Novel Viewpoints on Tobacco Smoking and COVID-19.

We read with great interest an article by Karanasos et al. titled "Impact of smoking status on disease severity and mortality of hospitalized patients with COVID-19 infection: a systematic review and meta-analysis".1 It is inferred that there is an adverse impact of smoking on disease severity and mortality of hospitalized COVID-19 patients, which is more pronounced in younger patients without diabetes. Literature is flooded with papers on possible interaction and outcome of COVID-19 association with smoking. However, there are still conflicting views on the effect of smoking in patient outcomes. These conclusions are data-driven and lack valid pathogenetic background for interpretation.

Double facial talons on maxillary incisor-A rare case report and new proposed classification system.

Background: Double facial talon's cusp is a rare developmental anomaly affecting the deciduous or/and permanent dentition. The major complications associated with facial talons of maxillary incisors include poor esthetic appearance with increased susceptibility to caries and, sometimes, even soft tissue irritation, thereby needing early detection and precise management. Case Report: We report a case of a 10 year-old female patient with a large double talon's cusp on the permanent left maxillary central incisor who presented with issues of soft tissue irritation and esthetic concern. One of the highlighting feature of this documented case was the difference in the extent of both talon's cusps on the facial surface of 21 teeth. As per Mayes' classification system, the talon towards the midline belonged to stage 2 and the talon away from the midline belonged to stage 3. Highlights: Based on the previous literature search on classification systems, we intended to propose a new classification system for double facial talons depending on their size (equal/unequal) and presence of developmental grooves (separate or fused). The aim of this new classification system is to enlighten a new area of research that can be conducted on the treatment aspect by studying the difference in the structure of enamel rods, dentin, especially in case of double talons of unequal size (as the direction of enamel rods/dentinal tubules of the talons with that of the direction of enamel rods/dentinal tubules of the underlying tooth will vary) and their compatibility with choice of dental materials, to be used for proper adaptation and develop new treatment protocols of tooth preparation and restoration for such cases.

Systematic review of the prevalence of current smoking among hospitalized COVID-19 patients in China: could nicotine be a therapeutic option?: Comment.

This is a comment on the low prevalence of smokers in hospitalized COVID-19 patients, citing the possible role of squamous cell metaplasia, which is commonly associated with smokers.

Comparative evaluation of dynamic contrast-enhanced perfusion with diffusion tensor imaging metrics in assessment of corticospinal tract infiltration in malignant glioma.

OBJECTIVE: To compare dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) with diffusion tensor imaging (DTI) for predicting tumor infiltration in a conventional MRI normal-appearing internal capsule adjacent to the tumor in patients with glioblastoma multiforme. METHODS: Thirty patients with glioblastoma multiforme underwent a neurological examination for motor assessment, DCE MRI, and DTI. On fused DCE and DTI images, regions of interest were placed on the normal-appearing internal capsule and the corresponding region of the contralateral internal capsule. These patients were pooled into group 1 (improved after surgery, n = 9) and group 2 (did not improve after surgery, n = 21) on the basis of motor strength. The DTI and perfusion metrics were statistically analyzed to look for a predictor of motor functionality. RESULTS: Multivariate logistic regression analysis showed only cerebral blood volume to be the predictor of improvement in motor functionality after surgery (P = 0.043). CONCLUSIONS: We conclude that cerebral blood volume appears to be the predictor of motor functionality after surgery and may indirectly suggest tumor infiltration, whereas DTI helps to precisely localize the fiber tracts.

Evaluation of glutathione peroxidase in the blood and tumor tissue of oral squamous cell carcinoma patients.

AIMS AND OBJECTIVES: The lowered antioxidant capacity and the oxidant-antioxidant imbalance have been considered to play a role in multistage carcinogenesis. The deleterious effects produced by reactive oxygen species depend on the imbalance between oxidant and antioxidant status in the body, so this study is aimed to evaluate the levels of antioxidant enzyme, glutathione peroxidase (GPx), in the blood and tumor tissues of oral squamous cell carcinoma (OSCC) patients in comparison with healthy controls. MATERIALS AND METHODS: The study comprised of 38 participants divided into two groups. Group 1 comprised of 20 patients with OSCC and Group 2 comprised of age- and sex-matched 18 healthy individuals free of any habits and systemic illness. The levels of GPx were estimated in the blood and tissue samples in both groups by Paglia and Valentine method using a Commercial Biochemical assay kit (RANDOX), by ultraviolet-visible spectrophotometer. RESULTS: The GPx levels were elevated in the whole blood and the tissue samples of OSCC cases as compared to the control group. It was also found that the GPx levels were increased in the tumor tissue with respect to the histopathological grading of the OSCC cases. CONCLUSION: Detection of antioxidant status may be useful to choose correct radiotherapy or chemotherapy, to monitor the effectiveness of the therapeutic strategy and to determine tumor resistance to therapy. Hence, the evaluation of GPx enzyme level can be used as a prognostic marker in patients with OSCC.

Aneurysmal bone cyst of clivus and C1 C2: case report and review of literature.

Aneurysmal bone cyst are benign rapidly expanding bone destructive lesions of any bone. They are common in the metaphysis of long bones but 10-30% involve the spine. Cervical region involvement is uncommon. We report a case of aneurysmal bone cyst of clivus C1 and C2 with minimum symptoms. Involvement of C1 and clivus separately had been reported in past, but simultaneous involvement of both is presented in this report for the very first time.

Recurrent chemical meningitis in craniopharyngioma without reduction in size of cyst: case report of two cases and review of the literature.

Chemical meningitis is a rare phenomenon due to rupture of a craniopharyngioma cyst; it develops because of presence of cholesterol crystals in cyst fluid secreted by the squamous epithelium lining of the cyst. Spontaneous rupture of the cyst may present with or without meningitis, depending upon the cholesterol contents of cystic fluid of tumor. A decrease in the size of cyst may or may not be noted. Here we report two cases of craniopharyngioma, one which had a recurrent episode of chemical meningitis after surgery due to leak from residual component of the craniopharyngioma without evidence of recurrence of lesion, or decrease in the size of the cyst. Another case presented with initial symptoms and signs of meningitis, with no change in the size of the lesion after the second episode of chemical meningitis.

A clinicopathological, immunohistochemical and neuroradiological study of eight patients with central neurocytoma.

Central neurocytomas are low-grade tumors of neuronal origin located in the lateral ventricle that present predominantly with raised intracranial pressure. In this retrospective study, we investigated the clinical, radiological, histopathological and immunohistochemical features of eight patients (seven males and one female; age range 16-61 years; mean=35.1 years) with neurocytoma. Raised intracranial pressure was the most common presenting feature. In addition, one patient presented with marked visual deterioration and one presented with a visual field defect. All lesions were located in the lateral ventricle (right lateral ventricle: four patients, left lateral ventricle: three patients, both ventricles: one patients). Radiology showed marked intratumoral calcification in two patients. Total microsurgical excision was achieved in seven patients. Histopathology showed sheets of monotonously small-to-medium-sized neoplastic cells with uniform round-to-oval nuclei and inconspicuous nucleoli. Immunohistochemistry was positive for synaptophysin and neuron-specific enolase (NSE) in all tumors, and glial fibrillary acidic protein was focally positive in two patients. One patient had lipomatous differentiation within the tumor. No recurrence was noted in any of our patients until the last follow-up; however, there were two deaths in our series.

Early detection of oral cancer: PAP and AgNOR staining in brush biopsies.

AIM: The aim of this study was to determine the diagnostic accuracy of routine Papanicolaou stain (PAP) and Silver stained Nucleolar Organizer Regions (AgNOR) staining in brush biopsies taken from suspected oral lesions for early detection of oral cancer. MATERIALS AND METHODS: Brush biopsies were collected from macroscopically suspicious lesions of the oral cavity of 34 patients and 10 normal-aged and sex-matched controls. The numbers of AgNORs were counted in 100 squamous epithelial cell nuclei per slide after silver staining of the smears (Ploton's one-step method). RESULTS: Sensitivity and specificity of PAP analysis in the oral smears for detection of oral cancer and normal cells was 91.176% and 100%. The positive and negative prediction values were 100% and 76.92%, respectively. Sensitivity and specificity of AgNOR analysis in the oral smears for detection of oral cancer and normal cells was 100%. The positive and negative prediction values were 100% each. CONCLUSION: Based on the above facts, we conclude that brush biopsy in conjunction with AgNOR staining is an easily practicable, non-invasive, safe and accurate screening method for the detection of macroscopically suspicious oral cancerous lesions. Because of its simple technique and high reliability for cellular proliferation, AgNOR staining in brush smears can be used as an adjunct to other routine cytological diagnoses for the early detection of oral cancer. However, further investigations with more number of study samples will be needed to establish this correlation beyond doubt.

Spinal epidural lipomatosis: An unusual cause of relapsing and remitting paraparesis.

Epidural lipomatosis is a rare entity to cause spinal cord compression and neurological deficits. This is usually associated with excess of steroids in the body either because of endogenous source as in Cushings disease or exogenous intake as in some diseases like systemic lupus erythematosus, in some endocrinopathies or in morbid obesity. But in some cases no cause has been found. Such idiopathic cases of spinal epidural lipomatosis have also been reported. Here, we report a case of idiopathic spinal epidural lipomatosis with relapsing and remitting paraparesis which is quite unusual. Treatment depends upon neurological status of the patient. We operated the patient as he had significant neurological compromise and he improved significantly.

Os odontoideum with "free-floating" atlantal arch causing C1-2 anterolisthesis and retrolisthesis with cervicomedullary compression.

BACKGROUND: Os odontoideum (OO) with C1-2 anterolisthesis and retrolisthesis may cause cervicomedullary injury both from anterior and posterior aspects. We analyzed fourteen such patients for biomechanical issues, radiological features and management of OO with free-floating atlantal arch and review pertinent literature. MATERIALS AND METHODS: Fourteen patients having nonsyndromic, reducible atlantoaxial dislocation (AAD) with orthotopic OO were analyzed. During neck flexion, their C1 anterior arch-os complex displaced anteriorly relative to remnant odontoid-C2 body. The posteriorly directed hypoplastic remnant odontoid sliding below the atlas and forward translation of the C1 posterior arch caused concomitant cervicomedullary compression. During neck extension, there was retrolisthesis of the "free-floating" C1 arch-os complex into spinal canal. Spinal stenosis and lateral C1-2 facet dislocation; Klippel-Feil anomaly; and posterior circulation infarcts were also present in one patient each, respectively. Posterior C1-2 (n=10) or occipitocervical fusion (n=3) was performed in neutral position to stabilize atlantoaxial movements. RESULTS: Follow-up (mean, 3.9 years) assessment revealed improvement in spasticity and weakness in 13 patients. One patient had neurological deterioration following C1-2 posterior sublaminar fusion, requiring its conversion to occipitocervical contoured rod fusion. One patient with posterior circulation stroke died prior to any operative intervention. Follow-up lateral view radiographs showed a bony union or a stable construct in these 13 patients. CONCLUSIONS: OO with free-floating atlantal arch may precipitate cord injury both during neck flexion and extension. This condition may be overlooked unless lateral radiographs of craniovertebral junction are undertaken in neck extension, along with the usual ones in neutral and flexed positions. Etiological factors include C1 ring-OO unrestrained movements above the hypoplastic odontoid; upward pull on OO by alar and apical ligaments; lax C1-2 facet joint ligaments; and congenital presence of horizontal facet joint surfaces that facilitates C1-2 translation.

Bilateral proptosis and bitemporal swelling: A rare manifestation of acute myeloid leukemia.

BACKGROUND: In Acute Myeloid Leukemia (AML), malignant clones of immature myeloid cells (primarily blasts) proliferate, replace bone marrow, circulate in blood and invade other tissues. The unique presentation of bilateral proptosis and bilateral temporal swelling in AML is being reported. CASE REPORT: A 6-year-old girl presented with low-grade fever, progressively increasing bitemporal swelling and bilateral proptosis. Contrast Enhanced Computed Tomographic (CECT) images revealed enhancing infiltrates occupying the lateral orbital wall, causing proptosis. The infiltrate extended toward the bilateral temporal fossae beneath the temporalis muscle and extradurally beneath the frontal and temporal bones. A high total leucocytic count with immature and deformed cells and, Fine Needle Aspiration Cytology (FNAC) from the temporal swelling, the bone marrow aspirate and biopsy showing leukemic blast cells confirmed the diagnosis of AML. Chemotherapy brought about remission of the disease. CONCLUSIONS: To the best of the authors' knowledge, simultaneous presence of both bilateral proptosis and bitemporal swellings have not been previously reported in AML. A peripheral blood smear with bone marrow aspirate and biopsy help in the early detection of AML. Institution of early intervention in this potentially fatal disease is often associated with gratifying survival rates.

Bilateral thalamic glioma in a 6-year-old child.

Bithalamic gliomas are extremely rare tumors of central nervous system. Although they are usually benign in nature, their outcome is poor because of the involvement of thalamic nuclei and inadequate surgical excision. Surgery is usually done to get tissue for diagnosis. Role of radiotherapy and chemotherapy is questionable. They are unique in their metabolic and neuroradiological properties. We report herein a 6-year-old male of bithalamic astrocytoma (WHO grade 2) who presented with raised intracranial pressure and tremors in right upper limb. The child had a very huge bithalamic mass which was debulked through the interhemispheric transcallosal approach in order to reduce the mass effect. He had a stormy post-operative course to recover gradually.