Introduction: Coated archwires improve aesthetics because of the tooth-coloured appearance. However, colour change of the coated archwires have been reported in vitro. Nonetheless, little is known to what extent this colour change occurs clinically. This second part of the multi-centre, double-blind, randomised controlled trial evaluated the colour change (∆E*) of three coated archwires with their controls and patient perception. Methods: 84 patients who received treatment with upper and lower fixed appliance treatment were invited. Consented patients were randomised to receive one of four treatment interventions using 0.014” superelastic nickel-titanium archwires from (1) Orthocare (2) RMO (3) G&H, and (4) 3M Unitek® uncoated. These archwires were ligated during bonding and collected after 8th week. After removal, the digital images of the archwires were assessed for colour change using Adobe® Photoshop® software, and the CIE L*a*b* system was used to calculate the ΔE* values. Patient perception was measured using oral aesthetic subjective impact scale (OASIS) questionnaire. Results: For colour change and patient perception assessment, 132 archwires from 66 participants who had been treated with aesthetic archwires were collected. Two fractured archwires were excluded. Initial analysis revealed all three aesthetic archwires groups showed significant mean of ∆E* with the highest was found in Orthocare (23.9), and the lowest is G&H (16.8). Post hoc comparison revealed statistically significant mean of ∆E* in Orthocare when compared with other groups (p <0.001). There was no statistically significant difference for patient perception between archwire groups. Conclusion: Preliminary results revealed that significant ∆E* in Orthocare group and patients showed positive perception following clinical use
Craniofacial & ; Biomaterial Sciences Cluster, Advanced Medical & ; Dental Institute, Universiti Sains Malaysia, 13200 Kepala Batas, Penang, Malaysia. 2 School of Dental Sciences, Universiti Sains Malaysia (Health Campus), 16150 Kubang Kerian, Kelantan, Malaysia

Chrysanthemum rubellum (durian) flower (CR) is well-known for its usefulness in conventional and advanced medicine. Bioactive glass properties are geared towards hard tissue regeneration. Hence, this study aims to investigate the response of dental pulp stem cells (DPSC) when exposed to bioactive glass-chrysanthemum flower extract-conditioned medium. Methods: Chrysanthemum rubellum (durian) yellow coloured petals freeze dried extracts (CRE) was prepared by separation and agitation in distilled water where the final powdery compound was being investigated and combined with melt-derived BG 45S5 powder to produce BGCRE-conditioned medium. The CRE extracts in various concentrations and BGCRE-conditioned medium were exposed to DPSC and the cells responses were assessed using AB and MTT assays. The CRE and BGCRE-conditioned media were also assessed using ICP-OES to check for ionic release profile from both medium. Results: The CRE-conditioned medium (7.81, 15.63, 31.25 and 62.5 μg/ml) showed a dose-dependent effect towards DPSC from Days 1 until 14. The BGCRE-conditioned medium containing BG powders (1 mg/ml) with the lower amount of CRE extracts (0.02 and 0.1 mg/ml) promoted DPSC viability and proliferation rate from Days 1 until 14 based on AB and MTT assays. The BGCRE-conditioned medium has potentially affected the DPSC viability and proliferation. Conclusion: The presence of CRE in BGCRE-conditioned medium enhanced the DPSC viability and proliferation possibly through the combined effect of CRE and BG. This BGCRE combination showed potential as natural medicament for dental tissue regeneration
Craniofacial and Biomaterials Sciences Cluster ; Advanced Medical & ; Dental Institute ; Universiti Sains Malaysia ; Bertam ; 13200 Kepala Batas ; Pulau Pinang ; Malaysia 2 Department of Paedodontics and Preventive Dentistry ; Coorg Institute of Dental Sciences ; Virajpet ; 571218 ; Coorg Institute ; Karnataka State ; India 3 Faculty of Applied Sciences ; Universiti Teknologi MARA ; 40450 Shah Alam ; Selangor ; Malaysia

The National Blood Center, Kuala Lumpur interprets laboratory results for the von Willebrand factor (VWF) profile based on guidelines which were established based on the Caucasian population. The VWF profiles among the Malay population has not yet been established. The current study aims to determine the VWF profiles of the different ABO blood types among Malays and to evaluate their association with demographic characteristics and smoking habits. Methods: One hundred and forty Malay donors were involved. Factor VIII (FVIII:C), VWF antigen (VWF:Ag), and ristocetin cofactor (VWF:RiCof) levels and collagen binding activity (VWF:CBA) were measured by coagulometric clot detection, latex agglutination, and enzyme-linked immunosorbent assay. Results: The majority of donors (59.3%) were 30–49 years old, male (81.43%), non-smokers (74.3%), and overweight (71.4%). The Malay VWF:Ag were slightly higher than those of Caucasians, Indians, Thais, and Chinese, but the average ratios of VWF activity (i.e., VWF:RiCof level and VWF:CBA) to VWF:Ag were slightly lower than those of the other populations. The highest level of VWF:Ag was found among those with the B blood group, followed by types A and O. Conclusion: Malays with type O blood had lower values of the components of the VWF profile compared to subjects with non-O blood. The higher levels of these elements and lower VWF activity to VWF:Ag ratio in Malays compared to other populations suggest that ethnicity impacts the plasma VWF levels and their interaction with collagen and platelets.
Medical Transfusion Unit, Pathology Department, Hospital Sultan Ismail, Johor Bahru, Malaysia. 2 National Blood Center, Jalan Tun Razak, 50400, Kuala Lumpur, Malaysia. 3 Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Pulau Pinang, Malaysia

Breast cancer is globally known to be the commonest cause of cancer-related deaths among women. Screening tools which include breast-self examination (BSE), clinical breast examination and mammography are well-recognised to aid the detection of breast cancer among high risk women. Thus, our study was aimed to evaluate breast cancer and BSE awareness and practice, and to perform mammography screening among women who attended community breast cancer awareness and screening programme. Methods: Data was collected cross-sectionally from 2,021 women during community services from September 2013 until December 2015. Results: Majority of the women had previously attended health education on breast cancer (56.3%) and had been taught BSE techniques (61.4%), but only 38.6% performed BSE monthly. Factors associated with regular BSE practice were older age, higher education level, being married, higher monthly income, had attended health education on breast cancer, and had been taught BSE techniques. A subset of 130 high-risk women had underwent mammography screening and majority had heterogenously dense and normal mammogram findings. Conclusion: These findings suggested that regular breast cancer awareness campaigns is needed to strengthen breast cancer knowledge and to emphasise BSE techniques. Such campaigns should target younger women and those with low socioeconomic status.
Regenerative Medicine Cluster, Advanced Medical & ; Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Penang, Malaysia. 2 Clinical Division, Advanced Medical & ; Dental Institute, Universiti Sains Malaysia, Bertam, 13200 Kepala Batas, Penang, Malaysia

Thalassemia prevalence in Malaysia is highest in Sabah. This study was conducted to characterize the demographic and socioeconomic profile of transfusion-dependent β-thalassemia major patients in Sabah, to explore their parents’ background, and to identify factors associated with having more than one thalassemia major children in the family. Methods: This was a cross-sectional study conducted in Hospital Wanita dan Kanak-Kanak Sabah and Hospital Kota Belud Sabah between February 2018 and Jun 2019. A total of 108 patients attending Thalassemia Treatment Clinic at both centers were selected randomly for interview. Results: β-thalassemia major patients in this study were majority from the indigenous ethnic groups (Kadazan, Dusun, Murut, Rungus, Sungai). Parents of the thalassemia patients mostly had low education level and socioeconomic status. Thirty-seven percent of parents have more than one children with thalassemia major and a high proportion (41.7%) have intermarriages. Parents with a higher number of children in the family are associated with having more than one thalassemia major children (OR: 2.1, 95% CI: 1.5, 2.9, P-value = 1.3 x 10-5). Conclusions: A considerably high proportion of parents have more than one children with thalassemia major in this study. Knowledge and counselling are important to parents with low educational level and socioeconomic status to ensure their understanding of thalassemia risk and prevention
Hospital Queen Elizabeth II, Ministry of Health Malaysia, 88300, Kota Kinabalu, Sabah, Malaysia 2 Regenerative Medicine Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Kepala Batas, Pulau Pinang, Malaysia 3 Hospital Wanita dan Kanak-Kanak Kuala Lumpur, Ministry of Health Malaysia, 50586, Kuala Lumpur, Malaysia 4 Hospital Wanita dan Kanak-Kanak Sabah, Ministry of Health Malaysia, 88996, Kota Kinabalu, Sabah, Malaysia 5 Hospital Kota Belud, Ministry of Health Malaysia, 89158, Kota Belud, Sabah, Malaysia

Colour stability of the material is an essential factor that contributes to the selection of a flexible denture material. Staining effects on the denture may result in unattractive appearance, the dissatisfaction of the wearer, and limited usage period of the denture. This study aims to identify the colour stability of the Valplast flexible denture material using three types of beverages. Methods: A total of 32 disc-shaped flexible resin materials (20 +/- 0.1 mm in diameter and thickness 3 +/- 0.1 mm) were prepared based on the manufacturer instructions. The samples were randomly divided into 4 groups of immersion: distilled water (control), coffee solution, tea solution and red wine. The samples were left in the specified immersion solution for up to 60 days. Colour changes were measured after 1, 3, 7, 14, 21, 30, 45 and 60 days of immersion. Results: The samples immersed in coffee solution changed from S1 to S2, whereas samples in tea solution changed from S1 to S3. Additionally, samples in red wine changed from S1 to S4, as observed using the Valplast colour tone guide. The highest reflection measured using spectroscopy was 65.146 at 385.19 nm of the control samples, whereas the lowest reflection was 1.974 at the wavelength of 385.97 nm on the samples immersed in the red wine. Conclusion: The most significant difference can be observed in the red wine group, followed by samples in tea and coffee solutions. Moreover, increasing the immersion period causes increasing staining effect of the denture.
Craniofacial and Biomaterial Sciences Cluster, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Bertam, Penang, Malaysia 2 Institut Latihan Kementerian Kesihatan Malaysia (Pergigian), No.3 Jalan Sepoy Lines, 10450 Georgetown, Penang, Malaysia 3 Division of Research and Networking, Advanced Medical and Dental Institute, Universiti Sains Malaysia, 13200, Bertam, Penang, Malaysia 4 School of Physics, Universiti Sains Malaysia, 11800 Minden, Penang, Malaysia

PURPOSE: It aimed to find if written test results improved for advanced cardiac life support (ACLS) taught in flipped classroom/team-based Learning (FC/TBL) vs. lecture-based (LB) control in University of California-Irvine School of Medicine, USA. METHODS: Medical students took 2010 ACLS with FC/TBL (2015), compared to 3 classes in LB (2012-14) format. There were 27.5 hours of instruction for FC/TBL model (TBL 10.5, podcasts 9, small-group simulation 8 hours), and 20 (12 lecture, simulation 8 hours) in LB. TBL covered 13 cardiac cases; LB had none. Seven simulation cases and didactic content were the same by lecture (2012-14) or podcast (2015) as was testing: 50 multiple-choice questions (MCQ), 20 rhythm matchings, and 7 fill-in clinical cases. RESULTS: 354 students took the course (259 [73.1%] in LB in 2012-14, and 95 [26.9%] in FC/TBL in 2015). Two of 3 tests (MCQ and fill-in) improved for FC/TBL. Overall, median scores increased from 93.5% (IQR 90.6, 95.4) to 95.1% (92.8, 96.7, P=0.0001). For the fill-in test: 94.1% for LB (89.6, 97.2) to 96.6% for FC/TBL (92.4, 99.20 P=0.0001). For MC: 88% for LB (84, 92) to 90% for FC/TBL (86, 94, P=0.0002). For the rhythm test: median 100% for both formats. More students failed 1 of 3 tests with LB vs. FC/TBL (24.7% vs. 14.7%), and 2 or 3 components (8.1% vs. 3.2%, P=0.006). Conversely, 82.1% passed all 3 with FC/TBL vs. 67.2% with LB (difference 14.9%, 95% CI 4.8-24.0%). CONCLUSION: A FC/TBL format for ACLS marginally improved written test results.
Advanced Cardiac Life Support* ; California* ; Choice Behavior ; Humans ; Learning* ; Students, Medical* ; United States

We validated the basic life support termination of resuscitation (BLS TOR) rule retrospectively using Out-of-Hospital Cardiac Arrest (OHCA) data of metropolitan emergency medical service (EMS) in Korea. We also tested it by investigating the scene time interval for supplementing the BLS TOR rule. OHCA database of Seoul (January 2011 to December 2012) was used, which is composed of ambulance data and hospital medical record review. EMS-treated OHCA and 19 yr or older victims were enrolled, after excluding cases occurred in the ambulance and with incomplete information. The primary and secondary outcomes were hospital mortality and poor neurologic outcome. After calculating the sensitivity (SS), specificity (SP), and the positive and negative predictive values (PPV and NPV), tested the rule according to the scene time interval group for sensitivity analysis. Of total 4,835 analyzed patients, 3,361 (69.5%) cases met all 3 criteria of the BLS TOR rule. Of these, 3,224 (95.9%) were dead at discharge (SS,73.5%; SP,69.6%; PPV,95.9%; NPV, 21.3%) and 3,342 (99.4%) showed poor neurologic outcome at discharge (SS, 75.2%; SP, 89.9%; PPV, 99.4%; NPV, 11.5%). The cut-off scene time intervals for 100% SS and PPV were more than 20 min for survival to discharge and more than 14 min for good neurological recovery. The BLS TOR rule showed relatively lower SS and PPV in OHCA data in Seoul, Korea.
Adult ; Advanced Cardiac Life Support/*mortality ; Cardiopulmonary Resuscitation/*mortality ; Critical Care/statistics & numerical data ; Decision Support Techniques ; Electric Countershock/*mortality ; Emergency Medical Services ; Female ; Hospital Mortality ; Humans ; Male ; Out-of-Hospital Cardiac Arrest/*epidemiology/*mortality/therapy ; Refusal to Treat ; Republic of Korea/epidemiology ; Retrospective Studies ; Survival Rate ; Time Factors ; Time-to-Treatment ; Treatment Outcome

OBJECTIVETo study the weak loop in the treatment of children with out-of-hospital cardiac arrest (OHCA) and the treatment strategy for improvement.

METHODData of a total of 133 patients with OHCA who were rescued by Wuxi pre-hospital care center during the 2005 - 2011 were analyzed.

RESULTThe main causes of pediatric OHCA were drowning (52/133) and accidental injury disease (30/133). The cases of OHCA were mainly located in public places (60/133) and the majority occurred in winter and summer. The emergency rescue response time was (13.21 ± 8.09) min, the rate of first witness treatment was 3.91%, intubations was performed in 11.11%, opening of vein access was 23.15% and one case got restoration of spontaneous circulation (ROSC).

CONCLUSIONThe rate of ROSC of pre-hospital cardiac arrest in children was significantly lower than that of hospital cardiac arrest. Preventive interventions on children's accidents and the skills of pre-hospital staff on pediatric advanced life support (PALS) need to be urgently improved.

Advanced Cardiac Life Support ; education ; Cardiopulmonary Resuscitation ; methods ; Chi-Square Distribution ; Child ; Child, Preschool ; China ; epidemiology ; Emergency Medical Services ; methods ; organization & administration ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Out-of-Hospital Cardiac Arrest ; epidemiology ; etiology ; therapy ; Pediatrics ; education ; Retrospective Studies ; Risk Factors ; Survival Rate ; Time Factors ; Treatment Outcome

OBJECTIVESince appropriate and time-table methods in trauma care have an important impact on patients'outcome, we evaluated the effect of Advanced Trauma Life Support (ATLS) program on medical interns' performance in simulated trauma patient management.

METHODSA descriptive and analytical study before and after the training was conducted on 24 randomly selected undergraduate medical interns from Imam Reza Hospital in Mashhad, Iran. On the first day, we assessed interns' clinical knowledge and their practical skill performance in confronting simulated trauma patients. After 2 days of ATLS training, we performed the same study and evaluated their score again on the fourth day. The two findings, pre- and post- ATLS periods, were compared through SPSS version 15.0 software. P values less than 0.05 were considered statistically significant.

RESULTSOur findings showed that interns'ability in all the three tasks improved after the training course. On the fourth day after training, there was a statistically significant increase in interns' clinical knowledge of ATLS procedures, the sequence of procedures and skill performance in trauma situations (P less than 0.001, P equal to 0.016 and P equal to 0.01 respectively).

CONCLUSIONATLS course has an important role in increasing clinical knowledge and practical skill performance of trauma care in medical interns.

Advanced Trauma Life Support Care ; Clinical Competence ; Humans ; Inservice Training ; Patient Simulation ; Students, Medical ; Wounds and Injuries ; diagnosis ; therapy