Incidental Prostate Cancer: A 23-Year Review Of A Tertiary Care Hospital.

Prostate cancer is the second most commonly diagnosed malignancy in men worldwide. The prevalence has been increasing with significant differences between regions. This study assesses the prevalence of incidental prostate cancer detected in specimens removed during bladder outlet obstruction operation. A retrospective analysis of the records of patients who had either endoscopic or open prostatectomy from January 1998 to December 2021 was conducted. The variables analysed were age, procedure, date of surgery, and Gleason score. A total of 2,842 patients underwent surgery on the prostate gland during the study period. Most of the patients, i.e. 2,733 (96.2%), were pathologically diagnosed with benign prostatic hyperplasia, while only 110 (3.9%) had prostate cancer. The frequency of incidental prostate cancer following surgery for bladder outlet obstruction has decreased over the last two decades at our centre, possibly because of an increase in PSA testing.

E-learning in postgraduate urology training: A Covid-19 pandemic experience.

Since the declaration of the Covid-19 pandemic in March 2020, several teaching institutions started the process of adjusting to the new challenge. Medical education could not be imparted the way it used to be and some new methods had to be taken to adapt to the pandemic. At our institute, an online e-teaching approach was adopted to ensure the continuation of post-graduate medical training. Each week two lectures were recorded and uploaded on the YouTube Channel and shared with the students. This was followed by an MCQ based test using Google forms. Ten lectures were delivered in five weeks to 55 participants. The majority of residents agreed that this activity increased their knowledge of the subject and opted to continue it in future. With the help of short online lectures (< 30 minutes) and online tests (5 MCQs), the learning experience of residents can be enhanced. In future, more online resources can be used to incorporate this method of teaching.

Inflammatory myofibroblastic tumour of genitourinary system.

Two cases of inflammatory myofibroblastic tumour (IMT) involving the genitourinary system are presented. One patient with mass of urinary bladder came in with lower abdominal pain whereas the second patient complained of right flank pain and investigations showed a mass involving the right kidney. At present, no specific guidelines exist for the management of inflammatory myofibroblastic tumours. In this case report, we will discuss the work-up and the management stratégies adopted for each case.

Assessment of factors influencing oral health-related quality of life (OHRQoL) of patients with removable dental prosthesis.

OBJECTIVE: The aim of this study was to evaluate factors affecting oral health related quality of life (OHRQoL) of patients using removable dental prosthesis. METHODS: The present study employed a cross sectional analytical design. A total of 200 patients participated and interviewed using a cross sectional analytical design. In the first section of the questionnaire patients were asked about demographic data whereas the second part of the questionnaire assessed medical history, oral habits, smoking status, oral hygiene habits and frequency of dental visit. The questionnaire also collected information regarding patient's removable prosthesis. Questionnaire of OHIP-DENT (Oral Health Impact Profile) was also employed to measure oral health quality of life (OHRQoL) on the domains of functional limitation (FL), physical pain (P1), psychological discomfort (P2), physical disability (D1), psychological disability (D2), social disability (D3) and handicap (H). Relationships between the demographic, socio-economic and education variables and others OHIP-EDENT scores were explored by comparing mean scores by applying ANOVA. RESULTS: The study participants comprised of 107 males (53.5%) and 93 females (46.5%). Regarding oral care, participants reporting to visit their dentist within one year were 40.0%. The highest score was recorded for the functional limitation (FL) domain (15.62±6.6), followed by social disability (D3) (15.23±5.06) and physical pain (P1) (14.28±4.8). The respective scores for physical (D1) and psychological disability (D2) and handicap (H) were 10.47±4.84, 11.32±5.38 and 12.45±4.50 respectively. CONCLUSIONS: Removable partial denture patients showed minimum problems with mastication, social compromise and functional discomfort. The oral health quality of life of removable denture patients is significantly influenced by patient education level, socio-economic status, medical conditions, smoking and tobacco use habits.

Managing iatrogenic bile duct injuries through a multidisciplinary team approach: A SIUT case series.

Iatrogenic injury to the bile duct is one of the most serious and feared complication of cholecystectomy, with a high mortality ranging between 3-12%. The management of such injuries of the bile duct is far more complicated and prolonged than the procedure itself. A retrospective analysis of 36 patients with bile duct injuries (BDI) was conducted over a period of 7 years, from January 2007 to December 2014. Most of their injuries occurred during open cholecystectomy, 22 rather than laparoscopic 14 and were mostly elective surgeries 34. Most injuries were identified postoperatively in 33 (91.6%) patients, at a median of 3.0 days. Among the modalities used to diagnose and treat these patients, endoscopy was performed in 32 of the cases (88.8%), followed by surgery on 17 (47.2%) patients and radiology on 16 (44.4%) cases. Surgery remains the gold standard for treatment of complete transection of bile duct injuries and long term outcomes are usually good. Endoscopy and radiology has an increasing role in the diagnosis and treatment of a leaking (non-transected) bile duct injury.

Comparison of oral Candida species prevalence and carriage among gutka-chewers and betel-quid chewers.

OBJECTIVE: To compare prevalence and carriage of Candida species among gutka-chewers and betel-quid-chewers. METHODS: The cross-sectional case-control study was conducted between January and December, 2015 at the Oral Surgery department of Abbasi Shaheed Hospital and the Dental department of Jinnah Postgraduate Medical Centre, Karachi, and comprised oral yeast samples of gutka-chewers, betel-quid-chewers, and non-chewers. A standardised questionnaire was used to gather demographic data and oral hygiene maintenance information. Oral Candida strains were collected, cultured and identified using standard techniques and yeast identification system. In all groups, unstimulated whole salivary flow rate was determined. Lesions on the tongue and oral mucosa were clinically investigated and numbers of missing teeth were recorded. SPSS 20 was used for data analysis. RESULTS: Of the total 185 samples, 50(27%) were from gutka-chewers, 50(27%)betel-quid-chewers, and 85(46%) non-chewers. Oral Candida carriage was comparable among betel-quid-chewers (18 [36%])and gutka-chewers (20 [40%]), but it was significantly higher than the non-chewers (11 [12.9%]) (p<0.05).Candida species were isolated from 45 (90%) of gutka-chewers and 45 (90%) of BQ-chewers. Among the groups, Candida albicans was the most commonly isolated yeast species (38% in gutka-chewers and 12.9% non-chewers). Mean numbers of missing teeth were significantly higher among BQ-chewers (6.8±0.4 teeth [range: 5-10]) (p<0.01) and gutka-chewers 6.8±0.6 teeth (range: 5-10) (p<0.01) than non-chewers (2.2±0.3 teeth [range: 0-3 teeth]). There was no significant difference in unstimulated whole salivary flow rate and the number of missing teeth among gutka-chewers and betel-quid-chewers (p>0.05). CONCLUSIONS: Prevalence and carriage of Candida species were comparable between betel-quid-chewers and gutka-chewers compared to non-chewers.

Enterolith causing bladder outlet obstruction in patient with imperforate anus. A rare case presentation.

Imperforate anus is a rare anomaly associated with defects commonly referred to as vertebral defects, anal atresia, cardiac defects, tracheo-oesophageal fistula, renal anomalies and limb abnormalities (VACTERL). With modern surgical procedures the overall outcome is excellent. Permanent colostomy which is required in some cases of this disease can result in some rare complications such as enteroliths formation, as illustrated in the case we are presenting here related to a 28-year-old male who reported at urology emergency with features of urinary and acute large bowel obstruction. On investigation he was found to have two enteroliths in his distal loop of sigmoid colostomy. The more distal of the two enteroliths caused urinary retention and hence acute renal failure, and the proximal one caused large bowel obstruction by compressing the proximal loop of colostomy. This case demonstrates that the blind distal sigmoid colostomy loop can grow enteroliths secondary to stasis of its own contents over a long period.

Grading Intraductal Carcinoma of the Prostate; ISUP versus GUPS Recommendations.

OBJECTIVE:  To evaluate the frequency of intraductal component (IDC-P) in prostatic adenocarcinoma and its effect on the final grade using the ISUP and GUPS grading system. STUDY DESIGN:  Descriptive study. Place and Duration of the Study: Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, between June 2021 and June 2022. METHODOLOGY: The study included 250 cases of prostatic adenocarcinoma. The presence of the intraductal carcinoma prostate (IDC-P) was confirmed by patchy or complete staining of the basal cell layer by p63 immunohistochemical stain. Cases with IDC-P were then graded using two different methods, first using the grading criteria based on the ISUP recommendations and then by the grading criteria based on the GUPS recommendations. RESULTS: Two hundred and fifty cases showed invasive prostatic carcinoma ranging from Gleason grade group 2-5. IDC-P was identified in 5 of the 250 biopsies (2%). The final Gleason grade remained unchanged in these cases, when they were graded using the ISUP and GUPS recommendations. CONCLUSION:  Although the present results are based on a relatively small sample size, IDC-P was not frequently present in biopsies of patients with adenocarcinoma in the studied population. Grading IDC-P in invasive prostate cancer led to only a minor change in grade group assignment of prostate cancer biopsies. KEY WORDS:  Prostatic adenocarcinoma, Intraductal carcinoma, IDC-P, ISUP, GUPS, Gleason Grade group.

Outcomes of Nephron-sparing Surgery in T1 vs T2 Renal Tumours.

OBJECTIVE:  To compare the drop in eGFR after nephron-sparing surgery in T1 and T2 renal tumours. STUDY DESIGN:  Descriptive study. PLACE AND DURATION OF STUDY:  Department of Uro-oncology, Sindh Institute of Urology, and Transplantation Karachi, from March 2020 to March 2021. METHODOLOGY:  Retrospective data were collected for all patients who underwent nephron-sparing surgery between 2014 to 2019. Eighty-seven patients were divided into two groups based on the T stage of renal tumours (T1 ≤7 cm and T2 >7 cm). The outcomes of the two groups were compared such as eGFR, blood transfusion, hospital stay and complications. RESULTS:  There was a higher drop in eGFR in T2 tumours when compared to T1 tumours at 1 year of follow-up. There were more perioperative complications, higher blood transfusions and longer hospital stays for T2 tumours. CONCLUSION:  Nephron sparing surgery for T2 renal tumours carries lower eGFR preservation, higher blood transfusions and complications when compared to T1 tumours. The indication for such extensive surgery should be individualized to specific contexts only. KEY WORDS: Adenocarcinoma kidney, Nephrectomy, Glomerular filtration rate, Length of hospital stay, Blood transfusion.

Excision of Postchemotherapy Residual Retroperitoneal Mass in Testicular Cancer.

In this study, patients, who underwent excision of retroperitoneal mass following chemotherapy for testicular cancers from 2006 to 2016, were studied and followed till 2021. The clinical and oncological outcomes were measured. Among 338 patients, who were treated for TC during the entire study period, 38 (11.2%) underwent excision of the residual retroperitoneal mass. The mean age of these patients was 26.9±6.3 years. The majority were stage 3 testicular cancer. Complete resection with negative microscopic margins was achieved in the majority of cases i.e. 31 (81.6%). Damage to the collateral structures was seen in 12 (31.6%) cases. On histopathological examination, teratoma was seen in 18 (47.4%) of the cases followed by necrosis in 10 (26.3%). Complications were recorded in 12 (31.5%) cases, most were low grades. At five years of follow-up, 19 (50%) were disease-free, 25 (65.8%) were alive, and 9 (23.6%) were lost to follow-up. Five-year survival rates are lower than standard template-based retroperitoneal dissection, however, complications rates are comparable. Such complex surgeries should only be performed in high-volume centres. Key Words: Testicular neoplasms, Lymph node excision, Seminoma, Germ cell and embryonal.

Determinants of COVID-19 Vaccine Acceptance among Dental Professionals: A Multi-Country Survey.

PURPOSE: This study sought to investigate the acceptance rate and associated factors of COVID-19 vaccines among dentists and dental students in seven countries. MATERIAL AND METHODS: A structured questionnaire prepared and guided by the report of the SAGE Working Group on Vaccine Hesitancy was distributed among groups of dentists and dental students in seven countries across four continents. RESULTS: A total of 1527 subjects (850 dentists and 677 dental students) participated in this survey. Although 72.5% of the respondents reported their intention to accept COVID-19 vaccines (dentists: 74.4%, dental students: 70.2%), there was a significant difference in agreement between dentists/dental students across countries; generally, respondents in upper-middle-, and high-income countries (UM-HICs) showed significantly higher acceptance rates compared to those in low- and lower-middle income countries (L-LMICs). Potential predictors of higher vaccine acceptance included being a dentist, being free of comorbidity, being well-informed about COVID-19 vaccines, having better knowledge about COVID-19 complications, having anxiety about COVID-19 infection, having no concerns about the side effects of the produced vaccines and being a resident of an UM-HIC. CONCLUSION: The results of our survey indicate a relatively good acceptance rate of COVID-19 among the surveyed dentists and dental students. However, dentists and dental students in L-LMICs showed significantly lower vaccine acceptance rates and trust in COVID-19 vaccines compared to their counterparts in UM-HICs. Our results provide important information to policymakers, highlighting the need for implementation of country-specific vaccine promotion strategies, with special focus on L-LMICs.

Outcomes of Transurethral Resection of Prostate in Patients with and without Renal Failure Secondary to an Enlarged Prostate.

The natural history of benign enlargement of the prostate is variable and ranges from mild symptoms to chronic retention and renal failure. In this study, the outcomes of patients with urinary retention alone were compared with those of chronic retention and renal failure caused by an enlarged prostate. The first group had 79, while the second group had 20 patients included. The mean maximum flow rate after transurethral resection of the prostate (TURP) in the two groups was 16.9 ± 7.9 vs. 14.6 ± 4.1 ml/sec (p value > 0.05), and the mean post-void volume was 15.1 ± 27.6 vs. 21.7 ± 35.7 ml (p value > 0.05), respectively. However, the residual symptoms after surgery were higher in the chronic retention group. It was concluded that patients, with chronic retention experience and higher postoperative residual storage symptoms, after transurethral resection of the prostate, are able to void without a catheter and their renal functions were stabilised. Key Words: Transurethral resection of the prostate, Prostatic hyperplasia, Renal insufficiency, Urinary bladder neck obstruction.

Endorsing Sustainable Enterprises Among Promising Entrepreneurs: A Comparative Study of Factor-Driven Economy and Efficiency-Driven Economy.

Understanding business trails among promising aspirants may contribute to an actual motive for diminishing ecological tracks and escort to developing devotion toward deciding intentions across various entrepreneurial types and tiers solely from the sustainability domains. Therefore, this study endeavors to comprehend and seek to employ the Theory of Planned Behavior (TPB) to inspect the relationship between antecedents on sustainable enterprise intention and sustainable value creation. In this study, we used the convenience sampling method and the quantitative data of 1,070 respondents from Pakistan and China and applied a SmartPLS structural equation model and partial least square path modeling by mediational and multigroup analyses. Findings divulge that R2 (79.8%) value in the Pakistan sample of attitudes to sustainability, perceived entrepreneurial desirability (PED), and perceived entrepreneurial feasibility (PEF) was comparatively higher than in China. The R2 (75.6%) variance value on sustainable entrepreneurial intentions (SEI) was recorded higher in the Pakistani sample. However, the relationship of environmental values, self-efficacy, and extrinsic and intrinsic rewards show positive and significant mediational effects on both the economies of SEI. The findings disclosed an inconsistent character of extrinsic rewards, general self-efficacy, and job security depict negative significant impacts of aspirations on sustainable entrepreneurship (SE) among promising entrepreneurs on sustainability enterprises in both Pakistan and China. This study extends on existing entrepreneurship literature. Results supported the designed hypothesis and played a significant role in shedding light on an individual trait underpinning a career in a sustainable business start-up. The study looks at the issue from the viewpoint of sustainability domains. It seeks to determine the individual PED, PEF, and attitude toward sustainable entrepreneurship (ATSE) as the mediational variables. The study highlights the importance of work values in pursuing sustainability-oriented entrepreneurship programs for promising aspirants to improve their entrepreneurial skills and knowledge podium, which will encourage them to become sustainable future entrepreneurs. Furthermore, the study provides understandings for ratifying sustainable openings and debates the potential paths for sustainable business growth and opportunities among nascent entrepreneurs in both economies.

Expression of B-cell Lymphoma 2 in Breast Cancer.

Introduction: Immunohistochemical expression of B-cell lymphoma 2 (BCL-2) is seen variably in invasive ductal carcinoma. This study was conducted to determine the frequency of BCL-2 expression in different histologic grades of invasive ductal carcinoma. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan, on subjects with invasive ductal carcinoma of various histologic grades. Immunohistochemistry was done using the BCL-2 antibody in all cases. The frequency of BCL-2-positive cases in different histologic grades was noted. Post-stratification, the Chi-square test was applied. P ≤ 0.05 was considered statistically significant. Results: All 52 subjects were female (100%) with a mean age of 47.58 ± 1.43 years. BCL-2 expression was observed in 28 (53.85 %) subjects with breast cancer. Out of 33 participants with Grade III, 13 (39.39 %) participants were positive for BCL- 2 expression. Among 18 subjects with Grade II, 14 (77.78 %) subjects were positive for BCL-2 expression. Reduced frequency of BCL-2 expression was observed with increasing histologic grade (i.e., more in low-grade tumours and less in Grade III), but the difference was statistically not significant. Conclusion: A differential expression of BCL-2 was observed across different grades of invasive ductal carcinoma. However, the difference was not statistically significant.

Adhesive strength of bioactive resin for endodontic tooth build up to dentin treated with conventional and contemporary treatments.

AIM: The aim of present ex-vivo study was to assess and evaluate the influence of alternative dentinal conditioning methods- Er,Cr:YSGG (ECL) and Photodynamic therapy (PDT) in comparison to traditional etching regimes- Self Etch Resin (SER) and total etch and rinse (TER) on the bond values of Bioactive restorative material (BA) and Multicore (MC) bulk filled resin composite restorations. MATERIAL AND METHODS: Eighty caries free mandibular molars were disinfected and embedded in acrylic resin up to Cemento enamel junction (CEJ). Buccal surfaces of all samples were grounded to depth of 2 mm. Specimens were divided into eight groups (n = 20) based on surface treatment received. Samples in group 1 and 2 conditioned with ECYL, group 3 and 4 pre-treated with methylene blue photosensitizer (MBP), group 5 and 6 surfaces conditioned with TER and samples in group 7 and 8 conditioned with SER. Dentin bonding agent was applied and samples of group 1, 3, 5 and 7 were bonded with BA and 2,4,6,8 bonded to MC. Samples were placed in universal testing machine for SBS testing. Data was assessed using analysis of variance (ANOVA) and Tukey multiple comparisons test. RESULTS: Specimens in group 6 treated with TER and bonded with MC demonstrated maximum SBS (19.61 ± 0.587 MPa). Whereas, group 3 dentin conditioned to MBP and bonded to BA displayed lowest bond values (12.01 ± 0.892 MPa). Samples in group 3 and group 4 dentin treated with MBP bonded to MC (13.68 ± 0.221 MPa) and BA (12.01 ± 0.892 MPa) displayed comparable bond integrity (p > 0.05) CONCLUSION: Dentin pre-treated with TER still remains the gold standard. ECYL as an alternative approach to condition dentin has shown potential and can be recommended in clinical settings. MC as bulk fill composite is recommended over BA irrespective of dentine conditioning technique. MBP as dentin conditioner needs further investigation.

Coexistence of Anti Neutrophilic Cytoplasmic Antibody (ANCA) Negative Renal Limited Vasculitis and Atypical- Hemolytic Uremic Syndrome (aHUS).

Small vessel necrotizing vasculitis is divided into two groups; Immune complex mediated and Pauci immune vasculitis. Hemolytic uremic syndrome (HUS) is a rare disease manifested as microangiopathic hemolytic anemia, thrombocytopenia and renal involvement. The coexistence of ANCA negative vasculitis and atypical HUS (aHUS) is rare. We describe a case of a 40 years old lady with rapidly declining kidney function. Renal Biopsy revealed Crescentic necrotizing glomerulonephritis (CGN). She was treated with plasmapheresis alternating with hemodialysis (HD) and immunosuppressive therapy. One month later she developed hemolytic anemia with peripheral schistocytes and thrombocytopenia and diagnosed as aHUS. Same treatment continued and her aHUS resolved spontaneously over one week. However her kidney functions didn't improve and ended up with end stage renal disease (ESRD). DOI: 10.52547/ijkd.6443.

How do gender disparities in entrepreneurial aspirations emerge in Pakistan? An approach to mediation and multi-group analysis.

This cross-sectional study sought to identify gender differences in individual behavioral attitudes, personal traits, and entrepreneurial education based on planned behavior theory. The Smart partial least squares (PLS) structural equation model and PLS path modeling were used. A survey design was used to collect data from 309 samples using quantitative measures. The model was tested for validity and reliability and showed variance (full, R2 = 58.9% and split, R2 = 62.7% and R2 = 52.7%) in male and female model predictive power, respectively. Subjective norms (SN), personality traits (PT), and entrepreneurial education (EE) significantly impacted the male sample's intention. Females' intentions toward entrepreneurship was less affected by attitude toward behavior (ATB), subjective norms (SN), perceived behavioral control (PBC), and entrepreneurship education (EE). Further, attitudes, social norms, and behavioral controls as mediation variables indicate a significant and positive role of male and female intentions. These findings imply that behavioral beliefs (ATB, PBC, and SN) influence entrepreneurial intention-action translation. The results significantly supported the designed hypotheses and shed light on individual personality traits (PT) and entrepreneurship education (EE) underpinning enterprise intention. The study determined that EE and PT are the strongest predictors of intention, thus highlighting the role of these motives in the entrepreneurial process. This study contributes to the growing body of knowledge on youth entrepreneurs, expands our understanding of entrepreneurship as a practical career choice, and offers a novel account differentiating male and female PT. The drive to evaluate the effects of entrepreneurial intention among budding disparities in Pakistan requires a more profound knowledge of the aspects that endorse entrepreneurship as a choice of profession and enhances youth incentive abilities to engage in entrepreneurial activities based on exploitation.

A Global Survey of COVID-19 Vaccine Acceptance Among Healthcare Workers.

Objectives: Even though several effective vaccines are available to combat the COVID-19 pandemic, wide disparities in vaccine distribution, and vaccine acceptance rates between high- and low-income countries appear to be major threats toward achieving population immunity. Our global descriptive study aims to inform policymakers on factors affecting COVID-19 vaccine acceptance among healthcare workers (HCWs) in 12 countries, based on income index. We also looked for possible predictors of vaccine acceptance among the study sample. Methods: A structured questionnaire prepared after consultation with experts in the field and guided by the "Report of the SAGE working group on vaccine hesitancy" was administered among 2,953 HCWs. Upon obtaining informed consent, apart from demographic information, we collected information on trust in vaccines and health authorities, and agreement to accept a COVID-19 vaccine. Results: Although 69% of the participants agreed to accept a vaccine, there was high heterogeneity in agreement between HCWs in low and lower-middle income countries (L-LMICs) and upper-middle- and high-income countries (UM-HICs), with acceptance rates of 62 and 75%, respectively. Potential predictors of vaccine acceptance included being male, 50 years of age or older, resident of an UM-HIC, updating self about COVID-19 vaccines, greater disease severity perception, greater anxiety of contracting COVID-19 and concern about side effects of vaccines. Conclusions: COVID-19 vaccine acceptance among HCWs in L-LMICs was considerably low as compared to those from UM-HICs. The lowest vaccine acceptance rates were among HCWs from the African continent. This underlines the need for the implementation of country-specific vaccine promotion strategies, with special focus on increasing vaccine supply in L-LMICs.

A mix-method investigation on acculturative stress among Pakistani students in China.

This article investigates acculturation stress among Pakistani students who are studying in Chinese universities, located in five provinces where international students are concentrated, with a mix-method approach. 203 students among 260 questionnaire recipients responded the online survey. When using the ASSIS (Acculturation Stress Scale for International Students) as instrument, the Principal Component Analysis Method and SPSS 20.0, we found that Pakistani students are under acculturative stress, 68.53%, 10.97% and 9.15% of them perceived discrimination, home sickness and perceived hate, and 5.25%, 3.11% and 2.58% of them fear, culture shock and guilt respectively. The qualitative segment of the study is consisted of 20 Pakistani students studying in 4 universities located in Wuhan city of Hubei capital enquiring through semi-structured interviews. The findings illustrate that Pakistani students in China are expressing their major concerns on culture shock, homesickness, food and language barriers while disconfirm ASSIS findings like perceived discrimination, hate, fear and guilt as factors responsible for acculturative stress. The study suggested that pre-departure orientation lectures about host country's cultural values and campus environment, and on-campus extra-curricular, cultural activities and maximum social interaction with local students can effectively acculturate students in new cultural setting, and can lower their acculturative stress.

Effectiveness of scaling and root planing with and without adjunct probiotic therapy in the treatment of chronic periodontitis among shamma users and non-users: A randomized controlled trial.

BACKGROUND: Effectiveness of scaling and root planing (SRP) with/without adjunct probiotic (Lactobacillus reuteri) treatment towards the reduction in periodontal inflammatory parameters (clinical attachment loss [AL], marginal bone loss [MBL], plaque index [PI], and bleeding on probing [BOP] in shamma users and non-users [controls] with chronic periodontitis [CP]) remains uninvestigated. The aim of the present randomized controlled trial was to compare the efficacy of SRP with and without adjunct probiotic therapy (PT) in the treatment of CP among shamma users and controls (individuals not using tobacco in any form). METHODS: The study was conducted in accordance with the Consolidated Standards of Reporting Trials guidelines. Patient demographics were recorded using a questionnaire. Therapeutically, patients were allotted into four groups as follows: 1) group 1: Shamma chewers that underwent SRP alone; 2) group 2: Shamma-chewers that underwent SRP + PT; 3) group 3: Non-chewers that underwent SRP alone; and 4) group 4: Non-chewers that underwent SRP + PT. Periodontal parameters (PI, BOP, PD, clinical AL and mesial and distal MBL) were measured on all teeth except third molars at baseline and at 3- and 6-month follow-ups. Level of significance was set at P < 0.05. RESULTS: In total, 31, 32, 31, and 33 individuals were included in groups 1, 2, 3, and 4, respectively. Among shamma users, there was no significant difference in the scores of PI, BOP, PD, clinical AL and MBL when SRP was performed with/without adjunct PT. Amongst controls, SRP with adjunct PT was more effective in reducing PI (P < 0.05), BOP (P < 0.05) and PD (P < 0.05) at 3-month follow-up. There was no significant difference in periodontal parameters at 3- and 6-month follow-ups in patients that underwent SRP with and without adjunct PT. CONCLUSIONS: Habitual shamma use compromises the outcome of SRP in patients with CP. Among patients that do not use any form of ST product, SRP is an effective treatment modality for the treatment of CP, and this relationship is independent of use of adjunct PT.