Navigating Additional Canals in Mandibular Teeth: A Case Series

Morphological variation exists in mandibular teeth. Thus, the clinician should be mindful of all the possibilities of variation. Following case series exhibit the variation of morphology in mandibular teeth within the Pakistani population reported at Operative and Endodontics Department of Islamabad Dental Hospital Keywords: Canine teeth, Endodontics, Mandibular incisor, Premolar, Root canal morphology

Length-weight relationships and condition factor of the sea urchin Echinometra mathaei (Echinoidea: Echinodermata) on Buleji rocky shore of Karachi, Pakistan

The length frequency, length-weight relationships and variation in condition factor was studied in the population of Echinometra mathaei (Blainville, 1825) found on the rocky shore of Buleji, Karachi, Pakistan during the period from April 2011 to November 2012. The test diameter (length) in E. mathaei ranged from 19.0 and 77.2 mm with mean test diameter of 46.6 ± 6.3 mm. The modal size-class in the population of this species was 41-50 mm. The total wet weight ranged from 13.3 to 121.6 g with a mean of 50.1 ± 18.3 g and showed the modal size class of weight to be 31–40 g. Sex-wise and season-wise length weight relationship (LWR) showed negative allometric growth trend (b not equal to 3, P 0.05). However, analysis of variance showed a significant difference between the Kn values in different seasons at Buleji (ANOVA, F = 59.57; P < 0.05)

Novel VPS13B Mutations in Three Large Pakistani Cohen Syndrome Families Suggests a Baloch Variant with Autistic-Like Features.

BackgroundCohen Syndrome (COH1) is a rare autosomal recessive disorder, principally identified by ocular, neural and muscular deficits. We identified three large consanguineous Pakistani families with intellectual disability and in some cases with autistic traits.MethodsClinical assessments were performed in order to allow comparison of clinical features with other VPS13B mutations. Homozygosity mapping followed by whole exome sequencing and Sanger sequencing strategies were used to identify disease-related mutations.ResultsWe identified two novel homozygous deletion mutations in VPS13B, firstly a 1 bp deletion, NM_017890.4:c.6879delT; p.Phe2293Leufs*24, and secondly a deletion of exons 37-40, which co-segregate with affected status. In addition to COH1-related traits, autistic features were reported in a number of family members, contrasting with the "friendly" demeanour often associated with COH1. The c.6879delT mutation is present in two families from different regions of the country, but both from the Baloch sub-ethnic group, and with a shared haplotype, indicating a founder effect among the Baloch population.ConclusionWe suspect that the c.6879delT mutation may be a common cause of COH1 and similar phenotypes among the Baloch population. Additionally, most of the individuals with the c.6879delT mutation in these two families also present with autistic like traits, and suggests that this variant may lead to a distinct autistic-like COH1 subgroup

Length-weight relationship and condition factor in Holothuria arenicola (Holothuroidea : Echinodermata) found on two rocky coasts of Karachi, Pakistan

The length-weight relationship and condition factor is determined for Holothuria arenicola collected between April 2011 to November 2012 from rocky shores of Manora and Buleji. The maximum total length recorded for this species was 416.0 mm at Manora and 376.0 mm at Buleji. Sex-wise and season wise LWR and slope (b) values revealed the negative allometric growth (b not equal to 3, P < 0.001) at both sites. The length-weight relationship in H. arenicola during different seasons showed the b value to range between 1.850 to 2.384 at Manora and 2.124 to 2.401 at Buleji. Correlation coefficient were noticed highly significant for sex and season wise with a good correlation between length and weight. The condition factor (Kn) for H. arenicola ranged between1.04 to 1.96 at Manora and 0.87 to 1.8 at Buleji. Analysis of variance showed that there is statistically significant difference between the means of the Kn values in 19 months at Manora (ANOVA, F = 10.96; P < 0.05) and Buleji (ANOVA, F = 13.42; P < 0.05) and in various seasons at Manora (ANOVA, F = 86.529; P < 0.05) and Buleji (F = 56.285; P < 0.05)

Oral Health Status of Pregnant Women and their Referral to Dentist during Antenatal Period

AbstractObjective: The aim of this study was to assess oral health status of pregnant women and theirreferral to dentist during antenatal period.Methodology: This descriptive cross-sectional study was conducted in Outpatient Department,(Gynae and Obs.) Jinnah Hospital Lahore, Pakistan after ethical committee approval. The sample sizewas calculated using formula for finite population and found to be 340 pregnant women who wereconveniently sampled and interviewed by using a self-administered questionnaire following verbaland written consent. Oral health status was examined clinically using dental mirror and Michiganprobe. Scoring was done using WHO oral health assessment form for adults, 2013 includingCommunity periodontal index, DMFT, and Dean's fluorosis index. Data was statistically analyzedusing SPSS version 24. Chi-square test was applied to compare categorical variables (p≤ 0.05 assignificant).Results: Total 236 (69.4%) out of 340 pregnant women had oral health problems. Only 11 (3.2%)participants were referred by the gynaecologist to dentist for their oral health issue. Out of 236participants, 67% had dental caries, 80.9% had gingival bleeding, 58.8% had gingival pockets, 41.7%had loss of attachment, 1.8% had dental erosions, 63.8% had dental fluorosis and 1.5% had oralmucosal lesions. The majority of pregnant women who participated in this study had lowsocioeconomic status (mean income PKR 20300±10304.14) reported with more oral health problems.Conclusion: As reported in this study, majority of pregnant women had oral health problems andonly few of them were referred to dentist by gynaecologist.Key Words: Pregnant women, Oral health status, Gynaecologist, Antenatal perio

Usability and acceptability of a mobile app for behavior change and to improve immunization coverage among children in Pakistan: A mixed-methods study

Background: Pakistan\u27s immunization uptake rates are still significantly lower than anticipated despite several initiatives. Lack of awareness, forgetting about vaccination schedule, and vaccine misconception/misinformation are a few of the major drivers that mitigate the rates of immunization. The current COVID-19 pandemic emphasizes the importance of immunization. The significant reductions in regular childhood vaccination during pandemic have increased the risk of outbreaks of vaccine-preventable diseases. Concerns among parents over possibly exposing their children to COVID-19 during child visits may have contributed to the reported declines. Innovative and cost-effective mHealth interventions must be implemented in order to address the problem of inadequate immunization rates. In addition, it is also critical to understand the end user needs in order to reflect on the highly relevant essence of the customized healthcare experience.Objective: The aim of this study was to learn about caregivers\u27 attitudes toward the usability and acceptability of behavior-change smartphone applications (mobile phones) for improving immunization coverage in Pakistan.Methods: A mixed-method design was employed for this study. The study was conducted at Aga Khan University, Hospital. Parents visiting the Community Health Center for 6-week vaccination of their children were recruited. The study was conducted in two stages. Stage 1 consisted of qualitative interviews that grasped the parent\u27s attitudes and challenges to immunization, as well as their acceptability and accessibility of the smartphone-based behavior-change application to increase vaccine uptake. Stage 1 was followed by stage 2, in which data were collected through a questionnaire designed by using data from qualitative interviews.Results: The majority of participants agreed that immunization serves an important role in protecting their child from illnesses that cause morbidity and mortality. Almost all of them emphasized the importance of using a pre-appointment method at vaccination center in order to reduce the waiting time. Furthermore, participants were also interested in AI-based behavior modification applications related to immunization. They also wanted to have applications in their native language for better understanding and communication of related information. In our study, approximately 95.2 percent of participants agreed to accept SMS immunization updates, which was also reasonably high. Lastly, the majority of them identified forgetfulness as a significant contributor to regular immunization.Conclusion: To enhance the uptake of childhood vaccines, overall vaccination rates, and overcome barriers related to vaccination coverage, cost-effective and user-friendly mHealth AI-based smart phone applications are required to raise awareness regarding the continuation of vaccination service and the importance of timely vaccination. Parents\u27 experiences and attitudes must be considered while designing and evaluating the efficacy of mHealth-based interventions

Synthesis, characterization of flavone, isoflavone, and 2,3-dihydrobenzofuran-3-carboxylate and density functional theory studies

We describe the oxidation of flavanones by employing phenyliodonium diacetate to form the flavone (15), isoflavone (8) and 2,3-dihydrobenzofurane (18) in this study. The oxidative method was found to be regioselective and dependent on the substitution pattern present on the two aromatic rings of the starting flavanone. The structures of products obtained were fully characterized by using IR, 1H and 13C NMR spectroscopy and Mass spectrometry. X-ray crystallography further confirms the structures of flavones and isoflavone. The density field theory calculations have also been performed to get more insight about the structures, electronic and spectroscopic properties of synthetic flavonoid derivatives. The geometrical parameters such as bond lengths and angels showed a good correlation with the values obtained through X-ray crystallography. Moreover, the theoretically simulated vibrational and UV-vis spectral values are in agreement with the experimental results

Respiratory syncytial virus-associated mortality among young infants in Karachi, Pakistan: A prospective postmortem surveillance study

Background: Respiratory syncytial virus (RSV) is an important cause of infant morbidity and mortality and a potential target for maternal immunization strategies. However, data on the role of RSV in young infant deaths in developing countries are limited.Methods: We conducted a community-based mortality surveillance from August 2018-March 2020 for infants ≤6 months in Karachi, Pakistan. We tested (reverse transcription-polymerase chain reaction) nasopharyngeal swabs from deceased infants for presence of RSV. We performed verbal autopsies and calculated odds of RSV-associated mortality with 95% CIs and used multivariable logistic regression to evaluate associations.Results: We collected 490 nasopharyngeal specimens from 1280 eligible infant deaths. There were 377/490 (76.9%) live births and 14/377 (3.7%; 95% CI: 1.8-5.6) were RSV positive. Most deaths occurred in neonates (254/377; 67.4%), males (226/377; 59.9%), and respiratory illnesses (206/377; 54.6%). Postneonatal age (10/14, 71.4%; OR: 5.5; 95% CI: 1.7-18.0), respiratory symptoms (12/14, 85.7%; OR: 5.2; 1.2-23.7), and high RSV season (9/14, 64.3%; OR: 4.4; 1.4-13.3) were associated with RSV mortality. In multivariable logistic regression analysis, respiratory symptoms (OR: 6.6; 95% CI: 1.3-32.5), RSV seasonality (6.1; 1.8-20.4), and age (9.2; 2.6-33.1) were significant predictors of RSV-associated mortality.Conclusions: RSV has a significant mortality burden in early infancy in Karachi, Pakistan. Age, RSV seasonality, and respiratory symptoms were significant predictors of RSV-associated mortality. Our findings have implications for clinical management of young infants with cold-like symptoms, policy development, and research regarding maternal immunization against RSV during pregnancy, in resource-constrained, low-income, and vaccine-hesitant populations

Developing an integrated depression and tuberculosis care pathway using a co-design approach in a low-resource setting

BACKGROUND: Evidence suggests the use of a participatory approach for the improvement of TB care, however, there is limited evidence on how integrated depression screening and care could be delivered with TB services. Thus, this study co-designed an integrated care pathway for depression case finding and treatment in TB services, that can be delivered by non-mental health specialists within a low resourced settings. METHODS: We conducted a total of 10 'co-design' workshops with people with TB, carers, tuberculosis and mental health healthcare providers between June and August 2021 in Dhaka, Bangladesh and Peshawar, Pakistan. We adapted the 'Hasso Plattner Institute of Design at Stanford University' for our codesign process. Information gathered during the workshop, through recordings and contemporaneous notes taking, was collated, and analysed to develop the integrated care pathways and materials for impmenting the carepathway. RESULTS: We co-designed and developed a culturally adaptable care pathway that integrates depression screening into tuberculosis (TB) care, working closely with people affected by TB and healthcare workers in primary, secondary, and tertiary care settings in Bangladesh and Pakistan. We used PHQ-9 only to identify and screen for depression among people with TB in Bangladesh, whereas both PHQ-2 and PHQ-9 were used for depression screening among the Pakistani population. A trained paramedic or laboratory technologist (Bangladesh) and DOTS Facilitator (Pakistan), working within the TB facilities were identified and agreed to deliver the integrated depression screening services. CONCLUSION: Stakeholders valued the opportunity to jointly design a care pathway. Iterative and coordinated working with these stakeholders enabled the researchers to understand better, explore and refine the co-design process. This approach assisted in mobilising knowledge about depression and integrating screening for depression within the existing usual TB care pathway, using the lived experience of people with TB and health workers' expertise