The standard procedure for alveolar cleft closure in cleft lip and palate patients is by alveolar bone grafting (ABG) where the residual opening of oronasal fistula in the palate is also closed simultaneously. Occasionally there is a situation of soft tissue inadequacy and attempt to close the fistula at the same procedure as ABG may compromise the result of the bone graft itself. An unforeseen leakage at the closure may cause graft infection leading to failure. This article reports on a technique where alveolar bone grafting was done without closure of residual palatal fistula to provide adequate soft tissue coverage for the grafted bone. This may reduce the risk of leakage at the oral mucosal coverage of the graft . The residual palatal fistula will be closed at later stage by muco-palatal flap or tongue flap. We reported on a case of a failed ABG which was reconstructed using this technique. Various other techniques to ensure success of ABG were also discussed. Conclusion: The alveolar bone grafting without closure of oro-nasal fistula reduced the risk of failure of ABG in a wide alveolar cleft.
MeSH terms: Cleft Lip; Humans; Mouth Mucosa; Palate; Bone Transplantation; Oral Fistula; Alveolar Bone Grafting
The aim of the study was to assess the association between past fluoride exposures from ingested toothpaste and current fluorosis manifestations in 10- 11 year old index subjects. Fluorosis was assessed with the Dean’s Index in 1343 10-11 year old index subjects. Two hundred index subjects who had younger 4-5 year old siblings were sub sampled and fluoride exposures from ingested toothpaste in their younger siblings (proxy subjects) were determined. The values for the fluoride ingested per brushing of the proxy subjects were utilised together with past frequency of toothbrushing of index subjects to extrapolate on the past exposure of index subjects. The mean extrapolated past fluoride exposure from ingestion of toothpaste was highly variable; 671.7 ug ± 739.3 ug (sem= 56.9). It was higher in the subjects with fluorosis (697.3 ug) than in those without fluorosis (646.89 ug) but differences were not of statistical significance. This approach of extrapolation has not been reported elsewhere and need to be validated. The implications of the present methodology to estimate past fluoride exposure is discussed.
The aim was to examine the protein profiles of whole and parotid saliva using Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis (SDS-PAGE) and MALDI-TOF mass spectrometry. The banding patterns of proteins exhibited by the unstimulated whole saliva samples on the gel remained quite constant but the intensity of the protein bands were slightly different from one sample to another. Comparison of the protein profiles of unstimulated whole saliva and stimulated parotid saliva showed almost similar banding pattern. The exception is the presence of a pink protein band in the 65-67 kD region in the stimulated parotid saliva samples which was also observed in the unstimulated whole saliva sample contributed by a cerebral palsy patient. Analysis of the saliva samples using MALDI-TOF mass spectrometry also revealed that the stimulated parotid saliva samples exhibited some peaks that were in the same region as those for the unstimulated whole saliva sample of the cerebral palsy subject. This may imply that there is ineffective control of the parotid secretion in cerebral palsy subject under unstimulated condition. The SDS-PAGE and MALDI-TOF analyses may provide more information on the profiles of the salivary proteins which could be beneficial in the diagnosis of salivary gland dysfunction.
Choosing the right light-curing unit can be a very difficult task for some orthodontists. Currently, there are various types of light curing units available in the market with various trade names and specifications. Most of the time information regarding light curing units is obtained from advertisements, websites or manufacturers’ catalogues. Sometimes such information can be misleading. This article attempts to provide several tips for orthodontists in selecting light curing units.
A retrospective study was carried out to review the records of 47 patients who had had in total 80 supernumerary teeth (ST) removed under general anaesthesia between 1975 and 2002. Malays made up 38.30%, Chinese 51.06%, and Indians 10.64% of the patients. The predominant age group was 6-10 year-old. The mean age was 12.96 ± 9.49 years. The male and female ratio was 1.35:1. Most of the patients had either one ST (n=31; 65.96%) or two ST (n=11; 23.40%). Five cases of multiple supernumeraries were recorded. Two patients experienced late formation of subsequent ST after the first surgery, thus requiring a second surgery. The majority of ST were conical in shape (n=35; 43.75%). Most of the ST were located in the premaxilla (n=55; 68.8%). Almost a quarter (23.75%) of ST were inclined towards the oral cavity. Some of the effects on the dentition were diastema, cystic changes, rotation, displacement, and retention of the permanent teeth and these were the indications for removal of ST. The most common surgical approach for maxillary ST was from the labial, buccal or labio-buccal approach.
Missing teeth can be due to hypodontia, trauma or extraction. In general, the options for treatment depend on the severity of the hypodontia and the severity of the malocclusion. Occasionally, the space from missing teeth has to be maintained for prosthetic replacement and require an orthodontic/restorative approach. It is very important to ensure the space maintained is adequate for aesthetic reason so that it can be replaced with a prosthesis after the orthodontic treatment is completed. This article discusses a new innovation and clinical technique for maintaining this space during orthodontic treatment by using an acrylic tooth with several modifications. This innovation will be illustrated using two cases.
Tarsal adhesive pads enable insects to hold on to smooth plant surfaces. Using a centrifuge technique, we tested whether a "wet adhesion" model of a thin film of liquid secreted between the pad and the surface can explain adhesive and frictional forces in Asian Weaver ants (Oecophylla smaragdina). When forces are acting parallel to the surface, pads in contact with the surface can slide smoothly. Force per unit pad contact area was strongly dependent on sliding velocity and temperature. Seemingly consistent with the effect of a thin liquid film in the contact zone, (1) frictional force linearly increased with sliding velocity, (2) the increment was greater at lower temperatures and (3) no temperature dependence was detected for low-rate perpendicular detachment forces. However, we observed a strong, temperature-independent static friction that was inconsistent with a fully lubricated contact. Static friction was too large to be explained by the contribution of other (sclerotized) body parts. Moreover, the rate-specific increase of shear stress strongly exceeded predictions derived from estimates of the adhesive liquid film's thickness and viscosity. Both lines of evidence indicate that the adhesive secretion alone is insufficient to explain the observed forces and that direct interaction of the soft pad cuticle with the surface ("rubber friction") is involved.
A gene encoding the larval excretory-secretory antigen TES-120 of the dog ascarid worm Toxocara canis was cloned into the methylotrophic yeast Pichia pastoris. Specificity of the recombinant TES-120 antigen produced by the yeast was investigated. Forty-five human serum samples from patients infected with different()parasitic organisms, including 8 cases of toxocariasis, were tested against the recombinant antigen in immunoblot assays. Results from the assays showed that the recombinant TES-120 antigen reacted with sera from toxocariasis patients only. This highly specific recombinant TES-120 antigen can potentially be used for the development of an inexpensive serodiagnostic assay for human toxocariasis.
It has been widely reported that heavy metal contamination in coastal waters can modify the allozyme profiles of marine organisms. Previous studies have recorded elevated metal concentrations in sediments and mussel tissues off Peninsular Malaysia. In the present study, horizontal starch gel electrophoresis was carried out to estimate the levels of allelic variation of the green-lipped mussel, Perna viridis, collected from one contaminated and three relatively uncontaminated sites off Peninsular Malaysia. Fourteen polymorphic loci were observed. In addition, the concentrations of cadmium, copper, lead, mercury and zinc were determined in the sediments and in the soft tissues of the mussels. Mussels from contaminated site, evidenced by high metal pollution indices (MPI) of the sediment and the mussel tissues, showed the highest percentage of polymorphic loci (78.6%), while those collected from the uncontaminated sites had lower MPI of the sediment and mussel tissue, and exhibited lower percentages of polymorphic loci (35.7-57.1%). The population from the contaminated site showed the highest excess of heterozygosity (0.289) when compared to that of the populations from the three uncontaminated sites (0.108-0.149). Allozyme frequencies at the phosphoglucomutase (PGM; E.C. 2.7.5.1) locus also differed between the contaminated and uncontaminated populations. Previous studies have shown that exposure to heavy metals can select or counter-select for particular alleles at this locus. The present results suggest that allozyme polymorphism in P. viridis is a potential biomonitoring tool for heavy metal contamination but further validation is required.
In the early 1940s and 1950s, tuberculosis (TB) was the number one cause of death in Malaysia. Patients with TB were admitted to the many sanatoria we had in various parts of the country and were often managed by surgical means. TB chemotherapy became available only in the late 1950s. At this time, TB was already a major cause of morbidity and mortality. Realizing its seriousness, the Malaysian government launched its National TB Control Programme (NTP) in 1961. At that time, the recommended treatment for TB was a combination of three drugs, namely, streptomycin, isoniazid and paraaminosalicylic acid (PAS) given for 2 months followed by isoniazid and PAS given for 12 months. Generally the treatment used to last for 1-2 years. The National TB Centre in Kuala Lumpur functioned as the headquarters of the NTP, and the state general hospitals with their chest clinics functioned as the state directorates. From the operational point of view, every state has a state TB directorate which is known as the State TB Managerial Team (Fig. 1). This team is responsible for the implementation of the activities of the NTP at the state and district levels. Ever since 1995, the national TB directorate has been shifted to the Public Health Division of the Ministry of Health (MOH) and is now under the Director of Disease Control (Fig. 2). The National TB Centre has now been renamed as The Institute of Respiratory Medicine. Over the years from being the number one cause of death, TB has dropped to being below number 10 (Fig. 3).
The objectives in this epidemiology review are to measure and report the extent of morbidity and mortality due to tuberculosis (TB), the proportion of new sputum smear positive cases in districts and the status of cohort analysis as of 1999. As for leprosy, the main objective is to determine morbidity and the treatment outcomes of Multiple Drug Therapy (MDT). Based on the results obtained, a comprehensive action plan for prevention, control and monitoring of tuberculosis and leprosy cases and patients is being produced and implemented throughout the state. The analysis concentrated on patients diagnosed at all out-patient units and admitted in all of the state's hospitals. The patient particulars were recorded using a standardized format based on TB and Leprosy Health Management Information System (TB HMIS). TB was the second highest by notification of communicable diseases in Malaysia in 2001. 29% or about one-third of the national TB cases are from Sabah. However, it has been noted that there was an average decline of 2.6% in annual notification since 10 years ago to date. There was also a reduction of 11.4% in 2001 as compared to annual notification in 2000. Immigrants contribute more than 24% in detection of new cases since 1990. Treatment success rate in term of completion of treatment to date is 82%. Mortality rate has steadily declined from 14 deaths to 7 deaths per 100,000 population. Leprosy in Sabah also contributes to 30% of the yearly total caseload of Malaysia and has the highest notification rate of 2 per every 100,000 population as compared to other states. The average registered leprosy cases over the past 5 years are 239 cases and the prevalence rate is 0.7/10,000 population. The state has successfully achieved its goal to decrease leprosy as per the World Health Organization (WHO) goal of yearly overall prevalence rate of less than 1 case for every 10,000 population. However, the districts of Kudat, Tawau, Lahad Datu, Kota Kinabalu and Semporna are still within the prevalence rate of more than one per 10,000 population. This review highlights some interesting findings which can be incorporated into the State and Districts action plans and strategies. It is also noted that in order to translate National Plans and Strategies into effective action at the community level, health workers need relevant up-to-date knowledge of the pattern of health and disease, and of their determinants, in each district. The Sabah Health Department continues to organize and support programs related to management and control of tuberculosis and leprosy to progressively reduce the incidence of these diseases in the community by breaking the chain of transmission of Mycobacterium tuberculosis and M. leprae, respectively.
Study site: outpatient clinics, inpatients, hospitals, Sabah, Malaysia
Tuberculosis (TB) is one of the main public health problems in Sabah; 30% of the total number of TB cases reported in Malaysia every year occur in Sabah. The average incidence of TB among health care workers over the past 5 years is 280.4 per 100,000 population (1, Annual Report of Sabah State TB Control Programme, 1998). At present, there are no specific measures for the prevention of TB transmission in health care facilities. A case-control study was conducted among health care workers in Sabah in 2000-2001. Cases were health care workers with TB diagnosed between January 1990 and June 2000. Controls were health care workers without TB and working in the same facility as cases during the disease episode. The study attempted to identify risk factors for TB among the study population. Data were collected through structured interviews and review of patients' records. The notification rate of TB among health care workers was significantly higher than that to the general population (Z=4.893, p<0.01). The average notification rate of TB among health care workers over the last 5 years was two times higher than in the general population (280.4/100,000 compared to 153.9/100,000). Regression results showed that ethnicity, designation, family contact and TB related knowledge did not significantly contribute to the risk of contracting TB in this study. However, after controlling for the above factors, age, gender, history of TB contact outside the workplace (other than family contact), duration of service and failure to use respiratory protection when performing high-risk procedures, were the main risk factors of TB among health care workers. This study succeeded in identifying some of the risk factors of TB among health care workers. We managed to include the large ratio of controls to case (3:1) and those cases spanned over a period of 10 years. However, the findings from the study have to be applied with caution due to the limitations of this study, which include recall bias, dropouts, and small sample size. Based on the study findings, we recommend that health care workers in the first 10 years of service should take extra precautions, such as using respiratory protection when performing procedures that are considered to be of high risk with respect to TB infection. They should also undergo TB screening at least once every 2 years and, if symptomatic, offered prophylactic treatment. The Respiratory Protection Programme should be fully implemented to help reduce the risk of TB among health care workers in Sabah.
A retrospective review of 33 patients with tuberculosis of the spine from January 2000 to April 2002 revealed that the mean age was 36.5 and peak incidence is in the second decade of life (27.3%). There were 24 males and 9 females. The majority of the lesions involved the thoracic spine (30.3%), followed by the lumbar spine (27.2%). Skip lesions was seen in 12.1% of cases. The erythrocyte sedimentation rate was normal in 9.1% of patients. Neurological involvement was seen in 51.5% of patients. Concomitant tuberculosis of the lung was 66.6%. The radical surgical debridement and grafting rate was 39.3%. The preferred surgical procedure was that of radical anterior debridement and fusion supplemented by anterior or posterior instrumentation if needed. Anti-tuberculous chemotherapy remained the mainstay of treatment. Surgery gives faster relief of pain and neurological recovery but is a major undertaking, and thus selection of patients is vital to avoid morbidity and mortality.
MeSH terms: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Humans; Malaysia/epidemiology; Male; Middle Aged; Retrospective Studies; Tuberculosis, Spinal/diagnosis; Tuberculosis, Spinal/epidemiology*; Tuberculosis, Spinal/surgery; Incidence; Treatment Outcome; Age Distribution; Sex Distribution
In this study, the susceptibility of Mycobacterium tuberculosis to isoniazid (INH) was compared with its derivative, 1-isonicotinyl-2-nonanoyl hydrazine (INH-C9), prepared synthetically. The minimum inhibitory concentration (MIC) of the drugs was determined using the 1% proportion method. INH-C9 was found to lower the MIC of INH from 0.05 to 0.025 microg/ml. Further studies on the effects of INH and INH-C9 on M. tuberculosis were assessed by exposing the cells to the above at the MIC level. M. tuberculosis cells grown on Middlebrook 7H10 agar were harvested at different stages of their growth cycle (initial stage, 24 and 72 h), exposed to the MICs of INH and INH-C9, and stained with acid-fast staining. The observations were made for a week. The cellular morphologies and staining characteristics were examined using a Brightfield microscope. The result indicated cells only at the initial stage of growth were most susceptible to the drugs resulting in the loss of acid-fastness and intact cellular morphology in the majority of cells.
The last few years have witnessed intense research on vaccine development against tuberculosis. This has been driven by the upsurge of tuberculosis cases globally, especially those caused by multi-drug-resistant Mycobacterium tuberculosis strains. Various vaccine strategies are currently being developed which can be broadly divided into the so-called living and non-living vaccines. Examples are attenuated members of the M. tuberculosis complex, recombinant mycobacteria, subunit proteins and DNA vaccines. Given current developments, we anticipate that recombinant BCG and DNA vaccines are the most promising. Multiple epitopes of M. tuberculosis may need to be cloned in a vaccine construct for the desired efficacy to be achieved. The technique of assembly polymerase chain reaction could facilitate such a cloning procedure.
A total of 723 accessions of oil palm ( Elaeis guineensis Jacq.) from 26 populations representing ten countries in Africa and one Deli dura family were screened for allelic variation at seven enzyme loci from six enzyme systems using starch gel electrophoresis. On average, 54.5% of the loci were polymorphic (0.99 criterion). The average and effective number of alleles per locus was 1.80 and 1.35, respectively. Mean expected heterozygosity was 0.184, with values ranging from 0.109 (population 8, Senegal) to 0.261 (population 29, Cameroon). The genetic differentiation among populations was high (F(ST)=0.301), indicating high genetic divergence. The calculation of F(ST) by geographic zones revealed that the high F(ST) was largely due to F(ST) among populations in West Africa, suggesting diversifying selection in this region. The mean genetic distance across populations was 0.113. The lowest genetic distance (D) was observed between population 5 from Tanzania and population 7 from the Democratic Republic of the Congo (0.000) and the highest was found between population 4 from Madagascar and population 13 from Sierra Leone (0.568). The total gene flow across oil palm populations was low, with an Nm of 0.576, enhancing genetic structuring, as evident from the high F(ST) values. UPGMA cluster analysis revealed three main clusters; the western outlying populations from Senegal and Sierra Leone were in one cluster but separated into two distinct sub-clusters; the eastern outlying populations from Madagascar were in one cluster; the populations from Angola, Cameroon, The Democratic Republic of the Congo, Ghana, Tanzania, Nigeria and Guinea were in one cluster. The Deli dura family seems to be closely related to population 6 from Guinea. Oil palm populations with high genetic diversity-i.e. all of the populations from Nigeria, Cameroon and Sierra Leone, population 6 of Guinea, population 1 of Madagascar and population 2 of Senegal should be used in improvement programmes, whereas for conservation purposes, oil palm populations with high allelic diversity (A(e)), which include populations 22 and 29 from Cameroon, populations 39 and 45 from Nigeria, population 6 from Guinea, populations 5 and 13 from Sierra Leone and population 1 from Madagascar should be selected for capturing as much genetic variation as possible.
Studies on toxicities and tolerances of cadmium (Cd), copper (Cu), lead (Pb) and zinc (Zn) in the brown alga Isochrysis galbana and in the green-lipped mussel Perna viridis were conducted by short-term bioassays using endpoints growth production and mortality, respectively. The 5-day EC(50) and 24-h LC(50) of these heavy metals were determined in the brown alga and mussel, respectively. The EC(50) values calculated for the alga were 0.74 mg/l for Cd, 0.91 mg/l for Cu, 1.40 mg/l for Pb and 0.60 mg/l for Zn. The LC(50) values for the mussels were 1.53 mg/l for Cd, 0.25 mg/l for Cu, 4.12 mg/l for Pb and 3.20 mg/l for Zn. These LC(50) values were within the concentration ranges as reported by other authors who used P. viridis as the test organism. Based on these EC(50) and LC(50) values, the alga was most sensitive to Zn, followed by Cd, Cu and Pb while the mussel was most sensitive to Cu, followed by Cd, Zn and Pb. Differences in the trophic levels, metal handling strategies, biology and ecology of the primary producer (brown alga) and the primary consumer (mussel) are believed to be the plausible causes for the different toxicities and tolerances of the metals studied.
MeSH terms: Adaptation, Physiological; Phaeophyta/physiology*; Animals; Biological Assay; Drug Resistance; Lethal Dose 50; Water Pollutants/pharmacology*; Water Pollutants/toxicity*; Metals, Heavy/pharmacology*; Metals, Heavy/toxicity*; Food Chain; Bivalvia/physiology*
A canonical/lognormal model for human demography is established, specifying the net maternity function and the age distribution for mothers of new-borns using a single macroscopic parameter vector of dimension five. The age distribution of mothers is canonical, while the net maternity function normalizes to a lognormal density. Comparison of an actual population with the model serves to identify anomalies in the population which may be indicative of phase transitions or influences from levels outside the demographic. Tracking the time development of the parameter vector may be used to predict the future state of a population, or to interpolate for data missing from the record. In accordance with classical theoretical considerations of Backman, Prigogine, et al., it emerges that the logarithm of a mother's age is the most fundamental time variable for demographic purposes.
MeSH terms: Adolescent; Adult; Age Factors; Cyprus; Demography*; Female; Humans; Malaysia; Maternal Age*; Population Dynamics; Population Growth; Reproduction; United States; Models, Statistical*; Statistical Distributions; Age Distribution
Rhodovulum sulfidophilum was grown in settled undiluted and nonsterilized sardine processing wastewater (SPW). The aims were to evaluate the effects of inoculum size and media on the biomass production with simultaneous reduction of chemical oxygen demand (COD).
MeSH terms: Biodegradation, Environmental; Culture Media/chemistry; Industrial Waste; Oxygen Consumption; Waste Disposal, Fluid/methods; Water Microbiology*; Water Pollution; Water Purification/methods*; Biomass; Food Industry; Rhodovulum/growth & development*; Rhodovulum/metabolism*