Volume 6 Issue-2 Apr-Jun, 16

The health of the common man, an oft-neglected issue in many developing countries, is marked by rampant corruption and gross neglect on the part of the very institutions delegated with this responsibility. It is rather unfortunate that Bioethics, despite being recognized as an important discipline and being around for more than 40 years, when there is a need to be reinforced in developing countries there is a blatant disregard for the ethical principles..

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Background & Objectives:

Diabetic nephropathy occurs as a result of proximal tubule dysfunction with podocyte damage due to increased advanced glycation end-products’ insult in diabetes. Nephrin, one of the three proteins that make up the podocyte architecture, is excreted foremost following renal damage. The aim of this study was to evaluate the efficiency and reliability of nephrin for an early biomarker of kidney damage in diabetic patients.

Methods:

Urine samples (78) were collected from diabetic center. Protein and glucose were determined by Dipstick. The patients were grouped on the basis of Albumin/creatinine ratio (UACR) as normoalbuminuric, Microalbuminuric and Macroalbuminuric with UACR less than 30 mg/g, from 30-300mg/g, and above 300mg/g respectively. ELISA KIT (Exocell USA) was used for Nephrin estimation. Statistical evaluation was done on SPSS version 20.

Results:

Nephrinuria was present in 70(89.7%) out of 78 diabetic patients including 35(81.4%) of 43(55.1%) normoalbuminurics, 5(6.4%) of 30(38.5%) microalbuminurics and all 5 of macroalbuminurics (p=0.027). Nephrinuria was found associated with duration of diabetes, 21(91.3%)/23 were positive with less than three years of disease, 24(92.3%)/26 with three to seven years and 25(86.2%)/29 in more than seven years (p=0.039). Nephrin levels were found increasing from normo- (0.86ug/ml) to Micro- (11.6μg/ml) to Macroalbuminuria group (47.6μg/ml), compared to 0.15 μg/ml in comparison group.

Conclusion:

The increase in Nephrin levels from 0.86μg/ml in patients with normal albuminuria to 47.6μg/ml in patients with macroalbuminuria suggests that Nephrin precedes albumin in urine predicting early signs of kidney damage. Nephrin biomarker can be used as predictor for early diagnosis of Nephropathy in diabetics.

Key Words:

Diabetic Nephropathy; Albuminuria; Podocytes

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Background:

The sphenoid sinuses are located at the skull base at the junction of the anterior and middle cerebral fossae. The sphenoid sinus drains through a single ostium into the sphenoethmoid recess: this ostium is classically situated 7 cm from the base of the columella at an angle of 30° with the floor of the nose in a parasagittal plane, and this usually corresponds to a location halfway up the anterior wall of the sinus. Endoscopically, the posteroinferior end of the superior turbinate points superiorly and medially toward the ostium and thus represents a very important landmark to identify it. The objective of this study was to establish whether there is uniformity of distance measurements both from nasal aperture and between right and left sphenoidal sinuses.

Methods:

This study was conducted in conjunction with the department of Anatomy at the National University of Ireland, Galway, Ireland. Total of 10 cadavers were examined with rigid nasal endoscopes, guide wires and digital vernier caliper. Distances were obtained for anterior and posterior sphenoid walls in each cadaver on each side.

Results:

The total mean distance from nasal aperture to anterior sphenoidal wall was 70.17mm (range 61.04-79.32) and the mean distance from nasal aperture to posterior sphenoidal wall was 83.82mm (range 75.10-90.87mm).

Conclusion:

The analysis of the study revealed wide variations of distance, both from the nasal aperture and between Right & Left sinuses.

Key Words:

Sphenoid sinus, Endoscopy of sphenoid sinus, anterior wall of sphenoid,

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Background:

Cholera, one of the most common cause of acute watery diarrhea in developing world, requires, along with correction of fluid and electrolyte imbalance, antibiotics in to shorten the duration of disease. Emergence of reistance with recommended antimicrobials is becoming an issue to treat Vibrio Cholerae. The purpose of this research was to determine the frequency and antimicrobial resistance pattern of Vibrio cholera isolated in stool samples at a tertiary care hospital.

Methods:

Stool samples were received from both in-patients and out-patients in sterile leak proof containers. All Vibrio Cholerae isolated from stool samples were included in the study. The stool samples were inoculated on Thiosulphate-citrate-Bile salts-sucrose agar. Suspected Vibrio cholerae colonies were stained by Gram’s stain Method. Oxidase positive colonies were isolated on Mueller Hinton agar (MHA). Slide agglunation tests were done to confirm presence of Vibrio cholera and its serotypes.

Results:

A total of 352 (6.37%) Isolates of Vibrio Cholerae archieved from 5524 stool samples.Vibrio Cholerae serotype Ogawa isolated 188/352 (352%), while 164(46.6%) were Vibrio cholerae serotype Inaba. Predominant the isolates were from male patients 184/352 (52.3%), while from females were 168/352 (47.7%). Male to female ratio was 1.095:1. Mean age of patients with positive Vibrio cholerae isolates was 27.15 ± 25.61 years. The Frequency of resistance with Co-trimoxazole, Tetracyline, Ampicillin, Chloramphanicol and Ciprofloxacin was 66.2%, 40.9%, 8.8%, 2.6% and 1.4% respectively.

Conclusion:

The multiple antimicrobials recommended to treat Cholera have been found to develop alarming resistance among Vibrio Cholerae isolates. This situation needs a regular surveillance of commonly used antibiotics and urgent discovery of alternative antibiotics.

Key Words:

Frequency.Antimicrobial resistance pattern.Vibriocholerae. Stool.

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Background:

Injuries due to motorcycle accidents are frequent happenings in developing countries as people utilize it commonly as a mode of transport. In Pakistan 56% of Maxillofacial injuries can be associated to Road traffic accidents (RTA) majority of which are due to involvement of motorbikes.

Methods:

This cross sectional survey was carried out in public tertiary care setting in the year 2016. Three Hundred and Seventy participants were inducted in the study using Purposive sampling technique. Only those with maxillofacial injuries were included and diagnosed through conventional and panoramic radiographs and computed tomographic scans. Those who consented were included whereas, participants with language barrier or unable to answer were excluded. Data was collected by questionnaire with analysis being performed on SPSS version 21. Descriptive analysis was performed for quantitative variables with association between categorical variables tested through chi square. Bond of error was taken at 5% with 95% confidence interval. Permission was sought from ethical review board.

Results:

Majority, [267(84.5%)] were young patients with [ 282(89.2%)] patients involved in Motorcycle accidents. Of total participants male gender was [275(87%)] the driver inflicted in most situations [184(58.2%)]. Most patients [285(90.2%)] were without any safety device. Majority [220(69.6%)] had Mandibular fractures whereas, 111(35.1%) had Maxillary fractures. Soft tissue injuries were seen in 212(67.1%) patients.

Conclusion:

Motorcycle related accidents are common cause for maxillofacial injuries in road traffic accidents. Most patients suffered soft tissue injuries. Most commonly fractured bones were mandible and maxilla.

Key Words:

Maxillofacial injuries, Motorcycle, Accidents

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Background:

Endodontics is the study of the form, function, diseases, health and injuries of the dental pulp and peri radicular region. It also deals with their prevention and treatment. Manual instruments have been used since long now significant development in modern endodontic instrumentation is introduction of Rotary files. In this study we have compared root canal curvature maintenance by manual and rotary instrumentation technique.
The objective of the study is to determine changes in root canal curvature after preparation with manual or rotary instrumentation technique

Methods:

This In vitro Quasi Experimental study was carried out over a period of six months. Mandibular molars, extracted due to caries or periodontal reasons and mesiobuccal canals, with curvature between 20- 400 were included. In Group A preparation was carried out with ProTaper instruments and in group B with manual NiTi files. An ISO #15 NiTi file was placed in the canal and radiograph taken to determine working length, radiograph was scanned, print made and canal curvature determined. Upon completion of preparation, radiograph with #30 NiTi file was taken and the working length was assessed. The same radiograph was scanned, and changes in curvature were assessed by comparing preoperative and postoperative prints. Data analysis was done with Paired and Independent sample t-tests using Statistical Package for the Social Sciences (SPSS) version 20.0 available at university campus. P-value < 0.005 was taken as statistically significant.

Results:

Difference in Pre and Post-operative root canal curvature was lower in ProTaper group, but not satisfactorily significant.

Conclusion:

ProTaper instrumentation technique maintained curvature better than manual instrumentation technique.

Key Words:

Root Canal Therapy, root canal preparation, pulpectomy

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Background:

Teacher’s role has evolved from a knowledge-transmitter to that of a learning-facilitator. To professionally develop postgraduate medical/dental trainees-as-teachers (PGTT) considering teaching as one of the exit-level outcomes of their Master’s program. A course was conducted on twelve-roles of medical teacher with patient-safety theme. This study was intended to explore the level of PGTT’s satisfaction regarding their roles developed in response to their engagement in course activities.

Methods:

In 2015, a one-week course, ‘Fundamentals of Health-Professions-Education (FHPE)’ was conducted for 25 PGTT, underpinned with adult learning principles in context of patient-safety theme for the development of twelve-roles of medical teacher. Variety of teaching approaches with formative and summative assessments were done to promote learning-by-doing (Kolb’s-theory). A self-administered cross-sectional questionnaire on a 5-point Likert scale was used with 29 questions on role of course facilitators, Course plan & conduct and Development of their own teaching skills. Satisfaction-level was expressed in the form of percentages.

Results:

All 25 PGTT responded on three major domains of the questionnaire. All (100%) agreed on the effectiveness of the roles of course facilitators and the course plan & conduct. Majority (96%) of them showed agreement on the improvement of their teaching skills developed during this course.

Conclusion:

The FHPE-course was found as a worthwhile opportunity for PGTT in acquiring the desired outcomes under-supervision and with respect to its future implications in their respective settings. Building capacity for scholarship of teaching & learning is a way forward to successful academic achievements.

Key Words:

Roles of medical teacher, patient-safety, post graduate students as teachers, capacity building, health professions education.

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Background:

To ensure quality of Diploma in Family medicine (DFM). An evaluation was conducted to determine the components and outcomes of the course for further development of the program.

Methods:

A Cross-sectional study was conducted with 15 students of three batches of DFM. Data collection form was designed on CIPP evaluation approach. It was used to collect information regarding goals and objectives, implementation strategy, satisfaction of instructor and trainees and impact of the program on the target population
Descriptive measures (frequency and percentage distributions) were used to analyze the data on SPSS 19.

Results:

Majority (92%) were satisfied with the course content, organization, learning environment and teaching methods of Family medicine rotation. Most of the respondents (92%) were also satisfied with learning recourses accessible and assessment methodologies employed for ongoing assessment. They found ‘the atmosphere conducive for learning’ ,‘the rotations were a good experience, well organized with learning objectives provided at all rotations’ some suggestions made by students for improvement of the course ‘were teaching should be more interactive and more opportunity should be provided to participate with consultants’ The top rated rotations were dermatology, emergency medicine, ENT and orthopedics; where organizational learning environment and quality of delivery were considered as the best parts.

Conclusion:

The program was found successful in achieving its broad objectives. The graduating students found the training effective in enhancing team building abilities, independent thinking, analytical and problem solving skills and professional development. They were very satisfied with the administrative support (67%), infrastructure of the department (33%) and guidance by supervisors (67%).

Key Words:

Evaluation, Family medicine, Diploma

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Background:

Cervical ribs and elongated transverse process are congenital anatomical variations incidentally seen during conventional radiography and are usually ignored as most cases are of less clinical relevance. Cervical rib is generally noted in 1-2 % of the population. The main objective of this study was to find out the prevalence of this variation in our adult population.

Methods:

It is a retrospective cross sectional study which was conducted in Karachi at Ziauddin university hospital Kemari campus radiology department targeting adult population above nineteen years. Study period was six months between January to July 2015. Subject’s x-ray chest P/A view were taken which were analyzed by radiologist for presence of these anatomic variations.

Results:

In this study one thousand conventional frontal chest radiograph were taken in which 460 were males and 540 females patients who were analyzed for cervical ribs and elongated transverse process. Cervical rib was seen in thirty six patients with 2:1 female to male ratio. Elongated transverse process was noted in two hundred and twenty five subjects. Eleven patients having cervical ribs were symptomatic.

Conclusion:

The prevalence of cervical rib and elongated transverse process as delineated by our study is slightly higher than reported in other populations. We also conclude that conventional radiography is effective diagnostic tool to determine presence of this anatomical variation.

Key Words:

Cervical rib, variant, transverse process elongation

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Decades of research has proven the significant role of telomeres in genomic stability and normal cellular function. Telomeres wrapped the end of chromosomes but start altering before birth and continue till adulthood by multiple socioeconomic and environmental factors or exposomes which reduces length with each cell division. An average normal cell has hay flick limit of average 50 divisions. Long expected ages are seen in children of people who practice late parenthood and can also pass this to their grandchildren. Current data on air pollution exposure confirms that the particulate matter(PM) especially PM2.5 and PM10 generating reactive oxygen and nitrogen species, DNA guanine oxidation, mitochondria NADPH-oxidase function and stimulation of inflammatory cells plays a significant role in chronic health effects. Exercise can combat aging by instigating 5′ AMP-activated protein kinase (AMPK) in muscles causing cell proliferation without making them immortal. Healthy Mediterranean diet and appropriate use of vitamins are supportive in reducing life threatening diseases. This review highlights recent knowledge and discoveries regarding the telomeres, with a focus on the latter-day factors altering its length.

Key Words:

Telomeres, Telomerase, Particulate matter (PM), Exercise, Air Pollution.

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Replacement of missing dentition is one of the common reasons to attend a dental practice for individuals who wish to restore their aesthetics and function. There are a variety of treatment modalities for the replacement of a single missing tooth that is a removable of partial denture, a fixed partial denture or an implant supported restoration. Each of these treatment options have their own advantages and disadvantages. Adequate clinical experience becomes a most important factor for treatment planning in fixed and removable prosthodontics. The cantilever fixed partial denture is defined as a restoration having one or more abutments at one end while the other end of the restoration remains unsupported. Anterior teeth replacement can be effectively done using a short-span cantilevered fixed partial denture. Studies report that conventional cantilevered fixed prostheses of various designs have a survival rate of 82% over a 10 year period and cantilevered resin-retained prosthesis show survival rates 83 92% during a 5 year period. While treatment planning for fixed cantilever bridges, there are aesthetic, design and occlusal considerations that should be kept in mind to achieve successful treatment outcome. These are discussed in this paper. Also included, is a clinical case report of a patient that had fixed cantilever prosthesis replacing the maxillary left central incisor with good aesthetic and functional results. Geriatric patients prefer the comfort of a cantilever fixed partial denture to a removable partial denture, since less maintenance is required at subsequent appointments. However, with the rapid advancement in implant dentistry, the use of cantilever fixed partial dentures may be decreasing. This article outlines the basic clinical considerations which may be applied during treatment for fixed cantilever bridges.

Key Words:

Cantilever bridges; clinical treatment planning; tooth replacement; fixed prosthodontics.

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Anatomically, the veins present in the rectal submucous layer are organised as internal and external haemorrhoidal plexus. Haemorrhoids develop due to abnormal varicose dilatations of the venous plexus in the rectal submucous layer. Haemorrhoidal disease is a common anorectal condition affecting 4% of the adult population. As far as prevalence is concerned, data is not easily available. Underreporting is very common and large numbers of cases are asymptomatic.

A 72years old male patient presented to emergency department with severe pain and per rectal bleeding due to third degree prolapsed haemorrhoids. He had co-morbidity of hypertension, diabetes and was asthmatic. His blood pressure was 180/96mmhg and blood random sugar was 330mg/dl, on examination of chest basal crepts were present and wheezing was also auscultated in the chest. The case was diagnosed as a complication of third degree haemorrhoid post banding attempt by an inexperienced GP. It was third or early fourth degree haemorrhoids, which was difficult to differentiate due to prolapse. The case was followed for 1 year, with no complications. Third degree haemorrhoids can be catered under local anesthesia.

Key Words:

Third degree haemorrhoids, haemorrhoids, rubber band ligation

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