Breastfeeding and female labor force participation: the probability of survival of children in Nepal under 3 years old.

BACKGROUND: The number of breastfeeding mothers participating in a labor force to generate income has been increasing in Nepal. In this regard, the study aims to assess the survival of Under 3 children in Nepal from the mother based on their labor force participation and breastfeeding status. METHODS: Data for the study were obtained from the Nepal Demographic and Health Survey 2016. The sample size of the study was 2,994 live births children, born in the last three years prior to the day of the interview. The robust hazard ratio and cox proportional hazard regression were conducted between dependent and independent variables with 95% confidence intervals (CIs) to conclude. RESULTS: From a total of 2,994 live births, 85 children died within 36 months of birth. More than 80% of the non-working mothers were breastfeeding their children. The findings shows that the survival of children under-3 is positively associated with the interaction with the mother's work and breastfeeding status (Hazard Ratio 0.428, 95% CI 0.24, 0.75), family structure (Hazard Ratio 1.511; 95% CI 1.37, 1.655), relationship with the household head (Hazard Ratio 0.452; 95% CI 0.311, 0.65), wealth quintiles (Hazard Ratio 0.390; 95% CI 0.33, 0.46), caste (Hazard Ratio 0.652; 95% CI 0.60, 0.69), and religion (Hazard Ratio 2.015; 95% CI 1.09, 3.70) with model CI 95%, Log pseudo likelihood = -521.39236, prob. χ2 = 0.005 and time at risk = 52,748. CONCLUSIONS: The highest rate of child survival was from the working mothers as well as continuing breastfeeding their children followed by mothers breastfeeding the child but not working, compared to mothers working but not breastfeeding the child, and mothers who were neither working nor breastfeeding their children respectively. This study provides clear evidence that breastfeeding is very important for the probability of survival of the child aged below 36 months and work of mother also have some positive impact on child survival. Employers should be encouraged to have a breastfeeding policy in the workplace through the establishment of a breastfeeding facility, and a flexible work schedule. At the same time government should also regulate the paid maternity leave and encourage societal support for the breastfeeding mothers.

Assessment of dental malocclusion and soft-tissue features among children with special needs in the Western UP region: A cross-sectional study.

Aims: Assessment of dental malocclusion and soft-tissue features among children with special needs and their correlation with normal children. Subjects and Methods: A cross-sectional study was carried out among 128 children (63 special health-care needs children and 65 normal children), between 8 and 18 years of age. Two special schools (Vatsalya and Jeevandhara) were included in the study for case group and two local schools (one government and one private) were included in the study for control group. Index of Orthodontic Treatment Need was used to measure the malocclusion. To assess and compare various facial features, extra-oral photographs were taken from two different views (frontal and side). Statistical Analysis Used: Data were analyzed using ANOVA and Chi-square test, with keeping level of significance at P < 0.05. Results: The result of the present study demonstrated a significant difference between the study and control group with respect to overjet, caries, stains and calculus, soft-tissue facial profile, lip competency, and Korkhaus lip step. Soft-tissue comparison demonstrated facial asymmetry; lip incompetency was more prevalent in the study group compared to the control group. Overall, it was concluded that malocclusion was more prevalent in the study group compared to their counterparts. Conclusions: Malocclusion was more prevalent in children with disability compared to their counterparts. On clinical examination, a significant difference in relation to overjet, caries and stains, and calculus was observed, whereas a significant difference on soft-tissue examination was observed in facial profile, lip competency, and Korkhaus lip step in the study group compared to normal children.

Proximal radioulnar synostosis following Monteggia fracture-dislocation: a case report.

Introduction and importance: Radioulnar synostosis is a rare complication of a forearm fracture that restricts pronation-supination. This study presents a case of proximal radioulnar synostosis in an adult male after Monteggia fracture-dislocation who had a loss of pronation and supination movements. Case presentation: Herein, we report a case of proximal radioulnar synostosis in a 43-year-old man who presented with loss of pronation and supination of the right forearm that restricted his daily activities. He had a history of Monteggia fracture-dislocation 9 months back, which was managed with open reduction and internal fixation with a dynamic compression plate. Plain radiography and computed tomography of the right forearm after 9 months of operation showed an implant in situ with proximal radioulnar synostosis. Implant removal was performed and the excess fibro-osseous connection in the proximal radius and ulna was removed. Clinical discussion: Forearm injuries that affect the interosseous membrane may result in radioulnar synostosis. Trauma and treatment-related factors increase the risk of radioulnar synostosis. The fibro-osseous fusion between the forearm bones restricts the pronation and supination movements. Conclusion: Loss of pronation-supination following forearm fracture should raise suspicion of radioulnar synostosis.

Comparative analysis of craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders: a cross-sectional study.

Objectives: The aim of the study was to quantify and compare craniofacial asymmetry in subjects with and without symptoms of temporomandibular joint disorders (TMDs). Materials and Methods: A total of 126 adult subjects were categorized into two groups (63 with a TMDs and 63 without a TMDs), based on detection of symptoms using the Temporomandibular Joint Disorder-Diagnostic Index (TMD-DI) questionnaire. Posteroanterior cephalograms of each subject were traced manually and 17 linear and angular measurements were analyzed. Craniofacial asymmetry was quantified by calculating the asymmetry index (AI) of bilateral parameters for both groups. Results: Intra- and intergroup comparisons were analyzed using independent t-test and Mann-Whitney U test, respectively, with a P<0.05 considered statistically significant. An AI for each linear and angular bilateral parameter was calculated; higher asymmetry was found in TMD-positive patients compared with TMD-negative patients. An intergroup comparison of AIs found highly significant differences for the parameters of antegonial notch to horizontal plane distance, jugular point to horizontal plane distance, antegonial notch to menton distance, antegonial notch to vertical plane distance, condylion to vertical plane distance, and angle formed by vertical plane, O point and antegonial notch. Significant deviation of the menton distance from the facial midline was also evident. Conclusion: Greater facial asymmetry was seen in the TMD-positive group compared with the TMD-negative group. The mandibular region was characterized by asymmetries of greater magnitude compared with the maxilla. Patients with facial asymmetry often require management of temporomandibular joint (TMJ) pathology to achieve a stable, functional, and esthetic result. Ignoring the TMJ during treatment or failing to provide proper management of the TMJ and performing only orthognathic surgery may result in worsening of TMJ-associated symptoms (jaw dysfunction and pain) and re-occurrence of asymmetry and malocclusion. Assessments of facial asymmetry should take into account TMJ disorders to improve diagnostic accuracy and treatment outcomes.

Glaucoma Screening in Family Members of Glaucoma Patients at a Tertiary Eye Hospital in Eastern Region of Nepal.

INTRODUCTION: The second most common cause of blindness in the world is glaucoma. Family history plays an important role in early detection and management of patients with glaucoma. The main objective of this study was to determine the prevalence of glaucoma in first degree relatives of Primary open angle glaucoma (POAG) and Primary angle closure glaucoma (PACG) patients. Glaucoma awareness among the first degree relatives was also assessed. MATERIALS AND METHODS: A  cross sectional hospital based study was designed to examine and diagnose glaucoma among first degree relatives of patients with POAG and PACG, attending the outpatient department at Ramlal Golchha Eye Hospital in the Eastern region of Nepal from June 2016 to May 2017. A comprehensive eye examination was conducted by a glaucoma specialist at the hospital. All subjects underwent vision screening, refraction, slit lamp biomicroscopy, intraocular pressure (IOP) measurement, gonioscopy and a dilated fundus examination. All glaucoma suspects and those diagnosed with glaucoma were enrolled for visual field examination. RESULTS:  Two hundred and twenty-seven first degree relatives of 72 patients were invited for the examination. Out of 227 individuals, 131 (males 67.94%, females 32.06%) agreed to participate in the study. A total of 23 (17.56%) individuals were diagnosed with glaucoma, 10 (43.47%) as POAG and 13 (56.52%) as PACG. Fourteen percent of parents, 22% of siblings and 9% of off-springs had open angle glaucoma. Among 13 PACG participants, 26.08% of parents, 26.08% of siblings and 4.34% of off-springs had angle closure glaucoma. Awareness among first degree relatives diagnosed with glaucoma was 21.74%. CONCLUSION:  The prevalence of glaucoma among first degree relatives of glaucoma patients was higher than individuals without family history of glaucoma. Promoting awareness on glaucoma and the timely screening of family members can lead to early detection and prevention of blindness from the disease. .

A missed medial humeral epicondyle fracture with incarcerated fragment in the elbow joint and ulnar nerve palsy: A rare case report.

Medial epicondyle fracture associated with incarcerated intra-articular fragment and ulnar nerve palsy is uncommon and frequently missed. We report a case of 13-year-old boy with incarcerated medial epicondyle fracture fragment in ulnohumeral joint and ulnar nerve palsy, which was managed successfully by open reduction internal fixation and ulnar nerve transposition.

Case Report on Surgery-First Approach.

The Rationale: The surgery-first approach provides immediate improvement in facial aesthetics in orthognathic cases with a shorter total treatment period. Patient Concerns: A 21-year-old male came with the chief complaint of protrusive lower front teeth and a large lower jaw. His main concern was aesthetics. Diagnosis: This was a case of skeletal Class III malocclusion with reverse overjet of 4 mm, overbite of 6 mm with a concave profile, and a protrusive chin. Treatment: The patient was treated by bilateral sagittal split setback osteotomy of the mandible with surgery first approach via nonextraction therapy. Outcome: After an active treatment of 15 months, improved facial profile, facial proportions, and a significant reduction of mandibular prognathism were much appreciated. The treatment results were stable after a 1-year follow-up of the treatment. Take-away Lesson: This case report highlights the utilization of nature's dental decompensation to achieve a desirable result, thereby attaining "more with less."

Comparison between Conventional, Game-based, and Self-made Storybook-based Oral Health Education on Children's Oral Hygiene Status: A Prospective Cohort Study.

INTRODUCTION: Dental caries is the most widespread disease affecting children worldwide. The reason for this increased prevalence is the use of more processed foods and beverages with the addition of refined sugars. General health affects oral health and its maintenance is of great importance. Lifestyle modifications and habits are formed at an early age therefore health education plays an important role in educating them about the prevention of problems related to oral health. Hence, the aim of this study was to assess and compare the effectiveness of conventional method, game-based and storybook-based oral health education on the oral hygiene status among 7-12-year-old schoolchildren. PURPOSE: To assess and compare the effectiveness of conventional method, game-based and storybook-based oral health education on the oral hygiene status among 7-12-year-old schoolchildren. MATERIALS AND METHODS: A total of 300 children aged 7-12 years were divided into 3 groups. Each group had 100 children which were randomly assigned to each of the three groups. In group I, oral health education with the help of conventional method using educative posters was given to children once daily for a week. In group II, oral health education was imparted to children through play method (i.e., snakes and ladders game combined with flash cards) followed by group III, in which children were given education through self-made storybooks. The oral hygiene of all the children was estimated through Oral Hygiene Index-Simplified Debris (DI-S) score at day 1 and after 3 months after intervention. RESULTS: In group III, storybooks showed maximum reduction in debris score which was found to be highly statistically significant followed by game based (group II) and conventional method (group I) of oral health education. CONCLUSION: The reduction in debris score was seen maximum in group III (storybooks). Hence, the use of storybooks should be encouraged for educating children regarding basic oral health concepts. CLINICAL SIGNIFICANCE: There is important need to understand differences in the mental cognitive ability of the children at different ages and the need to develop different intervention programs for different age-groups. Rationalizing reading can be an intelligent initiative toward the development of good oral habits and transforming the outlook of oral healthcare system in years to come. HOW TO CITE THIS ARTICLE: Sharma S, Saxena S, Naik SN, et al. Comparison between Conventional, Game-based, and Self-made Storybook-based Oral Health Education on Children's Oral Hygiene Status: A Prospective Cohort Study. Int J Clin Pediatr Dent 2021;14(2):273-277.

Orthopedic Implant Removal in the Department of Orthopedics of a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Implant removal surgery is one of the common surgical procedures done in orthopedics. Studies report that a major portion of orthopedic surgeries carried out in different institutions comprises implant removal procedures. This can be challenging in limited manpower and infrastructure availability scenarios, like in developing countries like Nepal. This study aims to study the prevalence of orthopedic implant removal procedures carried out among overall surgical procedures in the orthopedic department of a tertiary care center in Nepal. METHODS: A descriptive cross-sectional study was performed on the medical records of the department of orthopedics of a tertiary care center after approval from the institutional review committee. The data included records from the starting of 2018 to the end of 2019. Data related to the number of implant removal procedures, types of implants, indications, fracture sites, anesthesia use, gender and age distribution were studied. Statistical Package for Social Sciences version 20 was used to study descriptive data. RESULTS: Out of 2557 orthopedic operations carried out in the study duration, 458 (17.91%) of implant removal procedures were done in the department. The most common age group was the young adult age group, 255 (55.68%). Medium-sized implants were the commonly removed ones, 337 (73.58%). Elective procedures were the most common indication, 369 (80.57%). CONCLUSIONS: Implant removal procedures cover a major fraction of overall orthopedic operations carried out by the department, most of which are elective procedures. In limited-resource settings, this can be challenging, and a proper evaluation with counseling could be done before implant removal surgery.

Calcific Tendinitis in the Elbow Presented as Acute Tennis Elbow.

Calcific tendinitis occurs frequently in shoulder and hip region. Its occurrence in elbow joint is frequently misdiagnosed because of its rare incidence and similar clinical presentation with other acute conditions of elbow like trauma, infection and tennis elbow. Characteristic symptoms of this condition are acute onset of pain, tenderness and swelling on the lateral aspect the elbow. Plain Radiograph is the primary modality to distinguish and evaluate this condition. Awareness and familiarity with this condition helps in early diagnosis and avoids unnecessary treatments and biopsy as this condition is self-limited. Keywords: Calcific tendinitis; self-limited; tennis elbow.

Radial Head Dislocation with Ipsilateral Proximal Shaft of Radius Fracture: A Case Report.

Radial head dislocations are uncommon in adults. They are commonly seen in children and are generally associated with proximal ulna fracture. Radial head dislocation with associated proximal radial shaft fracture is rarer than isolated radial head dislocation in adults. Due to the rarity of this complex injury, in the absence of keen observation and meticulous attention, the correct diagnosis might be missed leading to unsatisfactory management and related complications. Here, a similar case of radial head dislocation with associated proximal radial shaft fracture has been presented.

Review of Subaxial Cervical Spine Injuries Presenting to a Tertiary-Level Hospital in Nepal: Challenges in Surgical Management in a Third World Scenario.

STUDY DESIGN: Epidemiological retrospective study. OBJECTIVE: To describe the demographics, timing to surgery, delay, short-term neurological recovery, and complications in surgically treated subaxial cervical trauma in a resource-constrained country. METHODS: Thirty consecutive subaxial cervical trauma patients presenting to a trauma hospital in Nepal between December 2015 and August 2017 were analyzed as a retrospective cohort. Patients were segregated into 4 groups based on the timing to surgery: within 2 days, 3 to 7 days, 8 to 30 days, and >31 days. RESULTS: There were 27 male and 3 female patients with mean age 40 years. Twenty-four sustained fall injury, and 27 patients were from outside Kathmandu. No patients were treated within the first 48 hours; only 9 were treated between 3 and 7 days, 16 between 8 and 30 days, and 5 a month later. Major delay was finance and operating room availability. Thirteen patients had a C6C7 involvement followed by C5C6 in 6 patients. Seven patients had complete neurological deficit while 18 patients had incomplete deficit. A total of 46.7% improved their neurology in 6 months. No neurological recovery was observed in complete deficit patients. CONCLUSION: Seventy percent of our patients were treated longer than 1 week after injury, which would likely be considered unacceptable in most first world countries. As expected, the outcomes for many of these patients were far worse than reported in North American centers with early access to medical care and insurance. Despite this, nearly half of our patients improved neurologically following treatment; hence, surgery holds hope of some restoration of neurologic deficits.

Shear Bond Strength of Ceramic Brackets with Different Base Designs: Comparative In-vitro Study.

INTRODUCTION: Knowledge about the Shear Bond Strength (SBS) of ceramic brackets with different base design is essential as it affects bond strength to enamel. AIM: The aim of the present study was to evaluate and compare the effect of base designs of different ceramic brackets on SBS, and to determine the fracture site after debonding. MATERIALS AND METHODS: Four groups of ceramic brackets and one group of metal brackets with different base designs were used. Adhesive precoated base of Clarity Advanced (APC Flash-free) (Unitek/3M, Monrovia, California), microcrystalline base of Clarity Advanced (Unitek/3M, Monrovia, California), polymer mesh base of InVu (TP Orthodontics, Inc., La Porte, IN, United States), patented bead ball base of Inspire Ice (Ormco, Glendora, California), and a mechanical mesh base of Gemini Metal bracket (Unitek/3M, Monrovia, California). Ten brackets of each type were bonded to 50 maxillary premolars with Transbond XT (Unitek/3M). Samples were stored in distilled water at room temperature for 24 hours and subsequently tested in shear mode on a universal testing machine (Model 3382; Instron Corp., Canton, Massachusetts, USA) at a cross head speed of 1mm/minute with the help of a chisel. The debonded interface was recorded and analyzed to determine the predominant bond failure site under an optical microscope (Stereomicroscope) at 10X magnification. One way analysis of variance (ANOVA) was used to compare SBS. Tukey's significant differences tests were used for post-hoc comparisons. The Adhesive Remnant Index (ARI) scores were compared by chi-square test. RESULTS: Mean SBS of microcrystalline base (27.26±1.73), was the highest followed by bead ball base (23.45±5.09), adhesive precoated base (20.13±5.20), polymer mesh base (17.54±1.91), and mechanical mesh base (17.50±2.41) the least. Comparing the frequency (%) of ARI Score among the groups, chi-square test showed significantly different ARI scores among the groups (χ2 = 34.07, p<0.001). CONCLUSION: Different base designs of metal and ceramic brackets influence SBS to enamel and all were clinically acceptable.

Assessment of Corticotomy Facilitated Tooth Movement and Changes in Alveolar Bone Thickness - A CT Scan Study.

INTRODUCTION: Corticotomy is an effective method of accelerating the orthodontic treatment. The aim of this study was to compare the treatment time for the extraction space closure, between corticotomy assisted and conventional orthodontic tooth movement and to check the alveolar bone thickness before and after corticotomy procedure in the corticotomy group. SETTINGS AND DESIGN: Cross-sectional clinical study. MATERIALS AND METHODS: Twenty patients (age>15 y) requiring orthodontic treatment with upper anterior retraction in the extraction space of 1(st) premolar were selected and were randomised into control and corticotomy group each group consisted of 10 subjects. Pre retraction, corticotomy was performed in the maxillary anterior segment. The pre and post retraction CT scans were recorded and the thickness of the alveolar plates were measured at crestal level (S1), mid root level (S2) and apical level (S3) PreTreatment (T1). The same measurements were repeated after incisor retraction was completed PostTreatment (T2). STATISTICAL ANALYSIS: Student's t-test, Pearson correlation coefficient. RESULTS: There was a significant difference in retraction time (days) between control and corticotomy groups (p<0.001). Also, there were significant difference in total alveolar bone thickness at the crest region for all the four incisor teeth (p<0.05). A significant difference was observed in total alveolar bone thickness at the S2 and S3 level for 11, 21 and 11, 12 and 22 (p<0.05) respectively. CONCLUSION: Alveolar corticotomies not only accelerates the orthodontic treatment but, also provides the advantage of increased alveolar width to support the teeth and overlying structures.