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Objective: To determine the pattern of partial edentulism and the cast removable dental prosthesis design in relation to the Classes recorded. Study Design: Cross-sectional study. Place and Duration of Study: Department of Prosthodontics, Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Apr to Sep 2021. Methodology: A total of 67 partially dentate male and female patients presenting to the Prosthodontics Department requiring partial cast dentures were included in the study. Visual inspection of the master casts and partial denture frameworks was carried out in the laboratory. Kennedy's Classification, modification areas, type of major connector, direct retainer, rest and use of indirect retention were recorded. Results: The most prevalent Class of partially dentate arch was Kennedy Class-II in maxilla 10 (45.5%) and Class-I and III in mandible 15 (33.3%) each. Major connectors most frequently encountered were anteroposterior palatal strap (59.1%) and lingual bar (57.8%). Circumferential clasp (35.8%) was the most used retainer type in Classes II and III, whereas RPI was mostly found in Classes I and II (32.1%). Occlusal rests were most commonly used (72.4%). Indirect retention was mostly used in Class-I and II denture frameworks (95.9%). Conclusion: The most commonly encountered partial edentulism pattern was Kennedy's Class I and II. Following basic principles of RPD design can help elevate the standards of removable denture treatment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of the study is to assess the variations in the root canal configuration of maxillary second permanent molars in the Pakistani subpopulation by using different clinical aids in vivo. METHODOLOGY: The Cross-sectional analytical study was conducted from April to October 2018 at the College of Dentistry, Riphah International University, Pakistan. The root canal configurations of Maxillary second molars were evaluated in 95 adult patients that presented to the Operative Department, after obtaining consent. After access cavity preparation the orifices were identified and cross checked using 2.5x magnification and different clinical tests. Data analysis was done by utilizing SPSS version 23. RESULTS: Out of the 95 teeth 6(6.3%) teeth had a single canal, 7(7.4%) teeth had two canals, 58(61.1%) teeth had three canals and 24(25.3%) teeth had four canals. Age-wise analysis of the frequency of different canals showed that prevalence of molars with three canals was significantly higher in the subjects with age between 41 and 50 years. CONCLUSION: Overall, the study noted four morphological variations in the root canal configuration of Maxillary second molar teeth in Pakistani subpopulation. Hence, while executing the endodontic treatment in the maxillary second molars a thorough assessment of the root canal system should be carried out. The results of the study can guide Pakistani dentists. [ABSTRACT FROM AUTHOR]

Objective: This study examined the perspectives of 18 health care providers (nurses, consultant doctors, residents, radiologists, and physiotherapists) and 18 patients regarding best practices for patient‐centred care (PCC) in a free private hospital in Pakistan, studying the congruence between provider and patient perspectives. Methods: Six focus group interviews (FGIs) were conducted from January to March 2017: three with providers and three with patients. Focus group interviews were audio‐recorded and transcribed verbatim. A deductive approach was used to analyse the data using the key dimensions of Scholl's framework, which was then complemented with constant comparison analysis to explore variability and similarity among participants across the six focus groups. Results: Findings indicated that providers and patients acknowledged maintaining a collaborative relationship with patients by using empathy. Patients and providers agreed that providers allocated time to counsel the patient and alleviated their fears. Family involvement was seen as a key indicator in decision making for patients. Some discrepancies were found between patient and provider perceptions of inhibitors to PCC, notably a lack of teamwork exhibited by providers and continuity of care offered postdischarge. Conclusions: We recommend practices of PCC that are congruent with non‐Western settings where religion and family play a primary role in matters dealing with patients' illnesses. Our findings suggest the need for recurrent training to improve teamwork among providers; questioning the implicit agreement of patients who may be vulnerable to decision making of authoritarian figures in their family; and the inclusion of peer‐support workers or community health workers to offer aftercare support to patients in their home. [ABSTRACT FROM AUTHOR]

Background/Aim: The aim of the study was to compare laparoscopic and open appendectomy (OA) in terms of primary outcome measures. Study design: A randomized controlled trial. Place and duration of the study: Khyber Teaching Hospital, Peshawar, Pakistan, February 2008 to December 2009. Patients and Methods: A total of 160 patients were divided into two groups, A and B. Group A patients were subjected to laparoscopic appendectomy (LA), whereas Group B patients were subjected to OA. Data regarding age, gender, and primary outcome measures, such as hospital stay, operative duration, and postoperative complication, were recorded and analyzed. Percentages were calculated for categorical data, whereas numerical data were represented as mean ±SD. Chi-square test and t test were used to compare categorical and numerical variables, respectively. Probability ≤0.05 (P ≤0.05) was considered significant. Results: After randomization, 72 patients in group A and 75 patients in group B were analyzed. The mean age of patients in groups A and B was 23.09 ±8.51 and 23.12±10.42 years, respectively, (P = 0.981). The mean hospital stay was 1.52±0.76 days in group A and 1.70±1.06 days in group B (P = 0.294). The mean operative duration in group A and B were 47.54±12.82 min and 31.36±11.43 min, respectively (P < 0.001). Pain (overall level) was significantly less in group A compared with group B (P = 0.004). The two groups were comparable in terms of other postoperative complications, such as hematoma (P = 0.87), paralytic ileus (P = 0.086), urinary retention (P = 0.504), and wound infection (P = 0.134). Conclusion: LA is an equivalent procedure and not superior to OA in terms of primary outcome measures. [ABSTRACT FROM AUTHOR]

Objective: To compare the conventional pyodine dressing with honey dressing in terms of recovery time and outcome (healed or ended up with amputation) in diabetic foot ulcers. Methodology: This quasi-experimental study was performed in surgical "C" ward, Lady Reading Hospital Peshawar from November 2007 to November 2008. All Wegner's grade I-IV, unilateral diabetic foot ulcer patients were admitted and their blood sugar profile, cardiac and renal status were investigated. Patients were assigned to group A and B with simple convenience method. After ample wound debridement group A and B were treated with daily conventional Pyodine dressing and Honey dressing respectively and their recovery time, outcome were recorded during the 10 weeks follow up period. Results: A total of 100 patients with 50 patients in each group A and B were enrolled in the study with mean age 56+8.0 years and male to female ratio of 1.7:1. Recovery time was significantly quicker in the Group B (Honey Dressing) as compared with the group A (conventional Pyodine dressing) with a p-valve of <0.0001. Healing rate was 69% and amputation rate was 31% as a whole. Healing rate was 66% in the Group A in comparison with 72% in the group B while amputation rates were 34% and 28% in the group A and B respectively with no statistical significance with a p-value of 0.6658. Conclusion: Honey dressing is more effective than conventional Pyodine dressing in terms of recovery time in the treatment of diabetic foot ulcer. [ABSTRACT FROM AUTHOR]

Summary: Objectives: The chewing habit of paan, chhaliya, and tobacco is common in the traditional culture of Pakistan. Currently, niswar, gutka and manpuri are also commercially available in the Pakistani market. Epidemiologic evidences and increased rate of oral squamous cell carcinoma (OSCC) cases may indicate a direct relationship of these chewing habits with oral carcinogenesis. The p53 gene has been known to be a tumor suppressor gene that is found mutated in common human cancers. The p53 gene contains a single nucleotide polymorphism at codon 72 of exon 4 which encodes either proline (Pro) or arginine (Arg). The aim of the present study was to investigate association of p53 gene codon 72 polymorphism with patients of oral squamous cell carcinoma consuming these carcinogenic chewable materials. Materials and Methods: Blood and tissue samples of 260 OSCC patients were collected with informed consent from the local hospitals of Karachi. The patients were compared with controls of similar age and sex. The exon 4 of p53 gene was examined by PCR-SSCP. The tumor samples showing mobility shift were purified and sequenced. Results: The C>G missense mutation at nucleotide position 215 of the coding sequence was identified which substitutes proline with arginine at codon 72 of p53 protein. When the data for CCC72CGC polymorphism was analyzed statistically, a significant difference was observed between OSCC and control samples. The Pro allelic frequencies were significantly higher in OSCC patients as compare to controls. The current study indicated the Pro form of p53 codon 72 increases the risk of developing OSCC in Pakistani population. The risk ratio for Pro allele was 1.5004 (95% confidence interval: 1.2559 to 1.7924) and odds ratio of Pro allele was 2.389 (95% confidence interval: 1.5591 to 2.8137) in comparison with the Arg and Pro alleles in the OSCC group. Conclusion: These evidences suggest that there may be specific genetic targets with these chewing ingredients that are responsible for causing OSCC. The p53 codon 72 polymorphism is associated with OSCC at somatic cell level but the polymorphism was not associated at inherited level. [Copyright &y& Elsevier]

Purpose: The major risk factor for developing OSCC in countries like Pakistan is the excessive chewing habit of paan (betel quid), chhaliya (betel nut), tobacco, niswar (type of dipping tobacco, made from fresh tobacco leaves, calcium oxide, and wood ash), gutka (the preparation of crushed betel nut, tobacco, catechu, lime, saffron, spices, menthol, and sweet or savory flavors), and manpuri (the powder of betel nut, tobacco and slaked lime). It has been reported that exon 4–9 were the hot spots of the mutation in TP53. This study aims to find out the loss of TP53 functions due to mutation/polymorphism caused by genomic alteration and interaction with tobacco and its related ingredients in Pakistan. Materials and methods: A total of 260 OSCC patient’s tissue and blood specimens were collected with informed consent from local hospitals of Karachi and compared with blood samples of 260 age and sex matched controls. Mutations in exons 2–11 of TP53 were examined by polymerase chain reaction and single stranded conformational polymorphisms (PCR-SSCP). The samples showing mobility shift were purified and directly sequenced. Results: The novel “AGT” to “ACT” missence mutation was identified at position 719 in exon 7 ofTP53. This change substitutes the amino acid serine with threonine at position 240 of p53 protein suggesting that the threonine allele of p53 gene is associated with mutation in conserved region. This mutation was observed in the tumors of the OSCC patients. The blood samples of the patients and the controls have not shown the nucleotide change in this region. Conclusions: This novel missence mutations in DNA binding domain indicated that the DNA structure may be damaged by the use of exogeneous DNA-damaging agents including tobacco related carcinogens present in gutka, niswar and manpuri, which may result in the loss of cellular processes and p53 protein function. [Copyright &y& Elsevier]