Effect of Dental Anxiety on Oral Health among the First-Time Dental Visitors: A Hospital-based Study.

Objective: The objective was to assess dental anxiety and to find its association with oral health status and oral health-related quality of life (OHRQoL) among 20-40-year-old patients visiting Vokkaligara Sangha Dental College and Hospital. Materials and Methods: A single-center, hospital-based cross-sectional study was done among first-time dental visitors in the Department of Oral Medicine and Radiology, Vokkaligara Sangha Dental College and Hospital over a period of 8 months (July 14-February 18). The sample size was determined to be 700. Participants in the age group of 20-40 years were selected based on inclusion and exclusion criteria. Data were collected using Corah's Modified Dental Anxiety Scale, Oral Health Impact Profile-14 (OHIP-14), and clinical examination was done using the WHO oral health assessment form and OHI-S. Data were analyzed using Chi-square test and t-test. The associations found through bivariate analysis were entered as predictor variables into linear and binomial logistic regression models with high dental anxiety as the outcome variable. Results: The results of the study suggested that 56% of the study participants were having dental anxiety. Local anesthetic injection (80%) and fear of tooth drilling (60%) were the most anxiety-provoking stimulus. Analysis of OHIP-14 suggested that respondents perceiving oral health as affecting their life quality (very often/fairly often) in the past year were observed for items such as tension, difficulty to relax, irritability, difficulty in doing usual jobs, and totally unable to function because of oral problems. Dental anxiety was significantly associated with gender (odds ratio [OR] = 1.32), education (OR = 1.43), occupation (OR = 2.07), poor oral hygiene status (OR = 3.15), presence of dental caries (OR = 2.67), bleeding on probing (OR = 1.57), presence of periodontal pockets (OR = 2.64), clinical attachment loss (OR = 1.63), and OHRQoL (OR = 1.76). Stepwise linear regression model of independent variables (<0.05 variables included) explained dental caries as highest predictor (39%), followed by debris (22%), calculus (38%), mean OHIS (27%), mean OHIP-14 (29%), deep pocket (14%), and the least predictor was shallow pocket (9%). Conclusion: Dental anxiety was associated with poor oral health status seeking further attention to modify patients' behavior regarding improvement in oral health status.

Time Metrics in Acute Ischemic Stroke Care During the Second and First Wave of COVID 19 Pandemic: A Tertiary Care Center Experience from South India.

BACKGROUND: During the first wave of the pandemic, stroke care suffered globally and there were reduced stroke admissions and delays in time metrics. Stroke care was reorganized during the second wave learning from the experience of previous wave. This study shares our experience in stroke time metrics during the second wave of pandemic compared to the first wave. METHODS: We did a single-center prospective study, where consecutive acute ischemic stroke patients within 24 hours of the onset of symptoms and aged more than 18 years, who presented to Stroke Unit, Department of Neurology, Government Medical College, Thiruvananthapuram from June 1st to 31st August, 2020 and June 1st to 31st August in 2021 were included. In-hospital time metrics (door to CT time and door to Needle time) were compared during the two time periods. We also compared functional outcomes at discharge and in-hospital mortality during the two periods. Functional outcome at discharge was assessed by modified Rankin scale (mRS). RESULTS: From June to August 2021 (second wave of the COVID 19 pandemic), compared to the same months during the first wave (2020), our study demonstrated better in-hospital time metrics (door to CT time and door to needle time). We also found lower admission systolic blood pressure and higher baseline CT early ischemic changes during the second wave. There was no difference in functional outcome at discharge and in-hospital mortality. Intravenous thrombolysis rates also remained the same during the two periods. CONCLUSION: Our study has confirmed that time metrics in stroke care can be improved through system rearrangement even during the pandemic. Acute stroke treatments are time-dependent and hospital administrators must stick to the maxim "Time is Brain" while restructuring stroke workflows during future challenges.

Deep Learned Quantization-Based Codec for 3D Airborne LiDAR Point Cloud Images.

This paper introduces a novel deep learned quantization-based coding for 3D Airborne LiDAR (Light detection and ranging) point cloud (pcd) image (DLQCPCD). The raw pcd signals are sampled and transformed by applying the Nyquist signal sampling and Min-max signal transformation techniques, respectively for improving the efficiency of the training process. Then, the transformed signals are feed into the deep learned quantization module for compressing the data. To the best of our knowledge, this proposed DLQCPCD is the first deep learning-based model for 3D airborne LiDAR pcd compression. The functions of Mean Squared Error and Stochastic Gradient Descent optimization function enhance the quality of the decompressed image by 67.01 percent on average, compared to other functions. The model's efficiency has been validated with established well-known compression techniques such as the 7-Zip, WinRAR, and tensor tucker decomposition algorithm on the three inconsistent airborne datasets. The experimental results show that the proposed model compresses every pcd image into constant 16 Number of Neurons of data and decompresses the image with approximately 160 dB of PSNR value, 174.46 s execution time with 0.6 s execution speed per instruction, and proved that it outperforms the other existing algorithms regarding space and time.

Tobacco Cessation Behavior Among Smoking and Smokeless Form Tobacco Users in the Indigenous Population of Ernakulam, India.

PURPOSE: Tobacco usage is the leading preventable cause of death in the world today. The tribes in Kuttampuzha region are the aboriginal tribal community found predominantly in the south Indian state of Kerala, India, and this study was conducted to identify tobacco cessation behavior in smoking and smokeless form of tobacco users among them. MATERIALS AND METHODS: A cross-sectional design survey was conducted among 516 indigenous community people of Kuttampuzha area of Kerala, India, for the outcome of quit attempts made by the current tobacco users. The sociodemographic variables and tobacco user data collected were subjected to statistical analysis using Open Source R Software. RESULTS: When considered the quit attempts among current smoking and smokeless form of tobacco users, a statistically significant difference was found in subjects who had quit attempts of 1 day or longer in the previous year (P = 0.01) than who were in groups of quit attempts more than 30 days or more than 6 months. Smokers had higher probability predicted of attempting quitting in comparison to smokeless form of tobacco users (odds ratio [OR] = 1.24, confidence interval [CI] = 1.09-1.39). The probability of doing a quit attempt was higher among users of tobacco who were having a comparatively higher socioeconomic status (OR = 1.30, CI = 1.12-1.48). CONCLUSION: This study provides useful insights into different determinants for quit attempts of tobacco users in South India, exploring the sociodemographic features of attempts to quit. International prevention and cessation initiatives will need to be customized to the social-cultural context of these primitive tribal areas of Kuttampuzha, Kerala, to help in prevention and cessation of tobacco usage.

Posterior reversible encephalopathy syndrome with PLEDs-plus due to mesalamine.

A 32-year-old lady developed status epilepticus and acute visual loss while on mesalamine for Crohn's disease. Her clinical course and magnetic resonance imaging (MRI) were suggestive of posterior reversible encephalopathy syndrome (PRES). She had periodic lateralized epileptiform discharges plus (PLEDs-plus) on electroencephalogram (EEG), which responded to sodium valproate. Her vision improved from counting fingers at one-meter distance to 6/12. Though different cytotoxic drugs have been implicated as causative agents, this is the first case report of mesalamine-induced PRES. This case highlights the need for aggressive treatment of PLEDs-plus with EEG monitoring using a broad-spectrum antiepileptic drug like valproate, which has contributed to the rapid reversibility of vision in PRES subjects, and the need for a thorough drug history for etiological clues.

Clinical and life style variables in functional dyspepsia and its sub-types.

BACKGROUND: Several definitions and classifications have been designed to characterize functional dyspepsia (FD), the recent one being the ROME III criteria. There have been many studies in the western population which aimed at identifying the risk factors involved in functional dyspepsia. There are fewer studies from south Asian countries. AIM: To determine the clinical and life style variables influencing functional dyspepsia and its sub-types in patients attending a tertiary care referral centre in the Indian subcontinent. METHODS: Consecutive patients with upper gastrointestinal symptoms including, epigastric pain/burning, early satiety, postprandial fullness, heartburn and/or chest discomfort, alone or in combination, on more than 3 occasions a week, within the preceding 6 months and with a normal endoscopy were included in the study. Demographic details and the symptom profile including frequency of symptoms were recorded in a pre-structured, validated, modified proforma as per the ROME III criteria and analyzed to test the study hypothesis. RESULTS: Of the 170 patients, the median age of presentation was 49 yrs and the male to female ratio was 0.62 (65:105). The mean BMI was 23.8 kg/m2. Women had a higher BMI than men. More than half of the study subjects were from the low socio-economic groups.77.6% had ulcer type symptoms and showed a decreasing trend with age. It was more common in patients with higher per capita income. Reflux type comprised of 60.6% with predominance in women. 7% had early satiety and 13.5% had postprandial fullness. Nausea and belch as an isolated (associated) phenomenon comprised of 18.8% and 17.1% respectively. None of the lifestyle variables or demographic characteristics showed a significant influence on symptom occurrence. CONCLUSIONS: There was a considerable overlap of various sub-types of dyspepsia. There were no differences in life style characteristics or significant risk factors in the various subtypes of dyspepsia.

Two cases of a rare treatable limb girdle muscle disease.

We report two cases of limb girdle pattern of muscle weakness caused by hyperparathyroidism due to parathyroid adenoma. It can be easily missed as early symptoms are non specific but once diagnosed it is easily treatable and complete recovery occurs over a period of time.

Acute disseminated encephalomyelitis following leptospirosis.

Acute disseminated encephalomyelitis is very rare following leptospirosis. Here we describe a patient who developed the condition after leptospiral infection, which responded to intravenous immunoglobulin only.

An in vitro study on the role of metal catalyzed oxidation in glycation and crosslinking of collagen.

The present investigation was carried out to understand the effect of metal catalyzed oxidation on glycation and crosslinking of collagen. Tail tendons obtained from rats weighing 200-225 g were incubated with glucose (250 mM) and increasing concentrations of copper ions (5, 25, 50 and 100 microM) under physiological conditions of temperature and pH. Early glycation, crosslinking and late glycation (fluorescence) of collagen samples were analyzed periodically. Early glycation was estimated by phenol sulfuric acid method, and the crosslinking was assessed by pepsin and cyanogen bromide digestion. A concentration-dependent effect of metal ions on the rate of glycation and crosslinking of collagen was observed. Tendon collagen incubated with glucose and 100 microM copper ions showed 80% reduction in pepsin digestion within seven days, indicating extensive crosslinking, whereas collagen incubated with glucose alone for the same period showed only 7% reduction. The presence of metal ions in the incubation medium accelerated the development of Maillard reaction fluorescence on collagen, and the increase was dependent on the concentration of metal ions used. The metal chelator diethylene triamine penta-acetate significantly prevented the increase in collagen crosslinking by glucose and copper ions. Free radical scavengers benzoate and mannitol effectively prevented the increased crosslinking and browning of collagen by glucose. The results indicate that the metal catalyzed oxidation reactions play a major role in the crosslinking of collagen by glucose. It is also suggested that the prevention of increased oxidative stress in diabetes may prevent the accelerated advanced glycation and crosslinking of collagen.

Influence of Aloe vera on collagen turnover in healing of dermal wounds in rats.

Treatment of full-thickness wounds with A. vera, on rats resulted in increased biosynthesis of collagen and its degradation. A corresponding increase in the urinary excretion of hydroxyproline was also observed. Elevated levels of lysyl oxidase also indicated increased crosslinking of newly synthesised collagen. The results suggest that A. vera influences the wound healing process by enhancing collagen turnover in the wound tissue.

Advanced glycation end products induce crosslinking of collagen in vitro.

We have investigated the effect of advanced glycation end products (AGEs) on the crosslinking of collagen. The potential pathological significance of AGEs and the altered metabolism of ascorbic acid (ASA) in diabetes have prompted us to investigate the role of ASA in the crosslinking and advanced glycation of collagen. Rat tail tendons were incubated with ASA and dehydroascorbic acid (DHA) under physiological conditions of temperature and pH, and the crosslinking and the level of AGEs were analyzed. Analysis of crosslinking was conducted by pepsin solubility and cyanogen bromide digestion. Level of AGEs was estimated by enzyme-linked immunosorbent assay (ELISA) using antibodies raised against AGE-ribonuclease. It was noted that ASA and DHA induced crosslinking of collagen and stimulated the formation of AGEs. It was also noted that these pathways were dependent on oxidative conditions. Similarly incubation of collagen with AGEs, prepared by the in vitro incubation of bovine serum albumin (BSA) with glucose, also resulted in increased crosslinking. The extent of crosslinking was dependent on the duration of incubation. The novel finding of this study, which is in contrast to the earlier reports on glucose-induced crosslinking of collagen, was that AGEs-induced crosslinking of collagen was not inhibited by radical scavengers and the metal chelator. EDTA, whereas glucose-induced crosslinking of collagen was almost completely prevented by free radical scavengers. The increased fluorescence intensity observed in collagen incubated with AGEs was also not prevented by radical scavengers. Estimation of AGEs by ELISA revealed an increased accumulation of AGEs in collagen incubated with AGE-BSA. The inhibitory effect of aminoguanidine and aspirin on AGEs-induced modification of collagen, strongly suggests that the amino-carbonyl interaction between AGEs and collagen may play a key role in the crosslinking process. The results obtained in this study indicate that soluble AGEs can directly induce crosslinking of collagen and this process is independent of oxidative conditions. From these results it may be hypothesized that glucose, under oxidative conditions, reacts with proteins to form potentially reactive end products called AGEs. These AGEs, once formed, could induce crosslinking of collagen even in the absence of both glucose and oxygen.

The role of metal-catalyzed oxidation in the formation of advanced glycation end products: an in vitro study on collagen.

The present study investigates the role of metal catalysed oxidation in the formation of Advanced Glycation End products (AGEs). Rat tail tendon collagen was incubated with glucose (250 mM) and increasing concentrations of copper ions (5-500 microM) under physiological conditions of temperature and pH. After 1 and 3 weeks of incubation the level of AGEs in collagen samples were estimated by enzyme linked immunoassay, using antibodies raised against AGE ribonuclease. It was observed that the presence of metal ions significantly increased the rate of accumulation of AGEs. The increase was dependent on the concentration of metal ions present in the incubation medium. Free radical scavengers such as mannitol, benzoate, catalase, and the antiglycating agent aminoguanidine almost completely inhibited the formation of AGEs. Incubation of collagen with copper ions alone did not show any increase in crosslinking, as detected by cyanogen bromide digestion, and AGEs formation. Further it was also noted that glycoxidation, i.e., oxidation of glycated collagen, was the major pathway that leads to increased formation of AGEs. These results indicate that metal-catalyzed oxidation and free radicals play a major role in the formation of AGEs. This work also strongly suggests that increased oxidative stress in diabetes may accelerate the formation of AGEs and thus contribute to the pathogenesis of diabetic complications.

Influence of Aloe vera on collagen characteristics in healing dermal wounds in rats.

Wound healing is a fundamental response to tissue injury that results in restoration of tissue integrity. This end is achieved mainly by the synthesis of the connective tissue matrix. Collagen is the major protein of the extracellular matrix, and is the component which ultimately contributes to wound strength. In this work, we report the influence of Aloe vera on the collagen content and its characteristics in a healing wound. It was observed that Aloe vera increased the collagen content of the granulation tissue as well as its degree of crosslinking as seen by increased aldehyde content and decreased acid solubility. The type I/type III collagen ratio of treated groups were lower than that of the untreated controls, indicating enhanced levels of type III collagen. Wounds were treated either by topical application or oral administration of Aloe vera to rats and both treatments were found to result in similar effects.

Influence of Aloe vera on the glycosaminoglycans in the matrix of healing dermal wounds in rats.

The influence of Aloe vera (L.) Burman f. on the glycosaminoglycan (GAG) components of the matrix in a healing wound was studied. Wound healing is a dynamic and complex sequence of events of which the major one is the synthesis of extracellular matrix components. The early stage of wound healing is characterized by the laying down of a provisional matrix, which is then followed by the formation of granulation tissue and synthesis of collagen and elastin. The provisional matrix or the ground substance consists of GAGs and proteoglycans (PGs), which are protein GAG conjugates. In the present work, we have studied the influence of Aloe vera on the content of GAG and its types in the granulation tissue of healing wounds. We have also reported the levels of a few enzymes involved in matrix metabolism. The amount of ground substance synthesized was found to be higher in the treated wounds, and in particular, hyaluronic acid and dermatan sulphate levels were increased. The levels of the reported glycohydrolases were elevated on treatment with Aloe vera, indicating increased turnover of the matrix. Both topical and oral treatments with Aloe vera were found to have a positive influence on the synthesis of GAGs and thereby beneficially modulate wound healing.

Influence of aloe vera on the healing of dermal wounds in diabetic rats.

The positive influence of Aloe vera, a tropical cactus, on the healing of full-thickness wounds in diabetic rats is reported. Full-thickness excision/incision wounds were created on the back of rats, and treated either by topical application on the wound surface or by oral administration of the Aloe vera gel to the rat. Wound granulation tissues were removed on various days and the collagen, hexosamine, total protein and DNA contents were determined, in addition to the rates of wound contraction and period of epithelialization. Measurements of tensile strength were made on treated/untreated incision wounds. The results indicated that Aloe vera treatment of wounds in diabetic rats may enhance the process of wound healing by influencing phases such as inflammation, fibroplasia, collagen synthesis and maturation, and wound contraction. These effects may be due to the reported hypoglycemic effects of the aloe gel.

Effect of curcumin on the advanced glycation and cross-linking of collagen in diabetic rats.

A close association between increased oxidative stress and hyperglycemia has been postulated to contribute significantly to the accelerated accumulation of advanced glycation end products (AGEs) and the cross-linking of collagen in diabetes mellitus. In the present work, we report the influence of curcumin, an efficient antioxidant, on the level of AGEs and the cross-linking of collagen in diabetic rats. Diabetic rats were given curcumin (200 mg/kg body wt) orally for a duration of 8 weeks. The antioxidant status in serum and the level of AGEs, cross-linking and browning of collagen in tail tendons and skin were investigated. The oxidative stress observed in diabetic rats was reduced significantly by curcumin administration. Nonenzymic antioxidants such as vitamin C, vitamin E, and glutathione were maintained at near normal values in curcumin-treated diabetic animals. Similarly, the accumulation of lipid peroxidation products in diabetic serum was reduced significantly by curcumin. Accelerated accumulation of AGE-collagen in diabetic animals, as detected by ELISA, was prevented by curcumin. Extensive cross-linking of collagen in the tail tendon and skin of diabetic animals was also prevented to a greater extent by curcumin treatment. A correlation between the level of AGEs and collagen cross-linking was noted, suggesting the involvement of advanced glycation in cross-linking. It was also noted that the preventive effect of curcumin on the advanced glycation and cross-linking of collagen was more pronounced than its therapeutic effect. However, the Maillard reaction fluorescence in both tail and skin collagen remained unaltered by curcumin. This study confirms the significance of free radicals in the accumulation of AGEs and cross-linking of collagen in diabetes. It supports curcumin administration for the prevention of AGE-induced complications of diabetes mellitus.

The possible relevance of autoxidative glycosylation in glucose mediated alterations of proteins: an in vitro study on myofibrillar proteins.

The present work was carried out to examine the role of glycation and transition metal catalysed autoxidation of sugars in glucose-mediated alterations of myofibrillar proteins. Myofibrils were prepared from rat skeletal muscle and incubated with 1) sugar alone 2) sugar and micromolar concentrations of transition metals (Cu2+ or Fe3+) 3) transition metals alone and the control remained without sugar or transition metals. A significant increase in extent of glycation and decrease in ATPase activity of myofibrils incubated under autoxidative conditions were observed over the other three incubations. Reducing agent 2-mercaptoethanol was highly effective in preventing the alterations induced by glucoxidation, compared to EDTA and aminoguanidine, suggesting the involvement of thiol group oxidation in the reduced function of the protein. Free radical scavengers like catalase, benzoic acid and mannitol were also effective in preventing glucose mediated alterations. Although a high concentration of glucose alone has an insignificant effect on myofibrils in vitro, the results from the present work suggest that glucose in combination with transition metals could lead to functional alterations of myofibrils, and this process by generating free radicals may contribute to the overall complications of diabetes and aging.