Fabrication of provisional restoration on freshly prepared tooth: indirect and direct technique.

Background: Provisional restorations are fabricated to protect the prepared tooth structure during period between the preparation and the final restoration, and the techniques applied are direct, indirect and indirect direct. Various materials are used to fabricate provisional restoration, such as, preformed crown, acrylic, metal shell, composite, etc. Objectives: The study was designed to evaluate the advantages of fabrication of provisional restorations by indirect technique over direct technique. Methods: This prospective comparative study carried out in the Department of Prosthodontics, Faculty of Dentistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, from January 2006 to December 2007, included 20 patients each for insertion of provisional restorations fabricated by indirect (group A) and direct (group B) technique. Outcome was evaluated on the basis of marginal adaptation, biocompatibility and aesthetic status. Results: On day 7 of provisional restoration, grade I marginal adaptation were observed in 75% and 40% of group A and group B patients, respectively, and on day 15 were 75% and 20%, respectively. Grade I biocompatibility on day 7 of group A patients were 100% and group B 30%, and on day 15 was 95% and 35%, respectively. Grade I aesthetic status on day 7 were in 100% of both group A and group B patients, and on day 15 was 95% and 85%, respectively. None of the patients was in grade III, either in marginal adaptation, biocompatibility or aesthetic status. Conclusion: Indirect provisional restoration is better and safer in relation to marginal adaptation, biocompatibility and aesthetic status.

Assessment of overweight, obesity and metabolic variables among students of a private medical college in Dhaka city.

Background: Overweight and obesity are recognized as recent threat which affecting both developing and developed countries. Obesity and its associated morbidities are leading cause of most non-communicable diseases. Few recent studies have indicated the presence of increase in overweight and obesity among children and adolescent but there is no study among adult groups. Method and material: This cross sectional study was done to assess the prevalence of overweight, obesity and metabolic variables with their relation among medical students. Result: Our result reveals that 8.6% & 1.9% male and 15% & 3.2% female are suffering from overweight and obesity (based on BMI) respectively. More females (31.3% and 65.2%) are centrally obese than males (3.5% and 34.8%) (According to Waist Hip ratio and Waist Height ratio respectively). But according to Waist circumference more males (30.7%) are obese than females (24%). There is also significant difference of male and female BP. DBP and SBP of male (79.22mmHg & 118.9 mmHg) have high normal level than female (72.71mmHg and 108.67mmHg) (P<0.001). There is no significant difference of glycaemic status (p<.286) and lipid profile (p<.347) with central obesity. Conclusion: Although male students have high upper level of blood pressure, female students are more obese than males (both according to BMI and central obesity). High blood pressure and obesity both acts as risk factors for the development of non communicable disease. Student’s awareness therefore should be increased to reduce central obesity and BP within normal range.

Association between reproductive factors and breast cancer in an urban set up at central India: A case-control study.

Background: Epigenetic changes, geography and environmental factors do surpass the genetic factors in the development of breast cancer. This study investigates the association of reproductive factors with the breast cancer in this context. Objective: To detect the association of reproductive risk factors with breast cancer in an urban set up at central India. Study Design: Matched paired community-based case-control study. Materials and Methods: The study was conducted for a period of a year from October 2008 to August 2009 in Bhopal (MP). Demographic data and reproductive risk factor related information were collected using structured questionnaire. Data analysis was done by Epi-info and SPSS 16. Results: History of using oral contraceptive pills (OR = 3.02, 95% CI: 1.28-7.11), history of not having breastfeeding (OR = 3.62, 95% CI: 1.29-10.16) and family history of breast cancer (OR = 3.98, 95%CI: 1.06-14.826) were associated significantly with the occurrence of breast cancer in multivariate analysis. Conclusions: The findings of the present study suggests that positive family history of breast cancer and history of using OCP may be the epigenetic factors promoting the occurrence of breast cancer while breastfeeding reduces the possibility of acquiring breast cancer.

Serum Total Protein and Albumin Levels in Different Grades of Protein Energy Malnutrition.

The present study has been designed to estimate serum total protein and albumin levels in different grades of protein energy malnutrition and this will be helpful in early diagnosis, management and rehabilitation of PEM. The serum total protein and albumin levels were studied on 20 healthy children and 30 children suffering from protein energy malnutrition of different grades. Serum total protein and albumin levels of different grades of protein energy malnutrition were significantly lowered than that of control. Lowering being maximum in grade III PEM. This lowering of total protein and albumin occur in any form of PEM and related to severity of the disease.

Comparative study between clinical and sonographic estimation of fetal weight in third trimester of pregnancy and its relationship with actual birth weight.

This prospective study was undertaken to assess the accuracy of clinical and sonographic estimated fetal weight (EFW) in Bangladeshi population. The study protocol consisted of achieving clinical followed by sonographic estimated fetal weight (uEFW) using Shepard formula and then its correlation with actual birth weight (BW). A total of 140 pregnant women participated in this study. The study was conducted in the department of Radiology & Imaging and in the department of Gynae & Obs., Bangladesh Medical College Hospital (BMCH) from January 2005 to December 2005.Maximum number of patients belonged to 26-30 years age group and the mean +/-SD age of the study patients was 26.8+/-4.7 years. Maximum number of women (41.4%) was primigravida and 24.3% women were second gravida. The mean+/-SD gestational age of the patient was 35.9+/-2.8 weeks. We found, clinically EFW was 3432.1+/-410.1 gm (mean+/-SD) and uEFW was 2715.4+/-509.1gm (mean+/-SD) with difference 716.7+/-278.5 gm (mean+/-SD), (P<0.001), which is highly significant. Babies who were delivered within 1st week of clinical and sonographic EFW were selected and their weights were compared with actual BW. The Pearson correlation chi square test and student 't' test were the statistical analysis used. It was found that the P value of clinical versus actual BW was <0.05, this was significant. P value of sonographic versus actual BW was >0.05, this was not significant. Percent error (PE) was found 2+/-7.33% in calculating uEFW from actual BW with minimum error -23.9% and maximum error 11.81%. This study conducted on Bangladeshi fetus using the Shepard formula showed that the actual BW recorded after delivery of the fetus is more close to uEFW than clinically EFW.

Cleidocranial dysplasia.

Cleidocranial dysplasia (CCD) is a disorder that affects mostly those bones which derived from endochrondal and intramembranous ossification, such as the cranium and the clavicles. CCD is present at a frequency of one in one million individuals. Over 500 cases have been reported. A 13 years old boy reported in the Paediatric Endocrinology outpatient department, Bangladesh Institute of Research and Rehabilitation on Diabetes, Endocrine and Metabolic Disorders (BIRDEM) on 6th April 2006 with complaints of not growing according to his age, a wide gap over the head since birth and delayed shedding of primary teeth and also eruption of secondary teeth. The boy had elongated facies with midfacial hypoplasia, depressed nasal bridge with hypertelorism. His anterior fontanelle was open about 3/1.5 cm. He had short clavicle and his shoulders could be easily apposed. Radiological findings showed anterior fontanellle and sutures were open and widened, all decidual teeth were intact and all secondary teeth were impacted beneath the primary teeth and hypoplastic clavicle. He was diagnosed as a case of Cleidocranial Dysplasia on the basis of history, clinical examination and investigation.

Serum Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) Levels in Different Grades of Protein Energy Malnutrition.

The present study was designed to analyze serum AST, ALT levels in different grades of protein energy malnutrition to facilitate early diagnosis, management and rehabilitation of PEM. The serum AST and ALT levels of 50 children of aged 5months to 5 years of both sexes were studied. Among them, 30 children suffering from protein energy malnutrition of 3 different grades were selected for experimental group. Age and sex matched 20 apparently healthy children with no systemic disorder and with weight/height ratio greater than 80% were included in control group. Serum AST and ALT levels were measured by kinetic ultraviolet method according to International Federation of Clinical Chemistry.. Data were analyzed statistically by un paired student “t” test. Mean Serum AST and ALT levels of different grades of protein energy malnutrition were significantly higher(p<0.001) than that of control. Values of mean serum AST and ALT levels were highest in grade-I PEM and it were significantly higher(p<0.001) than both grade-II and grade-III. Again mean serum AST and ALT levels were significantly higher (p<0.001) in grade-II PEM than that of grade-III PEM. The elevated levels of serum AST and ALT is due to tissue break down and hepatobiliary disorder. The results of this study indicate that serum ALT and AST levels are increased in PEM which varies according to its severity.

Vaginal bleeding with multicystic ovaries and a pituitary mass in a child with severe hypothyroidism.

A seven year and ten months old girl presented with cyclic vaginal bleeding and a huge abdominopelvic mass. She had clinical features of hypothyroidism. The investigation results were consistent with the diagnosis of primary hypothyroidism with precocious puberty. She also had bilaterally enlarged cystic ovaries on CT scan of abdomen and CT scan of brain showed pituitary macroadenoma. After starting treatment with thyroxine, patient became euthyroid and her general condition improved. Treatment with thyroxine alone halted the cyclic vaginal bleeding, led to rapid resolution of the ovarian cysts and regression of the pituitary mass.

Effects of substance P on spontaneous contraction in the flexure region of the guinea pig colon.

Effects of Substance P on spontaneous contractions of the circular muscle of the flexure region of guinea pig colon were studied by mechanical tension recording. Substance P (3 nM-10 nM) produced tonic contraction associated with phasic activities but the contraction was found stronger at higher concentration. Verapamil (3 microM), a voltage dependent L-type Ca(2+) channel blocker completely blocked the spontaneous activities and also Substance P induced contraction. These results suggest that Substance P produce contraction by Ca(2+) influx and the Ca(2+) influx occurs by activating verapamil sensitive Ca(2+) channel.

Clinical profile and predisposing factors of cerebral palsy.

This was an analysis of one hundred ten children with cerebral palsy (CP) attending at the Child Development & Neurology Care Center of Dhaka Medical College Hospital during January 2002 to December 2003. These children were observed to study their clinical profile, etiological factors and associated problems. The mean age of these children was 2.9 +/- 2.9 years, mostly being males (n=79, 71.8%). Most of the families of these children belonged to poorer socioeconomic strata. Spastic diplegia constituted the predominant group (34.5 per cent), followed by spastic quadriplegia (25.5 per cent). Dyskinetic CP was present in 15.5 percent of the cases. Hypotonic CP constituted a significant proportion of cases. Delayed Motor Function was observed in all 110 cases, delayed speech was complained in 67.3% cases and impaired hearing was identified in 26.8% CP children. Mothers of 43.6% CP cases reported that they had prolonged labour during delivery and almost one third (29.1%) had suffered from pre-eclampsia or eclampsia. Majority (53.6%) of the CP cases were reported to have had perinatal asphyxia. Comprehensive assessment and early management of these problems are emphasized, which can minimize the extent of disabilities. By proper perinatal care, CP can be prevented.

Long term outcome of birth asphyxiated infants.

Fifty eight neonates who survived birth asphyxia were prospectively studied in the department of Paediatrics, Dhaka Medical College Hospital, to see the incidence of long term neurodevelopmental sequelae among them and also to identify possible risk factors. All of them had been admitted in the Neonatal Unit of this hospital and were born between July 1997 & December 1999. After discharge from the hospital, the study infants were followed up at the Child Neurology Clinic of this hospital. They were seen at 6 weeks. at 3 months & then every 3 months upto 2 years of age for evaluation of growth and development (age corrected for prematurity for preterm babies) 69% of them were boys and 31% were girls. 74% of the babies were inborn in the same hospital & the rest were out born. Prolonged labour (24%) and PET (18.96%) were the most common obstetric factors & respiratory distress (38%) and neonatal convulsion (35%) were the important neonatal complications. Of the 58 enlisted study cases, 30 (51.7%) responded to complete 2 years follow up and the rest were lost. Normal growth and developments were observed in 12 (40%) cases, 7 (23.33%) had mild handicap, 6 (20%) moderate & 5 (16.6%) were left with severe neurodevelopmental handicaps at 2 years of age. 61% of the handicapped children had suffered from neonatal seizure for varying periods. It may be concluded that the response to follow up unsatisfactory, the number of severe handicap was alarmingly high and post asphyxiated seizure was associated with poor outcome. So prevention of perinatal asphyxia should be targeted. Further long term follow up study is required.

Use of Wigglesworth classification for the assessment of perinatal mortality in Bangladesh--a preliminary study.

The Wigglesworth pathophysiological classification was used to analyse perinatal deaths occurring in 5 health centres in Bangladesh. The aims were to assess the feasibility of this classification, to determine the causes of perinatal deaths and thereby to identify the areas in need of intervention. A total of 8058 births were recorded at 5 centres during the period of 11 months from mid-January to mid-December 2001. There were 1069 deaths in the perinatal period. Stillbirths were slightly more frequent (53.5%) than early neonatal deaths (46.5%). Among the stillbirths, fresh stillbirths predominated over normally formed macerated ones at all centers except BIRDEM, where the majority (52.5%) was macerated. The majority (71.6%) of perinatal deaths were in the groups comprising asphyxial conditions (46.8%), conditions associated with immaturity (13.3%), and normally formed macerated stillbirths (NFMSB, 11.5%). In the group, 'other specific conditions' which was responsible for 9.3% of perinatal deaths, all but one case was attributed to sepsis. When the cases were subdivided by birth groups, asphyxia predominated in all but the <1000g group, in whom immaturity was responsible. Conditions associated with immaturity were second highest in number. The majority of the perinatal deaths (83.4%) was in babies less than 2500g. The study has shown that the Wigglesworth classification can be used in different types of health facilities in Bangladesh by doctors, nurses and midwives. The areas which need intervention are antepartum care, obstetric and newborn care practices, and environmental factors responsible for the high prevalence of prematurity and low birth weight.

TSH assay using dried blood samples: a screening method for congenital hypothyroidism.

Capillary blood samples from three hundred healthy, full-term newborn within 48 and 120 hours of delivery, were collected on filter paper for analysis of thyroid-stimulating hormone (TSH). Blood was collected by pricking the heel of the newborn and spotted and dried on filter paper cards. The samples were analysed by immunoradiometric assay (IRMA) to determine the TSH level. Some fifteen percent of a total 1928 deliveries at two hospitals during a period of one year were included in the study. Male:female ratio was 1.1:1. There was no maternal history of thyroid disease. None of the babies had any clinical feature of hypothyroidism. On analysis, TSH level ranged from 0.6-19.3 microU/ml with a mean (SD) of 7.19 (4.21) microU/ml. TSH assay from dried filter paper blood spot is technically possible and is a cost-effective and reliable method for a screening programme. This is the first time in Bangladesh that this method has been successfully carried out.

Incidence of low birth weight in three selected communities of Bangladesh.

This prospective study was conducted in urban affluent, slum and rural communities of Bangladesh during Feb '94 to Feb '95. From each community, 250 pregnant mothers were recruited in the study and at the end total 660 live births were studied to determine the incidence and risk factors of low birth weight. Incidence of low birth weight was highest in urban slum (36.8%) followed by rural area (20.9%) and lowest in urban affluent community (18.3%). The area of residence had a significant influence on birth weight suggesting that environmental stress had detrimental effect on birth weight. Age, weight and height of mothers were also risk factor for low birth weight of their babies. Mothers of less than 20 years and more than 35 years, weighing less than 40 kg and having height less than 140 cm had the higher risk of giving birth to low birth weight babies. Incidence of low birth weight was highest (73.2%) among the primigravidae mothers and 36.8% among the mothers who had no antenatal check-up, but it was 15.9% among those who had check-up more than 7 times. The distribution of low birth weight babies was higher (48.2%) among the mothers who had never gone to school. To reduce the incidence of low birth weight, upliftment of socio-economic condition has got no alternative which is very much related to education level of the people. Emphasis should be given on mothers' education which is one of the influencing factors of birth weight of babies.

General yeast infection in Bangladeshi women using contraceptives.

A study on the vaginitis due to candida infection among Bengali women using different contraceptives was carried out. A total of 368 patients using three different contraceptives (Pills, Injectables, IUD) and 316 age and parity matched women as control were studied. The incidence of vaginal yeast infection was highest (17.6%) among pill user. In control group, the incidence is lower (6.7%). The difference is statistically significant (P less than 0.05). No significant difference in vaginal yeast infection in women using other two types of contraceptives (Injection, IUD) in contrast to control group was found (P greater than 0.5). Candida albicans was the most common type of yeast infection (91.8%). No Torulopsis glabrata was isolated in this study. we did not find any relationship between duration of contraceptive usages and higher incidence of vaginal candidiasis (P greater than 0.5). This study also indicated that culture examination is much more sensitive than microscopic examination of vaginal swab in detecting yeast infection.

Birth weight, length, head and chest circumference and haemoglobin level of new born.

The birth weight, length, head and chest circumference and haemoglobin level of 1002 full term new born babies (506 males and 496 females) were determined. The results were compared with similar data from other countries. The birth weight of the present series of newborns were similar to those of newborns from India, the crown-heel length agreed favourably with the data from India and Indonesia, and the head circumference were almost equal to those of the newborns from Sri Lanka, Jamaica and India.