iosr-JDMS   Volume-24 ~ Issue-11 ~ November 2025

Abstract: Background: Isoflurane has been a standard agent for CHA, but its sole use sometimes results in suboptimal hypotension and potential adverse effects. Dexmedetomidine is known for its sedative and sympatholytic effects, and it has been proposed as an adjunct to improve controlled hypotension and patient outcomes in surgeries. The study was conducted to assess and compare the efficacy of Isoflurane alone and the combination of Isoflurane and Dexmedetomidine for achieving controlled hypotension during middle ear surgeries. Materials and Methods: This....

Key Word: Middle ear surgery, Dexmedetomidine, Isoflurane, Controlled hypotensive anesthesia

[1]. Munhall CC, Warner BK, Nguyen SA, Guldan GJ 3rd, Meyer TA. Use Of Dexmedetomidine For Controlled Hypotension In Middle Ear Surgery: A Systematic Review And Meta-Analysis. Am J Otolaryngol. 2023;44(4):103917. Doi:10.1016/J.Amjoto.2023.103917
[2]. Degoute CS. Controlled Hypotension: A Guide To Drug Choice. Drugs. 2007;67(7):1053-1076. Doi:10.2165/00003495-200767070-00007
[3]. Hawkley TF, Patel P, Maani CV. Isoflurane. [Updated 2025 Apr 26]. In: Statpearls [Internet]. Treasure Island (FL): Statpearls Publishing; 2025 Jan-. Available From: Https://Www.Ncbi.Nlm.Nih.Gov/Books/NBK532957/
[4]. Reel B, Maani CV. Dexmedetomidine. [Updated 2023 May 1]. In: Statpearls [Internet]. Treasure Island (FL): Statpearls Publishing; 2025 Jan-. Available From: Https://Www.Ncbi.Nlm.Nih.Gov/Books/NBK513303/
[5]. Manuitt, María & Escamilla, Yolanda & Vallano, Antoni & Cardesin Revilla, Alda & Bernal-Sprekelsen, Manuel & Pontes, Caridad. (2017). Use Of Α 2 -Adrenergic Agonists To Improve Surgical Field Visibility In Endoscopy Sinus Surgery: A Systematic Review Of Randomised Controlled Trials. Clinical Therapeutics. 40. 10.1016/J.Clinthera.2017.11.010.
[6]. Pratyusha K, Managutti A, Tiwari RV, Tiwari HD, Das A, Dutta P. A RANDOMISED

Abstract: Background: Spinal anesthesia is a widely utilized regional anesthesia technique, particularly for infraumbilical surgeries. It provides effective sensory and motor blockade, minimal systemic side effects, and stable hemodynamics, making it a preferred choice in various surgical procedures, including lower abdominal, urological, and lower limb surgeries. Bupivacaine, a long-acting amide local anesthetic, is frequently used in spinal anesthesia.....

Key Word: Bupivacaine; Dexmedetomidine; Spinal Anaesthesia; Infraumbilical Surgeries

[1]. Brown DL, Neal JM, Butterworth JF. Spinal, Epidural, And Caudal Anesthesia. In: Miller RD, Editor. Miller’s Anesthesia. 9th Ed. Elsevier; 2020. P. 1553-1580.
[2]. Kalso EA, Poyhia R, Rosenberg PH. Spinal Antinociception By Dexmedetomidine, A Highly Selective A2-Adrenergic Agonist. Pharmacoltoxicol. 1991; 68:140–3.
[3]. Al-Mustafa MM, Badran I, Abu-Ali H, Darwish H, Al-Barazanchi M, Massad D. Effect Of Dexmedetomidine As An Adjuvant To Spinal Anesthesia: A Randomized Controlled Trial. J Anesth. 2009;23(2):187-193.
[4]. Bajwa SJ, Bajwa SK, Kaur J. Dexmedetomidine And Its Effects On Spinal Anesthesia: A Clinical Evaluation. Saudi J Anaesth. 2011;5(4):365-370.
[5]. Elia N, Culebras X, Mazza C, Schiffer E, Tramèr MR. Clonidine As An Adjuvant To Intrathecal Local Anesthetics For Surgery: Systematic Review Of Randomized Trials. Br J Anaesth. 2008;102(3):311-324

Abstract: Understanding root canal morphology is fundamental to successful endodontic treatment, yet anatomical variations often present unforeseen challenges that can compromise outcomes if not properly identified and managed. This case presentation explores the clinical significance of canal morphology variations and emphasizes the importance of adaptability, advanced diagnostic tools, and meticulous technique in navigating atypical anatomy. Through....

Keywords: Radix Entomolaris, C-shaped, CBCT, canal configuration, magnification, case report

[1]. Vertucci FJ. Root Canal Anatomy Of The Human Permanent Teeth. Oral Surgery, Oral Medicine, Oral Pathology. 1984 Nov 1;58(5):589-99.
[2]. Weine FS, Healey HJ, Gerstein H, Evanson L. Canal Configuration In The Mesiobuccal Root Of The Maxillary First Molar And Its Endodontic Significance. Oral Surgery, Oral Medicine, Oral Pathology. 1969 Sep 1;28(3):419-25.
[3]. Gulabivala K, Aung TH, Alavi A, Ng YL. Root And Canal Morphology Of Burmese Mandibular Molars. International Endodontic Journal. 2001 Jul;34(5):359-70.
[4]. Patel S, Dawood A, Whaites E, Pitt Ford T. New Dimensions In Endodontic Imaging: Part 1. Conventional And Alternative Radiographic Systems. International Endodontic Journal. 2009 Jun;42(6):447-62.

Abstract: Background: Uterine scar complications following cesarean delivery represent significant obstetric challenges with potentially severe maternal and neonatal consequences. Objective: To evaluate the incidence, risk factors, and outcomes of uterine scar dehiscence and rupture in post-cesarean pregnancies.
Materials and Methods: A prospective observational study of 120 women with previous cesarean sections was conducted at a tertiary care center, Department of Obstetrics and Gynecology at Katihar medical college, Katihar, Bihar from July.....

Key Word: Uterine rupture, Scar dehiscence, Cesarean section, Pregnancy complications, Ultrasonography, Maternal outcomes, Neonatal outcomes

[1]. Abbas A MA. Maternal And Perinatal Outcomes Of Uterine Rupture In A Tertiary Care Hospital: A Cross-Sectional Study. J Matern Fetal Neonatal Med. 2019;32(20):3352–3356. Doi: 10.1080/14767058.2018.1463369.
[2]. Astatikie G, Limenih M A, Kebede M. Maternal And Fetal Outcomes Of Uterine Rupture And Factors Associated With Maternal Death Secondary To Uterine Rupture. BMC Pregnancy Childbirth. 2017;17(01):117. Doi: 10.1186/S12884-017-1302-Z.
[3]. Motomura K, Ganchimeg T, Nagata C, Ota E, Vogel J P, Betran A P. Incidence And Outcomes Of Uterine Rupture Among Women With Prior Caesarean Section: WHO Multicountry Survey On Maternal And Newborn Health. Sci Rep. 2017;7:44093. Doi: 10.1038/Srep44093.
[4]. Kieser K E, Baskett T F. A 10-Year Population-Based Study Of Uterine Rupture. Obstet Gynecol. 2002;100(04):749–753. Doi: 10.1016/S0029-7844(02)02161-0.
[5]. Eunice Kennedy Shriver National Institute Of Child Health And Human Development Maternal–Fetal Medicine Units Network . Landon M B, Grobman W A. What We Have Learned About Trial Of Labor After Cesarean Delivery From The Maternal-Fetal Medicine Units Cesarean Registry. Semin Perinatol. 2016;40(05):281–286. Doi: 10.1053/J.Semperi.2016.03.003.

Abstract: Background: Glaucoma is a leading cause of irreversible blindness worldwide, characterized by progressive optic neuropathy. Early detection and monitoring are crucial, as structural damage often precedes functional vision loss. Traditional methods like intraocular pressure measurement and standard automated perimetry have limitations in sensitivity and subjectivity. This review synthesizes the current evidence on new imaging technologies that offer potential for earlier, more objective diagnosis and monitoring of glaucomatous changes. Materials and Methods....

Keywords: Glaucoma; Optical Coherence Tomography; Adaptive Optics; Retinal Nerve Fiber Layer; Optic Nerve Head; Diagnostic Imaging

[1]. Weinreb RN, Aung T, Medeiros FA. The Pathophysiology And Treatment Of Glaucoma: A Review. JAMA. 2014 May 14;311(18):1901-11.
[2]. Rodriguez-Una I, Azuara-Blanco A. New Technologies For Glaucoma Detection. Asia Pac J Ophthalmol (Phila). 2018 Nov-Dec;7(6):394-404.
[3]. Kotowski J, Wollstein G, Folio LS, Ishikawa H, Schuman JS. Clinical Use Of OCT In Assessing Glaucoma Progression. Ophthalmic Surg Lasers Imaging. 2011 Oct;42 Suppl:S6-S14.
[4]. Chen AX, Conti TF, Hom GL, Greenlee TE, Raimondi R, Briskin IN, Et Al. Functional Imaging Of Mitochondria In Retinal Diseases Using Flavoprotein Fluorescence. Eye (Lond). 2021 Jan;35(1):74-92.
[5]. Jun TJ, Eom Y, Kim D, Kim C Et Al. Trk-CNN: Transferable Ranking-CNN For Image Classification Of Glaucoma, Glaucoma Suspect, And Normal Eyes. Arxiv Preprint Arxiv:1905.06509. 2019.

Abstract: Synovial cysts are benign, fluid filled lesions arising from joint capsules, bursae or tendon sheaths. They are most commonly reported around the wrist and knee, but involvement of the foot is rare. The rice bodies are small proteinaceous bodies mostly contains fibrin and collagen that forms within joint spaces due to chronic inflammation. The presence of rice bodies within the synovial cyst is an exceptional finding. This case report reviews a 42 year old female with synovial cyst of the foot containing rice bodies.

[1]. Bian J, Liu Y, Tian K, Zheng H, Yuan L, Zhao X, Zhang Y, Wang G. Hip Joint Rice Body Bursitis Combined With Hip Dysplasia And Pelvic Fracture: A Case Report. BMC Musculoskelet Disord. 2024;25:831. Biomed Central
[2]. Zhao H, Zhang W, Zhang P, Li H, Wang J. A Case Of Rice Body Synovitis Of The Knee Joint. Orthop Surg. 2022 Mar;14(3):628–632. Doi:10.1111/Os.13195. PMCID: PMC8926980. Pubmed+1
[3]. Tian Y, Zhou HB, Yi K, Wang KJ. Idiopathic Tenosynovitis Of The Wrist With Multiple Rice Bodies: A Case Report And Review Of Literature. World J Clin Cases. 2022;10(32):11908–11920. PMCID: PMC9669876. PMC+1
[4]. Rice Bodies — Case Report And Review (Ankle/Foot). The Foot And Ankle Online Journal (FAOJ). (Case And Images Of Rice Bodies In Ankle/Tendon Sheath). Available From FAOJ Case Collection. Faoj.Org
[5]. Tschandl C, Kim M, Et Al. Mycobacterium Tuberculosis-Induced Multiple Tenosynovial Masses (Rice Bodies): Case Report And Review. Clin Case Rep. 2023;11:E8228. (Example Of Infectious Rice-Body Tenosynovitis; Highlights Need For Microbiologic Testing And Tailored Therapy). Wiley Online Library+1.

Abstract: High tibial osteotomy (HTO) is a joint-preserving procedure used to correct malalignment following a malunited proximal tibia fracture. It aims to restore mechanical axis alignment, redistribute load, and alleviate pain, particularly in cases of post-traumatic varus deformity. Various osteotomy techniques, including medial opening wedge and lateral closing wedge, are employed based on patient-specific factors. Proper preoperative planning, accurates....

Keywords: High tibial osteotomy, malunion

[1]. Knee Surgery, Sports Traumatology, Arthroscopy. Isolated High Tibial Osteotomy Is Appropriate In Less Than Two-Thirds Of Varus Knees If Excessive Overcorrection Of The Medial Proximal Tibial Angle Should Be Avoided.
[2]. Springerlink. Surgical Treatment And Overcoming Complications Of High Tibial Osteotomy..

Abstract: Introduction: Tuberculosis is a highly contagious and common disease in Morocco, the severity of which is related to several factors, including the occurrence of sequelae. The aim of this study was to define the factors that promote the development of sequelae in pulmonary tuberculosis patients.
Methods: Retrospective cohort of 390 tuberculosis patients whose diagnosis and follow-up of the disease were ensured at thes....

Keywords: tuberculosis; sequelae; risk factors; lung

[1]. Global Tuberculosis Report 2020. Geneva: World Health Organization; 2020.Licence: CC.BY-NC-SA 3.0IGO.
[2]. Allwood BW, Van Der Zalm MM, Amaral AFS, Byrne A, Datta S, Egere U Et Al. Post-Tuberculosis Lung Health: Perspectives From The First International Symposium. Int J Tuberc Lung Dis 2020; 24:820-828.
[3]. Migliori GB, Marx FM, Ambrosino N, Zampogna E, Schaaf HS, Van Der Zalm MM Et Al. Clinical Standards For The Assessment, Management And Rehabilitation Of Post-TB Lung Disease. Int J Tuberc Lung Dis 2021;25:797-813.
[4]. Sotgiu G, Centis R, Migliori GB. Post Tuberculosis Sequelae And Their Socioeconomic Consequences: Worth Investigating. Lancet Glob. Health 2021; 9:E1628-1629.
[5]. Direction De L’épidémiologie Et De La Lute Contre Les Maladies. Maroc : Ministère De La Santé Publique-Programme National De Lutte Antituberculeuse ; 2020.

Abstract: Epithelial tumours of thymus are rare tumors occurring frequently after the age of 50 years. They are classified histologically according to the World Health Organization (WHO), and staged according to the Masaoka-Koga classification and the TNM classification. We report a case of WHO type B1 thymoma in a young 17 years old, presenting a very aggressive character contrary to the presentation usually encountered in this type of thymomas. Surgery is challenged and chemotherapy is the first-line treatment.

Keywords: Thymoma- young- WHO- type B1- stage-treatment

[1]. Scorsetti M, Leo F, Trama A, D’Angelillo R, Serpico D, Macerelli M, Et Al. Thymoma And Thymic Carcinoma. Crit Rev Oncol Hematol 2016;99:332-50.
[2]. Jamilloux Y, Frih H, Bernard C, Broussolle C, Petiot P, Girard N, Sève P. Thymomes Et Maladies Autoimmunes. Rev. Med. Interne 2017 (Article In Press).
[3]. Bernard C, Frih H, Pasquet F, Kerever S, Jamilloux Y, Tronc F, Et Al. Thymoma Associated With Autoimmune Diseases : 85 Cases And Literature Review. Autoimmun Rev 2016 ;15 :82-92.
[4]. Ruffié P, Gory-Delabaere G, Fervers B, Lehmann M, Regnard JF, Resbeut M. Standards Options Et Recommandations Pour La Prise En Charge Des Patients Atteints De Tumeurs Epithéliales Du Thymus. Groupe De Travail SOR. Bull Cancer 1999 ;86 :365-84.
[5]. Tomaszek S, Wigle DA, Keshavjee S, Fischer S. Thymomas: Review Of Current Clinical Practice. Ann Thorac Surg 2009; 87: 1973-80..

Abstract: A retrospective study was conducted in the Department of Pneumology of the Mohamed V Military Training Hospital in Rabat over a period between 2016 and 2019, on all patients with a sequential or concomitant association of pulmonary tuberculosis and primary pulmonary neoplasia. The comparison was made with a control group with pulmonary neoplasia but no pulmonary tuberculosis.
14 cases of tuberculosis....

Keywords: Bronchopulmonary cancer, pulmonary tuberculosis, histological profile

[1]. Sharma SK, Mohan A, Kohli M. Coexistence Of Tuberculosis And Lung Cancer: Diagnostic And Therapeutic Challenges. Lung India. 2018;35(6):469–473.
[2]. Wu CY, Hu HY, Pu CY, Et Al. Pulmonary Tuberculosis Increases The Risk Of Lung Cancer: A Population-Based Cohort Study. Cancer. 2020;126(8):1878–1886.
[3]. Hirano T, Et Al. Lung Cancer Associated With Pulmonary Tuberculosis Scars. Respir Med Case Rep. 2017;22:29–32.
[4]. Lee CH, Lee MC, Shu CC, Et Al. The Impact Of Pulmonary Tuberculosis On The Development Of Lung Cancer: A Prospective Population-Based Study. Thorax. 2018;73(8):785–793.

Abstract: Background: Brachial plexus block (BPB) is a widely utilized regional anaesthesia technique for upper limb surgeries, offering effective intraoperative anaesthesia and postoperative analgesia. The supraclavicular approach is particularly favoured due to its rapid onset and dense blockade, making it suitable for procedures involving the arm, forearm, and hand. Recent studies have explored variations in SBPB techniques to enhance efficacy and safety. For instance, the intertruncal approach, targeting the divisions between the trunks of the brachial plexus....

Keywords: Supraclavicular brachial plexus block; Bupivacaine; Ropivacaine; Analgesic efficacy.

[1]. Sarath Surendran, Dhanya Rajeev, Raju Rajan, Et Al., Supraclavicular Brachial Plexus Block By PNS Or USG, An Observational Cross -Sectional Study,10.7860/JCDR/2022/59153.17173
[2]. Franco CD, Vieira ZE. Supraclavicular Brachial Plexus Block: What’s The Best Technique? Reg Anesth Pain Med. 2000; 25 (4): 306-310.
[3]. Duggan E, El-Beheiry H, Perlas A, Lupu CM, Nuica A, Chan VW. Ultrasound-Guided Supraclavicular Block Performance In Trainees: A Randomized Trial. Br J Anaesth. 2009;102(5):633-638.
[4]. Karmakar MK, Kwok WH, Ho AM. Ultrasound-Guided Supraclavicular Brachial Plexus Block. Anesth Analg. 2002;94(1):119-123.
[5]. Williams SR, Chovinard P, Arcand G, Et Al. Ultrasound Guidance Speeds Execution And Improves The Quality Of Supraclavicular Block. Anesth Analg. 2003;97(5):1518-1523

Abstract: Individuals with psychological distress are at significantly higher risk of arthritis, cardiovascular disease, and chronic obstructive pulmonary disease. However, influence of psychological distress on oral health remains a concern. Mental stress has a significant effect on both emotional and physical health, often manifesting in the oral cavity. Long-term psychological stress triggers the body's hormonal and immune responses, This raises cortisol levels, lowers immune system efficiency, and raises inflammation. These physiological changes can harm oral health by making....

Keywords: Psychological stress, Oral health, Immune response, Xerostomia, Hormones, Bruxism

[1]. Tiwari T, Kelly A, Randall CL, Tranby E, Franstve-Hawley J. Association Between Mental Health And Oral Health Status And Care Utilization. Front Oral Health. 2022;2:732882.
[2]. Jagadeeswara Rao Sukhabogi, Dolar Doshi, Hangirga Sai Sandeep Kumar, Sanju Sundeep Bhargeva, Katukuri Sai Kumar, Relationship Between Psychological Distress With Self-Rated Oral Health And Dental Caries Status Among Dental Patients,Clinical Epidemiology And Global Health,2023, 23:101395.
[3]. Cay M, Ucar C, Senol D, Cevirgen F, Ozbag D, Altay Z, Yildiz S. Effect Of Increase In Cortisol Level Due To Stress In Healthy Young Individuals On Dynamic And Static Balance Scores. North Clin Istanb. 2018;5(4):295-301.
[4]. Hensel Abby L. J. , Nicholson Kathryn , Anderson Kelly K. , Gomaa Noha Biopsychosocial Factors In Oral And Systemic Diseases: A Scoping Review, Frontiers In Oral Health, 2024;5
[5]. Z K, Siluvai S, Kanakavelan K, Agnes L, Kp I, G K. Mental And Oral Health: A Dual Frontier In Healthcare Integration And Prevention. Cureus ;16(12):E76264.

Abstract: Background: Hepatic hydatid cysts are a frequent manifestation of echinococcosis, often remaining asymptomatic until complications arise. The most common and serious complication is rupture into the biliary tree, leading to cholangitis or biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) has become a cornerstone in both diagnosis and management. Objective: To evaluate....

Keywords: Hydatid cyst; ERCP; biliary rupture; endoscopic management

[1]. Khuroo MS. Hydatid Disease: Current Status And Recent Advances. Ann Saudi Med. 2002;22(1–2):56–64.
[2]. Dziri C, Haouet K, Fingerhut A. Treatment Of Hydatid Cyst Of The Liver: Where Is The Evidence? World J Surg. 2004;28(8):731–736.
[3]. Ben Amor I, Ayadi S, Chakroun M, Et Al. Role Of ERCP In The Management Of Biliary Hydatid Disease: Experience From A Tertiary Center. Gastrointest Endosc. 2018;88(2):341–347.
[4]. Akçam AT, Alper E, Aydinli B, Et Al. Endoscopic Management Of Hepatic Hydatid Disease With Biliary Communication. Surg Endosc. 2006;20(3):463–466.
[5]. Kayaalp C, Bzeizi K, Demirbag AE, Et Al. Endoscopic Management Of Hepatic Hydatid Disease With Biliary Rupture: A Systematic Review. Surg Laparosc Endosc Percutan Tech. 2011;21(6):373–378

Abstract: Background: Scrotal lesions encompass a wide range of pathologies, including benign, inflammatory, traumatic, and malignant conditions. Accurate and timely diagnosis is essential to guide appropriate management and avoid unnecessary surgical interventions. Ultrasonography (US), particularly with the addition of color Doppler imaging, is the primary imaging modality for the evaluation of scrotal pathology due to its non-invasiveness, accessibility, and high diagnostic accuracy.
Objective: Aim to...

[1]. Rumack CM, Levine D, Et Al. Diagnostic Ultrasound. 5th Ed. Elsevier; 2018. Chapter: Scrotum And Testes. Comprehensive Overview Of Scrotal Sonography, Anatomy, Technique, And Differential Diagnosis.
[2]. Bateson EM, Golding SJ. Gray’s Ultrasound Anatomy. Churchill Livingstone; 2021. Includes Normal And Pathological Anatomy With Ultrasound Correlation.
[3]. Dahnert W. Radiology Review Manual. 9th Ed. Wolters Kluwer; 2022. Concise, Clinically Focused Summaries Of Sonographic Findings In Scrotal Pathologies

Abstract: The present study aims to describe the GS Power Protocol, developed by Professor Dr. Gleide Sá, based on anatomical principles validated by Moleiro; Ruiz et al. (2025) and focused on non-surgical gluteal remodeling. The method works on three therapeuticfronts integrated in female gluteal harmonization: orthomolecular supplementation, collagen biostimulation and filling with hyaluronic acid. The proposal is to offer a safe and physiologically based....

Keywords: Glutes, applied anatomy, collagen biostimulators, hyaluronic acid, Brazialian Butt Lift, gluteal harmonization.

[1]. International Society Of Aesthetic Plastic Surgery (ISAPS). Patient Safety Advisory: Gluteal Fat Grafting And Fat Embolism Risk. ISAPS Safety Committee Report, 2023.
[2]. Miller J, Gusenoff B, Rubin JP. Fat Embolism After Gluteal Fat Grafting: Mechanisms And Prevention Strategies. Aesthetic Surgery Journal, 2022; 42(1):25–33.
[3]. Moleiro D, Neto JP, Prosdocimi FC, Ruiz-Silva C. Anatomy In Fresh Frozen Corpses For Gluteal Harmonization. IOSR Journal Of Dental And Medical Sciences. 2025; 24(7):1–10.
[4]. Lefebvre T, Fontaine M, Gaspard N. Hexapeptide-38 As A Modulator Of Adipogenesis: In Vitro And In Vivo Evaluation. Journal Of Cosmetic Dermatology. 2020; 19(5):1142–1150.
[5]. Beer K, Shamban A, Carruthers J. Clinical Applications Of Poly-L-Lactic Acid In Aesthetics: Consensus And Safety Recommendations. Journal Of Drugs In Dermatology. 2020; 19(3):245–252.

Abstract: Background: Juxtapapillary diverticula (JPD) are common anatomical variations encountered during endoscopic retrograde cholangiopancreatography (ERCP) and may render biliary cannulation more difficult. The true magnitude of their impact on ERCP outcomes, however, remains debated.
Objective: To determine the prevalence of JPD and evaluate its effect on biliary cannulation success and early complications among....

[1]. Boix J, Lorenzo-Zúñiga V, Domènech E, Et Al. Duodenal Diverticula: Clinical Relevance And ERCP Implications. World J Gastroenterol. 2013;19(38):6314-6319.
[2]. Lobo DN, Balfour TW, Iftikhar SY. Periampullary Diverticula: Consequences Of Altered Anatomy. Br J Surg. 1999;86:1115-1119.
[3]. Chen L, Lu J, Zhang L, Et Al. Impact Of Periampullary Diverticulum On ERCP Procedures: A Systematic Review And Meta-Analysis. Surg Endosc. 2018;32(8):3892-3903.
[4]. Hu B, Zhong Y, Chen Y, Et Al. The Influence Of Periampullary Diverticula On ERCP For Treatment Of Common Bile Duct Stones. Sci Rep. 2020;10:11542.
[5]. Ketwaroo GA, Qureshi WA. Periampullary Diverticula And ERCP Success Rate: The Pocket Makes No Difference. Dig Dis Sci. 2019;64(7):1800-1806.

Abstract: Bull's Eye Maculopathy (BEM) is a rare but serious ocular complication that has been associated with certain antiretroviral therapies used in the treatment of HIV/AIDS. We present a case of a 53-year-old HIV-positive male who developed BEM after taking Tenofovir, Lamivudine, and Dolutegravir (TLD) regimen for 36 months. The patient presented with complaints of progressive central visual blurring and metamorphopsia in both eyes. Fundus examination....

Keywords: Bull’s eye maculopathy, metamorphopsia, tenofovir, lamivudine, dolutegravir

[1]. Mangioni, D., Bandera, A., Muscatello, A., Squillace, N., Crivellaro, C., Guerra, L., Messa, C., & Gori, A. Focal Bone Lesions In HIV-Positive Patient Treated With Tenofovir. BMC Infectious Diseases,2014: 14, 131. Https://Doi.Org/10.1186/1471-2334-14-131
[2]. Kozak, I., Sasik, R., Freeman, W. R., Sprague, L. J., Gomez, M. L., Cheng, L., El-Emam, S., Mojana, F., Bartsch, D. U., Bosten, J., Ayyagari, R., & Hardiman, G. A Degenerative Retinal Process In HIV-Associated Non-Infectious Retinopathy. Plos One, 8(9), E74712. Https://Doi.Org/10.1371/Journal.Pone.0074712
[3]. Kitagaki, T., Sato, T., Hirai, J., Kimura, D., Kakurai, K., Fukumoto, M., Tajiri, K., Kobayashi, T., Kida, T., Kojima, S., & Ikeda, T. A Case Of Proliferative Diabetic Retinopathy With HIV Infection In Which HAART Possibly Influenced The Prognosis Of Visual Function. Case Reports In Ophthalmology,2016: 7(3), 239–244. Https://Doi.Org/10.1159/000452789
[4]. Wong, K. L., Pautler, S. E., & Browning, D. J. Near-Infrared Reflectance Bull's Eye Maculopathy As An Early Indication Of Hydroxychloroquine Toxicity. Clinical Ophthalmology (Auckland, N.Z.),2015: 9, 521–525. Https://Doi.Org/10.2147/OPTH.S76963
[5]. Joharjy, H., Pisella, P. J., Audo, I., & Le-Lez, M. L. A Rare Case Of Didanosine-Induced Mid-Peripheral Chorioretinal Atrophy Identified Incidentally 11 Years After The Drug Cessation. Medicina (Kaunas, Lithuania),2022: 58(6), 735. Https://Doi.Org/10.3390/Medicina58060735

Abstract: Acute intermittent porphyria (AIP) is a rare genetic hepatic porphyria that can progress to severe neurovisceral complications. Its early presentation commonly mimics benign gastrointestinal (GI) disorders, often leading to misdiagnosis and delayed treatment. This review highlights subtle early clinical features, emphasizes the importance of including AIP in differential diagnoses of unexplained abdominal pain, and integrates multi-systemic manifestations....

Keywords: Porphyria, neurovisceral symptoms, diagnostic delay, abdominal pain, urinary PBG, acute hepatic porphyrias.

[1]. Gázquez Sisteré I, Luján Mavila K, Chordá Ribelles J, Touzón López C. Acute intermittent porphyria: a diagnostic dilemma. Gastroenterol Hepatol. 2010;33(6):436–439.
[2]. Gonzalez-Mosquera LF, Sonthalia S. Acute Intermittent Porphyria. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547665/
[3]. Gauri LA, Chajjar KS, Saxena HC. Epidemiologic study of acute intermittent porphyria in Maheshwari community. J Assoc Physicians India. 1990;38(2):151–153.
[4]. Alfadhel M, Saleh N, Alenazi H, Baffoe-Bonnie H. Acute intermittent porphyria caused by novel HMBS mutation, misdiagnosed as cholecystitis. Neuropsychiatr Dis Treat. 2014;10:2135–2137.
[5]. Farah T, Batool H, Ashraf N, Abbasi FQ, Nasir A. Worsening abdominal pain leading to false laparotomy: AIP case report. J Pak Med Assoc. 2024;74(11):2003–2005.

Abstract: Orthodontics has undergone a paradigm shift over the past two decades with the advent of clear aligner therapy, most notably Invisalign. Initially designed to treat mild crowding and spacing, Invisalign has evolved into a comprehensive orthodontic modality capable of managing increasingly complex malocclusions. This review provides a detailed examination of the historical background, biomechanical principles, clinical applications, advantages, limitations, and...

Keywords: Invisalign, clear aligners, orthodontics, biomechanics, malocclusion, digital dentistry, patient compliance

[1]. Kesling HD. The philosophy of the tooth positioning appliance. Am J Orthod. 1945.
[2]. Boyd RL, Vlaskalic V. Three-dimensional diagnosis and treatment planning in orthodontics using Invisalign. Semin Orthod. 2001.
[3]. Miller RJ, Duong TT. Clinical applications of Invisalign aligners. J Clin Orthod. 2002.
[4]. Kravitz ND, Kusnoto B. How well does Invisalign work? A prospective clinical study. Am J Orthod Dentofacial Orthop. 2009.
[5]. Phan X, Ling PH. Clinical limitations of Invisalign. Am J Orthod Dentofacial Orthop. 2007