Current Trends In Complete Denture Education In Undergraduate Dental Colleges Of Pakistan.

Objective: To determine the current trends in complete denture education in undergraduate dental colleges. METHODS: The survey-based study was conducted in April and May 2020 at undergraduate dental colleges of Pakistan, and comprised heads of the Prosthodontics Department at all dental colleges across Pakistan having at least one batch of final year dental students. Data was collected using an online predesigned questionnaire that explored theoretical and practical teaching patterns of complete denture prosthodontics in the undergraduate years, and the materials and practices of students when constructing complete dentures in the clinics. The participants were given the option of choosing more than one option where needed. Data was analysed using SPSS 23. RESULTS: Of the 49 subjects approached, 40(81.6%) returned the forms duly filled; 11(27.5%) from public-sector institutions and 29(72.5%) from the private sector. There were 26(65%) institutions which required that their undergraduate students fabricate 2-4 conventional complete dentures. In all 40(100%) colleges, faculty gave live clinical demonstrations before students fabricated conventional complete dentures in the outpatient departments. Teaching strategy included small group discussions in 25(62.5%) institutions. Green stick 40(100%), zinc oxide eugenol 40(100%) and impression compound 39(97.2%) were the materials of choice for various steps of impression making. In all the 40(100%) institutions, students fabricated conventional complete dentures during their prosthodontics rotation. Immediate, copy and overdentures were constructed by students in 8(20%), 3(7.5%) and 8(20%) institutions, respectively. Conclusion: Majority of the dental schools used similar impression materials and techniques for fabricating conventional complete dentures. Didactic teaching of conventional and unconventional complete dentures was being carried out at a huge majority of the dental institutions studied.

Microhardness of heat cure acrylic resin after treatment with disinfectants.

OBJECTIVE: To evaluate the effect of disinfectants and distilled water on the micro-hardness of heat cure acrylic resins. METHODS: The case-control study was conducted at Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, and Nadirshaw Edulji Dinshaw University of Engineering and Technology, Karachi, from April to October 2011. Specimens were fabricated from heat cure acrylic resin material and they were divided into four equal groups. Group 1 was evaluated at baseline and was taken as the control group. Group 2 was immersed in distilled water for 20 minutes, Group 3 in1% sodium hypochlorite for 20 minutes, and Group 4 in 2% alkaline gluteraldehyde for 10 minutes. All specimens were polished, stored in distilled water for 24 hours prior to experiment. All the specimens were immersed twice daily for a total of 60 days after which they were tested for Vickers micro-hardness test. Statistical analysis was conducted with one-way analysis of variance and Tukey post hoc test (a=0.05). RESULTS: There were 72 specimens divided into four groups of 18(25%) each. Statistically significant differences were found among all groups (p<0.0001). The storage medium had an effect on the micro-hardness of heat cure acrylic resins. Group 4 showed the most reduction in the hardness value which was followed by Group 3. CONCLUSIONS: The hardness of heat cure acrylic resin was affected by disinfectants.

Diametral tensile strength of two dental composites when immersed in ethanol, distilled water and artificial saliva.

OBJECTIVE: To examine the effect of distilled water, artificial saliva and ethanol on the tensile strength of direct tooth-coloured restorative material. METHODS: The study was conducted at Dr. Ishrat ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences (DUHS), Karachi, from April 2011 to September 2012. The testing was performed at the Pakistan Council of Scientific and Industrial Research (PCSIR) laboratories. Two composite resins Filtek Z250 and Spectrum TPH were tested. Specimens (13 mm x 3 mm x 2 mm) of each material were prepared in the stainless steel mould according to the manufacturers' instructions and distributed into 3 equal groups: one immersed in distilled water, the other in artificial saliva, and the last one in ethanol for 24 hours. Tensile strength was determined after 24 hours in universal Instron Testing Machine. RESULTS: There were 72 specimens in all; 36 (50%) each for Filtek Z250 and Spectrum TPH. The three sub-groups in each case had 12 (33.3%) specimens. For the Filtek Z250, there was no statistically significant difference between immersion in distilled water and artificial saliva, but the ethanol group presented lower tensile strength (p<0.05). For the Spectrum TPH, samples immersed in ethanol and artificial saliva presented lower tensile strength compared to distilled water (p<0.05). CONCLUSION: The tested composite resins were affected by the immersion media and adversely affected the mechanical properties of composite resins.

Evaluation of healthcare professionals' understanding of fluoroquinolones' safety profile, usage, and boxed warnings in Pakistan.

INTRODUCTION: Fluoroquinolones (FQs) is a distinct class of antibiotics which are prescribed and used quite frequently worldwide, despite the box warnings (BW) issued by Food and Drug Administration (FDA). Literature has shown in spite of BWs related to FQs there is minimal impact on health care professionals (HCPs) prescribing habits, potentially attributing towards limited and insufficient awareness. In Pakistan, FQs are mostly prescribed antibiotics for microbial treatments, therefore the purpose of this study was to determine the level of knowledge about the safety profile, use, and BW of FQs among HCPs working in Pakistan. METHODS: A cross-sectional study was undertaken among the HCPs of Khyber Pakhtunkhwa province of Pakistan from October 2022 to December 2022. A validated questionnaire was used to assess the knowledge of HCPs regarding FQs, its safety profile and BW. A random convenient sample technique was used while recruiting HCPs in this study. As the HCPs comprised physicians, dentists, pharmacist and nurses, all were approached in person and the study objective was fully elaborated and explained to them. The statistic test like: one-way ANOVA, independent-t test, multivariate logistic regression were used keeping the p-value < 0.05 as statistically significant. RESULTS: A total of n = 250 HCPs were approached, of which n = 186 HCPs completed the questionnaire with a response rate of 74.4%. FQs prescribing pattern was only assessed among the prescribers, i.e., physicians and dentists (39/186). The mean knowledge score for indications was 5.29 ± 3.05, while for the adverse effects was 7.70 ± 2.61. The highest score for knowledge for indications and adverse effect score was achieved by physicians followed by dentist. The mean knowledge score for the BW was 3.46 ± 2.93 and among the HCPs for the BW of FQs, 20.4% of the HCPs had appropriate knowledge score (score ≥ 50%). The knowledge score was significantly higher in males (p = 0.039), dentists (p = 0.001), HCPs having master/specialization level of education (p = 0.003), HCPs working in government sector hospitals (p = 0.010) and secondary care hospitals (p = 0.001) while the multivariate logistic regression analysis showed that HCPs working in primary care hospital (OR: 6.2) and secondary care hospital (OR: 20.3) were associated with the tendency to achieve 50% or above knowledge score. CONCLUSION:  Findings of this study reveals the unsatisfactory knowledge of HCPs regarding the safety profile, use, and BW of FQs putting patients at heightened risks of FQs associated AEs. Therefore, it is crucial to implement a national antimicrobial stewardship program, seminars and lectures aimed at continuously updating the knowledge of HCPs, regardless of their specialties, and effectively restrict the misuse of antimicrobial and disseminate FDA BWs in clinical practice.

Development and Evaluation of Self-Emulsifying Drug-Delivery System-Based Tablets for Simvastatin, a BCS Class II Drug.

Background: Self-emulsifying drug-delivery systems (SEDDSs) are designed to improve the oral bioavailability of poorly water-soluble drugs. This study aimed at formulating and characterization of SEDDS-based tablets for simvastatin using castor and olive oils as solvents and Tween 60 as surfactant. Methods: The liquids were adsorbed on microcrystalline cellulose, and all developed formulations were compressed using 10.5 mm shallow concave round punches. Results: The resulting tablets were evaluated for different quality-control parameters at pre- and postcompression levels. Simvastatin showed better solubility in a mixture of oils and Tween 60 (10:1). All the developed formulations showed lower self-emulsification time (˂200 seconds) and higher cloud point (˃60°C). They were free of physical defects and had drug content within the acceptable range (98.5%-101%). The crushing strength of all formulations was in the range of 58-96 N, and the results of the friability test were within the range of USP (≤1). Disintegration time was within the official limits (NMT 15 min), and complete drug release was achieved within 30 min. Conclusion: Using commonly available excipients and machinery, SEDDS-based tablets with better dissolution profile and bioavailability can be prepared by direct compression. These S-SEDDSs could be a better alternative to conventional tablets of simvastatin.

Probing the behavior and kinetic studies of amphiphilic acrylate copolymers with bovine serum albumin.

This article presents that acrylate copolymers are the potential candidate against the adsorption of bovine serum albumin (BSA). A series of copolymers poly(methyl methacrylate) (pMMA), poly(3-sulfopropyl methacrylate-co-methyl methacrylate) p(SPMA-co-MMA), and poly(dimethylaminoethyl methacrylate-co-methyl methacrylate) p(DMAEMA-co-MMA) were synthesized via free radical polymerization. These amphiphilic copolymers are thermally stable with a glass transition temperature (Tg) 50-120 °C and observed the impact of surface charge on amphiphilic copolymers to control interactions with the bovine serum albumin (BSA). These copolymers pMD1 and pMS1 have surface charges, - 56.6 and - 72.6 mV at pH 7.4 in PBS buffer solution that controls the adsorption capacity of bovine serum albumin (BSA) on polymers surface. Atomic force microscopy (AFM) analysis showed minimum roughness of 0.324 nm and 0.474 nm for pMS1 and pMD1. Kinetic studies for BSA adsorption on these amphiphilic copolymers showed the best fitting of the pseudo-first-order model that showed physisorption and attained at 25 °C and pH 7.4 within 24 h.

Investigating the self-assembling of nicotinic hydrazide-based amphiphile into nano-range vesicles and its amphotericin B loading applications.

Most of the drugs are hydrophobic and have low water solubility, therefore posing issues in their absorption and bioavailability. Nonionic surfactants improve the solubility of hydrophobic drugs by entrapping them in their lipid bilayers. Two nonionic surfactants NODNH-16 and NODNH-18 are synthesized and characterized using different techniques i.e. EI-MS, 1H NMR, and FTIR. These newly synthesized surfactants were screened for blood hemolysis assay and cell toxicity studies using the NIH/3T3 cell line to assess their biocompatibility. Then amphotericin B was loaded into niosomal vesicles, and the drug entrapment efficiency of these surfactants was measured using UV-visible spectroscopy. The morphology of drug-loaded niosomes of synthesized surfactants was investigated using AFM, and their size, polydispersity, and zeta potential were measured with the Zetasizer instrument. Finally, a simulation study was performed to determine the pattern of self-assembly of the synthesized amphiphiles. Both synthesized nonionic surfactants showed good entrapment efficiency of 60.65 ± 2.12% and 68.45 ± 2.12%, respectively. It was also confirmed that both these synthesized nonionic surfactants were safe and biocompatible and showed less blood hemolysis (i.e. 21.13 ± 2.11% and 23.32 ± 2.45%) and higher 3T3 cells' viability at 150 µg/mL concentration as compared to Tween®-80. The antifungal potential of amphotericin B-loaded niosomes has been evaluated against unicellular multi-fungal species, which showed a promising potential for fungicidal activity. These results are substantiated by constructing a safe vehicle system for drug delivery.

Comparative Evaluation of Condylar Guidance Angles Measured Using Arcon and Non-Arcon Articulators and Panoramic Radiographs-A Systematic Review and Meta-Analysis.

The condylar guidance value (CGV) measurement constitutes an important part of a holistic prosthodontic treatment plan, with horizontal CGVs (HCGVs) and lateral CGVs (LCGVs) being two of the most prominently recognized. This systematic review aimed at evaluating the efficacy of two different types of CGV measurement protocols-articulators (both arcon and non-arcon) and panoramic radiographs. Additionally, it attempts to determine which of the mentioned methods performs better across several parameters. Several important web databases were searched using search terms derived from medical subject headings (MeSH), using keywords linked to "Arcon articulator", "Condylar guidance angle", "non-arcon articulator", "Panoramic x-ray" and "Radiographic examination", which constituted the first step in the study selection strategy. After completion, the search strategy which initially turned up to 831 papers, eventually ended up with 13 studies. The review and subsequent meta-analysis revealed that panoramic radiographs had noticeably greater efficacy in terms of the CGVs as compared to the articulators in the majority of the studies. Within the articulators, the arcon types recorded slightly higher CGVs than the non-arcon variety owing to the precision of jaw movement simulation in the former. However, further studies are required to validate these findings and establish more precise guidelines for the use of CGV measurement protocols in prosthodontic practice.

Serpins in Tick Physiology and Tick-Host Interaction.

Tick saliva has been extensively studied in the context of tick-host interactions because it is involved in host homeostasis modulation and microbial pathogen transmission to the host. Accumulated knowledge about the tick saliva composition at the molecular level has revealed that serine protease inhibitors play a key role in the tick-host interaction. Serpins are one highly expressed group of protease inhibitors in tick salivary glands, their expression can be induced during tick blood-feeding, and they have many biological functions at the tick-host interface. Indeed, tick serpins have an important role in inhibiting host hemostatic processes and in the modulation of the innate and adaptive immune responses of their vertebrate hosts. Tick serpins have also been studied as potential candidates for therapeutic use and vaccine development. In this review, we critically summarize the current state of knowledge about the biological role of tick serpins in shaping tick-host interactions with emphasis on the mechanisms by which they modulate host immunity. Their potential use in drug and vaccine development is also discussed.

Color and translucency stability of novel restorative CAD/CAM materials.

BACKGROUND: The wide range of restorative materials available for use in the computer-aided design/ computer-aided manufacturing (CAD/CAM) technology requires a better understanding of their esthetic properties. OBJECTIVES: The aim of the study was to assess the stability of the color and translucency of different CAD/ CAM restorative materials before and after being subjected to different staining solutions. MATERIAL AND METHODS: A total of 160 disc-shaped specimens were prepared from glass ceramic (IPS-e.max®-CAD and Celtra Duo®), high-translucency zirconia (LavaTM Plus), resin nanoceramic (LavaTM Ultimate), and hybrid ceramic (VITA ENAMIC®) CAD/CAM blocks (5 groups, n = 32). The specimen color and translucency parameter (TP) were assessed using a spectrophotometer at baseline and after subjecting the specimens to different staining solutions (coffee, cola, ginger, and water). Changes in color (ΔE) and TP (ΔTP) were calculated. The data was analyzed using the analysis of variance (ANOVA) and Tukey's post hoc test (p < 0.05). The correlation between ΔE and ΔTP was investigated using Pearson's correlation coefficient. RESULTS: Staining significantly affected the baseline color of all specimens. Ginger had the most significant effect on Lava Plus (ΔE = 4.01 ±1.2), cola on Celtra Duo (ΔE = 2.29 ±0.25) and coffee on Lava Ultimate (ΔE = 2.59 ±0.17). Generally, IPS-e.max-CAD showed the smallest ΔE. No significant differences in ΔTP were found between different staining solutions. Increased ΔE correlated with decreased translucency for all the tested materials and staining solutions. CONCLUSIONS: Staining had a marked effect on the color and translucency of the tested CAD/CAM materials. The color change was staining solutionand material-dependent, with IPS-e.max-CAD showing the greatest color stability.

DNA scaffold nanoparticles coated with HPMC/EC for oral delivery.

The control of the glycemic level among diabetes/T2 patients is very important for their long term survival and avoiding further complexities including micro/macrovascular diseases as well as diabetic neuropathy. Vildagliptin (VD) is a drug that has addressed these issues successfully with the desired safety portfolio. We used DNA-nanocubes for initial nano-encapsulation of VD followed by HPMC/EC coating. The results revealed the stable, smooth, spherical and nano-sized nanoparticles with improved size uniformity (from 100 to 400 nm in diameter) and encapsulation-efficiency (E.E.%) than previously reported (500-2000 nm) with the chemical compatibility evident in ATR/FTIR and DSC results. Animal experiments results revealed the improvement of incretin level in the serums due to potent DPP-4 inhibition compared to the free-VD/solution with better maintenance of glycemic levels after feeding. The safety of these HPMC/EC-DNA-VD nanoparticles was assessed through the histological-examination after completion of the treatment turn. The solvent evaporation technique provided the better coating of HPMC around DNA-core with gastro-resistant and effervescent property due to presence of NaHCO3 (0.01%) in the formulations that caused delayed delivery of VD as well as nanoparticles to the intestine, increasing the availability time of the drug and nanospheres at the target sites (intestine and blood) where DPP-4 enzyme is most abundant (to degrade the GLP-1 and GIP causing loss of control of the postprandial glycemic levels. So the availability of sustained release nanospheres near the target sites and prolonged DPP-4 inhibition improved the outcomes of the therapy.

Design, synthesis and evaluation of DNA nano-cubes as a core material protected by the alginate coating for oral administration of anti-diabetic drug.

Poor control towards glycemic levels among diabetic patients may lead to severe micro/macro-vascular and neuropathic complexities. Proper functioning of alpha-beta cells of pancreases is required to attain long term glycemic control among type 2 diabetics. The recent developments to manage diabetes are focused on controlling the insulin-glucagon secretions from the pancreases. DPP-4 inhibitors class of drugs after elevating GLP-1/GIP (incretins) levels in the blood, not only raise the insulin levels but also suppress the glucagon level. Vildagliptin (VI) is a potent DPP-4 inhibitor with least adverse events compared to other DPP-4 inhibitors. We encapsulated VI into 3D nanocube that gets bind to the DNA due to secondary amine in its chemical structure. DNA-nanocube being negatively charged was incubated with the PLL to attain positive surface. Ultimately VI loaded nanocubes were coated with the negatively charged Na-alginate via electrostatic attraction method to get stable spherical nanospheres for oral delivery of VI. Nanospheres were evaluated physically through native PAGE analysis, DSC, TGA, dissolution testing, XRD and FTIR. We attained uniformed and spherical nanospheres with stable topology, nanoscale size precision (40-150 nm in diameter), Entrapment efficiency (up to 90%), prolonged drug release (13 ± 4 h) at basic pH, and superior oral antidiabetic effects with improved GLP1 and glycemic levels. The formulated nanospheres attained size uniformity and better therapeutic outcomes in terms of reduced adverse events and better control of glycemic levels than previously reported methods with decreased dosage frequency tested in Db/Db mice.

Cardio-supportive devices (VRD & DCC device) and patches for advanced heart failure: A review, summary of state of the art and future directions.

Congestive heart failure (CHF) is a complicated pathophysiological syndrome, leading cause of hospitalization as well as mortalities in developed countries wherein an irregular function of the heart leads to the insufficient blood supply to the body organs. It is an accumulative slackening of various complications including myocardial infarction (MI), coronary heart disease (CAD), hypertension, valvular heart disease (VHD) and cardiomyopathy; its hallmarks include hypertrophy, increased interstitial fibrosis and loss of myocytes. The etiology of CHF is very complex and despite the rapid advancement in pharmacological and device-based interventional therapies still, a single therapy may not be sufficient to meet the demand for coping with the diseases. Total artificial hearts (TAH) and ventricular assist devices (VADs) have been widely used clinically to assist patients with severe HF. Unfortunately, direct contact between the patient's blood and device leads to thromboembolic events, and then coagulatory factors, as well as, infection contribute significantly to complicate the situation. There is no effective treatment of HF except cardiac transplantation, however, genetic variations, tissue mismatch; differences in certain immune response and socioeconomic crisis are an important concern with cardiac transplantation suggesting an alternate bridge to transplant (BTT) or destination therapies (DT). For these reasons, researchers have turned to mechanically driven compression devices, ventricular restraint devices (VRD) and heart patches. The ASD is a combination of all operational patches and cardiac support devices (CSD) by delivering biological agents and can restrain or compress the heart. Present study summarizes the accessible peer-reviewed literature focusing on the mechanism of Direct Cardiac Compression (DCC) devices, VRD and patches and their acquaintance to optimize the therapeutic efficacy in a synergistic way.

The mean visible labial length of maxillary and mandibular anterior teeth at rest.

OBJECTIVE: To determine the mean visible labial length of maxillary and mandibular anterior teeth at rest. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Prosthodontics, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Karachi, from October 2012 to March 2013. METHODOLOGY: A total of 200 subjects were included. Measurements were carried out using digital caliper from the border of the lip to the incisal edges of incisor and to the cusp tip for the canines. The length of the upper lip was measured from subnasale to stomion. Statistical analyses were performed by Mann Whitney-U test and Kruskal Walli's test. RESULTS: The age of the participant ranged between 20 and 65 years. At rest, females significantly displayed more of the maxillary central incisor (2.93 ± 1.57 mm; p=0.003), lateral incisor (1.87 ± 1.12 mm; p=0.005) and canine (0.59 ± 0.62 mm; p=0.031). With increasing age, the amount of maxillary anterior teeth visible at rest significantly decreased (p < 0.001), and increased for the mandibular teeth (p < 0.001). Subjects with shorter upper lips significantly displayed more maxillary anterior incisor structure than subjects with longer upper lip (p < 0.001). CONCLUSION: Females displayed significantly more labial length of the maxillary anterior teeth. The mean visible labial length of maxillary anterior teeth significantly decreased with increasing age and increased for the mandibular teeth. As the upper lip length increased, the mean visible labial length of maxillary anterior teeth significantly decreased.

Frequency of gingival display during smiling and comparison of biometric measurements in subjects with and without gingival display.

OBJECTIVE: To determine the frequency of gingival display during smiling and to compare biometric measurements in subjects with and without gingival display. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Prosthodontics, Dr. Ishrat-ul-Ibad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi, from October 2012 to March 2013. METHODOLOGY: A total of 275 subjects (121 men and 154 women) were included in this study. The age of the participants ranged between 21 and 65 years. Measurements were carried out using digital caliper. For each participants, the gingival display was judged as either visible or not. The amounts of horizontal and vertical overlap of anterior teeth were measured using a digital caliper. Gender differences in these parameters and the relationship between subjects showing gingival display when smiling and the two intraoral dental biometric measurements were determined. Statistical analyses of data were performed using SPSS version 17.0 software. The mean scores for gender were calculated and a Student's t-test was used to identify significant differences between both groups. Significant level was set to 0.05. RESULTS: A relatively small percentage of the subjects (37.8%) displayed gingiva when smiling. More women significantly displayed gingiva when smiling than men, with a 2:1 female: male ratio. Women had significantly (p=0.001) more horizontal overlap (3.34 ± 1.45 mm) than men (2.90 ± 1.44 mm), although no significant gender difference were found in vertical overlap. Subjects with gingival display had significantly (p < 0.05) more horizontal (3.49 ± 1.36 mm) and vertical (3.26 ± 1.47 mm) overlap of anterior teeth compared to those who did not display gingiva when smiling. CONCLUSION: Significantly more women displayed gingiva in smiling. Women had significantly more horizontal overlap than men. No gender differences were recorded between vertical overlap. Subjects who displayed gingiva when smiling had more horizontal and vertical overlap of anterior teeth.