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Medicinal plants are extensively used in traditional folk medicine. High blood pressure is associated with the risk of cardiovascular diseases (CVDs) and many other serious health complications resulting from it as a major concern of morbidity and mortality in health sector. Use of diuretics, angiotensin converting enzyme (ACE) inhibitors, beta adrenergic receptor antagonists (beta blockers), alpha adrenergic receptor antagonists (alpha blockers), calcium channel blockers (CCBs) etc. are not efficient enough to cure hypertension. Side effects regarding these medications lead to intolerance, impaired control of the disease, and also mismanagement of therapy. So, approach regarding quenching new potent therapeutic compounds from medicinal plants draws attention nowadays. For example, as a first-line therapeutic agent, an alkaloid is highly effective in lowering systolic blood pressure which is isolated from root extract of the plant of Rauwolfia serpentina species, namely reserpine. This article comes up with a list of 63 plant species from 37 families, compiling information related to plant parts used for making extracts, types of extract and animals used in these studies, antihypertensive effect of the extracts etc. It also refers to 74 chemically defined molecules, with in vitro and in vivo anti-hypertensive potential, isolated from these extracts along with their dosage and mechanism of action by using electronic searches of published articles from various databases and reference books. Our present work would be beneficial for researchers to investigate and invent novel antihypertensive therapy to treat hypertension.

Objective. The aim of this systematic review was to evaluate the effectiveness of laser application in temporomandibular joint disorder. Methods. PubMed, SCOPUS, Science Direct, Web of Science, and Google Scholar electronic databases were searched systematically with restricting the languages to only English and year (January 2001 to March 2020), and studies were selected based on the inclusion criteria. Study quality and publication bias were assessed by using the Robvis, a software package of R statistical software. Results. This systematic review included 32 studies (1172 patients) based on the inclusion and exclusion criteria. Most of the studies reported significant reduction of pain by the use of the laser during TMD treatment. Two-thirds of the study (78.13%) found a better outcome comparing with conventional one. According to Robvis, 84.4% of the studies were high methodological studies with low risk of bias. Conclusion. TMD patients suffer with continuous pain for long time even after conventional treatment. Laser therapy shows a promising outcome of pain reduction for TMD patients. Therefore, laser therapy can be recommended for the TMD patients’ better outcome. This trial is registered with PROSPERO (CRD42020177562).

Sialolithiasis is considered as one of the most frequently encountered diseases of the salivary glands. The most susceptible site is the submandibular gland and its duct. However, megaliths have been sparsely reported in the literature. This article portrays management of a sialolith and a megalith in a 26-year-old and a 59-year-old male patient, respectively. The sialolith in the first case case was 4 mm long, whereas the second case demonstrated a megalith measuring 46 mm at its greatest size. Follow-up revealed normal functioning and a painless gland in the first case, while the second case showed no eventful complications. It is interesting to know that both patients remained relatively pain-free, despite having such longstanding sialolith/megaliths. After removal of the small sialolith, the gland regained its normal functioning swiftly, whereas in the case of the megalith, the gland removal was mandatory because such a longstanding megalith led to irreversible functional injury to the gland. CPD/Clinical Relevance: A giant sialolith can be easily misdiagnosed as a submandibular infection or neoplasm, especially when the patient presents with a longstanding pain-free swelling. Hence, early and appropriate referral and investigation is necessary for early diagnosis and treatment.

The average time consumed for disimpaction of mandibular third molar using rotatory instruments was approximately 17 mins and 23 mins while using a piezotome. The authors introduce a new technique of disimpaction of mandibular third molar with the least amount of bone removal ever achieved during mandibular third molar removal. This technique can be readily included in routine clinical practice and can be performed by using routine rotary instruments. This technique was successfully accomplished in 10 individuals with the least amount of discomfort and post-operative complications reported from day 1 to day 14. The procedure was evaluated based on time of the procedure, pain score, bleeding, nerve injury, trismus, swelling & dry socket. Third molar removal has been the most frequently performed oral surgical procedure in the modern world of dentistry.1 Although, mandibular third molar is the most commonly performed procedure, it demands skill, technique and experience. Several techniques have been implied for disimpaction of mandibular third molar, but every method involves either considerable amount of bone removal or splitting the bone. Bone manipulation is done by using a rotary instruments or chisel and mallet. The most popular techniques are buccal bone guttering, distal bone removal, lingual bone split technique and lingual bone guttering.2 According to the traditional classifications of impacted mandibular third molar (Pell & Gregory and Winter’s classification), the minimum amount of bucco-distal bone removed during disimpaction of mesioangularly positioned class I A impacted mandibular third molar using rotary instruments and conventional techniques can be calculated as 157.5 mm2 (volume of a rectangle = L X W X H; where L = 15 mm, W = 1.5 mm [width of the bur] and H = 7 mm). The mandibular third molar requiring osteotomy and tooth section have the highest risk of complications3. Surgical time had significantly increased in cases which required osteotomy and tooth section. Post-operative swelling and pain has been recorded as significant complications after using rotary instruments via buccal approach followed by use of chisel & mallet and least in lingual split approach. On the contrary, post-operative nerve injury and trismus were significantly high in lingual split technique. Dry socket was more in patients of bur technique.2

Oral cyst is uncommon in the neonatal period. Depending on the size and site of occurrence, its symptoms may vary. If not diagnosed and managed expeditiously, these oral cysts may cause significant and potentially fatal morbidity and mortality. We report a successfully managed case of oral cyst in neonate that presented with huge tongue at birth and complaints of impending airway obstruction. She was referred for tracheostomy as intubation was impossible. We attempted needle aspiration and the airway successfully relieved without the need for tracheostomy.

Oral health is a cardinal element of nutritional as well as systemic well-being and plays a substantial part in sustaining optimum general health condition. Various factors influence oral health including metabolic diseases such as endocrine (diabetes mellitus [DM]), hematological, gastrointestinal, cutaneous, and neurological diseases. The intent of this review is to accentuate the correlation between DM and oral disorders, like those upsetting oral mucosa and supporting tissues. A review of literature was performed using relevant key words (“Oral Manifestations of Diabetes” OR “Oral Complications of Diabetes” OR “Oral Impacts of Diabetes” OR “Oral Repercussions of Diabetes“) in prominent journals pertaining to Endocrinology and Dentistry (Journal of Periodontology, Periodontology 2000, British Dental Journal, The Lancet Diabetes and Endocrinology, PloS ONE, and Nature Reviews Genetics). The most frequently witnessed diabetic manifestations in oral cavity include gingivitis and periodontitis leading to premature tooth loss, salivary dysfunctions, dental caries, delayed wound healing, bacterial and fungal infections, lichen planus, taste impairment, tongue abnormalities, neurosensory oral disorders, halitosis, and dry socket. In the end, I have comprehensively described the role of antidiabetic drugs in the management of DM and eventually leading to prevention of its oral complications. In this review, etiopathophysiology of each oral complication has been prudently analyzed to contemplate the establishment of a possible preventive and treatment approach.

Oral health is a cardinal element of nutritional as well as systemic well-being and plays a substantial part in sustaining optimum general health condition. Various factors influence oral health including metabolic diseases such as endocrine, hematological, gastrointestinal, cutaneous, and neurological diseases. The intent of this review is to highlight the treatment as well as prevention strategies for one of the most devastating repercussions of chemotherapy (CT) and radiotherapy (RT) on the oral cavity in the form of oral mucositis (OM). A review of literature was performed using relevant key words (“Mucositis” OR “Oral Mucositis” OR “Oral Stomatitis” AND “Treatment of Mucositis” OR “Treatment of Oral Mucositis” OR “Treatment of Oral Stomatitis” AND “Prevention of Mucositis” OR “Prevention of Oral Mucositis” OR “Prevention of Oral Stomatitis“) in prominent journals pertaining to Oncology and Dentistry (CA: A Cancer Journal for Clinicians, Cancer, Frontiers in Oncology, Journal of Clinical Oncology, and Oral Oncology). It is basically sequelae of CT, RT, and radiochemotherapy in patients suffering from malignant diseases as well as those who require hematopoietic stem cell transplants. In addition to its negative effects on the oral cavity and consequently on the overall quality of life, OM may lead to delay in cancer treatment which incriminates in a poor prognosis of the disease.

BACKGROUND: Sleep apnoea is a diagnosed condition in which appurtenances interrupt breathing whilst sleeping. The consequence of obstructive sleep apnoea (OSA) includes road traffic accidents due to drowsiness, systemic hypertension, heart disease, diabetes mellitus and neurocognitive disorders. This condition extends the duration of recovery phase after traumatic brain injury. OBJECTIVE: This study was intended to assess the knowledge and attitude towards OSA and compare it among dental and medical undergraduate students of University Sains Malaysia (USM). METHODS: In this study, a total of 216 clinical undergraduate students (36 from each year; 108 from medical and 108 from dental school) of University Sains Malaysia (USM) Health campus were recruited for the study by non-probability stratified random sampling method. Total study period was October 2017 to October 2018. A self-administered questionnaire was used to assess the sociodemographic status and OSAKA questionnaire was used to assess knowledge and attitude regarding sleep apnoea of the respondents. Descriptive analysis was carried out to assess the knowledge and attitude of OSA amongst dental and medical undergraduate students of USM. The Mann–Whitney U test was carried out to compare the knowledge and attitude of OSA amongst dental and medical undergraduate students of USM. RESULTS: Our study findings revealed that 0.9 %and 6.5 %of the dental undergraduate students and medical undergraduate students could answer all the questions correctly regarding knowledge of OSA. Based on the assessment of the difference between medical and dental students in terms of knowledge towards OSA patients, significant difference was observed at the significance level of 95%, where p

Palatal defects are rehabilitated by fabricating maxillofacial prostheses called obturators. The treatment incorporates taking deviously unpredictable impressions to facsimile the palatal defects into plaster casts for obturator fabrication in the dental laboratory. The casts are then digitally stored using expensive hardware to prevent physical damage or data loss and, when required, future obturators are digitally designed, and 3D printed. Our objective was to construct and validate an economic in-house smartphone-integrated stereophotogrammetry (SPINS) 3D scanner and to evaluate its accuracy in designing prosthetics using open source/free (OS/F) digital pipeline. Palatal defect models were scanned using SPINS and its accuracy was compared against the standard laser scanner for virtual area and volumetric parameters. SPINS derived 3D models were then used to design obturators by using (OS/F) software. The resultant obturators were virtually compared against standard medical software designs. There were no significant differences in any of the virtual parameters when evaluating the accuracy of both SPINS, as well as OS/F derived obturators. However, limitations in the design process resulted in minimal dissimilarities. With further improvements, SPINS based prosthetic rehabilitation could create a viable, low cost method for rural and developing health services to embrace maxillofacial record keeping and digitised prosthetic rehabilitation.

Objective: To determine the association of socio-demographic and clinic-pathological risk factors with oral cancer in Kelantan, Malaysia . Material and Methods: A 19-year cross-sectional survey was performed in Hospital Universiti Sains Malaysia (HUSM), Malaysia. Medical record of 301 oral cancer patients was retrieved from the Medical Records office. Results: The majority of the oral cancer cases were male (62.8%), non-smokers (57.5%), non-alcohol consumers (83.4%), non-betel quid chewers (96.7%), and belonged to Malay ethnicity (68.8%). At the time of diagnosis, most of the patients were at stage II (38.9%). Approximately one-third (30.6%) of the total OC patients experienced loco-regional/distant metastasis, whereas no metastasis was detected in around two-thirds of cases (69.4%). A combination of surgery and radiotherapy was the most commonly employed treatment modality (27.2%). At the time of this study, the survival status of most of the patients was alive (69.1%). The most frequently encountered oral cancer in the Kelantanese population was oral squamous cell carcinoma (70.1%), with the tongue being the most frequently involved oral cavity site (35.5%) . Conclusion: More than three-fourths of the cases were alive at follow-up, which included the cases that did not undergo any form of treatment.

More than 15,000 prescriptions and over the counter drugs are available according to the US Food and Drug Administration website. Moreover, several herbal medicines and dietary supplements are readily available to add to the list of possible drugs, which can potentially cause adverse drug interactions. These are a pressing concern for all as they can interfere with many dental procedures. Additionally, the number of geriatric patients seen in routine dental practice has increased over time. This implies that there are more patients with multiple diseases and health conditions like hypertension, diabetes, problems associated with the cardiovascular, renal and gastrointestinal systems, arthritis, osteoporosis, etc. All these require patients to be on certain medications. Furthermore, advancement in the dental field has led to more complex dental procedures (implants, grafts) being carried out in a general dental practice. These advanced and slightly more invasive treatments require the use of certain drugs before, during and after the treatment like local anesthetics, vasoconstrictors, anxiolytics, analgesics and antibiotics. All of these can possibly interact with medications a patient is already taking and can also interfere with the current dental treatment and create complications. This article aims to provide necessary information about commonly encountered systemic diseases and associated treating medications, their mechanism of action, possible complications and their management. The classes of drugs discussed include anti-platelet agents, vitamin K antagonists, novel oral anticoagulants, bisphosphonates, disease-modifying anti-rheumatic drugs and oral contraceptives.

Objective A systematic search was performed for the identification and analysis of the 100 most often cited articles on dental caries and to highlight the changing trends in the field of dentistry over time. Materials and Methods The search was performed without any restriction on the study design, publication year, or language using the Web of Science (WoS) group of Clarivate Analytics enabling the search through “All Databases.” Based on the citation count as available in WoS, the articles were sorted in a descending manner. Information regarding each article was then extracted, which included its authorship, counts of citation (in other databases), citation density, current citation index (2019), publication year, country of publication, journal of article, evidence level based on study design, and keywords description. Results The count of citation for each article varied in each database, that is, 175 to 2,003 in WoS, 89 to 1,981 in Scopus, and 126 to 3,492 when searched in Google Scholar. The highest number of articles (n = 10) related to dental caries were published in 2004. A total of 301 authors made valuable contributions to this field, out of which J.D. Featherstone had coauthored 6 articles. A significant negative correlation (p < 0.01) was found between the age of the article and the citation density (r =–0.545). However, a nonsignificant correlation (p = 0.952) occurred between the age of publication and the citation count (r = 0.006). Conclusion The results of this systematic review provide a critical appraisal of the context underpinning scientific developments in the field of dental caries and also highlighted trends in clinical management and research.

International audience; Human Action Recognition is one of the key tasks in video understanding. Deep Convolutional Neural Networks (CNN) are often used for this purpose. Although they usually perform impressively, their decision interpretation remains challenging. We propose a novel visual CNN features understanding technique. Its objective is to find salient features that played a key role in decision making of the network. The technique only uses the features from the last convolutional layer before the fully connected layers of a trained model and builds an importance map of features. The map is propagated to the original frame thus highlighting the regions in them that contribute to the final decision. The method is fast as it does not require gradient computation as many state-of-the-art methods do. Proposed technique is applied to the Twin Spatio-Temporal 3D Convolutional Neural Network (TSTCNN), designed for Table Tennis Actions recognition. Features visualization is performed at the RGB and Optical flow branches of the network. Obtained results are compared to other visualization techniques both in terms of human understanding and similarity metrics. The metrics show that generated maps are similar to those obtained with known Grad-CAM method, e.g. Pearson Correlation Coefficient between the maps generated of RGB data for Grad-CAM and our method is 0.7 ± 0.05 and 0.72 ± 0.06 on Optical Flow data.

Autism is a severe disorder affecting 1 in 160 children globally. Autism comprises of several development disabilities such as social, communicational and behavioural challenges. Children being diagnosed by the autism mainly face a hard time studying curriculum in inclusive classrooms based on their IQ level and the autism levels. Although, different strategies and learning teaching tools are available to support autistic children, only few systems aid them in learning efficiently, and are not highly interactive. Thus, the proposed Intelligent Education System primarily focuses on providing interactive learning experience to the autistic children with IQ level >50% and efficient teaching assistance to their tutors using augmented reality and machine learning in both English and Arabic The capability of the education system to perform an action, allows the autistic child to interact with the playable sand and gain interest. In learning stage, once the child scribbles on the sandbox, Kinect 3D camera captures and recognizes the drawn image. After the refinement and recognition of the image using OpenCV and classification model, the stored set of real world object are projected on the canvas. Besides, a webcam captures the facial expression of the child, and emotion detection algorithm determines the reaction of the child. Based on the child’s emotion, the current object is projected and pronounced three times to enforce better learning. Once the instructor chooses the language and character to be taught using the developed mobile application, the system displays it over the sandbox and further three objects that starts with the particular character are pronounced and projected. The system is tested rigorously with large set of users, and the results prove the efficiency of the system and happiness of the autistic children in better learning.

This prospective study on result of internal fixation of femoral shaft nonunion with implant failure by SIGN interlocking nail was carried out during the period of January 2009 to December 2016at Rajshahi Medical College Hospital, Bangladesh. Mean age of the patient was 34 years (11-70 years), majority of the patients were male (76%), injury was due to high energy trauma (88%), right side involvement was more (68%).Closed exchange nailing was done in 28 cases (56%) and open nailing was done in 22 cases (44%). In the open cases previous implants were removed, refreshening of the fracture ends was done. Antegrade or retrograde SIGN interlocking nailing depend on the site involvement. Reaming materials were used as internal bone graft in all the cases. Autogenouscancellous bone graft was given in 5 cases due to comminution at fracture site (2 cases) and severe osteoporosis (3 cases). The final outcome satisfactory result was found in 44 (88%) cases and unsatisfactory result in 6 (12%) cases.TAJ 2017; 30(1): 11-16

The study was carried out to report the results of marginal resection in sacral chordoma using a posterior midline approach. The study was carried out between July 2008 to June 2016, there were 21 patients who underwent the operation. Fourteen patients were male and seven were female and age ranging from 28 and 76 years. All most of the patients presented with pain, sacral mass and neurological deficit. Total sacrectomy and bone reconstruction were carried out in 11 patients. Subtotal sacrectomy was carried out in the remaining ten patients. Patients were followed up for at least seven years. Recovery after the operation was good. Duration of operation ranged between three to six hours. Three to five units blood was transfused in all patients after operation .Bowel and bladder dysfunction were almost all patients. After surgery following local complications including infection and wound disruption occurs in three patients and seroma occurs in two patients. Three patients (14%) had tumor recurrence and one patient expired three years after operation. 18 patients were still tumor-free at long term (seven years) follow-up. Marginal resection of sacral chordoma through posterior approachcan be a management plan for sacral chordoma with acceptable results.TAJ 2017; 30(1): 21-26

Background : Expansive open-door laminoplasty is widely accepted as a reliable procedure for cervical myelopathy. However, one acknowledged complication is spring-back complication or closure of the door which may result in re-stenosis of cervical canal and neurologic deterioration. The study aimed for addressing our cervical open-door laminoplasty technique with plate and screw and subsequently the follow-up outcomes.Methods: Thirty consecutive patients who underwent open-door laminoplasty with the novel technique were included and followed for minimum 5 years from July 2011 to June 2016. Antero-posterior diameter (APD) of the vertebral canal of C4 was measured in lateral cervical radiographs. Neurologic scenarios were assessed using the Japanese Orthopaedic Association (JOA) scores.Results: Twenty-five males (83.3%) and five (16.7%) females with an average follow-up of 68 months were enrolled. The preoperative APD was 13.22 mm (±1.15), whereas the postoperative APD increased to 31.23 mm (±2.43) with an expansion ratio of 136.23% (P < 0.05). The JOA score increased from 8.5 preoperatively to 13.45 postoperatively with a recovery rate of 58.2% (P < 0.05). The elevated laminas were maintained open during the follow-up period.Conclusions: Our technique with plate and screw for laminoplasty is a simple and efficient method for maintaining the decompression of cervical canal and neurologic improvement.TAJ 2016; 29(1): 33-38

Ewing's sarcoma is a primary bone malignancy with the highest incidence in the first decade of life. Although it mostly affects the diaphyseal as well as metaphysical region of growing long bones but involvement of spine is not very uncommon especially the sacrum. Nonsacral spinal Ewing's sarcoma is rarer and often mimics a benign condition before spreading extensively. They present with neurologic deficits due to spinal cord compression, but acute onset paraplegia is very rare.A high index of clinical suspicion can clinch the diagnosis early in the course of the disease. A prompt intervention is required to keep neurological damage to a minimum, and a correct combination of surgery, chemotherapy, and radiotherapy is required for better long-term patient outcome. We report a 15-years old male who presented with acute paraplegia and had an excellent postoperative outcome after posterior decompression of a D 11 Ewing's sarcoma.TAJ 2013; 26: 92-97

Aim The purpose for this study was to investigate and elucidate the relationships between the mandibular third molar and mandibular angle fractures. Materials and methods This retrospective study incorporated the presence, position and angulation of mandibular third molar and prevalence of fracture of angle of mandible among patients treated in Hospital Universiti Sains Malaysia. The medical records were scanned and 427 patients with mandibular fractures from 2001 until 2016 were identified. Depending on the notes and various radiographic images, 77 of 427 patients had mandibular angle fracture. The presence or absence of impacted mandibular third molar was assessed for each patient that had angle fracture. In presence of impacted mandibular third molar, their position and angulation of the tooth were evaluated. The positions were classified using Pell and Gregory system while the angulations were classified using Winter's classification. Data were analysed using SPSS 22.0 system and applying a chi-square test. Results Among 77 patients with angle fracture, 67 (87%) had impacted mandibular third molar while 10 (13%) had no evidence of mandibular third molar. The incidence of mandibular angle fracture was found to be significantly greater when impacted third molar was present (P < 0.05). Conclusion The results of this study showed that the patients with impacted mandibular third molar have an increased risk of mandibular angle fracture compared to those without.

In Malaysia, oral cancer is very common and the reported 5-year survival of such patients is nearly 50% after treatment with surgery and radiotherapy, much lower than most of the developed countries. This study aimed to investigate the socio-demographic and clinicopathological parameters that influence the mortality rate of the patients suffering from oral squamous cell carcinoma (OSCC) in the Kelantanse population.In this retrospective study, data regarding socio-demographic, clinicopathological factors, and treatment outcome associated with OSCC were gathered from the archives of the medical records office of Hospital Universiti Sains Malaysia. For statistical analysis, simple and multiple logistic regression were performed. The significance level was set to P

Various iatrogenic mishaps can impede adequate biomechanical preparation of the root canal system. Instrument separation can be treated by orthograde retreatment, with or without instrument removal, endodontic surgery or extraction. The aim of this case report is to describe a minor surgical procedure to resect an infected root containing a separated instrument. A fractured instrument was detected in the mesiobuccal root of the maxillary first molar extending beyond the apex. This fractured instrument was serving as a niche for infection and formation of a sinus tract. The fractured instrument could not be retrieved through the root canal, hence the root canal was obturated up to the fractured instrument and the apical half of the mesiobuccal root was resected surgically. At the two years recall the clinical and radiographic outcome was considered favourable. CPD/Clinical Relevance: Endodontic surgery, while classically being considered as the last resort, becomes important when orthograde retreatment fails to remove the cause of persisting infection.

Auto-transplantation is the repositioning of an autogenously erupted, partially erupted, or unerupted tooth from one site to another in the same individual. The purpose of this case report is to describe the auto-transplantation of the mandibular third molars as an alternative means of replacing second molars requiring extraction. An orthopantomogram revealed horizontal impaction of teeth #37 and 47 and mesio-angular impaction of teeth #38 and 48. Cone beam computed tomography revealed that the roots of #37 and 47 were in close proximity to the inferior alveolar canal bilaterally. As atraumatic and complete removal of these two teeth was not possible, #38 and 48 were chosen as the donor teeth instead. The procedure was carried out under general anesthesia. Teeth #38 and 48 were extracted atraumatically; teeth #37 and 47 were pulled out by sectioning and transplant sites prepared. Teeth #38 and 48 were transplanted to the sites vacated by teeth #37 and 47, respectively. Endodontic treatment of teeth #38 and 48 was completed within 1 month following transplantation. Both clinical and radiographic outcomes were considered satisfactory at 1 year postoperatively. Bone healing was observed around the roots of teeth #38 and 48. In conclusion, although auto-transplantation is not very common in general dental practice, we believe that it offers a clinically and economically viable alternative to other complicated prosthetic and dental implant treatments.

Background: Anterior cervical discectomy with fusion (ACDF) is challenging with respect to both patient selection and choice of surgical procedure.Objectives: The aim of this study was to evaluate the clinical outcome of anterior cervical discectomy and fusion with an artificial cage made of polyetheretherketoneMaterials & Methods: From January 2012 to January 2017, 80 consecutive patients referred to the Department of spine surgery, Bangabandhu Shekh Mujib Medical University were recruited for the study. Postoperative Clinical outcome assessed with Nurick scale for myelopathy, Odom's criteria for functional outcome and Visual Analogue Scale (VAS) for both neck and arm pain. Radiological fusion was assessed by X-ray. Operative complications were reported.Results: 36 patients were operated for one level discectomy and fusion with PEEK cages and 44 patients for two levels. There were 48 (60%) males and 32 (40%) females. The age of the patients ranged from 30-72 years, a mean ± SD 45 ± 8.34. At the 2 years clinical follow-up, there were significant post operative improvements of Nurick scale, and VAS comparative to preoperative record. According to Odom's criteria, 72/80 patients (90%) were graded excellent-good.Conclusion: Anterior cervical discectomy and fusion with polyetheretherketone (PEEK) cage is an effective treatment of cervical myelopathy having higher fusion rate and lack of donor site morbidity.KYAMC Journal Vol. 9, No.-1, April 2018, Page 32-34

Objective To design and compare the outcome of commercial (CS) and open source (OS) software-based 3D prosthetic templates for rehabilitation of maxillofacial defects using a low powered personal computer setup. Method Medical image data for five types of defects were selected, segmented, converted and decimated to 3D polygon models on a personal computer. The models were transferred to a computer aided design (CAD) software which aided in designing the prosthesis according to the virtual models. Two templates were designed for each defect, one by an OS (free) system and one by CS. The parameters for analyses were the virtual volume, Dice similarity coefficient (DSC) and Hausdorff's distance (HD) and were executed by the OS point cloud comparison tool. Result There was no significant difference (p > 0.05) between CS and OS when comparing the volume of the template outputs. While HD was within 0.05–4.33 mm, evaluation of the percentage similarity and spatial overlap following the DSC showed an average similarity of 67.7% between the two groups. The highest similarity was with orbito-facial prostheses (88.5%) and the lowest with facial plate prosthetics (28.7%). Conclusion Although CS and OS pipelines are capable of producing templates which are aesthetically and volumetrically similar, there are slight comparative discrepancies in the landmark position and spatial overlap. This is dependent on the software, associated commands and experienced decision-making. CAD-based templates can be planned on current personal computers following appropriate decimation.

Background Neurological disorders are the most common cause of morbidity and mortality in developing countries. Available evidence on urban–rural differences on neurological diseases is scare in such countries. Our study objective was to determine the prevalence of neurological diseases in urban and rural tertiary care hospitals of Sindh, Pakistan. Methods This was a cross sectional study conducted in selected urban and rural region of tertiary care hospitals of Sindh, Pakistan. The outpatients medical records of adults (18 years and above) was obtained from January 1st, 2014 to December 31st, 2014. Results A total of 10,786 outpatients visit were recorded in this period. Mean age of the participants was 40.6 ± 15 years; majority was females 6104 (56.6%). About three-fourth of the patients were from rural hospital 7828 (72.6%). Common neurological diseases were headache disorders 3613 (33.4%), nerve and root lesion 2928 (27.1%), vascular diseases 1440 (13.3%), epilepsies 566 (5.2%), muscle disorders 424 (3.9%), psychiatric disorders 340 (3.1%) and CNS infection 303 (2.8%). Comparison between the urban and rural samples showed that ischaemic stroke (72.7% vs. 82%) and psychiatric disorders (2.1% vs. 3.5%) were more prevalent in rural area as compared to urban setting. Conclusion Stroke, headache and nerve and root lesion are major causes of neurological disorders in urban and rural settings of Sindh, Pakistan. The policy and planning must be focus on primary care, preventive measures and the promotion of health. Electronic supplementary material The online version of this article (10.1186/s12883-019-1424-1) contains supplementary material, which is available to authorized users.

Aim\ud \ud To identify and analyse the main features of the top 100 most‐cited randomized controlled trials, systematic reviews and meta‐analyses published in endodontic journals from 1961 to 2018.\ud \ud \ud Methodology\ud \ud The Clarivate Analytics’ Web of Science ‘All Databases’ was used to search and analyse the 100 most frequently cited randomized controlled trials, systematic reviews and meta‐analyses having ‘randomized’, ‘randomised’, ‘randomized controlled’, ‘randomised controlled’, ‘randomized controlled trial’, ‘randomized controlled trials’, ‘clinical trial’, ‘systematic’, ‘systematic review’, ‘meta‐analysis’, and ‘meta‐analyses’ in the title section. The ‘International Endodontic Journal’, ‘Journal of Endodontics’, ‘Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology’, ‘Australian Endodontic Journal’, ‘Endodontics & Dental Traumatology’, ‘Endo‐Endodontic Practice Today’ and ‘European Endodontic Journal’ were included in the publication name section. After ranking the articles in a descending order based on their citation counts, each article was cross‐matched with the citation counts in Elsevier's Scopus and Google Scholar. The articles were analysed, and information on citation counts, citation density, year of publication, contributing authors, institutions and countries, journal of publication, study design, topic of the article and keywords was extracted.\ud \ud \ud Results\ud \ud The citation counts of the 100 most‐cited articles varied from 235 to 20 (Web of Science), 276 to 17 (Scopus) and 696 to 1 (Google Scholar). The year in which the top 100 articles were published was 2010 (n = 13). Among 373 authors, the greatest number of articles was associated with three individuals namely Reader A (n = 5), Beck M (n = 5) and Kvist T (n = 5). Most of the articles originated from the United States (n = 24) with the greatest contribution from Ohio State University (USA) (n = 5). Randomized controlled trials were the most frequent study design (n = 45) followed by systematic reviews (n = 30) with outcome studies of root canal treatment being the major topic (n = 35). The Journal of Endodontics published the largest number of included articles (n = 70) followed by the International Endodontic Journal (n = 27). Among 259 unique keywords, meta‐analysis (n = 23) and systematic review (n = 23) were the most frequently used. \ud \ud \ud Conclusion\ud \ud This study has revealed that year of publication had no obvious impact on citation count. The bibliometric analysis highlighted the quantity and quality of research, and the evolution of scientific advancements made in the field of Endodontology over time. Articles before 1996, that is prior to the CONSORT statement that encouraged authors to include specific terms in the title and keywords, may not have been included in this electronic search.

Objective We aimed to assess the response and impact of covid 19 pandemic at tertiary care centers in Pakistan especially pertaining to neurological care, facilities and training. Methods A pre-tested survey form was sent to 40 neurology tertiary care centers in all the provinces in the country in the first week of July 2020. 33 filled forms were received, out of which 18 were public (government) and 15 were private hospitals. Results Estimated 1300 HCW (faculty, medical officers, trainees and nurses) work at these 33 participating centers. There were 17 deaths among HCW (1.3%) at ten centers. Sufficient personal protective equipment (PPE) were provided to 158 HCW (12%). 129 (10%)HCW tested positive for COVID 19 at 31 centers including trainees/medical officers (39), consultants (29) and nursing and other staff (61). Due to low neurology admissions, 23/33 hospitals (70%) posted neurology trainees in COVID 19 units to contribute to covid care. Less than 50% hospitals did covid screening PCR before admission to neurology wards. Only 10% hospitals provide training and regular update to HCW. Neurology tele-health services were started for clinically stable patients at 15 (45%) centers. Only 60% neurology training programs were able to start online training. Ongoing research studies and trials focusing neurological manifestations of COVID-19 were done at 10 (30%) centers. Modification of facilities for COVID patients showed that 24(72%) hospitals strictly reduced the number of attendants accompanying patients. Only 10 (30%) centers had neurophysiological tests being conducted on COVID-19 patients. Mental health support services to HCW were provided at 12 (36%) centers. Conclusions Among HCW 10% tested positive for covid and 1.3% died. Mental health support services offered for HCW were available in 36% institutions. Neurology training was substantially affected due to low admissions, limited ward rounds and limited availability of online training.

Numerous studies have been conducted in the previous years with an objective to determine the ideal biomarker or set of biomarkers in temporomandibular disorders (TMDs). It was recorded that tumour necrosis factor (TNF), interleukin 8 (IL-8), IL-6, and IL-1 were the most common biomarkers of TMDs. As of recently, although the research on TMDs biomarkers still aims to find more diagnostic agents, no recent study employs the biomarker as a targeting point of pharmacotherapy to suppress the inflammatory responses. This article represents an explicit review on the biomarkers of TMDs that have been discovered so far and provides possible future directions towards further research on these biomarkers. The potential implementation of the interactions of TNF with its receptor 2 (TNFR2) in the inflammatory process has been interpreted, and thus, this review presents a new hypothesis towards suppression of the inflammatory response using TNFR2-agonist. Subsequently, this hypothesis could be explored as a potential pain elimination approach in patients with TMDs.

Ameloblastoma is a benign locally aggressive odontogenic epithelial neoplasm. It is slow growing tumour and mostly of benign behaviour. The most frequent location is at lower molar region and rarely involve upper jaw or maxillary sinus. Patients are usually asymptomatic until reaching a certain large size. Delayedtreatment is relatively common in our society. Patients mostly seek for treatment when a large tumour size is achieved. Herein we report a case due to its rarity, giant size, imaging challenge and management, which involves radical resection and free flap reconstruction.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 313-318

Citation frequencies represent the most significant contributions in any respective field. This bibliometric analysis aimed to identify and analyze the 100 most-cited publications in the field of antibiotics and to highlight the trends of research in this field. “All databases” of Clarivate Analytics' Web of Science was used to identify and analyze the 100 publications. The articles were then cross-matched with Scopus and Google Scholar. The frequency of citation ranged from 940 to 11051 for the Web of Science, 1053 to 10740 for Scopus, and 1162 to 20041 for Google Scholar. Five hundred thirteen authors made contributions to the ranked list, and Robert E.W. Hancock contributed in six articles, which made it to the ranked list. Sixty-six scientific contributions originated from the United States of America. In contrast, five publications were linked to the University of Manitoba, Canada, that was identified as the educational organization, which made the most contributions (n=5). According to the methodological design, 26 of the most cited works were review-type closely followed by 23 expert opinions/perspectives. Eight articles were published in Nature journal, making it the journal with the most scientific contribution in this field. Correlation analysis between the publication age and citation frequency was found statistically significant (P = .012).

Although huge advances have been made in the field of medicine, fever of unknown origin (FUO) continues to be a significant health problem and an important cause of morbidity and mortality, especially in children. The aim of this study was to study current spectrum of FUO, newly emerging challenges and outcome of FUO. A prospective observational study was conducted over a 16 month period (May 2012-September 2013). 53 children aged 4 months to 15 years met the definition of FUO and were included. Children with known immunodeficiency disorders or other chronic disorders were excluded. A diagnosis was reached in 47 (88.7%) patients. Infections were the commonest cause accounting for FUO in 37 (69.8%) patients. Haematological disorders were found in 8 (15%) and autoimmune diseases in 2 (3.8%) patients. Among infections, the most common causes of FUO were tuberculosis (TB) (37.8%), enteric fever (29.7%), Epstein-Barr virus (EBV) (8.1%) and brucellosis (8.1%). TB was extra-pulmonary in 11 cases and pulmonary in 3 cases. Amongst the haematological disorders, 3 patients had haemophagocytic lymphohistiocytosis (HLH), 3 had leukemia, 1 had non-Hodgkin lymphoma and 1 had autoimmune lymphoproliferative syndrome. Juvenile idiopathic arthritis with systemic onset and polyarteritis nodosa accounted for the two cases of autoimmune disease. Elevated C-reactive protein (CRP) levels were associated with an infectious etiology. Bone tenderness, thrombocytopenia and neutropenia predicted haematological malignancy. 1 patient of HLH died of complications during initial hospitalization and 3 other patients (1 HIV, 2 TB) died on follow up. TB, especially extrapulmonary, and enteric fever are still significant public health problems and were the commonest causes of FUO in our population. Due to advances in diagnostic facilities, some diseases like urinary tract infection (UTI) and hepatitis have become less common; however, other diseases like EBV have become more common causes of FUO. HLH is emerging as a significant cause of morbidity and mortality in FUO patients.

Edge detection is a method to detect presence of an object’s imagetypically this is identified by sharp changes in pixel density. We realized Canny Edge Detection Algorithm, the most optimal edge detector, in FPGA hardware utilizing Hardware-Software Co-Simulation with the help of Simulink (Mathworks) and System Generator (Xilinx). We explored and utilized different edge detection operators, in addition to Sobel, which is the typical such operator, for gradient calculation (the primary edge detection process). After comparative analysis, we found both Sobel and Robert operators among the best with hardware realization of Robert operator utilizing less resources (LUT & Flip-Flops). All the different versions of the algorithm was synthesized for Spartan-6 LX16 FPGAs from Xilinx. General Terms Edge Detection Algorithm, Canny Edge Detection, H/W Software Co-Simulation.

Automated anti-collision system by detecting obstacles for automobile industry is one the emerging technologies nowadays. An automated vehicle anti-collision system is an automobile safety system which prevents collision among cars and objects automatically. In this paper, we have discussed about implementation of the prototype of our designed microcontroller based automated car anti-collision system. Our system specializes in detecting obstacles by sharp distance sensor and alerts within close distance of collision and hereafter brakes automatically by actuator in critical distance without the help of driving person. If somehow driver fails avoiding the collision, this system will automatically stop the vehicle as it monitors the condition of the vehicle continuously. So it is a user friendly and versatile system which can prevent road accidents, reduce the rate of accidents as well as accidental death of human life. It can be used in any kind of automobile vehicle as it's a cost effective system.

This paper discusses the design, modeling and energy usage simulation of 2 robotic manipulators. Both robots have a large workspace and are comparable to serial type robots, but their motor/gearbox pairs are held stationary at the robot base, and joint control is achieved by using concentric cylinder links and gears. Their energy usage is compared to a pure serial robot model to gauge if removing those motor/gearbox masses from the arm is in fact beneficial.

This essay takes a longitudinal look at how different communities dealt with political and theological difference in the same space. It examines accounts of Uch Sharif, in contemporary Pakistan, from the thirteenth century to the present. It specifically traces a motif of ‘ruby eyes’ in Arabic and Persian historiography in an effort to delineate how difference was represented and assimilated. It argues that until the late colonial period, religious difference was mutually comprehensible, even if incommensurate. The rupture of meaning in recognising difference continued in different ways in the post-colonial state of Pakistan. The study provides a methodological argument for reshaping the ways in which we look at landscape, built environment and community, in contemporary South Asia. By situating the textual production of the past alongside the material remnants of the past, this essay reads simultaneously ethnographic and textual understandings of difference in Uch Sharif.

A 30-year-old male presented with diplopia for 20 days post occupational accident involving left side of his nose, while he was working with a nail gun. He was fully conscious and did not have any neurological deficits. Patient narrated the mechanism of injury and was sure that the nail fell down after hitting the left side of his nose. He had normal vision, but extra ocular movements were restricted and painful. Computed tomography (CT) scan revealed a curved metal object lodged in the posterior aspect of the left orbit extending diagonally from medial wall to the anterior-superior aspect of the orbital roof. The object was removed via a small surgical approach, inflicting least possible surgical trauma. Post surgery, the patient recovered with complete resolution of diplopia. The original aspects of this case are the lack of signs of a foreign body entry and its relative harmlessness in spite of its large size.

In this paper, we have proposed a new a structure of power system network which has a connection between central unit and user through GSM-GPRS internet protocol which provides us the opportunity to control the load. Load side device can work on the basis of information provided by central processing unit as a result we can implement different features such as prepaid billing with different billing rate for different types of electrical load, priority service, scheduled service etc. The central processing unit will be able to predict future demand as it will have all load usage of every individual user. Proposed transformer side device will be available be provide transformer protection as it monitors the status of the transformers. After implementing our proposed project ‘Power Theft’ can be reduced as transformer side current information and load side information is available.

Virtually all computer controlled multi-axis machines operate under ‘open loop’ control, in the sense that the exact position in space of the end effector cannot be sensed directly. Instead the position of the tool point is calculated in software by monitoring sensors on axes that track linear translation and rotations of motor shafts and gears. This may be suitable for low precision applications, however positional errors occur, and in cases accumulate. Hence there is a need for a sensor system with direct feedback of the end effector's spatial coordinates.

The aim of this project was to create a 6 degree of freedom (DOF) robotic manipulator that had a workspace to footprint ratio comparable to that of a serial robot but with a lower inertia, higher speed and improved energy efficiency. This paper briefly describes some parts of the design and then discusses the method used to obtain results for a simulated energy comparison against a serial robot.

A low cost sensor system is envisaged that has 2 distinct routes for resolution enhancement in position detection. The main area for application of the sensor design would be in the food processing and packaging industry where position resolution of the end effector is in the millimetre to sub-millimetre range. The sensor concept consists of a grid of laser light detectors attached to the stationary base and a grid of lasers attached to the mobile end effector. The photo detectors on the base provide one level for position detection enhancement, that is, the density of the sensor array. The second degree of freedom in improvement comes from the strategic positioning of a set of lasers attached to the end effector.

The serial robot architecture is widespread in modern day manufacturing, and over the last few decades the technology has matured and settled to its current state. One drawback from the architecture however is the location of motors and gearboxes which are either at the joint it controls or close by. A novel hybrid 6 DOF robot was designed to move all the actuators to the robot base, and to control the desired axis through a set of connected links and gears, while maintaining the same workspace and dexterity. This would reduce the inertia of the movable part of the robot and some of the moment arms on the 3 axes required for translation of the 3 DOF spherical wrist. Doing so would decrease the energy requirements when compared to a 6 DOF serial robot. This paper focuses on the mathematical modelling and simulation of the novel hybrid machine design and compares it to an equivalent serial robot.

Industrial robot arms are an essential part of automated manufacturing. They automate tasks such as component assembly, welding, light machining and spray painting due to their repeatability, speed and accuracy. The serial industrial robot arm architecture is the most ubiquitous in modern day manufacturing as its technology is mature; the machine architecture provides extreme dexterity and it has a large useful workspace. This architecture however does have some problems; first the machine mass distribution is not efficient as that mass is spread throughout the arm, and the arm itself contains significant inertia, which also leads to some inaccuracy and dynamic vibration problems. The reason for this lies in the location of the motors. This paper focuses on the conceptual design of a novel robotic arm having a hybrid nature, as its architecture departs from both the classic definitions of Serial Kinematics Machines (SKMs) and Parallel Kinematics Machines (PKMs).

For many parallel robots, the exact position in space of the end effector or tool head cannot be sensed directly. They operate under overall 'open loop' control as the software controlling the machine makes a calculated estimate of where the tool head should be. This is done by monitoring sensors on axes that track linear translation and rotations of shafts/gears. For low precision applications, this system is appropriate. However, positional errors can occur and accumulate. There exists a need for a sensor system that is capable of acquiring the exact spatial coordinates of the tool point or end effector directly.