The impact of COVID-19 pandemic on access to treatment for children with cancer in India and treating center practices.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic led the Indian government to announce a nationwide lockdown on March 23, 2020. This study aimed to explore the impact of the pandemic on the accessibility of care for children with cancer and to view strategies adopted by hospitals for service delivery. METHODS: Weekly average of childhood cancer (≤18 years) patient registrations during pre-lockdown period (January 1 to March 23, 2020) were compared with post-lockdown period (March 24 to May 31, 2020). The effect on the scheduled treatment was investigated for post-lockdown period. A survey of health care providers was conducted to determine centers' adopted strategies. RESULTS: In 30 participating centers, 1146 patients with childhood cancer (797 pre-lockdown period and 349 post-lockdown period) were registered. The weekly average registration was 67.3 and 35.5 patients during pre-lockdown and post-lockdown respectively (decline of 47.9%). Although most centers experienced this decline, there were 4 that saw an increase in patient registrations. The distribution of patients registered post-lockdown was found significantly different by age (lesser older age, P = .010) and distance (lesser travel distance, P = .001). 36.1% of patients, who were scheduled for any of the treatment modalities (chemotherapy, surgery, radiotherapy, and hematopoietic stem cell transplantation) during the post-lockdown period, experienced delays. Centers adopted several strategies including modifications to treatment protocols, increased use of growth factors, and increased support from social organizations. CONCLUSIONS: This multicenter study from India suggests that the COVID-19 pandemic and the lockdown impacted 2 out of 3 children with cancer. The effect of this on survival is yet to be established.

Predominant Neurologic Manifestations Seen in a Patient With a Biallelic Perforin1 Mutation (PRF1; p.R225W).

Neurological manifestations in familial hemophagocytic lymphohistiocytosis (FHL) are common, seen in up to 73% of patients in their course of disease. However, in majority of the cases central nervous system manifestations are associated with other clinical and laboratory parameters of hemophagocytic lymphohistiocytosis. We report here a case with FHL2 in whom hemophagocytic lymphohistiocytosis was a presenting manifestation which responded to specific therapy, however, there was isolated central nervous system relapse while patient was in remission and off therapy. FHL2 was confirmed on the basis of reduced perforin expression and homozygous mutation in PRF1at codon 637 in exon 3 (c.673C>T p.Arg225Trp).

Systemic xanthogranuloma involving bone marrow and skin in a case of B-Lymphoblastic Leukemia.

Juvenile xanthogranuloma is a benign self-limiting lesion commonly described in infants and young children. It most commonly involves the skin presenting as single or multiple yellowish-brown papules. Clinical scenario with the classic histomorphology showing histiocytic aggregates in the dermis with xanthomatous cytoplasm, toutan type giant cells, immunohistochemistry with positive CD68, CD163, factor XIIIa and negative CD1a and S-100 help in diagnosis. However, diagnosis becomes challenging with predominant systemic bone marrow involvement in post-B-lymphoblastic leukemia settings.

Influence of needle gauge on pain perception and use of obturators in achieving profound pulpal anesthesia - A double-blinded in vivo study.

Introduction: Achieving profound pupal anesthesia and pain management is key in endodontic practice. However, inferior alveolar nerve block (IANB) does not always result in successful pulpal anesthesia, during symptomatic irreversible pulpitis and has a high failure rate between 35% and 45%. Intrapulpal (IP) injection has been found to have increased efficiency and pain. The study aims to find the pain perception of 26G and 31G and the use of obturators in improving the efficacy of IP anesthesia. Materials and Methods: Eighty patients with symptomatic irreversible pulpitis after the failure of IANB were recruited and divided into four groups to receive IP with Group I A: 26G with obturators, Group I B: 26G without obturators, Group IIA: 31G with obturators, and Group IIB: 31G without obturators. The pain was measured using the visual analog scale and the effectivity of anesthetic injection by the duration of action. Results: A 31G needle produced the least pain perception compared to the 26G needle during IP injection. A 31G with an obturator was the most efficient, acting in less than a minute and 26G without an obturator showed the least. Conclusion: Within the limitation of this trial, it can be concluded that lesser gauge needles reduce pain perception during IP, and obturators achieve adequate back pressure.

Grossing to reporting of Wilms tumor with emphasis on proper sampling in treatment-naive and postchemotherapy specimens and their clinicopathological correlation with outcome.

Context: Emphasis on grossing to reporting for the assessment of histopathological parameters predicting outcomes in Wilms tumor. Aims: To analyze various clinicopathological parameters that effect outcomes in treatment naïve and post chemotherapy Wilms tumor specimens. Settings and Design: This was a retrospective observational study. Subjects and Methods: All patients diagnosed with Wilms tumor between 2012 and 2018 at our institute will be included with their clinical findings, laboratory reports, and radiological findings. The patients will be categorized into two groups based on treatment protocol (Society of Pediatric Oncology (SIOP) or the National Wilms Tumor Study Group/Children's Oncology Group (COG) guidelines) used. Details of Grossing and reporting protocols used for the in pre treatment and post treatment specimens will be analyzed. Follow-up till December 2020 will be analyzed. Statistical Analysis Used: Chi-square and Fisher's exact tests were used for statistical analysis. Results: A total of 36 patients with the diagnosis of Wilms tumor were included in the present study. The mean age of presentation was 3.9 ± 0.7 years, and males were more common than females. Most of them presented as abdominal mass and few with isolated hematuria. Twenty-six (72%) patients were treated under SIOP protocol with preoperative neoadjuvant chemotherapy. Ten patients underwent upfront surgery as per COG protocol. In SIOP group patients, the mean tumor size was 9.3cm. Forty percent (n = 10) we mixed histological type followed by blastemal type constituting (32%, n = 8). Regressive and epithelial histological types constituted 16% (n = 4) and 12% (n = 3), respectively. In the SIOP group 72% (n = 19) had no anaplasia and 28% (n = 7) had anaplasia. Fifty seven percent (n = 15) cases were Stage I, followed by 26.9% n = 7) and 11.5% (n = 3) being Stage II and Stage III, respectively. Ten patients underwent upfront surgery as per COG protocol. The mean tumor size among this group was 8 cm ranging from 7 cm to 11 cm. Eight (80%) cases had favorable histology and two cases showed focal anaplasia. Heterologous differentiation is seen in 3 (70%). Out of the 10 cases, one case was Stage I, six were Stage 2, one was Stage III, and two were clinical Stage IV. None of the cases showed either vessel or lymph node metastasis. All the patients received adjuvant chemotherapy postsurgery and were followed up till December 2020 for (at least 3 years). Of 25 patients in the SIOP group, 18 (72%) had complete remission with no radiological evidence of residual disease. Of the 10 patients in the COG group, 6 (70%) had complete remission. Conclusions: Histopathological evaluation of Wilms tumor is a critical aspect in the management of Wilms tumor, as tumor characteristics are different in the tumors treated under SIOP and COG protocols, which will ultimately affect the prognostic risk stratification. This necessitates the knowledge of the important grossing and reporting of these tumors under the two protocols.

Evaluation of detrimental effects of impacted Mandibular third molars on adjacent second molars - A retrospective observational study.

Context: Mandibular impacted third molars are the most frequently impacted teeth in humans and can predispose the adjacent second molar to an array of detrimental effects such as caries, periodontitis, and cervical resorption thus the aim of this study was to determine the same. Subjects and Methods: A retrospective observational cross-sectional study involving patients with orthopantomography presenting with impacted lower third molar. The type, depth, and level of impaction, the extent of caries, periodontal changes, and the presence of cervical resorption were assessed. Statistical Analysis Used: Data were analyzed using SPSS version 21.0. with Chi-square. Results: Mesioangular impaction was most commonly noted. The pattern of impaction had a direct influence in the formation of carious lesions, cervical resorption, and periodontal ligament (PDL) changes. Conclusions: Noting the pattern of third molar impaction helps the clinician to forecast problems that may occur on adjacent teeth and initiate necessary prophylactic treatment.

Influence of three different types of desensitizing agents on bond strength of etch-and-rinse and self-etch adhesive system on dentin: An in vitro study.

Aim: To determine the effect of three different dentin hypersensitivity treatment procedures on the microtensile bond strength of etch and rinse and self-etch adhesive system. Materials and Methods: Eighty extracted intact human permanent lower premolars were decoronated, and dentin was exposed on the buccal surface. The teeth were randomly assigned to two experimental groups of 40 teeth each: etch and rinse system or self-etch system. The 40 samples assigned were further randomly assigned to four desensitizing treatment subgroups: Control, Gluma, NovaMin, and GC tooth Mousse with 10 samples per subgroup. Desensitizing treatment was performed two times each day for 2 weeks respectively. The exposed dentin was subjected to etch and rinse or self-etch adhesive system bonding agent as per the group and restored using composite to 4-mm thickness. Samples were then subjected to universal testing machine for microtensile bond strength. Results: The bond strength to the dentin obtained with etch and rinse adhesive system group where significantly higher (P < 0.05) when compared to self-etch adhesive system. However, there was no significant effect of the desensitizing agent on the microtensile bond strength in its own. Scanning electron microscope imaging reviled tubular occlusion in all specimens treated with desensitizer. Conclusion: The bond strength was majorly impacted by the type of adhesive system used. While the desensitizing agents used in the study had little or no adverse effect on the bond strength of composites to dentin surface.

Comparative evaluation of antimicrobial efficacy of mushroom, Aloe vera, and Curcuma longa with calcium hydroxide as an intracanal medicament against Enterococcus faecalis: An in vitro study.

Background: The success of endodontic treatment mainly depends on the eradication of microorganisms from the root canal system. The use of intracanal medicaments plays a crucial role in eliminating resistant bacteria such as Enterococcus faecalis. Intracanal medicaments similar to herbal compounds can be used as a substitute for conventional calcium hydroxide (CaOH2) to prevent toxicity. The existing study aimed to compare and evaluate the antimicrobial activity of four different intracanal medicaments against E. faecalis. Objectives: The objective of this study is to compare and evaluate the antimicrobial efficacy of CaOH2, extracts of mushroom, aloe vera, and Curcuma longa as intracanal medicaments against E. faecalis. Materials and Methods: A total of 120 extracted human permanent premolars were decoronated, and chemomechanical preparation of the root canal was performed. After sterilization of the samples, pure cultures of E. faecalis were inoculated and incubated. Then, samples were separated randomly into five groups (n = 24). The antibacterial efficacy of the different intracanal medicaments was recorded at the end of days 1, 7, and 14 by determining the % reduction colony count. Data were statistically analyzed using a one-way analysis of variance, a Chi-square test for association, and a comparison of means using a t-test. Results: Curcuma longa exhibited an increased percentage reduction in colony counts compared to other herbal extracts against E. faecalis. Conclusion: Antibacterial action of the C. longa extract was uppermost followed by CaOH2, A. vera, and mushroom against E. faecalis.

Comparative analysis of smear layer removal by conventional endodontic irrigants with a newly experimented irrigant-fumaric acid: A scanning electron microscopic study.

INTRODUCTION: This study was aimed to evaluate the efficacy of 17% ethylenediaminetetraacetate (EDTA), 7% maleic acid and 0.7% fumaric acid in smear layer removal from the root canal walls. MATERIALS AND METHODS: Forty single-rooted mandibular premolars were collected and prepared till F3 rotary ProTaper file with 1 ml of 3% of sodium hypochlorite after each instrument change. Samples were randomly divided into 4 groups according to the final irrigating solution: 17% EDTA, 7% maleic acid, 0.7% fumaric acid, and 0.9% saline. The samples were prepared for scanning electron microscope analysis to observe smear layer removal at coronal, middle, and apical third level of root canal system. RESULTS: At coronal third level, fumaric acid was equally efficient in smear layer removal when compared to maleic acid and EDTA without any significant difference between them. At the middle third, fumaric acid showed significantly better results than maleic acid followed by EDTA. At the apical third, both fumaric acid and maleic acid were equally effective without any significant difference between them but both showed significantly better results than EDTA. CONCLUSION: Fumaric acid can be tried as a new irrigating agent for smear layer removal in root canal system.

Comparison of antiemetic efficacy and safety of palonosetron vs ondansetron in the prevention of chemotherapy-induced nausea and vomiting in children.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) in children is a major side effect despite the use of combination antiemetic drugs. OBJECTIVE: To compare the efficacy and safety profile of palonosetron, a second-generation 5-hydroxytryptamine-3 (5-HT3) receptor antagonist, with ondansetron in the prevention of CINV in children. METHODS: A prospective, randomized, crossover study was conducted in patients aged 2-18 years. 160 chemotherapy cycles, consisting of chemotherapy drugs with moderate- and high-emetogenic potential, were studied. The study group received a single dose of intravenous (IV) palonosetron 5 mcg/kg, and the standard group received IV ondansetron 5 mg/m2 every 8 hours while receiving chemotherapy. The patients were observed for vomiting, use of rescue antiemetic medications, and nausea from Day 1 0-72 hours after completion of each chemotherapy cycle. All adverse events during the study period were recorded. RESULTS: The overall percentage of patients with complete response (CR) in the palonosetron and ondansetron groups were 60% and 56.2%, respectively (𝑃 = .631). The CR rates in the palonosetron and ondansetron groups were 75% and 70%, respectively, in the acute phase (𝑃 = .479), and 68.8% and 65%, respectively, in the delayed phase (𝑃 = .614). There was no statistically significant difference in the CR rates cross both groups. CONCLUSION: A single dose of palonosetron is noninferior to ondansetron in the prevention of CINV in children and can be considered as an alternative antiemetic drug. There was no significant difference in adverse effects between the palonosetron and ondansetron group.

Age estimation by modified Demirjian's method (2004) and its applicability in Tibetan young adults: A digital panoramic study.

CONTEXT: Estimation of the age is a procedure adopted by anthropologists, archeologists and forensic scientists. Different methods have been undertaken. However none of them meet the standards as Demirjian's method since 1973. Various researchers have applied this method, in both original and modified form (Chaillet and Demirjian in 2004) in different ethnic groups and the results obtained were not satisfactory. AIMS: To determine the applicability and accuracy of modified Demirjian's method of dental age estimation (AE) in 8-18 year old Tibetan young adults to evaluate the interrelationship between dental and chronological age and the reliability between intra- and inter observer relationship. SETTINGS AND DESIGN: Clinical setting and computerized design. SUBJECTS AND METHODS: A total of 300 Tibetan young adults with an age range from 8 to 18 years were recruited in the study. Digital panoramic radiographs (DPRs) were evaluated as per the modified Demirjian's method (2004). STATISTICAL ANALYSIS USED: Pearson correlation, paired t-test, linear regression analysis. RESULTS: Inter -and intraobserver reliability revealed a strong agreement. A positive and strong association was found between chronological age and estimated dental age (r = 0.839) with P < 0.01. Modified Demirjian method (2004) overestimated the age by 0.04 years (2.04 months)in Tibetan young adults. CONCLUSIONS: Results suggest that, the modified Demirjian method of AE is not suitable for Tibetan young adults. Further studies: With larger sample size and comparision with different methods of AE in a given population would be an interesting area for future research.

A novel approach for treatment of an unusual presentation of radicular cysts using autologous periosteum and platelet-rich fibrin in combination with demineralized freeze-dried bone allograft.

Radicular cysts are the most common cystic lesions affecting the jaws. They are most commonly found at the apices of the involved teeth. This condition is usually asymptomatic but can result in a slow-growth tumefaction in the affected region. The following case report presents the successful treatment of radicular cysts using autologous periosteum and platelet-rich fibrin with demineralized freeze-dried bone allograft.

A study of correlation between iron deficiency anaemia and serum lipid profile in Indian adults in BRIMS, Bidar.

Both iron deficiency anemia and dyslipidaemia are widely prevalent public health problems, especially in the Indian population. Some link has been suggested between the two potentially morbid conditions but a sufficient Indian study could not be found in this regard. Methods: This study was planned to find the changes in serum lipid profile in adult Indian patients with iron deficiency anemia and the effect of oral iron therapy on them. 100 iron deficiency anemia and 70 age and sex matched healthy controls, in the age group 18-35 years were investigated for any possible changes in serum lipid profile i.e., triglycerides, total cholesterol, high density lipoprotein cholesterol, very low density lipoprotein cholesterol. The patients were followed up after 3 months of oral iron therapy. Results: The results are shown as mean± standard deviation. Triglycerides and very low density lipoprotein cholesterol levels were found to be significantly (P <0.001) elevated in the iron deficiency anemia group (151.87 ± 48.06 mg/dl and 30.40 ± 9.71 mg/dl) as compared to controls (109.99 ± 30.81 mg/dl and 21.96 ± 6.69 mg/dl), whereas level of low density lipoprotein cholesterol were found to be significantly (P = 0.02) lower in patients (90.96 ± 41.55 mg/dl) as compared to controls (105.24 ± 26.45 mg/dl). However, after treatment (in 43 patients) there was significant (P <0.001) reduction in the levels of triglycerides and very low density lipoprotein cholesterol (111.56 ± 26.87 mg/dl and 22.30 ± 5.36 mg/dl) when compared to their pretreatment level (154.70 ± 53.89 mg/dl and 30.93 ± 10.84 mg/dl), whereas low density lipoprotein cholesterol levels did not show any significant change. Conclusion: These findings indicate that iron deficiency anemia in Indian adults is attended by abnormal serum lipid profile, which responds significantly to iron therapy.