Food Exchange List and Dietary Management of Non-Communicable Diseases in Cultural Perspective

This review focuses at highlighting the importance of Food Exchange List in cultural perspective, as an effective dietary tool to help individuals' manage their dietary modifications in relation to non communicable diseases whilst specifying measures that can help improve the quality of Food Exchange Lists for combating various non communicable diseases and addressing adherence related issues to specialized diets. A search was done using PubMed and Google Scholar till June 2016. Search terms used were food exchange list AND disease, diet AND non-communicable diseases. We included only studies that discussed Food Exchange List [PEL] in relation to non-communicable diseases; in addition to factors like cultural relevance and adherence

Out of the 837 papers accessed 57 were identified as relevant to the Food Exchange List, out of which 39 papers were focused to the concept and development of the Food Exchange List. Only 18 discussed FEL in relation to non communicable diseases and were thus included in the review.

Food exchange list is a user friendly tool for dietary modification due to disease. This tool may help to customize meals for people as it provides information regarding various food items in different groups. This tool is helpful in reducing blood and plasma glucose levels, maintaining lipid profile and effectively combating other diet related diseases and those ailments in which diet plays a significant role in maintenance 4 prevention from reoccurrences. However, better management and adherence to modified diets for non communicable diseases can be ensured by keeping cultural relevance under consideration before using Food Exchange Lists for such diseases

Knowledge, attitude and practices of dentists of pakistan regarding informed Consent

Though ongoing medical advancements has helped the man kind in many ways but it has also tailored the attitude of both the doctors and the patient to insecurity. It has now become immensely important to protect legal and ethical rights of the patients and as well as that of the doctors. Therefore, the application of the informed consent has become immensely important almost in all health care disciplines

Aims: The aim of the study was to gather base-line information on consent knowledge, attitude and practices of dentists of the different cities of Pakistan with the view of utilizing this information in dental practice of this population

Methods: A cross sectional survey was done at different cities of Pakistan including Lahore, Karachi, Peshawar, Quetta and Islamabad. A total of 359 dentists were studied for the practice of informed consent [1C] by filling a self-designed, semi-structured questionnaire in a one-to-one interview by the researcher

Results: The data recorded was then entered in SPSS. 16 and analyzed. Knowledge and attitude of the dentists is seen to be considerably high as compared to their practices which means that they are over reporting in relation to what they know about the essence of consent and hence its application. A need of proper legislature and its implementation is necessary for the improvement of practice of informed consent

Conclusion: Refresher courses regarding 1C practice should be introduced on regular basis among the medical and dental professionals

How we helped 3[rd] year medical students' transition from basic sciences to bedside; experience at a tertiary care teaching hospital

Clinical bed side teaching to learn the art and science of reaching an appropriate diagnosis is the most important part of training of medical students. Transition from basic science teaching to the complex world of clinical problem solving dealing with real patients is a difficult task to which some adapt quickly while for others it is a challenging proposition. Clinical faculty needs to focus on facilitating this transition helping medical students adjust and adapt to their new roles as future doctors

Study design: Cross sectional non comparative study

Place and duration of study: Gastroenterology Department, Shaikh Zayed Postgraduate Mediical Institute, Lahore from March to May 2013

Methodology: A total of twenty seven 3[rd] year MBBS students already experienced in history taking and clinical examination techniques were included. Facilitator adopted a constructivist approach with schema activation recalling applied aspects of anatomy, physiology and biochemistry relevant to diagnostic approach to 6 patient scenarios of which one is presented. A 7 item questionnaire recorded responses of students on a 5-point Likert scale

Results: Seventy seven percent medical students reported an improved ability to appreciate the relevance of knowledge gained in basic sciences to bed side teaching. Role of teacher was declared positive by 83%, 85% had improved their ability to correlate basic sciences to clinical inferences. Seventy five percent appreciated that mistakes identified helped them in improving performance with 92% confident of applying clinical reasoning skills obtained in solving future clinical problems

Conclusion: Clinical teaching should be based on the principles of adult learning employing a constructivist approach. Linking previous knowledge of basic sciences to the information obtained from bed side examination is the key to help medical students learn the art and science of medicine and become lifelong self-directed learners

Association of alveolar bone loss with obesity: a comparative study

Background: Obesity acts as a risk factor for many diseases like diabetes mellitus, hypertension, and ischemic heart disease. Recently, it has been found that obesity is also associated with periodontal disease especially in adults and urban population

Objective: The objective of the present study was to assess association between obesity and alveolar bone loss caused by periodontal diseases in urban Pakistani population in 30-40 years age group

Subjects and Methods: 100 patients of established periodontal disease were selected based on Community Periodontal Index [CPI]. Patients were divided into obese and non-obese groups of 50 each. The criterion for diagnosis obesity was based on body mass index [BMI]. The selection of all 100 subjects was done according to exclusion and inclusion criteria which possibly excluded all other factors which might enhance alveolar bone loss except obesity. Then panoramic radiographs of all subjects were taken and alveolar bone loss was measured. Then to rule out the effect of age on alveolar bone loss an age-related alveolar bone score was calculated for all subjects of both; obese and non-obese group

Results: In this study there were 43 males and 57 females with the mean age of 35.10+2.24 and mean alveolar bone score 64.51+8.21. Obese patients had higher Alveolar Bone loss sore than non-obese individuals with an odds ratio of 4.33 [2.43 - 6.57]

Conclusion: In middle aged patients of periodontal disease belonging to urban Pakistani population obesity as assessed by body mass index [BMI] is associated with increased alveolar bone loss

simplified examination for detecting dental caries, plaque, gingivitis and calculus in school children-A longitudinal study

The objective of the present study was to compare longitudinally the simplified dental examination involving the use of a wooden spatula and a tooth pick with the conventional dental mirror and probe examination for the detection of cavitated carious lesions, dental plaque [with and without gingival bleeding] and calculus. This was a quasi-experimental study that involved 632 children having a mean age of 10 4 years at the start of the study and studying in eight different secondary schools of Karachi, Pakistan The children were subjected to two types of dental examination on three occasions with intervals of six and twelve months in between to detect cavitated carious lesions, dental plaque [with and without gingival bleeding] and calculus. All examinations were conducted by a single examiner who was trained and calibrated for both types of examination. One type of examination involved the use of a wooden spatula and a toothpick [TS examination] while the other type was carried out using the plain mouth mirror and CPI [Community Periodontal Index] probe [MP Examination]. All examinations were performed under identical conditions using natural light Teeth' and 'sextants of oral cavity' were considered as the units of measurement for data analysis. The WHO recommended criteria for decayed, missing and filled teeth were followed for caries detection. A dichotomous scale was used for plaque [with and without gingival bleeding] and calculus with 'present' or 'absent categories. The sensitivity of TS examination for detecting cavitated carious lesions in three examinations ranged from 88.35% to 90.86%; and for Plaque [with and without bleeding] and calculus from 92-99%, the lowest value being for 'calculus' and the highest for 'plaq 1 ue with bleeding' The specificity, positive predictive value and negative predictive value were between 98-99% for both caries and the three components of oral hygiene status, The TS examination can provide a desirable substitute to conventional MP examination in order to undertake regular dental check-ups of school children including detection of cavitated various lesions and assessment of oral hygiene status

Causes of dental extractions in a teaching hospital: a retrospective study

Objectives: the aim of the study was to examine the reasons for dental extraction and to determine the pattern of extractions in patients seeking care at the Dr. Ishrat ul Ibad Institute of Oral Health Sciences [DIKIOHS] over a period of 5 months

Methods: a cross-sectional study on 1300 patients aged between 4-80yrs was conducted at the Oral Biology Department of DIKIOHS. Information regarding the patients age, sex, type of tooth extracted and reason for extraction was recorded. Results were compiled and analyzed using SPSS version 15

Results: total 1300 study cases with 1705 extractions were evaluated. Out of the total 594 [45.69%] were females while 706 were males [54.3%] with 780 and 925 extractions respectively. The most common reason for tooth extraction for both genders was caries. The total population was divided into 3 age groups, 4 - 20 yrs, 20 - 40 yrs and 40 - 80 yrs. The number of extractions in each group was 240, 807 and 658 respectively. Hence the age group with the most frequent number of tooth extractions was 20 - 40 years. The most common type of extracted tooth in the study population was tooth number 36 [mandibular permanent left first molar] and the least common was tooth number 81 [mandibular deciduous right central incisor]

Conclusion: the most common reason for extraction in the present study was found to be dental caries. The age group with the most extractions was between 20 - 40 years which indicates that awareness regarding oral hygiene needs to be improved in young adults

Cytological findings of buccal mucosa in megaloblastic anemia

Megaloblastic anemia is a common problem in Pakistan, that can lead to negative health outcomes with increasing age. Apart from the general effect due to the deficiencies of fo late and vitamin B 12 as observed in blood, bone marrow cells and epithelial cell surfaces, similar changes in oral epithelium have also been found. These cellular findings however have been limited to a very few studies and offers a good research scope for more studies to be conducted. Healthcare strategies that consider the impact of laboratory tests on the overall costs and quality of care should consider the advantages of including cytological findings of buccal mucosal scraps for evaluation of these patients and can serve as a prerequisite of diagnosing this disease

Tooth loss prevalence among cardiac males and females

Objective: Objective of study was to observe differences of tooth loss prevalence in males and females with cardiac diseases

Introduction: Poor oral health, tooth loss and periodontal diseases have been reported to be associated with coronary heart diseases. Studies report gender differences in prevalence of cardiac diseases and tooth loss. This paper presents gender differences of tooth loss in cardiac patients of a cardiac hospital of Lahore, Pakistan

Methodology: Age matched Cardiac males and females attending OPD of the Punjab Institute of Cardiology [PIC], Lahore were included in the study. Personal and health-related information were questioned and noted. Oral examination was performed for recording of missing teeth

Results: 1200 CHD study subjects with age-range of 30 to 80 years were enrolled for study. 1045 age matched, 766 [73.30%] males and 279 [26.70%] females were examined for tooth loss. 852 [81.53%] genders had at least one tooth missing. 599 [78.19] males and 253 [90.68%] females were observed with mean tooth loss of 7.5 [SD 8.720] and 11.15 [SD 10.375] respectively. Statistical association among them was also significant [P= 0.000] with OR of 2.339. More subjects [76.29%] showed a loss of 1-15 teeth that was also significant among males and females. Tooth loss was significant in age groups of 41-50 years [P=0.001] and 51-60 years [P=0.000]

Conclusion: Gender differences of tooth loss prevalence among CHD subjects were significant with more risk for males as compared to females

pilot study of knowledge, attitudes and practices [KAP] of barbers and unqualified dentists in transmission of hepatitis Band C in an urban and rural setting in Punjab

Chronic viral hepatitis secondary to hepatitis B and C infections with its sequale of cirrhosis and hepatocellular carcinoma has emerged as a modern day epidemic worldwide with huge sections of population being afflicted by these diseases both in underdeveloped and developed countries. More than 10 million people in Pakistan are estimated to suffer from chronic hepatitis B and C. Treatment of chronic viral hepatitis is expensive and effective in only 50% of patients. Urgent measures are therefore needed to curtail the spread of viral hepatitis by focusing on the possible routes of spread including but not limited to unsafe use of therapeutic injections, blood transfusion, surgical interventions, shaving from barbers, tattooing, mother to child transmission and unsafe sexual practices. Barbers and unqualified dental surgeons without adequate sterilization facilities could play an important role in the spread and transmission of hepatitis B and C. A pilot KAP [Knowledge, Attitudes and Practices] Survey of barbers and street dentists from an urban and a rural location in Punjab was carried out in November.2006 to determine the state of knowledge, attitudes and practices of the above two groups regarding risk of transmission of HBV and HCV as well as to evaluate differences in these parameters between the urban and rural population. This study has revealed that while knowledgeable about the transmission of hepatitis, attitudes and practices regarding prevention of transmission by the two groups of professionals were very unsatisfactory. Additionally on all the domains measured in this pilot study, urban professionals did better than their rural counterparts

Periodontal status of women during pregnancy

Objectives: Periodontal condition of women is considered to be debilitated during pregnancy. This is suggested to increase the chances of complications during pregnancy. This study aimed at obtaining information regarding periodontal status during pregnancy, which may be necessary for planning periodontal disease preventive programs for pregnant women in our population

Material and Methods: A cross-sectional study was conducted on a sample of 322 registered women at department of Gynecology and Obstetric. Periodontal condition was assessed by CPITN Index and recorded in a semi-structured performa. The data was coded and entered in SPSS version 11.0 and percentage frequencies with their mean and standard deviations were calculated. Exact Chi-sqaure test was used to analyze any significant changes observed in the CPITN scores amongst the study population, where level of significance was p < 0.05 with confidence interval 95%

Results: Only 17% of these women were observed to have healthy periodontal status and 83% of women had some signs involving a mean of 3 out of six sextants with different levels of signs of periodontal disease, with only less than half sextant with periodontal pockets. However, a moderate level of periodontal debilitation was observed in this population with a mean of 3 sextants having healthy periodontal status. The present study observed a constant level of periodontal status assessed by CPITN Index (p>0.05) in women during pregnancy

Conclusion: Although CPITN scores remained constant through out pregnancy and no significant change observed in this moderate level of diseased condition. However, shallow and deep periodontal pockets, although not very severe, are observed to be more prevalent. Therefore, special preventive and prophylaxis oral health care programs remain the need for these women during pregnancy

Oral manifestations of hospitalized cirrhotic at Shaikh Zayed hospital, Lahore: a pilot study

Background: in Pakistan cirrhosis has reached alarming proportions due to spread of HCV and HBV viruses. Some of the oral manifestations of cirrhosis have been found to exhibit geographically variability. There is no research available on the oral health of these patients in Pakistan and their specific oral problems are not known

Objectives: this study examined a cohort of cirrhotic patients admitted at Shaikh Zayed hospital Lahore to assess their oral health status and needs

Materials and methods: thirty consecutive patients admitted with diagnosis of cirrhosis were examined for oral health status. Extra oral examination included any visible lesions or abnormalities on the face, head or neck region, lymph node enlargement and TMJ dysfunction. Intra oral examination included measurement of caries [DMFT] and periodontal disease level [CPITN], oral mucosal lesions, prosthetic status and prosthetic needs of the patients. All findings were recorded on the standard WHO oral health survey form

Results: the oral health of this cohort was poor compared to the general population. Xerostomia [20%], papillary atrophy [1 00%], oral Melanosis [90%], petechieal hemaorrhages [26%] and glossitis [53%] were found prevalent in the sample. Two females had oral lichen planus and one of the patients had oral ulceration. DMFT score [Mean=5.7] was not different from national average [Mean=8.02]. Periodontal disease was more severe than general population. Less than 21% of the sample wore prostheses and over 50% needed one. TMJ dysfunction was common but fewer patient complained of the condition that the number of patients with clinical signs

Conclusions: oral health of cirrhotic population is worse than general population and they have significant oral health needs. Further research is required to investigate this relationship. Effective oral health educatior of patients' and physicians' is required to reduce the burden of oral disease thus mproving quality of life for these patients

Oral health status in diabetic children

Objectives: diabetes causes numerous oral and salivary changes leading to cariogenic and gingival lesions. The present study was designed to elucidate the role of diabetes mellitus in oral health

Methods: a cross-sectional study including 60 diabetic children [case group] and 30 non diabetic children [control group] of age 3-14 years was conducted. HbA1c and blood glucose level was measured along with the oral health including gingival status and dental caries status was visually assessed. Gingival status was coded for healthy, marginal gingivitis and calculus. Dental caries status [decayed and filled] for both deciduous and permanent dentition was assessed. Data was recorded in a pre-coded oral health proforma, which was then entered and analyzed in SPSS version 10.0. Descriptive analysis such as percentage frequencies and means was performed. Exact Chi-square test was used to analyze any significant changes observed amongst the study population, where level of significance was p < 0.05 with confidence interval 95%

Results: the results show important difference between both groups of children. Dental caries level is significantly higher in diabetic children both in deciduous and permanent dentition than in non-diabetic children [p <0.05]. Gingival health was also observed to be debilitated in diabetic children than non- diabetic children [p < 0.05]

Conclusion: the study highlights that special preventive measures must be adopted to maintain a good oral health of the diabetic children

Maternal attitudes and practices towards child dental health of 3[1/2] to 4[1/2] year old in Lahore, Pakistan

The present study is a cross-sectional survey undertaken to assess the dental health attitudes and behaviours of 95 mothers of preschool children, from middle and low socio-economic groups, in urban Lahore, using a questionnaire adapted from the one used in an international collaborative study on child dental health. The results fail to achieve significance for the frequency of sugar consumption, consumption of sweetened milk, Toothache experience, history of dental visits and the choice of professional in case of dental problem, quantity of toothpaste used for the child and dental health beliefs of the mothers

Pathogenesis of recurrent aphthous stomatitis: a review of literature

Recurrent aphthous stomatitis represents a very common chronic but poorly understood mucosal disorder, affecting 10% to 20% of the world population. They occur in men and women of all ages, races and geographic regions. It is estimated that at least 1 in 5 individuals has at least once been afflicted with aphthous ulcers. There are 3 clinical subtypes that is minor, major, and herpetiform on the basis of their size and number. Minor aphthous ulcers are the most common subtype, representing 80% to 90% of all recurrent aphthous ulcers. There are-four stages of the lesion, these includes premonitory, preulcerative, ulcerative, and healing stage. Clinically, RAS present as extremely painful, shallow ulcerations with an erythematous halo on unattached oral mucosa. Attacks may be precipitated by local trauma, stress, food intake, drugs, hormonal changes and vitamin and trace element deficiencies. Local and systemic conditions and genetic, immunological and microbial factors all may play a role in the pathogenesis o recurrent aphthous stomatitis. The primary differential diagnosis is herpes simplex

Bread wheat varieties as influenced by different nitrogen levels / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Experiment was conducted to determine the effect of different nitrogen levels on four bread wheat varieties (Triticum aestivum L.) viz. Inqilab-91, Daman-98, Dera-98 and Punjab-96 at Gomal University, Dera Ismail Khan (NWFP), Pakistan during 2000 approximatey 2001. The experiment was laid out in split plot design having four replications using a net plot size of 2 m x 5 m. Nitrogen doses used were 0, 50, 100, 150 and 200 kg/ha. The results showed that different nitrogen levels had significant effects on plant height, total number of plants/m(2), number of grains/spike, number of spike/m(2), spike weight, biological yield, grain yield and grain protein content. Maximum plant height, total number of plants/m(2), number of spikes/m(2), spike weight, biological yield and grain protein content were observed at 200 kg N/ha. Among wheat varieties Daman-98 had maximum plant height, spike weight, grains/spike, 1000-grain weight, biological yield and grain yield. Inqilab-91 had heavier grains and the most grain protein content, while Dera-98 had the maximum plant population and spikes/m(2). Grain yield and biological yield were statistically similar at doses of 150 kg N/ha and 200 kg N/ha. However, dose of 200 kg N/ha, compared to dose of 150 Kg N/ha, significantly increased the protein content.

Oral hygiene status and brushing practices of individuals with sensory and physical disabilities in Lahore, Pakistan

Objective: this study was designed to determine the oral hygiene status and brushing habits of individuals with special needs having sensory and physical disabilities in Lahore, and compare the results with an age- and gender-matched healthy control group

Materials and methods: a cross-sectional descriptive study was conducted and a convenience sample of 300 individuals including 200 individuals with special needs having sensory and physical disabilities and 100 healthy control individuals with mean age of 11.49 +/- 2.961 years [age range: 6-17 years] was selected for the study. The oral hygiene status was determined utilizing the Simplified Oral Hygiene Index. Information regarding the brushing habits was obtained through an especially designed questionnaire. Study groups were selected from three special education institutions and one school for normal individuals from Lahore. All the subjects belonged to the low socioeconomic group

Results: the mean OHI [S] score for the complete sample was 2.0780 +/- 1.46470. Mean OHI [S] values for control individuals were significantly lower than that for individuals with sensory and physical disabilities. When the OHI [S] scores of individuals were analyzed based on the groups i.e. normal, sensory disabled and physically disabled, the difference was statistically significant [p <0.05]. Physically disabled persons were having significantly higher mean OHI [S] values than the sensory disabled group. Among individual classes of people with sensory disabilities, blind, individuals with uncontrolled reflexes and cerebral palsy were having the highest mean OHI [S] values. Data regarding the brushing practices suggested that normal individuals were more regular in brushing teeth as compared to individuals with sensory and physical disabilities. The difference was statistically significant [p < 0.05]. No significant age and sex differences were found in the oral hygiene and brushing practices of normal and special needs categories

Conclusions: oral hygiene status of special needs group was significantly poorer than that of control group. Among the individual classes of special needs group, blind individuals in the sensory disabled and individuals uncontrolled reflexes were having the worst oral hygiene status. The individuals with special needs were having more irregular brushing habits as compared to the control group