Relationship of early weaning and non-nutritive sucking habits with facial development.

OBJECTIVE: To determine the frequency of malocclusion features, convex facial profile and non-nutritive sucking habits among children with and without early weaning. METHODS: The cross-sectional study was conducted at the National Institute of Child Health, Karachi, from June to December 2020, and comprised of either gender aged 3-6 years. The subjects were clinically examined, and details of lactation period, bottle feeding, thumb and pacifiers sucking were gathered from the parents to assess association with malocclusion. Data was analysed using SPSS 20. RESULTS: Of the 180 subjects, 100(55.5%) were boys and 80(45.5%) were girls. There was significant association of early weaning with non-nutritive sucking habits, absent primate spaces, deviated midlines, and complete overbite (p<0.05). Breastfeeding <2 years was significantly associated with anterior crossbite (p<0.05). Early weaning had no association with convex facial profile, distoclusion, anterior and posterior crossbite and increased overjet (p>0.05). Non-nutritive sucking habits had significant relationship with deviated dental midlines (p>0.05). Conclusion: Early weaning was found to be a factor in establishing non-nutritive sucking habits, and was strongly associated with crowding, disturbed vertical overlapping of incisors and developing decreased facial height. Breastfeeding for less than the recommended duration had a tendency to lead to anterior cross-bite.

Precontoured anatomical plates new era in the complex tibail plateau fractures fixation.

OBJECTIVE: Functional outcome of Intraarticular Tibial Plateau Fractures fixed with precontoured anatomical plates using Knee Society Score. METHODS: Observational study with retrospective review of collected data. Patient's demography, mechanism of injury, schatzker's classification includingtype IV, V and VI. All patients underwent screw and plate fixation using two incision technique with pre-contoured anatomical plates and intercondylar lag screws where indicated. Passive range of motion exercises started at 2 weeks. Postoperative knee pain, range of motion and stiffness were recorded at followup 3 and 4 months. Mean±SD were calculated for quantitative variables and qualitative variables were presented with frequency and percentages. The association of outcome (Knee Society Score) with gender, age and Schatzker's type was evaluated by applying Fisher's Exact test considering p-value <0.05 as significant. RESULTS: Twenty-five patients were included in study. 20 patients were available and 05 lost to follow up. 16 were males and 4 females out of 20 patients. Average age is 36.2±12.89 years. All patients sustained injuries after RTA. 5 patients had postoperative knee pain while remaining were pain free. Average flexion was 123.8 with (SD 8.88)range of 105 to 135 degree. Average extension was 3.15 with (SD 2.41) range of 0 to 8 degress. 4 patients developed stiffness of knee. 2 patients symptomatic implant. All fractures healed at follow up at 4 months. According to Knee Society score (SD 7.65) 14 cases scored as good, 4 cases scored fair and 2 cases scored poor. There was no association of knee score was found with gender (p=0.493) but significant association of knee score was found with age (p=0.007) and Schatzker's type (p=0.028). CONCLUSIONS: Tibial plateau fractures can be effectively treated by anatomical reduction and absolute fixation using pre-contoured anatomical plates. Functional outcome calculated by Knee Society score is better in young patients. With appropriate surgical techniques and early post-operative rehabilitation, good functional results can be achieved.

Functional outcome of ACL reconstruction using patellar bone tendon bone graft.

PURPOSE: To evaluate the mid-term functional outcome using Lysholm score of anterior cruciate ligamentreconstruction using bone patella-tendon bone graft. METHODS: The retrospective study of prospectively collected data was conducted at Liaquat National Hospital, Karachi, from June 2010to June 2013, and comprised patients with complete anterior cruciate ligamenttear who were treated with diagnostic arthroscopy and open reconstruction using bone patella-tendon bone graft. All patients were operated under tourniquet control and knee immobiliser was applied. Straight leg raise procedure was started on 2nd postoperative day. One year after surgery, functional outcome was assessed using Lysholm score. RESULTS: All the 36(100%) patients in the study were males. Four (11%) patients were lost to follow-up and were excluded, while 32(89%) completed the study. Right knee was involved in 16(50%) patients while left knee was involved in 16(50%) patients. Overall, 31(97%) patients had history of contact sports injury. The average age of patients was 28.25±8.32 years. All patients were operated at an average of 17.5±10.3 weeks. The ligament tear was associated with medial meniscal tear in 16(50%) patients, while lateral meniscal tear was noted in 10(31.25%). The mean Lysholm score was 83.06±4.17at 1 year (fair to good outcome). The average range of motion 1 year after surgery was 127.5±11.25. Loss of extension <3o was noted in 20(62.5%) patients, while >3o was noted in 12(37.5%). The average loss of extension was 3.5±2.3 degrees. Two (6.25%) patients developed superficial infection which subsided with oral antibiotics. Anterior knee pain was reported by 8(25%) patients. CONCLUSIONS: Patellar bone tendon bone graft was a reliable method for reconstruction of anterior cruciate ligament.

Long-term clinical outcomes of intravascular imaging-guided percutaneous coronary intervention versus angiography-guided percutaneous coronary intervention in complex coronary lesions: a systematic review and meta-analysis.

Background: In this study, we aim to discuss the long-term clinical outcomes of intravascular ultrasound imaging-guided percutaneous intervention (IVUS-PCI) versus angiography-guided percutaneous coronary intervention (PCI) in complex coronary lesions over a mean period of 2 years. Methods: A systematic search and meta-analysis were conducted to assess the efficacy of using intravascular ultrasound or optical coherence tomography guidance in coronary artery stenting compared to angiography. Results: A total of 11 randomized controlled trials with 6740 patients were included. For the primary outcome, a pooled analysis (3.2 vs 5.6%). For secondary outcomes, the risk was significantly low in image-guided percutaneous intervention compared with angiography. Conclusion: Intravascular imaging-guided PCI is significantly more effective than angiography-guided PCI in reducing the risk of target lesion revascularization, target vessel revascularization, cardiac death, major adverse cardiovascular events and stent thrombosis.

A meta-analysis was conducted to compare intravascular ultrasound guidance/optical coherence tomography percutaneous coronary intervention with angiography percutaneous coronary intervention with target lesion revascularization as the primary outcome and target vessel revascularization, stent thrombosis, myocardial infarction, major adverse cardiovascular events, all cause death and cardiac death as the secondary outcomes.

An Unusual Case of May-Thurner Syndrome in a Middle-Aged IV Drug Abuser.

May-Thurner syndrome (MTS) is an extrinsic venous compression of the iliocaval venous territory by the arterial system. MTS is common in middle-aged women. Despite its importance, it is uncommonly considered in the differential diagnosis of deep vein thrombosis (DVT), especially in males with other risk factors. Due to the perianal abscess, a 35-year-old male health care worker was abusing IV opioids through his left leg veins. His symptoms included signs and symptoms of cellulitis around the catheter site, followed by recurrent DVTs due to poor response to anticoagulation therapy alone. A comprehensive workup revealed the diagnosis of MTS. The patient eventually required endovenous treatment with stent placement, after which his condition improved dramatically.

The Relationship between Psychological Disability and Religious Practice and Coping Strategies in Caregivers of Children with Traumatic Brain Injury in Pakistani Population.

BACKGROUND: Traumatic brain injury (TBI) is a serious issue and a leading cause of death and disability worldwide. Caregivers of TBI patients experience psychological distress and a variety of social and financial issues. The present study aims to investigate the caregiver's burden and the factors that influence this burden. Furthermore, the present study will find out the association of religious practice, religious coping relations and psychological distress among caregivers of children affected with TBI. METHODS: A cross-sectional survey was conducted on 302 caregivers of children with TBI using Duke University Religion Index (DURL) for religious practice. General Health Questionaire-12 (GHQ-12) was used for anxiety and depression and Brief Religious Coping Scale (RCOPE) was used for coping strategies. The caregivers were conveniently chosen from different regions of Khyber Pakhtunkhwa province and data was collected from different tertiary care hospitals in Peshawar. RESULTS: Forty-nine (49) % of caregivers score ≥ 3 on GHQ suffer from psychological distress with a Mean of 20.957 ± 4.175). Positive coping methods were mostly used by caregivers than negative coping have a low level of distress with a Mean Positive Coping (P-COPE ) of 6.93 ± 0.41, Mean of Negative Coping (N-COPE) 0.486 ± 1.023. In religious practice, caregivers mostly participate in Organized Reliogious Activities (ORA) or some Non-Organized Reliogious Activities (NORA) with a Mean ORA of 4.20 ± 1.27, and NORA Mean of 4.17 ± 1.37 used by the caregivers. Coping methods were related to Caregiver psychological distress (GHQ-12 and P-COPE co-relation scores are (ρ -0.022, p b 0.05); GHQ-12 scores and N-COPE (ρ + 0.221=, p b 0.001). There is a negative correlation between GHQ 12 and PCOPE, while GHQ12 is positively correlated with NCOPE. CONCLUSION: According to this study, there is a significant association between religious coping methods, religious practice, and psychological distress among caregivers of children with traumatic brain injury.

Cloud-Based Zero Trust Access Control Policy: An Approach to Support Work-From-Home Driven by COVID-19 Pandemic.

The ubiquitous cloud computing services provide a new paradigm to the work-from-home environment adopted by the enterprise in the unprecedented crisis of the COVID-19 outbreak. However, the change in work culture would also increase the chances of the cybersecurity attack, MAC spoofing attack, and DDoS/DoS attack due to the divergent incoming traffic from the untrusted network for accessing the enterprise's resources. Networks are usually unable to detect spoofing if the intruder already forges the host's MAC address. However, the techniques used in the existing researches mistakenly classify the malicious host as the legitimate one. This paper proposes a novel access control policy based on a zero-trust network by explicitly restricting the incoming network traffic to substantiate MAC spoofing attacks in the software-defined network (SDN) paradigm of cloud computing. The multiplicative increase and additive decrease algorithm helps to detect the advanced MAC spoofing attack before penetrating the SDN-based cloud resources. Based on the proposed approach, a dynamic threshold is assigned to the incoming port number. The self-learning feature of the threshold stamping helps to rectify a legitimate user's traffic before classifying it to the attacker. Finally, the mathematical and experimental results exhibit high accuracy and detection rate than the existing methodologies. The novelty of this approach strengthens the security of the SDN paradigm of cloud resources by redefining conventional access control policy.

Coal fly ash driven zeolites for the adsorptive removal of the ceftazidime drug.

The overall cost and efficiency of an adsorbent material is a major issue in deriving a sorbent into commercial markets. In this study, efforts have been directed to produce adsorption-capable zeolites from the dispensable product of coal power plants, i.e., coal fly ash (CFA). In addition, coal mining water (CW) was used as a direct hydrothermal solvent. The mine water from China's coal mines was used in this experiment to substitute tap water (TP) for synthesizing zeolite from C-type fly ashes with different crystallization temperatures (45 to 95 °C). Here, CW led to the formation of X-type and A-type zeolites of comparable size. Regarding the proper utilization of waste products, i.e., coal fly ash and mine water, the study paves a simple yet extremely cost-effective approach to synthesize workable zeolitic materials for adsorption purposes. The detailed characterization justified the use of CW as a better solvent than TP to prepare zeolites based on their better granular size and fewer carbon impurities. The prepared zeolites were later used as an adsorbent for the trace removal of ceftazidime (CAZ), taken as a model pharmaceutical pollutant. The zeolites prepared using CW realised a higher adsorption capacity of 80 mg g-1 during 20 min of agitation time. The pH, concentration, and external salt effects were also studied to achieve maximum removal efficiency. In general, the proposed approach enables the production of affordable yet efficient zeolite-based adsorbent materials without consuming any toxic and expensive reagents for practical application in environmental remediations.

Surface modification of tin oxide through reduced graphene oxide as a highly efficient cathode material for magnesium-ion batteries.

Among post-lithium ion technologies, magnesium-ion batteries (MIBs) are receiving great concern in recent years. However, MIBs are mainly restrained by the lack of cathode materials, which may accommodate the fast diffusion kinetics of Mg2+ ions. To overcome this problem, herein we attempt to synthesize a reduced graphene oxide (rGO) encapsulated tin oxide (SnO2) nanoparticles composites through an electrostatic-interaction-induced-self-assembly approach at low temperature. The surface modification of SnO2 via carbonaceous coating enhanced the electrical conductivity of final composites. The SnO2-rGO composites with different weight ratios of rGO and SnO2 are employed as cathode material in magnesium-ion batteries. Experimental results show that MIB exhibits a maximum specific capacity of 222 mAhg-1 at the current density of 20 mAg-1 with a good cycle life (capacity retention of 90%). Unlike Li-ion batteries, no SnO2 nanoparticles expansion is observed during electrochemical cycling in all-phenyl-complex (APC) magnesium electrolytes, which ultimately improves the capacity retention. Furthermore, ex-situ x-ray diffraction and scanning electron microscopy (SEM) studies are used to understand the magnesiation/de-magnesiation mechanisms. At the end, SnO2-rGO composites are tested for Mg2+/Li+ hybrid ion batteries and results reveal a specific capacity of 350 mAhg-1 at the current density of 20 mAg-1. However, hybrid ion battery exhibited sharp decay in capacity owing to volume expansion of SnO2 based cathodes. This work will provide a new insight for synthesis of electrode materials for energy storage devices.

Iron and silicon oxide doped/PAN-based carbon nanofibers as free-standing anode material for Li-ion batteries.

The advanced rechargeable batteries have been upgraded by the production of free-standing electrodes through electrospinning technology. This study aimed to introduce a novel hybrid composition to design a free-standing carbon nanofiber (CNF) based anode by the addition of iron acetylacetonate Fe(AcAc)3 as active material and TEOS(tetraethoxysilane)/APTES(aminopropyl triethoxysilane) as an additive for Li-ion batteries. Polyacrylonitrile(PAN) was used as the polymer matrix in the spin dope, and the inclusion of Fe(AcAc)3 and TEOS/APTES resulted in compositional change, producing iron oxide and silica nanoparticles throughout the matrix. Different oxidation states and the presence of embedded iron oxide nanoparticles in CNF were identified by XPS and EDX elemental mapping analysis. PAN-TEOS-APTES-Fe(AcAc)3 based anode material was capable of enhancing the reversible specific capacity as much as 732 mAhg-1 at 500 mAg-1 lasting for 300 cycles, along with the rate capability as high as 815 mAhg-1 at 200 mAg-1. Furthermore, EIS analysis and EX-situ FESEM showed decreased impedance after cycling with the stable morphology of PAN-TEOS-APTES-Fe(AcAc)3 CNF-film. Conclusively, non-woven, binder-free, current collector free, free-standing CNF anode film doped with iron-oxide and silica nanoparticles was indeed a novel approach for Li-ion batteries and can be considered for other batteries particularly for Li-S batteries.