Oro-Facial manifestations of COVID-19 infection in a sample of Iraqi people

Public health officials are gravely concerned about the harm that viral illnesses continue to pose to humanity, various viral outbreaks, including the Middle East Respiratory Syndrome Corona-Virus (MERS-CoV), H1N1 influenza, the severe acute respiratory syndrome coronavirus (SARS-CoV-2) and SARS CoV-2 or COVID-19 that struck the globe in December 2019. A wide range of COVID-19 oral symptoms, such as ulceration, blisters, enanthems, hemorrhagic sores and cheilitis. Aim(s): to investigate the prevalence of oral symptoms amongst COVID-19 patients due to the disease's aggressive nature and diverse symptomatology and to assess the impact of oral health conditions on COVID-19 disease severity in a sample of Iraqi people. Material(s) and Method(s): a cross-sectional study was conducted on (200) patients in total, (81) male and (119) female, who were identified as SARS-COV2 patients. Result(s): COVID confirmed patients were involved in the present study with mean age (36.69+/-17.22) years & age range of (16-78) years. at least one of the oral manifestations was present in 72.5% of the patients, while about 27.5% did not experience any oro-facial symptoms. The oral symptom with the highest prevalence was dry mouth 50% followed by gustatory dysfunction 37% then burning mouth sensation 22.5% after that the oral pain 17%;myofacial pain 15.5 %;stomatitis\mucositis 14.5%;the prevalence of aphthous lesions, fissural cheilitis and tongue depapillation were at the same percentage which was 9.5%;then candidiasis 7.5%;the least prevalent oral symptoms was gingival bleeding at percentage of 2.5%. Conclusion(s): COVID-19 has a noticeable effect on oral cavity, there was a correlations between some general and orofacial manifestations of COVID-19.Copyright © 2023, Codon Publications. All rights reserved.

Ayurvedic and Other Herbal Remedies for Dengue: An Update

Dengue fever is a flu-like ailment propagated by female mosquitos of the Aedes aegypti species. It is also known as dandaka jwara in Ayurveda. It is most common in the world's subtropical and tropical climate zones. Vomiting, severe headache, nausea, rashes, joint pain, pain behind the eyes, muscle pain, and swollen glands are all common dengue symptoms. If not handled promptly, these symptoms can lead to more severe issues such as exhaustion, blood in the vomit, continuous vomiting, bleeding gums, restlessness, severe abdominal pain, and rapid bleeding. Because there is no specific medication for dengue fever, the disease is treated by eliminating and managing the symptoms. Fortunately, there are a variety of ayurvedic remedies (like Carica papaya L., Cissampelos pareira L., etc.) that can help to tackle the same by strengthening the immune system and controlling hyperthermia. This review article provides a comprehensive overview of dengue virus infections, clinical symptoms, diagnosis, mitigation, and treatments, focusing on ayurvedic and herbal remedies.Copyright © 2022 The Author(s)

Atypical presentation of covid-19 as acute leukemia: A case report

In the absence of respiratory system involvement, COVID-19 patients developing ARDS can clinically mimic other diseases including acute leukemia due to presence of atypical lymphocytes in peripheral blood smear and increased serum lactate dehydrogenase and serum uric acid levels. Herein, we report a case who was initially suspected to have acute leukemia based on his atypical symptoms without any respiratory system involvement and deranged laboratory parameters and finally, diagnosed with COVID-19. Our patient presented with fever, myalgia, gum bleed, and petechiae. On clinical and laboratory evaluation, he was suspected to have acute leukemia based on markedly deranged serum lactate dehydrogenase and serum uric acid and the presence of atypical cells in peripheral blood smear and bone marrow. On day 3 of hospitalization, he developed respiratory symptoms, breathing difficulty which progressed to ARDS, and subsequently, he succumbed to his illness. His real-time reverse transcriptase-polymerase chain reaction test for severe acute respiratory syndrome coronavirus-2 yielded positive results. Also, Flow cytometry and fluorescence in situ hybridization studies for leukemia workup did not show any abnormalities. Although we are reporting the findings of only a single case, we aim to enhance and contribute further to the understanding of this novel infection.Copyright © 2021 Necati Ozpinar. All right reserved.

Thrombotic Thrombocytopenic Purpura (TTP) secondary to Covid-19 infection in a patient with Systemic Lupus Erythematosus (SLE)

Background: Covid-19 infection has caused a global pandemic in the recent years and although initially it was considered mainly a respiratory ailment it has proven over time to cause a constellation of complications across various systems such as hematological, immune, cardiovascular, gastrointestinal, and neurological. Method(s): We report a case of a lupus patient with Covid-19 infection who presented initially with fever and gum bleeding with a negative dengue serology and negative HIV serology. Result(s): A 45-year- old lady with a 30-year history of SLE was admitted to our hospital with Covid 19 infection. She had relatively stable disease over the past few years but was admitted to the hospital with complaints of fever, gum bleeding and shortness of breath with no chest x-ray changes. Her oxygen saturations were 95% under room air and her vital signs were stable. Laboratory examinations revealed raised white cell count (11.63) with neutrophilia and elevated C-reactive protein (2.84mg/dl). Her platelet count was low at 113 when compared to her baseline of 549. An urgent peripheral blood film showed an incidental finding of Stomato-ovalocytosis with mild anaemia however there was no features of haemolysis. She was initially treated as acquired Immune thrombocytopenia provoked by Covid-19 infection and was started on IV hydrocortisone. She had a lack of response as evident of a further decline in her platelet counts and the following day, she developed rapid decline in her renal function wherein her creatinine increased from 83 to 207. An urgent ultrasound doppler of the kidneys to rule out acute renal vein thrombosis was organised however it showed normal patent renal vessels. Peripheral blood films were repeated which showed minimal schistocytes and the diagnosis was clinched with the Adamst13 activity levels being less than 0.2%. She was started on 20g IVIG per day with plasma exchange however succumbed to the illness. Conclusion(s): The diagnosis of TTP classically involves the recognition of the pentad of fever, microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure, and neurological abnormalities however 60% of patients do not fulfil the pentad. It is essential to recognize that Covid-19 is an acquired cause of TTP, and a high index of suspicion must be maintained for early treatment institution.

Exploring the correlation between covid-19 and periodontal diseases-An original research

Aim: Purpose of the present research was to assess the co-relation between covid-19 and periodontal disease. Methodology: A case-control study was conducted amongst 150 participants. Patients who had positive real time reverse transcription polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were included in the case group (n = 79), and patients with negative results were included in the control group (n = 71). The periodontal examination involved recording the plaque scores, calculus scores, tooth mobility, gingival bleeding, probing depth, recession, and clinical attachment level (CAL). Result(s): Logistic regression analysis showed significant associations of mean plaque scores >= 1 (odds ratio (OR), 7.01;95% confidence interval (CI), 1.83 to 26.94), gingivitis (OR, 17.65;95% CI, 5.95 to 52.37), mean CAL >= 2 mm (OR, 8.46;95% CI, 3.47 to 20.63), and severe periodontitis (OR, 11.75;95% CI, 3.89 to 35.49) with COVID-19;these findings were more prevalent in the case group. Conclusion(s): Based on the above mentioned observations, it can be concluded that there is an association between periodontitis severity and COVID-19. Gingival bleeding and dental plaque accumulation are also more frequent among COVID-19 patients. Hence, it is essential to maintain periodontal health and good oral hygiene as an important measure for COVID-19 prevention and management. Copyright © 2022 Ubiquity Press. All rights reserved.

Necrotizing periodontal disease in a patient with COVID-19 history: A case report

Background: Necrotizing periodontal diseases (NPD) are fuso-spirochetal infections causing ulceration and destruction of periodontal tissues and associate with impaired host response. Elevated bacterial levels of Prevotella intermedia, Veillonella and Streptococci present in NPD lesions were detected in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Description of the procedure: A 40-year-old female, non-smoker patient was referred to the clinic with complaints of fever, halitosis, bad taste, severe gingival pain and bleeding. The patient reported a history of COVID-19 a month prior to any symptoms. Extra and intraoral examinations revealed submandibular lymphadenopathy, plaque accumulation, necrotic areas covered with pseudo-membranes, spontaneous gingival bleeding and suppuration. Alveolar bone loss was detected in the radiographic examination. Since periodontal pocket formation was present, the clinical diagnosis of the case was necrotizing gingivitis as a result of previously occurred periodontitis. During the first visit, necrotic areas were gently swabbed with 3% H2O2 moistened cotton pellets and oral hygiene instructions were given. Systemic antibiotic (metronidazole 500 mg 2 × 1) was prescribed for 5 days and rinsing with 0.12% chlorhexidine and 3% H2O2 was recommended. Three days later, since the acute complaints were reduced, clinical periodontal parameters were recorded and nonsurgical periodontal treatment (NSPT) was performed in 4 sessions in 2 weeks. One month after NSPT, all clinical periodontal parameters were recorded again. Outcomes: Following NSPT with the combination of systemic antibiotic regimen, all symptoms were resolved leading to the dissolution of necrotic areas. All clinical parameters were improved after NSPT. Conclusions: This case may be an evidence that COVID-19 could be a contributing factor for the appearance of NPD. Since COVID-19 leads to an altered immune response of the patient, a suitable environment becomes present orally for bacteria causing infections that result in NPD. The importance of routine intra-oral examination for COVID-19 patients is highlighted.

Perception of the changes in the marginal periodontium aspect in a group of young adults during the onset of the COVID-19 pandemic

Background and Aim: To determine the influence of the SARS-CoV 2 virus pandemic on periodontal status and to establish which factors are involved in these changes. Methods: Analysis of 50 questionnaires randomly distributed through the google forms program, with easy-to-follow graphics and processing of personal data while respecting confidentiality. The questionnaire included 30 questions with one or multiple answers and text boxes for individual completion. The questions were about oral hygiene and the gingival changes observed by participants in the first months after the pandemic broke out, including the lockdown period. Results: The average age of participants was between 20 and 30 years, most with higher education, from urban areas, 8.2% of them with pre-existing periodontal diseases but only 6.3% followed a periodontal treatment. 32.7% of participants tested positive for Sarcov2. The impairments of the marginal periodontium were observed by the increase with 9.6% (from 19.4% to 29%) of the gingival color changes, with 16.2% (from 16.1% to 32.3%) of the gingival volume, with 23% (from 51.6% to 74.2%) of gingival bleeding at tooth brushing and with 6.5% (from 0% to 6.5%) of dental mobility. Interest in oral health was modified by changing the frequency and the time of tooth brushing (less than 3 min increased with 8.2%), by reducing dental checks and halving specialized prophylaxis. 75% of the participants noticed an increase in stress during the pandemic, and 38.8% noticed a direct influence of the pandemic situation on their oral hygiene. Conclusions: The negative action of the SARS-CoV 2 virus is not limited to the direct one, the effects of the pandemic being felt in the field of oral health, having repercussions on the condition of periodontal tissues by influencing the measures of prophylaxis of these diseases.

Recall intervals for periodontal health in primary care patients

Background & Aim: There is ongoing international debate about the optimal frequency of dental check-ups and the effects of different recall intervals on periodontal health. Recommendations vary between countries but six-month dental check-ups have traditionally been advocated by clinicians in many high-income countries.The aim of this systematic review was to determine the optimal recall interval for maintaining periodontal health in a primary care setting. Methods: Cochrane Oral Health methods were followed. Randomized controlled trials assessing the effects of different dental recall intervals in a primary care setting were included. Two authors screened search results, extracted data and assessed risk of bias. The certainty of the evidence was assessed using GRADE. Results: Two studies were included with data from a total of 1736 participants. The main outcomes considered were: percentage of sites with gingival bleeding, mean periodontal probing depths and oralhealth- related quality of life (OHRQoL) measured using Oral Health Impact Profile-14 (OHIP-14). This review found high-certainty evidence of little to no difference between risk-based and 6-month recall intervals after four years for the outcomes: gingival bleeding (MD 0.78%, 95% CI -1.17% to 2.73%);periodontal disease (MD 0.03 mm, 95% CI -0.01 to 0.07) and OHRQoL (MD -0.35, 95% CI -1.02 to 0.32). There is high-certainty evidence of little to no difference between risk-based and 24-month recall intervals after four years for gingival bleeding (MD -0.07%, 95% CI -4.10% to 3.96%);periodontal disease (MD 0.10 mm, 95% CI 0.01 to 0.19) and OHRQoL (MD -0.37, 95% CI -1.69 to 0.95). Conclusions: The results of this systematic review affirm that dentists can accurately assess patients' risk of periodontal disease and allocate appropriate risk-based recall intervals. This research is valuable when considering the impact of the COVID-19 pandemic on dental services and provides reassurance those intervals between check-ups can be extended beyond six months without detriment to periodontal health.

Oral manifestations in patients with COVID- 19 disease

The aim is to determine oral manifestations in patients with COVID-19 disease and in the postcovid period. Methods: A special survey (questionnaire) was made in 424 people who had COVID-19 confirmed by RT-PCR, ELISA for specific IgM and IgG antibodies and Chest CT scan (168 people). 123 people had complaints and clinical symptoms in the oral cavity 2-6 months after the illness and they came to the University dental clinic. Laboratory tests have been performed (clinical blood test, blood immunogram, virus and fungal identification). Results: Survey results showed that 16,0% participants had asymptomatic COVID-19, 23,6% - mild and 48,1% moderate disease. 12,3% with severe COVID-19 were treated in a hospital with oxygen support. In the first 2 weeks 44,3% indicated xerostomia, dysgeusia (21,7%), muscle pain during chewing (11,3%), pain during swallowing (30,2%), burning and painful tongue (1,9%), tongue swelling (30,2%), catharal stomatitis (16,0%), gingival bleeding (22,6%), painful ulcers (aphthae) (8,5%) and signs of candidiasis - white plaque in the tongue (12,3%). After illness (3-6 months), patients indicated dry mouth (12,3%), progressing of gingivitis (20,7%) and periodontitis (11,3%). In patients who applied to the clinic we identified such diagnoses: desquamative glossitis - 16 cases, glossodynia (11), herpes labialis and recurrent herpetic gingivostomatitis (27), hairy leukoplakia (1), recurrent aphthous stomatitis (22), aphthosis Sutton (4), necrotising ulcerative gingivitis (13), oral candidiasis (14), erythema multiforme (8), Stevens-Johnson syndrome (2), oral squamous cell papillomas on the gingiva (4) and the lower lip (1). According to laboratory studies, virus reactivation (HSV, VZV, EBV, CMV, Papilloma viruces) was noted in 52 patients (42,3%), immunodeficiency in 96 people (78,0%), immunoregulation disorders (allergic and autoimmune reactions) in 24 people (19,5%). Conclusions: Lack of oral hygiene, hyposalivation, vascular compromise, stress, immunodeficiency and reactivation of persistent viral and fungal infections in patients with COVID-19 disease are risk factors for progression of periodontal and oral mucosal diseases.

Common Symptom, Rare Etiology: A Case Metastatic Cancers of Unknown Primary Origin Presenting with Epistaxis and Gingival Bleeding

Introduction: Epistaxis and gingival bleeding are among the most common presentation to the emergency department for patients with thrombocytopenia. Here, we present a case who was admitted to the emergency department with thrombocytopenia and was diagnosed with metastatic cancer of unknown primary origin. Case Report: A 26-year-old male patient was admitted to the emergency department with gingival bleeding and epistaxis. The body temperature was 38.3 °C. Petechial rash, ecchymosis or organomegaly was not detected on physical examination. Laboratory results revealed thrombocytopenia as 31 × 103 (159-388 × 103/μL). Although hemoglobin and leukocyte counts were normal, no band or precursor cell was observed in the patient's peripheral blood smear. There was no history of weight loss, night sweats, arthritis, malar rash, photosensitivity, contact with ticks, animals, or a COVID-19 patient. Serological tests performed for infections such as HIV, EBV, HCV, Crimean-Congo hemorrhagic fever were negative. Bone marrow biopsy was performed due to the unexplained cytopenia, reported as "signet ring cell metastatic adenocarcinoma". Gastrointestinal system endoscopy was performed to detect primary cancer. A biopsy was taken from the antrum and corpus revealed gastritis. An FDG PET-CT was revealed heterogeneously pathologically increased FDG attitude in all axial and appendicular bones. Despite all the modalities of diagnosis, the origin was not found and the patient was transferred to the oncology department for treatment with a diagnosis of cancer of unknown origin with bone marrow infiltration. Conclusion: Bone marrow metastases should be kept in mind in patients presenting with thrombocytopenia.