Pain Perception and Rate of Canine Retraction Through Self-Ligating Brackets and Conventional Elastomeric Ligation System: A Split Mouth Study

Abstract Objective: To evaluate the rate of tooth movement and the pain perception via self-ligating (SL) and conventional elastomeric ligation brackets (CB) system. Material and Methods: This study has been conducted at the Orthodontic Department of Baqai Dental College, Baqai Medical University. The sample size of this study comprised 40 patients, falling between the age of 12-30 years without any sex discrimination. Shapiro-Wilk was used to check the distribution of data. Non-parametric Mann Whitney U test was applied to evaluate the pain associated with SL and CB brackets system. To analysis the canine retraction Wilcoxon test was applied for the comparison of CB and SL brackets system. For all statistical analyses, the p-value of <0.05 was considered significant. Results: Pain level associated with retraction via CB and SL shows significant differences. However, the rate of canine retraction via CB and SL shows no significant differences at stages T0-T1 and T1-T2. However, stage T2-T3 shows a significant difference. Conclusion: As pain during orthodontic treatment is mostly associated with the level of compression of the periodontal ligament, it may be hypothesized that lower frictional forces generate less compression of the periodontal ligament and blood vessels, and so alter the type of pain experienced.

Role of wound classification in predicting the outcome of diabetic foot ulcer

To compare the effectiveness of Wagner and University of Texas [UT] classification systems of diabetic foot ulcers in directing appropriate therapy and possibly predicting outcomes. A total of 383 patients with foot ulcer were seen. Details of socio-demographic and clinical profiles of 200 patients were completely available. Patients were assessed and classified into different grades and stages according to Wagner's and UT classification systems. Their duration of healing was recorded. The outcome endpoints were defined as complete healing, major or minor amputations, or expired. Out of the 200 subjects, 65% were males and 35% were females. Mean age in males was 53.04 +/- 10.33 years and in females was 51.14 +/- 9.94 years. Average duration of treatment in males was 109.68 +/- 82.26 days and in females was 85.10 +/- 61.97 days. Forty five percent of the subjects had neuropathic ulcers. Median healing time increased with increase in Wagner grade and UT grade and stage. The higher the UT grade and stage at the time of presentation, the less the chances of ulcer to heal within the study period. Our study has shown that grading and staging of diabetic foot ulcer affects and predicts the outcome. Amputation rates increase with increase in grade. Addition of stage to grade in UT classification helps further on assessing the severity of wound at the time of presentation and shows better association with the outcome

Outcome of patient referral made by the lady health workers in Karachi, Pakistan

The outcome and consequences of referral made by the Lady Health Workers [LHWs] are largely unknown. This cross sectional study was conducted as part of a larger study and aims to assess outcome of patients' referrals made by the LHWs in Karachi, Pakistan. Only 4% of patients referred visited government facilities, the rest having visited private physicians and in-formal practitioners. The median cost of the treatment was 200 Pakistani Rupees [PKR] and 1230 PKR as out -patient and in-patient respectively with almost half the patients [41.3%] borrowed money to finance their treatment. Seventy-eight [31.6%] patients were not satisfied with the management they received from the referral health facilities. Major reasons cited were non-improvement in their condition, expensive, long waiting time and rudeness of the health facility staff. Factors identified in this study should be taken into account to ensure continuity and quality of care and to provide efficient, effective and equitable health services to all.

Assessment of insulin resistance in type 2 diabetic subjects at a tertiary care hospital of Karachi Pakistan

During the last few decades there has been a surge of interest in the assessment of insulin resistance. Our study aims to identify the insulin resistance in type 2 diabetic population so that we might be able to identify insulin resistance easily in daily routine clinical practice. All type 2 diabetic subjects having age 30 years or more are selected with exclusion criteria [hepatic, renal or cardiac impairment]. After taking informed consent from the patients fasting blood samples were taken. Assessment of insulin resistance was done by homeostasis model assessment HOMA. HOMA-R = Insulin [mu/ml] x glucose [mmol/1]/22.5 All statistical analyses were performed using the statistical program SPSS [version 11] A Total of 118 subjects were recruited in the study. Mean age of subjects was 49.1 +/- 10.2 years. Mean BMI was 27.8 +/- 4.9 kg/m2o Subjects comprising of 62.4% males and 37.6% females. Mean HOMA in our Type 2 diabetic subjects was 4.1 [male 4.41 and female 3.73]. In our study 73.7% subjects has HOMA value of 1. 77 or more, while 57% have HOMA value of 2.8 or more

Prevalence of microalbuminuria in type 2 diabetic patients in Karachi: Pakistan a multi-center study

To determine the frequency of microalbuminuria and its associations in type-2 diabetic subjects attending diabetes centers/clinics across Karachi, Pakistan. Two thousand one hundred subjects with type-2 diabetes were screened for microalbuminuria using Micral test strip II. A single screening test was performed in 25 diabetes centers/units in different districts of Karachi from January 2003 to December 2003. The overall prevalence of microalbuminuria was 34%. Mean age of subjects was 53.1 years + 11.9 years, mean BMI was 25.8 ' 4.1 and mean duration of diabetes was 8.8 ' 5.21 years. Fifty seven percent were males and 43% females. Sixty two percent of the subjects had a systolic blood pressure >130 mmHg. Forty five percent had a family history of diabetes and 5% had a family history of hypertension. Univariate analyses demonstrated significant associations between microalbuminuria and age, duration of diabetes, male gender, smoking status, microvascular and macrovascular complications, hypertension, high triglycerides, high serum LDL, low serum HDL, and high fasting and random blood sugars. When adjusted for the effects of other variables in the model, age, diastolic blood pressure, serum LDL and retinopathy were found to be significantly associated with microalbuminuria. The prevalence of microalbuminuria in type 2 diabetic subjects in this cross-sectional multicentre study across Karachi was 34% and this was significantly related to age, diastolic blood pressure, serum LDL and retinopathy

Septic induced abortion maternal mortality and morbidity

A total 1932 patient were admitted in Gynae ward. Out of these 188 patients were of septic induced abortions. Incidence of septic abortion is [8.6%] of total admissions. [14.28%] were first trimester below 6 weeks, [57%] were 7-12 weeks and 29% were 2nd trimester. The reason for termination was unplanned Pregnancy in most of cases [42.85%]. Maternal mortality rate was [7.1%] due to induced abortion

Rupture of previously scarred uterus

Objective: To determine causative factors, find out associated maternal and faetal morbidity and mortality and to discuss preventive measures

Design: A prospective study

Place and duration of study: Department of Obs. And Gynae, Lahore General Hospital, [PGMI]. Lahore for a period of four years, Jan. 2002 to Dec. 2003

Subject and methods: This study was conducted on sixty patients, with rupture of previously scarred uterus

Results: Total number of deliveries during these four years was 15,628. Rupture of uterus occurred in 0.47% cases [1: 214]. Out of these rupture of previously scarred uterus accured in 82% cases. Most of the patients were between ages 21 - 30 years unbooked illiterate, belonged to poor class. 83% caesarean sections had been done in some peripheral non teaching hospitals. 13% patients had no labour pains at time of admission. The maternal mortality in this study was 3.33% and fetal mortality was 60%

Conclusion: First caesarean section should only be done if genuinely indicated, by some skilled obstetrician, in well equipped hospital. Patients with scarred uterus should be educated to have regular antenatal checkup and hospital delivery in next pregnancy