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Objectives: The objectives of this study were to determine the colonization of the throat and skin among patients of rheumatic heart disease (RHD) or acute rheumatic fever (ARF) and to elucidate the different Lancefield serotypes of streptococci (Group A, Group C, and Group G) among them. Methods: The prospective observational surveillance study was conducted from November 2016 to March 2018 among 161 enrolled family members belonging to 30 families with one of their patients being diagnosed with RHD/ARF. The outcome measures were period prevalence of serotypes of streptococci, streptococcal colonization of throat and skin lesions, and association of age and antibody titers with RHD/ARF. Results: Out of 30 families enrolled in our study, positive throat (n = 18)/skin (n = 1) cultures were found in 7 families (n = 19). The cultures were positive only for Group A streptococci (GAS), while none of the samples showed positivity for Group C or G serotypes. Overall period prevalence for our study period was 3.2%. Among the 18 members positive for GAS throat culture, 13 (72.2%) belonged to the age group 0.05). Conclusion: In conclusion, we found only GAS colonization in significantly higher proportion among the family members of cases of ARF in comparison to RHD. Rather there was no case of Group C and G streptococci colonization in cases or family members of RHD/ARF.

Background: Enteric fever is a major public health problem; the burden of disease worldwide is approximately 11.9–26.9 million cases and 129,000–217,000 deaths each year. The burden of disease in India is approximately 6 million per year. Enteric fever is caused by Gram-negative bacteria Salmonella typhi or Salmonella paratyphi A, B or C, which is a bloodstream infection. The re-emergence of susceptibility of old antibiotics such as ampicillin, co-trimoxazole, and chloramphenicol in S. typhi has been observed. Aims: The objective of the study was to study the antibiotic sensitivity pattern of S. typhi, S. paratyphi A and S. paratyphi B and also the clinical and laboratory profile of enteric fever with respect to blood counts, liver function tests and typhoid serology in adult patients with enteric fever. Materials and Methods: The study was conducted in the Department of Internal Medicine and Microbiology at Sir Ganga Ram Hospital in 76 adult patients of blood culture-positive enteric fever. Clinical and laboratory profile of patients was recorded. Antibiotic sensitivity patterns were studied in all cases and the prevalence of multidrug-resistant strains, if the present was established. Results: The mean age in this study was 31.46 + 11.29 years. There were 46 male patients and 30 female patients. Fever was present amongst all patients (100%). Myalgia/headache was present amongst the majority of patients (98.7%). Pain in the abdomen (57.9%) was present. Leucopenia and leucocytosis were present in 25% and 2.6% of patients, respectively. Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase were abnormal amongst 36.8% and 38.2% of patients, respectively. Complications, such as ileal perforation and gastrointestinal (GI) bleed, were not seen in the patients of enteric fever in this study. Typhidot IgM was positive in 50% of patients. S. typhi (blood culture) was amongst more than half of the patients (69.7%) and S. paratyphi A was 30.3%. Ampicillin was resistant to 5.3% and chloramphenicol and cotrimoxazole each were resistant to 2.6%. Levofloxacin was resistant to 38.2%. Ceftriaxone, azithromycin and cefixime were sensitive to 100%. Multidrug resistance (resistance to ampicillin, chloramphenicol and cotrimoxazole) was seen in 2.6% of cases, which was associated with S. typhi. There was no multidrug resistant (MDR) strain seen with S. paratyphi A. Conclusions: This study showed that fever, myalgia/headache, pain in the abdomen, nausea/vomiting and diarrhoea were the common clinical manifestations of enteric fever. Other important conclusions were low percentages of comorbidities, low occurrence of leucocytosis, high typhidot IgM positivity, low MDR and most of the drugs were 100% sensitive. Ileal perforation and GI bleeding were not found in any case of enteric fever in this study.

Context: Clinical study for immunity. Aims: The present study aimed to assess the effect of proprietary polyherbal formulation (PPHF), labelled as Kofol immunity tablets (KIT) on innate and adaptive immune responses in healthy individuals, on the backdrop of COVID-19 pandemic. Settings and Design: Single-blind, randomized, placebo-controlled, exploratory study in institutional setting. Materials and Methods: Post Ethics Committee permission, screened healthy individuals of either sex aged 18–35 years were randomized to PPHF/Placebo for 2 months. Major assessment variables included peak expiratory flow rate (PEFR), questionnaire-based immune status, perceived stress, and quality of life (QOL) with immune-specific cell counts (CD4+, CD8+), cytokines (interferon gamma [IFN-γ], tumor necrosis factor-alpha [TNF-α], interleukin 10 [IL-10]), and oxidative stress in red blood cells (RBCs) (malondialdehyde (MDA), glutathione peroxidase [GPx]), done at day 60. Statistical Analysis Used: Mean ± standard deviation and paired/unpaired t-test for parametric data analysis while median (range) and Wilcoxon Rank sum test/Mann–Whitney test for nonparametric data analysis, were done. Categorical data was analyzed using Chi-square test. GraphPad InStat software, version 9 was used with p < 0.05, as the level of statistical significance. Results: Of 52 recruited, 28 individuals completed the study. PPHF significantly increased PEFR, improved immune status along with QOL compared to baseline. It also decreased perceived stress from moderate and severe grade to mild. Serum IFN-γ levels remained almost constant post-PPHF treatment. PPHF significantly decreased MDA and increased GPx in RBCs. Significant decrease and increase in TNF-α and IL-10, respectively, were seen in PPHF group. The safety parameters post-PPHF treatment remained within normal reference ranges. Conclusions: PPHF is an efficacious and safe formulation with immunomodulatory potential.

This case report describes the endodontic management of bilateral mandibular canines with unusual root canal anatomy in a patient. The right mandibular canine had two separate roots (buccal and lingual), each root having a single canal. The left mandibular molar had two separate canals coronally joining into a single canal in the apical 3 rd (Vertucci Type II). While the presence of two roots and two canals in one root is not uncommon, finding a combination of these morphological variations in the same patient has not been reported previously. This emphasizes the perception of the clinician that a given tooth will contain a specific number of roots and/or root canals canal should be changed, and such variations should be kept in mind during the endodontic treatment of permanent mandibular canines.

Chest wall and cheek swelling are rare sites of involvement by lymphoma. We hereby present two such cases with atypical presentations. Case 1: A 48-year-old male patient presented with a painful swelling over right cheek, which was clinically and radiologically suspected to be cellulitis and thus, incised and drained. Later patient presented to our hospital and fine-needle aspiration (FNA) was performed, which revealed cytological features consistent with non-Hodgkin′s lymphoma. Case 2: A 30-year-old female patient presented with right anterior chest wall swelling, which was clinically diagnosed as cold abscess. However, FNA revealed cytological features consistent with Hodgkin′s lymphoma. Both cases being reported were thought to be of infective etiology, which were however, diagnosed as lymphoma on FNA and thus led to a different management plan.

A thorough knowledge of root canal anatomy is essential for the endodontic therapy.Aberrations in the root canal system, especially in multirooted teeth, can pose a considerable challenge to the endodontist during root canal treatment. The dentist should be familiar with various root canal configurations and their variations for successful endodontic therapy. It is important to evaluate each individual case for variations.There are rare variations in root canal number and configuration in maxillary molars, which could affect treatment outcome. The present case report presents the endodontic management of a maxillary first molar with a variant root canal anatomy, having five root canals, with mesiobuccal root havingtwocanals (Vertucci type II), distobuccal root having onecanal and the palatal root having twocanals (Vertucci type II). The variant root canal anatomywas confirmed using a spiral computed tomography (SCT).With 3D reconstruction of the SCT image of the tooth, it was possible to scrutinize the patency of the canal lumens, throughout the entire length of the palatal root.This case report highlights the value of a SCT scan as a supplement to plain radiographs for the accurate diagnosis and successful endodontic management of a complex morphological variation in root canals.It also serves to remind the clinicians that such anatomic variations should be kept in mind during the endodontic treatment of maxillary first molars.

The absence of a natural apical constriction in a nonvital young permanent tooth makes endodontic treatment a challenge. There is a need to induce or create an apical barrier against, which the obturating material can be condensed. Traditionally, calcium hydroxide is the material of choice to induce apexification. Due to certain drawbacks such as prolonged treatment duration and unpredictable apical barrier formation, it is being replaced by materials, which have a more predictable outcome like mineral trioxide aggregate (MTA). One-step apexification with MTA reduces the treatment time when compared with traditional calcium hydroxide apexification, which requires an average time of 12-19 months. In one-step apexification using MTA, the technical problem encountered is controlling the overfill or underfill of MTA. The use of a matrix material helps to overcome this shortcoming. Platelet rich fibrin (PRF) is an immune platelet concentrate, which can be used as a matrix, it also promotes wound healing and repair. This case report presents a case of one step apexification using MTA as an apical barrier and autologous PRF as an internal matrix.