Persistent left superior vena cava remnant causing cyanosis in a post-Fontan patient

We report the successful surgical closure of a persistent left superior vena cava remnant draining into the pulmonary venous circulation causing cyanosis in a post-Fontan patient who had previously undergone Damus-Kaye-Stansel and bidirectional superior cavopulmonary connection followed by a transcatheter coil occlusion of his persistent left superior vena cava.

HbA(1c) as a diagnostic tool for diabetes and pre-diabetes: the Bangladesh experience

AIMS

To evaluate HbA(1c) as a tool for the diagnosis of diabetes and pre-diabetes (impaired glucose tolerance and/or impaired fasting glucose) and to identify the optimal cut-off values suitable for a Bangladeshi population.

METHODS

In this cross-sectional survey in a rural community, 2293 randomly selected individuals aged ≥ 20 years without prior history of diabetes were included. HbA(1c) and other clinical covariates necessary for the diagnosis of diabetes were recorded. Diabetes and pre-diabetes were defined according to the World Health Organization 1999 criteria. The receiver operating characteristic curve was used to determine the performance of HbA(1c).

RESULTS

The prevalences of diabetes and pre-diabetes were 7.9 and 8.6%, respectively. Based on receiver operating characteristic curve analysis, an HbA(1c) cut-off value of ≥ 42 mmol/mol (≥ 6.0%) gave an optimal sensitivity of 86.2% and specificity of 93.3%, with an area under the curve of 0.949 to predict diabetes using the oral glucose tolerance test as the gold standard; a cut-off value of ≥ 38 mmol/mol (≥ 5.6%) gave an optimal sensitivity of 68.0% and specificity of 66.4%, with an area under the curve of 0.714 to predict pre-diabetes. In subjects at high risk of diabetes, HbA(1c) ≥ 42 mmol/mol (≥ 6.0%) showed higher sensitivity than fasting plasma glucose ≥ 7.0 mmol/l, 2-h plasma glucose ≥ 11.1 mmol/l and HbA(1c) ≥ 48 mmol/mol (≥ 6.5%).

CONCLUSIONS

An HbA(1c) cut-off value of ≥ 42 mmol/mol (≥ 6.0%) was highly sensitive and specific in diagnosing diabetes mellitus. This optimal cut-off level may be suitable as a diagnostic criterion for diabetes in a Bangladeshi population.

Pitfalls in neuroimaging of headache: a case report and review of the literature

Headache is a common symptom, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. Neuroimaging is indicated in patients with red flag features for secondary headaches. The guidelines recommend CT or MRI scan to identify any intracranial pathology. We present a unique case where the initial noncontrast CT scan failed to identify a potential treatable cause for headache. A middle aged man presented with headache and underwent a CT scan without contrast enhancement. The scan was reported as normal. The headache persisted for years and the patient underwent a staging CT scan to investigate an oropharyngeal cancer. This repeat CT scan utilized contrast enhancement and revealed a meningioma. Along with other symptoms, headache is an established presenting complaint in patients with meningioma. The contrast enhanced CT brain proved superior to a nonenhanced CT scan in identifying the meningioma. In a patient with persistent headache where other causes are excluded and a scan is to be requested, perhaps contrast enhanced CT is a better option than a plain CT scan of brain.

Heterogeneity of treatment effects (HTE) in stage IV prostate cancer (S4PC)

180

Background: HTE occurs when individual patient factors modify a treatment’s effect on health outcomes in a non-random and predictable manner. HTE results in specific subgroups of patients in the same study having different responses to the same treatment due to interactions between their individual factors and the treatment. Methods: A systematic literature review was conducted of articles published between 1946 and 2011. Inclusion criteria required that articles examine the impact of HTE factors on survival outcomes (OS, TTP, PFS) or QOL among S4PC patients, in the context of a specific treatment. The quality of evidence was graded as good, fair or poor, per AHRQ guidelines. Results: The search identified 2,659 articles of which 92 met study inclusion criteria. Most articles (46%) were post-hoc analyses of randomized clinical trials. PC treatments included chemotherapy, radiation, hormonal therapy (74%) and bone-modifying agents. HTE in S4PC was identified for both biologic and non-biologic factors. Factors related to clinical signs/symptoms, laboratory tests and disease severity have been extensively studied in the literature (Table). Age and race seldom showed any correlation with PC outcomes. Conclusions: Current evidence reveals diverse factors contributing to HTE in S4PC. Ultimately, such knowledge can help oncologists prescribe more personalized medicine, help patients make more informed treatment choices, and inform policy making and treatment coverage decisions. [Table: see text]

Predictors and prognostic implication of pathologic fracture (PF), spinal cord compression (SCC), and bone surgery (BS) following diagnosis of metastatic prostate cancer (PCa)

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Background: Information is limited about the predictors of PF, SCC, or BS and their relationship with PCa mortality in older men diagnosed with metastatic PCa. Methods: We analyzed patients aged 66 or older from the linked Surveillance, Epidemiology, and End Results & Medicare (SEER-Medicare) database. Cases were diagnosed with M1 PCa between 2000 and 2007. Patients surviving at least 30 days post-diagnosis were identified and followed until death or censoring in December, 2009. Post-diagnosis occurrence of PF, SCC, and BS was identified using Medicare claims. (Multinomial) logistic and Cox proportional hazards regression models controlled for demographic characteristics, preventive service use, comorbidity status, and performance status proxies. Survival models were estimated in the full sample (FS) and in a propensity-score matched sample (PSMS). The survival requirement was relaxed and patients diagnosed with stage M1b were considered in sensitivity analyses. Results: Application of inclusion criteria resulted in 7,062 patients in FS (2,398 in PSMS). PCa-specific and all-cause mortality were 54% and 80% at a median (mean; min; max) follow up of 609 days (837; 30; 3,653). The average age for the sample was 78 yrs and 14% were non-Hispanic African American. The proportion with any event, SCC, PF, and BS were: 17%; 10%; 5%; 3%. Race, marital status, comorbid conditions, and health services use related to bone metastases were correlated with the likelihood of sustaining a PF, SCC, or BS, with differences based on the type of event. In the PCa mortality model the HR associated with each event was as follows using FS: [SCC] HR 1.12, 1.01 – 1.24; [PF] HR 1.14, 1.00 – 1.31; [BS] 0.61, 0.50 – 0.75. Results using PSMS were: [SCC] HR 1.04, 0.92 – 1.17; [PF] HR 1.11, 0.96 – 1.28; [BS] 0.58, 0.47 – 0.72. Relaxing the assumption of a minimum survival requirement did not change qualitative results. Conclusions: Patient demographics and clinical comorbid conditions correlate with the likelihood of sustaining PF, SCC or BS. Compared to fractures and spinal cord compression, the relationship between bone surgery and PCa-specific survival is more favorable.

Randomized phase II trial of docetaxel (Doc) and prednisone (Pred) with or without AZD2171 (cediranib), in chemotherapy-naive, metastatic castrate-resistant prostate cancer (mCRPC) (NCI 7451)

38

Background: Cediranib + Doc were shown in a phase I trial to be feasible, with early evidence for efficacy in mCRPC patients (pts). A multi-center randomized Phase II screening trial of Cediranib+Doc+Pred (Arm A) vs. Doc+Pred (Arm B) was initiated in mCRPC pts. Methods: mCRPC pts with no prior chemotherapy were eligible. All received Doc at 75 mg/m2IV q 3 weeks and Pred 5 mg po bid. Cycle length was 21 days. Arm A pts also received Cediranib at 30 mg po daily. The primary endpoint was 6-month progression-free survival (PFS). We hypothesized 6-month PFS rates of 0.70 on Arm A and 0.50 on Arm B. Secondary endpoints included toxicity, PSA response, and RECIST response. Here we report the toxicity and PSA response data. Results: Of 58 pts enrolled, 57 were treated (29 Arm A, 28 Arm B). Median age = 68 years (range 51-84); 33% African-American, 63% Caucasian; median baseline PSA136 ng/mL (range 0.12 – 3,650); 57% had Gleason grade 8-10; and 40% had both bone/ visceral disease. Median nadir PSA was 10.5 ng/mL (range 0.10 – 1,484) in Arm A, and 25.9 ng/mL (range 0.00 – 2,076) in Arm B. Median number of cycles (range): Arm A = 9 (0 - 31); Arm B = 6.5 (1-39 ). 68% pts in Arm A required a dose reduction of at least one Cediranib dose level. Doc dose was reduced in 45% pts on Arm A and in 18% pts on Arm B. Primary grade 4 toxicity was neutropenia (11 [38%] pts A; 5 [18%] pts B), which prompted Cediranib dose reduction. Grade 3 toxicities included fatigue (9 (31%) A, 1 (4%) B); hypertension (8 (28%) A, 1 (4%) B); anemia (6 (21%) A, 2 (7%) B); neutropenia (4 (14%) A; 6 (21%) B); diarrhea (3 (10%) A, 1 (4%) B); deep vein thrombosis (2 (7%) A, 1 (4%) B); and pulmonary embolism (1 (3%) A). An amendment reduced Cediranib to 20 mg daily dose. PSA decrease ≥ 90% at nadir occurred for 13/29 = 45% on Arm A, and 6/28 = 21% on Arm B. PSA decrease ≥ 50% at nadir occurred for 19/29 = 66% on Arm A, and 17/28 = 61% on Arm B. Clinical partial response rates were 8/15 = 53% on Arm A and 3/9 = 33% on Arm B. Conclusions: The addition of Cediranib to Doc/Pred has increased toxicity but may be associated with higher rates of PSA response and clinical response in mCRPC patients. PFS results will be reported. Clinical trial information: NCT00527124.

The effects of age, stage, treatment, and Charlson comorbidity index (CCI) on quality of life after prostate cancer diagnosis in a single cohort

242

Background: Long term quality of life after diagnosis of prostate cancer (PC) is an important factor in determining treatment success and satisfaction. Here we investigate the quality of life in a rural cohort of individuals treated for PC within a single institution. Methods: The Expanded Prostate Cancer Index Composite (EPIC) and the Medical Outcomes Short-Form 36 (SF 36) were completed by a rural population based cohort diagnosed with prostate cancer between January of 2005 and December of 2010, enrolled in a population based biorepository. Medical records were interrogated electronically for information such as age at treatment, stage, CCI, and first course of treatment. Results: Of the 173 individuals within the cohort, we received 95 completed survey instruments. No differences in age group, stage at treatment, or treatment type between individuals who completed the survey and those who did not were observed. Median summary score for the sexual domain was 10 (min -6 max 77), median summary score for urinary domain was 85 (min 36 max 100), and median summary score for the bowel domain was 95 (min 68 max 100). Median physical health score was 80 (min 20 max 100) and median general health score was 67 (min 20 max 100). Overall satisfaction score was 75 (min 25 max 100). Scores for bowel and urinary function were not significantly associated with treatment, age, CCI, or stage at diagnosis. For the sexual domain, individuals with hormonal treatment scored worse than other treatments (ttest p=0.05). Overall physical health was associated (anova, p<=0.05) with treatment, age, CCI, and stage. In a multivariate model only treatment and an interaction term with treatment and CCI were significant. Satisfaction score varied with treatment, individuals who received radiation treatment had a higher mean satisfaction score (87 vs 68 for the other groups ANOVA p=0.03). Conclusions: The treatment for prostate cancer affected an individual's quality of life in the domains of physical function, and sexual health. Treatment also affected satisfaction score regardless of age or stage at diagnosis.

Prostate cancer (PC) follow-up and treatment by race in an equal access health system: A pilot study

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Background: There are known racial disparities in the incidence and outcomes of PC as well as in receipt of treatment. Although some studies in the Veterans Affairs Health System (VA) suggest that utilization and outcomes are as good, if not better, for African Americans (AA) as for Whites (WH), race appears to have mixed impact on stage-specific PC survival in the VA population. This pilot study aims to identify racial disparities in PC care in an equal access health system such as the VA. Methods: A retrospective cohort study was conducted of 109 consecutive patients with newly diagnosed PC in the year 2010 at the Baltimore VA Medical Center (BVAMC). Baseline characteristics (age, prostate specific antigen (PSA) at diagnosis, Gleason score (GS), stage, race) were extracted from the electronic medical records. Patterns of treatment and follow-up care, including specialist (urologist, medical oncologist, radiation oncologist) visits, time to first treatment, and primary treatment in the first year of diagnosis were examined. Results: Of 109 patients, 32 (30%) were WH, 69 (63%) AA and 8 (7%) other racial groups. AA and WH had similar median age (62, 64), GS (7, 7) and PSA (8.06, 7.46) at diagnosis. More AA were diagnosed with stage IV PC compared to WH (13% vs. 3%). Median time to first follow-up specialist visit since diagnosis was 15 (0-140) and 19.5 (2-169) days for AA and WH, respectively. Median time to initial treatment was 99.5 (1-306) and 146 (6-345) days for AA and WH, respectively. For localized PC, 30% AA received prostatectomy (RP) and 70% external beam radiation therapy (EBRT); in WH it was 19% and 76%, respectively. Conclusions: In an equal access health system such as the BVAMC, there did not appear to be racial differences in PC follow-up with specialists and time to initial treatment. AA had more advanced disease at diagnosis. Interestingly, although both AA and WH received EBRT more often than RP for localized PC, AA underwent RP more frequently than WH. It will be of interest to determine whether these patterns hold for other years and in other equal access health systems.

Time to follow-up and treatment in patients with newly diagnosed prostate cancer (PC) across clinical stages in an equal access health system

210

Background: The purpose of this pilot study is to describe the time interval from diagnosis to initial specialist visit and treatment initiation in pts with newly diagnosed PC across different clinical stages (S1- 4) in an equal access system such as a Veterans Affairs Medical Center (VAMC). Methods: Data from the Baltimore VAMC database were used to examine pts diagnosed with PC in 2010 to assess variation across different clinical stages with respect to follow up with specialists, diagnostic tests and treatment initiation during the year following diagnosis. Specialists include urologists, medical oncologists and radiation oncologists. Diagnostic tests included CT and/or bone scans. Treatments based on clinical staging included active surveillance, radical prostatectomy, external beam radiation therapy, brachytherapy, androgen deprivation therapy, chemotherapy or enrollment into clinical trials. Results: One hundred and nine pts were diagnosed with PC at the BVAMC in 2010. All but one patient had follow-up with a specialist after positive prostate biopsy. Majority of pts in each stage saw more than one specialist (S1-50%, S2-74%, S3-60%, S4-82%). The median number of days to first follow up visit with a specialist was similar across all stages (S1-16 d, S2-15 d, S3-17 d, S4-14 d). Four out of the 109 pts were lost to follow up. S4 pts were initiated on treatment at a median of 26 days after diagnosis, whereas S1, S2 and S3 pts were initiated on treatment at a median of 151,100 and135 days respectively, after diagnosis. Pretreatment CT scan and/or bone scans were done in S1-38%, S2 -70%, S3-80% and S4-100% pts. Conclusions: The results of this pilot study showed that while time to initial follow up visit after diagnosis of PC does not differ across the clinical stages, treatment for S4 pts is initiated much earlier than for the other stages. It will be of interest to determine whether these patterns hold for other years and in other VA Medical Centers.

Age at diagnosis and treatment for prostate cancer (PC) in two distinct integrated health care systems

240

Background: An older age at diagnosis may affect the stage at which PC is diagnosed as well as the treatment decisions made by the providers and/or the patients. Here we compare two geographically and ethnically distinct PC cohorts to determine whether age affects treatment decisions. Methods: Populations- Marshfield Clinic (MC): individuals were included in the cohort if they were diagnosed with PC between January, 2005 and December, 2010 and enrolled in a population based biorepository. Veterans Affairs (VA):– cohort included individuals diagnosed with PC between January, 2010 and December, 2010 within the Baltimore VA Medical Center (BVAMC). Retrospective chart review using electronic abstraction from the EMR was performed at each site. Statistical analysis was performed using the chi-square test for categorical variables or Fisher's exact test if the cell size was under 5. Results: Compared to the MC population, the VA population had a younger median age at diagnosis (63 vs. 68), more African American men (63% vs. 0.5%) and exhibited higher median PSA at diagnosis (7.92 vs 5.78 ng/dL). Seventy nine percent of VA and 87% of MCpatientswere stage 1 or 2 at diagnosis (p=0.03). Stage was not associated with older age (age >/= 75) in either population. Individuals in the VA system were more likely to receive radiation (48% vs. 16%) and less likely to receive surgery than the MC population (18% vs. 59%). There were also several similarities in treatment decisions amongst these different populations. For instance, individuals with an older age (>/= 75 vs. other age categories) at diagnosis were more likely to receive non-aggressive treatments such as hormonal therapy or no treatment (>67% vs. <15% p=0.0001). Because the stage at diagnosis may affect treatment decisions, we also investigated treatments for stage 2 disease; in this category, individuals >/= 75 were still more likely to receive less aggressive treatment at both MC and BVAMC (>29% versus <3.4%, p=0.0001). Conclusions: This initial analysis suggests that individuals with an older age at diagnosis are more likely to receive non-aggressive treatment even when the stage of disease is the same as that of a younger individual across two distinct patient populations.

Health services utilization differences between patients with metastatic (M1) and nonmetastatic (M0) prostate cancer (PCa)

203

Background: Metastatic (M1) disease is diagnosed in up to 5% of PCa patients, but there is limited information about the differences in health services utilization between stage IV M1 and stage IV M0 patients in the one year leading up to and following diagnosis. Methods: We analyzed patients aged 66 or older from the linked Surveillance, Epidemiology, and End Results & Medicare (SEER-Medicare) database. Patients with incident stage IV PCa diagnosed between 2005 and 2007 were identified and followed until one year post-diagnosis. Health services utilization measures included skilled nursing facility (SNF) stay, hospice stay, hospitalization, use of walking aid, wheelchair, and oxygen. We calculated the proportion of M1 and M0 patients utilizing each health service in the year before and after diagnosis. Results: Application of inclusion criteria resulted in 3,379 patients, of which 671 (19.9%) had M0 and 2,708 (80.1%) had M1 disease. The mean (median) age of the sample was 78 (77) years. The increase in the percentage of patients with SNF stay from the year prior to diagnosis to the year post-diagnosis was much larger in the M1 population (M0: 2.1% to 8.7%; M1: 5.2% to 23.6%). The proportion of M1 patients with hospice stay increased from 0.1% in the year prior to diagnosis to 21.1% in the year post-diagnosis, compared to an increase from 0% to 5.1% in the M0 population. Compared to M0 patients, M1 patients also exhibited greater increases in oxygen use (M0: 5.3% to 6.6%; M1: 6.5% to 12.6%), walking aid use (M0: 3.4% to 4.3%; M1: 3.5% to 10.6%), and wheelchair use (M0: 1.8% to 4.5%; M1: 4.1% to 11.4%) in the year following diagnosis. However, the increase in hospitalization in the year following diagnosis was lower in the M1 population (M0: 17.9% to 76.9%; M1: 24.4% to 66.6%). Conclusions: Among stage IV PCa patients, health services utilization is generally higher for M1 patients than M0 patients in the one year following diagnosis. However, hospitalization is lower among M1 patients compared to M0 patients in the one year following diagnosis. The finding that more than 20% of M1 patients had SNF and hospice stays in the one year following diagnosis suggests that M1 PCa is associated with substantial disease burden.

Efficacy and safety of zoledronic acid in men with castration-sensitive prostate cancer and bone metastases: Results of CALGB 90202 (Alliance)

27

Background: Zoledronic acid (ZA) decreases risk of skeletal-related events (SREs) in men with castration-resistant prostate cancer (CRPC) and bone metastases. This phase III study evaluated efficacy and safety of earlier treatment with ZA in men with castration-sensitive metastatic prostate cancer. Methods: CALGB 90202 was a randomized, double-blinded, placebo-controlled phase III trial in men with castration-sensitive prostate cancer and bone metastases who had initiated androgen deprivation therapy within six months of study entry. Subjects were randomized 1:1 in blinded manner to receive ZA (4 mg intravenously every 4 weeks) or placebo (P). After progression to CRPC, all patients crossed over to open-label ZA. The primary endpoint was time to first SRE. Target sample size was 680. Time to SRE was defined as interval between date of randomization and date of first SRE (radiation to bone, or clinical fracture, or surgery to bone, or death due to prostate cancer). With 470 SRE events, the log-rank test has 88% power to detect a 23% decrease in hazard rate of SRE event assuming a one-sided type I error rate of 0.05. The study was discontinued prematurely after the corporate supporter withdrew study drug supply. Primary analysis was based on the stratified log-rank statistic adjusting on the stratification factors following observation of 284 SREs (60% of total events). Results: Between June 2004 and April 2012, 645 patients were randomly assigned to ZA or P. Median time to first SRE was 32.5 months in the ZA group and 29.8 months in the P group (hazard ratio (HR) 0.96 [0.76-1.22]; stratified log-rank P=0.74). A total of 271 deaths were observed; median follow-up time for surviving patients was 24.4 months (20.6, 28.3). Overall survival was similar between groups (HR= 0.89 [0.70-1.14]; stratified P=0.34). Rates of grade 3 or higher adverse events were similar between groups (15% vs. 12% in ZA and P). Conclusions: In men with castration-sensitive prostate cancer and bone metastases, early treatment with zoledronic acid was not associated with lower risk for SREs or death. Early termination limited statistical power of the study. Clinical trial information: NCT00079001.

Effects of surface-bound and intravenously administered heparin on cell-surface interactions: inflammation and coagulation

Intravenous administration of heparin and heparin-bonded extracorporeal circuits are frequently used to mitigate the deleterious effects of blood contact with synthetic materials. The work described here utilized human blood in a micro-perfusion circuit to experimentally examine the effects of intravenous and surface-bound heparin on cellular activation. Activation markers of coagulation and of the inflammatory response were examined using flow cytometry; specifically, markers of platelet, monocyte, polymorphonuclear leukocyte (PMN), and lymphocyte activation were quantified. The results indicate that surface-bound heparin reduces the inflammatory response whereas systemically administered heparin does not. This finding has important implications for blood-contacting devices, particularly within the context of recently elucidated connections between inflammation pathways and coagulation disorders. Data presented indicate that surface-bound heparin and intravenously administered heparin play distinct, but vital roles in rendering biomaterial surfaces compatible with blood.

Association between urinary 6β-hydroxycortisol/cortisol ratio and CYP3A5 genotypes in a normotensive population

Genetic polymorphism of genes involved in renal salt handling and arterial vessel tone is considered to be one of the causes of hypertension. Numerous reports suggest that cytochrome P4503A5 (CYP3A5) catalyzes 6β-hydroxylation of endogenous cortisol (CS), which is associated with sodium and water retention in the kidney and involved in the regulation of blood pressure. The purpose of the present study was to study the associations of single nucleotide polymorphisms in the CYP3A5 gene with the urinary 6β-hydroxycortisol/cortisol (6β-OH-CS/CS) ratio considered as quantitative phenotypes. CS measurements of three hundred (n=300) healthy, normotensive North Indian individuals was performed on morning spot urine samples by high-performance liquid chromatography. Furthermore, genotyping for CYP3A5*3 and CYP3A5*6 was performed by PCR-RFLP. The results indicated a unimodal distribution of CYP3A phenotypes in the North Indian population. In further analysis, all the phenotypes were distributed into three groups, demonstrating low (n=75), intermediate (n=150) and high CYP3A activity (n=75) based on CS and 6β-OH-CS levels and log 6β-OH-CS/CS ratios. The subjects in the low and high activity groups were genotyped for the CYP3A5*3 and *6 alleles. The present study demonstrated that the allele frequencies of CYP3A5*1 and *3 were 0.29 (95% CI, 0.22–0.36) and 0.71 (95% CI, 0.64–0.78), respectively. Notably, the frequency of normal homozygotes (CYP3A5*1/*1) was significantly higher in the high activity than the low activity group (11% vs. 5%). Similarly, the frequency of mutant homozygotes (CYP3A5*3/*3) was significantly higher in the low activity group than the high activity group (57% vs. 44%). The allele frequency of CYP3A5*3 was significantly higher in the low activity group (0.76) than the high activity group (0.67). The mean 6β-OH-CS/CS ratios were 110, 76 and 69 in wild-type homozygotes (n=12), heterozygotes (n=62) and mutant homozygotes (n=76), respectively. The difference between the normal and mutant homozygotes was statistically significant (P<0.05). The CYP3A5*6 allele was absent from all the subjects genotyped. This is the first study to report the genetic polymorphism of CYP3A5 in a North Indian population and its association with urinary 6β-OH-CS/CS ratio reflecting the CYP3A phenotypes.

Association between selected socio demographic variables and musculoskeletal symptoms experienced by dentists in a southern Karnataka district

BACKGROUND

The majority of working dentists experience some type of musculoskeletal discomfort during the course of their professional career. The prevalence and location of musculoskeletal symptoms are influenced by work habits, postures adopted by dentists while performing their professional work and socio demographic variables.

OBJECTIVES

The current study was carried out to find the association between musculoskeletal symptoms experienced by dentists and selected socio demographic variables in a southern Karnataka district.

METHODS

For this study 300 dentists were selected by using convenience sampling method among post graduate dental students, faculty members and private practitioners with more than one year of experience from in and around Mangalore city. In order to find the association, a pre-tested, self-administered questionnaire - Musculoskeletal Disorder Rating Scale was used.

RESULTS

The study showed that there was statistically significant association between frequency of pain and average patient(s) treated per day. The association between intensity of pain and average patient(s) treated per day was highly significant. Further there was a significant association between intensity of pain and field of dental practice. With regard to the field of dental practice, frequency of stiffness was significantly associated with the age. The association between frequency of stiffness and no. of year(s) in profession was highly significant.

CONCLUSION

The study revealed a significant association between musculoskeletal symptoms experienced by the dentists and socio demographic variables like; age, field of dental practice, no. of years in profession and average patients treated per day.