Prediction of pre-eclampsia in diabetic pregnant women

Background & objectives: Gestational or preexisting diabetes is one of the risk factors of pre-eclampsia. Both are responsible for higher maternal and fetal complications. The objective was to study clinical risk factors of pre-eclampsia and biochemical markers in early pregnancy of women with diabetes mellitus (DM)/gestational diabetes mellitus (GDM) for the development of pre-eclampsia. Methods: The study group comprised pregnant women diagnosed with GDM before the 20 wk of gestation and DM before pregnancy and the control group had age-, parity- and period of gestation-matched healthy women. Sex hormone-binding globulin (SHBG), insulin-like growth factor-I (IGF-I) and 25-hydroxy vitamin D [25(OH)D] levels and the polymorphism of these genes was evaluated at recruitment. Results: Out of 2050 pregnant women, 316 (15.41%) women (296 had GDM and 20 DM before pregnancy) were included in the study group. Of these, 96 women (30.38%) in the study group and 44 (13.92%) controls developed pre-eclampsia. Multivariate logistic regression analysis indicated those who belonged to the upper middle and upper class of socio-economic status (SES) were likely to be at 4.50 and 6.10 times higher risk of developing pre-eclampsia. The risk of getting pre-eclampsia among those who had DM before pregnancy and pre-eclampsia in their previous pregnancy was about 2.34 and 4.56 times higher compared to those who had no such events, respectively. The serum biomarkers [SHBG, IGF-I and 25(OH)D] were not found to be useful in predicting pre-eclampsia in women with GDM. To predict risk of development of pre-eclampsia, the fitted risk model by backward elimination procedure was used to calculate a risk score for each patient. Receiver operating characteristic (ROC) curve for pre-eclampsia showed that area under the curve was 0.68 (95% confidence interval: 0.63-0.73); P<0.001. Interpretation & conclusions: The findings of this study suggested that pregnant women with diabetes were at a higher risk for pre-eclampsia. SES, history of pre-eclampsia in previous pregnancy and pre-GDM were found to be the risk factors.

Hemodialysis internal jugular vein versus subclavian vein catheters: complications, patients' comfort, tolerance and cost-effectiveness

Objective: To compare hemodialysis [HD] internal jugular vein [IJV] versus subclavian vein [SCV] catheters in terms of procedural complications, patients' comfort, tolerance and cost effectiveness

Methods: Sixty six consecutive eligible adult patients planned for hemodialysis @ 3 sessions/ week for maximum 42 days in a private hospital at Sialkot, Pakistan were documented between March 2017 and April 2018. A group, IJV or SCV catheter was allotted to alternate subjects. The catheters were inserted as per practice guidelines. Record of catheter-related complications [CRCs] was computerized. Similarly, patients' uncomfortability and expenditures on management of CRCs were recorded

Results: Of 66 cases, 62 [93.9%, 31/group] successfully completed the study. Baseline information showed male predominance [n = 47, 75.8%], age [M = 47, range 24-75 years] or catheter stay time [M = 40 days]. The rate of vein damage or artery puncture was found higher in IJV than SCV group [[13.9 vs. 6.5%] or [9.7 vs. 3.2%], respectively] during catheterization. The difference also existed in late CRCs such as bacterial infection [32.3 vs. 16.1%], or device dysfunctioning [9.7 vs. 3.2%] with an exception of mechanical kinking. All the patients of IJV or SCV group with missed [19.4 vs. 6.5%] or shortened HD sessions [22.6 vs. 12.9%] reported CRCs-based discomfort as a cause of the regularity. Moreover, the participants of IJV group consumed 69% of the total expenditures on CRCs management

Conclusion: SCV is a better site for HD catheterization as it has comparatively lesser likelihood of complications, patients' feel comfortable and it is also cost-effective.than IJV

Prevalence and severity of temporomandibular disorders [TMD] in undergraduate medical students using Fonseca's questionnaire

Objective was to assess the prevalence and severity of TMD in undergraduate medical students. It was a cross sectional descriptive study based on Fonseca's Questionnaire. It was conducted in four medical disciplines [Dentistry, Medicine, Pharmacy and Physical therapy] of The University of Faisalabad. All study participants were full time students and were females. Self-reported questionnaire was distributed among students and they were given detailed explanation to fill it. After collection of forms, scoring was done according to given standard method and data was entered in SPSS and statistical test of Chi-squared was applied. One hundred and thirty seven [137] students were enrolled and completed questionnaire of the study. 11[7.9%] students were observed with No TMD, 62[44.3%] with mild TMD, 62[44.3%] with moderate TMD and 5[3.6%] students with severe TMD [Fig 1]. Difference among age groups was significant [p?0.047] for three questions [Q2, Q, 5, Q10] There was no statistically significant difference regarding prevalence of TMD among all four disciplines of students. Regarding severity of TMD, it was observed that MBBS students were more in category of severe TMD as compared to other disciplines. It was concluded that the mean level of stress and TMD is almost equivalent in different disciplines of professional education with a variation in its level of severity which is 2 times more in MBBS students as compared to other students. There was no significant difference regarding prevalence of TMD in four groups of study

Infection control practices among dental practitioners of Lahore, Pakistan

To observe adoption of infection control measures among dental practitioners. A cross-sectional study based on a convenient sampling technique was conducted. Dental Practitioners in each subdivision [towns] of the Lahore, Pakistan were approached through 15 dental hygiene students to fill a close ended structured questionnaire. Study was conducted during 1[st] March-15 March 2005. Chi square test was applied with a significance level of p<0.05. Four hundred dental practices were visited and response rate of 83.25% was obtained. 62.76% surgeries were found being run by un-qualified dental practitioners and 37.23% by qualified dentists. 94.35% qualified practitioners used gloves as compared to only 28.2% of the un-qualified practitioners and a high percentage of qualified practitioners used gloves for every patients compared to their un-qualified counter parts [85.48% and 14.35%] respectively. 97.5% qualified practitioners and 80.3% of the un-qualified dentists used face masks. 85.1% of un-qualified and 98.3% of the qualified dental practitioners used fresh set of instruments for each patient. Use of sterilization methods including disinfectants, autoclaving of instruments was higher in qualified practitioners. Infection control measures among qualified and non-qualified practitioners were statistically significant. [p= 0.000] A poor level of infection control practice was observed in dental practices run by un-qualified practitioners. Majority of qualified dentists were observing infection control measures. There is need for further education and training for all the dental practitioners

Self-reported oral health related knowledge, attitude and practices among medical doctors of Lahore, Pakistan- a pilot study

Objective of this study was to investigate oral health-related knowledge, attitude, and practices of medical doctors of Lahore, Pakistan. Three hundred sixty medical doctors were approached consecutively, through undergraduate students of a dental college, at their workplaces in Lahore, Pakistan and self-reported questionnaires were filled. Response rate was 100%. Eight four percent completely filled questionnaires' were analyzed. Ninety nine percent subjects brushed their teeth, 55% showed twice a day frequency; 82% used soft/medium textured brushed and 95% changed brushes in 4-6 months period, 98.7% subjects used toothpastes, 73.1% knew how to brush, 91.9% professionals did not complain of foul breath, 54% had dental hypersensitivity, 14.5% reported pain in teeth, 34.2% had bleeding gums and 76.1% had visited a dentist. Only 4.70% males were smokers. Significant association [p=0.05] was found for use of tooth brush, brushing frequency and timing of brushing, brush change, use of mouth wash with gender; complaint of bad breath with education; sensitivity of teeth with income groups; bleeding gums, and visit to a dentist with education and income; and smokers with gender, education and income group. All other variables showed no statistical significance with respect to gender, education and income levels. Medical doctors were better in their oral health knowledge, attitude, and practices which were associated with education and socio-economic status

Oxidants, antioxidants and carcinogenesis.

Reactive oxygen metabolites (ROMs), such as superoxide anions (O2*-) hydrogen peroxide (H2O2), and hydroxyl radical (*OH), malondialdehyde (MDA) and nitric oxide (NO) are directly or indirectly involved in multistage process of carcinogenesis. They are mainly involved in DNA damage leading sometimes to mutations in tumour suppressor genes. They also act as initiator and/or promotor in carcinogenesis. Some of them are mutagenic in mammalian systems. O2*-, H2O2 and *OH are reported to be involved in higher frequencies of sister chromatid exchanges (SCEs) and chromosome breaks and gaps (CBGs). MDA, a bi-product of lipid peroxidation (LPO), is said to be involved in DNA adduct formations, which are believed to be responsible for carcinogenesis. NO, on the other hand, plays a duel role in cancer. At high concentration it kills tumour cells, but at low concentration it promotes tumour growth and metastasis. It causes DNA single and double strand breaks. The metabolites of NO such as peroxynitrite (OONO-) is a potent mutagen that can induce transversion mutations. NO can stimulate O2*-/H2O2/*OH-induced LPO. These deleterious actions of oxidants can be countered by antioxidant defence system in humans. There are first line defense antioxidants such as superoxide dismutase (SOD), glutathione peroxidase (GPx), and catalase (CAT). SOD converts O2*- to H2O2, which is further converted to H2O with the help of GPx and CAT. SOD inhibits *OH production. SOD also act as antipoliferative agent, anticarcinogens, and inhibitor at initiation and promotion/transformation stage in carcinogenesis. GPx is another antioxidative enzyme which catalyses to convert H2O2, to H2O. The most potent enzyme is CAT. GPx and CAT are important in the inactivation of many environmental mutagens. CAT is also found to reduce the SCE levels and chromosomal aberrations. Antioxidative vitamins such as vitamin A, E, and C have a number of biological activities such as immune stimulation, inhibition of nitrosamine formation and an alteration of metabolic activations of carcinogens. They can prevent genetic changes by inhibiting DNA damage induced by the ROMs. Therefore, these antioxidants may be helpful in the treatment of human cancer. However, detailed studies are required to draw a definite conclusion.