Prevalence of dental erosion in Pakistani children: A cross-sectional study

Introduction: 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

Impact of End Stage Renal Disease on the Clinical Outcomes Of Diabetics Admitted for Heart Failure: Analysis of National Inpatient Sample

Introduction: Patients with diabetes and heart failure (HF) can have varying outcomes depending on whether they also have End Stage Renal Disease (ESRD). This study aimed to compare the outcomes of patients with diabetes and HF with and without ESRD. Methods: Data from the National Inpatient Sample (NIS) 2016-2018 was analyzed to find hospitalizations for patients with HF as the main diagnosis and diabetes as a secondary diagnosis, with and without ESRD. Multivariable logistic and linear regression analysis was used to adjust for confounding factors. Results: In the total cohort of 12215 patients with a principal diagnosis of heart failure and secondary diagnosis of type 2 diabetes, the in-hospital mortality rate was 2.5%. Patients with ESRD had higher odds of in-hospital mortality (1.37x) compared to those without ESRD. The mean difference in length of stay was higher for patients with ESRD (0.49 days) and in total hospital charges (13360 US$). Patients with ESRD had higher odds of developing acute pulmonary edema, cardiac arrest, and requiring endotracheal intubation. However, they had lower odds of developing cardiogenic shock or requiring an intra-aortic balloon pump insertion. Conclusion: The results suggest that ESRD leads to higher in-patient mortality, length of stay, and total hospital charges for patients with diabetes admitted for HF. The lower incidence of cardiogenic shock and intra-aortic balloon pump insertion in patients with ESRD may be due to timely dialysis

A rare case of three years disease free survival in a locally advanced parathyroid carcinoma successfully excised by complete surgical resection

Parathyroid carcinoma (PC) is one of the rarest malignancies making approximately 0.005% of all cancers. It may arise sporadically or less commonly, in conjunction with genetic endocrine syndromes. Due to the rarity of the disease, no general consensus or definitive guidelines exist for its pre-operative diagnosis, management, or follow up. Surgical tumor removal is the gold standard treatment to prevent its recurrence. Parathyroid carcinoma has a high recurrence rate ranging from 40 to 60% in recent literature. We report a case of a seventy-year-old elderly female with locally advanced parathyroid carcinoma successfully surgically excised completely with a 3 year disease free survival period without adjuvant chemotherapy or radiotherapy

A Case of Asymptomatic Pulmonary Artery Aneurysm with Review of Management Strategies

Pulmonary artery aneurysm (PAA) is defined as pulmonary artery diameter greater than 4 cm. With advances in cardiac imaging, the detection rate has increased but the natural history remains unknown. We present the case of a large, incidentally identified PAA in a patient with a history of congenital pulmonic stenosis

The novelty of icosapent ethyl in the management of hypertriglyceridemia and alleviating cardiovascular risk

Hypertriglyceridemia is believed to be independently associated with an elevated risk of cardiovascular disease (CVD) events. Lifestyle changes and dietary modifications are recommended for individuals with high serum triglyceride (TG) levels (150-499 mg/dl), and pharmacological therapy in addition to lifestyle modification is recommended when serum TG levels ≥ 500 mg/dl. A residual cardiovascular risk remains even in statin appropriate treated patients with CVD risk factors, and in this patient population, hypertriglyceridemia poses an independent and increased risk of ischemic events. In December 2019, the US FDA approved icosapent ethyl (IPE) as an adjunct to a maximally tolerated statin to reduce the risk of CVD events in adults with serum triglycerides \u3e 150 mg/dl and have either established cardiovascular disease or diabetes and two or more additional CVD risk factors. Since IPE significantly decreases total ischemic events in the aforementioned patient population, it would be intriguing to know whether IPE alone added an advantage to lifestyle modification in the low-risk population, who has serum triglyceride between 150 mg/dl and 499 mg/dl

To assess the aggressiveness of oral squamous cell carcinoma in the young population

Introduction: Squamous cell carcinoma of the oral cavity has a high prevalence not only worldwide but also in Asian countries. It has been estimated that the mortality from the tumor has remained almost 56% and cancer presenting at a younger age tends to be more aggressive and advance at the time of presentation. Objectives: To assess the pattern of recurrence and disease-free survival in two age groups. Materials and methods: This is a retrospective, cohort study of patients diagnosed with oral squamous cell carcinoma admitted between 2008 to 2018. Two groups were made with 40 years as a cut off mean. Various etiological factors, staging, treatment, site of the tumor, and recurrence and mortality were assessed. Results: Patients who underwent treatment for the cancer of which 124 patients were of less than 40 years and 327 were of age above 40 years. The ratio between males to females in Age40 was 3:1 respectively. The most common site of the tumor is cheek in origin. Patients in Age 40 years recurrence of tumor is (n=120, 37%) with CI of 95% (P=0.653) and the overall mortality in Age40 (n=168, 51%) of patients have a mortality with CI of 95% (P=0.811). Conclusion: Overall the study suggests that mortality of the tumor is almost the same with a slight difference in recurrence of the disease. Cheek is the most common site of presentation

Culprit Vessel Only Versus Multivessel Percutaneous Coronary Intervention in Acute Myocardial Infarction with Cardiogenic Shock: A Systematic Review and Meta-Analysis

Background: Previous studies comparing outcomes between culprit vessel only percutaneous coronary intervention (CV-PCI) versus multivessel percutaneous coronary intervention (MV-PCI) in patients with cardiogenic shock in the setting of acute myocardial infarction have shown conflicting results. This meta-analysis investigates the optimal approach for management of these patients considering recently published data. Methods: Electronic databases including MEDLINE, ClinicalTrials.gov and the Cochrane Library were searched for all clinical studies published until May 1, 2018, which compared outcomes in patients presenting with acute myocardial infarction and cardiogenic shock. Studies comparing CV-PCI versus MV-PCI in patients with multivessel coronary artery disease were screened for inclusion in final analysis. The primary end point was in-hospital/30 day mortality. Secondary endpoints included long term (\u3e6 months) mortality, renal failure requiring renal replacement therapy, stroke, bleeding, and recurrent myocardial infarction. Odds ratio (OR) with 95% of confidence interval (CI) were computed and p values \u3c0.05 were considered significant. Results: Patient who underwent CV-PCI had significantly lower short-term mortality (in-hospital or 30-day mortality) (OR: 0.73, CI: 0.61–0.87, p = 0.0005), and lower odds of severe renal failure requiring renal replacement therapy (OR: 0.76, CI: 0.59‐0.98, p = 0.03). There was no statistically significant difference in long-term mortality, stroke, bleeding, and recurrent myocardial infarction between two groups. Conclusion: This meta-analysis showed lower short-term mortality and decreased odds of renal failure requiring renal replacement therapy with CV-PCI compared to MV-PCI. However, subgroup analysis including studies exclusively assessing STEMI patients revealed no statistically significant difference in outcomes. Further randomized trials are needed to confirm these findings and evaluate long term results