Journal of Muhammad Medical College ( J Muhammad Med Coll)
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Prevalence of dental erosion in Pakistani children: A cross-sectional study
Full text linkIntroduction: Dental erosion has remained a topic of interest for more than a decade and now gripping greater attention with the rise in the number of cases being reported in children and young adults. Prevalence of dental erosion varies in different countries according to their different geographical locations, dietary habits and life styles of their people. However, little is known about the prevalence of tooth erosion in Pakistani children particular regarding the associated risk factors. Aims: This study was designed to explore the prevalence of dental erosion and to determine the associated predictors of dental erosion in school children of Pakistan aged 12 to 14 years.
Methodology: A comparative cross-sectional Analytical study was conducted at a private school of Karachi, Pakistan from April 2016 till March 2017. The subjects were selected on the basis of non-probability convenient sampling. Children aged 12-14 years were included for this study and children having frequent hospitalizations were excluded. The two previously calibrated examiners participated in the clinical examinations and visited the selected schools. The clinical examinations were performed in well-lit classrooms or in shaded places under natural light using plane mouth mirrors and sterilized cotton to remove debris. The central incisors, lateral incisors, and first molars in the upper and lower jaws were examined.
Results: School children were assessed by O’sullivan index which showed dental erosion of 42.8% on labial or buccal surface, 9.7% on lingual or palatal surface, 7.4% on occlusal or incisal, 4% on labial, incisal/occlusal and 7% on lingual, incisal/occlusal. Grade of severity of dental erosion showed normal enamel in 43.1%, matt appearance of enamel surface with no loss of contour in 20.1%, loss of enamel only in 35.8% and loss of enamel with exposure of dentine in 1%.
Conclusion: The study concludes that dental erosion is a multifactor in origin and with time is becoming increasingly commonly in younger age group. It is important that as health providers we need to identify the possible risk factors and make the community aware of the ways to prevent this condition.
Key words: Surfaces of teeth, enamel surface, Soft drinks and straw
Association of blood lipids, cortisol and Hemodynamics Under stress: A possible role in early Atherogenesis
Full text linkIntroduction: High blood cholesterol is claimed as a risk factor but recently it is accepted that cholesterol is increased under psychological stress. When raised in blood, cholesterol plays role in atherosclerosis formation; a role which is being debated since last many decades but still various questions is un-answered. Role of stress in early atherogenesis with association to alteration in blood lipids has been proposed but the available literature is scanty on the subject.
Objective: To explore the association of alterations in blood lipids, cortisol level and hemodynamics under mental stress in youth with no apparent heart disease.
Methodology: 114 male participants were selected from 397 volunteers as per ‘selection criterion’ approved by scientific committee. The volunteers were examined two times: during stress task as ‘stress-study’ and during non-stress period as ‘control’ according to ‘paired sample’ design. Thus, 56.54% apparently healthy subjects were included with exclusion ratio of 43.58%. All experiments were conducted under standard methods at LINAR-Larkana and Physiology Department of Sindh University, Jamshoro. Blood sample were taken between 9.00 am to 12.00 pm.
Results: Cortisol, systolic and diastolic blood pressures and heart rate were significantly increased during stress session. Different lipid levels were changed with different significant values. Correlations of some altered lipid levels with raised values of hemodynamics and cortisol detected were positive and significant.
Conclusion: Most changes in the level of variables were found prone to be “atherogenic in pattern” due to psychological stress. This work may pave a way for better understanding of relationship in between lipid alterations, mental stress and early atherogenesis. For that further studies are needed.
Key Words: Cholesterol, Hemodynamics, Cortisol, psychological stress
Dynamic Compression Plate: A useful procedure for sub-trochanteric femur fracture with osteopetrosis.
Full text linkIntroduction: Osteopetrosis is an un common disease. It is of infantile and adult type. With adult type osteopetrosis, bones are vulnerable to fracture even with minimal injury. As there is increased bone density and small medullary canal, therefore, these fractures are challenging for orthopedic surgeons.Objective: To evaluate the results of Dynamic Compression Plate (DCP) for the fixation of sub-trochanteric fractures of femur with osteopetrosis in term of union malunion, non-union and post-operative infection.Methodology: This prospective study was conducted in the department of Orthopedic surgery at Muhammad Medical College Mirpur Khas from March 2015 to February 2017. Patients, with sub-trochanteric fractures of femur having osteopetrosis, between the age of 20-60 years of either gender were included in this study. All fractures were fixed with DCP. Post-operatively patients were mobilized with crutches in 1st week, followed by partial weight bearing in 3rd week and full weight bearing in 6 weeks.Results: Union of fractures occur in 98 %patients. Mal union in one patient and nonunion in one patient. Post-operative infection was observed in one patient.Conclusion: This study shows management of sub trochanteric fractures of femur in patients with osteopetrosis are best treated with DCP with little or no complications.Key words: Osteopetrosis, sub trochanteric fractures, DCP
Knowledge, Attitude and Practice regarding management of HIV /AIDS among Postgraduate Medical Internee working in Tertiary Hospitals of Karachi
Full text linkIntroduction: In this modern era the number of new HIV infections has dropped; but Pakistan remains among few regional countries witnessing an increase in cases. On the other hand most, Pakistani people have inadequate knowledge regarding HIV/AIDS. In a study conducted in Pakistan concluded that it is a mutual misconception in overall population or society is that being Muslim, HIV cannot be contracted.Objective: To assess the knowledge, attitude, and practice about HIV/AIDS among post-graduate medical Doctor of Medicine Working in the tertiary care Hospitals of Karachi.Methodology: This descriptive cross-sectional study was done at three randomly selected tertiary care hospitals of Karachi. All the postgraduates’ medicine’s trainee of three hospitals were approached for data collection. The data was collected by the principal investigator through structured questionnaire based on 31 questions regarding knowledge, attitude, practice and management of HIV/AIDS patients by the participants. The study duration was 6 months. SPSS version 24 was used to analyze data.Results: The study showed that the one third of participants (35.3%) had adequate knowledge regarding HIV/AIDS, whereas large number of internees had adequate attitude (69.7%) towards HIV Patients, and almost one fourth participants had adequate practice and management (26.1%) approach towards HIV/AIDS cases.Conclusion: The Postgraduate internee has sufficient attitude, while poor knowledge and practices towards HIV/AIDS cases. To improve HIV/AIDS management strategy, it is highly recommended to create awareness among health care provider as well as general population through emphasis on all components of KAP.Keywords: KAP, HIV, AIDS, tertiary care hospital
Impact of Continuing Medical Education on Health Care Provider Performance in a Medical University, Karachi, Pakistan.
Full text linkIntroduction: Basic life support (BLS), is the chain of survival and decreases the rate of cardiac arrest; health care professionals should know at least how to perform BLS individually as they may encounter such emergency very often. In the developed world, sudden cardiac death represents the single largest cause of natural death accounting for 12–18% of total mortality and 50% of cardiac mortality.
Objectives: To determine the level of awareness regarding Basic Life Support and knowledge of involved skills and its practice among medical and non-medical personnel.
Methodology: A retrospective study conducted by using valid questionnaire regarding Basic Life Support by 323 personnel. The results were analyzed with SPSS version 16.
Results: Twenty-five questions were used to assess the level of knowledge/awareness and skills after BLS training. The percentage of correct answer varied from 33.1% to 95.7% for knowledge related items; and for skills items, it was varied from 35.3% to 68.4%.
Conclusion: We recommend that Cardio Pulmonary Resuscitation/Basic Life Support should be a basic skill across all medical and non-medical personnel.
Key words: Cardio-pulmonary resuscitation, Basic Life Support, KAP
Incidence of Adenomyosis and its association with other benign lesions in Hysterectomy with BSO.
Full text linkObjectives: To determine the incidence of adenomyosis and to assess its association with co– existing benign lesions.
Methodology: This prospective cross section study carried out at the Department of Pathology, Muhammad Medical College Mirpurkhas Sindh Pakistan from 1st January 2016 to 31st December 2016. Total 53 cases of hysterectomies with BSO were assessed. All specimens were grossly examined in detail and processed through hematoxylin and eosin stains. All the sections were examined for adenomyosis and its associated co – existing benign lesions.
Results: Out of 53 specimens of hysterectomies with BSO, in 39.6% were found adenomyotic foci. The patients mean age was 40 years. Besides adenomyosis alone 14.2%, the associated co – existing benign lesion were ovarian cysts (57.1 %). Endometrial polyps and adenomyomatous Polyps
(19 %) and Leiomyomas (9.5 %).
Conclusion: Adenomyosis is common in middle aged women. The ovarian cysts are frequent co – existing benign lesions of adenomyosis.
Key Words: Adenomyosis, Bilateral Salpingo-oophorectomy, Hysterectomy
Association of HbA1c and total cholesterol levels in child bearing age using injectable contraceptives.
Full text linkIntroduction: Injectables contraceptives are convenient and highly effective methods for fertility regulation, being simple to administer and long acting, but affect lipids by increasing total cholesterol and triglycerides1 , the major health risk of injectables contraceptives are cardiovascular diseases (CVS), particularly heart attacks (myocardial infarction), stroke and venous thromboembolism2 Hormonal contraceptives have traditionally being thought to adversely affect carbohydrate metabolism by increasing insulin resistance and decreasing glucose tolerance.3
Objective: To determine and compare the values of HbA1c and total cholesterol levels in child bearing age using Depot Medroxy Progesterone Acetate (DMPA).
Methodology: This comparative cross-sectional study was conducted at Department of Pharmacology, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Centre, Karachi, from January 2016 to December 2016. Total 200 fertile females in their child bearing age were selected. They were divided into two groups, Group 1 (controls) and Group 2 (DMPA users). Total cholesterol levels were measured before starting therapy, in the middle and the end of the therapy by using standard procedures on semi- automatic clinical chemistry analyser (Microlab 400). HbA1c levels were measured by using semiautomatic clinical chemistry HbA1c analyser (Microlab 300). Results were analyzed by using Statistical Package for Social Sciences (SPSS) version 21.
Results: DMPA causes significant increase (p < 0.05) in total cholesterol, but insignificant changes (p > 0.05) in HbA1c levels.
Conclusion: It is suggested that total cholesterol and HbS1c levels should be measured before starting and during the course of injectable contraceptives to the subjects. As deranged cholesterol levels can increase the risk of cardio- vascular disease outcomes.4 Also injectable contraceptives may cause pre- diabetes (increased in levels of HbA1c 5.7-6.4)5.
Key Words: Depot medroxyprogesterone Acetate (DMPA), Glycated hemoglobin (HbA1c), Total Cholesterol, Statistical Package for Social Sciences (SPSS)
Patients Perceptions of Doctors Empathy in MMCH.
Full text linkPatients Perceptions of Doctors Empathy in MMCH
*Aiman Mustafa, **Muhammad Zeeshan Zafar, ***Muhammad Asad Khan
*Muhammad Medical College, Mirpurkhas, **Rashid Latif Medical College, ***Kind Edward Medical University.
Abstract
Introduction: Empathy is defined as understanding of patient’s experiences, concern and perceptive, combined with a capacity to communicate and intention to help. Patient takes doctors empathy as his good will for successful treatment of his patient while understanding his misery. This study was designed to in investigate the perception of patients regarding doctor empathy and to examine their satisfaction and personal interest or indications of patient compliance.
Methodology: A cross-sectional survey was conducted between August 1, 2015 50 August 26, 2015. 100 patients selected purposively from OPD and ward. A self-administrated Likert styled questionnaire originally developed by Hojat et al at Jefferson school of Medicine with Urdu translation was administered. The data was analyzed using SPSS version 16.
Results: Among the total of 100 patients, 98%patients accept that their Doctor has been taking care of them, 74% patients were satisfied that the Doctor explain the reason for any test, 94% thought that their Doctor explained things clearly to them, 96% strongly agreed that their doctor had knowledge and skills, 100% were satisfied with the care their doctor provided, while 82%claimed that their doctor encourage them to explain the disease to him, 94% wanted their doctor to be present in any medical emergency.
Conclusions: This study reveals a high degree of patient’s satisfaction with empathy of Doctors of MMCH, although some improvement is still possible.
Key words: Patient, empathy, concern, satisfaction, MMC
Risk assessment of gallstone among indoor patients of chronic liver diseases secondary to Hepatitis C.
Full text linkIntroduction: Gallstones (GS) are widely reported as the major cause of mortality and morbidity globally.1 The frequency of GS in patients with chronic liver disease (CLD) is considerably higher than in the general population.1-7 Moreover, prevailing risk of gallstone is associated with disease frequency and severity in advance stages of CLD.1,3 The predictable local incidence of gallstones in CLD patients is approximately 24-31%.6-7 HCV is presumed to be the major cause of CLD in the local settings6-7. Despite high prevalence of GS and HCV CLD in our population, the occurrence of GS in HCV CLD cases has not been assessed so far. Objective: To assess gallstone disease in indoor patients of chronic liver diseases secondary to Hepatitis-C.Methodology: This cross-sectional study was carried out at Department of Gastroenterology, Liaquat National Hospital (LNH), Institute for postgraduate medical studies and health sciences, Karachi from January 2013 to July 2013. Totalof145 patients of chronic liver disease (CLD) secondary to Hepatitis C Virus (HCV) of either gender, regardless of duration of disease, having age more than 30 years were selected purposively. Structured questionnaire used for data collection. Ultrasonography was done to diagnose gallstones. The routine investigations such as platelet count, anti HCV antibodies, and prothrombin time (PT) were performed. SPSS version 20 was used to analyze data. Variables like gallstone was presented through percentages and frequencies, age as mean and SD. After stratification of age, gender and severity of liver disease, chi-square test was applied and p-value less than 0.05 was considered statistically significant.Results: The mean age of patients (n=145) was 54.8±9.4 years, whereas mean of males was 53.9±9.3 years and females were 56.2±9.5years. Among total cases86(59.3%) were males and59(40.7%) were females. The gallstones in male patients (n= 30, 58.8%) was higher than female patients (n=21, 41.2%). However, this difference with regards to gender, was not statistically significant (p-value=0.9). The Child-Pugh score with gallstones patients was (10.0±2.1) slightly higher than patients without gallstone (10.7±2.1). In patients with gallstone, Child’sPughclass-Cwasfoundin51(54.3%) patients, class-Bin37(39.4, %) and class-A in 6 (6.3%) patients.
Conclusion: HCV infection is independent risk factor for gallstones in cirrhotic patients. Laparoscopic cholecystectomy in Child-Pugh A and B patients with symptomatic gallstone disease is a safe procedure.
Keywords: Gallstones, HCVCLD, Child-Turcotte-Pugh, Cholecystectom
Prevalence of Xerostomia in Diabetes Mellitus at lower Sindh.
Full text linkIntroduction: Xerostomia is a common problem in apparently normal as well as in ill individuals. Diabetes mellitus is a common endocrine disorder in which Xerostomia is complained frequently. Xerostomia contributes to altered eating habits and increase risk of dental caries and oral infection if there is inadequate blood glucose control. Factors affecting Xerostomia includes socioeconomic and medical condition, includes uncontrolled diabetes mellitus, presence of peripheral neuropathy, use of medications, gender and age.
Objective: To document the prevalence of Xerostomia among diabetic patients.
Methodology: This prospective, cross sectional study was conducted on known cases of Diabetes mellitus attending medical OPD at Muhammad Medical College, Mirpurkhas Sindh from March 2017 to August 2017. During this period 100 patients were included according to inclusion criteria. Demographic details were recorded. Fox questionnaire was filled in, the data collected was analyzed by SPSS version 22, and presented as number and percentage.
Result: Among100 patients; 37% were xerostomic and 63% were non xerostomic, age range of xerostomic was 50 ±7years and non xerostomic was 35 ±11 years. 21 females had Xerostomia and 29 had no Xerostomia .16 males were xerostomic, and 34 males were non xerostomic. Among xerostomic patients 15 were insulin dependent and 21 were non-insulin dependent. Where as in non xerostomic 22 were insulin dependent and 42 were non-insulin dependent. The mean duration of diabetes mellitus was 10 ±5 years in Xerostomic and it was 8 ±3 years in non xerostomic diabetes mellitus.
Conclusion: Xerostomia is common in elderly diabetics and in females and is dependent on glycemic control and duration of diabetes.
Key words: Xerostomia, Diabetes mellitus, Elderly and Duration of Diabetes Mellitus.