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Introduction: Pregnancy is a physiological state of women which is associated with intricate endocrinological, immunological, metabolic & vascular changes. So pregnancy makes a woman susceptible to various changes in skin & appendages. Alteration to the immune state of the pregnant women is necessary to allow mother to tolerate genetically different tissue during pregnancy. Decrease in cell mediated immunity in normal pregnancy is mainly responsible for the higher frequency and severity of certain infectious diseases. Some of which can also be transmitted to the baby during child birth. Moreover there are marked changes in the levels of sex hormones particularly oestrogen & progesterone and this can lead to profound changes in skin. Objective: To find the prevalence of dermatological manifestations in pregnant patients presenting in a tertiary care hospital Study Design: Descriptive/Cross-sectional Study Setting: The study was done in the Dermatology unit DHQ Hospital Faisalabad. Duration of Study: The study was carried out from 1st October 2016 to 10th March 2017 Subjects and methods: 185 pregnant women presenting at any gestational age in dermatology department and patients referred from Gynae department with dermatological complaints were included in the study. Patients with pre-existing medical conditions such as hypertension and diabetes were excluded. Complete history and clinical features of the patients were accessed and relevant investigations were done to support the diagnosis. Final diagnosis was made on basis of history, clinical examination and laboratory confirmation of disease as per operational definition. LFT’s for intrahepatic cholestasis of pregnancy was done from DHQ laboratory and sample for skin biopsy for pemphigoid gestationis were sent to pathology laboratory FMU. All the data was recorded in a well-structured questionnaire. Results: Age range in this study was from 18 to 40 years with mean age of 30.129±3.26 years and mean duration of disease was 5.864±1.79 week. Majority of the women were with 2nd trimester of pregnancy (67%). 60% of women had no occupation. Striae Gravidarum was seen in 48.1%, Linea Nigra 45.9%, Melasma 25.4%, Hirsutism 16.2%, Palmer Erythema 8.1%, Atopic eruption of Pregnancy 11.9%, Polymorphic eruption of Pregnancy 3.2%, Intrahepatic Cholestasis of Pregnancy 1.6%, Pemphigoid gestationis 1.1%, Acne Vulgaris 9.7%, Vulvovaginal candidosis 8.1%, Urticaria 6.5% and Scabies was 5.4%. Practical Implication: We set out to investigate the prevalence of dermatological manifestations during pregnancy, as well as other clinical characteristics affecting pregnant women in Pakistan. Conclusion: If infections during pregnancy are diagnosed at the earliest stage it may prevent morbidity during and after antenatal period. Keywords: Pregnancy; Dermatological manifestations; Frequency, Clinical Patterns, Pemphigoid Gestationis, Acne Vulgaris, Vulvovaginal Candidosis

Objective: To know the frequency of occurrence of metabolic syndrome in patients suffering from chronic plaque psoriasis. Methods: This cross-sectional study was done in dermatology outpatient clinic of tertiary care hospital Faisalabad. Sample size of the study was 125 patients from population of Faisalabad. For enrolling patients in our study consecutive sampling method was used. After seeking approval from ethical hospital committee and completing inclusion and exclusion criteria, a total 125 patients of both gender having plaque psoriasis (between ages of 20-60 years) were taken in this study. Demographic details were noted. A fasting venous blood sample was taken and delivered to hospital laboratory for accessing triglycerides, HDL and fasting blood glucose levels. Waist circumference and blood pressure reading was taken by staff nurse. All the data was recorded on self-made performa. Results: Out of 125 patients, 71(56.8%) were male and 54(43.2%) were females; 31 (24.8%) were in the range of 20-30 years of age whereas 94(75.2%) were in the range of 31-60 years. Mean +Standard Deviation was measured as 37.96+8.05 years. Out of 125 psoriatic patients, the frequency of metabolic syndrome was seen in 37 (29.6%) of cases. Practical Implication: The connections between MS and psoriasis provide psoriasis patients with early possibilities for MS diagnosis and treatment, which could result in a significant decrease in morbidity and mortality. Different geographic regions and ethnic groups show significant differences in the symptoms of psoriasis and metabolic disorders. It can aid in the prevention and treatment of metabolic syndrome-related complications. Conclusion: Because of significant relationship of metabolic syndrome with chronic plaque psoriasis, all psoriatic patients must be tested for metabolic syndrome and thus managed according to fasting lipid profile levels to decrease the incidence of cardiovascular morbidity and mortality Keywords: chronic plaque psoriasis, metabolic syndrome, dermatology, triglycerides, waist circumference

Responsiveness depends on properties of statistical analysis, commonly referred to being as, distribution-based responsiveness. Time Up and Go Test (TUG) is a common assessment to evaluate the mobilization in patients with complications pertaining to stroke. Objective: The major emphasis of this study was to analyse the improvement in functional mobility of the patients with symptoms related to stroke. Methods: This study is carried out in Fauji Foundation Hospital and National Institute of Rehabilitation Medicine (NIRM), Islamabad Pakistan. Sample size consisted of 116 patients including both genders, with age ranging between 45-65 years. Clinically, the diagnosis of stoke can be concluded in compliance with reported criteria and standards of World Health Organization (WHO). Out of total 116 sample size 25 were excluded and 91 patients were assessed to detect mobility response by using TUG test, pertaining to four different intervals. The overall procedure implemented for the conclusion of TUG test included the following points; a) patients were advised to stand on toes, b) walk 3 meters, c) turn around and walk back to the chair from which they initially started, and d) asked to sit down quickly. Results: Between the first 7 days and 12 weeks the median of TUG test, time (mobility) was reduced from 17s to 12s. The improvement in mobility is most seen in 1st week to 3rd month. Conclusion: Findings indicate that the TUG test is capable to evaluate the change in functional mobility in patients with stroke. Hence, the outcomes justify the use of TUG in stroke rehabilitation

Objective: To compare the mean craniofacial linear and angular measurements derived from cone beam computed tomography synthesized lateral cephalogram and those obtained from conventional cephalogram. Study Design: Comparative cross-sectional study. Place and Duration of Study: Armed Forces Institute of Dentistry (AFID), Rawalpindi Pakistan, from Feb 2017 to Nov 2018. Methodology: Sample size was 32. Following linear measurements were evaluated; anterior facial height, right side and left side of mandibular length, nasal spine length, Upper and lower incisors to A-Pog distance. These measurements were obtained by both means i.e., conventional cephalogram and cone beam computed tomography synthesized cephalogram. Each of the measurement were taken twice by the single operator with a difference of two weeks. Results: No significant difference was found among measurements obtained through lateral head film cephalograph and cone beam synthesized cephalograph except for mandibular length (for which p=0.04). Conclusions: Cone beam computed tomography synthesized lateral cephalogram can be suggested as a substitute to conventional lateral cephalogram. Especially in conditions when cone beam computed tomography is already required for treatment planning thus reducing supplementary x- ray exposure and expenditure of an additional x-ray.

Neck pain is the most common complaint and Cervical pain is more common in middle-aged women than in males. The most prevalent reason for patients to seek medical attention is neck pain. Objective: To identify the effectiveness of stretching and muscle energy techniques along with mobilization of cervical segment in the management of upper cross syndrome.Methods: The randomized controlled experiment took place from August 2018 to January 2019 at Benazir Bhutto Orthopedic and Rehabilitation Centre in Pakistan (Rawalpindi) and included patients with upper cross syndrome that were randomly consigned to two equal groups using a lottery system. The Group-A patients management is eccentric muscular energy therapy with cervical segmental mobilization, although Group-B patients treatment protocol is static stretching exercises accompanied by segmental mobilization of cervical spine . Each patient received two sessions each week for three weeks, during which their visual analogue scale, and neck disability index were measured. An inclinometer was used to measure the cervical passive range of motion. Data was collected at the commencement of the study and again after three weeks of treatment. SPSS 21 was used to analyze the data. Results: Twenty (20%) of the 40 individuals were in each of the two groups. The average age in Group-A was 42.7511.13 years. It remained 40.509.14 years in Group-B. On all metrics, the eccentric muscular energy technique and static stretching approach equally demonstrated substantial results that is P Value is less than 0.05.Conclusion: Both approaches were shown to be equally successful in lowering neck impairment, enhancing cervical range of motion, and decreasing pain

Provision of copy dentures to complete denture patients is often needed in clinical practice. Several edentulous patients want an additional set of dentures to avoid being without them in case the existing ones are broken or lost, whereas some patients have adapted to their old dentures so much that they do not want them to be replaced by a completely new prosthesis. This article presents a technique for the fabrication of a copy denture that allows duplicate dentures to be processed in heat-cure acrylic resin in two clinical visits, without leaving the dentures at dental office.

The aim of the current research was to investigate breathing exercise as prenatal education during primigravida and its effect on labor pain. Selfreporting Visual Analogue Scale, Present Behavioral Intensity, and Three Types of Breathing Exercises were used to assess variables under study. Data was collected from (n=140) primigravida. Experimental research design was used in the current study. The results revealed a significant difference between the two groups. The Slow Deep Breathing group (2.820.60) experienced far less pain than the other two groups. Moreover, ANOVA findings showed significant results and indicated that the expecting mothers in the study group (2.82) had a significantly lower mean pain score (P=0.035) than those in the control group (3.20). Furthermore, the results of evaluating pain on a visual analogue scale every 30 minutes suggested that the mothers in the study group suffering from chronic pain (6.72) had a considerably lower mean score (P=0.001) than those in the control group (9.36). During the course of labor, each group's pain level grew but the study group experienced less pain than the control group, which experienced pain at a near-maximal level.

Objective: To evaluate the frequency of PPD allergic contact dermatitis in hair dye users in Faisalabad district. Study Design: Cross Sectional study. Place and Duration of Study: Dermatology Outpatient Department of District Headquarter Hospital, Faisalabad from 01-07-2018 to 31-12-2018. Methodology: A cross sectional study was carried out in Dermatology Outpatient Department and 135 patients were included. Male and female patients were included in this study with the age between Results: A total number of 135 patients were included in this study. Gendser distribution showed that there were 110 (81.5%) males and 25 (18.5%) females. The mean age of the patients was 38.04±4.96 years. The mean duration of hair dye use of the patients was 4±1.5 years. There were 92 (68.1%) patients between 30-40 years of age and 43 (31.9%) patients between 41-50 years of age. There were 80 (59.3%) patients between 3-4 years of duration of hair dye and 55 (40.7%) patients between 4-5 years of duration of hair dye. PPD allergic dermatitis was observed in 13 (9.6) patients. There was no association between gender (p=0.232), age (p=0.591) and duration of hair dye use (p=0.676) with respect to PPD allergic dermatitis. Conclusion: Para-phenylenediamineis the commonest cause of hair dye contact dermatitis. Patients can present with a variety of clinical manifestations, including severe reactions. Patch testing remains the gold standard method for confirming PPD allergy. Avoiding future contact with permanent and semi-permanent hair dyes is the standard preventative measure. Keywords: Allergy, Hair, Phenylenediamine, Para-Phenylenediamine.

Objective: Was to determine the frequency of post cementation sensitivity of glass ionomer cement (GIC). Materials and methods: This cross sectional study included 86 participants with age from 20 to 65 years, both males and females, Pakistani nationals, abutment teeth with vital pulp without attrition, erosion or abrasion and no pulp capping agents used. The participants who had undergone Orthodontic treatment in last three months, or used bleach, having periodontal surgery, using medication like carbamazepine or analgesics and Psychiatric patients were excluded. Participants were asked about post cementation sensitivity on call at 24 hours. Descriptive statistics were calculated. Chi-square test was applied for comparison among gender and age groups. Results: The mean age was 40.27±10.68 years. The females were 33 (38.37%) and males were 53(61.63%). Postcementation sensitivity was found in 10(11.63%) participants. The most common type of sensitivity was moderate present in 5(5.81%) followed by severe present in 3(3.49%) and least was mild present in 2(2.23%) participants. The frequency of postcementation sensitivity was higher in younger age (n=7, 35%) than older ages statistically (p=0.003). Similar results were found for type of postcementation sensitivity (p=0.046). Conclusion: The frequency of post cementation sensitivity is quiet higher and most frequent in young ages. Keywords: Post cementation sensitivity, glass ionomer cement, luting agent.

Objective: To evaluate the mean values of Genial angle measured by Lateral cephalogram and Orthopantomogram. Study Design: comparative cross sectional study. Place and Duration of Study: Armed Forces Institute of Dentistry, Rawalpindi, from Aug 2018 to Feb 2019. Methodology: Patients irrespective of gender between the ages of 13-20 who reported for the treatment of class I malocclusion with complete anterior dentition were included. Orthopantomogram and lateral cephalogram were drawn by the same person. Gonial angle on orthopantomogram was measured by drawing tangents on posterior border of ramus and lower border of mandible on both halves of orthopantomogram. On lateral cephalogram the angle was measured between ramus and mandible. Gonial angle measured from lateral cephalogram and orthopantomogram were compared. T-test was applied. Results: Mean age of the individuals was 18.33 ± 3.97 years. The mean gonial angle measured on lateral cephalogram was 122.66 ± 1.64 degrees while the mean gonial angle measured on right and left side of orthopantomogram was 122.41 ± 1.56 degrees and 122.33 ± 1.55 degrees respectively. Conclusion: Orthopantomogram can also be used to measure gonial angle as accurately as a lateral cephalogram with the advantage that there are no superimpositions and both the gonial angles can be measured simultaneously on orthopantomogram.

Aim: To assess the efficacy of Narrowband Ultraviolet B therapy for management of patients presenting with hand vitiligo. Study design: Descriptive case series. Place and duration of study: Department of Dermatology Unit-II, Mayo Hospital, Lahore from 15-03-2018 to 5-09-2018. Methodology: This descriptive case series study was done at Mayo Hospital, Lahore from 15-03-2021 to 05-09-2018. A total of 355 patients were included in this study from 16-60 years of age either gender. Results: The mean age was 37.79±12.66 years from 16 to 60 years. There were 176(49.6%) male and 179(50.4%) female cases. According to operational definition, 25(70.4%) cases achieved efficacy of treatment. Conclusion: It is concluded that efficacy of Narrowband Ultraviolet B therapy for the management of patients presenting with hand vitiligo is 70.4%. So, using this treatment method we can improve patient quality of life and can reduce the psychological squeal. Keywords: Vitiligo, Phototherapy, Treatment, Targeted Narrowband Ultraviolet B Phototherapy, Efficacy.

Objective: To compare the frequency of clinical failure of lingual retainers bonded with primerless flowable adhesives and conventional bonding adhesives. Study Design: Quasi experimental study. Place and Duration of Study: Department of Orthodontics, Armed Forces Institute of Dentistry Rawalpindi, from Jul 2017 to Jun 2018. Methodology: As per selection criteria, 76 patients were selected by non-probability consecutive sampling technique. Patients were divided into two groups: the conventional bonding adhesive and the primerless flowable adhesive group with 38 patients in each group. Retainers were bonded using standardized procedure with conventional bonding adhesive in one group and primerless flowable adhesive for bonding in the other group. After bonding of retainers, patients were recalled after 3 months and any bonding failures were recorded. Results: Failure rate with conventional bonding adhesive was 10.5% while on the other hand, failure with primerless flowable adhesive was 31.6% with a p-value of 0.047 which showed a statistically significant difference. Conclusion: There was a statistically significant difference of clinical failure rate of lingual retainers bonded with conventional bonding adhesive versus primerless flowable adhesive with greater failure rate of the primerless flowable adhesive.

In this study, fertility enhancing effect of ethanol extract of aerial parts of Fagonia arabica was evaluated. 24 female and 12 male virgin Wistar rats (Average wt 150-250g) were selected. Dose was given daily for 23 days in 4 groups of animal. After 23 days, they were cohabitated for mating. Then dosing was continued for further 5 days. On 5th day of mating, sperm counting was done by observing vaginal smear under the microscope which showed fertility enhancement in male. Female were kept separately until delivery. The number of pubs born provided female fertility enhancement as compared to control. Average sperm count in 1 cm2 were counted in group A, B, C and control as 14.000±1.732, 12.000±1.000, 23.333±1.528 and 11.000±1.000 respectively. Number of pubs were counted in Group A, B, C and D as 8.667±2.082, 7.333±1.528, 7.333±1.528 10.000±2.000 and 5.333±0.577 respectively and fertility index was calculated for Group A, B and C as 62.516%, 37.502% and 87.512% respectively. Result showed that the orally administered dose of Fagonia arabica possess highly significant fertility enhancing activity in male and female rats after observing improvement in the sperm count and number of pubs as compared to control.

Overuse or repetitive motion can develop De-syndrome, Quervain's which produces pain along the thumb side of the wrist. The thumb tendons get irritated or inflamed as a result of these motions. Activities that involve regular side-to-side extension of the thumb or wrist might trigger De Quervain's tenosynovitis. Objective: To assess the efficacy of therapeutic ultrasound in De-Quervain's Tenosynovitis. Methods: In this study, forty people were separated into two groups: interventional and control groups, each with 20 people. Results: The interventional group's mean age was 37.70 with a standard deviation of 7.921, while the control group's mean age was 36.60 with a standard deviation of 7.816. Out of 20 individuals in the intervention group, 10 were male and 10 were female, whereas in the control group, 11 were male and 9 were female. The interventional group's mean height and weight were 1.642m0.1740 and 75.9515.830, respectively, while the control group's mean height and weight were 1.675m01517 and 75.5013.296. Out of the 20 patients in the interventional group, one was underweight, seven were normal weight, four were overweight, and eight were obese. Eight patients in the control group were of normal weight, seven were overweight, and five were obese. Conclusions: It was determined that ultrasonic therapy is useful in treating De-tenosynovitis quervain's when the tendon is inflamed

Macrodontia presents various complications such as arch length discrepancies, unstable occlusion and esthetic issues.Complex treatment planning and a multidisciplinary approach are required in treating these patients. We have presented two cases of bilateral mandibular second premolar macrodontia associated with a bilateral crossbite.

Introduction We evaluated the knowledge of non-steroidal antiinflammatorydrugs (NSAIDs) including their dosage, side effects,contraindications, and drug interactions among the patients in anoutpatient rheumatology clinic. Methods Patients in a rheumatology clinic completed a short surveyassessing their knowledge of over-the-counter NSAIDs. Results The survey was provided to 400 participants and 275(68.5%) were using over-the-counter (OTC) NSAIDs. The majorityof the participants identified their commonly used NSAID. Almost athird were unaware of the contraindication of NSAIDs such as pepticulcer disease, chronic kidney disease, and hypertension. Nearly 53.9%participants denied having any discussion of OTC medications withtheir providers. Two-thirds of the respondents reported seeing onlythe medication packaging for the dose determination (67.8%). Conclusions The gap in patient knowledge of the potential sideeffects and the lack of discussion of OTC medications by the providersmay be predisposing the patients to preventable side effects fromNSAIDs.

Five different isolates of Pakistani cannabis belonging to varying locations were analyzed for the presence of a reported tetrahydrocannabinolic acid (THCA) synthase marker or gene. The amplification of the marker (12 kb) from the five isolates confirmed them to be drug-type since the association of the marker with drug-type cannabis plants had already been established in other reports. The sequence analysis of the THCA synthase marker revealed two single nucleotide polymorphisms (SNPs) (i.e. A851→T851 and A883→C883) specific to Pakistani drug-type cannabis. Furthermore, the predicted protein sequence of the isolated sequences also showed two amino acid substitutions (D284→V284 and T295→P295) corresponding to the identified SNPs. However, the homology based three dimensional models of the inferred proteins generated via Swiss-Model-an automated online server did not project any changes at the active sites of the enzyme (THCA) due to D→V and T→P substitutions. The two missense mutations uncovered as a result of this study may assist in distinguishing the products of Pakistani cannabis among the smuggled materials.

Objective To determine the frequency of coincidence of facial and dental midlines in a sample of Pakistani subjects. Study design Cross-sectional study. Place and duration of study Department of Prosthodontics, Fatima Jinnah Dental College and Hospital, Karachi, from October to December 2017. Methodology Subjects of either gender (n=117) were selected from pool of otherwise healthy dental students. Facial portrait photographs using a DSLR camera were obtained while keeping the teeth in maximum inter-cuspation position. Auto-CAD software was used to analyse the coincidence of facial, maxillary and mandibular midlines. SPSS Version 23.0 was used for data analysis. The coincidence of the midlines were determined using Pearson correlation test. Level of significance was set at 0.05. Results The coincidence of maxilla-mandible midlines was 64.1% (75/117); whereas, coincidence of facial midline with maxillary and mandibular midlines were 47.9% (56/117) and 46.1% (54/117), respectively. Left sided deviations of dental midlines were more frequent than the right side. Conclusion The coincidence of inter-maxillary midlines was seen in two-thirds of the participants only. The dental midlines were coincident with the facial midline in less than half of the sample.

Objective To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects. Methods The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper's plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper's plane was measured. On both profile pictures, lines were drawn from base of the ala to the superior, middle and inferior points on the tragus. The angle between ala-tragus line and Camper's plane were measured. Intra-orally, height of the mandibular occlusal plane in relation to the retromolar pad was evaluated using a stainless steel scale. Data was analysed using SPSS 23. Results Of the 109 subjects with a mean age of 23.03±1.36 years, 76(69.72%) were females. Horizontal parallelism of occlusal plane with inter-pupillary line was observed with a mean angle of 1.17±1.27 degrees. The angle between the occlusal plane and the inferior ala-tragus line was 4.25 degrees on the right side, and 4.50 degrees on the left. Intraorally, mandibular occlusal plane coincided with the inferior 48(44%) and the middle third 48(44%) of the retromolar pad. Conclusions Inter-pupillary line and retromolar pad area should be used as a guide in the determination of plane of occlusion. The ala-tragus line was not found to be a reliable guide.

Introduction Analysis of smile is imperative in the diagnosis and treatment planning phases of aesthetic dentistry. Aim To evaluate the components of smile among students of a dental institution. Methods Frontal view digital photographs with posed smile of 157 dental students were assessed using Adobe Photoshop7.0. Smile characteristics evaluated included; smile line, smile arc, smile design, upper lip curvature, labiodental relationship and number of teeth displayed. Data were analyzed using SPSS version 23.0. Pearson chi-square test was used to determine the gender based differences for various parameters. Results Average smile line (43.3%), consonant smile arcs (45.2%), cuspid smiles (45.9%), upward lip curvature (43.9%), maxillary anterior teeth not covered by lower lip (60.5%) and teeth displayed up to first premolars (35.7%). Gender based differences were not statistically significant except for smile arc (p value = 0.02) and number of teeth displayed (p value p value p value = 0.01) revealing that upward lip curvature was associated with commissure type smiles and consonant smile arcs. Conclusions The smile characteristics should be considered before beginning the aesthetic treatment of the patient to obtain adequate results in oral rehabilitation.