Development and validation of a novel screening instrument to prioritize the orthodontic referral of developing malocclusion in children: The index for interceptive orthodontics referral / 대한치과교정학회지

Objective@#The absence of a guideline to refer to developing malocclusions appropriately, may be a contributing factor to the inadequacy of timely interceptive orthodontics provision. This study aimed to develop and validate a new orthodontic grading and referral index to be used by dental frontliners to prioritize the orthodontic referral of developing malocclusion in children based on its severity. @*Methods@#A cross-sectional study involving clinical assessment with 413 schoolchildren aged between 8.1 and 11.9 years was conducted in 2018. All the presenting malocclusion was listed and graded based on a few dental guidelines to produce the draft index. The validity and reliability of the draft index were tested using twenty study models. Face and content validation was carried out using the content validation index and Modified Kappa Statistics. @*Results@#Fourteen dental and occlusal anomalies were identified as components of malocclusion and three grades of referral (monitor, standard, urgent) were included in the final index. The scale-level content validity index average value of 0.86 and 0.87 was obtained for content and face validation, respectively. There was moderate to excellent agreement in the Modified Kappa Statistics for both validations. Excellent inter- and intra-assessor agreement was obtained. The new index displayed valid and reliable scores. @*Conclusions@#The Index for Interceptive Orthodontics Referral was developed and validated for the dental frontliners to identify and prioritize the developing malocclusion in children based on its severity and refer for orthodontic consultation to increase the possibility for interceptive orthodontics.

The Effect of Metallic Dental Restorations and Implants in Causing Patient Discomfort and Artefacts During Magnetic Resonance Imaging of the Head and Neck

Context: Patients with metallic dental objects in their oral cavity are often associated with discomfort or artefacts during magnetic resonance imaging (MRI) of the head and neck. Aim: This study was conducted to evaluate the effects of metallic dental objects in causing patient discomfort and artefacts during MRI of the head and neck region. Design: This is an observational study including 538 participants from various specialized MRI centres in Kozhikode. Methods and Material: MRI records of 538 participants who underwent head and neck MRI as a part of their medical treatment were collected. With the help of questionnaire and clinical examination, the type of metallic dental object in the patient’s oral cavity was identified. After examining the MRI images, four categories of artefacts were established. In MRI brain, artefacts in three different sequences were also studied. Statistical Analysis Used: The significance of the difference between proportions was analysed by the Chi?square test. Results: Artefacts were found in 65 cases with metallic dental objects but none of the participants had experienced any kind of discomfort. The artefact formation significantly depended on the type of metallic dental restoration in the patient’s oral cavity. Orthodontic braces and titanium bone plate created severe artefacts in head and neck MRI making interpretation almost impossible. In the MRI brain, diffusion?weighted imaging is most sensitive to artefact followed by fluid?attenuated inversion recovery. Conclusions: Artefacts were found in 65 cases with metallic dental restorations but none of the participants had experienced any kind of discomfort.

Effectiveness of Shiatsu Massage on First Stage Labour Pain among Parturient Mothers

Childbirth is an experience in a woman' s life that holds the power to transform her forever. The objective of the study was to assess the effectiveness of Shiatsu massage upon rst stage Labour pain among the parturient mothers. In this pre-test, post-test experimental study, 60 parturient mothers were selected by simple random sampling technique among which 30 were assigned to the control group and 30 mothers to the experimental group. The labour pain level was assessed by the visual pain analogue scale, and foeto maternal parameters using modi- ed WHO partograph before and after intervention for both control and experimental group of parturient mothers. The experimental group was provided with Shiatsu massage on UB30 of the sacro-meridian region for 10 minutes for every two hours along with the routine care and the control group was treated only with the routine care during the labour process. The results showed a signi cant difference in after therapy pain score, at p'lt;0.001 between the control and experimental group. The foeto maternal parameters like foetal heart rate, uterine contraction and cervical dilatation was stable throughout the labour process. The Shiatsu massage was effective in reducing the level of labour pain perception. The management of labour pain is a primary responsibility of the nurse. Midwives can be empowered to provide Shiatsu massage as non-pharmacological pain management during childbirth.

Dietary diversity as a sustainable approach towards micronutrient Deficiencies in India

The silent epidemic of micronutrient deficiencies (MNDs) continues to be a major public health challenge in the developing world, including India. The prevalence of iron, iodine, zinc, vitamin A and folate deficiencies is alarmingly high worldwide. India is additionally facing a high prevalence of vitamin D and B12 deficiencies. To combat the hidden epidemic of MNDs, various governments around the world have mostly relied on supplementation or fortification-based interventions. India launched salt iodization programme in 1962 and vitamin A and iron-folate supplementation programmes in 1970. Yet, even after decades of these programmes, MNDs are still widespread in the country. Due to slow progress in alleviating the burden of most MNDs, the Government of India aims to scale up fortification-based intervention programmes. However, there are safety and effectiveness concerns with such approaches. Hence, overdependence on supplementation and fortification alone may be counterproductive. Instead, food based dietary diversification approach can be the way forward. In this article, we list the common MNDs in India, evaluate major policy interventions, discuss concerns pertaining to fortification and suggest the need for a concurrent food-based approach, in particular dietary diversification, as a long-term and sustainable strategy to address population-based MNDs.

Perception of nurses on the practice environment: Experience from Malaysia

@#Introduction: Positive professional practice environments are crucial to safeguard a healthy and safe working conditions for health workforce, including nurses; so as to ensure provision of quality healthcare and safety of patient. Methods: This was a cross-sectional study to assess nurses’ perceptions towards nursing practice environment and factors associated with their perceptions. A validated Practice Environment Scale of the Nursing Work Index (PESNWI) questionnaire was administered to nurses working in two Ministry of Health hospitals. The questionnaire comprises of five subscales: Participation, Foundation, Managers Support, Workforce Adequacy and Physician/Nurse Relations. Mean scores of >2.50 were considered as favourable, and ≤2.50 were considered as unfavourable. Simple linear and multiple linear regression analysis were employed to identify factors associated with their perceptions. Analysis was carried out using STATA version 14.0. Results: A total of 366 respondents took part in the study, with a response rate of 98.4%. Majority were working shift (89.6%) and working extended hours (62.3%). In general, the nursing practice environments were rated as favourable. Overall mean score was 2.90±0.03 and four out of five subscales’ mean scores were >2.50. Foundation for quality nursing care was perceived as the most favourable subscale, while workforce adequacy was perceived as the least favourable. There were statistically significant association between working extended hours, doing double shift and working during day off with perceived unfavourable workforce adequacy. Conclusion: Nursing practice environment was perceived as favourable in the studied hospitals. Policy makers, service providers, and hospital managers could explore further on human resource planning and management of nursing personnel to tackle the issue of nurse staffing in the country.

Diagnostic dilemma of a thumb swelling: An unpropitious turn of events

Benign and malignant bone tumors arise in small bones of the hands and feet. Nevertheless, secondary deposits at these sites are extremely rare. We report a peculiar case of an adult man who presented with thumb swelling, which was later discovered to be a metastasis from renal cell carcinoma. Such cases have a sinister prognosis with a survival rate of 6–12 months from the time of diagnosis. We intend to discuss the diagnostic dilemma and treatment of acrometastases

Microneedles: An advancement to transdermal drug delivery system approach

Novel drug delivery system offers several advantages which could outweigh the benefits of other drug deliverysystems. The transdermal drug delivery system being one of them offers supremacy by by-passing the first passmetabolism which eventually helps in eradication of gastrointestinal irritation. However, the major drawback of thetransdermal drug delivery system is the hindrance created via the stratum corneum. This protective barrier of the skindoes not allow required penetration of the drug via skin into the systemic circulation. Thus, in order to overcome thishurdle, a replacement to this type of novel drug delivery system, namely, “microneedle drug delivery system” helpedto improve various pitfalls of transdermal drug delivery system, such as skin barrier function, restrictions towardusing of specific drugs only, bioavailability, patient compliance, diffusion rate, and plasma concentration level. Amicroneedle drug delivery system, thus, is advancement to transdermal drug delivery system which includes deliveryof drug via microneedle into systemic circulation, thus increasing patient compliance and avoiding problems renderedby transdermal drug delivery system.

Knowledge and Risk Perceptions of Occupational Infections Among Health-care Workers in Malaysia

Health-care workers are at risk of exposure to occupational infections with subsequent risk of contracting diseases, disability, and even death. A systematic collection of occupational disease data is useful for monitoring current trends in work situations and disease exposures; however, these data are usually limited due to under-reporting. The objective of this study was to review literature related to knowledge, risk perceptions, and practices regarding occupational exposures to infectious diseases in Malaysian health-care settings, in particular regarding blood-borne infections, universal precautions, use of personal protective equipment, and clinical waste management. The data are useful for determining improvements in knowledge and risk perceptions among health-care workers with developments of health policies and essential interventions for prevention and control of occupational diseases.

Sharing experiences from a reference laboratory in the public health response for Ebola viral disease, MERS-CoV and H7N9 influenza virus investigations

An efficient public health preparedness and response plan for infectious disease management is important in recent times when emerging and exotic diseases that hitherto were not common have surfaced in countries with potential to spread outside borders. Stewardship from a reference laboratory is important to take the lead for the laboratory network, to proactively set up disease surveillance, provide referral diagnostic services, on-going training and mentorship and to ensure coordination of an effective laboratory response. In Malaysia, the Institute for Medical Research has provided the stewardship for the Ministry of Health's laboratory network that comprises of hospital pathology, public health and university laboratories. In this paper we share our experiences in recent infectious disease outbreak investigations as a reference laboratory within the Ministry of Health infectious disease surveillance network.

Echovirus serotypes circulating in Malaysia from 2002 to 2013

OBJECTIVE@#To identify the circulating serotypes of human echovirus in Malaysia from 2002 to 2013.@*METHODS@#A total of 31 retrospective samples from non-polio acute flacid paralysis, hand-food-and-mouth disease, viral meningitis and enterovirus cases were subjected to amplification of partial VP1 gene by RT-PCR.@*RESULTS@#Sequencing and phylogenetic analysis of the partial sequences identified presence of human echovirus and human coxsackie viruses. It was found that echovirus 11 was the commonly circulating serotype followed by echovirus 6, echovirus 7, echovirus 3, echovirus 9, echovirus 30 and echovirus 1 in decreasing order. Additionally two types of human coxsackie virus isolates were detected which were coxsackie A24 and B3.@*CONCLUSIONS@#From the findings, there is a possibility that echovirus 11 is the predominant serotype among Malaysian patients with echovirus infection. However, a larger sample size will yield a more confident result to support this evidence.

Echovirus serotypes circulating in Malaysia from 2002 to 2013

Objective: To identify the circulating serotypes of human echovirus in Malaysia from 2002 to 2013. Methods: A total of 31 retrospective samples from non-polio acute flacid paralysis, hand-food-and-mouth disease, viral meningitis and enterovirus cases were subjected to amplification of partial VP1 gene by RT-PCR. Results: Sequencing and phylogenetic analysis of the partial sequences identified presence of human echovirus and human coxsackie viruses. It was found that echovirus 11 was the commonly circulating serotype followed by echovirus 6, echovirus 7, echovirus 3, echovirus 9, echovirus 30 and echovirus 1 in decreasing order. Additionally two types of human coxsackie virus isolates were detected which were coxsackie A24 and B3. Conclusions: From the findings, there is a possibility that echovirus 11 is the predominant serotype among Malaysian patients with echovirus infection. However, a larger sample size will yield a more confident result to support this evidence.

Alteration in Levels of Minerals in DEN induced Hepatocellular carcinoma in Wistar Albino Rats.

The present attempt has been made to evaluate, and examine the levels of minerals in serum and liver in DEN induced hepatocellular carcinoma in wistar albino rats for possible chemopreventive effect. In hepatocellular carcinogenesis complications such as hepatic fibrosis and cirrhosis may lead to several abnormalities in mineral metabolism, hence attempt is made to evaluate on the level of minerals. Hepatic cancer was induced by single dose of intraperitoneal injections of DEN (200mg/kg body weight) followed by phenobarbital of 0.05% mixed with drinking water for 20 weeks. Concentration of calcium, magnesium, sodium and potassium were assessed in the serum and liver at the end of experimental period. Negative correlations were observed between liver function tests and serum mineral levels, except with albumin. Calcium, magnesium, potassium and sodium concentrations in the serum were decreased after the induction of hepatic cancer. The liver calcium content was increased after DEN treatment. No change occurred in liver sodium content. However, magnesium and potassium content was significantly reduced in the hepatic tissue. The results suggest that in DEN-induced hepato cellular carcinoma alteration of essential elements is noted. The low levels of albumin and the related ascites may be one of the major causes of the imbalance of mineral metabolism in hepatocellular carcinoma. Abbreviations: N-Nitrosodiethylamine (DEN), Hepatocellular carcinoma (HCC), Captain Srinivasa Murti Drug Research Institute for Ayurveda (CCRAS), Tamilnadu Veterinary and animal Science University (TANUVAS), Institutional Animal Ethics Committee (IAEC).

Periodontal findings in patients with Hansen's disease

OBJECTIVE@#To find out whether there are any relationship between leprosy and periodontitis as evidenced by clinical parameters.@*METHODS@#Fifteen diagnosed patients with Hansen's disease were selected and compared against 50 healthy individuals. Clinical parameters like probing pocket depth and clinical attachment level were evaluated for both the groups and the results were subjected to statistical analysis.@*RESULTS@#Mean probing depth and attachment loss is seen more in patients with Hansen's disease than the healthy controls which are statistically significant.@*CONCLUSIONS@#Patients with Hansen's disease tend to have more periodontal destruction than the healthy controls.

In vitro studies on phytochemical evaluation and antimicrobial activity of Borassus flabellifer Linn against some human pathogens

OBJECTIVE@#To detect preliminary phytochemicals and antimicrobial activity of seed coat of Borassus flabellifer (B. flabellifer) against some human pathogens.@*METHODS@#The antimicrobial activity of the organic solvent extracts of seed coat of B. flabellifer against various test microorganisms including bacteria and fungi was investigated using agar well diffusion technique.@*RESULTS@#The preliminary phytochemical screening of the aqueous, methanoic and ethanolic extracts of seed coat of B. flabellifer revealed the presence of certain phytochemicals like tannins, flavonoids, saponins, glycosides and terpenoids. The zone of inhibition of methanolic extracts varied from 16 to 23 mm where as with ethanol extracts from 14 to 23 mm and aqueous extracts from 10 to 15 mm at 50 mg/mL concentrations. Among all tested organisms, Aspergillus brasiliensis and Bacillus subtilis showed a higher rate of inhibition with ethanolic and methanolic extracts of B. flabellifer.@*CONCLUSIONS@#B. flabellifer exhibited higher rate of growth inhibition against some human pathogens, so it can be used for treatment of some infectious diseases. Further studies are being carried out to separate and purify the individual compounds that are present in seed coat of B. flabellifer by using various chromatographic techniques.

In vitro studies on phytochemical evaluation and antimicrobial activity of Borassus flabellifer Linn against some human pathogens

Objective: To detect preliminary phytochemicals and antimicrobial activity of seed coat of Borassus flabellifer (B. flabellifer) against some human pathogens. Methods: The antimicrobial activity of the organic solvent extracts of seed coat of B. flabellifer against various test microorganisms including bacteria and fungi was investigated using agar well diffusion technique. Results: The preliminary phytochemical screening of the aqueous, methanoic and ethanolic extracts of seed coat of B. flabellifer revealed the presence of certain phytochemicals like tannins, flavonoids, saponins, glycosides and terpenoids. The zone of inhibition of methanolic extracts varied from 16 to 23 mm where as with ethanol extracts from 14 to 23 mm and aqueous extracts from 10 to 15 mm at 50 mg/mL concentrations. Among all tested organisms, Aspergillus brasiliensis and Bacillus subtilis showed a higher rate of inhibition with ethanolic and methanolic extracts of B. flabellifer. Conclusions: B. flabellifer exhibited higher rate of growth inhibition against some human pathogens, so it can be used for treatment of some infectious diseases. Further studies are being carried out to separate and purify the individual compounds that are present in seed coat of B. flabellifer by using various chromatographic techniques.

Periodontal findings in patients with Hansen's disease

Objective: To find out whether there are any relationship between leprosy and periodontitis as evidenced by clinical parameters. Methods: Fifteen diagnosed patients with Hansen's disease were selected and compared against 50 healthy individuals. Clinical parameters like probing pocket depth and clinical attachment level were evaluated for both the groups and the results were subjected to statistical analysis. Results: Mean probing depth and attachment loss is seen more in patients with Hansen's disease than the healthy controls which are statistically significant. Conclusions: Patients with Hansen's disease tend to have more periodontal destruction than the healthy controls.

Effect of ion-implantation on surface characteristics of nickel titanium and titanium molybdenum alloy arch wires.

Aim: To evaluate the changes in surface roughness and frictional features of 'ion-implanted nickel titanium (NiTi) and titanium molybdenum alloy (TMA) arch wires' from its conventional types in an in-vitro laboratory set up. Materials and Methods: 'Ion-implanted NiTi and low friction TMA arch wires' were assessed for surface roughness with scanning electron microscopy (SEM) and 3 dimensional (3D) optical profilometry. Frictional forces were studied in a universal testing machine. Surface roughness of arch wires were determined as Root Mean Square (RMS) values in nanometers and Frictional Forces (FF) in grams. Statistical Analysis Used: Mean values of RMS and FF were compared by Student's 't' test and one way analysis of variance (ANOVA). Results: SEM images showed a smooth topography for ion-implanted versions. 3D optical profilometry demonstrated reduction of RMS values by 58.43% for ion-implanted NiTi (795.95 to 330.87 nm) and 48.90% for TMA groups (463.28 to 236.35 nm) from controls. Nonetheless, the corresponding decrease in FF was only 29.18% for NiTi and 22.04% for TMA, suggesting partial correction of surface roughness and disproportionate reduction in frictional forces with ion-implantation. Though the reductions were highly significant at P < 0.001, relations between surface roughness and frictional forces remained non conclusive even after ion-implantation. Conclusion: The study proved that ion-implantation can significantly reduce the surface roughness of NiTi and TMA wires but could not make a similar reduction in frictional forces. This can be attributed to the inherent differences in stiffness and surface reactivity of NiTi and TMA wires when used in combination with stainless steel brackets, which needs further investigations.

Effect of maternal Tp53 gene G412C polymorphism on neural tube defects: A study from North India.

Context: Tumor protein 53 (tp53) is one of the candidate gene proposed for neural tube defects, which affects central nervous system during early embryonic development, on the basis of mouse models. Aims: The present study is an attempt to unfold the possible role of tp53 G412C polymorphism in the incidence of neural tube defect (NTDs) in humans. Settings and Design: Case-control study was carried out in government hospitals of Delhi, India. Materials and Methods: Subjects comprised of 100 mothers of NTD children and 100 matched control mothers. Information on some environmental exposures was collected along with blood samples. After DNA extraction, the genotyping of tp53 G412C polymorphism was carried out by PCR-RFLP method. Statistical Analysys: Fisher Exact or Chi square test, binary logistic model, and odds ratio (95% confidence interval) calculations were used to evaluate effect of risk factors on NTDs using SPSS v17.0. Results: The 'CC' genotype of tp53 G412C showed protective effect towards the development of anencephaly and/or encephalocele (OR: 0.44; 95% CI: 0.19-1.00); however, no significant difference among overall NTD cases and controls was observed (P>0.05). Further segregation of all subjects based on 2 different communities, Hindus and Muslims, the association of 'CC' genotype of the polymorphism with reduced NTD risk was observed among Hindu community (OR: 0.33; 95% CI: 0.13-0.79). Conclusion: The study highlights the selective advantage provided by maternal 'CC' genotype, thereby reducing risk of cephalic NTDs, probably due to the lower apoptotic activity of the protein, however, more specifically in the presence of community-specific microenvironment.

Occupational Risk Factors for Carpal Tunnel Syndrome among Nurses in Medical

Carpal tunnel syndrome (CTS) is a hand disorder which indicates the presence of symptoms such as pain, numbness, and muscle weakness among the patient. CTS is an occupational related disorder which can occur in any profession. However, it can be prevented and managed. The aims of the research were to determine the prevalence of acquiring CTS among nurses who worked in the wards and occupational risk factors involving the upper limbs during nursing tasks performance. The specific aims were to determine the relationship between the prevalence of acquiring CTS and individual factors (age, gender, race, educational level, duration of work and medical history), relationship between the prevalence of acquiring CTS and occupational risk factors in nursing tasks. Nurses profession was chosen as they are performing multitask involving upper limbs especially the wrist joints. Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) was used to determine the level of severity in CTS. Occupational risk factors were assessed by using the Rapid Upper Limb Assessment (RULA). This research was a cross sectional mode which was carried out at a government university medical centre from November through December 2010. Eighty nurses were involved in the research. The respondents were required to fill in the socio-demographic information sheet. Those having CTS were required to fill in the BCTQ. Assessments were performed by observing of the job activity through RULA. The results showed that the prevalence for nurses acquiring CTS is 7.5%. The RULA assessment also indicated that the risk factor was in the highest level with a score of 7. No relationship was shown between the prevalence of CTS and race, gender, educational level and medical history. Significant relationship was indicated by the prevalence of CTS and occupational risk factors. In conclusion, a significant prevalence of CTS related to age of more than 30 years old, Malay races compared to Indian, working experience of more than 10 years and respondents with right hand dominant. Occupational risk factors also indicated among the active nurses. Therefore, it is important for us to modify the work environment, work flow, work methodology and ergonomic factors in order to prevent the nurses from acquiring CTS. Furthermore, education about the condition of CTS should be implemented and reinforced especially among the higher risk nurses.