Revascularization of Non-vital Permanent Teeth with Open Apices: A New Treatment Modality

Objective: To determine increase in root(s) length and thickness and closure of apical foramen in patients undergoing revascularization of immature, permanent, necrotic teeth Material and Methods: This study was conducted at outpatient department of Operative Dentistry, Pakistan institute of medical sciences (PIMS), Islamabad, from 22nd January 2011 to 22nd January 2013. All the patients were assessed with the detailed history and clinical examination. On the first visit, pulp chambers of the teeth were opened followed by minimal instrumentation. Disinfection of the root canal was done with 2.5% sodium hypochlorite (NaOCl), saline, and 2% chlorhexidine (CHX). Then triple antibiotic paste (TAP) was placed in the canal till next visit. In the next visit, in the absence of clinical signs and symptoms, under local anesthesia without vasoconstrictor, bleeding was induced in the root canal. Blood clot was allowed to form beyond the level of cementoenamel junction (CEJ) which was then covered with non-setting formulation of calcium hydroxide{Ca(OH)2}and bacteria tight coronal seal with glass ionomer cement or composite was made. Patients were evaluated clinically and radiographically at 0, 3, 6, 12, 18 till 24 months. Results: Efficacy of revascularization was measured on 24 months follow up of patients having immature, permanent and necrotic teeth. Out of 36 teeth, 34 (94.4%) showed increase in root length and whereas only 2 (5.6%) teeth showed no increase in root length. Similarly, 33 (91.7%) teeth showed increase in root thickness and 3 (8.3%) patients showed no increase in root thickness. Conclusion: On the basis of follow-up period of at least 24 months, the present study demonstrates favorable outcome of the revascularization procedure in terms of increase in root length and thickness in immature permanent necrotic maxillary anterior teeth. The cases remained successful even with the use of non-setting formulation of Ca(OH)2 in place of mineral trioxide aggregate(MTA)

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Enhancing environmental performance through green HRM and green innovation: Examining the mediating role of green creativity and moderating role of green shared vision

Organizations encourage green creativity among workers to mitigate pollution and achieve sustainable growth. Green human resource management (GHRM) activities have a welldocumented role in influencing workers' green attitudes and environmental efficiency. The aim of this research is to see how Green HRM activities affect employee green innovation. Furthermore, the mediating influence of green creativity between the association of GHRM and green innovation is explored. Moderation of green shared vision between the association of green innovation and environmental performance is also investigated. In this analysis, we used SPSS and AMOS software to run structural equation modeling to test study hypotheses. For hypothesis testing, data was obtained from 437 employees employed in a variety of industries of Pakistan. Results show that GHRM has a positive and significant influence on green creativity and green innovation. Moreover, green creativity significantly mediates the association between GHRM and green innovation. It means that GHRM can not only directly affect green innovation, but also indirectly influence it via green creativity. Moreover, this study also explores that the significant positive association between green innovation and environmental performance is moderated by green shared vision. This study adds the indicator of green creativity as one of the key antecedents of green innovation and environmental performance to the previous literature. Furthermore, this study contributes to the prior literature by using green shared vision as a moderator between green innovation and environmental performance. Overall, findings of this study support all direct and indirect hypotheses and have several theoretical and practical implications for top management and policymakers to ensure employee commitment to GHRM practices and green innovation implementation in order to achieve high environmental performance

Impact of Strategic Human Resource Management on Rule Breaking and Job Satisfaction: Moderating Role of Servant Leadership and Mediating Role of Rules Control: Muhammad Siddique Malik, Kamran Ali, Naila Kausar, Muhammad Amir Chaudhry

Although all forms of resources are necessary for organizational success, the literature seems to agree that human capital and its management have a substantial influence on the performance of corporations. In today's dynamic world, where communication and technologies continually grow, the actions and behavior of employees in their organizations are gaining importance with regard to the workers’ performance, SHRM, and servant leadership positions. In this study, the impact of SHRM, servant leadership, and rule control on Job Satisfaction and rule-breaking behavior of employees have been analyzed. Our study consists of a sample population of 287 white collar employees in the public and private sectors of Pakistan. Analysis was carried out using SPSS and AMO programs. Hypotheses were tested by the structural equation model. Finding reveals that SHRM has a positive and significant influence on job satisfaction but an insignificant impact on the rule-breaking behavior of employees. Servant leadership positively influenced job satisfaction and significantly moderates the association between SHRM and job satisfaction indicating that the servant attitude of the manager increases the satisfaction of the personnel. Rules control plays a significant mediating role. The current study contributed that employee exhibit greater levels of persistence, competence, and competitiveness while they are motivated by servant leaders. Managing workers from different backgrounds and with different work ethics require proactive leadership that disciplines organizational life according to predetermined guidelines for job involvement

Antibiotic Over Prescription In Irreversible Pulpitis- A Perception-Based Study In Quetta, Pakistan

Introduction:  In early phase of irreversible pulpitis, there is normally no clinically significant sings of infections specially bacterial infections but still there are a lot of dental practitioners that prescribe antibiotics in case of irreversible pulpitis, though there is limited data evidence that the antibiotic penicillin cause reduction in percussion sensitivity and pain (Nagle, Reader, Beck, & Weaver, 2000).There is increasing trend by dental prescription regarding over use of antibiotics in treatment of orofacial and endodontic infections and the culture in these dental infections isolated those pathogens that are multi drug resistant towards commonly prescribed antibiotics (Rôças & Siqueira Jr, 2013). Setting: Sandeman Provincial Hospital and Bolan Medical Complex Hospital Quetta. Study Duration: Duration of this study was 6 months that is from March till August 2021. Results: Majority (n=68,55.3%) of respondents were general dental practitioners followed by operative dentistry respondents (n=21,17.1%). Majority (n=54,43.9) of prescribers were having perception that analgesic should be prescribed and perform concurrent pulpectomy while (n=25, 20.3%) of prescribers had perception that in patients with irreversible pulpitis, prescribe antibiotics, analgesics and perform concurrent pulpectomy whereas majority (n= 6) of orthodontics would Immediately prescribes analgesic and schedule for RCT later.  Prescribers having experience of 1 to 10 years would prescribe analgesic and perform concurrent pulpectomy. Conclusion This study concluded that majority of dental practitioners had perception of prescribing antibiotics in irreversible pulpitis while there were still a good number of those dental prescribers that had perception of prescribing analgesics and performing concurrent Pulpectomy. &nbsp

RESPONSIBLE LEADERSHIP AND KNOWLEDGE SHARING IN HIGH TECH FIRMS: ASSESSING THE ROLE OF HELPING INITIATIVE AND LEADER’S EMPATHY ON JOB PERFORMANCE: Kamran Ali, Dr. Muhammad Siddique Malik, Naila Kausar, Muhammad Amir Ch, Hadiqa Liaqat

The current study is having the capacity to address the major ongoing issues of the IT sector of Pakistan, as the underlying sector is facing issues regarding the job performance of the employees. Responsible leadership is got importance due to its emergence in this sector. In order to check the impact of responsible leadership and knowledge sharing on job performance, this study has also incorporated the moderating factor of leader empathy and mediating role of helping initiatives at the workplace as well. For the completion of the study, a sample of 273 respondents was drawn out of the population in order to generalize the results to the whole population. These respondents were taken out from the IT sector of Pakistan, SPSS and AMOS were used to analyse the data. Through the help of the analysis, the researcher found out that there is no impact of responsible leadership on job performance and no impact has been observed while studying the knowledge sharing and helping initiatives as well. The rest of the study hypothesis are proved significant. This is also having its practical, theoretical, and policy-making contributions. This study is also significant by its nature as it took the leader empathy as a moderator to check the job performance of employees of the high technological sector of Pakistan

Algae and Hydrophytes as Potential Plants for Bioremediation of Heavy Metals from Industrial Wastewater

Aquatic bodies contaminated by heavy metals (HMs) are one of the leading issues due to rapidly growing industries. The remediation of using algae and hydrophytes acts as an environmentally friendly and cost effective. This study was performed to investigate the pollution load, especially HMs, in the wastewater of the Gadoon Industrial Estate and to utilize the hydrophytes (Typha latifolia (TL) and Eicchornia crassipes (EI)) and algae (Zygnema pectiantum (ZP) and Spyrogyra species (SS)) as bioremediators. The wastewater was obtained and assessed for physiochemical parameters before treating with the selected species. The pot experiment was performed for 40 days. Then the wastewater samples and selected species were obtained from each pot to analyze the metal removal efficiency and assess for metal concentrations using atomic absorption spectrophotometry. The dissolved oxygen (DO; 114 mg/L), total suspended solids (TSS; 89.30 mg/L), electrical conductivity (EC; 6.35 mS/cm), chemical oxygen demand (COD) (236 mg/L), biological oxygen demand (BOD; 143 mg/L), and total dissolved solids (TDS; 559.67 mg/L), pH (6.85) were analyzed. The HMs were noted as Zn (5.73 mg/L) and Cu (7.13 mg/L). The wastewater was then treated with the species, and significant reductions were detected in physicochemical characteristics of the wastewater such as DO (13.15–62.20%), TSS (9.18–67.99%), EC (74.01–91.18%), COD (25.84–73.30%), BOD (21.67–73.42%), and TDS (14.02–95.93%). The hydrophytes and algae removed up to 82.19% of the Zn and 85.13% of the Cu from the wastewater. The study revealed that the hydrophytes and algae significantly decreased the HM levels in the wastewater (p ≤ 0.05). The study found TL, EI, ZP, and SS as the best hyper accumulative species for Zn and Cu removal from wastewater. The HMs were removed in the order of Cu > Zn. The most efficient removal for Cu was found by Typha latifolia and Zn by Zygnema pectiantum. It was concluded that bioremediation is an environmentally friendly and cost-effective technique that can be used for the treatment of wastewater due to the efficiency of algae and hydrophytes species in terms of HM removal

The Effect of Calcium Hydroxide, Triple Antibiotic Paste and Chlorhexidine on Pain in Teeth with Symptomatic Apical Periodontitis: A Randomised Controlled Trial

Background: One of the main reasons for post endodontic pain is the polymicrobial intracanal flora that may survive the initial disinfection. A single antimicrobial agent might not provide adequate disinfection, and an antimicrobial combination such as triple antibiotic paste was tested to achieve this goal. Aim: The study aimed to assess the efficacy of three intra-canal medicaments on post root canal preparation pain. Materials and Methods: Eighty patients with single-rooted necrotic teeth and symptomatic apical periodontitis were randomly assigned to four treatment groups (n = 20). Their preoperative pain was recorded on Wong-Baker’s FACES pain rating scale. After chemo-mechanical canal preparation, intracanal medications were applied to the groups (Group 1 (20% calcium hydroxide), Group 2 (2% chlorhexidine), Group 3 (tri-antibiotic paste), Group 4 (no medication (Control group)). Patients were instructed to record pain on the Wong-Baker FACES pain rating scale at 4, 48, 72 and 96 hrs, postoperatively. Pain scores were analyzed using a one-way ANOVA test and Tukey’s post hoc test and, if significant, Dunn’s test was used for pair-wise comparisons. The significance level was set at a p-value ≤ 0.05. Results: Tukey’s post hoc test revealed significantly lower pain scores in Group 3 compared with other groups at all follow up intervals. Dunnett’s test showed significantly lower pain in Group 3 compared with the Control group at 48, 72 and 96 hrs, postoperatively. Conclusions: Triple-antibiotic paste showed effective pain control as an intracanal medication on necrotic teeth with symptomatic apical periodontitis