Medical Research Council of South Africa.

Background Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0•7 per 100 000 population (IQR 0•2-2•0). Maternal mortality was 20 (0•5%) of 3684 patients (95% CI 0•3-0•8). Complications occurred in 633 (17•4%) of 3636 mothers (16•2-18•6), which were predominantly severe intraoperative and postoperative bleeding (136 [3•8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4•47 [95% CI 1•46-13•65]), and perioperative severe obstetric haemorrhage (5•87 [1•99-17•34]) or anaesthesia complications (11•47 (1•20-109•20]). Neonatal mortality was 153 (4•4%) of 3506 infants (95% CI 3•7-5•0). Interpretation Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.

The self-reported stress in the dental environment is still high and the stressors seem to be comparable amongst the participating countries. Effective management programmes are needed to minimise dental environment stress.

Determination of the occlusal vertical dimension (OVD) is an integral part of complete dentures fabrication. Due to the lack of teeth, the clinician faces the challenge of how to accurately establish the OVD of the new denture. Therefore, the purpose of this review article was to present, discuss and critique the available methods used in determining the OVD for complete dentures patients. This review identified two main streams to determine the OVD: (i) pre-extraction methods and (ii) post-extraction methods. For the pre-extraction methods, the OVD of the natural dentition is transferred to the new dentures mainly by intra-oral measurements, profile tracing and cephalometric analysis. The post-extraction methods rely on mandibular rest position, facial aesthetic appearance, swallowing pattern, craniofacial landmarks measurements, cephalometric analysis, phonetics and existing dentures. In general, all the available techniques have merits and are helpful for routine clinical use. However, they are empirical in nature, controversial and lack the scientific support. Further, there is no single accurate method for OVD determination. To overcome the limitations of the techniques, the clinician will benefit from applying combination of techniques to approximate the OVD.

AimThis study aimed at evaluating the perceived stress and its sources among undergraduate dental students at Jazan University, Saudi Arabia.Materials and MethodsIn this cross-sectional study, the data were collected using the DES questionnaire. The overall score of stress and scores by individual domains were described and analyzed by different grouping factors: gender, study level, marital status and GPA.ResultsA total of 366 dental students agreed to take a part in this study. Up to 57% of the participants were females. The overall DES score was 1.67 ± 0.45. Female students and married students scored higher stress levels than their counterparts. Stress increased significantly among students as their educational level increased. Inversely, the stress levels were lower in participants with high GPA. Multiple linear regression analyses revealed that “Study level” and “Gender” were significant independent determinants of overall DES and, also, most of the stress domains. Forty one percent of the variability in DES score can be explained by these determinants.ConclusionDES among dental students in Jazan University is moderate and slightly higher. It is higher among females and increases significantly with study progression. However, students who had higher GPA showed lower levels of stress.Clinical significanceReduction and/or relief of stress among dental students will reflect positively on persistence and academic achievement, which will lead to better management and care of patients.

BackgroundMaxillary defects predispose patients to different undesirable effects. The aim of this study was to assess the quality of life (QoL) of patients with maxillary defects (acquired/congenital) wearing obturators.MethodsThe study comprised 30 patients aged between 16 and 78 years. Interviews were conducted to collect information pertaining to patients; sociodemographic, self-reported function of obturator using Obturator Functioning Scale (OFS), self-evaluation of general health using Visual Analogue Scale (VAS), radiotherapy treatment, salivary gland removal, reconstructive surgery, neck dissection and length of time obturators were worn. Clinical examination included type of maxillectomy, Aramany classification of the defect, and evaluation of obturator function using the Kapur retention and stability scoring system.ResultQuality of life was affected significantly by marital status (P = 0.026). Married patients had better quality of life 61.3%, followed by divorced patients 38.8%, widowed 37.3% and the least QoL was detected in single patients 36.5%. Significant association between the type of maxillectomy and QoL was detected (P = 0.002). Retention of obturator prosthesis had a highly significant association with QoL (P < 0.001). Type of maxillectomy had a significant relation with obturator retention (P = 0.005). Stability had a significant correlation with QoL (P = 0.022). Obturator wearers who were treated with radiotherapy had lower QoL than those who were not treated with radiotherapy.ConclusionRehabilitation of patients with maxillary defects using obturator prosthesis is an appropriate and not invasive treatment modality. Results support that good obturators contribute to a better life quality.

ObjectivesThe present systematic review assessed the efficacy of aloe vera mouthrinse on plaque and gingival inflammation.MethodsA comprehensive search of PubMed, EMBASE, Scopus and Web of Science was conducted in February 2018 to identify all relevant studies using the following keywords: aloe vera, gingivitis, gingival inflammation, plaque‐induced gingivitis, periodontal health and plaque control. The eligibility criteria were all randomized clinical trials that assessed the efficacy of aloe vera mouthrinse in comparison to chlorhexidine on plaque and gingivitis. The risk of bias of the included studies was assessed using the Cochrane risk of bias assessment tool.ResultsSix randomized clinical trials comprising 1358 subjects were included in this systematic review. All included studies showed that aloe vera was effective in reducing plaque and gingival inflammation. Four studies found aloe vera as effective as chlorhexidine in reducing plaque scores, while two studies found chlorhexidine significantly more effective than aloe vera. With regard to gingival inflammation, three studies showed comparable results between aloe vera and chlorhexidine, while one study showed better results with chlorhexidine. Moreover, the results showed that aloe vera had no or very minimal side effects compared to chlorhexidine, which showed significant side effects including stains and altered taste sensation.ConclusionThe available evidence remains inconclusive but suggests that aloe vera mouthwash is comparable to chlorhexidine in reducing gingival inflammation but inferior to chlorhexidine in reducing plaque. These findings are preliminary and further high‐quality studies with adequate sample sizes are highly recommended.

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. Clinical trial registration: NCT03044899.