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Background & Objective: Amongst head and neck malignancies, tongue is the second commonest site. Th is study aims at efficacy of elective neck dissection in management of early carcinoma oral tongue without neck involvement clinically. Th is study focuses on lymph node metastasis in early carcinoma oral tongue, its management and prognosis. Material and Methods: Th is cross-sectional study included the patients presenting from June 2005 to June 2019 retrospectively at Jamal Noor Hospital, Karachi. Total 47-patients were included who presented with early squamous carcinoma oral tongue with no stage (no neck involvement clinically). Patients with metastatic disease were excluded. Th ey were treated by wide local excision (hemi-glossectomy) and elective neck dissection. Th e biopsy report was studied for histo-pathological evidence of metastasis. Data analyzed by SPSS. Results: Amongst the 47 cases, 16-patients had T1 while 31 had T2 lesion. Out of 16 cases of T1 lesion; 4(25%) patients had nodal metastases, while amongst 31-patients with T2 lesions 10(32%) patients had nodal metastases. Th e skip lesion metastases were observed in 01(6%) case to the level III. Metastasis to the level IV & V were not seen in any case. Conclusions: Th e lymph node metastasis in 31% patients of early carcinoma oral tongue with no clinical involvement of neck supports the role of elective neck dissection. Th e supraomohyoid neck dissection seems to be a safe and effective option. Level IV and V metastasis was less likely seen in such cases. However, neck dissection should include IV and V levels if per-operative extensive metastases is seen in levels II and III. [ABSTRACT FROM AUTHOR]

Objective: To determine the association between serum vitamin D levels and febrile seizures in the paediatric patients. Study Design: Case-Control Study. Place and Duration of Study: Abbasi Shaheed Hospital, Karachi Pakistan, from Mar 2020 to Mar 2021. Methodology: The study included all pyrexia paediatric patients, both with and without febrile seizures, as cases and controls. Children aged below six months or older than 60 months, with a previous history of afebrile seizures, diagnosed with central nervous system infection, dehydration, or electrolyte disturbance, were excluded from the study. Serum vitamin D levels and other demographic data were documented. Results: The study included 86 cases and controls. The mean age of cases was 28.07±16.47, and the controls were 26.38±15.72 months. The rate of vitamin D insufficiency was three times more likely in cases compared to controls, i.e. [OR, 95% CI: 3.95 (2.084-7.489)] with p=0.0001. Conclusion: Vitamin D deficiency is substantially more likely in the case than in the control group. As a result, children with febrile seizures should have their serum vitamin D levels tested. [ABSTRACT FROM AUTHOR]

Background. We evaluated the prevalence and clustering pattern of cardiovascular disease (CVD) related lifestyle factors and their association with CVD among patients with type 2 diabetes. We also examined the association of these factors with various sociodemographic characteristics. Methods. A total of 1000 patients with type 2 diabetes were interviewed in a cross-sectional, multicenter study in out-patient clinics in Karachi, Pakistan. Results. In this study 30.3% study participants had CVD. Majority of the patients were physically inactive and had adverse psychosocial factors. Forty percent of the study participants were exposed to passive smoking while 12.7% were current smokers. Only 8.8% of study subjects had none of the studied lifestyle factor, 27.5% had one, while 63.7% had two or three factors. CVDs were independently associated with physical inactivity, adverse psychosocial factors, passive smoking and clustering of two or three lifestyle factors. Physical inactivity was more prevalent among females and patients with no/less education. Proportion of adverse psychosocial factors were higher among females, elders and patients with no/less education. Clustering of these lifestyle factors was significantly higher among females, elderly and no/less educated patients. Conclusion. These results suggest the need of comprehensive and integrated interventions to reduce the prevalence of lifestyle factors. [ABSTRACT FROM AUTHOR]

• An ANN based model has been suggested for f o F 2 values over EIA region stations during 1958–2008. • The developed model predicts f o F 2 with a root mean square error of less than 1 MHz for the unseen testing data. • The model may be used for practical purposes over Asian longitude sector, particularly for Pakistan. The critical frequency of F 2 -layer in the Equatorial Ionization Anomaly (EIA) region is one of the most challenging ionospheric characteristics to model. We illustrate the efforts to model monthly hourly medians of f o F 2 using Artificial Neural Network (ANN) over five EIA crest stations between 23.1° N – 30.5° N of Eastern longitudes during 1958–2008 (as per data availability per station). The ANN based model was designed to obtain f o F 2 values as output by inputting seven parameters defining diurnal (hour), seasonal (month), geographical (latitude & longitude) and solar cycle (year, F10.7 & F10.7P indices) dependency of f o F 2 . With this input space, the model uses a hidden layer of 96 neurons to generate output f o F 2 , producing a mean squared error of less than 1.0 MHz 2 . Additionally, the convergence of the model improved on introducing derived solar radio flux (F10.7P) by 6.0%. After training and validation, the model predicts f o F 2 values over the locations under study for unseen testing data of 1989, 1998 & 2008 as a representation of high, moderate and low solar activity, respectively. Our ANN based climatological model gave a Root Mean Square Error (RMSE) of 0.956 MHz and goodness of fit, r 2 =0.929 for the testing data. Data-model comparison with ANN model is better than the International Reference Ionosphere (IRI) estimations of f o F 2 with CCIR (IRIC) and URSI (IRIU) coefficients. IRIC and IRIU produced RMSE of 1.901 MHz ( r 2 = 0.732) and 1.926 MHz ( r 2 =0.716) for the same testing data set, respectively. The designed ANN based model successfully captures the climatological features of f o F 2 in the EIA region. After necessary modifications, the model may be applied for predicting daily hourly values, particularly in the Asian-longitudinal range over Pakistan, in future. [ABSTRACT FROM AUTHOR]

Background: Early childhood caries poses a significant health issue in children under 6 years old. It is determined that Streptococcus mutans is a primary etiological agent, likely to be transferred through maternal contact. Objectives: To determine the association of maternal S. mutans counts with S. mutans counts in their children between 6 and 30 months of age, and to determine the maternal and child DMFT (decayed, missing, and filled teeth) indices. Material and Methods: A community‐based cross‐sectional study was conducted in Karachi, Pakistan. A sample of 193 dyads of mother–children (6–30 months of age) was selected via purposive sampling. Saliva samples of the dyads were collected to assess S. mutans count. Caries assessment was performed for both using the DMFT index. A pretested questionnaire was used. The association of bottle‐feeding, oral hygiene measures, and other factors with S. mutans counts in children were also explored. Zero‐inflated negative binomial regression model at a 5% level of significance was applied using STATA version 12.0. Results: Out of 193 children, 109 (56.47%) were males and 84 (43.52%) were females. The mean age of mothers and children was 29.4 ± 6.2 years and 19.54 ± 6.8 months, respectively. Maternal S. mutans counts were not statistically associated with child's S. mutans counts (Mean child's S. mutans count ratio: 1; 95% confidence interval [CI]: 1, 1.01; p =.882). Compared with children who were breastfed, S. mutans counts were higher in children who were bottle‐fed (mean S. mutans count ratio= 4.85 [95% CI: 1.53, 15.41], p =.007). Age of mother and present caries status of mothers was significantly associated with the child's S. mutans count. Conclusion: No association between maternal S. mutans and child S. mutans was observed. However, maternal age, children who were breastfed, children who did not use pacifiers, and children with mothers who did not have caries, exhibited low S. mutans counts in their saliva. WHY THIS PAPER IS IMPORTANT: No association was observed between maternal S. mutans and child S. mutans count.Breastfeeding, pacifier use, increasing maternal age, and absence of maternal caries were linked to lower S. mutans counts in children. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to determine the health beliefs and prevalence of cardiovascular disease (CVD) risk factors among the college students of Karachi city. Methods: A survey among students of the United Medical and Dental College and non-medical students was performed from the period of October 2019 to January 2020. A validated questionnaire was used to identify the health beliefs of the subjects, related to CVD and its determinants, along with a brief medical history to determine the prevalence of risk factors. The data was analysed by using SPSS version 23. Results: Among total subjects of 140, 53 (37.8%) males and 87 (62.1%) females participated in the study. The analysis presented an adequate knowledge of CVD and its determinants among 133 (95%) of the respondents. 112 (80%) of the participants demonstrated a significantly positive attitude and supported the primary prevention of CVD. However, the practices were found optimum in 80 (60%) of the respondents only, the rest were not up to the mark. It was identified that 69% of the respondents had at least one of the risk factors leading to CVD, which is a significant proportion. Conclusion: The majority of the participants of this study were aware of the CVD and its determinants, however, the practices observed for the primary prevention of CVDs were not up to the standard. Risk factors were significantly pervasive among the participants. The findings of this survey support the need for modification of lifestyle to promote primary prevention of CVD from an early age [ABSTRACT FROM AUTHOR]

Objective: The objective of study was to compare oral health knowledge, attitude and practice scores between medical and dental students of Karachi, Pakistan. Methods: It was cross-sectional study conducted at private medical and dental college of Karachi, Pakistan from Jul 2018-Jul 2019. Hundred medical and 100 dental students of age 22-26 years of either gender, enrolled in 2nd year of their medical and dental school were recruited for the study by using non-probability convenience sampling technique. The adapted questionnaire was used which consist of 16 items to assess knowledge, attitude and practice regarding oral health. SPSS version 23 was used to analyse data. Results: The mean age of participants was reported as 22.77 years. Among all medical students, the high mean knowledge score was observed for brushing timings (0.90), for attitude, the high mean score for use of floss/interdental brush was reported (4.41). Among all the dental students, the high mean score was observed for knowledge of brushing timings, frequency of replacing toothbrush and amount of toothpaste on your brush (0.93). According to attitude, high mean score for use of mouthwash was reported (4.45) followed by method of tooth brushing (4.35). According to practice the high mean score was reported for treatment of gum problems as 4.51.The knowledge, attitude and practice score of dental students were significantly high as compared to medical students (p<0.05). Among males, knowledge and attitude of dental students were significantly high as compared to medical students (p<0.05), whereas no significant difference was found between practice score. Among females, knowledge, attitude and practice score of dental students were significantly high as compared to medical students (p<0.05). Conclusion: The study ascertained that knowledge, attitude and practice regarding oral health was better in dental students as compared to medical students. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of sodium polystyrene subpoenaed in treating hyperkalemia and its effect on different serum electrolytes level. Study Design: Quasi-experimental study. Place and Duration of Study: Lyari general hospital, 500 bedded tertiary care public sector hospital at Karachi, from Jan 2017 to Mar 2017. Material and Methods: Hyperkalemic patients were included in study who fulfilled inclusion criteria and were administered with single STAT 30 grams dose of Sodium Polystyrene Sulfonate. Serum electrolytes such as sodium, chloride, magnesium, phosphate and calcium were measured before and after 2 hours of administration of Sodium Polystyrene Sulfonate. Paired t-test was used as tool for statistical analysis. Results: Significant (p<0.05) decrease in serum potassium level with mean decrease of 0.61 mmol/L was observed in hyperkalemic patients (n=83) after single dose of Sodium Polystyrene Sulfonate. Among 83 studied patient, 67 (81%) recovered from hyperkalemia. Besides, there was significant (p<0.05) increase in sodium level with a mean increase of 2.26 mmol/L. Serum magnesium and calcium levels were significantly decreased (p<0.05) with mean difference of 0.02mmol/L and 0.13mmol/L respectively. No significant difference was found in serum chloride and phosphate levels (p>0.05). Conclusion: Sodium polystyrene sulphonate found to be effective in treating hyperkalemia and considerable changes in serum sodium level have been observed with minimal changes in serum magnesium and calcium levels. [ABSTRACT FROM AUTHOR]

Objectives: 1- To compare the effectiveness of 1% Hydrogen peroxide, 0.2% Povidone-Iodine, 2% hypertonic saline and a novel solution Neem extract (Azardirachta indica) in reducing intra-oral viral load in COVID-19 positive patients. 2- To determine the salivary cytokine profiles of IL-2, IL-4, IL-6, IL-10, TNF-α, IFN-γ and IL- 17 among COVID-19 patients subjected to 1% Hydrogen peroxide, 0.2% Povidone-Iodine, 2% hypertonic saline or Neem extract (Azardirachta indica) based gargles.Trial Design: This will be a parallel group, quadruple blind-randomised controlled pilot trial with an add on laboratory based study.Participants: A non-probability, purposive sampling technique will be followed to identify participants for this study. The clinical trial will be carried out at the Aga Khan University Hospital (AKUH), Karachi, Pakistan. The viral PCR tests will be done at main AKUH clinical laboratories whereas the immunological tests (cytokine analysis) will be done at the Juma research laboratory of AKUH. The inclusion criteria are laboratory-confirmed COVID-19 positive patients, male or female, in the age range of 18-65 years, with mild to moderate disease, already admitted to the AKUH. Subjects with low Glasgow coma score, with a history of radiotherapy or chemotherapy, who are more than 7 days past the onset of COVID- 19 symptoms, or intubated or edentulous patients will be excluded. Patients who are being treated with any form of oral or parenteral antiviral therapy will be excluded, as well as patients with known pre-existing chronic mucosal lesions such as lichen planus.Intervention and Comparator: Group A (n=10) patients on 10 ml gargle and nasal lavage using 0.2% Povidone-Iodine (Betadiene® by Aviro Health Inc./ Pyodine® by Brooks Pharma Inc.) for 20-30 seconds, thrice daily for 6 days. Group B (n=10) patients will be subjected to 10 ml gargle and nasal lavage using 1% Hydrogen peroxide (HP® by Karachi Chemicals Products Inc./ ActiveOxy® by Boumatic Inc.) for 20-30 seconds, thrice daily for 6 days. Group C will comprised of (n=10) subjects on 10ml gargle and nasal lavage using Neem extract solution (Azardirachta indica) formulated by Karachi University (chemistry department laboratories) for 20-30 seconds, thrice daily for 6 days. Group D (n=10) patients will use 2% hypertonic saline (Plabottle® by Otsuka Inc.) gargle and nasal lavage for a similar time period. Group E (n=10) will serve as positive controls. These will be given simple distilled water gargles and nasal lavage for 20-30 seconds, thrice daily for six days. For nasal lavage, a special douche syringe will be provided to each participant. Its use will be thoroughly explained by the data collection officer. After each use, the patient is asked not to eat, drink, or rinse their mouth for the next 30 minutes.Main Outcomes: The primary outcome is the reduction in the intra-oral viral load confirmed with real time quantitative PCR.Randomisation: The assignment to the study group/ allocation will be done using the sealed envelope method under the supervision of Clinical Trial Unit (CTU) of Aga Khan University, Karachi, Pakistan. The patients will be randomised to their respective study group (1:1:1:1:1 allocation ratio) immediately after the eligibility assessment and consent administration is done.Blinding (masking): The study will be quadruple-blinded. Patients, intervention provider, outcome assessor and the data collection officer will be blinded. The groups will be labelled as A, B, C, D or E. The codes of the intervention will be kept in lock & key at the CTU and will only be revealed at the end of study or if the study is terminated prematurely.Numbers To Be Randomised (sample Size): As there is no prior work on this research question, so no assumptions for the sample size calculation could be made. The present study will serve as a pilot trial. We intend to study 50 patients in five study groups with 10 patients in each study group. For details, please refer to Fig. 1 for details.Trial Status: Protocol version is 7.0, approved by the department and institutional ethics committees and clinical trial unit of the university hospital. Recruitment is planned to start as soon as the funding is sanctioned. The total duration of the study is expected to be 6 months i.e. August 2020-January 2021.Trial Registration: This study protocol was registered at www.clinicaltrials.gov on 10 April 2020 NCT04341688 .Full Protocol: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines (Additional file 2). Fig. 1 Flow diagram of study-participants' timeline. [ABSTRACT FROM AUTHOR]