Learning from the handling of the referral of Dr Manjula Arora.

The Singh and Forde review of the General Medical Council's handling of Dr Manjula Arora's referral made a number of recommendations for the General Medical Council, the wider NHS and other organisations. This article discusses how to move forward with the recommendations and deliver 21st-century regulation that is truly compassionate, fair and supportive.

System failures and learning from the case of Dr Manjula Arora: 21st century regulation needs to be compassionate, caring and supportive.

The recent judgement and suspension of Dr Manjula Arora has caused huge apprehension within the medical community and raised debate about whether the fitness to practise process is fit for purpose. This editorial focuses on the need for 21st century regulation to be proportionate, fair, supportive and compassionate.

Development of inclined plate honey moisture reduction system.

Honey is delicious, nutritious and has high medicinal value in comparison to other sweeteners. Honey is usually extracted from comb as immature product which results in high moisture which makes it more liable to be fermented by osmophilic yeasts. So, it needs to be processed for moisture reduction, to delay crystallization and to overcome the problem of fermentation. In the present investigation, a honey moisture reduction system was developed and tested to reduce the moisture content of honey to about 17%. The system consisted of a flat plate inclined at an angle. The plate was heated from the underside and honey for moisture reduction was re-circulated over it until desired moisture content was achieved. Experiments were conducted for honey moisture reduction at water temperature of 40-70 °C with plate inclinations of 30°-60° according to four level full factorial design of experiment. The results showed that the total reduction time required for reaching moisture content of about 17% varied with water temperature and angle of inclination. The moisture reduction time required for reaching a moisture content of 17 percent at 40 °C was about five times the time required at 70 °C. The energy cost of honey moisture content reduction from 21.5 to 17% was Rs. 4.7 to Rs. 12.5 per kg.

Spectrophotometric analysis of color stability of esthetic restorative material in chlorhexidine mouthwash: An in vitro study.

Background: Commendable aesthetic properties of composites make it a pioneer filling material. However, discoloration of composite resin materials emerges as a major clinical problem in a long term. Aims and Objectives: Aim of the study is to evaluate the color stability of nano filled and micro hybrid dental composite resin in chlorhexidine mouthwash. Materials and Methods: 20 specimens of dimension 10*2mm were prepared of A2 shade. All the prepared samples were immersed in 20 ml of distilled water in separate containers according to the group. Further incubation at 37°C for 24 h was done. After 24 h, baseline color values of each sample were recorded using a spectrophotometer. After recording the baseline color measurements, 10 specimens (random selection) from each group were placed in 20 ml of 0.2% chlorhexidine mouthwash for 24 h duration. The L*a*b* system of the Commission Internationale de l'Eclairage (CIE L*a*b* Color Scale) was used for the determination of colorimetric values of the specimens. Results: The color change was displayed by both the samples after immersion in the mouthwash but the change was not statistically significant (0.763). ΔE value for nano filled composites is 3.25 while for the micro-hybrid composites the value is 3.56. Conclusion: The colorimetric values of nano filled composite resins are more stable than the micro hybrid composite due to exposure to chlorhexidine mouthwash.

Assessment of Prevalence of Dental Caries among School-going Children: A Cross-sectional Study.

BACKGROUND: The background of the study was to assess the prevalence of dental caries among school-going children. MATERIALS AND METHODS: Six thousand eight hundred and ninety school-going children was enrolled. General clinical examination was carried out. Mouth mirror, probe, and explorer were used for carrying out the clinical examination. Over a time span of 6 months, the entire study was completed. All the examiners who performed clinical examination underwent a single-day training program for detecting dental caries. All the participants were seated on straight wooden chairs and were examined clinically. The prevalence of caries was recorded. RESULTS: The prevalence was 26.02%. Among these children with dental caries, 50.25% of the children belonged to the age group of 13-15 years, while the remaining 49.75% of the children belonged to the age group of 9-12 years. Prevalence of dental caries was significantly higher in females (71.11%) in comparison to males. Furthermore, dental caries was significantly more prevalent among participants with toothbrushing frequency of less than once a day (51.20%). CONCLUSION: There is an imperative need for intimating health check-up camps among school-going children.

Assessment of Habits of Tobacco Use among Dental and Nondental Students of Indian Population: A Cross-sectional Study.

BACKGROUND: Tobacco usage can be equated to an unending progressive pandemic which continues to spread globally at an alarming unhindered pace. Dental surgeons have a key role in initiating reduction and even cessation of tobacco habits. Hence, the present study was undertaken for analyzing the habits of tobacco use among dental and nondental students of Indian population. MATERIALS AND METHODS: A total of 500 dental students and 500 nondental students were enrolled in the present study. Among dental students, only interns were enrolled across different dental colleges of India. A questionnaire was framed and was sent to all the students in the form of Google Forms. The questionnaire contained questions pertaining to the assessment of prevalence of tobacco use and type of tobacco use habit. All the results were recorded and analyzed. RESULTS: Five hundred dental students and 500 nondental students were enrolled. Among the dental group, tobacco use habits were present in 23.8% of the students, whereas in the nondental group, tobacco use habits were present in 43.6% of the students. While comparing the prevalence of tobacco use habits among the dental and nondental groups, significant results were obtained. In the dental group, smoking habit and chewing habit were present in 44.54% and 32.77% of the students, respectively. In the nondental group, smoking habit and chewing habit were present in 52.29% and 29.82% of the students, respectively. While comparing the pattern of tobacco use among students of the two study groups, nonsignificant results were obtained. CONCLUSION: There is an urgent need of tobacco cessation programs in the community to decrease the morbidity and mortality associated with it.

Efficacy and safety of tamsulosin vs its combination with mirabegron in the management of lower urinary tract non-neurogenic overactive bladder symptoms (OABS) because of Benign Prostatic Enlargement (BPE)-An open label randomised controlled clinical study.

PURPOSE: The efficacy and safety of ßeta-3 agonists (Mirabegron 50 mg) have been sparingly assessed in the published English literature. We aim to do an efficacy-safety analysis of Mirabegron-Tamsulosin combination therapy vs tamsulosin-placebo monotherapy in a select subset of medication virgin Benign Prostatic Enlargement (BPE) patients with coexisting predominant non-neurogenic overactive bladder symptoms (OABS). METHODS: After prior written informed consent and IEC, 80 patients of uncomplicated BPE with coexisting non-neurogenic OABS and IPSS of >7 without contraindications to drug therapy were computer randomised/allocated to receive either[50 mg Mirabegron plus Tamsulosin 0.4 mg (Intervention arm-I)]or [Tamsulosin 0.4 mg plus capsule lactobacillus (Comparator arm-II)] once daily for 8 weeks. Efficacy was evaluated using the OABS Score (OABSS), mean change in nocturnal frequency (NF), PVR and IPSS, while safety was assessed by recording treatment emergent adverse events (TEAE). Follow-up visits were performed at second, fourth and eighth week. RESULTS: Patient data in both groups were generally comparable with the exception of NF and IPSS storage sub score (IPSS-ss). Significant improvements were visualised in the eighth week primary endpoint total OABS sub score (OABSS-ss) in the combination group (P < .001).Similar significant improvements were seen with most secondary parameters such as the mean change in NF, IPSS, IPSS-ss, OABS-ss, voided volume, Qmax, and Quality of life index (QOL) (P < .001). No significant increase in PVR was observed in the Mirabegron arm and no patient developed urinary retention. The TEAE were minor, self-limiting and managed symptomatically without drug discontinuity. CONCLUSION: Mirabegron can be significantly efficacious and safe in ameliorating non-neurogenic OABS induced by BPE vs placebo by initiating combination therapy from the start as opposed to the usual 'add on therapy' protocol. This combination appeared to be superior in terms of overall safety, minimal side effects, better compliance and tolerability vs Tamsulosin monotherapy in select BPE patients with predominant non-neurogenic OABS.

Efficacy and safety of tadalafil vs tamsulosin in lower urinary tract symptoms (LUTS) as a result of benign prostate hyperplasia (BPH)-open label randomised controlled study.

INTRODUCTION & AIM: Several newer medications have emerged for the management of lower urinary tract symptoms secondary to benign prostate hyperplasia (BPH). The efficacy/safety of PDE-5 inhibitors (Tadalafil 5 mg) in BPH-lower urinary tract symptoms (LUTS) has been sparingly assessed in the published English literature as compared with their established role in erectile dysfunction. We aim to assess the efficacy/safety of tadalafil vs tamsulosin in symptomatic patients of BPH in a tertiary care teaching institution. METHODS: After obtaining an informed written consent and institutional ethics clearance, 100 patients of BPH with an IPSS score of more than 7, without any complications of the disease were computer randomised to receive therapy with either tamsulosin 0.4 mg or tadalafil 5 mg once daily for a period of 2 months. They were evaluated for its efficacy (IPSS, Peak flow rate, IIEF-5, quality of life index [QOL] and PVR) and safety (side effect profile) with monthly visit assessments for 2 months. Data were analysed statistically using ANOVA and unpaired t-tests.The protocol was registered with the CTRI/2018/03/012825. RESULTS: Patients in both groups were comparable on basis of their demographic data, renal function, PSA and baseline efficacy parameters. Significant improvements were visualised amongst/within both groups for IPSS, however the intergroup improvement was not significant (P = .096). Similar trends were seen with peak flow rate and PVR with intergroup improvement differences not being significant (P = .552 and P = .131, respectively).Improvements in QOL index were more significant in the tamsulosin group (mean difference -2.3 vs -3.06 P = .010).The adverse effects were minor and were managed symptomatically without any drug discontinuity. CONCLUSIONS: In summary, therefore, we may conclude that that once daily monotherapy with tadalafil 5 mg or tamsulosin 0.4 mg was equally efficacious in the management of moderate to severely bothersome LUTS in majority of patients as a result of BPH. The role of Tadalafil monotherapy in BPH patients with predominant storage LUTS merits further evaluation with larger trials.

Time for a culture change: understanding and reducing risk, morbidity and mortality from COVID-19 in those of black and minority ethnicity.

Following a number of epidemics in the 21st century, including Ebola and Middle East respiratory syndrome, the SARS-COV-2 virus, causing COVID-19 disease, was declared a pandemic health emergency of international concern in January 2020.

A histological continuum between dentinogenesis imperfecta and dentin dysplasia: A case report with literature review.

Dentinogenesis Imperfecta and dentin dysplasia are genetic oral diseases inherited in a simple autosomal dominant mode, with high penetrance and a low mutation rate. Both of them are present with bulbous crowns, marked cervical constrictions, severe attritions, few periapical radiolucencies, and premature tooth loss. The diagnosis is based on family history, and detailed clinical examination, while genetic diagnosis may become useful in the future once sufficient disease-causing mutations have been discovered. Here, we present a case with overlapping features of both dentinogenesis imperfecta and dentin dysplasia asserting both the anomalies to be part of the same continuum of the genetic event.

Immunoexpression of alpha smooth muscle actin correlates with serum transforming growth factor-ß1 levels in oral submucous fibrosis.

AIM: The aim of the present study was to correlate the immunoexpression of alpha-smooth muscle actin (α-SMA) for myofibroblasts with the serum levels of transforming growth factor-ß1 (TGF-ß1) in oral submucous fibrosis (OSMF). METHODS: A total of 100 cases of histopathologically confirmed OSMF were assessed for α-SMA expression. Clinical data, such as age, sex, mouth opening, and habit history, were obtained for each case. Serum TGF-ß1 levels were recorded in 73 patients with the help of enzymelinked immunosorbent assay technique. RESULTS: The staining index of α-SMA increased concomitantly with higher myofibroblast count in the increasing histopathological grades of OSMF (P ≤ .05). Serum TGF-ß1 levels were highest in the intermediate grades of OSMF. Clinical parameters, such as mouth opening, cheek flexibility, and tongue protrusion, showed a direct correlation with increasing clinical grades of OSMF. CONCLUSIONS: The progressive increase in myofibroblasts from early to advanced stages suggests their potential use as markers for evaluating the severity of OSMF. Additionally, as myofibroblasts are responsible for producing a variety of factors that are involved in the fibrotic processes; they could be the key link in the pathogenesis of OSMF. Interruption of their development, recruitment, or activation could provide a unique therapeutic target for future treatment options in patients with OSMF.

Efficacy of intercostal nerve block with 0.25% bupivacaine in percutaneous nephrolithotomy: A prospective randomized clinical trial.

INTRODUCTION AND AIM: Several techniques have been used to lower the morbidity of percutaneous nephrostomy (PCN) tube after percutaneous nephrolithotomy (PCNL). The outcomes of intercostal nerve block (ICB) versus peritubal block (PTB) with 0.25% bupivacaine to alleviate post-PCNL pain were compared. MATERIALS AND METHODS: After obtaining an informed written consent and local institutional ethics clearance, 64 patients undergoing PCNL were computer randomized to receive either an intercostal block/ICB (Group I) or a peritubal block/PTB (Group II) using 0.25% bupivacaine infiltration, after termination of the procedure. They were evaluated for visual analog scale (VAS) score, first analgesic requirement, and the total analgesic demand along with fall in hematocrit, PCN indwelling time, blood transfusion rate, complications, and mean hospital stay in the postoperative period. The protocol was registered with CTRI/2018/03/012717. RESULTS: Patients in both the groups were comparable on the basis of demographic data, preoperative renal function, stone burden, and hematocrit value. The mean VAS score at 6, 12, 24, and 48 h was significantly lower in the Group II versus Group I (P < 0.001). The total mean analgesic requirement was 160.16 and 103.13 mg of diclofenac sodium in Group I and Group II, respectively, which was significantly higher in Group I versus Group II (P < 0.001). The time to first analgesic demand was significantly higher in PT group (8.06 ± 1.99 h vs. 12.97 ± 1.96 h) in Group I/ICNB and Group II/PT, respectively (P < 0.001). Both the groups were comparable in terms of postoperative hematuria, hematocrit fall, nephrostomy site leak, hospital stay, need of blood transfusions, stone-free rate/retreatment rate, postoperative urinary tract infections, and overall complication rate (Modified Clavien-Dindo classification) which were not statistically significant. CONCLUSION: Post PCNL, PTB was associated with significantly lower post operative pain and discomfort versus ICB as demonstrated by the significantly lower DVAS pain scores, higher mean time to first analgesic demand and lower mean total analgesic demandt with ICB. Bupivacaine was a safe and effective local anesthetic agent for PTB in select patients for facilitating quick relief from the morbid postoperative pain and discomfort following PCNL.

Diffuse large B-cell lymphoma: An immunohistochemical approach to diagnosis.

Diffuse large B-cell lymphoma (DLBCL) is an aggressive type of non-Hodgkin's lymphoma (NHL) that develops from the B-cells of the lymphatic system. It is the most common subtype of NHL accounting for 30%-40% of all cases. In addition to determining if NHL is indolent or aggressive and whether it is B-cell, T-cell or NK-cell lymphoma, it is very important to determine the subtype of NHL. This is because each subtype can behave differently and may require different treatments. This warrants the need for an accurate and explicit subtype-specific diagnosis that catalogs the molecular prognostic indicators. Moreover, retrospective studies have confirmed that diagnosis to treatment interval is strongly associated with prognostic clinical factors and outcome in newly diagnosed cases of DLBCL. Therefore, an expeditious histological and immunohistochemical investigation should be compassed in cases of oral lymphomas.

H1N1 Influenza: Assessment of knowledge and awareness of private dental health professionals of a Tricity.

BACKGROUND: Influenza like Swine flu virus has posed a greater risk of occupational transmission to dental professionals as it can spread through the aerosols. AIM: To assess knowledge and awareness of private dental health care professionals regarding swine flu of a Tricity in India. MATERIALS AND METHODS: A cross-sectional study was conducted among 255 private dentists practising in the Tricity. A self-administered, anonymous, multiple choice type questionnaire was administered to gather information. The questionnaire contained 12 questions on knowledge and awareness regarding swine flu keeping in view the time constraints. Statistical analysis was done using ANOVA and student t-test. RESULTS: Awareness regarding mode of transmission of swine flu were reported positively by 88.5% of subjects. About 24.6% of subjects reported about having encountered a swine flu patient at their clinic. Preventive measures to prevent spread of swine flu were known to 71.2% of subjects. Statistically significant association of mean knowledge scores was noted with education level (P = 0.015) and working profile (P = 0.017) of the subjects. CONCLUSION: The results of the present review showed that some knowledge gaps existed among dentists regarding some important aspects of swine flu. Therefore, there is an urgent need for training and continuous education programs regarding infectious diseases.

CTAB Surfactant Assisted and High pH Nano-Formulations of CuO Nanoparticles Pose Greater Cytotoxic and Genotoxic Effects.

Toxicity of synthesized nanoparticles is the area of concern to all the researchers due to their possible health implications. Here we synthesized copper oxide nanoparticles (CuO NPs) without surfactant at pH value of 2, 7, 10 and with cetyletrimethylammoniumbromide (CTAB) surfactant at pH 7. Synthesized nanoparticles were characterized for various structural parameters including crystallite size, lattice parameters, strain, phase analysis using X-ray diffraction analysis, and morphological aspects have been analyzed using FESEM and HRTEM imaging. All the four nano-formulations were analyzed for their toxic potential using Allium cepa L. at three different concentrations (0.1, 0.01 and 0.001 g/100 ml). Cytological and genetic parameters including mitotic index, mitotic inhibition, aberrant cells, binucleated cells, micronucleated cells, chromosomal bridges, fragmentation, stickiness, laggards, vagrants, c-mitosis and disturbed spindle were analyzed. Our results revealed a dose dependent increase in cytotoxic parameters including decreased total dividing cells, mitotic index, and increased mitotic inhibition. Genotoxic parameters also increased at higher treatment concentrations including chromosomal aberrations and percent aberrant cells. The pH value at the time of particle synthesis has significant influence on the crystallite size and agglomeration as assessed by XRD, FESEM and HRTEM analysis. The NPs synthesized at pH 2 and 10 were found to be of smaller size and posed more toxic effects as compared to particles synthesized at neutral pH. On the other hand, CTAB assisted CuO NPs synthesized at pH 7 revealed even smaller crystallite sizes and thus boost the toxicity in all the parameters as compared to NPs synthesized without CTAB. The present study suggested an increase in toxic parameters of synthesized CuO NPs with respect to crystallite size which is pH dependent. Addition of CTAB at pH 7 decreased the crystallite as well as particle size and enhanced the toxic potential. Further studies are recommended to analyze the effect of surfactant addition in toxicological studies on CuO NPs.