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1.  Total knee arthroplasty: good agreement of clinical severity scores between patients and consultants 
Nearly 20,000 patients per year in the UK receive total knee arthroplasty (TKA). One of the problems faced by the health services of many developed countries is the length of time patients spend waiting for elective treatment. We therefore report the results of a study in which the Salisbury Priority Scoring System (SPSS) was used by both the surgeon and their patients to ascertain whether there were differences between the surgeon generated and patient generated Salisbury Priority Scores.
The Salisbury Priority Scoring System (SPSS) was used to assign relative priority to patients with knee osteoarthritis as part of a randomised controlled trial comparing the standard medial parapatellar approach versus the sub-vastus approach in TKA. The operating surgeons and each patient completed the SPSS at the same pre-assessment clinic. The SPSS assesses four criteria, namely progression of disease, pain or distress, disability or dependence on others, and loss of usual occupation. Crosstabs and agreement measures (Cohen's kappa) were performed.
Overall, the four SPSS criteria showed a kappa value of 0.526, 0.796, 0.813, and 0.820, respectively, showing moderate to very good agreement between the patient and the operating consultant. Male patients showed better agreement than female patients.
The Salisbury Priority Scoring System is a good means of assessing patients' needs in relation to elective surgery, with high agreement between the patient and the operating surgeon.
PMCID: PMC1552065  PMID: 16879741
2.  Evaluation of SOVAT: An OLAP-GIS decision support system for community health assessment data analysis 
Data analysis in community health assessment (CHA) involves the collection, integration, and analysis of large numerical and spatial data sets in order to identify health priorities. Geographic Information Systems (GIS) enable for management and analysis using spatial data, but have limitations in performing analysis of numerical data because of its traditional database architecture.
On-Line Analytical Processing (OLAP) is a multidimensional datawarehouse designed to facilitate querying of large numerical data. Coupling the spatial capabilities of GIS with the numerical analysis of OLAP, might enhance CHA data analysis. OLAP-GIS systems have been developed by university researchers and corporations, yet their potential for CHA data analysis is not well understood. To evaluate the potential of an OLAP-GIS decision support system for CHA problem solving, we compared OLAP-GIS to the standard information technology (IT) currently used by many public health professionals.
SOVAT, an OLAP-GIS decision support system developed at the University of Pittsburgh, was compared against current IT for data analysis for CHA. For this study, current IT was considered the combined use of SPSS and GIS ("SPSS-GIS"). Graduate students, researchers, and faculty in the health sciences at the University of Pittsburgh were recruited. Each round consisted of: an instructional video of the system being evaluated, two practice tasks, five assessment tasks, and one post-study questionnaire. Objective and subjective measurement included: task completion time, success in answering the tasks, and system satisfaction.
Thirteen individuals participated. Inferential statistics were analyzed using linear mixed model analysis. SOVAT was statistically significant (α = .01) from SPSS-GIS for satisfaction and time (p < .002). Descriptive results indicated that participants had greater success in answering the tasks when using SOVAT as compared to SPSS-GIS.
Using SOVAT, tasks were completed more efficiently, with a higher rate of success, and with greater satisfaction, than the combined use of SPSS and GIS. The results from this study indicate a potential for OLAP-GIS decision support systems as a valuable tool for CHA data analysis.
PMCID: PMC2438346  PMID: 18541037
3.  Effect of Progressive Muscle Relaxation in Female Health Care Professionals 
Increasing population, fast paced industrialization, increased, competitiveness, unanticipated problems in the work place have increased the stress among the females working in health care in recent times.
The aim of the following study is to detect the stress levels among female health care professionals in the age group of 25-35 years and its impact on health.
Subjects and Methods:
A prospective cross-sectional pilot project was conducted in a tertiary care hospital in Eastern part of India, after receiving approval from the Institutional Ethics Committee and informed consent form was taken from the subjects. Stress level in the subjects was assessed according to the presumptive life event stress scale. Females with scores above 200 were selected. For these, initial assessment of anthropometric measurement, electrocardiogram and lipid profile analysis, resting pulse rate, blood pressure, physical fitness index (PFI), breath holding time (BHT), isometric hand grip (IHG) test results were evaluated and recorded. All subjects were given training of progressive muscle relaxation (PMR) for 3 months. After 3 months, the lipid profile and vital parameters, Perceived Stress Scale values were re-evaluated and subjects were asked to repeat the same exercises and data thus recorded were analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.).
Significant decrease in resting heart rate, blood pressure and Perceived Stress Scale levels was seen after PMR training in the subjects. Results of BHT, IHG tests and PFI were significantly increased after PMR training. There was a significant decrease in total cholesterol, triglyceride and low-density lipoprotein cholesterol in subjects after practicing PMR for 3 months.
Increasing stress among female health care professionals is a cause for concern and there is a need to adopt early life-style modification by practicing relaxation exercises to ameliorate stress and to improve not only their quality-of-life in general, but patient care in particular.
PMCID: PMC4199176  PMID: 25328795
Female stress; relaxation techniques; health care professionals
4.  Prevalence of Hand Disorders in Type 2 Diabetes Mellitus and its Correlation with Microvascular Complications 
Physicians have long recognized the association between diabetes mellitus and several pathologic conditions of the hand. The most commonly recognized maladies are limited joint mobility (LJM), Dupuytren's disease (DD), trigger finger (TF), and carpal tunnel syndrome (CTS). Incidence of these hand disorders has increased in the setting of diabetes. Collectively, these are described as diabetic hand syndrome.
The aims were to find out the prevalence of hand disorders in diabetic patients, and to study the relation of these hand disorders with microvascular complications.
Subjects and Methods:
This is an observational cross-sectional case-control study done over a period of 1 year Patients of type 2 DM, of age < 65 years, who visited Gandhi Memorial Hospital, Lucknow were enrolled and were described as cases. Age- and sex-matched nondiabetic individuals were taken in the control group. The data were analyzed using software SPSS. SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Means and standard deviations were computed; the Student t-test and Chi-square (χ2) test were used as appropriate.
A total of 400 subjects were studied, 200 each in the case and control groups. Of total 200 diabetic patients, 30% (60/200) patients had neuropathy, 37.5% (75/200) had nephropathy, and 44.5% (89/200) patients had retinopathy. In the study population, 67% patients were having one or more hand disorders, in which LJM was found in 40.5% (81/200) patients, DD was found in 19% (38/200) patients, TF in 16.5% (33/200), and CTS in 14% (28/200) patients.
This study shows a high prevalence of hand disorders in diabetic patients and also correlates with the duration of type 2 DM, LJM being the most common hand disorder and more common in patients who have microvascular complications.
PMCID: PMC3793438  PMID: 24116312
Carpal tunnel syndrome; Dupuytren's disease; Limited joint mobility; Trigger finger
5.  Medicaid Policies and Practices in US State Prison Systems 
American journal of public health  2014;104(3):418-420.
Medicaid is an important source of health care coverage for prison-involved populations. From 2011 to 2012, we surveyed state prison system (SPS) policies affecting Medicaid enrollment during incarceration and upon release; 42 of 50 SPSs participated.
Upon incarceration, Medicaid benefits were suspended in 9 (21.4%) SPSs and terminated in 28 (66.7%); 27 (64.3%) SPSs screened prisoners for potential Medicaid eligibility.
Although many states supported Medicaid enrollment upon release, several did not. We have considered implications for Medicaid expansion.
PMCID: PMC3953759  PMID: 24432881
6.  Estimation of Dental and Facial Proportions Using Height as Criteria 
Ideal dental restoration is one which not only restores optimal functions but also confirm to standard dental and facial relations. This is important to achieve long term patient satisfaction both with regard to esthetics as well as functions. Objective was to find a credible relationship between dental and facial proportions using height of individuals as the criteria in a specific group of population. To determine a regression equation for determination of various dental and facial proportions using height.
Materials and Methods:
One hundred and forty-four (n = 144) students, of which 91 were males (n = 91) and 53 were females (n = 53) of the dental college participated in this study. Height of the individual, the lower facial height, inter-incisal and inter-canine and inter-commissural width was measured as per protocol and resulting data was analyzed using SPSS 17 (SPSS Statistics for Windows, Version 17.0. Chicago SPSS Inc. Released 2008) version software regression equations were obtained.
The study included 144 college students significant correlations were found between height of the individuals, inter-canine distance and lower facial height using Pearson correlation coefficient. The calculated values of t-test were significant. Regression equations were determined for determination of various parameters using height as the sole criteria.
There exists a definite relationship between height of the individual and their dental and facial parameters in this group of population and values of maxillary anterior teeth can be determined using regression equations.
PMCID: PMC4148568  PMID: 25214728
Height; inter-canine distance; maxillary anterior teeth
7.  Self-Confidence in Women with and without Polycystic Ovary Syndrome 
Objective: To compare self-confidence in woman with and without PCOS according to their ages.
Materials and methods: This comparative study was conducted on 400 women (100 with and 300 without PCOS) in clinics of Shahid Akbar-Abadi and Firouzgar Hospitals, from July 2012 to February 2013. SPSS-16 used for statistical analysis (SPSS; SPSS Inc., Chicago, IL, USA).
Results: This study showed 98% of PCOS and 93% in non-PCOS groups had average self-confidence with scores of 15-25. None of women in PCOS group and 6.7% of non-PCOS group had high self-confidence (score>25). There was a significant difference between two groups in term of self-confidence level (p< 0.001). There was no significant difference in self-confidence between age group ≤ 30 and age group> 30 in both group, but in PCOS group, self-confidence were significantly higher in both age group under 30 (p<0.0001) and 30 and higher (p<0.0001).
Conclusion: Impaired self-confidence in PCOS groups (under 30 and 30 and higher age groups) in comparison with related value of non-PCOS group shows that mental health status in women with PCOS requires urgent psychological attention and support.
PMCID: PMC4275552  PMID: 25628720
Polycystic Ovary Syndrome; PCOS; Self-Confidence; Self-Reliance
8.  Suprascapular nerve block for the treatment of frozen shoulder 
Saudi Journal of Anaesthesia  2012;6(1):52-55.
The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections.
Settings and Design:
Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block.
Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients’ simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block.
Statistical Analysis:
In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA). To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used.
Patient's simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block.
Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.
PMCID: PMC3299117  PMID: 22412778
Frozen shoulder; nerve block; suprascapular nerve
9.  KMWin – A Convenient Tool for Graphical Presentation of Results from Kaplan-Meier Survival Time Analysis 
PLoS ONE  2012;7(6):e38960.
Analysis of clinical studies often necessitates multiple graphical representations of the results. Many professional software packages are available for this purpose. Most packages are either only commercially available or hard to use especially if one aims to generate or customize a huge number of similar graphical outputs. We developed a new, freely available software tool called KMWin (Kaplan-Meier for Windows) facilitating Kaplan-Meier survival time analysis. KMWin is based on the statistical software environment R and provides an easy to use graphical interface. Survival time data can be supplied as SPSS (sav), SAS export (xpt) or text file (dat), which is also a common export format of other applications such as Excel. Figures can directly be exported in any graphical file format supported by R.
On the basis of a working example, we demonstrate how to use KMWin and present its main functions. We show how to control the interface, customize the graphical output, and analyse survival time data. A number of comparisons are performed between KMWin and SPSS regarding graphical output, statistical output, data management and development. Although the general functionality of SPSS is larger, KMWin comprises a number of features useful for survival time analysis in clinical trials and other applications. These are for example number of cases and number of cases under risk within the figure or provision of a queue system for repetitive analyses of updated data sets. Moreover, major adjustments of graphical settings can be performed easily on a single window.
We conclude that our tool is well suited and convenient for repetitive analyses of survival time data. It can be used by non-statisticians and provides often used functions as well as functions which are not supplied by standard software packages. The software is routinely applied in several clinical study groups.
PMCID: PMC3376120  PMID: 22723912
10.  Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux 
Yonsei Medical Journal  2012;53(4):748-752.
Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses.
Materials and Methods
We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)].
Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0±8.2 months) than in boys (5.8±4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean±SD age at diagnosis of VUR in patients with breakthrough infection (1.14±3.14) was significantly younger than in those without breakthrough infection (5.05±3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028).
Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
PMCID: PMC3381488  PMID: 22665341
Vesico-ureteral reflux; radioisotope scanning; urinary tract infections; antibiotic prophylaxis
11.  The relationship between binocular vision symptoms and near point of convergence 
Indian Journal of Ophthalmology  2013;61(7):325-328.
Aim and Background:
Due to the relatively high prevalence of binocular vision anomalies, a regular examination including tests for assessment and determination of these anomalies is necessary. The aim of this study was to assess the relationship between near point of convergence (NPC) and near binocular vision symptoms and finding of an NPC cutoff point for symptoms in university students.
Materials and Methods:
In this cross-sectional study, 124 students of different majors of Zahedan University of Medical Sciences were randomly selected. If they met the inclusion criteria, they were divided into two groups (symptomatic and asymptomatic) according to the convergence insufficiency symptom survey questionnaire. For NPC measurement, a small isolated letter E of approximately 20/30 size on a metal rod was used. After data collection, data were analyzed in SPSS.17 software (SPSS for Windows, SPSS Inc., Chicago, IL) using descriptive and analytical statistics, including Mann–Whitney U test and receiver operating characteristic (ROC) curve.
The mean NPC findings in the symptomatic and asymptomatic groups were 11.7 ± 5.0 and 8.4 ± 3.4 cm, respectively, with a significant difference between the two groups (P < 0.001). The ROC curve suggests an NPC cutoff point of 9.5 cm for the presence of symptoms with the testing procedures used in this study.
The determination of NPC is helpful in the differentiation of symptomatic from asymptomatic subjects.
PMCID: PMC3759101  PMID: 23552348
Binocular vision; near point of convergence; visual symptoms
12.  Availability and needs of herbal medicinal information resources at community pharmacy, Riyadh region, Saudi Arabia 
A cross-sectional survey of community pharmacists in Riyadh region, Saudi Arabia was conducted over a period of 6 months from July through December 2011. Data collection was carried out using a structured self-administered questionnaire. The survey questionnaire consisted of a brief introduction to the study and eleven questions. The questions consisted of close ended, multiple-choice, and fill-in short answers. A stratified random sample of one thousand and seven hundred registered pharmacy practitioners all over Saudi Arabia were randomly chosen to respond to the survey. The data from each of the returned questionnaire were coded and entered into Statistical Package for the Social Sciences (SPSS) version 19 software (SPSS Inc., Chicago, IL, USA) which was used for statistical analysis. Only one thousand four hundred one pharmacists responded to the survey (response rate is 82.4%) with a completely answered questionnaire. The study results show that 59.7% of the participants sometimes discuss herbal medicine use with their patients, while only 4.25% never discuss it. The study shows 48.5% of participated pharmacists record herbal medicine use sometimes where only 9.4% of them never did so. However, with regard to initiation of the discussion, the study shows that 44.3% of the respondents reported that patients initiate herbal issue discussion while 20.8% reported that pharmacists initiate the discussion. This discussion was reported to be a one time discussion or an ongoing discussion by 14.3% or 9.9% of the respondents respectively. According to the study results, respondents reported that the most common barriers that limit discussing herbal medicines’ use with their patients were lack of time due to other obligations assigned to the community pharmacist (46%), lack of reliable resources (30.3%), lack of scientific evidence that support herbal medicine use (15.2%), or lack of knowledge of herbal medicines (13.4%). Yet, a small number of respondents was concerned about interest in herbal medicines (9.1%) and other reasons (2.4%). So it is urgent to ensure that pharmacists are appropriately educated and trained. Extra efforts are needed to increase the awareness of pharmacists to adverse drug reactions reporting system at Saudi Food and Drug Authority. Finally, more consideration to herbal issues should be addressed in both pharmacy colleges’ curricula and continuous education program..
PMCID: PMC3824944  PMID: 24227954
Recourse; Medicinal; Herbal; Availability
13.  Survey of responsible handling of local anesthetic in Indian dental operatory 
Dental operatory requires handling of numerous toxic fluids such as denture acrylic monomer, alcohol and formalin for effective oral care delivery. The efficacy and responsible handling of such fluids has not been analyzed among Indian dentists and this study aims to address this lacunae.
Materials and Methods:
Closed ended questionnaire was distributed through email to Indian dentists in July 2012. After inclusion/exclusion criteria, 1484 practitioners constituted the study group with a response rate of 52%.
SPSS® Version 17.0 (SPSS-IBM Inc., IL, USA) was used to carry out statistical analysis. Descriptive statistics were presented. Chi square test was used to identify the association between the parameters; P ≤ 0.05 was considered as statistically significant.
Males (80.8%), undergraduates (78%), exclusive practitioners (81.2%), urban practitioners (68.5%) were the predominant respondents. Predominant of the respondents (97%) used local anesthetic (LA) from bottles. Eight percent have encountered instances of injecting formalin instead of LA in their settings. Safe disposal rules and regulations (P ≤ 0.05), opinion on injecting the other fluids instead of LA as a severe negligent act (P ≤ 0.05) were statistically significant between age groups. Educational status did not appear to influence the outcome. Only a third of the respondents were aware of the rules and regulations for safe disposal of empty LA bottles while 49.1% were not aware of them and willing to learn.
The lacunae in responsible handling of toxic fluids need to be addressed to prevent inadvertent and negligence suits against dentists, highlighting the need through continuing dental education programmes.
PMCID: PMC3826043  PMID: 24255564
Formalin; injection; local anesthetics; responsible handling; safe disposal
14.  The Comparison of Sagittal Spinopelvic Parameters between Young Adult Patients with L5 Spondylolysis and Age-Matched Control Group 
To compare spinopelvic parameters in young adult patients with spondylolysis to those in age-matched patients without spondylolysis and investigate the clinical impact of sagittal spinopelvic parameters in patients with L5 spondylolysis.
From 2009 to 2012, a total of 198 young adult male patients with spondylolysis were identified. Eighty age-matched patients without spondylolysis were also selected. Standing lateral films that included both hip joints were obtained for each subject. Pelvic incidence (PI), sacral slope (SS), pelvic tilt, lumbar lordosis angle, sacral inclination, lumbosacral angle, and sacral table angle were measured in both groups. A comparative study of the spinopelvic parameters of these two groups was performed using SPSS 15.0 (SPSS Inc., Chicago, IL, USA).
Among the aforementioned spinopelvic parameters, PI, SS and STA were significantly different between patients with spondylolysis and those without spondylolysis. PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group.
PI and SS were higher in the spondylolysis group than in the control group, but STA was lower in the spondylolysis group than in the control group. Patients with spondylolysis have low STA at birth, which remains constant during growth; a low STA translates into high SS. As a result, PI is also increased in accordance with SS. Therefore, we suggest that STA is an important etiologic factor in young adult patients with L5 spondylolysis.
PMCID: PMC3836927  PMID: 24278649
Spondylolysis; Spondylolisthesis; Spinal curvature
15.  Correlation between serum neuron specific enolase and functional neurological outcome in patients of acute ischemic stroke 
The use of biomarkers to predict stroke prognosis is gaining particular attention nowadays. Neuron specific enolase (NSE), which is a dimeric isoenzyme of the glycolytic enzyme enolase and is found mainly in the neurons is one such biomarker.
This study was carried out on patients of acute ischemic stroke with the aims to determine the correlation between NSE levels on the day of admission with infarct volume, stroke severity, and functional neurological outcome on day 30.
Materials and Methods:
Seventy five patients of acute ischemic stroke admitted in the Department of Medicine were included in the study. Levels of NSE were determined on day 1 using the human NSE ELISA kit (Alpha Diagnostic International Texas 78244, USA). Volume of infarct was measured by computed tomography (CT) scan using the preinstalled software Syngo (version A40A) of Siemen's medical solutions (Forchheim, Germany). Stroke severity at admission was assessed using Glasgow coma scale (GCS) and functional neurological outcome was assessed using modified Rankin scale (mRS) on day 30.
Statistical Analysis Used:
Statistical analysis was performed using the SPSS software for windows version 15.0 (SPSS).
A positive correlation was found between concentration of NSE on day 1 and infarct volume determined by CT scan (r = 0.955, P < 0.001). A strong negative correlation was found between GCS at presentation and concentration of NSE on day 1 (r = −0.806, P < 0.001). There was a positive correlation between NSE levels at day 1 and functional neurological outcome assessed by mRS at day 30 (r = 0.744, P < 0.001).
Serum levels of NSE in first few days of ischemic stroke can serve as a useful marker to predict stroke severity and early functional outcome. However, larger studies with serial estimation of NSE are needed to establish these observations more firmly.
PMCID: PMC3841589  PMID: 24339568
Glasgow coma scale; infarct volume; ischemic stroke; modified Rankin scale; neuron specific enolase
16.  Quality of life impairment in patients of obstructive sleep apnea and its relation with the severity of disease 
Several studies have demonstrated considerable impairment of quality of life (QOL) in obstructive sleep apnea (OSA) patients, but its relation with severity of OSA is yet unclear.
Study Objectives:
To investigate the effects of OSA on the QOL and its association with the disease severity.
Design and Setting:
Observational, prospective case-control study.
Materials and Methods:
QOL of 69 OSA patients and 41 healthy controls were assessed using the Calgary sleep apnea quality of life index (SAQLI) on the morning following the polysomnography (PSG) study.
All statistical analyses were performed using the SPSS 17.0 (SPSS Inc., Chicago). Differences between sleep-related symptoms and SAQLI subscales scores were assessed with the Chi-square test and the Student t-test. Due to non-normal distribution, differences between SAQLI scores of controls and OSA patients were evaluated using a non-parametric Mann-Whitney test. Spearman correlation and backward multiple regression analysis were used to analyze the association between SAQLI scores and sleep indices and anthropometric variables and PSG variables.
Study included 69 cases (57 male and 12 females) with a mean age, weight, height, neck circumference, and body mass index 48.45 ± 10.12 years, 83.03 ± 16.48 kg, 159.75 ± 28.29 cm, 44.01 ± 3.23 cm and 30.77 ± 6.71 kg/m2. Mean apnea-hypopnea index was 26.39 ± 16.62. The median score of four SAQLI domains daily function, social interaction, emotional, symptoms and total mean SAQLI score were 3.64 (3.46-3.90), 3.77 (3.51-3.88), 3.64 (3.53-3.83), 4.80 (4.68-5.11), 4.09 (3.88-4.09),and 1.36 (1.29-1.71), 1.38 (1.24-1.62), 1.45 (1.23-1.62), 2.00 (1.78-2.26), 1.55 (1.46-1.73) for patients and controls respectively. All the individual domain scores and the mean SAQLI scores of patients were significantly higher than the controls.
OSA causes significant impairment of QOL, but the severity of impairment is not directly proportional to the severity of OSA.
PMCID: PMC3841684  PMID: 24339485
Apnea; obstructive sleep; quality of life; sleep apnea quality of life index
17.  An Exploratory Analysis of Levels of Evidence for Articles Published in Indian Journal of Palliative Care in the years 2010-2011 
Indian Journal of Palliative Care  2013;19(3):170-179.
Indian Journal of Palliative Care (IJPC) provides a comprehensive multidisciplinary evidence base for an evidence-informed clinical decision making.
To analyze the levels of evidence of articles published in IJPC in the years 2010-2011.
Settings and Design:
Systematic review of palliative care journals.
Materials and Methods:
Systematic review of articles was done and was scored according to Center for Evidence-Based Medicine levels of evidence into any of the five grades. The articles were categorized based upon article type, number of authors, study approach, age focus, population focus, disease focus, goals of care, domains of care, models of care, and year of publication.
Statistical Analysis Used:
All descriptive analysis was done using frequencies and percentiles, and association between all categorical variables was done using Chi-square test at 95% confidence interval (CI) using Statistical Package for Social Sciences (SPSS) version 16 for Windows (SPSS Inc, Chicago, IL).
There was a greater prevalence of low level evidence (level 4: n = 46, 51%; level 5: n = 35, 39%) among the 90 selected articles, and article type (original articles with higher level of evidence, P = 0.000), article approach (analytical studies with higher level of evidence, P = 0.000), domains of palliative care (practice-related studies with higher level of evidence, P = 0.000) and models of care (biological or psychosocial model with higher level of evidence, P = 0.044) had a significant association with the grade of levels of evidence. Association with other factors was not statistically significant (P < 0.05).
The levels of research evidence for palliative care provided by articles published in IJPC were predominantly level 4 and level 5, and there is scope for more high quality evidence to inform palliative care decisions in the developing countries.
PMCID: PMC3853396  PMID: 24347908
Evidence analysis; Evidence-based palliative care; Evidence hierarchy; Journal analysis; Levels of evidence
18.  Lateral ridge split and immediate implant placement in moderately resorbed alveolar ridges: How much is the added width? 
Dental Research Journal  2013;10(5):602-608.
Lateral ridge split technique is a way to solve the problem of the width in narrow ridges with adequate height. Simultaneous insertion of dental implants will considerably reduce the edentulism time.
Materials and Methods:
Twenty-five patients who were managed with ridge splitting technique were enrolled. Thirty-eight locations in both jaws with near equal distribution in quadrants received 82 dental fixtures. Beta Tricalcium phosphate (Cerasorb® ) was used as biomaterial to fill the intercortical space. Submerged implants were used and 3 months later healing caps were placed. Direct bone measurements before and after split were done with a Collis. Patients were clinically re-evaluated at least 6 months after implant loading. All the data were analyzed by Statistical Package for Social Sciences (SPSS) software version 11.5 (SPSS Inc, Chicago Illinois, USA). Frequency of edentulous spaces and pre/post operative bone width was analyzed. Paired t-test was used for statistical analysis. Difference was considered significant if P value was less than 0.05.
Mean value for presplit width was 3.2 ± 0.34 mm while post-split mean width was 5.57 ± 0.49 mm. Mean gain in crest ridge after ridge splitting was 2 ± 0.3 mm. Statistical analysis showed significant differences in width before and after operation ((P > 0.05). All implants (n = 82) survived and were in full function at follow up (at least 6 months after implant loading).
Ridge splitting technique in both jaws showed the predictable outcomes, if appropriate cases selected and special attention paid to details; then the waiting time between surgery and beginning of prosthodontic treatment can be reduced to 3 month.
PMCID: PMC3858733  PMID: 24348616
Atrophic ridge; dental implant; ridge splitting
19.  Assessment of prophylactic bone grafting effect on union of open tibial fracture 
Objective: The fracture of the tibial shaft is the most common fracture of long bone in human. Considerable proportion of this fractures are open fractures. Treatment of open fractures is one of the orthopedic problems. In the developing country with economic problem, early mobilization and returning to work may be important for people. We compared result of treatment with addition of autogenus bone graft in two different time periods in two groups.
Methodology: In this study, 144 patients with open tibial fracture were randomly divided in two groups and were treated with autogenus bone graft at two different time intervals, the first group in the end of third week and second group in the end of sixth week. All Patients were followed up periodically in first two month every month and then every two weeks. T-test was used for comparison. SPSS ver. 13.0 (SPSS Inc, Chicago, IL, USA) was used for analysis.
Results: The mean fracture healing time in the first group (with bone graft in 3rd week) was 14.24±4.4 week and in the second group (with bone graft in 6th week) was 16.4±5.4 week and the difference was statistically meaningful. Differences in the rate of delayed union and none union in two groups were statistically insignificant. In addition to time of bone graft, the age, gender, injury mechanism, fixation method, cigarette smoking and drug abuse were studied in two groups. The difference as regards these factors in two groups was statically insignificant.
Conclusions: Achievement of autogenus bone graft in open tibial fracture at the end of third week causes reduction of union time from 16.4 week to 14.4 week without increment of deep infection.
PMCID: PMC3809178  PMID: 24353519
Open tibial fracture; Autogenus bone graft; Time of union; Infection
20.  A Molecular Insight into the Role of Inflammation in the Behavior and Pathogenesis of Odontogenic Cysts 
Although, odontogenickeratocyst (OKC) and dentigerous cyst (DC) are considered asdevelopmental cysts inflammation has been seen in its connective tissue wall. Inflammation is seen to alter the epithelial lining of both OKC and DC butwhether it plays in altering the behavior of these cysts is not fully understood.
The present study is conducted with the help of molecular marker proliferating cellular nuclear antigen (PCNA) to assess the proliferative activity of OKC and DC and to further evaluate and correlate the effect of inflammation on the proliferative activity and hence on biological behavior of these cysts.
Materials and Methods:
Immunohistochemicalstaining was performed using anti-PCNA antibody in 10 cases each of classical OKC, inflamed OKC, classical DC, and inflamed DC. The resulting data was tabulated on Microsoft excel and subjected to statistical analysis using two-way analysis of variance test, t test and post-hoc test followed by Bonferroni test with the application of statistical package for social sciences (SPSS) (SPSS, Chicago, IL, USA) and Epi-Info 6.04 d, Atlanta, Georgia (USA).
Total mean PCNA expression is statistically higher in inflamed OKC than classical OKC and inflamed DC also showed significantly higher PCNA expression than classical DC (P < 0.001). Correlation between inflammation and PCNA expression was not statistically significant (P ≥ 0.05).
Inflammation is responsible for change in behavior of neoplastic epithelium of OKC, whereas in dentigerous it is responsible for changes in epithelial lining and hence should be treated meticulously.
PMCID: PMC3868117  PMID: 24380002
Cyst pathogenesis; Dentigerouscyst; Odontogeniccyst; Odontogenickeratocyst; Proliferatingcellular nuclear antigen
21.  Knowledge and Practice of Emergency Contraception Among Female Undergraduates in South Eastern Nigeria 
Unintended pregnancy remains a major challenge to the reproductive health of women especially in the developing countries. It is a major reason for unsafe abortion, a major contributor to maternal mortality.
This study was designed to assess the knowledge and practice of emergency contraception among female non-medical undergraduates.
Subjects and Methods:
In this cross sectional observational study, 675 female non medical undergraduates were interviewed using pretested semi structured questionnaire to assess their knowledge and experience with emergency contraception. Data was analysed using SPSS version 17 (SPSS, Chicago, IL, USA). Data were presented as percentages and tables. Associaton between variables was tested using the χ2 test.
Only 51.6% (348/675) of the respondents reported knowledge of emergency contraception. Being sexually active, use of regular family planning methods and having an extra risk for unintended pregnancy were factors that significantly influenced knowledge. Only 45.7% (159/348) knew the correct methods (Postinor-2, combined oral contraceptive and intra uterine contraceptive device), 37.9% (132/348) practiced any method with about half of them using the correct methods.
There is poor basic knowledge of emergency contraception among these female undergraduates in south eastern Nigeria. A sizeable number of them depend on unconventional methods for emergency contraception. We recommend the introduction of formal lessons on emergency contraception and other reproductive health issues into the Nigerian undergraduate curriculum.
PMCID: PMC3868120  PMID: 24380005
Africa; Emergency contraception; Female; Knowledge; Practice
22.  Incidence and Distribution of Pulp Stones Found in Radiographic Dental Examination of Adult Turkish Dental Patients 
Pulp stones (PS) are discrete calcified masses found in the dental pulp, in the pulp tissue or become attached to or embedded into the dentine. The formation of pulp stones is still something of an enigma, leading to existence of some epidemiological gaps.
To determine the prevalence and distribution of pulp stones in posterior tooth group by using panoramic radiograph.
Materials and Methods:
Panoramic radiographs from 6912 patients attending Kirikkale University Dental Faculty Hospital, Kirikkale, Turkey during the period from July 2009 to August 2011 were reviewed for the presence of pulp stones. The overall incidence of pulp stones in the patients and their correlations between female and male patients and between the right-side and left-side occurrences were analyzed by computer program, SPSS 15. (SPSS Inc. Chicago, USA) with using the χ2 test. Differences were considered as significant when P < 0.05.
Pulp stones were detected in 879 out of 6912 patients (person prevalence 12.7%). Pulp stones were detected in 2009 teeth out of a total of 96240 teeth to give a tooth prevalence of 2.1%. Their occurrence was higher in the maxilla than in the mandible for each tooth type. Pulp stones were found to involve the right side more (1224/2009) (61%) than the left side (785/2009)(39%) and they were significantly more common in females than males (P < 0.001).
Attention should be paid to the presence of pulp stones and the treatment problems associated with them.
PMCID: PMC3868126  PMID: 24380011
Prevalence; Pulp stones; Turkish
23.  Relationship between anterior disc displacement with/without reduction and effusion in temporomandibular disorder patients using magnetic resonance imaging 
Imaging Science in Dentistry  2013;43(4):245-251.
This study was performed to evaluate the relationship between anterior disc displacement and effusion in temporomandibular disorder (TMD) patients using magnetic resonance imaging (MRI).
Materials and Methods
The study subjects included 253 TMD patients. MRI examinations were performed using a 1.5 T MRI scanner. T1- and T2-weighted images with para-sagittal and para-coronal images were obtained. According to the MRI findings, temporomandibular joint (TMJ) disc positions were divided into 3 subgroups: normal, anterior disc displacement with reduction (DWR), and anterior disc displacement without reduction (DWOR). The cases of effusion were divided into 4 groups: normal, mild (E1), moderate (E2), and marked effusion (E3). Statistical analysis was made by the Fisher's exact test using SPSS (version 12.0, SPSS Inc., Chicago, IL, USA).
The subjects consisted of 62 males and 191 females with a mean age of 28.5 years. Of the 253 patients, T1- and T2-weighted images revealed 34 (13.4%) normal, DWR in 103 (40.7%), and DWOR in 116 (45.9%) on the right side and 37 (14.6%) normal, DWR in 94 (37.2%), and DWOR in 122 (48.2%) joints on the left side. Also, T2-images revealed 82 (32.4%) normal, 78 (30.8%) E1, 51 (20.2%) E2, and 42 (16.6%) E3 joints on the right side and 79 (31.2%) normal, 85 (33.6%) E1, 57 (22.5%) E2, and 32 (12.7%) E3 on the left side. There was no difference between the right and left side.
Anterior disc displacement was not related to the MRI findings of effusion in TMD patients (P>0.05).
PMCID: PMC3873312  PMID: 24380063
Disc Displacement; Effusion; Temporomandibular Joint; Magnetic Resonance Imaging
24.  Anxiety level of early- and late-stage prostate cancer patients 
Prostate International  2013;1(4):177-182.
Anxiety can worsen prostate cancer patients’ decision making and quality of life. Early identification of anxiety disorders is thus very important for excellent prostate cancer treatment. This study aimed to determine the levels of anxiety in patients with early-stage prostate cancer compared with advanced-stage disease.
This cross-sectional study was performed at the Department of Urology, ‘Cipto Mangunkusumo’ Hospital, Faculty of Medicine, University of Indonesia. The subjects were early-stage prostate cancer patients and advanced-stage prostate cancer patients with bone metastatic lesions proved by bone scan. Comparative analysis was done to analyze anxiety scores assessed by use of an 11-item modified Memorial Anxiety Scale for Prostate Cancer (MAX-PC) questionnaire. We also assessed the relationship of the MAX-PC score with age, prostate-specific antigen (PSA) value, number of bone metastases, and pain. Data were analyzed by using SPSS ver. 17 (SPSS Inc.).
There were 34 subjects with early-stage prostate cancer and 34 subjects with advanced-stage prostate cancer. We found that the mean anxiety score was significantly lower (P=0.0001) in the early-stage prostate cancer group (8.32±3.65) than in the advanced-stage prostate cancer group (12.61±4.56). Nine subjects had a pathological MAX-PC score (≥16), of whom 1 subject had early-stage disease and 8 subjects had advanced-stage disease. Furthermore, there were significant positive correlations (P<0.001) between MAX-PC score and visual analogue scale pain score (r=0.633), PSA value (r=0.263), and number of bone metastatic lesions (r=0.464). However, the correlation between age and anxiety score was not significant (P=0.170).
The MAX-PC anxiety score was significantly associated with the stage of prostate cancer. Furthermore, visual analogue scale pain score, PSA value, and number of bone metastatic lesions can also affect the MAX-PC anxiety score.
PMCID: PMC3879056  PMID: 24392443
Prostatic neoplasms; Neoplasm staging; Anxiety disorders; Pain measurement
25.  Biaxial flexural strength of Turkom-Cera core compared to two other all-ceramic systems 
Journal of Applied Oral Science  2010;18(6):607-612.
Advances in all-ceramic systems have established predictable means of providing metal-free aesthetic and biocompatible materials. These materials must have sufficient strength to be a practical treatment alternative for the fabrication of crowns and fixed partial dentures.
The aim of this study was to compare the biaxial flexural strength of three core ceramic materials.
Material and methods
Three groups of 10 disc-shaped specimens (16 mm diameter x 1.2 mm thickness - in accordance with ISO-6872, 1995) were made from the following ceramic materials: Turkom-Cera Fused Alumina [(Turkom-Ceramic (M) Sdn Bhd, Puchong, Selangor, Malaysia)], In-Ceram (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany) and Vitadur-N (Vita Zahnfabrik, Bad Säckingen, Baden-Württemberg, Germany), which were sintered according to the manufacturer's recommendations. The specimens were subjected to biaxial flexural strength test in a universal testing machine at a crosshead speed of 0.5 mm/min. The definitive fracture load was recorded for each specimen and the biaxial flexural strength was calculated from an equation in accordance with ISO-6872.
The mean biaxial flexural strength values were: Turkom-Cera: 506.8±87.01 MPa, In-Ceram: 347.4±28.83 MPa and Vitadur-N: 128.7±12.72 MPa. The results were analyzed by the Levene's test and Dunnett's T3 post-hoc test (SPSS software V11.5.0 for Windows, SPSS, Chicago, IL, USA ) at a preset significance level of 5% because of unequal group variances (P<0.001). There was statistically significant difference between the three core ceramics (P<0.05). Turkom-Cera showed the highest biaxial flexural strength, followed by In-Ceram and Vitadur-N.
Turkom-Cera core had significantly higher flexural strength than In-Ceram and Vitadur-N ceramic core materials.
PMCID: PMC3881768  PMID: 21308292
Ceramics; Strength; Dental materials

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