Therapeutic plasma exchange for coronavirus disease-2019 triggered cytokine release syndrome; a retrospective propensity matched control study.

BACKGROUND: Cytokine release syndrome (CRS) plays a pivotal role in the pathophysiology and progression of Coronavirus disease-2019 (COVID-19). Therapeutic plasma exchange (TPE) by removing the pathogenic cytokines is hypothesized to dampen CRS. OBJECTIVE: To evaluate the outcomes of the patients with COVID-19 having CRS being treated with TPE compared to controls on the standard of care. METHODOLOGY: Retrospective propensity score-matched analysis in a single centre from 1st April to 31st July 2020. We retrospectively analyzed data of 280 hospitalized patients developing CRS initially. PSM was used to minimize bias from non-randomized treatment assignment. Using PSM 1:1, 90 patients were selected and assigned to 2 equal groups. Forced matching was done for disease severity, routine standard care and advanced supportive care. Many other Co-variates were matched. Primary outcome was 28 days overall survival. Secondary outcomes were duration of hospitalization, CRS resolution time and timing of viral clearance on Polymerase chain reaction testing. RESULTS: After PS-matching, the selected cohort had a median age of 60 years (range 32-73 in TPE, 37-75 in controls), p = 0.325 and all were males. Median symptoms duration was 7 days (range 3-22 days' TPE and 3-20 days controls), p = 0.266. Disease severity in both groups was 6 (6.6%) moderate, 40 (44.4%) severe and 44 (49%) critical. Overall, 28-day survival was significantly superior in the TPE group (91.1%), 95% CI 78.33-97.76; as compared to PS-matched controls (61.5%), 95% CI 51.29-78.76 (log rank 0.002), p<0.001. Median duration of hospitalization was significantly reduced in the TPE treated group (10 days vs 15 days) (p< 0.01). CRS resolution time was also significantly reduced in the TPE group (6 days vs. 12 days) (p< 0.001). In 71 patients who underwent TPE, the mortality was 0 (n = 43) if TPE was done within the first 12 days of illness while it was 17.9% (deaths 5, n = 28 who received it after 12th day (p = 0.0045). CONCLUSION: An earlier use of TPE was associated with improved overall survival, early CRS resolution and time to discharge compared to SOC for COVID-19 triggered CRS in this selected cohort of PS-matched male patients from one major hospital in Pakistan.

Emerging Challenges and Threats for Dental Health Care Sector Attributable to COVID-19: Tale of a Developing Country.

Prevention and control of infection in dentistry is an essential matter that has gained immense attention in recent years. There exist a lack of scientific data about the cross-transmission and its associated risk, especially in the dental health care setting of Pakistan. This article will evaluate the emerging challenges and threats for the dental community in Pakistan attributable to the COVID-19 outbreak. There is a significant knowledge gap regarding the state- and institutional-level of infection prevention and control (IPC) policies and practices. In addition, not much is known about the development, implementation, and monitoring of IPC policies and its challenges.

Maxillofacial rehabilitation of a large cleft palate using fixed-removable prosthesis.

Maxillofacial defects either congenital or acquired, lead to a marked loss of both the functional efficiency and aesthetic profile of the affected individuals. Plastic surgery and tissue reconstruction is the treatment of choice. However, in certain clinical scenarios, removable and/or fixed obturator prosthesis can be the only option available. The management of these critical cases should be planned after a detailed investigation and diagnosis, evaluation of the subject's expectations and demands, socioeconomic status, available technical facilities and utilization of a multi-disciplinary team approach. This report discusses the intra oral rehabilitation of a complete, unilateral cleft palate along with dento-alveolar rehabilitation. A fixed-removable prosthesis was provided to gain functional as well as aesthetic results without extensive surgical correction.

Rehabilitation of nose using silicone based maxillofacial prosthesis.

Surgical reconstruction of large facial defects is not possible at times due to extensive loss of tissue that cannot be corrected by surgery alone. In these cases, prosthetic restoration of lost facial tissue can be done using maxillofacial prosthetics. Introduction of new material which gives life-like appearance to such prosthetic restorations e.g. silicone and poly ether rubbers and use of implants to retain these prostheses have given a new dimension to rehabilitation of such patients. This report presents a case of prosthetic rehabilitation of the nasal component of the face secondary to nasal leishmaniasis, using precision attachment retained maxillofacial prosthesis.

Oral stereognostic ability: a test of oral perception.

Oral stereognosis (form or shape recognition in the oral cavity) can be utilized to assess oral perceptual abilities. This assessment can be beneficial in planning as well as predicting the future outcome of any treatment modality in the orodental region. This article provides a meta analysis of different studies conducted in the last fifty years to quantify magnitude of oral sensory capacity using oral stereognostic ability tests and their implication in clinical dental sciences.