Herbal oral care: an old concept or a new model?

Ayurveda, the oldest medical science originating from Indian subcontinent, has been practiced since the 12th century BC. Its objective is to accomplish physical, mental, social and spiritual well- being by adopting preventive, health promoting and holistic approach towards life. Ayurveda is the science that developed as humans evolved and has stood the test of time. Oral diseases are major health problems worldwide and are not limited to dental caries and periodontal diseases but to various autoimmune conditions. Oral health influences the general quality of life and poor oral health is linked to chronic conditions and systemic diseases. Recently there is renewed interest in use of various Ayurvedic drugs for oral and dental health.

How different are students and their learning styles?

Introduction: Students, like anybody else differ from each other. As students they differ in their preferred mode of learning, i.e. their preferred modes in gathering, organizing and thinking about information. A recent classification proposed by Neil Fleming and associates state that students learning styles can be divided into Visual/graphic, Aural, Read/write and Kinesthetic types, VARK.Aim: The aim of the recent study is to investigate learning styles among dental students in two different dental colleges of India.Method: The VARK-questionnaire contains 15 multiple-choice- questions with four possibilities to select an answer. Each possibility represents one of the four modes of perception. But, one can select more than one answer to each question, which is necessary for the identification of poly modal modes of perception and learning. This is also a psychometric problem when trying to state a measure of the reliability of the questionnaire. The VARK-questionnaire was distributed among 200 students and was collected back. This sample size represents 100% response rate from the students in the class and is markedly above the level required to make conclusions about student preferences for receiving and processing information. The students spent about 10 minutes in an ordinary lesson to fill in the questionnaire. Students register number and name were used in the study and there was no blinding practiced.Study Design: Questionnaire based clinical studyResults: The responses from the students in our University where classified into multi-modal (VARK), tri-modal (VRK, VAK, VAR, ARK), bi-modal (VR, VA, VK, RK) and uni-modal (V, A, R.K) categories. Results showed that subjects had a higher preference for multimodal learning.Conclusion: We conclude that students in our set up prefer multimodal and more of Kinesthetic of learning. To meet their needs, a variation in teaching, learning and examination must be implemented. If not, these students with a high kinesthetic preference for perception and learning may be at the losing end

Correlation of serum fructosamine, erythrocyte Na+-K+ ATPase and glutathione peroxidase with HbA1c levels

Glycated hemoglobin is the frequently used test in the diagnosis of diabetes mellitus. However, because this test is affected by various factors and may not be accurate for patients of certain health conditions, the present study aims to explore the association between potential and cost-effective markers like serum Fructosamine, Erythrocyte Na+-K+ ATPase, and Glutathione peroxidase with altering levels of established marker HbA1c (Glycated haemoglobin). The study showed that serum Fructosamine has a statistically significant (P = <0.0001) association with increasing levels of HbA1c as well as blood glucose. There was a 100% sensitivity and specificity for serum fructosamine test against HbA1c in ROC analysis, however, the erythrocyte glutathione peroxidase and erythrocyte membrane Na+-K+ ATPase activity was not affected by increasing HbA1c levels

Correlation of serum fructosamine, erythrocyte Na+-K+ ATPase and glutathione peroxidase with HbA1c levels

334-338Glycated hemoglobin is the frequently used test in the diagnosis of diabetes mellitus. However, because this test is affected by various factors and may not be accurate for patients of certain health conditions, the present study aims to explore the association between potential and cost-effective markers like serum Fructosamine, Erythrocyte Na+-K+ ATPase, and Glutathione peroxidase with altering levels of established marker HbA1c (Glycated haemoglobin). The study showed that serum Fructosamine has a statistically significant (P = <0.0001) association with increasing levels of HbA1c as well as blood glucose. There was a 100% sensitivity and specificity for serum fructosamine test against HbA1c in ROC analysis, however, the erythrocyte glutathione peroxidase and erythrocyte membrane Na+-K+ ATPase activity was not affected by increasing HbA1c levels

Challenges in Early Diagnosis of Oral Cancer: Cases Series

Za oralni rak prosječna je stopa preživljavanja samo 50 %. Ta se prognoza može znatno poboljšati ako se bolest dijagnosticira i liječi u ranoj fazi, a obično se povezuje s klasičnim kliničkim karakteristikama povezanima s malignošću koje rezultiraju točnom dijagnozom. No, neki slučajevi, posebno u ranim fazama, mogu biti klinički varljivi pa se i pogrešno dijagnosticiraju. No postoji noviji trend u demografskim i etiološkim obilježjima koja se povezuju s oralnim karcinomom, a za kliničara su dijagnostički izazovi. Svjesnost o tim trendovima je potrebna kako bi se oralni rak rano dijagnosticirao. Ovdje su opisana tri takva izazovna slučaja.Oral cancer has an overall survival rate of only 50%. This prognosis is significantly improved when this disease is diagnosed and treated in its early stages. Oral cancer is usually associated with classical clinical features associated with malignancy resulting in accurate diagnosis. However, certain cases of oral cancer, especially in its early stages, can be clinically deceptive and can be misdiagnosed. There is a recent trend of changing demographics and etiology associated with oral cancer adding to the diagnostic challenges faced by the clinician. The awareness of these changing trends is needed to aid in early diagnosis of oral cancer. In this case series, we have presented three cases of patients with challenging aspects

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Detection of human papilloma virus in potentially malignant and malignant lesions of the oral cavity and a study of associated risk factors

Background: Squamous cell carcinoma of the head and neck is the 6 th most frequently occurring cancer worldwide, with over 400,000 cases projected annually. Multiple factors such as tobacco, alcohol, irradiation, virus, and chronic irritants are involved in the development of oral squamous cell carcinomas (OSCCs). The most important risk factors are chronic exposure to tobacco and alcohol. Although the evidence that implicates virus is increasing, particularly (human papillomavirus [HPV]), in the carcinogenesis process, the role of virus is not well established. Aim and Objective: This study is designed to assess the presence of HPV in potentially malignant and malignant lesions of the oral cavity as well as to correlate the presence of HPV with addictive habits and histopathological grading of the disease. Materials and Methods: Biopsy samples of OSCC and potentially malignant lesions were obtained and 3, 5 μm thickness sections were cut using a microtome. The sections were collected using a sterile brush and transferred to an Eppendorf tube. DNA extraction and polymerase chain reaction for the detection of HPV were done. Results and Conclusion: The association between histopathological grading and presence of HPV was assessed using Chi-square test and the values thus obtained were found to be statistically significant. HPV was more predominantly seen in well-differentiated carcinomas and moderately differentiated carcinomas as compared to poorly differentiated carcinomas

Prevalence of Incidental Maxillary Sinus Anomalies on CBCT Scans: A Radiographic Study

CBCT significantly impacts dental procedures and has brought significant reforms to our approach to diagnosis and treatment planning despite its limitations in differentiating soft tissues. It is an excellent imaging modality and quickly identifies sinus opacification and provides valuable insight into paranasal sinus pathologies, with considerably lower radiation exposure. The present study aimed to investigate the occurrence of maxillary sinus abnormalities in CBCT scans, identify the frequency, type, and location of these findings, and find the correlation between the distance of periapical lesions and radiographic changes in the maxillary sinus. Two examiners independently evaluated 117 patients to diagnose and classify the cases into different abnormality subtypes. The periapical lesions most closely related to the sinus were recorded. The diameters of the left and right maxillary sinus ostium and the distance of the ostium’s lower border to the sinus’s osseous floor were recorded. The findings were correlated with the age and gender of these patients. The present study reveals that sixty-one patients were diagnosed with mucosal thickening (52.1%). The sinus wall most affected by mucosal thickening was the maxillary sinus floor, followed by the medial and lateral walls. Of 19 patients with periapical lesions, 15 had maxillary sinus mucosal thickening, which is statistically significant (p = 0.004). The high occurrence of abnormalities in the maxillary sinus emphasizes the importance for the radiologist to comprehensively interpret the whole volume acquired in CBCT images, including the entire sinus. Incidental findings may be considered in the individual clinical context of signs and symptoms, reducing the risk of overestimating the real impact of radiographic findings