Systematic Review of the roles of Inositol and Vitamin D in improving fertility among patients with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine and metabolic disorder among reproductive-age women. As a leading cause of anovulatory infertility, it complicates fertility treatments, including in vitro fertilization. The widely accepted 2003 Rotterdam diagnostic criteria for PCOS include sub-phenotypes based on variations in androgen excess, ovulatory dysfunction, and polycystic ovarian morphology. In this systematic review, we examined the impacts of inositol and vitamin D on fertility in PCOS. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we used relevant keywords to comprehensively search databases including PubMed, Google Scholar, and MDPI. From an initial pool of 345 articles, 10 met the inclusion criteria. The articles suggest that vitamin D and inositol, particularly myo-inositol and D-chiro-inositol, may represent therapeutic options for PCOS. Vitamin D influences ovarian follicular development, glucose regulation, and insulin sensitivity. When combined with metformin therapy, it is associated with improved menstrual regularity and ovulation. Inositol is crucial for cellular signaling, energy metabolism, glucose regulation, and fertility. This systematic review underscores the importance of investigating inositol and vitamin D within a PCOS management strategy, given the disorder's prevalence and impacts on fertility and metabolic health. Although these agents show promise, additional research could clarify their mechanisms of action and therapeutic benefits. This review emphasizes the need for exploration of effective treatments to improve the quality of life among individuals with PCOS. Inositol and vitamin D represent potential options, but more studies are required to elucidate their roles in the management of this condition.

Single-Layer or Double-Layer Intestinal Anastomosis: A Systematic Review of Randomized Controlled Trials

Several malignant and benign indications may necessitate bowel resection. Despite the emergence of newer techniques, the hand-sewn technique remains popular for the reestablishment of intestinal continuity after resection. This method can achieve anastomosis in one or two layers. Some studies have suggested that the single-layer technique has several potential benefits compared to its rivals while simultaneously maintaining a comparable efficacy and safety profile. Previous reviews have failed to recommend either of these methods over the other due to a lack of high-quality evidence. This review aims to establish which technique provides the best outcomes by reviewing recent relevant trials and comparing both methods. We conducted a systematic review of randomized controlled trials (RCTs) using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. A database search of PubMed, Google Scholar, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) ultimately returned nine randomized trials published between 2003 and 2023 comparing single-layer intestinal anastomosis (SLIA) and double-layer intestinal anastomosis (DLIA) that fit the inclusion criteria. Overall, results show a dearth of robust trials, and the included studies displayed variable eligibility criteria and materials used for anastomosis. The available evidence, however, does suggest that neither technique is inferior in terms of preventing post-operative complications, but SLIA is less expensive and quicker to perform. The evidence is, however, limited, and further high-quality research is needed.

PCSK-9 Inhibitors and Cardiovascular Outcomes: A Systematic Review With Meta-Analysis

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been approved to treat dyslipidaemia. However, there is a lack of knowledge on the most efficient PCSK9 therapies that target PCSK9 for secondary prevention in subjects at high risk for cardiovascular (CV) events. Thus, this study aimed to assess the efficacy and safety of anti-PCSK9 antibodies in randomized controlled trials (RCTs). A comprehensive review of the available literature was done to identify RCTs that compared the use of PCSK9 inhibitors coupled with placebo or ezetimibe for the secondary prevention of CV events in patients on statin-background therapy. All-cause mortality was the major efficacy endpoint, while severe adverse events were the key safety outcome. A random effects model was used, and data were presented as risk ratio (RR) or risk difference with their corresponding 95% confidence intervals (CI). The heterogeneity of the publications was determined using Cochran's Q test, and publication bias was visually examined using funnel plots. All the chosen studies' quality was assessed using the Critical Appraisal Checklists for Studies created by the Joanna Briggs Institute (JBI). Forty-one studies (76,304 patients: 49,086 on evolocumab, and 27,218 on alirocumab) were included, and their years of publication spanned from 2010 to 2023. Overall, no significant differences were observed in CV and all-cause mortality between PCSK9 inhibitors and controls. However, alirocumab use was linked to a reduced risk of all-cause death compared to control, but not evolocumab. Each of the drugs, evolocumab and alirocumab, significantly reduced the risk of myocardial infarction (MI), coronary revascularization, and ischemic stroke. In comparison to the control therapy, the risk of major detrimental sequelae was significantly reduced by alirocumab therapy in the subgroup analysis of each PCSK9 inhibitor, whereas evolocumab treatment did not demonstrate significant differences (RR = 0.88; 95% CI = 0.72-1.04; evolocumab: RR = 0.99; 95% CI = 0.87-1.11). Both evolocumab and alirocumab are well-tolerated, safe medications that significantly lower low-density lipoprotein (LDL) levels.

Does the severity of untreated dental caries of preschool children influence the oral health-related quality of life?

AIM

To assess the impact of untreated dental caries and its severity on the oral health-related quality of life (OHRQoL) of Kuwaiti preschool children and their caregivers.

METHODS

Participants were 4- and 5-year-old kindergarten children attending preselected public schools from one of the Governorates in Kuwait. Early childhood caries (ECC) was evaluated by clinical examinations and presented using decayed, missed, filled teeth/surface (dmft/dmfs). The clinical consequences of untreated dental caries were assessed using the pufa (pulp, ulcers, fistula, abscess) index for primary teeth. A structured questionnaire obtained demographic information of children and their caregivers. OHRQoL was assessed using the Arabic version of Early Childhood Oral Health Impact Scale (A-ECOHIS).

RESULTS

Among the 334 participants, 171 were kindergarten level-1 (KG1), and 163 were level-2 (KG2). The overall prevalence of dental caries was 78.9% for KG1 children and 67.4% for KG2 children. Decayed teeth were the main component for both dmft (84%) and dmfs (68%). The total mean (SD) pufa score was 0.54 (1.5), and about 19.2% of participants had at least one tooth with pufa > 0. A total of 207 A-ECOHIS were completed. Both family and child impact scores were significantly higher for children with a dmft score of 1 or more (p < 0.001) or with one or more pufa (p < 0.001). Child impact section scores were significantly higher with the increasing degrees of untreated caries (dt) (p = 0.004).

CONCLUSION

The severity of untreated dental caries and caries experience had a negative impact on the OHRQoL of Kuwaiti preschool children and their families. Using the pufa index had provided additional information about the effect of the caries severity on the OHRQoL than assessing the caries experience alone.

Role of meteorological parameters with the spread of Covid-19 in Pakistan: application of autoregressive distributed lag approach

This research focuses on the impacts of different meteorological parameters (temperature, humidity, rainfall, and evapotranspiration) on the transmission of Covid-19 in the administrative regions and provinces of Pakistan, i.e., Azad Jammu and Kashmir, Gilgit Baltistan, Khyber Pakhtunkhwa, Islamabad, Punjab, Sindh, and Balochistan from June 10, 2020, to August 31, 2021. This study analyzes the relation between Covid-19-confirmed cases and the meteorological parameters with the help of the autoregressive distributed lag model. In this research, additional tools (t-statistics, f-statistics, and time series analysis) are used for the motive of examining the linear relationship, the productivity of the model, and for the significant association between dependent and independent variables, lnccc and lnevp, lnhum, lnrain, lntemp, respectively. Values of t-statistics and f-statistics reveal that variables have a connection and individual significance for the model exist. Time series display that the Covid-19 spread increased from June 10, 2020, to August 31, 2021, in Pakistan. Temperature positively influenced the Covid-19-confirmed cases in all provinces of Pakistan in the long run. Evapotranspiration and rainfall influenced positively, while specific humidity influenced negatively on the confirmed Covid-19 cases in Azad Jammu Kashmir, Khyber Pakhtunkhwa, and Punjab. Specific humidity had a positive impact, while evapotranspiration and rainfall had the negative impact on the Covid-19-confirmed cases in Sindh and Balochistan. Evapotranspiration and specific humidity influenced positively, while rainfall influenced the Covid-19-confirmed cases negatively in Gilgit Baltistan. Evapotranspiration influenced positively, while specific humidity and rainfall influenced negatively on the Covid-19-confirmed cases in Islamabad.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13762-023-04997-4.

Effect of Non-surgical Periodontal Therapy on the Clinical Periodontal Inflammatory Parameters in \(\beta\)-Thalassemia Major (TM-\(\beta\)) Patients with Gingivitis

Background: Increased prevalence of gingival diseases in thalassemia patients has been consistently reported. In diseases with neutrophil dysfunctions, periodontal tissue is lost very rapidly. \(\beta\)-thalassemia major (TM- \(\beta\)) patients exhibit defective neutrophils and macrophages. Therefore, supplementary gingival inflammation is detrimental to periodontal tissues in these patients. This warrants attention to specialized oral health care intervention in these patients. This is the pioneer pre and post study that evaluates the effect of non-surgical periodontal therapy (NSPT) in \(\beta\)-thalassemia major (TM- \(\beta\)) patients with gingivitis. And also reports the prevalence and distribution of disease severity in TM- \(\beta\)patients. Methods: 31 patients (15 females, 16 males) fulfilling the inclusion criteria were provided with protocol guided NSPT including scaling, polishing and chemical mouthrinse (0.2% CHX). Gingival index (GI), plaque score, Papillary bleeding index (PI) and periodontal pocket depth (PPD) were recorded with a periodontal probe (UNC-15) at baseline and evaluated after 6 weeks of intervention. Paired T-test was applied for GI, PBI and plaque and Wilcoxon signed rank test for PPD at the P-value of <0.05 Results: 86% of the assessed individuals had gingivitis (6% -mild, 44%- moderate and 36% - severe). NSPT showed highly significant (P - <0.000) improvement from baseline to 6 weeks after intervention for all the clinical parameters, GI, PBI, plaque score and PPD. Conclusion: Within the limitations of the study, the results show that with proper protocol, multidisciplinary approach and careful screening of the patient’s systemic status, TM-\(\beta\)patients with gingivitis respond positively to local measures of plaque control.

Fighting Airborne Spread of COVID-19: An Innovative, Economical and Effective High Vacuum Extra Oral Dental Suction System (HVEDS) for Dental Practices

Introduction:

The COVID-19 pandemic has led to a great deal of commentary about the airborne spread of the disease. It is of special concern for dentists as most dental procedures generate a significant amount of aerosols and droplets. Given such high risk and inevitable aerosol production in dentistry, special precautions and protective measures to ensure the safe delivery of dental treatment are directed. To ensure negligence-free dental practice, in addition to the standard protective procedures and measures, a high vacuum extra oral dental suction system is a mandated dental armamentarium.

Aims and Objectives:

Most commercially available vacuum aspirators are pricey and require special units with which they can work. In a country like Pakistan, where an expensive armamentarium is neither available nor easily affordable, we present an economical yet effective, high volume extra oral dental suction system for the dental offices which does not require a heavy monetary investment.

Equipment:

An in-house alternate to the commercially available extra oral aspirator is introduced here. We devised a make-shift extra oral aerosol aspirator that can be effortlessly assembled with the materials easily available around dental offices.

Result:

When tried in use, the aerosol and spatter were eliminated through the cone-shaped oil key and collected into the collection bin as observed visually. The equipment, due to its high vacuum suction capability, sucks the aerosol and splatter from the working area to the collection cone.

Conclusion:

Post COVID-19, we can expect a lot of changes in the infection control practices and guidelines. The use of extra oral vacuum aspiration along with the conventional protocol has been recommended to protect both the dental staff and the patients as the high vacuum extra oral aspirator may offer a way to reduce the generated aerosol particulate

Relationship between HbA1c Levels and Severity of Diabetic Retinopathy

Purpose:  To determine the relationship between HbA1c and severity of retinopathy in diabetic patients. Study Design:  Cross sectional study. Place and Duration of Study:  Eye department of DHQ-UTH Gujranwala, from July 2020 to Dec 2020. Methods:  An observational cross-sectional study including 100 patients was conducted at eye department of DHQ-UTH Gujranwala from January 2018 to December 2018. After approval from institutional review board, written informed consent with demographic variables was collected from every patient. Patients of either gender between 40-80 years of age with both types I and type II diabetes were included in this study. Complete ophthalmic examination including Best Corrected Visual Acuity, slit lamp biomicroscopy, Goldmann Applanation tonometry and fundus examination carried out. Diabetic retinopathy was classified from grade 0 to grade 5. Results:  Out of 100 patients, 46 (46%) were males and 54 (54%) were females. Mean age was 60 ± 2.4 years with a range of 40 – 80 years among males and 40 – 70 years among females. Forty patients presented with grade 1 diabetic retinopathy and 4% presented with grade 5. Thirty two patients had good glycemic control while 20% had glycemic control of grade III. Patients with grade 4 diabetic retinopathy had the worst glycemic control of HbA1c level of 11.5. Conclusion:  This study concluded that patients with poor glycemic control had severe diabetic retinopathy as compared to the patients with good diabetic control. There is a direct relation between HbA1c level and severity of diabetic retinopathy. Key Words:  HbA1C, Diabetic retinopathy, Non proliferative diabetic retinopathy, Proliferative diabetic retinopathy, Vitreous hemorrhage.

Tuning the optoelectronic properties of superalkali doped phosphorene

In this study, the nonlinear optical (NLO) properties of pristine phosphorene and superalkali (Li₃O) doped phosphorene are estimated through the density functional theory (DFT) method to investigate the optical properties. The geometries of complexes have been optimized using the B3LYP/6-31G (d, p) level of theory. The effects of doping on phosphorene have been thoroughly explained by vertical ionization energy (VIE), interaction energies (E_int), and natural bond orbitals (NBO), Moreover, the density of states (DOS), electron density difference map (EDDM) analysis, the frontier molecular orbitals (FMO) plots are also given out to find more physical divination into the electronic communication and structure property relationship. The doping of superalkali conclusively has reduced the HOMO-LUMO energy gap of M1 3.28 eV-1.25 eV for M2 making it the n-type semiconductor. The higher values of E_int,E_fm and VIE obtained for M2 has indicated that this complex has higher stability and stronger interaction between superalkalis and phosphorene. More interestingly, there has been a gradual increase in the first static hyperpolarizability (β_static) values for M1, M2 and M3 are 115.75 au, 4118.6 au, and 659.30 au respectively. The Static second hyperpolarizability (γ_static) of the doped complexes has also been calculated from which the M2 has the highest value of 1382.5 ҳ 10³ au. The TD-DFT exploration has exhibited that the doped molecules are adequately transparent in the UV region. Some selected systems are also compared with the p-NA reference molecule which is a familiar external reference molecule for NLO applications. From UV absorption analysis, it can be found that these doped complexes of phosphorene may be contemplated as a new applicant for intense ultraviolet NLO materials. Computational studies have revealed the stability of M2 and M3 making them feasible as NLO materials in optoelectronic applications.

Frequency of Hepatitis C in Patients Undergoing Ophthalmic Surgeries; A Multicenter Study

Purpose: To find the frequency of Hepatitis C in tertiary care hospitals in Gujranwala and Lahore.Study Design: Cross sectional observational study.Place and Duration of Study: Ophthalmology Departments of District Head Quarters Teaching Hospital Gujranwala and at Sardar Trust Eye Hospital, Garhi Shahu, Lahore for a duration of 12 months from March 2017 to March 2018.Material and Methods: A chart review of all patients admitted in the above mentioned hospitals was conducted. Patients with insufficient clinical information documented in hospital record were excluded from the study. Status of each of the patient whether Hepatitis C positive or not, was determined by the method of rapid chromatography immunoassay for qualitative detection. The results of all patients were recorded according to their age, sex and their demography.Results: The study was conducted on 4968 patients admitted for ophthalmic surgeries above the age of 13 years. There were 1003 patients at DHQ Hospital Gujranwala and 3965 at Sardar Trust Eye Hospital. Out of 1003, 548 patients (54.6%) were male and 455 (45.3%) were female. 189 patients turned out to have Hepatitis C having a prevalence of 18.8%. However, at Sardar Trust Eye Hospital, out of 3965 patients admitted, 2914 (73%) were male, and remaining (27%) were female. 418 patients were found to be Hepatitis C positive, which constituted about 10.5% of all patients in Lahore.Conclusion: Frequency of Hepatitis C was 18% in Gujranwala with female dominance and 10.5% in Lahore with male predominance

Complications in implant dentistry

After tooth loss, an individual may seek tooth replacement so that his/her function and esthetics could be restored. Clinical prosthodontics, during the past decade, has significantly improved and developed according to the advancements in the science and patient's demands and needs. Conventional options in prosthodontics for substituting a missing single tooth include the removable partial denture, partial and full coverage bridgework, and resin-bonded bridgework. Dental implants have gained increasing popularity over the years as they are capable of restoring the function to near normal in both partial and completely edentulous arches. With substantial evidence available, fixed implant-supported prosthesis are fully acknowledged as a reliable treatment option for the replacement of single or multiple missing teeth nowadays. While dental implants are increasingly becoming the choice of replacement for missing teeth, the impediments associated with them are progressively emerging too.

Prevalence and Predictors of the Burnout Syndrome in Medical Students of Karachi, Pakistan

Objectives

Burnout is a psychophysiological syndrome, consisting of a triad of emotional and physical exhaustion, exhibition of impersonal attitude and loss of a sense of achievement for oneself. This study aimed to pinpoint its risk factors, measure its current prevalence in medical students of Karachi, Pakistan and accentuate the areas of focus to benefit the primary care-oriented community as a whole.

Methods

This cross-sectional study included responses from 600 medical students in Karachi (third to final year). A self-administered questionnaire using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), multi-dimensional mood state questionnaire and perceived stress scale was used, along with a section about burnout prevention assessment. Data were analyzed using SPSS version 24.0 (IBM Corp., Armonk, NY) and chi-square tests used to find significant associations.

Results

One-fifth (n=109, 18.2%) of our subjects were burned out. The syndrome was significantly observed in those who operated on insufficient sleep (p-value 0.028) and in those having anger management issues and non-dominating temperaments (p-value 0.05). Furthermore, it was statistically significant in those who gave up easily, in those who had no hobbies and had no time to exercise and pray (p-value <0.05). It was more prevalent in pupils of private medical colleges whereas two of its three constitutive factors, Emotional Exhaustion (p-value 0.03) and Personal Achievement (p-value <0.001) were significantly higher in pupils of public sector universities. 

Conclusion

The deleterious repercussions of burnout syndrome warrant the need for extensive efforts towards the propagation of its awareness.

Prevalence of Rheumatic Diseases in a Tertiary Care Hospital of Karachi

BACKGROUND

Rheumatic diseases are referred to as conditions affecting joints, muscles, ligaments, tendons, and bones. According to a report by World Health Organization, rheumatic and musculoskeletal diseases were labeled as the second most reported cause of disability around the globe. The purpose of this study was to estimate the prevalence of rheumatic diseases in a tertiary care hospital of Karachi; additionally, associations with age groups, gender and comorbidities were obtained as well.

METHODS

A cross-sectional study was conducted at the Orthopedic Out Patient Department (OPD) of Dr. Ruth KM Pfau Civil Hospital, Karachi over a span of three months in 2018 (February till May). All 346 patients were follow-up diagnosed cases in the age range of 11-90 years, divided into groups of adolescents, young adults, adults, and older adults. The subjects were questioned about their symptoms, duration of illness, presence of comorbidities, genetic background and the therapy they are undergoing along with compliance. Simple statistical analysis of frequency was done, whereas chi-square test was applied to study associations with gender, age groups, and comorbidities.

RESULTS

During the study period, a total of 2000 patients visited the orthopedic OPD, 346 of which were diagnosed cases of rheumatic diseases, yielding a prevalence of 17.3%. The mean age of rheumatic patients who partook in the study was 46.15 ± 15.49 (Range: 12 - 84). Osteoarthritis was recorded as the most prevalent condition, followed by non-specific low back pain and rheumatoid arthritis. Osteoarthritis was statistically significant in young adults, adults, and older adults, while non-specific low back pain had significant associations with gender, young adults, and adults. Diabetes was significantly associated with osteoarthritis, non-specific low back pain, shoulder pain syndrome and psoriatic arthritis, while hypertension significantly co-existed with systemic lupus erthematosus.

CONCLUSION

Rheumatic diseases constitute a major disease burden in almost all of the age groups, especially in young patients (18-40 years) within our setup.

Attitude and knowledge of family medicine practitioners towards the association between periodontal disease and obesity

OBJECTIVES

To assess the attitude and knowledge of family medicine practitioners (FMPs) towards the association between periodontal disease and obesity.

MATERIALS AND METHODS

A cross-sectional study was performed and a 13-item survey questionnaire was given to FMPs practicing in 12 different teaching hospitals in Karachi, Pakistan. The questions were aimed at exploring the knowledge of FMP's regarding the association of obesity and periodontal disease and their attitude towards the association of obesity and periodontal disease. Chi-square and Spearman co-efficient were conducted to compare subgroups and correlate factors with the knowledge score of FMPs.

RESULTS

A total of 314 questionnaires were completed (response rate = 92%). Median age of participants was 41 years and 57% were females. Almost 61% of FMPs answered all the knowledge questions correctly and 64% reported moderate understanding of the association between periodontal health and obesity. Nearly 73% FMPs inquired from obese patients regarding the periodontal disease and more than half (58%) refer patients to a dentist for evaluation. More than half of FMPs perform periodontal disease screening. Nearly all FMPs considered informing obese patients regarding periodontal disease as one of their roles.

CONCLUSIONS

FMP's play an important role in the early diagnosis, prevention and treatment of periodontal conditions in obese patients. More than two thirds of FMPs showed good knowledge of the association of obesity and periodontal disease. The attitudes of FMPs towards assessing and referring obese patients at a risk of having periodontal disease were reassuring.

Abstract P6-09-37: Ductal carcinoma in situ: Patient outcomes and association with hormone receptors

Background

Local recurrence is a major concern in patients (pts) diagnosed with ductal carcinoma in situ (DCIS). Therefore, the need to identify pts at risk for DCIS recurrence is a significant priority. In invasive breast cancers, ER+/PR- subtype is considered a more aggressive tumor phenotype with poorer prognosis as compared to ER+/PR+ tumors. It is unclear whether this molecular subtype holds the same significance in pts with DCIS.

Methods

We designed an analysis to determine if a significant difference exists in the recurrence rates in pts with ER+/PR- DCIS when compared to ER+/PR+ tumors. Six hundred and ninety three pts diagnosed and treated for DCIS at Froedtert & MCW Clinical Cancer Center from Feb 2002-March 2015 were included in our study. Recurrence was defined as either non-invasive or invasive ipsilateral, contralateral or distant disease. Probabilities of recurrences were calculated using Kaplan-Meier estimator. Cox proportional hazards model was used to evaluate the effect of prognostic factors on DCIS recurrence.

Results

Median follow up was 5.2 years. Five year recurrence free survival (RFS) was 91% (95% CI 88.2-93.3) while estimated 7 year RFS was 86% (95% CI 81.9-89.2). Patient characteristics are shown in table below. Seventy five pts were found to have a recurrence during their follow-up. Most of the grade 1 tumors were ER+/PR+ whereas almost all of the ER-/PR- subtype were high grade tumors. ER+/PR- tumors were mainly intermediate and high grade (p &lt;0.0001). Pts with ER-/PR- tumors had a significantly higher risk of recurrence (HR 3.7, 95% CI 1.9-7.2, p=0.0001) and those with ER+/PR- tumor subtype did not have a statistically significant difference in risk of recurrence when compared to ER+/PR+ tumors (HR 1.75, 95% CI 0.92-3.32, p=0.085). Pts who did not receive endocrine therapy for their ER+ DCIS had a significantly higher risk of recurrence as compared to those who received endocrine therapy (HR 2.2, 95% CI 1.23-3.92, p=0.0073). When compared to pts undergoing lumpectomy and radiation, pts undergoing lumpectomy alone had a significantly higher risk of recurrence (HR 2.5, 95% CI 1.32-4.93, p=0.005) whereas those who underwent mastectomy had a significantly lower risk of recurrence (HR 0.34, 95% CI 0.15-0.8, p=0.014).

Patient characteristicsCharacteristicsN (%)Total no. of patients693Median age53 (21-91)Median BMI27 (17-65)Post-menopausal480 (69)OCP use301 (43)HRT use201 (29)Tumor characteristics Median size0.8cm (0.2-6.5)Histology Solid349 (52)Cribriform290 (43)Papillary35 (5)Comedo necrosis423 (61)ER/PR status ER+/PR+482 (71.2)ER+/PR-77 (11.4)ER-/PR-118 (17.4)Tumor grade Low125 (18)Intermediate305 (45)High250 (37)Treatment Lumpectomy517 (75)Mastectomy169 (25)Radiation450 (66)Endocrine therapy286 (42)Patients with recurrence75 (11)Type of recurrence In-situ44 (6)Invasive31 (5)BMI=body mass index, OCP=oral contraceptive pills, HRT=hormone replacement therapy

Conclusion

ER+/PR- subtype was not a significant predictor of recurrence in DCIS patients. This finding is in contrast to the risk of recurrence and tumor aggressiveness seen in invasive breast cancers. Mastectomy and post lumpectomy radiation were associated with improved outcomes as was adjuvant endocrine therapy.

Citation Format: Chaudhary LN, Jawa Z, Hanif A, Szabo A, Chitambar CR. Ductal carcinoma in situ: Patient outcomes and association with hormone receptors [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-09-37.

Measuring the well-being of health care professionals in the Punjab: a psychometric evaluation of the Warwick-Edinburgh Mental Well-being Scale in a Pakistani population

Background. There is growing awareness of the public health importance of mental well-being both in the general population and in specific groups. The well-being of health professionals is likely to influence the quality of the care they deliver. This study was carried out to examine the well-being of Pakistani healthcare professionals, and to evaluate the psychometric performance of the Warwick–Edinburgh Mental Well-being Scale (WEMWBS) in this population.

Methods. A cross-sectional survey was carried out from June, 2013 to December, 2014 among 1,271 Pakistani health care providers (HCPs) working in seven different cities in Punjab province, Pakistan, to examine the acceptability, internal consistency, test-retest reliability and content and construct validity of the English version of the WEMWBS in a Pakistani population sample. All data were analyzed in SPSS v. 21.

Results. Our analysis demonstrated unidimensional construct validity, high internal consistency (0.89) and test-retest reliability, good validity and easy readability of WEMWBS in our sample of Pakistani HCPs. The mean WEMWBS score was 48.1 (SD 9.4), which is lower than in the general population in other countries. Male HCPs scored significantly higher on the WEMWBS than their female counterparts (P < 0.05), and older respondents had higher scores.

Conclusion. The WEMWBS appears acceptable for use in Pakistani HCPs, and findings from this study verify its validity and internal consistency for this population sample. Our respondents had lower well-being scores than those reported in general population surveys in the UK.

TRENDS IN COMPLETE DENTURE IMPRESSIONS IN PAKISTAN

BACKGROUND

Multiple materials and techniques have been reported for complete denture impressions in literature. The aim of the study was to assess the trends in complete denture impression materials and techniques among general dental practitioners (GDP) and specialists (SP) in Pakistan.

METHODS

In this cross-sectional study, self-designed-structured questionnaires were distributed among 500 dentists in Pakistan. The three-part questionnaire enquired about the demographic features, preferred impression materials, impression techniques and related procedures commonly used in their clinical practice. A comparison between the responses of SP and GDP was also drawn. Frequency distribution and Chi-square test were performed to compare the responses.

RESULTS

A total of 294 questionnaires were completed at a response rate of 58.8%. 75% of GDP used alginate for primary impressions and 66% of SP preferred impression compound for the same. A majority of both SP and GDP favoured the used of custom trays (SP 81%, GDP 85%) and selective pressure technique (SP 84%, GDP 53%) for final impression. However, 85% of GDP used zinc-oxide eugenol and 62% of SP favoured elastomeric materials for the same. Most of the SP and GDP used chemical cured resin custom trays (SP 54%, GDP 75%), however, 86% of SP used spaced trays and almost 60% of GDP preferred close-fitting trays.

CONCLUSIONS

The practice of GDP and SP with regards to CD impression materials and techniques differed significantly. Continued education and training for GDP and SP with respect to procedures and techniques related to CD is recommended.

A vapor phase adsorptive desulfurization process for producing ultra low sulphur diesel using NiY zeolite as a regenerable adsorbent

A NiY zeolite based vapor phase adsorptive desulfurization process has been described which can bring down sulphur concentration of a commercial BS IV grade (Euro IV equivalent) diesel from 50 ppm to a <5 ppm level.

Morbidity from episiotomy

OBJECTIVE

To assess the morbidity from episiotomy.

METHODS

The prospective randomised control study was conducted at the Military Hospital Rawalpindi's Gynaecology & Obstetrics Department from January 2006 to April 2008. It comprised 100 patients who were given a mediolateral episiotomy at the crowning of the foetal head (group 1). Another group of 100 patients were delivered without an episiotomy (group 2). Postpartum morbidity was compared in the two groups. Morbidity included perineal damage by tears, subjective assessment of pain at perineum, dyspareunia after puerperium, feeling of pressure puerperium, incontinence and objective assessment of prolapse after puerperium.

RESULTS

Morbidity including perineal damage by tears, pain at perineum and dyspareunia, was much more in group I as compared to the group II. There was no significant difference in feeling of pressure perineum, subjective feeling of urinary and flatus incontinence or objective assessment of prolapse of vagina and uterus.

CONCLUSION

There are no significant advantages of episiotomy. In fact, it leads to morbidity which is otherwise avoidable in deliveries that are episiotomy-free.

Evaluating trial of scar in patients with a history of caesarean section

Aims:

To analyze the outcome of trial of scar in patients with previous caesarean section and to assess the fetal and maternal complications after trial of scar.

Patients and Methods:

The study was conducted at Military Hospital, Rawalpindi, Pakistan, with 375 pregnant patients who had a previous delivery by caesarean and who had regular antenatal checkup. Data were recorded on special pro-forms designed for the purpose.

Results:

The results from the 375 patients who had one previous lower segment caesarean section due to non-recurrent causes were analyzed and compared with national and international studies. Indications of previous caesarean section (non-recurrent causes) included malpresentations, fetal distress/cord prolapse, failure to progress, severe pregnancy-induced hypertension/eclampsia and twins with abnormal lie of the first twin. 0 218 patients reported spontaneous labor. Among these patients, 176 delivered vaginally and 42 patients had repeat caesarean sections. There were a total of 157 patients who experienced induction of labor. 97 patients were induced by cervical ripening with mechanical method, followed by artificial rupture of membranes and augmentation (if required) with syntocinon infusion. 60 patients were induced with prostaglandin E₂ vaginal tablet.

Conclusion:

This study concludes that females with a prior caesarean are at increased risk for subsequent caesareans, regardless of mode of delivery. Eliminating vaginal-birth-after-caesarean will not eliminate the risk. Therefore, vaginal birth after caesarean should be encouraged in selected cases from obstetric units to reduce the risks of repeated caesarean sections. Failed vaginal-birth-after-caesarean can result in increased morbidity than that with elective caesarean section.

Evaluation of existing curriculum (2002) of undergraduate medical education in Bangladesh

This study was conducted for evaluation of existing MBBS curriculum (2002) of undergraduate medical education in Bangladesh. The specific objectives of this study were: i) to assess the subject wise course content coverage in the new MBBS curriculum, ii) to assess different examination system for evaluation of MBBS students, iii) to evaluate the effectiveness of teaching and learning activities under the curriculum, iv) to explore students opinions regarding improvement of new curriculum. This was a descriptive cross-sectional study. The study was conducted among the students of Dhaka medical colleges of Bangladesh in 2008. Data was collected by self administered structured questioner adopting convenient sampling method. About ninety percent students opined that the coverage of course content of subjects in the curriculum in Phase I was enough. In case of the subjects in phase II except community medicine more than four fifth of the students expressed their opinion about coverage of course content in the curriculum as enough. In case of phase III it was mentioned by most of the students that coverage of course content was enough. Study revealed that teaching methods were perceived suitable by about three fourth of the respondents, to achieve learning objectives. Most of the students expressed their positive views regarding practice of block posting teaching. More than three fourth of the students perceived that formative assessment was encouraging for students to become time bound learner and Structured Oral Examination (SOE) was fair on an average. Only 31(8.6%) of the respondents had opinion that Objective Structured Practical Examination (OSPE)/Objective Structured Clinical Examination (OSCE) was not well organized. About half of the students opined that 20% marks in written test should be allocated for Multiple Choice Question (MCQ). Students' suggestions regarding teaching were: there should be smaller group sessions; more interactive sessions; more clinical and practical sessions; more problem oriented sessions; more sessions with senior and experienced teachers; teachers should follow the curriculum properly; and should be well prepared for class. Regarding assessment suggestions were: written script of the formative examination should be returned to students with feedback; teachers should not be biased. Study recommended that training of the teachers on teaching methodology and assessment system is needed; teachers should provide feedback to the students according to the performance of the formative assessment at the individual level; to maintain the standards of assessment proper planning, designing, conduction and evaluation of assessment should be taken into consideration; subject wise review and updating is essential to make the curriculum more need based, user friendly and applicable considering context of Bangladesh.

Plasma Renin in ipsilateral renal vein in patients with chronic unilateral pelvic ureteric junction obstruction

Acute experimental hydronephrosis induces increased output of renin from ipsilateral kidney. In most clinical presentation of unilateral hydronephrosis the patients are however, normotensive with normal circulating plasma renin activity. In consideration of this argument we undertook this prospective study of ipsilateral renal vein renin activity in children with congenital Pelvic Ureteric Junction Obstruction (PUJO) and compared with other wise normal children. In this prospective cross-sectional study, started from July 99 to June 2001, twenty patients, age upto 12 years, with unilateral hydronephrosis and in control group ten patients without hydronephrosis were taken. 2ml blood was taken from the renal vein in study group and from infrarenal portion of inferior vena cava during exploratory laparotomy from the control group. All the patients had advanced grade of hydronephrosis and two patients (13%) had mild hypertension. In this study the mean plasma renin activity (PRA) was 45.58 ng/ml/hr (range: 11.69-67.56 ng/ml/hr) in study group. The mean PRA in control group was 5.9ng/ml/hr. The result of study group was significantly higher than normal (P value 0.0003). In Bangladesh we are doing more conservative kidney preserving surgery for PUJO, but need long term follow up of the patients undergoing surgery for PUJO in childhood for potential of developing renin-angiotensin induced hypertension in later life.

The effect of sea bream (Sparus aurata) broodstock and larval vaccination on the susceptibility by Photobacterium damsela subsp. piscicida and on the humoral immune parameters

Sea bream broodstock were immunised 1 or 2 months before spawning with a novel photobacteriosis vaccine. Sixty-seven-day-old larvae (mean weight 22.3 mg) originating from immunised and non-immunised parents were experimentally infected with the Photobacterium damsela subsp. piscicida (Phdp). Larvae from immunised fish showed delayed onset and lower mortality (66.67%) compared with larvae from control fish (80%). Eighty-nine-day-old larvae (mean weight 162.2 mg) from both groups were bath vaccinated with Phdp and Escherichia coli lipopolysaccharides (LPS) and larval samples were collected for measurement of humoral parameters. Larvae vaccinated with Phdp and LPS showed significantly higher anti-protease activity, lysozyme activity and total immunoglobulin compared to the controls. One-hundred-and-twenty-day-old larvae (mean weight 297.85 mg) from both parental groups were challenged with (LD70) virulent Phdp bacterial cells. Vaccinated larvae from both groups showed significantly less mortality compared to the respective controls. The RPS values of larvae from immunised parents vaccinated with Phdp and LPS was 95.83% and 72.22%, respectively. The RPS values of larvae from non-immunised parents vaccinated with Phdp and LPS was 62.5% and 70.83%, respectively. Results are discussed with respect to the beneficial effect of broodstock immunisation prior to spawning and the immunisation of larvae on their survival against photobacteriosis.

Maternal transfer of humoral specific and non-specific immune parameters to sea bream (Sparus aurata) larvae

Immunisation of sea bream (Sparus aurata L.) broodstock with a novel vaccine mixture of Photobacterium damsela subsp. piscicida SK7 (Phdp) was performed during the period of egg development and the changes in specific and non-specific humoral immune parameters were measured. Total immunoglobulin level, specific antibody titre, anti-protease activity and lysozyme activity were significantly higher in immunised parents compared to the control. After spawning significantly higher anti-protease activity, lysozyme activity and total immunoglobulin level were detected in the eggs from immunised parents. Specific antibody titres against Phdp were only detected in the eggs from the immunised parents. The larvae from immunised parents also expressed significantly higher levels of specific and non-specific humoral immune parameters compared to the controls. A small amount of total immunoglobulin was detected in larvae decreasing gradually until day 8 post-hatching and then an increase was measured in larvae from immunised parents, whereas no immunoglobulin was detected at days 4, 6 and 8 in larvae from non-immunised parents. The specific antibody titre against Phdp was detected only in larvae from immunised broodstock until day 14 post-hatching. The higher humoral immune parameters in eggs and larvae from immunised parents in comparison to eggs and larvae from non-immunised parents, suggest transfer of maternal specific and non-specific immune factors.

The effect of in vivo growth on the cellular and extracellular components of the marine bacterial pathogen Photobacterium damsela subsp. piscicida

Photobacterium damsela subsp. piscicida, the causative agent of fish pasteurellosis, was grown in vivo. Bacterial cells and extracellular products (ECPs) were analysed via electrophoresis and immunoblot analysis, using specific sea bass antisera. Growth in vivo induced the synthesis of unique bacterial cell proteins at > 206, 206, 21.3, 18, 7.6 and < 7.6 kDa. Sea bass serum raised against live bacterial cells of the pathogen and especially a sea bass serum raised against formalin-inactivated bacterial cells grown in a specific novel medium recognized the novel antigens at > 206 (associated with iron sequestration), 21.3, 7.6 and < 7.6 kDa, suggesting that the latter medium conserves the synthesis of natural bacterial cell proteins in vitro. In vivo growth of the pathogen induced the synthesis of more toxic ECPs in comparison with in vitro growth and an inverse correlation between total protein concentration in the ECPs and toxicity per unit of protein was observed. Substrate-polyacrylamide electrophoresis revealed the presence of in vivo synthesized ECPs of the pathogen (proteases) at 175, 132, < 79 and 48.3 kDa. Histological examination of tissues isolated from fish injected with these ECPs revealed inflammatory and necrotic lesions in the spleen, liver, head kidney, intestine and heart as soon as 48 h post-introduction of the ECPs.

In hydronephrosis less than 10 % kidney function is not an indication for nephrectomy in children

PURPOSE

To reduce the incidence of nephrectomy or hydronephrosis in children.

MATERIALS AND METHODS

From September 1998 to October 2000, we treated 58 patients with hydronephrosis; their ages ranged from 35 days to 11 years (mean age 4 years 7 months). All patients were subjected to a DTPA renogram with split function. In 12 patients (study group), kidney function was less than 10 % (range 0 - 10 %). Initially, nephrostomy was carried out in all 12 patients followed by Anderson-Hyne's pyeloplasty after 4 - 6 weeks. Postoperatively renal USG, urine r/m/e & c/s (routine and microscopic examination and culture and sensitivity test), blood urea, serum creatinine were assessed and DMSA scan and DTPA renogram with split functions were carried out in all patients.

RESULTS

In the study group, all 12 patients showed improvement of renal function (more than 10 %) after nephrostomy and in all of them pyeloplasty was subsequently carried out within 4 - 6 weeks. There were no significant pre-, peri- or postoperative complications.

CONCLUSIONS

Contrary to common practice we do not recommend nephrectomy for hydronephrotic kidneys which show < 10 % of renal function on renogram. The renal functional status improves significantly after a preliminary nephrostomy, thus avoiding the need for a straightforward nephrectomy in children along with all the possible long-term effects of a single kidney.