Denture care and oral health-related quality of life among complete denture wearers in Eastern Province of Saudi Arabia

INTRODUCTION

This study aimed to evaluate denture care and hygiene and oral health-related quality of life (OHRQoL) among complete denture (CD) wearers in the Eastern Province of Saudi Arabia.

METHODOLOGY

This cross-sectional study was conducted on CD wearers in the Eastern Province of Saudi Arabia. A pre-tested questionnaire was administered among study participants. Questionnaire was divided in three sections: (1) patients' demographic data, (2) awareness and maintenance of CD and (3) OHRQoL. Independent sample t-test and one-way ANOVA test were performed.

RESULTS

The study included data of 300 participants with 71% of males and 28% of females. Majority of participants (82.7%) cleaned CD daily, removed CD while sleeping (88.0%) and knew that unhygienic dentures can cause oral infection (92.7%). Only 19.3% used denture cleansing tables, 41% used toothpaste, and 60.7% rinsed CD with water. Regarding OHIP-DENT domains, highest score was for functional limitation domain (2.20 ± 1.67) and the lowest for handicap domain (0.94 ± 1.09). The mean OHIP-DENT score of the sample was 12.02 ± 8.52. Females (p = 0.006), participants below 65 years of age (p = 0.029), non-Saudis (p = 0.042), those with university education (p = 0.030) and low monthly income (p = 0.045) and participants who visited dentist due to problem with CD (p = 0.041) demonstrated significantly higher mean OHIP-DENT score.

CONCLUSION

Majority of participants demonstrated appropriate denture care behaviours because they were aware of the importance of denture care and hygiene. Female gender, age below 65 years, non-Saudi nationality, university education, low monthly income and visiting dentist due to problem were related to poor OHRQoL.

Stone clearance and complication rate of micro percutaneous nephrolithotomy and retrograde intrarenal surgery for lower pole renal stone: A randomized trial

Background

The use of unhealthy food and a sedentary lifestyle increases daily health problems. Renal stones are one among others. Endourology promises the minimum complications and the highest stone clearance rate. Indications of the two procedures overlap micro-PCNL and RIRS. The objective was to evaluate stone clearance and complication rate of micro-PCNL and RIRS for lower pole renal stones.

Methods

The research design of this study was a randomized trial and was done after approval of the ethical review committee. The sampling technique was consecutive sampling at the Urology department. Patients included in the study according to inclusion criteria were 96 in number. Randomization into two groups (RIRS vs micro-PCNL) was done by even odd method. All the procedure was done by a single senior urologist.

Results

Their ratio among males and females was 2:1. Mean LOS in the RIRS group was 2.89±0.86 days and in the micro-PCNL group 2.58±0.65 days (p=0.047). The complication rate in the RIRS group was 6.2% and 8.3% in micro-PCNL (p=0.695). Mean post-operative haemoglobin was 12.30±1.07 g/dL among the RIRS group and among the micro-PCNL group it was 11.21±1.08 g/dL (p<0.001). There was an average haemoglobin drop in the micro-PCNL group of 1.09±0.01 g/dL. 75% clearance of stone after one session was achieved in the RIRS group while 79.2% was achieved in the micro-PCNL group (p=0.627).

Conclusion

Length of hospital stay (LOS) and stone clearance rate (SFR) were similar in both groups with insignificant statistical differences. There is a need to conduct more studies with a large number of study participants and involving multi-centers.

Dental Anxiety Among Physicians: Relationship with Oral Problems, Dental Visits, and Socio-Demographic Factors

Purpose

The purpose of study was to investigate dental anxiety (DA) and its relationship with oral health problems, dental visits, and socio-demographic factors among physicians.

Patients and Methods

This cross-sectional study was conducted on physicians working in Dhahran, Khobar, Dammam, and Qatif cities of the kingdom of Saudi Arabia. The study included physicians (general practitioners, residents, specialists, and consultants) working in the public and private sectors. Modified Dental Anxiety Scale and World Health Organization's Oral Health Questionnaire for Adults were used to evaluate DA, oral health problems, and dental attendance.

Results

The study included data from 355 participants with a mean age of 40.13 ± 10.45 years. There were 57.2% of non-Saudi and 42.8% of Saudi participants in the study. Bad dental experience in the previous dental visit was reported by 40% of participants, which was significantly related to DA (P = 0.002). Only 9.60% of participants had no DA, whereas 41.10% demonstrated low DA, 23.4% moderate DA, 18.9% high DA, and 7% extreme DA. Common oral problems included tooth sensitivity (65.40%), tooth cavities (45.90%), bleeding gums (43.10%), and bad breath (36.90%). More than half of participants (58.3%) visited the dentist during the last year and dental pain was the most common reason for dental visits (31.3%). Saudi participants demonstrated significantly increased DA than non-Saudis (P = 0.019). DA was significantly related to tooth sensitivity (P = 0.001), tooth cavities (P = 0.002), dry mouth (P = 0.044), and bad breath (P = 0.005). The participants with difficulty in biting foods (P > 0.001) and feeling embarrassed due to the appearance of teeth (P < 0.001) demonstrated significantly higher DA.

Conclusion

This sample of physicians showed a high prevalence of DA, oral problems, and dental visits due to pain. DA was significantly related to physicians' negative dental experience, tooth sensitivity, dental decay, dry mouth, and bad breath.

Tobacco Use and Cessation Counseling among Dental Professionals in Saudi Arabia

The study aimed to assess the prevalence of tobacco use among dental professionals and their attitudes and behaviors about tobacco cessation counseling in Saudi Arabia. A total of 359 male and female dental professionals participated in this cross-sectional study. A pretested self-administered questionnaire was administered among study participants by visiting dental hospitals and clinics in Saudi Arabia. In the study, 15.9% of the participants were current tobacco users and 50.4% had a tobacco user at home or the workplace. Most participants reported that tobacco use is associated with bad breath (88.9%), oral cancer (88.3%), dryness of the mouth (80.8%), and bad taste (79.9%). Most participants asked patients about their tobacco habits (86.6%), mentioned tobacco habits in patient records (71.3%), and explained the benefits of quitting tobacco (79.9%). Less than half the sample (47.1%) referred patients to tobacco quitting services/programs. Male gender (Adjusted odds ratio (AOR) 5.50, 95% CI 2.48−12.23, p < 0.001), having a tobacco user at home/the workplace (AOR 3.18, 95% CI 1.57−6.45, p 0.001), and believing that tobacco cessation counseling was a waste of time (AOR 2.32, 95% CI 1.13−4.76, p 0.021) were associated with significantly increased odds of tobacco use among dental professionals. The study concluded that tobacco use was common among dental professionals despite their awareness of the adverse effects of tobacco. Reduction in tobacco use and promotion of counseling skills among dental professionals should be achieved through public health measures.

Sealant Utilization and its Influence on Caries Reduction in First Permanent Molars in Saudi Female School Children

Purpose:

This study aimed to assess the utilization of fissure sealants and their influence on caries reduction in first permanent molars (FPMs) among 6-9 years old female schoolchildren in Dammam, Eastern Province of Saudi Arabia.

Materials and Methods:

First to fourth grade female children from public schools in Dammam participated in this cross-sectional study. Dental caries and fissure sealants in FPMs were examined clinically using the World Health Organization guidelines. In addition, the parents of the participants responded to a self-reported questionnaire.

Results:

The study analyzed the data of 449 children. Almost 44.3% of the participants had at least one FPM affected with caries. There were 8.7% of the participants who had fissure sealants in at least one FPM, and out of these, only 2.2% had four FPMs filled with sealants. A significantly greater proportion of participants with sealed FPMs had no caries than the lower proportion of participants without sealants who had caries (P=<0.05). The use of sealants increased significantly from first grade (10.3%) to second grade (30.8%), third grade (38.5%), and fourth grade (20.5%) (P=0.006). High monthly family income (P= 0.047) and having insurance (P=0.017) were significantly associated with increased sealant application. Nearly 21.9% of participants’ parents were aware of caries protective effects of dental sealants.

Conclusion:

The application of sealants was significantly associated with reduced caries in FPMs. Class year, monthly family income, and insurance were significantly associated with having sealants. Caries prevention programs for children should incorporate sealant application.

Effect of Low-Energy Shockwave Therapy Versus Platelets Rich Plasma Therapy in Patients with Erectile Dysfunction

Phosphodiesterase 5 inhibitors (PDE5Is) and low-energy shock wave therapy (LESWT) have created a revolution in the treatment of erectile dysfunction (ED).  However, they are not able to restore the actual changes in the penis. An emerging new therapy called platelet-rich plasma (PRP) is believed to be more beneficial in treating ED.  The objective of this study is to evaluate and compare the efficacy of LESWT and PRP in treating ED. A total of sixty participants of pathological ED was included in the study and divided into two groups. Group A received the LESWT, whereas Group B received the PRP. The benefits were measured by the International Index of Erectile Function (IIEF), an erection hardness score (EHS) and Self-Esteem And Relationship (SEAR) questionnaires. The results of this analysis demonstrated a larger effect in treatment group B in percentage terms, but there were no statistical differences in the two groups. In the near future, PCP may be a new modality for treating ED, especially PDE5I non-respondents with organic ED. However, more extensive preclinical and applied research needs to be conducted.

Novel dark-blood versus conventional bright-blood late gadolinium enhancement CMR: A pilot study comparing impact on myocardial ischaemic burden

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): British Heart Foundation

Background

In patients with coronary artery disease (CAD), increasing myocardial ischaemic burden (MIB) is a strong predictor of adverse events. When measured by cardiovascular magnetic resonance (CMR), a MIB ≥12.5% is considered significant and often used as a threshold to guide revascularisation. Ischaemic scar can cause stress perfusion defects which do not represent ischaemia and should be excluded from the MIB calculation. Conventional bright-blood late gadolinium enhancement (LGE) is able to identify ischaemic scar but can suffer from poor scar-to-blood contrast, making accurate assessment of scar volume difficult. Dark-blood LGE methods increase scar-to-blood contrast and improve scar conspicuity which may impact the calculated scar burden and consequently the estimation of MIB when read in conjunction with perfusion images.

Purpose

To evaluate the impact of dark-blood LGE versus conventional bright-blood LGE on the estimation of MIB in patients with CAD.

Methods

37 patients with suspected or known CAD who had evidence of CMR stress perfusion defects and ischaemic scar on LGE imaging were recruited. Patients underwent adenosine stress perfusion imaging followed by dark-blood LGE then conventional bright-blood LGE imaging at 3T. For dark-blood LGE, phase sensitive inversion recovery imaging with a shorter inversion time to null the LV blood-pool was used without any additional magnetization preparation. For each patient, three short-axis LGE slices were selected to match the three perfusion slice locations. Images were anonymised and analysed in random order. Ischaemic scar burden (ISB) was quantified for both LGE methods using a threshold &gt;5 standard deviations above remote myocardium. Perfusion defect burden (PDB) was quantified by manual contouring of perfusion defects. MIB was calculated by subtracting the ISB from the PDB.

Results

MIB calculated using dark-blood LGE was 19% less compared to bright-blood LGE (15.7 ± 15.2% vs 19.4 ± 15.2%, p &lt; 0.001). There was a strong positive correlation between the two LGE methods (rs = 0.960, p &lt; 0.001, Figure 1A). Bland-Altman analysis revealed a significant fixed bias (mean bias = -3.6%, bias 95% CI: -2.6 to -4.7%, 95% limits of agreement: -9.8 to 2.5%) with no proportional bias (Figure 1B). MIB was calculated ≥12.5% and &lt;12.5% by both LGE methods in 19 (51%) and 12 (32%) patients respectively. In 6 patients (16%), MIB was ≥12.5% using bright-blood LGE and &lt;12.5% using dark-blood LGE (Figure 1A – orange data points). Overall, when used to classify MIB as &lt;12.5% or ≥12.5%, there was only substantial agreement between the two LGE methods (κ=0.67, 95% CI: 0.45 to 0.90).

Conclusions

The use of dark-blood LGE in conjunction with perfusion imaging results in a lower estimate of MIB compared to conventional bright-blood LGE. This can cause disagreement around the threshold of clinically significant ischaemia which could impact clinical management in patients being considered for coronary revascularisation.

Abstract Figure. Linear regression with corresponding B&A

Study of the histidine complex of uranium(IV): synthesis, spectrophotometric, magnetic and electrochemical properties

We synthesized the novel histidine complex of uranium(IV). A 1:3 mole ratio was found between metal and ligand by the mole ratio method, while –NH2 and –COO– groups of histidine behave as coordinating sites. The IR spectra confirmed the lone pair donating or coordinating sites. The elemental analysis confirmed the stoichiometry. The bathochromic shift with an increase in the optical density in the UV-Visible range indicated that the compound and its central metal ion hold uniform electronic charge distribution. The electrochemical results indicated a quasi-reversible (neither completely reversible nor completely irreversible) oxidation of the complex to its uranium(V) product at the platinum working electrode. The quasi-reversible process shows a comparatively slow electron transfer (ET) rate with the heterogeneous electron transfer rate constant ‘ks’ (3.4 ×  10–4 cm s-1) at 50 mV s-1 and 305 ± 0.5 K. The kinetics such as diffusion and charge transfer lead the reaction with an ECE (electrochemical–chemical–electrochemical) mechanism. The thermodynamic parameters of activation such as ΔH*; 4.257 kJ mol–1, ΔS*; -2.519 × 10–3 J mol–1 K–1 and ΔG* 4.26 kJ mol–1 helped to propose an associative mechanism of the electron transfer at the platinum working electrode.                     KEY WORDS: Uranium, Histidine, Spectroscopy, Electrochemistry, Kinetics   Bull. Chem. Soc. Ethiop. 2020, 34(3), 557-569.  DOI: https://dx.doi.org/10.4314/bcse.v34i3.11

Dental Fear and Patient Preference for Emergency Dental Treatment Among Adults in COVID-19 Quarantine Centers in Dammam, Saudi Arabia

PURPOSE

Dental fear is associated with the avoidance of dental visits and negative oral health outcomes. It is important to assess distribution of dental fear and preference for emergency dental treatment among adult population during COVID-19. Therefore, the purpose of this study was to evaluate dental fear and emergency dental treatment among adults in COVID-19 quarantine centers in Greater Dammam, Saudi Arabia.

MATERIALS AND METHODS

Male and female adults (N=606) in quarantine centers for COVID-19 participated in this cross-sectional study (June-July 2020). Dental Fear Survey was used to collect data on dental fear. The participants also provided their responses about emergency dental treatment/dental attendance patterns in addition to demographic information.

RESULTS

The mean DFS score of the sample was 39.08 ± 19.47, and 23.1% of the participants were a little fearful and 22.6% were highly fearful. About 36.8% reported that they would prefer to visit a dental office in case of dental emergency mostly for dental pain and fractured tooth during the COVID-19 pandemic. Only 10.4% of the participants reported visiting a dentist in less than 3 months, 35.8% in less than 6 months, 52.5% between 6 and 12 months and more, and 1.3% never visited the dentist. DFS scores significantly differed among participants who visited the dentist in less than 3 months (31.86 ± 14.57), less than 6 months (37.70 ± 18.57), between 6 and 12 months and more (40.78 ± 20.23), and never visited the dentist (65.75 ± 14.74) (P < 0.001). The timing of last dental visit (P < 0.001), female gender (P 0.039), and dental pain (P < 0.001) were the significant predictors of dental fear.

CONCLUSION

Dental fear was common among adults with a predilection for the female gender. Increased dental fear was significantly related to dental pain and reduced dental attendance. Only one-third of adults were willing to perform emergency dental visits.

Medical Imaging Fusion Techniques: A Survey Benchmark Analysis, Open Challenges and Recommendations

Background—Recent improvements in image processing along with active collaborations of health experts have started an era of inventions in medical imaging. From the last two decades, computer vision empowers computers to analyze the data in bulk using machine learning methods in developing intelligent models. Several techniques are already available in the literature that is capable of learning intricate patterns to generate meaningful output. A set of areas, which researchers have preferably covered are related to contrast stretching, segmentation, feature extraction/fusion, and classification. In the medical domain, feature fusion is an active area, which plays a vital role in the final classification step. Objective—In this review article, our primary objective is to discuss and validate the advantages of feature fusion and present its roles in this domain. The fusion of two images or multiple features gives better results in the form of either detection or classification of infected areas. For this purpose, we discuss a set of techniques used by several researchers in the medical domain. Method—A detailed and comprehensive review of the fusion techniques are presenting. The key challenges and shortcomings of existing image and feature fusion methods are presenting along with the possible future directions. Conclusion—At the end of this review, we conclude that fusion techniques improves the image quality, as well as for salient (infected) regions detection. Moreover, the fusion of medical images increases the overall segmentation accuracy, and feature fusion shows its effects in the final stage of classification.

Automated design for recognition of blood cells diseases from hematopathology using classical features selection and ELM

In the human immune system, the white blood cells (WBC) creates bone and lymphoid masses. These cells defend the human body toward several infections, such as fungi and bacteria. The popular WBC types are Eosinophils, Lymphocytes, Neutrophils, and Monocytes, which are manually diagnosis by the experts. The manual diagnosis process is complicated and time-consuming; therefore, an automated system is required to classify these WBC. In this article, a new method is presented for WBC classification using feature selection and extreme learning machine (ELM). At the very first step, data augmentation is performed to increases the number of images and then implement a new contrast stretching technique name pixel stretch (PS). In the next step, color and gray level size zone matrix (GLSZM) features are calculated from PS images and fused in one vector based on the level of high similarity. However, few redundant features are also included that affect the classification performance. For handling this problem, a maximum relevance probability (MRP) based feature selection technique is implemented. The best-selected features computed from a fitness function are ELM in this work. All maximum relevance features are put to ELM, and this process is continued until the error rate is minimized. In the end, the final selected features are classified through Cubic SVM. For validation of the proposed method, LISC and Dhruv datasets are used, and it achieved the highest accuracy of 96.60%. From the results, it is clearly shown that the proposed method results are improved as compared to other implemented techniques.

First Permanent Molar Caries and Oral Health Practices in Saudi Male Teenagers: Inequalities by Socioeconomic Position

OBJECTIVES

Caries remains a problem in high-risk groups aggravated by socioeconomic inequalities. The study aimed to investigate (1) oral health practices associated with caries in the 1^st permanent molars in Saudi male teenagers and (2) the impact of socioeconomic position (SEP) on caries control using these practices.

METHODS

A cross-sectional study targeted 1137 male teenagers in intermediate schools in Khobar and Dammam, Saudi Arabia, in 2016. Caries was examined using the World Health Organization criteria and plaque was assessed using the plaque index of Loe and Silness. A questionnaire assessed SEP (parental education, employment, and home ownership) and oral health practices (using fluoridated toothpaste twice daily, regular dental visits for check-ups, and avoiding daily sugary snacks). Regression models analysed the association of these factors with caries presence and the mean number of decayed 1^st permanent molars. Stratification was used to assess differences between SEP levels.

RESULTS

The response rate was 81.7%. Caries prevalence and mean (SD) number of decayed 1^st permanent molars were 50.4% and 1.08 (1.31). The use of fluoride toothpaste was associated with lower odds of caries and fewer decayed molars (OR = 0.50 and regression coefficient = -0.35). Differences in the relationship between caries and toothpaste were observed by SEP levels with stronger associations in less advantaged groups.

CONCLUSIONS

Brushing twice daily using fluoride toothpaste was associated with less caries in Saudi male teenagers with stronger association observed in groups with lower SEP. The use of fluoride toothpaste helps in reducing health inequalities associated with SEP.

Internet Addiction, Oral Health Practices, Clinical Outcomes, and Self-Perceived Oral Health in Young Saudi Adults

The study assessed the relationship between Internet addiction and oral health practices and clinical outcomes and whether this was affected by oral health perception. In 2017, a cross-sectional study included university students in the Eastern Province of Saudi Arabia. Questionnaires assessed demographic background, oral health practices (consuming sugar, tobacco use, and oral hygiene), perceived oral health, and Internet addiction. Caries experience and gingivitis were assessed using the World Health Organization criteria. The multivariate general linear analysis assessed the relationship between dependent variables (oral health practices, DMFT, and gingivitis) and exposure (Internet addiction). Data were available for 919 participants, 75.4% females, mean age = 19.8 years, and 1.6% with significant Internet use problem. The mean percentage of teeth with gingivitis was 8.5% and mean DMFT was 2.9. Among those with good perception of oral health and compared with participants with significant Internet use problem, average Internet users had lower consumption of sugar and tobacco (B = -6.52, P = 0.03 and B = -2.04, P = 0.03), better oral hygiene practices (B = 2.07, P = 0.33), higher DMFT (B = 2.53, P = 0.10), and lesser gingivitis (B = -15.45, P = 0.06). Internet addiction was associated with negative oral health practices and poor clinical outcomes among young Saudis. Holistic health promotion approaches need to address the negative impact of Internet addiction on health and oral health status for this at-risk age group.

Correlation of bile acids and aspartate-aminotransferase with outcomes in cholestasis of pregnancy

OBJECTIVE

To identify laboratory data that correlates with poor perinatal outcomes.

METHODS

A retrospective chart review of women with intrahepatic cholestasis of pregnancy (ICP), admitted for delivery between January 1, 2013 and December 31, 2017, was performed. Chi-square, student's t-test, and ANOVA statistical analysis was performed. The receiver-operator characteristic curves were plotted for the prediction of each category of perinatal outcome and the areas under the curves were determined. All p-values were two-sided, and p < 0.05 was considered statistically significant.

RESULTS

Analysis of the 61 ICP cases showed no occurrence of the intrauterine fetal demise (IUFD), stillbirth, abruption, or neonatal demise. ROC curve analysis revealed a statistically significant correlation between bile acid and AST levels and perinatal outcomes. A bile acid (BA) level equal to or greater than 37μmol/L strongly predicted spontaneous preterm labor in women affected by ICP with a sensitivity of 100% and specificity of 60.70% (p = 0.002). A BA level equal to or greater than 42μmol/L strongly predicted meconium-stained amniotic fluid with a sensitivity of 85.70% and specificity of 66.70% (p = 0.006). AST levels equal to or greater than 62 IU/L strongly predicted NICU admission with a sensitivity of 81.30% and specificity of 62.20% (p = 0.002). AST levels equal to or greater than 75 IU/L strongly predicted hyperbilirubinemia in the neonates with a sensitivity of 87.50% and specificity of 69.80% (p = 0.001).

CONCLUSIONS

There is a statistically significant correlation between elevated BA and elevated AST levels and adverse perinatal outcomes.

Description of Renal Biopsy in Frequently Relapsing and Corticosteroid Non Responsive Nephrotic Syndrome in Childhood

A study of 71 children with nephrotic syndrome admitted to the Department of Child Health, Medical School, Sriwijaya University Palembang General Hospital between November 1981 and November 1983 has been reported. Of the 71 children, there were 50 (70.4%) boys and 21 (29.6%) girls, in which 31 were less than 6 years of age. During the first eight weeks complete rem1sswn was found in 66 patients. The other five were steroid resistant. Among the 66 patients who responded to steroid, 61 had remission with the first 4 weeks. Further observation up to two years, 3 patients were still in remission, 36 had one relapse and 22 had frequent relapses. The other 5 patients, who had remission on the second 4 weeks, one had one relapse, two had frequent relapses and the other two were not available for follow up. Renal biopsy was performed in 31 patients. The representative results of the renal biopsy were found in only 20 patients : Eleven patients showed minimal change nephrotic syndrome (MCNS). Ten of these patients had frequent relapses while one patient was steroid resistant. Two had renal insufficiency. Three patients had focal glomerulosclerosis (FGS); two of them were frequently relapsing patients and the other one had steroid resistant. Four patients had mesangial proliferative glomerulonephritis (Mes. PGN). All of them had frequent relapses. One patient with diffuse proliferative glomerulonephritis (DPGN) was steroid resistant. One patient with crescentic glomerulonephritis (CrGN) was also steroid resistant.

Reasons for and Barriers to Attending Continuing Education Activities and Priorities for Different Dental Specialties

BACKGROUND

Continuing education (CE) activities help dentists update their knowledge and skills to ensure high standards of patient care.

AIM

This study aimed to evaluate the reasons for and barriers to attending CE activities including the priorities for different dental specialities.

METHODS

The study involves a cross-sectional research design. After statistical consultation, a questionnaire was distributed among 323 dental practitioners in the Eastern province of Saudi Arabia. The questionnaire was checked for face and content validity, and it was pilot-tested before its administration.

RESULTS

The response rate was 79.5% as 257 of 323 dentists returned the questionnaire. Most dentists reported that they attended CE activities because of personal learning needs (67.3%) and career development (66.9%). Lack of clinical experience to effectively manage patients and the practice was the least common (15.2%) reason for attending CE activities. Esthetic dentistry (77.4%), restorative dentistry (70.8%), and endodontics (70%) were the three most preferred dental specialities for CE activities. Lack of time was the most common (69.3%) barrier to attending CE activities followed by the cost (62.6%) and the distance (57.2%). More male (n = 104) than female (n = 69) dentists believed personal learning needs a reason for attending CE activities (P = 0.01). Similarly, more male (n = 104) than female dentists (n = 68) considered lack of time a barrier (P = 0.046).

CONCLUSION

Most dentists attended CE activities to fulfil their personal learning needs, and aesthetic dentistry was the most preferred dental speciality for CE activities. Lack of time and cost were important barriers to attending CE activities.

Cerebrospinal fluid procalcitonin as a biomarker of bacterial meningitis in neonates

OBJECTIVE

The objective of the study was to study the performance of cerebrospinal fluid (CSF) procalcitonin as a marker for bacterial meningitis in neonates, and to determine its optimal 'cutoff' in CSF that can be called significant for the diagnosis.

STUDY DESIGN

Neonates qualifying for lumbar puncture were prospectively studied. Procalcitonin and established CSF parameters were recorded.

RESULTS

At a cut-off value of 0.33 ng ml^-1, CSF procalcitonin had a sensitivity of 0.92, specificity of 0.87, with positive and negative likelihood ratios of 7.13 and 0.092, respectively. The area under the curve for different CSF parameters was: 0.926 (0.887 to 0.964) (P<0.001) for procalcitonin, 0.965 (0.956 to 0.974) for total leukocyte count, 0.961 (0.94 to 0.983) for neutrophil count, 0.874 (0.825 to 0.923) for protein, 0.946 (0.914 to 0.978) for sugar and 0.92 (0.955 to 0.992) for CSF:serum sugar ratio. The lumbar puncture was traumatic in 36 (21.4%) patients; out of these 15 (41.7%) had bacterial meningitis and 21 (58.3%) had no meningitis. In traumatic lumbar tap group, the median (IQR) CSF procalcitonin in patients with and without meningitis was 1.41 (0.32-3.42) ng/ml and 0.21(0.20-0.31) ng/ml respectively (p<0.05).

CONCLUSIONS

Procalcitonin measurement has diagnostic efficiency similar to the established CSF markers. Routine assessment of procalcitonin in clean non-contaminated CSF may not yield additional information, but it may have clinical utility in situations where diagnosis of meningitis is in dilemma, as in the case of blood contamination of CSF in traumatic lumbar punctures.

Profil Kecukupan Asupan Makanan pada Rawat Inap

Latar belakang. Kekurangan Jumlah asupan makanan pasien rawat inap sering kali ditemukan.Tujuan. Mengetahui profil kecukupan asupan makanan pada pasien anak rawat inap. Metode. Penelitian cross sectionaldilakukan November 2011- Januari 2012 pada pasien anak rawat inap di RSUP Dr. Mohammad Hoesin, Palembang. Sampel dipilih secara consecutivedengan kriteria usia >1-10 tahun, dirawat >24 jam, tidak menderita sakit kritis, bukan gizi buruk, tidak terdapat kontraindikasi makan per oral, tidak terdapat masa atau asites diberikan asupan nutrisi berdasarkan buku rekomendasi IDAI tentang asuhan nutrisi pediatrik. Data asupan makan dihitung setelah perawatan 3 hari rawat dan data dianalisis dengan uji Fisher. Asupan dinyatakan tidak cukup apabila asupan rata-rata energi dan protein 3 hari pertama <80% kebutuhan.Hasil. Didapatkan 105 pasien yang diteliti, terbanyak usia 6-10 (59%) tahun, jenis kelamin perempuan (52%), status gizi baik (52%). Umur 1–5 tahun, asupan energi tidak cukup 27,9%; asupan protein tidak cukup 34,9%. Umur 6–10 tahun, asupan energi tidak cukup 50%; asupan protein tidak cukup 37,1%. Anak laki-laki, asupan energi tidak cukup 36%; asupan protein tidak cukup 15 30%. Anak perempuan, asupan energi tidak cukup 45,5%; asupan protein tidak cukup 41,8%. Gizi baik, asupan energi tidak cukup 38,2%; asupan protein tidak cukup 36,4%. Gizi kurang, asupan energi tidak cukup 44%; asupan protein tidak cukup 36%.Kesimpulan. Ketidakcukupan energi dan protein lebih banyak dialami oleh perempuan dan kelompok umur 6–10 tahun.

Pharmacological agents for reducing the haemodynamic response to tracheal intubation in paediatric patients: a systematic review

The primary aim of this review was to assess the effect of pharmacological agents administered to attenuate the haemodynamic response to tracheal intubation in paediatric patients up to 16 years of age undergoing elective surgery. Secondary aims were to identify adverse effects related to these agents, and the agents' roles in decreasing arrhythmias. A systematic search was conducted for articles listed in PubMed, CINAHL or the Cochrane database between January 1980 and June 2014. We included randomised controlled trials where the stated aim of the study included observing the effects of pharmacological agents on the haemodynamic response to tracheal intubation. The outcome measures were changes in mean, systolic and diastolic blood pressure and heart rate, adverse effects of drugs and arrhythmias. Sixteen publications with a total of 1408 children (ages two to 15 years) were identified. These studies varied in methodology and quality. Opioids were the commonest agents used and appeared to obtund the response in a dose-related manner. Fentanyl 2 µg/kg, remifentanil 1 µg/kg, sufentanil 0.1 and 0.2 µg/kg and alfentanil 25 µg/kg blunted the haemodynamic response. Remifentanil 3 µg/kg and sufentanil 0.3 µg/kg were the most effective in obliterating the response but led to hypotension in unstimulated patients. Opioid-related side-effects and arrhythmias were observed in few patients. We recommend that when required, the safe and effective doses identified in this review be used to obtund the haemodynamic response to intubation in paediatric patients, with close observation for the uncommon but recognised side-effects.

Management of Post Traumatic Posterior Urethral Stricture; Internal Urethrotomy verses Perennial Urethroplasty

Objective: To compare the efficacy and cost effectiveness of cold knife optical internal urethrotomy with perineal urethroplasty (excision and end to end anastomosis) in the management of post traumatic short posterior urethral stricture. Design: an observational prospective study. Place and duration of study: the study was performed in the department of urology and kidney transplantation Services hospital/post graduate medical institute Lahore, from September 1997 to December 1999. Patients and methods: Forty male patients of post traumatic posterior urethral stricture revealed by their urethrogram were included in the study. Patients were divided in two groups randomly (group A & group B). After complete evaluation, patients of group A were managed by internal uretherotomy, while those of group B by perineal urethroplasty. Follow up was done at 1,3,6,9 & 12 months. Results: age range of the patients was 20 to 59 years with the mean age of 35.5 years. Road traffic accident was the main cause (82.5%). After facing the traumatic urethral injury, there was history of attempted Foley catheterization (47.5%), bouginage (15%) and intervention by rail road technique in 10% of the patients. All patients were with supra pubic catheter because of failure to void. The length of stricture varied from 0.5 to 2.0 cm (mean 1.4 cm). Clinical response at the end of the study in group A & B was "good" in 58.82% & 66.66%, "satisfactory" in 23.52% & 22.22% and "poor" in 17.64% &11.11% respectively. The mean cost of operation, hospital stay and loss of working hours were less in group A as compared to that of group B. Conclusion: The results of perineal urethroplasty are comparatively better than optical urethrotomy. The other differences of the two procedures lie in operative time cost of the operation and mean hospital stay. It is concluded that optical urethrotomy is an acceptable alternative to urethroplasty in patients with short post traumatic posterior urethral stricture.

Comparison of Snodgross and para-meatal based flap technique for hypospadiasis

Objective: To compare the two surgical procedures Snod gross & parameatal based flap technique for mid & distal penile hypospadias including cosmosis. Study design: Randomized Clinical interventional trail. Place of study: This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology & Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Material & Methods: Thirty-two patients were selected for this randomized clinical intervention study with mid shaft & distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Results: Th irty-two patients who underwent procedure of Snodgross & parameatal-based flap in the management of mid shaft & distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen (50%) patients, spraying of urine in six (25%) and narrow stream in 4(13%) patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients (6.3%) develop wound dehiscence, three patients (18.8%) develop urethral fistula, two patients (12.5%) showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross & parameatal-based flap, the success rate was 100% and 62.4% respectively. Conclusions: Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6 % in-patient with para-meatal technique.

Serum vitamin D and vitamin D receptor gene FokI polymorphisms in children with tuberculosis

Background Vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms are strongly associated with tuberculosis (TB) susceptibility in countries with four seasons. As a country with sufficient sunlight for vitamin D production in skin, the incidence of TB in Indonesia remains high. Objective To assess for possible associations between the incidence of tuberculosis and serum vitamin D level, as well as VDR FokI polymorphisms in children. Methods A case-control study was conducted at the Department of Child Health, Dr. Mohammad Hoesin Hospital, Palembang from November 2011 to April 2012. Subjects were children with TB (the case) and children without TB who had been exposed to TB in the home (the control). Serum vitamin D [1,25(OH)2D3 or calcitriol] level was measured by immunodiagnostic system (IDS) 1,25-dihydroxy vitamin D enzyme immunoassay (EIA) kit. The VDR FokI polymorphisms were identified by polymerase chain reaction (PCR) and restriction-fragment length polymorphism (RFLP) analysis. Results Sixty subjects was divided equally into the case and control groups. The mean serum calcitriol level in the case group was significantly lower than that of the control group [105.5 (SD 66.9) pmol/L vs. 162.9 (SD 52.9) pmol/L, respectively; (P=0.001)]. We found 9 subjects with calcitriol deficiency, 8 in the TB group and 1 in the healthy contact group (OR 10.5; 95%CI 1.2 to 90.7) The VDR FokI polymorphism was seen in 28 subjects in the case group and 22 in the control group (OR 5.0; 95%CI 0.9 to 26.4). Conclusion Vitamin D (calcitriol) deficiency and lower serum levels are associated with higher risk of TB in children. The VDR gene FokI polymorphism also contributes to susceptibility for TB.

Micropropagation and Attempts to Develop RAPD Molecular Markers for Salt Tolerant Cultivars of Pearl Millet

Differences were observed among four salt tolerant cultivars of pearl millet to in vitro culture media. Among the four cultivars, Cv IP 6098 is the most salt sensitive had maximum number of multiple shoots (15)/ seed, and the more salt tolerant cvs IP 6106 and IP 22269 developed 3-6 shoots/seed while cv IP 19612 the seeds remained single shooted in MS+3.0mg/L media up to 7 months. The multiple shoots 20% of cv IP 6098, flowered in 5 months with the reduction in hormone concentration (MS+1.0 mg/L BAP) whereas, the other three cultivars did not flower under the tested conditions. The present study was carried to detect genetic differences among the four cultivars of pearl millet at molecular level through RAPD PCR markers. RAPD analysis was carried with 12 primers, each 10-mer, only 7 primers were amplified showed polymorphism for the four cultivars. Primer OPM 16 revealed a single unique band of approx. 485bp in the genotype IP 22269 and three polymorphic bands in the genotype IP 6106. The results were repeatable, and further studies in this direction may enable to link the single band in the genotype IP 22269 to a morphological trait or physiological condition like salt tolerance.

Comparison of awareness about nephrology and kidney diseases amongst doctors in institutes with and without nephrology departments

Objective: To compare the awareness about nephrology and kidney diseases in medical officers and postgraduate trainee doctors working in institutes with and without nephrology departments.

Methods: This cross sectional study was conducted at Nephrology Department, Shalamar Hospital Lahore from 1^st Jan to 31^st Mar 2013. Doctors working on medical floor with more than one year experience after house job were included in the study. Each doctor was given questionnaire comprising of 28 questions.

Results: Two hundred and eleven doctors fulfilling the criteria were included in the study. Most of the doctors were male 150(71.1%). Knowledge had strong correlation with practice (p= 0.001). Knowledge regarding nephrology and chronic kidney disease (CKD) was found significantly different among doctors of different hospitals [(F=36.09, p=0.000). Practice regarding nephrology and chronic kidney disease (CKD) was found significantly different (F= 7.222, p=0.000)] among doctors of different hospitals of Lahore. Doctors working in the Shaikh Zayed Hospital (SZH), Lahore were having maximum score in the components of the knowledge and practice than other hospitals.

Conclusion: Awareness of the Medical Officers and postgraduate doctors is poor regarding nephrology and kidney diseases. Doctors working in institutes with established nephrology services have better knowledge than other units. Working experience of doctors improve the practice significantly.

Cervical spinal injuries in moderate to severe head injuries

BACKGROUND

Traumatic Brain Injury (TBI) is the leading cause of death in all age group. The incidence of CSI increases with the severity of TBI so prompt care of cervical spine is necessary in all patients with moderate to severe head injury. The objective of this study was to determine the frequency of cervical injury in patients with moderate to severe head injury and different types of trauma.

METHODS

This descriptive cross sectional study was conducted in department of Neurosurgery Ayub Medical College, Abbottabad from October 2011 to October 2012. A total of 369 patients were included in this study by consecutive (non probability) sampling. All patients were subjected to X-rays and CT-Scan of the skull for evaluation of head injury. X-rays and CT scan with MRI of cervical spine were done for evaluation of cervical spinal injury.

RESULTS

A total of 369 patients were included in our study, out of which 276 (74.8%) were males and 93 (25.2%) were females. Age of the patients ranged from 3-90) years with mean of 31.93 +/- 21.35. Among these patients most common cause of injury was fall 196 (53.1%), whereas the RTA was 159 (43.1%) and assault was 14 (3.8%). Out of the 369 patients 42 (11.3%) were found to have cervical spinal injuries.

CONCLUSION

The frequency of cervical injury associated with moderate to severe head injury remains the same in all over the world with minor difference in percentages; that we have observed in our study. Furthermore, we have observed that cervical injury is directly proportional to the severity of head injury. All the head injured patients should be suspected of having cervical spinal injury unless proved otherwise.

Lack of germ line changes in KISS1 and KAI1 genes in sporadic head and neck cancer patients of Pakistani origin

BACKGROUND

Head and neck cancer is included among the top five most commonly prevailing cancers worldwide. Abnormalities of either genetic or epigenetic factors are found responsible for the development and progression of head and neck cancer. Metastasis is the leading cause of death in patients with head and neck cancer. Down regulation of metastasis suppressor genes (MSGs) expression have been frequently observed in advanced tumours.

METHODOLOGY

The present study was designed to screen two of the most frequently down-regulated MSGs (KISS1 and KAI1) for mutations in 120 diagnosed head and neck cancer affected Pakistani patients. The questionnaire was filled for basic information about age, gender, smoking habits and area of cancer affected and other relevant details. Primers for both genes were designed using "Primer 3" software in such a way that both intron exon boundaries were included in this region. DNA isolation and estimation was done by using organic method and agarose gel electrophoresis. Single Strand conformational polymorphism technique was used after amplification of the respective genes. Mobility patterns were analyzed using BioDoc Analyzer.

RESULTS

Data of patients were analyzed on the basis of age, sex and type of cancer as variables. The mean age of patients and controls was 44 years. There were 53% females and 47% males in this group of study, 63% nonsmokers and 37% smokers and larynx cancer was found to be most frequent type of cancer with a percentage of 64. Lack of germ line mutation was observed in the entire coding region in both coding regions as well as splice sites of the respective genes.

CONCLUSION

Germ line mutations in KISS1 and KAI1 are thus considered to be a less frequent event in head and neck cancer patients. However, two polymorphisms in intronic region of exon 3 and exon 9 of KAI1 gene were observed in 1% of patients. In non coding region downstream of exon 3 (KAI1), there was a C 29166 T substitution and in intronic region upstream exon 9 of KAI1 gene, a C 52840 A substitution was observed. Both patients were females with ages 47 and 50 years respectively. A detailed analysis of regulatory mechanism is required to explore the genetic basis of down regulation of these MSGs for a better understanding of head and neck cancer progression.

Erectile dysfunction in haemodialysis patients

BACKGROUND AND OBJECTIVE

There is a very high prevalence of Erectile Dysfunction (ED) in dialysis patients. There is no as such available data on ED and factors affecting it in our patients.

METHODS

Analytical, cross-sectional, hospital based study conducted from January to March 2008, Haemodialysis unit of Shalimar and Mayo Hospital, Lahore. All male patients of end stage renal disease (ESRD) on maintenance haemodialysis therapy, whose spouses are alive and able to perform intercourse, were included in the study. Patient with cognitive and communication deficits were excluded from study. International index of erectile function-5 (IIEF-5), adopted in Urdu was used for the determination of prevalence of erectile function. Categorization of erectile dysfunction was done as mild, moderate and severe. Demographic data were collected and certain laboratory parameters (haemoglobin, haematocrit, urea, HBsAg and Anti HCV) were sent.

RESULTS

Total numbers of patient were fifty. Major cause of ESRD was diabetes mellitus 28 (56%). Most of the patients 33 (66%) have passed 10tH grade or they were under 10TH grade. Prevalence of ED was 86% with mean IIEF-5 score of 10.36 +/- 7.13. Majority of patients 33 (64.7%) were suffering from severe degree of ED. Factors responsible for ED are diabetes mellitus, age more than 50 year, high pre dialysis urea and Anti HCV positive patients. In this study, smoking, duration of dialysis and monthly spending is not related with ED.

CONCLUSION

Majority of the patients suffering from ESRD, on maintenance haemodialysis are having ED. None of the patients suffering from ED were taking any treatment for it. Haemodialysis does not improve sexual dysfunction. Major factors responsible for ED are diabetes mellitus, age more than 50 years, high pre dialysis urea and Anti HCV positive patients.

Choroidal metastasis from renal cell carcinoma presenting with cataract

We report a case of rare involvement of the eye with choroidal metastasis from renal cell carcinoma presenting 08 years after the primary tumor was removed. The patient initially presented with cataract most probably induced by the tumor. After cataract extraction, tumor was detected when it induced vitreous involvement and retinal detachment. Enucleation was performed and an extraocular mass was also excised. Histopathology confirmed the diagnosis of metastasis from renal cell carcinoma in the ocular tumor, extraocular mass and the vitreous.

Campomelic dysplasia: case report and review

Initial ultrasound of a fetus in the third trimester demonstrated shortened and bent fetal extremities with a narrow and misshapen thorax. These findings were suggestive of a fetus affected with a possible lethal skeletal dysplasia. Decisions regarding antepartum, intrapartum and neonatal care were made in this context. A newborn with campomelic dysplasia was delivered and suffered a rapid downhill course.

Referral pattern fof hemodialysis patients to nephrologists

OBJECTIVE

To determine the referral pattern of dialysis patients to nephrologists and the effects of late referral on clinical, hematological and biochemical parameters in patients presenting for the first-time to dialysis center.

STUDY DESIGN

Cross-sectional study.

PLACE AND DURATION

Hemodialysis Unit of Shalamar Hospital, Lahore, from June 2003 to October 2006.

PATIENTS AND METHODS

This study was conducted on all patients of end stage renal diseases presenting for the first-time for undergoing hemodialysis at our center. Patients with acute renal failure were excluded from the study. At presentation, a history was taken from all the patients regarding seeking of nephrology services and referral pattern. Early and late referral was defined as the time of first referral or admission to a nephrologists greater or less than six months respectively before initiation of hemodialysis. All the patients were examined and their blood sample was drawn at the same time for routine hematological, biochemical parameters (urea, creatinine, serum potassium, calcium, phosphate and albumin) and viral markers (Anti HCV and HbsAg).

RESULTS

In this study, 248 patients were enrolled, amongst them, 131 (52.8%) were male and 117 (47.2%) were female. Major causes of renal failure were diabetes mellitus, chronic glomerulonephritis and hypertension. Most of the patients were euvolemic and hypertensive. Sixty percent of patients were having very high urea ( > 200 mg/dl) and creatinine ( > 8.0 mg/dl). Most of the patients, 226 (91.1%), were anemic (Hemoglobin < 11gm/dl) and 224(90%) were hypoalbuminemic (serum albumin<4gm/dl) on first presentation. Majority of patients were hyperkalemic, 139 (56.0%), hypocalcemic, 168 (67.7%) and serum phosphate level was high in only 117 (47%) patients.

CONCLUSION

All the patients presented in emergency room to nephrologists at very late stage (100% late referral), when disease was very much advanced. All of them did not have permanent vascular access for hemodialysis on first presentation to dialysis center. Reasons for late referral were non-availability of nephrologists and nephrology services, non-renal doctors biased, unawareness and training of medical professionals for these patients, patients' own denial for dialysis, fear and wrong perception about dialysis procedure, socioeconomic factors and use of non-evidenced based treatment modalities.