An In vitro evaluation of effect of implant abutment on human gingival epithelial keratinocytes.

Background: Abutment surfaces are being designed to promote gingival soft tissue attachment and integration. This confirms implant survival for long term by forming a seal around the prosthetics. Objectives: This study was done to compare the biocompatibility of three implant abutments: titanium uncoated, Ti-nitride coated, and modified polyetheretherketone (PEEK) with human gingival keratinocytes. Materials and Methods: The titanium-uncoated, titanium-nitride-coated, and modified PEEK discs (13 mm × 3 mm) were fabricated and compared with uncoated polyester cell culture discs, which were used as controls. These three implant abutments were evaluated for biocompatibility with respect to human gingival keratinocytes for viability, morphology, proliferation, and migration by scanning electron microscopy imaging and scratch wound healing assays. Measurements of roughness show changes between the investigated surfaces. Results: Keratinocytes cultured on all examined surfaces indicated adhesion and attachment. An assay of cell viability showed no substantial variances among the groups. The modified PEEK surface showed greater cell proliferation and migration among the three abutment materials. Conclusion: All three abutment material surface types showed similar epithelial biological responses. However, modified PEEK material showed the highest biocompatibility.

Résumé Contexte: Les surfaces des piliers sont conçues pour favoriser la fixation et l'intégration des tissus mous gingivaux. Cela confirme l'implantation survie à long terme en formant un joint autour des prothèses. Objectifs : Cette étude a été réalisée pour comparer la biocompatibilité de trois Piliers Implantaires : titane non revêtu, revêtu de nitrure de titane et polyétheréthercétone modifié (PEEK) avec des kératinocytes gingivaux humains. Matériaux et Méthodes: les disques PEEK non revêtus de titane, revêtus de nitrure de titane et modifiés (13 mm × 3 mm) ont été fabriqués et comparés à des disques de culture cellulaire en polyester non revêtus, qui ont été utilisés comme témoins. Ces trois piliers implantaires ont été évalués pour biocompatibilité vis-à-vis des kératinocytes gingivaux humains pour la viabilité, la morphologie, la prolifération et la migration par balayage électronique l'imagerie microscopique et les tests de cicatrisation des plaies. Les mesures de rugosité montrent des changements entre les surfaces étudiées. Résultats: Les kératinocytes cultivés sur toutes les surfaces examinées ont indiqué une adhérence et une fixation. Un test de viabilité cellulaire n'a montré aucune écarts entre les groupes. La surface PEEK modifiée a montré une plus grande prolifération et migration cellulaire parmi les trois matériaux de pilier. Conclusion: Les trois types de surfaces de matériaux de pilier ont montré des réponses biologiques épithéliales similaires. Cependant, le matériau PEEK modifié a montré la biocompatibilité la plus élevée. Mots-clés: Biocompatibilité, implant, kératinocytes, prothèses, microscopie électronique à balayage.

An in vitro comparative assessment of manual hand file, rotary protaper ni-ti, erbium:yttrium-aluminum-garnet laser, canal brush, and ultrasound methods for smear layer removal.

Background: Selection of instruments is important to prevent any complications such as ledge formation and instrument breakage. The main drawback linked with instrumentation is smear layer formation. Objectives: This study was done for comparison of manual hand file, rotary ProTaper Ni-Ti, erbium:yttrium-aluminum-garnet (Er:YAG) laser, ultrasound, and CanalBrush (CB) methods for smear layer removal. Methodology: Sixty freshly extracted single-rooted mandibular first premolars extracted for orthodontic treatment purpose were selected and classified into six groups. Group I was negative control in which no final agitation of irrigant was performed. In Group II, solution activation was performed with ProTaper Universal System, in Group III, solution activation was done with canal brush, in Group IV, ultrasound activation was done, in Group V, solution agitation was performed with Er:YAG laser agitation, and in Group VI, canal preparation with hand files was performed. Smear layer score was evaluated after canal preparation with each method. Results: Score 1 was seen in 3 (30%) in Group IV and 6 (60%) in Group V, score 2 was seen in 3 (30%) in Group I, 8 (80%) in Group II, 7 (70%) in Group III, 5 (50%) in Group IV, 3 (30%) in Group V, and 4 (40%) in Group VI. Score 3 was observed in 7 (70%) in Group I, 2 (20%) in Group II, 3 (70%) in Group III, 2 (20%) in Group IV, 1 (10%) in Group V, and 6 (60%) in Group VI. A statistically significant difference was found in smear layer removal score in all groups (P < 0.05) except between Group I versus VI (P > 0.05). Conclusion: Complete removal of the smear layer was not observed in any of the methods used in the study; however, Er: YAG laser was found to be better as compared to other methods.

Résumé Contexte: La sélection des instruments est importante pour éviter toute complication telle que la formation de rebords et la rupture d'instruments. Les Le principal inconvénient lié à l'instrumentation est la formation d'une couche de frottis. Objectifs: Cette étude a été réalisée pour comparer des limes manuelles, méthodes rotatives ProTaper Ni-Ti, laser erbium:yttrium-aluminium-grenat (Er:YAG), ultrasons et CanalBrush (CB) pour l'élimination des frottis. Méthodologie: Soixante premières prémolaires mandibulaires monoracinaires fraîchement extraites à des fins de traitement orthodontique ont été sélectionnées et classés en six groupes. Le groupe I était un témoin négatif dans lequel aucune agitation finale de l'irrigant n'a été effectuée. Dans le groupe II, l'activation de la solution a été réalisée avec le système universel ProTaper, dans le groupe III, l'activation de la solution a été effectuée avec une brosse canalaire, dans le groupe IV, l'activation par ultrasons a été fait, dans le groupe V, l'agitation de la solution a été effectuée avec une agitation au laser Er:YAG, et dans le groupe VI, la préparation du canal avec des limes manuelles a été effectué. Le score de la couche de frottis a été évalué après la préparation du canal avec chaque méthode. Résultats: le score 1 a été observé chez 3 (30 %) dans le groupe IV et 6 (60 %) dans le groupe V, le score 2 a été observé chez 3 (30 %) dans le groupe I, 8 (80 %) dans le groupe II, 7 (70 %) dans le groupe III, 5 (50 %) dans le groupe IV , 3 (30%) dans le groupe V, et 4 (40 %) dans le groupe VI. Le score 3 a été observé chez 7 (70 %) dans le groupe I, 2 (20 %) dans le groupe II, 3 (70 %) dans le groupe III, 2 (20 %) dans Groupe IV, 1 (10 %) dans le groupe V et 6 (60 %) dans le groupe VI. Une différence statistiquement significative a été trouvée dans le score d'élimination des frottis dans tous les groupes (P < 0,05) sauf entre le groupe I et VI (P > 0,05). Conclusion: L'élimination complète de la frottis n'a été observée dans aucun des méthodes utilisées dans l'étude; cependant, le laser Er:YAG s'est avéré meilleur par rapport aux autres méthodes. Mots-clés: Brosse canalaire, erbium : laser yttrium-aluminium-grenat, ProTaper, frottis, ultrasons.

Serum GGT and serum ferritin as early markers for metabolic syndrome.

BACKGROUND: In India, the prevalence of lifestyle diseases like diabetes, hypertension, and metabolic syndrome (MetS) is showing an upward trend. Gamma glutamate transferase (GGT) and ferritin increase oxidant stress in the body through their role in glutathione homeostasis and iron metabolism, respectively. The increase in oxidant stress increases the inflammatory load, a risk factor for metabolic syndrome. These parameters are cheap, patient-friendly, and available in routine diagnostic labs compatible for follow-up, relieving the already overburdened healthcare system. METHODOLOGY: In a case-control study, samples of 77 cases of metabolic syndrome and 77 age and sex-matched controls were analyzed for serum GGT (by modified IFCC) and serum ferritin (by CLIA). Statistical analysis was done by SPSS 20.0 version. RESULTS: The mean ± SD for ferritin and GGT were 101.58 ± 84.20 ng/dL and 36.67 ± 26.40 IU/L, respectively in cases, whereas in control group these values were 38.38 ± 29.26 ng/dL and 16.5 3 ± 6.79 IU/L (P < 0.001). Positive and significant correlation was seen between GGT with TG (r-value- 0.376/P-value-0.001) and GGT with waist circumference (r-value- 0.298/P-value- 0.022). A positive and significant correlation was seen between GGT and ferritin in cases with an r-value of 0.307 (P-value - 0.01). CONCLUSION: The increased values of GGT and ferritin in cases suggest an inflammatory load. The positive and significant correlation between GGT and triglyceride indicates its role in increasing oxidants' stress leading to inflammation and the development of MetS. The association of ferritin with MetS though insignificant may be considered as a biomarker.

A Hospital-Based Insight into the Antinuclear Antibody Patterns in Autoimmune Disorders.

Background The incidence of autoimmune disorders has seen a rise in India in recent times. The symptoms and signs of these conditions are caused by a systemic autoimmune response, essentially characterized by the expression of the antinuclear antibodies (ANA). Presence of ANA in serum of patient could be the prime evidence of an autoimmune disorder. Aim This study aimed to determine the antibody patterns and assess the clinical significance of ANA in patients of a teaching tertiary care hospital of central India. Material and Methods This retrospective cross-sectional data analysis study retrieved 538 reports of individuals, who were prescribed the ANA test by indirect immunofluorescence assay over a period of 11 months, from the archives of the Department of Biochemistry. For continuous data, student t -test was used while Chi-square and Fisher exact was conducted for categorical data. A p value less than 0.05 were taken as significant. Results Out of the 538 patients investigated for ANA testing by indirect immunofluorescence assay, 33% were positive, among which 74% were female, and majority belonged to the young adult age group. The most common pattern identified was nuclear, subpattern nuclear speckled. Conclusion A high-ANA pattern positivity could be related to a high-autoimmunity prevalence in this region, and also promotes its use as a tool of evidence of suspected autoimmune disorders.

AYUSH for COVID-19: Science or Superstition?

There is a lot of discussion on COVID-19 control strategies from the mainstream approaches, but it is also necessary to examine the contributions of the Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Riga and Homeopathy (AYUSH) sector, which is now being brought into public health interventions nationally. Although the AYUSH sector had previously joined the management of dengue and chikungunya outbreaks in some Indian states, its participation has remained contentious and there is reluctance in mainstream public health discourses to seriously examine their interventions. This is a commentary on the efforts made by the Ministry of AYUSH, state AYUSH directorates, AYUSH research institutions, and public hospitals, based on official documents as well as official statements reported in the media, with the aim of bringing out concerns in the process of adapting traditional textual knowledge and practices to public health requirements of the current age.

Health Implications of Diverse Visions of Urban Spaces: Bridging the Formal-Informal Divide.

In the past 200 years, urban spaces have been imagined as neatly laid out, well-planned, sanitised and civilised places of dense human habitation with regulated economic activity, where political power, financial capital, the frontiers of knowledge and technology thrive. This has been the urban planners dream, even while it does not reflect the full reality, whether of cities in the LMICs or the HICs. In the face of such homogenising visions arising from Euro-American models, formal urban systems fail to provide adequately for residents' needs, who then carve out their own resources and processes for meeting them, largely within the domain of urban "informality." While large part of literature presents urban informality as reflected in the slum, others have shown how it is found in relation to all classes (1). The concept of informality has largely been applied to the core dimensions of economic life of the city. Applied to people's "ways of life," intermingling of the formal and informal becomes distinctly evident in everyday practices in locations such as the peri-urban, and in activities such as health care. This paper opens up the sphere of health care for urban planning that has, in recent decades, left it largely untouched. It uses data from a rapid assessment of health seeking behaviour of three socioeconomic groups-the middle class, slum-dwellers, and homeless- in Delhi, the capital city of India. The findings, relevant beyond the specific location, reveal that people of all sections resort to myriad informal arrangements for their health care, challenging the dominant connotation of the formal-informal denoting a legitimate-illegitimate dichotomy. This provides potential directions to bridge the formal-informal divide, to re-configure urban planning towards more sustainable futures with plural visions of land use and urban greening for healthier urban conditions and for health care provisioning. The analysis posits that, besides the economic and political relations shaping the formal and informal, the politics of knowledge must be factored in if the informal has to be adequately understood for building sustainable futures.

Peri-Urbanism in Globalizing India: A Study of Pollution, Health and Community Awareness.

This paper examines the intersection between environmental pollution and people's acknowledgements of, and responses to, health issues in Karhera, a former agricultural village situated between the rapidly expanding cities of New Delhi (India's capital) and Ghaziabad (an industrial district in Uttar Pradesh). A relational place-based view is integrated with an interpretive approach, highlighting the significance of place, people's emic experiences, and the creation of meaning through social interactions. Research included surveying 1788 households, in-depth interviews, participatory mapping exercises, and a review of media articles on environment, pollution, and health. Karhera experiences both domestic pollution, through the use of domestic waste water, or gandapani, for vegetable irrigation, and industrial pollution through factories' emissions into both the air and water. The paper shows that there is no uniform articulation of any environment/health threats associated with gandapani. Some people take preventative actions to avoid exposure while others do not acknowledge health implications. By contrast, industrial pollution is widely noted and frequently commented upon, but little collective action addresses this. The paper explores how the characteristics of Karhera, its heterogeneous population, diverse forms of environmental pollution, and broader governance processes, limit the potential for citizen action against pollution.

Public Report on Health: Development of a Nutritive Value Calculator for Indian Foods and Analysis of Food Logs and Nutrient Intake in six States.

UNLABELLED: The Public Report on Health (PRoH) was initiated in 2005 to understand public health issues for people from diverse backgrounds living in different region specific contexts. States were selected purposively to capture a diversity of situations from better-performing states and not-so-well performing states. Based on these considerations, six states - the better-performing states of Tamil Nadu (TN), Maharashtra (MH) and Himachal Pradesh (HP) and the not-so-well performing states of Madhya Pradesh (MP), Uttar Pradesh (UP) and Orissa (OR) - were selected. This is a report of a study using food diaries to assess food intakes in sample households from six states of India. METHOD: Food diaries were maintained and all the raw food items that went into making the food in the household was measured using a measuring cup that converted volumes into dry weights for each item. The proportion consumed by individual adults was recorded. A nutrient calculator that computed the total nutrient in the food items consumed, using the 'Nutritive Value of Indian Foods by Gopalan et al., was developed to analyze the data and this is now been made available as freeware (http://bit.ly/ncalculator). The total nutrients consumed by the adults, men and women was calculated. RESULTS: Identifying details having been removed, the raw data is available, open access on the internet http://bit.ly/foodlogxls.The energy consumption in our study was 2379 kcal per capita per day. According to the Summary Report World Agriculture the per capita food consumption in 1997-99 was 2803 which is higher than that in the best state in India. The consumption for developing countries a decade ago was 2681 and in Sub-Saharan Africa it was 2195. Our data is compatible in 2005 with the South Asia consumption of 2403 Kcal per capita per day in 1997-99. For comparison, in industrialized countries it was 3380. In Tamil Nadu it was a mere 1817 kcal. DISCUSSION: The nutrient consumption in this study suggests that food security in the villages studied is far from achieved. It is hoped that the new Food Security Ordinance will make a dent in the situation. The calculator for computing nutrients of foods consumed which we developed based on the ICMR defined nutrient values for Indian foods has been made available as freeware on the internet. This is with the hope that more such studies can be carried out at the household level.

Aren't technological choices central to designing health systems?

This paper argues that delivery of technology-based preventive, promotive and curative care is one of the central tasks of any health-care system and therefore it forms one of the central pivots for rational structuring/re-structuring of a health-care system. The development of our public health system has, historically, adopted health technologies (HT) uncritically and thereby not explicitly developed institutional mechanisms to assess them for rational choice. Determinants of HT policy choices and structuring of a service delivery system based on that are discussed with examples of modern low cost HT, technologies of codified health knowledge systems other than the modern and local health traditions. Various forms of institutional structures for HT assessment and R and D using a comprehensive primary health-care approach are suggested.

Developing a public health cadre in 21 st century India: addressing gaps in technical, administrative and social dimensions of public health services.

This paper presents a possible framework for designing a public health cadre in the present context, with lessons from health services development of the last six decades. Three major gaps that the public health cadre is meant to bridge have been identified. These are capacities within the system to address the technical requirements (epidemiological and health systems analysis); administrative/managerial dimensions; and the social determinants of health. Therefore, it argues that the cadre must not only have a techno-managerial structure, but also create a specific sub-cadre for the social determinants of health.

Evidence-based National Vaccine Policy.

India has over a century old tradition of development and production of vaccines. The Government rightly adopted self-sufficiency in vaccine production and self-reliance in vaccine technology as its policy objectives in 1986. However, in the absence of a full-fledged vaccine policy, there have been concerns related to demand and supply, manufacture vs. import, role of public and private sectors, choice of vaccines, new and combination vaccines, universal vs. selective vaccination, routine immunization vs. special drives, cost-benefit aspects, regulatory issues, logistics etc. The need for a comprehensive and evidence based vaccine policy that enables informed decisions on all these aspects from the public health point of view brought together doctors, scientists, policy analysts, lawyers and civil society representatives to formulate this policy paper for the consideration of the Government. This paper evolved out of the first ever ICMR-NISTADS national brainstorming workshop on vaccine policy held during 4-5 June, 2009 in New Delhi, and subsequent discussions over email for several weeks, before being adopted unanimously in the present form.

Toward an ecosocial epidemiological approach to goiter and other iodine deficiency disorders: a case study of India's technocratic program for universal iodization of salt.

The program of universal salt iodization (USI) was intensified in the 1990s. Unfortunately, a recent World Health Organization review finds that there was a global increase of 31.7 percent in total goiter rate from 1993 to 2003. However, the WHO review places only 1 country as severely, 13 as moderately, and 40 as mildly deficient in populations' iodine nutrition, and places 43 countries at optimal, 24 at high, and 5 at excessive levels of iodine nutrition. Thus, it is imperative to weigh the benefits and risks of intensifying USI further. The WHO review places India in the category of "adequate" iodine nutrition, but in 2005 the Government of India promulgated a universal ban on sale of non-iodized salt, calling iodine deficiency disorders (IDDs) a major public health problem. This article attempts to understand these contradictions and weigh the benefits and costs of USI. Based on a review of studies since the 1920s, the authors reconstruct the evolution of IDD control in India. Conceptual and methodological limitations challenge the evidence base and rationale of stricter implementation of USI now. Finding evidence for its negative impact, the authors recommend a reexamination of the USI strategy and propose a safer, people-centered, ecosocial epidemiological approach rather than a universal legal ban.

Goiter and other iodine deficiency disorders: A systematic review of epidemiological studies to deconstruct the complex web.

A systematic review of the available literature on goiter and other iodine deficiency disorders (IDDs) was carried out with the aim of analyzing available evidence and providing inputs to the policy makers and program formulators regarding the entire issue. The findings point to major issues such as the following: methodological issues in epidemiology of goiter and other iodine deficiency disorders (IDDs); lacunae in causal linkages; inadequate attention to multicausality; flawed assessment of the impact of intervention, i.e., iodized salt; and harmful effects of iodine not given due cognizance. Most of the research to date has been unidirectional and does not provide comprehensive data on all aspects of IDDs. To further compound the issue, many independent researchers, on finding something different from the existing dominant paradigm (iodized salt as panacea for goiter) have tended to ignore these in their final conclusions and recommendations. Thus, evidence from this systematic review demonstrates enough basis to start a debate on the entire issue, recognizing opposing research findings while continuing with the present strategy. This imposes specific problems and necessitates area-specific solutions instead of a universal solution, which apart from being less effective may be harmful in the long run.

Polio eradication initiative in India: deconstructing the GPEI.

The Global Polio Eradication Initiative (GPEI) promised eradication of polio by the year 2000 and certification of eradication by 2005. The first deadline is already a matter of history. With the reporting of polio cases in 2004, the new deadline for polio eradication by 2004 is postponed further. This article seeks to argue that the scientific and technical bodies spear-heading the GPEI, including the WHO, UNICEF, and the U.S. Centers for Disease Control, have formulated a conceptually flawed strategy and that it is not weak political will that is the central obstacle in this final push for global eradication. The validity of the claims of "near success" by the proponents of the GPEI is also examined in detail. By taking India as a case study, the authors examine the achievements of the GPEI in nine years of intense effort since 1995. They conclude that the GPEI is yet another exercise in mismanaging the health priorities and programs in developing countries in the era of globalization.