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   Table of Contents - Current issue
January-February 2021
Volume 11 | Issue 1
Page Nos. 1-114

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Protection measures, dental education, and Covid-19 spread: a brief narrative review p. 1
Silvia DAgostino, Luca DAgostino, Marco Dolci,
Objectives: The aim of the study was to evaluate and check the international literature for Covid-19 prevention and dental education. Materials and Methods: A review of the international literature was performed, including articles in English about different aspects of transmission, preventive actions, and educational topics. Results: As a result, it seems that the better way to avoid contagion was represented by the use of personal protective equipment and handwashing in conjunction with social distancing and treatment limitation. Conclusions: Dental treatment limitation to emergencies, social distancing, and online teaching seemed to be the key to limit the Covid-19 outbreak, although there was no evidence of a universal guideline. This suggests that we have to establish general guidelines to avoid a second rush of contagion and limit the spread of infection in the future.
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Influence of the surface energy of different brands of polymethyl methacrylate on the adherence of Candida albicans: An in vitro study p. 6
Betty Cabanillas, Adrián Mallma-Medina, Marieta Petkova-Gueorguieva, Daniel Alvitez-Temoche, Román Mendoza, Frank Mayta-Tovalino
Objective: The objective of this study was to evaluate the influence of the surface energy of different brands of polymethyl methacrylate (PMMA) on the adherence of Candida albicans ATCC 10231 in an in vitro study. Materials and Methods: The study had an in vitro, longitudinal, and comparative experimental design. The following groups were made: (1) Vitacryl versus controls (water, dimethyl sulfoxide, glycerol, diethylene glycol, and formamide); (2) Triplex versus the same controls; (3) Vitacryl versus Triplex (surface energy); and (4) Vitacryl versus Triplex (adhesion per cell/field). Adhesion was measured in the area of each field magnified 10 × 10, and with an increase in magnification to 40 × 10, very dense colonies of 0.152 mm2 were observed. Results: The surface energy of Vitacryl and Triplex was 40.3 ± 0.3 and 39.5 ± 0.3N/m, respectively, showing statistically significant differences (P < 0.001). On the contrary, in relation to the adhesion per cell/field of C. albicans, Vitacryl presented 15.7 ± 1.1, whereas Triplex had 16.7 ± 2.3, with no significant differences (P = 0.058). Conclusion: In relation to the adhesion per cell/field of C. albicans, there was no evidence of significant differences between Vitacryl and Triplex.
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Forensic evaluation of Highmore antrum sexual dimorphism by cone beam computed tomography: A retrospective study of a Peruvian population p. 13
Rosmery Bezada-Carrasco, Daniel G Suárez-Ponce, Daniel Alvitez-Temoche, Gerardo Ayala, Romel Watanabe, Doris Salcedo-Moncada, Frank Mayta-Tovalino
Objective: The aim of this study was to evaluate Highmore antrum sexual dimorphism by cone-beam computed tomography (CBCT) in a Peruvian population. Materials and Methods: This was a retrospective analytical study. The sample consisted of 190 CBCT scans. Inter-observer concordance was performed previously obtaining an intraclass correlation coefficient (ICC) of 0.99 for the width, length, and height of the right and left maxillary sinus. Then the dimensions of the maxillary sinus (left and right) were measured. All statistical analyses were performed using the Student’s t test and Lambda de Wilks, establishing a level of significance of P < 0.05. Results: It was observed that on the right side of the maxillary sinus there were only statistically significant differences between the width, height, area, perimeter, and volume of the Highmore’s antrum and sex with a P < 0.05. Statistically significant differences were observed between sex and the width, height, area, perimeter, and volume of the Highmore’s antrum in the right side of the maxillary sinus (P < 0.05), whereas the left side only showed statistically significant differences between the height and volume of the Highmore’s antrum and sex (P < 0.05). Conclusion: The maxillary sinuses have significant sexual dimorphism, with the parameter of height showing the greatest dimorphism according to the discriminant analysis.
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Productivity characteristics of the thesis rate of PhD students in biomedical areas of the different doctoral programs in Lima, Peru: A 20-year retrospective study p. 19
Alicia Fernandez-Giusti, Gerardo Ronceros, Juan Matzumura-Kasano, Luis Podesta, Jose Canchis-Aremburgo, Frank Mayta-Tovalino
Objective: The aim of this study was to determine the productivity characteristics related to the thesis rate of biomedical students of the PhD program in Health Sciences in Lima, Peru through a 20-year retrospective study. Materials and Methods: This was a retrospective, comparative, cross-sectional study. The evaluation period consisted of two time periods, 1999–2014 and 2015–2019, to differentiate thesis defense production both before and after the promulgation of the new University Law 30220 in Peru. The student population included graduates from different professional areas (Dentistry, Medicine, etc.). An electronic search for all the data was carried out by using the Universidad Nacional Mayor de San Marcos (UNMSM) SUM (Unique Registration System) software. Results: It was found that the highest prevalence of students who entered in the doctoral programs of the UNMSM Faculty of Medicine was 26.6% in 2013, whereas the highest prevalence of graduates was 24.4% in 2016. Finally, the highest prevalence of graduates who engaged in thesis defense was 41.4% in 2017. There has been a constant increase in thesis production, with the cutoff point being from 2014 onward. The Pearson’s chi-square test showed a significant association between the type of PhD program and thesis defense (P = 0.008). Conclusion: The greatest production of thesis defense was carried out from 2014 to 2019. In addition, there was a significant association between thesis defense according to the PhD program and the professional career of the PhD student; however, none of the factors associated with the influence of obtaining a PhD degree in any of the programs evaluated was statistically significant.
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The perception of undergraduate dental students toward a clinical learning environment at school of dentistry and oral health, fiji national university, fiji p. 26
Ashneeta Prasad Ali, Masoud Mohammadnezhad, William May, Russell Kabir
Background: The clinical learning environment is one of the key factors for undergraduate dental students to excel in their academic career. There has been no previous study in Fiji regarding dental students’ perception of their learning environment. Aim: This study aimed at investigating the perception of undergraduate dental students toward the clinical learning environment at the School of Dentistry and Oral Health (SDOH), Fiji. Materials and Methods: This is a cross-sectional prospective study conducted among 157 undergraduate dental students, all of whom were selected from three undergraduate dental programs. The modified 24-item Dental Clinical Learning Environment Inventory (DECLEI) was used to assess students’ perceptions. The mean DECLEI score was interpreted as follows: ≤19.9 is very poor perception, 20–39.9 is poor perception, 40–59.9 is moderate perception, 60–79.9 is good perception, and >80 is excellent perception toward the clinical learning environment. A correlation test was used to examine the relationship between independent variables and DECLEI scores. P < 0.05 was considered as level of significance. Results: The response rate was 82.8%. Majority of the participants (76.9%) were in the age range of 20–29 years, were females (72.3%), and were Fijians of Indian descent (75.4%). The mean DECLEI score was 70.83 ± 9.11 which could be interpreted as a good perception toward the clinical learning environment. Age and gender had a statistically significant negative correlation with DECLEI scores (P < 0.05). Conclusion: The dental clinical learning environment at SDOH can be perceived as “good”; however, issues related to patients’ missing appointment were highlighted.
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Oral health-related quality of life of adult Orang Asli in Jelebu, Malaysia: A cross-sectional study p. 33
Wan Mohamad Nasir Othman, Muslimah Ithnin, Wan Nur Alwani Wan Abdul Aziz, Wan Nor Syariza Wan Ali, Haslinda Ramli
Aims: This study aimed at exploring the self-perception of Orang Asli (OA) from the Temuan tribe in Jelebu by using the Global Self-rated Oral Health (GSROH) and General Oral Health Assessment Index (GOHAI). Materials and Methods: It was a cross-sectional study involving a two-stage sampling to select the district and villages. A total of 325 participants were selected based on convenience sampling. Results: Almost half of the participants rated their oral health as poor or average. The mean GOHAI score was 52.96 (±7.749), ranging from 29 to 60. The GOHAI score was statistically significantly lower for female gender (P = 0.025), lower education level (P = 0.001), and elderly (P = 0.001). The GSROH score was also statistically significant with GOHAI score (P = 0.001). Conclusions: A limited number of studies were conducted in this area, particularly in the vulnerable population of OA. Our study found that half of the OA living in the fringe had a poor GOHAI score. It is, therefore, suggested that potential study and intervention programs concentrate on the low GOHAI score group; the male, lower educational context, and the elderly.
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Comparison between integrated and parallel interlock designs of an extra-coronal attachment-retained distal extension removable partial dentures: A clinical trial p. 41
Maria R Reslan, Essam Osman, Lucette Segaan, Mohammad Rayyan, Christelle Joukhadar, Mohamed fattouh
Objective: Precision attachments may exert unfavorable stresses on abutments in distal extension bases. This study compared between two reciprocation designs in attachment removable partial dentures (RPDs). Materials and Methods: Fourteen patients were allocated into two groups. Each patient received an attachment-retained RPD with one of the two types of attachments being studied. Group I received the integrated interlock type of reciprocation and group II received the parallel interlock type. Abutments were examined for modified plaque index, modified bleeding index, periodontal probing pocket depth, clinical attachment level, and modified papillary bleeding Index. Results: Comparisons of periodontal parameters between mesial and distal abutments within each group revealed no statistically significant difference. Means of these parameters were used for the comparisons. There was a significant difference at P < 0.05 in all parameters between the two groups at time of insertion and at 3, 6, and 9 months of follow-up with values of group (II) higher than group (I). Conclusion: RPDs of both designs showed an increase in periodontal parameters. Integrated interlock design showed better scores. It is preferable to use the attachment-retained RPD with integrated interlock instead of parallel interlock design.
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Evaluation of cognitive impairment in Type 2 diabetic patients with chronic periodontitis: a cross-sectional study p. 50
Shikha Sharma, Sangeeta Umesh Nayak, Ashita Uppoor, Satish Rao, Keshava Pai, Srikant Natarajan
Background: Type 2 diabetes mellitus is an important risk factor for dementia; it also shares a bidirectional relationship with periodontitis. It is hypothesized that the increased severity of periodontitis is associated with cognitive decline in patients having uncontrolled diabetes mellitus. An added risk for future development as well as progression of dementia may be prophesied in such a scenario. Therefore, the present study was conducted to find a correlation between the cognitive impairment (CI) and periodontitis in type 2 diabetes mellitus patients. Materials and Methods: A total of 160 older adults aged ≥60 years in Mangalore, Karnataka, India, were included in the present analysis. Known T2DM patients aged ≥60 years and diagnosed with periodontitis with a minimum clinical attachment loss (CAL) of ≥2 mm were considered in the present study. Montreal cognitive assessment test assessed the CI. The analysis was carried out using the χ2 test, an independent t-test. Binary logistic regression analysis (enter method) was performed to derive the odds ratios (95% confidence interval). Results: The study included 160 participants, out of which 120 had CI and 40 did not have CI. A statistically significant association was observed between moderate-to-severe periodontitis, HbA1c levels ≥7%, and CI after excluding the confounding factors like age, gender, diet, lifestyle habits, and education. Conclusion: In the present study, cognitive impairment was found to coexist with HbA1c levels ≥7% and moderate-to-severe periodontitis in the elderly diabetics. The clinical implication of these findings adds opportunities to form disease modifiable areas in the elderly diabetic population at a risk for the development of dementia. Additionally, the impact of pre-existing CI on progression of periodontitis and vice versa has been discussed.
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Influence of a low-carbohydrate and rich in Omega-3 fatty acids, ascorbic acid, antioxidants, and fiber diet on clinical outcomes in patients with chronic gingivitis: A randomized controlled trial p. 58
Savan Sunari Rajaram, Swet Nisha, Nada Musharraf Ali, Pratibha Shashikumar, Shaswata Karmakar, Vijayendra Pandey
Background: Nutrition has a significant impact on the pathophysiology of periodontal disease. Both micro- and macronutrients have an impact on periodontal health. This study aimed at the evaluation of the effects of a diet low in carbohydrate and rich in omega-3 fatty acids, ascorbic acid, antioxidants, and fiber on clinical outcomes in patients with gingival inflammation for four weeks. Materials and Methods: Overall, 54 systemically healthy subjects were enrolled in this study. The clinical trial consisted of two groups: Group A (test group) (n = 27) was instructed to consume a diet comprising low carbohydrates, rich in omega-3 fatty acids, ascorbic acid, antioxidants, and fibers for the next four weeks; in Group B (control group) (n = 27), no alteration in dietary behavior was done, and these subjects were instructed to have their daily routine diet. Clinical parameters measured were plaque index (PI), gingival bleeding index (GI), probing depths (PD), clinical attachment level (CAL), and bleeding on probing (BOP) at one week without any dietary changes (baseline) for both the groups, followed by a one-week adaptation period; then, the parameters were checked on a weekly basis for the next four weeks. Results: Primary clinical outcome BOP and secondary outcome GI showed significant changes in the test group compared with the control group (P < 0.05). However, no significant changes were seen in the plaque scores in the test group (P > 0.05). The degree of diet compliance on the clinical parameters (PI, GI, and BOP) was assessed by using regression analysis. Conclusion: Dietary recommendations can be beneficial in managing gingival and periodontal inflammation. Nutritional interventional studies as monotherapy are required to evaluate the clinical significance of diet in periodontal therapy.
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Knowledge, attitude, and perception among endodontists toward regenerative endodontics: A cross-sectional survey of four Indian universities p. 68
Arun Mayya, Rajaram Naik, Maria Priya Paul, Swathi Amin, Shreemathi S Mayya
Background: Regenerative endodontics is a rapidly developing field in dentistry. However, the regenerative endodontic procedures are not familiar to many clinicians in India. Aim: This survey aimed at assessing the level of knowledge, attitude, and perception (KAP) among endodontists toward regenerative endodontics. Materials and Methods: A cross-sectional survey was conducted in the year 2019 to collect data. A questionnaire to collect data on KAP toward regenerative endodontics was administered to 49 faculty and 69 postgraduate students of endodontics from four universities. The Chi-Square test and logistic regression were applied to study the association between KAP and demographic variables. Spearman’s rho was computed to study the correlation between KAP scale scores of the participants. The data were analyzed by using Statistical Package for the Social Sciences software program (SPSS), version 15.0 (South Asia, Bangalore). Results: The survey yielded an overall response rate of 81%. Less than 50% of the participants had sound knowledge, 65% had a positive attitude, and only 21% had a positive perception about Regenerative Endodontic Procedures (REPs). Most of the participants (86.5%) were of the opinion that regenerative therapies should be a part of dentistry. Majority of the participants (89.6%) were inclined to receive training in REPs. About 80% of the participants felt that the higher cost of treatment is a significant hurdle for patients to accept REPs. Less than half the participants (41.7%) were using REPs in their clinical practice, such as the use of membranes, scaffolds, and revascularization. Conclusion: Endodontists have a positive attitude toward the use of regenerative therapies. However, there is a deficiency of training in REPs in dental colleges.
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Evaluation of reparative dentine bridge formation after direct pulp capping with biodentine p. 77
Anh Huynh Bui, Khoa Van Pham
Aim: To evaluate the capability of Biodentine for direct pulp capping in permanent teeth. Materials and Methods: The pulp of 11 human intact premolars were mechanically exposed in standard cavity dimensions and then capped with Biodentine for direct pulp capping. After 9–12 weeks, all teeth were extracted. All teeth were scanned using intraoral radiograph or cone-beam computed tomography (CBCT) scan before, right after pulp capping therapy, and after 9–12 weeks on both patient real and extracted teeth for evaluation of reparative dentin bridge formation. All clinical symptoms and signs were also recorded. Data were collected and analyzed using the MedCal statistical software at the significance of 0.05. Results: There was reparative dentin bridge formation in all experimental teeth, on both patient real and extracted teeth. Conclusions: The Biodentine could induce the formation of reparative dentin in direct pulp capping. The CBCT scan was the reliable modality for evaluation of dentin bridge formation.
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Mothers' knowledge, attitudes, and fears about dental visits during the COVID-19 pandemic: A cross-sectional study p. 83
Deema Farsi, Nada Farsi
Objectives: This study aimed to assess mothers' knowledge of coronavirus disease 2019 and to evaluate their attitudes and fears about dental visits during the pandemic. Materials and Methods: A structured questionnaire, developed in English and Arabic, adapted from previous questionnaires was remotely applied to a sample of 833 mothers of children aged 17 years and younger, from different socioeconomic backgrounds. Eligible participants were encouraged to invite others. The questionnaire collected information on knowledge about COVID-19, dental visit patterns, willingness of mothers to take their children to the dentist, and factors affecting it during the pandemic. Frequencies and percentages of categorical variables were presented, and predictors of willingness to visit a dentist during the pandemic were examined by logistic regression. Results: Mothers who perceived the dental clinic to be of less or similar danger to public places were more willing to take their children to the dentist during the pandemic than were those who perceived it to be more dangerous (odds ratio [OR] = 2.9, 95% confidence interval [CI]: 1.2–7.0; OR = 2.3, 95% CI: 1.1–4.8, respectively). Mothers who were willing to go to the dentist during the pandemic were more likely to take their children to the dentist compared with mothers who were not willing to go themselves, OR = 16.9 (6.0–47.1). The most commonly reported barrier to visiting the dental clinic was fear of contracting the virus from someone there (80%). Most parents did not take their child to the dentist during the pandemic (83%), and 24% of those who had an appointment did not allow their children to attend. Conclusion: Mothers were unlikely to take their children to the dentist except for an emergency and perceived the dental clinic as a risky place for contracting the virus. More reassuring information about infection control measures at dental clinics should be delivered to this population.
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A retrospective cohort study to evaluate the association between types of nonsyndromic oral clefts and a child’s gender and maternal age p. 92
Raed H Alrbata, Hussein Y Almaaiteh, Mohammad N Albdour, Raghda W Alshammout
Aims: To evaluate the association between nonsyndromic cleft lip with or without cleft palate (NSCL±P) anomaly and the affected child’s gender and maternal age. Materials and Methods: Records of 141 newborns received at the orthodontic craniofacial clinic of the Jordanian Royal Rehabilitation Center between 2017 and 2019 were retrospectively analyzed. Two variables were paid attention to: child’s gender and maternal age. Five cleft types were considered: unilateral CLP (right; URCLP and left; ULCLP), bilateral CLP (BCLP), isolated cleft palate (CP) and isolated cleft lip (CL). Maternal age was classified into four subgroups: “26–30” years, “31–35” years, “36–40” years, and “above 40” years. Chi-square test and multinomial logistic regression analysis were used to analyze the resultant data. Results: A significant occurrence of the NSCL±P in females was found compared with males. The different cleft types were found to be significantly associated with the different maternal age groups investigated. The ULCLP was the most prevalent cleft type for affected children among all maternal age groups except the “31–35” group, at which the BCLP exceeded. Conclusions: The children’s gender and the maternal age have a significant impact on defining the developing oral cleft types.
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Reciproc endodontic file surface defects after single use: An SEM analysis p. 98
Mohammed Howait
Objective: The aim of this investigation was to detect defects that may occur to Reciproc endodontic files after a single use. Materials and Methods: A sample of convenience of Reciproc files (VDW GmbH, Munich, Germany) that were used to prepare root canals of anterior or posterior teeth were collected. The files were divided equally into two groups: Group 1 (R25) files were used to prepare mesial root canals of 50 human permanent mandibular molars, and Group 2 (R40) included 50 files that were used to prepare permanent maxillary incisor teeth. Files were analyzed after single use by using a scanning electron microscope at X120 to detect changes in surface morphology. The data were statistically analyzed by using the χ2 test, and statistical significance was set at P < 0.05. Results: A total of 96 Reciproc NiTi files were collected; of those, 67 (70%) were unaffected and 29 (30%) showed overall surface deformations. The types of deformation were blade disruption (22%), surface pitting (12%), and unwinding and tip deformation (1%). No microcracks were detected, and none of the studied files showed fracture. R40 was three times more likely to be deformed and showed blade disruption compared with R25 (P < 0.05). Conclusions: Reciproc rotary NiTi files show high resistance to deformation after a single use. Blade disruption was the most frequent defect occurring in both the small and large files.
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Survey of mental health of dentists in the COVID-19 pandemic in the UK p. 104
Meena Satish Ranka, Satish R Ranka
Aim: To assess the impact of work-related changes on the mental health (MH) of dentists during the peak of COVID-19 pandemic in the UK. Materials and Methods: Dentists involved in certain treatments, for example, high-speed drilling procedures, generate infectious aerosols. These Aerosol Generating Procedures (AGPs) are at the highest risk of transmission of coronavirus. During the COVID-19 pandemic, a significant number of dentists in the UK were restricted from providing treatments to reduce the risk of viral transmission. Some of the dentists providing urgent dental treatment were involved in AGPs. Significant and sudden changes in the delivery of dental care in the current pandemic may have impacted the MH of dentists. An online survey was conducted, using validated tools to measure the MH symptoms and stress. Pearson’s chi-squared test of independence was used for statistical analysis. Results: Overall, 123 dentists participated in the survey. The prevalence of anxiety-related symptoms was 71% (95% CI 0.62–0.78), depression-related symptoms was 60% (95% CI 0.51–0.68), and stress was 92% (95% CI 0.86–0.96). Dentists working in the independent sector had more psychological symptoms compared with those in the public sector (P = 0.014). Conclusions: Working in the public sector appeared to have a protective effect. Almost all the dentists in this survey were experiencing MH symptoms and stress. Further research is needed to assess the long-term effect of the COVID-19 pandemic on dentists.
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Management of peri-implant mucositis of multiple osseointegrated implants using a modified free gingival graft “Punch technique” in the total edentulous area: A case report p. 109
Frank Mayta-Tovalino, José Rosas, Franco Mauricio, Silvia Luza, Daniel Alvitez-Temoche, Cesar Mauricio-Vilchez
The purpose of this case report was to describe a technique to modify the free gingival graft by perforations within the graft to guarantee a horizontal increase in the keratinized mucosa in the anteroinferior sector of a total edentulous mandible after osseointegration of previously placed dental implants in a hybrid prosthesis protocol. A 71-year-old male underwent free modified gingival graft surgery with perforations at the level of each implant. At 3 months, the mucosa appeared to be healthy and keratinized, especially at a horizontal level around the implants previously diagnosed with mucositis, providing the patient with satisfactory results. Finally, the hybrid prosthesis was cleaned and polished due to the presentation of a hard plate at the level of the abutments. Within the limitations of this case report, further research is needed to evaluate the long-term efficacy of this modification to the free gingival graft.
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Reviewers List, 2020 p. 114

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