Assessing the level and diagnostic accuracy of osteopontin and oral health status in periodontitis patients with/without Type-2 Diabetes Mellitus / Avaliação do nível e precisão do diagnóstico de Osteopontina e estado de saúde bucal em pacientes com periodontite com/sem Diabetes Mellitus tipo 2

Objective: Investigating osteopontin (OPN) level in gingival crevicular fluid (GCF) of patients affected by periodontitis with or without Type-2 diabetes mellitus (T2DM). The aim of this study is to explore the possibility of OPN to differentiate between periodontal health and disease. Material and Methods: A total number of 36 participants seeking periodontal treatment were recruited in this pilot study and divided into three study groups. Periodontitis [systemically healthy participants with periodontitis (probing pocket depth) PPD (probing pocket depth) ≥ 4mm], periodontitis and poorly controlled type 2 diabetes mellitus (), and control (systemically and periodontally healthy periodontium) groups. Plaque index (PI), gingival index (GI) and PPD were examined. OPN level was measured in the GCF and analysed, using Enzyme-Linked Immunosorbent assay. Results: PI and GI were significantly higher in T2DM with periodontitis compared to periodontitis and control groups. Both periodontitis and P-T2DM groups showed significant increase in the OPN levels compared to control group (p<0.001). PPD showed the only significant positive association with OPN (p<0.001) compared to other clinical parameters. The receiver operating characteristics curve analysis demonstrated that OPN had higher area under the curve value (AUC: 0.95) in periodontitis compared to P-T2DM patients (AUC: 0.86). Conclusion: In periodontitis groups, clinical parameters were equally deteriorated together with significant increase in the expression of OPN compared to control. Furthermore, GCF levels of OPN were sensitive and specific enough to discriminate between health and periodontitis even with T2DM. This could introduce OPN to be as a candidate diagnostic biomarker of periodontal disease. (AU)

Objetivo: Investigar o nível de osteopontina (OPN) no fluido gengival crevicular (GCF) de pacientes com periodontite com ou sem diabetes mellitus tipo 2 (T2DM). O objetivo deste estudo foi explorar a possibilidade da OPN diferenciar entre saúde e doença periodontal. Material e Métodos: No total, para este estudo piloto foram recrutados 36 participantes que estavam em busca de tratamento periodontal e divididos em três grupos de estudo: grupos periodontite [participantes sistemicamente saudáveis com periodontite (profundidade de sondagem) PPD ≥ 4 mm], grupo periodontite e Diabetes Mellitus tipo 2 mal controlada (P-T2DM) e grupo controle (saudáveis sistemicamente e periodontalmente). Índice de placa (PI), índice gengival (GI) e PPD foram examinados. O nível de OPN foi medido no GCF e analisado usando o ensaio ELISA (Enzyme-Linked Immuno Sorbent Assay). Resultados: PI e GI foram significativamente maiores no T2DM com periodontite em comparação aos grupos com periodontite e controle. Os grupos com periodontite e P-T2DM apresentaram aumento significativo nos níveis de OPN em comparação ao grupo controle (p <0,001). PPD mostrou a única associação positiva significativa com OPN (p <0,001) em comparação com outros parâmetros clínicos. A análise da curva de características operacionais do receptor demonstrou que OPN teve maior área sob o valor da curva (AUC: 0,95) na periodontite em comparação com pacientes com P-T2DM (AUC: 0,86). Conclusão: Nos grupos com periodontite, os parâmetros clínicos foram igualmente deteriorados juntamente com aumento significativo na expressão de OPN em comparação com o grupo controle. Além disso, os níveis de OPN no GCF foram sensíveis e específicos o suficiente para discernir entre saúde e periodontite, mesmo com T2DM. Isso poderia apresentar a OPN como um candidato a biomarcador diagnóstico de doença periodontal.(AU)

Efficacy of prophylactic intravenous administration of ondansetron for prevention of spinal anesthesia induced hypotension in elderly patients

Objective: Hypotension is the commonest side effect associated with spinal anesthesia. Multiple modalities have been tested to find adequate preventive measure. Main objective of this study is to find out the effectiveness of prophylactic administration of inj. ondansetron for prevention of spinal anesthesia induced hypotension in elderly patients

Study design: Double blind, randomized controlled trial

Place and duration of study: This study was conducted in our anesthesiology department from 01 July 2014 to 31 December 2014

Methodology: 100 patients were selected for the study using non-probability sampling technique, and divided into two groups of 50 each using random numbers table. Each patient was preloaded with ringer's lactate solution in a dose of 10 ml/kg Patients of Group A received 8 mg of ondansetron IV five minutes prior to administration of spinal anesthesia; whereas patients of Group B were injected normal saline IV. Data were collected and analyzed using IBM SPSS version 20. Chi square test was used to compare hypotension between two groups. A p-value < 0.05 was taken as significant

Results: Mean age of Group A was 64.16 +/- 8.47 years, whereas that of Group B was 62.58 +/- 8.99 [p value= 0.39]. Mean weight of Group A was 72.64 + 5.82 kg, whereas that of Group B was 70.66 + 5.96 kg [p = value p- 0.295]. Hypotension was present in 23 [46%] patients in Group A, where as it was present in 34 [68%] patients in Group B [p value= 0.026]. Bradycardia was recorded in 3[06%] vs. 11 [22%] patients in Group A and B respectively [p=0.021]

Conclusion: We conclude that intravenous administration of 8 mg of ondansetron, 5 minutes prior to subarachnoid block, is effective in decreasing frequency of hypotension and bradycardia in elderly patients

Use of neostigmine in black mamba snake bite: a case report

Snake bite is quite common in most of the countries of the world, especially tropics and subtropical areas. The snake venom is usually one of the two types; neurotoxins and hemotoxins or hemolysins. The management of snake bite consists of supportive treatment and anti-snake venom serum. The patients suffering from respiratory problems due to muscular paralysis will require mechanical ventilatory support. We present a case of a victim of black mamba bite, which is one of the most dreaded snakes in Africa. His recovery was slow and marred with coagulation profile derangement. Finally we started neostigmine and atropine and witnessed a dramatic improvement in his muscle power. He rapidly improved and was discharged with complete recovery

Glanzmann's thrombasthenia: role of angioembolization and factor VII in recurrent bleeding from ulcerated duodenum

Introduction: Glanzmann's thrombasthenia [GT] is a rare, genetically inherited, functional disorder of platelets. The pathology is deficient or dysfunctional platelet glycoprotein IIb/IIIa [GP IIb/IIIa] complex resulting in bleeding diathesis

Case Report: Here in, we report the effectivity of angioembolization with factor VII in a patient with Glanzmann's thrombasthenia [GT], who presented with recurrent bleeding from duodenal ulcer

Conclusion: Angioembolization with added infusion of factor VII, can be considered an equally effective alternate to platelet transfusion in patients of GT, who present with recurrent bleeding

Does ultrasonographic volume of the thyroid gland correlate with difficult intubation? An observational study / Existe correlação entre o volume ultrassonográfico da glândula tireóide e intubação difícil? Um estudo observacional / ¿Existe una correlación entre el volumen ecográfico de la glándula tiroides y la intubación difícil? Un estudio observacional

BACKGROUND AND OBJECTIVES: Preoperative ultrasonographic evaluation of the thyroid gland done by surgeons could let us foresee airway management challenges. The aim of this observational study was to evaluate the effects of thyroid-related parameters assessed preoperatively by surgeons via ultrasonography and chest X-ray on intubation conditions. METHODS: Fifty patients undergoing thyroid surgery were enrolled. Thyromental distance, Mallampati score, neck circumference and range of neck movement were evaluated before the operation. Thyroid volume, signs of invasion or compression and tracheal deviation on chest X-ray were also noted. The intubation conditions were assessed with Cormack and Lehane score and the intubation difficulty scale. Statistical analyses were done with SPSS 15.0 software. RESULTS: The mean thyroid volume of the patients was 26.38 ± 14 mL. The median intubation difficulty scale was 1 (0-2). Thyromental distance (p = 0.011; r = 0.36; 95% CI 0.582-0.088), Mallampati score (p = 0.041; r = 0.29; 95% CI 0.013-0.526), compression or invasion signs (p = 0.041; r = 0.28; 95% CI 0.006-0.521) and tracheal deviation on chest X-ray (p = 0.041; r = 0.52; 95% CI 0.268-0.702) were correlated with intubation difficulty scale. Also patients were classified into two groups related to their intubation difficulty scale (Group I, n = 19: intubation difficulty scale = 0; Group II, n = 31: 1 < intubation difficulty scale ≤ 5) and difficult intubation predictors and thyroid-related parameters were compared. Only Mallampati score was significantly different between groups (p = 0.025). CONCLUSION: The thyroid volume is not associated with difficult intubation. However clinical assessment parameters may predict difficult intubation. .

JUSTIFICATIVA E OBJETIVOS: A avaliação ultrassonográfica pré-operatória da glândula tireóide feita por cirurgiões pode prever desafios no manejo das vias aéreas. O objetivo deste estudo observacional foi avaliar os efeitos de parâmetros relacionados à tireóide investigados pré-operatoriamente por cirurgiões mediante ultrassonografia e radiografia de tórax em condições de intubação. MÉTODOS: Foram inscritos 50 pacientes submetidos à cirurgia de tireóide. Distância tireomentoniana (DTM), escore de Mallampati, circunferência do pescoço e amplitude de movimento do pescoço foram avaliados antes da operação. Volume da tireóide, sinais de invasão ou compressão e desvio da traqueia na radiografia de tórax também foram registrados. As condições de intubação foram avaliadas com o escore de Cormack e Lehane (CL) e a escala de intubação difícil (EID). Análises estatísticas foram feitas com o software SPSS 15.0. RESULTADOS: A média do volume da tireóide dos pacientes foi de 26,38 ± 14 mL. A mediana da EID foi de 1 (0-2). DTM (p = 0,011; r = 0,36, IC 95% 0,582-0,088); escore de Mallampati (p = 0,041; r = 0,29, IC 95% 013-0,526); sinais de compressão ou invasão (p = 0,041; r = 0,28; IC 95% 0,006-0,521) e desvio da traqueia na radiografia de tórax (p = 0,041; r = 0,52, IC 95% 0,268-0,702) foram correlacionados com a EID. Os pacientes foram classificados em dois grupos também relacionados à EID (Grupo I, n = 19: EID = 0; Grupo II, n = 31: 1 < EID ≤ 5) e os preditivos de intubação difícil e os parâmetros da tireóide relacionados foram comparados. Apenas o escore de Mallampati foi significativamente diferente entre os grupos (p = 0,025). CONCLUSÃO: O volume da tireóide não está associado à intubação difícil. Contudo, os parâmetros de avaliação clínica podem prever intubação difícil. .

JUSTIFICACIÓN Y OBJETIVOS: La evaluación ecográfica preoperatoria de la glándula tiroides hecha por los cirujanos puede prevenir los retos en el manejo de las vías aéreas. El objetivo de este estudio observacional fue evaluar los efectos de parámetros relacionados con la tiroides investigados por cirujanos antes de la operación, mediante ecografía y radiografía de tórax en condiciones de intubación. MÉTODOS: Fueron inscritos 50 pacientes sometidos a cirugía de tiroides. La distancia tiromentoniana, puntuación de Mallampati, circunferencia del cuello y amplitud de movimiento del cuello fueron evaluados antes de la operación. También fueron registrados el volumen de la tiroides, signos de invasión o compresión, y desviación de la tráquea en la radiografía de tórax. Las condiciones de intubación se calcularon con la puntuación de Cormack y Lehane y la escala de intubación difícil (EID). Los análisis estadísticos fueron realizados con el software SPSS 15.0. RESULTADOS: La media del volumen de la tiroides de los pacientes fue de 26,38 ± 14 mL. La mediana de la EID fue 1 (0-2). Fueron correlacionados con la EID la distancia tiromentoniana (p = 0,011; r = 0,36; IC 95%: 0,582-0,088), puntuación de Mallampati (p = 0,041; r = 0,29; IC 95%: 013-0,526), signos de compresión o invasión (p = 0,041; r = 0,28; IC 95%: 0,006-0,521) y desviación de la tráquea en la radiografía de tórax (p = 0,041; r = 0,52; IC 95%: 0,268-0,702). Los pacientes fueron clasificados en 2 grupos también relacionados con la EID (grupo i, n = 19: EID = 0; grupo ii, n = 31: 1 < EID ≤ 5), y los predictores de intubación difícil y los parámetros de la tiroides relacionados fueron comparados. Solamente la puntuación de Mallampati fue significativamente diferente entre los grupos (p = 0,025). CONCLUSIÓN: El volumen de la tiroides no está asociado con la intubación difícil. Sin embargo, los parámetros de evaluación clínica pueden prever la intubación difícil. .

Health issues confronting muslims on hajj

Objective: To determine the prevalence of health issues among hajj pilgrims and the factors associated with them

Method: An observational study conducted during hajj [Year 2011] using a questionnaire which was filled by pilgrims on their visit to the health clinics conducted by the Imamia Medics International

Results: During the period, pilgrims presented complaints related to the respiratory system 52.5% [n=394] followed by musculoskeletal system 29.6% [n=222], gastrointestinal system 15.5%[n=116], skin problems 5.9%[n=44], central nervous system 3.1%[n=23], cardiovascular system 2.9%[n=22], reproductive system 2.7%[n=20], urinary tract problems 2.3%[n=17] were dealt with. Out of 750, 17.9% [n=134] were diabetic and 26.4% [n=198] were hypertensive. Amongst the total, 24.8% [n=186] were vaccinated against hepatitis while 35.7% [n=268] were vaccinated against pneumonia. An astonishingly high percentage of the pilgrims had no prior immunization to both hepatitis and pneumonia

Conclusion: This data tries to emphasize awareness regarding the importance of vaccination and the potential problems which are faced by diabetic, hypertensive and older population which can help to improve the health condition of hajj pilgrims and can lessen the burden faced by concerned authorities

[Wiscott-Aldrich syndrome [WAS]]

Wiscott-Aldrich syndrome [WAS] is an x-linked immune-deficiency disorder associated with eczema, recurrent infections, and increased frequency of autoimmune diseases, malignancy and thrombocytopenia with small size platelet. Our case is an 11 year old from a non- related parent, who was admitted with abdominal pain [hematoma], lower extremities bleeding [ecchymosed] and vomiting. Also, he had many admition cause bleeding in different areas. Lastly, he had retinal bleeding associated with blindness from 1 year ago

Effects of pre-treatment with lignocaine on pain of rocuronium injection and withdrawal movements of the arm

The study was carried out to assess the frequency of pain and withdrawal movements after injection of rocuronium and effects of pre-treatment with lignocaine. It was a double blind study. This study was of six months duration and was carried out from March 2004 to September 2004 at Combined Military Hospital Kharian. One hundred and twenty unpremedicated patients with ASA grade I and II, aged between 18-60 years and of both sexes were enrolled in the study. Patients were randomly divided into two groups of 60 patients each. After induction of anaesthesia with thiopentone, patients in group A, received 3 ml of lignocaine plain while those in group B, received 3 ml of normal saline as pre-treatment before injection of rocuronium. Their effects on pain on injection and withdrawal movements of the arm were studied. Out of total of 120 patients, only 17 patients [14%] developed withdrawal movements of the arm or wrist. In Group A, who received lignocaine plain before rocuronium injection, only 3 out of 60 patients had withdrawal movements while in Group B, who received normal saline as pretreatment, fourteen out of 60 patients developed withdrawal movements of the arm or wrist. Only one patient belonging to Group B experienced pain. Pre-treatment with lignocaine plain greatly reduces the chances of withdrawal movements and pain on injection of rocuronium

Toward establishing normal waist circumference in Eastern Mediterranean and Middle East [Arab] populations. Cutoff values for waist circumference in Iraqi adults

Determination of cutoff points for waist circumference [WC] is of paramount importance for prevention, optimum management, and prognosis of obesity, the metabolic syndrome [MetS], type 2 diabetes mellitus, and coronary heart disease. The aim of this project was to establish cut-off levels for waist circumference in Eastern Mediterranean and Middle East [Arab] populations in Basrah, Iraq. This was a community-based cross-sectional survey for establishing normal value of WC from one district in Basrah [Abu-Al-khasib]. A multiple stratified sampling procedure was used for sample selection. The cutoff level yielding the maximal sensitivity plus specificity for predicting the presence of multiple risk factors was 97cm in men and 99 cm in women. Sensitivity and specificity using these cut-off values were 70% and 50% respectively in men and 70% and 45% respectively in women. We propose an optimal cutoff point of WC for the diagnosis of MetS in the Iraqi population: 99 cm in women and 97 men

Use of continuous low pressure suction on chest drain in thoracic surgical unit

To assess the merits and demerits of continuous Low Pressure Suction applied to the chest drain in both preoperative and postoperative thoracic patients. Department of Cardiothoracic Surgery, Postgraduate Medical Institute, ady Reading Hospital Peshawar from Jan 2005 to March 2005. It was a prospective study carried out over the period of three months to assess the benefits of Low Pressure Suction. Patients with Chest trauma, inflammatory disease of the lung and pleura, carcinomas and postoperative patients were included in the study. Patients with multiple trauma and moribund patients were excluded from the study. Postoperative patients were given priority for suction beds. The suction applied to the chest drain ranged from -05 to -20 KPa. It was continuously applied to the chest drain 24hrs a day and 7 days a week and only interrupted at the time of bottle change or patients going to toilets. A total of 180 patients were included in the study, which were divided into two groups depending upon the availability of suction beds. Group I: Included those patients who were put on Continuous Low Pressure Suction. Group II: Included those patients who were not put on Continuous Low Pressure Suction because lack of suction beds. Ninety patients were included in group I and similar number of patients into group II. In group I out of 90 patients 40 were non-operative and 50 were operative. In group II out of 90 patients 55 were non-operative while 35 were operative. Out of operated patients [total 85] full lung expansion was achieved in 42 [84%] in group I and 25 [71.4%] in group II while partial lung expansion was achieved in 08 [16%] in group I and 10 [28.6%] patients in group II. Out of non-operated patients [total 95] full expansion was achieved in 35 [87.5%] in group I and 42 [76.4%] in group II while partial expansion was achieved in 05 [12.5%] patients in group I and 13 [23.6%] in group II. Out of 5 partial expansions in group I suction had to be discontinued in 2 patients because of increasing air leak. Continuous low pressure suction helps to decrease the need for surgery in patients following chest trauma, inflammatory lung disease and decreases morbidity in postoperative patients

Surgical repair of cauliflower ear deformity by anterior approach: Report of three cases

The cauliflower ear or wrestler's ear is the ultimate deformity of the ear following otohaematoma due to repeated high intensity trauma to the auricle. If the haematoma is not treated by early proper evaluation, the damaged perichondrium will alllow the growth of an "ectopic" fibrous cartilage responsible for the disfigurement. It constitutes a real cosmetic and therapeutic dilemma for the patient and the clinician especially if the deformity was left untreated for a long time, as technical difficulties will be encountered for excision of the thickened cartilage and for ensuring a satisfactory esthetic outcome. Three adult patients from Qatar with long-standing cauliflower ears were successfully corrected in 2002 by a single stage operation using the anterior approach. The deformed cartilage was shaved under a raised cutaneous flap and the concha was re-sculptured. The procedure gave satisfactory results. The pathogenesis, adopted surgical technique, post-operative care and histopathology are discussed together with a review of the literature

Chemical composition of urinary stones and presentation of potients reporting at PIMS, Islamabad

Urinary stones are the commonest cause of acute ureteric obstruction, which if left untreated, may result in the dilatation of proximal renal tract ultimately leading to irreversible kidney damage. Of the 80 cases of urinary stones reported at the Pakistan Institute of Medical Sciences, Islamabad, 43 [53.75 percent] were in the kidney, 18 [22.5 percent] in the urinary bladder, 10 [12.5 percent] and 9 [11.25 percent] passed through the urine. Of these cases, the incidence among males was higher than in females [3:1] with the greatest occurrence in the 25 - 34 years age group [35 percent]. The three predominant symptoms associated with urinary stones were lumbar pain [43 percent], dysuria [25 percent] and hematuria [12 percent]. Other symptoms included history of passing urinary stones [9 percent], urinary retention [7 percent], bladder irritation [3 percent] and vomiting [2 percent]. As for the chemical composition of urinary stones, most of the stones isolated in this study were composed of calcium oxalate and calcium phosphate [56.25 percent], calcium oxalate and uric acid [22.5 percent] and calcium oxalate, calcium phosphate and uric acid [12.5], however, stones composed solely of uric acid, calcium oxalate, calcium phosphate and struvite were also found

Prevalence of anti-hepatitis C antibodies in patients with liver disease

108 liver diseased patients, either admitted as indoor patients, or attending the hospital as outdoor patients were included in the present study. Four hospitals of Islamabad and Rawalpindi, namely; Federal Government Services Hospital, Pakistan Institute of Medical Sciences, Capital Hospital and Rawalpindi General Hospital were selected for this study. The selection of cases was based on the relevant case history, which was recorded in each case on a proforma. The patients were selected for the serological studies of HCV antibodies based on the recorded information and clinical diagnosis of the attending physician. In addition, one hundred apparently healthy individuals, showing no liver ailment, were also tested for anti-HCV antibody as a control population. Among the liver dysfunction patients, 32 [29.63%] were found positive for anti-HCV antibodies. Of these positive patients, four had received blood transfusion and seven gave a positive history of surgery. Out of the surgical interventions, five had had cataract surgery and two had received dental treatment. No known source of infection could be attributed to the remaining positive patients. Among the control population, 4% were positive for HCV antibodies. The possible source of infection among the controls could be recorded only in two cases. One had received blood transfusion and the other had undergone surgery without transfusion. The source of infection in the remaining control positive cases could not be attributed to any cause

Relationship between liver cancer and trace metals scalp hair

The aim of this investigation was to use scalp hair as a possible indicator of trace element abnormality and to ascertain whether or not differences in their levels may occur due to liver cancer and subsequent treatment. The concentration of Cr, Cu, Fe, Mn, Ni, Pb, Sr, Zn, Ca, and Mg were determined by atomic absorption spectrophotometry. This study showed higher average concentrations of Cu, Fe, Mn, and Mg in normal, as compared with diseased male subjects. Levels of Pb, however, were lower in normal male subjects as compared to the diseased male patients. Diseased female patients showed lower concentrations of Fe, Ca and Mg, as compared to normal female subjects. Levels of Ni and Zn were higher in diseased, as compared to the normal females. The correlation coefficient study did not reveal strong positive correlation between any trace elements in diseased and normal subjects. However, the regression equation showed a significant role of Ca, Fe, Mg and Zn in scalp hair. of normal and diseased subjects. T-test analysis showed distinct Fe and Mg levels for each male and female groups. Hence, Fe and Mg may perhaps play an important role in the diseased and normal subjects

Thyroid cancer in Iraq: report on 358 cases

358 cases of malignant tumours of the thyroid gland were referred to our institute in the 10 year period 1969-1979. The role of iodine deficiency in the aetiology of carcinoma of the thyroid is discussed. The distribution of the different histological types of carcinoma of the thyroid is presented. The prognosis of cases of differentiated thyroid cancer is worse than that reported in the literature because of the advanced state on first presentation of the patients and the inadequate follow up after the diagnosis and initial treatment is done. The value of 1-131- studies and therapy after surgery is discussed