Volume 7 Issue-1

  • Editorial
  • Original Article
  • Kap
  • Case Report
  • Review Article

 

The articles for the PJMD Issue are listed below. The articles are in PDF Format which requires Adobe Acrobat Reader for viewing.

EDITORIAL

CAN WE DO BETTER THAN JUST SCRATCHING AT THE SURFACE OF UNENDING MISERY 2?

In a 1997 Editorial in the Pakistan Journal of Otolaryngology.1 I wrote, under that title, on the then emerging role of Oral and Maxillofacial Surgery (OMFS) specialization in Pakistan noting, with a degree of pride, the beneficial introductory addition of the expertise of the dento-facial specialist surgeon to the then existing group of Head and Neck surgical specialties.
Oral cancer, already acknowledged in the late eighties as the second most common non-gender specific cancer after lung cancer- both tobacco related and largely preventable- was rising. 1 It noted that the majority of patients seen at the OMFS and ENT Units at Dow Medical / Civil Hospital, Karachi, presented late requiring heroic, always painfully mutilating, and even in the mileu of the public sector hospitals, financially draining and often pointless, surgical procedures; or as often happened, were rejected as already beyond salvage. Evidence based introduction of selective rather than routine radical neck dissections and the advent of microvascular anastomosed free flaps, still mainly limited to a few private sector institutions Evidence based introduction of selective rather than routine radical neck dissections and the advent of microvascular anastomosed free flaps, still mainly limited to a few private sector institutions, has done much to improve the quality of care and reduce the morbidity of this terrible disease.
Oral cancer is essentially a male predominant (2:1) disease the incidence of which has risen exponentially in these intervening years with an average age of incidence of 45 years. Today, oropharyngeal largely tobacco related are the sixth most common Head and Neck cancers worldwide2and may well become the Number One cancer in Pakistan. Potentiating this and essentially areca nut chewing habit caused, is Oral sub Mucosal Fibrosis (OSMF) the most prevalent oral premalignant condition, affecting persons, including children as young as 6 years and with an inordinately high potential for malignant transformation especially when tobacco and other chemicals are added to the easily available and widely chewed commercial mixtures.3 The most worrisome aspect of this study is that malignant transformation (OSMFCancer) occurred in over 30% of the oral carcinomas with females predominantly affected in a reverse (4:1) ratio and of an age group 10 years younger than those without evidence of pre-existing OSMF. In our society, women tend to be among the most socioeconomically and nutritionally deprived and disadvantaged. These are young persons in their prime; the women, often bread earners and usually multiparous. For all practical purposes oral cancer is a disease affecting people of lower socio-economic strata with the oral habit of betel / tobacco. Delay in presentation and poor nutritional status results4 in a high mortality rate- and a lot of orphans! The increasing number of affected young women signals a potential demographic disaster and the need to ring major alarm bells. The sheer volume of oral cancer and prohibitive treatment costs make prevention the only viable option. Recognizing this, the WHO in 2012 released an action plan calling for a combination of policy, public awareness campaigns, and community outreach to curb the habit.2

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 1-3
Published : 2018
Publisher Name : Ziauddin University
  • Dr. Mervyn Hosein
    • Professor of Oral & Maxillo-Facial Surgery Principal, Ziauddin College of Dentistry,Ziauddin University

ORIGINAL ARTICLE

RESISTANCE TO QUINOLONES, AMINOGLYCOSIDES AND CAPREOMYCIN IN MULTI-DRUG RESISTANT (MDR-TB) M.TUBERCULOSIS

Background:

Tuberculosis is a major health issue of developing countries like Pakistan. Multi drug resistance (MDR) and Extensive drug resistance (XDR) in M. tuberculosis is on continuous rise in our region. Detection and prevalence of resistance in tuberculosis patients were discussed in few of the studies in Pakistan but pattern of resistance to second-line anti-tuberculosis drugs was still unknown and was a gap in the knowledge. This study was aimed to determine the pattern of resistance against Quinolones, Aminoglycosides and Capreomycin in Multi-drug resistant (MDR-TB) tuberculosis from a tertiary care hospital of Karachi.

Method:

The cross-sectional study was carried out from January 2007 to October 2008 in the Department of Microbiology, Basic Medical Sciences Institute, Jinnah Post Graduate Medical Centre, Karachi. Sixty MDR-M.tuberculosis strains of two groups were collected. Group 1 consisting of 30 samples from stock cultures of MDR-TB collected during previous 5 years (Laboratory of Microbiology, BMSI) and Group 2 consisting of 30 culture positive specimens from JPMC and Ojha Institute of Chest diseases, Karachi. These samples were further analysed for anti-microbial sensitivity against Quinolones (Ofloxacin), Aminoglycosides (Amikacin and Kanamycin) and Capreomycin. Indirect Proportion Method is used for drug susceptibility test (DST) following WHO guidelines 2001. For calculations & results, Quantitative analysis was done and percentages were calculated.

Results:

From among 60 MDR-TB isolates, 3 (5%) were resistant to Ofloxacin; 1 (1.6%) resistant to Amikacin; 4 (6.6%) were resistant to Kanamycin and 60 (100%) were sensitive to Capreomycin. There was an increase in resistance in-group 2.

Conclusion:

Our study confirmed the resistance against second-line anti-tuberculous drugs. Overall resistance to second-line anti-tuberculous is at low percentage but results clearly show the marked increase in resistance in Group 2. Immediate measures are surely required to detect and control drug resistance in our country.

KEYWORDS: MDR-TB, Drug resistance, Quinolones, Capreomycin, Aminoglycosides

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 4-10
Published : 2018
Publisher Name : Ziauddin University
  • Samia Khanam
  • Sobia Hasan
    • Department of Pathology
  • Rabia Arshad
    • Department of Pharmacology, Altamash Institute of Dental Medicine
  • Muhammad Adnan Kanpurwala
    • Department of Physiology, Karachi Institute of Medical Sciences, CMH
  • Fakhur uddin
  • Mohammad Asif Durrani
    • Department of Microbiology, JPMC. Karachi.

RUGOSCOPY IN FIVE DIFFERENT ETHNIC GROUPS OF PAKISTANI POPULATION

Background:

Rugoscopy is the study of palatal rugae. Palatal rugae are irregular ridges on the mucosal membrane projections extending from incisive papilla to anterior part of palate. They are unique to an individual similar to finger prints. They support in post mortem identification. The aim of this study was to find out predominant rugae patterns and their variations amongst five different linguistic populations of Pakistan.

Method:

A Cross sectional comparative study was conducted at different campuses of Out Patient Departments of Ziauddin Hospital and Al-Zohra Welfare Association, Karachi from July 2016 to January 2017. The study population of 456 subjects included five Pakistani races namely Balochi, Punjabi, Pushto, Sindhi and Urdu speaking with age groups between 15 to 55 years. The shapes of rugae were evaluated on dental casts using the Kapali et al’s classification. Chi square test was used for association of qualitative variables. A p-value of ≤ 0.05 was considered significant.

Results:

There was a significant difference in rugae pattern amongst five ethnicities of Pakistan (p= 0.010). The most prevalent rugae shape among Punjabi and Pushto was wavy followed by straight and curved patterns. Among Sindhi and Urdu speaking the most common pattern was wavy followed by curved and straight rugae pattern. Balochi speaking presented with curved, wavy and divergent patterns. The least common among all the races was circular rugae pattern.

Conclusion:

This study indicates an association between rugae pattern and ethnic groups. This can be used as an additional tool in forensic identification.

KEYWORDS: Rugoscopy, Ehnicity, Forensic identification.

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 11-15
Published : 2018
Publisher Name : Ziauddin University
  • Sara Gardezi
    • Department of Oral Biology
  • Nuzhat Hassan
    • Department of Orthodontic, Ziauddin College of Dentistry,Ziauddin University
  •  Sarwat Memon
  • Arsalan Mughal
    • Department of Anatomy, Ziauddin University

IMPACT OF MULTIDISCIPLINARY TEAM APPROACH TO THE MANAGEMENT OF OTALGIA PATIENT

Background:

Otalgia, one of the most common complain reported in OPD of otorhinolaryngologist, is agonizing and affects all age groups. The objective of the study was to highlight the use of Multidisciplinary team approach to the management of otalgia patients for speedy recovery.

Methods: A cross sectional study was conducted on patients having ear pain. These patients presented to the out-patient department (OPD) of otolaryngology of a tertiary care hospital. Data was collected through questionnaire prepared in advance. Informed oral consent was taken from participants before administration of the questionnaire.

Results:

A total of 216 patients were included in the study. Out of these only 33(15.2%) were less than 18 years of age. Majority [139(64.35%)] of subjects belonged to a low socioeconomic class. Out of these patients 119(55.1%) had ear infections who has to be seen by otolaryngologists. 63(29.2%) of patients had temporomandibular joint pain, referred to the Maxillofacial Surgeons and 34(15.7%) of patients suffering from neck pain, referred to Orthopaedic Surgeon.

Conclusion:

Multidisciplinary team approach was found effective in treating otalgia patients visiting the otorhinolaryngology clinics for the symptom, should be closely examined and referred to concerned departments if required for complete recovery.

KEYWORDS: Otalgia, Multidisciplinary team approach, Otolaryngology, Ear pain

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 16-21
Published : 2018
Publisher Name : Ziauddin University
  • Salman Baig
    • Assistant Professor of ENT. Ziauddin Medical University
  • Ahsan Panhwar
    • Post-graduate trainee at Dr. Ziauddin Hospital Kemari
  • Muaaz Karim
    • 3MBBS graduate from Ziauddin Medical University
  • Abdul Ahad Sohail
  • Ali Zohaib Kaka
  • Mina Afzal Lakha
  • Zawwar Reza
  • Mujeeb-U-Rehman
  • Maha Hassan
  • Noor-e- Zahra
  • Eiman Rahat
  • Shahwar Kazmi
  • Hasham Masood
  • Syed Ali Shayan
  • Maria Owais Saleem Khan
  • Rabia Bhadelia
  • Jawahar Khan Durrani
    • 5th Year MBBS. Ziauddin Medical University

INFERIOR ALVEOLAR NERVE IMPAIRMENT SUBSEQUENT TO REDUCTION OF MANDIBULAR FRACTURES

Background:

Consequent Injury to branches of the trigeminal nerve is a well-recognized risk of dental and oral surgical procedures. Neurosensory impairment of inferior alveolar nerve is seen in traumatic mandibular fractures and after the reduction of these fractures. We conducted a study at Oral & Maxillofacial Surgery Department of Lahore Medical and Dental College from November 2016 to July 2017, to assess the frequency of inferior alveolar nerve impairment after reduction of open and close mandibular fractures.

Methods:

In this randomized controlled trial 60 patients with mandibular fractures between lingula and symphysis and matching the inclusion criteria were inducted and allocated into two groups; Group 1 patients were treated by open reduction and internal fixation by 2mm mini hole plate. Group 2 were treated by closed reduction achieved by eyelet intermaxillary fixation. The inferior alveolar nerve function was clinically evaluated on seventh postoperative day. The results of these evaluations were recorded in a specially designed proforma. Data was analyzed by using SPSS Version 10.0.

Results:

The mean age of patients was 25.25 ± 9.207 years (range 15 to 60). In this study there were 53 (88.3%) males and 7 (11.7%) females (male to female ratio 7.57: 1). Using chi-square test we found closed reduction group was statistically significant [p-value = 0.001 (< 0.0001)]. in getting the higher NST score compared to open reduction.

Conclusion:

There is relatively greater risk of sensory impairment of inferior alveolar nerve with open reduction and internal fixation compared to closed reduction of mandibular fractures.

KEYWORDS: Inferior alveolar nerve, mandibular fractures,peripheral nerve injuries, neurosensory test

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 22-28
Published : 2018
Publisher Name : Ziauddin University
  • Nighat Zahid
  • Aqib Sohail
    • Lahore Medical & Dental CollegeLahore.
  •  Aneela Amjad
    • Sharif Medical & Dental College Lahore
  • Shahid Adil Khalid
    • University of Lahore

SENSITIVITY ASSOCIATED WITH NON CARIOUS CERVICAL LESIONS AND THERE RESTORATIVE TREATMENT

Background:

Tooth structure loss can be due to carious or non carious lesions. Non carious lesions are of different type’s attrition, abrasion and erosion. They may be symptomatic or asymptomatic and treated accordingly.

Objectives:

To assess sensitivity linked to non carious cervical lesions (NCCLs) and there restoration.

Design:

Cross sectional study.

Methods:

Total 100 patients were examined and information was filled on a questionnaire. In these patients 700 teeth with NCCLs were evaluated. Patients with permanent dentition and symptomatic or asymptomatic NCCLs were included. Patients with primary dentition, cracked enamel, carious lesions, defective restorations, pulpitis, active untreatable periodontal disease, xerostomia, braces or hostiry of bleaching were excluded from the study. Sensitivity was assessed by cold air syringe and recorded by the visual analogue scale (VAS). Data collection was done and analyzed on SPSS version 20. Analysis was done using Spearman’s correlation and Mann Whitney test.

Results:

Males (73%) had more NCCLs than females (27%). Mean age of patients was 50 years. Majority (75%) of the patients did not have sensitivity (12%) had mild, (10%) moderate and (3%) had severe sensitivity. Majority (55%) of the patients did not get restorative treatment. Rest (45%) opted for restorative treatment, 13% patients opted because of sensitivity and 32% because of esthetic reasons.

Conclusion:

NCCLs were found more in males and middle aged patients. Weak positive correlation was found between age and NCCLs. Majority of patients did not have sensitivity or esthetic concerns and did not get restorative treatment.

KEYWORDS: Abrasion, Sensitivity, Dental wear

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 22-28
Published : 2018
Publisher Name : Ziauddin University
  • Dr. Hina Ahmed
    • Associate Professor & Head of Operative Dentistry Department Ziauddin College of Dentistry/Ziauddin University

SURGICAL OUTCOME OF LUMBAR DEGENERATIVE SPONDYLOLISTHESIS WITH REDUCTION VERSUS FUSION IN SITU.

Background:

Surgical approaches used in the treatment of patients with severe lumbar spondylolisthesis(Grade II and Grade III)are usually associated with a great deal of controversies. The objective of the study was to assessthe surgical outcomes of severe Lumbar spondylolisthesis treated with either pedicle screw fixation,reduction and fusion or instrumented Fusion in-situ.

Methods:

We retrospectively studied 32 patients (20 females and 12 males),whohadsevere lumbar spondylolisthesis. All patients were divided in two groups (group Areduction and fusion and group B fusion in-situ).The mean follow-up period was 6 months. Radiological and clinical outcomes were measured by slip percentage, slip angle correction rate, Oswestry Disability index(ODI), visual analogue scale (VAS). Data was analyzed by SPSS version 22.0

Results:

The analysis of the preoperative visits and final follow-up of all patients indicated that vertebral reduction and fusioncould slightly enhance the surgicaloutcome in comparison to instrumentedfusion in situ. Preoperative and Postoperative data was collected in all patients and found VAS from7.76to 2.08 in group-A and VAS from 8.5 preoperative to 2.4 postoperative in group-B and ODI from 69.42% to 20.06 % in group-A and 70.9% to 22% in group-B and mean slipcorrection rate was 59.8 % . There wasno single caseof loss of reduction.

Conclusion:

The reduction, fusion and spinal decompression enhances surgical outcome and it can be concluded thatsuch procedure is slightly superior over fusion in situ.Excellent and good levels of satisfaction were observed in all group-A patients,although surgical time was slightly more than fusion in-situ group.

KEYWORDS: lumbar vertebrae, Instrumentation, Spinal Fusion

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 33-38
Published : 2018
Publisher Name : Ziauddin University
  • Aqeel Ahmed Memon
  • Imtiaz Hashmi
  • Sohail Rafi
  • Idrees shah
  • Mustufa Perwaiz1
    • Department of Orthopaedic, Ziauddin University Hospital

KAP

ASSESSING THE ATTITUDE OF MEDICAL STUDENTS TOWARDS LEARNING COMMUNICATION SKILLS

BACKGROUND:

Efficient communication skills are essential for doctors to extract relevant information, counsel the patients and formulate a warm relationship with the patients. It’s essential for medical schools to incorporate communication skills learning courses in their undergraduate curricula. This study assesses the attitudes of Pakistani medical students toward learning communication skills.

METHODS:

A prospective, cross sectional study was designed to ascertain the attitude of students studying in Jinnah Sindh Medical University towards formal teaching of communication skills. From all five years, 480 medical students participated in the study. Written informed consent was received Communication Skills Attitude Scale (CSAS) was selected as the assessment tool. Approval from Ethics review committee was sought. Data was entered and analyzed using SPSS v. 23.

RESULTS:

With a mean age of 20.66 years, 39.2% (n=188) were preclinical students and 60.8% (n=292) were clinical students. Female to male proportion was 60.4% vs. 39.6%. Cronbach’s alpha of PAS was above 0.7 and that of NAS was less than 0.7. Therefore, only the PAS was considered for analysis. PAS mean score of the students was significantly related to the five years of medical education. The trend of positive attitude declined as the seniority in education was achieved.

CONCLUSION:

In conclusion, this study demonstrated a positive attitude toward learning communication skills among younger and fresher medical students. This study adds to the growing evidence that supports the investigation of medical students’ attitudes towards learning communication skills and its critical role in curriculum design. The study opens gates for more investigations in this domain and modifications in medical education curriculum.
KEYWORDS: CSAS, medical students, attitude, communication skills, interpersonal skills, Pakistan

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 39-43
Published : 2018
Publisher Name : Ziauddin University
  • Ghazala Usman
    • Department of Community Medicine, Jinnah Sindh Medical University
  • Tahir Siddiqui
    • Sindh Medical College Dow University of Health Sciences (DUHS)

ASSOCIATION BETWEEN MALNUTRITION & COLOSTRUM FOR SEVERE PNEUMONIA

Background:

Pneumonia remains one of the main causes of childhood mortality despite the availability of simple, safe, effective and inexpensive interventions to curb its mortality. This could result from sub-optimal care seeking practices and child rearing, supplemented by lack of access to healthcare.We conducted a studyto identify the association of malnutrition and initiation of breastfeeding variables with severe pneumonia and pneumonia/no pneumonia

Objective:

To determine association of malnutrition and colostrums intake among children aged 2-24 months admitted in tertiary care hospital for severe pneumonia.

Methods:

A total of 288 patients with severe pneumonia were included in this case-control study. Patients were divided into 2 groups with 144 patients in each group selected through non-probability consecutive sampling. Sample size was calculated using WHO sample size calculator keeping power of test at 80%, P1= 1% and P2=7.8%. Data was analyzed through SPSS version 19 and p-value < 0.05 considered as significant. Association between study variables and severe pneumonia was computed using Chi Square Test.

Results:

Mean age for group A (67 males and 77 females) was 13.00±6.40 months and group B (78 males, 66 females) 12.83±6.90 months. Malnutrition was seen in 41% of group A and 17.4% of group B patients. Colostrum intake (Initiation of breast feeding with 72 hours) was reported in 78.5% of group A and 79.2% of group B. There was a significant association of malnutrition with severe pneumonia (p=0.000) whereas, no significant relation was found with colostrum intake (p=0.885).

Conclusion:

Malnutrition was significantly associated with severe pneumonia. Colostrum was the most prevalent factor in both groups but the difference was insignificant.

KEYWORDS: Malnutrition, Colostrum, pneumonia, child mortality, breast feeding, immunization, measles, infant, low birth weight

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 44-49
Published : 2018
Publisher Name : Ziauddin University
  • Faiza Siddiqui
  • Mohammad Iqbal
    • Department of Pediatric Medicine, Ziauddin Hospital North campus, Karachi
  •  Kausar Aamir
    • Department of Pharmacology & Therapeutics, Basic Medical Sciences Institute, Jinnah Postgraduate Medical Center-Karachi
  • Zareen Naz
    • Department of Pharmacology, Liaquat College of Medicine and Dentistry, Karachi

REVIEW ARTICLE

ROLE OF VITAMINS IN CARDIOVASCULAR SYSTEM –A REVIEW

Cardiovascular disease (CVD), the leading cause of mortality around the world, among many risk factors has but some are modifiable one of which is lifestyle. The key element in the healthy lifestyle is diet that boosts cardiovascular health, especially few key vitamins which have been found to help the heart and blood vessels working properly. Vitamins, especially those with antioxidant potency, may have a role in the prevention of and therapy for CVD. Antioxidant vitamins such as vitamin C, vitamin E, and carotenoids are able to decrease the rate of oxidative stress, which may have a principal role in the pathogenesis of atherosclerosis and CVD. Vitamin D also contributes to the maintenance of cardiovascular health and can induce cardio protective effects. Although most of the randomized controlled trials on vitamins failed to show the benefit of vitamin supplementation for cardiovascular outcomes, a number of observational and cohort studies, meta-analyses, and stratified analyses of large vitamin trials appeared to show an effect in some aspects of cardiovascular prevention. Moreover, many of the vitamin trials for secondary prevention are biased by use of vitamins and drugs effective for cardiovascular prevention; therefore, the conclusions drawn from them supporting the effectiveness of vitamin substitution for the prevention of CVD may be inappropriate. This review summarizes the available data suggesting the role of few vitamins in cardiovascular health and in the primary prevention of CVD; also, examining the use of new concepts and new study designs to establish the effectiveness of vitamin supplementation in the therapy for and prevention of CVD.

KEYWORDS: Hematomatrocolpos, transverse vaginal septum, imperforate hymens

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 50-54
Published : 2018
Publisher Name : Ziauddin University
  • Hafiz Syed Mohammad Osama Jafri
    • Department of Biochemistry, Ziauddin University, Karachi
  •  Saeeda Baig1, Sabra Siraj
    • Department of Oral Biology, Dow University of Health Sciences, Karachi

CASE REPORT

UNILATERAL FUSION OF TEETH IN MANDIBULAR ARCH – AN UNUSUAL FINDING

Fusion of two teeth is rare developmental disorder which is encountered by a clinician. It is commonly reported in deciduous dentition. The fused crown appears broader and usually an esthetic concern. This condition usually reveals a decreased teeth count. Unilateral occurrence of fusion in permanent mandibular anterior teeth is a rare phenomenon. Hence this case report is presented.

KEYWORDS: fusion, gemination, double teeth, mandibular

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Volume 7 Issue-1
ISSN : 2308-2593
Page No. : 55-57
Published : 2018
Publisher Name : Ziauddin University
  • Banerjee Abhishek
    • Consultant oral pathologist and dental surgeon,Lions eye and dental hospital, Durgapur 
  • Rashmi M
    • Reader,Dept of Prosthodontics and implantology, Sri Siddhartha university, Tumkur
  • Baruah Akash Narayan
    • Endodontist , Guwahati
  • Latawa Raghav
    • Orthodontist , Panchkula , Haryana
  • Chugh Niranjan Kumar
    • Assistant Professor, Dept of dentistry, Sri Ramkrishna institute of medical sciences, Sanaka institutions, Durgapur
  • Pranay Dutta Dwivedi
    • Oral pathologist, Bangalore