ROLE OF DIABETES IN ATYPICAL RADIOLOGICAL PRESENTATION OF PULMONARY TUBERCULOSIS

Background; Diabetes mellitus has been reported to modify the presenting features of pulmonary tuberculosis, but there are varying data, particularly regarding the association with lower lung field involvement. This study was conducted to document frequency of atypical radiological presentation of pulmonary tuberculosis in our population of Southern Punjab. Material and methods; A total of 200 study cases having age range; 35 – 70 years of either sex having diabetes for more than 1 year and pulmonary tuberculosis (irrespective of disease duration) were included in our study. Known cases having Malignancies, HIV, pregnant ladies, asthmatic patients and those with COPD were excluded from our study. Patients of pulmonary tuberculosis fulfilling the inclusion and exclusion criteria was included in this study. Sociodemographic and Radiological data from each was collected and recorded on a performa. Results; Of these 200 study cases, 116 (58%) were male patients while 84 (42%) were female patients. Mean age of our study cases was noted to be 55.52 ± 9.33 years (with minimum age was 38 years while maximum age was 70 years). Of these 200 study cases, 117 (58.5%) were from rural areas and 117 (58.5 %) were poor. Mean duration of diabetes in these patients was 7.41 ± 3.76 years (with minimum duration of diabetes was 3 years while maximum duration was noted to 15 years). Mean duration of tuberculosis was 6.74 ± 2.29 months (with minimum duration of disease was 2 months and maximum duration was 12 months). Diabetes was controlled in only 33 (16.5%) of our study cases and only 63 (31.5%) were taking treatment for diabetes. Right side of lungs affected was seen in 105 (52.5%) and lower lung field was affected in 116 (58 %) of our study cases. Atypical presentation was seen in 95 (47.5%) of our study cases. Conclusion; Frequency of atypical radiological presentation of pulmonary tuberculosis was high in our study. Atypical presentation of pulmonary tuberculosis in patients with diabetes is quite common. Atypical presentation was significantly associated with gender, age groups, residential status, socioeconomic status, duration of diabetes, control of diabetes, treatment status of diabetes, lung side affected and lung field affected. Clinicians treating diabetic patients must keep these facts in their minds while treating such patients to avoid miss-diagnosis. Keywords; Diabetes, tuberculosis, atypical presentation

FREQUENCY OF CATHETER INDUCED THROMBOSIS IN PATIENTS WITH END STAGE RENAL DISEASE (ESRD) ON HEMODIALYSIS

Objective; To determine the frequency of catheter induced thrombosis in patients with end stage renal disease (ESRD) on hemodialysis. Material and Methods; All the cases (86) undergoing hemodialysis were recruited from Department of Medicine, Nishtar Hospital Multan, Pakistan. Double lumen hemodialysis catheter was inserted by a senior consultant. Color Doppler sonography was done at the 6th day of placement of catheter and presence of thrombus was noted in the study proforma. History was taken for hypertension, smoking, family history and previous history of thrombosis. Results; Of these 86 study cases, 51 (59.3 %) were male patients and 35 (40.7%) were female patients. Mean age of our study cases was 45.62 ± 8.44 years. Of these 86 patients 28 (32.6%) were diabetic, 35 (40.7%) were hypertensive, 34 (39.5%) were smokers and 07 (8.1%) had previous history of thrombosis. Mean duration of catheter placement was 81.62 ± 41.67 days and mean duration on hemodialysis was 22.36 ± 10.43 months. Majority of our study cases i.e. 65 (75.6%) had to undergo hemodialysis three times in one week. Catheter related thrombosis was noted in 29 (33.7%) of our study cases. Conclusion; Frequency of catheter-related thrombosis was high in patients with end-stage renal disease (ESRD) in our study. Thrombosis in ESRD patients was significantly associated with male gender, age, duration of catheter placement and duration of hemodialysis. Keywords; End-stage renal disease, catheter, thrombosis

Practice of standard Cross Infection Protocol in Private Dental Clinics of Khyber Pakhtunkhwa, Pakistan: A cross-sectional study

Background: Infection control, which is considered to be the backbone of dentistry, has become a particularly essential piece of dental training because both the dentists and patients are at an expanded danger of cross-contamination. Dental clinical settings represent a high organic hazard of spreading a wide scope of microorganisms. The objective of this study is to gather information of different dentists regarding their practice of standard cross infection protocols and how can they improve the same in their private practices. Materials and Methods: This cross-sectional study was conducted in dental clinics of Khyber Pakhtunkhwa, KPK from January 2020 to July 2020 by distributing a questionnaire among dentists. It was a pre-designed questionnaire that was circulated in Google forms through Whatsapp and emails. The questionnaire was divided into 2 sections. Data was compiled and statistical tests were applied using the Statistical Package for Social Sciences SPSS® ver.23.0 Results: Regarding cross infection control measures, maximum dentists seem to have knowledge of cross infection control techniques. A significant difference was found (p= 0.05) between male & female dentists in disposing dental waste from clinical set up properly. A significant difference was also found between male & female dentists about rubber dam isolation (p=0.02). Conclusion: The result of this study showed that practice of dentists in KPK is not up to standard protocols of cross infection control. In this way, the need of great importance is to authorize and execute better proportions of infection control to improve dental practice in KPK. Key words: Infection control, Dental practice, Sterilizatio

A Comparative Evaluation Of Premedication With Flurbiprofen And Prednisolone On Post Endodontic Pain In Teeth With Symptomatic Irreversible Pulpitis: A Randomized Clinical Trial

Background: Root canal treatment is an endodontic procedure that encompasses cleaning & shaping i.e. preparation of root canals followed by obturation of the prepared canals. Pain is a very common sensation that occurs few hours after root canal treatment (RCT). Objective: To evaluate and compare the efficacy of premedication with flurbiprofen and prednisolone on post-endodontic pain in teeth with symptomatic irreversible pulpitis. Materials and Methods: It is a randomized control trial study conducted in the department of Operative Dentistry & Endodontics, Sardar Begum Dental College, & Hospital Peshawar. Patients were randomly allocated into two groups i.e. A and B using coin flip technique. Thirty minutes before starting the endodontic therapy, single pretreatment dose of Flurbiprofen (100mg) was given to patients in Group A and Prednisolone (30mg) to patients in Group B. Patients’ pain intensity experience was measured using the visual analog scale (VAS) after root canal treatment. They were instructed to complete a pain diary at specific intervals (i.e. at 6, 12 and 24 hours after the commencement of treatment) in order to determine efficacy in both groups. Results: As per efficacy in both groups, in Group A, 44 (55%) showed effective results whereas in Group B, only 20 (25%) patients showed effective results. Conclusion: Single pretreatment dose of flurbiprofen has a more sustained effect in reducing post-endodontic pain as compared to prednisolone

Reducing Sugar Production by Cellulose Immobilized Enzyme from the Oil Palm Empty Fruit Brunch (OPEFB) Treated by Organosolv Pretreatment

Oil Palm Empty Fruit Bunches (OPEFB) is lignocellulosic that consists of 13.20-25.31% lignin, 42.70-65.00% cellulose, and 17.10-33.50% hemicellulose. Cellulose can be used as a material for a new renewable energy source in the term of reducing sugar through a combination of organosolv pretreatment and hydrolysis process using immobilized enzymes. Organosolv pretreatment was used for lignin degradation, by using ethanol as solvent, which are environmentally friendly and easy to recover, with a concentration S/L 10%(w/w), in 160°C for 90-150 min. The following process is to produce crude enzyme from Aspergillus niger and Trichoderma viride. The resulting crude enzyme cellulase activity of 0.774 U/mL. Then, the crude enzyme is immobilized by Chitosan-GDA. OPEFB hydrolysis process with immobilized cellulase was carried out for 5, 7 and 9 days at 37°C. The best result of lignin degradation reaches out 56.68% lignin removal at 160°C for 150 min, while the hydrolysis of cellulose gives the highest yield, 47.59%, in the 9 days processing time

The Outcome of Bicolumnar Acetabular Fracture Treated by Single Anterior Ilioinguinal Approach

Background: Acetabular fracture therapy, being complicated, is generally treated by non-operative methods due to a lack of surgeons’ expertise in pelvis surgery. The surgical exposure and reduction of acetabular fractures may become more direct and practical with the altered technique since it is closer to the acetabular quadrilateral plate. This study aimed to determine the efficacy of a single anterior illio-inguinal approach for the management of a Bi-columnar acetabulum fracture. Methods: Sixty patients, fulfilling the selection criteria were selected for descriptive case series from Orthopedic Surgery Department at Lahore General Hospital, from 02-12-2020 to 02-06-2021. After informed consent, surgery was performed on all patients under general anesthesia. Patients were followed-up and evaluated for efficacy in OPD after 12 weeks of surgery with a Harris hip score. All demographic and other information was recorded on a Proforma. SPSS 22 was used to assess data. Post-stratification, efficacy was compared by using chi-square, p-value ≤0.05 was considered significant. Results: Out of 60 patients, 45(75 %) were male, whereas 15(25%) were female (Mean age 52.71±10.50yrs). The Mean of duration fracture (in days) and Harris score are 11.03±5.29 and 2.83±0.45 respectively. The efficacy concerning lateral side was 60% for left side and 26.7% for right side. Efficacy was higher in less than 10 days old fractures at 55.0% while after 10 days it was 31.7%. We found that the percentage of efficacy was 86.7%. Conclusion: The current study concluded that the anterior illio-inguinal approach is highly effective (p=0.001) in the management of acetabular fractures. Keywords: Acetabulum; Pelvic; Fracture; General Surgery

Impact of thermal extrusion and microwave vacuum drying on fatty acids profile during fish powder preparation

The current study aimed to optimize the process for ready-to-eat extruded fish powder preparation and to ascertain the impact of two methods on fatty acid profiles. For the investigation, Labeo rohita (Rohu) fish was first minced, extruded, and microwave vacuum-dried. The results show that the yield for extruded fish powder (EFP) fluctuated from 22.32% to 29.07%. The maximum retention for docosahexaenoic acid (DHA), arachidonic acid (AA), and eicosapentaenoic acid (EPA) was 3.24 ± 0.08 g/100 g lipids, 2.74 ± 0.05 g/100 g lipids, and 1.24 ± 0.09 g/100 g lipids, by using different extrusion parameters. Moreover, nonsignificant changes were observed during 0 days, and 1 and 3 months of storage (at 4°C and 25°C) for DHA, AA, and EPA, whereas significant results were recorded for the samples stored for 6 months at 25°C. Also, the maximum peroxide value (PV) and thiobarbituric acid reactive substance values (TBARS) were 1.72 ± 0.04 meq/kg fat and 0.135 ± 0.008 mg malondialdehyde/kg fat. It is anticipated from the outcomes that the study will be helpful to prepare value-added food products in future studies

Biallelic Variants in Seven Different Genes Associated with Clinically Suspected Bardet-Biedl Syndrome

Bardet-Biedl syndrome (BBS) is a rare clinically and genetically heterogeneous autosomal recessive multi-systemic disorder with 22 known genes. The primary clinical and diagnostic features include six different hallmarks, such as rod-cone dystrophy, learning difficulties, renal abnormalities, male hypogonadism, post-axial polydactyly, and obesity. Here, we report nine consanguineous families and a non-consanguineous family with several affected individuals presenting typical clinical features of BBS. In the present study, 10 BBS Pakistani families were subjected to whole exome sequencing (WES), which revealed novel/recurrent gene variants, including a homozygous nonsense mutation (c.94C>T; p.Gln32Ter) in the IFT27 (NM_006860.5) gene in family A, a homozygous nonsense mutation (c.160A>T; p.Lys54Ter) in the BBIP1 (NM_001195306.1) gene in family B, a homozygous nonsense variant (c.720C>A; p.Cys240Ter) in the WDPCP (NM_015910.7) in family C, a homozygous nonsense variant (c.505A>T; p.Lys169Ter) in the LZTFL1 (NM_020347.4) in family D, pathogenic homozygous 1 bp deletion (c.775delA; p.Thr259Leufs*21) in the MKKS/BBS5 (NM_170784.3) gene in family E, a pathogenic homozygous missense variant (c.1339G>A; p.Ala447Thr) in BBS1 (NM_024649.4) in families F and G, a pathogenic homozygous donor splice site variant (c.951+1G>A; p?) in BBS1 (NM_024649.4) in family H, a pathogenic bi-allelic nonsense variant in MKKS (NM_170784.3) (c.119C>G; p.Ser40*) in family I, and homozygous pathogenic frameshift variants (c.196delA; p.Arg66Glufs*12) in BBS5 (NM_152384.3) in family J. Our findings extend the mutation and phenotypic spectrum of four different types of ciliopathies causing BBS and also support the importance of these genes in the development of multi-systemic human genetic disorders

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec