Prevalence of different types of temporomandibular disorders seen at armed forces institute of dentistry

The temporomandibular joint [TMJ] is a synovial joint that connects the mandible to the skull. Each joint is composed of condyle of the mandible, an articulating disc and an articular fossa of the temporal bone. Temporomandibular joint disorders [TMD's] are characterized by decreased mandibular range of movements, inadequate mouth opening and TMJ sounds such as click, pop, crepitations. TMD's can be classified as masticatory muscle disorders, Temporomandibular joint disorders, chronic mandibular hypomobility disorders and growth disorders. This cross sectional study was carried out in the Prosthodontics department at Armed Forces Institute of Dentistry, Rawalpindi. A total of 140 subjects were evaluated both clinically and radiographically to estimate the prevalence of symptoms of TMDs as a function of age and gender. The most common disorder in the age frame, less than 20 years was found to be disc dislocation with reduction, while disc displacement was the most common disorder in older age groups. Inferior head of lateral pterygoid muscle was most commonly found to be involved in 88.6% individuals, followed by Medial pterygoid muscle that was tender in 82.9% individuals

Medication errors and strategies for their prevention

Medication errors occur every day causing injury to the patients and even deaths. The health care professionals are not fully aware of the damages done by medication errors in terms of patients' discomfort and economic burden. There is a need to provide information about medication errors to health care providers. This article reviews research done on the various aspects of medication errors. The research work done on prescribing errors, transcribing errors, dispensing errors, administration errors and discharged summaries errors have been examined. Eight strategies to reduce the occurrence of medication errors have been reviewed: [1] Electronic prescribing and computerized physician order entry [CPOE] with clinical decision support systems [CDSSs], [2] Bar Code, [3] Interventions to reduce medication errors, [4] Medication Error Reporting Systems [MERSs], [5] Alerts about medication errors, [6] Prevention of harm from high-alert drugs, [7] Smart Infusion Pumps and [8] Telemedicine or Telehealth or Telepharmacy. Statistical tests used in medication error studies have also been stated

Frequency of ICD-10 psychiatric diagnosis in children with intellectual disability in Lahore, Pakistan and caregivers perspective

Association between Intellectual disability [ID] and psychiatric disorders in children and adolescents is well established but there is a paucity of published studies from Pakistan on this topic. The main aim of the study was to assess the frequency of ICD-10 psychiatric diagnosis in the hospital outpatient sample of children with ID in Lahore, Pakistan as well as to find out which challenging behaviors, caregivers find difficult to manage in this setup. Socio-demographic information was collected, Wechsler Intelligence Scale for Children-Revised and ICD-10 diagnostic criteria was used to assess children [age range 6–16 years] with suspected ID along with identification of behaviors found to be difficult to manage by caregivers. 150 children were assessed with mean age of 10.7 years [males 70%]. Majority [72%] had mild ID while 18.7% and 9.3% had moderate and severe ID respectively. Thirty percent of children met the criteria for any psychiatric diagnosis, the most common being Oppositional Defiant Disorder [14%] and Hyperkinetic Disorders [10%]. Verbal and physical aggression, school difficulties, socialization problems, inappropriate behaviors [e.g. disinhibition], sleep and feeding difficulties were the significant areas identified by the caregivers as a cause of major concern. Significantly high prevalence of ICD-10 psychiatric diagnosis in children with ID was found in Lahore, Pakistan. Support services for these children should be responsive not only to the needs of the child, but also to the needs of the family

Acute anal fissure; effect of topical glyceryl trinitrate [GTN] on its management

To evaluate the role of topical glyceryl trinitrate [0.2% GTN] on the clinical features of acute anal fissure. A prospective, open label therapeutic trial was carried out at Combined Military Hospital, Kharian Cantonment during one calendar year. All adult males and females presenting with acute anal fissure were included. Patients with chronic anal fissure, associated pathology [hemorrhoids, fistula in ano], age < 15 years, previous surgery of anal canal were excluded. The diagnosis was based upon history and physical examination. A detailed history was taken regarding their symptoms like painful defecation, bleeding per rectum, constipation and itching. Then the patients were examined to look for anal fissure, associated mucus discharge and sphincter tone and recorded in the proforma. 0.2% topical GTN ointment was prescribed twice daily for local application in the anal canal with the help of cotton pledget on a stick [soaked completely in ointment]. The duration of treatment was four weeks and their symptomatology and healing of anal fissure was assessed weekly. A total of 40 patients were treated in this study. Age varied between 22 - 51 years. 36 patients [90%] were male while only 4 patients [10%] were females. Painful defecation [100%], bleeding PR [87.5%] constipation [50%], and itching [40%] were the main complaints. Posterior fissure was seen in 85%, anterior fissure in 12.5%, while both anterior and posterior fissures were seen in 2.5% of patients. Out of 40 patients 21 had complete healing of anal fissure while 03 patients recovered partially. Thus the healing rate was 60%. Topical glyceryl trinitrate is an effective treatment modality for acute anal fissure

Stridor in afebrile children

To enlist the causes of stridor in afebrile children under twelve years of age. Design: Descriptive study. Carried out in ENT Dept CMH Rwp from Sep 2001 to Feb 2003. Fifty children presenting for the first time with symptoms of stridor were selected according to the inclusion criteria by non-probability purposive sampling. Every patient was evaluated by detailed history, thorough physical examination and investigations including radiographic studies, laryngoscopy and bronchoscopy. Data was recorded on the performa attached as Annex 'A'. Of the 50 patients, there were 29 males and 21 females. The mean age at presentation was 3.8 years. About forty-eight diagnostic observations were made during the initial endoscopic procedure on these 50 children. Acquired lesions [76%] outnumbered the congenital lesions [24%]. Of the congenital type, laryngomalacia [42%] was the commonest cause followed by vocal cord paralysis [17%], laryngocele [17%], laryngeal web [8%], tracheomalacia [8%] and tracheal stenosis [8%]. The most important acquired lesion was foreign body in the Aerodigestive tract [55.26%], followed by respiratory papilomatosis [21.05%], traumatic [13.16%] and subglottic stenosis [10.13%] Because of chronic and presistent upper airway obstruction, tracheostomy was electively performed in 02 cases in this series. There was no complication associated with complete endoscopic examination Foreign body in the tracheobronchial tree is the most frequent cause of stridor in afebrile children followed by congenital conditions and recurrent respiratory papillomatosis

Allergens in allergic rhinitis

Allergic rhinitis disrupts the quality of life of a large segment of our population. Mostly it effects young individuals and can lead to considerable morbidity and complications. There were two main objectives of the study. To find out the allergens responsible for causing allergic rhinitis in the Armed forces personnel and their families residing in Rawalpindi and Islamabad. To determine the rate of positivity of the skin prick test in these selected patients. The study was carried on 200 cases in ENT department CMH Rawalpindi during March 2001 to March 2003. Patients were selected irrespective of sex, between the age brackets of 12-60 years. Patients presented with clinical features of allergic rhinitis were clinically examined and then skin prick test were carried out in AFIP Rawalpindi to find out the causative allergens. Common allergens on skin prick test were found to be house dust [72.6%], house dust mites [64%], mixed pollens [59.5%], grass pollens [46%], paper mulberry [21.5%], cannabis [13.5%] and moulds [20%]. The rate of positivity of skin prick test was found to be 88% among the selected patients of allergic rhinitis. It is concluded that determination of causative allergens form the cornerstone in the management of allergic rhinitis. Based on these findings a patient can take preventive measures against the causative allergens and a physician can diagnose and treat the patients in a better way

Spectrum of common childhood skin disease: a single centre experience

To assess the pattern of childhood skin diseases and to analyze the attitude towards consultation and self-treatment. Children with complaints of skin diseases visiting outpatient department of Jinnah Postgraduate Medical Centre and National Institute of Child Health were enrolled in this study during the period of May 2002 to July 2003. A detail performa was filled in, for all the patients. 250 cases were finally analyzed in 15 months duration. The diseases were sub-classified on etiological basis e.g. infectious [bacterial, fungal, viral, parasitic] immune mediated, congenital, allergic and miscellaneous. The children's sex, race, age, duration, history of previous treatment and family and past history for skin or systemic diseases were noted. Of all the patients visiting the outpatient department [OPD], 31% were children with skin diseases. Infectious skin diseases were the commonest [60%]. Among the infections, fungal were maximum [20.6%], followed by bacterial diseases [12%]. Eczemas constituted 21% of skin diseases and 6.4% children had congenital skin conditions. Previous treatment history was present in 43.6% patients. Antibiotics [topical and/or systemic] were taken by 28.4% of patients; whereas history of steroids [topical and/or systemic] was present in 15.2% of patients. Most children [550] had a normal weight and 13.6% were severely malnourished. Skin diseases are fairly common in children especially infectious skin diseases. Eczematous and allergic skin diseases are also frequently encountered in children. Self medication is a common practice. Topical steroids were the most commonly used medications

Role of calcium and frusemide in aminoglycoside nephrotoxicity

Fourty two, adult, male, albino rats were used to study the nephrotoxicity due to gentamicin and amikacin, and the role of calcium and frusemide. Calcium ameliorated while frusemide further accentuated nephrotoxicity of aminoglycosides

Cadmium induced nephrotoxicity

Humans are exposed to Cadmium through environmental pollution, industries, food contamination and cigarette smoking and is a sort of cumulative poison especially in kidneys, where it is nephrotoxic. Calcium has been reported to modify cadmium binding to its proximal brush border membrane receptors. In this study, adult spraguedawly rats were fed identical diet, treated with cadmium 1.0 mg, 0.5mg and O. lmg/Kg body weight twice a day for tweleve weeks. Other groups were treated similarly with cadmium and calcium carbonate orally. There was severe renal parenchymal damage in cadmium treated groups than the groups which received both cadmium and calcium carbonate orally

Chemistry of the medicinal plants of the genus trianthema [family ficoidaceae]

The genus Trianthema belonging to the family Ficoidaceae includes Trianthema portulacastrum, T. triquetra, T. pentandra, T. govinda, T. monogyna and T. decandra as important species, which are weeds and shrubs of the tropical region. This manuscript reviews the chemical constituents like hydrocarbons, proteins, amino acids, glycosides, alkaloids, oxalic/fatty acids, of these plants. It also describes the medicinal aspects of these shrubs as well