Journal of Gandhara Medical and Dental Science

Navigating the Challenges of Sustainable Dental Practices: Opportunities for Green Innovation in Dentistry

Wajiha Qamar — Wed, 01 Jan 2025 00:00:00 -0600

As environmental concerns progress, it is becoming increasingly crucial to consider the transition to sustainable periodontal care. Adopting eco-friendly materials and techniques in dentistry not only fulfils international sustainability criteria but also provides considerable long-term benefits to dental practices and their patients.¹ Traditional dental products and practices have a significant environmental impact. The consumption of harmful compounds, non-biodegradable plastics, and heavy metals contributes to environmental contamination. Dental practices can drastically reduce their impact on the environment by transitioning to environmentally friendly materials like biodegradable composites and non-toxic sterilization processes.² The transition is essential to developing a sustainable healthcare system prioritizing human and environmental well-being. While eco-friendly products and technologies may appear expensive initially, they provide significant economic advantages in the future. For example, installing water- and energy-efficient equipment can result in substantial long-term savings on utility expenses. These projects' incremental cost-effectiveness ratios (ICERs) often demonstrate that long- term savings outweigh the initial costs. By carefully analyzing the ICER, dental practices may make informed decisions that benefit both the environment and their economic line. Additionally, promoting green dentistry can help a practice's reputation and attract environmentally concerned patients, potentially increasing patient referrals and loyalty while improving financial stability.³ Patients with concerns about the environment and who prefer to receive care from providers prioritizing sustainability are becoming increasingly prevalent. In a competitive market, dental clinics can differentiate themselves by promoting green dentistry, which may increase patient referral and loyalty rates. This may increase income growth and improve the practice’s overall financial stability. Biocompatible materials, for instance, reduce the risk of allergic reactions and other side effects, enhancing patient safety and satisfaction. Additionally, advanced, environmentally friendly technologies like digital radiography minimize radiation exposure while improving diagnostic accuracy and treatment planning. These benefits contribute to higher standards of care, a core objective of the periodontal community.

Eco-friendly products can produce better therapeutic benefits. For example, biocompatible materials can improve patient safety and satisfaction by lowering the risk of allergic reactions and other side effects.⁴ Also, environmentally friendly materials can provide better clinical effects. Biocompatible materials, for example, minimize the likelihood of allergic responses and other side effects, hence improving patient safety and satisfaction. Adopting sophisticated, sustainable technology, such as digital radiography, decreases radiation exposure while improving diagnostic accuracy and treatment planning. These advantages contribute to greater care levels, which is the periodontal community’s primary goal. Adopting sustainable periodontal procedures is both ethical and practical. Adopting environmentally friendly materials and methods can help dental offices save money over time, enhance patient outcomes, and gain a competitive advantage in their sector. The periodontal community must advocate for and support integrating sustainable practices to advance patient health and global environmental well-being.

Anatomical Variations of Extrahepatic Biliary Tract and Related Vessels during Laparoscopic Cholecystectomy

Muhammad Bilawal Khan, Muhammad Iftikhar, Siddique Ahmad — Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

This study aims to add to the existing knowledge by evaluating the frequency of usual pathologies in the biliary system and blood vessels observed during Laparoscopic cholecystectomy.

METHODOLOGY

This cross-sectional study was conducted at the General Surgery Department of Hayatabad Medical Complex, Peshawar, from November 2022 to November 2023. The study comprised 65 patients aged 18-50 with known cases of cholelithiasis. Exclusion criteria included patients with empyema gallbladder, gallbladder carcinoma, and a history of diabetes mellitus or hypertension.
RESULTS
The mean age of patients was 40.1±3.95 years, with females comprising 64.6% and males comprising 35.4% of the sample. Overall, extrahepatic biliary tract anomalies were found in 24.6% of cases. The incidence of anatomic variations in the present study was as follows; a short cystic duct was the most frequent variation observed in the present study and was found in 9.2%, followed by a long cystic duct (7.7%), duct of Luschka, and Moynihan hump anomaly (3.1% each).

CONCLUSION

Out of all the parameters, short cystic duct predominated, emphasizing the significance of a perfect surgical approach. The fact that anomalies are distributed equally across the various demographics underlines their inherent attributes. These findings call for further research that will enhance the performance of surgeries and the benefits of laparoscopic cholecystectomy treatments.

Understanding the Coexistence of Adenomyosis and Uterine Fibroids in Patients with Endometriosis to Enhance Treatment and Fertility Outcomes

Hina Niaz, Dure Nayab, Asaf Alam Khan — Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

This study investigated the coexistence of adenomyosis and uterine fibroids in individuals diagnosed with endometriosis. This research seeks to contribute to understanding how these conditions interact, aiming to improve treatment strategies and enhance patient fertility outcomes.

METHODOLOGY

This study aims to evaluate 250 patients suspected of endometriosis with the help of clinical investigation and ultrasound (US). From the US study, we examined the existence of endometriosis with either uterine fibroid or adenomyosis based on patient age groups (less than 32 years, 33 to 42 years, and 43 and above). In addition, ovarian endometriosis and profoundly infiltrating endometriosis were evaluated.
RESULTS
US study diagnosed adenomyosis in 3.2% of cases, fibroids in 21.8%, and the coexistence of both fibroid and adenomyosis in 14.2% of the cases. Intranural fibroids were found at 11.4%, submucous fibroids 1.6% and subserous at 8.1% of the total. Patients with an age of more than 33 years were more affected by adenomyosis, uterine fibroids, and both adenomyosis and uterine fibroid. There was no statistically significant correlation between uterine diseases and endometriosis. Additionally, no correlation was found between endometriosis and the patient’s age.
CONCLUSION
Our findings indicate that women over 32 are more likely to experience these comorbidities, complicating infertility outcomes. The significant association between adenomyosis and severe endometriosis reinforces the need for comprehensive diagnostic evaluation to inform tailored treatment plans. Future research should investigate the interactions between these conditions further to improve diagnostic and therapeutic approaches.

Comparison of Vaginal Versus Sublingual Misoprostol in the Treatment of First-Trimester Missed Miscarriages

Maimoona Qadir — Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

To evaluate the efficacy of sublingual versus vaginal misoprostol for the treatment of missed miscarriages in the first trimester of pregnancy.

METHODOLOGY

The gynecology and obstetrics department of Khyber Teaching Hospital in Peshawar conducted this Randomized Controlled Trial investigation from January 2021 to December 2023. Two groups of patients were formed, according to the FIGO procedure, based on whether misoprostol was given vaginally or orally. The dosages of 800 micrograms were administered vaginally to the first group and sublingually to the second group every three hours. Patients were observed for vaginal bleeding and evacuation after 24 hours; if neither happened, the dose was repeated.

RESULTS
The groups did not differ statistically (P-value > 0.05). The mean age of the patients (26.56 ± 5.73 versus 25.45 ± 5.63), parity of the patients (3.31 ± 0.56 versus 3.22 ± 0.54), period of gestation (8.85 ± 1.63 versus 9.37 ± 1.48), and time from initiation of induction till expulsion (13.68 ± 3.52 versus 12.94 ± 3.45) were similar in both groups. For a complete miscarriage in the vaginal misoprostol group, more doses (4.28 ± 0.65 vs 3.26 ± 1.23, P-value < 0.05) were needed. In comparison to the vaginal misoprostol group (56%), the sublingual group (91.6%) reported feeling more comfortable (P-value < 0.05) throughout the drug’s administration. The sublingual misoprostol group had a considerably (P-value < 0.05) better success rate (77.66%) compared to the vaginal misoprostol group (56.32%). Such adverse effects as bleeding during menstruation (68.33% versus 93.33%), vaginal bleeding (31.66% versus 84%), and diarrhoea (30.57% vs 59%) had significant (P-value < 0.05) association with sublingual misoprostol.

CONCLUSION

The efficacy of sublingual misoprostol surpasses vaginal misoprostol. Patients are more satisfied and respond more favourably to the sublingual approach.

Salivary Biomarker Levels and Periodontal Health Status in Patients with Diabetic and Healthy Lifestyle: A Comparative Study

Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

To evaluate and compare the periodontal health status and salivary biomarker levels in diabetic patients and non-diabetic individuals, thereby determining the association between these factors.

METHODOLOGY

A comparative study included 100 participants divided into two groups: 50 diabetic patients and 50 healthy controls. Periodontal parameters such as the gingival index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) were assessed. Salivary biomarkers, including interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and glucose levels, were measured using enzyme-linked immunosorbent assay (ELISA) techniques. Statistical analysis was conducted using SPSS software.

RESULTS
Diabetic patients exhibited significantly higher periodontal parameters (GI, PPD, CAL) compared to healthy controls (p < 0.05). Salivary biomarkers, particularly IL-6 and TNF-α, were markedly elevated in the diabetic group (p < 0.01). There was a strong positive correlation between salivary glucose levels and periodontal parameters (p < 0.001).

CONCLUSION

Diabetic individuals show worse periodontal health and elevated salivary inflammatory biomarkers compared to non-diabetic controls. This suggests a need for closer periodontal monitoring in diabetic patients to mitigate further systemic complications.

Comparative Evaluation of Periodontal Parameters and Microbiological Profile in Smokers and Non-Smokers

Zeeshan Danish, Mahirah Iqbal, Irfan Salim, Taif Ahmad, Abira Hamid , Hina Tariq — Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

This study aims to evaluate the differences in periodontal parameters and the microbiological profile between smokers and non-smokers to analyze the impact of smoking on periodontal health.

METHODOLOGY

A cross-sectional study was conducted involving 100 participants divided into two groups: smokers (n=50) and non-smokers (n=50). Clinical periodontal parameters, including probing depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), and plaque index (PI) were recorded. Subgingival plaque samples were collected and analyzed using quantitative polymerase chain reaction (qPCR) for key periodontal pathogens.

RESULTS
Smokers exhibited significantly higher PD and CAL, with lower BOP compared to non-smokers. The microbiological analysis revealed a higher prevalence of Porphyromonas gingivalis and Tannerella forsythia in smokers, while non-smokers had a more diverse microbiota with higher levels of Streptococcus spp (p < 0.05).

CONCLUSION

These findings underscore the importance of smoking cessation in periodontal therapy and the need for tailored treatment strategies for smokers.

Frequency of Metabolic Syndrome in Schizophrenic Patients in a Tertiary Care Hospital, Peshawar, Pakistan

Fazle Rabbani , Waleed Ahmed — Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

This study aimed to determine the prevalence of metabolic syndrome in schizophrenic patients in a tertiary care hospital.

METHODOLOGY

This descriptive cross-sectional study was conducted at the Department of Psychiatry, PGMI Lady Reading Hospital Peshawar, Pakistan, from March 2023 to February 2024. A total of 196 schizophrenic patients were studied. After obtaining permission from the hospital's ethical committee and consent from patients included in the study, metabolic syndrome was diagnosed based on the American Association of Clinical Endocrinology criteria (2003). All the data, like age, gender, height, weight, BMI, smoking status, and metabolic syndrome, were recorded in a pre-designed proforma. All the data were analyzed in SPSS version 20. Mean and standard deviation were calculated for numerical variables, and frequencies and percentages for qualitative variables. The Chi-square test for categorical variables was applied with a p-value of < 0.05 as significant. Results were presented in the form of tables and charts.

RESULTS
The mean and standard deviation of age, height, weight, and BMI were 35.72±13.28, 164.80±11.50, 71.87±13.60 and 27.00±6.96, respectively. Out of 196 schizophrenic patients, 59 patients had metabolic syndrome, making up 31.1%, while 69.9% of patients had no metabolic syndrome. Of 196 schizophrenic patients, 106 were female, and 90 were male, making 54.1% and 45.9%, respectively, of all schizophrenic patients. Among 196 patients, 28 were from the BMI group < 18kg/m2, 71 from the BMI group 18-24kg/m2, 51 from the BMI group 25-30kg/m2, and 46 from the BMI group> 30kg/m2 making 14.3%, 36.2%, 26.0% and 23.5% respectively. Metabolic syndrome was statistically significant in age and BMI groups using the chi-square test with a p-value < 0.05 as significant.

CONCLUSION

The metabolic syndrome affects individuals with schizophrenia, particularly among older patients and those with a high BMI. Significant associations were observed with age and BMI, but gender and smoking status did not show significant differences.

A Five-Year Trend of Medical Books among House Officers of Abbottabad-In the Perspective Of Self-Regulated Learning Mode

Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

In the current study, the primary motive is to access the choices of medical books and trends among house officers retrospectively, from 1^st year to the final year of MBBS.

METHODOLOGY

After approval of the study from the ethical committee, the cross-sectional study was undertaken in the public-private medical teaching hospitals of Abbottabad-Pakistan. The study was conducted from January 2023 to January 2024. The nonprobability purposive sampling technique was applied for data collection on a predesigned written questionnaire. The data was analyzed using SPSS software version 21.

RESULTS
Around 344 house officers (n=344) participated in the present study. Most of the participants were male {65% (225/344)}. About 300/344 use electronic media with significant female gender predominance (p=0.03). In terms of 5-year academic performance, 60% of females (71/119) had average scores in MBBS with a significance of 0.003. The rate of below-average results was 32% (96/300) in participants who preferred electronic media, while the rate was only 18% (8/44) in participants who used print media with a significance of 0.05. The fundamentals of gynecology by Arshad Chohan was significantly preferred by females as compared to Irfan Masood by males with a p-value of 0.04.

CONCLUSION

The majority of house officers used the textbooks of international authors in the first 3 years of graduation as a standard primary book but here after many preferred the books of local authors. The use of electronic media to achieve the goal is common but the effect on academics was not productive.

Frequency of Positive Fecal Occult Blood Test in Patients with Cirrhosis

Faisal Khan, Aliena Badshah, Durkho Atif, Muhammad Irshad — Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

The objective of this study is to determine the frequency of positive fecal occult blood tests in patients with cirrhosis.

METHODOLOGY

This descriptive cross-sectional study had a total of 154 patients observed for six months i.e., from 12/3/2023 to 12/9/2023 in the Department of Medicine, Khyber Teaching Hospital, Peshawar. Patients (aged 18-70 years) were worked up with detailed history and clinical examination to reveal ascites, coagulopathy, jaundice, splenomegaly, cachexia, and gynecomastia. After having excluded the confounders, a morning fecal sample was taken under aseptic conditions in a specialized fecal occult blood testing kit and sent for laboratory evaluation for interpretation. The sampling technique was consecutive non-probability. All investigations were done from the same laboratory and under the supervision of a hematologist with three years of fellowship experience. Data was stored and analyzed by the statistical program IBM-SPSS version 22. Frequencies and percentages were calculated for qualitative variables like gender, child-pugh class for cirrhosis, and positive fecal occult blood test. Post-stratification was done through a chi-square test and p-values <0.05 were considered as significant.

RESULTS
In this study, the mean age was 57 years with SD ± 11.27. Sixty-two percent of patients were males while 38% of patients were females. The mean duration of the disease was 1 year with SD ± 3.57. More than 37% of patients had a positive fecal occult blood test while 63% of patients had a negative fecal occult blood test.

CONCLUSION

Our study shows that the frequency of positive fecal occult blood tests was 37% in patients with cirrhosis.

Impact of Diabetes on Outcomes of Laparoscopic Cholecystectomy: A Prospective Study

Wed, 31 Dec 2025 00:00:00 -0600

OBJECTIVES

This study aims to assess the impact of diabetes on laparoscopic cholecystectomy (LC) outcomes, as optimizing results for diabetic patients undergoing this common surgery presents unique clinical challenges.

METHODOLOGY

We comprehensively analyzed 258 participants, comparing 60 individuals with diabetes to 198 non-diabetic counterparts. Key variables, including age, gender, BMI, comorbidities, ASA grade, and CCI index, were assessed. Additionally, intraoperative and postoperative characteristics, ultrasound findings, and outcomes were analyzed.
RESULTS
Diabetic individuals exhibited advanced age, a higher BMI, and increased severity of illness based on their ASA grade and CCI index. Intraoperatively, diabetic individuals showed higher probabilities of empyema of the GB (23.3%), thick wall gallbladder (3.8%), mucocele (8.3%), gangrenous (10.8%), and other complications. The model explained variability in outcomes such as severe complications (6.6%), intraoperative hemorrhages (5%), conversion to open surgery (4.2%), and length of hospital stay (1.58±1.01 SD). Persistent pain 13 (5.03%), port site infection 30 (11.6%), intraabdominal abscess 5 (1.9%), bile duct injury 8 (3.1%), jaundice 8 (3.1%), and readmission to the hospital 4 (1.5%) were noted.
CONCLUSION
Diabetic individuals undergoing laparoscopic cholecystectomy present distinct clinical features and higher probabilities of specific intraoperative and postoperative complications. The multivariate analysis provides insights into the variability of outcomes, emphasizing the importance of tailored approaches for diabetic patients in this surgical context.

Race of GLPS: Impact on Weight and Glycemic Control on Type 2 Diabetes with Semaglutide Versus Liraglutide

Tue, 31 Dec 2024 00:00:00 -0600

OBJECTIVES

Semaglutide is a glucagon-like peptide-1 receptor agonist that improves glycemic control and reduces body weight in patients with type 2 diabetes. This study aimed to evaluate the effect of Semaglutide with standard Metformin on glycemic control and BMI after 3 and 6 months of treatment. Additionally, we compared the glycemic control and weight benefits of Semaglutide vs. liraglutide.

METHODOLOGY

This longitudinal cohort study was conducted in a general practice clinic in Clifton and a family medicine health center in Ziauddin University, Karachi from April 2022 till April 2023. We enrolled 128 patients with type 2 diabetes who were treated with metformin alone. Patients received Semaglutide 2mg once weekly in addition to standard metformin 1gm bid for 6 months. HbA1C and BMI were measured at baseline, 3 months, and 6 months. We compared the glycemic control and weight loss of Semaglutide with a cohort of participants taking Liraglutide over a period of 6 months in the same catchment area in 2021 to determine which drug has an edge over the other.
RESULTS
Semaglutide was superior to Liraglutide in controlling sugars (HbA1c% reduction 1.13 vs 0.94) as well as in weight loss (10.6 vs 6.2kg) respectively. Single sample t-test showed a statistically significant difference from the hypothetical mean of HbA1C <6.5% (p-value <0.00) Paired t-test showed a strong correlation between initial weight and after 6 months’ weight and HbA1C respectively. (p-value <0.00 & 0.004).

CONCLUSION

Semaglutide has proven to be substantially beneficial in reducing weight (10.6kgs) and achieving optimal glycemic control (1.13% HbA1C reduction) over the 6-month study period. Semaglutide is superior to Liraglutide in controlling sugars and weight.

Clinical and Radiological Outcomes of Minimally Invasive vs Conventional Surgery for Lumbar Spinal Stenosis: A Prospective Cohort Study

Tue, 31 Dec 2024 00:00:00 -0600

Objective

The objective of this study is to compare the clinical and radiological outcomes of minimally invasive surgery (MIS) versus conventional surgery for patients with lumbar spinal stenosis (LSS).

Methods: This prospective cohort study was conducted at a tertiary care hospital in Peshawar, Pakistan, the study enrolled 200 patients diagnosed with symptomatic LSS, confirmed by MRI. Patients were assigned to MIS (n=100) or conventional surgery (n=100) groups based on surgeon discretion and patient preference. Preoperative and postoperative evaluations included clinical assessments using the Visual Analog Scale (VAS) for pain, Oswestry Disability Index (ODI), and patient satisfaction scores, alongside radiological assessments of spinal canal diameter and residual stenosis. Data analysis was performed using SPSS version 25.0, with a significance level set at p<0.05.

Results: The MIS group exhibited significantly lower VAS scores (6 months: 2.8±1.2 vs. 4.5±1.5, p<0.01; 12 months: 2.5±1.1 vs. 4.2±1.3, p<0.01) and ODI scores (6 months: 18.4±5.2 vs. 25.6±6.3, p<0.01; 12 months: 17.8±4.9 vs. 24.8±6.0, p<0.01) compared to the conventional surgery group. Patient satisfaction was higher in the MIS group (85% vs. 70%, p<0.05). Radiological outcomes showed a greater increase in spinal canal diameter in the MIS group at 6 months (13.5±1.4 mm vs. 12.1±1.5 mm, p<0.01) and 12 months (13.2±1.3 mm vs. 11.8±1.4 mm, p<0.01) postoperatively. The incidence of residual stenosis was lower in the MIS group at both follow-ups (6 months: 10% vs. 25%, p<0.05; 12 months: 12% vs. 28%, p<0.05).

Conclusion: MIS offers superior clinical and radiological outcomes compared to conventional surgery for LSS, with better pain relief, functional improvement, and patient satisfaction. The study supports MIS as a viable alternative to conventional surgery, though further research is needed to explore its long-term efficacy and safety.

Keywords: lumbar spinal stenosis, minimally invasive surgery, conventional surgery, clinical outcomes, radiological outcomes, prospective cohort study.