This document discusses a study on the correlation between CD4+ cell count and orofacial and systemic manifestations in newly diagnosed HIV positive patients in India. The study involved 100 patients who were grouped based on their CD4+ cell count. Results showed a significant correlation between lower CD4+ cell count and increased prevalence of both systemic manifestations like tuberculosis and orofacial manifestations like oral candidiasis. A literature review found that oral candidiasis was one of the most common oral manifestations reported in various Asian studies on HIV/AIDS patients. The findings suggest that CD4+ cell count can be used as a diagnostic and prognostic marker for immune suppression in HIV positive individuals.
This document describes a study that evaluated the correlation between CD4+ T-cell count and orofacial and systemic manifestations in 100 newly diagnosed HIV-positive patients in India. The patients were grouped based on their CD4+ count, and oral exams and medical histories were recorded. Results showed a significant correlation between lower CD4+ counts and more prevalent systemic manifestations like tuberculosis. Lower CD4+ counts also significantly correlated with more common oral manifestations like oral candidiasis. The study aims to evaluate CD4+ count as a prognostic marker for immune suppression in HIV patients.
This document discusses pool testing as a strategy to increase testing capacity and reduce costs during the COVID-19 pandemic. Pool testing involves combining multiple patient samples and testing them as a single pool. If the pool tests negative, then all samples in that pool are considered negative. Only positive pools would require individual re-testing to identify the positive sample(s). The document recommends pool testing in areas with low COVID-19 prevalence (<5%) as a way to screen asymptomatic individuals or for community surveillance. Pool sizes should be adjusted based on local positivity rates. Pool testing has been used successfully for other infectious diseases and could help address shortages in testing capacity and supplies for COVID-19.
- The document discusses using animal models to test vaccines for SARS-CoV-2. It conducted a systematic review of studies published between January-August 2020 on this topic.
- The review identified 20 relevant studies examining non-human primates, mice, hamsters, ferrets, cats and dogs. These studies aimed to investigate the pathogenesis of COVID-19 and use the animals to test vaccines.
- The findings showed that while animal models only mimic some symptoms of COVID-19 infection in humans, they are still essential for understanding disease pathogenesis, viral transmission and vaccine testing. Rhesus macaques in particular mimicked pulmonary infection when inoculated with SARS-CoV-2.
The document provides information on the COVID-19 pandemic as of April 2020. It discusses the epidemiology and spread of the virus globally. Key points include:
- COVID-19 originated in Wuhan, China in late 2019 and has since spread to over 210 countries. As of April 2020, there were over 29 lakh confirmed cases and 200,568 deaths worldwide, with the US becoming the new epicenter.
- The virus spreads mainly person-to-person via respiratory droplets. Common symptoms include fever, cough and shortness of breath, though many cases are asymptomatic. Chest CT scans show bilateral lung involvement like ground-glass opacities or consolidation.
- While most cases are mild, the elderly and those
1) The study aimed to evaluate saliva as an alternative to blood for detecting HIV antibodies using ELISA tests.
2) Saliva and blood samples were collected from 100 confirmed HIV-positive patients and 100 healthy controls.
3) ELISA tests found HIV antibodies in 99% of saliva samples and 100% of blood samples from HIV-positive patients. The tests found no HIV antibodies in samples from healthy controls, showing the tests were 100% specific.
4) The results demonstrate saliva can accurately detect HIV antibodies and is as effective as blood testing, but is less invasive making it preferable for testing.
This document discusses diagnosis and treatment options for coronavirus. It begins by describing the properties and transmission of coronavirus. Diagnosis is primarily done through respiratory or blood samples that test positive for coronavirus nucleic acids on RT-PCR. Treatment involves supportive care, antiviral drugs like interferon-α, and management of symptoms. Severe cases may require oxygen therapy, ventilation, or treatment for organ dysfunction. While no specific treatment for 2019-nCoV exists, several antiviral drugs are being trialled.
Bacille Calmette-Guérin (BCG) vaccine, intended to prevent tuberculosis, may also provide non-specific protection against other pathogens like coronaviruses. The BCG vaccine induces trained immunity through epigenetic and metabolic changes in immune cells. This results in enhanced immune responses to subsequent pathogens. Some studies show countries with widespread BCG use have lower COVID-19 incidence. While more evidence is needed, BCG's ability to boost general immune function means it warrants further study as a potential temporary measure until a coronavirus-specific vaccine is available.
This case report describes a 35-year-old male with acute myeloid leukemia who presented with ptosis of both eyes after receiving aminoglycosides for a chest infection. He was initially diagnosed with a post-synaptic neuromuscular junction disorder but later developed progressive symmetrical weakness and respiratory difficulty, confirming a diagnosis of myasthenic crisis. Treatment with high-dose steroids was started. Further evaluation ruled out thymoma or central nervous system involvement. The case report discusses myasthenic crisis as exacerbation of muscle weakness that can lead to respiratory failure and highlights common precipitating factors like infection.
This document describes a study that evaluated the correlation between CD4+ T-cell count and orofacial and systemic manifestations in 100 newly diagnosed HIV-positive patients in India. The patients were grouped based on their CD4+ count, and oral exams and medical histories were recorded. Results showed a significant correlation between lower CD4+ counts and more prevalent systemic manifestations like tuberculosis. Lower CD4+ counts also significantly correlated with more common oral manifestations like oral candidiasis. The study aims to evaluate CD4+ count as a prognostic marker for immune suppression in HIV patients.
This document discusses pool testing as a strategy to increase testing capacity and reduce costs during the COVID-19 pandemic. Pool testing involves combining multiple patient samples and testing them as a single pool. If the pool tests negative, then all samples in that pool are considered negative. Only positive pools would require individual re-testing to identify the positive sample(s). The document recommends pool testing in areas with low COVID-19 prevalence (<5%) as a way to screen asymptomatic individuals or for community surveillance. Pool sizes should be adjusted based on local positivity rates. Pool testing has been used successfully for other infectious diseases and could help address shortages in testing capacity and supplies for COVID-19.
- The document discusses using animal models to test vaccines for SARS-CoV-2. It conducted a systematic review of studies published between January-August 2020 on this topic.
- The review identified 20 relevant studies examining non-human primates, mice, hamsters, ferrets, cats and dogs. These studies aimed to investigate the pathogenesis of COVID-19 and use the animals to test vaccines.
- The findings showed that while animal models only mimic some symptoms of COVID-19 infection in humans, they are still essential for understanding disease pathogenesis, viral transmission and vaccine testing. Rhesus macaques in particular mimicked pulmonary infection when inoculated with SARS-CoV-2.
The document provides information on the COVID-19 pandemic as of April 2020. It discusses the epidemiology and spread of the virus globally. Key points include:
- COVID-19 originated in Wuhan, China in late 2019 and has since spread to over 210 countries. As of April 2020, there were over 29 lakh confirmed cases and 200,568 deaths worldwide, with the US becoming the new epicenter.
- The virus spreads mainly person-to-person via respiratory droplets. Common symptoms include fever, cough and shortness of breath, though many cases are asymptomatic. Chest CT scans show bilateral lung involvement like ground-glass opacities or consolidation.
- While most cases are mild, the elderly and those
1) The study aimed to evaluate saliva as an alternative to blood for detecting HIV antibodies using ELISA tests.
2) Saliva and blood samples were collected from 100 confirmed HIV-positive patients and 100 healthy controls.
3) ELISA tests found HIV antibodies in 99% of saliva samples and 100% of blood samples from HIV-positive patients. The tests found no HIV antibodies in samples from healthy controls, showing the tests were 100% specific.
4) The results demonstrate saliva can accurately detect HIV antibodies and is as effective as blood testing, but is less invasive making it preferable for testing.
This document discusses diagnosis and treatment options for coronavirus. It begins by describing the properties and transmission of coronavirus. Diagnosis is primarily done through respiratory or blood samples that test positive for coronavirus nucleic acids on RT-PCR. Treatment involves supportive care, antiviral drugs like interferon-α, and management of symptoms. Severe cases may require oxygen therapy, ventilation, or treatment for organ dysfunction. While no specific treatment for 2019-nCoV exists, several antiviral drugs are being trialled.
Bacille Calmette-Guérin (BCG) vaccine, intended to prevent tuberculosis, may also provide non-specific protection against other pathogens like coronaviruses. The BCG vaccine induces trained immunity through epigenetic and metabolic changes in immune cells. This results in enhanced immune responses to subsequent pathogens. Some studies show countries with widespread BCG use have lower COVID-19 incidence. While more evidence is needed, BCG's ability to boost general immune function means it warrants further study as a potential temporary measure until a coronavirus-specific vaccine is available.
This case report describes a 35-year-old male with acute myeloid leukemia who presented with ptosis of both eyes after receiving aminoglycosides for a chest infection. He was initially diagnosed with a post-synaptic neuromuscular junction disorder but later developed progressive symmetrical weakness and respiratory difficulty, confirming a diagnosis of myasthenic crisis. Treatment with high-dose steroids was started. Further evaluation ruled out thymoma or central nervous system involvement. The case report discusses myasthenic crisis as exacerbation of muscle weakness that can lead to respiratory failure and highlights common precipitating factors like infection.
This document discusses using convalescent plasma therapy to treat critically ill COVID-19 patients. It provides background on using convalescent plasma to treat emerging infectious diseases. Limited data from China suggests convalescent plasma therapy provided clinical benefits for COVID-19 patients, including reduced viral loads and improved survival. However, there are challenges in recruiting eligible donors and ensuring the plasma contains sufficient neutralizing antibodies against SARS-CoV-2.
A study was conducted among 1256 dental professionals to assess their knowledge and attitudes regarding conservative and endodontic practices during the COVID-19 pandemic. It was found that while the participants had good basic knowledge of COVID-19, areas for improvement were identified. For example, only 43% knew the accurate incubation period. Rubber dams were recognized as useful by 83% but techniques like low-speed handpieces were preferred by only 25%. While PPE kits were seen as important by 72%, only surgical masks were deemed sufficient by 37%. The study concluded that dental professionals need to be cautious when treating patients during the pandemic and limit disease spread.
Knowledge and Attitude of Prosthodontic Post Graduates on COVID 19: A Qualita...DrHeena tiwari
This document summarizes a study that surveyed 60 prosthodontic post-graduate students regarding their knowledge and attitudes about COVID-19. The results found that 80% felt they received adequate training on COVID-19 prevention and control, while over 60% were confident in managing patients with required precautions. However, only around 63% knew who to contact if they encountered a suspected COVID-19 patient. Nearly all (96.6%) agreed that the pandemic has affected their academic activities. The study concludes that understanding aerosol transmission in dentistry can help identify risks and improve practices to prevent disease spread.
Necessity of COVID-19 vaccination in previously infected individualsMattisHallsteinVolla
This study examined the incidence of COVID-19 among 52,238 employees in an American healthcare system over 5 months. The study found:
1) The cumulative incidence of COVID-19 remained almost zero among those previously infected who remained unvaccinated, those previously infected who were vaccinated, and those not previously infected who were vaccinated.
2) In contrast, there was a steady increase in cumulative incidence among those not previously infected who remained unvaccinated.
3) Not one of the 1,359 previously infected subjects who remained unvaccinated had COVID-19 over the duration of the study.
The results suggest individuals who have had COVID-19 are unlikely to benefit from vaccination, and vaccines
This study evaluated the knowledge and concerns of 124 dentists in southern India regarding COVID-19 through a questionnaire. The results showed good knowledge of COVID-19 itself and oral manifestations, but less awareness of appropriate testing and disinfection procedures. While most dentists understood risk levels and emergency procedures, some lacked knowledge of ideal mouthwashes or managing contaminated air. Overall, the study found that while knowledge of COVID-19 was fairly good, greater education was still needed on testing, prevention and infection control practices.
This document discusses a study comparing the efficacy of placentrex and hydrocortisone injections as adjunct treatments for oral submucous fibrosis (OSMF). 60 patients with stage II or III OSMF were divided into two groups. Group A received placentrex injections while Group B received hydrocortisone injections over 2 months. Mouth opening and burning sensation were measured before and after treatment. Results found a statistically significant greater increase in mean mouth opening for Group B compared to Group A. Burning sensation was reduced more in Group A than Group B. Overall, hydrocortisone seemed to be more effective at improving mouth opening and mucosal health, while placentrex was better at reducing burning
This document discusses the importance of aerosol suction devices in dentistry to prevent the spread of infections like COVID-19. It notes that many dental procedures generate aerosols and droplets that can transmit diseases. Using high-volume evacuator devices can reduce aerosols by 90-98% by suctioning the air and particles generated during treatment. Such devices will be essential equipment for dental practices once lockdowns are lifted to help prevent future outbreaks from spreading via aerosols in the dental setting.
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
- 84 of the 201 patients with COVID-19 pneumonia (41.8%) developed acute respiratory distress syndrome (ARDS), and of those 84 patients, 44 (52.4%) died.
- Risk factors for developing ARDS included older age, pre-existing comorbidities like hypertension and diabetes, and signs of disease severity like dyspnea.
- Risk factors for progression from ARDS to death included older age, signs of immune system overactivation and organ dysfunction like neutrophilia and elevated lactate dehydrogenase and D-dimer levels.
- Treatment with the corticosteroid methylprednisolone was associated with decreased risk of death among patients with ARDS.
A trial of Lopinavir-Ritonavir in Adults Hospitalized with Sever COVID-19Valentina Corona
This randomized controlled trial studied 199 hospitalized adult patients with severe Covid-19 in Wuhan, China to evaluate if the drug combination lopinavir-ritonavir provided benefits beyond standard care. Patients received either lopinavir-ritonavir plus standard care or standard care alone. Treatment with lopinavir-ritonavir did not significantly reduce time to clinical improvement or mortality at 28 days compared to standard care. Gastrointestinal side effects were more common with lopinavir-ritonavir. The study found no clinical benefit to using lopinavir-ritonavir for severe Covid-19.
COVID-19: in gastroenterology a clinical perspectiveValentina Corona
This document discusses gastrointestinal symptoms and liver involvement in COVID-19. It notes that while fever and cough are the most commonly reported COVID-19 symptoms, diarrhea is reported in 17% of cases in Singapore. SARS-CoV-2 RNA has been detected in stool samples. Abnormal liver function tests occurred in around 50% of COVID-19 patients in Chinese studies. The causes of diarrhea and liver abnormalities in COVID-19 are likely multifactorial and may involve the virus binding to ACE2 receptors in the gut and bile ducts. Gastroenterologists need to be aware of atypical COVID-19 presentations that can mimic other gastrointestinal or liver conditions.
This document discusses using fractal dimension analysis to detect dysplasia in oral leukoplakia. It begins by providing background on fractals and fractal dimension. The study aimed to determine if fractal dimension analysis could help detect malignant transformation in oral leukoplakia. 121 patients with oral leukoplakia had digital images taken before and after staining, which were analyzed using fractal dimension analysis software. Results found fractal dimension values were higher in dysplastic leukoplakia compared to nondysplastic. Values also increased with patient age and were higher in those using surti/khaini tobacco. The study concludes fractal dimension analysis may be a useful noninvasive screening tool for early detection of
Baseline characteristics and outcomes of 1591 patients infected with sars co ...Valentina Corona
This case series describes 1591 critically ill patients with COVID-19 admitted to ICUs in Lombardy, Italy between February 20th and March 18th. The median age was 63 years and 82% were male. Of those with available data, 68% had at least one comorbidity and 49% had hypertension. Among those with respiratory support data, 99% required support including 88% who received mechanical ventilation. ICU mortality was 26% as of March 25th and older patients had higher mortality than younger patients.
Role of Budesonide in Corona Virus Disease: Systematic Review DrHeena tiwari
Inhaled budesonide has been shown to significantly reduce the likelihood of Covid-19 patients requiring urgent or emergency care or hospitalization when given early to patients with mild symptoms. A systematic review of studies found inhaled budesonide reduced the risk of these adverse outcomes by 91% in one study. It also reduced the median time to recovery by 3 days in another study of patients with risk factors who were not hospitalized. The studies support the potential for inhaled budesonide to control the excessive inflammatory response to Covid-19 and prevent disease progression when administered early in mild cases.
Respiratory virus shedding in exhaled breath and efficacy of face masksValentina Corona
1) The study identified seasonal human coronaviruses, influenza viruses, and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness.
2) Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols. There was also a trend toward reduced detection of coronavirus RNA in respiratory droplets.
3) The results indicate that surgical face masks could help prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
This study was conducted to understand the status of scabies infection and its
epidemic characteristics in the Korean hospitals. 43 hospitals (86.0%) received the
reports of scabies infection with suspicious or definite diagnosis to infection control
department, implicating continuous increases 14.6% (7/48), 20.8% (10/48), 35.7%
(17/48), 44.1% (21/48), and 56.7% (27/48) in 2010 to 2013 and 35.7% (17/48) in 2014
up to April.
92.0% of the hospitals had the rules and guideline of scabies infection control,
which seemed to be prepared by the recent certifications of medical institutions and
establishment of rules in infection control departments. However, less than half of the
hospitals 44.0% (22/50) prepared the screening system related to scabies during the
admission processes of the patients, 56.7% of the patients had the typical symptoms
related to scabies when they admitted with 47.0% of pruritus, requiring the system to
prevent from the scabies epidemic beforehand
This document summarizes a study on the seroprevalence of hepatitis B antigenemia among dental students in South India. The study found:
1) A total of 352 dental students participated in the study, with 46% vaccinated against hepatitis B and 54% unvaccinated.
2) All 352 dental students tested negative for hepatitis B surface antigen.
3) While the study found no current hepatitis B infections, the significant number of unvaccinated students indicates a need for improved vaccination programs for dental students to protect against occupational risk of hepatitis B exposure.
33.Vohra P, Jamatia K, Subhada B, Tiwari RVC, Althaf MN, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care. 2019 Oct;8(10):3247-3252. doi: 10.4103/jfmpc.jfmpc_767_19. eCollection 2019 Oct. PubMed PMID: 31742150; PubMed Central PMCID: PMC6857402.
This document summarizes a study that correlated CD4 counts with oral and systemic manifestations in 100 HIV-positive patients in India. The study found that lower CD4 counts were associated with a wider range of oral and systemic manifestations, which can serve as a prognostic marker for immune suppression. Specifically, the study found that tuberculosis was the most common systemic manifestation. Candidiasis and chronic generalized periodontitis were the most prevalent oral manifestations in males, while candidiasis and recurrent aphthous ulcers were most common in females. Nearly all patients with CD4 counts below 200 showed oral manifestations, demonstrating a significant correlation between oral manifestations and lower CD4 counts.
Vohra P, Jamatia K, Subhada B, Tiwari RV, Althaf MS, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care 2019;8:3247-52.
This document discusses using convalescent plasma therapy to treat critically ill COVID-19 patients. It provides background on using convalescent plasma to treat emerging infectious diseases. Limited data from China suggests convalescent plasma therapy provided clinical benefits for COVID-19 patients, including reduced viral loads and improved survival. However, there are challenges in recruiting eligible donors and ensuring the plasma contains sufficient neutralizing antibodies against SARS-CoV-2.
A study was conducted among 1256 dental professionals to assess their knowledge and attitudes regarding conservative and endodontic practices during the COVID-19 pandemic. It was found that while the participants had good basic knowledge of COVID-19, areas for improvement were identified. For example, only 43% knew the accurate incubation period. Rubber dams were recognized as useful by 83% but techniques like low-speed handpieces were preferred by only 25%. While PPE kits were seen as important by 72%, only surgical masks were deemed sufficient by 37%. The study concluded that dental professionals need to be cautious when treating patients during the pandemic and limit disease spread.
Knowledge and Attitude of Prosthodontic Post Graduates on COVID 19: A Qualita...DrHeena tiwari
This document summarizes a study that surveyed 60 prosthodontic post-graduate students regarding their knowledge and attitudes about COVID-19. The results found that 80% felt they received adequate training on COVID-19 prevention and control, while over 60% were confident in managing patients with required precautions. However, only around 63% knew who to contact if they encountered a suspected COVID-19 patient. Nearly all (96.6%) agreed that the pandemic has affected their academic activities. The study concludes that understanding aerosol transmission in dentistry can help identify risks and improve practices to prevent disease spread.
Necessity of COVID-19 vaccination in previously infected individualsMattisHallsteinVolla
This study examined the incidence of COVID-19 among 52,238 employees in an American healthcare system over 5 months. The study found:
1) The cumulative incidence of COVID-19 remained almost zero among those previously infected who remained unvaccinated, those previously infected who were vaccinated, and those not previously infected who were vaccinated.
2) In contrast, there was a steady increase in cumulative incidence among those not previously infected who remained unvaccinated.
3) Not one of the 1,359 previously infected subjects who remained unvaccinated had COVID-19 over the duration of the study.
The results suggest individuals who have had COVID-19 are unlikely to benefit from vaccination, and vaccines
This study evaluated the knowledge and concerns of 124 dentists in southern India regarding COVID-19 through a questionnaire. The results showed good knowledge of COVID-19 itself and oral manifestations, but less awareness of appropriate testing and disinfection procedures. While most dentists understood risk levels and emergency procedures, some lacked knowledge of ideal mouthwashes or managing contaminated air. Overall, the study found that while knowledge of COVID-19 was fairly good, greater education was still needed on testing, prevention and infection control practices.
This document discusses a study comparing the efficacy of placentrex and hydrocortisone injections as adjunct treatments for oral submucous fibrosis (OSMF). 60 patients with stage II or III OSMF were divided into two groups. Group A received placentrex injections while Group B received hydrocortisone injections over 2 months. Mouth opening and burning sensation were measured before and after treatment. Results found a statistically significant greater increase in mean mouth opening for Group B compared to Group A. Burning sensation was reduced more in Group A than Group B. Overall, hydrocortisone seemed to be more effective at improving mouth opening and mucosal health, while placentrex was better at reducing burning
This document discusses the importance of aerosol suction devices in dentistry to prevent the spread of infections like COVID-19. It notes that many dental procedures generate aerosols and droplets that can transmit diseases. Using high-volume evacuator devices can reduce aerosols by 90-98% by suctioning the air and particles generated during treatment. Such devices will be essential equipment for dental practices once lockdowns are lifted to help prevent future outbreaks from spreading via aerosols in the dental setting.
THE IMPORTANCE OF SCIENCE AND THE ROLE OF GOVERNMENTS IN THE FIGHT AGAINST TH...Fernando Alcoforado
This article aims to emphasize the importance of using the scientific method in the search for a drug for the cure of people infected with the new Coronavirus and a vaccine to immunize the population, as well as coordinating action by governments to prevent the spread of viruses in order to safeguard the population's health and avoid its harmful effects on the economy.
- 84 of the 201 patients with COVID-19 pneumonia (41.8%) developed acute respiratory distress syndrome (ARDS), and of those 84 patients, 44 (52.4%) died.
- Risk factors for developing ARDS included older age, pre-existing comorbidities like hypertension and diabetes, and signs of disease severity like dyspnea.
- Risk factors for progression from ARDS to death included older age, signs of immune system overactivation and organ dysfunction like neutrophilia and elevated lactate dehydrogenase and D-dimer levels.
- Treatment with the corticosteroid methylprednisolone was associated with decreased risk of death among patients with ARDS.
A trial of Lopinavir-Ritonavir in Adults Hospitalized with Sever COVID-19Valentina Corona
This randomized controlled trial studied 199 hospitalized adult patients with severe Covid-19 in Wuhan, China to evaluate if the drug combination lopinavir-ritonavir provided benefits beyond standard care. Patients received either lopinavir-ritonavir plus standard care or standard care alone. Treatment with lopinavir-ritonavir did not significantly reduce time to clinical improvement or mortality at 28 days compared to standard care. Gastrointestinal side effects were more common with lopinavir-ritonavir. The study found no clinical benefit to using lopinavir-ritonavir for severe Covid-19.
COVID-19: in gastroenterology a clinical perspectiveValentina Corona
This document discusses gastrointestinal symptoms and liver involvement in COVID-19. It notes that while fever and cough are the most commonly reported COVID-19 symptoms, diarrhea is reported in 17% of cases in Singapore. SARS-CoV-2 RNA has been detected in stool samples. Abnormal liver function tests occurred in around 50% of COVID-19 patients in Chinese studies. The causes of diarrhea and liver abnormalities in COVID-19 are likely multifactorial and may involve the virus binding to ACE2 receptors in the gut and bile ducts. Gastroenterologists need to be aware of atypical COVID-19 presentations that can mimic other gastrointestinal or liver conditions.
This document discusses using fractal dimension analysis to detect dysplasia in oral leukoplakia. It begins by providing background on fractals and fractal dimension. The study aimed to determine if fractal dimension analysis could help detect malignant transformation in oral leukoplakia. 121 patients with oral leukoplakia had digital images taken before and after staining, which were analyzed using fractal dimension analysis software. Results found fractal dimension values were higher in dysplastic leukoplakia compared to nondysplastic. Values also increased with patient age and were higher in those using surti/khaini tobacco. The study concludes fractal dimension analysis may be a useful noninvasive screening tool for early detection of
Baseline characteristics and outcomes of 1591 patients infected with sars co ...Valentina Corona
This case series describes 1591 critically ill patients with COVID-19 admitted to ICUs in Lombardy, Italy between February 20th and March 18th. The median age was 63 years and 82% were male. Of those with available data, 68% had at least one comorbidity and 49% had hypertension. Among those with respiratory support data, 99% required support including 88% who received mechanical ventilation. ICU mortality was 26% as of March 25th and older patients had higher mortality than younger patients.
Role of Budesonide in Corona Virus Disease: Systematic Review DrHeena tiwari
Inhaled budesonide has been shown to significantly reduce the likelihood of Covid-19 patients requiring urgent or emergency care or hospitalization when given early to patients with mild symptoms. A systematic review of studies found inhaled budesonide reduced the risk of these adverse outcomes by 91% in one study. It also reduced the median time to recovery by 3 days in another study of patients with risk factors who were not hospitalized. The studies support the potential for inhaled budesonide to control the excessive inflammatory response to Covid-19 and prevent disease progression when administered early in mild cases.
Respiratory virus shedding in exhaled breath and efficacy of face masksValentina Corona
1) The study identified seasonal human coronaviruses, influenza viruses, and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness.
2) Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols. There was also a trend toward reduced detection of coronavirus RNA in respiratory droplets.
3) The results indicate that surgical face masks could help prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.
This study was conducted to understand the status of scabies infection and its
epidemic characteristics in the Korean hospitals. 43 hospitals (86.0%) received the
reports of scabies infection with suspicious or definite diagnosis to infection control
department, implicating continuous increases 14.6% (7/48), 20.8% (10/48), 35.7%
(17/48), 44.1% (21/48), and 56.7% (27/48) in 2010 to 2013 and 35.7% (17/48) in 2014
up to April.
92.0% of the hospitals had the rules and guideline of scabies infection control,
which seemed to be prepared by the recent certifications of medical institutions and
establishment of rules in infection control departments. However, less than half of the
hospitals 44.0% (22/50) prepared the screening system related to scabies during the
admission processes of the patients, 56.7% of the patients had the typical symptoms
related to scabies when they admitted with 47.0% of pruritus, requiring the system to
prevent from the scabies epidemic beforehand
This document summarizes a study on the seroprevalence of hepatitis B antigenemia among dental students in South India. The study found:
1) A total of 352 dental students participated in the study, with 46% vaccinated against hepatitis B and 54% unvaccinated.
2) All 352 dental students tested negative for hepatitis B surface antigen.
3) While the study found no current hepatitis B infections, the significant number of unvaccinated students indicates a need for improved vaccination programs for dental students to protect against occupational risk of hepatitis B exposure.
33.Vohra P, Jamatia K, Subhada B, Tiwari RVC, Althaf MN, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care. 2019 Oct;8(10):3247-3252. doi: 10.4103/jfmpc.jfmpc_767_19. eCollection 2019 Oct. PubMed PMID: 31742150; PubMed Central PMCID: PMC6857402.
This document summarizes a study that correlated CD4 counts with oral and systemic manifestations in 100 HIV-positive patients in India. The study found that lower CD4 counts were associated with a wider range of oral and systemic manifestations, which can serve as a prognostic marker for immune suppression. Specifically, the study found that tuberculosis was the most common systemic manifestation. Candidiasis and chronic generalized periodontitis were the most prevalent oral manifestations in males, while candidiasis and recurrent aphthous ulcers were most common in females. Nearly all patients with CD4 counts below 200 showed oral manifestations, demonstrating a significant correlation between oral manifestations and lower CD4 counts.
Vohra P, Jamatia K, Subhada B, Tiwari RV, Althaf MS, Jain C. Correlation of CD4 counts with oral and systemic manifestations in HIV patients. J Family Med Prim Care 2019;8:3247-52.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
This study aimed to establish baseline CD4+ T-lymphocyte counts in 100 HIV-negative adults in eastern India. The mean CD4+ count was 823.9 cells/μl, with women having significantly higher counts than men. Younger age groups between 18-27 years had the highest mean count of 893.3 cells/μl, with counts declining with increasing age. The study provides reference ranges for this population to assess HIV disease progression and treatment responses.
Risk of hiv infection among men aged 50 to 75 years using erectile dysfunctio...Alexander Decker
This study examined the risk of HIV infection among men aged 50 to 75 years who use erectile dysfunction drugs (EDDs) in Kenya. A case-control study was conducted of 137 HIV-positive men (cases) and 137 HIV-negative men (controls). The study found that a higher percentage of cases than controls reported using EDDs. However, after adjusting for other risk factors like having multiple sexual partners or a history of STDs, EDD use was not a significant independent risk factor for HIV infection. Multiple sexual partners, a history of STDs, and alcohol use were identified as independent risk factors for HIV in this population. The study suggests that while EDD use may be associated with HIV risk, other behavioral
This study examined predictors of loss to follow up (LTFU) in patients receiving antiretroviral therapy (ART) in Ethiopia. The study included 2133 HIV patients who initiated ART between 2005-2013 at a hospital in Ethiopia. 26.7% of patients were lost to follow up, defined as not returning for a refill for at least 3 months. Patients who had regimen substitutions, were adolescents, lacked isoniazid prophylaxis, or had low baseline CD4 counts (<200 cells/mm3) were at higher risk of LTFU. Patients with more advanced clinical stages at initiation were less likely to be lost to follow up. The cumulative incidence of LTFU was 8.
Socio-demographic Characteristics of Clients Visiting Integrated Counseling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India-Human immunodeficiency virus (HIV) infection is a global pandemic and India counts for 10% of the global HIV burden and 65% of that in the South and South-East Asia. This study of clients of ICTC was carried out to know the association of HIV positivity with socio-demographic variables. Total 2412 clients have visited at ICTC of SMS Medical College, Jaipur, either voluntarily or referred by various department of this institute in ICTC in 1st quarter of 2009. They Overall HIV positivity was found 12.35% with a significant difference in voluntary and referred clients i.e. 83.59% v/s 8.36%. It was also found that HIV positivity is more in reproductive age group than extremes of ages, more in females than males, more in person who were married but presently single because of separation of spouse, divorce form spouse or death of spouse than the unmarried or married living with their spouses.
People Living with Human Immunodeficiency Virus in Hadhramout: Clinical Prese...asclepiuspdfs
The objective of the study was to determine the clinical features and outcome of patients living with human immunodeficiency virus (HIV) in Hadhramout and nearby governorates. Materials and Methods: This descriptive study was conducted in the antiretroviral therapy (ART) site at Ibn-Sina General Hospital, Mukalla, Hadhramout governorate. All 145 patients were enrolled in HIV treatment and care program from December 2008 to the end of December 2016 with confirmed HIV test. Data included all personal data, clinical staging, drugs taken, and outcomes. Patients were grouped according to the decades to five groups, ≤15 years, 16–30 years, 31–50 years, 51–70 years, and >70 years. Cases classify according to the antiretroviral drugs to ART group and Pre-ART group. The relevant data parameters were analyzed using SPSS statistical software version 21 and Excel 10. Results: A total of 145 cases, most adults (97.9%), males and females were104 (71.7%) and 41 (28.3%), respectively. Mean age was 36.46 years and 30–50 years the most affected age group (55.2%). Clinical Stages 3 and 4 were the common presentation in 73.8%, and most cases were from Mukalla city. Of the total cases, 74.5% were on ART 53.1 of them improved, pulmonary tuberculosis was found in 4 cases, and death cases were (18.5%), mostly due to late presentation and non-adherence, and mostly occurred in early 6 months of starting the ART. 37 patients were in a pre-treatment group (21.6%), where the mortality rate is 35.1%, mainly due to loss of follow-up. Conclusions: Most cases were adult males, young age and have had late presentation, where mortality is higher in the pre-treatment group due to loss of follow-up and in early 6 months of treatment.
This study analyzed data from over 18,000 pregnant women tested for HIV between 2005-2012 at a hospital in southern Odisha, India. The overall HIV prevalence was 0.66%, declining from 1.53% in 2006 to 0.34% in 2012. Most HIV-positive women were aged 25-29, married, from rural areas with low education/socioeconomic status. The declining prevalence suggests prevention campaigns promoting condom use and safe sexual behaviors are having a positive impact.
Tarannum Yasmin1*, Krishan Nandan2
1Associate Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
2Assistant Professor, Department of Microbiology, Katihar Medical College Katihar, Bihar, India
*Address for Correspondence: Dr Tarannum Yasmin, Associate Professor, Department of Microbiology, Katihar
Medical College, Katihar, Bihar, India
Received: 15 September 2016/Revised: 03 October 2016/Accepted: 22 October 2016
ABSTRACT- INTRODUCTION- HIV/AIDS pandemic is responsible for the resurgence of Tuberculosis worldwide,
resulting in increased morbidity and mortality. Co-infection with HIV infection leads to difficulty in both the diagnosis
and treatment of Tuberculosis, increased risk of death, treatment failure and relapse.
OBJECTIVE- The present study highlights the correlation of Pulmonary Tuberculosis in HIV positive cases and its
association with CD4 count.
MATERIAL & METHODS- A total of 72 known case of HIV were screened for tuberculosis infection by clinical
examination, radiology & ZN staining.
RESULTS AND CONCLUSIONS- From our study 60 (83.33%) were diagnosed as tuberculosis and 12 (16.67%) were
negative. More common HIV infection in case of male 48 (66.67%). Out of 60 tuberculosis infection 53 (88.33%) were
diagnosed as Pulmonary Tuberculosis and 7 (11.67%) were diagnosed as Extrapulmonary Tuberculosis. The result of
study emphasizes that co-infection of tuberculosis in HIV/AIDS patient is a concern. There is direct correlation between
CD4 counts depletion and Pulmonary Tuberculosis in HIV/AIDS patients.
Key-words- Pulmonary Tuberculosis, HIV, AIDS, CD4 count
Adherence to Antiretroviral Therapy among HIVPositive Patients in Central Hos...Efe Clement Abel
Abstract: Adherence is the quantified level to which an individual follows a prescribed treatment and a low level of adherence to antiretroviral therapy(ART) adversely affects a patient’s treatment outcome and results in a rebound of plasma viraemia, development of resistant strains of HIV, more rapid immune deterioration, development of AIDS and death. This study is aimed at assessing the level of adherence to ART among HIV-positive patients assessing care in Central Hospital, Warri, Delta State, Nigeria. A descriptive cross-sectional study. Data were obtained using a semi-structured, interviewer-administered questionnaire and analysed using SPSS version 23. A total of 303 persons were recruited for the study. The mean age of respondents was 36.2±10.8years. Less than half of the subjects (45.5%) were adherent to their ART. Among the non-adherent subjects, the common reasons reported for missing doses of ART were forgetfulness (50.9%), too busy with other things (43.6%) and away from home (35.8%). This study showed that adherence to ART among the study population was poor. Forgetfulness, too busy with other things and being away from home were the most common reason for non-adherence. It is, therefore, recommended that; regular health education should be organised for HIV patients on ART on the importance of being adherent to their ART, regular assessment of adherence to ART should be carried out and a method of reminding patients who are non-adherent to ART on the need to take their ART as at when due should be considered as part of the routine services provided by ART centres.
This document summarizes a longitudinal study examining the effects of antiretroviral therapy (ART) on CD4 count and body weight in HIV/AIDS patients in Ethiopia. The study analyzed data from 536 patients over 4 years who were receiving ART. Descriptive statistics showed that mean CD4 count increased over time on ART until peaking at time point 6, while mean body weight fluctuated with a maximum at time point 6 as well. The study concluded that ART had positive effects on both CD4 count and body weight outcomes over time for HIV/AIDS patients.
A study was conducted on HIV counseling and testing clients at an integrated counseling and testing center in a tertiary hospital in Odisha, India between 2009-2012. Of the 22,897 clients tested, 1732 (7.5%) tested positive for HIV. Most of the HIV-positive clients were males between 15-49 years old. Client-initiated testing identified more HIV-positive clients than provider-initiated testing. The majority of HIV transmission was found to be through heterosexual contact. There was a need found to increase HIV counseling and testing activities to diagnose more cases of HIV infection.
This study assessed antiretroviral treatment failure and associated risk factors among HIV patients in Sekota, northeast Ethiopia. The researchers conducted a cross-sectional study of 295 patients on first-line antiretroviral treatment. They found that 16.6% experienced virological failure and 6.1% experienced immunological failure. Poor adherence, CD4 count below 500 cells/μL, and duration of ART between 6-24 months were associated with virological failure. Poor adherence and drug interruption were associated with immunological failure. The study highlights the need for more efforts to address risk factors and maximize viral load testing to monitor treatment failures.
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv...CrimsonpublishersCJMI
Comparison of Ultrabio HIV DNA PCR and Gag Real-Time PCR Assays for Total Hiv-1 DNA Quantification by Tuofu Zhu in Cohesive Journal of Microbiology & Infectious Disease
This study examined the HIV/AIDS-related knowledge and attitudes of engineering college students in Lucknow, India. A questionnaire was administered to 192 students to gather information. The results found that most students had some basic knowledge about HIV transmission routes, though some misconceptions remained. While most students said they would support friends with HIV, nearly half were unwilling to have HIV-positive friends. The study concluded that youth are central to India's HIV epidemic and that comprehensive sex education programs for students delivered by trained teachers are needed.
Vohra P, Belkhode V, Nimonkar S, Potdar S, Bhanot R, Izna, Tiwari RVC. Evaluation and diagnostic usefulness of saliva for detection of HIV antibodies: A cross-sectional study. J Family Med Prim Care. 2020 May;9(5):2437-2441. doi: 10.4103/jfmpc.jfmpc_138_20. eCollection 2020 May. PubMed PMID: 32754516; PubMed Central PMCID: PMC7380795
1) The study aimed to evaluate saliva as an alternative to blood for detecting HIV antibodies using ELISA tests.
2) Saliva and blood samples were collected from 100 confirmed HIV-positive patients and 100 healthy controls.
3) ELISA tests found HIV antibodies in 99% of saliva samples and 100% of blood samples from HIV-positive patients. The tests found no HIV antibodies in samples from healthy controls, showing the tests to be 100% specific for blood and 99% specific for saliva.
The UC San Diego AntiViral Research Center sponsors weekly presentations on infectious diseases research and clinical practices. A presentation on whether widespread HIV treatment can end transmission discussed recent trends showing HIV declining among adolescents and young adults in the US. The presentation reviewed research showing that early HIV treatment dramatically reduces heterosexual transmission but some transmission may still occur through anal sex among men who have sex with men on antiretroviral therapy. Future interventions could focus on optimizing HIV treatment, comparing antiretroviral regimens, and suppressing coinfections like CMV to further reduce HIV transmission.
This case report describes an unusual case of pseudo-ankylosis in an 8-year-old child with a history of trauma. Imaging revealed an old fractured right condyle that had been anteriorly displaced and dislocated into the sigmoid notch, where it had fused to the zygomatic arch. Computed tomography with 3D reconstruction clearly showed the displaced condylar fragment. The child underwent surgery to release the ankylotic mass and perform a coronoidectomy to improve mouth opening. Post-operatively, aggressive physiotherapy helped increase the child's maximum interincisal opening. This unique case highlights the importance of accurate imaging and diagnosis for successful treatment of complex facial injuries.
This document provides information about the editors and contributors of the book "Oral and Maxillofacial Surgery for the Clinician". It begins with an introduction by the editors explaining the motivation and scope of the book. It aims to be a comprehensive textbook on oral and maxillofacial surgery for clinicians and trainees. The book has contributions from AOMSI members in India as well as 41 international authors to represent global expertise. It contains 22 sections and 88 chapters covering all aspects of cranio-maxillofacial surgery, along with 68 video demonstrations. The editors thank the contributors and AOMSI for their support in producing this open access textbook.
Here are the key points about suction:
- The objective of suction is to maintain a clear airway by removing secretions like saliva, blood or vomit from the mouth or surgical site.
- It prevents aspiration which can lead to infections. Suction also helps surgeons see clearly during procedures.
- Safety considerations include using proper technique to avoid injury, knowing which patients are at risk of aspiration, monitoring for respiratory distress, and addressing other potential causes of distress beyond just secretions.
This document provides an introduction to mixed dentition space analysis. It discusses that during the mixed dentition period, there may be discrepancies between the space available in the dental arches and the size of the teeth. Accurate mixed dentition space analysis is important for orthodontic diagnosis and treatment planning. The document outlines that mixed dentition typically lasts from ages 6 to 12 years and is when maximum orthodontic problems can develop due to inadequate space for permanent teeth. It also categorizes different methods for mixed dentition space analysis, including those based on regression equations using measurements of erupted permanent teeth and those using radiographs.
This study compared the antifungal efficacy of various endodontic irrigants, with and without the antifungal agent clotrimazole, against Candida albicans in extracted human teeth. Teeth were inoculated with C. albicans and irrigated with sodium hypochlorite, chlorhexidine gluconate, doxycycline hydrochloride, or combinations of these with 1% clotrimazole. Colony forming units were significantly lower for sodium hypochlorite and chlorhexidine alone compared to doxycycline or the control. Adding clotrimazole increased the efficacy of all irrigants, with sodium hypochlorite with clotrimaz
This document discusses the importance of adult immunization and provides guidelines for vaccination against various diseases. It begins by noting that while childhood immunization is well-known, adult immunization is less understood but still important. It then reviews literature on vaccination protocols for adults, including for travel, communicable diseases, hepatitis B, shingles, and more. The document focuses in depth on recommended vaccination for human papillomavirus (HPV), hepatitis, and human immunodeficiency virus (HIV). It provides vaccination schedules, target groups, and notes the need to increase awareness of adult immunization among healthcare professionals and the public.
Mathew P, Kattimani VS, Tiwari RV, Iqbal MS, Tabassum A, Syed KG. New Classification System for Cleft Alveolus: A Computed Tomography-based Appraisal. J Contemp Dent Pract. 2020 Aug 1;21(8):942-948. PubMed PMID: 33568619
Sahu S, Patley A, Kharsan V, Madan RS, Manjula V, Tiwari RVC. Comparative evaluation of efficacy and latency of twin mix vs 2% lignocaine HCL with 1:80000 epinephrine in surgical removal of impacted mandibular third molar. J Family Med Prim Care. 2020 Feb;9(2):904-908. doi: 10.4103/jfmpc.jfmpc_998_19. eCollection 2020 Feb. PubMed PMID: 32318443; PubMed Central PMCID: PMC7113948.
- The document discusses animal models that are being used to test vaccines for COVID-19. It conducted a systematic review of studies published between January and August 2020.
- The review identified 20 relevant studies examining nonhuman primates, mice, hamsters, ferrets, cats and dogs. These animal models show some similar responses to SARS-CoV-2 infection as humans such as respiratory symptoms.
- However, the models do not fully mimic the severe complications seen in human COVID-19 patients such as acute respiratory distress syndrome and coagulopathy. While the models provide useful information, they have limitations in replicating the full disease severity in humans.
This study aimed to evaluate the knowledge and concerns of 124 dental health professionals in southern India regarding COVID-19. A survey was administered to assess understanding of COVID-19 transmission, oral manifestations, appropriate testing and emergency procedures. The results found good knowledge of COVID-19 and precautions, but some lack of awareness regarding appropriate testing and managing contaminated air. While most respondents understood transmission risks and emergency protocols, there was uncertainty around testing patients and using mouthwashes as prevention. This highlights gaps in knowledge that could be addressed with further education for dental professionals on COVID-19 clinical guidelines.
A 34-year-old male presented with pain and pus discharge from a recently extracted tooth. Radiographs showed two distinct radiolucencies - a large cyst in the left mandible and a smaller cyst in the right mandible. Histological examination found the left cyst to be a radicular cyst and the right cyst to be a dentigerous cyst. This presented a diagnostic dilemma as it is uncommon to have multiple cyst types occurring bilaterally in the mandible without an associated syndrome. Careful radiographic and histological analysis was needed to arrive at the accurate diagnosis and appropriate treatment.
Mittal S, Hussain SA, Tiwari RVC, Poovathingal AB, Priya BP, Bhanot R, Tiwari H. Extensive pelvic and abdominal lymphadenopathy with hepatosplenomegaly treated with radiotherapy-A case report. J Family Med Prim Care. 2020 Feb;9(2):1215-1218. doi: 10.4103/jfmpc.jfmpc_1125_19. eCollection 2020 Feb. PubMed PMID: 32318498; PubMed Central PMCID: PMC7113973.
36.Kesharwani P, Hussain SA, Sharma N, Karpathak S, Bhanot R, Kothari S, Tiwari RVC. Massive radicular cyst involving multiple teeth in pediatric mandible- A case report. J Family Med Prim Care. 2020 Feb;9(2):1253-1256. doi: 10.4103/jfmpc.jfmpc_1059_19. eCollection 2020 Feb. PubMed PMID: 32318508; PubMed Central PMCID: PMC7113959.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
The droplets have a tendency to conglomerate to one big mass, but on being shaken they fall apart into countless little droplets again. It is used to ignite explosives, like mercury fulminate, the explosive character is one of its general themes.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
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Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
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2. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2432 Volume 9 : Issue 5 : May 2020
therapy (ART). Therefore, HIV infection is still a major health
concern in India.[2]
HIV is a retrovirus which affects the human
immune system. This virus hinders the body’s defense mechanism
by depletion of cluster of differentiation 4 (CD4) cells.[3]
When
newly produced CD4+ cells cannot replace the destroyed ones, it
results in shutting down of the immune system leading to AIDS.
As a result of the immunosuppression, people living with AIDS
become susceptible to systemic opportunistic infections and
malignancies. However, oral lesions are generally the primary sign
of HIV/AIDS infections. These oral lesion plays an important
in diagnosis as well as the prognosis of the disease because the
severity of the oral lesions correlates with the decrease in the
number of CD4+ cells count.[4,5]
Many studies have shown
discrepancies among these oral manifestations according to
development status and continents. It can be explained by the
disparity in health care system, availability of ART, transmission
route, gender, HIV stage, and deleterious habits. These specific
oral and systemic manifestations are widely documented as well
as correlated with CD4+ cells count in both developed and
developing countries.[6]
But, in certain parts of the developing
nations like India, the data is either negligible or none. Hence, we
conducted this cross‑sectional study among the newly diagnosed
HIV seropositive patients in Gujarat (western India). The goal
of the study was to evaluate the correlation between CD4+ cells
count with orofacial and systemic manifestations.
Materials and Methods
Hundred (100; 57 males and 43 females) newly diagnosed
HIV seropositive patients before starting ART were included
into this cross‑sectional study after the approval of institute
research ethical committee SUVEC/ON/20/2007 (dated
20‑08‑2007) along with approval taken from NACO to conduct
the study. Written informed consents were taken from all the
participants in their regional language. The patients were selected
from Outpatient Department of Infectious Disease (Dheeraj
General Hospital, Vadodara), Department of Oral Medicine and
Radiology (K. M. Shah Dental College and Hospital, Vadodara),
and NGOs (Non‑Governmental organizations) working for
HIV positive individuals in Vadodara. Participants were excluded
who were already started ART and who did not give informed
consent. The personal and medical history along with the
findings of Oral examination and Investigations were recorded
in the performa specially designed for this study. Patients
according to CD4+ cells count were clustered into three groups:
Group A: 0–200 cells/mm3
, Group B: 201–499 cells/mm3
,
and Group C: 500 cells/mm3
. A single examiner trained in
oral diagnosis examined and recorded all oral lesions. These
lesions were diagnosed according to presumptive criteria of
EEC Clearinghouse Classification.[7]
Statistical analysis was done
using SPSS (Statistical Package for Social Sciences) version 21.
Independent t‑test was used to find a correlation between CD4
cells count of males and females. Chi‑square test was used to
find a correlation between the systemic manifestations and
CD4+ cells count in different groups. It was also used to find
a correlation between the oral manifestations and CD4+ cells
count categories.
Results
The study group consisted of a total 100 HIV seropositive,
57 (57%) males and 43 (43%) females. The age range for
study group was from 6 years to 65 years with mean age of
34.14 ± 11.51 years. In study group, out of total 57 males,
40 (70%) were married, 12 (21%) unmarried, 4 (7%) divorced, and
1 (1.75%) widow, whereas out of total 43 females, 25 (58.13%)
were married, 5 (11.6%) unmarried, 2 (4.65%) divorced, and
11 (25.5%) were widows. The most common mode of HIV
transmission was unprotected sexual practices (70%) followed
by blood transfusion (18%), vertical transmission (9%), and
intravenous drug users (3%). In study group, mean CD4 cells
count in males was 253.51 ± 220.773, whereas it was
230.86 ± 153.327 in females. On applying independent t‑test, no
correlation was found between CD4+ cells count of males and
females (P‑value > 0.005). In study group of 100 patients, 55%
patients had CD4+ cells count below 200 (Group C), 34% had
CD4 cells count between 201 and 499 (Group B), and 11% had
CD4 cells count above 500 (Group A). Out of total 55 patients
in group C, 34 (61.8%) and 54 (99%) patients had systemic and
oral manifestations, respectively. In group B, out of 34 patients,
12 patients (35.2%) had systemic and 30 patients (88.2%) had
oral manifestations. Only 2 (18.1%) patients out of 11 had
systemic manifestations in group A with no oral manifestations
as shown in Table 1. On applying Chi‑square test, a significant
correlation (P‑value <0.05) of CD4 cells count was found with
the systemic and oral manifestations among three different
groups. Out of total 57 males, 21 (36.8%) had tuberculosis
followed by 3 (5.2%) cases of herpes zoster, 2 (3.5%) cases of
pneumonia, and 1 (1.75%) case of typhoid, jaundice, and malaria
each. Out of total 43 females, 13 (30.2%) cases had tuberculosis
and 2 (4.6%) cases of pneumonia, anemia, and typhoid each.
The most common systemic manifestation in both genders
was tuberculosis [Table 2]. In the study group of 100 subjects,
17 (20.2%) cases had candidiasis, 14 (16.6%) cases chronic
generalized periodontitis, 9 (10.7%) cases gingivitis, 7 (8.3%) cases
aphthous, 6 (7.1%) cases premalignant lesions and conditions,
Table 1: Gender-wise distribution of systemic and oral manifestations among different groups based on CD4 cells count
Groups CD4 cells count Males Females Total Systemic manifestations Oral manifestations
A >500 7 4 11 02 00
B 200-499 17 17 34 12 30
C <200 33 22 55 34 54
Total 57 43 100 48 74
[Downloaded free from http://www.jfmpc.com on Sunday, May 31, 2020, IP: 183.83.46.254]
3. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2433 Volume 9 : Issue 5 : May 2020
4 (4.7%) cases recurrent aphthous ulceration and angular cheilitis
each, 3 (3.5%) cases erythema multiforme and hairy leukoplakia
each, 2 (2.3%) cases herpes zoster, herpes labialis, and periodontal
abscess each, and remaining others had single lesions like fissured
tongue, mucous patches of secondary syphilis, acute necrotizing
ulcerative periodontitis, linear gingival erythema, molluscum
contagiosum, and oral pemphigus. A brief comparison of oral
manifestations in HIV positive patients in our study and the
previous studies conducted in Asia is shown in Table 3. The most
common oral manifestation in males was found to be candidiasis
12 (21%) and chronic generalized periodontitis in 11 (19.2%)
cases with an average CD4 cells count of 322.46 ± 219.14 and
191.76 ± 120.05,respectively,whereasinfemales,thecommonoral
manifestations were candidiasis and aphthous ulcers in 5 (11.6%)
cases with an average CD4 cells count of 191.76 ± 120.05 and
130.08 ± 77.35, respectively. The most frequently encountered
Table 2. Gender-wise distribution of different systemic
manifestations
Systemic manifestations Male Female Total
Tuberculosis 21 13 34
Pneumonia 02 02 04
Anemia 00 02 02
Jaundice 01 00 01
Typhoid 01 02 03
Herpes 03 00 03
Malaria 01 00 01
Total 29 19 48
Table 3: A brief comparison of oral manifestations in HIV positive patients in our study and previous studies conducted
in Asia
Country
(Region)
Year Study
Sample
size
OC
%
CGP
%
CGG/ LGE
%
Aphthous
%
PMLs
%
AC
%
OHL
%
HZ
%
HSV
%
ANUP
%
ANUG
%
Oral
melanosis
%
Others
India (west) Present
study
100 17 14 10 7 6 4 3 2 2 1 1 10 9
India
(South)
2012 50 36 - - 6 2 18 2 4 - - - 28 -
India 2012 604 32.2 - - 4.4 - - - 3.3 - - - - -
India 2011 399 39.3 - - 2.5 - 4.3 11.5 0.3 2 5.3 8.5 19.5 -
India
(South)
2011 103 44 - - 4.9 - 5.8 17.5 1.9 - 3.9 9.7 35.9 -
India 2011 124 32 - - - - - 4 - - - - 31 -
India 2011 96 - - - 2.7 - 8.2 - 5.5 1.4 8.2 - 8.2 -
India 2010 321 11 17.3 - 4 - 0.6 2.8 - 3.1 - - 1.2 -
India
(South)
2009 200 - - - 5 - 9 18.5 1 2 7 9 33.5 -
India 2009 150 - - - - - - 2.6 - - - - 29.3 -
India
(South)
2007 100 16 - - 1 - 3 1 - - - - 29 -
India
(South)
2006 101 - - - 4.7 - 11.8 15.8 1.9 - 0.9 - 34.6 -
India 2004 1000 23.8 - - - - 7.9 3.3 3.3 0.9 - - 26.3 -
India 2004 410 36 - - 3 - 1 3 - 5 - - 3 -
India 2000 300 56 - - - - 7.7 3 - - - - - -
India 1997 96 81 - - 6 - - - - - - - - -
Thailand 2010 207 - 82 - 3.2 - - 2.5 - - - - 38.2 -
Thailand 2004 237 40 14.5 - 5 - 3.5 29.5 - - 0.5 1.5 - --
Thailand 2001 87 - - - - - 6.9 11.5 - 1 - - - -
Thailand 2001 364 39.6 - - - - 18.3 26.3 - - - - - -
Thailand 1997 41 76 - - - - - 7 - - - - - -
Thailand 1997 214 66 - - - - - 13 - - - - - -
Malaysia 1997 145 35.9 - - - - - 2.8 - - - - - -
Hong Kong 1999 32 - - - 27.4 - - 11 - 4.1 2.7 1.4 1.4 -
Japan 2000 110 15 - - - - - 1.8 - - - - - -
Singapore 2001 35 16 - - - - 5 - - - - - -
Iran 2011 200 22 - - - - - 3 - - 1.5 4 5.5 -
Iran 2010 100 - 44 - - - 17 4 - - - - 42 -
Cambodia 2002 101 - - - - - 12.9 45.5 4 7.9 - 27.7 - -
Georgia 2008 732 64 - - - - - 8 - 7 - - - -
Taiwan 2004 64 71.1 - - - - - 8 - - - - - -
Vietnam 2005 170 37.5 - - - - - 16.1 - - - - - -
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4. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2434 Volume 9 : Issue 5 : May 2020
variant of candidiasis was pseudomembranous candidiasis in
total 9 (52.9%) patients (5 males and 4 females), while 6 (35.2%)
patients (5 males, 1 female) had erythematous candidiasis and
only 2 (11.7%) patients (2 males) had hyperplastic type of
candidiasis [Table 4].
Discussion
Numerous studies had been conducted to find the correlation
of CD4+ cells count with the oral and systemic manifestations
in HIV positive patients. Results of these studies had established
CD4+ cells count as a diagnostic and prognostic marker for
the immunosuppression in these patients.[8‑11]
Oral cavity being
the most dynamic part of the whole body get predispose to
severe infections secondary to immunosuppression resulting
in various HIV associated oral manifestations.[12]
These oral
manifestations not only serve as an early sign of this infection
but also clinically correlates with CD4+ cells count.[13]
Numerous
studies have concluded that oral manifestations are of diagnostic
and prognostic importance.[10,11,13,14]
These oral manifestations
have shown discrepancies depending upon the regional/
geographical variations and over different period of time.[6,15]
Hence, we conducted this cross‑sectional study to evaluate
the correlation between CD4+ cells count with orofacial and
systemic manifestations among HIV seropositive patients in
the third‑largest Metropolis city of western Indian state of
Gujarat. In the present study, there were 57 (57%) males and
43 (43%) females. This male predominance was in accordance
with the findings of Ranganathan et al.[16]
but was in contrast to
the findings of Annapurna et al.,[10]
where female predominance
was present. In our study, there was no significant difference
in the average CD4+ cells count of males and females, which
was in contrast to the findings of the Ranganathan et al.[8]
Our
study reported a significant correlation between the systemic
manifestations and CD4+ cells count categories. There were
29 males and 19 females in which the systemic manifestations
were recorded. Out of 29 males, 21 (72.4%) had tuberculosis
followed by 3 (10.3%) cases of herpes zoster, 2 (6.8%) cases of
pneumonia, and 1 (3.4%) case of typhoid, jaundice, and malaria
each. Out of 19 females, 13 (68.4%) had tuberculosis and
2 (10.5%) cases of pneumonia, anemia, and typhoid each. The
most common systemic manifestation in HIV positive males and
females was tuberculosis (70.4%). This finding was congruent
to the previous studies conducted by Ranganathan et al.[8,16]
Our study also reported a significant correlation between the
oral manifestations and CD4+ cells count categories. The oral
manifestations were seen in 30 (88.2%) and 54 (99%) individuals
in Groups B and C, respectively, whereas no oral manifestations
were noted in Group A. A total of 84 (84%) patients had
oral manifestations. The common oral manifestations
recorded in males were, candidiasis (25%) followed by chronic
generalized periodontitis (22.9%), aphthous stomatitis (16.6%),
gingivitis (10.4%), and premalignant lesions (8.3%). The common
oral manifestations recorded in females were candidiasis (13.8%)
and aphthous stomatitis (13.8%) followed by chronic generalized
periodontitis (8.3%), gingivitis (11.1%), and premalignant
lesions (5.5%). A brief comparison of other oral manifestations
in HIV positive patients in our study and the previous studies
conducted in Asia[15]
is shown in Table 4. Unlike the previous
studies, there was no significant difference was found in the
prevalence of oral lesions in both sexes in our study.[16,17‑21]
The
most common oral manifestation in males and females was
found to be candidiasis (19.4%) with the average CD4 cells count
of 191 ± 120.05 and the most common variant of candidiasis
encountered was pseudomembranous type. These results are
consistent with findings of other investigators who examined
oral lesions and conditions associated with HIV positive
patients.[8,14,18‑26]
Conclusion
In our study, we concluded that the most common cause of HIV
among males was unprotected sexual practices with multiple
partners including commercial sex workers by heterosexual
route and most of women had acquired HIV infection from
their infected spouses. There was no significant difference in
the average CD4+ cells count of males and females. The most
common systemic manifestation of HIV positive patients in both
males and females was tuberculosis. Oral manifestations were
recorded in almost all HIV positive patients with CD4 cells count
below 500. There was equal prevalence of oral manifestations in
both genders. Most common oral manifestation in both males
and females was candidiasis with CD4+ cells count below 200.
Hence, we can conclude that oral manifestations/lesions are
the hallmarks of this infection. It directly reflects the extent
of systemic immunosuppression of the infected individual.
Therefore, oral physician should be capable to diagnose these
lesions and should provide guidance to the patient for the early
diagnosis and treatment of this life‑threatening infection.
Key message: Hence, we can conclude that the oral
manifestations/lesions are the hallmark of HIV infection. It
directly reflects the extent of systemic immunosuppression of
the infected individual. Therefore, oral and general physician
Table 4: Most common oral manifestation in males and females of HIV positive patients
Oral Manifestations Total (n=84) Males (n=48) Females (n=36) Avg CD4 cells Count Std Deviation
Candidiasis 17 12 5 191.76 120.05
Chronic Generalized Periodontitis 14 11 3 322.466 219.14
Aphthous 13 8 5 130.08 77.35
Melanosis 10 5 5 244.7 182.33
Gingivitis 9 5 4 553.4 273.96
Premalignant Lesions 6 4 2 221.857 99.8
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5. Vohra, et al.: CD4 cells as a prognostic marker in HIV patients
Journal of Family Medicine and Primary Care 2435 Volume 9 : Issue 5 : May 2020
should be capable to diagnose these lesions and should provide
guidance to the patient for the early diagnosis and treatment of
this life‑threatening infection which will help the patient. Early
diagnosis of the disease will help in primary care of diagnosed
HIV cases and also if the physician has the slightest suspicion
while screening the oral cavity, they can motivate the patient for
HIV testing and further investigations.
Acknowledgements
We are grateful to Kirpa foundation, Vadodara and Supratech
laboratories Ahmadabad for providing the CD4 cells count
reports.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient
consent forms. In the form, the patients have given their consent
for their images and other clinical information to be reported in
the journal. The patients understand that their names and initials
will not be published and due efforts will be made to conceal
their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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