A Novel Method for Intracavitary Cervical HDR Brachytherapy: Express Finger-Guided Implant Insertion at Simulation Table without Speculum, Cervical Dilatation, Sleeve, Anesthesia, or Sedation

PURPOSE/OBJECTIVE(S)

Our purpose is to develop a fast, effective, and independent intracavitary brachytherapy implant insertion method that does not need sleeve insertion, anesthesia or conscious sedation, and that can be performed at the front edge of the simulation table (CT or MRI), using finger guidance without a need for speculum or cervical dilatation.

MATERIALS/METHODS

From February 2022 to January 2023, we treated 27 locally advanced cervical cancer patients. In the last week of EBRT, we assessed patients with MRI and pelvic exam to determine their eligibility: 89% (24 patients) met the two inclusion criteria for the express insertion which are: the ability to cover any residual disease with intracavitary brachytherapy, and the accessibility of cervix external os. Each patient had 3 HDR express insertions (8Gy x3). A total of 72 consecutive express implant insertions were performed. Each insertion is evaluated for the success of procedure, number of attempts, and time taken. Patients started on laxative 3 days prior to the procedure, and paracetamol & Ibuprofen taken at home 2 hours before the procedure. On arrival, patients used the bathroom, and IM/SC morphine given. Patients were prepared at the front edge of the simulation table and topical lidocaine applied to the cervix. The external os identified with the index finger of one hand which also guided the tandem insertion using the other hand. No cervical dilatation was used. CT simulation was performed to confirm adequate implant placement and to contour and plan CTV-HR and OARs as per GEC-ESTRO/ABS guidelines.

RESULTS

The success rate was 100% in all the 72 express insertions. >90% (66 insertions) were smooth and fast, i.e., completed in 1 attempt that took <20 minutes. <10% (6 insertions) were challenging but successful, in 2 patients: one patient had an acute anteverted uterus for which suprapubic abdominal pressure facilitated the procedure that took <3 attempts and completed in <40 minutes, the other patient had an acute retroverted uterus which was associated with the most challenging procedure that took >3 attempts and completed in >40 minutes. The success rate was not affected by the type of applicator used. 85% of our applications used multichannel tandem and cylinder, 10% used tandem and ovoids, and 5% used tandem and ring applicators.

CONCLUSION

Express finger-guided intracavitary brachytherapy implant insertion at the simulation table without speculum, cervical dilatation, sleeve, anesthesia, or sedation is fast, effective, and an independent method that can be used in most cervical cancer patients to complete their planned brachytherapy treatment regardless of limited resources. Practice and dissemination of this innovative method is important especially when operative rooms and anesthesia support are limited (e.g., epidemics and closures) and in centers lacking such support. Further studies are warranted to optimize the procedure and to highlight its significant medical and socioeconomic benefits.

Prevention of mother-to-child transmission of hepatitis B virus: An observation of routine practice in a tertiary liver centre before and after the introduction of the global health sector strategy on viral hepatitis

INTRODUCTION

Worldwide, around 296 million people have hepatitis B virus (HBV) infection, most commonly transmitted from mother-to-child. Global Health Sector Strategy on Viral Hepatitis (GHSSVH) was introduced in May 2016, calling for elimination of viral hepatitis by 2030. This study aims to compare practice in a tertiary liver centre before and after GHSSVH introduction for prevention of mother-to-child transmission (MTCT).

MATERIALS AND METHODS

This retrospective cohort study was performed in a tertiary referral liver centre in Malaysia, using data from electronic medical record from January 2015 to December 2019. A total of 1457 medical records of female with HBV infection were screened. The inclusion criteria of the study were pregnant women with HBsAg positive or known to have HBV infection during the study period. We excluded patients with co-infections of other types of viral hepatitis or human immunodeficiency virus, concurrent liver diseases (e.g.: autoimmune hepatitis, Wilson’s disease), previous organ transplant and malignancy—except for hepatocellular carcinoma (HCC).

RESULTS

This study included 117 pregnancies and 21/117 (17.9%) were on antiviral therapy (AVT) for HBV. In 2017– 2019, 13/18 (72.2%) of those with HBV DNA >200,000IU/ml were on AVT, compared to 5/9 (55.6%) for 2015–2016, indicating 58% (95% CI −63% to 568%) higher odds of being on AVT in post GHSSVH group after accounting for HBV DNA.

CONCLUSION

Uptake of maternal AVT for the prevention of MTCT shows an increased trend since the introduction of GHSSVH, with room for improvement.

Lab-scale Preparation of Recombinant Human Insulin-like Growth Factor-1 in Escherichia coli and its Potential Safety on Normal Human Lung Cell Line

BACKGROUND

Insulin-like growth factor-1 (IGF-1) is structurally similar to insulin and acts as an endocrine hormone secreted by the liver.

OBJECTIVE

Production of recombinant human IGF-1 (rhIGF-1) in Escherichia coli (E.coli) and evaluation of its proliferation stimulatory activity.

METHODS

hIGF-1 gene cloned into pBSK (+) simple vector was transformed into TOP 10 chemically competent cells of E. coli. Polymerase chain reaction (PCR) was achieved using specific hIGF-1 gene primers to confirm the successful transformation. To express the rhIGF-1 in E. coli (Rosetta (DE3) pLysS); the hIGF-1 gene was cloned into the pET-15b expression vector and then the recombinant pET-15b/IGF-1 vector was transformed into a chemically prepared competent expression bacterial cells; Rosetta (DE3) pLysS. The rhIGF-1 was expressed as insoluble aggregates called inclusion bodies (IBs) using a 2 mM Isopropyl β-D-1-thiogalactopyranoside (IPTG) inducer. IBs were solubilized in a denatured form using 6 M guanidinium hydrochloride (GdmCl), followed by in vitro protein refolding using the rapid dilution method. The refolded hIGF-1 was purified using the HiTrap- ANX anion exchange column. Western blot and ELISA using rabbit polyvalent anti-hIGF- 1 were performed to confirm the protein antigenic identity. Cell proliferation activity of rhIGF-1 was testified on normal human lung cell line (WI-38).

RESULTS

rhIGF-1 was purified from the HiTrap-ANX column at a concentration of 300 μg/ml. Western blot showed a single 7.6 kDa band obtained in the induced Rosetta (DE3) pLYsS. ELISA confirmed the molecular identity of the rhIGF-1 epitope, the concentration of purified rhIGF-1 obtained from the ELISA standard curve using rhIGF-1 reference protein as a standard was 300 μg/ml, and activity on WI-38 cells was 2604.17I U/mg.

CONCLUSION

Biologically active native rhIGF-1 protein was successfully expressed. Patents related to the preparation of IGF-1 were mentioned along the text.

Interleukin 16 polymorphism and susceptibility of rheumatoid arthritis disease in Egyptian population

Rheumatoid arthritis (RA) is a systemic and multiple-stage disorder characterized by chronic inflammation with extensive synovitis. The genetic and environmental factors are associated with the risk for RA development. In RA, the induced IL-16 may play a role in initiating, sustaining and increasing the inflammatory response and development of synovitis, nevertheless IL-16’s actual role in RA pathogenesis must be studied further. This study intended to investigate the association of IL-16 gene polymorphism and RA disease, to determine the genetic role of IL-16 polymorphism and predict the risk of RA development and clinical disease activity. One hundred and Fifty RA patients and 150 apparently healthy control subjects were included in this case-control study. RA disease activity and functional status were evaluated for all RA patients. IL-16 gene polymorphism (SNP rs11556218 T/G) was genotyped using real-time polymerase chain reaction. The difference in IL-16 (rs11556218 T/G) genotype frequencies between RA patients and controls was not statistically significant. However, the G allele was frequently presented in RA patients as compared to controls (p=0.047). Moreover, G allele carriers had two times more risk to develop RA disease than T allele carriers (OR=2.598; 95%CI=1.078-6.825) with dominant genetic association. Alternatively, the G/G genotype was associated with high CDAI, RADAS-5 and HAQ disability index in comparing to other genotypes (T/T-T/G). In conclusion, there was an association between allele G of IL-16 polymorphism (rs11556218 T/G) and risk of RA disease development. In addition, there was an association between genotype G/G and increased clinical disease activity and health disability.

Attitudes of dental and chiropractic students towards a shared learning programme-An interprofessional learning model

INTRODUCTION

Interprofessional learning (IPL) is the first stage towards the goal of interprofessional collaborative care. To enhance IPL experience, the School of Dentistry, International Medical University developed an IPL model based on the core competencies and the learning outcomes for dental and chiropractic students in their second and fourth year, respectively. The model was based on experiential learning and adult learning theories in addition to Miller's framework for clinical competencies.

METHODS

The programme was developed as a student-centred, collaborative approach to achieve the learning outcomes for dental and chiropractic students. Second-year dental students (n = 46) and chiropractic students (n = 23) in their fourth year participated in the programme. The focus of the programme was to address the prevention of work-related musculoskeletal disorders (WMSDs) amongst dental students and to provide the chiropractic students with the opportunity to assess and identify risk factors for WMSDs in the dental setting. The readiness for interprofessional learning scale (RIPLS) questionnaire was completed prior to the interprofessional education programme and once again afterwards to determine dental and chiropractic students' awareness of roles and responsibilities of the other profession, and their attitudes to interprofessional education and teamwork.

RESULTS

Dental and chiropractic students showed similar levels of readiness for shared learning. The results of this study suggest that the IPL programme contributed to the development of the students' positive perceptions towards the positive professional identity and the roles of other healthcare professionals.

CONCLUSION

This study provides initial support for the integrated interprofessional learning experiences within the school. The results of the study will shape future curricula changes to further strengthen interprofessional education and subsequent interprofessional collaborative care.

Enteral myiasis causing acute dysentery: A case report

Enteral myiasis or intestinal myiasis is acquired by ingesting food or water contaminated with dipteran fly eggs or larvae. Here, we describe a patient with intestinal myiasis presenting with acute dysentery caused by the larva of Hermetia illucens. The larva was identified morphologically, and its species confirmed through molecular analysis using polymerase chain reaction and sequencing based on mitochondrial cytochrome c oxidase subunit I gene (COI).

New antimicrobial and collagen crosslinking formulated dentin adhesive with improved bond durability

OBJECTIVE

Here we describe a novel formulation, based on quaternary ammonium (QA) and riboflavin (RF), which combines antimicrobial activities and protease inhibitory properties with collagen crosslinking without interference to bonding capabilities, was investigated.

METHODS

Experimental adhesives modified with different fractions of dioctadecyldimethyl ammonium bromide quaternary ammonium and riboflavin (QARF) were formulated. Dentine specimens were bonded to resincomposites with control or the experimental adhesives to be evaluated for bond strength, interfacial morphology, micro-Raman analysis, nano-CT and nano-leakage expression. In addition, the antibacterial and biocompatibilities of the experimental adhesives were investigated. The endogenous proteases activities and their molecular binding-sites were studied.

RESULTS

Modifying the experimental adhesives with QARF did not adversely affect micro-tensile bond strength or the degree of conversion along with the demonstration of anti-proteases and antibacterial abilities with acceptable biocompatibilities. In general, all experimental adhesives demonstrated favourable bond strength with increased and improved values in 1% QARF adhesive at 24 h (39.2 ± 3.0 MPa) and following thermocycling (34.8 ± 4.3 MPa).

SIGNIFICANCE

It is possible to conclude that the use of QARF with defined concentration can maintain bond strength values when an appropriate protocol is used and have contributed in ensuring a significant decrease in microbial growth of biofilms. Incorporation of 1% QARF in the experimental adhesive lead to simultaneous antimicrobial and anti-proteolytic effects with low cytotoxic effects, acceptable bond strength and interfacial morphology.

Functionally graded biomimetic biomaterials in dentistry: an evidence-based update

Design and development of novel therapeutic strategies to regenerate lost tissue structure and function is a serious clinical hurdle for researchers. Traditionally, much of the research is dedicated in optimising properties of scaffolds. Current synthetic biomaterials remain rudimentary in comparison to their natural counterparts. The ability to incorporate biologically inspired elements into the design of synthetic materials has advanced with time. Recent reports suggest that functionally graded material mimicking the natural tissue morphology can have a more exaggerated response on the targeted tissue. The aim of this review is to deliver an overview of the functionally graded concept with respect to applications in clinical dentistry. A comprehensive understanding of spatiotemporal arrangement in fields of restorative, prosthodontics, periodontics, orthodontics and oral surgery is presented. Different processing techniques have been adapted to achieve such gradients ranging from additive manufacturing (three dimensional printing/rapid prototyping) to conventional techniques of freeze gelation, freeze drying, electrospinning and particulate leaching. The scope of employing additive manufacturing technique as a reliable and predictable tool for the design and accurate reproduction of biomimetic templates is vast by any measure. Further research in the materials used and refinement of the synthesis techniques will continue to expand the frontiers of functionally graded membrane based biomaterials application in the clinical domain.

Brain responses to high frequencies (270 Hz-480 Hz) changes due to vibratory stimulation of human fingertips: An fMRI study

This fMRI study investigated the effects of vibratory stimulation on somatosensory areas during high-frequencies stimulation using a piezoelectric finger stimulation system during an fMRI scan. Twelve healthy right-handed subjects were stimulated at 270 Hz-480 Hz and the fMRI dataset was analysed to generate the activated regions due to the high-frequencies stimulation. The activated regions were identified and thresholded at Puncorrected<0.001 for multiple comparisons. The average effect of frequencies revealed significant activation in the left thalamus, right inferior parietal gyrus, right medial frontal gyrus, and right precuneus whereas the main effect of frequencies revealed significant activation in the left thalamus. The positive effect of frequencies displayed significant activation in the left pallidum, right amygdala, right superior temporal gyrus, right medial temporal gyrus. The vibratory stimulation at a frequency of 330 Hz and 360 Hz (330 Hz<360 Hz) revealed a significant difference in the left thalamus. Findings indicated the role of the secondary somatosensory areas processing and transporting sensory information to perform the perceptual and cognitive function.

Novel riboflavin/VE-TPGS modified universal dentine adhesive with superior dentine bond strength and self-crosslinking potential

OBJECTIVE

To modify a universal dentine adhesive with different concentrations of riboflavin and D-Alpha 1000 Succinate polyethylene (VE-TPGS) as a chemical enhancer and to assess the micro-tensile bond strength (24h/12 months), determine resin penetration, measurement of intermolecular interactions and cytotoxicity.

MATERIALS AND METHODS

An experimental adhesive system based on bis-GMA, HEMA and hydrophobic monomer was doped with RF0.125 (RF - Riboflavin) or RF/VE-TPGS (_0.25/0.50) and submitted to μTBS evaluation. Resin dentine slabs were prepared and examined using SEM and TEM. Adhesion force was analysed on ends of AFM cantilevers deflection. Quenched peptide assays were performed using fluorescence scanner and wavelengths set to 320nm and 405nm. Cytotoxicity was assessed using human peripheral blood mononuclear cell line. Molecular docking studies were carried out using Schrödinger small-molecule drug discovery suite 2018-2. Data from viable cell results was analyzed using one-way ANOVA. Bond strength values were analysed by two-way ANOVA. Nonparametric results were analyzed using a Kruskal-Wallis test at a 0.05 significance level.

RESULTS

RF/VE-TPGS_0.25 groups showed highest bond strength results after 24-h storage in artificial saliva (p<0.05). RF/VE-TPGS_0.50 groups showed increased bond strength after 12-months of ageing. RF/VE-TPGS modified adhesives showed appreciable presence of a hybrid layer. Packing fraction indicated solid angle profiles describing well sized density and topology relations for the RF/VE-TPGS adhesives, in particular with the RF/VE-TPGS_0.50 specimens. Qualitative analysis of the phenotype of macrophages was prominently CD163+ in the RF/VE-TPGS_0.50. Both the compounds showed favourable negative binding energies as expressed in terms of 'XP GScore'.

CONCLUSION

New formulations based on the incorporation of RF/VE-TPGS in universal adhesives may be of significant potential in facilitating penetration, distribution and uptake of riboflavin within the dentine surface.

Brain responses to frequency changes due to vibratory stimulation of human fingertips: An fMRI study

Vibratory (e.g., piezoelectric) devices can stimulate cortical responses from the somatosensory area during functional magnetic resonance imaging. Twelve healthy, right-handed subjects (7 males and 5 females) were scanned with a 3.0 T magnetic resonance imaging scanner and stimulated at 30-240 Hz using a piezoelectric vibrator attached to the subjects’ index fingers. The functional images were analysed to determine the brain activation region by performing random effects analyses at the group level. One-way analysis of variance was used to measure changes in frequency on brain activity. The activated regions were identified with WFU PickAtlas software, and the images were thresholded at Puncorrected < 0.001 for multiple comparisons. The average effect of frequency revealed significant activations in the right insula and right middle frontal gyrus; the corresponding region in the somatosensory area may act as a top-down control signal to improve sensory targets. Results revealed significant differences between frequencies; 90 Hz > 120 Hz activated right inferior parietal gyrus, 120 Hz > 150 Hz activated right cerebellum, and 60 Hz > 90 Hz activated right supramarginal gyrus and bilateral inferior frontal gyrus pars triangularis. Findings indicated the role of secondary somatosensory areas and the cerebellum in performing higher-order functions and discriminating various frequencies during vibratory stimulation. Increasing the patient sample size and testing higher frequencies in future experiments will contribute to furthering brain mapping of somatosensory areas.

The renin angiotensin system in liver and lung: impact and therapeutic potential in organ fibrosis

Liver and lung fibrosis are two main organ diseases that are of particular importance in both Egypt and the US. Hepatitis C Virus "HCV" infection and idiopathic pulmonary fibrosis (IPF) are fibrotic diseases of the liver and lung respectively. The liver and lung are reported in literature to share many immune/inflammatory responses to damage through the lung-liver axis. Most importantly, HCV was shown to enhance the development of IPF and is considered one of the risk factors for IPF. The renin angiotensin system (RAS) plays a critical role in the fibrogenesis and inflammation damage of many organs including liver and lung. The relatively recently identified component of RAS, angiotensin converting enzyme-2 (ACE-2), has shown a promising therapeutic potential in models of liver and pulmonary fibrosis. This article reviews the role of RAS in organ fibrosis with focus on role of ACE-2 in fibrotic diseases of the liver and the lung.

Generic daclatasvir plus sofosbuvir, with or without ribavirin, in treatment of chronic hepatitis C: real-world results from 18 378 patients in Egypt

BACKGROUND

Treatment of chronic hepatitis C using combination of sofosbuvir (SOF) and daclatasvir (DCV) was used in several clinical trials and multicentre studies, which were somewhat limited to genotypes 1-3. The national program in Egypt is using SOF-DCV combination for large scale treatment.

AIM

To assess the efficacy and safety of combined SOF-DCV in treating patients with HCV-G4 in a real-world setting.

METHODS

Data and outcome of chronic HCV patients who were treated for 12 weeks with generic medications: DCV 60 mg plus SOF 400 mg ± ribavirin (RBV) within the national hepatitis C treatment program in Egypt are presented. Treatment-naïve patients without cirrhosis were treated without RBV, and those who had cirrhosis or were treatment-experienced (interferon experienced or SOF experienced) received RBV. Efficacy and safety were assessed, and baseline factors associated with sustained virological response at post-treatment week 12 (SVR12) were explored.

RESULTS

During the first 2 months of the programme, 18 378 patients with HCV-G4 started treatment with SOF-DCV with or without RBV. Overall, 95.1% achieved SVR12 (95.4% among patients treated without RBV and 94.7% for patients treated with RBV, P = .32). Treatment was prematurely discontinued in only 1.5% of patients. The most common events leading to discontinuation were patient withdrawal (n = 76) and pregnancy (n = 5). Five deaths occurred within this group.

CONCLUSIONS

Real-world experience of generic SOF-DCV in patients with chronic HCV-G4 proved to be safe and associated with a high SVR12 rate, in patients with different stages of fibrosis.

Factors associated with faculty participation in research activities in dental schools

BACKGROUND

To quantify participation in dental research activities in Malaysia, and investigate its association with socio-demographic and professional characteristics, and perceptions of research and development (R&D) culture.

MATERIALS AND METHODS

Dental academics in Malaysian dental schools were invited to complete a questionnaire by email and post. The survey comprised questions on research activities in the past 12 months, socio-demographic and professional characteristics, and the R&D Culture Index. Principal components factor analysis was carried out to confirm the factor structure of the R&D Culture Index. Chi-square test was used to identify association of research activities with R&D culture, and socio-demographic and professional characteristics. Binary logistic regression was carried to identify predicators of research activities.

RESULTS

Of 256 potential participants contacted, 128 (50%) useable responses were returned. Three R&D Culture factors accounting for 57.4% of variance were extracted. More positive perception of R&D Support was associated with Malaysians (0.025) and those employed in Government schools (0.017). R&D Skills and Aptitude were associated with older respondents (0.050), PhD qualification (0.014) and more years in academia (0.014). R&D Intention was associated with any of the socio-demographic characteristics. Thirty (23.4%) respondents reported a peer-review research publication in the past 12 months, which was associated with having a PhD (OR 12.79, CI 1.28-127.96), after adjustment in regression analyses.

DISCUSSION

Postgraduate research training should be encouraged to promote participation in research activities. R&D culture did not appear to impact on research productivity. Other factors such as individual attitudinal interests should be studied.

Role of ethical beliefs and attitudes of dental students in providing care for HIV/AIDS patients

Introduction

Dental care has remained as an unmet need for people living with HIV/AIDS (PLWHAs). Dental students are considered as future healthcare workforce and having beliefs which are discriminating may have negative attitudes towards providing care to these individuals (Azodo et al., 2010). The study aimed to assess the ethical beliefs and attitudes of dental students towards PLWHAs for providing care.

Methods

It is a descriptive correlational and cross sectional study. Nine public and private dental schools in Malaysia participated in the study. Data was collected using a validated self-administered questionnaire.

Results

A total of 481 dental students participated in this study, yielding response rate of 78%. Majority of the participants (74%) believed that patients’ HIV status should be disclosed to patients’ sexual partner without permission. Approximately 60% of the participants reported that rooms/beds of HIV patients should be clearly marked. Regarding patient disease status 28% of the students reported that it is appropriate to test a patient for HIV/AIDS without patient’s permission. Only Fifty five percent of the students expressed the willingness to treat HIV patients and 49% reported to held fear of getting infected while treating patients with HIV/AIDS. Sixty four percent of the participants reported to be more comfortable giving care to non-HIV patients than HIV-positive patients.

Conclusion

Dental students’ ethical beliefs about HIV/AIDS were not consistent with the ethical principles as stated in the code of ethics and they held negative attitudes towards PLWHAs. Ethical beliefs were found to be a determinant that may influence future attitudes of these students towards individuals with HIV/AIDS when providing care.

Angiopoietin-2 as A Biomarker For Echocardiographic Abnormalities and Carotid Atherosclerosis In Rheumatoid Arthritis Patients

Atherosclerosis and cardiovascular diseases (CVD) are increasingly recognised complications of rheumatoid arthritis (RA). Angiopoietin 2 (Ang-2) levels have been associated with clinically overt CVD in general population; we assessed serum Ang-2 levels and its correlation with Echocardiographic abnormalities and carotid intima-media thickness in RA patients. 44 RA patients without clinically overt CVD and 44 healthy controls were assessed by questionnaire and clinical examination. Disease activity score (DAS-28) was calculated. Laboratory investigations included measurement of serum Ang-2, Rheumatoid factor (RF), anti-cyclic citrullinated peptide (Anti-CCP), and C reactive protein (CRP). Doppler Echocardiography and Carotid ultrasonography were done to all patients and controls. Mean age of RA patients was 44.4±9.6 and about (86.4%) 38 were females. Mean levels of Ang-2 was higher in RA patients (17.591±13.9 ng/ml) as compared to controls (7.909 ±4.10 ng/ml) P<0.001 and was significantly elevated in RA patients with left ventricular (LV) diastolic dysfunction (23.53±7.75 ng/ml) than those without dysfunction (14.81±15.33ng/ml), P<0.05 and was significantly elevated in RA patients with carotid intima-media thickness (cITM) >0.6mm (21.12±14.79 ng/ml), P<0.005. Serum Ang-2 correlated positively with disease duration, DAS-28, LV posterior wall thickness, E wave velocity and cIMT. In conclusion, serum Ang-2 level is associated with LV diastolic dysfunction and increased carotid intima-media thickness in RA patients and may be useful biomarker for subclinical CVD and atherosclerosis in RA patients.

Poor outcome of adenovirus infections in adult hematopoietic stem cell transplant patients with sustained adenovirus viremia

The outcome of adenovirus (ADV) infections in adult hematopoietic stem cell transplant (HSCT) patients remains poorly characterized. We studied 14 adults and 3 children, who had undergone HSCT and had developed ADV viremia. Peak ADV DNA levels were significantly higher in patients with ADV diseases than in those without (P=0.03). All children survived the ADV infections. Among the 14 adult HSCT patients, 11 were treated with cidofovir, 2 with ribavirin, and 1 did not receive antiviral treatment. Six of the 13 (46%) treated patients developed ADV diseases and 3 of them (23%) died of ADV infections. Sustained viremia (≥3 positive polymerase chain reaction assays during follow-up) was detected in all patients who finally died of ADV infections. However, 2 adults having had transient ADV viremia either survived or died of diseases other than ADV infections. Our study indicates that the outcome of adult HSCT patients with sustained ADV viremia may be poor, even for those who have received anti-ADV treatment.

Teledentistry in practice: literature review

Teledentistry can be defined as the remote provision of dental care, advice, or treatment through the medium of information technology, rather than through direct personal contact with any patient(s) involved. Within dental practice, teledentistry is used extensively in disciplines like preventive dentistry, orthodontics, endodontics, oral surgery, periodontal conditions, detection of early dental caries, patient education, oral medicine, and diagnosis. Some of the key modes and methods used in teledentistry are electronic health records, electronic referral systems, digitizing images, teleconsultations, and telediagnosis. All the applications used in teledentistry aim to bring about efficiency, provide access to underserved population, improve quality of care, and reduce oral disease burden.

Structured student-generated videos for first-year students at a dental school in Malaysia

Student-generated videos provide an authentic learning experience for students, enhance motivation and engagement, improve communication skills, and improve collaborative learning skills. This article describes the development and implementation of a student-generated video activity as part of a knowledge, observation, simulation, and experience (KOSE) program at the School of Dentistry, International Medical University, Kuala Lumpur, Malaysia. It also reports the students' perceptions of an activity that introduced first-year dental students (n=44) to clinical scenarios involving patients and dental team aiming to improve professional behavior and communication skills. The learning activity was divided into three phases: preparatory phase, video production phase, and video-watching. Students were organized into five groups and were instructed to generate videos addressing given clinical scenarios. Following the activity, students' perceptions were assessed with a questionnaire. The results showed that 86 percent and 88 percent, respectively, of the students agreed that preparation of the activity enhanced their understanding of the role of dentists in provision of health care and the role of enhanced teamwork. In addition, 86 percent and 75 percent, respectively, agreed that the activity improved their communication and project management skills. Overall, the dental students perceived that the student-generated video activity was a positive experience and enabled them to play the major role in driving their learning process.

Utilization of debate as an educational tool to learn health economics for dental students in Malaysia

Health economics, a special branch of science applying economic principles to the health delivery system, is a relatively young subdiscipline. The literature is scanty about teaching health economics in the medical and dental fields. Delivery methods of this topic vary from one university to another, with lectures, seminars, and independent learning reported as teaching/learning tools used for the topic. Ideally, debates should foster the development of logical reasoning and communication skills. Health economics in dentistry is taught under the community oral health module that constitutes part of an outcome-based dental curriculum in a private dental school in Kuala Lumpur, Malaysia. For this study, the students were divided into two groups: active participants (active debaters) and supporting participants (nonactive debaters). The debate style chosen for this activity was parliamentary style. Active and nonactive debaters' perceptions were evaluated before and after the activity through a structured questionnaire using a five-point rating scale addressing the topic and perceptions about debate as an educational tool. Cronbach's alpha coefficient was used as a measure of internal consistency for the questionnaire items. Among a total of eighty-two third-year dental students of two successive cohorts (thirty-eight students and forty-four students), seventy-three completed the questionnaire, yielding a response rate of 89 percent. Students' responses to the questionnaire were analyzed with the Kruskal-Wallis analysis of variance test. Results revealed that the students felt that their interest in debate, knowledge of the topic, and reinforcement of the previous knowledge had improved following participation in the debate. Within the limitations of this study, it can be concluded that debate was a useful tool in teaching health economics to dental students.

People living with HIV/AIDS (PLWHA) and HIV/AIDS associated oral lesions; a study in Malaysia

BACKGROUND

The continuous increase in number of people living with HIV/AIDS (PLWHA) represents a serious health and economic burden. HIV positive individuals with oral lesions have significantly lower oral health-related quality of life than HIV positive individuals without oral lesions. The objective of this study was to assess the knowledge, attitude and practices (KAP) within a cohort of HIV/AIDS positive patients towards HIV/AIDS associated oral lesions.

METHODS

Two hundred seventy patients attending a national referral hospital of infectious disease in Malaysia were recruited for the study. The study involved the administration of a validated interview-based questionnaire designed to elicit knowledge, attitude and practices of these patients towards HIV associated oral lesions. The last part of the questionnaire assessed the training provided to the patients in relation to the oral lesions associated with the disease and the effectiveness of this training. Data analysis was carried out using SPSS version 18.

RESULTS

Thirty seven percent of patients were reported as knowledgeable, while sixty four percent reported to have positive attitude towards the care of oral hygiene. Sixty six percent of the patients reported that they would seek professional care when experiencing oral lesion. Training was reported effective for 93% patients.

CONCLUSIONS

Patients were non-knowledgeable in relation to oral manifestations of the disease and one third of the participating patients showed negative attitudes towards oral health care and reported various measures to manage oral lesions rather than seeking professional care. Developing effective educational methodologies can empower patients with knowledge that may translate to positive attitudes and practices.

Study the effect of beryllium reflector poisoning on the Syrian MNSR

Neutron interactions with beryllium lead to formation of (3)H and strong neutron absorbers (3)He and (6)Li in the reflector (so called beryllium poisoning). After the reactor shutdown, the concentration of (3)He increases in time due to tritium decay. This paper illustrates the impact of poisoning accumulation in the beryllium reflectors on reactivity for the Syrian MNSR research reactor. The prediction of (6)Li and (3)He poison concentrations, initiated by the 9Be(n,α) reaction, in the beryllium reflectors of the MNSR was also presented. The results were based on MCNP Monte Carlo calculations and solutions to the differential equations which describe the time dependent poison concentrations as a function of reactor operation time and shutdown periods. The whole reactor history was taken into account to predict reliable values of parasitic isotope concentrations. It was found that the (3)He and (6)Li accumulations in the beryllium reflectors during the actual working history decreased the excess reactivity by about 28%. While, the effect became more significant at the reactor life's end and the reactor became subcritical after 25,000 h operation. The results contained in this paper could be used in assess the safety analysis of the MNSR reactor.

Surface characterization analysis of failed dental implants using scanning electron microscopy

OBJECTIVE

To investigate the failure of 15 dental implants (Paragon/Zimmer) in relation to their surface quality.

MATERIALS AND METHODS

The study comprised of 15 dental implants (7 mm D Advent Implant, 3.9 mm D apex design implant), which were followed from surgery to completion of prosthetic restorations. The implants were placed during a 6-year period from 2003-2009 in non-smoking patients (male; 7, females; 5). There were eight upper and seven lower implants. Surface characterization after immersion in SBF of these failed implants was investigated using SEM and EDS compared to that of an unused implant of the same brand.

RESULTS

Results revealed that, following immersion in SBF, the implant surfaces showed new components like Ca(+), Na(+) and Cl(-), but in trace quantities.

CONCLUSIONS

After SEM observation and EDS analysis, it was concluded that the apatite layer formation could not be verified.