Disorders of the musculoskeletal system amongst practicing dentists

The aim of this study is to find out the frequency of musculoskeletal disorders among dentists working in Karachi and to establish factors associated with these disorders. Cross-sectional descriptive and analytical study. This study was conducted at Jinnah Medical and Dental College, Karachi from June 2014 to August 2014. The data was collected from three dental colleges of Karachi. The study was conducted at Jinnah Medical and Dental College. The study included 222 dentists working in different faculty positions from house officers to professors. The data was collected to find out the frequency of musculoskeletal disorders among dentists working in five different dental institutions of Karachi. A 22-item questionnaire was used to collect the data. The questionnaire was validated among a group of five dentists before using it for final survey. The questionnaire consisted of number of questions about age, gender, number of years in profession, pain in the back and neck, working hours per day, number of patients treated per day, any break taken between patients or not, working with assistant or not, working positions used, and medicines taken due to musculoskeletal pain. The data was stored in excel worksheet and was analyzed using SPSS. 222 dentists from five dental institutions of Karachi participated in the study. The study sample comprised of 90 males [40.5%] and 132 females [59.5%]. The study highlighted that dentist who are involved in clinical practice are more prone to musculoskeletal problems accounting for about 79%. Amongst these 52.8% having backache, while 43.9% of the dentists having pain in the neck. The factors that were found to be significantly associated with musculoskeletal pain included; Dentists working without assistance experience more musculoskeletal problem approximately 47.6%. Dentist working more than 7 hours a day experienced more neck pain 40%. In the light of this study it is apparent that musculoskeletal disorders are very common amongst the dentist working in Karachi. It is seen more in those who are working for long hours and those working without trained assistants. Breaks between patients and reducing the number of working hours as well as trained dental assistance can reduce the incidence of these disorders

Dental caries prevalence in 3-8 year old children of army schools in Lahore

This study was carried out to measure the prevalence of dental caries among 3-8 years old children of Army schools in the cantonment area in Lahore. This was a cross sectional study and the data were collected from 7 public primary schools [n=642]. The oral examination was conducted by single calibrated examiner by using examination instruments in natural day light. The findings were charted on WHO oral assessment form. Mean number of decayed, missing or filled teeth [DMFT index], caries distribution among the children were measured. Significant Caries Index [SiC Index], Plaque index and Care Index were used to measure the unequal distribution of the dental caries and oral health care. The study showed that only 39.06% of the students were caries free. The mean DMFT was 2.69, [boys 3.02 and girls 2.37]. F component of DMFT showed only 4.05% had fillings. SiC index was 6.58 which showed high caries distribution, the Care index was 0.06% indicating extremely low utilization of oral health services. A high prevalence of unmet health care need still exists in Lahore as reflected through high D and very low F scores in DMFT index. Furthermore; presence of dental plaque and poor oral hygiene has a significant impact on caries experience in primary school children in Lahore

Oral health status of the elderly in Lahore district of Pakistan

Poor oral health among old aged people is an important public health issue and a growing burden to countries worldwide. In Pakistan, there is paucity of data available regarding the oral health status of the elderly. This study was aimed to describe oral health status of the elderly in Lahore district, by assessing the dental disease prevalence in the 60+ age group. The current study was conducted in Lahore district. The results of the study are based on 470 valid examination proformas. The mean age of the total sample was 66.71+6.39 falling in the range of 60-91 years. Extra and intra oral examination were carried out. All clinical findings were recorded on the standard World Health Organization [WHO] oral health assessment form. Prevalence of periodontal disease as observed by Community Periodontal Index [CPI] was almost 70% in the study population. Calculus, most frequent findings, was observed in 28% subjects, shallow pocketing in 23.25% whereas deep pocketing was reported in 18.75%. Mean Decayed Missing Filled [DMF] score for the sample was 16.3 with females scoring higher than males. Missing component constituted 86.5% of the DMF score. 80% of the subjects did not wear any prosthesis, while almost 11.85% wore either a bridge or a partial denture or both; and another 8.5% wore a complete denture. Temporomandibular joint [TMJ] symptoms were reported by 11.25% of the subjects whereas TMJ clicking was the most common sign observed in 38%. TMJ tenderness and reduced jaw mobility was observed in 11.1% and 1.4% of the subjects respectively. Results of the current study clearly indicate poor oral health status of the elderly in the study population of Lahore. The level of unmet needs is very high hence; more attention needs to be given towards is improving and maintaining the oral health status of the elderly

Improving quality of life of diabetic patients through non-surgical periodontal treatment

Improving the periodontal health leads to better glycemic control in type 2 diabetic patients. [6,7] The study included known type II diabetic patients registered with the Diabetic Out Patient Department of Shaikh Zayed Hospital Lahore and Oral examinations were carried out in the Department of Oral Health Sciences of Shaikh Zayed Medical Institute. 61 subjects, 31 treatment group 30 control group. All the patients were non smokers with at least 14 teeth and showed wild to severe level of periodontal disease. Age ranged from 45-65 years. HbA1c values varied from 5-8%. No history of systemic antibiotic administration in the past 3 months. Subjects with any change in oral glycemic drug or its dose altered renal medication or any antibiotics were not included in the study. Treatment group showed a statistically and clinical significant improvement of 16.25% in HbA1c values. The periodontal therapy improves quality of life of diabetic person by improving glycemic control and decreasing the patients' dosage of oral glycemic drugs. In review of this advantage periodontal therapy should be made an integral part of the regime to improve glycemic control

Malignant solid pseudopapillary tumor of pancreas causing sinistral portal hypertension.

Solid pseudopapillary tumor (SPT) of the pancreas is a rare benign or low-grade malignant epithelial tumor that occurs mainly in young females in second to fourth decades of life. Pathologic and imaging findings include a well-defined, encapsulated pancreatic mass with cystic and solid components with evidence of hemorrhage. We report a 23-year-old female who presented with upper abdominal pain of long duration and epigastric mass on palpation. Multidetector-row CT (MDCT) demonstrated a large well-defined heterogeneous attenuation mass, containing hyperdense areas of hemorrhage mixed with solid enhancing and cystic non-enhancing areas, arising from the pancreatic body and tail. Splenic vein thrombosis was present with dilated splenoportal collateral vessels between splenic hilum and portal/superior mesenteric veins, with dilated vessels seen in the gastric wall, with patent portal vein, compatible with sinistral portal hypertension. Typical imaging features and age and sex of the patient suggested a diagnosis of SPT of pancreas complicated by segmental portal hypertension due to splenic vein thrombosis. Histopathology of the biopsy material was confirmatory.

Oral health attitudes, knowledge, and behavior amongst high and low socioeconomic school going children in Lahore, Pakistan

This study was carried out to evaluate the knowledge, attitude and behavior of low and high socioeconomic school going children and the type of food available and consumed at school premises, as well as the dental health care facilities available at schools. It was a multi-centric study which analysed school going children [n=281] from grade 1 to grade 10 who attended private schools of both high and low income groups in Lahore, Pakistan. A questionnaire adapted from Peterson and Stenberg et al designed to assess children's behavior, knowledge and perception of their oral health and dental treatment along with the availability of healthy food in the school was used. Results showed that 54% of HSES students bought food from cafeteria as compared to only 11% of LSES School. 41% LSES children's parents did not observe their child while brushing. 54% of LSES and 41% of HSES visited the dentist only in pain. 39% of HSES but only 12%of LSES went for regular checkups. Reason for not visiting the dentist among HSES students was fear of drilling [40.3%] and 9.3% in LSES. It was concluded that there was a dire need of health education programs especially for low socio economic school children. This study provides baseline information about children's knowledge, their attitudes and behavior towards eating habits, maintaining oral hygiene, seeking dental treatment of low socio economic and high socio economic school children in Lahore

Primitive neuroectodermal tumor/Ewing's sarcoma in adult uro-oncology: a case series from a developing country

Peripheral primitive neuroectodermal tumor/Ewing's sarcoma [PNET/EWS] is primarily a tumor of soft tissues and bones. Primary localization of PNET/EWS in genitourinary organs is rare. No data on this localization of PNET/EWS are available in literature from Pakistan. We searched our adult uro-oncology records from 1994 till date and identified all cases of adult genitourinary and adrenal PNET/EWS diagnosed on histology and immunohistochemistry. Their case records were reviewed to obtain data on demographics, presentation, pathologic features, management and outcome. Six cases were found; all were young and had aggressive disease at presentation. Four had renal PNET/EWS. One case each of prostate and adrenal PNET/EWS was seen. Surgery and chemotherapy formed the mainstay of management. Three patients [50%] died during treatment, two were lost to follow-up and one case with renal PNET/EWS showed good initial response to chemotherapy but was later on lost to follow-up. In conclusion, PNET/EWS should be considered in the differential diagnosis of genitourinary malignant tumors in young patients. These tumors are aggressive with poor outcome

Giant adrenal myelolipoma: Incidentaloma with a rare incidental association

Adrenal myelolipoma is an unusual, benign and biochemically inactive tumor that is composed of mature adipose and hematopoietic tissue. It is usually diagnosed accidentally and nowadays much more frequently because of widespread use of ultrasonography, computed tomography [CT] and magnetic resonance imaging. Adrenal myelolipoma is usually unilateral and asymptomatic, though known to be associated with obesity, hypertension, endocrinological disorders and some malignancies. We report herein two cases of right-sided giant adrenal myelolipoma diagnosed by multidetector-row CT. One patient was symptomatic because of a large mass in the right upper abdomen, which on imaging with CT was seen to be right adrenal myelolipoma. Another patient had a large left side Bochdalek hernia and right adrenal myelolipoma was incidentally discovered on CT

Oral health related quality of life individuals with down syndrome

Down syndrome [DS] is the most common cause of mental and physical retardation in the world. Individuals with Ds have skeletal, dental and soft tissue anomalies which along with their mental retardation lead to poor level of oral health as compared to normal population. This in turn has a negative impact on their quality of life. Despite all the problems oral health is reported to be the greatest unattended need of the disabled. The present review highlights the dental and oral problems that are faced by individual with DS so that a strategy can be devised to handle these conditions in the dental office

Tension Free Mesh Hernioplasty Is safe and effective

To evaluate clinically the outcome of mesh hernioplasty in terms of operation time, patient comfort, hospital stay, return to work, post-operative complications and cost.: Descriptive prospective study conducted from July 2003 to June 2005.Khyber Teaching Hospital and Lady Reading Hospital, Peshawar.A total of 80 patients, age >20 years, who presented with inguinal hernia.The data of all these patients was analyzed as regard to the clinical outcome, complications and cost. Inguinal hernia repair was performed on 80 patients with a mean age of 52.6 years. Fifty patients had direct while 30 had indirect hernia. The average duration of surgery was 30 minutes. Three patients had wound infection, four had scrotal oedema, and one had haematoma; but none had persistent pain. The length of follow-up ranged from 2-24 months and no recurrence has been reported so far The extra expenditure for the mesh and antibiotics make the whole procedure more expensive as compared to simple repair.The tension free mesh repair for the inguinal hernia is a safe, very simple and effective technique, and the overall morbidity is very low The clinical outcome and a very low recurrence rate has made it the procedure of choice for all hernia patients, inspite of the fact that it is a bit expensive

study of effectiveness of local bupivacaine infiltration of the wound in reducing the post-operative parenteral narcotic analgesic requirement

Objective: to see the effectiveness of local perfusion of the wound with bupivacaine .5% following cholecystectomy was studied

Material and Methods: a prospective randomized clinical trail involving 140 patients undergoing cholecystectomy for symptomatic gallstones, using Kocher's incision, was undertaken. Patients were randomized to receive either intermittent intravenous tramadol infusion on demand [parenteral analgesia, PA-group] or wound perfusion with local bupivacaine .5% per-operatively followed by intravenous tramadol infusion, if needed [local analgesia, LA-group]. On hundred and forty patients were recruited in the study, 70 in each group. Patient demographics were comparable in the two groups

Results: there was no statistically significant difference in post-operative pain scores at rest and with movement between the two groups, excepts for pain scores at rest on the first post-operative day [P = 0.03]. The median total amount of tramadol used was significantly greater in PA group i.e. 600 [range 500-1000] mg as compared to the amount used in LA-group i.e. 200 [range 0-400] mg

Conclusion: direct local wound perfusion of bupivacaine 0.5% provides good pain relief after cholecystectomy and reduces the requirements of parenteral narcotic analgesia with no major side effect. In other words, it is a safe and feasible alternative to parenteral opiods