Osteomielite maxilar associada ao COVID-19: mucormicose ou não? Uma série de casos / Maxillary osteomyelitis associated with COVID-19: mucormycosis or not? A series of cases

Aim: A series of cases have been presented involving the oral cavity focusing on the presentation, diagnosis and treatment of mucormycosis that can form a basis for successful therapy. Background: The management of severe coronavirus disease (COVID-19) in conjunction with comorbidities such as diabetes mellitus, hematological malignancies, organ transplants, and immunosuppression have led to a rise of mucormycosis which is an opportunistic infection. Cases Description: The various forms that have been enlisted till date are rhino-cerebral, rhino-orbital, gastrointestinal, cutaneous, and disseminated mucormycosis. From the dentistry and maxillofacial surgery perspective, the cases depicting extension of mucormycosis into the oral cavity have been less frequently recorded and thus, require a detailed study. The patients that reported to our private practice had non-tender swelling, draining sinuses and mobility of teeth. A similarity was observed in the clinical signs both in osteomyelitis and mucormycosis. Thus, a histopathological examination was used to establish the definitive diagnosis. Conclusion: Mucormycosis is a life threatening pathology that requires intervention by other branches to make an early diagnosis and commence the treatment. The characteristic ulceration or necrosis is often absent in the initial stage and thus, histopathological examination and radiographic assessment are required to formulate a definitive diagnosis. Early intervention is a necessity to avoid morbidity. The treatment involves surgical debridement of the necrotic infected tissue followed by systemic antifungal therapy. Mucormycosis has recently seen a spike in its prevalence, post the second-wave of coronavirus pandemic in India. It was seen commonly in patients with compromised immunity, diabetes mellitus, hematological malignancies, or on corticosteroid therapy. Mucormycosis invading the palate mostly via maxillary sinus has been less frequently described. In the post-COVID era the features associated with mucormycosis involving oral cavity, should warrant a possible differential diagnosis and managed appropriately. (AU)

Objetivo: Apresentar uma série de casos com enfâse na apresentação, diagnóstico e tratamento da mucormicose oral, assim como uma revisão sistemática que sirva como base para estabelecimento de terapias de sucesso. Introdução: A forma severa da infecção por coronavirus (COVID-19) associada a diabetes mellitus, doenças hematológicas malignas, transplante de órgãos e imunossupressão levaram a um aumento das infecções oportunistas de mucormicose. Descrição dos Casos: As diversas apresentações clínicas que foram descritas até o momento são a rinocerebral, rino-orbital, gastrointestinal, cutânea e mucormicose disseminada. No que concerne a odontologia e a cirurgia maxillofacial, os casos que apresentam extensão de mucormicose para cavidade oral tem sido menos reportados e assim requerem mais estudos. Os pacientes que compareceram a nossa clínica apresentavam aumento de volume endurecido, drenagem de fluidos dos seios maxilares e mobilidade dentária. Clinicamente tanto a osteomielite quanto a mucormicose apresentaram-se de forma semelhante. Assim, análise histopatológica foi utilizada para estabelecimento do diagnóstico definitivo. Conclusão: A mucormicose é uma patologia grave que requer intervenção precoce para estabelecimento do tratamento. A ulceração e necrose características usualmente estão ausentes nos estágios iniciais da lesão, assim análise histopatológica e radiográfica são necessárias para o diagnóstico final. Intervenção precoce é necessária para diminuir a morbidade. O tratamento envolve o debridamento cirúrgico da área necrosada seguida de terapia antifúngica sistêmica. Recentemente, houve um aumento nos casos de mucormicose, após a Segunda onda da pandemia de COVID-19 na índia. Os casos acometiam principalmente pacientes imunocomprometidos, com diabetes mellitus, doenças hematológicas malignas e em uso de corticosteróides. A mucormicose invadindo o palato pelos seios maxilares foi raramente descrita. Na era pós-COVID a mucormicose envolvendo a cavidade oral deve entrar no painel de diagnósticos diferenciais para que o tratamento adequado possa ser instituído precocemente.(AU)

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Age and growth assessment of the near-threatened fish Rita rita (Siluriformes: Bagridae) in the Ganges basin

Introduction: Rita rita is a freshwater catfish under threat of extinction, mainly from loss of breeding and nursing grounds. A reliable method for age and growth estimation is needed by fishery managers. Objective: To identify the best body structure for age and growth estimation. Methods: We assessed estimates precision based on Average Percent Error (APE), Coefficient Variation (CV), and Percent Agreement (PA) between readers separately analyzed each calcified structure. We used 390 fish samples from three rivers, Ganga, Yamuna and Ramganga, from September 2018 to August 2019. Results: The three indicators favored the use of vertebrae for age estimation; the growth band seems to be annual and formed from May to September. The growth equations were Lt = 90.19(1-e-0.145(t+0.51)) for Ganga; Lt = 91.19 (1-e-0.14(t+0.59)) for Yamuna and Lt = 89.63 (1-e-0.15(t+0.68)) for Ramganga. Conclusion: This species reaches moderate growth in these rivers, where vertebrae are the recommended age estimation structure, followed, in case of need, by sectioned otoliths, whole otoliths and opercular bones. Pectoral spines should be avoided, especially in older fish.

Introducción: Rita rita es un pez de agua dulce bajo amenaza de extinción, principalmente por la pérdida de sitios de reproducción y crianza. Un método fiable para las estimaciones de edad y crecimiento es necesario para los administradores de recursos pesqueros. Objetivo: Identificar la mejor estructura corporal para estimaciones de edad y crecimiento. Métodos: Evaluamos la precisión de las estimaciones mediante el Porcentaje de Error Promedio (APE), Coeficiente de Variación (CV), y Porcentaje de Acuerdo (PA) entre lecturas para cada estructura calcificada. Usamos 390 muestras de peces de tres ríos, Ganga, Yamuna y Ramganga, de setiembre 2018 hasta agosto 2019. Resultados: Los tres indicadores favorecieron el uso de vértebras para la estimación de edad; la banda de crecimiento parece ser anual y se forma entre mayo y setiembre. Las ecuaciones de crecimiento fueron Lt = 90.19(1-e-0.145(t+0.51)) para Ganga; Lt = 91.19 (1-e-0.14(t+0.59)) para Yamuna y Lt = 89.63 (1-e-0.15(t+0.68)) para Ramganga. Conclusión: La especie alcanza un crecimiento moderado en estos ríos, dónde las vértebras son la estructura de estimación etaria recomendada, seguido de, en caso de ser necesario, los otolitos segmentados, otolitos enteros y huesos operculares. Debe evitarse el uso de espinas pectorales, especialmente en peces de mayor edad.

Association of acanthosis nigricans with metabolic syndrome - An analytic cross-sectional study

Abstract Background: Globally, few studies have been undertaken to assess the association of acanthosis nigricans (AN) with metabolic syndrome (MS). Most of the available studies have either focused on a particular age group, gender, ethnicity or on a single component of MS. Objectives: To determine the association between AN and MS as a whole and with all individual components of MS in adult patients of either gender. Material and methods: This was a cross-sectional study with a comparative group. Eighty-one subjects were recruited in each group. Fasting plasma glucose (FPG) and lipid profile were done. MS was defined by using the international diabetic federation (IDF) criteria. Association of body mass index (BMI), waist circumference, blood pressure, FPG, high-density lipoprotein (HDL) and triglycerides (TG) with AN was assessed by Pearson's chi-square test followed by univariate and multivariate analysis. Results: The prevalence of MS was found to be significantly higher in the group with AN. On univariate analysis, a significant association of AN was found with BMI, waist circumference, high systolic and diastolic blood pressure, HDL, and TG. Multivariate analysis revealed a significant association between waist circumference, high systolic and diastolic blood pressure, and high TG levels with AN. The risk of MS was found to be eight times higher in cases of AN. Study limitations: The small sample size and single-center data are the limitations of the present study. Conclusion: AN is strongly associated with MS as a whole and with its individual components including increased waist circumference, hypertension, and dyslipidemia.

A STUDY OF HEMATOLOGICAL AND BIOCHEMICAL PARAMETERS IN ASSESSING SEVERITY IN COVID-19 PATIENTS

Background: The severity of COVID-19 could be evaluated by examining several blood parameters mainly white blood cell (WBC) count, granulocytes, platelet, and novel hemocytometric markers neutrophils to lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR),lymphocyte to monocyte ratio (LMR) and biochemical parameters such as CRP,D-dimer,Serum ferritin, LFT, KFT etc. The present study has been carried out Methods and Material: on 100 RTPCR conrmed covid-19 patients over a period of one year from July 2021 to June 2022. Clinical features, investigations, and history of associated risk factors were extracted from case records.Samples were processed in Medonic M series ve part haematology analyzer.SELECTRA PRO M and ARCHITECT plus machine was used for LDH, AST, ALT,C- reactive protein (CRP),Serum creatinine and serum urea.Samples for electrolytes were processed in INNOLYTE MACHINE. The sample for D-dimer and PT INR were processed in STA SETELLITE Max haemostasis analyser. Samples for procalcitonin were processed in CARDIAMARKER HIA-1200 machine.Chi squre test was used for analyzing signicant correlation among different parameters and covid-19 severity.P value<0.05 was dened as statistically signicant for all statistical test. Statistical analysis used: Results:Retrospective observational study Among 100 RTPCR conrmed cases,40,36,20 and 4 were mild, moderate, severe and critical respectively.Total total neutrophils count signicantly raised in critical patients(p value<0.05) while absolute lymphocyte count was signicantly decreased in critical patients(p value<0.05).NLR was signicantly raised in critical patients and LMR,PLR were also signicantly related to disease severity.CRP,S.ferritin and D- dimer were signicantly raised in critical patients(p value<0.05).Besides above parameters, Serum LDH,Serum electrolytes,AST,AL,.PT-INR were also raised in critically ill patients(p value<0.05). The severity of COVID-19 can Conclusions: be identied at an early stage by following the different routine biochemical marker levels and subsequently improve prognosis.parameters

Use of Pre?Operative Hemoglobin A1c to Predict Early Post?Operative Renal Failure and Infection Risks in Patients who are not Diabetics and Undergoing Elective off Pump Coronary Artery Bypass Graft Surgery

Background: Recent studies have indicated that patients, both with and without diabetes with an increased HbA1c, have a higher rate of adverse outcomes following cardiac surgeries. Our study is focused on to evaluate the prognostic impact of admission value of HbA1c in non?diabetic patients for postoperative renal failure and infections. Materials and Methods: Plasma HbA1c levels were collected from 200 consecutive nondiabetic patients who got admitted for elective off pump coronary artery bypass graft (CABG) procedure over a 2?year period under two groups, Group A whose HbA1c was < 6% at admission and Group B whose HbA1c was ?6% and ?6.4% at admission. After surgery, patients were followed up to see if they have got infection or renal failure as postoperative complication. Student抯 unpaired t test was used to test the significance of difference between the quantitative variables, Yate抯 and Fisher抯 chi square tests were used for qualitative variables. Results: We found early postoperative renal failure in 14 (3/96 in Group A and 11/104 in Group B) out of 200 patients (7%) and infection in 21 (8/96 in Group A and 13/104 in Group B) out of 200 patients (10.5%). After data analysis, it was noted that there is a positive correlation between HbA1c and postoperative renal failure (P = 0.0213) whereas no association was found between HbA1c and postoperative infections (P = 0.175) in patients undergoing off?pump CABG surgery. Conclusion: In patients without diabetes, a plasma HbA1c ?6% was a significant independent predictor for early postoperative renal failure.

CYTOTOXICITY TESTING OF A NOVEL CROSSLINKED PRF (C-PRF) DEVELOPED FOR DENTAL PULP TISSUE ENGINEERING PURPOSE

Background- Whole pulp amputation followed by pulp space disinfection and ?lling with an arti?cial material causes loss of signi?cant amount of dentin leaving a non-vital and weakened tooth. Regenerative endodontics with its emerging ?eld of modern tissue engineering has demonstrated promising results using stem cells associated with scaffolds and responsive molecules. [1] Introduction- PRF was recognized as the “second generation” of this family of biomaterials. [6] PRF being tested in pulp tissue engineering by different research groups showed mixed results. (7,8) Research studies have shown that the interactions between the cells and their niche are closely related to physicochemical properties of the scaffolding materials [9, 10]. As PRF is a fragile gel its physical character needs to be improved by cross linking and thereby more longer period of liberation of its growth factors and delayed disintegration in physiological system. Aims and Objectives- Aim of our study was to prepare a very economical and autologous biomaterial for pulp tissue engineering by crosslinking of PRF with tannic acid. Our objective was to detect cytotoxic effect of tannic acid in PRF. Methods and Materials- We followed Choukroun et al. protocol to prepare PRF samples from whole venous blood collected from donors. PRF samples were then cross-linked in freshly prepared TA solution in dapendish for 10 minutes at room temperature. Concentrations of TA 1 wt% was used for preparing samples. After crosslinking, the gels were washed with normal saline for 5 min. to ensure that all excess TA was removed. The viability of cells cultured on the scaffolds was assessed through MTT assay (EZcountTM MTT cell Assay Kit, HiMedia, Mumbai, India). Observations- Both MTT Assay and Phalloidine staining showed favourable results of no clear cytotoxic effects of C-PRF. Conclusion- Based on the results of the cell viability analysis it can be concluded that none of the tannic acid crosslinked PRF created any clear cytotoxicity in the MC3T3 cells. So, C-PRF can safely be used as scaffold for dental pulp or similar tissue engineering purposes

STATUS OF WOMEN THROUGH EONS

Life in the 21 Century has changed, developed albeit rather slowly evolved to a higher dimension with the advancement of technology and education. However, one thing that has been dragged from the medieval ages into this new era is the status of women in the society. Women in the new eon are still ill-treated, and it is not astonishing at all. However, when a deep study of the subject is made in history, we understand that it is surprisingly a newer concept. In the ancient India, somewhere around the Vedic period, women were respected and valued highly in the society. A woman could fight wars, take part in philosophical discussions, join in festivals along with men, or even remain unmarried if she desired so. So, how and why did such concepts of inequality and discrimination arose in the past are interesting studies which are yet less-known to people. Later on, around the eleventh century, women lost these perks, and consequently their status in the society due to some social, political and economic changes. The rise in evil customs and traditions like female feticide, dowry deaths, sexual assault, rape enslaved women to the boundaries of their houses. Women were mentally threatened and emotionally handcuffed from being active participants of discussions, hence their role in the society became passive in nature. The process of reawakening of the human conscience begun in the 19th Century. Reformers like Raja Ram Mohan Roy and Swami Dayanand threw light on the need of eliminating all forms of gender discrimination and biasedness. The logic behind this activation of mind was simple- without women, life on the planet wouldn't have sustained. A woman is the source of creation, she bears a child and hence the progeny maintains the continuum of life. For the species to survive, both the genders were to be conserved equally. Hence, the society started acknowledging this perspective of mind, though with a steadier pace this time. This change wasn't easy to accept for most of the people who now considered men to be on the cliff, i.e. above and higher than a woman's st position. This paper displays the status of women and her empowerment in the 21 Century in all aspects of life due to the rise in education.

Causes & risk factors for unscheduled readmissions in the paediatric ward of a major public hospital

Background & objectives: Readmissions are often considered as an indicator of poor quality of care during previous hospitalization, although many of these are unavoidable or unrelated to the past admission. The identification of high-risk cases for readmissions and appropriate interventions will help not only reduce the hospital burden but also to establish the credibility of the hospital. So this study aimed to determine the readmission percentage in the paediatric wards of a tertiary care hospital and to identify the reasons and risk factors that can help minimize preventable re-hospitalizations. Methods: This prospective study from a public hospital included 563 hospitalized children, classified as first admission or readmissions. Readmissions were defined as one or more hospitalizations within preceding six months, excluding scheduled admissions for investigations or treatment. Reason-wise, the readmissions were classified into various categories, based on the opinion of three paediatricians. Results: The percentage of children getting readmitted within six, three and one month time from the index admission was 18.8, 11.1 and 6.4 per cent, respectively. Among readmissions, 61.2 per cent were disease-related, 16.5 per cent unrelated, 15.5 per cent patient-related, 3.8 per cent medication/procedure-related and 2.9 per cent physician-related causes. Patient- and physician-related causes were deemed preventable, contributing to 18.4 per cent. The proximity of residence, undernutrition, poor education of the caretaker and non-infectious diseases were associated with increased risk of readmission. Interpretation & conclusions: The findings of this study suggest that readmissions pose a substantial burden on the hospital services. The primary disease process and certain sociodemographic factors are the major determinants for the increased risk of readmissions among paediatric patients.

EFFECT OF SUBCHORIONIC HAEMATOMA ON PREGNANCY OUTCOME: A RETROSPECTIVE STUDY

Objective: This study aims at comparative analysis of outcome of pregnancy in patients with 1st trimester bleeding ,with & without sub-chorionic haemorrhage (SCH). Pregnant Material and Methods: women with vaginal bleeding upto14 wks. Study period was Jan 2020 - Dec 2021. Presence& absence of SCH formed the study & the control group respectively. Both groups had similar demographic patterns & parameters (parity, previous Results: miscarriages & gestational age at ?rst miscarriage). 15 out of 50 pregnancies (30%) with subchorionic Hematoma resulted in miscarriage, whereas it was 28 out of 210 pregnancies (13%) withoutsubchorionic hematoma. No signi?cant difference was found on the gestational age at miscarriage & duration between 1st vaginal bleeding & miscarriage.The outcome measures were also similar in both groups. Presence of subchorionic hematoma up to 14 wks. Of gestation increases risk of Conclusion: miscarriage, but pregnancy outcome in ongoing pregnancy is not altered

Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review

Objectives@#Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients. @*Methods@#An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values < 0.01 were considered statistically significant. @*Results@#In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n = 33), and Italy was the most common country (n = 14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n = 65), followed by the oral mucosa (n = 37) and lips (n = 19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively. @*Conclusion@#COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.

Comparative evaluation of photobiomodulation therapy at 660 and 810 nm wavelengths on the soft tissue local anesthesia reversal in pediatric dentistry:an in-vivo study

Background@#Local anesthesia has been reliably used to control pain during dental procedures and is important in pediatric dentistry. However, children occasionally complain of prolonged numbness after dental treatment, leading to several problems. Studies conducted to reverse the effect of local anesthesia using phentolamine mesylate and photobiomodulation therapy (PBM) are encouraging but limited. PBM is a type of light therapy that utilizes visible and near-infrared non-ionizing electromagnetic spectral light sources. Hence, this study used this modality to compare the reversal of local anesthesia at two different wavelengths. This study compared the effect of PBM at 660 and 810 nm wavelengths on the reversal of soft tissue local anesthesia using a diode LASER in pediatric dentistry.Method: Informed consent and assent were obtained, and the participants were then divided randomly into three groups of 20 children each: control group-without LASER irradiation, LASER irradiation at 660 nm, and LASER irradiation at 810 nm. Sixty children aged 4–8 years with deciduous mandibular molars indicated for pulp therapy were administered an inferior alveolar nerve block. After 45 min of injection, a duration that was similar to the approximate duration of treatment, they were exposed to 660- and 810-nm LASER irradiation according to their groups until reversal of local anesthesia was achieved. The control group did not undergo LASER irradiation. The reversal of the soft tissue local anesthetic effect was evaluated using palpation and pin prick tests every 15 min, and the LASER irradiation cycle continued until reversal of the soft tissue local anesthesia was achieved. @*Results@#A significant reduction of 55.5 min (27.6%) in the mean soft tissue local anesthesia reversal time was observed after the application of 810 nm wavelength PBM and 69 min (34.7%) after 660 nm wavelength LASER irradiation. @*Conclusion@#PBM with a 660 nm wavelength was more effective in reducing the mean soft tissue local anesthesia reversal duration, and thus can be used as a reversal agent for soft tissue local anesthesia in pediatric dentistry.

Clinical outcome and course of Tenon’s patch graft in corneal perforation and descemetocele

Purpose: To assess the efficacy and clinical outcome of Tenon’s patch graft (TPG) in corneal perforation and descemetocele. Methods: In this retrospective study, medical records of 83 patients (85 eyes) who underwent TPG for corneal perforation (58, 68%) or descemetocele (27, 32%) between July 2018 and October 2021 were reviewed. Clinical examination and anterior segment optical coherence tomography (AS?OCT) were performed on every follow?up visit. Anatomical success was considered as the restoration of the structural integrity with the formation of scar and anterior chamber (AC). Results: The mean size of the corneal lesions (corneal perforation or descemetocele) was 4.20 ± 1.01 mm. The mean follow?up period was 9.2 ± 5.48 months. The common underlying etiologies were infectious keratitis in 48% and autoimmune disorders in 35% of cases. TPG successfully restored the globe integrity in 74 (87%) eyes (83% in perforation and 96% in descemetocele). Anatomical failure occurred in 11 eyes (13%). The failures were due to graft dehiscence (8 eyes), graft ectasia (1 eye), and scarring with flat AC (2 eyes). The median time to epithelialization and scar formation were 3 and 15 weeks, respectively. Logistic regression analysis showed few predictors for a successful outcome: descemetoceles, noninfective causes, viral keratitis in infectious etiology, and paracentral or peripheral lesions. Conclusion: TPG can be considered an effective and inexpensive treatment for restoring the structural integrity in the eyes with perforations and descemetoceles, particularly when the donor tissue is unavailable. AS?OCT is a valuable noninvasive tool for monitoring the graft status

Recurrence Developing 21 Years after Treatment of Breast Cancer

Background: Breast cancer is a very common cancer among females. In which most recurrence (around 75%) occurs within the initial 5 years after diagnosis, especially within 3 years. Recurrence after 20 years is very less reported in the last few decades. Case Information: We are presenting a case of a 67-year old female patient presented with pleural based nodules suggestive of lung metastasis followed by brain metastasis. After reviewing history we came to know that the patient was a previously treated case of breast carcinoma treated 22 years back with mastectomy. Conclusion: We report late recurrence of breast cancer occurring 21 years after mastectomy suggesting that possibility of recurrence in carcinoma breast with 21-years latency period although rare should be taken into consideration when making decisions regarding patients who may need long term follow up.

A study to assess the knowledge on hypoglycemia among the diabetic patient in selected hospital, Siliguri

Background:The prevalence of diabetes mellitus, is a major health concern that affects people around the world, and is increasing yearly. When blood glucose levels go below normal, a condition known as hypoglycemia, an immediate consequence of diabetes mellitus, occurs. The International Diabetes Federation reported thatthere were 451 million diabetics globally in 2017 and by 2045, it is anticipated that there will be 693 million. The objective of this study was to assess the level of knowledge of diabetic patient regarding hypoglycaemia and to find out the association between the levels of knowledge of diabetic patient on hypoglycaemia with their selected demographic variable.Methods:A descriptive cross-sectional study, was carried out in the month of June 2022. A semi-structured questionnaire was used to interview 100 study participants who were diabetes patients who had been admitted to the medical ward and who had visited the endocrinology outpatient department.Results:52% of the samples had fair knowledge on hypoglycemia, while 23% of them had poor knowledge. Demographic variable such as age, income, treatment, frequency of taking medicine, experience of symptoms of hypoglycemia and dietary habit were statistically significant with the level of knowledge, p<0.05.Conclusions:The study's findings highlighted the fact that most diabetes mellitus patients had a fair understanding of hypoglycemia. The health care personnel should also take time and efforts to educate patients about the sign of hypoglycemia. So that hypoglycemic episodes and morbidity could be reduced or prevented at primordial level.

Unusual Involvement of Basal Ganglia and Dentate Nucleus in Children with Acute Encephalopathy with COVID-19

Children account for 1% to 5% of diagnosed COVID-19 infection with relatively mild presentation compared to adults. The frequency of neurological involvement in acute COVID-19 infection in children is unclear. COVID-19 is also considered to be a neurotropic virus, but so far, in the pediatric age group, very few cases with involvement of basal ganglia and no case of dentate nucleus involvement have been reported in the literature. The present paper reports two cases of acute encephalopathy with COVID-19, the frst case with basal ganglia involvement and the second with dentate nucleus involvement. Both cases required aggressive management and had complete neurological recovery on follow-up. Hence, these cases are reported to make everyone aware of the neurological presentation with atypical neuroimaging fnding of acute COVID-19 infection in the pediatric age group; timely management improves the outcome.

Interpreting Mortality in COVID Associated Mucormycosis (CAM) : A Learning Experience from a Tertiary Care Centre

Mucormycosis has emerged as an important fungal infection with high associated mortality rates. Mucormycosis causes devastating angio-invasive fungal infections, primarily in patients with underlying risk factors. The prevalence of mortality associated with invasive Mucormycosis is high (>30-50%), with 90% mortality contributed by disseminated disease. Sudden rise in Mucormycosis cases during the COVID-19 pandemic came as a surprise to all. Lowered immunity due to COVID and associated conditions like diabetes, made the population susceptible to this dreaded disease. This disease led to both increase in morbidity and mortality among the general population. Aim of the Study : To interpret in detail the causes of mortality of patients presenting with COVID Associated Mucormycosis (CAM-19) at AIIMS Patna between May-November, 2021. Materials and Methods : An observational study of all patients who were treated for mucormycosis during the period of May 2021-Nov 2021 in ENT Department, AIIMS, Patna. During the period of study, 219 patients of RhinoOrbital-Cerebral Mucormycosis (ROCM) were admitted for treatment. Five patients had gone on Leave Against Medical Advice (LAMA). So, 214 patients were included in the study. Results : Among the 214 patients, 165 patients were treated surgically through both endoscopic and open approaches along with antifungal therapy management. 41 patients died during the hospital course of the treatment. The mortality rate of ROCM stood at 19.15% in our series. Pulmonary Mucormycosis had high mortality (100%). Diabetes is the most common risk factor. Multiple co-morbidities and extensive intracranial involvement had a strong association with mortality. Conclusion : The advanced stage of ROCM was associated with more deaths. Our series mortality rate of 19.15% is lower than most of the other documented mortality rates. Our results support that early aggressive surgical approach, antifungal therapy and multidisciplinary approach has reduced the mortality

An insight into the altered ophthalmic dynamics during the COVID-19 pandemic

Purpose: The objective of this survey?based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology. Methods: The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question. Results: A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic?appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor. Conclusion: The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department?based and surgical procedures in ophthalmology

Prospective evaluation of wipe-out after glaucoma filtration surgery in eyes with split fixation

Purpose: To assess the incidence and cause of idiopathic, irreversible loss of vision (“wipe?out”) in the early post?operative period after glaucoma?filtration surgery in advanced glaucoma. Methods: It was a prospective, interventional cohort study. Patients with advanced glaucoma and macular split fixation underwent either only trabeculectomy (group A) or combined phaco?emulsification with trabeculectomy (group B). The incidence and cause of visual loss, changes in intra?ocular pressure, visual acuity, and visual field indices during 2 months post surgery were assessed. Results: Thirty patients (30 eyes) were divided in two groups. No significant difference was noted between the pre?operative and post?operative mean deviations in both groups (P = 0.41, P = 0.65). Two eyes in group A and one eye in group B had visual loss of two lines or more at the end of 2 months because of cataract and choroidal detachment. None of the eyes showed “wipe?out”. Conclusion: “Wipe?out” is a rare phenomenon after surgery in advanced glaucoma