Crow Moon,τα κοράκια και άλλα πουλιά εμφανίζονται καθώς ο χειμώνας τραβάει το τέλος.March’s full moon is commonly called the Full Worm Moon. This is because of the earthworms that wriggle out of the ground as the earth begins to thaw in March.

One of its other names is the Chaste Moon, symbolizing the purity of early spring. The Pueblo tribe named it the Moon When the Leaves Break Forth, while in Shoshone culture it was known as the Warming Moon. Sometimes it is called the Crow Moon, after the crows and other birds that appear as winter draws to a close. Other times, it's called the Crust Moon, because of the snow that becomes crusty when it thaws in the sun and freezes in the moonlight. 

In India, March's full moon is also seen as a symbol of the arrival of spring, and coincides with the festival of Holi. This is a riotous party where Indian communities all around the world engage in a huge water fight. Everyone goes out into the streets and sprays each other with colored water and powders, singing and dancing with strangers and loved ones alike. Playing and feasting together is a chance for you to repair relationships that have gone bad, reaffirming your existing social bonds as you move forward together into the new year.

Clinical Practice

Clinical effect of balloon kyphoplasty in elderly patients with multiple osteoporotic vertebral fracture Q Liu, J Cao, JJ Kong Nigerian Journal of Clinical Practice 2019 22(3):289-292 Objective: This study aims to discuss the clinical effect of balloon kyphoplasty on elderly patients with multiple osteoporotic vertebral fractures. Methods: The observation group was treated with balloon kyphoplasty, and the control group was managed with conservative treatment. Image indices, pain degree, daily life disturbance, and occurrences of complications were compared between the two groups. Results: In total, 116 elderly patients with multiple osteoporotic vertebral fracture admitted in our hospital from January 2016 to June 2017 were chosen and divided randomly into observation (n = 58) and control groups (n = 58). The observation group showed a significantly higher trailing edge, leading edge, and midcourt line and larger upper thoracic kyphosis compared with the control group (P < 0.05). Before the treatment, no statistically significant differences were observed between the two groups in terms of visual analog scale (VAS) score and daily life disturbance score (P > 0.05). However, the VAS score and the daily life disturbance score of the two groups decreased sharply after the treatment (P < 0.05). Moreover, the VAS score and the daily life disturbance score of the observation group were significantly lower than those of the control group (P < 0.05). The observation group showed lower occurrence rate of complications compared with the control group (P < 0.05). Conclusions: Balloon kyphoplasty can significantly improve the image indices of patients with multiple osteoporotic vertebral fractures and relieve their pain degree and daily life disturbance. Balloon kyphoplasty exhibited a low occurrence rate of complications and high safety and is, thus, worthy of clinical applications.

A cross-sectional study of cytomegalovirus retinitis in HIV-1 infected adults in Nigeria MA Adeiza, AG Habib Nigerian Journal of Clinical Practice 2019 22(3):293-297 Background: Cytomegalovirus (CMV) retinitis is one of the most important opportunistic infections in HIV-infected patients in developing countries before the introduction of highly active antiretroviral therapy. In Nigerian and African HIV populations, CMV retinitis is under-reported. Patients and Methods: In a cross-sectional study, 250 HIV-infected adults ≥18 years were recruited by systematic random sampling from March to August 2013. Using a structured questionnaire, information was obtained on socio-demographic characteristics and symptoms of visual impairment. HIV disease was staged according to the WHO clinical staging, and CD4+ T-lymphocyte count was measured. Participants with symptoms of impaired vision and/or CD4+ T-lymphocyte count <50 cells/μL had indirect ophthalmoscopic examination of the retina to detect CMV related eye lesions. Results: Two hundred and fifty adults were HIV-infected, out of which 114 (46%) were males and 136 (54%) were females. The mean age of study participants was 35 years. History of impaired vision was reported by 21 (8.4%) of participants. The right eye was involved in 7 (33%), the left eye in 4 (19%), and both eyes in 10 (48%) of participants. The predominant symptoms were blurred vision 9 (43%), floaters 9 (43%), and blindness 3 (14%). Among participants who had indirect ophthalmoscopy, 3 (1.2%) had characteristic retinal changes suggestive of CMV retinitis. Two (67%) of patients with CMV retinitis were females and 1 (33%) was male. Mean CD4+ count was 25.33 ± 14.19 and all were WHO HIV clinical stage 4 with death occurring within 6 months of diagnosis. Conclusion: CMV retinitis though rare is associated with advanced HIV disease and attendant morbidity and mortality. We recommend integration of CMV diagnostic services and ophthalmological services as routine in HIV care and treatment programs in Nigeria targeted toward high-risk patients.

Factors associated with intraventricular hemorrhage among preterm neonates in Aminu Kano teaching hospital CC Egwu, WN Ogala, ZL Farouk, AM Tabari, AH Dambatta Nigerian Journal of Clinical Practice 2019 22(3):298-304 Background: Intraventricular hemorrhage (IVH) is a severe complication among preterm neonates which can result in hydrocephalus, cerebral palsy, behavioural disorders, learning disabilities, or death. It is important to identify the factors associated with IVH in order to prevent these neurological consequences and reduce the resultant burden of neurological disease. Aim: To determine the factors associated with IVH among preterm neonates. Design: The study was prospective cross-sectional in design. Subjects and Methods: Ninety-nine preterm neonates who were < 37 completed weeks of gestation were recruited consecutively from the Special Care Baby Unit of a Tertiary Hospital. Transfontanelle ultrasonography was used to detect IVH and the factors associated with IVH were classified into: neonatal, maternal (prenatal), and clinical factors. Data were analyzed using SPSS version 16.0 for windows. Chi-squared test and Fisher's exact probability test were used as appropriate. The level of significance was set at P < 0.05. The association between these factors and IVH was evaluated by univariate and multivariate logistic regression analyses. Results: Among the 99 preterm neonates studied, 36 (36.4%) of them were between 28 and 31 weeks of gestation, whereas 63 (63.6%) were between 32 and 36 weeks of gestation. In univariate analysis, the factors found to be associated with IVH were lower gestational age <32 weeks gestation, low Apgar score of <3 in 1 and 5 min, respectively, outborn status of neonates, lower social class, need for respiratory support, and blood transfusion. However, the lower gestational age (odds ratio [OR]: 10.9, 95% confidence interval [CI]:1.95–61.04) and respiratory support (continuous positive airway pressure (CPAP)) [OR: 52.24; CI: 3.40–721.84] were retained as significant predictors of IVH in the multivariate logistic regression model. Conclusion: The lower gestational age and respiratory support (CPAP) are independent predictors for IVH. Prevention of preterm delivery and improvement in interventions of neonatal care (CPAP) are necessary to prevent the risk for IVH especially in the early preterm neonates.

Primary molar pulpotomies with different hemorrhage control agents and base materials: A randomized clinical trial G Atasever, TI Keceli, S Uysal, HC Gungor, S Olmez Nigerian Journal of Clinical Practice 2019 22(3):305-312 Objective: To evaluate the clinical and radiographical success of primary molar pulpotomies which used 15.5% ferric sulfate (FS) or 1.25% sodium hypochlorite (NaOCl) for hemostasis and zinc oxide–eugenol (ZOE) and calcium hydroxide (CH) pastes as base materials. Methods: In 29 healthy children, 80 primary molars were randomly allocated to one of the study groups: Group 1: FS-ZOE, Group 2: FS-CH, Group 3: NaOCl-ZOE, and Group 4: NaOCl-CH. After hemostasis with the respective solutions, pulp stumps and floor of the pulp chambers were covered with either ZOE or CH pastes. All teeth were restored with stainless steel crowns. Follow-up examinations were carried out at 1, 3, 6, and 12 months. Results: One tooth in Group 1 and two teeth in Group 4 were extracted because of pain and periapial pathosis at sixth month. After 12 months, clinical success rates of pulpotomies in Groups 1–4 were 95%, 100%, 100%, and 89.5%, respectively. The differences were not significant (P = 0.548). Radiographic success rates for Groups 1–4 were 80%, 88.9%, 78.9%, and 84.2%, respectively. No statistically significant difference was found (P = 0.968). Pain on percussion was the most observed clinical finding. However, internal root resorption was the most common radiological finding and it was observed significantly more in mandibular primary molars (P < 0.05). Conclusion: Both ZOE and CH can be preferred as base materials after hemostasis achieved by the use of 15.5% FS or 1.25% NaOCl in primary tooth pulpotomy.

In Vitro evaluation of the wear of primary tooth enamel against different ceramic and composite resin materials A Bolaca, Y Erdogan Nigerian Journal of Clinical Practice 2019 22(3):313-319 Background: Although there are several studies on permanent tooth wear caused by dental materials, studies concerning primary teeth are limited. Aim: To evaluate the wear of primary tooth enamel against different ceramic and composite resin materials. Settings and Design: In vitro study. Materials and Methods: We assessed five materials (n = 10 per group): monolithic zirconia (group Z), lithium disilicate glass ceramic (group L), resin nanoceramic (group R), nanohybrid composite resin (group C), and primary tooth enamel (group E). The mesiopalatal cusps of primary maxillary second molars were used as antagonists. Wear tests were performed in a dual-axis chewing simulator, and the volume loss in the antagonist tooth was evaluated using a laser scanner and three-dimensional profiling system. Statistical Analysis Used: Data were statistically analyzed using one-way analysis of variance with Tukey's post hoc tests (P < 0.05). Results: The maximum antagonist tooth wear was observed in group L (3.84 ± 0.7 mm3), followed by groups C (3.68 ± 0.76 mm3), R (3.48 ± 0.71 mm3), Z (2.66 ± 0.65 mm3), and E (1.66 ± 0.42 mm3). Volume loss was significantly lesser in group Z than in groups L and C (P < 0.05), whereas there were no significant differences among groups L, C, and R. Conclusion: Within the limitations of this in vitro study, our findings suggest that zirconia should be used for full coronal coverage in primary tooth restorations because it causes lesser antagonist tooth wear than does lithium disilicate, resin nanoceramic, and nanohybrid composite resin.

The evaluation of preoperative and postoperative fetuin-A levels in patients with primary hyperparathyroidism M Keskin, C Culha, NE Gulcelik, LI Al, M Senes, Y Aral Nigerian Journal of Clinical Practice 2019 22(3):320-327 Objectives: Our objective was to evaluate preoperative and postoperative serum fetuin-A levels in female patients with primary hyperparathyroidism (PHPT) and search for the relationship with parathyroid hormone (PTH) and vitamin D (25OHD). Although a role for fetuin-A is suggested in regulating bone mineralization, its function has not been completely defined. Materials and Methods: In this cross-sectional study, 43 female patients with PHPT and 30 healthy women were recruited as the control group. We evaluated 73 women because we had only women patients with PHPT. Of the 43 patients, 10 symptomatic and 23 asymptomatic patients were surgically treated, whereas 10 patients were not operated. In all 43 patients, 25OHD, PTH, fetuin-A levels, and bone mineral densitometry were evaluated. The biochemical parameters of 33 operated patients were reevaluated at the postoperative sixth week. Results: Fetuin-A levels of the patients with PHPT were significantly higher than that in the controls (56.6 ± 13.8 vs. 42.6 ± 20.7 ng/mL; P = 0.010). Fetuin-A levels of the operated patients were higher than nonoperated group. Furthermore, serum fetuin-A levels of the nonoperated patients were not different from those of controls. After parathyroidectomy, fetuin-A (41.5 ± 25.2 vs. 56.4 ± 13.7 ng/mL; P = 0.003), PTH [80.0 (51.5–137.5) vs. 211.0 (151.5–278.5) pg/mL; P < 0.001], and calcium (9.2 ± 0.7 vs. 10.7 ± 0.8 mg/dL; P < 0.001) values were found to be decreased significantly. Conclusion: In this study, fetuin-A levels of patients with PHPT were higher than those of the controls and significantly decreased after parathyroidectomy compared with the preoperative levels. Fetuin-A levels could be a beneficial marker to determine the changes in bone metabolism of the patients with PHPT and to detect the patients suitable for surgery.

Evaluation of the influence of various restoration techniques on fracture resistance of endodontically treated teeth with different cavity wall thicknesses ET Basaran, Y Gokce Nigerian Journal of Clinical Practice 2019 22(3):328-334 Aims: The aim of this study was to compare the effect of different restoration techniques on fracture resistance of endodontically treated teeth with different wall thicknesses. Materials and Methods: Extracted and endodontically treated 210 premolars were randomly divided into three thickness groups [2 mm (A), 1.5 mm (B), and 1 mm (C)] and, each group was further divided into seven restoration subgroups (n = 10): direct composite (control) (K), composite with fiber on cavity floor (KT), composite with fiber on occlusal level (KO), fiber post and composite (FP), inlay (L), fiber on cavity floor and inlay (LT), and inlay and fiber on occlusal level (LO). Fracture test was performed, and data were compared with Kruskal–Wallis and Mann–Whitney U tests (P < 0.05). Results: There were no differences between the subgroups in A and C statistically (P > 0.05). However, in B, KO subgroup showed statistically higher values (P = 0.039). Conclusion: Wall support of 2 mm was adequate, and support of 1 mm was completely insufficient. When the wall thickness was 1.5 mm, direct restoration with fiber at the occlusal level significantly improved resistance.

Effect of different surface treatments and ceramic primers on shear bond strength of self-adhesive resin cement to zirconia ceramic NE Saleh, MC Guven, G Yildirim, F Erol Nigerian Journal of Clinical Practice 2019 22(3):335-341 Aims: To evaluate the effect of different surface treatments and ceramic primers on the shear bond strength (SBS) of self-adhesive resin cement to zirconia ceramic. Materials and Methods: A total of 40 zirconia discs (10 mm in diameter and 3 mm in height; StarCeram Z-Med, H.C. Starck, Selb, Germany) were prepared from pre-sintered zirconia blocks. Discs were divided into two groups according to surface treatment: (a) airborne particle abrasion (sandblasting) with 50-μm Al2O3 particles and (b) 9.5% hydrofluoric acid etching. Each of these groups was subdivided into two groups according to the type of primer applied: (a) Z-Prime Plus primer and (b) Clearfil Ceramic Primer. A self-adhesive resin cement (Multilink Speed, Ivoclar Vivadent, Schaan, Liechtenstein) was used to bond with polyethylene molds. All specimens were tested at thermocycled (5000 cycles at 5–55°C for 30 s) conditions. The SBS of the luting cement to the ceramic was measured in a universal testing machine (1 mm/min). Results: The sandblasted groups showed significantly higher SBS values than the acid-etched groups for both primers (P = 0.0001). Independent of the surface treatment, the Z-Prime Plus primer groups showed higher SBS values than the Clearfil Ceramic Primer groups (P = 0.0001). Conclusions: Sandblasting is a more effective method to increase bond strength on zirconia ceramics than hydrofluoric acid etching, and the application of Z-Prime Plus primer increases SBS better than Clearfil Ceramic Primer.

Clinical and radiographic characterization of primary seminomas and nonseminomatous germ cell tumors L Gu, L Zhang, N Hou, M Li, W Shen, X Xie, Y Teng Nigerian Journal of Clinical Practice 2019 22(3):342-349 Background: Primary malignant mediastinal germ cell tumors (PMMGCTs) including seminomas and nonseminomatous germ cell tumors (NSGCTs) are rare, and sometimes the diagnosis is very difficult. Purpose: The purpose of this study is to compare the clinical characteristics, biomarkers, and imaging findings of seminomas and NSGCTs and to determine whether these features could help distinguish these two types of PMMGCT. Material and Methods: A retrospective study of 24 male patients with histopathologically proven PMMGCT was performed. We collected the information of computed tomography (CT) (the scan area ranged from the apex of lung to the costophrenic angles) and magnetic resonance imaging blood test and histology characteristics of these patients. Results: Twelve of 24 cases were confirmed to be seminomas, whereas the other 12 cases were NSGCTs. Alfa-fetoprotein (AFP) was found to be elevated in all patients with NSGCT, whereas none of the patients with seminomas had elevated AFP level. Beta-human chorionic gonadotropin (β-HCG) level was elevated in all the patients with seminomas (seven/seven), whereas in NSGCT only two of seven patients had elevated β-HCG. Lactate dehydrogenase level was increased in five of the nine patients with seminomas, as well as in the eight patients with NSGCT. CT imaging revealed that 12 masses from the seminoma group were homogeneous, soft tissue opacity and showed minimal contrast enhancement. On the contrary, all 12 NSGCT cases showed cystic and solid masses; on contrast-enhanced CT, heterogeneous enhancement was found on the capsule of the tumor, septum, and solid masses. Conclusion: Seminomas and NSGCT showed different profiles of tumor biomarkers and radiographic features. Evidence from serum test, histopathological analysis, and imaging should be combined to ensure the accurate diagnosis of these two types of PMMGCT.

An In-vitro study on thermal changes during implant drilling with different irrigation volumes U Mercan, M Sumer, OA Kaya, I Keskiner, DG Meral, O Erdogan Nigerian Journal of Clinical Practice 2019 22(3):350-354 Objective: Irrigation with saline is one of the essential methods for reducing the heat generated during dental implant osteotomy. High irrigation volume impairs visibility of the surgical field, thus complicates the surgery. In this study, we aimed to determine the optimal irrigation volume for heat reduction during dental implant drilling. Materials and Methods: Thirty-two implant osteotomies were prepared on four fresh cow ribs. Heat generated during the final implant drilling was measured both with infrared thermography and thermocouple method. Initial and maximum temperatures were measured at four different irrigation volumes; 32, 44, 56, and 68 ml/min. Results: Both measurement methods showed that the amount of temperature rise is associated with the irrigation volume during implant drilling. There is no further decrease in temperature rise above irrigation volume of 56 ml/min. Conclusion: Saline irrigation with 56 ml/min provides sufficient heat reduction during dental implant drilling and higher irrigation volumes are not necessary.

Pharmacognosy

Quality assessment of pollen typhae by high-performance liquid chromatography fingerprint, hierarchical cluster analysis, and principal component analysis Xin Ma, Haimiao Zou, Yibin Pan, Jing Su, Yujiao Qiu, Mingfeng Qiu Pharmacognosy Magazine 2019 15(61):177-182 Aim: This study aims to establish the quality assessment methods of Pollen Typhae. Materials and Methods: High performance liquid chromatography (HPLC) fingerprint analysis, hierarchical cluster analysis (HCA), and principal component analysis (PCA) were used for quality evaluation of Pollen Typhae from different origins together with microscopic identification. Then, the quantity of 43 crude Pollen Typhae samples in the market was collected and analyzed. Results: In true and false test, four False Pollen Typhae samples, 13 Net Pollen Typhae (NPT) samples, and 26 Grass Pollen Typhae (GPT) samples were identified by microscopic identification. In quality test, the amounts and percentages of Qualified Pollen Typhae, Unqualified Pollen Typhae were 24 (55.81%) and 19 (44.19%), respectively with typhaneoside and isorhamnetin-3-O-neohesperidoside determined by HPLC according to China Pharmacopeia. We analyzed 43 samples from 20 regions and established their fingerprints, then selected 31 peaks as characteristic peaks and calculated their relative peak areas. To express the HPLC fingerprints quantitatively, peak 16, 18, 22, 23, and 26 were verified as typhaneoside, isorhamnetin-3-O-neoheptanoside, rutin, quercetin, and isorhamnetin. The similarity of correlation coefficients in chromatogram was 0.954 ± 0.007 and 0.922 ± 0.004 for NPT and GPT, respectively, while 0.67 ± 0.008 for 43 samples. The analysis of HCA and PCA can distinguish true or false, qualified or unqualified of Pollen Typhae. Conclusion: HPLC fingerprint combined with HCA and PCA provides a very efficient and comprehensive method for quality evaluation of Pollen Typhae. Abbreviations used: HCA: Hierarchical cluster analysis; PCA: Principal component analysis; FPT: False Pollen Typhae; NPT: Net Pollen Typhae; GPT: Grass Pollen Typhae; QPT: Qualified Pollen Typhae; UPT: Unqualified Pollen Typhae; RSDs: The relative standard deviations; CASE: Computer Aided Similarity Evaluation; TCM: Traditional Chinese medicine.

Chamuangone-enriched Garcinia cowa leaf extract with rice bran oil: Extraction and cytotoxic activity against cancer cells Pirunrat Sae-Lim, Supreeya Yuenyongsawad, Pharkphoom Panichayupakaranant Pharmacognosy Magazine 2019 15(61):183-188 Background: Chamuangone has been isolated from Garcinia cowa leaves and exhibited various biological activities, i.e., antibacterial, anti-Leishmania major, and cytotoxic activity against cancer cells. n-Hexane has been reported to be the most suitable solvent for extraction of chamuangone. Objectives: Some vegetable oils were determined as an alternative green solvent for extraction of an anticancer compound, chamuangone from G. cowa leaf. The chamuangone-enriched extract was standardized and evaluated for cytotoxic activity against human cancer cell lines. Materials and Methods: Microwave-assisted extraction and high-performance liquid chromatography were used for extraction and standardization. The cytotoxic activity was determined using a sulforhodamine B assay. Results: The chamuangone-enriched extract was obtained using rice bran oil as the alternative green solvent and standardized to contain 1.97 mg/mL chamuangone. The extract exhibited cytotoxic activity against human lung adenocarcinoma, human breast adenocarcinoma, and human colorectal adenocarcinoma cell lines, with IC50 values of 15.3, 15.9, and 12.8 μg/mL, respectively, but was nontoxic to human gingival fibroblasts, a normal cell line, at a concentration of 50 μg/mL. Moreover, the extract contained several natural antioxidants, including α-tocopherol (76.7 mg/100 g), γ-oryzanol (cycloartenol ferulate: 67.1 μg/mL and 24-methylenecycloartanol ferulate: 85.6 μg/mL), and antioxidant capacity determined as ascorbic acid (258.7-mM ascorbic acid equivalent per gram). Conclusion: Based on these findings, the chamuangone-enriched extract may be considered as a novel functional food in cancer chemopreventive action. Abbreviations used: AAE/g: Ascorbic acid equivalent per gram; CEO: Chamuangone-enriched Garcinia cowa leaf extract with rice bran oil; DMEM: Dulbecco's Modified Eagle Medium; FBS: Fetal bovine serum; HGF: Human gingival fibroblasts; HPLC: High-performance liquid chromatography; IC50:50% Inhibitory concentration; MAE: Microwave-assisted extraction; MHz: Megahertz; MUFAs: Monounsaturated fatty acids; NMR: Nuclear magnetic resonance; ODS: Octadecylsilane; PUFAs Polyunsaturated fatty acids; SD: Standard deviation; SFAs: Saturated fatty acids; SRB: Sulforhodamine B; TCA: Trichloroacetic acid; UFAs: Unsaturated fatty acids; UV: Ultraviolet; W: Watt.

Impact of ginsenoside-Rg3 on catecholamine secretion in the perfused model of the rat adrenal medullae Ki-Hwan Kim, Hyo-Jeong Lim, Young-Jae Ki, Dong-Yoon Lim Pharmacognosy Magazine 2019 15(61):189-198 Background: The present study was the first attempt to explore the characteristics of ginsenoside-Rg3 (Rg3) on release of catecholamines (CA) in the perfused rat adrenal medullae and also to verify the underlying action mechanism. Materials and Methods: The adrenal medulla was separated by some modification of the previous method and perfused with Krebs solution. CA was assayed directly by the fluorometry. Results: Rg3 reduced acetylcholine (ACh)-produced CA release in a dose- and time-dependent manner. Rg3 time-dependently depressed CA release produced by 3-(m-chloro-phenyl-carbamoyl-oxy)-2-butynyltrimethyl ammonium chloride (McN-A-343), 1,1-dimethyl-4-phenyl piperazinium iodide, and angiotensin II. In the presence of Rg3, the CA release produced by high K+, veratridine, cyclopiazonic acid, and methyl-1,4-dihydro-2,6-dimethyl-3-nitro-4- (2-trifluoromethyl-phenyl)-pyridine-5-carboxylate (Bay-K-8644) was also markedly suppressed. However, during the simultaneous perfusion of Rg3 and Nω-nitro-l-arginine methyl ester hydrochloride (l-NAME), the release of CA produced by ACh, angiotensin II, Bay-K-8644, and veratridine was restored closely to the level of each control, in contrast to that of Rg3-treatment alone. The nitric oxide (NO) release was significantly elevated by Rg3-treatment. Furthermore, in the coexistence of Rg3 and fimasartan, ACh-produced CA release was more significantly reduced as compared to that of fimasartan-treatment alone. Conclusions: We present the first evidence that Rg3 markedly depresses the CA secretion produced by activation of neuronal cholinergic and angiotensinergic receptors. Rg3-produced inhibition appears to be evoked not only by blocking the inflow of Na+ and Ca2+ into adrenomedullary cells but also by preventing the Ca2+ release from intracellular storage, partly through enhancement of NO release by NO synthase activation. Coadministration of Rg3 and fimasartan may be clinically beneficial for the treatment of cardiovascular diseases. Abbreviations used: Rg3: Ginsenoside-Rg3; VDCC: L-type voltage-dependent Ca2+ channels; Bay–K-8644: Methyl-1,4-dihydro-2,6-dimethyl-3-nitro-4-(2-trifluoromethyl-phenyl)-pyridine-5-carboxylate; ACh: Acetylcholine; McN-A-343: 3-(m-chloro-phenyl-carbamoyl-oxy)-2-butynyltrimethyl ammonium; DMPP: 1.1-dimethyl-4-phenyl piperazinium; NO: Nitric oxide; L-NAME: Nω-nitro-l-arginine methyl ester; nNOS: Neuronal NO synthase.

New bioactive C15 acetogenins from the red alga Laurencia obtusa Mohamed A Ghandourah, Walied M Alarif, Nahed O Bawakid Pharmacognosy Magazine 2019 15(61):199-203 Background and Objective: With regard to the uniqueness of the red algae of the genus Laurencia as the source of C15-acetogenins, along with the diversity of biological applications; the acetogenin content of the Red Sea Laurencia obtusa was investigated. Materials and Methods: Fractionation and purification of the CH2Cl2/MeOH extract were carried out by applying several chromatographic techniques, including column and preparative thin-layer chromatography; followed by a series of 1H nuclear magnetic resonance measurements to give rise of some interesting notes. Toxicity to Artemia salina was evaluated. The apoptosis induced by these two compounds was demonstrated by DNA fragmentation assay and microscopic observation. Results: A new rare chloroallene-based C15 acetogenin, laurentusenin (1) along with a new furan ring containing C15 acetogenin, laurenfuresenin (2), were isolated from the red alga L. obtusa. Comparing 1D and 2D NMR, MS, ultraviolet and infrared radiation spectral data for the newly isolated compounds with the reported bromoallene containing acetogenins spectral data was played the crucial role for characterization of their chemical structures. 1 and 2 exhibited bare toxicity (LD50 >12 mM) in test organism, A. salina and induced apoptotic death confirmed by DNA fragmentation and microscopic investigations. Conclusion: The isolated metabolite 1 showed unusual substituted allene side chain, while 2 inserted furan ring as a new acetogenin nucleus. Both compounds may play a role in apoptosis induction and initiation and propagation of inflammatory responses. Abbreviations used: NMR: Nuclear magnetic resonance; MS: Mass spectrometry; UV: Ultraviolet spectroscopy; IR: infrared radiation; EIMS: Electron ionization mass spectra; TLC: Thin-layer chromatography; PPP: Platelet poor plasma; PRPDS: platelet-rich plasma derived serum. DEPT: Destortionless Enhancement by Polarization Transfer; NOESY: Nuclear Overhauser Effect Spectroscopy; HSQC: Heteronuclear Single Quantum Coherence; HMBC: Heteronuclear Multiple-quantum Correlation; 1H-1H COSY: Correlation Spectroscopy.

A new antifungal aminobenzamide derivative from the endophytic fungus Fusarium sp. Sabrin R M. Ibrahim, Gamal A Mohamed, Maan T Khayat, Rwaida A Al Haidari, Amal A El-Kholy, Mohamed F Zayed Pharmacognosy Magazine 2019 15(61):204-207 Background: Endophytic fungi attracted attention as a prolific source of bioactive natural products with a potent pharmaceutical activity and unique structure. Objective: The main goal of the study is to separate and identify the bioactive constituents from the endophytic fungus Fusarium sp. as well as to evaluate the antimicrobial of the new metabolites. Materials and Methods: The fungus was cultured on a rice medium, and then, the cultures were extracted with ethyl acetate (EtOAc). The EtOAc extract was chromatographed utilizing different chromatographic methods to give five metabolites. The structural determination of these metabolites was carried out by the analyses of various spectroscopic data, in addition to comparison with the formerly reported data. The antifungal and antibacterial potentials were evaluated toward various microbial strains using disc diffusion assay. Results: A new aminobenzamide derivative, namely fusaribenzamide A (2), and four known metabolites: (22E,24R)-stigmasta-5,7,22-trien-3-β-ol (1), adenosine (3), p-hydroxyacetophenone (4), and tyrosol (5) were isolated. Fusaribenzamide A (2) possessed significant antifungal activity toward Candida albicans with minimum inhibitory concentration (MIC) value 11.9 μg/disc compared to nystatin (MIC 4.9 μg/disc). Conclusion: The endophytic fungus Fusarium sp. could be considered as a wealthy pool for the isolation of aminobenzamide derivatives. Fusaribenzamide A may be a candidate for the discovery of a promising antifungal agent. Abbreviations Used: CC: Column chromatography; CHCl3: Chloroform; COSY: Correlations spectroscopy; DBE: double bond equivalent; EtOAc: Ethyl acetate; DMSO: Dimethyl sulfoxide; H2SO4: Sulfuric acid; HMBC: Heteronuclear multiple bond correlation experiment; HRMS: High-resolution mass spectrometry; HRESIMS: High-resolution electrospray ionization mass spectrometry; HSQC: Heteronuclear single quantum correlation; IR: Infrared; IZD: Inhibition zone diameter; KBr: Potassium bromide; LTQ: Linear trap quadrupole; MeOH; Methanol; MIC: Minimum inhibitory concentration; NMR: Nuclear magnetic resonance; RP: Reversed phase; SiO2: Silica gel; TLC: Thin-layer chromatography; UV: Ultraviolet; VLC: Vacuum liquid chromatography.

Optimization of infrared-assisted extraction of bioactive lactones from Saussurea lappa L. and their effects against gestational diabetes Karim Raafat, Nada El-Darra, Fatima A Saleh, Hiba N Rajha, Nicolas Louka Pharmacognosy Magazine 2019 15(61):208-218 Background: Saussurea lappa (S. lappa, Asteraceae) have immunomodulatory effects and used in the management of many metabolic disorders. Gestational diabetes is one of the metabolic disorders affecting globally one in seven pregnant women. Objectives: The aim of the current study is to optimize an infrared-assisted extraction (IR-AE) method for S. lappa bioactive constituents, phytochemically investigate its content, isolate its most active constituent, and to assess their biological effects against gestational diabetes. Materials and Methods: To optimize IR-AE conditions, four main factors were studied including solvent concentration, extraction time, powder size, and IR power in the yielded extract (SL-IR). Reversed-phase high-performance liquid chromatography coupled with bio-guided fractionation and isolation procedures using 1H and 13C NMR method were utilized. Solid–liquid (SL-SLE) and ultrasound (SL-US) extraction methods were also done. Results: The optimal IR-AE extraction conditions were found to be 20% aqueous phase concentration, 60-min extraction time, 70 mesh powder size, and 70 W IR power. Phytochemically, four major lactones were identified, including costunolide, dehydrocostuslactone, isoalantolactone, and alantolactone (ATL). ATL was the most active lactone. SL-IR, SL-US, SL-SLE, or ATL showed a significant (P < 0.05) and dose-dependent hypoglycemia in pregnant diabetic group, adequate fetus weight percentage elevation and did not show any external anomalies. The best control of gestational diabetes, insulin secretagogue potentials, elevation in serum catalase and reduced glutathione levels, and lipid peroxidation decrease were demonstrated by SL-IR 250 mg/Kg. The antioxidant and the insulin secretagogue activities might be among the main mechanisms, whereby the SL-IR controls gestational diabetes and decreases offspring anomalies. Conclusion: Currently, it is the first time to optimize an IR-AE method for extracting bioactive lactones from S. lappa. The optimized IR-AE technique has shown to be a rapid and efficient extraction method with SL-IR showing superiority in controlling gestational diabetes for pregnant groups coupled with high safety profile on the offspring. Abbreviations used: IR-AE: Infrared-assisted extraction; SL: Saussurea lappa, S. lappa; SL-IR: Saussurea lappa infrared extract; SL-US: Saussurea lappa ultrasound extract; SL-SLE: Saussurea lappa solid–liquid extract; ATL: Alantolactone; NDC: Nondiabetic control; DC: Diabetic control; MTF: Metformin; TBARS: Thiobarbituric acid; GSH: Reduced glutathione; CAT: Catalase; APA: Adequate for pregnancy age; LPA: Large for pregnancy age; SPA: Small for pregnancy age.

Dictamnus dasycarpus Turcz., root bark alleviates oxazolone-induced atopy-like dermatitis in mice Beodeul Yang, Ji Hyo Lyu, Sura Kim, Young Chul Park, Koanhoi Kim, Hyungwoo Kim Pharmacognosy Magazine 2019 15(61):219-225 Background: Dictamnus dasycarpus Turcz., is one of the most frequently used herbal medicine to treat dermatosis associated with psoriasis, pruritus, scabies, and eczema. Objective: We investigated the anti-inflammatory effects of D. dasycarpus extract (DDE) using a mouse model with atopic dermatitis (AD)-like dermatitis. Materials and Methods: The therapeutic effects of DDE on skin lesion, tone of color, and inhibitory effects on histopathological changes and cytokine production in skin tissues were assessed in mice with AD-like dermatitis induced by oxazolone. Results: Topical application of DDE alleviated skin lesions such as erythema, scaling and excoriations, and ameliorated erythema and the melanin index. In addition, DDE effectively prevented skin enlargement induced by oxazolone, while also preventing epidermal hyperplasia, spongiotic change, and hyperkeratosis and reducing the production of tumor necrosis factor-alpha and interleukin (IL)-4 and IL-5 in inflamed tissues. Finally, DDE did not affect changes in body weight and spleen–body weight ratio relative to dexamethasone. Conclusion: These results indicate that D. dasycarpus can be used as a topical agent for inflammatory skin diseases with relative safety. Abbreviation used: HM: Herbal medicine; DNFB: Dinitrofluorobenzene, ICAM-1: Intercellular adhesion molecule-1, AD: Atopic dermatitis, DDE: Dictamnus dasycarpus extract, AOO: Vehicle composed of acetone and olive oil, DEX: Dexamethasone, CBA: Cytometric bead array.

Antidepressant-like effects of methanol extract and fractions of Hypericum juniperinum kunth in the forced swimming test Laura A Mejía-Agudelo, Maritza A Rojas, Mario F Guerrero-Pabón, Freddy A Ramos, Leonardo Castellanos, Juan Camilo Marín-Loaiza Pharmacognosy Magazine 2019 15(61):226-231 Background: Some members of the genus Hypericum have been shown to demonstrate antidepressant-like effects. In Colombia, approximately 54 species of Hypericum have been reported, and only a few have been investigated chemical and pharmacologically. Objective: The aim of this study was to evaluate the antidepressant-like effects of a methanol extract, as well as ethyl acetate and butanol fractions, obtained from aerial parts of Hypericum juniperinum K. Materials and Methods: Behavioral and locomotor activities were evaluated in the open field test (OFT). Antidepressant-like activity was measured in the forced swimming test (FST) in male Swiss albino mice. Preliminary phytochemical screening as well as a high-performance liquid chromatography (HPLC) profile of the active fractions of H. juniperinum was performed. Results: Treatment with the methanol extract at 500 mg/kg and the ethyl acetate and butanol fractions at 150 and 300 mg/kg resulted in a decrease in the immobility times in FST. In the OFT, none of the treatments presented altered behavior or locomotor activity of mice. Preliminary phytochemical screening identified terpenes/steroids, flavonoids, phenol derivatives, tannins, and saponins. In the HPLC analysis of the fractions, rutin, quercitrin, and quercetin were identified with the help of coinjection of standards. Conclusion: This is the first report of the antidepressant-like activity of extracts and fractions obtained from H. juniperinum in the FST model of depression. Flavonoids may be responsible for the antidepressant-like action of H. juniperinum. Abbreviations used: FST: Forced swimming test; HJE: Methanol extract of Hypericum juniperinum; HJEAF: Ethyl acetate fraction obtained from the methanol extract of Hypericum juniperinum; HJEBF: Butanol fraction obtained from the methanol extract of Hypericum juniperinum; HPE: Methanol extract of Hypericum perforatum; HPLC: High-performance liquid chromatography; IMI: Imipramine; MeOH: Methanol; OFT: Open field test; tR: Retention time; UV: Ultra violet; VEH: Vehicle.

Biological evaluation and molecular docking study of metabolites from Salvadora Persica L. Growing in Egypt Mohammed M Ghoneim, Wael M Afifi, Mohamed Ibrahim, Mohamed Elagawany, Maan T Khayat, Mohamed H Aboutaleb, Ahmed M Metwaly Pharmacognosy Magazine 2019 15(61):232-237 Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a resistant staph bacterium to several antibiotics causing several lives-threating diseases such as pneumonia and sepsis. Meswak, Salvadora persica, exhibited promising antimicrobial properties before. Objective: Exploring the anti-MRSA activity of S. persica L. metabolites and its mechanism of action on a molecular level. Materials and Methods: Structure elucidation of the isolated metabolites was carried out by spectroscopic data (one-dimensional and two-dimensional nuclear magnetic resonance). The biological activities of the isolated metabolites against MRSA were evaluated and the molecular mode of action against the dehydrosqualene synthase enzyme have been done. Results: Four compounds have been isolated and identifies to be; apigenin (1), luteolin (2), astragalin (3), and kaempferol-3-O-rhamnoside (4). Compounds 1–4 showed good anti-MRSA activities with IC50 values of 10.3, 11.5, 3.5, and 4.5 μg/mL, respectively. In consistent, astragalin and kaempferol-3 rhamnoside showed close high docking scores. Herein, we are reporting the molecular determinates of activity of these new scaffolds as anti-MRSA, which would be of great importance to developing new anti-MRSA candidates. Abbreviations Used: 1D: One-dimensional; 2D: Two-dimensional; CC: Column chromatography; COSY: Correlations spectroscopy; DMSO: Dimethyl sulfoxide; HMBC: Heteronuclear multiple-bond correlation experiment; HRESIMS: High-resolution electrospray ionization mass spectrometry; HSQC: Heteronuclear single-quantum correlation; IR: Infrared; MRSA: Methicillin-resistant Staphylococcus aureus; NMR: Nuclear magnetic resonance; RP: Reversed phase; TLC: Thin-layer chromatography; UV: Ultraviolet; VLC: Vacuum liquid chromatography.

Ameliorative effects of tannic acid on lipopolysaccharide-induced sepsis and acute lung injury in mice Ruirui Zhang, Minyan Dang, Shoutian Qiu, Hongyan Gu, Pingping He, Gang Guo, Tao Zhang Pharmacognosy Magazine 2019 15(61):238-243 Background: Acute lung injury (ALI) caused by endotoxins is a severe complication causing lethal conditions. Prevention of the inflammatory response is necessary to overcome this condition. Tannic acid is a polyphenol known for its pharmacological properties such as antioxidant, antimicrobial, anti-inflammatory, anticancer, antitumor, and antimutagenic. This study aims to investigate the anti-inflammatory mechanism of tannic acid on lipopolysaccharide (LPS)-induced sepsis and ALI in mice. Materials and Methods: Male BALB/c mice were divided into five groups (n = 12) and induced with LPS (50 mg/kg body weight) and treated with tannic acid (25, 50, and 100 mg/kg) after 1 h. The bronchoalveolar lavage fluids were collected to determine the myeloperoxidase activity and levels of inflammatory cytokines (tumor necrosis factor-α, interleukin [IL]-6, and IL-1 β). Nuclear factor-kappa-β (NF-κβ) activities were examined through Western blot analysis, and hematoxylin and eosin staining was done for histopathological alterations of lung tissues. Results: Results of the study showed that tannic acid was able to prevent the infiltration of inflammatory cells and cytokines into the site of ALI which is also connected to the suppression of NF-κβ activation as shown in the Western blot analysis. The histopathological results further support these results. The safety of tannic acid was also proven on the survival of RAW264.7 cells. Conclusion: The anti-inflammatory mechanism of tannic acid on LPS-induced ALI and sepsis can be credited to the inhibition of inflammatory cytokines production mediated by NF-κβ pathway suppression. Abbreviations used: ALI: Acute lung injury; BALFs: Bronchoalveolar lavage fluids; NO: Nitric oxide; COX-2: Cyclooxygenase-2; iNOS: Inducible nitric oxide synthase; TNF-α: Tumor necrosis factor-α; IL-1β: Interleukin-1 β; IL-6: Interleukin-6.

Oral Research and Review

Oral Health Status of Martyr Memorial Residential School Children of Sunsari, Nepal Santosh Kumari Agrawal, Ashish Shrestha, Tarakant Bhagat Journal of Oral Research and Review 2019 11(1):1-6 Context: Students, who are healthy, active, and well nourished, are likely to attend schools regularly which accelerate their learning process. Poor oral health has a profound effect on general health and quality of life. Aims: The aim of this study was to assess the oral health status of Martyr Memorial Residential School Children of Sunsari, Nepal, during 5-year period and also to assess the effectiveness of school oral health program. Settings and Design: A retrospective longitudinal study was carried out among Martyr Memorial Residential School children. Subjects and Methods: Aretrospective longitudinal study was performed among 411 school children of Martyr Memorial Residential School, Sunsari, Nepal. Five years' data of children were collected from the department record forms from 2009 to 2014. Data on demographic parameters, oral health condition (Decayed, Missing, and Filled Teeth [DMFT], oral hygiene status, type of dentition, malocclusion, and diet history), and treatment done for each child were collected from the surveyed forms. Statistical Analysis Used: Frequency distribution, prevalence, and incidence of dental caries were calculated. Results: This study showed that the prevalence of dental caries in 2009, 2010, 2011, 2012, 2013, and 2014 was 21.0%, 23%, 29.1%, 10.0%, 13.5%, and 30.9%, respectively. The incidence of dental caries in permanent dentition was high (22.0%) in 2011 follow-up. None of the dentition developed new cavity in 2010 follow-up period. More than half of the children had good oral hygiene status in 2012, whereas only 32.9% had so in 2009. Majority (95.5%) of the enrolled children had normal occlusion. Conclusions: This study showed the overall positive impact on the children's prevalence and incidence of dental caries as well as on oral hygiene status. The incidence of developing new caries in both types of dentition decreased. There was an increase in filled component of DMFT/decayed, filled teeth index. Most of them had good oral hygiene status at the end of the study.

Assessment of child's mental health problems using Strengths and Difficulties Questionnaire Miranda George, Shweta Chandak, Milind Wasnik, Sneha Khekade, Niharika Gahlod, Harshita Shukla Journal of Oral Research and Review 2019 11(1):7-11 Background: While a number of studies in the Western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like India. Aim: The aim of this study was to assess the patients' emotional status in an age group of 3–14 years to evaluate children's cooperative potential. Methodology: The Goodman's Strengths and Difficulties Questionnaire assessing the mental health status of the child was distributed to the Vidharbhan population attending the dental hospital. A cross-sectional survey including 168 children aged 3–14 years who were instructed how to fill the questions participated in the study. Results: Overall 53% of the children belonged to the normal category, whereas 33% and 14% were under abnormal and borderline categories, respectively. The abnormal category was slightly higher in the age groups of 3.1–5 (35%) and 11.1–14 (28%) years. Similar to certain studies, the mental health problems with males (52.9%) were higher than that of females (47.6%). Conclusion: Identifying the mental health problems of the child seeking dental treatment will help the dentist to formulate an idea of the child's emotional status at the time of treatment and thereby make proper amendments during the treatment procedure. There is a need for developing programs to train, sensitize, and mobilize teachers and parents regarding children's psychological, emotional, and behavioral problems, with special attention to the common population.

The importance of oral health education in patients receiving orthodontic treatment Emad E M. Alzoubi, Valentina Tabone Borg, Gabriella Gatt, Anne Marie Aguis, Nikolai Attard Journal of Oral Research and Review 2019 11(1):12-19 Introduction: Evaluation of the effectiveness of a well-targeted educational campaign specially designed toward the improvement of oral health and maintenance of removable orthodontic appliances should be considered during an orthodontic treatment. Objectives: The objective of this study was to assess the impact of the oral hygiene protocol on oral health through assessing plaque accumulation on the removable orthodontic appliance, to establish the impact of oral hygiene protocol on oral health through assessing the patients' plaque accumulation on the tooth surface and gingival bleeding, and to evaluate the degree of halitosis between the intervention and control groups. Materials and Methods: The study involved 80 patients who were equally assigned to the intervention and control removable orthodontic treatment groups. Data were collected by means of questionnaires, soft-tissue examination, breath checker, and staining the appliance with methylene blue disclosing solution. Results: The plaque score of both groups at Review 2 emphasized a significant difference (P = 0.021), yet neither differences at baseline (P = 0.989) nor Review 1 (P = 0.786) were found. The odor score of both groups at Review 2 showed a significant difference (P = 0.012). All interventional patients and only 10% of the control group patients were aware of appliance removal during sport. There was no significant difference (P = 0.211) between the responses of patients concerning the cleaning method of the appliance. The patients showed a higher user rate of mouthwash, and they were more successful with respect to when it should be used. Conclusion: The effectiveness of an educational session has been demonstrated in some aspects of the research.

Comparative evaluation of two suturing models for preclinical training Triveni Kale, Shruti Shankarrao Lendhey, Varsha Ranmare, Govind Bhartiya, Anuja Hudwekar, Pranav Lendhey Journal of Oral Research and Review 2019 11(1):20-24 Introduction: Demonstration and training on the live subject are not always an optimal means of introducing students to suturing technique. The use of live patient as a test subject is not acceptable with today's ethical standard. It would be advantageous to use a preclinical training model that impersonates real-life conditions, through which manual dexterity and a high degree of psychomotor skill can be achieved. This helps to master the suturing technique under semi-realistic circumstances at an affordable cost. The model most closely resembling the actual condition should be considered. Materials and Methods: A total of 54 postgraduate students participated in the study. The material required for both the models were distributed among participants and asked to prepare the models. Then, suturing was performed on models, and the questionnaires were given for feedback. Model 1: Require orange peel, alginate impression material, and dental stone. Model 2: Require mackintosh, sponge, alginate impression material, and glass slab. Depending on the questionnaire, response results were calculated. Results: All participants experienced that glass slab model was more durable than the orange model. Thirty-six participants experienced that orange model is easy to prepare compared to glass slab model. There was a significant linear trend among the ordered categories seen using Chi-square test. Conclusion: According to the participant's preference orange model was better in all aspects such as ease of preparation, the passage of suture needle, and the time required for suturing compared to glass slab model which was more durable and less gaping experienced with it. Hence, we concluded that orange model was better for preclinical suturing training.

Salivary duct carcinoma of minor salivary gland: A case report with review of literature Arshdeep Kaur, Chetan Dev Singh Boparai, Anusha Rangare Lakshman, Gogineni Subhas Babu Journal of Oral Research and Review 2019 11(1):25-28 Salivary duct carcinoma (SDC) is a rare, highly aggressive neoplasm representing about 1%–3% of all malignant salivary gland tumors. Approximately, 85% of the cases occur in the parotid gland followed by the submandibular gland and minor salivary gland. Pathomorphologically, these tumors showed great similarities to ductal carcinoma of the female breast, which is why they described this tumor as “SDC.” This article highlights a case of rapidly growing swelling in the left mandibular region in a 60-year-old female. As this entity is rare and highly aggressive, an early detection followed by appropriate treatment is very important to improve the survival rate of the patient.

Acquired maxillary double lip Chaithra Kalkur, Krishna Burde, Anusha R L, Nilofer Halim, Atul Sattur Journal of Oral Research and Review 2019 11(1):29-31 Double lip is a rare deformity of the face, which can occur as congenital and acquired anomaly. It most often appears as syndromic variety along with systemic manifestations. It is a rare occurrence with slight male predilection. This article is a report of a 20-year-old female presented with the acquired double upper lip for 1 year developed after orthodontic treatment.

Is drug substitution always a solution? Phenytoin induced gingival enlargement – A case report Chandni Gupta, Ritika Arora, Himani Sharma Journal of Oral Research and Review 2019 11(1):32-36 Gingival enlargement is the most common side effect which is reported with the administration of the anti-epilepsy drug phenytoin (PHT). It is of vital importance as it greatly affects the esthetics and also interferes with the mastication and oral hygiene practices. It is now well known that the presence of gingival inflammation resulting from poor oral hygiene acts as a major risk factor and leads to worsening the condition. Therefore, the patients taking PHT should be made aware of the possible outcomes and the importance of maintaining oral hygiene and periodontal maintenance therapy. This case report describes a case of PHT-induced gingival enlargement in which surgical intervention was done to correct the gingival enlargement, and in spite of patient not discontinuing the drug (PHT), no recurrence of enlargement was seen even after 1 year.

Endodontic management of badly broken down tooth with radix entomolaris using the canal projection technique Huma Iftekhar Journal of Oral Research and Review 2019 11(1):36-40 The management of teeth with minimal coronal structure can be a challenging task when root canal treatment is required as a part of oral rehabilitation. Coronal leakage, isolation complexities, and risk of interappointment coronal-radicular fracture may be major contributors to endodontic failure. It is a great challenge to an endodontist to maintain root canal patency while isolating grossly destructed tooth with open pulp chamber, without blocking the root canals with restorative material. Pre-endodontic build-up of the coronal tooth structure following caries removal and identification of all the canal orifices while maintaining the canal patency can facilitate the endodontic process by providing a strong core and coronal seal. Hence, a restoration before endodontic treatment is mandatory during management of these teeth. This can be achieved successfully by the canal projection technique, wherein a tapered plastic sleeve is used to maintain the canal patency, projecting the canal from pulp chamber to cavosurface margin. Taking into consideration the limited worldwide availability and cost of original projectors, the aim of the present case is to highlight a simple yet effective method of placement of a pre-endodontic restoration using the canal projection technique by custom made plastic sleeves. This case report demonstrates the use of an innovative technique for canal projection, as an efficient method for managing complex cases.

An update on nicotine replacement therapy KA Kamala, S Sankethguddad, SG Sujith Journal of Oral Research and Review 2019 11(1):41-47 Tobacco use is the single greatest preventable cause of death in the world. Most tobacco users want to quit but find it difficult to stop due to the addictiveness of nicotine. Interventions for tobacco cessation are important in enabling tobacco users to stop using, which includes pharmacological and nonpharmacological approaches to aid tobacco cessation. Pharmacological approaches include nicotine replacement therapy (NRT) and nonnicotine medications (bupropion and varenicline). NRT delivers nontoxic forms of nicotine to help tobacco user's deal with nicotine cravings and maintains stimulation of the nicotine receptors. Forms of delivery for NRT include the following: nicotine chewing gum, nicotine lozenge, transdermal patch, nicotine inhaler, nicotine nasal spray, and nicotine sublingual tablets. These NRTs are in general well tolerated and have minimal adverse effects. The present review gives an overview about various modes of NRT methods currently used to treat nicotine dependence.

Periodontal implications of argyrophilic nucleolar organizer region: A mini reviewPeriodontal implications of argyrophilic nucleolar organizer region: A mini review Vandana Kharidi Laxman, GS Madhushankari, Mini Saluja, Shivani Singh Journal of Oral Research and Review 2019 11(1):48-51 The periodontal lesions with cellular proliferation can be assessed by various methods. One of the methods to determine the proliferative activity is silver-staining argyrophilic nucleolar organizer region (AgNOR) staining. AgNOR can be used as diagnostic and prognostic tool for many of periodontal lesions which are proliferative in nature and may be quantitative marker of incipient cellular alterations before the histologic hallmarks appear. Hence, this paper reviewed about the periodontal applications of AgNOR staining.

Oral Oncology

Patient access to voice prostheses and heat and moisture exchangers: Factors influencing physician's prescription and reimbursement in eight European countries Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): A.C.C. Beck, V.P. Retèl, M.W.M. van den Brekel, W.H. van Harten Abstract Objectives Patient access to the voice prosthesis and heat and moisture exchanger (HME) is not always guaranteed in Europe. Therefore, the aim of this qualitative study is to evaluate factors influencing physician's prescription and reimbursement of these devices in eight European countries, and to identify barriers of and facilitators to effective patient access. Materials and methods In this mixed methods study, we conducted a survey among stakeholders evaluating prescription (Part 1 of the survey), reimbursement (Part 2), and barriers of and facilitators to effective patient access (Part 3). Part 1 was completed by head and neck surgeons employed in France, Germany, the United Kingdom, Italy, Spain, Belgium, the Netherlands and Poland. Part 2 and 3 were completed by medical device company representatives in respective countries, followed by semi-structured interviews. Results Based on the survey, filled in by 36 surgeons, all prescribed the voice prosthesis. Four surgeons didn't prescribe the HME in Italy and Poland due to lack of both reimbursement and experience/training, and feeling uncomfortable with device use. Most restrictive factors (e.g. increased workload, insufficient staff) occurred in countries with decentralized healthcare systems including Spain and Italy. Conclusion Non-HME-usage was influenced by economical and physician-related factors. Restrictive factors were related to limited regional device reimbursement and provision. Nationwide reimbursement, guideline implementation, support for physicians by training/education and providing a rehabilitation team will increase device use.

Results of a combination treatment with intensity modulated radiotherapy and active raster-scanning carbon ion boost for adenoid cystic carcinoma of the minor salivary glands of the nasopharynx Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Sati Akbaba, Dina Ahmed, Kristin Lang, Thomas Held, Matthias Mattke, Juliane Hoerner-Rieber, Klaus Herfarth, Stefan Rieken, Peter Plinkert, Juergen Debus, Sebastian Adeberg Abstract Objectives We aimed to present the first clinical results for adenoid cystic carcinoma (ACC) of the nasopharynx after primary radiotherapy (RT) with the focus on local control (LC) and patterns of recurrence. Materials and methods We retrospectively analyzed 59 patients with ACC of the nasopharynx, who were treated with bimodal radiotherapy (RT) consisting of intensity modulated radiotherapy and carbon ion boost at the Heidelberg Ion-Beam Therapy Center between 2009 and 2018. The patients had predominantly inoperable (n = 42, 72%) or incompletely resected (n = 17, 29%) tumors. Kaplan-Meier estimates and the log-rank (Mantel-Cox) test were used for univariate and multivariate analyses. Results The median follow-up was 32 months. At last follow-up, 67% of the patients were still alive (n = 39/58), of whom 74% were free of progression (n = 29/39). The 2-year LC, distant progression-free survival (DPFS) and overall survival (OS) were 83%, 81%, 87% and the estimated 5-year LC, DPFS and OS were 49%, 54%, 69%, respectively. LC was significantly inferior in patients with large tumor volumes (gross tumor volume, GTV > 100 cc, p = 0.020) and T4 tumors (p = 0.021). The majority of the recurrences occurred at the margin, where critical structures were spared (n = 11/19, 58%). Overall, grade 3 toxicity was moderate with 12% acute and 8% late side effects. Conclusion Bimodal RT including active raster-scanning carbon ion boost for nasopharyngeal ACC resulted in adequate LC and OS rates with moderate toxicity. T4 stage, large tumor volume and the necessary dose sparing in critical structures, i.e. optic nerves, brain stem and orbit, negatively affected LC.

Quality insurance in head and neck cancer multidisciplinary team meetings: A watchful eye on real-life experience Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Jean-Baptiste Guy, Marouan Benna, Yaoxiong Xia, Elisabteh Daguenet, Majed Ben Mrad, Omar Jmour, Nicolas Vial, Yann Lelonge, Pierre Fournel, Jean-Michel Prades, Alexis Vallard, Nicolas Magné Abstract Introduction Although Multidisciplinary Team Management (MDT) is integrated in most international head and neck cancer treatment guidelines, its applications and proceedings were rarely described. The present study explores a 6-year real-life experience in a French Comprehensive Cancer Care Center. Methods Patients, tumor and meeting characteristics of all consecutive cases discussed in head and neck MDT meetings between 2010 and 2015 were retrospectively reviewed. Results From 2010 to 2015, 1849 cases (accounting for 1786 patients) were discussed in 138 MDT meetings. Median age was 62 (range: 15–96). When reported (n = 310, 16.8%), performance status was ≥2 in 36.1% of patients. Tumors were mainly squamous cell carcinomas (n = 1664, 91.5%) of the larynx/hypo-pharynx (n = 630, 34.4%), oropharynx (n = 518; 28.3%) and oral cavity (n = 339; 18.5%). Tumors were diagnosed at a locally (n = 358, 25%), locally advanced (n = 946, 66%) or metastatic setting (n = 53, 3.7%). Mean number of discussed patients per MDT meeting was 16 (range: 3–32). Most patients were discussed once (n = 1663, 97%). Most patients (n = 969, 52%) underwent treatment before MDT meetings: mainly surgery (n = 709, 73.2%). The mean time between MDT meeting and first radiation course was 21 days (range: 1–116). Discussion Optimal multimodal treatment management is based on MDT meetings and results from the interaction and coordination of surgeons, medical and radiation oncologists. In the present series, most patients were discussed once despite the number of expected recurrences, suggesting that the management of tumor progression was not discussed in head and neck MDT meetings. Furthermore, most patients had surgery before MDT meeting, pointing out that MDT role and place still needs to be improved. Finally, the present population significantly differed from patients included in phase III clinical trials, with more advanced age and poorer condition. It calls for the necessity of a high-quality head and neck MDT meeting since evidence-based recommendations should be adapted to patient's frailties.

Time trends of thyroglobulin antibody in ablated papillary thyroid carcinoma patients: Can we predict the rate of negative conversion? Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Eyun Song, Jonghwa Ahn, Hye-Seon Oh, Min Ji Jeon, Won Gu Kim, Won Bae Kim, Young Kee Shong, Jung Hwan Baek, Jeong Hyun Lee, Jin Sook Ryu, Ki Wook Chung, Suck Joon Hong, Tae Yong Kim Abstract Objectives Persistence of thyroglobulin antibody (TgAb) in patients with papillary thyroid carcinoma (PTC) years after total thyroidectomy (TT) followed by ablation occurs even without any evidence of structural disease. Few studies have studied the natural course of TgAb positivity and factors that may influence this course. The present study evaluated the time trends of TgAb in ablated PTC patients and aimed to identify the predictive factors for the rate of negative conversion of TgAb. Materials and methods Overall, 1279 patients who underwent TT and subsequent ablation for PTC, with available data on thyroid peroxidase Ab (TPOAb) and TgAb prior to surgery (preop-) and ablation (abl-) were enrolled. Patients with initial distant metastasis or recurrence during follow-up were excluded. Results and conclusion Preop-TgAb was positive in 24.9% of patients (n = 319), whereas abl-TgAb positivity decreased to 12.8% (n = 164). In 164 patients positive for abl-TgAb, TgAb in patients with higher abl-TgAb levels decreased more gradually than those observed in patients with lower abl-TgAb levels (p < 0.001). Furthermore, in patients within the same range of abl-TgAb levels, patients positive for abl-TPOAb had a higher rate of negative conversion of TgAb compared with negative patients for abl-TPOAb (log rank p < 0.001). TPOAb significantly increased the rate of negative conversion in multivariate analysis adjusted for abl-TgAb (odds ratio 1.59, 95% confidence interval 1.11–2.28, p = 0.011). This study clearly showed that abl-TgAb titers and abl-TPOAb status can predict the rate of negative conversion. These findings can guide the optimal timing for additional examination in patients positive for TgAb during follow-up.

Differences of tumor-recruiting myeloid cells in murine squamous cell carcinoma influence the efficacy of immunotherapy combined with a TLR7 agonist and PD-L1 blockade Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Hidetake Tachinami, Naoto Nishii, Yulong Xia, Yoshihisa Kashima, Tatsukuni Ohno, Shigenori Nagai, Lixin Li, Walter Lau, Kei Tomihara, Makoto Noguchi, Miyuki Azuma Abstract Objectives The immune status of the tumor microenvironment has a marked impact on clinical outcomes. Here we examined the immune environments of tumor-infiltrating leukocytes (TILes) in two murine models of squamous cell carcinoma and compared the effects of immunotherapeutic agents, including a TLR7 agonist and an immune checkpoint inhibitor, and a chemotherapeutic agent, gemcitabine, in these models. Materials and methods TILes from NR-S1- and SCCVII-grafted mice were analyzed by flow cytometry. NR-S1-inoculated mice received resiquimod (a synthetic TLR7 agonist), an anti-PD-L1 antibody, or both, and tumor growth and TILs were examined. Gemcitabine was administered to deplete CD11b+ cells. Results More than 50% of TILes from NR-S1- and SCCVII-inoculated mice were CD11b+Gr-1+ cells. A major fraction of NR-S1 CD11b+ cells was Ly6GhighLy6Clow-negaF4/80− tumor-associated neutrophils (TANs) and the majority of SCCVII CD11b+ cells were Ly6GlowLy6C−F4/80+ tumor-associated macrophages. NR-S1 TANs did not express MHC class II and CD86, but did express reactive oxygen species and PD-L1. Resiquimod, alone and in combination with an anti-PD-L1 antibody, did not regress NR-S1 tumors, but the combination increased the CD8/regulatory T cell-ratio, and IFN-γ and PD-1 expression in CD8+ TILes. Pre-administration of low-dose gemcitabine prior to the combination treatment suppressed the progression of NR-S1 tumors. Conclusions NR-S1 tumors with abundant recruitment of TANs were resistant to treatments with a TLR7 agonist, alone and in combination with PD-1 blockade, and required an additional gemcitabine treatment. The phenotype and status of tumor-infiltrating CD11b+ myeloid cells may influence the efficacy of immunotherapeutic agents.

Patient-reported outcomes of symptom burden in patients receiving surgical or nonsurgical treatment for low-intermediate risk oropharyngeal squamous cell carcinoma: A comparative analysis of a prospective registry Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Moran Amit, Kate Hutcheson, Jhankruti Zaveri, Jan Lewin, Michael E Kupferman, Amy C Hessel, Ryan P Goepfert, G. Brandon Gunn, Adam S Garden, Renata Ferraratto, C. Dave Fuller, Samantha Tam, Neil D. Gross Abstract Purpose To explore treatment-related changes in symptom burden and quality of life (QOL) in oropharyngeal squamous cell cancer (OPSCC) patients treated surgically and non-surgically. Patients and Methods Eighty-six patients with human papillomavirus–associated OPSCC treated at the Head and Neck Center at The University of Texas MD Anderson Cancer Center were recruited to a prospective registry study between 2014 and 2016 and completed the core, head and neck-specific, and symptom interference sections of the MD Anderson symptom inventory (MDASI) multi-symptom questionnaire and the EQ-5D health status assessment as a measure of QOL at four time points. Results Longitudinal improvements from post-treatment nadir were observed across all groups. For patients treated with single modality, symptom interference, but not core and head and neck specific, MDASI scores were significantly better at 6 months in patients treated with surgery than radiation (P = 0.04). For patients treated with multiple modalities, scores for each of the three domains (i.e., core, head and neck -specific, and interference MDASI) were significantly better in the surgical group than the nonsurgical group at treatment completion (P = 0.0003, P = 0.0006 and P = 0.02) and 6 weeks (P = 0.001, P = 0.05 and P = 0.04), but not 6 months (P = 0.11, P = 0.16 and P = 0.040). No significant differences in EQ5D health status were observed between groups at any time point, reflecting similar overall QOL in all groups. Conclusion Symptom burden and QOL improves after treatment in OPSCC survivors over time regardless of whether primary surgical or nonsurgical treatment is used, although acute symptom profiles may differ.

Patterns of EBV-positive cervical lymph node involvement in head and neck cancer and implications for the management of nasopharyngeal carcinoma T0 classification Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Wei-Jie Luo, Yan-Fen Feng, Rui Guo, Ling-Long Tang, Lei Chen, Guan-Qun Zhou, Wen-Fei Li, Xu Liu, Ying Sun, Ai-Hua Lin, Jun Ma, Yan-Ping Mao Abstract Objectives Epstein-Barr virus (EBV)-positive cervical lymph node (CLN) metastasis of unknown primary origin is classified as nasopharyngeal carcinoma (NPC) T0 by the American Joint Committee on Cancer staging manual (8th edition). We aimed to investigate the possible primary sites and patterns of EBV-positive CLN metastases and to provide implications for the management of NPC T0 classification. Materials and methods We retrospectively reviewed 269 patients with newly diagnosed EBV-positive CLN metastatic disease who underwent EBV detection via EBV-encoded RNA in situ hybridization. Fifteen patients with unknown primary tumors underwent follow-up after initial treatment. Results In patients with EBV-positive CLNs, the most common primary sites after the nasopharynx (51.7%) were the salivary gland (24.5%), lung (7.8%), oropharynx (3.3%), nasal cavity/maxillary (3.3%), oral cavity (2.2%), orbit (1.1%), and liver (0.4%). No primary site was found in 15 patients (5.6%). For salivary gland malignancies, level II and I were the most frequently involved regions. Tumors arising from the lung or liver metastasized to the lower neck (level IV, V, and VI) rather than the upper neck. After initial treatment, 2/15 patients with EBV-positive CLNs of unknown primary exhibited primary NPC and oropharyngeal tumor, respectively. Further, even without prophylactic irradiation to the nasopharynx, only one of 13 unknown primary patients developed NPC. Conclusions The origins of EBV-positive CLNs may not be restricted to the nasopharynx alone, and are likely to involve the head and neck or non-head and neck regions. NPC T0 classification should be cautiously assigned to such tumors.

Human papillomavirus detection in matched oral rinses, oropharyngeal and oral brushings of cancer-free high-risk individuals Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Maria Gabriella Donà, Barbara Pichi, Francesca Rollo, Maria Benevolo, Alessandra Latini, Valentina Laquintana, Raul Pellini, Manuela Colafigli, Mirko Frasca, Massimo Giuliani, Antonio Cristaudo Abstract Objectives The detection of oral Human Papillomavirus (HPV) may be of clinical utility because of the major role HPV plays in the etiology of oropharyngeal cancer. However, oral HPV testing is not standardized and the best sampling method has yet to be identified. We aimed to compare HPV findings in matched oral rinse-and-gargles (rinses), oropharyngeal brushings and oral brushings. Materials and methods HPV-DNA was investigated using Linear Array in samples collected from cancer-free individuals at increased risk for oral HPV. Results 163 oral rinses already tested for HPV were selected. The matched oropharyngeal (n = 163) and oral brushings (n = 100) were analyzed. The detection rate for any HPV, high-risk (HR)-HPVs and HPV16 was significantly higher in rinses than brushings. The overall agreement for any HPV between rinses and oropharyngeal brushings was 51.2% (Cohen K: 0.14, 95% CI: 0.07–0.21). The proportion of positive agreement was 16.8%. The overall agreement for HR-HPVs was 74.1% (Cohen K: 0.20, 95% CI: 0.07–0.33). The genotype-specific profile of rinses and brushings which were concomitantly HPV-positive only partially overlapped in cases with multiple infections, with more genotypes detected in the rinse, which were not isolated in the corresponding brushings. Conclusion The agreement for HPV status between rinses and brushings is poor, particularly for the HPV-positive findings. Despite the fact that the origin of the HPV-infected cells present in the oral rinse is unclear, since they could not be traced back to the oropharynx or oral cavity, oral rinses provided the highest detection rate for HR-HPVs and HPV16.

The prognosis of head and neck squamous cell carcinoma related to immunosuppressive tumor microenvironment regulated by IL-6 signaling Publication date: April 2019 Source: Oral Oncology, Volume 91 Author(s): Ming-Shao Tsai, Wen-Cheng Chen, Chang-Hsien Lu, Miao-Fen Chen Abstract Evasion of immune surveillance is a significant factor in head and neck squamous cell carcinoma (HNSCC) carcinogenesis. IL-6 signaling is a critical mechanism for the induction of dysfunctional immune responses. In the present study, we examined the role of IL-6 in the prognosis of HNSCC regarding the immunosuppressive tumor microenvironment. We retrospectively analyzed the clinical outcomes of HNSCC patients and examined its correlation with the levels of IL-6 in tumors and circulating myeloid-derived suppressor cells (MDSCs) in peripheral blood. Furthermore, the relationships between IL and 6, programmed death ligand (PD-L1) expression, and immune response were examined in vitro and in vivo. Our data revealed that IL-6 overexpression was associated with the increased risk of developing disease failure and poor prognosis for HNSCC. The immunoreactivity of IL-6 in HNSCC specimens was positively linked to the staining of PD-L1 and the level of circulating MDSCs. By cellular and animal experiments, there were augmented radiation-induced increases in the expression of PD-L1 and the activation of MDSCs noted in IL-6-positive tumors. When IL-6 signaling was inhibited, the levels of PD-L1 and MDSC recruitment were significantly down-regulated. Furthermore, the neutrophil-to-lymphocyte ratio (NLR) was positively correlated with the levels of IL-6 and PD-L1 in tumor, and circulating MDSCs. In conclusion, IL-6 is a significant predictor of treatment outcome in HNSCC patients, and plays an important role in the induction of immunosuppressive tumor microenvironment mediated by increased MDSCs and PD-L1 expression. Furthermore, IL-6 combined with NLR can assist the clinician to make an informed decision regarding treatment options.

Organ preservation in laryngeal and hypopharyngeal cancer Publication date: March 2019 Source: Oral Oncology, Volume 90 Author(s): Stephen Kang

Patient Safety and Infection Control

ORIGINAL ARTICLES
	Objective assessment of hand hygiene: When we see it, we believe it!	p. 67
	Shikha Ranjan, Dhivya Venkatesan, Ramya Devi DOI:10.4103/jpsic.jpsic_10_18   Background: Hand hygiene is the fundamental and leading measure to prevent the spread of antimicrobial resistance and to reduce hospital-acquired infections. Several strategies are recommended to increase the compliance for hand hygiene practice; however, health-care worker (HCW) compliance with optimal practices remains low in most settings. Aim: This study aims to assess the efficacy of hand hygiene practice in HCWs at our hospital, and to demonstrate objective result of their practices, followed by a questionnaire-based study to assess their attitude towards hand hygiene, and effect of workshop on their hand hygiene practice pattern.Materials and Methods: Participants were asked to disinfect their hands using a hand rub solution mixed with the fluorescent dye. Photos were taken under an ultraviolet lamp. A self-designed questionnaire was given to all the participants. Results: A total of 94 HCWs participated in the hand hygiene workshop. Only 11.11% nurses (6/54) and 17.5% doctors (7/40) were able to use disinfectant solution with complete coverage of hand areas. Incomplete coverage of dorsum of hand was more common than that of palms. About 84.21% doctors (32/38) and 80% nurses (36/45) wanted to participate in such hand hygiene workshop in future with majority of them opting for frequent workshop. All the participants admitted that such workshop changed their attitude towards their practice pattern. Conclusion: It is important to carry out hand hygiene training programmes regularly to achieve increased compliance with hand hygiene practices. This study also emphasises that an objective technique of demonstration has a greater effect in changing professional's attitude towards hand hygiene.
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	An analysis of health economics related to hospital-associated infections: A prospective case–control analysis of 7-year data from a tertiary referral corporate hospital in India	p. 73
	Murali Chakravarthy, Raj Gore, Navin Yellappa, Antony George, Sukanya Rangaswamy, Rajathadri Hosur, Sumant Pargaonkar, Chidananda Harivelam, Priyadarshini Senthilkumar, Tejaswini Saravanan, Suganya Arul Rose DOI:10.4103/jpsic.jpsic_20_18   Objective: Healthcare associated infections cause significant morbidity, mortality and escalation of cost of care. It is the responsibility of all concerned to work towards reducing this potentially preventable increase in morbidity, mortality and cost caused by healthcare associated infections. Such data in Indian subcontinent has been studied sparingly. The objective of this study was to understand the degree of the cost escalation, morbidity and mortality associated with healthcare associated infections. Design: This prospective case controlled observational study was carried out from the year 2007 onwards. All the infections that occurred unto 2014 were included. Cost, morbidity and mortality of two similar matched controls for each infected case were chosen.Setting: Tertiary referral hospital. Participants: All patients with healthcare associated infections and twice that number as control. Interventions: None. Main outcome measure: Escalation of cost, morbidity and mortality due to healthcare. Results: There were five hundred fifteen infections during the study period. The escalation of cost due to infection was $ 4611. The mean mortality in the infected group was 8.75% in contrast to 2.5 in the non infected group. The mortality due to central line associated blood stream infection and ventilator associated pneumonia was more than 30% each. The length of stay in the intensive care unit was 8 days in the infected group in contrast to 2.27 days in the non infected group. Length of stay in the hospital was 33.5 days in the infected patients in contrast to 10.3 days in the non infected group. Conclusions: Healthcare associated infections caused escalation of cost, length of stay in the intensive care unit and hospital. Mortality in the infected cohort was more in contrast to the controls.
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	A cross-sectional pilot survey of sharp injuries among dental students in a tertiary care dental hospital in Lucknow, India	p. 78
	Rhythm Bains, Vivek K Bains, Reema Kumari DOI:10.4103/jpsic.jpsic_22_18   Aim: This study aims to estimate the frequency of sharp injuries among the post-graduate and undergraduate dental students and evaluate their knowledge regarding the needle-stick/sharp injuries, proper handling and disposal of sharp waste. Methodology: A written questionnaire containing questions regarding frequency of sharps injury, source of injury, status of immunisation and knowledge regarding handling and disposal of sharps waste was personally distributed to the participants and collected on the same day. Informed consent was obtained from the participants, and the purpose of the study was explained to them. The data obtained was statistically analysed. Percentage distribution of responses for Bachelor of Dental Surgery (BDS) and Master of Dental Surgery (MDS) students was recorded. Furthermore, the comparison of responses for BDS and MDS was analysed using the t-test. Chi-square test was used to find the significance difference between responses by BDS and MDS students. Results: The results of the present questionnaire study revealed that 38.5% (10/26) post-graduate students and 37.2% (16/42) undergraduate respondents had a history of sharps injury (P = 0.917). Most common reason for the injury among post-graduates was recapping of needles 84.6% (22/26) followed by endodontic instruments 11.5% (3/26) and use of probes/explorer 3% (1/26). Among the undergraduates, the most common source of injury was again recapping of needles 97.7% (42/43), followed by endodontic instruments 2.3% (1/43). Conclusion: Both undergraduates and post-graduates reported with history of sharps injury, though the difference among them was not significant. Needle-stick or sharps injury can prove to be fatal, and as dental students have an early clinical exposure, they should be trained early in their curriculum regarding correct disposal and handling of sharps.
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	A study of microbial flora of mobile phones used by health-care professionals in a tertiary care hospital in North India	p. 83
	Gurjeet Singh, Raksha Singh DOI:10.4103/jpsic.jpsic_19_18   Context: Mobile phones give all the advantages to its users but it also acted as a house for harbour the bacteria and causing health hazard that should not be over looked. Aim of study was study the prevalence of bacterial and fungal pathogens on mobile phones and their identification. Aims: 1. To study the prevalence of bacterial and fungal pathogens on mobile phones. 2. Identification of bacterial and fungal pathogens to species level.Settings and Design: The study was conducted in the Department of Microbiology, N. C. Medical College and Hospital, Israna, Panipat. Methods and Material: A total of 100 mobile phones were randomly sampled with sterile moistened swabs from doctors, nurses, laboratory technicians and attendants working in the hospital on the days of sampling. Statistical Analysis Used: Statistical analysis was done using SPSS 20.0 v. Descriptive analysis was done to estimate the percentage of microorganisms and Chi Square test was done to assess the difference in proportions. Level of significance was taken at p<0.05 Results: Total 100 mobile phones of health care professional were swabbed to check microbial flora harboured on mobile phones. Out of 100 mobile phones 79 (79%) were found with contaminated with microbial flora. Conclusions: Mobile phones may act as carrier for cross contamination among patients and dental personnel. Simple cleaning with isopropyl alcohol reduced the microbial load of the cellular phones. Hence it is recommended that dental colleges should develop strict guidelines concerning cell phone use and hygiene.
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PERSPECTIVE
	Needle-stick injury: A perspective	p. 90
	Padma Srikanth, Yazhini Ravi, Shyamala Mani DOI:10.4103/jpsic.jpsic_16_18
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LETTER TO EDITOR
	ABC's of hand hygiene: An aid to improve adherence	p. 93
	Chepsy C Philip, Shilpa Abraham, Amrith Mathew, M Joseph John DOI:10.4103/jpsic.jpsic_21_18
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