Dentoalveolar heights in vertical and sagittal facial patterns

Objective: To determine and compare the mean dentoalveolar heights [mm] in different vertical and sagittal facial patterns

Study Design: Cross-sectional study

Place and Duration of Study: Orthodontics Clinic, The Aga Khan University Hospital, Karachi, from September to November 2013

Methodology: Subjects, aged 15 - 20 years, having fully erupted first permanent molars and central incisors were included in the study from orthodontic records. The pretreatment cephalographs of subjects were traced manually over an illuminator. The various parameters like angles and dentoalveolar heights were measured and recorded on data collection form. Mean value +/- SD for the variables were generated. ANOVA was used to compare the means of dentoalveolar heights among the vertical and sagittal facial patterns. Post Hoc Bonferroni test was applied to show difference among the three vertical and three sagittal facial patterns. P-value equal to or less than 0.05 was taken as statistically significant

Results: The mean age of subjects was 15.8 +/-3.2 years in vertical group and 16.3 +/-2.9 years in sagittal group. There was statistically significant difference [p=0.008] for the upper anterior dentoalveolar height [UADH] among vertical groups, with statistically significant difference for UADH between hyperdivergent and normodivergent [p=0.04] and hyperdivergent and hypodivergent [p=0.01] facial patterns

Conclusion: The UADH were significantly greater in the hyperdivergent group as compared to both the normodivergent and hypodivergent groups. The sagittal groups showed no statistically significant difference for dentoalveolar heights

Plaque index in multi-bracket fixed appliances

To compare the plaque index in patients receiving multi-bracket fixed orthodontic treatment for various factors like age, gender, socio-economic status, brushing practices, meal habits, types of brackets, types of ligations, use of mouthwash and duration of treatment. Cross-sectional analytical study. Orthodontics Clinic, The Aga Khan University Hospital, from September to November 2011. Socio-demographic and clinical modalities were defined and recorded for 131 patients having multi-bracket fixed appliances. The plaque index of subjects were recorded according to the Silness and Loe plaque index method. Independent sample t-test was used to see difference in plaque index in factors having two variables. One way ANOVA and Post-Hoc Tukey tests were used to see difference in plaque index in factors having three variables. Kappa statistics was used to assess inter examiner reliability. P-value of

Double stick approach for chronic total occlusion of coronary arteries

To describe experience of double stick access to arterial system with contralateral injection of the opposite artery to visualize the distal cross filling vessel when a totally occluded vessel has no antegrade flow. A Quasi-experimental study. Armed Forces Institute of Cardiology / National Institute of Heart Disease Rawalpindi from Jan 2009 to Aug 2010. Retrospective analysis of 20 coronary angiograms performed for CTO at the cardiac catheterization laboratory of AFIC/NIHD were included in the study. Double stick access was gained through femoral artery in the groin 1cm apart. Twenty patients with chronic total occlusions underwent PCI with contralateral injection technique. Out of them 70% were male and 30% were female. The mean age was 53.65 years. Multivessel coronary artery disease was seen in 45% of patients. Left anterior descending artery lesion was present in 60%, while right coronary artery lesion in 40%. There was no LCX lesion. Single wire was used in 55% of cases while 40% required a second wire which was stiffer and heavier than the previous one. Pilot 50 was successful in 70% and 10% required cross it 200. Predilation was done in all cases using multiple balloons. DES was used in 93.75% cases of CTO. The procedure was successful in 80% while in 20% it was unsuccessful. There was no death during the procedure, nor any other periprocedural or access site complications. We conclude that double stick approach with contralateral injection is a safe and effective way to cross total occlusion

Coronary artery disease in the elderly

The objective of our study is to assess the severity of coronary artery disease in the elderly and predict the safety outcome of coronary angiography. A cross sectional observational study. AFIC/NIHD Rawalpindi. February 2011 and August 2011. The study population included 100 elderly patients [age>60 years] undergoing coronary angiography. Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries [>50% for the left main coronary artery]. We attempted to quantify the "severity of CAD" by ascertaining the prevalence of high-risk coronary anatomy [HRCA, defined as >50% stenosis of the left main coronary artery and/or significant three-vessel coronary artery disease]. More than 70% stenosis in more than one coronary artery was considered as severe coronary artery disease. Our study cohort comprised of 100 consecutive subjects 82 [82.0%] men and 18 [18.0%] women with a mean age of 78.6 years [Range 70 years - 94 years]. 77 patients [77.0%] had severe coronary artery disease; 50 with triple vessel coronary artery disease [TVCAD] 1 with TVCAD with Left Main Stem Disease, 26 had double coronary artery disease [DVCAD]. 12 patients [12.0%] had moderate coronary artery disease with single vessel involvement [SVCAD], 6 patients [6.0%] had subcritical coronary artery disease with < 60% stenosis in any of the vessel while only 5 patients [5%] had a normal coronary angiogram. Patients of elderly age group have more severe CAD and coronary angiography is a relatively safe procedure.

Dentoalveolar heights in skeletal class I normodivergent facial patterns

To determine the dentoalveolar heights [mm] in skeletal class I normodivergent facial pattern and compare the same heights in male and female subjects. Cross-sectional observational study. Orthodontics Clinic, The Aga Khan University Hospital, Karachi, from July to October 2009. Eighty one subjects were selected from the orthodontic record at the Aga Khan University Hospital Karachi.The inclusion criteria were an age range of 12 to 30 years and skeletal class I normodivergent facial pattern with exclusion criteria of prior orthodontic treatment, restored teeth and craniofacial anomalies/syndromes. The pre-treatment cephalographs of the patients were traced manually on acetate paper by the principal investigator. The various land marks were marked and the parameters were recorded. Mean and standard deviations were determined. Independent sample t-test was used to find gender dimorphism. The mean age of the sample was 15.8 +/- 3.4 years. Mean ANB angle for the entire sample was 2.6° +/- 1.2° and for angle SN-MP was 31.5° +/- 2.5°. Descriptive analysis presented mean value of upper anterior, upper posterior, lower anterior and lower posterior dentoalveolar heights to be 28.5 +/- 2.7 mm, 22.9 +/- 2.6 mm, 41.3 +/- 2.9 mm and 31.5 +/- 3.2 mm respectively. Male subjects had significantly greater mean values for lower anterior and posterior dentoalveolar heights [p=0.02 and 0.05 respectively]. The mean dentoalveolar heights for the skeletal class I normodivergent sample were established. No gender dimorphism was found for upper dentoalveolar heights however, lower anterior and lower posterior were significantly greater in males as compared to females. All the values of dentoalveolar heights for male subjects were greater than female subjects

Left radial artery approach for coronary artery intervention

To determine the success rate of left radial artery approach for coronary intervention. Descriptive study. Armed Forces Institute of Cardiology/ National Institute of Heart Diseases Rawalpindi. Study Period spanned from 15 January 2010 to 15 July 2010. The study was conducted on a total of 41 patients, out of these 41 patients, 25[61%] had undergone diagnostic coronary angiography using left radial artery approach and 16[39%] underwent percutaneus coronary intervention. Left radial artery route was selected after Positive Allen Test. Injection Verapamil 5mg was given through side connection of radial artery sheath to prevent spasm. No conversion to femoral artery route was done, establishing 100% success rate, without any bleeding or haematoma. Left radial artery approach for coronary angiography and percutaneus intervention in convenient and safe for the patient and almost free from major access site complication

Experience of percutaneous coronary intervention of chronic total occlusion in native coronary arteries

To evaluate the procedural outcome and periprocedural complications of PCI in CTO. Observational study. During 2008 at AFIC/ NIHD. This study was carried out on 311 patients with 319 Chronic total occlusion [CTOs] who underwent percutaneous coronary intervention [PCI] in catheterization laboratory at AFIC/ NIHD. Patients with total occlusions less than three months duration were excluded. After informed consent data was gathered on standard proforma and was analyzed using SPSS 13.0. Out of 311 patients, 264 were males and 47 were females, ranging in age from 30 years to 80 years. Technical success was obtained in 78% of patients and procedural success in 76%. Most common location was LAD 48.2% followed by RCA 32.5%, LCx 18.6%, and LMS 0.6%. Technical success in LAD was 48.3%, RCA was 30.6%, LCx was 20.2% and LMS was 0.8% of the total successful PCIs. Among failed procedures inability to cross the lesion with a guidewire and inability to adequately dilate the lesion with balloon were the reasons of failure in 82.6% and 17.4% patients respectively. No patients died, three patients suffered MI, one patient underwent urgent coronary artery bypass surgery [CABG] and two patients underwent repeat PCI. PCI to CTO is a safe procedure in carefully selected patients and should be offered as a revascularization modality

Use of exercise tolerance test and thallium stress test in the diagnosis of ischemic heart disease in soldiers

To determine the role of Exercise Tolerance Test [ETT] and Thallium Stress Test [TST] in the detection of Coronary Artery Disease [CAD] among soldiers. Descriptive study. This study was conducted at Combined Military Hospital [CMH], Multan, Pakistan, from 2002 to 2004. There were 291 male soldiers between ages 30 and 45 years who presented with chest pain and had normal resting ECG. All patients were subjected to ETT. Positive ETT cases had Coronary Angiogram [CA] as the gold standard. Negative cases were subjected to TST. Normal CA cases also had TST to rule out microvascular disease. Those with normal ETT and positive CAD risk factors also had TST. Those with negative TST had CA as service requirement. All 291 cases had ETT, 130 cases were found positive, 161 had negative ETT. When CA was done on 130 positive cases, 95 had CAD [true positive, TP] and 35 had normal coronaries [false positive, FP]. Out of the 161 negative ETT cases, 128 had normal coronaries [true negative, TN] and 33 had CAD [false negative, FN]. TST was conducted on 196 cases, out of which 78 cases were found positive and 118 had negative TST. When subjected to CA, out of 78 positive cases, 30 had CAD [TP] and 48 had normal coronaries [FP]. Out of 118 negative TST cases, 115 had normal coronaries [TN] and 3 had CAD [FN]. ETT was found to have sensitivity of 74.2%, specificity of 78.5%, Positive Predictive Value [PPV] of 73.1%, Negative Predictive Value [NPV] of 79.5% and test accuracy of 76.6%. TST had sensitivity of 90.9%, specificity of 70.6%, PPV of 38.5%, NPV of 97.5% and accuracy of 74.0%. TST was found to be more sensitive and less specific than ETT in the diagnosis of CAD

Awareness diabetic retinopathy amongst known diabetics

To study awareness regarding Diabetic Retinopathy [DR] amongst established diabetics. This cross-sectional observational study was done at Department of Diabetes and Endocrinology, Hayatabad Medical Complex Peshawar, Pakistan with technical support from Hyber Institute of Ophthalmic Medical Sciences, Peshawar. Two hundred and two indoor patients were interviewed and duration of diabetes, drugs taken for the control of diabetes, history of any previous eye examination was recorded. Later dilated fundoscopy was done by endocrinologist and finally all the patients were sent for independent assessment by an ophthalmologist for categorizing DR and if needed laser was done for the affected eyes. Of 202 patients only 9 [4%] patients had optimum diabetic control with HbA[1]C of <7. Ninety four [47%] had previous eye examination while 18 [53%] had never had their eyes examined. Of those examined 77 [81.9%] had been seen by ophthalmologist, 13 [13.8%] by physician/endocrinologist and only 4[4.3%] by general practitioners [G.Ps]. Dilated fundoscopy showed 118[58%] patients had retinopathy. Thirty eight [18.8%] patients were offered laser treatment after appropriate investigations. Screening and awareness of DR amongst patients is particularly low in our setup. We need to increase awareness amongst our patients regarding this complication of diabetes

Incidence and prognosis of concessive hyphema in northwest frontier province of Pakistan

Sixty-three consecutive cases of concussive traumatic hyphema admitted to the Department of Ophthalmology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar from May 1987 to July 1988 were studied prospectively. Majority of the patients [61.9%] were under the age of 15, and male to female ratio was 7:1. Eye Injury mostly occurred during sports, while at play, by flying objects such as stones, mudballs and goli dandas. Only a little over one half of the patients, 35 [55.6%], sought medical attention within 24 hours. Twenty-seven [42.9%] patients had total hyphema. Recurrent hyphema occurred in 12 [19.0%] patients, and nine of these had delayed presentation. Glaucoma, corneal staining, necessity of surgical intervention, and poor visual outcome often accompanied recurrent hyphema. Of the 36 patients with known final visual acuity, 12 [33.3%] had a visual acuity of 20/200 [6/60] in the affected eye. These figures are much higher than the figures reported from the developed countries, despite the fact that in the developing countries the incidence of hyphema in more or less similar to that of our study. The reason for delayed presentation, higher number of total hyphemas, and poor visual outcome are poverty, illiteracy, poor public awareness, and a lack of eye care facilities in the rural areas of Pakistan. An aggressive public health education and implementation of sound epidemiological principals are needed to improve the situation