Prediction of pre-eclampsia during early pregnancy in primiparas with soluble fms-like tyrosine kinase-1 and placental growth factor.

BACKGROUND: We hypothesized that pre-eclampsia (PE) can be predicted early in primiparas by measuring serum levels of soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). METHODS: All normotensive primiparas attending the antenatal clinics of Aga Khan University Hospital and Aga Khan Hospital for Women, Karachi, Pakistan without any known risk factor for PE were invited to participate in the study. They were divided into two groups based on the development of PE. Their blood samples were collected at 8-15, 16-22, 23-28, 29v34 weeks of pregnancy and once within 1 week of delivery. All samples were analysed for sFlt-1 and PlGF. RESULTS: Six hundred and eleven (46.7%) of 1307 recruited primiparas completed the study according to the protocol. Of these, 39 (6.4%) women developed PE. The difference in serum sFlt-1 was evident as early as 15 weeks of gestation. Higher levels of serum sFlt-1 were present in women who later developed PE. Relatively higher levels of PlGF were observed in non-PE women compared to PE women up to 22 weeks of gestation. However, after 23 weeks of pregnancy, PlGF levels increased in both the groups, but less so in the PE group. Receiver operator characteristics (ROC) curve analysis showed that even in early pregnancy (<15 weeks of gestation), serum sFlt-1 alone has the potential to predict PE with area under the curve (AUC), sensitivity and specificity of 0.81, 75.9 and 72.4, respectively. CONCLUSION: PE can be predicted in primiparas in the early part of second trimester with serum levels of sFlt-1 and in the later part of second trimester with serum levels of PlGF.

Temporomandibular joint status, occlusal attrition, cervical erosion and facial pain among substance abusers.

STATEMENT OF THE PROBLEM: Drug addiction or substance abuse is an endemic habit globally. At present there is no data available regarding the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among substance abusers from the Saudi Arabia. PURPOSE: The aim of the study was to investigate the temporomandibular joint status, occlusal and cervical tooth wear and facial pain among the drug abusers from narcotics control prison, Riyadh, Saudi Arabia. MATERIALS AND METHODS: One hundred subjects were included in the study as a convenience sample. Male comprised of 56 and female 44. An interview and clinical examination were performed. RESULTS: The age ranged from 20-65 years with mean (31.4 +/- 8.9). Smoking, drinking and chewing habits were most common modes of drug used. 98.0% were smokers, 61.0% alcohol drinkers and 41.0% were cannabis user. The duration of drug abuse was more than 5 years among most of the candidates. TMJ status revealed that clicking was reported by 40.0%, tenderness by 9% and reduced jaw mobility 0.0%. Occlusal enamel wear (attrition) was reported by 16.1% of male and 18.1% of female. However, the occlusal dentine exposure was among female only (18.1%). Cervical erosion abrasion was common among 16.1% male and 54.5% female. Facial pain was experienced by 6.0% and facial numbness by only 1.0% of the subjects. CONCLUSION: Smoking, alcohol and cannabis were common among the studied population. Only 9.0% of the subjects had tenderness in TMJ, occlusal enamel wear was among 17.0% of subjects. Only female subjects had dentinal exposure. Facial pain was common among up to only 6.0% of the studied population. From public health point of view, smoking cessation programs and oral health education should be introduced to adolescents to prevent unhealthy illicit substance abusing habits in future. Further studies are needed to assess the oral mucosal changes, dietary pattern, oral hygiene behavior, quality of life and level of satisfaction among the substance abusers from Saudi Arabia.

Caries prevalence and its relation to water fluoride levels among schoolchildren in Central Province of Saudi Arabia.

OBJECTIVE: To determine dental caries prevalence and severity among primary and intermediate schoolchildren in Riyadh and Qaseem Regions, and to determine any correlation between dental caries and fluoride levels in drinking water. DESIGN: Cross-sectional. METHODS: 1,104 children; 431 (6-7-year-old) primary schoolchildren (249 in Riyadh and 182 in Qaseem) and 673 (12-13-year-old) intermediate schoolchildren (392 in Riyadh and 281 in Qaseem) were examined for dental caries utilising the WHO criteria for diagnosis of dental caries. RESULTS: In primary schoolchildren the prevalence of caries was 91.2% both in Riyadh and Qaseem. The mean dmft scores were similar in Riyadh (6.53, SD 4.30) and Qaseem (6.35, SD 3.83). Among the intermediate schoolchildren the prevalence of dental caries was slightly higher in Riyadh (92.3%) than Qaseem (87.9%). The mean DMFT score was higher in Riyadh (5.06, SD 3.65) as compared with Qaseem (4.53, SD 3.57) with marginal statistical significance (p = 0.057). Among the primary schoolchildren there was statistically significant (p < 0.05) difference in mean dmft scores at various fluoride levels with lowest dmft scores at the optimum water fluoride level (0.61-0.80ppm) and highest at two extremes i.e. 0.0 to 0.3ppm and > 2.5ppm, while in intermediate schoolchildren no significant difference in overall mean DMFT scores of children at various water fluoride levels could be found. CONCLUSION: The caries experience among the primary and intermediate schoolchildren in Riyadh and Qaseem was very high, and that there was no linear correlation between water fluoride level and caries experience in these children.

Caries prediction model in pre-school children in Riyadh, Saudi Arabia.

OBJECTIVES: To evaluate the significance of variables such as oral hygiene, dietary habits, socio-economic status and medical history of a child in assessing the level of caries risk and to generate a caries prediction model for pre-school Saudi children. DESIGN: Cross-sectional study of pre-school children. SETTING: Clinics and schools in Riyadh, Saudi Arabia. SAMPLE AND METHODS: A sample of 446 Saudi pre-school children, 199 males and 247 females, with a mean age of 4.13 years, were selected at random from clinics and schools. Selection was limited to subjects who either had no caries (dmft = 0) or who had high caries experience (dmft > 8). Each child was examined for caries experience and oral hygiene status. Their mothers were interviewed through a standardized questionnaire for information about oral hygiene habits of the children, diet history, childhood illness and socio-economic status. RESULTS: There was a highly significant difference between the two groups in: debris index (P < 0.0001), aged child started tooth brushing, (P < 0.0001), age breastfeeding was stopped (P < 0.005), nocturnal bottle feeding with milk formula (P < 0.001), use of sweetened milk (P < 0.0001), frequency of use of soft drinks (P < 0.0005), frequency of consumption of sweets (P < 0.0001), and age at first dental visit (P < 0.0001). A caries prediction model developed through stepwise multivariate Logistic Regression (LR) analyses showed debris index, use of sweetened milk in bottle, frequency of consumption of soft drinks, frequency of intake of sweets and child's age at the first dental visit to be significant. Predictive probability of the model was 86.31% with a sensitivity of 90.1% and a specificity of 80.6%. CONCLUSIONS: Risk factors for dental caries have been identified and a caries prediction model has been developed for Saudi pre-school children. The prediction model, if verified, may provide with guidance in identifying high caries risk Saudi preschool children as targets for preventive programmes.

Nutritional stress of reproduction. A cohort study over two consecutive pregnancies.

BACKGROUND: The evaluation of nutritional stresses of reproduction is far more complex than perceived in the literature so far. The use of inappropriate outcome measures, the lack of adjustment for the complex inter-relationships among confounding variables, and the poverty of analytical models, has led to conflicting results. Our objective was to evaluate, using a new analytical framework, the maternal and fetal effects of the nutritional stress imposed by reproduction in a cohort of 278 women followed over two consecutive pregnancies. METHODS: The analytical framework evaluated nutritional stress over successive pregnancies. The effect of birth interval on change in maternal weight, body mass index and hemoglobin over two consecutive pregnancies was evaluated using multiple linear regression accounting for the effects of maternal age, parity and weight or body mass index or hemoglobin in the first of the two pregnancies. For change in fetal birth weight correction was made for the confounding effect of maternal age, parity and weight, and fetal gestational age, sex and birth weight. RESULTS: Birth interval was associated with change in maternal weight (p=0.001); change in body mass index (p=0.002); and change in birth weight (p=0.048). No association was found between birth interval and change in hemoglobin. CONCLUSIONS: The nutritional stress imposed by reproduction affects maternal and fetal outcomes. Maternal nutrient stores can be depleted and fetal growth can be restricted in association with shorter birth intervals. Perinatal nutrition may be improved by adequate spacing of pregnancies with appropriate birth control.

Caries prevalence in 2 and 3 year old children of Adelaide, Australia.

Information on caries experience in Australian preschool children is scarcely available. The aim of present study was to determine caries prevalence in two and three year old children in Adelaide, Australia. A weighted random sample of 160 two and three old children was examined by one examiner (AHW) for caries experience. Most children (88.1%) had no clinical caries. Mean dmft (decayed, missing and filled teeth) score was 0.49 (+/- 1.7), with dt component of 0.39 (+/- 1.41), mt of 0.03 (+/- 0.39) and ft of 0.06 (+/- 0.6). The most susceptible tooth in children with clinical caries was maxillary central incisor (63.2%), while the least susceptible was mandibular central incisor (0%). The results have indicated that the percentage of two and three year old children with clinical caries was low in Adelaide Statistical District.