Mucocutaneous manifestations of COVID-19-associated mucormycosis: A retrospective cross-sectional study

Background: Cutaneous mucormycosis has shown a significant upsurge during the COVID-19 pandemic. Due to the rapid progression and high mortality of cutaneous mucormycosis in this context, it is important to identify it early. However, very few studies report detailed clinical descriptions of cutaneous mucormycosis in COVID-19 patients. Objectives: To describe mucocutaneous lesions of COVID-19-associated mucormycosis based on clinical morphology and attempt to correlate them with radiological changes. Methods: A retrospective cross-sectional study was conducted at a tertiary care centre from 1st April to 31st July 2021. Eligibility criteria included hospitalised adult patients of COVID-19-associated mucormycosis with mucocutaneous lesions. Results: All subjects were recently recovering COVID-19 patients diagnosed with cutaneous mucormycosis. One of fifty-three (2%) patients had primary cutaneous mucormycosis, and all of the rest had secondary cutaneous mucormycosis. Secondary cutaneous mucormycosis lesions presented as cutaneous-abscess in 25/52 (48%), nodulo-pustular lesions in 1/52 (2%), necrotic eschar in 1/52 (2%) and ulcero-necrotic in 1/52 (2%). Mucosal lesions were of three broad sub-types: ulcero-necrotic in 1/52 (2%), pustular in 2/52 (4%) and plaques in 1/52 (2%). Twenty out of fifty-two patients (38%) presented with simultaneous mucosal and cutaneous lesions belonging to the above categories. Magnetic resonance imaging of the face showed variable features of cutaneous and subcutaneous tissue involvement, viz. peripherally enhancing collection in the abscess group, “dot in circle sign” and heterogeneous contrast enhancement in the nodulo-pustular group; and fat stranding with infiltration of subcutaneous tissue in cases with necrotic eschar and ulcero-necrotic lesions. Limitations: The morphological variety of cutaneous mucormycosis patients in a single-centre study like ours might not be very precise. Thus, there is a need to conduct multi-centric prospective studies with larger sample sizes in the future to substantiate our morphological and radiological findings. Conclusions: COVID-19-associated mucormycosis patients in our study presented with a few specific types of mucocutaneous manifestations, with distinct magnetic resonance imaging findings. If corroborated by larger studies, these observations would be helpful in the early diagnosis of this serious illness.

An overview of mycetoma and its diagnostic dilemma: Time to move on to advanced techniques

The neglected tropical disease mycetoma can become extremely devastating, and can be caused both by fungi and bacteria; these are popularly known as eumycetoma and actinomycetoma respectively. The classical triad of the disease is subcutaneous swelling, multiple discharging sinuses and the presence of macroscopic granules. The present study aims to highlight the existing diagnostic modalities and the need to incorporate newer and more advanced laboratory techniques like pan fungal/pan bacterial 16S rRNA gene polymerase chain reaction (PCR) and sequencing, Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), rolling circle amplification (RCA), loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA). It is important for the medical team to be aware of the various diagnostic options (both existing and future), so that diagnosis of such a debilitating disease is never missed, both by clinicians and microbiologists/pathologists. The newer diagnostic methods discussed in this article will help in rapid, accurate diagnosis thus facilitating early treatment initiation, and decreasing the overall morbidity of the disease. In the Indian context, newer technologies need to be made available more widely. Making clinicians aware and promoting research and development in mycetoma diagnostics is the need of the hour.

Comparative Evaluation of Sealing Ability of Newer Materials Used As Dentin Substitutes in Class II Sandwich Restorations: An In Vitro Study

Introduction: Even with the advances and innovations inrestorative dentistry, microleakage is regarded one of the mainproblems in this area.Objective: To evaluate in vitro marginal microleakage ofBiodentine, Fuji II LC and SDR at the cervical level and at theinterface these materials with Tetric N Ceram Bulk fillcomposite and also to note the marginal microleakage whenthese materials were used as bulk fill materials.Materials and Methods: Cavities, standardized on the mesialand distal surfaces, were prepared in thirty molars andrandomly assigned to two groups (n = 30), according to themode of restoration done.Goup1 (control) in which testmaterials were used as bulk fill. These were further subdividedinto subgroups according to the material. SG1: Biodentine(SEPTODONT); SG2: Fuji II LC (GC); SG3: SDR (Dentsply).Group2 (experimental) in which test materials used as dentinsubstituent in class II sandwich technique followed byrestoration with Tetric N Ceram (Ivoclar vivadent). These werealso divided into subgroups, SG4: Biodentine + Tetric NCeram; SG5: Fuji II LC + Tetric N Ceram; SG6: SDR + Tetric NCeram. After storage for 24 hours in an incubator (37 °C), thesamples were submitted to the thermocycling test (500 cycles:5 °C/55 °C). They were later waterproofed, immersed in 1%methylene blue solution and sectioned in the mesialdistal direction for evaluation under stereomicroscope at 30xmagnification (Nikon SMZ 1500 Zoom Stereomicroscope)Scores from 0 to 3 using the ISO microleakage scoring system(ISO/TS 11405:2003). The ANOVA Test and Post- hoc Test,with a significance level of 5%, were used for statisticalanalysis.Conclusion: The study concluded that SDR (SD 2.38) showedthe least amount of microleakage both at the occlusal and atthe cervical levels in open sandwich restorations and alsowhen used as bulk fill materials as compared with Biodentine(SD 1.73) and Fuji II LC (SD 1.00).

Comparative Evaluation of Mechanical Failure of Different Rotary Endodontic Files: An SEM Study

Conventional endodontic instruments make the intracanalprocedures versatile with more efficiency and minimumcomplication. The development of microfractures in the I-RaCeNickel-Titanium rotary (NTR) file and ProFile NTR file wasevaluated by using Scanning electron microscopy (SEM).Thirty six maxillary buccal roots and thirty six mandibularmesial roots with an average canal curvature of 37° wereassigned to each group and prepared with 21mm, 0.04 taperNTR files as follows: (1) I-RaCe (2) ProFile. File sizes 0.06 to0.04 were used in a crown-down technique to a master apicalfile (MAF) size of 0.04/25. The MAF instruments wereevaluated by SEM before use, after completion of 7 canals,and after completion of 14 canals. All I-RaCe instrumentsdeveloped microfrcatures by the seven canal evaluation. TheProFile instruments showed no microfrctures at the 7-or-14canal evaluations. I-RaCe files separated at a higher rate thanProFile instruments. Under the conditions of this study, uniquefile design and electropolishing did not inhibit the developmentof microfractures in I-RaCe NTR.

Micronuclei in exfoliated cells : a biomarker of genotoxicity in tobacco users

Aims: The aim of this study was to analyze the tobacco-related genotoxic effects in individual with habit of smoking and chewing tobacco. Materials and Methods: The present study sample consisted of 120 individuals attending the outpatient department of D. J. College of Dental Sciences and Research, Modinagar, Uttar Pradesh (UP). The sample was divided into four groups as follows: Group I (individuals with habit of smoking tobacco), Group II (individuals with habit of chewing tobacco), Group III (individuals with habit of smoking and chewing tobacco), and Group IV control group (nontobacco-exposed individuals). Patients were asked to rinse their mouth gently with water. The exfoliated cells were obtained by scraping the buccal mucosa of individuals with a wooden spatula. The scraped cells were placed on the precleaned slides. The smears were then stained with RAPID-PAP™ and analyzed under the microscope. Data were analyzed using SPSS statistical software. Results: In the present study, an arbitrary unit was obtained using frequency/day multiplied by the duration of years (risk multiplication factor [RMF], a positive and significant correlation were observed between the RMF and the mean percentage of micronucleated cell count in smokers, chewers, and in individuals with both smoking and chewing habit, respectively. A weak positive and nonsignificant correlation were observed between age and mean percentage of micronucleated cells in smokers and smokers + chewers, respectively, while it was weak negative and nonsignificant in chewers. In control group, correlation between age and percentage of micronucleated cells was weak positive and nonsignificant at 5% level of significance. Conclusion: The micronuclei in exfoliated mucosal cells from buccal mucosa can be used as a biomarker of genotoxicity in predicting the effects of carcinogens

Follicular Dowling Degos disease: A rare variant of an evolving dermatosis.

Dowling Degos disease is a rare, reticulate pigmentary disorder with variable phenotypic expression that manifests as hyperpigmented macules and reticulate pigmentary anomaly of the fl exures. Many variants of this condition and its overlap with other reticulate pigmentary disorders have been reported in the literature. We present here two cases of DDD with follicular localization, both clinically and histologically. It was associated with ichthyosis vulgaris in one case. Follicular DDD is an uncommon variant of this evolving dermatosis. Our report supports the possible role for disordered follicular keratinisation in its pathogenesis.

Parthenium dermatitis in India: Past, present and future.

Parthenium dermatitis is an immuno-inflammatory disease caused by Parthenium hysterophorus and is the commonest cause of plant dermatitis in India. It is caused by airborne dry and friable plant particles including trichomes, and the most important allergens responsible for allergic contact dermatitis are sesquiterpene lactones. The combined type IV and type I hypersensitivity to parthenium has been recently postulated. In sensitized individuals, it can cause a spectrum of clinical patterns, such as classical airborne pattern, chronic actinic dermatitis-like presentation, mixed pattern dermatitis, exfoliative dermatitis, widespread dermatitis, and other rare patterns. There is definite trend towards change from airborne pattern to chronic actinic pattern in natural history of parthenium dermatitis. Contact sensitivity to parthenium is everlasting, and hence the disease runs a chronic course with exacerbation during summers. Patch testing with acetone or aqueous plant extract is the simplest way of confirming parthenium contact allergy. Management includes avoiding contact with allergen, managing dermatitis with topical corticosteroids/tacrolimus, and other immunosupressives like azathioprine. In future, we expect parthenium dermatitis to become less prevalent due to rapid urbanization and possible development of new biological methods to eradicate the parthenium. Genetic factors associated with susceptibility to parthenium dermatitis need to be studied.

Bullous pemphigoid.

Bullous pemphigoid (BP) is a relatively common autoimmune vesicobullous disease encountered in India. It is a subepidermal bullous disorder most commonly seen in the elderly and manifests as tense blisters on urticarial base, predominantly over flexures, and is associated with pruritus. The diagnosis can be confirmed by histology, direct and indirect immunofluorescence. Several new diagnostic techniques have also been developed. Treatment of BP is based on the extent and rate of progression of the disease. Several topical and systemic anti-inflammatory and immunosuppressive agents have been used with variable results.