Programmatic Effectiveness of a Pediatric Typhoid Conjugate Vaccine Campaign in Navi Mumbai, India.

BACKGROUND: The World Health Organization recommends vaccines for prevention and control of typhoid fever, especially where antimicrobial-resistant typhoid circulates. In 2018, the Navi Mumbai Municipal Corporation (NMMC) implemented a typhoid conjugate vaccine (TCV) campaign. The campaign targeted all children aged 9 months through 14 years within NMMC boundaries (approximately 320 000 children) over 2 vaccination phases. The phase 1 campaign occurred from 14 July 2018 through 25 August 2018 (71% coverage, approximately 113 420 children). We evaluated the phase 1 campaign's programmatic effectiveness in reducing typhoid cases at the community level. METHODS: We established prospective, blood culture-based surveillance at 6 hospitals in Navi Mumbai and offered blood cultures to children who presented with fever ≥3 days. We used a cluster-randomized (by administrative boundary) test-negative design to estimate the effectiveness of the vaccination campaign on pediatric typhoid cases. We matched test-positive, culture-confirmed typhoid cases with up to 3 test-negative, culture-negative controls by age and date of blood culture and assessed community vaccine campaign phase as an exposure using conditional logistic regression. RESULTS: Between 1 September 2018 and 31 March 2021, we identified 81 typhoid cases and matched these with 238 controls. Cases were 0.44 times as likely to live in vaccine campaign communities (programmatic effectiveness, 56%; 95% confidence interval [CI], 25% to 74%; P = .002). Cases aged ≥5 years were 0.37 times as likely (95% CI, .19 to .70; P = .002) and cases during the first year of surveillance were 0.30 times as likely (95% CI, .14 to .64; P = .002) to live in vaccine campaign communities. CONCLUSIONS: Our findings support the use of TCV mass vaccination campaigns as effective population-based tools to combat typhoid fever.

Knowledge and attitude of dental students of Navi Mumbai on tobacco cessation counseling: A cross-sectional study.

BACKGROUND: Due to the increasing awareness about the harmful effects of tobacco, quite a few tobacco users have shown interest in quitting. But, still there is lack of knowledge, lack of tobacco cessation support, and strong cultural habits which influence their inability to quit. Dentists are less likely to provide tobacco cessation advice and counseling and they feel inadequately prepared to provide tobacco cessation education to their patients as compared to physicians and other health professionals. Furthermore, tobacco cessation counseling is not yet a part of routine dental practice and is not incorporated in the dental curriculum. The purpose of this study was to determine the knowledge and attitude of dental students of Navi Mumbai on tobacco cessation counseling. METHODS: It is a cross-sectional survey-based study. A total of 691 interns and 4th year BDS students were assessed using a structured questionnaire. RESULTS: About 75.3% of the participants claimed that they were not sufficiently trained to provide tobacco cessation counseling. However, 84.2% indicated willingness to counsel their patients regarding the same. About 62.1% felt that the patients do not listen to dental students about quitting and 89.6% of students agreed that counseling patients on tobacco cessation is their duty. DISCUSSION: Dental students lacked confidence in providing counseling to tobacco users due to lack of knowledge on tobacco cessation counseling. However, majority of the participants were also motivated to undertake special training for counseling. The study highlights the importance of introducing tobacco cessation counseling program in the curriculum of dental students to create awareness about the same and to help dental professionals provide effective tobacco cessation counseling.

Assessment of the Efficiency of Tulsi Extract as a Locally Administered Medication Agent and Its Comparison With Curcumin in the Treatment of Periodontal Pockets.

INTRODUCTION: The use of locally administered medication (LAM) agents such as minocycline, metronidazole, and tetracycline as antimicrobials has drawbacks, including the development of microorganism resistance, exorbitant pricing, and limited accessibility. Thus, there is a need for safer and more affordable alternatives. Numerous natural therapies have been found to be superior in this situation. In this study, the efficacy of tulsi extract as a LAM agent was assessed and it was compared with curcumin, which is currently used for the treatment of periodontal pockets. METHODS AND MATERIALS: There were three categories: each category had 30 sites. Category 1 sites underwent scaling along with root planing (SRP) solely, Category 2 sites received curcumin extract as LAM in the periodontal pocket in addition to SRP, and Category 3 sites received tulsi extract as LAM in the periodontal pocket in addition to SRP. The stent was used to ensure consistent and unbiased measurements on the 30th day after treatment. Clinical attachment level (CAL) and probing pocket depth (PPD) were measured at six points around each tooth.  Results: The reduction in values of periodontal parameters such as BAPNA (Nα-benzoyl-DL-arginine-p-nitroanilide) assays, modified sulcus bleeding index (mSBI), gingival index (GI), plaque index (PI), CAL, and PPD in sites within Category 1, Category 2, and Category 3 was statistically significant. The decrease in BAPNA assay results indicates that tulsi extract is more effective than curcumin gel at eradicating red-complex bacteria. Although not significantly different, the decrease in PI and GI was observed to be greater when curcumin jelly was used. This suggests that curcumin jelly has a stronger impact on reducing plaque, which in turn decreases gingival inflammation. CONCLUSION: Based on the overall results of the study, it can be said that both tulsi and curcumin have similar effectiveness in reducing periodontal markers.

Comparison of the Efficacy of Different Oral Hygiene Aids in Maintaining Periodontal Health in Patients With Gingivitis.

Background Gingivitis is a common oral health condition characterized by inflammation of the gingiva, which, if left untreated, can progress to more severe forms of periodontal disease. Effective oral hygiene practices play a crucial role in managing gingivitis, but the comparative efficacy of different oral hygiene aids remains unclear. This study aimed to evaluate and compare the efficacy of various oral hygiene aids in maintaining periodontal health in patients with gingivitis, considering gender and the degree of gingivitis as potential influencing factors. Methods A total of 120 participants with gingivitis were enrolled in this study. The participants were randomly assigned to one of four groups, each utilizing a different oral hygiene aid: Group A (toothbrush), Group B (electric toothbrush), Group C (brushing along with the use of an interdental brush), and Group D (brushing along with the use of a water flosser). All participants received toothpaste for use with their respective oral hygiene aids. Periodontal health parameters, including plaque index (PI), gingival index (GI), and bleeding on probing (BOP) score, were assessed at baseline and after a specified duration of oral hygiene intervention. Also, the microbial count for Streptococcus, Actinomyces, Porphyromonas, Fusobacterium, and Veillonella species was evaluated. Results No significant differences in periodontal health outcomes were observed between males and females in any of the oral hygiene aid groups. Similarly, no significant differences were found among the mild, moderate, and severe gingivitis groups within each oral hygiene aid group. The microbial count also has no statistical significance except for streptococcus species. These findings indicate that the efficacy of the tested oral hygiene aids was comparable across genders and different degrees of gingivitis. Conclusion The findings of this study suggest that the tested oral hygiene aids were effective in maintaining periodontal health in patients with gingivitis, irrespective of gender and the degree of gingivitis. These results have implications for oral healthcare professionals in their recommendations to patients regarding oral hygiene practices. However, it is important to consider the limitations of this study, including the relatively small sample size and the specific oral hygiene aids tested.

Implant abutment using hand drivers versus torque wrench.

The most frequent instrument used to begin tightening screws is a manually regulated screwdriver. Regarding manually regulated screwdrivers, predicted margins of error vary between fifteen percent to forty eight percent. Mechanical Torque restricting devices can consistently produce the requisite torques. As a result, devices like wrenches are needed to achieve the desirable values of torque. Hence, the present study was designed to evaluate the torque difference between handheld drivers and torque wrench and thereby its effect on the internal threads of implant surface.120 blocks was prepared from an autopolymerizing type of acrylic material each with a dimension of 1 inch. The centre of each block was affixed with analogue of dental impalnts with dimensions of 3.5 mm width and 13 mm length. With 60 specimens each, these models were split into two categories: hand torque specimens category and torque wrench specimens category. A stereomicroscope was used to look at the implant analog's internal threading architecture at a magnification of 100. At the bottom and top, four threads were spaced apart by a certain amount. Biowizard software was used for the assessment, and the results were recorded. Threads on the internal surface of dental implants were produced once more following torquing the implant's impression, and the stereomicroscope was used to quantify the separation between the 4 threads. Statistics were used to correlate the readings. All study participants' hand torque as well as torque wrench measurements were documented and statistical analysis was performed on them. When there was statistical analysis of the measurements then it was observed that mean values of torque in specimens included category of manual torque application was found out to be 33.6 ± 6.510 Ncm. On the other hand the mean values of torque in specimens included in category of torque application by torque wrench were found out to be 33.57 ± 3.472 Ncm. The outcome showed operator heterogeneity for both categories and operator variance when using a manual driver to generate torque. One independent - sample t test was used to contrast the mean data between the two categories, and P< 0.05 was chosen to determine whether the intergroup difference was meaningful. Because the torque values obtained with hand tightening were uneven, it may be concluded that different levels of hand torquing skill caused the torque to fluctuate. The torque wrench device displayed the desired torque data in the range that the manufacturer had advised. However, utilising manual drivers and a mechanical torque instrument did not cause any modifications to thread on the internal surface, and it rarely underwent significant deformation during the preliminary tightening torque readings. Thus, given that manually hand regulated drivers create a range of torques, it may be inferred that the employment of mechanical torque restricting instruments should be required.

Population structure and antimicrobial resistance patterns of Salmonella Typhi and Paratyphi A amid a phased municipal vaccination campaign in Navi Mumbai, India.

We performed whole-genome sequencing of 174 Salmonella Typhi and 54 Salmonella Paratyphi A isolates collected through prospective surveillance in the context of a phased typhoid conjugate vaccine introduction in Navi Mumbai, India. We investigate the temporal and geographical patterns of emergence and spread of antimicrobial resistance. We evaluated the relationship between the spatial distance between households and genetic clustering of isolates. Most isolates were non-susceptible to fluoroquinolones, with nearly 20% containing ≥3 quinolone resistance-determining region mutations. Two H58 isolates carried an IncX3 plasmid containing blaSHV-12, associated with ceftriaxone resistance, suggesting that the ceftriaxone-resistant isolates from India independently evolved on multiple occasions. Among S. Typhi, we identified two main clades circulating (2.2 and 4.3.1 [H58]); 2.2 isolates were closely related following a single introduction around 2007, whereas H58 isolates had been introduced multiple times to the city. Increasing geographic distance between isolates was strongly associated with genetic clustering (odds ratio [OR] = 0.72 per km; 95% credible interval [CrI]: 0.66-0.79). This effect was seen for distances up to 5 km (OR = 0.65 per km; 95% CrI: 0.59-0.73) but not seen for distances beyond 5 km (OR = 1.02 per km; 95% CrI: 0.83-1.26). There was a non-significant reduction in odds of clustering for pairs of isolates in vaccination communities compared with non-vaccination communities or mixed pairs compared with non-vaccination communities. Our findings indicate that S. Typhi was repeatedly introduced into Navi Mumbai and then spread locally, with strong evidence of spatial genetic clustering. In addition to vaccination, local interventions to improve water and sanitation will be critical to interrupt transmission. IMPORTANCE Enteric fever remains a major public health concern in many low- and middle-income countries, as antimicrobial resistance (AMR) continues to emerge. Geographical patterns of typhoidal Salmonella spread, critical to monitoring AMR and planning interventions, are poorly understood. We performed whole-genome sequencing of S. Typhi and S. Paratyphi A isolates collected in Navi Mumbai, India before and after a typhoid conjugate vaccine introduction. From timed phylogenies, we found two dominant circulating lineages of S. Typhi in Navi Mumbai-lineage 2.2, which expanded following a single introduction a decade prior, and 4.3.1 (H58), which had been introduced repeatedly from other parts of India, frequently containing "triple mutations" conferring high-level ciprofloxacin resistance. Using Bayesian hierarchical statistical models, we found that spatial distance between cases was strongly associated with genetic clustering at a fine scale (<5 km). Together, these findings suggest that antimicrobial-resistant S. Typhi frequently flows between cities and then spreads highly locally, which may inform surveillance and prevention strategies.

In vitro Analysis of Surface Roughness Produced by an Air Polishing Device and Conventional Root Planing on Cementum: A Profilometric Study.

Context: Tooth surface polishing is an integral part of periodontal therapy. Enamel and cementum show a smooth surface clinically after debridement with the naked eye, but numerous surface irregularities can be detected microscopically. Air polishing is safe and effective when used by trained professionals. Aims: The aim of the study is to evaluate and compare the surface roughness of cementum by using an air polishing device and conventional root planing with hand instruments. Materials and Methods: A total of 45 extracted teeth stored in saline were divided into three groups randomly - Group A (conventional root planing), Group B (hand instrumentation and air polishing), and Group C (air polishing alone) - with 15 samples each. Samples were evaluated for surface roughness by using profilometer. Six parameters were checked for surface roughness. Statistical Analysis Used: The data were collected, charted, and analyzed using one-way ANOVA with post hoc LSD method for pairwise comparisons. Results: Least amount of surface roughness was achieved with Group C when compared with Group A and Group B. These differences were statistical significant (P < 0.0001). Conclusions: Air polishing can effectively smoothen the root surface by removing surface irregularities which are produced hand/ultrasonic instruments. Profilometer can be effectively used to measure the surface roughness.

Occupational exposures to bloodborne pathogens and its underreporting in dental teaching environment in an Indian dental school.

INTRODUCTION: The aims of this study were 1) to find out the prevalence of occupational exposures to contaminated biological material among undergraduate students and interns; 2) to find out how many cases of occupational exposures to bloodborne pathogens are reported; and 3) to know the reasons for non-reporting of occupational exposures. MATERIALS AND METHODS: The study was conducted in a Dental School in Navi-Mumbai, India. An anonymous self-administered questionnaire was formulated. 210 dental students were given a questionnaire out of which 150 students attending clinical postings in their third year, final year, and internship responded. Approval was obtained from the Institutional Ethical Committee. RESULTS: The study revealed a very high prevalence (66.7%) of exposures among the students. Only 12% of the students reported the exposures to the staff. Students from III year and final year BDS (Bachelor of Dental Surgery) had mean exposure of 2.40 as compared to 1.94 among interns. 46% of the students stated that they did not report about the exposure because they thought that injury was of minor nature. CONCLUSION: There is a very high prevalence of occupational exposures among students which are not reported. There is a need for the development of a post exposure protocol which has to be strictly implemented. The principle of infection control has to be emphasised to the students periodically and they should be encouraged to report incidences of exposures to biological material.

Correlation of gingival thickness with gingival width, probing depth, and papillary fill in maxillary anterior teeth in students of a dental college in Navi Mumbai.

CONTEXT: The gingival biotype is of utmost importance for esthetics and biologic function. Anatomical characteristic of periodontium such as gingival thickness (GT), width of keratinized gingiva, and alveolar bone morphology will determine the behavior of periodontium when subjected to physical, chemical, or bacterial insult or during therapeutic procedure. AIMS: The aim of this study was to correlate the GT with gingival width (GW), probing depth (PD), and papillary fill (PF) in relation to maxillary anterior region. SETTINGS AND DESIGN: Undergraduate dental students and interns from a dental college in Navi Mumbai were enrolled in the study according to the inclusion criteria. Six teeth per subject were assessed; a total of 2178 maxillary anterior teeth were examined. SUBJECTS AND METHODS: Subjects were examined clinically for GT, width of keratinized gingiva, pocket depth, and interdental PF. The data obtained was tabulated and subjected to statistical analysis. STATISTICAL ANALYSIS USED: Spearman's correlation analysis test was performed to find the correlation of GT with GW, PD, and PF. RESULTS: Positive correlation was found between GT and GW (r = 0.241). No significant correlation could be found between GT and PD; and between GT and PF. CONCLUSIONS: The present study confirmed a positive correlation between GT and GW. A weak negative correlation was found between GT and PD.

Genetic diversity of 17 Y-short tandem repeats in Indian population.

Seventeen short tandem repeats (DYS389I, DYS390, DYS389II, DYS19, DYS385a/b, DYS393, DYS391, DYS392, DYS439, DYS438, DYS456, DYS458, DYS635, Y(GATA)H4, DYS437, and DYS448) from the non-recombining region of the human Y-chromosome were analyzed in 750 unrelated males representing four major linguistic families of India using AmpFlSTR(®) Yfiler(®) PCR Amplification kit. A total of 612 distinct haplotypes were observed, of which 545 were unique. Rare alleles for the loci DYS456, DYS458, DYS635, Y(GATA)H4, and duplication at the loci DYS389I and DYS389II were also observed. To understand the genetic diversity of the Indian population, and utility of Y-STRs in forensics, the locus diversity, haplotype diversity, and discrimination capacity in all populations was determined. MDS plot based on pairwise Φ(st) and AMOVA revealed the high genetic heterogeneity among the Indian populations due to linguistic diversity and social stratification.

Papillon-Lefevre syndrome: A report of two cases.

Papillon-Lefevre syndrome is a rare (1-4 cases per million) autosomal recessive disorder showing predominantly oral and dermatological manifestations in the form of aggressive periodontitis affecting both primary and permanent dentition and palmoplantar hyperkeratosis. Genetic studies have shown that mutations in the major gene locus of chromosome 11q14 with loss of function of cathepsin C gene are responsible for Papillon-Lefevre syndrome. This report presents two siblings with classic signs and symptoms of Papillon-Lefevre syndrome. The exact cause for periodontal destruction in patients with Papillon-Lefevre syndrome is not known but it is thought to be due to defect in neutrophil function, immune suppression and mutations in cathepsin C gene.