Comparative Evaluation of Octenidine with Chlorhexidine Mouthwash in Gingivitis and Periodontitis Patients: A Randomized Clinical Trial.

Introduction: Chlorhexidine gluconate (CHX) has been still regarded as the most efficient mouthwash. Due to its recognized negative effects, it can only be used for a short duration. Octenidine dihydrochloride (OCT), an antiseptic substance found by Sterling Winthrop in the 1980s, has proven helpful in preventing the co-aggregation of dental plaque microbial invaders without disrupting the typical, healthy oral flora. However, there is very little research on octenidine's effectiveness as a mouthwash for preventing plaque. Therefore, this study is being conducted to examine the effectiveness of mouthwashes containing 0.1% Octenidine and 0.2% chlorhexidine. Methodology: In this clinical trial, subjects were divided into two groups, 60 patients each with gingivitis and periodontitis. Then, from each group, 30 patients were advised to use octenidine mouthwash, and 30 patients were prescribed chlorhexidine mouthwash as an adjunct to scaling and root planning. Clinical parameters like O'Leary plaque index, Bleeding index, Probing pocket depth, and clinical attachment loss were evaluated at baseline and after 3 months. Result: In both the gingivitis and periodontitis groups, the octenidine group significantly outperformed the chlorhexidine group in all clinical metrics. Conclusion: Octenidine showed better results in comparison to chlorhexidine with respect to all the above-mentioned clinical parameters. Hence, it can be considered a promising mouthwash for future therapeutic and research studies.

N-acetyl-l-tryptophan (NAT) ameliorates radiation-induced cell death in murine macrophages J774A.1 via regulating redox homeostasis and mitochondrial dysfunction.

Ionizing radiation interacts with the immune system and induces molecular damage in the cellular milieu by generating reactive oxygen species (ROS) leading to cell death. The present study was performed to investigate the protective efficacy of N-acetyl-L-tryptophan (NAT) against gamma-radiation-induced cell death in murine macrophage J774A.1 cells. The radioprotective efficacy of NAT was evaluated in terms of cell survivability, effect on antioxidant enzyme activity, and free radicals inhibition. Radioprotective efficacy of NAT pretreatment to irradiated cells was assessed via cell cycle progression, mitochondrial membrane potential (MMP) perturbation, and apoptosis regulation using flow cytometry. Results of the study demonstrated significant radioprotective efficacy (>80%) of NAT in irradiated cells as estimated by sulforhodamine B (SRB), MTT, and clonogenic assay. Significant (p < 0.001) reduction in ROS, xanthine oxidase, and mitochondrial superoxide levels along with increment in catalase, glutathione-s-transferase, glutathione, and ATPase activities in NAT pretreated plus irradiated cells was observed as compared to the gamma-irradiated cells. Further, significant (p < 0.001) stabilization of MMP and reduction in apoptosis was also observed in NAT pretreated plus irradiated cells as compared to irradiated cells that not pretreated with NAT. The current study demonstrates that NAT pretreatment to irradiated cells protects against gamma radiation-induced cell death by reducing oxidative stress, stabilizing MMP, and inhibiting apoptosis. These observations conclusively highlight the potential of developing NAT as a prospective radioprotective agent upon further validation using in-depth preclinical assessment in cellular and animal models.

Applicability of Concept Maps to Assess Higher Order Thinking in the Context of Indian Medical Education: An Analytical Study in the Subject of Physiology.

Introduction: Concept mapping is a multidimensional tool that has been put to little use in India. We designed this study to check its applicability for assessing higher-order thinking in the subject of Physiology. Methods: This interventional analytical study was carried out among 65 students of Phase I of MBBS in the year 2021. The students were sensitized to the technique and were given a practice session. On a pre-informed date, an assessment of a topic taught to them was done using concept mapping and a multiple-choice question (MCQ) based test. Feedback on the technique was taken from the students. The statistical tests used were test of normality - Kolmogorov-Smirnov Test, significance of association - Wilcoxon Signed Rank test, correlation - Spearman's correlation, and agreement - Bland Altman Analysis. The discrimination index was calculated for both concept mapping and MCQ based tests, separately. Percentages were calculated for feedback questionnaire items. The data were analysed using Microsoft Excel (2019) and an online calculator. P-values <0.05 were considered statistically significant. Results: Students scored more in concept mapping. There was a significant difference in the scores of the students on the two tests (Wilcoxon Signed-Rank test, Z=-2.66, p=0.008) and a weakly positive non-significant correlation between them (Spearman's correlation coefficient, rs=0.07 p=0.60). Bland Altman's Analysis showed agreement in the scores of the students in the two tests. The mean score of the students in the two tests increased, so did the difference in the scores in the two tests. The discrimination index of concept mapping (0.28) was higher than that of the MCQ-based test (0.18). Most of the students agreed on the advantages of concept mapping in the feedback. Conclusion: The assessment result of concept mapping is better than that of MCQ-based test and it may be included as a teaching-learning and assessment strategy in the context of Indian medical education in the subject of Physiology.

In-vitro alleviation of ochratoxin a mediated cytotoxicity using N-acetyl-L-tryptophan glucoside pretreatment.

AIMS: Ochratoxin A (OTA) has been reported to exhibit nephrotoxicity through induction of cell redox homeostasis perturbation, mitochondrial hyperpolarization and depolarization, protein synthesis inhibition, apoptosis, etc. In the present examination, the protective efficiency of novel synthesized molecule, N-acetyl-L-Tryptophan glucoside (NATG) towards OTA prompted toxicity was evaluated using Human Embryonic Kidney (HEK-293) cells. MAIN METHODS & KEY FINDINGS: The cells were treated with NATG (0-200 µg/ml) before OTA treatment (0-20 µg/ml) the and protection efficiency of NATG was evaluated using MTT and SRB assay. OTA-induced intracellular ROS and its inhibition via NATG (10 µg/ml) pre-treatment was evaluated using the 2',7'-dichlorodihydrofluorescein diacetate (H2DCFDA) probe. Protective effects of NATG pre-treatment on OTA treated cells had been evaluated in terms of oxidative stress, cell cycle perturbations, mitochondrial membrane disturbance and apoptotic modulation through flowcytometry. Results of the study demonstrated that NATG provides significant protection to HEK -293 cells against OTA induced toxicity primarily by reducing oxidative stress, maintaining mitochondrial membrane homeostasis and inhibiting apoptosis. Furthermore, molecular docking study demonstrated that NATG may efficiently bind with OTA binding pocket on phenylalanyl t-RNA synthetase, resulting in inhibiting OTA incorporation within the newly synthesized peptides and therefore may ameliorate OTA mediated protein synthesis inhibition. SIGNIFICANCE: Present study demonstrated a significant protective efficacy of N acetyl-L- tryptophan glucoside (NATG) against OTA induced toxicity in HEK -293 cells. In future, NATG can be developed as a potential protective agent against OTA induced toxicity in humans.

Evaluation of association between potential stress markers and periodontal health in medical and dental students: A questionnaire-based study.

Aims and Objectives: Psychological conditions, particularly psychosocial stress, have been implicated as risk indicators for periodontal disease. The aim of the present study was to explore the role of psychosocial stress on periodontium through questionnaire and serum cortisol level. Subjects and Methods: Two hundred medical and dental undergraduates were recruited for the study. Case group included 82 examination going and control group had 79 nonexam going students. Their stress level was evaluated using a standard questionnaire (perceived stress scale). Gingival index, periodontal disease index, bleeding on probing index, serum cortisol level, and serum alpha-amylase level were also measured. Statistical Analysis Used: Bivariate correlations and multiple regression tests were done. Results: A positive correlation was found among stress scores, salivary cortisol, alpha-amylase, and periodontal disease measures. Conclusion: Periodontitis can be related to immunologic changes related to psychological states.

Implementation of Self-Directed Learning in Physiology for Phase 1 Undergraduate Medical Students.

Background: One of the primary roles played by Indian medical graduates is that of a lifelong learner. To this end, students must acquire the habit of self-directed learning (SDL). Lack of SDL skills among undergraduate medical students is a concern; hence, this study was designed to introduce SDL in physiology to phase 1 undergraduate medical students and assess its effectiveness through student and faculty perceptions. Methods: The project commenced after obtaining clearance from the institutional ethics committee. The faculty members and students were sensitized on SDL. A feedback questionnaire was framed and the topics for SDL were selected. SDL was implemented for six topics. The effectiveness of the sessions was evaluated by administering the feedback questionnaire to the students and recording perceptions of the students and faculty on SDL. The data were subjected to quantitative and qualitative analysis. Results: A total of 96 phase 1 students participated in the study. A majority of the students felt that after SDL sessions, they were more prepared and aware of their learning strengths and had started taking ownership of their learning. However, some students felt that the activity was not useful in improving their analytical skills. Both the students and the faculty were fairly satisfied with this teaching learning innovation. Conclusions: SDL was successfully implemented for phase 1 medical students. Both the students and faculty were satisfied with the SDL strategy. SDL has been shown to make students independent learners who are aware of their learning goals and capable of evaluating their learning.

Impact of RASSF1A gene methylation on clinico-pathological features of tumor and non-tumor tissue of breast cancer.

BACKGROUND: Breast cancer is the most common malignancy in women caused by genetic and epigenetic changes. Promoter DNA methylation in tumor suppressor gene plays a major role in breast cancer. The study determined the association of promoter DNA methylation of RASSF1A gene with clinicopathological features in tumor and non-tumor tissue. MATERIALS AND METHODS: A cross sectional study was conducted in the Department of Pathology, Government Institute of Medical Sciences, Greater Noida and Molecular Pathology Laboratory, Department of Pathology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences. Two sections, one from tumor and the other from non-tumor tissue, were obtained and processed for DNA extraction and bisulphite conversion. Methylation specific PCR was done and results of RASSF1A promoter methylation were statistically correlated with clinicopathological features. RESULTS: Of the 27 breast cancer tissue, 22 showed invasive ductal carcinoma, one showed invasive lobular carcinoma, another showed ductal carcinoma in situ and three cases showed malignant phyllodes tumor of breast. DNA promoter methylation was found in all the cases. 93% of tumor tissue samples and 67% of the non-tumor tissue samples were found to be aberrantly methylated. Tumor size and histological grade were found to be significantly (p-val <0.05) associated with the RASSF1A gene promoter methylation. CONCLUSION: A significant association of higher tumor size and tumor histological grade with promoter methylation of RASSF1A gene exists suggestive of its being an important determinant of prognostic staging. This critical event in tumorigenesis may be of clinical utility in assessing breast cancer progression. MICRO ABSTRACT: The study focuses on the RASSF1A gene promoter methylation and its impact on the clinicopathological features in Indian breast cancer patients highlighting the differences from other genetically different population. We found that RASFF1A gene methylation has significant impact on tumor size and tumor grade. The work carries high significance because it addresses the DNA methylation of tumor suppressor gene in relevance of breast cancer. It may also be the first such report on Indian patients with breast cancer.

Amelioration of ochratoxin-A induced cytotoxicity by prophylactic treatment of N-Acetyl-L-Tryptophan in human embryonic kidney cells.

Ochratoxin A (OTA) is known to induce nephro-toxicity via induction of cellular redox homeostasis perturbation, mitochondrial hyperpolarisation and depolarization, protein synthesis inhibition leading to apoptosis. In the present study, protective efficacy of N-Acetyl-L-Tryptophan (NAT) against OTA induced toxicity was evaluated using Human Embryonic Kidney (HEK-293) cells. Cells were treated with NAT (0-200 µg/ml) before OTA treatment (0-20 µg/ml) and protective efficacy of NAT was evaluated using MTT and SRB assay. OTA-induced intracellular ROS generation and its inhibition by NAT (2.5 µg/ml) pre-treatment was evaluated using 2',7'-dichlorodihydrofluorescein diacetate (H2DCFDA) probe. Effects of NAT pre-treatment on OTA treated cells were also evaluated in terms of cell cycle perturbations and mitochondrial membrane potential disturbance using flowcytometry. Results of the study demonstrated significant (∼89 % cell growth in comparison to 50% in OTA alone group; P < 0.05) protection by NAT to the HEK-293 cells against OTA mediated cell death in terms of cell viability. Further, significant reduction in ROS levels and mitochondrial membrane potential disturbance was also observed in NAT pre-treated plus OTA cells as compared to only OTA treated cells. Significant (p < 0.05) arrest in G0 and S phase of cell cycle was observed in OTA treated cells that was found to be inhibited by NAT pre-treatment to OTA treated cells. Also, molecular docking analysis demonstrated higher probability of NAT to bind with OTA binding pocket on phenylalanyl t-RNA synthetase, resulting in inhibition of OTA incorporation in the newly synthesized peptides and thus may ameliorate OTA induced protein synthesis inhibition. Conclusively, present study suggested that NAT offers protection against OTA toxicity in HEK-293 cells by counterbalancing oxidative stress, cell cycle regulation, mitochondrial membrane potential stabilization, protein synthesis inhibition and cell death retardation.

Laying the Foundation of Medical Professionalism among Pre-clinical Students: Importance of Reflection.

This article was migrated. The article was marked as recommended. Introduction: The escalating problem of unprofessionalism calls for teaching medical professionalism in a manner that should lead to deeper learning. Early clinical exposure (ECE) to an Intensive Care Unit (ICU) presents the issues pertaining to medical professionalism to the students in a more explicit and emotionally challenging manner. And reflection note writing evokes the critical process of thought and analysis required for learning. We conducted the present study to sensitize the pre-clinical students towards medical professionalism using these two tools, ECE and Reflection. Methods:Two hundred students of 1st MBBS were given an Objective Structured Clinical Examinations (OSCE). The students were then taken for ECE to an ICU. There, the students observed different ongoing activities and critical patients, a doctor discussed some cases with them, and they also interacted with the relatives of patients admitted in the ICU. Thereafter, students wrote a 'reflection' note describing what did you see? so what? and now what? Students were again given an OSCE, similar to the one given before the ECE, for assessing any change in their professional behaviour.Analysis of reflection notes was done thematically and of OSCE scores using paired t-test (p<0.05). Results: The analysis of reflection notes revealed the budding of different elements of professionalism among the students. Post-visit OSCE scores also showed significant improvement. Conclusion: Incorporation of reflection note writing along with ECE is helpful in laying the foundation of medical professionalism among pre-clinical students.

Vestibular Incision Subperiosteal Tunnel Access with Titanium-Prepared Platelet-Rich Fibrin - A Golden Approach for Treating Multiple Recession Defects in Esthetic Zone.

Gingival recession is defined as apical migration of marginal gingival tissue causing the exposure of root surface. Abnormal brushing techniques, trauma, anatomical presence of tooth, caries, and improper oral hygiene measures are some of the problems leading to gingival recession. Several treatment modalities such as coronary advanced flaps and free gingival grafts have been used for the treatment of gingival recession defects and showed good results. However, while treating multiple gingival recessions, some new treatment modalities were introduced in literature. Vestibular incision subperiosteal tunnel access (VISTA) as a minimally invasive technique for root coverage was introduced with various advantages such as no secondary surgical site needed for harvestment of donor tissue and it provides excellent esthetic results with decreased patient morbidity. The present case report emphasizes on the treatment of multiple gingival recessions in the maxillary anterior teeth region using VISTA with titanium-prepared platelet-rich fibrin.

Evaluation of platelet-rich plasma alone or in combination with demineralized freeze dried bone allograft in treatment of periodontal infrabony defects: A comparative clinical trial.

AIMS: The use of platelet-rich plasma (PRP) alone in periodontal defects has been controversial and inconclusive. Hence, the present study was designed with the aim to assess the clinical and radiographic effectiveness of PRP alone in infrabony defects. MATERIALS AND METHODS: Thirty infrabony defects were treated with either autologous PRP with open flap debridement (OFD) or autologous PRP + demineralized freeze dried bone graft (DFDBA) with OFD or OFD alone. Clinical parameters recorded were gingival index, plaque index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). Radiographic parameters included defect depth reduction, defect resolution, and crestal bone level. All the parameters were recorded at baseline and 12 months postoperatively. RESULTS: Mean PD reduction and CAL gain were greater in PRP + DFDBA (4.88 ± 1.12 mm and 4.26 ± 1.85 mm) and PRP (4.86 ± 2.12 mm and 4.10 ± 1.47 mm) groups than the control group (2.69 ± 1.37 mm and 1.27 ± 0.89 mm). CONCLUSIONS: Within the limits of the study, all the three groups showed significant improvement in clinical parameters from baseline to postoperative 12 months. The amount of defect depth reduction and defect resolution treated with PRP alone group were significantly < PRP + DFDBA. The results pertaining to these parameters were significantly better than the control group.

Natural windbreaks sustain bird diversity in a tea-dominated landscape.

Windbreaks often form networks of forest habitats that improve connectivity and thus conserve biodiversity, but little is known of such effects in the tropics. We determined bird species richness and community composition in windbreaks composed of remnant native vegetation amongst tea plantations (natural windbreaks), and compared it with the surrounding primary forests. Fifty-one, ten-minute point counts were conducted in each habitat type over three days. Despite the limited sampling period, our bird inventories in both natural windbreaks and primary forests were nearly complete, as indicated by bootstrap true richness estimator. Bird species richness and abundance between primary forests and windbreaks were similar, however a difference in bird community composition was observed. Abundances of important functional groups such as frugivores and insectivores did not vary between habitat types but nectarivores were more abundant in windbreaks, potentially as a result of the use of windbreaks as traveling routes, foraging and nesting sites. This preliminary study suggests that natural windbreaks may be important habitats for the persistence of bird species in a production landscape. However, a better understanding of the required physical and compositional characteristics for windbreaks to sustain bird communities is needed for effective conservation management.

Clinical and epidemiological characteristics of 2009 pandemic influenza A in hospitalized pediatric patients of the Saurashtra region, India.

BACKGROUND: The first case of 2009 pandemic influenza A or H1N1 virus infection in India was reported in May 2009 and in the Saurashtra region in August 2009. We describe the two waves clinicoepidemiological characteristics of children who were hospitalized with 2009 influenza A infection in the Saurashtra region. METHODS: From September 2009 to February 2011, we treated 117 children infected with 2009 influenza A virus who were admitted in different hospitals in Rajkot city. Real-time reverse transcriptase polymerase chain reaction (RT-PCR) test was used to confirm infection, and the clinico-epidemiological features of the disease were closely monitored. RESULTS: In the 117 patients, with a median age of 2 years, 59.8% were male. The median time from onset of the disease to influenza A diagnosis was 5 days, and that from onset of the disease to hospitalization was 7 days. The admitted patients took oseltamivir, but only 11.1% of them took it within 2 days after onset of the disease. More than one fourth (29.1%) of the admitted patients died. The most common symptoms of the patients were cough (98.3%), fever (94.0%), sore throat and shortness of breathing. Pneumonia was detected by chest radiography in 80.2% of the patients. CONCLUSIONS: In children with infection-related illness, the survival rate was about 71% after oseltamivir treatment. The median time for virus detection with real-time RT-PCR is 5 days. Early diagnosis and treatment may reduce the severity of the disease.