Background: The anterior-middle superior alveolar (AMSA) anesthetic technique has been reported to be a less traumatic alternative to several conventional nerve blocks and local infiltration for anesthesia of the maxillary teeth, their periodontium, and the palate. However, its anatomic basis remains controversial. The present study aimed to determine if the pattern of cortical and cancellous bone density in the maxillary premolar region can provide a rationale for the success of the AMSA anesthetic technique.Method: Cone-beam computed tomography scans of 66 maxillary quadrants from 34 patients (16 men and 18 women) were evaluated using a volumetric imaging software for cortical and cancellous bone densities in three interdental regions between the canine and first molar. Bone density was measured in Hounsfield units (HU) separately for the buccal cortical, palatal cortical, buccal cancellous, and palatal cancellous bones. Mean HU values were compared using the Mann-Whitney U test and one-way ANOVA with post-hoc analysis. Results: Cancellous bone density was significantly lower (P ≤ 0.001) in the palatal half than in the buccal half across all three interdental regions. However, there was no significant difference (P = 0.106) between the buccal and palatal cortical bone densities at the site of AMSA injection. No significant difference was observed between the two genders for any of the evaluated parameters. Conclusions The palatal half of the cancellous bone had a significantly lower density than the buccal half, which could be a reason for the effective diffusion of the anesthetic solution following a palatal injection during the AMSA anesthetic technique.

BACKGROUND: Profound anesthesia with adequate duration is required in periodontal flap surgery, which involves the manipulation of both hard and soft tissues. The anterior middle superior alveolar (AMSA) injection may be an alternative to multiple injections required for this purpose in the maxilla. The present study aimed to assess the effectiveness of AMSA injection using computer-controlled local anesthetic delivery (CCLAD) system to anesthetize buccal hard tissue (BHT), buccal soft tissue (BST), palatal hard tissue (PHT), and palatal soft tissue (PST) around the maxillary teeth. METHODS: Thirty-five patients who were indicated for open flap debridement in a whole maxillary quadrant were given AMSA injection using the CCLAD. The effectiveness of anesthesia was evaluated using subjective and objective parameters around each tooth. Supraperiosteal infiltrations were administered to complete the surgery wherever the AMSA injection was ineffective. RESULTS: The AMSA injection was more effective on the palatal tissues than on the buccal tissues, as 94.14% of PST and 87.89% of PHT sites were anesthetized compared to 49.22% and 43.75% of BHT and BST sites, respectively. There was no significant difference in the frequency of anesthesia around the anterior and posterior teeth. The PHT was significantly more anesthetized (P = 0.003) in males than in females. CONCLUSIONS: The AMSA injection using CCLAD is highly effective on palatal tissues and could be used as a first-line anesthesia for periodontal flap surgery. However, its effect on buccal tissues is less predictable, with supraperiosteal infiltration often required to supplement the AMSA injection.
Amsacrine ; Anesthesia ; Anesthetics, Local ; Butylated Hydroxytoluene ; Debridement ; Female ; Humans ; Male ; Maxilla ; Palate ; Periodontal Debridement ; Tooth

Periodontal procedures require adequate anesthesia not only to ensure the patient's comfort but also to enhance the operator's performance and minimize chair time. In the maxilla, anesthesia is often achieved using highly traumatic nerve blocks, apart from multiple local infiltrations through the buccal vestibule. In recent years, anterior middle superior alveolar (AMSA) field block has been claimed to be a less traumatic alternative to several of these conventional injections, and it has many other advantages. This critical review of the existing literature aimed to discuss the rationale, mechanism, effectiveness, extent, and duration of AMSA injections for periodontal surgical and non-surgical procedures in the maxilla. It also focused on future prospects, particularly in relation to computer-controlled local anesthetic delivery systems, which aim to achieve the goal of pain-free anesthesia. A literature search of different databases was performed to retrieve relevant articles related to AMSA injections. After analyzing the existing data, it can be concluded that this anesthetic technique may be used as a predictable method of effective palatal anesthesia with adequate duration for different periodontal procedures. It has additional advantages of being less traumatic, requiring lesser amounts of local anesthetics and vasoconstrictors, as well as achieving good hemostasis. However, its effect on the buccal periodontium appears highly unpredictable.
Amsacrine ; Anesthesia ; Anesthetics, Local ; Hemostasis ; Maxilla ; Methods ; Nerve Block ; Palate ; Periodontal Debridement ; Periodontium ; Vasoconstrictor Agents

Aims: Antimicrobial resistance (AMR) is a significant public health concern of modern civilization. The potential risk of AMR is significant in terms of both human and animal health. This study aims to assess the antimicrobial resistance pattern of selected antimicrobials against Escherichia coli of animal, poultry and human origin in the Cumilla district of Bangladesh. Methodology and results: A total of 200 samples were collected from different sources. Isolation and identification of commensal E. coli were performed following standard bacteriological and molecular techniques. Antimicrobial susceptibility testing was performed following the Kirby-Bauer disc diffusion technique. Ampicillin, tetracycline and sulfamethoxazole-trimethoprim resistance genes were detected by polymerase chain reactions (PCR). A total of 152 (76%; 95% confidence interval (CI) 70-81%) E. coli were isolated from cattle, sheep, chicken and human, where 37.5% of isolates were found to be multidrug-resistant (MDR). In the cultural sensitivity test, E. coli showed the highest resistance to sulfamethoxazole-trimethoprim (71%), tetracycline (63%), ampicillin (62%), where gentamicin (23%) showed the lowest resistance, followed by ceftriaxone (26%). The prevalence of resistance genes like blaTEM, tetA, tetB, tetC, sul1 and sul2 were 100%, 95%, 11%, 8%, 58% and 52%, respectively. Conclusion, significance and impact of study The emergence of multidrug-resistant commensal E. coli and resistance genes circulating in animals, poultry and humans limit the treatment options for serious infections.
Escherichia coli ; Drug Resistance, Multiple, Bacterial

Objective: To carry out the genetic characterization and evolutionary analysis of three avian orthoavulavirus 1 (AOAV-1) isolates from poultry workers with respiratory symptoms. Methods: Using Illumina MiSeq, whole-genome sequencing was carried out to assess the evolutionary dynamics of three AOAV-1 isolates. A phylogenetic and comparative analysis of all coding genes was done using bioinformatics tools. Results: Phylogenetic analysis and genetic distance estimation suggested a close relationship among human- and avian-originated velogenic strains of genotype XIII, sub-genotype XIII.2.1. Several substitutions in the significant structural and biological motifs were exclusively identified in the human-originated strains. Conclusions: To our knowledge, this is the first report of a velogenic AOAV-1 isolate from natural infection of the human upper respiratory tract. Our findings highlight the evolution and zoonotic potential of velogenic AOAV-1 in a disease endemic setting.