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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also currently known as CoV disease 2019 (COVID-19), has created a global health upheaval. The saliva of an infected person serves as a source for the transmission of CoV. The angiotensin-converting enzyme-2 receptors serve as the host receptor cells for CoV which is expressed in high numbers in salivary glands, oral mucosa, and gingiva. The salivary gland is a potential reservoir for COVID-19 even in asymptomatic but infected carriers. This knowledge could be used to employ salivary sampling as a noninvasive diagnostic method. IgA, IgM antibodies detected in self-collected saliva show more stability than RNA and may aid in the identification of asymptomatic patients. Saliva shows high sensitivity and specificity in the diagnosis of COVID-19 with >90% concordance reported between the saliva and nasopharyngeal swabs. Standardization with respect to sample collection, storage, and transport media can help in validation of diagnostic application of salivary-based testing.

An explosion is caused by conversion of solid, liquid into gas with resultant energy release. Blast injuries of large tyres are similar to injuries resulting from landmine explosions. Most of the patients were polytraumatised, initial evaluation and management should follow ATLS. Trauma following tyre blast results in severe soft tissue, orthopedic and head injuries. Head and face is the most commonly affected region followed by upper limb. A 40 year old male patient was watching a car tyre getting inflated with air. Unfortunately the tyre rim exploded on his face, which led to penetrating injury to the eye ball and comminuted middle third fractures. Patient was stabilized and primary hemostasis was achieved. Fractured maxilla was fixed by arch bar wiring and stabilized by using circum-suspension wiring bilaterally. Left eyeball was removed due to open globe injury and intraocular content loss. Unusual maxillofacial injuries are more common. Decision making and treatment of facial penetrating injuries depends on number of factors, which includes location and extent of injury, type of foreign body involved, proximity of vital structures, extent of injury to soft and hard tissue and the relative benefits and risk ratio for the patient. In this case report we have explained about the primary assessment and management of blast injuries.

An echocardiographic investigation is one of the key modalities of diagnosis in patients suffering from COVID-19, especially if they are elderly, have associated comorbid conditions, and pregnant. Hence, it is becoming extremely essential to look into the correct safety precautions, health-care professionals must take while conducting an echo investigation. At the same time, a focused echo examination aimed at correct imaging view acquisition in the shortest possible time is the need of the hour. The decision matrix formulated for conducting an echocardiographic evaluation is based on the presence or absence of cardiological comorbidity vis-a-vis positive or suspected for COVID-19. The safety measures and image acquisition have been constructed keeping in mind the current safety precautions by the World Health Organization, the Centers for Disease Control and Prevention, and the Ministry of Health and Family Welfare, India.

Context: Perioperative nausea and vomiting is an important clinical problem that occurs in a group of patients requiring carboprost during cesarean section. Apart from pharmacological measures, other modalities have also been introduced to decrease the incidence. Aims: Our study aimed at comparing the effectiveness of acupressure and ondansetron in the prevention of nausea and vomiting following the use of carboprost. Settings and Design: This was a prospective randomized controlled study. Methods and Materials: One hundred patients scheduled for elective caesarean section under spinal anesthesia were divided into two groups of 50 each to receive either acupressure (Group A) or injection ondansetron (Group O) 0.1 mg/kg intravenous (i.v.) immediately after spinal anesthesia. Injection carboprost 250 μg was given intramuscularly in both groups after delivery of the anterior shoulder. Incidences of nausea and vomiting were observed intraoperatively and postoperatively for 2 h. Statistical Analysis Used: Standard qualitative and quantitative tests were used to compare data. A value of P = 0.05 was considered significant. Results: A total of 11 patients had nausea, of whom 7 were in Group O and 4 patients were in Group A (P = 0.350). In total, six patients had nausea and vomiting, of whom four were in Group O and two were in Group A (P = 0.424). No statistical difference was observed between two groups in the incidences of nausea and vomiting. However, the incidence rates were low in Group A as compared to Group O. Conclusion: P6 point acupressure is as effective and comparable as ondansetron in the prevention of carboprost-induced nausea and vomiting.

Purpose: The history of dentistry is not short; it started from ancient Egypt to ancient Romans and ancient Greeks. When it comes to extraction, all of them have made their own discoveries and progress. The progress they made also helped dentistry to move ahead in evolution of new extraction technique – the Physics Forceps. We have assessed the viability in using the Physics Forceps for routine dental extraction in our study for a period of 1 year. Materials and Methods: The study was conducted on 241 patients indicated for extraction based on our inclusion criteria using Physics Forceps after obtaining informed consent and University Ethics Committee approval. Tooth fracture, buccal alveolar bone fracture, and soft tissue injury around the tooth to be extracted were studied. Results: In our present study of 241 patients, 57.67% were females and 42.32% were males, out of which 93.77% had no tooth fracture, 3.32% had crown fracture, 1.65% had root fracture, and 1.24% had apex fracture. Further, 85.47% had no buccal alveolar bone fracture and 14.53% had buccal alveolar bone fracture. Using proper technique, 96.26% of patients had no soft tissue damage, and minimal damage was seen in 3.73% of patients. Discussion: Extraction by Physics Forceps is a very good technique of extraction. No or very minimal tooth fracture and soft tissue injury were noted. Though the forceps is costly, it represents a valuable addition to regular armamentarium for a general dentist for routine extraction. Physics Forceps is a dental extractor rather than a forceps.

Context: Peripheral vein cannulation is commonly performed for rapid and accurate administration of medications. Phlebitis is one of the commonest complications that develop after intravenous catheter application. Aims: This study aims to investigate the incidence of phlebitis and to evaluate factors contributing to the development of phlebitis. Settings and Design: This was a prospective observational study conducted on patients admitted at 4 Air Force Hospital Kalaikunda. Methods: Study conducted on 150 patients who were admitted to the medical and surgical division of the hospital during the period from July 2018 to April 2019. The factors studied were age, gender, site of insertion, place of insertion, cannula size, IV medications, and blood products used. Phlebitis was graded using Visual Infusion Phlebitis Score. Statistical Analysis Used: The incidence of phlebitis was expressed in percentage and odds ratio was calculated to estimate the effects of suspected risk factors. Results: Incidence of phlebitis was found to be 31.4% from our study. The increased incidence rate of phlebitis was seen in the female gender, age less than 60 years, insertion in the lower limb, large catheter size, catheters inserted in emergency situations, and IV drugs administration. Conclusion: Phlebitis is an important on-going problem in present-day clinical practice. Avoiding of preventable risk factors, proper nursing care, and daily inspection of catheters needed for prevention of phlebitis.

Background: Pain relief after cesarean section is essential for the early mobilization of the mother and proper care of the newborn. Among the several modalities available,transverse abdominis plane (TAP) block is newer and attractive. This study aims to compare the efficacy of TAP block compared to sodium diclofenac-acetaminophen combination for postoperative pain following cesarean section. Patients and Methods: Sixty patients undergoing elective cesarean section were included and divided into two groups: Group A received TAP block with 20 ml of 0.25% bupivacaine and Group B received 100 mg diclofenac suppositories followed by intravenous 1 g acetaminophen every 8 h. Participants were assessed for the severity of pain at 0, 4, 8, 12, 24, 36, and 48 h after surgery using the Numeric Rating Scale, the time of first demand for rescue analgesia, and total consumption of rescue analgesia. Results: Pain scores were lower at each point of time during 48 h in Group A as compared to Group B. Time of the first analgesia was statistically significantly longer (7.93 ± 0.70 vs. 4.47 ± 1.36;P < 0.001), and total consumption of rescue analgesia was also lower in Group A (78.13 ± 39.66 mg vs. 140.79 ± 40.15 mg;P < 0.001). Conclusion: TAP block was effective in controlling postoperative pain following cesarean section with a significant reduction in the use of rescue analgesia and their side effects.

>Background: Hypotension is a well-known side effect of spinal anaesthesia in obstetrics patients undergoing caesarean section. This is likely to affect both mother and fetal well-being. Systemic haemodynamics are modulated by autonomic nervous system (ANS). Evaluation of ANS may be helpful in predicting hypotension. The present study is designed to identify the subset of pregnant patients at higher risk of developing post-spinal hypotension based on baseline heart rate (HR) prior to administration of anaesthesia.Materials and Methods: This was a prospective study conducted on 100 patients aged 20–30 years, of American Society of Anaesthesiologists (ASA) grade I or II, scheduled for elective caesarean section under spinal anaesthesia. Patients were divided into two groups based on their baseline HR. Incidence of hypotension and ephedrine requirement following spinal anaesthesia were noted.Results: Thirty nine patients out of 100 developed hypotension (39%), of whom 27 were in the group with HR >91 beats per minute (bpm) (50.9%) and 12 patients were in the group with HR 91 bpm than group with HR

Background and Aims: Hypotension and bradycardia are the common side effects seen after spinal anesthesia. Multiple strategies are tested to prevent the postspinal anesthesia-induced hypotension. Recently, Ondansetron, a 5-HT3 antagonist commonly used as an antiemetic was found to be effective in preventing spinal anesthesia-induced hypotension. The aim of this study is to evaluate the effect of ondansetron in the prevention of spinal anesthesia-induced hypotension. Materials and Methods: A prospective, randomized, and double-blind study was conducted on 110 elderly patients, aged 50–70 years, of the American Society of Anesthesiologists Grade I or II category, scheduled for various surgeries under spinal anesthesia. The patients were randomly divided into two groups of 55 each to receive either ondansetron 8 mg (Group A) or saline (Group B) before spinal anesthesia. The primary outcome of the study was the incidence of hypotension (systolic blood pressure 20% in the baseline values). Secondary outcomes, such as the requirement of ephedrine, the incidence of bradycardia, nausea, and vomiting were also recorded during the study. Results: Group A and Group B were comparable with respect to age, sex, height, and weight. Thirty-four patients in Group B (60.7%) and 22 patients in Group A developed hypotension (39.3%) (P = 0.0359) [Table 1]. The use of ephedrine was greater in Group B than that of Group A (mean 4.61 ± 1.80 vs. 3.45 ± 1.09, P = 0.0107). Thirteen patients in Group B and four patients in Group A had bradycardia (P = 0.0176). Nine patients in Group B and two patients in Group A had vomiting (P = 0.0261). Conclusion: We conclude that prophylactic administration of ondansetron is effective in reducing the incidence of spinal anesthesia-induced hypotension.

Background: Aorto-left ventricular tunnel (ALVT) is a rare congenital extracardiac channel with progressive left ventricular dilatation needs early correction. Materials and Methods: This is a report of diagnosis and management of aorto-left ventricular tunnel (ALVT) over a period of 11 years from a single institution. Seven patients (age range: 7 days-45 years) presented with heart failure. The diagnosis of ALVT was made by transthoracic echocardiogram in all cases. Results: Treatment was refused by two patients who died during follow-up. Surgical closure of the tunnel was done in four cases, of which one needed Bentall procedure. Two patients had residual leak after the surgery. Transcatheter closure using Amplatzer muscular device was performed in two cases (for postoperative residual leak in one and primary procedure in the other). Significant hemolysis developed in one of them, necessitating the removal of the device and closed surgically. This child underwent aortic valve replacement two years later. All the remaining patients were doing well during the median follow-up of 30 months (range: 1.5-9 years). Conclusion: ALVT is a rare and potentially fatal anomaly that is ideally managed surgically. Catheter closure has a limited role.

Abstract Microorganisms exist in large communities of diverse species, exhibiting various functionalities. The mammalian gut microbiome, for instance, has the functionality of digesting dietary fibre and producing different short-chain fatty acids. Not all microbes present in a community contribute to a given functionality; it is possible to find a minimal microbiome, which is a subset of the large microbiome, that is capable of performing the functionality while maintaining other community properties such as growth rate and metabolite production. Such a minimal microbiome will also contain keystone species for SCFA production in that community. In this work, we present a systematic constraint-based approach to identify a minimal microbiome from a large community for a user-proposed function. We employ a top-down approach with sequential deletion followed by solving a mixed-integer linear programming problem with the objective of minimising the L 1-norm of the membership vector. Notably, we consider quantitative measures of community growth rate and metabolite production rates. We demonstrate the utility of our algorithm by identifying the minimal microbiomes corresponding to three model communities of the gut, and discuss their validity based on the presence of the keystone species in the community. Our approach is generic, flexible and finds application in studying a variety of microbial communities. The algorithm is available from https://github.com/RamanLab/minMicrobiome .

Abstract Background Heavy smokers are at increased risk for cardiovascular disease and may benefit from individualized risk quantification using routine lung cancer screening chest computed tomography. We investigated the prognostic value of deep learning-based automated epicardial adipose tissue quantification and compared it to established cardiovascular risk factors and coronary artery calcium. Methods We investigated the prognostic value of automated epicardial adipose tissue quantification in heavy smokers enrolled in the National Lung Screening Trial and followed for 12.3 (11.9–12.8) years. The epicardial adipose tissue was segmented and quantified on non-ECG-synchronized, non-contrast low-dose chest computed tomography scans using a validated deep-learning algorithm. Multivariable survival regression analyses were then utilized to determine the associations of epicardial adipose tissue volume and density with all-cause and cardiovascular mortality (myocardial infarction and stroke). Results Here we show in 24,090 adult heavy smokers (59% men; 61 ± 5 years) that epicardial adipose tissue volume and density are independently associated with all-cause (adjusted hazard ratios: 1.10 and 1.38; P

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Background There are limited data on the occurrence, associations and outcomes of pericardial effusions and pericarditis on or after treatment with immune checkpoint inhibitors (ICIs).Methods This was a retrospective study at a single academic center that compared 2842 consecutive patients who received ICIs with 2699 age- and cancer-type matched patients with metastatic disease who did not receive ICI. A pericardial event was defined as a composite outcome of pericarditis and new or worsening moderate or large pericardial effusion. The endpoints were obtained through chart review and were blindly adjudicated. To identify risk factors associated with a pericardial event, we compared patients who developed an event on an ICI with patients treated with an ICI who did not develop a pericardial event. Cox proportional-hazard model and logistical regression analysis were performed to study the association between ICI use and pericardial disease as well as pericardial disease and mortality. An additional 6-week landmark analysis was performed to account for lead-time bias.Results There were 42 pericardial events in the patients treated with ICI (n=2842) over 193 days (IQR: 64–411), yielding an incidence rate of 1.57 events per 100 person-years. There was a more than fourfold increase in risk of pericarditis or a pericardial effusion among patients on an ICI compared with controls not treated with ICI after adjusting for potential confounders (HR 4.37, 95% CI 2.09 to 9.14, p0.7 mg/kg prednisone) was associated with increased risk of pericardial disease (HR 2.56, 95% CI 1.00 to 6.57, p=0.049).Conclusions ICI use was associated with an increased risk of development of pericardial disease among patients with cancer and a pericardial event on an ICI was associated with a trend towards increase in mortality.

Induction of mycobacterial efflux pumps is a cause of Mycobacterium tuberculosis (Mtb) drug tolerance, a barrier to shortening antitubercular treatment. Verapamil inhibits Mtb efflux pumps that mediate tolerance to rifampin, a cornerstone of tuberculosis (TB) treatment. Verapamil's mycobacterial efflux pump inhibition also limits Mtb growth in macrophages in the absence of antibiotic treatment. These findings suggest that verapamil could be used as an adjunctive therapy for TB treatment shortening. However, verapamil is rapidly and substantially metabolized when co‐administered with rifampin. We determined in a dose‐escalation clinical trial of persons with pulmonary TB that rifampin‐induced clearance of verapamil can be countered without toxicity by the administration of larger than usual doses of verapamil. An oral dosage of 360 mg sustained‐release (SR) verapamil given every 12 hours concomitantly with rifampin achieved median verapamil exposures of 903.1 ng.h/mL (area under the curve (AUC)0‐12 h) in the 18 participants receiving this highest studied verapamil dose; these AUC findings are similar to those in persons receiving daily doses of 240 mg verapamil SR but not rifampin. Moreover, norverapamil:verapamil, R:S verapamil, and R:S norverapamil AUC ratios were all significantly greater than those of historical controls receiving SR verapamil in the absence of rifampin. Thus, rifampin administration favors the less‐cardioactive verapamil metabolites and enantiomers that retain similar Mtb efflux inhibitory activity to verapamil, increasing overall benefit. Finally, rifampin exposures were 50% greater after verapamil administration, which may also be advantageous. Our findings suggest that a higher dosage of verapamil can be safely used as adjunctive treatment in rifampin‐containing treatment regimens. [ABSTRACT FROM AUTHOR]