Effect of Ramadan fasting on glucose level, lipid profile, HbA1c and uric acid among medical students in Karachi, Pakistan

To assess the effect of Ramadan fasting on blood pressure, fasting glucose, lipid profile, uric acid, HbA1c, body mass index, body adiposity index and visceral adiposity index among fasting medical students, 35 students were recorded before, during and after Ramadan [August] 2011, for their blood pressure, anthropometric measurements, questionnaire response and blood sample. A blood sample was taken at each visit for glucose, lipid profile and HbA1c. Total physical activity, weight-to-height ratio, body adiposity index and visceral adiposity index were calculated for insulin sensitivity. Changes in anthropometric measurements were not statistically significant. However, physical activities increased significantly after Ramadan. Changes in blood pressure, fasting blood sugar, total cholesterol, HbA1c, uric acid and triglyceride were not statistically significant. Mean high density lipoprotein decreased significantly in Ramadan, while low density lipoprotein increased significantly

Clinical spectrum of posterior reversible encephalopathy syndrome [PRES] in patients with eclampsia

To identify the prevalence, demographic details and clinical features of PRES in women suffering from eclampsia. Women admitted in the labor room suite with diagnosis of eclampsia were studied. The study period was from October 15. 2011 to March 15. 2012, in the department of obstetrics and gynecology unit 3, Civil hospital Karachi.Of all patients with diagnosis of eclampsia, 22 underwent neuro imaging by computerized tomography. Demographic details, clinical findings and maternal and perinatal outcome were entered on a predesigned Performa. Thirty four women were identified, with eclampsia. Neuro imaging was done in 22 women. Posterior reversible encephalopathy syndrome was recognized in 9 [22] patients. The mean systolic blood pressure was 161 [ +/- 11] mm Hg, and mean diastolic blood pressure was 111 [ +/- 10] mm Hg. Mean number of fits were three, and the mean gestational age of patients were 35 weeks. Gestational age was found significantly associated with PRES [p <0.3] Mean leukocyte count in patients with eclampsi

MRI features of spinal fluorosis: results of an endemic community screening

Fluorosis is endemic in many parts of the world. However community studies on MRI features of fluorosis are lacking. The aim of this study was to determine MRI features of spinal changes in a community with endemic fluorosis in the Thar Desert Pakistan. Randomly selected adults from the Village Samorindh, district Thar parker, Sindh, Pakistan, with spinal fluorosis diagnosed on plain x-rays and raised serum fluoride levels were studied from June 2008 to January 2009. MRI was carried out on 0.5 T open magnet MRI system. Features of vertebral body, spinal ligaments, intervertebral disc, facet joints, iliac wings and other incidental findings were noted. Sclerosis was defined as low signal intensity on both T1 and T2 weighted images. Results were described as mean and percentage values. All the studied 27 subjects complained of back ache without neurological signs. The average age was 43.33 +/- 10.45 years; 21 being male [77.8%]. The most frequent findings included generalized vertebral sclerosis [24, 88.8%], ligamentum flavum hypertrophy [23, 85%], anterior [20, 74%] and lateral [17, 62.9%] disc herniation, thickened longitudinal ligaments, and narrowing of spinal foramina. Hemangioma was seen in 04[14.8%]. The most commonly involved level was L1-2, L4-5 and lower dorsal spine. Vertebral sclerosis, a combination of premature degeneration with anterior disc herniation and an unusually high frequency of vertebral hemangioma formed the spectrum of MRI findings in subjects with spinal fluorosis having back ache but no neurological findings

Effects of Ramadan fasting and physical activity on glucose levels and serum lipid profile among type 2 diabetic patients

To assess the effect of fasting and physical activity on blood pressure, fasting glucose, cholesterol, triglyceride, high density and low density lipoproteins among diabetic type 2 patients. Seventy five patients who had three visits [last ten days of Shabann [visit 1], Ramadan [visit 2] and Shawwal [visit 3]] were included in the study. Physical measurements, clinical measurements and 12 hours fasting blood sample were taken, along with an interview for demographic information and physical activity on each visit. The samples were analyzed for 1] Glucose, 2] Cholesterol, 3] Triglyceride, 4] Uric Acid, 5] HDL-C, and 6] LDL-C. The mean weight of the patients decreased significantly from 71.43 kg to 69.41 kg from visit 1 to visit 2. Mean systolic blood pressure also decreased significantly from 124.25 mm/Hg to 119.86 mm/Hg while. Mean triglyceride level decreased from 239.095mg/L to 207.07 mg/L from visit 1 to visit 2 and it kept decreasing to 159.25 mg/L till third visit. Mean LDL value increased from 104.12 mg/L to 112.64 mg/L from visit one to visit two and then further increased to 119.0 mg/L on the third visit. Ramadan fasting is safe for diabetes type II patients and is associated with weight loss and improvement in the overall diabetic control. Furthermore, the physical activities could reduce the body weight, waist measurement, systolic blood pressure, triglyceride and HDL

Survey of statistical methods and type of articles published in the selected Pakistani medical journals from 1999 to 2007

To determine the frequency of type of articles and statistical methods used in 6 leading Pakistani medical journals of 1999 to 2007. All the original articles, case report, review articles and short communications published in 1999 to 2007 of those journals were reviewed. Total number of articles reviewed was 5001. The information recorded from these journals was: types of article; any statistical methods used and correctness of statistics. Out of 5001 articles reviewed, 1110 [22.2%] were case reports, 3395 [67.9%] were original articles, 213 [4.3%] were short communications, and 283 [5.7%] were review articles. The percentage of case reports was increased from 17.6% to 26.1%, while the percentage of original articles was reduced from 73.1% to 64.4%. Fifty nine percent of the original articles either did not contain any statistics or used only descriptive statistics. Seventy seven percent of the original articles have used appropriate statistics for making inferences. There is a significant improvement in the use of statistics during the study period of 9 years. However with the introduction of systematic review, Chochran library and Meta Analysis, advanced techniques of biostatistics are needed to understand these types of articles

Maternal and perinatal outcome of hypertensive disorders of pregnancy at a tertiary care hospital

To study the frequency of various hypertensive disorders of pregnancy and to determine their maternal and perinatal outcome. Retrospective descriptive study. Department of Obstetrics and Gynecology Unit III, Civil Hospital Karachi, from January 2002 to December 2007. A total of 626 cases were reviewed for age, parity, gestational age, diagnosis, antenatal and intra partum complications, mode of delivery and neonatal outcome. Data was analyzed using SPSS software [version 16]. Total number of deliveries during the study period was 11,718 and there were 626 cases of hypertensive disorders of pregnancy giving a frequency of 5.34%. Pre-eclampsia was seen in 308 [49%], severe pre-eclampsia in 85 [13%], eclampsia in 121 [19.2%], chronic hypertension in 41[6%] and postpartum eclampsia in 21 [3.3%] patients. There were 39 maternal deaths [case fatality rate: 6.23%]. The mean ages for pre-eclampsia, severe pre-eclampsia, eclampsia and chronic hypertension were 28, 27, 24 and 29 [27 years] years respectively. The commonest maternal complication of hypertensive disorders was postpartum hemorrhage in 24 women [4.2%]. This was followed by placental abruption in 9 women [1.6%] and pulmonary edema in 8 women [1.4]. The prevalence of prematurity in pre-eclampsia, severe pre-eclampsia and eclampsia in study population was 14%, 5% and 8.6% respectively. Cesarean section was required for pre-eclampsia, severe pre-eclampsia and eclampsia in 46%, 51% and 61% of patients respectively. The main fetal complications were found to be still birth [14% in pre-eclampsia, 18% in severe pre-eclampsia and 15% in eclampsia] and low birth weight [31% in pre-eclampsia, 49% in severe pre-eclampsia and 52% in eclampsia]. Hypertensive disorders in pregnancy are an important cause of maternal and perinatal mortality and morbidity

Age estimation of female schoolchildren by number of permanent teeth erupted; a study from Riyadh, Saudi Arabia

To find out the most suitable and reliable method for estimation of age of Saudi female children at the time of eruption of a permanent tooth. The population used for this cross-sectional study was comprised of female schoolchildren from kindergarten to intermediate schools [pre-school to grade 9] of Riyadh, Saudi Arabia. A total of 4836 children were examined and only 1599 children showed at least one tooth [just1] erupted. Height and weight of the selected sample were recorded after the clinical examination. The demographic information was recorded from their personal files of the school record. Number of teeth present at the time of eruption of a new permanent tooth [Method 1] and linear regression [Method 2] were employed to estimate the calendar age. On average time of 5 years and 9 months, two teeth are erupted in Saudi female children and about 13 years of age all the teeth except third molars are erupted. The regression equation of age [Y] with height[X[1]], weight[X[2]] and total number of teeth[X[3]] erupted was as follows: Y = -6,008 + 0.182 X[1] + 0.096 X[2] - 0.013 X[3] R[2]= 0.847; Results showed that calendar age of 63% and 70.8% of the Saudi females can be estimated accurately within +/- 1 year by Method 1 and Method 2, respectively, furthermore, age of 38,5% and 39.4% of Saudi female children can be accurately estimated within +/- 0.5 years by these two methods, respectively. Regression method showed better age estimation procedure than simply counting the number of teeth at the time eruption

Phenomena of physical activity in with myocardial infarction patients of Karachi, Pakistan

To assess the physical activity level among MI patients and to examine the relationship of physical activity with some MI risk factors such as age, gender, body mass index [BMI], waist circumference [WC], obesity, and occupation. The data of the present study were collected from different cardiac hospitals [Civil Hospital, Liaquat National Hopsital and National Institute of Cardiovescular Diseases] of Karachi. 235 patients of ages 30-70 years were interviewed through a questionnaire. The questionnaire included basic demographic and some socio-economic information and risk factors associated with MI patients. The questionnaire also included questions on the type, frequency and duration of physical activity of the patients. Activities were classified into five intensity categories and assigned metabolic equivalents [MET] according to the compendium of physical activity. Subjects were classified into physically active or inactive categories. Activity prevalence [10.2%] was very low among MI patients. There were more active male patients [10.8%] than female patients [7.8%]. Activity prevalence decreases with age and increases with increasing educational level. In the risk assessment model, age group [P<0.0001], occupation categories [[skilled vs. semi skilled] [p=0.028]] and [[skilled vs. house wife] [p=0.003]] were significant. Highly educated patients were significantly [p=0.022] more active than others. Furthermore, active patients had lower values of body mass index and waist circumference. The finding of the study revealed that most of the MI patients have sedentary life style and due to increasing age and low level of education they are inactive

Prevalence, knowledge, attitude and practice of shisha smoking among medical and dental students of Karachi, Pakistan

To determine the prevalence of shisha smokers among medical and dental students of Karachi and assess their knowledge, attitude and practice regarding shisha, and the effect of discipline [medical/dental] and year of professional education with their responses. Cross sectional, observational study. One thousand two hundred and four students from the six medical/dental colleges of Karachi participated in the study. The present study was conducted during April and May of the year 2007. The questionnaire consisted of personal questions like gender, field of study, name, and year of study; smoking habits, frequency and place of smoking, attitude and knowledge about diseases developed due to shisha smoking. Chi-square test was used to find relationship between independent variables i.e. field of study [medical/ dental], and year of study [1[st], 2[nd], 3[rd], 4[th] and final year] with response variables. The mean age of the participants was 20.2 +/- 1.6 years. Two hundred and seventy three students [22.7%] indicated that they smoke shisha. One hundred and nineteen of the male students [41.2%] and 154 female students [16.8%] indicated positively for shisha smoking. Dental students showed 13% higher prevalence of shisha smoking than medical students [p<0.0001]. Eighty percent of respondents selected either restaurants or 'shisha bar' for the place of smoking. Sixty four percent of the respondents were influenced by their friends to adopt this habit. Eighty one percent of the respondents admitted that shisha smoking was harmful. Twenty eight percent of the respondents believed an association between shisha smoking and cancer, and about a quarter related it with heart diseases. Thirty eight percent of the shisha smokers were also involved in cigarette smoking. High prevalence of shisha smoking was observed among medical and dental students. However, most of them had adopted this habit as leisure and for socialization. The awareness about the health hazards due to shisha smoking is needed as an intervention to extricate them from this habit

Statistical presentation of eruption age of permanent second molars, premolars and canines in female school children living in Riyadh, Saudi Arabia

To determine the mean eruption times of permanent canines, premolars and second molars; and the relationship of the eruption times of these teeth with height, weight and Body Mass Index [BMI] in Saudi female school children in Riyadh. DESIGN: Cross-sectional study using stratified cluster random sampling. The data were collected within one and a half months [September to October 2005] from 10 schools of Riyadh, Saudi Arabia. SUBJECTS and The study comprised female school children of grade 4 to grade 9 from primary and intermediate schools in Riyadh. Ten schools [8 public and 2 private] were randomly selected from four regions of Riyadh City. A total of 3186 children were examined of which 889 children were found suitable for the study. Clinical examination was carried out under natural light by direct visual inspection and manual palpation. Height and weight of the selected subjects were recorded. Demographic information on age, educational level, date of birth, place of birth and family name of the children were recorded from the school record. The mean age of 889 subjects was 11.58 +/- 1.57 years [R: 8.8 _ 16.1 years]. Mandibular left canine showed the lowest mean eruption age of 10.5 +/- 0.9 years. Maxillary left second molar showed the highest mean eruption time of 13.0 +/- 1.3 years. Maxillary second molars and maxillary canines showed significantly late eruption than the corresponding mandibular teeth [P < 0.0001]. All comparisons of contralateral teeth were insignificant [P > 0.05], except the maxillary second molars and second premolars [P = 0.025 and P = 0.012, respectively]. Eruption time was significantly positively correlated, linear as well as partial, with height of the children for all the studied teeth. However, the partial correlation with weight was negatively correlated for all the studied teeth except maxillary right second premolar. There was no statistically significant correlation between eruption time and BMI [P > 0.05]. Mandibular left canine showed the lowest mean eruption time, while maxillary left second molar showed the highest mean eruption time. The mandibular teeth erupted before their maxillary counterparts, except right second premolar and left first premolar. Eruption of teeth was positively related to somatic growth [height and weight], while it became negatively correlated with weight, when height was controlled

survey of patients1 opinion for business and professional factors affecting private dental practices in Riyadh, Saudi Arabia

To assess the criteria identified as important by the patients attending private dental clinics in Riyadh, Saudi Arabia. A cross sectional survey. Information was collected on a especially designed questionnaire from 575 patients of 30 private dental clinics, 6 each from 5 regions of Riyadh City. The questionnaire was divided into two parts. The first part contained demographic information about the patient and the second part listed a set of 16 criteria about the opinion of the patients for a good dental practice in private clinics. Crohnbech's alpha, chi-square, two-sample !t' and factor analysis were utilized for data analysis. The internal consistency of the respondents, using Crohnbech's alpha method, was 87.2%. 'caring dentist' showed the highest percentage [97.2%] followed by 'friendly staff [95.1%] among the 16 criteria. 'Accessible location of the clinic' showed the least percentage [80.3%], while, 'pleasant decor and comfortable surroundings' [81.4%] took the second lowest place in the list. Factor analysis created only two groups of criteria [factors]. The first group covered the factors, which are related to money, communication, administration and high values of the treatment, while the second group identified those factors, which are related to personality behavior of dentist and staff, professional competence and quality. In general, the patients were more interested to see better communication and behavior of dentists and staff in private practices as compared to public clinics

Effect of Babul and alum on salivary flow and oral bacterial growth

Objectives: Compare the effect of Babul and Alum on salivary flow, and saliva micro-organisms

Materials: Ninety volunteers, 20-25 years of age, were recruited. They were divided into 3 groups. Mouthwashes used: 25% aqueous Babul solution, 6.2% aqueous Alum solution, or distilled water. Unstimulated and stimulated saliva were collected for five minutes. The first change to visit one sample was a base line then after one week [visit 2]. Each subject was given 15 ml of randomized assigned mouthwash to rinse for one minute daily, then measurements were done after 2 and 4 weeks [visit 3,4]. Count of Streptococcus mutans and Lactobacilli were performed

Results: Results showed that unstimulated saliva in visit one had significantly higher mean values than visit 3 and visit 4 [p<0.05]. However, mean stimulated saliva in visit 2 was significantly lower than visit 3 and visit 4 [p<0.05]. There was an observable difference in the count of Streptococcus mutans. The number of cases with high count was reduced in final assessment to zero, while subjects with low count increased similarly relative to one use of Babul mouthwash. Although there were no significant differences among count of Lactobacillus, both mouthwashes showed a progressive decrease in the subjects with high bacterial count of Lactobacillus

Conclusions: Babul and Alum reduced salivary flow rate after the repeated use, which could be used in moisture control for dental procedures. Both mouthwashes had antibacterial effect against Streptocuccus mutans and Lactobacilli indicating the promising use of these natural substances as antibacterial compounds

Measuring the blood pressure, do we really need sleeves rolled up?

Technical issues and techniques are very important while measuring the Blood Pressure. It has been recommended that blood pressure should be measured on bare arm. In Pakistani society especially in females, this procedure becomes difficult to practice due to social and cultural issues. This study is carried out to check that measuring the Blood Pressure with cuff placed over the sleeve or without sleeve [bare arm] makes any difference

Method: two hundred subjects admitted in Civil Hospital Karachi, attending the OPD of CHK and their attendants were examined under standard conditions and Blood Pressure was measured by mercury sphygmomanometer. Three readings were recorded first with cuff placed over sleeves and with cuff placed on bare arm. Mean of systolic and diastolic blood pressure with and without sleeve were analysis on SPSS Version 11.5

Result: difference in means of systolic blood pressure between clothed and unclothed arm was 0.94 mmHg with a standard deviation of 4.32 and difference of means of diastolic blood pressure for the same was 0.58 mmHg with a standard deviation of 3.80. This was clinically insignificant

Conclusion: the difference found in blood pressure with and without sleeve was not significant clinically

Reasons for extraction of teeth in paramilitary personnel in Saudi Arabia. A pilot study

Objective: the objective of this multicenter survey was to determine the causes of tooth loss among patients who attended the National Guard Primary Health Care Centers [PHCC] of Saudi Arabia over a period of three months

Patients and methods: the forms of three hundred and nine patients who had 362 extractions were received after the study period

Results: teeth extractions due to caries, periodontal diseases, orthodontic and prosthodontic treatments were 72.7%, 14.9%, 3.6% and 8% respectively. Other reasons, like impaction, trauma pericardia and on-patient- request had less than 5% of the cases. The first and third molars showed higher frequency of extractions, whilst incisors and canines showed the least number of extractions. Females showed significantly higher extractions due to caries and orthodontic treatments, whilst males shown significantly higher frequency due to periodontal diseases and prosthodontic treatments

Conclusions: caries was the leading cause of extractions up to the age of 50 years, and then periodontitis became the main cause

Dental caries, hygiene, fluorosis and oral health knowledge of primary school teachers of Riyadh, Saudi Arabia

The objectives of this study were to determine the status of caries, oral hygiene condition and fluorosis of primary school teachers of Riyadh urban area and to assess some basic knowledge about oral diseases and habits of these subjects. Two hundred ninety seven male school teachers were selected randomly from 16 public schools, using stratified cluster random sampling. High caries experience and fluorosis level were observed when compared with the general normal population of Riyadh region. Five% of the teachers did not clean their teeth. One-third of the teachers showed poor knowledge about caries and gum diseases. Even though very few teachers were involved in giving lectures about preventive measures and oral diseases, nevertheless more than ninety% of them agreed that these types of lectures were beneficial to the students

Meta-analysis: a quantitative approach of data pooling

Recently a systematic method of literature review known as meta-analysis, is being extensively used in medical research and replacing the old method of narrative literature review. This method, not only quantifies the literature review but also increases the statistical power by combining the study results and thus increases the sample size. This review covers the definition, purpose, statistical methods and presentation of meta-analysis. Furthermore, it also covers the reliability of meta-analysis and appropriateness for the combinability of the studies. In addition, the questions, whether meta-analysis can be called as a scientific research and whether policy could be formed on the basis of meta-analysis, is also discussed