Poor adherence with ACE inhibitors is a risk factor of CVA with oral hypoglycemic agents in diabetic patients

Poor adherence with medicine declines the clinical outcome of pharmacotherapy. It may carry serious sequelae especially in case of antihypertensive drugs like cerebrovascular accident [CVA]. This study has been planned to find the association of poor adherence with anti-hypertensive with CVA in diabetic and non- diabetic patients. One hundred CVA patients who were admitted through Emergency in Abbasi Shaheed hospital, a tertiary care hospital in Karachi, were recruited from Jun 2013 till Dec 2013. The criteria of inclusion was, diagnosed case of CVA, with primary hypertension, availability of patient's therapeutic record, consent of the patient or legal successor/heir. The criteria of exclusion was, secondary hypertension, newly diagnosed primary hypertensive patients and complete adherence with medication. Morisky medication adherence scale was applied. Therapeutic record was accessed. The mean age was 62.15 years with 3:1 male to female ratio. Adherence to medicine was graded <6. Patients with hypertension were 41 and with diabetes and hypertension were 59. Majority of patients were on monotherapy as compared to polytherapy [62% versus 38%].The mode of therapy was significantly different [P<0.05] in the two groups. ACE Inhibitors, Calcium Channel Blockers, Beta Blockers and other agents were used by 45.16%, 35.48%, 16.12% and 03.24% patients respectively. The aforementioned drugs were used by 57.14%, 33.33% and 09.52% respectively in 21 patients who were on antihypertensive and oral hypoglycemic agents. A statistical significant difference [P<0.05] was seen in the case of ACE Inhibitors. Similarly they were used by 42.10%, 39.47% and 18.42% in 38 patients respectively, who were on antihypertensive and insulin. No statistical significant difference [P>0.05] was seen in any combination [p>0.05]. Thus it is concluded that poor adherence with ACE inhibitors may be a risk factor of CVA in diabetic patients using oral hypoglycemic agents

Prevalence of malocclusion and its relationship with dental caries in a sample of Pakistani school children

Malocclusion is one of the most prevalent dental problems observed in children which may cause oral health problems, loss of function and psychosocial problems related to impaired dentofacial aesthetics. Malocclusion and dental caries have a negative impact on Oral Health Related Quality of Life [OHRQoL]. The objective of the study was to assess the prevalence of malocclusion and dental caries in school children, using Index Of Orthodontic Treatment Need [Dental Health Component] IOTN [DHC] and Decayed, Missing, Filled,Teeth [DMFT] score.Also to evaluate any relationship between malocclusion/ orthodontic treatment need and dental caries. A cross-sectional study was conducted among 574 school children aged 11 to 16 years having permanent dentition, no history of orthodontic treatment and no dental anomalies. Each student's number of DMFT was computed and the IOTN [DHC] was recorded based on contact point displacement only. Results of the current study which comprised of 574 school children, with 320 males and 254 females, exhibited a mean IOTN grade of 2.4 +/- 1.016 and a mean DMFT score of 2.57 +/- 2.7. The prevalence of malocclusion was found to be 75.6% while the prevalence of dental caries was 64.6%. The Pearson correlation coefficient found a significant correlation between IOTN and DMFT scores. The brushing frequency and gender did not correlate with DMFT scores, while sugar intake, age and SES had a significant correlation with DMFT. Taking IOTN into consideration, age and diet showed no correlation with it, whereas gender and Socio Economic Status [SES] status displayed a significant correlation with IOTN grades. The current study yielded a significant correlation between malocclusion and dental caries. Healthy diet and proper brushing technique are important to maintain a healthy dentition, despite the presence of malocclusion

Comparison of research diagnostic criteria with magnetic resonance imaging in patients with myofascial pain

Temporomandibular disorders affect a considerable percentage of population. Myofascial pain is the most common of temporomandibular pain due to occlusal disharmony, jaw clenching, anxiety and other factors. The objective of this study was to compare the research diagnostic criteria for temporomandibular disorders with magnetic resonance imaging to determine validity for correct clinical diagnosis of patients having myofascial pain. The diagnoses from the clinical examination of 54 joints in 27 patients were compared with magnetic resonance imaging diagnoses. The readers of magnetic resonance images were blinded to the clinical diagnoses. Comparative cross sectional study was undertaken. 38 joints [70.4%] were clinically diagnosed with myofascial pain whereas 29 joints [53.7%] were shown to have myofascial pain by MRI examination. The results of our study showed that clinical diagnosis according to research diagnostic criteria for temporomandibular disorders is insufficiently reliable for diagnostic accuracy in comparison with magnetic resonance imaging, a gold standard. The kappa value for the agreement between clinical and magnetic resonance imaging diagnoses was 0.045. Kappa statistics measures the agreement in excess of chance with kappa values ranging between 0 and 1; values lower than 0.4 are considered to have poor agreement and 1.0 represents perfect agreement

Malocclusion and its relationship with dental caries in a sample of Pakistani school children

Malocclusion is one of the most prevalent dental problems observed in children which may cause oral health problems, loss of function and psychosocial problems related to impaired dentofacial aesthetics. Malocclusion and dental caries have a negative impact on Oral Health Related Quality of Life [OHRQoL]. The objective of the study was to assess the prevalence of malocclusion and dental caries in school children, using Index Of Orthodontic Treatment Need [Dental Health Component] IOTN [DHC] and Decayed, Missing, Filled,Teeth [DMFT] score. Also to evaluate any relationship between malocclusion/ orthodontic treatment need and dental caries. A cross-sectional study was conducted among 574 school children aged 11 to 16 years having permanent dentition, no history of orthodontic treatment and no dental anomalies. Each student's number of DMFT was computed and the IOTN [DHC] was recorded based on contact point displacement only. Results of the current study which comprised of 574 school children, with 320 males and 254 females, exhibited a mean IOTN grade of 2.4 +/- 1.016 and a mean DMFT score of 2.57 +/- 2.7. The prevalence of malocclusion was found to be 75.6% while the prevalence of dental caries was 64.6%. The Pearson correlation coefficient found a significant correlation between IOTN and DMFT scores. The brushing frequency and gender did not correlate with DMFT scores, while sugar intake, age and SES had a significant correlation with DMFT. Taking IOTN into consideration, age and diet showed no correlation with it, whereas gender and Socio Economic Status [SES] status displayed a significant correlation with IOTN grades. The current study yielded a significant correlation between malocclusion and dental caries. Healthy diet and proper brushing technique are important to maintain a healthy dentition, despite the presence of malocclusion

Root resorption of permanent incisors during three months of active orthodontic treatment

Root resorption is one of the most common and undesirable sequelea of orthodontic treatment. The aim of this study was to evaluate the amount of root resorption in permanent incisors during 3 month active period of fixed orthodontic appliance therapy using periapical radiographs. Periapical radiographs of a total of 138 permanent teeth [n=138, mandibular n1=52, maxillary n2=86] were evaluated for root resorption. All patients were treated with 3M MBT multibonded, pre-adjusted appliances with 0.022 inch slots. Initial levelling and alignment was achieved with 0.0175 inch co-axial wires. All four incisors [maxillary and mandibular] were measured for any change in root length. The change in root length between T[o] [pre-treatment] and T1 [post-treatment] was measured in millimetres and expressed in terms of percentage of original root length. The mean pre treatment [T[o]] root length for the maxillary teeth [n1=62] was 19.27 +/- 2.86 mm and 20.01 +/- 2.57 mm for the mandibular teeth [n2=31]. The post-treatment [T[1]] root length for the maxillary teeth was 18.96 +/- 2.85 mm and 19.49 +/- 2.4 mm for the mandibular teeth showing a mean resorption of 0.31 mm and 0.52 mm for the maxillary and mandibular teeth respectively. Root resorption was strongly correlated with active orthodontic appliance therapy with maxillary and mandibular incisors being most susceptible. It was found that root resorption can be detected even in the early levelling and alignment stages of orthodontic treatment