Phytotherapy in periodontics as an effective and sustainable supplemental treatment: a narrative review.

PURPOSE: Periodontal disease is a chronic condition caused by microbial infection and mediated by the host's immune response. Phytotherapy is a therapeutic approach that utilizes a renewable resource capable of supplying less expensive medicines for the world's growing population. This review aimed to present clinical evidence on the use of complementary medicinal herbs in the treatment of periodontal diseases. METHODS: Different databases were searched using the terms "herbal" and "periodontitis." All included studies were examined with a focus on herbal indications, type, and prescription length. Dentists' therapeutic and prophylactic herbal prescribing habits were also assessed. RESULTS: Various herbs such as turmeric, neem, aloe-vera, pomegranate, catechu, tulsi, cloves, lemon grass, green tea, tea tree oil, peppermint, garlic, pineapple, oak bark, babul, bakul, sage, coriander, moringa, amla, guava, and grape seed extract have been used in the treatment of periodontitis. These herbs have been reported to exhibit a range of therapeutic effects, including anti-inflammatory, antiplaque, antihalitosis, antiresorptive, antioxidant, antibacterial, antifungal, antiviral, and antimicrobial properties. These components can be utilized in various forms such as mouth rinse, gel, oil, toothpaste, aqueous extract, mouthwash, or tooth powder. CONCLUSIONS: Several readily available herbal formulations are now available on the market and have been shown to be effective as supplemental periodontal phytotherapy. However, these should be used under the supervision of a dental professional to ensure optimal benefits and effectiveness. Therefore, it is necessary to improve the understanding of suggested herbal prescription practices among dental professionals.

Biofilm Formation and Aspartyl Proteinase Activity and Their Association with Azole Resistance Among Candida albicans Causing Vulvovaginal Candidiasis, Egypt.

Background: Candida albicans (C. albicans) is a major cause of vulvovaginal candidiasis (VVC), a condition that is commonly treated with azole agents. Biofilm formation and aspartyl proteinase production are important virulence factors that could be linked to azole resistance in C. albicans impeding therapy. Aim: To find out the association of both factors with azole resistance among C. albicans isolated from VVC cases in Egyptian nonpregnant women of childbearing age. Patients and Methods: In a cross-sectional study, C. albicans was isolated from nonpregnant females diagnosed clinically as having VVC during a 1-year study period. Susceptibility to azole agents was tested using the disc diffusion method. Biofilm formation and aspartyl proteinase production were assessed phenotypically. Additionally, two biofilm-related genes (ALS1 and HWP1) and three proteinase genes (SAP2, SAP4, and SAP6) were screened for using polymerase chain reaction (PCR). Results: Among 204 C. albicans isolates, azole resistance ratios were as follows: voriconazole (30.4%), itraconazole (17.6%), fluconazole (11.3%) and econazole (6.4%). Biofilm-producing capacity was detected in 63.2% of isolates, and 63.2% were proteinase producers. The frequencies of ALS1 and HWP1 were 69.6% and 74.5%, respectively, while SAP2, SAP4, and SAP6 were 69.2%, 88.7%, and 64.7%, respectively. Biofilm formation was significantly associated with azole resistance (P < 0.001 for each tested azole agent) as was proteinase production (P < 0.001 for fluconazole, voriconazole, and econazole resistance and P = 0.047 for itraconazole). Conclusion: Among nonpregnant Egyptian women of childbearing age, azole resistance in C. albicans causing VVC is significantly associated with biofilm formation and proteinase production. The development of new therapeutic agents that can target these factors is warranted.

Intraoral Ultrasound in Early Stage Tongue Carcinoma.

Preoperative assessment of depth of invasion (DOI) is critical in the surgical management of early stage carcinoma tongue. Intraoral ultrasound (IOUS) has been recently described as a cost-effective alternative to MRI in the accurate measurement of DOI. We describe the technique of IOUS in different types of lesions (surface, ulcerative, and exophytic); and provide key imaging pearls for the routine use of this novel ultrasound application.

On the implementation of the circular economy route for E-waste management: A critical review and an analysis for the case of the state of Kuwait.

Electronic waste (e-waste) has become one of the major causes of environmental concerns due to its large volume, high generation rate and toxic environmental burdens. Recent estimates put e-waste generation at about 54 million tonnes per annum with figures reaching approximately 75 million tonnes per annum by 2030. In this manuscript, the state-of-the-art technologies and techniques for segregation, recovery and recycling of e-waste with a special focus on the valorisation aspects of e-plastics and e-metals which are critically reviewed. A history and insight into environmental aspects and regulation/legislations are presented including those that could be adopted in the near future for e-waste management. The prospects of implementing such technologies in the State of Kuwait for the recovery of materials and energy from e-waste where infrastructure is lacking still for waste management are presented through Material Flow Analysis. The information showed that Kuwait has a major problem in waste accumulation. It is estimated that e-waste in Kuwait (with no accumulation or backlog) is generated at a rate of 67,000 tpa, and the imports of broadcasting electronics generate some 19,428 tonnes. After reviewing economic factors of potential recovered plastics, iron and glass from broadcasting devices in Kuwait as e-waste, a total revenue of $399,729 per annum is estimated from their valorisation. This revenue will open the prospect of ventures for other e-waste and fuel recovery options as well as environmental benefits and the move to a circular economy.

Can plastic waste management be a novel solution in combating the novel Coronavirus (COVID-19)? A short research note.

The year 2020 has been noted to be one of major calamity the world over, in which the majority of efforts in research and development have been dedicated towards combating the threat of the novel Coronavirus (COVID-19). Ever since the announcement of COVID-19 as a pandemic, such efforts were dedicated towards the research of its spread and vaccination. Yet still, the world might reach a resolution via an environmental solution that various entities have overlooked, with a plethora of environmental benefits vis-à-vis waste management. In this short communication, the possibility of using plastic solid waste as a substrate to employ copper, and copper alloys and their nanocomposite nanopowders to be used as permanent surface protective coats, is presented. The fact that we present such materials to be of waste origin, is an added value advantage to their beneficial advantage of developing various commodities and products that could be used in our daily lives. Furthermore, the fact that such recyclable materials are susceptible to antiviral properties and chemicals, is an added value that we should not neglect.

3D Visualization of Brain Tumors Using MR Images: A Survey.

BACKGROUND: Three-Dimensional visualization of brain tumors is very useful in both diagnosis and treatment stages of brain cancer. DISCUSSION: It helps the oncologist/neurosurgeon to take the best decision in Radiotherapy and/or surgical resection techniques. 3D visualization involves two main steps; tumor segmentation and 3D modeling. CONCLUSION: In this article, we illustrate the most widely used segmentation and 3D modeling techniques for brain tumors visualization. We also survey the public databases available for evaluation of the mentioned techniques.

Shear wave elastography of the brachial plexus roots at the interscalene groove.

OBJECTIVES: Sonoelastography is an emerging technology that has been used to evaluate the musculoskeletal system including the brachial plexus of peripheral nerves, which has been only recently considered for study by shear wave elastography. The purpose of this study is to establish the normal sonoelastographic features of the C5-C7 nerve roots of the brachial plexus. METHODS: Forty healthy individuals (21 males and 19 females) were enrolled in the study. Shear wave elastography was used to evaluate the C5-C7 nerve roots of the brachial plexus at the interscalene interval. Normal sonoelastographic values were obtained. RESULTS: The mean shear elastic modulus of the C5 nerve root was 16.9 kPa (range 5.9-28.8 ± 4.9 standard deviation, SD), 15.7 kPa (range 5.4-26.3 ± 4.3 SD) for the C6 nerve root, and 16 kPa (range 8-29 ± 4.6 SD) for the C7 nerve root. There was a significant statistical difference between both sexes in the elastic modulus at the C6 and C7, but not at the C5 nerve roots. Significant inverse correlation with height was noted at the C6 nerve root. There was no statistical significant difference in tissue stiffness between right- and left-handed subjects, age, and body mass index. CONCLUSION: The elastic modulus of the C5-C7 nerve roots has been determined in asymptomatic individuals and can serve as a reference when studying pathological conditions of these structures. ABBREVIATIONS: BMI: body mass index; SWE: shear wave elastography.

Transabdominal ultrasonographic features in the diagnosis of gastrointestinal lymphoma.

BACKGROUND: Gastrointestinal (GI) lymphoma is a challenging disease. We aimed to study and characterize the different endoscopic and transabdominal ultrasonography (TUS) features of gut lymphoma and to assess whether TUS has a complementary role to endoscopy in the diagnosis of GI lymphoma. METHODS: This study was conducted on 21 patients with GI lymphoma, attending the GI endoscopy and liver unit, Endemic Medicine Department and Oncology Department in Kasr El Aini Hospital, Cairo University. Patients were subjected to GI endoscopy (upper endoscopy & colonoscopy) and transabdominal ultrasonography. The diagnosis was finally based on histopathology of core biopsies (obtained either endoscopically or by ultrasonography) and immuno-histochemistry. RESULTS: In all 21 patients with GI lymphoma included in this study, TUS could accurately determine the site of disease affection compared to endoscopy which is considered the gold standard for site localization. The main TUS pathologic features detected were increased wall thickness of the affected bowel segment with a mean value of (15.6±5.9 mm) and loss of layering pattern in 16 patients (76%). While the most common endoscopic features were ulcers and mass lesions accounting for 38% of the patients for each. Diffuse large B-cell lymphoma was found in 19 patients (90%). Because of endoscopic biopsies were conclusive in 14 patients (67%), TUS guided biopsy was resorted to in 7 patients and was diagnostic in all of them. CONCLUSIONS: Transabdominal ultrasonography is a useful tool in the diagnosis of GI lymphoma that is complementary to conventional diagnostic endoscopic procedures.

Traditional medicines and alternative practice in the management of prostate diseases in southern Ghana.

OBJECTIVE: This study was aimed at identifying Ghanaian traditional medicines used for the management of prostate diseases and their constituents. Reviews of studies conducted on them are also presented. METHODOLOGY: This was a prospective study. Traditional Medicine samples from consecutive patients with either lower urinary symptoms (LUTS) presenting at the Urology Unit of the Korle Bu Teaching Hospital (KBTH) in Accra from January 2015 to June 2016 and had a prior treatment with traditional medicines, had the samples retrieved. Additionally, all the 58 licensed pharmaceutical shops in Okaishie, a whole sale and retail depot for medicines in the main business district of Accra, were visited and traditional medicines for the management of prostate diseases acquired. The products constituent as labeled were documented and entered once on a proforma. This study was part of a study on the management of benign prostate hyperplasia at the KBTH approved by the Medical Directorate.The findings were analyzed and presented using descriptive statistics and presented as a table. RESULTS: Eleven products were identified with the main indigenous medicinal plant identified being the root extract of Croton membranaceus. This was the constituent in four products (Uro 500®, UR-Quick mixture®, Prostacure® and prostat®60). Although studies on the basic pharmacology and animal studies have confirmed its effect on the prostate, only one clinical study was identified. CONCLUSION: Croton membranaceus was the indigenous traditional medicine identified for relieving LUTS due to prostate disease. There is the need for empirical evidence on its efficacy in treating Prostate cancer. FUNDING: Not declared.

Spot urinary sodium for assessing dietary sodium restriction in cirrhotic ascites.

AIM: To evaluate the accuracy of spot urinary Na/K and Na/creatinine (Cr) ratios as an alternative to 24-h urinary sodium in monitoring dietary compliance in patients with liver cirrhosis and ascites treated with diuretics. METHODS: The study was carried on 40 patients with liver cirrhosis and ascites treated with diuretic therapy. Patients were divided into two groups according to 24-h urinary sodium. We measured spot urine Na/K ratio, Na/Cr ratio and 24-h urinary sodium. Student's t test was used to compare the interval variables and chi(2) test to compare the nominal variables between the two groups. Receiver operator characteristic curve was used to identify the best cutoff point for Na/K and Na/Cr ratio. RESULTS: The best cutoff point for Na/K ratio was 2.5 (P < 0.001) and area under the curve (AUC) was 0.9, and for Na/Cr ratio, the best cutoff point was 35 (P < 0.001) and AUC was 0.885. Na/K ratio showed higher sensitivity and accuracy compared to Na/Cr ratio (87.5% and 87% for Na/K ratio; 81% and 85% for Na/Cr ratio, respectively). CONCLUSION: Spot urine Na/K ratio has adequate accuracy for assessment of dietary sodium restriction compared with 24-h urinary sodium in patients with liver cirrhosis and ascites.

Assessment of epidermal growth factor receptor mutation by endobronchial ultrasound-guided transbronchial needle aspiration.

BACKGROUND: The presence of somatic mutations in epidermal growth factor receptor (EGFR) predicts the effectiveness of EGFR tyrosine kinase inhibitors (TKIs). It would be ideal if an EGFR mutation could be detected in biopsy samples, since the majority of non-small cell lung cancer patients are inoperable at the time of presentation. We have reported the usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for the lymph node staging of lung cancer. EBUS-TBNA enables the sampling of histologic cores, which can be used for genetic analysis. METHODS: The purpose of this study was to develop and analyze the feasibility of detecting EGFR mutations in samples obtained by EBUS-TBNA. Forty-six patients with primary lung cancer in whom metastatic adenocarcinoma in the hilar and/or mediastinal lymph node was diagnosed by EBUS-TBNA were enrolled into the study. DNA was extracted from paraffin-embedded samples, and the EGFR mutation was analyzed in exons 19 and 21 using a newly developed loop-hybrid mobility shift assay. The results were confirmed by direct sequencing. RESULTS: Forty-three cases were eligible for analysis and in 11 cases, EGFR mutation (25.6%) was detected; one case was an in-frame deletion (E746-A750del) of exon 19, nine cases were point mutations (L858R) of exon 21, and one case was a double point mutation (L858R+L861V). All cases with EGFR mutations were confirmed by direct sequencing. CONCLUSIONS: EGFR mutation can easily be detected in metastatic lymph nodes sampled by EBUS-TBNA. EBUS-TBNA allows genetic evaluations of tumor cells within the lymph node and may provide us with indications for EGFR-TKI therapy in the near future.

Renal involvement in lymphoma: prevalence and various patterns of involvement on abdominal CT.

OBJECTIVE: The kidney is a frequent site of involvement in lymphoproliferative disorders. The aim of this study was to demonstrate the prevalence and spectrum of morphologic appearances of renal involvement in patients with lymphoma on helical computed tomographic (CT) scan. METHODS: Three phases of post-contrast helical CT of the abdomen in 74 patients with lymphoma were reviewed for possible renal involvement: the cortico-medullary, nephrographic and delayed excretory phases. Tumor characteristics, patterns of distribution and enhancement features were evaluated. RESULTS: Of the 74 patients with lymphoma, 11 had CT evidence of renal involvement--ten with non-Hodgkin's lymphoma and one with Hodgkin's lymphoma--representing 15% of all patients scanned for routine staging of histologically diagnosed lymphoma. Five types of renal involvement were observed: enlarged lobular non-enhancing kidneys (four patients); bilateral multiple renal masses (two patients); focal single non-enhancing mass (two patients); perirenal infiltrations from retroperitoneal extension (two patients); bilateral diffuse areas of non-enhancing hypo-densities (one patient). CONCLUSION: Five distinct patterns of renal involvement with lymphoma were detected with helical CT. The most common appearance was enlarged lobular kidneys. CT with intravenous contrast enhancement is currently the approach of choice for both the evaluation of renal involvement as well as for accurate staging of lymphoma. Awareness of different patterns of renal involvement in lymphoma allows proper differentiation from other similar diseases.

Urinary bladder hyperreflexia: a rat animal model.

In this work, we are presenting a rat animal model for bladder hyperreflexia after suprasacral spinal cord transection. Our aim was to standardize an animal model that can be useful in studying this condition. After standardizing the animal model in a pilot study, 26 female Sprague-Dawley rats were subjected to spinal cord transection at the level of T10 vertebra. Four animals were subjected to cystometrogram (CMG) 24 hr after spinalization and six rats 3 weeks post-spinalization. These CMGs were compared to that of six normal controls. The detailed description of the model presented in this manuscript, is the final result after several modifications. All the animals consistently developed hyperreflexia after an initial period of spinal shock phase. Expressed volume of urine continued to decrease until it reached a plateau after peaking at 1-week post-spinalization. The attrition rate reached 27.3% after several improvements in the animal model and was mostly from self-inflicted injuries. Post-operative complications included hypothermia, decubitus ulcers, hematuria, urinary tract infection in addition to the unexplained death of two animals. In conclusion, we believe that this animal model closely resembles the clinical condition of hyperreflexia and follows similar course. The relative low cost of this animal model and the easy maintenance makes it a valuable tool to study such a condition.