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  1. The dental health of factory workers in Pasir Gudang, Johor (Malaysia)
    Abdul Majid Z, Zain RB
    Dent J Malays, 1988 May;10(1):38-41.
    PMID: 3271120
    A study on the oral health status of 198 factory workers (in Antara Steel, Pasir Gudang, Johor) was carried out in November 1986. The subjects were predominantly male (94%) and Malay (91%) with an average age of 27.4 years. The prevalence of caries was 87.4% with a mean DMFT of 7.1 + 5.4. There were 3 subjects with full upper, lower dentures and 16 subjects with partial dentures. Two subjects examined needed dentures but were not wearing them. Thirty five (17.7%) of those examined needed urgent extractions, and 8 needed emergency treatment for fillings. Enamel opacities were found in 141 subjects (75.6%) but only 9 were aware of these defects. Dental health was very poor with 72% examined needing scaling. Seventeen (9%) had gross supra and subgingival calculus. There was a total of 107 (54%) smokers and heavy nicotine stains were found in 41 (20.7%), of the population examined. Examination of soft tissues showed 111 (56%) subjects with recurrent aphthous ulcers whilst 15 (7.6%) suffered from herpes labialis. Five subjects (2.5%) suffered from denture stomatitis whilst the prevalence of other soft tissue lesions was very low.
  2. Fulltext Periodontal disease as the initial oral manifestation of langerhans cell histiocytosis - a case report
    Ahmad AR, Ismail SM, Zain RB, Mohamad Zaini Z
    Ann Dent, 2009;16(1):31-36.
    MyJurnal
    Langerhans Cell Histiocytosis (LCH) refers to a group of lesions presenting with a spectrum of clinical. features but sharing similar histology. These lesions are rare and treatment has been quite variable with current treatment protocol recommended being dependent on whether it is a unifocal or multi focal bone disease or a multi focal multisystem disease. However, the clinical presentations of LCH are variable and the decision to place into the appropriate clinical types may sometimes be masked by the non-discovery of all the lesions. In the oral maxillofacial area, the clinical features of these lesions may further pose a problem by nondescript manifestations as dental/periodontal/oral mucosal disorders. These oral findings may sometimes lead to inappropriate choice of treatment and delay in the diagnosis of all the lesions involved. This paper describes one such case where LCH manifest itself as a periodontal disease thus leading to delay in identifying all the sites involved and consequently a delay in id~ntifying the appropriate clinical type.
  3. Fulltext Development and Validation of Positive Smoker Identity Questionnaire (PSmoQi): A New Instrument for Smoking Cessation Correlates
    Ahmad MH, Ibrahim MI, Ab Rahman A, Musa KI, Mohd Zin F, Mohd Zain R, et al.
    Int J Environ Res Public Health, 2019 01 26;16(3).
    PMID: 30691181 DOI: 10.3390/ijerph16030351
    Background: The positive smoker identity construct, which was based on West's PRIME Theory, affected the smoking prevalence, quit attempts and cessation success. A validated questionnaire which could measure this rich and complex construct may facilitate prediction models of successful cessation. We aimed to develop and validate a questionnaire that assesses positive smoker identity based on West's PRIME Theory. Method: The initial item pool was developed based on a theoretical framework, empirical literature, existing scales and expert review. The questionnaire was conveniently distributed to 100 smokers. Exploratory factor analysis was utilized to explore domains in the questionnaire. Construct and criterion validity, internal consistency and reliability of the domains were analyzed. Results: The final positive smoker identity questionnaire (PSmoQi) has 26 items under four internally-consistent and reliable domains: Contributory factors, contextual and temporal patterning, identity related to smoking, and behaviour in relation to smoking. The full scale demonstrated good internal consistency (∝ = 0.78), acceptable convergent and divergent validity, and good concurrent validity with the smoker self-concept scale. Conclusion: The current study provides fundamental evidence for the PSmoQi as a valid instrument in research related to smoking cessation and interventional strategy. The PSmoQi contained validated domains which could measure almost a full spectrum of smoking cessation components.
  4. Fulltext Tobacco Denormalization Indicator in the Prevalence of Positive Smoker Identity and Its Associated Factors
    Ahmad MH, Ibrahim MI, Ab Rahman A, Musa KI, Mohd Zain F, Mohd Zain R, et al.
    Int J Environ Res Public Health, 2020 Mar 31;17(7).
    PMID: 32244417 DOI: 10.3390/ijerph17072363
    Positive smoker identity (PSI) is a construct that evaluates the degree of smokers' positive thoughts, images and feeling about smoking behavior and culture. PSI encompasses the indicators related to tobacco denormalization strategy, which is one of the four WHO tobacco endgame strategies. PSmoQi is a newly validated instrument which could reliably assess PSI. This study's objectives were to determine the prevalence of positive smoker identity and its associated factors using PSmoQi. A sample of 253 smokers from government agencies in Kota Bharu City, Malaysia were recruited using invitation letters sent to their head of agencies. Data collection was done in a briefing session voluntary attended by the smokers. Factors associated with PSI were analyzed using Multiple Logistic Regression. The prevalence of smokers with positive smoker identity was 72.3%. Factors associated with positive smoker identity were older age (Adjusted Odds ratio; AOR: 1.042; 95% confident interval; CI: 1.004, 1.081); p = 0.028), higher smoking self-concept scale Malay version (SSCS-M) score (AOR: 1.216; 95% CI: 1.112, 1.329; p < 0.001), higher heaviness index (AOR: 1.002; 95% CI: 1.001, 1.004; p = 0.011) and lower educational attainment (AOR: 0.458; 95% CI: 0.233, 0.900; p = 0.024). This study shows a high prevalence of PSI among smokers from government agencies in Kota Bharu City. Factors such as age, SSCS-M score, heaviness index and educational attainment influenced the level of positive smoker identity in a smoker. The finding would contribute an evidentiary guideline in screening smokers for smoking cessation clinic enrollment to achieve the best interventional outcome, as well as it would provide an objective indicator for tobacco denormalization status in a population.
  5. Bullous pemphigoid--management of a patient with oral and skin lesions
    Ali TB, Zain RB, Adam BA
    Singapore Dent J, 1994 Jan;19(1):18-21.
    PMID: 9582679
    A case of bullous pemphigoid with extra-oral and intraoral lesions in a 60-year-old female is reported. Diagnosis is based on histopathology and direct immunofluorescence, and the treatment regime described included oral prescription of prednisolone and topical application of a mixture of fluocinonide ointment and triamcinolone acetonide in Orabase on the oral lesions.
  6. Prevalence of oral precancerous and cancerous lesions in elderly Malaysians
    Ali TB, Jalalluddin RL, Abdul Razak I, Zain RB
    Asia Pac J Public Health, 1996;9:24-7.
    PMID: 10050195
    A house to house survey on elderly subjects aged 60 years old and above was undertaken in a large district in Malaysia. A total of 486 subjects in randomly selected Enumeration Blocks were interviewed and examined. The prevalence of oral precancerous lesions was recorded at 3.3%, of which leukoplakia was the most common. When the ethnic distribution of these oral precancerous and cancerous (OPC) lesions was compared, 72% of those inflicted were Indians. Oral cancer was detected in two subjects (0.4%), both of whom were of Indian origin. Among subjects with OPC lesions, 4.2% were smokers, 12.7% were betelquid chewers, 11.8% had indulged in both habits, whilst one subject had not practised any of the oral habits of interest (0.4%). The findings suggest the occurrence of OPC lesions to be related to betelquid chewing.
    Publication year=1996-1997
  7. Fulltext GSTM1, GSTT1 and CYP1A1 polymorphisms and risk of oral cancer: a case-control study in Jakarta, Indonesia
    Amtha R, Ching CS, Zain R, Razak IA, Basuki B, Roeslan BO, et al.
    Asian Pac J Cancer Prev, 2009 Jan-Mar;10(1):21-6.
    PMID: 19469619
    PURPOSE: to investigate genetic polymorphisms in GSTM1, GSTT1 and CYP1A1 and the association with the risk of oral cancer in the Jakarta population.
    METHOD: A total of 81 cases and 162 controls matched for age and sex were selected from 5 hospitals in Jakarta. Sociodemographic data using questionnaires were obtained and peripheral blood samples were collected with informed consent for PCR-RFLP assay. Conditional logistic regression analysis was performed to obtain the association between the risk of oral cancer and GSTM1, GSTT1 and CYP1A1 polymorphisms.
    RESULTS: GSTM1 and GSTT1 null were slightly overrepresented among cases (60.5% and 45.7% respectively) compared to controls (55.6% and 41.4% respectively), but no statistically significant differences were observed. In contrast, the distribution of CYP1A1 polymorphism was higher among controls compared to cases (52.5 % versus 42.4 %). The odds ratio of null GSTM1 and GSTT1 genotypes was slightly higher compared to wild type genotypes (OR 1.19, 95% CI 0.70-2.02 and OR 1.19, 95% CI 0.72-2.05 respectively). Furthermore, the presence of CYP1A1 polymorphism did not increase the risk of oral cancer (OR 0.70, 95% 0.39-1.25).
    CONCLUSION: Genetic polymorphisms of GSTM1, GSTT1 and CYP1A1 may not be risk factors for oral cancer in the Jakarta population.
  8. Prevalence of oral soft tissue lesions in out-patients at two Malaysian and Thai dental schools
    Axéll T, Zain RB, Siwamogstham P, Tantiniran D, Thampipit J
    Community Dent Oral Epidemiol, 1990 Apr;18(2):95-9.
    PMID: 2335069
    At the Faculties of Dentistry in Chiang Mai, Thailand (CM), and Kuala Lumpur, Malaysia (KL), 234 and 233 consecutive out-patients of mean ages 33.8 and 31.0 yr, respectively, were examined for the presence of oral mucosal lesions. Tobacco in some form was regularly used by 31.7% and 27.5% of the study populations in CM and KL, respectively. Cigarette smoking was the predominant habit. In CM three persons chewed betel quids and nine smoked banana leaf cigars daily. In addition, there were 24 habitual chewers of tea leaves (miang). In KL six persons chewed betel quids daily. In CM and KL three cases each (1.3%) of tobacco-associated leukoplakias were found. In KL an additional idiopathic leukoplakia was registered. One and three cases of betel related lesions were found in CM and KL, respectively. One case of a squamous cell carcinoma was found in a 45-yr-old Indian woman in KL who had been chewing betel with tobacco daily for many years. High prevalence figures were found for lichen planus, 3.8% in CM and 2.1% in KL, and an extremely high one, 48.3%, in CM for episodes of aphthous ulcers experienced during the last 2 yr. Comparatively low prevalence figures were found for herpes labialis. As could be expected melanin pigmentation was prevalent while only low figures were encountered for denture-related lesions and amalgam tattoos.
  9. Environmental surveillance of SARS-CoV-2 in municipal wastewater to monitor COVID-19 status in urban clusters in Malaysia
    Aziz MA, Norman S, Mohamed Zaid S, Simarani K, Sulaiman R, Mohd Aris A, et al.
    Arch Microbiol, 2023 Jan 28;205(2):76.
    PMID: 36708390 DOI: 10.1007/s00203-023-03417-y
    Wastewater monitoring for SARS-CoV-2 has attracted considerable attention worldwide to complement the existing clinical-based surveillance system. In this study, we report our first successful attempt to prove the circulation of SARS-CoV-2 genes in Malaysian urban wastewater. A total of 18 wastewater samples were obtained from a regional sewage treatment plant that received municipal sewage between February 2021 and May 2021. Using the quantitative PCR assay targeting the E and RdRp genes of SARS-CoV-2, we confirmed that both genes were detected in the raw sewage, while no viral RNA was found in the treated sewage. We were also able to show that the trend of COVID-19 cases in Kuala Lumpur and Selangor was related to the changes in SARS-CoV-2 RNA levels in the wastewater samples. Overall, our study highlights that monitoring wastewater for SARS-CoV-2 should help local health professionals to obtain additional information on the rapid and silent circulation of infectious agents in communities at the regional level.
  10. Gene expression in human oral squamous cell carcinoma is influenced by risk factor exposure
    Cheong SC, Chandramouli GV, Saleh A, Zain RB, Lau SH, Sivakumaren S, et al.
    Oral Oncol, 2009 Aug;45(8):712-9.
    PMID: 19147396 DOI: 10.1016/j.oraloncology.2008.11.002
    Oral squamous cell carcinoma (OSCC) is a world health problem and is associated with exposure to different risk factors. In the west, smoking and alcohol consumption are considered to be the main risk factors whilst in India and southeast Asia, betel quid (BQ) chewing is predominant. In this study, we compared the gene expression patterns of oral cancers associated with BQ chewing to those caused by smoking using Affymetrix microarrays. We found that 281 genes were differentially expressed between OSCC and normal oral mucosa regardless of aetiological factors including MMP1, PLAU, MAGE-D4, GNA12, IFITM3 and NMU. Further, we identified 168 genes that were differentially expressed between the BQ and smoking groups including CXCL-9, TMPRSS2, CA12 and RNF24. The expression of these genes was validated using qPCR using independent tissue samples. The results demonstrate that whilst common genes/pathways contribute to the development of oral cancer, there are also other gene expression changes that are specific to certain risk factors. The findings suggest that different carcinogens activate or inhibit specific pathways during cancer development and progression. These unique gene expression profiles should be taken into consideration when developing biomarkers for future use in prognostic or therapeutic applications.
  11. Changes in health-related quality of life of oral cancer patients treated with curative intent: experience of a developing country
    Doss JG, Ghani WMN, Razak IA, Yang YH, Rogers SN, Zain RB
    Int J Oral Maxillofac Surg, 2017 Jun;46(6):687-698.
    PMID: 28318871 DOI: 10.1016/j.ijom.2017.02.1269
    This study aimed to assess changes in oral cancer patients' health-related quality of life (HRQOL) and the impact of disease stage on HRQOL scores. HRQOL data were collected from seven hospital-based centres using the Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N) version 4.0 instrument. The independent samples t-test, χ(2) test, and paired samples t-test were used to analyse the data. A total of 300 patients were recruited. The most common oral cancer sub-site was tongue and floor of mouth (42.6%). Surgical intervention (41.1%) was the most common treatment modality. Significant differences in ethnicity and treatment modality were observed between early and late stage patients. Pre-treatment HRQOL scores were significantly lower for late than early stage patients. At 1 month post-treatment, the functional and head and neck domains and the FACT-H&N (TOI) summary scores showed significant deterioration in both early and late stage patients. In contrast, the emotional domain showed a significant improvement for early and late stage patients at 1, 3, and 6 months post-treatment. Although HRQOL deterioration was still observed among early and late stage patients at 6 months post-treatment, this was not statistically significant. In conclusion, advanced disease is associated with poorer HRQOL. Although ethnic differences were observed across different disease stages, the influence of ethnicity on patient HRQOL was not evident in this study.
  12. Fulltext Expression of Ki-67, Cornulin and ISG15 in non-involved mucosal surgical margins as predictive markers for relapse in oral squamous cell carcinoma (OSCC)
    Govindaraj PK, Kallarakkal TG, Mohd Zain R, Tilakaratne WM, Lew HL
    PLoS One, 2021;16(12):e0261575.
    PMID: 34941961 DOI: 10.1371/journal.pone.0261575
    BACKGROUND: Local relapse of oral squamous cell carcinoma in non-involved mucosal surgical margins indicated possibility of field alteration in the margins, which could be predicted with certain biomarkers. The objectives were to evaluate the expression of Ki-67, Cornulin and ISG15 in non-involved mucosal surgical margins and the association of clinicopathological prognosticators with local relapse in oral squamous cell carcinoma.

    METHODS: Surgical margins from the study (relapse) group (n = 23), control (non-relapse) group (n = 32) and normal oral mucosa (n = 5) were immunohistochemically stained using Ki-67, Cornulin and ISG15 antibodies. Association between expression of markers and clinicopathological prognosticators with local relapse in oral squamous cell carcinoma was analyzed statistically.

    RESULTS: The study group surgical margins demonstrated significantly decreased Cornulin expression (p = 0.032). Low Cornulin expression was significantly associated with local relapse (p = 0.004) and non-tongue primary tumor (p = 0.013). Although not significantly associated with local relapse, expression of Ki-67 was significantly reduced in female patients (p = 0.041). Age above 57.5 years, Chinese & Indian ethnicity, alcohol consumption, epithelial dysplasia in surgical margins, and type III and IV patterns of invasion of tumor were also significantly related to local relapse. Regression analysis showed low expression of Cornulin (p = 0.018), and increased patient's age (p = 0.008) were predictors of local relapse in oral squamous cell carcinoma, with 34-fold risk and 18-fold risk, respectively. Expression of Ki-67 and ISG15 did not show significant association with local relapse in oral squamous cell carcinoma.

    CONCLUSION: Low expression of Cornulin is an independent predictor of relapse in oral squamous cell carcinoma.

  13. The social impact of oral and facial pain in an industrial population
    Jaafar N, Razak IA, Zain RB
    Ann Acad Med Singap, 1989 Sep;18(5):553-5.
    PMID: 2619246
    The aim of this study is to determine the social impact of oral and facial pain in a sample involving an industrial population. Out of a total of 355 subjects interviewed, nearly one-half claimed to have oral and facial pain in the previous one month prior to the survey. The most common type of pain was that related to hot or cold fluids or sweet things followed by toothache. On the average, the pain lasted for 4.2 days (SD = 4.9) per person in the past one-month. About one in five persons with pain reported that it was severe enough to disrupt sleep. About one in ten persons reporting pain had to take sick leave because of the pain. However, only one in four persons with pain consulted a doctor or dentist. More than one-third tried to cope with the pain and did nothing while the rest tried various means of self-cure. It is therefore postulated that in this population, pain per se is a poor predictor of utilisation of dental services. Further research into pain coping behaviour and how this affects of pattern of utilisation of dental services is indicated in order to formulate a strategy to encourage the habit of seeking prompt dental care by the target population.
  14. Fulltext Multiyear prospective cohort study to evaluate the risk potential of MERS-CoV infection among Malaysian Hajj pilgrims (MERCURIAL): a study protocol
    Johari J, Hontz RD, Pike BL, Husain T, Chong CK, Rusli N, et al.
    BMJ Open, 2021 08 26;11(8):e050901.
    PMID: 34446498 DOI: 10.1136/bmjopen-2021-050901
    INTRODUCTION: Middle East respiratory syndrome (MERS) is a viral respiratory infection caused by the MERS-CoV. MERS was first reported in the Kingdom of Saudi Arabia in 2012. Every year, the Hajj pilgrimage to Mecca attracts more than two million pilgrims from 184 countries, making it one of the largest annual religious mass gatherings (MGs) worldwide. MGs in confined areas with a high number of pilgrims' movements worldwide continues to elicit significant global public health concerns. MERCURIAL was designed by adopting a seroconversion surveillance approach to provide multiyear evidence of MG-associated MERS-CoV seroconversion among the Malaysian Hajj pilgrims.

    METHODS AND ANALYSIS: MERCURIAL is an ongoing multiyear prospective cohort study. Every year, for the next 5 years, a cohort of 1000 Hajj pilgrims was enrolled beginning in the 2016 Hajj pilgrimage season. Pre-Hajj and post-Hajj serum samples were obtained and serologically analysed for evidence of MERS-CoV seroconversion. Sociodemographic data, underlying medical conditions, symptoms experienced during Hajj pilgrimage, and exposure to camel and untreated camel products were recorded using structured pre-Hajj and post-Hajj questionnaires. The possible risk factors associated with the seroconversion data were analysed using univariate and multivariate logistic regression. The primary outcome of this study is to better enhance our understanding of the potential threat of MERS-CoV spreading through MG beyond the Middle East.

    ETHICS AND DISSEMINATION: This study has obtained ethical approval from the Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia. Results from the study will be submitted for publication in peer-reviewed journals and presented in conferences and scientific meetings.

    TRIAL REGISTRATION NUMBER: NMRR-15-1640-25391.

  15. Fulltext MERS-CoV seroconversion amongst Malaysian Hajj pilgrims returning from the Middle East, 2016-2018: results from the MERCURIAL multiyear prospective cohort study
    Johari J, Hontz RD, Pike BL, Husain T, Rusli N, Mohd-Zain R, et al.
    Emerg Microbes Infect, 2023 Dec;12(1):2208678.
    PMID: 37101375 DOI: 10.1080/22221751.2023.2208678
    Prospective cohort study to investigate the potential exposure to the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV) following Hajj pilgrims is still very limited. Here, we report the antibody seroconversion study results obtained from successive three years cohort studies (2016-2018) involving the Malaysian Hajj pilgrims returning from the Middle East. A cohort study of Hajj pilgrims from Malaysia enrolled 2,863 participants from 2016-2018, all of whom consented to provide paired blood samples for both pre- and post-Hajj travel to the Middle East. ELISAs and micro-neutralization assays were performed to detect the presence of MERS-CoV IgG antibodies. Sociodemographic data, symptoms experienced during Hajj, and history of exposure to camels or camel products were recorded using structured pre- and post-Hajj questionnaires. A 4-fold increase in anti-MERS-CoV IgG between paired pre-Hajj and post-Hajj serum samples in twelve participants was observed. None of the twelve ELISA-positive sera had detectable levels of virus-neutralizing antibodies. All reportedly had mild symptoms of respiratory symptoms at a certain point during the pilgrimage, implying mild or asymptomatic infections. No association between post-Hajj serum positivity and a history of exposure to camels or camel products was obtained. Findings from the study suggest that serologic conversion to MERS-CoV occurred in at least 0.6% of the Hajj pilgrims returning from the Middle East. Since all the seroconvertants had mild to no symptoms during the sampling period, it highlights the likelihood of occurrence of only low infectivity spillover infections among the Hajj pilgrims.
  16. Human telomerase reverse transcriptase expression in oral carcinogenesis--a preliminary report
    Kumar SK, Zain RB, Ismail SM, Cheong SC
    J Exp Clin Cancer Res, 2005 Dec;24(4):639-46.
    PMID: 16471328
    Human telomerase reverse transcriptase (hTERT), the catalytic subunit of telomerase, is strongly associated with telomerase activity implicated in cellular immortalization and tumorigenesis. In situ detection of hTERT will aid in determining the localization of telomerase positive cells. The aim of this study was to detect hTERT protein expression in multistep oral carcinogenesis using paraffin embedded tissue samples, and to study the relationship of hTERT expression with different histological stages in oral carcinogenesis. Normal (n = 4), hyperplastic (n = 4), dysplastic (n = 4) and neoplastic (n = 10) oral epithelia representing different histological stages in oral carcinogenesis were included in the study. hTERT protein detection was done by immunohistochemistry (IHC) technique. Nuclear staining intensities were noted and the hTERT-labelling index was determined. Dysplastic and neoplastic oral epithelia showed an increased percentage of hTERT positive cells (Grade 4: > 50% positive staining nuclei) with intense staining in the basal, parabasal and superficial layers of the epithelia, unlike normal oral mucosa which showed intense staining only in the basal and parabasal cell layers, which are the normal proliferative progenitor compartments. hTERT protein expression was elevated with the corresponding advancement of the histological stages of oral carcinogenesis, from normal to hyperplasia to dysplasia to carcinoma. There seems to be an upregulation of hTERT protein expression during the progression of oral cancer, therefore, this may indicate the feasibility of IHC detection of hTERT protein in oral carcinogenesis as a potential diagnostic or prognostic marker.
  17. Fulltext Aetiology and risk factors for oral cancer - a brief overview
    Kumar SKS, Zain RB
    Ann Dent, 2004;11(1):41-50.
    MyJurnal
    Oral cancer is the sixth most common malignancy in the world. Despite recent advances in cancer diagnoses and therapies, the five-year survival rate of oral cancer patients has remained at a dismal 50% in the last few decades. Oral cancer is of major concern in Southeast Asia primarily because of the prevalent oral habits namely betel quid chewing, smoking and alcohol consumption. This paper provides a brief overview on the various aetiological agents and risk factors implicated in the development of oral cancer.
  18. Trigeminal neuralgia. A retrospective survey of a sample of patients in Singapore and Malaysia
    Loh HS, Ling SY, Shanmuhasuntharam P, Zain R, Yeo JF, Khoo SP
    Aust Dent J, 1998 Jun;43(3):188-91.
    PMID: 9707784
    This survey was undertaken to study the clinical features of trigeminal neuralgia in an Asian population. Demographic data of 44 patients treated at the Dental Faculty of the National University of Singapore and at the University of Malaya were reviewed. The results of the survey were analysed and comparisons made with those of Caucasian patients as reported in other studies where there was a general similarity in the clinical findings. Trigeminal neuralgia presented predominantly in females. Right-sided involvement occurred at a greater frequency, and the peak age at onset was between the sixth and seventh decades of life. The only significant variant in the present sample was the greater involvement of the mandibular branch of the trigeminal nerve rather than the maxillary division. In addition, there was a much greater representation from Chinese patients over Malays as compared with their ratios in the general population.
  19. The cracked tooth syndrome--crown root vertical fracture
    Majid ZA, Zain RB
    Singapore Dent J, 1988 Dec;13(1):44-6.
    PMID: 3155005
    A case of an incomplete tooth fracture followed by a complete fracture was presented. The difficulty of diagnosing this condition was discussed as well as the possible histological explanation of the symptoms experienced by the patient. It once again points out to practising dentists, that whilst deep pockets can give rise to severe periodontal pain, intense and excruciating pain should be investigated with the cracked tooth in mind.
  20. Fulltext Assessing the impact of simplified HCV care on linkage to care amongst high-risk patients at primary healthcare clinics in Malaysia: a prospective observational study
    Markby J, Shilton S, Sem X, Chan HK, Md Said R, Siva S, et al.
    BMJ Open, 2021 Dec 24;11(12):e055142.
    PMID: 34952885 DOI: 10.1136/bmjopen-2021-055142
    INTRODUCTION: To achieve the elimination of hepatitis C virus (HCV), substantial scale-up in access to testing and treatment is needed. This will require innovation and simplification of the care pathway, through decentralisation of testing and treatment to primary care settings and task-shifting to non-specialists. The objective of this study was to evaluate the feasibility and effectiveness of decentralisation of HCV testing and treatment using rapid diagnostic tests (RDTs) in primary healthcare clinics (PHCs) among high-risk populations, with referral of seropositive patients for confirmatory viral load testing and treatment.

    METHODS: This observational study was conducted between December 2018 and October 2019 at 25 PHCs in three regions in Malaysia. Each PHC was linked to one or more hospitals, for referral of seropositive participants for confirmatory testing and pretreatment evaluation. Treatment was provided in PHCs for non-cirrhotic patients and at hospitals for cirrhotic patients.

    RESULTS: During the study period, a total of 15 366 adults were screened at the 25 PHCs, using RDTs for HCV antibodies. Of the 2020 (13.2%) HCV antibody-positive participants, 1481/2020 (73.3%) had a confirmatory viral load test, 1241/1481 (83.8%) were HCV RNA-positive, 991/1241 (79.9%) completed pretreatment assessment, 632/991 (63.8%) initiated treatment, 518/632 (82.0%) completed treatment, 352/518 (68.0%) were eligible for a sustained virological response (SVR) cure assessment, 209/352 (59.4%) had an SVR cure assessment, and SVR was achieved in 202/209 (96.7%) patients. A significantly higher proportion of patients referred to PHCs initiated treatment compared with those who had treatment initiated at hospitals (71.0% vs 48.8%, p<0.001).

    CONCLUSIONS: This study demonstrated the effectiveness and feasibility of a simplified decentralised HCV testing and treatment model in primary healthcare settings, targeting high-risk groups in Malaysia. There were good outcomes across most steps of the cascade of care when treatment was provided at PHCs compared with hospitals.

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