Current Issue

The youth of any nation are its greatest asset, and by empowering them, especially adolescents, we lay the foundation for progress and meaningful transformation in any nation. In Pakistan, where a large segment of the population comprises of young people, investing in their health, education, and well-being is not just important, it is essential. Recognizing this, numerous universities, forums, and organizations across the country are actively working to educate and support adolescent girls in reproductive health related challenges. These initiatives address critical gaps in awareness, access, and education.

Worldwide, conjunctivitis (pink eye) outbreaks are common and affect people of all ages and socioeconomic backgrounds. The data available on Google Scholar, PubMed, World Health Organization (WHO)  and Centre for Disease Control (CDC) websites from the year 2014 onwards, showed that outbreaks typically have a seasonal trend in Pakistan. Pink eye outbreaks negatively impact education and productivity because of the lost time at work and school. The cases can be categorized into infectious and non-infectious conjunctivitis depending on the etiology. The most common and most contagious type of infectious conjunctivitis is viral conjunctivitis. The condition is marked by eye pain, redness or swelling of the eye, itching, discharge from the eyes, and a gritty feeling. It often has a self-limiting course. The outbreak in Pakistan which started in September 2023, has several contributing factors, including hot, humid weather, a low air quality index, little rainfall, inadequate hand hygiene practices, and densely populated areas. Effective management requires a prompt diagnosis and appropriate treatment for the underlying cause. Outbreak control measures include public health initiatives like awareness campaigns, surveillance, notification, and epidemiological investigation. Through the public health lens, this article reviews the etiology, epidemiology, clinical presentation, factors associated with outbreaks, surveillance, prevention, and control measures. 

Background and Objective: Creatine supplementation has shown potential benefits in improving muscle mass and strength; however, its effect in patients with rheumatoid arthritis is still under investigation. The current study aimed to evaluate the effectiveness of Creatine supplementation on body composition and physical function in the subjects presenting with rheumatoid arthritis in the local population. 

Methods: A double-blinded trial involving 30 patients with RA were assigned randomly in two groups each. One group received Creatine (Cr) supplementation (Cr group) and the other, a plain flavored drink (Control group) for 12 weeks. There was no difference in appearance, odor, and color between treatment and control intervention. Assessments were conducted at the initial (pre-supplementation), on the 6th day (after the loading phase), and 12th week (immediately after supplementation ended). Demographic and clinical data were required through interviews and reviewers of medical records. Body composition parameters such as muscle, fat, and bone mass were assessed using standardized methods. Knee extensor strength and objective physical functions were evaluated using validated tests. As the data were normally distributed independent sample t test was run for between-group analysis. p < 0.05 was considered statistically significant.

Results: The study outcomes included changes in body composition and physical functioning between Cr group and the control group. A significant improvement was noted for the 8 feet up and go (80UG) test with a mean difference of 1.14 ± 0.49 (p value = 0.029). The rest of the variables including isometric knee extensor strength, sit-to-stand-30, and 50-feet Walk (500W) test showed non-significant results (p > 0.05) with a mean difference of 2.66 ± 20.65, 0.62 ± 0.56, and 1.41 ± 1.06, respectively.

Conclusion: Our findings suggest more improvement in body mass, physical functions, and knee extensor strength parameters in the Creatine supplementation group. However, the statistically significant improvement was only seen in 80UG function in the Creatine group as compared to the control. Larger scale studies are required to explore the clinical benefits of creatine supplementation in patients with rheumatoid arthritis.

Background and Objective: Gentamicin is a commonly used antibiotic in hospitalized patients.The nephroprotective value of AlliumAllium cepa has been recognized against various nephrotoxic agents. The aim of this study was to evaluate nephroprotective effect of AlliumAllium cepa against gentamicin induced nephrotoxicity in male Wister rats.

Methods: It was an experimental study design including 90 adult healthy Wistar rats of male gender. Group A (n=30) was control group while Group B (n=30) was given intraperitoneal gentamicin at the dose of 100mg/Kg body weight/ day for 8 days. Group C was given gentamicn for 8 days followed by AlliumAllium cepa extract at dose of 1ml∕kg body weight/day for a week. Serum creatinine, urea and electrolyte levels were measured after 15 days. One way ANOVA test followed by post hock Tukey test was applied to compare the means of parameters and to determine the significance of difference between the groups.

Results: A significant differences in the serum urea and creatinine levels among the groups (p=0.000) was observed. Post hoc Tukey's test indicated that mice administered gentamicin had significantly elevated serum urea (130.70 ± 66.34 mg/dl) and creatinine levels (1.39 ± 0.64 mg/dl) compared to control mice (urea: 31.60 ± 9.26 mg/dl; creatinine: 0.453 ± 0.11 mg/dl) (p=0.000). Gentamicin administered mice that were give Allium cepa extract exhibited lower serum urea (61.30 ± 17.88 mg/dl) and creatinine levels (0.727 ± 0.22 mg/dl) than gentamicin administered mice (130±66.34, 1.39±0.64 respectively). One-way ANOVA analysis revealed no significant differences in serum sodium levels among the groups (p=0.784). However, significant differences were observed in serum potassium and chloride levels (p=0.000 for both). Gentamicin administered mice had a significant increase in serum potassium (5.79±1.34 mEq/L) and chloride(105.93±3.86) levels compared to control mice(p=0.000). Furthermore, Allium cepa extract significantly (p=0.000) reduced the increase in serum potassium (5.05±±0.26) and chloride levels (102.23±2.59) caused by gentamicin.

Background and Objective: Accurate identification of the mental foramen position is crucial for clinicians to prevent nerve injury and improve the safety of dental procedures. The study aims to evaluate the positional variability of the mental foramen (MF) in the mandible, and its comparison with age, side of the jaw, and gender. 
Methods: This cross-sectional study was performed at the “Oral and Maxillofacial Surgery Department” of Combined Military Hospital (CMH) Lahore, Pakistan from October 5, 2023, to April 10, 2024. A total of 190 patients over the age of 18 with complete skeletal development were selected using purposive non-probability sampling. “Cone-Beam Computed Tomography” (CBCT) scans were utilized to measure the closeness of the MF to the alveolar-crest and the mandible’s lower edge. An independent sample t-test was employed to determine differences based on age, gender, and jaw side.
Results: The study revealed significant gender differences in MF positioning. Males had larger mean distances from the alveolar crest (9.35 ± 5.06 mm) and lower border of the mandible (15.05 ± 5.06 mm) to the MF compared to females, who measured 6.07 ± 3.36 mm and 11.77 ± 3.36 mm, respectively (p < 0.001). Age differences were significant only for the distance from the alveolar crest, with younger individuals (18-30 years) showing greater distances than older individuals (31-45 years) (p = 0.009). No statistically significant difference was reported between the right and the left sides (p=0.13).
Conclusion:  There was a significant gender-based variation in the anatomical positioning of the MF with males exhibiting greater distances from both the alveolar crest and the lower border of the mandible. The utility of CBCT imaging in facilitating precise localization of the MF and contributing to safer surgical planning is invaluable.

Background and Objective:

There are no comprehensive regional data for Pakistan regarding the frequency of carotid plaques and associated risk factors. Early detection of atherosclerotic plaques by noninvasive screening methods can help reduce the disease burden.  As asymptomatic plaques are also one of the major causes of stroke in middle-aged individuals, the present study aimed to identify the frequency and clinical presentation of asymptomatic carotid plaques in high-risk middle-aged patients in local population.

Methods:

This cross-sectional study was conducted at the Department of Radiology, Shaikh Zayed Hospital Lahore, Pakistan. A total of 366 subjects aged 45-81 years old were screened for any atherosclerotic plaques at the bilateral extra cranial carotid artery tree by consultant radiologists through Doppler Ultrasound (DUS). Multi variable logistic regression was applied to determine the variables having an independent association with the development of carotid plaques.

 Results:

Carotid artery plaques were diagnosed in 156 (42.62%) patients. Age, sex, hypertension, dyslipidemia, and diabetes mellitus showed an independent association with carotid plaques (p-value < 0.001). Present history of smoking was not associated with carotid plaques (P-value > 0.005).

Conclusion:

The diagnostic accuracy of DUS is high for the detection of sub-clinical and clinical carotid plaques. The identification of asymptomatic carotid plaques in high-risk individuals with diabetes and hypertension can save much from debilitating cardiovascular diseases. 

Background and Objective: 

Aspirin, known less commonly by its generic name, Acetylsalicylic acid (ASA), increases bleeding time with a consequent risk of post-operative bleeding that places dental clinicians in a state of uncertainty as to whether or not Aspirin intake should be ceased prior to an elective dental extraction. This study was therefore designed to compare frequency of bleeding among patients of elective simple tooth extraction with or without discontinuation of Aspirin

Methods:

A randomized controlled study was conducted at the Department of Oral and Maxillofacial Surgery, Kahuta Research Laboratories (KRL) Hospital, Islamabad over the period of 1 year. A total of 324 patients were equally divided into two groups; Group A patients were advised to continue taking Aspirin before extraction, whereas, in Group B, the patients were advised to discontinue Aspirin 5 days before tooth extraction. In both groups, a single clinically indicated tooth was extracted under local anesthesia with standard procedure. The socket site was examined 30 minutes post extraction to assess active bleeding using a validated categorization method. The data was analyzed using statistical software.

Results:

It was observed that157(48.5%) patients in Group-A and 161(49.7%) patients in Group-B were found with grade 0 (no bleeding after 30 minutes of extraction) bleeding while 5(1.5%) patients in Group-A and 1(0.3%) patient in Group-B were found with grade I (presence of active bleeding after 30 minutes of extraction bleeding). This finding was not statistically (p=0.099).

Conclusion:

It is recommended to safely carry out simple extraction without discontinuing or altering the dose of Aspirin to avoid the thrombotic risk; provided the local hemostatic measures are in place.

Background and Objective:  Formocresol is a commonly used pulpotomy agent for primary teeth but concerns about its safety and efficacy have prompted the exploration of alternative treatments. This study aimed to compare the efficacy of turmeric extract and Formocresol as pulpotomy agents in primary molars, with the goal of identifying a potentially more effective and safer herbal alternative.

Methods: This experimental study comprised 54 asymptomatic carious primary molar teeth, divided into three groups according to time of extraction of teeth: one week, two weeks and six months. Each time-point group contained 18 teeth, which were further subdivided into two subgroups of 9 teeth each, based on the pulpotomy agent used: Formocresol or turmeric extract. Teeth were evaluated histologically post-extraction to assess the level of inflammation and dentine bridge formation. Statistical analysis was performed using Fisher's exact test in statistical software.

Results: Teeth treated with Formocresol showed a higher degree of inflammation compared to turmeric extract over time (p-value =0.005). Additionally, dentine formation was observed in 25-50% of teeth treated with turmeric extract after six months as compared to no bridge formation in teeth treated with Formocresol.

Conclusion: Turmeric extract has potent anti- inflammatory and regenerative effects on the dentine in primary molars compared to Formocresol. Being biocompatible agent, it may be used as an alternative for pulpotomy in primary teeth.