Fluoride removal and its impact on oral health in Sri Lanka's dry zone: Discussion and recommendation

Fifty percent of the dry zone areas in Sri Lanka have fluoride levels above 1 ppm. This paper discusses the ground conditions and recommends an appropriate range of fluoride in drinking water which can support preventive practices for improving the oral health of children 8-years old and younger. In efforts to address the Chronic Kidney Disease of Unknown etiology (CKDU), water treatment to reduce contaminant level in potable water has been implemented. Such treatment would also remove fluoride and has resulted in potable water with various fluoride levels, depending on concentrations in the raw water. While it is important to reduce fluoride levels, it is important to have appropriate residual levels for prevention of dental caries. It needs, however, to be noted fluoride in excess can cause dental fluorosis. In Sri Lanka's dry zone areas increasing prevalence of dental fluorosis with decreasing prevalence of dental caries has been noted. Consumption of tea and powdered milk could increase total intake of fluoride. Fluoridated toothpaste, when used properly, may, however, result in negligible intake of fluoride. Sri Lanka's hot tropical climate which results in substantial intake of fluids reinforces the need to consider reduction in water fluoride. Consideration of local studies and international standards indicate fluoride levels should be in the range of 0.225–0.500 ppm. In the range of 0.225–0.500 ppm, the prevalence of dental fluorosis and caries was only 14% and 8%, respectively, in an endemic district. When fluoride levels are above 0.500 ppm, the issue of dental fluorosis shall need to be addressed. When levels are below 0.225 ppm, oral health care services shall need to be directed at preventing dental caries.     

First-trimester fetal sex determination in maternal serum using real-time PCR

An Erratum has been published for this article in Prenatal Diagnosis 22(13) 2002, 1241. Fetal sex prediction can be achieved using PCR targeted at the SRY gene by analysing cell-free fetal DNA in maternal serum. Unfortunately, the results reported to date show a lack of sensitivity, especially during the first trimester of pregnancy. Therefore, determination of fetal sex by maternal serum analysis could not replace karyotype analysis following chorionic villus sampling. A new highly sensitive real-time PCR was developped to detect an SRY gene sequence in maternal serum. Analysis was performed on 121 pregnant women during the first trimester of pregnancy (mean gestational age: 11.8 weeks). Among them, 51 had at least one previous male-bearing pregnancy. Results were compared with fetal sex. SRY PCR analysis of maternal serum was in complete concordance with fetal sex. Among the 121 pregnant women, 61 were bearing a male fetus and 60 a female fetus. No false-negative results were observed. Furthermore, no false-positive results occurred, even though 27 women carrying a female fetus during the current pregnancy had at least one previous male-bearing pregnancy. This study demonstrates that a reliable, non-invasive sex determination can be achieved by PCR analysis of maternal serum during the first trimester of pregnancy. This non-invasive approach for fetal sex prediction should have great implications in the management of pregnant women who are carriers of an X-linked genetic disorder. Prenatal diagnosis might thus be performed for male fetuses only, avoiding invasive procedures and the risk of the loss of female fetuses. Copyright © 2001 John Wiley & Sons, Ltd.     

Prenatal ultrasound diagnosis of Toriello–Carey syndrome

Toriello–Carey syndrome is a rare malformative complex, described for the first time in 1988, characterized by agenesis of the corpus callosum, facial anomalies, cardiac defects and hypotonia. Relatively few neonatal cases have been reported. We describe here the first prenatal ultrasound diagnosis of the syndrome based on the detection of agenesis of the corpus callosum and spongious cardiomyopathy in a 22-week-old fetus of a couple with positive family history. The first sib of the couple was diagnosed with Toriello–Carey syndrome at 1 year of age, and had, in addition to the typical facial anomalies not detectable by ultrasound, agenesis of the corpus callosum and the same heart lesion (spongious cardiomyopathy). This report demonstrates that prenatal diagnosis of Toriello–Carey syndrome is feasible in the second trimester of pregnancy. Copyright © 2002 John Wiley & Sons, Ltd.     

Funipuncture for fetocide in late termination of pregnancy

The most widely used method for fetocide in late termination of pregnancy for fetal abnormalities (TOPFA) consists of injecting of potassium chloride (KCl) into the fetal heart and is likely to be painful after 22 weeks of gestation. We studied ten consecutive women undergoing TOPFA between 22 and 38 weeks. This technique for fetocide consisted of a single umbilical vein puncture under ultrasound guidance with injections of sufentanil 5 µg followed by KCl 2 g. No electrocardiographic modifications could be observed and maternal plasma potassium levels did not show any significant variation throughout the procedure. Fetal umbilical phlebotomy for fetal analgesia followed by fetocide therefore appears to be a safe procedure for the mother and allows the fetus to die without pain when late termination of pregnancy (TOP) is indicated. Copyright © 2002 John Wiley & Sons, Ltd.     

Prenatal diagnosis of congenital cystic adenomatoid malformation of the lung by fetal lung biopsy

A case of type III congenital cystic adenomatoid malformation of the lung was successfully diagnosed prenatally by fetal lung biopsy. We performed this procedure at 22 weeks of gestation, using a biopsy gun system under ultrasound guidance. The pregnancy was undisturbed by the procedure but as the condition was incompatible with life, an abortion was performed. The diagnosis was confirmed at post-mortem examination. Fetal lung biopsy appears to be a useful method for prenatal diagnosis of fetal lung disorders.     

Restrictive dermopathy and fetal behaviour

We report three siblings from consecutive pregnancies affected with restrictive dermopathy (RD). During the second pregnancy, fetal behavioural development and growth were studied extensively using ultrasound at 1–4 week intervals. Dramatic and sudden changes occurred in fetal body movements and growth but not until the end of the second trimester of pregnancy. Prominent at that time were prolonged periods of fetal quiescence and very low heart rate variability, together with abnormally executed body movements of short duration. Retarded femoral development and jerky abrupt fetal body movements (abnormal movement quality) were already present in the early second trimester of pregnancy. Facial anomalies emerged despite the presence of fetal mouth movements. The clinical features of RD were only partly explained by present knowledge of skin development and the fetal akinesia deformation sequence hypothesis. Quantitative assessment of fetal movements proved to be a poor early marker for antenatal diagnosis of this disorder. Copyright © 2001 John Wiley & Sons, Ltd.     

Changes in fetal heart rate pattern after intrauterine paracentesis in one twin with meconium peritonitis

We report a case of in utero paracentesis of ascites in a fetus with meconium peritonitis due to volvulus at 34 weeks which resulted in the correction of an abnormal fetal heart rate pattern and enabled vaginal delivery by preventing abdominal dystocia. The intrauterine intervention also helped to establish the diagnosis and potentially reduced the respiratory compromise after birth. Copyright © 2001 John Wiley & Sons, Ltd.     

南宁城市大气污染对人体健康的危害及治理对策

南宁市大气属煤烟型污染 ,大气的主要污染物为SO2 、NOx、TSP、降尘 ,虽然随着环境管理和污染治理工作的加强 ,污染物浓度逐年下降 ,但是工业区大气污染仍然较重。污染物流行病学调查显示 :工业区癌症和呼吸系统疾病死亡率均高于全市平均水平 2倍左右 ,城区又高于郊区 2倍 ,大气污染综合指数与呼吸内科门诊就诊人数呈正相关。用邓聚龙的灰色系统理论分析得知污染物对癌症和呼吸系统疾病死亡率有关联 ,关联度从大到小排序为 :TSP >降尘 >SO2 >NOx ,最后提出了大气污染治理的对策。