Asymmetric Extraction for Managing a Severely Crowded Malocclusion: A Case Report

The mandibular premolar impactions account for nearly 24% of all the dental impactions including the third molars. The literatureregarding the impactions of mandibular premolars is very limited although they are considered as the third most commonimpactions after all the third molars and maxillary canines. This case report describes the treatment of a Class I malocclusionhaving severe crowding in both the upper and lower arches, buccally placed maxillary canines and impacted mandibular rightsecond premolar with an asymmetric treatment approach in a young growing patient.

Knowledge, attitude and practice among healthcare staffsin the Emergency Department, Hospital Universiti Sains Malaysia towards Rape Victims In One Stop Crisis Centre (OSCC)

SUMMARY Introduction: Aimed at providing integrated multi-level crisis intervention to women experiencing violence such as rape, One Stop Crisis Centre (OSCC) in Malaysia is often located in the emergency department. Hence, it is imperative that emergency department healthcare providers possess adequate knowledge and acceptable attitudes and practices to ensure the smooth running of an efficient OSCC work process. Method: To study the knowledge, attitude and practice of rape management in OSCC among four groups of healthcare providers in the emergency department [i.e., the emergency medicine doctors (EDs), the staff nurses (SNs), the medical assistants (MAs) and the hospital attendants (HAs)], a selfadministered questionnaire in the form of Likert scale was conducted from January to October 2013. Correct or favourable responses were scored appropriately. Results: Out of the 159 participants invited, 110 responded (69.2% response rate). As all data sets in the Knowledge, Attitude and Practice sections are non-parametric, KruskalWallis test was performed. Homogeneity of variance was verified using non-parametric Levene test. In all three sections, there are statistically significant differences in scores obtained among the four groups of healthcare providers with H(3) = 16.0, p<0.001 for Knowledge, H(3) = 27.1, p<0.001 for Attitude and H(3) = 15.8, p<0.001 for Practice sections. Generally, the SNs obtained the highest mean rank score in the knowledge and practice sections but the EDs obtained the highest mean rank score in the attitude section. Some of the responses implied that our healthcare providers have the victim-blaming tendency that can negatively impact the victims. Conclusion: Healthcare providers must not only have adequate knowledge but also the non-judgemental attitude towards victims in OSCC.

Management of punctal occlusion post - viral conjunctivitis / 国际眼科杂志(Guoji Yanke Zazhi)

?AlM: To evaluate the effect of different methods in managing punctual and canalicular stenosis as a complication of viral conjunctivitis. ?METHODS: A retrospective cohort study, including 35 cases of punctal stenosis post-viral conjunctivitis. Cases were diagnosed clinically and treated after 4wk of complete remission from epidemic keratoconjunctivitis. Patients were treated with mechanical dilatation, insertion of perforated silicon punctual plugs or the use of Mini-Monoka stent. ?RESULTS: Six out of 35 ( 17. 14%) had a satisfactory outcome by punctal dilatation alone. Punctal dilatation with insertion of perforated punctal plugs was done in 20 cases ( 57. 14%). Nine cases ( 25. 71%) had punctal dilatation with Mini - Monoka tube insertion. Disease severity and the use of Mini-Monoka silicon tube did not correlate with bilateral eye involvement or involvement of both upper and lower punctum. ?CONCLUSlON: Management of punctal occlusion post viral conjunctivitis may be treated easily using perforated punctal plugs. Silicon intubation with Mini-Monoka might be needed to manage resistant cases.

Undiagnosed diabetes mellitus in rural communities in Sudan: prevalence and risk factors

Undiagnosed diabetes constitutes a challenge for health providers, especially in rural areas. The aim of this study was to determine the prevalence of undiagnosed diabetes mellitus and glucose intolerance among adults in rural communities in River Nile State, north Sudan. In a cross-sectional community-based study, blood glucose, anthropometric, demographic and clinical history data were obtained from 1111 individuals from 35 villages. The prevalence of undiagnosed diabetes was 2.6% [29 individuals]; glucose intolerance was detected in 1.3% [14 individuals]. Classic symptoms [polydipsia, polyuria and weight loss] were present in around half of the participants but were not more prevalent in those with diabetes. Lower educational level, increasing age, hypertension and unexplained weight loss were significant risk factors for diabetes. Other variables [obesity, sex, occupation, alcohol consumption and cigarette smoking] were not significant risk factors. There is a low prevalence of undiagnosed diabetes and glucose intolerance in the rural population of River Nile State

Multiplex PCR for detection of bla CTX-M genes among the extended spectrum beta lactamase [ESBL] producing gram-negative isolates

Broad spectrum beta-Lactamase producing organisms are a growing world wide problem. Resistance has emerged ever to newer, more potent antimicrobial agents. Although there are several guidelines available for the phenotypic detection of ESBL producing bacteria. This remains a continuous issue. In this study, we used a multiplex PCR as a rapid method to identify bla CTX-M genes and discriminate between its groups that are responsible for ESBL production in members of Enterobacteriacae. Our study includes: 250 clinical isolates [23 sputum, 64 urine, 46 from blood, 28 from pus aspirates, 58 from entotracheal secretions, and 31 swabs from cellulitis, impetigo contagiosum [non bullous] and sycosis]. All isolates were biochemically identified, based on colony morphology, and was speciated by standard biochemical tests. ESBL enzyme production was confirmed by double disc synergy test according to CLSI guidelines. Multiplex PCR was performed for bla CTX-M of ESBL +ve isolates for detection and discrimination between groups. Our findings were as follows: out of 250 isolates; only 98 were proved to be resistant to different antibiotics by the disc diffusion method according to NCCLS: 3 of 53 [5.66%] Enterobacter. All from group [25/26]. 65 of 74 [87.8%] E.coli strains: -37 of which from groups [1] [CTX-M 15], 9 from group [1] [CTX-M-3], 8 from group [9] [CTX-M-14], 9 from group [9] [CTX M-9], 2 from group [25/26] [CTX-M 26]. 1 of 50 [2%] non fermenting gram -ve bacilli which is from group [25/26]. 29 of 73 Klebsiella strains [39.7%]: 19 from group [9] [CTX-M14] and 10 from group [9] [CTX-M 9]

Knowledge, misconceptions and motivations towards blood donation among university students in Saudi Arabi

To determine the knowledge, misconceptions and motivations towards blood donation among university students in KSA. This cross sectional study was carried out at the King Abdulaziz University, Rabigh campus, Jeddah, KSA. A total of 326 adult males were interviewed and each individual completed a questionnaire in Arabic language on various aspects of blood donation. Data was analyzed using SPSS-16. Out of 326 individuals, 264 [80.98%] were non donors and 62 [19.02%] were donors, 13% donated once, 5% donated twice and 1% donating regularly. Regarding the knowledge part of the questionnaire many of the respondents did not have the basic knowledge and the two common sources of information for blood donation were friends [53%], and TV [24%]. The major motivations for donors were to help family or friend [30%], saving others lives [28%], religious reasons [20%] and altruism [12%]. Among the respondents the most prevalent misconception was contracting infection like HIV or Hepatitis B and C [26%]. The knowledge of blood donation is not up to the mark and many misconceptions exist among young Saudi University students

Fever prevalence and management among three rural communities in the North West Zone, Somalia

Between March and August 2008 we undertook 2 cross-sectional surveys among 1375 residents of 3 randomly selected villages in the district of Gebiley in the North-West Zone, Somalia. We investigated for the presence of malaria infection and the period prevalence of self-reported fever 14 days prior to both surveys. All blood samples examined were negative for both species of Plasmodium. The period prevalence of 14-day fevers was 4.8% in March and 0.6% in August; the majority of fevers [84.4%] were associated with other symptoms including cough, running nose and sore throat; 48/64 cases had resolved by the day of interview [mean duration 5.4 days]. Only 18 [37.5%] fever cases were managed at a formal health care facility: 7 within 24 hours and 10 within 24-72 hours of onset. None of the fevers were investigated for malaria; they were treated with antibiotics, antipyretics and vitamins

Cardiac involvement in Sudanese children with connective tissue disease

Connective tissue diseases [CTD] are associated with a variable range of cardiac abnormalities. We identified all patients with CTD and cardiac involvement seen at Jafar Ibn Ouf Children's Hospital and the Sudan Heart Centre by one cardiologist between Jan 2005 and January 2010. Clinical and echocardiographic evaluations were done and arranged consultation with rheumatologist. Nine patients were identified, three males and six females. Five patients [62%] were initially seen by the cardiologist and CTD was suspected by clinical examination in four patients and in one patient diagnosed by routine screening during workup for pulmonary hypertension. Symptoms were present for one month to 3 years before presentation to the cardiologist. In three patients [30%] the cardiac symptoms preceded the rheumatological symptoms. In one patient, aortic valve replacement for presumed rheumatic aortic regurgitation preceded arthritis by 12 months. Patients with CTD may present first to the cardiologist with findings that mimic common cardiac lesions. All patients with CTD should have routine evaluation by the cardiologist so as to implement optimal early interventions

Good outcome of neuromyelitis optica: a case report / 国际眼科杂志(Guoji Yanke Zazhi)

A 26 year-old Malay man presented with first attack of left eye optic neuritis that recovered fully with intravenous methylprednisolone after 3 weeks. He developed a second attack of optic neuritis in the right eye the following week. Lhermitte sign as well as Uthoff phenomenon were also positive. On day-3, he developed bilateral paraplegia and sensory loss at T8 level, which progressively worsen and became bedridden on day-5. MRI showed bilateral enhance-ment of the optic nerve with the presence of long multisegmental demyelinating plaque in the thoracic to lumbar spinal cord and the brainstem, sparing the brain hemisphere. He was promptly given high dose intravenous methylprednisolone followed by oral predni-solone. He was also assigned on intensive neuro-phy-siotherapy. He recovered after 3 months and was able to walk with walking aids. He recovered completely after 7 months and resumed working as site contactor. There was no relapse during the last 1 year follow-up. His final visual acuity improved to 6/9 in the right eye and 6/6 in the left eye. The visual field of the right eye showed per-sistent mild cecocentral scotoma. And diffuse depression.

Assessment of frequency and the risk factors of obesity based on body mass index in 1031 healthy adults from North West frontier province of Pakistan

Obesity is a growing health problem both in the developed and developing world. No study has been reported on the frequency of obesity in North West Frontier Province. In this study we found out the frequency and the risk factors for obesity based on body mass index [BMI] in 1031 adults healthy volunteers. This study was carried out at Hayatabad Medical Complex [HMC] and Welfare Clinics in Peshawar City, from November 2005 till April 2006 [6 months]. A convenient sample of 1031 healthy volunteers accompanying their patient to the Out Patient Department [OPD], Wards at HMC and at the welfare clinics in the city were recruited. A structured interview questionnaire was administered to all participants and their anthropometric measurements taken in a standardized way. The mean BMI for the whole sample was 26.9 +/- 7.3. The mean BMI was 31.1 +/- 10.4 and 25.4 +/- 5.2 in females and males respectively. The combined frequency of overweight and obese was 65.8% and 84.6% in males and females respectively [p < 0.001]. Increasing age [p < 0.001] in both sexes, being married [p < 0.001] and ownership/use of motorized vehicles [p < 0.001] were positively associated with increase in BMI. 77.3% of the graduates and 73.2% of illiterates were obese or overweight [p < 0.001]. 99.2% of the housewives and 69.7% of jobless people were obese or overweight [p < 0.001]. A statistically significant association of BMI with awareness was seen among Pakistanis [p = 0.002]. High Blood pressure was positively associated with higher BMI value [p < 0.001]. There is a very high frequency of obesity in our community particularly among females as compared to males and there is positive association of obesity with occupation, educational status, presence of vehicles at home, ethnicity, and married marital status. There is no association of obesity with smoking in our study

[Comparison of two commonly used IUDs in pain and menstrual bleeding]

The intrauterine device [IUD] is the most widely used reversible method of contraception in the world. One of the most common side effects of intrauterine device is increasing of menstrual blood loss, which may cause discontinuation and iron - deficiency anemia. BY considering the effects of IUD type on menstrual bleeding this study was conducted to compare the side effects of T Cu 380A and Cu safe300 IUDs including bleeding, pain on during 3-month period in clients referring to family planning center of Shahrekord Hajar hospital. This study was a randomized single-blind clinical trial, during which 70 candidates applied for IUD were randomly placed in two groups of IUD T Cu 380A and Cu safe300. The major side effects were recorded in the following 1, 2, 3 months. The comparisons were made using t-test, Mann-Whitney, Chi-Square and Wilcoxon tests by SPSS soft ware. Menstrual bleeding and dysmenorrheal was more commonly occurred during the 3 month of implantation in both groups but bleeding and pain was significantly lower in Cu safe300 group than the other group. With regard in this study showed menstrual blood loss and dysmenorrheal in the 3 months after IUD insertion a in Cu safe300 users were less than T Cu380A users therefore recommending to be possible this kind IUD to distribute in the health centers

Seroprevalence of toxoplasmosis: Comparative study between migrant workers from the Indian subcontinent and local Malaysian workers

Primary toxoplasmosis is usually subclinical, but in severely immunocompromised patients it may be life-threatening. For this reason, it could be important to monitor situations related to non-noticeable diseases among foreign arrivals in a country. In this study, we aimed to survey toxoplasmosis among migrants from Indian subcontinent to Malaysia. In a prospective, observational study, a serological evaluation on toxoplasmosis among 91 migrants from Indian Subcontinent in Malaysia was conducted in a plantation and a detention camp. We used study subject information sheet for demographic information and venous blood samples for serological study to determine Toxoplasma gondii IgG and IgM antibodies. The control group was composed of 198 local Malaysians working in the same plantation and detention camp. The age of study participants ranged from 19-45 years [geometric mean 29.9]. Except for the Nepalese, none of these migrants from the Indian Subcontinent were positive for IgM. IgG positive rates among the Nepalese, Indians and Pakistani were 46.2%, 6.6% and 5.9% respectively. All workers from Sri Lanka had 0.0% prevalence rate for both IgG and IgM. The prevalence rates of 44.9% was significantly [p <0.001] higher among local Malaysian workers when compared to migrant workers [18.8%]. No significant difference in the prevalence rates was noted among the migrants or local workers when they were grouped according to agricultural and non-agricultural occupations. Our data demonstrate that, with the exception of Nepalese population, there is a low frequency of toxoplasmosis infection among migrants from Indian subcontinent to Malaysia. A routine screening for toxoplasmosis may be indicated for sub-groups of migrants in this country

[In vitro investigation of the wear quantity of targis opposing the enamel, porcelain and composite]

Fracture of acrylic resin denture base is a common problem in maxillary dentures. Because the stresses in mouth on the denture base are of flexural type, the aim of this study was to determe the effect of palatal shape combined with acrylic resin thickness on the flexural strength of the denture base. In this experimental study, 48 stone casts in 3 groups [shallow, medium and deep palatal vault] were prepared. Eight casts of each palatal form were covered with a single layer of base-plate wax and eight were covered with two layers. Patterns were invested and processed with Acropars acrylic resin in the same manner. Flexural strength, deflection and fracture load were measured with DARTEC testing machine. Statistical analysis was performed using multivariate ANOVA, Kruskal-Wallis and Mann Whitney tests. The results showed that the flexural strength of shallow bases were significantly different from medium and deep palatal shapes at both thicknesses [P<0.001]. There were no statistically significant differences in flexural strength between the medium and deep palatal shapes [P=0.583]. Increasing the base thickness significantly increases the flexural strength in each palatal shape [P<0.001]. This study revealed that palatal shape and base thickness have significant effects on flexural strength of denture bases. In shallow palates, increasing the thickness of denture base can enhance flexural strength of denture

Comparison of the ease of insertion of the laryngeal tube VBM and laryngeal mask airway during manual in-line neck stabilization

The purpose of this study is to assess whether the newly developed laryngeal tube (LT) VBM is easy, simple to use and able to provide adequate ventilation and oxygenation to a patient with an unstable neck who required airway management. We compared the LT to the laryngeal mask airway (LMA) as alternative airway management tool in adult patient with unstable neck who underwent intubation with manual in-line neck stabilization. A randomized single-blinded prospective study was conducted involving a total of 40 ASA I and II premedicated patients who were divided into two groups with 20 patients for each group; either LT or LMA group for airway management during elective surgery. After preoxygenation, anaesthesia was induced and neuromuscular blockade was produced with intravenous drugs. The LT or LMA was inserted after neuromuscular blockade was confirmed using a peripheral nerve stimulator (TOF 1). A size 3, 4 or 5 LT OR a size 3 or 4 LMA was inserted while the patient's head and neck were being stabilized by an assistant who held the sides of the neck and the mastoid processes (manual in-line stabilization). If it was not possible to ventilate the lungs, or if endotrachial carbon dioxide (ETCO2) and/or chest movement did not indicate a patent airway, the LT or LMA was removed. After three failed attempts, the study was terminated and the airway was secured in the most suitable manner determined by the anaesthetist. There was a statistically significant difference for both groups in the time required for successful insertion (time required for LT was 24.8 +/- 7.7 seconds and LMA was 36.1+/-17.3 seconds) (p= 0.01). There was no statistical differences (p>0.05) in number of attempts needed to achieve a patent airway although we were able to achieve a clear airway in all patients in LT group at the first attempt compared with 85% in LMA group. successful insertion rate was 100% for both groups. We conclude that the LT is easier to insert and is a suitable alternative to the LMA for airway management when the patient's head and neck are stabilized by manual in-line method.

Comparison of the VBM laryngeal tube and laryngeal mask airway for ventilation during manual in-line neck stabilisation

<p><b>INTRODUCTION</b>The purpose of this study is to assess whether the newly-developed VBM (Medizintechnik GmbH, Sulz, Germany) laryngeal tube (LT) is able to provide adequate ventilation and oxygenation to patients with an unstable neck and require airway management. The haemodynamic responses to insertion between the two devices were also studied. We compared the LT to the laryngeal mask airway (LMA) as an alternative airway management tool in adult patients with unstable neck and who underwent intubation with manual in-line neck stabilisation.</p><p><b>METHODS</b>A randomised single-blinded prospective study was conducted involving a total of 40 American Society of Anesthesiology I and II pre-medicated patients who were divided into two groups, LT or LMA, for airway management during elective surgery. There were 20 patients for each group. After pre-oxygenation, anaesthesia was induced using intravenous (i.v.) fentanyl and i.v. propofol. The neuromuscular blockade was produced with either i.v. vecuronium or i.v. atracurium. The LT or LMA was inserted after neuromuscular blockade was confirmed using a peripheral nerve stimulator (train-of-four 1). A size 3, 4 or 5 LT or a size 3 or 4 LMA was inserted while the patient's head and neck were being stabilised by an assistant who held the sides of the neck and the mastoid processes (manual in-line stabilisation). If it was not possible to ventilate the lungs, or if end-tidal carbon dioxide and/or chest movement did not indicate a patent airway, the LT or LMA was removed. After three failed attempts, the study was terminated and the airway was secured in the most suitable manner determined by the anaesthetist. After successful placement of LT or LMA, anaesthesia was maintained with 66 percent nitrous oxide in oxygen and 2 minimum alveolar concentration sevoflurane. All patients received standard anaesthesia monitoring. The ease of insertion, the number of attempts needed to successfully secure the airway, episodes of desaturation (less than 95 percent) and end-tidal carbon dioxide at various time intervals were studied. The haemodynamic parameters such as systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at different time intervals were also studied.</p><p><b>RESULTS</b>The study showed a statistically significant difference in time required for successful insertion between the groups; time required for LT was 24.8 +/- 7.7 seconds and LMA was 36.1 +/- 17.3 seconds (p-value equals 0.01). Both groups had no statistical differences (p-value is greater than 0.05) in number of attempts needed to achieve a patent airway, and the successful insertion rate was 100 percent for both groups. There were also no statistical differences in the haemodynamic response to insertion and the end-tidal carbon dioxide in this study.</p><p><b>CONCLUSION</b>We conclude that, under anaesthesia, the LT was a valuable and better alternative to LMA for ventilation and airway management when the patient's head and neck are stabilised by the manual in-line method.</p>

Selection of proper dose of fentanyl with small-dose diluted bupivacaine intrathecally

This study was carried out on 39 patients undergoing day-case surgeries to evaluate the efficacy for the selection of a proper dose of fentanyl. They were randomly divided to three groups: Group I injected intrathecally with 5 ml of 0.125% bupivacaine; in group II, 10 mug fentanyl was added to the solution and in group III, 20 mug fentany1 was added to the solution. The highest level of block was T7, T8 and T8 in group I, II and III, respectively. The time to highest level of block was 11, 10 and 10 minutes, respectively. A small dose diluted bupivacaine was inadequate and the addition of 10 mug fentanyl made it reliable. With 20 mug fentanyl, there was no more improvement in the quality of anesthesia, but there was an increase in the time to discharge and the percentage of the side effects of fentanyl