunction Syndrome.

BACKGROUND: Temporomandibular joint (TMJ) dysfunction is painful condition of facial musculoskeletal system. Arthrocentesis is less invasive treatment of TMJ dysfunctions. It has been used to treat variety of TMJ disorders. The objective of this study was to determine the success of arthrocentesis in TMJPDS patients where conservative treatment had failed. METHODS: This descriptive case study of 45 patients was completed in 6 months at Outpatient Department of Oral and Maxillofacial Surgery, Mayo hospital Lahore. TMJPDS Patients who were unresponsive to conservative treatment were included in this study. The study consisted of a single arthrocentesis procedure performed by a single oral surgeon per patient. Visual Analogue Scale was used to record pain while maximum mouth opening was measured by the interincisal distance in millimetres, at 1 month and 2 months after the treatment. Success was measured two months after arthrocentesis. RESULTS: Thirty (66.7%) patients had no pain and 15 (33.3%) patients had mild pain. Similarly, 16 (35.5%) patients had maximum mouth opening more than 30mm and 29 (64.5%) patients had less than 30 mm mouth opening, two months after arthrocentesis procedure. CONCLUSIONS: Arthrocentesis is very effective in patients suffering from TMPDS by reducing pain and discomfort and increase in mouth opening. This procedure should be considered in TMPDS patients who do not respond to conservative treatment.