Cerebral Venous Thrombosis in COVID-19.

Background: COVID-19 causes a hypercoagulable state leading to thrombosis. Many of these thrombotic complications occur in those with severe disease and late in the disease course. COVID-19 has recently been associated with cerebral venous thrombosis (CVT). Objective: To study the onset of CVT in relation to COVID-19 and compare their characteristics and outcomes with non-COVID CVT patients admitted during the same period. Materials and Methods: This multicentric, retrospective study conducted between April 4 and October 15, 2020, included adult patients with CVT who were positive for the SARS-CoV-2 virus and compared them with CVT patients who were negative for the SARS-CoV-2 virus hospitalized during the same period. We studied their clinical profile, risk factors for CVT, and markers of COVID coagulopathy, imaging characteristics, and factors influencing their outcomes. Results: We included 18 COVID-19-infected patients and compared them with 43 non-COVID-19 CVT patients. Fourteen patients in the COVID-19 group presented with CVT without the other typical features of COVID-19. Thirteen patients had non-severe COVID-19 disease. Twelve patients had a good outcome (mRS ≤2). Mortality and disability outcomes were not significantly different between the two groups. Conclusion: Our study suggests a possible association between COVID-19 and CVT. CVT can be the presenting manifestation of an underlying COVID-19, occurring early in the course of COVID-19 and even in those with mild disease. Patients with worse GCS on admission, abnormal HRCT chest, severe COVID-19, and need for invasive ventilation had a poor outcome.

An assessment of coronal leakage of permanent filling materials in endodontically treated teeth: An in vitro study.

INTRODUCTION: The present in vitro study was undertaken to evaluate and compare the sealing ability of hybrid composite, glass ionomer cement type II, silver amalgam and Ketac molar as permanent filling material in root canal treated teeth. METHODOLOGY: Hundred maxillary central incisors were selected for the study. After cleaning all the teeth, root canal treatment was carried out on all of them. The crown portion was cut-off at the cervical level. Three millimeter of coronal Gutta-percha was replaced by four different restorative materials. Then after thermocycling, samples were immersed in dye for 2 weeks. The amount of dye penetration was measured using stereomicroscope. Data were collected and analyzed statistically with ANOVA test and Student-Newman-Keuls test. RESULTS: Coronal leakage was seen in all groups. Composite hybrid showed least amount of microleakage as compared to the other three experimental groups, and Ketac molar showed more leakage compared to other experimental groups. CONCLUSION: This study showed that hybrid composites offer better sealing ability compared to other materials tested in this study.

Innovative approach for prevention and treatment of post subarachnoid hemorrhage vasospasm: A preliminary report.

More than one third of patients with subarachnoid hemorrhage (SAH) develop clinically significant vasospasm, as a leading morbidity and mortality factor for these patients. It is widely accepted that a) Degradation products of blood are the causative factors of vasospasm b) The amount of subarachnoid blood seen on admission CT is correlated to the risk of vasospasm c) Reducing the subarachnoid clot burden at the time of surgery reduces the risk of vasospasm. But there is no existing method to clear the blood from subarachnoid spaces satisfactorily. We have evaluated safety and feasibility of fluid exchange catheter system in SAH, to achieve this goal. We were successful in clearing cisternal blood in three patients with aneurysmal rupture with fluid exchange catheter system. Baseline CT scan of brain was performed immediately after the surgery and then at the end of irrigation. The amount of subarachnoid blood was evaluated. This innovative, fluid exchange catheter system infuses and aspirates micro volumes of drug solution in a cyclic mode, ensuring isobaric exchange of fluids. The result is good clearance of blood in subarachnoid spaces were seen in all the patients. Also, significant improvement in neurological deficits secondary to vasospasm was seen. We conclude that the fluid exchange catheter system is safe and adoptable in neurosurgical practice.

The split hand sign.

Amyotrophic Lateral sclerosis (ALS) is a disease characterized by pure motor asymmetric wasting of various muscles with associated upper motor neuron signs. The split hand sign, which is because of dissociated muscle weakness in the hands (thenar muscles disproportionately wasted as compared to the hypothenar muscles) is a useful clinical sign for bed side diagnosis of ALS.

Idiopathic calcinosis cutis of nasal dorsum.

A 23-year-old lady presented with a slowly progressing firm mass on the nasal dorsum since 8 months. Her biochemical, haematological and collagen vascular disease screening tests were normal. Radiographs of the nasal bones showed a subcutaneous calcifying lesion with no evidence of nasal bone erosion. A diagnosis of idiopathic calcinosis cutis (ICC) was made. The mass was excised and soft tissue defect was augmented with silicone prosthesis. The histopathology with the haematoxylin and eosin staining and von Kossa stain confirmed the diagnosis of calcinosis cutis. This is an unusual presentation of ICC involving the nasal dorsum requiring surgery and nasal dorsal augmentation with silicone prosthesis.

Recurrent aphthous stomatitis.

Recurrent aphthous stomatitis is a common oral ulcerative disease, affecting 10% to 15% of the general US population. This article reviews the epidemiology and clinical presentations of recurrent aphthous stomatitis, including diagnosis and management.

Diagnosis and management of oral candidiasis.

Oral candidiasis is the most common fungal infection in both the immunocompetent and the immunocompromised populations. This article reviews the clinical presentations of the different forms of oral candidiasis, as well as the diagnosis and management.

Dysphagia: pathophysiology, presentation, diagnosis, and dental management.

Dysphagia is a common side effect of many systemic conditions that greatly affect oral care. This article draws from the literature concerning the pathophysiology, diagnosis, and treatment of dysphagia as it relates to dental care. Treatment of dysphagia requires a multidisciplinary approach. Dentists are integral to the management of dysphagic patients, which includes improving natural or artificial dentition to aid in mastication and function and stressing the importance of adequate oral hygiene.

Oral cancer risk factors among Mexican American Hispanic adolescents in South Texas.

PURPOSE: Tobacco use and alcohol consumption have been identified as the major risk factors for oral and pharyngeal cancers. This study aimed to assess the knowledge, attitudes and beliefs of adolescent high schoolers in South Texas regarding the risk factors and signs for oral cancer and to examine their prevalence of cigarette smoking, use of smokeless tobacco and alcohol consumption. METHOD: The sample population was drawn from the public school system in Brownsville, Texas. A 39 item self administered questionnaire was completed by 1667 students in four of the five high schools. 95.6% of the students were of Mexican American Hispanic ethnicity. RESULTS: Modeling with multivariate logistic regression revealed that among current cigarette smokers, regular alcohol use was the strongest associated risk [OR=15.7; 95% CI=10.9-22.5] followed by use of smokeless tobacco [OR=2.4; 95% CI=1.4 4.1]. There was a significantly greater (P<0.001) use of cigarettes, smokeless tobacco and alcohol among the Mexican American males than females. CONCLUSIONS: This study shows that the overall risk for oral cancer among the Mexican-American adolescent population is high especially among the males, and there is a great need for carefully planned health education and promotion programs for behavior change.

Residual (ghost) sockets in bisphosphonate use--evidence of poor healing and slow bone turnover.

Patients taking bisphosphonate drug therapy have demonstrated extremely poor alveolar bone healing after relatively minor oral surgical procedures. It would seem logical that extraction sockets could remain visible radiographically for an extended period after surgery, even in cases with soft tissue healing. This article chronicles the case of a patient who had been taking zoledronic acid chronically for metastatic cancer and who demonstrated numerous residual sockets (also known as ghost sockets), with lamina dura outlines that were visible radiographically.

Dental considerations in the management of the cardiac transplant patient.

Every year, more than 25,000 transplantation procedures are performed in the United States to replace solid organs, including the heart, intestine, kidney, liver, lung, and pancreas. Cardiac transplant patients need specialized dental care. The compromised health and immune systems of these patients place them at increased risk for systemic and oral infections, which must be considered when planning dental treatment before and after cardiac transplantation. This article reviews the current status of dental care practices that have been recommended and presents a rationale that can be applied as the basis of guidelines and recommendations for treating cardiac transplant patients.

Maxillary frenectomy using a carbon dioxide laser in a pediatric patient: a case report.

Dental lasers contribute significantly to the field of cosmetic dentistry, providing an invaluable resource for clinicians who perform different types of esthetic procedures. An increasing number of general dentists are using the carbon dioxide (CO2) laser for surgical procedures. However, the literature about using a CO2 laser to perform oral soft tissue ablation in the pediatric patient is limited. This case report presents a successful case of a maxillary labial frenectomy in a pediatric patient using a CO2 laser.

Current role of thalidomide in HIV-positive patients with recurrent aphthous ulcerations.

Among patients with HIV/AIDS, mucosal lesions of unknown etiology such as recurrent aphthous ulcerations (RAUs) often are unresponsive to standard therapies, resulting in substantial morbidity. The literature regarding RAUs suggests that the inflammatory response contributes to its pathogenesis; however, the role of cytokines in this mucosal immune response remains largely unknown. Thalidomide first was marketed as a sedative in the 1950s and withdrawn from the market in 1961 following reports of teratogenicity. Later, it was used as an investigational agent for the treatment of Hansen's disease, Kaposi's sarcoma, myelofibrosis, RAUs, and wasting associated with HIV. Thalidomide's mechanism of action in RAUs still is not understood completely, but it appears to be mediated by inhibition of the pro-inflammatory cytokine tumor necrosis factor alpha (TNF-alpha). This article discusses the current status of thalidomide for treating RAUs in HIV-positive patients. Suggestions regarding the safe and effective prescribing of thalidomide have been included so that dental professionals will be able to treat these patients safely.