Myocardial extracellular volume fraction radiomics analysis for differentiation of reversible versus irreversible myocardial damage and prediction of left ventricular adverse remodeling after ST-elevation myocardial infarction.

OBJECTIVES: Our study sought to explore the prognostic value of radiomic TA (texture analysis) on quantitative ECV (extracellular volume) fraction mapping to differentiate between reversible and irreversible myocardial damage and to predict left ventricular adverse remodeling in patients with reperfused STEMI (ST-elevation myocardial infarction). METHODS: This observational prospective cohort study identified 70 patients (62 ± 9 years, 62 men [85.70%]) with STEMI for TA who consecutively performed native and contrast T1 mapping. Texture features were extracted from each stack of ECV mapping based on ROI (region of interest) analysis. RESULTS: After texture feature selection and dimension reduction, five selected texture features were found to be statistically significant for differentiating the extent of myocardial injury. ROC (receiver operating characteristic) curve analysis for the differentiation of unsalvageable infarction and salvageable myocardium demonstrated a significantly higher AUC (area under the curve) (0.91 [95% CI, 0.86-0.96], p < 0.0001) for horizontal fraction than other texture features (p < 0.05). LVAR (left ventricular adverse remodeling) was predicted by those selected features. The differences in qualitative and quantitative baseline parameters and horizontal fractions were significant between the patients with and without LVAR. LGE (late gadolinium enhancement) and horizontal fraction features of infarcted myocardium in acute STEMI were the only two parameters selected in forming the optimal overall multivariable model for LVAR at 6 months. CONCLUSIONS: Radiomic analysis of ECV could discriminate reversible from irreversible myocardial injury after STEMI. LGE as well as radiomics TA (texture analysis) of ECV may provide an alternative to predict LVAR and functional recovery. KEY POINTS: • ECV quantification was able to differentiate between infarcted myocardium and non-infarcted myocardium. • Radiomics analysis of ECV could discriminate reversible from irreversible myocardial injury. • Radiomics TA analysis shows a promising similarity with LGE findings which could aid the prognosis of myocardial infarction patients.

Correction to: Non-contrast MRI for breast screening: preliminary study on detectability of benign and malignant lesions in women with dense breasts.

In the original version of the article, the image of Figure 2 was erroneously duplicated as Figure 4. The correct version of Figure 4 is given below. The original article has been corrected.

Non-contrast MRI for breast screening: preliminary study on detectability of benign and malignant lesions in women with dense breasts.

PURPOSE: The importance of breast cancer screening has long been known. Unfortunately, there is no imaging modality for screening women with dense breasts that is both sensitive and without concerns regarding potential side effects. The purpose of this study is to explore the possibility of combined diffusion-weighted imaging and turbo inversion recovery magnitude MRI (DWI + TIRM) to overcome the difficulty of detection sensitivity and safety. METHODS: One hundred and seventy-six breast lesions from 166 women with dense breasts were retrospectively evaluated. The lesion visibility, area under the curve (AUC), sensitivity and specificity of cancer detection by MG, DWI + TIRM, and clinical MRI were evaluated and compared. MG plus clinical MRI served as the gold standard for lesion detection and pathology served as the gold standard for cancer detection. RESULTS: Lesion visibility of DWI + TIRM (96.6%) was significantly superior to MG (67.6%) in women with dense breasts (p < 0.001). There was no significant difference compared with clinical MRI. DWI + TIRM showed higher accuracy (AUC = 0.935) and sensitivity (93.68%) for breast cancer detection than MG (AUC = 0.783, sensitivity = 46.32%), but was comparable to clinical MRI (AUC = 0.944, sensitivity = 93.68%). The specificity of DWI + TIRM (83.95%) was lower than MG (98.77%), but higher than clinical MRI (77.78%). CONCLUSIONS: DWI combined with TIRM could be a safe, sensitive, and practical alternative for screening women with dense breasts.

Incidence of occupational injuries among adults residing in a selected rural area of India: A cross sectional study.

OBJECTIVES: The objectives of this study were to assess the incidence and profile of occupational injuries among rural workers of rural India. METHODS: This study was conducted among all persons between the ages of 18 to 60 years and engaged in some occupation and residing in the villages under the three rural subcentres of Sarjapur Primary Health Centre during the time period of 2009-2012. The sample size was calculated to be 400 assuming a prevalence of 10% and absolute precision of 3% at 95% confidence limits and a systematic random sampling of the household was done to select the study population. RESULTS: The incidence of occupational injuries in the study period of 2009-2012 was 22%. Out of the total 91 injuries, the proportion of injuries, which were agriculture-related, was 62%. The most common cause of injury was due to contact with plant thorns. Above half (54%) involved the upper limbs, and (30%) involved the lower limbs. By using the injury severity scale, 88% were of minor degree. 67% required treatment and 32% of the injured persons took treatment in a private hospital. Those who sustained an injury, 9% required admission to a hospital. Three participants have sustained a permanent disability during this study. CONCLUSION: The Incidence of occupational injuries was found to be 22% and agriculture showed to have the highest proportion of injuries.

Awareness of Mouth Cancer Among Adult Dental Patients Attending the Kuwait University Dental School Clinic.

In Kuwait, the age-standardized incidence rate (per 100,000) for oral cancer is 1.5 and the mortality rate is 0.4. Early detection of oral cancer combined with appropriate treatment greatly improves the chances of cure and the quality of life. However, little is known about patient awareness of this disease and the ability to identify early signs, particularly among high-risk groups. Hence, the aim of this study is to assess dental patients' awareness and knowledge of mouth cancer and beliefs and perceptions about risk factors. A self-administered questionnaire was used to collect information from a convenience sample of outpatients attending the dental admission clinic. The questionnaire included questions to ascertain information on socio-demographic characteristics, knowledge of risk factors, and signs of oral cancer as well as sources of information regarding the same. Data were analyzed using the Statistical Package for the Social Sciences for Windows 19.0. A total of 160 questionnaires were distributed out of which 136 completed questionnaires were returned and used for the study. The mean knowledge score for oral cancer risk factors was found to be 5.2 ± 2.7 out of ten while that of signs and symptoms was 3.4 ± 2.7 out of eight. When the knowledge of risk factors of oral cancer was taken into consideration along with variables, significant difference was seen only in sex with women having better knowledge (p = 0.03). Knowledge about signs and symptoms of oral cancer revealed a highly significant difference with the level of education (p = 0.03). Family, friends, and colleagues were mentioned as the main source of information regarding oral cancer. Our findings suggest that knowledge regarding oral cancer risk factors, signs, and symptoms was found to be lacking among the dental patients which emphasizes the need for patient education at the dental centers as well as public awareness programs.

Effect of periodontal ligament removal with gauze prior to delayed replantation in rabbit incisors on rate of replacement resorption.

BACKGROUND/AIM: Delayed (dry storage > 60 minutes) replantation results in ankylosis and replacement resorption. It has been suggested to remove the non-viable periodontal ligament before replantation to possibly reduce the rate of replacement resorption. However there has been no study on the rate of replacement resorption after such measures. The aim of this study was to investigate if there was any difference in the rate of replacement resorption by either removing the periodontal ligament (PDL) with gauze or not removing PDL in teeth subjected to delayed replantation followed by healing for 2 or 6 weeks. MATERIALS AND METHODS: Maxillary central incisors were extracted in 8 rabbits. In the right central incisors, the necrotic PDL was removed by dry gauze over the root surface. In the left eight extracted teeth PDL was left on the root surface. All extracted teeth were left to dry for 60 minutes. Extra-oral root canal treatment was performed before replantation. The rabbits were sacrificed after 2 weeks and 6 weeks respectively. Histologic processing and evaluation was done. RESULTS: In the 2 weeks group, all teeth showed ankylosis. The cementum was intact, and fusion of the bone and root was generally seen without resorption of the root, whereas in the 6 weeks group regardless of whether PDL had been kept or not, ankylosis and osseous replacement of the dentin was seen. There was no evidence of inflammatory infiltrate in the sections examined. CONCLUSION: Removal of PDL prior to delayed replantation may result in some initial protection of the cementum during the first few weeks. However, over longer times there seems to be neither protection of the dentin from ankylosis and osseous replacement, nor any influence on the rate of replacement resorption.

Shift work disorder and its related factors among health-care workers in a Tertiary Care Hospital in Bangalore, India.

BACKGROUND & OBJECTIVE: Shift work disorder is the presence of excessive day time sleepiness and insomnia affecting people whose work hours overlap with the typical sleep period. Shift work has pronounced effect on physical and mental health of an individual. Our objective was to estimate the prevalence of symptoms of shift work disorder and the factors associated with it among hospital staff in a tertiary care hospital in Bangalore, India. METHODS: This cross-sectional study was conducted at a private teaching tertiary hospital among 318 hospital workers in Bangalore during September to December 2015. Stratified random sampling method was used and the study population was divided into five strata based upon their parent department. Socioeconomic details, work profile and standard tools- Insomnia severity index, The Epworth sleepiness scale and the FACIT fatigue scale were used. RESULTS: Of the 318 workers, 290 (91.2%) were females, between 21-25 years of age. Most had work experience of ≤4 years (77.6%). Insomnia was reported among 39.9%, and fatigue among 4.7% of hospital staff. Around 19.8% staff had excessive daytime sleepiness out of which 2.8% warranted medical attention. CONCLUSION: Periodic screening during annual medical check-ups and health education on practicing good sleep hygiene will help address this important issue of shift work disorders among workers.

Healing of soft tissue lacerations in diabetic-induced rats.

BACKGROUND/AIM: Prevalence and incidence of diabetes are increasing and many dental trauma patients today have diabetes. The implications of delayed wound healing, associated with diabetes mellitus, on oral mucosal wound healing have not been investigated extensively. The aim of this study was to investigate the implications of diabetes mellitus on the cellular, vascular, and fibroblastic changes induced by laceration on the oral mucosa of Wistar rats. MATERIALS AND METHODS: Sixteen female Wistar rats were randomly assigned into two groups: 1. Experimental Streptozotocin-induced diabetic group (8 rats). 2. Control group (8 rats). A standardized laceration injury was induced from the corner of the mouth to the mid-check penetrating through dermal and oral mucosal contaminated by saliva. Samples were taken from the rats after sacrificing them on days 1,3,7, and 10. Inflammation was evaluated both qualitatively and quantitatively. Two investigators evaluated samples in a blinded manner. RESULTS: Histology reports indicated delayed wound healing patterns in diabetic rats through days 1, 3, 7, and 10 when compared to controls. Inflammation was also noted to be consistently present more often in diabetic rats. Furthermore, polymorphonuclear cell count was consistently higher in diabetic rats. CONCLUSION: The results suggest that oral mucosa wound healing is delayed in diabetic Wistar rats compared to non-diabetic rats in terms of wound closure, angiogenesis, and polymorphonuclear cells number. Furthermore, it is also suggested that wound healing is impaired both in the early and late stages of soft tissue wound healing.

The oral-systemic disease connection: a retrospective study.

OBJECTIVES: The study aimed at determining the association between oral disease and systemic health based on panoramic radiographs and general health of patients treated at Kuwait University Dental Center. The objective was to determine whether individuals exhibiting good oral health have lower propensity to systemic diseases. MATERIALS AND METHODS: A total of 1000 adult patients treated at Kuwait University Dental Center were randomly selected from the patient's records. The general health of patients was assessed from the medical history of each patient recorded during their visit to the clinic. The number of reported diseases and serious symptoms were used to develop a medical index. The oral health of these patients was assessed from panoramic radiographs to create an oral index by evaluating such parameters as caries, periodontitis, periapical lesions, pericoronitis, and tooth loss. RESULTS: In a total of 887 patients, 43.8 % had an oral index between 3 and 8, of which significantly higher (62.1 %) patients were with medical conditions compared to those without (33.2 %; p < 0.001). The Spearmans's correlation (rho') revealed a positive correlation (rho' = 0.360, p 0.001) between oral and medical index. Partial correlation, while controlling demographics, gender, nationality, and age, also showed a significant positive correlation (p < 0.001) between medical and oral index. CONCLUSIONS: The findings of this study showed a significant association between oral health and general health and confirmed the findings of previous reports as regards the existing correlation between dental infections and medical disorders. These results are not indicative of a causal relationship when the diagnosis of oral disease was based primarily on radiographic findings. Future research needs to include prospective clinical and interventional studies. CLINICAL RELEVANCE: The significance of the oral-systemic disease connection highlights the importance of preventing and treating oral disease which have profound medical implications on general health.

An experimental model for studies on delayed tooth replantation and ankylosis in rabbits.

AIM: To develop an experimental in vivo model to study dentoalveolar ankylosis and osseous replacement resorption after delayed replantation. MATERIALS AND METHODS: The maxillary right incisors of eight rabbits were extracted and replanted, while the maxillary left incisors served as controls. A special technique for extraction was used, luxating the incisor laterally prior to extraction. Extra-oral root canal treatment was performed. In four of the eight replanted teeth, periodontal ligament was removed using gauze. All teeth were replanted after one-hour dry storage. A horizontal line was drilled on the labial enamel surface of the incisors to enable registration of possible subsequent infraposition. The rabbits were sacrificed after 1 week or 4 weeks, respectively. Percussion test of the teeth was carried out and infraposition was registered. Histological processing and evaluation were performed. RESULTS: Percussion sound was normal after 1 week and high in the 4 week group; infraposition was noted in all replanted teeth in the 4-week group. Fusion between the bone and dentin was seen in some areas on the root already after 1 week, but there was little or no osseous replacement. Larger areas of ankylosis were seen in the 4-week group although not significant, but deeper progressive osseous replacement was noted in this group. There was no significant difference in ankylosis with regard to periodontal ligament removal or not. Pulp and periodontal tissues were normal in all control teeth. CONCLUSION: The rabbit tooth model may be useful for experimental in-vivo studies on delayed replantation, subsequent ankylosis, osseous replacement and infraposition.

Assessing Oral Cancer Knowledge Among Undergraduate Dental Students in Kuwait University.

Lack of general dental practitioner oral cancer knowledge has been shown to be a major factor to delays in referral and treatment. Dentists' competence and confidence in detecting oral cancer may be strongly influenced by their dental school training. Therefore, the aim of this study was to assess dental student's awareness and knowledge of prevention and early detection of oral cancer. Through the use of questionnaires, the students' knowledge of oral cancer risk factors, diagnostic concepts, and clinical care of patients was assessed. An excellent response rate (97.3 %) was observed in this study. Overall, the students' knowledge of diagnostic items was significantly higher (p ≤ 0.001) than their knowledge of risk factors. A high percentage of students identified tobacco (98.6 %) and alcohol (76.7 %) as the principal risk factors and would offer advice regarding modification of these habits (75.3 %). Also, their knowledge of non-risk factors was significantly lower than their knowledge of proven risk factors (p ≤ 0.001). Only one fifth of the students regarded visual inspection to be an effective screening method. Only 32.9 % stated that all suspicious lesions should be biopsied, and as low as 2.7 % had assisted in taking a biopsy. This study highlights the need for a more structured teaching program with greater emphasis on the early signs and risk factors of oral cancer, performing routine oral examination, referral for biopsy, and appropriate early management of suspicious oral lesions.

In vitro adhesion of oral Candida dubliniensis isolates to acrylic denture surfaces following brief exposure to sub-cidal concentrations of polyenes, azoles and chlorhexidine.

OBJECTIVES: We aimed to investigate the effect of brief exposure to sub-cidal concentrations of nystatin, amphotericin B, ketoconazole, fluconazole and chlorhexidine gluconate on the adhesion of oral Candida dubliniensis isolates to the surface of acrylic dentures. METHODS: After determining the minimum inhibitory concentration of each drug, 20 oral isolates of C. dubliniensis were exposed to sub-cidal concentrations of the drugs for 1 h. The drugs were then removed by dilution, and the adhesion of the isolates to denture acrylic strips was assessed by an in vitro adhesion assay. RESULTS: Compared to the controls, exposure to nystatin, amphotericin B, ketoconazole, fluconazole and chlorhexidine gluconate suppressed the ability of C. dubliniensis isolates to adhere to acrylic denture surfaces with a reduction of 74.68, 74.27, 57.31, 44.57 and 56.53% (p < 0.001 for all drugs), respectively. CONCLUSIONS: Brief exposure to sub-cidal concentrations of anti-mycotics suppressed the adhesion of C. dubliniensis oral isolates to acrylic denture surfaces.

Postnatal depression among women availing maternal health services in a rural hospital in South India.

BACKGROUND AND OBJECTIVE: Postnatal depression, with an estimated prevalence of 13-19%, causes significant impairment of mental health among women worldwide and has long term consequences. However, more than half of all cases are not detected by healthcare providers. Screening for postnatal depression has not been given importance in maternal health programs in India. Our objective was to screen for postnatal depression among women attending a rural hospital in India, immediately postpartum and at 6-8 weeks post-delivery, and to study associated factors. METHODS: A cross sectional study was done on 123 postnatal women attending a rural maternity hospital in Karnataka, South India, of whom 74 women were interviewed within one week of childbirth, and 49 women at 6-8 weeks post-delivery. The Edinburgh Postnatal Depression Scale was used to screen for postnatal depression. RESULTS: About 45.5% of the women screened positive for postnatal depression (44.6% of all subjects within one week of delivery and 46.9% at 6-8 weeks after delivery). Postnatal depression was significantly associated with mood swings during antenatal period, staying with the family of birth during pregnancy and away from their husbands, and was significantly higher among women who perceived their life as stressful and having a low self-esteem (P<0.05). CONCLUSIONS: This study found a high prevalence of postnatal depression in women in rural Karnataka. This underlines the need for incorporating screening for postnatal depression in the routine care of women during pregnancy and delivery.

The postantifungal effect and phospholipase production of oral Candida albicans from smokers, diabetics, asthmatics, denture wearers and healthy individuals following brief exposure to subtherapeutic concentrations of chlorhexidine gluconate.

Candida albicans is the major aetiological agent of oral candidosis and one of its important virulent factors is the production of extracellular phospholipases, which can be modulated by subtherapeutic concentrations of antifungal agents thus decreasing their pathogenicity. Hence, considering that chlorhexidine gluconate (CG) is a common antimicrobial mouthwash used in dentistry and that its concentration in the mouth reaches subtherapeutic levels during dosage intervals due to the diluent effect of saliva and cleansing effect of the oral musculature, the postantifungal effect (PAFE) and the phospholipase production of oral C. albicans following brief exposure to subtherapeutic concentrations of CG was studied. Fifty C. albicans planktonic oral isolates obtained from smokers, diabetics, asthmatics using steroid inhalers, partial denture wearers and healthy individuals were exposed to three subtherapeutic concentrations of CG (0.005%, 0.0025% and 0.00125%) for 1 h. Isolates unexposed to CG was the control group. Thereafter the antiseptic was removed and the PAFE and phospholipase production was determined by a turbidometric method and a plate assay using an egg yolk agar medium respectively. Mean PAFE (hours) of 50 oral isolates of C. albicans following 1-h exposure to 0.005%, 0.0025% and 0.00125% CG was 6.97, 1.85 and 0.62 respectively. The phospholipase production of these isolates was significantly suppressed with a percentage reduction of 21.68, 18.20 and 14.04% following exposure to 0.005%, 0.0025% and 0.00125% CG respectively. Brief exposure of C. albicans isolates to subtherapeutic concentrations of CG would wield an antifungal effect by suppressing growth and phospholipase production, thereby quelling its pathogenicity.

The postantifungal effect of nystatin and its impact on adhesion attributes of oral Candida dubliniensis isolates.

The postantifungal effect (PAFE) has an impact on candidal pathogenicity. However, there is no information on either the PAFE or its impact on adhesion traits of oral Candida dubliniensis isolates. Oral candidosis can be treated topically with nystatin. Adhesion to buccal epithelial cells (BEC), germ tube (GT) formation and relative cell surface hydrophobicity (CSH) are all colonisation attributes of candidal pathogenicity. Hence, the main objective of this study was to investigate the in vitro PAFE on 20 C. dubliniensis isolates following exposure to nystatin. In addition, the impact of nystatin-induced PAFE on adhesion to BEC, GT formation and relative CSH of C. dubliniensis isolates were also evaluated. After determining the minimum inhibitory concentration (MIC) of nystatin, C. dubliniensis isolates were exposed to sublethal concentrations of nystatin for 1 h. Following this exposure, the drug was removed and PAFE, adhesion to BEC, GT formation and relative CSH were determined by a previously described turbidometric method, adhesion assay, germ tube induction assay and biphasic aqueous-hydrocarbon assay respectively. MIC (µg/ml) of C. dubliniensis isolates to nystatin ranged from 0.09 to 0.78. The nystatin-induced mean PAFE (hours) on C. dubliniensis isolates was 2.17. Compared with the controls, exposure to nystatin suppressed the ability of C. dubliniensis isolates to adhere BEC, GT formation and relative CSH by a mean percentage reduction of 74.45% (P < 0.0001), 95.92% (P < 0.0001) and 34.81 (P < 0.05) respectively. Hence, brief exposure of C. dubliniensis isolates to nystatin would continue to wield an antifungal effect by suppressing growth as well as its adhesion attributes.

Host tissue reactions of non-demineralized autogenic and xenogenic dentin blocks implanted in a non-osteogenic environment. An experimental study in rabbits.

Dentoalveolar ankylosis with osseous replacement is often seen after replantation of avulsed teeth, and this process may be used for preservation of alveolar crests after trauma. Its exact mechanisms with regard to osteoinductive properties are not yet fully understood and need to be systematically investigated. Dentin can possibly act as a slow-releasing carrier of bone morphogenic proteins (BMP), and this property of dentin has been proposed to be used as an alternative or supplement to bone grafting in the maxillofacial region. We aimed to initially asses host tissue reactions to dentin by implanting dentin blocks of autogenic and xenogenic human origin in rabbit connective tissue of the abdominal wall and femoral muscle. Animals were sacrificed after a period of 3 months, and histological processing, sectioning and examinations were carried out. Bone formation, cell counts and thickness of capsule surrounding the grafts were evaluated. Only minor signs of heterotopic bone formation were seen. There were no significant differences between autografts and xenografts or grafts implanted in connective tissue or muscle with regards to tissue reactions except for a significant difference (P = 0.018) in findings of more local inflammatory cells in relation to grafts placed in connective tissue in the autograft group. We conclude that during the time frame of this study, non-demineralized dentin, whether autogenous or xenogenic did not have the potential to induce bone formation when implanted in non-osteogenic areas such as the abdominal wall and abdominal muscle of rabbits.

A case of pigmented fungiform papillae of the tongue in a Middle Eastern woman.

OBJECTIVE: To report a case of pigmented fungiform papillae on the tongue. CLINICAL PRESENTATION AND INTERVENTION: A 29-year-old female presented with patchy pigmented areas on her tongue of 2 years' duration. Examination of the tongue showed pigmentation confined to the fungiform papillae on the dorsum of the tongue. She was healthy and was not taking any medications and hence a diagnosis of pigmented fungiform papillae was considered. The patient was reassured of the benign nature of this condition and no treatment was given. However, a 6-month follow-up was suggested. CONCLUSION: Clinicians should be aware of this benign variant of lingual pigmentation to avoid confusion with pathological conditions and also to avoid unnecessary investigative procedures.

Effect of scaling on levels of interleukin 1-beta and clinical periodontal parameters among e-cigarette users and non-smokers: A prospective study.

INTRODUCTION: This cohort study aimed to compare the effect of ultrasonic scaling on the expression of IL-1ß in the gingival crevicular fluid (GCF) among ENDS users and non-smokers (NS) with gingivitis. METHODS: Self-reported current electronic nicotine delivery system (ENDS) users and NS with generalized gingivitis were included in this study. All the patients underwent scaling at the baseline visit (T0). Clinical measures, periodontal parameters [probing depth (PD), plaque index (PI), and bleeding on probing (BOP)], and GCF IL-1ß were measured at T0, after 1 week (T1) and after 3 weeks (T2). Wilcoxon signed rank test was used to assess the changes in the periodontal measurements and IL-1ß levels at different time points and Mann-Whitney U Test was used to compare the two groups. RESULTS: A total of 38 individuals (18 NS and 20 ENDS users) participated in the study. The PD was significantly higher in ENDS users than in NS at baseline. However, the PI and BOP were similar in all groups at baseline. At T1, the PI was significantly lower for NS than for ENDS users (p=0.045). At T2, there were no significant differences in any of the parameters assessed between the two groups. For ENDS users, BOP was significantly lower at T1 than at baseline. For NS, the BOP at T1 and T2 and the PI at T1 were significantly lower than at baseline. There was no difference in the GCF IL-1ß levels in NS and ENDS users at baseline, T1, and T2. At T2, there was a significant reduction in IL-1ß (p<0.05) than at baseline in both groups. CONCLUSIONS: Both ENDS users and NS with gingivitis responded similarly to scaling. GCF IL-1ß levels were significantly higher at baseline (p<0.05) compared with their levels at T1 and T2 for both the groups. CLINICAL TRIAL REGISTRATION: The study was registered on the official website of ClinicalTrials.gov. IDENTIFIER: ID NCT05745324.

Changes in germ tube formation and cell-surface hydrophobicity of oral Candida dubliniensis isolates following brief exposure to sub-cidal concentrations of polyene and azole antifungal agents.

Adherence of Candida has been implicated as the initial process in the pathogenesis of oral candidosis. Candidal germ tubes and its relative cell-surface hydrophobicity (CSH) are contributory attributes. Candida dubliniensis is currently documented as an opportunistic pathogen allied with recurrent oral candidosis. Oral candidosis can be treated with polyene and azole antifungals such as amphotericin B, ketoconazole and fluconazole. However, the intraoral concentration of these drugs fluctuates and becomes sub-therapeutic because of the diluent effect of saliva and cleansing effect of the oral musculature. Hence, intraorally, the pathogenic yeast may undergo a brief exposure to antifungal drugs. The objective of this study was to investigate the effect of brief exposure to sub-lethal concentrations of these antifungals on the germ tube formation and CSH of C. dubliniensis. After determining the minimum inhibitory concentration of the drugs, 20 oral isolates of C. dubliniensis were exposed to sub-lethal concentrations of these antifungals for 1 h. Following this brief exposure, the drugs were removed, and following subsequent incubation in a germ tube inducing medium and exposure to bi-phasic hydrocarbon assay, the germ tube formation and CSH of these isolates was quantified respectively. Compared with controls, exposure to amphotericin B almost completely suppressed the ability to form germ tubes with a mean percentage reduction of 95.91% (P < 0.0001), whereas ketoconazole and fluconazole also significantly inhibited germ tube formation but to a lesser degree with a mean percentage reduction of 18.73% and 12.01% respectively (P < 0.05). Compared with controls, exposure to amphotericin B and ketoconazole elicited a significant suppression on CSH with a mean percentage reduction of 33.09% and 21.42%, respectively (P < 0.001), whereas exposure to fluconazole did not elicit a significant suppression on CSH (9.21%; P > 0.05). In clinical terms it appears that, even a short exposure to sub-lethal concentrations of these drugs, a situation all too familiar in the oral environment, would continue to exert an antifungal effect by suppressing the pathogenic potency of C. dubliniensis.