Non-vascularized autogenous bone grafts for reconstruction of maxillofacial osseous defects

Objective: To determine the outcomes of non-vascularized bone grafts for reconstruction of maxillofacial defects. Study Design: Case series. Place and Duration of Study: Department of Oral and Maxillofacial Surgery, Armed Forces Institute of Dentistry, Rawalpindi, from January 2013 to December 2015

Methodology: Descriptive analyses of 30 patients, who underwent maxillofacial reconstruction with non-vascularized bone grafts, were conducted. The demographic information, diagnosis, and type of graft harvested to reconstruct the defect were statistically analyzed. Outcomes of reconstruction with non-vascularized bone grafts were analyzed in terms of mouth opening, success of dental rehabilitation, and postoperative complications, i.e. surgical site infection and hardware loosening

Results: A total of 30 patients ranging from 8 to 60 years [33.57 +/- 14.74 years] had maxillofacial defects reconstructed mostly due to gunshot injuries, followed by post-resection defects. Overall 15 cases [50%] were reconstructed with iliac crest cortico-cancellous bone graft, 11 cases [36.7%] with rib; while in four cases [13.3%], costochondral graft was used for reconstruction. In 26 cases [86.7%], graft was found to be successful. In three cases, re-operation for onlay bone graft was required to provide optimal dental rehabilitation; while in just one case, postoperative surgical site infection was observed

Conclusion: Non-vascularized bone grafts provide a reasonable and effective modality for reconstruction of maxillofacial defects

Spectrum of complications of severe DKA in children in pediatric Intensive Care Unit

Objectives: To describe the spectrum of complications of Diabetic Ketoacidosis [DKA] observed in children admitted with severe DKA

Methods: Retrospective review of the medical records of all children admitted with the diagnosis of severe DKA in Pediatric Intensive Care Unit [PICU] of the Aga Khan University Hospital, from January 2010 to December 2015 was done. Data was collected on a structured proforma and descriptive statistics were applied

Results: Total 37 children were admitted with complicated DKA [1.9% of total PICU admission with 1.8% in 2010 and 3.4% in 2015]. Mean age of study population was 8.1 +/- 4.6 years and 70% were females [26/37]. Mean Prism III score was 9.4 +/- 6, mean GCS on presentation was 11 +/- 3.8 and mean lowest pH was 7.00 +/- 0.15. Complications observed included hyperchloremia [35.94%], hypokalemia [30.81%], hyponatremia [26.70%], cerebral edema [16.43%], shock [13.35%], acute kidney injury [10.27%], arrhythmias [3.8%], and thrombotic thrombocytopenic purpura [5.4%], while one patient had myocarditis and ARDS each. 13/37 children [35%] needed inotropic support, 11/37 [30%] required mechanical ventilation while only one patient required renal replacement therapy. Two patients [5.4%] died during their PICU stay

Conclusion: Hyperchloremia and other electrolyte abnormalities, cerebral edema and AKI are the most common complications of severe DKA

Use of N-acetylcysteine in children with fulminant hepatic failure caused by acute viral hepatitis

To determine the efficacy of N-acetylcysteine [NAC] in children aged > 1 month to 16 years admitted with Fulminant Hepatic Failure [FHF] secondary to Acute Viral Hepatitis [AVH] in a tertiary care center of a developing country. Analytical study. Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan, from January 2007 to December 2011. Medical records of children [> 1 month - 16 years] with FHF admitted with AVH of known etiology who received NAC were reviewed retrospectively. Liver function tests [mean +/- SD] at baseline, 24 hours after NAC and before or at the time of discharge/death were recorded and compared via using repeated measures ANOVA[r-ANOVA]. Efficacy of NAC is defined in improvement in biochemical markers, liver function test and discharge disposition [survived or died]. Mortality associated risk factors were identified by using logistic regression analysis. P-value and 95% confidence interval were recorded. Forty children [mean age was 80 +/- 40 months] with FHF secondary to AVH received NAC. Majority were males [n=25; 63%]. Vomiting [75%] and jaundice [65%] were the main presenting symptoms, one-third had hypoglycemic, while 40% had altered sensorium at the time of admission. There was significant statistical difference in liver enzymes and prothrombin time on admission comparing at discharge in children received NAC [p < 0.001]. Fifteen [38%] children died. Severe vomiting [Odds Ratio [OR] 0.22, 95% Confidence Interval [CI] 0.05 - 0.8], jaundice [OR 9.3, CI 1.1 - 82.6], inotropic support [OR 20.6, CI 3.5 - 118.3] and mechanical ventilation [OR 4.3, CI 1.1 - 16.6] at the time of admission are associated with risk factors for mortality in children with FHF secondary to AVH. NAC used in children with FHF secondary to AVH is associated with markedly improved liver function tests and recovery. FHF with complications is high risk for mortality

Burden of neurological illnesses in a pediatric intensive care unit of developing country

To assess the burden and spectrum of neurological illness in a pediatric intensive care unit and review the associated mortality. Retrospective review of medical records of children [1 mo-16 years] with acute neurological diagnosis admitted in PICU in Aga Khan University hospital from January 2008 to December 2011 was done. Basic demographic, diagnosis, neuro diagnostic procedures performed, therapies and outcomes were done on a structured datasheet. During study period, 231 [19.3%] patients were admitted with acute neurological illnesses in PICU. The mean age was 67 +/- 50 months, 54% [n=125] was under-five and 138 [59.7%] were males. Out of total, 144 [62.3%] had neurological illness and 87 [37.7%] had neurosurgical diagnosis. In acute neurological illness, 51.5% [n=119] had non-traumatic-coma [NTC] and 10.8% [n=25] had neuromuscular illness. CNS infection [26%, n=60] in structural cause and status epilepticus [10%, n=23] were the most common cause of structural and metabolic type of NTC respectively. Severe traumatic brain injury [21.2%, n=49] and postoperative neurosurgical illness [16.5%, n=38] were common neurosurgical cases in our cohort. The intensive care resources were utilized as mechanical ventilation in 78% [n=180], inotropic support in 29.4% [n=67] and therapeutic hypothermia in 33% [n=76]. Fifty children [21.6%] required PICU care for observation only. More than 500 neurodiagnostic tests/procedures were performed in this cohort of children with acute neurological disorders in PICU. The mortality rate in neurological cases was 18% [42/231] as compared to the overall mortality rate was 12% in PICU. Acute neurological disorders were common in PICU, and were associated with higher mortality. CNS infections, status epilepticus and severe traumatic brain injuries were the most common acute neurological illnesses in our cohort

Effect of fixed orthodontic apliances on the salivary pH

To assess the influence of fixed orthodontic appliances on the salivary pH. Randomized controlled trial. Department of Orthodontics, Armed Forces Institute of Dentistry in collaboration with the Department of Microbiology, Armed Forces Institute of Pathology Rawalpindi, from 10th September 2007 to 06th November 2008. Sixty Subjects [11 males and 49 females] with age ranging 13-20 years were randomly selected and divided into a control and an experimental group of 30 each. Study involved analysis of salivary samples. A proforma indicating salivary levels of pH at T1 [pre treatment] and at T2 [after 4 months] with the differences between T1 and T2 was prepared for each subject. In experimental group salivary pH depicted a statistically significant decrease between T1 and T2. These changes in control group were insignificant. Fixed orthodontic appliances [FOAs] tend to influence oral environment by lowering salivary pH towards acidic side

Prevalence of class II malocclusions in Pakistani sample - a study

The aim of this study was to determine the frequency of Class II malocclusion in seven different age groups in a local sample of patients seeking orthodontic treatment. Data for the study were retrieved from the patient's orthodontic records who sought orthodontic treatment at Armed Forces Institute of Dentistry [AFID] during the period of Oct 1999 through May 2008. A total of 1348 patients were screened. All the subjects had full complement of permanent teeth up to second molars. The patients with the history of previous orthodontic treatment, extractions of permanent teeth other than 3rd molars, mixed dentition, congenital malformations like Cleft lip or/ and palate and systemic diseases were excluded from the study. Assigning the subjects to various occlusal traits was based purely on clinical examination, study casts in centric occlusion, facial photographs and lateral cephalograms assessment. An overall prevalence of class II malocclusions within the selected sample was found to be 41%, with a male to female ratio of 1: 2.6. The three categories of Angle Class II malocclusion depicted a prevalence of 29.9% for Class II/1, 0.7% for Class II/2 and 10.4% for Class II subdivisions. All the three groups of Class II malocclusions reflected higher female ratios, presumably because of the higher number of female gender seeking orthodontic treatment in Pakistan

Frequency of dental anomalies in various malocclusions in orthodontic patients

The aim of this study was to determine the frequency of different dental anomalies in different malocclusion groups of patients seeking orthodontic treatment. This study was carried out at the Orthodontic Department of Armed Forces Institute of Dentistry [AFID], Rawalpindi. Data for the study were collected from the pretreatment diagnostic records of patients who reported at the department for orthodontic treatment from June 2003 to June 2009. A total of 503 patients of both gender [158 male, 345 female] with mean age 15.89+3.03 years [range, 11-22 years] were evaluated for study. All the subjects were in permanent dentition and had pretreatment diagnostic records were included in the study. Patients with syndromes, severe medical histories, impacted third molars, extraction of any permanent tooth, or trauma to any tooth before orthodontic treatment were excluded from the study. It was found that 55.3% of patients [n=503] had at least one dental anomaly. Agenesis [missing tooth or teeth] was the most common [24.9%], followed by ectopic eruption 21.3%, impaction 7.8% [canine] and supernumerary teeth 1.4%. The rate of tooth agenesis was higher in female than in males. No statistically significant correlations were found between dental anomaly and type of malocclusion. A remarkably high rate of dental anomalies was recorded. Dental anomalies reflected higher frequency in females, presumably because of the higher number of female gender seeking orthodontic treatment in Pakistan