Comparative effectiveness of medicinal interventions for oral submucous fibrosis: A network meta-analysis.

OBJECTIVES: This network meta-analysis presents an exhaustive description and comparison of the available medical interventions for the management of oral submucous fibrosis (OSMF). MATERIALS AND METHODS: A systematic review and network meta-analysis was conducted after registration with PROSPERO. (PROSPERO ID CRD42022303441). Databases (PubMed, Cochrane, EMBASE, Web of Science, and others) were searched for randomized clinical trials (RCT) trials from inception till September 2022 for the medical interventions in OSMF. The primary outcome was the improvement in mouth opening. The secondary outcomes were improvement in burning sensation, tongue protrusion, and cheek flexibility. The interventions were ranked according to their efficacy based on the surface under the cumulative ranking. RESULTS: 47 studies including 2393 patients were assessed for quantitative analysis. For mouth opening, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective [MD, 7.05 (95%CI 1.76,12.34)], followed by the combination of oral antioxidants with injectable steroids, [MD, 3.80 (95%CI -0.44,8.03)]. Additionally, the combined treatment with steroid, hyaluronidase, and antioxidant was most effective in reducing the burning sensation [MD, -8.62(-10.95,-6.30)], followed by aloe vera [MD, -8.45(-10.40,-6.49)] and pentoxifylline [MD -7.57(-9.46,-5.68)]. For tongue protrusion, curcumin was most effective followed by antioxidants. Most of the drugs used were reported to cause negligible or mild adverse effects. CONCLUSION: This network meta-analysis reported the efficacy of medicinal interventions in OSMF patients compared to the placebo in the improvement of mouth opening and burning sensation, and cheek flexibility. The methodological quality of included RCTs was low. Well-designed studies are recommended to obtain strong evidence.

Bacterial and fungal profile of corneal ulcers--a prospective study.

Corneal ulceration continues to be one of the most important causes of ocular morbidity and blindness worldwide. Between April 1999 and May 2001, 80 patients with corneal ulceration were examined to find the causative microorganisms, the sensitivity pattern of bacterial isolates to antibiotics, the predisposing factorsfor ulcerative keratitis and the comparison between culture and gram staining results. Corneal ulceration was seen more in males than females, predominantly in farmers (61.25%) and trauma was the commonest predisposing factor, the agents being mainly organic agricultural materials. Of the 80 corneal ulcers, 32(40%) yielded pure bacterial growth while fungal growth was seen in 10(12.5%). Streptococcus pneumoniae was the commonest bacterium while Aspergillus fumigatus and Fusarium species were the commonest fungi isolated. Most of the bacterial isolates were sensitive to chloramphenicol and tetracycline followed by the quinolones. The overall sensitivity and specificity of Gram staining as compared to culture was 57.14% and 94.7% respectively.

Infective endocarditis due to Salmonella typhi--a case report.

Endocarditis is a rare complication of typhoid fever. We report a case in which Salmonella enterica serotype typhi was isolated from a case of endocarditis. The isolate was resistant to ampicillin, chloramphenicol and ciprofloxacin but sensitive to ceftriaxone, amikacin and gentamicin.

Pulmonary pseudallescheriasis in a patient with healed tuberculosis.

Pulmonary pseudallescheriasis in an immunocompetent patient without a pre-existing cavity or cyst is a rare phenomenon. We report a case of invasive pulmonary pseudallescheriasis in a lobectomised patient treated for tuberculosis. Filamentous fungi with pyriform conidia were seen in the bronchoalveolar lavage fluid . The fungus was identified as Pseudallescheria boydii on culture.