ASSOCIATION OF VITAMIN D DEFICIENCY WITH PRETERM BIRTH

Background; Every year, 15 million neonates worldwide are born preterm.  Of these, 1.1 million die as a result of complications of being born too soon and even more suffer from serious prematurity-related complications including learning disabilities. Several studies point to the fact that vitamin D is involved in the regulation of acquired and innate immune responses at the fetal-maternal interface across gestation. Vitamin D reduces the risk of spontaneous preterm birth also by maintaining myometrial quiescence. This study was conducted to determine the role of Vitamin D deficiency with preterm labor in our population. Objective; To determine the frequency of vitamin D deficiency in preterm labour. Setting; Department of Obstetrics and Gynaecology, Fatima Memorial Hospital Lahore. Results; A total of 167 pregnant women were registered mean age of our study cases was 28.48 ± 3.58 years. Mean parity was 3.95 ± 1.15. Mean gestational age of our study cases was 30.29 ± 3.02 weeks. Majority of our study cases i.e. 105 (62.9%) had poor socioeconomic status, while 62 (37.1%) were from middle class while none of them were from rich class. Mean vitamin D level was 40.86 ± 8.51 ng/dl (with minimum vitamin D level was 22 ng/dl and maximum vitamin D level was 56 ng/dl). Vitamin D deficiency was seen in 27 (16.2%) of our study cases. Conclusion; High frequency of Vitamin D deficiency was noted in our study population. Pregnant women should be screened routinely for Vitamin D levels, particularly those with previous history of preterm births to avoid them in subsequent pregnancies. Vitamin D deficiency was significantly associated with poor socio-economic status, increasing age and gestational age less than 30 weeks. Keywords; Vitamin D deficiency, preterm labor, gestational age

Aesthetic rehabilitation in a patient with skeletal mandibular deficiency and open bite: Journey from splinted metalloceramic prosthesis to all-ceramic crowns

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high smile line and maintenance of an adequate biological width. After periodontal healing, all-ceramic individual crowns were placed on the maxillary anterior teeth along with a three-unit all-ceramic bridge for the replacement of the left upper maxillary first premolar. The final results were aesthetically pleasing with good marginal fit. The patient was extremely satisfied with the outcome as all her concerns were addressed. It is, therefore, advisable to consider placing individual crowns rather than multiunit splinted prosthesis whenever possible

Acquired aplastic anemia: treatment in a developing country.

Objective: The aim of this study was to evaluate the clinical presentation of aplastic anemia as well as to assess the efficacy of Cyclosporin -A in patients with aplastic anemia. Methodology: This is a hospital based interventional study. During the three year study period, 44 children were enrolled. Mean age was 9.3 years and there was a male predominance. Results: Most common clinical presentation was anemia and bleeding. Four children died before therapy was started. Cyclosporin-A was started in 40 patients. Eleven patients died before completion of therapy and three patients were lost to follow-up. Out of 26 patients who completed therapy, 11 were cured and 9 were responders while 6 were non responders according to the selected criteria. Conclusion: In developing third world countries like Pakistan majority of the patients with aplastic anemia cannot afford BMT. Alternative modalities of treatment must therefore be looked into. Cyclosporin-A seems to be a reasonable therapeutic option in such cases

Five year evaluation of the complications observed in porcelain fused to metal (PFM) crowns placed at a university hospital

Objective: To determine the frequency of complications in crowns cemented over a 5-year period in a tertiary care hospital and also to report the survival of these crowns.Methods: The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from March 2017 to March 2018 and comprised porcelain fused-to-metal crowns placed on the anterior or posterior teeth that were fabricated at the institutional laboratory and were placed in institutional dental clinics in the preceding 5 years. Porcelain-fused to-metal The crowns were clinically and radio-graphically evaluated in a duration of two months for presence/absence of complications. Factors associated with the failure of the crowns, their survival and the impact of covariates, like gender, flossing and bruxism, on the survival time were determined. Data was analysed using SPSS 22.Results: There were 150 crowns related to 107 patients who had a mean age of 45.0±11.4 years. The most common complication observed was open proximal contacts 9(6%) followed by de-cementation 8(5.3%), porcelain chipping 9(6%) and abutment fracture 2(1.3%). The 5-year survival rate of the crowns was 127(84.7%). The mean follow-up time was 57.2±1.0 months. Overall, year-wise survival of PFM crowns for one year till five years was 147 (98%), 144 (96%), 135 (90%), 130 (86%) and 119 (79%) respectively.Conclusions: The porcelain-fused-to-metal crowns had a high 5-year survival rate. Open proximal contacts represented the most common complication

Investment in paediatric tuberculosis prevention in Pakistan: loss or gain

OBJECTIVE: To assess the effectiveness of paediatric tuberculosis prevention, by reevaluation factors in children exposed to tuberculosis from less privileged strata of Pakistan. METHODS: This cross sectional descriptive study was conducted at National Institute of Child Health, from January 2004 to December 2005. Paediatric patients under 15 years of either gender, diagnosed with active tuberculosis were enrolled. Interviews were conducted with parents regarding common preventive measures and factors advocating tuberculosis spread. Later factors leading to non-compliance to safety recommendations were also evaluated. RESULTS: Fifty five (70%) children younger than 5 years, had index cases in direct contact within their own house. Fifteen (14%) patients contracted the infection from neighbours, with 11 being older than 5 years. There were 82 (51%) cases with Protein Calorie Malnutrition (PCM). Total of 66(41%) cases of PCM were (p \u3c 0.005). Data showed 123(77%) children living in a family with 5 or more members. Sixty eight (55%) children of these large families had to live in a single room house. CONCLUSION: There is a high frequency of direct contact tuberculosis in children belonging to the lower socioeconomic class. This is attributed to poor housing condition and over crowding. The current paediatric tuberculosis prevention strategies as adapted from World Health Organizations\u27 Millennium Development Goals are ineffectual to make changes in children exposed to tuberculosis from less privileged strata of Pakistan. Our societal and demographic factors remain static, continually exposing our children to higher risk of tuberculosis exposure

Adjuvant Hormonal Therapy in Postmenopausal Women with Breast Cancer: Physician\u27s Choices

The choice of adjuvant hormonal therapy in postmenopausal women with hormone receptor positive breast cancer has remained a matter of controversy and debate. The variety of agents is available, with each claiming to be superior. This clinical survey was undertaken to get an impression of the physician\u27s first choice of therapy in an attempt to find out what questions still need to be answered in the making of standard of care. A web-based clinical survey was sent to the cancer physicians around the world, and 182 physicians responded to the survey. Most were medical oncologists in a tertiary care hospital. 36.3% preferred Anastrozole, 35.2% Tamoxifen, and 22.2% Letrozole as their first choice. Data support (67.8%) and safety concerns (30%) were given as the main reasons for the choice, 63.7% switched their therapy, and 24% had to switch because of side effects. 73.6% used 5 years of adjuvant hormonal therapy, 6.6% for 7 years, and 4.4% for 10 years. 61.5% follow their patients 3 times monthly, and 73.2% used laboratory and radiological assessment at each followup. Conclusion. Physicians show disagreement over the choice and duration of hormonal therapy in this patient population. Clinical trials leading to firm recommendations to set standards from which patients benefit the most are needed

Recurrence Relations for Marginal and Joint Moment Generating Functions of Topp-Leone Generated Exponential Distribution based on Record Values and its Characterization

The exact expressions and some recurrence relations are derived for marginal and joint moment generating functions of kth lower record values from Topp-Leone Generated (TLG) Exponential distribution. This distribution is characterized by using the recurrence relation of the marginal moment generating function of kth lower record values

Mothers’s education and working status; do they contribute to corrosive poisoning among paediatric patients of Karachi, Pakistan?

Objectives: To determine the causative factors behind corrosive poisoning in children like effect of working mothers, their educational status, financial background, family size and number of siblings. Methods: The multi-centre, prospective, case series of all paediatric patients presenting to the Emergency Department of the National Institute of Child Health and the Aga Khan University Hospital, Karachi from August 2008 to July 2009 is presented. It comprised all paediatric patients with a history of corrosive poisoning at the two hospitals. SPSS 20 was used for statistical analysis. Results: Out of 105 cases, 56(53%) related to the private-sector Aga Khan University Hospital, and 49(47%) to the public-sector National Institute of Child Health. Of the total, 82(78%) were in 1-5 age group; 61 (58%) were males; and 44(42%) were females. While 59 (56.2%) mothers were educated, only 21 (20%) were working. Of the 46 (43.8%) non-educated mothers, 20 (19%) were working. The type of poison was alkali in 81(77%) cases, acid in 23(22%). The corrosive varied from liquid in 80(76%) cases to powder/gel/semi-solid form in 25(24%) exposures. Besides, 65 (61.9%) families had 3 or more siblings, and the age of siblings was less than 10 in 60 (57.14%) cases, In 34 (32.38%) cases, the chemical were kept in the original container, while in 71 (67.61%) cases other commonly used and familiar containers were used to store these chemicals. Kitchen was the most common place with 51 (48.57%) cases. The time of incident was afternoon in 51(48.57%) cases. Majority cases (n=23; 21.9%) occurred in October. Conclusion: There are multiple contributory factors in corrosive exposure among children rather than the mother\u27s working status and her educational background

Molecular Mechanism of Cancer Susceptibility Associated with Fok1 Single Nucleotide Polymorphism of VDR in Relation to Breast Cancer

Breast cancer is the leading cause of death among women worldwide. It is a multi-factorial disease caused by genetic and environmental factors. Vitamin D has been hypothesized to lower the risk of breast cancer via the nuclear vitamin D receptor (VDR). Genetic variants of these vitamin D metabolizing genes may alter the bioavailability of vitamin D, and hence modulate the risk of breast cancer. Materials and Methods: The distribution of Fok1 VDR gene (rs2228570) polymorphism and its association with breast cancer was analysed in a case–control study based on 125 breast cancer patients and 125 healthy females from North Indian population, using PCR-RFLP. An In silico exploration of the probable mechanism of increased risk of breast cancer was performed to investigate the role of single nucleotide polymorphisms (SNPs) in cancer susceptibility. Results: The Fok1 ff genotype was significantly associated with an increased risk of breast cancer (p=0.001; χ2=13.09; OR=16.909; %95 CI=2.20 - 130.11). In silico analysis indicated that SNPs may lead to a loss in affinity of VDR to calcitriol, and may also cause the impairment of normal interaction of liganded VDR with its heterodimeric partner, the retinoid X receptor (RXR), at protein level, thereby affecting target gene transcription. Conclusion: Breast cancer risk and pathogenesis in females can be influenced by SNPs. SNPs in VDR may cause alterations in the major molecular actions of VDR, namely ligand binding, heterodimerization and transactivation. VDRE binding and co-activator recruitment by VDR appear to be functionally inseparable events that affect vitamin D-elicited gene transcription. This indicates that breast cancer risk and pathogenesis in females may be influenced by SNPs