Much interest has been generated in tooth-co loured inlays/onlays especially with patient's concern for esthetic appearance and the dentist's appreciation for additional strength of the restored tooth, together with bonding. Many types of tooth-coloured inlay/onlay restorations are available but none have undergone extensive and long term research. The different types of inlay/onlay restorations together with steps in their preparation are presented in this paper.
This paper revisits the prescription of drugs for pregnant patients and the dental and oral changes during pregnancy. The management of these patients is also outlined. Emphasis should be placed on prevention of dental problem during pregnancy.
It is possible that different techniques used to measure axial length (AL) and anterior chamber depth (ACD) is the cause of discrepancy in refractive outcomes of cataract surgery. This study evaluated the agreement and repeatability of AL and ACD measurements using immersion and contact A-scan biometry techniques and compared the refractive outcomes from both techniques. Twenty four patients were evaluated for agreement and repeatability of AL and ACD measurements using the two different methods. The results were analyzed using Bland and Altman plots. Another 60 patients with age-related cataract were selected to compare the refractive outcomes between both methods. The IOL power was calculated using Sanders- Retzlaff- Kraff- Theoretical (SRK-T) equation. Refraction was determined between four to six weeks postoperatively and the results were analyzed using paired t-test. The results of this study showed good agreement between both techniques was noted with no significant difference detected between measurements (p > 0.05). Significant correlation was found in all parameters (AL: r = 0.99; p < 0.01, r = 0.99; p < 0.01) ACD: r = 0.91; p < 0.01, r = 0.97; p < 0.01). No significant difference in refractive outcomes of post cataract surgery was detected between the two techniques (p = 0.07). This study concludes that contact A-scan biometry and immersion techniques provide reliable results and should not be the cause of discrepancy in the refractive planned and outcome of cataract surgery.
Fat embolism syndrome is a well-recognised sequela of long bone trauma as well as intramedullary orthopaedic procedures. However, it has rarely been described following manipulation, reduction of fracture, and application of external fixator. Furthermore, bilateral ocular blindness is seldom the first manifestation; instead respiratory and other cerebral symptoms being most common. We describe a case with this rare presentation in a patient who underwent a trial of closed reduction, then open reduction of a femur fracture, followed by external fixation performed at day 47 post-initial trauma.
Simulated/ standardized patients (SPs) have become one of the significant components in today’s medical education and students’ assessment. Some differences exist in the training method of SPs for psychiatry examinations compared to other medical disciplines. This brief report highlights the challenges encountered in the training process and methods to overcome those challenges. A wellstructured, intensive training remains as one of the most important factors in ensuring standardization of SPs for psychiatric examinations.
The main aim of the study was to determine the effect of psychoeducation program on insight of patients with schizophrenia and to determine other factors associated with the change of the insight. This was an interventional study of 70 patients with schizophrenia who underwent a psychoeducation program. Diagnosis was confirmed using Mini International Neuropsychiatric Interview (M.I.N.I). Insight was assessed using the Schedule for the Assessment of Insight (SAI) before and after the psychoeducation programme. Effect on insight was measured as the change in SAI scores. There was an improvement in insight after the psychoeducation programme which was significant (p< 0.001). Patient’s age, shorter duration of illness and no previous history of admission to mental institution were significantly related to the improvement of insight (p< 0.05). Conclusion: Psychoeducation is an important tool in improving insight into illness among patients with schizophrenia. It needs to be given as early as possible during the course of the illness.
Alot has been said and debated about evidence-based clinical practice. What is it really and why so much of significance is attached to it? Is all the evidence from clinical trials relevant and reliable? How about experience-based clinical practice? How much of our practice is influenced by clinical data and how much of it by years of practice and number of patients managed? The clinician will still need to exercise common sense when treating patients and they must always remember that each individual patient is unique and a clinician’s approach will have to be catered to their needs. After all, the caveat is that we are treating individuals with feelings and emotions and not textbooks or journal articles.
To describe a quick and simple diagnostic approach to monocular diplopia. Diplopia is a common visual complain in casualty departments, general practice clinics, neurologic clinics as well as ophthalmic clinics. Monocular diplopia, however, is uncommon. Many well established clinical examination methods are available to address diplopia. Some require special equipments which are not easily available or unfamiliar outside of ophthalmic clinic. We describe a simple two-minute diagnostic approach to monocular diplopia. Basic knowledge and understanding of simple clinical examination techniques enhances diagnostic skill and allow proper localization of underlying disorders.
Thyroid hormones mediate the biological activities of almost all organ systems in the body. Patients with a deficiency of these hormones may present with a wide spectrum of clinical symptomatology. This report is of an infant who presented with chronic anaemia which was found to be secondary to hypothyroidism associated with a hypoplastic lingual thyroid gland. Physicians need to be alert to the varied manifestations of hypothyroidism so as to avoid delay in diagnosis and treatment.
Introduction : Health management is a tool to ensure an effective running of health program and at the same time avoiding flaws to its components including patients, workers and the entire organization. Risk management is a new concept in health management where the determinants of the problems or the risks are put to minima. It’s strategies are oriented towards prevention as well as controlling to all its administrative system.
Methodology : This is a systematic review on various papers, studies and observations put forwards by risk management experts. It is also supported by feedbacks from many scholars who are involved in research and teaching.
Results : It is been observed that risk management activities have been on practiced in health care delivery system. It is not a new form, but rather a situational action based on certain issues. In fact, it happens in any organization – public or private. Close observation on this area has triggered development of various risk management models including some administrative standard and guidelines.
Conclusion: Risk management is a new approach that need to be practiced by all manager and leader. Its discipline involves interpretation of risk at all angles. It is not only confined to the explicit component, but should also be expended to others area as well. It needs a good sense and good attitude of the manager. The essence of risk management is to minimize the risk to patient, staff, public and the entire organization.
This research aims to evaluate the effects of different cognitive training using imagery, general cognitive (CG) and specific cognitive (CS) (Paivio, 1985) to the achievement of service by the tekong in sepak takraw. The effects of imagery training with physical training towards achievement, imagery ability and exercise heart rate were also collected. The subjects consisted of 24 elite players sepak takraw (tekong) school level player that involved in Tunas Cemerlang program, aged 13 to 17 years old (M = 14.66, SD = 1.40). The subjects were divided into three groups, the test (CG & CS) and control (C) group with an exercise program to different imagery and physical training for eight weeks. Pre-test was conducted by testing the service performance appraisal based on the results of 25 landings repeated as in training, Miq-R questionnaire (Hall & Martin, 1997) and pulse rate immediately prior to the exercise of a service. ITP imagery training program adapted from Morris et at. (2005) was conducted using different imagery scripts for CG and CS groups and post-test was conducted at the end of the program. Independent samples t-test showed no significant difference when comparing the two test groups. Paired t-test and one-way ANOVA analysis showed that CG group significantly improved performance while not among C group. Analysis Miq-R and the average training heart rate is not significant for all subjects. The study has found that the imagery of CG and CS are not differed in terms of the effectiveness in improving achievement but both are suggested to be conducted in the training program to improve the service by the tekong.
World Health Organization has defined self-medication as the selection and use of medications (including herbal and traditional product) by individuals to treat self-recognized illnesses or symptoms. The prevalence of self-medication is reported to be higher among female students.
The use of manual stretching procedures has become more prevalent in cardiorespiratory physiotherapy to improve pulmonary functions. However, limited evidence exists regarding evaluation of their effectiveness. The study aimed to determine the impact of Intercostal (IC) stretch in improving the dynamic pulmonary function parameters (Forced Expiratory Volume in the first second (FEV1), Forced Vital Capacity (FVC) and FEV1/FVC % and respiratory rate among healthy adults. Thirty healthy male subjects were recruited based on inclusion and exclusion criteria. Subjects were assigned to the experimental group and the control group through random sampling method. In the experimental group, subjects underwent IC stretch for ten breaths on the inspiratory phase of the respiratory cycle with breathing control exercises in semi recumbent position, while in the control group, breathing control exercises alone were performed in the semi recumbent position. The results of the study showed, FEV1/FVC % in the experimental group significantly improved with P=0.017 (p<0.05) than the control group, which means IC stretch increased lung volume and lead to improved lung function. This study suggested the IC stretching with breathing control may be more effective in improving dynamic lung parameters especially FEV1/FVC % than breathing control alone.
The impaction rate is higher for the third molars than for any other tooth in modern human population. This study was conducted with the aim to evaluate the validity of linear and angular measurements on the digital panoramic radiograph as a reference for early prediction of mandibular third molar eruption/impaction.
The successful clinical applicability of rotary left ventricular assist devices (LVADs) has led to research interest in devising a total artificial heart (TAH) using two rotary blood pumps (RBPs). The major challenge when using two separately controlled LVADs for TAH support is the difficulty in maintaining the balance between pulmonary and systemic blood flows. In this study, a starling-like controller (SLC) hybridized with an adaptive mechanism was developed for a dual rotary LVAD TAH. The incorporation of the adaptive mechanism was intended not only to minimize the risk of pulmonary congestion and atrial suction but also to match cardiac demand. A comparative assessment was performed between the proposed adaptive starling-like controller (A-SLC) and a conventional SLC as well as a constant speed controller. The performance of all controllers was evaluated by subjecting them to three simulated scenarios [rest, exercise, head up tilt (HUT)] using a mock circulation loop. The overall results showed that A-SLC was superior in matching pump flow to cardiac demand without causing hemodynamic instabilities. In contrast, improper flow regulation by the SLC resulted in pulmonary congestion during exercise. From resting supine to HUT, overpumping of the RBPs at fixed speed (FS) caused atrial suction, whereas implementation of SLC resulted in insufficient flow. The comparative study signified the potential of the proposed A-SLC for future TAH implementation particularly among outpatients, who are susceptible to variety of clinical scenarios.
In Oceania, a region challenged by rapid urbanisation and climate change, integrative frameworks are required to enable effective actions on health and sustainability. The Ecohealth approach provides a framework for practice that acknowledges human health is intrinsically linked to ecosystem health. This research communication reports on a study involving interviews with twenty-seven leading health and sustainability thinkers from Oceania and across the globe. In examining their ideas for action, the report presents the study findings in relation to the guiding principles of Ecohealth: systems thinking, transdisciplinarity, participation, sustainability, equity and knowledge-to-action. Implications for Ecohealth practitioners working in Oceania are considered.
This chapter describes the development of the science of cryopreservation of gametes and embryos of various species including human. It attempts to record in brief the main contributions of workers in their attempts to cryopreserve gametes and embryos. The initial difficulties faced and subsequent developments and triumphs leading to present-day state of the art are given in a concise manner. The main players and their contributions are mentioned and the authors' aim is to do justice to them. This work also attempts to ensure that credit is correctly attributed for significant advances in gamete and embryo cryopreservation. In general this chapter has tried to describe the historical development of the science of cryopreservation of gametes and embryos as accurately as possible without bias or partiality.
Mastoid osteoma is a rare benign neoplasm of mesenchymal origin. Osteomas of the temporal bone are
infrequent, and these mastoid osteomas are a definite rare occurrence. These tumours can present with
cosmetic deformity and sometimes with pain. In this report we describe a patient with mastoid osteoma
who presented with cosmetic deformity and experienced retro auricular pain.
Objectives: This investigation focused on finding the changes in learning approaches of students’ while experiencing physiology curriculum and to explore the reflection of changes if any, on their critical thinking skills.
Methods: In this longitudinal study, information on students’ learning approaches was obtained using the revised two factor study process questionnaire (R-SPQ-2F) at the commencement (pre-test) and completion (post-test) of first year MBBS course. The total score and the scores obtained in the critical thinking questions in four physiology assessments were analysed. Pre and post-tests scores in R-SPQ-2F and assessment scores were compared using independent samples t-test and one way repeated measure ANOVA respectively. Correlation of scores between assessments was done using Pearson correlation. A p value < 0.05 was taken as significant.
Results: A significant increase in students’ deep learning approach at the completion of the physiology curriculum when compared to commencement (p < 0.001) was observed. A progressive improvement in their scores as they experienced the curriculum was also noticed. A moderate correlation among critical thinking questions scores and a strong correlation between critical thinking questions and total essay scores were also recorded.
Conclusion: The study revealed improvement in students’ deep approach to learning in physiology which was reflected in their performance in critical thinking questions.
Study site: Melaka Manipal Medical College, Manipal University, India
Malnutrition is one of the biggest challenges of the 21st century, with one in three people in the world malnourished, combined with poor diets being the leading cause of the global burden of disease. Fish is an under-recognised and undervalued source of micronutrients, which could play a more significant role in addressing this global challenge. With rising pressures on capture fisheries, demand is increasingly being met from aquaculture. However, aquaculture systems are designed to maximise productivity, with little consideration for nutritional quality of fish produced. A global shift away from diverse capture species towards consumption of few farmed species, has implications for diet quality that are yet to be fully explored. Bangladesh provides a useful case study of this transition, as fish is the most important animal-source food in diets, and is increasingly supplied from aquaculture. We conducted a temporal analysis of fish consumption and nutrient intakes from fish in Bangladesh, using nationally representative household expenditure surveys from 1991, 2000 and 2010 (n = 25,425 households), combined with detailed species-level nutrient composition data. Fish consumption increased by 30% from 1991-2010. Consumption of non-farmed species declined by 33% over this period, compensated (in terms of quantity) by large increases in consumption of farmed species. Despite increased total fish consumption, there were significant decreases in iron and calcium intakes from fish (P<0.01); and no significant change in intakes of zinc, vitamin A and vitamin B12 from fish, reflecting lower overall nutritional quality of fish available for consumption over time. Our results challenge the conventional narrative that increases in food supply lead to improvements in diet and nutrition. As aquaculture becomes an increasingly important food source, it must embrace a nutrition-sensitive approach, moving beyond maximising productivity to also consider nutritional quality. Doing so will optimise the complementary role that aquaculture and capture fisheries play in improving nutrition and health.