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Clostridioides difficile infection (CDI) is a pressing health care issue due to the limited effectiveness of current treatments and high recurrence rates. Current available antibiotic options for CDI disrupt the fecal microbiome which predisposes recurrent CDI. Fecal microbiota transplantation (FMT) has improved the outcomes of recurrent CDI, but concerns surrounding the safety and standardization of the product persist. Microbiota-based live biotherapeutic products (LBPs), are emerging as potential alternatives to FMT for CDI treatment. This review explores the potential of LBPs as safe and effective therapy for CDI. While preclinical and early clinical studies have shown promising results, further research is necessary to determine the optimal composition and dosage of LBPs and to ensure their safety and efficacy in clinical practice. Overall, LBPs hold great promise as a novel therapy for CDI and warrant further investigation in other conditions related to disruption of the colonic microbiota., Competing Interests: Robert Orenstein served as an advisor for Rebiotix/Ferring and Mayo Clinic has received research funding from Rebiotix/Ferring, Finch Therapeutics, and Vedanta. Dr Nagarakanti reports no conflicts of interest in this work., (© 2023 Nagarakanti and Orenstein.)

Context: Periodontitis is an inflammatory disease in which periodontal tissues are damaged as a result of an imbalance in the oxidant/antioxidant systems. Melatonin is one hormone that controls circadian rhythms and is also an antioxidant and immune modulator., Aim: The present study was aimed to evaluate the effect of scaling and root planing (SRP) on salivary melatonin levels (SM) in patients with periodontal disease., Settings and Design: A single-center clinical trial was conducted to evaluate the effect of SRP on SM levels in patients with periodontal disease., Materials and Methods: Forty-five participants of age 30-60 years were equally divided into three groups: 15 healthy participants, 15 participants with gingivitis, and 15 participants with periodontitis. Unstimulated salivary samples were collected from all the participants at baseline and 1 month after SRP from participants of gingivitis and periodontitis group and SM levels were determined by commercially available ELISA kit., Statistical Analysis Used: Group comparisons were made using t -test. The level of significance was set at a P < 0.05 for all tests., Results: SM levels were significantly lower in the chronic periodontitis group. There was a significant improvement in clinical parameters and SM levels in both chronic periodontitis and gingivitis groups after SRP., Conclusion: This study determined that there is a negative correlation between SM levels and the severity of periodontal disease and showed a significant increase in SM levels after SRP, suggesting that melatonin might have a protective role against periodontal disease and can be considered as an effective biomarker., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Indian Society of Periodontology.)

The Coronavirus disease 2019 (COVID-19) is a pandemic that affected the overall mental health of the population. As seen in previous situations, there seemed to be an extreme impact of disasters on the mental health of pregnant women and new mothers; therefore, we investigated the relationship between COVID-19 and maternal mental health. The pregnant subjects were identified during the study period through convenience sampling. The study received Institutional Review Board approval and online surveys were sent to subjects via email. The questions were focused on feelings about being pregnant and the influence of the practices during the pandemic. Fifty-one (51) pregnant patients were identified. Our study found that 92.3% of the participants felt negatively, as the COVID-19 precautions did not permit their significant other to attend their routine prenatal visits with them. 64.7% felt that the visits were less personal, 100% felt that they had to take more precautions. Only 42% of the doctors of the subjects discussed how COVID-19 could affect the pregnancy and the baby. Pregnant subjects all had negative feelings towards the pandemic, routine precautions, and the inability to include significant others in prenatal visits and delivery. The majority did not feel their medical teams discussed how COVID-19 could affect the baby.

Background: The goals of periodontal therapy are to prevent the disease, arrest the disease progression, and regeneration of lost periodontium. Diode laser gained popularity in periodontal practice with a wide range of potential benefits., Aim: This study aims to evaluate and compare the clinical effects of laser-assisted open flap debridement (OFD) versus conventional OFD for the periodontitis treatment., Materials and Methods: A split-mouth, randomized clinical trial was conducted on fifteen participants with periodontitis having probing pocket depths (PPD) ≥5 mm. A total of 30 sites, two sites in each patient, were randomly divided into two groups. Group A received conventional OFD, and Group B received laser-assisted OFD. The assessment of PPD, relative attachment level (RAL), modified sulcular bleeding index (mSBI) was done at baseline, 3 months, and 6 months. Wound healing index (WHI) was assessed at 3 rd and 7 th day postsurgery, patient response to pain using visual analog scale (VAS) was assessed immediately, 1 day, and 1 week after surgery., Results: The results revealed a significant reduction in PPD, mSBI, and gain in RAL within the groups from baseline to 3 months and 6 months. Intergroup comparison showed a significant difference in PPD, RAL, mSBI, WHI and VAS scores., Conclusions: The use of 980 nm diode laser provided additional benefits over conventional flap therapy., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Indian Society of Periodontology.)

Background: We sought to evaluate the effect of tocilizumab (TCB), a recombinant humanized monoclonal antibody against soluble interleukin-6 receptors, in patients hospitalized for coronavirus disease 2019 (COVID-19)., Methods: We included all patients with laboratory-confirmed COVID-19 who had completed hospitalization between March 10, 2020 and April 10, 2020 with follow-up through April 20, 2020. Patients who received TCB in addition to standard of care within 48 h of admission were matched in a 1:2 fashion to a similar cohort who received standard of care alone. Clinical outcomes were compared between matched groups. The primary outcome was de-escalation in oxygen therapy. Secondary outcomes were in-hospital death, septic shock, and acute kidney injury (AKI) requiring hemodialysis., Results: Out of 77 patients who received TCB in addition to standard of care, 34% (n = 26) received TCB within 48 h of admission. One-to-two propensity matching identified 20 versus 40 patients in the TCB and no-TCB treatment arms. In the TCB group, an improvement in oxygenation was observed in 80% (n = 16) of the patients by 7 days post TCB administration. After matching, there was no difference in clinical outcomes between TCB and no-TCB patients. In-hospital death: 10% versus 8%; p = .823, septic shock: 10% versus 11%, p = .912, AKI requiring hemodialysis (10% vs. 13%; p = .734)., Conclusions: Early treatment with TCB in patients admitted for COVID-19 led to an improvement in their oxygen status during hospitalization. This change however did not translate into improved survival when compared to a matched cohort with a similar clinical profile., (© 2020 Wiley Periodicals LLC.)

BACKGROUND Parainfluenza viruses (PIV) are known to cause mild respiratory tract infections in immunocompetent patients but can cause severe infections in immune-compromised patients such as transplant recipients and children with HIV. PIV infection in HIV-infected adults has rarely been reported. We report a case of PIV pneumonia in an adult with AIDS who was successfully treated with oral ribavirin. CASE REPORT A 64-year-old man with history of acquired immune deficiency syndrome (AIDS) was admitted to the hospital with shortness of breath that began 3 days before. He was in respiratory distress and required mechanical ventilation on arrival. A bronchoalveolar lavage (BAL) culture was positive for Hemophilus influenzae and a respiratory viral panel was positive for Parainfluenza virus. The patient was initially started on Cefepime and Trimethoprim- Sulfamethoxazole and later changed to Ceftriaxone based on culture results. As the patient's condition did not improve after 48 h, oral ribavirin was added to treat PIV. The patient subsequently improved and was extubated after 72 h. CONCLUSIONS Oral ribavirin can have a beneficial effect in AIDS patients who have PIV-associated pneumonia. Further investigation of the benefit of oral ribavirin in similar cases is warranted.

Background: The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey., Methods: This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death., Results: Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n = 97). Most common symptoms at initial presentation were dyspnea 39% (n = 162) followed by cough 38%(n = 156) and fever 34% (n = 143). Patients were in the highest quartile for population's density, number of housing units and disproportionately fell into the lowest median income quartile for the state of New Jersey. The incidence of septic shock, acute kidney injury (AKI) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n = 59), 21% (n = 52), 33% (n = 82) respectively. Independent predictors of in-hospital mortality were older age, lower serum Hemoglobin < 10 mg/dl, elevated serum Ferritin and Creatinine phosphokinase levels > 1200 U/L and > 1000 U/L., Conclusions: Findings from an inter-city hospital's experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death or morbidity. Older age and elevated inflammatory markers at presentation were associated with in-hospital death.

Background. Conventional mechanical debridement alone cannot eliminate bacteria and their products from periodontal pockets. Adjunctive therapies improve tissue healing through detoxification and bactericidal effects. Photodynamic therapy (PDT) is a non-invasive treatment procedure that involves the use of a dye as a photosensitizer to attach to the target cell and be activated by a photon of an appropriate wavelength. This study aimed to assess the effectiveness of PDT in treating periodontitis as an adjunct to scaling and root planing. Methods. Fifteen subjects with chronic periodontitis were treated randomly with scaling and root planing (SRP), followed by a single PDT (test) or SRP (control) episode alone. Full-mouth plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), and clinical attachment level (CAL) were assessed at baseline and 1-month and 3-month intervals. Microbiological evaluation of Porphyromonas gingivalis (Pg) in subgingival plaque samples was performed using a commercially available real-time polymerase chain reaction. Results. The results revealed a significant difference in PI, SBI, PD, CAL, and microbiological parameters between the groups one and three months after treatment. Conclusion. A combination of PDT and SRP gave rise to a significant improvement in clinical and microbiological parameters in patients with chronic periodontitis., (©2020 The Author(s).)

Background: Cardiac implantable electronic devices (CIED) have become a common treatment modality in clinical practice. The increase in utilization of these devices has been associated with an increase in infection rates. Published guidelines define when a device is deemed infected (CDI); recommendations for the work-up of CDI and criteria for extraction. Few data exist as to adherence to these guidelines., Objective: We wanted to o evaluate whether devices diagnosed as CDI fit guidelines, whether clinicians followed work-up recommendation of CDI, and whether CIED was extracted according to the guidelines criteria in our hospital., Methods: A retrospective review was performed in our hospital between 2008 and 2017. Adult patients (pts) 18 years and older who had their device extracted (DE) with a diagnosis of CDI were included. A total of 95 pts were identified., Results: We included 95 pts who were diagnosed as having CDI and who had their DE. Work-up of patients with a diagnosis of CDI was inconsistently followed. Blood cultures, Echocardiogram, lead cultures (LC), and device pocket cultures (PC) were done in 100%, 90.5%, 75.6%, and 49.3%, respectively. Thirty out of 90 pts. (33%) did not meet guidelines criteria for extraction., Conclusions: In our institution, a one third of the pts diagnosed with CDI who had DE had no indication for DE per guidelines recommendations. Clinicians did not follow recommendations for work-up of CDI consistently. Low adherence was seen in obtaining LC and PC. CIED extraction guidelines should be followed to prevent unnecessary complications and cost., Competing Interests: Authors declare no conflict of interests for this article., (© 2020 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of the Japanese Heart Rhythm Society.)

Treatment of hepatitis C virus (HCV) infection for patients with human immunodeficiency virus (HIV) has improved with direct acting antivirals. However, outcomes among Black persons treated with ledipasvir/sofosbuvir (LDV/SOF) may be inferior to non-Blacks. We assessed responses to LDV/SOF in a cohort of Black HIV/HCV coinfected persons.Retrospective chart reviews were conducted for Black, genotype 1 (GT1), HIV/HCV coinfected patients treated with LDV/SOF at 3 hospitals in Newark, NJ between January 2014 and July 2016. Data collected included demographics, HCV treatment history, treatment duration, and response.One hundred seventeen HIV/HCV coinfected Black patients started treatment with LDV/SOF but 5 had no follow-up data and 5 prematurely discontinued treatment (1 due to side effects). We included 107 HIV/HCV coinfected patients who completed LDV/SOF at all 3 sites. The study population was 65% male, median age 58 years, 26% had cirrhosis, and 78% had GT1a. Thirty-one percent were treatment experienced but none with prior NS5a treatment. At baseline, median CD4 count was 680 cells/mm, HIV viral load (VL) was <40 copies/mL in 94% and median HCV VL was 2,257,403 IU/mL. Twenty-nine percent of patients changed antiretroviral treatment before LDV/SOF treatment due to drug interactions. Six, 89, and 12 patients completed 8, 12, and 24 weeks of LDV/SOF, respectively. Overall sustained virologic response rate was 93% with 7 relapses.In this real-world cohort of Black, GT1, HIV/HCV coinfected patients, LDV/SOF had high sustained virologic response 12 weeks post completion of treatment rate of 93%. This data supports the overall high efficacy of LDV/SOF in a historically difficult-to-treat patient population.

Background: Several hospitalized patients with complex medical issues depend on nursing staff for their daily health care due to several functional limitations. This study investigates the Oral Hygiene Care (OHC) activities and attitudes of nurses toward hospitalized patients., Materials and Methods: A cross-sectional survey was conducted at two private hospitals using a self-administered, structured questionnaire distributed to 585 nursing staff. Data were analyzed through percentages., Results: About 85.70% of the nurses ranked OHC as important; among them, 74.00% ranked as important to extremely important. Very few (2.40%) rated providing OHC to be an unpleasant task and the majority (41.80%) felt lack or proper training is one of the reasons for providing OHC satisfactorily., Conclusions: Nurses experienced significant behavioral and physical difficulties while providing OHC, but still found it important. Therefore, training programs are needed for nurses to improve OHC to hospitalized patients., Competing Interests: Nothing to declare., (Copyright: © 2019 Iranian Journal of Nursing and Midwifery Research.)

Background. Elevated temperature has been recognized as an inflammatory sign. It is the only indication that can be both objectively and quantitatively evaluated and is considered as a potential indicator of periodontal disease. Assessing gingival surface temperature (GST) could be a diagnostic parameter to determine periodontal health. This pilot clinical study aimed to validate gingival surface temperature (GST) as a clinical diagnostic tool to measure periodontal disease activity by correlating with the periodontal inflamed surface area (PISA). Methods. A cross-sectional mono-center pilot study was conducted with a convenient sample of 50 participants with a mean age of 34.14±13.7 years. Clinical parameters such as probing pocket depth (PPD) clinical attachment loss (CAL) and bleeding on probing (BOP) were measured. GST was recorded with a single lead of the bedside patient monitor and correlated with PISA. Results. The results showed a positive correlation between PISA and GST (P=0.46). Conclusion. This study showed a rise in GST of inflamed sites, but the results did not support the hypothesis that increased GST is an indicator of periodontal disease. As this is a pilot study, further studies with more larger sample sizes need to be undertaken to confirm its use as a diagnostic tool in clinical trials., (© 2019 Gunupati et al.)

Introduction: Indian national law namely Cigarettes and Other Tobacco Products Act (COTPA) exists since 2003 and aims at protecting all the people in our country, but smoking is still prevalent among people. This study was aimed to assess awareness, attitudes, and practices regarding prohibition of sale of tobacco products near educational institutions of Nellore city, India., Materials and Methods: A descriptive cross-sectional study was conducted in degree colleges of Nellore city of Andhra Pradesh. The study population includes institutional personnel (student, teaching staff, nonteaching staff, and workers) of selected degree colleges of Nellore city. A structured questionnaire was designed for this study which was validated by Davis criteria; reliability was assessed by test-retest design. The questionnaire was divided into five parts consisting of demographic details (age and gender), smoking behavior, knowledge about tobacco control laws, attitudes toward the law and policies, and practices followed in the institution. Logistic regression analysis was used to find out the association between different independent variables to tobacco usage among institutional personnel., Results: Among the study population ( n = 400 [100%]), 75.8% of the teaching staff do not know that there should be a board in the institution saying that "sale of tobacco product in an area within the radius of 100 m of educational institution is strictly prohibited," 82.2% of the study population were not aware to whom should they report, 96.3% of the study population accepted that strict execution of COTPA law saves life, the participants who answered no to strict implementation of COTPA law, and to punish the person who is violating the COTPA law are susceptible to 0.28, and 0.14 times greater odds to be a smokeless tobacco user, respectively., Conclusion: The study concluded that there was lack of knowledge about smoke-free legislation among the study population and a high support for strict implementation of COTPA., Competing Interests: There are no conflicts of interest.

Background: Periodontitis and stress are among the areas of increasing interest over the past two decades. Early detection of these diseases plays a crucial role in successful therapy. Cortisol is a protein which was found to be consistently associated with both., Aim: The present study was aimed to evaluate saliva cortisol levels (SCLs) in chronic periodontitis (CP) patients with and without stress., Materials and Methods: In this cross-sectional study, saliva samples were collected and cortisol levels were determined using ELISA method in 92 participants. The participants were divided into four groups based on periodontal condition (number of teeth present, plaque index (PI), bleeding on probing (BOP), probing pocket depth, and clinical attachment level) and stress levels into Group 1 (no periodontitis and no stress), Group 2 (with periodontitis and no stress), Group 3 (without periodontitis and with stress), and Group 4 (with periodontitis and stress)., Results: Overall, 92 adult participants (41 males and 51 females) were included in the study. Participants with stress and periodontitis have high mean SCL when compared to other groups (Group 1: 15.01 ± 2.62, Group 2: 31.92 ± 6.80, Group 3: 34.47 ± 13.47, and Group 4: 60.13 ± 6.68). Group I shows a significant negative correlation of cortisol to BOP, stress to PI, and stress to cortisol level, whereas there is a positive correlation of SCL to PD in Group 4 which is not statistically significant., Conclusion: SCL showed difference among the groups. SCL were associated with both CP and psychological stress. Increase in inflammation and stress levels enhances the SCL., Competing Interests: There are no conflicts of interest.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, which negatively affects various health systems. There is an extensive literature regarding the association of PCOS and other systemic conditions such as diabetes mellitus, cardiovascular disease, and psychological disorders. However, there is a lack of literature in associating PCOS and periodontal disease. Hence, PubMed search was done for various articles related to PCOS and its association with other comorbidities, including periodontal diseases. Analysis was done and data were synthesized and compiled in a sequential and presentable paradigm. This literature review of the pathophysiological mechanisms linking the two diseases suggests a positive relation between the two comorbidities. However, multicenter studies, with larger sample sizes, are to be conducted to establish a clearer and stronger association., Competing Interests: There are no conflicts of interest.

Allograft infections post lung transplantation have a significant impact on morbidity and mortality. We report a rare case of triple viral infection with adenovirus, Herpes Simplex virus (HSV) and Cytomegalovirus (CMV) in a lung transplant recipient.

Introduction: Increased risk of periodontal disease has been associated with diabetes mellitus (DM) and also periodontitis is considered as the sixth complication of DM. Medical physicians may have an advantageous position compared to the dentists to provide early patient counseling about oral health because patients attend medical offices more often than to dental offices and are more likely to be affiliated to medical than to dental insurance. Hence, the medical practitioners should have sufficient knowledge in this regard. The study aimed to assess the knowledge, attitudes, and practice behaviors of endocrinologists, general medicine practitioners, and diabetologists on the relationship between periodontal disease and DM., Materials and Methods: Data were collected from sixty participants practicing in Nellore, using a structured questionnaire survey. The obtained data were analyzed through percentages., Results: All the participants (100%) were aware that there existed a relation between oral health and general health. However, only 17.8% (10) of the participants refer their patients to dentists without patients asking for referral., Conclusion: The endocrinologists were aware of the didactic relationship, whereas general medicine practitioners and diabetologists are not much well-equipped with the knowledge on relationship between DM and periodontitis. There exists a wide gap between their practice behaviors and current scientific evidence. Therefore, more emphasis must be made by medical practitioners for the diabetic patient toward periodontal health which is most important yet neglected aspect of comprehensive health care., Competing Interests: There are no conflicts of interest.

Infection with multiple pathogens concurrently has become less common since the introduction of potent antiretroviral agent and effective prophylactic agents. We describe a patient with pulmonary alveolar proteinosis (PAP) admitted with pneumonia who was found to have AIDS and diagnosed with Pneumocystis jiroveci pneumonia, human herpesvirus type 1 (HHV-1), and a concomitant cytomegalovirus viremia. Polymerase chain reaction viral load was used for diagnosis of HHV-1 and follow-up. The patient was treated with trimethoprim-sulfamethoxazole and ganciclovir and had a resolution of pneumonia. Since patients with PAP who are diagnosed as having AIDS could be concomitantly infected with multiple pathogens, rapid accurate diagnosis and treatment may have a positive effect on outcome.

Background: This study aimed to evaluate and compare the efficacy of three desensitizing dentifrices on dentinal hypersensitivity (DH) and salivary biochemical characteristics., Materials and Methods: A randomized, parallel arm, triple-blinded, clinical trial was conducted over a period of 12 weeks, with a total of three visits: baseline, 6 weeks, and 12 weeks. Calcium sodium phosphosilicate, potassium nitrate and amine fluoride dentifrices were compared. A total of 68 subjects who satisfied the inclusion criteria were included and randomly divided into four groups. Visual analog scale scores for controlled air stimulus were used to assess dentinal sensitivity and salivary pH and buffering capacity were recorded at baseline, 6 and 12 weeks., Results: All groups showed a reduction in sensitivity scores at 6 and 12 weeks. The calcium sodium phosphosilicate group showed a higher degree of effectiveness in reducing DH than potassium nitrate, amine fluoride dentifrices, and placebo for sensitivity measures. Salivary pH of calcium sodium phosphosilicate group was more toward neutral, and the buffering capacity of the same group showed significant changes from baseline to 6 and 12 weeks compared to the other groups., Conclusion: The desensitizing toothpaste containing calcium sodium phosphosilicate was found to be more effective in reducing DH and showed improvement in salivary biochemical characteristics over a period of 12 weeks compared to others., Competing Interests: The authors of this manuscript declare that they have no conflicts of interest, real or perceived, financial or nonfinancial in this article.

Minocycline is a second-generation semi-synthetic derivative of tetracycline and has well-known anti-bacterial effects. The drug possesses anti-inflammatory, anti-oxidant, anti-apoptotic and immunomodulatory effects. The drug is widely used in bacterial infections and non-infectious conditions such as acne, dermatitis, periodontitis and neurodegenerative conditions. Minocycline was shown to have antiviral activity in vitro and also against different viruses in some animal models. Some studies have been done on human patients infected with Human Immunodeficiency Virus. We have review the available data regarding minocycline activity as an antiviral agent., (© 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).)

Aim: Subgingival applications of various chemotherapeutic agents have been used as an adjunct to nonsurgical periodontal treatment and preventive periodontal therapy. Their use in regular clinical practice, however, is less, perhaps due to concerns about clinical success or probably due to a lack of knowledge of their effectiveness or cost. The aim of this systematic review is to obtain overall quantitative estimate of effectiveness of subgingival irrigation (SI) in the treatment of chronic periodontitis., Materials and Methods: A literature search of electronic database was performed for articles published through December 31, 2014, followed by manual search of dental journals. Randomized controlled trails (RCTs) assessing the effect of SI as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis evaluated by changes in the clinical and microbiological outcomes were included., Results: This literature search yielded only two randomized, placebo-controlled studies that evaluated the efficacy of SI as an adjunct to SRP in patients with chronic periodontitis. The studies were methodologically not perfect (in terms of mediocre quality) with a risk of bias to come to any final conclusions to be reached. These studies didn't clearly mention about randomization, allocation concealment, blinding, dosage and formulation of irrigants, severity of periodontal disease, patient-centered outcomes and results data., Conclusion: Due to insufficient evidence supporting the efficacy of SI as an adjunct to SRP in treating chronic periodontitis, more rigorous scientific research is required to assess the efficacy of SI as an adjunct to SRP in the treatment of periodontal diseases.

Post-transplant human herpes virus -8 (HHV-8)/Kaposi sarcoma herpes virus (KSHV) infection is associated with neoplastic and non-neoplastic diseases. Kaposi sarcoma (KS), multicentric Castleman's disease (MCD), and primary effusion lymphomas (PEL) are the most common HHV-8-associated neoplastic complications described in solid organ transplant (SOT) patients. Concurrent KS and MCD have been previously described after transplantation only twice - once after liver transplantation and once after renal transplantation. We describe a unique heart transplant patient who also developed concurrent KS and MCD. To our knowledge this is the first documented case of a heart transplant recipient presenting with these two HHV-8-mediated complications at the same time., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Patient: Female, 15 FINAL DIAGNOSIS: Mucormycosis Symptoms: Lower extremity swelling • respiratory failure • short of breath, Medication: - Clinical Procedure: - Specialty: Infectious Diseases., Objective: Rare disease., Background: Mucormycosis is an uncommonly encountered clinical syndrome in Human Immunodeficiency Virus (HIV)-infected patients. The syndrome is well described in solid organ transplant (SOT) patients, in whom it mainly causes pulmonary or rhinocerebral disease. Mucormycosis in HIV-infected patients who underwent SOT has rarely been described., Case Report: In this article, we describe an HIV-infected patient with a renal transplant who developed mucormycosis, and we review the literature. A 45-year-old African-American female with a history of HIV controlled by anti-retrovirals was admitted with shortness of breath, lower extremity swelling, and respiratory failure. Bronchoscopic results confirmed Mucor on pathology. She was treated with posaconazole and caspofungin, but her condition deteriorated. Computed axial tomography (CT) scan of the head without contrast showed multiple low attenuation lesions throughout the brain parenchyma, with the largest lesion centered in the left basal ganglia with extensive mass effect with subfalcine herniation and early transtentorial herniation with acute hydrocephalus. Even though we did not have brain tissue to make a precise diagnosis, it is likely that the central nervous system involvement in this patient was due to mucormycosis., Conclusions: In summary, we describe the case of an HIV-infected patient with renal transplant who died of disseminated mucormycosis. As the number of renal transplants in the HIV-infected population is increasing, clinicians should be aware of the possibility of disseminated mucormycosis. Early diagnosis and effective prophylaxis may alter the course of this devastating syndrome.

Hygiene hypothesis has been proposed more than two decades back to explain an increasing prevalence of allergic diseases and atopy. It states that, a lack of early childhood exposure to infectious agents increases susceptibility to allergic diseases and atopy later in life. The evidence in relation to hygiene hypothesis is controversial and inconclusive. Moreover, its underlying mechanisms are elusive and remain to be elucidated. Periodontitis is an inflammatory disease initiated by microorganisms present in the plaque biofilm. Association between periodontitis and various systemic diseases has already been established and is currently an area of interest particularly in periodontal research. Consistent with hygiene hypothesis, some researchers believed that pathogens associated with periodontal diseases might have a protective role in the development of asthma and other allergic diseases. Very few studies attempted to explore the concept of association between periodontitis, asthma and other respiratory allergic diseases which could neither support such a protective role for periodontal diseases nor reject such an association. This suggests a need for additional research to examine the relevance of hygiene hypothesis in periodontics. The purpose of the present article is to review the plausible scientific explanations available for hygiene hypothesis, to review some studies relating periodontitis, asthma and other respiratory allergic diseases and to stress the need for further research., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The study aimed to assess the knowledge of medical doctors on the association between periodontal disease and general health and their willingness to advise their patients to seek dental treatment. In a cross-sectional survey, randomly selected medical doctors (n = 267) practicing in Nellore District were interviewed through a questionnaire survey about their knowledge of periodontal diseases and the bidirectional relationship between general health and periodontal diseases. Data were analyzed through percentages. All the medical doctors (100%) were aware that there existed a relation between oral health and general health. But only 10% of respondents refer their patients to dentists without patients asking for referral. Very few respondents (21.3%) knew about different branches of dentistry. Screening and referral by healthcare professionals may benefit their patients by improving access to dental care. Therefore, there is a need to educate doctors about oral health and general health.

Disorders relating to short gestation and low birth weight are among the leading causes of death and disability in infants. About 25% of pre-term low birth weight (PLBW) cases occur without even a suspected risk factor. Of all PLBW cases, 18.2% may be attributable to periodontitis (Offenbacher et al. 1996 ). Therefore, this study was conducted to assess the views and knowledge of gynaecologist's on association between periodontal disease and pre-term low birth weight and their willingness to advise their patients to seek dental treatment.

Background: The effects of periodontal disease on the oral gingival epithelium (OGE) have not been documented fully because they may not be as dramatic as those seen on the junctional epithelium. The aim of this study was to estimate the changes occurring in the OGE with respect to its proliferation and E-cadherin and cytokeratin 19 (K19) expression during pocket formation., Methods: Gingival samples were collected from 17 periodontally healthy subjects and 18 subjects with chronic periodontitis. K19 and E-cadherin levels were analyzed immunohistochemically. The net proliferative rate was calculated as the difference between the proliferative rate and the apoptotic rate as determined by immunohistochemical analysis of Ki-67 and p53, respectively., Results: There was a significant increase in the net proliferative rate of the OGE during pocket formation (periodontitis group, 220.90+/-46.85; healthy group, 107.60+/-25.86; P<0.001). There was a significant reduction in E-cadherin expression (periodontitis group, 0.837+/-0.428; healthy group, 1.846+/-0.555) and a significant increase in K19 expression during pocket formation (periodontitis group, 1.45+/-0.686; healthy group, 0.533+/-0.410)., Conclusion: OGE appears to undergo significant changes in proliferation and differentiation during pocket formation that do not seem to be restricted to proteolytic destruction by the invading microorganisms.