Objective: The present prospective comparative clinical trial was undertaken to compare the outcomes of single and two-visit root canal treatment of irreversible pulpitis. Methodology: This prospective study was conducted in the Department of Conservative Dentistry and Endodontics of Dhaka Dental College on patients who presented with pain due to irreversible pulpitis. Patients with single-rooted teeth with uncomplicated canal and full-formed apex having irreversible pulpitis were included. However, pregnant women or patients under treatment of antibiotics, cortiosteiods or suffering from any systemic diseases or immuno-compromised patients or patients having teeth with calcified canal or periodontal disease were excluded. A total of 80 patients who met the eligibility criteria were consecutively included and were randomly assigned to either one-visit (n = 40) or two-visit (n = 40) treatment groups. Data were kept on pulp vitality status, the presence or absence of pre-operative pain and degree of post obturation pain at 6, 12, 24, 48 hours and 1 week postoperatively. The outcome variable was intensity of pain which was measured using a visual analogue scale (VAS) as 0 = no pain, 1 = slight pain or discomfort, 2 = moderate pain relieved by analgesic, 3 = moderate to severe pain not completely relieved by analgesics and 4 = severe pain or swelling not relieved by analgesics and required unscheduled visit. Result: Forty percent of the patients in the two-visit group did not have any pain (measured in terms of visual analogue scale) at 12 hours compared to 25% in the single visit group, although the difference did not turn significant (p = 0.580). Likewise the proportion of patients without pain in the two-visit group was considerably higher (52.5%) at 24 hours than that in the single-visit group (45%) (p = 0.852). Improvement in pain sensation was reported to be significantly higher in the two-visit group (as 95% of the patients did not complain any pain) at 48 hours than that in the single-visit group (80% of the patients did not complain any pain) (p = 0.015). None of the patients of either group complained of pain one week postoperatively. Conclusion: Compared to single-visit, two-visit root canal treatment showed better results in terms of intensity of post-obturation pain at 12, 24 and 48 hours after root canal treatment for irreversible pulpitis. Ibrahim Card Med J 2015; 5 (1&2): 45-48
Background & objective: Road traffic accident (RTA), now a days, has become a common event worldwide. As face is the most exposed part of the body, is most at risk of sustaining trauma in RTA. However, there is paucity of information regarding the relationship between head injuries and facial trauma. A number of reviews have looked at brain injuries in patients with facial fractures. But these reviews failed to differentiate between major and minor brain injuries. Moreover, most studies were retrospective and based upon large trauma registries, which tend to preselect patients with multiple trauma and capture only major brain injuries. The incidence of minor brain injuries and concussion in this population is thus overlooked. This study was aimed to find the proportion of major and minor brain injuries in patients with facial bone fracture. Materials & Methods: This cross-sectional study was carried out in patients with facial bone fractures who attended at outpatient clinic, hospital ward of the Department of Oral and Maxillofacial Surgery, Dhaka Dental College Hospital, Dhaka, Neurosurgery Department, Emergency Department of Intensive Care Unit of Dhaka Medical College Hospital, Dhaka over a period of 2 years from January 2012 to December 2013. Only the patients of first encounters were included in the study. Patients referred from other centers with facial bone fracture were excluded. A total of 150 such patients were enrolled in the study. To assess and communicate the extent of an unconscious patient’s injury rapidly Glasgow Coma Scale (GCS) was used. The outcome variable was brain injury (major and minor). Result: Majority (80%) of the patients was male with mean age of the patients being 25 years (range: from 4 – 80 years). The most common mechanism of injury in the present study was road-traffic accident (60%), followed by assault (20%), fall from height (12%), crash (6%) and blast trauma (2%). Nearly half (46%) of the patients had multiple facial bone fractures. Over 10% of the patients received Zygomatico-maxillary complex fracture. Mandible fracture and frontal bone fracture each accounted for 7.3%. Nasal bone fracture was 6.7%, isolated maxilla fracture was 5.3%, Le Fort I fracture was 4.7% and orbital floor fracture was 4.0%. The Glasgow coma score 12 or below 12 was found in 52% cases and loss of consciousness and perievent amenesia were observed in 54% and 56% cases respectively. The major and minor brain injuries were found in 52% and 32% cases respectively together comprising an occurrence of 84% in facial bone fractures. Male patients, receiving trauma through RTA and multiple facial bones fractures were significantly associated with brain injury (p = 0.019, p < 0.001, p = 0.001 respectively). However, mandible and nasal bone fractures were less prone to be associated with brain injury in (p = 0.001 and p < 0.001 respectively). Conclusion: The study concluded that majority of the patients with facial bone fractures have had concomitant brain injuries. Male patients, receiving trauma through RTA and multiple fractures of the facial bones are more prone to be associated with brain injury than females, receiving injury through mechanisms other than RTA and isolated facial bone fractures. Ibrahim Card Med J 2016; 6 (1&2): 33-40
Background & objective: To find the association between serum vitamin B12 and food behavior of the pregnant women and its influence on perinatal outcome. Methods: This cross-sectional study was conducted in the Department of Obstetrics & Gynaecology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka between June 2012 to July 2013. A total of 102 uncomplicated pregnant women attending at the Obstetrics & Gynaecology Department of BSMMU, Dhaka were the study population. Plasma vitamin B12 was measured by Abbott Axsym System using a Enzyme Immuno Assay Technique with the blood collected in a plain test tube. A serum vitamin B12 level of < 200 pg/mL was considered as low serum vitamin B12 level. The outcome variables were birth weight, small-for-date, neural tube defects and other congenital malformations. Result: The selected pregnant women were housewife (74.5%) from low socioeconomic strata. They were generally urban resident (90.2%) with mean age being 26.4 years. In terms of education 17.6% were primary level, 30.4% SSC level, 31.4% HSC level and 20.6% graduate and higher level educated. Majority (90.2%) was urban resident with average monthly family income being Taka 29460. One-third (33.3%) was overweight and 6.9% obese. Two-thirds (66.7%) were at 37-39 weeks of gestation and nullipara. More than 60% received ANC (antenatal care) aregularly. Over one-third (35.3%) had low serum vitamin B12 (< 200 pg/mL). The food behaviour of the women was found to be associated with vitamin B12 deficiency. The pregnant women with low serum vitamin B12 (< 200 pg/ml) had significantly lower weekly consumption of fishes and eggs which are the rich source of vitamin B12. The weekly fish, eggs and amount of milk consumed by the pregnant women with low serum vitamin B12 were much lower than those consumed by the pregnant women with normal serum vitamin B12. The pregnant women with low serum vitamin B12 were more likely to carry a higher risk of adverse perinatal outcome. The incidences of low-birth weight and small-for-dates were staggeringly higher in women with low serum vitamin B12 (33.3% and 27.8% respectively) compared to those in women with normal serum vitamin B12. Conclusion: The study concluded that pregnant women with low serum vitamin B12 are accustomed to taking low fish and eggs in their daily diet compared to those who have normal serum vitamin B12. The incidence of low birth weight and small-for-date babies are more prevalent in the pregnant women with subclinical deficiency of vitamin B12. Ibrahim Card Med J 2017; 7 (1&2): 84-91
Background & Objective: Postoperative surgical site infections (SSIs) are still among the most common serious complications of surgery in terms of cost and consequences. Different risk factors like age, sex, nutrition, immunity, operation type, duration of stay in hospital and presence of hair on the skin may involve with SSIs. This study was intended to determine the risk factors for surgical site infections in a tertiary level hospital. Methods: This Cross Sectional observational study was carried out in the Department of Surgery, Rajshahi Medical College Hospital, Rajshahi, over a period of 12 months from May 2009 to April 2010. A total of 232 patients (aged 18 years onwards) of either sex scheduled for elective operation were included in the study. Common indications for operation were chronic calculus cholecystitis, stoma in situ, inguinal hernia, renal/urinary stones and benign prostatic hyperplasia and so on. As two patients were discharged on request on 2nd postoperative day, 230 patients were left for final analysis. The patients were followed till discharge. Results: Of the total 230 patients, 21(9.1%) developed post-operative wound infection. The incidence of wound infection was significantly higher in older patients (p = 0.014). However sex did not have any influence on wound infection. The malnourished patients (underweight in terms of BMI) developed SSIs more frequently than their normal or overweight counterparts (p < 0.001). Diabetic patients developed post-operative wound infection more often than the non-diabetics(p = 0.072). The incidence of post-operative wound infection was not found to be associated with shaving of hair on the skin over the operative site (p = 0.378). Contaminated wounds encountered SSI significantly more than the clean wounds did (p = 0.001). Conclusion: The study concluded that one in every ten patients undergoing abdominal surgery may develop postoperative wound infection and factors commonly associated with wound infection are older age, underweight, diabetes, contaminated wound, longer preoperative and postoperative hospital stay. The study suggests that reducing the factors of SSI (as far as practicable) will reduce the incidence of SSI. Ibrahim Card Med J 2015; 5 (1&2): 15-20
Objective: The present quasi-experimental (comparative clinical trial) study was conducted to compare the outcome of active versus conservative management in patients with prelabour rupture of membrane (PROM) at term with an unfavourable cervix. Materials & Methods: The study was carried out at Gynae & Obstetrics Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka over a period of 12 months from July 2009 to June 2010. Women admitted in the Obstetrics & Gynaecology Ward of BSMMU with pre-mature rupture of membrane (PROM) at term with unfavourable cervix was the study population. A total of 86 women with rupture of membranes at > 37 weeks of gestation with a single foetus in a cephalic presentation, Bishop's score below 6, absence of active labour, no history of previous uterine surgery, no contraindication to vaginal delivery, a normal cardiotocogram and an adequate pelvis on clinical pelvimetry were included in the study and divided into two groups – study group (who received 25 μg of misoprostol every 6 hours in the posterior fornix of the vagina to a maximum of 4 doses) and control (who received conservative treatment for 24 hours). Result: The result shows that the study and control groups were almost identical in terms of age (p = 0.058), parity (p = 0.812), H/O past abortion (p = 0.366). Majority (94.3%) of the patients in case group and 64.4% in control group took 24 or < 24 hours to deliver their babies. The mean interval between PROM and uterine contraction and that between ROM and delivery were significantly less in the study group than those in the control group (p < 0.001 and p < 0.001 respectively). About 63% of study group experienced significant uterine contractions after 1st dose, 23.3% after 2nd dose, 9.3% after 3rd dose and 4.7% after 4th dose of misoprostol, while none of the patients in control group experienced significant contraction during the same period (p < 0.001). Twenty two (50.6%) of controls needed oxytocin for induction as opposed to none in the study group. The need for oxytocin during labour in study group were significantly less (37.2%) than that in control (80.5%) (p= 0.024). The incidence of failed induction was even less in study group (11.6%) than that in control (44.2 %) (p = 0.001). Two (4.7%) patients in the study group developed uterine hyperstimulation, 2.3% uterine tachysystole and another 2.3% nausea/vomiting while none of patients in control group developed the same complications. One (2.3%) of the patients in study group experienced chorioamnionitis and 9.3% exhibited group-B streptococci in high vaginal swab culture. In contrast, 18.6% of the controls developed chorioamnionitis and 14% showed the presence of group-B streptococci in high vaginal swab. In terms of mode of delivery, normal vaginal delivery (NVD) occurred in 88.4% study group as compared to 53.5% of control group (p<0.001). There was no significant difference between the groups in terms of foetal distress (p= 0.747) and neonatal sepsis (p = 0.121). Over half of the patients in the both groups had a history of less than 4 vaginal examinations during labour. There was no significant differences between the groups with respect to Apgar score at 1 minute of birth, neonatal sepsis and foetal distress (p=0.063, p=0.121 and p=0.747 respectively). Conclusion: The study concluded that management of premature rupture of membrane with unfavourable cervix using vaginal misoprostol increases the rate of normal delivery thereby reducing the risk of caesarean section, while conservative management of premature rupture of membrane usually fails to augment normal delivery. So it is safer to give induction to women presenting with premature rupture of membrane with unfavourable cervix using vaginal misoprostol. Ibrahim Card Med J 2015; 5 (1&2): 35-39
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