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Fulltext Prevention of oral health disease: knowledge and practices among pregnant women in Kuantan, Malaysia

Nurjasmine Aida Binti Jamani, Karimah Hanim Binti Abd. Aziz, Zurainie Binti Abllah

International Journal of Allied Health Sciences, 2019;3(4):923-932.
MyJurnal

Background: Oral disease in association of pregnancy outcome has been long researched.
Most pregnant women perceived that oral disease in pregnancy are expected and considered
to be normal. Objective: This study aims to evaluate the knowledge of pregnant women and
their practices towards oral disease. Methods: 296 pregnant mothers were recruited from
government clinics in Kuantan, Malaysia. A validated and self -administered questionnaire
assessing knowledge, attitudes and practices towards oral health was used. Results were
analysed by descriptive analysis, chi square test and multiple logistic regression. Results:
Most respondents showed poor knowledge on oral health problem with its pregnancy
outcome (66.6%) and poor attitude about dental health during pregnancy (53.4%). Half of
them had good practice on oral health. Tooth cavity (46.3%) and gum bleeding (29.4%) were
the commonest problem reported by them. Only one third of the mothers utilize dental
service. Higher level of education was associated with better oral health practice [OR:0.02 CI
(1.12,3.92)] Conclusions: Knowledge on the relationship between oral health and pregnancy
outcome is still low among pregnant mothers. Utilization of dental service was also low. High
level of education is proven to give better oral health care.

Matched MeSH terms: Gingival Hemorrhage
Fulltext A glimpse on the function of chitosan as a dental hemostatic agent

Lestari W, Yusry WNAW, Haris MS, Jaswir I, Idrus E

Jpn Dent Sci Rev, 2020 Nov;56(1):147-154.
PMID: 33204370 DOI: 10.1016/j.jdsr.2020.09.001

Managing a bleeding patient can be a challenge during dental surgery. Profuse hemorrhage due to platelet defects, coagulation disorders, vascular anomalies, medication-induced patients, as well as inherited bleeding ailments result in soft tissue hematoma, septic shock, compromised airway, and in some severe cases, death could occur. A vast array of surgical hemostatic agents are available to stop bleeding, including chitosan-based hemostatic agents. Chitosan has an advantage over other topical hemostatic materials for its ability to promote shorter bleeding times and assist in healing. Massive behind-the-scene research and development efforts are ongoing to increase the performance of chitosan as a hemostatic agent. Numerous studies on chitosan use in dental hemostasis have registered it as being safe, biodegradable, biocompatible, promoting healing, antimicrobial and bioactive. This article reviews the application of chitosan in managing hemostasis in dental patients.

Matched MeSH terms: Hemorrhage
Fulltext Congenital Giant Cell Fibroma – A Case Report

Mohd Ridzuan Mohd Razi, Nabilah Sawani Harith, Nur Fazilah Mohd Tahir, Nishanti Selvaraj

Malaysian Journal of Paediatrics and Child Health, 2020;26(1):21-28.
MyJurnal

Background: This paper aims to report a rare case of congenital giant cell fibroma (GCF). To the best of our knowledge, this is the first reported case of GCF in new-born. Case Report: A healthy one-month-old baby boy was referred to Department of Paediatric Dentistry for management of swelling on the upper left alveolar region which presented since birth. Clinical examination demonstrated a well define firm swelling over the upper left alveolar ridge, otherwise the swelling was asymptomatic. Patient was monitored periodically. At 1 year and 9 months of age, there were episodes of ulcerations and bleeding from the lesion as a result of trauma from eruption of opposing teeth. Surgical excision of the lesion was carried out under general anaesthesia. The histopathological examination (HPE) report interpreted the lesion as GCF. Conclusion: GCF is rare fibrous lesion that could be diagnosed only on HPE. Although it is an uncommon congenital lesion, GCF should be considered as one of differential diagnosis of swelling over the gingiva.

Matched MeSH terms: Hemorrhage
Fulltext Spontaneous spinal subarachnoid haemorrhage: a rare complication of dengue fever

Nur Hidayati Mohd Sharif, Nor Arisah Misnan, Norashikin Saidon, Phaik Yee Ooi, Hilwati Hashim

Journal of Clinical and Health Sciences, 2017;2:54-57.

A 37-year-old woman presented with a short history of fever and bilateral lower limb
weakness. She also had impaired sensory function up to T4 spine level and lax anal tone.
Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the
spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite
medical and surgical interventions, her lower limb weakness persists. A high index of
suspicion is needed to recognise dengue-related neurological complications. This diagnosis
should be considered in any patients from dengue endemic areas presenting with acute
febrile illness with atypical neurological manifestations.

Matched MeSH terms: Subarachnoid Hemorrhage
Fulltext HMGB1-Mediated Neuroinflammatory Responses in Brain Injuries: Potential Mechanisms and Therapeutic Opportunities

Paudel YN, Angelopoulou E, Piperi C, Othman I, Shaikh MF

Int J Mol Sci, 2020 Jun 29;21(13).
PMID: 32610502 DOI: 10.3390/ijms21134609

Brain injuries are devastating conditions, representing a global cause of mortality and morbidity, with no effective treatment to date. Increased evidence supports the role of neuroinflammation in driving several forms of brain injuries. High mobility group box 1 (HMGB1) protein is a pro-inflammatory-like cytokine with an initiator role in neuroinflammation that has been implicated in Traumatic brain injury (TBI) as well as in early brain injury (EBI) after subarachnoid hemorrhage (SAH). Herein, we discuss the implication of HMGB1-induced neuroinflammatory responses in these brain injuries, mediated through binding to the receptor for advanced glycation end products (RAGE), toll-like receptor4 (TLR4) and other inflammatory mediators. Moreover, we provide evidence on the biomarker potential of HMGB1 and the significance of its nucleocytoplasmic translocation during brain injuries along with the promising neuroprotective effects observed upon HMGB1 inhibition/neutralization in TBI and EBI induced by SAH. Overall, this review addresses the current advances on neuroinflammation driven by HMGB1 in brain injuries indicating a future treatment opportunity that may overcome current therapeutic gaps.

Matched MeSH terms: Subarachnoid Hemorrhage
Fulltext A case series of secondary Hemophagocytic Lymphohistiocytosis (HLH) secondary to dengue infection receiving dexamethasone in a tertiary centre

Liew Kean Yew, Suraya Hanim Abdullah, Beh Ting Yuen

Malaysian Journal of Medicine and Health Sciences, 2019;15(106):41-41.
MyJurnal

Introduction: Secondary Hemophagocytic Lymphohistiocytosis (HLH) is a condition seen in severe dengue that can be potentially fatal. Timely management using HLH-directed treatment such as steroids or etoposide have been seen to improve the outcome of patients however there is no protocol on how to manage the disease. Two criteria commonly used to guide the direction of treatment are namely the HLH-2004 criteria and the Hscore; with the latter being used more often. The best cut-off H score is 169 corresponding to a sensitivity of 93%, specificity of 86% and accurate classification of 90% of the patients. We described of five patients diagnosed with severe dengue compli-cated with HLH. Methods: 5 cases that were diagnosed with severe dengue with secondary HLH and received dexa-methasone were reviewed retrospectively and clinical data extracted. Results: All patients had fever beyond critical or leaking phase. Four out of five cases had Hscore higher than 169 and had a mean score of 181 with only one bone marrow performed. Three patients had concurrent leaking and bleeding and three patients had fast progression of se-vere transaminitis during the critical phase. The mean peak ferritin level was 21077 micro/L. The only bone marrow aspiration done revealed increased macrophages and hemophagocytic activity. All patients received a short course of dexamethasone and discharged well. Conclusion: Short course dexamethasone is effective in treatment of HLH in dengue despite the concerns of administration of steroids in bleeding dengue patient. Secondary HLH in dengue remains a clinical diagnosis with no conclusive diagnostic criteria. It should be suspected in a severe dengue patient with hyperferritinemia and persistent fever. Technical difficulty of performing bone marrow during severe dengue makes conclusive diagnosis remains elusive.

Matched MeSH terms: Hemorrhage
Fulltext Chronic liver disease is universal in children with biliary atresia living with native liver

Lee WS, Ong SY, Foo HW, Wong SY, Kong CX, Seah RB, et al.

World J Gastroenterol, 2017 Nov 21;23(43):7776-7784.
PMID: 29209118 DOI: 10.3748/wjg.v23.i43.7776

AIM: To examine the medical status of children with biliary atresia (BA) surviving with native livers.
METHODS: In this cross-sectional review, data collected included complications of chronic liver disease (CLD) (cholangitis in the preceding 12 mo, portal hypertension, variceal bleeding, fractures, hepatopulmonary syndrome, portopulmonary hypertension) and laboratory indices (white cell and platelet counts, total bilirubin, albumin, international normalized ratio, alanine aminotransferase, aspartate aminotransferase, γ-glutamyl transpeptidase). Ideal medical outcome was defined as absence of clinical evidence of CLD or abnormal laboratory indices.
RESULTS: Fifty-two children [females = 32, 62%; median age 7.4 years, n = 35 (67%) older than 5 years] with BA (median age at surgery 60 d, range of 30 to 148 d) survived with native liver. Common complications of CLD noted were portal hypertension (40%, n = 21; 2 younger than 5 years), cholangitis (36%) and bleeding varices (25%, n = 13; 1 younger than 5 years). Fifteen (29%) had no clinical complications of CLD and three (6%) had normal laboratory indices. Ideal medical outcome was only seen in 1 patient (2%).
CONCLUSION: Clinical or laboratory evidence of CLD are present in 98% of children with BA living with native livers after hepatoportoenterostomy. Portal hypertension and variceal bleeding may be seen in children younger than 5 years of age, underscoring the importance of medical surveillance for complications of BA starting at a young age.

Matched MeSH terms: Gastrointestinal Hemorrhage/blood; Gastrointestinal Hemorrhage/etiology; Gastrointestinal Hemorrhage/epidemiology*
Fulltext Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage

Abdul-Salim I, Embong Z, Khairy-Shamel ST, Raja-Azmi MN

Clin Ophthalmol, 2013;7:703-6.
PMID: 23589678 DOI: 10.2147/OPTH.S42208

Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days' duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive sub-macular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.

Matched MeSH terms: Retinal Hemorrhage
Anticoagulation Therapy in Patients with Chronic Kidney Disease

Saheb Sharif-Askari F, Syed Sulaiman SA, Saheb Sharif-Askari N

Adv Exp Med Biol, 2017;906:101-114.
PMID: 27628006

Patients with chronic kidney disease (CKD) are at increased risk for both thrombotic events and bleeding. The early stages of CKD are mainly associated with prothrombotic tendency, whereas in its more advanced stages, beside the prothrombotic state, platelets can become dysfunctional due to uremic-related toxin exposure leading to an increased bleeding tendency. Patients with CKD usually require anticoagulation therapy for treatment or prevention of thromboembolic diseases. However, this benefit could easily be offset by the risk of anticoagulant-induced bleeding. Treatment of patients with CKD should be based on evidence from randomized clinical trials, but usually CKD patients are excluded from these trials. In the past, unfractionated heparins were the anticoagulant of choice for patients with CKD because of its independence of kidney elimination. However, currently low-molecular-weight heparins have largely replaced the use of unfractionated heparins owing to fewer incidences of heparin-induced thrombocytopenia and bleeding. We undertook this review in order to explain the practical considerations for the management of anticoagulation in these high risk population.

Matched MeSH terms: Hemorrhage/complications; Hemorrhage/pathology; Hemorrhage/prevention & control
Fulltext Retrospective review of the adjunctive use of pre- operative ranibizumab “lucentistm” in the surgical management of diabetic retinopathy in a tertiary referral hospital in Malaysia

Bastion, M.L.C., Siti Aishah, S., Aida Zairani, M.Z., Barkeh, H.J.

Medicine & Health, 2010;5(2):93-102.
MyJurnal

A retrospective case series review was conducted to determine the pre-operative role and safety of pre-operative adjunctive anti-vascular endothelial growth factor (anti- VEGF) agent ranibizumab “LUCENTISTM” in patients with diabetic retinopathy requiring vitrectomy. The study involved twenty consecutive eyes of sixteen patients (age range: 46-72 years; mean 57.5 years) which received intravitreal injection of 0.5 - 1 mg of ranibizumab 3 to 8 days (mean 4.4 days) prior to vitrectomy for diabetic retinopathy. There were no local or systemic post-injection complications. Indications for vitrectomy were retinal detachment (RD) [n=11; 3 combined tractional (TRD) - rhegmatogenous RD (RRD), 8 TRD], TRD with vitreous haemorrhage (VH) (n=3) ,VH (n=8) and vitreomacular traction syndrome (n=1). Inclusion criteria include all consecutive eyes of diabetic patients requiring vitrectomy receiving a first pre-operative injection of anti- VEGF. Pre-operative visual acuity (VA) ranged from 6/36 to light perception. All eyes had minimal to moderate intraoperative bleeding. Post-operative VH in eyes without tamponade or gas tamponade was nil (n=1), mild (n=13) or moderate (n=1). Silicone filled eyes had nil (n=1), moderate (n=3) or severe haemorrhages (n=1). Post-operative VA was unchanged (n=2) (10%), improved (n = 14) (70%) or worsened (n=4). VA was 2/60 or better (n=15) to no light perception (n=1). Two eyes achieved 6/12 or better vision (10%). Ten eyes (50%) had 6/36 or better vision. In conclusion, pre-operative intravitreal ranibizumab is safe and useful in diabetic vitrectomy and appears to help with perioperative bleeding leading to improvement in vision.

Matched MeSH terms: Vitreous Hemorrhage
Fulltext The Effect Of 5 Units Oxytocin Preparation In The Augmentation Of Labour – Is It Cost Effective?

Roszaman Ramli, Ghazali Ismail

International Medical Journal Malaysia, 2006;5(1):1-8.
MyJurnal

Objectives: To evaluate the cost-effectiveness of the new oxytocin regimes in the augmentation of labour and the effect on the maternal and fetal outcome. Design: Randomized controlled trial. Setting: Labour ward of Hospital Tengku Ampuan Afzan, Kuantan. Participants: 230 pregnant women in labour at term with obstetric indications for labour augmentation. Methods: The women were randomly assigned to receive new oxytocin regime of 5 units in 500 cc of D/Saline at titration of 5 dpm with increments of 5 dpm to a maximum of 60 dpm. Or, old oxytocin regime of 1/2/4 units with titration of 20/40/60 dpm for primips and half the dosage for multips.
Main outcome measures: Cost analysis, duration of labour, duration of augmentation, complication of labour, post partum hemorrhage (PPH), mode of delivery and perinatal outcome.
Results: There was no significant difference in the mean duration of labour (6.8 h vs 6.7 h ; p = 0.45) and mean augmentation time (3.86 h vs 4.0 h; p = 0.9) between the regimes studied There seemed to be higher incidence of caesarean section in the old oxytocin group (6.5% vs 24.7%; p = 0.001). There was no significant influence on the neonatal morbidity and mortality (p = 0.07). A moderate reduction of annual cost for augmentation of labour was noted (RM 962.34).
Conclusion: The results showed that the new oxytocin regime was more cost-effective without apparent increased in the maternal and fetal mortality and morbidity.

Matched MeSH terms: Postpartum Hemorrhage
Fulltext Bilateral profound visual loss as a consequence of leukaemia – a case report

Raajini, Devi K., Safinaz, M.K., Hazlita, M.I.

Journal of Surgical Academia, 2015;5(1):61-63.
MyJurnal

An 18-year-old Malay gentleman was noted to have profound bilateral blurred vision for one month duration, associated with loss of weight, appetite, low grade fever and abdominal distension. Visual acuity on presentation was 6/60 on the right, counting finger on the left with no afferent pupillary defect. Anterior segments were unremarkable. Vitreous cells were occasional bilaterally. Fundus revealed multiple choroidal and sub-retinal Roth spots with areas of pre-retinal and intra-retinal haemorrhages, involving the macula in the left eye. Vessels were dilated and tortuous in all quadrants of the right eye. Many areas of capillary fall out at peripheral retina were demonstrated in fundus fluorescein angiogram. Further systemic and laboratory review confirmed the diagnosis of CML and chemotherapy was initiated. Both eye ischaemic retinopathy secondary to CML was confirmed and scatter pan retinal photocoagulation was performed bilaterally. Good improvement in vision noted during subsequent follow up to 6/24 on the right, 6/60 on the left. High levels of suspicion and accurate early recognition of fundus changes are vital in these types of cases to ensure the institution of prompt treatment.

Matched MeSH terms: Retinal Hemorrhage
Spontaneous retrobulbar haemorrhage secondary to orbital varices of inferior ophthalmic vein-a case report

Haizul, I.M., Umi Kalthum, M.N., Mae-Lynn, C.B., Faridah, H.A.

Journal of Surgical Academia, 2012;2(2):49-51.
MyJurnal

A 50-year-old Chinese man presented with sudden onset of painful right eye, diplopia, and redness associated with headache and deteriorating vision. Examination revealed obvious proptosis with elevated intraocular pressure. Computed tomography (CT) scan showed presence of retrobulbar haemmorhage. Emergency lateral canthotomy and cantholysis was performed followed by medical orbital decompression, resulting in improvements in visual acuity, and other ocular symptoms. The diagnosis of thrombosed orbital varices involving inferior ophthalmic vein was confirmed on radiological- angiographic study. To date, he is symptoms-free with good visual acuity. Immediate surgical decompression with lateral cantholysis for retrobulbar haemorrhage was effective in the treatment of retrobulbar haemorrhage.

Matched MeSH terms: Retrobulbar Hemorrhage
Fulltext Dengue infections and circulating serotypes in Negeri Sembilan, Malaysia

Ahmad Nizal, M.G., Rozita, H., Mazrura, S., Zainudin, M.A., Hidayatulfathi, O., Faridah, M.A, et al.

Malaysian Journal of Public Health Medicine, 2012;12(1):21-30.
MyJurnal

This study observed the pattern of reported dengue infections, clinical manifestations, and circulating dengue serotypes in Negeri Sembilan, Malaysia. The aim of this study was to determine the co-circulation of the four different dengue virus serotypes in Negeri Sembilan. We analyzed the surveillance data (VEKPRO) from Negeri Sembilan State Health Department and National Public Health Laboratory, Malaysia on reported dengue infections from 1st January 2010 to 31st December 2010. There were 1466 reported dengue infections, 1342 (91.5%) cases were dengue fever (DF) and 124 (8.5%) were dengue hemorrhagic fever (DHF). The mean age was 32.2± 15.8 years old and most were young adults, aged 15 years old and older. Males (p < 0.05), and those residing in Seremban district (p < 0.05) were more likely to get dengue infections. Symptoms presented upon admission were fever (100%), headache (99.9%), myalgia and arthralgia (98.8%), rash(24.2%), petechiae (16.0%),bleeding tendencies (7.0%) and neurological deficits(1.2%). All four dengue serotypes (DEN 1 – 4) were present, the pre-dominant serotype was DEN-3, noted in January, then existed together with DEN-2 until around May. DEN-1 was the most pre-dominant circulating dengue serotype afterwards, reaching a peak in December 2010. Dengue affected all age groups particularly young adults and males. Most cases reported were in urban areas and Seremban district. Most of the dengue infections occurred in the first half of the year, with the DEN-2 and DEN-3 serotypes being the most predominant.

Matched MeSH terms: Hemorrhage
Fulltext Parkinsonism and brain MRI findings in a relapsed culture-proven salmonella typhi infection: a case report in Malaysia

Ng, Y.M., Cheng, J.T.

JUMMEC, 2016;19(1):1-2.
MyJurnal

Typhoid fever is a systemic infection caused by Salmonella typhi, which may be associated with extra-intestinal
complications. Neurological manifestations, particularly Parkinsonism, are rarely reported. We report a
17-year-old patient with relapsed culture-proven Salmonella typhi infection who developed septic shock and
subsequently Parkinsonism. Lumbar puncture revealed acellular cerebrospinal fluid with raised protein level.
Magnetic resonance imaging revealed cerebral petechial haemorrhages resulted from small vessels vasculitis.
His symptoms resolved spontaneously after 3 months.

Matched MeSH terms: Cerebral Hemorrhage
Fulltext Renal angiomyolipoma during pregnancy: what can we offer?

Lim, Pei Shan, Ng, BK, Rozman, Z, Nirmala K, Shuhaila A, Omar MH

Journal of Surgical Academia, 2015;5(2):62-65.
MyJurnal

Renal angiomyolipoma is a rare disease seen during pregnancy. Rupture of renal angiomyolipoma could be catastrophic and might result in maternal and even perinatal mortality. Management includes conservative vs surgical approach. A 29-year-old woman Para 2 with history of bleeding renal angiomyolipoma in her first pregnancy at 11 weeks treated with selective arterial embolisation. The pregnancy was terminated. Even though having small residual tumour, her subsequent pregnancy progressed well with conservative management. Intervention is advisable in the presence of large or symptomatic renal angiomyolipoma prior to pregnancy in order to minimise potential life-threatening haemorrhage during pregnancy. For those with small tumour of less than 4cm, perhaps conservative approaches i.e. frequent follow-up and close monitoring would assist in early identification of any rupture or bleeding.

Matched MeSH terms: Hemorrhage
Fulltext Morbidly adherent placenta at extreme prematurity: can major haemorrhage and hysterectomy be prevented?

Shafiee, M.N., Rahana, A.R., Lim, P.S., Nor Azlin, M.I., Wan Faraliza, Z.A., Isa, M.R., et al.

Journal of Surgical Academia, 2011;1(1):56-60.
MyJurnal

Morbidly adherent placenta with spontaneous rupture of membrane at extreme prematurity poses poor pregnancy outcome. Various issues on different management modalities still remain perplexed and individual consideration is vital. Two cases of morbidly adherent placenta with symptomatic per vaginal bleeding and spontaneous rupture of membrane at severe prematurity were reviewed and discussed. We found that, active intervention by termination of pregnancy and methotrexate therapy at early gestation can prevent the need of hysterectomy following major obstetrics haemorrhage.

Matched MeSH terms: Uterine Hemorrhage
Fulltext Spontaneous spinal subarachnoid haemorrhage: a rare complication of dengue fever

Nur Hidayati Mohd Sharif, Nor Arisah Misnan, Norashikin Saidon, Phaik Yee Ooi, Hilwati Hashim

Journal of Clinical and Health Sciences, 2017;2(2):54-57.
MyJurnal

A 37-year-old woman presented with a short history of fever and bilateral lower limb
weakness. She also had impaired sensory function up to T4 spine level and lax anal tone.
Laboratory investigations confirmed dengue infection with mild thrombocytopenia. MRI of the
spine showed a spinal subarachnoid haemorrhage from the level of T4 till T9. Despite
medical and surgical interventions, her lower limb weakness persists. A high index of
suspicion is needed to recognise dengue-related neurological complications. This diagnosis
should be considered in any patients from dengue endemic areas presenting with acute
febrile illness with atypical neurological manifestations.

Matched MeSH terms: Subarachnoid Hemorrhage
Efficacy and tolerability of micronized purified flavonoid fractions (MPFF) for haemorrhoids: A systematic review and meta-analysis

Aziz Z, Huin WK, Badrul Hisham MD, Tang WL, Yaacob S

Complement Ther Med, 2018 Aug;39:49-55.
PMID: 30012392 DOI: 10.1016/j.ctim.2018.05.011

OBJECTIVE: To present a systematic review of randomised controlled trials (RCTs) examining the effects of MPFF in the management of haemorrhoid symptoms.
METHODS: Electronic databases including CENTRAL, CINAHL, EMBASE, MEDLINE were searched up to April 2018 for relevant RCTs. Journal and conference proceedings were also searched. Two review authors independently selected trials, extracted data, assessed the risks of bias in included trials and graded the quality of evidence. Meta-analyses were conducted for studies presenting similar outcomes.
RESULTS: Ten RCTs involving 1164 participants were included. These RCTs varied in terms of patients' grade of haemorrhoids, length of trials, and outcome assessed. Most of the studies did not describe adequately the process of randomisation and allocation concealment. The pooled analysis of data from three studies indicated that there was significant difference between groups for the bleeding outcome, favoring the MPFF group (RR 1.46; 95% CI 1.10-1.93; p = 0.008). Except for bleeding, the current evidence did not show MPFF has significant effects on all the other outcomes examined when compared with placebo. Even then, the quality of evidence for bleeding was judged as low due to the small number and inconsistent results among the included studies.
CONCLUSION: This review highlights the need for further rigorous research if MPFF was to be routinely used for the treatment of haemorrhoid symptoms.

Matched MeSH terms: Hemorrhage
Fulltext A survey of oral health experiences and practices among Malaysian submariners while under water

Nor Azman, A.R., Saub, R., Raja Latifah, R.J.

Malaysian Dental Journal, 2015;37(1):24-29.
MyJurnal

This study was conducted on Royal Malaysian Navy submariners who were having training in France. It was designed to compare the oral health experiences and practices while under water and on land. Methods Eightysix Royal Malaysian Navy (RMN) submariners, who had undergone at least one cycle (288 hours) of under water training, were selected to participate in a self-administered questionnaire survey. Results Seven percent of the respondents reported oro-facial pain and discomfort; 9.3% reported bleeding gums and 12.8% experienced halitosis while under water. Of those experience oral problems, 82% reported disruption of their daily activities while under water. The study showed that 82.5% of them brush their teeth at least twice a day and 94.2% rinse after meals when there were under water. Meanwhile studies on land showed that 90.7% of them brush their teeth at least twice a day and 96.5% rinse after meals. Flossing was not practiced by most of the respondents. Conclusion It is concluded that brushing and rinsing are practiced regularly by submariners regardless whether they are on land or under water but flossing is not a common practice both on land and under water. Dental emergencies, such as toothache, TMJ pain and discomfort do occur during submarine operations and disrupt their daily activities. This might poses a threat to submarine operations.

Matched MeSH terms: Gingival Hemorrhage

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