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Objectives: The purpose of this study was to clinically and cephalometrically evaluate the pharyngeal airway following mandibular distraction osteogenesis in patients with TMJ ankylosis and retrognathic mandible. Materials and Methods: A total of 10 patients were included in this study. These patients were thoroughly evaluated pre-operatively and post-operatively both clinically and radiologically using McNamara analysis allowing comparison of pre-op and post-op findings. Results: Out of 10 patients seven were females while three were male (Mean age 13.40 ±5.358 SD). Mean pre-operative UPPER airway width was 6.20±3.155 SD as compared to mean Post-operative upper airway (7.30±2.907 SD) with a statistically significant p-value (0.003). Mean pre-operative LOWER airway width was 4.90±1.969 SD as compared to mean Post-operative lower airway (7.10±2.9282 SD) with a statistically non-significant p-value (0.013). There was a negative correlation between post-operative lower airway and age (r= -0.26, sig=0.48). Conclusion: Mandibular distraction Osteogenesis can be used successfully in TMJ ankylosis patients with retrognathic mandible for the improvement of pharyngeal airway dimensions and relief from symptoms of obstructive sleep apnea due to decreased pharyngeal space.

Anastomotic leak (AL) is a potentially life-threatening complication after low anterior resection (LAR). This meta-analysis aimed to compare outcomes of LAR with and without diverting stoma and to determine factors associated with AL in non-diverted patients.This was a PRISMA-compliant systematic review of electronic databases (PubMed, Scopus, and Web of Science). Randomized controlled trials comparing LAR with and without diverting stoma were included. Main outcome measures were AL, complications, and operation time in the two groups and risk factors of AL in non-diverted patients.Nine randomized control trials (RCTs) (946 patients; 53.2% male) were included. The diverting stoma group had lower odds of complications (OR: 0.61, 95%CI: 0.461-0.828; p 0.001), AL (OR: 0.362, 95%CI: 0.236-0.555; p 0.001, INon-diverted patients with increased body mass index, high American Society of Anesthesiologists scores, low rectal cancers, received neoadjuvant therapy, underwent open surgery, end-to-end anastomosis, and longer operation times were at a higher risk of AL after LAR.

Aim: The goal of this analysis is to determine the proportion of psychoactive substance disorder and socio-demographic profile of Psychoactive Substance Users. Study Design: A descriptive study. Place and Duration: In the Psychiatry and Behavioral Sciences department PGMI/AMC/LGH Lahore, Pakistan and Mardan Medical Complex for six months duration from October 2021 to March 2022. Methods: A total of 120 subjects with psychoactive substance use disorder (conferring to the ICD-10 criteria) were recruited after attaining their written informed consent. In the course of the study, all patients with substance use disorders were interviewed through partially structured addiction questionnaire. Data was analyzed with SPSS version 21.0 using inferential and descriptive statistics. Results: Out of the 120 subjects, 100 were men and 20 were women. The adults and adolescents were the main groups indulging in the consumption of psychoactive substances. Most of the subjects, 45%, started substance abuse at 16-20 years of age. Of the remaining 18.3%, started substance abuse at 26 years old and older, 24.2% started at the age of 21-25 years, and 12.5% started at the age of 13-15 years. It was found that 50% were in the recovery process. The relapse rate was 33.3%, 12.5% were not in contact, 2.5% died, and 1.7% were in prison. Opioid was the psychoactive substance preferred by 66.7% of the young population. The most common opioid was brown sugar; 13.3% prefer cannabis, 2.5% prefer tablets, 4.2% prefer injectable use and 0.83% prefer volatile usage of substances. Conclusion: The main consumers of psychoactive substances were the adults and adolescents and majority start using it at a younger age. Psychoactive substance abuse is a serious problem effecting young people, which is a sensitive group. So, special consideration should be paid to psychoeducation about psychoactive substances prior to adolescent. Keywords: Psychoactive substance, Sociodemographic profile.

Anismus is a common cause of obstructed defaecation syndrome (ODS). The aim of the present review is to assess the efficacy and safety of puborectalis muscle (PRM) division in the treatment of anismus.PubMed, Scopus, Web of Science and the Cochrane Library were searched for studies that assessed the outcome of PRM division in the treatment of anismus. The main outcome measures were subjective improvement in ODS, decrease in the Wexner constipation score and ODS score, and complications, namely faecal incontinence (FI).Ten studies (204 patients, 63.7% male) were included. The weighted mean rate of initial subjective improvement across randomized trials was 97.6% (95% CI 94%-100%) and across nonrandomized studies it was 63.1 (95% CI 39.3%-87%). The weighted mean rate of 12-month improvement across randomized trials was 64.9% (95% CI 53.3%-76.4%) and across nonrandomized studies it was 55.9% (95% CI 30.8%-81%). The weighted mean rate of FI across randomized trials was 12.1% (95% CI 4.2%-20%) and across nonrandomized studies it was 10.4% (95% CI 1.6%-19.3%). Male sex and unilateral PRM division were significantly associated with recurrence of symptoms after PRM division. Bilateral PRM division, posterior division, complete division and concomitant sphincterotomy were significantly associated with FI after PRM division.The use of PRM division for treatment of anismus was followed by some initial improvement in ODS symptoms which decreased to60% 12 months after PRM division. The mean rate of FI after PRM division, namely 10%-12%, is a limitation of the technique. Further well-designed trials are needed to verify the outcome of PRM division in the treatment of anismus.

© 2022 Elsevier B.V.In this work, we report the preparation of Fe3O4-Ti3AlC2 max phase impregnated with 2-(5-Bromo-2-pyridylazo-5-(diethylamino) phenol) and its implementation for the extraction of cadmium, lead and cobalt from water and food samples. Blended Fe3O4-Ti3AlC2 max phase impregnated with 2-(5-Bromo-2-pyridylazo-5-(diethylamino) phenol) was characterized using different instrumental techniques like scanning electron microscopy (SEM), surface area analyser (SAA), energy dispersive X-rays (EDX), Fourier transform infrared spectroscopy (FT-IR) and X-rays diffraction (XRD) for surface morphology, surface region, elemental composition, functional group and crystallinity, respectively. Factors that impact the % recoveries of analyte i.e pH, sample volume, vortex time, desorption condition and matrix impact were optimized. Analytical parameters like limit of detection (LOD) (Cd: 0.093 µg/L, Pb: 0.297 µg/L, Co: 0.223 µg/L), limit of quantifications (LOQ) (Cd: 0.310 µg/L, Pb: 0.992 µg/L, Co: 0.744 µg/L) preconcentration factors (PF) (Cd = Pb = Co: 40), enrichment factors (EF) (Cd: 39.8, Pb: 39, Co: 40) and relative standard deviation (RSD) (Cd: 3.8, Pb: 5.98, Co: 4.0) were determined under optimized trial conditions. The proposed strategy was tested using certified reference materials like TMDA-64.3 natural water and tobacco leaves (INCT-OBTL-5) for trace metal analysis. The developed strategy was also applied effectively to natural water samples and food samples using the standard addition method with good recovery results.

This is a critical review of the current evidence on patients’ experiences with oral cancer. The impact on the quality of life and implications to clinical practice and research were also discussed. A comprehensive search of three databases, PubMed, Scopus, and Google Scholar was undertaken. The search was restricted to English-language primary research papers from 2009 till 2019. The following keywords were used: mouth neoplasms, patients, experiences, oral cancer, physical, social, psychological. A total of 173 studies were retrieved using the search strategy. After removing duplicate reports and scrutinising those based on title and abstract, 68 studies were shortlisted for full text review. Three major themes emerged from the literature: (1) physical experiences of oral cancer patients, (2) psychological experiences of oral cancer patients, and (3) social experiences of oral cancer patients. Experiences of oral cancer patients are complex and subjective, and phases of physical, psychological, and social experiences of oral cancer have not been explored in detail. However, there is evidence that experiences such as pain, facial alterations, body image disturbances, anxiety, depression, social avoidance, social support, and financial implications affect patients’ quality of life. This review underlines the importance of further research to look into the type of support needed to address various experiences of oral cancer patients.

Aim of doing this review was to give a uniform consensus on prognostic impact of tumor location (hepatic vs peritoneal), liver resection and adjuvant chemotherapy in gall bladder cancer and, to compare them with previous well-studied factors of survival. We systematically review PubMed, Scopus and Cochrane for relevant articles with no date restrictions, language was restricted to English. Those articles were included that had provided Hazard ratio (HR) of survival for T2 gall bladder cancer. We identified nine retrospective studies published between 2014 and 2020 with 2345 patients. Meta-analysis showed that T2b (hepatic) cancers had higher odds of mortality (HR 3.16 [2.11, 4.74], I2 = 0%). Liver resection was associated with significantly higher odds of 5-year overall survival only in T2b (2.20 [1.33, 3.63], I2 = 67%), adjuvant chemotherapy was not associated with any significant decrease in mortality risk (0.98 [0.83–1.16]. I2 = 20%). Hepatic sided gall bladder tumors carry higher odds for mortality and recurrence. T2a tumors can be managed without hepatic resection. To risk stratify patients we also formulated a scoring system for mortality risk.

Objective: To describe the demographic, clinical, serological and radiological scores in patients with rheumatoid arthritis (RA) presenting in a tertiary hospital in Pakistan. Study Design: Cross sectional study. Place and Duration of Study: Department of Rheumatology, Fauji Foundation Hospital (FFH), Rawalpindi, from Sep 2018 to Feb 2019. Methodology: The study included 52 female patients with RA between the ages of 18 and 80 years. Data were obtained from FFH Rawalpindi's outpatient department. Demographic details, reference data, and serological status were recorded. The joints involved in the onset of the disease, joint deformities, clinical disease activity index (CDAI) and overall functional status were evaluated. Extra-articular manifestations of rheumatoid arthritis have also been examined during a detailed physical examination. The patient's bone mineral density was calculated by the use of dual energy absorptiometry (DEXA scan). Radiological scores were evaluated using modified sharp score. Results: Mean age of the patient was 55.08 ± 8.79 and mean duration of disease 9 .73 ± 7.54. The most common co-morbidity in rheumatoid arthritis patients was hypertension 20 (38.5%). Twenty four (11.7%) patients had osteoporosis. Wrist was the first joint involved in 17 (32.7%) patients. Ulnar deviation was the most common deformity in 12 (23.1%) patients. Sharp score for joint space narrowing was 61.09 ± 36.90 and sharp score joint erosions were 36.90 ± 42.41. Most common extra articular manifestation was anemia. Conclusion: Rheumatoid arthritis as a variable spectrum of disease with different manifestations. Patients had radiological damage as demonstrated by high sharp score even before starting.................

Objective: To detect antibodies against p53 in serum of patients of oral squamous cell carcinoma and oral potentially malignant disorders compared to healthy individuals. Method: The descriptive cross-sectional study was conducted at the departments of Oral and Maxillofacial Surgery, Peshawar Dental College, Peshawar, Khyber College of Dentistry, Peshawar, and the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from April2016 to March2017, and comprised serum of oral squamous cell carcinoma patients in group A, oral potentially malignant disorder patients in group B and healthy individuals in group C. Serum concentrations of anti-p53 antibodies were determined by enzyme-linked immunosorbent assay. Data was analysed using SPSS 20. Results: Of the180 subjects, there were 60(33.3%) in each of the three groups. Circulating serum p53 antibodies were detected in 59(98.3%) cases in group A, 58(96.6%) in group B and in 20(33.3%) individuals in group C (p=0.001). Conclusion: The expression of circulating p53 antibodies in serum samples of squamous cell carcinoma and oral potentially malignant disorders patients indicates the potential to be a probable candidate for being taken as a diagnostic or prognostic biomarker. Key Words: Tumour suppressor genes, TSGs, Oral squamous cell carcinoma, OSCC, Oral potentially malignant disorders, OPMDs, p53, ELISA. Continuous...

Whiplash is a soft tissue injury of the cervical spine that is generally caused by trauma from a motor vehicle accident or gunshot. It is associated with a wide range of clinical symptoms, including neck pain and stiffness, pain and restricted movement in the upper arms. We report the manifestations of this trauma within the beliefs and psychological functioning based on a comprehensive psychological assessment that include a review of hospital records, clinical examinations, a structured clinical interview, an inventory of psychosocial function, and a post-traumatic maladaptive belief scale. The results show that the patient's traumatic cervical syndrome manifested as moderate impairment in friendships and romantic relationships which reveal severe daily impairment in work, parenting, and self-care activities. The study further suggests that the injury is associated with maladaptive beliefs and significant impairment in psychosocial functioning.

Background Non-operative management (NOM) of acute appendicitis has been assessed in several studies before COVID-19 pandemic. This systematic review aimed to assess the extent of adoption, efficacy, and safety of NOM of acute appendicitis in the setting of COVID-19. Methods This was a PRISMA-compliant systematic review of the literature. Electronic databases and Google Scholar were queried for studies that applied NOM of acute appendicitis during COVID-19. The main outcome measures were the rates of NOM application during the pandemic as compared to the pre-pandemic period, failure and complication rates of NOM. Failure was defined as the need for appendectomy during NOM and complications included development of appendicular mass or abscess. Results Fourteen studies (2140 patients) were included. The male to female ratio was 1.44:1 and median age was 34. Nine hundred fifty-nine (44.8%) patients had a trial of NOM. The weighted mean rate of NOM application was 50.1% (95%CI: 29.8–70.5%). The application of NOM during the pandemic was significantly more likely than its application before COVID-19 (OR = 6.7, p < 0.001). The weight mean failure rate of NOM was 16.4% (95%CI: 9.4–23.4). NOM failure was more likely in children and patients with complicated appendicitis. The weighted mean complication rate after NOM was 4.5% (95%CI: 1.4–7.7). NOM had significantly lower odds for complications than appendectomy (OR = 0.36, p = 0.03). There was no mortality after application of NOM. Conclusion NOM of acute appendicitis in the setting of COVID-19 may be a safe, short-term alternative to surgery with acceptably low failure and complication rates. Supplementary Information The online version contains supplementary material available at 10.1007/s11605-021-04988-1.

The COVID-19 pandemic has resulted in the scaling back or postponement of non-emergency hospital services, including care of cancer patients. The present qualitative study explored the experiences of newly diagnosed oral cancer patients during the first wave of the COVID-19 pandemic in Pakistan. Patients who attended the Department of Maxillofacial Surgery, Khyber College of Dentistry in July 2020 were selected using a maximum variation purposive sampling method. Seventeen semi-structured interviews were conducted in Pashto, the local language of Khyber Pakhtunkhwa. All interviews were audiotaped, transcribed verbatim, and translated into English. Thematic content analysis yielded eight major themes: pain and generalised physical weakness, shock at diagnosis, psychological distress of the COVID-19 pandemic, faith and religion, double hit loss of employment, social isolation, social support from caregivers, and lack of support from health care professionals. In conclusion, the COVID-19 pandemic has a clear impact on the life experiences of newly diagnosed oral cancer patients. Distress due to delay in accessing health care and lack of support from health care providers are a matter of great concern. Appropriate interventions should be introduced to ensure psychological and social support strategies are in place for patients during interruptions of health care services.

Uric acid (UA) is a metabolic byproduct of purine nucleotides and is excreted as a urine component. Abnormalities in UA metabolism cause localized inflammation due to crystal deposition and can lead to various diseases. In the current study, we successfully fabricated a biosensor based on 1-H-3-methylimidazolium acetate (ionic liquid, IL)-capped nickel nanoparticles (NiNPs) for the detection of uric acid in test samples. The structures of IL-capped NiNPs and their precursors were characterized by Fourier transform infrared spectroscopy, scanning electron microscopy, and X-ray diffraction. The IL-capped NiNPs possessed intrinsic peroxidase-like properties and displayed selective UA quenching after interacting with 3,3',5,5'-tetramethylbenzidine (TMB) solution. Different parameters such as pH, time, IL, TMB, and UA concentration were optimized to obtain the best results for the proposed sensor. The UA biosensor shows good responses in the linear range from 1 × 10

Despite robust management techniques, locoregional recurrence rates of rectal cancer are still significant. Although offering intensive follow-up has been shown to be beneficial in the early detection, it can be resource consuming. Having a robust knowledge of risk factors of locoregional recurrence will help in identification of patients who actually need intensive follow-up programs. This review aimed to identify the factors that can predict locoregional recurrence after Total mesorectal excision (TME). We systematically reviewed PubMed, Scopus and Cochrane for relevant articles with no date restrictions while language was restricted to English. We only included articles that had either provided Hazards ratio (HR)/odds ratio (OR) or provided enough data that allowed calculation of HR/OR specifically for rectal cancer. Articles were deemed eligible if they included patients undergoing (TME). Seventeen studies (18,605 patients) published between 2002 and 2019 were included. A total of 699 patients developed locoregional recurrence at a median time of 25.2 months after surgery. There were eight significant predictors evaluated by more than one study; T3–T4 stage, circumferential resection margin, lymphovascular invasion, mucinous histology, N1–N2 stage, positive distal resection margin, Tumor

Acute mesenteric ischemia (AMI) is a serious medical condition that can progress to transmural bowel necrosis. Prediction of the onset of bowel necrosis in AMI is crucial to justify surgical intervention before more severe consequences supervene. This systematic review aimed to identify the significant predictors of bowel necrosis in AMI in the current literature. In adherence to the PRISMA guidelines, electronic databases were searched for studies that reported significant independent predictors of bowel necrosis in AMI. The quality of the studies was assessed with MINORS score. The main outcomes of the review were the incidence and predictors of bowel necrosis in patients with AMI and the mortality rate. This systematic review comprised nine articles that included 963 patients of a median age of 57 years. Irreversible bowel necrosis was found in 402 (41.7%) patients. The significant predictors of bowel necrosis were subdivided into eight clinical, seven biochemical, and six radiologic parameters. Eight parameters were reported by two or more studies, whereas 13 were reported by a single study. Based on the weight and odds ratio of the predictive parameters, a prognostic scoring system, Emile-Khan Score, was proposed. Several clinical, biochemical, and radiologic predictors of bowel necrosis were reported in the literature. Pooling of odds ratios was feasible for eight factors that were reported by more than one study. Further studies are needed to ascertain the utility of the other predictive factors. Level of evidence: Level II (systematic review and meta-analysis).

Objective: To compare the frequency of dental fluorosis between residents and non-residents of Quetta reporting to Dental Centre Quetta. Study Design: Cross sectional comparative study. Place and Duration of Study: The study was carried out in Dental Centre Quetta, from Dec 2015 to Apr 2017. Methodology: On the basis of inclusion criteria; two groups of 500 patients each were selected. Dean’s fluorosis index was used for scoring of the dental fluorosis. Chi square test was used for finding the association of fluorosis between residents and non-residents of Quetta. Results: Out of the 1000 included patients 437 (43.7%) were males and 563 (56.3%) were females. The mean age was 12.25 ± 1.92 years. The mean fluorosis severity was 1.46 ± 1.67 years. For fluorosis comparison between residents and non-residents, our results showed that fluorosis was present in 71.4% of the resident and 24% of the non-residents, with a p-value of ≤0.001. Conclusion: There was a high frequency of dental fluorosis in residents of Quetta as compared to the non-residents (Pakistanis hailing from other parts of the country).

The objective of this study was to determine the frequency and patterns of maxillofacial fractures in falls due to environmental and occupational reasons.One hundred and nineteen patients were included in this study who presented to the department of Oral and maxillofacial surgery at Khyber College of Dentistry, Peshawar. The duration of study was 3 years from January 1, 2017 to December 31, 2019. Demographic data such as age, gender and data environmental or occupational etiology of falls and pattern of fractures was noted in a customized Performa after detailed history, clinical and radiographic examination. Patients of maxillofacial fractures resulting due to falls with age ranging from 16 to 64 years were included. Those cases of falls that presented with systemic diseases or had chances of pathological fractures were excluded from the study.Male population was affected more than females (60% vs. 39.4%). The mean age was 32.39 SD ± 16.031. Falls due to environmental factors were more common than occupational factors (81.5% vs 18.5%). Fracture of midface was more common (57.1%) than fracture of mandible (36.7%) in patients of falls. 5.5% had both midface and mandible fractures.We concluded that Environmental and work-related facial fractures in falls are common in third and fourth decade of life. Falls due to stumbling, tripping and slipping, falls from height and falls from stairs most commonly result in midface fractures. Mandible fractures are commonly seen in sportsmen and laborers. Preventive strategies shall be adopted to prevent morbidity and mortality associated with such injuries.

Background Ligation of intersphincteric fistula tract has gained increasing popularity as a sphincter-sparing technique for complex anal fistula. The present review aimed to investigate the pooled success and complication rates of ligation of intersphincteric fistula tract in the published literature and to explore the risk factors for failure after ligation of intersphincteric fistula tract. Methods A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant literature search was conducted. Electronic databases were searched in the period of January 2007 through April 2019 for studies that assessed the outcome of the ligation of intersphincteric fistula tract procedure. The main outcomes of the review were the pooled success and complication rates of ligation of intersphincteric fistula tract, predictors of failure after ligation of intersphincteric fistula tract, operation time, hospital stay, and how failures were managed. Results Twenty-six studies comprising 1,378 patients (996 male) were included in this review. The mean age of patients was 42.3 ± 4.2 years. The weighted mean rate of success was 76.5%. The median follow-up duration was 16.5 months. The weighted mean complication rate was 13.9%. The most common complication was wound dehiscence. Fecal incontinence was recorded in 1.4% of patients. Factors that were statistically significantly associated with failure after the ligation of intersphincteric fistula tract procedure were horseshoe fistulas, fistulas associated with Crohn’s disease, and those with a history of previous fistula surgery. Conclusion The pooled success and complication rates of the ligation of intersphincteric fistula tract procedure were about 76% and 14%, respectively. Horseshoe fistulas, Crohn’s disease, and previous fistula surgery were identified as predictors for failure after ligation of intersphincteric fistula tract procedure.

Background We conducted a systematic review on the diagnostic accuracy of classical and newly reported hematological parameters which are easily available in a resource limited setting in making a diagnosis of Acute Mesenteric Ischemia (AMI). Methods We searched the PubMed, Scopus, and Cochrane library from January 1940 to April 2018. The search was limited to studies published in English and those involving human subjects only. The diagnostic accuracy of conveniently available parameters: Mean Platelet Volume (MPV), Neutrophil to Lymphocyte Ratio (NLR), Red Cell Distribution Width (RDW), lactate, D-dimer, alkaline aminotransferase, aspartate amino transferase, white blood cell count, lactate dehydrogenase, and amylase were assessed in this review. Studies were only included if they provided sufficient information allowing us to make a diagnostic accuracy contingency table and define a gold standard test. We excluded letters, editorials, and case reports. There were no restrictions to any particular study design. The QUADAS 2 protocol was used for quality appraisal. This study protocol was registered on Prospero with ID CRD42018088953. Results Of 560 articles which were initially retrieved, 20 studies, comprising of 2043 participants, were eligible for this review. AMI was diagnosed in 518 patients. D-dimer had the highest median sensitivity of 93% while the median specificity of lactate and NLR were 85.9 and 85.8, respectively. Conclusion Observing the high heterogeneity among the studies, currently it is difficult to suggest any single marker for diagnosing AMI. Compared to the classical markers, RDW, NLR and MPV showed higher specificities. Using these new markers alongside with the classical markers in the context of a scoring system might help in making a diagnosis of AMI in emergency settings.

Urinary tract infection (UTI) is one of the most severe public health problem affecting both sexes but females are more susceptible due to the differences in urogenital and reproductive anatomy, physiology and lifestyle. As in UTI, different parts of the urinary tract are affected and morbidity due to UTI is more common in women of all ages and older men. Due to multi-drug resistant strains and high recurrence rate, UTI has become a major socioeconomic burden. The current review article was aimed to describe the natural therapeutic strategies to manage and cure the UTI. For this purpose, different databases including Google Scholar, Cochrane database, and PubMed etc. were explored. Inclusion criteria were any research article investigating the current therapy of UTI. It was found that microbial infections including Escherichia coli, Enterococcus faecalis and Klebsiella species are the major causes of UTI with different signs and symptoms including painful urination or dysuria, hematuria, urinary urgency, burning micturition, frequent urination, nausea, and vomiting. Antibiotics like trimethoprim, sulfamethoxazole, quinolone etc. as the first choice of the drug are used worldwide. However, due to microbial resistance, several life-threatening side effects, repeated high doses, high cost and low efficacy of these antibiotics motivated the researchers to explore natural remedies for the treatment of UTI. Herbal medicines are effective to combat bacterial resistance with high efficacy, and easy availability with minimal or no side effects. For these reasons it has attained the attention of researchers wanting to explore the herbal treatment of UTI. Vaccinium macrocarpon, Tribulus terrestris, Trachyspermum copticum, Cinnamomum verum and Hybanthusenn easpermus are some common medicinal plants reported to have therapeutic potential for the management and cure of the UTI. Although herbal medicines have more potential over conventional medicine but more discoveries are required to explore the phytoconstituents and their mechanism of action responsible for the management and cure of UTI.

The current work reports the drug-mediated synthesis of silver nanoparticles (AgNPs) and their functionalization with ionic liquid (IL) for acetone determination. The rationale behind the selection of the Augmentin drug was the aromaticity in its structure and the functional groups attached. These properties are not only supposed to work in the synthesis of the nanoparticles but also enhance their electron density. The nanoparticles were further coated with 1-H-3-methylimidazolium acetate IL, having conductivity and aromaticity in their structure. The synthesized nanoparticles have been characterized by different techniques such as FTIR, XRD, SEM, and EDX. Colorimetric determination of acetone was done by using IL capped AgNPs with the assistance of NaCl solution and results were analyzed by UV-Vis spectrophotometry. Low-cost, stable eosin dye works as a substrate and is consumed resulting in a color change from brown to transparent. The IL capped AgNPs act as a reducing agent for the production of reduced radical form of acetone which act on the carboxylate moiety and bubble it out in the form of CO

Background The aim of this review is to provide consensus on the impact of antihuman leukocyte antigen (anti-HLA) de novo donor-specific antibodies (dnDSA) on pancreatic allograft loss. Methods We systematically searched electronic databases through August 2020 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. Articles that provided or allowed estimation of the odds ratio (OR) and 95% confidence interval (CI) for pancreatic allograft loss in patients with and without anti-HLA dnDSA were included. Results Eight studies with a total of 1434 patients were included. Patients with anti-HLA dnDSA had significantly higher odds of graft failure (OR = 4.42, 95% CI [3.15-6.22], I2 = 38%). Pooled data on graft rejection showed that patients with anti-HLA dnDSA have significantly higher odds of rejection than patients without anti-HLA (OR = 3.35, 95% CI [2.28-4.91], I2 = 38%). Conclusion The results of our meta-analysis show that anti-HLA dnDSA is strongly associated with pancreas graft failure and rejection. Surveillance for anti-HLA dnDSA is an important component of post-transplant immune monitoring.

Cancer remains a global health burden prompting affordable, target-oriented, and safe chemotherapeutic agents to reduce its incidence rate worldwide. In this study, a rapid, cost-effective, and green synthesis of titanium dioxide (TiO2) nanoparticles (NPs) has been carried out, Ex vivo and in vivo evaluation of their safety and anti-tumor efficacy compared to doxorubicin (DOX), a highly efficient breast anti-cancer agent but limited by severe cardiotoxicity in many patients. Thereby, TiO2 NPs were eco-friendly synthetized using aqueous leaf extract of the tropical medicinal shrub Zanthoxylum armatum as a reducing agent. Butanol was used as a unique template. TiO2 NPs were physically characterized by ultraviolet-visible (UV–Vis) spectroscopy, dynamic light scattering (DLS), transmission electron microscopy (TEM), scanning electron microscope (SEM), X-ray powder diffraction (XRD), and Fourier-transform infrared spectroscopy (FTIR) as routine state-of-the art techniques. The synthesized TiO2 NPs were then evaluated for their cytotoxicity (by MTT, FACS, and oxidative stress assays) in 4T1 breast tumor cells, and their hemocompatibility (by hemolysis assay). In vivo anti-tumor efficacy and safety of the TiO2 NPs were further assessed using subcutaneous 4T1 breast BALB/c mouse tumor model. The greenly prepared TiO2 NPs were small, spherical, and crystalline in nature. Interestingly, they were hemocompatible and elicited a strong DOX-like concentration-dependent cytotoxicity-induced apoptosis both ex vivo and in vivo (with a noticeable tumor volume reduction). The underlying molecular mechanism was, at least partially, mediated through reactive oxygen species (ROS) generation (lipid peroxidation). Unlike DOX (P &lt, 0.05), it is important to mention that no cardiotoxicity or altered body weight were observed in both the TiO2 NPs-treated tumor-bearing mouse group and the PBS-treated mouse group (P &gt, 0.05). Taken together, Z. armatum-derived TiO2 NPs are cost-effective, more efficient, and safer than DOX. The present findings shall prompt clinical trials using green TiO2 NPs, at least as a possible alternative modality to DOX for effective breast cancer therapy.

In the present study, patients with colorectal anastomoses that were assessed with indocyanine green (ICG) fluorescence angiography (FA) were compared to patients who had only white light visual inspection of their anastomosis. The impact of change in surgical plan guided by ICG-FA on anastomotic leak (AL) rates was assessed.PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried for eligible studies. Studies included were comparative cohort studies and randomized trials that compared perfusion assessment of colorectal anastomosis with ICG-FA and inspection under white light. Main outcome measures were change in surgical plan guided by ICG-FA and rates of AL. Risk of bias was assessed using RoB-2 and ROBINS-1 tools. Differences between the two groups in categorical and continuous variables were expressed as odds ratio (OR) with 95% confidence interval (CI) and weighted mean difference.This systematic review included 27 studies comprising 8786 patients (48.5% males). Using ICG-FA was associated with significantly lower odds of AL (OR 0.452; 95% CI 0.366-0.558) and complications (OR 0.747; 95% CI 0.592-0.943) than the control group. The weighted mean rate of change in surgical plan based on ICG-FA was 9.6% (95% CI 7.3-11.8) and varied from 0.64% to 28.75%. A change in surgical plan was associated with significantly higher odds of AL (OR 2.73; 95% CI 1.54-4.82).Technical heterogeneity due to using different dosage of ICG and statistical heterogeneity in operative time and complication rates.Assessment of colorectal anastomoses with ICG-FA is likely to be associated with lower odds of anastomotic leak than is traditional white light assessment. Change in plan based on ICG-FA may be associated with higher odds of AL. PROSPERO registration number: CRD42021235644.

Ileal-pouch anal anastomosis is used for treatment of different conditions, including mucosal ulcerative colitis and familial adenomatous polyposis. The present systematic review aimed to assess the literature for studies that compared the outcome of ileal-pouch anal anastomosis in patients with obesity versus patients with ideal weight.A systematic literature search of electronic databases including PubMed, Scopus, Web of Science, and Cochrane library was performed and reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The main outcome measures were pouch failure, pouch complications, overall complications, operation time, blood loss, and hospital stay.This systematic review included 6 retrospective studies (3,460 patients). Out of the total number of patients, 19.8% had obesity or overweight. Patients with obesity were significantly less likely to have laparoscopic ileal-pouch anal anastomosis compared with patients with ideal body mass index (odds ratio = 0.436; P = .017). The weighted mean operation time and blood loss were significantly longer in the obesity group than the ideal weight group (weighted mean difference = 22.84; P = .006) and (weighted mean difference = 85.8; P.001). The obesity group was associated with significantly higher odds of total complications (odds ratio = 2.27; P.001), leak (odds ratio = 1.81; P = .036), and incisional hernia (odds ratio = 4.56; P.001). The 2 groups had comparable rates of pouch failure, pouchitis, stricture, pelvic sepsis, wound infection, bowel obstruction, ileus, and venous thromboembolism. Male sex, longer operation time, and including inflammatory bowel disease patients only were significantly associated with higher complications in the obesity group.Patients with obesity who undergo ileal-pouch anal anastomosis are more likely to have laparotomy rather than a laparoscopic procedure, have longer operation time, greater blood loss, higher overall complications, leak and incisional hernia, and longer hospital stay.

The Karydakis procedure (KP) and Limberg flap (LF) are two commonly performed operations for pilonidal sinus disease (PND). The present meta-analysis aimed to review the outcome of randomized trials that compared KP and LF. Electronic databases were searched in a systematic manner for randomized trials comparing KP and LF through July 2020. This meta-analysis was reported in line with the PRISMA statement. The main outcome measures were failure of healing of PND, complications, time to healing, time to return to work, and cosmetic satisfaction. Fifteen randomized controlled trials (1943 patients) were included. KP had a significantly shorter operation time than LF with a weighted mean difference (WMD) of −0.788 (95%CI: −11.55 to −4.21, p < 0.0001). Pain scores, hospital stay, and time to healing were similar. There was no significant difference in overall complications (OR= 1.61, 95%CI: 0.9–2.85, p = 0.11) and failure of healing (OR= 1.22, 95%CI: 0.76–1.95, p = 0.41). KP had higher odds of wound infection (OR= 1.87, 95%CI: 1.15–3.04, p = 0.011) and seroma formation (OR= 2.33, 95%CI: 1.39–3.9, p = 0.001). KP was followed by a shorter time to return to work (WMD= −0.182; 95%CI: −3.58 to −0.066, p = 0.04) and a higher satisfaction score than LF (WMD= 2.81, 95%CI: 0.65–3.77, p = 0.01). KP and LF were followed by similar rates of complications and failure of healing of PND and comparable stay, pain scores, and time to wound healing. KP was associated with higher rates of seroma and wound infection, shorter time to return to work, and higher cosmetic satisfaction than LF.

Objective. The objective of our study was to determine the incidence of postoperative complications associated with different kinds of genioplasties done with or without concomitant orthognathic surgeries. Materials and Methods. Patients in whom facial asymmetry was corrected by genioplasty with age ranging from 16 to 55 at the Department of Oral and Maxillofacial Surgery were included in the study. Patients with facial asymmetry due to congenital problems were excluded. Results. 59 patients were included, of which 38 were males and 21 were females with the age range of 16–55 (mean: 27.3729, Std. deviation: 4.70472). Advancement genioplasty was performed in 15.3%, reduction genioplasty was done in 16.9%, and advancement genioplasty with rotation was performed in 67.8% cases. In 28.8% cases, genioplasty was performed as an adjunct procedure with orthognathic surgery, and in 71.2% cases, genioplasty was performed alone. 3.4% patients developed infection, 8.5% had hematoma, and 6.8% had temporary numbness. Postoperative complications were seen more in men than in women. Correction of chin asymmetry by rotation/advancement showed the highest number of complications (84%). Conclusion. Temporary neurosensory disturbance of the inferior alveolar nerve is the most common complication that occurs after genioplasty. Patients shall be counselled preoperatively, and informed consent shall be obtained prior to surgery.

Depression is a common problem among women. Different variables contributein influencing depression among women. Menopause is one variable that may trigger symptomsof depression. Different variables jointly contribute in influencing the presentation of menopausalsymptoms including sociocultural, psychological and environmental factors. No studies havebeen conducted to assess mean age and symptoms of depression among menopausalwomen of Mardan. Objectives: To assess accompanying symptoms of depression and theirseverity among menopausal women. Study Design: Cross-sectional study. Setting: GynaeOut-patient Department at Mardan Medical Complex. Period: February 2017 to October 2017.Methods: The sample consisted of 200 women ranging in age from 45-71 years. Each patientwas assessed using sociodemographic sheet, menopausal symptoms were assessed usingMenopausal rating scale and severity of depression was measured using Hamilton depressionscale. Data was entered and analyzed using SPSS Version 21.0. Results: According to thefindings of this study, mean age at menopause was noted to be 49.1 ranging from 44-59. Amongthe many predominant menopausal symptoms, the most common among these symptomsreported were joint and muscle discomfort in 62% of women, followed by sleep problem (17%),and physical and mental exhaustion (11%). The least reported menopausal symptoms weredrying of vagina, sexual problems and anxiety. Depression was found among 26 % of thefemale participants according to Hamilton scoring criteria. Mild depressive symptoms werenoted among 24%, moderate depressive symptoms 14%, severe 5% and very severe 7%.Conclusion: According to the results of the current study, 50 % of the participants lies in therange of depression according to Hamilton depression scores. Among these 50%, more thanhalf 26 % lies in the range of severe to very severe depression while the rest 24% lies in therange of mild to moderate depression.

Table 4: The Column "Biochemical" the entire row "Hyperamylasemia" is missing the updated Table 4 has been copied below.

Introduction Severity of cholecystitis can be defined by the presence of histopathological changes such as gangrene, perforation, and empyema. Severe cholecystitis correlates with higher morbidity and longer hospital stay. The present review aimed to identify the predictors of severe cholecystitis. Methods Electronic databases including PubMed, Scopus, and Cochrane library were searched in the period of January 1980 to March 2019. The main outcome of this review was to assess the predictability of pre-operative parameters such as Leukocytosis, fever, tachycardia, gallbladder wall edema, gallbladder distension, serum platelet count, and gallbladder mural striation. The role of patients’ characteristics including age, gender, and diabetes mellitus in predicting severe cholecystitis was also assessed. Results A total of 8823 patients were analysed. The mean age of patients was 67.14 ± 4.17. The parameters that had the highest Odds ratio in predicting severe cholecystitis were all findings on CT scanning and included attenuation of arterial phase, mural striation of the gallbladder, and decreased gallbladder wall enhancement. Conclusion We conclude that CT findings were the most significant predictors of severe cholecystitis. Patients with clinical and laboratory predictors of severe cholecystitis should be urgently evaluated with contrast CT scan to rule out any severe complications

To discuss metformin and iv-contrast induced acute renal failure with its reported cases worldwide, associated risk factors and precautions that can be taken to reduce this tragedyto address this sensitive issue to my technologist family working in clinical situations. As these studies were observational studies and just report contrast induced nephrotoxicity in different countries by analyzing patients data. By Personal experience or by analyzing data available on PACS (Picture archiving and communication system) most commonly available in Hospitals now a days, that is why these studies did not use any scientific procedure. In our study, we collected opinions of Senior Doctors about use of Metformin before and after contrast study. All Doctors were agreed upon investigation of serum creatinine before contrast study. Doctors were not agreed on single opinion but surely they agreed on stop of Metformin before and after procedure. They said its responsibility of imaging technologist or Radiologist to guide patient about this problem. Diabetic patients using Metformin are at high risk of acute renal acidosis if they are undergoing for iodinated contrast study.

Malaria and typhoid fever are among the major infectious diseases which impose significant health and socioeconomic burden on affected populations. Further, co-infection and resembling symptomatology in both infections, mostly leads to misdiagnosis and mistreatment. So co-infection of malaria and typhoid fever is becoming a major issue in tropical and subtropical countries. The current study was planned to explore the rate of co-infection of malaria and typhoid fever to show the diagnostic challenges and people health implications in the local population of Faisalabad-Pakistan. For this purpose, 144 samples (n=144) were collected from suspected subjects both male (n=74) and female (n=70) (comprises of three age group ranges viz01-10, 11-20 and above 20 years old) of typhoid fever and malaria from October to December 2017 at Children Hospital, Faisalabad-Pakistan. Thick smear as a gold standard technique for malaria diagnosis and Widal agglutination technique for typhoid diagnosis were used. Results revealed that the prevalence of co-infection in selected subjects was 6.3% (n=9) with higher prevalence in female subjects (7.1%) as compared to males (5.4%). Further, it was also reported that age groups01-10 years old, 11-20 years old and 21-above years old have6.6 % (n=75), 5.7 % (n=35) and 5.8% (n=34), coinfection prevalence respectively. In the present study, it could be concluded that although the prevalence of co-infection of malaria and typhoid fever in the studied population was possible but sensitivity of diagnostic tools was limited, so more reliable, specific and sensitive diagnostic tools are required to report confidently more precise correlation of these infectious diseases.