JMMC

A Clinical Comparison of Dental impression accuracy between One-step and Two-step Dual phase impression technique by using Polyvinyl Siloxane Impression Material.

Shagufta Channa — 2024-04-30

Objective:: The objective was to assess the number of visible defects within impression made by two different

techniques.

Methodology: This was comparative cross-sectional study was conducted between June 2019 to December 2019 at out patient department of Institue of dentistry, LUMHS Jamshoro. Two impressions were made from 53 crown preparation by using one step and two step dual phase impression techniques. Totaling to 106 impressions. Polyvinyl Siloxane impression material was used with each technique. Evaluation of impressions were made for tears, voids and bubbles and impression were compute as acceptable (A or B) and unacceptable (C or D).

Result: There was no significant difference seen in proportion of overall evaluation of two impression technique, as compared by using “Chi-square test”.

Conclusion: Insignificant difference was seen b/w one step and two step dual phase impression techniques.

Keywords: One step impression technique, two step dual phase impression technique, dimensional accuracy.

Comparison of recurrence rate of primary pterygium using conjunctival autograft with sutures versus suture-free approach.

Ghulam Hyder Sahito — 2024-04-30

Objective: To compare the recurrence rate of primary pterygium treated with conjunctival autograft (CAG) using sutures versus a suture-free approach.

Methodology: From July 2022 to December 2022, a quasi-experimental study was carried out at the Institute of Ophthalmology, Liaquat University of Medical & Health Sciences Jamshoro. A total of 110 patients with primary pterygium underwent treatment with conjunctival autograft using sutures or a suture-less/glue-free approach, under local anaesthesia. The patients were monitored for 12 months after surgery to assess recurrence and complications, and all procedures were performed by a single surgeon. Data was collected and analyzed on SPSS version 22.

Result: The study included 110 patients with pterygium, mostly males (71.81%) and from rural areas, with the nasal location being the most common. Group A had 3 recurrences at 3 and 6 months, while Group B had 4 recurrences at similar intervals. Group A had fewer complications, including graft oedema, retraction, granuloma, and giant papillary conjunctivitis, while Group B had three cases of retraction. The recurrence rate was found to be 5.08% and 7.70% with and without sutures (P value ≥ 0.53) respectively.

Conclusion: The excision of primary pterygium using conjunctival autograft with sutures or suture-free/glue-free methods are safe and uncomplicated procedure that results in lower levels of induced astigmatism, improved cosmetic appearance, no tissue loss, reduced recurrence of pterygium, and decreased risk of, scleral thinning, granuloma formation. Suture-free conjunctival autograft results in less postoperative manifestation like discomfort foreign body sensation, shorter surgery time, and high levels of patient satisfaction compared to conjunctival autograft with sutures.

Key words: Primary pterygium, autograft and pterygium. recurrence rate of pterygium, suture with pterygium.

Diagnostic accuracy of estimated glomerular filtration rate in pediatric oncology patients.

Numan Majeed — 2024-04-30

Objective: To compare eGFR using different equations with 24-hour creatinine clearance

Methodology: We collected data of standardized 24-hour creatinine clearance of pediatric oncology patients for a period of one year and compared the efficiency of various equations for estimation of creatinine clearance with it. For error estimation we used mean relative prediction error (MRPE) and root mean square error (RMSE) and for accuracy estimation we used Lin’s correlation.

Results: Out of 100 study participants, 57 were males and 43 were females. Mean age of the population studied was 11.8 while mean BMI was 13.95. Most common tumor reported was osteosarcoma. Out of 18 equations evaluated only 5 showed an accuracy of 0.80 or more, while SEM of none of the equation is near to the desired value (zero). Minimum SEM was found to be for Schwartz (2012) equation.

Conclusions: According to our study none of the equations in current clinical practices showed a good correlation with creatinine clearance adjusted according to body surface area.

Keywords: eGFR, creatinine clarence, renal function, pediatric oncology.

Longitudinal Parallel Compression Suture To Control PPH Due to Placenta Previa & Accreta.

Nida Parveen — 2024-04-30

Objective: To determine the efficacy and safety of longitudinal parallel compression sutures to control postpartum haemorrhage (PPH) in placenta previa/accreta patients.

Methodology: This cross-sectional study was conducted at Department of obstetrics and gynaecology, Peoples University of Medical & Health Sciences for Women; Nawab shah for a period of six months from 7^th June 2023 to 6^th Dec 2023, after getting approval from ERB of People University of Medical & Health Science. Sample size achieved through non-probability consecutive sampling. Women fulfilling inclusion criteria were selected from the operation theatre of Obstetrics & Gynaecology, PUMHS Nawabshah. To control life threatening PPH owing to placenta previa (with or without accreta) during caesarean section, longitudinal parallel compression sutures in operating room. Outcome variables observed includes amount of blood loss, number of days stayed in the hospital, need for concurrent procedure, need of hysterectomy, and maternal death. Data was entered and analysed on SPSS 25.

Results:

The stitch was applied in 31 patients. The technique was effective, and successful as a single procedure in 11 patients (35.43%). 6 patients (19%) needed additional tamponade; 12 patients (38%) also received concurrent uterine artery ligation while 2 needed ovarian artery ligation. Despite concurrent procedure 3 patients ended up for hysterectomy (9.1%). The most common indication of caesarean section was placenta previa (51%), mostly done at a gestational age of 37 weeks ± 1.84 standard deviation. Mean age of the patient was 29 years. Estimated blood loss was more than 1.5 litre as seen in 22.6% of the patients and 71.6% patients need blood transfusion. Uterine atony was a common cause of PPH (51%). 51.6% of patients discharged within 3 days of surgery. Two patients expired.

Conclusion:

The innovative suture techniques have shown promise in improving surgical outcomes in resource-constrained environments, especially in developing countries. This effectiveness can help bridge the gap between limited resources and the need for quality surgical care.

Key words: PPH, Uterine Compression Suture, Placenta Previa, Placenta Accreta.

Determinants of Mortality in Primigravida in Peoples Medical College Nawabshah.

Sabeena — 2024-04-30

Objective: To determine the determinants of maternal mortality in primigravida.

Methodology: This cross-sectional, descriptive study was conducted from June 2023 to Dec 2023 at the department of Gynecology and Obstetrics of Peoples University of Medical & Health Sciences for women, Nawabshah; a tertiary care center. We studied overall causes of death (direct and indirect) during pregnancy, delivery, and puerperium. Those patients who died after admission were included and analyzed on specially designed proforma. Information collected from hospital records/patient attendants. The reason for admission, status at arrival, cause of death, and potential variables answerable for death were recognized. Data including age, booking status, parity, gestational age, and relevant variables from the current pregnancy, along with the traveling distance from the clinic, was recorded on Performa, and analyses were done on SPSS adaptation 25.

Results: During study period 43 maternal deaths occurred in their first pregnancy. The live birth rate was 10020. MMR counted to 429 per lac live birth. Most frequent death occurs at 19 years of age, from the rural population (62%), the majority un-booked (72%), history of domestic violence (48%) was not uncommon. Among these primigravida; 60% having no formal education, 65% were referral cases presented with obstetrical complication and in labor (34.9%). Almost all deaths were due to direct causes (99%). The highest contribution was by hemorrhage 39.5% (PPH=27.9%+ APH 11.6%), followed by sepsis (27.9%), pre-eclampsia/ eclampsia (18.6%), pulmonary embolism (7%), while 4.7% deaths due to unsafe abortion in early pregnancy complications. We found only 2.3% of deaths due to indirect causes.

CONCLUSION: It is crucial to highlight that tackling maternal mortality requires a comprehensive strategy, which encompasses enhancing healthcare infrastructure, guaranteeing access to high-quality prenatal and obstetric care, advocating for education and awareness, and tackling social determinants of health. Recognizing and dealing with these factors can help decrease maternal mortality rates for all expectant mothers, including primigravidae.

Key words: Primigravida, Maternal Mortality Rate, antenatal care, Obstetric emergency.

Challenges to implementation of IMNCI strategy in First Level Care Facilities.

Muhammad Akram Shaikh — 2024-04-30

Objective: To assess IMNCI implementation strategy and identify challenges towards effective implementation in first level care facilities of district Jamshoro.

Methodology: This mixed method research was carried out from Jan 2020 to March 2020 at Rural Health Centers (RHC) in District Jamshoro using semi-structured, pre-tested, written questionnaires after taking due approval and written informed consent from respondents. The respondents (representing different cadres of healthcare providers i.e., medical officers (male & female), lady health workers (LHWs), vaccinators, pharmacists and 13 administrative staff. The data obtained (pertaining to perception and views regarding IMNCI implementation and availability of relevant logistics for service provision) was analyzed using SPSS version 22.0 for windows.

Results: The mean age of the sample stood at 42 (SD ± 4) years with a majority comprising of male, dispensing/nursing staff with a mean work experience of 13.2 years (SD ± 1.1) Pneumonia was deemed the commonest childhood problem by most respondents, followed by malaria and others uniformly across all catchments. The understanding regarding IMNCI was common (despite the absence of formal training) yet often, the strategies were not implemented while caring for children.

Conclusion: Effective implementation is a seldom sight with many challenges, including but not limited to shortage of human resource and a rather limited supply of medicines. Thus, efforts must be dedicated at ensuring an ample human resource and a consistent supply of necessary medication.

Keywords: IMNCI, Childhood Illness, Neonatal Illness, Integrated Management, Primary care facility.

Assessing the Professionalism Levels of Undergraduate Medical Students at a Medical College.

Syed Bilal Yousuf Ghaznavi — 2024-04-30

Objectives:

To evaluate the professionalism of medical students at Bahria University Medical and Dental College (BUMDC), at the same it will let us know the range of differences among students in different classes (1-5 years).

Methodology: It was a cross-sectional study conducted on 583 students of BUMDC, ranging from 1st year to 5th year (academic session 2021-2022). A validated tool was utilized to collect data. The tool assessed 6 aspects of professionalism: excellence, respect for others, altruism, duty, accountability, honor, and integrity, using a 5-point Likert scale.

Results: The results indicated a notable variance in the overall professionalism score (p=0.000), altruism (p=0.000), duty (p=0.000), accountability (p=0.000), excellence (p=0.000), honor and integrity (p=0.000), and respect for others (0.001) based on the clinical status of students.

Conclusion: It is evident from the study that the level of professionalism among the graduating 5^th year class is significantly below the ideal standard. Additionally, it is concerning to observe a notable decline in professionalism from 1^st year to 5^th year medical students. It is crucial to educate medical students on all essential skills required to deliver top-notch healthcare services efficiently during their practice.

Key Words: Professionalism, medical students, undergraduate, attitude, behavior.

Learner Competence Across Cognitive Levels In Undergraduate Medical Education: An Item Response Approach.

Zeeshan A Rehman — 2024-04-30

Objective: The current study endeavors to evaluate competence of learners using item response theory approach in undergraduate medical education.

Methodology: The responses of the examinees from first professional year (MBBS) were evaluated for Anatomy discipline to gauge learner competence through knowledge, understanding and application in the subject using item response theory approach (IRT) which is an effective tool to measure the validity (discrimination and difficulty index) of assessment, while KR-20 is used to gauge reliability of the items with statistical software STATA 17. The quality of question and level of examinee responses provide skill level and competence of learners.

Results: The current study found that the C1 and C3 level items from the Anatomy discipline are mostly acceptable and effectively gauge learner competence while flawed C2 level items need complete restructuring. The study also identified weak areas of average learner for items in each cognitive level.

Conclusion: The study found significant role of IRT in effectively estimating competence of the examinees across cognitive levels for each discipline and in building of an effective test pool through assessment of learner ability and construction of quality SBAs to achieve valid and reliable assessment tool.

Keywords: Difficulty index; Discrimination index; Single best answer questions; Cognitive levels; Item characteristic curve.

Medical Student's Knowledge and Perspective Regarding Organ Donation In Punjab.

Iqra Arshad — 2024-04-30

Objectives: This study aimed to evaluate the knowledge, attitudes, and practices of organ donation among undergraduate medical students and explore potential variations based on demographic characteristics.

Methodology: A Cross-Sectional Study was conducted from June to September 2023; participants were recruited from Punjab medical, dental, and paramedic colleges. Data was gathered using a structured questionnaire, which was pre-tested prior to the study. The online data collected was analyzed using SPSS version 28. Qualitative variables were reported in frequencies and percentages, and the Chi-square test assessed associations among study variables and sociodemographic traits.

Results: The study enrolled 152 students, predominantly from the MBBS program (80%). Inconsistencies were observed in knowledge, attitude, and practice domains. Approximately 55.6% of students were aware of organ donation, while only 45.5% exhibited a positive attitude, particularly in donating under exceptional circumstances. The group below 18 years demonstrated a high percentage (45.5%) of willingness to become organ donors. Notably, a significant portion of participants expressed comfort and positive feelings about posthumous organ donation.

Conclusion: The data revealed various perspectives and challenges associated with organ donation. Some participants mentioned issues like religious constraints, family opposition, and concerns about physical appearance or mortality. Moreover, a variety of "Other" barriers were identified, indicating a wide range of reservations. Nevertheless, the majority clearly grasped the selfless intent behind organ donation, with the main drive being to preserve and prolong human life. The results highlight the necessity for continuous efforts to enhance awareness, educate the public, and address reservations in order to encourage organ donation and ultimately save lives.

Keywords: Organ donor, Organ recipient, Undergraduate Medical Students. Item characteristic curve.

Dentistry's use of artificial intelligence: Past, Present, and Future.

Anita kumari — 2024-04-30

The significance and use of artificial intelligence (AI) in dentistry and other industries has significantly increased. In the healthcare sector, particularly in endodontics, AI can replicate human intelligence to make complex predictions and decisions. Convolutional neural networks or artificial neural networks have shown promise in endodontics for various applications, including analyzing the anatomy of the root canal system, enhancing the viability of dental pulp stem cells, determining working lengths, identifying periapical lesions and root fractures, and predicting retreatment outcomes. Future applications of this technology, such as prognostic assessment, drug interactions, treatment planning, patient care, and automated endodontic surgery, have been considered. AI has demonstrated precision and accuracy. AI holds potential for improving endodontic treatment and diagnosis, ultimately leading to increased procedure effectiveness. However, before incorporating these models into routine clinical practices, it is essential to validate their usability, reliability, and accessibility.

Keywords: Artificial intelligence in dentistry, Digital dentistry, use of AI in dentistry.

Impact of oral health on quality of life and its potential long-term effects.

Romesa Khero — 2024-04-30

In light of its relative uniqueness, oral health-related quality of life (OHRQoL) has gained importance in recent years. This has impacted research in the fields of dentistry and medical practice. OHRQoL encompasses an individual's subjective evaluation of their oral health, self-esteem, functional emotional well-being, and expectations and satisfaction with care. It is highly valuable in clinical and research settings. The factors that support well-being and quality of life are closely linked to OHRQoL. According to the World Health Organization (WHO) in 2003, it is often a crucial component of overall oral healthcare. This article presents a theoretical model of oral health and explains the role of OHRQoL. The significance of OHRQoL for both patients and healthcare providers is being recognized by community dental schools. Consequently, health strategies and oral health alternatives are also being given attention.

Seronegative Polyarticular Juvenile Idiopathic Arthritis: A Case Report.

Nauman Ismat Butt — 2024-04-30

Juvenile idiopathic arthritis (JIA) is a chronic rheumatologic childhood disorder of unknown etiology usually presenting with peripheral arthritis. Usually involving the small joints symmetrically, polyarticular JIA is characterized by involvement of 5 or more peripheral joints and is further categorized depending on RA Factor positivity. We aim to report a case of seronegative polyarticular JIA to increase awareness regarding this disease. A 15-year-old boy presented with 3-month history of bilateral symmetrical joint pains, swelling and morning stiffness lasting 3-4 hours. For his ankle and knee pain, he had consulted a local doctor who suspected Rheumatic Fever and started penicillin and analgesics resulting in minimal improvement. He was a student but was unable to attend school in last 2 months due to this illness and had become bed-bound for last 2 weeks. On examination, there was swelling and tenderness of ankles, knees, elbows, wrists, metacarpophalangeal and proximal interphalangeal joints bilaterally. On investigation, ESR, CRP and serum ferritin were raised with normal complete blood count, urinalysis, liver and renal function tests, ASO test, blood and urine cultures, TSH, serum CPK and serum aldolase. Echocardiography did not reveal any abnormalities. His ANA, RA factor and Anti-CCP antibodies were negative. He was diagnosed with Seronegative Polyarticular Juvenile Idiopathic Arthritis and started on oral prednisolone and methotrexate. Currently the patient is asymptomatic on methotrexate 20mg/week. Our patient with symmetrical polyarthritis had negative ANA, RA Factor and Anti-CCP antibodies leading to a diagnosis of seronegative polyarticular JIA. Early screening and prompt management of JIA is required to improve prognosis and reduce risk of disability. The differential diagnosis of childhood joint pains is wide and variable including diseases of autoimmune, cardiac and haematological systems. For diagnosis of JIA, arthritis persisting for more than 6 weeks with onset of symptoms prior to 16 years of age is required with exclusion of secondary causes of joint inflammation.

Keywords: Juvenile Idiopathic Arthritis, ANA, RA Factor, Anti-CCP antibodies, Methotrexate.