Oral microbiological evidence among palliative patients: An integrated systematic review

Life-limiting diseases such as cancers and its related treatments often compromise normal oral microbial flora and predispose a palliative patient to diverse oral infections. Knowledge on microbial flora in the oral cavity of patients with life-limiting diseases is essential to develop treatment options for clinical practitioners. This review aimed to systematically synthesize the published evidence on the oral microbiology of palliative patients. An integrative review was undertaken with defined search strategy from five databases with manual search through key journals and reference list. Studies included were published during the year 2000–2017 focusing on microbiological evidence associated with oral conditions among palliative patients. Candida presence was reported in the oral cavity of terminally ill patients in seven of nine articles, with Candida albicans being the predominant species. The majority of the included studies used oral swabs as a technique for isolation of the organism. This review is first to systematically synthesize the published evidence on the oral microbial flora of palliative patients, taking into account the techniques for identification of the microbiota. Larger multicenter studies may help in developing standardized clinical guidelines for the oral care of these patients

Protocol for a three-phase prospective study to develop educational resource of antimicrobial resistance and stewardship for medical programme

INTRODUCTION: Antimicrobial resistance (AMR) is one of the critical medical issues of the 21st century. Medical professionals are the primary prescribers of antimicrobials; their undergraduate education of antimicrobial stewardship (AMS) is considered one of the fundamental approaches in combating the issue of AMR. This education level provides a platform to bridge any gaps in their knowledge and competency in AMS. This study aims to develop an educational resource on microbes, hygiene and prudent antimicrobial use for the undergraduate medical programme. The guideline produced will then be assimilated into the existing curriculum which will help to improve the quality of education which in turn will improve rationale as the use of antimicrobials in the future. METHODS AND ANALYSIS: A three-step approach consensus approach will be adopted for this study for the development of a validated medical curriculum guideline on AMR. A preliminary curriculum for the programme will be drafted from reviews of published literature including syllabi as well as national and international guidelines. A total of 26 potential sources were found to be relevant, and selected for this study. Subsequently, the drafted curriculum will be subjected for validation via online surveys by various infectious disease experts. Finally, a Delphi technique will be employed to obtain consensus on heterogeneous findings to the revised curriculum. The quantitative and qualitative responses will be analysed and discussed among the panel of researchers. ETHICS AND DISSEMINATION: This study protocol has been approved by the Institute of Health Sciences Research Ethics Committee of Universiti Brunei Darussalam (Reference: UBD/PAPRSBIHSREC/2020/124). Informed consent declaration will be collected prior to data collections as indication of agreement of participation in the study. Results will be made available to medical educators and also researchers on AMR and stewardship. The results also will be disseminated at feedback sessions to officers at Ministry of Health and Ministry of Education, Brunei Darussalam

Pharmacotherapeutics applications and chemistry of chalcone derivatives

Chalcones have been well examined in the extant literature and demonstrated antibacterial, antifungal, anti-inflammatory, and anticancer properties. A detailed evaluation of the purported health benefits of chalcone and its derivatives, including molecular mechanisms of pharmacological activities, can be further explored. Therefore, this review aimed to describe the main characteristics of chalcone and its derivatives, including their method synthesis and pharmacotherapeutics applications with molecular mechanisms. The presence of the reactive α,β-unsaturated system in the chalcone’s rings showed different potential pharmacological properties, including inhibitory activity on enzymes, anticancer, anti-inflammatory, antibacterial, antifungal, antimalarial, antiprotozoal, and anti-filarial activity. Changing the structure by adding substituent groups to the aromatic ring can increase potency, reduce toxicity, and broaden pharmacological action. This report also summarized the potential health benefits of chalcone derivatives, particularly antimicrobial activity. We found that several chalcone compounds can inhibit diverse targets of antibiotic-resistance development pathways; therefore, they overcome resistance, and bacteria become susceptible to antibacterial compounds. A few chalcone compounds were more active than conventional antibiotics, like vancomycin and tetracycline. On another note, a series of pyran-fused chalcones and trichalcones can block the NF-B signaling complement system implicated in inflammation, and several compounds demonstrated more potent lipoxygenase inhibition than NSAIDs, such as indomethacin. This report integrated discussion from the domains of medicinal chemistry, organic synthesis, and diverse pharmacological applications, particularly for the development of new anti-infective agents that could be a useful reference for pharmaceutical scientists

Knowledge and awareness of Consumer Protection Act among private dentists in Tricity, Punjab

Background: Consumer Protection Act (CPA) aims to protect the interests of the patients in case of any unethical treatment rendered by a medical or a dental health professional. The present study was conducted to assess knowledge and awareness of CPA among dental professionals in a Tricity in India. Materials and Methods: A cross-sectional study was conducted among 265 private dental practitioners in Tricity. A close-ended self-structured questionnaire was administered which contained 15 questions on knowledge and awareness regarding CPA. Categorization of knowledge scores was done at three levels-low, medium and high. Statistical analysis was done using ANOVA and Student t-test. Results: 54.7% (145) of subjects were having low knowledge scores, 23.3% (62) had a medium score and 21.8% (58) had a high score. Mean knowledge score according to educational level was statistically significant (P 0.05). Conclusion: The results of the present study showed that majority of the subjects were aware of the existence of CPA but knowledge regarding basic rules and regulations was lacking in few studies. Therefore, dental professionals need to keep them updated of various rules and latest amendments to save themselves from any litigation

Evaluation of socio-demographic variables affecting the periodontal health of pregnant women in Chandigarh, India

Background: The literature is replete with reports that pregnant women have an increased level of periodontal disease as compared with non-pregnant women of the same age. There are many studies correlating the effect of periodontal disease on the adverse pregnancy outcomes. The development of periodontal diseases during pregnancy can be influenced by factors such as preexisting oral conditions, general health, and socio-cultural background. There is very little data studying the effect of socio-demographic factors on the periodontal health of pregnant women. This study evaluated the periodontal status of a sample of pregnant women of Chandigarh and adjoining areas. The study also investigated the relationship between these variables and a series of demographic and clinical variables. Materials and Methods: The participants were 190 pregnant women attending Gynecology and Obstetrics outpatient department of Government Medical College and Hospital, Chandigarh. The participants were examined for their periodontal health and various socio-demographic variables were recorded on performas designed for the purpose of study. Statistical analysis was done. Results: The results revealed that the mean bleeding index scores and probing depth increased with statistical significance when the socio-economic status was lower ( P0.1). The plaque index was not significantly associated with the socio-economic status, profession, place of residence, and trimester of pregnancy ( P>0.1). Conclusion: In the population of pregnant women investigated under this study, the clinical and socio-demographic characteristics showed non-significant correlation except socio-economic status which showed statistically significant correlation with bleeding on probing and pocket depth. Further studies may be required in Indian population to determine the association of periodontal diseases in pregnant women with socio-demographic variables

Oral Hygiene Practices among Adults with Intellectual Disabilities—A Pilot Study

It is known that the oral health status of people with intellectual disabilities (IDs) is likely to be compromised as compared with the general population. Until recently, the trend of oral hygiene among the adult population with intellectual disabilities in Brunei Darussalam had yet to be studied. Thus, the aim of this study was to determine the oral hygiene practices, oral health knowledge and dental appointment patterns among the adult population with IDs in Brunei Darussalam. A cross-sectional study was conducted at different service providers in Brunei Darussalam for adults with IDs. An easy-to-read questionnaire was distributed to the participants. The responses of the questionnaire for IDs were analyzed. A total of 34 participants were recruited. It was found that all participants were practicing their daily oral hygiene routine. In terms of dental visits, more than half visit the dentist at least once a year. The majority of the participants agreed that visiting the dentist every 6 months was essential. This study showed that adults with IDs in Brunei Darussalam were aware of the importance of oral health and were maintaining their daily oral hygiene, although not with the ideal method. It is important for clinicians to not only educate the individuals with IDs but also their carer(s) when it comes to oral health knowledge, as carers play a key role in the oral health of the people under their care

In vitro comparison of two titanium dental implant surface treatments: 3M™ESPE™ MDIs versus Ankylos®

Abstract Background An ideal implant should have a surface that is conducive to osseointegration. In vitro cell culture studies using disks made of same materials and surface as of implants may provide useful information on the events occurring at the implant-tissue interface. In the current study, we tested the hypothesis that there is no difference in the proliferation and differentiation capacities of osteoblastic cells when cultured on titanium disks mimicking the surface of 3M™ESPE™ MDIs or standard (Ankylos®) implants. Methods Cells were grown on disks made of the same materials and with same surface texture as those of the original implants. Disks were sterilized and coated with 2% gelatin solution prior to the cell culture experiments. C2C12 pluripotent cells treated with 300 ng/ml bone morphogenetic protein 2 BMP-2 and a stably transfected C2C12 cell line expressing BMP2 were used as models for osteogenic cells. The Hoechst 33258-stained nuclei were counted to assay cell proliferation, while alkaline phosphatase (ALPL) immunostaining was performed to investigate osteogenic differentiation. MC3T3-E1 cells were cultured as model osteoblasts. The cells were differentiated and assayed for proliferation and metabolic activities by Hoechst 33258 staining and Alamar blue reduction assays, respectively. Additionally, cultures were stained by calcein to investigate their mineral deposition properties. Results Electron microscopy showed greater degree of roughness on the MDI surfaces. Nuclear counting showed significantly higher number of C2C12 cells on the MDI surface. Although immunostaining detected higher number of ALPL-positive cells, it was not significant when normalized by cell numbers. The number of MC3T3-E1 cells was also higher on the MDI surface, and accordingly, these cultures showed higher Alamar blue reduction. Finally, calcein staining revealed that the MC3T3-E1 cells grown on MDI surfaces deposited more minerals. Conclusions Although both implant surfaces are conducive for osteoblastic cell attachment, proliferation, and extracellular matrix mineralization, cell proliferation is higher on MDI surfaces, which may in turn facilitate osseointegration via increased ECM mineralization

Acquaintance, attitude, practices and challenges of palliative oral care among healthcare professionals: A cross-sectional survey at a tertiary healthcare institute in India

Introduction: To assess knowledge, experiences, perceptions and barriers of healthcare professionals regarding oral palliative care. Material and methods: The study involved 150 participants working at a tertiary healthcare institute in India. The data collection tool was pretested and self-administered with sections on demographics, knowledge, attitude and practices, patient referral, perspectives, and barriers to oral palliative care. Results: The majority of participants 142 (94.6%) believed that palliative care patients need oral care, 85 (68.6%) participants had treated palliative care patients with dental problems. However, 60 (40%) had not received formal training for assessment and referral of patients with oral problems; 95 (63.4%) had never used tools to assess oral conditions of palliative care patients. According to 69 (46%), the best method to maintain oral hygiene is rinsing with saline and 81 (54%) expected physicians to be responsible for oral care of palliative care patients. The main challenges in providing oral care were lack of proper guidelines listed by 117 (78%) and lack of formal training indicated by 60 (40%) respondents. Conclusions: This study highlighted the need for effective assessment of the mouth and appropriate oral care. Training of healthcare professionals, educating families and patients with oral palliative care are necessary to effectively manage oral symptoms. An appropriate patient follow-up and care delivery system should be structured at comprehensive cancer centres, which can improve the quality of life and compliance of patients. There is a need for the development of assessment tools and referral practices for providing relief, comfort and consolation to patients and families

Role of Immunotherapy in the Treatment of Cancer:A Systematic Review

Tremendous progress has been made in cancer research over the years, and, as a result, immunotherapy has emerged as an important therapy for the treatment of cancer, either as a stand-alone treatment or in conjunction with other cancer therapies. Immunotherapy has demonstrated encouraging outcomes and offers a viable strategy for not only enhancing the quality of life but also dramatically boosting the overall survival rate of cancer patients. The objective of this systematic review was to assess the efficacy of immunotherapy in the treatment of cancer. Databases such as PubMed and Science Direct were searched from their inception until September 2021, using the following keywords: cancer immunotherapy, cancer recurrence, cancer treatment options, and cancer therapies. The systematic review was conducted in accordance with the PRISMA protocol. There were a total of 599 articles; however, after applying the inclusion and exclusion criteria, the final review ended up with 34 publications. In conclusion, the studies have demonstrated that immunotherapy is a viable alternative treatment option for patients with recurrent or metastatic cancer, since the overall survival rate and progression-free survival rate were shown to be successful

Assessment of oral health problems and oral hygiene practices among palliative care patients using a new tool: A pilot study

Introduction: This research paper is a cross-sectional study that aims to estimate the prevalence oforal health problems among adult patients in palliative care, as well as to investigate the oral hygienepractices of palliative care patients in Brunei Darussalam.Patients and methods: In this study, the Oral Palliative Care and Assessment and Referral tool (OPCAR)along with a 15-item questionnaire were utilized as reliable tools for measurements. All palliative carepatients who had been assessed in this study were invited to participate. A total of 90 palliative carepatients were invited to participate and 73 patient data were used for the subsequent data analysis.Results: The three most common problems among palliative care patients were saliva, lips, and teethcategory. Fisher’s exact test identified there were significantly higher teeth-related problems (teeth caries,fracture, broken root stumps) in non-denture wearing patients as compared with denture wearingpatients. However, other associations between denture wearing to oral hygiene was of little significance.Conclusions: Using the normal approximation sample method, it was revealed that almost all the participantswere eligible to be referred to the dental clinic for at least one oral problem