Rural–urban disparities in knowledge, attitude, and practice toward child oral health among mothers of 9–36-month-old children / Journal of Rural Medicine

Objective: To assess and compare the knowledge, attitude, and practice of mothers of pre-school children in urban and rural areas toward maintaining child oral health.Materials and Methods: A cross-sectional comparative study was conducted in a convenient sample of 400 mothers of pre-school children (aged 9 months to 3 years) visiting the outpatient department of the Department of Dentistry, Shyam Shah Medical College, Rewa (M.P), India between February 1 and April 21, 2022. The study sample was divided into two groups based on whether they belonged to a rural area (Group A) or urban area (Group B). Group A included 236 participants, and Group B 186 participants. They were served a 24-item questionnaire to assess and compare their knowledge, attitude, and practice toward child oral health. The data were represented as mean and proportions, and a student t test and analysis of variance were performed.Results: In Group A and Group B, 93.64% and 98.17% mothers respectively had the knowledge of cariogenic food. While 66.10% of mothers in Group A and 73.78% in Group B were aware that regular cleaning of teeth protects against tooth decay, only 5.49% of mothers in Group B and none in Group A reported taking their children to routine dental visits; the majority (94.07% in Group A and 78.05% in Group B) had never taken their children to the dentist. Urban background was significantly associated with better knowledge, attitude, and practice scores. Mother’s’ age and education level were significantly associated with better Knowledge, Attitude, and Practice scores in both groups.Conclusion: Mothers can play an important role in promoting positive attitudes and healthy practices toward oral health care in children. Knowledge, attitude, and practice score were found to be significantly low in mothers who belonged to the rural subgroup.

Pre- and apnoeic high-flow oxygenation for rapid sequence intubation in the emergency department (the Pre-AeRATE trial): A multicentre randomised controlled trial

INTRODUCTION@#Evidence regarding the efficacy of high-flow nasal cannula (HFNC) oxygenation for preoxygenation and apnoeic oxygenation is conflicting. Our objective is to evaluate whether HFNC oxygenation for preoxygenation and apnoeic oxygenation maintains higher oxygen saturation (SpO2) during rapid sequence intubation (RSI) in ED patients compared to usual care.@*METHODS@#This was a multicentre, open-label, randomised controlled trial in adult ED patients requiring RSI. Patients were randomly assigned 1:1 to either intervention (HFNC oxygenation at 60L/min) group or control (non-rebreather mask for preoxygenation and nasal prongs of at least 15L/min oxygen flow for apnoeic oxygenation) group. Primary outcome was lowest SpO2 during the first intubation attempt. Secondary outcomes included incidence of SpO2 falling below 90% and safe apnoea time.@*RESULTS@#One hundred and ninety patients were included, with 97 in the intervention and 93 in the control group. Median lowest SpO2 during the first intubation attempt was 100% in both groups. Incidence of SpO2 falling below 90% was lower in the intervention group (15.5%) compared to the control group (22.6%) (adjusted relative risk=0.68, 95% confidence interval [CI] 0.37-1.25). Post hoc quantile regression analysis showed that the first quartile of lowest SpO2 during the first intubation attempt was greater by 5.46% (95% CI 1.48-9.45%, P=0.007) in the intervention group.@*CONCLUSION@#Use of HFNC for preoxygenation and apnoeic oxygenation, when compared to usual care, did not improve lowest SpO2 during the first intubation attempt but may prolong safe apnoea time.

In Silico Screening of Natural Products as Potential Inhibitors of SARS-CoV-2 Using Molecular Docking Simulation / 中国结合医学杂志

OBJECTIVE@#To explore potential natural products against severe acute respiratory syndrome coronavirus (SARS-CoV-2) via the study of structural and non-structural proteins of human coronaviruses.@*METHODS@#In this study, we performed an in-silico survey of 25 potential natural compounds acting against SARS-CoV-2. Molecular docking studies were carried out using compounds against 3-chymotrypsin-like protease (3CLPRO), papain-like protease (PLPRO), RNA-dependent RNA polymerase (RdRp), non-structural protein (nsp), human angiotensin converting enzyme 2 receptor (hACE2R), spike glycoprotein (S protein), abelson murine leukemia viral oncogene homolog 1 (ABL1), calcineurin-nuclear factor of activated T-cells (NFAT) and transmembrane protease serine 2.@*RESULTS@#Among the screened compounds, amentoflavone showed the best binding affinity with the 3CLPRO, RdRp, nsp13, nsp15, hACE2R. ABL1 and calcineurin-NFAT; berbamine with hACE2R and ABL1; cepharanthine with nsp10, nsp14, nsp16, S protein and ABL1; glucogallin with nsp15; and papyriflavonol A with PLPRO protein. Other good interacting compounds were juglanin, betulinic acid, betulonic acid, broussooflavan A, tomentin A, B and E, 7-methoxycryptopleurine, aloe emodin, quercetin, tanshinone I, tylophorine and furruginol, which also showed excellent binding affinity towards a number of target proteins. Most of these compounds showed better binding affinities towards the target proteins than the standard drugs used in this study.@*CONCLUSION@#Natural products or their derivatives may be one of the potential targets to fight against SARS-CoV-2.

Prioritizing mosquito-borne diseases during and after the COVID-19 pandemic

@#The world is facing serious health and economic threats from the global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The burden of disease has been significant, with tens of millions of cases and more than 1.5 million deaths reported globally.1 Since its emergence in Wuhan, China, in late 2019, COVID-19 has spread around the world, affecting almost all countries. COVID-19 is a highly contagious disease that is spread by direct contact and respiratory droplets, and patients can be infective while presymptomatic or asymptomatic.2 To reduce opportunities for transmission, most developed countries have implemented lockdowns, causing significant social and economic disruption. Mosquito-borne diseases, such as malaria and dengue, are a substantial burden in many countries, especially those with developing economies. Malaria is the most significant mosquito-borne disease, with about 228 million cases reported in 2018 and 231 million in 2017, and 405 000 deaths in 2018 and 416 000 in 2017.3 Dengue is the most commonly reported arboviral disease internationally, with Asia suffering a significant disease burden.4 In countries facing endemic and epidemic malaria and dengue, disruption to government services (in health and non-health sectors) and to public health services could severely impact the ability to implement strategic responses to mosquito-borne diseases. As of 30 June 2020, all malaria-endemic countries in Asia had confirmed cases of COVID-19, and those with developing economies face a particularly serious threat to malaria control efforts. In these countries, local authorities responsible for malaria and dengue control must make strategic preparations for continuing with control measures, both during and after the COVID-19 pandemic.

Rare bleeding disorders: spectrum of disease and clinical manifestations in the Pakistani population

Background@#Rare inherited coagulation factor deficiencies constitute an important group of bleeding disorders. A higher frequency of these disorders is seen in areas of high consanguinity.Our aim was to study the prevalence and spectrum of rare inherited bleeding disorders, characterize the severity of the deficiencies, identify different clinical manifestations, and evaluate different treatments provided. @*Methods@#This cross-sectional study was conducted in the Department of Haematology, Armed Forces Institute of Pathology Rawalpindi, between January 2014 and December 2018.A detailed history was taken, and an examination was performed. The signs and symptoms were noted, and the patients were diagnosed on the basis of a coagulation profile. The disease severity was assessed using factor assays. @*Results@#Among 2,516 patients with suspected coagulation disorders, 774 (30.8%) had an inherited bleeding disorder. Of the 774 patients, 165 (21.3%) had a rare bleeding disorder;91 (55.2%) of them were males, and 74 (44.9%) were females, with a male-to-female ratio of 1.2:1. The median patient age was 9 years 3 months. The most common disorder was factor VII deficiency (46 patients, 27.9%). The most common clinical presentation was bruising in 102 (61.8%) and gum bleeding in 91 (55.2%) patients. @*Conclusion@#The most common rare bleeding disorder in our population is factor VII deficiency. The prevalence of these bleeding disorders is high in our population due to a high number of consanguineous marriages.

Potential bioactive phytochemicals, antioxidant properties and anticancer pathways of Nymphaea nouchali

Objective: To investigate bioactive phytochemicals and antioxidant activities of Nymphaea nouchali and to explore its anticancer pathways by a network pharmacology approach. Methods: Using a spectrophotometer and high-performance liquid chromatography-diode array detector (HPLC-DAD), we quantified bioactive phytochemicals in methanolic extract of Nymphaea nouchali tuber. The extracts were investigated for in vitro antioxidant properties. Targets of these bioactive phytochemicals were predicted and anticancer-associated pathways were analyzed by a network pharmacology approach. Moreover, we identified the predicted genes associated with cancer pathways and the hub genes in the protein-protein interaction network of predicted genes. Results: Quantitative results indicated the total phenolics, total flavonoids, and total proanthocyanidins in the methanolic extract of Nymphaea nouchali tuber. HPLC-DAD analysis showed rutin (39.44 mg), catechin (39.20 mg), myricetin (30.77 mg), ellagic acid (11.05 mg), gallic acid (3.67 mg), vanillic acid (0.75 mg), rosmarinic acid (4.81 mg), p-coumaric acid (3.35 mg), and quercetin (0.90 mg) in 1 g of dry extract. The extract showed the radical scavenging activities of 2, 2-diphenyl-1-picrylhydrazyl, 2,2'-azino- bis (3-ethylbenzothiazoline-6-sulfonic acid) and N,N-dimethyl-p phenylenediamine. By using network pharmacology, we predicted 130 target genes associated with cancer pathways. The top hub genes (IL6, AKT1, EGFR, JUN, PTGS2, MAPK3, CASP3, and CXCL8) were also identified, which were associated with cancer pathways and interacted with bioactive phytochemicals of the methanolic extract of Nymphaea nouchali tuber. Conclusions: Our study provides insights into the mechanism of anticancer activities of the methanolic extract of Nymphaea nouchali tuber.

Morphological and molecular characterization of Acanthamoeba isolated from contact lens paraphernalia in Malaysia: Highlighting the pathogenic potential of T4 genotype

Objective: To determine the morphological and molecular characterization of Acanthamoeba isolates from contact lens paraphernalia in Malaysia and to investigate their pathogenic potential based on the physiological tolerance. Methods: One hundred and eighty contact lens wearers donated their contact lens, lens storage cases and lens solutions between 2018 and 2019. The samples were inoculated onto 1.5% non-nutrient agar plates for 14 d. Polymerase chain reaction (PCR) was performed and the amplified PCR products were sequenced and compared with the published sequences in GenBank. The pathogenic potential of positive isolates was further tested using temperature-tolerance and osmo-tolerance assays. Acanthamoeba species were categorized into three distinct morphological groups established by Pussard and Pons. Results: Acanthamoeba was successfully isolated from 14 (7.8%) culture-positive samples in which 11 belong to morphological group II and 3 belong to morphological group III, respectively. The sequencing of 18S ribosomal RNA gene led to the identification of the T4 genotype in all the isolated strains. In vitro assays revealed that 9 (64.3%) Acanthamoeba isolates were able to grow at 42 °C and 1 M mannitol and were thus considered to be highly pathogenic. Conclusions: To the best of our knowledge, this is the first report identifying the Acanthamoeba genotype and their pathogenic potential among contact lens wearers in Malaysia. The potentially pathogenic T4 genotype isolated in this study is the most predominant genotype responsible for human ocular infection worldwide. Hence, increasing attention should be aimed at the prevention of contamination by Acanthamoeba and the disinfection of contact lens paraphernalia.

Prevalence of extended spectrum beta-lactamase (ESBL) and AmpC beta-lactamase producing bacteria in urinary tract infection patients in Bangladesh

Aims@#This study aimed to determine the prevalence of pathogens in urinary tract and their antimicrobial susceptibilities, based on extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase production in Bangladesh. @*Methodology and results@#The prevalence of pathogenic microorganisms in urinary tract and their antimicrobial resistance patterns were identified in 200 isolates from patients with urinary tract infections. Combined disc diffusion was performed to identify the presence of ESBL-producing strains. Moreover, disc approximation assay, disc potentiation test and double disc synergy test were performed to determine the presence of AmpC beta-lactamase producing bacterial strains. This study demonstrated a higher prevalence of UTIs in females (83.5%) than in males (16.5%). The most common pathogen was found Escherichia coli (44.5%), followed by Enterococcus fecalis (24%), Klebsiella pneumoniae (7.5%), Staphylococcus aureus (6%), Pseudomonas aeruginosa (5.5%) and Staphylococcus saprophyticus (4.5%). ESBL and AmpC beta-lactamase production occurred more frequently in E. coli (25.84%) and P. aeruginosa (100%) respectively. @*Conclusion, significance and impact of study@#The result of this study would provide physicians with important information which help them to make a judicious choice of antibiotics for therapeutic purposes. However, it is emphasized that continuous surveillance of antibiogram of medically important organisms causing UTI is necessary for adopting a rational antibiotic policy in the country.

Obstructive Sleep Apnea (OSA) in Patients with Type 2 Diabetes: A Prospective Study

Background:The incidence of obstructive sleep apnea (OSA) is more in type II diabetis patients as compared to healthy individuals. One of the links between OSA and type 2 diabetes is obesity and increased Body mass index is found to be associated with increased risk of metabolic syndrome, diabetes and OSA. OSA is found to have an adverse effect on overall glycemic control in type 2 diabetes and diabetics who have OSA have found to have relatively higher levels of HbA1c indicating poor long-term glycemic controls. As the diagnosis of OSA is usually delayed due to non-specific symptomatology any patient having disturbed sleep and daytime somnolence must be investigated for OSA. It is important from the perspective of treating physician to diagnose OSA in diabetics so as to optimally manage long term glycemic control. We conducted this study to find out the incidence of OSA in type 2 diabetics and its effect on long term glycemic control. Methods: This was a prospective observational study conducted in a tertiary care hospital in which 50 diagnosed cases of type 2 diabetes and suspected to be having Obstructive sleep apnea and came for evaluation were included on the basis of a predefined inclusion and exclusion criteria. Detailed history was taken and thorough clinical examination was done. OSA was diagnosed on the basis of polysomnography. The diagnosis of OSA was done on the basis ofpolysomnography OSA was defined as apnea-hypopnea index (AHI) > 5 per hour sleep. The incidence of OSA in diabetics and its effect on long term glycemic control was studied. Data was analyzed using SSPE 17.0 software. P value less than 0.05 was taken as significant for statistical purposes. Results: Out of 50 studied cases there were 32 (64%) were males and 18 (36%) were females with a M:F ratio of 1:0.56. Mean age of the studied cases was found to be 46.16+/- 8.53 years. 32 patients were obese (BMI =/> 30) and 10 patients were overweight (BMI=\> 25 but < 30). Common co-morbidities seen were hypertension (36%), hypertriglyceridemia (68%) and low HDL levels (44%). 24 (48%) patients were found to be having obstructive sleep apnea on the basis of polysomnography and history of associated symptoms. Raised BMI and Fasting blood sugar levels were found to be higher in patients with OSD (P<0.0001). There was a statistically significant difference in glycosylated Hemoglobin levels in patients with and without OSA. Patients with OSA were found to have higher HbA1c levels indicating poor glycemic control. Conclusion: Patients with Type 2 Diabetes are more at risk of developing OSA which is usually diagnosed late due to non-specific symptomatology. OSA is associated with poor long-term glycemic control in these patients. It is important from the perspective of treating physician to diagnose and treat OSA in diabetics for optimum management.

Clinicohematological parameters and outcomes in a cohort of chronic lymphocytic leukemia patients with Deletion 17p from Pakistan

BACKGROUND: Chronic lymphocytic leukemia (CLL) exhibits profound heterogeneity in its clinical course. Its clinicohematological and cytogenetic features play a significant role in determining the clinical course and in predicting the treatment response and prognosis. In this context, 17p deletion is known to predict a poor prognosis, as these cases are refractory to conventional therapy. This study aimed to evaluate the clinicohematological characteristics, outcomes, and prognostic factors among CLL patients with and without del 17p in Pakistan. METHODS: This prospective observational study was conducted at the Department of Haematology, Armed Forces Institute of Pathology (Rawalpindi, Pakistan) between January 2013 and December 2017. Patients were diagnosed based on the International Workshop on Chronic Lymphocytic Leukaemia IWCLL criteria, their clinicohematological parameters were recorded, and cytogenetic analyses were performed. The time from diagnosis to treatment and the 2-year overall survival rate were also evaluated. RESULTS: We evaluated 130 CLL cases, including 24 patients (18.5%) with del 17p, who included 18 men (75%) and 6 women (25%). The median age was 68 years. Binet stage C was detected at the presentation in 16 patients (67%). Treatment was administered to 14 patients (70%) at a median interval of 11 months (range, 0–28 mo) after diagnosis. The overall response rate was 64.3%, the median event-free survival was 9 months (range, 1–23 mo), and the 2-year overall survival rate was 65%. CONCLUSION: Del 17p is relatively common in Pakistan, and patients harboring this deletion had poor treatment response and survival outcomes.

Evaluation of the Causes of Erectile Dysfunction in Patients Undergoing Penile Doppler Ultrasonography in Pakistan

PURPOSE: In patients with erectile dysfunction, it is important to differentiate psychogenic from organic causes. Penile Doppler ultrasonography is a relatively inexpensive and minimally invasive tool for this purpose. This study was conducted to evaluate the causes of erectile dysfunction in an adult male population, using penile Doppler ultrasonography. MATERIALS AND METHODS: A retrospective study was conducted in a single center. All patients who presented with complaints of erectile dysfunction and underwent penile Doppler ultrasonography between July 2014 and June 2016 were included in this study. All examinations were performed using GE Voluson S6 and GE Logiq P5 devices. Following baseline scans, an intracavernosal injection of 20 µg of prostaglandin E1 was given. Peak systolic and end diastolic velocities were measured in each cavernosal artery. Patients with a peak systolic velocity of 5 cm/s was considered to indicate venous incompetence. RESULTS: Out of 97 patients (mean age, 37.09±11.59 years; range, 19~69 years), 50 patients (51.5%) had normal findings, 24 patients (24.7%) had arterial insufficiency, 15 patients (15.5%) had a venous leak, and 8 patients (8.2%) patients had arterial insufficiency with a venous leak. Psychogenic erectile dysfunction was significantly higher among patients aged ≤40 years, while arterial insufficiency with or without a venous leak was significantly higher among patients aged >40 years (p=0.022). CONCLUSIONS: A majority of the studied individuals demonstrated no organic cause of erectile dysfunction, thus confirming a high prevalence of the psychogenic etiology, particularly in relatively young individuals.

Facture of the Pars Interarticularis with or without Spondylolisthesis in an Adult Population in a Developing Country: Evaluation by Multidetector Computed Tomography

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the prevalence of lumbar spondylolysis and spondylolisthesis in a general adult population unrelated to lower back pain as evaluated by multidetector computed tomography. OVERVIEW OF LITERATURE: There is a significant paucity of information related to the prevalence of spondylolysis and spondylolisthesis and its degenerative changes in a general adult population unrelated to lower back pain in developing countries. METHODS: A retrospective study was conducted on abdominopelvic computed tomography (CT) scans performed between January 1st 2015 and December 31st 2015 for various clinical indications. Patients with lower back pain, with a history of trauma or road traffic accident, or referred from orthopedic or neurosurgery departments were excluded to avoid any bias. CT scans were reviewed in axial, sagittal, and coronal planes using bone window settings for evaluating spondylolysis and spondylolisthesis. RESULTS: Of 4,348 patients recruited, spondylolysis and spondylolisthesis were identified in 266 (6.1%) and 142 (3.3%) patients, respectively. Age was significantly higher in both spondylolysis and spondylolisthesis patients than in those without spondylolysis and spondylolisthesis (47.19±15.45 vs. 42.5±15.96, p60 years old, both spondylolysis (p=0.018) and spondylolisthesis (p=0.025) were significantly more prevalent in females. CONCLUSIONS: The prevalence of pars interarticularis fracture observed higher with gradual increase in the prevalence with advancing age. In particular, preponderance was significantly higher among older females.

Prevalence of Lumbosacral Transitional Vertebra in Individuals with Low Back Pain: Evaluation Using Plain Radiography and Magnetic Resonance Imaging

STUDY DESIGN: Descriptive cross-sectional study. PURPOSE: To determine the frequency of lumbosacral transitional vertebrae (LSTV) in patients with low back pain (LBP) and the role of iliolumbar ligament (ILL) origin from L5 in LSTV cases. OVERVIEW OF LITERATURE: Transitional vertebrae are developmental variants of the spine. LSTV is a common congenital abnormality, and failure to recognize this anomaly may result in serious consequences during surgery. METHODS: All patients aged 11–90 years of either gender with LBP for any duration, who presented for X-ray and magnetic resonance imaging (MRI) of the lumbosacral spine, were included. X-rays of the lumbosacral spine in anteroposterior and lateral views were acquired. In addition, T1- and T2-weighted sagittal and axial MRI was performed. Images were evaluated on a workstation. RESULTS: Of 504 patients, transitional vertebrae were observed in 75 patients (15%). Among them, 39 (52%) patients had Castellvi type III and 36 (48%) patients had Castellvi type II. However, on MRI, 42 (56%) patients had O'Driscoll type II, 18 (24%) patients had O'Driscoll type IV, and 15 patients (20%) had O'Driscoll type III. ILL origin from L5 was significantly higher (n=429, 100%) among patients with a normal lumbosacral junction than among patients with a transitional lumbosacral junction (n=22, 29.3%) (p < 0.001). CONCLUSIONS: LSTV occurs at a high frequency in patients with LBP. Furthermore, in the presence of LSTV, the ILL is not a reliable marker for the identification of L5.

Nosocomial infections: Epidemiology, prevention, control and surveillance

Nosocomial infections or healthcare associated infections occur in patients under medical care. These infections occur worldwide both in developed and developing countries. Nosocomial infections accounts for 7% in developed and 10% in developing countries. As these infections occur during hospital stay, they cause prolonged stay, disability, and economic burden. Frequently prevalent infections include central line-associated bloodstream infections, catheter-associated urinary tract infections, surgical site infections and ventilator-associated pneumonia. Nosocomial pathogens include bacteria, viruses and fungal parasites. According to WHO estimates, approximately 15% of all hospitalized patients suffer from these infections. During hospitalization, patient is exposed to pathogens through different sources environment, healthcare staff, and other infected patients. Transmission of these infections should be restricted for prevention. Hospital waste serves as potential source of pathogens and about 20%–25% of hospital waste is termed as hazardous. Nosocomial infections can be controlled by practicing infection control programs, keep check on antimicrobial use and its resistance, adopting antibiotic control policy. Efficient surveillance system can play its part at national and international level. Efforts are required by all stakeholders to prevent and control nosocomial infections.

Radiological presentation of post primary tuberculosis in adult sputum smear positive patients

Background: Pulmonary Tuberculosis [TB] is traditionally classified into primary and post primary tuberculosis; both have distinct characteristics on radiology. Adetailed knowledge of different radiological patterns is helpful in diagnosis of TB

Objective: To determine the frequency of various radiological presentation of post primary tuberculosis in adult sputum smear positive patients

Methodology: This cross sectional study was carried out at Department of Pulmonology, Sheikh Zayed Medical College / Hospital, Rahim Yar Khan on adult sputum smear positive pulmonary TB patients. A total of 250 new cases of pulmonary TB with no previous history of Anti-Tuberculosis treatment were included in this study. Socio demographic data and findings of X -ray Chest from each sputum smear positive patient were collected and recorded on a predesigned performa. The data was entered and analyzed by using SPSS version 17

Result: Out of 250 patients, 146 were male and 104 were female with mean age of 35.76 +/- 16.25 years. Left lung was most affected in 40.4% cases, right lung in 35.6%, while 24% has bilateral involvement. Duration of illness prior to diagnosis was 3 +/- 1.66 months. Among the radiological presentation, cavitation was seen in 49.2% cases, alveolar consolidation in 42.4%, nodular pattern in 3.2%, reticulonodular pattern in 3.2% and reticular pattern in 2% cases. There was significant association of alveolar consolidation with male gender [0.03] while reticulonodular pattern was significantly seen in female gender [0.007]. Majority of the patients were young; 42.8% were below the age of 30 years and 82% patients were below the age of 50 years and there was a delay of > 03 months in the diagnosis

Conclusion: According to this study, cavitations and alveolar consolidation were the commonest radiological presentations of post primary TB. Majority of patients were young and there was a considerable delay in diagnosis

Relationship of oral tumor thickness with the rate of lymph node metastasis in neck based on CT scan

Objective: To determine the relationship of tumor thickness of oral lesions with metastasis in neck based on CT scan

Methods: A total of 58 oral squamous cell carcinoma patients having the median age of 46 [39-55] years, with either gender presented with malignant tumor of buccal mucosa and tongue were prospectively enrolled. A CT Scan with contrast was performed on all patients. Correlation of tumor thickness level with metastasis in neck was calculated using spearman's rank correlation coefficient test

Results: Median age of the patients was 46 [39-55] years with preponderance of male gender, i.e. 48 [82.8%]. Strong positive significant correlation was observed in between transverse dimension [TS] tumor size and stages of tumor [rho 0.673, p-value <0.001], Anterioposterior [AP] tumor size and stages of tumor [rho 0.675, p-value <0.001], and Craniocaudal [CC] tumor size and stages of tumor [rho 0.771, p-value <0.001]

Conclusion: CT scan of neck with contrast can be used for predicting the positive presence of lymph node in neck with primary tumors having a size of more than 4 mm

Association of [hypovitaminosis v] with persistent non-specific musculoskeletal pains

Objective: The study was conducted in Pakistani population to find association of vitamin D deficiency with persistent non-specific musculoskeletal pains by comparing with pain free controls

Study Design: Case control study

Material and Methods: Patients aged 12 years or more presenting to Medical OPD with persistent nonspecific musculoskeletal pains for more than 3 months were selected as cases, while healthy individuals served as controls

Results: A total of 60 cases [patients with persistent non-specific pains] presenting to medical outpatients department at Military Hospital Rawalpindi and 60 controls were studied. Mean age of cases was 43.9 +/- 14.0 years and amongst controls were 33.2 +/- 17.8 years. Mean serum vitamin D level of 32.8 nmol/L was reported in cases whereas mean serum vitamin D level amongst controls was 26.7 +/- 17.8 nmol/L. Hypovitaminosis D amongst cases and controls was 86.6% and 95% respectively. The proportion of vitamin D deficiency did not differ significantly as compared to controls. There was non-significant difference in proportion of deficiency amongst cases and controls

Conclusion: Overall there was no association between persistent non-specific musculoskeletal pains and vitamin D deficiency

Knowledge, attitudes and practices of lady health workers regarding family planning program in tehsil muzaffargarh

Objective: To assess the knowledge, attitudes and practices of lady health workers [LHWs] regarding implementation of family planning program in Tehsil MuzaffarGarh

Study Design: Cross sectional study

Place and Duration of Study: It was carried out from December 2015 to May 2016 involving Lady Health Workers from 10 union councils of Tehsil Muzaffar Garh including both urban and rural areas

Material and Methods: The data were collected by interviewing 307 LHWs using a structured closed ended questionnaire

The data were entered and analyzed through SPSS version 22

Results: Lady health workers [LHWs] demonstrated a good knowledge ranging from 78% to 99% of different aspects of family planning. They were poorly informed regarding pregnancy complications, breast feeding and infertility. Almost all of them 305 [99%] showed positive attitude regarding job, trainings, compatibility of family planning with religion, although were unsatisfied with their salaries and monetary incentives

Conclusions: LHWs have a good knowledge and positive attitude towards family planning except knowledge about infertility, pregnancy complications and breast feeding. Family planning practices are difficult in rural areas because of low literacy rate and dominance of mothers in law, which needs attention

Frequency and intensity of shoulder pain after stroke A hospital based study

Objective: To determine the frequency and intensity of shoulder pain in stroke patients and explore any relation of shoulder pain with the side of involvement and the primary etiology of stroke

Study Design: A cross-sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi from January 2012 to June 2012

Material and Methods: Through non-probability convenience sampling 100 patients of both genders satisfying the World Health Organization clinical definition of stroke and reporting within one year of stroke development were included and those with cognitive dysfunction and rheumatic diseases or a history of chronic pain prior to the stroke were excluded. Shoulder pain was defined as pain in the shoulder area requiring analgesia for two or more consecutive days and its intensity was graded on visual analogue scale [VAS]

Results: Of 100 patients [mean age: 63 +/- 18 years], majority were males [76%], diagnosed with ischemic stroke [80%] and had a right sided pain [44%]. Patients with moderate to severe pain were more common [83.3%]. On comparison with the type of stroke, the pain was more prevalent on left side [72.7%] and in patients of ischemic stroke [62.5%]. However, these relations were statistically insignificant [p=0.061 and p=0.197 respectively]

Conclusion: More than half of the stroke patients reporting to our institute developed shoulder pain in first year after stroke the majority of whom had moderate to severe pain. The shoulder pain is not related to the primary etiology of stroke and side of involvement