Medication-related osteonecrosis of the external auditory canal - A rapid review of the literature and relevance to special care dentists.

AIMS: There is growing evidence that anti-resorptive and anti-angiogenic medications can cause medication-related osteonecrosis of the external auditory canal (MROEAC). It is possible that patients taking risk medications may also suffer from concomitant medication -related osteonecrosis of the jaw (MRONJ) or temporomandibular joint (TMJ) involvement. The aim of this paper is to conduct a rapid review of the literature on MROEAC, and, its relevance to special care dentists. METHODS AND RESULTS: A rapid review of the literature was carried out using PubMed, Science Direct and Google Scholar to identify papers relating to MROEAC. The grey literature and non-English papers were also consulted. Overall, 19 papers were identified from 2005 until December 2022. CONCLUSIONS: Patients at risk of MRONJ may also be at risk of MROEAC and present to special care dentists. Dental/orofacial disease may cause signs and symptoms suggestive of MROEAC. It should be considered as a potential cause of orofacial pain in special care patients. MROEAC can have a significant impact on a patient's dental treatment, including access, the provision of sedation, communication difficulties, and consent issues.

Postoperative Epistaxis Following Dental Treatment With Nitrous Oxide/Oxygen Sedation.

A 12-year-old Caucasian male undergoing a dental extraction for a grossly carious mandibular molar under inhalational sedation with nitrous oxide/oxygen experienced an episode of anterior epistaxis postoperatively that was controlled well with local measures. Epistaxis following inhalational sedation with nitrous oxide/oxygen in the dental setting is a very rare complication but has been previously reported in the literature. This case report provides a review of the existing literature regarding cases of epistaxis associated with inhalational sedation using nitrous oxide/oxygen and discusses the potential etiology of epistaxis associated with inhalational sedation. Patients at higher risk of epistaxis should be properly informed of the risks prior to inhalational sedation with nitrous oxide/oxygen, and dentists should also be familiar with epistaxis management in the dental setting.

Immunomodulatory efficacy of Cousinia thomsonii C.B. Clarke in ameliorating inflammatory cascade expressions.

ETHNOPHARMACOLOGICAL RELEVANCE: Cousinia thomsonii is traditionally known for treating various diseases including joint pain, swelling, body ache, asthma, dermatitis, cough and arthritis. AIM OF THE STUDY: This study employs lipopolysaccharide induced inflammatory wistar-rat model to evaluate efficacy of Cousinia thomsonii active-extracts on the expression of crucial inflammatory markers viz. iNOS, PPAR-γ, Rel-A, COX-2 and serum analysis of CRP. MATERIALS AND METHODS: Methanol and aqueous extracts were administered orally at 25, 50, 100 mg/kg doses for 21 days. Serum was collected on 22nd day and rats were sacrificed to extract paw tissues. Dexamethasone (0.5 mg/kg) served as positive control. Immunoblotting and qPCR was used for expression analysis of iNOS, PPAR-γ, Rel-A, COX-2 respectively. ELISA was employed for evaluating CRP levels. Discovery-studio and Auto-Dock-Vina were used to check docking interactions of various identified compounds. RESULTS: Both extracts caused dose-dependent decline in iNOS, Rel-A, COX-2 and CRP levels, while there was a dose-dependent increase in PPAR-γ expression. Methanol extract dominated immunomodulatory potential as compared with the aqueous extract. The results of the GCMS revealed the presence of ten compounds. Some of these compounds include 1-Octacosanol, Ethyl Linoleate, 1-Heptacosanol, 1-Hexadecanol, 1-Dodecanol and Behenic alcohol having strong anti-inflammatory, antimicrobial, anti-acne and anti-viral activities. Molecular Docking scores were calculated between each target protein and selected compounds. The best affinity/interactions were observed between 1-Octacosanol towards iNOS, PPAR-γ, Rel-A, COX-2 and CRP with binding energy of -10.4, -11.1, -8.6, -9.9 and -7.9 (kcal/mol) respectively. These compounds may act as strong inhibitors for iNOS, Rel-A, COX-2 and CRP or as agonists for PPAR-γ; thereby inducing anti-inflammatory/immuno-modulatory activities. CONCLUSIONS: The results indicate that Cousinia thomsonii contains therapeutically active compounds and thus could serve as potential therapeutic regimen against diverse inflammatory diseases.

The Emotional Impact of Novel Coronavirus on Healthcare Workers: A Cross-Sectional Study.

Introduction Healthcare workers (HCWs) are the foundation of the response to a pandemic. Also termed as frontline workers, not only are they at a health risk but also suffer from emotional and psychological stress. Objective The objective of the study was to determine the emotional impact of novel coronavirus on healthcare workers. Methodology An online survey was completed by 239 HCWs from five different countries during the peak of the coronavirus disease 2019 (COVID-19) outbreak amidst the lockdown. Their feelings and concerns as well as the safety measures they adopted were identified. Results The response rate was 100%. Most of the respondents were 20-40 years old (85.36%) and working as doctors (73.22%); 44.77% were working at middle grade. The majority felt confused (19.67%), whereas others felt stressed/overworked (17.15%), unhappy (16.74%), scared (13.81%), nervous (13.39%), motivated (8.79%), and privileged (5.86%). A few felt pressurized to perform their duty (4.6%), and 69.87% felt that it was their moral obligation to continue their duty, whereas 13.39% felt administrative pressure for the same. Of the respondents, 53.97% feared transferring the disease to their family and friends, while others feared the lack of personal protective equipment (PPE) (13.39%). According to the majority of the respondents (25.94%), support from family and friends had them going through the crisis. The most common safety measure adopted by the HCWs was strict hand hygiene (43.51%). The HCWs (28.87%) felt that adequate and easy access to PPE would have helped them better during the pandemic. Conclusion Healthcare institutions are responsible for protecting HCWs or frontline workers during pandemics so they can continue with their duty. From our study, we have concluded that simple protective measures as uninterrupted and easy access to PPE would have helped HCWs deal with their stress and concerns.

Ultrasound-guided peripheral intravenous cannulation for patients requiring dental surgery under intravenous dental sedation.

Dental surgeons regularly provide intravenous dental sedation and oral/transmucosal sedation, which involves cannulation. Cannulation is an essential skill that dental surgeons should be competent to perform, but certain patient groups may be difficult to cannulate. Ultrasound-guided peripheral intravenous cannulation is an evidence-based technique already used in radiology, emergency medicine, and anaesthesia. Ultrasound-guided peripheral intravenous cannulation has been shown to reduce complications and significantly increase the success of cannulation in patients with difficult intravenous access (DIVA); it may also be preferable in certain special care patient groups. The application of ultrasound-guided peripheral intravenous cannulation should be considered for patients with DIVA who require intravenous dental sedation or other common procedures in dental surgery that involve cannulation.

Toxicological impact of sodium benzoate on inflammatory cytokines, oxidative stress and biochemical markers in male Wistar rats.

Sodium benzoate is a widely used food and pharmaceutical preservative due to its antibacterial and antifungal activity. In the present study effect of different concentrations of sodium benzoate on hepatic antioxidants, inflammatory cytokines (TNF-α, IFN-γ, IL-1ß and IL-6), biochemical markers and histopathology of liver was evaluated. Twenty five adult rats (aged 1-2 months) with 5 rats per group were randomly distributed into 5 groups. Group 1 rats were used as control and all groups (1-5) were provided with water and fed ad libitum. In addition to usual water and food, rats of group 2, 3, 4 and 5 were treated with 70, 200, 400 and 700 mg/kg b.wt of sodium benzoate once a day via oral gavage for 30 days. Our results showed that activity of glutathione peroxidase (GPx), catalase (CAT), glutathione-s-transferase (GST), glutathione reductase (GR) and superoxide dismutase (SOD) in rats decreased significantly when treated with 200, 400 and 700 mg/kg b.wt of sodium benzoate. Increase in the concentration of alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serum total protein, albumin, globulin, urea and creatinine was found to be dose dependent. Severe histopathological damage was observed in the hepatic tissue at higher concentrations of sodium benzoate. It was noticed that high concentrations of sodium benzoate (200, 400 and 700 mg/kg b.wt) produce significant increase in inflammatory cytokine markers (TNF-α, IFN-γ, IL-1ß and IL-6) in comparison to control. Sodium benzoate at concentration of 70 mg/kg b.wt did not produce any significant changes in any of the above studied parameters.

Toxicological analysis of synthetic dye orange red on expression of NFκB-mediated inflammatory markers in Wistar rats.

Orange red is a food and cosmetic coloring agent made by the amalgamation of two azo dyes carmoisine and sunset yellow. The current study demonstrates the effect of different concentrations of orange red on antioxidant status, inflammatory biomarkers (TNFα, IFNγ, IL1ß, IL6, COX-2, iNOS, and NFκB/p65), biochemical enzymes, and liver histology. In totality, 25 male Wistar rats were procured and arbitrarily alienated into 5 different groups each with 5 animals. Group I was taken as the control. Groups II-V were designated as treatment groups. Groups II and III were administered with (5 and 25 mg/kg b.wt.) and groups IV and V with (150 and 300 mg/kg b.wt.) of orange red via oral gavage for 30 days. It was observed that both low and high concentrations of orange red (25, 150, and 300 mg/kg) remarkably augmented the levels of serum inflammatory cytokines (TNFα, IFNγ, IL1ß, and IL6) and the protein and gene expression of COX-2, iNOS, and NFκB/p65. A significant decrease in glutathione reductase, glutathione peroxidase, glutathione-S-transferase, superoxidase dismutase, and catalase activity was observed with increasing concentration of orange red. Furthermore, an increase in the level of several vital biochemical parameters and damage severity to hepatic tissue was also found dose dependent.

Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy in Morbidly Obese and Super Obese Patients.

Background Laparoscopic sleeve gastrectomy (LSG) is a modified procedure derived from a biliopancreatic diversion (BPD)-duodenal switch. The present study evaluated the role of LSG in morbidly and super obese patients and compare its efficacy between the two groups. Methodology A retrospective review was conducted in Dr. Sulaiman Al Habib Specialist Hospital, Riyadh, KSA, from January 2020 to April 2021. Patients' records were divided into two groups, morbidly obese (body mass index (BMI): 40-49 kg/m2) and super obese (BMI: 50-59 kg/m2), who were admitted to the department for laparoscopic sleeve gastrectomy during the study duration. However, patients with a history of gut surgery, hernias, comorbid use of illicit substances, and psychiatric disorders were excluded. For all patients, a routine preoperative investigation protocol was conducted. Postoperative surgical complications were also recorded. The Clavien-Dindo classification (CDC) score was applied to record surgical complications. Data collection was done using a semi-structured questionnaire. The Statistical Package for Social Sciences (SPSS) version 26 (IBM, Chicago, USA) was used to perform data analysis. Results A total of 176 patient records were included in this analysis, of which 126 (71.6%) were females. There were 101 (57.1%) patients who were morbidly obese and 76 (42.9%) who were super obese. The mean duration of follow-up records in this study was 23.2 ± 3.6 weeks, which was slightly longer in the morbidly obese group. Change in BMI was higher in the super obese patients (18.6 ± 3.1 versus 10.5 ± 1.9). Final body weight was still lower in the morbidly obese group as they were relatively slimmer even before the procedure. A higher reduction in excess weight loss (EWL) is seen in the morbidly obese group. Comorbidity resolution status was also remarkable with the procedure. Overall, there were procedure-associated complications in 11 (10.9%) patients in the morbidly obese group and 10 (13.2%) in the super obese group. Conclusion Laparoscopic sleeve gastrectomy is a safe procedure in morbidly and super obese patients. It is effective in sustainable total and excess weight loss over time. It is also effective in comorbidity resolution. Complications with LSG are minimal and nonserious. LSG should be the recommended procedure in morbidly and super obese patients with adverse health consequences to improve their morbidity, mortality, and overall quality of life.

Active Cousinia thomsonii Extracts Modulate Expression of Crucial Proinflammatory Mediators/Cytokines and NFκB Cascade in Lipopolysaccharide-Induced Albino Wistar Rat Model.

INTRODUCTION: Chronic inflammation is implicated in a multitude of diseases, including arthritis, neurodegeneration, autoimmune myositis, type 2 diabetes, rheumatic disorders, spondylitis, and cancer. Therefore, strategies to explore potent anti-inflammatory regimens are pivotal from a human-health perspective. Medicinal plants represent a vast unexplored treasure trove of therapeutically active constituents with diverse pharmacological activities, including anti-inflammatory properties. Herein, we evaluated Cousinia thomsonii, an edible medicinal herb, for its anti-inflammatory/immunomodulatory properties. METHODS: Soxhlet extraction was used to obtain different solvent extracts (hexane, ethyl acetate, ethanol, methanol, and aqueous extract) in increasing order of polarity. In vitro anti-inflammatory assays were performed to investigate the effects of extracts on protein denaturation, proteinase activity, nitric oxide surge, and erythrocyte-membrane stabilization. The most effective extracts, ie, ethyl acetate (CTEA) and ethanol (CTE) extracts (150-200 g) were selected for further in vivo analysis using albino Wistar rats. Wistar rats received varying concentrations of CTEA and CTE (25, 50, and 100 mg/kg) for 3 weeks, followed by a single subplantar injection of lipopolysaccharide. Dexamethasone served as positive control. Blood was obtained from the retro-orbital plexus and serum separated for estimation of proinflammatory cytokines (IL6, IL1ß, IFNγ and TNFα). Western blotting was performed to study expression patterns of crucial proteins implicated in the NFκB pathway, ie, NFκB p65, NFκB1 p50, and NFκB2 p52. Histopathological examination was done and gas chromatography-mass spectrometry (GC-MS) carried out to reveal the identity of compounds responsible for ameliorating effects of C. thomsonii. RESULTS: Among five tested extracts, CTEA and CTE showed marked inhibition of protein denaturation, proteinase activity, nitric oxide surge and erythrocyte-membrane hemolysis at 600 µg/mL (P<0.001). Both these extracts showed no toxic effects up to a dose of 2,500 mg/kg. Extracts exhibited concentration-dependent reductions in expression of IL6, IL1ß, IFNγ, TNFα, NFκB-p65, NFκB1, and NFκB2 (P<0.05). Healing effects of extracts were evident from histopathological investigation. GC-MS analysis revealed the presence of important anti-inflammatory compounds, notably stigmast-5-en-3-ol, oleate, dotriacontane, ascorbic acid, n-hexadecanoic acid, and α-tocopherol, in C. thomsonii. CONCLUSION: C. thomsonii possesses significant anti-inflammatory/immunomodulatory potential by virtue of modifying levels of proinflammatory cytokines/markers and NFκB proteins.

Falls: considerations for the dental surgeon.

Falls are a serious issue that occur mainly among older people. Due to an increasingly ageing population, worldwide, dental surgeons will very likely see patients who either have suffered or are at risk of a fall. In addition, other at-risk patient groups may visit dental surgeons, such as paediatric, special care or medically compromised patients - the latter suffering neurological or movement disorders, sensory impairments, and cardiorespiratory and bone or joint diseases. Patients at risk of falls may also be at risk of medication-related osteonecrosis of the jaw (MRONJ); further challenges for the dental surgeon include transfer to the dental chair and the provision of sedation or general anaesthesia. While falls could cause dental and maxillofacial trauma, emerging evidence suggests dental health could also be an independent risk factor for falls; therefore, dental surgeons may have a role in preventing falls. NICE and Public Health England (PHE) both recommend that all healthcare professionals caring for at-risk patients should maintain a basic knowledge of falls and be able to advise on falls prevention.

Genotoxic effect of two commonly used food dyes metanil yellow and carmoisine using Allium cepa L. as indicator.

Food dyes are important component of food in this fast life. Metanil yellow and carmoisine are two azo dyes which are being used at an alarming rate for increasing visual appearance and consumer validity of food. There is a lot of controversy regarding the genotoxicity of these two dyes. In the present study genotoxicity of two food dyes metanil yellow and carmoisine was evaluated using Allium cepa as indicator. The effect of these two azo dyes was determined at concentration of 0.25 %, 0.50 %, 0.75 % and 1.0 % for 24 h and 48 h of exposure period using root meristematic cells of Allium cepa. Some genotoxicity parameters like mitotic indices and chromosomal aberrations were studied. It was found that both metanil yellow and carmoisine caused a significant reduction in mitotic index and also produce different kinds of chromosomal aberrations mostly at higher concentration and longer exposure period. The different kinds of aberrations that were observed in meristematic cells after treatment with both metanil yellow and carmoisine are disorientation at metaphase, metaphase stickiness, anaphase stickiness, anaphase bridge, c-mitosis and chromosome breaks. The genotoxicity of carmoisine was found very high as compared to metanil yellow at all concentrations and exposure periods. Thus it was concluded from the present study that carmoisine and metanil yellow have genotoxic activities and should be taken in very control and limited doses.

Socioeconomic and ethnic status of two- and three-year-olds undergoing dental extractions under general anaesthesia in Wolverhampton, 2011-2016.

Introduction Socioeconomic and ethnic status have in the past been implicated as possible causes of dental caries. Aims To assess the role that relative social depravation and ethnicity has on dental caries in two- and three-year-olds undergoing DGA in Wolverhampton. Design and methods Retrospective analysis of hospital records of 213 patients over a six-year period (2011-2016). A three-way analysis of variance (ANOVA) and chi-square tests were used to test statistical significance. Results The most significant factor between ethnicity, year and sex, was ethnicity (P = 0.026), with the greatest difference between mean number of teeth extracted per treatment visit for Other Whites (mean = 6.3) compared with White British (mean = 4.0) (difference P = 0.012). The association between the difference in extracted quadrant and year of treatment was significant (P = 0.011), with the greatest frequency of extractions involving three and four quadrants in the later years of 2015 and 2016. Seventy percent of children treated were living in the 20% most deprived areas (deciles one and two) compared with children living in more affluent areas (deciles three to ten) (P <0.001). Conclusion An important public health issue is highlighted which needs to be addressed, both at a national level and locally, through early oral health education for mothers from relatively deprived areas; particularly those of Other White ethnicity.

Duplication of cervical oesophagus: a case report and review of literatures.

Foregut duplication is commonly found in the posterior mediastinum. 10-20% of these anomalies are associated with oesophageal duplication. It can occur in all parts of oesophageal length. Although duplication of cervical oesophagus has been previously reported, but a majority of them were found in thoracic oesophagus. Infants with oesophageal duplication usually manifested by respiratory distress or asymptomatic thoracic mass, casually, detected in X-ray. A 7-month-old infant weighing about 7.5 kg, with the signboard of respiratory distress, fever and nutritional intolerance was admitted to our hospital. Physical examination showed dehydration, stridor, tachypnoea, intercostal retraction and neck stiffness. Plain chest radiogram showed dubious cystic mass in the distal neck. Cervical and chest computed tomography scan showed neck cystic lesion disseminated to posterior mediastinum, probably propagated to the respiratory system. Cystic lesion connected to oesophagus was partially resected, oesophagus was repaired and remaining mucous of a cyst was removed, then gastrostomy tube was applied. Although cervical oesophageal duplication cysts are rare, but they must be considered as one of the differential diagnoses of cervical mass with respiratory distress in infants.

Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy.

OBJECTIVE: The objective of our study was to identify the incidence and risk factors of anastomotic leaks following transhiatal esophagectomy (THE). MATERIALS AND METHODS: A prospective study was conducted on 61 patients treated for carcinoma of the esophagus between 2006 and 2007. We examined the following variables: age, gender, preoperative cardiovascular function, intraoperative complications such as hypotension, arrhythmia, mediastinal manipulation period, blood loss volume, blood transfusion, duration of surgery, postoperative complications such as anastomotic leak, anastomotic stricture, requiring reoperation, respiratory complications, and total morbidity and mortality. Variables were compared between the patients with and without anastomotic leak. T-test for quantitative variables and Chi-square test for qualitative variables were used to find out any relationship. P value less than 0.05 was considered significant. RESULTS: Out of 61 patients, anastomotic leaks occurred in 13 (21.3%). Weight loss, forced expiratory volume (FEV1) < 2 lit, preoperative albumin, intaoperative blood loss volume, and respiratory complication were associated with the anastomotic leak in patients undergoing THE. Anastomotic leaks were the leading cause of postoperative morbidity, anastomotic stricture, and reoperation. CONCLUSION: Anastomotic leakage is a life-threatening postoperative complication. Careful attention to the factors contributing to the development of a leak can reduce the incidence of anastomotic complications postoperatively.