Long term outcome of schizophrenia - a cross-sectional study

Objective: To assess the Positive and Negative Symptoms Scale pattern and World Health Organization Quality of Life-BREF scale scores of patients with schizophrenia after seven years of the initial diagnosis

Study Design: A cross sectional observational study

Place and Duration of Study: Department of Psychiatry, Military Hospital Rawalpindi from Jan 2007 to Dec 2008

Material and Methods: Thirty patients who were invalided out of military service with the diagnosis of schizophrenia in 2000 and 2001 were subjected to psychometric evaluation seven years after the initial diagnosis in 2007 and 2008. They were assessed for their current symptoms and Quality of life using Positive and Negative Symptoms Scale [PANSS] and World Health Organization Quality of Life [WHOQoL-BREF] scale respectively. Both are established psychometric tools to assess the entire spectrum of schizophrenia and quality of life

Result: All patients were males. Forty three percent of the subjects had Positive and Negative Symptoms Scale [PANSS] score i.e. below cut off value of 65. Mean PANSS score of the group was 72. A score of more than 12 on World Health Organization Quality of Life-BREF [WHOQoL-BREF] scale indicating better quality of life was seen in 43 % of the patients. Factors linked with PANSS score > 65 and poor Quality of life [Qol score 4-12] were being single, unemployed, living in cities, using psychoactive substances and in initial years of military service

Conclusion: More than half of the patients with diagnosis of schizophrenia continue to show high Positive and Negative Symptoms Scale [PANSS] score and poor quality of life after seven years of initial diagnosis of schizophrenia

Periodontal health and oral hygiene status during the second trimester and its effects on pregnancy outcomes - preterm and low birth weight

Periodontal disease is one of the most prevalent chronic diseases known to mankind. Recently there have been studies that suggest a possible inter-relationship between periodontal disease and systemic diseases including, cardiovascular disease, diabetes, and adverse pregnancy outcomes including pre-term and low birth weight deliveries. However, most of these studies are carried out in the western part of the world and the results may not be directly applicable to the population in Pakistan. This research is an exploratory study that aims to find the relationship between periodontal disease and adverse pregnancy outcomes including preterm and low-birth weight in Pakistani population. The periodontal status in forty-five medically healthy pregnant females aged less than 35 years during the second trimester of pregnancy were assessed. A detailed periodontal examination, including plaque score, bleeding score, probing pocket depth and clinical attachment loss were recorded. Postpartum data was collected and the outcomes were recorded as pre-term [<32 weeks of gestation], term [on or >37 weeks], post term [>40 weeks] and low birth weight [< 2.5 kg]. Pregnant females in the second trimester had an average plaque score of 84% [95% C.I. 51.1-87], average bleeding on probing score of 66.3% [95% C.I= 60.4-72.2], and average clinical attachment loss of 2.5 mm [95% C.I= 2.35-2.6]. Thirty-four participants delivered on or term [>37 weeks] and 8 participants delivered pre-term [<32 weeks of gestation]. Only one patient delivered post term [>40 weeks]. This exploratory study highlights that the oral hygiene and periodontal status of these female patients in the second trimester of pregnancy is poor. These patients had high plaque scores, marked gingival inflammation as evidenced by high gingival bleeding score, and were diagnosed with mild generalized periodontitis. None of the periodontal variables had a significant correlation with pre-term or post-term pregnancy outcomes [p>0.05]

Global assessment of functioning of patients with schizophrenia a cross-sectional study

To assess psychological, social and occupational functioning of patients after seven years of diagnosis of schizophrenia using Global Assessment of Functioning [GAF] scale [DSM-IV Axis-V]. A cross sectional study. Department of Psychiatry, Military Hospital Rawalpindi from October 2007 to October 2008. This study included 30 patients who were retired military personnel invalided out of service with diagnosis of Schizophrenia between 1[st] Jan 2000 to 31[st] Dec 2001. After recording demographic data, patients underwent psychometric evaluation seven years after the diagnosis in 2007 and 2008 respectively for assessment of their psychological, social and occupational functioning using Global Assessment of Functioning [GAF] Scale [DSM - IV Axis V]. All subjects were male. Majority of the patients i.e. 14 [46.7%] patients had mild to moderate symptoms of the disease [GAF score 41 - 80]. Those having high income, employed and living in cities were associated with better global functioning. Schizophrenia continues to be a chronic disabling severe mental illness with deterioration in all aspects of functioning of patients

Frequency of cerebral infarction and haemorrhage in the patients of stroke

Stroke is rapidly developing phenomena of symptoms and signs of focal, and at times global, loss of cerebral function with no apparent cause other than that of vascular origin. The Objective was to know the frequency of cerebral infarction and haemorrhage in one hundred patients of stroke in a period of one year. Data was collected by consecutive sampling technique. Total one hundred patients of stroke were collected for the study. They were assessed through a detailed history of hypertension, diabetes mellitus, smoking, previous stroke, transient ischemic attack [TIA], previous myocardial infarction, angina, atrial fibrillation, alcohol intake, drugs used for hypertension/diabetes mellitus. Blood pressure was recorded at arrival and 24 hours after admission. There were 70% males and 30% females. Twenty percent of the patients were in the age range of 51-60 years, 26% of the patients were in the age range of 61-70 years and 18% were in the age range of 71-80 years. Cerebral infarction was present in 72% patients while cerebral haemorrhage was present in 28% patients. Hypertension was the most common risk factor among these stroke patients. Average blood pressure was 180/100 mmHg. Cerebral infarction is the commonest form of stroke. Hypertension is the leading risk factor in stroke patients

Dentists perceptions about practices, undergraduate training and training needs of local anesthesia

The objective of this study was to assess dentists perceptions about safety and efficacy of their practices; their undergraduate training; and training requirements about local anesthesia [LA]. A prospective, questionnaire-based survey of 181 dentists from Lahore and Karachi was carried out. The questionnaire was designed to collect information about general dentists perceptions about their salient local anesthesia practices, the level of training provided to them at under-graduate level and the training needs at different levels of professional careers. Sixty eight percent of the participants did not aspirate during inferior alveolar nerve block LA injections. Training in important LA nerve block injections was not provided to the majority of participants at the undergraduate level. Most of the participants felt that improvement in training of LA at under-graduate, post-graduate and continuing professional development levels were needed. Serious shortcomings in the practice and training of safe and effective LA were noticed in this survey. In accordance with the need felt by the survey participants for improved teaching and training of LA, the curriculum for local anesthesia training should be revised and implemented

Diagnosis of temporomandibular disorders based on research diagnostic criteria

The Research diagnostic criteria for Temporomandibular Disorders [RDC/TMD] is a tool used by International RDC/TMD Consortium [A Designated Network of the International Association for Dental Research], to diagnose and categorize TMD patients. The aim of the present study was to investigate the frequency of TMD in undergraduate dental and medical students based on RDC/TMD; and its relation with depression and somatization. 37 male and 48 female dental and medical students from FMH College of Medicine and Dentistry, Lahore, Pakistan were evaluated. A clinical physical diagnosis [Axis I] and pain related disability and psychological status [Axis II] were assessed using a questionnaire and clinical examination on RDC/TMD protocol. Seventeen students diagnosed with TMD showed significantly higher incidence in females [p=0.003]. Maximum number of TMD was in internal derangement group, followed by pathosis and muscle disorder groups. Significantly higher TMD incidence was noted in; participants [p = 0.00, Likelihood ratio = 10.80] with Axis II than those without Axis II. Significant TMD participants showed somatization than those without TMD [p = 0.000, Likelihood ratio = 12.04]. A comparatively lower incidence of TMD in young adults, with much higher prevalence in females was found. Disc displacement was the commonest Axis I diagnosis. TMD patients showed greater RDC/TMD Axis II

Frequency of rectal varices in patients with cirrhosis

To document the frequency of rectal varices in patients with cirrhosis of liver and compare it with that of oesophageal varices in liver and to compare the frequency of rectal varices with non-cirrhotic controls. Design: A cross-sectional analytical survey. Place and Duration of Study: The study was conducted in the medical wards of Civil Hospital, Karachi from August 2000 to July 2001. Patients and All patients of confirmed cirrhosis of liver, presenting during the study period, were selected for initial workup. On the basis of upper gastrointestinal [GI] endoscopy, patients were segregated into those with oesophageal varices [Group-A] and those without them [Group-B]. A matched control group [Group-C] was added, which consisted of patients of irritable bowel syndrome [IBS] who underwent sigmoidoscopic/colonoscopic examination during the study period. Fiberoptic sigmoidoscopy was done in all selected patients. Statistical analysis for continuous variables was done by student's 't' test while non-continuous variables were analyzed by Mann-Whitney-U test. A total of 104 patients [males 61; females 43] were included. Hepatic encephalopathy grade was significantly lower in Group-B [p < 0.0001]. Grade-I varices were seen in 13 patients, Grade-II in 38 and Grade-III in 33 patients of Group-A. Rectal varices were present in 59.9% of patients in Group-A as compared to Group-B in which no one had them [p<0.0001]. Rectal varices are common in patients of portal hypertention

open evaluation of fluconazole as a single dose oral treatment for vaginal infections with candida

The clinical and mycological efficacy of single-dose oral treatment with Fluconazole 150mg was evaluated in 29 patients with vaginal candidiasis confirmed by microscopic and culture examination. Clinical and mycological evaluations were done at 5-9 days after treatment and again at 4-6 weeks after treatment. Fluconazole produced rapid relief of signs and symptoms [erythema, excoriation, erosion, discharge, pruritis and burning/irritation] and this relief persisted in 80 to 90% of patients 4-6 weeks after treatment. At 5-9 days post treatment, 93% of patients were clinically cured or improved while 76% of patients were mycologically cured. At long term follow-up visit 4-6 weeks after treatment, 100% of patients were found clinically cured or improved while 97% were determined candida-free on microscopic/culture examination. Overall therapeutic response [combining clinical and mycological response to treatment] at the end of the study was rated excellent or good in 93% of the patients. Toleration of the drug was exceptional as no side effect was reported by the patients during the study. Results of this study suggest that fluconazolc as a single dose oral treatment is effective in providing both short-term and long-term control of vaginal candidiasis clinically as well as mycologically, with no problem of toleration