Concurrent cisplatin-based chemoradiation in squamous cell carcinoma of cervix

Objective: to evaluate the efficacy of cisplatin-based concurrent chemoradiation in squamous cell carcinoma of cervix and the frequency of acute toxicity

Study Design: case series

Place and Duration of Study: department of Clinical Oncology, Karachi Institute of Radiotherapy and Nuclear Medicine [KIRAN], Karachi, from September 2010 to September 2011

Methodology: eighty patients with histologically proven squamous cell carcinoma of cervix were included. Patients were treated with concurrent chemoradiation. External beam radiation was delivered with 50 Gy whole pelvis along with 40 mg/m2 weekly cisplatin followed by brachytherapy three insertions of 6.5 Gy each, one week apart. Response to treatment was assessed using response evaluation criteria in solid tumours [RECIST] criteria at 4 weeks after treatment. Acute toxicity of chemoradiation was assessed using common toxicity criteria

Results: out of the 80 patients, 8 patients were lost to follow-up. Remaining 72 patients aged 28 - 65 years with mean age of 48.03 +/- 8.9 years. Forty-eight patients [66%] were in stage II-B, 5 [7%] were in stage III-A, 7 [10%] were in stage III-B, and 12 [17%] were in stage IV-A. Overall response to treatment was 92%, in which 39 [54%] had complete response, and 27 [38%] had partial response while 6 [8%] show progressive disease. About 70% patients had diarrhea, 61.2% patients developed vomiting, 45.8% patients had dermatitis, 43% patients had vaginal mucositis, 40.3% had anemia, 13.9% patients had neutropenia, 27.8% patients had dysuria, and 22.2% patients had proctitis

Conclusion: cisplatin-based concurrent chemoradiation is an effective treatment in locally advanced stage of cervical cancer with manageable toxicity

Frequency of high degree AV blocks in acute inferior myocardial infarction and their impact on clinical outcomes

Objective: To evaluate the frequency of high degree AV block in acute inferior wall myocardial infarction and to compare in hospital clinical outcomes in patients with inferior wall MI with and without AV Block

Study Design: Cross sectional descriptive study

Place and Duration of Study: Study was carried out at Armed Forces Institute of Cardiology, National Institute of Heart Diseases [AFIC-NIHD] Rawalpindi from Nov 2011 to June 2012, on patients admitted with acute inferior ML

Patients and Methods: Standard 12 lead ECG was recorded immediately after admission. Diagnosis of acute inferior wall MI was made in the presence of ST elevation >0.1 mv [1mm] in two or more of leads II, III and aVF. Continuous bed side cardiac monitoring was carried out. Two groups were made out of 193 patients. GROUPA [AVB+]=Patients having acute inferior wall infarction with AV block, GROUPB [AVB-jPatients having acute inferior wall infarction without AV block. Each group was compared for different variables. Data analysis was done by SPSS 17 statistical software

Results: AVB was found in 54 of 193 patients with inferior wall MI [28%]. Five patients [9.25%] of group A and 2 patients [1.43%] of group B died during hospital stay showing significantly higher mortality in patients with AVB [p=0.009]

Conclusion: Heart blocks are frequent among patients with inferior wall MI and are accompanied with a variety of in hospital complications. These complications can be minimized by early recognition and timely management including interventions like temporary cardiac pacing

E·health as a component of school health services in Lahore

Objective: facilitating health provision to masses involving internet is an emerging aspect of medical profession. This exploratory study aims to assess the adequacy of such services in schools of Lahore and form basis for further work up in this aspect

Material and Methods: out of 1400 schools registered with BISE, Lahore, private [43] and public [16] schools of Lahore were included in the study [purposive sampling by inclusion criteria] who had web pages [n=59]; Data was collected by data extraction form through internet and descriptive analysis was done using SPSS version 17. It was a self-financed study

Results: our results concluded that 53% schools [n=59] had well-equipped computer laboratories; out which 40% were private and only 13% were public, however not all of them provided access to internet. 39% of the schools regularly updated their websites; 29% were private and only 10% were public. 28% of the 59 schools provided their telephone numbers which the parents can contact in case of any emergency or otherwise.14% of the total schools had health related content available on their website. Only 3% each of both the schools displayed messages regarding health education

Conclusion: this study implies that the provision of e-health services in the schools of Lahore is almost negligible. Internet is a rising technology in Pakistan and steps should be taken to incorporate internet based innovations in the school health policy of Pakistan

Comparison of accuracy of working length measured by apex locator and periapical radiograph

The aim of this study was to compare the accuracy of working length measured by electronic apex locator andperiapical radiograph. This cross sectional analytical study was conducted at Department of Operative Dentistry, Dental section, Dow International Medical College, DUHS from November 2014 till December 2014. Thirteen teeth with twenty three canals were selected in patients having age between 18 to 60 years, who were advised extraction of teeth due to any reason. Access opening was performed and working lengths of all canals were measured using Kfile with apex locator and periapical radiographs. Access opening was filled with restorative GIC with the files present in canals. Teeth were then subjected to extraction. All extracted teeth were evaluated by sectioning the lower half or lower one third of the apices longitudinally. The distance of the file tip from the minor constriction was measured and recorded. Data were analyzed by using SPSS version 16. Intraclass co-efficient test was applied to see the agreement between the lengths measured with radiograph and apex locator than compared to the actual lengths as noted after sectioning. P-value of <0.05 was considered as significant. The results of the study showed that accuracy of apex locator were 65% [n=15] with the file tip at minor constriction, while 22% [n=5] for periapical radiograph. Thus it is concluded that electronic apex locator is more accurate and reliable then periapical radiograph

Dental anxiety level of patients presenting to operative dentistry department

Dental anxiety is a fear of visiting a dental health care provider for preventive or therapeutic care that leads to deterioration in oral health. The aim of this study was to measure the dental anxiety levels of patients presenting to the Operative dentistry department of Dental Section Dow International Medical College. It was a cross sectional study conducted between December 2014 and February 2015. Norman Corah's dental anxiety scale was used to measure the anxiety levels of patients.1 A questionnaire was developed based on this scale and a valid record of 383 forms was obtained. Amongst 383 patients, 125 were male patients [32%] while 258[67%] were female. Descriptive analysis was performed. Frequencies and cross tab calculations were carried out using SPSS version 20. Among other stressors, dental handpiece stood out as the most frightening. 12% of the respondents replied that they would get extremely anxious, making them feel physically sick while anticipating the use of a dental drill. Result showed that most of the patients [49%] had moderate dental anxiety that could be managed by simple non pharmacological means and counselling. While only 5% and 8% of the patients had high and severe [phobia] dental anxiety respectively. The mean dental anxiety level was 9.35 with Standard Deviation of +/- 3.06. More females had severe dental anxiety as compared to males [9% as compared to 5%]

Comparison of post instrumentation pain in teeth during root canal treatment with or with out occlusal reduction

The objective of the study was to compare the post instrumentation pain in teeth undergoing root canal treatment with or without occlusal tooth reduction. This randomized control trial was conducted at Outpatient Department of Operative Dentistry at Altamash Institute of Dental Medicine from September 2011 to March 2014. A total of 402 patients with irreversible pulpitis and normal periapical radiographic appearance of posterior teeth were included in this study. Patients were randomly allocated into two groups i.e occlusal tooth reduction [OTR] group and no occlusal tooth reduction [NOTR] group. After root canal instrumentation, patients were instructed to complete a Visual Analogue Scale [VAS] to score their pain at 6 hours, 12 hours, 18 hours, 24 hours, 2 days, 3 days, 4 days, 5 days, and 6 days. The final outcome that is mean post instrumentation pain score was measured at 6 days of post instrumentation. This randomized control trial was conducted at Outpatient Department of Operative Dentistry at Altamash Institute of Dental Medicine from September 2011 to March 2014. A total of 402 patients with irreversible pulpitis and normal periapical radiographic appearance of posterior teeth were included in this study. Patients were randomly allocated into two groups i.e occlusal tooth reduction [OTR] group and no occlusal tooth reduction [NOTR] group. After root canal instrumentation, patients were instructed to complete a Visual Analogue Scale [VAS] to score their pain at 6 hours, 12 hours, 18 hours, 24 hours, 2 days, 3 days, 4 days, 5 days, and 6 days. The final outcome that is mean post instrumentation pain score was measured at 6 days of post instrumentation. Mean post instrumentation pain score at 6 days was significantly low in OTR group than NOTR groups [2.44 +/- 0.86 vs. 3.24 +/- 0.89; p=0.0005]. Thus, it is concluded that occlusal reduction help in the prevention of post instrumentation pain in teeth with irreversible pulpitis, sensitivity to purcussion, pre- treatment pain and absence of periradicular radiolucency. Whereas the presence of all four conditions are the strong predictors, the presence of any one or more of the conditions is enough to indicate a need for occlusal reduction

Bonding of acrylic resin teeth with denture base resin

The debonding of acrylic resin teeth with the denture base resin has been related to several different factors of which contamination of the bonding surfaces with wax has been suggested as the major cause. The purpose of this study was to determine the efficient method of wax removal from denture teeth using hot water at different temperatures ranges. Acrylic rods were used as tooth analogues and Raman spectroscopy was used to detect the presence of wax on the surfaces of the specimens. It was found that none of the techniques studied was able to remove all of the wax. Abraded ridge-lap surface showed least wax contamination when dewaxed at 100 degree C as compared to dewaxed at 85 degreeC and 65 degree C respectively. The spectrum for each specimen demonstrated peaks at different wavelengths and varying intensities, the spectra demonstrated traces of wax on abraded surfaces showed least wax when dewaxed at 100 degreeC as compared abraded surfaces dewaxed at 65 degree C and 85 degree C temperatures respectively

Strategies for prevention of road traffic injuries [RTIS] in pakistan: situational analysis

Road traffic injuries [RTIs] are one of the leading causes of death among productive age group. Using systems approach framework [SAP], current preventive strategies for RTI control were reviewed in Pakistan. A review of the literature was done using four international search engines. Only ten studies on preventive strategies for RTI stemming from Pakistan were found. The first Road Traffic Injuries Research Network [RTIRN] surveillance system for road traffic injuries was established in urban city [Karachi] in Pakistan has shown promise for injury control and should be scaled up to other cities. Enforcement of traffic laws on seat-belt and helmet wearing is poor. National Highway and Motorway Police Ordinance [2000] was one of the few legislative measure so far taken in Pakistan. Using SAP, efforts are required to implement interventions targeting human, vehicle design and also making environment safer for road users

Quality of post graduate medical training in public and private tertiary care hospitals of Karachi

To assess the quality of postgraduate fellowship training and to determine the differences in the quality of postgraduate fellowship training in public and private teaching hospitals of Karachi. It was a cross sectional survey conducted in four public and private sector hospitals of Karachi from January to March 2012. A total of 246 postgraduate fellowship trainees were interviewed. A standardized questionnaire adopted from CPSP guidelines on postgraduate training standards was developed. Postgraduate fellowship trainees [PG's] were selected on the basis of convenient non-probability sampling technique. Fisher's exact test and chi-square test were used to find differences in quality of postgraduate training. The mean duty hours per week was highest in private sector hospitals i.e., 72.1 as compared to government sector hospital which was 58.3 [P-value <0.01]. Of the respondents, 66.0% of PG's in private hospitals agreed that they have a structured study program as compare to 46.5% in public hospitals [P-value <0.001]. Only 38.1% of PG's in public hospitals agreed that they spent appropriate amount of time with their family and friends as compare to 1.8% of PG's in private hospitals [P-value <0.001]. No significant difference was found in quality of supervision in both public sector and private sector hospitals. The attributes of different aspects of training were different in public and private sector hospitals. So significant room exists for improvement in the quality of postgraduate medical training as indicated by the less than desirable proportion of trainees being satisfied with different aspects of training

Comparison of frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion

To compare the frequency of recurrence following aspiration and injection of steroid versus surgical excision in the treatment of wrist ganglion. Randomized controlled trial. General surgical department, Combined Military Hospital, Rawalpindi, Pakistan, from Jan 2010 to Dec 2010. Sixty patients of clinically diagnosed wrist ganglia were randomized into groups A and 'B' with 30 patients in each group. After approval by the hospital ethical committee, patients in group 'A' were subjected to aspiration and injection of methyl-prednisolone acetate 40 mg/ml and those in group 'B' underwent surgical excision of the ganglion. Patients were explained the procedure they were subjected to and they were also counselled about the risk of recurrence after a particular procedure and after that informed written consent was obtained from them. Patients were followed up at intervals of 2 weeks, 6 weeks, 3 months and 6 months after the procedure to look for recurrence in both groups. On follow up at 6 months, 12 [40%] patients in group A while only 2 [6.66%] patients in group B had recurrence of the ganglion. No complications were noted. This difference was found to be statistically significant [p = 0.0023]. Recurrence of wrist ganglion is considerably less in patients treated with surgical excision and should be preferred over aspiration and steroid injection

Successful intubation with air-Q in Pierre Robin syndrome

Airway access is particularly difficult in infants and children with some anatomical deformities, usually associated with congenital syndromes. Craniofacial abnormalities are commonly seen in the Pierre Robin Syndrome [PRS], Treacher Collins and Goldenhar syndromes. The Pierre Robin sequence consists of micrognathia and relative macroglossia with or without cleft palate. In the severe case, airway obstruction and feeding difficulties are present. Endotracheal intubation may be difficult, or in some case even impossible. We present a case report of intubation of a child, suffering from PRS, by using air-Q, a new intubating LMA, and use of tongue stitches to maintain airway during recovery

Assessment of microleakage of three restorative materials in class V cavities. an in vitro study

To evaluate the marginal microleakage in class V cavities restored with three different restorative materials using dye penetration scoring system. Cross sectional study. This study was conducted at Dental Clinic laboratory, Juma building research laboratory, and Multidisciplinary laboratory, The Aga Khan University, Karachi for a period of six months from April 2008 to September 2008. One hundered and fifty extracted premolars were randomly selected. Standardized class V cavities were prepared and then divided into three equal groups: Group I was restored with composite resin, Group II with glass ionomer cement and group III with resin modified glass ionomers. They were then subjected to thermocycling, immersed in 2% methylene blue dye, sectioned and examined under dissection microscope. Dye penetration for each section was recorded and data was analyzed. Lowest leakage was found in Group I [composite resin] and maximum in Group II [conventional glass ionomer]. Microleakage at gingival margins was significantly more than that at occlusal margins in all groups. Composite resins and resin modified glass ionomers provide a better seal than glass ionomers in class V cavities. All materials show more microleakage at gingival margins as compared to occlusal margins

Frequency of infectious diseases among flood affected people at district Rajanpur, Pakistan

To identify the frequency of infectious diseases among flood victims during and after disaster at district Rajanpur, Punjab, Pakistan. A cross sectional study was conducted from 15[th] to 31[st] August 2010 at 17 flood affected places of District Rajanpur of Punjab Province, Pakistan. A total of 7814 affected people were interviewed consecutively by using semi-structured questionnaire visiting the relief camps during the study period. Information was obtained after taking informed consent regarding infectious diseases: Acute Respiratory Tract Infection, Eye Infection, Gastrointestinal Tract Infection, Ear Infection, Skin and Soft tissue Infection, and suspected Malaria. Data was entered and analyzed by using SPSS version 16.0. The results showed that the distribution of infectious disease cases presented to relief camps were Gastrointestinal cases [Acute Diarrhea]-30%, Skin and Soft Tissue Infection [33%], Eye [Conjunctivitis]-07%, Ear, Nose and Throat Infection [05%], Respiratory Tract Infection [21%], and Suspected Malaria [4%]. Their mean age was 23.15 +/- 17.53 years. Our study concluded that there was a high frequency of infectious diseases. The morbidity and mortality resulting from infectious diseases can be minimized if public health intervention efforts are implemented in a timely and coordinated fashion

Safety and efficacy of ureteroscopic pneumatic lithotripsy

To determine the safety and efficacy of ureteroscopic pneumatic lithotripsy [PL] for the clearance of ureteral calculi [UC]. Experimental study. Department of Urology, KRL Hospital, Islamabad, from March 2006 till December 2008. Ureteroscopic PL was performed on 104 patients with ureteric calculus measuring >/= 6 mm; using Swiss Lithoclast through a 9.5 French semi-rigid ureteroscope. At the end of the procedure, a DJ stent was inserted. Complications were noted. Stone clearance was assessed through X-ray KUB. DJ stent was removed within 3 - 6 weeks after the procedure. Sixty-eight patients [65.4%] were males and 36 [34.6%] females. The average hospital stay was 2.6 +/- 2.8 days; 72 [69.6%] patients were discharged on the first post-procedure day. Complete stone clearance was achieved in 98 [94.2%] patients, at 3-6 weeks. Four patients [26.7% of upper ureteral stones] had stone retropulsion. The only major complication was perforation occurring in 2 [1.9%] distal ureters. One case was successfully managed by endoscopic DJ stent placement, the other required open repair. Ureteroscopic PL is effective in clearing majority of middle and distal UC. Patients with proximal stones may have stone retropulsion. Ureteric perforation is an uncommon complication

Epidemiology of non-disaster spinal injuries at a spine unit

To describe the demography, types of injuries and their management in all non-disaster spinal injury patients admitted to the Spine Unit of a tertiary care hospital in Pakistan from 2001-2008. Case series. Spine Unit, Orthopaedic Department, Combined Military Hospital, Rawalpindi, from April 2001 to December 2008. Data of all new non-disaster spinal injury patient admissions, kept in a custom-built database at Spine Unit, was analyzed. Demography, type of injuries and their management was described in percentages. Five hundred and twenty one non-disaster patients were selected out of a total 671 new admissions with spinal injuries. Mean age was 39.1 years and 77% were males. Mechanisms of injury included; fall in 62% and road traffic accidents in 32%. Fracture dislocations and burst fractures were equally distributed [36% each]. Most of the injuries [43.6%] were at T11-L1 level. Forty three percent patients had complete spinal cord injury [SCI], 33% had incomplete SCI and 24% did not have any SCI. Eight patients had concomitant spinal injury at a different level. Twelve percent patients had associated other major injuries. Seventy percent patients were treated surgically. Average follow-up was for 4 years. Non-disaster spinal injury was frequent in young males usually due to fall or road traffic accident. It involved fracture dislocation or burst fracture at T11-L1, level in most cases requiring surgical treatment

Laboratory evaluation of a new molluscicide application method

The paper reports an investigation, in the laboratory, of a new method for the application of the molluscicide, Niclosamide, using the concept of slow-release with local materials as matrices. The local matrices tested were the seeds of the mango and the cobs of the maize. The objective was to reduce the cost of the snail control operations. 1, 5 and 10 seeds and/or cobs were immersed into 4 concentrations [0.6, 1.0, 2.0 and 4.0 ppm] of Niclosamide for different hours [1, 2, 6, 12, 24 and 48 hrs]. B. pfeifferi snails were then exposed to the immersed seeds and cobs for different hours [1, 2, 6, 24, 48 and 72 hours]. Different statistical procedures were used to analyze the data. The mean time of mortality of B. pfeifferi snail indicated that the cobs of the maize were a superior matrix for Niclosamide than the seeds of the mango. The LC[50] and LC[95] indicated that the combination of 10 cobs immersed for 12 hours in 4.0 ppm was the effective combination to achieve high mortality rates among B. pflefferi snails after 48 hours exposure. The method proved to be, in the laboratory, cost-effective in terms of the quantity of Niclosamide required to result in a high mortality among the snails