Effect of local probiotic (Lactobacillus reuteri) vs systemic antibiotic therapy as an adjunct to non-surgical periodontal treatment in chronic periodontitis.

AIM: The aim of the present study was to assess and compare the clinical efficacy of local probiotic Lactobacillus reuteri (L. reuteri) and systemic antibiotics as adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis (CP). METHODS: Thirty systemically-healthy participants (15 probiotic and 15 antibiotic), clinically diagnosed with CP, were enrolled. All patients underwent SRP. Adjunctive probiotics were administered twice daily for 3 months, whereas a combination of amoxicillin and metronidazole were given three times daily for 7 days. RESULTS: Intragroup analysis showed statistically-significant improvement in all clinical parameters: plaque index, bleeding on probing, periodontal pocket depth, and clinical attachment level gain at each follow-up visit. However, intergroup comparison of clinical periodontal parameters did not show statistical significance. CONCLUSION: The adjunctive use of L. reuteri and systemic antibiotics along with SRP showed similar improvement in all clinical periodontal parameters. This indicates that both adjunctive therapeutic agents showed similar efficacy in resolving inflammation and improving periodontal outcomes.

Systematic review and meta-analysis of double-blind, placebo-controlled, randomized clinical trials using probiotics in chronic periodontitis.

AIM: The aim of the present study was to evaluate the efficacy of probiotics as an adjunct to scaling and root planning (SRP) in the treatment of chronic periodontitis (CP). METHODS: The focused question of the study was: Does adjunctive use of probiotics yield better clinical periodontal outcomes compared to placebo/no treatment group in the treatment of CP? Electronic and manual literature searches were conducted up to December 2017 using the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Oral Health Group Trials Register. Forest plots were computed reporting weighted mean difference (WMD) of outcomes and 95% confidence intervals (CI). RESULTS: Seven clinical studies were included. Four studies showed additional benefits in reducing periodontal probing depth (PPD) and gaining clinical attachment level (CAL), whereas, three studies showed comparable clinical periodontal outcomes between probiotics and SRP/placebo. Significant heterogeneity was observed for PPD reduction and CAL gain. The overall mean difference for CAL gain between probiotics and placebo/SRP was significant (WMD = 1.41, 95% CI = 0.15-2.67, P = .028) at follow up. CONCLUSION: Adjunctive probiotics could result in additional benefits in CAL gain in CP. Nevertheless, further high-quality randomized clinical trials with microbiological outcomes are warranted to obtain strong conclusions in this regard.

Analysis of renal artery morphometery in adults: A study conducted by using Multidetector computed Tomography Angiography.

OBJECTIVE: To determine a reference range of renal artery measurements by using Multidetector Computed Tomography (MDCT) angiography and to find association of renal artery measurements with side of artery, gender and age. METHOD: Two hundred and fifty study participants without renal artery disease who werepresented to Radiology Department, Ziauddin Hospital, Karachi, from November, 2016 to April, 2017 were included in this study. Main renal artery measurements were taken on Multidetector computed angiography and variation with side, gender and age were analyzed. Statistical analysis was done on Statistical Package for Social Sciences (SPSS) version 20. Independent sample T test, one way ANOVA and Pearson's correlation analysis were applied. P-value of < 0.05 was considered significant. RESULTS: A significance difference (p=0.001) was seen between mean right renal artery (diameter 6.66 ± 0.39 mm; length 44.69 ± 2.48 mm) and left renal artery (diameter 6.79 ± 0.36; length 35.10 ± 2.86 mm). Females found to have smaller mean diameter and length of renal arteries than males. However, a weak negative correlation was seen between mean renal artery diameter and age (right r= -0.158, p=0.0121; left r= -0.017, p= 0.708). CONCLUSION: The mean diameter and mean length were found to be significantly different between right and left main renal artery and between males and females. A significant weak negative correlation was observed between renal artery diameter and age.

Frequency of thyroid incidentalomas in Karachi population.

OBJECTIVES: The aim of this study was to determine frequency of thyroid incidentalomas (TI) through ultrasound (US) and its association with age, gender and ethnicities. METHODS: It was a cross-sectional study. Total 269 adults who were asymptomatic for thyroid disease aged 21 years and above underwent ultrasound examination of their thyroid. RESULTS: Frequency of TI found was 21%. TI was detected in 25% of females and 16% males (P= 0.078). 61% had thyroid nodules (TNs) in one lobe (right, left or isthmus) and 39% had TNs in more than one location. About 55% had single TN and 45% had multiple TNs. 38% had TNs greater than 1cm while 57% had TNs smaller than 1 cm. 5% had TNs greater and smaller than 1 cm. TI was equally common in individuals of different ethinicities (P= 0.758). CONCLUSION: Frequency of thyroid incidentalomas found in our study was higher than most of the other iodine sufficient states. Unlike other studies, incidentalomas were equally common in both the genders of our study. This may be due to the previous iodine deficient status of Pakistan which was prevalent. However further studies on the same topic will help us in identifying the correct status of thyroid incidentalomas if Pakistan retains it's status as an iodine sufficient state.

Impact of anthropometrical parameters on portal vein diameter and liver size in a subset of Karachi based population.

OBJECTIVE: The purpose was to study the impact of anthropometrical parameters on portal vein diameter and liver size by ultrasound in a subset of Karachi population. METHODS: Four hundred and fifty nine apparently healthy subjects were included in this cross sectional study. After recording weight and height of each subject, Portal vein diameter and both liver lobes were measured by gray scale ultrasonography. Students T test and ANOVA were applied for statistical analyses. RESULTS: With increasing age, portal vein diameter and right lobe of liver increased significantly (p value < 0.001). Increase in portal vein diameter was also observed with rise in body mass index (0.8 cm in underweight - 1.1 cm in obese subjects). Sizes of right and left liver lobes also increased with a rise in body mass index (p value < 0.001 and 0.001). Gender, however, did not have any effect on portal vein diameter and liver size. CONCLUSION: Age and body mass index are reliable parameters to consider for avoiding false positive diagnosis of hepatomegaly and portal hypertension. Knowing the right and left liver size with respect to anthropometrical measurements also assist a clinician in selecting a subject for liver transplantation.

The applicability of the Greulich & Pyle Atlas for bone age assessment in primary school-going children of Karachi, Pakistan.

OBJECTIVE: To assess the degree of applicability of bone age calculated by Greulich & Pyle Atlas in estimation of chronological age for therapeutic and medico legal purposes. METHODS: Two Hundred and Twenty children (139 males, 81 females) between ages of 56 and 113 months (4.5 to 9.5 years) were randomly selected from 4 primary schools of Shireen Jinnah & Clifton, Karachi. Digital images of hand and wrist radiographs were obtained by a computed radiography at Ziauddin Hospital Clifton. Bone ages were computed using Greulich & Pyle Atlas by radiologists at Ziauddin Hospital, North Nazimabad, Karachi. RESULTS: On average, the Greulich & Pyle Atlas underestimates chronological age by 6.65 ± 13.47 months in females and 15.78 ± 12.83 months in males (p-values < 0.001). High correlation was found between chronological age and bone age in both genders (Females r=0.778; p-value< 0.001, Males r=0.816; p-value < 0.001). CONCLUSION: Bone age calculated by Greulich & Pyle Atlas should not be used for estimating chronological age in children of ages 56-113 months in situations where high accuracy is required (e.g. medicolegal cases). However, serial measurements of bone age by this atlas can be used in management of growth related endocrine disorders in these children.

Bone age assessment methods: a critical review.

The bone age of a child indicates his/her level of biological and structural maturity better than the chronological age calculated from the date of birth. Radiography of the hand & wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation based techniques of visualizing hand & wrist bones such as ultrasonography for bone age calculation have been theorized but are not as accurate as radiographic methods. By the age of 18 years, bone age cannot be computed from hand & wrist radiographs, therefore the medial end of the clavicle is used for bone age calculation in individuals aged 18-22 years. CT visualization of the clavicle has been extensively studied but requires a high dose of radiation. MRI based methods are being developed but require more research. Dental age is an alternate form of bone age determination, which also gives an estimate of skeletal maturity. The iliac bone and femoral head have also been studied for computation of bone age but no standardized methods have yet been generated. As different modalities of bone age estimation provide different results and their applicability differs in different ethnicities, we need to design studies in order to compare them and select the method best suited to Pakistani children. Sources of Data/Study Selection: Recent articles published between years 2004-2013 obtained from online search engines Pubmed and Google Scholar were used in preparation of this review.

Effects of variation in umbilical artery resistive index on placental morphology and birth weight in pregnancy induced hypertension.

BACKGROUND: Pregnancy induced hypertension results from defective trophoblast invasion and increased umbilical artery resistance which in turn results in decreased blood supply to the placenta and hence to the foetus. This arterial resistance varies in different cases of PIH thus causing variable effects on placenta and foetus. The objective of this study was to study the morpho-metric changes in placenta and alterations in birth weight with differences in umbilical artery resistive index in hypertensive pregnancies. METHODS: Ninety pregnant women with pregnancy induced hypertension were selected with gestational age greater than 35 weeks. Doppler ultrasound examinations were carried out to record umbilical artery resistive index (UARI). 2 groups were made on the basis of median values of UARI. Plain ultrasound examination was then carried out to record presentation, site of placentation, grade of maturity, insertion of the cord, cord thickness, placental thickness, vacuolation and amniotic fluid index (AFI). After delivery, foetal birth weight was noted and placentae examined for placental weight, infarcts, number of cotyledons, umbilical cord insertion, cord thickness and placental thickness were noted. Foetoplacental weight ratio was also calculated. RESULTS: Significantly higher UARI was seen in the high-resistance group. Significantly lower values of placental thickness, AFI, birth weight, placental weight and placental thickness, whereas greater number of grade-III maturity, infarcts and marginal cord insertion were noted in the high-resistance group. CONCLUSION: Increased UARI leads to a spectrum of changes in the placenta and also decreased birth weight. Marginal cord insertion causes greater risk of increased UARI.