Parental anxiety associated with children undergoing dental treatment.

AIM: Over the past two decades, improvements in both the safety of anaesthetic agents and the techniques of operative dentistry have resulted in the popularity of "day-case anaesthesia". The aim of this study was to evaluate the stress felt by parents of children undergoing dental treatment. The study also aimed to compare the stress felt by parents of children undergoing chairside treatment to the stress felt by parents of children who received their treatment under general anaesthesia. MATERIALS AND METHODS: Study Design: Stress among parents was assessed subjectively using the Modified Dental Anxiety Stress (MDAS) questionnaire and objectively using a pulse oximeter to record the heart rate. The sample comprised of 60 parents of children aged between 4 and 7 years who were divided into three groups. Group A comprised of 20 sets of parents of children who underwent complete dental treatment without any pharmacological behaviour management. Group B comprised of 20 sets of parents of children who were treated at the dental chair with N2O used as pharmacological behaviour management. Group C comprised of 20 sets of parents of children who underwent dental rehabilitation under general anaesthesia. Objective signs were recorded preoperatively, during the procedure and post-operatively. RESULTS: Dental treatment is a stressful experience for a parent. The introduction of a pharmacological method of behaviour management seems to significantly increase the stress felt by the parent. CONCLUSIONS: A significant increase in heart rate was observed among parents whose children were under treatment.

Efficacy of external cold and a vibrating device in reducing discomfort of dental injections in children: A split mouth randomised crossover study.

AIM: To study the discomfort and fear associated with maxillary infiltration injections when using a combination of external cold and a commercially available vibrating device. METHODOLOGY: A total of 60 children aged 7 years old participated in this split mouth randomised crossover study. The control intervention comprised of the administration of 1.8 ml of 2% lidocaine with 1:100,000 adrenaline using a 24 mm 30 gauge needle, while the test intervention used external cold and a commercially available vibrating device in addition to the control protocol. The heart rate of the child at the time of injection was used as an objective measure and the Wong-Baker pain scale was used as a subjective measure of the child's discomfort. The face, limbs, arms, cry and consolability (FLACC) scale was used to record the child's pain as perceived by the dentist. RESULTS: Children reported a significantly lower Wong-Baker score and the operators observed a significantly lower heart rate and FLACC scores in the test visit than the control visit. CONCLUSIONS: Combining external cold with vibrating devices might be effective in reducing discomfort and fear in children undergoing infiltration dental analgesia. CLINICAL TRIALS IDENTIFIER: NCT02675387.

High sensitivity organic inorganic hybrid X-ray detectors with direct transduction and broadband response.

X-ray detectors are critical to healthcare diagnostics, cancer therapy and homeland security, with many potential uses limited by system cost and/or detector dimensions. Current X-ray detector sensitivities are limited by the bulk X-ray attenuation of the materials and consequently necessitate thick crystals (~1 mm-1 cm), resulting in rigid structures, high operational voltages and high cost. Here we present a disruptive, flexible, low cost, broadband, and high sensitivity direct X-ray transduction technology produced by embedding high atomic number bismuth oxide nanoparticles in an organic bulk heterojunction. These hybrid detectors demonstrate sensitivities of 1712 µC mGy-1 cm-3 for "soft" X-rays and ~30 and 58 µC mGy-1 cm-3 under 6 and 15 MV "hard" X-rays generated from a medical linear accelerator; strongly competing with the current solid state detectors, all achieved at low bias voltages (-10 V) and low power, enabling detector operation powered by coin cell batteries.

The relationship between examination-related academic stress, salivary antioxidant capacity and exercise patterns of final-year Saudi dental students.

OBJECTIVE: To study the impact of examination stress on the total antioxidant capacity (TAC) of senior dental students and compare changes in TAC between students who exercise regularly and those who do not. METHODS: A questionnaire designed to evaluate physical activity levels, body mass index (BMI) and academic performance was distributed to 325 senior dental students. Of the 312 who responded, a total of 70 were enrolled in the study, of whom 60 completed the study. The students were composed of a low-activity group (n = 30), who had a Goddard-Sheppard (GS) exercise score of <25, and a high-exercise group (n = 30), who had a GS score >60. Dental Environment Stress (DES) questionnaires and salivary samples were collected at the first week of the semester and at the week of the examinations. Salivary TAC was measured using a commercially available Radical Absorbance Antioxidant Assay measurement kit (Zen-Bio ORAC™, AMS Biotechnology, Abington UK). A total of 60 students completed the study. RESULTS: A significant increase in DES values and a significant reduction in salivary TAC values were observed in the week of the examination compared to baseline scores. Although no differences were observed in the DES scores between the high-exercise and low-exercise groups, the high-exercise group showed a significantly lower reduction in examination week salivary TAC compared to their counterparts in the low-exercise group. Regression models showed a significant association between the TAC, exercise scores and DES scores in the week of the examinations. CONCLUSION: Regular exercise may help protect students against the oxidative stress associated with academic stress.

Scatter free imaging for the improvement of breast cancer detection in mammography.

In mammography, the reduction of scattered x-rays is vital due to the low contrast or small dimension of the details that are searched for. The typical method of doing so in current conventional mammography is the anti-scatter grid. The disadvantage of this method is the absorption of a proportion of the primary beam and therefore an increase in dose is required to compensate for the loss of counts. An alternative method is proposed, using quasi-monochromatic beams and a pixellated spectroscopic detector. As Compton-scattered x-rays lose energy in the scattering process, they are detected at a lower energy in the spectrum. Therefore the spectrum can be windowed around the monochromatic energy peak, removing the scattered x-rays from the image. The work presented here shows contrast improvement of up to 50% and contrast to noise ratio improvements of around 20% for scatter free imaging in comparison to full spectrum imaging. Contrast improvements of around 45% were found when comparing scatter free images to conventional polychromatic imaging for both the low contrast test object and the Rachel anthropomorphic breast phantom.

Enhanced efficacy of sequential administration of Albendazole for the clearance of Wuchereria bancrofti infection: Double blind RCT.

Till today, there is no effective treatment protocol for the complete clearance of Wuchereria bancrofti (W.b) infection that causes secondary lymphoedema. In a double blind randomized control trial (RCT), 146 asymptomatic W. b infected individuals were randomly assigned to one of the four regimens for 12 days, DEC 300 mg + Doxycycline 100 mg coadministration or DEC 300 mg + Albendazole 400 mg co-administration or DEC 300 mg + Albendazole 400 mg sequential administration or control regimen DEC 300 mg and were followed up at 13, 26 and 52 weeks post-treatment for the clearance of infection. At intake, there was no significant variation in mf counts (F(3,137)=0.044; P=0.988) and antigen levels (F(3,137)=1.433; P=0.236) between the regimens. Primary outcome analysis showed that DEC + Albendazole sequential administration has an enhanced efficacy over DEC + Albendazole co-administration (80.6 Vs 64.7%), and this regimen is significantly different when compared to DEC + doxycycline co-administration and control (P<0.05), in clearing microfilaria in 13 weeks. Secondary outcome analysis showed that, all the trial regimens were comparable to control regimen in clearing antigen (F(3, 109)=0.405; P=0.750). Therefore, DEC + Albendazole sequential administration appears to be a better option for rapid clearance of W. b microfilariae in 13 weeks time. (Clinical trials.gov identifier - NCT02005653).

The role of an occlusal template during the placement of preformed metal crowns in children under general anaesthesia: a randomised control trial.

AIM: This aim was to evaluate preformed metal crowns (PMC) placed under general anaesthesia using an occlusal template in comparison to crowns placed without the use of a template. METHODOLOGY: CONSORT protocols were followed in the design of the study. A total of 60 children between 4-7 years requiring pulpotomy and PMC for all primary molars met the inclusion criteria for this study. The control group comprised patients for whom the PMC were placed without the use of an occlusal template, while in the test group crowns were placed using a polyvinyl siloxane occlusal template. Patients were followed up at 24 h, 7 days, 3 and 6 months. The time taken for the placement of crowns, instances of post-operative discomfort, success or failure of the pulp therapy and loss of any crowns were compared between the groups. RESULTS: The mean time taken for completion of the procedure in the control group was significantly greater than the template group (t = 2.566, p = 0.013). Significantly fewer patients in the template group reported symptoms of discomfort or high points at the 24-h recall; however, these differences were not significant at the 1-week, 3- or 6-month recall. CONCLUSION: The use of an occlusal template for the placement of multiple PMC under general anaesthesia reduces the time taken for their placement and reduces the incidence of immediate post-operative discomfort.

Mutant p53-R273H mediates cancer cell survival and anoikis resistance through AKT-dependent suppression of BCL2-modifying factor (BMF).

p53 is the most frequently mutated tumor-suppressor gene in human cancers. Unlike other tumor-suppressor genes, p53 mutations mainly occur as missense mutations within the DNA-binding domain, leading to the expression of full-length mutant p53 protein. Mutant p53 proteins not only lose their tumor-suppressor function, but may also gain new oncogenic functions and promote tumorigenesis. Here, we showed that silencing of endogenous p53-R273H contact mutant, but not p53-R175H conformational mutant, reduced AKT phosphorylation, induced BCL2-modifying factor (BMF) expression, sensitized BIM dissociation from BCL-XL and induced mitochondria-dependent apoptosis in cancer cells. Importantly, cancer cells harboring endogenous p53-R273H mutant were also found to be inherently resistant to anoikis and lack BMF induction following culture in suspension. Underlying these activities is the ability of p53-R273H mutant to suppress BMF expression that is dependent on constitutively active PI3K/AKT signaling. Collectively, these findings suggest that p53-R273H can specifically drive AKT signaling and suppress BMF expression, resulting in enhanced cell survivability and anoikis resistance. These findings open the possibility that blocking of PI3K/AKT will have therapeutic benefit in mutant p53-R273H expressing cancers.

Accuracy of electronic apex locators in primary teeth: a meta-analysis.

AIM: To conduct a meta-analysis on the accuracy of electronic apex locators (EALs) in determining working length in human primary teeth. METHODOLOGY: An electronic literature search was conducted using a combination of the terms 'primary teeth', 'root canal length' and 'electronic apex locators'. Additional eligible articles were identified using a manual search. The full texts of identified articles were screened according to inclusion criteria. RESULTS: Overall, 19 studies met the inclusion criteria and were subjected to further data extraction. Meta-analysis of studies that reported mean lengths and difference in mean lengths between EAL and actual root canal length (ARCL) revealed a significant difference (P = 0.015) between the two readings whilst those studies that evaluated intraclass correlation (ICC) suggested a high correlation (P < 0.0001) between the EAL and ARCL readings. A subgroup analysis revealed that the presence of root resorption did not affect the accuracy of EALs (P = 0.567). CONCLUSION: Electronic apex locators offer an acceptable level of accuracy in the measurement of root canal length in primary teeth.

Enhanced efficacy of sequential administration of Albendazole for the clearance of Wuchereria bancrofti infection: Double blind RCT

Till today, there is no effective treatment protocol for the complete clearance of Wuchereria bancrofti (W.b) infection that causes secondary lymphoedema. In a double blind randomized control trial (RCT), 146 asymptomatic W. b infected individuals were randomly assigned to one of the four regimens for 12 days, DEC 300 mg + Doxycycline 100 mg coadministration or DEC 300 mg + Albendazole 400 mg co-administration or DEC 300 mg + Albendazole 400 mg sequential administration or control regimen DEC 300 mg and were followed up at 13, 26 and 52 weeks post-treatment for the clearance of infection. At intake, there was no significant variation in mf counts (F(3,137)=0.044; P=0.988) and antigen levels (F(3,137)=1.433; P=0.236) between the regimens. Primary outcome analysis showed that DEC + Albendazole sequential administration has an enhanced efficacy over DEC + Albendazole co-administration (80.6 Vs 64.7%), and this regimen is significantly different when compared to DEC + doxycycline co-administration and control (P<0.05), in clearing microfilaria in 13 weeks. Secondary outcome analysis showed that, all the trial regimens were comparable to control regimen in clearing antigen (F(3, 109)=0.405; P=0.750). Therefore, DEC + Albendazole sequential administration appears to be a better option for rapid clearance of W. b microfilariae in 13 weeks time. (Clinical trials.gov identifier – NCT02005653)

Aerosol optical and physical properties during winter monsoon pollution transport in an urban environment.

We analysed aerosol optical and physical properties in an urban environment (Kolkata) during winter monsoon pollution transport from nearby and far-off regions. Prevailing meteorological conditions, viz. low temperature and wind speed, and a strong downdraft of air mass, indicated weak dispersion and inhibition of vertical mixing of aerosols. Spectral features of WinMon aerosol optical depth (AOD) showed larger variability (0.68-1.13) in monthly mean AOD at short-wavelength (SW) channels (0.34-0.5 µm) compared to that (0.28-0.37) at long-wavelength (LW) channels (0.87-1.02 µm), thereby indicating sensitivity of WinMon AOD to fine aerosol constituents and the predominant contribution from fine aerosol constituents to WinMon AOD. WinMon AOD at 0.5 µm (AOD 0. 5) and Angstrom parameter ( α) were 0.68-0.82 and 1.14-1.32, respectively, with their highest value in December. Consistent with inference from spectral features of AOD, surface aerosol loading was primarily constituted of fine aerosols (size 0.23-3 µm) which was 60-70 % of aerosol 10- µm (size 0.23-10 µm) concentration. Three distinct modes of aerosol distribution were obtained, with the highest WinMon concentration at a mass median diameter (MMD) of 0.3 µm during December, thereby indicating characteristics of primary contribution related to anthropogenic pollutants that were inferred to be mostly due to contribution from air mass originating in nearby region having predominant emissions from biofuel and fossil fuel combustion. A relatively higher contribution from aerosols in the upper atmospheric layers than at the surface to WinMon AOD was inferred during February compared to other months and was attributed to predominant contribution from open burning emissions arising from nearby and far-off regions. A comparison of ground-based measurements with Moderate Resolution Imaging Spectroradiometer (MODIS) data showed an underestimation of MODIS AOD and α values for most of the days. Discrepancy in relative distribution of fine and coarse mode of MODIS AOD was also inferred.

The impact of dental treatment on the salivary cortisol levels of children with severe early childhood caries.

AIM: To compare salivary cortisol levels of caries-free children with those of children with severe early childhood caries (S-ECC) before and 3 months after comprehensive dental treatment. METHODS: Thirty children with S-ECC were matched with 30 caries-free children from middle income families with college-educated working mothers. Early-morning saliva samples were collected from the children using the passive drool method. Post-treatment saliva samples were collected 3 months after completion of treatment in the S-ECC group. Salivary cortisol levels were analysed using electrochemiluminescence immunoassay. RESULTS: Salivary cortisol levels of caries-free children were significantly lower than both the pre-treatment and post-treatment levels of children with S-ECC (F = 26.221, p < 0.0001). The pre-treatment cortisol levels of children with S-ECC were significantly higher than the post-treatment levels (t = 2.588, p = 0.015). No significant differences in cortisol levels were observed between genders or between children treated over multiple visits under local analgesia and in a single visit under general anaesthesia. CONCLUSION: Dental treatment significantly reduced the salivary cortisol levels of children with S-ECC, however, the post-treatment levels remained significantly higher than those of caries-free children.

Sources and radiative effects of wintertime black carbon aerosols in an urban atmosphere in east India.

We carried out an analysis of black carbon (BC) surface mass concentration, its radiative effects, and sources of origin in an urban atmosphere in east India, during winter season, through ground-based measurements and application of modelling tools. BC surface mass concentration exhibited diurnal variation with their higher values and a larger variability during evening to early morning hours than during daytime (1100-1600 h, Local Time, LT) hours. Daytime mean surface BC mass concentration and BC mass fraction in total aerosol (size range 0.23-20 µm) and in submicronic aerosol (size range 0.23-1 µm) during the study period, corresponding to the well-mixed atmospheric layer were 11 µg m(-3), 3-10%, and 9-16% respectively. The mean BC optical depth (BC-AOD) and BC-AOD fraction at 0.5 µm were estimated in an optical model as 0.11 and 13% respectively. Mean shortwave aerosol radiative forcing due to BC at top-of-atmosphere (TOA) during the study period was found to be +0.94 Wm(-2), which is about 59% the global mean radiative forcing due to carbon-dioxide gases. Estimates from BC simulations in a general circulation model showed BC surface concentration and BC optical depth in east India are primarily attributed to emissions from biofuel and fossil fuel combustion. Most of BC surface concentration (95%) and BC optical depth (60%) are contributed by emissions arising from the Indo-Gangetic plain (IGP) but there is a significant influence to BC columnar loading through elevated transport channels attributed mainly to emissions from open biomass burning from distant regions outside IGP.

Cost-effective antigen testing for delimitation, monitoring and evaluation in bancroftian filariasis.

This study was focussed on identifying a cost-effective method for delimitation, monitoring and evaluation in bancroftian filariasis. Finger prick blood samples were collected between 20.00 and 23.00 hours for the detection of microfilariae (mf) from the available population in a village which was endemic for lymphatic filariasis. Simultaneously, from each individual, four spots of 25-µl blood samples were collected on Whatman number 3 filter paper and air dried. Dried filter paper spots were pooled in quantities of 1, 5, 10, 15, 20 and 25 on unknown and simulated mf and antigen prevalence. Pooled samples were assayed for circulating filarial antigen (CFA) using TropBIO Og4C3 ELISA kits. The community mf and CFA rates were 3.4% and 25.9%, respectively. The pool sizes of 20 and 25 showed CFA positivity in all the above categories tested. The results of the pooled blood spot samples suggest that, in areas with mf and CFA prevalence rates between 1 and 10%, pools of 20 or 25 could be considered as the ideal pool size for the detection of filarial infection in the community. CFA prevalence at the level of 5-6% following desirable rounds of mass drug administration (MDA) indicates that the community mf prevalence is likely to be at the 1% level.

A comparison of genotype and markers of disease severity of chronic hepatitis C in patients with and without end-stage renal disease.

INTRODUCTION: This study was conducted to compare the genotype and markers of disease severity of chronic hepatitis C (CHC), namely viral load, alanine transaminase (ALT) levels and histopathological findings on liver biopsy, in patients with and without end-stage renal disease (ESRD). METHODS: This was a cross-sectional retrospective comparative study that included ESRD patients on haemodialysis and non-ESRD patients with CHC who underwent liver biopsy between January 2004 and December 2006. Blood tests for viral load (VL) (hepatitis C virus, ribonucleic acid, polymerase chain reaction), genotyping and ALT were administered. VL was grouped into low (less than 5 log10) and high (more than or equal to 5 log10) VL, genotype into G1 and 2, 3, 4, and ALT into normal and elevated ALT. Necroinflammatory activity was grouped into mild (G0-6) and moderate/severe (G7-18) activity, and fibrosis into mild (S0-2) and moderate/severe (S3-6) fibrosis. These variables were compared between the two groups. RESULTS: Genotype 1 was significantly higher in ESRD patients than in non-ESRD patients, in whom genotypes 2, 3 and 4 were higher. Although the proportion of patients with high VL was greater and the duration of CHC was longer in the ESRD group, the ALT levels were lower and the histopathological grading of necroinflammatory activity and stages of fibrosis were less severe in ESRD compared to non-ESRD patients. CONCLUSION: The lower levels of ALT observed in CHC patients with ESRD translate to histopathological benefits.

Pixellated Cd(Zn)Te high-energy X-ray instrument.

We have developed a pixellated high energy X-ray detector instrument to be used in a variety of imaging applications. The instrument consists of either a Cadmium Zinc Telluride or Cadmium Telluride (Cd(Zn)Te) detector bump-bonded to a large area ASIC and packaged with a high performance data acquisition system. The 80 by 80 pixels each of 250 µm by 250 µm give better than 1 keV FWHM energy resolution at 59.5 keV and 1.5 keV FWHM at 141 keV, at the same time providing a high speed imaging performance. This system uses a relatively simple wire-bonded interconnection scheme but this is being upgraded to allow multiple modules to be used with very small dead space. The readout system and the novel interconnect technology is described and how the system is performing in several target applications.

Effect of a single dose of diethylcarbamazine, albendazole or both on the clearance of Wuchereria bancrofti microfilariae and antigenaemia among microfilaria carriers: a randomized trial.

BACKGROUND: Lymphatic filariasis is a major vector-borne parasitic disease. The global programme to eliminate lymphatic filariasis was launched in 1997 and currently over 570 million people are covered under it in 48 countries. Mass annual single-dose drug administration of diethylcarbamazine (DEC), co-administrated with albendazole for 5-6 years and mass distribution of diethylcarbamazine-fortified salt are the two strategies for elimination of filariasis. METHODS: Asymptomatic volunteers residing in Puducherry, India were screened for microfilaria (mf) by examining nocturnal thick blood smears. Those testing positive were randomly assigned to receive a single dose of DEC (6 mg/kg body weight) or albendazole 400 mg or both. Participants were hospitalized for 5 days. Membrane filtration count was used to assess microfilaraemia and ELISA (Og4C3) assay to measure circulating filarial antigens (CFA). Measurements were done before treatment and at 1, 2 and 3 years post-treatment. Viability of the adult worms was assessed by looking for the filarial dance sign (FDS) using ultrasound examination of the scrotum in men with hydrocele. RESULTS: Fifty-four microfilaraemic Individuals were studied. The mf prevalence started decreasing only by day 180 posttreatment in the DEC group but much earlier in the other two groups (day 30 in the albendazole and day 90 in the DEC with albendazole group). The decrease in mfwas marginal (17.6%, 26.3% and 27.8%, respectively) by the end of year 1 posttreatment, but significant (96.7%, 78.6% and 93.3%, respectively) by the end of year 2 post-treatment (p < 0.05). By the end of year 3, the level decreased to 80% in the DEC, 90% in the albendazole and to 100% in the DEC and albendazole groups. However, the mf intensity decreased significantly (by 39%; p < 0.05) by day 7 post-treatment in both the DEC and DEC with albendazole groups, but only by day 30 in the albendazole group. In all the drug groups, the prevalence as well as intensity of CFA returned to pretreatment levels by the end of year 3 post-treatment. CONCLUSION: Annual single-dose administration of all the 3 drug regimens significantly reduced antigenaemia levels. There were no significant differences in the efficacy and overall pattern of CFA clearance between the 3 drug regimens.

Characterization of breast tissue using energy-dispersive X-ray diffraction computed tomography.

A method for sample characterization using energy-dispersive X-ray diffraction computed tomography (EDXRDCT) is presented. The procedures for extracting diffraction patterns from the data and the corrections applied are discussed. The procedures were applied to the characterization of breast tissue samples, 6mm in diameter. Comparison with histological sections of the samples confirmed the possibility of grouping the patterns into five families, corresponding to adipose tissue, fibrosis, poorly differentiated cancer, well differentiated cancer and benign tumour.

Impact of seven rounds of mass administration of diethylcarbamazine and ivermectin on prevalence of chronic lymphatic filariasis in south India.

OBJECTIVE: To evaluate the impact of seven rounds of mass administration of diethylcarbamazine (DEC) and ivermectin on the prevalence of chronic lymphatic filariasis and to compare it with that observed in a placebo arm in a community-level trial. METHODS: Cross-sectional clinical surveys were carried out before and after seven rounds of mass drug administration (MDA). About 54-75% of the target population were treated at each round of MDA. RESULTS: After seven rounds, the hydrocele prevalence had declined from the pre-intervention level of 20.5-5.1% (P < 0.05) in the DEC arm, from 23.9% to 10.4% (P < 0.05) in the ivermectin arm and from 20.4% to 10.9% (P < 0.05) in the placebo arm, equivalent to reductions of 75.3%, 56.6% and 46.6%, respectively. The lymphoedema/elephantiasis prevalence declined only marginally and without statistical significance from 3.7% to 3.2%, 4.6% to 3.9% and 2.9% to 2.3% in the DEC, ivermectin and placebo arm. After the seventh MDA, none of the sampled people in the 0-20 age group was found with hydrocele and there was a statistically significant decline in hydrocele prevalence in all other age groups in the communities treated with DEC, the drug known to have macrofilaricidal effect. The impact was relatively less in ivermectin arm. CONCLUSION: Repeated DEC administration has the potential to prevent incidence of new hydrocele cases and may resolve the manifestation at least in a proportion of affected people. Apart from reducing the microfilaraemia prevalence and transmission of infection, MDA also results in significant public health benefits by reducing the burden of hydrocele in treated communities.