Probiotics are the living microorganisms that provide health benefits to the recipient. Lactobacillus and Bifidobacterium genera have been used since long for the competitive exclusion of pathogens from the gut. However, their limitations such as sensitivity to gastric acid, temperature, slow growth, and specific stability conditions lead to search for a novel probiotic that is stable through its shelf-life as well as during gastrointestinal transit; hence, offering better efficacy. Bacillus bacteria have strong scientific data which substantiates the validity of the use as preferred probiotics. In recent times, there has been significant progress in scientific evaluation and studies on probiotic Bacillus subtilis, revealing possible mechanisms of action like antimicrobial effect by synthesis of antimicrobial substances, antidiarrheal effect, immunostimulatory effect, competitive exclusion of pathogens, prevention of intestinal inflammation, and normalization of intestinal flora. Numerous preclinical and clinical studies on B. subtilis have shown its promising efficacy in the treatment and prevention of diarrhea of various etiologies. B. subtilis is certified as generally recognized as safe by Food and Drug Administration and features in the European Food Safety Authority Qualified Presumption of Safety, hence suggesting as safe for human use. All of these beneficial attributes make B. subtilis the most attractive probiotic species for various clinical conditions.

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Purpose: Studies have demonstrated the ability of Vitamin C (ascorbic acid) to inhibit pathogenic bacteria and inhibit biofilms. The effect of varying concentrations of ascorbic acid on bacterial growth was studied on uropathogenic Escherichia coli and Klebsiella pneumoniae. The concentration at which maximal inhibition occurred was determined. Methods: All uropathogenic strains of E. coli and K. pneumoniae isolated from patients over a 3-month period were incubated in varying concentrations (5, 10 and 20 mg/ml) of Vitamin C-supplemented Trypticase Soy Broth. Effect on bacterial growth was quantified as a change in absorbance measured by spectrophotometry (450 nm), as compared to controls. Independent samples t-test was used to calculate P value. Results: Bacterial growth was inhibited at all Vitamin C concentrations. Mean absorbances of E. coli and K. pneumoniae broths containing 5, 10, and 20 mg/ml Vitamin C were significantly less than absorbances of growth control broths without Vitamin C (P < 0.005). This inhibition was independent of antimicrobial resistance profiles of isolates. Differences between mean absorbance at 10 and 20 mg/ml Vitamin C for both species were not significant (P > 0.005). Thus, the inhibitory activity of Vitamin C appears to be dose-dependent, with 10 mg/ml being the optimum concentration of ascorbic acid. Conclusions: Ascorbic acid's ability to inhibit bacterial growth may find novel clinical applications. Vitamin C may find potential use in topical antibacterial applications, or urinary bladder irrigation fluid for catheterized patients with urinary tract infections or during bladder instrumentation. There is a need to further explore the possibility of using Vitamin C safely as an effective antimicrobial agent.

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Acinetobacter baumannii, an emerging nosocomial pathogen, is increasingly associated with serious infections among hospitalized patients, especially those on life-support systems. A. baumannii has become resistant to almost all currently available antibacterial agents, including carbapenems, which were once considered the drug of choice for the treatment of infections with multidrug-resistant (MDR) organisms. A. baumannii is notorious in its ability to spread among hospitalized patients and causes outbreaks which have been reported worldwide. The capability of these strains to circulate widely seems to depend on the expression of virulence factors that allow bacterial colonization as well as on the expression of antibiotic resistance. Biofilm production by A. baumannii appears to be one of the major contributing factors in colonization, notably of medical devices. This review explores published literature on the association of biofilms and MDR A. baumannii in hospitalized patients. An online search was made for articles of original work and reviews on biofilms production among Acinetobacter and their association with virulence. The articles were reviewed and results were analyzed based on biofilm production and the factors associated with it, namely biofilm cycle, biofilm-associated protein, chaperone-usher secretion system, and quorum sensing.

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the respiratory coronavirus disease 2019 (COVID-19). Coronaviruses are a large family of enveloped, positive-sense, single-stranded RNA viruses, which infect a broad range of vertebrate animals. The SARS-CoV-2 is spread primarily between people through close contact and through respiratory droplets produced from coughs or sneezes by the infected individuals. After entering into the human body, it enters human cells by binding to the angiotensin-converting enzyme 2 receptors, prominently present in lung, kidney, and gastrointestinal tract. Older people and people of all ages with severe chronic medical conditions such as diabetes, lung disease, and heart disease seem to be at higher risk of developing serious COVID-19 illness. There have been four pandemics caused by the emergence of new influenza viruses in the past century such as H1N1 Spanish flu (1918), H2N2 Asian flu (1957), the H3N2 Hong Kong flu (1968), and the H1N1 Swine flu (2009). Community interventions are important response strategies that can reduce the impact of disease. Widespread transmission of the virus could translate the situation into large numbers of people needing medical care at the same time. Better understanding of the complexity and dynamics of influenza pandemics reduces the further risk effect of such critical situations. Global efforts in tackling the virus at this time are focused all together on lessening the spread and impact of this virus.

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Background: Frail elderly persons, who are characterized by a greater vulnerability to stressing factors, often present with comorbid cardiovascular diseases. Endothelial dysfunction, a pathological process involved in the development of cardiovascular diseases, can be examined noninvasively through the technique of flow-mediated dilation (FMD). We studied a group of hospitalized elderly persons analyzing their endothelial function by FMD aiming to investigate the relationship between their frailty status and endothelial dysfunction. Materials and Methods: Thirty hospitalized elderly patients were evaluated by ultrasound examination of endothelium-dependent vasodilation of the brachial artery. The Study of Osteoporotic Fracture Criteria for Frailty index was used for the definition of frailty status of enrolled cases. Results: Statistical analysis revealed the existence of significant associations between frailty status, ischemic heart disease (P = 0.013 by Chi-square), and cognitive impairment (P = 0.001 by Chi-square). Moreover, frail cases showed lower values of diastolic blood pressure (61 mm Hg vs. 71 mm Hg P< 0.001 by Student's t-test) and a reduced FMD compared to not frail ones (5.45% vs. 10.42%, P= 0.021 by Student's t-test). Conclusions: The identification of reduced FMD in frail elderly may suggest endothelial dysfunction as a pathological “common ground” shared by cardiovascular diseases and frailty. FMD could help clinicians in the management of elderly at risk of developing frailty and cardiovascular disease. In further multicenter studies, FMD could be used to evaluate which early interventions have the potential of preventing the disastrous consequences related to both cardiovascular events and frailty.

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Background: Self-directed learning (SDL) is considered as one of the best teaching tools for adult education, which is considered to be associated with the management of lifelong learning, for better outcomes. In line with the Medical Council of India vision to promote innovations in education, to create lifelong learners, and to encourage creative youngsters, SDL sessions were conducted for the third-semester students in the Department of Microbiology. Materials and Methods: An interventional study was carried out among all 96 Bachelor of Medicine and Bachelor of Surgery students in the third semester, in the academic year 2014, at Pondicherry Institute of Medical Sciences for systematic bacteriology topics by the Department of Microbiology. Didactic lectures and SDL sessions were conducted simultaneously. Both sessions were evaluated by a pretest and posttest using MCQs as assessment tool. Students' feedback was also collected. Results: Out of 96 third-semester students participated in the study, 36 were males and 60 were females. Results of pre- and post-test scores for both sessions were analyzed, which showed an increase in the mean score of 2.70 in the didactic lectures group, as against 2.09 in the SDL group. Anonymous feedback from students revealed that SDL classes were interesting, helped in better understanding of the topics, stimulated reasoning, and helped in active learning process. Conclusion: SDL strategies were found to be effective in stimulating thinking and understanding of the topics and to enhance the cognitive skills among the learners.

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Background: Preeclampsia (PE) is a pregnancy specific syndrome characterized by hypertension and proteinuria after 20 weeks of gestation. There is inadequate placentation due to a deficiency in trophoblastic invasion which causes placental hypoxia leading to pro-inflammatory cytokine secretion, neutrophil activation, and endothelial dysfunction. Material and Methods: This prospective case–control study was carried out over a period of 1 year after informed consent and ethical clearance. Total 543 pregnant women were recruited and 43 women were lost to follow up, so 500 pregnant women followed upto 6 weeks after delivery. Out of these 51 women developed hypertensive disorders of pregnancy. 1 subject excluded during analysis since she developed Eclampsia. Thus study comprised of total 50 cases [Group 1(nonsevere PE)-34 cases and Group 2 (severe PE)-16 cases] and 51 healthy pregnant women who were controls. 5 ml venous blood samples were obtained from all the cases and controls. Samples were collected 2 times; first during the enrollment and second sample was collected after the development of disease. Neutrophil, and lymphocyte levels were measured by Medonic M 20, automated cell counter which gives the reading of cell counts, when microlitres of blood pass through it, NL ratio was obtained after reading. Results: Those women who developed PE during follow-up (Groups 1 and 2) had higher neutrophil to lymphocyte ratio (NLR) than that of the healthy pregnant women even at early gestation. The receiver operating curve showed significant diagnostic accuracy of NLR between controls and nonsevere PE (NSPE) cases (area under the curve [AUC] = 0.75, P = 0.01) at cutoff value of >3.35%, 52.9% sensitivity, and 74.5% specificity. It also showed significant diagnostic accuracy (AUC = 0.894, P = 0.005) between NSPE and severe PE, at a cutoff value of 3.42 with a sensitivity of 81.3% and specificity of 64.7%. Conclusion: NLR is a promising marker for the prediction of PE and in the detection of severe PE too.

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Mental health has been long neglected. Even though it causes substantial loss of disability-adjusted life years, it does not receive proportionate funding. India spends <2% of its annual health budget on mental health. India has been witnessing a great push for mental health. A number of policy-level reforms have been undertaken, and efforts are on to tackle this issue in a better way. In this study, we have reviewed various factors contributing towards policy, implementation, and utilization gaps based on published studies and Mental Health Survey reports and suggested ways to address these. Bottleneck analysis reveals that interventions to improve mental health scenario extend beyond the ambit of the National Mental Health Policy and requires strong policy negotiations and reforms to resuscitate the dying public health-care system of India.

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Background: As malaria is still an important life-threatening infection in many tropical countries and drug resistance has become increasingly common to drugs used nowadays, there is a pressing need to find more drugs that may contribute to the reduction of malaria in the future. This calls for an inward look into harnessing the full potential of medicinal plants that abound around us. Objective: To evaluate the antiplasmodial activity of aqueous leaf and root extracts of Cymbopogon citratus against Plasmodium berghei in mice. Materials and Methods: Cymbopogon citratus extracts of 200, 400, 800 mg/kg, and 5 mg/kg of chloroquine were used. Antiplasmodial activity of the extracts was evaluated using 4-day suppressive test model. Results: The extracts exhibited significant (P < 0.05) antiplasmodial activity in all the experimental doses used. The aqueous leaf extract produced a percentage suppressive effect of 20.83%, 55.56%, and 80.56% while that of the root extract produced a percentage suppression of 50.38%, 77.78%, and 100%. The suppressive effect of the extracts followed a dose-dependent pattern with 800 mg/kg of the aqueous root extract having the highest activity and producing the same 100% suppressive effect as chloroquine. In addition, the extracts had a mild effect on the body temperature of the infected mice; there was a significant increase only on the 2 ^nd day of the study. Conclusion: The results of the study suggested that the aqueous root extract possesses a better antiplasmodial activity than the aqueous leaf extract.

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Elizabethkingia meningoseptica is a nonfermentative Gram-negative bacillus that is ubiquitously found in hospital environments, and it has been associated with various nosocomial infections. Immunocompromised individuals are particularly at increased risk for developing severe infections due to E. meningoseptica, including bacteremia. E. meningoseptica is resistant to multiple antimicrobials commonly used for Gram-negative bacteria. Rapid diagnosis and early institution of appropriate therapy for prolonged period are essential in management of such infections. We report a case of bacteremia due to E. meningoseptica in a neonate who presented with clinical findings suggestive of epidermolysis bullosa. Based on the clinical diagnosis and preliminary blood culture report, baby was started on syrup cefixime, topical fucidin cream along with fluid correction for electrolyte imbalance. As baby's general and systemic status were stable, the baby was discharged with the advice to review after 3 days. Awareness among clinicians along with correct identification by the diagnostic microbiology laboratory is required to reduce the fatal outcome associated with E. meningoseptica infections.

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A 5-year-old girl presented with continuous wetting with normal voiding pattern since birth. Ultrasonography (USG) showed a solitary left kidney. Excretory urography showed a normal left kidney. Right kidney was not seen but lower ureter was faintly delineated. Hence, contrast enhanced computed tomography (CECT) was done to look for any right kidney which was not seen on USG. CT showed a normal left kidney with a small ectopic kidney in right hemipelvis but ureteric orifice could not be traced to its insertion. Dimercaptosuccinic acid confirmed it to be a poorly functioning (6%) ectopic right kidney. Cystourethroscopy and vaginoscopy done could not localize the right ureteric orifice. The child underwent right nephrectomy along with excision of ectopic ureter inserting into vagina with complete resolution of her symptoms.

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Introduction: Antimicrobial mouth rinses as an adjunct to nonsurgical periodontal therapy can play an important role in maintaining oral health. Aim: The aim of this study is to evaluate the antimicrobial effect of Listerine and HiOra^® mouthrinses and compare their efficacy on four specific standard bacterial strains, namely, Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), and Fusobacterium nucleatum (Fn). Settings and Design: Ethical clearance for the study was granted by the Institutional Ethics Committee. Materials and Methods: Aa, Pg, Pi, and Fn were maintained on enriched tryptic soy agar. Listerine and HiOra were tested against these bacterial strains using agar diffusion and broth dilution assay method where minimal inhibitory concentrations (MICs) were defined as the lowest concentration of test agent, either showing no or few bacterial growth colonies and by lack of turbidity, respectively. Distilled water was used as the control group. The tests were run three times for each mouthrinse against each organism. The results obtained were compared by their median values. Results: All the strains showed sensitivity towards both the test solutions. Listerine showed a lower MIC value than HiOra against all the strains, except Fn where the MIC value by broth dilution was 3.12 mcg/ml and by agar method was 90% concentration for both the test solutions. Both the test solutions had antibacterial effect at various concentrations. Conclusion: Listerine, the essential oil-based mouthrinse, was observed to be more potent than the herbal mouthrinse HiOra where both had antimicrobial effect.

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Background: Hospital-acquired infections (HAIs) are a threat to public health and addressing this issue will help to plan appropriate preventive strategies. Full-fledged active HAIs surveillance is the cornerstone in assessing the burden of HAIs. This study was planned to assess the burden of HAIs by implementing a hospital-wide active surveillance system in a large tertiary care teaching hospital in south India and compare findings with those of National Health Safety Network United States (NHSN US) and International Nosocomial Infection Control Consortium (INICC) India HAI rates. Materials and Methods: Active HAIs' surveillance was initiated in 18 Intensive Care Units (ICUs) from January 2015 to September 2016. All patients admitted in the ICUs were followed up by the infection control nurses, and surveillance was done for device-associated infections (DAIs). The cumulative rates of the DAIs and device utilization (DU) rates and surgical site infection (SSI) rates were determined for all the ICUs. These data were compared with corresponding NHSN and INICC India HAI rates. Results: Total number of patient days for the entire study period was 111294, pooled mean ventilator-associated pneumonia rate was 25.00/1000 ventilator days (NHSN US 2.0 and INICC India 9.4); Pooled mean central line-associated blood stream infection rate was 7.2/1000 central line days (NHSN US 1.1 and INICC India 5.1). The pooled mean ICU catheter-associated urinary tract infection rate was 6.1/1000 catheter days (2.1 NHSN US and 2.9 INICC India). The pooled mean SSI rate was found to be 3.5/100 surgeries. The DU rates had a significant positive agreement with the DAI rates. The DAI rates of most of the ICUs were found be to be higher than NHSN US and INICC India rates. Conclusion: There is an increasing need to implement an active surveillance system to detect and monitor the HAI rates which would be vital to implement infection control measures in a proactive manner rather than reactive.

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Background: Asafoetida is used as an antiulcer agent in Iran and Afghanistan. This study was undertaken to determine the healing of ulcers induced by indomethacin (IND) due to the protective role of asafoetida on ulcers in rats. Materials and Methods: Rats were divided into four groups with five rats in each group. One group only received IND as negative control group and other group received normal saline and considered as control group, respectively. Two groups were pretreated by asafoetida (25 and 50 mg/kg) by oral gavage for 4 days, and after this time, rats were kept fasted for 12 h and received IND at 48 mg/kg orally. Four hour later, animals were killed and their stomach and liver were fixed in formalin (10%) and sections of 5 μm in diameter were prepared. Histological and morphological characteristics of stomach and liver were assessed using hematoxylin and eosin (H and E) staining. Results: Treatment groups with asafoetida (25 and 50 mg/kg) showed significant (P < 0.05) reduction in microscopic and macroscopic ulcer index as compared to the IND control group. Asafoetida promotes ulcer protection as ascertained histologically by comparatively decrease in ulcer areas, reduction or absence of edema and leukocytes infiltration of submucosal layer compared to IND control group. The results also indicated that asafoetida has a protective effect on liver tissues. In general, ameliorative effects of asafoetida in animals treated at 50 mg/kg were better than dose of 25 mg/kg, respectively. Conclusions: Data indicates that asafoetida has anti-ulcer and hepatoprotective activity that these beneficial effects may be or mainly related to anticholinergic antihistaminergic and antioxidant effects.

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Traumatic or irritation fibroma is the healed end product of the inflammatory hyperplastic lesion which can occur at any age from almost any soft-tissue site, tongue, gingiva, and buccal mucosa being the most common. The aim of this case report is to present the clinical features and management of the benign lesion which was posteriorly positioned in the interdental papillary region of mandibular premolars. A female patient, 40 years old, reported to the department with a chief complaint of pain and swelling in the right lower back tooth region for the past 1 year. On examination, the lesion was found to be a well circumscribed, smooth, tender, firm and lobulated pink swelling measuring 2 cm × 2 cm in its greatest diameter in relation to right mandibular premolar region. Surgical therapy was carried out for the management of the same. There was no recurrence reported at the end of 2 months showing that treatment with electrocautery was highly effective as it was a relatively simple and safe method with easy handling of the electrodes without any bleeding or scarring. Irritation fibroma clinically resembles as pyogenic granuloma, peripheral giant cell granuloma, or odontogenic tumors, so radiographic and histopathological examination is essential for accurate diagnosis. Furthermore, complete excision is the choice of treatment as recurrence has been associated with incomplete removal of the lesion.

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Background: Bloodstream infections remain a major cause of mortality and morbidity. Respiratory tract, genitourinary tract, and intra-abdominal foci are often the common identifiable foci of these infections. Definitive treatment based on blood cultures and susceptibility is essential to treat sepsis cases for better outcome. This study was conducted to document the bacteriological profile, their susceptibility pattern, antibiotics used for empiric and definitive treatment, escalation or de-escalation of antibiotics done following antibiogram report. Materials and Methods: descriptive study was carried out for a period of 1 year after obtaining waiver of consent from Institute Ethics Committee. Demographic details, length of hospital stay, risk factors, bacteriological profile with antimicrobial resistance pattern, empiric antibiotic and definitive antibiotic given and outcome of patient were recorded. Statistical analysis was done by using IBM SPSS version 16.0 (SPSS Inc., Chicago, IL, USA) software. Results: Overall prevalence of sepsis was 9.5%. Gram-negative bacteria were more commonly isolated (62.8%) than Gram-positive bacteria (37.2%), and Escherichia coli was the most common isolate (24.3%). Antimicrobial resistance among Gram-negative bacterial isolates was maximum with ciprofloxacin (51.3%) and ceftriaxone (45.2%), and least with amikacin, imipenem (16.7%), and polymyxin B (2.6%). Penicillin group of antibiotics were commonly used for empiric treatment, and glycopeptides/polymyxins and carbapenems were most preferred for definitive treatment. Conclusion: Knowledge about prevalence, risk factors, bacteriological profile, and their antibiogram resistance pattern is essential to select the antibiotic for the empiric treatment of suspected cases of sepsis and to formulate antibiotic policy. It is also important to de-escalate/escalate antibiotics according to the susceptibility report for a better outcome and to shorten the period of morbidity.

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Background: Needlestick, sharp, and splash injuries (NSSSIs) are the major occupational hazards among the healthcare workers (HCWs) for blood-borne viruses (BBVs) such as hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). This study was designed to determine the impact of an established nodal center for NSSSI management and to analyze the epidemiological characteristics. Materials and Methods: Dedicated nodal center was established for NSSSI documentation. A standard operating protocol was set for NSSSI management and postexposure prophylaxis (PEP) for BBVs. The epidemiological characteristics of NSSSIs were collected using a structured pro forma. Results: Between December 2014 and November 2016, 452 NSSSIs were reported, which included 411 (90.9%) needlestick and other sharp injuries and 41 (9.1%) splash injuries. Doctors reported the maximum episodes (32.5%), followed by attenders (28.8%) and nurses (21.9%). Most injuries were contracted during device use (44.8%), followed by after withdrawal before disposing (28.5%) and recapping (14.8%). Increased reporting was observed among newly-joined junior doctors. 6.9% of source was positive for BBVs (1.8% HIV; 4.0% HBV; 1.1% HCV). PEP first dose was taken by 30.5% of HCWs. PEP continuation was indicated in 161 cases but could not be traced. 40.9% HCWs were completely vaccinated for HBV (of which 49.2% are protected), 7.1% were partially, and 52.0% were not vaccinated. Conclusion: Our findings endorse the essential role of an established nodal center for NSSSI documentation. Continuous education, engineering control, vaccination campaign, and other interventional strategies such as biomedical waste auditing are crucial measures which should be taken to tackle this issue.

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Progressive inflammatory periodontal disease, if left untreated, it will ultimately result in attachment loss. This can affect the bifurcation or trifurcation of multirooted teeth. Dentists are challenged to save those teeth that earlier would have been extracted without a second thought to save it. Hence, resective therapy has been utilized in the treatment of furcation defects. Hemisection is a removal of compromised root and the associated crown portion. It is one of the treatment options for preserving remaining part of molar having sound periodontium. This case report presents a patient in whom distal half of the carious and periodontally compromised tooth was resected, and after healing, fixed dental prosthesis was given to restore proper form and function.

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Loss of a single anterior tooth causes a major functional and aesthetic concern to the patient. There are different treatment options available for replacing a missing incisor. If the economic status of the patient permits, it is the responsibility of the clinician to explain the benefits of dental implant to replace a single missing tooth. This case report describes the replacement of a missing maxillary left central incisor tooth of a patient with dental implants for better function and esthtics.

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This manuscript briefly describes the concept and terminologies related to survival analysis, characteristics, need, data mechanism, functions, and application in health sciences along with different estimation procedure.

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The infectious etiology of periodontitis is complex. Due to its high prevalence rate, this disease has created an interest in finding a solution in the form of vaccines. Vaccination is the best known and the most important application of immunological principles to human health. The complexity of the periodontopathic bacteria might be a problem in the determination of antigens, thus complicating the development of periodontal vaccine. An attempt to review the literature on periodontal vaccine, including active immunization: Whole bacterial cells, sub-unit vaccines, synthetic peptides as antigens; passive immunization: Murine monoclonal antibodies and plantibodies; and genetic immunization: Plasmid vaccines, live, viral vector vaccines, has been done in this study.

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In the quest for safer and effective anesthesia and analgesia, local anesthetics such as levobupivacaine or ropivacaine have been introduced into the clinical practice. Several studies have been done to assess their efficacy and relative superiority to bupivacaine. The aim of this review is to provide the recent and comprehensive updates regarding the clinical and pharmacological utility of levobupivacaine. Using Google search for indexing databases, a search for articles published was performed using various combinations of the following search terms: (a) Pharmacology; (b) clinical; (c) profile; (d) levobupivacaine; (e) local anesthetic; (f) recent. Additional sources were also identified by exploring the primary reference list.

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