Utilization of dental health care services in context of the HIV epidemic- a cross-sectional study of dental patients in the Sudan

Background: HIV infected patients should be expected in the Sudanese dental health care services with an increasing frequency. Dental care utilization in the context of the HIV epidemic is generally poorly understood. Focusing on Sudanese dental patients with reported unknown HIV status, this study assessed the extent to which Andersen's model in terms of predisposing (sociodemographics), enabling (knowledge, attitudes and perceived risk related to HIV) and need related factors (oral health status) predict dental care utilization. It was hypothesized that enabling factors would add to the explanation of dental care utilization beyond that of predisposing and need related factors. Methods: Dental patients were recruited from Khartoum Dental Teaching Hospital (KDTH) and University of Science and Technology (UST) during March-July 2008. A total of 1262 patients (mean age 30.7, 56.5% females and 61% from KDTH) were examined clinically (DMFT) and participated in an interview. Results: A total of 53.9% confirmed having attended a dental clinic for treatment at least once in the past 2 years. Logistic regression analysis revealed that predisposing factors; travelling inside Sudan (OR = 0.5) were associated with lower odds and females were associated with higher odds (OR = 2.0) for dental service utilization. Enabling factors; higher knowledge of HIV transmission (OR = 0.6) and higher HIV related experience (OR = 0.7) were associated with lower odds, whereas positive attitudes towards infected people and high perceived risk of contagion (OR = 1.3) were associated with higher odds for dental care utilization. Among need related factors dental caries experience was strongly associated with dental care utilization (OR = 4.8). Conclusion: Disparity in the history of dental care utilization goes beyond socio-demographic position and need for dental care. Public awareness of HIV infection control and confidence on the competence of dentists should be improved to minimize avoidance behaviour and help establish dental health care patterns in Sudan.publishedVersio

Inflammatory mediators in saliva and gingival fluid of children with congenital heart defect

Objectives (a) To compare levels of pro- and anti-inflammatory mediators in saliva and gingival crevicular fluid (GCF) in children with and without congenital heart defects (CHD cases and controls) and to test whether a systemic component exists in CHD cases by controlling for gingivitis and plaque scores. (b) To correlate the levels of pro- and anti-inflammatory mediators in GCF and saliva with plaque bacterial composition among CHD cases and controls. Materials and Methods Whole un-stimulated saliva and GCF samples were collected (60 CHD cases, 60 controls [Sudan]) and were analysed for levels of prostaglandin E2 (PGE2), interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α), interleukin-1ra (IL-1ra) and interleukin-10 (IL-10) levels. These levels were correlated with the previously reported levels of four red complex bacteria. Results Significantly elevated levels of PGE2 and IL-1β in GCF and IL-1β and TNF-α in saliva were detected among CHD cases compared with controls. General linear model (GLM) analyses revealed that PGE2 and IL-1β levels remained significantly higher in GCF and saliva samples, respectively, among CHD cases after controlling for gingivitis and plaque score, whereas TNF-α and IL-10 levels were significantly lower in their GCF samples. Additionally, IL-1β level was significantly positively correlated to the counts of the four red complex species in their GCF. Conclusion In addition to higher levels of some pro-inflammatory mediators in saliva and GCF corresponding to more gingivitis in CHD cases, also a systemic inflammatory component exists and is reflected in these two oral fluids.publishedVersio

Oral-health-related background factors and dental service utilisation among Sudanese children with and without a congenital heart defects

Background: Sudanese children with congenital heart defects (CHDs) were found to have poorer oral health than those without CHDs. The aims of this study were to: describe the patterns of oral-health-related background factors in children with and without CHD and explore any differences, and to evaluate the effects of background factors on caries and gingivitis prevalence and dental services utilisation. Methods: In this analytical cross-sectional study, caregivers of children aged 3–12 years with (CHD cases n = 111) and without CHDs (Controls n = 182), underwent face-to-face interviews using a structured questionnaire. The questionnaire items covered several oral health background factors (independent variables) including: child’s health status, oral hygiene practices, dental services utilization, mother’s level of education, and caregiver’s perception and awareness of their child’s oral health. The relationship between these factors and occurrence of ‘caries’ and ‘gingivitis’ as well as ‘child’s dental services utilisation’ (dependent variables) were explored using multiple adjusted and hierarchal logistic regression analyses. Results: Compared with controls, CHD cases had lower frequencies of brushing and use of fluoridated toothpaste, and their caregivers were less knowledgeable about caries. Among CHD cases, the variables (brushing and fluoridated toothpaste use) had significant impacts on caries prevalence (odd ratio (OR) =5.6, 95% confidence interval (CI): 1.4–22.8 and OR = 0.3, 95% CI: 0.1–0.8 for infrequent compared to frequent ones, respectively) as well as the mother’s level of education (OR = 2.6, 95% CI: 1.0–6.4). When differences in background factors were controlled for, the adjusted ORs for caries and gingivitis prevalence in CHD cases compared with controls were 1.8, (95% CI: 1.1–3.2) and 5.3 (95% CI: 2.9–9.4), respectively. Among CHD cases, the child’s age (8–12 years: OR = 11.9, 95% CI: 1.9–71.6), and the mother’s level of education (lower education: OR = 0.2, 95% CI: 0.03–0.9) were significantly associated with the child’s dental services utilisation. Conclusions: Lower frequencies of brushing and use of fluoride tooth paste were reported among CHD cases, and brushing had the predominant significant impact on caries prevalence. The child’s age and the mother’s level of education were the main factors affecting the child’s (CHD cases) dental services utilisation.publishedVersio

Oral health status of 12-year-old school children in Khartoum state, the Sudan; a school-based survey

<p>Abstract</p> <p>Background</p> <p>Few studies have investigated the prevalence of dental caries among school children in the past decades in Sudan rendering it difficult to understand the status and pattern of oral health.</p> <p>Methods</p> <p>A school-based survey was conducted using stratified random cluster sampling in Khartoum state, Sudan. Data was collected through interviews and clinical examination by a single examiner. DMFT was measured according to WHO criteria. Gingival index (GI) of Loe & Silness and Plaque index (PI) of Silness & Loe were used.</p> <p>Results</p> <p>The mean DMFT for 12-year-olds was found to be 0.42 with a significant caries index (SiC) of 1.4. Private school attendees had significantly higher DMFT (0.57) when compared to public school attendees (0.4). The untreated caries prevalence was 30.5%. In multivariate analysis caries experience (DMFT > 0) was found to be significantly and directly associated with socioeconomic status. The mean GI for the six index teeth was found to be 1.05 (CI 1.03 – 1.07) and the mean PI was 1.30 (CI 1.22 – 1.38).</p> <p>Conclusion</p> <p>The prevalence of caries was found to be low. The school children with the higher socioeconomic status formed the high risk group.</p

COVID-19 Vaccination Among Diverse Population Groups in the Northern Governorates of Iraq

Objectives: The present study was carried out to investigate COVID-19 vaccination coverage among populations of internally displaced persons (IDPs), refugees, and host communities in northern Iraq and the related underlying factors.Methods: Through a cross-sectional study conducted in five governorates in April–May 2022, 4,564 individuals were surveyed. Data were collected through an adapted questionnaire designed to gather data on participants.Results: 4,564 subjects were included (59.55% were 19–45 years old; 54.51% male). 50.48% of the participants (51.49% of host communities, 48.83% of IDPs, and 45.87% of refugees) had been vaccinated with at least one dose of COVID-19 vaccine. 40.84% of participants (42.28% of host communities, 35.75% of IDPs, and 36.14% of refugees) had been vaccinated by two doses, and 1.56% (1.65% of host communities, 0.93% of IDPs, and 1.46% of refugees) were vaccinated with three doses.Conclusion: Sociodemographic factors including age, gender, education, occupation, and nationality could affect vaccination coverage. Moreover, higher acceptance rate of vaccination is associated with belief in vaccine safety and effectiveness and trust in the ability of the vaccine to prevent complications

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Tricalcium silicate cements: in-vitro comparative studies of mechanical and biological characteristics of relevance to regenerative endodontics

Tricalcium silicate cements (TSC), are bioactive ceramic materials with a wide range of clinical applications in the field of “regenerative endodontics”, i.e. tissue engineering concepts applied to regeneration of damaged or lost dental tissue. This broad definition includes both vital pulp therapy (VPT) and regenerative endodontic procedures (REP) in immature permanent teeth with necrotic pulps. Both procedures involve direct contact between stem cells and TSC: the ensuing interaction is an essential determinant of regeneration and/or repair. It is therefore important to determine the bioactivity and biocompatibility properties of TSC. In REP moreover, the application of TSC should take into account potential mechanical effects on teeth at greater risk of fracture because of the thin dentinal walls. In this thesis three commercially available TSC were compared: White MTA-Angelus (MTA), Biodentine and TotalFill BC Root Repair Material PUTTY (TotalFill). The surface microhardness of MTA, Biodentine and TotalFill was evaluated by the Vicker’s Hardness Test. Biodentine showed the highest microhardness whereas TotalFill, which failed to achieve a measurable level, had the lowest. Based on the Vicker’s test results, the potential effect of MTA, Biodentine and TotalFill on tooth resistance to fracture was investigated. The aim of Study 1 was to compare the fracture resistance of immature teeth treated with REP and MTA, Biodentine or TotalFill applied to the cervical area. The study utilized an acknowledged bovine tooth model. The teeth were prepared to simulate immature permanent teeth, then treated with REP and tested for fracture resistance. No differences in fracture resistance were observed in relation to the three TSC tested. Cellular responses to MTA, Biodentine and TotalFill were evaluated and compared in cell culture experiments. Cell proliferation was assessed by MTT assay and osteogenic/angiogenic/ inflammatory responses were assessed with qRT-PCR, ELISA, ALP quantification and Alizarin red staining. In Study 2 the effect of TSC on human bone marrow stem cells (hBMSC) was investigated. Compared to MTA and TotalFill, Biodentine had the least inhibitory effect on hBMSC proliferation. The osteogenic and angiogenic responses to the materials varied. Biodentine and TotalFill induced earlier changes at gene level. All TSC induced mineralization after 14 days, with MTA possibly demonstrating the greatest effect. In Study 3 the effect of TSC on human dental pulp stromal cells (hDPSC) was investigated. Biodentine exhibited the least inhibitory effect on proliferation and induced upregulation of most osteogenic markers. TotalFill had an anti-inflammatory effect, expressed as downregulation of IL6. Moreover, TotalFill induced increased gene expression and production of VEGFA and had a long-lasting effect on the inhibition of ALP production. The results indicate that although the TSC tested tend to be used interchangeably in clinical practice, these materials have not only different mechanical properties but also different biological effects. The microhardness levels of TSC differed, but there were no associated differences in fracture resistance. With respect to cellular responses, Biodentine was the most inert. It had the least effect on cell proliferation and induced pronounced expression of osteogenic markers in both hBMSC and hDPSC. TotalFill exhibited enhanced angiogenic and anti-inflammatory effects on hDPSC. The results of these studies have potential clinical implications and further investigation is therefore warranted