Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6-59 Months.

INTRODUCTION: Globally around 47.4% of children and in India, 58% of children aged 6-59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. OBJECTIVES: To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6-59 months compared with hematology analyzer. METHODS: The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli's hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. RESULTS: A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli's hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli's hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli's hemoglobinometer (70%). Invasive DH took the least time (2-3 min) for estimation of hemoglobin per participant, followed by Sahli's (4-5 min) and non-invasive DH (5-7 min). CONCLUSION: All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli's can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summaryIn India, anemia is a serious public health problem, where 58% of the children aged 6-59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices-invasive DH, non-invasive DH and Sahli's hemoglobinometer among 6-59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6-59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli's (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli's hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli's (70%).

Comparative Evaluation of Two Esthetic Full Coronal Restorative Materials for Primary Incisors.

Aim: This study was designed to compare the clinical efficacy of two esthetic restorative materials, nanoceramic (Magma NT®) and giomer (Beautifil II®), as full coronal restoration in primary maxillary incisors. Materials and methods: A total of 15 patients aged 3-5 years presenting with mutilated primary maxillary incisors due to caries or trauma were selected for the study using randomized simple sampling. A total of 40 maxillary incisors were randomly divided into two equal groups, with 20 teeth in each group. Teeth in group I (GP I) were restored with nanoceramic (Magma NT®) and group II (GP II) with giomer (Beautifil II®). The full coronal restorations were done using strip crowns (3M ESPE). The restorations were evaluated for gross fracture, marginal integrity, and secondary caries according to modified Ryge's criteria [United States Public Health Service (USPHS)] at baseline (immediate postoperative), 3, 6, and 9 months. Parental satisfaction with each type of restoration was also evaluated using the Likert 5-point scale. Results: The data obtained was statistically analyzed using the Chi-squared test, and the level of significance, that is, the p-value, was determined. The Chi-squared test showed no significant changes to all modified USPHS criteria for each material at baseline and 3-month evaluation period. The changes recorded were after a 3-month follow-up between the two materials; nanoceramic (Magma NT®) restoration demonstrated marginally better than giomer (Beautifil II®) in terms of gross fracture and marginal integrity; however, there was no statically significant difference between them (p > 0.05), while giomer (Beautifil II®) was better than nanoceramic in terms of secondary caries (p < 0.05). Parental satisfaction for both entities was comparable in terms of color and durability; however, they were cost-ineffective. Conclusion: Nanoceramic restoration demonstrated better results in terms of gross fracture and marginal integrity, while giomer was better in terms of secondary caries. Clinical significance: Nanoceramics and giomers can serve as an alternative to conventional restorative materials in primary anterior teeth because of their improved qualities. How to cite this article: Dhaker KK, Tandon S, Rathore AS, et al. Comparative Evaluation of Two Esthetic Full Coronal Restorative Materials for Primary Incisors. Int J Clin Pediatr Dent 2024;17(3):321-327.

Don't Rush with Your Brush: An In Vitro Study on Toothbrush Hygiene.

Aim: To evaluate the effectiveness of audiovisual (AV) aids in creating awareness of toothbrush hygiene. Materials and methods: This randomized trial study was conducted on 40 children aged 6-11 years. Children were given soft toothbrushes and then collected after brushing for 14 days. The toothbrushes were collected and sent to the laboratory for microbial culture evaluation. A questionnaire consisting of various questions regarding daily toothbrush hygiene practices was filled by the parents at the same time. After 14 days, brushes were collected, and the parents were shown an AV aid regarding toothbrush decontamination, parental awareness, and supervision. Those children were given new sets of toothbrushes and instructed to decontaminate them with chlorhexidine solution. After 14 days, the same questionnaire was filled out by the parents and toothbrushes were collected and immediately sent to the laboratory for microbial culture evaluation. Results: All the sampled toothbrushes had significant (p < 0.001) bacterial growth after 14 days of use. The use of disinfectant led to a 99.98% reduction in microbial colony counts. Hence, showed a significant result. Questionnaire analysis showed a positive parental approach toward maintaining toothbrush hygiene. Conclusion: Cleaning and disinfection of toothbrushes is crucial to stop the spread of disease since bacterial contamination cannot be 100% eliminated. AV aids can be effective tools for increasing awareness. Clinical significance: Through this study, we want to emphasize toothbrush hygiene and create awareness for the same through AV aid because a healthy toothbrush leads to healthy oral health. How to cite this article: Sharma S, Tandon S, Rai TS, et al. Don't Rush with Your Brush: An In Vitro Study on Toothbrush Hygiene. Int J Clin Pediatr Dent 2024;17(2):162-167.

Palatogingival Groove: The Known-unknown Devourer.

Aim: This case report aims to describe the management of a maxillary lateral incisor with a palatogingival groove (PGG) associated with a complex lesion. Background: The PGG is a rare developmental anomaly that involves the lingual surface of the maxillary incisors and extends for varying distances and depths on the root surface. This anomaly is usually inconspicuous and funnel-shaped, which forms a niche where bacterial plaque and calculus can accumulate to levels significant for pathological changes resulting in endodontic and periodontal lesions. These grooves are easily overlooked as etiologic factors, as they are concealed by the periodontal tissues. Case description: This paper describes the successful management of a rare case of maxillary lateral incisor with an accessory root, two canals, and a complex or type III PGG with a endodontic-periodontic lesion using a multidisciplinary approach. Conclusion: Recognizing PGG as the initiator of pathology is critical for the successful treatment and favorable prognosis of the affected tooth. Clinical significance: This case report highlights the importance of three-dimensional (3D) imaging using cone beam computed tomography (CBCT) that can provide accurate and sensitive information to assess and plan the treatment of the teeth with PGG. It also emphasizes that with the development of newer materials and diagnostic tools, clinicians need a detailed understanding of the characteristics, treatment, and prognosis of PGG to successfully manage the condition. How to cite this article: Gupta S, Tandon S, Rathore AS, et al. Palatogingival Groove: The Known-unknown Devourer. Int J Clin Pediatr Dent 2024;17(S-1):S95-S99.

A Comparative Evaluation of Xylitol Chewing Gum and a Combination of IgY + Xylitol Chewable Tablet on Salivary Streptococcus mutans Count in Children: A Double-blind Randomized Controlled Trial.

Aim: The study was designed for evaluation and comparison of the efficacy of Xylitol chewing gum and a combination of IgY + Xylitol chewable tablet (Nodecay TM) against the "salivary Streptococcus mutans " count in children. Materials and methods: About 120 children belonging to 6-12 years age-group were enrolled into this "double-blind randomized control clinical trial" according to the selection criteria. They were randomly assigned to three groups of 40 each: Group I-Xylitol chewing gum, Group II-IgY + Xylitol Chewable tablet (Nodecay TM), and Group III-Control. Children in all the groups had to chew the gum/tablet twice daily for 5 minutes during the 15-day period. The salivary samples at baseline, 15 days, 1, 2, and 3 months were inoculated on mitis salivarius bacitracin agar with potassium tellurite medium and the number of colony-forming units (CFUs) of Streptococcus mutans were determined. The data obtained was subjected to statistical analysis. Result: There was a "significant" difference in the number of "S. mutans CFUs" amongst the three groups at 15 days, 1st month, 2nd month, 3rd month with highest levels of S. mutans CFUs in Group III-Control and least in Group II-IgY + Xylitol (NodecayTM). Conclusion: The combination of IgY + Xylitol (NodecayTM) when administered for 15 days had significant efficacy against "S. mutans" when compared to Xylitol and control group. Clinical significance: Passive immunization with immunoglobulin Y is known not only to decrease the S. mutans count but also confers extended immunity by preventing recolonization of the tooth surface by persistence of the antibodies in saliva. How to cite this article: Jain RL, Tandon S, Rai TS, et al. A Comparative Evaluation of Xylitol Chewing Gum and a Combination of IgY + Xylitol Chewable Tablet on Salivary Streptococcus mutans Count in Children: A Double-blind Randomized Controlled Trial. Int J Clin Pediatr Dent 2022;15(S-2):S212-S220.

Efficacy of Audiovisual Aid in Assessing Parental Attitude toward their Child's Oral Health.

OBJECTIVE: To evaluate the effectiveness of audiovisual (AV) aid in assessing the parental attitude for their child's oral health. MATERIALS AND METHODS: A study (cross-sectional) was conducted in 50 parents of the children between age group of 0 and 14 years. A PowerPoint presentation was given to parents in two batches, and its effectiveness was assessed by comparing results of questionnaire before and after presentation. Data were collected through a questionnaire. STATISTICAL ANALYSIS: All data were compiled using MS Office Excel Sheet, and analysis was performed using the Statistical Package for Social Sciences software for descriptive analysis, and the level of statistical significance used in this study was chosen at p value < 0.005. RESULTS: The results proved that selected sample had lack of knowledge regarding primary teeth and its importance, oral health care of the child from birth, ideal time of first dental visit, and preventive treatments before awareness program. But there was significant difference in attitude of parents regarding their child's oral health care after presentation. CONCLUSION: Within the limitation of the study, the high prevalence dental caries in children showed that change of parental behavior and attitude is much more important rather than focusing on increasing knowledge only. Hence, AV aids can be effective tools for increasing awareness. HOW TO CITE THIS ARTICLE: Kajal A, Tandon S, Rai TS, et al. Efficacy of Audiovisual Aid in Assessing Parental Attitude toward their Child's Oral Health. Int J Clin Pediatr Dent 2020;13(5):437-441.

Recurrent Irritation Fibroma-"What Lies Beneath": A Multidisciplinary Treatment Approach.

Irritation fibroma is a benign, exophytic reactive oral lesion that develops secondary to injury. Its recurrence rate is rare but may happen in case of repeated trauma at the same site. This case report describes a recurrent fibroma in the anterior region of the hard palate in a 13-year-old male patient, which recurred in less than 1 year of surgical excision of the previous lesion. Through a detailed case history and clinical examination, the etiological factor of the same was found to be trauma from occlusion by the lower incisors. A multidisciplinary treatment approach was, therefore, undertaken, which included surgical excision of the lesion and correction of the underlying deep bite to prevent recurrence of the lesion. Thus, this article highlights the significance of a multidisciplinary approach for holistic dental treatment. HOW TO CITE THIS ARTICLE: Lalchandani CM, Tandon S, Rai TS, et al. Recurrent Irritation Fibroma-"What Lies Beneath": A Multidisciplinary Treatment Approach. Int J Clin Pediatr Dent 2020;13(3):306-309.

Comparative Evaluation of Ocimum sanctum and Calcium Hydroxide Mix as an Obturating Material in Deciduous Molars: An In Vivo Study.

AIM AND OBJECTIVES: To evaluate clinical and radiographic efficacy of a mix of O. sanctum (tulsi extract) and calcium hydroxide as an obturating material in primary molars and to compare these findings with commercially available iodoform with calcium hydroxide paste (metapex). MATERIALS AND METHODS: The present study was conducted on sixty children age group 4-7 years requiring multiple visit pulpectomy for their primary molars. The teeth selected were randomly divided into two groups. One group received Metapex and other group received Tulsi extract with calcium hydroxide as an obturating material. Clinical and radiographic evaluation were done between both the groups. RESULTS: There was no significant difference in the clinical and radiographic success rate between both the groups. CONCLUSION: Tulsi extract with calcium hydroxide can be used as an obturating material in primary molars. HOW TO CITE THIS ARTICLE: Agarwal S, Gupta S, Tandon S, et al. Comparative Evaluation of Ocimum sanctum and Calcium Hydroxide Mix as an Obturating Material in Deciduous Molars: An In Vivo Study. Int J Clin Pediatr Dent 2020;13(6):617-621.

Genetic Polymorphisms in the Open Reading Frame of the CCR5 gene From HIV-1 Seronegative and Seropositive Individuals From National Capital Regions of India.

C-C chemokine receptor type 5 (CCR5) serves as a co-receptor for Human immunodeficiency virus (HIV), enabling the virus to enter human CD4 T cells and macrophages. In the absence of CCR5, HIV strains that require CCR5 (R5 or M-tropic HIV) fail to successfully initiate infection. Various natural mutations of the CCR5 gene have been reported to interfere with the HIV-CCR5 interaction, which influences the rate of AIDS progression. Genetic characterization of the CCR5 gene in individuals from the National Capital Regions (NCRs) of India revealed several natural point mutations in HIV seropositive/negative individuals. Furthermore, we identified novel frame-shifts mutations in the CCR5 gene in HIV seronegative individuals, as well as the well reported CCR5Δ32 mutation. Additionally, we observed a number of mutations present only in HIV seropositive individuals. This is the first report to describe the genetic variations of CCR5 in individuals from the NCRs of India and demonstrates the utility of investigating understudied populations to identify novel CCR5 polymorphisms.

Interaction of proteins with lemon-juice/glutathione-derived carbon nanodot: Interplay of induced-aggregation and co-solubilization.

The accumulation of protein aggregates (tau) causes Alzheimer's disease (AD), Parkinson's disease (PD), and a range of neurodegenerative diseases. To develop a less toxic and bio-derived nanomaterials for inhibition of protein-aggregation, carbon nanodot has been used for this study. Nanodot have generated huge interest in biomedical applications owing to unique emission property and good biocompatibility. A carbon nanodot is synthesized from a natural resource-lemon juice and glutathione. The synthesized nanodot possesses excitation-independent emission and nano-sheet like with high graphitic content. Interaction of protein with CND is monitored by intrinsic fluorescence (trp residues), FT-IR and circular dichroism spectroscopy. Whereas it solubilizes the protein aggregates at its higher concentration. Both induced-aggregation and co-solubilization are sequence-independent and dictated by nanodot. The study may shed light on the role of glutathione in glutathione-dependent glyoxalase system toward defence against glycation product.

In silico Analyses of Subtype Specific HIV-1 Tat-TAR RNA Interaction Reveals the Structural Determinants for Viral Activity.

HIV-1 Tat transactivates viral genes through strong interaction with TAR RNA. The stem-loop bulged region of TAR consisting of three nucleotides at the position 23-25 and the loop region consisting of six nucleotides at the position 30-35 are essential for viral transactivation. The arginine motif of Tat (five arginine residues on subtype TatC) is critically important for TAR interaction. Any mutations in this motif could lead to reduce transactivation ability and pathogenesis. Here, we identified structurally important residues (arginine and lysine residues) of Tat in this motif could bind to TAR via hydrogen bond interactions which is critical for transactivation. Natural mutant Ser46Phe in the core motif could likely led to conformational change resulting in more hydrogen bond interactions than the wild type Tat making it highly potent transactivator. Importantly, we report the possible probabilities of number of hydrogen bond interactions in the wild type Tat and the mutants with TAR complexes. This study revealed the differential transactivation of subtype B and C Tat could likely be due to the varying number of hydrogen bonds with TAR. Our data support that the N-terminal and the C-terminal domains of Tat is involved in the TAR interactions through hydrogen bonds which is important for transactivation. This study highlights the evolving pattern of structurally important determinants of Tat in the arginine motif for viral transactivation.

Impact of Genetic Variations in HIV-1 Tat on LTR-Mediated Transcription via TAR RNA Interaction.

HIV-1 evades host defense through mutations and recombination events, generating numerous variants in an infected patient. These variants with an undiminished virulence can multiply rapidly in order to progress to AIDS. One of the targets to intervene in HIV-1 replication is the trans-activator of transcription (Tat), a major regulatory protein that transactivates the long terminal repeat promoter through its interaction with trans-activation response (TAR) RNA. In this study, HIV-1 infected patients (n = 120) from North India revealed Ser46Phe (20%) and Ser61Arg (2%) mutations in the Tat variants with a strong interaction toward TAR leading to enhanced transactivation activities. Molecular dynamics simulation data verified that the variants with this mutation had a higher binding affinity for TAR than both the wild-type Tat and other variants that lacked Ser46Phe and Ser61Arg. Other mutations in Tat conferred varying affinities for TAR interaction leading to differential transactivation abilities. This is the first report from North India with a clinical validation of CD4 counts to demonstrate the influence of Tat genetic variations affecting the stability of Tat and its interaction with TAR. This study highlights the co-evolution pattern of Tat and predominant nucleotides for Tat activity, facilitating the identification of genetic determinants for the attenuation of viral gene expression.