Dental caries among the patients visiting out patient department of liaquat medical uinversity Hospital, Hyderabad - Sindh

The objective of this study was to find out the prevalence of dental caries and DMFT score among the patients visiting out-patient department ofLiaquat Medical University Hospital. This was cross sectional study conducted at the Liaquat Medical University Hospital. The minimum sample size calculated was 278. Oral examination was carried out using mouth mirror and a blunt ball-ended probe on the dental chair using artificial light. The results showed that there were 57.2% male and 42.8% female. The prevalence of dental caries was 60.4%.The mean DMFT score was 2.10 with Standard Deviation 2.11. 59.5% caries was present in male and 40.5% caries was present in female, the male patients were more affected than female showed insignificant results. Male and female patients had mean DMFT score 1.26 with a Standard Deviation [SD] 0.449 and 1.39 with a Standard Deviation [SD] 0.493 respectively. It was concluded that the prevalence of dental caries and DMFT score is higher in the selected study population so for prevention and control of dental caries continuing dental health education programs should be emphasized for general population as a whole

Plaque score and gingival health status among 6-12 years old children in hyderabad division

The objective of this study was to evaluate the plaque score and gingival health status among 6-12 years old school children. This cross sectional study was done from 15th July to 10th August 2014 among the students of Matiari [Rural Area] and Hirabad Hyderabad [Urban Area]. Schools were selected on convenient basis. Age ranged from six to twelve years and only boys were included in the study. All clinical dental examinations were conducted in schools with mouth mirror and explorer in the day light. Plaque index and gingival index developed by Loe and Silness were used for each student to record the plaque score and gingival condition. The plaque disclosing tablet [Eviplac Pastilhas; Biodinamicas TM], was used to identify the plaque score. All the students were asked about routine oral hygiene procedures. Data were analyzed in statistical package for social sciences [SPSS] version 16. Quantitative variables are presented in percentages. Mean and standard deviations were computed for qualitative variables. Chi-square test and independent sample t-test were applied to see the significant association. Total one hundred seventy six school children were included in this study; ninety six were from rural area and eighty from urban area. The mean age was 15.85 +/- 7.773. The gingivitis was seen in 80.7% students. Gingivitis was more in the rural children than from urban areas which was statistically not significant. The mean plaque score was 39.63 +/- 19.15 in present study. The independent sample T-test analysis revealed no significant difference between rural and urban students. Gum bleeding was more common in rural school students which is statistically significant. It is concluded that there was a higher gingival inflammation in present study population. Urban students had good gingival condition and low mean plaque score than rural students. Mild type of gingivitis was more common in rural students

Frequency and mortality associated with Hyperglycemia in critically ill children

Objective: To determine the frequency of hyperglycemia in critically ill children admitted in PICU of a tertiary care hospital of Karachi and to compare the mortality of critically ill children with and without hyperglycemia

Study Design: Cross-sectional study

Place and Duration of Study: Paediatrics Intensive Care Unit [PICU] of National Institute of Child Health [NICH], Karachi, from November 2011 to April 2012

Methodology: One hundred fifty critically ill children admitted to PICU were included. Patients who had fasting blood sugar levels more than 126 mg/dl within 48 hours of admission were included in the hyperglycemic group. The normoglycemic and hyperglycemic groups were followed till 10 days to determine the mortality associated with hyperglycemia

Results: Out of 150 patients, 82 [54.7%] had hyperglycemia. Mortality rate was 48.7% [n=73/150]. However, mortality rate was significantly high 57.3% [n=47] in hyperglycemic patients than non-hyperglycemic patients [p=0.019]

Conclusion: The presence of stress-induced hyperglycemia in critically ill patients is a well established marker of poor outcome, and a very high mortality rate. Normoglycemia was associated with favorable outcomes in terms of hospital stay and mortality

Analysis of primary intrathoracic extrapulmonary hydatid cysts a rare clinical entity

To evaluate the anatomic location of cysts, operative characteristics of intrathoracic extrapulmonary hydatid cyst and to determine the outcome of aggressive surgical interventions.Case series. Thoracic Surgery Unit Lady Reading Hospital Peshawar from 1[st] July 2008 to 30[th] June 2011. All patients admitted to Thoracic unit from July 2008 to June 2011 with intra thoracic hydatid cysts were evaluated prospectively as to age, sex, symptoms, diagnostic procedures, anatomic location of cysts, surgical procedures, complications, and outcomes. Chest radiography, computed tomography, and thoracic and abdominal ultrasonography had been performed preoperatively in all of them. Bronchoscopy and spirometry was also performed in all patients for assessment and operability.Echocardiography had been used in 2 patients to determine the contiguity of the cyst to the pericardium. Cystectomy and wide resection were the chief operative procedures. Most of the patients were having cysts in the pulmonary parenchyma only 10 patients had intrathoracic cysts in extrapulmonary locations. This group of patients was included in the study. We excluded patients who had a parenchymal cyst that had perforated to the pleura, myocardial hydatid and patients who had Total of 149 patients were operated for hydatid cystectomy, out of these 139 patients had pulmonary hydatid and 10 patients had intrathoracic extrapulmonary hydatid cysts. These 10 patients constitute our study group; out of these 7 were men and 3 women whose mean age was 39.14 +/- 16.8 years range, [16-69 years]. Eight [80%] of these were symptomatic, most commonly with chest pain, two patients were asymptomatic. There were 2 [20%] mediastinal hydatid, 2 [20%] diaphragmatic, 2 [20%] pericardial, 2 [20%] oblique fissure, and 1 [10%] each in chest wall and pleural hydatid in our study. Albendazole [10 mg/kg] was prescribed to all patients for as long as 3 months postoperatively. No complication, recurrence, or death occurred during the follow up period of 13 +/- 15.4 months [range, 2-36 months].The extrapulmonary location of Hydatid cysts within the thorax is very rare. This rarity may cause difficulties in diagnosis. To avoid recurrence, it is necessary to resect the affected tissues completely and an anthelmintic medical regimen post operatively

Evaluation of pain after administration of local anesthesia with and without medication [midazolam] in irreversible pulpitis in a sample of Sindh

The objective was to evaluate pain experience of the patient after administration of local anesthesia in symptomatic irreversible pulpitis with and without pre-medication Patients were diagnosed after taking medical and dental history, clinical examination, thermal tests and by taking radio-graphs. One hundred patients formed the study group. They were divided into two groups of fifty each, Group-A patients were given oral medication [Midazolan, Dormicum 7.5mg] and inferior dental nerve Block, while Group-B patients were given only Inferior Alveolar Nerve [IAN] Block [1.8 ml cartridge-1:100000 epinephrine] of Xylestesin-S [ESPE-Germany] without any pre-medication. Pre-operative pain of patients of both groups was recorded on Visual Analogue Scale [VAS] i.e: 0= no pain, 10 = most severe pain. [VAS 0>10] Group-A patients were given anesthesia 45 minutes after pre medication while Group-B, patients were treated routinely after administrating inferior dental nerve Block block. In group A [40% showed no pain, 44% mild pain, 12% moderate pain and 4% suffered severe pain n=50] while in group B [20% showed no pain, 50% mild pain, 20% moderate pain and 10% suffered from severe pain after the procedure was done. It was concluded that the patients who had received sedation, prior to anesthesia showed better results

Gastroesophageal anastomosis: single-layer versus double-layer technique-an experience on 50 cases

Considerable controversy exists regarding the optimum technique for gastroesophageal anastomosis. Double layer technique has long been considered important for safe healing but there is evidence that single layer technique is also safe and can be performed in much shorter time. The purpose of this study was to compare the outcome of single layer and double layer techniques for gastroesophageal anastomosis. A prospective randomized study was conducted in cardiothoracic unit, Lady Reading Hospital from Jan 2006 to Jan 2008. Fifty patients with oesophageal carcinoma undergoing subtotal oesophagectomy were randomized to have the anastomosis by single layer continuous or double layer continuous technique [group A [n=24] and B [n=26] respectively]. The demographic data, operative and anastomosis time, postoperative complications and hospital mortality were recorded on a proforma and analyzed on SPSS 10. There was no significant difference between group A and B in terms of age, gender, postoperative complications and duration of hospital stay. Anastomotic leak occurred in 4.2% patients in group A and 7.7% in group B [p=NS]. Mean anastomosis time was 10.04 minutes in group A and 19.2 minutes in group B [p=0.0001]. Mean operative time was 163.83 minutes and 170.96 minutes in group A and B respectively. Overall hospital mortality was 2%; no deaths occurred due to anastomotic leak. Single layer continuous technique is equally safe and can be performed in shorter time and at a lower cost than the double layer technique

Tube thorocostomy: management and outcome in patients with penetrating chest trauma

Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six [92%] patients in group I and thirty seven [74%] in group II. Partial lung expansion or pneumothorax was present in three [6%] in group I and 10 [20%] in group II. One patient in group I and three [6%] patients in group II had no response. The mean time to removal of chest drains were 8.2 +/- 3.14 days in group I and 12.6 +/- 4.20 days in group II. The length of hospital stay was 7.2 +/- 2.07 days and 12.4 +/- 3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developed in three [6%] patients in group I and 8 [16%] patients in group II. Placing chest tubes on continuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion of lung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chest drains, the hospital stay and the chances of surgery for clotted Haemothorax or Empyema

One stage resection of sigmoid volvulus: an experience of 50 cases

To assess the outcome of one stage resection and primary anastomosis without intraoperative colonic lavage in patients with acute sigmoid volvulus. A prospective, descriptive study was carried out in the Surgical department of Lady Reading Hospital, Peshawar from Jan 2002 to Dec 2003. Fifty patients with sigmoid volvulus were included in the study. Patients with serious co morbidity, hemodynamic instability, gangrenous or compound volvulus on laparotomy were excluded from the study. All the patients were assessed and operated upon by a senior surgeon. Resection of the sigmoid colon and primary anastomosis was done after only manual decompression in all cases. The demographic data, clinical features, radiologic and operative findings, out come of the procedure in terms of postoperative complications and duration of hospital stay were recorded on a proforma. The data was entered and processed on the SPSS 10 version. The patients included 44 males and 6 females. Male to female ratio was 7.3:1. Mean age was 57 years. Most frequent clinical features were abdominal pain, distension and constipation. Postoperatively, superficial wound infection was seen in 14% patients [n=7], transient paralytic ileus in 22% cases [n=11]. Pulmonary complications occurred in 6% patients [n=3]. No deaths or clinical anastomotic leak occurred. Duration of hospital stay ranged from 6-17days [mean 11 days]. Resection of sigmoid colon primary anastomosis can safely be carried out without on-table colonic lavage in selected patients with viable colon

Efficacy of thrombolytic therapy in preserving left ventricular function following acute myocardial infarction

This study is a prospective study to determine the value of thrombolytic agents in restoring patency in the infarct related artery and its consequent effect on left ventricular function. At total of 48 patients were investigated, all presenting with symptoms of chest pain. Clinical, electrocardiography and echocardiographic criteria were used to document myocardial infarction. 2-D and M-mode echocardiography was used to detect abnormalities of contraction and relaxation of myocardium. Two group of patients were formed giving thrombolytic and non thrombolytic therapy. Echocardiography was done on admission, discharge and three weeks after discharge from hospital. Patients in both group were evaluated for clinical signs of left ventricular dysfunction according to Killip criteria. The study showed a better left ventricular function in group receiving thrombolytic therapy. Patients who could not be given thrombolytic therapy showed deteriorating left ventricular function which progressed even after one week. It is concluded that addition of thrombolytic therapy definitely improves left ventricular function by restoring patency of infarct related artery, and thereby improving perfusion of ischemic myocardium

Efficacy of monotherapy versus combination therapy in moderate hypertension

This prospective study was conducted to ascertain the difference in efficacy of a long term ACE inhibitor, Ramipril, used alone and in combination with a dihydropyridine calcium antagonist, amlodipine, in moderate hypertension. The patients were free from long term complications of hypertension. This study included 60 patients aged 25-62 years [42 males, 18 females] with essential hypertension, stage II i.e. systolic B.P ³160 mmHg and diastolic B.P[3] 100mmHg [JNCVI ]. Two groups of patients were formed, group A included patients treated with Ramipril alone and group B included patients treated with combination of Ramipril and amlodipine over a period of six weeks. The study showed a prominent decline in blood pressure of patients in both groups, however target blood pressure was achieved and sustained more effectively in group B. It is concluded that in order to obtain a more stable drop in blood pressure, combination therapy is more beneficial both in efficacy and cost effectiveness than monotherapy

Two dimensional echocardiography in acute myocardial infarction

100 Patients with first episode of acute myocardial infarction were examined. 9 patients were excluded from study because of poor echgenicity and the study consisted of 91 patients [53 anterior, 31 inferior, 6 posterior and 1 lateral]. Diagnostic admission electrocardiograph was possible in 31 [69 percent] of anterior and 14 [46 percent] of inferior infarcts. 6 patients of posterior and one of lateral wall infarct had the first electrocardiograph within normal limits. Adequate 2 dimensional echocardiography was possible in 91 patients, 71 [79 percent] had the typical wall motion abnormalities. 45 [84 percent] of anterior, 22 [70 percent] of inferior, 4 [60 percent] of posterior and one [50 percent] patient of lateral wall infarct had the diagnostic segmental dysfunction suggestive of myocardial infarction