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Objective: The aim of this study is to analyze the perception of Dentists in Pakistan towards Tele-Dentistry and its usefulness during Covid-19 pandemic. Materials & Methods: The study was conducted among general dentists of Lahore after taking approval from the Ethics and Research Committee of the institution. This descriptive cross-sectional study was completed over the period of three months. Non-probability snowball sampling technique was used. Results: The results revealed that most of the dentists (89.5%) perceived that Tele-Dentistry can be of help during COVID 19 Pandemic in Pakistan. Conclusion: Most of the dentists were aware of teledentistry, and its uses, advantages and disadvantages in Covid-19 pandemic. Keywords: teledentistry, Covid-19, dentistry, Lahore, perception, health care professionals

Objective To describe the protocol of a statewide educational program for healthcare professionals (HCP) addressing COVID-19 disparities using quality improvement (QI) approach. Intervention A 19-month program to educate HCP has been developed in the priority areas of health equity, cultural sensitivity, infection prevention and control (IPC), and QI to address COVID-19 disparities. Method This innovative approach combines the Extension for Community Healthcare Outcomes (ECHOTM) model of learning with one-on-one coaching to assist participants with practical application. Participants are a diverse group of HCP and stakeholders working in healthcare and public health organizations. Participants meet twice monthly for 90-minute virtual interactive sessions led by subject matter experts and project consultants. The sessions are divided into didactic presentations, case discussions, COVID-19 updates, and pre/post-session assessments, and are eligible for continuing education credits. Participants are supported to develop a QI project addressing an area for health disparities in their work setting under the guidance of QI and health equity coaches. Using the RE-AIM framework, a mixed-mode approach is used to collect quantitative data on continuing education credit claims, participants’ characteristics, participation, satisfaction, and learning competence. Semi-structured qualitative interviews are used to gain insights into participants’ application of ECHO training and the project's impact on their competence and plan to implement relevant changes using QI approach. Conclusion The ECHO model has significant strengths based on its multidisciplinary approach and case-based learning that help interlinks priority areas to uniquely address COVID-19 disparities. Disseminating protocol for this novel intervention has the potential to generate additional projects addressing health disparities using this educational platform.

Background Nebraska Infection Control Assessment and Promotion Program (ICAP) is funded by Nebraska Department of Health and Human Services through Centers for Disease Control and Prevention (CDC) grants to support Infection Prevention and Control (IPC) activities in the state. In early 2022, ICAP launched COVID-19-specific basic infection prevention and control (IPC) training to frontline healthcare providers (HCPs) through a discussion-based webinar series using curricular materials created by the CDC Project Firstline. Here, we report pre- and post-training survey responses demonstrating improvement in participants' perceived knowledge across a number of IPC domains. Methods Training was completed over a 14-week period via a weekly, interactive 30-minute webinars with a new topic covered each week. A survey was administered to participants prior to the webinar series and at the conclusion of training to assess effectiveness. The pre-survey evaluated HCP confidence in their knowledge of each of the 14 topics to be covered in the course. The post-survey evaluated both confidence and perceived value in each of the training topics. Results Prior to the training series, a mean 40.3% of participants judge themselves “very confident” in IPC topics, versus 52.7% “somewhat confident” and 7.1% “not confident” (figure 1); by the end of the training, these levels had improved to 85.4%, 14.3%, and 0.4%, respectively (figure 2). The largest gains in the category “very confident” concerned “source control” (+65%) and “COVID-19 variants” (+63%). A majority of participants perceived each topic covered in the series to be “very valuable” (figure 3); 98% of participants indicated interest in a future IPC training series and 95% indicated that they would recommend the training series to a colleague. Figure 1Results of a pre-course survey on knowledge of training topics completed by participants.Figure 2Results of a post-course survey on knowledge of training topics completed by participants.Figure 3Results of a post-course survey on value of the training course completed by participants. Conclusion This survey data suggests that a discussion-based webinar using CDC Project Firstline materials is highly effective at conveying fundamental concepts in infection control to frontline HCPs. Moreover, HCPs rated themselves as likely to return, suggesting this format is a promising modality for simple and widespread dissemination of IPC training. Disclosures M. Salman Ashraf, MBBS, Merck & Co. Inc: Grant/Research Support.

Coastal communities are highly exposed to ocean- and climate-related hazards but often lack an accurate population and infrastructure database. On January 15, 2022 and for many days thereafter, the Kingdom of Tonga was cut off from the rest of the world by a destructive tsunami associated with the Hunga Tonga Hunga Ha’apai volcanic eruption. This situation was made worse by COVID-19-related lockdowns and no precise idea of the magnitude and pattern of destruction incurred. The occurrence of such events in remote island communities highlights the need for (1) precisely knowing the distribution of residential and public buildings, and (2) evaluating what proportion of those would be vulnerable to a tsunami. A GIS-based dasymetric mapping method, previously tested in New Caledonia for assessing and calibrating population distribution at high resolution, is improved and implemented in less than a day to jointly map population clusters and critical elevation contours based on runup scenarios, and is tested against destruction patterns independently recorded in Tonga after the two recent tsunamis of 2009 and 2022. Results show that 62% of the population of Tonga lives in well-defined clusters between sea level and the 15 m elevation contour. The patterns of vulnerability thus obtained for each island of the archipelago allow exposure and potential for cumulative damage to be ranked as a function of tsunami magnitude and source-area. By relying on low-cost tools and incomplete datasets for rapid implementation in the context of natural disasters, this approach works for all types of natural hazards, is easily transferable to other insular settings, can assist in guiding emergency rescue targets, and can help to elaborate future land-use planning priorities for disaster risk reduction purposes.

Non-targeted persistent immune activation or suppression by different drug delivery platforms can cause adverse and chronic physiological effects including cancer and arthritis. Therefore, non-toxic materials that do not trigger an immunogenic response during delivery are crucial for safe and effective in vivo treatment. Hydrogels are excellent candidates that can be engineered to control immune responses by modulating biomolecule release/adsorption, improving regeneration of lymphoid tissues, and enhancing function during antigen presentation. This review discusses the aspects of hydrogel-based systems used as drug delivery platforms for various diseases. A detailed investigation on different immunomodulation strategies for various delivery options and deliberate upon the outlook of such drug delivery platforms are conducted.

In present study, we describe the biodegradation of direct blue (DB) 297 and reactive blue (RB) 221 by immobilizing horseradish peroxidase (HRP) isolated from fresh leaves of Moringa Oliefera on iron oxide nanoparticles. Iron oxide nanoparticles were synthesized by co-precipitation method and showed a maximum immobilization efficiency of 87%. The surface topography of iron oxide nanoparticles was envisaged by scanning electron microscopy (SEM), results showed that magnetic nanoparticles (MNPs) were in the form of aggregates having size of 1 μm. Furthermore, immobilization was confirmed via functional group identification performed by Fourier transformed infrared spectroscopy (FTIR). Immobilization phenomena displaced the optimum temperature from 35 °C to 50 °C moreover, pH optima were altered from 5.0 to 7.0. V

The rational design of catalysts that fine-tune/mimics the enzyme microenvironment remains the subject of supreme interest. Several strategies moving from traditional to technologically advanced methods have been proposed and deployed to develop high efficacy enzymes. There is a plethora of literature on simple enzyme immobilization through different materials as support carriers, even at the micro- and nanoscale. Regardless of extensive strategic efforts, the existing literature lacks deep insight into tailoring the microenvironment surrounding the target enzyme molecules and can sophisticatedly integrate the bio-catalysis for multipurpose applications. The ongoing advancement in the industrial sector also demands catalysts with unique features. For instance, catalytic turnover, substrate affinity, stability, specificity, selectivity, resistivity against reaction impurities or inhibitors, prevention of subunit dissociation, ease in recovery, and reusability are highly requisite features. This review spotlight state-of-the-art protein engineering approaches that facilitate the redesigning of robust catalysts or fine-tuning the catalytic microenvironment of enzymes. The entire work critically focuses on protein engineering approaches, i.e., regulating pH microenvironment, creating a water-like microenvironment, activating enzyme catalysis in organic solvents and gas phase, tuning reaction kinetics (KM and kcat), engineering substrate specificity, reaction promiscuity, computational design, and structure-guided biocatalyst engineering. This study unveils the advanced insights of enzyme microenvironment engineering, which can also be considered catalytic yield enhancement strategies to green the future bio-catalysis research for industrial bioprocesses.

The accumulation of toxic chemical constituents in sludge and wastewater has fuelled an interest in investigating efficient and eco-friendly wastewater remediation approaches. In this study, a set of bacterial samples were isolated from petroleum sludge and tested for their ability to degrade different aromatic pollutants, including azo dyes and emerging pollutants. Although exhibiting differential specificity, all bacterial isolates were able to degrade different classes of aromatic dyes efficiently. Ribosomal 16S rRNA sequencing of the 12 bacterial isolates showed that they belonged to two different bacterial genera: Bacillus cereus and Pseudomonas guariconensis. Of these 12 strains, MA1 (B. cereus) was the most promising and was chosen for further optimization and biochemical studies. The optimum culture and remediation conditions for MA1 was found to be at pH 7, with 100 ppm dye concentration, and under aerobic condition. In addition to efficiently degrading various aromatic dyes (e.g. Congo Red, Reactive Black 5, PBS, and Toluidine Blue), MA1 was also found to be capable of degrading various emerging pollutants (e.g. prometryn, fluometuron and sulfamethoxazole). Preliminary transcriptome analysis shows that MA1 grown on media containing a mixture of aromatic dyes appears to differentially express a number of genes. Data shown here strongly suggests that petroleum sludge is a rich reservoir of bacteria with powerful remediation abilities. HIGHLIGHTS Bacteria isolated from petroleum sludge can be potent agents for bioremediation.; Dye-based high-throughput approach can be used to screen for strains of interest.; B. cereus species can efficiently degrade various classes of emerging pollutants.; Whole transcriptome analyses can be used to identify genes involved in remediation.

Hypocalcaemia following thyroid surgery can occur in up to 38% of patients. With over 7100 thyroid surgeries performed in 2018 in the UK, this is a common postoperative complication. Undertreated hypocalcaemia can result in cardiac arrhythmias and death. Preventing adverse events from hypocalcaemia requires preoperative identification and treatment of at-risk patients with vitamin D deficiency, timely recognition of postoperative hypocalcaemia and prompt appropriate treatment with calcium supplementation. This project aimed to design and implement a perioperative protocol for prevention, detection and management of post-thyroidectomy hypocalcaemia. A retrospective audit of thyroid surgeries (n=67; October 2017 to June 2018) was undertaken to establish baseline practice of (1) preoperative vitamin D levels assessment, (2) postoperative calcium checks and incidence of postoperative hypocalcaemia and (3) management of postoperative hypocalcaemia. A multidisciplinary team approach following quality improvement principles was then used to design a perioperative management protocol with all relevant stakeholders involved. After dissemination and implementation, the above measures were reassessed prospectively (n=23; April–July 2019). The percentage of patients having their preoperative vitamin D measured increased from 40.3% to 65.2%. Postoperative day-of-surgery calcium checks increased from 76.1% to 87.0%. Hypocalcaemia was detected in 26.8% of patients before and 30.43% of patients after protocol implementation. The postoperative component of the protocol was followed in 78.3% of patients. Limitations include low number of patients which precluded from analysis of the impact of the protocol on length of stay. Our protocol provides a foundation for preoperative risk stratification and prevention, early detection and subsequent management of hypocalcaemia in thyroidectomy patients. This aligns with enhanced recovery protocols. Moreover, we offer suggestions for others to build on this quality improvement project with the aim to further advance the perioperative care of thyroidectomy patients.

OBJECTIVE: The purpose of this study is to reinforce the safety of non-surgical endodontic treatment in the management of acute dental pain of pulpal origin in pregnant patients in all trimesters. METHODOLOGY: The study was conducted amongst pregnant females with acute dental pain. Pain of endodontic origin in 273 pregnant patients was managed by performing non-surgical root canal treatment. Percentages were calculated as descriptive statistics to have a comparison of preferred treatment by dentists for acute pain management during pregnancy. One Way ANOVA was used to explore the difference between treatment selection plans. RESULTS: From the total sample of 273 participants, there was no significant difference found between the selection of endodontic treatment and Trimesters (F (2,270) = .79, p=.45) same results were obtained for the analgesics prescription during pregnancy and the trimesters during pregnancy (F (2,270) = 1.41, p=.24). On the other hand, the difference between the prescription of antibiotics during 1st, 2nd and 3rd trimesters was found which was statistically significant (F (2,270) = 12.38, p> .001). Endodontic treatment was completed on 251 (91.6%) pregnant patients to relieve the acute dental pain whereas only 22 (8.4%) patients did not undergo endodontic treatment in pregnancy. Among the cases who had endodontic treatment, 75.4% of cases were dealt with in the second trimester of pregnancy. The recommendation of antibiotics was less. In the entire data, antibiotic prescription was seen in the second trimester of pregnancy, whereas, overall, antibiotic prescription was at minimal level. Analgesic prescription was found to be (44.1%) in practice among pregnant participants during the treatment. CONCLUSION: Non-Surgical Endodontic Treatment is a safe and reliable treatment option for the management of restorable teeth with acute pain of pulpal origin in pregnant patients. Dentists should not be reluctant in prompt invasive dental management in these patients if indicated. KEYWORDS: pregnancy, pain, dental treatment, endodontic treatment HOW TO CITE: Khan SA, Hassan AU, Iqbal Z, Hassan M. Endodontic management of acute dental pain among pregnant patients. J Pak Dent Assoc 2021;30(1):7-11.

In the recent past, numerous new types of nanostructured carriers, as support matrices, have been engineered to advance the traditional enzyme immobilization strategies. The current research aimed to develop a robust enzyme-based biocatalytic platform and its effective deployment in the industrial biotechnology sectors at large and catalysis area, in particular, as low-cost biocatalytic systems. Suitable coordination between the target enzyme molecules and surface pendent multifunctional entities of nanostructured carriers has led an effective and significant contribution in myriad novel industrial, biotechnological, and biomedical applications. As compared to the immobilization on planar two-dimensional (2-D) surface, the unique physicochemical, structural and functional attributes of nano-engineered matrices, such as high surface-to-volume ratio, surface area, robust chemical and mechanical stability, surface pendant functional groups, outstanding optical, thermal, and electrical characteristics, resulted in the concentration of the immobilized entity being substantially higher, which is highly requisite from applied bio-catalysis perspective. Besides inherited features, nanostructured materials-based enzyme immobilization aided additional features, such as (1) ease in the preparation or green synthesis route, (2) no or minimal use of surfactants and harsh reagents, (3) homogeneous and well-defined core-shell nanostructures with thick enzyme shell, and (4) nano-size can be conveniently tailored within utility limits, as compared to the conventional enzyme immobilization. Moreover, the growing catalytic needs can be fulfilled by multi-enzymes co-immobilization on these nanostructured materials-based support matrices. This review spotlights the unique structural and functional attributes of several nanostructured materials, including carbon nanotubes, graphene, and its derivate constructs, nanoparticles, nanoflowers, and metal-organic frameworks as robust matrices for laccase immobilization. The later half of the review focuses on the applied perspective of immobilized laccases for the degradation of emergent contaminants, biosensing cues, and lignin deconstruction and high-value products.

The synergistic combination of biocatalysts and nanomaterials provides a new interface of a robust biocatalytic system that can effectively remediate environmental pollutants. Enzymes, such as catalase-based constructs, impart the desired candidature for catalytic transformation processes and are potential alternatives to replace conventional remediation strategies that have become laborious and somewhat inefficient. Furthermore, the controlled or uncontrolled discharge of various emerging pollutants (EPs) into water bodies is equally proportional to the fast-growing population and extensive urbanization. EPs affect the entire living being and continuously deteriorate the environmental system, directly or indirectly. The occurrence of EPs (even released after partial treatments, but still in bioactive forms) disturbs ecological integrity. Due to the ineffectiveness of in-practice traditional remediation processes, new and robust treatment measures as effective and sustainable remediation have become a meaningful goal. In this context, special attention has been shifted to engineering an enzyme (catalase)-based biodegradation system with immense prospects in environmental cleanup. The unique synergistic combination of nanomaterials (having multifunctional attributes) with enzymes of interest makes them a state-of-the-art interface that can further ameliorate bio-catalysis and biodegradation performance. This review covers current research and scientific advancement in developing and deploying catalase-based biocatalytic systems to mitigate several EPs from the environment matrices. The biocatalytic features of catalase, along with the mechanistic insight into H

Nanostructured materials constitute an interesting and novel class of support matrices for the immobilization of peroxidase enzymes. Owing to the high surface area, robust mechanical stability, outstanding optical, thermal, and electrical properties, nanomaterials have been rightly perceived as immobilization matrices for enzyme immobilization with applications in diverse areas such as nano-biocatalysis, biosensing, drug delivery, antimicrobial activities, solar cells, and environmental protection. Many nano-scale materials have been employed as support matrices for the immobilization of different classes of enzymes. Nanobiocatalysts, enzymes immobilized on nano-size materials, are more stable, catalytically robust, and could be reused and recycled in multiple reaction cycles. In this review, we illustrate the unique structural/functional features and potentialities of nanomaterials-immobilized peroxidase enzymes in different biotechnological applications. After a comprehensive introduction to the immobilized enzymes and nanocarriers, the first section reviewed carbonaceous nanomaterials (carbon nanotube, graphene, and its derivatives) as a host matrix to constitute robust peroxidases-based nanobiocatalytic systems. The second half covers metallic nanomaterials (metals, and metal oxides) and some other novel materials as host carriers for peroxidases immobilization. The next section vetted the potential biotechnological applications of the resulted nanomaterials-immobilized robust peroxidases-based nanobiocatalytic systems. Concluding remarks, trends, and future recommendations for nanomaterial immobilized enzymes are also given.

The burden of occupational health hazards in dentists, final year bachelor of dental surgery (BDS) students and dental assistants are tremendous. Developing countries have controversial situation about the prevalence because of inadequate facilities in rural and urban areas of each nation. Objective: To determine the prevalence of occupational health hazards in dentists, final year BDS students and dental assistants of Lahore. Methods: A total of 300 subjects comprising of 150 dentists, 50 final year BDS students and 100 dental assistants were selected through simple random sampling technique. The cross sectional study was carried out in both private and public based teaching hospitals of Lahore to assess the differences of prevalence of occupational health hazards between them with a pre-tested questionnaire. Results: Among all the occupational health hazards under study a maximum problem of stress was manifested and reported in 87% of all the subjects of private university hospital and 66% in public university dental hospital. Minimum health hazard in the term of prevalence of hearing impairment among public university dental hospitals was 25% in public and 36% in private university dental hospital. Conclusions: The burden of occupational health hazards and its prevalence was higher as an average in private university dental hospitals as compared to public university dental hospitals.

Accurate, sensitive, and rapid screening of performance-enhancing drugs, including glucocorticoids, is critical to combat doping in animal racing sports. Samples of urine, saliva, and serum are usually used for random screening of controlled substances; however, they tend to provide only acute usage and doping information. Hair testing has the potential to detect long-term drug use in racing animals. In the present study, commercially available ELISA-kits were used to rapidly screen and analyze various natural and synthetic glucocorticoids in the hair of camels. The four glucocorticoids that were screened using the competitive ELISA were hydrocortisone, dexamethasone, flumethasone, and methylprednisolone. However, comparison of the results obtained using the ELISA method with our previously published LC-MS/MS assay did not show a good correlation. The results obtained with the ELISA analysis of hair samples of 27 different camels showed that this technique consistently yielded significantly higher levels of glucocorticoids compared with the LC-MS/MS assay. This is an interesting finding and suggests that commercially available ELISA tests may overestimate the amount of glucocorticoids present in camel hair, perhaps due to specificity and cross-reactivity issues.

Understanding how different insecticides influence bee health is very essential. The aim of this work was to evaluate enzyme kinetics and inhibition by insecticides in Apis mellifera and Apis florea. Tested enzymes showed variable affinity to substrates. In A. florea, glutathione S-transferase (GST) showed significantly higher affinity for its 1-Chloro-2,4-Dinitrobenzene (CDNB) substrate than in A. mellifera. Carbosulfan caused the highest inhibition to acetylcholinesterase (AChE) in both tested species in comparison with chlorpyrifos, dimethoate and pirimiphos-methyl. Our results show that exposure to insecticides is harmful to honey bees and results in negative effects on enzyme activity.

The accumulation of emerging pollutants in the environment remains a major concern as evidenced by the increasing number of reports citing their potential risk on environment and health. Hence, removal strategies of such pollutants remain an active area of investigation. One way through which emerging pollutants can be eliminated from the environment is by enzyme-mediated bioremediation. Enzyme-based degradation can be further enhanced via advanced protein engineering approaches. In the present study a sensitive and robust bioanalytical liquid chromatography-tandem mass spectrometry (LCMSMS)-based approach was used to investigate the ability of a fungal dye decolorizing peroxidase 4 (DyP4) and two of its evolved variants—that were previously shown to be H2O2 tolerant—to degrade a panel of 15 different emerging pollutants. Additionally, the role of a redox mediator was examined in these enzymatic degradation reactions. Our results show that three emerging pollutants (2-mercaptobenzothiazole (MBT), paracetamol, and furosemide) were efficiently degraded by DyP4. Addition of the redox mediator had a synergistic effect as it enabled complete degradation of three more emerging pollutants (methyl paraben, sulfamethoxazole and salicylic acid) and dramatically reduced the time needed for the complete degradation of MBT, paracetamol, and furosemide. Further investigation was carried out using pure MBT to study its degradation by DyP4. Five potential transformation products were generated during the enzymatic degradation of MBT, which were previously reported to be produced during different bioremediation approaches. The current study provides the first instance of the application of fungal DyP4 peroxidases in bioremediation of emerging pollutants.

High stereoselectivity, catalytic efficiency, and sustainability outcomes impart desired candidature to enzymes for catalytic transformation processes, to replace conventional synthetic methodologies. Due to high versatility, horseradish peroxidase (HRP)-based catalytic systems are widely being applied in chemical and/or biological transformation processes. However, as several other enzymes, HRP also destabilize or denature in harsh conditions because of its intrinsically sensitive nature, which increases the bioprocess cost and shorten the lifespan of the enzymes. To overcome stability and recyclability issues, biocatalytic immobilization is performed on biopolymer and/or nanostructured materials which impart useful characteristics for various industrial and biotechnological processes. The nanomaterial design for immobilization support, having the greater surface area, fascinating features, and high mechanical and chemical stability, have recently gained research interest in the immobilization of HRP and other enzymes. Many systems for biocatalytic immobilization have reported improved characteristic performance than the enzymes in free form, for example, selectivity, efficiency, recyclability, and stability, due to the defense against microenvironment provided by the various nanostructure materials. This chapter aims to highlight the advancements in production and immobilization of HRP using the variety of support matrices. In addition to improved catalytic features, physicochemical aspects, and rapid implementation in practicalities of engineered HRP-based catalytic systems, has also been discussed with appropriate examples.

Antibiotics are frequently prescribed inappropriately for acute respiratory infections in the outpatient setting. We report the implementation of a multifaceted outpatient antimicrobial stewardship initiative resulting in a 12.3% absolute reduction of antibiotic prescribing for acute bronchitis in primary care clinics receiving active interventions.

The COVID-19 pandemic presents significant challenges to face-to-face communication with people residing in post-acute and long-term care (PALTC) settings. Telemedicine is an alternative, but facility staff may be over-burdened with the management of the equipment. Here we introduce the use of a mobile HIPPA-compliant telepresence robot (MTR) to bridge this barrier which may be beneficial to reimagine options for PALTC in the future.

Vitamin D deficiency is being recognized as a global issue and has been implicated in many health issues. Hence, there is an increased interest in developing sensitive, reproducible, and non-invasive assays to measure Vitamin D levels. This study aimed to apply a sensitive liquid chromatography-mass spectrometric assay to hair samples to develop and validate a clinical assay to provide a quarterly average level of vitamin D in one test. Hair samples were collected from 70 male university students/young adults and pulverized/sonicated in methanol/water for 2 h to extract Vitamin D metabolites. A sensitive liquid chromatographic-mass spectrometric assay was employed to quantitate Vitamin D and metabolites. Of the eight Vitamin D and metabolites screened, only the primary, clinically significant form of vitamin D (25OHD₃) was detected and quantified in hair samples in the range of 17–1541 pg/mg. One-third of the hair samples (21 out of 70) had Vitamin D levels below the LLOD of the assay (10 pg/mg). The mean and standard deviation values for hair (25OHD₃) were 276.7 ± 329.9, respectively. This pilot study reveals the potential of the vitamin D hair test in clinical assays as a complementary test to a vitamin D blood test, which would provide a quarterly average.