Oral manifestations as predictors of immune suppression in a HIV-/AIDS-infected population in south India

The objectives of the study are to evaluate the relationship between common HIV-related oral lesions and absolute CD4+ count, age, gender, and medication used and to assess the sensitivity, specificity, positive and negative predictive value of oral manifestations for low absolute CD4+ counts. HIV-positive patients, 200, from south India were selected, whose absolute CD4+ counts were determined within 2 weeks of oral examination. Sociodemographic data was obtained using a structured questionnaire. Oral manifestations were diagnosed according to presumptive criteria of EEC-clearinghouse classification (1993). Four or more concurrent oral lesions were statistically significant with low CD4+ counts <200 cells/mm3 (P = 0.005). The highest and lowest mean CD4+ cell counts were seen in individuals with linear gingival erythema (LGE; 172.5 cells/mm³) and pseudomembranous candidiasis (PC; 87 cells/mm³), respectively. Smoking, age (<35 years), and males had a positive association with oral hairy leukoplakia (OHL; P < 0.05). Patients with CD4+ counts < 200 cells/mm³ were associated with 15 times greater risk of PC and four times at greater risk for occurrence of any oral manifestation. Concurrent oral manifestations (≥4) were good predictors (80–100%) of severe immune suppression. In most resource poor countries where facilities for undertaking CD4+ counts are not available, the presence of concurrent oral manifestations may be used as an indicator of deteriorating immune status.     

An In Vitro Study to Evaluate the Retention of Complete Crowns Prepared with Five Different Tapers and Luted with Two Different Cements

This study includes comparatively evaluating and drawing general conclusion about the best advisable taper and cement for maximal retention. Eighty extracted human maxillary premolar teeth with sound surfaces were selected using dial vernier caliper. Selected teeth were randomly divided into five different taper groups (0°, 3°, 6°, 9° and 12°). The crown preparations with different tapers respectively were achieved by graduated customized device. Preparations were verified with special set up. Crowns were cast with Co–Cr alloy; metal copings were luted with glass ionomer and zinc phosphate cement. Retention was measured (MPa) by separating the metal crowns from the teeth under tension on a universal testing machine, data was recorded and statistically analyzed. Glass ionomer cemented 0° and 12° taper group showed increase in retentive strength (p = 0.003 hs), when compared to zinc phosphate cement. 9° and 12° group showed decreased retentive strength (p = 0.001 vhs) when compared with 0° taper group. No significant difference found between 0° and 3° and 6° group. The choice of cement for crowns prepared within this ideal range (0°–6° taper) might be of limited clinical significance. 3° and 6° taper with zinc phosphate or glass ionomer cement shown to be ideal for maximum retention.     

Multiple supernumerary teeth and odontoma in the maxilla: A case report

Most supernumerary impacted teeth are located in the anterior maxillary region. They are classified according to their form and location. Their presence may give rise to a variety of clinical problems. The detection of supernumerary teeth is best achieved by thorough clinical and radiographic examination. Their management should form part of a comprehensive treatment plan. This article presents an overview of the diagnostic problems associated with multiple supernumerary impacted teeth and includes a discussion of the classification, diagnosis, and management of this difficult clinical entity.     

Self reported dental health attitude and behavior of dental students in India

The aim of the present study was to evaluate the oral health attitudes and behavior of undergraduate dental students in India according to age, sex and level of dental education, and to compare it with those of other countries with different socioeconomic conditions. A self-administered questionnaire based on the Hiroshima University - Dental Behavior Inventory (HU-DBI) was distributed among 372 dental students at Darshan Dental College and Hospital (DDCH). The response rate was 75.8% with 44% males and 56% females. The mean HU-DBI score showed a significant relationship (P < 0.05) with age by one way-analysis of variance (ANOVA). The students were considerably concerned about the appearance of their teeth and gums and halitosis. The total mean score was not markedly higher in the clinical years (years 3 and 4) than in the non-clinical years (years 1 and 2), indicating that the students were almost equally aware. Although there were no statistically significant differences in gender and academic year for the mean score of HU-DBI, the present study showed that dental students in India generally had poorer oral health awareness compared to several other countries. The oral health behavior of Indian dental students has to be improved in order to serve as a positive model for their patients, family, and friends.     

The impact of a private-public partnership delivery system on the HIV continuum of care in a South Indian city

We characterized the impact of a Private-Public Partnership (PPP) on the continuum of HIV care (e.g., treatment initiation, ART effectiveness and loss to follow-up) among adults enrolled at a private hospital/ART link center in the southern state of Karnataka, India from 2007 through 2012. Data on 2326 adults in care were compiled using an electronic database supplemented with medical chart abstraction. Survival methods with staggered entries were used to analyze time to ART initiation and loss to follow-up as well as associated factors. Mixed effects linear regression models were used to assess ART effectiveness. The mean age of adults in care was 36 years; 40% were male. The majority were married, had less than primary education, and less than 45 US dollars (3000 Indian Rupee) monthly income. The mean CD4 at presentation was 527?cells/mm³. The median time from ART eligibility to initiation was 5 and 2 months for before and after the PPP, respectively (p?p?=?0.25) and there was a significant interaction between ART status and calendar time before and after the PPP (p?p-value for interaction <0.001. Treatment response measured by CD4 was comparable before and after the PPP (p?=?0.088). Our findings suggest that PPP models of ART delivery may improve HIV treatment initiation and loss to follow-up without compromising the effectiveness of treatment. Efforts to expand these system-level interventions should be considered with on-going evaluation.     

Hydroxyapatite nanorods loaded with parathyroid hormone (PTH) synergistically enhance the net formative effect of PTH anabolic therapy

Parathyroid hormone (PTH) has been a major contributor to the anabolic therapy for osteoporosis, but its delivery to bone without losing activity and avoiding adverse local effects remain a challenge. Being the natural component of bone, use of hydroxyapatite for this purpose brings a major breakthrough in synergistic anabolism. This study focuses on synthesis, characterization and evaluation of in vitro and in vivo efficacy of PTH (1-34) adsorbed hydroxyapatite nanocarrier for synergistic enhancement in the anabolic activity of PTH for bone regeneration. The negative zeta potential of this nanocarrier facilitated its affinity to the Ca²⁺ rich bone tissue and solubilization at low pH enhanced specific delivery of PTH to the resorption pits in osteoporotic bone. In this process, PTH retained its anabolic effect and at the same time an increase in bone mineral content indicated enhancement of the net formative effect of the PTH anabolic therapy.     

Development of Solid Dispersion by Hot Melt Extrusion Using Mixtures of Polyoxylglycerides With Polymers as Carriers for Increasing Dissolution Rate of a Poorly Soluble Drug Model

Various polyoxylglycerides have been researched extensively in the development of solid dispersions (SDs) for bioavailability enhancement of poorly water-soluble drugs. However, because of their low melting points (40°C-60°C), SDs produced are usually soft and semisolid. The objective of present study was to prepare SDs of a Biopharmaceutical Classification System class II drug, carvedilol, in mixtures of stearoyl polyoxylglycerides (Acconon^® C-50; m.p. ～50°C) with polymers by hot melt extrusion to obtain free-flowing powder upon grinding. Miscibility of carvedilol with Kollidon^® VA64, hydroxypropyl methylcellulose acetate succinate, and Klucel^? EXF was first evaluated by film casting, and Kollidon^® VA64 was selected for further study. SDs containing 5%-20% carvedilol, 0%-20% Acconon^® C-50, and the remaining Kollidon^® VA64 were prepared for hot melt extrusion. SDs were characterized by differential scanning calorimetry and powder X-ray diffraction analysis, and dissolution tests were conducted in 250 mL of pH 6.8 phosphate buffer by filling powders in capsules. Carvedilol was miscible with all polymers tested up to 50% and remained amorphous in SDs. The drug release from formulations containing 20% carvedilol and 0, 5%, 10%, and 20% Acconon^® C-50 were 30%, 30%, 70%, and 90%, respectively, in 60 min. SDs containing carvedilol and Acconon^® C-50, up to 20% each, as well as Kollidon^® VA64, were physically stable after 3 months of storage at 25°C/60% relative humidity.     

Dental caries experience among kindergarten school going children of,India

ObjectiveThe aim of the present study was to estimate the prevalence of dental caries in the primary dentition of kindergarten school children of Udaipur city Rajasthan in a cross sectional study design.Materials and methodsStudy population comprised of around 355 children aged 3–6 years old randomly selected from 10 kindergarten schools in Udaipur city from all preselected five zones. Dental caries was recorded using the decayed, missing, filled teeth [dmf-t] index and the decayed, missing, filled surfaces [dmf-s] index according to WHO 1997 standards.ResultsSeventy-nine point one five percent are caries free individuals while 20.85% are individuals having caries. The mean dt scores for the age group six is found to be highest with 0.45 (0.86) and least for the age group of four with 0.28 (0.74). Sixty-five point six three percent of the subjects brushed their teeth by themselves while 34.37% do it with the help of their mothers.ConclusionDental caries prevalence and severity is low among the students.