Outcome of post-COVID-19 fungal pyelonephritis: A single Indian tertiary center experience.

Introduction: COVID-19 pandemic is associated with secondary opportunistic fungal infections. These have an aggressive course with a high mortality rate. We present our experience of seven cases of post-COVID-19 fungal pyelonephritis. Methods: An observational study over a period of 8 months of May to December 2021 was carried out at our tertiary care hospital, including all patients with features of fungal pyelonephritis in post-COVID-19 setting. The patient demographics, details of previous COVID-19 infection, details of present admission and management were collected. The endpoints were either discharge from the hospital or death. Results: Seven patients were included. Mean age of presentation was 42 years (range: 20-63 years, standard deviation ± 14.2). Male-to-female ratio was 6:1. One patient was diabetic. Two patients were asymptomatic, one had mild infection, and four patients had severe COVID-19 infection as per National Institute of Health criteria. In the present admission, all patients had symptomatic pyelonephritis with laboratory parameters showing elevated D dimer, C reactive protein, and total leukocyte counts. In all seven patients, ultrasound of kidney ureter bladder region showed bulky kidney, color Doppler showed main renal arterial thrombosis in two patients, segmental arterial thrombosis in another patient. Computed tomography scan was suggestive of changes of pyelonephritis in all patients with multiple renal hypodense areas. All patients required nephrectomy with biopsy suggestive of changes of necrotizing fungal inflammation. Three patients expired. Conclusion: Management of post-COVID-19 fungal pyelonephritis should be aggressive and suspicious laboratory and imaging findings should be treated by early nephrectomy.

Size Distribution of Fragments by High-power Holmium Laser Lithotripsy in MiniPCNL with Suction.

PURPOSE OF REVIEW: Data are lacking on distribution of size of fragments created with the laser lithotripsy, stone density, and composition. Dust (< 1 mm) and small fragments (1-3 mm) may be too small to be efficiently removed with forceps compared to larger fragments (> 3 mm). We aim to report the size distribution of fragments formed during holmium laser lithotripsy. RECENT FINDINGS: One hundred ten patients with renal calculi < 3 cm underwent miniPCNL using ClearPetra sheath (Well Lead Medical Co., China) with controllable irrigation and suction system that minimizes fragment dispersion and maximizes fragment aspiration. Moses holmium laser (Lumenis INC, Israel) was used with predefined laser energy settings for lithotripsy. Proportion of fragment size < 1 mm was 46.36 ± 16.68%, 1-3 mm was 28.18 ± 10.01%, and > 3 mm was 25.19 ± 16.18% for the entire cohort. Complete stone clearance at 48 h was achieved in 77.3% cases. The remaining 22.7% patients had complete clearance at 1-month follow-up CT. In all the stone density, volume, and composition groups, majority of fragments created were either < 1 mm or 1-3 mm. Only 25% fragments were > 3 mm that would get aspirated out through the sheath with suction or could be retrieved with forceps. The combination of a high-power holmium laser and suction would help in complete stone clearance with effective aspiration of smaller stone fragments and dust simultaneously during lasing.

Unique, Cost-effective and Retentive Removable Prosthesis to Rehabilitate Long Span Kennedy's Class I Edentulism with Custom Attachment System: A Case Report.

AIM: This case report describes about a distinctive custom-made attachment on the abutment teeth to improve the retention and stability of the removable partial denture (RPD). It also throws light on the cost-effective method for altering the abutment teeth with the aid of the crowns and custom-made attachments. BACKGROUND: Achieving retention in Kennedy's class I bilateral edentulism usually affects the abutment teeth's periodontal health and eventually the retention is compromised. Distal extension edentulism also affects patient's masticatory efficiency. The rehabilitation of a patient with the long span Kennedy's class I condition complicates the problem because of the unavailability of enough abutments to support the prosthesis. Conventional removable prosthesis with clasps and cantilever fixed partial prosthesis are not advisable in this situation for the same reason. CASE DESCRIPTION: A case with Kennedy's class I modification 1 partially edentulous arch with 1st and 2nd molars missing along with central incisors was rehabilitated with an inexpensive custom attachment using die pin and sleeve for giving a fixed prosthesis on abutment teeth and removable prosthesis with missing teeth. CONCLUSION: This technique has advantages of retention better than conventional RPDs, protection of abutment health by restoring it with crown, easy to place and remove and very cost-effective. CLINICAL SIGNIFICANCE: The entire technique demands less skill compared to semi precision and precision attachments.

Evaluation of Antibacterial Effect and Dimensional Stability of Self-disinfecting Irreversible Hydrocolloid: An in vitro Study.

AIM: This study evaluated the antibacterial activity and dimensional stability of irreversible hydrocolloids mixed with different concentrations of chlorhexidine gluconate instead of water. MATERIALS AND METHODS: Experimental specimens (45 specimens) were prepared and allocated into three groups of 15 each. Group I: Impression material mixed with distilled water served as control. Groups II and III were prepared with 0.12 and 0.2% chlorhexidine gluconate solution, respectively. Specimens in each group were subjected to tests for dimensional stability. For antimicrobial activity, 30 specimens were prepared and allocated into three groups of 10 each named as group I (control), group II (0.12% chlorhexidine gluconate), and group III (0.2% chlorhexidine gluconate) similar to specimens for dimensional stability. Statistical analysis was performed using a one-way analysis of variance (ANOVA) and Tukey test. RESULTS: Zones of inhibition were observed around test specimens, but not around control specimens; there was a significant intergroup difference in the diameters of the inhibition zones. In the test for dimensional stability, no significant differences were detected among groups, and the accuracy was clinically acceptable. CONCLUSION: Irreversible hydrocolloid impression material mixed with chlorhexidine exhibits varying degrees of antibacterial activity without influencing the dimensional stability of set material. CLINICAL SIGNIFICANCE: Many contagious diseases can be prevented by practical control of infection in the dental office. Chlorhexidine gluconate, as a mixing liquid, ensures disinfection of impression, and this method of disinfection is more convenient and avoids extra effort as in other disinfection techniques.