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COVID-19 since the dawn has changed the way we look at things around us. Medical practice has changed drastically, so is dermatology practice. Clinical and procedural dermatology practice had come to a standstill in India, due to the past COVID-19 situations. With the changing scenario, now it is time for dermatologists as well as dermatology field to sail through these difficult times, with extra care and precautions. According to the latest CDC and ICMR guidelines, we have designed the following proposed guidelines from entrance to exit for the smooth functioning of dermatology institute/hospital/clinic. Potential setbacks related to patient and manpower, their management during COVID-19 pandemic has been reviewed. Potential setbacks related to clinical dermatology practice and procedures, their management during COVID-19 pandemic has been reviewed and briefed. Hard times are usually blessings in disguise; hence, we should utilize this pandemic period to learn and rejuvenate our practice.

Novel corona virus infection or COVID-19 saw its dawn in first fortnight of Decemberin the city of Wuhan, China, since then it is unstoppable and has spread like a wild-fire, involving most parts of the world. The causative virus is named as SARS-CoV-2. Although the reproductive number (R0) of two to three has been suggested, it is still unknown. The symptoms of COVID-19 infection have a broad spectrum of severity, which ranges from asymptomatic to mildly symptomatic to severe illness that require mechanical ventilation. The virus seldom causes any viral exanthem, but dermatologists should have good working knowledge about COVID-19 and its manifestations, which would help to explore the unexplored cutaneous manifestation of the disease in near future. Due to limited availability of testing kits, RT-PCR test is done only in patients who have a clinical diagnosis of COVID-19 based on symptoms, exposures and chest imaging. Basic public health measures like frequent efficient handwashing, social distancing, staying home, respiratory etiquette like covering nose and mouth while coughing and sneezing are to be followed to prevent the spread of disease. It is now time for our specialty to get involved actively and share the burden of COVID-19. Though not directly connected in dealing with COVID-19 patients, dermatologists should work together with other specialties as a multidisciplinary team. We carried out a PubMed, Medline search using the following terms “COVID-19, dermatology, rash, skin, health care” and have included all data and latest national guidelines related to COVID-19 in dermatology.

Background: Psoriasis is a common, chronic inflammatory disorder of skin characterized by a long clinical course with exacerbations, remissions, and relapses. The cost of therapy and psychological burden of the disease depends on disease severity. The objective of this study was to assess the quality of life and financial status and to correlate the financial burden of the disease with the severity of psoriasis and quality of life. Materials and Methods: A total of 102 psoriasis patients attending the dermatology outpatient department in our hospital were enrolled in this study. A detailed history and complete physical examination, including, Psoriasis Area and Severity Index (PASI), was done. Their family income was calculated. Quality of life was measured using the dermatology life quality index (DLQI) proposed by Finlay et al. Multiple linear regression was done to identify the predictor variables of quality of life (DLQI). P < 0.05 was considered statistically significant. Results: Among the 102 psoriasis patients 78 were men(76.5%) and 24 were women(23.5%). The mean PASI score was 8.20 ± 6.18 the mean DLQI was 13.01 ± 6.95, and mean family income was INR 15570.10 ± INR 10081.82 per month. There was a significant positive correlation between disease severity and DLQI, and a significant negative correlation between family income and PASI as well as DLQI. Conclusion: The quality of life in psoriasis is affected by both the disease severity and financial status of the patient. The chronic course of psoriasis along with disease severity, in a background of low financial status, impairs the quality of life.

Context: Psoriasis is a chronic, systemic disease with the beneficial effect of topical vitamin D3 analogs, known for a long time. Low levels of vitamin D are increasingly found to be associated with the initial development of some autoimmune diseases. There are contradictory reports of low serum levels of vitamin D3 in the pathogenesis of psoriasis. Aims: (1) To determine the serum levels of vitamin D, calcium and C-reactive protein (CRP) in patients with psoriasis vulgaris, (2) To compare these levels with the serum levels of controls, and (3) To correlate them with the severity of the disease. Subjects and Methods: A hospital-based case–control study with 61 patients of psoriasis and 61 age- and sex-matched controls was undertaken. A detailed history was taken and examination including body mass index, Psoriasis Area and Severity Index (PASI) was done. Estimations of serum vitamin D, serum calcium, and CRP levels were done. Results: Mean 25(OH) vitamin D level was not significantly different between persons with and without psoriasis. Mean vitamin D level in cases was 18.41±9.41 and that in controls was 17.24±13.03 (P=0.63). However, vitamin D level were significantly lower in females than in males in both cases (P=0.02) and controls (P=0.006). There was no significant correlation between the severity of psoriasis and serum levels of vitamin D, serum calcium, and CRP. Conclusions: Serum level of vitamin D did not correlate with the severity of psoriasis in our study.

Context: Phosphatase and tensin homolog (PTEN) is a tumor suppressor gene located on chromosome 10q23. PTEN has its major function in the regulation of cell adhesion, cell cycle arrest, migration, apoptosis programming, and differentiation. This genomic region suffers loss of heterozygosity in many human cancers. Aims: The aim of this study was to compare the immunohistochemical expression of PTEN in normal oral mucosa and oral squamous cell carcinoma (OSCC) and to correlate the PTEN expression in gradings of OSCC. Materials and Methods: Thirty cases of paraffin tissue sections of previously diagnosed OSCC were taken. Of thirty cases, ten were well differentiated, ten were moderately differentiated, and ten were poorly differentiated. As a control, ten paraffin sections of oral normal mucosa tissue specimens were taken from patients undergoing extractions. The sections were stained for immunohistochemical expression of PTEN. The cells stained by PTEN antibody were counted, and an immunohistochemical score was obtained. Statistical Analysis Used: Statistical analysis was done using Mann–Whitney's test and Kruskal–Wallis test. Results: Statistical analysis revealed that there was a significant difference between normal mucosa and OSCC in immunohistochemistry staining. However, there was no significant difference in PTEN expression among gradings of OSCC. Conclusions: The study concluded that there was a decrease in PTEN expression in OSCC than normal mucosa. It also concluded that PTEN is a tumor suppressor gene which has a wide role in oral carcinogenesis.

Background and Aims: Accurate prediction of the Cormack-Lehane (CL) grade preoperatively can help in better airway management of the patient during induction of anaesthesia. Our aim was to determine the utility of ultrasonography in predicting CL grade. Methods: We studied 100 patients undergoing general endotracheal anaesthesia. Mallampati (MP) class, thyromental distance (TMD) and sternomental distance (SMD) were noted. Ultrasound measurements of the anterior neck soft tissue thickness at the level of the hyoid (ANS-Hyoid), anterior neck soft tissue thickness at the level of the vocal cords (ANS-VC) and ratio of the depth of the pre-epiglottic space (Pre-E) to the distance from the epiglottis to the mid-point of the distance between the vocal cords (E-VC) were obtained. CL grade was noted during intubation. Chi-square test was employed to determine if there was any statistical difference in the measurements of patients with different CL grades. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy were calculated for the various parameters. Results: The incidence of difficult intubation was 14%. An ANS-VC >0.23 cm had a sensitivity of 85.7% in predicting a CL Grade of 3 or 4, which was higher than that of MP class, TMD and SMD. However, the specificity, PPV and accuracy were lower than the physical parameters. The NPV was comparable. Conclusion: Ultrasound is a useful tool in airway assessment. ANS-VC >0.23 cm is a potential predictor of difficult intubation. ANS-Hyoid is not indicative of difficult intubation. The ratio Pre-E/E-VC has a low to moderate predictive value.

Alzheimer's disease is a degenerative brain disease and the most common cause of dementia. The characteristic symptoms of dementia are difficulties with memory, language, problem solving, and other cognitive skills which affects a person's ability to perform everyday activities. Trace elements have found to play a major role in the Alzheimer's disease. Nowadays, the association of trace elements in the pathogenesis of Alzheimer's disease is more considered, and trace elements such as aluminum (Al), iron (Fe), copper (Cu), and zinc (Zn) imbalances in the amyloid beta peptides have been seen in the Alzheimer's disease This review focuses on the accumulation of trace elements aluminum (Al), copper (Cu), iron (Fe), and zinc (Zn) in the pathogenesis of Alzheimer's disease.

Neurodegenerative diseases are debilitating and incurable condition resulting in the progressive degeneration of nerve cells which causes problems with movement or mental functioning. Alzheimer's disease is the most common form of dementia and an irreversible neurodegenerative disorder. The mechanism of Alzheimer's disease is still unknown. The changes in the primary DNA sequence due to heritable alterations in the gene are known as epigenetics. The most studied epigenetic mechanisms are DNA methylation, histone modifications, and noncoding RNAs. Therefore, this change triggers the alterations in the transcriptional level of genes which are involved in the pathogenesis of Alzheimer's disease. Over the past decade, it is progressively clear that the epigenetic mechanisms play an important role in the pathogenesis of Alzheimer's disease. The literature search was performed on reviews addressing the topics in the databases PubMed and Google Scholar. This review focuses on the three major epigenetic mechanisms and their role in the pathogenesis of Alzheimer's disease.

We report a case of a 17-year-old female patient who presented with sudden, painless, nonprogressive diminished vision in both eyes (best corrected visual acuity in right eye - 6/60 and left eye - 6/36). An ophthalmological evaluation revealed bilateral pale tarsal conjunctiva and bilateral macular hemorrhage. Hematological evaluation revealed the presence of megalocytic anemia (with hemoglobin - 4.9 g%). General examination showed severe pallor. On systemic examination, no abnormality was detected, confirmed by ultrasonography abdomen. Other causes of severe anemia have been ruled out. Intraocular pressure in both eyes was 12 mmHg. This case documents the rare occurrence of bilateral subinternal limiting membrane macular hemorrhage with megaloblastic anemia without thrombocytopenia and other retinal features of anemic retinopathy.

Intraosseous vascular lesions are rare conditions, comprising only 0.5% to 1% of all intraosseous tumors. They present with variable and atypical radiographic appearances. Because of this variation, no pathognomonic sign exists that can be used to make a definite clinical diagnosis of these tumors. But, early diagnosis of central hemangioma is essential for preventing uncontrollable hemorrhage and even death during biopsy or surgery. The purpose of this article is to stress on the importance of radiology in the timely diagnosis of such lesions, which can prevent the disaster not only to the patient but also to oral surgeon in legal and professional aspects.

Marfan syndrome (MFS) is a variable, autosomal dominant disorder of connective tissue whose cardinal features affect the cardiovascular system, eyes, and skeleton. The patient′s prognosis depends on the severity of cardiovascular complications and is mainly determined by progressive dilation of the aorta. If signs of MFS are recognized, it is important to refer to the correct health care professional for further testing to prevent associated complications. Hereby, we report a case of MFS who was unaware about the cardiac manifestations, thereby emphasizing the importance in identifying this potentially life-threatening condition in dental practice.

Background: Tobacco causes the generation of free radicals and reactive oxygen species (ROS) which are responsible for the high rate of lipid peroxidation. Malondialdehyde (MDA) is the most widely used agent to estimate the extent of lipid peroxidation. Timely diagnosis of the condition followed by supplementation with antioxidants like beta-carotene, pro-vitamin A, vitamin A, vitamin C, vitamin E, lipoic acid, zinc, selenium, and spirulina can prevent potentially malignant disorders. Materials and Methods: In this study, serum MDA was measured according to the method of Buege, in 15 normal samples and 15 patients who were histopathologically diagnosed with potentially malignant disordered and they were prescribed with antioxidants for a period of 4 week-time following which potentially malignant patients serum MDA was analyzed again to determine the extent of peroxidation reactions. Results: The mean serum MDA level in Group C1 was 0.7900 ± 0.2336 μM/L were as the mean serum MDA level of Group S1 was 2.478 ± 0.50756 μM/L and the values between them were highly significant. The values between C1 and S2 were found to be statistically significant. The mean serum MDA of S2 was 2.160 ± 0.41252 μM/L and the values were significant when compared to S1. Conclusion: Serum MDA estimation in oral pre-cancer would serve in determining the extent of lipid peroxidation. Diagnosis of patients and administration of antioxidants has proven to be effective in declining the ROS and thus reducing the extent of damage on the cells. MDA may serve as a diagnostic tool in the estimation of oral pre-cancer and in evaluation of post-treated cases.