Unexpected Culprit: Unveiling a Unique Case of Appendicitis Triggered by a Foreign Object.

Appendicitis is a common surgical emergency marked by inflammation of the appendix, often due to blockage of the appendix lumen by fecoliths, lymphoid hyperplasia, or neoplasms. While various causes are known, appendicitis triggered by a foreign body (FB) is exceptionally rare. This case report highlights a rare presentation of appendicitis in a 32-year-old male with no significant medical history, who presented with acute lower right abdominal pain, fever, and vomiting. Initial evaluation suggested appendicitis, further supported by laboratory findings and diagnostic imaging revealing a retrocecal appendix with surrounding inflammation. Remarkably, an FB, a fish bone, was discovered lodged within the perforated appendix, elucidating the unusual etiology. Emergency laparotomy confirmed the diagnosis and facilitated prompt surgical intervention. This case underscores the importance of thorough evaluation and consideration of uncommon causes in patients presenting with acute abdominal pain, illustrating the critical role of detailed history-taking and clinical acumen in guiding management decisions and ensuring favorable patient outcomes.

Presence of viral RNA of SARS-CoV-2 in conjunctival swab specimens of COVID-19 patients.

Purpose: To detect the presence of viral RNA of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in conjunctival swab specimens of coronavirus disease-19 (COVID-19) patients. Methods: Forty-five COVID-19 patients positive for real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 in nasopharyngeal swab with or without ocular manifestations were included in the study. The conjunctival swab of each patient was collected by an ophthalmologist posted for COVID duty. Results: Out of 45 patients, 35 (77.77%) were males and the rest were females. The mean age was 31.26 ± 12.81 years. None of the patients had any ocular manifestations. One (2.23%) out of 45 patients was positive for RT-PCR SARS-CoV-2 in the conjunctival swab. Conclusion: This study shows that SARS-CoV-2 can be detected in conjunctival swabs of confirmed cases of COVID-19 patients. Though the positivity rate of detecting SARS-CoV-2 in conjunctival swabs is very less, care should be exercised during the ocular examination of patients of COVID-19.

Co-aggregation of bacterial flora isolated from the human skin surface.

Human hands play a prominent role in the intra and interpersonal transmission of microbes that constantly connect one's microbiome to other individuals and the environment. Along with beneficial bacteria, an individual may harbor pathogenic organisms which may get transferred to others. Thus, understanding the transmission mechanism and interaction among microbiota is crucial in preventing infection. In the present study, the ability of skin microbes, isolated from different individuals, to physically interact (coaggregate) intergenically was assessed. The bacterial flora from the hands (palm area) of similar age group students was isolated. The predominant isolates were selected and identified using 16s rRNA gene sequencing. Further, these isolates were subjected to visual coaggregation assay. A total of 27 bacteria were isolated from the human skin (palm area-fingers) of 10 individuals. These isolates belong to seven bacterial genera and 10 different species. Among 123 combinational visual coaggregation positive reactions; 53.66% showed a reaction score of +1, while 32.52%, 11.38% and 2.44% showed a score of +2, +3, and +4 respectively. Among 27 isolates, Staphylococcus haemolyticus had highest coaggregation partners of 17 followed by Acinetobacter spp. and Pseudomonas spp. with 15 partners each. The present study is the first report demonstrating the coaggregation potential of microbiota harboring the skin surface of the human hand. The study indicates that few microbes have high potential to influence coaggregation among distinct genera isolated from the skin. However, further studies are needed to understand the ability of these bacteria to coaggregate, their influence in interpersonal transmission and shaping of microbial ecology of the host skin.

ESSENS dyslipidemia: A placebo-controlled, randomized study of a nutritional supplement containing red yeast rice in subjects with newly diagnosed dyslipidemia.

OBJECTIVE: Evidence suggests prolonged exposure to lower levels of low-density lipoprotein cholesterol (LDL-C), starting at a younger age, substantially lowers cardiovascular (CV) risk. Accordingly, the CV pandemic affecting younger population in low- to low-middle-income countries, where statin usage is poor even in secondary prevention, may benefit from lipid-lowering nutritional products, as nutritional intervention is generally preferred in these cultures. However, the safety and efficacy of such preparations have not been systematically tested. METHODS: In this multicenter, double-blind study, 191 statin-free subjects with newly-diagnosed hyperlipidemia (LDL-C >120 mg/dL, 3.11 mmol/L) and no evidence of CV disease were randomized to one capsule of a proprietary bioactive phytonutrient formulation containing red yeast rice, grape-seed, niacinamide, and folic acid (RYR-NS) or matched placebo twice daily, along with lifestyle modification, for 12 wk. RESULTS: Mean baseline LDL-C levels were 148.5 ± 24.0 mg/dL (3.85 ± 0.62 mmol/L) and 148.6 ± 21.9 mg/dL (3.85 ± 0.57 mmol/L) in the RYR-NS and placebo groups respectively. Compared with placebo, RYR-NS resulted in a significant reduction in LDL-C (-29.4% versus -3.5%, P < 0.0001) and non-high-density lipoprotein cholesterol (non-HDL-C; -29.8% versus -10.3%, P < 0.0001) at 12 wk. With RYR-NS, 43.4% individuals attained desirable LDL-C levels and 55.4% desirable non-HDL-C levels by week 12, compared to only 0% and 1.1%, respectively, at baseline. No safety issues were observed. CONCLUSION: This study demonstrates the efficacy and safety of RYR-NS in lowering LDL-C and non-HDL-C after 12 wk, with magnitude of LDL-C reduction being comparable to that seen with moderate-intensity statin therapy. Further long-term studies are required to determine the impact of RYR-NS on treatment adherence and clinical outcomes.

Long-term mortality after lower-limb amputation.

BACKGROUND: Mortality after amputation is known to be extremely high and is associated with a number of patient features. We wished to calculate this mortality after first-time lower-limb amputation and investigate whether any population or treatment factors are associated with worse mortality. OBJECTIVE: To follow up individuals after lower limb amputation and ascertain the mortality rate as well as population or treatment features associated with mortality. STUDY DESIGN: A prospective cohort study. METHODS: Prospective lower-limb amputations over 1 year (N = 105) at a Regional Rehabilitation Centre were followed up for 3 years. RESULTS: After 3 years, 35 individuals in the cohort had died, representing a mortality of 33%. On initial univariate analysis, those who died were more likely to have diabetes mellitus (χ(2) = 7.16, df = 1, p = 0.007) and less likely to have been fitted with a prosthesis (χ(2) = 5.84, df = 1, p = 0.016). There was no association with age, gender, level of amputation, social isolation, significant medical co-morbidity other than diabetes or presence of mood disorders. A multi-variable logistic regression (backward step) confirmed that diabetes (odds ratio = 3.04, confidence intervals = 1.25-7.40, p = 0.014) and absence of prosthesis-fitting (odds ratio = 2.60, confidence interval = 1.16-6.25, p = 0.028) were independent predictors of mortality. CONCLUSION: Mortality after amputation is extremely high and is increased in individuals with diabetes or in those who are not fitted with a prosthesis after amputation. CLINICAL RELEVANCE: The link between diabetes and mortality after amputation has been noted by others, but this is the first study to find an effect from prosthetic limb-wearing. This requires further investigation to ascertain why the wearing of a prosthetic limb, confers an independent survival benefit that is not related to the presence of medical co-morbidity.

Oral Myiasis: A Rare Case Report and Literature Review.

Myiasis is a rare disease caused by infestation of tissue by larvae of flies. Oral myiasis is still "rare" and "unique" owing to the fact that oral cavity rarely provides the necessary habitat for a larval lifecycle. Herein, we present a case of extensive gingival myiasis in a 12-year-old mentally retarded, epileptic child as well as a literature review.

Nonsyndromic double mesiodentes--hidden lambs among normal flock!

Mesiodens, a common supernumerary tooth, is found in the midline in anterior maxilla between the incisors. Its occurrence as multiples is termed as 'mesiodentes'. Double mesiodentes, a rare phenomenon, is seldom reported in literature and show a plethora of manifestations as described in the case report. They may not be apparent clinically, necessitating the use of imaging modalities and require careful evaluation to prevent complications. This paper presents a report of six double mesiodentes cases with negative family history for supernumerary teeth and absence of any syndromes. This is an effort to educate dentists about signs, symptoms, complications and management of mesiodentes.

Extrafollicular adenomatoid odontogenic tumour.

Adenomatoid odontogenic tumour (AOT) is an uncommon, benign tumour that represents 3-7% of all odontogenic tumours. It is slow growing, occurs twice as common in females and usually in the second decade of life. There are three subclinical types of this tumour with identical histology: follicular type (73%), extrafollicular variant (24%) and peripheral form (3%). Here, the authors have presented two rare cases of extrafollicular varieties of AOT in 25-year-old female patients, of which one was situated in the maxillary canine area and the other one situated in an unusual location of mandibular premolar area. Such lesions may be confused as an odontogenic cyst and should be carefully differentiated from other benign and malignant lesions arising in this region.