Protective Face Masks: Effect on the Oxygenation and Heart Rate Status of Oral Surgeons during Surgery

Objective and subjective evaluation of the use of protective clothing on the thermal strain and mental workload of nurses during the Covid-19 pandemic

BACKGROUND

Nurses are among high-risk occupational groups during the outbreak of epidemics. Therefore, these people are required to use personal protective equipment (PPE). Previous studies have shown that the use of personal protective equipment can affect people's thermal strain and mental workload.

OBJECTIVE

The present study was conducted with the aim of objectively and subjectively evaluating the use of protective clothing on the thermal strain and mental workload of nurses during the covid-19 pandemic.

METHODS

This cross-sectional study was divided into two groups with a sample size of 300 people who were selected by systematic random method. In the first group, 120 people were objectively evaluated (use of protective clothing). In the second group, 180 people only completed the questionnaire of mental workload, feeling of heat and sweating and other information related to the type of clothing and the duration of its use, etc. Measurements were done in August and September of 2021 and in the morning shift of hospitals. Data were analyzed using SPSS version 21 software and chi-square, independent T-test and linear regression tests.

RESULTS

The average age and average working hours per month of the participants in the study were 33.51±7.88 years, 187.91±35.37 hours, respectively. The results showed that the predicted average vote (PMV) index and the predicted percentage of dissatisfied (PPD), moisture felt on the skin surface, the feeling of desirability and pleasantness of the temperature, the weight of sweat and the humidity inside the clothes between the two groups of people using insulated clothes There is a significant difference between medicine and dressing (P < 0.05). There was a significant relationship between mental workload and type of clothing, average working hours per month.

CONCLUSIONS

The use of medical isolation clothes causes a high heat load on nurses and can increase their mental workload. On the other hand, people using normal gowns suffer from a high mental workload due to the fear of disease due to the uncertainty of high-level protection. In addition, medical isolation clothes increase the humidity of the skin due to their impermeability, which causes skin complications.

Impact of Concurrent Use of N95 and Surgical Masks on Peripheral Oxygen Saturation and Heart Rate Frequency-A Prospective Study during the COVID-19 Outbreak

Background and Objectives: The COVID-19 outbreak has necessitated the prolonged use of N95 facemasks in addition to traditional surgical facemasks by healthcare workers. The aim of this study was to investigate the effect of wearing N95 facemasks in addition to surgical facemasks on peripheral oxygen saturation (SpO2) and heart rate (HR) among dental professionals during routine care. Materials and Methods: This prospective study compared SpO2 and HR between dental providers wearing N95 + surgical facemasks vs. wearing a surgical facemask only. SpO2 and HR were recorded using a portable pulse oximeter before wearing the facemask (T0); at 30 min (T1); at 1 h (T2); and at the end of clinical activity (T3). Inter-group and intra-group differences were assessed with independent t tests and repeated measures ANOVA, respectively. Results: A total of 88 participants (57 wearing N95 + surgical facemasks, and 31 wearing a surgical facemask only) completed the study. The two groups did not statistically differ in SpO2 at different timepoints nor showed any intra-group differences. The participants wearing N95 + surgical facemasks exhibited a statistically higher HR at T0 (p = 0.007), T2 (p = 0.010), and T3 (p = 0.014) compared to those wearing a surgical facemask only. A statistically significant decrease was observed in HR between T0 and T3 in those wearing N95 + surgical facemasks (p = 0.012). No intra-group differences were seen in HR over time in those wearing a surgical facemask only. Conclusions: The continuous use of an N95 in addition to a surgical facemask did not show any significant effects in SpO2 during routine care; however, the concurrent use of an N95 and a surgical facemask seemed to be accompanied by a decrease in HR, although the values remained within the normal range.

Analyzing neural activity under prolonged mask usage through EEG

In recent COVID times, mask has been a compulsion at workplaces and institutes as a preventive measure against multiple viral diseases including coronavirus (COVID-19) disease. However, the effects of prolonged mask-wearing on humans' neural activity are not well known. This paper is to investigate the effect of prolonged mask usage on the human brain through electroencephalogram (EEG), which acquires neural activity and translates it into comprehensible electrical signals. The performances of 10 human subjects with and without mask were assessed on a random patterned alphabet game. Besides EEG, physiological parameters of oxygen saturation, heart rate, blood pressure, and body temperature were recorded. Spectral and statistical analysis were performed on the recorded entities along with linear discriminant analysis (LDA) on extracted spectral features. The mean EEG spectral power in alpha, beta, and gamma sub-bands of the subjects with mask was smaller than the subjects without mask. The performances on the task and the oxygen saturation level between the two groups differed significantly (p < 0.05). Whereas, the blood pressure, body temperature, and heart rate of both groups were similar. Based on the LDA analysis, the occipital and frontal lobes exhibited the greatest variability in channel measurements, with O1 and O2 channels in the occipital lobe demonstrating significant variations within the alpha band due to visual focus, while the F3, AF3, and F7 channels were found to be differentiating within the beta and gamma frequency bands due to the cognitive stimulating tasks. All other channels were observed to be non-discriminatory.

COVID-19 on Oral Health: A New Bilateral Connection for the Pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and transmission are generally known to be produced by respiratory droplets and aerosols from the oral cavity (O.C.) of infected subjects, as stated by the World Health Organization. Saliva also retains the viral particles and aids in the spread of COVID-19. Angiotensin-converting enzyme Type 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) are two of the numerous factors that promote SARS-CoV-2 infection, expressed by O.C. structures, various mucosa types, and the epithelia of salivary glands. A systemic SARS-CoV-2 infection might result from viral replication in O.C. cells. On the other hand, cellular damage of different subtypes in the O.C. might be associated with various clinical signs and symptoms. Factors interfering with SARS-CoV-2 infection potential might represent fertile ground for possible local pharmacotherapeutic interventions, which may confine SARS-CoV-2 virus entry and transmission in the O.C., finally representing a way to reduce COVID-19 incidence and severity.

Ozone Therapy as an Adjuvant in the Treatment of Periodontitis

The current study aimed to assess the efficacy of ozone therapy in the treatment of stage II and stage III periodontitis. This prospective split-mouth study selected patients who were diagnosed with either stage II or stage III periodontitis. All patients were treated with scaling and root-planing (SRP) on the control side and SRP with ozone therapy on the test side. Probing depth (PD), clinical attachment loss (CAL), O'Leary plaque index (PI), and bleeding on probing (BOP) scores were recorded at baseline and six weeks after the SRP treatment. A total of 46 patients were selected for this study, including 31 males and 15 females. All periodontal variables (PD, CAL, PI, and BOP) showed significant changes (p < 0.0001) from baseline to six weeks. Moreover, significant changes (PD = 0.0001, CAL = 0.0001, PI = 0.042 and BOP = 0.0001) were also observed between the control and test sides. Gender showed no significance on periodontal variables (p > 0.05) except PD on the test side (p = 0.030). In addition, periodontal stages and grades showed no significant changes (p > 0.05) in any periodontal variables on both sides. Ozone therapy significantly improves the periodontal condition compared to SRP treatment alone. However, the stages and grades of periodontitis do not influence the outcome of ozone therapy.

Personalized Nasal Protective Devices: Importance and Perspectives

Nowadays, in addition to diseases caused by environmental pollution, the importance of personalized protection against various infectious agents has become of paramount importance. Besides medicine, several technical and technological studies have been carried out to develop suitable devices. One such revolutionary solution is the use of personalized nasal filters, which allow our body to defend itself more effectively against external environmental damage and pathogens. These filters are small devices that are placed in the nose and specifically filter the inhaled environmental contaminants, allergens, and microorganisms according to individual needs. These devices not only play a key role in maintaining our health but also contribute to environmental protection, reducing the inhalation of pollutants and their harmful impact on the natural environment. Another advantage of personalized filters is that they also provide an opportunity to strengthen our individual immune systems. The use of personalized filters allows medicine to provide optimized protection for everyone, focusing on individual genetic and immunological conditions. The momentum behind the development and research of personalized nasal filters has reached astonishing proportions today. Nowadays, many research groups and medical institutions are working to create new materials, nanotechnologies, and bioinformatics solutions in order to create even more effective personalized nasal filters that can also be shaped easily and safely. Considering the needs of the users is at least as important during development as the efficiency of the device. These two properties together determine the success of the product. Industry research focuses not only on improving the efficiency of devices, but also on making them more responsive to user needs, comfort, and portability. Based on all this, it can be concluded that personalized nasal filters can be a promising and innovative solution for protection against environmental pollutants and pathogens. Through a commitment to the research and development of technology, the long-term impact of such devices on our health and the environment can be significant, contributing to improving people's quality of life and creating a sustainable future. With unique solutions and continuous research, we give hope that in the future, despite the environmental challenges, we can enjoy the protection of our health with even more efficient and sophisticated devices.

Correlation between use of different type protective facemasks and the oral ecosystem

BACKGROUND

Spread worldwide through droplets, the Virus Sars-Cov-19 has caused a global health emergency alarm. In order to limit its spread, the use of masks has become part of the daily life of the entire population, however, little is known about its constant use and the changes generated in the oral cavity. This work aims to investigate correlations between the continuous use of masks covering the nose and mouth for 3 h and changes in the ecological factors of the oral cavity.

METHODS

34 volunteers were divided into 2 groups: wear only the filtering facepiece code 2 (FFP2) mask (Group A) and wear the FFP2 mask covered by a surgical mask (Group B). Measurement of Volatile Organic Compounds (VOCs), saliva rehydration and consistency test, collection of basal saliva and saliva stimulated with paraffin gum and mucosal swab were collected and analyzed at two times: before using the mask(s) (T0) and 3 h after continuous use of the mask(s) (T1).

RESULTS

The results indicated a significant difference between the groups, in which the basal saliva volume and pH and the peaks of VOCs increased for group B between T0 and T1. The rehydration time decreased and the volume and pH of the stimulated saliva increased, but with no significant difference between the groups. Furthermore, group B showed a significant decrease in Candida albicans Colony Forming Units (CFUs) and Total Bacterial Count (TBC) between T0 and T1.

CONCLUSION

It is concluded that the prolonged use of the FFP2 mask covered by a surgical mask can generate oral alterations in the user.

Clinical Hematochemical Parameters in Differential Diagnosis between Pediatric SARS-CoV-2 and Influenza Virus Infection: An Automated Machine Learning Approach

BACKGROUND

The influenza virus and the novel beta coronavirus (SARS-CoV-2) have similar transmission characteristics, and it is very difficult to distinguish them clinically. With the development of information technologies, novel opportunities have arisen for the application of intelligent software systems in disease diagnosis and patient triage.

METHODS

A cross-sectional study was conducted on 268 infants: 133 infants with a SARS-CoV-2 infection and 135 infants with an influenza virus infection. In total, 10 hematochemical variables were used to construct an automated machine learning model.

RESULTS

An accuracy range from 53.8% to 60.7% was obtained by applying support vector machine, random forest, k-nearest neighbors, logistic regression, and neural network models. Alternatively, an automated model convincingly outperformed other models with an accuracy of 98.4%. The proposed automated algorithm recommended a random tree model, a randomization-based ensemble method, as the most appropriate for the given dataset.

CONCLUSIONS

The application of automated machine learning in clinical practice can contribute to more objective, accurate, and rapid diagnosis of SARS-CoV-2 and influenza virus infections in children.

Does the COVID-19 personal protective equipment impair the surgeon's performance?

INTRODUCTION

Despite increasing vaccination rates, new viral variants of SARS-CoV-2 (severe acute respiratory syndrome coronavirus type 2) are advancing the COVID 19 (coronavirus disease 2019) pandemic and continue to challenge the entire world. Surgical care of SARS-CoV-2 positive patients requires special protective measures. We hypothesized that "COVID-19" personal protective equipment (PPE) during surgery of SARS-CoV-2 positive or potentially positive patients would negatively affect the surgeon and thus the surgical outcome.

MATERIALS AND METHODS

Ten experienced trauma surgeons participated in the study. Each surgeon performed two simulated surgeries of a distal tibial fracture on a Sawbone® under standardized conditions either wearing regular PPE or special COVID-19 PPE. Baseline values at rest were acquired for heart rate, blood pressure, saturation of peripheral oxygen (SpO₂), respiratory rate and capillary blood gas (CBG) analysis including capillary partial pressure of oxygen (pO₂) and carbon dioxide (pCO₂), followed by four different standardized tests of attentional performance (TAP). Subsequently, the surgeon performed the first surgery according to a randomly determined order, with regular or COVID-19 PPE conditions in an operation theatre. After each surgery vital signs were acquired and CBG and TAP were performed again.

RESULTS

In our simulated surgical procedure heart rate, respiratory rate, systolic and diastolic blood pressure did not show relevant differences. Percutaneously measured SpO₂ decreased with additional layers of PPE, while CBG parameters were not affected. TAP tests showed a significant impairment of attention if PPEs were compared to the baseline, but both PPEs had similar results and no meaningful differences could be measured.

CONCLUSIONS

According to our results, for surgical procedures additional PPE required during COVID-19 pandemic does not relevant affect the surgeon's mental and physical performance. Surgeries under COVID-19 PPE conditions appear safe and do not increase patient risk.

LEVEL OF EVIDENCE

Level I.

Evaluation of respiratory function in healthcare workers wearing face masks during the COVID-19 pandemic

BACKGROUND

The COVID pandemic, which has caused high mortality rates worldwide, has mainly affected the working environment of healthcare workers. Metabolic and respiratory changes occur in healthcare workers working with surgical masks.

OBJECTIVE

Our aim is to identify the metabolic and respiratory problems faced by healthcare personnel working with surgical masks and to produce solutions to minimize them.

METHODS

The study was conducted among emergency service workers who used surgical masks for at least 8 h in the emergency room between June 2020 and July 2020. Venous blood gas samples were taken from the health personnel participating in the study and their vital signs were checked.

RESULT

A total of 60 healthcare professionals with a mean age of 28.20 ± 6.30 years were included in the study. The distribution of men and women in the study was balanced with 30 (50.0%) men and 30 (50.0%) women. When the first and last vital signs (blood pressure, pulse, saturation) of the health workers participating in the study were examined, no statistically significant differences were found (p > 0.05). While there was no statistically significant difference in the Na, Chlorine, Ca values of metabolic indicators (p > 0.05), the first measurements of K (0.017) and Lactate (0.037) values were found to be higher than the last measurements (p > 0.05). The first measurements of the respiratory parameters pH (0.002), pCO2 (0.028), sO2 (0.045) and pO2 (0.048) were lower than the last measurements (p > 0.05). The first measurement value of pCO2 (0.028) was found to be higher than the last (p > 0.05).

CONCLUSIONS

Regular and long-term use of surgical masks does not harm the body metabolically and respiratorily.

Impact of Post-Covid-19 on driver behaviour: A perspective towards pandemic-sustained transportation

Introduction

With the announcement of novel Coronavirus disease 2019 (Covid-19) as a pandemic by World Health Organization (WHO) in March 2020, the whole world went into a lockdown that heavily affected human economic and social life. Since December 2020, with the discovery of effective vaccines, the world is now returning to some normality, particularly for those who are vaccinated. The multimodal transportation has resumed with majority of vaccinated drivers being back on road, driving to their work, and providing transport services. However, there are still several long-term Post-Covid-19 factors, affecting driver health and psychology.

Methods

The study deployed a systematic search strategy and selected 62 research publications after rigorous evaluation of the literature. The review was based on (1) forming the inclusion and exclusion criteria, (2) selecting the appropriate keywords, and (3) searching of relevant publications and assessing the eligible articles.

Results

A broad perspective study is carried out to gauge the impact of Post-Covid-19 scenarios on the driver physical health and mindset in the context of road safety and pandemic-sustained transportation. It was found that the Post-Covid-19 factors such as wearing face-mask during driving, taking oral anti-viral drugs, and fear of contracting disease, significantly impact the driver's performance and situation awareness skills. The analysis suggested that driver's health vitals and psychological driving awareness can be precisely detected through hybrid driver state monitoring methods.

Conclusions

The paper conducts a comprehensive review of the published work and provides unique research opportunities to counteract the challenges involved in precise monitoring of driver behaviour under the effects of different Post-Covid-19 factors. The perspective suggested the possible solutions to live with the pandemic in the context of pandemic-sustained transportation.

Personal protective equipment-associated headaches in health care workers during COVID-19: A systematic review and meta-analysis

Introduction

Health Care Workers (HCWs) use Personal Protective Equipment (PPE) during the COVID-19 pandemic to protect themselves and prevent the transmission of the disease. The use of PPE, especially respiratory masks, has adverse consequences, including headaches, which have been secondary and unusual. The aim of the present systematic review and meta-analysis study was to investigate the prevalence of PPE-associated headaches in HCWs during COVID-19 pandemic.

Methods

The present review study was performed based on the PRISMA guideline. The protocol of the present study was registered in PROSPERO with the code CRD42022304437. Valid data resources such as Scopus, PubMed, Web of Science, Science Direct, Google Scholar, Embase were used to identify and extract relevant studies. The searches were conducted between the beginning of 2020 and the end of January 2022. A random effects model was used for meta-analysis and I ² index was used to investigate between-study heterogeneity. Data were analyzed using STATA ver. 14.

Results

A total of 539 articles were first identified through initial search and finally 26 final studies were selected to undergo the meta-analysis phase. According to the results of meta-analysis, the prevalence of headache after and before the use of PPE was 48.27% (95% CI: 40.20-56.34, I ² = 99.3%, p = 0 < 001) and 30.47% (95% CI: 20.47-40.47, I ² = 97.3%, p = 0 < 001), respectively.

Conclusion

The results of the present study showed that the prevalence of PPE-associated headache in HCWs was relatively high, so, the use of PPE during COVID-19 pandemic can be considered as one of the causes of headache. Therefore, management strategies such as regular screening of HCWs for headaches and regular rest periods without the use of PPE can be effective in reducing the prevalence of headaches.

Antispike Immunoglobulin-G (IgG) Titer Response of SARS-CoV-2 mRNA-Vaccine (BNT162b2): A Monitoring Study on Healthcare Workers

The secretion of IgG SARS-CoV-2 antispike antibodies after vaccination with BNT162b2 and the protection represent the response of the human organism to the viral vector symptomatic infections. The aim of the present investigation was to evaluate the immune reaction in health workers of the Polyclinic of Bari to identify the relationship of antispike titers with blood type, sex, age, and comorbidities. This prospective observational study (RENAISSANCE) had as its primary endpoint the assessment of serologic response to BNT162b2 at three blood titers: the first at 60 days after the second dose (3 February 2021); the second titer at 75 days after the first titer; and the third titer at 130 days after the second titer. Out of 230 enrolled staff members, all responded excellently to the mRna Pfizer (BNT162b) vaccine. Only one patient, 40 days after the second dose (3 February 2021), was positive on the swab control performed on 15 March 2021, although completely asymptomatic, and was negative on the subsequent molecular swab performed on 30 March 2021. All the patients responded to the mRNA Pfizer (BNT162b) vaccine with an antispike IgG level above 500 BAU/mL at the first antispike protein essay (60 days after the second dose on 3 April 2021); at the second titer (75 days after the first titer on 20 June 2021), 4 (1.7% of 230 enrolled) patients showed an antispike IgG level under 500 BAU/mL; at the third titer (130 days after the second titer on 30 June 2021, which means 9 months after the second dose), 37 (16.1% of 230 enrolled) patients showed an antispike IgG level under 500 BAU/mL. The data analysis demonstrated that patients belonging to blood group 0, regardless of their rhesus factor, showed the strongest level of antibodies compared to the other groups. No dependency was found between low antibodies level and sex or age. Molecular swab controls were performed every 15th of the month continuously. However, the enrolled patients' activity was at high risk because they carried out medical activities such as dental and surgical as well with droplets of water vaporized by the effect of turbines, piezosurgery. The vaccination campaign among health workers of the Policlinico of the University of Bari "Aldo Moro" led to an excellent serological response and the complete absence of COVID-19 incident cases, so the antibody response was excellent. The COVID-19 vaccine booster shot should be administered after 9 months and not without prompt antispike titer detection to assess if any sign of waning immunity is present in that specific patient.

The Physiological Effects of Face Masks During Exercise Worn Due to COVID-19: A Systematic Review

CONTEXT

Use of face masks in sport has been a particularly complex issue during the COVID-19 pandemic.

OBJECTIVES

A systematic review to examine the physiological effects the different types of masks have on healthy adults when doing physical exercise.

DATA SOURCES

PubMed, SPORTDiscus, Scopus, and Litcovid were searched up to March 20, 2021, following the PRISMA model. Articles published in the last 5 years with healthy adults.

STUDY SELECTION

A total of 633 studies related to the use of masks during physical exercise were found, of which 8 articles met the criteria to be included.

STUDY DESIGN

Systematic review.

LEVEL OF EVIDENCE

Level 2.

DATA EXTRACTION

The search process and the review of the articles were carried out by independent expert researchers. The risk of bias and the methodological quality of the different studies included in the systematic review were calculated following the Cochrane criteria using an adaptation for random cross-studies. Once the information was properly structured, the results were extracted, and the findings of the study analyzed.

RESULTS

There were significant changes in the following physiological variables when engaging in physical exercise using masks: 25% in the heart rate and dyspnea, 37.5% in the rating of perceived exertion, 50% in the pulmonary variables, and 37.5% in discomfort. The oxygen saturation, blood pressure, systolic blood pressure, diastolic blood pressure, and the concentration of blood lactate did not present any significant effect in this study.

CONCLUSION

The usage of masks by a healthy adult population during the performance of physical exercise has shown minimal effects with regard to physiological, cardiorespiratory, and perceived responses. Some symptoms can be dyspnea, effort perceived, or discomfort, among others. These findings indicate that the use of masks is not harmful to individuals' health. It does not present any significant detrimental effect on physical performance or risk to their well-being. However, further experiments are required to corroborate the findings of this review.

The Effect of Face Masks on Physiological Data and the Classification of Rehabilitation Walking

Gait analysis and the assessment of rehabilitation exercises are important processes that occur during fitness level monitoring and the treatment of neurological disorders. This paper presents the possibility of using oximetric, heart rate (HR), accelerometric, and global navigation satellite systems (GNSSs) to analyse signals recorded during uphill and downhill walking without and with a face mask to find its influence on physiological functions during selected walking patterns. The experimental dataset includes 86 signal segments acquired under different conditions. The proposed methodology is based on signal analysis in both the time and frequency domains. The results indicate that face mask use has a minimal effect on blood oxygen concentration and heart rate, with the average mean changes of these parameters being less than 2%. The support vector machine, a Bayesian method, the k -nearest neighbour method, and a two-layer neural network showed very good separation abilities and successfully classified different walking patterns only in the case when the effect of face mask wearing was not included in the classification process. Our methodology suggests that artificial intelligence and machine learning tools are efficient methods for the assessment of motion patterns in different motion conditions and that face masks have a negligible effect for short-duration experiments.

Effectiveness of SARS-CoV-2 Vaccines for Short- and Long-Term Immunity: A General Overview for the Pandemic Contrast

BACKGROUND

The recent COVID-19 pandemic produced a significant increase in cases and an emergency state was induced worldwide. The current knowledge about the COVID-19 disease concerning diagnoses, patient tracking, the treatment protocol, and vaccines provides a consistent contribution for the primary prevention of the viral infection and decreasing the severity of the SARS-CoV-2 disease. The aim of the present investigation was to produce a general overview about the current findings for the COVID-19 disease, SARS-CoV-2 interaction mechanisms with the host, therapies and vaccines' immunization findings.

METHODS

A literature overview was produced in order to evaluate the state-of-art in SARS-CoV-2 diagnoses, prognoses, therapies, and prevention.

RESULTS

Concerning to the interaction mechanisms with the host, the virus binds to target with its Spike proteins on its surface and uses it as an anchor. The Spike protein targets the ACE2 cell receptor and enters into the cells by using a special enzyme (TMPRSS2). Once the virion is quietly accommodated, it releases its RNA. Proteins and RNA are used in the Golgi apparatus to produce more viruses that are released. Concerning the therapies, different protocols have been developed in observance of the disease severity and comorbidity with a consistent reduction in the mortality rate. Currently, different vaccines are currently in phase IV but a remarkable difference in efficiency has been detected concerning the more recent SARS-CoV-2 variants.

CONCLUSIONS

Among the many questions in this pandemic state, the one that recurs most is knowing why some people become more seriously ill than others who instead contract the infection as if it was a trivial flu. More studies are necessary to investigate the efficiency of the treatment protocols and vaccines for the more recent detected SARS-CoV-2 variant.

Early Response and Clinical Efficacy of a Mouthwash Containing Chlorhexidine, Anti Discoloration System, Polyvinylpyrrolidone/Vinyl Acetate and Sodium DNA in Periodontitis Model: A Triple-Blind Randomized Controlled Clinical Trial

Polyvinylpyrrolidone/vinyl acetate (PVP/VA) is a molecule with increased adhesion capacity, and can be associated in the bacterial plaque control with sodium DNA, a natural anti-aging molecule able to improve gingival trophism. The aim of the study is to test at two weeks the antimicrobial and antiplaque properties, subjects affected by chronic periodontitis, showed by a mouthwash containing Chlorhexidine (CHX) 0.2% with Anti Discoloration System (ADS), PVP-VA, and Sodium DNA in comparison with a placebo mouthwash. A single center randomized controlled trial was conducted on a total of fifty-four (54) subjects. In the test Group (n = 27) patients were treated by a 0.2% Chlorhexidine (CHX) mouthwash with ADS, PVP-VA, and Sodium DNA, while a placebo mouthwash was used in the control Group (B). The full mouth plaque score (FMPS), full mouth bleeding score (FMBS), and gingival index (GI) were assessed at baseline, and at 1 and 2 weeks after treatment. FMPS score recorded at baseline (V2) was 52.7 ± 9.2 in the Group Test and 58.2 ± 6.1 in the Group Control (p > 0.05). After 1 week (V3), FMPS was 13.3 ± 5.6 in the Group Test and 18.7 ± 4.3 in the Group Control (p < 0.05), while at V4 (2 weeks), FMPS was 14.2 ± 4.1 in the Group Test and 20.3 ± 5.2 in the Group Control (p < 0.05). FMBS score recorded at baseline (V2) was 46.7 ± 8.7 in the Group Test and 49.2 ± 6.2 in the Group Control (p > 0.05). After 1 week (V3), FMBS was 12.7 ± 4.2 in the test Group Test and 18.5 ± 5.9 in the control Group Control (p < 0.05), while after 2 weeks (V4), it was 13.1 ± 3.2 in the Group Test and 19.8 ± 4.9 Group Control (p < 0.05). This trial has clinically showed the efficacy of a new formulation of chlorhexidine mouthwash in reducing bacterial plaque and gingival inflammation. A significant reduction of inflammation and bleeding scores was found in periodontal patients treated by a mouthwash containing CHX 0.2% with ADS, PVP-VA, and Sodium DNA compared to those treated with a placebo mouthwash.

Dento-Skeletal Class III Treatment with Mixed Anchored Palatal Expander: A Systematic Review

Bone-anchored appliances for the treatment of Class III malocclusions have recently been found to reduce the dentoalveolar effects caused by conventional tooth-borne devices while also improving orthopaedic outcomes in growing patients. The goal of this systematic review was to compare the outcomes of skeletal Class III interceptive treatment with dental anchoring devices to those achieved with mixed anchored palatal expanders. The inclusion criteria were as follows: patients who were treated with hybrid anchored palatal expanders and different maxillary advancement appliances. Study quality was estimated using the Newcastle–Ottawa scale. A search on the Pubmed, Scopus, Embase and Cochrane Library databases yielded 350 papers. Following the initial abstract selection, 65 potentially acceptable papers were thoroughly examined, resulting in a final selection of 9 articles. The results in the short-term showed that combined tooth-borne and bone-borne appliances for rapid maxillary expansion might be recommended in protocols of skeletal Class III treatment to obtain more skeletal effects and reduce side effects on the upper teeth.

Surgical Masks Affect the Peripheral Oxygen Saturation and Respiratory Rate of Anesthesiologists

Background

Surgical masks (SMs) protect medical staff and reduce surgical site infections. Extended SM use may reduce oxygen concentrations in circulation, causing hypoxia, headache, and fatigue. However, no research has examined the effects of wearing SMs on oxygenation and physical discomfort of anesthesiologists.

Methods

An electronic questionnaire was established and administered through WeChat, and a cross-sectional survey was conducted to determine SM use duration and related discomfort of operating room medical staff. Then, operating room anesthesiologists were enrolled in a single-arm study. Peripheral blood oxygen saturation (SpO2), heart rate, and respiratory rate were determined at different times before and after SM use. Shortness of breath, dizziness, and headache were subjectively assessed based on the visual analog scale (VAS) scores.

Results

In total, 485 operating room medical staff completed the electronic questionnaire; 70.5% of them did not change SMs until after work, and 63.9% wore SMs continuously for more than 4 h. The proportion of anesthesiologists was the highest. After wearing masks for 4 h, the shortness of breath, fatigue, and dizziness/headache rates were 42.1, 34.6, and 30.9%, respectively. Compared with other medical staff, the proportion of subjective discomfort of anesthesiologists increased significantly with prolonged SM use from 1 to 4 h. Thirty-five anesthesiologists completed the study. There was no difference in anesthesiologist SpO2, heart rate, or respiratory rate within 2 h of wearing SMs. After more than 2 h, the variation appears to be statistically rather than clinically significant—SpO2 decreased (98.0 [1.0] vs. 97.0 [1.0], p &lt; 0.05), respiratory rate increased (16.0 [3.0] vs. 17.0 [2.0], p &lt; 0.01), and heart rate remained unchanged. As mask use duration increased, the VAS scores of shortness of breath, dizziness, and headache gradually increased.

Conclusion

In healthy anesthesiologists, wearing SMs for more than 2 h can significantly decrease SpO2 and increase respiratory rates without affecting heart rates.

Effectiveness and Applications of a Metal-Coated HNT/Polylactic Acid Antimicrobial Filtration System

A broad-spectrum antimicrobial respiration apparatus designed to fight bacteria, viruses, fungi, and other biological agents is critical in halting the current pandemic's trajectory and containing future outbreaks. We applied a simple and effective electrodeposition method for metal (copper, silver, and zinc) coating the surface of halloysite nanotubes (HNTs). These nanoparticles are known to possess potent antiviral and antimicrobial properties. Metal-coated HNTs (mHNTs) were then added to polylactic acid (PLA) and extruded to form an mHNT/PLA 3D composite printer filament. Our composite 3D printer filament was then used to fabricate an N95-style mask with an interchangeable/replaceable filter with surfaces designed to inactivate a virus and kill bacteria on contact, thus reducing deadly infections. The filter, made of a multilayered antimicrobial/mHNT blow spun polymer and fabric, is disposable, while the mask can be sanitized and reused. We used several in vitro means of assessing critical clinical features and assessed the bacterial growth inhibition against commonly encountered bacterial strains. These tests demonstrated the capability of our antimicrobial filament to fabricate N95 masks and filters that possessed antibacterial capabilities against both Gram-negative and Gram-positive bacteria.

Coughing Intensity and Wind Direction Effects on the Transmission of Respiratory Droplets: A Computation with Euler–Lagrange Method

Studies on droplet transmission are needed to understand the infection mechanism of SARS-CoV-2. This research investigated the effects of coughing intensity and wind direction on respiratory droplets transportation using the Euler–Lagrange method. The results revealed that both coughing intensity and wind conditions considerably influence the transmission of small and medium droplets but had little effect on large droplets. A stronger coughing intensity resulted in small and medium droplets traveling farther in a calm wind and spreading widely and rapidly in a windy environment. The droplets do not travel far in the absence of ambient wind, even with stronger coughing. Medium droplets spread in clusters, and small droplets drifted out of the domain in the band area in different wind conditions except for 60° and 90° wind directions, in which cases, the droplets were blown directly downstream. In 0° wind direction, many droplets were deposited on the human body. The fast and upward movement of particles in 60° and 90° directions could cause infection risk with short exposure. In 180° wind direction, droplets spread widely and traveled slowly because of the reverse flow downstream, prolonged exposure can result in a high risk of infection.

Benefits and Implications of Resveratrol Supplementation on Microbiota Modulations: A Systematic Review of the Literature

Resveratrol is a polyphenol that has been shown to possess many applications in different fields of medicine. This systematic review has drawn attention to the axis between resveratrol and human microbiota, which plays a key role in maintaining an adequate immune response that can lead to different diseases when compromised. Resveratrol can also be an asset in new technologies, such as gene therapy. PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar were searched to find papers that matched our topic dating from 1 January 2017 up to 18 January 2022, with English-language restriction using the following Boolean keywords: ("resveratrol" AND "microbio*"). Eighteen studies were included as relevant papers matching the purpose of our investigation. Immune response, prevention of thrombotic complications, microbiota, gene therapy, and bone regeneration were retrieved as the main topics. The analyzed studies mostly involved resveratrol supplementation and its effects on human microbiota by trials in vitro, in vivo, and ex vivo. The beneficial activity of resveratrol is evident by analyzing the changes in the host's genetic expression and the gastrointestinal microbial community with its administration. The possibility of identifying individual microbial families may allow to tailor therapeutic plans with targeted polyphenolic diets when associated with microbial dysbiosis, such as inflammatory diseases of the gastrointestinal tract, degenerative diseases, tumors, obesity, diabetes, bone tissue regeneration, and metabolic syndrome.

Evaluation of the effects on SpO2 of N95 mask (FFP2) on dental health care providers: a cross-sectional observational study

Objective

The purpose of this cross-sectional observational study was to evaluate the effects of SpO2 in a sample of dental health care providers who wear a N95 mask or Filtering Face Piece (FFP2) for four consecutive hours, measured by a pulse oximeter before donning the mask and again after four hours of work and to offer some strategies to minimize discomfort and improve communication with their patients while wearing the mask.

Materials and methods

A 17-item questionnaire was sent via Google Drive to various practitioners in Italy and the USA. A sample of 162 questionnaires were returned from dentists, orthodontists, dental hygienists and dental assistants who committed to wearing a FFP2 for 4 consecutive hours during a work day and then measuring the oxygen saturation by way of a pulse oximeter before and after the 4 working hours. The final analysis was performer on 147 viable questionnaires returned. The sample was composed of 62 males and 85 females with an average age of 42.9 ± 12.0 years.

Results

For the entire sample population, the baseline saturation was 98.6 ± 1.2 and, after four hours of mask wearing, there was a significant decrease in oxygen saturation to 97.0 ± 2.9 (p < 0.01). No statistical differences in SpO² were found across specialties or across types of procedures performed during the 4 h. Heart rates were not significantly different before and after the 4 h in all categories. The 3 most frequent reported complaints were: fatigue (64%), headache (36%) and external ear pain (31%). The most common additional personal protective equipment (PPE) was a mask shield (78%) and those who wore the mask continuously reported more communication difficulty with patients, compared with those who took the mask off more often, in fact, 64% of the subjects reported that using the mask influenced their communication with their patients. Based on the results of the questionnaire, a list of breathing and vocal folds health strategies was devised and proposed, along with strategies to augment communication with patients.

Conclusions

This study highlights a significant decrease in oxygen saturation after only 4 h of work (except for smokers) while wearing a FFP2, and confirms the widespread symptoms of fatigue, headache and pain behind the ears that dental professionals experience. But it also highlighted how mask wearing impaired communication with patients and wearing additional masks and a facial shield may add to those communications difficulties. This aspect and the need for better communication can lead the operators to remove the mask to improve breathing and communication, thus putting themselves at a risk of infection. Of all the aspects explored in this study, the most interesting was indeed the impact on fatigue and communication and the strategies proposed in this article can easily be implemented to reduce headache and fatigue by improving breathing efficiency and by aiding communication while donning a mask by improving voice quality and by using augmentative communication tools.

COVID-19 Infection in Children and Infants: Current Status on Therapies and Vaccines

Since the beginning in December 2019, the SARS-CoV-2 outbreak appeared to affect mostly the adult population, sparing the vast majority of children who only showed mild symptoms. The purpose of this investigation is to assess the status on the mechanisms that give children and infants this variation in epidemiology compared to the adult population and its impact on therapies and vaccines that are aimed towards them. A literature review, including in vitro studies, reviews, published guidelines and clinical trials was performed. Clinical trials concerned topics that allowed a descriptive synthesis to be produced. Four underlying mechanisms were found that may play a key role in providing COVID-19 protection in babies. No guidelines are available yet for therapy due to insufficient data; support therapy remains the most used. Only two vaccines are approved by the World Health Organization to be used in children from 12 years of age, and there are currently no efficacy or safety data for children below the age of 12 years. The COVID-19 clinical frame infection is milder in children and adolescents. This section of the population can act as vectors and reservoirs and play a key role in the transmission of the infection; therefore, vaccines are paramount. More evidence is required to guide safely the vaccination campaign.

Profilometer Comparison of the Surface Roughness of Four Denture Base Resins: An In Vitro Study

Background: The roughness of denture base materials is mainly affected by inherent material features, the polishing technique, and the operator’s manual skills. The surface irregularities of the denture base resin’s roughness profile is one of the components characterizing the superficial topography of dental prostheses, and it is a critical parameter for describing surface morphology. Generally, the increment of the surface roughness minimizes cleanability and promotes the rate of bacterial adherence, affecting the expression of bacterial adhesins. The purpose of this in vitro study was to investigate the roughness of four commercially available denture base resins employed for removable prosthodontics. Methods: Twenty-five specimens were realized and submitted to observation for three dimensions (vertically, horizontally, 45°). Average surface roughness (Ra), Rv, Rp, and Rq were measured with a calibrated mechanical roughness tester (Taylor Hobson Surtronic 25; Taylor Hobson, Leicester, UK). Data were analyzed through a Kruskal–Wallis test. Results: Significant differences in Ra between the groups were assessed. Baltic Denture System™ (Merz Dental GmbH; Lütjenburg, Germania) showed a lower surface roughness coefficient and a more homogeneous surface. Conclusions: The functional importance of surface roughness parameters for denture base materials must be explored, not only considering recognized surface features.

Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center

This study aims to investigate whether wearing face masks (filtering facepieces, FFP class 2) with personal protective equipment (FPP2/PPE), while working a 12-h shift in a COVID-19 referral center, affects the blood saturation, heart rate (HR), and well-being of health care providers (HCPs). The study included a group of 37 HCPs. To perform continuous recordings of the SpO₂ and heart rate (HR) in real time, we used a Nellcor PM10N (Covidien, Mansfield, MA, USA) portable monitoring system. SpO₂, HR, and HCP well-being scales were measured during two 3-h shifts, while HCPs worked during a 12-h period. Additionally, each subject completed a questionnaire concerning their well-being. The difference in the SpO₂ level between the 1st and 2nd working shifts while wearing an FFP2/PPE was small, with a median decrease in SpO₂ of -1%. The scales of the well-being indicators increased within the shift. They were mainly fatigue and thirst with median scores of 2 out of 6 (range 0-4). We assume that during a 12-h period, a work scheme that consists of a 3-h shift in FFP2/PPE and a 3-h rest period (working without FPP2/PPE) is a reliable and safe solution for HCPs working in specialized COVID-19 referral hospitals.

The impact of FFP3 respirators on the blood saturation

This study aims to investigate whether wearing a filtering facepiece class 3 respirators with personal protective equipment (FPP3/PPE) during work in the intensive care unit (ICU) affects the blood saturation (SpO2), the heart rate (HR), and the well-being of health care workers (HCWs). This preliminary study included a group of 21 volunteers (including 16 females (76%), with a median age of 23 years). Each worker served as his own control and performed the test two times: they wore the FFP3/PPE and did not wear it for a three-hour shift in the ICU. The working with an FFP3/PPE compared to not working with an FFP3/PPE caused a significant, but within normal ranges, influence on the level of SpO2 with a mean decrease of - 1.43%. The highest reduction in the SpO2 was - 2.29% and occurred after 150 min of work. All of the score scales of the well-being markers increased consecutively but moderately during the shift while wearing the FFP3/PPE. We assume that a 3-h shift rhythm is a safe and reliable solution, i.e., three hours of working in the FFP3/PPE in the ICU, followed by rest or working without an FFP3/PPE.

The Gaseous Ozone Therapy as a Promising Antiseptic Adjuvant of Periodontal Treatment: A Randomized Controlled Clinical Trial

Background: the establishment of periodontitis is regulated by the primary etiological factor and several individual conditions including the immune response mechanism of the host and individual genetic factors. It results when the oral homeostasis is interrupted, and biological reactions favor the development and progression of periodontal tissues damage. Different strategies have been explored for reinforcing the therapeutic effect of non-surgical periodontal treatment of periodontal tissue damage. Gaseous ozone therapy has been recognized as a promising antiseptic adjuvant, because of its immunostimulating, antimicrobial, antihypoxic, and biosynthetic effects. Then, we hypothesized that the adjunct of gaseous ozone therapy to standard periodontal treatment may be leveraged to promote the tissue healing response. Methods: to test this hypothesis, we conducted a prospective randomized study comparing non-surgical periodontal treatment plus gaseous ozone therapy to standard therapy. A total of 90 healthy individuals with moderate or severe generalized periodontitis were involved in the study. The trial was conducted from September 2019 to October 2020. Forty-five patients were randomized to receive scaling and root-planning (SRP) used as conventional non-surgical periodontal therapy plus gaseous ozone therapy (GROUP A); forty-five were allocated to standard treatment (GROUP B). The endpoint was defined as the periodontal response rate after the application of the ozone therapy at 3 months and 6 months, defined as no longer meeting the criteria for active periodontitis. Statistical analysis was performed employing SPSS v.18 Chicago: SPSS Inc. Results: periodontal parameters differed significantly between patients treated with the two distinct procedures at 3 months (p ≤ 0.005); a statistically significant difference between groups was observed from baseline in the CAL (p ≤ 0.0001), PPD (p ≤ 0.0001) and BOP (p ≤ 0.0001) scores. Conclusions: The present study suggests that SRP combined with ozone therapy in the treatment of periodontitis revealed an improved outcome than SRP alone.

COVID-19 pandemic impact on headache in healthcare workers: a narrative review

Background: Pandemic of COVID-19, the potentially fatal disease caused by SARS-CoV-2, had caused intangible consequences on global health systems, economy, daily life, education, travel, leisure, work, and mental health. Its impact on mental and physical health, especially in health professionals, has been described. Objective: This study aimed to review and discuss the published evidence regarding the presence of headache on COVID-19 healthcare workers. Methods: In this review, we searched for all articles published in various data bases including PubMed / Medline, Scopus, and Web of Science and all original research studies, letters to editor, case reports, commentaries and reviews published in English, Portuguese or Spanish were searched. Two researchers independently analyzed published articles in order to include/exclude based on inclusion or exclusion criteria.  Results: Thirteen articles were included.  All studies included in this review were observational; eleven were cross-sectional studies, one was a prospective/cohort and one was a retrospective. Two studies evaluated psychological outcomes, mental health disorders and associated factors, one study investigated symptoms and causes of somatic symptom disorder and all other studies evaluated headaches associated with Personal Protective Equipment (PPI). Conclusions: The present review shows that COVID-19 pandemic has negative impact on physical and mental health in healthcare workers and headache has been associated to psychological stress and work overload during pandemic.  Further studies are necessary to better investigate COVID-19 pandemic effects on headaches and other neurological conditions.

COVID-19 Infection in Children, Infants and Pregnant Subjects: An Overview of Recent Insights and Therapies

BACKGROUND

The SARS-CoV-2 pandemic has involved a severe increase of cases worldwide in a wide range of populations. The aim of the present investigation was to evaluate recent insights about COVID-19 infection in children, infants and pregnant subjects.

METHODS

a literature overview was performed including clinical trials, in vitro studies, reviews and published guidelines regarding the present paper topic. A descriptive synthesis was performed to evaluate recent insights and the effectiveness of therapies for SARS-CoV-2 infection in children, infants and pregnant subjects.

RESULTS

Insufficient data are available regarding the relationship between COVID-19 and the clinical risk of spontaneous abortion and premature foetus death. A decrease in the incidence of COVID-19 could be correlated to a minor expression of ACE2 in childrens' lungs. At present, a modulation of the dose-effect posology for children and infants is necessary.

CONCLUSIONS

Pregnant vertical transmission has been hypothesised for SARS-CoV-2 infection. Vaccines are necessary to achieve mass immunity for children and also pregnant subjects.

Association between Long COVID and Overweight/Obesity

Background: Long COVID is a syndrome characterized by the persistence of SARS-CoV-2 infection symptoms. Among HCWs, prolonged COVID symptoms could lead to the inability to perform work tasks. The aim of this study is to investigate 35-day long-COVID (35-LC) characteristics and risk factors in a one-year period. Methods: We carried out a retrospective cohort study during the COVID-19 pandemic at University Hospital of Bari. A total of 5750 HCWs were tested for close contact with a confirmed case, in the absence of personal protective equipment, or for symptom development. Results: Each positive HCW was investigated for cardiovascular risk factors or respiratory diseases. An amount of 352 HCWs (6.1%) were infected by SARS-CoV-2, and 168 cases evolved to long COVID. The 35-LC group showed mean BMI values higher than the non-35-LC group (25.9 kg/m² vs. 24.8 kg/m², respectively), and this difference was significant (p-value: 0.020). Moreover, HCWs who suffered from pulmonary disease (OR = 3.7, CL 95%: 1.35–10.53; p-value = 0.007) or overweight (OR = 1.6 CL 95%: 1.05–2.56; p-value = 0.029) had an increased risk of developing 35-LC. Conclusions: Long COVID is an emerging problem for hospital managers as it may reduce the number of HCWs deployed in the fight against COVID-19. High BMI and previous pulmonary disease could be risk factors for 35-LC development in exposed HCWs.

Mask-Related Glasses Fogging: A Predisposing Mechanism of Falls during the COVID-19 Pandemic

Fogging is a relatively infrequent, yet annoying, issue encountered by individuals who wear glasses. With the arrival of COVID-19, glasses fogging is more common due to the ubiquitous use of face masks. Individuals are stuck wrestling between leaving their mask off or trying to navigate their day-to-day lives with fogged glasses and risk falling. We report a case of an olecranon fracture sustained due to reduced visibility secondary to mask-related fogging during the COVID-19 pandemic. The recommendations included here will provide health care providers with the necessary information to educate patients regarding prevention of mask-related glass fogging.

Cannabinoids Drugs and Oral Health-From Recreational Side-Effects to Medicinal Purposes: A Systematic Review

Background: marijuana, the common name for cannabis sativa preparations, is one of the most consumed drug all over the world, both at therapeutical and recreational levels. With the legalization of medical uses of cannabis in many countries, and even its recreational use in most of these, the prevalence of marijuana use has markedly risen over the last decade. At the same time, there is also a higher prevalence in the health concerns related to cannabis use and abuse. Thus, it is mandatory for oral healthcare operators to know and deal with the consequences and effects of cannabis use on oral cavity health. This review will briefly summarize the components of cannabis and the endocannabinoid system, as well as the cellular and molecular mechanisms of biological cannabis action in human cells and biologic activities on tissues. We will also look into oropharyngeal tissue expression of cannabinoid receptors, together with a putative association of cannabis to several oral diseases. Therefore, this review will elaborate the basic biology and physiology of cannabinoids in human oral tissues with the aim of providing a better comprehension of the effects of its use and abuse on oral health, in order to include cannabinoid usage into dental patient health records as well as good medicinal practice. Methods: the paper selection was performed by PubMed/Medline and EMBASE electronic databases, and reported according to the PRISMA guidelines. The scientific products were included for qualitative analysis. Results: the paper search screened a total of 276 papers. After the initial screening and the eligibility assessment, a total of 32 articles were considered for the qualitative analysis. Conclusions: today, cannabis consumption has been correlated to a higher risk of gingival and periodontal disease, oral infection and cancer of the oral cavity, while the physico-chemical activity has not been completely clarified. Further investigations are necessary to evaluate a therapeutic efficacy of this class of drugs for the promising treatment of several different diseases of the salivary glands and oral diseases.

Implications of surgical mask use in physical education lessons

COVID-19 is being a huge challenge for education systems. Mandatory use of face masks in presential classes may lead to psychophysiological impairment of students, which affect lessons. Thus, the aim of the present research was to analyze the effect of mask use in basal psychophysiological status of physical education students prior to a physical education lesson. We analyzed 72 physical education students in two moments prior to two physical education lessons with 48 h between them. Blood oxygen saturation, body, temple and face temperatures, perceived stress and exertion, and heart rate variability were measured. Results showed that the use of surgical masks in physical education students produced a significant increase on subjective stress perception, sympathetic modulation, cardiovascular response, face, and temple temperature while decreasing blood oxygen saturation. We concluded that the use of surgical masks by physical education students induce modifications on the organic status, which could represent a handicap compromising the academic objectives of physical education lessons. This information can help teachers design efficient physical education lessons.

Education Technology in Orthodontics and Paediatric Dentistry during the COVID-19 Pandemic: A Systematic Review

Over the last decade, medical education changed from traditional teaching methods to telematic and networking scholar and e-learning approach. The objective of the present systematic review was to evaluate the effectiveness and teachers/student's acceptability of e-learning applied to the field of orthodontics and paediatric dentistry. A database search of the literature was conducted on PubMed and Embase databases from January 2005 to May 2021. A total of 172 articles were identified by the electronic search, while a total of 32 papers were selected for qualitative analysis. Overall, 19 articles investigated the effectiveness of e-learning, and no difference of acceptability was reported between e-learning and traditional methods for a wide part of the articles selected. A total of 25 papers provided a satisfaction questionnaire for learners and all were positive in their attitude towards e-learning. The results showed that e-learning is an effective method of instruction, complementing the traditional teaching methods, and learners had a positive attitude and perception. The evidence of the present study reported a high level of acceptability and knowledge level of e-learning techniques, compared to frontal lecture methods, in the fields of orthodontics and paediatric dentistry.

The 15-Months Clinical Experience of SARS-CoV-2: A Literature Review of Therapies and Adjuvants

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for the coronavirus disease of 2019 (COVID-19) that emerged in December 2019 in Wuhan, China, and rapidly spread worldwide, with a daily increase in confirmed cases and infection-related deaths. The World Health Organization declared a pandemic on the 11th of March 2020. COVID-19 presents flu-like symptoms that become severe in high-risk medically compromised subjects. The aim of this study was to perform an updated overview of the treatments and adjuvant protocols for COVID-19.

METHODS

A systematic literature search of databases was performed (MEDLINE PubMed, Google Scholar, UpToDate, Embase, and Web of Science) using the keywords: "COVID-19", "2019-nCoV", "coronavirus" and "SARS-CoV-2" (date range: 1 January 2019 to 31st October 2020), focused on clinical features and treatments.

RESULTS

The main treatments retrieved were antivirals, antimalarials, convalescent plasma, immunomodulators, corticosteroids, anticoagulants, and mesenchymal stem cells. Most of the described treatments may provide benefits to COVID-19 subjects, but no one protocol has definitively proven its efficacy.

CONCLUSIONS

While many efforts are being spent worldwide in research aimed at identifying early diagnostic methods and evidence-based effective treatments, mass vaccination is thought to be the best option against this disease in the near future.

SARS-CoV-2 Disease through Viral Genomic and Receptor Implications: An Overview of Diagnostic and Immunology Breakthroughs

The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), which is believed to have originated in China towards the end of November 2019, has now spread across the globe, causing a pandemic in 192 countries. The World Health Organization has called it the SARS-CoV-2 pandemic. Rapid dissemination of the virus occurs mainly through the saliva (Flügge's droplets) and aerosol, together with nasal and lachrymal passages. The literature associated with the recent advancement in terms of rapid diagnostics and SARS-CoV-2 vaccines has thoroughly studied the role of ACE2 receptors and Furin, as well as viral agent access into the host cell and its significant persistence at the level of the oral mucosa, which represents the main access to the virus. The purpose of this review was to underline the processes of SARS-CoV-2 infection mechanisms and novel breakthroughs in diagnostics and vaccines. Different technologies, such as the RT-PCR molecular test and the antigenic test, have been developed to identify subjects affected by the SARS-CoV-2 in order to improve the tracking of infection geographical diffusion. Novel rapid and highly sensitive diagnostic tests has been proposed for the detection of SARS-CoV-2 to improve the screening capability of suspected contagions. The strengthening of the vaccination campaign represents the most effective means to combat the SARS-CoV-2 infection and prevent severe manifestations of the virus-different classes of vaccines have been developed for this purpose. Further attention on the novel SARS-CoV-2 variant is necessary in order to verify the protection efficacy and virulence reduction of the infective agent in the recent vaccine campaign.

SARS-CoV-2 Disease Adjuvant Therapies and Supplements Breakthrough for the Infection Prevention

The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a high-risk viral agent involved in the recent pandemic stated worldwide by the World Health Organization. The infection is correlated to a severe systemic and respiratory disease in many cases, which is clinically treated with a multi-drug pharmacological approach. The purpose of this investigation was to evaluate through a literature overview the effect of adjuvant therapies and supplements for the SARS-CoV-2 infection. The research has analyzed the advantage of the EK1C4, by also assessing the studies on the resveratrol, vitamin D, and melatonin as adjuvant supplements for long hauler patients' prognosis. The evaluated substances reported important benefits for the improvement of the immune system and as a potential inhibitor molecules against SARS-CoV-2, highlighting the use of sartans as therapy. The adjuvant supplements seem to create an advantage for the healing of the long hauler patients affected by chronic symptoms of constant chest and heart pain, intestinal disorders, headache, difficulty concentrating, memory loss, and tachycardia.