A stitch in time saves nine: All about pediatric facial fracture.

Fractures of the pediatric craniofacial skeleton can be challenging to engage in. The initial injury and subsequent treatment can cause long-term growth disturbances yielding problematic secondary deformities. It is important that clinicians involved in the care of these patients understand the differences between children and adult fracture patterns and understand the potential long-term effects on the growth of the pediatric skeleton and how to manage these problems when they occur.

Mixed Dentition Analysis in and around Kanpur City: An Existential and Illustrative Study.

Context: Mixed dentition space analysis helps in determining the discrepancy between the available and required space in each dental arch during the mixed dentition period; further, it helps to diagnose and plan the treatment of developing malocclusion. Aim: The aim of this study is to evaluate the applicability of Tanaka and Johnston's and Moyer's methods of predicting the size of permanent canines and premolars and compare the tooth size between the right and left sides between males and females, and also to compare the predicted values of mesiodistal widths of permanent canines and premolars from Tanaka and Johnston and Moyer's method with the measured values. Materials and methods: The sample consisted of 58 sets of study models, of which 20 were girls and 38 were boys, that were collected from the children of the 12-15 year age-group. A digital vernier gauge, whose beaks were sharpened, was used to measure the mesiodistal widths of the individual teeth in order to increase accuracy. Statistical analysis: The two-tailed paired t-tests were used to assess the bilateral symmetry of the mesiodistal diameter of all measured individual teeth. Results and conclusion: It was concluded that Tanaka and Johnston's method could not accurately predict the mesiodistal widths of unerupted canines and premolars of children of Kanpur city due to the high variability in estimation, whereas the least statistically significant difference was obtained only at 65% level of Moyer's probability chart for male, female, and combined sample. How to cite this article: Gaur S, Singh N, Singh R, et al. Mixed Dentition Analysis in and around Kanpur City: An Existential and Illustrative Study. Int J Clin Pediatr Dent 2022;15(5):603-609.

Comparative Study of Dental Health Status and Its Determinants among Children Attending Government and Private Schools in Kanpur City.

The purpose of this study was to evaluate the prevalence of dental caries and gingivitis and its relation to various determinants like dietary habits, habits related to oral health, and oral hygiene practice among private and government school children of age 6-12 years in Kanpur City. A total of 1,550 children (775 from government school and 775 from private school) were selected. Overall, 60% children presented with caries. Prevalence of caries was significantly more associated with government school children (63.1%) compared with private school children (56.9%). The mean deft scores were high in government school children (1.08 ± 1.91) compared with private school children (0.93 ± 1.53). This was statistically significant (p < 0.05). The DMFT scores were also high among government school children (0.84 ± 1.25) compared with private school children (0.67 ± 1.19). This was statistically significant (p < 0.05). On the whole, out of 1,550 children only 17.8% children presented with gingivitis, in which majority had mild form of gingivitis when compared with moderate and severe forms. The prevalence of gingivitis was relatively high among government school children (55%) compared with private school children (45%). This was statistically significant (p < 0.05). Summing up, a conclusion could be drawn that the prevalence of both dental caries and gingivitis depends on the state of the oral hygiene habits and practices, correspondingly, due to schoolchildren's knowledge of individual oral hygiene and skills. HOW TO CITE THIS ARTICLE: Singh N, Gaur S, Kumar M, et al. Comparative Study of Dental Health Status and Its Determinants among Children Attending Government and Private Schools in Kanpur City. Int J Clin Pediatr Dent 2021;14(5):666-673.

Effect of Multiple Micronutrient Fortification on Physico-Chemical and Sensory Properties of Chhash (Traditional Indian Yogurt-Based Drink).

INTRODUCTION: Micronutrient malnutrition is a persistent problem in India mainly due to low dietary diversity and poor nutrient density of staple foods. The addition of a commercial micronutrient mix in terms of physico-chemical and sensory characteristics was evaluated. METHODS: The yogurt prepared with reduce-fat milk (2%), 20 g/L CHN-11 fermentation culture and 12 h incubation (42 °C) was diluted at a rate of 35% to yield a 32 mg/100 mL concentration. The premix provided vitamin A, vitamin D, folic acid, iodine, iron, and zinc oxide to cover ~20⁻35% recommended RDA (recommended dietary allowance) per serving (250 mL). A three-factorial design, 2 treatments (control and fortified), 3 temperatures (4, 25, and 40 °C) and 4 time points (1, 2, 3 and 6 days), was used to analyze the physico-chemical properties in terms of titratable acidity, pH, color, and viscosity. A discriminatory sensory test (triangle) was performed with college students (n = 58) and mothers with young children (n = 25), who were living in Mehsana, India to evaluate the difference between fortified and non-fortified cooled (4 °C) product. RESULTS: Fortification did not affect most of the physico-chemical properties of chhash. As expected, titratable acidity increased whereas pH decreased with increasing storage time and temperature. Fortified samples showed higher b* values, whereas L* and a* were not affected. Viscosity changed due to temperature and time, but not fortification. Participants could not discriminate between samples in terms of color, aroma, and taste. CONCLUSION: Fortification of chhash is technically feasible.

Iron Fortification of Spiced Vinegar in the Philippines.

Despite existent fortification initiatives in the Philippines, approximately 50% of the population still suffers from iron deficiency anemia (IDA), mainly in rural areas. Fortification of staple foods has been proved successful in China and Vietnam. Coconut spiced vinegar (SV) is an inexpensive, widely available, and culturally acceptable condiment in Filipino households; however, no technical evidence exists on its potential as fortification vehicle. This study aimed to physicochemically characterize and evaluate the consumer acceptability of SV fortified with ferrous sulfate (FS), ferrous fumarate (FF), or sodium iron ethylenediaminetetraacetate (NaFeEDTA) at 0.2 mg Fe/mL. Iron fortificants were added directly to SV, vortexed, and stored for analysis. A nonfortified SV served as a control. Physicochemical analyses (pH, titratable acidity, color, turbidity, and iron recovery) were conducted from 0 to 6 months postfortification. Consumer acceptability (9-point hedonic scale: color, appearance, aroma, sourness, and overall acceptability) was conducted using 1-month fortified vinegar in 96 students and 27 women. Iron recovery of fortified samples was high and similar (>97%) after 3 days of fortification and remained >87% at 6 months postfortification. All samples had minimum acidity of 5.31% and pH between 3.12 and 3.3. Color difference against the control followed the next order: SV-NaFeEDTA < SV-FS = SV-FF. Among students, acceptability of SV-FS and SV-FF were lower than the control and SV-NaFeEDTA for all attributes (P < 0.05) except aroma. In women, overall acceptability and aroma were not different among samples (P > 0.05). Overall, SV-NaFeEDTA had similar acceptability to the control, and was the most accepted fortified vinegar. SV-NaFeEDTA shows potential (in terms of physicochemical stability and consumer acceptability) to be used as an iron-delivery vehicle to address IDA. PRACTICAL APPLICATION: The present study addresses the technical and organoleptic challenges of fortifying Filipino spiced vinegar with three iron sources. About 50% of the Filipino population (especially women and children) still suffers from iron deficiency, thus, more effective ways to deliver iron are needed. If successful, our study could pose as the base milestone for implementing mass iron fortification of spiced vinegar, given its frequent consumption and reach of all socioeconomic pockets of the Filipino population. Our aim is to improve the overall nutritional health of at-risk populations, and our study is one step closer to achieve this goal.

Evaluation of Micronutrient Sensors for Food Matrices in Resource-Limited Settings: A Systematic Narrative Review.

In resource-limited settings, mass food fortification is a common strategy to ensure the population consumes appropriate quantities of essential micronutrients. Food and government organizations in these settings, however, lack tools to monitor the quality and compliance of fortified products and their efficacy to enhance nutrient status. The World Health Organization has developed general guidelines known as ASSURED (Affordable, Sensitive, Specific, User-friendly, Rapid and Robust, Equipment-free, and Deliverable to end-users) to aid the development of useful diagnostic tools for these settings. These guidelines assume performance aspects such as sufficient accuracy, reliability, and validity. The purpose of this systematic narrative review is to examine the micronutrient sensor literature on its adherence towards the ASSURED criteria along with accuracy, reliability, and validation when developing micronutrient sensors for resource-limited settings. Keyword searches were conducted in three databases: Web of Science, PubMed, and Scopus and were based on 6-point inclusion criteria. A 16-question quality assessment tool was developed to determine the adherence towards quality and performance criteria. Of the 2,365 retrieved studies, 42 sensors were included based on inclusion/exclusion criteria. Results showed that improvements to the current sensor design are necessary, especially their affordability, user-friendliness, robustness, equipment-free, and deliverability within the ASSURED criteria, and accuracy and validity of the additional criteria to be useful in resource-limited settings. Although it requires further validation, the 16-question quality assessment tool can be used as a guide in the development of sensors for resource-limited settings.

Functionalization of Lipid-Based Nutrient Supplement with ß-Cyclodextrin Inclusions of Oregano Essential Oil.

Intestinal parasitic infection is one of the main causes of acute undernutrition in children. Oral consumption of oregano essential oil (OEO) can reduce intestinal parasitic infections, however, its addition to therapeutic and supplementary foods is hampered by its undesirable flavor. The objective of this study was to develop a functional lipid-based nutrient supplement (LNS) containing OEO, which is stable, acceptable and provides targeted intestinal delivery of bioactive. ß-cyclodextrin (ß-CyD) inclusion complexes of OEO (ß-CyD-OEO), and carvacrol (ß-CyD-CV) (1:1 molar) were prepared using slurry complexation (-20 °C) method and characterized based on encapsulation efficiency, moisture content, morphology, and 2-phase in vitro digestion stability. Carvacrol (CV) content was measured using reverse phase HPLC-UV. LNS containing ß-CyD-OEO (27.2 mg encapsulate/20 g LNS) was formulated using Indian staples and ingredients. Discriminatory sensory tests (triangle) were performed with college students (n = 58) and low-income women (n = 25), with young children at home (1 to 6 years), living in Mehsana, India to evaluate differences between LNS with and without bioactive ingredient (ß-CyD-OEO only). Moisture of dried complexes ranged 9.1% to 9.7% d.b., whereas water activity 0.35 to 0.412. The complex size and encapsulation efficiency of ß-CyD-OEO and ß-CyD-CV were 1.5 to 7 µm and 4 to 20 µm, and 86.04 ± 4.48% and 81.39 ± 3.34%, respectively. The bioactive complexes were stable through the gastric and intestinal phases. Bioaccessibility of encapsulated CV ranged 6.0% to 7.7%. Sensory tests revealed no differences (P > 0.05) in color, aroma, and taste between LNS with and without ß-CyD-OEO complexes. Functionalization of LNS with ß-CyD-OEO is feasible based on in vitro stability and sensory studies. PRACTICAL APPLICATION: Despite its antiparasitic activities, the addition of oregano essential oil into foods is limited due to its strong flavor and volatility. In this study, we evaluated the encapsulation of oregano essential oil with ß-cyclodextrin and its addition into lipid-based nutrition supplements. The results revealed that complex encapsulation efficiency was above 80%. Also, the bioactive complexes were stable under in vitro gastrointestinal conditions. Sensory evaluation of LNS with and without encapsulated essential oil showed no difference in terms of color, aroma, and taste. The functional LNS can both address nutrient insufficiency as well as parasitic infection among malnourished populations in low-resource settings.

Microencapsulation of docosahexaenoic acid (DHA) with four wall materials including pea protein-modified starch complex.

Omega-3 fatty acids, specifically docosahexaenoic acid (DHA, 22 carbons and 6 double bonds) are fundamental compounds for a healthy diet. However, due to their unsaturated nature, omega fatty acid-rich oils are chemically unstable and susceptible to oxidative deterioration. The oxidation results in production of free radicals and unpleasant tastes, negatively impacting the shelf-life, sensory properties, and acceptability of food products. This study was conducted to examine the effect of wall materials on protection of DHA in canola oil against oxidation. A total of 4 wall materials including pea protein isolate (PPI), pea protein isolate - modified starch complex (PPI-MS), Tween 20, and SDS were used for microemulsion preparation with canola oil containing DHA. The freeze-dried powders were analyzed with respect to physicochemical characteristics, oxidative stability, and release properties. The results showed that the PPI-MS as a natural polymeric wall material exhibited similar or better encapsulation efficiency and acceptable level of peroxide value compared to the synthetic surfactants (Tween 20 and SDS). The utilization of protein-polysaccharide complexes enabled the incorporation of specific properties of each biopolymer to further improve emulsion stability for the production of capsules with improved oxidative stability.

Effect of oregano essential oil and carvacrol on Cryptosporidium parvum infectivity in HCT-8 cells.

Cryptosporidium parvum is the second leading cause of persistent diarrhea among children in low-resource settings. This study examined the effect of oregano essential oil (OEO) and carvacrol (CV) on inhibition of C. parvum infectivity in vitro. HCT-8 cells were seeded (1×106) in 96-well microtiter plates until confluency. Cell viability and infectivity were assessed by seeding HCT-8 cell monolayers with C. parvum oocysts (1×104) in two modalities: 1) 4h co-culture with bioactive (0-250µg/mL) followed by washing and incubation (48h, 37°C, 5% CO2) in bioactive-free media; and 2) 4h co-culture of C. parvum oocysts followed by washing and treatment with bioactive (0-250µg/mL) during 48-h incubation. Cell viability was tested using Live/Dead™ assay whereas infectivity was measured using C. parvum-specific antibody staining via immunofluorescence detection. Loss of cell viability was observed starting at 125µg/mL and 60µg/mL for OEO and CV, respectively. Neither OEO nor CV modulated the invasion of C. parvum sporozoites in HCT-8 cells. Treatment with bioactive after invasion reduced relative C. parvum infectivity in a dose-dependent manner to 55.6±10.4% and 45.8±4.1% at 60 and 30µg/mL of OEO and CV, respectively. OEO and CV are potential bioactives to counteract C. parvum infection in children.

Development and Physico-Chemical Characterization of a Shea Butter-Containing Lipid Nutrition Supplement for Sub-Saharan Africa.

Lipid-based nutrient supplements (LNS) are used to prevent and treat moderate and severe acute malnutrition, a leading cause of mortality in children-under-five. The physical and chemical changes of two new LNS products were evaluated before and after accelerated shelf life testing (ASLT) according to protocols suggested by the U.S. Agency for International Development (USAID) and Doctors without Borders and compared against USAID's A-20 paste as a control. LNS formulas containing Shea butter from the Shea nut tree (Vitellaria paradoxa), a common fat source in parts of Sub-Saharan Africa, with and without flax-seed oil, as a source of omega-3 fatty acids, were developed. LNS formulas were batched (0.8 kg) in a wet grinder, sealed under nitrogen in three-layer mini-pouches (20 g), and underwent ASLT at 40 ± 2 °C for six months with sampling every eight weeks. At each time point, water activity, moisture, peroxide value, oil separation, vitamin C content, and hardness were evaluated. Results showed comparable stability among all formulas with an increase in Aw (p < 0.05) but no change in vitamin C, oil separation, or peroxide value. Addition of Shea butter improved the LNS's hardness, which remained stable over time. Modifying fat profile in LNS can improve its texture and essential fatty acid content without affecting its storage stability.

Supplementation with RRR- or all-rac-α-Tocopherol Differentially Affects the α-Tocopherol Stereoisomer Profile in the Milk and Plasma of Lactating Women.

Background: The naturally occurring α-tocopherol stereoisomer RRR-α-tocopherol is known to be more bioactive than synthetic α-tocopherol (all-rac-α-tocopherol). However, the influence of this difference on the α-tocopherol stereoisomer profile of human milk is not understood.Objective: We investigated whether supplemental RRR-α-tocopherol or all-rac-α-tocopherol differentially affected the distribution of α-tocopherol stereoisomers in milk and plasma from lactating women.Methods: Eighty-nine lactating women aged 19-40 y and with a body mass index (in kg/m2) ≤30 were randomly assigned at 4-6 wk postpartum to receive a daily supplement containing 45.5 mg all-rac-α-tocopherol acetate (ARAC), 22.8 mg all-rac-α-tocopherol acetate + 20.1 mg RRR-α-tocopherol (MIX), or 40.2 mg RRR-α-tocopherol (RRR). Milk and plasma were analyzed for α-tocopherol structural isomers and α-tocopherol stereoisomers at baseline and after 6 wk supplementation with the use of chiral HPLC.Results: There were no significant treatment group or time-dependent changes in milk or plasma α, γ, or δ-tocopherol. RRR-α-tocopherol was the most abundant stereoisomer in both milk and plasma in each group. Supplementation changed both milk and plasma percentage RRR-α-tocopherol (RRR > MIX > ARAC) (P < 0.05) and percentage non-RRR-α-tocopherol (ARAC > MIX > RRR) (P < 0.05). In the RRR group, percentage RRR-α-tocopherol increased in milk (mean ± SEM: 78% ± 2.3% compared with 82% ± 1.7%) (P < 0.05) and plasma (mean ± SEM: 77% ± 1.8% compared with 87% ± 1%) (P < 0.05). In contrast, the percentage RRR-α-tocopherol decreased in the MIX and ARAC groups (MIX, P < 0.05; ARAC, P < 0.0001), and percentage non-RRR-α-tocopherol stereoisomers increased (MIX, P < 0.05; ARAC, P < 0.0001) commensurate with an accumulation of 2S-α-tocopherol stereoisomers (P < 0.05) in both milk and plasma. Milk and plasma RRR-α-tocopherol was positively correlated at baseline (r = 0.67; P < 0.0001) and 6 wk (r = 0.80; P < 0.0001).Conclusion: The α-tocopherol supplementation strategy differentially affected the α-tocopherol milk and plasma stereoisomer profile in lactating women. RRR-α-tocopherol increased milk and plasma percentage RRR-α-tocopherol, whereas all-rac-α-tocopherol acetate reduced these percentages. Because RRR-α-tocopherol is the most bioactive stereoisomer, investigating the impact of supplement-driven changes in the milk α-tocopherol stereoisomer profile on the α-tocopherol status of breastfed infants is warranted.

Omega-3-Fortified Lipid-Based Nutrient Supplement: Development, Characterization, and Consumer Acceptability.

BACKGROUND: Incorporation of omega-3 polyunsaturated fatty acid (PUFA) sources to lipid-based nutrition supplement (LNS) formulations for undernourished populations presents a challenge due to reduced shelf life and poor consumer acceptability. OBJECTIVE: To systematically develop an omega-3-fortified LNS formulation, using flaxseed oil (FO), by optimizing its processing stability and evaluating its sensory acceptance. METHODS: LNS formulations were formulated to yield approximately 452 kcal, 13.2 g of protein, 30 g of fat, and 53 g of carbohydrates per 100 g. Response surface methodology (RSM) with 4-factor-3-level: omega-3 fatty acid source (FO; 0%-10%), antioxidant (ascorbyl palmitate: 0.0%-0.03%), emulsifier (soy lecithin: 0.5%-1.5%), and storage time (0-6 months at 40°C) was used to optimize LNS's functionality and storage stability. Factor effects were evaluated for peroxide value, oil separation, water activity, moisture content, hardness, and vitamin C content of the samples. Consumer acceptability was assessed using a 9-point hedonic scale. RESULTS: After 6 months of accelerated storage, the addition of FO to LNS formula resulted in increased peroxide values (7.75 mEq/kg fat) and lipid separation and a reduction in vitamin C and water activity. Optimal levels to maximize storage time and FO and minimize oxidation were 0.02% antioxidant, 1.5% emulsifier, and 4.9% FO. Indian women and students accepted LNS formulations with or without FO similar to other commercial supplements. CONCLUSION: An LNS containing FO with improved omega-6/omega-3 PUFA ratio was successfully formulated with staple Indian ingredients and optimized for storage stability using RSM.

Simultaneous estimation of atorvastatin and its two metabolites from human plasma by ESI-LC-MS/MS.

A selective, sensitive, and fast high performance liquid chromatography (HPLC) method with mass spectrometric (MS) detection mode has been developed and validated completely in human plasma. Atorvastatin (ATO), p-hydroxy atorvastatin (p-HATO), o-hydroxy atorvastatin (o-HATO) and internal standard (IS) are extracted from human plasma via solid phase extraction (SPE) technique. After elution, the solution is evaporated, then reconstituted with 250 µL of Mobile Phase and analyzed using HPLC/MS/MS system. An isocratic mode is used to separate interference peaks using a Symmetry C-18, 75 × 4.6 mm ID, 3.5 µ, column. The m/z of ATO, o-HATO and p-HATO are 559.2/440.2, 575.3/440.4 and 575.0/440.4 respectively. Linearity ranges are 0.05 to 252.92 ng/mL for ATO, p-HATO and o-HATO respectively. Calibration functions, lower limit of quantitation (LLOQ), stability, intra- and inter-day reproducibility, accuracy, and recovery are estimated. This method is free from matrix effects and any abnormal ionization. This method was successfully applied to a single dose 80 mg tablet bioequivalence (BE) study of Atorvastatin. Copyright © 2011 John Wiley & Sons, Ltd.