Maxillary Mucormycotic Osteonecrosis as a Manifestation of Post-COVID-19 Infection in Non-diabetic Patients: Report of Two Cases.

Mucormycosis is a rare, opportunistic fungal infection prevalent in the elderly, especially in patients with uncontrolled diabetes or a compromised immune system. However, the outbreak of the pandemic declared by the World Health Organization in late 2019 increased the incidence of mucormycosis cases in COVID-19 patients due to increased steroid usage that resulted in an immunocompromised state. The current report presents two cases of oral mucormycotic osteomyelitis in patients who developed diabetes post-COVID infection, along with a review and relevant literature.

Comparison of Wrinkle Patterns Generated by Intradermal and Intramuscular Botulinum Toxin Injections by Clinical Evaluation.

Purpose: Botulinum toxin has played a remarkable role in management of forehead wrinkles. Most used is intramuscular technique due to its deposition into the muscles, however, with adverse effects like brow ptosis. This study has been designed for the evaluation of efficacy for intradermal v/s intramuscular route of botulinum toxin injections for forehead wrinkles using clinical correlation. Methods: This study included a clinical trial of 32 facial halves divided equally into intradermal and intramuscular injection technique groups, receiving total dose of 8 U. Results were assessed by clinical examination upto 2 weeks and 4 weeks with parameters; objective wrinkle rate, eyebrow height, eyebrow movement, pain, and satisfaction after treatment. Result: Results showed least mean for objective wrinkle rate in intramuscular group, showing statistically significant improvement. Overall improvement in eyebrow height and eyebrow movement were slightly more for intramuscular group. Pain was lesser for intradermal group, whereas satisfaction of patient of patient post treatment is similar for both the groups. Conclusion: Among intradermal and intramuscular botulinum toxin injection technique, the effect and potency were better for intramuscular technique, whereas the patient comfort and compliance were better for intradermal technique.

Exploring the Influence of Nanocrystalline Structure and Aluminum Content on High-Temperature Oxidation Behavior of Fe-Cr-Al Alloys.

The present study examines the high-temperature (500-800 °C) oxidation behavior of Fe-10Cr-(3,5) Al alloys and studies the effect of nanocrystalline structure and Al content on their resistance to oxidation. The nanocrystalline (NC) alloy powder was synthesized via planetary ball milling. The prepared NC alloy powder was consolidated using spark plasma sintering to form NC alloys. Subsequently, an annealing of the NC alloys was performed to transform them into microcrystalline (MC) alloys. It was observed that the NC alloys exhibit superior resistance to oxidation compared to their MC counterparts at high temperatures. The superior resistance to oxidation of the NC alloys is attributed to their considerably finer grain size, which enhances the diffusion of those elements to the metal-oxide interface that forms the protective oxide layer. Conversely, the coarser grain size in MC alloys limits the diffusion of the oxide-forming components. Furthermore, the Fe-10Cr-5Al alloy showed greater resistance to oxidation than the Fe-10Cr-3Al alloy.

Management of multiple and displaced mandibular fractures in a pediatric patient sans mandibular immobilization, sans open reduction and internal fixation.

Maxillofacial fractures in the pediatric population are generally managed by conservative approaches such as soft diet and medication or semi-invasive procedures namely inter-maxillary fixation or circum-mandibular wiring. These approaches are preferred over any invasive treatment to minimize injury to the growing skeleton and tooth germs. Displaced fractures that cause functional problems such as restricted mouth opening, malocclusion or impaired breathing, mandate open reduction and internal fixation. However, surgical management is associated with morbidity related to general anesthesia, risk of injury to vital structures, and potential, skeletal or dental growth disturbances. This case report describes a non-invasive method of managing displaced, multiple fractures of the mandible in a pediatric patient, with the use of low intensity pulsed ultrasound to achieve favorable clinical outcomes and nil complications. Neither immobilization of the mandible with inter-maxillary fixation nor open reduction and internal fixation was used. Low intensity pulsed ultrasound therapy is painless and patient-friendly.

Evaluation of the efficacy of autologous conditioned serum versus dextrose prolotherapy in internal derangement of the TMJ - A pilot study.

It was the aim of the study to compare the effectiveness of autologous conditioned serum (ACS) and dextrose prolotherapy (DP) solutions, in treating patients with TMJ internal derangement (ID). 24 participants with TMJ ID (Wilkes II-V) were recruited and randomized into study and control groups, with 12 patients each, treated with IA injection of ACS and DP, respectively. Pain, mouth opening, joint sounds, and jaw deviation were evaluated, with patients reviewed at 2 weeks, 1 month, and 2 months intervals. Based on the nature of the variables, appropriate descriptive statistics and statistical tests were applied. The pain score was zero in the study group after 2 months of treatment, which was statistically significant (p = 0.006). Deviation was also significantly reduced (p < 0.001) and mouth opening significantly improved (p = 0.004) in the ACS-treated patients. ACS demonstrated superiority over DP in the management of TMJ dysfunction. Therefore, ACS can be considered an ideal, minimally invasive treatment option for TMJ ID. Clinical trial registry number: (CTRI/2021/10/037043).

Management of Lingual Cortex Fracture of Mandible Using Lingual Arch Bar: A Finite Element Analysis of Reduction with a Pilot Clinical Trial.

Purpose: Fractures of lingual cortex are frequently left untreated leading to poor resolution of patient's symptoms and function. Positioning an implant on same side of fracture would provide better reduction. The study aims at improving stability offered by Erich arch bar placed on lingual surface, by Finite element analysis (FEA) along with a pilot clinical trial. Methods: Two FEA models were generated from CT scan of an individual having lingual cortex fracture: control model with labial arch bar and study model with lingual arch bar. Parameters assessed: Stress distribution (Mpa) along lines of osteosynthesis; Separation of fracture fragments (mm) across fracture line. Associated, was a clinical trial of 5 patients, managed by placing lingual arch bar. Feasibility of arch bar, post-operative pain, radiographic inter-fragmentary gap and complications were assessed clinically. Results: Lingual positioning of arch bar demonstrated less displacement (mm) of fracture fragments compared to labial placement (0.123 vs. 0.677) upon application of masticatory load. Insignificant lingual splay and lesser degree of stress distribution (Mpa) was observed (83.1 vs. 99.3) favoring placement of arch bar on lingual side. Clinical trial correlated with outcomes of FEA, resulting in improvement of patient's symptoms. Conclusion: FEA and supporting clinical trial provided an effective method of reduction for lingual cortical fracture.

Energy generation from bioelectrochemical techniques: Concepts, reactor configurations and modeling approaches.

The process industries play a significant role in boosting the economy of any nation. However, poor management in several industries has been posing worrisome threats to an environment that was previously immaculate. As a result, the untreated waste and wastewater discarded by many industries contain abundant organic matter and other toxic chemicals. It is more likely that they disrupt the proper functioning of the water bodies by perturbing the sustenance of many species of flora and fauna occupying the different trophic levels. The simultaneous threats to human health and the environment, as well as the global energy problem, have encouraged a number of nations to work on the development of renewable energy sources. Hence, bioelectrochemical systems (BESs) have attracted the attention of several stakeholders throughout the world on many counts. The bioelectricity generated from BESs has been recognized as a clean fuel. Besides, this technology has advantages such as the direct conversion of substrate to electricity, and efficient operation at ambient and even low temperatures. An overview of the BESs, its important operating parameters, bioremediation of industrial waste and wastewaters, biodegradation kinetics, and artificial neural network (ANN) modeling to describe substrate removal/elimination and energy production of the BESs are discussed. When considering the potential for use in the industrial sector, certain technical issues of BES design and the principal microorganisms/biocatalysts involved in the degradation of waste are also highlighted in this review.

Lung cancer recovery focus post pandemic: an income-deprived area paradigm.

'Stage shift' has been proposed as a marker of impact of Coronavirus 2019 (COVID-19) in lung cancer services; however, there are no data available specifically from income-deprived areas. Thus, this study evaluated the impact of the COVID-19 pandemic on lung cancer care in our area (Corby; among the most income deprived in England) and identified focus recovery areas. The study was a retrospective observational study of 668 consecutive patients with lung cancer at a district general hospital, pre-, during and after the COVID peak. Outcomes were the overall number of cases, presenting staging and treatment pathway. Overall, 32 fewer patients were diagnosed during the pandemic, with more inpatient diagnoses (p=0.01) and fewer primary care referrals (p<0.0001). There were no differences observed in treatment intent or 'stage shift'. Our results suggest that COVID-19 negatively affected the whole lung cancer pathway in our area. However, 'stage shift' might not be ideal to assess the impact of COVID-19 in income-deprived areas. Further studies will help the strategic rollout of a screening programme to identify patients with lung cancer earlier on in such areas.

"Trans-zygomatic approach" for reduction & internal fixation of a malunited, medially dislocated condyle fracture in a geriatric patient with cervical spine injury.

The open reduction and internal fixation of medially displaced/dislocated condyle fracture is challenging due to inadequate visibility and access to the dislocated condyle. The common approach to reduction of such condyles is by inferior distraction of the mandible which facilitates visualization as well as instrumentation. However, this maneuver may be difficult, or contraindicated in patients with concomitant cervical spine injury where excessive manipulation of the mandible may predispose the spine to further trauma. Ramus osteotomies which are used when conventional reduction methods fail, facilitate reduction but are associated with additional incision, complications and surgical time. This case report presents an alternative method, the "trans-zygomatic approach" which was used effectively to reduce a dislocated and malunited condyle fracture in a geriatric patient with co-existent cervical spine injury. The approach facilitated precise reduction of condyle fracture with minimal impact on the cervical spine.

A Prospective Hospital-Based Study on the Clinico-Etiological Profile of the First Episode of a Seizure in Children.

Background  This study aims to examine the clinico-etiological profile of children with the first episode of a seizure and categorize seizure types based on age groups in a tertiary care hospital. Methodology  This was a prospective observational study conducted at a tertiary care medical institute in India over two years. Children (one month to 12 years of age) with the first episode of a seizure were included in the study population. The data collected included demographic profile, history, examination, biochemical profile, electroencephalogram (EEG), and neuroimaging. Children were categorized as generalized-onset, focal-onset, and unknown-onset seizures based on the International League Against Epilepsy 2017 seizure classification. Children were also classified according to specific etiologies such as structural, metabolic, or other specific causes. All the children were followed up at the hospital's outpatient clinic or through a telephonic interview. Results  A total of 220 children were examined in this study. Among them, 64% were male and 36% were female, with a male-to-female ratio of 1.75:1. Among the 220 children, 21.8% had a family history of seizure. The most common type of seizures were generalized-onset seizures (n = 110, 50%), followed by focal-onset seizures (n = 96, 43.6%). Overall, 9% of children presented with status epilepticus as their first-episode seizure. An abnormal EEG was recorded for 122 (76%) children. While 60% of children had abnormal neuroimaging findings, the remaining had normal neuroimaging. Febrile seizures (n = 92, 41.9%) were the most common cause of the first episode of a seizure. Most of the febrile seizures occurred between the age of one and four (n = 60, 65.2%). Epilepsy syndromes were the second most common etiology, followed by central nervous system (CNS) infections, structural brain abnormalities, metabolic disorders, vascular lesions, toxins, and immune-mediated causes, in that order. In 14 (6.36%) children, the etiology was unknown at the time of the study. Conclusions First-episode seizures in children cause physical, mental, and financial stress on the parents. The collection of detailed history, examinations, and appropriate investigations can help identify the etiology of seizures. It was possible to determine the etiology of the first episode of a seizure in the majority of the patients. Generalized-onset seizures were the most common. Febrile seizures, epilepsy syndrome, CNS infections, vascular lesions, and metabolic disorders were the main etiological factors, in that order.

Effect of platelet-rich fibrin on extraction socket healing in diabetic patients - A split-mouth crossover study: A prospective clinical trial.

Aims: The aim of this study is to evaluate the effectiveness of platelet-rich fibrin (PRF) in postextraction socket healing in diabetic patients. Subjects and Methods: The investigators implemented a randomized, split-mouth study in 100 Type 2 diabetic patients undergoing dental extraction of two or more teeth. Following extraction, the experimental socket was packed with PRF and sutured, while the control socket was sutured without packing. The primary outcome measures were soft-tissue healing (assessed by color, bleeding on palpation, granulation tissue, and incidence of suppuration and dry socket), hard-tissue healing (measured by visual interpretation, area of bone coverage, and grayscale analysis), and visual pain scores. Statistical Analysis: Statistical analysis was done using the independent and paired t-tests, analysis of variance, and Chi-square test. Results: Both soft-tissue healing and hard-tissue healing were significantly better in the experimental socket as compared to the control socket. Pain levels, as measured by the visual analog score, were similar in both the extraction sockets. Conclusions: The use of PRF has beneficial effects in extraction socket healing in diabetic patients.

Mental health of hypertensive patients and its association with their blood pressure in a rural area of Kancheepuram District, Tamil Nadu.

Introduction: Chronic diseases, such as type 2 diabetes mellitus and hypertension, are often associated with psychiatric comorbidities such as anxiety, depression, and somatization. Approximately, one-fourth of the adults were diagnosed with hypertension, and the proportion will reach about one-third by 2025. The prevalence of hypertension throughout India is 29.8% and the burden of hypertension in a rural area of Tamil Nadu is 25.2%. The compliance of drug intake depends on the mental health of the patient and this study intends to take care of patients with chronic illnesses. This study is designed to assess the mental health of hypertensive patients and its association with their blood pressure. Materials and Methods: A cross-sectional descriptive study was conducted among hypertensive patients in the field practice of a tertiary care medical college in the Kancheepuram district for a period of 3 months using a semi-structured validated schedule after obtaining the informed consent. The depression anxiety stress scale (DASS) scale was used to assess the mental health of hypertensive patients. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 23.0. Results: Most hypertensive patients were found in the age group of 40 to 60 years. About 53.4% of hypertensive patients with normal blood pressure were suffering from depression. In addition, about 44.6% of pre-hypertensive patients and 44.6% of stage II hypertensive patients were found to have severe depression. Conclusion: Overall, pre-hypertensive patients were suffering from depression when compared to other hypertensive patients. Family history and tobacco and alcohol intake were other factors associated with depression in hypertensive patients.

Outcomes from a virtual ward delivering oxygen at home for patients recovering from COVID-19: a real world observational study.

BACKGROUND: There is a lack of data on the safety of providing oxygen at home to stable patients recovering from COVID-19. METHODS: A retrospective analysis of patients discharged to a COVID-19 virtual ward (CVW) between January 2021 and March 2021 at a UK district general hospital was performed. Patients with improving clinical trajectories and oxygen requirements up to 4 L/minute were eligible. Outcomes measured were 30-day mortality and readmission rate. RESULTS: From 02 January 2021 to 16 March 2021 (74 days), 147 patients discharged to the CVW were included: 71 received continuous or ambulatory oxygen, and 76 received pulse oximetry monitoring only. Five patients were readmitted within 30 days and two patients died. There were no significant differences between readmission and mortality rates between those discharged with or without oxygen. CONCLUSION: Provision of oxygen at home for selected patients recovering from COVID-19 is safe with low risk of readmission and death.

Aberrations in Maxillary Anatomy of Adult Patients with Cleft Maxillary Hypoplasia: A Computed Tomographic Study.

Aim: The aim of this study was to evaluate the maxillary anatomy in patients with cleft maxillary hypoplasia using computed tomogram. Materials and Methods: A cross-sectional observational study was carried out in all cleft patients reporting to our department for the correction of secondary cleft deformities. A preoperative computed tomogram of the midface (from the superior orbital rim to the maxillary occlusal plane) was recorded to assess the parameters which evaluate the maxillary and pterygomaxillary anatomy in cleft maxillary hypoplasia patients. Results: A total of 18 adult patients (female-5; male-13) were included in the study, which includes 15 unilateral and 3 bilateral cleft lip and palate patients. All the patients had undergone palatoplasty in their early childhood. Evaluation of the circum maxillary and pterygo-maxillary anatomy on the computed tomogram revealed that the average width of maxillary tuberosity was (mean-6.91 mm on cleft side, 4.51 mm on noncleft side); distance between medial and lateral pterygoid plates was (mean-6.45 mm on cleft side, 5.94 mm on noncleft side); distance from greater palatine foramen to posterior palatal border was (mean-5.6 mm on cleft side, 6.1 mm on noncleft side); distance from greater palatine foramen to pterygoid process was (mean-4.83 mm on cleft side, 5.6 mm on noncleft side); distance from pyriform rim to greater palatine foramen was (mean-30.0 mm on cleft side, 31.8 mm on noncleft side); inter pterygoid distance between medial pterygoid plates at the level of pterygoidhamulus was (mean-3.3 cms = 33 mm); inter pterygoid distance between medial pterygoid plates at skull base was (mean-3.0 = 30 mm). Conclusion: Maxillary hypoplasia in adult cleft patients distorts the circum maxillary and pterygomaxillary anatomy with cleft side being more hypoplastic compared to the noncleft side which needs to be evaluated prior to planning maxillary advancement.

Remediation techniques for uranium removal from polluted environment - Review on methods, mechanism and toxicology.

Uranium, a radionuclide, is a predominant element utilized for speciality requirements in industrial applications, as fuels and catalyst. The radioactive properties and chemical toxicity of uranium causes a major threat to the ecosystem. The hazards associated with Uranium pollution includes the cancer in bones, liver, and lungs. The toxicological properties of Uranium are discussed in detail. Although there are many methods to eliminate those hazards, this research work is aimed to describe the application of bioremediation methods. Bioremediation methods involve elimination of the hazards of uranium, by transforming into low oxidation form using natural microbes and plants. This study deeply elucidates the methods as bioleaching, biosorption, bioreduction and phytoremediation. Bioleaching process involves bio-oxidation of tetravalent uranium when it gets in contact with acidophilic metal bacterial complex to obtain leach liquor. In biosorption, chitin/chitosan derived sorbents act as chelators and binds with uranium by electrostatic attraction. Bio reduction employs a bacterial transformation into enzymes which immobilize and reduce uranium. Phytoremediation includes phytoextraction and phytotranslocation of uranium through xylems from soil to roots and shoots of plants. The highest uranium removal and uptake reported using the different methods are listed as follows: bioleaching (100% uranium recovery), biosorption (167 g kg-1 uranium uptake), bioreduction (98.9% uranium recovery), and phytoremediation (49,639 mg kg-1 uranium uptake). Among all the techniques mentioned above, bioleaching has been proved to be the most efficient for uranium remediation.

Evaluating the efficacy of disc repositioning in the management of high condylar fracture - A prospective clinical trial.

AIM: The aim of the study was to assess the role of disc repositioning in treating high condylar fractures. MATERIALS AND METHODS: Patients who reported to the Department of Oral and Maxillofacial surgery with high condylar fractures were recruited for this study, and randomized into two groups. The study group underwent 'disc repositioning during ORIF', while 'ORIF without disc repositioning' was performed for the control group. Patients were assessed for pain, mouth opening, clicking, and mandibular deviation (Helkimo clinical dysfunction Index), preoperatively and postoperatively (immediate and at 3 months). The position of the disc was assessed by MRI preoperatively and at 3 months postoperatively. RESULTS: 24 patients were included in the study, and divided equally into test (N = 12) and control (N = 12) groups. Descriptive statistics were used to find the means and standard deviations of the parameters, and inferential statistics to assess p-values, using an independent-sample t-test. At 3 months after surgery, 10 patients in the test group demonstrated absence of pain (mean 0.1 ± 0.3), while only one patient was pain free in the control group (mean 5.2 ± 2.3). There was a significant improvement in mouth opening in the study group (mean 37.4 ± 3.4) in comparison with the control group (mean 22.5 ± 9.5). The study group demonstrated favourable surgical outcomes for all parameters (p < 0.0001), aside from clicking. CONCLUSION: Within the limitations of the study, disc repositioning in high condylar fractures appeared to demonstrate a positive effect on TMJ function, and hence should be considered in appropriate indications.

Comparison of LRINEC Scoring System with Finger Test and Histopathological Examination for Necrotizing Fasciitis.

Background Necrotizing fasciitis (NF) is a life-threatening condition requiring urgent attention. It is clinically difficult to diagnose, linked to severe systemic toxicity, and has poor prognosis. In 2001, Andreasen and coworkers described the "Finger test" for the diagnosis of NF. Subsequent studies have suggested early recognition and management of NF. In this study, we compare the LRINEC-Laboratory Risk Indicator for Necrotizing Fasciitis-scoring system with the "Finger test" and histopathological examination for diagnosis of NF. Results In our study, LRINEC scoring system and Finger test are statistically significant in the diagnosis of NF. Males are more frequently affected, and the most common organism causing NF is Staphylococcus . Histopathology remained the gold standard for diagnosis of NF, while LRINEC score and Finger test were good diagnostic tools for early diagnosis, with sensitivities of 83.33 and 86.11%, respectively. Conclusion LRINEC laboratory-based scoring system is easy and reliable diagnostic tool though histopathology remains the gold standard. There is statistically significant correlation between histopathology and laboratory criteria. LRINEC test is independently better than bedside Finger test alone or combined LRINEC and bedside Finger test.

A Novel Modified-Vista Technique With Connective Tissue Graft in the Treatment of Gingival Recession: A Case Report.

INTRODUCTION: The increasing esthetic demands from patients have required that clinicians sharpen their skills and adopt newer and more novel techniques to satisfy these demands. In periodontal therapy, periodontal plastic surgery poses a substantial challenge to the clinician, both because it is technique sensitive and also because it includes a wide array of procedures and their variations. Conventional plastic procedures have provided satisfactory results in the treatment of gingival recession but there is, presently, a greater need for more advanced procedures that cause less surgical morbidity as also provide improved results. Minimally invasive surgery has been harnessed in periodontics for this purpose and has been extensively used in multiple indications, including root coverage. Modified-Vestibular Incision Supra-periosteal Tunnel Access (M-VISTA) applies the principles of minimally invasive surgery to provide satisfactory results in root coverage. CASE PRESENTATION: A 28-year-old male patient presented with multiple Miller Class I/II buccal recession defects and associated high labial frenum on right maxillary anterior teeth. M-VISTA technique allowed coronal repositioning of gingival margin, which was then stabilized by orthodontics bracket assisted suturing technique. The V-shaped incision in the region of the frenal attachment allowed for conducting both the M-VISTA and frenectomy techniques simultaneously. Connective tissue graft was inserted in the supra-periosteal tunnel and vertical incision was sutured. Complete root coverage was achieved and maintained at 9 months with excellent esthetic outcomes. CONCLUSIONS: The use of connective tissue graft along with M-VISTA technique allows the clinician to successfully treat multiple recession defects.

Utilization of High-pressure Suction for EBUS-TBNA Sampling in Suspected Lung Cancer.

BACKGROUND: Sample adequacy for immediate molecular testing is paramount in lung cancer. To date, several endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) sampling setups have been evaluated, however, the utilization of high-pressure suction (HPS) has not yet been reported.The aim of this study was to evaluate the utilization of HPS onto the needle and its effect on sample volume and adequacy for molecular testing in patients with suspected lung cancer. METHODS: We retrospectively analyzed 128 consecutive EBUS-TBNA performed for suspected lung cancer. This was confirmed in 109 patients. Other diagnoses confirmed in 12, and 7 referred for surgery. Sixty-three patients (89 targets) had HPS (May to September 2020), and compared with 46 (72 targets) who had standard vacuum syringe suction (October 2019 to March 2020). Several parameters and outcomes evaluated, such as number of needle passes, needle strokes, needle size, target size, positron emission tomography avidity, procedure time, blood content score, sample volume, adequacy for molecular testing, as well as baseline patient characteristics and complication rate. RESULTS: There was no difference between the 2 groups in all baseline parameters and characteristics. In multivariable analysis, HPS was associated with significantly higher sample volume (11.2 vs. 9.1 mm3, P=0.036) and less additional procedures to achieve full molecular profiling (2/52 vs. 7/40, P=0.042), in necrotic targets of non-small cell lung cancer. Diagnostic yields were comparable. CONCLUSION: HPS appears to be simple, no-cost, and safe, promising higher sample volume compared with vacuum syringe suction, and also appears to be associated with higher success of full molecular testing with less additional procedures, in non-small cell lung cancer necrotic targets.