Comparison of two dosages of Submucosal Dexamethasone to control Postoperative Trismus after surgical extraction of Mandibular impacted third molar

Objective: To compare the post surgical effects of two different concentrations' i.e. 4mg [milligram] and 8mg of sub mucosal dexamethasone to decrease trismus by comparing the mean decrease in interincisal distance in patients undergoing impacted mandibular third molar surgery

Study Design: Randomized controlled clinical trial

Place and Duration of Study: Outpatient department of oral and maxillofacial surgery unit, Mayo Hospital, Lahore. The study was completed in 6 months, from Jan 2012 to Jul 2012

Material and Methods: This randomized controlled clinical trial was conducted on 150 patients. Patients were divided into two groups A and B. Mean interincisal distance of all patients was recorded pre operatively and post operatively. All patients were advised to use a mouthwash clorhexidine 0.2 percent before surgery. Group A received 4 mg dexamethasone and group B received 8 mg dexamethasone in the buccal vestibular tissues. Standard surgical procedure was performed by the same operator under same conditions. Postoperative mean interincisal distance of all patients was recorded on day 2 [after 48 hours of surgery]

Results: Average age of patients was 32.62 +/- 7.86 years with minimum and maximum ages of 20 and 50 years respectively. Gender distribution was almost equal. Average [maximum interincisal] mouth opening distance was significantly higher in group B as compared to group A i.e. [36 +/- 3.928 mm [millimeter] versus 26.04 +/- 3.097 mm] with p-value=0.000

Conclusion: Eight mg dose of dexamethasone was statistically more significant in reducing the trismus as compare to 4mg [p-value=0.000]

Learning styles of medical students and their demographic characteristics

Background: Learning styles are different ways of collecting information. Every individual has a different learning style which can be measured by using different inventories

Objective: To determine the learning styles of the third year medical students in Sheikh Zayed Medical College Rahim Yar Khan and to find association of learning styles with the demographic characteristics

Material and Methods: This cross sectional study was conducted at Sheikh Zayed Medical College Rahim Yar Khan during May 2013 and target population was 3[rd] year medical students including all the medical students of third year MBBS to analyse learning styles. The instrument used was the "Kolb Learning Style Inventory" which divides the individuals in to four different types of learning styles. The results were tabulated and were analysed by using SPSS version 17

Results: Analysis of learning styles inventory showed that among third year medical students, the dominant learning style was convergent learning style as 42 out of 122 [34.4%] students' opted for it. The second, third and fourth preferred learning styles were accommodative 33 [27%], assimilative 25[20.5%] and divergent 24[19.7%] respectively

Conclusion: The dominant learning style was convergent among 3[rd] year medical students and there was significant association of learning styles with demographic characteristics

Comparing histopathological and magnetic resonance imaging based mesorectal fascia status in patients with rectal carcinoma

To compare mesorectal fascia status on histopathological findings with MRI based radiological mesorectal fascia status in patients with rectal carcinoma taking histopathology finding as gold standard. Analytical study. Department of Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from January 2011 to April 2012. Biopsy proven cases of rectal adenocarcinoma undergoing abdominoperineal resection were included in this study. Microscopic examination of slides was done to determine mesorectal fascia status as involved or otherwise without knowing the results of mesorectal fascia status on MRI. Mesorectal fascia status of MRI was determined by a radiologist who was not aware of the histopathological assessment of mesorectal fascia. Mean and standard deviation was calculated for age. Frequency and percentage were calculated for gender and mesorectal fascia status. 2 x 2 table was generated to calculate sensitivity, specificity, positive predictive value and negative predictive values and diagnostic accuracy of MRI for mesorectal fascia involvement taking histopathology as gold standard. The sensitivity of MRI to detect mesorectal fascia involvement was 23.07% and specificity was 70.5%. Positive predictive value of MRI was 10% and negative predictive value was 54.54%. Diagnostic accuracy of MRI for mesorectal fascia involvement was calculated as 50%.MRI findings regarding mesorectal fascia status as involved or otherwise are not helpful when compared with histopathological findings which is the gold standard.

Spectrum of Pediatric Dermatosis and Seasonal Variation

To determine the pattern of skin disorders seen among children attending a Medical College Hospital. A descriptive Study. The study was conducted at Dermatology Dept. Pakistan Railway Hospital from Dec 2011 to July 2012. All children 13 years and below attending the Dermatology OPD with skin diseases were included between the period of December 2011 to July 2012. A detailed history was taken; thorough clinical examination was done and was supported by investigations wherever necessary. The diseases were tabulated based on the various groups and results were analysed. A total of 2357 cases [boys 1037; girls 1320] with different dermatosis were included in the study. Most of the disorders were seen between 1 to 5 years of age. The most common dermatoses were bacterial infections [26.21%] and infestations [13.70%] followed by viral and fungal infections [11.96%, 1.41%]. Seasonal variation among childhood dermatosis were also noted during summer and winter. Total of 996 patients were included in the study. Most common dermatosis seen among children during summer were bacterial infections [41.16%] followed by miliaria [12.55], viral and fungal infections [11%] napkin dermatitis [10.84] and infestations [9.63]. During winter most common dermatosis seen were infestations [26.26%], seborrheic dermatitis [24.45%] bacterial and fungal infections and pityriasis alba [9.31%]. Among other dermatosis seen were papular urticaria, vitiligo, alopecia areata, papulosquamous disorders, acne and genetic disorders [0.76%]. In the present setting bacterial infections and infestations are the most common pediatric dermatoses followed by viral and fungal infections and eczematous eruptions

Dengue fever outbreak in Lahore

Dengue fever has now affected all the major cities of country. About 41,354 patients underwent antibody screening for dengue fever from Shaukat Khanum Memorial Cancer Hospital, Lahore, during the epidemic period [October 1st 2010 to December 20[th] 2010]. Out of them, 1294 [3.1%] patients were positive for IgM antibodies, and 124 [0.3%] for IgG antibodies. A total of 722 [1.7%] patients were borderline positive for IgM antibodies and 108 [0.26%] were borderline positive for IgG antibodies. Dengue fever has emerged as a global problem over the last 5 years. It has also hit Lahore badly especially after the floods in 2010. High index of suspicion should be there in case of related symptoms

Causes of hand impairment

The objective of this study was to identify the causes leading to impairments of hand. Descriptive case series. This study was conducted at Rehabilitation Medicine department of Combined Military Hospital, Abbottabad from July 2010 to June 2011. 100 patients diagnosed to be having hand impairments were sampled by convenience sampling and through a face-to-face interview. Data was collected and analyzed using SPSS 10. Frequencies and descriptive statistics were calculated for the various variables. 84% [n=84] of the participants were males whereas 16% [n=16] were females. Mean age of study participants was 37.36 years [SD +/- 16.18 yrs]. Among these patients 94% [n=94] were right-handers and 6% [n=6] were left-handers. Dominant hand was affected in 51% [n=51] of patients, non-dominant hand was affected in 37% [n=37] of patients while in 12% [n=12] of patients both hands were affected. The most common cause of hand impairment was road traffic accidents at 28% [n=28], followed by falls 16% [n=16] and firearm injuries at 12% [n=12]. Number of genetic causes, sharp injury, blast injury and overuse were 7% [n=7], 6% [n=6], 6% [n=6] and 5% [n=5] respectively. Carpal tunnel syndrome, electric shock, infection, iatrogenic injury and sports injury were 3% [n=3] each. While cubital tunnel syndrome, and occupational injury were found to be 2% [n=2] each and Neuroma was 1% [n=1]. A large number of patients had hand impairments resulting from trauma. At the top of the list of causes of impairment was road traffic accidents followed by falls. Traumatic causes of hand impairment were 75% while non-traumatic causes were 25%

Primary pulmonary rhabdomyosarcoma

Rhabdomyosarcoma is the commonest soft tissue malignancy in children; its common sites of occurrence include head and neck regions, chest wall, abdomen, perineal and anal regions. Lung is an unusual site. We report a case of two years old female child who presented with fever cough, shortness of breath and chest pain. Radiological examination showed a bullous lesion in the left lower lobe. Histological examination of bullectomy specimen revealed sheets and clusters of round blue cells with mild to moderate atypia. There were some hypocellular areas containing characteristic perivascular arrangement of tumour cells. Tumor cells showed strong positivity for Desmin. Based on histopathological and immunostain findings, diagnosis of Embryonal Rhabdomyosarcoma was made

Outcome of allogeneic haematopoietic stem cell transplantation in aplastic Anaemia

To analyze factors associated with survival, rejection and graft versus host disease in aplastic anaemia patients undergoing allogeneic haematopoietic stem cell transplantation [SCT] from HLA matched sibling donors. Analytical study. Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan from July 2001 to June 2010. Consecutive aplastic anaemia [AA] patients undergoing haematopoietic stem cell transplantation from HLA-matched sibling donors at this centre were included in this study. Potential factors affecting overall survival, rejection, disease-free survival and graft versus host disease were analyzed. Survival analysis was done by Kaplan-Meier method. Cox regression model was applied for multivariate analysis. Ninety male and thirty-five female patients with AA were included in the study. Median age was 18 years. Conditioning regimens used were cyclophosphamide [Cy] plus antilymphocyte globulin [ALG] or antithymocyte globulin [ATG], fludarabine [FLU] +Cy+ATG, Campath 1-H +Cy in 89, 30 and 6 cases respectively. GVHD prophylaxis used was ciclosporin [CSA] plus prednisolone and short methotrexate in 81 while 44 received CSA plus prednisolone. At a median follow-up of 1185 days OS and DFS were 84% and 78% respectively. Factors associated with better OS were male sex, Flu/Cy/ATG conditioning and use of bone marrow as stem cell source. Flu/Cy/ATG conditioning regimen, bone marrow as stem cell source and CSA, prednisolone and short methotrexate regimen were associated with better survival in AA

Postnatal encephalitis: a diagnosis not to be missed

Viral encephalitis is a common condition but only a few studies are available on occurrence of viral encephalitis in postnatal women. The objective of this study was to determine the frequency of postnatal encephalitis among patients presenting with cerebral neurological complications during puerperium and to determine a response to 10 day course of acyclovir therapy and final outcome of the patients. This cross-sectional descriptive study was conducted at Department of Medicine, Unit A, Ayub Teaching Hospital, Abbottabad from Jan to Dec 2011. All patients presenting with encephalitis in their postnatal period were enrolled. Eclampsia patients were excluded from study. The diagnosis of encephalitis was made on clinical assessment, CSF routine examination, CT scan and MRI. Among patients 16 [84.2%] presented with fever, 13 [68.42%] with headache, 8 [42.1%] with meningeal irritation, 7 [36.84%] with hemiparesis, 18 [94.7%] with altered sensorium, 13 [68.42%] with seizures, and 7 [36.84%] with coma. Cerebrospinal fluid of 16 [84.21%] patient had the changes consistent with viral encephalitis. It was normal in 2 [10.52%] patients and showed picture of pyogenic meningitis in 1 [5.26%] cases. On CT scan of brain, 3 [15.78%] had normal scans, 3 [15.78%] had cerebral oedema, 4 [21.05%] had ischemic infarct, 3 [15.78%] had meningo-encephalitis, 2 [10.52%] had infarct plus cerebral oedema, 1 [5.26%] had encephalitis and 3 [15.78%] had infarct plus haemorrhage. On MRI brain 15 out of 17 [88.2%] had lesions consistent with encephalitis. All 19 [100%] patients were treated with 10 days course of acyclovir and a broad spectrum third generation antibiotic. After hospitalisation 11 [57.8%] patients were discharged with complete recovery, 5 [26.31%] were discharged with partial recovery and 3 [15.78%] patients expired. Clinical presentation of the patient is most important in diagnosing viral encephalitis in postnatal women especially when patient presents with fever, altered sensorium and convulsions. Acyclovir therapy should be started without delay while awaiting other investigations.

Nail mine in stomach

Ingestion of foreign bodies is a common clinical scenario in any emergency department. Presence of thousands of ingested foreign bodies inside stomach is a rare scene. However, only a few such cases have been reported. Here we present a case of young adult man with known psychiatric disorder, having 2562 nails in his stomach leading to gastric outlet obstruction. Gastrotomy was employed to relieve the stomach of this mine of nails. Later psychiatric care was also provided

Exploring determinants of academic achievement among college students of age between 16-18 years

This study was designed to assess the effect of emotional intelligence and self esteem on academic achievement of adolescents. It was hypothesized that: [Emotional Intelligence and self esteem would predict academic achievement of adolescents]. The sample consisted of 112 college going adolescent students [61 males and 51 females] between age ranges of 16 to 18 years. Entire sample was recruited from middle socio economic status. Initially the participants were requested to fill the demographic form and then to measure the level of Emotional Intelligence and Self Esteem, the Trait Emotional Intelligence Questionnaire [TEIQue-SF; Petrides, and Furnham, 2003] and Rosenberg Self Esteem Scale [Rosenberg, 1965] was administered respectively. Multiple regression analysis was used in order to explore the predictive relationship of Emotional Intelligence and Self esteem with academic achievement. Results showed Emotional Intelligence and Self Esteem as significant predictors of academic achievement [R[2] = .156, F[2, 109] = 10.067, p<001]]

Relapsed diffuse large B-cell lymphoma treated by reduced-intensity allogeneic stem cell transplantation with donor lymphocyte infusion

A 42 years old male with relapsed diffuse large B-cell lymphoma was given second-line chemotherapy followed by reduced intensity allogeneic stem cell transplantation from HLA matched brother. Twelve weeks posttransplant, his disease relapsed evidenced by the appearance of lymphoma cells in the peripheral blood and declining donor chimerism. Donor lymphocyte infusion was given that induced complete lymphoma remission. The patient is well 3 years posttransplant with his disease in complete remission

Emotional intelligence as a determinant of self esteem and depression among adolescents

This study was designed to assess the relationship of emotional intelligence with self esteem and depression among adolescents. After detailed literature review, it was hypothesized that: 1] Emotional Intelligence would be positively related to self esteem among adolescents, 2] Emotional intelligence would be negatively related to depression among adolescents. Entire sample was drawn form different colleges of Karachi city. The sample consisted of 112 participants [61 males adolescents and 51 females adolescents] between age range of 16 to 18 years. Entire sample was recruited from middle socio economic status. Initially the participants were requested to Jill the demographic form and to measure the level of Emotional Intelligence, Self Esteem and Depression, the Trait Emotional Intelligence Questionnaire [TEIQue-SF; Petrides, and Furnhm, 2003], Rosenberg Self Esteem Scale [Rosenberg, 1965] and Siddiqui Shah Depression Scale [Siddiqui, 1992] were administered respectively. Pearson product correlation coefficient was used in order to explore the relationship of Emotional Intelligence with Self Esteem and Depression. Results showed significant positive correlation between Emotional Intelligence and Self Esteem [r = .457, p<.001], and Emotional Intelligence was found to be negatively correlated with Depression [r = -.566p<. 001]

Frequency of dyslipidemia in Pakistani soldiers in multan garrison

To determine the frequency of dyslipidemia in army soldiers in Multan garrison. Descriptive study. Department of Medicine at Combined Military Hospital Multan from January 1998 to January 2000. One thousand, otherwise healthy male soldiers, from various units in Multan Garrison were included in this study. Their fasting venous blood samples were obtained in sterile disposable syringe for lipid profile test. Those who were smokers or had history of diabetes mellitus, hypothyroidism or family history of early coronary heart disease [CHD] were excluded. Sixty eight [6.8%] soldiers were found to have dyslipidemia. Thirty [3%] had low HDL levels, 26 [2.6%] had increased serum triglyceride levels, 10 [1.0%] soldiers were found having isolated increase in LDL-cholesterol level with normal total serum cholesterol, and 2[0.2%] were having raised total and LDL cholesterol levels. Eighty four percent of studied population was not aware of the fact that dyslipidemia is a risk factor for heart disease. Frequency of dyslipidemia in Pakistani soldiers is moderate and it can be further reduced by increasing the awareness of disease

HBV and HCV infection: incidence and risk factors among injecting drug users in Bahawalpur city

To determine the incidence and risk factors in a well characterized cohort of injecting drug users who have been monitored in Psychiatry and Behavioral Sciences Department, Bahawal Victoria Hospital, Bahawalpur. Prospective and experimental. April, 06 to April, 08 in Psychiatry and Behavioral Sciences Department, QAMC and Bahawal Victoria Hospital, Bahawalpur. The 12 month incidence of HCV infection was relatively high in IDUs aged 24 years or younger [36%] and also elevated in 26-40 years old [23%] compared with older injectors [12%]. Statistically significant [P=<0.01] differences in incidence was found in subjects who belonged to low socioeconomic group [67%] verses high socioeconomic group [19%]. Similarly higher incidence [P=<0.23] seen in heterosexuals [20%] verses homosexuals IDU's [10%]. HCV incidence was particularly higher among IDU's who had been injecting for more than 6 years [P<0.01], whereas HBV incidence was not associated with duration of drug [P<0.7]. High incidence of HCV and HBV infection is seen in IDU's. Patients with age groups < 24, lower socioeconomic status and sharing of syringes among drug users and showed statistically significant [<0.05] higher chances of HBV and HCV infection

Uro-dynamic evaluation

drsaqii1711@hotmail.com To describe the pattern of Urodynamic evaluation at Armed Forces Institute of Rehab Medicine, Rawalpindi. Descriptive study. This study was conducted on 466 patients reporting for urodynamic evaluation at Urodynamic/Incontinence Clinic at A F Institute of Rehab Medicine from Feb 2003 to Dec 2006. We considered the age, gender, etiology, reason for referral, and presenting complaints whereas results were formulated according to Classification of voiding disorders by International society of Incontinence. Data was analyzed using statistical package for Social Science version 10. In all [466] patients, 58% were males and 42% were females. Mean age was 46.8 years. Increased frequency [61%] and incontinence [52%] were the most common presenting complaints, 158[34%] had spinal cord injuries, 58 were cases of myelodysplasias and 128 reported with stress incontinence. Urodynamic studies showed that 152[33%] had hyperactive bladders, 110[24%] had a contractile/hypo-contractile bladders, 104[22%] had stress incontinence and 56[12%] cases had normal results. Urodynamics helps in diagnosis of potentially life threatening urinary problems. The availability of this equipment and trained staff must be encouraged at tertiary care hospital. More research is required in this regard in Pakistan, which shall help in formulating better management protocols in future

Prevalence of Torus Palatinus among 300 Indonesian patients

The aim of this study was to investigate the prevalence of Torus Palatinus [TP] in the earthquake effected population of Indonesia. This study was conducted in out door dental clinic at a Pakistan Medical Mission Hospital during earthquake relief activities in June - July 2006 in Kalatan District Chawas Central Java, Indonesia. With clinical inspection and palpation 300 individuals were examined for presence or absence of Torus Palatinus. 26.9% exhibited TP. Age ranged from 20-70. Torus Palatinus was more common in men than women, and it was more common in second and third decade irrespective of sex. The occurrence of TP is related to increasing age and we also support the hypothesis that the etiology of torus palatinus involves interplay of multifactorial genetic and environmental factors

Serum hyaluronic acid as a marker of hepatic fibrosis

To determine the serum hyaluronic acid [HA] levels as biochemical marker of hepatic fibrosis and cirrhosis and correlate it with the degree of hepatic fibrosis and cirrhosis. Comparative cross-sectional study. The Armed Forces Institute of Pathology, Rawalpindi from September 2003 to August 2004. This study was performed on 100 patients of chronic liver disease whose liver biopsies had been carried out. Fifty healthy controls were also included in the study. Routine liver function tests, hepatitis serology and serum hyaluronic acid levels were carried out on patients and controls. Liver biopsy of 100 patients revealed that 21 were in stage 0 fibrosis, 38 in stage 1 fibrosis, 26 in stage 3 fibrosis and 15 in stage 4 fibrosis. Mean Serum HA [mean +/- SD] concentration in patients were 189 +/- 98 micro g/L vs. 21 +/- 10 micro g/L of healthy controls. The difference observed was statistically significant [p < 0.001]. Patients in stage 4 fibrosis had significantly higher [p <0.001] mean serum HA concentration as compared to other stages of liver fibrosis. Diagnostic accuracy of serum HA at marginally elevated level of 60 micro g/L determined the sensitivity 78.4%, specificity 80.9%, positive predicted value 93.9% and negative predicted value of 50%. Serum HA is a useful non-invasive marker of liver fibrosis. There is a strong positive correlation between serum HA levels and degree of liver fibrosis. The concentration of serum HA rises according to progression of liver fibrosis and levels are highest in patients with liver cirrhosis

Estimation of ionized calcium, total calcium and albumin corrected calcium for the diagnosis of hypercalcaemia of malignancy

To measure levels of ionized calcium, total calcium and albumin corrected calcium in patients with different malignant disorders for the diagnosis of hypercalcaemia of malignancy. A case control comparative study. The study was carried out in the Department of Pathology, Army Medical College Rawalpindi, Armed Forces Institute of Pathology and Department of Oncology CMH, Rawalpindi from March 2003 to December 2003. Ninetyseven patients of various malignant disorders, admitted in the Department of Oncology, CMH, Rawalpindi, and 39 age and gender-matched disease-free persons [as control] were included in the study. Blood ionized calcium [Ca++], pH, sodium [Na+] and potassium [K+] were analysed by Ion selective electrode [ISE] on Easylyte[R] auto analyser. Other related parameters were measured by colourimetric methods. Blood Ca++ levels in patients suffering from malignant disorders were found significantly high [mean +/- SD: 1.30+017 mmol/L] as compared to control subjects [mean +/- SD: 1.23+0.03 mmol/L] [p<0.001]. The number of patients with hypercalcaemia of malignancy detected by Ca++ estimation was significantly higher [38%] as compared to total calcium [8.4%] and albumin corrected calcium ACC [10.6%] [p<0.001]. There was no statistically significant difference in other parameters e.g. phosphate, urea, creatinine, pH, Na+ and K+ levels in study subjects and controls. Detection of hypercalcaemia can be markedly improved if ionized calcium estimation is used in patients with malignant disorders

Pseudoxanthoma elasticum

Pseudoxanthoma elasticum is an inherited disorder of connective tissue that is associated with numerous systemic manifestations including various cardiovascular abnormalities. We present a case of a 35 years old lady who presented with abnormal wrinkling, pigmentation and laxity of skin. She also had hypertension, peripheral vascular disease, angioid streaks and mitral valve prolapse. She was thoroughly investigated and managed accordingly. She was also educated to minimize the potential risks involved and advised regular follow-up