In-vitro comparison of bonding time and strength of adhesive pre-coated and standard metal orthodontic brackets

To compare the shear bond strength and bond time of 3M Unitek's APC (Adehesive Pre-Coated) Flash-Free™system applied to metal brackets. An in vitro study was performed on 40 extracted sound human premolar teeth randomly divided into two groups (20 per group) bonded either with Adhesive Pre-Coated Flash-Free metal brackets or metal brackets coated manually with Transbond XT™ light-cure adhesive. Bonding time was measured using a stopwatch. Thermoycling was performed on the samples (500 cycles) to simulate the oral environment between baths of 5°C and 55°C distilled water. Debonding shear bond strength measurements were performed in an Instron universal testing machine. The APC Flash-Free group bonded in significantly (p<0.001) less time (mean 34.06s/tooth) than the manually coated group (mean 55.14s/tooth). Shear bond strength of the manually coated group was significantly (p<0.001) higher (mean 13.32 MPa) than the APC Flash-Free group (mean 10.95 MPa). The APC Flash-Free free system is efficient and allows for reduced chair time during the bonding appointment while attaining a mean shear bond strength of 10.95MPa, which is higher than the minimum shear bond strength of between 4MPa and 7MPa

Development of a clinical prediction model for high hospital cost in patients admitted for elective non-cardiac surgery to a private hospital in South Africa

INTRODUCTION : Clinicians may find early identification of patients at risk for high cost of care during and after surgery useful, to prepare for focused management that results in optimal clinical outcome. The aim of the study was to develop a clinical prediction model to identify high and low hospital cost outcome after elective non-cardiac surgery using predictors identified from a preoperative self-assessment questionnaire. METHODS : Data to develop a clinical prediction model were collected for this purpose at a private hospital in South Africa. Predictors were defined from a preoperative questionnaire. Cost of hospital admission data were received from hospital administration, which reflected the financial risk the hospital carries and which could be reasonably attributed to a patient’s individual clinical risk profile. The hospital cost excluded fees charged (by any healthcare provider), and cost of prosthesis and other consignment items that are related to the type of procedure. The cost outcome measure was described as cost per total Work Relative Value Units (Work RVUs) for the procedure, and dichotomised. Variables that were associated with the outcome during univariate analysis were subjected to a forward stepwise regression selection technique. The prediction model was evaluated for discrimination and calibration, and internally validated. RESULTS : Data from 770 participants were used to develop the prediction model. The number of participants with the outcome of high cost were 142/770 (18.4%). The predictors included in the full prediction model were type of surgery, treatment for chronic pain with depression, and activity status. The area under the receiver operating curve (AUROC) for the prediction model was 0.83 (95% confidence interval [CI]: 0.79 to 0.86). The Hosmer–Lemeshow indicated goodness-of-fit (p = 0.967). The prediction model was internally validated using bootstrap resampling from the development cohort, with a resultant AUROC of 0.86 (95% CI: 0.82 to 0.89). CONCLUSION : The study describes a clinical risk prediction model developed using easily collected patient-reported variables and readily available administrative information. The prediction model should be validated and updated using a larger dataset, and used to identify patients in which cost-effective care pathways can add value.Supplement 1: Patient information and self-assessment questionnaire.Supplement 2: Binary outcome definition.Supplement 3: Table – Use of self-assessment questions to define predictor variables.Supplement 4: Table – Information on cases with extreme values excluded from derivation cohort.The South African Society of Anaesthesiologists (SASA) Jan Pretorius Research Fund; University of Pretoria, Faculty of Health Sciences, School of Medicine – research assistant grant; The SASA Acacia Branch Committee.http://www.sajaa.co.zadm2022Anaesthesiolog

Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars : its effect on the sagittal split ramus osteotomy

The authors undertook a prospective study to evaluate the influence that the anatomical dimensions of the ramus of the mandible and the presence of lower third molar teeth may have on the sagittal split ramus osteotomy. The anatomical dimensions measured included the width of the anterior mandibular ramus, the height of the corpus posterior to the second mandibular molar and the antero-posterior anatomical position of the lingual. The influence that these dimensions of the mandible may have on the successful splitting of the mandibular ramus wasThe effect that the presence of wisdom teeth had on the difficulty of the procedure was also investigated. This study found that, unlike the presence of third molars, there was no single anatomical measurement that contributed to the level of difficulty of the sagittal split osteotomy. For descriptive purposes the authors proposes a classification of the four typical patterns of unfavourable splits.http://www.sciencedirect.comhb201

Serious bacterial infections in febrile young children: Lack of value of biomarkers

BACKGROUND : Serious infections in children are difficult to determine from symptoms and signs alone. Fever is both a marker of insignificant viral infection, as well as more serious bacterial sepsis. Therefore, seeking markers of invasive disease, as well as culture positivity for organisms, has been a goal of paediatricians for many years. In addition, the avoidance of unnecessary antibiotics is important in this time of emerging multiresistant micro-organisms. OBJECTIVE : To ascertain whether acute-phase reactant tests predict positive culture results. METHODS : A prospective, cross-sectional study over a 1-year period included all documented febrile children under the age of 5 years (with an axillary temperature ≥38°C) who presented to Steve Biko Academic Hospital, Pretoria, with signs and symptoms of pneumonia, meningitis and/or generalised sepsis. Every child had clinical signs, chest radiograph findings, urine culture, blood testing (full blood count, C-reactive protein, procalcitonin) and blood culture results recorded. RESULTS : A total of 63 patients were enrolled, all of whom had an axillary temperature ≥38°C. C-reactive protein, procalcitonin and white cell count did not predict the presence of positive blood culture or cerebrospinal fluid culture results, nor infiltrates on chest radiographs. No statistically significant correlations were found between the duration of hospital stay and the degree of fever (p=0.123), white cell count (p=0.611), C-reactive protein (p=0.863) or procalcitonin (p=0.392). CONCLUSION : Biomarkers do not seem to predict severity of infection, source of infection, or duration of hospitalisation in children presenting to hospital with fever. The sample size is however too small to definitively confirm this viewpoint. This study suggests that clinical suspicion of serious infection and appropriate action are as valuable as extensive testing.http://www.sajch.org.za/index.php/SAJCHhb2016Paediatrics and Child Healt

The Vaccine and Cervical Cancer Screen project 2 (VACCS 2): Linking cervical cancer screening to a two-dose HPV vaccination schedule in the South-West District of Tshwane, Gauteng, South Africa

BACKGROUND : Cervical cancer is preventable, but still highly prevalent in South Africa (SA). Screening strategies in the country have been ineffective, and new ways to prevent the disease are needed. OBJECTIVES : To investigate the feasibility of linking cervical cancer screening in adult women to human papillomavirus (HPV) vaccination in schoolgirls. METHODS : Ten primary schools in the South-West District of Tshwane, Gauteng Province, SA, took part in the study. Cervical cancer and HPV vaccine information was provided to schoolgirls and their parents. Consented schoolgirls were vaccinated and their female parents were invited to participate in self-screening. RESULTS : Among 1 654 girls invited for vaccination, the consented and invited uptake rates were 99.4% and 64.0%, respectively. Vaccine completion rates were higher in schools where the vaccination programme was completed in the same calendar year than in those where it was administered over two calendar years. Of 569 adult females invited, 253 (44.5%) returned screen tests; 169 (66.8%) tested negative and 75 (29.6%) positive for any high-risk HPV (hrHPV). There were no differences in level of education, employment status or access to healthcare between women with positive and those with negative screen results. CONCLUSIONS : Implementation of HPV vaccination in a primary school-based programme was successful, with high vaccine uptake and completion rates. Self-screening reached the ideal target group, and it is possible to link cervical cancer screening to the cervical cancer vaccine by giving women the opportunity of self-sampling for hrHPV testing. This is a novel and feasible approach that would require some adaptive strategies.http://www.samj.org.zahb201

The impact of a change in work posture from seated to stand-up on work-related musculoskeletal disorders among sewing-machine operators

BACKGROUND : Work‐related postural change could lead to improved musculoskeletal health. METHOD(S) : In a quantitative, retrospective, longitudinal study, data of work‐related musculoskeletal disorders of 123 sewing‐machine operators were captured for 4.5 years, and analysed using Poisson regression. RESULTS : Stand‐up work posture (SUWP) reduced the incidence for spinal disorders (SD) to 0.29 fold the incidence for sitting work posture (SWP) (P < 0.001). Morbid obesity had significantly increased (P = 0.04) incidence of upper limb disorders (ULD), 3.35 times that of normal body mass index (BMI) (regardless of work posture). SUWP was associated with increased IRR (1.49) for lower limb disorders (LLD). LLDs were associated with obesity (overweight (IRR = 2.58; P = 0.08), obese (IRR = 2.45; P = 0.09), and morbidly obese (IRR = 6.24; P = 0.001)). CONCLUSIONS : The protective benefit of the SUWP was statistically significant for SD incidence. Owing to high mean BMI, SUWP had a negative impact on the incidence of LLDs for the first 2 monthshttp://wileyonlinelibrary.com/journal/ajim2019-08-01hj2018Physiotherap

The effectiveness of the pregnancy adapted YEARS algorithm to safely identify patients for CT pulmonary angiogram in pregnant and puerperal patients suspected of having pulmonary embolism

BACKGROUND: Pulmonary thromboembolism is one of the leading causes of maternal death worldwide. Globally there has been increasing physician reliance on CT pulmonary angiogram for definitive diagnoses and exclusion of pulmonary thromboembolism. The problem, however, arises when considering the high radiation penalty from performing these investigations, highlighted by the low diagnostic yield. Of recent, the pregnancy-adapted YEARS algorithm has shown promise in international studies as a possible alternative for stratifying risk of pulmonary thromboembolism during the pregnancy and puerperal period. OBJECTIVES: To determine the effectiveness of the pregnancy adapted YEARS algorithm to safely minimise the number of true negative CT pulmonary angiograms for patients suspected of having pulmonary embolism in our clinical setting. METHOD: A cross-sectional study was performed in a tertiary hospital in Gauteng on puerperal and pregnant patients suspected of having pulmonary embolism. We retrospectively applied the pregnancy adapted YEARS algorithm and reviewed the various outcomes. RESULTS: The pregnancy adapted YEARS algorithm proved effective in safely identifying patients for CT pulmonary angiography. By retrospectively applying the algorithm, there could have been a 25.7% scan reduction, whilst maintaining a negative predictive value of 100.0%. CONCLUSION: As physician reliance on radiological investigations increases, we must remain cognisant of the added radiation exposure and the long-term adverse effects of ionising radiation. The pregnancy-adapted YEARS algorithm provides a safe, reproducible alternative to aid our bid going forward.Principal investigatorhttp://www.sajr.org.za/index.php/sajrdm2022RadiologyStatistic

The impact of hypothermia in a tertiary hospital neonatal unit

BACKGROUND : Neonatal hypothermia, defined as a body temperature <36.5°C, is a known contributor to neonatal morbidity and mortality. The admission temperature is an important predictor of neonatal outcomes, and a measure of quality of care. OBJECTIVES : This study aims to determine the incidence of and factors associated with hypothermia on admission to the neonatal unit at Steve Biko Academic Hospital (SBAH), a public tertiary hospital in South Africa. METHODS : A retrospective, cross-sectional study of infants admitted to the neonatal unit from September 2019 to February 2020 using data from patient records. RESULTS : The overall incidence of hypothermia on admission was 66% (mild 25%, moderate to severe 41%), with a mean (standard deviation (SD)) admission temperature of 35.1 (4.7)°C, and 82% (mild 19%, moderate to severe 62%) in very-low-birthweight infants. Infants remained hypothermic for a mean (SD) of 4.1 (3.9) hours post admission. Birthweight ≤1 500 g (odds ratio (OR) 1.87; p=0.019), admission to the neonatal intensive care unit (OR 1.97; p<0.0001), and admission from the delivery room within the first 60 minutes of life (OR 3.06; p=0.026) were independent risk factors for hypothermia. Hypothermia was associated with increased duration of respiratory support (mean 3.2 (5.6) v. 1.7 (4.5) days; p<0.0001), and longer length of hospital stay (mean 17.9 (18.8) v. 10.9 (12.6) days; p<0.0001). CONCLUSION : The incidence of hypothermia on admission to the unit is significantly high, and hypothermic infants take a significant length of time to regain normothermia. A standardised protocol for the prevention and management of hypothermia needs to be introduced in the unit.http://www.sajch.org.za/index.php/SAJCHhj2024Paediatrics and Child HealthSDG-03:Good heatlh and well-bein

Caesarean section indications and outcomes at a tertiary level hospital in South Africa

Caesarean section rates have increased over the past 30 years and there has been lack of understanding of the drivers of these increased rates. The World Health Organisation has recommended the use of the Robson ten group classification as a system for assessing, monitoring, and comparing caesarean section rates at all levels. AIM : The aim of this study was to determine the indications and caesarean section rate at a tertiary referral hospital. METHODS : This was a retrospective analysis of deliveries between 1 January 2014 and 31 December 2018 at a tertiary level hospital in Pretoria, South Africa. The Robson’s 10 group classification was used in classifying the caesarean sections. RESULTS : A total of 15 295 deliveries took place during the study period: 6 883 women delivered vaginally (NVD) and 8 412 women by caesarean sections (CS). The average CS rate was 55%. Robson’s 10 Group 5 (all multiparous, ≥1 previous CS, ≥ 37 weeks, single cephalic pregnancy) was the greatest contributor to the CS rate (29%). Most women who delivered were between the ages 20-35yrs (n= 12000, 78.6%), with majority delivering via CS deliveries (n=6616, 55.1%) compared to NVDs (n=5388, 44.9%). The CS rate for women with underlying medical disease was 19% and women with hypertensive disorders of pregnancy were the largest contributor to this group (n=1241, 14.8%). The caesarean section rate for women classified as a maternal near miss was 69.6%. There was no statistically significant difference in the rate of postpartum haemorrhage between women who delivered vaginally NVD (n=173) compared to those who delivered by CS (n=245) p=0.132). CONCLUSION : Strategies to reduce the primary caesarean deliveries and steps to improve VBAC success rates should be considered and implemented. In a tertiary hospital, Robson’s 10 group classification alone does not give a full description of the caesarean section rate; other causes like medical conditions need to be considered. Health care workers should follow local guidelines to reduce the risk of complications related to hypertensive disorders in pregnancy.https://journals.co.za/journal/medogam2022Obstetrics and Gynaecolog