Global perspective on child and adolescent oral health: a systematic review and meta-analysis of oral impacts on daily performance.

OBJECTIVE: Several prevalence studies have estimated the region-specific impact of oral diseases on oral health-related quality of life. However, none of them reported and compared the same from a global perspective. This meta-analysis aims to evaluate pooled epidemiologic data about child-oral impacts on daily performance (C-OIDP) globally. METHODS: A search was conducted in PubMed, Science Direct, SciELO, Semantic scholar, and Cochrane databases up to January 2023. Studies evaluating OIDP among 11-18-year-olds were included in the review. Quality of the included studies was evaluated using the health states quality index for cross-sectional studies. The meta-analysis used R package software version 4.3.0. A common effect model was used to calculate the pooled prevalence. The protocol was registered in the PROSPERO (CRD-NIHR) database with Reference ID CRD42023393798. RESULTS: The systematic literature search yielded 257 unique citations. After screening titles and abstracts, 214 irrelevant citations were excluded, leaving 55 for full-text review. Overall, 43 studies from 23 countries were included. The meta-analysis reported a pooled prevalence impact C-OIDP of 53.36% (CI: 52.78-53.95, 43 studies, 16,622 participants). The prevalence of C-OIDP scores among South America, Asia, Europe, Africa and Oceania was 83%, 63%, 58%, 33% and 47%, respectively. The maximum prevalence was reported in South America while the least prevalence was noted in the African population. CONCLUSION: Oral diseases affect the oral health-related quality of life of more than half of children and adolescents globally. Huge variations were noted in the prevalence of oral impacts across different regions. These findings can be utilized by policymakers to draft measures required for reducing impacts of oral diseases and improving the health-related quality of life.

Maxillary defects due to COVID-19 associated mucormycosis: Impact on quality of life after rehabilitation with an obturator.

STATEMENT OF PROBLEM: Aggressive surgical debridement including maxillectomy in patients with coronavirus disease 2019 (COVID-19) associated mucormycosis of the maxilla alters facial appearance, function, and an individual's overall quality of life (QOL). These patients require rehabilitation of defects with obturators to help them recover from esthetic and functional disabilities and regain near-normal quality of life. Because COVID-19 associated with mucormycosis is a newer entity, less is known about the quality of life of these patients after rehabilitation with obturators. Hence, the effects of COVID-19 associated with mucormycosis, treatment, and rehabilitation need to be evaluated to assess QOL. PURPOSE: The purpose of this clinical study was to assess the impact on QOL after rehabilitation with obturators for participants with COVID-19-associated mucormycosis who underwent maxillectomy. MATERIAL AND METHODS: Oral health impact profile-14 (OHIP-14) and obturator functioning scale (OFS) questionnaires were administered to 26 participants with COVID-19-associated mucormycosis of the maxilla who underwent maxillectomy and required rehabilitation with obturators. Questionnaire responses were received on numerical Likert scales of 0 to 4 for OHIP-14 and 1 to 5 for OFS. The repeated measures analysis of variance (ANOVA) with pairwise post hoc Bonferroni tests were used to evaluate and compare mean scores of OHIP-14 and OFS at different preoperative and postoperative stages (α=.05). RESULTS: A total of 26 participants who underwent maxillectomy were provided with obturators. A higher mean ±standard deviation OHIP score was observed before rehabilitation at T1 (51.0 ±9.6) followed by 1 week after fabrication of the surgical obturator at T2 (18.6 ±16.4), and 1 week after fabrication of the interim obturator at T3 (4.7 ±8.2). The lower mean scores ±standard deviation were seen 1 week after the fabrication of definitive obturators at T4 (2.9 ±7.2). Comparison of the scores at T1, T2, T3, and T4 found significant difference (P≤.001). Similarly, higher mean ±standard deviation OFS scores were seen 1 week after rehabilitation with surgical obturators at T2 (27.3 ±12.6) and at least 1 week after fabrication with definitive obturators at T4 (15.7 ±5.6). A comparison of the scores at T2, T3, and T4 found significant differences (P≤.001). CONCLUSIONS: Considerable improvement was seen in QOL with the fabrication of surgical obturators in participants who had received maxillectomy/debridement for mucormycosis. This improvement had a linear relationship with the time elapsed and the consecutive fitting of the obturators with healing.

Association of Serum Complement C3 Levels with Severity and Mortality in COVID 19.

The severe acute respiratory distress syndrome-associated coronavirus-2 infection can activate innate and adaptive immune responses which may lead to harmful tissue damage, both locally and systemically. C3, a member of complement system of serum proteins, is a major component of innate immune and inflammatory responses. This study is aimed to assess serum C3 as a marker of COVID-19 severity and a predictor of disease progression. A total of 150 COVID-19 patients, confirmed by RT-PCR, and 50 healthy controls were recruited. Serum C3 levels were determined by using direct colorimetric method. Median levels of serum C3 in total cases and controls were 157.8 and 165.7 mg/dL respectively. Serum C3 although not significantly decreased, they were lower in cases when compared to controls. Similarly, significant differences were found between the groups, with severe group (140.6 mg/dL) having low levels of serum C3 protein when compared to mild (161.0 mg/dL) and moderate group (167.1 mg/dL). Interestingly, during hospitalization, significant difference between baseline (admission) and follow-up (discharge) was observed only in patients with moderate disease. Based on our results, lower levels of C3, with an increase in IL-6 and d-dimer levels, are associated with higher odds of mortality. Therefore, we would like to emphasize that measuring serum C3 levels along with other inflammatory markers might give an added advantage in early identification of patients who are prone to having a severe disease course and can help in a more effective follow-up of disease progression. Supplementary Information: The online version contains supplementary material available at 10.1007/s12291-023-01148-x.

Detection of paroxysmal nocturnal haemoglobinuria clones in cases of deep vein thrombosis in a tertiary care centre, western Rajasthan.

Background & objectives: Paroxysmal nocturnal haemoglobinuria is a rare acquired disease characterized by bone marrow failure, intravascular haemolysis and thrombophilia. Thrombosis is the deadliest complication of paroxysmal nocturnal haemoglobinuria (PNH). The present study was conducted to study the prevalence of PNH in cases of deep vein thrombosis (DVT) which was previously undocumented from western Rajasthan. Methods: In the present cross-sectional study, 61 adult patients with DVT were tested using flow cytometry to detect PNH clones. Blood samples were processed using fluorescein-labelled proaerolysin, CD14, CD24, CD33 and CD45 panels for granulocytes and monocytes and CD59 and CD235a panel for red blood cells. Results: Three cases (4.92%) having large clones on monocytes as well as granulocytes, which fulfilled the diagnostic criteria of PNH were detected. Further, three cases (4.92%) showed small clones on both granulocytes and monocytes. Nine (15%) cases showed small clones only on granulocytes, and 11 (18%) cases showed small clones only on monocytes. Interpretation & conclusions: The results of the present study suggest that a higher proportion of patients had PNH in western Rajasthan compared to previously reported studies from elsewhere. It is suggested that PNH testing should be added to the procoagulant work-up panel in institutions of this region where it is not routinely done. This provides an otherwise missed opportunity to diagnose this disorder. Eculizumab may be employed, which is effective in reducing thrombophilic events in cases of PNH.

Home video prediction of epileptic vs. nonepileptic seizures in US veterans.

OBJECTIVE: Using video-EEG (v-EEG) diagnosis as a gold standard, we assessed the predictive diagnostic value of home videos of spells with or without additional limited demographic data in US veterans referred for evaluation of epilepsy. Veterans, in particular, stand to benefit from improved diagnostic tools given higher rates of PNES and limited accessibility to care. METHODS: This was a prospective, blinded diagnostic accuracy study in adults conducted at the Houston VA Medical Center from 12/2015-06/2019. Patients with a definitive diagnosis of epileptic seizures (ES), psychogenic nonepileptic seizures (PNES), or physiologic nonepileptic events (PhysNEE) from v-EEG monitoring were asked to submit home videos. Four board-certified epileptologists blinded to the original diagnosis formulated a diagnostic impression based upon the home video review alone and video plus limited demographic data. RESULTS: Fifty patients (30 males; mean age 47.7 years) submitted home videos. Of these, 14 had ES, 33 had PNES, and three had PhysNEE diagnosed by v-EEG. The diagnostic accuracy by video alone was 88.0%, with a sensitivity of 83.9% and specificity of 89.6%. Providing raters with basic patient demographic information in addition to the home videos did not significantly improve diagnostic accuracy when comparing to reviewing the videos alone. Inter-rater agreement between four raters based on video was moderate with both videos alone (kappa = 0.59) and video plus limited demographic data (kappa = 0.60). SIGNIFICANCE: This study demonstrated that home videos of paroxysmal events could be an important tool in reliably diagnosing ES vs. PNES in veterans referred for evaluation of epilepsy when interpreted by experts. A moderate inter-rater reliability was observed in this study.

Diagnostic accuracy of point-of-care devices for detection of anemia in community settings in India.

BACKGROUND: Accurate diagnosis of anemia by community workers using a point-of-care device is a challenge. The objective of the study was to establish the diagnostic accuracy of point-of-care devices for detecting anemia in community settings. METHODS: It was diagnostic accuracy study with cross-sectional design on adult patients attending the outpatient department of rural/ urban health centres of Medical colleges from India. The index tests were HemoCue, TrueHb, Massimo's device and spectroscopic device, compared against autoanalyzer (gold standard). Accuracy was expressed by sensitivity, specificity, likelihood ratios, predictive values, area under the curve (AUC) and levels of agreement. For the diagnostic accuracy component, 1407 participants were recruited with a minimum of 600 for each device. An additional 200 participants were considered to elucidate the performance of devices in different weather conditions. RESULTS: HemoCue and TrueHb performed better than Massimo and spectroscopic devices. Detection of anemia by technicians was similar between TrueHb and HemoCue (AUC 0.92 v/s 0.90, p > 0.05). Community workers performed better with Hemocue for detecting anemia compared to TrueHb (AUC 0.92 v/s 0.90, p < 0.05). For detection of severe anemia, accuracy of TrueHb was significantly better with technicians (AUC 0.91 v/s 0.70; p < 0.05) and community workers (AUC 0.91 v/s 0.73; p < 0.05). HemoCue showed a bias or mean difference (95%CI) of 0.47 g/dl (0.42, 0.52) for all values, and 0.92 g/dl (0.82, 1.03) for severe anemia. For TrueHb, it was - 0.28 g/dl (- 0.37, - 0.20) for all readings, and 0.06 g/dl (- 0.52, 0.63) for severe anemia. TrueHb appeared to be more consistent across different weather conditions, although it overestimated Hb in extreme cold weather conditions. CONCLUSION: For detection of anemia, True Hb and HemoCue were comparable. For severe anemia, True Hb seemed to be a better and feasible point-of-care device for detecting anemia in the community settings.

Evaluation of platelet surface glycoproteins in patients with Glanzmann thrombasthenia: Association with bleeding symptoms.

BACKGROUND & OBJECTIVES: Glanzmann thrombasthenia (GT) is a rare, inherited autosomal recessive disorder characterized by qualitative or quantitative deficiency of integrin αIIbß3 [glycoprotein IIb (GPIIb)/IIIa, CD41/CD61] diagnosed by absent or reduced platelet aggregation to physiological agonists, namely, collagen, adenosine-di-phosphate, epinephrine and arachidonic acid. The objective of this study was to quantitate platelet surface GPs, classify GT patients and relate the results with the severity of bleeding and platelet aggregation studies. METHODS: Fifty one patients of GT diagnosed by platelet aggregation studies were evaluated for the expression of CD41, CD61, CD42a and CD42b on platelet surface by flow cytometry. The association between the clinical phenotype based on bleeding score and GT subtype on flow cytometric evaluation was assessed. RESULTS: Twenty four (47%) patients of GT were classified as type I (as CD41/CD61 were virtually absent, <5%), six (11.8%) patients as type II (5-20% CD41/CD61) and 21 (41.2%) as type III or GT variants as they had near normal levels of CD41 and CD61. Type III GT patients had significantly lower numbers of severe bleeders (P=0.034), but the severity of bleeding did not vary significantly in type I and II GT patients. In all GT patients, mean CD41 expression was found to be lower than mean CD61 expression (P=0.002). INTERPRETATION & CONCLUSIONS: Type I GT was found most common in our patients and with lowered mean CD41 expression in comparison with CD61. Type III GT patients had significantly lower numbers of severe bleeders, but the severity of bleeding did not vary significantly in type I and II GT patients.

Value of CD16/CD66b/CD45 in comparison to CD55/CD59/CD45 in diagnosis of paroxysmal nocturnal haemoglobinuria: An Indian experience.

BACKGROUND & OBJECTIVES: Diagnosis of paroxysmal nocturnal haemoglobinuria (PNH), a rare haematopoietic stem cell disorder, is challenging in patients with bone marrow failure (BMF) syndrome like aplastic anaemia (AA). This study was conducted with the aim to test the efficacy of the newly recommended markers viz. anti-CD16 and CD66b antibody over the existing anti-CD55 and CD59 antibody for PNH diagnosis in India. METHODS: This study was conducted on 193 suspected cases of PNH by flow cytometry using lyse wash technique to stain the granulocytes with CD16/CD66b and CD55/CD59. RESULTS: Of the 193 suspected cases, 62 patients showed the presence of PNH clone. Forty six patients were detected by CD55/CD59/CD45, whereas 61 were detected by CD16/CD66b/CD45. CD16/CD66b detected 16 (25.8%) additional patients over CD55/CD59 (P<0.05) and was more sensitive in detecting the PNH clone with higher negative predictive value. Most of the patients (11/16) who were picked up by CD16/CD66b were of AA who had small clone sizes. Further, the PNH clones were more discreetly identified in CD16/CD66b plots than by CD55/CD59. Clone size assessed by CD16/CD66b which reflects the clinical severity of classical PNH (thrombosis/haemolysis), was more representative of the underlying clinical condition than CD55/59. INTERPRETATION & CONCLUSIONS: In our experience of 62 patients of PNH, CD16/CD66b proved to be more efficacious in detecting PNH. The new panel was especially useful in monitoring PNH associated with BMF which had small clone sizes.

Risk factors and associated pathway for rural and urban unmet dental prosthetic needs among older adults in Central India.

AIM: This study was undertaken to evaluate the risk factors and associated pathways for unmet dental prosthetic needs among older adult population in Central India. METHODS: A total of 11,145 randomly selected older adults participated in the study; 4613 from urban region and 6532 form rural region. Oral examinations were conducted at individual households for recording dental caries, periodontal disease, prosthetic status and needs. Structural Equation Modelling (SEM) was used to examine relationship between a set of exogenous variables and unmet dental prosthetic needs with variables that remained significant in the adjusted multilevel logistic model. Path coefficients were calculated for all variables with 95% confidence interval. Goodness of fit of the model was assessed by several indices. RESULTS: A total of 8433 (75.7%) participants had never visited a dentist and 9139 (82%) had unmet dental prosthetic needs. Dental caries was observed among 3207 (69.5%) and 4644 (71.1%) study participants from urban and rural regions respectively (p < .05). Low utilization of dental services was associated with high dental prosthetic needs in upper arch and lower arch (PC = -0.05, 0.001) and DMFT was associated with lower utilization of dental services (PC = -0.09, 0.001). DMFT was also associated with age, annual income, level of education, paternal education, type of family, tobacco consumption and CPI score in the hypothesized model. The fit indices used indicated that the model was adequate. CONCLUSIONS: Dental prosthetic needs in the proposed pathway model was associated with low utilization of dental services, dental caries, periodontal disease and other socio-demographic factors.

Enteric Fever-Associated Hemophagocytic Lymphohistiocytosis: A Systematic Review of Clinical Characteristics and Outcomes.

Enteric fever is a major contributor to rising health care costs in developing countries. Associated disease-related complications and drug resistance further compound this problem. Hemophagocytic lymphohistiocytosis (HLH) is an uncommon complication of enteric fever with high morbidity and mortality. This systematic review aimed to evaluate the clinical characteristics and treatment outcomes in enteric fever-associated HLH syndrome. We searched major electronic databases (PubMed, Google Scholar, and Scopus) to identify the cases of enteric fever associated with HLH from inception until June 2023. Prespecified data regarding clinical presentation, outcomes, and HLH therapy were collected. A total of 53 cases of enteric fever with HLH were included in the final analysis. The mean age of patients was 20 years, and the proportions of female and pediatric patients were 52.8% and 45.3%, respectively. The mean duration of illness was 10.4 days. A total of 39.6% of patients had enteric fever-associated complications; coagulopathy and encephalopathy were the most common (23.1% and 13.5%). The overall mortality rate was 9.4% in HLH. A total of 51% of patients received HLH-specific therapy (corticosteroids in 41.5% and intravenous immunoglobulin in 20.8% of patients). On multivariate analysis, high ferritin levels (≥5,000 ng/mL) were significantly associated with mortality (hazard ratio, 3.01; 95% CI = 0.62-14.12, P = 0.041). Enteric fever with secondary HLH is associated with high mortality. This review reveals the potential role of ferritin in disease prognosis. In cases with significantly elevated ferritin levels, the role of immunosuppressants or combination antibiotics should be explored.

Congenital dyserythropoietic anemia type II-A rare case report.

ABSTRACT: Congenital dyserythropoietic anemia type II (CDA II), initially described as hereditary erythroblastic multinuclearity with a positive acidified serum test (HEMPAS), is a rare genetic disease inherited in an autosomal recessive mode that presents with mild to severe anemia. The occurrence of this entity is quite uncommon and requires extensive work-up for a conclusive diagnosis. Here, we are reporting a case of two-year-old male child who presented with severe anemia, abdominal distension, and delayed milestones. Evaluation of bone marrow aspirate suggested the possibility of CDA which led to molecular work-up by whole exome sequencing with detection of c.1142C>T (p.Thr381lle) variant in SEC23B (NM_006363.6) gene.

Case of angioimmunoblastic T-cell lymphoma presenting as peripheral and bone marrow plasmacytosis: A diagnostic conundrum.

ABSTRACT: Angioimmunoblastic T-cell lymphoma (AITL), a subtype of peripheral T-cell lymphoma (PTCL), is associated with unique clinical, morphological, and immunohistochemical features. The peripheral circulation might show presence of an occasional reactive plasma cell but significant plasmacytosis masquerading as plasma cell leukemia is rare. We report a case of AITL in a 42-year-old male, who presented with two-month history of generalized lymphadenopathy. On investigations, he had hypergammaglobulinemia and plasmacytosis in the peripheral blood and bone marrow masquerading as plasma cell leukemia. Immunohistochemistry and serum protein electrophoresis revealed polyclonal nature of plasma cells. Diagnosis of AITL was made on cervical lymph node biopsy. This case highlights the diagnostic challenge faced due to heterogeneity in the clinical presentation and pathological findings and to alert the clinician so that timely accurate diagnosis can be made to initiate the treatment.

Estimating the prevalence of oral manifestations in COVID-19 patients: a systematic review.

BACKGROUND: Patients with coronavirus disease 2019 (COVID-19) present with a variety of oral manifestations. Therefore, we conducted a systematic review to estimate the prevalence of oral lesions among COVID-19 patients. METHODS: An extensive literature search of several electronic bibliographic databases (PubMed, Scopus, Science Direct, Litcovid) was conducted to retrieve all articles published in the English language from January 1, 2020 to March 31, 2023 that reported the prevalence of oral manifestations among COVID-19 patients. A meta-analysis of pooled prevalence was performed using Jamovi ver. 2.3 (2022). The I2 and Q statistics were used to assess heterogeneity between studies, and p-values <0.01 were considered statistically significant. RESULTS: In total, 79 studies with data from 13,252 patients were included. The articles were predominantly published in 2020 (n=33), and Italy was the most common country (n=14). Most of the affected patients more than 50 years old and women (56.6%). The most common sites of involvement were the tongue (n=65), followed by the oral mucosa (n=37) and lips (n=19). High heterogeneity was found between studies. The most common oral manifestation was taste alteration, followed by xerostomia and ulceration, showing pooled prevalence rates of 48%, 35%, and 21%, respectively. CONCLUSION: COVID-19 patients show various oral manifestations that may help clinicians identify the disease promptly. Recognition of the signs and symptoms of COVID-19 is critical for an early diagnosis and better prognosis.

Effect of premature loss of primary teeth on prevalence of malocclusion in permanent dentition: A systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to assess the effect of premature loss of primary teeth in children of mixed dentition age on the prevalence of malocclusion in permanent dentition. MATERIAL AND METHODS: A search was conducted in Medline through PubMed, Cochrane databases, Google Scholar, and Directory of Open Access Journals (DOAJ) through March 2023. All observational studies that evaluated the association between premature loss of primary teeth and malocclusion in permanent dentition were included for analysis. Quality of studies was evaluated using the Newcastle-Ottawa tool. Meta-analysis was conducted using Cochrane Review Manager (RevMan) Version 5.3. The association between different categories of malocclusion and premature loss of primary teeth was assessed using a random-effects model. Heterogeneity was explored through sensitivity analysis. Certainty of evidence was evaluated using GRADE analysis. RESULTS: This meta-analysis showed that the premature loss of primary teeth significantly increases the prevalence of overall malocclusion in permanent dentition (OR=2.54, P=0.003; I2: 83%). Subgroup analysis showed an insignificant relationship of premature loss of primary teeth with Class I malocclusion (OR=1.14, P=0.45; I2: 63%) and Class II malocclusion (OR=1.63, P=0.18; I2: 87%) but statistically significant relationship with Class III malocclusion (OR=3.73, P=0.006; I2: 71%). Sensitivity analysis reflected a significant reduction in I2 values. CONCLUSION: This meta-analysis provides substantial evidence supporting the relationship between premature loss of primary teeth and malocclusion in permanent dentition. Notably, Class III malocclusions exhibited a significant association with premature loss of primary teeth.

Evaluation of Diagnostic Usefulness of CD200 Expression in B-cell Chronic Lymphoproliferative Disorders.

Immunophenotyping by flow cytometry (FCM) is a useful diagnostic tool for the evaluation of mature B-cell neoplasms (MBN). Here, CD200 expression may play a significant role and improve the distinction between various MBNs, but any potential as a prognostic marker is yet to be established. The present prospective study was conducted on all the suspected cases of MBNs. Immunophenotyping was done using a BD FACS Canto FCM using a panel of 4 to 6 color combinations of monoclonal antibodies; CD45, CD34, CD5, CD19, CD20, CD22, CD23, CD79b, FMC7, CD10, CD38, ZAP70, CD200, IgG, IgM, CD25, CD103, CD2, CD3, CD11c as well as κ and λ light chains. CD200 expression was compared in different subgroups. Of the total of 130 cases included in the study, CD200 was positive in 118 cases (90%). CD200 was expressed in 100% of the cases of CLL(86 cases), atypical CLL(06 cases), HCL(14 cases), FL(02 cases), SMZL(04 cases), LPL (01 case), and low-grade NHL (05 cases), with the highest intensity of fluorescence in HCL followed by CLL. All the cases of MCL and PLL were exclusively negative for CD200. In conclusion, the results of the present study support inclusion of this marker in the flow cytometric panels for the differential diagnosis of MBNs.

Iron Deficiency Anemia Presenting With Pancytopenia: A Study From India.

INTRODUCTION: Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA is commonly associated with thrombocytosis and normal or slightly decreased leukocyte count. Sometimes it can present with thrombocytopenia, but rarely present with pancytopenia. Here we are presenting six cases of severe iron deficiency presenting with pancytopenia, which responded to iron replenishment. METHODS:  This 12-month observational study was conducted in the Department of General Medicine at a tertiary care Centre in India. All cases of pancytopenia (after exclusion of other causes) with IDA were included. IDA was established with the help of a complete blood count (CBC), peripheral smear examination, serum iron studies, and serum ferritin.  Results: In our study, CBC at four weeks later of iron transfusion without other supplementation showed significant improvement in hematological parameters. CONCLUSION:  Severe iron deficiency is a reversible etiology of pancytopenia. It should be kept as a differential diagnosis of pancytopenia if common causes of pancytopenia are ruled out.

Comparative Analysis of Serum Zinc, Copper and Magnesium Level and Their Relations in Association with Severity and Mortality in SARS-CoV-2 Patients.

The deficiencies of trace elements and infectious diseases often coexist and exhibit complex interactions. Several trace elements such as zinc (Zn), copper (Cu) and magnesium (Mg) have immunomodulatory functions and thus influence the susceptibility to the course and outcome of a variety of viral infections. So, this present study was aimed to study relations of trace metals in association with severity and mortality in SARS-CoV-2 patients. A total of 150 individuals infected with COVID-19 and 50 healthy individuals were recruited. Cases were divided based on severity (mild, moderate and severe) and outcome (discharged or deceased). Serum Zn, Mg and Cu levels were analysed by direct colourimetric method. Both serum Cu and Zn levels were significantly decreased in cases when compared to those in controls (p < 0.005 and p < 0.0001). Serum magnesium levels although not significant were found to be slightly decreased in controls. On comparing the trace elements between the deceased and discharged cases, a significant difference was found between serum copper and zinc levels, but for magnesium, both groups have similar levels. The receiver operating characteristic (ROC) curve results indicate that a serum Cu/Zn ratio along with the age of patient provides some reliable information on COVID-19 course and survival odds by yielding an AUC of 95.1% with a sensitivity of 93.8% and specificity of 89.8%. Therefore, we would like to emphasize that measuring the serum copper and zinc along with their ratio can be used as routine investigations for COVID-19 patients in proper identification and management of severe cases in upcoming new waves of COVID-19.

Maxillary Incisor Intrusion Using Mini-Implants and Conventional Intrusion Arch: A Systematic Review and Meta-Analysis.

The aim of this analysis was to evaluate the maxillary incisor intrusion and change in overbite achieved by micro-implants compared to Connecticut intrusion arches among post-pubertal patients with deep bite. Medline, PubMed, Cochrane, and Google scholar were searched for studies falling under the inclusion criteria. Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) com- paring maxillary incisor intrusion among post-pubertal deep bite cases treated by mini-implants and Connecticut intrusion arches were to be included. Outcome data were extracted using guidelines published by the Cochrane Collaboration. A systematic review was conducted using Cochrane Program Review Manager, version 5. A random effects model was used to assess the mean difference in the amount of incisor intrusion and overbite correction achieved between the 2 methods. Statistical significance was set at P < .05. Assessment of certainty of evidence was conducted using GRADE analysis. Six trials met the inclusion criteria. Mean differences for incisor intrusion -0.67 [95% CI, 0.97, 0.38] I2 = 31%; P < .00001) and overbite correction -0.51 [95% CI, 0.85, 0.16] I2 = 50%; P = .004) achieved with mini-implants were found to be significantly effective when compared to the Connecticut intrusion arch. Low to mod- erate heterogeneity was noted for incisor intrusion and change in overbite analysis respectively. High certainty of evidence was noted for higher association of mini-implants with incisor intrusion and overbite correction. Our meta-analysis suggests that mini-implants are superior to the Connecticut intrusion arch with respect to the amount of incisor intrusion and overbite correction. Further studies are still needed to confirm the superiority.

Splenic Infarct as the Presenting Manifestation of Essential Thrombocythemia.

Background: Essential thrombocythemia is a chronic myeloproliferative neoplasm characterized by thrombotic and hemorrhagic complications. Essential thrombocythemia can be considered a risk factor for thrombotic events. Case Report: A 34-year-old female presented with sudden onset of abdominal pain from splenic infarction for which she underwent splenectomy. Bone marrow examination performed because of increasing thrombocytosis led to a diagnosis of essential thrombocythemia. Postoperatively, she was maintained on low-dose aspirin and doing well at follow-up. Conclusion: Our patient had an undiagnosed case of essential thrombocythemia and presented with symptoms related to splenic infarction. To the best of our knowledge, few cases of splenic infarction consequent to essential thrombocythemia have been reported.

Progressive disseminated histoplasmosis in idiopathic CD4 lymphocytopenia an underdiagnosed combination - a case report.

Progressive disseminated histoplasmosis (PDH) usually presents as fever, anemia, leukopenia, hepatosplenomegaly, lymphadenopathy and pulmonary symptoms. There are few reports on the association of idiopathic CD4 lymphocytopenia (ICL) with histoplasmosis. We describe a 65-year-old female presented with a history of fever, papulo-nodular rash and significant weight loss and diagnosed as progressive disseminated histoplasmosis. All immunocompromised conditions were ruled out. In addition, her 2 consecutive CD4 counts were below 300. The patient was diagnosed with PDH associated with ICL. The patient showed significant improvement with liposomal amphotericin B and itraconazole. Absolute CD4 counts should be done in all cases of progressive disseminated histoplasmosis even in HIV negative individuals to rule out associated ICL.