Prescription Patterns for Bipolar Disorder in Asian Countries:Findings from Research on Asian Prescription Pattern-Bipolar Disorder

Objective@#Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. @*Methods@#The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≥ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. @*Results@#Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. @*Conclusion@#Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≥ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment.

Sport-related oral injuries and mouthguard use among athletes in Kelantan, Malaysia

To assess their awareness and usage of mouthguard and occurrence of sports-related oral injuries in athletes who involve in various sports activities in Kota Bharu. A cross-sectional study was carried out among 180 athletes aged 12 to 27 years. A structured interviewer-guided questionnaire was used to determine the prevalence of oral injuries sustained during sport activities, the use of mouthguard as well as the athletes’ awareness of mouthguard use. The respondents consisted of 107 males (59.5%) and 73 females (40.5%) with a mean age of 16.7 years (SD 5.53). There were 60 (22.2%) athletes who had one or more types of sports-related oral injuries sustained. Laceration of lips, tongue and gums were the most frequent injuries (57.5%) while loosening of teeth and fracture of teeth sustained in 12.5% and 10.0% of athletes respectively. Malay traditional martial arts silat athletes, 17(68.0%) experienced the highest oral injuries among athletes. The prevalence of oral injuries was significantly different between ball sports, martial arts and other non-contact sports (p=0.002). Sixty-one athletes (33.9%) reported that they were aware of mouthguard; however none of the athletes used the mouthguards during their sports activities. Malay traditional martial arts silat was the most common susceptible to sustain oral injuries. None of the athletes were wearing mouthguard. Education on prevention of orofacial trauma should be given to the coaches and athletes. Wearing of mouthguard during sport activities should be compulsory during practice and competition events.

Dental caries experience and treatment needs in the mixed dentition in North East Malaysia

Dental caries is an important community dental health problem with limited studies in the mixed dentition stage. The aim of this study was to determine the caries prevalence and treatment needs among 7- 9 year old school children in Kelantan which is situated in North East Malaysia. A retrospective dental record review of fully documented dental records belonging to primary school children attending a paediatric dental clinic was conducted. Dental caries was recorded using dmft index and DMFT index for deciduous teeth and permanent teeth respectively. Three hundred and nineteen dental records of 175 (54.9%) boys’ and 144 (45.1%) girls’ were selected and subjected to a ‘dental record study’. The prevalence of dental caries was 93% (95% CI : 89,97) in primary dentition and 50.5% (95% CI : 42.2, 58.8) in permanent teeth. Mean dmft and DMFT was 6.2(SD 3.39) and 1.04(SD 1.34) respectively. Regarding treatment needs in the primary dentition, 35.4% of teeth needed one surface filling, 34.7% needed extraction, 24.5% needed two or more surfaces filling and 5.6% needed pulp care. In the permanent dentition, 54.7% required sealants and 21.9% required one surface restoration. The caries prevalence and treatment needs were high among this study population in the mixed dentition stage, particularly showing the early involvement of newly erupted permanent teeth. It appears that high caries prevalence in the primary dentition is a risk factor for caries in newly erupted permanent teeth. Oral health promotions programmes are required in the mixed dentition stage and may reduce the risk of caries in permanent dentition.

Impacted mandibular third molars among patients attending Hospital Universiti Sains Malaysia

The aim of this study was to identify the position of impacted mandibular third molars based on the classifications of Pell & Gregory and Winter, the indications for extraction, and the relation of post-operative complications and position. Records of patients who attended Hospital Universiti Sains Malaysia between January and December 2007 for surgical removal of mandibular third molars were reviewed. The angulation type, width and depth of impaction were determined by reviewing the orthopantomograms. The indications of extraction and occurrence of any post- operative complications were recorded. A total of 238 impacted teeth were surgically extracted from 194 patients (97 males, 97 females). The reasons for extraction include recurrent pericoronitis (43.1%) followed by prophylactic purposes (33.5%). Mesioangular impactions accounted for 52.3% and Class IIA position of impaction accounted for 45.7% of extractions. The most common post-operative complication was persistent pain and swelling (14.7%) followed by trismus (4.1%) and dry socket (3.0%). There was no significant relationship between the angulation, width and depth of impaction and the occurrence of complication. Mesioangular type and Class IIA position of impaction were the most common impaction. Although the association was not significant, high frequency of post-operative complications was observed in mesioangular, horizontal, IIA and IIC positions.

Antibacterial property of locally produced hydroxyapatite

Use of synthetic hydroxyapatite (HA) in biomedical applications is well warranted. It has shown to have an excellent biocompatibility in human tooth and bones. Additionally it has been documented to possess antibacterial potentials. The present study was conducted to assess the presence of any such potential in locally produced (HA) using Streptococcus mutans, a common pathogen in the oral cavity. The study was carried out using 50, 100, 150, 200, 300, 400 and 800 mg/ml concentration of HA. The antibacterial property of HA was assessed using Miles and Misra method. Our studies showed that bacterial growth inhibitions of S. mutans occurred from 50 mg/ml, and complete inhibition was perceived at concentrations at 200mg/ml of HA. The antibacterial property HA should be used to good advantage as a bioactive biomaterial in dental and maxillofacial applications.

Gender, mosquitos and malaria: implications for community development programs in Laputta, Myanmar.

This paper examines the gender roles linked to division of labor and potential exposure to mosquitos and malaria prevention activities. A "Human Development Initiative" (HDI) Project has been launched in Laputta, a mangrove delta region of Myanmar assisted by United Nations Development Program since 1994. The project aims to improve rural community access to primary health care and provide micro-credit programs, income generation schemes, and educational opportunities as a basis for community empowerment. Women and children of low-income households are the target beneficiaries. Prior to self-care training program and distribution of self-care manuals, altogether 20 focus group discussions (separately assigned to men and women) were conducted in eight study villages between January to February 2000. The primary vector for malaria in study area is Anopheles sundaicus. Rural women were prone to malaria due to exposure to mosquitos within the peak biting period at night because of their gender assigned roles. Both men and women perceived that mosquitos commonly bite before midnight, more at dusk. Lack of awareness of correlation between mosquitos and malaria together with lack of affordability enhance either non-use or shared use of bed-nets at home. Rural women did not consider destruction of breeding places of mosquitos as their major concern. Thus, it is essential for program planners to motivate local women for more active participation in vector control measures within and beyond their households in the context of community development programs.

Orocaecal transit time measured by breath hydrogen test in pre-school children

The orocaecal transit time (OCTT) was measured in 90 healthy children aged 1 to 5 years with the hydrogen breath test using lactulose (10 g in 10 per cent aqueous solution) as the test meal. The re1ationships between OCTT and gender, age, malnutrition status were assessed. The OCTT for 1.5 year-old children was 90.2 +/- 20.25 min (mean +/- SD). There was no significant difference in mean OCTT between boys and girls (89.03 +/- 15.45 vs. 91.05+/- 23.24). The mean OCTT of children who were still breast-fed (92.86+/-27.1 min) was also not different from those who were completely weaned (89.15+/-17.0 min). There was also no difference in OCTT between malnourished and non-malnourished children, and between age groups (1-2 y, 2-3 y, 3-4 y and 4-5 y).

Russell's viper bites in Taungdwingyi Civil Hospital:Clinical features and respones to antivenom

One hundred thirty-four Russell's viper (Daboia russell siamensis) bite cases were studies in Taungdwingyi during six months from June to December 1994. Forty percent of the victims were under 20 years of age. Thirty-eight percent showed no evidence of envenoming, 28 percent had local and 34 percent systemic features of envenoming. Ten percent of the cases developed local necrosis. Fifteen percent of the victims received antivenom therapy at the villages. Cases presenting with systemic manifestations had spontaneous systemic bleeding (29 percent); malena (18 percent), hypotension (22 percent), oliguria (42 percent), conjunctival oedema (18 percent) and renal failure (33 percent). Twelve deaths (9 percent) were due to hypotension and renal failure. Spontaneous systemic bleedings were late manifestations and seen from day 2 to 6 after the bite. Thirty-seven percent of the cases with systemic bleeding failed to have normal clot restoration in 6 hours following 40 ml of antivenom administration. Antivenom reactions were observed in 50 percent of the cases. Fifty two percent of juvenile and 19 percent of adult viper bites resulted in blank bites and 16 percent of the former and 31 percent of the latter bites led to systemic envenoming.

Clinical significance of early intravenous antivenom in russell's viper bite casces in Taungdwingyi District:A preliminary study

A retrospective study of 26 Russell's viper (Daboia russelii siamensis) bite cases who received 1-2 ampoules of anti venom at the villages in Taungdwingyi Township was carried out. Sixteen pad-applied cases were included in the study. Pad-treated cases who received early anti venom irrespective of the time after the bite developed no systemic complications (n=0/4) compared to those without pad (n=7/8) or cases who received 4 ampoules of antivenom within 4 hours after the bite at the hospital (n=5/10). Those who received antivenom 4 hours after the bite at the villages irrespective of pad carried the same risk of developing systemic complications compared to those who received 4 ampoules of antivenom at the hospital. Early administration of 1-2 ampoules of anti venom is indicated for treatment of local envenomed cases and 4 ampoules of antivenom should be given to early systemic cases following bites of big snakes. Application of compression immobilisation first-aid technique with an early intravenous anti venom at the villages is to be recommended in Russell's viper bite cases. Antivenom could have been saved in 24 percent of snake bite cases if guidelines for antivenom therapy were properly followed.

Comparison of lactose breath hydrogen test and milk breath hydrogen test in the diagnosis of lactose malabsorption

In both clinical and field situations, breath hydrogen analysis has been widely used in evaluating lactose malabsorption. It is as accurate as other tolerance tests and has an advantage of being noninvasive. The use of milk (360 ml) as a test meal for breath hydrogen test was evaluated in 16 adult subjects (8M:8F), age ranging from 20 to 50 years. Lactose (17.6 g) breath hydrogen test was used as standard test. Of 16 subjects tested, 5 subjects were found to be lactose absorbers and 11 subjects were lactose malabsorbers by lactose breath hydrogen test. In milk breath hydrogen test, the same 5 subjects were found to be lactose absorbers and 8 out of 11 subjects (lactose malabsorbers) were detected as lactose malabsorbers. The present study demonstrates that breath hydrogen test using milk (360 ml) as a test meal has a sensitivity of 73 per cent and a specificity of 100 per cent and could be used as an alternative test in the diagnosis of lactose malabosorption.

Breath methane excretion status in children with lactose malabsorption

We carried out a study to determine breath methane excretion status in relation to lactose absorption in children. The lactose absorption status of 125 children aged 1 to 12 years was defined using the hydrogen breath test using lactose test meal (2 g/kg, maximum 50 g). Lactose malabsorption was detected in 16.7 percent of children aged 1-2.9 years, the prevalence increasing with age to 39.5 percent of 3-5.9 year-olds and 88.5 years, the prevalence increasing with age to 39.5 percent of 3-5.9 year-olds and 88.5 percent of 6-8.9 years and reaching 91.7 percent 9-11.9 year-old children. We measured breath methane excretion status in 69 children (56 lactose-malabsorbers and 13 lactose-absorbers) and found significantly higher breath methane excretion in lactose-malabsorbers.

Evaluation of copper sulfate method for screening anaemia

The haemoglobin values of 102 blood samples were determined by 3 different observers; the first two observers using the copper sulfate method, and the third observer using the cyanmethaemoglobin method. The sensitivity and specificity of copper sulfate method was callculated at haemoglobin levels of 80 g/l and 100 g/l with comparison to the cyanmethaemoglobin method. At 80 g/l level, it was found to be 100 percent sensitive with a specificity of 70 percent. At 110 g/l level, the sensitivity was reduced to 82 percent while the specificity increased to 100 percent. The numbers of cases that were either correctly or incorrectly diagnosed by each observer were not significantly different and a good agreement (Kappa statistic = 0.82, 95 percent Confidence Intervals 0.77 to 0.87) was found between the two observers. The copper sulfate method was found to be reasonably accurate for screening anaemia.

Breath methane analysis in the diagnosis of rice carbohydrate malabsorption

Rice carbohydrate malabsorption is common in Myanmar village children and adults. The diagnosis is dependent on the use of a rice breath hydrogen test which has potential limitations. As methane production has been identified in almost 20 percent of Myanmar children under age 5, it was possible that an increased carbohydrate load in the colon consequent upon rice malabsorption may provide increased substrate for methanogenic bacteria in the left colon. A rise in methane production might be reflected in fasting breath methane concentration and therefore simplify the diagnosis of rece malabsorption. 79 children had a rice breath hydrogen test with measurement of hydrogen over a four hour period allied with a breath methane measurement and anthropometric measurement. There was no correlation between rice malabsorption and methane production and the measurement of breath methane does not, therefore, correlate with the rice absorption status.

Study of venom neutralising efficacy of monospecific cloudy liquid antivenom

Venom neutralizing efficacy of a batch of monospecific cloudy liquid antivenom H 93723 expiry 8-9-97 was assessed retrospectively on seven systemic Russell's viper bite cases. Each received 40 mls (4 ampoules) of antivenom which includes one to four ampoules of cloudy antivenom. Venom antigen and antivenom levels before and after the antivenom were followed up to 72 h by enzyme immunoassay technique. Results indicated that in severe envenomed cases (venom level > 80 ng/ml) (n=4), venom antigen remained detectable up to 8 to 12 h and antivenom was not detected until 4 to 10 h (12-20 h in 2 cases) after the antivenom. Dose related neutralising efficacy of cloudy antivenom was observed. Five out of 7 patients were fatal. Use of cloudy or precipitated antivenom should be discontinued.