Prevalence of Pulpal Stones in a Saudi Subpopulation

Introduction: The aim of the study was to determine how prevalent pulpal stones are in the Saudi subpopulation utilizing periapical radiographs, and also to see if there is any correlation between pulpal stone and age, sex, position in the dental arch or any other dental condition or irritant. Methods: A sample of 700 patients were randomly selected from the dental records available in the database at College of Dentistry, University of Hail. The final sample was 298 dental patient records, 1306 teeth were examined from 1052 periapical radiographs, both parallel and bisecting techniques were included. All radiographs were examined by two examiners. Data were analyzed using (SPSS) utilizing Chi-square analysis. Any difference was considered significant if the p ≤ 0.05. Results: Of the 298 patients, 153 were males and 145 were females. We assessed a total of 1306 teeth for the presence of pulp stones. The overall prevalence of pulp stones in the whole study population was 28% and the prevalence based on the number of teeth examined was found to be 12%. The prevalence of pulpal stones was noted to be higher in molars, and in non-intact teeth. Conclusion: The prevalence of pulp stones in the Saudi subpopulation studied was 28% in patients, and 12% in all teeth. Pulp stones prevailed more in carious and restored teeth. Aging was associated with an increase in pulpal stones incidence. Sex predilection, however, didn’t have any influence on the occurrence of pulpal stones.

Xantho granulomatous pyelonephritis presenting as migratory polyarthritis in 40 years old female in department of medicine in services hospital Lahore

We report a case of Xantho granulomatous pyelonephritis presenting with migratory polyarthritis in a 40 years old female patient. The patient presented to us with complaint of high grade fever and large joints pain and swelling. The diagnosis was confirmed with CT-scan abdomen and histopathology of specimen. Xantho granulomatous pyelonephritis is an unusual variant of chronic pyelonephritis. Fleeting arthritis is very rare presenting complaint of the disease

Hypotension after spinal anaesthesia; efficacy of ephedrine and phenylephrine for treatment during elective caesarean section

Aim of the study is to compare the efficacy of Ephedrine and Phenylephrine for treatment of hypotension after spinal anaesthesia for elective caesarean section. Randomized Clinical Trial. Operation theatre Department of Anaesthesiology, Combined Military Hospital Quetta. Six month from 16th Sep 2011 to 15th March 2012. Seventy women undergoing LSCS for singleton pregnancy under spinal anesthesia were randomly assigned in group A and B [35 in each group]. All patients preloaded with Lactated Ringer's solution 15ml/kg body weight 10 minutes before administration of spinal anaesthesia. Mean Arterial Pressure [MAP]] was recorded before administration of spinal anaesthesia considered as Base-line MAP and then at 1 Minute, 3 minutes and at 5 minutes after administration of spinal anaesthesia. When hypotension developed [MAP falls >20% from base line], intravenous single dose of ephedrine administered in group A patients, while in group B, Phenylephrine was given. Blood pressure was recorded after 1 minute following drug administration and up to 3 minutes at 1 minute interval. Patient handed over for procedure after 10 minutes of spinal block. The SPSS version 13 was applied to the data. Mean and standard deviation were computed for numerical variables like age, weight, height, systolic blood pressure, Diastolic blood pressure, and Mean Arterial pressure; whereas frequency and percentages were employed to assess the categorical variable like efficacy. Chi-square test was used to compare the efficacy of intravenous bolus of ephedrine and phenylephrine. Statistical significance was taken at p<0.05. There was significant difference in the efficacy of both the drugs, in the treatment of maternal hypotension. 74.29% were successfully treated in group [A] with a single dose of Ephedrine, as compared to group B where 51.43% were successfully treated with a single dose of Phenylephrine. [p-value = 0.048]. Intravenous ephedrine has more efficacy than phenylephrine in the treatment of maternal hypotension after spinal anesthesia for elective cesarean section

Pseudoaneurysms in intravenous drug abusers

lntravenous drug abuse can lead to vascular complications, most frequent of which is pseudoaneurysm. These pseudoaneurysms [false aneurysms] are prone to rupture, leading to profuse hemorrhage and death. To evaluate pseudoaneurysms in intravenous drug addicts for the site, mode of presentation, management and outcome. Descriptive study. Surgical unit I, Combined Military Hospital, Rawalpindi. Surgical unit 2, Combined Military Hospital, Lahore. January 2006 to September 2010. All cases of pseudoaneurysms in intravenous drug addicts who presented to a single vascular surgeon, between 1st January 2006 and 30 th September 2010, were evaluated for site, mode of presentation, treatment and the outcome. Surgical procedures included excision of pseudoaneurysm with interpositioning of graft, repair of vascular rent, ligation of vessel and debridement. All cases were referred to psychiatrist for management of drug addiction. Total 12 cases of pseudoaneurysms due to IV drug abuse were included in our study. Arteries affected included 9[75%] common femoral arteries [CFA]. ln 3[25%] cases, both common femoral artery and vein were involved with arteriovenous fistula between them. There was 1[8.3%] pseudoaneurysm each of external iliac artery, superficial femoral artery and brachial artery. Nine cases [75%] presented with recurrent hemorrhage from a swelling while in 3[25%] cases there was swelling with no history of hemorrhage. ln 7[58.3%] cases, repair/grafting, while in 5[41.6%] cases ligation and debridement was done. There was seroma formation in 1[8.3%] case after excision and grafting. ln none of the cases, in which artery was ligated, critical limb ischaemia occurred. Common femoral artery is the most frequent site of pseudoaneurysms in lV drug abuse. ln those cases where vascular reconstruction is not possible due to extensive skin necrosis or infection, ligation of affected vessel is not only a life saving procedure but a safe option also.

Comparison of effectiveness of thoracic epidural and paravertebral block for post thoracotomy pain relief

To compare the effects of thoracic epidural and thoracic paravertebral block in post thoracotomy pain relief and early ambulation. Randomized control trial [RCT]. Combined Military Hospital Rawalpindi a tertiary care health facility, from Jan 2007 to Dec 2007. Thoracic epidural block was given in group-A while thoracic paravertebral block was given in group-B patients post operatively. Pain scores were assessed at 30 min intervals after the dose of 0.25% Bupivacaine using visual analogue scale [VAS]. There was no significant difference for pain scores in first 24 hours after surgery between paravertebral block [PVB] and thoracic epidural group measured at 30 min interval. But complication like hypotension occurred less with PVB. Paravertebral block is a safe and effective technique and can to be used more widely for unilateral post thoracotomy pain relief

PDPH by using gauge of needles

There is increase incidence of Lower Segment Caesarean section [LSCS] being performed under sub-arachnoid block [SAB] because it is relatively safe. One of the complications of SAB is Post Dural Puncture Headache [PDPH] which is very distressing to the patient. To observe the incidence of PDPH by using two different types of spinal needle of 25 gauge in females undergoing LSCS under SAB. Currently, in our setup 25G cutting [quincke] spinal needle is routinely used. Randomized controlled trial. Department of Anesthesia, Officers Family Hospital, Rawalpindi Cantt. 6 months from 15 February 2011 to 15 July 2011. 100 pregnant patients undergoing elective CD under spinal anaesthesia were randomized into two group A and B. Group A received SAB with 25G Quincke needle; Group B-received SAB with 25G pencil-point needle. Follow up was done up to 72 hours after the surgery. Data obtained through study was analysed through computer software SPSS version 12. quantitative variables like age, weight and height are presented as mean and standard deviation. The frequency of PDPH was qualitatively analysed in percentage. The frequency of PDPH was compared between two groups with the application of Chi-square as test of significance at P-value <0.05. It was found that the incidence of PDPH with Quincke [cutting tip] needle was significantly higher [7.%] as compared to pencil point needle [0%]. Pencil-point needle is associated with lesser incidence of PDPH and should be preferred to Quincke needle to achieve SAB in patients undergoing LSCS

Effect of general anaesthesia versus spinal anaesthesia on apgar score in elective caesarean section

To compare the effects of general versus spinal anaesthesia on Apgar score of neonates in elective Caesarean section. Randomized control trial. The Department of Anaesthesia and Intensive care CMH Lahore over duration of six month from 20-02-07 to 19-08-07. A total of 100 pregnant patients undergoing elective Caesarean section were divided into two groups: Group-A [General anaesthesia], Group-B [spinal anaesthesia]. In both the groups the patients were randomly divided using random number table and were blind to the technique of anaesthesia used. Mean Apgar score at one minute in group-A was 6.4 +/- 1.1 and in group-B was 8.4 +/- 1.1. The difference between two groups was statistically significant [p< 0.001]. Mean Apgar score at 5 minute was observed 9.4 +/- 0.7 in group-A and 9.5 +/- 0.6 in group-B. The difference between these two groups was not statistically significant [p=0.202]. Apgar score of neonates whose mothers received spinal anaesthesia was better at 1 minute than neonates whose mothers received general anaesthesia but there was no significant difference in Apgar score after 5 minutes in both techniques

Intra-operative hypotension; induction of anesthesia in patients continuing their routine dose of angiotensin system inhibitor therapy before surgery

To determine the frequency of intra-operative hypotension following induction of Anesthesia in patients continuing their routine dose of angiotensin system inhibitor therapy before surgery. Cross-sectional study. Department of Anaesthesiology, Combined Military Hospital, Quetta. One year from 20-08-2010 to 19-08-2011. Total 92 hypertensive patients were included in this study. Diagnostic criteria for patients was those cases receiving ACEI/ARA therapy for at least 3 months with admission preoperative arterial blood pressure of >150/90mmHg. Mean age of the patients was 47.70 +/- 8.47 years. Out of 92 patients, 38 patients [41.3%] were male while remaining 54 patients [58.7%] were female. Distribution of cases by hypotension after induction of anesthesia shows, hypotension at 30 minute in 55 patients [59.8%] and hypotension at 60 minute in 37 patients [40.2%]. Out of 55 hypotensive patients [at 30 minute] 17 patients [30.9%] had mild hypotension, 32 patients [58.2%] had moderate hypotension and 6 patients [10.9%] had severe hypotension. Out of 37 hypotensive patients [at 60 minute] 8 patients [21.6%] had mild hypotension, 25 patients [67.6%] had moderate hypotension and 4 patients [10.8%] had severe hypotension. Hypertensive patients continuing their routine angiotensin system inhibitors therapy [<10 hr preoperative] have a variable risk of developing moderate hypotension within 30 minutes after induction. This moderate hypotension proved to be of little clinical significance as it responded to conventional therapy

Postdural puncture headache; comparison between lumbar puncture needle no 25 G and 27 G

To evaluate the role of needle diameter in causing postdural puncture headache [PDPH] in patients undergoing elective caesarian section. Comparative cross-sectional study. This study was conducted in Department of Anaesthesia and Intensive care PNS Shifa Karachi over duration of six months. It was a cross sectional study of 100 patients, which were divided into two separate groups. Group I and Group II were given spinal anaesthesia with 25 gauge and 27 gauge Quincke needles respectively. In both the groups the patients were randomly selected and were blind to size of the spinal needle used. The data was analyzed using Chi-square test. A P value of <0.05 was considered statistically significant. Two patients in 25-G group and one in 27-G group required additional general anaesthesia because of inadequate spinal anaesthesia. Thus, a total of three patients were excluded from the study. Five out of forty-eight patients in group 1 and one out of forty-nine patients in Group II suffered from post spinal headache. The proportion of patients with post spinal headache with 25 G needle is significantly more than those with 27 G

Comparison of median and paramedian techniques of spinal anaesthesia

To compare median and paramedian technique of spinal anaesthesia in terms of success rate, number of attempts, paresthesia, bloody tap and length of needle. Comparative cross-sectional study. Department of Anaesthesia and Intensive care PNS Shifa Karachi over duration of one year from March 2007 to Feb 2008. This was a comparative cross-sectional study and 100 patients undergoing spinal anaesthesia for lower abdominal and lower limb surgeries were included. Hundred patients were divided into two separate groups. Group I was given spinal anaesthesia with median approach and Group II was given spinal anaesthesia with paramedian approach. In both the groups the patients were divided using non probability convenience sampling and patients were blind to the choice of technique of spinal anaesthesia used, however consent was obtained from every patient to be included in study. The success rate of median approach was found to be 84%, with the first attempt success rate of 48%. Paresthesia was felt by 38% of patients and incidence of bloody tap was 6%. Length of needle required most of the time was between 4-6 cms. The success rate of paramedian approach was found to be 96%, with first attempt success rate of 70%. Paresthesia was felt by 20% of patients and incidence of bloody tap was 12%. Most of the time length of needle required was between 6-8 cms. Paramedian approach is associated with higher success rate with lesser number of attempts and decreased incidence of paresthesia

Awareness of viral hepatitis in ten villages of district nowshera

Viral hepatitis is a cause of great concerns the world over and more so in the developing countries like Pakistan. Its incidence has increased to alarming proportions and is likely to increase further in near future. This study was conducted to assess awareness of a rural community to Hepatitis B and C. A cross-sectional study was conducted from November 2007 to October 2008, in ten villages of District Nowshera. Questionnaire was designed to assess their knowledge about viral Hepatitis. Data was computed using SPSS version 10. A total of 3654 respondents were interviewed, 642 [17.6%] were aware that Hepatitis B and C were diseases of liver and transmitted by a virus. Respondents reported that there were multiple routes of transmission of this disease. Used syringes were the most common factor reported to be responsible for spread of this disease, followed by dental apparatus, injuries caused by nail cutters and sexual contact. One fifth [20%] of the respondents were unable to identify any physical sign or symptom of the disease. Television, Doctors and Radio appeared to be the most popular sources of information used for obtaining health information on these diseases this was reported by 43%.42% and 40% of the population respectively. Knowledge and awareness regarding the causative agent, mode of transmission and the consequences of Hepatitis B and C are poor in rural communities

Prevalence of obesity in men and its relationship with diet and physical activity

Obesity is one of the major nutritional problems in the world as well as in Pakistan. The objective of this study was to find out the prevalence of obesity in males in six socio-economically diverse areas of Peshawar, and its relationship to energy intake and physical activity. Three urban and three rural areas were selected from District Peshawar to cover the diverse socio-economic variation. One hundred households were randomly selected from all the 4 areas. Male participants who gave consent and were above 30 years of age were selected. A total of 600 participants fulfilled the selection criteria and were included in the study. Data was collected using structured questionnaire and anthropometric indices were calculated using standard tools for measuring height, weight and body mass index. The prevalence of obesity in our male participants was 7% and overweight 34%. The average energy intake in urban areas was 2593 +/- 465 Kcal/day and in rural areas 2433 +/- 425 Kcal/day. The calories consumed consisted of 50-56% of fats, 32-33% of carbohydrates and 11-12% of proteins. Participants who did less physical activity were three time more likely to have a high Body Mass Index, and those who consumed more calories were twice as likely to have higher BMI than those who did not. Multivariate logistic regression showed that high energy intake, living in urban areas and sedentary lifestyle is positively associated with obesity. The prevalence of obesity in males in our set up is 7% and overweight 34%. High energy intake, living in urban areas and sedentary lifestyles are positively associated with obesity

Frequency of vitamin A defficiency in children of age 6 months to 72 months at the out patient ophthalmology department of agency headquarter hospital Landikotal, Khyber agency

To determine the frequency of Vitamin A deficiency [VAD] and associated clinical features in children of age group 6 months to 72 months in order to plan comprehensive eye care program. It was a non-interventional, cross- sectional study based on 2373 children aged between 6 months to 72 months, attending the Eye OPD from 1 st April 2005 to 1 st April 2006. Xerophthalmia was diagnosed on the basis of ocular signs and symptoms set by WHO. Dietary intake of Vitamin A was assessed and correlation of vitamin A deficiency with various risk factors was evaluated. Out of 2373 children, 94 [4%] children were suffering from VAD. Out of 94 children, 37 [39.4%] had Bitot spots, 27 [28.7%] had signs of corneal Xerosis/ Ulceration/ Keratomalacia while 24/94 [25.5%] had a history of night blindness. Thirty one [33%] children belonged to age group 61-72 months. Diarrhoea was the most frequent illness in 33[35%]. Most of the children [80/94; 85%] belonged to poor socio economic class. Vitamin A deficiency is not uncommon in children attending eye OPD. Most of them had already developed corneal involvement. Majority are under the age of 3 years; belonging to poor families, with poor dietary intake of vitamin A and with history of preceding illnesses like diarrhea etc. Community based studies are needed to assess the real burden of VAD and to plan for the major preventive strategies

Risk factors of ischemic heart diseases in Peshawar

To highlight various predictive, relative and contributory risk factors in the causation of ischemic heart diseases. A retrospective study was conducted in which about 150 diagnosed cases were studied in rural population at Budhney, Peshawar between April 1997 and July 1998. The patients were interviewed for specific period, filling the questionnaires prepared for this purpose. The questions included in the proforma were mostly about the educational status, economical background, personal and environmental life style, frequency of consumption of vital foods, fresh fruits and vegetables, family history of ischemic heart diseases, exercise entertainments, social set up and tense and serious moods. The survey comprised of about 78 males and 72 females respondents. 36% of the respondents were between the age of 30 - 40 years. 63% of the total cases were above the age of 40 years. 65% males and 72% females were totally illiterate and hence devoid of all knowledge of preventive aspect of cardiovascular disorder. 84% of the respondents belonged to upper social class and that is why most of them had to pay for their life style in the form of crippled manpower and economical loss. A positive history of hypertension and chronic smoking was noted in 13% and 4% cases respectively. The investigative profile revealed a raised blood cholesterol level and fasting sugar level in 10% and 5% of the respondents respectively. The survey unveiled a chain of multifactor causation, which is not usually taken into account in our cultural setup like excessive consumption of fatty food, Type A personality, sedentary life style, lack of regular exercise and competitive stressful and ambitious life conditions

Bacteriological analysis of drinking water from urban and peri-Urban areas of Peshawar

Objective: to determine bacterial loads and contaminants in drinking water in and around Peshawar as to form water quality guidelines for judgement of the acceptability of public drinking water supplies

Material and Methods: a total of 224 water samples in an around Peshawar were assessed for bacteriological contamination

Results: ninety-two [81%] untreated and forty-two [19%] treated water samples were positive for coliforms. Faecal colifoms and faecal Streptococci were found in 52 and 12 numbers of samples respectively, indicating contamination of faecal origin, and inadequate treatment of water supplies. Escherichia coli was found in 43.28% of the samples, which is substantial indicator of faecal pollution

Conclusion: it is desirable to disinfect all supplies of drinking water before distribution and consumption in view of its great public health significance

Acute poisoning due to commercial pesticides in Multan

To assess various mode of acute poisoning due to pesticides with respect to period of time, gender and age. Indoor patients poisoned by pesticide during 1996 - 2000. Pesticide Poisoning Centre and ALMONAR Section, Nishtar Hospital, Multan. Age and gender factors, mode of incidences and mortality rates. Out of 578 poisoned patients, 370 were pesticides victims [73% males and 27% females]. Suicidal, occupational and accidental incidences were 53%, 23% and 24% respectively. A total of 54 deaths [34 males and 20 females] with cumulative death rate of about 15% was observed. About 81% of the victims were in the age range of 14-30 years. Pesticides are the major chemical agents which pose a health threat, particularly to young people, depressed females and farm workers, in Multan