Farhan Raza Khan’s research while affiliated with Aga Khan University and other places

Background Non-functioning pituitary adenomas (NFPAs) are well-differentiated benign tumors originating from the adenohypophyseal cells of the pituitary gland. They present with headaches, visual disorders, or cranial nerve deficits. NFPAs can recur, progress, or present as residual tumors. We, therefore, conducted this review to compare the effects of both revision surgery and stereotactic surgery on tumor size, visual status, endocrine status, and complications. Methods A systematic review of published literature on recurrent, residual, or progressing NFPAs that underwent redo surgery or stereotactic radiosurgery from the inception till June 2020 was conducted as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirteen records (1209 patients) were included, and risk ratio (RR) and 95% confidence intervals (CIs) estimated from each study were pooled using a random-effects meta-analysis model. Results Redo surgery was the preferred intervention in patients presenting with larger tumor sizes and was more effective in reducing the tumor size as compared to stereotactic radiosurgery (SRS) (risk ratio [RR] 56.14; 95% CI, 16.45–191.58). There was more visual loss with revision surgery as compared to SRS (risk ratio [RR] 0.08; 95% CI, 0.03–0.20). However, SRS was associated with fewer complications, such as new diabetes insipidus, as compared to the redo surgery (risk ratio [RR] 0.01; 95% CI 0.01–0.03). Conclusion Redo surgery is the superior choice in the treatment of recurrent/residual or progressing NFPAs if the tumor size is large and an immediate reduction in tumor burden through debulking is warranted. However, redo surgery is associated with a higher risk of visual loss, new endocrinopathies, and other complications, in contrast to SRS.

Dental academia in Pakistan has recently achieved an important milestone. The name of Operative Dentistry speciality has been changed to Operative Dentistry & Endodontics (ODE). It was a much-needed change that was first felt about two decades ago. However, with the correction of name, there are certain challenges that this speciality has to manage now. These include improving the curriculum, setting up standards, and lastly, setting up its boundaries and scope of practice as some of its scope overlaps with a sister speciality called Prosthodontics. This overlapping of the boundaries of dental disciplines is a problem that is unique to Pakistan, India, and some East Asian countries where Operative Dentistry or Conservative Dentistry is combined with Endodontics. This paper aims to discuss the objective delineation of dental procedures and suggest a model of peaceful co-existence of sister dental specialities. Keywords: Scope-of-practice regulation, Appointment, Credentialing, Group practice.

Objective: To compare disease-free survival rates in oral squamous cell carcinoma patients initially attended and referred by dentists versus other physicians. Methods: The systematic review was conducted after registration with the International prospective register of systematic reviews at the University of York, the United Kingdom, and comprised search on Medline, PubMed, Cochrane and CINAHAL Plus databases for studies published up to December 2021. The Population-Intervention-Comparison- Outcomes-Study criteria was used to search for studies involving patients diagnosed with oral squamous cell carcinoma receiving referrals by dentist or by other healthcare providers. Disease-free survival of patients was taken as the main outcome. Customized data collection proforma was used to record data in line with the Preferred Reporting Items in Systematic Reviews and Meta- Analysis guidelines. Data was subjected to systematic, qualitative review. Results: Of the 344 studies found, 8(2.3%) were analysed in detail. Patients referred by dentists ranged from 22.6% to 54%. Males comprised 53% to 70.3% of the sample. The highest number of referrals was made by primary physicians, ranging from 27.4% to 71.6%. Upto 67.6% cases were diagnosed with stage 1 and 2 oral cancer. The highest 5-year survival rate was 75% in a study where 59% patients were diagnosed at an early stage of disease. Conclusion: The relative scarcity of studies makes it impossible to draw an association between oral cancer survival rate and type of referral.

The study evaluated the position of gingival margins in anterior teeth using clinical and 3-dimensional (3D) optical scanning method among patients subjected to non-surgical periodontal treatment (NSPT). A single arm, longitudinal study was undertaken at the Archway Dental Center, University of Manchester, UK. History and clinical examination were done. Gingival recession, attachment loss (AL), and periodontal probing depth (PD) were recorded at baseline and 12-weeks follow-up. NSPT was done using hand and ultrasonic instruments. Impressions were made, the resultant gypsum models were scanned to generate 3D images. The change in the gingival level and thickness of facial gingiva were assessed. Out of eight patients recruited, three were lost to follow up. The 3D scan showed a poor correlation with the clinical assessment of gingival recession in anterior teeth following NSPT (r=-0.0089). Recession did not improve after NSPT (p 0.20). Keywords: Gingival recession; biotype; probing depth; attachment loss; non-surgical periodontal treatment.

Background: Probiotics are viable micro-organisms which if delivered in appropriate dose, can provide health benefits. Lactobacillus-reuteri (DM17938+ATCC PTA 5289) has been recommended as a safe choice for probiotics. The objective of this study is to compare the improvement in the periodontal parameters amongst smokers with generalized periodontitis with stage III, Grade C treated with non-surgical periodontal treatment (NSPT) to which either an antibiotics or probiotics were given as an adjuvant. Methodology: Sixty smokers with Stage III, Grade C generalized periodontitis was randomized in two groups after taking informed consent. Periodontal parameters including bleeding on probing (BOP), probing depth (PD), attachment loss (AL), gingival index (GI), and plaque index (PI) were recorded. Group 1 received (after NSPT and oral hygiene instructions) amoxicillin and metronidazole for 7 days and a placebo for Probiotics for 30 days. Group 2 was provided (after NSPT and oral hygiene instructions) with one tablet of Lactobacillus-reuteri Probiotics (2×108 CFU) twice daily for 30 days and placebo antibiotics for 7 days. The periodontal parameters were recorded again at 1 month and 3 months follow-ups as outcome variables. Mean, standard deviation and confidence interval were reported using SPSS 20.0. Results: A statistically significant clinical improvement in the PD, BOP, PI, and GI were observed in both the groups at 3 months follow-up. However, the AL remained unchanged in both the groups. Conclusions: Administration of probiotics and antibiotics along with NSPT yield statistically significant differences in PD and BOP from baseline to 3 months follow-up. However, between the group differences were not statistically significant for the periodontal parameters (AL, PD, and BOP). This article is protected by copyright. All rights reserved.

Dental implants offer a predictable solution for the replacement of missing dentition. This report describes the case of a patient who underwent dental implant surgery several years ago but due to negligence on the part of previous dentist, her implant pushed into the maxillary sinus. The patient presented with vague pain and swelling in the right maxillary region. Orthopantomogram (OPG) showed that the implant was lying in the right maxillary sinus which the patient had no clue of. It was decided to retrieve the implant and later restore the missing teeth for definitive function and aesthetics. However, at the time of surgery, the implant in question was missing from the anticipated position as it had migrated to the most posterior-superior compartment of the antrum making its retrieval difficult in the first attempt. Later, a maxillofacial surgeon carried out the retrieval. ---Continue

Background: Bisphosphonate medication can cause osteonecrosis of the jaw, which is an uncommon but serious complication. The exact mechanism for the development of MRONJ is not known clearly. Dentoalveolar surgery is considered the major risk factor as a local risk factor with pre-existing inflammatory dental diseases, such as periodontal disease or periapical pathology. Therefore, this survey aims to explore the cross-reference of the patients before prescribing anti-resorptive and related medicines to avoid medication-related osteonecrosis of the jaw (MRONJ) by evaluating and managing any potential dental issues and do the required surgeries and uplift their oral hygiene before the commencement of such medications. Methods: An observational cross-sectional study was conducted among physicians and dentists of secondary and tertiary care hospitals and clinics in Pakistan between March and June 2021. Data were collected through a web-based questionnaire distributed among the eligible sample of physicians and dentists in the departments involved in prescribing bisphosphonates and managing the Osteonecrosis. SPSS 23.0 was used for data analysis. Frequencies and percentages were reported for all variables while Chi-squares and Fischer’s exact test was used to see differences in responses among physicians and dentists. A p-value of <0.05 was taken as statistically significant. Results: A response rate of 29% was achieved. All dentists answered correctly when asked about the indications of bisphosphonates but only about half of them agreed that bisphosphonates can cause but have limited knowledge related to other medicines like anti-angiogenic and mTOR inhibitors. 50% of the physicians provide patient education regarding the potential adverse effect of bisphosphonate medicine and related drugs while others don’t educate the patient regularly. Conclusions: Our study revealed a deficient knowledge regarding bisphosphonate-related ONJ among physicians and dentists. Appropriate training measures are required to raise their awareness.

World is experiencing an unprecedented pandemic of COVID-19 for over a year. This viral infection outbreak originated in December 2019 at Wuhan, China and within three months became a global pandemic. The outbreak has affected over 200 countries and territories of the world. Despite of having well-established health care system, countries such as China, Italy, Iran, Spain, France, Germany and USA have experienced a high death toll in this pandemic. Pakistan although being geographic neighbor of China and Iran, is somehow protected from the otherwise expected high case-fatality of COVID-19. This papers explains what factors have protected Pakistan from a high mortality in this pandemic.

Background and objectives: Owing to high proliferation rate, multipotency and self-renewal capability, dental pulp stem cells (DPSC) and stem cells from human exfoliated teeth (SHED) have become stem cell source of choice for cell based regenerative therapies. We aimed to compare DPSC and SHED as stem cell sources with a future use in regeneration of calcified tissue. Methods: Explant derived human DPSC (n=9) and SHED (n=1) were cryopreserved, thawed and expanded for analysis of population doubling time, colony forming unit assay and efficiency. A growth curve was plotted to determine population doubling time, while colony forming numbers and efficiency was determined at plating cell densities of 5.6, 11.1 and 22.2 / cm2. The isolated cells were characterized for the presence of stem cell markers by immunophenotyping and immunofluorescence staining, and tri-lineage differentiation. Statistical analysis was performed by Pearson correlation, Exponential regression and two way Anova with Tukey test at p<0.05. Results: DPSC and SHED exhibited spindle shaped fibroblast like morphology. SHED was found superior than DPSC in terms of proliferation and colony forming efficiency. Immunophenotypes showed that DPSC contain 62.6±26.3 %, 90.9±14.8% and 19.8±0.1%, while SHED contain 90.5%, 97.7% and 0.1% positive cells for CD90, CD73 and CD105. DPSC were strongly positive for vimentin, CD29, CD73, while reactivity was moderate to weak against CD44 and CD90. SHED expressed vimentin, CD29, CD105, CD90 and CD44. Both were negative for CD45. Upon induction, both cell types differentiated into bone, fat and cartilage like cells. Conclusion: Cultured DPSC and SHED were proliferative and exhibited self-renewal property. Both DPSC and SHED expressed stem cell markers and were able to differentiate into bone, fat and cartilage like cells. Thus, these could be a suitable stem cell sources for cell based regenerative therapies.

Background: Preparation of root canal according to its desired anatomy and complete disinfection is a laborious task. Several factors influence the endodontic treatment including operator's skill and knowledge, anatomy of the tooth, the instruments and equipment used. In the past stainless-steel instruments were used to prepare the root canal but it causes many iatrogenic errors. Nickel titanium instruments evolved to overcome the iatrogenic damages caused by stainless steel instruments. Keeping this in mind a comparative study was conducted on the clinical work of dental intern using stainless steel files and progressively taper nickel titanium instruments. The objective of this study was to compare the performance of interns using either stainless Steel or progressively tapered hand operated NiTi instruments. Methods: This retrospective study included post-treatment radiographs of root canal treatments performed by interns by using either stainless steel files or NiTi Protaper files, in the endodontic department of Hamdard University Dental Hospital, Karachi, Pakistan. It was a 10-year audit, from 2008 to 2018, of endodontic performance. A total of 1219 post treatment radiographs of good quality and showing at least 2mm periapical area beyond the root apex were included. In SS group, preparation were performed by step back method, while in NiTi group the Protaper instruments for hand were used. Scoring criteria was used to evaluate technical quality. The data was analysed using SPSS for windows version 17.0. Chi-square test was used to determine difference in proportions between the outcomes in SS and NiTi groups at p0.05. Results: A total of 1219 radiographs were included out of which 584 (47.9%) belonged to SS and 635 (52.1%) to NiTi group. Overall satisfactory performance was in 553 (45.4%) teeth. Treatment done with NiTi was only marginally better than that achieved with SS files (NiTi n=298 (46.9%), SS n=255 (43.7%)). In the SS group, there were more overfills and internal and external transportation (p<0.001). NiTi reported more cases of inadequate lateral seal and separated instruments (p<0.05). Conclusions: Endodontic performance of interns was not improved with progressive taper NiTi manual instruments.