Role of bone graft materials for cleft lip and palate patients: A systematic review

AbstractCleft lip and palate is a congenital anomaly. Its management requires a long term commitment, multidisciplinary and structured treatment. Treatment is initiated at infancy and continues till adolescence. Bone grafting is performed in order to provide bony stabilization for cleft maxillary alveolar arch and room for subsequent canine tooth eruption. The aim of this review was to discuss the success of various bone graft materials in managing unilateral and bilateral cleft lip and palate patients. For this purpose, a detailed literature search was performed using available electronic databases for peer reviewed papers published in English language. The review is based on published papers reporting the use of various bone graft materials for managing cleft lip and palate patients. The success of bone grafts was studied using the grading scales measuring the bone height at the grafted sites. Various types of bone graft materials including autogenous and allogenic were reviewed. Implant placement in cleft lip and palate patients required bone grafting after orthodontic expansion because of deficient bone in the anterior maxillary region. The grafted bone consequently provides stability and support to the maxillary alveolar arch. Success of bone graft as well as dental implants is multifactorial and therefore depends upon the type of bone graft, bone quality at cleft site and severity of cleft lip and palate

CAPM based Quantification of Bankruptcy Risk: A Heuristic Approach

This paper builds on Capital Asset Pricing Model (CAPM) and its ability to validate market and firm specific risk. The effort is aimed at ascertaining the role of bankruptcy risk in determining the cost of capital in firms and its impact on corporate valuation. We also attempt to replace and analyze disparity of systematic and unsystematic components of risk with bankruptcy and risk of future liquidity. A similar study has recently been carried out in Indian market by Shirur (2013) for checking the validity of beta and cumulative risk measurement for identifying the presence of bankruptcy risk. This research may be the first attempt at analyzing such semantics with data from Pakistan. Therefore, the current study attempts to investigate the role of bankruptcy risk in determining the cost of capital in corporate valuation and the need of segregating systematic risk and unsystematic risk into liquidity risk and bankruptcy risk. The findings of this study suggest that unsystematic risk shall be eluded while investing in a well-diversified portfolio, but after investing in a specific firm, the unsystematic risk needs to be incorporated in total corporate valuation

QRS duration and echocardiographic evidence of left ventricular dyssynchrony in patients with left ventricular systolic dysfunction

OBJECTIVE: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) \u3c 35% and prolonged ventricular depolarization on electrocardiography. STUDY DESIGN: A cross-sectional study. PLACE AND DURATION OF STUDY: The Aga Khan University, Karachi, from June to September 2007. METHODOLOGY: All patients with LVEF \u3c 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer\u27s exact test was used to determine the association between QRS duration and left ventricular dyssynchrony. RESULTS: A total of 60 patients were included. Twenty one patients had QRS duration of \u3e 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference (p=0.045) and 6 patients (28.6%) had evidence of dyssynchrony based on basal anterior and basal inferior velocity difference (p=0.018). Out of the remaining 39 patients with narrow QRS complex, only 2 patients (5.1%) had dyssynchrony on TDI. CONCLUSION: The study demonstrates a significant association between prolonged QRS duration and left ventricular dyssynchrony on TDI. Therefore, such patients should be screened for prolonged QRS duration on ECG before cardiac resynchronization therapy (CRT)

Does green environmental policy promote renewable energy consumption in BRICST? Fresh insights from panel quantile regression

Understanding the aspects of renewable energy consumption is important because it contains low-carbon emissions, which could significantly reduce global greenhouse gas emissions. Little research is done on exploring the factors of renewable energy consumption. The primary objective of this study is to examine the impact of the green environmental policy on renewable energy consumption in the BRICST economies over data ranging from 1991 and 2019 by using panel quantile regression. The fixedeffects and quantile regressions confirm the positive effects of economic growth and non-renewable energy on renewable energy consumption. In contrast, the consumer price index and CO2 hurt the renewable energy consumption in the BRICST economies. The estimate of the environmental policy stringency appears to be negative and insignificant in the fixed-effects model. On the other side, the estimates of the environmental stringency index appear to be positively significant from the 10th–40th quantiles and negatively significant from 50th–90th quantiles. Robust policy implications of our outcomes are also discussed

Perceptions on bioethics among general practitioners in Karachi, Pakistan

Objective: To study the perceptions on bioethics among general practitioners in Karachi, Pakistan. Design: A questionnaire based cross sectional survey. Settings: 85 general practitioners in Karachi were surveyed at their clinic premises. Main outcome measures: Perceptions on the broad principles of bioethics. Results: The majority of general practitioners were males, with mean age of 36.3 years, had minimal postgraduate qualifications and continuing medical education. They reported the top five moral duties of a physician and their reaction in the event of the death of a close relative due to a doctor\u27s negligence. A significant number of respondents agreed that a doctor is next to God . Other issues studied include discontinuation of artificial life support, giving of gifts by pharmaceutical companies to doctors, sickness certification, organ donation, human cloning, disclosure of information to cancer patient and patient confidentiality. Conclusion: We have documented the perceptions of general practitioners on broad principles of bioethics. These views have significant implications for medical practice

Perceptions on bioethics among patients presenting to family physicians at a teaching hospital in Karachi

Objective: To study the perceptions on bioethics among patients presenting to family physicians at a teaching hospital in Karachi, Pakistan Study design: Questionnaire based cross sectional survey Settings: The study was carried out at the family practice center, the Aga Khan University Hospital, Karachi Main outcome measures: Perceptions on the broad principles of bioethics Results: Majority of the respondents were young and well educated and better placed socioeconomically. Respondents reported the moral duties of a physician and their reaction in the event of the death of a close relative due to a doctor`s negligence. The majority agreed that a doctor is next to god . Other issues studied include discontinuation of artificial life support, giving of gifts by pharmaceutical companies to doctors, sickness certification, organ donation, human cloning, disclosure of information to cancer patient and patient confidentiality. Conclusion: We have found interesting patient`s perceptions on Bioethics with important implications for clinical practic

Laparoscopic total colectomy in an eight-year-old with familial adenomatous polyposis: A case report

Familial Adenomatous Polyposis accounts for20 years of age. Endoscopy is essential for the diagnosis with definitive treatment involving prophylactic total colectomy. With current surgical advances, this is routinely being performed with the aid of laparoscopy. Due to resource limitations and non-availability of the screening programs in the developing world, such cases remain under diagnosed. Genetic testing is necessary for prognostication of both the index case and their at-risk family members. Thus, we present a rare case of an eight-year-old female, with an early onset progression to colorectal cancer with Familial Adenomatous Polyposis. We performed a prophylactic laparoscopic total procto-colectomy with ileo-anal anastomosis, which to our knowledge is the first ever-performed procedure in Pakistan. We conclude that progression to colorectal carcinoma in familial adenomatous polyposis can present at an earlier age than that reported in the literature. Laparoscopic total colectomy has similar outcomes than open surgical methods with better cosmetic results

Development and validation of a spectroscopic method for the simultaneous analysis of miconazole nitrate and hydrocortisone acetate in pharmaceutical dosage form

Purpose: To develop a new analytical method for the quantitative analysis of miconazole nitrate (MCN) and hydrocortisone (HCA) in pharmaceutical creams.Methods: The study was accomplished in three steps. In the first stage, a spectroscopic method was developed for the simultaneous analysis of miconazole (MCN) and hydrocortisone (HCA). For this purpose, serial dilutions of both drugs were prepared using ethanol: water (50:50) as the solvent system. All solutions were analyzed for absorbance spectrophotometrically at 205 and 249 nm for MCN and HCA, respectively. The method was validated for linearity, range, accuracy, precision and robustness. A commercial formulation was also assayed by the proposed method.Results: The absorbance data were linear over a concentration range of 1 to 12 μg/mL for MCN and 1 to 40 μg/mL for HCA, with correlation coefficient of 0.9995 and 0.9984, respectively. Limit of detection (LOD) and of quantification (LOQ) of MCN were  0.49 and 1.49 μg/mL, respectively, and for HCA, 1.50 and 4.57 μg/mL, respectively. The assay results for the commercial  formulation were within the limits specified in British Pharmacopoeia.Conclusion: Simultaneous quantification of miconazole (MCN) and hydrocortisone (HCA) by UV spectroscopy provides a simple, reliable and robust method for the characterization of a mixture of the drugs in a dosage form.Keywords: Simultaneous analysis, Miconazole nitrate, Hdrocortisone acetate, UV-visible spectroscopy, Method validatio

CAN SHOE SIZE CORRECTLY PREDICT THE SIZE OF COMPONENTS OF TOTAL KNEE REPLACEMENT PRE-OPERATIVELY

Objective: To ascertain the correlation between shoe size and sizes of femoral and tibial components of total knee replacement preoperatively in patients undergoing total knee arthroplasty. Study design: Prospective cohort study Study settings and duration: This study was conducted at department of orthopedic surgery, Shifa International Hospital, Islamabad from July 2020 – December 2020. Material and methods: Sample size was calculated using WHO calculator and it was 43 patients in total. Patients were approached through non-probability consecutive sampling. Shoe size of patients was measured using a Brannock device. During surgery, Implant model and sizes of the femoral and tibial components implanted during knee replacement were noted. Data was analyzed with the help of SPSS version 24. We applied Pearson’s correlation cofficeint. P value ≤ 0.05 was considered significant. Results: Out of 43, there were 9(20.9%) male and female 34(79.1%). Mean age of patients was 51.7±6.8 (SD). We found good positive correlation between shoe size and tibial component (p=<0.001). Positive co relation was found between femoral component and shoe size (p=0.001). Shoe size predict 72% of Tibial component and 65% femoral component. Conclusion: Shoe size is effective and safe predictors of total knee replacement components pre-operatively. This procedure is more accurate and less labor intensive. Accurate templating result in less surgical duration and provide several benefits to patients and health care providers.  

Effect of Salinity Stress on Physiological Changes in Winter and Spring Wheat

Salinity is a leading threat to crop growth throughout the world. Salt stress induces altered physiological processes and several inhibitory effects on the growth of cereals, including wheat (Triticum aestivum L.). In this study, we determined the effects of salinity on five spring and five winter wheat genotypes seedlings. We evaluated the salt stress on root and shoot growth attributes, i.e., root length (RL), shoot length (SL), the relative growth rate of root length (RGR-RL), and shoot length (RGR-SL). The ionic content of the leaves was also measured. Physiological traits were also assessed, including stomatal conductance (gs), chlorophyll content index (CCI), and light-adapted leaf chlorophyll fluorescence, i.e., the quantum yield of photosystem II (Fv′/Fm′) and instantaneous chlorophyll fluorescence (Ft). Physiological and growth performance under salt stress (0, 100, and 200 mol/L) were explored at the seedling stage. The analysis showed that spring wheat accumulated low Na+ and high K+ in leaf blades compared with winter wheat. Among the genotypes, Sakha 8, S-24, W4909, and W4910 performed better and had improved physiological attributes (gs, Fv′/Fm′, and Ft) and seedling growth traits (RL, SL, RGR-SL, and RGR-RL), which were strongly linked with proper Na+ and K+ discrimination in leaves and the CCI in leaves. The identified genotypes could represent valuable resources for genetic improvement programs to provide a greater understanding of plant tolerance to salt stress.Salinity is a leading threat to crop growth throughout the world. Salt stress induces altered physiological processes and several inhibitory effects on the growth of cereals, including wheat (Triticum aestivum L.). In this study, we determined the effects of salinity on five spring and five winter wheat genotypes seedlings. We evaluated the salt stress on root and shoot growth attributes, i.e., root length (RL), shoot length (SL), the relative growth rate of root length (RGR-RL), and shoot length (RGR-SL). The ionic content of the leaves was also measured. Physiological traits were also assessed, including stomatal conductance (gs), chlorophyll content index (CCI), and light-adapted leaf chlorophyll fluorescence, i.e., the quantum yield of photosystem II (Fv′ /Fm′ ) and instantaneous chlorophyll fluorescence (Ft). Physiological and growth performance under salt stress (0, 100, and 200 mol/L) were explored at the seedling stage. The analysis showed that spring wheat accumulated low Na+ and high K+ in leaf blades compared with winter wheat. Among the genotypes, Sakha 8, S-24, W4909, and W4910 performed better and had improved physiological attributes (gs, Fv′ /Fm′, and Ft) and seedling growth traits (RL, SL, RGR-SL, and RGR-RL), which were strongly linked with proper Na+ and K+ discrimination in leaves and the CCI in leaves. The identified genotypes could represent valuable resources for genetic improvement programs to provide a greater understanding of plant tolerance to salt stress