DENTAL TRIBUNE The World’s Dental Newspaper · South Asia Edition Published in India Winning molecule Nitric Oxide- the Nobel prize winning molecule, can play a critical role in the Covid-19 cure ” Page 02 www.dental-tribune.in 11/20 Pediatric dentistry Pediatric dentistry in 2020 and beyond: A perspective of two young pediatric dentists ” Page 04 Respiratory illness COVID-19: Beyond a respiratory illness. A Multi-system Inflammatory Syndrome (MIS) - Amisha Parekh Dental schools Leading dental schools unite ” Page 06 ” Page 07 “Z-plate for mandibular fractures”- Design patent for Dr Kende & team (OMFS), GDCH Mumbai patent from the authorities. Also, we are conducting a Randomized Controlled Trial (RCT) where we will compare our Z plate with the conventional 3D miniplate. We hope on achieving positive results which can help us in promoting our Z plate for routine use thus improving the overall efficiency of mandibular fracture management. Author: Z plate reduces the time & materials needed and provides better strength & stability in fracture immobilization. by Rajeev Chitguppi, Dental Tribune South Asia for Dr Prajwalit Kende and his team, Dept of Oral & Maxillofacial Surgery, Govt Dental College & Hospital, Mumbai has innovated “Z-plate“ the management of mandibular fractures. Government of India has granted a design patent for the same and published the work in their journal. Dr Prajwalit Kende describes his innovation in this conversation. What inspired you to come up with this idea? The face is an anatomically complex region which is vital in terms of aesthetics as well as function. Any injury to the face can impair the person’s ability to eat, speak, interact with others, and perform other important functions. Out of these injuries, mandibular fractures are the most common owing to its anatomic position with less support from the cranium. These fractures are either managed by open reduction or closed reduction. Out of which open reduction is carried out by rigid or semi- rigid fixation which is promoted by the AO/ASIF. In this concept, compression, tension, torsion and shearing forces which develop under functional loading, are neutralized by thick solid plates fixed by bicortical screws. The success of this approach not only depends on the surgeon’s clinical expertise but also on the efficiency of the plate systems that are used which still has a lot of scope for improvement. Therefore, we thought of coming up with an innovation pertaining to this field for the betterment of patients. Can you brief us about the different plate systems currently available in the market? There are different kinds of plate systems currently available in the market. The most basic being mini-plates which provide semi-rigid fixation. There are also newer categories of plates made available as of today such as the 3D mini-plates by Framed and Dupoirieux where its shape is based on the principle of the quadrangle as a geometrically stable configuration for support. fractures Why did you feel there was a need for innovation in this field? We found that the currently available plates have a few shortcomings which hamper the post-operative results in the patient. In the conventional mini- plates, a doubt arises whether its fixation is sufficiently stable for that cannot be adequately reduced. Even the newer variety of 3D mini-plates have a few drawbacks such as being difficult to adapt, difficult involving to use in fractures important structures like the mental nerve and has to be bent in 3 dimensions. Looking at these shortcomings we thought of developing a plate system which can overcome these issues while maintaining the same level of efficiency. What makes your Z plate different than others? In our Z plate, instead of two vertical bars connecting the two horizontal bars, we have provided a single oblique bar connecting the two horizontal bars thus reducing the material, providing inter-plate stabilization and for easy adaptation in the region of the mental nerve. The plate has also shown better stability and strength compared to other conventional plate systems based on Finite Element Analysis results. What are your expectations with this design? We expect that this Z plate can be easily adapted in the transition zone of Parasymphysis and body of mandible without damaging the mental nerve & it can also be adapted in symphysis, the body of mandible & angle region. Thus reducing time & material and providing better strength & stability in fracture immobilization. What are your future plans pertaining to this innovation? We have already completed a finite element analysis on this plate and received promising data. Along with this, we have recently acquired its design Dr Prajwalit Kende Post-Graduate Teacher, Dept of Oral & Maxillofacial Surgery, Govt Dental College & Hospital, Mumbai. Fellow AOCMF - Morriston Hospital, Swansea, United Kingdom. Trainee - Surgical Oncology, Head & Neck, Tata Hospital, Mumbai. 1. Copyright granted for the work on “Temporomandibular Joint Hematoma Nerve Block” in May-2020 (Diary No- 4741/2020- CO/L) 2. Design patent granted with number 327731-001 on 02/10/2020 for “Z plate for management of mandibular fracture”. 3. Patent application filled with BR no- 24735 (patent numbered- 201921046736 dated 15/11/2019) for Mobile Dental Vehicle with a solar-powered portable dental treatment unit & portable dental chair.
2 News 11/20 Nitric Oxide- the Nobel prize winning molecule, can play a critical role in the Covid-19 cure by Dental Tribune South Asia The world is still grappling with the Covid19 pandemic and researchers are trying hard to find a cure via repurposed drugs. One such molecule, which has shown great promise is Nitric oxide. Dr. Mihir Shah (MDS, pediatric dentistry) describes in detail the data available on the use of Nitric oxide. A Facebook post that went viNitric oxide was discovered by Robert F., Louis J. Ignarro, and Ferid Murad for which they were awarded Nobel prize in 1998. Covid19 was earlier postulated to be respiratory tract infection, but now we know that severe Covid19 is associated with endothelial dysfunction & cytokine storm. Nitric oxide has the potential to act not only at the stage of initial infection in the respiratory tract but also in the prevention & management of endothelial dysfunction & complications associated with the same. Here we discuss Nitric Oxide under the following topics: A. Nitric Oxide & Types of Nitric Oxide Synthase enzymes B. Covid19 infection & Complications C. Role of Nitric Oxide as Initial Line of Defence D. Role of Nitric Oxide in Advanced Stage of Inflammation E. Role of Nitric Oxide in Blood vessels F. Vitamin D & Nitric Oxide: Is there any connection G. Studies on Nitric Oxide & Covid19 tone, which is involved in the regulation of cardiac function and angiogenesis. 2. iNOS- The iNOS produces inducible isoform large amounts of NO as a defense mechanism. It is synthesized by many cell types in response to cytokines and is an important factor in the response of the body to attack by viruses, parasites, bacterial infection, and tumor growth 3. nNOS- The neuronal the the nervous involved in is isoform development of system. 2. Covid-19 Infection & Complications Covid-19 infection is caused by the Sars-Cov-2 virus first reported in Wuhan China. The spectrum of Covid19 Infection is associated with a broad spectrum of clinical respiratory syndromes, ranging from mild upper airway symptoms to progressive life- threatening viral pneumonia with severe respiratory failure & multiorgan damage. The lung injury of Sars-Cov-2 to infected patients appears happen due to the following • Directly through viral disruption of alveolar and bronchial epithelial cells and indirectly macrophages, via inflammatory mediators. triggering and • The severe form is due to heightened host response- Hyperinflammation & cytokine storm H. Optimization of Nitric 3. Role of Nitric Oxide as Oxide in our Body Initial Line of Defence 1. What is Nitric Oxide? Nitric Oxide (NO) is a molecule that is naturally produced in the nose as well as throughout the body. It has antiviral, antibacterial & anti-inflammatory effects. It also is a potent vasodilator that causes blood vessels to widen and stimulates the release of certain hormones, such as insulin and human growth hormone. It is used as a pharmacological inhalational agent as well for various ailments. In our body, there are three types of Nitric Oxide main Synthase enzyme 1. eNOS- In mammals, the endothelial isoform is the primary signal generator in the control of vascular (vasodilator), insulin secretion, and airway tone Covid19 begins primarily as a Respiratory tract infection via Breathing. Breathing is the most important function of The Nose. The nasal cavity, turbinates, and paranasal sinuses play important physiological functions by filtering, warming, humidifying inhaled air. They are lined by epithelium which is the first line of defense against infection. The epithelium of paranasal air sinuses & nasopharynx produces a unique molecular gas called Nitric Oxide- NO via NO synthase (NOS) enzymes and Role of Nitric Oxide in Airway NO is produced up to • 10ppm & it produces antimicrobial effects against bacteria, fungi, viruses, etc which may help prevent pulmonary infections • NO brings bronchodilatory vasodilatory effects in the lungs. effects about & • It has surfactant action & it activates ciliary movement and mucus secretion to remove dust and pathogens. • NO has been shown to have an antiviral effect on several DNA and RNA virus families (Colasanti, Persichini, Venturini, & Ascenzi, 1999). • The NO-mediated S-nitrosation of viral molecules might be an intriguing general mechanism for the control of the virus‘s life cycle. In this regard, it is conceivable that NO could nitrosylate cysteine-containing enzymes and proteins, including and nucleocapsid glycoproteins, present the coronavirus. proteins in • NO has been shown to have an antiviral effect on several DNA and RNA virus families through NO-mediated S-nitrosation & inactivates them by modifying proteins and nucleic acids that are essential for viral replication including herpesvirus, rhinovirus, hantavirus, and the SarsCov-1 • Invitro studies have now shown that Nitric oxide is an effective antiviral agent against SarsCov-2 as well. (Nitric oxide has a high to be an effective potential antiviral agent at this stage. Continue Reading below about the section on Optimization of Nitric Oxide in Airway with Breathing Techniques.) 4. Role of Nitric Oxide in Advanced Stage of Inflammation (Killing Stage & Healing Stage) the During advanced stage of inflammation, there is Diffuse Alveolar Damage with perivascular T-cell infiltration, Pulmonary Vasoconstriction, and tissue inflammation. The understanding of activation and differentiation of macrophages in inflammation is essential for understanding the immunology of inflammation. These cells are categorized into two principal subtypes, 1. M1 macrophages, which secrete great quantities of Proinflammatory cytokines (such as IFN-γ, TNF-α, IL-6, and IL- 12, etc), nitric oxide and reactive oxygen species (ROS), Nitric oxide has the potential to act not only at the stage of initial infection in the respiratory tract but also in the prevention & management of endothelial dysfunction & complications associated with the same. Patients with severe disease have increased pro-inflammatory cytokines (Cytokine Storm) 2. M2 macrophages release large concentrations of Anti- inflammatory cytokines such as IL-10, TGF-β, and IL-1 receptor antagonists. The most important dichotomy in Macrophage function as we see here is that M1 macrophages organisms, Kill (infectious virus- infected cells, or tumor cells) & M2 macrophages Heal (sterile wounds and, with less success, cancer). However, Killing comes at a price: M1-mediated killing is associated with collateral tissue damage that M2 macrophages must clean up and heal after the dangerous invader has been eliminated. Recent evidence suggests that the polarization of Macrophages (Proinflammatory) from M1 to M2 (Anti-inflammatory) occurs using (Nitric Oxide) NO- VASP (Vasodilator-stimulated phosphoprotein) pathway. This constitutes an important pathway in the prevention of the cytokine storm. Thus, Nitric Oxide plays an important role in Macrophage polarization & the prevention of Cytokine storm. 5. Nitric Oxide & Its Role in Blood Vessels: Due to these pro-inflammatory pulmonary cytokines & vasoconstriction, there is associated Pulmonary Vascular Endothelialitis, Microthrombosis, and intussusceptive Angiogenesis. These may to Respiratory failure & multiorgan damage further lead Nitric Oxide is a potent vasodilator and may help to reverse pulmonary vasoconstriction. This may thus help in oxygenation of the blood in the pulmonary arterioles & prevent Hypoxia as well which is the main issue of the complication of Covid19. Vasodilation of blood vessels may also help in the prevention of the formation of microthrombi & the complication associated with the same. (Continue Reading below about section on Dietary ways to Optimize Nitric Oxide in our Body) 6. Nitric Oxide & Vitamin D: Is there any connection Vitamin D is the most talked- about Vitamin since the start of the pandemic as the evidence is getting clear that the complications of Covid 19 are more common in patients with Vitamin D deficiency Growing literature & evidence now the endothelial function of Vitamin D is carried out by stimulation of release of Nitric Oxide from blood vessels. This also confirms the Role of Vitamin D in the prevention of Cytokine Storm suggest Similarly, sun exposure, sauna exposure also helps in the release of Nitric Oxide 7. Studies on Inhaled Nitric Oxide: Inhaled Nitric oxide (iNo) if started early have shown good success rate in the treatment of Covid19 as shown in multiple research papers. This was also seen during the 2003 pandemic of Sarscov1 One such study reports that in spontaneously breathing patients with Covid-19 who underwent therapy with iNO, more than half did not require mechanical ventilation after treatment. These findings suggest that iNO therapy may have a role in preventing the progression of hypoxic respiratory failure in Covid-19 patients. Inhaled Nitric Oxide has also shown success in a patient
3 News Idiopathic with hypertension. Pulmonary Inhaled Nitric oxide at 160-200 ppm is shown to be well-tolerated and may benefit pregnant patients with COVID-19 with hypoxic respiratory failure. Also, multiple papers suggest that impairment of Nitric Oxide production is seen in Diabetes mellitus & Hypertension which comorbidities are also main associated Covid19 complications & mortality. This also suggests that Nitric Oxide may have a potential role in the prevention & management of Covid19. with Potential effects of nasal breathing and nitric oxide on SARS- CoV-2 viral load and oxygenation. Nasal breathing may reduce viral load and improve oxygenation in COVID-19subjects by filtering the air and by increasing NO levels in the airways. Several factors may reduce or increase the levels of nitric oxide as shown in the pink and green rectangles, respectively. 8. Optimization of Nitric Oxide in body Breathing Techniques to Boost Nitric Oxide Levels According to Louis Ignarro, (Nobel Prize for the discovery of NO) in April’20 published Fig 1: The influence of 1,25(OH)2D on the different cell types of these immune system segments (Shymanskyi I et al, 2019) “Inhaled Nitric Oxide and COVID- 19” - “One practice to consider during this coronavirus pandemic is to breathe or inhale through the NOSE and exhale through the Mouth” Jan Martel in May’20 has published “Could nasal nitric oxide help to mitigate the severity of COVID-19? Breathing Methods. 1. Exclusive Nose Breathing throughout the day & night is a must for optimum availability of Nitric Oxide from the Nose. Mouth breathers tend to have lower levels of Nitric oxide as nitric oxide is produced in the nose & not in the mouth. 2. A slow rate of breathing from 6-10 breaths per minute can not only help to increase Nitric Oxide but also improves Heart Rate variability. 3. Humming (similar to chanting Om with Nose) can increase Nitric oxide up to 3000ppm. is This is similar to Brahmari Pranayama which also recommended by the Ministry of Health and Family welfare as part of Yoga guidelines for Covid19 patients. 4. Breath-holding for 5-10seconds after (& exhalation more time under professional guidance) helps to increase Nitric oxide. (Contraindicated in CVD patients, pregnancy, or any other major ailments) 11/20 Nitric Oxide for the prevention & management of Covid19. References: Available on request Author: Dr. Mihir Shah Dr. Mihir Shah is a Pediatric Dentist & Certified Orofacial Myology Specialist practicing in Mumbai. He works in the field of Preventive Pediatric Dentistry for the prevention of Dental Malocclusion & Dental Caries. His forte includes Airway dentistry for Dental management of Mouth Breathing, Sleep Disordered Breathing & Obstructive Sleep Apnea in children. https://www. pediatricsmiles.in Ad Dietary Methods to optimize Nitric oxide in our body. 1. Diet rich in Nitrates helps to increase Nitric oxide. Nitrates are reduced to Nitrites by oral bacteria in the Oral Cavity. Hence it is important to use antimicrobial Mouthwashes judiciously as mouthwashes may reduce the availability of these bacteria and reduce Nitric oxide as well. The foods highest in nitrate include beetroots, watermelon, pomegranate, garlic, leafy greens such as kale, arugula, chard, and spinach. Others include parsley, Chinese cabbage, leeks, celery, radishes, and turnips. 2. Diet Rich in L Arginine, Citrulline, Vitamin C also helps to optimize Nitric oxide levels Conclusion: Nitric Oxide is a promising agent that has not only shown antiviral action against Sars- cov-2 but also optimizes body functions & prevents any major complications associated with Covid19. Randomised Controlled trials are underway in the use of inhaled Nitric Oxide (iNO) which will definitely lead us the way. Randomised Controlled trials must also be carried out in the Role of various Breathing techniques & Dietary measures to optimize PRINT EVENTS EDUCATION DIGITAL SERVICES Dental Tribune International The World's Dental Marketplace www.dental-tribune.com
4 News 11/20 Pediatric dentistry in 2020 and beyond: A perspective of two young pediatric dentists by Dental Tribune South Asia Two young pediatric dentists describe the emerging philosophies concepts in Pediatric dentistry. What pediatric dentistry looks like, now & beyond 2020. and Introduction The scientific revolution of the 21st century heralds the new dimensions in pediatric oral health care.  Pediatric dentistry is a discipline that has now embraced the concept of ‘oral and overall health’ to explain how right from the womb until adolescence; the growth and development of the jaws and the face, the power of maintaining healthy airways contributes to one’s quality of life.  Dentists and researchers have shown how growth during early life is related to chronic diseases that emerge many decades later.  A new era has begun, encouraging healthcare practitioners to look at dentistry with a new perspective. “In these waves of change we pediatric dentists will find our direction.” including Pediatric dentistry speciality is an age-defined that provides both primary and comprehensive preventive and therapeutic, oral health care for infants and children through adolescence, those with special health care needs.  Today, Pediatric Dentistry is recognized as a speciality which is not based on a particular skill set, but encompassing all of dentistry’s technical skills against a philosophical background of understanding child development in health and disease. The focus has changed from providing restorative/ surgical treatment to disease prevention and interception. Dental caries is the single most common chronic childhood disease - 5 times more common than asthma,  times more common than early childhood obesity and 20 times more common than diabetes.  Mouth breathing and Sleep Disordered Breathing (SDB) is also one of the most common diseases in children.  It is therefore time for a breakthrough in thinking and a clearly defined vision for developing strategies to disease management. In fact, the American Dental Association, the American Academy of General Dentistry, and the Pediatric dentistry looks so different from what it used to be a few decades before. (Photo by form PxHere) AAPD all recognize that the dual role of pediatric dentists is similar to that of paediatricians, gynaecologists, and internists in medicine. It is of utmost importance that children must obtain collaborative care from dental and medical teams for a complete physical, mental and social well-being.  Different Revolutions Dentistry Areas of Pediatric In Oral Care framework • Every child is different, a customized and comprehensive treatment plan along with a for home oral hygiene must be provided to help the child. The oral health team must emphasize on full mouth rehabilitation, it will also eliminate the increasing cost and discomfort of re-treatments.  The current approach is caries lesion management at tooth level, followed by caries management to control the ongoing caries process in the oral cavity such that the balance is sustained towards net mineral gain. The control of dental biofilm plays an essential role in caries development.  Thus, evidence supporting toothbrushing, flossing, varnish, gels, (rubber cup) at recall visits before the varnish application is weak and conflicting. In addition, the recent paradigm shift puts equal emphasis on modifying dietary behaviours.  prophylaxis • Breastfeeding and Pediatric Dentistry The role Tethered Oral Tissues (TOT’s) was underestimated and has gained a lot of momentum in recent years. Today, there is enough research showing the role of TOT’s in breastfeeding , speech , breathing [11,13], sleep , swallowing [11,12], oral myofascial dysfunction  and growth of jaws . The definition and assessment of Ankyloglossia have been revisited in recent years based on a function that is tongue mobility.  The understanding in treating infant oral health is growing and changing and this represents an excellent opportunity for physicians and dentists to find ways to effectively join forces to create a successful outcome. and Sedation • Most of the pediatric patients have received treatment in the dental office with minimal discomfort without expressed fear, using behaviour guidance techniques. A dentist who treats children should be able to accurately assess and implement basic and advanced behaviour management techniques. Minimal or moderate sedation can be used for less compliant patients. Some patients with special care needs who have extensive oral healthcare needs, acute situational anxiety, pre- co-operative age-appropriate behaviour, immature cognitive functioning, or medical conditions require deep sedation/general anaesthesia in a safe manner.  In these cases, the operating dentist, the licensed anaesthesia provider and the dental assistant must be trained in pediatric advanced life support (PALS).  disabilities, • Restorative Dentistry Dentistry is moving away from the mechanistic approach which failed to address the underlying cause of the disease, leading to a continuing process of replacement dentistry called the ‘repeat restoration cycle’.8 It is time to update your team’s approach to the non-surgical management of caries. Micro- the Hall invasive ways Technique Silver and like  Diamine Fluoride (SDF) are used most commonly. Moreover, in some situations, SDF may replace waitlists and sedation for many young patients until they mature before performing the treatment.  Newly developed materials, technologies and techniques have now given ways to preserve tooth structure more effectively. Not only are they child-friendly and cost-effective, but they also provide a painless and anxiety- free experience. in • Interceptive Orthodontics The importance and the role of epigenetic factors in growth have been stressed upon right from the time Melvin Moss mentioned in the Functional Matrix Theory that there are no genes for bone development. Soft tissue dysfunction is an alteration the muscular activity of the muscles. Ramirez et al  mention that dentists must be aware and evaluate each patient if dysfunction in the muscular activity is present and how this soft tissue dysfunction has affected the occlusion. We don’t need to wait and wait until all teeth erupt and eventually extract them due to lack of space and inability to modify growth at a later age. Pediatric dentists are the ones watching the child’s growth; any prefabricated or customized growth modification appliances should be considered as the first line of treatment.  • Oral Myofunctional Therapy results adaptation According to the Academy of Orofacial Myofunctional Therapy (AOMT), Orofacial Myofunctional Disorders (OMD’s) are disorders of the muscles and functions of the face and mouth. An incorrect in breathing pattern dysfunctional of the orofacial muscles. OMD’s may directly or indirectly result in dysfunctional habits like atypical swallowing and chewing, non-nutritive sucking, bruxism, speech disorders, TMJ disorders, incorrect postures, malocclusions [20,21] and sleep disorders  develop. OMD’s also interfere with the stability of treatments. These disorders are important to be diagnosed by dentists, pediatric dentists, orthodontists, dental speech- orthodontics hygienists, language pathologists and other professionals dealing with the orofacial complex. Our ability to identify these disorders can help widen our scope of practice. Furthermore, it will support us in reasoning out the etiology behind the commonly observed signs and symptoms in our practices. • Importance Of Anticipatory Guidance On Weaning Attention has been drawn to the strong correlation between jaw shrinkage and the agricultural and industrial revolutions. What has changed in this revolution? The transition to softening diets and a reduction in the amount of chewing, resulting in an improper swallow.  A person swallows 500-1000 times in a day and this incorrect swallowing can affect the growth of the jaws, the position of teeth and muscle dysfunction. It is a relevant and meaningful responsibility of a pediatric dentist to give this anticipatory guidance to parents.  • Pediatric Sleep Disordered Breathing (SDB) the Presently, resistance impetus behind understating Pediatric SDB is a revolution in itself. SDB refers to a spectrum of sleep- related breathing abnormalities include snoring, upper that airway syndrome, obstructive hypopnea syndrome, and obstructive sleep apnea (OSA).  It has been seen that Pediatric SDB is affecting the children’s growth behaviorally, socially, academically and their overall well-being. A study conducted by Bonuck et al  found a high prevalence of UARS and mouth breathing compared to sleep apnea in children. The symptoms of these were dynamic, suggesting the need for early and continued vigilance in early childhood. Ultimately, concluding that a very strong association present between SDB and orofacial muscle tone and development of nasomaxillary complex.  was This is where our role as a pediatric dentist becomes important. Even the ADA and FDA in its policies state that we as pediatric dentists must undergo training to identify signs of SDB and how it can be treated with an interdisciplinary approach.
6 News 11/20 COVID-19: Beyond a respiratory illness. A Multi-system Inflammatory Syndrome (MIS)- Amisha Parekh by Dental Tribune South Asia COVID-19, although previously considered to be an exclusively respiratory illness, in the course of the disease has presented itself with a variety of symptoms from the involvement of multiple systems such as ophthalmologic, dermatologic, hepatic or abdominal symptoms and sometimes with just mere loss of sense of smell. This article by Amisha Parekh describes the multi-system involvement seen in Covid-19. Multisystem syndrome (mis): inflammation It or . (MIS-C) MIS-C: Recently, reports have shown that the majority of the deaths in young people having COVID19 have occurred due to multisystem inflammatory syndrome is a syndrome found in young people below 21 years of age and is presented as fever, severe illness, and the involvement of two or more organ systems, in combination with laboratory evidence of inflammation and laboratory epidemiologic evidence of SARS-CoV-2 infection . MIS-C typically manifests 3-4 weeks after SAR-COV2 infection, clinical features of which predominantly included shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers [3,4]. The abdominal pain in MIS-C can be so severe that patients could even be presumed to be having appendicitis. Children who develop MIS-C could be even for COVID19, asymptomatic having SAR-COV2 antibodies but negative RT-PCR at the time of evaluation . positive MIS-A: A syndrome similar to MIS-C has also been found in adults above 21 years of age having extra-pulmonary dysfunction who may not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection in these patients. A study found that MIS-A patients had only minimal respiratory symptoms, or abnormalities, radiographic thereby, distinguishing itself from severe COVID-19 patients . hypoxemia, MIS-C and MIS-A might represent post-infectious processes? 30% adults and 45% of the children reported to CDC through July 2020, had negative PCR and positive SARS-CoV-2 antibody test results indicating MIS to be a post-infectious process . However, a study recently contemplated that MIS-C could be a persistent infection as there is an increase in the number of naive T-cells at different locations in the body which would eventually clear the infection in lungs but remain as a persistent infection at other sites . A Lancet study also suggested that there is persistent activation of the innate immune inflammatory response to curb the ongoing infection probably occurring due to the ability of SARS-CoV-2 type 1 and type 3 interferon response signalling to the adaptive immune system without disruption of cytokine production . to block G a s t r o i n t e s t i n a l involvement in covid19: Disturbance in the gut microbiome: A recent study revealed for the first time that COVID19 patients expressed a disturbance in the gut microbiome. The study found an increase in the number of opportunistic pathogens in the gut of COVID19, one of which was A. viscosus, an opportunistic pathogen of the oral cavity and upper respiratory tract. This study suggested that COVID19 infection could be associated with long-term detrimental effects on the gut microbiome as there was a loss of salutary species in the gut of the patients despite clearance of the virus . Gastrointestinal symptoms and COVID19 severity: A study found that COVID19 patients persistently presented with gastrointestinal symptoms (GI) like diarrhoea, nausea and vomiting and 28% of these patients with GI symptoms did not have any respiratory symptoms . This study also revealed that the severity of the disease was more in patients having GI symptoms than those without GI symptoms . A six virus SARS-COV-2 study in at various locations in the GI tract: performed endoscopy subjects revealed that SARS-COV2 virus was detected in three out of six subjects in biopsies taken during endoscopy at various GI locations. In two severely diseased patients, the virus could be detected in oesophagus, stomach, duodenum and rectum proving that this virus is present throughout the GI tract [8,9]. Delayed viral clearance in covid19 patients having gi symptoms: SARS-COV2 virus in stools of COVID19 patients: Various studies have detected SARS-CoV-2 virus in anal swabs and stool samples in almost 50% of patients with COVID- 19 and elevated levels of faecal calprotectin have been found in COVID19 patients with diarrhoea, indicating inflammatory response in the gut . an Presence of the virus in faeces even after clearance from the respiratory system: tested A study found that there were 53.4% patients that tested positive for the virus in the stool and more than 20% of infected patients had a positive virus in faeces even after clearance of virus from the respiratory tract . Similarly, a study found that eight out of ten pediatric COVID19 patients persistently positive rectal swabs even after on nasopharyngeal tests became negative and SARS-CoV-2 RNA was detected in the stool of these children 20 days after negative conversion of viral RNA in respiratory specimens . A Lancet study has even suggested the possibility of extended duration of viral shedding in faeces, for nearly 5 weeks after the patients’ respiratory samples tested negative SARS- CoV-2 RNA . Thus, it may be necessary to conduct stool tests before the patient is discharged or before the patient is declared as recovered. the Variation inflammatory in patients with only digestive symptoms: response for in were A study found that the levels of some inflammatory cytokines such as IL-2, IL-4, and IL-10 in patients with only digestive symptoms slightly higher compared to those with respiratory symptoms and there was also a delay in achieving the peak values during the course of the disease . This study demonstrated significant correlation between IL-2 and TNF level in patients having only digestive symptoms compared with the patients having only respiratory and suggested respiratory and digestive symptoms may correspond to two different T-cell differentiation patterns . symptoms that a Covid-19 presents itself with a variety of symptoms from the involvement of multiple systems. (Photo by Tmaximumge form PxHere) Liver involvement in covid19: Abnormal liver function and COVID19: Various studies have shown that SARS-CoV-2 infection can lead to liver injury . Liver injury associated with COVID-19 infection has also been revealed through autopsy and biopsy. Severe COVID-19 patients have been found to have higher levels of aspartate aminotransferase, alanine aminotransferase, and total bilirubin (TBL) compared to others. Recently a study found that COVID19 infection can cause acute hepatitis and this severe liver damage could be expressed even before the typical symptoms of COVID-19 which could result in misdiagnosis in the early stages. A study also suggested that the hepatobiliary system was vulnerable to damage not only in severe COVID19 patients but even if the patients had relatively mild symptoms . Dermatologic symptoms of covid19: Lesions associated with asymptomatic or mild COVID19: Chilblain-like acral eruptions and purpuric and erythema multiforme-like lesions . COVID19 Conclusion: During the course of this has pandemic, presented itself with numerous involving atypical symptoms multiple systems which could help in identifying the asymptomatic individuals. A careful observation of these symptoms and timely check can help curb further spread by the asymptomatic individuals as well as prevent severity by early diagnosis. Antibody tests and lab tests that would help in identifying SARS-COV2 virus and associated inflammatory states could be performed to fatality curb MIS associated and test negativity for weeks after the nasopharyngeal swab tests have turned negative before declaring the patient as recovered could help in preventing further spread of the infection. confirming stool References: Available on request Author: Lesions associated with form of COVID19: and a severe Acro-ischemic lesion maculopapular rash . Ophthalmologic symptoms of covid19: SARS-CoV-2 has been found in tears and conjunctival secretions of COVID19 patients with conjunctivitis . A study found that 31.6% of COVID19 patients ocular manifestations had including like conjunctival hyperemia, chemosis, epiphora, or increased secretions . conjunctivitis, Anosmia (loss of sense of smell) and covid19: Recent evidence suggests that anosmia is experienced by most of the COVID19 patients and has also been found in many patients who are asymptomatic except for the loss of sense of smell . Amisha Parekh Amisha Parekh is currently an intern in the YMT Dental College and Hospital under Maharashtra University of Health Sciences. Her interests include both clinical dentistry and research. Being an innovator, she has designed and received the copyright for „dental high-speed handpiece fitted with overhead high vacuum evacuator to control aerosol splatter“ – copyrighted
7 News 11/20 Leading dental schools unite institutions. The virtual launch was a sign of the times, but it also highlighted the extent to which digital technologies have created new interaction within dental education. forums for In her opening comments, Gallagher said: “Whilst we would love to be in a room together, socially networking and not distancing, we are delighted that current technology means that it is possible for many more of us to connect virtually today.” subsequently release, Prof. Mike Curtis, executive dean of King’s dental faculty, Gallagher concurred with released in a press stating: “Our experiences over the last year have demonstrated how it is entirely possible to conduct truly meaningful and productive collaboration and teaching in a virtual format and we are therefore really well placed to make rapid progress in achieving the goals of this unique partnership.” King’s College London said in the press release that the DentAlliance partners will collaborate to transform dental education and the development of dental curricula and to pursue research new, transformative initiatives. Each of the four dental schools will bring their expertise to the collaboration, through which the partners will work to enhance dental practice and the oral and craniofacial health sciences. DentAlliance was developed by the participating dental schools, and four deans of the Prof. Jenny Gallagher, dean for international affairs at King’s dental faculty, welcomed attendees from around the world to the virtual launch of DentAlliance on 23 October. (Image: King’s College London/Zoom) the partnership aims to create new and transformative training and exchange opportunities for students and employees and to inspire and train future leaders within the dental profession. Anusha Chopra, chair of the King’s College London Dental Student Council, and Nima Kazempour, student president of King’s College London Dental Society, said that DentAlliance was a unique opportunity for collaboration between dental students on a global scale. “We are excited to compare our experience in patient care, dental education, and careers beyond,” they enthused. for Three of the four DentAlliance partners were ranked in the 2020 list of the top 50 dental schools in the world compiled by the higher education think tank Quacquarelli Symonds (QS). Released in March, the QS World University Rankings the subject of dentistry rated King’s College London’s Faculty of Dentistry, Oral and Craniofacial Sciences as the leading dental college The University of North Carolina at Chapel Hill Adams School of Dentistry was ranked 18th and the Melbourne Dental School 26th. internationally. Top dental faculties in the UK, the US, Singapore and Australia have begun a new collaboration. (Image: silvabom/Shutterstock) by Jeremy Booth, Dental Tribune International LONDON, UK: Four of the world’s top dental colleges have entered into an alliance that aims to advance dental education and pursue new research initiatives. The new partnership—named D e n t A l l i a n c e — c o n n e c t s leading dental faculties on four continents, and its launch has been hailed as a transformative step for dental education. Many readers will be familiar with King’s College London’s Faculty of Dentistry, Oral and Craniofacial Sciences in the UK, the University of North Carolina at Chapel Hill Adams School of Dentistry in the US, the National University of Singapore Faculty of Dentistry and the Melbourne in Australia. Dental School Through DentAlliance, these four schools will work together over the next five years towards the creation of an agreement for DentAlliance partners will collaborate to transform dental education and the development of dental curricula global collaboration in both their curricula and their research initiatives. The new alliance was launched on 23 October through a virtual event, which included presentations by Prof. Jenny Gallagher, dean for international affairs at King’s dental faculty, and a number of her colleagues and the freshly partnered educational counterparts from Relax your patients and make them feel more comfortable during dental procedures Ad Matrx Nitrous Oxide and Oxygen Conscious Sedation Systems There are many good reasons to use nitrous oxide sedation in your dental practice: • Safe - N2O/O2 has been used globally for over 100 years • Relieves patient anxiety and discomfort • Patients remain awake, yet more relaxed, making it an excellent patient management tool • Improves patient experience, resulting in return visits Matrx is made in the USA 210 Udyog Mandir 1 7-C Bhagoji Keer Road Mahim West, Mumbai 400016 India Phone: +91 22 61 46 47 48 Email: firstname.lastname@example.org www.lifecare.in
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