Assessment of parents' attitude toward EPI [expanded program on immunization] in tertiary care hospitals of Karachi

Objective:To assess parents' attitude toward EPI [Expanded program on Immunization] in three Tertiary Care Hospitals of Karachi

Materials and Methods:This cross sectional hospital based study was conducted at three tertiary care hospitals of Karachi,PNS SHIFA Hospital, Jinnah Postgraduate Medical Center [JPMC] and Liaquat National Hospital [LNH] from a period of 20th July to 20th September, 2015. A structured questionnaire based interview was conducted on150 parents of children less than 5 year of age visiting for vaccination at these three tertiary care hospitals.Data was analyzed using SPSS version 23

Results:A total of 150 parents were interviewed, out of which 93 [62.0%] parents vaccinated their child immediately after birth, 148[98.7%] parents considered EPI as beneficial for their child's health, 113 [75.3%] parents were found to be aware of the complete vaccination schedule, 56[37.3%] parents had appropriate knowledge regarding vaccines and diseases enlisted on the EPI card, 139 [92.7%] parents kept the record of vaccination schedule, 143[95.3%] parents didn't ignored vaccination due to increased number of children and 21[14%]parents had fear regarding vaccination program

Conclusion:Parent's attitude toward EPI was positive. However, knowledge about vaccines and diseases and vaccines enlisted on EPI card was low

In-vitro comparative study of in-office and home bleaching agents on surface micro-morphology of enamel

Objective: To evaluate the effect of home-use bleaching agent containing 16% Carbamide Peroxide [CP] and in-office bleaching agent with 38% Hydrogen Peroxide [HP] on surface micro-morphology of enamel

Study Design: An experimental study

Place and Duration of Study: The discs were prepared at Material Engineering Department of NED University of Engineering and Technology, Karachi, and surface morphology was analyzed at Centralized Science Laboratory of Karachi University, Pakistan. Duration of study was one year from January to December 2012

Methodology: Forty five sound human third molar crowns, extracted for periodontal reason, were included in the study. Longitudinal sections were made using diamond disks [0.2 mm] under water lubrication to obtain enamel slabs measuring [3 mm x 3 mm]. The slabs were embedded in polystyrene resin by using 2.0 cm diameter PVC molds, leaving the outer enamel surface uncovered by the resin. Ninety dental enamel slabs were prepared. The slabs were then randomly divided into 3 groups. Each group contained thirty specimens [n=30]. Group 1 was kept in artificial saliva at 37[degree]C in incubator [Memart, Germany] during whole experiment. Group 2 was treated with power whitening gel [White Smile 2011, Germany]. Group 3 was treated with tooth whitening pen [White Smile 2011, Germany]. The most central region or the region that was most representative of the entire surface area was used. The SEM [Jeol-Japan-JSM6380A, JAPAN] micrographs were examined to determine the type of surface presented. The enamel changes were classified as no or mild alteration, moderate alteration and severe altered surface

Results: Regarding micro-morphology, the enamel surface of control groups showed smooth surface in general with some scattered clear scratches due to the polishing procedure. The specimens bleached in group 2 and group 3, represented areas of mild erosion

Conclusion: Bleaching with 38% Hydrogen Peroxide [HP] and 16% Carbamide Peroxide [CP] resulted in mild changes in surface micro-morphology of enamel

In vitro comparative study of two different bleaching agents on micro-hardness dental enamel

Objective: To evaluate the effect of home-use bleaching agent containing 16% Carbamide Peroxide [CP] and in-office bleaching agent containing 38% Hydrogen Peroxide [HP] on enamel micro-hardness

Study Design: An in vitro experimental study

Place and Duration of Study: Department of Operative Dentistry and Science of Dental Materials at Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and Material Engineering Department of NED University of Engineering and Technology, Karachi, from July to December 2014

Methodology: A total of 90 enamel slabs from 45 sound human 3rd molar were randomly divided into 3 groups. Each group contained 30 specimens [n=30]. Group 1 was kept in artificial saliva at 37[degree]C in incubator during the whole experiment. However, Groups 2 and 3 were treated with power whitening gel and tooth whitening pen respectively. After bleaching session, specimens were thoroughly rinsed with deionized water again for 10 seconds and then stored in artificial saliva at 37[degree]C in incubator. Artificial saliva was changed after every 2 days. The Vickers hardness tester [Wolpert 402 MVD, Germany] was adjusted to a load of 0.1 kg [100 gm] and dwell time of 5 seconds. Three Vickers were performed on each specimen using a hardness tester according to the ISO 6507-3:1998 specification. Micro-hardness measurements were performed before and after bleaching at day 1, 7 and 14

Results: In the control group, the baseline micro-hardness was 181.1 +/- 9.3 which was reduced after the storage on day 1, 7 and 14 [p = 0.104]. In Group 2, baseline micro-hardness was 180.4 +/- 10.1 which was reduced to 179.79 +/- 10.0 units after day 1. Whereas, on day 7 and 14, the values of micro-hardness were 179.8 +/- 10 and 179.7 +/- 10.29, respectively [p=0.091]. Furthermore, the baseline micro-hardness in Group 3 was 174.0 +/- 22.9 units which was reduced to 173 +/- 23 on day 1, 170 +/- 30 on day 7 and 173 +/- 23 on day 14 [p = 0.256]. The statistically insignificant difference was found among micro-hardness values of different bleaching agents [p = 0.118]

Conclusion: Bleaching with 38% Hydrogen Peroxide [HP] and 16% Carbamide Peroxide [CP] resulted in insignificant effect on surface micro-hardness of enamel

Association Between Grading of Oral Submucous Fibrosis With Frequency and Consumption of Areca Nut and Its Derivatives in a Wide Age Group: A Multi-centric Cross Sectional Study From Karachi, Pakistan

BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic, premalignant condition of the oral mucosa and one of the commonest potentially malignant disorders amongst the Asian population. The objective of this study was to investigate the association of etiologic factors with: age, frequency, duration of consumption of areca nut and its derivatives, and the severity of clinical manifestations. METHODS: A cross-sectional, multi centric study was conducted over 8 years on clinically diagnosed OSMF cases (n = 765) from both public and private tertiary care centers. Sample size was determined by World Health Organization sample size calculator. Consumption of areca nut in different forms, frequency of daily usage, years of chewing, degree of mouth opening and duration of the condition were recorded. Level of significance was kept at P < or = 0.05. RESULTS: A total of 765 patients of OSMF were examined, of whom 396 (51.8%) were male and 369 (48.2%) female with a mean age of 29.17 years. Mild OSMF was seen in 61 cases (8.0%), moderate OSMF in 353 (46.1%) and severe OSMF in 417 (54.5%) subjects. Areca nut and other derivatives were most frequently consumed and showed significant risk in the severity of OSMF (P < or = 0.0001). Age of the sample and duration of chewing years were also significant (P = 0.012). CONCLUSIONS: The relative risk of OSMF increased with duration and frequency of areca nut consumption especially from an early age of onset.

Effect of immediate and delayed finishing and polishing procedures on micro hardness and gloss of esthetic restorative materials

To study the immediate and delayed finishing and polishing procedures effects on surface micro hardness and gloss of different composite. Materials and The restorative materials included a Hybrid composite [Valux TM Plus], Nano resin composite [Filtek_ Z350] and a poly acid modified resin composite Dyract Extra [Dentsply Caulk, Milford, DE, USA]. 30 discs were fabricated from every restorative material and at random divided into three groups. The group one served as control. Group two was finished and polished immediately and the third group was finished and polished after 24 hours. Three Vickers micro hardness indentation were performed on every disc surface under 100g load and 10s dwell time. Gloss measurements were done using a small-area glossmetre. Data for surface micro hardness and gloss were analyzed by two-way ANOVA and Tukey test [P<.05]. With respect to material wise comparisons the lowest values of micro hardness were observed for every restorative material which was cured under Mylar strip [control]. The greatest values of micro hardness were observed when finishing and polishing of samples was delayed [P<0.05]. There was not significant difference in gloss measurements with respect to material and time. All three types of composites tested showed highest value of micro hardness when finishing and polishing procedures were delayed for 24 hours. There is no statistical difference in gloss measurements with respect to material and time

Effects of light activated bleaching and tetra pack orange juice on micro-morphology and composition of dental enamel

To study the effects of 38% Hydrogen peroxide activated with LED light and tetra pack orange juice on micro morphology and mineral content of enamel surface. A total of 45 human enamel discs were incubated in saliva overnight to allow pellicle formation and then divided into three groups: 15 for control [G1], 15 for bleaching treatment [G2], and 15 for orange juice immersions [G3]. Surface micro-morphology, calcium and phosphorus were measured with Scanning electron microscope along with energy dispersive spectroscopy five day after treatment. Enamel discs of group 2 were treated with H2O2 with LED and group 3 with orange juice for 15 min each cycle repeated four times for five days to simulate daily treatment with the products for 5 days. The discs were stored in saliva between treatment cycles. Normality of the variables was checked by Shapiro-Wilk's test and all variables were found to be approximately symmetric. Repeated measures ANOVA with post-hoc analysis was run to assess the changes in percentages of calcium and phosphorus due to different application. Mild alteration was seen on enamel surface of control group. The photomicrographs of enamel surface after bleaching and irradiated showed moderate generalized surface roughening. Severe alteration of enamel surface was observed in group 3. Group 3 [Orange juice] produced greater calcium and phosphate loss in comparison with all the other groups [p<0.0001]. No significant difference [p>0.999] was observed in calcium and phosphorus loss between group I [control] and group 2 [bleached]. Group 3 [Orange juice immersion] significantly altered morphology and increased loss of calcium and phosphorus erosion of enamel as compared to group I [control] and group 2 [Bleached] so, there was significant difference between control and immersion group. There was in significant difference between control and bleached group

Effectiveness of commonly available surface protecting agents in maintaining microhardness of two cements

To estimate the microhardness of glass ionomer cement [vitrofil] and resin modified glass ionomer cement [vitremere] in the presence and absence of different surface protections. An in-vitro experimental study. The Department of Operative Dentistry, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences and the Department of Material Sciences, NED University, Karachi, from August 2011 to January 2012. Seventy-two discs of each material were made in polytetrafluoroethylene mold which was 10 mm in diameter and 2 mm in thickness. Four groups were made for each material containing 18 discs; G1/G5 [control group], G2/G6 [solid petroleum jelly], G3/G7 vernal [resin varnish], G4/G8 [nail varnish]. After initial setting reaction surface protection was applied to discs. Once the surface protection was dried, discs were stored in deionized water at 37°C for 24 hours. After 24 hours, the discs were polished. Microhardness test were performed in digital microhardness tester. The results were statistically analyzed with the help of two-way ANOVA. For glass ionomer cement the only G4 [nail varnish] differed from the G1 [control group] [p < 0.05], No significant difference was seen with other surface protection agents. For resin modified glass ionomer cement, the G7 [resin varnish] and G8 [nail varnish] gave better result from the G5 [control group]. Nail varnish and resin varnish showed better surface protection for GIC and RMGIC. The presence of toluene in nail varnish have harmful effects so should not be preferred if resin varnish is available

Effect of different tetra pack juices on microhardness of direct tooth colored-restorative materials

To examine the effect of apple and orange juices on the surface h ardness of direct tooth-colored restorative materials. The materials included resin-modified glass ionomer cement [Vitremer 3M[tm] ESPE[tm] Core buildup restorative] and composite resin [Filtek[tm] 3M[tm] ESPE[tm] Z350]. A total of 45 disks of each restorative material were prepared. The disks were divided into groups of 15, which were immersed for 7 days in deionized water [G1/G4, control group], apple juice [G2/G5], or orange juice [G3/G6]. The pH of the apple juice was approximately 4.8 and the pH of the orange juice was approximately 4.9. Surface hardness tests were performed before immersion and at various times following immersion. Statistical analysis included two-way ANOVA with repeated measurement and Tukey's test. Exposure to juices significantly reduced the hardness of both materials [p < 0.05], while deionized water did not affect the surface hardness of either material. The ionomer cement experienced a greater reduction than the composite resin [p = 0.000]. There was no significant difference in the effect of apple and orange juices. Juice box-type fruit juices reduced the hardness of direct tooth-colored restorative materials. Material selection should be considered when planning restorations in patients who have experienced tooth surface loss. In terms of the materials evaluated in this study, the composite material provides greater durability under acidic conditions

Bacterial meningitis in North India: Trends over a period of eight years

Background: Acute bacterial meningitis is a medical emergency which warrants early diagnosis and aggressive therapy. It is important to know the regional bacterial etiology in semitropical countries like India along with their sensitivity profi le to allow optimum management of such patients with least possible mortality. This study was undertaken to study the trends in etiology and the antimicrobial resistance pattern of the pathogens prevalent in North India over a period of 8 years. Methods: The study was performed from June 2001 to June 2009. CSF and blood samples were collected from all patients suspected of meningitis and inoculated on chocolate agar, blood agar and MacConkey agar. Antimicrobial susceptibility testing was done using Kirby Bauer disc diffusion method. Detection of methicillin resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) in Enterococcus species, extended spectrum β lactamases (ESBL), Amp C and metallo-betalactamases was also done. Results: 403 samples were positive on culture. S. aureus was the most common pathogen. Among the gram positive cocci as well as the gram negative bacilli, a gradual decline in the antimicrobial susceptibility was seen. The aminoglycosides had the best spectrum of antimicrobial activity. Towards the end of the study, an alarming rise of MRSA to 69.4%, HLAR among the Enterococci to 60% was noted. Among the Enterobacteriaceae, ESBL and Amp C production was found to be 16.7% and 42% respectively. No vancomycin and imipenem resistance was observed. Conclusion: An entirely different trend in etiology in bacterial meningitis was observed in the semitropical region of North India. The high prevalence of drug resistant pathogens is a cause for worry and should be dealt with by rational use of antimicrobials. Frequent revision in drug policy may be necessitated for optimum management of patients.

Association between serum C- reactive protein levels and other important predictive markers of outcome in COPD

C-reactive protein [CRP] is an acute-phase protein synthesized predominantly by the hepatocytes in response to tissue damage or inflammation. Levels of acute-phase proteins rise rapidly, during infection and after injury. We take up the study to correlate serum CRP levels with other important predictive markers of outcome in COPD. Patient with stable COPD [no exacerbation in the last two months] were taken up for the study. Parameters taken to correlate were age, grade of dyspnea, FEV1. It was found the CRP is negatively correlated with FEV1 and grade of dyspnea but not correlated with age