Background Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life. Methods This retrospective cohort study was conducted including neonates of < 32 weeks gestational age (GA) and birth weight < 1500 g, admitted to NICU from April-2017 to December-2018 and received caffeine therapy till 28 days of life for AOP. Based on serum-ALP levels, formed the high and low-ALP groups. Neonatal characteristics, caffeine regimen, risk factors for OOP, including duration of parenteral nutrition (PN), exposure to medicines associated with MBD, and intake of essential vitamins and minerals, were compared in both groups. Predictors of OOP were analyzed through logistic regression. Results From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p < 0.001). The high-ALP group received significantly (p < 0.001) higher daily and cumulative caffeine doses and were associated with a higher likelihood of developing OOP in this study cohort [cumulative dose (mg) (AOR = 1.082 95% CI 1.011 to 1.157) and daily dose (mg/kg/day) (AOR = 2.892 95% CI 1.392 to 6.007)]. Smaller GA was found directly related to OOP. Among the other medical risk factors, phosphorus intake was significantly low in the high-ALP group. No, significant relationship between duration of PN and use of steroids and diuretics, and intake of vitamins and minerals were identified. Conclusion The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.

Zygomatic region is involved in 42% of facial fractures and accounts for 64% of all middle third fractures. 3 Common reasons for zygomatic complex fractures include road traffic accidents, physical assaults, fall and sports injuries. The relative contribution of these factors varies from region to region. 4,5 Fractures of the zygomatic complex appear commoner in young adult males. The zygomatic complex fractures are characterized by enophthalmos, flattening of the cheek, trismus sensory disturbances and diplopia. Zygomatic complex fractures ABSTRACT Background: Isolated zygomatic or malar bone fractures are second most common fracture among facial skeletal injuries. It has been reported that three point fixation is appropriate for isolated zygomatic bone fracture. The objective of current study was to compare the mean difference in terms of malar height outcome by using different fixation techniques (two point and three point) in patients with zygomatic complex fracture. Methods: This randomized controlled trial was conducted at Department of Oral and Maxillofacial Surgery, MMDC, Multan, during a period of six months from 1st June 2017 to 30th November 2017. A total 182 patients of both genders were included in this study. Two point fixation techniques were used in Group-A patients. While 3 point fixation was used in Group-B patients. After 6 weeks follow-up, patients were assessed for malar height. Outcome was measured by comparing the mean difference of pre and postoperative malar height of both techniques. Data were analyzed using computer program SPSS-21. P≤0.05 was taken as significant in all analysis. Results: Among patients in two point fixation group, the mean malar height was 67.55±2.98 mm and in three point fixation group, means malar height was 71.55±2.36 mm. The difference of malar height among two treatments was highly significant with p<0.01. Conclusions: Using three point fixation results better as compared to two point fixations in terms of malar height outcome.

S oil salinity is the most vicious environmental factor (Akramkhanov et al., 2010) adversely affecting the agricultural productivity (Shrivastava and Kumar, 2015). Although its accurate estimation is difficult, the salinized soils area is increasing globally and affecting irrigated soils intensely. An estimated 6% of the world's land is already facing salinity problems (Silva et al., 2010). About 20% (45 million-ha) of cultivated land and 33% of irrigated agricultural land, producing one third of the world's food, is salt affected (Machado and Serralheiro, 2017;Shrivastava and Kumar, 2015). Salt accumulation is destroying approximately 10 million-ha agricultural land annually (Pimentel et al., 2004). Moreover, the salinized areas are increasing at a rate of 10% annually across the globe for several reasons, including weathering of native rocks, low

Synopsis In soil profiles in which salts are rising towards the surface, damage to productivity was prevented by adoption of suitable crop rotations. When the salts had risen up to 5‐foot depth from the surface a 2‐year rotation with one rice crop—cotton‐senji, rice, wheat—was initially required to depress the salts below 6‐feet depth. When the salts were below 6 feet and 8 feet, respectively, a 4‐year rotation—cotton‐senji, sugarcane, wheat, rice”was found adequate for keeping the salts depressed below that depth.

Objective: To determine anesthetic efficacy of single buccal infiltration of 4% articaine and 2% lignocaine in extraction of maxillary 1st molar. Study Settings: This study was carried out at The Department of Oral & Maxillofacial Surgery, Bakhtawar Amin Medical and Dental College, Multan from March 2021 to August 2021. Material and Methods: Patients were divided in two groups randomly Articaine HCl. 4% with Epinephrine 1:100,000 injection and Lignocaine HCl. 2% and Epinephrine 1:100,000 injection. Buccal infiltration was given in the area between the two molar buccal roots, along the long axis. One person carried out all injections by using slow injection method (roughly 1ml/min) and deposited full cartridge (1.8ml of solution). 4% articaine or 2% lignocaine was used on each patient when extraction was performed however in cartridges labeled 1 to 100 with the use of suitable blinding technique. Results of the Study: VAS scores after injection of lignocaine were: mild for 5 patients (10%), moderate for 34 patients (68%), and severe for 11 patients (22%), while none of the patients reported with no pain after lignocaine injection. The mean pain experienced by patients on VAS, after extraction using articaine was 2.70 ± 1.91 and VAS after extraction using lignocaine was 2.58 ± 1.94. Conclusion: It was concluded that during articaine single buccal injection observed pain is significantly less in contrast to combined buccal and palatal lignocaine injection.. Keywords: Single buccal infiltration, articaine, lignocaine, maxillary 1st molar