Informed Consent in Adult Psychiatry

Ahmed Bait Amer*

Abstract

This article addresses some of the groundwork of informed consent in people with mental illness whose decision-making capacity has obviously been compromised. This article examines four crucial aspects in particular, namely: i) the main elements of informed consent; ii) difficulties pertaining to psychiatric illnesses; iii) the effect of psychiatric disorders on the patient’s capability; iv) how to assess situations in which consents may not be required.

Keywords: Informed consent; Adult psychiatry; Voluntarism; Competency; Psychiatric disorders; Assessment; Ethical dilemma.

Diagnostic Utility of Coeliac Disease: A Descriptive Study in a Tertiary Care Hospital, Oman

Safana Salim Al Saidi,¹ Salim Omar Al Harthi,² and Waad-Allah Sharef Mula-Abed^3*

Abstract

Objectives: The prevalence of coeliac disease in Oman is unknown. We aim to estimate the prevalence of coeliac disease in at-risk subjects, describe the clinical characteristics and laboratory findings associated with coeliac disease and the validity of serological testing for coeliac disease at the Royal Hospital, Oman over a period of three years.

Methods: This is a retrospective case finding study. The medical and laboratory records were reviewed for patients for whom serum antiendomysium IgA antibodies were requested at the Royal Hospital during a 3-year period (1^st Jan 2006-31^st Dec 2008). The data were extracted in order to assess the following: a) Prevalence rate of coeliac disease among at-risk subjects; b) Clinical characteristics in patients with coeliac disease and clinical manifestations for which the requesting clinicians considered coeliac disease as a possible diagnosis, including their specialties; c) Laboratory tests results in patients with coeliac disease; and d) Validity of antiendomysium antibodies testing in comparison with histopathology of jejunal biopsies for diagnosing coeliac disease.

Results: The study included 431 patients (250 females, 181 males) who were suspected of having (or screened for) coeliac disease. The median of age was 15 years (range: 9 months-74 years) with mean ± SD 18.95 ± 14.1 years. Of these, 15 (3.5%) patients (10 females, 5 males) with a median age of 19 years and mean 21.4 ± 13.0 years (range: 2.5-38 years), had positive antiendomysium antibodies results with median (range) of 160 (40-320) IU/L and mean± SD 204.5 ± 160 IU/L. Of these 15 patients, 13 had positive jejunal histopathological changes indicative of coeliac disease; the remaining 2 patients had no biopsy examination. Of the 44 patients with negative antiendomysium antibodies <10 IU/L who had jejunal biopsy, 41 were negative and 3 had histopathological changes suggestive of mild coeliac disease. All the 3 patients had serum total IgA levels within the reference range. The calculated validity indicators for antiendomysium antibodies were: sensitivity 81.3%, specificity 100%, positive predictive value 100%, negative predictive value 93.2% and efficiency 94.7%. The most common mode of presentation in patients with coeliac disease was gastrointestinal features, type 1 diabetes mellitus, anemia, short stature and hypothyroidism. The seropositivity in tye 1 diabetics was 4.9%. Investigations for coeliac disease were most frequently made by endocrinologists (pediatric and adult) who accounted for 53.8% followed by gastroenterologists (pediatric and adult) with 40.6% with less consideration by the other clinicians (5.6%).

Conclusion: The availability of highly specific and sensitive serological test and increased awareness for coeliac disease among some medical specialties has increased the number of diagnosed cases of coeliac disease. The requesting for serological test is being made mainly by endocrinologists and gastroenterologists.

Genetic Polymorphism of Cytochrome p450 (2C19) Enzyme in Iranian Turkman Ethnic Group

Robabeh Ghiyas Tabari, Abdoljalal Marjani,* Ogholdondy Agh Ataby, Azad Reza Mansourian, and Nader Mansour Samai

Abstract

Objective: Different findings indicate that CYP2C plays a clinical role in determining interindividual and interethnic differences in drug effectiveness. The ethnic differences in the frequency of CYP2C19 mutant alleles continue to be a significant study topic. The aim of the present study was to assess the frequency of allelic variants of CYP2C19 in Turkman ethnic groups and compare them with the frequencies in other ethnic populations.

Methods: The study group included 140 unrelated healthy ethnic Turkman subject referred to the Health Center. Genotyping of CYP2C19 alleles (CYP2C19*1, CYP2C19*2, and CYP2C19*3 alleles) was carried out by Polymerase Chain Reaction-Restriction Fragment Length Polymorphism technique

Results: The allele frequency of CYP2C19*1, CYP2C19*2 and CYP2C19*3 were 56.43%, 23.57% and 20%, respectively. The result also showed that 39.7% of subjects expressed the CYP2C19*1/*1 genotype. While 42.1%, 9.3%, 9.3% and 1.4% expressed CYP2C19*1/*2, CYP2C19*1/*3, CYP2C19*2/*2 and CYP2C19*3/*3 genotypes, respectively. The genotype CYP2C19*2/*3 was not expressed in this study population. The findings suggested that 10% of subjects were poor metabolizers by expressing CYP2C19*2/*2 and CYP2C19*3/*3 genotypes. Fifty one percent of subjects were intermediate metabolizers having CYP2C19*1/*2, CYP2C19*2/*3 and CYP2C19*1/*3 genotypes and 37.86% were found to be extensive metabolizers expressing CYP2C19*1/*1 genotype. The frequency of intermediate metabolizers genotype was high (51%) in Turkman ethnic groups.

Conclusion: This study showed that the determined allelic variants of CYP2C19 (CYP2C19*2 and CYP2C19*3 mutations) in Turkman ethnic group are comparable to other populations. These findings could be useful for the clinicians in different country to determine optimal dosage and effectiveness of drugs metabolized by this polymorphic enzyme.

Quality of Life after Cesarean and Vaginal Delivery

Seyed Abbas Mousavi,¹ Forough Mortazavi,^2* Reza Chaman,³ and Ahmad Khosravi⁴

Abstract

Objective: Cesarean rates in recent decades have been increasing and a number of studies have shown that cesarean increases maternal morbidities. The aim of this study is to compare the quality of life after cesarean and vaginal delivery.

Methods: This prospective study was carried out on 356 pregnant women visiting urban health centers in Shahroud City, Northeast Iran, in 2011. The subjects completed the quality of life questionnaire in the third trimester of pregnancy and at 8 weeks postpartum.

Results: In primiparas, the mean global QOL scores for the cesarean and vaginal delivery groups were 67.65 ± 12.7 and 72.12 ± 11.8, respectively. Also, the scores for the physical, psychological and social domains of QOL as well as the global score of QOL were higher in the vaginal delivery group than the cesarean group (p<0.05). In the case of primiparas, multiple regression analysis revealed that after adjusting for education, desirability of pregnancy and the General Health Questionnaire score, the delivery type remained as a predictor of the scores for the physical (R²=1.7%; B=-3.826; p=0.031; CI [-7.301, -.350]) and social (R²=2.5%; B=-5.708; p=0.017; CI [-10.392, -1.023]) domains of QOL and the global QOL score (R²=2.6%; B=-4.065; p=0.006; CI [-6.964, -1.164]). While multiparas, there was no relationship between QOL and type of delivery.

Conclusion: In this sample of low-risk women, cesarean negatively affected the QOL of primiparas. More studies with larger sample sizes should be conducted to examine the effects of cesarean on QOL in both primiparas and multiparas within a shorter period after delivery.

Burnout Syndrome in Pediatric Practice

Reem A. Al-Youbi and Mohammed M. Jan*

Abstract

Objectives: Burnout is a common work-related syndrome consisting of emotional exhaustion, depersonalization and diminished feelings of personal accomplishment. Burnout influences the performance and efficiency of the healthcare professionals and therefore the quality of the care provided. This study aims to assess the burnout rates and potential determinants in pediatrics.

Methods: A cross-sectional, descriptive study involving physicians practicing pediatrics in the Jeddah area of Saudi Arabia was conducted utilizing the Maslach Burnout Inventory in addition to questions regarding work-related and lifestyle-related factors.

Results: One hundred and thirty pediatricians (55% females) were included with age ranging between 25 and 45 years (mean: 30). Most (46%) were consultants and 54% practiced in a university based setting. Burnout scores were abnormal in 107 (82%) and in 45 (34%) the syndrome was severe. Males were more likely to reach a severe burnout category compared to females (40% vs. 31%; p=0.012). Academic pediatricians working in a university setting were much more likely to experience severe burnout compared to their counterparts working in other hospitals (50% vs. 19%; p=0.0005). Consultants were also more likely to experience severe burnout compared to residents and assistants (46% vs. 27%; p=0.03).

Conclusion: At least one third of practicing pediatricians suffer from burnout syndrome. Specific strategies should be developed and implemented to limit and prevent professional burnout.

Extracorporeal Shock-wave Lithotripsy Success Rate and Complications: Initial Experience at Sultan Qaboos University Hospital

Mohammed S. Al-Marhoon,* Omar Shareef, Ismail S. Al-Habsi, Ataalrahman S. Al Balushi, Josephkunju Mathew, and Krishna P. Venkiteswaran

Abstract

Objective: To assess the efficacy and safety of extracorporeal shock wave lithotripsy with Modularis Vario Siemens in the management of patients with renal and ureteral stones.

Methods: Between 2007 and 2009, 225 outpatients were treated with Siemens Modularis Vario lithotripter at Sultan Qaboos University Hospital. Stone size, location, total number of shockwaves, stone-free rate, complications and adjunctive interventions were investigated. Chi-Square and Logistic Regression analyses were used, with p<0.05 set as the level of significance.

Results: Of the 225 initial consecutive patients who underwent extracorporeal shock wave lithotripsy, 192 (85%) had renal stones and 33 (15%) had ureteric stones. The mean±SD stone size was 11.3 ± 4.5 mm, while the mean age of the patients was 39.9 ± 12.8 years with 68.5% males. The mean renal stone size was 11.6 ± 4.7 mm; a mean of 1.3 sessions was required. The mean ureteric stone size was 9.9 ± 3 mm; and a mean of 1.3 sessions was required. Treatment success (defined as complete clearance of ureteric stones, stone-free or clinically insignificant residual fragments of <4 mm for renal stones) was 74% for renal stones and 88% for ureteric stones. Additional extracorporeal shock wave lithotripsy and ureteroscopy were the most adjunctive procedures used for stone clearance. Complications occurred in 74 patients (38.5%) with renal stones and 13 patients (39.4%) with uretetric stones. The most common complication was loin pain (experienced by 16.7% with renal stones and 21% with ureteric stones). Severe renal colic mandating admission occurred in 2% of patients with renal stones and 6% of patients with ureteric stones. In patients with renal stone, steinstrasse occurred in 3.6% and infection post extracorporeal shock wave lithotripsy in 0.5%. Using Multivariate Logistic Regression analysis, factors found to have significant effect on complete stone clearance were serum creatinine (p=0.004) and the number of shockwaves (p=0.021).

Conclusion: Siemens Modularis Vario lithotripter is a safe and effective tool for treating renal and ureteric stones.

Prevalence of Celiac Disease in Omani Children with Type 1 Diabetes Mellitus: A Cross Sectional Study

Siham Al-Sinani,^1* Sharef Waadallah Sharef,¹ Saif Al-Yaarubi,¹ Ibrahim Al-Zakwani,² Khalid Al-Naamani,³ Aisha Al-Hajri,¹ and Said Al-Hasani¹

Abstract

Objective: Published studies on the prevalence of celiac disease in type 1 diabetes mellitus from the Arab World are scant. We aim to report the prevalence of celiac disease in Omani children with type 1 diabetes mellitus.

Methods: Children with type 1 diabetes mellitus were prospectively screened for celiac disease, at Sultan Qaboos University Hospital, Muscat, Oman over a period of one year (June 2011 - May 2012). Serum anti tissue transglutaminase IgA, endomysial IgA antibodies and total IgA were measured for screening of celiac disease. Children with positive anti-tissue transglutaminase and/or endomysial IgA antibodies underwent endoscopy.

Results: A total of 103 children with type 1 diabetes mellitus were initially included. Ten patients were lost to follow up. Ninety-three patients aged 2-17 years underwent screening for celiac disease. Sixteen patients had positive anti-tissue transglutaminase (17%). Fourteen patients underwent endoscopy with duodenal biopsies, while two were lost to follow-up. Five patients with positive anti-tissue transglutaminase had intestinal biopsy proven celiac disease. The prevalence of celiac disease is 5.5% in our cohort of children and adolescents with type 1 diabetes mellitus.

Conclusions: The prevalence of celiac disease in Omani children and adolescents with type 1 diabetes mellitus is similar to the World’s reported prevalence, but is less than that reported for Middle Eastern Arab children. To our knowledge, this is the first reported study on the prevalence of celiac disease in Omani children with type 1 diabetes mellitus.

Higher Serum Levels of Rheumatoid Factor and Anti-Nuclear Antibodies in Helicobacter Pylori-Infected Peptic Ulcer Patients

Abdollah Jafarzadeh,^1* Maryam Nemati,² Mohammad Taghi Rezayati,³ Mansooreh Nabizadeh,³ and Medhi Ebrahimi⁴

Abstract

Objectives: H. pylori infection has been associated with some autoimmune disorders. The aim of this study was to evaluate the serum concentrations of rheumatoid factor and anti-nuclear antibodies in H. pylori-infected peptic ulcer patients, H. pylori-infected asymptomatic carriers and a healthy control group.

Methods: A Total of 100 H. pylori-infected peptic ulcer patients, 65 asymptomatic carriers and 30 healthy H. pylori-negative subjects (as a control group) were enrolled into study. Serum samples of participants tested for the levels of rheumatoid factor and anti-nuclear antibodies by use of ELISA.

Results: The mean serum levels of rheumatoid factor and anti-nuclear antibodies in peptic ulcer group was significantly higher in comparison to the control group (p<0.05). Although, the mean serum levels of rheumatoid factor and anti-nuclear antibodies in the asymptomatic carriers group was higher than those in the control group, the difference was not statistically significant. No significant differences were observed between peptic ulcer patients and asymptomatic carriers groups regarding the mean serum levels of rheumatoid factor and anti-nuclear antibodies. The mean serum levels of rheumatoid factor in men with peptic ulcer was significantly higher compared to the group of healthy men (p<0.05). Although in female of peptic ulcer patients or asymptomatic carriers groups, the mean serum levels of rheumatoid factor was higher than that in healthy women, but the differences were not statistically significant. Also, no significant differences were observed between men and women with peptic ulcer, asymptomatic carriers control groups based on the serum levels of anti-nuclear antibodies.

Conclusion: The results showed higher serum levels of rheumatoid factor and anti-nuclear antibodies in H. pylori-infected patients with peptic ulcer disease which represent the H. pylori-related immune disturbance in these patients. Additional follow-up studies are necessary to clarify the clinical significance of these autoantibodies in patients with H. pylori infection.

Quality of Life and Nutritional Status Among Cancer Patients on Chemotherapy

Nunilon Vergara,* Jose Enrique Montoya, Herdee Gloriane Luna, Jose Roberto Amparo, and Gloria Cristal-Luna

Abstract

Objectives: Malnutrition is prevalent among cancer patients, and maybe correlated with altered quality of life. The objective of this study is to determine whether quality of life among cancer patients on chemotherapy at the National Kidney and Transplant Institute- Cancer Unit differs from patients with normal nutrition based on the Subjective Global Assessment scale.

Methods: A cross sectional study was conducted among cancer patients admitted for chemotherapy at the National Kidney and Transplant Institute-Cancer Unit from January to May 2011. Demographic profile, performance status by Eastern Cooperative Oncology Group performance scale, nutritional status assessment by Subjective Global Assessment, and quality of life assessment by the European Organization for Research and Treatment of Cancer QoL-30 core module were obtained. Descriptive statistics and ANOVA were performed for analysis of quality of life parameters and nutritional status.

Results: A total of 97 subjects were included in this study, 66 subjects (68.04%) were females and 31 (31.96%) were males. Mean age was 54.55 ± 11.14 years, while mean performance status by the Eastern Cooperative Oncology Group classification was 0.88 ± 0.83 with a range of 0-3. According to the Subjective Global Assessment, there were 58 patients with SGA A, classified to have adequate nutrition, and 39 patients (40.21%) were considered malnourished. Among these 39 patients, 32 were classified SGA-B (moderately malnourished) and 7 were classified SGA C (severely malnourished) mean global quality of life was 68.73 ± 19.05. Results from ANOVA test revealed that patients were statistically different across the Subjective Global Assessment groups according to global quality of life (p<0.001), physical (p<0.001), role (p<0.001), emotional (p<0.001), and cognitive functioning (p<0.001); fatigue (p<0.001), nausea and vomiting (p<0.001), pain (p<0.001), insomnia (p<0.001), and appetite loss (p<0.001).

Conclusion: Global quality of life and its parameters: physical state, role, emotional state, cognitive functioning, cancer fatigue, nausea and vomiting, pain, insomnia, and loss of appetite were statistically different across all Subjective Global Assessment groups. Moreover, there was no difference between financial difficulties, social functioning, constipation and diarrhea among the Subjective Global Assessment groups.

Hypocomplementemic Urticarial Vasculitis Syndrome in an 8-year-old Boy: A Case Report and Review of Literature

Zakiya Saleh Adnan Al Mosawi,^1* and Badriya Ebrahim Ahmed Al Hermi²

Abstract

Hypocomplementemic urticarial vasculitis syndrome is an immune complex-mediated disease of unknown etiology. The clinical course is characterized by urticaria, conjunctivitis, joint pain, and hypocomplementemia. We here report a case of a child with hypocomplementemic urticarial vasculitis syndrome that progressed to nephritis. Renal biopsy was consistent with diffuse proliferative glomerulonephritis with diffuse subendothelial immune deposits. He responded well to a combination of steroid and mofetil micofenolate.

External Jugular Vein Aneurysm with Thrombus Presenting as Painful Neck Mass: A Case Report

Roshan Kumar Verma*, Darwin Kaushal, and Naresh K. Panda

Abstract

External jugular vein aneurysm with thrombosis presenting as neck swelling is a rare clinical entity and rarely encountered in routine clinical practice. We present a case of a 45-year-old female with external jugular vein aneurysm presenting as a painful lump in the neck. Ultrasound of the neck and CT angiography showed saccular dilation of the lower end of the external jugular vein with thrombosis within the aneurysm. Saccular aneurysm of the external jugular vein is very uncommon and can lead to thrombotic complications with serious consequence.

Dyskeratosis Congenita- Management and Review of Complications: A Case Report

Shivam Sinha,^1* Vikas Trivedi,² Arvind Krishna,³ and Nidhi Rao⁴

Abstract

Among the inherited bone marrow failure disorders, dyskeratosis congenita is an X-linked inherited disorder arising as a consequence of short telomere and mutations in telomere biology. Production of the altered protein dyskerin, leads to vulnerable skin, nails, and teeth which lead to higher permeability for noxious agents which can induce carcinogenesis accounting for the classical triad of skin pigmentation, nail dystrophy and oral leukoplakia. This condition is fatal and patients succumb to aplastic anemia, malignancy or immunocompromised state. We present a young male with the classic clinical triad and avascular necrosis of both femoral heads, with no evidence of hematologic anomaly or any malignancy. He was managed for osteonecrosis with uncemented total hip arthroplasty for the symptomatic left hip. Our case represents a benign form of such a fatal and rare condition, which if detected and managed early can result in improved quality of life for the patient suffering from this disorder. This patient is under our meticulous follow-up for the last 2 years in order to determine any late development of complications before being labelled as a variant of this syndrome.

A Case of Ocular Torticollis

Doddaiah Narayanappa,¹* Hassan Srinivasamurthy Rajani,¹ Timmanahalli Girish Anita,² and Nagaraj Rashmi¹

Abstract

A 1-year-and-2-month-old male baby was brought to Pediatric out patient department with head tilt to left side, chin rotated to right side with full range of neck movement, right eye hypertropia increased on left gaze, and not associated with any other musculoskeletal abnormalities. Diagnosis of ocular torticollis secondary to right superior oblique muscle palsy was made.

Keywords: Ocular; Superior oblique muscle; Torticollis.

Urinary Ascites Secondary to Bladder Perforation in a Neonate with Posterior Urethral Valves

Pankaj Gupta, Arun Kumar Gupta,* and Sandeep Aggarwala

Abstract

Neonatal urinary ascites is a rare condition. It can be spontaneous or iatrogenic. Posterior urethral valve is the most common cause of spontaneous urinary ascites. It occurs most commonly from the rupture of calyceal fornices secondary to raised intrarenal pressure. Rarely, urinary bladder perforation is responsible for urinary ascites in Posterior urethral valve. Urinary ascites should be considered in a neonate with ascites with unexplained renal failure. In this article, we present the imaging feature and brief review of literature of a child with urinary ascites secondary to Posterior urethral valve.

Keywords: Urinary ascites; Posterior urethral valve; Bladder perforation.

Atypical Skin Rash in a Patient with Adult-Onset Still's Disease: A Case Report

Aysegul Kucukali Turkyilmaz,^1* Gul Devrimsel,¹ Mehmet Serhat Topaloglu,¹ Ayse Erturk,² Arzu Aydın Capkin,³ and Murat Yildirim¹

Abstract

Adult-onset Still's disease (AOSD) is an uncommon idiopathic disorder with various clinical manifestations. The absence of specific serological and pathological findings often makes the disease difficult to diagnose. The presence of skin lesions is important to the correct diagnosis of the disease. Various atypical skin lesions have been reported in association with Adult-onset Still's disease. We present a 52-year-old male who had atypical cutaneous manifestations of Adult-onset Still's disease. The rash manifested as persistent, pruritic, dark reddish, confluent, erythematous maculopapules and plaques on his chest, abdomen, upper back and proximal extremities. He suffered high, spiking fevers and had marked elevations of ferritin, C-reactive protein, and the erythrocyte sedimentation rate, which are characteristic of Adult-onset Still's disease. The fever and systemic symptoms improved after the administration of intravenous pulse methylprednisolone therapy. The skin lesions improved after prednisolone and methotrexate combination therapy. Therefore, to make the correct diagnosis, it is important to understand that patients with Adult-onset Still's disease may present with various types of skin lesions.

Keywords: Adult-onset Still's disease; Skin rash; Pruritic papular eruption.

Intact Left Cornual Ectopic Pregnancy: A Case Report

Nidal Al-Ibrahim

Abstract

Cornual ectopic pregnancy is a rare form of ectopic pregnancy but has catastrophic presentation when diagnosis is missed. It is usually misdiagnosed as degenerated myoma at uterine fundus but can be differentiated by positive pregnancy test, absence of intrauterine gestational sac and diagnostic laparoscopy when necessary. In this case, we present a case of cornual ectopic pregnancy diagnosed by serial serum beta subunit of human chorionic gonadotropin, vaginal ultrasound and diagnostic laparoscopy, which was managed by evacuation of the cornual ectopic by laparotomy, excision of the tube and then suturing the pedicle adjacent to the uterine wall.

Keywords: Beta subunit of human chorionic gonadotropin; Cornual ectopic pregnancy; Vaginal ultrasound.

A Rare Presentation of a Newborn with Subcutaneous Fat Necrosis

Khawla Said Hamed Al Shidhani,^1* Amal Saif Al Maani,² and Ali Talib Jumaa Al Jabri³

Abstract

Subcutaneous fat necrosis of newborn is a form of panniculitis that often occurs in term and post-term neonate with predisposing risk factors such as perinatal asphyxia and maternal gestational diabetes. A cutaneous involvement may be associated with metabolic complications such as hypoglycemia, hypercalcemia and hypertriglyceridemia. Here, we present a case of Subcutaneous fat necrosis of newborn with bilateral symmetrical involvement of both axillas in a perinatal asphyxiated newborn that has not been previously described in the literature. In this case, there were no major complications apart from asymptomatic hypercalcemia.

Keywords: Subcutaneous fat necrosis; Neonate; Hypercalcemia.

Follicular Dendritic Cell Sarcoma of Ileoceacal Region in a Young Woman: A Rare Case Report with Review of Literature

Ratan Sarkar,* Shyam Sharma, Niladri Roy, Abhash Shankar, and Siddhartha Basu

Abstract

Follicular dendritic cell sarcoma arises from the follicular dendritic cells present in the lymph nodes, especially of the head and neck area. Rarely, extranodal sites may be affected including tonsil, the oral cavity, liver, spleen and the gastrointestinal tract. Here, we report a case of intra-abdominal follicular dendritic cell sarcoma presenting as a huge mass in the ileocecal region of a 24-year young woman.

Keywords: Follicular dendritic cell sarcoma; Ileocecal; Extranodal.

Knowledge, Attitude and Practice of Oral and Dental Healthcare in Pregnant Women

Sunita Bamanikar,^1* and Liew Kok Kee²

Abstract

Objectives: Pregnant women are more susceptible to periodontal disease like gingivitis. Periodontal disease may be associated with adverse pregnancy outcomes. There is no published literature on dental health in pregnant women in Brunei, Darussalam. The objective of this study was to assess women’s knowledge and attitude towards oral and dental health during pregnancy and to examine their self-care practices in relation to oral and dental health. This study was carried out at the maternal child health clinic, Jubli Perak Sengkurong Health Centre, Brunei, Darussalam.

Methods: This was a cross-sectional descriptive and analytical study conducted at the maternal child health center in Brunei, Darussalam. The study group was comprised of 95 pregnant women attending the MCH clinic, Jubli Perak Sengkurong Health Centre, September 2010, using convenience sampling method. A self-administered questionnaire was used, after it was pre-tested and validated. Statistical analysis was done using SPSS version16.

Results: Of the total study group, 97.9% responded to the questionnaire and participated in the study. All the women brushed at least twice daily. However, only 40.9% flossed daily, 31.2% brushed after meals and 26.9% had a dental check-up at least twice a year. The knowledge related to dental care was also poor among the pregnant women. Though the majority of them (96.8%) agreed that women should have a dental check-up during pregnancy, only 55.9% actually practiced this. This raises serious concern since pregnant women may need extra oral and dental care due to susceptibility to gum diseases during pregnancy, which may contribute to low birth weight babies and premature births.

Conclusion: This study highlights important gaps in dental knowledge and practices related to oral and dental healthcare among pregnant women in Brunei, Darussalam. More intense dental health education, including oral health promotion in maternal child health centers can lead to improved oral and dental health, and ultimately pregnancy outcomes.