Evaluation of panoramic radiography at showing width of the dental follicle

Considering probable incidence of pathological changes in the follicles of impacted teeth, this study is conducted to evaluate pericoronal radiolucency of impacted third molars. In this cross-sectional study, widths of follicular spaces of 201 impacted third molars were measured on panoramic radiographs. Under local anesthesia, the teeth along with the dental follicles were surgically removed. After routine procedure, they histopathological were examined. After evaluating 201 dental follicles it was observed that, 50.7% of cases [102 cases] showed pathological changes and all of them were dentigerous cysts. Incidence of cystic changes in the follicles of third molars of patients aged 21 years and above, is 1.465 times more than patients who were under 21 years old. Also in dental follicles of lower third molars, the incidence of pathological changes was 1.957 times more than maxilla. Cystic changes in the evaluation of follicular widths up to 1.5 mm, was observed in 48% of cases, up to 2 mm, in 73.5% of cases, up to 2.5 mm, in 87.2% of cases and up to 3 mm, in 92.1% of cases. It seems that occurrence of cystic changes in dental follicles increases with increase in age and width of follicular space. However, considering the high incidence of cystic changes in pericoronal radiolucency around the impacted third molars, this study supports the prophylactic removal of impacted third molars

Inter tester and intra tester reliability of eight sacroiliac joint static and dynamic and three pain provocation tests

The purpose of this study was to determine the inter tester and intra tester reliability of 5 static and 3 dynamic palpation tests, and three pain provocation tests used to diagnose sacroiliac joint dysfunction. Five static palpation tests, namely palpation and assessment of the levels of the 1] posterior superior iliac spine [PSIS] in standing position, 2] PSIS in sitting position, 3] anterior superior iliac spine [ASIS] in standing position, 4] Medial Maleolus [MM] in supine position, and 5] MM in long sitting position, and three dynamic [motion palpation] tests, 1] the Gillet test, 2] the standing flexion test, and 3] the sitting flexion test were performed on ten asymptomatic subjects by four examiners. Each test was performed four times by each examiner resulting in 1280 assessments in total. Pain provocation tests were posterior pelvic pain provocation test [PPPPT] or posterior shear test, patric test, and hip resisted abduction test. The Study included twenty women with chronic low back pain, aged between 20 to 30 years. Each of pain provocation tests were performed two times by two examiners. Reliability was determined using Kappa Statistic which allows assessment of observer agreement for more than two examiners and multiple examiners. Intra examiner agreement of static palpation tests revealed a range of reliability from slight to good. Kappa coefficient yielded intra examiner agreement that ranged between slight to good for the PSIS in standing position [0.18-0.75], slight to moderate for the ASIS [0.15-0.5], and slight to fair [0.1-0.35] for other static and all motion palpation tests. Inter examiner reliability of all the static and dynamic tests did not exceed slight reliability [0.0-0.2]. Kappa value for intertester reliability of posterior shear test, patric test, and hip resisted abduction test for right limb was 0.7, 0.7, and 0.6, and for left one was 0.7, 0.78, 0.34, respectively, and the mean value of kappa for intratester reliability was between 0.75 and 0.91. The results of this study suggest that the reliability of palpation and assessment of the levels of the PSIS, ASIS, and MM in static positions, and the gillet, standing flexion, and sitting flexion tests as indicators of sacroiliac joint dysfunction still remain questionable. Therapists should reconsider the usefulness of evaluation techniques that rely on the assessment of the anatomical symmetry of bony landmarks of the innominates in static and dynamic conditions. About pain provocation tests, the results showed that posterior shear and hip resisted abduction tests are reliable tests to diagnose the pathology in the sacroiliac joints. The reliability of patric test that commonly used to determine the sacroiliac joints pathologies is in under question

Toxicokinetic study of a sea anemone toxin in mice after intraperitoneal injection

One of the two low molecular weight [200-300 Dalton] toxins extracted from sea anemone, Gyrostoma helianthus, from the vicinity of Hurgada, Red Sea, Egypt was subjected to a toxicokinetic study. The concentration-time profile of the acetylcholine esterase [AchE] inhibitor sea anemone toxin was characterized using 20g male mice injected with 10 mg toxin as a single dose. Serum and five tissues were collected at 8 interval points [5, 10, 20, 30, 45, 60, 75 and 90 minutes]. The toxin was extracted from these biological matrixes by acetonitrile. The Gyrostoma helianthus toxin showed short action as the half-life values vary from 4.5 to 27.5 min .The maximum time [tmax] was 30 min in serum and in all tissues except the heart which peaked at 45 min. The sea anemone toxin also showed first order kinetic

General Anaesthesia for emergency caesarian section in a patient with Eisenmenger's Syndrome and Pre-eclampsia

Pregnancy is poorly tolerated in patients with Eisenmenger syndrome [ES] with maternal mortality of 30-50%. Physiological changes of pregnancy decreases systemic vascular resistance that further aggravates the bi-directional or right to left shunt associated with ES. When it occurs with eclampsia, the morbidity and mortality are even higher. We report a case of 30 weeks pregnant woman with ES, who underwent emergency caesarian section because of pre-eclampsia. The intra-operative course was uneventful but she died on the second post-operative day. Post-operatively she was managed by the cardiologist in the coronary care unit. The probable cause being that she was over transfused, as the fluid status was not assessed by any invasive monitoring [like CVP]. It was concluded that patients should be monitored closely in the post-operative period in the intensive care unit with complete invasive monitoring for up to a week to prevent factors resulting in worsening of the shunt [such as fluid balance] and thromboembolic phenomenon

[Relationship between substance abuse and mental disorders of family [2001]]

Background and aim: one of the consequences of substance abuse is psychiatric disorder in the society and family. The aim of this study was to find the possible relationship between substance abuse and mental disorders of the other family members

Method: this descriptive and study was performed on 724 [514 female and 210 male] outpatients referred to counseling center of the Kashani clinic, Shahrekord. The data was analyzed by descriptive statistics, chi-square, Fishers test and adds Ratio

Results: the results showed that 49.4% of the patients stated that at least one of their family members was substance abuser. Chance of a depressive person to have a family member abuser was 1.97 times more than patients with other mental disorders. This chance ratio for anxiety was 0.45, for conversion disorder was 2.77, and for interpersonal problems and conduct disorders was 0.38. These differences were statistically significant. But the odd ratios for social phobia, sleep disorder and impotence were nonsignificant

Conclusion: there was a significant deference between patient mental disorders with members family substance abuse and dependent

differential study of breast cancer patients in Punjab, Pakistan

To determine the comparative pattern of distribution of four stages of breast cancer in 2 different hospitals in Lahore. For all the variables under study test-statistic t has been used for stagewise comparisons between the Institute of Nuclear Medicine and Oncology [INMOL] and Shaukat Khanum Memorial Cancer Hospital [SKMCH] whereas the four stages of the disease were compared by using test-statistic F. The study is based on 1171 patients [672 from INMOL and 499 from SKMCH]. This paper is an attempt to find out the pattern for the spread of breast cancer among its four stages and its comparative study between the two hospitals, at stage level. It unveils the important fact of late presentation of breast cancer [25% of INMOL and 36% at SKMCH] compared in 10% or less in international literature [18]. No impact of the variables under study was observed [P>0.05] on the stage of the disease. Most of the cases [71% in INMOL and 63% [SKMCH] present at stage III and IV of breast cancer therefore it is necessary that attention should be made to increase the awareness about the need and benefits of early detection of breast cancer

Intravenous Immunoglobulin therapy versus exchange transfusion in the management of neonatal sepsis

Neonatal sepsis is a significant cause of morbidity and mortality among the newborns which represents after congenital malformations the most important cause of morbidity. 130 neonates with proven sepsis [who had positive blood culture] were included to evaluate and compare the role of intravenous immunoglobulins and exchange transfusion as adjuvant therapy in the management of neonatal sepsis. They are subdivided into three groups: Group A [50 cases] who were undergone exchange transfusion [ET], Group B [50 neonates] who received IVIG [pentaglobin] therapy and Group C [30 neonates] received only antibiotics [control group]. Complete blood picture, C-reactive protein and blood culture were done for all cases at onset of therapy and after 48 hours. Urine and CSF cultures were done for selected cases. The results of the present study showed that the commonest causative organisms among our cases were staph aureus and Klebsiella [22.5% of cases for each] followed by enterobacter [20%]. It was found that the mortality rate among IVIG group [38%] was less than ET group [58%] but the difference did not reach the significant value. Also, IVIG was found to decrease significantly the period of stay in hospital for survived cases [P-value = 0.03]. The results of IVIG in preterm neonates [

Risk of developing right bundle branch block [R. B. B. B.] and complete heart block [C. H. B.] during pulmonary artery catheterization in open heart surgery patients

To analyze the incidence and associated haemodynamic disturbances of a new Right Bundle Branch Block [R.B.B.B] induced by Pulmonary Artery Catheter [P.A.C] with a particular emphasis in patients with preexisting Left Bundle Branch Block [L.B.B.B.] in a prospective manner. To establish whether prophylactic placement of a ventricular pacemaker in patients with pre existing L.B.B.B. during pulmonary artery cotheterization is necessary. The study was conducted at the department of Anaesthesiology and intensive care of the Aga Khan University Hospital, Karachi. Pulmonary artery catheterization was performed in 125 adult patients who underwent various open heart surgical procedures. Outcome studied: Incidence of new R.B.B.B induced by P.A.C. and its associated haemodynamic disturbances with a particular emphasis in patients with a pre existing L.B.B.B. was recorded. New R.B.B.B. occurred in 13 [10.4%] patients while none of the 1 1 patients with a preexisting R.B.B.B. developed C.H.B. during the procedure. Development of new block was not associated with any haemodynamic disturbance. Prophylactic temporary pacing is recommended in patients having a pre-existing R.B.B.B. before placement of P.A.C. in previous studies. However, our study does not show that previous R.B.B.B. is at risk of developing complete heart block [C.H.B.] during the procedure. In view of grave consequences of C.H.B. It is recommended that facilities of pacing should be on board in case it happens

Complications of pulmonary artery catheterization: a prospective study in open heart surgery patients

Pulmonary artery was catheterized in 125 adult patients undergoing various open-heart surgical procedures for perioperative haemodynamic monitoring. A standard approach to right internal jugular vein was used in all patients. Complications noted were related either to central venous access, pulmonary artery catheter [PAC] threading and during stay of catheter in the pulmonary artery. Post-operatively, X-ray chest was done in every patient and tip of the catheter was sent for culture once the PAC was removed. There was 8.8 percent incidence of inadvertent carotid artery puncture. Pneumothorax occurred in one patient. Arrhythmias occurred in 49.6 percent of the patients. New right bundle branch block occurred in 10.4 percent of the patients, while none of the 11 patients with a pre-existing left bundle branch block developed complete heart block during pulmonary artery catheterization. There was no incidence of pulmonary artery rupture associated with the use of PAC. There was a 9.6 percent incidence of PAC colonization, which was seen on culture of catheter tip. This investigation revealed a low incidence of morbidity associated with the use of PAC

Combined carotid endarterectomy and myocardial revascularization - anaesthetic management

Coronary and carotid artery disease frequently coexist. When a patient who requires myocardial revascularization is found to have significant carotid artery disease as well it raises the question that whether simultaneous or staged operations should be done. Anaesthetic management of a case of simultaneous myocardial revascularization and carotid endarterectomy is being presented

medial gastrocnemius myocutaneous flap with a laterally extended skin paddle

Eighteen gastrocnemius flaps were used to cover soft tissue defects in legs and feet of seventeen male patients. As defects were larger than the standard medial gastrocnemius myocutaneous flap in eight cases, the skin over the lateral belly was elevated medially based together with the flap to compensate for width discrepancy. Based on survival of these eight modified flaps and on a previous anatomical study [Kamal et al, 1992], we conclude that the skin paddle of the medial flap can safely be laterally extended to include the fasciocutaneous tissue overlying the lateral belly

Value of routine pre-operative chest x-ray in patients over the age of 40 years

The overall usefulness of routine chest X-ray, its cost benefit ratio and effect on anaesthetic management in patients over the age of 40 years was assessed. Four hundred and seventy-seven consecutive patients undergoing elective non-cardiopulmonary surgery with no cardiopulmonary diseases, having a routine preoperative chest x-ray were selected at the Aga Khan University Hospital, Karachi. Twenty five [5.2%] were excluded from the study as their chest x-ray were not available at the time of surgery. Twenty eight [8.3%] below and 33 [28.7%] above 60 years of age had abnormalities in chest x-ray but the difference in cardiac abnormalities in two age groups was insignificant. The frequency of lung field abnormalities increased with age from 3.2% in less than 60 to 15.6% in patients above 60 years of age. The difference in frequency of occurrence of lung field abnormalities was statistically significant in case of lung abnormalities. Only one case required change in anaesthetic management based on routine preoperative chest x-ray. Our study showed that the incidence of significant lung field abnormalities increased in patients aged 60 years and above with no history of chronic obstructive airway disease. We recommend routine preoperative chest x-ray be carried out only in patients over the age of 60 years

Experience with laryngeal mask airway in Pakistani patients

One hundred and thirty seven adult patients undergoing peripheral surgery were studied regarding ease of larangeal mask airway [LMA] insertion, airway maintenance during surgery and complication encountered during insertion, maintenance and in the postoperative period. In a majority [84%] of patients, the airway was positioned correctly at the first attempt, 3% patients had mild laryngospasm at insertion and in 85% a good airway was obtained. No airway related problems were encountered intraoperatively. Two percent patients had laryngospasm on removal of LMA. Postoperatively, the complaint of sore throat and uvular trauma was seen in 4% cases

Study design and statistics

Soundly planned study may well lead to the findings that are of wide scientific application and interest. This paper is intended to provide a simple and systematic guideline pertinent to the design, analysis and interpretation of studies, especially in the health care. It emphases on the importance of 'Statistics' in the design, conduct, analysis and interpretation of the studies. It is pointed out that all the stages of research studies are vulnerable to statistical mismanagement. The most important thing is to balance the interests of the individuals in the study with those of the much larger number who may benefit in the long run. Concerning the proper use of statistics, the following things are recommended. [a] Statistical advice is needed at the planning stage of a project and not at its end; [b] statistical advice may be saught at almost every stage of a project; [c] the important aspects of logic and correctness of argument may be carefully looked before interpreting the results and [d] finally, before getting any work published, opinion of an expert statistician must be saught, so that erroneous conclusions may not become enshrined as the truth

Ecological and epidemiological studies of barley yellow dwarf virus in the western mediterranean desert of Egypt

Three isolates of barley yellow dwarf virus were detected in six selected wheat and barley fields in the Western Mediterranean Desert of Egypt. The highest level of infection was in irrigated fields with high levels of hygroscopic moisture, organic matter and clay. BYDV has been detected in a number of annual wild grass species but only in one perennial weed, Cynodon dacrylion. This might suggest that BYDV primary inoculum source in successive years could be due to regional or distant migratory aphid flights rather than overseasoning local sources. Species richness was not correlated to BYDV infection as most sampled weeds were not susceptible to the virus. They could act as barriers decreasing the overall rate of virus spread. Diversity of perennial weeds showed no remarkable variations per location and seems to play no role in affecting virus spread. In case of annual species, diversity is low in irrigated fields with high virus incidence. This is because such fields allocate their resources to the production of the crop which is the main source of infection

Sonographic estimation of uterine dimensions in women with different parities and in cases of polycystic ovary syndrome

The mean uterine dimensions [length, transverse and anteroposterior diameters] in 53 normal nulliparous women were ultrasonically estimated to be 71 mm, 49 mm and 32 mm, respectively. In 40 normal multiparous women they were 77 mm and 37 mm, respectively, while in 32 grandmultiparous women [para >5] they were 83 mm, 60 mm and 42 mm, respectively. There is significant increase in all uterine dimensions with increasing parity. In 23 women with clinical polycystic ovary syndrome [PCOS], the uterine dimensions were 66 mm, 43 mm and 30 mm, respectively. The uteri of these women had significantly smaller length and transverse diameters than normal nulligravidae. A uterine length of 70 mm or less and a transverse diameter of 42 mm or less were significantly commoner in PCOS cases than normal nulligravidae. This may be an additional helpful ultrasonic measurement in the diagnosis of PCOS