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Sjogren's syndrome (SS) is characterized as an autoimmune disorder targeting secretory glands, including the lacrimal and salivary glands, causing dry eye and dry mouth predominantly in women over the age of 40. In this review, we summarize recent advancements in SS diagnostics, treatments, and our understanding of correlations between oral and ocular manifestations of SS. Google Scholar and PubMed databases were utilized to search peer-reviewed papers since 2016 on SS diagnosis, treatment, and correlations between oral and ocular manifestations. For diagnostics, we discuss the updated SS classification criteria by the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR), new biomarkers, and compare studies of current diagnostic methods with alternative technologies. For treatments, we discuss topical, systemic, and surgical treatment developments in the management of oral and ocular symptoms of SS as there is still no cure for the disorder. Finally, we report studies that directly suggest correlations between the ocular surface disease and oral disease in SS, as well as shared abnormalities in the microbiome and cytokine expression that may be correlated. We conclude by stating limitations to our review as well as paths moving forward. Elucidating correlations between oral and ocular manifestations may be the key to furthering our understanding of SS pathogenesis as well as defining new standards for diagnosis and treatment.

Purpose: To investigate the anti-sickling activity of Senna alexandrina, Aerva javanica, and Ficus palmate extracts. Methods: The leaves were extracted with water and methanol. The anti-sickling effect of extracts was determined using blood from 20 sickle cell disease (SCD) patients by mixing it with 500 and 1000 μg/mL of extract. The treated blood samples were then examined under a light microscope. The osmotic fragility of erythrocytes was determined using 4 mL (0 – 0.9 %) buffered saline mixed with 1 mL extract (500 μg/mL) and 0.05 mL sickled red blood cells (RBCs). Results: Aerva javanica extract significantly (p < 0.0001) reduced the percentage of sickle cells compared to control. The sickle-shaped cells were 29.47 % when treated with 125 μg/mL concentration of methanol extract of A. javanica that was further decreased to 0.35 % on increasing the concentration to 500 μg/mL. A similar trend was also observed with extracts of F. palmata. Extracts had protective effect on erythrocyte osmotic fragility. Results of comet assay suggested that extracts did not damage DNA. Conclusion: These plant extracts have promising anti-sickling activity and protect erythrocyte osmotic fragility. However, in vivo studies are required to validate these results and for further development of the extracts for therapeutic use.

OBJECTIVES Patients with the low-dose long-term aspirin regime have a severe risk of excessive bleeding during surgery, placing them at risk of "adverse thrombotic events". This study aims to evaluate the bleeding in patients undergoing minor oral surgery procedures without stopping daily low-dose aspirin therapy. METHODOLOGY A descriptive cross-sectional hospital-based investigation involved the patient with minor oral surgery at "Altamash Institute of Dental Medicine, Karachi, Pakistan" from mid-April 2021 to mid-June 2021, who were between the age group 30 to 75 with a low-dose aspirin regime. The data was collected via a questionnaire to record the variables, i.e. duration of aspirin, postoperative medications, platelets count, clotting time, normal bleeding time, and intraoperative bleeding time. RESULTS 51 patients, of which 32 were males while 19, were females. The normal bleeding time was comparatively analyzed with the intraoperative bleeding time using SPSS statistical software version 22. The results revealed that the mean bleeding time for the patients with a low-dose aspirin regime during minor oral surgery was 5.49 ± 1.07, while for the patients with a stopped aspirin dose was 4.57 ± 1.07. The comparative analysis using a t-test doesn't reveal significant statistical differences of p

The primary aim of the study is to investigate the English language learning at intermediate level in the Province of Punjab, Pakistan. To achieve the objective of the study situational analysis and literature review approach for substantive theorizing and historical interpretation is adopted as suggested by Karl Popper. Teachers and students of numerous social surroundings who teach and study in the public and private sector colleges in the province of Punjab have reported numerous problems, in the published articles from 2015 to 2022, they face in learning English language. In the teaching and learning contexts Urdu and regional languages have been reported widely used in the previous studies, and other main reasons highlighted through the review of the literature which are impeding the learners in second language learning include; crowded classrooms, less motivation, literature, teacher-centered teaching, indifferent teacher attitude, inadequate teacher training, and ineffective Syllabus. This study has recommended with teachers' training support, implementing interactive teaching methods, and using the target language in the classes by motivating the learners, these hurdles can be overcome easily.

AimsFrozen shoulder is a common, painful condition that results in impairment of function. Corticosteroid injections are commonly used for frozen shoulder and can be given as glenohumeral joint (GHJ) injection or suprascapular nerve block (SSNB). Both injection types have been shown to significantly improve shoulder pain and range of motion. It is not currently known which is superior in terms of relieving patients’ symptoms. This is the protocol for a randomized clinical trial to investigate the clinical effectiveness of corticosteroid injection given as either a GHJ injection or SSNB.MethodsThe Therapeutic Injections For Frozen Shoulder (TIFFS) study is a single centre, parallel, two-arm, randomized clinical trial. Participants will be allocated on a 1:1 basis to either a GHJ corticosteroid injection or SSNB. Participants in both trial arms will then receive physiotherapy as normal for frozen shoulder. The primary analysis will compare the Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include OSS at six and 12 months, range of shoulder movement at three months, and Numeric Pain Rating Scale, abbreviated Disabilities of Arm, Shoulder and Hand score, and EuroQol five-level five-dimension health index at three months, six months, and one year after injection. A minimum of 40 patients will be recruited to obtain 80% power to detect a minimally important difference of ten points on the OSS between the groups at three months after injection. The study is registered under ClinicalTrials.gov with the identifier NCT04965376.ConclusionThe results of this trial will demonstrate if there is a difference in shoulder pain and function after GHJ injection or SSNB in patients with frozen shoulder. This will help provide effective treatment to patients with frozen shoulder.Cite this article: Bone Jt Open 2023;4(3):205–209.

Objective: To identify the fears and concerns regarding HCV amongst people presenting to a free screening camp and to identify the barriers preventing patients from linkage to care (seeking medical care for HCV). Study Design: Cross Sectional study. Setting: Gajrakh District, Gujranwala. Period: 15th February to 14th March 2019. Material & Methods: Questionnaire was filled by all the participants attending free screening and treatment camp. Questionnaire explored socio-demographic features, financial status, knowledge regarding awareness of disease e.g. risk factors for transmission of disease, possible complications of disease, fears regarding diagnosis &treatment of HCV and possible concerns of female population. Results: This study included 100 participants, 58% were females and 42% were males with a mean age of 46.23±12.36. Fifty seven percent of the participants were laborer, 15 were salary based, 6 were shopkeepers and 7 were housewives. Majority of participants have a sound knowledge about transmission of HCV i.e 95% said yes to the question about spread via ear/nose piercing by unsterilized needles, however, 49% and 61% think that hugging the patient and eating and drinking with patient also caused viral spread respectively. Most important factors contributing to inability to start treatment were inability to bear cost, missing of daily wages, lack of transport, fear of side effects and fear of being outcast in 75, 66, 41, 26 and 25% respectively. Conclusion: Socioeconomic factors like costly treatment, missing of daily wages, lack of transport, fear of side effects and being outcast are real hindrance in getting HCV treatment.

Aim: To assess the aesthetic satisfaction with the metal-ceramic dental prosthesis in relation to patient education, age and gender. Methods: This prospective longitudinal study was undertaken by selecting 360 adult patients from both genders indicated for single maxillary porcelain fused to metal crowns. These patients were categorized into three groups based on gender, age, and education. Patients were assessed for aesthetic satisfaction for tooth shape; color, angulation, visibility, and shade at the time of insertion and at a follow-up of 12 weeks. At the time of the prosthesis insertion, a self-evaluation questionnaire was provided to each patient to record their satisfaction levels with the prosthesis. Satisfaction levels among the participants were evaluated based on participants' age, gender, and education level (Chi-square). A p-value of 0.05 was considered statistically significant. Results: The study enrolled 150(41.67%) males and 210(58.33%) females with the participant age ranging from 19 to 60 years and a mean age of 30.53 (± 10.88 years). 84(23.3%) were uneducated participants, 210(58.3%) were high school graduates, and 66(18.3%) were university graduates. A decrease in the level of satisfaction was observed with increasing years of patient education at insertion. The overall aesthetic satisfaction among patients at PFM crown insertion (65%) and at 12 weeks follow-up (69.2%) was statistically comparable (p>0.05). Practical implication: Aesthetic is the most important consideration for the replacement of anterior teeth. Numerous studies evaluated the aesthetic satisfaction of the patients after providing full ceramic prosthesis, however, data regarding patient satisfaction after the metal ceramic dental prosthesisis scarce in the scientific literature. Conclusion: Satisfaction with the esthetic restoration depends on patient education and awareness. Age and education add to a person's experience and increase awareness with respect to better aesthetics. Keywords: Aesthetics; patient satisfaction; assessment; patient care, metal ceramic prosthesis

This paper is an overview of the work done for the design and analysis of the multi-storey building (G+5) under the effect of various forces acting on the building such as dead load, imposed load, wind load, and seismic load. The work was done for the purpose of designing and analyzing the building to withstand the effects of these various forces. The fact that these pressures are working on the building demonstrates that if the buildings are not carefully planned and built with enough strength, then this may lead to the partial or entire collapse of the multi-storey structures. It is necessary to do an analysis and design the structures of multi-story buildings in such a way that they are able to resist the numerous pressures that operate on these buildings in order to guarantee the inhabitants' safety. The primary purpose of this endeavor is to investigate and analyze the effects of wind and seismic activity on the structures. The residential building is a G+5 storey construction, and it is situated in Raipur city, which is the capital of Chhattisgarh state. According to the criteria for the study of seismic load, zone II applies to the location of the building. Throughout the course of its lifetime, every structure will be susceptible to the impacts of a variety of forces, including those caused by dead load, live load, wind forces, and seismic forces. Both wind load and earthquake load contribute to the dynamic load, whereas dead load and imposed load only contribute to the static load. The whole of the structure was analyzed with the assistance of the STAAD PRO programme.

Introduction: Carbapenemases are primarily responsible for the intensified spread of multidrug-resistant (MDR) K. pneumoniae by virtue of antibiotics overuse. Therefore, frequent investigation of high-risk clones especially from developing world is crucial to curtail global spread. Methodology: In this observational study, 107 K. pneumoniae were retrieved and confirmed genotypically from April 2018 to March 2020 from tertiary care hospitals in Lahore, Pakistan. Carbapenemases and extended-spectrum β-lactamases were verified by Polymerase Chain Reaction and Sanger sequencing. Multilocus sequence typing and plasmid replicon typing were used to assign clonal lineages and plasmid replicons. Results: Among the K. pneumoniae, 72.9% (78/107) strains were carbapenem resistant (CR) with 65.4% (51/78) exhibiting carbapenemase producing phenotype. Among CR K. pneumoniae 38.5% (30/78) strains exhibited the following carbapenemase genotypes: blaNDM-1 (26.7%, 8/30), blaOXA-48 (26.7%, 8/30), blaKPC-2 (20.0%, 6/30), blaVIM (10.0%, 3/30), blaNDM-1/blaOXA-48 (10.0%, 3/30), blaOXA-48/blaVIM (3.3%, 1/30) and blaOXA-48/blaIMP (3.3%, 1/30). Tigecycline and polymyxin-B retained susceptible profile. β-lactam drugs showed intermediate to high resistance. The occurrence of CR K. pneumoniae infections was significantly associated with wound (39.7%, p = 0.0007), pus (38.5%, p = 0.009), general surgery (34.6%, p = 0.002) and intensive-care unit (26.9%, p = 0.04). blaKPC-2 producing K. pneumoniae coharboring blaCTX-M/blaSHV (66.7%) and blaCTX-M (33.3%) exhibited sequence type (ST) 258 (n = 4) and ST11 (n = 2) sequence types with IncFII, IncN, IncFIIA, IncL/M and IncFIIK plasmids. Conclusions: This is the first report describing the emergence of MDR blaKPC-2 producing K. pneumoniae ST11 coharboring blaCTX-M and blaSHV in Pakistan.

A pectin-based one-pot aqueous approach was reported to valorize coco coir into multifunctional biocomposites. These biocomposites were demonstrated to be effective hydroponic growth media.

While racial/ethnic disparities in blood pressure control are documented, few interventions have successfully reduced these gaps. Under-prescribing, lack of treatment intensification, and suboptimal follow-up care are thought to be central contributors. Electronic health record (EHR) tools may help address these barriers and may be enhanced with behavioral science techniques.To evaluate the impact of a multicomponent behaviorally-informed EHR-based intervention on blood pressure control.Reducing Ethnic and racial Disparities by improving Undertreatment, Control, and Engagement in Blood Pressure management with health information technology (REDUCE-BP) (NCT05030467) is a two-arm cluster-randomized hybrid type 1 pragmatic trial in a large multi-ethnic health care system. Twenty-four clinics (350 primary care providers [PCPs] and10,000 eligible patients) are assigned to either multi-component EHR-based intervention or usual care. Intervention clinic PCPs will receive several EHR tools designed to reduce disparities delivered at different points, including a: (1) dashboard of all patients visible upon logging on to the EHR displaying blood pressure control by race/ethnicity compared to their PCP peers and (2) set of tools in an individual patient's chart containing decision support to encourage treatment intensification, ordering home blood pressure measurement, interventions to address health-related social needs, default text for note documentation, and enhanced patient education materials. The primary outcome is patient-level change in systolic blood pressure over 12 months between arms; secondary outcomes include changes in disparities and other clinical outcomes.REDUCE-BP will provide important insights into whether an EHR-based intervention designed using behavioral science can improve hypertension control and reduce disparities.

There is an increasing awareness of the lack of diversity within the Psychology workforce. This article consists of reflections from three assistant psychologists hired on the Health Education England (HEE) funding scheme to increase equality and diversity in the psychology workforce. Here we have reflected on our journey from recruitment; what we have learnt, how we feel about future career aspirations whilst reflecting on our own diversity.

Objective: To study the association between hepatitis C virus viral load by real-time PCR and core antigen value of HCV and define an antiviral treatment monitoring cut-off value for HCV core antigen. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Infectious Diseases, Chughtai Lab Lahore Pakistan, from Jun 2017 to Mar 2018. Methodology: To establish the association between these two parameters, we took a hundred positive plasma samples for HCV RNA and subjected them to an HCV Core antigen test. Furthermore, the samples were divided into three categories based on their viral load; 10000 IU/ml. Results: Our results showed that the hepatitis C virus core antigen was concordant with hepatitis C virus RNA by PCR when the viral load was above 2000 IU/ml. Below the HCV RNA load of 2000 IU/ml, the HCV core antigen had a sensitivity of 94.95% and specificity of 88.89%. Conclusion: In patients having a viral load above 2,000 IU/ml, the hepatitis C virus core antigen value can be used as a marker for diagnosis and monitoring antiviral therapy. After the antiviral treatment, HCV RNA real-time PCR should be performed to validate viral clearance.

Patients with chronic limb-threatening ischemia (CLTI) require revascularization to improve limb perfusion and thereby limit the risk of amputation. It is uncertain whether an initial strategy of endovascular therapy or surgical revascularization for CLTI is superior for improving limb outcomes.In this international, randomized trial, we enrolled 1830 patients with CLTI and infrainguinal peripheral artery disease in two parallel-cohort trials. Patients who had a single segment of great saphenous vein that could be used for surgery were assigned to cohort 1. Patients who needed an alternative bypass conduit were assigned to cohort 2. The primary outcome was a composite of a major adverse limb event - which was defined as amputation above the ankle or a major limb reintervention (a new bypass graft or graft revision, thrombectomy, or thrombolysis) - or death from any cause.In cohort 1, after a median follow-up of 2.7 years, a primary-outcome event occurred in 302 of 709 patients (42.6%) in the surgical group and in 408 of 711 patients (57.4%) in the endovascular group (hazard ratio, 0.68; 95% confidence interval [CI], 0.59 to 0.79; P0.001). In cohort 2, a primary-outcome event occurred in 83 of 194 patients (42.8%) in the surgical group and in 95 of 199 patients (47.7%) in the endovascular group (hazard ratio, 0.79; 95% CI, 0.58 to 1.06; P = 0.12) after a median follow-up of 1.6 years. The incidence of adverse events was similar in the two groups in the two cohorts.Among patients with CLTI who had an adequate great saphenous vein for surgical revascularization (cohort 1), the incidence of a major adverse limb event or death was significantly lower in the surgical group than in the endovascular group. Among the patients who lacked an adequate saphenous vein conduit (cohort 2), the outcomes in the two groups were similar. (Funded by the National Heart, Lung, and Blood Institute; BEST-CLI ClinicalTrials.gov number, NCT02060630.).

Background: Cardiovascular diseases (CVD) are a major cause of premature deaths globally. The gap between knowledge and behavior regarding modifiable risk factors related to these diseases has been noticed in medical students and is associated with a high number of morbidity and mortality. The aim of this study was to assess knowledge and behavior regarding cardiovascular diseases risk factors among newly enrolled MBBS students. Subjects and methods: This cross-sectional study was conducted from May to September 2021. A total of 140 first-year MBBS students participated including 80 females and 60 males. Data were collected through a self-administered questionnaire having 17 questions and two sections, one for knowledge assessment and the other for the behavior of participants regarding CVD risk factors. Results: Major risk factors for heart disease identified by students included obesity (99.3%), high cholesterol (98.6%), hypertension (97.9%), lack of physical activity (95.7%), smoking (82.1%), older age (89.3%), family history of heart disease (73.6%) and diabetes (78.6%). Pertaining to personal history, 10% were smokers, 32.1% regularly consumed soft drinks and 79.3% reported having any physical activities. Significant differences were found between male and female students regarding knowledge of CVD risk factors such as smoking (p-value = 0.003). Similarly, significant differences were observed between male and female students heart health behavior such as cholesterol checkup (31.7% vs. 16.2%, p-value = 0.032), use of soft drinks (48.3% vs 20%, p-value = 0.001) and physical activity (90% vs. 71.2%, p-value = 0.007). Conclusion: First-year medical students have good knowledge of CVD risk factors but the behavior, regarding practice to avoid these risk factors, needs improvement. It was also observed by comparison that male students have more knowledge of heart disease risk factors as compared to female students.

Objective The aim of this study was to analyze malpractice claims for aortic pathologies and to assess if there has been a change in rate of malpractice lawsuits with evolution of endovascular therapy. Methods Malpractice lawsuits were individually screened and compiled from the Westlaw database from 2000 to 2017 through use of relevant search terms. Data were collected of allegations, diagnoses, and outcomes of each case and compared. Results 268 unique cases were included in this study, with aneurysms (54%, n = 145) and dissection (35%, n = 94) making up the majority. There was a defendant verdict in 53% (n = 141), plaintiff verdict in 24% (n = 65), and settlements in 23% (n = 62) of lawsuits. Litigation was higher in the Midwest and Northeast. There was a gradual decline in litigation overall, however endovascular case numbers remained constant. There was negligible difference in the primary allegation underlying the litigation for various aortic pathologies, time to litigation and award between open and endovascular procedures. Conclusion The proportion of litigation for clinical negligence in endovascular cases amongst all vascular surgical lawsuits is increasing. As novel methods of endovascular therapy emerge, it is imperative that physicians remain vigilant to legal considerations to minimize malpractice risk.

In December 2020, The North Thames Learning Disabilities Special Interest Group (SIG) met over video to discuss how Clinical Psychologists and aspiring psychologists experience, manage and combat racism in their work. This paper focuses on two presentations from the day by Islington Learning Disabilities Partnership. The first presentation focused on the barriers faced by people with Learning Disabilities (PWLD) to understand racism and receive support as victims or perpetrators. The talk identified a clear need for further accessible resources about racism and strategies to unlearn racism that go beyond cultural appreciation. The second presentation focused on the experiences of a black and a brown undergraduate psychologist joining an all-white LD psychology team in October 2020. Live semi-structured interviews were completed, informed by Whyte’s (2019) concept of robust vulnerability. The purpose was to explore different perspectives and experiences around what anti-racism means and what work that needs to be done by clinical psychologists individually and as a collective. It is the responsibility of the profession to not only diversify but ensure the needs of victims of racism are put before white discomfort and that black and ethnic minorities are not burdened with implementing anti-racist practices.Easy read summaryThe Learning Disabilities Special Interest Group (SIG) met over video in December 2020. The group talked about how racism affects the Learning Disabilities (LD) community. Racism is the unfair treatment of people based on their skin colour.This paper talks about two presentations from the day by Islington Learning Disabilities Partnership (ILDP). The first presentation was about support for people with learning disabilities. People are not always given support to cope with racism or to understand how to stop it.The second presentation was about anti-racism. Anti-racism means doing things to understand and fight racism. A black and a brown female student psychologist talked about their experiences in a team with all white psychologists. They interviewed two white psychologists about what they know and do to be anti-racist. They then interviewed each other about their experiences. They said that talking about racism helps people to cope with it and to stop it.

Alcohol misuse contributes to the dysregulation of immune responses and multiorgan dysfunction across various tissues, which are associated with higher risk of morbidity and mortality in people with alcohol use disorders. Organ-specific immune cells, including microglia in the brain, alveolar macrophages in the lungs, and Kupffer cells in the liver, play vital functions in host immune defense through tissue repair and maintenance of homeostasis. However, binge drinking and chronic alcohol misuse impair these immune cells' abilities to regulate inflammatory signaling and metabolism, thus contributing to multiorgan dysfunction. Further complicating these delicate systems, immune cell dysfunction associated with alcohol misuse is exacerbated by aging and gut barrier leakage. This critical review describes recent advances in elucidating the potential mechanisms by which alcohol misuse leads to derangements in host immunity and highlights current gaps in knowledge that may be the focus of future investigations.

In this work, a model based on the Physics - Informed Neural Networks (PINNs) for solving elastic deformation of heterogeneous solids and associated Uncertainty Quantification (UQ) is presented. For the present study, the PINNs framework - Modulus developed by Nvidia is utilized, wherein we implement a module for mechanics of heterogeneous solids. We use PINNs to approximate momentum balance by assuming isotropic linear elastic constitutive behavior against a loss function. Along with governing equations, the associated initial / boundary conditions also softly participate in the loss function. Solids where the heterogeneity manifests as voids (low elastic modulus regions) and fibers (high elastic modulus regions) in a matrix are analyzed, and the results are validated against solutions obtained from a commercial Finite Element (FE) analysis package. The present study also reveals that PINNs can capture the stress jumps precisely at the material interfaces. Additionally, the present study explores the advantages associated with the surrogate features in PINNs via the variation in geometry and material properties. The presented UQ studies suggest that the mean and standard deviation of the PINNs solution are in good agreement with Monte Carlo FE results. The effective Young's modulus predicted by PINNs for single representative void and single fiber composites compare very well against the ones predicted by FE, which establishes the PINNs formulation as an efficient homogenization tool.

Randomised controlled clinical trials are widely considered the preferred method for evaluating the efficacy or effectiveness of interventions in healthcare. Adaptive trials incorporate changes as the study proceeds, such as modifying allocation probabilities or eliminating treatment arms that are likely to be ineffective. These designs have been widely used in drug discovery studies but can also be useful in health services and implementation research and have been minimally used. In this article, we use an ongoing adaptive trial and two completed parallel group studies as motivating examples to highlight the potential advantages, disadvantages, and important considerations when using adaptive trial designs in health services and implementation research. We also investigate the impact on power and the study duration if the two completed parallel group trials had instead been conducted using adaptive principles. Compared with traditional trial designs, adaptive designs can often allow the evaluation of more interventions, adjust participant allocation probabilities (eg, to achieve covariate balance), and identify participants who are likely to agree to enrol. These features could reduce resources needed to conduct a trial. However, adaptive trials have potential disadvantages and practical aspects that need to be considered, most notably: outcomes that can be rapidly measured and extracted (eg, long term outcomes that take considerable time to measure from data sources can be challenging), minimal missing data, and time trends. In conclusion, adaptive designs are a promising approach to help identify how best to implement evidence based interventions into real world practice in health services and implementation research.

The SARS-COV-2 infection-related severe illness is prevented by vaccinations. Therefore, it is relevant to report a case of post vaccine meningoencephalitis in a 30 year old male Indian patient, who presented with weakness in all the extremities, episodes of loose stool, fever, vomiting, tachypnea and loss of consciousness immediately following the 2nd dose of the COVID vaccination (COVAXIN).

Background: Endodontic pain is related to inflammatory reactions in the tissues correlated to the damage, and the nature of damage. Inter-appointment pain is correlated to the instrumentation, irrigation and all the other procedures done during appointments. Triple antibiotic paste can be more effective intacanal medicament than calcium hydroxide. But there was a need to confirm its effectiveness. Aim: To compare the effect of calcium hydroxide and triple antibiotic on inter-appointment endodontic pain. Methods: This randomized controlled trial was conducted in the Department of Operative Dentistry, PMC Dental Institute, Faisalabad Medical University, Faisalabad for four months. Sixty cases were enrolled by using Non-probability, consecutive sampling and were divided randomly in two groups. In group 1, triple antibiotic paste was placed for inter-appointment pain. In group 2, calcium hydroxide was placed. After one week, pain was observed. Data was analyzed in SPSS 25. Results: In patients who received triple antibiotics paste, the mean age of patients was 36.90±9.49 years. In patients who received calcium hydroxide, the mean age of patients was 34.83±10.32 years. In patients who received triple antibiotics paste, there were 15(50%) males and 15(50%) females. In patients who received calcium hydroxide, there were 16(53.3%) males and 14 (48.7%) females. In patients who received triple antibiotics paste, the mean pain score was 0.90±1.88. In patients who received calcium hydroxide, the mean pain score was 2.83 ± 3.07. In patients who received triple antibiotics paste, there were 6 (20%) patients who had pain while 24(80%) patients did not report about pain. In patients who received calcium hydroxide, there were 15 (50%) patients who had pain while 15(50%) patients did not report about pain. Conclusion: Triple antibiotic paste was found to be more effective in relieving pain than calcium hydroxide. Key words: Calcium hydroxide, triple antibiotic paste, inter-appointment endodontic pain, visual analogue scale

Introduction: Abnormal uterine bleeding is one of the commonest issues in perimenopausal age group. The proportion is 9-30% in reproductive age group. This extent rises to 70% in perimenopausal and postmenopausal women’s. Irregular uterine dying (AUB) warrants an intensive assessment in perimenopausal females and subsequently it’s vital to perform it in a cost-effective way with available resources. Objective: To compare the efficacy of Hysteroscopic guided biopsy and endometrial cytology To find out the efficacy of endometrial cytology in detecting different normal and abnormal endometrial patterns Study design & Settings: It is a prospective comparative study conducted at Social Security Hospital, Multan Road, Lahore included patients 30 years and above with the chief complaints of abnormal uterine bleeding. Study Duration: 01 year January 2020 to December 2020 Sample: 100 patients Inclusion Exclusion Criteria: Females having symptoms of abnormal uterine bleeding and age above than 30 years are included in the study. The females who are pregnant and having infection or malignancy are excluded from the research Results: This Planned comparative hospital-based study was done in one hundred patients with abnormal uterine bleeding taken after the informed consent, inclusion and exclusion criteria. Endometrial thickness was assessed and all cases with

Sashiananthan Ganesananthan,1,2 Abeer Zahid,2 Anam Choudhry,2 Thivya V Vadiveloo,2 Nailah Khan,2 Ting Yang,2 Haroon Urrehman,2 Sahana Mahesh,2 Zaheer Yousef2– 4 1National Heart and Lung Institute, Imperial College London, London, UK; 2Cardiff University School of Medicine, Cardiff University, Cardiff, Wales, UK; 3Department of Cardiology, University Hospital Wales, Cardiff, Wales, UK; 4Welsh Heart Research Institute, Cardiff University, Cardiff, Wales, UKCorrespondence: Sashiananthan Ganesananthan, National Heart and Lung Institute, Imperial College London, London, UK, Email sashiganes96@yahoo.co.ukIntroduction: Conferences are an important avenue for dissemination of knowledge, research and provide networking opportunities for career development. The COVID-19 pandemic has prompted adoption of virtual platforms for delivery of these conferences. The aim of the study was to determine the utility and educational impact of a student-led virtual webinar to deliver an undergraduate cardiovascular conference compared to a traditional in-person conference.Methods: We conducted a two-day virtual conference using the Zoom platform in June 2021. The conference consisted of cardiology subspecialty lectures, and workshops were conducted by a junior doctor, senior cardiology trainees and consultants. The conference also outlaid a virtual poster hall and oral presentation session while networking opportunities were encouraged using breakout rooms and poster hall chat function. A 38-item self-administered online questionnaire was designed and disseminated at the end of the conference to all attending delegates. All data analysis and data visualisation strategies were conducted on R statistical programming.Results: Eight-hundred and forty students from 55 countries attended the event. Four hundred and ninety participants (58.5% response rate, 55.9% female) completed the questionnaire. Factors such as weekend conference (84.9%), student-led or organised (84.1%), environmental/sustainable (82.3%), appropriate level for me (81.5%) and comfort to present (80.8%) were deemed to be at least equal to traditional in-person conference. The conference also increased participants’ interest, their core cardiology knowledge and improved their critical analysis and basic echocardiography skills [median 4 (IQR 3– 5) for all parameters]. Overall, participants also found it easy to use the virtual platform [median 5 (IQR 5– 5)] and easier to ask questions compared to in-person conferences [median 5 (IQR 4– 5) vs median 4 (IQR 3– 5), p < 0.001].Conclusion: Our virtual conference provided opportunities to students that the COVID-19 pandemic would have otherwise affected; however, its utility and educational impact will need to be assessed within its individual context of delivery.Keywords: virtual conference, undergraduate, international, educational impact, cardiology, webinar

Alcohol intoxication combined with burn injury can lead to life-threatening complications, including sepsis, multiple organ failure, and death. After an acute burn, the gastrointestinal system becomes hypoxic because of fluid loss and reduction of intestinal blood flow. This can cause perturbations in the intestinal epithelial barrier, immune function, and the composition of the gut microbiome. Increased gut permeability leads to proinflammatory signaling, contributing to further damage to the intestinal barrier. Recent studies have suggested that IL-27 plays an anti-inflammatory role, which may be beneficial in intestinal barrier repair. Therefore, in this study, we examined the effect of ethanol and burn injury on IL-27 in the small intestine, as well as the potential beneficial role of IL-27 in restoring the intestinal barrier after intoxication and burn. Male C57BL/6 mice were gavaged with 2.9 g/kg ethanol before receiving a ∼12.5% total body surface area scald burn with or without rIL-27 in resuscitation fluid. Our results demonstrate that IL-27–producing cells are reduced in the small intestine after injury. When IL-27 is supplemented in resuscitation fluid, we were able to restore intestinal barrier integrity and transit, mediated through increased intestinal epithelial cell proliferation, reduced inflammatory cytokines, and increased anti-inflammatory cytokine IL-10. We also observed increased gene expression of tight junction proteins. These findings suggest that IL-27 may be a contributor to maintaining proper intestinal barrier function after injury through multiple mechanisms, including preventing excess inflammation and promoting intestinal epithelial cell proliferation and tight junction integrity.