Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 Infection During the First and Second Waves of the Pandemic

Objectives To compare the clinical profle and short-term outcome of children admitted with acute SARS-CoV-2 infection during the frst and second waves of the Coronavirus Disease (COVID-19). Methods This retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confrmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay. Results One thousand and twenty-four children were recruited, 592 of the frst wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR=3.38) and neurological manifestations (OR=4.61). There was a higher requirement of intensive care (OR=4.2) and invasive mechanical ventilation (OR=4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the diference was not statistically signifcant. Children with neurological comorbidities (OR=8.73), malnutrition (OR=3.01), and preterm babies (OR=6.8) were associated with severe COVID. Conclusion The clinical profle of the second wave of COVID-19 in children was diferent from the frst wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a signifcant increase in the incidence of severe infections requiring ICU care was observed.

Childhood posterior circulation arterial ischemic stroke – An unusual case with a possible COVID-19-related arteriopathy

Viral infections are known to increase predilection to stroke and coronavirus disease 2019 (COVID-19) has proven these concerns true. We are presenting the case of a 6-year-old previously normal male child diagnosed with posterior circulation stroke who had all etiological workups negative except for the COVID antibody. Imaging showed thrombi over the V3 segment of the vertebral artery at C1–C2 level causing near complete occlusion, with embolic infarct in the bilateral posterior inferior cerebellar artery, bilateral posterior cerebral artery, bilateral anterior inferior cerebellar artery, and the left superior cerebellar artery. The child was managed with methylprednisolone, anticoagulation, and supportive care and was able to restore near-normal neurological status within months. This case is unique in terms of the involvement of posterior circulation which is rare in the pediatric population. A possibility of inflammation-related arteriopathy secondary to infection should be considered in the etiological workup of stroke. Anti-inflammatory measures to control cytokine storm along with supportive care will ensure a good outcome.

Effect of low intensity ultra sound on bone regeneration and healing: a systematic review

ABSTRACT Objective: Low Intensity Pulsed Ultra Sound (LIPUS) is found to have stimulatory effect on bone healing and regeneration. This review aimed to assess whether LIPUS enhances bone regeneration and healing in terms of efficiency in improving clinical, radiographic, histologic parameters or serum and tissue biomarkers. Methods: A comprehensive search based on PRISMA guidelines with pre-determined eligibility criteria was conducted to identify randomized controlled clinical trials evaluating effectiveness of Low intensity pulsed ultrasound in bone regeneration and healing. The title and abstract of the entries in all languages yielded from the PubMed, Google scholar and Cochrane library were screened. Results: 14 eligible Randomized controlled trials testing the effectiveness of LIPUS was evaluated. More heterogeneity was seen in the screened studies with respect to sample characteristics, type of bone and outcome measures. The studies that screened histological parameters state that LIPUS is significantly beneficial than control. In terms of time for radiographic union, most of the studies stated that LIPUS was more effective than control but numberof studies are very few. Whereas studies which evaluated parameters such as healing time and radiographic union were showing highly inconsistent results regarding effectiveness of LIPUS. Conclusion: This review cannot give a definitive conclusion that LIPUS is effective in bone healing with respect to clinical parameters but a positive influence on radiographical and histological parameters in bone healing and regeneration is promising to pursue future research.

Nod-like receptor protein 3 inflammasome in head-and-neck cancer

Activation of inflammasomes has a decisive role in host defense mechanism against pathogens and other intracellular risk factors, but recently, it has been revealed that they play a significant role in the pathogenesis of several diseases, including cancer. Nod-like receptor protein 3 (NLRP3) inflammasome, the best-studied inflammasome, has contrasting roles in cancer development and progressions. In head-and-neck cancers, the upregulated level of NLRP3 promotes tumor progression. The main objective of this review is to provide current knowledge on the involvement of NLRP3 inflammasome in head-and-neck cancers. Deeper understanding of the biology of this dynamic protein complex provides new scope for the development of more effective anticancer therapies

Cancer burden and alarm signals: a community based study from Kerala, India

Background: Cancer is emerging as a major public health concern in many countries including India. Kerala state has the highest burden of cancer in the country. Objective of this study was to estimate the prevalence of diagnosed cancers, warning signs and selected risk factors of cancer in Kadapra Panchayath of Pathanamthitta district, Kerala.Methods: A total of 16,391 population was covered by door to door survey using a structured questionnaire. The questionnaire collected information on the sociodemographic variables of the residents, source of water supply, warning signs of cancer and details of diagnosed cancer cases.Results: The mean age of the population was 40.9+21 years. The prevalence of diagnosed cases of cancer in our study population was 776/100,000 population. Breast cancer was the most common cancer (43.5%) identified in the population. The prevalence of any warning sign among the study population was 220/100,000 population. Breast lump was the common warning sign identified. Increasing age and female gender were the factors found to be significantly associated with cancer.Conclusions: As prevalence of cancer was found to be high in this population, an active community based screening along with teaching self-breast examination to the women in the community are required. Improving community awareness could help in early diagnosis, treatment and prevention. Soil and water testing for carcinogens is recommended.

Periodontal vaccines: a systematic review / Vacinas periodontais: uma revisão sistemática

Background: vaccination is the best known application of immunology to human health. Effective vaccines have successfully eradicated the prevalence of several infectious diseases that were common less than a generation ago. The success of Periodontal vaccines is still elusive due to the complexity of periodontal pathogens that have multiple serotypes. No periodontal vaccine trials have satisfied all the requirements such as preventing colonization of pathogens, protection against tissue destruction and alveolar bone loss, elicit immunoglobulins for phagocytosis, stimulation of T-helper cells. This review aims to discuss the various immunization strategies attempted so far. Objective: this review aims to discuss the various in-vitro and in vivo studies that present supporting evidence for the feasibility of formulating a prophylactic periodontal vaccine that could emerge as an adjunct to mechanical therapy in the future. Material and Methods: an extensive literature Search was performed in electronic databases, such as PUBMED, Cochrane central register of controlled trials, Google scholar and science direct using various search terms such as " periodontal vaccines", " porphyromonas gingivalis", "chronic periodontitis", " genomic vaccine ", " recombinant vaccine", "immune response", " vaccination against periodontal bacteria". No limits and language restriction were applied during the electronic search to include all the possible animal studies, clinical trials in the potential relevant article search phase of the systematic review. Conclusion: Studies evaluating Porphyromonas gingivalis are the most common and the structures showing the most potential as a vaccine candidate are Outer membrane proteins, fimbriae and gingipains, the structure having the least potential is Lipopolysaccharide. (AU)

Fundamentação: a vacinação é a aplicação mais conhecida da imunologia à saúde humana. As vacinas eficazes erradicaram com sucesso a prevalência de várias doenças infecciosas que eram comuns há menos de uma geração atrás. O sucesso das vacinas periodontais ainda é ilusório devido à complexidade de patógenos periodontais que possuem múltiplos sorotipos. Nenhum estudo de vacina periodontal atendeu a todos os requisitos, como prevenção da colonização de patógenos, proteção contra destruição de tecidos e perda óssea alveolar, estimulação de imunoglobulinas para fagocitose, estimulação de células T auxiliares. Esta revisão tem como objetivo discutir as várias estratégias de imunização tentadas até o momento. Objetivo: esta revisão tem como objetivo discutir os vários estudos in vitro e in vivo que apresentam evidências de apoio à viabilidade de formular uma vacina periodontal profilática que possa emergir como um complemento da terapia mecânica no futuro. Material e Métodos: Foi realizada uma extensa pesquisa bibliográfica em bancos de dados eletrônicos, como PUBMED, registro central de ensaios controlados Cochrane, Google Acadêmico e science direct, usando vários termos de pesquisa como "vacinas periodontais", "porphyromonas gingivalis", "periodontite crônica" , "Vacina genômica", "vacina recombinante", "resposta imune", "vacinação contra bactérias periodontais". Nenhum limite e restrição de idioma foi aplicado durante a busca eletrônica para incluir todos os possíveis estudos em animais e ensaios clínicos na fase de busca de artigos potencialmente relevantes da revisão sistemática. Conclusão: Estudos avaliando Porphyromonas gingivalis são os mais comuns e as estruturas que mostram maior potencial como candidato a vacina são proteínas de membrana externa, fímbrias e gengivinas, a estrutura com o menor potencial é lipopolissacarídeo.(AU)

Assessment of Maximum Bite Force in Oral Submucous Fibrosis Patients: A Preliminary Study

Abstract Objective: To determine the maximum bite force (MBF) in oral submucous fibrosis (OSMF) patients and to compare them with that of healthy subjects. Material and Methods: Twenty patients who were clinically confirmed, as OSMF and 20 healthy controls matched for age, gender, and number of intact functional teeth were included in this study. For each subject, age, gender, weight, height and body mass index (BMI) were recorded. The MBF registration was carried out by the two evaluators, who were previously calibrated. Bite force was measured in the first molar region using a force transducer occlusal force meter for each subject seated at the upright position, with Frankfort's plane nearly parallel to the floor, and no head support. The Student's independent t-test was used to determine the statistical significance in relation to mean height, weight, BMI and the presence of number of intact teeth and MBF between the healthy subjects and OSMF individuals. A comparison of grades of OSMF with all variables was carried out by one-way ANOVA test. Results: No significant difference was found in mean age, mean height, weight, BMI and the presence of the number of intact teeth between healthy individuals and OSMF patients. The mean MBF in healthy subjects was 628.23 ± 24.39 N and 635.47 ± 31.22 N in OSMF patients. Even though the healthy subjects reported a higher MBF than OSMF patients did, the difference was statistically non-significant. With regards to sides, no significant difference was observed in mean MBF in healthy subjects and OSMF patients on the right (p=0.7818) and left side (p=0.6154). Conclusion: The healthy subjects reported higher MBF values than OSMF patients did and the difference was statistically non-significant.

Development And Validation Of Uv-Visible Spectrophotmetric Method For The Simultaneous Estimation Of Emtricitabine And Tenofovir Alafenamide In Bulk And Tablet Dosage Form

Abstract: A simple, rapid, accurate and economical method has been developed for thesimultaneous estimation of Emtricitabine and Tenofovir Alafenamide in tablet dosage form.The linearity of the method was found to be in the range of 10.8µg/ml- 12.8µg/ml forTenofovir Alafenamide and 86.4µg/ml-102.4µg/ml for Emtricitabine. From the developedmethod the drugs showed maximum absorbance at 263 and 281nm for Tenofovir Alafenamideand Emtricitabine respectively. The percentage purity of the drugs was found as 96.8 and97.6%w/w for Tenofovir Alafenamide and Emtricitabine respectively. The method was alsofound to be accurate, precise, robust and rugged. The limit of detection and the limit ofquantification were found to be 0.234µg/ml and 0.710µg/ml for Tenofovir Alafenamide and2.25µg/ml and 6.83µg/ml for Emtricitabine respectively..

Safety-pin Induced Hemopericardium and Cardiac Tamponade in an Infant

Background: Safety-pin ingestion causing cardiovascular complications are very rarewith high risk for mortality. Case characteristics: A 10-month-old child who presentedwith persistent irritability and intermittent fever of 1 month duration. The child hadtachypnea and mild subcostal retractions. Observation: Investigations revealed opensafety-pin in lower esophagus, and pericardial effusion that later progressed to cardiactamponade during handling of the safety pin by endoscope. Message: It may be safer todrain pericardial collection before handling sharp foreign bodies in lower end of esophagusas it can worsen cardiac complications.

Role of endothelin‑1 in periodontal diseases: A structured review.

Background and Objective: Endothelin‑1 (ET‑1) is a 21‑amino acid peptide and is a potent vasoconstrictor produced by endothelial cells. It plays a role in the development of diseases such as hypertension and atherosclerosis. Previous studies have identified ET‑1 in gingival tissues obtained from patients affected by chronic periodontitis or gingival overgrowth. Thus, there is a need to appraise the role of ET‑1 in periodontal disease. Materials and Methods: The electronic search strategy included the databases such as PubMed, PubMed Central, LILACS, MEDLINE, ScienceDirect, MeSH, Cochrane database of systematic reviews, and EMBASE databases. Hand search of relevant journals was also carried out until September 2013. The included studies were both cross‑sectional and longitudinal performed in vivo/in vitro, which measures the expression of ET‑1 from various cells of the periodontium and in periodontal disease. Further, studies assessing the factors which influence ET‑1 expression were included in the study. Results: A total of 15 articles were found relevant and fulfilled the inclusion criteria posed in this review. Ten studies discussed the concentration of ET‑1 in periodontal disease, whereas eight studies investigated the cells expressing ET‑1. Nine studies assessed the factors influencing ET‑1 expression and two studies evaluated the influence of ET‑1 on inflammatory mediators and other cytokines. The results suggested that ET‑1 is elevated in periodontal diseases and is influenced by inflammatory cytokines and periodontal pathogens. Conclusion: ET‑1 was found to have a role in periodontal disease, but further research will be required to substantiate its use as a biomarker.

Aesthetic Papillary Reconstruction – A Case Report of a New Technique Using Connective Tissue Graft.

Lost interdental papilla- commonly known as ‘black triangles’ are of great concern from the aesthetic as well as phonetics point of view when occurs in the anterior maxillary region. This causes an enormous effect on the self esteem of a person. The correction of lost interdental papillae is however one of the most challenging periodontal plastic surgical procedures as the interdental papilla is an end organ and does not have a blood supply of its own. Various techniques have been proposed with varied success rate for its management. We elicit a case report of papillary reconstruction in this article using connective tissue graft by undermining the gingiva-papillary unit to preserve the papillary blood supply.

Spectrum of ocular firework injuries in children: A 5‑year retrospective study during a festive season in Southern India.

Purpose: Ocular trauma is a major cause of acquired monocular blindness in children. Firework injuries account for 20% of ocular trauma. The purpose of our study was to document the profile of ocular firework injuries in children during the festive season of Diwali and to determine the prevalence of unilateral blindness in them. Materials and Methods: A retrospective chart analysis of ocular firework injury in children during the festival of Diwali from 2009 to 2013, conducted in a tertiary care eye center in Tamil Nadu, Southern India. Children below 18 years of age with ocular firework injuries who presented to the emergency department for 3 consecutive days ‑ the day of Diwali, 1 day before, and 1 day after Diwali ‑ were included in this study. Results: Eighty‑four children presented with firework‑related ocular injuries during the study period. Male to female ratio was 4:1 with mean age 9.48 ± 4 years. Forty‑four percentage required hospitalization. The prevalence of unilateral blindness in children due to fireworks was found to be 8% (95% confidence interval ‑ 2–13%). Conclusion: Vision 2020 gives high priority to avoidable blindness, especially in children. In our study, for every 12 children who presented with firecracker injury, one resulted in unilateral blindness. This is an avoidable cause of blindness. Awareness needs to be created, and changes in policy regarding sales and handling of firecrackers including mandatory use of protective eyewear should be considered.

Anaemia among schoolchildren from southern Kerala, India: A cross-sectional study.

Background. Iron deficiency anaemia remains a major nutritional problem among adolescents in India. The weekly iron and folic acid supplementation programme was launched in Kerala in 2013–14. We aimed to estimate the prevalence of anaemia among schoolchildren in Kollam district, Kerala and determine the associated factors. Methods. The haemoglobin level of 1600 boys and 1600 girls belonging to class V to IX in 32 randomly selected schools in Kollam district was measured using HemoCue 301 photometers by trained nurses. They also recorded details about the intake of food as well as iron tablets by the students. The anaemia status was evaluated as per the WHO guidelines. Univariate analysis for factors associated with anaemia was done and selected variables were entered into a logistic regression model. Results. The prevalence of anaemia among the students was estimated to be 31.4% (95% CI 29.76–33.04). About 1% had severe, 11.9% had moderate and 18.5% had mild anaemia. Among them 35.3%, 22.3% and 45.3% reported that they were not in the habit of consuming meat, green leafy vegetables and citrus fruits, respectively, at least once a week. Anaemia among schoolgoing children was associated with irregular consumption of weekly iron folic acid supplementation tablets (adjusted OR 1.39, 95% CI 1.08–1.82) and regular intake of tea/coffee along with major meals (adjusted OR 1.41, 95% CI 1.21–1.66). Conclusion. Anaemia among schoolgoing adolescents in Kollam district is a public health problem and is more among those who consumed less quantities of weekly iron and folic acid supplementation tablets and those who regularly consumed tea/coffee along with major meals. It may be helpful to introduce a comprehensive school health anaemia prevention package with effective behaviour change communication for dietary modification as well as strategies to improve the

Analysis of association of TaqI VDR gene polymorphism with the chronic periodontitis in Dravidian ethnicity.

AIM: The aim of this study is to analyze the association of TaqI vitamin D receptor (VDR) gene polymorphism with the chronic periodontitis (CP) in Dravidian ethnicity. MATERIALS AND METHODS: A total of 120 subjects were recruited for this study, which included 60 CP and 60 healthy controls. TaqI VDR gene polymorphism was analyzed using specific primers and amplified by polymerase chain reaction (PCR) and visualized under 2% agarose gel. RESULTS: Our study results showed that Tt and tt genotype had a higher frequency of occurrence in CP compared with controls. Similarly, t allele was found to be associated with CP. CONCLUSION: Our study concludes that TaqI VDR gene polymorphism is associated with CP in Dravidian ethnicity.

Placental mesenchymal dysplasia: A report of two cases with review of literature.

Placental mesenchymal dysplasia (PMD) is a recently recognized, rare placental vascular anomaly characterized by placentomegaly and grape-like vesicles mimicking partial molar pregnancy. It is associated with significant fetal morbidity and mortality. We describe the histologic features of PMD in two different cases with different disease outcomes, one in a preterm intrauterine death (IUD) and another in a live birth. Placental examination in both the cases revealed large placenta with multiple vesicles and mesenchymal dysplasia.

Comparative analysis of presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1) in cases of chronic periodontitis and aggressive periodontitis with controls.

Aim : The aim of the present study was to evaluate the presence of Cytomegalovirus (CMV) and Epsteinbarr virus -1 (EBV-1)viruses in sub gingival plaque of chronic periodontitis (groupA), aggressive periodontitis patients (group B), periodontally healthy controls (group C) and to compare the clinical parameters between virus negative and positive sites in each of these groups. Materials and Methods : Sixty subjects were included in the study and equally divided into the 3 groups (group A - 20, group B - 20, group C - 20). Sub gingival plaque samples were obtained from the 3 deepest periodontal pocket sites in case of subjects suffering from periodontitis, and from one random bleeding site per quadrant in healthy groups. Clinical parameters like plaque index (PI), gingival index (GI), pocket depth (PD) and clinical loss of attachment (CAL) were recorded. Viral Deoxyribonucleic acid (DNA) was extracted using Proteinase-K DNA Extraction method, and the presence of CMV and EBV-1 was detected by polymerase chain reaction and 2% agarose gel. Results: Results of our study showed a 45% prevalence of CMV and EBV-1 in Aggressive periodontitis cases. Prevalence of CMV in chronic periodontitis and healthy subjects was 20% and 10%, respectively; while for EBV-1 it was 25% and 0%, respectively. In terms of comparison of the clinical parameters with virus presence, both CMV and EBV-1 positive sites showed a significantly higher mean pocket depth compared to virus negative sites. Conclusion: Our studyshowed that the prevalence of EBV1 was higher in chronic and aggressive periodontitis subjects compared to controls and the prevalence of CMV was higher in aggressive periodontitis patients. The virus positive sites showed higher pocket depth compared to virus negative sites.

Ocular clinical profile of patients with pseudoexfoliation syndrome in a Tertiary Eye Care Center in South India

To study the clinical profile of pseudoexfoliation [PEX] syndrome in a hospital setting. A case series of patients with PEX, with and without glaucoma attending the general ophthalmology clinic of a tertiary care center in South India. All patients underwent a complete ophthalmologic evaluation including recording diurnal variation of tension [DVT], gonioscopy and visual field assessment. The study cohort comprised 529 patients [752 eyes]. There were 296 [56%] females. The highest number of patients [261 patients] was from the age group between 60 and 69 years. Of 752 eyes, 57.8% eyes had unilateral PEX and 72% had established PEX. Gonioscopy showed open angles in 98.1% of eyes. Intraocular pressure [IOP] greater than 21 mmHg in at least 1 of 4 measurements was recorded in 5.7% eyes. DVT was normal in 96.4% of unilateral PEX eyes, similar to fellow non-PEX eyes. Pseudoexfoliation glaucoma occurred in 1.9% of eyes and 4.7% of eyes were glaucoma suspects. There was no correlation between the stage of PEX and increased IOP. Mean central corneal thickness of PEX eyes was 522 +/- 27æ. Pupillary dilatation in 90.5% eyes with early PEX was=7 mm. Conclusions: A small percentage of PEX eyes had raised IOP, and the number of eyes with glaucomatous optic neuropathy was even lower. PEX eyes did not demonstrate wide fluctuations in IOP. No correlation was found between raised IOP and stage of PEX. There was good pupillary dilatation in early stage PEX eyes suggesting that all PEX eyes may not have poor pupillary dilatation and related complications

Treatment of human periodontal infrabony defects with hydroxyapatite+ β tricalcium phosphate bone graft alone and in combination with platelet rich plasma: A randomized clinical trial.

Background: The present study was aimed at comparing the clinical effectiveness of two regenerative techniques - platelet rich plasma (PRP) + bone graft (HA + β TCP) versus bone graft (HA + β TCP) + normal saline in the treatment of periodontal intrabony defects. Materials and Methods: Ten patients diagnosed with chronic periodontitis were enrolled in a randomized split mouth clinical trial. Following phase I therapy the sites were randomly assigned to the test group - PRP + bone graft (HA + β TCP) and control group - saline + bone graft (HA + β TCP). Clinical parameters recorded at baseline and 6 months included plaque index, probing pocket depth, relative attachment levels, and relative gingival margin levels. Hard tissue evaluation was done using digital radiography to evaluate the image intensity and therefore the radioopacity of a desired region of interest in the intrabony defect. Pre- and postoperative comparisons were made between the treatment groups at 6 months. Results: Test group sites showed a significantly higher reduction in pocket depth compared to control group sites. Test group sites showed a significantly higher amount of radioopacity in the regions of interest, indicative of better graft remodeling, compared to control group sites. Conclusion: (HA + β TCP) bone graft appears to be a beneficial material in the treatment of human periodontal intrabony defects. When combined with platelet-rich plasma there is a significantly higher reduction in probing pocket depth, higher gain in attachment levels and higher amount of radio-density seen in the intrabony defects.

Prevalence of TT Virus in patients with chronic periodontitis, patients with aggressive periodontitis and healthy controls: a pilot study

Torque teno virus (TTV), a novel DNA virus resides in peripheral blood mononuclear cells and replicates when these cells get activated. The TTV replication shifts the immunobalance. Aim: To determine the presence of TTV in the gingiva of patients with aggressive periodontitis, patients withchronic periodontitis, and healthy controls, and to correlate the presence of TTV with probing pocket depth and clinical attachment level. Methods: Forty-two subjects (22 males and 20 females)aged 21 to 55 years were recruited for this study. Subjects were stratified into aggressive periodontitis (Group I), chronic periodontitis (Group II) and healthy controls (Group III). Gingival tissue biopsy was taken from all the subjects and the presence of TTV was analyzed using PCR and 2% agarose gel electrophoresis. Results: TTV was identified in half of the subjects and more number of subjects with periodontitis have TT virus compared to controls. There was significant association between presence of TT virus and pocket depth, clinical attachment level. Conclusions: The findings from the present study shows that there was no significant association between TT virus and periodontitis, even though it was isolated from more number of subjects with aggressive periodontitis, and TTV was associated with pocket depth and clinical attachment level. These findings need to be investigated in further studies.