Nevin Manimala

PLoS One. 2021 Jun 17;16(6):e0252146. doi: 10.1371/journal.pone.0252146. eCollection 2021.

ABSTRACT

Tuberculosis (TB) cases have increased drastically over the last two decades and it remains as one of the deadliest infectious diseases in Malaysia. This cross-sectional study aimed to establish the spatial distribution of TB cases and its association with the sociodemographic and environmental factors in the Gombak district. The sociodemographic data of 3325 TB cases such as age, gender, race, nationality, country of origin, educational level, employment status, health care worker status, income status, residency, and smoking status from 1st January 2013 to 31st December 2017 in Gombak district were collected from the MyTB web and Tuberculosis Information System (TBIS) database at the Gombak District Health Office and Rawang Health Clinic. Environmental data consisting of air pollution such as air quality index (AQI), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and particulate matter 10 (PM10,) were obtained from the Department of Environment Malaysia from 1st July 2012 to 31st December 2017; whereas weather data such as rainfall were obtained from the Department of Irrigation and Drainage Malaysia and relative humidity, temperature, wind speed, and atmospheric pressure were obtained from the Malaysia Meteorological Department in the same period. Global Moran’s I, kernel density estimation, Getis-Ord Gi* statistics, and heat maps were applied to identify the spatial pattern of TB cases. Ordinary least squares (OLS) and geographically weighted regression (GWR) models were used to determine the spatial association of sociodemographic and environmental factors with the TB cases. Spatial autocorrelation analysis indicated that the cases was clustered (p<0.05) over the five-year period and year 2016 and 2017 while random pattern (p>0.05) was observed from year 2013 to 2015. Kernel density estimation identified the high-density regions while Getis-Ord Gi* statistics observed hotspot locations, whereby consistently located in the southwestern part of the study area. This could be attributed to the overcrowding of inmates in the Sungai Buloh prison located there. Sociodemographic factors such as gender, nationality, employment status, health care worker status, income status, residency, and smoking status as well as; environmental factors such as AQI (lag 1), CO (lag 2), NO2 (lag 2), SO2 (lag 1), PM10 (lag 5), rainfall (lag 2), relative humidity (lag 4), temperature (lag 2), wind speed (lag 4), and atmospheric pressure (lag 6) were associated with TB cases (p<0.05). The GWR model based on the environmental factors i.e. GWR2 was the best model to determine the spatial distribution of TB cases based on the highest R2 value i.e. 0.98. The maps of estimated local coefficients in GWR models confirmed that the effects of sociodemographic and environmental factors on TB cases spatially varied. This study highlighted the importance of spatial analysis to identify areas with a high TB burden based on its associated factors, which further helps in improving targeted surveillance.

PMID:34138899 | DOI:10.1371/journal.pone.0252146

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):322-327.

ABSTRACT

BACKGROUND: Osteoarthritis is regarded as one of the most frequent disorders of musculoskeletal, which is characterized by the degeneration of articular cartilage and loss of cartilage of the joints. However, the relationship of OA susceptibility with rs12901499 polymorphism in SMAD3 is controversial. Although multiple studies have investigated the correlation of rs12901499A/G polymorphism in SMAD family member 3 (SMAD3) andosteoarthritis (OA) susceptibility, the results from previous studies remain controversial and unsolved. A meta-analysis utilizing fixed and random effects model was performed to clarify the association.

METHODS: Eligible studies were systematically searched from PubMed, Web of Science, Cochrane Library and EMBASE on April 17, 2019 for reporting the correlation of rs12901499 polymorphism and osteoarthritis susceptibility. Pooled Odds ratio of 95% confidence interval was performed to estimate the strength of relationship of rs12901499 polymorphism and osteoarthritis susceptibility. Publication bias was detected by Begg’s test and STATA 11.0 software was used to evaluate statistical analysis.

RESULTS: Seven case-control papers involving eight studies from Caucasian and Asian populations were included. A significant increase in osteoarthritis susceptibility was found in recessive, homozygous and allele models. Stratified analysis on ethnicity suggested that the polymorphism with increased risk of OA only in Asians under allele model. Stratified analysis related to population-based studies indicated the increased risk of OA with polymorphism in recessive, homozygous, allele and dominant models.

CONCLUSIONS: This meta-analysis demonstrated that there may be a weak association of rs12901499 polymorphism and OA susceptibility. Due to the limited size of sample and given ethnic groups, more studies need to validate the result in future.

PMID:34137553

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):299-302.

ABSTRACT

BACKGROUND: The permanent maxillary lateral incisor (PMLI) shows morphological variations, in the form of different crown shapes such as peg-shaped, cone-shaped, barrel-shaped and canine-shaped. The frequency of developmentally malformed permanent maxillary lateral incisors varies among different populations. The aim of this study was to document the frequency of different shapes of developmentally malformed permanent maxillary lateral incisors in patients visiting the three teaching dental hospitals of Peshawar.

METHODS: It was a cross-sectional study conducted in the Oral Diagnosis department of Peshawar Dental College, Sardar Begum Dental College, and Khyber College of Dentistry from 1st Sep 2018 to 15th June 2019. A total of 82 subjects were included that fulfilled the inclusion criteria. Shape of the malformed PMLI was determined using Computer-aided design/Computer-aided manufacturing software. Descriptive statistics including frequencies and percentages for observed developmental malformation and their types were computed and Chi-square test was applied to see the relation between various shapes and their occurrence with respect to site and position within the jaws.

RESULTS: The peg shaped PMLI was seen in 81 (98.87%) patients and barrel shaped was present in 1 (1.22%) patient. The malformed PMLIs was found to be unilateral in 38 (46.3%) and bilateral in 44 (53.7%) patients, with more common presence on both sides 44 (53.7%) followed by right side 20 (24.4%) and left side 18 (22.0%).

CONCLUSIONS: The subjects having predominant developmental malformation in case of permanent maxillary lateral incisor was peg-shaped permanent maxillary lateral incisor.

PMID:34137549

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):293-298.

ABSTRACT

BACKGROUND: Melasma is an acquired cutaneous disorder characterized by hyperpigmentation of the face predominantly affecting the areas exposed to direct sun light. The triple combination cream, i.e., a mid-potency corticosteroid (Fluocinolone acetonide 0.01%), a retinoid (Tretinoin 0.05%), and Hydroquinone 4% is one of the widely used topical medicament for melasma treatment world over. Tranexamic acid is another agent found to be effective in melasma treatment when used topically, intra-lesionally or orally. This study has been conducted to compare mean decrease in Melasma Area Severity Index (MASI) score when tranexamic acid is combined with triple combination cream versus triple combination cream alone for melasma treatment.

METHODS: A randomized controlled trial was conducted in a tertiary care hospital of Pakistan. Sixty-three patients of melasma who met the inclusion criteria and gave written informed consent for the study were enrolled. These patients were randomly divided into 2 treatment groups. Group A was given triple combination cream and oral tranxemic acid while Group B was given triple combination cream for duration of 8 weeks. Severity of melasma was assessed by MASI, which was calculated at baseline and at the end of week 8. Mean decrease in MASI score was calculated in both groups and statistically analysed employing SPSS 20.

RESULTS: Sixty patients, 30 in both groups, completed the study. Study participants were predominantly female (81.67%), with mean age of 30.46±6.24 years in group A while 31.90±4.53 in group B. No statistically significant difference was noted in both treatment groups for mean decrease in the MASI score (6.4933±4.38358 in group A compared to 5.7833±5.04251 in the group B; p-value 0.56).

CONCLUSIONS: The addition of oral tranexamic acid did not contribute significantly in decrease in MASI score when used in combination with topical triple regimen. It may have a role as an adjuvant to topical triple combination cream.

PMID:34137548

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):257-261.

ABSTRACT

BACKGROUND: Intertrochanteric fractures are a common cause of disability, morbidity and mortality in aged population across the globe. The same population is also vulnerable to ill effects of vitamin D deficiency and presence of multiple comorbidities. Very few studies have been done in our part of the world to find the association of vitamin D deficiency with type of intertrochanteric fractures.

METHODS: This cross-sectional study was conducted during July 2019 to June 2020 at tertiary care hospital in the megacity of Lahore, Pakistan. Demographic variables were recorded and anteroposterior and lateral views of plain radiographs were used to classify the fractures. History of chronic illness was taken and confirmed with available prescription. Vitamin D level was measured using standard laboratory techniques. Data was entered into IBM SPSS Statistics (version 25) software and analysed.

RESULTS: Mean age for males was 65 years and for females 71 years. Boyd and Griffin type II fracture was most common injury (62%). 67% of our study population was suffering from some degree of vitamin D deficiency. Results have shown the significant association of vitamin D deficiency and severity of intertrochanteric fractures (p <0.05). There was no significant difference of degree of vitamin D deficiency and injury pattern among both genders.

CONCLUSIONS: There is a strong association between degree of vitamin D deficiency and type of intertrochanteric fractures. Our study also highlighted the importance of mechanism of injury, age and presence of diabetes in association with these fractures.

PMID:34137541

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):244-247.

ABSTRACT

OBJECTIVES: To compare the efficacy of Single dose with Divided dose regimen of Carbimazole for the induction of Euthyroidism in hyperthyroid patients.

METHODS: All consecutive hyperthyroidism patients from December 2018 to December 2019 fulfilling the inclusion criteria were included. They were allocated randomly into 2 groups: Group A – single dose of Carbimazole (OD-CMZ) and Group B – divided dose of Carbimazole (DD-CMZ). The therapeutic efficacy was measured at regular intervals (every 4 weeks) for 6 months. Their demographics and therapeutic management were analysed.

RESULTS: Of a total of 69 (n=34 in Group A, n=35 in Group B) patients, there was no significant difference in baseline concentrations of TSH and T4 as well as their cumulative rate of reductions (p-value, 0.023). Furthermore, no difference in achieving euthyroidism was noted at follow-up visits between Group A and B respectively ([0:0%; p-value 1.00, month 1], [70.6:74.3%; p value 0.22, month 2], [85.3:85.7%; p value 0.39, month 3], 97.1:82.9%; p-value 0.23, month 4], [100:91.4%; p-value 0.29, month 5], [100:100%%; p value 1.00, month 6] at monthly intervals. Cases of Hypothyroidism were reported more in the DD-CMZ (14.3%) and the difference was statistically significant (p-value 0.003).

CONCLUSIONS: Due to no significant difference in the efficacy and more chances of getting hypothyroid in divided dose regimen, we conclude that single dose regimen is more effective method for treating hyperthyroidism.

PMID:34137538

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):217-221.

ABSTRACT

BACKGROUND: Urolithiasis is a prevailing ailment affecting all age groups across global population. In modern innovative industry endoscopic instruments alterations and miniaturization has simplified the interventional strategy for undertaking these procedures for renal stones. However, there has been paucity of studies regarding outcomes of Percutaneous Nephrolithotomy (PCNL) in elder age group. We aimed to report success rates and complications in elder age group.

METHODS: This was a retrospective review of the charts for subjects that underwent unilateral PCNL from 2012 till 2018 November at a tertiary care hospital at capital of Pakistan. Patients of age ≥60 years were chosen for this study. PCNL procedures were done in prone position. We implemented the Guy stone scoring (stone complexity) to forecast the net results of PCNL. Information regarding variables were recorded in specified proforma and then processed in SPSS version 16 for the statistical computations.

RESULTS: On the whole 79 patients were incorporated for this study. Most common presenting complaint in clinic was flank pain followed by haematuria and fever respectively. Mean age in this analysis was calculated as 63.36±5.19 years. Mean size for calculi was 449±163mm2. One patient underwent transfusion after surgery while only 2.5% of these patients had sepsis (post PCNL procedure). Stone free rate was significantly affected by Guys stone score (GSS).

CONCLUSIONS: PCNL can be undertaken safely and effectually for achieving treatment goals even in elder subjects. Stone free rates are higher in lower Guys stone score as compared to the higher scores.

PMID:34137532

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):202-206.

ABSTRACT

BACKGROUND: To compare the effect of ProTaper Next and One Shape rotary files on canal transportation and centering abilities in resin block with simulated curved canal.

METHODS: An in-vitro experimental study was carried out in Dental clinics. Sixty resin blocks (30 per group) having simulated curved canals prepared with ProTaper Next and One Shape and then filled with red and blue Indian ink, respectively. Photographs of resin blocks obtained using standardized manner were then transferred to the Adobe Photoshop 7.0. Centering abilities and amount of transportation were then calculated at coronal, middle and apical portion of canal for both the groups. Independent sample t-test was used to compare the transportation and centering ability of both file systems. Level of significance was kept at p-value ≤0.01.

RESULTS: One Shape file resulted in more canal transportation at all the levels (apical, middle and coronal part) as compared to ProTaper Next file, however, difference was not statistically significant (p-value >0.01). Statistically significant difference was noted at the apical third between these two rotary files with One Shape file showing more centered preparation as opposed to ProTaper Next file (p-value <0.01).

CONCLUSIONS: One Shape file system had more centered canal preparations specifically at the apical region as compared to ProTaper Next. One Shape also lead to more canal transportation in comparison to ProTaper Next, however the difference was not statistically significant.

PMID:34137529

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):192-197.

ABSTRACT

BACKGROUND: Inferior Alveolar Nerve Block (IANB) with Buccal Infiltration (BI) anaesthesia is required to completely anesthetize the mandibular molars with symptomatic irreversible pulpitis. 4% Articaine and 2% Lidocaine provide local anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic irreversible pulpitis. Objective of the study was to compare the effect of Articaine and Lidocaine in the combination of Inferior alveolar nerve block with buccal infiltration anaesthesia during the nonsurgical endodontic treatment of mandibular molars with symptomatic Irreversible Pulpitis.

METHODS: One hundred and sixty participants with Symptomatic Irreversible Pulpitis of permanent mandibular molars were divided randomly in two groups. Group A was given Articaine 4% IANB along with BI whereas group B was given Lidocaine 2%. Pain was assessed after 15 minutes of administration of local anaesthesia. Anaesthetic success of the agents is defined as, absence of pain or mild pain first during the access cavity preparation then instrumentation of the canals of tooth. Chi-square test was applied to analyse data for statistical significance.

RESULTS: Anaesthetic success of Articaine was 96.2% during access cavity preparation compared to Lidocaine (86.2%). Success during instrumentation of canals was also found to be high in Articaine (90.2%) compared to Lidocaine (76.2%). This difference of anaesthetic efficacy between Articaine and Lidocaine was found statistically significant. (p=0.02).

CONCLUSIONS: Articaine is found to be better than Lidocaine regarding anaesthetic efficacy and hence, it can be a safer alternative to Lidocaine.

PMID:34137527

J Ayub Med Coll Abbottabad. 2021 Apr-Jun;33(2):183-187.

ABSTRACT

BACKGROUND: Anti-VEGF agents have been proven to be effective in treating macular oedema secondary to a multitude of pathological conditions. However, in large clinical trial settings, the results may be overstated. This study aimed to evaluate the short-term efficacy of intraocular Bevacizumab in consecutive patients with macular oedema being treated in a ‘real-world’ setting in Pakistan.

METHODS: A prospective study was conducted at Amanat Eye Hospital, Rawalpindi from August 2018 to November 2019. Thirty-five eyes of 29 patients with macular oedema were treated with monthly intravitreal Bevacizumab injections for three consecutive months. Best-corrected visual acuity (BCVA), and OCT parameters including central retinal thickness (CRT) and macular volume were assessed prior to the injections and then 4 weeks post the final injection and compared.

RESULTS: BCVA improved from 1.00±0.44 at baseline to 0.83±0.48 four weeks after the third intravitreal injection. CRT decreased significantly from 492.77±192.31 at baseline to 362.91±126.11 (p<0.05), and macular volume decreased significantly from 11.61±2.39 at baseline to 9.87±1.68 (p<0.05) four weeks after the third intravitreal injection. No systemic or ocular complications were observed during the course of the study.

CONCLUSIONS: Treatment with intravitreal Bevacizumab injections was found safe and resulted in clinically and statistically significant improvement in SD-OCT parameters and visual acuity in patients with macular oedema secondary to various retinal pathologies. However, the improvement in a real-world setting was sub-optimal in comparison to larger clinical trials for specific diseases in the developed world.

PMID:34137525