Treatment outcome and long-term stability of orthognathic surgery for facial asymmetry: A systematic review and meta-analysis

Objective

: This systematic review aimed to provide a comparative analysis of the treatment outcomes, including hard and soft tissues, postoperative stability, temporomandibular disorders (TMD), and quality of life (QoL), in patients with facial asymmetry who underwent orthognathic surgery.

Methods

: The primary objective was to address the question, "How do different factors related to surgery affect the outcomes and stability of orthognathic surgery in the correction of facial asymmetry?" A meta-analysis was conducted on the outcome parameters, such as skeletal, dental, and soft tissue symmetry, TMD, QoL, and relapse, using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Subgroup analyses were conducted considering surgery-related factors such as surgical techniques (one-jaw vs. two-jaw), use of the surgery-first approach, utilization of computer simulation, and analytical methods employed to evaluate asymmetry (2D vs. 3D).

Results

: Forty-nine articles met the inclusion criteria. The meta-analysis demonstrated a significant improvement in the symmetry of hard and soft tissues. The subgroup analysis indicated that the treatment outcomes showed significant improvement, regardless of the factors related to surgery. Changes in TMD signs and symptoms varied according to the surgical technique used. Quality of life improved in the facial, oral, and social domains. Skeletal relapse was observed during the follow-up.

Conclusions

: Our findings support the positive outcomes of orthognathic surgery in the treatment of facial asymmetry in terms of skeletal and soft tissue improvements, stability, relief of TMD symptoms, and enhancement of QoL. However, most of the included studies showed a low certainty of evidence and high heterogeneity.

Novel Procedure for Automatic Registration between Cone-Beam Computed Tomography and Intraoral Scan Data Supported with 3D Segmentation

In contemporary practice, intraoral scans and cone-beam computed tomography (CBCT) are widely adopted techniques for tooth localization and the acquisition of comprehensive three-dimensional models. Despite their utility, each dataset presents inherent merits and limitations, prompting the pursuit of an amalgamated solution for optimization. Thus, this research introduces a novel 3D registration approach aimed at harmonizing these distinct datasets to offer a holistic perspective. In the pre-processing phase, a retrained Mask-RCNN is deployed on both sagittal and panoramic projections to partition upper and lower teeth from the encompassing CBCT raw data. Simultaneously, a chromatic classification model is proposed for segregating gingival tissue from tooth structures in intraoral scan data. Subsequently, the segregated datasets are aligned based on dental crowns, employing the robust RANSAC and ICP algorithms. To assess the proposed methodology's efficacy, the Euclidean distance between corresponding points is statistically evaluated. Additionally, dental experts, including two orthodontists and an experienced general dentist, evaluate the clinical potential by measuring distances between landmarks on tooth surfaces. The computed error in corresponding point distances between intraoral scan data and CBCT data in the automatically registered datasets utilizing the proposed technique is quantified at 0.234 ± 0.019 mm, which is significantly below the 0.3 mm CBCT voxel size. Moreover, the average measurement discrepancy among expert-identified landmarks ranges from 0.368 to 1.079 mm, underscoring the promise of the proposed method.

Diagnosis of temporomandibular disorders using artificial intelligence technologies: A systematic review and meta-analysis

Background

Artificial intelligence (AI) algorithms have been applied to diagnose temporomandibular disorders (TMDs). However, studies have used different patient selection criteria, disease subtypes, input data, and outcome measures. Resultantly, the performance of the AI models varies.

Objective

This study aimed to systematically summarize the current literature on the application of AI technologies for diagnosis of different TMD subtypes, evaluate the quality of these studies, and assess the diagnostic accuracy of existing AI models.

Materials and methods

The study protocol was carried out based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA). The PubMed, Embase, and Web of Science databases were searched to find relevant articles from database inception to June 2022. Studies that used AI algorithms to diagnose at least one subtype of TMD and those that assessed the performance of AI algorithms were included. We excluded studies on orofacial pain that were not directly related to the TMD, such as studies on atypical facial pain and neuropathic pain, editorials, book chapters, and excerpts without detailed empirical data. The risk of bias was assessed using the QUADAS-2 tool. We used Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) to provide certainty of evidence.

Results

A total of 17 articles for automated diagnosis of masticatory muscle disorders, TMJ osteoarthrosis, internal derangement, and disc perforation were included; they were retrospective studies, case-control studies, cohort studies, and a pilot study. Seven studies were subjected to a meta-analysis for diagnostic accuracy. According to the GRADE, the certainty of evidence was very low. The performance of the AI models had accuracy and specificity ranging from 84% to 99.9% and 73% to 100%, respectively. The pooled accuracy was 0.91 (95% CI 0.76–0.99), I² = 97% (95% CI 0.96–0.98), p < 0.001.

Conclusions

Various AI algorithms developed for diagnosing TMDs may provide additional clinical expertise to increase diagnostic accuracy. However, it should be noted that a high risk of bias was present in the included studies. Also, certainty of evidence was very low. Future research of higher quality is strongly recommended.

Undiagnosed and Uncontrolled Hypertension and Access to Health Care among Residents of an Urban Area of Eastern Nepal: a Cross-sectional Study

Background The burden and complication of hypertension is increasing as most of the people living with hypertension are unaware of their condition and those who are already diagnosed with it do not have their blood pressure under control. Objective To assess the prevalence of undiagnosed and uncontrolled hypertension among residents of Itahari sub metropolitan city of eastern Nepal, along with its associated socio demographic and behavioral risk factors and access to health care services. Method Cross sectional study was conducted in five wards of Itahari, among 1161 participants, using population proportionate to sample size sampling technique. Face to face interview was conducted with participants for data collection applying semi- structured questionnaire and physical measurement like blood pressure, weight and height. Result Prevalence of hypertension was 26.5% includingundiagnosed 11.0% and previously diagnosed 15.5%. Among diagnosed, 76.6% had uncontrolled blood pressure and 56.70% were taking anti-hypertensive medicine, and 7.8% were under Ayurvedic medicine. More than 70% participants preferred private health facility for treatment and 22.7% had faced financial barrier to seek healthcare. About 64% of participants did not visit health services or had visited only once in past six months. Increasing age, Body Mass Index (BMI), smoking status and positive family history were found to be significantly associated with hypertension at < 0.05 level. Conclusion Prevalence of hypertension is high and awareness regarding available health services in local primary health center and its utilization is lacking among participants. Regular screening program for hypertension and awareness program to disseminate the knowledge of availability of primary health center should be conducted.

A Point Prevalence Study of the Use of Antibiotics in Six Tertiary Care Hospitals in the Kathmandu Valley, Nepal

Background Point prevalence survey (PPS) on antibiotic use developed by the WHO has already been used in many hospitals globally. Objective To obtain information on antibiotic prescribtion using point prevalence survey methodology in six private hospitals in the Kathmandu valley. Method This descriptive cross-sectional study was completed during 20th July to 28th July 2021 using point prevalence survey methodology. The study was conducted among inpatients admitted at or before 8:00 AM on the day of survey in various wards. Data was presented as frequencies and percentages. Result Maximum number of patients were above 60 years [34 (18.7%)]. Number of male and female participants were equal [91 (50%)]. Only one antibiotic was used in 81 patients (44.5%) followed by two antibiotics in 71 (39%) patients. Duration of prophylactic antibiotic use was one day in 66 (63.7%) patients. Blood, urine, sputum, and wound swabs were the common samples for culture. Cultures were positive for 17 (24.7%) samples. The common organisms isolated were E. Coli, Pseudomonas aeruginosa and Klebsiella pneumoniae. Ceftriaxone was the most used antibiotic. Drug and therapeutics, infection control committee and pharmacovigilance activities were present in 3/6 (50%) study sites. Antimicrobial stewardship was present in 3/6 (50%) and microbiological services was present in all hospitals. Antibiotic formulary and antibiotic guideline were present in 4/6 sites and facilities to audit or review surgical antibiotic prophylaxis choice in 2/6 (33.3%) sites, facility to monitor antibiotic use in 4/6 (66.6%) and cumulative antibiotic susceptibility reports in 2/6 (33.3%) study sites. Conclusion Ceftriaxone was the most used antibiotic. E. Coli, Pseudomonas aeruginosa and Klebsiella pneumonia were the commonly isolated organisms. Not all parameters for infrastructure, policy and practice and monitoring and feedback were present at the study sites. KEY WORDS.

Human Resources for Cardiovascular Disease Management in Nepal: A National Need Assessment

Background Human resources are the mainstay of the healthcare system. Higher numbers of health workers have better healthcare coverage and outcomes. Availability of trained human resources to address the exponential rise in cardiovascular disease in Nepal is a national concern. Objective To assess the need of human resources for cardiovascular disease management in Nepal. Method We conducted an exploratory sequential mixed-method study. We developed a task force and organized a national workshop to engage stakeholders and collect feedback on the research process. We did a desk review and conducted 24 key informant interviews. We did thematic analysis from the codes generated. Result There is no clear definition and required estimation of health workers for cardiovascular disease management. There is a shortage of health workers with 8.9 doctors, 20.8 nurses, 0.05 cardiologist/cardiac surgeon, 4.2 pharmacist, 10.2 laboratory technicians per 10,000 population. There is a comprehensive human resource plan but it does not provide details of human resources for cardiovascular disease management. There is a lack of public private collaboration for human resource management. However, there is production of human resources for cardiovascular disease management through pre-service specialized courses and inservice training. Conclusion A clear definition and estimation of health workers with stringent human resource plan for cardiovascular disease management is essential. The government can still address these gaps by establishing a well-equipped central health workforce unit and expanding collaboration with private sectors.

Medical Products for Cardiovascular Disease Management in Nepal: a needs assessment study

Background Medical Products and Technologies is a key component of the health system. Quality medicines and efficient management of the medical products can secure effective cardiovascular diseases management. Objective To collate information and identify strengths, weaknesses, opportunities and threats (SWOT) associated with medical products and technology component for cardiovascular disease management in Nepal. Method This study is a part of a larger rapid assessment of Nepal's health system for cardiovascular disease management and based on The Health System Assessment Approach: A How-To Manual (USAID). The authors conducted a desk review of documents related to the WHO "medical product and technology" building block component and key informant interviews using a pre-tested interview protocol. The first eight interviews were transcribed verbatim and analysed inductively to generate a codebook; and the remaining, transcribed and deductively coded based on the codebook. Findings were categorised into relevant topical area and SWOT components. Result Nepal has laws and provisions for medicine regulation, pharmacovigilance, post marketing surveillance, registration and licensing provisions for pharmacy industries/ outlets, essential medicine lists and national formulary. These provisions also apply to medicines used for cardiovascular diseases. The challenge however, is the lack of effective implementation and monitoring, due to shortages of technical workforce and state of art information and technologies. Information on pharmaceutical expenditures for cardiovascular disease management is scarce; there are no standard national level guidelines that are consistently used to manage cardiovascular diseases in health facilities. Conclusion There are limited provisions and information on medical products for cardiovascular disease management in Nepal, and a need to strengthen existing provisions for medicine regulations and surveillance.

Assessment of Health Service Delivery to Address Cardiovascular Diseases in Nepal

Background A health care delivery system is the organization of people, institutions, and resources designed to deliver health services. A comprehensive study to explore cardiovascular health service delivery in Nepal is lacking. Objective This study attempted to assess Nepal's health system gap on organization and delivery of cardiovascular disease prevention and management services. Method This mixed-method study used the six building blocks of the World Health Organization health system framework: organization; access; coverage, utilization and demand; equity; quality of services; and outcomes. We conducted the desk reviews of national and international documents, performed several key informant interviews, calculated the relevant indicators, and assessed the Strengths, Weaknesses, Opportunities, and Threats of the cardiovascular health service delivery. Result We found that most of the cardiovascular services are concentrated in urban areas, and suffer from poor access, quality, utilization, and coverage in most of the areas resulting in poor health outcomes. Though the services have recently improved due to increased primary care interventions, there is scope for the development of competent human resources, advancement of technologies, development of national protocols, and improved monitoring and supervision. Improved disease system including the medical recording and reporting mechanism to incorporate and reflect the true burden of CVD in Nepal is lacking. Conclusion Despite having health facilities from grassroots to the central level, availability, access, and quality of cardiovascular health services are poor. Further improvement and equitable expansion of promotive, preventive, diagnostic, referral, and rehabilitative cardiovascular services are needed to ensure universal health coverage.

Needs Assessment of Leadership and Governance in Cardiovascular Health in Nepal

Background Good governance and leadership are essential to improve healthy life expectancy particularly in low and middle-income countries (LMICs). This study aimed to epitomize the challenges and opportunities for leadership and good governance for the health system to address non-communicable diseases particularly cardiovascular diseases (CVD) in Nepal. Objective The objective of this study was to understand and document CVD programs and policy formulation processes and to identify the government capacity to engage stakeholders for planning and implementation purposes. Method A national-level task force was formed to coordinate and steer the overall need assessment process. A qualitative study design was adopted using "The Health System Assessment Approach". Eighteen indicators under six topical areas in leadership and governance in cardiovascular health were assessed using desk review and key informant interviews. Result Voice and accountability exist in planning for health from the local level. The government has shown a strong willingness and has a strategy to work together with the private and non-government sectors in health however, the coordination has not been effective. There are strong rules in place for regulatory quality, control of corruption, and maintaining financial transparency. The government frequently relies on evidence generated from large-scale surveys for health policy formulation and planning but research in cardiovascular health has been minimum. There is a scarcity of cardiovascular disease-specific protocols. Conclusion Despite plenty of opportunities, much homework is needed to improve leadership and governance in cardiovascular health in Nepal. The government needs to designate a workforce for specific programs to help monitor the enforcement of health sector regulations, allocate enough funding to encourage CVD research, and work towards developing CVD-specific guidelines, protocols, and capacity building. KEY WORDS Cardiovascular diseases, Governance, Leadership, Needs assessment, Nepal.

National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study

Background Health financing is a major domain of health system building blocks. With the epidemiological transition and increasing trend of Cardiovascular diseases (CVDs), it is crucial to assess the status of health financing to address the gap of prevention, control, and treatment of CVDs in Nepal. Objective This paper aims to assess the situation of healthcare financing on Cardiovascular diseases in Nepal. We framed three key functions of health system financing: (a) revenue collection, (b) pooling of resources, and (c) purchasing of services for this study. Method We used sequential explanatory mixed-method research design. We conducted desk reviews, analyzed secondary data on health financing followed by Key-Informant Interviews with five relevant policymakers and experts between February and September 2019. We obtained the Ethical clearance from the Nepal Health Research Council. Result Out of pocket (OOP) expenditure remains the highest source (52%) of total health care expenditure in Nepal, and two third of it is made for NCDs. Out of total current health expenditure on outpatient and inpatient services for fiscal year 2015/16, only 7% of total NCDs was spent on CVDs. Hypertension is the third-most utilized insurance service out of 36 CVD related services provided by the Health Insurance Board. The existing health related social service schemes covers the high costs associated with treatment, and streamlining these services including provider payment mechanisms with the health insurance program could open up opportunities to expand quality CVD services and make it accessible to the marginalized population. Conclusion Health Financing is the integral part of the health system. With the rising burden of cardiovascular diseases and its impact on impoverishment due to high OOP, integrated health care services, budget specification based on the evidence-based burden of disease such as CVD needs to be prioritized by the government.

National Needs Assessment of Health Information System to Address Cardiovascular Diseases in Nepal: A Mixed Method Study

Background Health information system is an integral component of a country's capacity to integrate, process, report, and use information in improving health services. Objective This study aims to assess the infrastructure and capacity of the national Health information system to address cardiovascular diseases in Nepal. Method We adopted the United States Agency for International Development manual "The Health System Assessment Approach: A How-To Manual", Version 2.0. Three topical areas: input, process and output, were identified. Stepwise approach for Health information system assessment was done. A desk review and key informant interview was performed. Audio recordings were transcribed in Nepali language and intercoder reliability was checked. Result The upgraded District Health Information Software 2.3 provides a comprehensive online data management solution. Sustainable funding to upgrade the system exists. Annual report provides performance of all the components of the health care delivery system. Data were reviewed quarterly. However, no dedicated section for cardiovascular diseases in the Health information system is present. Private health facilities are poorly represented. Strategic planning, management, and evaluation of the Health information system are lacking. Inadequacy of timeliness, completeness, and periodicity of the reporting still exist. Conclusion A separate section of cardiovascular diseases in the Health information system is required. Better reporting of private sectors and its inclusion in databases is of utmost importance. Adaptation in the recently introduced federal structure is key for development of Health information system in the country.

Risk factor assessments of temporomandibular disorders via machine learning

This study aimed to use artificial intelligence to determine whether biological and psychosocial factors, such as stress, socioeconomic status, and working conditions, were major risk factors for temporomandibular disorders (TMDs). Data were retrieved from the fourth Korea National Health and Nutritional Examination Survey (2009), with information concerning 4744 participants' TMDs, demographic factors, socioeconomic status, working conditions, and health-related determinants. Based on variable importance observed from the random forest, the top 20 determinants of self-reported TMDs were body mass index (BMI), household income (monthly), sleep (daily), obesity (subjective), health (subjective), working conditions (control, hygiene, respect, risks, and workload), occupation, education, region (metropolitan), residence type (apartment), stress, smoking status, marital status, and sex. The top 20 determinants of temporomandibular disorders determined via a doctor's diagnosis were BMI, age, household income (monthly), sleep (daily), obesity (subjective), working conditions (control, hygiene, risks, and workload), household income (subjective), subjective health, education, smoking status, residence type (apartment), region (metropolitan), sex, marital status, and allergic rhinitis. This study supports the hypothesis, highlighting the importance of obesity, general health, stress, socioeconomic status, and working conditions in the management of TMDs.

Projected lifetime cancer risk from cone-beam computed tomography for orthodontic treatment

Objective

To estimate the projected cancer risk attributable to diagnostic cone-beam computed tomography (CBCT) performed under different exposure settings for orthodontic purposes in children and adults.

Methods

We collected a list of CBCT machines and their specifications from 38 orthodontists. Organ doses were estimated using median and maximum exposure settings of 105 kVp/156.8 mAs and 130 kVp/200 mAs, respectively. The projected cancer risk attributable to CBCT procedures performed 1-3 times within 2 years was calculated for children (aged 5 and 10 years) and adult (aged 20, 30, and 40 years) male and female patients.

Results

For maximum exposure settings, the mean lifetime fractional ratio (LFR) was 14.28% for children and 0.91% for adults; this indicated that the risk to children was 16 times the risk to adults. For median exposure settings, the mean LFR was 5.25% and 0.58% for children and adults, respectively. The risk of cancer decreased with increasing age. For both median and maximum exposure settings, females showed a higher risk of cancer than did males in all age groups. Cancer risk increased with an increase in the frequency of CBCT procedures within a given period.

Conclusions

The projected dental CBCT-associated cancer risk spans over a wide range depending on the machine parameters and image acquisition settings. Children and female patients are at a higher risk of developing cancer associated with diagnostic CBCT. Therefore, the use of diagnostic CBCT should be justified, and protective measures should be taken to minimize the harmful biological effects of radiation.

Probiotic characterization of bacterial strains from fermented South Indian tomato pickle and country chicken intestine having antioxidative and antiproliferative activities

AIM

The present study aims to evaluate the potential antioxidant and antiproliferative properties of probiotic bacterial isolates Weissella cibaria p3B, Bacillus subtilis CS, and Bacillus tequilensis CL, isolated from South Indian fermented tomato pickle (homemade) and gut content of indigenous country chicken.

METHODS AND RESULTS

The bacterial isolates exhibited antimicrobial activity against food-borne, human pathogenic bacteria, along with better survival under different bile and acidic conditions, hydrophobicity towards several hydrocarbons, and adherence to intestinal epithelial cells (INT-407 cells). Also, the intact cell (IC) mixture of the three species showed better DPPH, ABTS, and Fe²⁺ chelating activity as compared to the individual IC or cell extract (CE) activity. Among the three bacterial species, W. cibaria p3B revealed maximum antiproliferative activity against HeLa and Caco-2 cancer cells, all of which were nontoxic to INT-407 cells. Apart from being non-hemolytic, the bacterial isolates did not display any necrotic inhibition in HeLa and Caco-2 cells. The cell free supernatant (CFS) of the three bacterial isolates were tested for the production of antimicrobial peptides or bacteriocins. It found that the CFS of bacterial isolates was stable at various temperature, pH and sensitive to proteolytic enzymes confirms protenoius in nature of the antimicrobil peptides or bacteriocins.

CONCLUSION

The bacterial isolates showed promising antimicrobial, antioxidant as well as antiproliferative activities with better survival ability at different pH and bile concentrations. The three bacterial isolates were able to produce potential antimicrobial peptides or bacteriocins.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results indicate better compatibility of our bacterial isolates against synthetic drugs to avoid adverse side effects and can be processed as dietary supplements against food and human pathogens. They can also provide antioxidative and antiproliferative benefits to humans and animals.

Automated Detection of TMJ Osteoarthritis Based on Artificial Intelligence

The purpose of this study was to develop a diagnostic tool to automatically detect temporomandibular joint osteoarthritis (TMJOA) from cone beam computed tomography (CBCT) images with artificial intelligence. CBCT images of patients diagnosed with temporomandibular disorder were included for image preparation. Single-shot detection, an object detection model, was trained with 3,514 sagittal CBCT images of the temporomandibular joint that showed signs of osseous changes in the mandibular condyle. The region of interest (condylar head) was defined and classified into 2 categories-indeterminate for TMJOA and TMJOA-according to image analysis criteria for the diagnosis of temporomandibular disorder. The model was tested with 2 sets of 300 images in total. The average accuracy, precision, recall, and F1 score over the 2 test sets were 0.86, 0.85, 0.84, and 0.84, respectively. Automated detection of TMJOA from sagittal CBCT images is possible by using a deep neural networks model. It may be used to support clinicians with diagnosis and decision making for treatments of TMJOA.

Biological and medical applications of plasma-activated media, water and solutions

Non-thermal atmospheric pressure plasma has been proposed as a new tool for various biological and medical applications. Plasma in close proximity to cell culture media or water creates reactive oxygen and nitrogen species containing solutions known as plasma-activated media (PAM) or plasma-activated water (PAW) - the latter even displays acidification. These plasma-treated solutions remain stable for several days with respect to the storage temperature. Recently, PAM and PAW have been widely studied for many biomedical applications. Here, we reviewed promising reports demonstrating plasma-liquid interaction chemistry and the application of PAM or PAW as an anti-cancer, anti-metastatic, antimicrobial, regenerative medicine for blood coagulation and even as a dental treatment agent. We also discuss the role of PAM on cancer initiation cells (spheroids or cancer stem cells), on the epithelial mesenchymal transition (EMT), and when used for metastasis inhibition considering its anticancer effects. The roles of PAW in controlling plant disease, seed decontamination, seed germination and plant growth are also considered in this review. Finally, we emphasize the future prospects of PAM, PAW or plasma-activated solutions in biomedical applications with a discussion of the mechanisms and the stability and safety issues in relation to humans.

Antimicrobial activity of NO-releasing compounds against periodontal pathogens

This study describes the successful synthesis of nitric oxide (NO)-releasing compounds with biodegradable and injectable properties and demonstrates that the kinetics of NO release vary according to the type of NO donor. The antimicrobial activity of NO-releasing compounds against three common periodontal pathogens, i.e., Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Actinomyces israelii, was investigated using a susceptibility assay. Human gingival fibroblasts were treated with NO-releasing compounds at the minimum concentrations required for bacterial growth and cytotoxicity was evaluated using the MTT cell proliferation assay. Our results suggest that NO-releasing compounds can be used topically to treat both gram-negative and gram-positive periodontal pathogens. Comparison of the antimicrobial activity and cytotoxicity assay results between the NO-releasing compounds revealed that an NO donor comprising a macromolecule without surface charge, a lower instantaneous NO concentration, and an adequate supply of NO were associated with a strong bactericidal effect and low cytotoxicity. NO-releasing compounds with these properties may be suitable for treatment of periodontitis.

Effect of Irradiance and Exposure Duration on Temperature and Degree of Conversion of Dual-Cure Resin Cement for Ceramic Restorations

This study investigated the effects of irradiance and exposure duration on dual-cured resin cements irradiated through ceramic restorative materials. A single light-curing unit was calibrated to three different irradiances (500, 1000, and 1500 mW/cm²) and irradiated to three different attenuating materials (transparent acryl, lithium disilicate, zirconia) with 1-mm thicknesses for 20 or 60 seconds. The changes in irradiance and temperature were measured with a radiometer (or digital thermometer) under the attenuating materials. The degree of conversion (DC) of dual-cure resin cement after irradiation at different irradiances and exposure durations was measured with Fourier transform near infrared spectroscopy. Two-way analysis of variance revealed that irradiance ( p<0.001) and exposure duration ( p<0.001) significantly affected temperature and DC. All groups showed higher DCs with increased exposure times ( p<0.05), but there were no statistically significant differences between the groups irradiated with 1000 mW/cm² and 1500 mW/cm² ( p>0.05). Higher-intensity irradiances yielded higher temperatures ( p<0.05), but exposure time did not affect temperature when materials were irradiated at 500 mW/cm² ( p>0.05).

Treatment of oral hyperpigmentation and gummy smile using lasers and role of plasma as a novel treatment technique in dentistry: An introductory review

Gingival hyperpigmentation and the condition known as gummy smile are very common dental cosmetic problems. Gingival hyperpigmentation arises due to the excess presence of melanin in certain regions of the gums. In the case of gummy smile, more than the required amount of gingival tissue is exposed upon smiling. An aesthetically pleasing smile should expose only a negligible amount of gingival tissue. Gummy smile and gingival hyperpigmentation can have detrimental effects on the aesthetic quality of a smile, and thereby a wide variety of treatment options must be taken into consideration depending patient outcome objectives. The use of a laser as a treatment modality is considered to be a promising option for such cases. We aim to explain the effects of using a laser on the gingiva and discuss the advantages and disadvantages of this type of treatment and the resulting alteration of the genetic composition of the gingival tissue. This article reviews the histological aspects and biological effects of a laser treatment for oral hyperpigmentation and gummy smile and analyzes the use of the laser as a modality to improve the smiles of people with hyperpigmentation and excessive gingival display. We also attempt to provide insight into the use of plasma as a novel technology for medical and dental research and its future implications with regard to, dental soft tissue procedures.

Knowledge, Attitude and Practice Regarding Pharmacovigilance and Consumer Pharmacovigilance among Consumers at Lalitpur District, Nepal

BACKGROUND

Adverse drug reactions (ADRs) can be a big threat to the health of people in Nepal as a variety of medicines are consumed in the country. Involving consumers in pharmacovigilance can strengthen ADR reporting. The study aims to find out knowledge, attitude and practice regarding pharmacovigilance and consumer pharmacovigilance among consumers at Lalitpur district, Nepal Methods: It was carried out in outpatients visiting in KIST Medical College and Teaching Hospital, Lalitpur, Nepal. Participant's knowledge, attitude and practice were measured by noting their agreement with a set of 21 statements along with multiple choice and open ended questions.

RESULTS

A total of 157 outpatients were surveyed. The knowledge scores for males (12) was better compared to the females (11), but the scores for attitude and practice were same for both groups. The maximum score for knowledge was 29, attitude was 6 and practice was 10. The overall KAP scores was 45. The total scores for knowledge, attitude and practice for males (24) were better compared to female (22) respondents. Seventy-one patients (68%) who participated in this study favoured establishing a consumer centre for obtaining information about ADRs.

CONCLUSIONS

Knowledge scores among consumers regarding pharmacovigilance is low and require advocacy and improvement.

Epidemiological Study of Tobacco Smoking Behaviour amongst Residents of the Hill Region of Nepal

Background Tobacco use is still a serious public health problem in the world and represents a major cause of morbidity and mortality in most parts of the world. Objective To measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of Dhankuta Municipality. Method The cross-sectional study was conducted among the residents of the Dhankuta Municipality where 205 households were taken as subjects. Pretested semistructured questionnaire was used for data collection and face to face interview was conducted. Univariate and multivariate logistic regression was used to see the association between various factors and tobacco use and identify the predictor variables. Result Overall prevalence of tobacco consumption in Dhankuta Municipality was found to be 57.1%. Prevalence of tobacco consumption among the male was significantly higher (67%) than female (47.1%) (p<0.05). Most of the respondents (56.4%) started consuming tobacco due to peer pressure and for recreation (24.8%). The multivariate logistic regression showed that the people with illiterate have higher chances of consuming tobacco than above School Leaving Certificate (OR 38.395, 95% CI=3.209- 459.417). The respondents below poverty line (<1.25 US$) was consuming tobacco more than above poverty line (> 1.25 US $) (OR 6.814, 95% CI= 1.255-36.986). Conclusion The aims of this study was to measure the prevalence of tobacco use and to identify the factors associated with tobacco use among the residents of the Dhankuta Municipality. We conclude that the prevalence rate of tobacco consumption in the Dhankuta Municipality was found to be moderately high. Factors like male in gender, Brahmin/Chhetri in ethnicity, lack of education, poor occupation like farmer and housewife, poor economic status were associated with tobacco use.

Aetioepidemiological profile of spinal injury patients in Eastern Nepal

This is a retrospective case series of 233 spinal injury patients admitted to the orthopaedic ward of BPKIHS from May 1997 to April 2001. The inpatient records were analysed. In all, 40.3% of spinal injuries resulted from falls from trees while cutting leaves for fodder, and 27.9% resulted from falls from first/second floors. More than 75% of total spinal injuries are largely preventable. Overall, 46.8% of our spinal injury patients had complete cord transection at the level of injury. All adolescents and adults, irrespective of age or sex, should be the target groups for community education and intervention programmes for prevention of spinal injury.

An Assessment of Diabetic Retinopathy and Diabetes Management System in Nepal

BACKGROUND

Visual damage due to diabetic retinopathy is a major concern which can be reduced through appropriate coordination and cooperation between the diabetes management services and diabetic retinopathy services. The study assessed the existence, availability and accessibility of health care services for diabetes mellitus and diabetic retinopathy in Nepal.

METHODS

The study was carried out from 1 April to 24 June 2015. The tool for assessment of diabetic retinopathy and diabetes management systems developed by the World Health Organization was used for the assessment of major stakeholders like endocrinologists, ophthalmologists, ophthalmic assistants, nurses involved in diabetes care, patients and human resources from Ministry of Health and Population and international non-governmental organizations dealing with eye care services in Nepal.

RESULTS

Thirty-seven key stakeholders were selected for the study. Six out of fifteen ophthalmologists were unaware about the prioritization of diabetes as national health concern. The main function of diabetes association included patient education and awareness 18(48.6%), clinician education and awareness 16(43.2%). Thirteen professionals (35.1%) said that the patients were not found to be aware about diabetic patients' organizations. The information to community is provided occasionally and only through national-level media. All forms of diabetes care were funded out-of-pocket by the patients themselves.

CONCLUSIONS

Coordination should be strengthened for an effective and holistic management of diabetes mellitus making diabetes care and diabetic retinopathy services more accessible. Diabetes mellitus and its complications are becoming a public health threat in Nepal.

Towards a Mg Lattice Clock: Observation of the ^{1}S_{0}-^{3}P_{0} Transition and Determination of the Magic Wavelength

We optically excite the electronic state 3s3p ^{3}P_{0} in ^{24}Mg   atoms, laser cooled and trapped in a magic-wavelength lattice. An applied magnetic field enhances the coupling of the light to the otherwise strictly forbidden transition. We determine the magic wavelength, the quadratic magnetic Zeeman shift, and the transition frequency to be 468.46(21) nm, -206.6(2.0)  MHz/T^{2}, and 655 058 646 691(101) kHz, respectively. These are compared with theoretical predictions and results from complementary experiments. We also develop a high-precision relativistic structure model for magnesium, give an improved theoretical value for the blackbody radiation shift, and discuss a clock based on bosonic magnesium.

Nutritional supplementation practices during pregnancy in Village Development Committees of Morang District, Nepal

BACKGROUND Pregnancy is a critical period for both woman and baby from a nutritional perspective. Poor nutrition, during pregnancy is associated with adverse maternal and fetal outcomes. However, due to various factors, pregnant women do not increase the quality or quantity of diet during pregnancy. OBJECTIVE To find out the prevalence of nutritional supplementations taken during pregnancy and to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. MATERIALS AND METHODS The cross-sectional study was conducted from 1st March to 14th March, 2014 among the residents of Rangeli VDC of Morang District in Eastern Nepal where 300 households were taken as subjects. Semistructured questionnaire was used and face to face interview was conducted. Chi-square test was applied to find out the association between sociodemographic characteristics and nutritional supplementations taken during pregnancy. RESULT The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy. CONCLUSION The problem of not taking extra nutritional supplementations during pregnancy is common and has become a key public health concern. Lack of education of wife and husband led some of the respondents not taking more nutritional supplementations during pregnancy.DOI: http://dx.doi.org/10.3126/jcmsn.v10i2.12948 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(2); 10-17

Opportunistic infections and clinical profile of HIV/AIDS patients: A study from eastern region of Nepal

There is a wide spread availability of highly active antiretroviral treatment but opportunistic illnesses still occur and result in an increased risk of mortality among persons with HIV/AIDS. The spectrum of illness that one observes, changes as the CD4+ cell count declines. The close relationship between clinical manifestation and CD4+ cell count has made measurement of the latter a routine part of evaluation of the progress of HIV infection in individuals: The objective of this study was to reveal the clinical spectrum and explore the different types of opportunistic infections in HIV/AIDS patients. A total of 234 patients with HIV/AIDS from three ART centers of Eastern Nepal were purposively selected for this cross sectional study conducted from May 2009 to April 2010. Statistical analysis was done using SPSS version 11.5. Chi-squared test and Student's t test were applied to find the association between the variables. A p-value less than 0.05 was considered to be significant. Out of the 234 patient, 85% were found to be symptomatic. Most common presenting symptoms were weight loss (74.4%) followed by fever (59.4%). Around 64% of HIV/AIDS patients had a CD4+ cell count below 200 cells/mm3. Most common opportunistic infections were tuberculosis (51.1%) followed by oral candidiasis (21.7%). A significant relationship (p < 0.001) between decrease in CD4+ cell count and occurrence of opportunistic infections in HIV/AIDS patients was seen.

Anemia in pregnancy and its associated factors: A study from Eastern Nepal

Background  Anemia in pregnancy is responsible for many adverse effects on maternal and fetal outcome. It is the commonest hematological disorder accompanying pregnancy. Prevalence of anemia among pregnant women is fairly high worldwide, especially in developing countries. A research finding published by World Health organization revels that the prevalence of anemia among pregnant women in developing countries averages 56% (ranging between 35 to 100%). Though Nepal has decreasing trend of prevalence of anemia, it is still high (42% in 2006). Identifying the associated factors which are responsible for the development of anemia during pregnancy would be of great help in mitigating the burden to some extent. Ojective of the study was to find out the pattern of anemia and associated risk factors for anemia during pregnancy. Materials and Methods A cross-sectional study was conducted in VDC named Hansposa.  Door to door survey was carried out to collect data using pre-designed questionnaires. Ante-natal check-ups were provided with analysis of hemoglobin levels, in every individual of study population, using conventional Shali's method. Chi-square test was applied, where applicable. Results Altogether 249 pregnant women were included in the study. The proportion of anemia was found to be 46.6%, the cases of mild anemia, and moderate anemia were 51.0% and 49.0% respectively. Risk factors includes: history of complications during previous pregnancy (P<0.001), education (P<0.05), age at marriage (P=0.028), low socio-economic status (P<0.001), gravidity and parity (P<0.01), poor knowledge about anemia (P<0.001), abnormal body mass index (P<0.001) and smoking (P=0.05). Conclusion This study indicates that the prevalence of anemia during pregnancy bears a resemblance to national value. Major associated risk factors include: history of complications during previous pregnancy, low knowledge about anemia in pregnant women, women with low body mass index, age at marriage, socio-economic status, gravidity and parity, and smoking. Most importantly, the lack of commitment in female education plays vital role in its existence.DOI: http://dx.doi.org/10.3126/nje.v4i4.11358 Nepal Journal of Epidemiology 2014; 4(4):386-92

Factors affecting Early Age Marriage in Dhankuta Municipality, Nepal

Background: Child marriage is a substantial barrier to social and economic development in Nepal, and a primary concern for women’s health. Little evidence from Nepal is available regarding the ways in which early marriage may compromise young women’s lives and their reproductive health and choices. The objectives of this study was to find out the factors associated with early age marriages in Dhankuta Municipality. Methods: The cross-sectional study was conducted among the residents of Dhankuta municipality, Nepal; where 246 households were taken as subjects. Pretested semi-structured questionnaire was administered to the study subjects and face to face interview was conducted. Chi-square test was applied to find out the association between factors and age of marriages. Results: Almost 53.3% of women were married before age 18 years. Education of wife and husband, and economic status are found to be the important variables in explaining early age marriage. Prevalence of child marriage was higher in Hindu than in Buddhist and Christian women but the difference was not significant. Age of marriage was not significantly associated with contraceptive use. Unwanted pregnancies were higher in early age marriage. It was also seen that unwanted pregnancies was higher (59.3%) than wanted pregnancies (48.6%). Conclusion: The findings of the study indicate that early age marriage was associated with low education and being poor. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 26-30 DOI: http://dx.doi.org/10.3126/njms.v3i1.10354

Social Marketing in Health: Developing Country’s Perspective

No abstract available.Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 2 / Issue 16 / July-Dec, 2013 / 1-4 DOI: http://dx.doi.org/10.3126/njog.v8i2.9758  

Denitrification and N2O:N2 production in temperate grasslands: processes, measurements, modelling and mitigating negative impacts

In this review we explore the biotic transformations of nitrogenous compounds that occur during denitrification, and the factors that influence denitrifier populations and enzyme activities, and hence, affect the production of nitrous oxide (N2O) and dinitrogen (N2) in soils. Characteristics of the genes related to denitrification are also presented. Denitrification is discussed with particular emphasis on nitrogen (N) inputs and dynamics within grasslands, and their impacts on the key soil variables and processes regulating denitrification and related gaseous N2O and N2 emissions. Factors affecting denitrification include soil N, carbon (C), pH, temperature, oxygen supply and water content. We understand that the N2O:N2 production ratio responds to the changes in these factors. Increased soil N supply, decreased soil pH, C availability and water content generally increase N2O:N2 ratio. The review also covers approaches to identify and quantify denitrification, including acetylene inhibition, (15)N tracer and direct N2 quantification techniques. We also outline the importance of emerging molecular techniques to assess gene diversity and reveal enzymes that consume N2O during denitrification and the factors affecting their activities and consider a process-based approach that can be used to quantify the N2O:N2 product ratio and N2O emissions with known levels of uncertainty in soils. Finally, we explore strategies to reduce the N2O:N2 product ratio during denitrification to mitigate N2O emissions. Future research needs to focus on evaluating the N2O-reducing ability of the denitrifiers to accelerate the conversion of N2O to N2 and the reduction of N2O:N2 ratio during denitrification.

A study of prevalence of Taenia infestation and associated risk factors among the school children of Dharan

BACKGROUND

Taenia prevalence has remained high among certain ethnic groups and occupational diseases in Nepal. Taenia saginata and Taenia solium species are worldwide in distribution. Infection is found most often in rural areas of developing countries with poor hygiene and living in close contact with pigs and eating undercooked pork meats. This allows the tapeworm infection to be completed and its cycle to continue.

OBJECTIVES

To measure the prevalence of taenia infestation and to identify risk factors associated with taenia infestation among the school children of Dharan.

METHODS

A cross sectional study was conducted among 935 Government and private school going children of Grade VI, VII, and VIII of Dharan during 2007 to 2008. Stratified random sampling method was applied to choose the schools and the study subjects. The prevalence was calculated, Chi-square test was used to measure the association of risk factors and taenia infestation.

RESULTS

Taenia species was found to be high (5.5%) among the school children of Dharan. Infection rate of taenia among the male children (6.0%) was slightly higher than female (4.8%). There were no cases of taenia infestation found among children washing hands with soap. Regarding meat consumption in the non-vegetarian group, taenia infestation was found higher (6.5%) among pork eating than nonpork eating (4.7%). No significant relationship was traced among the factors in the causation of taenia infestation although slight indications present.

CONCLUSION

Taenia species was found very high among the school children of Dharan. No such association was found with the risk factors.

Economic impact of pulmonary tuberculosis on patients and their families of Dharan municipality, Nepal

Tuberculosis (TB) affects mostly economically active population in underdeveloped and developing countries, therefore TB can have far reaching economic and social consequences among infected people and their household members. The objectives of this study were to estimate the household expenditure before and during the course of disease, to explore the direct and indirect cost burden of tuberculosis in terms of annual family income and to compare the total cost burden in a family of case treated with directly observed treatment shortcourse (DOTS) and without DOTS. A total of 160 treatment completed, pulmonary tuberculosis (PTB) cases fulfilling the inclusion criteria were interviewed. The median patients income before and during illness was US$1.95 and US$0.9 respectively. Similarly, household expenditure before illness was US$3.24 and during illness was US$4.28. Direct cost burden in terms of annual family income was higher (15.2%) than indirect cost burden (8.2%). But, free distribution of anti tuberculosis therapy (ATT) through DOTS reduced the total cost burden of patient by more than 8%. In conclusion, overall cost burden of pulmonary tuberculosis is high even though the treatment is free of cost.

Factors associated with patient delay in diagnosis of pulmonary tuberculosis in a district

BACKGROUND

Tuberculosis one of the major public health problems that is affecting large number of people each year including Nepal.

METHODS

A descriptive cross sectional study was conducted in Sunsari district of Nepal. The patients with pulmonary tuberculosis patients from 14 DOTS centers in the District were interviewed. Face to face interview by using structured questionnaire was used for data collection. Extra pulmonary tuberculosis and patients under Category II were excluded from the study.Data entry and analysis was carried out in SPSS version 16. Pearson Chi square test was used to test the association between outcome variable with different categorical independent variables.

RESULTS

Out of the total 215 patients, 91 (65.6%) were male, 109 (50.7%) were from rural residence, 69 (32.1%) were illiterate, 147 (68.4%) were married and 141 (66%) were sputum positive. The overall median patient delay was 42 days. About 145 (67.4%) of the patients had delayed their first consultation for more than 30 days. The patient delays were 56 out of 68 (82.4%) in age above 50 years patients, 121 out of 161 (75.2%) in married patients, 37 out of 45 (82.2%) in Kirats, 55 out of 69 (72.7%) in illiterates and 95 out of 124 (76.6%) in those who travel the distance of 2 or more km from the place of residence to health facility.

CONCLUSIONS

Since the time duration before the treatment and diagnosis in TB patients is long, this study emphasizes the need of awareness about symptoms of tuberculosis among general population.

Adverse drug reaction reporting in a pharmacovigilance centre of Nepal

BACKGROUND

Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored.

AIMS

To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal.

METHOD

A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability.

RESULTS

A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs.

CONCLUSION

Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.

Adverse drug reaction reporting in a pharmacovigilance centre of Nepal

BACKGROUND

Pharmacovigilance is the "science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems". Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored.

AIMS

To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal.

METHOD

A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability.

RESULTS

A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs.

CONCLUSION

Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.

The Burden of Injury in terms of Economic Loss and Disability Days: A Community Based Study from Eastern Nepal

Background Injuries are already a substantial public Health problem all over the world and are expected to increase in the 211st Century. They are major causes of deaths and disability in the population and also involve high societal costs. Objectives This study was designed to assess the economic loss due to the injury and the disability days due to different types of injuries. Methods A systematic random sampling technique was used to select 1388 households from 19 wards. A detailed questionnaire was used to collect information related to injuries to the persons suffered from injuries including treatment obtained, cost of treatment (direct/indirect cost) and length of disability. Results Among the minor injured persons, majority (93.2%) did not spend any indirect cost. 36.7% of the major inured persons spent Nepalese rupees 10,001 to NRs 100,000 as direct treatment costs. But 50% spent less than 5000 NRs as indirect cost for major injury treatment. Maximum number (67.4%) of major injured persons had disability days of 31 to 90 days. Conclusion The high incidence of injuries, especially road traffic injuries, adds a huge economic burden to nation.DOI: http://dx.doi.org/10.3126/kumj.v9i2.6283Kathmandu Univ Med J 2011;9(2):27-30

Health seeking behavior during pregnancy and child birth among Muslim women of Biratnagar, Nepal

Maternal mortality remains one of the biggest public health challenges in Nepal. This paper explores the health seeking behavior, during pregnancy and child birth in certain ethnic group. The poverty, illiteracy, women's low status in the society, lack of access and difficult geographical terrain are major reasons for poor maternal health status in Nepal. Cross-sectional study was conducted among 200 Muslim women of ward # 7 of Biratnagar municipality. They were interviewed to understand their health seeking behavior during pregnancy and childbirth, factors associated with use of health services and their role in the family. Information's on usages of health services, education level, family stricture, and occupational status, information were collected using a pretested and structured questionnaire. The overall institutional delivery in study population was found 24.5%. Low socio-economic status, Illiteracy and poverty in women are the major challenging features of pregnancy and child birth.