Challenges with the use of Xpert HPV as a screening tool for oral HPV among people living with HIV (PLHIV): experiences from Pune, India.

BACKGROUND: People living with HIV (PLHIV) are at higher risk for human papillomavirus (HPV)-related oropharyngeal cancers compared to the general population. Xpert HPV test is a polymerase chain reaction (PCR) assay capable of rapid HPV detection. Performing the assay requires minimal intervention by laboratory personnel. Its use could improve oropharyngeal cancer screening among PLHIV living in low-and middle-income countries (LMICs) with limited diagnostic capacities. However, Xpert HPV performance for oral samples has not been evaluated. Here, we describe our experience with Xpert HPV and compare its results with traditional PCR, for oral samples. METHODS: Oral samples from 429 PLHIV receiving care at a tertiary care hospital affiliated antiretroviral therapy center in Pune, India were used. Samples were collected either after a 30s oral rinse and gargle (n = 335) or in combination with cytobrush scraping of the oral mucosa (n = 91). Unsuccessful tests were those that generated an invalid or error result on Xpert HPV. Successful tests were those that generated a positive or negative result. Kappa statistic was used to compare concordance between Xpert HPV and traditional real-time PCR results. RESULTS: There were 29.8% (n = 127) unsuccessful tests, of which 78.7% (n = 100) were invalid and 21.3% (n = 27) were error results. Adding cytobrush scraping to oral rinse as a collection procedure did not significantly reduce the proportion of unsuccessful tests (p = 0.9). For successful tests, HPV positivity on Xpert was 0.3% (n = 1/299). Kappa statistic was 0.11, indicating poor agreement between Xpert HPV and traditional PCR results. CONCLUSIONS: Presently, Xpert HPV appears to have limited use for oral HPV detection among PLHIV using oral samples. More research to improve the diagnostic capabilities of Xpert HPV for oral samples among PLHIV is needed.

Outbreak of Mucormycosis in Coronavirus Disease Patients, Pune, India.

We provide an overview of the epidemiology and clinical course of mucormycosis in the coronavirus disease (COVID-19) pandemic era. We conducted a retrospective chart review of 178 patients with clinical or diagnostic, endoscopically or histopathologically confirmed rhino-sino-orbital or cerebral mucormycosis after COVID-19 treatment during the second wave of COVID-19 in Pune, India. Median time to symptom onset from COVID-19 detection was 28 days. Moderate or severe COVID-19 was seen in 73% of patients and diabetes in 74.2%. A total of 52.8% received steroids. Eschar over or inside the nose was seen in 75%, but baseline clinical and laboratory parameters were mostly unremarkable. Bone penetration was present in ≈90% of cases, 30% had soft-tissue swelling of the pterygopalatine fossa and 7% had cavernous sinus thrombosis, and 60% had multifocal mucormycosis. Of the 178 study cases, 151 (85%) underwent surgical debridement. Twenty-six (15%) died, and 16 (62%) of those had multifocal mucormycosis.

High Burden of Antimicrobial Resistance and Mortality Among Adults and Children With Community-Onset Bacterial Infections in India.

Background: In India, antimicrobial consumption is high, yet systematically collected data on the epidemiology, risk factors, and outcomes of antimicrobial-resistant infections are limited. Methods: A prospective study of adults and children hospitalized for acute febrile illness was conducted between August 2013 and December 2015. In-hospital outcomes were recorded, and logistic regression was performed to identify independent predictors of community-onset antimicrobial-resistant infections. Results: Among 1524 patients hospitalized with acute febrile illness, 133 isolates were found among 115 patients with community-onset infections; 66 isolates (50.0%) were multidrug resistant and, of 33 isolates tested for carbapenem susceptibility, 12 (36%) were resistant. Multidrug-resistant infections were associated with recent antecedent antibiotic use (adjusted odds ratio [aOR], 4.17; 95% confidence interval [CI], 1.19-19.7) and were independently associated with mortality (aOR, 6.06; 95% CI, 1.2-55.7). Conclusion: We found a high burden of community-onset antimicrobial-resistant infection among patients with acute febrile illness in India. Multidrug-resistant infection was associated with prior antibiotic use and an increased risk of mortality.

Quantitative IFN-γ and IL-2 Response Associated with Latent Tuberculosis Test Discordance in HIV-infected Pregnant Women.

RATIONALE: Pregnant women with latent tuberculosis infection (LTBI) are at high risk for development of TB, especially if infected with HIV. OBJECTIVES: To assess the performance of LTBI tests in pregnant and postpartum women infected with HIV, investigate the immunology behind discordance in pregnancy, and explore the implications for the development of postpartum TB. METHODS: We screened pregnant women in their second/third trimester and at delivery for LTBI using the tuberculin skin test (TST) and IFN-γ release assay (IGRA) (QuantiFERON Gold). A subset of antepartum women had longitudinal testing, with repeat testing at delivery and postpartum and additional cytokines measured from the IGRA supernatant. The kappa statistic and Wilcoxon rank sum test were used to determine agreement and comparison of cytokine concentrations, respectively. MEASUREMENTS AND MAIN RESULTS: Of 252 enrolled, 71 (28%) women had a positive IGRA but only 27 (10%) had a positive TST (P < 0.005). There was 75% agreement (kappa, 0.25). When stratified by pregnancy versus delivery, 20% had IGRA(+)/TST(-) discordance at each time point. A positive IGRA was associated with known TB contact (odds ratio, 3.6; confidence interval, 1.2-11.1; P = 0.02). Compared with IGRA(+)/TST(+), women with IGRA(+)/TST(-) discordance had significantly less IFN-γ (1.85 vs. 3.48 IU/ml; P = 0.02) and IL-2 (46.17 vs. 84.03 pg/ml; P = 0.01). Five developed postpartum TB, of which three had IGRA(+)/TST(-) discordance during pregnancy. CONCLUSIONS: Choice of LTBI test in pregnant women infected with HIV affects results. Pregnant women with IGRA(+)/TST(-) discordance had less IFN-γ and IL-2 than those with concordant-positive results and may represent an especially high-risk subset for the development of active TB postpartum.

Tuberculosis Risk among Medical Trainees, Pune, India.

During 2012-2013, at a public hospital in Pune, India, 26 (3.9%) cases of tuberculosis were reported among 662 medical trainees, representing an estimated incidence of 3,279 cases/100,000 person-years. Three of these infections were isoniazid-resistant, 1 was multidrug-resistant, and 1 occurred in a trainee who had fulminant hepatitis after starting treatment for TB.

Efficacy for Lidocaine and Articaine in Inferior Alveolar Nerve Block - A Comparative Study.

AIMS: Compare the efficacy of 2% lidocaine with adrenaline (1:200,000) and 4% articaine with adrenaline (1:100,000) in inferior alveolar nerve block prior to extraction of bilateral teeth posterior to canine in interval of one week. METHODS AND MATERIAL: Thirty-five patients were selected for the study. Patients were divided into two different groups: Group 1 - (2% lignocaine with adrenaline (1:200,000)) and Group 2 - (4% articaine with adrenaline (1:100,000)) solution. The study variables for each anaesthetic agent were: onset of action and depth of anaesthesia. A pulp tester was used to demonstrate quantitative values and a visual analogue scale (VAS) was used for qualitative evaluation of the two anaesthetic drugs in 2 min cycle for 10 min with respect to test canine. Anaesthesia was considered successful when pulp tester value 64 was achieved in 10 min for both the anaesthetic agent. STATISTICAL ANALYSIS USED: The difference in the efficacy of lignocaine and articaine was analysed using Student's t test. Within group comparison of the response to the pulp vitality test and VAS over various time periods was analysed using repeated measures Analysis of Variance (ANOVA) with post-hoc Bonferroni test. RESULTS: Data analysis showed statistical differences in onset and depth of anaesthesia between the two groups (P < 0.05). CONCLUSIONS: 4% Articaine with adrenaline (1:100,000) onset of action is faster and depth of anaesthesia is better compared to 2% lignocaine with adrenaline (1:200,000). Many previous studies reported onset of anaesthesia, but this study evaluates onset and depth of both the anaesthetic agent quantitatively and qualitatively.

Evaluation of the Role of C-reactive Protein as a Prognostic Indicator in Oral Pre-malignant and Malignant Lesions.

Biopsy is the gold standard in the diagnosis of oral pre-malignant and malignant cases. In borderline cases, false-positive or false-negative results can grossly affect treatment planning, leading to a bad prognosis. C-reactive protein (CRP) has been linked to poorer outcomes for patients with oral pre-malignant and malignant lesions. To validate the histopathological finding and ultimately direct treatment, the study aims to correlate pre-treatment levels of CRP in oral pre-malignant and malignant lesions. This will provide a biomarker to assess the prognosis in such cases. Our study investigated 53 patients, out of whom 35 were males and 18 were females. A CRP analysis was performed on each patient. The automated immunoturbidimetric method was utilized to quantify CRP levels. The CRP values of pre-malignant lesions ranged from 2.46±1.79 mg/L, while the malignant group's levels ranged from 7.90±3.18 mg/L. The findings imply that plasma CRP levels may be a potential indicator of elevated cancer risk and that pre-diagnostic CRP concentrations are linked to the later development of oral cancer.

Comparative Evaluation of Different Alveolar Ridge Width Measurement Techniques in Dental Implant Treatment Planning: An in Vivo Observational Non-Interventional Study.

In todays era dental implant has become the dependable therapeutic treatment for the replacement of missing teeth. The success of dental implants depends not only on osteointegration of the implant but also on the surrounding hard and soft tissue. Presurgical evaluation of alveolar ridge width and height is of paramount important for implant placement. There are several methods to evaluate the alveolar ridge width and height such as ridge mapping and CBCT. This study included 30 sites from 8 patients in the age ranging from 30 to 65 years. A stent was prepared and the width of the alveolar ridge was estimated employing the following techniques: Group I: Measurement of alveolar ridge width on cone-beam computed tomography (CBCT) method, group II: Measurement of alveolar ridge width by ridge mapping technique, group III: Measurement of alveolar ridge width by surgical exposure. The minimum value for ridge mapping with caliper is 2 and maximum value is 9 with mean 4.5667 ± 1.63335 with standard error 0.29821. The minimum value for Cone beam computed tomography (CBCT) is 1.80 and maximum value is 9.30 with mean 4.6233 ± 1.67119 with standard error 0.30512. The minimum value for direct intrasurgical measurement with caliper is 2 and maximum value is 9 with mean 4.2000 ± 1.58441 with standard error 0.28927. Cone beam computed tomography could also be used to measure the ridge width accurately. Apart from measurement of alveolar ridge dimensions it had multiple other uses and thus can be advised as per requirement of the clinician.

Transosseous fixation of pediatric displaced mandibular fractures with polyglactin resorbable suture--a simplified technique.

Management of pediatric mandibular fractures presents a unique challenge to surgeons in terms of its numerous variations compared to adults. Both conservative and open methods have been advocated with their obvious limitations and complications. However, conservative modalities may not be possible in grossly displaced fractures, which necessitate the open method of fixation. We present a novel and simplified technique of transosseous fixation of displaced pediatric mandibular fractures with polyglactin resorbable suture, which provides adequate stability without any interference with tooth buds and which is easy to master.

Impetigo Herpetiformis Complicating Pregnancy: A Case Report on a Rare Gestational Dermatosis With Constitutional Symptoms.

Impetigo herpetiformis (IH) is a rare dermatosis that can manifest during the last trimester of pregnancy. It has the potential to cause fatality to both the mother and the fetus. After birth, it often vanishes spontaneously and rapidly. Clinically and histologically, it resembles pustular psoriasis, leading some authors to call it "the pustular psoriasis of pregnancy." Steroids were previously the treatment of choice, but treatment remains challenging. A dermatologist with experience in skin conditions during pregnancy should assess any generalized pustular psoriasis instances. There is a danger of stillbirth when a systemic sickness develops, so both the mother and fetus should be properly watched. A well-known side effect of pregnancy-related generalized pustular psoriasis is maternal sepsis. We report our own experience with a case of a 26-year-old pregnant woman who presented with IH that resolved postpartum.

Evaluation of the Effect of Distant Cold Stimulation on Pain During Palatal Injection: A Randomized Split-Mouth Study.

Objective Delivery of a robust local anesthetic injection aids in the successful management of all patients' fears, anxieties, and discomfort during dental treatments. The most expected or frightening stimuli in the dental operatory are local anesthetic injections. The objective of this trial was to study the analgesic efficacy of distant cold stimulation in relieving injection pain from the greater palatine nerve block. Before receiving local anesthetic injections, employing cryotherapy by using an ice bath changes the pain perceptions and also increases the pain threshold. Purpose The aim of this study is to evaluate the effect of distant cold stimulation on palatal injection pain using an ice-cold bath. Method This was a randomized, controlled trial conducted at an oral and maxillofacial surgery department. A split-mouth technique was employed for the study, in which patients requiring bilateral greater palatine nerve block for any dental procedures were included. The bilateral greater palatine nerve block was given one at a time, separated by an interval of three days. The inclusion criteria for this study were no history of drug allergy and an extraction site free of any active infection. There were 28 participants in this experimental study. Two groups were randomly created from this research sample: group A (palatal injection with distant cold stimulation) and group B (palatal injection without distant cold stimulation). In group A, the patient was asked to put his or her hand of the same side as the palatal injection in an ice-cold bath till the time patient could tolerate it; immediately after the patient removed his hand, the greater palatine nerve block was given, and the patient was assessed for the injection pain. In group B, the patient was directly given the greater palatine nerve block without any distant cold stimulation. The time interval between the two extractions/dental procedures was three days. Outcomes of interest were pain severity with and without distant cold stimulation which were assessed using a Visual Analogue Scale (VAS) pain scale, and a comparison was made between the two groups. Results As per our study, in terms of pain, there was a statistically significant difference between the two interventions at all time points. Patients in group A had a lower score on the VAS pain scale as compared to group B. The standard deviation (STD) for group A was 0.81, and the standard deviation for group B was 0.92. P value was derived to be P < 0.001, which is suggestive of a significant difference between the pain scores of both groups. Conclusion Hence, we conclude that the use of distant cryotherapy as an adjunct is an effective way to reduce pain perception and increase pain threshold. This technique is comparatively simple, painless, and easy for the surgeon and for apprehensive patients, and it offers a fair cost solution for the suffering often associated with dental procedures requiring local anesthetic injections.

Patient-Specific Implants in Maxillofacial Reconstruction - A Case Report.

Rationale: The successful utilisation of three dimensional (3D) techniques in engineering a titanium patient specific implant (PSI) for a patient who underwent hemimaxillectomy following post COVID mucormycosis infection. Patient Concerns: Issues related to problems associated with resection following mucormycosis, such as occlusal function, aesthetics and facial asymmetry. Diagnosis: The patient affected by mucormycosis was left with Aramany class 1 and Cordeiro type II sub total maxillectomy defect. Treatment: The patient was operated for mucormycosis followed by reconstruction with patient specific implant. Outcome: Positive clinical outcomes, including improved facial symmetry, function and psychological well being with immediate replacement of the teeth, the benefits of which far outweigh the traditional approach. Take away Lessons: The advances in the use of PSI by integration of 3D printing and computer aided design computer aided manufacturing (CAD-CAM) technology for extensive and challenging defects in the maxillofacial region have been highlighted in this case report.

Evaluation of the Efficacy of Oral and Intramuscular Administration of Dexamethasone on Postoperative Pain, Swelling, and Trismus After Surgical Removal of Impacted Third Molar: A Comparative Split-Mouth Study.

Context Over the past 60 years, several researchers have conducted extensive studies on the use of dexamethasone to reduce the postoperative complications of lower third molar surgery, namely, pain, edema, and trismus. In this study, we compared the oral and intramuscular methods of dexamethasone administration. Purpose The aim of this research was to assess pain, edema, and trismus in the postoperative period following the surgical removal of the lower third molar using 8 mg of dexamethasone given orally or by intramuscular injection. Method A split-mouth technique was employed for the study, in which each of the two bilaterally impacted mandibular third molars was removed one at a time, separated by at least two weeks. There were 26 participants in this experiment. Two groups were created from the research sample: group A (injection dexamethasone) and group B (tablet dexamethasone). The pain was assessed on the first, second, and third postoperative days. On the first, third, and seventh postoperative days, the parameters, such as edema and trismus, were evaluated. Results As per our study, in terms of edema and trismus, there was less of a statistically significant difference between the two interventions at all time points. While the pain score had a significant difference between both interventions. Conclusion Hence, we conclude that oral dexamethasone is an effective alternative to intramuscular dexamethasone. Oral dexamethasone is comparatively simple, less invasive, painless, and easy for the surgeon and for apprehensive patients, and it offers a cost-effective solution for the suffering often associated with the extraction of impacted lower third molars.

Persistent olfactory learning deficits during and post-COVID-19 infection.

Quantifying olfactory impairments can facilitate early detection of Coronavirus disease 2019 (COVID-19). Despite being a debated topic, many reports provide evidence for the neurotropism of SARS-CoV-2. However, a sensitive, specific, and accurate non-invasive method for quantifying persistent neurological impairments is missing to date. To quantify olfactory detectabilities and neurocognitive impairments in symptomatic COVID-19 patients during and post-infection periods, we used a custom-built olfactory-action meter (OAM) providing accurate behavioral readouts. Ten monomolecular odors were used for quantifying olfactory detectabilities and two pairs of odors were employed for olfactory matching tests. We followed cohorts of healthy subjects, symptomatic patients, and recovered subjects for probing olfactory learning deficits, before the Coronavirus Omicron variant was reported in India. Our method identifies severe and persistent olfactory dysfunctions in symptomatic patients during COVID-19 infection. Symptomatic patients and recovered subjects showed significant olfactory learning deficits during and post-infection periods, 4-18 months, in comparison to healthy subjects. On comparing olfactory fitness, we found differential odor detectabilities and olfactory function scores in symptomatic patients and asymptomatic carriers. Our results indicate probable long-term neurocognitive deficits in COVID-19 patients imploring the necessity of long-term tracking during post-infection period. Differential olfactory fitness observed in symptomatic patients and asymptomatic carriers demand probing mechanisms of potentially distinct infection routes.

Maternal Serum High-Sensitivity C-Reactive Protein (hsCRP) as a Prognostic Marker of Fetomaternal Outcome in Hypertensive Disorders of Pregnancy: A Novel Study.

INTRODUCTION: Hypertensive disorders of pregnancy (HDP) are a group of obstetric disorders causing profound fetomaternal compromise, leading to adverse obstetric outcomes. High-sensitivity c-reactive protein (hsCRP), an inflammatory marker of systemic inflammation, is elevated in HDP and correlates with the severity of the disease. However, prediction and prevention of HDP and its associated fetomaternal complications remain elusive to most obstetricians. The present study aimed to evaluate the use of hsCRP as a prognostic marker of adverse fetomaternal outcome in HDP. METHODS: The study included 132 third-trimester pregnancies with HDP who underwent hsCRP quantification at the time of presentation to the out-patient department and followed up till delivery. HsCRP quantification was done using immunoturbidimetry method. RESULTS: Of the 132 cases studied, 72 had normal hsCRP levels while the remaining 60 had raised hsCRP levels. It was observed that patients with raised hsCRP levels had poorer fetomaternal outcomes at delivery as compared to those with normal hsCRP levels.  Conclusion: The obstetric outcomes of patients with HDP worsened with increasing levels of hsCRP, as shown in our study, when compared to normotensive patients. Thus, hsCRP delivers promising results as a prognostic marker of adverse fetomaternal outcomes in patients of HDP.

Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla.

Aim: To present a case of adenomatoid odontogenic tumor (AOT) associated with impacted maxillary lateral incisor in a 12-year-old female that mimicked dentigerous cyst. Background: Adenomatoid odontogenic tumor (AOT) was first mentioned by Steensland in 1905, which is a rare tumor of odontogenic origin. Dreibladt in 1907 coined the term pseudo ameloblastoma. In 1948, Stafne considered it a distinct pathological entity. Case description: A 12-year-old female reported to the Department of Oral and Maxillofacial Surgery with the chief complaint of progressive swelling on the left maxillary anterior region for 6 months. The clinical and radiographical findings of the case represented a dentigerous cyst or unicystic ameloblastoma, but the histopathological interpretation was interpreted as AOT. Conclusion: The AOT is an unusual entity that is commonly misdiagnosed as a dentigerous or odontogenic cyst. Histopathology plays a vital role in diagnosis and further management. Clinical significance: The interest and relevance of the present case are the difficulties in diagnosing accurately based on the radiograph and histopathology. Both dentigerous cysts and AOT are entirely benign and encapsulated lesions, and enucleation poses no major difficulties. The case report highlights the importance of early diagnosis of neoplasm arising in odontogenic tissues. The fact that in cases of unilocular lesions surrounding the impacted tooth in the anterior maxillary region, AOT should also be considered as a differential diagnosis. How to cite this article: Pawar SR, Kshirsagar RA, Purkayastha RS, et al. Adenomatoid Odontogenic Tumor Mimicking a Dentigerous Cyst in Maxilla. Int J Clin Pediatr Dent 2022;15(6):770-773.

Smokeless tobacco use and oral potentially malignant disorders among people living with HIV (PLHIV) in Pune, India: Implications for oral cancer screening in PLHIV.

INTRODUCTION: In India, smokeless tobacco (SLT) is a predominant form of tobacco used among people living with HIV (PLHIV). Despite SLT being a risk factor for oral potentially malignant disorders (OPMDs), no prior studies have quantified the association of OPMDs with SLT use among PLHIV. This limits the planning of preventive and control strategies for oral cancer among PLHIV, who are at higher risk for the disease. METHODS: We enrolled 601 PLHIV and 633 HIV-uninfected individuals in an oral cancer screening study at BJ Government Medical College, Pune, India. Oral cavity images were collected using an m-Health application and reviewed by three clinicians. Participants with two clinician positive diagnoses were deemed to have suspected OPMDs. Prevalence ratios (PRs) were used to quantify the association between suspected OPMDs and SLT use among PLHIV. PRs for current SLT users, across HIV status and use duration were also estimated. Corrected PRs were obtained by modifying the maximum likelihood estimation. Models were adjusted for age, smoking, alcohol use and CD4 counts. RESULTS: Of those enrolled, 61% were men, median age was 36 years (IQR: 28-44), and 33% currently use SLT. Proportion of current SLT users was similar across PLHIV and HIV-uninfected groups but use duration for current SLT use was higher among PLHIV(p<0.05). Among PLHIV, current SLT users had a 5-times (95% CI:3.1-7.0) higher prevalence of suspected OPMDs, compared to non-users. Relative to HIV uninfected individuals with the same SLT use duration, significant associations with suspected OPMDs were seen for PLHIV with<10 use years (PR: 3.5, 95% CI: 1.5-8.1) but not for PLHIV with≥10 use years (PR: 1.3, 95% CI: 0.9-1.8). CONCLUSION: PLHIV that are current SLT users are at high risk of OPMDs and potentially oral cancer. The development of strategies for screening, early detection, and management of OPMDs must be considered for this group.

Posterior Nasal Nerve Resection-A Novel and Effective Way to Surgically Treat Refractory Allergic and Vasomotor Rhinitis.

This study focused on outcomes of endoscopic posterior nasal neurectomy and turbinate reduction with regard to the common symptoms of allergic and vasomotor rhinitis. This randomized experimental study conducted between December 2018 to November 2020 included 60 patients, aged 18-50 years with allergic or vasomotor rhinitis with/ without deviated nasal septum of grade 3 and 4, not responding to conservative management. Patients were divided into two groups. 30 patients were operated for Posterior nasal nerve resection and 30 patients underwent turbinate reduction. SNOT 22 (Sino-nasal outcome test) questionnaire was given to every patient and they were asked four major symptoms of nasal obstruction, rhinorrhoea, sneezing and post nasal discharge and were told to rate their symptom in 1 to 5 severity scale before surgery and in postoperative follow up. Mean ± SD(standard deviation) of percentage change in SNOT 22 score in Posterior Nasal Nerve resection was 88.09 ± 4.38 which was significantly higher than turbinate reduction (82.95 ± 5.33) (p value = 0.0001). Distribution of post-operative complications was comparable in turbinate reduction and Posterior Nasal Nerve resection (Both synechia and crusting:10 versus 6.67% respectively) (p value = 1). No patient had bleeding in both groups. Though skill demand is high, posterior nasal neurectomy is highly safe and effective, as there was no bleeding post-operatively in spite of handling the sphenopalatine artery. Symptom relief with this surgery was 88.09% which was significantly higher as compared to submucosal resection of inferior turbinate with microdebrider (82.95%).

Quantitative assessment of olfactory dysfunction accurately detects asymptomatic COVID-19 carriers.

BACKGROUND: COVID-19 threatens the global community because a large fraction of infected people are asymptomatic, yet can effectively transmit SARS-CoV-2. Finding and isolating these silent carriers is a crucial step in confining the spread of the disease. A sudden loss of the sense of smell has been self-reported by COVID-19 patients across different countries, consistent with expression of the molecular factors mediating SARS-CoV-2 uptake into human olfactory epithelial supporting cells. However, precise quantification of olfactory loss in asymptomatic COVID-19 carriers is missing to date. METHODS: To quantify olfactory functions in asymptomatic COVID-19 patients, we designed an olfactory-action meter that determines detectability indices at different odor concentrations and an olfactory matching accuracy score using monomolecular odors. The optimization of test parameters allowed us to reliably and accurately assess olfactory deficits in a patient within 20 minutes. FINDINGS: Measurement of detection indices at low concentrations revealed a 50% reduction in asymptomatic COVID-19 carriers. Further, patients with better detection scores showed significantly reduced olfactory matching accuracies compared to normal healthy subjects. Our quantification of olfactory loss, considering all parameters, identified 82% of the asymptomatic SARS-CoV-2 carriers with olfactory deficits. However, on subjective evaluation, only 15% of the patients noticed a compromised ability to smell. INTERPRETATION: Compromised olfactory fitness can serve as a strong basis for identifying asymptomatic COVID-19 patients. Detailed design specifications and protocols provided here should enable the development of a sensitive, fast, and economical screening strategy that can be administered to large populations to prevent the rapid spread of COVID-19. FUNDING: This work was supported by the DBT - Wellcome Trust India Alliance intermediate grant (IA/I/14/1/501,306 to N.A.) and UGC NET Fellowship (A.B.). All the funding sources played no roles in the study.

Cryosurgery Vs Trichloroacetic Acid Chemical Cautery for the Treatment of Hypertrophied Nasal Turbinate: A Comparative Study.

INTRODUCTION: The Study Aimed To Compare The Results of Cryosurgery With Trichloroacetic Acid Chemical (TCA) Cautery For The Treatment of Hypertrophied Nasal Turbinates. MATERIALS AND METHODS: This was a prospective study of 70 patients with nasal obstruction due to hypertrophied nasal turbinates who were randomly divided in 2 groups of 35 each. In group 1, patients underwent inferior nasal turbinate reduction by cryosurgery and in group 2 patients with cautery by 50 % TCA. The patients were evaluated using SNOT-20 score pre and postoperatively on 6th month. RESULTS: Significant improvement in symptoms was seen in 28 patients (80 %) in group 1 and in 10 patients (28.57%) in group 2..Improvement in average SNOT Score after cauterization of hypertrophied nasal turbinates by cryosurgery was from 55(severe) to 16(mild) and by TCA was from 54(severe) to 32(mod) in 6 months and this was statistically significant (P<0.001). Complications like bleeding, scarring, infection and adhesion formation were more with TCA than that of cryosurgery group and among these complications scarring was statistically significant (P =0.003). CONCLUSION: The use of cryosurgical treatment for hypertrophied nasal turbinates is a safe, curative method as compared to that of TCA cautery which is less curative and with more complications.