Journal of Gandhara Medical and Dental Science
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Novel Effects Associated with the Use of Probiotics, Synbiotics and Prebiotics
Get PDFTo maintain the wellbeing of the human gut, the role of its microflora and their metabolites is fundamental. Probiotics is a Greek term, which is used to define non-living microbes that are beneficial in nature and exert numerous advantages on the host body. The intestinal microflora’s function and activity may also be improved by administering some of the prebiotics (indigestible dietary fibers) independently or in a c combination with probiotics. The term “Synbiotics” is used to denote the combination of both prebiotics and probiotics. It should always be noted that numerous disorders are being associated with the abnormal function of microbiota/microflora that can be regulated and stabilized with the help of ingestion of probiotics, prebiotics or their combination. Multiple benefits are associated with the use of these probiotics, synbiotics and prebiotics including healthier digestive system, proper immune response of the gut and treatment of numerous GI tract disorders. All these issues are encountered because of treatments with new synthetic drugs that affect the digestive system as well as numerous organs in the body. Ulcerative colitis is a term that refers to chronic inflammation of the colon emerging as a result of improper immune response to intestinal microflora of the host. Researchers have studied the effects of synbiotics to treat this chronic condition1. As for the action mechanism of the synbiotics is concerned, it is assumed that they modulate the inflammatory response through expression of the cytokines, probiotic bacteria assisted modulation of the immune cells and prebiotics assisted production of certain short chain fatty acids. Jayanama and Theou studied the consequences of improper ingestion of probiotics and prebiotics in elderly patients. They revealed that physical inactivity, sarcopenia, and polypharmacy could be treated with the help of probiotics, prebiotics or a combination of both2. All the aforementioned disorders can lead to gut dysbiosis.
The researchers have also revealed that the gut microbiota homeostasis can be improved with the help of probiotics and prebiotics and they can be a helping hand in the prevention of aging and frailty. It is evident that left and right prescriptions of antibiotics and their use caused antibiotic resistance in the pathogens. This issue can be best resolved with the ingestion of probiotics and prebiotics. The systematic evidence to treat infected chronic wounds has been provided by Brognara et al3. Similarly, chronic wounds and burns treatment is done widely with the use of Lactobacillus plantarum. Some other researchers have reviewed the available data associated with the use of numerous prebiotics in the treatment of idiopathic constipation, and highly prevalent GIT disorrderrs4-6. This is due to the capability of prebiotics to improve the consistency of the stool, bloating and number of bowel movements. A limited data is available regarding the efficacy of prebiotics in the treatment of ulcerative colitis and pouchitis. It is concluded that probiotics, prebiotics and synbiotics have been imparting a role in treating GIT disorders including indigestion, traveler’s diarrhea, IBD etc. Scientific reports have revealed their role in the treatment of cancerous disease, obesity, kidney and brain disorders. Many tools for the research of probiotics, prebiotics and synbiotics are now available; therefore, the future bio-therapeutics are going to be changed with the passage of time
Management of Epulis Fissuratum of Mandibular Anterior Region By Maintaining The Vestibular Depth. A Case Report
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Epulis Fissuratum or Denture-induced hyperplasia is benign tumor-like hyperplasia of fibrous connective tissue, which develops usually in association with an ill-fitting complete or partial denture. The aim of this report is to present a case showing the treatment of Epulis fissuratum in relation to an ill-fitting denture with a Simple but innovative technique. The epulis was removed with the conventional surgical approach in which the excision of the epulis was carried out by a split-thickness flap approach in which the wound healing is achieved by secondary closure. The existing denture was relined with a soft tissue conditioner to maintain the depth of the vestibule by preventing the post-surgical wound contracture during healing and to prevent further surgery for vestibulopathy. In addition, the patient continued using the existing denture for functional and aesthetic purposes. After two weeks of wound healing, the vestibular depth was maintained by the relined existing denture. Then the new dentures were fabricated accordingly. After one month of follow-up, no signs of recurrence of epulis fissuratum were noticed
Correlation of Dental and Skeletal Maturity Using Dimirgian and Cervical Vertebral Maturation Indices in Orthodontic Patients
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To determine the correlation between skeletal and dental maturity using the cervical vertebral maturation (CVM) index (CVMI) and Demirjian index (DI) in orthodontic patients.
METHODOLOGY
Panoramic and lateral cephalogram radiographs of 105 patients pretreatment records were retrieved. Tooth calcification stages for mandibular left molar were recorded using Demirjian Index on the panoramic radiograph. The skeletal maturation stages were evaluated on a lateral cephalogram through CVMI staging. Fisher’s exact test and Cramer’s V values were estimated to determine the correlation between DI and CVMI. Weighted kappa statistics were used to determine the reproducibility of inter-observer assessment of DI and CVMI. A p-value of ≤ 0.05 was taken to be statistically significant.
RESULTS
A statistically significant correlation is present among the various stages of DI and CVMI for the males (Fisher exact = 25.006, Cramer’s V = 0.848, p = < 0.001) and females (Fisher exact = 41.006, Cramer’s V = 0.623, p = <0.001). A comparison of DI with respect to CVMI shows a more advanced skeletal stage in males than for female subjects.
CONCLUSION
The correlation between CVMI and DI stages was found to be highly significant. Stage D and F of DI were significantly correlated with stage 3 and stage 4 of CVMI in females and males respectively
Risk Factors for Bronchiolitis in Infants of Hazara Division - A Cross Sectional Study
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Bronchiolitis is one of the major causes of hospitalization in the infants. Higher rate of hospitalization and mortality can be reduced by recognizing and control of risk factors for bronchiolitis. The objective of this study is to ascertain risk factors of bronchiolitis in infants, in local population of Hazara Division.
METHODOLOGY
This cross-sectional study was done in Ayub teaching hospital form January, 2020 till June 2020. Infants of both gender from age of 3 months to 12 months were included with diagnosis of bronchiolitis. Patients with croup, pneumonia, cystic fibrosis and bronchomalasia are excluded. Demographic variables, clinical characteristics and risk factors of bronchiolitis related to infant, mother and family were documented on specific proforma. The data was analyzed by SPSS 21.
RESULTS
There were 101 infants. Mean age was 5±3.5 months. Male to female ratio was 2.8. 77.2% infant had de livery through surgical procedure and 82% are term. 45% infants were exclusively breast fed. 34% patients room were carpeted, 35% exposed to molds and 81% had history of contact with infected person.28% infants are exposed to passive smoke, 49% had history of allergies and 60% mothers uses perfume to their child’s. 31% infants have more than 10 family members and are living in 2 rooms (p=0.000). Infant weaned at 6month have late onset of bronchiolitis as compare to infants weaned before 6 months (p=0.000).
CONCLUSION
Perfume/powder use, family history of allergies, history of contact with respiratory infection, delivery with surgical procedure as major new risk factors. Carpets, mold, passive smoking, overcrowding, are also contributing risk factors
To Know the Effectiveness of Disc Excision in the Treatment of Herniated Lumbar Intervertebral Disc
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To evaluate the effectiveness of disc excision in the treatment of herniated lumbar intervertebral disc.METHODOLOGY
METHODOLGY
This study was conducted in the Department of Neurosurgery, Lady Reading Hospital, Peshawar. A total of 62 patients had moderate to severe radicular pain due to Prolapsed intervertebral disc at L4/5 or L5/S1. All the enrolled patients were subjected to disc excision surgery. Postoperatively the patients were kept for 48 hours for observation and then discharged. All the patients were advised to come after 2 weeks for the follow-up to check effectiveness.
RESULTS
The mean age of patients was 34.59± 7.49 years. There were 64.5% male and 35.5% female. 53.2% of patients had L4-L5, 33.9% of patients had L5-S1 and 12.9% of patients had both L4–L5 and L5–S1 level disc herniation. 85.5% of patients had no pain, 8.1% had mild pain and 04.8% had moderate pain. Postoperatively 79.0% of patients were satisfied.
CONCLUSION
As compared to conservative care limited disc excision is safe, effective, and reliable in terms of pain. Disc excision technique provides immediate relief from radicular pain
ROLE OF PAP SMEAR TEST: FROM SCREENING TO CURE IN TERTIARY CARE HOSPITAL
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This study aims to assess the Pap smear screening method’s accuracy in detecting precancerous lesions.
METHODOLOGY
After fulfilling the inclusion criteria patients were selected, the patient’s bladder was emptied and put in a dorsal position, and Cusco’s speculum was introduced after lubrication followed by insertion of Ayer’s spatula, applied on the transformational zone, and rotated in 360 degrees. Specimen smeared on glass slides and sent to the laboratory with fulfilled lab pre-requisite form. Patients were requested to follow up with a histopathology report.
RESULTS
Mean age of the patient was 38.111+9.461 years. Among the 77 patients whose samples were taken 15.4% were asymptomatic, 32.1% with vaginal discharge, 17.9% vaginal discharge,17.0% with intermenstrual bleeding and 16.7% were having lower abdominal pain with p-value=0.087. Histopathology reports were interpreted upon follow-up visit among those 1.3% came out to be positive for malignancy, 76.6% negative for malignancy while 22.1% had an inadequate sample.
CONCLUSION
The most common method for screening for cervical cancer is the Pap smear, but its efficacy in detecting early precancerous lesions is very low, possibly due to laboratory error or false technique to a gynecologist of sample technique in our tertiary care hospital. Other screening methods should be used instead of conventional Pap smear
Frequency of Post-Operative Fecal Incontinence and Healing Rate in Patients with Open and Closed Lateral Internal Anal Sphincterotomy
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This study aims to compare the frequency of fecal incontinence and healing rate in patients treated with Open Internal Anal Sphincterotomy (OIAS) and Closed Lateral Internal Anal Sphincterotomy (CLIAS).
METHODOLOGY
This randomized control trial was carried out in the Department of Surgery Hayatabad Medical Complex, Peshawar Pakistan from Feb 2019 to Feb 2020. Eighty-four patients were assigned to the open method in Group B while eighty-four patients were allocated to the closed method in Group A (using blade 11) through the randomized control trial method. Fecal incontinence and healing rate were observed on the 7 th postoperative day. SPSS 23.0 software was used to analyse the data.
RESULTS
In group A out of a total of 84 patients, 96% of patients were in category A, 4% of patients were in category B, and no patients were in categories C and D. In group B out of 84 patients, 96% of patients were in category A while 4% patients were in category B and no patients were in category C and D. The total faecal incontinence in Group B (open method) was 21% while total fecal incontinence in Group A (closed method) was only 4% that is a clear dierence between the two groups. In group A (closed method) out of 84 patients, 2 patients (2.38 %) showed delayed healing while 82 patients (97.61 %) showed normal healing. In group B (open method) 7.4% of patients showed delayed healing with a signicance p level of 0.04 while 92.85 showed normal healing.
CONCLUSION
Fecal incontinence was less in closed Lateral Anal Sphincterotomy due to the use of blade 11 while it was higher in open internal anal sphincterotomy. Similarly, the healing rate was signicantly higher in the closed method while delayed healing was seen in the open method
Knowledge, Attitude & Behaviors Related to Oral Health among Students & Faculty of Ayub Medical College, Abbottabad, Pakistan
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The aim of this study was to analyze the knowledge, attitude and practices of medical students and faculty related to oral health.
METHODOLOGY:
A cross-sectional study was conducted at Ayub Medical College, Abbottabad Pakistan comprising of medical students and their teaching faculty. The participants out of total 400 distributed data forms responded 330 questionnaires positively. Data analysis was performed using SPSS software version 25.0 (using descriptive analysis and Chi Square test). P value of less than 0.05 was statistically significant.
RESULTS:
The survey revealed that the high proportion (96.6%) of teachers knew about dental caries, which was significantly higher than students (p-value 0.031). High percentage of teachers had habit of brushing twice daily as compared to students (p=0.001).
CONCLUSION:
Within limitations of this survey, teaching faculty possessed better knowledge, attitude and behavior related to oral health as compared to medical students
Efficacy and Safety of Empagliflozin as Add-On Therapy in Patients of Type-2 Diabetes Mellitus
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To assess efficacy of two doses i.e., 10 mg and 25 mg in lowering the glycated haemoglobin (HbA1C) and fasting blood glucose (FBG) in patients of type 2 diabetes mellitus (T2DM) having suboptimal glycaemic control on maximal doses of Metformin and Sitagliptin, and to see the frequency of its side-effects.
METHODOLOGY:
The study design was a randomized control trial. Fifty nine adult patients of T2DM who were already on 2000 mg of Metformin and 100 mg of Sitagliptin and were having suboptimal glycaemic control (HBA1C >7% and <12%) were randomized to two groups, one group receiving 10 mg (Group A) and the other group receiving 25 mg of empagliflozin (Group B) as an additional treatment. HbA1C and FBG were taken before and 12 weeks after addition of empagliflozin in both the groups. Side effects of empagliflozin such as urinary tract infections (UTI) and genital mycotic infections were also recorded in both the groups.
RESULTS:
Total patients in-group A were 31 and their mean age was 51.48±4.29 years. In-group B there were 28 patients and their mean age was 52.39±5.20 years. There was a statistically significant reduction of both HbA1C and FBG in both the groups after empagliflozin treatment; (p=0.000) for both HbA1C and FBG in both the groups. Although numerically UTI and genital mycotic infections were more than pre-treatment numbers, they were not statistically significant (p>0.05).
CONCLUSION:
Empagliflozin can be safely added to the oral anti-diabetic regimen of patients with type 2 diabetes mellitus who have suboptimal glycaemic control and results in significant improvement in HbA1C
Outcome of Fistula in Ano after Incision Drainage of Acute Peri Anal Abscess
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To determine outcome of fistula in ano after incision drainage of acute peri anal abscess.
METHODOLOGY:
This descriptive case series study was conducted after approval of the Ethical committee. A total of 154 patients were observed for a six-month duration. Pre-design proforma was used to collect data. An inclusive criterion was age between 18-50 years of both genders with acute perianal abscess with low-level fistula (submucosal and mucocutaneous) and high-level fistula (ischiorectal and pelvirectal). Exclusive criterion was observed in all admitted patients who include secondary abscess formation for example diabetes mellitus, tuberculosis, and carcinoma with any previous history of fistula in ano. The result was analyzed through the SPSS-24 version.
RESULTS:
Ratio 35 (22.72%) was obtained for age group 18-30, 49 (31.81%) for age group 31-40 and 70 (45.44%) were in age group 41-50. The mean age was 38.25 years with SD ±9.70. The ratio of Males 143 (92.85%) leads high to females 11 (7.15%). The fistula was found in 64 (41.55%) patients postoperative after incision drainage for perianal abscess. Among 64 patients, 54 (37.01%) were male and 7 (4.54%) females. 90 (58.44%) patients had no fistula postoperatively. Low-level 45 (29.22%) and 19 (12.33%) high-level fistula was found in patients. Among the low-level ratio, 40 were male and 5 were female. Similarly, in high-level fistula 17 were male and 2 were female.
CONCLUSION:
Fistula is more common in males than females. Low lying fistula leads the chart more than a high lying fistula. The incidence of anal fistula in our observed patient’s abscess was 41.55%