Potential therapies for obesity management: Exploring novel frontiers.

Humans are becoming less active in the current age of technological advancement, which leads to poor health. Many factors, including unregulated diet, lack of exercise, environmental pollution and genetic factors are contributing to an increase in overweight. Obesity is a chronic condition that disturbs the physical health of a person, resulting in various other complications including cardiac, respiratory, and psychosocial issues. According to WHO, the current trend of obesity has shown a sharp increase in recent years. Methods ranging from as simple as regulating the diet to as complex as surgery are available. There are many approved drugs to treat the obesity majority of them works as suppressing the appetite and making the patient satisfy. Some of other agents works by insulinotropic activity. However, these agents need to be taken for longer period of time thus are associated with significant adverse drug reactions. Thus, the motive of this study is to understand obesity and the various methods available to manage it using the recent pharmacological and non-pharmacological approaches.

Interplay of inflammatory biomarkers in heart disease patients with depressive symptoms: An update.

The pathophysiological mechanisms that connect heart disease and depressive disorders have been identified as abnormal endothelial function, dysregulation of the Hypothalamic Pituitary Adrenal (HPA) axis and abnormal platelet activities. Among these mechanisms, both endothelial dysfunction and HPA axis dysregulation are influenced by low grade inflammation and play significant roles in both conditions. Consequently, it is hypothesized that inflammation is an integral part of the formation of atherosclerotic plaques, linking the occurrence of heart diseases to the activation and shedding of intercellular adhesion molecules (ICAMs), especially soluble ICAM-1. This process is accompanied by the local and systemic secretion of various inflammatory markers like interleukin-6, Tumour Necrosis Factor, and C-reactive protein. Therefore, this review primarily focuses on defining the potential role of different inflammatory biomarkers in depression and heart disease and assessing whether mediators could serve as predictive biomarkers for detecting depressive symptoms in patients with heart disease.

Comparative evaluation of dental implants in posterior maxilla placed using unicortical and bicortical anchorage-A split-mouth prospective study.

Background: The use of dental implants has become a very predictive method of rehabilitation for patients with partial or complete edentulism. It is more challenging to treat the posterior quadrants of the maxillary ridges using dental implants due to their anatomical and physiological characteristics. So to overcome the limitations of other techniques, short implants were introduced recently as a new approach to simplify implant placement in compromised alveolar bone and to prevent possible damage to vital structures. Purpose: This study aims to compare the clinical outcomes of dental implants placed using the osteotomized sinus floor elevation (OSFE) technique side engaging the bony floor of the maxillary sinus (bicortical anchorage) on one side and the conventional technique by split mouth on the other side. Materials and Method: This study included 15 patients. Study participants had dental implants placed on both sides of the mouth at the same time, so one side was implanted according to the test method, while the other side used the control method. Randomization determined which side would be implanted. Conclusion: The OSFE technique provides greater stability to the implant via bicortical anchorage than conventional techniques, which only provide unicortical anchorage.

Stylalgia and Styloidectomy: A Review.

Stylalgia also referred to as Eagle's or stylohyoid syndrome (first described by Watt Eagle) is a constellation of signs secondary to an elongated styloid process or due to mineralization of the stylohyoid or stylomandibular ligament or the posterior belly of the digastric muscle (Malik et al. in Iran J Otorhinolaryngol 30(6): 101, 2018). The Eagle's syndrome includes symptoms ranging from stylalgia (i.e., pain in the tonsillar fossa, pharyngeal or hyoid region) to foreign-body sensation in the throat, cervicofacial pain, otalgia or even increased salivation or giddiness. Diagnosis is primarily based on symptomatology, physical examination and radiographic investigations and should not be missed. However, palpation of tonsillar fossa with radiological demonstration of the elongated styloid process confirms the diagnosis. Surgical treatment by tonsillo-styloidectomy produces satisfactory results in stylalgia. (Malik et al. in Iran J Otorhinolaryngol 30(6):101, 2018).

Withanolides from Withania somnifera as an immunity booster and their therapeutic options against COVID-19.

Traditionally, Withania somnifera is widely used as an immune booster, anti-viral, and for multiple medicinal purposes. The present study investigated the withanolides as an immune booster and anti-viral agents against the coronavirus-19. Withanolides from Withania somnifera were retrieved from the open-source database, their targets were predicted using DIGEP-Pred, and the protein-protein interaction was evaluated. The drug-likeness score and intestinal absorptivity of each compound were also predicted. The network of compounds, proteins, and modulated pathways was constructed using Cytoscape, and docking was performed using autodock4.0, and selected protein-ligand complexes were subjected to 100 ns Molecular Dynamics simulations. The molecular dynamics trajectories were subjected to free energy calculation by the MM-GBSA method. Withanolide_Q was predicted to modulate the highest number of proteins, showed human intestinal absorption, and was predicted for the highest drug-likeness score. Similarly, combined network interaction identified Withanolide_Q to target the highest number of proteins; RAC1 was majorly targeted, and fluid shear stress and atherosclerosis associated pathway were chiefly regulated. Similarly, Withanolide_D and Withanolide_G were predicted to have a better binding affinity with PLpro, Withanolide_M with 3CLpro, and Withanolide_M with spike protein based on binding energy and number of hydrogen bond interactions. MD studies suggested Withanoside_I with the highest binding free energy (ΔGbind-31.56 kcal/mol) as the most promising inhibitor. Among multiple withanolides from W. somnifera, Withanolide_D, Withanolide_G, Withanolide_M, and Withanolide_Q were predicted as the lead hits based on drug-likeness score, modulated proteins, and docking score to boost the immune system and inhibit the COVID-19 infection, which could primarily act against COVID-19. HighlightsWithanolides are immunity boosters.Withanolides are a group of bio-actives with potential anti-viral properties.Withanolide_G, Withanolide_I, and Withanolide_M from Withania somnifera showed the highest binding affinity with PLpro, 3CLpro, and spike protein, respectively.Withanolides from Withania somnifera holds promising anti-viral efficacy against COVID-19.Communicated by Vsevolod Makeev.

Altered Sleep Duration and Poor Quality of Sleep Among Pharmacy Students Amidst COVID-19 Lockdown: A South-Indian Study.

Introduction/background: The nationwide lockdown enforced due to the spread of coronavirus disease-2019 had a definite impact on sleep. Objective: To observe any changes in the duration, pattern and quality of sleep among pharmacy students due to the lockdown. Methods: A google form-based cross-sectional and descriptive study was carried out after approval was obtained from the ethical committee in the month of July 2021 among 310 pharmacy students. The validated form was electronically administered after obtaining the informed consent. All the data pertaining to duration, pattern and quality of sleep before and during the lockdown was collected and analyzed using STATA version 16.0. Results and Discussion: Out of 310 participants, the study revealed an increase in the time needed to fall asleep (p value < 0.001) and in the total duration of sleep (p value < 0.001). A delay in the time of sleep in the morning (p value < 0.001) and at night (p value < 0.001) was also one among the many significant results. The incidences of jerky leg movements (p value < 0.001), snoring (p value < 0.001), frequent nightmares (p value < 0.001) and anxiety (p value < 0.001) were also increased as a direct effect of the lockdown. Conclusion: The study has confirmed the detrimental impact of the lockdown on sleep among pharmacy students. All attributes of sleep duration and sleep quality have achieved statistical significance signifying the need to develop cognitive behavioral interventions and prevent the worsening of mental health amidst the COVID-19 era.

Was Sleep a Problem for the Elderly During COVID-19?

Over the past few decades, the population of geriatrics has seen an exponential rise and it is well known that the prevalence of chronic diseases and other associated comorbidities is higher among them which in turn, has an established association with sleep disorders. During these unprecedented circumstances, geriatrics are predisposed to be at an increased risk of sleep disorders due to the social isolation and loneliness imposed on them by the lockdowns. The fact that older adults are at a greater risk of contracting the virus due to the presence of comorbidities and the high virulence adds on to the existing risk of sleep disturbances. A lack of sleep in these circumstances has the potential to add on to the vicious cycle of sleep disorders predisposed by chronic disease and vice versa. Mental health, sleep and the presence of comorbidities are closely interlinked and they often tend to overlap. Research in sleep has established insomnia to be the most commonly diagnosed sleep disorder affecting almost 50% of the older adults which can subsequently, elevate their risk of falls. This prevalence of sleep disorders is hypothesized to increase during the second wave of the COVID-19 pandemic and a good sleep routine needs to be advocated for to improve the quality of life of this population. However, scientific evidence concerning this is scarce and this review aims to highlight the significance of sleep and urges its readers to undertake studies that investigate the architecture of sleep amongst older adults during the pandemic.

Screening of JAK-STAT modulators from the antiviral plants of Indian traditional system of medicine with the potential to inhibit 2019 novel coronavirus using network pharmacology.

The majority of the bioactives under investigation were predicted to target TNF receptor-associated factor 5 in the Janus kinase/signal transducers and activators of the transcription pathway. Similarly, druglikeness prediction identified vitexilactone to possess the highest druglikeness score, i.e., 0.88. Furthermore, proteins targeted in the Janus kinase/signal transducers and activators of transcription pathway were also predicted to regulate multiple pathways, i.e., ErbB, AGE-RAGE, NF-kappa B, Measles, insulin, mTOR, chemokine, Ras, and pathways associated with infectious and non-infectious pathogenesis, where the immune system is compromised. Similarly, the docking study identified sesaminol 2-O-ß-D-gentiobioside to possess the highest binding affinity with 3CLpro, PLpro, and spike proteins. Furthermore, phylogeny comparison identified the common protein domains with other stains of microbes like murine hepatitis virus strain A59, avian infectious bronchitis virus, and porcine epidemic diarrhea virus CV777.

Impact of pharmacist care in the management of autoimmune disorders: A systematic review of randomized control trials and non-randomized studies.

INTRODUCTION: Autoimmune disorders are chronic, self-mediated, misdirected immune responses against their own immune system. It required intensive, complex and costly drug treatment regimen increased the risk of pharmacotherapy error and adversely affects patients. Hence, pharmacist care will have vital roles in autoimmune disorders to achieve health related outcomes. OBJECTIVES: This review aimed to gather evidence on the impact of pharmacist care on clinical, humanistic and economic outcomes, adherence to medications, and drug related problems in the management of autoimmune disorders among the usual care group. METHODOLOGY: A comprehensive review conducted in compliance with the PRISMA statement and systematic search was performed across five databases included PubMed Central, Web of Sciences, Scopus, Cochrane Library andgoogle scholar from inception until August 2020. This research included full-text articles of randomized and non-randomized studies that evaluated impact of pharmacist care in autoimmune disorders. RESULTS: A total of nine studies were included (seven RCTs and two non-RCTs), including 829 patients with autoimmune disorders. A total of four studies (80%) show an enhancement in at least one clinical parameter due to pharmacist care. A substantial improvement in at least one humanistic parameter observed in all five studies (100%). While four out of five studies (80%) clearly displayed a remarkable improvement in medication adherence in the pharmacist care group from baseline to the completion of follow-ups. One study quantified a 99.08% resolution of DRPs in the pharmacist care group. Another study estimated the cost of medical resources uses per patient and found no difference in cost-effectiveness over six months between groups. CONCLUSION: This review reinforces the vital contribution of pharmacists to achieve clinical outcomes, humanistic outcomes, adherence to medications and DRPs in the efficient management of autoimmune disorders. However, no notable changes in economic outcomes were observed in this review.

Updates on biomedical waste management during COVID-19: The Indian scenario.

Biomedical waste poses various health and environmental hazards. Hence, it should be handled with the utmost care and disposed off safely. Several lacunas exist in the management of biomedical waste in India, and the pandemic posed by the coronavirus has made it even more challenging. The sudden outbreak of the virus led to an exponential rise in the quantity of biomedical waste. Furthermore, the poor infrastructure and lack of human resources have aggravated this situation. To combat this serious problem in a timely manner, the government has formulated various standard operating procedures and has amended the existing rules and guidelines.

Association Between Metabolic Syndrome and Diabetes Mellitus According to International Diabetic Federation and National Cholesterol Education Program Adult Treatment Panel III Criteria: a Cross-sectional Study.

PURPOSE: Lifestyle changes in diabetes mellitus leads to metabolic syndrome, thus resulting in a hike in micro and macrovascular complications in diabetes mellitus patients. The main objective of the study was to identify the occurrence of metabolic syndrome and to evaluate the gender-associated difference in each component of metabolic syndrome by using International Diabetic Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III)criteria. METHODS: This is a cross-sectional study conducted in 350 type II diabetes mellitus patients. All the study participants within 30-80 years were enrolled. Subjects with type I DM and pregnant women were excluded from the study. RESULTS: The occurrence of metabolic syndrome among the diabetic population was found to be 42.28% and 28.85% using the IDF and the NCEP ATP III criteria respectively. It was observed that the prevalence was found to be higher in females than males as per IDF and NCEP ATP III criteria and was found to be statistically significant (p < 0.001). Central obesity elevated blood pressure, and reduced high-density lipoprotein was significantly higher in female patients. The most frequently occurring risk factor in this study population was central obesity followed by hypertension. A comparative analysis of IDF and NCEP ATP III criteria implies that when compared to diabetes patients without metabolic syndrome, all the metabolic risk elements were significantly higher in diabetes patients with metabolic syndrome. CONCLUSIONS: This study concluded that the occurrence of metabolic syndrome was dreadfully high among the diabetic population, especially among female subjects.

Poor and Unsatisfactory Disposal of Expired and Unused Pharmaceuticals: A Global Issue.

Pharmaceuticals are beneficial to humankind and emerged as crucial arms to treat/manage multiple disease pathogenesis in the present era. In analogous, these medicines/ medical devices should be used cautiously as they possess a potential threat to induce multiple undesired effects that may be related to human health or the environment. Daunting effects may arise due to the improper disposal of unused/expired medicines. Hence, to minimize such harm, there should be adequate knowledge and practice among the population regarding the safe disposal of unused/expired medicines or related pharmaceutical devices. The lack of approved information regarding safe disposal of such substances may invite serious concerns like environmental pollution, which may induce immediate health hazards to the present population and upcoming future generations. There are numerous ways to dispose of, or manage the unused and expired pharmaceutical substances. Sharing the medicines among siblings, friends, and family members are never free from serious health risks. Storing the unused and expired medicines in the home increases the risk of intentional or accidental ingestion of such substances and may create a health emergency. Disposing medicines like household and municipal waste may lead to environmental pollution and harm to humans and animals. The present review finds the multiple unsafe ways of disposal of unutilized medications/tools. Furthermore, it also summarizes the disposal pattern of unutilized medications among the few developed and undeveloped nations.

Depression Related Pathophysiologies Relevant in Heart Disease: Insights into the Mechanism Based on Pharmacological Treatments.

Depressive symptoms are highly prevalent in patients with cardiac diseases. Co-morbid Depression in cardiac patients causes a significant reduction in health-related quality of life for the patients and inflicts an economic burden on the society. Two types of mechanisms that may explain the link between depression and cardiac diseases are the psychosocial and physiopathological mechanisms. Physiopathological mechanisms are direct biological mechanisms, which include hyperactivity of non-adrenergic and Hypothalamic Pituitary Adrenal Axis (HPA), abnormal platelet activation, endothelial dysfunction, and inflammatory process. Psychosocial factors include behavioral or lifestyle factors like smoking alcoholism and physical inactivity. Pharmacologic and therapeutic interventions are effective at reducing symptoms of depression in patients with cardiac disorders. Among pharmacological treatment, SSRIs seems to be effective for the reduction of depressive symptoms among patients with cardiac disorders because of their good efficacy and minimal cardiovascular side effects. Mechanisms of action of SSRI's in depressive patients with cardiac disorders are associated with their ability to reduce inflammation, platelet, and endothelial dysfunction. This review focuses on the potential pathophysiological and psychosocial links between cardiac diseases and depression, the treatment options, and the importance of routine screening of depressive symptoms in cardiac settings.

Central mucoepidermoid carcinoma: Case report with review of literature.

Occurrence of central mucoepidermoid carcinoma within the jaw bones from aberrant salivary tissues is extremely rare and accounts for 2%-4% of all central mucoepidermoid carcinoma. Mandible is more commonly affected than maxilla in a ratio of 2:1. The origin of mucoepidermoid carcinoma is controversial and questionable. Central mucoepidermoid carcinoma is frequently misdiagnosed radiographically and clinically as a benign odontogenic tumor or cyst. Hence, it is important to detect malignant signs and histopathological feature of central mucoepidermoid carcinoma of the mandible to confirm the diagnosis. This paper reports a case of central mucoepidermoid carcinoma of the mandible in a 56-year-old patient with review of literature.

Orofacial cysticercosis: Report of a rare case with review of literature.

Cysticercosis is common in developing countries in which the combination of rural society, crowding, and poor sanitation facilities allows greater contact between humans and pigs and thus more opportunities for fecal contamination of food and water occurs. They are rarely located in oral and perioral tissues, particularly in the muscles of mastication, muscle of the facial expression, suprahyoid muscles, and postcervical musculature and also as in the tongue, buccal mucosa, and lip. Cysticercosis is a potentially fatal parasitic disease that rarely found in the maxillofacial region in humans. This paper reports the case of a young female patient presented with isolated lesion of cysticercosis involving buccinator muscle. In conclusion, we suggest that cysticercosis should be considered in the differential diagnosis of intraoral solitary nodules within the oral and maxillofacial region, especially in endemic areas. High-resolution ultrasonography is an excellent noninvasive and cost-effective modality for the diagnosis and also suggests that localized parasitic infections such as Cysticercus cellulosae can be successfully treated with conservative management using oral antiparasitic (antihelminthic) medication.

Obturator prosthesis for hemimaxillectomy patients.

Rehabilitation of hemimaxillectomy patients can be challenging. The most common problem with prosthetic treatment in such patients is in getting adequate retention, stability, and support. The size and location of the defect usually influences the amount of impairment and difficulty in prosthetic rehabilitation. The obturator prosthesis is commonly used as an effective means for rehabilitating hemimaxillectomy cases. In cases of large maxillary defects, movement of the obturator prosthesis is inevitable and requires a form of indirect retention to limit the rotation of the prosthesis. The goal of prosthodontics is rehabilitation of missing oral and extraoral structures along with restoration of the normal functions of mastication, speech, swallowing, appearance, and so on. Malignancies are common in the oral region, which are treated through surgical intervention. Surgical intervention creates communication between the oral cavity, nasal cavity, and maxillary sinus. In such cases, it is very difficult for the patient to perform various normal functions like mastication, swallowing, speaking, and so on. Prosthodontic rehabilitation with obturator prosthesis restores the missing structures and acts as a barrier between the communication among the various cavities.

Retrospective study of absorbable gelatin sponge soaked in triamicinolone acetonide as interpositioning material in temporomandibular joint ankylosis in 350 patients.

AIM: To evaluate the feasibility and usefulness of absorbable gelatin sponge soaked in triamcinolone acetonide as an interposition material in the treatment of temporomandibular joint (TMJ) ankylosis. MATERIALS AND METHODS: This retrospective study was conducted in 350 patients of TMJ ankylosis who visited our outpatient department between 2000 and 2010, and were treated by the same surgeon. Patients were randomly divided into two groups, where in group 1, absorbable gelatin sponge soaked with triamcinolone acetonide was interposed in the surgical gap created after arthroplasty and in group 2, temporalis fascia was interposed. Preoperative assessment included history and physical examination, along with cause of ankylosis, Postoperative observation were undertaken for maximum mouth opening (MMO), facial nerve paralysis and recurrence. RESULTS: At one year follow-up, in group 1 MMO ranged from 35 to 45 mm with no case of re-ankylosis while in the other group 25-43 mm, with re-ankylosis in 20 patients (13.69%). CONCLUSION: The findings of this study showed successful management of TMJ ankylosis using absorbable gelatin sponge soaked in triamcinolone acetonide in cases which did not require condylar reconstruction.

Matrix miniplate versus locking miniplate in the management of displaced mandibular angle fractures.

AIM: The purpose of this study was to determine and compare various postoperative parameters like ease of operability, plate adaptability, stability etc., associated with use of matrix miniplate versus locking miniplate in the treatment of displaced mandibular angle fractures. MATERIALS AND METHODS: The study was carried out in the Department of Oral and Maxillofacial surgery, King George's Medical College, GM and Associated Hospital, Lucknow. Total 50 patients were treated and included in the study. These were divided into two groups of 25 each and were treated with two of the standard techniques, i.e., one is matrix miniplate osteosynthesis and other is locking miniplate osteosynthesis. These patients were evaluated for postoperative complications and the differences between the two Groups were assessed. RESULTS: Patients treated by matrix miniplate showed better recovery phase postoperatively as compared to locking miniplate group. CONCLUSION: Based on this study matrix mini plate osteosynthesis may be considered as the better alternative method available for the treatment of displaced mandibular angle fractures.

Clinical negligence or endodontic mishaps: A surgeons dilemma.

Complications may occur during and after endodontic treatment, which may be due to negligence of the operator. The surgical treatment of a case presenting pain and persistent pus discharge and swelling due to the extrusion of the root canal filling to the base of the nasal floor between left maxillary lateral and canine teeth is presented in this report. First, carelessness was during root canal treatment that was over obturated and second time during extraction in which overextended gutta-percha remained in the bone, caused the complications like pain, persistent pus discharge, and headache. Clinicians should be aware of the fact that endodontic instruments and filling materials (solid or liquid) can be extended in such a degree that can lead to neurological or sinus complications.