Over dental anxiety problems among university students: perspective from Pakistan

Oral health seeking behavior is compromised by dental anxiety, and affects quality of life. This preliminary study using convenience sampling was conducted among university students in the cities of Islamabad, Rawalpindi, and Multan, Pakistan, using standardized, valid and reliable scales to determine the prevalence and correlates of dental anxiety. Cumulatively 503 students including 278 males and 225 females, completed the questionnaire. High to severe anxiety on Dental Anxiety Scale-Revised was reported by 60 (21.6%) males and 54 (24%) females. Seventy-five (27%) males and 62 (27.6%) females reported being quite afraid to very afraid on Dental Anxiety Question. Results underline the need for population-based representative studies to determine the prevalence and correlates of dental anxiety for better dental health in Pakistan.     

Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis

We conducted a systematic review of large, well-conducted randomised trials designed to evaluate the effectiveness of telemonitoring on patients with congestive heart failure (CHF). Two people reviewed 125 articles independently and selected 13 articles for final review. These studies concerned 3480 patients. The follow-up period of the studies was 3-15 months. Pooled estimate results showed that there was an overall reduction in all-cause mortality (P = 0.02). There was no overall reduction in all-cause hospital admission (P = 0.84), although there was a reduction in CHF hospital admission (P = 0.0004). There was no reduction in all-cause emergency admission (P = 0.67). There was no significant difference in length of stay in hospital, medication adherence or cost. Telemonitoring in conjunction with nurse home visiting and specialist unit support can be effective in the clinical management of patients with CHF and help to improve their quality of life.     

Cushing's syndrome in a case of thymic carcinoma

A 29-year-old gentleman presented with episodic features suggestive of Cushing's syndrome. He was evaluated and diagnosed with ectopic Adrenocorticotropic hormone (ACTH)-dependent Cushing's syndrome due to a thymic tumor. The thymic lesion was excised and histopathology confirmed thymic carcinoma with neuroendocrine differentiation, with local, perineural, and vascular invasion. The postoperative problems and further treatment options have been discussed in this case report.     

HLA-A, -B, -C, -DQB1, and -DRB1,3,4,5 allele and haplotype frequencies in the Costa Rica Central Valley Population and its relationship to worldwide populations

The human leukocyte antigen (HLA) system is the most polymorphic in humans. Its allele, genotype, and haplotype frequencies vary significantly among different populations. Molecular typing data on HLA are necessary for the development of stem cell donor registries, cord blood banks, HLA-disease association studies, and anthropology studies. The Costa Rica Central Valley Population (CCVP) is the major population in this country. No previous study has characterized HLA frequencies in this population. Allele group and haplotype frequencies of HLA genes in the CCVP were determined by means of molecular typing in a sample of 130 unrelated blood donors from one of the country's major hospitals. A comparison between these frequencies and those of 126 populations worldwide was also carried out. A minimum variance dendrogram based on squared Euclidean distances was constructed to assess the relationship between the CCVP sample and populations from all over the world. Allele group and haplotype frequencies observed in this study are consistent with a profile of a dynamic and diverse population, with a hybrid ethnic origin, predominantly Caucasian-Amerindian. Results showed that populations genetically closest to the CCVP are a Mestizo urban population from Venezuela, and another one from Guadalajara, Mexico.     

Alzheimer's disease: cholesterol a menace?

Alzheimer's disease (AD) is the most prevalent neurodegenerative disease manifested by cognitive and memory deterioration, culminating in a spectrum of neuropsychiatric disturbances and the impairment of daily activities. AD is a multifactorial disease with a range of contributing factors which includes genes and diet. The magnitude of AD is reflected in the loss of individuality of the affected person and in the terminal course through which the disease develops. In this review, we aim to provide a background on AD and the contribution of cholesterol in the etiology of Alzheimer's. Cholesterol seems to be intimately linked with the generation of amyloid plaques, which is central to the pathogenesis of AD. Although there are conflicting reports on the role of cholesterol in AD, majority of the studies point out the positive association of cholesterol with AD.     

Prevalence of community acquired MRSA in a tertiary care facility

Traditionally, methicillin resistant Staphylococcus aureus (MRSA) is considered as a nosocomial pathogen, but an increasing prevalence of community acquired MRSA is being reported worldwide including India, which implies a strategic change in the antibiotic of choice for treatment of community acquired Staphylococcal infections, which till now is cloxacillin. This study is aimed at identifying the prevalence and susceptibility characteristics of community acquired MRSA in our hospital. The study group consisted of 208 consecutive MRSA identified on the basis of their resistance to cefoxitin disk (30 microg) by the disc diffusion method and mecA gene detection by polymerase chain reaction (PCR). Isolates were categorized as community acquired MRSA based on criteria for inclusion and their antibiotic susceptibility was compared with that of the hospital acquired MRSA isolates. Among the 208 MRSA analyzed, 18% (n = 37) were community acquired and were from infections such as cellulitis and superficial injuries. The isolates were significantly more sensitive to ciprofloxacin than the hospital acquired MRSA isolates. The prevalence of community acquired MRSA in this study (18%) is comparable to its prevalence in other studies across India. Susceptibility to antibiotics other than glycopeptides was an important characteristic of community acquired MRSA. In the absence of other reliable phenotypic test for its identification, susceptibility to ciprofloxacin is suggested as an alternative. A prudent clinician should be aware that, cloxacillin, the drug of choice for skin infections such as carbuncle and cellulitis, will not be effective in these cases and that community acquired MRSA has a range of antibiotics to choose from, other than the glycopeptides, when compared with that of hospital acquired MRSA.     

Type 2 diabetes mellitus in childhood: obesity and insulin resistance

As rates of childhood obesity climb, type 2 diabetes mellitus has increasingly been diagnosed in children and adolescents, with the highest incidence occurring among youth from racial and ethnic minority backgrounds. The serious complications associated with type 2 diabetes mellitus make it essential for physicians to be aware of risk factors and screening guidelines, allowing for earlier patient diagnosis and treatment. It is also important for physicians to be aware of the treatment options available, including weight control through diet and exercise as well as common pharmacotherapeutic options.