Intermittent bupivacaine infusion into the rectus sheath space after midline laparotomy does not reduce postoperative opioid requirement nor does it affect postoperative pain score or peak expiratory flow rate.

Aim: Infection control is crucial in any clinical setting. It is vital that all dentists must follow the infection control protocols in their clinics to prevent cross-infection. In a dental clinic, even simple dental procedures including extractions, scaling and root planning, dental crown preparations and root canal treatment, have a high risk of exposure to blood, which may cause transmission bloodborne diseases. Dentist's compliance with these guidelines and recommendations have been recently studied in different parts of the world. Hence this study was performed to evaluate the knowledge, attitude, and practice regarding infection control measures among private dental practioners in Karachi, Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: This study was conducted for a period of four months in Karachi, Pakistan. Arif et al.; JAMMR, 30(8): 1-7, 2019; Article no.JAMMR.51446 2 Materials and Methods: Present cross-sectional study was performed by interviewing 234 dentists via a questionnaire based upon various questions regarding infection control. Sample were collected using convenience sampling, from private dental clinics in Karachi, Pakistan. Setting: Questionnaire were sent to 400 general dentist in Karachi, out of which 234 replied. Results: Mostly (69%) dentists who took part in the study were males. Regarding infection control, most of the individuals had a comprehensive understanding of infection control techniques. Isolation was considered to play a vital role in cross-infection prevention by 97.3% of the dentists. 93.2% used autoclave for sterilization and majority had thorough knowledge of the process involved. Regarding preventive measures, 66.7% of the dentists were vaccinated against major infectious agents in our society and 92.2% took protective measures required to prevent crossinfection. Conclusion: Knowledge, attitudes and practices regarding infection control of dentists in private clinic of Karachi, Pakistan are satisfactory. Original Research Article

Background: Medical emergencies are an unfortunate part of the dental practice, to which the dentist must have the required knowledge and means to counter them. In this study, we aimed to determine the nature and frequency of medical emergencies occurring in the dental offices of Karachi, Pakistan. We also aimed to ascertain the awareness and preparedness of dentists and their attitude towards training in management of these medical emergencies. Methods: In this study, 300 questionnaire forms were distributed to dentist at various colleges in Karachi city in the year 2015, out of which 244 complete and valid forms were received and used, giving a response rate of 81%. SPSS version 16.0 was used to compute and analyze the collected data. Results: Out of 244 respondents, 23% were males and 77% were females. Since, 83% of the dentist had faced a medical emergency at least once in their practice. Highest recorded medical emergency was found to be syncope (faints) being reported by 71% of the dentist. Most of the medical emergencies (89%) took place during an extraction procedure. 55% dentist claimed that they were prepared enough to manage an emergency. Irrespective of their perceived abilities, 100% showed keen interest in the field of improvement through continuing education in management of medical emergency. Conclusion: Medical emergencies are common in dental practice and a substantial proportion of dentists feel incompetent in handling such situations. This requires better medical emergency management courses and training in undergraduate dental programs as well as continued dental education and training.

Purpose: To determine whether oil-pulling with sesame or coconut oil yields a better result in reducing Streptococcus mutans count compared to conventional chlorhexidine mouthwashes. Methods: Multiple databases were used to search for articles up to and including August 2019. Studies which reported use of oil-pulling and chlorhexidine mouthwashes to reduce Streptococcus mutans bacterial count were analyzed procedurally. Studies that fulfilled the inclusion criteria were then undertaken for qualitative and quantitative analysis. Results: Five studies were included in this analysis, which used oil-pulling (test group) and chlorhexidine mouthwash (control group). The follow-up period ranged from 14 to 30 days. The oil used in oil-pulling group were either sesame or coconut oil. Quantitative analysis showed a significant reduction in oral Streptococcus mutans count with oil-pulling as compared to chlorhexidine mouthwash at follow-up (Q value = 6.61, DF = 4, I2 = 39.50%). Conclusion: Use of oil-pulling showed better result in reducing cariogenic bacterial count as compared to the gold standard chlorhexidine mouthwashes. More clinical trials, evaluating additional oral hygiene parameters, would further validate the effects of oil-pulling on the oral cavity. Clinicians may advise their patients to use oil-pulling instead of chlorhexidine mouthwashes, as it is safe, cost-effective, and easily available.

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