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Objective Shade matching is a critical procedure in prosthetic dentistry. The correct identification of the shade by the doctor as well as the perception of the shade by the dental technician becomes critical due to the high patient expectations. The current study aims to evaluate the effect of gender and clinical experience on shade perception by dental professionals. Materials and methods A total of 100 dental professionals with normal color vision who were categorized as dental students, dental doctors, and dental specialists were included in the study. Masked A2 and B2 shades tabs were made to match with a complete set of shade guide. The obtained data were entered, coded, and analyzed using SPSS version 17 for Windows. Results Total number of participants who identified both shade tabs correctly was 44%. There were no statistically significant differences among the gender or the clinical experience with regard to correct identification of shade tabs. Conclusion Within its limitations of fewer number (two) of shade tabs for comparison, the study concludes that multiple opinions may be taken clinically irrespective of the gender or clinical experience as gender and experience do not have a significant role to play for shade matching in prosthetic and restorative dentistry.

Background: The primary dentition for children is, perhaps, the most essential and yet the most neglected concern by a parent. Often, these parents who are responsible for the health of the primary dentition of their children feel that primary teeth eventually shed, and hence does not deserve heed on providing adequate oral health. Aim: The aim of this study was to evaluate the parental knowledge, attitude, and practices on the importance of primary dentition of their children. Materials and Methods: An institution-based cross-sectional study was done among parents of children below 12 years of age. A 25-item semi-structured questionnaire, in both English and Malayalam languages, was prepared for the data collection. Statistical analysis was done using the Statistical Package for the Social Sciences. The quantitative variables were described as mean and standard deviation. To find out the association between categorical variables, the Chi-square test was applied. A multivariate logistic regression was done to find the independent predictors of knowledge. P

Esophageal adenocarcinoma (EAC), a highly aggressive cancer with limited therapeutic options, often arises in the backdrop of a molecularly-complex esophageal metaplasia disorder, Barrett’s Esophagus (BE). Using transcriptomics and systems biology analyses of treatment-naïve malignant/pre-malignant biopsy tissues, we found Eph receptor B2 (EphB2) tyrosine kinase signaling to be frequently hyperactivated during early stages of EAC development, and across the BE-EAC continuum. Functional studies revealed EphB2 to be an upstream post-translational regulator of c-MYC activity and as a key molecular dependency in BE/EAC. Single-cell transcriptomics in a porcine esophageal 3D spheroid model showed enhanced EphB2 and MYC activity to be significantly associated with BE-like cell fate. shRNA-based knockdown of EphB2 or small molecule inhibitors of MEK, that modulate MYC protein stability, proved effective in suppressing EAC tumor growth in vivo. These findings point to EphB2-MYC axis as an early promoter of EAC and a novel therapeutic vulnerability in this increasingly-prevalent esophageal malignancy.STATEMENT OF SIGNIFICANCEWe identify EphB2 signaling as a potential master regulator and early promoter of esophageal adenocarcinoma, and the proto-oncogene MYC as a key downstream effector of EphB2 function. Targeting the EphB2-MYC axis could be a promising therapeutic strategy for these often refractory and lethal EAC tumors.

The Covid-19 pandemic has affected dental practice globally. Proximity with patients and predominance of aerosol-generating procedures has raised concerns regarding the safety of dentists and patients alike. The near-total, yet inevitable, suspension of dental practice has raised several ethical issues.

Compressor stations utilizing large-bore natural gas engines transport natural gas through pipelines worldwide. One emission class regulated by the Environmental Protection Agency (EPA) is volatile organic compounds (VOCs), which are nonmethane, nonethane, nonaldehyde hydrocarbons. The combination of a gas chromatograph (GC) and a flame ionization detector (FID) can measure VOCs, following EPA Method 18/25A. The Fourier transform infrared spectrometer (FTIR) also measures VOCs, following EPA Method 320. Multiple VOC calculation techniques are utilized, some combining measurements from separate analyzers. Two basic methods of extracting exhaust gas are direct extraction and Tedlar bag sampling. In this study, various VOC quantification methods are evaluated. Exhaust gas was sampled from a Cooper-Bessemer GMV lean-burn engine and a Caterpillar G3304 rich-burn engine. The GMV was tested in three configurations: open chamber spark ignition, precombustion chamber (PCC) ignition, and PCC ignition with high-pressure fuel injection. Ignition timing sweeps were performed on both engines, and a fuel variability test was performed on the GMV. Results showed that the Gasmet and MKS FTIRs’ (Method 320) VOC measurements deviate significantly from the HP GC when measuring low molar concentrations, albeit below regulatory limits. A common VOC quantification approach is subtracting the sum of methane and ethane FTIR measurements from a total hydrocarbon measurement utilizing a FID. This method produces uncertainties of 190% and overestimates VOC concentration by an average of 100%. The Tedlar bag sampling method produced VOC measurements within −2% of the direct extraction method.

Background Of the 15 million annual premature deaths from non-communicable diseases (NCDs), 85% occur in low- and middle-income countries (LMICs). Affecting individuals in the prime of their lives, NCDs impose severe economic damage to economies and businesses, owing to the high mortality and morbidity within the workforce. The Novartis Foundation urban health initiative, Better Hearts Better Cities, was designed to improve cardiovascular health in Dakar, Senegal through a combination of interventions including a workplace health program. In this study, we describe the labor policy environment in Senegal and the outcomes of a Novartis Foundation-supported multisector workplace health coalition bringing together volunteering private companies. Methods A mixed method design was applied between April 2018 and February 2020 to evaluate the workplace health program as a case study. Qualitative methods included a desk review of documents relevant to the Senegalese employment context and work environment and in-depth interviews with eight key informants including human resource representatives and physicians working in the participating companies. Quantitative methods involved an analysis of workplace health program indicators, including data on diagnosis, treatment and control of hypertension in employees, provided by the coalition companies, and a cost estimate of NCD-related ill-health as compared to the investment needed for hypertension screening and awareness raising events. Results Senegal has a legal and regulatory system that ensures employee protection, supports social security benefits, and promotes health and hygiene in companies. The Dakar Workplace Health Coalition comprised 18 companies, with a range of staff between 300 and 4′220, covering 36′268 employees in total. Interviews suggested that the main enablers for workplace program success were strong leadership support within the company and a central coordination mechanism for the program. The main barrier to monitor progress and outcomes was the reluctance of companies to share data. Four companies provided aggregated anonymized cohort data, documenting a total of 21′392 hypertension screenings and an increasing trend in blood pressure control (from 34% in Q4 2018 to 39% in Q2 2019) in employees who received antihypertensive treatment. Conclusion Evidence on workplace health and wellness programs in Africa is scarce. This study highlights how private sector companies can play a significant role in improving cardiovascular population health in LMICs.

This study aimed to examine variability in pricing of generic antipsychotic medications in a diverse metropolitan area and to determine whether prices varied by pharmacy type.A cross-sectional survey was conducted of pharmacy-level variability in retail cash prices for a 30-day supply of one first-generation and five generically available second-generation antipsychotic medications at community pharmacies in the Kansas City metropolitan area. All community pharmacies in the area were identified (N=281), and 94% (N=265, with 147 in Missouri and 118 in Kansas) responded to phone queries between April 25 and May 25, 2017, requesting the cash price of a 30-day supply of each of the six antipsychotics. All included pharmacies were categorized as a nationwide chain (N=182), grocery store (N=53), or independent pharmacy (N=30).Retail cash prices varied for all antipsychotic medications, with significant differences in price by pharmacy type. Price variation across all pharmacy types was lowest for haloperidol ($20-$102.99) and highest for aripiprazole ($29.99-$1,345.00). Pairwise comparisons showed that chain pharmacies had higher prices, compared with independent pharmacies, for all medications except haloperidol. Overall, chain pharmacies had the highest prices, with prices at grocery store pharmacies averaging $180 lower than chain pharmacies, and independent pharmacies averaging $415 lower than chain pharmacies.This report is the first on pharmacy-level variability in the costs of generic antipsychotic treatment options for schizophrenia. Appreciable differences were found in the costs of generic antipsychotics. Understanding variability in antipsychotic pricing may be important for providers serving uninsured patients.

Analyzing a consumer’s experience in an online session is a fundamental task of a marketer to enrich, personalize and enhance their future interactions with a firm. Click (web) or tap (mobile) event streams efficiently capture a consumer’s experience in an online session. In this work, we propose CrEOS contributing to the extant literature in the deployment of deep learning techniques to model online consumer behaviour. CrEOS models consumer conversion behaviour using a multi-variable LSTM, enriching the consumer event stream with a series of contextual features. In addition to the predictions, CrEOS identifies events that either hamper or help a conversion at three levels - consumer, consumer segment and transitions in marketing funnel. We validate CrEOS on click-stream data of a large US based e-commerce firm, compare it with single variable LSTM and discuss the insights derived from the critical event identification considering a series of marketing tasks.

Background Despite the large number of trials conducted using herbal oral care products for the reduction of dental plaque or gingivitis, results are conflicting and inconclusive. Objective To assess the effectiveness of herbal oral care products compared to conventional products in reducing dental plaque and gingivitis adults. Methods We searched the following databases for Randomised controlled trials (RCTs): MEDLINE Ovid, EMBASE Ovid etc. which yielded 493 trails. Of which 24 RCTs comparing herbal toothpaste or mouth rinse with over the counter toothpaste or mouth rinse in adults aged 18 to 65 years were included. Two authors extracted information and assessed the methodological quality of the included studies using Risk of Bias. Meta-analyses using the random-effects model were conducted for four outcomes for tooth paste and mouth rinse respectively. Mean difference (MD) or standardized mean difference (SMD) were used to estimate the effect, with 95% confidence intervals. Results A total of 1597 adults participated in 24 RCT studies. These were classified as herbal toothpaste (HTP) (15 trials, 899 participants) and herbal mouth rinse (HMR) (9 trials, 698 participants) compared with non-herbal toothpaste (NHTP) or non-herbal mouth rinse (NHMR). We found that HTP was superior over NHTP (SMD 1.95, 95% CI (0.97–2.93)) in plaque reduction. The long-term use of NHMR was superior in reduction of dental plaque over HMR (SMD -2.61, 95% (CI 4.42–0.80)). From subgroup analysis it showed that HTP was not superior over fluoride toothpaste (SMD 0.99, 95% CI (0.14–2.13)) in reducing dental plaque. However, HTP was favoured over non-fluoride toothpaste (SMD 4.64, 95% CI (2.23–7.05)). Conclusion For short-term reduction in dental plaque, current evidence suggests that HTP is as effective as compared to NHTP; however, evidence is from low quality studies.

Background To compare the anti plaque efficacy of Modified Bass, Fones and Normal brushing techniques in young adults. Material and methods An investigator blinded randomized controlled trial with parallel design was adopted to compare the anti plaque efficacy of three tooth brushing techniques. The study population consisted of 120 dental students aged between 18 and 30 years. Results At the baseline, the mean plaque scores were 0.74 ± 0.39, 0.77 ± 0.34 and 0.98 ± 0.36 respectively, for Modified Bass, Fones and Normal brushing technique. After 24 hours without any oral hygiene activity, the plaque scores increased to 1.04 ± 0.30, 1.11 ± 0.32 and 1.21 ± 0.40, respectively. After 1 week of using the intervention, the mean plaque scores were 0.78 ± 0.36, 0.94 ± 0.34 and 1.03 ± 0.43, respectively and increased to 1.13 ± 0.44, 1.14 ± 0.40 and 1.08 ± 0.34 after 28 days. The mean gingival scores were 0.23 ± 0.66, 0.02 ± 0.52 and 0.42 ± 0.74 for Modified Bass, Fones and Normal Brushing technique during baseline visit and after 28 days. Conclusions There was a significant reduction in the amount of plaque with the three brushing techniques. Although the short-term outcomes with the Modified Bass method were promising, a long-term effect was not evident. Further, there was no significant difference in plaque control between the three groups. Key words:Gingival scores, plaque scores, tooth brushing techniques, young adults.

Additional file 1 Figure S1 Review authors' judgements about each risk of bias item for each included study. Figure S2 Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across included studies. Table S1 Table S2. List of excluded studies and reasons for exclusion

Transformation of education to virtual mode during COVID-19 pandemic was a major challenge for a clinical specialty like dentistry.A sequential explanatory mixed method was adopted with quantitative dominant design. A self-reported questionnaire on attitude and perceptions toward online learning were distributed among dental undergraduate students. The qualitative arm explored perceptions of online teaching among various stakeholders and thematic content analysis was performed.A total of 141 responses were obtained, about 21% of them felt online classes to be highly useful and 78% felt it was moderately useful. About 80% of the students were satisfied with the online education. About 40% of participants felt internet connectivity was a frequent issue. The qualitative data analysis revealed five emergent themes of lecture content and delivery, instructional control, resource management, interaction, and evaluation exploring the perceptions of various stakeholders toward online learning and provided several insights.Though online education cannot be compared to traditional education in a clinical specialty like dentistry, it does have its advantages and a portion of student learning can be conducted through this mode.

INTRODUCTION Airway assessment before any type of anesthesia is mandatory. Upper lip bite test (ULBT) is a relatively new test for assessing the airway. Range of freedom of mandible and dental architecture has a significant role in facilitating intubation, both of which are assessed by this single test. ULBT with good neck movements are sufficient criteria for assessing the airway. Hyomental distance ratio (HMDR) assesses the range of neck movements. So by combining these two tests we expect an increase in reliability and validity. METHODS Preoperatively we assessed the airway using ULBT, HMDR, and Mallampati (MP) tests of 300 patients. The anesthesiologist doing laryngoscopy is blinded to the results of pre op airway evaluation. Direct laryngoscopies are graded using the modified Cormack and Lehane scale. Difficult laryngoscopy was defined as Grade 3 or 4 view. ULBT class 3, and HMDR with optimal cutoff point 1.2 are considered as difficult intubation predictors. Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) and Accuracy of both ULBT and HMDR separately and then both in combination are calculated and compared with those of MP. RESULTS ULBT:-Sensitivity - 88.2%, Specificity - 99.62%, PPV - 96.77%, NPV - 98.51%, Accuracy - 98.33% HMDR: - Sensitivity - 88.2%, Specificity – 99.25%, PPV - 93.75%, NPV - 98.50%, Accuracy - 98.00% MP: - Sensitivity - 17.65%, specificity - 88.72%, PPV - 16.67%, NPV - 89.39%, Accuracy - 80.66% ULBT+HMDR: - Sensitivity - 82.35%, specificity-100%, PPV100%, NPV97.75%, Accuracy - 98.00 % CONCLUSION Upper Lip Bite test is good screening test for assessing the airway. ULBT in combination with HMDR increased the specificity and positive predictive value.

Background Studies among type 2 diabetes mellitus patients have reported total caries experience; however the severity and clinical consequences of untreated dental caries are often ignored. Methods For this study, 150 well (I) and poorly controlled (II) diabetic participants were recruited. The spectrum of caries was evaluated using DMFT (Decayed, Missing and Filled Tooth) index, Dental Caries Severity Classification Scale, PUFA (Pulpal involvement, Ulceration, Fistula and Abscess) index, RCI (Root Caries Index) and the severity of radicular caries by Root Surface Caries Severity Index. Results The prevalence of coronal and root caries was 90.7% and 23.3%, respectively. There was significant difference among caries experiences for D, M and DMFT. In group II, severity of coronal caries and mean rank of P, F, A and PUFA scores were higher, so were prevalence of root caries and severity of RD2, RD3 and RD4. HbA1c level had positive correlation with DMFT and PUFA scores (r = 0.458 and 0.522), so was the duration of diabetes with coronal caries, DMFT, PUFA score, root caries and RCI score (r = 0.235, 0.320, 0.273, 0.308 and 0.323). Conclusion This is probably the first study to examine the severity of coronal caries, prevalence of untreated dental caries and severity of radicular caries in diabetic patients. Uncontrolled diabetes causes substantial increase in prevalence and severity of coronal and radicular caries.

Characterizing moderate penetrance susceptibility genes is an emerging frontier in colorectal cancer (CRC) research. GALNT12 is a strong candidate CRC-susceptibility gene given previous linkage and association studies, and inactivating somatic and germline alleles in CRC patients. Previously, we found rare segregating germline GALNT12 variants in a clinic-based cohort (N = 118) with predisposition for CRC. Here, we screened a new population-based cohort of incident CRC cases (N = 479) for rare (MAF ≤1%) deleterious germline GALNT12 variants. GALNT12 screening revealed eight rare variants. Two variants were previously described (p.Asp303Asn, p.Arg297Trp), and additionally, we found six other rare variants: five missense (p.His101Gln, p.Ile142Thr, p.Glu239Gln, p.Thr286Met, p.Val290Phe) and one putative splice-altering variant (c.732-8 G>T). Sequencing of population-matched controls (N = 400) revealed higher burden of these variants in CRC cases compared with healthy controls (P = 0.0381). We then functionally characterized the impact of substitutions on GALNT12 enzyme activity using in vitro-derived peptide substrates. Three of the newly identified GALNT12 missense variants (p.His101Gln, p.Ile142Thr, p.Val290Phe) demonstrated a marked loss (>2-fold reduction) of enzymatic activity compared with wild-type (P ≤ 0.05), whereas p.Glu239Gln exhibited a ∼2-fold reduction in activity (P = 0.077). These findings provide strong, independent evidence for the association of GALNT12 defects with CRC-susceptibility; underscoring implications for glycosylation pathway defects in CRC.

We present the case of a 50-year-old man who presented to us with a history of having received radiation therapy for a glomus jugulare tumor. He had been on regular follow-up with serial imaging scans. The MRI done after 4 years of treatment revealed an interval increase in size. Carotid angiogram revealed, in addition to the glomus, multiple lymph nodes of similar pattern of vascularity, well lateral to the carotid sheath, in the ipsilateral neck. He underwent resection of the tumor and a neck dissection. Histopathology confirmed metastatic glomus jugulare in the cervical lymph nodes. He received adjuvant radiotherapy and is doing well.

Background: The medical prescription is a valid and legal document. Prescriptions can also be used as a measure of the quality of medical education, observance of the laws and regulations, and sociocultural beliefs. Aims: To assess the quality of prescription written by dental and medical students and practitioners. Settings and Design: A cross-sectional study was conducted in three dental and two medical colleges in Kerala covering 345 participants (dental - 235 and medical - 110). Materials and Methods: Simulation exercise was conducted for drafting a model prescription based on a given clinical condition. The variables were identified based on the model prescription format by the Medical Council of India and were classified into four domains. Points were assigned for each variable. Statistical Analysis Used: Analysis was performed using descriptive statistics and Mann–Whitney U-test. Results and Conclusion: The total scores were found to be higher among dental fraternity (10.93 ± 2.88) to medical (10.81 ± 2.55). The medical house surgeons and postgraduates fared better in the doctor identification domain. Among the dental professionals, there was a significant difference among the undergraduates (mean score = 1.91) and postgraduates (mean score = 1.60) in the doctor identification domain. However, among the medical professionals, in the patient identification domain, house surgeons had a significantly higher score compared to postgraduates. There were no significant differences in quality of prescription writing among medical and dental professionals.

Neuropathic pain (NeP) constitutes a major pain-related disorder, which is often underdiagnosed and undertreated. Adverse physical, psychological, and economic consequences associated with NeP lead to poor quality of life. Burden of NeP in developing countries like India is colossal. Various international guidelines provide effective approaches to diagnose and manage NeP. However, differences in the genetic makeup of Indian population can result in subtle differences in clinical response, considering their low body weight, drug metabolism ability, and pain perception. Similarly, treatment-related adverse effects may also vary. Practice of Indian physicians may also differ for choice of drugs based on their availability and affordability. In the absence of country-specific guidelines, this document could serve as a guiding tool for health-care providers, ensuring uniformity in the treatment of NeP. Thus, applicability of all recommendations from any of these guidelines in Indian setting demands careful evaluation. Clinical experience of Indian physicians suggests that there are lot many challenges (e.g., busy outpatient departments, nonavailability of screening questionnaires in regional languages, and availability and affordability of medications) faced by them when managing NeP. In addition, in India, there are no country-specific guidelines that would help them to address these challenges. The objective for this consensus was to develop an expert opinion guideline to harmonize the management of NeP in India. The expert panel consisted of experts from various specialties such as pain medicine, anesthesiology, diabetology, neurology, and orthopedics. The panel critically reviewed the existing literature evidence and guideline recommendations to provide India-specific consensus on the management of NeP. The final consensus document was reviewed and approved by all the experts. This expert opinion consensus will help health-care professionals as a guiding tool for effective management of NeP in India. Use of Douleur Neuropathique 4 (DN4) questionnaire for NeP screening should be routine in day-to-day clinical practice. For effective utilization of DN4 questionnaire, it should be converted to regional language. If DN4 questionnaire screening fails to identify NeP, it should not be disregarded and should not replace the sound clinical judgment from the treating physician. Diagnostic tests may be considered as a supplement to clinical judgment. Cost-effective treatment should be the initial choice. Dosing should be individualized based on efficacy and tolerability. Tricyclic antidepressants (TCAs), gabapentinoids, and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be considered among initial choices. Tramadol can be considered as a second-line add-on treatment for NeP if there is partial response to the first-line agent either alone or in combination. Fixed-dose combination (FDC) of gabapentinoids such as pregabalin (75 mg) with TCA such as nortriptyline (10 mg) is synergistic and improves treatment adherence. Among other treatments, Vitamin B12 (methylcobalamin) can be used either alone or in combination for the management of NeP. Use of Vitamin D and steroids should be limited to specific NeP in individual cases. Referral to pain specialists can be considered if two drugs fail to provide relief in NeP.