Journal of Chemical Health Risks (Islamic Azad University, Iran)
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Spectrum of Liver Diseases and Associated Coagulation Abnormalities: A Comprehensive Review
No full textThe liver is central to hemostasis, orchestrating the synthesis of coagulation factors, natural anticoagulants, fibrinolytic regulators, and thrombopoietin, while also clearing activated clotting proteins. Liver diseases disrupt these pathways, causing dynamic and often paradoxical hemostatic alterations. Traditionally considered hemorrhagic disorders due to prolonged prothrombin time (PT), international normalized ratio (INR), and thrombocytopenia, liver diseases are now recognized to induce a fragile equilibrium known as rebalanced hemostasis, which explains the simultaneous risk of bleeding and thrombosis. This comprehensive review examines coagulation abnormalities across the spectrum of liver disorders, including acute liver failure (ALF), chronic hepatitis, cirrhosis, metabolic dysfunction–associated steatotic liver disease (MASLD), cholestatic liver diseases, and vascular liver disorders. It discusses underlying pathophysiology, laboratory assessment using conventional and global hemostatic assays, clinical implications, and evidence-based management strategies. The review emphasizes individualized risk assessment, judicious transfusion, selective anticoagulation, and the integration of viscoelastic and thrombin generation testing into clinical practice. Finally, future research directions focusing on novel biomarkers, therapeutic targets, and outcome-based studies are highlighted
Implementation of a Standardized Trauma Triage Protocol and Its Impact on Time-to-Definitive Care
No full textBackground: Trauma is a leading cause of morbidity and mortality globally, especially in low- and middle-income countries. LMIC trauma mortality far exceeds high-income rates[1][2]. Delays in definitive care worsen outcomes, a principle often invoked by the “golden hour” concept[3][4]. However, evidence for the strict 60-minute golden-hour rule is mixed, and many contemporary studies have found no clear mortality benefit from faster transport alone[3][4]. Nonetheless, structured triage protocols and trauma system development aim to expedite critical interventions and improve survival[5][6]. In India, prehospital care remains fragmented and lacks a standardized triage policy[2]; mortality studies suggest that standardized, protocol-driven care could greatly reduce preventable deaths[1][2]. This study evaluated the effect of implementing a simple, color-coded trauma triage protocol on time intervals to key interventions (e.g. imaging and surgery) in an urban trauma center.
Materials and Methods: We conducted a retrospective cohort study (January–December 2024) including 200 consecutive trauma patients (all mechanisms, all severities) admitted to our emergency department before and after the new triage protocol. Patients were divided into pre-protocol (Jan–Jun, n=100) and post-protocol (Jul–Dec, n=100) cohorts. The standardized protocol classified arriving trauma patients into priority categories (color-coded “Red” [immediate], “Yellow” [urgent], “Green” [minor]) using an algorithm adapted from established triage systems. Key time intervals were measured: arrival-to-triage, triage-to-definitive-care (e.g. CT scan or operating room), and overall ED length of stay. We compared median times and outcomes between cohorts using nonparametric tests. Statistical significance was set at p<0.05.
Results: The triage protocol was successfully applied to all post-protocol patients. Time to triage (door-to-priority designation) fell from a median of 9 minutes (IQR 7–12) pre- to 3 minutes (IQR 2–5) post-protocol (p<0.001). Definitive care (first CT or emergent surgery) occurred significantly faster after protocol implementation. Median door-to-CT time improved from 65 min (IQR 50–85) to 45 min (IQR 30–60) (p<0.001), and median door-to-OR time for operative cases fell from 150 min (IQR 120–180) to 100 min (IQR 80–130) (p<0.001). The proportion of patients taken directly to CT/OR without secondary delays increased. Protocol compliance was high (95%), with under-triage rates dropping and over-triage remaining stable. Overall ED length of stay also decreased. In-hospital mortality and complication rates trended lower post-protocol. These improvements align with reports that systematic trauma activation markedly shortens care intervals.
Conclusion: Implementing a standardized, simple trauma triage protocol dramatically improved the speed of critical interventions. Time-to-imaging and time-to-surgery were significantly reduced, reflecting more efficient in-hospital workflow. Although evidence on the “golden hour” is mixed[3][9], expedited definitive care remains an intuitive goal. Our findings suggest that structured triage can meaningfully reduce system delays. Given the high preventable trauma mortality in our setting[1][2], broader adoption of standardized triage may enhance outcomes. Future work will examine long-term outcomes and refine triage criteria for optimal resource use
Role of Occlusion in Restorative Dentistry: A Review
No full textThe way our teeth come together, known as occlusion, is fundamental to proper oral function. Unfortunately, it is often overlooked or taken for granted during patient treatment. Achieving successful and long-lasting dental restorations hinges on maintaining occlusal harmony. The term "occlusion" refers to the contact between teeth in the upper and lower jaws, both when the jaws are closed (static occlusal relationships) and during various jaw movements (dynamic occlusal relationships). A thorough understanding and evaluation of the concepts and factors influencing occlusion are crucial in both prosthodontics (replacement of missing teeth) and restorative dentistry (repairing damaged teeth). Specifically, the shapes of cusps, fossae, grooves, and marginal ridges of teeth should properly support the mandible (lower jaw) during rest and function. Restored teeth should not interfere with normal mandibular movements. Restorations should not transmit excessive forces to the tooth\u27s attachment apparatus (periodontal ligament and bone) or the temporomandibular joint (TMJ), whether the jaws are fully closed, in other positions, or during movement. When occlusion functions optimally, it allows proper operation of oral functions like chewing and speaking. It contributes to the best possible aesthetics. Helps prevent problems with oral function. The biting surfaces (occlusal surfaces) of teeth are frequently involved in dental restorations. The significance of this lies in: Its relationship within the entire chewing system (articulatory system).The potential impact of occlusal trauma (damage from improper bite forces) on the tooth and its supporting tissues. Successful occlusal management leads to Predictable fitting of restorations and prostheses
In- Vitro Evaluation of Hepatoprotective Potential of Diplocyclos Palmatus (L) C. Jeffrey Leaf Against Paracetamol Induced Liver Toxicity using HEPG2 Cell Line
No full textAim:
To evaluate In-vitro hepatoprotective activity of Hydro alcoholic extract of Diplocyclos palmatus (HADP) leaf extract against paracetamol induced liver toxicity in HepG2 Cell line.
Methods:
HepG2 cells were plated using 96 well microplate and incubated at 37 °C for 24 h in 5% CO2.After incubation the cells were exposed to 14 Mm paracetamol to induce hepatotoxicity. Cells are then treated with different concentrations of Plant extract (200µg/ml and 400µg/ml and incubated for 24 h in CO2 incubator and silymarin as standard (300µg/ml). The morphological cells were observed under digital inverted microscope (20X magnification) after 24 h and photographed. The cells were then washed with phosphate-buffer saline (PBS, pH-7.4) and 20 μL of (MTT) solution (5 mg/mL in PBS) was added to each well. The plates were then stand at 37ºC in the dark for 4 h. The formazan crystals were dissolved in 100μL DMSO and the absorbance was read spectrophotometrically at 570 nm.
Results:
The results indicated that paracetamol induced causes a significant decrease in cell viability about (18.5%).HADP at 200µg &400 µg showed increase in cell viability (34.1%,70.8%).Silymarin showed increase in cell viability (88.1%).
Conclusion
Our study revealed that HADP leaf extract has potent hepatoprotective effect against paracetamol induced liver toxicity in HepG2 cell line and which may be attributed to decrease in paracetamol induced reactive oxygen species levels and resultant oxidative stress
Prosthodontic Aspects of Screw Loosening in Dental Implants: A Review
No full textScrew loosening remains one of the most frequently reported mechanical complications associated with implant-supported prostheses. Although advances in implant design, materials, and connection geometries have significantly reduced its incidence, screw loosening continues to challenge long-term prosthodontic success. From a prosthodontic perspective, multiple factors—including occlusal loading patterns, prosthesis design, accuracy of fit, torque application, and abutment–implant interface—play critical roles in the development of screw loosening. This review aims to analyze the prosthodontic determinants of screw loosening in dental implants, discuss underlying biomechanical principles, and outline preventive and management strategies to enhance implant prosthesis longevity
Prevalence and Predictors of Early Childhood Caries in Children aged between 48 to 71 months in District Hapur, Uttar Pradesh: An Epidemiological Study
No full textBackground: Early Childhood Caries affects preschool children all over the world which directly has implications on a child’s overall health and quality of life. Most studies on ECC have been focused on specific ethnic and lower social economics communities. However, there is shortage of epidemiological data and their association with its determinants regarding ECC in Hapur District.
Aim: The aim of this study was to assess the prevalence of ECC in District Hapur, Uttar Pradesh and its correlation with the predictors of ECC.
Methods: An epidemiological study was carried out on 2500 school going children from 10 schools located in urban and rural areas of 5 zones of Hapur district. A prior permission was taken from all the 10 schools and informed consent was sent to the schools prior to the day of examination. Among the study participants the presence of dental caries was assessed using, deft indices. Patients Oral hygiene practices and oral health literacy data of the parents was pre-evaluated through a questionnaire. Also, the socio-economic status of the participants was obtained through kuppuswamy scale. Lastly, drinking water was collected from each school of each zone and sent to the laboratory for estimating the fluoride level in each belt.
Results: The overall caries prevalence in 4-6 year age group was found to be 88.4%. There was statistically no significant difference found in gender-wise comparison (p=0.001) and SES comparison (p=0.961), but a significant difference was seen in oral hygiene practice (p=0.001), oral health literacy (p=0.001), was evaluated with caries prevalence. The mean water fluoride level in the surveyed area was found to be 0.8 ppm and was found to be significantly (p = 0.001) associated with caries prevalence.
Conclusion: An extremely high prevalence of ECC was seen in the Hapur district, UP. The risk factors, such as gender, oral hygiene practices, oral health literacy, SES of parents, and fluoride level of the area, were found to important determinants associated with the prevalence of dental caries in school-going children of 4-5 year age group
Effectiveness of Vector Control Interventions in Preventing Dengue Outbreaks: A Systematic Review and Meta-analysis
No full textBackground: Dengue fever is one of the most widespread vector-borne viral infections globally, transmitted primarily by Aedes aegypti and Aedes albopictus mosquitoes. In the absence of an effective universal vaccine, vector control remains the cornerstone of dengue prevention. However, the relative effectiveness of different vector control interventions-chemical, environmental, biological, or integrated approaches-in reducing dengue incidence and preventing outbreaks remains uncertain.
Objectives: To systematically review and quantitatively assess the effectiveness of vector control interventions in reducing dengue incidence and outbreak occurrence, and to compare the impact of novel biological strategies such as Wolbachia deployment with conventional methods.
Methods: Following PRISMA 2020 guidelines, a comprehensive search of PubMed, Embase, Cochrane CENTRAL, Scopus, Web of Science, and WHO databases was conducted up to June 2025. Eligible studies included randomized controlled trials, quasi-experimental, and observational designs reporting dengue incidence, outbreak occurrence, or entomological indices. Two reviewers independently screened studies, extracted data, and assessed bias using Cochrane RoB 2 and ROBINS-I tools. Pooled relative risks (RRs) were estimated using a random-effects model (DerSimonian-Laird), and certainty of evidence was evaluated using GRADE.
Results: Twelve studies (4 RCTs, 8 quasi-experimental/observational) with clinical outcomes and 23 with entomological data met inclusion criteria. Wolbachia-based biological control interventions demonstrated the greatest effectiveness, yielding a pooled RR = 0.25 (95 % CI 0.17-0.37; I² = 54 %), corresponding to a 75 % reduction in dengue incidence. Integrated vector management (IVM) and community-based environmental control achieved moderate reductions (RR = 0.61 (95 % CI 0.40-0.92)), whereas chemical control (fogging and residual spraying) had minimal effect (RR = 0.87 (95 % CI 0.65-1.16)). Overall pooled RR across all interventions was 0.68 (95 % CI 0.51-0.91), with moderate heterogeneity. Funnel plot and Egger’s test indicated no significant publication bias. Certainty of evidence was moderate for Wolbachia and low for other interventions.
Conclusions: Vector control interventions collectively reduce dengue incidence, but effectiveness varies widely by strategy. Biological control through Wolbachia-infected Aedes aegypti offers the most robust and sustainable reduction in dengue transmission, while multi-component IVM programs provide additional benefit when community engagement is high. Conventional chemical control alone remains insufficient for outbreak prevention. Future research should emphasize high-quality cluster-randomized trials, standardized dengue outcome measures, and cost-effectiveness evaluations to optimize integrated dengue prevention strategies
Assessment of Health Related Behavior Changes in Obese Patients with Chronic Periodontitis Before and After Non Surgical Periodontal Therapy
No full textAim: To measure and correlate oral and overall health-related behavior changes in obese patients with chronic periodontitis after nonsurgical periodontal therapy.
Methods: A total of 200 obese patients diagnosed with chronic periodontitis were enrolled. Clinical parameters, including Oral Hygiene Index-Simplified (OHI-S), Patient Hygiene Performance (PHP) index, and Community Periodontal Index (CPI), were assessed at baseline and six months after nonsurgical periodontal therapy (NSPT). Lifestyle-related behavior was evaluated using a health practice index at the same time points.
Results: Six months following non surgical periodontal therapy the mean OHI-S, PHP, and CPI scores showed marked reductions, indicating improved oral hygiene and periodontal health (p < 0.001). Lifestyle behaviors also improved, with the proportion of participants categorized as poor decreasing from 36.5% to 22.5%, those with average practices increasing from 41% to 45%, and those with healthy practices increases from 22.5% to 32.5%.
Conclusion: Nonsurgical periodontal therapy in obese patients with chronic periodontitis not only improved clinical periodontal parameters but also promoted favorable lifestyle and health-related behavior changes. 
Evaluation of Peak Expiratory Flow Rate (PEFR) In Vitamin D Deficient Asthmatics
No full textBackground: Bronchial asthma is a chronic inflammatory airway disorder influenced by multiple environmental and immunological factors. Vitamin D, a secosteroid hormone known for its anti-inflammatory and immunomodulatory properties, has been implicated in the pathogenesis and control of asthma. Vitamin D deficiency is prevalent in India and may adversely affect airway function and disease control. This study aimed to evaluate the association between serum Vitamin D levels and Peak Expiratory Flow Rate (PEFR) among Vitamin D deficient asthmatics and to assess changes in PEFR following Vitamin D supplementation.
Methods: This cross-sectional interventional study was conducted in the Department of Pulmonary Medicine, a tertiary care hospital in South India, among 38 stable adult asthmatics with serum 25(OH) Vitamin D levels ≤20 ng/mL. Baseline demographic, clinical, and asthma-related parameters were recorded. PEFR was measured using a mini-Wright peak flow meter, and the best of three attempts was taken. Participants received oral Vitamin D supplementation (60,000 IU weekly for 8 weeks) as per Endocrine Society guidelines. PEFR was reassessed after 8 weeks of therapy. Data were analyzed using paired t-test, with p<0.05 considered statistically significant.
Results: The study population demonstrated a female predominance (63.2%) with most participants aged 18–30 years. Severe Vitamin D deficiency (≤10 ng/mL) was present in 23.7% of subjects. There was no significant correlation between baseline Vitamin D levels and PEFR values. However, a statistically significant improvement in mean PEFR was observed following Vitamin D supplementation (p<0.05).
Conclusion: Vitamin D supplementation in deficient asthmatics resulted in improved PEFR, suggesting a beneficial effect on airway function and respiratory muscle performance. These findings highlight the potential role of Vitamin D optimization as an adjunctive measure in asthma management, particularly in populations with high prevalence of deficiency
Review on Circulating Endothelin 1 as a Pathogenic Relator for Endothelial Dysfunction in Preeclampsia
No full textIn pregnancy, pre-eclampsia [PE] is a condition which is characterised by rise in systemic vascularity with proteinuria. It is considered as a major complication, known to cause considerable morbidity and mortality among pregnant woman and her offspring. Preeclampsia has remained elusive to the researchers with respect to its aetiology and pathophysiology. To acquiesce generation of the treatment to better management of PE patients, is too cognizant of search for molecular level key components which leads to pathogenesis of PE. Placental hypoxia is seen in PE, because of inadequate placentation leads, however, endothelial dysfunction is the basic mechanism which is setting the stage for the cascade of events ensuing in hypertensive disorders of pregnancy. Endothelin 1(ET1) is a marker of endothelial dysfunction and most prominent vasoactive member. Recent studies divulged that endothelin system as a pivotal path way for clinical manifestations of PE. To enlighten the role of ET1 as a marker of endothelial dysfunction and understanding the molecular mechanism underlying in pathophysiology of preeclampsia, the present review discusses on history, discovery, biosynthesis, mechanism of action and role of ET 1in PE