Introduction: Fixed appliance orthodontic treatment (braces) is routinely used to address mal-positions of teeth and create esthetic smiles. Although it is desirable that treatment not exceed two years but, in practice, duration of up to two-and-a-half years is deemed acceptable. This review was undertaken to determine treatment duration for routine state-funded fixed appliance treatment in Brunei Darussalam and identify possible influencing factors. Materials and Methods: 100 consecutive cases (Malocclusion class I [29%], II [51%] and III [20%]) of completed routine, single-phase fixed appliance treatment treated at the National Dental Centre, Bandar Seri Begawan, selected retrospectively from 31st December 2008 were reviewed for treatment duration including possible factors affecting this parameter. Results: Only 19% had desirable treatment duration (≤2 years) and 41% had acceptable treatment duration (2.01 to 2.5 years). Forty percent had treatment duration in excess of 2.5 years. Excess time due to accumulative non-optimal visit intervals, and number of adjustment visits showed significant high correlation coefficient values to treatment duration (p<0.01). Extractions showed low but significant correlation to treatment duration while age revealed low negative correlation to treatment duration (p<0.05). The lowest incidence of repairs occurred in those whose treatment did not exceed two years whilst the highest incidence of broken appointments was observed in those who had treatment duration in excess of three years. Conclusions: This retrospective review indicates that treatment duration for most of our sample is longer than desirable. The accumulative effect of non-optimal visit intervals, increased number of adjustment visits, age at start of treatment, high proportion of extraction cases, increased incidence of repairs and broken appointments may be contributory. Further investigations including prospective studies are required.

Objective: To formulate diclofenac sodium as fast dissolving tablets (FDTs) using fenugreek gum as a natural superdisintegrant which also possess anti-inflammatory activity.Methods:physicochemical characterizations. The swelling index and viscosity of fenugreek gum was 221% and 293.4 mpa.s respectively. FDTs of diclofenac sodium was formulated by direct compression technique using different concentrations (1%-6%, w/w) of fenugreek gum as a natural superdisintegrant and compared with renowned synthetic superdisintegrants like sodium starch glycolate and croscarmellose sodium. The anti-inflammatory activity of a formulation was evaluated with carrageenan induced experimental rats.Results:An attempt was made to extract the fenugreek gum and evaluated it for various friability, hardness and results complied with the limits. The drug release from all the formulations ascertained first order kinetics. Among all the formulations F3 containing fenugreek gum with the concentration of 6% produced least disintegrating time 21 seconds resulting in higher drug release rate 93.74% at the end of 25 min. Hence, it was considered as optimized formulation. The present study revealed that the fenugreek gum as a natural superdisintegrant showed better disintegrating property than the most widely used synthetic superdisintegrants like sodium starch glycolate and croscarmellose sodium in the formulations of FDTs. The formulated tablets were evaluated for various physical tests like weight variation, Conclusions: The results suggested that the fenugreek gum act as a good super disintegrating agent and it showed promising additive anti-inflammatory activity with diclofenac sodium.

Animals ; Bone and Bones ; drug effects ; Copper ; pharmacology ; therapeutic use ; Fluoride Poisoning ; prevention & control ; Fluorides ; blood ; toxicity ; urine ; Lipid Metabolism ; drug effects ; Molybdenum ; toxicity ; Rabbits ; Trace Elements ; pharmacology ; therapeutic use

No abstract available.
Fasting ; Humans ; Hydrogen ; Irritable Bowel Syndrome

This study assesses inter-examiner reproducibility in recording various malocclusion parameters and Index of Orthodontic Treatment Need (IOTN) grade during patient examination by utilising the kappa statistic. Five previously calibrated orthodontists clinically examined 233 non-orthodontically treated schoolchildren aged 14-17 years for recording various malocclusion parameters. The examination was repeated twice, thirty days apart and precluded the use of study-models or radiographs. Although good inter-examiner reproducibility was observed in recording incisor class, IOTN dental health grade, type of posterior crossbite, and excellent for parameters with absolute criteria like erupted supernumeraries, etc, substantial examiner variation resulted in only fair reproducibility for recording IOTN esthetic category, canine class, overbite category, traumatic overbite and upper centre-line shift of two millimetres or more from the facial midline. Reproducibility for detecting occlusal displacement in the presence of crossbite was poor, and kappa statistic was incalculable for recording openbite and number of upper incisors rotated 30° or more. Kappa was also incalculable for recording IOTN dental health subcategory due to the creation of asymmetric tables caused by rarely chosen subcategory options. Despite prior agreement between previously calibrated examiners on evaluation criteria, detection of certain malocclusion parameters during an epidemiological examination can prove to be challenging. Epidemiological studies that report on prevalence of malocclusion in the population should always report on the kappa reproducibility, especially if the study is carried out by multiple examiners.
Malocclusion ; Orthodontics ; Epidemiologic Studies

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is a common disorder with significant morbidity and impairment of quality of life. Most patients (26%-83%) with IBS from Asia reported bloating. Bloating may result from increased amount or distribution of gas in the gut or exaggerated perception of distension. To evaluate whether patients with IBS produce more hydrogen even in fasting state, we conducted a study with the following aims: (1) to estimate fasting breath hydrogen levels among patients with IBS as compared with healthy controls (HC) and (2) to study relationship between symptoms of IBS and stool frequency and fasting breath hydrogen levels. METHODS: Eighty-one patients with IBS (Rome III criteria) and 123 HC were included. Hydrogen breath test was performed using a gas analyzer after an overnight (12 hours) fast. Both patients with IBS and HC had similar preparation before breath hydrogen estimation. RESULTS: Of 93 patients with symptoms of functional gastrointestinal disorders, 81 (87.1%) met Rome III criteria and 12 (12.9%) were negative and hence, excluded from the study. Patients with IBS were comparable in age (35 +/- 11.8 years vs 37.5 +/- 13.1 years, p = NS) and gender (male 61/81 [75.3%] vs 77/123 [62.6%], p=0.67) with HC. Average fasting breath hydrogen was higher in patients with IBS as compared to HC (mean 10.1 +/- 6.5 ppm vs 5.5 +/- 6.2 ppm, p < 0.0001). Number of stools per week correlated with average fasting breath hydrogen excretion in patients with IBS (r = 0.26, p = 0.02). CONCLUSIONS: Inspite of similar preparation for the test, fasting breath hydrogen was higher in patients with IBS as compared to HC. Number of stools per week correlated with fasting breath hydrogen levels among patients with IBS.
Asia ; Breath Tests ; Diarrhea ; Fasting ; Gastrointestinal Diseases ; Humans ; Hydrogen ; Intestine, Small ; Irritable Bowel Syndrome ; Quality of Life ; Rome

BACKGROUND/AIMS: Data on normal stool form and frequency, which are important for defining constipation, are scanty; hence, we studied these in an eastern Indian population. METHODS: One thousand and two hundred apparently healthy asymptomatic subjects were evaluated for predominant stool form (Bristol chart with descriptor) and frequency. Data on demographic and life-style (diet and physical activity) were collected. RESULTS: Of 1,200 subjects (age 42 +/- 14.5 years, 711, 59% male), most passed predominantly Bristol type IV stool (699 [58.2%]; other forms were: type I (23 [1.9%]), type II (38 [3.2%]), type III (99 [8.2%]), type V (73 [6%]), type VI (177 [14.7%]), type VII (7 [0.6%]) and an irregular combination (84 [7%]). Weekly stool frequency was 12.1 +/- 4.7 (median 14, range 2-42). Less than 3 stools/week was noted in 32/1,200 (2.6%). Female subjects (n = 489) passed stools less frequently than males (n = 711) (11.1 +/- 5.6/week vs. 12.8 +/- 3.8/week, P < 0.001) and tended to pass harder forms (type I: 17, type II: 20, type III: 39 vs. 6, 18 and 60, respectively, P = 0.061). Vegetarians (n = 252) and physically active (n = 379) subjects tended to pass stool more frequently than occasional (n = 553) and regular non-vegetarian (n = 395) (11.8 +/- 4.5 and 12.8 +/- 4.7 vs. 11.3 +/- 4.7; P < 0.05) and sedentary (n = 464) and intermediately active (n = 357) subjects (13.4 +/- 4.0 and 12.3 +/- 4.5 vs. 10.9 +/- 5.1, P = 0.080) in different age groups, respectively. Older age was associated with less frequent stool, particularly among female population. Female gender and age > 35 years were significant on multivariate analysis. CONCLUSIONS: Median stool frequency in the studied population was 14/week (range 2-42) and predominant form was Bristol type IV. Older age was associated with lesser stool frequency, particularly among female subjects.
Constipation ; Defecation ; Female ; Gastrointestinal Diseases ; Gastrointestinal Transit ; Humans ; Irritable Bowel Syndrome ; Male

BACKGROUND/AIMS: Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position. METHODS: Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position. RESULTS: The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position. CONCLUSIONS: The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.
Angiography ; Barium ; Cohort Studies ; Colon, Sigmoid ; Colostomy ; Fecal Incontinence ; Follow-Up Studies ; Gastroepiploic Artery ; Hand Strength ; Humans ; Manometry ; Perineum ; Pylorus ; Retention (Psychology) ; Sensation ; Transplants

BACKGROUND/AIMS: Irritable bowel syndrome (IBS) is associated with exaggerated cerebral response including emotional processing following visceral stimulation; though data on this issue is available in female IBS patients, it is scanty among males. Hence, we aimed to study brain response of male IBS patients following rectal balloon distension as compared to healthy controls using functional magnetic resonance imaging (fMRI). Data between diarrhea and constipation predominant IBS (IBS-D and IBS-C) were also compared. METHODS: Rectal balloon distension threshold was assessed in 20 male IBS patients (10 IBS-C and 10 IBS-D) and 10 age-matched male healthy controls. Subsequently, fMRI on all the participants was performed at their respective rectal pain threshold. The fMRI data were analysed using the Statistical Parametric Mapping software. RESULTS: IBS patients showed greater cerebral activations in insula, middle temporal gyrus, and cerebellum in the left hemisphere compared to healthy controls. Neural activation was found in bilateral precuneus/superior parietal lobules in controls but not in patients with IBS. The brain activation differed among IBS-C and IBS-D patients; while the right mid-cingulate cortex was activated in IBS-C, the left inferior orbito-frontal cortex, left calcarine, and bilateral fusiform gyri were activated among patients with IBS-D following rectal balloon distension. CONCLUSIONS: Brain response to rectal balloon distension differed among male patients with IBS and controls and among patients with IBS-C and IBS-D. Differential activation among patients with IBS-C and IBS-D was seen in the brain regions controlling affective motivation, homeostatic emotions, and autonomic responses to pain.
Brain* ; Cerebellum ; Constipation ; Diarrhea ; Female ; Humans ; Irritable Bowel Syndrome* ; Magnetic Resonance Imaging* ; Male* ; Motivation ; Pain Threshold ; Parietal Lobe ; Temporal Lobe

BACKGROUND/AIMS: Chronic constipation is commonly managed medically, and surgical options have been advocated in patients with refractory symptoms. We aimed to study the role of surgical procedures in patients with constipation, refractory to medical therapy. METHODS: Data on 34 surgically managed patients with refractory chronic constipation during a 6-year period (March 2003 to May 2009) were retrospectively analyzed. RESULTS: All the 34 patients (24 males and 10 females, median age of 45 years [range, 18-77 years]) had symptoms for a long period (median 96 months [range, 12-360 months]) without response to medical treatment including biofeedback. Preopertive investigations included barium enema, colonoscopy, colonic transit study, defecography and anorectal manometry as indicated. Eight patients (23.5%) had slow transit constipation, 4 (11.8%) had Hirschsprung's disease and 22 (64.7%) had rectal prolapse. Total colectomy and ileo-rectal anastomosis, anterior resection, Delorme's procedure, resection rectopexy and Duhamel's operation were the surgical procedures performed. Though 7 (20.6%) patients had post operative complications, there was no mortality. One patient whose symptoms recurred following anterior resection was successfully treated by total colectomy and ileo-rectal anastomosis. Median spontaneous bowel movements increased following surgical treatment compared to that while on medical treatment (1 per week [range, 0 to 3 per week] vs. 14 per week [range, 7-28 per week], P < 0.00001). Patients remained well during 3-60 months follow-up (n = 27). CONCLUSIONS: Spontaneous bowel movements significantly increased following surgical operation for refractory chronic constipation, nature of which is dependent on underlying etiology and the expertise available. Careful preoperative work-up and selection of patients are critical for obtaining good functional results.
Barium ; Biofeedback, Psychology ; Colectomy ; Colon ; Colonoscopy ; Constipation ; Defecography ; Enema ; Female ; Follow-Up Studies ; Hirschsprung Disease ; Humans ; Male ; Manometry ; Rectal Prolapse ; Retrospective Studies