Topical application of tocopherol with corticosteroid in reducing the early signs and symptoms of oral submucous fibrosis patients

Objective: The aim of this study was to compare the topical application of steroid alone or with combination use of steroid and tocopherol in reducing oral mucositis in Oral Submucous Fibrosis [OSMF], patients

Methods: In Pakistani population a rapidly advancing premalignant condition, Oral submucous fibrosis [OSMF] is present which has deteriorated the quality of life. The study was conducted in Department of Oral Medicine and Diagnosis, College of Dentistry, Ziauddin University Karachi, from December 2013 till July 2015. Randomly selected 76 patients with diagnosed OSMF, with history of chewing areca/betal nut or other similar products, with burning sensation on having spicy ingredient, trismus >20mm with or without palpable fibrous bands on the buccal mucosa intraorally with rigidity and blanching were included in the study. Total 38 out of 76 patients were given a combination of topical tocopherol application100mg and betamethasone [betonil 0.1%] twice daily and remaining 38 were on topical rinse of betamethasone [betonil 0.1%] alone. OSMF patients were clinically examined to assess the mouth opening and other clinical symptoms during three months and were followed up for next two months

Results: In the amelioration of early signs and symptoms of OSMF topical tocopherol combination with steroid application was found to be significantly efficacious. Objective signs of OSMF were reduced with improved mouth opening in 69.56% [p<0.05] of the cases

Conclusion: This study has shown that tocopherol, appears to be an effective drug in treating the early signs of OSMF

Oral submucous fibrosis: successful management of fifty cases with interpositioning buccal Fat Pad Flap

Objective: The aim of this study was to evaluate the clinical and anatomical application of buccal fat pad as an interpositional material in the surgical treatment of oral submucous fibrosis [OSMF] for improvement of mouth opening and its movements

Methods: OSMF has become a chronic, distressing condition of uncertain aetiology in Pakistan which rapidly involves the oral structures along with other parts of upper gastrointestinal tract

The study was conducted in Department of Oral and Maxillofacial Surgery, Ziauddin College of Dentistry, Ziauddin University, Karachi, from December 2013 till July 2015. We evaluated 50 diagnosed OSMF patients, with history of chewing areca/betal nut or other similar products, with burning sensation on having spicy ingredient, trismus 4-25mm with palpable fibrous bands on the buccal mucosa intraorally with rigidity and blanching were included in the study. Good clinical improvement with minimal morbidity by the use of buccal fat pad was noticed in patients with severe limited mouth opening along with regular and vigorous physiotherapy

Results: In 50 patients, the range of preoperative mouth opening was 4-24mm [14 +/- 4.90], the intra operative mouth opening was 25-38mm [33.25 +/- 4.17]. The patients were discharged after 72 hours at this time mouth opening was 25-36mm [0.63 +/- 3.82]

Comparison of pre-operative with intra and post-operative mouth opening was statistically significant

Conclusion: This study has shown that use of interpositioning buccal fat pad flap improves the mouth opening and movement in OSMF patients

Experience with wide and narrow caliber percutaneous radiologically guided gastrostomy tubes

Objective: To compare the percutaneous radiologically guided gastrostomy [PeRG] tubes of wide caliber with narrow caliber tubes

Methodology: This retrospective study was performed on 36 patients who were referred to Radiology department for PeRG tube placement between 2008 till 2012. Comparison of wide caliber gastrostomy tubes [18-24 Fr] was done with narrow caliber tubes [14 Fr] considering procedure success rate, procedure related complications and catheter related minor and major complications

Results: Out of 36 patients, 18 patients were present in each group. Mean age of patients was 53.944 +/- 19.380. Procedure success rate was 100% in both groups and procedure related immediate complications were none in either groups. Peri-catheter leakage was observed in 1 patient in each group. Tube occlusion was present in 2 patients in narrow caliber group. Two patients had severe pain in wide caliber group and also 3 patients had wound infection in this group

Conclusion: Regardless of the type of radiologic catheter placed, PeRG can be considered as safe and highly successful procedure. Use of a 24 Fr gastrostomy tubes may show promising results if placed under radiological guidance with comparable technical success and complication rates to other caliber tubes

Does gauge of needle effects causation of pneumothorax following ultrasound guided thoracentesis?

Objective: to determine the frequency of pneumothorax following ultrasound guided thoracentesis in our department and its association with gauge of needle in causation of pneumothorax

Methadology: this is descriptive cross sectional study conducted at the Department of Diagnostic and Interventional Radiology, Shifa International Hospital [SIH], Islamabad from January 2010 to April, 2012. A total of 359 ultrasound guided thoracentesis were performed followed by a chest radiograph between January 2010 and April, 2012 fulfilling the inclusion criteria. All procedures were performed by radiology consultants and residents. Generally 18 and 16 G cannulas were used. A few were done with 16 and 18 G spinal needle and 21G syringe needle. Relevant data was collected from hospital data base system on the performa and was analyzed for demographic variables, frequency of pneumothorax, and its association with operator's experience [residents or consultants] and gauge of needle by applying chi square test. P value of < 0.05 was considered significant

Results: 309 patients had thoracocentesis while performed by residents and 50 by consultants. Pneumothorax occurred in 22 of these 359 cases with an overall frequency of 6%. In 219 patients 18 G cannula was used and 8 of these developed pneumothorax [3.6%]. In 94 patients 16 G cannula was used. Pneumothorax occurred in 11 [11.6%]. Statistical analysis confirmed that the frequency of pneumothorax was significantly increased following use of 16G as compared to 18G [p=0.02]

Conclusion: the frequency of pneumothorax following ultrasound guided thoracentesis increases significantly with use of 16G as compared to 18G [p=0.02]

Role of non coaxial bone marrow biopsy needle and bone biopsy needle in CT guided core needle biopsies

Objective: to compare bone marrow biopsy needle [BMBN] with bone biopsy needle [BBN] in CT guided core biopsies considering size of core, diagnostic yield and cost of needles

Methodology: retrospective study was done on 50 out of 68 patients referred to Interventional Radiology department for CT guided bone biopsy from 2008 till 2013. Grading of specimen length was done as small, medium and large. Diagnostic yield was determined on basis of clinical, imaging and histopathology data. Local cost of both needle types was determined. Comparison was made and statistical analysis was performed

Results: biopsy was performed by BBN in 16 patients and by BMBN in 34 patients. Overall diagnostic yield of bone biopsies was 82% [41 of 50 biopsies]. Diagnostic yield with BMBN was 85% and with BBN was 75%. Overall longer specimen length was obtained using BMBN. Statistically, there was no significant difference between them in diagnostic yield and specimen length; however, BMBN costs almost one half than BBN

Conclusion: diagnostic yield and sample length using bone marrow biopsy needle proved to be equivalent to bone biopsy needle. Bone marrow biopsy needle has an added benefit of being low in cost. Despite being a non-coaxial technique these needles can achieve diagnostic yield comparable to that of coaxial techniques as reported in past literature

Pattern of bacteraemia after non-surgical extraction of tooth

Objective: The objective of this study was to assess the pattern of bacteraemia after non surgical extraction of teeth. Methods: This prospective descriptive study was conducted at an out-patient setting at Karachi Medical and Dental College, Dental Hospital Karachi, over a period of six months [January 2007 to June 2007] on fifty patients. A pre designed performa was used to collect the relevant information from the patients. All cases of bacteremia [diagnosed on culture media] after non-surgical extraction of tooth/ teeth were included in the study. Total seven culture samples were taken from each patient pre and post extraction. Results: Thirty-four [68%] patients were male and sixteen [32%] were female. Mean age of patients was 32.14 +/- 11 years. The commonest reason for tooth extraction was dental caries. The preextraction intravenous blood culture was negative in all fifty patients. The post extraction intravenous culture after one minute was negative in 60% of patients, after five minutes it was negative in 18% of patients. After fifteen minutes post extraction, 99% of blood cultures were positive for bacterial growth, while 56% of blood cultures were negative for any bacterial growth after thirty minutes. Peptostreptococci and Streptococcus viridians species were the commonest bacterial isolates. Conclusion: Highest level of bacteraemia occurred after fifteen minutes of non-surgical tooth extraction. Peptostreptococci and Streptococcus species were found to be the commonest isolates

Socioeconomic status and smokeless tobacco consumption in fishermen community of a coastal area of Karachi

Objective: The aim of this study was to assess the frequency of Gutka consumption and its relationship with socioeconomic status among fisherman community of Costal area of Karachi. Methods: Socioeconomic status and information about Gutka habit was collected from 408 fisherman of Ibrahim Hyderi, a coastal area of Karachi from 15th July 2014 to 21st July 2014.The Kuppuswamy scale was used to measure socioeconomic status [SES]. A subject was considered to be belonging to higher socioeconomic status if the family head's education and the number of earning members were higher and the number of children and dependents was less since childhood in his or her household. Single investigator carried out structured face-to-face interview. Convenient sampling technique was used. Results: Out of 408 subjects, 326 regularly consumed Gutka, the common reasons for the habit were the co-workers' influence and to keep awake at work. The prevalence of the Gutka chewing habit was much lesser [25%] among the people belonging to higher social class when compared to the minimal or no improvement group [75%]. A majority of those free from the habit [73.7%] were belonging to the group, which showed improved educational attainment. Among those with good social status, the percentage of workers with high frequency of Gutka chewing and those with a longer duration of the Gutka chewing habit was low when compared to the lower social class group. Conclusion: This study based on data collected by questioner and analyzed on SPSS version 17.It is recommended that intervention in the form of primary and secondary smokeless tobacco use, prevention with association and careful planning including restricted resources available to be implemented efficiently