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Lindsay K Finkas,1 Navneet Ramesh,2 Lawrence S Block,3 Bing Q Yu,3 Mei-Tsung Lee,3 Meng Lu,3 Jacek Skarbinski,2,3 Carlos Iribarren3 1Kaiser Permanente San Rafael Medical Center, San Rafael, CA, USA; 2Kaiser Permanente Oakland Medical Center, Oakland, CA, USA; 3Kaiser Permanente Division of Research, Oakland, CA, USACorrespondence: Carlos Iribarren, Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA, Email Carlos.Iribarren@kp.orgIntroduction: Previous studies on the outcomes of asthma and COVID-19 have shown inconsistent results. This study aimed to elucidate the association between asthma and COVID-19 outcomes.Methods: We conducted a prospective study with a large health plan to compare the incidence of COVID-19 infection, hospitalization and ICU admission in a cohort of 41,282 patients with asthma and a 1:1 age-, sex-, and race-ethnicity-matched cohort without asthma across the following pandemic periods: pre-Delta (03/01/2020 to 05/31/2021), Delta (06/01/2021 to 12/31/2021), and Omicron (01/01/2022 to 08/13/2022). Demographic factors, comorbidities, COVID-19 test results, inpatient utilization, and COVID-19 vaccination status were collected from electronic health records.Results: Subjects with asthma were more likely than controls to undergo COVID-19 testing during the three pandemic periods and were less likely to test positive in the Omicron period (fully adjusted odds ratio=0.92; 95% CI=0.86– 0.98; p=0.01). Relative to controls, patients with asthma had an increased risk of hospitalization for COVID-19 (fully adjusted hazard ratio=1.33; 95% CI=1.08– 1.64; p=0.01) and borderline significant (p=0.05) higher rates of ICU admissions in the pre-delta period but not during the delta or Omicron periods. The increased risk of COVID-19 hospitalization associated with asthma was more pronounced in patients with severe asthma and in women compared with men. None of the associations were significantly modified by vaccination status.Conclusion: Asthma was associated with a lower risk of COVID-19 infection but only during the Omicron period. Asthma was an independent risk factor for hospitalization for COVID-19 in the pre-delta period and this association was stronger for severe asthma and in women.Keywords: asthma, COVID-19, severe asthma, cohort study

Introduction: Physiotherapy and medical management have shown to be beneficial in managing COVID-19 patients. Prone positioning was maximally used in managing these patients, which helped improve ventilation. Crocodile breathing emphasizes diaphragmatic recruitment, decreases accessory muscle use, and triggers the body's relaxation response. The study aims to see the immediate effect of crocodile breathing versus prone positioning in COVID-19. Methods: Thirty participants who passed the eligibility criteria were randomly assigned into two groups. Group A was asked to perform standard of care treatment followed by prone positioning, and after a washout period of a day, they were made to perform standard of care treatment followed by crocodile breathing. Group B performed crocodile breathing on Day 1 and prone positioning on the next day. Outcome measures pulse rate, respiratory rate, rate of perceived exertion, oxygen saturation, single-breath count (SBC), and chest expansion. The patient's feedback was recorded immediately within 1 min pre and post-treatment on both days. Results: Significant improvement was seen in physiological parameters (P < 0.0001), chest expansion (P < 0.0001), and SBC (P < 0.0001) in both groups. However, crocodile breathing was seen to be more effective than prone positioning on SBC (P < 0.0001), rate of perceived exertion (P = 0.000), and chest expansion (P < 0.0001). Twenty-six out of 30 (86%) participants reported crocodile breathing was a more comfortable and better position to relieve dyspnea. Conclusion: Crocodile breathing effectively manages COVID-19 and can be safely incorporated into physiotherapy management for patients with COVID-19.

Muthukumar Santhanakrishnan,1 Vedavalli Subramanian,2 Nithyakalyani Ramesh,2 R Kamaleeshwari2 1Faculty of Dental Sciences, Department of Periodontology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India; 2Department of Periodontology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, IndiaCorrespondence: Muthukumar Santhanakrishnan Tel +9884118681Email muthukumars@sriramachandra.edu.inObjective: The purpose of this study was assessment of the changes in soft and hard tissues in the esthetic zone of maxilla following immediate implant placement (IIP) with and without the socket shield technique (SST) and placement of implants 4 months following socket preservation (DIP) in terms of alterations in crestal bone thickness (CBT) and soft tissue changes evaluated by means of pink esthetic scores (PES) following placement of implants in the esthetic zone of maxilla.Materials and Methods: In the maxillary esthetic region, 75 dental implants were placed totally, with 25 implants each in the SST, IIP, and DIP groups. All participants were subjected to undergo CBCT for assessing the variations in thickness of crestal aspect of facial/buccal/labial alveolar bone (CBT). PES and PROMS (patient-related outcome measures) were assessed using VAS for pain threshold and esthetic satisfaction following implant placement and after 6th post-operative month.Results: The mean reduction in CBT showed a statistically significant difference between and within the groups, in comparison to IIP and DIP groups, which demonstrated an average reduction in CBT 0.4 ± 0.1 and 0.2 ± 0.1 at 6 months following implant placement, respectively. The SST group showed a significantly lesser reduction in CBT of 0.05 ± 0.02. However, the mean difference in PES within and among the groups showed no significant difference statistically at P < 0.05. On comparison of individual scores of PES between the groups, the results showed significant difference statistically at P < 0.001.Conclusion: The SST group demonstrated minimal reduction in CBT and a superior PES at the end of 6 months compared with the IIP and DIP groups.Keywords: socket shield technique, immediate implant placement, socket preservation, randomized controlled trial, pink esthetic score

The differential diagnosis of mediastinal masses encompasses a vast spectrum ranging from benign tumors to notorious malignancies. Mediastinal lipoma is a very rarely encountered mediastinal mass. It is usually an incidentally unearthed finding. It has a classical radiographic countenance. Knowledge of its existence and presentation aids early diagnosis and can avert unnecessary invasive investigations for alternative diagnosis. The radiographic picture of cardiophrenic obliteration may be seen in a number of heterogeneous conditions such as loculated pleural effusion, pericardial effusion, diaphragmatic hernias, or in certain mediastinal masses. However, mediastinal masses are rarely kept as a differential of this radiological presentation due to a lack of awareness. This leads to performance of invasive tests like thoracocentesis. We herein report an interesting case of mediastinal lipoma incidentally picked up during a chest radiograph done as a part of preoperative evaluation for an unrelated diagnosis. The chest radiograph exhibited a lesion with an obliteration of the right cardiophrenic angle.