Role of neuroinflammation mediated potential alterations in adult neurogenesis as a factor for neuropsychiatric symptoms in Post-Acute COVID-19 syndrome-A narrative review.

Persistence of symptoms beyond the initial 3 to 4 weeks after infection is defined as post-acute COVID-19 syndrome (PACS). A wide range of neuropsychiatric symptoms like anxiety, depression, post-traumatic stress disorder, sleep disorders and cognitive disturbances have been observed in PACS. The review was conducted based on PRISMA-S guidelines for literature search strategy for systematic reviews. A cytokine storm in COVID-19 may cause a breach in the blood brain barrier leading to cytokine and SARS-CoV-2 entry into the brain. This triggers an immune response in the brain by activating microglia, astrocytes, and other immune cells leading to neuroinflammation. Various inflammatory biomarkers like inflammatory cytokines, chemokines, acute phase proteins and adhesion molecules have been implicated in psychiatric disorders and play a major role in the precipitation of neuropsychiatric symptoms. Impaired adult neurogenesis has been linked with a variety of disorders like depression, anxiety, cognitive decline, and dementia. Persistence of neuroinflammation was observed in COVID-19 survivors 3 months after recovery. Chronic neuroinflammation alters adult neurogenesis with pro-inflammatory cytokines supressing anti-inflammatory cytokines and chemokines favouring adult neurogenesis. Based on the prevalence of neuropsychiatric symptoms/disorders in PACS, there is more possibility for a potential impairment in adult neurogenesis in COVID-19 survivors. This narrative review aims to discuss the various neuroinflammatory processes during PACS and its effect on adult neurogenesis.

Perspective and practice of root caries management: a multicountry study - Part I.

BACKGROUND: Every effort needs to be made to better understand the current state of practice and trends relating to root caries management which will be of benefit to dentists universally in the practice of dentistry. AIM: This article presents a multicountry questionnaire survey of the current state of practice in the management of root caries among dentists in nine different countries to get a wider range of opinions and perspectives. METHODOLOGY: A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among groups. RESULTS: The results showed statistically significant differences among dentists in most questionnaire aspects. Bleeding is the greatest obstacle facing dentists when restoring root surface lesions. Reported survival rates reflect uncertainty about the material and/or approach of choice in the management of root surface caries. CONCLUSION: This questionnaire survey revealed the current status of management of root surface caries in clinical practice in various countries. Substantial attention is required to bridge the knowledge gap and address the current void of uncertainty as relates to root caries management by providing a common ground for communication between dentists from all around the globe. In all, this work found a degree of consensus at the international level on what appears to work well among the dental practices surveyed and identified several issues with existing approaches that need to be addressed in future studies.

Perspective and practice of root caries management: A multicountry study - Part II: A deeper dive into risk factors.

BACKGROUND: The potential of an improved understanding to prevent and treat a complex oral condition such as root caries is important, given its correlation with multiple factors and the uncertainty surrounding the approach/material of choice. Deeper insights into risk factors may improve the quality of treatment and reduce the formation of root surface caries. AIM: The present work aims to gain knowledge about dentists' opinions and experiences on assessing the risk factor related to the development of root caries and to help identify any overlooked factors that may contribute to less efficacious clinical outcomes. METHODOLOGY: A questionnaire related to root surface caries was distributed among practicing dentists in nine different countries, namely the United Kingdom, Libya, Jordan, Saudi Arabia, Egypt, Brazil, India, Malaysia, and Iraq. Questionnaire responses were analyzed, and the results were compared among the groups. RESULTS: Dentists around the world ranked the oral hygiene status of patients as the most important factor in the development of root surface caries. Patients with poor oral hygiene, active periodontal disease, reduced salivary flow, and gingival recession are perceived to have a higher risk of developing new root surface caries. There is a greater focus on prevention in the UK and greater levels of untreated dental disease in other countries, especially those recovering from civil wars. CONCLUSION: This work identified some overlooked factors that may have contributed to the less efficacious clinical outcomes reported in the literature. It is hoped that this deep dive into risk factors coupled with the findings presented in Part I of this study will be used as a basis for a more comprehensive investigation into the management of patients with root surface caries.

Arabian undergraduates perceptions regarding barriers among the geriatric patients for failing to keep dental appointments: A cross-sectional study.

BACKGROUND: Regular visits to the health care providers can develop a relationship that can extend beyond the physical health alone as the patient is transiting towards older age, adapting to changes in physical health, emotional health, and social connections. Apart from limiting access to health care services, the attitudes, beliefs, comfort level of the treating doctors towards the geriatric patients can motivate or demotivate them to access dental care. AIM: To explore the Saudi Arabian undergraduate students perception of geriatric patients and identify potential barriers that prevent the utilization of their dental appointment. METHODS: A close-ended questionnaire with one question and eight reasons was administered to the fifth year clinical students. The students were requested to specify their agreement with each question on a 5-point Likert scale. Among the barriers presented, each reason's approval was expressed as the percentage of the total number of responses. In addition, the gender comparison of mean scores was made, and an independent sample t-test was used to analyze the statements agreed by the students. All analyses were performed using Statistical Package of Social Sciences (SPSS) version 21.0 (IBM, USA) with the probability of statistical significance at 0.05 level. RESULTS: Fifty-one students recorded their perceptions on the questionnaire administered during their clinical posting in the fifth year of the geriatric dental education program. It was concluded that students believed that geriatric patients give overwhelming importance to other problems with minor importance to oral health care. In addition, gender comparison was more evident as the percentage expressed was more in females. CONCLUSIONS: There is a need for more clinical exposure of geriatric patients during their clinical postings. Student's acquaintance with didactic and clinical settings appears to be a critical element towards positive knowledge and attitude towards the geriatric population.

Risk factors and patterns of traumatic dental injuries among Indian adolescents.

BACKGROUND/PURPOSE: Dental injuries in children have functional, esthetic, and psychological effects, with consequences for the child, parent, and dentist. This study assessed the pattern of traumatic dental injuries and their relationship with predisposing factors among 12- and 15-year-old school children in Kanpur, India. MATERIALS AND METHODS: A cross-sectional study was conducted on 1100 boys and girls aged 12 or 15 years. Anterior permanent teeth were examined based on the modified Ellis classification. Type of damage, size of incisal overjet, and adequacy of lip coverage were also recorded. Chi-square tests and multiple regression analysis were used for statistical analysis. RESULTS: The prevalence of traumatic dental injuries to anterior teeth was 10.9%. Age and gender distribution indicated that most injuries occurred in 15-year-old age group (11.3%) and among boys (11.5%). The gender-related difference was statistically significant (p < 0.024). Maxillary central incisors (83.7%) were frequently involved. The predominant injury type was enamel fracture (68.3%) mainly due to falls (52.5%). Increased overjet, inadequate lip coverage, type of school, and gender were significant contributing factors for traumatic dental injuries. CONCLUSION: Study reveals the frequency and cause of traumatic injuries to anterior teeth, which assists in identifying risk groups and treatment needs in order to establish effective preventive strategies.

The Role of Faculty Development in Improving the Quality of Multiple-Choice Questions in Dental Education.

Valid and reliable assessment of students' knowledge and skills is integral to dental education. However, most faculty members receive no formal training on student assessment techniques. The aim of this study was to quantify the value of a professional development program designed to improve the test item-writing skills of dental faculty members. A quasi-experimental (pretest, intervention, posttest) study was conducted with faculty members in the dental school of Majmaah University, Saudi Arabia. Data assessed were 450 multiple-choice questions (MCQs) from final exams in 15 courses in 2017 (prior to the intervention; pretest) and the same number in 2018 (after the intervention; posttest). The intervention was a faculty development program implemented in 2018 to improve the writing of MCQs. This training highlighted construct-irrelevant variance-the abnormal increase or decrease in test scores due to factors extraneous to constructs of interest-and provided expert advice to rectify flaws. Item analysis of pre- and post-intervention MCQs determined the difficulty index, discrimination index, and proportion of non-functional distractors for each question. MCQs on 2017 and 2018 exams were compared on each of these parameters. The results showed statistically significant improvements in MCQs from 2017 to 2018 on all parameters. MCQs with low discrimination decreased, those with high discrimination increased, and the proportion of questions with more than two non-functional distractors were reduced. These results provide evidence of improved test item quality following implementation of a long-term faculty development program. Additionally, the findings underscore the need for an active dental education department and demonstrate its value for dental schools.

Maternal Mortality due to Eclampsia in Khyber Pakhtunkhwa: Identifying Underlying Risk Factors, and Care-seeking Behaviours.

OBJECTIVE: To identify the characteristics of women at risk of death due to eclampsia, and steps to improve maternal outcome. METHODS: This study is a part of a retrospective study conducted in 2016 and included Mansehra, Swabi, Haripur, Nowshera, Kohat, and Dera Ismail Khan districts of the Khyber Pakhtunkhwa province of Pakistan, and used information cited by a 2016 study to estimate the maternal mortality rate in the province based on data pertaining to the 2013-14 period. The Maternal Death from Informants / Maternal Death Follow-on Review method was applied to identify the magnitude, causes and circumstances of maternal deaths in the province. SPSS 21 was used for data analysis. RESULTS: Of the 958 cases of maternal death identified, 167(17%) were related to eclampsia. The median age of such women was 28 years (interquartile range: 11 years). Of them, 88 (53%) died undelivered, 48 (29%) had a live birth while 31 (18%) had a stillbirth or abortion. Mothers aged 25 years or above (p<0.01), primiparous (p<0.01) and those with a previous history of stillbirth (p<0.005) carried higher risk, while higher socioeconomic status had a protective effect (p<0.007). CONCLUSIONS: Eclampsia deaths can be prevented through Continuum of Care approach and by ensuring provision of basic health facilities across the board.

Evaluation of Bond Failure Rate of Orthodontic Brackets Bonded with Green Gloo-Two Way Color Changes Adhesive: A Clinical Study.

BACKGROUND: Bonding is an important step in fixed orthodontic mechanotherapy. Many new materials introduced an adhesive for bonding. This study was designed to evaluate the clinical bond failure rate of orthodontic brackets bonded with green glue: two way color changes adhesive and transbond XT adhesive paste. METHODS: Eighteen male patients with a mean age of 16 years were included in the study. Convenience sampling technique was used to select the sample for this study. The split-mouth design was used to bond 360 brackets by one operator and both adhesives were used in each patient. Bond failure rates were estimated with respect to bonding procedure, dental arch, tooth type (incisor, canine, and premolar). The results were evaluated using the chisquare test. Kaplan - Meier analysis and the log rank test were used to estimate the survival rate of the brackets. Bracket failure rates for each system were analyzed, and failure causes as reported by the patients and the quadrant of each tooth in which brackets failed were recorded. RESULTS: The bond failure rate was 5.00% and 4.44% for green gloo and transbond XT group. No significant difference was found in the bond failure rate between transbond XT and Green gloo group. No significant difference was found in the bond failure rate between the two groups, in relation to right and left side and the type of teeth. CONCLUSION: Green gloo adhesive can be effectively used to bond orthodontic brackets.

Impact of an IEC (Information, Education and Communication) intervention on key family practices of mothers related to child health in Jamshoro, Sindh.

OBJECTIVE: To determine change in practice of mothers having children less than five years of age in five key areas related to child health, growth and development including immunization, feeding during illness, appropriate home treatment for infections and care seeking behavior. METHODS: This was a community based interventional study of Information, Education and Communication (IEC) intervention in the UC Jamshoro, Taluka Kotri, district Jamshoro of 15 months duration from March 2011 to June 2012. Ninety five mothers having children less than five years of age were selected by systematic random sampling for house hold based survey by questionnaire designed by EPP evaluation and health section of UNICEF during baseline and post-intervention phases. Base line data was collected from the interventional area then health education messages were given through written and pictorial material by LHWs for 9 months. To measure the impact helath education messages, data was again collected by same questionnaire are from the same union council during post-intervention phase. RESULTS: During baseline survey except immunization all other key family practices were poor. After 9 months of intervention of repeated heath education sessions through LHW during their routine visits all practices were improved with statistically significant difference. Regarding the comparison of the results between baseline and post-intervention surveys we found that except immunization which was already better, all those practices which requires mother's knowledge and practice were improved after our intervention with significant P-values. CONCLUSIONS: Improving the mother's education level is very important, to empower the first care provider of child in the community. However, in the mean time, health educational messages related to the limited number of key family practices should be disseminated.

Determination of sodium hyaluronate in pharmaceutical formulations by HPLC-UV.

A liquid chromatography (HPLC) method with UV detection was developed for determination of sodium hyaluronate in pharmaceutical formulation. Sodium hyaluronate is a polymer of disaccharides, composed of d-glucuronic acid and d-N-acetylglucosamine, linked via alternating ß-1, 4 and ß-1, 3 glycosidic bonds. Being a polymer compound it lacks a UV absorbing chromophore. In the absence of a UV absorbing chromophore and highly polar nature of compound, the analysis becomes a major challenge. To overcome these problems a novel method for the determination of sodium hyaluronate was developed and validated based on size exclusion liquid chromatography (SEC) with UV detection. An isocratic mobile phase consisting of buffer 0.05 M potassium dihydrogen phosphate, pH adjusted to 7.0 using potassium hydroxide (10%) was used. Chromatography was carried out at 25 °C on a BioSep SEC S2000, 300 mm×7.8 mm column. The detection was carried out using variable wavelength UV-vis detector set at 205 nm. The compounds were eluted isocratically at a steady flow rate of 1.0 mL/min. Sodium hyaluronate retention time was about 4.9 min with an asymmetry factor of 1.93. A calibration curve was obtained from 1 to 38 g/mL (r>0.9998). Within-day % RSD was 1.0 and between-day % RSD was 1.10. Specificity/selectivity experiments revealed the absence of interference from excipients, recovery from spiked samples for sodium hyaluronate was 99-102. The developed method was applied to the determination of sodium hyaluronate in pharmaceutical drug substance and product.

Tracing disease gene(s) in non-syndromic clefts of orofacial region: HLA haplotypic linkage by analyzing the microsatellite markers: MIB, C1_2_5, C1_4_1, and C1_2_A.

BACKGROUND: Cleft lip with or without cleft palate (CL/P) is the most frequent craniofacial malformation seen in man. The etiology of CL/P is complex involving both genetic and epigenetic (environmental) factors, and the genes play an almost deterministic role in the normal development of craniofacial structures. This study was aimed at ascertaining the association of HLA microsatellites in CL/P patients. MATERIALS AND METHODS: Case DNA was obtained from 76 patients (40M and 36 F, average age 7.8 years, range 1-16 years). Unaffected individuals from the same geographical area without population mixing included as controls (n=154, 76 M and 78 F, average age 8.2 years, range 2-17 years). All DNA samples were purified from peripheral blood by standard techniques. RESULTS: Four microsatellites were compared in this case-control study. C1_2_5 locus was the most polymorphic marker with 15 observed alleles while C1_4_1 had the least number of alleles. Three of the four markers viz MIB,C1_4_1 and C1_2_5 showed a significant association of microsatellite alleles with CL/P. Five alleles (MIB_326,332,350; C1_4_1 - 213 and C1_2_5-204) were seen with an increased frequency among the test samples, whereas two alleles (C1-4_1_217, and C1_2_5_196) had an increased frequency among the control samples. One allele (C1-4-1-209) had an increased frequency in patient group but was not observed in the controls. CONCLUSION: The role of HLA complex in the pathogenesis of CL/P is speculative and has not been established so far. The result of this study shows that a few alleles have an increased frequency of expression in the diseased group which suggests that these alleles may predispose the individuals to clefting. This finding may be beneficial to aid in early diagnosis and plan intervention strategies.

A simple and rapid high-performance liquid chromatographic method for determining tobramycin in pharmaceutical formulations by direct UV detection.

BACKGROUND: Tobramycin, an aminoglycoside antibiotic, is a polar pharmaceutical compound which lacks a UV absorbing chromophore. Due to the absence of a UV absorbing chromophore and high polar nature of this antibiotic, the analysis of such compounds becomes a major challenge. OBJECTIVE: To overcome these problems, a novel method for the determination aminoglycoside tobramycin was developed and validated based on reversed-phase high-performance liquid chromatography (RP-HPLC) with UV detector. MATERIALS AND METHODS: An isocratic mobile phase consists of buffer 0.05 M diammonium hydrogen phosphate, pH adjusted to 10.0 using tetramethyl ammonium hydroxide. Chromatography was carried out at 25°C on a Purosphere RP-8e, 250 mm × 4.6 mm, 5mm. The detection was carried out using variable wavelength UV-Vis detector set at 210 nm. The compounds were eluted isocratically at a steady flow rate of 1.0 mL/min. RESULT AND DISCUSSION: Tobramycin retention time was about 9.0 min with an asymmetry factor of 1.4. A logarithmic calibration curve was obtained from 0.47 to 0.71 mg/mL (r > 0.9998). Within-day %RSD was 0.29 (n = 6, 0.60 mg/mL) and between-day %RSD was 0.54 Specificity/ selectivity experiments revealed the absence of interference from excipients, recovery from spiked samples was between 99.0-100.0 percent. CONCLUSIONS: A HPLC method based on UV detection has been developed and validated for determination of tobramycin from ophthalmic solution. The method is simple, rapid, specific, accurate (error 0.80%), precise (RSD <2.0%) and linear (r2=0.9998). The described method is suitable for routine analysis and quality control of ophthalmic solution containing tobramycin.

Outcome of cervical disectomy and fusion with stabilization in single level cervical disc.

BACKGROUND: Cervical radiculopathy is a common and distressing problem. Only those patients who failed conservative treatment should undergo surgery. The anterior cervical disectomy is the procedure which offers maximal exposure of the disc space. It easily removes the portion of disc which compresses the nerve root. Possibility of developing late kyphosis from disc space collapse supported the fusion procedure after single level disectomy. The goal of instrumentation is to provide immediate stability, increase fusion rate, prevent graft failure, improve rehabilitation process and possibly no need for external orthosis. Objective of study was To see the results and complications of cervical disectomy thru anterior approach and fusion and stabilisation with titanium made plate. METHODS: This was a prospective study, comprised of 32 patients admitted during period from 2005-2008. Patients presented with radiculopathy or radiculo-myelopathy were evaluated. MRI was carried out in all the cases. Each patient was carefully evaluated to confirm clinico-radiological correlation and patients with significant disc and failure of conservative treatment were included in the study. RESULTS: Males were 28 (87.5%) and female were 4 (12.5%). Twenty patients (62.5%) were in fourth decade. C5-6 was involved in 18 (56.25%) patients. No significant postoperative complications noted. Persistent neck and back pain noted in patients in disectomy group without plating. CONCLUSION: Anterior cervical disectomy, fusion and stabilisation with plating is a safe and easy procedure in single level cervical disc disease without significant complications.

A simple RP-HPLC method for the simultaneous quantitation of chlorocresol, mometasone furoate, and fusidic acid in creams.

A simple, specific, and precise high-performance liquid chromatographic method is developed and validated for the simultaneous determination of chlorocresol (CC), mometasone furoate (MF), and fusidic acid (FA) in a cream formulation. The isocratic mobile phase consists of 1.5% w/v aqueous ammonium acetate buffer-acetonitrile, 55:45 (v/v) of pH 3.8. The column contains octylsilyl chemically bonded to porous silica particle (Symmetry C8, 150x3.9 mm, 5 microm). The detection is carried out using variable wavelength UV-vis detector set at 240 nm. The solutions are chromatographed at a steady flow rate of 1.0 mL/min. The current method separates CC, MF, and FA in less than 8 min with good resolution and peak shapes, minimal tailing, and with retention factors between approximately 1 and 5. Linearity range and percent recoveries for CC, MF, and FA are 10-30, 10-30, and 200-600 microg/mL; and 100.31%, 100.38%, and 100.34%, respectively. The method is validated according to International Conference on Harmonization guidelines and proven to be suitable for stability testing, content uniformity testing, and quality control of these compounds in pharmaceutical preparations.

A simple and rapid high-performance liquid chromatographic method for the determination of bisoprolol fumarate and hydrochlorothiazide in a tablet dosage form.

A simple and precise high performance liquid chromatographic method has been developed and validated for the simultaneous determination of bisoprolol fumarate (BF), and hydrochlorothiazide (HCTZ) in a tablet formulation. Chromatography was carried out at 25 degrees C on a 4.6 mm x 250 mm, 5 microm cyano column with the isocratic mobile phase of 0.1M aqueous phosphate buffer, acetonitrile and tetrahydrofuran (85:10:5, v/v/v) at a flow rate of 1.0 ml/min. The UV detection was carried out at 225 nm. HCTZ and BF were separated in less than 10 min with good resolution and minimal tailing, without interference of excipients. The method was validated according to ICH guidelines and the acceptance criteria for accuracy, precision, linearity, specificity and system suitability were met in all cases. The method was linear in the range of 50-150 microg/ml for BF and 125-375 microg/ml for HCTZ.

Development and validation of a selective online dissolution method for rosiglitazone maleate.

A new specific, accurate, precise, and reproducible selective online dissolution method for rosiglitazone maleate is developed and validated for the dissolution of rosiglitazone maleate in pharmaceutical formulations. The rationale of the method is based on the direct measurement of the absorbance of the analyte in the buffer medium at 242 nm using buffer as blank. Dissolution is achieved on a dissolution test apparatus consisting of photo diode array spectrophotometer, peristaltic pump, and temperature controller, using 0.01N HCl and 0.05M potassium chloride as the dissolution medium. The proposed method is developed, optimized, and validated in terms of linearity, reproducibility, accuracy, and selectivity for the dissolution of rosiglitazone maleate in pharmaceutical formulations. The method is found to be linear in the range of 1 to 14 microg/mL of rosiglitazone maleate with a correlation coefficient of 0.999. The dissolution studies of rosiglitazone maleate tablets obtained by the proposed method are in good agreement with those by high-performance liquid chromatography.

Pentoxifylline therapy: a new adjunct in the treatment of oral submucous fibrosis.

OBJECTIVE: This study was designed to determine the effect of pentoxifylline (Trental) on the clinical and pathologic course of oral submucous fibrosis. This drug is a methylxanthine derivative that has vasodilating properties and was envisaged to increase mucosal vascularity. STUDY DESIGN: This investigation was conducted as a randomized clinical trial incorporating a control group (Standard drug group SDG, multivitamin, and local heat therapy) in comparison to pentoxifylline test cases (Experimental drug group EDG, 400mg 3 times daily, as coated, sustained release tablets). The stipulated treatment period was 7 months and a total of 29 cases of advanced fibrosis (14 test subjects and 15 age and sex matched diseased controls) were included in this study and 100% compliance was reported at the end ofthe test period. RESULTS: Mild gastric irritation that could be managed by diet protocols was the only untoward symptom reported during this trial. Review of the patients and controls was done at an interval of 30 days and subjective and objective measurements were recorded. The follow up data at each visit with respect to each other and to base-line values was calibrated using a nonparametric test of Mann-Whitney (Kruskal-Wallis test). Significant comparisons with regard to improvement were recorded as objective criteria of mouth opening (t=11.285, p= 0.000), tongue protrusion (t= 3.898, p = 0.002), and relief from perioral fibrotic bands (p = 0.0001554). Subjective symptoms of intolerance to spices (p = 0.0063218), burning sensation of mouth (p = 0.0005797), tinnitus (p=0.000042), difficulty in swallowing (p=0.0000714). and difficulty in speech (p=0.0000020) were also recorded significant improvement at the end of the trial period. CONCLUSION: This pilot investigation points to the effectiveness of pentoxifylline as an adjunct therapy in the routine management of oral submucous fibrosis.