Left atrial to left ventricular end diastolic diameter ratio in left ventricular diastolic dysfunction

Background: Diastolic dysfunction [DD] is difficult to diagnose and characterize despite many techniques. It is known that left atrial diameter [LAD] increases and left ventricular internal end diastolic diameter [LVIDD] remains the same in moderate to severe diastolic dysfunction [grade II and above] but a ratio between these two [LAD/LVIDD] has never been used to assess diastolic dysfunction. This study aims to analyze the relationship between the ratio, left atrial diameter/ left ventricular internal end diastolic diameter [LAD/LVIDD] and diastolic dysfunction [grade II and above]. This study also aims to give a statistical model based upon this relationship that is able to help in diagnosing diastolic dysfunction

Methods: This case control analytical study was carried out at the Department of Cardiology, Holy Family Hospital, Rawalpindi, from Jan 2014 to Jan 2016. On the basis of echocardiographic findings, 226 patients were identified as normal healthy control group whereas 226 patients were identified as having diastolic dysfunction of grade II and above and were categorised as disease group. Doppler diastolic function parameters were used to assess diastolic function in all of these 452 patients. Appropriate statistical methods were then applied on the data by using IBM statistical package for social sciences [SPSS]

Results: LAD/LVIDD was correlated to diastolic dysfunction at r=0.858 [p<0.01]. A binary logistic regression model using age, sex and LAD/LVIDD gave an accuracy of 96.9% in diagnosing diastolic dysfunction. LAD/LVIDD in the model had an odds ratio of 2.678?1024. A Receiver Operation Characteristic curve between diastolic dysfunction and LAD/LVIDD yielded a specificity of 93.8% and sensitivity of 99.1% at the cut-off value of 0.7268

Conclusion: A new parameter, left atrial diameter [LAD] to left ventricular internal end diastolic diameter [LVIDD] ratio [LAD/LVIDD], is significantly correlated to diastolic dysfunction [grade II and above]. It is also a significant predictor for diastolic dysfunction

Effect of variations in buccal bone thickness, implant diameter and thread pitch on stress distributions upon implant placements at high insertion torques: a three-dimensional finite element analysis

The objective of this study was to investigative the influence of high insertion torques on the stress distribution around dental implants with variations in thread pitch and reductions in buccal cortical bone thickness. Two bone level dental implants [3.8mm and 5.0mm diameters and a standard length of 10mm] were modeled each having a thread pitch of 0.4mm and 0.65mm. Each implant was placed in two mandibular bone segments having buccal cortical bone thickness set at 2.0mm and 1.5mm. A total of 8 such models were created and discretized with hexahedral mesh elements with an average element size of 0.2mm. Implant-bone interface was simulated with non-linear contacts and friction. Static torque values from 50Ncm to 90Ncm were applied with an increment of 5Ncm on each fully inserted implant. Maximum von-Mises along with maximum frictional stresses were used to record stress distribution within each model. Maximum stresses seem to follow a linear relation with insertion torque showing an over-all increase in stress magnitudes with 1] a reduction in the diameter of the implants 2] decrease in thickness of the buccal cortical bone and 3] decrease in pitch of the dental implant threads from 0.65mm to 0.4mm. The maximum stress of 171.4 MPa was recorded at 90 Ncm for the 3.8mm diameter implant adjacent to a buccal bone thickness of 1mm with a thread pitch of 0.4mm. With an increase in insertion torque there is a corresponding increase in the magnitude of stress production. Maximum stresses are primarily distributed in the peri-implant region in particularly the buccal cortical bony plates. The use of profile drills to coronally flare the osteotomy especially in dense bone is highly recommended if the diameter of the final widening drills to place progressively tapered implants is narrower as compared to the diameter of the implants at the neck

Mother's awareness and practices regarding home management of childhood diarrhea in a squatter settlement of Karachi

Background: Diarrhea is cited as one of the main causes of death for infants and children, especially in squatter settlements, owing to poor sanitary conditions. Treatment and prevention of diarrhea can be managed at home by primary caregivers. It is therefore important for mothers and primary care givers to be aware of strategies for management and treatment of diarrhea

Objective: To assess the awareness of mothers regarding home management of childhood diarrhea in a squatter settlement of Karachi

Methods: A cross sectional study was conducted from 2012 to 2013 among mothers from Gulshan-eSikanderabad of Karachi who had at least one child under age of 5 years. In total 110 mothers were interviewed. Non probability convenience sampling technique was used. Data was collected by structured questionnaire filled via personal interview. Informed consent was obtained before collection of data. Data Analysis was done by using SPSS version 20

Results: Out of total 110, 93 [84.5%] mothers said that their children had an episode of childhood diarrhea during last 3 months. For the management of diarrhea 91 [82.7%] mothers took their children to PHC centre and 99 [89.9%] mothers were aware about ORS. Almost two third of them aware about the ingredients of homemade ORS but their knowledge about correct amount was poor. Dirty water and food was identified as the important causes of diarrhea by 106 [96%] and 76 [69%] mothers respectively. According to 101 [91.8%] mothers hand washing would be an effective measure to prevent diarrhea

Conclusion: Despite the high rate of diarrhea in this community, knowledge of mothers regarding home management of diarrhea was found satisfactory. Adopting the preventive measures and intensifying the mothers education is the dire need to reduce the high rate of diarrhea in this community

Patient Compliance in Systemic Hypertension and to Identify Causes of Non-Compliance

To assess patient compliance in systemic hypertension and to identify the causes of non-compliance. A descriptive observational study. The study was conducted in the Department of Medicine Unit I and Unit II at Pakistan Railway Hospital, Rawalpindi, for 1 month from 5th of September, 2012 to 5th of October, 2012. Semi structured interviews of 32 patients with primary hypertension who were admitted in medical ward were done along with their blood pressure readings and their compliance was assessed. Morisky 8-item medication adherence questionnaire1 was used to assess the adherence to anti-hypertensive medication. Scores of less than 3 out of 8 were termed as compliant while scores of 3 or more were termed as non-compliant. Non-compliance was defined as missing at least two days of medications per week. This definition was arrived at from the general understanding that a minimum compliance of 80% is needed to achieve an adequate reduction in blood pressure in the treatment of hypertension.2 Among 32 patients, 18 were male while 14 were female with mean age of 56 years. Twenty six out of thirty two [81.25%] patients did not comply with their antihypertensive medications. In majority of the patients [42.3%], misperception about disease and management due to inadequate education by health care providers was found to be the cause of non-compliance. Other causes were considering medication unnecessary [15.3%] or ineffective [11.5%], forgetting to take them regularly [11.5%], unaffordable drug prices [11.5%] and unpleasant side effects [7.7%]. Patients compliance in hypertension was sub-optimal and misperceptions of the disease and its management seemed to play a major role for non-compliance. Physician-patient relationship, effective communication and better understanding of the disease can result in adequate control of hypertension and its complications

Efficacy of gluma desensitizer[TM] and duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions

The objective of this study was to compare the efficacy of Gluma Desensitizer[TM] and Duraphat[TM] in relieving dentinal hypersensitivity in non-carious cervical lesions by a randomized control trial. 196 patients having hypersensitive non-carious cervical lesions were divided into two groups. Gluma Desensitizer[TM] was applied to patients in Group A and Duraphat[TM] to patients ingroup B. Patient's pain response to compressed air was recorded on the visual analogue scale at baseline, 5 minutes, 7 days and 30 days after treatment. Data were analyzed using SPSS version 12. Comparison of sensitivity between the two treatment groups on application of compressed air showed a statistically significant difference. The results of this study showed that Gluma Desensitizer[TM] showed better results in relieving dentinal hypersensitivity than Duraphat[TM] in non-carious cervical lesions