Introduction: Occlusal adjustment is crucial for optimizing the longevity and performance of porcelain-fused-to-metal (PFM) crowns. Occlusal discrepancies can cause uneven force distribution, excessive wear, and restoration failure. Proper occlusal refinement reduces mechanical complications and improves patient satisfaction. This study aimed to evaluate the effects of occlusal adjustment on PFM crown wear and performance by comparing adjusted and non-adjusted restorations. Methods: A retrospective observational study was conducted at the Department of Prosthodontics, Bangabandhu Sheikh Mujib Medical University (BSMMU) and beau-dent, Dhaka, Bangladesh from  January to December 2009, on 40 patients who received PFM crowns, 20 with occlusal adjustment and 20 without. Data on wear, mechanical complications and patient satisfaction were analyzed using independent t-tests and chi-squared tests.  Results: The adjusted crowns exhibited significantly lower wear rates (121.5 µm vs. 162.5 µm, p=0.04), indicating better resistance to occlusal forces. Chipping and fracture incidences were lower in adjusted crowns, though not statistically significant. Patient satisfaction was higher in the adjusted group (90% vs. 70%). Adjusted crowns also showed fewer secondary complications, such as marginal leakage (5% vs. 20%) and secondary caries (5% vs. 15%), suggesting proper occlusal modification reduces long-term restoration failure risk. Conclusion: Occlusal adjustment improved the durability and performance of PFM crowns by reducing wear, enhancing mechanical stability and increasing patient satisfaction. These findings highlight the importance of occlusal modifications in restorative dentistry to optimize clinical outcomes.

Introduction and Background: A major public health issue worldwide, anaemia affects people of all ages and is more common in underdeveloped nations. Patients presenting to a tertiary healthcare facility for anaemia will have their clinical profile, underlying causes, and degree of anaemia assessed in this study. Materials and Methods: Six-month hospital-based observational study at a tertiary healthcare centre. Included were 250 individuals with anaemia, defined by WHO criteria (Hb <13 g/dL in males and <12 g/dL in females). This study was conducted at the department of General Medicine, Sardar Rajas Medical College Hospital and Research Center, Bhawanipatna, Odisha, India from June 2009 to May 2010. Demographics, clinical history, laboratory tests (complete blood count, serum ferritin, vitamin B12, and folate levels), and anaemia reasons were recorded. The severity of anaemia was classified as mild (10-12 g/dL), moderate (7-9.9 g/dL), and severe (<7 g/dL). Statistical analysis examined clinical parameters and anaemia severity. Results: The 250 patients had a mean age of 42.5 ± 15.3 years, with 150 female and 100 male patients. The most common early symptoms were weariness (85%), pale complexion (78%), lightheadedness (65%), and difficulty breathing (40%). According to haemoglobin levels, 30% had moderate anaemia, 50% mild, and 20% severe. Iron deficiency caused 60% of anaemia, chronic disease 20%, vitamin B12 insufficiency 10%, and haemolytic anaemia 5%. Cancer, chronic kidney disease, and infections caused 15% of cases. Anaemia caused by pregnancy affected 25% of women. Patients with iron-insufficiency anaemia had an average haemoglobin level of 9.2 ± 2.1 g/dL, while those with vitamin B12 shortage had an average serum ferritin level of 18.5 ± 5.2 ng/mL and those with vitamin B12 deficiency had an average vitamin B12 level of 215 ± 45 pg/mL. Conclusion: Iron deficiency is the main cause of anaemia, which is still a common health problem. Better dietary interventions are needed, especially for pregnant women, because to the greater frequency among females. To reduce the number of illnesses caused by anaemia, public health campaigns should encourage people to take nutritional supplements and have regular screenings

Background: Prolapsed lumbar intervertebral disc (PLID) is a common cause of lower back pain and sciatica, often requiring surgical intervention when conservative treatments fail. However, surgical outcomes can be inconsistent, with recurrence and persistent symptoms reported. Aim of the study: To evaluate the demographic, clinical characteristics, and surgical outcomes of patients undergoing PLID surgery. Methods: A cross-sectional study of 59 patients with MRI-confirmed PLID was conducted. Demographic data, clinical presentation, and postoperative outcomes were analyzed. Statistical analysis was conducted using SPSS, with results presented as means and percentages. Result: The mean patient age was 35.31 ± 3.24 years, with 71.19% being male. Radicular pain (49.15%) was the most common symptom. The L4-L5 level was affected in 54.24% of cases, and 91.53% of patients reported being pain-free postoperatively. Conclusion: Surgical intervention for PLID shows favorable outcomes, with the majority of patients experiencing significant pain relief. Further research is required to enhance long-term results.

Ectopic pregnancy is a public health issue and a life-threatening condition in Sub-Saharan Africa due to high risk of sexually transmitted infections. While surgical option of management is often advocated for cases of ruptured ectopic gestation, unruptured cases can be managed medically especially where fertility is of a major concern. The case presented is that of a 30-year-old GIP0+0 who presented at a private health facility with mild right sided lower abdominal pain and spotting per vaginal of 2days duration at a gestational age of 7weeks and 2days, she was hemodynamically stable. A pelvic Ultrasound done showed a right sided gestational sac with no cardiac activity and an empty uterus. Serum β HCG done was 913mIU/ml. She was managed as a case of unruptured ectopic gestation with intramuscular methotrexate injections and she had a complete resolution of the ectopic gestation as evidenced by the disappearance of the symptoms and biochemical assessment of the level of serum β HCG which dropped to zero

Emergency contraception (E.C) is also known as post-coital pill (PCC) or ‘the morning after pill’. It is the provision of preventing the establishment of a pregnancy following either an unprotected sexual intercourse or a potential contraceptive failure (1). Patients presenting to a general practitioner asking for emergency contraception should be seen and treated the same day. All the reception staff working in a surgery should be trained and patient requesting a PCC over the phone should be fitted in the surgery the same day. Teenage pregnancy is a public health priority (2) and government targets have been set to half the rate of conceptions in people under the age of 18 years in England by 2010 (3). Most people begin to consider sexual activity in adolescence (4). This is a period of psychological maturation. The UK has a higher teenage birth rate in Western Europe (5). About 90,000 teenagers in England become pregnant, resulting in 56,000 live births. Of these 2,200 are to girls aged 14 or under and 7,700 are to under 16 years age. There is a need to improve the provision of emergency contraception (6), but access to the service within 72 hours can be difficult for young girls who may be worried about the confidentiality (2).

Ectopic pregnancy is a public health issue and a life-threatening condition in Sub-Saharan Africa due to high risk of sexually transmitted infections. While surgical option of management is often advocated for cases of ruptured ectopic gestation, unruptured cases can be managed medically especially where fertility is of a major concern. The case presented is that of a 30-year-old GIP0+0 who presented at a private health facility with mild right sided lower abdominal pain and spotting per vaginal of 2days duration at a gestational age of 7weeks and 2days, she was hemodynamically stable. A pelvic Ultrasound done showed a right sided gestational sac with no cardiac activity and an empty uterus. Serum β HCG done was 913mIU/ml. She was managed as a case of unruptured ectopic gestation with intramuscular methotrexate injections and she had a complete resolution of the ectopic gestation as evidenced by the disappearance of the symptoms and biochemical assessment of the level of serum β HCG which dropped to zero.

We present a case of a 72-year-old man with acute on chronic renal failure referred for intensive care (ITU) management. History revealed dehydration and anuria for 3 days. His blood pressure was 80/40, sinus tachycardia around 130/min with cold clammy peripheries. Blood investigations revealed urea 23mmol, creatinine 800mmol, and potassium-7.7, with ECG changes of hyperkalemia. We attempted a right internal jugular (IJV) venous cannulation using landmark technique and inserted an Arrow-Howes central venous catheter with blue flexi tip, 8.5FR, 5 lumen, and 16cm length. The technique was difficult due to low blood pressure, and patient’s inability to lie flat. The ultrasound machine was unavailable at that moment. Soon after the catheter was introduced using seldinger technique, a swelling was noticed from the site of IJV cannulation. the blood sample analysis revealed arterial blood. The catheter was removed and pressure applied for 45 minutes. Thereafter, a left femoral vein catheter was inserted for central venous access and right femoral vascath –VYGON, DUALYSE Expert, 2 lumen catheters set, 12 fr, 20cm was inserted uneventfully.1 hour later the bleeding from the right carotid puncture site was examined and was found to have ceased. The patient was put on the continuous veno- venous haemofiltration (CVVHF), which clotted after 15minutes.Heparin was used as an anticoagulant for the filter. This was repeated thrice with same result. Three hours later, a haematoma was noticed in area of IJV puncture, which was gradually increasing in size.

Introduction: Schwannoma is a peripheral nerve s eath tumour and commonly occurs on the head, neck and trunk. Giant schwannoma is rarely located in the retroperitoneum, the pelvis and rarer in the mesorectum. Case presentation: A 36-year-old Asian male patient presented with a lower abdominal mass since 2 months, urgency of defecation since 6 months, erectile dysfunction for more than 3 years. Conclusion: We report this patient with a mesorectal schwannoma because of its giant size, rare location, vague sympto s and diagnostic dilemma

Objectives: As pain management is important to facilitate early mobilization after surgery, which in turn results in a shorter hospital stay since early discharge and patient satisfaction are important goals in day-case surgery. The aim of this study was to demonstrate the perioperative analgesic efficacy of lornoxicam in minor to moderate day-case ENT surgical procedures. Study design: Hundred and five (105) patients 18 to 52 years (yr), scheduled for day-case ENT surgery, were enrolled in this randomized, double-blind study. They were divided into three equal groups to receive intravenous (IV) lornoxicam 8 mg (group L8) or lornoxicam 16 mg (group L16) half an hour before induction or fentanyl 100 µg (group F) at induction of anesthesia. Mean arterial pressure (MAP), heart rate (HR), electrocardiography (ECG), oxygen saturation (SpO2) and end-tidal capnography (EtCO2) were recorded during the procedure. Pain, additional perioperative analgesic requirements, the incidence of postoperative nausea and vomiting (PONV) and any adverse events were recorded at 0.5, 1, 2, 3 and 4 hours postoperatively. Results: There were no significant demographic differences between groups. Intra-operatively, the time to first analgesic requirement in group L8 was shorter compared to other groups, while postoperatively it was shorter in group F and group L8. Visual Analog Scale (VAS) was significantly greater at 40 minutes postoperatively in group F and in group L8. The incidence of PONV was significantly higher in group F and group L8. Conclusion: Lornoxicam 16 mg is comparable to fentanyl as intra-operative IV analgesia but more effective than fentanyl in preventing early postoperative pain in patients undergoing minor to moderate day-case ENT surgical procedures.

Background: An assessment of the extent of Foundation Doctors’ involvement in clinical audit and actual or perceived barriers to their completion within normal working hours. Method: Questionnaire of 119 Foundation Doctors in a South East England Hospital NHS Trust, July 2008. Results: 92 of the 119 trainees responded (77.3%). The majority of F1 and F2 doctors had attempted 1-2 audits (73.7% and 65.7% respectively). 30.2% and 58.5% of all attempted audits were completed by F1s and F2s respectively. Thirty-three (57.9%) F1s and ten (28.6%) F2s failed to complete an audit. Trainees disagreed that audits can be completed within working hours (mean score 2.1 on a scale of 1-5) and that they could undertake audits in their areas of specialist interest (mean score 2.6). Conclusions: A large number of Foundation Year doctors did not complete audits. Confusion as to the definition of “audit” and “completed audits”, and a conflict of interests between the audit departments and trainees, were barriers to audit completion and satisfaction among trainees. Audit departments, clinical leads and trainees need to work together to perform audits during working hours that are of clinical interest in order to improve clinical standards and benefit patients, junior trainees and senior clinicians.

Objectives: To study mesh related complications in various hernias and their management. Methods: It’s a descriptive observational study of 638 hernia repairs of different types with mesh fixation in a teaching hospital as well as in private hospitals from June 2003 to June 2008. All the patients were operated by the open technique regardless of the type of hernia. Prolene mesh of varying sizes is used according to the size of defect and fixed in place by applying few stitches with prolene 3/o. Suction drain used selectively. The patients were followed up for three years and the complications associated with the use of mesh were noted. The data is statistically analyzed on SPSS version 12. Results: The mean age of the patients is 41 years with a range of 73 years and a Std of 19.089. There were 531 males (83%) and 107(16 %) females. Commonest variety is inguinal hernia (n=518, 81%) followed by Para-umbilical hernia (n=83, 13%). Wound infection was the commonest complication observed during the same admission. Mesh infection can lead to total failure and is difficult to manage. Recurrence occurred in 11(2 %) cases and 15(2%) patients complained of continued pain and discomfort over a long time. Conclusion: Mesh repair of hernias is not free from complications. Intensive broad-spectrum antibiotics can help control mesh infection and failure of repair. Suction drainage plays a vital role in Para-umbilical and Incisional hernias.