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Context: For successfully managing pediatric dental patients, local anesthesia is essential to eliminate pain during or after the operative period. An early recovery from soft-tissue anesthesia after an inferior alveolar nerve block (IANB) should benefit a young child patient by avoiding the risk of inadvertently biting the soft tissues. Aims: Hence, the purpose of the study was to (1) evaluate and compare the efficacy of pre- and postoperative ibuprofen on pain perception in children who undergo IANB anesthesia with or without the use of PM and (2) evaluate the average time required for reversal of anesthesia symptoms using phentolamine mesylate. Methods: The present study was a randomized, clinical trial performed among 60 children between 6 and 8 years of age using a convenient sampling method. The children were randomly assigned into four equal groups of 15 each using the computer-generated randomization sequence. IANB anesthesia was performed using 2% lignocaine with 1:100,000 epinephrine, and a mandibular primary molar pulpotomy was performed on each group. Group 1: the ibuprofen tablet was taken 1 h before the onset of the procedure. Group 2: ibuprofen tablet 30 min after the pulpotomy procedure. Group 3: the ibuprofen tablet was taken 1 h before the onset of the procedure, and the Phentolamine mesylate (PM) injection was administered. Group 4: immediately after the pulpotomy, the PM injection was administered, and an ibuprofen tablet was taken 30 min after the pulpotomy procedure. All children were assessed for the duration of soft-tissue anesthesia, their behavior scores and pain rating, as well as the incidence of postoperative self-inflicted injuries. Statistical Analysis Used: A one-way ANOVA was used to compare the average time needed for the reversal of anesthetic symptoms between groups. The effects of phentolamine, local anesthetics, and ibuprofen on the child’s behavior and pain scores were compared using the Student’s t-test. For the study, P < 0.05 was accepted as statistically significant. Results: The time needed for the full reversal of anesthetic symptoms to manifest on the tongue and lip was substantially reduced by the injection of phentolamine (P < 0.001). The use of phentolamine for reversal or the intake of ibuprofen pre- or postoperatively did not exhibit any significant variation in the behavior, pain experience, or incidence of self-inflicted injuries in the child. Conclusion: It is evident that although phentolamine injections shorten the duration of anesthesia, the adjunctive use of pre- or postoperative ibuprofen did not significantly alter pain scores.

Nadine Horneck,1,&ast; Ifrah Ahmed,1,&ast; Kayla Umemoto,1 Anvay Ullal,1 Dinesh Vyas1,2 1Department of Surgery, California Northstate University, College of Medicine, Elk Grove, CA, USA; 2Department of Surgery, Dameron Adventist Hospital, Stockton, CA, USA&ast;These authors contributed equally to this workCorrespondence: Dinesh Vyas, 525 Acacia Street, Stockton, CA, 95203, USA, Tel +1 314 680 1347, Email dineshvyas@yahoo.comAbstract: Over the past half century, diseases that were predominantly treated surgically have transitioned to less invasive medical therapies. Such diseases that are now effectively treated with medicine are (1) peptic ulcer disease (PUD), (2) coronary artery disease (CAD), and (3) gastrointestinal stromal tumors (GISTs). Likewise, gallstone disease may soon follow this trend. Currently, the gold standard treatment of symptomatic gallstones is laparoscopic cholecystectomies. Though one of the most common surgeries in the United States, certain cases of acute and gangrenous cholecystitis can be some of the most difficult surgeries to perform. Advancements in neutrophil extracellular trap (NET) inhibitor medical therapies will alter gallstone disease management and the mainstream role of surgical interventions. This focus on less invasive therapies will greatly impact the quality of patient care, financial obligations, and even resident training opportunities.Keywords: gallstone disease, medical therapies, NET inhibitor, invasive surgical therapy, drug discovery

Introduction: Despite advancements in dentistry, children with special needs continue to have poor oral health, with a higher prevalence of untreated dental caries and periodontal disease. Many treating dentists and the parents of these children encounter difficulty managing these children and the quality of their oral health will be determined by this. Hence, identifying and overcoming the barriers of managing children with Special Healthcare Needs (SHCN) can be assessed as important step in addressing their treatment needs. Aim: The study investigated the perceptions of general and paediatric dentists in Saudi Arabia, regarding the treatment needs and challenges posed while providing dental care to children with special needs. Materials and Methods: A cross-sectional, questionnairebased study was conducted among 447 general dentists and 76 paediatric dentists in Saudi Arabia during five month period between 15th October 2021 to 15th March 2022. A prevalidated questionnaire consisting of 18 close-ended questions assessing the knowledge, attitude and practices of the dentists related to children with SHCN was emailed to each dentist. The data was analysed using the IBM Statistical Package for Social Sciences (SPSS) version 22.0 (IBM, Chicago, USA). The threshold for significance was established at 5%. The significance of study variables was determined utilising Chi-square test. Results: Most paediatric dentists and general dentists were of the opinion that mental/behavioural/cognitive disability was the most difficult to manage (p

Introduction: An adolescent’s personal experiences, peer influences and social environment can affect their preference towards smile aesthetics and have influence apart from the opinion of their orthodontists. Aim: To evaluate and compare the preferences regarding smile arc, gingival display, midline symmetry, shape and size of incisor teeth, buccal corridor space and smile index of adolescent subjects between late adolescents, general dentists and orthodontists. Materials and Methods: A total of 52 orthodontists, 111 general dentists and 275 adolescents (156 females, 119 males) had participated in this cross-sectional study from 1st September 2019 to 31st January 2020. Each participant was shown a photo album consisting of 5 sets of photographs of male and female adolescent subjects and was asked to rate them on 7 selected variables. The data obtained was subjected to comparison between the groups using Chi-square test. Results: While assessing smile of the female subject, other than the incisal edge position, the intergroup comparisons of gingival display (p=0.0001), midline symmetry (p=0.0001), shape of incisor teeth (p-value=0.0001), buccal corridor space (p=0.001), ratio of central: lateral incisor (p=0.016) and smile index (p=0.0001) were statistically significant. While assessing smile of the male subject, the intergroup comparisons of incisal edge position (p=0.0001), gingival display (p=0.001), midline symmetry (p=0.007), shape of incisor teeth (p-value=0.0001), buccal corridor space (p=0.0001), ratio of central: lateral incisor (p=0.0001) and smile index (p=0.0001) were statistically significant. Orthodontists’ accepted gingival display of 0-2 mm, midline deviation up to 2 mm and buccal corridor space of upto 5 mm and upto 25% increase in smile index in both genders. Conclusion: The Orthodontists and dentists have more similarities than differences in comparison to adolescents with respect to the smile preferences of adolescent subjects.

Background: The impact of early childhood caries (ECC) seen in infants and young children to the society is enormous. Most studies on ECC have been focused on specific ethnic and lower socioeconomic communities, however fewer studies are conducted in India as compared to other developed countries. Aims: The study investigates the association between selected feeding practices and the presence of early ECC among 3–5 year-old children of Indore city. Methodology: A cross-sectional sample consisted of 640 preschool children of different socioeconomic status (SES). A self-administered questionnaire was used to obtain information about demographic backgrounds and feeding history of the child. The caries experience of children was recorded. Statistical Analysis: The data were evaluated using Chi-square and multivariate logistic regression. Results: The prevalence of ECC was found to be 64%. ECC was found to be significantly associated with age, SES, breastfeeding for more than 1 year, bottle feeding, bottle content used other than water, feeding at night, and cup drinking after 1 year. Conclusion: The present study indicates that ECC and feeding habits have a significant relationship. The content of the bottle feed and feeding practices at night are the strongest factors among all feeding habits associated with ECC

Introduction: White Spot Lesions (WSLs) observed during or after fixed orthodontic therapy has known to cause several dental problems clinically and aesthetically. It becomes imperative to understand the perception of treating dentists of the paediatric dentists to whom the children first visit, and also of the treating orthodontists and restorative dentists. Aim: To assess the knowledge, attitude, and practices of dentists regarding WSLs related to orthodontic treatment, and also to assess the preferences of these dentists regarding its management. Materials and Methods: A cross-sectional survey was planned for a period of two months (15th August 2020 to 15th October 2020) using a close ended, multiple choice questionnaire directed to evaluate the perspective of 260 dentists of Saudi Arabia towards white spot lesions associated with orthodontic treatment. The self designed validated questionnaire was prepared and mailed to dentists across the Kingdom of Saudi Arabia. Descriptive statistics followed by Chi-sqaure test was done to compare variables in the questionnaire. Results: A total of 52 paediatric dentists, 53 orthodontists, 51 restorative dentists, and 104 general dentists participated in the study. Out of 260 dentists, 236 (90.8%) of them have observed WSLs in their patients during/after orthodontic treatment. Adolescent patients more commonly complained of undesirable aesthetics due to WSLs. Incisors were the most commonly affected teeth. All dentists except orthodontists believed that they were proficient in diagnosing superficial or deep WSLs (p-value=0.005). Most dentists preferred professional application of high concentration topical fluorides. Most patients demanded an instant correction of these WSLs as reported by all groups of dentists. Conclusion: WSLs are commonly observed by dentists during the initial 7 to 12 months period of starting orthodontic therapy, more commonly on incisor teeth among the adolescent age group. The dentists recommended maintaining good oral hygiene as the most effective way of preventing WSLs. They also believed that high concentration fluoride agents are well suited for treating superficial lesions and composite resin restorations for deeper lesions.

Physical activity or structured exercise is beneficial in a wide range of circumstances. Nevertheless, individual-level data on differential responses to various types of activity are not yet sufficient in scale, duration or level of annotation to understand the mechanisms of discrete outcomes nor to support personalized recommendations. The Apple Heart & Movement Study was designed to passively collect the dense physiologic data accessible on Apple Watch and iPhone from a large real-world cohort distributed across the US in order to address these knowledge gaps.

In this study borassus and tamarind fruit fibers were extracted and their physical and mechanical properties such as diameter, density, tensile strength and interfacial adhesion strength (IAS) were experimentally determined. To study the effect of alkali treatment, both the fruit fibers were treated with 5% vol. sodium hydroxide solution for 0.5 h, 1 h, 2 h, and 4 h durations. Morphological studies of untreated and alkali treated fibers by using scanning electron microscope (SEM) revealed the presence of the surface impurities on the untreated fiber whereas the same were absent on the treated fibers. Fourier transform infrared spectrometry (FTIR) and X-ray diffraction (XRD) analysis also confirmed the elimination of amorphous hemicellulose of the fibers on treatment. Borassus fruit fine fibers and tamarind fruit fibers treated for 2 h exhibited better mechanical properties and improved IAS with Cashew Nut Shell Liquid (CNSL) -Epoxy matrix.

Research being an investigative process is employed to increase or revise the current knowledge. Scientific research involves the conduct of a methodical study to prove a hypothesis or give an answer to a specific question with the main aim of finding definitive answer. This paper aims to advance knowledge of research and develop interest in the postgraduate students. It also throws light on the existing and emerging research strengths within a “high-performance culture.” The trends in dental research worldwide are looked at, in particular, a comparison between the publication status in two countries, namely India and Australia. The current themes in dental research are also discussed to facilitate future projects for the aspiring pediatric dentists. Stress is given to the importance of evidence-based dentistry as the current times call for high-quality and ethical papers which are devoid of plagiarism. The common reasons for failure of a research are explored and the strengthening factors are highlighted. Proper planning of a pertinent research project is beneficial to the researcher as well as the dental community.

Introduction: Dental caries is one of the most common preventable childhood infections. a number of measures are available to prevent occlusal caries; pit and fissure sealants are one of the various methods currently available to cost effectively reduce dental caries. Aim: To evaluate the retention of pit and fissure sealant bonded using sixth (Adper promt), seventh (Optibond) and eighth (Futurabond Dual Cure) generations of adhesives. Settings and Design: A total of 37 healthy children who fulfilled the inclusion were randomly selected. A total of 148 teeth (4 in each subject) were used as samples for the study. Methods and Material: The teeth to be sealed were then isolated using rubber dam. The placement of adhesives was done using split mouth design. The first permanent molars were randomly divided into four groups on the basis of sealant placed without and with using 6th, 7th and 8th generation bonding agents as follows: GROUP A (N=37):- Pit and fissure sealant placed without bonding agent. GROUP B (N=37):- Pit and fissure sealant placed following sixth generation bonding agent (ADPER PROMT). GROUP C (N=37):- Pit and fissure sealant placed following seventh generation bonding agent. (OPTIBOND). GROUP D (N=37):- Pit and fissure sealant placed following eighth generation bonding agent. (FUTURA BOND DUAL CURE). The integrity of the sealant placed was assessed immediately after completion of the procedure, 3 months and 6 months after placement. The post-operative evaluation for retention was done using Simonsen criteria. A score of 0 was given for complete retention, 1 for partial retention and 2 for no retention. Statistical analysis used: The statistical analysis was done using SPSS (Statistical Package for Social Sciences) software version 21. Results: It was found that there was no statistically significant difference between the groups after 3 and 6 months as the value obtained (0.133) was much greater than the p-value (0.05). Conclusions: This study concluded that the use of bonding agent prior to application of pit and fissure sealant does not necessarily aid in retention of sealant as compared to pit and fissure sealant placed without bonding agent, Sealants effectiveness is directly related to its retention and it dependent on application procedures. The failure of retention of pit and fissure sealants can attribute to moisture contamination, improper curing methods, inadequate adhesion, improper application procedure or early age placement.

Introduction: Management of pulpally involved primary teeth has recently gained importance inspite of the barriers faced by general dentists such as limited exposure to paediatric dentistry, skill and chair-side time. The advancements in technological and material sciences necessitate a practicing dentist to update themselves to deliver comprehensive dental care in most effective way. Aim: The study was aimed to assess and compare the perspective of pulpal treatment of primary teeth among general and paediatric dentists of Saudi Arabia. Materials and Methods: Close-ended, multiple-choice questionnaire evaluating their preferences towards pulp therapy in primary teeth was designed as part of a survey and mailed to 100 general dentists and 50 paediatric dentists across Kingdom of Saudi Arabia. Descriptive statistics followed by χ2 -test was applied to test of variables in the questionnaire to determine their association. Results: Paediatric dentists (68%) performed pulpal treatment in primary teeth more frequently under rubber dam isolation than general dentists (47%) (p=0.025). Traditional indirect pulp capping was preferred to Indirect Pulp Treatment (IPT) by both groups under local anaesthesia. Caries detector dye was used to facilitate precise caries removal more frequently by Paediatric dentists than general dentists (p=0.001). Pulpotomy was preferred over IPT by both groups when there was a probability of pulp exposure following complete caries excavation. Pulpectomy was infrequently performed. Zinc oxide eugenol was the material preferred for obturation in both groups. Paediatric dentists preferred stainless steel crown whereas General dentists preferred glass ionomer restoration after pulp therapy (p=0.004). There was no significant difference between follow-up schedule followed by general and paediatric dentists even though most dentists recalled their patients immediately and after 3 months follow-up. Conclusion: The survey helps in refining the approaches of dentists towards pulp therapy in primary teeth and ascertains whether they are according to recent trends.

Introduction: High prevalence of dental caries in children has led to search simple and easy adjunctive preventive strategies of caries prevention. A plethora of products claim success in reducing cariogenic bacteria there by increasing the available choice for clinician. Aim: The study comparatively evaluated the adjunctive effect of tongue brushing and mouth rinsing in addition to regular tooth brushing on salivary Mutans Streptococci (MS) Colony Forming Units (CFU). Materials and Methods: A total of 48 selected children were randomly assigned to four mouthwash groups: distilled water, chlorhexidine gluconate, HiOra and xylitol. The phase I salivary MS CFU levels were determined at baseline (after oral prophylaxis) and after one week use of mouthwashes. After one-week washout period, the children again underwent oral prophylaxis and second baseline salivary MS CFU levels were estimated. The phase II evaluation (addition of tongue brushing) was carried out for one week, after which the salivary MS CFU levels were again recorded. Paired t-test or Dependent sample t-test was used for intragroup comparison. The intergroup comparison of salivary mutans streptococci was done by Unpaired t-test of Independent sample t-test and then ANOVA followed by Post-hoc Bonferroni test. Results: Inclusion of tongue brushing significantly reduced the salivary MS CFU’s only in the control group (p=0.009) but not in experimental mouthwash groups. Conclusion: Mouth rinsing alone is effective in reducing the salivary MS CFU’s. Performing tongue brushing in addition to mouth rinsing does not significantly reduce MS levels in saliva.

BACKGROUND: Sliding hiatal herniation (SHH) and gastroesophageal reflux (GER) commonly occur in French bulldogs. Wireless pH monitoring can quantitatively assess acidic GER in dogs affected by SHH. HYPOTHESIS/OBJECTIVES: Measure acidic GER in French bulldogs with SHH, pre- and post-brachycephalic obstructive airway syndrome (BOAS) surgery, utilizing a wireless pH capsule (Bravo Calibration-free, Medtronic, Minnesota), and correlate with owners observations of regurgitation. ANIMALS: Eleven French bulldogs diagnosed with SHH via swallowing fluoroscopy. METHODS: Prospective cohort study. A pH capsule was endoscopically placed in the esophagus. Up to 96 hours of data were acquired as the owner logged clinical signs. Spearmans correlation and Wilcoxon rank-sum tests evaluated factors correlated with acid exposure time (AET), defined by the % time pH

Background and Aim: Bacterial lipopolysaccharide (LPS)-induced neuroinflammation can be the most dependable animal model for studying neurodegeneration mechanisms driven by systemic inflammation-induced neuroinflammation. Hence, this study aimed to standardize the LPS model of neuroinflammation by comparing the effect of relatively low-dose LPS administered for different durations on the induction of neurodegeneration in Wistar rats. Materials and Methods: Six groups of six adult Wistar rats per group were used in the study. Group 1 was the control group, and the other five were administered single weekly dose of LPS (170 μg/kg) for increasing durations, ranging from 4 weeks to 8 weeks. The study endpoints included behavioral parameters, neuronal assay results, and the expression of microglia and astrocytes in the frontal cortex, dentate gyrus, and hippocampus. Results: We observed a significant reduction in the number of neurons and an increase in glial cells at 5 weeks of exposure, along with a decline in memory. Thereafter, these changes were gradual until 7 weeks of exposure. However, at 8 weeks of exposure, there was no further statistically significant worsening compared with the group exposed for 7 weeks. Conclusion: To effectively induce neuroinflammation and cause neuronal damage, a minimum of five weekly LPS administrations at a dose of 170 μg/kg is required. Moreover, our results recommend a maximum of 7 weeks of LPS exposure to create a chronic inflammatory model of neuroinflammation.

OBJECTIVES: The primary objective of this study was to evaluate the prescription patterns and appropriateness of the use of gastroprotectant medication in cats. METHODS: Pharmacy dispensation logs from an academic tertiary referral center were reviewed between 1 January 2018 and 31 December 2018. Cats that were administered proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), sucralfate, misoprostol, antacids or a combination were included. Data regarding medication, dosage, formulation, duration of administration, completeness of discharge instructions and clinical rationales for administration were obtained from medical records. The appropriateness of gastroprotectant use was assessed according to the American College of Veterinary Internal Medicine consensus statement guidelines. RESULTS: Of the 110 cases, 67 (60.9%) were prescribed a gastroprotectant medication without an appropriate indication. The most common reason for prescription was acute kidney injury in 26/67 (38.8%). PPIs were the most common gastroprotectant medication administered in 95/110 (86.3%) cats, followed by sucralfate in 18/110 (16.4%) and H2RAs in 11/110 (10%). Of the 35 cases in which gastroprotectant therapy was indicated, the medication chosen or dosage administered was considered suboptimal in 16 (45.7%). Instructions regarding the duration of administration, potential adverse effects and timing of administration in relation to meals or other medications were inconsistently provided in discharge instructions to pet owners. Of the 29 cases discharged with omeprazole, only 13 (44.8%) instructions included a duration of administration, while 6 (20.7%) recommended continuing gastroprotectants indefinitely until further notice, 16 (55.2%) discussed the timing of the administration in relation to a meal and six (20.7%) mentioned potential adverse effects; none advised tapering of omeprazole before discontinuation. CONCLUSIONS AND RELEVANCE: When prescribed, gastroprotectant medications were frequently prescribed injudiciously to cats in this referral population over a 12-month period. Discharge instructions to pet owners also often lacked information and recommendations regarding optimal administration, potential adverse effects, and tapering or discontinuation of the medications.

Root canal treatment in teeth with incomplete root formation is a challenge. A case of maturogenesis in an immature infected tooth along with probable factors needed for success is discussed. Although clinical and radiographic evidence points to healing and root development, the long-term prognosis and the behavior of tissue occupying the canal space needs further investigation before the procedure can be adopted into routine clinical practice.

Aims: The aim of this study is to find out whether Oratest can be used as a diagnostic tool in assessing the caries activity by evaluating its relationship to the existing caries status and the salivary streptococcus mutans level. Materials and Methods: The study sample consists of 90 students divided into two groups. Group I (test group) and Group II (control group) consisting of 30 children for control group and 60 children for test group. The sampling of unstimulated saliva for the estimation of streptococcus mutans was done as per the method suggested by Kohler and Bratthall. The plates were then incubated. Rough surface colonies were identified as streptococcus mutans on a pre-determined area of the tip (approximately 1.5 cm 2 ) were counted for each side of spatula pressed against mitis salivarius bacitracin agar using digital colony counter. The results were expressed in colony forming units (CFU). Oratest was carried out in the same patients after the collection of salivary sample for the microbiological method to evaluate the relationship between the two tests. Statistical Analysis Used: The tests used were ANOVA, Pearson Chi-square test, Pearson′s correlation analysis, Mann-Whitney U test and Student′s independent t-test. Results: In the control group and test group, when the streptococcus mutans count (CFU) and Oratest time (minutes) were correlated using Pearson′s correlation analysis, the streptococcus mutans counts was found to be in a statistically significant negative linear relationship with the Oratest time. When the caries status of the children, participated in the test group were correlated with mutans count (CFU) and Oratest time, caries status were found to be in a statistically significant positive linear relationship with streptococcus mutans count and in a significant negative linear relationship with Oratest time. Conclusions: The test proved to be a simple, inexpensive and rapid technique for assessing caries activity since a significant relationship exists clinically with caries status and microbiologically with the streptococcus mutans count of the individual.

Background Opportunistic fungal infections like oral candidiasis account for a significant amount of morbidity in HIV disease and an indicator of immune suppression. Fluconazole is a broad-spectrum antifungal agent that has been extensively used in the management of oral, candidiasis. Highly efficacious fluconazole is also known to have systemic toxicity due to high drug interaction and hence the present study focuses on the formulation of bioadhesive film as a controlled release carrier for fluconazole. Materials and Methods Patients were randomised, using a computer-generated list of random numbers, into one of the three groups: patients in group A received fluconazole mucoadhesive film 20 mg (sustained release) that was to be applied at bedtime and film 10 mg (intermediate release) to be applied during the day after lunch. Results There was a significant decrease in oral discomfort, pain and clinical improvement in group A compared to group B (Fluconazole oral tablets 100 mg/day) (P = 0.005) and group C (Fluconazole Mouth rinse) (P = 0.002). The patients who received the mucoadhesive patches had a more tolerable safety profile as expected compared to the other groups. Conclusion The bioadhesive films of fluconazole were used in HIV positive patients with oral candidiasis to overcome the problems of high dose requirement of the drug and reduce associated adverse reactions in an already immunocompromised patients and improve the quality of life.

Introduction: Chewing Side Preference (CSP) is said to occur when mastication is recognized exclusively/consistently or predominantly on the same side of the jaw. It can be assessed by using the direct method - visual observation and indirect methods by electric programs, such as cinematography, kinetography and computerized electromyography. Aim: The present study was aimed at evaluating the prevalence of CSP in deciduous, mixed and permanent dentitions and relating its association with dental caries. Materials and Methods: In a cross-sectional observational study, 240 school going children aged 3 to 18years were randomly allocated to three experimental groups according to the deciduous dentition, mixed dentition and permanent dentition period. The existence of a CSP was determined using a direct method by asking the children to chew on a piece of gum (trident sugarless). The Mann Whitney U-test was used to compare the CSP and also among the boys and girls. The Spearman’s Correlation Coefficient was used to correlate CSP and dental caries among the three study groups and also among the groups. Results: CSP was observed in 69%, 83% and 76% of children with primary, mixed and permanent dentition respectively (p>0.05). There was no statistically significant association between the presence of CSP and dental caries among the three study groups. Conclusion: There was a weak or no correlation between gender and distribution of CSP and between presence of CSP and dental caries.

Introduction: Basal Cell Carcinoma (BCC) is the most common skin cancer worldwide, which appears over sun-exposed skin as slow-growing, locally invasive lesion that rarely metastasizes. Many phenotypic presentations are possible. BCCs are more common in males and tend to occur in older people. Majority is found on the head and neck. Many histopathological subtypes have been defined including nodular, micronodular, cystic, superficial, pigmented, adenoid, infiltrating, sclerosing, keratotic, infundibulocystic, metatypical, basosquamous and fibroepitheliomatous. Mixed patterns are common. Aim: The aim was to study morphological spectrum of BCC in a tertiary care hospital in southern Karnataka. Materials and Methods: This was a retrospective analysis of 100 cases of BCCs reported in the Department of Pathology over a 9-year period from 2006 to 2014. Results: The mean age of presentation was 62 years. There was slight female preponderance (56%). The most common location was face (65%) and the most common presentation was ulceration (45%). Of the 100 BCCs, 50% were nodular, 13% infiltrating, 6% basosquamous, 4% superficial, 3% keratotic, 3% multinodular and 1% mixed. Conclusion: BCC, besides being the commonest cutaneous cancer, is also known for its numerous histological patterns which are shown to have prognostic implications. This study reveals the frequency of the various histological patterns of BCC in southern Karnataka, where it has been rarely studied before.

Purpose: The aim of the study was to find the relationship between salivary IgA (s-IgA) levels and dental caries in children. Materials and Methods: A total of 40 children in the age group of 8 to 12 years were selected and divided into two groups. Group I with DMFT score 0 and Group II with DMFT score ≥3. The whole unstimulated s-IgA levels were estimated using ELISA method. Results: Whole s-IgA levels were significantly higher in group II with DMFT score ≥3 as compared with group I with DMFT score 0. Conclusions: There was an increase in s-IgA levels in caries-active mouth to give protection mechanism against dental caries and the Streptococcus mutans which are active in caries-active mouth. The s-IgA antibodies can play an important role in control of dental caries.

Aims: To compare the effect of Manuka honey, chlorhexidine gluconate (0.2%) mouthwash and xylitol chewing gum on the dental plaque levels. Materials and Methods: Sixty healthy male dental students aged between 21 and 25 years (mean age 23.4 years) participated in the study. All the subjects received a professional prophylaxis at the start of the study, with the purpose of making the dentition 100% free of plaque and calculus. The subjects were then randomly divided into three groups, i.e. the Manuka honey group, the chlorhexidine gluconate mouthwash group and the xylitol chewing gum group. Rinsing with water or any other fluid after the procedure was not allowed as also any form of mechanical oral hygiene for all the subjects during the experimental period of 72 h. After the experimental period, the plaque was disclosed using disclosing solution and their scores were recorded at six sites per tooth using the Quigley and Hein plaque index modified by Turesky-Gilmore-Glickman. Results: The mean plaque scores for Groups I, II and III were 1.37, 1.35 and 1.57, respectively. The ANOVA revealed that between-group comparison was significant, with an F-value of 5.99 and a probability value of 0.004. The T-test was carried out to evaluate the inter-group significance, which revealed that the plaque inhibition by Manuka honey was similar to that of chlorhexidine mouthwash. Both Manuka honey and chlorhexidine mouthwash reduced plaque formation significantly, better than the xylitol chewing gum. Conclusion: Manuka honey and chlorhexidine mouthwash reduced plaque formation significantly better than xylitol chewing gum.

Trisomy 13 is a rare chromosomal disorder in which all or a percentage (mosaicism) of cells contain an extra 13th chromosome. Sinus of Valsalva aneurysms are rare, with an incidence of 0.1% to 3.5% of all congenital heart defects. This article reports the case of a patient with trisomy 13 with a new systolic murmur found to have a ruptured sinus of Valsalva aneurysm diagnosed on coronary computed tomography angiography. This is the first case to report sinus of Valsalva aneurysm rupture secondary to Streptococcus viridans endocarditis in a patient with trisomy 13 syndrome and highlights the importance of coronary computed tomography angiography in noninvasive imaging and surgical planning.

BackgroundSerum folate is considered a biomarker of chronic enteropathy (CE) in dogs, but few studies have examined associations with markers of CE.Hypothesis/objectivesTo evaluate serum folate concentrations in dogs with and without CE and associations with sample hemolysis and selected markers of CE. We hypothesized that hypofolatemia would be more common in dogs with CE and associated with hypocobalaminemia, higher CIBDAI, and hypoalbuminemia.AnimalsSix hundred seventy-three dogs with available serum folate measurements performed at an academic veterinary hospital between January 2016 and December 2019.MethodsMedical records were retrospectively reviewed to categorize cases as CE or non-CE and record clinical details and laboratory markers. Relationships between serum folate, cobalamin, and CE variables were assessed using chi-square, Kruskal-Wallis, or Spearman's correlation tests.ResultsOf the 673 dogs, 99 CE were compared to 95 non-CE. In the overall cohort, serum folate concentration did not correlate with sample hemolysis (P = .75). In the CE subset, serum folate and cobalamin concentrations were positively associated (rho = 0.34, FDR = 0.02). However, serum folate concentrations (median [25th, 75th percentiles]) were higher (CE: 12.1 (8.9, 16.1), non-CE: 10.4 (7.2, 15.5); P = .04) and cobalamin concentrations were lower (CE: 343 (240, 597), non-CE: 550 (329, 749); P = .001) in the CE vs non-CE group. Serum folate was not associated with markers of CE, but serum cobalamin was associated with albumin (P = .04) and cholesterol (P = .03).Conclusions and clinical importanceHypofolatemia is an inferior biomarker of CE compared to hypocobalaminemia.

BACKGROUND: Hospitalizations related to the consequences of opioid use are rising. National guidelines directing in-hospital opioid use disorder (OUD) management do not exist. OUD treatment guidelines intended for other treatment settings could inform in-hospital OUD management. OBJECTIVE: Evaluate the quality and content of existing guidelines for OUD treatment and management. DATA SOURCES: OVID MEDLINE, PubMed, Ovid PsychINFO, EBSCOhost CINHAL, ERCI Guidelines Trust, websites of relevant societies and advocacy organizations, and selected international search engines. STUDY SELECTION: Guidelines published between January 2010 to June 2020 addressing OUD treatment, opioid withdrawal management, opioid overdose prevention, and care transitions among adults. DATA EXTRACTION: We assessed quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. DATA SYNTHESIS: Nineteen guidelines met the selection criteria. Most recommendations were based on observational studies or expert consensus. Guidelines recommended the use of nonstigmatizing language among patients with OUD; to assess patients with unhealthy opioid use for OUD using the Diagnostic Statistical Manual of Diseases-5th Edition criteria; use of methadone or buprenorphine to treat OUD and opioid withdrawal; use of multimodal, nonopioid therapy, and when needed, short-acting opioid analgesics in addition to buprenorphine or methadone, for acute pain management; ensuring linkage to ongoing methadone or buprenorphine treatment; referring patients to psychosocial treatment; and ensuring access to naloxone for opioid overdose reversal. CONCLUSIONS: Included guidelines were informed by studies with various levels of rigor and quality. Future research should systematically study buprenorphine and methadone initiation and titration among people using fentanyl and people with pain, especially during hospitalization.

BACKGROUND: The Get With The Guidelines - Atrial Fibrillation (GWTG-AFIB) Registry uses achievement and quality measures to improve the care of patients with atrial fibrillation (AF). We sought to evaluate overall and site-level variation in attainment of these measures among sites participating in the GWTG-AFIB Registry. METHODS: From the GWTG-AFIB registry, we included patients with AF admitted between 1/3/2013 and 6/30/2019. We described patient-level attainment and variation in attainment across sites of 6 achievement measures with 1) defect-free scores (percent of patients with all eligible measures attained), and 2) composite opportunity scores (percent of all eligible patient measures attained). We also described attainment of 11 quality measures at the patient-level. RESULTS: Among 80,951 patients hospitalized for AF (age 70±13 years, 47.0% female; CHA2DS2-VASc 3.6±1.8) at 132 sites. Site-level defect-free scores ranged from 4.7% to 85.8% (25th, 50th, 75th percentile: 32.7%, 52.1%, 64.4%). Composite opportunity scores ranged from 39.4% to 97.5% (25th, 50th, 75th: 68.1%, 80.3%, 87.1%). Attainment was notably low for the following quality measures: 1) aldosterone antagonist prescription when ejection fraction ≤35% (29% of those eligible); and 2) avoidance of antiplatelet therapy with OAC in patients without coronary/peripheral artery disease (81% of those eligible). CONCLUSIONS: Despite high overall attainment of care measures across GWTG-AFIB registry sites, large site variation was present with meaningful opportunities to improve AF care beyond OAC prescription, including but not limited to prescription of aldosterone antagonists in those with AF and systolic dysfunction and avoidance of non-indicated adjunctive antiplatelet therapy.

Swallowing impairment is a highly prevalent and clinically significant problem affecting people and dogs. There are myriad causes of swallowing impairment of which gastroesophageal reflux is the most common in both species. Similarities in anatomy and physiology between humans and canines results in analogous swallowing disorders including cricopharyngeus muscle achalasia, esophageal achalasia, hiatal herniation, and gastroesophageal reflux with secondary esophagitis and esophageal dysmotility. Accordingly, the diagnostic approach to human and canine patients with swallowing impairment is similar. Diagnostic procedures such as swallowing fluoroscopy, high-resolution manometry, pH/impedance monitoring, and endolumenal functional luminal imaging probe can be performed in both species; however, nasofacial conformation, increased esophageal length, and the difficulty of completing several of these procedures in awake dogs are inherent challenges that need to be considered. Human patients can convey their symptoms and respond to verbal cues, whereas veterinarians must rely on clinical histories narrated by pet owners followed by comprehensive physical examination and observation of the animal eating different food consistencies and drinking water. Dogs may also be unwilling to drink or eat in the hospital setting and may be resistant to physical restraint during diagnostic procedures. Despite the species differences and diagnostic challenges, dogs are a natural animal model for many oropharyngeal and esophageal disorders affecting people, which presents a tremendous opportunity for shared learnings. This manuscript reviews the comparative aspects of esophageal anatomy and physiology between humans and canines, summarizes the diagnostic assessment of swallowing impairment in both species, and discusses future considerations for collaborative medicine and translational research.