Orofacial clefts
Professor Peter Mossey with Professor Puneet Batra (right) and his wife Dr Shweta (left) and colleagues in New Delhi
Continued »
The specific project actions would consist of the following: • Recruitment through the Sri Ramachandra Hospital Cleft Lip and Palate Surgical Unit of mothers of children born with OFC in the past year and who have attended for primary repair of the cleft of the lip and palate.
• Recruitment of mothers of control children (without clefts) from a local community maternal hospital in Chennai, with matching criteria for children being: date of birth, sex and geographic location of birth.
• Obtaining consent for the three compo- nents of the study, i.e. nutritional, environmental exposure and metabolic markers with the knowledge that IRB approval has already been obtained.
• Eliciting the appropriate informa- tion on nutrition, environmental exposure and maternal metabolism via validated questionnaires.
• Obtaining a 5ml blood sample in EDTA tubes with an offer of screening for general health, diabetes and heart disease so that there is an immediate benefit to the participating mothers.
• Laboratory procedures to assess biomarkers of maternal nutrition, environmental exposure and maternal metabolism using unique and validated techniques.
Potential for wider collaboration There is a significant shift in emphasis in
“The scientists from India bring special skills to research teams”
medicine and healthcare to seek a common risk factor approach to chronic diseases, and included in this is the WHO Global Burden of Disease Initiative that includes cleft lip and palate. The issues in reproductive health
include smoking, maternal metabolic syndrome, hyperglycaemia, diabetes and obesity, cardiovascular disease, and with risk factors such as smoking, alcohol consumption and nutrition, there is an opportunity for this research to be carried out in parallel with other major chronic diseases. The choice of cleft lip and palate is because of its aetiology and that it is regarded as a sentinel birth defect because of the high level of ascertainment and, therefore, the findings in relation to cleft lip and palate may well be transferrable to a range of other birth defects, particularly structural birth defects such as congenital heart problems, genito-urinary, digestive tract and limb reduction defects.
Partnership benefits Research in the area of birth defects has demonstrated in the past that there are possibilities for generalisability of findings to populations around the world – and this applies to aspects of nutrition (e.g. folic acid and NTDs) and exposures (e.g. smoking and OFC). There is also a recognition that as well
as some aspects of research expertise and training being transported from the US and UK to India, the research expertise and the scientists from India bring special skills, expertise, work ethic and cultural qualities to research teams in the US and the UK. The UK-India Education and Research
Initiative (UKIERI) trilateral partner- ship (TRIP) grant enables such research to be conducted and the involvement of colleagues in the US and India helps fulfil not only the WHO terms of reference, but
Above Diagram illustrating cleft palate repair surgery
also the aspirations of the US Government in the Obama-Singh accord and pledges made by the UK Prime Minister David Cameron in his visit to India in 20ıı.
The role of the University of Dundee in the UKIERI TRIP project In August 2004, Dundee was granted WHO Collaboration Centre (CC) status for research into craniofacial anomalies and technology transfer. The Terms of Reference (ToR) in the agreement with WHO means that the University of Dundee has a remit involving setting up research projects in the developing world. The University of Dundee WHO CC
has assisted with research in the developing world, most notably in Nigeria and Brazil, and this expertise can be applied to the UKIERI project in the field of craniofacial anomalies in India. The College of Medicine, Dentistry and Nursing has selected craniofacial anoma- lies as one of the main areas of research activity and this is also supported through the Scottish Government’s research prior- ities in oral health as detailed in the Transforming Research into Better Oral Health in Scotland document published in January 20ıı.
Scottish Dental magazine 23
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