Pervasiveness of prosthesis amongst the patients of gadap visiting baqai dental college hospital

Edentulism is consistently shown to increase with age, gender and socioeconomic status. This study was done to assess the occurrence of complete and partial edentulousness in relation to age and gender amongst the low socio-economic population of Gadap area in suburb of Karachi.In this cross-sectional study, subjects of both the genders irrespective of their ages were included. The subjects were divided into Group 1: 17-35 years, Group 2: 36- 55, Group 3: 56-75, Group 4: 75 and above. The data of one year was collected from Baqai Dental College Hospital records and evaluated using SPSS version 23. The significance level was set at p < 0.05.A total of 319 subjects reported for seeking treatment of their missing tooth / teeth. 123[38.6%] patients were females and 196 [61.4%] were male. For comparison of frequencies between the groups, chi-square test was employed. It was found that male predilection for complete denture and group 3 [56-75 years] indicated highest number subjects suffering from complete edentulism.Though a lot of advancement has been made regarding treatment options and in generating awareness amongst the population regarding oral health, prevalence of edentulism still prevails due to socioeconomic and cultural constrains

Acute febrile illness; during the course of oral anticoagulation warrants immediate INR check

Oral anticoagulation is needed in many patients like after prosthetic valves insertion, in atrial fibrillation, clots in LA, clots in LV and DVT etc. It is mainly achieved by warfarin sodium which has many interactions with multiple other drugs and its action varies in different other chronic diseased states. to see the response of acute febrile illness on the chronic stable state of INR on a fixed dose of oral warfarin sodium. All the patients with acutely deranged INR who had a stable and controlled INR previously and a fixed dose of warfarin sodium were admitted in the cardiac surgical ward at FIC and their history was explored and recorded. A total of 966 patients were admitted in [CSW] during the period of April, 2012 to April, 2014 with deranged INR. INR was checked twice or sometimes thrice to rule out the laboratory error. 504 patients were female and 462 patients were male, 56 patients had repeated admission for their INR control, most of them were callous regarding taking dose of warfarin so they were excluded from the study. A total of 631 patients had low INR due to missed dose of warfarin sodium. Out of them 13 patients got stuck valve for which emergency redo prosthetic valve replacement was done. 06 patients died in emergency due to late presentation after the prosthetic valve got stuck. Only 279 patients had high INR on the previous dose of warfarin sodium, out of them 216 patients had out of range INR. They were treated by FFP transfusion and holding the Warfarin sodium dose for certain period of time.76% of the patients give H/o acute febrile states 101-103 with rigor and chills [Malaria, enteric fever, pharangitis, cellulitis, boils and UTI etc. etc.] since last 3-4 days for which they had got treatment from some local Gen. practitioners and gave the H/o bleeding gums, general body malaise, bruising, joint aches and pains. 24% of patients denied any acute febrile illness before their INR got out of range 2 patients died in emergency due to intra cerebral bleed after INR got uncontrolled. Any acute febrile illness even of short duration may cause sudden derangement of previously controlled INR on certain fixed dose of warfarin sodium which can create a life threatening situation like intra-cerebral bleed, haem-arthrosis, excessive menstrual blood loss leading to severe anemia. Other less dangerous situation are gum bleed, bruising, joint aches and pains and general malaise. So, it is always advisable and logical to get INR check when ever any acute febrile illness even of short duration is encountered to avoid grave situations

Cardiac manifestations in patients of rehumatoid arthritis

Abstracts: Cardiovascular manifestations of Rheumatoid arthritis have never been studied before therefore this study was designed to evaluate cardiac disease in patients suffering from rheumatoid arthritis

Methodology: Fifty patients of Rheumatoid Arthritis presenting in Out Patient, Emergency and Rheumatology Clinic of Mayo Hospital Lahore from March 1998 till January 1999 were studied. All of them full filled the criteria for the diagnosis of Rheumatoid Arthritis as described by the American Rheumatism Association. After history and physical examination, a clinical assessment of the patient was made of whether he / she had Cardiac Manifestations of Rheumatoid Arthritis or not

Results: Out of 50 patients seen 35 were female, and 15 were male. Giving a female to male ratio of 2.3 to 1. Maximum number of patients seen were between 26 45 years i.e 31[62%] In which 19 [38%] were between 26 to 35 years and 12 [24%] were between 36-45 years. Next most frequent group was of 8 [16%] patients, between 15-25 years of age. Short systolic murmurs were heard in four patients. One patient showed pulsus paradoxus while in the rest no rhythm irregularity was felt. Myocarditis or Coronary Rheumatoid disease was not noticed in any patient. No heart block of any degree was seen. In 4 E.C.G's low voltage was demonstrated in the limb leads. Out of 50 Patients only 3 had pericardial effusion. In one patient it was only a thin rim more prominent posteriorly than anteriorly

Conclusion: Cardiac manifestations of Rheumatoid Arthritis also occur in Pakistani Population, although not with the same frequency as in the Western world. It is also concluded that in Pakistani population, like in the West, the most common Cardiac complication is Pericardial Effusion