P252 Identifying predictors for all-cause mortality at admission, 1 and 3 years after admission for acute decompensated heart failure amongst patients with atrial fibrillation

Background

Heart failure (HF) and atrial fibrillation (AF) commonly co-exist, each, predisposing the other. AF may inflict haemodynamic disturbances, leading to reduced cardiac output and hence acute decompensation. Ultimately mortality risk is further increased. Identifying contributing factors is thus vital lest increasing risk of poor outcome.

Purpose

Identify predictors of all-cause mortality in AF patients after admission for acute decompensation HF (ADHF) at admission, 1 and 3 years. 

Methods

A retrospective observational study of 810 AF patients" first admission from 2009 to 2018, analysed using descriptive, ROC curve and Cox regression.

Results

Mortality at admission, 1 and 3 years following ADHF were 5.1%, 14.4% and 40.5% respectively. Majority of AF patients were male (64.7%) but there was no significant statistical difference between gender with associated mortality during those timelines. Using multivariate analysis, predictors associated with increased in-hospital mortality were Hyponatraemia, Na < 135mmol/L (adjusted Odds Ratio, aOR 2.49; 95% Confidence Interval, CI 1.91-5.20; p0.015), Uric Acid ≥ 675 (aOR 2.75; CI 1.31-5.79; p0.008), Ejection Fraction, EF < 40% (aOR 3.93; CI 1.63-9.49; p0.002). Medications on admission associated with reduced inpatient mortality were Angiotensin Converting Enzyme inhibitor (ACEi) / Angiotensin Receptor Blocker (ARB) + Beta Blocker (BB) + Mineralocorticoid Receptor Antagonist (MRA) (aOR 0.07; CI 0.02-0.30; p < 0.001). At 1 year, multivariate analysis showed an associated increase in mortality when NTProBNP ≥ 7500pg/ml (adjusted Hazard Ratio, aHR 1.64; CI 1.02-2.65; p0.042) and Urea > 7mmol/L (aHR 1.86; CI 1.04-3.32, p0.036). Medications on discharge comprising ACEi/ARB + BB + MRA were the only combination that showed a reduction in mortality (aHR 0.23; CI 0.09-0.60; p0.003). At 3 years, background coronary artery disease (aHR 1.72; CI 1.09-2.71; p0.02), hypernatraemia, Na > 145mmol/L (aHR 14.89; CI 3.17-69.86; p0.001), EF < 40% (aHR 2.00; CI 1.28-3.12; p0.002) were associated with increased mortality. Medications on discharge namely ACEi/ARB (aHR 0.14; CI 0.03-0.70; p0.013), BB (aHR 0.23; CI 0.10-0.51; p < 0.001), ACEi/ARB + BB (aHR 0.16; CI0.06-0.41; p < 0.001), ACEi/ARB + MRA (aHR 0.34; CI 0.14-0.85; p0.021), BB + MRA (aHR 0.38; CI 0.17-0.83; p0.016), ACEi/ARB + BB + MRA (aHR 0.193; CI 0.09-0.43; p < 0.001) showed an associated reduction in mortality.

Conclusions

In this single centre study, patients with AF who presented with ADHF had a variety of mortality predictors that influence at different timelines. They had higher risk of inpatient mortality with hyponatraemia, hyperuricaemia and EF < 40%. Elevated NTProBNP and Urea levels seemed to have more effect on mortality at 1 year compared to 3 years. Having 3 disease-modifying heart failure medications at discharge exerted the most benefit up to 3 years of follow up.

Abstract P252 Figure.

Quantitative analysis of classical and new putative periodontal pathogens in subgingival biofilm: a case-control study

BACKGROUND AND OBJECTIVES

A number of species/phylotypes have been newly implicated as putative periopathogens. The objective of this study was to explore associations among classical and new pathogens in subgingival biofilm and to assess their relative importance to chronic periodontitis.

MATERIAL AND METHODS

Pooled subgingival biofilm samples were obtained from 40 patients with chronic periodontitis and 40 healthy controls. Taqman q-PCR assays were used to determine the absolute and relative counts of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Parvimonas micra, Filifactor alocis, oral Synergistetes and oral TM7s. Microbial associations were assessed using cluster analysis. Different statistical models were used to explore associations between microbial parameters and periodontitis.

RESULTS

The median log and relative counts were lowest for TM7s (4.4 and 0.0016%, respectively) and highest for oral Synergistetes (7.2 and 1.4%, respectively). Oral Synergistetes clustered strongly with the red complex, particularly T. forsythia (100% rescaled similarity). All species/phylotypes except TM7s were significantly associated with periodontitis (Mann-Whitney test; p ≤ 0.005). However, P. gingivalis and F. alocis lost association after adjusting for confounders (ordinal regression). In receiving operator characteristic curve analysis, the log counts of oral Synergistetes were the best markers of periodontitis (82.5% sensitivity and specificity), followed by those of T. forsythia, P. micra and T. denticola. In prediction analysis, however, P. micra was the only microbial predictor of periodontal parameters.

CONCLUSIONS

Oral Synergistetes are presented here as new members of the red complex, with relative importance to periodontitis exceeding that of the classical members. P. micra is shown as an important periodontal pathogen warranting more attention.

Attitudes towards the use of fluorides for oral health among Islamic clerics in Kelantan Province, Malaysia

OBJECTIVE

To assess the knowledge, attitudes and practices of Imams (Islamic clerics) concerning fluoride toothpaste and fluoridated water to improve oral health in Kelantan.

BASIC RESEARCH DESIGN

Cross sectional study of Imams in 65 registered mosques in Pasir Puteh district, Kelantan.

METHOD AND PARTICIPANTS

Face-to-face interview, using structured questionnaire and some open ended questions.

RESULTS

Most of the 83 interviewees (82% participation rate) were unsure whether their toothpaste contained fluoride (64%), only 25% were sure. More than one-third (37%) were using fluoridated piped water. Most (87%) had little knowledge of fluorides and more than two-thirds (69%) had lacked positive attitudes towards its use. Television (54%) was the most common source of information about fluorides, followed by newspapers (9%). The main reasons given among the few who opposed fluoride use were i) fear of dangerous side effects (4%) and ii) uncertainty about the halal status of fluoride (2%), Attitudes were not associated with the use of fluoridated water supply (p=0.999), age (p=0.103), income (p=0.540) and location (p=0.999).

CONCLUSION

Over two-thirds of Imams had little knowledge of and lacked positive attitudes towards fluoride use in toothpaste and piped water supplies.

Molecular characterization of maple syrup urine disease patients from Tunisia

Maple syrup urine disease (MSUD) is a rare disorder of branched-chain amino acids (BCAA) metabolism caused by the defective function of branched-chain α-ketoacid dehydrogenase complex (BCKD). The disease causal mutations can occur either in BCKDHA, BCKDHB or DBT genes encoding respectively the E1α, E1β and E2 subunits of the complex. In this study we report the molecular characterization of 3 Tunisian patients with the classic form of MSUD. Two novel putative mutations have been identified: the alteration c.716A>G (p.Glu239Gly) in BCKDHB and a small deletion (c.1333_1336delAATG; p.Asn445X) detected in DBT gene.

Longitudinal study of dental caries increment in Malaysian school children: a 5-year cohort study

The aim of this 5-year longitudinal cohort study was to assess the prevalence, severity, and trends in caries increment and impact of the School Dental Incremental Care Programme (SDICP). Data were gathered from school dental records as part of the SDICP. A sample of 1830 children were included and checked for caries experience annually using World Health Organization criteria. In total, 95.4% of the children were caries free in 2004, and caries experience declined to 70.5% in 2009 with an average of 4.9% annually. At baseline, the mean DMFT (confidence interval [CI]) was 0.06 (0.05-0.08) and increased to 0.58 (0.53-0.63) in 2009. Children with active caries were 4.4% in 2004, and figures rose to 9.6% in 2009. The FT component increased most rapidly during these 5 years from 0.2% to 25.1%. Overall caries prevalence and increment was low in this study. Proportions of FT component were higher as compared with DT component with low rate of extractions during the latter years of the study.

Fluoride toothpaste utilization behaviour among preschool children in Perlis, Malaysia

BACKGROUND

Very mild fluorosis is quite prevalent in children and one of the sources may be attributed to poor fluoride toothpaste utilization habits.

AIM

To investigate the frequency of toothbrushing, parental supervision, the person who usually applied the toothpaste, toothpaste swallowing and spitting habits, size of toothbrush, type of toothpaste used and amount of toothpaste used by shape and weight.

METHODOLOGY

Observational cross-sectional study of a representative random sample of 373 children aged 5-6 year-old. The children were interviewed using a structured close ended questionnaire. Direct observations were made on their toothpaste dispensing habit during a toothbrushing exercise.

RESULTS

All children reported practising toothbrushing with 90% on a daily basis. Almost all used fluoridated toothpaste (91.4%). About one-half (50.7%) reported that their parents never supervised them. More than one-third of children used adult toothpaste and 60.1% of the toothpaste was flavoured. Most (92%) used toothbrush meant for children. About 40% applied a pea-sized amount of toothpaste. The mean weight of toothpaste applied was 0.43 g (SID + 0.35 g).

CONCLUSIONS

The majority used the recommended child-sized toothbrush and toothpaste that contained fluoride but less than one-half of the parents supervised their children. Most children used flavoured children's toothpaste but a sizable proportion used toothpastes meant for adults. The amount applied by shape and weight exceeded the amount recommended by experts.

The prevalence of enamel opacities in permanent teeth of 11-12 year-old school children in Kuala Lumpur, Malaysia

OBJECTIVE

To determine the prevalence, distribution, severity and treatment need of enamel opacities among 11-12 year-old school children in a fluoridated urban community.

DESIGN

A cross-sectional descriptive survey of enamel opacities in 11-12 year-old schoolchildren.

CLINICAL SETTING

A questionnaire survey and a clinical examination of erupted teeth using the Modified DDE Index was conducted on schoolchildren in randomly selected schools.

PARTICIPANTS

957 schoolchildren from government schools in Kuala Lumpur comprising the three major ethnic groups of Malay, Chinese and Indian children.

MAIN OUTCOME MEASURES

The severity of enamel opacities was assessed by the extent of buccal surface involvement. Normative treatment need was based on severity of opacities.

RESULTS

Enamel opacities were found in 90.7% of subjects and 47.2% of teeth. Malays have the highest prevalence with Chinese the least. Although ethnic differences is statistically significant (p < 0.01), the differences in prevalence between ethnicity is small. The most common type of defect was "diffuse opacities" (88.6% of subjects). Most subjects (70%) showed bilateral distribution of diffuse opacities indicating a systemic disturbance. Posterior teeth were twice more commonly affected (p < 0.05). The majority of opacities in anterior teeth (66.7%) were minor, involving less than 1/3 of the labial surface. Only 0.6% of the whole sample required some form of aesthetic intervention.

CONCLUSION

Despite the high prevalence of enamel opacities, the degree of severity is very mild with only minimal aesthetic and public health concern.

Profile of the oral healthcare team in countries with emerging economies

Health is a critical dimension of human well-being and flourishing, and oral health is an integral component of health: one is not healthy without oral health. Significant barriers exist to ensuring the world's people receive basic healthcare, including oral healthcare. Amongst these are poverty, ignorance, inadequate financial resources and lack of adequate numbers of educated and trained (oral) healthcare workers. Emerging economies are encouraged to develop a national strategic plan for oral health. International organizations have developed goals for oral health that can be referenced and adapted by emerging economies as they seek to formulate specific objectives for their countries. Demographic data that assess the nature and extent of oral diseases in a country are essential to sound planning and the development of an oral healthcare system that is relevant, effective and economically viable. Prevention should be emphasized and priority consideration be given to oral healthcare for children. The types and numbers of members of the oral healthcare team (workforce) will vary from country to country depending on the system developed. Potential members of the workforce include: generalist dentists, specialist dentists, dental therapists, dental hygienists, denturists, expanded function dental assistants (dental nurses) and community oral health workers/aides. Competences for dentists, and other members of the team, should be developed to ensure quality care and developed economies should cooperate with emerging economies. The development, by more advanced economies, of digital, virtual curricula, which could be used by emerging economies for educating and training members of the oral healthcare team, should be an important initiative. The International Federation of Dental Educators and Associations (IFDEA) should lead in such an effort.

A dental-anthropological study of health and illness behaviour among Orang Asli of the Semai Tribe: the perspective of traditional healers

This observational study investigates and describes the oral health beliefs and illness behaviour in the Semai tribe of Orang Asli community. Data was obtained from a "Key informant interview" method i.e. the village Tok Halaq (Traditional healer). Information about common oral diseases and conditions were illustrated with enlarged pictures of dental caries, periodontal disease, oral cancer and cleft. The most common oral problem was toothache. This is treated by self-medication. However if the pain still persist, the Tok Halaq was consulted to start traditional methods. He will identify the cause. If "germs" were thought to be the cause, he will ask the person to see a doctor. Otherwise, he attempts traditional treatment. If the effort failed after a few days, the person will be advised to see a doctor. It appears that the Tok Halaq plays an influential role in prevention, promotion and the healing process in this community. Hence any effort to promote oral health and prevent oral disease must seek their cooperation. Their beliefs on causes of common oral diseases are described in the text.

The prevalence of post-extraction complications in an outpatient dental clinic in Kuala Lumpur Malaysia--a retrospective survey

The aim of this retrospective study is to report on the prevalence of post-extraction complications among patients attending the Oral Surgery outpatient clinic of the Faculty of Dentistry, University of Malaya over a 12-month period from January to December, 1992. The prevalence of post-extraction complications which required further treatment was only 3.4% (n = 100), out of a total of 2968 patients who had extraction of one or more permanent teeth. Analysis based on complete clinical reports (n = 79) showed that dry socket accounted for nine out of ten cases of post-extraction complications. However the aetiology was largely unknown. No obvious association with medical history could be made. Lower teeth were more likely to have complications. The most common teeth associated with dry socket were the molars (76%) and premolars (19%). The most common molars to be affected are the first, followed by the third and lastly the second molars. A brief review of current aetiological factors of dry socket was discussed.

Investigation of delay in utilization of government dental services in Malaysia

Although delays in seeking dental care among patients are frequently observed in daily practice, this problem has never been investigated in other utilization studies. This study attempts to establish the magnitude and severity of the problem of delay in a delivery system where cost is not a major barrier to utilization. 555 users of Government dental services were interviewed. Only 37% of them came promptly within 6 days of perceiving a dental need. The majority (63%) had delayed their dental visit for more than 1 week. In fact, the highest frequency of delay was for more than 1 month. Prompt attendance was found to be associated with people who regularly came for asymptomatic check-ups. In contrast, more than 50% of those who thought they needed fillings and extractions had delayed their visit for more than a month. The main causes of delays were attributed to work commitments and the lack of perceived need for urgent care. Barriers related to transport or financial problems were ranked very low. The implications of these findings are discussed.

A survey on oral hygiene practices among Malaysian adults

A survey on oral hygiene practices was conducted on 537 dentate adult patients aged 15 years and over. The aim of this study was to investigate the variation in dental behavior with regards to socio-demographic factors, namely age, sex, ethnicity, income, education and occupational status. Patients attending nine randomly selected government dental clinics were interviewed on their daily oral hygiene practices. The majority (89.7%) of the subjects reported that they brushed their teeth, 68% used toothpaste containing fluoride, but only 8.4% flossed their teeth. Generally the younger group had better oral hygiene habits. The higher the socioeconomic status of the adults, the better their toothcleaning practices. Awareness concerning dental floss was low regardless of all the socio-demographic variables. It was concluded that there is a need to improve the dental health practices of adults in Malaysia.

Patients' preference for exodontia versus preservation in Malaysia

A total of 537 dentate adults from nine randomly selected government dental centers in three states in Malaysia were interviewed to assess their preference for either exodontia or preservation of teeth when they experience toothache, or have carious anterior or posterior teeth. The assumptions tested were i) patients prefer exodontia rather than preservation when they have toothache, and ii) patients are more willing to have posterior teeth extracted than anterior teeth for caries. Both these assumptions were rejected. Even though the majority of the subjects preferred preservation (59%) when having toothache, exodontia was the treatment of choice in a large proportion of subjects (41%). Significant differences in preference were found among the various ethnic, educational, income, and age groups. However, when ethnicity was held constant, binary regression indicated that the variations observed were determined by education, income, and age groups and not by ethnicity.

Trends in tooth loss due to caries and periodontal disease by tooth type

Although the patterns of dental disease is gradually changing, caries and periodontal disease still account for the most important reason for extractions in most countries. However their relative contributions towards overall tooth mortality figures varies. The aim of this study is to investigate the types of teeth usually associated with extractions due to caries or periodontal disease and its relation to the age at which the tooth was lost. The highest proportion of extractions due to caries occurred between 21 to 30 years of age while that for periodontal disease occurred between 41 to 50 years. For caries, the greatest proportion of extractions involved the posterior teeth. The most frequently extracted teeth due to caries are the molars, in particular the first permanent molar. However, for periodontal disease a slightly greater proportion of anterior teeth were lost than the posteriors. This trend is more marked in the lower jaw than the upper. Overall, extractions related to caries tend to increase posteriorly, while that for periodontal disease tend to increase anteriorly.

The social impact of oral and facial pain in an industrial population

The aim of this study is to determine the social impact of oral and facial pain in a sample involving an industrial population. Out of a total of 355 subjects interviewed, nearly one-half claimed to have oral and facial pain in the previous one month prior to the survey. The most common type of pain was that related to hot or cold fluids or sweet things followed by toothache. On the average, the pain lasted for 4.2 days (SD = 4.9) per person in the past one-month. About one in five persons with pain reported that it was severe enough to disrupt sleep. About one in ten persons reporting pain had to take sick leave because of the pain. However, only one in four persons with pain consulted a doctor or dentist. More than one-third tried to cope with the pain and did nothing while the rest tried various means of self-cure. It is therefore postulated that in this population, pain per se is a poor predictor of utilisation of dental services. Further research into pain coping behaviour and how this affects of pattern of utilisation of dental services is indicated in order to formulate a strategy to encourage the habit of seeking prompt dental care by the target population.

Reasons for seeking dental care in a Malaysian urban adult population: an analysis by sex and ethnic group

Different groups of people will view and use modern dental services differently. This is determined by their traditional beliefs and cultural background. The aim of this study is to identify variations in utilization among adults in the three major ethnic groups in Malaysia. Dental records of 500 adults attending the University dental center were randomly selected and analyzed by sex and ethnic group. Results from this pilot study clearly indicate that different ethnic groups tend to use certain types of services more than others. Similarly, there is evidence of variation in the type of dental service preferred between males and females. The implications of these findings for dental health educators, program planners and further research is emphasized in order to promote a more positive pattern of utilization among the various ethnic groups.

Dental needs, demands and patterns of service utilization in a selected Malaysian urban population

The dental needs, demands and patterns of service utilization were assessed in a randomly selected sample of 750 subjects attending the Dental Faculty, University of Malaya, Kuala Lumpur. Toothache accounted for the most frequent overall dental complaint. However, the most common motives for seeking dental care varied among children (2-12 yr), adolescents (13-18 yr) and adults (19 + yr). The attendance behavior of women is more preventively orientated and more inclined towards rehabilitation compared to that of men. The proportion of normative needs of the patients varies from 7.5% for dentures to 66% for dental caries. About 50% of service utilization for the first visit consisted primarily of extractions in the oral surgery department.