Maxillary osteomyelitis secondary to mucormycosis, a sequel of COVID-19: a clinical case report

Introduction: One of the consequences of COVID-19 is the incidence of mucormycosis in the jaws and subsequent osteomyelitis in patients with undiagnosed or uncontrolled comorbidities, such as diabetes mellitus and associated immunosuppression. Case Report: A 52-year-old male patient with a history of COVID-19 two months ago presented a painful ulcerative lesion of insidious onset in the palatal raphe measuring approximately 2 mm. He referred to numbness of the palatal region of one month of evolution. During the physical examination, purulent content, multiple pustules in the anterior maxillary buccal mucosa, and mobility of upper anterior teeth were observed. The CT revealed isodense bilateral images in maxillary and ethmoidal sinuses, bone sequestrations, and partial loss of anterior vestibular cortical bone. Laboratory tests revealed no abnormality, except for HbH1c: 10.2gr/dl. The patient was hospitalized for control of newly diagnosed diabetes mellitus. Maxillary incisional biopsy was performed, and microscopic analysis showed a mixed inflammatory infiltrate, fibrin deposits with eosinophilic and birefringent ribbon-like hyphae, branched at right angles, compatible with maxillary osteomyelitis secondary to mucormycosis. The treatment started with antifungal and intravenous antibiotics, followed by surgical cleaning under general anesthesia. The patient progressed favorably. Conclusion(s): Immunosuppression resulting from COVID-19 and/or uncontrolled systemic diseases can condition the appearance of rare opportunistic microorganisms causing infections such as mucormycosis. Early diagnosis and treatment make a difference in the morbidity and mortality of patients.

Differentially induced immunity in buccal and nasal mucosae after vaccination for SARS-CoV-2: Prospects for mass scale immunity-screening in large populations.

Introduction: Humoral immunity after SARS-CoV-2 vaccination has been extensively investigated in blood. Aim of this study was to develop an ELISA method in order to determine the prevalence of IgG and IgA SARS-CoV-2 domain 1 spike-protein (S) specific antibodies (Abs) in buccal and nasal mucosal surfaces of vaccinees. Methods: To this end, we analyzed 69 individuals who received their first vaccine dose between February and July 2021. Vaccines administered were BNT162b2, mRNA-1273 or ChAdOx1-nCoV-19. Detection of IgG and IgA Abs was performed using commercial ELISA kits for both blood and swab samples after protocol modification for the latter. Results: Anti-spike IgG and IgA Abs in the buccal and/or nasal swabs were detectable in >81% of the study subjects after the second dose. The IgG measurements in buccal swabs appeared to correlate in a more consistent way with the respective measurements in blood with a correlation coefficient of r=0.74. It is of note that IgA Abs appeared to be significantly more prevalent in the nasal compared to the buccal mucosa. Optimal selection of the assay cut-off for the IgG antibody detection in buccal swabs conferred a sensitivity of 91.8% and a specificity of 100%. Last, individuals vaccinated with mRNA-based vaccines exhibited higher antibody levels in both blood and mucosal surfaces compared to those receiving ChAdOx1-nCoV-19 confirming previously reported results. Conclusion: In conclusion, our findings show a differential prevalence of anti-S Abs on mucosal surfaces after vaccination for SARS-CoV-2, while they also set the basis for potential future use of IgG antibody detection in buccal swabs for extended immunity screening in large populations.

Reactive infectious mucocutaneous eruption (RIME) secondary to COVID-19 infection

A 17-year-old-male presented to an acute medical take with severe mouth pain, and poor oral intake. This occurred 6 days after a positive SARS CoV-2 test, with which he had only mild symptoms. He was unvaccinated against SARS CoV-2. Clinically, he had a severe ulcerated mucositis present on his lips, buccal mucosa and lateral edge of the tongue. He had not been commenced on any new medications prior. There was no other skin involvement. Viral swabs for herpes simplex virus and varicella zoster virus were negative. His presentation was in keeping with a reactive infectious mucocutaneous eruption (RIME) secondary to COVID-19 infection. This typically presents with severe painful mucositis with mild nonspecific skin manifestations. This entity was previously classically described in association with Mycoplasma infection. Since the emergence of COVID-19, several cutaneous manifestations have been observed. There is only one other published case of RIME associated with COVID-19 infection. This was in a similarly aged male presenting with severe mucositis and lack of significant cutaneous involvement. The patient was treated with a 5-day course of 40 mg oral prednisolone, which led to complete resolution with no scarring or subsequent recurrence. A literature review revealed only one other case of RIME associated with COVID-19, which was successfully treated with oral steroid therapy. The case exemplifies new, emerging presentations related to COVID-19 infection that may present to dermatology services.

A cross-sectional and histological analysis to understand the cytological effects of cell phone radiation on buccal mucosa of children.

Context: The ongoing pandemic has affected all the spheres of life and one of the severely affected avenues is the education of a child. The online education has seen an upward curve since the start of COVID-19 pandemic. Schools globally have adopted online class tutorials as the main method to impart education and directly increasing the screen time for a child. Aim: The aim of the present study was to evaluate the cytological effects of prolonged mobile phone usage on the buccal mucosa of children. Settings and Design: Stratified sampling was used for the selection of subjects for the study. After a questionnaire regarding the usage of a mobile phone was distributed among the parents of children. Among them, 90 children were selected on the basis of pattern and frequency of mobile phone usage in the child. Materials and Methodology: The children were divided into three groups based on the per day hours of viewing of mobile phone, i.e., Group 1: Usage of 1-2 h a day, Group 2: Usage of 3-6 h a day, and Group 3: Usage of >6 h a day. The time frame taken into consideration was 1 year after the pandemic started. This was specifically to understand the impact of the online education. Swab was obtained by using the conventional ice-cream stick method from the buccal mucosa. Statistical Analysis: The samples were subjected to histological and microscopical analysis to observe for cytological changes. One-way ANOVA was used to determine the statistical significance if any. Results: The results obtained clearly showed that Group 3 (>6 h usage per day) showed the highest number of cellular and chromosomal aberrations which was significant. Conclusion: The results indicated that impact due to the prolonged screen time on the buccal mucosa is significant. A direct proportionality was seen between the apoptotic changes and chromosomal aberrations and the number of daily hour usage.

BMS e-CON 2021 Conference Proceedings on “Exploring the Newer Modalities in Teaching - Learning and Research in Basic Medical Sciences during COVID-19 Era”

The proceedings contain 194 papers. The topics discussed include: regional variation of human pancreatic islets dimension and its impact on beta cells in Indian population;cytogenetic effects of formalin exposure on buccal mucosa: a cross-sectional observational study;association of sperm DNA fragmentation with serum lipid profile among males with abnormal semen parameters;embryological and clinico-anatomical perspective of ilioinguinal nerve variations in inguinal region;student involved fun activities- a novel strategy to teach functional correlation of brain in anatomy lectures;anti-hyperglycemic activity of ethonalic extract of stem of cissus quadrangularis in streptozotocin induced experimental diabetic rats-blood parameters;attitude and response of first year medical students towards cadaveric dissection in medical colleges of south Karnataka;and unilateral ectopic pelvic kidney - a rare case.