Publications by authors named "Naseer Ahmed"

91 Publications

Hypokalemic Periodic Paralysis: An Atypical Presentation of Non-autoimmune Hypothyroidism With Distal Renal Tubular Acidosis.

Cureus 2022 Apr 11;14(4):e24046. Epub 2022 Apr 11.

Internal Medicine, Rehman Medical Institute, Peshawar, PAK.

Hypokalemic periodic paralysis (hypo KPP) is a rare form of autosomal dominant channelopathy characterized by muscular weakness and paralysis caused by decreased potassium levels. Precipitating factors are a diet rich in starches and sweets, and rest after an unusual degree of exercise. Paralytic attacks are more common between the ages of 15 and 40 years. The presentation can be a total paralysis or severe quadriplegia or mild weakness in certain group of muscles. During the acute episode of weakness proximal muscles are involved initially with gradual spread to the distal muscles. Deep reflexes are decreased or absent but the cognitive functions and sensory systems are intact. The paralysis may last for few hours to several days, but recovery is usually sudden in most patients. Hypo KPP is usually associated with thyroid disorders and distal renal tubular acidosis (DRTA). Here we report a case of young female patient who presented in emergency with two days history of weakness of all four limbs. The patient also had two episodes of similar illness in the last two and half years. On examination she had decreased tone and power in all four limbs with absent deep tendon reflexes, and plantar reflexes were down going bilaterally. On initial laboratory workup, patient was diagnosed to have hypokalemic, hyperchloremic metabolic acidosis with alkaline urine secondary to hypothyroidism. Features of hypokalemia with metabolic acidosis and failure to acidify urine was consistent with DRTA. Intravenous potassium chloride and bicarbonate replacement resulted in biochemical and clinical improvement.
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http://dx.doi.org/10.7759/cureus.24046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9094734PMC
April 2022

Oral Health Status in Marfan Syndrome: A Systematic Review and Meta-Analysis of 353 Cases.

Int J Environ Res Public Health 2022 Apr 21;19(9). Epub 2022 Apr 21.

Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi 75500, Pakistan.

This meta-analysis aimed to compare Marfan syndrome (MFS) patients with non-MFS populations based on orofacial health status to combine publicly available scientific information while also improving the validity of primary study findings. A comprehensive search was performed in the following databases: PubMed, Google Scholar, Scopus, Medline, and Web of Science, for articles published between 1 January 2000 and 17 February 2022. PRISMA guidelines were followed to carry out this systematic review. We used the PECO system to classify people with MFS based on whether or not they had distinctive oral health characteristics compared to the non-MFS population. The following are some examples of how PECO is used: P denotes someone who has MFS; E stands for a medical or genetic assessment of MFS; C stands for people who do not have MFS; and O stands for the orofacial characteristics of MFS. Using the Newcastle-Ottawa Quality Assessment Scale, independent reviewers assessed the articles' methodological quality and extracted data. Four case-control studies were analyzed for meta-analysis. Due to the wide range of variability, we were only able to include data from at least three previous studies. There was a statistically significant difference in bleeding on probing and pocket depth between MFS and non-MFS subjects. MFS patients are more prone to periodontal tissue inflammation due to the activity of FBN1 and MMPs. Early orthodontic treatment is beneficial for the correction of a narrow upper jaw and a high palate, as well as a skeletal class II with retrognathism of the lower jaw and crowding of teeth.
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http://dx.doi.org/10.3390/ijerph19095048DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9101956PMC
April 2022

The Effectiveness of Lasers in Treatment of Oral Mucocele in Pediatric Patients: A Systematic Review.

Materials (Basel) 2022 Mar 26;15(7). Epub 2022 Mar 26.

Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi 75500, Pakistan.

The mucocele is the most common minor salivary gland associated disease of the oral cavity. It is also considered one of the most common biopsied oral lesions in pediatric patients. In recent years, extensive evidence has been published about the usage of lasers in treating mucoceles in pediatric patients. The aim of the present study was to assess the effectiveness of laser irradiation in the treatment of pediatric mucocele. An electronic search of databases (PubMed, Scopus, Web of Science and Google Scholar) was carried out in order to identify all relevant articles using a combination of the following keywords: "Pediatric", "Oral", "Mucocele", "Dental", "Oral Medicine", "Soft Dental Lasers", "Hard Dental Lasers", and "Lasers," for all case reports, case series, case-control and cohort studies published from 2007 to 2021. After limiting the search results, removing duplicate titles, and eligibility evaluation, 17 papers were enrolled in the study. Out of the total studies included, 10 articles were related to the diode (635 nm, 808 nm, 810 nm, and 980 nm), 5 to CO (10,600 nm), 3 to Er, Cr: YSGG (2780 nm), and 1 involving KTP lasers (532 nm). All studies indicated successful clinical results on mucocele excision with better intra- and post-operative indicators. The general characteristics and outcomes were summarized, and the quality of the studies was assessed using CARE guidelines in this systematic review. The reduction or absence of pain and bleeding, hemostasis, reduced operating time, minimal analgesic consumption, and an antibacterial effect were among the advantages of laser irradiation in the included studies. The laser has proven itself to play an effective role in the treatment of oral mucocele in paediatric patients.
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http://dx.doi.org/10.3390/ma15072452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8999795PMC
March 2022

Assessment of Potential Benefits of Functional Food Characteristics of Beetroot Energy Drink and Flavored Milk.

Biomed Res Int 2022 15;2022:1971018. Epub 2022 Mar 15.

Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al Jouf 72345, Saudi Arabia.

Objective: This study was designed to determine the antioxidant activity of the extracts of beetroot by using beetroot energy drink and flavored milk (products). . This experimental trial was conducted at Jinnah University for Women, Pakistan, under the approval of local institutional review board number JUW/DFST/RCB010/2020. All the materials such as beetroot, carrot, cucumber, and lemon were obtained commercially from which two products were formulated: beetroot energy drink (sample1) and flavored milk (sample 2). These formulated products were evaluated for quality analysis (pH and brix), phytochemical screening using the Keller-Kiliani test, Salkowski's test, Alkaline reagent test, lead acetate test, ferric chloride test, protein test, quantitative test of phenol, antioxidant activity, sensory analysis, and shelf life study. The paired -test was applied to detect significant differences between two samples.

Results: The phytochemical analysis revealed that cardiac glycosides, phytosterol, flavonoids, and terpenoids were found in both energy booster drink (EBD) and flavored milk (FM) except phenolic compounds that were found only in EBD. The antioxidant capacity of beetroot juice was far greater than FM. The statistical sensorial analysis of FM and EBD reported a significant mean difference between most of the groups with < 0.0001.

Conclusion: This study concludes that energy drinks having beetroot indicated higher antioxidant capacity than flavored milk. The nutraceutical products (energy booster drink and flavored milk) containing beetroot are enriched with optimum quantities of proteins and fats and low carbohydrates at a stable pH with an adequate total energy content.
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http://dx.doi.org/10.1155/2022/1971018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947884PMC
April 2022

Analysis of recurrent esthetic dental proportion of natural maxillary anterior teeth: A systematic review.

J Prosthet Dent 2022 Mar 8. Epub 2022 Mar 8.

Professor, Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.

Statement Of Problem: The recurrent esthetic dental (RED) proportion has been a benchmark for the rehabilitation of the maxillary anterior teeth of North American patients. While it has been evaluated in other populations, the global application of RED proportions in the rehabilitation of maxillary anterior teeth is unclear.

Purpose: The purpose of this systematic review was to examine the existing evidence on dental proportion to evaluate the existence of RED proportions in the esthetic smile in different geographic regions.

Material And Methods: A systematic search was conducted by reviewing different databases. The focused question was "Does RED proportion exist in esthetically pleasing smiles in different populations around the world?" The search included articles with a combination of MeSH keywords based on dental proportion from January 2000 to July 2020. The titles and abstracts were identified by using a search protocol. Full text of the articles was independently evaluated. The systematic review was modified to summarize the relevant data. The general characteristics, outcomes, and quality of studies were reviewed and analyzed systematically.

Results: Seventeen studies were selected from the reviewed articles. Three studies were conducted in Europe, 10 in South Asia, and 4 in Western Asia. Eleven studies found that the mean perceived ratio of anterior teeth was not constant when progressing distally. Five studies reported that the ratio was constant in a small percentage of their populations, and 1 suggested that the ratio was constant if it remains between 60% and 80%. The central-to-LI and Ca-to-LI proportion values were not constant. Overall, the Ca-to-LI proportion values were higher than the central-to-LI proportions.

Conclusions: RED proportions were not found in the successive widths of maxillary anterior teeth among the reviewed data from different geographic regions. RED proportions are not the only standard for restoring esthetic smiles worldwide, and anterior tooth proportions differ among populations based on their race and ethnicity.
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http://dx.doi.org/10.1016/j.prosdent.2021.11.035DOI Listing
March 2022

Safe practices of biomedical and dental waste management amongst practicing dental professionals amid the COVID-19 pandemic.

Work 2022 ;71(4):851-858

Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia.

Background: Biomedical waste can potentially compromise the environment and public safety if not safely disposed.

Objective: The aim was to assess the understanding and safe practices of biomedical and dental waste amongst the dental practitioners and practical year students amid the COVID-19 pandemic.

Methods: A structured and validated questionnaire consisting of 21 closed ended questions was used to collect data from dental practitioners and students working in hospitals and clinics. The questionnaire was distributed in paper and digital form amongst the participants. Descriptive analysis was performed for categorical and numerical variables. Spearman correlation test was used to assess the relationship between awareness and waste disposal practices of dentists. A p-value of≤0.05 was considered as statistically significant.

Results: More than three fourth of the participants were aware of proper dental waste disposal steps. One half was aware of the color-coded segregation of biomedical waste management. Two third of the participants were deploying safe biomedical waste practices. Nearly 68% subjects allocated separate labeled containers for disposal of COVID-19 suspected patient's waste. Furthermore, 71.63% participants were practicing PCR test before aerosol procedures. While 88.65% participants believed that the COVID-19 pandemic has increased the financial burden in terms of safe practices and dental waste management.

Conclusion: The awareness and practices of the participants towards dental waste management was found to be moderate. Satisfactory COVID-19 prevention and transmission measures were observed amongst the participants. BMW management lessons should be included in the academic curriculum and training program needs to be adopted for mass awareness.
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http://dx.doi.org/10.3233/WOR-211099DOI Listing
May 2022

Association of the Unstimulated Whole Salivary Cytokine IL-1β Levels with Initial, Moderate and Severe Periodontitis. A Case Control Study.

Int J Environ Res Public Health 2022 03 2;19(5). Epub 2022 Mar 2.

Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 12372, Saudi Arabia.

Periodontitis (P) is a highly prevalent inflammatory disease of the oral cavity. The objective of the study was to evaluate the stages of pro-inflammatory cytokine IL-1β in initial, moderate and severe periodontitis. One hundred and twenty two patients were included in the study. Periodontitis subjects had at least 20 natural teeth and ≥8 sites with pocket depths of >4 mm and clinical attachment loss (CAL). A questionnaire was used with respect to the socio demographic parameters which included age, gender, ethnicity, education, marital, residence and occupation. To categorize the severity of the disease, teeth were assessed for, Plaque index (PI), Bleeding on probing (BOP), CAL, missing tooth, tooth mobility and bone loss. Unstimulated whole saliva (UWS) was collected and Interleukin-1β (IL-1β) cytokine levels were analyzed using enzyme linked immunosorbent assay with microplate reader at 450 nm. Clinical parameters and salivary cytokine concentrations were assessed using one-way analysis of variance, whereas a correlation of cases with gender and severity of periodontitis was evaluated using chi-square test. Fifty-nine patients were healthy controls and 63 were periodontitis patients Thirty two percent ( = 20) had initial periodontitis, 40% ( = 25) suffered from moderate and 29% ( = 18) had severe periodontitis. Periodontitis subgroups were significantly different with regards to age and gender ( < 0.001). The mean PPD and CAL among the periodontitis patients (PPD, 3.52 ± 1.25 mm; CAL, 4.04 ± 1.64 mm) were significantly compromised ( < 0.05) compared to healthy controls (PPD, 1.52 ± 0.73 mm; CAL, 0.08 ± 0.28 mm). Increased levels of IL-1β were associated with high CAL and PPD findings. UWS IL-1β levels were higher in periodontitis patients compared to healthy individuals. In addition, cases of severe periodontitis showed significantly higher UWS IL-1β levels compared to initial and moderate periodontitis patients. Comparative levels of salivary IL-1β can be potentially used as a diagnostic tool for periodontitis identification and disease progression along with clinical parameters.
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http://dx.doi.org/10.3390/ijerph19052889DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8910701PMC
March 2022

An Analysis of Maxillary Anterior Teeth Crown Width-Height Ratios: A Photographic, Three-Dimensional, and Standardized Plaster Model's Study.

Biomed Res Int 2022 7;2022:4695193. Epub 2022 Feb 7.

Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al Jouf 72345, Saudi Arabia.

Objective: To analyze the width and height ratios of maxillary anterior teeth at different crown levels through photographs, 3D, and plaster dental model techniques in a subset of the Pakistani population. . This clinical study consisted of 230 participants. The maxillary impression, standardized photographs, and models were constructed for crown width and height analysis. The SPSS version 25 was used for statistical analysis. Descriptive statistics were carried out for mean, standard deviation, and percentage calculation of teeth width and height, gender, and age of participants. Paired -test analysis was carried out to compare the dependent variables (teeth size, width, and height ratios) with independent variables (techniques applied, side disparity). A value of ≤ 0.05 was considered statistically significant.

Results: The mean width and height of maxillary anterior teeth obtained through photographs, 3D, and plater models were statistically different. The 3D dental model analysis showed reliable and accurate results. The mean width and height ratio of teeth were different on both sides of the arch. There was a significant difference ( = 0.001) in crown width-height ratios at different crown levels.

Conclusion: The width and height ratios in the studied population were different at various crown levels. The dimensions of teeth varied from the incisal to the cervical part of the crown. Hence, rather than relying on a single, fixed ratio of 78% to 80% suggested by researchers for anterior teeth, the clinician should adopt different crown width-height ratios to restore teeth with the optimum esthetic outcome.
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http://dx.doi.org/10.1155/2022/4695193DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8882051PMC
March 2022

Assessing the impact of workaholism and work engagement on medical university employee stress and satisfaction levels.

PeerJ 2022 4;10:e12565. Epub 2022 Feb 4.

Department of Psychology, College of Education, King Saud University, Riyadh, Saudi Arabia.

Background: Workaholism (WH) is related with high mental trouble and physical objections, low employment and family fulfillment, and low occupation execution; however, work commitment is related with job and life satisfaction. This study aimed to assess the impact of WH and work engagement (WE) on medical university employee job stress and satisfaction.

Methods: This descriptive analytical study was conducted on workers employed in medical universities using validated questionnaires for data collection. The sample size was 330, from which 305 responded with completed questionnaire. The employees were the direct workers of different accessible medical universities in Karachi, Pakistan. The employee enrolment and distribution of the questionnaire was performed using non-probability convenient sampling. The Brief Job Questionnaire (BJQ), Dutch Work Addiction Scale (DUWAS) and Utrecht Work Engagement Scale (UWES) were used to assess the impact of job stress on job satisfaction and WE. The data was analyzed by applying descriptive statistics, Spearman correlation and regression analysis. A -value of ≤ 0.05 was taken as significant.

Results: The study consisted of 117 (38.4%) male and 188 (61.6%) female participants; the mean age of participating employee was 28.50 ± 6.192. The mean score for WE was 3.78 ± 0.467, that of WH was 3.42 ± 0.559, for JS was 4.29 ± 0.400, whereas JSF was 3.10 ± 0.591. A positive correlation was observed between job stress, WH and WE. WH had a strong correlation with job stress and weak correlation with job satisfaction and performance. A significant difference was observed between WE and WH among males and females.

Conclusions: The study presented with a significant effect of job satisfaction with WH and WE with job stress. Hence, indicating the importance of social skills and WE with fellow employees to increase the work productivity and performance. However, in case of over work and WH, an increase of job stress is inevitable.
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http://dx.doi.org/10.7717/peerj.12565DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820209PMC
February 2022

An In-Vitro Evaluation of Microleakage in Resin-Based Restorative Materials at Different Time Intervals.

Polymers (Basel) 2022 Jan 24;14(3). Epub 2022 Jan 24.

Oral Medicine & Radiology, Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia.

A vital feature of conservative dentistry is the adhesion of the restorative material to the tooth structure for restoration of the tooth substance lost due to dental decay, trauma, or dental imperfections. In a perfect world, a restorative material should generate a lasting adhesion by bonding the restoration with tooth tissues. The ingress of micro-organisms, oral fluids, molecules, and ions through microscopic spaces due to faulty adhesion between restoration and tooth structure is known as microleakage. This study is focuses on the evaluation of adhesive failures between the restorative materials. In the past, studies have focused more on the bonding potential of a restorative material with the tooth surface. Therefore, there is need to carry out a study that compares the microleakage between resin-based restorative materials in a sandwich manner with and without the intermediate bonding layer after immersion in 2% methylene blue dye at different time intervals. The restorative materials used were composite Ceram X Mono plus (DENTSPLY) and Z350 (3M ESPE), Vitremer resin modified glass ionomer cement (RMGIC) (3M ESPE), smart dentine replacement SDR (3M ESPE), Bond NT (DENTSPLY), and Universal Bond (3M ESPE). A light emitting diode (LED) was used to cure the specimens. Artificial saliva was used as a storage medium for the specimens. Thermocycling of specimens was carried out at 500 cycles/30 s and 1000 cycles/30 s. The world health organization (WHO) grading tool for microleakage was used to analyze fluid ingress in the specimens through disclosing by 2% methylene blue dye. The statistical analysis was carried out with one-way analysis of variance (ANOVA) and Tukey post hoc test, keeping the level of significance at ≤ 0.05. In Grade 0 = 85 samples, Grade 1 = 10 samples, Grade 2 = 7 samples, Grade 3 = 16 samples, and in Grade 4 = 2 samples were identified. This study describes that no microleakage was observed in SDR and resin composite groups as compared to Vitremer and resin composite groups.
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http://dx.doi.org/10.3390/polym14030466DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8838729PMC
January 2022

Management of Edentulous Microstomia Patient: A Case Report and Classification System.

Case Rep Dent 2022 1;2022:2686983. Epub 2022 Feb 1.

Department of Prosthetic Dental Science, College of Dentistry, King Saud University, 60169, Riyadh 11545, Saudi Arabia.

Microstomia is an abnormally reduced oral aperture. In the literature, it is not classified by any particular size criteria, rather defined by its effects on function and esthetics. Prosthodontic management of edentulous patients with microstomia is a challenging task. Use of conventional methods for recording an impression and fabricating prosthesis is not effective in such patients. To fabricate well-fitting prosthesis, accuracy of impression recording important anatomic landmarks is essential. Formation of an exacting custom tray and diagnostic cast is critical for final impression accuracy. Provision of a well-fitting prosthesis in microstomia patient will restore esthetics, comfort, and function with oral and systemic patient wellbeing. This paper presents a case report of managing an edentulous microstomia patient with sectional removable prosthesis. Furthermore, it proposes a novel classification system for microstomia patients according to severity of the condition.
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http://dx.doi.org/10.1155/2022/2686983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8825675PMC
February 2022

Comparison of Dental Anxiety While Visiting Dental Clinics before and after Getting Vaccinated in Midst of COVID-19 Pandemic.

Vaccines (Basel) 2022 Jan 13;10(1). Epub 2022 Jan 13.

Department of Orthodontics, College of Dentistry, Ajman University, Ajman 346, United Arab Emirates.

Vaccination is critical to control the rate of coronavirus transmission and infectivity. Dental practices are a high-risk area for contracting coronavirus; this fact generates psychological disturbances amongst patients. In this study, we aimed to assess the levels of anxiety of patients while visiting dental practices before and after getting vaccinated. This cross-sectional study was carried out between March and December 2021. An electronic survey was distributed among the vaccinated individuals who visited dental clinics before and after getting vaccinated. The survey consisted of the following four parts: demographic characteristics, questions related to coronavirus, and anxiety scores before and after getting vaccinated. SPSS-25 was used to perform the statistical analysis, where paired -test was used to compare the anxiety scores, and Mann-Whitney U test to assess the association of gender with anxiety scores. A -value of ≤0.05 was considered to be statistically significant. A total of 400 vaccinated individuals participated in this study, with a response rate of 88.23%. The majority of the respondents (71.0%) did not test positive for coronavirus. More than half of the participants (54.0%) reported to not be suffering from any coronavirus-related symptoms. About 100 (25.0%) of the individuals stated that dental clinics are an environment in which there is a high risk of contracting coronavirus. In regards to the comparison of the mean MDAS scores of the participants before and after getting vaccinated, a significant difference ( = 0.001) was found. Vaccination has been recommended for all eligible individuals to control the transmission and infectivity of coronavirus. Vaccinations have decreased the dental anxiety of patients while visiting dental clinics. However, the protective measures are still valid and should be followed, regardless of the vaccination status.
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http://dx.doi.org/10.3390/vaccines10010115DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8777748PMC
January 2022

Impact of Pre-Treatment NLR and Other Hematologic Biomarkers on the Outcomes of Early-Stage Non-Small-Cell Lung Cancer Treated with Stereotactic Body Radiation Therapy.

Curr Oncol 2022 01 4;29(1):193-208. Epub 2022 Jan 4.

Department of Radiation Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada.

Introduction: We evaluated the association of pre-treatment immunologic biomarkers on the outcomes of early-stage non-small-cell lung cancer (NSCLC) patients treated with stereotactic body radiation therapy (SBRT).

Materials And Methods: In this retrospective study, all newly diagnosed early-stage NSCLC treated with SBRT between January 2010 and December 2017 were screened and included for further analysis. The pre-treatment neutrophil-lymphocyte ratio (NLR), monocyte lymphocyte ratio (MLR), and platelet-lymphocyte ratio (PLR) were calculated. Overall survival (OS) and recurrence-free survival (RFS) were estimated by Kaplan-Meier. Multivariable models were constructed to determine the impact of different biomarkers and the Akaike information criterion (AIC), index of adequacy, and scaled Brier scores were calculated.

Results: A total of 72 patients were identified and 61 were included in final analysis. The median neutrophil count at baseline was 5.4 × 10/L (IQR: 4.17-7.05 × 10/L). Median lymphocyte count was 1.63 × 10/L (IQR: 1.29-2.10 × 10/L), median monocyte count was 0.65 × 10/L (IQR: 0.54-0.83 × 10/L), median platelet count was 260.0 × 10/L (IQR: 211.0-302.0 × 10/L). The median NLR was 3.42 (IQR: 2.38-5.04), median MLR was 0.39 (IQR: 0.31-0.53), and median PLR was 156.4 (IQR: 117.2-197.5). On multivariable regression a higher NLR was associated with worse OS ( = 0.01; HR-1.26; 95% CI 1.04-1.53). The delta AIC between the two multivariable models was 3.4, suggesting a moderate impact of NLR on OS. On multivariable analysis, higher NLR was associated with poor RFS ( = 0.001; NLR^1 HR 0.36; 0.17-0.78; NLR^2 HR-1.16; 95% CI 1.06-1.26) with a nonlinear relationship. The delta AIC between the two multivariable models was 16.2, suggesting a strong impact of NLR on RFS. In our cohort, MLR and PLR were not associated with RFS or OS in multivariable models.

Conclusions: Our study suggests NLR, as a biomarker of systemic inflammation, is an independent prognostic factor for OS and RFS. The nonlinear relationship with RFS may indicate a suitable immunological environment is needed for optimal SBRT action and tumoricidal mechanisms. These findings require further validation in independent cohorts.
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http://dx.doi.org/10.3390/curroncol29010019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8774597PMC
January 2022

Impact of Oral Health Educational Interventions on Oral Hygiene Status of Children with Hearing Loss: A Randomized Controlled Trial.

Biomed Res Int 2021 17;2021:5185613. Epub 2021 Nov 17.

Department of Prosthodontics, Altamash Institute of Dental Medicine, Karachi 75500, Pakistan.

Introduction: Oral health is considered as one of the essential components of the overall health of every individual. Maintaining oral health is a gradual process that requires commitment. Children who require special care such as hearing impairment experience difficulty in maintaining oral health primarily due to communication difficulties. This study is aimed at using different interventions to evaluate the improvement of oral hygiene in hearing impaired children.

Materials And Methods: Fifty-nine children were recruited in this study that were allocated randomly into each group with twenty children as follows: group 1: pictorial, group 2: video, and group 3: control. Mean plaque and gingival scores were noted before and after the use of different interventions. Oral hygiene was categorized as "excellent," "good," and "fair." Gingival health was categorized as "healthy," "mild gingivitis," and "moderate gingivitis."

Results: Thirty-four children (57.6%) were from 12-13 years of age bracket, and 25 (42.4%) belonged to 14-16 years of age. Regarding gender, there were 37 (62.7%) males and 22 (37.3%) females. About comparison of mean gingival and plaque scores before and after interventions in each group, a significant difference was found in group 1 ( < 0.001) and group 2 ( < 0.001), as compared to group 3 where the difference in scores was not significant ( > 0.05).

Conclusion: Maintaining oral health requires the compliance of individuals to perform different methods of preventive dentistry, such as tooth brushing and use of dental floss. The use of different oral hygiene educational interventions such as pictorial and video methods have been proven and useful for hearing impaired children in improving oral health.
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http://dx.doi.org/10.1155/2021/5185613DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8692028PMC
January 2022

Edible Mushrooms: A Comprehensive Review on Bioactive Compounds with Health Benefits and Processing Aspects.

Foods 2021 Dec 4;10(12). Epub 2021 Dec 4.

Amity Institute of Biotechnology, Amity University Rajasthan, Jaipur 303002, Rajasthan, India.

Mushrooms are well-known functional foods due to the presence of a huge quantity of nutraceutical components. These are well recognized for their nutritional importance such as high protein, low fat, and low energy contents. These are rich in minerals such as iron, phosphorus, as well as in vitamins like riboflavin, thiamine, ergosterol, niacin, and ascorbic acid. They also contain bioactive constituents like secondary metabolites (terpenoids, acids, alkaloids, sesquiterpenes, polyphenolic compounds, lactones, sterols, nucleotide analogues, vitamins, and metal chelating agents) and polysaccharides chiefly -glucans and glycoproteins. Due to the occurrence of biologically active substances, mushrooms can serve as hepatoprotective, immune-potentiating, anti-cancer, anti-viral, and hypocholesterolemic agents. They have great potential to prevent cardiovascular diseases due to their low fat and high fiber contents, as well as being foremost sources of natural antioxidants useful in reducing oxidative damages. However, mushrooms remained underutilized, despite their wide nutritional and bioactive potential. Novel green techniques are being explored for the extraction of bioactive components from edible mushrooms. The current review is intended to deliberate the nutraceutical potential of mushrooms, therapeutic properties, bioactive compounds, health benefits, and processing aspects of edible mushrooms for maintenance, and promotion of a healthy lifestyle.
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http://dx.doi.org/10.3390/foods10122996DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8700757PMC
December 2021

Effect of soaking and germination treatments on nutritional, anti-nutritional, and bioactive properties of amaranth ( L.), quinoa ( L.), and buckwheat ( L.).

Curr Res Food Sci 2021 1;4:917-925. Epub 2021 Dec 1.

Department of Biotechnology, Dr. Khem Singh Gill Akal College of Agriculture, Eternal University, Baru Sahib, Sirmour, HP, 173101, India.

Pseudocereals have attracted the attention of nutritionists and food technologists due to their high nutritional value. In addition to their richness in nutritional and bioactive components, these are deficient in gluten and can serve as valuable food for persons suffering from gluten allergies. Processing treatments are considered an effective way to enhance the quality of food grains. Soaking and germination are traditional and most effective treatments for enhancing the nutritional and bioactive potential as well as reducing the anti-nutritional components in food grains. This study reflects the effect of soaking and germination treatments on nutritional, bioactive, and anti-nutritional characteristics of pseudocereals. There was a significant (p ≤ 0.05) increase in nutritional and bioactive components such as crude fiber, crude protein, phenolic components, antioxidant activity, and mineral content but reduced the anti-nutrients such as tannin and phytic acid. In amaranth, there was a significant increase (p ≤ 0.05) of 7.01, 74.67, 126.62, and 87.47% in crude protein, crude fiber, phenolic content, and antioxidant activity but significant (p ≤ 0.05) reduction of 32.30% and 29.57% in tannin and phytic acid contents, respectively. Similar changes in values of crude proteins, crude fiber, phenolic content, and antioxidant activity were observed in buckwheat and quinoa. While the anti-nutritional components such as tannin and phytic acid decreased by 59.91 and 17.42%, in buckwheat and 27.08% and 47.57%, in quinoa, respectively. Therefore, soaking and germination proved to be excellent techniques to minimize the anti-nutritional component and enhance the nutritional, bioactive, and antioxidant potential of these underutilized grains.
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http://dx.doi.org/10.1016/j.crfs.2021.11.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8646961PMC
December 2021

Nano Drug Delivery Platforms for Dental Application: Infection Control and TMJ Management-A Review.

Polymers (Basel) 2021 Nov 29;13(23). Epub 2021 Nov 29.

Oral Medicine & Radiology, Department of Oral & Maxillofacial Surgery & Diagnostic Sciences, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia.

The oral cavity is an intricate environment subjected to various chemical, physical, and thermal injuries. The effectiveness of the local and systemically administered drugs is limited mainly due to their toxicities and poor oral bioavailability that leads to the limited effectiveness of the drugs in the target tissues. To address these issues, nanoparticle drug delivery systems based on metals, liposomes, polymeric particles, and core shells have been developed in recent years. Nano drug delivery systems have applications in the treatment of patients suffering from temporomandibular joint disorders such as preventing degeneration of cartilage in patients suffering from rheumatoid arthritis and osteoarthritis and alleviating the pain along with it. The antibacterial dental applications of nano-drug delivery systems such as silver and copper-based nanoparticles include these agents used to arrest dental caries, multiple steps in root canal treatment, and patients suffering from periodontitis. Nanoparticles have been used in adjunct with antifungals to treat oral fungal infections such as candida albicans in denture wearers. Acyclovir being the most commonly used antiviral has been used in combination with nanoparticles against an array of viral infections such as the herpes simplex virus. Nanoparticles based combination agents offer more favorable drug release in a controlled manner along with efficient delivery at the site of action. This review presents an updated overview of the recently developed nanoparticles delivery systems for the management of temporomandibular joint disorders along with the treatment of different oral infections.
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http://dx.doi.org/10.3390/polym13234175DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8659450PMC
November 2021

Surface Properties of Polymer Resins Fabricated with Subtractive and Additive Manufacturing Techniques.

Polymers (Basel) 2021 Nov 24;13(23). Epub 2021 Nov 24.

Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, P.O. Box 21069, Riyadh 11475, Saudi Arabia.

This study aimed to compare the surface roughness, hardness, and flexure strength of interim indirect resin restorations fabricated with CAD-CAM (CC), 3D printing (3D), and conventional techniques (CV). Twenty disk (3 mm × Ø10 mm) and ten bar specimens (25 × 2 × 2 mm) were fabricated for the CC, 3D, and CV groups, to be used for surface roughness, micro-hardness, and flexural strength testing using standardized protocol. Three indentations for Vickers micro-hardness (VHN) were performed on each disk and an average was identified for each specimen. Surface micro-roughness (Ra) was calculated in micrometers (μm) using a 3D optical non-contact surface microscope. A three-point bending test with a universal testing machine was utilized for assessing flexural strength. The load was applied at a crosshead speed of 3 mm/min over a distance of 25 mm until fracture. Means and standard deviations were compared using ANOVA and post hoc Tukey-Kramer tests, and a -value of ≤0.05 was considered statistically significant. Ra was significantly different among the study groups ( < 0.05). Surface roughness among the CC and CV groups was statistically comparable ( > 0.05). However, 3D showed significantly higher Ra compared to CC and CV samples ( < 0.05). Micro-hardness was significantly higher in 3D samples ( < 0.05) compared to CC and CV specimens. In addition, CC and CV showed comparable micro-hardness ( > 0.05). A significant difference in flexural strength was observed among the study groups ( < 0.05). CC and 3D showed comparable strength outcomes ( > 0.05), although CV specimens showed significantly lower ( < 0.05) strength compared to CC and 3D samples. The 3D-printed provisional restorative resins showed flexural strength and micro-hardness comparable to CAD-CAM fabricated specimens, and surface micro-roughness for printed specimens was considerably higher compared to CAD-CAM and conventional fabrication techniques.
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http://dx.doi.org/10.3390/polym13234077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658960PMC
November 2021

The Teledentistry, Impact, Current Trends, and Application in Dentistry: A Global Study.

Biomed Res Int 2021 25;2021:5437237. Epub 2021 Oct 25.

Conservative Dentistry Unit, School of Dental Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kota Bharu, Kelantan, Malaysia.

Objective: The present study was aimed at assessing the impact of teledentistry, its application, and trends in uplifting dental practice and clinical care around the world. . The present observational study comprised of an electronic survey distributed among dental professionals around the globe. The validated survey form consisted of a total 26 questions with 5-point Likert scale response. The questionnaire used was divided into four domains: usefulness of teledentistry for patients, its usefulness in dental practice, its capacity to improve the existing practice, and the concerns attached to its use. The statistical analysis was performed using SPSS-25. ANOVA test was used to assess the effect of independent variables on dependent variables. A value of ≤0.05 was taken as statistically significant.

Results: A total of 506 dental professionals participated in the study with the response rate of 89.39%. More than half of the participants (50-75%) endorsed that teledentistry is a useful tool for improving clinical practice as well as patient care. Two-thirds of the participants (69.96%) considered that teledentistry would reduce cost for the dental practices. On the other hand, about 50-70% of dental professionals expressed their concerns regarding the security of the data and consent of patients. The most preferred communication tool for teledentistry was reported to be videoconference followed by phone. The majority of participants recommended the use of teledentistry in the specialty of oral medicine, operative dentistry, and periodontics. There was a significant difference between the age, experience of dentists, and their qualifications with domains of teledentistry.

Conclusions: The overall impact of dental professionals towards teledentistry was positive with adequate willingness to incorporate this modality in their clinical practice. However, the perceived concerns pertaining to teledentistry are significant impediments towards its integration within the oral health system. An in-depth study of its business model and cost-benefit needs of time, especially in the context of developing countries, in order to avail the optimum benefits of teledentistry.
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http://dx.doi.org/10.1155/2021/5437237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8627361PMC
January 2022

Operational Implications and Risk Assessment of COVID-19 in Dental Practices.

Int J Environ Res Public Health 2021 11 22;18(22). Epub 2021 Nov 22.

Department of Preventive Dental Science, College of Dentistry, Jouf University, Sakaka 72345, Saudi Arabia.

The unprecedented situation of the coronavirus pandemic has impacted the entire world, with dental practice being significantly affected. In this study, we aim to evaluate the operational implications and risk assessment of the coronavirus in dental practice. This observational study comprised the electronic distribution of two surveys, one to patients and the second to dental professionals. The first questionnaire consisted of demographics along with 15 closed-ended questions. The second questionnaire consisted of demographics along with 43 questions from eight domains: financial impact, psychological impact, patient satisfaction, hygiene, patient management, COVID-19 lockdown, perspective, and practicing dentistry after the COVID-19 pandemic. The statistical analysis was performed using SPSS-25. A linear regression test was applied to assess the effect of the dependent variable (patient's satisfaction with the dental practice) on independent variables (age, gender, education). The ANOVA test was applied to assess the effect of the independent variables (financial impact, psychological impact, patient satisfaction, hygiene, patient management, lockdown, perspective, and post-COVID-19) on the dependent variables (age, gender, education, experience of dentists, qualification of dentists). A total of 711 patients and dental professionals participated in this study, with a response rate of 88.87%. Approximately 67.9% of the patients felt comfortable in the dental clinic, with 74.5% being satisfied with the dental clinic's services. The majority (77.4%) of the dentists were psychologically affected. Many of the participants chose to use masks, gowns, respiratory equipment, and face shields for protection. Teledentistry was preferred by the majority of dentists in non-emergency cases. Many of the dentists chose alternative procedures to minimize the generation of aerosols. The majority of the dentists suggested changes in the dynamics of dentistry in the post-COVID era, such as the suggestion that the management of the finances of a dental practice along with infection control protocols should be practiced more optimally. Patients and dental professionals were well aware of the necessary precautionary measures required to combat the coronavirus, as well as the implications of different operational measures along with performing risk assessment, keeping in mind the changing dynamics of dentistry.
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http://dx.doi.org/10.3390/ijerph182212244DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8619992PMC
November 2021

Prevalence of self-medication in children under-five years by their mothers in Yogyakarta city Indonesia.

J Family Med Prim Care 2021 Aug 27;10(8):2798-2803. Epub 2021 Aug 27.

Faculty of Pharmacy, UGM Yogyakarta, Indonesia.

Background: The trend of combating minor ailments at home in children is a common practice in Indonesia. When it comes to very smaller children like those of age under-five.

Aims: Consequences can be worse if not managed well. Self-medication among these children is not well studied in Yogyakarta, Indonesia.

Materials And Methodology: In this study a questionnaire-based random survey among different areas of Yogyakarta city from the mothers bearing children if age under five. Questionnaire were validated by three experts, for reliability test a pilot study conducted on 10 mothers, after that questionnaire used for data collection. Data were analyzed by using SPSS Descriptive analysis to get frequency and percentage.

Results: The overall prevalence reported is 58.82% (50/85). An increasing trend of self-medication was seen among high-higher secondary schools education mothers with 35.3%. In income factor 2600K-3000K mostly found in the self-medication. The residential area also seems influential upon this practice, i.e., 58.8% rural people depends on self-medication while urban people only 39.2% involved in self-medications.

Conclusion: As a large population of very small children is under this practice so, proper education of mothers especially in rural areas is needed for the appropriate use of medicines.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_2457_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483128PMC
August 2021

Combined role of industrialization and urbanization in determining carbon neutrality: empirical story of Pakistan.

Environ Sci Pollut Res Int 2022 Mar 9;29(11):15551-15563. Epub 2021 Oct 9.

Virtual University of Pakistan, Lahore, Pakistan.

A rapid process of industrialization, on the one hand, transformed the economies from agrarian to industrial societies to improve the living standards and welfare of people. On the other hand, the urbanized and industrialized economies have posed challenging threats to environmental sustainability. The query at hand is whether the growing environmental emissions are driven by industrialization and urbanization or not. This research aims to empirically examine the combined role of industrialization and urbanization in achieving carbon neutrality in Pakistan by considering foreign direct investment and economic growth as control variables in the model. The core empirical results are the following: firstly, industrialization and economic growth exhibit negative but statistically insignificant impacts on CO emissions, imparting a neutral role in determining the environmental degradation in Pakistan. Secondly, urbanization and foreign direct investment disclose positive and statistically significant (at 1% level of significance) impacts on CO emissions, manifesting an environmental degradation driving impact in the country. Thirdly, given the slope coefficients of urbanization and foreign direct investment (0.058 and 0.035), urbanization proved to be a stronger driver than foreign direct investment. Finally, foreign direct investment is revealed to make the Pakistani economy a "Pollution Haven" for the foreign enterprises in the country. Based on empirical results, none of the variables predicted the support for carbon neutrality in Pakistan.
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http://dx.doi.org/10.1007/s11356-021-16868-xDOI Listing
March 2022

An assessment of unstimulated salivary flow rate, IgA and clinical oral dryness among active and passive smokers.

Int J Occup Med Environ Health 2022 Feb 17;35(1):39-51. Epub 2021 Sep 17.

King Saud University, Riyadh, Saudi Arabia (Department of Prosthetic Dental Science, College of Dentistry).

Objectives: The aim of this study was to assess the impact of smoking on the whole salivary flow rate (SFR), IgA levels and clinical oral dryness (COD) among active and passive smokers.

Material And Methods: The participants were categorized as active smokers (N = 54) or passive smokers (N = 163). Saliva was collected in tubes and placed in ice storage at -70°C. Salivary IgA levels were assessed in duplication using the enzyme linked immunosorbent assay (ELISA) method. Following the saliva sample collection, the subjects were assessed for COD using the COD score, SFR and caries. Chi-square test, the t-test and ANOVA were employed to compare the clinical impact of the smoking status associated with specific variables (smoking status, number of cigarettes, active caries, gender, age, COD score, IgA level and SFR). A p-value of <0.05 was considered significant.

Results: Two hundred and seventeen subjects with the mean age of 32.86±6.30 years, with 145 males (66.8%) and 72 females (33.2%), were included in the study. Among the active smokers, 88.8% were males compared to 11.2% females. The active smokers had the mean age of 32.52 years, a COD score of 1.43, an IgA level of 1.39 g/l, and a SFR of 0.37 ml/min. Among the passive smokers, 59.5% were males and 40.5% were females, with the mean age of 32.97 years, a COD score of 0.87 g/l, an IgA level of 1.47, and a SFR of 0.42 ml/min. Active caries showed a positive correlation with the number of cigarettes, with significance in the >35 years age group (p < 0.05).

Conclusions: The study demonstrated significant differences in SFR, IgA and COD scores among the active and passive smokers. The number of cigarettes had a negative impact on saliva production, IgA levels, the oral health status, and the progression of caries with respect to age and gender. Smoking potentially leads to xerostomia associated with active caries. Int J Occup Med Environ Health. 2022;35(1):39-51.
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http://dx.doi.org/10.13075/ijomeh.1896.01829DOI Listing
February 2022

Editorial: Vitamin D Deficiency and Sufficiency in Reproduction and Bone Metabolism.

Front Endocrinol (Lausanne) 2021 6;12:740021. Epub 2021 Sep 6.

Department of Medicine, Rehman Medical Institute, Peshawar, Pakistan.

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http://dx.doi.org/10.3389/fendo.2021.740021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451175PMC
February 2022

Fit Accuracy of Removable Partial Denture Frameworks Fabricated with CAD/CAM, Rapid Prototyping, and Conventional Techniques: A Systematic Review.

Biomed Res Int 2021 6;2021:3194433. Epub 2021 Sep 6.

Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al Jouf 72345, Saudi Arabia.

Objective: Analyzing and comparing the fit and accuracy of removable partial denture (RPDs) frameworks fabricated with CAD/CAM and rapid prototyping methods with conventional techniques.

Materials And Methods: The present systematic review was carried out according to PRISMA guidelines. The search was carried out on PubMed/MEDLINE, Cochrane collaboration, Science direct, and Scopus scientific engines using selected MeSH keywords. The articles fulfilling the predefined selection criteria based on the fit and accuracy of removable partial denture (RPD) frameworks constructed from digital workflow (CAD/CAM; rapid prototyping) and conventional techniques were included.

Results: Nine full-text articles comprising 6 in vitro and 3 in vivo studies were included in this review. The digital RPDs were fabricated in all articles by CAD/CAM selective laser sintering and selective laser melting techniques. The articles that have used CAD/CAM and rapid prototyping technique demonstrated better fit and accuracy as compared to the RPDs fabricated through conventional techniques. The least gaps between the framework and cast (41.677 ± 15.546 m) were found in RPDs constructed through digital CAD/CAM systems.

Conclusion: A better accuracy was achieved using CAD/CAM and rapid prototyping techniques. The RPD frameworks fabricated by CAD/CAM and rapid prototyping techniques had clinically acceptable fit, superior precision, and better accuracy than conventionally fabricated RPD frameworks.
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http://dx.doi.org/10.1155/2021/3194433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8440078PMC
October 2021

Evaluation of golden percentage in natural maxillary anterior teeth width: A systematic review.

J Prosthet Dent 2021 Jul 31. Epub 2021 Jul 31.

Senior Lecturer, Division of Restorative Dentistry (Prosthodontics), School of Dentistry, International Medical University, Kuala Lumpur, Malaysia.

Statement Of Problem: The color and form of teeth are 2 of the 3 main determinants of success in an esthetic restoration; the third is dental proportion. A recent systematic review of the literature devoted to the evaluation of dental proportion is lacking.

Purpose: The purpose of this systematic review was to investigate the quality and outcome of studies into maxillary anterior tooth proportion and to determine whether dental proportion ratios based on different geographic regions are appropriate.

Material And Methods: An electronic search was conducted using PubMed, MEDLINE, Google Scholar, Embase, Scopus, Cochrane Library, Web of Science, and Science Direct databases. English-language articles reporting with the specific combination of medical subject heading (MeSH) key words were analyzed by 2 investigators. The titles, full text, and abstracts were scanned by investigators independently to identify articles that fulfilled the inclusion criteria. The general characteristics, outcomes, and quality of each study were reviewed and analyzed systematically.

Results: The search plan resulted in a total of 73 articles until September 2020; of which, 16 articles fulfilling the inclusion criteria were selected. The geographic distribution of the selected article revealed 12 articles from Asia, 2 from Continental Europe, and 2 from the United Kingdom. Golden percentage values of 25%, 15%, and 10% for central, lateral incisor, and canine teeth were not found. The mean predicted dental percentage was either larger or smaller than the successive widths of maxillary natural anterior teeth.

Conclusions: The golden percentage could not be used to formulate a smile design. Rather, the dental ratios should be set on a racial and ethnic basis for a population.
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http://dx.doi.org/10.1016/j.prosdent.2021.06.015DOI Listing
July 2021

Metformin in Combination With Chemoradiotherapy in Locally Advanced Non-Small Cell Lung Cancer: The OCOG-ALMERA Randomized Clinical Trial.

JAMA Oncol 2021 Sep;7(9):1333-1341

Juravinski Cancer Center, Hamilton Health Science, Hamilton, Ontario, Canada.

Importance: Unresected locally advanced non-small cell lung cancer (LA-NSCLC) shows poor survival outcomes even after aggressive concurrent chemoradiotherapy. Whether metformin, a diabetes agent that inhibits the mitochondria oxidative phosphorylation chain, could improve radiotherapy and chemotherapy response in LA-NSCLC remains to be studied.

Objective: To examine whether metformin, given concurrently with chemoradiotherapy and as consolidation treatment, could improve outcomes in patients with LA-NSCLC.

Design, Setting, And Participants: The Ontario Clinical Oncology Group Advanced Lung Cancer Treatment With Metformin and Chemoradiotherapy (OCOG-ALMERA) study was a multicenter phase 2 randomized clinical trial. Patients were stratified for stage IIIA vs IIIB LA-NSCLC and use of consolidation chemotherapy. The trial was designed to enroll 96 patients with unresected LA-NSCLC who did not have diabetes. The trial was conducted from September 24, 2014, to March 8, 2019.

Interventions: Patients were randomized to platinum-based chemotherapy, concurrent with chest radiotherapy (60-63 Gy), with or without consolidation chemotherapy or the same treatment plus metformin, 2000 mg/d, during chemoradiotherapy and afterward for up to 12 months.

Main Outcomes And Measures: The primary outcome was the proportion of patients who experienced a failure event (ie, locoregional disease progression, distant metastases, death, and discontinuation of trial treatment or planned evaluations for any reason within 12 months). Proportions were compared using a 2-sided Fisher exact test. Conventional progression-free and overall survival were estimated using the Kaplan-Meier method. Adverse events were graded with Common Terminology Criteria for Adverse Events, version 4.03. All randomized patients were included in an intention-to-treat analysis.

Results: The trial was stopped early due to slow accrual. Between 2014 and 2019, 54 patients were randomized (26 in experimental arm and 28 in control arm). Participants included 30 women (55.6%); mean (SD) age was 65.6 (7.6) years. Treatment failure was detected in 18 patients (69.2%) receiving metformin within 1 year vs 12 (42.9%) control patients (P = .05). The 1-year progression-free survival rate was 34.8% (95% CI, 16.6%-53.7%) in the metformin arm and 63.0% (95% CI, 42.1%-78.1%) in the control arm (hazard ratio, 2.42; 95% CI, 1.14-5.10) The overall survival rates were 47.4% (95% CI, 26.3%-65.9%) in the metformin arm and 85.2% (95% CI, 65.2%-94.2%) in the control arm (hazard ratio, 3.80; 95% CI, 1.49-9.73). More patients in the experimental arm vs control arm (53.8% vs 25.0%) reported at least 1 grade 3 or higher adverse event.

Conclusions And Relevance: In this randomized clinical trial, the addition of metformin to chemoradiotherapy was associated with worse treatment efficacy and increased toxic effects compared with combined modality therapy alone. Metformin is not recommended in patients with LA-NSCLC who are candidates for chemoradiotherapy.

Trial Registration: ClinicalTrials.gov Identifier: NCT02115464.
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http://dx.doi.org/10.1001/jamaoncol.2021.2328DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323053PMC
September 2021

Assessment of Unstimulated Whole Salivary Tumor Necrosis Factor Alpha (TNF-α) and Cellular Micronuclei Levels in Snuff (Naswar) Users and Non-Users for Early Diagnosis of Oral Squamous Cell Carcinoma.

Int J Environ Res Public Health 2021 07 6;18(14). Epub 2021 Jul 6.

Department of Prosthetic Dental Science, College of Dentistry, King Saud University, Riyadh 11545, Saudi Arabia.

The aim of the study was to investigate the unstimulated whole saliva (UWS) tumor necrosis factor alpha (TNF-α) and cellular micronuclei in snuff dippers (Naswar) compared to healthy control subjects. The case control study was conducted over 9 months at a tertiary care center. Sixty patients were divided into two groups: Snuff dippers (SD) (Naswar) and non-snuff dippers (NSD) (control subjects). The included self-reported SD used Snuff twice daily for more than 12 months. UWS was collected and salivary TNF-α assessment was performed using enzyme-linked immunosorbent assay (ELISA). For cellular micronuclei, buccal mucosa was brushed to obtain cells in Naswar users, fixed with a dibutylphthalate polystyrene xylene (DPX) mounting to view micronuclei. Means and standard deviations were compared using the t-test and outcomes were related using Pearson correlation, considering ≤ 0.05 as significant. The mean age of participants was 38.85 ± 11.56 years. The mean duration of snuff use was 20.43 ± 12.79 years and the common site for Naswar placement was the lower vestibule ( = 19, 63.3%). TNF-α levels among SD were 9.6 ± 3.3 pg/mL, which were significantly higher than levels in NSD, 5.2 ± 3 pg/mL ( < 0.05). The number of cellular micronuclei in SD was 30.7 ± 7.8, which was comparatively higher than in NSD, which was 9.2 ± 3.3 ( < 0.05). The duration of snuff use was positively correlated to TNF-α levels ( = 0.048) rather than the micronuclei number ( = 0.97). SD showed higher levels of TNF-α and cellular micronuclei compared with NSD (control subjects); a positive correlation was shown with the duration of snuff use. We conclude that TNF-α and micronuclei are potential salivary biomarkers for an oral biological effect in snuff (Naswar) users.
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http://dx.doi.org/10.3390/ijerph18147230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307060PMC
July 2021

Artificial Intelligence Techniques: Analysis, Application, and Outcome in Dentistry-A Systematic Review.

Biomed Res Int 2021 22;2021:9751564. Epub 2021 Jun 22.

Department of Preventive Dentistry, College of Dentistry, Jouf University, Sakaka, Al Jouf, 72345, Saudi Arabia.

Objective: The objective of this systematic review was to investigate the quality and outcome of studies into artificial intelligence techniques, analysis, and effect in dentistry.

Materials And Methods: Using the MeSH keywords: artificial intelligence (AI), dentistry, AI in dentistry, neural networks and dentistry, machine learning, AI dental imaging, and AI treatment recommendations and dentistry. Two investigators performed an electronic search in 5 databases: PubMed/MEDLINE (National Library of Medicine), Scopus (Elsevier), ScienceDirect databases (Elsevier), Web of Science (Clarivate Analytics), and the Cochrane Collaboration (Wiley). The English language articles reporting on AI in different dental specialties were screened for eligibility. Thirty-two full-text articles were selected and systematically analyzed according to a predefined inclusion criterion. These articles were analyzed as per a specific research question, and the relevant data based on article general characteristics, study and control groups, assessment methods, outcomes, and quality assessment were extracted.

Results: The initial search identified 175 articles related to AI in dentistry based on the title and abstracts. The full text of 38 articles was assessed for eligibility to exclude studies not fulfilling the inclusion criteria. Six articles not related to AI in dentistry were excluded. Thirty-two articles were included in the systematic review. It was revealed that AI provides accurate patient management, dental diagnosis, prediction, and decision making. Artificial intelligence appeared as a reliable modality to enhance future implications in the various fields of dentistry, i.e., diagnostic dentistry, patient management, head and neck cancer, restorative dentistry, prosthetic dental sciences, orthodontics, radiology, and periodontics.

Conclusion: The included studies describe that AI is a reliable tool to make dental care smooth, better, time-saving, and economical for practitioners. AI benefits them in fulfilling patient demand and expectations. The dentists can use AI to ensure quality treatment, better oral health care outcome, and achieve precision. AI can help to predict failures in clinical scenarios and depict reliable solutions. However, AI is increasing the scope of state-of-the-art models in dentistry but is still under development. Further studies are required to assess the clinical performance of AI techniques in dentistry.
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http://dx.doi.org/10.1155/2021/9751564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245240PMC
October 2021

Metabolic Changes in Early-Stage Non-Small Cell Lung Cancer Patients after Surgical Resection.

Cancers (Basel) 2021 Jun 16;13(12). Epub 2021 Jun 16.

St. Boniface Hospital Albrechtsen Research Centre, Winnipeg, MB R2H 2A6, Canada.

Metabolic alterations in malignant cells play a vital role in tumor initiation, proliferation, and metastasis. Biofluids from patients with non-small cell lung cancer (NSCLC) harbor metabolic biomarkers with potential clinical applications. In this study, we assessed the changes in the metabolic profile of patients with early-stage NSCLC using mass spectrometry and nuclear magnetic resonance spectroscopy before and after surgical resection. A single cohort of 35 patients provided a total of 29 and 32 pairs of urine and serum samples, respectively, pre-and post-surgery. We identified a profile of 48 metabolites that were significantly different pre- and post-surgery: 17 in urine and 31 in serum. A higher proportion of metabolites were upregulated than downregulated post-surgery ( < 0.01); however, the median fold change (FC) was higher for downregulated than upregulated metabolites ( < 0.05). Purines/pyrimidines and proteins had a larger dysregulation than other classes of metabolites ( < 0.05 for each class). Several of the dysregulated metabolites have been previously associated with cancer, including leucyl proline, asymmetric dimethylarginine, isopentenyladenine, fumaric acid (all downregulated post-surgery), as well as N6-methyladenosine and several deoxycholic acid moieties, which were upregulated post-surgery. This study establishes metabolomic analysis of biofluids as a path to non-invasive diagnostics, screening, and monitoring in NSCLC.
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http://dx.doi.org/10.3390/cancers13123012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234274PMC
June 2021
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