Lipaemic serum in Hb E-Beta thalassaemia major: A rare case of hypertriglyceridaemia thalassaemia syndrome.

INTRODUCTION: A 1-year-old Malay girl presented with pallor, failure to thrive and hepatosplenomegaly. Her blood was sent for thalassaemia screening and it was incidentally found that her blood appeared lipaemic. CASE REPORT: Primary and secondary causes of hyperlipidaemia were investigated. Her blood was sent for fasting lipid profile, thyroid function test (TFT), fasting plasma glucose (FPG), liver function test (LFT), renal profile (RP) and HIV screening. Lipaemic interference was removed by high-speed centrifugation. She is a product of non-consanguineous marriage. She is staying together with her stepfather who is HIV positive. Her mother's infective status was negative with no dyslipidaemic features and a normal lipid profile. Lipid profile of her biological father was not known. No other lipid stigmata such as eruptive xanthoma or lipaemia retinalis was seen in the patient. Haemoglobin analysis showed Hb E-Beta thalassaemia major. Her triglycerides was 9.05 mmol/L with normal total cholesterol, 2.85 mmol/L and high-density lipoprotein cholesterol (HDL-c), 0.26 mmol/L. Calculated low-density lipoprotein cholesterol (LDL-c) was invalid as triglycerides was >4.5 mmol/L. TFT, RP, FPG, LFT were normal and HIV status was negative. She was transfused with 10 ml/kg packed cell and her blood post transfusion appeared non lipaemic. CONCLUSION: Primary hypertriglyceridaemia was excluded based on insignificant family history of dyslipidaemia. Secondary causes of hypertriglyceridaemia were ruled out based on unremarkable laboratory investigations. Thus, we conclude that this patient is having hypertriglyceridaemia thalassaemia syndrome (HTS) which is a rare disorder with unknown pathogenesis. Further research may be required to explore this unknown association.

Periodontal health status of children and adolescents with diabetes mellitus: a systematic review and meta-analysis.

Diabetes mellitus (DM) is a complex metabolic disease characterized by hyperglycaemia resulted from defects in insulin secretion or action, or both. Various studies have reported on the bidirectional relationship between DM and periodontal disease. A systematic search of the literature was performed in several databases, EBSCO Medline Complete, PubMed, Science Direct and a manual search for articles from 2000 until 2019. Literature that fulfilled the inclusion criteria were identified, and data measuring plaque index (PI), gingival index (GI), clinical attachment loss (CAL) and periodontal probing depth (PPD) were extracted and subjected to Random-effects meta-analysis. From 947 titles and abstracts screened, 11 articles were included for meta-analysis. It was found that PI, GI, CAL and PPD were significantly higher in DM children than in non-DM children according to the Standardized Mean different (SMD) and 95% confidence intervals (CI) (SMD 0.54, 95% CI 0.20-0.87, P = 0.002; SMD 0.63, 95% CI 0.39-0.87, P < 0.001; SMD 0.79, 95% CI 0.52-1.05, P < 0.001, SMD 0.67, 95% CI 0.23-1.11, P = 0.003, respectively). The meta-analysis showed significant differences in PI, GI, PD and CAL between the two groups, favouring non-DM children. Therefore, early detection of DM children with periodontal disease is crucial to prevent periodontal disease.

Maternal and neonatal effects of Acinetobacter colonisation in preterm premature rupture of membrane and term labour.

INTRODUCTION: Some anecdotal reports suggest that maternal colonisation with Acinetobacter baumannii during pregnancy is associated with adverse maternal and neonatal effects, including preterm premature rupture of membrane (PPROM). The objective of this study was to compare the maternal and neonatal effects of A. baumannii colonisation in cases with PPROM and those with spontaneous onset of labour at term. METHODS: The recruitment of participants' was carried out at Selayang Hospital, Selangor, Malaysia. Vaginal swabs were prospectively taken from 104 patients of PPROM and 111 with spontaneous onset of labour at term. Swabs were also taken from the axillae and ears of their babies. These swabs were cultured to isolate A. baumannii. Maternal and neonatal adverse outcomes were documented. RESULTS: Sixteen mothers were A. baumannii positive, eight from each group respectively. None of the cases developed chorioamnionitis or sepsis. Those positive were four cases of PPROM and two babies of term labour. None of the babies developed sepsis. CONCLUSIONS: This study does not support the suggestion that A. baumannii colonisation during pregnancy is associated with adverse maternal and neonatal outcomes.

Examiner reliability in fluorosis scoring: a comparison of photographic and clinical methods.

OBJECTIVE: To assess examiner reliability when scoring dental fluorosis in Malaysian children using clinical (Dean's Index) and photographic methods. METHOD: The upper central incisors of 111 children were examined both clinically and photographically for fluorosis status using Dean's index. Twenty children were re-examined after a two-week interval for intra-examiner reliability by a single examiner. In addition, two independent examiners and the clinical examiner scored 111 photographic images of the same children in a standardized manner. Fluorosis scores were compared individually between examiners for both clinical and photographic scoring. Examiner reliability was assessed using both simple and weighted kappa statistics at tooth level. Sensitivity, specificity, positive-negative predictive values and a Receiver Operating Characteristic (ROC) curve were also calculated to determine the accuracy of the test. RESULTS: Across the three examiners, the prevalence of fluorosis (Dean's score ≥ 2) using photographs was lower (ranged from 23% to 26%) than the prevalence recorded by clinical examination (30%). The kappa score for intra-examiner reliability for the duplicate clinical examination was excellent (0.89). Inter-examiner reliability between the photographic method and the clinical examination (gold standard) for each examiner was substantial with weighted kappa values ranging from 0.74 to 0.77. The photographic method indicated higher specificity (99%) than sensitivity (79%) and the area under the ROC curve was also high (0.89) which suggests good accuracy of the diagnostic test. CONCLUSION: These results suggest that photographic examination of fluorosis on central incisors can be recorded with good examiner reliability. The recorded fluorosis prevalence was lower using the photographic scores.

The total cost of rearing a heifer on Dutch dairy farms: calculated versus perceived cost.

BACKGROUND: As farmers do not often keep a record of the expenditures for rearing, an economic tool that provides insight into the cost of rearing is useful. In the Netherlands, an economic tool (Jonkos) has been developed that can be used by farmers to obtain insight into the cost of rearing on their farm. The first objective of this study is to calculate the total cost of rearing young stock in Dutch dairy herds using Jonkos. The second objective is to compare the calculated total cost of rearing with the farmers' own estimation of the cost of rearing (the perceived cost). FINDINGS: Information was available for 75 herds that reared their own young stock and who had used the Jonkos tool. The perceived cost of rearing young stock was only available for 36 herds. In the 75 herds, the average herd size was 100 dairy cows. The average calculated total cost of rearing a heifer was €1,790. The average perceived total cost of rearing a heifer (including labour and housing costs) was €1,030. CONCLUSION: Most Dutch farmers in the study underestimated the total cost of rearing. The Jonkos economic tool has the advantage that herd-specific information can be entered as input values. The output of the tool can improve the awareness of farmers about the total costs of rearing. This awareness can lead to a higher priority of young stock rearing and consequently to an improved quality of young stock rearing.

Job satisfaction and perceived future roles of Malaysian dental therapists: findings from a national survey.

OBJECTIVE: To assess Malaysian dental therapists' perceptions of their job satisfaction and future roles. METHODS: A nationwide postal survey involving all Malaysian dental therapists who met the inclusion criteria (n = 1726). RESULTS: The response rate was 76.8%. All respondents were females; mean age 35.4 years (SD = 8.4). Majority were married (85.5%) and more than one-half had a working experience of <10 years (56.1%). Majority worked in community dental service (94.3%) and in urban areas (61.7%). Overall, they were highly satisfied with most aspects of their career. However, they were least satisfied with administrative workload (58.1%), career advancement opportunities (51.9%) and remuneration package; specifically income (45.2%), allowances (45.2%) and non-commensurate between pay and performance (44.0%). Majority perceived their role as very important in routine clinical tasks such as examination and diagnosis, preventive treatment, extraction of deciduous teeth and oral health promotion. However, fewer than one-half consider complex treatment such as placement of preformed crowns on deciduous teeth (37.1%) and extraction of permanent teeth (37.2%) as very important tasks. CONCLUSION: Majority expressed high career satisfaction with most aspects of their employment but expressed low satisfaction in remuneration, lack of career advancement opportunities and administrative tasks. We conclude that most Malaysian dental therapists have positive perceptions of their current roles but do not favour wider expansion of their roles. These findings imply that there was a need to develop a more attractive career pathway for therapists to ensure sustainability of effective primary oral healthcare delivery system for Malaysia's children.

The optimal number of heifer calves to be reared as dairy replacements.

Dairy farmers often keep almost all their newborn heifer calves despite the high cost of rearing. By rearing all heifer calves, farmers have more security and retain flexibility to cope with the uncertainty in the availability of replacement heifers in time. This uncertainty is due to mortality or infertility during the rearing period and the variation in culling rate of lactating cows. The objective of this study is to provide insight in the economically optimal number of heifer calves to be reared as replacements. A herd-level stochastic simulation model was developed specific for this purpose with a herd of 100 dairy cows; the biological part of the model consisted of a dairy herd unit and rearing unit for replacement heifers. The dairy herd unit included variation in the number of culled dairy cows. The rearing unit incorporated variation in the number of heifers present in the herd by including uncertainty in mortality and variation in fertility. The dairy herd unit and rearing unit were linked by the number of replacement heifers and culled dairy cows. When not enough replacement heifers were available to replace culled dairy cows, the herd size was temporarily reduced, resulting in an additional cost for the empty slots. When the herd size reached 100 dairy cows, the available replacement heifers that were not needed were sold. It was assumed that no purchase of cows and calves occurred. The optimal percentage of 2-wk-old heifer calves to be retained was defined as the percentage of heifer calves that minimized the average net costs of rearing replacement heifers. In the default scenario, the optimal retention was 73% and the total net cost of rearing was estimated at €40,939 per herd per year. This total net cost was 6.5% lower than when all heifer calves were kept. An earlier first-calving age resulted in an optimal retention of 75%, and the net costs of rearing were €581 per herd per year lower than in the default scenario. For herds with a lower or higher culling rate of dairy cows (10 or 40% instead of 25% in the default scenario), it was optimal to retain 35 or 100% of the heifer calves per year. Herds that had a lower or higher cost of empty slots (€50 or €120 per month instead of €82 in the default scenario) had an optimal retention of 49 or 83% per year; the optimal retention percentage was dependent on farm and herd characteristics. For Dutch dairy farming conditions, it was not optimal to keep all heifer calves.

First-calving age and first-lactation milk production on Dutch dairy farms.

Farmers attempting to reduce first-calving age (FCA) need to understand which rearing management factors influence FCA and first-lactation milk production (FLP). Reduced FCA might be associated with lower FLP. This study describes the association between herd FCA, FLP, and several herd-level health and rearing management variables and describes the association between FCA and FLP at the cow level. It uses data from a 2010 survey of 100 Dutch dairy farms about general management, colostrum and milk feeding, housing, cleanliness, healthcare, disease, and breeding. It also used available data on FCA and 305-d FLP at both cow and herd level. The associations between median FCA and median FLP of the herd and herd-level health and rearing management variables were determined using multivariate regression analysis. The median FCA was associated with minimum age of first insemination, feeding of waste milk, and the amount of milk given preweaning. The median FLP was associated with median FCA and vaccination status for bovine respiratory syncytial virus. The association between FCA and FLP (based on 8,454 heifers) was analyzed with a single-effect linear mixed model, where the dependent variable was either FCA or relative FCA (defined as the difference between FCA of the heifer and median FCA of the herd to which they belonged). Heifers having an FCA of 24 mo produced, on average, 7,164 kg of milk per 305 d, and calving 1 mo earlier gave 143 kg less milk per 305 d. When FCA did not deviate from the median herd FCA, heifers produced, on average, 7,272 kg of milk per 305 d. From the median FCA of the herd, heifers calving 1 mo earlier produced 90 kg of milk per 305 d less, and heifers calving 1 mo later produced 86 kg per 305 d more. This is the first study that explained FLP using relative FCA. It assumes that heifers raised within the same farm have similar development because they are similarly managed. Similar management is reflected by the median FCA of the herd, with a deviation of the heifer's FCA from median FCA reflecting the heifer's development relative to the herd's average. The advantage of using relative FCA was that it accounts for between-farm differences in rearing management. It showed that earlier insemination without adjusting management to ensure sufficient development lowers FLP. An economic optimum exists between rearing costs, FCA, and FLP and, as a consequence, decisions with regard to young stock management should be made with care.

Estimating the costs of rearing young dairy cattle in the Netherlands using a simulation model that accounts for uncertainty related to diseases.

The costs of rearing young dairy cattle are a part of the cost of the price of milk, as rearing produces the future dairy cows. As most dairy farmers are not aware of the rearing costs, the rearing of dairy replacements often does not get the attention it deserves. Calculating the distribution of the rearing costs throughout the rearing process is difficult as the costs are correlated with biological processes, such as variation in growth rate and disease uncertainty. In this study, a calf level simulation model was built to estimate the rearing costs and their distribution from 2 weeks of age until first calving in the Netherlands. The uncertainties related to calf diseases (calf scours and bovine respiratory disease) were included, in which both the probabilities of disease and the effects of diseases (growth reduction) differ at different ages. In addition, growth was modeled stochastically and in a detailed manner using a two-phase growth function. The total cost of rearing young dairy cattle was estimated as €1567 per successfully reared heifer and varied between €1423 and €1715. Reducing the age of first calving by 1 month reduced the total cost between 2.6% and 5.7%. The difference in the average cost of rearing between heifers that calved at 24 months and those calving at 30 months was €400 per heifer reared. Average rearing costs were especially influenced by labor efficiency and cost of feed. The rearing costs of a heifer that experienced disease at least once (20% of the simulated heifers) were on average €95 higher than those of healthy heifers. Hence, for an individual diseased heifer, disease costs can be rather high, while the relative contribution to the average rearing cost for a standard Dutch dairy farm is low (approx. 3%). Overall, the model developed proved to be a useful tool to investigate the total cost of rearing young dairy cattle, providing insights to dairy farmers with respect to the cost-efficiency of their own rearing management.