Phylogenetic Characterization of the 5' Untranslated Region of Untypable HCV Genotypes Circulating in Pakistan.

INTRODUCTION: Commercial methods for HCV genotyping is challenged by the increased prevalence of untypable genotypes in Pakistan. OBJECTIVE: The aim of the current study was to perform nucleotide sequencing of 5' UTR region for genotyping of viral isolates circulating in Peshawar, Pakistan. METHODS: The total number of commercially untypable samples were 94 in which 18 samples were sequenced for the characterization of 5' UTR region. Post-sequencing analysis was performed for genotype identification (n = 18) and molecular phylogenetic analysis. RESULTS: The current study reveals different genotypes, that is, 10/18 viral isolates were found to be genotype 3a (55.55%), 3 isolates (genotype 3b, 16.66%), 2 isolates (genotype 6h/6g, 11.11%), 2 (6g/d, 11.11%), and 1 sample (genotype 1c, 5.55%). In addition, genotype 3a is the dominant representative of HCV circulating in Pakistan and has been increasing across the country. CONCLUSION: The current study also reveals that genotype 6 (2 were genotype 6h/6g and 2 were 6g/d) is also circulating in Pakistan and not restricted to South China and Hong Kong.

Redox imbalance correlates with high Nugent score in bacterial vaginosis.

AIM: The main goal of this work was to highlight the significance of redox imbalance in the pathophysiology of bacterial vaginosis (BV). We studied the pro-oxidant (malondialdehyde) and antioxidants (glutathione, total antioxidant capacity) in the vaginal fluids of women and compared them on the basis of their Nugent score (NS). METHODS: Women were clinically screened using Amsel criteria (≥2 were regarded as positive) and were further screened for NS on the basis of microscopic examination. Subjects were classified into one of three groups - healthy controls, intermediate, and BV - on the basis of NS (0-3, 4-6, and 7-10, respectively). High vaginal swabs were collected from the study participants in order to estimate the levels of pro and antioxidants in the vaginal fluids. RESULTS: Our results indicated that levels of both pro- and antioxidants were elevated in high vaginal swabs of women in the intermediate (NS: 4-6) and BV (NS: 7-10) groups as compared to those of healthy control women. The difference in mean values for total antioxidant capacity and glutathione was found to be statistically significant. Furthermore, in the BV group (NS: ≥7) both antioxidants (glutathione and total antioxidant capacity) and the pro-oxidant, malondialdehyde, were found to be negatively correlated to NS. Interestingly, the correlation between NS and malondialdehyde was statistically significant. CONCLUSION: Our results suggest a significant correlation between redox imbalance and NS, which signifies changes in vaginal ecology from normal flora (Lactobacillus spp.) towards a more mixed bacterial population representing BV.

Dental graduates perspective of professionalism competences from a developing country.

OBJECTIVE: To evaluate the perception of fresh dental graduates regarding professional competences essential for a graduating dentist. METHODS: This quantitative, descriptive, cross-sectional study was conducted at four public and four private sector dental colleges in Punjab, Pakistan, from June to December 2014, and comprised dental graduates of the years 2013 and 2014. A comprehensive document containing 32 professionalism competences, divided into 3 sub-domains, was developed based on the competence documents of local and foreign accrediting bodies. Responses were recorded on a five-point Likert scale. The competences were categorised as 'essential' and 'good to have' based on the agreement cut-off of 75%. SPSS 21 was used for data analysis. RESULTS: Of the 386 participants, 152(39.4%) were from public-sector colleges and 234(60.6%) from private ones. The overall mean age was 23.69±1.06 years. Of the 32 competences, the participants marked 18(56.25%) as 'essential' and 15(46.9%) as 'good to have'. In the latter category, 3(20%) competences were from the domain of professional attitude and behaviour, 7(46.6%) from ethics and jurisprudence and 4(26.7%) from the domain of communication and interpersonal skills. CONCLUSIONS: Pakistani dental graduates had an overall positive attitude regarding professionalism competences.

Food Exchange List and Dietary Management of Non-Communicable Diseases in Cultural Perspective.

This review focuses at highlighting the importance of Food Exchange List in cultural perspective, as an effective dietary tool to help individuals' manage their dietary modifications in relation to non communicable diseases whilst specifying measures that can help improve the quality of Food Exchange Lists for combating various non communicable diseases and addressing adherence related issues to specialized diets. A search was done using PubMed & Google Scholar till June 2016. Search terms used were food exchange list AND disease, diet AND non-communicable diseases. We included only studies that discussed Food Exchange List (FEL) in relation to non-communicable diseases; in addition to factors like cultural relevance and adherence. Out of the 837 papers accessed 57 were identified as relevant to the Food Exchange List, out of which 39 papers were focused to the concept and development of the Food Exchange List. Only 18 discussed FEL in relation to non communicable diseases and were thus included in the review. Food exchange list is a user friendly tool for dietary modification due to disease. This tool may help to customize meals for people as it provides information regarding various food items in different groups. This tool is helpful in reducing blood & plasma glucose levels, maintaining lipid profile & effectively combating other diet related diseases & those ailments in which diet plays a significant role in maintenance & prevention from reoccurrences. However, better management and adherence to modified diets for non communicable diseases can be ensured by keeping cultural relevance under consideration before using Food Exchange Lists for such diseases.

The role of repetition and reinforcement in school-based oral health education-a cluster randomized controlled trial.

BACKGROUND: Repetition and reinforcement have been shown to play a crucial role in the sustainability of the effect of Oral Health Education (OHE) programs. However, its relevance to school-based OHE imparted by different personnel is not depicted by the existing dental literature. The present study was undertaken to determine the effectiveness of the repeated and reinforced OHE (RR-OHE) compared to one-time OHE intervention and to assess its role in school-based OHE imparted by dentist, teachers and peers. METHODS: The study was a cluster randomized controlled trial that involved 935 adolescents aged 10-11 years. Twenty four boys' and girls' schools selected at random in two towns of Karachi, Pakistan were randomly assigned to three groups to receive OHE by dentist (DL), teachers (TL) and peer-leaders (PL). The groups received a single OHE session and were evaluated post-intervention and 6 months after. The three groups were then exposed to OHE for 6 months followed by 1 year of no OHE activity. Two further evaluations at 6-month and 12-month intervals were conducted. The data were collected by a self-administered questionnaire preceded by a structured interview and followed by oral examination of participants. RESULTS: The adolescents' oral health knowledge (OHK) in the DL and PL groups increased significantly by a single OHE session compared to their baseline knowledge (p < 0.05) and the increase was sustained over 6 months. Although one-time OHE resulted in a significant improvement in adolescents' oral health behavior (OHB) related to the prevention of gingivitis in the two groups (p < 0.05), no significant change was observed in their behavior towards prevention of oral cancer. One-time teacher-led OHE was ineffective in improving adolescents' OHK and OHB. The oral hygiene status (OHS) of the participants in all three groups did not change statistically after one-time OHE. The OHK, OHB and OHS indices increased significantly 6 months after RR-OHE than the initial scores (p < 0.001) irrespective of OHE strategy. Although the OHK scores of the DL and PL groups decreased significantly at 12-month evaluation of RR-OHE (p < 0.05), the said score of the TL group; and OHB and OHS scores of all three groups remained statistically unchanged during this period. CONCLUSIONS: The repetition and reinforcement play a key role in school-based OHE irrespective of educators. The trained teachers and peers can play a complementary role in RR-OHE.

Salivary Immunosuppressive Cytokines IL-10 and IL-13 Are Significantly Elevated in Oral Squamous Cell Carcinoma Patients.

Oral squamous cell carcinoma (OSCC) is considered to be one of the most fatal diseases worldwide, owing to its late diagnosis and lack of availability of established reliable biomarkers. The aim of this study was to highlight the significance of immunosuppressive cytokines as potential biomarkers in OSCC. Whole unstimulated saliva was collected from each individual (30 OSCC patients and 33 age- and gender-matched healthy controls). Immunosuppressive cytokines, including IL-4, IL-10, IL-13, and IL-1RA, were evaluated in each sample using Luminex multianalyte profiling (xMAP) technology on BioPlex instrument. Our results showed that all the studied salivary cytokines were raised in OSCC patients as compared to controls, where IL-10 and IL-13 salivary levels showed statistically significant difference (p = .004 and p = .010, respectively). Mean levels of salivary cytokines in three histologically defined OSCC categories, compared employing one-way ANOVA, showed that salivary levels of IL-1RA were highest in patients having poorly differentiated OSCC tumors as compared to those having moderately and well-differentiated tumors (p = .000 and p = .002, respectively). Among OSCC individuals, duration of smokeless tobacco correlated positively with IL-1RA (p = .036). We conclude that salivary levels of immunosuppressive cytokines, IL-4, IL-10, IL-13, and IL-1RA, could prove to be potential biomarkers of OSCC and can be further investigated as markers of early detection and disease progression.

Periodontitis in coronary heart disease patients: strong association between bleeding on probing and systemic biomarkers.

AIM: Few studies have examined the relationship of individual periodontal parameters with individual systemic biomarkers. This study assessed the possible association between specific clinical parameters of periodontitis and systemic biomarkers of coronary heart disease risk in coronary heart disease patients with periodontitis. MATERIALS AND METHODS: Angiographically proven coronary heart disease patients with periodontitis (n = 317), aged >30 years and without other systemic illness were examined. Periodontal clinical parameters of bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL) and systemic levels of high-sensitivity C-reactive protein (CRP), fibrinogen (FIB) and white blood cells (WBC) were noted and analyzed to identify associations through linear and stepwise multiple regression analyses. RESULTS: Unadjusted linear regression showed significant associations between periodontal and systemic parameters; the strongest association (r = 0.629; p < 0.001) was found between BOP and CRP levels, the periodontal and systemic inflammation marker, respectively. Stepwise regression analysis models revealed that BOP was a predictor of systemic CRP levels (p < 0.0001). BOP was the only periodontal parameter significantly associated with each systemic parameter (CRP, FIB, and WBC). CONCLUSION: In coronary heart disease patients with periodontitis, BOP is strongly associated with systemic CRP levels; this association possibly reflects the potential significance of the local periodontal inflammatory burden for systemic inflammation.

Bidirectional Relationship between Chronic Kidney Disease & Periodontal Disease.

UNLABELLED: Non communicable diseases (NCDs) affect the life of an individual in terms of mortality, morbidity and financial crises. Main NCDs are diabetes mellitus (DM), cardiovascular diseases (CVD), pulmonary diseases, osteoporosis and chronic kidney diseases (CKD). About 40% of the total deaths can be controlled by eliminating the risk factors for NCDs. Periodontitis have recently been labeled as an important potential risk factor for NCDs. CKD affect the oral health status of patients by inducing gingival hyperplasia, xerostomia, calcification of root canals and delayed eruption of teeth. Periodontitis increases systemic inflammatory burden leading to worsening of CKD which in turn has been has been found to negatively affect CKD of patients on hemodialysis therapy by altering their serum albumin and C-reactive protein levels. As hypoalbuminemia leads to increased mortality in CKD patients, it needs to be avoided by reducing systemic inflammatory burden in patients receiving HD therapy. Treating periodontal disease could be one factor that might decrease the systemic inflammatory burden and thereby improve quality of life of these patients. SOURCES OF DATA: Data from descriptive, cross sectional and longitudinal studies published between 2000 and 2012 were included. Data searches based on human studies only. DATA EXTRACTION: The key words, periodontitis, chronic kidney disease and hemodialysis, on MEDLINE, approximately 120 studies were identified. 35 of them were relevant to all three keywords. Most of them were cross sectional studies and total 7 clinical trials were identified regarding checking of serum levels after periodontal therapy with variable results. CONCLUSION: Patients with CKD have higher prevalence of periodontal disease while non-surgical periodontal therapy has been indicated to decrease the systemic inflammatory burden in patients with CKD specially those undergoing HD therapy.

Non-surgical periodontal therapy reduces coronary heart disease risk markers: a randomized controlled trial.

AIM: Periodontal disease elevates systemic inflammatory markers strongly associated with coronary heart disease (CHD) risk. The aim of this randomized controlled trial was to investigate the effect of non-surgical periodontal therapy on systemic C-reactive protein (CRP), fibrinogen and white blood cells in CHD patients. MATERIALS AND METHODS: Angiographically proven CHD patients with periodontitis (n = 317) were randomized to intervention (n = 212) or control group (n = 105). Primary outcome was reduction in serum CRP levels; secondary outcomes were reductions in fibrinogen and white blood cells. Periodontal treatment included scaling, root planing and oral hygiene instructions. Periodontal and systemic parameters were assessed at baseline and at 2-month follow-up. Intent-to-treat (ITT) analysis was performed. RESULTS: Study was completed by 246 subjects (intervention group = 161; control group = 85). Significant improvements in periodontal and systemic parameters were observed in intervention group. The number of subjects with CRP > 3mg/L in intervention group decreased by 38% and in control group increased by 4%. ITT analysis gave a significant (χ(2) =4.381, p = 0.036) absolute risk reduction of 12.5%. CONCLUSION: In CHD patients with periodontitis, non-surgical mechanical periodontal therapy significantly reduced systemic levels of C-reactive protein, fibrinogen and white blood cells.

School-based strategies for oral health education of adolescents--a cluster randomized controlled trial.

BACKGROUND: Oral health education (OHE) in schools has largely been imparted by dental professionals. Considering the substantial cost of this expert-led approach, the strategies relying on teachers, peer-leaders and learners themselves have also been utilized. However the evidence for comparative effectiveness of these strategies is lacking in the dental literature. The present study was conducted to compare the effectiveness of dentist-led, teacher-led, peer-led and self-learning strategies of oral health education. METHODS: A two-year cluster randomized controlled trial following a parallel design was conducted. It involved five groups of adolescents aged 10-11 years at the start of the study. The trial involved process as well as four outcome evaluations. The present paper discusses the findings of the study pertaining to the baseline and final outcome evaluation, both comprising of a self-administered questionnaire, a structured interview and clinical oral examination. The data were analyzed using Generalized Estimating Equations. RESULTS: All the three educator-led strategies of OHE had statistically higher mean oral health knowledge (OHK), oral health behavior (OHB), oral hygiene status (OHS) and combined knowledge, behavior and oral hygiene status (KBS) scores than the self-learning and control groups (p<0.001). The mean OHK, OHS and KBS scores of the three educator-led strategies did not differ significantly. The peer-led strategy was, however, found to have a significantly better OHB score than the respective score of the teacher-led strategy (p<0.05). The self-learning group had significantly higher OHB score than the control group (p<0.05) but the OHK, OHS and KBS scores of the two groups were not significantly different. CONCLUSIONS: The dentist-led, teacher-led and peer-led strategies of oral health education are equally effective in improving the oral health knowledge and oral hygiene status of adolescents. The peer-led strategy, however, is almost as effective as the dentist-led strategy and comparatively more effective than the teacher-led and self-learning strategies in improving their oral health behavior. SRCTN39391017

Core amino acid substitutions in HCV-3a isolates from Pakistan and opportunities for multi-epitopic vaccines.

Hepatitis C virus (HCV), which infected 71 million worldwide and about 5%-6% are from Pakistan, is an ssRNA virus, responsible for end-stage liver disease. To date, no effective therapy is available to cure this disease. Hence, it is important to study the most prevalent genotypes infecting human population and design novel vaccine or small molecule inhibitors to control the infections associated with HCV. Therefore, in this study clinical samples (n = 35; HCV-3a) from HCV patients were subjected to Sanger sequencing method. The sequencing of the core gene, which is generally considered as conserved, involved in the detection, quantitation and genotyping of HCV was performed. Multiple mutations, that is, R46C, R70Q, L91C, G60E, N/S105A, P108A, N110I, S116V, G90S, A77G and G145R that could be linked with response to antiviral therapies were detected. Phylogenetic analysis suggests emerging viral isolates are circulating in Pakistan. Using ab initio modelling technique, we predicted the 3D structure of core protein and subjected to molecular dynamics simulation to extract the most stable conformation of the structure for further analysis. Immunoinformatic approaches were used to propose a multi-epitopes vaccine against HCV by using core protein. The vaccine constructs consist of nine CTL and three HTL epitopes joined by different linkers were docked against the two reported Toll-like receptors (TLR-3 and TLR-8). Docking of vaccine construct with TLR-3 and TLR-8 shows proper binding and in silico expression of the vaccine resulted in a CAI value of 0.93. These analyses suggest that specific immune responses may be produced by the proposed vaccine.Communicated by Ramaswamy H. Sarma.

Simultaneous amplification of two bacterial genes: more reliable method of Helicobacter pylori detection in microbial rich dental plaque samples.

Polymerase Chain reaction (PCR) assay is considered superior to other methods for detection of Helicobacter pylori (H. pylori) in oral cavity; however, it also has limitations when sample under study is microbial rich dental plaque. The type of gene targeted and number of primers used for bacterial detection in dental plaque samples can have a significant effect on the results obtained as there are a number of closely related bacterial species residing in plaque biofilm. Also due to high recombination rate of H. pylori some of the genes might be down regulated or absent. The present study was conducted to determine the frequency of H. pylori colonization of dental plaque by simultaneously amplifying two genes of the bacterium. One hundred dental plaque specimens were collected from dyspeptic patients before their upper gastrointestinal endoscopy and presence of H. pylori was determined through PCR assay using primers targeting two different genes of the bacterium. Eighty-nine of the 100 samples were included in final analysis. With simultaneous amplification of two bacterial genes 51.6% of the dental plaque samples were positive for H. pylori while this prevalence increased to 73% when only one gene amplification was used for bacterial identification. Detection of H. pylori in dental plaque samples is more reliable when two genes of the bacterium are simultaneously amplified as compared to one gene amplification only.

Dental caries experience in preschool children: is it related to a child's place of residence and family income?

PURPOSE: To assess the caries prevalence in 3- to 5-year-old children and determine whether urbanisation and income are associated with the dental decay status of these preschool children residing in the district of Lahore, Pakistan. MATERIALS AND METHODS: Multistage random sampling was done to collect the sample of children from urban and rural areas. A list of children 3 to 5 years of age was prepared, and every 2nd child on the list was randomly selected until a total of 700 children were enrolled in the study. Lady Health Workers (LHWs) were trained to conduct this survey after permission from the pertinent authorities. The data of the children and their mothers regarding their age, gender, socioeconomic status (SES) and area of residence were collected. The caries status of children was recorded using the dmft index as per WHO criteria. RESULTS: The prevalence of dental caries in preschool children of Lahore was found to be 40.5%. Within this group, caries prevalence was 33.3% in 3-year-old children, 47.6% in 4-year-old children and 75% in the 5-year-old children. The mean dmft score for the entire child population was 1.85 ± 3.26. A significant association was found between caries prevalence, low socioeconomic status, female gender and rural residence. CONCLUSION: Preschool children in Lahore, Pakistan have average dmft scores of 1.85 (± 3.26), which are mostly related to untreated carious lesions. Lower caries experience was found to be associated with rural residence and low family income.

Effect on blood pressure and pulse rate after administration of an epinephrine containing dental local anaesthetic in hypertensive patients.

OBJECTIVE: To document safety for use, through recording changes in blood pressure and pulse rate, after administering 3.6 ml of a 2% lignocaine with 1:100,000 epinephrine dental local anaesthetic in a group of hypertensive patients. METHODOLOGY: The present study was conducted at Shaikh Zayed Medical Complex, Lahore, from May to December 2008, using a convenience sampling technique. The first 60 walk-in patients in the dental outpatient department planned for tooth extraction were enrolled in the study. Out of these 60 patients, 10 had pre-hypertension (BP = 130/90), 10 had stage 1 hypertension (BP =140-159/90-99) and 10 study subjects were suffering from stage 2 hypertension (BP = 160-179/100-109). Thirty age and sex matched normo-tensive patients requiring tooth extraction acted as the control group. All patients were administered two cartridges each of 1.8 ml of dental local anaesthesia containing 2% Lignocaine with 1:100,000 epinephrine. Blood pressure and pulse rate (PR) were the risk indicators that were measured thrice; pre-injection, 2 minutes and 5 minutes after injection. RESULTS: A decrease in systolic in stage 2 hypertension patients after 2 and 5 minutes of injections was noted. The diastolic BP (DBP) fell in all the groups after injections. Mean pulse rate increased from three to four beats per minute in all groups except in stage 2 hypertension patients where it slightly decreased. CONCLUSION: Epinephrine containing dental local anaesthesia decreased systolic blood pressure in stage 2 hypertension patients included in this study. There was an observed decrease of 21 mm Hg in systolic blood pressure hypertension patients but with no adverse effects.

An update on stem cells applications in burn wound healing.

Burn wounds have proven to be capable of having a long lasting devastating effects on human body. Conventional therapeutic approaches are not up to the mark as they are unable to completely heal the burn wound easily and effectively. Major pitfalls of these treatments include hypertrophic scarring, contracture and necrosis. Presence of these limitations in the current therapies necessitate the search for a better and more efficient cure. Regenerative potency of stem cells in burn wound healing outweigh the traditional treatment procedures. The use of multiple kinds of stem cells are gaining interest due to their enhanced healing efficiency. Distinctions of stem cells include better and faster burn wound healing, decreased inflammation levels, less scar progression and fibrosis on site. In this review, we have discussed the wound-healing process, present methods used for stem cells administration, methods of enhancing stem cells potency and human studies. Pre-clinical and the clinical studies focused on the treatment of thermal and radiation burns using stem cells from 2003 till the present time have been enlisted. Studies shows that the use of stem cells on burn wounds, whether alone or by the help of a scaffold significantly improves healing. Homing of the stem cells at the wound site results in the re-epithelialization, angiogenesis, granulation, inhibition of apoptosis, and regeneration of skin appendages together with reduced infection rate in the human studies. Several studies on animals have shown that stem cells can effectively promote wound healing. Although more research is needed to find out the effectiveness of this treatment in patients with severe burn wounds.

Bidirectional relationship between diabetes and periodontal disease: review of evidence.

Presently there are 170 million diabetic patients worldwide. Pakistan ranks sixth in the world with approximately 6.2 million in the 20-79 year age affected by the diabetes. 6-10% of the 35-44year old diabetic patients have been reported to be affected by moderate form of periodontal disease in Pakistan. Periodontal disease is referred to as sixth complication of diabetes. The association between diabetes and periodontal disease has been reported for more than 40 years but reverse has not been the focus of researchers until recently. Studies have suggested a bidirectional relationship between periodontal disease and glycaemic control with each disease having a potential impact on the other.

Bibliometric analysis of publications on research into cotton leaf curl disease.

Cotton leaf curl disease (CLCuD), caused by viruses of the family Geminiviridae (genus Begomovirus), is of great concern for cotton production worldwide. The aim of the study was to characterize and quantify the worldwide scientific output of CLCuD research using bibliometric analysis. PubMed, Google Scholar and Scopus search engines were used to extract available data from 1901 to July 2017. A total of 854 CLCuD-related published documents were identified. Most of the documents were published in the form of original research articles (644, 75.4 %) and English was the main language of publication (807, 94 %). The results demonstrate that the study of CLCuD exhibits an overall increasing trend from 1991 to 2017, with the highest number of articles published in 2013. The top 10 countries in terms of absolute research output (number of publications) on this subject were Pakistan (217; 25.40%), India (161; 18.85%), the United States of America (USA; 122; 14.85%), China (85; 9.95%), United Kingdom (57; 6.67%), Sudan (31; 3.62%), Israel (14; 1.63%), Spain (13; 1.52%), Australia (11; 1.28%), Saudi Arabia (9; 1.05%) and Iran (9; 1.05%). Pakistan's most important collaborator was United States of America, followed by China. Noteworthy, not one of the papers listed here was the result of scientific collaboration between India and Pakistan. The total number of citations for all the publications was 3174, with an average of 3.71 citations per publication. The h-index for all extracted data related to CLCuD was 91. The top h-index was achieved by Pakistan (54) followed by the United Kingdom (43), the USA (41) and India (39). The National Institute for Biotechnology and Genetic Engineering (NIBGE), Faisalabad, ranked the first in the top 10 list of the most productive institutes. This bibliometric analysis highlights the leading role of Pakistan, India and the USA in research on CLCuD and points out that the initiation of a collaboration between Pakistan and India may have a significant impact on the research output and progress.

Epidemiological features of cutaneous leishmaniasis endemic in hilly areas of district Karak, Khyber-Pakhtunkhwa province of Pakistan.

Cutaneous leishmaniasis is a vector borne infection caused by flagellated parasitic protozoans of the genus Leishmania. This is an emergent threat and endemic in areas of tropic and sub-tropics and has a wider geographical distribution. This study was aimed to find the epidemiological aspects of cutaneous leishmaniasis during the recent epidemic in district Karak in 2018-2019. The suspected patients of leishmaniasis from different areas of district Karak were examined. We came across 803 cases during six-month period from August 2018 to January 2019. A major portion (> 37%; n = 299) of these patients were in age 11-20 years. The infection rate was higher in female (55.3%; n = 803) compared to males (44.6%; n = 803). Both gender and age showed a significant effect on the occurrence of infection. It is concluded that cutaneous leishmaniasis has appeared as a major health issue in district Karak. The current study report CL outbreak in Karak district which need immediate response from the healthcare authorities. In addition, extensive awareness campaigns are needed for timely prevention of such outbreaks.

COVID-19: Review of Epidemiology and Potential Treatments Against 2019 Novel Coronavirus.

An epidemic of extreme respiratory deterrence, pneumonia and shortness of breath, the SARS-CoV-2 viral infection began in Wuhan, Hubei Province, China in December 2019, and rapidly spread across China and beyond, with human to human transmission. On February 12, 2020, World Health Organization officially named the new coronavirus disease as coronavirus disease 19 (COVID-19). Most COVID-19 patients were diagnosed with pneumonia and many were treated using Chinese medicines and other secondary therapies. As of April 22, 2020, the total figure of infected patients has crossed 2.6 million people worldwide with over 180,000 deaths and 700,000 patients that have recovered. Preliminary reports suggest that certain drugs, such as chloroquine and antiviral nucleotide analogues such as remdesivir, which inhibit viral replication, can target the new coronavirus, although their usefulness in the clinic is still under debate. An expert US committee developed the US NIH guidelines for COVID-19 treatment, which was just released and will be regularly updated. This manuscript reviews the epidemiology, etiology, mortality, COVID-19 clinical symptoms, and potential therapeutic drugs, while highlighting the seriousness and damage-induced by SARS-CoV-2.

Comparison of the plaque-removing efficacy of toothpaste and toothpowder.

BACKGROUND: Removing dental plaque may play a key role in maintaining oral health. Methods for oral hygiene vary from country to country and from culture to culture. Chewing sticks (miswak) and toothpowders are popular oral hygiene tools in Pakistan. OBJECTIVE: To compare the plaque-removing efficacy of toothpaste and toothpowder with and without manual toothbrushes. MATERIALS AND METHODS: The study was designed as an examiner-blind crossover study. The Silness and Löe plaque index was used to evaluate the plaque distribution. Thirty-six volunteer dental students were recruited for the experiment. After scoring, the subjects were randomly divided into two groups. The first group was asked to brush with toothpaste or toothpowder according to a split mouth protocol. The second group was asked to follow the same protocol except they were asked to use their finger instead of the brush. The remaining plaque was scored again. RESULTS: Plaque-removing efficacy of the toothpowder was higher whether it was used with brush or with finger. There was a significant difference between paste and powder users (p = 0.009). CONCLUSION: The results of this study indicate that toothpowder is an effective means to remove plaque with a brush.