Challenges in management of microbial keratitis during COVID-19 pandemic related lockdown: a comparative analysis with pre pandemic data.

PURPOSE: To study the challenges of managing microbial keratitis(MK) during the COVID19 pandemic related lockdown and assess the outcomes of treatment at a tertiary cornea service. METHODS: Retrospective, non comparative study of electronic medical records of MK presenting to a network of four tertiary care cornea services. The medical history, presenting clinical features, microbiology work up and treatment outcomes were analyzed. The primary outcome measure was final outcome at last follow up. Secondary outcomes measures were non-compliance to treatment due to travel restrictions, therapeutic PKP not done due non availability of corneal tissues. Results- MK was noted in 330 eyes of 330 patients between April and May 2020. Of these 237(71.8%) were males. Median age was 45 years(IQR, 33-56). Low socioeconomic status noted in 102(30.9%). Patients travelling beyond the district from where the hospital was located comprised of 64.9%(n=214). At a median follow up of 32 days(IQR, 9-54), 118(35.8%) patients had resolved, with medical management, 73(22.1%) patients were under active treatment, 139(42.1%) were lost to follow up. Sixty-six patients(20%) were non-compliant to treatment of which 59 could not follow appointment schedule due to travel restrictions. Therapeutic PKP (TPK) was planned in 48/128 (37.5%) patients, but was performed in only 34/48 (70.8%) due to non-availability of donor corneas. CONCLUSIONS: Abnormal social circumstances due to the COVID pandemic and the ensuing impediments to travel for access to health care affected compliance to treatment of ocular emergencies such as microbial keratitis.

Variations of Mandibular First Molar Root Canal in School Children: An Observational Study.

BACKGROUND: Root canal (RC) treatment is most common and effective method for treatment of diseases related to periapical area and pulp of teeth. With the increase in age, the formation of secondary dentin, calcification of canals, and reduction of medullary cavity volume, it becomes increasingly difficult to accomplish a perfect RC treatment, hence the understanding of RC variation and changes in variation with increasing age improves the success rates. AIM: The aim of this study was to study the RC variation in the age-group of 10-14 years and to find if the gradual increase in age plays a role in increasing the complexity of RC variation. MATERIALS AND METHODS: This study was carried out in Government Medical College, Patna, Bihar, India, from January 2018 to April 2019. Subjects within the age range of 10-14 years were selected conferring to predetermined inclusion and exclusion criteria. The subjects were divided into the groups according to age-Group I: 10-11 years, Group II: 11-12 years, Group III: 12-13 years, and Group IV: 13-14 years. The subjects were further divided into Group A and B according to sex to study if there is any significant difference in RC variation. Three intraoral periapical (IOPA) radiography with radiovisiography (RVG) of each subject were taken from three different predetermined angles and these IOPAs were then analyzed by three independent observers and the most agreed on value was included. The IOPAs were analyzed for the number of roots, the number of canals in each root and the variation of each RC were classified according to Vertucci's Classification. RESULTS: The most common T of RC variation in mesial root of mandibular first molar was T IV succeeded by T II and T I. For distal canal of mandibular first molar, the most common variation was T I, followed by T II and T III. In our study we found that 98.88% of mandibular molars were having two roots. No significant difference was found in the variation of canal according to age or sex in our study. CONCLUSION: Hence, we conclude that no significant difference is seen in RC variation according to sex and age. As the groups we included in our study were not wide apart enough in age, a further long-term study is needed to ascertain if the complexity of RC increases with age.