Browsing by Author "Premviyasa, Vinayagie"

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A retrospective study of histologically diagnosed intra-oral lesions within Ugu district, KZN, South Africa
(University of the Witwatersrand, Johannesburg, 2023-10) Reddy, Larisha Yashoda; Premviyasa, Vinayagie
Introduction: The oral cavity is exposed to a magnitude of physical and chemical trauma, carcinogenic agents and microbial pathogens that may cause a wide spectrum of oral lesions. These oral lesions may appear as benign, potentially malignant, or malignant thereby requiring biopsies to determine histopathological features to confirm a diagnosis. Oral lesions have the potential to hinder the quality of life for the afflicted patient. The patients’ speech, mastication, swallowing may be affected with the occurrence of oral dysesthesia. With the confirmation of a positive malignant biopsy, the afflicted individual will have to endure the possible side effects of chemotherapy and radiation. In global studies, the prevalence of oral lesions may vary amongst different countries, geographical areas, ethnicities, cultural practices, and social habits. Aim: To identify the different types of intra-oral lesions and the prevalence of malignant oral lesions within UGU district, Kwa- Zulu Natal (KZN). Objectives: 1. To identify the different types of intra oral lesions and characterise by demographics. 2. To determine the prevalence of malignant oral lesions within UGU district, KZN. 3. To determine the association between patients’ social habits and the development of the most common intra oral lesions, with the differentiation of malignant vs non-malignant oral lesions. 4. To assess the concordance of a clinical differential diagnosis and histopathological diagnosis. Study design and Methodology: A quantitative, retrospective case review of dental patient files and histopathological reports of the four selected hospitals in UGU were analysed from January 2016 to August 2022. One hundred and thirty-four patient records were reviewed. Data collected included patients’ age, gender, comorbidities, social habits, differential diagnosis, and histological diagnosis. The data was analysed using a free open-source statistical software program called “R”. Study results: One hundred and thirty-four patients met the criteria of this study. The age of patients ranged between seven and eighty-seven (M= 46.37; SD= 20.77). There were 81 females (60.4%) and 53 males (39.6%). Benign lesions had represented 67.2% (N: 90) of the intra oral biopsies, with the remaining 32.8 %, (N:44), representing malignant lesions. The most common lesions presenting in UGU district were fibrous epulis (N: 15, 11.2%), pyogenic granuloma (N:36, 26.9%) and squamous cell carcinoma (N:37, 27.6%). No statistical relation was proven between ethnicity, sex, and social habits with the benign lesions of fibrous epulis and pyogenic granuloma. Statistical relation was proven between squamous cell carcinoma and ethnicity, gender, and social habits. A substantial level of concordance (agreement) was proven with the Kappa Statistic of 0.7437, hereby indicating a good general knowledge of intra-oral lesions amongst the dentist performing the intra oral biopsies within UGU district. Conclusion: Fibrous epulis, pyogenic granuloma and oral squamous cell carcinoma had been identified as the three most common lesions in UGU, KZN, representing 65.7% of the confirmed biopsy results. Fibrous epulis and pyogenic granuloma had shown no statistical association to ethnicity, gender, alcohol consumption and smoking. In this study, oral squamous cell carcinoma had shown statistical association to white males and consumption of alcohol and smoking. This study has demonstrated the diversity and prevalence of intra-oral lesions within the rural district of UGU, KZN, South Africa as compared to global studies.
Antibiotic prescribing patterns among dentists in the Durban metro region, South Africa
(University of the Witwatersrand, Johannesburg, 2024) Rampersad, Yuvti; Premviyasa, Vinayagie
Antibiotic resistance is a rising global phenomenon which challenges the delivery and efficacy of both simple and complex medical treatments. While the development of resistance is a natural progression for organisms, evidence suggests that there is a correlation between misuse and overuse of antibiotics and the subsequent development of resistant organisms. The aim of this study was to analyze the antibiotic prescribing patterns among dentists in the Durban-metro region. Methods This was a cross-sectional analysis of the antibiotic prescribing patterns among dentists in the Durban metro region, South Africa in 2022.The inclusion criteria adopted in this study were qualified dentists in the Durban metro region who are currently registered with the HPCSA. A sample size of 183 participants was calculated. The survey was sent to dentists on a closed-dental groups of 210 participants. Ninety-one responses to the survey were received. The survey was distributed on Microsoft forms and responses were recorded and captured in excel and exported to Stata for analysis. Results Amoxicillin was the most prescribed antibiotic (48%) while the most common antibiotic prescribed for patients who are allergic to penicillin was Clindamycin (58%). Seventy one out of ninety-one dentists prescribed antibiotics for a 5-day course (78%). The most common reason for prescribing antibiotics was facial swelling 89% (81/91 dentists). More than half of dentists did not report any adverse effects after prescribing an antibiotic to a patient (57%). Seventy-three out of ninety-one dentists believed that dentists are contributing to antibiotic resistance (80%). Of the 80% that believe that dentists are contributing to antibiotic resistance, sixty-five out of ninety-one (71%) stated the most common reason for dentists contributing to antibiotic resistance to be unclear guidelines on antibiotic prescribing. Conclusion Most dentists in the study had a fairly good knowledge on how to prescribe antibiotics. However, a significant number of dentists (62%) incorrectly prescribed antibiotics for irreversible pulpitis. There was an overall good attitude towards antibiotic resistance with more than half of the dentists being aware that dentists are contributing to antibiotic resistance (80%)
Quantification of the volume of antogenous bone required for grafting of mandibular continuity defects
(2017) Premviyasa, Vinayagie
Introduction: The amount of particulate bone and cancellous marrow (PBCM) graft required for mandibular reconstruction is unclear, in particular with regard to the relationship between defect length and volume of bone needed. This often leads to procurement of either too little or too much bone. Although volume guidelines exist, measuring uncompressed bone volume is onerous, and mass measurement is easier. Aims: A retrospective study to quantify the mass of autogenous PBCM bone required to graft a 1cm continuity defect of the mandible. Materials and Methods: Patients with mandibular continuity defects who returned for bony reconstruction (6 - 8 weeks post-resection and placement of a reconstruction plate and a spacer) were included in the study. The graft was harvested from the posterior iliac crest, weighed on a kitchen scale and recorded as the wet weight in grams. The harvested bone was milled with a power bone mill. The milled PBCM was transferred to 10 and 20 ml syringes, maximally compressed and the compressed bone volume recorded. After the removal of the spacer, the defect length was measured in centimetres (cm) with a flexible ruler, and the volume of compressed bone used was recorded. The mass of the bone required to produce 1cc of compressed bone was calculated, as was the mass of bone required per centimetre of mandibular defect. Results were analysed statistically to determine whether sexual differences exist. Results and Discussion: Thirty one patients (11 males and 20 females) with mandibular continuity defects, resulting from resection of benign pathology and trauma were included in the study. The mean age of patients in years was 27.43 ± 10.63 (range 12 - 62). The mean defect length in centimetres was 9.15 cm ± 2.61 (range 6 - 16 cm). The mean wet bone mass harvested (wet weight) in grams in males was 70.82 g ± 16.73 (range 47 - 98 g) and in females, 62.2 g ± 15.97 (range 32 - 100 g). The combined mean compressed bone volume (cc) used was 31.73 cc ± 8.25 (range 20 - 50 cc). In males, the average wet bone mass used per cm of mandibular defect was 7.4 g/cm ± 2.04 (range 4.09 - 11.38 g/cm), while the compressed bone volume used per centimetre of mandibular defect was 3.74 cc/cm ± 0.75 (range 2.27 - 4.88 cc/cm) and the compressed volume of bone produced by 1g of wet bone was 0.54 cc/g ± 0.09 (range 0.40 – 0.74 cc/g). In females, the mean wet bone mass per cm of mandibular defect was 7.39 g/cm ± 1.84 (range 4.6 - 10.72 g/cm), while the compressed bone volume per centimetre of mandibular defect was 3.49 cc/cm ± 0.72 (range 2.2 - 4.67 cc/g) and the volume of compressed bone produced by 1g of wet bone was 0.48 cc/g ± 0.07 (range 0.37 - 0.63 cc/g). There was a statistically significant difference in the compressed bone volume obtained and the compressed bone volume used in males and females, but this difference was not of clinical significance. Conclusion: For each centimetre of mandibular continuity defect a wet bone mass of approximately 7.5 g is required to adequately reconstruct a mandible. There was a statistical difference in the compressed bone volume and the compressed bone volume used between males and females but all other variables were not significant. Female bone was 12% more compressible than male bone.