Incidence of alveoloplasty and its indications - protocol to reduce the incidence

Alveoloplasty is one of the common pre prosthetic surgical procedure carried out in dental surgical practice setups. The aim of pre-prosthetic surgery is to improve the quality of oral supporting structures, which can provide better retention and stability to dental prosthesis. It also prevents any further hard or soft tissue loss. Alveoloplasty procedure is used for recontouring of bony irregularities at time of extractions or after initial healing. Simplest form includes squeezing of socket walls at time of extraction, which reduces the incidence of secondary alveoloplasty at later stages when patient requires denture rehabilitation. It may involve more complex procedures such as maxillary tuberosity reduction, removal of excessive undercuts, and bony exostosis like mandibular and palatal tori. It also reduces the chances of post-operative discomfort and complications. Mucosa covering the alveolar arches after alveoloplasty should be of uniform thickness and density so that occlusal load is distributed equally throughout the dental arches, making it more comfortable for patients to wear prosthesis. This study includes data consisting of number of patients requiring secondary alveoloplasty at Oral and Maxillofacial Surgery department of Islamic International Dental Hospital in last 3 years [2009, 2010 and 2011]. It also includes the symptoms with which patients present and suggestions / protocols to reduce the incidence of this second surgical procedure. We have implemented these protocols in this department, to reduce the need of secondary alveoloplasty because this procedure causes extra financial and surgical burden on patients. It also delays the rehabilitation of oral health. Second arm of this study is being planned after implementation of these protocols to evaluate their outcome

Success and evaluation of dental implant patients at Islamic international dental college and hospital

Dental implant is a permanent metal fixture anchored into the jaw bone topped with individual replacement of a tooth, teeth or a bridge that screws or cements into the implant fixture. The successful outcome of implant procedure depends on a series of patient-related and procedure-dependent parameters. Predictors of success or failure are related to quality and quantity of the bone at the intended site, length of implant, axial loading, operator skills, patient's overall general health, age, habits and oral hygiene. Although long-term studies continue to show improving success rates for implants, failures occur unavoidably. Successful provision of dental implants to patients who have lost tooth/teeth and the surrounding bone, relies on careful gathering of clinical and radiological information, interdisciplinary communication and input, a detailed treatment planning and regular evaluation of the patients. Under proper conditions and diligent patient maintenance, implants can last for lifetime. The objective of this study is to assess and evaluate patients reporting to Islamic International Dental College and Hospital receiving implant therapy. We, very carefully conducted an evaluation of patients in order to find out our success rate. From August 2010 to December 2011, 31 patients received 68 implants. Vast majority of implants [63] were of Bio-Horizon of USA and rest [5] were Straumann implants of Switzerland. Out of these 68 implants, we had 3 failed cases. Further-more, we looked in detail the likely reasons of these failures

Effect of carvedilol on portal pressure estimated by hepatic vein doppler ultrasound waveform and damping index in cirrhotic patients

To assess the effect of Carvedilol in reducing portal pressure estimated non-invasively by studying Doppler ultrasound waveforms [DUS] and hepatic vein Damping Index [DI]. Quasi-experimental study. Department of Medical ICU in collaboration with Department of Radiology, JPMC, over a period of 6 months [June 1st to 30th November, 2008]. Of the enrolled 65 patients, 47 patients [33 males and 14 females] completed the study. The mean age was 47.4 years. Cirrhotic patients of Hepatitis B, C, D [delta], B and C combined, B and D combined with varying degrees of portal hypertension were included in the study. Cirrhotic patients with bronchial asthma, congestive heart failure, Insulin dependent Diabetes, portal vein thrombosis and hepatorenal syndrome were excluded from the study. The patients were examined by color flow Doppler of the right hepatic vein before and after administration of Carvedilol. Their waveforms and Damping Index [Dl] were recorded and compared by Wilcoxon signed ranks test through SPSS version 12.0. Responders were described as those showing a positive change in wave forms or a decrese of 0.10 or more in Dl. Of the 47 patients, 30 [63%] showed a positive response and 10 [21%] showed no favorable response to Carvedilol, while 7 [14%] patients showed deterioration. The mean Dl on DUS dropped from 0.62 to 0.41 in responders after treatment, while in the non-responders it ranged between 0.42 and 0.57. Ultrasonography Carvedilol reduced portal pressure of cirrhotic patients, as measured indirectly by the damping index of hepatic waveform by Doppler

evaluation of relationship between group A streptococcal infection with tic disorders in children

To evaluate the relationship between group A beta hemolytic streptococcus infection [GABHS] and tic disorders in children. This is a case-control study that was conducted in Child and Adolescent Psychiatric Clinic, Isfahan, Iran, between May 2008 and February 2009. Thirty-six children [aged 5-15] with tic and 36 children without tic and obsessive-compulsive disorder [OCD] were investigated for clinical and laboratory signs of GABHS. The tools utilized in this research were clinical interview according to the DSM IV-TR and laboratory tests [throat culture, rapid antigen detection test [RADT], anti streptolysin O [ASO] and yale global tics severity scale [YGTSS]]. The control group was of the same gender and age as the tic group who had come to the clinic for other illnesses and was in need of blood test. None of the subjects in the case and control groups had a clinical history of GABHS infection. The relationship between tic disorder and GABHS infection [if any of these laboratory tests takes place: throat culture, RADT, ASO >/= 250] in the tic group was 16 [44.4%] and in the control group was 9 [25%], there were significant differences [p<0.05]. No significant correlation was found between ASO titer and YGTSS scores. The specificity of RADT was 100%. The result showed correlation between GABHS infection and tic disorder, but it does not mean that GABHS infection caused tic disorder

Echocardiographic profile of rheumatic heart disease at a tertiary cardiac centre

Rheumatic Heart Disease [RHD] continues to be a major public health problem in developing countries like Pakistan. Objective of this cross sectional-analytical study was to analyze the severity of valvular lesions on echocardiography in patients pre-diagnosed with RHD. The transthoracic echocardiographic records of RHD patients from 2004 to 2008 were retrospectively reviewed for type and degree of valvular involvement according to AHA/ACC guidelines. A total of 13, 414 patients [7, 219 Males [53.8%], 6, 195 Females[46.2%]] ranging from 11 to 90 years with a mean age of 42.33 +/- 18.976 were studied. On echocardiography, 7, 500 [56%] had mitral regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4%] had aortic regurgitation [8.8% severe MR], 6, 449 [48.2%] had tricuspid regurgitation [7.1% severe TR] and 5, 550 [41.4$] had aortic regurgitation [4.8% severe AR]. MS was detected in 2, 729 [20.3%] patients [15.3% severe MS], AS in 102 [0.8%] and TS in 31 [0.2%] patients. Mixed mitral valve disease was seen in 3, 185 [23.7%], mixed aortic valve disease in 222 [1.7%] and mixed tricuspid valve disease in 47 [0.4%] patients. All three valves were involved in 2, 826 [21.06%] patients, combination of mitral and aortic valves in 3, 103 [23.13%], mitral and tricuspid in 3, 784 [28.2%], and mitral only in 3, 701 [27.59%] patients. There was some mitral valve abnormality in all patients. Mitral valve was most commonly affected, while regurgitant lesions were more common than stenotic lesions, and most severe in younger patients. All valvular lesions had almost an equal distribution among the sexes, except aortic regurgitation, which was more common in females. Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger population, to facilitate diagnosis and definitive treatment before complications set in

Study on ST- segment elevation acute myocardial infarction [STEMI] in diabetic and non- diabetic patients

To compare some epidemiological and other parameters between diabetic and non-diabetic subjects admitted with STEMI. Two hundred and forty patients were included in the study, 76 [32%] were diabetic, and 164 [68%] were non-diabetic. Among diabetic patients 11/76 were newly diagnosed. The male to female ratio in diabetic was 1.5:1 [P=0.02], while in non-diabetic it was 5.8:1 [P=0.001]. At age 55-64 years, STEMI was observed in higher [P=0.001] percentage of diabetic than non-diabetic patients. 82% of the patients reached the hospital within six hours of chest pain. 52.5% of patients were smokers, 40% had long-standing dyslipidaemia, 32.5% were obese, 32% were diabetic and 29% had hypertension. Significant [P = 0.000003] percentage of non-diabetic patients were smokers, while of diabetic patients [P = 0.03] were obese. Dyslipidaemia was the stronger risk factor among diabetics, while it ranked number three in non-diabetic patients. The lateral infarction was more common [P =0.01] in diabetics. Anterior and inferior infarction was more common than inferior + right ventricular and lateral infarction in both diabetic and non-diabetic patients. Trop-T level was low in 46% and high in 54% of diabetic patients, while it was negative in 10%, detectable in 3%, low in 39% and high in 48% of non-diabetic patients. The mean level of various enzymes did not show statistical difference between diabetic and non-diabetics including CK [2008 +/- 785; 1045 +/- 356], CK-MB [211 +/- 75; 157 +/- 23] and Trop-T [1.85 +/- 0.28; 1.77 +/- 0.21]. Irrespective of diabetic status, the mean stay of patients in the hospital was 5.99 +/- 1.04 days. Smoking, dyslipidaemia and obesity are strong risk factor for STEMI. Infarction of anterior site is more frequent. Among diabetics, chances of STEMI are almost equal in male and female, while among non-diabetics it is six male to one female

[Evaluation of family training effect on salivary cortisol and behavioral symptoms in children and adolescents with disruptive behavior disorder]

Association between biological factors and disruptive behaviors in children and adolescents is important to investigate. Antisocial, aggressive and delinquent behaviors in adults often begin early in life. Basal cortisol is a valuable biological characteristic of children with disruptive behavior disorder [DBD]. In this study the effect of family training on basal salivary cortisol in children with DBD was investigated. This is a clinical trial study. Basal salivary cortisol levels were studied in 19 children between 8-13 years old with DBD, before and 2 months after treatment [family training]. The disruptive behavior of the child was assessed with child behavior checklist [CBCL]. Before and after treatment cortisol levels and score of behavior were compared. Data was analyzed using descriptive statistics, paired T test and pearson correlation. Salivary cortisol before family training was 7.9 +/- 4.6 nmol/L and after that was 10.46 +/- 3.84 nmol/L which was significantly different [p<0.001]. Behavior score before treatment was 72.05 +/- 10.10 and after that was 49.361 +/- 1.89 that was also significantly different [p<0.0001]. Children with lower basal salivary cortisol had a better response to intervention. Parent training is an effective method for behavioral modification in DBD. Salivary cortisol can be considered as a predictive factor for severity of disruptive behavior, also the response to parent training in children with DBD

Electrocardiographic patterns of Atrial Septal defects

This study was designed to evaluate the electrocardiographic features of Atrial Septal Defect to establish an association with crochetage pattern and incomplete RBBB. ASDs of Primum, Secundum and Sinus Venosus type were included in this study. From October 15, 2003 till January 15, 2004, a total of 104 consecutive patients of ASD were studied at Punjab Institute of Cardiology, Lahore. Patients were included in the study after confirmation of Atrial Septal Defect on transesophageal echocardiography. The mean age of the study population was 26.28 +/- 11.40 years. Among these 56[53.8%] patients were females and 48[46.2%] patients were males. The study population consisted of 94[90.4%] Secundum ASD patients followed by Sinus Venosus ASD 8[7.7%] patients and Primum ASD in only 2[l.9%] patients. Only 59[56.7%] patients had crochetage pattern in any of the leads while it was absent in 45[43.3%] patients p=0.470. Incomplete RBBB was present in 92[88.4%] patients. It was observed in 2[1.9%] patients in ASD Primum, 82[78.8%] patients in ASD Secundum and 8[7.7%] patients in ASD Sinus Venosus type. P=0.483. Although we did not observe a statistically significant association between crochetage pattern or incomplete RBBB and ASD but the presence of any of these two considerably increases the specificity of the ECG for the diagnosis of ASD

Clinical and angiographic findings in patients with significant left main coronary artery stenosis

To evaluate the clinical and angiographic features of patients with significant [>50%] left main coronary artery [LMCA] stenosis. In this prospective descriptive study, we evaluated clinical and angiographic features of 100 consecutive patients with significant LMCA stenosis, which were selected from 1284 patients undergoing coronary angiography at Punjab Institute of Cardiology, Lahore. Significant LMCA stenosis was seen in 7.7% patients. There were 83 males [83%] and 17 females [17%]. Age of the patients ranged from 35 to 72 with mean age of male patients 55.84 +/- 9.99 years and that of female patients 54.12 +/- 9.89 years. Severe angina [NYHA class III-IV] was the most common finding. 54% of the patients had ST depression in resting ECG while ECG was found to be normal in 19 [19%] patients. Hypercholesterolemia was the most commonly found risk factor. 94% patients had disease in other coronary arteries and left anterior descending artery [LAD] was the most commonly involved vessel. Majority of the patients [>70%] had preserved left ventricular [LV] systolic function. All patients underwent coronary angiography safely without any serious complication. Among patients undergoing routine coronary angiography about 8% had significant LMCA stenosis. Most of these had disease in other coronary arteries, especially in males. Severe angina along with diffuse ST depression in multiple ECG leads and strongly positive exercise test were common findings in patients with LMCA stenosis However no specific clinical features were found which could distinguish the patients with LMCA stenosis from other patients with coronary artery disease [CAD]

Pericardial effusion in acute myocardial infarction: frequency and in-hospital course

To determine the frequency and in-hospital course of pericardial effusion in acute myocardial infarction in our population. Prospective observational study. The study was conducted in the Department of Cardiology and Medicine, Mayo Hospital, Lahore. One hundred consecutive patients presented within first 24 hours of first episode of ST elevation myocardial infarction [STEMI] were studied. Patients with known coronary artery disease [CAD], chronic renal failure, collagen vascular disease, cardiac surgery and metastatic disease were [PE] was considered to be present when separation between two pericardial layers persisted throughout the cardiac cycle. Among 100 patients who were enrolled, 27 developed PE. Frequency of baseline variable like age, gender, and risk factors for coronary artery disease including hypertension, smoking, and diabetes mellitus were same in patients who developed PE when compared to those who did not. Most of the PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and <10 mm]. Moderate PE was detected on day 5 of the admission. About 82% patients had mild PE [only posteriorly and < 10 mm]. Moderate PE was detected in 18% [present all around and between 10-20 mm]. None of the patients developed large PE [>20 mm]. About 15% patients who were thrombolysed and 40% who could not be thrombolysed developed PE [p <0.01]. Frequency of PE was statistically highly significant [p <0.001] among patients with higher Killip class and lower ejection fraction at the time of presentation. Patients who developed PE had statistically significant longer hospital stay [p <0.001] and higher in-hospital mortality [p<0.05].Thrombolysis decreased the frequency of PE in acute STEMI. Development of PE during the course of acute STEMI has prognostic implications and early invasive strategy may be offered for patients who develop this complication

Radiocontrast nephropathy: is it dose related or not?

To assess the safety of high dose non-ionic contrast media during a single radiological procedure in patients with pre-existing renal impairment. One hundred eighteen patients, with serum Creatinine greater than 1.3 mg/dl who were undergoing coronary angiography or percutaneous transluminal coronary angiography [PTCA] were included in the study. All patients received the nonionic dye ULTRAVIST [Iopromide]. Serum creatinine were measured before, 48 hours and 1 week after the administration of contrast agent. An acute contrast induced reduction in renal function was defined as an increase in Serum Creatinine concentration of >=0.5mg/dl, 48 hours after the administration of contrast agent. All patients with end stage renal disease or patients undergoing coronary bypass surgery within a week after coronary angiography or had any concomitant factors that could cause acute renal failure e.g., sepsis, hypotention, etc., were excluded. Patients receiving a dose of upto100 ml of contrast agent [low dose group] were separated from those who received greater than 100 ml of contrast agent [high dose group]. Patients in both groups had similar characteristics in terms of sex, age, weight and underlying disease. Student's t-test was used for statistical analysis. The mean age of our patients was 62.3 + 8.83 [range 40 - 84 years]. There were 93 [78.8%] males and 25 [21.2%] females. The mean pre-contrast creatinine in the low contrast group was 1.97+0.92 and high dose group was 2.16+1.90 [p=0.48]. The post-contrast Creatinine at 48 hours was 2.11+1.11 and 2.06+1.39 in the groups receiving low and high dose contrast agents respectively [p=0.830], while at 7 days post-contrast it was 2.17+1.28 and 1.95+1.43 respectively in the two groups [p=0.391]. The contrast-induced reduction in renal function [rise in serum Cr >=0.5 mg/dl above base line] occurred in 14% [n=8] of patients in low dose and in 11% [n=7] in high dose contrast group [p=0.830, insignificant]. The results of our study confirm that high dose non-ionic contrast is not associated with increased risk of contrast-mediated nephrotoxicity in patients with pre-existing renal insufficiency undergoing cardiac angiography [p=0.830, insignificant]

Prevalence of bacterascites

This is a Hospital based prospective study carried out in Medical Unit-I, Department of Medicine, Jinnah Postgraduate Medical Centre, Karachi from June, 1993 to May, 1994, to find the prevalence of bacterascites in cirrhotic patients with ascites. 65 cirrhotic patients with ascites were selected. Aspiration of ascitic fluid of all patients was done. The fluid was sent for analysis, culture and sensitivity. The main laboratory indicators were polymorph count/mm3 and culture positive ascitic fluid. Patients with bacterascites were followed for 12 weeks. Prevalence of bacterascites was 8%. Twenty% patients of bacterascites developed spontaneous bacterial peritonitis [SBP] during 12 weeks follow up. Bacterascites does not require aggressive treatment. It usually resolves spontaneously

Blind extrathoracic subclavian venipuncture for temporary pacing lead insertion: a 4 year experience in 760 patients

Seven hundred and sixty patients admitted in Cardiology Dept. Mayo Hospital, Lahore from Feb.1994 to Jan 1998 were inserted temporary pacing lead for different indications. Modification of the percutaneous technique for extrathoracic subclavian venipuncture proposed by Magney and colleagues for permanent pacing lead placement was used. Before puncturing bony landmarks were marked on the skin according to Magney's description to identify the needle entry point. Then the venipuncture was accomplished by inserting the needle through a standard infraclavicular land mark. 760 patients were approached with this technique with in a span period of four years. This technique was successful in 684 [90%] cases with first puncture, additional 35 [5%] with second attempt, while additional 14 [2%] patients required multiple attempts or the change of the site. In rest 3% the procedure was completed using other routes. Patients were followed till the removal of temporary pacing wire or implantation with permanent pacing system. In the present study the blind approach to the extrathoracic portion of the subclavian vein proved to be safe and effective for pacing lead insertion. Further observations are required to establish whether this method decreases the complication rate

Experience with permanent pacemaker implantation at Mayo Hospital, Lahore

Permanent pacemaker implantation procedure was started at Mayo Hospital, Lahore in March, 1978. Till December 31st 1998 nine hundred and sixty six permanent pacemakers had been implanted in this institution. 53% patients were males and 47% patients were females. 55% patients were between 50-70 years old. The youngest patient was only six months old while maximum age of the patients implanted with permanent pacemaker was ninety nine years old. 92% patients had fist implant while 6% patient had second implant and 2% patient had third implant. 84% patients had complete heart block, 5.5% patients had sick sinus syndrome, 2.7% patients had symptomatic second degree heart block, 2.6% patients had congenital heart block