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  1. Lal A, Sanaullah A, M Saleem MK, Ahmed N, Maqsood A, Ahmed N
    Eur J Dent, 2020 Dec;14(S 01):S27-S33.
    PMID: 33242914 DOI: 10.1055/s-0040-1718644
    OBJECTIVES:  The aim of this study was to evaluate psychological distress caused by the novel coronavirus disease 2019 (COVID-19) pandemic among the adult population residing in Pakistan.

    MATERIALS AND METHODS:  This cross-sectional survey-based study comprised 1,000 adults residing in Pakistan. A questionnaire was formulated and circulated among adult population of Pakistan, the depression and anxiety symptoms using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales were assessed.

    STATISTICAL ANALYSIS:  Independent t-test, cross tabulation, and regression analysis were used to identify variables having impact on PHQ-9 and GAD-7 scores. A p-value of ≤ 0.05 was considered statistically significant.

    RESULTS:  Among 1,000 participants, 573 were males and 427 were females who completed the survey. Majority were restricted to home for more than 40 days. Considerable number of participants reported depressive (540, 54%) and anxiety (480, 48%) symptoms. Gender, age, earnings, and occupation have significant relation with psychological distress, although similar was not found with education levels.

    CONCLUSION:  Psychological distress, a concerning yet addressable issue was found among adults arising amid COVID-19 outbreak. Currently, physical health effects of COVID-19 are being looked, while mental health effects being under-addressed. This issue should be addressed to avoid any psychological impact in future.

  2. Bashir TF, Hassan S, Maqsood A, Khan ZA, Issrani R, Ahmed N, et al.
    Eur J Dent, 2020 Dec;14(S 01):S91-S96.
    PMID: 33368064 DOI: 10.1055/s-0040-1721653
    OBJECTIVE:  To evaluate the anxiety and depression amid novel coronavirus disease-19 (COVID-19) pandemic in health sciences students around the globe.

    MATERIALS AND METHODS:  This cross-sectional observational study comprised 523 health science students. A well-structured online questionnaire consisting of closed-ended questions based on student's general information, Patient Heath Questionnaire (PHQ)-9 and Generalized Anxiety Disorder (GAD)-7 scales were used to assess the psychological impact of COVID-19.

    STATISTICAL ANALYSIS:  SPSS-25 was used to analyze the outcome of this study. Multiple linear regression analysis test was used to assess variables which had impact on PHQ-9 and GAD-7 scores among the participants. A p-value of ≤ 0.05 was considered as statistically significant.

    RESULTS:  Among the 523 participants, 365 (69.55%) students were from developing countries and 158 (30.21%) from developed countries; 424 (81.1%) students were tested negative for COVID-19 and 99 (18.9%) had suffered from severe acute respiratory syndrome coronavirus 2 infection during pandemic. The mean GAD-7 and PHQ-9 scores were 7.16 ± 5.755 and 7.30 ± 6.166, respectively. Significant impact on anxiety levels was associated with age, gender, education status, and COVID-19 positive patient, while depression was not significantly associated with gender, COVID-19, and its reported symptoms in participants.

    CONCLUSION:  As the world is trying to contain the health effects of COVID-19, the psychological effects might take a longer time to be addressed. Our study highlights the dire need to identify mental well-being of health science students as this may have a direct impact on their professional commitments and future responsibilities.

  3. Ahmed N, Abbasi MS, Zuberi F, Qamar W, Halim MSB, Maqsood A, et al.
    Biomed Res Int, 2021;2021:9751564.
    PMID: 34258283 DOI: 10.1155/2021/9751564
    Objective: The objective of this systematic review was to investigate the quality and outcome of studies into artificial intelligence techniques, analysis, and effect in dentistry.

    Materials and Methods: Using the MeSH keywords: artificial intelligence (AI), dentistry, AI in dentistry, neural networks and dentistry, machine learning, AI dental imaging, and AI treatment recommendations and dentistry. Two investigators performed an electronic search in 5 databases: PubMed/MEDLINE (National Library of Medicine), Scopus (Elsevier), ScienceDirect databases (Elsevier), Web of Science (Clarivate Analytics), and the Cochrane Collaboration (Wiley). The English language articles reporting on AI in different dental specialties were screened for eligibility. Thirty-two full-text articles were selected and systematically analyzed according to a predefined inclusion criterion. These articles were analyzed as per a specific research question, and the relevant data based on article general characteristics, study and control groups, assessment methods, outcomes, and quality assessment were extracted.

    Results: The initial search identified 175 articles related to AI in dentistry based on the title and abstracts. The full text of 38 articles was assessed for eligibility to exclude studies not fulfilling the inclusion criteria. Six articles not related to AI in dentistry were excluded. Thirty-two articles were included in the systematic review. It was revealed that AI provides accurate patient management, dental diagnosis, prediction, and decision making. Artificial intelligence appeared as a reliable modality to enhance future implications in the various fields of dentistry, i.e., diagnostic dentistry, patient management, head and neck cancer, restorative dentistry, prosthetic dental sciences, orthodontics, radiology, and periodontics.

    Conclusion: The included studies describe that AI is a reliable tool to make dental care smooth, better, time-saving, and economical for practitioners. AI benefits them in fulfilling patient demand and expectations. The dentists can use AI to ensure quality treatment, better oral health care outcome, and achieve precision. AI can help to predict failures in clinical scenarios and depict reliable solutions. However, AI is increasing the scope of state-of-the-art models in dentistry but is still under development. Further studies are required to assess the clinical performance of AI techniques in dentistry.

  4. Moin M, Saadat S, Rafique S, Maqsood A, Lal A, Vohra F, et al.
    Biomed Res Int, 2021;2021:5185613.
    PMID: 34950734 DOI: 10.1155/2021/5185613
    Introduction: Oral health is considered as one of the essential components of the overall health of every individual. Maintaining oral health is a gradual process that requires commitment. Children who require special care such as hearing impairment experience difficulty in maintaining oral health primarily due to communication difficulties. This study is aimed at using different interventions to evaluate the improvement of oral hygiene in hearing impaired children.

    Materials and Methods: Fifty-nine children were recruited in this study that were allocated randomly into each group with twenty children as follows: group 1: pictorial, group 2: video, and group 3: control. Mean plaque and gingival scores were noted before and after the use of different interventions. Oral hygiene was categorized as "excellent," "good," and "fair." Gingival health was categorized as "healthy," "mild gingivitis," and "moderate gingivitis."

    Results: Thirty-four children (57.6%) were from 12-13 years of age bracket, and 25 (42.4%) belonged to 14-16 years of age. Regarding gender, there were 37 (62.7%) males and 22 (37.3%) females. About comparison of mean gingival and plaque scores before and after interventions in each group, a significant difference was found in group 1 (p < 0.001) and group 2 (p < 0.001), as compared to group 3 where the difference in scores was not significant (p > 0.05).

    Conclusion: Maintaining oral health requires the compliance of individuals to perform different methods of preventive dentistry, such as tooth brushing and use of dental floss. The use of different oral hygiene educational interventions such as pictorial and video methods have been proven and useful for hearing impaired children in improving oral health.

  5. Maqsood A, Sadiq MSK, Mirza D, Ahmed N, Lal A, Alam MK, et al.
    Biomed Res Int, 2021;2021:5437237.
    PMID: 34845437 DOI: 10.1155/2021/5437237
    Objective: The present study was aimed at assessing the impact of teledentistry, its application, and trends in uplifting dental practice and clinical care around the world. Material and Methods. The present observational study comprised of an electronic survey distributed among dental professionals around the globe. The validated survey form consisted of a total 26 questions with 5-point Likert scale response. The questionnaire used was divided into four domains: usefulness of teledentistry for patients, its usefulness in dental practice, its capacity to improve the existing practice, and the concerns attached to its use. The statistical analysis was performed using SPSS-25. ANOVA test was used to assess the effect of independent variables on dependent variables. A p value of ≤0.05 was taken as statistically significant.

    Results: A total of 506 dental professionals participated in the study with the response rate of 89.39%. More than half of the participants (50-75%) endorsed that teledentistry is a useful tool for improving clinical practice as well as patient care. Two-thirds of the participants (69.96%) considered that teledentistry would reduce cost for the dental practices. On the other hand, about 50-70% of dental professionals expressed their concerns regarding the security of the data and consent of patients. The most preferred communication tool for teledentistry was reported to be videoconference followed by phone. The majority of participants recommended the use of teledentistry in the specialty of oral medicine, operative dentistry, and periodontics. There was a significant difference between the age, experience of dentists, and their qualifications with domains of teledentistry.

    Conclusions: The overall impact of dental professionals towards teledentistry was positive with adequate willingness to incorporate this modality in their clinical practice. However, the perceived concerns pertaining to teledentistry are significant impediments towards its integration within the oral health system. An in-depth study of its business model and cost-benefit needs of time, especially in the context of developing countries, in order to avail the optimum benefits of teledentistry.

  6. Aboul-Soud MAM, Ashour AE, Challis JK, Ahmed AF, Kumar A, Nassrallah A, et al.
    Plants (Basel), 2020 Sep 30;9(10).
    PMID: 33008079 DOI: 10.3390/plants9101295
    Organic fractions and extracts of willow (Salix safsaf) leaves, produced by sequential solvent extraction as well as infusion and decoction, exhibited anticancer potencies in four cancerous cell lines, including breast (MCF-7), colorectal (HCT-116), cervical (HeLa) and liver (HepG2). Results of the MTT assay revealed that chloroform (CHCl3) and ethyl acetate (EtOAc)-soluble fractions exhibited specific anticancer activities as marginal toxicities were observed against two non-cancerous control cell lines (BJ-1 and MCF-12). Ultra-high-resolution mass spectrometry Q-Exactive™ HF Hybrid Quadrupole-Orbitrap™ coupled with liquid chromatography (UHPLC) indicated that both extracts are enriched in features belonging to major phenolic and purine derivatives. Fluorescence-activated cell sorter analysis (FACS), employing annexin V-FITC/PI double staining indicated that the observed cytotoxic potency was mediated via apoptosis. FACS analysis, monitoring the increase in fluorescence signal, associated with oxidation of DCFH to DCF, indicated that the mechanism of apoptosis is independent of reactive oxygen species (ROS). Results of immunoblotting and RT-qPCR assays showed that treatment with organic fractions under investigation resulted in significant up-regulation of pro-apoptotic protein and mRNA markers for Caspase-3, p53 and Bax, whereas it resulted in a significant reduction in amounts of both protein and mRNA of the anti-apoptotic marker Bcl-2. FACS analysis also indicated that pre-treatment and co-treatment of human amniotic epithelial (WISH) cells exposed to the ROS H2O2 with EtOAc fraction provide a cytoprotective and antioxidant capacity against generated oxidative stress. In conclusion, our findings highlight the importance of natural phenolic and flavonoid compounds with unparalleled and unique antioxidant and anticancer properties.
  7. Badami ZA, Mustafa H, Maqsood A, Aijaz S, Altamash S, Lal A, et al.
    Vaccines (Basel), 2022 Dec 05;10(12).
    PMID: 36560486 DOI: 10.3390/vaccines10122076
    Vaccination plays a crucial role in controlling the rate of coronavirus transmission and infectivity. Healthcare professionals are, in fact, at the greatest risk of contracting coronavirus due to their proximity and prolonged exposure to infected patients; this certitude alone enhances the stress and anxiety among patients and professionals alike. In this study, we aimed to assess the levels of anxiety experienced by healthcare professionals in their practices before and after getting vaccinated. This cross-sectional study was carried out in 2021. An electronic survey was distributed among the non-vaccinated and vaccinated healthcare workers. The survey consisted of the following parts: demographic characteristics, coronavirus-related questions, questions related to the specific field of healthcare professions, general anxiety questions, and working-hour-related questions. The Modified General Anxiety Scale (GAD-7) was used along with the paired t-test, Mann-Whitney U test, and Spearmen's test for comparison. p ≤ 0.05 was considered statistically significant. A total of 798 healthcare professionals participated in the study. In this study, the majority of participants were females, with 598 (74.9%) being between the ages of 21 and 30, and 646 (80.9%) participants were graduates, with the majority being dentists. Non-vaccinated healthcare professionals had severe anxiety (30.9%), whereas, in vaccinated participants, anxiety levels were minimal (56.9%). A statistically significant correlation was discovered when comparing the scores of the vaccinated and non-vaccinated individuals as well as when comparing the professions of vaccinated participants, whereas no association was found with the gender and education level of participants. Vaccination is necessary for all entitled individuals to control the spread of coronavirus. It was discovered that there was an increase in anxiety levels before the vaccination was introduced. The anxiousness was greatly lessened following mass immunizations. Our research will help to raise public awareness of stigmatized mental health disorders in the healthcare industry.
  8. Al-Mhanna SB, Wan Ghazali WS, Maqsood A, Mohamed M, Ahmed N, Afolabi HA, et al.
    SAGE Open Med, 2023;11:20503121231158981.
    PMID: 36909796 DOI: 10.1177/20503121231158981
    Coronavirus disease 2019 is a severe communicable pulmonary medical problem that has been a challenging disease for everyone in the globe, but vaccines development and administration against this severe acute respiratory syndrome-inducing disease (coronavirus disease 2019) are currently yielding fabulous results. The mean duration of the coronavirus disease 2019 pandemic for this study spanned from 2020 until 2022. These manifestations are accompanied by symptoms of respiratory tract illnesses such as non-productive cough, sore throat, and nasal discharge. Relevant reviews on coronavirus disease 2019 manifestations and outcomes, consisting mainly of the infections/outbreaks, experimental information, and pre- and post-serovaccination details that occurred, were described. After a typical vaccination course, the study aims to summarize and understand more about the effectiveness of exercise on the pre-and post-coronavirus disease 2019 vaccination and its implementations. Physical activity is an immunological function adjuvant to decrease communicable disease risk and enhance immunity post-viral infection vaccination. Moderate-intensity resistance exercisesession directly before getting the influenza vaccine decreases vaccine responses in older adults, such as redness, pain, or inflammation at the injection spot or other adverse consequences compared to the inactive circumstance. However, it was reported that exercise after a shot is generally safe as long as vaccinated people feel well enough. Though exercise before or after vaccination has no negative impact on the protection afforded by the vaccine, people can exercise immediately after receiving the vaccine, as any changes in blood flow will not affect the vaccine's response. One episode of light-to-moderate-intensifying exercise after vaccination may improve the antibody reactions to influenza or the coronavirus disease 2019 vaccine. Vaccination administered pre- and post-regular exercise is an effective approach for boosting antibody responses due to its immunostimulant effects. Future research should investigate how different vaccine antibodies respond to low, moderate, and high physical activity levels.
  9. Farooq A, Bilgrami A, Faraz SA, Qazi FUR, Maqsood A, Altamash S, et al.
    J Appl Biomater Funct Mater, 2023;21:22808000231166210.
    PMID: 37029505 DOI: 10.1177/22808000231166210
    OBJECTIVES: This study aimed to compare the effectiveness of an experimental root canal irrigant and 17% Ethylene-di-amine tetra acetic acid for removal of the smear layer in the coronal, middle and apical portions of the root canal.

    MATERIALS AND METHODS: Ninety human single rooted maxillary and mandibular teeth were selected for this study. The teeth were randomly divided into two experimental groups and one control group as follows: Group A (Ethanolic extract of Sapindus Mukorossi), Group B (17% EDTA), and Group C (Distilled water). The root canals of all three groups were prepared with stainless steel K-files by means of the standard step-back technique and irrigated with 5.25% sodium hypo chloride. The teeth were decoronated, following the irrigation and divided longitudinally into two-halves and visualized using scanning electron microscope (SEM) for the amount of smear layer present utilizing the three-point score system. The observations were noted both before and after the treatment. Nonparametric tests were applied for the comparison and p-value ⩽ 0.05 was considered as statistically significant.

    RESULTS: It was evident from that smear layer was completely removed in coronal portion of 27 out of 30 teeth in-group A. For middle and apical areas of group A, 24 and 19 teeth showed complete smear layer removal. In-group B it was found that there were 24, 21, and 3 teeth at coronal, middle and apical, areas respectively where smear layer were completely absent. Intra group comparison showed a significant difference (p = 0.002) in smear layer removal was found for group A at coronal, middle and apical thirds. Similarly, a significant difference (p = 0.001) was also found for group B; however heavy smear layer was found among the three parts of the canal for group C.

    CONCLUSIONS: Ethanolic extract of Sapindus Mukorossi have higher effectiveness in removing the smear layer from the root canal in comparison to 17% EDTA.

  10. Bilgrami A, Alam MK, Qazi FUR, Maqsood A, Basha S, Ahmed N, et al.
    Polymers (Basel), 2022 Jan 24;14(3).
    PMID: 35160456 DOI: 10.3390/polym14030466
    A vital feature of conservative dentistry is the adhesion of the restorative material to the tooth structure for restoration of the tooth substance lost due to dental decay, trauma, or dental imperfections. In a perfect world, a restorative material should generate a lasting adhesion by bonding the restoration with tooth tissues. The ingress of micro-organisms, oral fluids, molecules, and ions through microscopic spaces due to faulty adhesion between restoration and tooth structure is known as microleakage. This study is focuses on the evaluation of adhesive failures between the restorative materials. In the past, studies have focused more on the bonding potential of a restorative material with the tooth surface. Therefore, there is need to carry out a study that compares the microleakage between resin-based restorative materials in a sandwich manner with and without the intermediate bonding layer after immersion in 2% methylene blue dye at different time intervals. The restorative materials used were composite Ceram X Mono plus (DENTSPLY) and Z350 (3M ESPE), Vitremer resin modified glass ionomer cement (RMGIC) (3M ESPE), smart dentine replacement SDR (3M ESPE), Bond NT (DENTSPLY), and Universal Bond (3M ESPE). A light emitting diode (LED) was used to cure the specimens. Artificial saliva was used as a storage medium for the specimens. Thermocycling of specimens was carried out at 500 cycles/30 s and 1000 cycles/30 s. The world health organization (WHO) grading tool for microleakage was used to analyze fluid ingress in the specimens through disclosing by 2% methylene blue dye. The statistical analysis was carried out with one-way analysis of variance (ANOVA) and Tukey post hoc test, keeping the level of significance at p ≤ 0.05. In Grade 0 = 85 samples, Grade 1 = 10 samples, Grade 2 = 7 samples, Grade 3 = 16 samples, and in Grade 4 = 2 samples were identified. This study describes that no microleakage was observed in SDR and resin composite groups as compared to Vitremer and resin composite groups.
  11. Bashir A, Khan ZA, Maqsood A, Prabhu N, Saleem MM, Alzarea BK, et al.
    Healthcare (Basel), 2023 Jan 09;11(2).
    PMID: 36673562 DOI: 10.3390/healthcare11020194
    This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients (52.9%), and oroantral fistula was noted in 37 patients (55.9%). Additionally, 67 (95.7%) of the patients complained of nasal obstruction. Similarly, facial asymmetry was observed in 69 (98.6%) of the patients and double vision was observed in 24 (34.4%). Tumors of the maxillary sinus have a very insidious course of spread and uncertain clinical signs and symptoms. What makes diagnosis worse is the fact that the symptoms of these tumors are so well hidden in the sponge-like nature of the midfacial region that they are easily misinterpreted by patients. Therefore, diagnoses must be made early, dentists must be vigilant, and patients must be fully investigated at the slightest suspicion of a tumor, albeit benign.
  12. Moin M, Maqsood A, Haider MM, Asghar H, Rizvi KF, Shqaidef A, et al.
    Healthcare (Basel), 2023 Mar 04;11(5).
    PMID: 36900761 DOI: 10.3390/healthcare11050756
    The data on how lifestyle factors of school-going children affect their oral health are not sufficient; therefore, there is a need to analyze the adverse effects of poor lifestyle habits and the role of mothers' education on oral health. The aim of this study was to analyze the association of socioeconomic and lifestyle factors with the oral health status of school-going children through a structured questionnaire and oral examination. Ninety-five (26.5%) children were from class 1. One hundred eighty-seven (52.1%) mothers were educated while 172 (47.9%) were uneducated. Two hundred seventy-six (76.9%) children had never visited the dentist. The results indicate that dental health behavior is associated with lifestyle factors as well as socio-demographic variables. Parent education and awareness regarding oral health plays a major role in determining the oral health of children.
  13. Ashraf S, Ashraf S, Akmal R, Ashraf M, Kalsoom L, Maqsood A, et al.
    Trials, 2021 Sep 15;22(1):618.
    PMID: 34526081 DOI: 10.1186/s13063-021-05510-3
    OBJECTIVES: Considering the therapeutic potential of honey and Nigella sativa (HNS) in coronavirus disease 2019 (COVID-19) patients, the objective of the study is defined to evaluate the prophylactic role of HNS.

    TRIAL DESIGN: The study is a randomized, placebo-controlled, adaptive clinical trial with parallel group design, superiority framework with an allocation ratio of 1:1 among experimental (HNS) and placebo group. An interim analysis will be done when half of the patients have been recruited to evaluate the need to adapt sample size, efficacy, and futility of the trial.

    PARTICIPANTS: All asymptomatic patients with hospital or community based COVID-19 exposure will be screened if they have had 4 days exposure to a confirmed case. Non-pregnant adults with significant exposure level will be enrolled in the study High-risk exposure (<6 feet distance for >10min without face protection) Moderate exposure (<6 feet distance for >10min with face protection) Subjects with acute or chronic infection, COVID-19 vaccinated, and allergy to HNS will be excluded from the study. Recruitment will be done at Shaikh Zayed Post-Graduate Medical Institute, Ali Clinic and Doctors Lounge in Lahore (Pakistan).

    INTERVENTION AND COMPARATOR: In this clinical study, patients will receive either raw natural honey (0.5 g) and encapsulated organic Nigella sativa seeds (40 mg) per kg body weight per day or empty capsule with and 30 ml of 5% dextrose water as a placebo for 14 days. Both the natural products will be certified for standardization by Government College University (Botany department). Furthermore, each patient will be given standard care therapy according to version 3.0 of the COVID-19 clinical management guidelines by the Ministry of National Health Services of Pakistan.

    MAIN OUTCOMES: Primary outcome will be Incidence of COVID-19 cases within 14 days of randomisation. Secondary endpoints include incidence of COVID-19-related symptoms, hospitalizations, and deaths along with the severity of COVID-19-related symptoms till 14th day of randomization.

    RANDOMISATION: Participants will be randomized into experimental and control groups (1:1 allocation ratio) via the lottery method. There will be stratification based on high risk and moderate risk exposure.

    BLINDING (MASKING): Quadruple blinding will be ensured for the participants, care providers and outcome accessors. Data analysts will also be blinded to avoid conflict of interest. Site principal investigator will be responsible for ensuring masking.

    NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 1000 participants will be enrolled in the study with 1:1 allocation.

    TRIAL STATUS: The final protocol version 1.4 was approved by institutional review board of Shaikh Zayed Post-Graduate Medical Complex on February 15, 2021. The trial recruitment was started on March 05, 2021, with a trial completion date of February 15, 2022.

    TRIAL REGISTRATION: Clinical trial was registered on February 23, 2021, www.clinicaltrials.gov with registration ID NCT04767087 .

    FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.

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