Post-COVID Syndrome: The Stranger Ghost of Culprit COVID-19

Background: Post-COVID syndromes are the most abundant sequel of coronavirus disease of 2019 (COVID-19) infection, which affects millions of people around the whole world. There is a significant difference observed during the acute phase as well as during the post-COVID period between patients hospitalized with (alpha, delta, or omicron) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant. In the present scenario, when most people are vaccinated, COVID-19 disease is less likely, but the remnants of previous COVID-19 infections are still a vast health burden. Materials and methods: This prospective, observational, comparative, and analytical study included a total of 3,840 COVID-19-infected patients who visited the hospital. We included 1,150 patients of alpha variants, 1,845 patients of delta variants, and 815 patients of omicron variants, from June 2020 to November 2020, March 2021 to July 2021, and January 2022 to May 2022, respectively. All medical data of the study population, including hospital stay and vaccination status, were collected, and all patients were followed up for 6 months of duration. All collected data were compiled and analyzed to compare the post-COVID thrombotic and other events among different variants of COVID-19. Results: Patients infected during the delta variant are the most symptomatic at onset (higher prevalence of fever, dyspnea, cough, myalgia, headache, or gastrointestinal problems) than those infected with the alpha or omicron variant (p < 0.01). A total of 2,830 patients (7.48%) [1,520 (82.38%) of delta variant, 598 (73.37%) of omicron variant, and 712 (60.34%) of omicron variant] developed post-COVID syndrome during their follow-up period out of 3,220 enrolled patients and the difference was statistically significant when compared among variants (p < 0.05). In this study, the highly prevalent post-COVID syndrome was mucormycosis (11.41%), followed by new-onset diabetes (9.89%), pulmonary fibrosis (7.67%), ischemic heart disease (6.46%), brain stroke (3.29%), and other thromboembolic disorders (2.37%). Conclusion: COVID-19-associated onset symptoms during the delta variant were more severe and highly prevalent, while neurological symptoms (aguesia and anosmia) were more common during the alpha variant. Patients infected with the delta variant of COVID-19 are more prone to develop post-COVID-associated complications with minimal risk in the omicron variant and intermediate risk in the alpha variant. Long COVID-19 requires specific attention for management, irrespective of the SARS-CoV-2 variant.

Establishment of SMS Dengue Severity Score

Background: Dengue infection is a disease that progresses rapidly to life-threatening conditions. Our goal was to develop a practical scoring system based on clinical profiles and routine tests to predict the severity of infection. Methods: This cross-sectional observational study included 500 patients with dengue infection. Patient demographics, clinical symptoms, regular laboratory tests, and results were collected. Dengue infections are divided into three classes, depending on their severity: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Based on the total score, patients were divided into three severities. Results: Patients with DSS and DHF scored higher with worsening clinical features and routine laboratory tests compared to DF. Clinical predictors of severity include older age, increased white blood cell (WBC) count, increased hematocrit, increased prothrombin time, decreased platelet count, decreased blood pressure, presence of peri-gallbladder (GB) edema, third space loss, hepatomegaly, and other organ involvement. The severity range is 0–12, and the score is 0–3 for DF, 4–8 for DHF, and 9–12 for DSS. Based on the derived scores, patients were classified according to their original severity in 63% of cases. Conclusion: This dengue infection severity scores correctly classified patients according to their original severity grade of DF, DHF, or DSS. This scoring system helps to quickly assess dengue infections and start treatment according to the correct severity category.

Occlusal Splint: A Vital Adjunct in Full Mouth Rehabilitation for Cases of Severely Worn Dentition

Introduction: Excessive wear of dentition results infunctional disharmony, loss of esthetics, pulpal injuries andcompromises longevity of dentition adversely. The etiologicalfactors of tooth wear may be abrasion, attrition, or erosionacting individually or in combination.Case Report: The present case report emphasizes the use ofa ‘sectional occlusal verticalization splint’, as a guide for fullmouth rehabilitation. As the treatment plan envisaged wasocclusal rehabilitation using reorganized approach, sectionalsplint offered the advantage of restoring the exact amount ofvertical dimension to which patient had got programmed. Thevertical dimension was maintained during various phases ofsegmental technique using sectional splint.Conclusion: Although there are plethora of philosophiesand techniques available for full mouth rehabilitation thereis a limited evidence-based literature on a particular methodfor exact restoration of vertical dimension. Also, due topresence of many hard and soft tissues variables in humanstomatognathic system, making various occlusal records andrepeated transfer to mechanical articulator may introduceerrors. Therefore, an occlusal ‘verticalization splint’, wellaccepted by patients stomathognathic dynamics, may act asthe best guide to restore vertical dimension with an addedadvantage of reduction in errors due to omission of varioussteps of occlusal recordings, transfers and use of mechanicaldevices.

Rehabilitation of an Orbital Defect with Silicone Orbital Prosthesis: A Case Report

Introduction: Loss of eye, apart from impaired vision has adetrimental effect on psychosocial wellbeing of an individual.The replacement of the lost eye as soon as possible after thesurgery is necessary to improve social acceptance and qualityof life. Multidisciplinary management and team approachbetween surgeon and prosthodontist are essential in providingaccurate and effective rehabilitation and follow-up care for thepatient.Case report: This case report describes a simplified methodfor the fabrication of a custom silicone orbital prosthesisretained with spectacles for rehabilitation of a residual defectpost exenteration of left eye. It highlights the importance ofindepth analysis & comparison of the defect with the normalcontralateral eye which was used as an anatomical guide forfabrication of an aesthetic prosthesis.Conclusion: Advanced digital technology like rapidprototyping and CAD/CAM have made fabrication ofcomplex prosthesis like orbital prosthesis simpler andquicker. However, these contemporary methods are techniquesensitive, equipment dependent and may not be availableeasily. Thus, a maxillofacial prosthodontist should be able toread the available anatomical guides and use them to fabricatean aesthetically acceptable prosthesis using conventionaltechnique to rehabilitate patients and improving quality of lifeas soon as possible.

Acute isolated medial rectus palsy due to infarction as a result of hypercoagulable state: A case report and literature review

Isolated medial rectus palsy in an otherwise healthy individual is a very rare entity. However, this may point towards underlying systemic pathology. This is a case report of an otherwise healthy young adult male who presented with sudden onset non-progressive blurring of vision in right eye. A series of investigations were performed and the patient was diagnosed to have a rheumatological disorder. Isolated muscle palsies in young patient may be masking a systemic disorder and needs to be evaluated thoroughly.

Comparative Evaluation of Various Cooling Techniques on Intrapulpal Temperature Rise during Direct Provisionalization - An Ex-vivo Study.

Introduction: Use of autopolymerising resin for directprovisionalization is one of the commonest methodsemployed by clinicians. However, these materials exhibit anexothermic reaction and are prone to cause pulpal damage.Thus, a combination of cooling technique and matrix materialto reduce the quantum of heat transferred to a healthy vitalpulpal tissue may be employed for minimal tissue damage.An ex-vivo study was thus envisaged to compare the efficacyof various matrix materials and cooling techniques on timerelated temperature changes in the pulp chamber duringthe fabrication of provisional FPD restorations using directtechnique.Material and Methods: A total of 100 provisionalrestorations were fabricated and were grouped on the basisof three different matrices: Vacuum template, Putty index andAlginate index and further subgrouped on the basis of variouscooling techniques employed. Thermal changes in the pulpchamber was evaluated using Cr/ Al thermocouple placedin the pulp chamber of a prepared tooth and connected to adigital thermometer. Intrapulpal temperature variations wererecorded, tabulated and statistically analysed.Results: The inter-group and intra-group statisticalcomparisons of continuous variables were done using analysisof variance with Bonferroni’s correction for multiple groupcomparisons considering the independent study groups. Theunderlying normality assumption was tested before subjectingeach variable to t test and ANOVA. In the entire study, thep-values less than 0.05 were considered to be statisticallysignificant. All the hypotheses were formulated using twotailed alternatives against each null hypothesis (hypothesis ofno difference). The entire data was statistically analysed usingStatistical Package for Social Sciences (SPSS ver 21.0, IBMCorporation, USA) for MS Windows.Conclusion: The order of heat dissipation for the differentmatrices used is as follows: Irreversible hydrocolloid matrix >PVS putty matrix > vacuum form template. It was concludedthat intrapulpal temperature rise during the direct fabricationof provisional restorations can be limited by employingdifferent cooling techniques. “Cooling” of PVS putty andalginate impression index for 2 minutes in refrigerator(Ambient temperature 10-120C) was found to be most effective“cooling” method for preventing temperature rise in pulp.

Retrospective study on outcomes of terminal chop technique of nuclear fragmentation in phacoemulsification and combined surgery: An observational study

Purpose: Terminal chop, a new technique of nuclear segmentation, has been recently described in literature. The technique is considered to be a safe and effective option. Methods: We did a retrospective study to evaluate the outcome of terminal chop. Patients operated for terminal chop (phacoemulsification with or without trabeculectomy) from October 2016 to July 2018 were included in the study. Results: In all, 933 patients were included in the study. The grade of nuclear sclerosis ranged from 2 to 5. All the patients had a significant visual improvement at 1 month postop. Around 3.4% had pseudoexfoliation and 8.89% of the eyes underwent combined surgery. Cumulative dissipated energy showed a proportionate relation with the grade of nucleus. Intraoperative complication rate was 0.08%. Postoperative complication rate was 3.50%. Conclusion: Terminal chop proved to be a safe, reproducible, and effective technique of nuclear segmentation in different grades of cataract.

Osteopetrosis: A rare cause of anemia - Review of literature.

Normocytic anaemia is caused either by hypoproliferation of haemopoietic tissue or increased destruction of red cell. Osteopetrosis is a rare cause of anaemia. The leading clinical features are pallor, growth failure, hepatosplenomegaly.On hematological examination, anemia, thrombocytopenia, leucocytosis and myelophthisic anemia are commonly observed in this disease. We are highlighting osteopetrosis as a rare cause of anemia presenting to us for evaluation of anemia.

Prevalence of otitis media in school going children in Eastern Nepal.

OBJECTIVES: To find out the prevalence of otitis media in school going children from lower socio-economic strata. MATERIAL AND METHODS: This study was carried out in a government school, Shree Naragram Secondary School in Morang district, eastern Nepal, and included 1050 children aged between 5-15 years. RESULTS: Of the 1050 school children, 346 children were found to have various ENT related problems. Hearing assessment revealed a conductive hearing loss on one or both sides in 114 cases (87%). Various middle ear pathologies were detected in these children, out of which chronic suppurative otitis media "Tubotympanic type" was the most common, followed by otitis media with effusion. The prevalence of otitis media in these children was found to be13.2% and those with hearing loss comprised 12.47%. Prevalence of otitis media is found to be much higher in school going children as compared to adults, and is even higher amongst children belonging to the lower socio-economic strata. Conditions complicating otitis media are more common and severe in children as compared to adults. CONCLUSION: Primary ear care education to teachers, students and guardians can prevent these vulnerable children from developing hearing impairment. School based study could be one of the useful and cost-effective modality aimed at community oriented program.

Eptifibatide-induced profound thrombocytopenia.

We report a case of profound thrombocytopenia, 2 hours following eptifibatide therapy which got reversed within 12 hours of discontinuation of eptifibatide.

Histoplasma capsulatum in adrenal gland aspirate--a case report.

We report a case of disseminated histoplasmosis in a 60-year-old non-immunocompromised patient who presented to us with fever and hepatosplenomegaly. Sonographic & CT examination of the abdomen showed bilateral adrenal masses. Cytological examination of the aspirated material from the mass showed yeast forms of H. capsulatum.

Antihypertensive efficacy and tolerability of once-daily sustained-release diltiazem alone and in combination with ramipril in hypertension.

This study assessed once-daily (OD), sustained-release (SR) diltiazem alone and in combination with ramipril in essential hypertension. Fifty patients with supine diastolic blood pressure (DBP) > or = 95-< or = 114 mm Hg were entered into the active treatment phase of the study after 2 weeks of placebo run-in. Sustained-release diltiazem 180 mg OD was administered for 2 weeks, then optimally titrated, at 2 week intervals, to SR diltiazem 240 mg OD and then SR diltiazem 180 mg + ramipril 2.5 mg OD to achieve supine DBP < or = 90 mm Hg. After 4 weeks of diltiazem monotherapy (SR diltiazem 180 mg or 240 mg OD) mean supine DBP was reduced from 102.84 +/- 3.81 mm Hg to 90.15 +/- 5.02 mm Hg (P < 0.01) and mean supine heart rate was reduced from 85.15 +/- 11.02 bpm to 77.62 +/- 11.45 bpm (p < 0.01). Diltiazem monotherapy reduced supine DBP to < or = 90 mm Hg in 35/45 (77.77%) patients. Combination therapy (SR diltiazem 180 mg + ramipril 2.5 mg OD), received by non-responders to diltiazem monotherapy, reduced supine DBP to < or = 90 mm Hg in 3/10 (30%) patients. Sinus bradycardia was observed in one patient. Sustained-release diltiazem alone and in combination with ramipril reduce blood pressure in a dose related manner and is well tolerated.

An open study to evaluate the efficacy of artemether in severe falciparum malaria.

An open clinical trial was conducted in 30 patients of severe falciparum malaria with heavy parasitaemia (parasitized erythrocytes above 5%). Artemether (methyl ether of dihydroartemisinin-active principle isolated from Chinese plant Qinghaosu) was administered as 80 mg intramuscular injection twice on first day and then single dose of 80 mg intramuscular on 2nd to 5th day. The trial could be completed in 28 patients and two patients expired. In our observation falciparum malaria affected the young adults in their most productive period of life i.e. 25-44 yrs. All patients became afebrile by the 4th day with fever clearance time approximately 31.92 +/- 15.30 hr. Twenty-five patients (83.33%) became parasite free by 5th day with mean parasite clearance time approximately 47.04 +/- 19.95 hr. Deranged liver function and renal profile was observed in 63% and 50% patients respectively. Two patients, who died had very high degree of parasitaemia (50% and 16%) with cerebral malaria. One died due to multiorgan failure and other due to massive hematemesis and shock. The type of response achieved by artemether therapy was analysed as per WHO criteria suggested for chloroquine resistance. S response was observed in 25 patients (cure rate 83.33%). Two patients (6.66%) patients showed R II response, one patient (3.33%) showed R III response and R I response was not observed in any patient. No significant side effects were noted. This pilot study demonstrated that intramuscular artemether is a useful addition to antimalarial drugs in this era of multidrug resistant P. falciparum malaria showing high clinical potency with virtually no side effect.

Serum zinc, copper, magnesium, proteins and superoxide dismutase in leprosy patients on multidrug therapy--a follow-up study.

Serum zinc, copper, magnesium, total proteins and albumin-globulin fractions and superoxide dismutase (SOD) were estimated in 80 untreated patients with TT/BT/BL/LL type of leprosy and in 40 controls. The investigations were repeated on day 30, 60 and 120 after starting multidrug therapy (MDT-WHO) on the patients. Serum zinc was significantly lowered in all types of leprosy on days 0 and 30. Serum copper was significantly raised in all types of leprosy. This was not significant in BT/TT cases on 60, 120 days. There was a correlation between serum zinc and copper levels and the severity and type of leprosy. The lowering of serum magnesium values were not significant. With therapy, there was a shift of all the three elements towards normal values. Serum total proteins reduction was not significant. Serum albumin was significantly lowered in all types of leprosy. Serum globulin was significantly raised in all types of leprosy. This rise in TT/BT was not significant on day 60 and 120 after starting treatment. Serum SOD was significantly reduced in all the untreated cases. It gradually increased with the clinical improvement under MDT.

An outbreak of multidrug resistant Salmonella typhimurium in Delhi (India).

A total of 85 patients with multidrug resistant S. typhimurium were isolated between May and September 1991 at the Sir Ganga Ram Hospital, New Delhi, India. Fifty eight (72.5%) patients out of 80 stool culture positives suffered from enteritis and 23 (39.6%) of them settled with oral rehydration therapy alone. All strains were sensitive to 4 aminoquinolones (oflaxcin) but five were resistant to third generation cephalosporin (Cefotaxime; MIC between 50-75 micrograms/ml) whereas 88-96 per cent isolated were resistant to most of the other antibiotics. The convalescent carrier rate was prolonged with the use of antibiotics. The phage type of S. typhimurium isolated from the index and other cases was 178 and multidrug resistance strains had seven plasmids (1.2 to 16 kb). Barrier nursing and sodium hypochlorite disinfection helped in limiting the outbreak.

Percutaneous intraaortic balloon pulsation for management of life threatening emergencies in an intensive coronary care unit.

The indications for the outcome of use of intraaortic balloon pulsation (IABP) in 66 patients (65 males, 1 female), in addition to the usual conventional medical therapy, are reported here. IABP was used for treatment of cardiogenic shock (5 patients), acute myocardial infarction with rupture of interventricular septum (2 patients), acute myocardial infarction with refractory left ventricular failure (2 patients), resistant ventricular tachyarrhythmias (5 patients), refractory angina (50 patients) and for hypotension following high risk coronary angiography (2 patients). A Datascope 10.5 F percutaneous balloon was inserted in all, mostly using the left femoral artery. Either definitive treatment (coronary artery bypass surgery or coronary angioplasty) was offered when feasible or the balloon was weaned off. Twelve patients underwent coronary angiography on IABP; while 31 patients had undergone the angiography earlier. Surgery was possible in 33 patients with 90% survival rate. The non surgical group showed 30% survival rate. The complications of IABP encountered were: leg ischaemia (2 patients), septicemia (4 patients) and balloon rupture (2 patients). Our experience suggests that percutaneous IABP is a very useful management procedure for seriously sick high risk patients prior to definitive therapy. Patients who could have a definitive treatment while on IABP, especially the group with refractory angina, did best on a short term follow up. Vascular complications are minimal while on IABP.