Combined Endodontic and Surgical Management of Twin Rooted Maxillary Lateral Incisor with a Palatogingival Groove

A case of unusual anatomy in a maxillary lateral incisor is presented. A 20-year old female presented with failing endodontics. Clinical examination and radiographs revealed poorly obturated maxillary left lateral incisor with an untreated patent second root and a palatogingival groove. A decision was made to treat the tooth non-surgically. After removing gutta-percha from main canal, the orifice of second root could not be located from inside the chamber. After determining the position of this root to be mesial and palatal to main canal, gingival tissue was removed from mesio-palatal side and access was extended to include the cingulum and orifice was located mesio-palatally. This canal was mechanically prepared and both canals were filled with calcium hydroxide. Three weeks later when symptoms subsided, the canals were obturated using the warm vertical technique. However, patient returned after a month complaining of pain and pus discharge. The tooth was surgically retreated; the enucleation was performed without root end resection. Patient returned after two years and reported complete healing but with mild discoloration of crown which was treated with walking bleach technique.Keywords:Aberrant Anatomy; Accessory Root; Maxillary Lateral Incisor; Retreatment; Two Roots

Our experience of mega-prosthesis in bone tumours: A retrospective cross-sectional study in a tertiary care hospital

Objective: To evaluate the oncological and functional outcomes of bone tumour patients who underwent reconstruction with mega prosthesis.Methodology: A retrospective study was conducted in the department of Orthopaedics Aga Khan University Hospital, Karachi. All the paediatric and adult age group patients diagnosed with malignant, benign and metastatic bone tumours and meeting the inclusion criteria were selected and analysed. Retrospective data was collected from January 2008-January 2018.Results: Sixty-two patients, 30 (48.4%) females and 32 (51.6%) males. were included in the study. Of these 57 (92%) cases had involvement of the lower limb. The mean age was 36.95±19.1 years with a range of 9-81 years. The duration of patients follow up was from 1-124 months (mean 32.7±36.43 months). There were 29 (47%) malignant cases. The most commonly occurring tumour site was distal femur and proximal femur. There were 53 (85%) primary surgeries (first time conducted surgeries) while 9(15%) revision surgeries were done. Major complications were encountered in 19 (30.6%) patients and 13 (20.9%) had minor complications. Post-surgery local recurrence occurred in 2 (3.2%) patients while 7 (11.2%) had distant metastasis. In functional outcomes the mean MSTS score of our patients was 72.09±26.43. The survival rate was 69.8% with 45 patients recovered.Conclusions: With a good patient selection, adherence to the principles of tumour surgery and an adequate applied knowledge of mega prosthesis insertion, a good functional outcome was achieved

FACTORS INFLUENCING DESTINATION IMAGE THROUGH SOCIAL MEDIA IN THE PRE-PURCHASE PERIOD OF TOURISM IN PAKISTAN

Due to the technological advancements, people start depending on social media for various matters. As social media provides a tool for developing an image of the destination, it became an essential component in the process of decision-making regarding traveling. This study aims to investigate the influence of user-generated content (UGC), Information Quality (IQ) and Tourist’s Motivation (TM) on destination image through social media in the pre-trip period of tourism in Pakistan. The empirical analysis was conducted by using the survey method through online Google forms. Data was collected from social media (Facebook) users who were the members of the Facebook tourism groups in Pakistan. The findings of the study revealed that UGC does not significantly affect the destination image in the pre-purchase period. Whereas, information quality and tourist’s motivation significantly affect the destination image of Pakistani tourists. The research concludes that tourist’s motivation before experiencing tourism and the information they have exposed to plays a significant role in developing a destination image in the tourism market. Furthermore, this research contributes to the tourism sector of Pakistan by providing information regarding factors developing destination image. This information may help in developing a positive image of the destinations in Pakistan. Also, this study contributes by providing the tourism sector an understanding of the tourist’s behaviors in the pre-purchase period of traveling in Pakistan

FACTORS INFLUENCING DESTINATION IMAGE THROUGH SOCIAL MEDIA IN THE PRE-PURCHASE PERIOD OF TOURISM IN PAKISTAN

Due to the technological advancements, people start depending on social media for various matters. As social media provides a tool for developing an image of the destination, it became an essential component in the process of decision-making regarding traveling. This study aims to investigate the influence of user-generated content (UGC), Information Quality (IQ) and Tourist’s Motivation (TM) on destination image through social media in the pre-trip period of tourism in Pakistan. The empirical analysis was conducted by using the survey method through online Google forms. Data was collected from social media (Facebook) users who were the members of the Facebook tourism groups in Pakistan. The findings of the study revealed that UGC does not significantly affect the destination image in the pre-purchase period. Whereas, information quality and tourist’s motivation significantly affect the destination image of Pakistani tourists. The research concludes that tourist’s motivation before experiencing tourism and the information they have exposed to plays a significant role in developing a destination image in the tourism market. Furthermore, this research contributes to the tourism sector of Pakistan by providing information regarding factors developing destination image. This information may help in developing a positive image of the destinations in Pakistan. Also, this study contributes by providing the tourism sector an understanding of the tourist’s behaviors in the pre-purchase period of traveling in Pakistan

Culture-Based Identification of Causative Organisms in Ascitic Fluids of Patients with Spontaneous Bacterial Peritonitis Secondary to Decompensated Liver Disease and their Sensitivities to Ceftriaxone as an Empiric Therapy

OBJECTIVES To identify the pathogens in the ascitic fluids of patients with spontaneous bacterial peritonitis and then to determine their sensitivity pattern to ceftriaxone. METHODOLOGY The cross-sectional study was conducted at the Medical Unit-A, Department of Medicine, Hayatabad Medical Complex, Peshawar, from November 2021 to April 2022. Before ceftriaxone treatment was started, a minimum of 10 ml of ascitic fluid was introduced into a blood culture vial. Only patients with a positive culture were registered, and their information was gathered using a proforma. For statistical analysis, SPSS version 23 was used. RESULTSA total of 96 patients were enrolled in our study. There were 62 (59.52%) male and 34 (40.48%) female patients. Based on the isolation and identification of bacteria, the most prevalent bacteria isolated was Escherichia coli in 36 (37.5%) patients, followed by Acinetobacter Spp in 13 (13.54%) patients, Streptococcus spp in 14 (14.58%), Enterococcus spp in 11 (11.45%), Staphylococcus aureus in 9 (9.39%), MRSA in 8(8.33%) and K. Pneumonia in  5(5.21%) patients. The overall sensitivity of ceftriaxone to gram-positive bacteria was observed in 12 (42.85%) isolates, whereas the overall sensitivity of ceftriaxone to gram-negative bacteria was observed in 25 (36.76%) isolates. (p=0.091) (Figure 6). CONCLUSION Our study concludes that gram-negative bacteria were more prevalent than gram-positive bacteria in ascitic fluids of patients with spontaneous bacterial peritonitis. The most common isolated pathogen was E.coli. Gram-negative was more resistant to ceftriaxone as compared to gram-positive bacteria

Functional outcomes and complications of total hip arthroplasty with dual mobility cup : An audit

Objective: To determine the functional outcomes in total hip arthroplasty with a dual mobility cup, performed in our hospital.Methods: After receiving an exemption from the Ethics review committee of the hospital, data collection for audit was started in January 2019. Records from July 2016 to June 2018 were included. All patients who underwent total hip arthroplasty with dual mobility prosthesis without any age limit were included. A proforma was prepared to collect the required information. Data was entered and analyzed on SPSS v. 21.Results: Two hundred and ten patients were included, 114 females and 96 males. Of the total, 188 patients underwent unilateral surgery while 22 had bilateral hip arthroplasty. The mean postoperative hospital stay was 5.91±3.9 days. . Mean pre-op Harris score was 33.7±7.6 and the post-op mean score was 75.9± 5.34. Eighty-three (39.5 %) patients had the neck of femur fracture, 31(14.8%) had osteoarthritis while 28(13.3%) had avascular necrosis. Post-surgery complications included, wound infection, surgical site haematoma, NSTEMI, and only one patient reported dislocation after use of dual mobility cup.Conclusions: The dislocation rate which was the prime concern, has been reduced with the use of dual mobility implant in total hip arthroplasty patients

Frequency of mortality in patients with high AIMS65 score presenting with upper GI bleed

Introduction: Upper gastrointestinal bleeding is a common reason for hospitalisation across the world, with a UK frequency of 10% and a death rate of 8-14 percent. [1] Several risk assessment scores have been created to predict clinically relevant outcomes like death, the requirement for hospital-based care, rebleeding, and hospital stay length Objective: To determine frequency of mortality in patients with high AIMS65 score presenting with upper gastrointestinal bleeding. Setting: Gastroenterology Department –removed for blind review--- Material & Methods: It was a cross-sectional, prospective, observational research study. Patients having a high AIMS score were recruited in the study. The patient's medical history, physical examination, and biochemical data were all properly recorded. Patients were observed for the outcome variable, which was hospital mortality. Results: 119 patients fulfilling the inclusion criteria were included. There were 77 (64.7%) males and 42 (35.3%) females. The mean age was 43.10 ± 14.213 years On analysis of demographic data, it was observed that 61 (51.3%) patients were below 40 years of age. On analysis of organ dysfunction 79 (66.4%) had cardiovascular dysfunction, 55 (46.2%) had respiratory dysfunction, 39 (32.8%) had renal dysfunction. On outcome variable, It was observed that 81 (68.1%) of the people had died. Conclusion: Majority of the patients with high AIMS had mortality. Majority of the patients were males and had cardiovascular dysfunction. Key words: GERD, endoscopy, gastroduedonal disease, carcinoma, gastritis

Frequency and Progression of Gliomas in Pregnancy in Population Presenting at Lahore General Hospital, Pakistan

Objective:  To study the frequency and progression of gliomas in pregnant patients in our population. Materials and Methods:  A retrospective study of 30 pregnant patients between 18 to 40 years of age with confirmed gliomas from July 2015 to July 2020 was conducted at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore. Time of diagnosis, grade of glioma, the outcome of pregnancy, and mode of treatment were studied in these patients. Results:  Out of 30 patients, 29 were freshly diagnosed during pregnancy. All patients underwent cesarean section. If the patient presented before 30 weeks of pregnancy, irrespective of the outcome of the baby, the caesarian section was done. If a patient presented after 7 months, in case of low-grade glioma, the patient was in-house transferred and operated for tumor after delivery. A total of 17 patients had low-grade glioma and 12 patients had high-grade glioma. One patient had a recurrent disease during pregnancy, with the progression of tumor from low grade to high grade. Conclusion:  There is an association between pregnancy and the incidence of gliomas. They can be both high or low grades. The mode of delivery is preferably the caesarian section because the stress of labor causes an increase in the frequency of seizures. There is the possibility of recurrence as well as progression to higher grade during pregnancy

Our experience of treating adult bone lymphoma, a retrospective cross-sectional study in a tertiary care center, Aga Khan University hospital, Karachi

Objective: To determine the experience at the Aga Khan University Hospital in diagnosing and treating adult patients with primary lymphoma of bone.Methodology: All patients with Primary lymphoma of bone (PLB) that were diagnosed and/or treated at Aga Khan University Hospital, Karachi from 2005 to 2019 were included as part of this study.Results: There were 17 patients with PLB including 13 (76.5%) males and 4 (23.5%) females with a mean age of 44 ± 16.5 years. Nine patients were between 30-59 years of age at diagnosis. The mean follow-up time of patients was 80±46.7 months. Six patients had tumours of pelvic bone followed by tibia (5) and femur (4). Four patients had a pathological fracture at the time of presentation whereas 2 (11.8%) required surgical fixation of the pathological fracture. The stage of the tumour was based on Ann Arbor classification. Nine (52.9%) cases had Stage 1 disease, 7 (41.2%) had stage IV disease with metastasis in extra nodal tissues. As for treatment, every patient received chemotherapy whereas 5 (29.4%) received adjuvant radiotherapy. Complete remission in the size of the tumour was seen in 11 (64.7%) patients while 6 (35.3%) had partial remission. Post-treatment, 4 (23.5%) patients expired. The mean Overall Survival (OS) time was 80.18 ± 46.71months with a survival rate of 76.5.Conclusions: Primary lymphoma of the bone can be treated with medical regime and good prophylactic surgeries to avoid pathological fracture such as intramedullary nailing