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Aim: To compare pain score and trismus in primary and secondary closure of surgical wound after removal of impacted mandibular third molar. Study design: Randomized controlled trial. Place and duration of study: Bacha Khan Medical Complex, Gajju Khan Medical College, Shah Mansoor Swabi Pakistan from 1stMay 2020 to 30thJune 2021. Methodology: Fifty patients were divided into two groups i-e group A (Primary closure) and group B (secondary closure). Demographic data (name, age, gender and contact number) was recorded. Pre-operative mouth opening was measured as maximum interincisal distance in millimetres. Pre-operative variables were again re-evaluated on 3rd post-operative day for pain on Visual analogue scale (VAS 0-10) and for mouth opening. Results: Thirty one (62%) patients were males and 19(38%) were females. Overall mean pain score was 2.48±1.90 on visual analogue scale (VAS). Mean age was 30.24±7.64 years while mean post-operative interincisal distance was 43.5±4.717 mm. The difference between Group A and B for both mouth opening ((P=0.03; 95% CI = 0.135, 0.434) and pain (P=0.006; 95% CI = 0.426, 2.453) were statistically significant. Conclusion: When intra operative parameters of impaction difficulty are the same, secondary closure ensures minimal morbidity of pain and trismus as compared to primary wound closure. Keywords: Flap closure; Primary closure; Secondary closure; Impacted third molar

Objective: To determine the frequency of elevated systolic blood pressure and early mortality in patients with Intracerebral hemorrhage. Study Design: Descriptive Case Series study. Setting: Department of Medicine, Unit IV of Jinnah Hospital Lahore. Period: 6th April 2018 to 7th October 2018. Material & Methods: Total 335 patients of intracerebral hemorrhage, fulfilling inclusion criteria were recruited for the study. Blood pressure levels was measured by researcher using random-zero sphygmomanometers with the subject lying quietly. Two readings of blood pressure 5 minutes apart were taken and average of the two readings was noted in the proforma. CT scan brain was done and analyzed by consultant radiologist. These study cases were followed till discharge to note outcome (mortality). Data was entered and analyzed in SPSS version 20. Frequency and percentages were used for expressing qualitative variables while quantitative variables were expressed in the form of mean and standard deviation. Results: The mean age of the study participants was 64.39 + 8.50 years. Majority of the cases were males with the frequency of 285(85.1%). Early mortality was noted in 132(39%) of cases. Diabetes Mellitus was noted in 144(43%) of cases. There was significant difference noted with p-value

Aim: To determine the frequency of Hepatitis C virus infection in confirmed cases of ischemic heart disease. Material and Methods: Study design: Cross sectional descriptive study. Study Place and Duration: The study was done at department of medicine, Services hospital Lahore over a period of 6 months after approval of Synopsis (December 7, 2017 till June 7, 2108).This descriptive cross sectional study was conducted from 15 June to December 2019 in the Radiology Department of Avicenna Medical College. A total of 90 ultrasounds undertaken at the Gynecological Ultrasound Unit. A total of 32 patients with functioning ovarian cysts were included. A total of 46 individuals with benign tumors and 9 patients with malignant cysts were included in the control group. The remaining patients were not followed up on and were treated at a different center. The majority of the patients had issues with their menstrual cycle and pain. Data Collection Procedure: All 291 patients meeting selection criteria were taken after approval of synopsis in this study. All data was taken from medical departments of SIMS after written informed consent along with their biodata like name, age, along with contact details. A sample of appropriate size of blood was drawn out with help of senior staff nurse in aseptic / sterilized container and was sent out to hospital laboratory for the analysis of HCV. The diagnosis of HCV was done as per operational definition. Results: The mean age of cases was 53.36 ± 15.21 with minimum and maximum age as 28 and 80 years. There were 200(68.7%) male and 91(31.3%) female cases with 2.20:1 male to female ratio. There were 100(34.4%) cases who belonged to lower, 116(39.9%) belonged to middle and 75(25.8%) cases belonged to upper class. According to operational definition, 80(27.5%) of the cases had Hepatitis C while in 211(72.5%) cases Hepatitis C was negative. Conclusion: It is concluded that the prevalence of Hepatitis C virus was positive in 27.5% that’s too high, so it must be ensure in all cases IHD to screen and diagnosis of HCV. If they remained undiagnosed then they may develop related complications such as severe coronary lesions that can further elevate the risk of cardiac morbidity and mortality. Keywords: Cardiovascular disease, ischemia heart diseases, risk factor, extra hepatic manifestations

This paper is concerned to establish an advanced form of the well-known Hermite-Hadamard (HH) inequality for recently-defined Generalized Conformable (GC) fractional operators. This form of the HH inequality combines various versions (new and old) of this inequality, containing operators of the types Katugampula, Hadamard, Riemann-Liouville, conformable and Riemann, into a single form. Moreover, a novel identity containing the new GC fractional integral operators is proved. By using this identity, a bound for the absolute of the difference between the two rightmost terms in the newly-established Hermite-Hadamard inequality is obtained. Also, some relations of our results with the already existing results are presented. Conclusion and future works are presented in the last section.

Variceal bleeding is a key and most fatal complication observed in chronic liver disease patients with portal hypertension and is a major contributor to the high morbidity and mortality seen in these patients. Exploring the predictors of rebleeding in chronic liver disease patients is of paramount importance to alter disease course and impact on morbidity and mortality.About 50 patients with chronic liver disease who previously had evidence of varices on upper GI endoscopy and had at least one episode of rebleeding after EVBL were included in this study. Patients were assessed for the possible contributors to rebleeding through complete history, clinical examination, coagulation profile and platelet count, ultrasound features (splenic size and portal pressure), and upper GI endoscopic findings (site and grade of varices, red sign). Sample selection was done using non-probability purposive sampling technique and sample size calculated using the standard WHO formula. Data was entered and analyzed using SPSS version 20.In this study, mean age of the patients was 51.34±6.34 years with male predominance (64%). Rebleeding was significantly associated with grade of varices, presence of red sign on upper GI endoscopy, site of varices, splenic size and coagulopathy.Rebleeding in chronic liver disease patients following EVBL is predicted by grade, extent and site of varices, red sign on upper GI endoscopy, splenic size and coagulation disturbances.

Background: In December 2019, a group of cases of pneumonia of unknown cause was found in Wuhan, China, now known as coronavirus disease 2019, and the coronavirus was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). High-resolution computed1tomography (HRCT) is currently regarded as a significant imaging technique for aiding in the diagnosis & management of COVID-19 patients. Objective: To find the different patterns of1manifestation in HRCT chest in COVID-19 patients. Study Design: Descriptive Cross-Sectional Setting: University of Lahore Teaching Hospital, Lahore Methodology: A descriptive, cross-sectional study was conducted in Radiology Department in University of teaching hospital, Lahore. 240 participants' medical histories were thoroughly reviewed, both directly from them and on case sheets. All patients with confirmed cases of COVID-19 pneumonia were admitted to the hospital and received a chest HRCT. Three follow-up HRCT chest scans were performed on one patient. The distribution and patterns of lung involvement were studied. Each of the five lung lobes was evaluated visually for degree of involvement and categorized as mild (26-50 percent), moderate (51-75 percent), or severe (75 percent) (76-100 percent). Data was analyzing in SPSS. Age was presented as mean + SD. Gender and other HRCT patterns were presented as frequency & percentage. Result: Total 240 COVID-19 patients included. There were 142(59.4%) male and 97(40.6%) female. The mean age was 54.0+15.71 with age range of 4 to 84 years. Large number of patients 114(47.7%) were in the age group 45-64 years. Ground glass opacity was the most common CT abnormality, with 236(99.2%) cases. Among them 49(20.5%) cases had GGO plus consolidations. Crazy paving pattern was seen in 136(56.9%) cases. Only 10(4.2%) patients with GGO pulmonary nodules and pleural effusion were involved. The majority of the patients had a fever 114(47.5%), while the least frequent symptom was a runny nose (7(2.9%). Conclusion: Pure GGO pneumonia is the most prevalent pattern of COVID-19 pneumonia seen on HRCT scans, GGO consolidation, with crazy paving with prominent distribution in the lung posterior & peripheral area. Keywords: COVID-19, HRCT, GGO, Pneumonia.

Objectives: To determine the prevalence of Vitamin B12 deficiency in type II diabetic patients using metformin. Study Design: Cross Sectional study. Setting: Endocrinology Unit Shalamar Hospital Lahore. Period: July to September 2017. Material & Methods: All of our patients were having previously diagnosed type II diabetes and using metformin for more than six months. Using strict exclusion criteria, vitamin B12 levels of patients were measured and analyzed. Results: It was evident from the present study that 27.33% of type II diabetic patients using metformin were having vitamin B12 levels less than 150pg/ml. Furthermore, our study showed that smokers are more liable to develop vitamin B12 deficiency than the nonsmokers. Also, use of multivitamins (containing vitamin B12) had a protective role against vitamin B12 deficiency. Conclusions: Long term use of metformin in type II diabetic patients is strongly associated with Vitamin B12 deficiency, therefore endocrinologists and physicians should take into consideration this significant adverse effect of metformin and screen for vitamin B12 deficiency in diabetic population before starting metformin therapy.

Aim: To compare the efficacy of double dose hepatitis B vaccine with conventional dose hepatitis B vaccine in hepatitis C related chronic liver disease patients. Study design: Interventional study (randomized controlled clinical trial) Place and duration of study: Outpatient Department of Medicine, Services Hospital, Lahore from 12th August 2019 to 12th February 2020. Methodology: One hundred and ten patients of both male and female age group 30 to 70 years diagnosed with chronic liver disease on the basis of changed liver echo texture on ultrasound were included. Patients were divided into two groups, each group having 55 patients. One group was given double dose (2ml) while the other was given conventional dose (1ml). Both groups were compared for efficacy in terms of prevention of CLD. Results: The mean age of conventional group was 33.8±9.6 years while 33.7±9.1 years in the double dose group with male predominance (69.10%). Hypo-responsiveness was detected in 23.6% and 32.7% of conventional low dose group and double dose group respectively. There were gender variations in mean Anti-HBs levels. It was 129.80±70.53 mIU/mL in males and 113.26±75.57 mIU/mL in female patients (P= 0.039). Mean titers of anti-HBs in conventional dose group and high dose group were 127.82±67.59 mIU/mL and 121.56±77.00 mIU/mL, respectively (P= 0.52). Conclusion: Double dose hepatitis B vaccination in chronic HCV infected patients efficiently increases the response rate and hence protection against chronic hepatitis B. Keywords: Double dose hepatitis B vaccine, conventional hepatitis B vaccine, chronic hepatitis.

Aim: To observe the mean alteration in potassium levels one-hour post-antihyperkalemic treatment in end stage renal disease patients presenting with hyperkalemia. Study design: Quazi interventional (experimental) study. Place and duration of study: Department of Medicine, Sir Ganga Ram Hospital Lahore from 28th June 2018 to 27th December 2018. Methodology: Sixty patients of both genders with age range between 14 to 70 years having stage 5 CKD (thrice-weekly dialysis dependent) for at least 6 months with raised serum potassium (>5.5 mEq/L). These patients were given medical treatment in the form of salbutamol nebulization, injectable calcium gluconate, and 100ml 25% dextrose water solution neutralized with Humulin R Insulin 12 units. Serum potassium was reassessed 1 hour after the treatment. Mean change in serum potassium was observed and was compared across various subgroups of patients. A written informed consent was taken from each patient. Results: In the current study, mean age of our studied population was 50.6±10.4 years with male-gender dominance (81.7%). Mean ESRD duration was 11.8±3.7 months while the mean BMI was 27.6±3.6Kg/m2. 15 (25.0%) patients were obese. The serum potassium level at presentation ranged from 5.6mEq/L to 6.9mEq/L with a mean of 6.25±0.39mEq/L. The serum potassium level 1 hour after medical treatment ranged from 4.8mEq/L to 6.3mEq/L with a mean of 5.58±0.43mEq/L. This change in mean serum potassium was significant (p-value

Objective: To determine the understanding of irritable bowel syndrome among general practitioners in Lahore in terms of diagnosis and treatment. Study Design: Observational, cross sectional study. Place and Duration of Study: Department of Medicine, University of Lahore Teaching Hospital, Lahore from 1st October 2020 to 31st March 2021. Methodology: Two hundred and ninety eight patients from both urban and rural territory in Lahore were enrolled. Manning and Rome criteria were applied to establish diagnosis of irritable syndrome. Patient’s history, investigations and final diagnosis were recorded. After three months, patients were reassessed for final diagnosis and any alternative diagnosis if under consideration. Results: There were 180 (60.4%) females and 118 (39.6%) males with mean age of 34 years. About 70 patients presented with GIT complains were functional and 45 with organic problems. Out of 70 functional patients, 45 have irritable bowel syndrome. The condition was functional or organic quite inadequate and amounted to 56%. Conclusion: Majority of irritable bowel syndrome patients were either wrongly diagnosed by the general practitioners or inadequately treated. Key words: Irritable bowel syndrome (IBS), Functional and organic diarrhea

Objective: To determine the frequency of elevated homocysteine levels in patients with ischemic stroke. Study Design: Cross-sectional study. Place and Duration of Study: Department of Medicine Unit II, Jinnah Hospital, Lahore from 13th October 2017 to 12th April 2018. Methodology: Two hundred and fifty subjects of ischemic cerebral stroke were included in this study using non probability sampling technique. Diagnosis of ischemic stroke was confirmed by CT brain and serum homocysteine level was measured in micromoles/L. Results: The average age of our studied population was 64.9±11.5 years with 141 males (56.4%) and 109 (43.6%) females. Mean total homocysteine levels were 55.5±2.9 μm/L and the range was 8-148.7. Elevated homocysteine levels were found in 239 (95.6%) and were normal in 11 (4.4%). Highly elevated levels were present in 18 (7.5%), moderately elevated in 179 (74.9%) and lightly elevated levels were found in 82 (17.6%). Conclusion: The elevated homocysteine levels are a strong risk factor for ischemic cerebral Stroke. About 74.9% of the patients with ischemic stroke had moderately elevated levels whereas 7.5% had highly elevated serum homocysteine levels. Key words: Ischemic stroke, Elevated homocysteine levels

Background: Polycystic ovary syndrome (PCOS) is the most frequent pathology among women of reproductive age characterized by menstrual irregularities, hyperandrogenism and polycystic ovaries on ultrasound. Evidence suggests that high androgen levels are the fundamental factor in the pathogenesis of PCOS. The objectives of the present study was to determine serum free testosterone levels in polycystic ovarian syndrome patients, and observe its correlation with clinical hyperandrogenism. Patients and methods: This cross-sectional study was conducted at Jinnah Allama Iqbal Institute of Diabetes and Endocrinology Lahore, Pakistan from 15th May 2019 to 15th November 2019. The study included 140 patients of PCOS diagnosed as per Rotterdam criteria. Serum testosterone levels were determined in these patients by ELISA method. Ferriman-Gallwey (FG) score was used to assess severity of clinical hyperandrogenism in the form of hirsutism. Patients were categorized into three groups, mild (FG score 8-15), moderate (FG score 15-25) and severe (FG score >25). Correlation between clinical (hirsutism) and biochemical hyperandrogenism (serum free testosterone levels) was assessed using Fisher exact test. Data was analyzed using SPSS version 25. Results: Biochemical hyperandrogenism in the form of raised free testosterone levels was present in 46 (32.9%) PCOS patients. Out of 12 patients having Ferriman Gallwey score >25, 10 (83.3%) had biochemical hyperandrogenism. Out of 70 patients having Ferriman Gallwey score 15-25, 22 (31.4%) had biochemical hyperandrogenism whereas out of 58 patients having Ferriman Gallwey score 8-15, only 14 (24.1%) patients had biochemical hyperandrogenism. Conclusion: Prevalence of biochemical hyperandrogenism in PCOS patients in our studied population was significantly low when compared to the population studied worldwide making it less reliable as diagnostic tool in this part of the world. Also there was significant positive correlation between free testosterone levels and degree of hirsutism which means that diagnostic accuracy of free testosterone in PCOS patients is considerably high in those having clinical hyperandrogenism.

Objectives: To determine the association of low serum vitamin D levels with poor glycemic control and obesity in type 2 diabetic patients. Study Design: Descriptive Cross Sectional study. Setting: Sakina Institute of Diabetes and Endocrine Research Centre (SIDER), Shalamar Hospital Lahore. Period: 1st June to 31th august 2017. Material & Methods: After applying strict exclusion criteria, about 450 patients with known type II diabetes were enrolled in the present study and their HBA1C and fasting vitamin D levels were measured. Patients were divided into two groups, group 1 with poor glycemic control (HBA1C>8%) and group 2 with good glycemic control (HBA1C 23 were having suboptimal Vitamin D levels (p value

Objectives: To determine the frequency of hypothyroidism in type II diabetic patients and to compare the lipid profile of diabetic patients with and without hypothyroidism. Study Design: Cross Sectional Study. Setting: Medicine Unit I Shaikh Zayed Hospital Lahore. Period: 5th August 2016 to 5th February 2017. Material & Methods: A total of 350 patients, aged 35-80 years, of both gender and having type II DM diagnosed at least 1 year ago were enrolled in our study. Fasting (12hr) blood samples were obtained and sent to the laboratory for measurement of serum TSH, total cholesterol, LDL and TGs. Patients with TSH value >10 μg/ml were labeled as hypothyroid. Two groups (hypothyroid diabetic and euthyroid diabetic) were made and lipid profile was compared in both groups. Results: Frequency of hypothyroidism in type II diabetic patients was recorded as 13.42% (n=47). When lipid profile of hypothyroid diabetic patients (group I) was compared with euthyroid diabetics (group II), it was noted that patients in group I had mean total cholesterol of 170.32 ± 12.90 mg/dl whereas in group II, it was 138.81 ± 28.89 mg/dl. Mean triglyceride level in group I was 176.21 ± 15.98 mg/dl, whereas in group II, it was 151.02 ± 27.78mg/dl. Mean LDL in group I was 87.17±15.97mg/dl, and 71.35±20.40 mg/dl in group II. Conclusions: Frequency of hypothyroidism in type II diabetic patients is higher as compared to general population. Moreover, dyslipidemia is significantly higher in hypothyroid diabetics when compared with euthyroid diabetics.

Objectives: To determine the frequency of spontaneous bacterial peritonitis (SBP) in chronic liver disease patients with ascites using proton pump inhibitors (PPI). Study Design: Prospective cohort study. Setting: Medicine Unit-II, Shalamar Hospital Lahore. Period: From 1st January to 30thJune 2017. Materials & Methods: A total of 380 patients enrolled in present study were divided into two groups; PPI group and non PPI group. Each group had 190 patients. We performed an extensive matching in both groups to minimize selection bias and SBP incidence was compared in both groups. Multivariate analysis was applied to sort out the causal relationship between PPI use and SBP. Results: Applying strict exclusion criteria, SBP incidence in chronic liver disease patients with ascites was found significantly high in PPI group than non-PPI group (12.63% vs. 6.84%, P Value 0.002). Moreover, a large no of patients (39.47%) were using PPI for inappropriate indications while acid peptic disease was the most common indication for its use (60.53%). Conclusion: Use of proton pump inhibitors in chronic liver disease patients with ascites significantly increases the risk of spontaneous bacterial peritonitis.

Objectives: To determine the factors those may predict hyperkalemia in cirrhotic patients receiving spironolactone. Study Design: Cross sectional descriptive study. Setting: Medicine Department Shalamar Hospital, Lahore. Period: 15 days from 1st September to 15th September 2017. Materials & Methods: 150 patients with documented liver cirrhosis, receiving spironolactone and fulfilling the inclusion criteria were made part of the study. Five mL blood was drawn in two different vials; 2 mL in EDTA vial to check the prothrombin time (PT) and 3 mL in clotted vial to measure serum potassium, sodium, creatinine, urea, albumin, and bilirubin in serum after centrifugation. Potassium level was measured at baseline (Day-0) and two weeks later after receiving spironolactone. Results: Patients with raised serum creatinine (>1.3 mg/dL) and hyperbilirubinemia (>2.8 mg/dL) were found to have serum potassium more than 5 mmol/L. Increased potassium levels were found in patients receiving high dosage of spironolactone (>100mg/day). These patients had decompensated liver cirrhosis as evident from their child-class C and significant hypoalbuminemia. Conclusion: Decompensated cirrhotic patients with raised serum creatinine, hyperbilirubinemia, hypoalbuminemia and receiving high dosage of spironolactone remain at higher risk of developing hyperkalemia.

Thrombocytopenia increases the risk of bleeding in CLD patients. The determination of the presence of Esophageal Varices (EV) by endoscopy is an invasive procedure. As a noninvasive tool, low platelet count (PC) can be helpful in prediction of variceal bleed in CLD patients with esophageal varices. Objectives: To assess the diagnostic accuracy of thrombocytopenia in predicting the presence of esophageal varices in patients with chronic liver disease. Study Design: Descriptive Cross sectional study. Setting: Medicine Unit I, Sheikh Zayed Hospital, Lahore. Period: 6 months from 1-07-2015 to 31-12-2015. Material and Methods: About 150 cases were included in our study through Non-Probability, Consecutive sampling method after obtaining written Informed consent. Blood sample was obtained from each patient and were immediately sent to the laboratory for assessment of platelet count. Reports were assessed. Those with low platelet count were referred to endoscopy room for confirmation of esophageal varices. Reports of endoscopy were compared with platelet count. Data was entered and analyzed through SPSS version 23. Results: Mean age of patients was 49.64±11.54 years. There were 97(64.7%) male and 53(35.3%) female patients. Mean duration of chronic liver disease of patients was 3.51±1.39. Mean platelet count of patients was 172.3±81.20. Sensitivity and Specificity of Thrombocytopenia for prediction of esophageal varices in patients presenting with chronic liver disease was 92.63% and 89.09%. While PPV, NPV and Diagnostic accuracy of Thrombocytopenia for prediction of esophageal varices was 93.62%, 87.5% and 91.33% respectively. Conclusion: It has been concluded from the present study that PC has high accuracy for detection of EVs and can be helpful in prediction of EVs in CLD patients.

The theory of symmetry has a significant influence in many research areas of mathematics. The class of symmetric functions has wide connections with other classes of functions. Among these, one is the class of convex functions, which has deep relations with the concept of symmetry. In recent years, the Schur convexity, convex geometry, probability theory on convex sets, and Schur geometric and harmonic convexities of various symmetric functions have been extensively studied topics of research in inequalities. The present attempt provides novel portmanteauHermite–Hadamard–Jensen–Mercer-type inequalities for convex functions that unify continuous and discrete versions into single forms. They come as a result of using Riemann–Liouville fractional operators with the joint implementations of the notions of majorization theory and convex functions. The obtained inequalities are in compact forms, containing both weighted and unweighted results, where by fixing the parameters, new and old versions of the discrete and continuous inequalities are obtained. Moreover, some new identities are discovered, upon employing which, the bounds for the absolute difference of the two left-most and right-most sides of the main results are established.

To find out frequency of low HDL-C levels in patients suffering from acute coronary syndrome. Study Design: Descriptive cross sectional study. Setting: Department of cardiology Khyber Teaching Hospital (KTH) Peshawar. Period: 04/04/2016 to 04/10/2016. Material & Methods: By applying WHO formula for sample size calculation and 95% confidence interval, a total of 154 Patients admitted to coronary care unit (CCU) of Khyber Teaching Hospital with acute coronary syndrome were selected. Anticipated portion of low HDL in ACS was 73.3 % and absolute precision of about 7%. Results: In this study, mean age was 55.720 ± 8.901 years. About 38% patients were of female gender while 62% patients were male. About 20 % patients had UA, 9% patients had NSTEMI, and 71% patients had STEMI. Patients with low high density lipoproteins constituted about 48% of the total patients admitted with ACS. Conclusion: Our study concluded that significant number (48%) of patients with ACS had low HDL levels.

Introduction: The frequency of QT interval prolongation as published in the international and local literature has been variable. Aims & Objectives: To determine the frequency of QT interval prolongation in patients with chronic liver disease and resolve the variability in the literature. Place and duration of study: The present study was conducted in Gastroenterology and Hepatology Unit Shaikh Zayed Hospital Lahore from 1st March 2017 to 31st August 2017. Material & Methods: About 240 patients with diagnosed chronic liver disease were selected. Electrocardiography (12 lead) was performed in all patients to look for QT interval prolongation and their mean was calculated for purpose of analysis. Results: Mean age of our patients was 53.7±11.9 and male gender was dominant (55.8%). It was noted that QT interval was prolonged in 62 patients (25.8%) while rest of the 178 patients had normal QT interval. Conclusion: QT interval prolongation is frequently observed (25.8%) in chronic liver disease patients. Therefore, every patient with chronic liver disease should be investigated for QT interval prolongation. Key words: Chronic liver disease, QT interval, Electrocardiography

The aim of the study was to assess the influence of flap designs (Envelope flap (EF) and Szmyd flap (SF)) for impacted mandibular third molar extraction, on periodontal pocket depth (PPD), clinical attachment loss (CAL) and bone levels (BL) of second molar. Sixty patients indicated for third molar extractions with healthy second molars were allocated into two groups: EF and SF (n = 30). Third molars were assessed for angulation, root patterns, depth of impactions and relation with ramus (Pell and Gregory classification). Extraction of third molars was performed and PPD, CAL and BL around second molars at 0, 3 and 6 month (mon) follow-ups (FU) were assessed clinically and radiographically. ANOVA, Chi-square and Fisher’s exact test were employed to compare periodontal factors between EF and SF groups, considering p ≤ 0.05 as significant. Sixty participants with a mean age of 23.22 ± 3.17 were included in the study. Based on angulation, the most common impaction in the EF and SF groups was mesio-angular (EF, 50%, SF, 36.7%). Buccal and distal PPD showed a significant increase (p &lt, 0.001) in both EF and SF patients from baseline to 6 mons. EF patients showed significantly higher distal and buccal CAL (6.67 ± 0.18 mm, 6.91 ± 0.17 mm) and BL (7.64 ± 0.16 mm, 7.90 ± 0.15 mm) as compared to SF patients (CAL, 6.76 ± 0.26 mm, 6.91 ± 0.17 mm- BL, 7.42 ± 0.38 mm, 7.34 ± 0.34 mm) at 6 mon FU. SF showed better soft tissue attachment (PPD and CAL) and bone stability (less bone loss) around second molars compared to EF after third molar extractions regardless of the patient, tooth and operator factors.

This paper is concerned to present and apply a new generalized fractional derivative, that is the Generalized Hilfer-type (GH) fractional derivative. This derivative unifies various previously defined fractional derivatives of the types Hilfer-Katugampola, Hilfer-Hadamard, Caputo-Hadamard, Hadamard, Hilfer, Riemann-Liouville, Caputo etc into a single form. The mellin transform of this new GH fractional derivative is obtained. As an application, a generalized space-time fractional diffusion equation is constructed using the newly obtained GH fractional derivative in the time-variable and the already existing Riesz fractional derivative in the space-variable. For the solution of this new generalized fractional diffusion equation, the similarity transformations and the mellin transform methods are used where an explicit solution in terms of the Fox’s H-function is derived. The diffusive behavior and the role of various parameters involved in the newly obtained GH fractional derivative are described with the help of 3D plots.

Introduction Metformin is one of the safest, first-line oral hypoglycemic agents used in type-2 diabetes mellitus patients. This study aims to study the effect of metformin on thyroid-stimulating hormone (TSH) in hypothyroid and euthyroid individuals, as both these diseases have an increased prevalence and coexistence. Method This hospital-based study was conducted in Jinnah Allama Iqbal Institute of Diabetes and Endocrinology (JAIDE), Allama Iqbal Medical College/Jinnah Hospital Lahore, Pakistan, from October 2019 to April 2020. One hundred and sixty type-2 diabetic participants, aged 25-60 years and meeting the inclusion criteria were enrolled in the study after informed consent. They were divided into two groups, the hypothyroid group who were already on levothyroxine therapy and had a stable TSH in the normal range, and a euthyroid group who had no thyroid dysfunction. Both the groups were started on metformin therapy for the control of type-2 diabetes mellitus and followed for six months. Their blood samples for TSH and free thyroid hormone (fT4) were drawn both prior to and after the study period. Results Out of the 160 type-2 diabetic patients, TSH levels showed a significant reduction in the hypothyroid patients (2.33 ± 0.70, p < 0.001) with no significant changes in the euthyroid patients (3.87 ± 0.40, p = 0.206) following six months of metformin therapy. However, there was no significant difference in the fT4 levels in either of the groups. Conclusion Metformin has the effect of significantly lowering TSH levels in hypothyroid individuals. However, no such effect was observed in euthyroid patients.

Phosphaturic Mesenchymal Tumor (PMT) is a polymorphic group of extremely rare and usually benign, slow-growing tumors. PMT is frequently associated with tumor-induced osteomalacia (TIO), a paraneoplastic syndrome that manifests as renal phosphate wasting. The diagnosis is often delayed due to the non-specific nature of the symptoms and is also misdiagnosed due to histological overlap with other mesenchymal neoplasms. Serious disabilities may occur if they are not treated. Complete resection of the tumor is curative and leads to the normalization of biochemical abnormalities and inversion of symptoms. The majority of these tumors occur in the extremities (95%) with rare cases reported in the jaws. This patient presented to the Oral and Maxillofacial Surgery Department, Lady Reading Hospital Peshawar Pakistan with a recurrent PMT involving a mandible with a history of three months, which had already been misdiagnosed previously. Biochemical reports were normal as our case was diagnosed at a very early stage due to a prominent location and rapidly increasing size. Resection of the tumor was performed with a 1.5 cm safe margin. The mandibular reconstruction was then done with an L-type reconstruction plate fixed with bi-cortical screws on the remaining mandible on each side. Patient recovery was uneventful and he is now on follow up. At present, the patient remains well without any evidence of local recurrence.

In this article first, we give an integral identity and prove some Hermite-Hadamard type inequalities for the function f such that |f″|qis convex or concave for q ≥ 1. Second, by using these results, we present applications to f-divergence measures. At the end, we obtain some bounds for special means of real numbers and new error estimates for the trapezoidal formula.

This paper aims to develop novel generalized mean square fractional integral and derivative operators (for second-order stochastic processes) and presents an application of these operators. To conduct our study, first, the Riemann-Liouville’s approach is applied to iterate and fractionalize two specially constructed mean square Riemann integral operators. This procedure leads us to define new generalized left-sided and right-sided mean square fractional integral operators based on which the associated generalized mean square fractional derivative operators (left- and right-sided) are also defined. Some properties such as linearity, semigroup property, boundedness, continuity, and inverse property are investigated for these operators. It is proved that new classes of these left- and right-sided integral and derivative operators constitute Banach spaces and they also exist in the sense of probability. These operators generalize various mean square operators of the types Katugampola, Hadamard, Riemann-Liouville, Riemann, in which the operators of Riemann-Liouville and that of the Riemann have already been previously defined and the rest are new in the sense of mean square stochastic calculus. As an application, the newly established results are applied to prove a generalized fractional stochastic version of the well-known Hermite-Hadamard inequality for convex stochastic processes, where a bound for the absolute of the difference between the two rightmost terms is also obtained. Some relations of our results with the already existing results are also discussed.

Objectives: To determine the pattern of maxillofacial injuries in the localpopulation. Study Design: Retrospective clinical and epidemiologic study. Period: January2009 to December 2013. Setting: Tertiary care hospital. Methods: 3360 patients reported formaxillofacial injuries. A number of parameters, including age, gender, facial bone fractures,laceration on face, injury of trigeminal and facial nerve branches, sensory and motor deficit inrelation to soft tissue trauma and bone fracture, were evaluated. Results: Males were dominantand male to female ratio was 6.3:1. Patients of 3rd decade were more and constitute 63.2%.Road traffic accident was the common etiological factor (78%). Mandible fracture was dominantand it was present in 1591 patients (47.7%). Soft tissue laceration frequency was high in cheekregion and was 13.7%. Sensory deficit (Trigeminal nerve injury) was present in 1167 patients(34.7%). Motor deficit (Facial nerve injury) was present in 249 patients (6.83%). Nerve injuriesin relation to mandible fracture were common. Conclusion: Road traffic accident was the mostcommon etiological factor and mandible fracture was common. Trigeminal nerve injuries werecommon and frequency of nerve injuries was high in relation to mandible fracture.

Temporomandibular joint (TMJ) dysfunction is painful condition of facial musculoskeletal system. Arthrocentesis is less invasive treatment of TMJ dysfunctions. It has been used to treat variety of TMJ disorders. The objective of this study was to determine the success of arthrocentesis in TMJPDS patients where conservative treatment had failed.This descriptive case study of 45 patients was completed in 6 months at Outpatient Department of Oral and Maxillofacial Surgery, Mayo hospital Lahore. TMJPDS Patients who were unresponsive to conservative treatment were included in this study. The study consisted of a single arthrocentesis procedure performed by a single oral surgeon per patient. Visual Analogue Scale was used to record pain while maximum mouth opening was measured by the interincisal distance in millimetres, at 1 month and 2 months after the treatment. Success was measured two months after arthrocentesis.Thirty (66.7%) patients had no pain and 15 (33.3%) patients had mild pain. Similarly, 16 (35.5%) patients had maximum mouth opening more than 30mm and 29 (64.5%) patients had less than 30 mm mouth opening, two months after arthrocentesis procedure.Arthrocentesis is very effective in patients suffering from TMPDS by reducing pain and discomfort and increase in mouth opening. This procedure should be considered in TMPDS patients who do not respond to conservative treatment.