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  1. Jamayet NB, Rahman AM, Nizami MMUI, Johari Y, Husein A
    Indian J Dent Res, 2018 12 28;29(6):840-843.
    PMID: 30589017 DOI: 10.4103/ijdr.IJDR_20_17
    Exenteration surgery greatly affects a person in terms of function, esthetics, and psychological trauma. In such cases, restoration by silicone orbital prosthesis is a well-accepted treatment option. However, this is a difficult task, necessitating personalized design of method for each patient. This case report describes the technique for fabrication of a silicone orbital prosthesis for a male patient with left orbital defect due to exenteration of a Grade 3 squamous cell carcinoma of the left eye and surrounding tissues. The patient was delivered with a satisfactory silicone orbital prosthesis having good retention and finish. Multidisciplinary management and team approach are crucial in providing precise and effective rehabilitation for improving the patient's quality of life and help them return to their normal social life.
  2. Sarmin S, Ethiraj B, Islam MA, Ideris A, Yee CS, Khan MMR
    Sci Total Environ, 2019 Dec 10;695:133820.
    PMID: 31416036 DOI: 10.1016/j.scitotenv.2019.133820
    The petrochemical wastewater (PCW) from acrylic acid plants possesses a very high chemical oxygen demand (COD) due to the presence of acrylic acid along with other organic acids. The treatment of PCW by conventional aerobic and anaerobic methods is energy intensive. Therefore, the treatment of PCW with concurrent power generation by employing microbial fuel cell (MFC) could be a potential alternative to solve the energy and environmental issues. This study demonstrates the potentiality of PCW from acrylic acid plant with an initial COD of 45,000 mg L-1 generating maximum power density of 850 mW m-2 at a current density of 1500 mA m-2 using acclimatized anaerobic sludge (AS) as biocatalyst. The predominant microbes present in acclimatized AS were identified using Biolog GEN III analysis, which include the electrogenic genera namely Pseudomonas spp. and Bacillus spp. along with methanogenic archea Methanobacterium spp. The mechanism of electron transfer was elucidated by cyclic voltammetry (CV) and electrochemical impedance spectroscopy (EIS) which clearly demonstrated the natural metabolite-based electron transfer across the electrode/biofilm/solution interface. The abundance of the electron shuttle metabolites was increased with the microbial growth in the bulk solution as well as in the biofilm leading to a high power generation. The COD removal efficiency and the coulombic efficiency (CE) were found to be 40% and 21%, respectively after 11 days of operation using initial COD of 45,000 mg L-1. The low COD removal efficiency could drastically be increased to 82% when the initial COD of PCW was 5000 mg L-1 generating a power density of 150 mW m-2. The current work proves the feasibility of the MFC for the treatment of acrylic acid plant PCW using acclimatized anaerobic sludge (AS) as a biocatalyst.
  3. Inn FX, Ahmed N, Hou LG, Abidin ZAZ, Yi LL, Zainuddin ZM
    Int Urol Nephrol, 2019 Nov;51(11):1949-1953.
    PMID: 31441009 DOI: 10.1007/s11255-019-02262-7
    PURPOSE: The internal drainage provided by a ureteral stent helps with the relief and prevention of ureteral obstruction. By definition, correct stent placement is one with a complete loop in both the renal pelvis and bladder. This prevents stent migration proximally or distally despite urinary flow, patient movement, and ureteral peristalsis.

    METHODS: We performed a comparative prospective cross-sectional study assessing the impact of intravesical stent position on the quality of life in 46 patients with a ureteral stent. This is done using the Ureteral Stent Symptom Questionnaire (USSQ).

    RESULTS: 52.5% of patients had an ipsilateral positioned intravesical stent, while the remaining had their stent positioned contralaterally. Intravesical stent position significantly influenced the quality of life. The USSQ score was worse for the contralateral group. Subscore analysis found that urinary symptoms and body pain index contribute significantly to the morbidity. Majority of patients in the ipsilateral group reported no discomfort as compared to the contralateral group.

    CONCLUSIONS: To the best of our knowledge, this is the first study assessing the impact of intravesical stent position on the quality of life in the Asian population. Intravesical stent position has a significant influence on patient's morbidity and quality of life in particular towards their urinary irritative symptoms and body pain. It is imperative to ensure correct distal placement of ureteric stent that does not cross the midline to the contralateral site. We believe that the USSQ should be used in daily clinical practice in assessing the symptoms related to indwelling ureteric stents.

  4. Khaleel I, Zaidi STR, Shastri MD, Eapen MS, Ming LC, Wanandy T, et al.
    Eur J Hosp Pharm, 2018 Oct;25(e2):e102-e108.
    PMID: 31157078 DOI: 10.1136/ejhpharm-2017-001225
    Objectives: High dose of intravenous sulfamethoxazole and trimethoprim (co-trimoxazole) is often used in immunocompromised patients for the treatment of Pneumocystis jiroveci pneumonia. Current manufacturer's dilution recommendation for intravenous co-trimoxazole (1:25 v/v) requires the administration of 2 L of additional fluid per day causing serious complications including pulmonary oedema. Intravenous administration of concentrated solution of co-trimoxazole may minimise the risk of fluid overload associated side effects. Therefore, the objective of the study was to investigate the physicochemical stability of concentrated intravenous co-trimoxazole solutions.

    Methods: Four ampoules of intravenous co-trimoxazole were injected into an infusion bag containing either 480 (1:25 v/v), 380 (1:20 v/v), 280 (1:15 v/v) or 180 (1:10 v/v) mL of glucose 5% solution. Three bags for each dilution (total 12 bags) were prepared and stored at room temperature. An aliquot was withdrawn immediately (at 0 hour) and after 0.5, 1, 2 and 4 hours of storage for high-performance liquid-chromatography (HPLC) analysis, and additional samples were withdrawn every half an hour for microscopic examination. Each sample was analysed for the concentration of trimethoprim and sulfamethoxazole using a stability indicating HPLC method. Samples were assessed for pH, change in colour (visually) and for particle content (microscopically) immediately after preparation and on each time of analysis.

    Results: Intravenous co-trimoxazole at 1:25, 1:20, 1:15 and 1:10 v/v retained more than 98% of the initial concentration of trimethoprim and sulfamethoxazole for 4 hours. There was no major change in pH at time zero and at various time points. Microscopically, no particles were detected for at least 4 hours and 2 hours when intravenous co-trimoxazole was diluted at 1:25 or 1:20 and 1:15 v/v, respectively. More than 1200 particles/mL were detected after 2.5 hours of storage when intravenous co-trimoxazole was diluted at 1:15 v/v.

    Conclusions: Intravenous co-trimoxazole is stable over a period of 4 hours when diluted with 380 mL of glucose 5% solution (1:20 v/v) and for 2 hours when diluted with 280 mL glucose 5% solution (1:15 v/v).

  5. Elias MS, Ibrahim S, Samuding K, Kantasamy N, Rahman SA, Hashim A
    Appl Radiat Isot, 2019 Sep;151:116-123.
    PMID: 31174051 DOI: 10.1016/j.apradiso.2019.05.038
    A study was carried out to determine the concentrations of rare earth elements (REEs) in Linggi river sediments collected from 113 sampling locations. The sediment analysis was performed by Neutron activation analysis (NAA) and Inductively coupled plasma - mass spectrometry (ICP-MS). The results of Linggi river sediment were normalized to "recent" reference shale values. The means of total concentrations of REEs (ΣREE), light REEs (ΣLREE) and heavy REEs (ΣHREE) in Linggi sediment were 241.2, 219.2, and 22.0 mg/kg, respectively, which indicates enrichment compared to ΣREE, ΣLREE and ΣHREE reference shale values. Results obtained from enrichment factors (EF) show no enrichment to moderate enrichment of Linggi sediments, indicating the sources of REEs pollution originated from natural and land-based activities. A similar pattern was observed by comparing the REEs values of Linggi sediments to other references shale values. Ce (δCe) and Eu (δEu) anomalies indicate Linggi sediments showed positive anomaly of Ce whilst negative anomaly of Eu.
  6. Goh SW, Adawiyah J, Md Nor N, Yap F, Ch'ng P, Chang CC
    Malays Fam Physician, 2019;14(1):42-46.
    PMID: 31289632
    Prurigo pigmentosa is an inflammatory dermatosis characterized by a pruritic, symmetrically distributed erythematous papular or papulo-vesicular eruption on the trunk arranged in a reticulated pattern that resolves with hyperpigmentation. It is typically non-responsive to topical or systemic steroid therapy. The exact etiology is unknown, but it is more commonly described in the Far East countries. Dietary change is one of the predisposing factors. We report on nine young adult patients with prurigo pigmentosa, among whom five were on ketogenic diets prior to the onset of the eruptions. All cases resolved with oral doxycycline with no recurrence. We hope to improve the awareness of this uncommon skin condition among general practitioners and physicians so that disfiguring hyperpigmentation due to delayed diagnosis and treatment can be avoided.
  7. Gopal Krishnan S, Fun WH, Ramadras MD, Yunus R, Lye YF, Sararaks S
    PLoS One, 2019;14(7):e0219534.
    PMID: 31291359 DOI: 10.1371/journal.pone.0219534
    BACKGROUND: Developing countries still struggle with late detection and mortality from pertussis. A review of clinical case definitions is necessary for early disease detection. This paper aimed to study possible clinical characteristics for earlier pertussis detection in a sporadic setting.

    METHODS: We conducted a retrospective review of medical and laboratory records in a general paediatric ward of a district hospital in a developing country. Inclusion criteria were all children hospitalised with nasopharyngeal swab taken for Bordetella pertussis. We compared sensitivity and specificity of World Health Organization diagnostic criteria with other clinical characteristics. Polymerase chain reaction Bordetella pertussis was the gold standard used.

    RESULTS: Out of 207 eligible admissions, the study retrieved 128 complete records. Approximately half of the children were less than 3 months old. The World Health Organization diagnostic criteria had a low sensitivity (15%), but high specificity (92%). In comparison, combinations that included paroxysmal cough, ill contact and facial congestion had higher sensitivity. Increasing cough duration improved specificity while compromising sensitivity.

    CONCLUSION: Several clinical characteristics such as paroxysmal cough, facial congestion and a history of ill contact have potential for early clinical detection. Conventional emphasis on cough duration may hamper early detection.

  8. Ramanathan S, Gopinath SCB, Arshad MKM, Poopalan P, Anbu P
    Mikrochim Acta, 2019 07 18;186(8):546.
    PMID: 31321546 DOI: 10.1007/s00604-019-3696-y
    A genomic DNA-based colorimetric assay is described for the detection of the early growth factor receptor (EGFR) mutation, which is the protruding reason for non-small cell lung cancer. A DNA sequence was designed and immobilized on unmodified gold nanoparticles (GNPs). The formation of the respective duplex indicates the presence of an EGFR mutation. It is accompanied by the aggregation of the GNPs in the presence of monovalent ions, and it indicates the presence of an EGFR mutation. This is accompanied by a color change from red (520 nm) to purple (620 nm). Aggregation was evidenced by transmission electron microscopy, scanning electron microscopy and atomic force microscopy. The limit of detection is 313 nM of the mutant target strand. A similar peak shift was observed for 2.5 μM concentrations of wild type target. No significant peak shift was observed with probe and non-complementary DNA. Graphical abstract Schematic representation of high-specific genomic DNA sequence on gold nanoparticle (GNP) aggregation with sodium chloride (NaCl). It illustrates the detection method for EGFR mutation on lung cancer detection. Red and purple colors of tubes represent dispersed and aggregated GNP, respectively.
  9. Le MHT, Noor Hayaty AK, Zaini ZM, Dom SM, Ibrahim N, Radzi ZB
    Korean J Orthod, 2019 Jul;49(4):235-245.
    PMID: 31367578 DOI: 10.4041/kjod.2019.49.4.235
    Objective: This study examined bone microstructure restoration after rapid maxillary expansion (RME) with and without corticotomy over multiple retention periods.

    Methods: Eighteen male Dorper sheep were randomly distributed into three groups (n = 6 each group): group 1, RME with corticotomy on the buccal and palatal sides; group 2, conventional RME treatment; and group 3, no treatment. Post-RME, trabecular bone microstructure and new bone formation were evaluated by using microcomputed tomography (microCT) and histomorphometry after a 4- or 12-week retention period. Intergroup differences in bone quality and bone remodeling were analyzed by using two-way analysis of variance with Bonferroni post-hoc test.

    Results: The bone volume fraction (bone volume [BV]/total volume [TV]) values relative to the control in groups 1 and 2 were 54.40% to 69.88% after the 4-week retention period and returned to approximately 80% after the 12-week retention period. The pooled BV/TV values of the banded teeth in groups 1 and 2 were significantly lower than those of the control after the 4-week retention period (p < 0.05). However, after the 12-week retention period, the pooled BV/TV values in group 2 were significantly lower than those in groups 1 and 3 (p < 0.05). Histomorphological analysis showed that the new bone formation area in group 1 was approximately two to three times of those in group 2 and control.

    Conclusions: Corticotomy significantly enhanced the restoration of bone quality after the retention periods for banded teeth. This benefit might result from the increased new bone formation after corticotomy.

  10. Mohajerani A, Hui SQ, Mirzababaei M, Arulrajah A, Horpibulsuk S, Abdul Kadir A, et al.
    Materials (Basel), 2019 Aug 07;12(16).
    PMID: 31394815 DOI: 10.3390/ma12162513
    Fibres have been used in construction materials for a very long time. Through previous research and investigations, the use of natural and synthetic fibres have shown promising results, as their presence has demonstrated significant benefits in terms of the overall physical and mechanical properties of the composite material. When comparing fibre reinforcement to traditional reinforcement, the ratio of fibre required is significantly less, making fibre reinforcement both energy and economically efficient. More recently, waste fibres have been studied for their potential as reinforcement in construction materials. The build-up of waste materials all around the world is a known issue, as landfill space is limited, and the incineration process requires considerable energy and produces unwanted emissions. The utilisation of waste fibres in construction materials can alleviate these issues and promote environmentally friendly and sustainable solutions that work in the industry. This study reviews the types, properties, and applications of different fibres used in a wide range of materials in the construction industry, including concrete, asphalt concrete, soil, earth materials, blocks and bricks, composites, and other applications.
  11. Koh FX, Nurhidayah MN, Tan PE, Kho KL, Tay ST
    Vet Parasitol Reg Stud Reports, 2019 08;17:100315.
    PMID: 31303231 DOI: 10.1016/j.vprsr.2019.100315
    Limited information is available on tropical ticks and tick-borne bacteria affecting the health of humans and animals in the Southeast Asia region. Francisella tularensis is a tick-borne bacterium which causes a potentially life-threatening disease known as tularemia. This study was conducted to determine the occurrence of Francisella spp. in questing ticks collected from Malaysian forest reserve areas. A total of 106 ticks (mainly Dermacentor and Haemaphysalis spp.) were examined for Francisella DNA using a Polymerase chain reaction (PCR) assay targeting the bacterial 16S rDNA. Francisella DNA was detected from 12 Dermacentor ticks. Sequence analysis of the amplified 16S rDNA sequences (1035 bp) show >99% identity with that of Francisella endosymbiont reported in a tick from Thailand. A dendrogram constructed based on the bacterial 16S rDNA shows that the Francisella spp. were distantly related to the pathogenic strains of F. tularensis. Three Francisella-positive ticks were identified as Dermacentor atrosignatus, based on sequence analysis of the tick mitochondrial 16S rRNA gene. Further screening of cattle and sheep ticks (Haemaphysalis bispinosa and Rhipicephalus microplus) and animal samples (cattle, sheep, and goats) did not yield any positive findings. Our findings provide the first molecular data on the occurrence of a Francisella strain with unknown pathogenicity in Dermacentor questing ticks in Malaysia.
  12. Balami AD, Said SM, Zulkefli NAM, Bachok N, Balami EL
    BMC Med Res Methodol, 2019 07 18;19(1):157.
    PMID: 31319810 DOI: 10.1186/s12874-019-0803-z
    BACKGROUND: Sleeping under a long-lasting insecticidal net (LLIN) is recommended for all pregnant women in sub-Saharan Africa, due to the high prevalence of malaria infection and its associated complications in the region. Despite this, LLIN use has still remained sub-optimal among pregnant women in Maiduguri, Nigeria. Understanding the interplay of factors influencing this important health behaviour would guide the development of interventions to promote its adoption.

    METHODS: Data was collected from 380 randomly selected antenatal care attendees of a hospital in Maiduguri, using structured questionnaires. This data was then used to test the Information-Motivation-Behavioural Skills (IMB) model, for model fit, and interrelations among the constructs, using the structural equation modelling analysis with Smart-PLS.

    RESULTS: Information and motivation were significantly related to behavioural skills (r = 0.29, p 

  13. Dzulkharnien NSF, Karim MR, Zahid NI, Rahman NMMA, Abdullah I, Salleh NM
    J Fluoresc, 2019 Jul;29(4):1049-1056.
    PMID: 31338718 DOI: 10.1007/s10895-019-02418-9
    The optical properties of a series of side chain liquid crystalline polymers (P1-P3) containing azo-benzothiazole mesogen with different terminal substituents (-H, -CH3 and -OCH2CH3) in four organic solvents of varying polarity have been investigated by absorption and fluorescence spectral analysis. Solvatochromic studies of P1-P3 did not show any regular variation on the absorption and emission intensities with changing the polarity of solvent. Theoretical studies were performed based on different solvent correlation methods such as Dimroth-Reichardt and Kamlet-Taft methods to investigate the solute-solvent interactions. Both absorption and emission maxima of investigated polymers were bathochromically shifted with the replacement of sixth position hydrogen atom by electron donating groups in benzothiazole moiety. The emission intensities of the studied polymers showed decreasing trend with increasing temperature.
  14. Ralib AM, Nanyan S, Ramly NF, Har LC, Cheng TC, Mat Nor MB
    Indian J Crit Care Med, 2018 Dec;22(12):831-835.
    PMID: 30662220 DOI: 10.4103/ijccm.IJCCM_193_18
    Introduction: Acute kidney injury (AKI) is common in the intensive care unit (ICU) with a high risk of morbidity and mortality. The high incidence of AKI in our population may be attributed to sepsis. We investigated the incidence, risk factors, and outcome of AKI in four tertiary Malaysian ICUs. We also evaluated its association with sepsis.

    Materials and Methods: This retrospective cohort study extracted de-identified data from the Malaysian Registry of Intensive Care in four Malaysian tertiary ICUs between January 2010 and December 2014. The study was registered under the NMRR and approved by the ethics committee. AKI was defined as twice the baseline creatinine or urine output <0.5 ml/kg/h for 12 h.

    Results: Of 26,663 patients, 24.2% had AKI within 24 h of admission. Patients with AKI were older and had higher severity of illness compared to those without AKI. AKI patients had a longer duration of mechanical ventilation, length of ICU, and hospital stay. Age, Simplified Acute Physiological II Score, and the presence of sepsis and preexisting hypertension, chronic cardiovascular disease independently associated with AKI. About 32.3% had sepsis. Patients with both AKI and sepsis had the highest risk of mortality (relative risk 3.43 [3.34-3.53]).

    Conclusions: AKI is common in our ICU, with higher morbidity and mortality. Independent risk factors of AKI include age, the severity of illness, sepsis and preexisting hypertension, and chronic cardiovascular disease. AKI independently contributes to mortality. The presence of AKI and sepsis increased the risk of mortality by three times.

  15. Al-Jbour ND, Beg MD, Gimbun J, Alam AKMM
    Curr Drug Deliv, 2019;16(4):272-294.
    PMID: 30674256 DOI: 10.2174/1567201816666190123121425
    Chitosan is a polycationic natural polymer which is abundant in nature. Chitosan has gained much attention as natural polymer in the biomedical field. The up to date drug delivery as well as the nanotechnology in controlled release of drugs from chitosan nanofibers are focused in this review. Electrospinning is one of the most established and widely used techniques for preparing nanofibers. This method is versatile and efficient for the production of continuous nanofibers. The chitosan-based nanofibers are emerging materials in the arena of biomaterials. Recent studies revealed that various drugs such as antibiotics, chemotherapeutic agents, proteins and anti-inflammatory analgesic drugs were successfully loaded onto electrospun nanofibers. Chitosan nanofibers have several outstanding properties for different significant pharmaceutical applications such as wound dressing, tissue engineering, enzyme immobilization, and drug delivery systems. This review highlights different issues of chitosan nanofibers in drug delivery applications, starting from the preparation of chitosan nanofibers, followed by giving an idea about the biocompatibility and degradation of chitosan nanofibers, then describing how to load the drug into the nanofibers. Finally, the major applications of chitosan nanofibers in drug delivery systems.
  16. Naeem J, Hamzaid NA, Islam MA, Azman AW, Bijak M
    Med Biol Eng Comput, 2019 Jun;57(6):1199-1211.
    PMID: 30687901 DOI: 10.1007/s11517-019-01949-4
    Patients with spinal cord injury (SCI) benefit from muscle training with functional electrical stimulation (FES). For safety reasons and to optimize training outcome, the fatigue state of the target muscle must be monitored. Detection of muscle fatigue from mel frequency cepstral coefficient (MFCC) feature of mechanomyographic (MMG) signal using support vector machine (SVM) classifier is a promising new approach. Five individuals with SCI performed FES cycling exercises for 30 min. MMG signals were recorded on the quadriceps muscle group (rectus femoris (RF), vastus lateralis (VL), vastus medialis (VM)) and categorized into non-fatigued and fatigued muscle contractions for the first and last 10 min of the cycling session. For each subject, a total of 1800 contraction-related MMG signals were used to train the SVM classifier and another 300 signals were used for testing. The average classification accuracy (4-fold) of non-fatigued and fatigued state was 90.7% using MFCC feature, 74.5% using root mean square (RMS), and 88.8% with combined MFCC and RMS features. Inter-subject prediction accuracy suggested training and testing data to be based on a particular subject or large collection of subjects to improve fatigue prediction capacity. Graphical abstract ᅟ.
  17. Singh R, Singh G, Singh J, Kumar R, Rahman MM, Ramakrishna S
    Proc Inst Mech Eng H, 2019 Nov;233(11):1196-1203.
    PMID: 31545132 DOI: 10.1177/0954411919877979
    In this experimental study, a composite of poly-ether-ketone-ketone by reinforcement of hydroxyapatite and chitosan has been prepared for possible applications as orthopaedic scaffolds. Initially, different weight percentages of hydroxyapatite and chitosan were reinforced in the poly-ether-ketone-ketone matrix and tested for melt flow index in order to check the flowability of different compositions/proportions. Suitable compositions revealed by the melt flow index test were then taken forward for the extrusion of filament required for fused deposition modelling. For thermomechanical investigations, Taguchi-based design of experiments has been used with input variables in the extrusion process as follows: temperature, load applied and different composition/proportions. The specimens in the form of feedstock filament produced by the extrusion process were made to undergo tensile testing. The specimens were also inspected by differential scanning calorimetry and photomicrographs. Finally, the specimen showing the best performance from the thermomechanical viewpoint has been selected to extrude the filament for the fused deposition modelling process.
  18. Aina GQ, Erwanto Y, Hossain M, Johan MR, Ali ME, Rohman A
    J Adv Vet Anim Res, 2019 Sep;6(3):300-307.
    PMID: 31583226 DOI: 10.5455/javar.2019.f348
    Objective: The objective of this study was to employ real-time or quantitative polymerase chain reaction (q-PCR) using novel species specific primer (SSP) targeting on mitochondrial cytochrome-b of wild boar species (CYTBWB2-wb) gene for the identification of non-halal meat of wild boar meat (WBM) in meatball products.

    Materials and Methods: The novel SSP of CYTBWB2-wb was designed by our group using PRIMERQUEST and NCBI software. DNA was extracted using propanol-chloroform-isoamyl alcohol method. The designed SSP was further subjected for validation protocols using DNA isolated from fresh meat and from meatball, which include specificity test, determination of efficiency, limit of detection and repeatability, and application of developed method for analysis of commercially meatball samples.

    Results: The results showed that CYTBWB2-wb was specific to wild boar species against other animal species with optimized annealing temperature of 59°C. The efficiency of q-PCR obtained was 91.9% which is acceptable according to the Codex Allimentarius Commission (2010). DNA, with as low as 5 pg/μl, could be detected using q-PCR with primer of CYTBWB2-wb. The developed method was also used for DNA analysis extracted from meatball samples commercially available.

    Conclusion: q-PCR using CYTBWB2-wb primers targeting on mitochondrial cytochrome-b gene (forward: CGG TTC CCT CTT AGG CAT TT; Reverse: GGA TGA ACA GGC AGA TGA AGA) can be fruitfully used for the analysis of WBM in commercial meatball samples.

  19. Yusof ZYM, Anwar NH, Mohd Nor NA, Nor MM, Mustafa SE
    Trials, 2021 Feb 22;22(1):156.
    PMID: 33618735 DOI: 10.1186/s13063-021-05111-0
    BACKGROUND: Despite the implementation of the preschool oral healthcare programme (POHP) for 5-6-year-old children over the past 3 decades in Malaysia, dental plaque and caries levels in this age group remain high. Among the child-level attributable factors are unhealthy self-care behaviours (poor oral hygiene and high sugary diet). In order to improve the children's oral health, an improved programme called the 'Senyuman Indah Milik Semua' Programme (SIMSP) or 'Beautiful Smile for All' programme is introduced. In this programme, a triad of dental hygienist-teacher-parent works together to improve children's oral hygiene levels compared with the existing POHP that involves dental hygienists only. The aim of this study is to compare the effect of the SIMSP versus the existing POHP on oral hygiene levels of 5-6-year-old children in the Kampar district, Perak state, Malaysia.

    METHODS: This study is a pragmatic, cluster-randomised, parallel-group, matched pair, controlled trial with blinded outcome assessment. Randomisation is performed using a computer-generated table with a 1:1 allocation comparing the SIMSP and the POHP involving 28 preschools in the Kampar district, Perak, Malaysia. The intervention consists of preschool visits by a group of dental therapists, in-class oral health lessons and daily toothbrushing conducted by class teacher, child home toothbrushing supervised by parents, and infographic oral health messages to parents. The control consists of the existing POHP that involves preschool visits by a group of dental therapists only. The trial lasts for 6 months. Primary outcome variable is the mean plaque score change after 6 months. To determine the feasibility of the SIMSP, a process evaluation will be conducted using the perspectives of dental therapists, teachers, and parents on the appropriateness, effectiveness, facilitators, and barriers to the SIMSP implementation as well as an audit trail to assess the trial intervention.

    DISCUSSION: Cluster randomisation may lead to a random effect and cluster selection bias. These factors will be accounted for when analysing the data and interpreting the outcomes. The effectiveness of the SIMSP will be evaluated by comparing the results with those of the POHP.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT04339647 . Registered on 5 April 2020 - Retrospectively registered.

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