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  1. Nagendrababu V, Pulikkotil SJ, Suresh A, Veettil SK, Bhatia S, Setzer FC
    Int Endod J, 2019 Jun;52(6):779-789.
    PMID: 30638269 DOI: 10.1111/iej.13072
    The management of pain during root canal treatment is important. The aim of this systematic review and network meta-analysis was to identify the anaesthetic solution that would provide the best pulpal anaesthesia for inferior alveolar nerve blocks (IANB) treating mandibular teeth with irreversible pulpitis. Two electronic databases (PubMed and Scopus) were searched to identify studies up to October 2018. Randomized clinical trials comparing at least two anaesthetic solutions (lidocaine (lignocaine), articaine, bupivacaine, prilocaine or mepivacaine) used for IANB for treatment of irreversible pulpitis were included. The revised Cochrane risk of bias tool for randomized trials was used to assess the quality of the included studies. Pairwise meta-analysis, network meta-analysis using a random-effects model, and SUCRA ranking were performed. The network meta-analysis estimated the probability of each treatment performing best. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. In total, 11 studies (n = 750) were included in the meta-analysis. The network meta-analysis revealed that only mepivacaine significantly increased the success rate of IANB compared to lidocaine (RR, 1.42 [95% CI 1.04-1.95]). However, no significant differences in the success rate of IANB were observed between mepivacaine and other anaesthetic agents (articaine and bupivacaine). Of all anaesthetic agents, mepivacaine (SUCRA = 0.81) ranked first in increasing the success rate of IANB, followed by prilocaine (SUCRA = 0.62), articaine (SUCRA = 0.54), bupivacaine (SUCRA = 0.41) and lidocaine (SUCRA = 0.13). The overall quality of evidence was very low to moderate. In conclusion, based on the evidence from the randomized clinical trials included in this review, mepivacaine with epinephrine demonstrated the highest probability of providing effective pulpal anaesthesia using IANB for teeth with irreversible pulpitis compared to prilocaine, articaine, bupivacaine and lidocaine. Further, high-quality clinical trials are needed to support the conclusion of this review.
  2. Nagendrababu V, Jayaraman J, Suresh A, Kalyanasundaram S, Neelakantan P
    Clin Oral Investig, 2018 Mar;22(2):655-670.
    PMID: 29372445 DOI: 10.1007/s00784-018-2345-x
    OBJECTIVES: Reduction of microbial load from the root canal systems is a pre-requisite for healing of lesions of endodontic origin. Such microbial reduction is influenced by the method of irrigant delivery and activation. The aim of this systematic review was to compare the effect of ultrasonically activated irrigation (UAI) with other irrigation techniques on the reduction of microorganisms during root canal disinfection.

    MATERIALS AND METHODS: The research question was created based on the PICO strategy. Two reviewers independently performed a comprehensive literature search in electronic databases. Following application of inclusion and exclusion criteria to the selected articles, a systematic data extraction sheet was constructed. The selected articles were assessed using methodological quality scoring protocol. The risk of bias in selected studies was critically assessed by two reviewers.

    RESULTS: A total of 15 articles were included for the systematic review. The included studies were heterogeneous in study design; hence, meta-analysis was not performed. The overall risk of bias for the selected studies was moderate. Overall, UAI showed superior reduction of microbial counts, resulting in better disinfection compared to other irrigation systems chosen for comparison in this review.

    CONCLUSION: The use of UAI can bring about superior microbial reduction within the root canal system compared to other irrigant activation techniques.

    CLINICAL RELEVANCE: Activation of irrigants with ultrasonic brings about significant bacterial reduction from the root canal systems compared to other methods of irrigant activation and conventional syringe irrigation. This might help in improving the outcome of root canal treatment.

  3. Suresh A, Karthikraja V, Lulu S, Kangueane U, Kangueane P
    Bioinformation, 2009 Nov 17;4(5):197-205.
    PMID: 20461159
    The formation of protein homodimer complexes for molecular catalysis and regulation is fascinating. The homodimer formation through 2S (2 state), 3SMI (3 state with monomer intermediate) and 3SDI (3 state with dimer intermediate) folding mechanism is known for 47 homodimer structures. Our dataset of forty-seven homodimers consists of twenty-eight 2S, twelve 3SMI and seven 3SDI. The dataset is characterized using monomer length, interface area and interface/total (I/T) residue ratio. It is found that 2S are often small in size with large I/T ratio and 3SDI are frequently large in size with small I/T ratio. Nonetheless, 3SMI have a mixture of these features. Hence, we used these parameters to develop a decision tree model. The decision tree model produced positive predictive values (PPV) of 72% for 2S, 58% for 3SMI and 57% for 3SDI in cross validation. Thus, the method finds application in assigning homodimers with folding mechanism.
  4. Sajid MR, Muhammad N, Zakaria R, Shahbaz A, Bukhari SAC, Kadry S, et al.
    Interdiscip Sci, 2021 Jun;13(2):201-211.
    PMID: 33675528 DOI: 10.1007/s12539-021-00423-w
    BACKGROUND: In the broader healthcare domain, the prediction bears more value than an explanation considering the cost of delays in its services. There are various risk prediction models for cardiovascular diseases (CVDs) in the literature for early risk assessment. However, the substantial increase in CVDs-related mortality is challenging global health systems, especially in developing countries. This situation allows researchers to improve CVDs prediction models using new features and risk computing methods. This study aims to assess nonclinical features that can be easily available in any healthcare systems, in predicting CVDs using advanced and flexible machine learning (ML) algorithms.

    METHODS: A gender-matched case-control study was conducted in the largest public sector cardiac hospital of Pakistan, and the data of 460 subjects were collected. The dataset comprised of eight nonclinical features. Four supervised ML algorithms were used to train and test the models to predict the CVDs status by considering traditional logistic regression (LR) as the baseline model. The models were validated through the train-test split (70:30) and tenfold cross-validation approaches.

    RESULTS: Random forest (RF), a nonlinear ML algorithm, performed better than other ML algorithms and LR. The area under the curve (AUC) of RF was 0.851 and 0.853 in the train-test split and tenfold cross-validation approach, respectively. The nonclinical features yielded an admissible accuracy (minimum 71%) through the LR and ML models, exhibiting its predictive capability in risk estimation.

    CONCLUSION: The satisfactory performance of nonclinical features reveals that these features and flexible computational methodologies can reinforce the existing risk prediction models for better healthcare services.

  5. Chum JD, Lim DJZ, Sheriff SO, Pulikkotil SJ, Suresh A, Davamani F
    Restor Dent Endod, 2019 Feb;44(1):e8.
    PMID: 30834230 DOI: 10.5395/rde.2019.44.e8
    Objectives: Irrigants are imperative in endodontic therapy for the elimination of pathogens from the infected root canal. The present study compared the antimicrobial efficacy of octenidine dihydrochloride (OCT) with chlorhexidine (CHX) and sodium hypochlorite (NaOCl) against Staphylococcus epidermidis (S. epidermidis) for root canal disinfection.

    Materials and Methods: The minimum inhibitory concentration (MIC) was obtained using serial dilution method. The agar diffusion method was then used to determine the zones of inhibition for each irrigant. Lastly, forty 6-mm dentin blocks were prepared from human mandibular premolars and inoculated with S. epidermidis. Samples were randomly divided into 4 groups of 10 blocks and irrigated for 3 minutes with saline (control), 2% CHX, 3% NaOCl, or 0.1% OCT. Dentin samples were then collected immediately for microbial analysis, including an analysis of colony-forming units (CFUs).

    Results: The MICs of each tested irrigant were 0.05% for CHX, 0.25% for NaOCl, and 0.0125% for OCT. All tested irrigants showed concentration-dependent increase in zones of inhibition, and 3% NaOCl showed the largest zone of inhibition amongst all tested irrigants (p < 0.05). There were no significant differences among the CFU measurements of 2% CHX, 3% NaOCl, and 0.1% OCT showing complete elimination of S. epidermidis in all samples.

    Conclusions: This study showed that OCT was comparable to or even more effective than CHX and NaOCl, demonstrating antimicrobial activity at low concentrations against S. epidermidis.

  6. Venkatraman SK, Choudhary R, Krishnamurithy G, Raghavendran HRB, Murali MR, Kamarul T, et al.
    Mater Sci Eng C Mater Biol Appl, 2021 Jan;118:111466.
    PMID: 33255048 DOI: 10.1016/j.msec.2020.111466
    This work is aimed to develop a biocompatible, bactericidal and mechanically stable biomaterial to overcome the challenges associated with calcium phosphate bioceramics. The influence of chemical composition on synthesis temperature, bioactivity, antibacterial activity and mechanical stability of least explored calcium silicate bioceramics was studied. The current study also investigates the biomedical applications of rankinite (Ca3Si2O7) for the first time. Sol-gel combustion method was employed for their preparation using citric acid as a fuel. Differential thermal analysis indicated that the crystallization of larnite and rankinite occurred at 795 °C and 1000 °C respectively. The transformation of secondary phases into the desired product was confirmed by XRD and FT-IR. TEM micrographs showed the particle size of larnite in the range of 100-200 nm. The surface of the samples was entirely covered by the dominant apatite phase within one week of immersion. Moreover, the compressive strength of larnite and rankinite was found to be 143 MPa and 233 MPa even after 28 days of soaking in SBF. Both samples prevented the growth of clinical pathogens at a concentration of 2 mg/mL. Larnite and rankinite supported the adhesion, proliferation and osteogenic differentiation of hBMSCs. The variation in chemical composition was found to influence the properties of larnite and rankinite. The results observed in this work signify that these materials not only exhibit faster biomineralization ability, excellent cytocompatibility but also enhanced mechanical stability and antibacterial properties.
  7. Krishnakumar P, Sundaramurthy S, Baredar P, Suresh A, Khan MA, Sharma G, et al.
    Environ Sci Pollut Res Int, 2023 Dec;30(60):125104-125116.
    PMID: 37099105 DOI: 10.1007/s11356-023-26991-6
    There are several environmental and human health impacts if human hair waste is not adequately disposed of. In this study, pyrolysis of discarded human hair was carried out. This research focused on the pyrolysis of discarded human hair under controlled environmental conditions. The effects of the mass of discarded human hair and temperature on bio-oil yield were studied. The proximate and ultimate analyses and calorific values of disposed of human hair, bio-oil, and biochar were determined. Further, chemical compounds of bio-oil were analyzed using a gas chromatograph and a mass spectrometer. Finally, the kinetic modeling and behavior of the pyrolysis process were characterized through FT-IR spectroscopy and thermal analysis. Based on the optimized mass of disposed of human hair, 250 g had a better bio-oil yield of 97% in the temperature range of 210-300 °C. The different parameters of bio-oil were: pH (2.87), specific gravity (1.17), moisture content (19%), heating value (19.34 MJ/kg), and viscosity (50 CP). C (56.4%), H (6.1%), N (0.16%), S (0.01%), O (38.4%), and Ash (0.1%) were discovered to be the elemental chemical composition of bio-oil (on a dry basis). During breakdown, the release of different compounds like hydrocarbons, aldehydes, ketones, acids, and alcohols takes place. According to the GC-MS results, several amino acids were discovered in the bio-oil, 12 abundant in the discarded human hair. The FTIR and thermal analysis found different concluding temperatures and wave numbers for functional groups. Two main stages are partially separated at about 305 °C, with maximum degradation rates at about 293 oC and 400-4140 °C, respectively. The mass loss was 30% at 293 0C and 82% at temperatures above 293 0C. When the temperature reached 4100C, the entire bio-oil from discarded human hair was distilled or thermally decomposed.
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