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Objective: To evaluate the effect of tracheostomy on COVID positive patients and the risk included in the procedure for the patient and health care workers. Study Design: Retrospective Observational Study. Setting: Shifa International Hospital Islamabad, Pakistan. Period: 30th May 2020 to 15th February 2022. Material & Methods: The tracheostomies were performed in COVID ICU at bed side by ENT team. This is a study of 22 patients mostly with multiple comorbidities who presented to the hospital with symptoms of SARS-COVID-19. The changes in their ventilation were recorded before and after the tracheostomy. The health care workers included in the study were also kept under observation for any possible cross infection. Results: Eight out of twenty two patients were weaned off from ventilator. There was decrease in partial pressure of oxygen after the procedure but the mortality rate was high. None of the members of operating team, ICU team, anaesthesia team was infected with the virus. Conclusion: Our study shows that although tracheostomy helps in weaning off from ventilator, it has no role in weaning off COVID patients. There is no benefit of tracheostomy for a COVID positive patients. Furthermore, if adequate personal protective equipment's are used, there is no risk of spread of infection from patient during the procedure of tracheostomy. [ABSTRACT FROM AUTHOR]

Objectives: To compare clinical retention of a low-shrinkage posterior resin composite by using incremental versus bulk placement technique in deep Class I cavities. Setting: Operative Dentistry Department, Altamash Institute of Dental Medicine, Karachi, Pakistan. Period: 6 months from 1st Oct 2017 - 30th March 2018. Study Design: Randomized control trial. Materials and Methods: This study was a randomized control trial study which consists of total of 94 teeth having class I cavity of 3mm minimum depth on occlusal surface. The restorative material evaluated in this study was Filtek Z250 (3M, ESPE) and the cavities were restored according to two different techniques. Patients in Group A were treated with bulk fill technique and patients in Group B were treated with incremental technique. The retention of the composite were clinically evaluated after 6 months (180 days) post-operatively. SPSS version 23 was used to analyze data. Results: The result of 6 months observation revealed retention of 43(91.4%) incremental fill composite and 39(85.4%) bulk fill composite resin restorations which was statistically insignificant. Conclusion: Outcomes of incremental fill composite resin in terms of retention is equal to bulk fill composite resin with Filtek Z250 (3M, ESPE) in class I restorations of permanent molar teeth. [ABSTRACT FROM AUTHOR]

Objectives: To find out the diagnostic accuracy of ascitic fluid Lactate Dehydrogenase in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard. Study Design: Cross sectional (validation) study. Setting: This study was conducted in department of Medicine, Madina Teaching Hospital Faisalabad. Duration of Study: 6 months starting after approval of synopsis (From:01-06-2016 to 30-11-16). Methodology: 10 ml of ascitic fluid was withdrawn from these patients, and sent for cytology and biochemistry. Ascitic fluid cell count, total protein, albumin and LDH wascalculated along with serum albumin and serum LDH. Serum LDH and ascitic fluid LDH was calculated by using Cobas C311 Roche Analyzer, serum/ascitic albumin gradient (SAAG) was calculated by subtracting ascitic albumin from serum albumin to prove portal hypertension as a cause of ascites. AsciticLDH/serum LDH ratio was calculated by dividing ascitic LDH by serum LDH.Absolute neutrophil count was derived from total WBC count. Results: In our study, mean age was calculated as 45.37+11.13 years, 53.75% (n=43) were male and 46.25% (n=37) were females. Frequency SBP on gold standard was recorded in 52.5% (n=42). Diagnostic accuracy of ascitic fluid lactate dehydrogenase in diagnosis of spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a gold standard was recorded as 82.22%, 85.71%, 88.09%, 78.95%, 83.75% for sensitivity, specificity, positive predictive value, negative predictive value and accuracy rate, positive likelihood ratio was calculated as 5.75 and 0.21 for negative likelihood ratio was calculated as 5.75. Conclusion: The diagnostic accuracy of ascitic fluid Lactate Dehydrogenase is higher in diagnosis of Spontaneous bacterial peritonitis using ascitic fluid absolute neutrophil count equal to or greater than 250 cells/mm3 as a Gold Standard. [ABSTRACT FROM AUTHOR]

Objectives: To assess the efficacy of mineral trioxide aggregate (MTA) pulpotomy in mature permanent teeth with irreversible pulpitis due to carious exposure. Place and Duration: The study was conducted in the Department of Operative Dentistry, Altamash Institute of Dental Medicine from 05-01-2016 to 05-07-2016. Methodology: A total of 70 teeth of 70 patients with irreversible pulpitis were treated with mineral trioxide aggregate (MTA) pulpotomy. The patients were re-evaluated after 2 months. All patients were asked whether they had experienced spontaneous pain, pain on chewing or pain stimulated by hot/cold and the treatment was counted as successful in case of no post-operative symptoms. Results: Efficacy of pulpotomy treatment with mineral trioxide aggregate in symptomatic mature permanent teeth with irreversible pulpitis and normal periapical periodontium was 88.57%. Conclusion: MTA pulputomy is a good alternative treatment for cases of irreversible pulpitis in permanent teeth with mature roots and normal apical periodontium. However, long term clinical trials and histological assessment is desirable. [ABSTRACT FROM AUTHOR]

Breast carcinomas are an uncommon neoplastic condition in men, which accounts for only 1% of all breast cancers, and not more than 1% of all malignancies in men. A 55 years old man presented with a ulcerated mass in the left breast with a history of pain, discharge and fever. On examination, there was an ulcerating growth above the left nipple with numerous maggots. The fine needle aspiration cytology confirmed the ductal cell carcinoma which was further confirmed by ulcer edge biopsy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of the study was to evaluate the clinical results after operative treatment of open tibia fractures (grade IIIA/B) with external fixator. Material and methods: 25 patients with open fractures of the tibial diaphysis, classified as type III A and B, according to the Gustilo classification, were operatively treated in Agency Headquarter Hospital Landikotal. All the patients were treated with an external fixator. The time of the union of the fracture, problems with the union (malunion and nonunion), infection were examined as treatment outcome. Late complications and their treatment was not the object of the study. The follow-up period was at least 8 months. Result: The end results of the external fixation of 25 tibial shaft fractures, 18 (72%) men and 7 (28%) women, average age 37.7 (16-65). The union rate was 83%. Nonunion rate was 12%. And malunion rate was 5% (fig-I). Fifteen patients had Gustilo type IIIA injury while 10 patients had type IIIB injury (fig-II). Pins tract infection rate was 10%. The average time of fractures healing was 28.5 weeks (15-22). There were 3 cases with wound infection and no sequestrum formation. Conclusions: External fixation is a simple and effective means of treating all types of open tibial shaft fractures. [ABSTRACT FROM AUTHOR]

The children presenting with acute scrotum have many diseases in differential diagnosis and testicular torsion in undescended testis and normal testis is an important consideration. Torsion of the testis, or more correctly, torsion of the spermatic cord, is a surgical emergency because it causes strangulation of gonadal blood supply with subsequent testicular necrosis and atrophy. In most of cases history and physical examination are sufficient to make an accurate diagnosis. While other causes may require simple treatment but torsion require immediate exploration to save the testis. Early diagnosis and prompt treatment is essential to help such children. [ABSTRACT FROM AUTHOR]