ABSTRACT
Objective To explore the effects of endoscopic reprocessing on disinfection and its influential factors under the coronavirus disease 2019 (COVID-19) pandemic. Methods A total of 450 endoscopes cleaned and disinfected according to Technical Specifications for Cleaning and Disinfection of Endoscopes from November 2019 to January 2020, and 450 endoscopes cleaned and disinfected according to The recommended procedure for cleaning and disinfection of gastrointestinal endoscopes during COVID-19 epidemic by Chinese Society of Digestive Endoscopology from February to April 2020 in the Second Affiliated Hospital of Chongqing Medical University were enrolled in the control group and observation group respectively by random number method. Both the control group and the observation group contained 200 gastroscopes, 200 enteroscopes and 50 ultrasound endoscopes. ATP fluorescence detection method and pour plate technique were used to evaluate the disinfection effect of endoscopes. Single factor analysis and multiple logistic regression were used to analyze the risk factors for unqualified sterilization after endoscopic reprocessing. Results The disinfection pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were not significantly different compared with those of the control group (P>0. 05). The sterilization pass rates and ATP test pass rates of gastroscopes, enteroscopes and ultrasound endoscopes in the observation group were significantly higher than those in the control group (all P<0. 05). Multivariate logistic regression analysis showed that non-strict implementation of endoscopic reprocessing (OR = 7. 96, 95%CI: 4. 55-22. 84, P<0. 001), non-standard operation (OR = 2. 26, 95%CI: 1. 24-5. 63, P<0. 001), insufficient concentration of disinfectant (OR = 5. 43, 95% CI: 2. 52-9. 02, P < 0. 001), insufficient concentration ratio of multi-enzyme solution (OR = 4. 38, 95% CI: 1. 95-8. 61, P < 0. 001), non-timely cleaning (OR= 2. 86, 95%CI: 1. 33-6. 42, P<0. 001), incomplete cleaning (OR = 3. 75, 95%CI: 1. 61-7. 49, P<0. 001) and improper endoscopic preservation (OR= 2. 12, 95%CI: 1. 36-4. 12, P<0. 001) were independent risk factors for unqualified sterilization after endoscopic reprocessing. Conclusion In COVID-19 pandemic, endoscope reprocessing can significantly improve the disinfection effect of endoscopes, worthy of further clinical promotion. The failure to strictly implement the reprocessing procedure is an important factor that may lead to unqualified sterilization.Copyright © 2021 The authors.
ABSTRACT
Health service station is a place in which close contacts with the COVID-19 and other key populations are centralized quarantined for medical observation.A newly built health service station is equipped with 4 700 beds and a supporting sewage treatment station with a designed treatment scale of2 200 m~3/d.The treatment process consists of enhanced biological treatment system,sewage virus disinfection and sterilization system,aerosol disinfection and sterilization system and sludge disinfection and sterilization system.After treatment,the effluent and waste gas can meet the limit specified in Discharge Standard of Water Pollutants for Medical Organization （GB 18466-2005）.The average COD,NH3-N and SS in effluent are 14.53 mg/L,1.26 mg/L and 9.11 mg/L,respectively,and the average concentrations of H2S,NH3 and odor at the outlet are 0.01 mg/L,0.8 mg/L and 6.3,respectively.The sludge is disinfected regularly and then transported outside for disposal.This project can provide reference for sewage treatment design of emergency medical temporary isolation and observation facility and cabin hospital.
ABSTRACT
The rise in subsidized spay-neuter access helped drive the euthanasia of shelter pets in the US from an estimated 13. 5 million in 1973 to 1.5 million in 2019. When the arrival of the COVID-19 pandemic triggered lockdowns beginning in March 2020, many veterinary providers suspended nonessential services such as routine spay-neuter surgeries. The purpose of this study was to determine the impact of the COVID-19 pandemic on the volume of spay-neuter procedures performed by spay-neuter clinics. A retrospective study of patient data from 212 spay-neuter clinics using Clinic HQ practice management software was conducted from January 2019 through December 2021. The clinics collectively performed 1,217,240 surgeries in the pre-COVID baseline year of 2019. A sharp decline in surgeries began in March 2020 (-22%) and reached a nadir in April 2020 (-80%). Surgeries began to increase in May 2020 (-39%), before plateauing in July 2020 (-6%) and remaining slightly below the 2019 baseline in most months through the end of 2021. Compared to 2019, total surgeries decreased 13% to 1,059,388 in 2020 and decreased 3% to 1,184,274 in 2021. In 2020, when clinic disruptions were highest, the impact of the surgery cutbacks varied by geographic region, species, age, and source of animals. Compared with 2019, in 2020 surgeries decreased 17% in the Midwest region, 15% in the Northeast and West, and 11% in the South. Surgeries were reduced 19% in dogs and 10% in cats. When grouped by age, surgeries were reduced by 18% in geriatrics, 14% in adults, and 11% in juveniles. Reductions were similar for females (-14%) and males (-12%) and similar for unowned/organization-owned animals (-14%) and privately owned animals (-12%). In total, 190,818 fewer surgeries were performed by the 212 studied clinics in the 24 months from January 2020 through December 2021 than would be expected had 2019 levels been maintained. If a similar pattern was experienced by other spay/neuter providers in the US, it would suggest there is a deficit of more than 2.7 million spay/neuter surgeries that animal welfare organizations have yet to address.
ABSTRACT
Sterilization of hospitals is one of the major concerns when it comes to hygiene and cleanliness especially during a pandemic situation. The existing methodologies include ultraviolet disinfection or hydrochloride spraying for sterilizing hospital rooms and chemical treatment for surgical and medical equipment. However since COVID strains are developing at a rapid rate, it is necessary for more efficacy and accuracy in sterilization. According to the August 2021 census collected by NCBI, 87 percent of virus transmission is only because of improper sterilization. The following paper proposes efficient and proven ultrasonic sterilization methods that can be preferred to ultraviolet and chemical sterilization in sterilizing not only hospital rooms but also any crowded regions like malls and schools. The Cremant's formula helps in determining the appropriate and effective sterilization ultrasonic frequency level. Using machine learning algorithms, the approximate location, and the number of droplets per second present in the room will be calculated and treated with ultrasonic waves. This demonstration is proved using micro silicon balls which are similar in properties of COVID - 19 viruses. Simulation results are displayed to show the working of the same.
ABSTRACT
The temperature-dependent external quantum efficiency (EQE) droops of 265 nm, 275 nm, 280 nm, and 285 nm AlGaN-based ultraviolet-c light-emitting diodes (UVC-LEDs) differed in Al contents have been comprehensively investigated. The modifiedABCmodel (R = An+Bn2+Cn3) with the current-leakage related term,f(n)= Dn4, has been employed to analyze the recombination mechanisms in these UVC-LED samples. Experimental results reveal that, at relatively low electrical-current levels, the contribution of Shockley-Read-Hall (SRH) recombination exceeds those of the Auger recombination and carrier leakage. At relatively high electrical-current levels, the Auger recombination and carrier leakage jointly dominate the EQE droop phenomenon. Moreover, the inactivation efficiencies of 222 nm excimer lamp, 254 nm portable Mercury lamp, 265 nm, 280 nm, and 285 nm UVC-LED arrays in the inactivation ofEscherichia colihave been experimentally investigated, which could provide a technical reference for fighting against the new COVID-19.
ABSTRACT
Operation theatres are one of the busiest parts of the hospital with high flow of patients and staff. It is the place where patient is most vulnerable due to the invasiveness of procedures performed and they come in close contact with various surgical and anaesthetic equipment. It is of utmost importance to create safe and clean environment for each patient and staff. In this chapter we discuss the means of cleaning, disinfection, sterilization, and other parts of infections prevention on operation theatre. Additionally, we will cover the management of new emerging infectious threats, COVID-19, and rare diseases such as prions. © Springer Nature Switzerland AG 2022.
ABSTRACT
The biosafety protocols in dental care in the face of the COVID-19 pandemic, in medical offices in Los Ceibos sector of Ibarra city during the period October 2021 to March 2022 had deficiencies, they do not have enough information about their application. The stated objective was the biosafety protocol's evaluation for dental care in the Los Ceibos sector. In this research, methods of the theoretical level have been used;as well as the empirical level, which are applied with their respective instruments, such as the interview guide and the questionnaire. With this preliminary result, it is concluded that the knowledge of the inhabitants about these protocols is regular. At the doctor's office does not possess all of the level of requisite information to achieve the effectiveness of the protocols so that a revision of the existent bibliography prevails over the theme to complement its implementation. 23 documentary sources was consulted, 18 of them in Spanish and 5 in English among primary sources and secondaries as well as another one back up acceded by means of the principal managers of quest.
ABSTRACT
Male and female sterilisation are important forms of contraception worldwide despite declining popularity in developed countries and limited access during the Covid-19 global pandemic. Vasectomy is the only highly reliable form of male contraception. Appropriate counselling about permanent methods of contraception in both sexes is vital and should include information about irreversibility, failure rates and complications. The alternatives to sterilisation, particularly long-acting reversible contraception (LARC), should be discussed in detail as they are at least as effective and have the advantage of reversibility. Hysteroscopic techniques for female sterilisation are no longer available. In males the no-scalpel technique vasectomy requires minimal operating time and results in less post-operative discomfort than the incisional method. Regret after sterilisation and requests for reversal are more common in patients under 30 years and in men with no children.Copyright © 2023
ABSTRACT
The Covid-19 epidemic has been the most consequential global health crisis since the era of the influenza pandemic of 1918 [1]. Due to its high spreading rate, the virus disseminated across the world in a very short time span, forcing the World Health Organization to declare Covid-19 a global pandemic after just 3 months from the first reported case in China. At the beginning of the pandemic, when no vaccines were available, people entrust their safety to very few devices such as personal protective equipment (face masks, shields, and gloves), lock-down, and social distancing. The lack of alternative and not conventional techniques to suppress the spread of airborne epidemics among humans has pushed the research to develop new antiviral devices. The SAVE-US project (Suppression of Airborne Viral Epidemic Spread by UV-Light Barriers) aims at developing and demonstrating an innovative antimicrobial device based on 222nm-radiation. As known from the literature, the UVC radiation (200-280 nm) is the most effective wavelength for the inactivation of viruses and bacteria, corresponding to the DNA and RNA absorption peaks, but may also be mutagenic. For this reason, UVC-light sterilization is commonly performed in the absence of living organisms. Radiation in the far-UVC, especially at 222 nm, has been recently investigated because it shows a good antimicrobial efficacy, tested already on both bacteria [2] and virus [3] models including coronavirus, with very limited risks to human health. The low risk is associated to the small penetration depth of 222 nm light (a few mum): the energy is absorbed by the superficial stratum corneum of the skin that contains dead cells, with negligible irradiation of the underlying live tissue [4]. We will present the first version of a new prototype of 222 nm-illuminator and some preliminary results on its characterization;the presented device will be used in successive in vitro and in vivo experiments with SARS-CoV-2 virus. The device embeds a far-UVC lamp emitting at 222 nm, optical filters, and the controlling electronics. We show results on the spatial homogeneity of the emission intensity and the dependence on the lamp-virus distance. We also report on the ozone production due to absorption of far-UVC light from molecular oxygen naturally present in the air in order to evaluate its safety for human being and to properly evaluate its photo-killing efficacy.Copyright © 2023
ABSTRACT
Despite the gradual return to pre-pandemic conditions, the spreading of COVID-19 (SARS-CoV-2) left several open issues. Nowadays it is know that airborne infections, including COVID-19, are conveyed by particles having the size of >5 mum (droplets) and <5 mum (droplets nuclei), ejected by coughing and sneezing [1]. While droplets undergo to dehydration and precipitation, droplet nuclei persist in air for long time after their ejection, contributing to infection spreading. Actual prevention strategies are based on non-pharmaceutical interventions act to reduce droplets diffusion and spacing from Personal Protective Equipment, such as facial masks, and social distancing measure. Nevertheless, for the new endemic phase of COVID-19 the development of new strategies for airborne infections' containment becomes unavoidable. In this project, we propose a new device for the suppression of Airborne Viral Aerosols designed to work in situations with constrained geometries (e.g. public transportation, offices, waiting rooms etc.) not allowing social distancing. The device, devised to perform photokilling of viral aerosols in air in presence of humans, has its core in an UV illumination system operating at 222 nm. It is know from literature that UV radiation alters the genetic material of viruses and bacteria whose maximum absorption wavelengths are in the far-UV range (UVC, 100-280 nm), the most effective for sterilization [2]. Differently from the operative wavelength of most commercial systems (254 nm), the higher tissue absorption prevents the 222 nm radiation to travel over the very first epidermal layers [3] constituting a minor health risk for applications in presence of people. The device combines the UV illumination system with a vertical flux of air that conveys exhaled particles to the light source and controls humidity and temperature, crucial parameters for virus diffusion. After its development, the device prototype will be tested in model experiments. Initially, its safety will be verified by monitoring in particular the UVC-induced ozone production. Then, in vitro photokilling experiments will be performed in two steps: (i) on a layer of immobilized SARS-Cov-2 virus act to obtain optimal UV doses for an effective sterilization;(ii) on SARS-Cov-2 aerosol models. For this last experiment, a model viral aerosol miming the characteristics of cough and sneeze particles will be preliminary studied and supported by synthetic data to characterize the optical properties of the reference scenario. The resulting information will be crucial for the final design of the device itself. As a last step, we will test the device in in vivo experiments. An air flux, harvesting exhaled air by infected mice, will be illuminated by the device and will be sent to healthy mice. Finally, the infectiveness of exhaled air after the UV treatment will be evaluated, providing more information for further applications in the presence of humans.Copyright © 2023
ABSTRACT
Coronavirus 2019 is considered the health disaster of the century and has caused a wave of global panic. Healthcare professionals were at the forefront of this pandemic to provide quality care respecting the safety of patients and the environment. The objective of this study is to determine the preventive measures applied by healthcare professionals towards patients and the environment to combat Covid19. The study was realized during April and May 2020 at the public hospital dedicated to the care of Covid patients in central Morocco in Meknes. Convenience sampling was used to collect the data. 104 people participated in the study, including 61 (58.7%) nurses and 12 (11.5%) doctors. Also, 73 (70.2%) of the healthcare professionals were men and 35 (33.7%) contracted the Coronavirus during their healthcare activity. According to the participants, the causes of this infection lie mainly in their interaction with their professional environment (71.4%). The main preventive measures applied by healthcare professionals were regular hand washing and wearing 104 masks (100%), of which 88 (84.6%) used the FFP2 mask and wore personal protective equipment. However, healthcare professionals were found to adopt other environmental practices, including surface disinfection 95 (91.3%), ventilation and sterilization of premises 46 (44.2%), maintenance and sterilization of equipment 78 (75%), and effective management of hospital waste 75 (72.1%). The study concluded that the preventive measures applied by the professionals were sufficient and complied with global recommendations to minimize the risk of contamination and maintain a healthy healthcare environment for themselves and their patients. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.
ABSTRACT
OBJECTIVE: The COVID-19 pandemic presented new care delivery obstacles in the form of scheduling procedures and safe presentation to in-person visits. Contraception provision is an indispensable component of postpartum care that was not immune to these challenges. Given the barriers to care during the initial months of the pandemic, we sought to examine how postpartum contraception, sterilization, and visit attendance were affected during this period. STUDY DESIGN: We performed a retrospective chart review to examine contraception initiation, sterilization, and postpartum virtual and in-person visit attendance rates during the first six months (March 15 to September 7, 2020) of the COVID-19 pandemic compared to the rates in the same period in the year prior at a single tertiary academic care center. We abstracted data from the first prenatal visit through twelve weeks postpartum. RESULTS: With the initiation of virtual appointments, postpartum visit attendance significantly increased (94.6 % vs 88.4 %, p < 0.001) during the pandemic with no difference in overall contraception uptake (51 % vs 54.1 %, p = 0.2) or sterilization (11.0 % vs 11.5 %, p = 0.88). During the pandemic, contraception prescribed differed significantly with a trend towards patient-administered methods including pills, patches, and rings (21 % vs 16 %, p = 0.02). In both periods, there was a significantly younger mean age (p < 0.001), higher proportion of non-White and non-Asian race (p < 0.001), public insurance (p = 0.003, 0.004), and an established contraceptive plan prenatally (p < 0.001) in the group that received contraception. CONCLUSION: As virtual postpartum visits were instituted, contraception initiation and sterilization were maintained at pre-pandemic rates and visit attendance rose despite the obstacles to care presented by the COVID-19 pandemic. Provision of virtual postpartum visits may be a driver to maintain contraception and sterilization rates at a time, such as early in the COVID-19 pandemic, when patient care is at risk to be disrupted by social distancing, isolation, and avoidance of medical campuses.
Subject(s)
COVID-19 , Pandemics , Pregnancy , Female , Humans , Retrospective Studies , Contraception/methods , Postpartum PeriodSubject(s)
Abortion, Induced , Contraception , Pregnancy , Female , Humans , Wales , Family Planning Services , EnglandABSTRACT
Background: Covid-19 has dramatically changed everyday life across the globe. Otorhinolaryngologists were at the forefront of being exposed to the virus. As the virus evolved so did the practice of otorhinolaryngology in the country. Some innovative tacks for protecting otorhinolaryngologists and improving patient care were put into our practice by many doctors. Assessment of these techniques will help us to overcome the difficulties if a similar situation arises in the future. Material(s) and Method(s): An online survey was conducted among Indian otorhinolaryngologists. The invitation to participate in the survey was circulated among otolaryngology consultants and postgraduates all over India through multiple modalities on social media. The survey consisted of 4 sections with a total of 24 questions, related to covid vaccination status, changes made in practice, OPD (outpatient department) consultations during the lockdown period, and modifications done in outpatient and operation theatre setups. Google forms were kept open for one month. Result(s): There were changes in outpatient and operation procedure management like screening of patients before treatment and surgery, patient health care declarations, vaccination status, improvisation done in the methods of sterilization of ENT instruments, endoscopes, case selection of elective OT (operation theatre) cases. This paper aims to give a brief overview of current knowledge about the impact of covid 19 on otolaryngology practice using the best available evidence. Conclusion(s): COVID-19 had made crucial changes in ENT practice forever which will help otorhinolaryngologists in the better care of patients if a similar situation arises in the future.Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
ABSTRACT
In this study, we develop a system to provide information on the sterilization of baggage carts and arriving passenger baggage to airport (Hereafter referred as arrival baggage) by using ultraviolet (UV) sterilization and information communication technology as border quarantine measures at airports. This system sterilizes arrival baggage and baggage carts by UV irradiation, and allows passengers to easily view the sterilization information recognized by radio frequency indentation technology. This is to provide safety and security not only to passengers, but also to staff, who may come into direct contact with the arrival baggage, of airport, airline, customs, and so on. In addition, the passengers can be provided with baggage tracking information, such as the current location and estimated delivering time of the baggage. This makes it possible to keep social distancing at baggage claims as an infection prevention. Furthermore, we verify the feasibility of the developed system and identify the issues to be addressed for its practical application through a demonstration of proof of concept at Central Japan International Airport. © 2022 International Association of Traffic and Safety Sciences
ABSTRACT
The World Health Organization (WHO) has declared a public health pandemic state due to the trans-mission of the new coronavirus on March 11th, 2020. COVID-19, that is caused by SARS-CoV-2, has a very broad clinical spectrum, with predominantly respiratory symptoms developments. The role of the health professionals in fighting the pandemic requires the use of Personal Protective Equipment (PPE). PFF2 / N95 masks are suitable PPEs for this purpose. Due to the high demand for PFF2 / N95 masks to fight the pandemic, there was a shortage of this PPE world-wide. This work aims to present a characterization of the device called DELUX, utilized for UVC (ultra-violet C light spectra) sterilization of PFF2 / N95 masks, and allowing to extend the time of safe use of this PPE in emergency conditions. The photometric validation of the device resulted in the verification of the emission spectrum of the lamps used in the device, and the measurement of the optical power, demonstrating the adequacy of irradiation with UVC light, with a 15-minute cycle, and safely. Biological validation showed that DELUX is capable of inacti-vating SARS-CoV-2 present on the surface of PFF2 / N95 masks, thus being efficient for their sterilization. The safety offered by the sterilization cycle allows to extend the safe use of those masks. © 2022, Universidad Politecnica Salesiana. All rights reserved.
ABSTRACT
Sterilization of hospitals is one of the major concerns when it comes to hygiene and cleanliness especially during a pandemic situation. The existing methodologies include ultraviolet disinfection or hydrochloride spraying for sterilizing hospital rooms and chemical treatment for surgical and medical equipment. However since COVID strains are developing at a rapid rate, it is necessary for more efficacy and accuracy in sterilization. According to the August 2021 census collected by NCBI, 87 percent of virus transmission is only because of improper sterilization. The following paper proposes efficient and proven ultrasonic sterilization methods that can be preferred to ultraviolet and chemical sterilization in sterilizing not only hospital rooms but also any crowded regions like malls and schools. The Cremant's formula helps in determining the appropriate and effective sterilization ultrasonic frequency level. Using machine learning algorithms, the approximate location, and the number of droplets per second present in the room will be calculated and treated with ultrasonic waves. This demonstration is proved using micro silicon balls which are similar in properties of COVID - 19 viruses. Simulation results are displayed to show the working of the same. © 2022 IEEE.
ABSTRACT
Coronavirus (COVID-19) is an infectious illness due to serious respiratory trouble. It is impacted numerous humans and has asserted the living expectancy of a greater number of persons from all over the planet. The maturation period of this virus, on typically about 5-6 days but it might also be up to 2 weeks. Throughout this period, the individual may not feel any indications but could still be transmissible. A person could develop this disease if he/ she inhales the virus while a diseased person/ virus carrier within close vicinity sneezes or coughs otherwise tapping an infected place in addition to afterward again his/ her eyes, nose or mouth. To prevent this, the region of the COVID-19 patient must be decontaminated with virucidal disinfectants, such as and 0.05% sodium hypochlorite (NaClO) and ethanol-based products (at least 70%) an optional technique used is UV light sterilization. Ultraviolet (UV) sterilization technology is used to help reduce micro-organisms that can remain on surfaces after basic sprinkling to the minimum amount. The proposed work has established an UV robot or UV bot to perform decontamination in an operating room or in-patients room. Three 19.3-watt UV lights are positioned in a 360-degree circle on the UV bot platform. It used an integrated system based on a microprocessor and a metal frame to aid in navigation in a fixed path to avoid barriers. In addition, a sanitizer dispenser is also included to clean the viral organisms, which is spread through the water droplets of the patient. © 2022 IEEE.
ABSTRACT
COVID-19 pandemic outbreak poses a great threat to human health. Face masks have been considered as important personal protective equipment to prevent the COVID-19 transmission. However, pathogens can survive up to several days on the fabrics of commercial masks, which increases the risk of direct/indirect microbial transmission. Herein, new cationic conjugated microporous polymers (CCMPs)-based coating is developed, which possesses extended π-conjugated skeletons and massive quaternary ammonium salt (QAS) groups, exhibiting dual-modal antimicrobial inactivation, including sunlight-driven photodynamic sterilization through the generation of reactive oxygen species and contact sterilization through QAS groups. As a result, the CCMPs coatings can rapidly and efficiently eradicate 99% of model microbes, such as Escherichia coli and Staphylococcus aureus under solar illumination, and also ensure the great antimicrobial effect in the absence of light. More importantly, the CCMPs coatings exhibit excellent durability, reusability as well as antimicrobial stability in humid environment. Contributing to the outstanding processability and formability, CCMPs can be in situ synthesized and coated over fibers through a simple spray procedure. Taken together, the design provides a promising strategy for developing reusable and self-sterilizing antimicrobial fabrics, particularly for the application of face masks to tackle infectious pathogen and viruses in daily protection and medical applications. © 2023 Wiley-VCH GmbH.
ABSTRACT
Lateral luxation injuries are common during childhood and in young adolescence. These injuries involve the surrounding tissues that could lead to extensive clinical treatment problems with a risk of pulpal complications such as pulp necrosis. A case of a healthy 4-year-old Malay boy visiting the paediatric dental clinic after seven months of laterally luxated injury on the lower right lateral incisor (tooth 82) was reported. The traumatic tooth was splinted by a private practitioner three days after the trauma, however, the splint dislodged less than 24-hour after placement. In view of the mother's fear of bringing her child to the dentist due to the COVID-19, no follow-up and further treatment were carried out. This has resulted in the development of discolouration and pulpal necrosis to the injured tooth. Lesion sterilization and tissue repair technique (LSTR) was performed. This report highlights the rare occurrence of lateral luxation injury on tooth 82 and the management of pulp necrosis as a complication via lesion sterilization and tissue repair technique due to the uncooperative behaviour of the child.Copyright © 2022, Faculty of Medicine, University of Malaya. All rights reserved.