Smoking cessation and duloxetine toxicity: A case report.

OBJECTIVE: Psychiatric medications are among the drugs affected by cigarette smoke, and because of the high prevalence of smoking in the psychiatric community, psychiatric patients are particularly at risk when entering the smoke-free environment of a hospital. CASE SUMMARY: Polycyclic aromatic hydrocarbons present in cigarette smoke are well-known inducers of cytochrome P450 (CYP) enzymes. CYP1A2 induction by cigarette smoking increases metabolic clearance of substrates of this enzyme; smoking cessation results in a decrease in CYP1A2 activity, which causes an increase in serum substrate levels. Although these effects are well documented, the effect of smoking cessation remains a hidden danger, in part, because computerized drug interaction surveillance systems are not designed to alert clinicians when an offending agent is discontinued. PRACTICE IMPLICATION: To raise awareness and demonstrate the importance of a thorough assessment of smoking status, we present a case in which the temporal relationship of smoking cessation to the emergence of nausea, vomiting, and tachycardia 3 days later (day 3); the development of myoclonic jerks by day 5; and the resolution of symptoms on reduction of duloxetine dosage on day 44 implicates duloxetine toxicity in a patient with ischemic cardiomyopathy awaiting implantation of a left ventricular assist device.

Understanding the role of intersectoral convergence in the delivery of essential maternal and child nutrition interventions in Odisha, India: a qualitative study.

BACKGROUND: Convergence of sectoral programs is important for scaling up essential maternal and child health and nutrition interventions. In India, these interventions are implemented by two government programs - Integrated Child Development Services (ICDS) and National Rural Health Mission (NRHM). These programs are designed to work together, but there is limited understanding of the nature and extent of coordination in place and needed at the various administrative levels. Our study examined how intersectoral convergence in nutrition programming is operationalized between ICDS and NRHM from the state to village levels in Odisha, and the factors influencing convergence in policy implementation and service delivery. METHODS: Semi-structured interviews were conducted with state-level stakeholders (n = 12), district (n = 19) and block officials (n = 66), and frontline workers (FLWs, n = 48). Systematic coding and content analysis of transcripts were undertaken to elucidate themes and patterns related to the degree and mechanisms of convergence, types of actions/services, and facilitators and barriers. RESULTS: Close collaboration at state level was observed in developing guidelines, planning, and reviewing programs, facilitated by a shared motivation and recognized leadership for coordination. However, the health department was perceived to drive the agenda, and different priorities and little data sharing presented challenges. At the district level, there were joint planning and review meetings, trainings, and data sharing, but poor participation in the intersectoral meetings and limited supervision. While the block level is the hub for planning and supervision, cooperation is limited by the lack of guidelines for coordination, heavy workload, inadequate resources, and poor communication. Strong collaboration among FLWs was facilitated by close interpersonal communication and mutual understanding of roles and responsibilities. CONCLUSIONS: Congruent or shared priorities and regularity of actions between sectors across all levels will likely improve the quality of coordination, and clear roles and leadership and accountability are imperative. As convergence is a means to achieving effective coverage and delivery of services for improved maternal and child health and nutrition, focus should be on delivering all the essential services to the mother-child dyads through mechanisms that facilitate a continuum of care approach, rather than sectorally-driven, service-specific delivery processes.

Oral delivery of bioencapsulated proteins across blood-brain and blood-retinal barriers.

Delivering neurotherapeutics to target brain-associated diseases is a major challenge. Therefore, we investigated oral delivery of green fluorescence protein (GFP) or myelin basic protein (MBP) fused with the transmucosal carrier cholera toxin B subunit (CTB), expressed in chloroplasts (bioencapsulated within plant cells) to the brain and retinae of triple transgenic Alzheimer's disease (3×TgAD) mice, across the blood-brain barriers (BBB) and blood-retinal barriers (BRB). Human neuroblastoma cells internalized GFP when incubated with CTB-GFP but not with GFP alone. Oral delivery of CTB-MBP in healthy and 3×TgAD mice shows increased MBP levels in different regions of the brain, crossing intact BBB. Thioflavin S-stained amyloid plaque intensity was reduced up to 60% by CTB-MBP incubation with human AD and 3×TgAD mice brain sections ex vivo. Amyloid loads were reduced in vivo by 70% in hippocampus and cortex brain regions of 3×TgAD mice fed with bioencapsulated CTB-MBP, along with reduction in the ratio of insoluble amyloid ß 42 (Aß42) to soluble fractions. CTB-MBP oral delivery reduced Aß42 accumulation in retinae and prevented loss of retinal ganglion cells in 3×TgAD mice. Lyophilization of leaves increased CTB-MBP concentration by 17-fold and stabilized it during long-term storage in capsules, facilitating low-cost oral delivery of therapeutic proteins across the BBB and BRB.

Is There an Enabling Environment for Nutrition-Sensitive Agriculture in South Asia? Stakeholder Perspectives from India, Bangladesh, and Pakistan.

BACKGROUND: Almost half of all children in South Asia are stunted. Although agriculture has the potential to be a strong driver of undernutrition reduction and serves as the main source of livelihood for over half of South Asia's population, its potential to reduce undernutrition is currently not being realized. OBJECTIVE: The Leveraging Agriculture for Nutrition in South Asia (LANSA) research consortium seeks to understand how agriculture and agrifood systems can be better designed to improve nutrition in South Asia. In 2013 and 2014, LANSA carried out interviews with stakeholders influential in, and/or knowledgeable of, agriculture-nutrition policy in India, Pakistan, and Bangladesh, to gain a better understanding of the institutional and political factors surrounding the nutrition sensitivity of agriculture in the region. METHODS: Semistructured interviews were carried out in India, Bangladesh, and Pakistan with a total of 56 stakeholders representing international organizations, research, government, civil society, donors, and the private sector. RESULTS: The findings point to mixed perspectives on countries' policy sensitivity toward nutrition. There was consensus among stakeholders on the importance of political commitment to nutrition, improving nutrition literacy, strengthening capacities, and improving the use of financial resources. CONCLUSIONS: Although there are different ways in which South Asian agriculture can improve its impact on nutrition, sensitizing key influencers to the importance of nutrition for the health of a country's population appears as a critical issue. This should in turn serve as the premise for political commitment, intersectoral coordination to implement nutrition-relevant policies, adequately resourced nutrition-specific and nutrition-sensitive programs, and sufficient capacities at all levels.

Comparative Evaluation of Antibacterial Efficacy and Remineralization Potential of Acidulated Phosphate Fluoride Gel with Herbal Dental Gel Containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum: An In Vitro Study.

Aim: The aim of the study is to evaluate and compare the antibacterial efficacy and remineralization potential of acidulated phosphate fluoride (APF) gel with herbal dental gel containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum. Materials and methods: Ethanolic extracts of Z. officinale, S. persica, and C. zeylanicum were prepared. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of these extracts were determined against Streptococcus mutans and Lactobacillus acidophilus using the resazurin method and agar plate streaking method, respectively. The herbal dental gel was formulated, and its cytotoxicity was evaluated using an 3-(4,5-dimethythiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. The antibacterial susceptibility of APF gel and the herbal dental gel was assessed using the agar well diffusion method and time-kill assay. The remineralizing potential was evaluated using a stereomicroscope. Results: Herbal dental gel showed better antibacterial efficacy as depicted by the zone of inhibition of 20 and 21 mm obtained against S. mutans and L. acidophilus, respectively, compared to 11.50 and 16.50 mm zone of inhibition obtained by APF gel. The herbal dental gel also showed better remineralization potential than APF gel after a time interval of 24 and 48 hours, as depicted with a statistically significant p-value of 0.0061 and 0.0219, respectively. In the cytotoxicity test, the fibroblasts showed 100% viability in the presence of both study groups. Conclusion: The results of our study concluded that herbal dental gel is safe and nontoxic, having anticariogenic potential due to its good antibacterial action and remineralization potential as compared to conventional APF gel. How to cite this article: Kohli N, Hugar SM, Hallikerimath S, et al. Comparative Evaluation of Antibacterial Efficacy and Remineralization Potential of Acidulated Phosphate Fluoride Gel with Herbal Dental Gel Containing Zingiber officinale, Salvadora persica, and Cinnamomum zeylanicum: An In Vitro Study. Int J Clin Pediatr Dent 2024;17(3):307-315.

Effect of dimethyl fumarate on mitochondrial metabolism in a pediatric porcine model of asphyxia-induced in-hospital cardiac arrest.

Neurological and cardiac injuries are significant contributors to morbidity and mortality following pediatric in-hospital cardiac arrest (IHCA). Preservation of mitochondrial function may be critical for reducing these injuries. Dimethyl fumarate (DMF) has shown potential to enhance mitochondrial content and reduce oxidative damage. To investigate the efficacy of DMF in mitigating mitochondrial injury in a pediatric porcine model of IHCA, toddler-aged piglets were subjected to asphyxia-induced CA, followed by ventricular fibrillation, high-quality cardiopulmonary resuscitation, and random assignment to receive either DMF (30 mg/kg) or placebo for four days. Sham animals underwent similar anesthesia protocols without CA. After four days, tissues were analyzed for mitochondrial markers. In the brain, untreated CA animals exhibited a reduced expression of proteins of the oxidative phosphorylation system (CI, CIV, CV) and decreased mitochondrial respiration (p < 0.001). Despite alterations in mitochondrial content and morphology in the myocardium, as assessed per transmission electron microscopy, mitochondrial function was unchanged. DMF treatment counteracted 25% of the proteomic changes induced by CA in the brain, and preserved mitochondrial structure in the myocardium. DMF demonstrates a potential therapeutic benefit in preserving mitochondrial integrity following asphyxia-induced IHCA. Further investigation is warranted to fully elucidate DMF's protective mechanisms and optimize its therapeutic application in post-arrest care.

Comparative evaluation of anxiety level during restorative treatment using no music, monaural beats, and binaural auditory beats as audio distraction behavior guidance technique in children aged 6-12 years: A randomized clinical trial.

Background: Binaural auditory beat is an auditory illusion perceived when two different pure-tone sine waves with less than a 30 Hz difference are presented to a listener dichotically. Monaural beat stimulation is achieved by the superposition of amplitude-modulated signals of nearby frequencies to both ears simultaneously. Aim: The study aims to evaluate and compare anxiety level during restorative treatment using no music, monaural beats, and binaural auditory beats as audio distraction behavior guidance techniques in children aged 6-12 years. Settings and Design: Three-arm, parallel-group randomized study was conducted in the department of pediatric and preventive dentistry. Materials and Methods: The sample size of 45 participants was calculated and allocated into three groups as no music, monaural beats, and binaural auditory beats group. Teeth with Class I cavity in primary or permanent molars were prepared and restored. Anxiety was measured pre and postintervention using pulse oximeter and Venham's picture test. Statistical Analysis Used: Data obtained were analyzed with SPSS software version 20.0 and were carried out using one-way analysis of variance and dependent t-test and significance value < 0.05 was considered. Results: Binaural auditory beats and monaural beats showed a better reduction in anxiety levels as per Venham's picture test scores with statistically significant "P" value 0.0001 and 0.064, respectively. Likewise, binaural auditory beats showed better reduction in anxiety levels as per pulse rate scores with statistically significant "P" value 0.0001 as compared to conventional treatment technique. Conclusion: Binaural auditory beat was found to be the most effective followed by the monaural beat compared to the control group. Thus, binaural auditory beats and monaural beats can be used effectively as an essential aid to reduce anxiety in children.

Evaluating anxiety levels and pain perception while administering local anesthesia using conventional, insulin, and deception syringes in 6-12-year-olds.

Background: Injections are one of the most fear-provoking stimuli in dentistry. Painless administration of an injection is a vital step in alleviating anxiety, which in turn leads to good behavior in children. The aim is to evaluate and compare anxiety levels and pain perception using conventional, insulin, and deception syringes during the administration of local anesthesia in children. Methods: Forty-five children aged 6-12 were selected using a standard sample size formula and equally divided into three groups. Local anesthesia was administered using a conventional syringe to Group A participants and an insulin syringe for Group B participants. Group C participants were administered local anesthesia using a deception syringe by showing the patient disposable obturation tips, and eventually a conventional syringe was used for administration of local anesthesia after hiding them from the patient. Anxiety levels were assessed using Venham's Picture Scale and pulse rate at baseline and after administration of local anesthesia. The Wong-Baker Faces Pain Rating Scale was used to assess pain perception after the administration of local anesthesia. Results: Insulin and deception syringes showed better reduction in anxiety levels and pain perception than conventional syringes, demonstrating a high statistically significant difference. Conclusion: The use of insulin and deception syringes for administration of anesthesia was demonstrated to be effective in alleviating anxiety in children and is therefore recommended as an alternative to conventional syringes.

An In Vivo Evaluation of Retention and Antibacterial Efficacy of Posterior High Strength Glass Ionomer Cement and Glass Hybrid Bulk-fill Alkasite Restorative Material as Conservative Adhesive Restoration in Children with Mixed Dentition: A Comparative Study.

Aim: The aim of the study was to compare and evaluate the retention and antibacterial efficacy of posterior high strength glass ionomer cement and glass hybrid bulk-fill alkasite restorative material as a conservative adhesive restoration in children with mixed dentition. Materials and methods: A total of 60 children of age 6-12 years with mixed dentition were selected and divided into group I (control group n = 30): posterior high strength glass ionomer cement and group II (experimental group n = 30): glass hybrid bulk-fill alkasite restorative material. Restorative treatment was carried out using these two materials. Retention of the material and salivary Streptococcus mutans and Lactobacillus species count was estimated at baseline, 1, 3, and 6 months. The collected data were statistically analyzed using International Business Machines (IBM) Statistical Package for the Social Sciences (SPSS) software (version 20.0 Chicago, Illinois, USA). Results: About 100% retention of glass hybrid bulk-fill alkasite restorative material, and 90% retention of posterior high strength glass ionomer cement was observed according to United State Public Health Criteria. The * signifies statistically significant results, i.e. p < 0.0001 reduction in salivary S. mutans colony count and Lactobacillus species colony count was seen in both groups at different time intervals. Conclusion: Both the materials showed good antibacterial properties, but glass hybrid bulk-fill alkasite restorative showed better retention, that is, 100% when compared to posterior high strength glass ionomer cement, which showed 90% retention at the end of 6 months follow-up. How to cite this article: Soneta SP, Hugar SM, Hallikerimath S, et al. An In Vivo Evaluation of Retention and Antibacterial Efficacy of Posterior High Strength Glass Ionomer Cement and Glass Hybrid Bulk-fill Alkasite Restorative Material as Conservative Adhesive Restoration in Children with Mixed Dentition: A Comparative Study. Int J Clin Pediatr Dent 2022;15(5):529-534.

Psychological behavior management techniques to alleviate dental fear and anxiety in 4-14-year-old children in pediatric dentistry: A systematic review and meta-analysis.

Child's uncooperative behavior can impede the efficient delivery of dental care. Therefore, in spite of exceeding availability of behavior management techniques there is a need to search for a psychological behavior management technique that effectively reduces fear and anxiety during dental treatment and instill a change in child's attitude toward the treatment and is also acceptable by the parents. The aim of our systematic review is to determine the efficacy of various psychological behavior management techniques in managing a child's behavior in pediatric dentistry by assessing the fear and anxiety levels, ease of use by the clinician, application in various operative procedures, and parental acceptance. A systematic search was conducted by two reviewers in databases PubMed, Google Scholar, Scopus, Web of Science, and Cochrane for the studies published from January 1, 2011, to December 31, 2020. Studies included were clinical studies which evaluated the efficacy of various psychological behavior management techniques by evaluating the fear and anxiety levels and the changes in behavior during dental treatment in children aged between 4 and 14 years. The studies selected were then assessed for quality with the help of predetermined criteria which categorized the studies into high, medium, and low. Through search strategy, 7147 articles were yielded. After screening through titles and abstracts, 60 nonduplicated articles were selected which were further screened for full text. At the end, 15 articles were included in systematic review and 3 articles for meta-analysis. It was concluded that all the psychological behavior management techniques aided in reduction of fear and anxiety. In noninvasive procedures, conventional psychological behavior management techniques can be effective but in invasive procedures other newer psychological behavior management techniques showed better results. The aspect of parental acceptance regarding various techniques was not discussed in any of the included studies.

[18F]ROStrace detects oxidative stress in vivo and predicts progression of Alzheimer's disease pathology in APP/PS1 mice.

BACKGROUND: Oxidative stress is implicated in the pathogenesis of the most common neurodegenerative diseases, such as Alzheimer's disease (AD). However, tracking oxidative stress in the brain has proven difficult and impeded its use as a biomarker. Herein, we investigate the utility of a novel positron emission tomography (PET) tracer, [18F]ROStrace, as a biomarker of oxidative stress throughout the course of AD in the well-established APP/PS1 double-mutant mouse model. PET imaging studies were conducted in wild-type (WT) and APP/PS1 mice at 3 different time points, representing early (5 mo.), middle (10 mo.), and advanced (16 mo.) life (n = 6-12, per sex). Semi-quantitation SUVRs of the plateau phase (40-60 min post-injection; SUVR40-60) of ten brain subregions were designated by the Mirrione atlas and analyzed by Pmod. Statistical parametric mapping (SPM) was used to distinguish brain regions with elevated ROS in APP/PS1 relative to WT in both sexes. The PET studies were validated by ex vivo autoradiography and immunofluorescence with the parent compound, dihydroethidium. RESULTS: [18F]ROStrace retention was increased in the APP/PS1 brain compared to age-matched controls by 10 mo. of age (p < 0.0001) and preceded the accumulation of oxidative damage in APP/PS1 neurons at 16 mo. (p < 0.005). [18F]ROStrace retention and oxidative damages were higher and occurred earlier in female APP/PS1 mice as measured by PET (p < 0.001), autoradiography, and immunohistochemistry (p < 0.05). [18F]ROStrace differences emerged midlife, temporally and spatially correlating with increased Aß burden (r2 = 0.36; p = 0.0003), which was also greatest in the female brain (p < 0.001). CONCLUSIONS: [18F]ROStrace identifies increased oxidative stress and neuroinflammation in APP/PS1 female mice, concurrent with increased amyloid burden midlife. Differences in oxidative stress during this crucial time may partially explain the sexual dimorphism in AD. [18F]ROStrace may provide a long-awaited tool to stratify at-risk patients who may benefit from antioxidant therapy prior to irreparable neurodegeneration.

The role of the state government, civil society and programmes across sectors in stunting reduction in Chhattisgarh, India, 2006-2016.

INTRODUCTION: Childhood stunting has declined in India between 2006 and 2016, but not uniformly across all states. Little is known about what helped some states accelerate progress while others did not. Insights on subnational drivers of progress are useful not just for India but for other decentralised policy contexts. Thus, we aimed to identify the factors that contributed to declines in childhood stunting (from 52.9% to 37.6%) between 2006 and 2016 in the state of Chhattisgarh, a subnational success story in stunting reduction in India. METHODS: We examined time trends in determinants of stunting using descriptive and regression decomposition analysis of National Family Health Survey data from 2005 to 2006 and 2015-2016. We reviewed nutrition-relevant policies and programmes associated with the drivers of change to construct a policy timeline. Finally, we interviewed multiple stakeholders in the state to understand the changes in the drivers of undernutrition. RESULTS: The regression decomposition analysis shows that multiple factors explain 66% of the change in stunting between 2006 and 2016. Improvements in three key drivers-health and nutrition services, household assets, and sanitation and hygiene-explained 47% of the change in stunting. A shared vision for impact, political stability and capable bureaucracy, state-level innovations, support from development partners and civil society, and community mobilisation were found to contribute to improvements in programmes for health, poverty and sanitation. CONCLUSION: Change in multiple sectors is important for stunting reduction and can be achieved in subnational contexts. More work lies ahead to close gaps in various determinants of stunting.