Is clindamycin-modified triple antibiotic paste better than iodoform-based medicament for the treatment of non-vital primary molars using LSTR technique – A randomised clinical trial

Objectives: The objectives of this study were to evaluate and compare the success rate of local application of iodoform-based obturating material (Pulpotec – [Produits Dentaires S.A., Switzerland]) and clindamycinmodified triple antibiotic paste (ClinM-TAP) in pulp chamber using minimally invasive endodontic treatment of carious primary molars indicated for pulpectomy, for 12 months, using clinical and radiographic parameters. Materials and Methods: A randomised clinical trial was conducted in 60 children in the age group of 3–8 years reporting carious primary molars with symptoms of irreversible pulpitis and pulpal involvement clinically, allocated into Group 1 (30) and Group 2 (30). In Group 1, Lesion sterilisation and tissue repair (LSTR) was done using Pulpotec (Produits Dentaires S.A., Switzerland) as medicament and in Group 2, ClinM-TAP (Clindamycinmodified triple antibiotic paste) was used as medicament. Clinical follow-up was done at 3, 6 and 12 months; radiographic follow-up was done at 6 and 12 months. Clinical parameters compared were tenderness on percussion, spontaneous pain, intraoral swelling and sinus/fistula. Radiographic comparison was done based on furcation radiolucency, root resorption and bone regeneration. Both intergroup and intragroup statistical analysis was done using Chi-square test or Fisher exact test, Cochran’s Q Test and Mann–Whitney U-Test for the test of significance. All the statistical tests were performed at 5% significance level. Results: The mean age of patients in the study was 5.25 ± 1.3years with 45% males and 55% females. Both groups showed significant improvement in terms of clinical symptoms from baseline to 12 months. On intergroup comparison clinical parameters, TOP was present in 11.2% and 44% of cases at the end of 12 months in Groups 1 and 2, respectively (P < 0 0.05). On intergroup comparison of radiographic parameters, at the end of 12 months, furcation radiolucency was seen in 32% and 73% (P < 0.05) and root resorption was seen in 16% and 30% cases in Group 1 and 2, respectively (P > 0.05). Overall clinical success rate of Group 1 and Group 2 was 88% and 50%, respectively (P < 0.05) and radiographic success rate was 60% and 27%, respectively (P < 0.05). Conclusion: LSTR using Pulpotec as a medicament has shown promising results in the present study. It could be a better alternative to conventional endodontic treatment in primary teeth. In the present study, ClinM-TAP has shown poor radiographic success; hence, it should be used with caution.

A Clinicodemographic Study of Leprosy in Elderly: 8-Year Data from a Tertiary Care Centre in North India

The changing demographics of India due to better life expectancy has led to significant increase in the geriatric population. Physiological changes due to aging lead to altered biological response to disease as well as coping with it. There are very few published studies that have addressed the issue of geriatric leprosy. This was a retrospective record review of 8-year data from a tertiary care centre in North India of leprosy patients aged 60 years or more. Clinical and demographic details were noted. Data was compared with 154 other leprosy patients aged 18-59 years. Out of 1083 leprosy cases, 80 (7.4%) were elderly and 67.5% of these were males. Majority (92.5%) were in the multibacillary (MB) spectrum. Type 2 reactions were more commonly seen than type 1 reactions in this age group. Pre-existing co-morbidities were present in 52.5% of patients. Grade 2 disability (G2D) was noted in 13.8% of cases, all of whom were in MB spectrum. Comorbidities were significantly higher amongst the elders whereas nerve involvement and G2D rates were higher amongst other leprosy patients (18-59 years). The prevalence of geriatric leprosy is on the rise due to better life expectancy. The high MB rate and G2D rate in geriatric population is a cause of concern for ongoing disease transmission and leprosy control programs. Due to a higher proportion of patients having pre-existing co-morbid conditions and polypharmacy, this sub-group needs special attention and care after release from treatment

Exacerbation of Erythema Nodosum Leprosum Possibly Triggered by COVID-19 Vaccine : A Case Repor

Erythema nodosum leprosum (ENL) is an immune complex mediated type III hypersensitivity reaction seen in patients of borderline lepromatous and lepromatous leprosy. It can be caused by a wide array of triggers and can be seen before, during, or after completion of anti-leprosy therapy. There are multiple well-known triggers for type 2 reactions like the initiation of multidrug therapy, Mantoux testing, vaccination, mental and physical stress, and physiological states like pregnancy. Herein, we report a case of exacerbation of ENL in a middle-aged woman, probably due to COVID-19 vaccine while she was well-controlled on immunosuppressive therapy. The episode was treated with non-steroid anti-inflammatory drugs and oral steroids and the symptoms resolved within 2 weeks. Although causality was highly possible between the occurrence of ENL and COVID-19 vaccine, physicians should be aware that it can be easily managed with proper care and medicines and this should not be a basis for deferring the vaccine.

Challenges Faced by People Affected with Leprosy During the COVID-19 Pandemic: A Questionnaire Based Study

This study aims to assess the continuity of medical care, the impact on disease condition and to highlight the major challenges faced by people affected by leprosy during the pandemic. Telephonic questionnaire-based survey was conducted among previously registered patients of leprosy at referral hospitals in India. Leprosy affected people aged >18 years, either on treatment or who had completed treatment with access to phone and willingness to participate were included. The questions were asked pertaining to demographic details, baseline disease characteristics and various problems faced during lockdown relating to livelihood, finances, treatment, and mental status. A total of 196 patients consented to participate in the study. Mean age of study participants was 37.31 (13.86) years, male participants (n=123, 62.7%) were more than females (n=73, 37.2%). Overall, 101 patients (51.5%) experienced exacerbation, 21 patients (10.7%) reported improvement and 74 patients (37.8%) reported no change in disease status during the pandemic. Most common difficulty faced was the procurement of medicines (115 patients, 58.6%) followed by difficulty in diagnostic testing (61 patients, 31.1%). Course of treatment was interrupted in 16 patients. Most of the patients (n=147, 75%), agreed that teleconsultation services would aid in management of their disease. The majority of patients (88.2%) were able to continue some form of treatment. Two patients (1%) tested positive for COVID-19. Nearly all patients (n=189, 96.4%) were informed regarding the risks and preventive measures related to COVID-19. Fifty percent of the patients reported deterioration in mental health due to the pandemic. The present study highlights the gaps in healthcare delivery and social inequalities along with their impact on the health, livelihood and mental status of people affected by leprosy during the current COVID-19 pandemic.

Papillary tumor in pineal region: Immunohistochemistry meeting the diagnostic challenge

Papillary tumor of pineal region (PTPR) is extremely rare and poses diagnostic challenge with other central nervous system tumors having papillary architecture. Immunohistochemistry is crucial for a definitive diagnosis of PTPR.

Isolated pancreatic tuberculosis.

Isolated pancreatic tuberculosis (TB) is extremely rare, even in countries where TB is endemic. The recent increased reporting of TB of the pancreas is related to a worldwide increase in TB and an increase in emigration from countries where TB is endemic into countries where more sophisticated healthcare and diagnostic facilities are available. Herein, we report an unusual case of isolated pancreatic region TB, which presented with dyspeptic symptoms and was diagnosed by ultrasonography-guided needle aspiration and computed tomography scan of the abdomen. This case is unique with regard to abundant bacterial load, as evident by Ziehl Neelsen staining and absence of evidence of TB elsewhere. Pancreatic TB should be considered as a differential diagnosis of a pancreatic mass and most patients have an excellent clinical response to standard antituberculosis regimens.

Influence of colchicine on pulmonary silicotic fibrogenesis in rats.

With an aim to evaluate the antifibrotic action of colchicine in experimental model of pulmonary silicosis, the effect of colchicine on developing and developed pulmonary silicosis induced by quartz was studied in rats in vivo and on alveolar macrophages exposed to quartz particulates in vitro. A progressive increase in wet and dry weight of lungs exposed to quartz dust alone, and quartz dust and colchicine injected orally was investigated. An increase in collagen contents, with lapse in time, in animals exposed intratracheally to quartz dust, or exposed similarly to quartz dust but receiving colchicine simultaneously through oral route was observed. A blindfold evaluation of histological sections of lungs of silicotic animals with or without colchicine administration during development of lesions did not reveal any difference between two groups of silicotic rats. Administration of colchicine for 4 weeks after the lesions were developed neither inhibited nor retarded the laying down of collagen. The studies were extended to investigate the effect of colchicine on quartz-induced alveolar macrophage cytotoxicity. The presence of varying concentrations of colchicine in the culture medium did not significantly alter cytotoxic potential of quartz. The results reveal that colchicine administration during the development of and on developed silicosis does not significantly alter pathogenesis of silicotic lesions. At the cellular level colchicine does not modulate quartz-induced alveolar macrophage cytotoxicity, believed to be a significant event for the onset of pulmonary silicotic fibrogenesis.

Leprosy and herpes zoster; an association or dissociation?

Nerve involvement is common to the pathogenesis of both leprosy and herpes zoster. We report two cases of borderline leprosy in which the skin lesions characteristically spared the healed zoster scar. Possible mechanisms and relationship are discussed.

Pattern of injuries in a hydro-electric project.

A study of work-related injuries at a hydro-electric project site (May 1991-April 1992) was undertaken to determine the incidence and pattern of the injuries out of a total number of 119 injuries in the year. A significant proportion of these were orthopaedic in nature and the commonest site of injury was limbs (both upper and lower limbs) like auto-amputations and head injuries. A large proportion of these accidents (24.37%) resulted in permanent disability likely to interfere in the normal activities or locomotion of those injured.