This study compared the antifungal efficacy of various endodontic irrigants, with and without the antifungal agent clotrimazole, against Candida albicans in extracted human teeth. Teeth were inoculated with C. albicans and irrigated with sodium hypochlorite, chlorhexidine gluconate, doxycycline hydrochloride, or combinations of these with 1% clotrimazole. Colony forming units were significantly lower for sodium hypochlorite and chlorhexidine alone compared to doxycycline or the control. Adding clotrimazole increased the efficacy of all irrigants, with sodium hypochlorite with clotrimaz
Objective: To evaluate the antibacterial effects of 4 different cavity disinfectants on Streptococcus mutans, Lactobacillus acidophilus, and Enterococcus faecalis bacteria in different time periods.
Study Design: The antibacterial effects of Cavity Cleanser, Tubulicid Red Label, Chloraxid 2%, and Oxygenated Water cavity disinfectant solutions on E. faecalis (ATCC 29212), S. mutans (ATCC 25175), and L. acidophilus (RSKK 03037) bacterial strains were evaluated by disk diffusion method. In the study where vancomycin antibiogram disc constituted the positive control group, physiological saline solution was used as the negative control group. Standard, sterile, blank antibiogram discs of 5 mm in diameter, in which 15 μL of each material were added, were placed on agar plates at 2.5–3 cm intervals. The inhibition zone diameters formed around the discs that were left to incubate for 24–48 hours at 37°C were measured in millimeters. Statistical analysis of the data was performed using one-way analysis of variance, Kolmogorov-Smirnov, Levene, and Bonferroni tests.
Results: At the end of the study the solutions tested showed a statistically significant antibacterial effect on all bacterial strains used (p<0.05). Cavity Cleanser disinfectant containing 2% chlorhexidine showed the highest antibacterial effect on S. mutans and L. acidophilus, and benzalkonium-containing Tubulicid Red disinfectant on E. faecalis.
Conclusion: The antibacterial effect of all cavity disinfectants used in the study was found to be higher at the end of the 48th hour than at the end of the 24th hour, but there was no statistically significant difference (p>0.05).
Keywords: antibacterial agents; antibacterial effect; cavity disinfectants; chlorhexidine; contamination; dental caries; disinfection; disc diffusion; gram-negative bacteria; gram-positive bacteria
Objective: To evaluate the antibacterial effects of 4 different cavity disinfectants on Streptococcus mutans, Lactobacillus acidophilus, and Enterococcus faecalis bacteria in different time periods.
Study Design: The antibacterial effects of Cavity Cleanser, Tubulicid Red Label, Chloraxid 2%, and Oxygenated Water cavity disinfectant solutions on E. faecalis (ATCC 29212), S. mutans (ATCC 25175), and L. acidophilus (RSKK 03037) bacterial strains were evaluated by disk diffusion method. In the study where vancomycin antibiogram disc constituted the positive control group, physiological saline solution was used as the negative control group. Standard, sterile, blank antibiogram discs of 5 mm in diameter, in which 15 μL of each material were added, were placed on agar plates at 2.5–3 cm intervals. The inhibition zone diameters formed around the discs that were left to incubate for 24–48 hours at 37°C were measured in millimeters. Statistical analysis of the data was performed using one-way analysis of variance, Kolmogorov-Smirnov, Levene, and Bonferroni tests.
Results: At the end of the study the solutions tested showed a statistically significant antibacterial effect on all bacterial strains used (p<0.05). Cavity Cleanser disinfectant containing 2% chlorhexidine showed the highest antibacterial effect on S. mutans and L. acidophilus, and benzalkonium-containing Tubulicid Red disinfectant on E. faecalis.
Conclusion: The antibacterial effect of all cavity disinfectants used in the study was found to be higher at the end of the 48th hour than at the end of the 24th hour, but there was no statistically significant difference (p>0.05).
Keywords: antibacterial agents; antibacterial effect; cavity disinfectants; chlorhexidine; contamination; dental caries; disinfection; disc diffusion; gram-negative bacteria; gram-positive bacteria
Short-term improvement of clinical parameters and microbial diversity in peri...M ALTAMIMI
Indocyanine green-mediated photodynamic therapy is effective against chronic periodontitis. Here, we evaluated the efficiency of indocyanine green-based adjunctive antimicrobial photodynamic therapy in non- surgical treatment of chronic periodontitis patients
Ganoderma lucidum against Candida albicansCsikós Ilona
Ganoderma lucidum has been in use in Traditional Chinese Medicine for years. Literature supports the use of this Ganoderma lucidum as a medicinal mushroom for its antimicrobial, antiviral properties. Candida albicans is the most common oral fungus associated with oral candidial infections. More: http://www.ganodermacoffee.dxnnet.com
Assessment of Microbial Contamination of the Tooth Brush Head Used On Orthodo...inventionjournals
Introduction: Oral diseases can be greatly controlled by reducing the microbial load in the oral cavity and this can be achieved by maintaining proper oral hygiene.Tooth brushes are the most commonly used oral hygiene aid to promote oral health and prevent dental diseases. The insertion of fixed appliances alters the oral microbiological profile, thus increasing the risk for caries and gingivitis considerably. Aim: To assess the microbial growth of S.Mutans and Lactobacillus between and among the brushes. Setting and Study Design: A Hospital setting and Randomized Control study design Methods:A total of 56 (MB) patients aged 16-26 years received a toothbrush [Regular soft bristle design (group-A) and Orthodontic bristle design (group B)],A sterile gamma radiated pouch and checklist was distributed to each participant. After 2 weeks period the brushes were collected and placed in 5ml saline solution (0.05g Sodium Chloride). The suspension was incubated on selective agar plates and the amount of Streptococcus mutans and lactobacilli for each brush head was assessed. Results:The retention of S.Mutanswas found to be higher in group A, as compared to group B and was found to be statistically more significant between the two groups (P<0.001). The retention of Lactobacillus was also found to be higher in group A, as compared to group B and was found to be statistically significant between the groups (P= 0.001). However, there was no significant difference (P= 0.101) observedamong the microbial growth of S.Mutans and Lactobacillus in two bristle designs. Conclusions: Regular soft bristle design had a higher microbial load than those of subjects using orthodontic bristle design, a more frequent replacement of toothbrushes during t treatment may be advisable. Due to significant differences between the two bristle designs, the orthodontic toothbrush is recommended for patients undergoing orthodontic t appliances
Assessment of Microbial Contamination of the Tooth Brush Head Used On Orthodo...inventionjournals
Introduction: Oral diseases can be greatly controlled by reducing the microbial load in the oral cavity and this can be achieved by maintaining proper oral hygiene.Tooth brushes are the most commonly used oral hygiene aid to promote oral health and prevent dental diseases. The insertion of fixed appliances alters the oral microbiological profile, thus increasing the risk for caries and gingivitis considerably. Aim: To assess the microbial growth of S.Mutans and Lactobacillus between and among the brushes. Setting and Study Design: A Hospital setting and Randomized Control study design Methods:A total of 56 (MB) patients aged 16-26 years received a toothbrush [Regular soft bristle design (group-A) and Orthodontic bristle design (group B)],A sterile gamma radiated pouch and checklist was distributed to each participant. After 2 weeks period the brushes were collected and placed in 5ml saline solution (0.05g Sodium Chloride). The suspension was incubated on selective agar plates and the amount of Streptococcus mutans and lactobacilli for each brush head was assessed. Results:The retention of S.Mutanswas found to be higher in group A, as compared to group B and was found to be statistically more significant between the two groups (P<0.001). The retention of Lactobacillus was also found to be higher in group A, as compared to group B and was found to be statistically significant between the groups (P= 0.001). However, there was no significant difference (P= 0.101) observedamong the microbial growth of S.Mutans and Lactobacillus in two bristle designs. Conclusions: Regular soft bristle design had a higher microbial load than those of subjects using orthodontic bristle design, a more frequent replacement of toothbrushes during t treatment may be advisable. Due to significant differences between the two bristle designs, the orthodontic toothbrush is recommended for patients undergoing orthodontic t appliances
Evaluation of role of periodontal pathogens in endodontic periodontal diseasesDr. Anuj S Parihar
Aim: This study aimed to correlate periodontal pathogens in endodontic periodontal diseases. Methodology: This study was conducted on 40 patients of both genders. All the participants were obtained from department of endodontics and periodontology with history of endo‑perio lesion in same teeth. Polymerase chain reaction was performed and correlation was established. Results: This study included 18 males and 22 females. The mean age of male was 42.5 years and female was 41.3 years. Specimens of Tannerella forsythia were isolated from 94% endodontium and 92% periodontium, Porphyromonas gingivalis from 71% endodontium and 55% periodontium,
Aggregatibacter actinomycetemcomitans from 12% endodontium and 58% periodontium. The difference was significant (P < 0.05). Bacteria in endodontic‑periodontal infection confirmed statistically significant correlation between absolute quantitation of T. forsythia and P. gingivalis (r = 0.412, P < 0.05), P. gingivalis and A. actinomycetemcomitans (r = 0.524, P < 0.05), and T. forsythia and A. actinomycetemcomitans (r = 0.427, P < 0.05). Conclusion: There was correlation between targeted bacterial species levels from concurrent endodontic‑periodontal diseases. Thus, it can be suggested that dentinal tubules may be the pathway for spread of bacteria.
Short-term improvement of clinical parameters and microbial diversity in peri...M ALTAMIMI
Indocyanine green-mediated photodynamic therapy is effective against chronic periodontitis. Here, we evaluated the efficiency of indocyanine green-based adjunctive antimicrobial photodynamic therapy in non- surgical treatment of chronic periodontitis patients
Ganoderma lucidum against Candida albicansCsikós Ilona
Ganoderma lucidum has been in use in Traditional Chinese Medicine for years. Literature supports the use of this Ganoderma lucidum as a medicinal mushroom for its antimicrobial, antiviral properties. Candida albicans is the most common oral fungus associated with oral candidial infections. More: http://www.ganodermacoffee.dxnnet.com
Assessment of Microbial Contamination of the Tooth Brush Head Used On Orthodo...inventionjournals
Introduction: Oral diseases can be greatly controlled by reducing the microbial load in the oral cavity and this can be achieved by maintaining proper oral hygiene.Tooth brushes are the most commonly used oral hygiene aid to promote oral health and prevent dental diseases. The insertion of fixed appliances alters the oral microbiological profile, thus increasing the risk for caries and gingivitis considerably. Aim: To assess the microbial growth of S.Mutans and Lactobacillus between and among the brushes. Setting and Study Design: A Hospital setting and Randomized Control study design Methods:A total of 56 (MB) patients aged 16-26 years received a toothbrush [Regular soft bristle design (group-A) and Orthodontic bristle design (group B)],A sterile gamma radiated pouch and checklist was distributed to each participant. After 2 weeks period the brushes were collected and placed in 5ml saline solution (0.05g Sodium Chloride). The suspension was incubated on selective agar plates and the amount of Streptococcus mutans and lactobacilli for each brush head was assessed. Results:The retention of S.Mutanswas found to be higher in group A, as compared to group B and was found to be statistically more significant between the two groups (P<0.001). The retention of Lactobacillus was also found to be higher in group A, as compared to group B and was found to be statistically significant between the groups (P= 0.001). However, there was no significant difference (P= 0.101) observedamong the microbial growth of S.Mutans and Lactobacillus in two bristle designs. Conclusions: Regular soft bristle design had a higher microbial load than those of subjects using orthodontic bristle design, a more frequent replacement of toothbrushes during t treatment may be advisable. Due to significant differences between the two bristle designs, the orthodontic toothbrush is recommended for patients undergoing orthodontic t appliances
Assessment of Microbial Contamination of the Tooth Brush Head Used On Orthodo...inventionjournals
Introduction: Oral diseases can be greatly controlled by reducing the microbial load in the oral cavity and this can be achieved by maintaining proper oral hygiene.Tooth brushes are the most commonly used oral hygiene aid to promote oral health and prevent dental diseases. The insertion of fixed appliances alters the oral microbiological profile, thus increasing the risk for caries and gingivitis considerably. Aim: To assess the microbial growth of S.Mutans and Lactobacillus between and among the brushes. Setting and Study Design: A Hospital setting and Randomized Control study design Methods:A total of 56 (MB) patients aged 16-26 years received a toothbrush [Regular soft bristle design (group-A) and Orthodontic bristle design (group B)],A sterile gamma radiated pouch and checklist was distributed to each participant. After 2 weeks period the brushes were collected and placed in 5ml saline solution (0.05g Sodium Chloride). The suspension was incubated on selective agar plates and the amount of Streptococcus mutans and lactobacilli for each brush head was assessed. Results:The retention of S.Mutanswas found to be higher in group A, as compared to group B and was found to be statistically more significant between the two groups (P<0.001). The retention of Lactobacillus was also found to be higher in group A, as compared to group B and was found to be statistically significant between the groups (P= 0.001). However, there was no significant difference (P= 0.101) observedamong the microbial growth of S.Mutans and Lactobacillus in two bristle designs. Conclusions: Regular soft bristle design had a higher microbial load than those of subjects using orthodontic bristle design, a more frequent replacement of toothbrushes during t treatment may be advisable. Due to significant differences between the two bristle designs, the orthodontic toothbrush is recommended for patients undergoing orthodontic t appliances
Evaluation of role of periodontal pathogens in endodontic periodontal diseasesDr. Anuj S Parihar
Aim: This study aimed to correlate periodontal pathogens in endodontic periodontal diseases. Methodology: This study was conducted on 40 patients of both genders. All the participants were obtained from department of endodontics and periodontology with history of endo‑perio lesion in same teeth. Polymerase chain reaction was performed and correlation was established. Results: This study included 18 males and 22 females. The mean age of male was 42.5 years and female was 41.3 years. Specimens of Tannerella forsythia were isolated from 94% endodontium and 92% periodontium, Porphyromonas gingivalis from 71% endodontium and 55% periodontium,
Aggregatibacter actinomycetemcomitans from 12% endodontium and 58% periodontium. The difference was significant (P < 0.05). Bacteria in endodontic‑periodontal infection confirmed statistically significant correlation between absolute quantitation of T. forsythia and P. gingivalis (r = 0.412, P < 0.05), P. gingivalis and A. actinomycetemcomitans (r = 0.524, P < 0.05), and T. forsythia and A. actinomycetemcomitans (r = 0.427, P < 0.05). Conclusion: There was correlation between targeted bacterial species levels from concurrent endodontic‑periodontal diseases. Thus, it can be suggested that dentinal tubules may be the pathway for spread of bacteria.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
65.Izna, Sasank Kuntamukkula VK, Khanna SS, Salokhe O, Chandra Tiwari RV, Tiwari H. Knowledge and Apprehension of Dental Health Professionals Pertaining to COVID in Southern India: A Questionnaire Study. J Pharm Bioallied Sci. 2021 Jun;13(Suppl 1):S448-S451. doi: 10.4103/jpbs.JPBS_551_20. Epub 2021 Jun 5. PubMed PMID: 34447131; PubMed Central PMCID: PMC8375944.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. Antifungal Efficacy of Endodontic Irrigants
The Journal of Contemporary Dental Practice, Volume 21 Issue 12 (December 2020)
1326
established a correlation between secondary infection and the
posttreatment apical periodontitis.
There has been little attention given to the antifungal activity
of disinfectants for cleaning the canal. The cleaning prevents
reinfection and it is the need of the hour to avoid root canal failures
related to fungal activity. In this context, antifungal properties of
variousirrigatingsolutionsandendodonticdisinfectantshavebeen
exploredincludingsodiumhypochlorite(NaOCl),calciumhydroxide
(CaOH), and chlorhexidine gluconate (CHX).9–12
0.5–5.25% NaOCl
is extensively used as a root canal irrigant in endodontics.
Previous studies demonstrated substantial antifungal properties
of ethylenediaminetetraacetic acid (EDTA).13,14
However, contrary
to the literature, no specific single antifungal agent is used at the
moment for the irrigation of the infected root canals.
Clotrimazole is an imidazole and commonly used for treating the
systemic mycoses as an antifungal agent in both medical as well as
dentalpractice.Ketoconazole,econazole,andmiconazolearetheother
antifungal agents that come under the same group. These antifungal
agentshaveawiderangeofactivityagainstCandida,Dermatophytes,
Streptococcus faecalis, and Staphylococcus aureus.15
These are widely
used in diseases like oral, otomycosis, cutaneous, as well as vaginal
candidiasis.15
Thereby, the spectrum of antimicrobial activity of
endodonticirrigantsshouldalsoincludetheantifungalmedicaments
to assist in the successful management of secondary or persistent
endodontic infections caused by the fungi.16,17
So, the present study
aimstoexaminetheefficiencyof1%clotrimazoleasacomplementary
antifungalagentalongwith5.25%NaOCl,2%chlorhexidinegluconate,
and 5% doxycycline hydrochloride against C.albicans.
Materials andMethods
The experiment was performed in the Department of Conservative
Dentistry and Endodontics, Government Dental College,
Thiruvananthapuram, and the DDRC Microbiology Centre,
Thiruvananthapuram. Seventy single-rooted human permanent
premolar teeth with matured apices extracted due to orthodontic
treatment and periodontal disease were collected, stored, as
well as handled according to the Occupational Safety and Health
Administration (OSHA) and the Center for Disease Control and
Prevention (CDC) guidelines and recommendations. The age
range of the patients included in the study for the extracted teeth
collection ranged from 17 to 60 years. The other inclusion criteria
comprised of a fully matured (closed apex), noncarious single-
rooted tooth with intact radicular portion without any resorption,
i.e., internal, external, or apical.
The standard strain of C. albicans (MTCC3108) used in the
study was obtained from the Microbial Type Culture Collection
and Gene Bank, Institute of Microbial Technology, Chandigarh.
The commercially available NaOCl (5.25%—DENTPRO), distilled
water, EDTA (17%), sterile saline, chlorhexidine gluconate (2%—
DENTOCHLOR), 5% doxycycline hydrochloride, clotrimazole
(1%—Candid Mouth Paint, Glenmark, India) were used in the
experiment. All irrigating solutions were stored in an autoclavable
polypropylene container, in a cool, dry, and sterile field. Sabouraud
dextrose agar—HIMEDIA was used as a microbiological media.
The statistical analysis was done using the SPSS software by using
ANOVA and Scheffe multiple comparisons (p < 0.001).
Preparation and Mounting of the Samples
The extracted teeth were prepared by overnight immersion in the
NaOCl (to remove the surface and soft tissue debris), followed by
removal of the coronal part of the tooth at the cementoenamel
junction (CEJ) to obtain approximately 13 mm length of the root
(Fig.1).Further,thetoothapicesweresealedwiththeglassionomer
cement and the remaining root surface was coated with a double
layer of nail varnish to isolate the internal root canal environment.
The tooth roots were cleaned and shaped to the ISO size of 50 K
file by using hand files. The copious irrigation with NaOCl (5.25%)
and EDTA (17%) was done for 5 minutes to remove the smear layer.
Finally, each canal was flushed with NaOCl, dried up with the
absorbent paper points, and stored in the distilled water until use.
So, prepared root samples were mounted in four sterilized micro-
tip polypropylene boxes (Tarsons, Kolkata) and sterilized using an
autoclave at 121°C for 20 minutes at 15 psi pressure.
Further following steps were performed to complete the
experiment:
First step—to assure the negativity of the specimen, all samples
wereinjectedandaspiratedwith1mLofsterilesalinesolutionusing
an insulin syringe in the root canal. The aspirate was placed onto
a Sabouraud 4% dextrose agar plate and incubated aerobically at
37°C for 2 days. The samples were stored under sterile conditions
duringthewaitingperiodforcultureresults.Afterculturenegativity,
step 2 was followed.
Second step—the candidal suspension was inoculated in the root
canal, keeping the teeth mounted in an upright position in the
sterilized micro-tip boxes, and the samples were incubated in a
BOD incubator for 96 hours.
Thirdstep—foridentificationoftheCandidagrowth,asmallsample
was taken from the canal of every tooth at 48 hours and was kept
on a 4% Sabouraud dextrose agar plate to verify the growth of C.
albicans. All the cultures were positive, confirming the growth of C.
albicans within the root canals. After 96 hours, teeth were removed
and the canal was cleaned with the help of sterile paper points and
wasrandomlydividedintogroupsIandIIastestgroupsandgroupIII
ascontrolbasedontheirrigantsused.GroupsIandIIfurtherdivided
intothreesubgroupsasA,B,andCconsistingof10teetheach.Group
III served as a control group comprising of 10 teeth (Fig. 2).
Group I (Only Irrigant Group)
IA: Irrigated with 2 mL of 5.25% NaOCl.
IB: Irrigated with 2 mL of 2% CHX.
IC: Irrigated with 2 mL of 5% doxycycline hydrochloride.
Group II (Irrigant with an Antifungal Group)
IIA: Irrigated with 2 mL of 5.25% NaOCl and with 1% clotrimazole.
IIB: Irrigated with 2 mL of 2% CHX and with 1% clotrimazole.
Figs 1A and B: Samples: (A) Decoronated samples with nail varnish
coating; (B) Teeth mounted on the microtip box
3. Antifungal Efficacy of Endodontic Irrigants
The Journal of Contemporary Dental Practice, Volume 21 Issue 12 (December 2020) 1327
IIC: Irrigated with 2 mL of 5% doxycycline hydrochloride and with
1% clotrimazole.
In groups I and II, all the samples were irrigated with respective
irrigantsfor1minuteandthenflushedwith5mLofdistilledwaterto
preventtheeffectofirrigant.Followingthis,2mLof1%clotrimazole
was irrigated in all the samples of group II with the contact time of
1 minute, then flushed with 5 mL of distilled water to prevent the
effect of irrigant.
Group III (Control Group)
The control group was irrigated with distilled water, and further
flushing was performed using 15 mL of saline. The aliquots were
removed from the fluid by using a 1 μm inoculation loop and were
placedontheSabouraud4%dextroseagarplatesincubatedat91%
humidity and 36°C for 48 hours. After the incubation period, the
colony-forming units (CFUs) of candida were taken as a measure of
the antifungal activity of irrigants.
Results
The results obtained were statistically analyzed by the multiple
intergroup comparisons using the SPSS software by using ANOVA
andScheffemultiplecomparisons(p<0.001).Sodiumhypochlorite
(group IA—mean 129.6) has shown a statistically significant
decrease in CFU (p < 0.01) on comparison with chlorhexidine
[(IB) mean 190.2]. A similar result was obtained in comparison with
the NaOCl group (IA) and the doxycycline HCl group [(IC) mean
318.4] and also between the NaOCl group (IA) and control Group
[(III) mean 554.2].
The chlorhexidine group (IB) showed a statistically significant
decrease in the CFU (p < 0.01) in comparison with the doxycycline
HCl (IC) group; moreover, a similar result was obtained on
comparison with the chlorhexidine group (IB) and the control
group (III). Doxycycline HCl group (IC) showed a statistically
significantdecreaseinCFU(p<0.01)incomparisonwiththecontrol
group (Table 1 and Fig. 3). One-way ANOVA showed a statistically
significant difference among group II subgroups and control
(Table 2 and Fig. 4). No statistically significant results were obtained
on comparison of NaOCl with clotrimazole group [(IIA) mean 63.3]
and chlorhexidine with clotrimazole group [(IIB) mean 73.8].
However, NaOCl with the clotrimazole group (IIA) showed a
statistically significant decrease in CFU (p < 0.01) in comparison
withthehypochloriteandclotrimazolegroup(IIA)withdoxycycline
HCl and clotrimazole group [(IIC) mean 250.9]. A similar result was
obtained when NaOCl with clotrimazole group (IIA) was compared
with the control group (III). On comparison of doxycycline HCl and
clotrimazole group (IIC) with the control group III, doxycycline
HCl and clotrimazole group (IIC) showed a statistically significant
decrease in CFUs (p < 0.01) (Table 3 and Fig. 5).
Figs2AtoH:VerificationofC.albicanson4%Sabourauddextroseagarplate:(A)AssuranceofpositiveC.albicansculture;(B)5%sodiumhypochlorite
irrigant group; (C) 2% chlorhexidine irrigant group; (D) 5% doxycycline HCl irrigant group; (E) 5% sodium hypochlorite + 1% clotrimazole group;
(F) 2% chlorhexidine + 1% clotrimazole group; (G) Doxycycline HCl + 1% clotrimazole group; (H) Control group
Table 1: Comparison of CFU within the group I and control
Group Mean SD N F p Value
NaOCl (IA) 129.6 8.2 10 595.03** 0.000
CHX (IB) 190.2 12.5 10
Doxycycline HCl (IC) 318.4 15.8 10
Control 554.2 43.6 10
SD—standard deviation; ** significant 0.01 level; F—ANOVA
4. Antifungal Efficacy of Endodontic Irrigants
The Journal of Contemporary Dental Practice, Volume 21 Issue 12 (December 2020)
1328
In an intragroup comparison of group I, group IA (mean 129.6)
showed the highest antifungal efficacy followed by group IB (mean
190.2)andgroupIC(mean318.4)(Table1andFig.3).Intheintragroup
comparison of group II, group IIA (mean 63.3) and group IIB (mean
73.8) showed no statistically significant difference. However, groups
IIA and IIB comparison with the group IIC (mean 250.9), both IIA and
IIBshowedastatisticallysignificantdecreaseinCFUs(p<0.01)(Table2
andFig.4).Inintergroupcomparison,allthegroupIIsubgroupirrigants
(irrigant with an antifungal group), IIA, IIB, IIC, showed less number of
CFUs than their respective group I irrigant (irrigant alone group) IA,
IB, IC (Table 3 and Fig. 5). Group III (mean 554.2) was least effective
than all the subgroups. Overall, in the present study, clotrimazole as
a supplementary irrigant with other irrigants showed a significant
decrease in CFUs than the irrigants alone.
Discussion
Oral microbiota constitutes a small part of fungi, and Candida
species are the most predominant.18
Some studies have shown the
occurrence of fungi in endodontic infections and their role in the
etiopathogenesis of periradicular diseases.19,20
According to Sen
et al. study, the root canal exhibits an ecologic environment that
generally favors the growth of anaerobes. But, Candida, being an
aerobicmicroorganism,cansurvivetheharshenvironmentbecause
of its unique “dentinophilic” character.20
It can also accommodate
a broad range of pH levels.21
Candida shows pleomorphism. It can
grow in various morphologic forms like blastospores, germ tubes,
true hyphae, pseudohyphae, and chlamydospores.22
Moreover, it also exhibits a variety of virulence factors and can
secrete “aspartyl protease,” which is a degenerative enzyme that
can degrade the dentinal collagen.23
In HIV-infected patients, 95%
of the patients may present with a history of oral candidiasis. The
invasion of dental tissues, including root canals by the yeasts, is
inevitable. Thereby, to perform a successful endodontic treatment,
thorough debridement of the root canal system is crucial. Apart
from adequate instrumentation of the root canals, irrigation with
an appropriate agent has also been a norm of the debridement
procedure. Thus, in the patients having local or systemic
predisposing factors to oral candidiasis, specific antifungal agents
may be recommended in their endodontic therapy.
The present study aimed to evaluate and compare the
antifungal efficacy of root canal irrigants with and without
clotrimazole. The efficiency of NaOCl and CHX on C. albicans has
been well recorded in the literature. But very few studies have
evaluated the efficacy of NaOCl and CHX along with an antifungal
agent. The present study used and adopted an in vitro model from
thestudybyOrstavikandHaapasalo.24
Thebacterialgrowthcanbe
restricted from the pulpal side when there is intact root cementum
due to the limited nutritional availability (Haapasalo and Orstavik
1987). This indicates that the different environments (i.e., nutrient-
rich or nutrient-deficient) can determine the variability of the
microorganisms in dentinal tubules.
According to the results obtained in the present study, it was
foundthat5.25%NaOClwasmoreeffectiveagainstC.albicans than
2% CHX and 5% doxycycline hydrochloride (p < 0.01). Besides, 5%
ofdoxycyclinehydrochlorideirrigantwastheleasteffectiveagainst
Candida. Moreover, when clotrimazole was included with the
experimentalirrigants,therewasapronounceddecreaseintheCFU
count. It has been suggested by various studies that chlorhexidine
gluconate and sodium hypochlorite diffuse through the root canal,
Fig. 3: Comparison of CFU within the group I and control
Table 2: Comparison of CFU within group II and control
Group Mean SD N F p Value
NaOCl + clotrimazole
(IIA)
63.3 10.1 10 889.84** 0.000
CHX + clotrimazole
(IIB)
73.8 14.0 10
Doxycycline HCl +
clotrimazole (IIC)
250.9 12.7 10
Control (III) 554.2 43.6 10
SD—standard deviation; ** significant at 0.01 level; F—ANOVA
Fig. 4: Comparison of CFU within group II and control
5. Antifungal Efficacy of Endodontic Irrigants
The Journal of Contemporary Dental Practice, Volume 21 Issue 12 (December 2020) 1329
and perhaps also into the dentinal tubules and even in significantly
diluted form; they are effective candidacidal agents.
In contrast, due to the less penetrability of doxycycline
hydrochloride, it was shown to be less effective as compared to
chlorhexidine gluconate and sodium hypochlorite. But, according
to Ruff et al. study, 6% NaOCl and 2% CHX are equally effective
against C.albicans, which is in contrast with this study.12
According
to Himani Lau et al., 5% doxycycline hydrochloride showed good
antifungalefficacycomparedto17%EDTA,butlessthanNaOCland
CHX.25
When clotrimazole was included with 5.25% NaOCl and 2%
CHX, respectively, there was no statistically significant difference
in their antifungal efficacy. This has been found in accordance with
a previous study done by Chandra et al.15
Our study showed that
the antifungal efficiency of all the three irrigants was increased
with clotrimazole inclusion. In a study by Babu et al., chitosan silver
nanocomposite and 1% clotrimazole showed better antifungal
efficacy when used along with standard irrigants like NaOCl than
standard irrigants alone.26
The results of this study are also in
compliance with our study.26
Every irrigant used in endodontics
has its particular action to make sure the total disinfection of the
root canal. With the increasing incidence of yeast in endodontics,
antifungal irrigants should be recruited in specific cases where it
is required. Hence, clotrimazole can be used as a supplement with
the commonly used endodontic irrigants for root canal irrigation.
A limitation of the present study is that a single organism has
been used to infect the root canal. Since the root canal system
consists of various microorganisms, hence the irrigant used
effectively in vitro against a single microbe may not necessarily
be effective against the same microbe in vivo. However, further
investigations are necessary to assess the efficacy of clotrimazole
invivo.Moreover,thereactionbetweentheirrigantsandantifungal
agents also needs to be evaluated in the future.
Conclusion
Among the three irrigants, sodium hypochlorite showed better
antifungal efficacy than chlorhexidine and doxycycline when
used alone. But, the inclusion of clotrimazole as a final irrigant
increased the antifungal efficacy of both sodium hypochlorite
and chlorhexidine, resulting in no statistical difference between
both the irrigants. The addition of clotrimazole increased the
effectiveness of doxycycline also, but less when compared to
sodium hypochlorite and chlorhexidine. Within the limitations of
thisstudy,theinclusionof1%clotrimazoleincreasedtheantifungal
efficacy of all the three irrigants.
AuthorContributions
SudhakarSrinivasan,RahulVCTiwari—draftedtheresearchprotocol
and developed an experimental strategy. Gayathri Velusamy, Meer
Ahamed Ibrahim Munshi, Karthikeyan Radhakrishnan—collected
samples and performed the preparation of samples. Sudhakar
Srinivasan, Rahul VC Tiwari—collected the results and interpreted.
Gayathri Velusamy, Meer Ahamed Ibrahim Munshi, Karthikeyan
Radhakrishnan—revisedexistingliteratureforwritingintroduction
anddiscussion.SudhakarSrinivasan,RahulVCTiwari—finalizedthe
article draft. Gayathri Velusamy, Meer Ahamed Ibrahim Munshi,
Karthikeyan Radhakrishnan—approved the draft with corrections.
All authors approved final version of the article for submission.
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