Correlation of self-esteem with oral hygiene behaviour and oral health status among adult dental patients

Background

Self-esteem is a psychological construct that has been consistently linked to general and oral health. However, most studies interpolating self-esteem and oral health behaviour have been focused on children and adolescents, and there is a dearth of scientific literature on adults. Hence, this study, that is aimed to correlate self-esteem with oral hygiene behaviour and oral health status in Telugu-speaking adult dental patients.

Methods

A cross-sectional study involving adult dental patients who were 35-44 years of age and visited the Government Dental Hospital in Hyderabad city, India, was conducted. Self-esteem was assessed using the Telugu-translated version of the Rosenberg Self-esteem Scale, oral health behaviour was determined using the Oral Hygiene Behaviour Index and oral health assessment was performed using the World Health Organization Dentition status, the modified Community Periodontal Index and the Loss of Attachment.

Results

A total of 456 patients were included in this study. Most of the participants reported low self-esteem, with a mean score of 11.8 ± 2.7. Patients with primary school education reported higher self-esteem scores than those with high school and university education (p = 0.0001). Furthermore, low Oral Hygiene Behaviour Index scores (64.9%) in the study population and high Decayed, Missing, Filled Teeth scores in females (5.7 ± 4.4; p = 0.09) were noted. None of the variables (Decayed, Missing, Filled Teeth scores, Oral Hygiene Behaviour, gingival bleeding and Loss of Attachment) were significantly correlated with self-esteem. Multivariable regression analysis revealed that younger age, lower educational level and presence of dental caries resulted in higher odds for high self-esteem (p < 0.01).

Conclusion

The findings indicated a significant association between self-esteem and oral health. Indivi-duals with dental caries had significantly higher odds for high self-esteem. Thus, this study emphasises the relevance of psychosocial factors, such as self-esteem, as the mediator of oral health.

Psychometric properties of the Telugu version of Rosenberg Self-esteem scale (RSES-T)

Background

The Rosenberg Self-esteem Scale (RSES) is the most commonly used tool for measuring global self-esteem. Till date, RSES has been translated into different languages and the reports are good for their validity and reliability. Telugu being the fourth most spoken language in India, it is timely to translate and validate the Telugu version of RSES. The aim of this study thus is to assess the psychometric properties of the Telugu version of Rosenberg Self-esteem Scale (RSES-T).

Study design

Cross-sectional study.

Methods

This study was carried out to assess the psychometric properties of RSES-T among undergraduate students of a dental college. For this purpose, the English version of RSES was translated into Telugu and was administered to the participants along with the revised English version of Self-Liking/Self-Competence Scale (SL/SC-R) to evaluate the construct validity. The internal consistency of RSES-T was assessed using Cronbach´s α and the temporal stability was tested by test-retest reliability. Confirmatory factor analysis was conducted to examine the underlying dimensional structure of the questionnaire by assessing the cor-relation of RSES-T with SL/SC-R.

Results

Confirmatory factor analysis revealed a positive one-factor structure with Model 3 showing the best fit to data. Internal consistency for RSES-T was found to be good with Cronbach's α of 0.82 at follow-up and the test-retest reliability was found to be satisfactory (0.42) after a two weeks' interval. Furthermore, the item-wise mean score differences showed higher scores for male students than females. Likewise, the item-total correlation of RSES-T showed positive correlation with scores varying from 0.17 to 0.69 at the follow-up.

Conclusion

The Telugu version of RSES exhibited a unidimensional structure and showed good psychometric properties in terms of internal consistency, construct validity and reliability. Hence, these findings provide empirical support to evaluate global self-esteem among Telugu speaking population in future.

COVID-19 VACCINE REACTIONS AND SUSPECTED POLYETHYLENE GLYCOL ALLERGY: A PEDIATRIC CASE SERIES

Introduction

Studies have demonstrated tolerance in high risk patients receiving Covid-19 m-RNA vaccines containing polyethylene glycol (PEG) with rare reactions.There is limited pediatric data regarding safety in receiving PEG containing Covid-19 vaccines with a history of prior hypersensitivity reactions to PEG containing chemotherapy (PEG-CTX).

Methods

Retrospective chart review from referred Pediatric Oncology patients with a history of prior reactions to PEG-CTX (01/2020-04/2022). Selective skin testing was completed using PEG molecular weigh 3350 and m-RNA Covid-19 vaccines with controls.

Results

Four pediatric patients (≤18 years old) had evidence suggestive of an immediate, hypersensitive reaction to PEG-CTX following treatment for acute lymphoblastic leukemia (ALL). All 4 patients experienced prior reactions to chemotherapy (L-Asparaginase). Symptoms included: hypotension, flushing, urticaria, angioedema, emesis and tachycardia. Due to prior reactions, these high-risk patients were not administered PEG containing Covid-19 vaccines due to safety concerns. Non-PEG containing Covid-19 vaccines were not approved for use in pediatric patients. Allergy skin testing (skin prick and intradermal) was completed in all four patients. One of 4 patients tested positive to both PEG and PEG containing Covid-19 vaccine. The 3 negative patients were administered PEG containing Covid-19 vaccine with monitoring for one hour without symptoms.

Conclusion

Pediatric patients in our study with prior reactions to PEG-CTX tolerated PEG containing Covid-19 vaccines. Further studies are needed in assessing PEG allergy in high-risk patients with a past history of reactions to PEG-CTX.

'Stability' of Assessment: Extending the Utility Equation

This article was migrated. The article was marked as recommended. The COVID-19 pandemic has brought many challenges to medical education, necessitating a rapid transition to digital delivery. The widespread move to online exams has introduced novel risks, including the risk of catastrophic IT failure. These are not 'black swan' events - something so unexpected and devastating that we could not anticipate them and prepare accordingly. The phrase 'black elephants', a cross between a black swan and 'the elephant in the room' has been coined to describe these events. Moving to high-stakes online examinations introduces another element that needs to be considered and managed: the 'stability' of the assessment format used. This dimension incorporates notions of 'platform reliability' and 'internal risk management' and can be caused by both unplanned events eg IT failures, and planned events like security breaches Developing approaches to mitigate this new risk suggests another dimension to the well-known assessment 'utility equation': stability of the platform used. This paper explores the concept of stability from the perspectives of educational institutions and candidates and offers some approaches to achieving stability. The delivery of assessment in the digital age, requires the 'utility equation' to be recalibrated and establishment of a new "sweet spot" for each assessment program.

Bell'S Palsy in Children: Is There Any Role of Steroid or Acyclovir?

We describe a case of a seven-year-old child with Bell's palsy who made a full recovery without the use of steroid or acyclovir. This is followed by a review of the literature to see whether or not there is any role of steroid or acyclovir in childhood Bell's palsy.

Review article: Critical Care Airway Management eLearning modules

The Australasian College for Emergency Medicine (ACEM) has recently launched the Critical Care Airway Management eLearning modules to support emergency medicine trainees in developing their airway management skills in the ED. A team of emergency physicians and trainees worked collaboratively to develop the eLearning resources ensuring extensive stakeholder consultation. A comprehensive resource manual was written to provide learners with knowledge that underpins the modules. ACEM provided project coordination as well as administrative and technical team support to the production. Although specifically developed with early ACEM trainees in mind, it is envisaged the resources will be useful for all emergency clinicians. The project was funded by the Australian Commonwealth Department of Health.

Validation of a short food frequency questionnaire in Australian adults

The aim of this article is to report on the validity and internal consistency of a short food frequency questionnaire (FFQ) to measure dietary intake in Australian adults. A total of 407 individuals completed the short FFQ. The Cronbach's alpha of 0.66 indicated acceptable internal consistency for the FFQ. Content validity was measured using factor analysis showed that 35% of total variance was explained by factor analysis. The FFQ was also validated against 31 3-day food records (FR). No significant difference between average intake of energy, most macronutrients, and some micronutrients between two instruments was identified. An acceptable levels of correlation (0.39-0.69) was observed between the two instruments. Bland and Altman's plots showed relative agreement in both instruments with potential bias in measuring iron and iodine. The current FFQ can be an acceptable tool to quickly measuring dietary intake in Australian adults.

Effectiveness and tolerability of simeprevir and sofosbuvir in nontransplant and post-liver transplant patients with hepatitis C genotype 1

BACKGROUND

Hepatitis C virus genotype 1a (HCV-1a), prior treatment, cirrhosis and post-transplant status are historically associated with poor treatment responses. The new oral direct-acting agents appear to be effective and safe in these patients.

AIMS

To evaluate the effectiveness and tolerability of simeprevir and sofosbuvir in a diverse real-life cohort of patients, including difficult-to-treat patients.

METHODS

We conducted a retrospective cohort study in 198 consecutive patients with hepatitis C genotype 1 (148 nontransplant, 50 post transplant), who were treated with simeprevir and sofosbuvir for 12 weeks between December 2013 and December 2014. Primary outcome was sustained virological response with undetectable HCV RNA 12 weeks after completion of therapy (SVR12). Risk factors evaluated for lack of SVR12 included HCV 1a (vs. 1b), prior treatment (vs. none), and cirrhosis (vs. no cirrhosis).

RESULTS

SVR12 rates were similar in non- and post-transplant settings, 82% and 88%, respectively. There were no significant differences in adverse events in patients regardless of cirrhosis or transplant status. On multivariate analysis also inclusive of gender and liver transplant status, negative predictors of SVR12 were having at least 2 or 3 risk factors (OR 0.30, 95% CI 0.10-0.87, P = 0.027 or 0.29, 95% CI 0.09-0.85, P = 0.025, respectively).

CONCLUSION

Simeprevir and sofosbuvir combination is a safe and effective regimen for the treatment of non- and post-transplant patients with traditional risk factors for poor treatment response, unless more than 2 difficult-to-treat risk factors are present.

Knowledge, Attitude and Practice Regarding Organ Donation among Indian Dental Students

BACKGROUND

Of the overall 9.5 million deaths annually in India, nearly 100,000 are due to organ failure. To save and extend lives, organ donation and organ transplantation have become the only hope. Health care professionals (HCPs) are a key element in facilitating cadaveric organ donation process.

OBJECTIVE

To assess and compare the knowledge, attitude, and practice regarding organ donation among undergraduate dental students.

METHODS

A cross-sectional study was conducted among 298 undergraduate dental students of the Panineeya Institute of Dental Sciences and Hospital, Hyderabad, India. A 27-item self-administered questionnaire, which assessed the levels of knowledge (Q1-13), positive attitude (Q14-24) and practice habits (Q25-27) regarding organ donation with dichotomous scale (Yes/No).

RESULTS

As compared to males, females reported better mean±SD scores in knowledge (8.22±1.51) and practice (0.91±0.8); higher mean±SD attitude scores (8.55±1.56) were reported among males (p<0.001). While second year dental students had higher scores for their knowledge (8.55±1.56) and practice (1.02±0.44) compared to other year of training, third year students showed a significant higher mean attitude score (1.73±1.17) (p=0.02). Hindus and Muslims scored significantly lower mean knowledge, attitude and practice habits compared to others (Christians, Jains and Athesists) (p<0.001). There was a positive correlation between mean knowledge, attitude, and practice habits.

CONCLUSION

There are an average level of knowledge and low levels of positive attitude and practice habits among studied dental students towards organ donation and transplantation.

Amiodarone-Induced Life-Threatening Refractory Hypotension

BACKGROUND

Amiodarone is frequently used in emergency departments for treatment of arrhythmias. Incidence of several amiodarone-related adverse events is unknown. The literature is sparse for potentially life-threatening adverse effects of amiodarone.

CASE REPORT

We present a case of a male patient who presented with chest discomfort and rapid atrial fibrillation. He was known to have paroxysmal atrial fibrillation, which did not respond to initial beta-blocker treatment. The second-line drug amiodarone was given to the patient for rate control. He developed severe hypotension related to amiodarone and required inotropic support along with rapid-sequence intubation.

CONCLUSIONS

Intravenous amiodarone can cause severe and refractory hypotension.

A new patient-controlled technique for shoulder relocation in emergency departments

BACKGROUND

The glenohumeral joint is the most mobile joint in the human body due to the shallowness of the glenoid socket. This unique anatomy also makes it the most dislocated joint in humans. All the techniques described so far for relocation require operator control and prescription drugs. We describe a technique that is unique, easy, and patient-controlled.

CASE REPORT

A 29-year-old male patient presented to the Emergency Department after falling from scaffolding at work. He had left shoulder dislocation confirmed by clinical and radiological examination. The patient lay face down on the trolley with trolley being raised with electronic controls. The shoulder was reduced with ease and the patient was discharged home after radiologic confirmation of reduction.

CONCLUSIONS

A new patient-controlled technique for reduction of the glenohumeral joint following dislocation is described. It is simple, safe, and effective to perform in Emergency Departments.

FAST scan in the diagnosis of acute diaphragmatic rupture

Focused assessment with sonography in trauma (FAST) scan can be used by emergency physicians in the diagnosis of diaphragmatic rupture in blunt abdominal trauma. We introduce a new feature 'Rip's absent organ sign' on FAST scan in the diagnosis of acute diaphragmatic rupture.

Controlling Seizures in Children: Diazepam or Midazolam? Systematic Review

Introduction

Diazepam is commonly used to treat acute childhood seizures, but difficulty gaining intravenous access and variability of absorption after rectal administration can limit its efficacy. Midazolam is a water soluble benzodiazepine that has a rapid onset of action after intranasal or buccal administration and provides an alternative to diazepam in the control of acute childhood seizures.

Methods

A literature search was performed to identify papers comparing the efficacy and tolerability of midazolam and diazepam in the management of childhood seizures.

Results

Intranasal or buccal midazolam are at least as effective as rectal or intravenous diazepam in controlling acute childhood seizures. In all robust studies reporting a significant difference, time to gain seizure control was shorter in patients treated with midazolam than those treated with diazepam, predominantly due to shorter drug administration time. The incidence of seizure recurrence was lower in patients treated with midazolam than diazepam. Respiratory depression was uncommon in both groups.

Conclusion

Intranasal or buccal midazolam provides a safe, effective and acceptable alternative to intravenous or rectal diazepam in the management of acute childhood seizures.

Periodontal status of HIV-positive patients

OBJECTIVE

To assess the periodontal status of HIV positive individuals and to compare it with age-and gender-matched controls.

MATERIALS AND METHODS

The cross-sectional study comprised fifty-two HIV positive individuals and fifty-two controls. OHI-S and PI were recorded by a single pre-trained and pre-calibrated examiner.

RESULTS

Based on antiretroviral therapy use, mean OHI-S was higher among HIV positive females undergoing therapy. A significant gender difference was observed in the PI score among those on antiretroviral therapy, with females having a lower score (p = 0.04). Also, significant gender difference was observed in the mean PI score among HIV positive individuals, with males having a higher score.

CONCLUSION

There was a significant difference in the overall mean OHI-S score among HIV positive individuals and controls (p = 0.03). However, no significant difference was observed when the overall PI score was calculated for both groups (p = 0.95).

Dorsal dislocation of the intermediate cuneiform with fracture of the Lisfranc joint: a case report

Tarsal cuneiform dislocation in association with Lisfranc fracture-dislocation is a rare pedal injury. In this report, we describe the case of a patient who sustained a dorsal dislocation of the intermediate cuneiform in association with tarsometatarsal fracture-dislocation following traumatic axial loading and torsion of his foot. A satisfactory outcome was achieved by treating the injury by means of closed reduction and percutaneous Kirschner wire fixation. ACFAS Level of Clinical Evidence: 4.

Atypical presentation of renal cell carcinoma: a case report

A case of Renal Cell Carcinoma (RCC) presenting to the Emergency Department with pyrexia and rigors is discussed.

Oral manifestations in HIV/AIDS infected patients from India

OBJECTIVES

To assess types and prevalence of HIV-related oral lesions among HIV-infected individuals in south India and to correlate common oral findings with co-morbidities, gender, age and medication.

SUBJECTS AND METHODS

One hundred and one patients with HIV infection or AIDS at infectious diseases units of Attavar Hospital, Mangalore, and medical wards of Kasturba Medical College, Manipal, were selected. Sociodemographic information was obtained using a structured questionnaire. Oral lesions were diagnosed according to the presumptive criteria of EEC-Clearinghouse Classification. Clinical history was retrieved from patient's medical records.

RESULTS

Erythematous candidiasis (44.5%), melanotic hyperpigmentaion (34.6%) and xerostomia (29.7%) were among the most common oral manifestations. A significant association was found between oral candidiasis and advanced immunosuppression (P < 0.05). Oral hairy leukoplakia (OHL) was predominant in individuals <35 years (P < 0.05). Melanotic hyperpigmentation was significantly associated with highly active antiretroviral therapy (P < 0.05). OHL was more frequent in patients with HIV-associated tuberculosis. Linear gingival erythema was more predominant in females.

CONCLUSIONS

Oral hairy leukoplakia showed a positive relationship with patients younger than 35 years. Oral candidiasis can act as a marker for immunosuppression. Angular cheilitis was predominant in the symptomatic stage.

A case of pyrexia from abroad

A case of pyrexia from abroad presenting to the emergency department is discussed. The causes of such pyrexia are outlined and the investigations are described. We stress that vaccination is not foolproof from acquiring an infection from abroad.

Heart rate measures in blind cave crayfish during environmental disturbances and social interactions

Most animals continually assess the environment in which they live and alter their behavior according to various stimuli. As an observer, one looks for changes in a behavior indicating that an animal responded to a particular event. When the animal does not make significant behavioral changes as measured by bodily movements, the animal may be characterized as unresponsive to a given stimulus. This study demonstrates that when behavioral body movements can not be observed an internal physiological measure of heart rate (HR) shows dramatic changes following presentation of defined stimuli. This study used the blind cave crayfish and examined their responsiveness to the following stimuli: light (infrared, dim red, and white), water-borne vibrations, removal of water, olfactory cues, and social interaction with partners. This study demonstrates that there is substantial individual variation of HR at basal levels and with the intensity of an social interaction. We find HR is a reasonable measure of the responsiveness of blind cave crayfish to given stimuli even in the absence of observable behavioral changes. This enables the observer to determine if an individual is responsive to and making an assessment of particular cues.

Medical Outcomes Study Short Form 36: a possible source of utilities?

General health-status questionnaires such as the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) are frequently used to measure health-related quality of life. The SF-36, in its current form, cannot be used to measure individuals' utilities or preferences for their health state. Recently, several investigators have explored the possibility of obtaining utilities from the SF-36. This article reviews the SF-36 survey, selected measures of utility, and the differences between health-status and utility measures, with an emphasis on use of SF-36 results to derive utility scores. We searched the literature from January 1966 to July 1999 using MEDLINE and HEALTHSTAR. The terms SF-36, health-status instruments, utilities, and preferences were searched to identify studies that had used both the SF-36 and a utility-based instrument. We first discuss studies that were specifically designed to find a predictive equation to obtain utilities from SF-36 scores. We then discuss studies that examined the correlation between the SF-36 and a utility-based instrument but that were not intended to develop a predictive equation as their primary objective. The studies that have tried to derive utilities from the SF-36 using a predictive equation have used different methodologies; to date, no reliable method has been appropriately validated. The poor correlation reported in most of the studies attests to the complex relationship between utility-based instruments and the SF-36. More work is needed to elucidate if utilities can be obtained from the SF-36.

Uptake and distribution of lidocaine in fetal lambs

The fetal uptake of lidocaine was measured continually and quantitatively during and after a constant rate intravenous (iv) maternal infusion into five chronically prepared pregnant ewes. Lidocaine, 6 mg/kg (base), was infused at a constant rate for 1 h and measurements continued to 5 h. Rate of fetal uptake was determined from the product of the umbilical venous (UV) and fetal aortic (FA) concentration difference and umbilical blood flow (Qu). Total fetal uptake was determined by integrating fetal uptake rate with respect to time. Maternal and fetal protein binding was determined, and its effect on fetal blood concentrations was evaluated. Mean total fetal uptake as it related to time and infused dose increased linearly (r = 0.998, P less than 0.001) with a constant, weight-normalized fetal-maternal dose fraction of 0.45 during the infusion. Despite rapidly declining blood concentrations after the infusion, uptake increased an additional 17%. The sevenfold variation in uptake appeared to be inversely related to the biodegradation rate of lidocaine. Fetal-maternal concentration ratios (F/M) increased during declining blood concentrations. Protein binding determinations for maternal and fetal blood were 43.6 +/- 2.48% and 26.9 +/- 1.59%, respectively. These values were used to calculate the F/M in conjunction with the maternal and fetal pH. At maternal-fetal equilibrium the calculated F/M, 1.0 +/- 0.05, closely approximated the observed, 1.0 +/- 0.03. Variations in lidocaine concentrations among the vital organs 4 h after the infusion were small, but high concentrations of metabolites were found in the lungs and kidneys. The results challenge the validity of placental transfer estimates commonly based on the F/M and umbilical cord blood concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)

Uptake and distribution of bupivacaine in fetal lambs

Direct continual measurement of placental drug transfer was introduced to evaluate more precisely the fetal uptake of a commonly used local anesthetic in obstetrics. Bupivacaine, 2.7 mg X kg-1 (base), was infused at a constant rate over 1 h into a maternal jugular vein of five chronically prepared pregnant ewes. Blood was sampled simultaneously from the umbilical vein (UV), fetal aorta (FA), and a maternal artery (MA). Fetal uptake rate was determined from the product of the bupivacaine UV-FA blood concentration difference and the umbilical flow rate (Qu). Total fetal accumulation was determined by integrating uptake rate over 5 h. Correlation of total fetal uptake and the infused mean maternal dose (r = 0.993, P less than 0.001) indicated that during the infusion, mean fetal uptake was a constant fraction (0.16) of the maternal infused dose. Total fetal uptake was linear despite wide individual changes in Qu, suggesting that within limits fetal accumulation is not Qu-dependent. Mean ovine protein binding of bupivacaine by maternal and fetal whole blood was 85.49% +/- 2.61 (SD) and by fetal blood, 40.43% +/- 9.60 (SD). Back-transfer of bupivacaine to the mother proceeded against a higher total bupivacaine concentration because unbound unionized drug concentrations in maternal blood were less than in fetal blood. At maternal-fetal equilibrium when UV and FA total blood concentrations were equal, the calculated fetal/maternal concentration ratio (f/m) (0.36) determined from the maternal and fetal protein binding and pH closely approximated the observed (0.35). The f/m increased during both fetal uptake and back-transfer and cannot be considered a good index of placental transfer.(ABSTRACT TRUNCATED AT 250 WORDS)