Evaluation of the efficacy of tongue swab and saliva as samples for testing COVID-19 infection in symptomatic cases in comparison with nasopharyngeal swab.

Introduction. COVID-19 caused by SARS CoV-2 continues to be a major health concern globally. Methods for detection of the disease are necessary for public health efforts to monitor the spread of this disease as well as for detecting the emergence of new variants.Gap statement. Collection of Nasopharyngeal swab (NPS), the gold standard sample for the detection of COVID-19 infection by RT-qPCR is invasive and requires the expertise of a trained medical provider. This highlights the need for validating less invasive samples that can be self-collected without the need for trained medical provider.Aim. To validate saliva and tongue swab as potential samples for the diagnosis of COVID-19.Methodology. Adult and paediatric cases who had acute influenza like illness were enrolled in the study. The study involved comparison of Nucleic Acid Amplification Tests (NAAT) results for the detection of COVID-19 obtained by using saliva and tongue swab with that of NPS.Result and Conclusion. The sensitivity and specificity of saliva as sample for COVID-19 detection were found to be 71 and 88% respectively whereas those of tongue swab as sample were 78 and 90 %. Further validation was based on the positive and negative predictive values, the likelihood ratio, agreement percentage and the kappa statistic. The findings of the study point towards tongue swab and saliva as suitable alternative samples for the diagnosis of COVID-19 with a slightly higher accuracy and agreement for tongue swab than saliva. However considering the fatality of COVID-19, they are better suited for mass screening of people than for diagnosis.

Effect of Dental Anxiety on Oral Health among the First-Time Dental Visitors: A Hospital-based Study.

Objective: The objective was to assess dental anxiety and to find its association with oral health status and oral health-related quality of life (OHRQoL) among 20-40-year-old patients visiting Vokkaligara Sangha Dental College and Hospital. Materials and Methods: A single-center, hospital-based cross-sectional study was done among first-time dental visitors in the Department of Oral Medicine and Radiology, Vokkaligara Sangha Dental College and Hospital over a period of 8 months (July 14-February 18). The sample size was determined to be 700. Participants in the age group of 20-40 years were selected based on inclusion and exclusion criteria. Data were collected using Corah's Modified Dental Anxiety Scale, Oral Health Impact Profile-14 (OHIP-14), and clinical examination was done using the WHO oral health assessment form and OHI-S. Data were analyzed using Chi-square test and t-test. The associations found through bivariate analysis were entered as predictor variables into linear and binomial logistic regression models with high dental anxiety as the outcome variable. Results: The results of the study suggested that 56% of the study participants were having dental anxiety. Local anesthetic injection (80%) and fear of tooth drilling (60%) were the most anxiety-provoking stimulus. Analysis of OHIP-14 suggested that respondents perceiving oral health as affecting their life quality (very often/fairly often) in the past year were observed for items such as tension, difficulty to relax, irritability, difficulty in doing usual jobs, and totally unable to function because of oral problems. Dental anxiety was significantly associated with gender (odds ratio [OR] = 1.32), education (OR = 1.43), occupation (OR = 2.07), poor oral hygiene status (OR = 3.15), presence of dental caries (OR = 2.67), bleeding on probing (OR = 1.57), presence of periodontal pockets (OR = 2.64), clinical attachment loss (OR = 1.63), and OHRQoL (OR = 1.76). Stepwise linear regression model of independent variables (<0.05 variables included) explained dental caries as highest predictor (39%), followed by debris (22%), calculus (38%), mean OHIS (27%), mean OHIP-14 (29%), deep pocket (14%), and the least predictor was shallow pocket (9%). Conclusion: Dental anxiety was associated with poor oral health status seeking further attention to modify patients' behavior regarding improvement in oral health status.

Non O1/ O139 Vibrio Cholerae Septicemia in a Patient with Hepatocellular Carcinoma.

BACKGROUND: An elderly male with underlying Hepatocellular carcinoma came with history of fall with head and ear trauma, vomiting, abdominal pain, fatigue. Patient died within hours due to Septic shock Blood culture grew Non O1/O139 Vibrio cholerae which was later found to be non-toxigenic. This was a lethal case of non-O1/non-O139 V. cholerae sepsis and we focus on the dilemmas in identification and management of this rare bacterium.

Chromobacterium violaceum causing deadly sepsis.

Infections caused by Chromobacterium violaceum are extremely rare but can be relatively fatal in septicemia. We report a case of a 76 year old female who presented with pustules in the skin and later developed into septicemia. She succumbed to the illness despite escalating the antibiotic therapy to meropenem. To the best of our knowledge this is the 16th case report from India.

Purple Urine Bag Syndrome.

Purple urine bag syndrome (PUBS) is a rare disorder seen in elderly persons, wherein the urinary bag and the tubing turn in to purple colour. It is usually seen in patients who are on urinary catheters for a long time. Purple coloured urine occurs due to the accumulation of indigo and indirubin, which are the end products of tryptophan metabolism due to the action of sulfatases and phosphatases formed by bacteria like Providencia, Citrobacter, Enterobacter, Klebsiella etc. We present this interesting phenomenon of purple urine in a young male who was on prolonged urinary catheterization. The urine culture was positive for Providencia and constipation was an added risk factor for the purple urine. The urinary catheter and tubing was changed along with a course of antibiotics which lead to the normalization of the urine colour.

Retroperitoneal approach for dissection of inflamed pelvic viscera in acute pelvic inflammatory disease- case report.

Tubo-ovarian abscesses can rupture spontaneously after a manual examination or an accidental trauma. A critically ill patient with septic peritonitis will only deteriorate if timely surgical removal of pus is not done. The operation of choice is removal of free pus, together with the abscess, the uterus, the tubes and usually, the ovaries. Anatomy is distorted, dependable landmarks are obscured and tissues are thick and oedematous. Loops of densely adhered intestine are difficult to separate. If an intra peritoneal approach is used, it is likely that the fragments of ovary will be left behind. This can subsequently cause signs and symptoms of ovarian remnant syndrome. Injury to the serosa of distended bowel occurs inadvertently, thus increasing the morbidity which results from the procedure. We are hereby presenting a unique case of a ruptured tubo-ovarian abscess where a retroperitoneal approach was used.

Prevalence of High and Low Level Mupirocin Resistance among Staphylococcal Isolates from Skin Infection in a Tertiary Care Hospital.

BACKGROUND: Mupirocin has been used for the treatment of skin infections and for the eradication of the nasal carriage of Methicillin -resistant Staphylococcus aureus (MRSA). The increased use of this antibiotic has been accompanied by its resistance, resulting in treatment failures. OBJECTIVE: This study was aimed at determining the prevalences of low and high level Mupirocin resistance among the clinical isolates of Staphylococcus species which were obtained from pyogenic infections. MATERIAL AND METHOD: Clinical samples such as wound swabs, tissues and pus which were submitted to the microbiology laboratory during a period of six months were screened for the growth of Staphylococcus species, which were identified as Staphylococcus aureus and Coagulase negative Staphylococcus species by the routine microbiological procedures. All the isolates were tested for their Mupirocin susceptibilities by using 5 and 200 µg discs and their resistance was confirmed from their Minimum Inhibitory Concentrations (MICs). RESULT: Out of 400 samples, 150 samples grew Staphylococcus species, of which 113 were Staphylococcus aureus and 37 were Coagulase negative Staphylococcus (CoNS). Only 5(3.3%) mupirocin resistant Staphylococcus species: three high level and two low level strains were detected. The MICs for the two low level and three high level Mupirocin resistant strains were 256 mg/L and ≥512mg/L each respectively. CONCLUSION: We conclude that the screening for mupirocin resistance, in terms of high-level and low-level resistance among the Staphylococcus species from patients with skin and soft tissue infections is warranted and that it is important for the clinicians in selecting the appropriate, empirical, topical, antimicrobial therapy. It also provides useful information about the prevalence of these resistant pathogens.

Successful treatment of extensive basidiobolomycosis with oral itraconazole in a child.

BACKGROUND: Basidiobolomycosis is a rare chronic subcutaneous infection caused by Basidiobolus ranarum, which is usually treated with potassium iodide. Extensive deforming lesions in children can occur owing to lack of early diagnosis and/or inappropriate treatment. CASE REPORT: An 8-year-old girl child presented to us with extensive deforming plaque-like lesions over the left thigh and leg with multiple ulcerations of 1 year's duration. Histopathology was suggestive of subcutaneous zygomycosis with Splendore Hoeppli phenomenon. Microscopic examination of the tissue showed branching, sparsely septate fungal hyphae on a 10%KOH mount, and culture yielded Basidiobolus ranarum. The patient was initially treated with potassium iodide for 6 weeks to which only a poor response was observed. Itraconazole therapy resulted in rapid regression of the lesions and complete resolution after 15 weeks of therapy. She continues to be disease-free at 1 year of follow up. CONCLUSIONS: This case report highlights that in an older child even longstanding extensive basidiobolomycosis can be safely treated with itraconazole. Surgery is not usually necessary in these patients.

Successful treatment of tuberculous and nocardial arthritis in a hemodialysis patient with subsequent kidney transplant.

A 42-year-old physician on maintenance hemodialysis for chronic renal failure presented with intermittent fever and arthritis of the right knee. Synovectomy specimen of the right knee showed caseating granuloma, consistent with tuberculosis, which was successfully treated with a four-drug regimen of anti-tuberculous therapy. Subsequently, he had a recurrent effusion of the same joint, which on aspiration showed nocardial infection. He was treated with a combination therapy (sulfamethoxazole-trimethoprim and amoxicillin) for four months. He underwent a successful living-related transplant two months later, and was doing well on triple immunosuppression one year after transplantation.