Osteomyelitis of Jaw Bone due to Aspergillosis in Post-COVID-19 Patients: An Observational Study.

Background: In the second wave of COVID-19 pandemic, there has been an increase in number of cases with Post-COVID-19 fungal osteomyelitis of jaws. Aspergillosis was found to be one of the causes of osteomyelitis of jaw bones in these patients. Aim: To evaluate the incidence and pattern of osteomyelitis of jaw due to aspergillosis in post-COVID-19 patients and to discuss the management protocol of the same. Method: Data were obtained at our institution from the period of January 2021 to June 2021. Patients of all age groups with Post-COVID-19 osteomyelitis of jaw due to aspergillosis and those with combined aspergillosis and mucormycosis infection were included. Patients having rhino-orbito-cerebral fungal infection were excluded. Results: A total of 47 patients reported to our center. Demographically the average age of the patients was 49.11 years with 72% being males. All 47 patients (N = 100%) had received steroids. 21 of them (N = 44.7%) had diabetes mellitus and 14 (N = 29.8%) patients had other comorbidities. Out of 47 patients, 42 (N = 89.7%) patients were diagnosed with aspergillosis and the remaining 5 (N = 10.3%) cases had a mixed fungal infection of mucormycosis and aspergillosis. On fungal culture Aspergillus flavus was the most common species detected followed by Aspergillus niger and Aspergillus fumigatus. All patients were treated with oral Voriconazole and local surgical debridement. Prompt laboratory testing such as a timely KOH mount, galactomannan test, beta-D-glucan test, histopathology of tissue specimens could help to give an early and definitive diagnosis. The mortality rate we encountered in this study was nil. Conclusions: Early and definitive diagnosis and immediate initiation of antifungal drug therapy and surgical intervention will significantly reduce the rate of morbidity and mortality.

Effect of PEGylation on drug uptake, biodistribution, and tissue toxicity of efavirenz-ritonavir loaded PAMAM G4 dendrimers.

The present investigations aimed to compare the efficiency of PAMAM G4 (PG4) and PEGylated PAMAM G4 (PPG4) dendrimers as novel nanocarriers for the treatment of HIV-1. Synthesized PG4 and PPG4 dendrimers were confirmed by electrospray ionization and particle size with its morphology. The anti-human immunodeficiency virus (HIV) drug efavirenz (EFV) with a booster dose of ritonavir (RTV) was encapsulated into PG4 and PPG4 formerly noted as PG4ER and PPG4ER, respectively. Further, evaluated for dendrimers mediated solubilization, drug release, cytotoxicity, drug uptake, plasma, and tissue pharmacokinetics, and histopathology. PG4ER and PPG4ER both promoted a prolonged release of EFV in weakly acidic pH 4 up to 84 h and 132 h, respectively. The results of the cytotoxicity assay and drug uptake study showed that PPG4ER was safe and biocompatible up to 12.5 µg/ml. The plasma pharmacokinetic profile of EFV and RTV was significantly increased by PPG4ER with prolonged t1/2 up to three times as compared to free EFV-RTV and PG4ER. Histopathological analysis showed remarkably lower tissue toxicity in PPG4ER as compared to free EFV-RTV. Therefore, overall data suggested that PPG4 has a great potential for prolonged release of EFV and RTV with enhanced bioavailability and lower toxicity.

Assessment of salivary thiocyanate levels and pH in the saliva of smokers and nonsmokers with chronic periodontitis - A comparative study.

BACKGROUND: It has been speculated that the pathogenesis of diseases prompted by cigarette smoking includes oxidative damage by free radicals. Though, definitive evidence that smoking may cause the oxidative modification of target molecules in vivo is lacking. Therefore, the purpose of this study was to estimate and compare the levels of salivary Thiocyanate (SCN) and power of hydrogen (pH) in the saliva of smokers and nonsmokers with chronic periodontitis (ChP). MATERIALS AND METHODS: A study population consisted of 60 male systemically healthy subjects in the age group of 20-65 years that was further divided into three groups: Group 1: 20 Healthy nonsmokers, who never smoked. Group 2: 20 nonsmokers with chronic periodontitis. Group 3: 20 smokers with chronic periodontitis. Unstimulated saliva was collected for at least 5 mins and clinical parameters; salivary pH and SCN thiocyanate levels were assessed using the spectrophotometric method. Statistical analysis was performed using SPSS Inc 21.0, Chicago, II, United States of America. RESULTS: Data showed that the mean salivary SCN level, periodontal parameters were higher in smokers with chronic periodontitis as compared to nonsmokers with chronic periodontitis and healthy subjects (P < 0.05.) Post Hoc tests multiple comparisons Tukey Honest Significant Difference (HSD) among three groups were statistically significant (p < 0.05). CONCLUSION: Salivary thiocyanate levels remain increased by smoking in addition to the impact of periodontitis, and these results also indicated a significant change in the pH depending on the severity of the periodontal condition in smokers. Thus, the measurement of salivary thiocyanate may prove to be useful in the early detection of periodontal disease. The salivary pH shows significant changes and, consequently, relevant to the severity of the periodontal disease. Salivary pH may thus be used as a quick chairside diagnostic biomarker.

Analyzing Effects of Sickle Cell Disease on Morphometric and Cranial Growth in Indian Population.

BACKGROUND: Sickle cell disease is the most pervasive autosomal recessive hereditary blood diseases and is characterized by the presence of sickle hemoglobin (HbS), which in turn gives rise to pathophysiological consequences. This HbS reduces the agility of erythrocytes plummeting their ability to pass through small vascular channels, which in turn results in increased blood viscosity and congestion of vascular beds, causing ischemia, local infarction, and hemolysis. OBJECTIVES: The current study was conducted to carry out the morphometric analysis in patients with sickle cell disease. MATERIALS AND METHODS: This study was conducted on 75 subjects detected with sickle cell disease aged between 8 and 16.5 years. The study involved 38 males and 37 females. All the subjects were subjected to lateral cephalogram for the calculation of various angular and linear dimensions of the craniofacial structures. The linear measurements made were nasion-menton height, anterior nasal spine (ANS)-menton height, and nasion-ANS height, whereas the angular measurements made were Frankfurt mandibular plane angle, Frankfort mandibular incisor angle, and incisor mandibular plane angle. RESULTS: Major chunk of the subjects had retruded mandible and vertical growth pattern. Few subjects exhibited with maxillary protrusion. CONCLUSION: It is concluded that early diagnosis and management of dental malocclusion in patients with sickle cell disease plays a pivotal role in an attempt to endow with a better quality of life to these individuals.

Comparative Evaluation of Salivary Biomarker Levels in e-Cigarette Smokers and Conventional Smokers.

BACKGROUND: The cigarette smoking and its effect on the inflammatory cytokine levels in the smoker's saliva depicted the influence of electronic cigarettes on oral cytokine levels in oral fluids are scarce in the literature. OBJECTIVES: The present trial was conducted to compare and determine the proinflammatory and anti-inflammatory cytokines in whole stimulated saliva samples of electronic cigarette smokers, conventional smokers, and participants with no smoke exposure. MATERIALS AND METHODS: Sixty adult participants were divided into the following four groups of nonsmokers, current smokers, smokers smoking both conventional and e-cigarettes, and e-cigarette smokers. The saliva samples were assessed for Interleukins (IL-1B, 6, 8, 10, and IL-1RA), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) using enzyme-linked immunosorbent assay. Plaque scores and Gingival Index, and body mass index were also calculated. RESULTS: Statistically significant (P < 0.05) and remarkable relationship was seen in plaque scores and IL 1RA, 1 ß, and 10 with the respective values as-0.285, 0.268, and 0.267. Regarding anti-inflammatory cytokines, CRP, IL-10, and IL-RA had the P-value of 0.073, 0.945, and 0.834 respectively. When these values were evaluated for proinflammatory cytokines, the P values were 0.0001, 0.019, 0.991, and 903 for TNF-α, IL-1 ß, IL-6, and IL-8, respectively. These results were statistically significant for TNF-α (P = 0.001). CONCLUSION: Within its limitations, the present study concludes that smoking e-cigarettes whether solely or in combination with conventional smoking increases the levels of proinflammatory cytokines such as TNF-α and IL-1 ß with decreased counter IL-1RA levels.

Comparative evaluation of microleakage around Class V cavities restored with alkasite restorative material with and without bonding agent and flowable composite resin: An in vitro study.

BACKGROUND: Marginal adaptability of restorative material is one of the prime factors for success of a restoration. AIM: To evaluate microleakage at enamel restoration and dentin restoration interface of Class V cavities restored with new alkasite restorative material Cention-N, with and without using bonding agent and flowable composite resin. MATERIALS AND METHODS: Thirty Class V tooth preparations were divided into three groups (n = 10): Group-I restored with Cention-N (Ivoclar Vivadent) without adhesive, Group-II was restored with Cention-N after application of eighth-generation bonding agent (3M ESPE, Single Bond Universal Adhesive), and Group-III was restored with flowable composite resin (Tetric-N-Flow, Ivoclar Vivadent). All samples were subjected to 200 thermocycles between temperature baths at 5°C and 55°C. All samples were cut longitudinally through the center of the restorations with the help of isomet diamond saw. The sections were then observed under binocular stereomicroscope at 20×. Two evaluators scored the depth of dye penetration independently at enamel and dentin margins. STATISTICAL ANALYSIS: Kruskal-Wallis nonparametric analysis followed by Dunn's multiple comparison tests were done to evaluate differences among the experimental groups. Mann-Whitney test was used to compare the difference between occlusal and gingival scores within each restoration. RESULTS: Microleakage seen in decreasing order: Cention-N without adhesive >Flowable composite >Cention-N with adhesive. CONCLUSION: Microleakage at enamel restoration interface was less than microleakage at dentin restoration interface of each group, but the difference was not statistically significant. Least microleakage was seen with Cention-N with adhesive followed by flowable composite. More microleakage was seen with Cention-N without adhesive.

Schwannoma of the cheek: clinical case and literature review.

INTRODUCTION: Schwannoma is a relatively uncommon benign tumor that apparently originates from Schwann cells of peripheral nerves. The most common intraoral site is the tongue followed by the palate, floor of mouth, buccal mucosa, lips and the jaws. The preoperative diagnosis is often difficult, and in the majority of cases, the diagnosis can only be made during surgery and by histological study. The immunohistochemistry reveals that the schwannoma cells test positive for S-100 protein. CASE REPORT: The authors report here a case of an intraoral schwannoma situated in the cheek, treated by complete surgical excision. In the present case the schwannoma presented as a slow growing, circumscribed swelling without any particular features to distinguish it from other benign soft-tissue lesions. The final diagnosis was established based on the clinical, histopathologic and immunohistochemical findings. CONCLUSION: The presence of schwannoma calls for the careful search for nerve tumors in other parts of the body, although in most cases none may be found. The differentiation of schwannoma from neurofibroma is essential, because an apparently solitary neurofibroma may be a manifestation of neurofibromatosis.