Adaptation of cobalt chromium frameworks fabricated by conventional versus selective laser melting techniques: An in vitro and clinical assessment.

STATEMENT OF PROBLEM: Three-dimensional (3D) printing of cobalt chromium (Co-Cr) removable partial dentures (RPDs)by selective laser melting (SLM) has been claimed to be less challenging than by conventional casting and provides significant improvements. However, the adaptation and fit of the SLM framework and the optimum build orientation are still unclear. PURPOSE: The purpose of this in vitro and clinical study was to evaluate the effect of different build orientations on the adaptation of removable partial denture frameworks fabricated by SLM technology in vitro and to compare the adaptation of the SLM and conventional RPD frameworks clinically. MATERIAL AND METHODS: A master model simulating a maxillary arch of Kennedy class III modification 1 was scanned and duplicated to create a virtual 3D cast and reference cast. Four groups (n=40) of Co-Cr RPD frameworks were fabricated. For the SLM groups, the Co-Cr framework was virtually designed and exported for SLM printing. The SLM printing was done in 3 different build orientations: 0-degree (n=10), 45-degree (n=10), and 90-degree (n=10) groups. Other Co-Cr frameworks were conventionally cast (n=10). All Co-Cr frameworks were scanned and virtually superimposed with the master model using a surface-matching software program. The gap under 9 selected points in the palatal major connectors was analyzed and calculated. A smaller gap indicates more surface adaptation and close contact between the palatal major connector and the master model. The data were analyzed using the Kruskal-Wallis and Dunnett T3 tests (α=.05). Three patients with a partially dentate maxillary arch were enrolled in the clinical part based on inclusion criteria. Two RPD frameworks were provided for each patient (conventional casting and SLM printing). The adaptation of each framework was assessed by measuring the gap between the palatal major connector of the framework and the palate with light-body silicone. The differences in adaptation between the conventional and SLM frameworks were compared by using independent t tests (α=.05). RESULTS: The in vitro study identified significant differences in the adaptation of the palatal major connector among the 4 groups (P<.001), except for conventional and 0-degree SLM printing (P=.999). The conventional and 0-degree SLM frameworks exhibited the best adaptation, with the lowest gap underneath the palatal major connector of the RPD framework (0.01 ±0.02 mm and 0.01 ±0.01 mm, respectively). In the clinical part of the study, no significant difference was found between the adaptation of SLM and the conventional framework (P=.430) CONCLUSIONS: The adaptation of SLM printing can be maximized with less gap under the palatal major connector of the RPD framework when using the 0-degree build orientation. Co-Cr frameworks produced with SLM printing technology were comparable with conventionally produced frameworks; hence, SLM printed frameworks can be an alternative for clinical applications when optimum SLM parameters are applied.

Validation of the questionnaire "Pregnancy Vaccine Hesitancy Scale (pVHS)" toward COVID-19 vaccine for Malaysian pregnant women.

Background: Pregnancy is one of the risks for severe COVID-19 infection, and receiving a vaccination is one of the effective methods to reduce disease severity. However, COVID-19 vaccine hesitancy among pregnant women remains an issue. This study aims to develop and validate the pregnancy Vaccine Hesitancy Scale (pVHS) toward COVID-19 vaccine for Malaysian pregnant women. Method: An 8-item Malay language pregnancy Vaccine Hesitancy Scale (pVHS-M) for COVID-19 was adapted from the adult Vaccine Hesitancy Scale and validated using Exploratory Factor Analysis. Six expert panels were involved in content validity, and ten pregnant women were involved in face validity. A cross-sectional study on 200 pregnant women was conducted between October 2022 and March 2023 at the Obstetrics and Gynaecology Clinic, Universiti Sains Malaysia, Kelantan. Result: The item-level content validity index is 1.00, demonstrating good relevance of the eight items used to assess COVID-19 vaccine hesitancy. The item-level face validity index obtained is 0.99, indicating that the items were clear and comprehensible. The Cronbach alpha score was 0.944, with factor loadings ranging from 0.79 to 0.89. Conclusion: The pVHS-M demonstrated good internal consistency, indicating that it is a valid and reliable tool for assessing COVID-19 vaccine hesitancy among pregnant women.

Labisia pumila standardized extract (SKF7®) reduces percentage of waist circumference and waist-to-height ratio in individuals with obesity.

AIM: Evidence from the literature points towards a viable choice of utilizing Labisia pumila to improve the metabolic profile in animal studies. To that end, this prospective study was designed to assess the health impact of the consumption of L. pumila standardized extract (SKF7®) on key parameters of obesity in humans such as body weight (BW), body mass index (BMI), waist circumference (WC) and waist-to-height ratio (WHtR). MATERIALS AND METHODS: A dose-ranging analysis using SKF7® was conducted through a randomized, double-blind, multicentre, placebo-controlled, phase 2 clinical trial involving individuals with obesity (N = 133) between January 2020 and April 2021. The potential percentage of change was assessed in relation to BW, BMI, WC and WHtR. RESULTS: Average treatment effect estimates (treatment group vs. placebo) show a statistically significant reduction in the percentage of change for BW (mean = -2.915; CI: -4.546, -1.285), BMI (-2.921; CI: -4.551, -1.291), WC (mean = -2.187; CI: -3.784, -0.589) and WHtR (mean = -2.294, CI: -3.908, -0.681) in the group with a total of 750 mg of SKF7® (p < .01). An incremental reduction in WC and WHtR was consistent with the gradual increase in the total daily concentration of SKF7® from 375 to 750 mg. WC and WHtR had higher effect size (f 2 = 0.11 and f 2 = 0.13 respectively) in comparison with BW and BMI. CONCLUSIONS: SKF7® is potentially a novel therapeutic treatment for obesity, reflected by reductions in BW, BMI, WC and WHtR. The use of SKF7® suggests a dose-dependent reduction in abdominal obesity, exemplified by a decline in WC and WHtR.

Short-acting ß2-agonist prescription patterns and clinical outcomes in Malaysia: A nationwide cohort of the SABINA III study.

Introduction: SABINA III assessed short-acting ß2-agonist (SABA) prescription patterns and their association with asthma-related outcomes globally. Herein, we examined SABA prescription and clinical outcomes in the Malaysian cohort of SABINA III. Method: In this observational, cross-sectional study, patients (≥12 years) were recruited between July and December 2019 from 15 primary and specialty care centres in Malaysia. Prescribed asthma treatments and severe exacerbation history within 12 months prior and asthma symptom control during the study visit were evaluated. Associations of SABA prescription with asthma control and severe exacerbation were analysed using multivariable regression models. Results: Seven hundred thirty-one patients (primary care, n=265 [36.3%]; specialty care, n=466 [63.7%]) were evaluated. The prevalence of SABA over-prescription (≥3 SABA prescriptions/year) was 47.4% (primary care, 47.1%; specialty care, 47.6%), 51.8% and 44.5% among all patients and patients with mild and moderate-to-severe asthma, respectively. Altogether 9.0% (n=66) purchased SABA without a prescription; among them, 43.9% (n=29) purchased ≥3 inhalers. The mean (standard deviation) number of severe asthma exacerbations was 1.38 (2.76), and 19.7% (n=144) and 25.7% (n=188) had uncontrolled and partly controlled symptoms, respectively. Prescriptions of ≥3 SABA inhalers (vs 1-2) were associated with lower odds of at least partly controlled asthma (odds ratio=0.42; 95% confidence interval [CI]=0.27-0.67) and higher odds of having severe exacerbation(s) (odds ratio=2.04; 95% CI=1.44-2.89). Conclusion: The prevalence of SABA over-prescription in Malaysia is high, regardless of the prescriber type, emphasising the need for healthcare providers and policymakers to adopt latest evidence-based recommendations to address this public health concern.

Is microbial adhesion affected by the build orientation of a 3-dimensionally printed denture base resin?

STATEMENT OF PROBLEM: How the build orientation of a 3-dimensionally (3D) printed denture affects microbial adhesion is unclear. PURPOSE: The purpose of this in vitro study was to compare the adherence of Streptococcus spp. and Candida spp. on 3D-printed denture bases prepared at different build orientations with conventional heat-polymerized resin. MATERIAL AND METHODS: Resin specimens (n=5) with standardized 28.3 mm2 surface area were 3D printed at 0 and 60 degrees, and heat-polymerized (3DP-0, 3DP-60, and HP, respectively). The specimens were placed in a Nordini artificial mouth (NAM) model and exposed to 2 mL of clarified whole saliva to create a pellicle-coated substratum. Suspensions of Streptococcus mitis and Streptococcus sanguinis, Candida albicans and Candida glabrata, and a mixed species, each at 108 cfu/mL were pumped separately into the model for 24 hours to promote microbial adhesion. The resin specimens were then removed, placed in fresh media, and sonicated to dislodge attached microbes. Each suspension (100 µL) was aliquoted and spread on agar plates for colony counting. The resin specimens were also examined under a scanning electron microscope. The interaction between types of specimen and groups of microbes was examined with 2-way ANOVA and then further analysis with Tukey honest significant test and Kruskal-Wallis post hoc tests (α=.05). RESULTS: A significant interaction was observed between the 3DP-0, 3DP-60, and HP specimen types and the groups of microbes adhering to the corresponding denture resin specimens (P<.05). The difference was statistically significant among 3DP-0, 3DP-60, and HP specimens (P<.05). The adherence of candida was 3.98-times lower on the 3DP-0 than that of HP (P<.05). However, adherence of the mixed-species microbes and streptococci on the 3DP-60 were 1.75 times and 2-fold higher, respectively (P<.05). The scanning electron micrographs showed that 3DP-0 exhibited the lowest microbial adherence compared with HP and 3DP-60. CONCLUSIONS: Adherence affinity of denture base resin is affected by the build orientation rather than by the group of different microbes. Three-dimensionally printed denture base resin fabricated at a 0-degree build orientation exhibited low affinity for microbial adhesion. Three-dimensionally printed dentures may reduce microbial adhesion when printed at a 0-degree build orientation.

Physicomechanical properties of cobalt-chromium removable partial denture palatal major connectors fabricated by selective laser melting.

STATEMENT OF PROBLEM: Additive manufacturing by selective laser melting (SLM) has been claimed to be less challenging than conventional casting of cobalt-chromium (Co-Cr) removable partial dentures (RPDs), providing significant improvements. However, how the physicomechanical properties of Co-Cr RPDs fabricated by SLM compare with those fabricated by conventional casting is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the physicomechanical properties of Co-Cr RPD palatal major connectors fabricated by SLM compared with those fabricated by conventional casting. MATERIAL AND METHODS: A master die simulating a maxillary arch of Kennedy class III modification 1 was scanned to create a virtual 3-dimensional (3D) cast. Two groups of 5 Co-Cr RPD major connectors were fabricated. In the 3D printing group, the Co-Cr major connector was virtually designed and exported for direct SLM 3D printing. For the conventional group, Co-Cr major connectors were constructed conventionally. The Co-Cr major connectors were virtually superimposed with the master die for surface adaptation analysis. Additional comparative analyses of surface roughness, relative density, microhardness, and microstructure of the 2 groups were performed. Data were analyzed by using independent t tests (α=.05). RESULTS: The overall volumetric and linear discrepancies were significantly higher (P<.05) in the 3D printing group. Significant differences in the surface roughness (P<.05) and microhardness (P<.05) were observed, with the 3D printing group having higher surface roughness and microhardness than the conventional group. Unlike conventional connectors, the microstructure of 3D-printed connectors showed fine homogeneous granules. CONCLUSIONS: Compared with the conventional casting technique, SLM 3D printing enabled the fabrication of Co-Cr RPD major connectors with higher microhardness and fine homogenous microstructure. However, the surface adaptation and surface roughness of SLM 3D printing Co-Cr connectors were worse than those produced conventionally. Both techniques showed similar relative densities.

Patient profile and antibiotic use in a dedicated upper respiratory tract infection clinic based in a primary healthcare setting during COVID-19 pandemic in Malaysia: A cross sectional study.

Introduction: Upper respiratory tract infection (URTI) is commonly encountered at the primary care level. Its management is particularly challenging due to the similarity of its symptoms to coronavirus disease 2019 (COVID-19) infection. Our study evaluated the profiles and antibiotic use of patients seeking care from a dedicated community-based URTI clinic during the COVID-19 pandemic. Method: A cross-sectional study was conducted. Data were obtained from the medical records of patients visiting the URTI clinic at the Alor Setar Primary Healthcare Centre between March and April 2020. Results: Overall, 587/4388 (13.3%) patients received treatment at the URTI clinic. Most patients were male (60.6%) and aged between 20 and 39 years (35.5%). Their most common symptoms were cough (68.4%), fever (31.6%), runny nose (24.6%), and sore throat (24.1%). Most patients were diagnosed with acute nasopharyngitis (52.5%), acute pharyngitis (18.6%), or acute tonsillitis (5.3%). The symptomatic medication prescription rate was 96.5%. Only 26 of the 435 patients diagnosed with URTI received antibiotics, yielding an antibiotic use rate of only 6.0% for URTI relative to overall drug use. Acute tonsillitis was more common in children <12 years old (p<0.001), while a cough and runny nose were more commonly indicative of acute nasopharyngitis than other conditions (p<0.001). Sore throat was more likely to be a symptom of acute pharyngitis (p<0.001) and acute tonsillitis (p<0.001). Conclusion: Despite the challenges faced during the COVID-19 pandemic, the findings suggest that patients with URTI-like symptoms were properly managed, and the rate of antibiotic usage remained reasonable.

Retrospective review of the prevalence and risk factors of anaemia among antenatal mothers attending health clinics in Alor Gajah, Melaka.

Introduction: Anaemia is common during pregnancy and can lead to miscarriage, intrauterine growth retardation, premature labour and antepartum haemorrhage. Anaemia in pregnancy is defined as a haemoglobin (Hb) level of <11 g/dL. Method: This retrospective review included 407 antenatal mothers diagnosed with anaemia at 36±1 weeks of gestation at all 10 health clinics in Alor Gajah between January and December 2018. Results: According to the district annual returns, 2,407 antenatal mothers (36 weeks of gestation) were registered in the health clinics in Alor Gajah in 2018. Among them, the prevalence of anaemia was 18.6% (n=448). However, there were only 407 cards found. Most participants were Malays (89.4%), aged 20-40 years (93.6%) and married (96.3%). Almost all anaemia cases (96.5%) were mild (Hb level of 9-10.9 g/dL). Approximately 34.4% of the mothers were already anaemic at booking; 77.6% belonged to the B40 income group; and 31.6% had poor pregnancy spacing of <2 years. Iron deficiency anaemia was the most common type of anaemia (51.0%), followed by dilutional anaemia (34.0%), which did not normalise at 36 weeks of gestation. Anaemia was associated with lower educational (p<0.05) and Hb levels at booking (p<0.001). Conclusion: Having normal maternal Hb levels in early pregnancy especially at booking is crucial, as it may reduce the possibility of anaemia during pregnancy. Early screening and supplementation of at-risk pregnancies may be applied as a preventive strategy. Suitable methods of iron treatment and investigation need further exploration.

Characteristics of pregnant women with diabetes using injectable glucose-lowering drugs in the EVOLVE study.

AIMS: To examine clinical parameters, glycemic control, folic acid supplementation, and the presence of other chronic diseases during early pregnancy in the EVOLVE study population (women with pre-existing diabetes treated with injectable glucose-lowering drugs). METHODS: Cross-sectional baseline evaluation of EVOLVE: an international, multicenter, non-interventional study investigating the safety of injectable glucose-lowering drugs in pregnant women with pre-existing type 1 (T1D) or type 2 diabetes (T2D). Data were collected at enrollment visit interviews before gestational week 16. RESULTS: In total, 2383 women from 17 mainly European countries were enrolled in the study: 2122 with T1D and 261 with T2D; mean age was 31 and 33 years, and duration of diabetes was 15 and 6 years, respectively. For women with T1D or T2D, 63% and 75%, respectively, received basal and rapid-acting insulin, 36% and 3% rapid-acting insulin only, 0.7% and 14.0% basal insulin only, 0.2% and 5.4% premix insulin, 0.0% and 1.2% injectable glucagon-like peptide-1 receptor agonist treatment without insulin. In women with T1D or T2D, respectively, during early pregnancy, 59% and 62% had HbA1c <7.0% (53 mmol/mol); 16% and 36% reported not taking folic acid before or during early pregnancy. Overall, >40% of women had ≥1 chronic concomitant condition (predominantly thyroid disease or hypertension). Retinopathy was the most commonly reported diabetic complication. The most commonly reported previous pregnancy complication was miscarriage. CONCLUSIONS: Baseline data from this large multinational population of women with pre-existing diabetes indicate that sub-optimal glycemic control, poor pregnancy planning, and chronic concomitant conditions were common in early pregnancy.

Risk of Major Congenital Malformations or Perinatal or Neonatal Death With Insulin Detemir Versus Other Basal Insulins in Pregnant Women With Preexisting Diabetes: The Real-World EVOLVE Study.

OBJECTIVE: To compare the risk of severe adverse pregnancy complications in women with preexisting diabetes. RESEARCH DESIGN AND METHODS: Multinational, prospective cohort study to assess the prevalence of newborns free from major congenital malformations or perinatal or neonatal death (primary end point) following treatment with insulin detemir (detemir) versus other basal insulins. RESULTS: Of 1,457 women included, 727 received detemir and 730 received other basal insulins. The prevalence of newborns free from major congenital malformations or perinatal or neonatal death was similar between detemir (97.0%) and other basal insulins (95.5%) (crude risk difference 0.015 [95% CI -0.01, 0.04]; adjusted risk difference -0.003 [95% CI -0.03, 0.03]). The crude prevalence of one or more congenital malformations (major plus minor) was 9.4% vs. 12.6%, with a similar risk difference before (-0.032 [95% CI -0.064, 0.000]) and after (-0.036 [95% CI -0.081, 0.009]) adjustment for confounders. Crude data showed lower maternal HbA1c during the first trimester (6.5% vs. 6.7% [48 vs. 50 mmol/mol]; estimated mean difference -0.181 [95% CI -0.300, -0.062]) and the second trimester (6.1% vs. 6.3% [43 vs. 45 mmol/mol]; -0.139 [95% CI -0.232, -0.046]) and a lower prevalence of major hypoglycemia (6.0% vs. 9.0%; risk difference -0.030 [95% CI -0.058, -0.002]), preeclampsia (6.4% vs. 10.0%; -0.036 [95% CI -0.064, -0.007]), and stillbirth (0.4% vs. 1.8%; -0.013 [95% CI -0.024, -0.002]) with detemir compared with other basal insulins. However, differences were not significant postadjustment. CONCLUSIONS: Insulin detemir was associated with a similar risk to other basal insulins of major congenital malformations, perinatal or neonatal death, hypoglycemia, preeclampsia, and stillbirth.

Validity and reliability of an adapted questionnaire measuring knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia.

BACKGROUND: Primary care physicians (PCP) play an important role in detecting Familial Hypercholesterolaemia (FH) early. However, knowledge, awareness and practice (KAP) regarding FH among Malaysian PCP are not well established, and there was no validated tool to assess their FH KAP. Thus, the aim of this study was to adapt an FH KAP questionnaire and determine its validity and reliability among Malaysian PCP. METHODS: This cross-sectional validation study involved Malaysian PCP with ≥ 1-year work experience in the primary care settings. In Phase 1, the original 19-item FH KAP questionnaire underwent content validation and adaptation by 7 experts. The questionnaire was then converted into an online survey instrument and was face validated by 10 PCP. In Phase 2, the adapted questionnaire was disseminated through e-mail to 1500 PCP. Data were collected on their KAP, demography, qualification and work experience. The construct validity was tested using known-groups validation method. The hypothesis was PCP holding postgraduate qualification (PCP-PG-Qual) would have better FH KAP compared with PCP without postgraduate qualification (PCP-noPG-Qual). Internal consistency reliability was calculated using Kuder Richardson formula-20 (KR-20) and test-retest reliability was tested on 26 PCP using kappa statistics. RESULTS: During content validation and adaptation, 10 items remained unchanged, 8 items were modified, 1 item was moved to demography and 7 items were added. The adapted questionnaire consisted of 25 items (11 knowledge, 5 awareness and 9 practice items). A total of 130 out of 1500 PCP (response rate: 8.7%) completed the questionnaire. The mean percentage knowledge score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (53.5, SD ± 13.9 vs. 35.9, SD ± 11.79), t(128) = 6.90, p < 0.001. The median percentage awareness score was found to be significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (15.4, IqR ± 23.08 vs. 7.7, IqR ± 15.38), p = 0.030. The mean percentage practice score was significantly higher in PCP-PG-Qual compared with PCP-noPG-Qual (69.2, SD ± 17.62 vs. 54.4, SD ± 19.28), t(128) = 3.79, p < 0.001. KR-20 value was 0.79 (moderate reliability) and average Kappa was 0.796 (substantial agreement). CONCLUSION: This study has proven that the 25-item adapted FH KAP questionnaire is valid and reliable. It can be used to measure and establish FH KAP among PCP in Malaysia.

Digital workflow for articulating maxillary and mandibular 3D arch models using an open source 3D modeling software program.

Virtual planning in digital dentistry enables easier communication between technicians, clinicians, and patients, and faster performance. Dental computer-aided design (CAD) software programs have been used for this purpose. One of the most crucial steps in virtual planning is mounting and articulating the maxillary and mandibular arch 3D models to simulate and evaluate the occlusion as a part of the virtual mock-up. The aim of this article was to describe a more cost-effective digital technique utilizing a scanned interocclusal record for articulating the cast models virtually. For this purpose, the open source Autodesk Meshmixer software program was used.

Exploratory study of brain waves and corresponding brain regions of fatigue on-call doctors using quantitative electroencephalogram.

OBJECTIVES: It is common to find doctors working long and odd hours and many at times without rest and sleep. Despite the evidence of adverse risk, jeopardizing patient safety under the hands of fatigue doctors under such working hours has not changed in many places. It has argued that with such training and subsequent experience, such issues with patient safety reduce. Fatigue too is argued as subjective, as those who can withstand the stress still perform. Nevertheless, undeniably working under fatigue is not safe for both the patient and the doctor. This study is a novel attempt to explore and objectify the state of fatigue using quantitative EEG among post-call doctors. METHOD: Seven volunteer post-call doctors were recruited to go through an EEG recording before and after their on-call rotation while at rest and subsequently while carrying out Stroop Test, putting their cognitive function at work. RESULTS: The doctors have worked up to 33 hours in a row and have had sleep of an average of 1.5 hours. It is found that during task there is a statistically significant increase in theta (frontal and occipital regions) and beta (occipital region) band power while at task post-call. Alpha band power is increased in the frontal and reduced in other regions. Correlation with Stroop Test results indicated that those who have higher alpha, beta, and lower relative theta powers at the frontal region at post-call rest have higher percentage of correct congruent trials. CONCLUSION: The results objectively imply that these fatigue doctors are under more strain while carrying out a task and corresponds to the implicated regions of brain stimulated by the task accordingly.

Assessment of masticatory function of mandibular implant-supported overdenture wearers: A 3-year prospective study.

STATEMENT OF PROBLEM: Wearers of mandibular complete dentures (CDs) often complain of retention and stability problems resulting in poor masticatory function. Evidence suggests that a mandibular overdenture (MOD) stabilized by 2 implants represents the treatment of choice to improve stability and masticatory function. Measurements are needed of the improvement in masticatory function after providing mandibular implant-stabilized overdentures. PURPOSE: The purpose of this prospective clinical study was to evaluate the changes in masticatory function from baseline (T0) to 3 months (T1) and 3 years (T2) in participants with MODs and to assess the effect of baseline mandibular bone height and volume on masticatory function after 3 years. MATERIAL AND METHODS: Participants were assessed for masticatory function by using masticatory performance involving paraffin wax cubes as an objective measure and by using masticatory ability involving a questionnaire as a subjective measure. Edentulous individuals presenting for replacement dentures were provided with conventional mucosa-supported prostheses and evaluated for masticatory function after a 3-month settling-in period (baseline measure). Before implant placement, baseline measures of bone height and volume were recorded from cone beam computed tomography (CBCT) images. The prostheses were then converted to implant-stabilized mandibular overdentures while any maxillary prostheses remained supported by the mucosa. Masticatory function was reassessed at 3 months and 3 years after insertion of the mandibular overdentures, and the mean changes from baseline were analyzed with the Wilcoxon signed-rank test. The effect of variables on masticatory function was determined by using multivariate linear regression analyses. RESULTS: A total of 23 participants were included in the study, with only 1 participant not completing the 3-year assessment. Significant improvement was observed in the masticatory performance (mixing ability index) (P<.01) and masticatory ability score (P<.001) from baseline to 3 months and baseline to 3 years. Bone height and volume had no significant effect on the improvement of masticatory function after conversion to an implant-stabilized mandibular overdenture. CONCLUSIONS: Masticatory function significantly improved after 3 months and was maintained over 3 years in participants with implant-stabilized mandibular overdentures. However, baseline bone height and volume had no significant effect on these changes in masticatory function after 3 years.

Anaemia among primary care patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD): a multicentred cross-sectional study.

OBJECTIVES: This study aimed to determine the prevalence of anaemia among patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) at primary care settings and its associated factors. DESIGN, SETTING AND PARTICIPANTS: This cross-sectional study involved 808 adult patients with T2DM and CKD who were recruited via systematic sampling from 20 public primary care clinics in Peninsular Malaysia. Their sociodemographic, clinical and biomedical profiles were collected through interviews, examination of medical records and blood testing. RESULTS: The prevalence of anaemia was 31.7% (256/808). The anaemia was mainly mild (61.5%) and normocytic normochromic (58.7%). About 88.7% of the patients with anaemia were not known to have anaemia prior to the study. Among 36 patients with documented history of anaemia, 80.6% were still anaemic, and only a half received iron therapy. Multivariate regression analysis showed that women (adjusted odd ratio (AOR): 1.57, 95% CI: 1.12 to 2.21, p=0.009) and those with older age (AOR: 1.04, 95% CI: 1.01 to 1.06, p<0.001), CKD stage 3a (AOR: 2.47; 95% CI: 1.25 to 4.87, p=0.009), CKD stage 3b (AOR: 4.36; 95% CI: 2.14 to 8.85, p<0.001), CKD stage 4 (AOR: 10.12; 95% CI: 4.36 to 23.47, p<0.001), CKD stage 5 (AOR: 10.80; 95% CI: 3.32 to 35.11, p<0.001) and foot complication (AOR 3.12, 95% CI: 1.51 to 6.46, p=0.002) were more likely to have anaemia. Having higher body mass index (AOR 0.95, 95% CI: 0.92 to 0.99, p=0.012) and higher diastolic blood pressure (AOR 0.97, 95% CI: 0.95 to 0.99, p<0.001) were associated with lower odds to have anaemia. CONCLUSION: Anaemia among patients with T2DM and CKD in primary care was common, and the majority was unrecognised. Inadequate treatment of anaemia was also prevalent. Therefore, screening of anaemia should be incorporated into the routine assessment of diabetic complications particularly for those with significant associated factors. It is hoped that such strategy could lead to early treatment and hence improve their overall care. TRIAL REGISTRATION NUMBER: NMRR-15-660-24324.

Knowledge, awareness and practice regarding familial hypercholesterolaemia among primary care physicians in Malaysia: The importance of professional training.

BACKGROUND AND AIMS: This study aimed to determine knowledge, awareness and practice (KAP) regarding familial hypercholesterolaemia (FH) among Malaysian primary care physicians (PCP), and to compare KAP between PCP with postgraduate qualification (PCP-PG-Qual) and PCP without PG qualification (PCP-noPG-Qual). METHODS: This was a cross-sectional study involving PCP with ≥1-year working experience in Malaysian primary care settings. An adapted and validated 25-item FH-KAP questionnaire was disseminated during primary care courses. Total score for each domain was calculated by summing-up the correct responses, converted into percentage scores. Normality distribution was examined and comparisons of mean/median percentage scores were made between the two groups of PCP. RESULTS: A total of 372 PCP completed the questionnaire. Regarding knowledge, 77.7% correctly defined FH. However, only 8.3% correctly identified coronary artery disease risk in untreated FH. The mean percentage knowledge score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (48.9, SD ±â€¯13.92 vs. 35.2, SD ±â€¯14.13), t(370) = 8.66, p < 0.001. Regarding awareness, 39% were aware of the NICE FH guideline and only 27.2% were aware of FH diagnostic criteria. The median percentage awareness score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (15.4, IqR ±â€¯23.08 vs. 7.7, IqR ±â€¯11.54), p = 0.013. Regarding practice, only 19.1% stratified FH patients as high risk irrespective of other risk factors. The mean percentage practice score was significantly higher in PCP-PG-Qual compared to PCP-noPG-Qual (52.4, SD ±â€¯12.92 vs. 42.7, SD ±â€¯16.63), t(370) = 9.65, p < 0.001. CONCLUSIONS: Substantial gaps in FH-KAP among Malaysian PCP were identified, with PCP-PG-Qual having better knowledge, awareness and practice than PCP-noPG-Qual, emphasising the importance of professional training and certification.

The effect of mobile messaging apps on cardiac patient knowledge of coronary artery disease risk factors and adherence to a healthy lifestyle.

AIMS: To determine the effect mobile messaging apps on coronary artery disease patient knowledge of and adherence to a healthy lifestyle. BACKGROUND: Due to the increasing incidence of coronary artery disease in recent years, interventions targeting coronary artery disease risk factors are urgent public priorities. The use of mobile technology in healthcare services and medical education is relatively new with promising future prospects. DESIGN: This study used a quasiexperimental design that included pre- and posttest for intervention and control groups. METHODS: The study was conducted from January-April 2017 with both intervention and control groups, in a teaching hospital in Klang Valley. Convenience sampling was used with inclusive criteria in choosing the 94 patients with coronary artery disease (intervention group: 47 patients; control group: 47 patients). The pretest was conducted as a baseline measurement for both groups before they were given standard care from a hospital. However, only the intervention group was given a daily information update via WhatsApp for 1 month. After 1 month, both groups were assessed with a posttest. RESULTS: The split-plot ANOVA analysis indicates that there is a significant and positive effect of the intervention on coronary artery disease patients' knowledge on coronary artery disease risk factors [F(1, 92) = 168.15, p < 0.001] with a large effect size ( η p 2  = 0.65). The mobile messaging apps also significantly improve the patients' adherence to a healthy lifestyle [F(1, 92) = 83.75, p < 0.001] with a large effect size ( η p 2  = 0.48). CONCLUSION: This study concluded that WhatsApp was an effective health intervention in increasing coronary artery disease patient's knowledge and subsequently increasing their adherence to healthy lifestyles. RELEVANCE TO CLINICAL PRACTICE: In clinical setting, mobile messaging apps are useful in information delivery and efficient patient monitory.

Accuracy of a new elastomeric impression material for complete-arch dental implant impressions.

AIM: The aim of the present study was to assess the accuracy of multi-unit dental implant casts obtained from two elastomeric impression materials, vinyl polyether silicone (VPES) and polyether (PE), and to test the effect of splinting of impression copings on the accuracy of implant casts. METHODS: Forty direct impressions of a mandibular reference model fitted with six dental implants and multibase abutments were made using VPES and PE, and implant casts were poured (N = 20). The VPES and PE groups were split into four subgroups of five each, based on splinting type: (a) no splinting; (b) bite registration polyether; (c) bite registration addition silicone; and (d) autopolymerizing acrylic resin. The accuracy of implant-abutment replica positions was calculated on the experimental casts, in terms of interimplant distances in the x, y, and z-axes, using a coordinate measuring machine; values were compared with those measured on the reference model. Data were analyzed using non-parametrical Kruskal-Wallis and Mann-Whitney tests at α = .05. RESULTS: The differences between the two impression materials, VPES and PE, regardless of splinting type, were not statistically significant (P>.05). Non-splinting and splinting groups were also not significantly different for both PE and VPES (P>.05). CONCLUSIONS: The accuracy of VPES impression material seemed comparable with PE for multi-implant abutment-level impressions. Splinting had no effect on the accuracy of implant impressions.

Nurse-led intervention on knowledge, attitude and beliefs towards acute coronary syndrome.

BACKGROUND: Coronary heart disease has emerged as a number one killer in Malaysia and globally. Much of the morbidity and mortality in acute coronary syndrome patients is because of patients not recognizing their symptoms which contributes to delay in seeking early treatment. AIM: The aim of this study is to evaluate the effectiveness of a nurse-led health education programme on knowledge, attitude and beliefs of coronary patients towards the responses to acute coronary syndrome and the association with patients' characteristics. METHODS: A single-group quasi-experimental design took place in a tertiary hospital. A total of 60 coronary patients were recruited to this study. The knowledge, attitude and beliefs towards acute coronary syndrome (ACS) were evaluated at baseline and after 1 month of giving education intervention. RESULTS: Knowledge, attitude and beliefs about ACS increased significantly from baseline to 1 month after intervention. Level of attitude was associated with gender, educational level and employment status. CONCLUSIONS: The findings of this study suggest that an education program conducted by a nurse improved patients' level of knowledge, attitudes and beliefs in response to ACS symptoms at 1 month compared to baseline, but whether they are sustained for a longer period is unclear. Improving the responses towards ACS might reduce decision delay in symptom interpretation and seeking early treatment. RELEVANCE TO CLINICAL PRACTICE: Nurse-led interventions have imparted positive outcomes in response to ACS symptoms among coronary patients. Therefore, nurses should take the initiative in educating patients to minimize delay in symptom interpretation and seeking early treatment.

Evaluation of Methadone Treatment in Malaysia: Findings from the Malaysian Methadone Treatment Outcome Study (MyTOS).

BACKGROUND: Opioid misuse and dependence is a global issue with a huge negative impact. In Malaysia, heroin is still the main illicit drug used, and methadone maintenance treatment (MMT) has been used since 2005. OBJECTIVE: To evaluate the effectiveness of MMT. METHODS: This was a cross-sectional study conducted in 103 treatment centers between October and December 2014 using a set of standard questionnaires. Data were analyzed using SPSS Statistics 20. RESULTS: There were 3254 respondents (93.6% response rate); of these 17.5% (n = 570) transferred to another treatment center, 8.6% (n = 280) died, 29.2% (n = 950) defaulted, and 7.6% (n = 247) were terminated for various reasons. Hence, 1233 (37%) respondents' baseline and follow-up data were further analyzed. Respondents had a mean age of 39.2 years old and were mainly male, Malay, Muslim, married (51.1%, n = 617), and currently employed. Few showed viral seroconversion after they started MMT (HIV: 0.5%, n = 6; Hepatitis B: 0.3%, n = 4; Hepatitis C: 2.7%, n = 29). There were significant reductions in opioid use, HIV risk-taking score (p < 0.01), social functioning (p < 0.01), crime (p < 0.01), and health (p < 0.01). However, there were significant improvements in quality of life in the physical, psychological, social, and environmental domains. Factors associated with change were being married, employed, consuming alcohol, and high criminality at baseline. Lower methadone dosage was significantly associated with improvements in the physical, psychological, and environmental domains. Conclusion/Importance: The MMT program was found to be successful; hence, it should be expanded.