Introduction: Chronic kidney disease (CKD) is associated with periodontal disease due to its hyperinflammatory state. Limited studies have explored the prevalence of periodontal disease among CKD patients in Malaysia. Objective: To assess the periodontal status of pre-dialysis CKD patients in Hospital Universiti Sains Malaysia. Methods: A total of 46 pre-dialysis CKD patients who attended the nephrology clinic at Hospital Universiti Sains Malaysia were enrolled in this study. Periodontal examination was performed using the periodontal probing depth (PPD), clinical attachment loss (CAL) and plaque index. Results: The majority of the CKD patients were Malay (95.7%) and 80.4% were males. The mean age of the patients was 58.5 years. Using PPD measurement, 37 (74.0%) of the patients had mild periodontitis, 9 (20.0%) had moderate periodontitis and 3 (6.0%) had no periodontitis. Based on CAL measurement, 12 (26%) patients had mild periodontitis, 29 (63.0%) had moderate periodontitis and 5 (11%) had severe periodontitis. The mean (standard deviation [SD]) value of mild and moderate-to-severe periodontitis by PPD measurement were 4.26 (0.26) and 5.24 (0.36), respectively. The mean of mild and moderate-to-severe periodontitis by CAL measurement were 2.66 (0.62) and 4.98 (0.73), respectively. There was no correlation between the periodontal parameters and estimated glomerular filtration rate (PPD: r = −0.160, P = 0.914; CAL: r = −0.135, P = 0.372; plaque index: r = 0.005, P = 0.974). Conclusion: This study revealed a greater prevalence and severity of chronic periodontitis among CKD patients. Thus, the periodontal health of CKD patients' needs to be screened and monitored.

Objective. The aim of this systematic review was to evaluate the effectiveness of laser application in temporomandibular joint disorder. Methods. PubMed, SCOPUS, Science Direct, Web of Science, and Google Scholar electronic databases were searched systematically with restricting the languages to only English and year (January 2001 to March 2020), and studies were selected based on the inclusion criteria. Study quality and publication bias were assessed by using the Robvis, a software package of R statistical software. Results. This systematic review included 32 studies (1172 patients) based on the inclusion and exclusion criteria. Most of the studies reported significant reduction of pain by the use of the laser during TMD treatment. Two-thirds of the study (78.13%) found a better outcome comparing with conventional one. According to Robvis, 84.4% of the studies were high methodological studies with low risk of bias. Conclusion. TMD patients suffer with continuous pain for long time even after conventional treatment. Laser therapy shows a promising outcome of pain reduction for TMD patients. Therefore, laser therapy can be recommended for the TMD patients’ better outcome. This trial is registered with PROSPERO (CRD42020177562).

Numerous studies have been conducted in the previous years with an objective to determine the ideal biomarker or set of biomarkers in temporomandibular disorders (TMDs). It was recorded that tumour necrosis factor (TNF), interleukin 8 (IL-8), IL-6, and IL-1 were the most common biomarkers of TMDs. As of recently, although the research on TMDs biomarkers still aims to find more diagnostic agents, no recent study employs the biomarker as a targeting point of pharmacotherapy to suppress the inflammatory responses. This article represents an explicit review on the biomarkers of TMDs that have been discovered so far and provides possible future directions towards further research on these biomarkers. The potential implementation of the interactions of TNF with its receptor 2 (TNFR2) in the inflammatory process has been interpreted, and thus, this review presents a new hypothesis towards suppression of the inflammatory response using TNFR2-agonist. Subsequently, this hypothesis could be explored as a potential pain elimination approach in patients with TMDs.

BackgroundStroke is one of the leading causes of mortality and morbidity in Malaysia. Repetitive transcranial magnetic stimulation (rTMS) is one of the new non-invasive modality to enhance the motor recovery in stroke patients.ObjectivesThis pilot study compared the motor evoked potential (MEP) changes using different settings of rTMS in the post-ischemic stroke patient. The goal of the study is to identify effect sizes for a further trial and evaluate safety aspects.MethodsEight post-stroke patients with upper limb hemiparesis for at least six months duration were studied in a tertiary hospital in Northeast Malaysia. Quasi experimental design was applied and the participants were randomised into two groups using software generated random numbers. One of the two settings: i) inhibitory setting, or ii) facilitatory setting have been applied randomly during the first meeting. The motor evoked potential (MEP) were recorded before and after application of the rTMS setting. A week later, a similar procedure will be repeated but using different setting than the first intervention. Each patient will serve as their own control. Repeated measures ANOVA test was applied to determine the effect sizes for both intervention through the options of partial eta-squared (η2p).ResultThe study observed large effect sizes (η2p > 0.14) for both rTMS settings in the lesion and non-lesion sides. For safety aspects, no minor or major side effects associated with the rTMS was reported by the participants.ConclusionsThe partial eta square of MEP value for both rTMS settings (fascilitatory and inhibitory) in both lesion and non-lesion sides represents large effect sizes. We recommend further trial to increase number of sample in order to study the effectiveness of both settings in ischemic stroke patient. Our preliminary data showed both settings may improve the MEP of the upper extremity in the ischemic stroke patient. No significant improvement noted when comparing both settings.

Background This study was aimed to determine the levels of salivary receptor activator of NF-κB ligand (RANKL) and osteoprotegerin (OPG) and its association with periodontal status among periodontitis patients. Patients and Methods A cross-sectional study was designed and performed at the Dental Clinic, Hospital Universiti Sains Malaysia (HUSM). Random sampling was employed to identify 88 participants into three groups: 30 mild periodontitis, 30 moderate to severe periodontitis, and 28 healthy (nonperiodontitis) patients. Periodontal parameters: periodontal pocket depth (PPD), clinical attachment level (CAL), plaque score (PS), and gingival bleeding index (GBI) were recorded. In total, 4 mL of unstimulated whole saliva was collected to determine the levels of salivary RANKL and OPG proteins by using ELISA technique. Data were analyzed by using SPSS software version 24.0. Results Mean values for PPD (5.3 ± 0.5) and CAL (5.6 ± 0.5) were observed higher for moderate to severe periodontitis as compared with values (4.4 ± 0.2) (4.5 ± 0.2) in mild periodontitis patients. The mean salivary RANKL and OPG was 0.23 ± 0.07 ng/mL and 1.78 ± 0.70 ng/mL respectively in moderate to severe periodontitis. Only salivary RANKL levels were significantly and positively correlated with all the clinical periodontal parameters. Conclusion The levels of salivary RANKL were higher as opposed to lower OPG levels in periodontitis patients in contrast to healthy (nonperiodontitis) patients. RANKL levels were significantly associated with the periodontal parameters. Therefore, we can conclude that RANKL can potentially aid as an adjunctive diagnostic protein in evaluating periodontal disease.

Introduction: Oral cancer is a life-threatening disease. Lack of public awareness is a potent barrier for the early detection of oral cancer, especially for high-risk populations.Objective: This study aimed to determine the awareness and knowledge of the signs, symptoms and risk factors of oral cancer among a Siamese ethnic group in Tumpat, Kelantan. Methods: A cross-sectional study was conducted, using a guided questionnaire on sociodemography, habits, awareness and knowledge of the signs, symptoms and risk factors of oral cancer. Individuals under 18 years old and who had been diagnosed with oral cancer were excluded from this study.Results: A total of 195 respondents participated, 61.5% were female and the mean age was 46 (1.64). About 41% of the respondents had received secondary education and 35.4% were illiterate. Most respondents were self-employed (21.5%), followed by farmers (19.5%) and housewives (20%). The majority of them had a monthly income that fell below the poverty level of RM 830 (76.9%). Among the respondents, 22.6% had the habit of smoking, 25.6% consumed alcohol, 8.2% were betel quid chewers and 2.6% chewed tobacco. Out of 195 respondents, only 6.7% were aware of oral cancer. About 16.9% of the respondents correctly answered all of the questions regarding the signs and symptoms of oral cancer and only 4.1% knew the risk factors of oral cancer.Conclusion: The awareness and knowledge of oral cancer in this targeted population were unsatisfactory. Future effective health promotion programs and education should be emphasised.

Temporomandibular disorders (TMDs) are a type of idiopathic orofacial pain. Inflammation, particularly elevated circulating levels of high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8), has been linked to pain symptoms. The purpose of this study was to compare hs-CRP, IL-6, and IL-8 biomarkers and pain intensity with different treatment strategies (LLLT, standard conservative treatment, and combination) for TMD patients. Methods: A total of 32 participants were randomly included in the study and divided into three groups (Group I, Group II, and Group III) referred from the Dental Clinic, School of Dental Science, HUSM. Patients received LLLT (Groups II and III) in five sessions for the duration of 10 days. Patients in Groups I and III received standard conservative TMD treatment (diet and stress counseling, jaw exercises, physical therapy, which was a hot towel application) by the principal investigator. All blood samples for biomarkers were performed before starting treatments and directly after finishing the treatment protocols, where all results were recorded. Results: The result showed a significant difference in the mean IL-8 (p = 0.001) between the three intervention groups (LLLT, standard treatment, and combined treatment). IL-6 showed an increase in the mean of IL-6 levels from baseline to post-treatment with a better mean in the LLLT treatment group without any significant differences. Additionally, there were no significant mean differences found between the groups and in the group for the hs-CRP biomarker. Conclusions: A statistically non-significant difference was found in hs-CRP and IL-6 before and after LLLT, conservative, and combined treatment strategies of TMD. A statistically significant difference was observed in the mean levels of IL-8 between the LLLT intervention group and the combined treatment group. Although there was no statistically significant correlation between pain intensity and biomarkers, a statistically significant difference was found in pain intensity before and after LLLT, conservative, and combined treatment strategies. TMJ degeneration could be exacerbated by elevated IL-8 levels. Thus, this can be an important biomarker to mark or identify the painful condition of TMJ.

Objectives: Acute appendicitis is one of the most common surgical emergencies. Perforated appendicitis can result in increased morbidity and mortality. Thus, early identification of perforation can reduce the impact on patient and improve outcome. Apart from total white cell count (TWCC), serum total bilirubin (SB) has been shown to indicate perforation in appendicitis. The aim of this study was to assess the usefulness of serum total bilirubin (SB) as the preoperative indicator for perforated appendicitis. Materials and Methods: This was a retrospective study of all appendicectomies cases done in Hospital Universiti Sains Malaysia (HUSM) over a one-year period in 2014. Only patients with histopathologically confirmed appendicitis with available liver function tests and total white blood cell count preoperatively were included in the study. These appendicitis cases were further divided into perforated and non-perforated based on histopathological reports obtained. Results: A total of 245 patients had appendicectomy done in 2014 between January to December 2014. Out of 110 from these 245 patients met the inclusion and exclusion criteria. SB was significantly higher (p<0.001) in patients with perforated appendix compared to non-perforated. Conclusion: In conclusion, this study showed that preoperative SB is a useful laboratory parameter for perforated appendicitis to improve clinical decision-making by the clinician. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.233-237