Evaluation of detrimental effects of impacted Mandibular third molars on adjacent second molars - A retrospective observational study.

Context: Mandibular impacted third molars are the most frequently impacted teeth in humans and can predispose the adjacent second molar to an array of detrimental effects such as caries, periodontitis, and cervical resorption thus the aim of this study was to determine the same. Subjects and Methods: A retrospective observational cross-sectional study involving patients with orthopantomography presenting with impacted lower third molar. The type, depth, and level of impaction, the extent of caries, periodontal changes, and the presence of cervical resorption were assessed. Statistical Analysis Used: Data were analyzed using SPSS version 21.0. with Chi-square. Results: Mesioangular impaction was most commonly noted. The pattern of impaction had a direct influence in the formation of carious lesions, cervical resorption, and periodontal ligament (PDL) changes. Conclusions: Noting the pattern of third molar impaction helps the clinician to forecast problems that may occur on adjacent teeth and initiate necessary prophylactic treatment.

Influence of three different types of desensitizing agents on bond strength of etch-and-rinse and self-etch adhesive system on dentin: An in vitro study.

Aim: To determine the effect of three different dentin hypersensitivity treatment procedures on the microtensile bond strength of etch and rinse and self-etch adhesive system. Materials and Methods: Eighty extracted intact human permanent lower premolars were decoronated, and dentin was exposed on the buccal surface. The teeth were randomly assigned to two experimental groups of 40 teeth each: etch and rinse system or self-etch system. The 40 samples assigned were further randomly assigned to four desensitizing treatment subgroups: Control, Gluma, NovaMin, and GC tooth Mousse with 10 samples per subgroup. Desensitizing treatment was performed two times each day for 2 weeks respectively. The exposed dentin was subjected to etch and rinse or self-etch adhesive system bonding agent as per the group and restored using composite to 4-mm thickness. Samples were then subjected to universal testing machine for microtensile bond strength. Results: The bond strength to the dentin obtained with etch and rinse adhesive system group where significantly higher (P < 0.05) when compared to self-etch adhesive system. However, there was no significant effect of the desensitizing agent on the microtensile bond strength in its own. Scanning electron microscope imaging reviled tubular occlusion in all specimens treated with desensitizer. Conclusion: The bond strength was majorly impacted by the type of adhesive system used. While the desensitizing agents used in the study had little or no adverse effect on the bond strength of composites to dentin surface.

Comparative Evaluation of Novel Bulk Fill Resin Composites with Conventional Composites for Microleakage Formation - A Steromicroscopic Study.

Aim: The purpose of this study was to assess and compare microleakage of two novel bulk-fill resin composites with traditional incremental composites. Materials and Methods: Standardized conservative Class II cavities were made on 120 sound maxillary premolars having approximately 4 mm of width with 2 mm gingival extension below CEJ keeping all line angles round and cavosurface margins beveled. Samples were categorized into the group of three (n = 40), based on composites used; Smart Dentine Replacement (SDR), X Tra Fill, and Z350 XT. The prepared cavities were filled with respective composites to a depth of 4 mm. Post thermocycling, Specimens were absorbed in 0.5% methylene blue for 8 h and soaked in tap water for 12 h samples were later split in mesiodistal direction at the center of the composite restorations with diamond disc. A total of 240 samples were obtained. The samples were viewed with ×20. One-way ANOVA and post-hoc Bonferroni test were used to derive statistical data. Results: SDR demonstrated considerably less micro leakage in comparison with X-Tra fill composites. Significantly high microleakage was observed in the traditional composites (Z350 XT). Conclusion: Novel Bulk-fill resin composites exhibited better adaptability and less microleakage compared to traditional multilayer composites.

Agreement between dried blood spots and HemoCue in Tamil Nadu, India.

India retains the world's largest burden of anemia despite decades of economic growth and anemia prevention programming. Accurate screening and estimates of anemia prevalence are critical for successful anemia control. Evidence is mixed on the performance of HemoCue, a point-of-care testing device most widely used for large-scale surveys. The use of dried blood spots (DBS) to assess hemoglobin (Hb) concentration is a potential alternative, particularly in field settings. The objective of this study is to assess Hb measurement agreement between capillary HemoCue and DBS among two age groups, children 6-59 months and females age 12-40 years. We analyzed data from the baseline round of a cluster randomized rice fortification intervention in Cuddalore district of Tamil Nadu, India. Capillary blood was collected from a subset of participants for Hb assessment by HemoCue 301 and DBS methods. We calculated Lin's concordance correlation coefficient, and tested bias by conducting paired t-tests of Hb concentration. Independence of the bias and Hb magnitude was examined visually using Bland-Altman plots and statistically tested by Pearson's correlation. We assessed differences in anemia classification using McNemar's test of marginal homogeneity. Concordance between HemoCue and DBS Hb measures was moderate for both children 6-59 months (ρc = 0.67; 95% CI 0.65, 0.71) and females 12-40 years (ρc = 0.67: 95% CI 0.64, 0.69). HemoCue measures were on average 0.06 g/dL higher than DBS for children (95% CI 0.002, 0.12; p = 0.043) and 0.29 g/dL lower than DBS for females (95% CI - 0.34, - 0.23; p < 0.0001). 50% and 56% of children were classified as anemic according to HemoCue and DBS, respectively (p < 0.0001). 55% and 47% of females were classified as anemic according to HemoCue and DBS, respectively (p < 0.0001). There is moderate statistical agreement of Hb concentration between HemoCue and DBS for both age groups. The choice of Hb assessment method has important implications for individual anemia diagnosis and population prevalence estimates. Further research is required to understand factors that influence the accuracy and reliability of DBS as a methodology for Hb assessment.

Evaluation of 2% Chlorhexidine and 2% Sodium Fluoride as Endodontic Irrigating Solutions on Root Dentine Microhardness: An In Vitro Study.

OBJECTIVES: The aim of this study was to evaluate the effects of 2% chlorhexidine gluconate (CHG) and 2% sodium fluoride (NaF) as endodontic irrigants on microhardness of root dentin. MATERIALS AND METHODS: In this in vitro study, access cavity and root canal preparations were done on 24 freshly extracted anterior teeth. After sectioning into 24 dentin discs using hard tissue microtome in 2 mm thickness, all samples were immersed in solutions of 17% ethylenediamine tetra-acetic acid (EDTA) (2 minutes) followed by 2.5% of sodium hypochlorite (NaOCl) (10 minutes). Then samples were randomly divided into three groups based on the irrigant used: Group I: saline (control group); Group II: 2% NaF; Group III: 2% CHG for two minutes each. Dentin microhardness was measured before (pretreatment), during (after treatment with 17% EDTA and 2.5% NaOCl), and after the experimental period (after treatment with saline, 2% NaF, and 2% CHG) using a Vickers indenter. Statistical evaluation of the data was done using one-way analysis of variance (ANOVA) and the Student's t-test, and the values are tabulated. RESULTS: Specimens rinsed in 2% CHG showed a significant increase in Vickers hardness number (VHN) values (p < 0.05), as compared with EDTA and NaOCl groups, whereas saline and 2% NaF groups showed no significant difference. CONCLUSIONS: NaF did not show any significant effect on microhardness of the root dentin. CHG as an irrigant was seen to have a strengthening effect on dentin microhardness in comparison to NaOCl and EDTA, which has decreased the strength of root dentin.

Evaluation of indomethacin as matrix metalloproteases inhibitor in human dentin.

OBJECTIVE: The objective was to determine a new experimental material, indomethacin's inhibitory effect on the enzymatic activity of dentin collagen. MATERIALS AND METHODS: Fifteen freshly extracted teeth were collected and stored at 4°C until use. Enamel, roots, and remnant pulp tissue were removed, and dentin powder was obtained by pulverizing liquid nitrogen-frozen coronal dentin with a mortar pestle. The obtained protein extract from human dentin powder was treated with indomethacin and incubated. The inhibition of enzymatic activity was analyzed using plate assay method and zymographic analysis. RESULTS: Plate assay method and zymograms showed that indomethacin-treated samples inhibited dentin enzymatic activity. SIGNIFICANCE: Bond strength at the dentin adhesive interface decreases because of the hydrolytic degradation of dentin collagen. The inhibition of enzymes responsible for collagen degradation may improve the bond strength durability. This study demonstrates the efficacy of indomethacin in inhibiting enzymatic activity.

Antibiotic susceptibility pattern of Neisseria gonorrhoeae strains isolated from five cities in India during 2013-2016.

PURPOSE: Emergence of multidrug resistance in Neisseria gonorrhoeae, an STI of public health significance is the biggest challenge to gonorrhoea control. Monitoring for antimicrobial resistance is essential for the early detection of emergent drug resistance patterns. METHODOLOGY: One hundred and twenty four N. gonorrhoeae strains were isolated between September 2013-August 2016 [82-New Delhi, 3-Pune, 3-Mumbai, 20-Secunderabad and 16-Hyderabad] to determine antimicrobial susceptibility and to compare the CLSI disc diffusion method with Etest for these strains. The results of the two methods were compared by using kappa statistics. RESULTS: Ninety eight percent [CI: 96.2-100] of isolates were resistant to ciprofloxacin, 52 % [CI: 43.2-60.8] to penicillin, 56 % [CI: 47.2-64.7] to tetracycline and 5 % [CI: 1.2-8.8] to azithromycin. All the strains were susceptible to spectinomycin, ceftriaxone and cefixime except for two strains which showed decreased susceptibility to ceftriaxone and cefixime. Kappa scores for penicillin, azithromycin, ciprofloxacin, ceftriaxone and cefixime showed that the CLSI method had high agreement with Etest while tetracycline had substantial agreement. CONCLUSION: Our data suggest that the disc diffusion method which is both cost effective and more feasible, can effectively be used routinely for monitoring antibiotic susceptibility in N. gonorrhoeae, in limited resource countries like India. We demonstrate the emergence of decreased susceptibility to ceftriaxone and cefixime and threshold levels of resistance to azithromycin in India. This underscores the importance of maintaining continued surveillance for antibiotic resistance in N. gonorrhoeae and a potential requirement for strategic change in guidelines in the not so distant future.

Antimicrobial activity of plant extracts against sexually transmitted pathogens.

Comprehensive management of sexually transmitted infections (STIs) using vaginal or rectal microbicide-based intervention is one of the strategies for prevention of HIV infection. Herbal products have been used for treating STIs traditionally. Herein, we present in vitro activity of 10 plant extracts and their 34 fractions against three sexually transmitted/reproductive tract pathogens - Neisseria gonorrhoeae, Haemophilus ducreyi and Candida albicans. The plant parts were selected; the extracts/fractions were prepared and screened by disc diffusion method. The minimum inhibitory and minimum cidal concentrations were determined. The qualitative phytochemical analysis of selected extracts/fractions showing activity was performed. Of the extracts/fractions tested, three inhibited C. albicans, ten inhibited N. gonorrhoeae and five inhibited H. ducreyi growth. Our study demonstrated that Terminalia paniculata Roth. extracts/fractions inhibited growth of all three organisms. The ethyl acetate fraction of Syzygium cumini Linn. and Bridelia retusa (L.) Spreng. extracts was found to inhibit N. gonorrhoeae at lowest concentrations.

Enteric pathogens in HIV infected and HIV uninfected individuals with diarrhea in Pune.

BACKGROUND: Diarrhea in HIV infected individuals is a common complication seen in about 90% of patients in developing countries. The objective of this study was to identify enteric pathogens in HIV infected and HIV uninfected individuals in Pune. METHOD: This study was conducted from January 2009 to May 2010 on 331 consecutive patients presenting with diarrhea admitted at Naidu Municipal Corporation Hospital, Pune and processed using conventional methods. RESULTS: Intestinal parasitic pathogens were detected in 60% (39/65) of HIV infected and 14.3 (38/266) of HIV uninfected individuals. Bacterial pathogens were detected in 34% (22/65) of HIV infected individuals and 28.2% (75/266) of the HIV uninfected individuals. The common enteric pathogens detected in HIV infected individuals were Cystoisospora belli (28%, 18/65) followed by Cryprotosporidium parvum (12%, 8/65). In HIV uninfected individuals Entamoeba histolytica (7.1%, 19/266) followed by Shigella flexnari (4.9%, 13/266) were the most common pathogens. The difference in detection of enteric parasites in HIV infected individuals and HIV uninfected individuals was found to be significant (p < 0.01). CONCLUSIONS: Intestinal parasitic pathogens are more common in HIV infected antiretroviral therapy naïve patients. Early detection of enteric pathogens by routine examination of stool samples will help in the management and to improve the quality of life for HIV infected individuals.

A natural meliorate: revolutionary tissue engineering in endodontics.

Platelet-Rich Fibrin (PRF) was first described by Choukroun et al., (2001). It has been referred to as a second-generation platelet concentrate, which has been shown to have several advantages over traditionally prepared platelet-rich plasma. PRF has a physiologic architecture that is very favourable to the healing process, obtained due to the slow polymerization process. The development of platelet concentrate as bioactive surgical additives that are applied locally to promote wound healing stems from the use of fibrin adhesive. Developments in the field of tissue engineering have made the generation of artificial substitutes in several areas of medicine. Various clinical applications in endodontics include Periapical surgeries, Revascularisationprocedures, Regenerative pulpotomy, Perforation repair. This article aims to discuss the various applications of PRF in the field of Endodontics with few case reports.

Mutations in the gyrA and parC genes of quinolone-resistant Neisseria gonorrhoeae isolates in India.

A dramatic increase in the number of quinolone-resistant Neisseria gonorrhoeae isolates in India and worldwide has been reported recently. This study was undertaken to identify and characterise mutations in the gyrA and parC genes of N. gonorrhoeae resistant to six different quinolone antibiotics. In total, 64 N. gonorrhoeae clinical isolates were obtained during 2007-2009 from patients attending sexually transmitted diseases clinics (New Delhi, 35; Pune, 16; Mumbai, 6; Hyderabad, 6; and Nagpur, 1). Antimicrobial susceptibility was determined by Etest and mutation patterns in gyrA and parC were determined by sequencing analysis. All strains showed varying resistance to different quinolone analogues, ranging from 17.2% (gatifloxacin) to 98.4% (ofloxacin and norfloxacin). Sequencing of gyrA and parC revealed that 100% of strains showed mutations in gyrA and 46.9% showed mutations both in gyrA and parC. All strains showed single or double mutations at Ser-91→Phe, Ser-91→Thr and Asp-95→Gly/Asn in gyrA and at Glu-91→Gly in parC. Asp-95→Asn mutation was the most prevalent in strains isolated from New Delhi, whilst Asp-95→Gly was prevalent in strains isolated from Pune. Strains were categorised into eight different mutation patterns. Resistant strains with high minimum inhibitory concentrations (≥8 µg/mL) showed mutations both in gyrA and parC. The difference in the proportion of strains showing mutations in gyrA and parC was found to be significant (P<0.001). The mutation Asp-95→Asn was restricted to Pune strains only. These results indicate that mutations in quinolone target enzymes may have resulted in the high-level resistance seen in these isolates.

Antimicrobial susceptibility testing, auxotyping, and serotyping of Neisseria gonorrhoeae strains isolated in India.

Sixty-four Neisseria gonorrhoeae strains isolated from patients attending sexually transmitted disease clinics at Pune and Delhi between January 2007 and June 2008, were subjected to antimicrobial susceptibility testing, auxotyping, and serotyping. We observed 6 antibiotic resistance patterns, 6 auxotypes, 3 serogroups, and 17 serovars. The combination of auxotyping and serotyping is a potential useful method for typing N. gonorrhoeae as a result of high discriminatory index, rapidity, ease, and relatively lower cost.

Phase I safety study of Praneem polyherbal vaginal tablet use among HIV-uninfected women in Pune, India.

Praneem polyherbal formulations containing purified extracts of Azadirachta indica (neem tree) have shown activity against HIV and sexually transmitted disease pathogens in studies in vitro. The product also has contraceptive properties. This has prompted its development as a possible microbicide. We evaluated the safety of Praneem polyherbal tablet use among HIV-uninfected women. Twenty eligible women were enrolled in a Phase I open-label study requiring 14 days of consecutive intravaginal use of Praneem polyherbal tablets. Nine (45%) participants experienced 17 episodes of genital irritation. Transient genital itching was reported by eight (40%) participants, burning micturation by two (10%) and lower abdominal pain, genital burning and intermenstrual spotting by one (5%) each. On colposcopy, petechial haemorrhage was observed in two participants, one on day 7 and the other on day 14, and both were resolved without any treatment. There were no serious adverse events. Praneem polyherbal tablets were found to be safe for once daily intravaginal use for 14 consecutive days in sexually active HIV-uninfected women and a Phase II study may be taken up as a priority.

Consistent subtype-specific anti-HIV type 1 T lymphocyte responses in Indian subjects recently infected with HIV type 1.

Anti-HIV-1-specific T cell responses in early HIV-1 infection have been found to be important in deciding the course of disease progression. But there are few data concerning nonsubtype B HIV infection. HIV-1 subtype C is the most prevalent subtype in India. HIV-1 Gag-specific T cell responses in 12 Indian subjects with recent HIV-1 infection were characterized by an ELISpot assay at two consecutive visits and their correlation with plasma viral load and CD4(+) T lymphocyte counts was studied. Ten of the 12 subjects demonstrated T cell responses to either one or both Gag B and C peptides, on at least one visit. Five of 10 responders showed a consistent response (response at both visits): 4 exhibited a Gag C-specific consistent response and 1 showed a consistent response to Gag B. The remaining five patients, showing response at only one of the two visits, were considered inconsistent responders. None of the individuals showed a consistent response to both B and C Gag peptides. Marginally significant correlation was observed between consistency of the response and lower plasma viral load (p = 0.062). The subtype-specific Gag C response was also found to be correlated with lower viral load as compared with the response to Gag B (r = -0.336, p = 0.054 for subtype C and r = -0.234, p = 0.13 for subtype B). The data suggest that the patients exhibiting consistent subtype-specific responses to HIV-1 Gag might have better control of viral replication in early HIV infection.