Association between Periodontitis and Rheumatic Diseases

BACKGROUND: Periodontitis (PD) is a chronic disease defined by the loss of the teeth supporting tissues including bone and periodontal ligament and it is a major cause behind tooth loss. Several studies suggested that PD is more prevalent in patients with Rheumatic Diseases (RD) but inconclusive evidence on a direct association has been reported. Specific plausible biological mechanisms have been proposed as a basis for the association between PD and RD. The aim of this research programme was to explore the nature of the association between PD and RD. METHODS: The research programme methodology included, critical appraisal, observational and experimental evidence generated from the following studies: (1) Study I: A systematic review aimed at exploring the prevalence of PD in SLE patients (both sex and females only). Differences in periodontal clinical parameters including probing pocket depth (PPD), clinical attachment level (CAL), SLE disease activity index (SLEDAI) scores of SLE in patients with or without PD were also examined. 2) Study II: A systematic review of the association between PD and Rheumatoid Arthritis (RA). The bidirectional nature of their association was assessed with both qualitative and quantitative methodology. 3) Study III: A critical review and observational questionnaire survey linking self-reported PD and Rheumatic Diseases (SLE and RA) with particular emphasis on describing the plausible common mechanistic pathways. 4) Study IV: A secondary analysis of a representative sample of the US population (n= 13,677, NHANES III, 1988-1994) to define the potential association between PD (exposure) and self-reported SLE (outcome) using multivariate linear and logistic regression models. Case-definition, clinical periodontal parameters and periodontal pathogen serum antibodies were used as specific measure of exposure. 5) Study V: A synopsis and protocols for the pilot study with the aim of assessing the impact of Intensive periodontal treatment (IPT) compared to control (CPT) on measures of vascular function in patients with moderate to severe PD and SLE. RESULTS: Study I systematic review data demonstrated that SLE diagnosis was associated with greater odds of PD (OR = 1.33, 95% Confidence Interval [CI]: 1.20–1.48). Patients with SLE exhibited no differences in PPD (SMD: −0.09 mm, 95%CI: −0.45–0.27) and CAL (SMD: 0.05 mm, 95%CI: −0.30–0.40) when compared with systemically healthy controls. PD diagnosis was, however, associated with higher SLEDAI scores in patients suffering from SLE (SMD: 0.68, 95% CI: 0.03–1.32). Study II systematic review data confirmed no substantial effect of RA on PPD and CAL levels of patients with PD when compared to controls, but high degree of study heterogeneity was found. Diagnosis of PD was associated with worse RA disease activity as assessed by an increased DAS28 score of 0.74 (0.25-1.24, 95%CI, p < 0.001). Study III critical review and a questionnaire survey data confirmed that there was no statistically significant difference in the prevalence of self-reported PD in two patients’ cohorts (SLE and RA). Self-reported PD had increased CRP levels compared to controls (p = 0.033) in patients with SLE whilst in RA patients PD was associated with higher ESR (p = 0.022). Study IV The NHANES data demonstrated that the participants with PD were more likely to have self-reported SLE (OR 2.6 [95%CI 1.1, 6.0]) compared to those without PD. The association was stronger in those with moderate PD diagnosis (OR 6.3 [95%CI 1.4, 28.7]). Participants with higher serum antibody levels of Mm (OR 1.6 [95%CI 1.0, 2.4]) and lower antibody levels of Pg (OR 0.8 [95%CI 0.6, 1.0]) reported higher prevalence of SLE. CONCLUSION: The evidence identified and produced by this study confirmed that PD is closely linked to Rheumatic Diseases such as SLE and RA. Further studies should explore the impact of treatment of PD on the management of Rheumatic Diseases. A pilot RCT as future work will also explore and observe the bi-directional association between the two conditions. Oral health should be promoted in patients suffering from Rheumatic Diseases

Association of metabolic syndrome with gestational hypertension

Background: Metabolic syndrome is a group of clinical, metabolic and biochemical abnormalities with negative impact on global health. The aim of the study was to determine the association between metabolic syndrome and pregnancy induced hypertension, and incidence and effects of metabolic syndrome in pregnant patients. Methods: Prospective observational study, performed in the Department of Obstetrics and Gynecology, Holy Family Hospital, New Delhi. Antenatal women before 20 weeks of gestation were enrolled in the study. Metabolic syndrome was diagnosed by utilizing the pregnancy adaptation of MeS criteria of NCEPATP III laboratory and clinical criteria. Cases were followed throughout pregnancy to observe their progression into hypertensive disorders of pregnancy i.e. gestational hypertension, pre-eclampsia and eclampsia. Results: Out of 100 cases with metabolic syndrome 37% developed PIH, 21 developed pre-eclampsia and 14 developed gestational hypertension, 2 patients developed eclampsia as compared to controls in which only 10% developed PIH among which only 3% developed pre-eclampsia. Conclusions: Our study demonstrates a higher rate of complicated pregnancy with higher incidence of PIH in association with metabolic syndrome compared to control group. Each component of metabolic syndrome increases the probability of PIH. The addition of components of metabolic syndrome exacerbates this probability, especially the combination of increased BMI, increased blood sugar levels and increased triglycerides

A comparative study of intrapartum epidural analgesia with intramuscular tramadol on labor outcome

Background: Epidural analgesia produces analgesia in labour without affecting nervous system, allows the mother to be well oriented, fully conscious and alert throughout labour. The aim of this study is to study the effect of epidural analgesia and intramuscular (IM) tramadol in different stages of labour and compare the effect of epidural analgesia with intramuscular tramadol on progress of labour and its outcome. Methods: Continuous monitoring of the haemodynamic parameters of the mother was done using multiparameter monitors. Foetal monitoring was done using continuous cardiotocography (CTG) monitor. Primigravida in spontaneous labour were randomly divided into two groups. Group I received epidural analgesia and group II received IM tramadol. Results: Duration of Ist stage of labour in group I was 167.0±47.2 min and in group II was 214.4±50.2 min. Mean duration of III stage of labour in the present group I was 7.9 min and 7.5 min in the group II. In the present study, total duration of labour is shortened by 47 min in group I compared to group II. Conclusions: Epidural analgesia during labour is a simple and effective method for painless and safe delivery. Analgesia produced by epidural route is significantly more effective than intramuscular tramadol. Epidural analgesia has favourable effect on the progress of labour. In developing nations where availability of facilities is the main limiting factor, intramuscular tramadol which is a safe and satisfactory drug for relief of labour pain, can be considered as a suitable alternative

Role of multi-parametric (mp) MRI in prostate cancer

Multi-parametric magnetic resonance imaging is increasingly being recommended as standard imaging modality for prostate cancer diagnosis and staging. It comprises structural T2 and T1 sequences supplemented by functional imaging techniques, i.e. diffusion-weighted, dynamic contrast enhanced and spectroscopic imaging. Pre-biopsy multi-parametric magnetic resonance imaging is recommended for both detection and staging as it avoids biopsy artefact, and when normal, has a negative predictive value of 95% for significant cancer. Magnetic resonance imaging-guided prostate biopsy targets only area(s) considered to be suspicious for prostate cancer, hence resulting in improved accuracy. Dynamic contrast enhancing helps in the detection of cancer and for the assessment of extra-capsular extension, distal urethral sphincter and seminal vesicles involvement. The role of multi-parametric magnetic resonance imaging in follow-up of patients on active surveillance is also increasingly recognised. Its role is now further expanded to facilitate targeted therapies. This review focuses on the evolving role of multi-parametric magnetic resonance imaging in diagnosis and management of prostate cancer

Dimensioning of LTE Network.

Long Term Evolution (LTE) is 3GPP enhancement to the current cellular system in use. The purpose of developing this system is to keep 3GPP systems competent enough for decades to come. LTE is designed to have wider channels up to 20MHz, with low latency and packet optimized radio access technology. The peak data rate envisaged for LTE is 100 Mbps in downlink and 50 Mbps in the uplink. With OFDM as the radio access technology, LTE has very promising features, like bandwidth scalability and both FDD and TDD duplexing methods. This thesis is related to the dimensioning of LTE radio access networks and the development of tool for dimensioning purpose. Different steps of the dimensioning process are listed and explained. Methods and models for coverage and capacity planning are developed for dimensioning of LTE radio access networks. Special emphasis is laid on radio link budget along with detailed coverage and capacity. The results are fabricated in an easy-to-use tool for dimensioning. The tool is made in Excel to serve the ease of working. Particular importance is given to clarity in the design of dimensioning tool, achieved by dividing the tool into clearly defined sections. Inputs and outputs are placed on separate sheets. The dimensioning tool calculates the number of cells needed to cover a given area with the user-provided parameters. Excel based tool covers all the basic aspects of the dimensioning process for LTE Access Networks

Prospective evaluation of outcome of percutaneous nephrolithotomy using the ‘STONE’ nephrolithometry score: a single-centre experience

Abstract OBJECTIVE: To assess the prediction of stone clearance and complications of percutaneous nephrolithotomy (PCNL) using the \u27STONE\u27 nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density). PATIENTS AND METHODS: This was a prospective study of patients undergoing single-tract PCNL while prone, conducted at a university hospital. All patients had non-contrast-enhanced computed tomography within 3 weeks of the procedure. Only patients with a unilateral procedure and radio-opaque stones were included. The five variables of the STONE nephrolithometry score were calculated before the procedure. The stone-free rates were assessed with a plain abdominal film at 4 weeks and complications were graded using the modified Clavien system. RESULTS: In all, 107 patients were included in the final analysis. Overall, 80% of patients were rendered stone-free. Among the individual variables, a larger stone (P = 0.002) and the involvement of multiple calyces (P = 0.04) were associated with residual stones, while tract length (skin-to-stone distance), stone density and presence of hydronephrosis were not. Patients who were rendered stone-free had a statistically significant lower overall STONE score than those with residual stones, at 7.24 vs. 8.14 (P = 0.02). The score also correlated with operative duration, which was significantly longer with a higher STONE score (P = 0.03). The complication rate was 18% and most complications were Clavien grade 2, with bleeding requiring a blood transfusion (11 patients) being the commonest. There were no deaths within 30 days of surgery, but there was no correlation between the STONE score and complications. CONCLUSION: The STONE nephrolithometry score is a simple and easy to apply system for predicting complexity in stone clearance with PCNL

An assessment of the impact of flow disruptions on mental workload and performance of surgeons during percutaneous nephrolithotomy

Objective: The aim of this study was to assess the impact of intraoperative disruptions on surgeons’ workload and performance during percutaneous nephrolithotomy (PCNL).Materials and methods: A structured and standardized tool was used to identify disruptions and interferences that occurred during 33 PCNL procedures. The surgical steps during PCNL were divided into four phases: ureteric catheter placement (phase I), puncture and tract dilation (phase II), intra-calyceal navigation and stone fragmentation (phase III), and tube placement (phase IV). Surgeons’ workload was evaluated using a validated tool: Surgery Task Load Index (SURG-TLX), and correlated with the mean observed intraoperative disruptions. All operating team members evaluated the teamwork immediately after the procedure. Statistical analysis was performed using SPSS Statistics version 22 (IBM, Armonk, NY).Results: A total of 1,897 disturbances were observed, with an average of 57.48 ± 16.36 disruptions per case. The largest number of disruptions occurred during phase III of PCNL (32.06 ± 14.12). The most common cause of the disruption was people entering or exiting the operating room (OR) (29.1 ± 10.03/case), followed by the ringing of phones or pagers (6.42 ± 2.4). The mean observed intraoperative disruptions were significantly associated with the operating surgeon’s mental workload, and it had a significant impact on all domains of surgeons’ mental workload as measured by SURG-TLX. Compared to other team members, surgeons’ assistants experienced an inferior sense of teamwork (r=-0.433; p=0.012).Conclusion: Significant intraoperative disruptions were observed during PCNL. They were observed to directly correlate with the surgeon\u27s workload and had a detrimental effect on teamwork. Improving OR dynamics by reducing unnecessary disruptions would help establish an efficient and smooth surgical work environment for safe surgical care

Endovascular approach as primary treatment for traumatic carotid cavernous fistula: Local experience from Pakistan

Objective: To evaluate the technical success, complications and outcome of endovascular management of post traumatic carotid cavernous fistula (CCF) in patients presenting at a tertiary care hospital in Karahci.Methods: Descriptive case series of 26 patients of post traumatic CCF treated by endovascular techniques was carried out at Radiology and Neurosurgery departments of Aga Khan University hospital between January 2010 to March 2010. Medical records and radiology reports were retrospectively reviewed from November 2000 to December 2009. The diagnosis was primarily clinical and was confirmed in all cases by CT or MRI. Endovascular procedures were performed under general anaesthesia through femoral artery or femoral vein approach. Detachable balloons pushable coils and/or glue was used for fistula closure. Follow up was done via medical records and on phone. Technical success and safety of the procedure were analyzed and outcome in terms of symptomatic improvement was recorded wherever available.Results: Out of a total of 26 patients; 20 were male and 6 were female, with age range of 14 to 62 years, mean age 31.4 +/- 12.6 years. Technical success rate of endovascular embolization was 92.3% (24 out of 26 patients). Procedure could not be performed in 2 patients. In 20 out of 24 patients (83.3%) single session of embolization was performed while 4 patients required 2 sessions due to recurrence. In one of these patients the detachable balloon deflated after 2 hours of deployment and another session of embolization was immediately carried out by deploying a larger sized balloon. Complication rate was 15.3% (n = 4) one patient had infarction which recovered completely in 6 months. There was no procedure related mortality. Five patients were lost to follow up. In rest of the 19 patients follow up ranged from 1 to 14 months (Mean 11.0 +/- 11.8 months) 8 out of 19 (42.1%) patients showed complete resolution of symptoms and 9 (47.3%) reported improvement.Conclusion: Endovascular approach is a safe and useful option for treatment of traumatic carotid cavernous fistula

The descriptive study of anxiety levels among diabetics: insulin users versus non-insulin users

Background: Anxiety is an emotion characterized by an unpleasant state of turmoil often accompanied by nervous behaviours such as pacing back and forth, somatic complaints and rumination. Diabetes is the most metabolically active disease which can influence the psychological state. This study evaluates the anxiety levels among diabetics (Insulin users versus non-insulin users) along with its relation to certain demographic factors like age, sex, education, type of medication and medication compliance.Methods: Hamilton anxiety rating scale (HAM-A) was used to test the anxiety levels in 187 diabetic patients visiting the diabetic clinic and research centre, Nishtar Hospital, Multan and other diabetic clinics in the area. 97 (51.87%) patients of the total sample are males and 90 (48.12%) patients are females.Results: In this study, 170 (91%) had type 2 diabetes while 17 (9%) suffered from Type 1 Diabetes. 66.66% of the patients in the sample were insulin users while 34.34% were non-insulin users. The overall mean anxiety level in insulin users is 24.55 and in non-insulin users is 23.92.Conclusions: Our study showed a high prevalence of anxiety levels in insulin users as compared to non-insulin users. Certain symptoms like anxious mood, tension, fears, depressed mood, cardiovascular and gastrointestinal symptoms appeared with mild anxiety levels while other symptoms like insomnia, somatic symptoms, autonomic symptoms, respiratory and genitourinary symptoms appeared with high severity levels. The presence of risk factors for anxiety among patients of diabetes predicts a causal relationship and deserves attention from clinicians

Rates of publication of FCPS dissertations in international and national peer-review journals among residents at AKUH; A cross sectional review of 15 years

Objective: To see the rate of publication of postgraduate residents\u27 dissertation. Methods: The single-centre retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised research publications from the residents of the departments of Surgery and Medicine who graduated between 2005 and 2020. The surgical subspecialties included Otolaryngology, Ophthalmology, Dentistry, General Surgery, Orthopaedics, Paediatric Surgery, Urology, Plastic Surgery and Cardiovascular Surgery. Data comprised demographics, current institution, current designation, information on dissertation/paper publication, topic of study, year of completion of dissertation, input from the research department, delay in exam due to incomplete dissertation and whether the paper got published in national or international journal. Data was analysed using SPSS 21. Results: Of the 103 subjects, 70(68%) were males and 33(32%) were females, while 73(70.8%) belonged to surgical specialties and 30(29.2%) were from non-surgical specialties. Of the 22(22.9%) who were able to convert, 12(54.5%) publications were carried by national peer-reviewed journals, while 10(45.4%) were carried by international journals; 9(40.9%) unpaid peer review journals and 13(59.1%) paid journals. Delay in exam due to incomplete dissertation was faced by only 16(16.6%) candidates. Conclusions: The rate of publication for resident dissertation was found to be low