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A little over century after the 1918 influenza pandemic, the world is witnessing another pandemic of similar magnitude, caused by SARS-CoV-2 and affecting nearly 215 countries. Although SARS-CoV-2 primarily affects the lungs, neurological presentations are being recognised with increasing frequency. Recently, Ellul and colleagues1 have elaborated a spectrum of neurological diseases in 901 patients of COVID-19. Here, we describe three case series of brain autopsies2–4 that have revealed distinctly different pathologies, failing to explain the common pathobiological mechanism of central nervous system (CNS) involvement in severe COVID-19. Solomon et al 2 reported histopathological changes in autopsies of 18 patients with COVID-19 from a teaching hospital. Gross inspection showed no changes suggestive of acute stroke, herniation or olfactory bulb damage. Microscopic examination revealed changes of acute hypoxia in the cerebrum and cerebellum in 100% of patients with COVID-19, with neuronal loss in various structures like cerebral cortex, hippocampus and cerebellar Purkinje cell layer. There were no findings of thrombosis or vasculitis. Focal …

ObjectivesConvalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19.DesignOpen-label, parallel-arm, phase II, multicentre, randomized controlled trial.SettingThirty-nine public and private hospitals across India.ParticipantsHospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 ≤ 93% on room air).InterventionParticipants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm.Main Outcome MeasureComposite of progression to severe disease (PaO2/FiO2< 100) or all-cause mortality at 28 days post-enrolment.ResultsBetween 22ndApril to 14thJuly 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: −0.61 to 1.83].InterpretationCP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19.Trial registrationThe trial was registered with Clinical Trial Registry of India (CTRI); CTRI/2020/04/024775.

The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance and for determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for detection of SARS-CoV-2, with an additional advantage of enabling genetic epidemiology of SARS-CoV-2.

Since the outbreak of coronavirus disease-19 research has been continued to explore multiple facets of the disease. The objective of the present study is to evaluate the relationship between blood group phenotypes and COVID-19 susceptibility. In this hospital based, retrospective observational study 132 COVID-19 patients were enrolled from SMS Medical College and attached Hospitals, Jaipur, India after the proper approval from the institutional ethics committee. The ABO, Rh and Kell blood group phenotypes and demographic data of the patients were recorded. The observed proportions of ‘A’ , ‘B’, ‘AB’, ‘O’, ‘Rh’, and ‘Kell’ blood groups phenotypes in COVID-19 patients were compared against the expected proportions (our null hypothesis) of the general population using multinomial tests and partition analysis. There were significant differences between observed and expected frequency in ABO and Kell blood group phenotypes. Further partition analysis of ABO blood phenotypes showed that the group ‘A’ phenotypes were more susceptible for COVID-19. The Kell negatives were also more susceptible. The blood groups ‘AB’, ‘B’, ‘O’, and ‘Rh’ phenotypes showed no significantly different susceptibility for COVID-19. The study shows relationship between ABO, Rh, and Kell blood group phenotypes and COVID-19 susceptibility. The application of these relationship in clinical practice requires more exploratory studies. The following core competencies are addressed in this article: Screening Tool, Epidemiology, Patient Management, Medical Research.

The forecasting of Coronavirus Disease-19 (COVID-19) dynamics is a centerpiece in evidence based disease management. Numerous approaches that use mathematical modeling have been used to predict the outcome of the pandemic, including data driven models, empirical and hybrid models. This study was aimed at prediction COVID-19 evolution in India using a model based on autoregressive integrated moving average (ARIMA). Retrieving real time data from the Johns Hopkins dashboard from 11 Mar 2020 to 25 Jun 2020 (N = 107 time points) to fit the model. The ARIMA (1,3,2) and ARIMA (3,3,1) model fit best for cumulative cases and deaths respectively with minimum Akaike Informaton Criteria. The prediction of cumulative cases and deaths for next 10 days from 26 Jun 2020 to 05 Jul 2020 showed a trend toward continuous increment. The predicted root mean square error (PredRMSE) and base root mean square error (BaseRMSE) of ARIMA(1,3,2) model was 21137 and 166330 respectively. Similarly, PredRMSE and BaseRMSE of ARIMA(3,3,1) model was 668.7 and 5431 respectively. We propose that data on COVID-19 be collected continuously, and that forecasting continue in real time. The COVID-19 forecast assist government in resource optimization and evidence based decision making for a subsequent state of affairs.

The present study was undertaken to investigate epidemiological distribution, clinical manifestation, co morbid status, treatment strategy and case fatality index of emerging COVID-19 infection at SMS Medical College Hospital, Jaipur, Rajasthan. It also evaluated efficacy of hydroxychloroquine (HCQ) in treatment of patients and risk of serious adverse outcomes in patients with COVID-19 in relation to their co morbid status.In an attempt to provide extensive information pertaining to epidemiological and clinical characteristics of COVID-19, the present study was undertaken on 522 patients. The patients were COVID-19 confirmed positive by genomic analysis through Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) at SMS Medical College and Attached Hospitals, Jaipur. The indoor admitted patient's information inclusive of demographic profile (age, sex, nationality, residence), date of confirmation for positive COVID-19 case, travel/ exposure history, date of recovery/ death, clinical features, co morbidities and treatment plan was recorded. A serial follow-up of recovered patients to evaluate infective period of the disease was also part of the study.A total of 522 patients of laboratory confirmed COVID-19 test by RT-PCR at SMS Hospitals, Jaipur were assessed. Among the confirmed cases, most of patients were young adult in the age group with mean age of 35.42 years. 22.41% patients were below 20 years of age, majority of patients (58.80%) were in the age range of 21 to 50 years and only 18.79% patient population was in the age range of above 50 years. Females (39.08%) were affected less than males (60.91%) with an average sex ratio of female: male being 0.64. Out of the total analyzed patients, only 24.32% patients were symptomatic, among them fever (55.90%), cough (52.75%), sore throat (49.60%) and shortness of breath (46.45%) were the most common presenting clinical manifestations while a few patients also had symptoms of headache (26.77%), chest pain (6.29%) and other symptoms (7.87%) like pain abdomen, fatigue, joints pain, altered sensorium etc. Most of symptomatic patients belonging to older age group. An average of 40.40% patient population of above 50 years of age, were symptomatic while none of the patients below 10 years of age were symptomatic. 13.98% patients had some or the other underlying co morbid disease. The most prevalent co morbidity was hypertension (42.46%) followed by Diabetes mellitus (39.72%), Old k-chest (20.54%), COPD/ Bronchial Asthma (16.43%), Coronary artery disease (13.69%), Chronic kidney disease (13.69%) and Valvular heart disease (6.84%) distributed in co morbid patients of COVID-19. 60.27% of patient population with underlying co morbid conditions were more prone to develop symptomatology complex as compared to that observed in patients with no co morbidity (18.42%). 116 patients had recovered with effective treatment till the date of data analysis. Time of recovery was counted from the date of positive report to 1st negative report of oropharyngeal sample by RT-PCR for COVID-19 with an average recovery time of 8.15 days. 23.27% patients recovered within 5 days, while 52.58% patients took about 6-10 days, 23.27% patients took 11-15 days and remaining 0.86% took more than 16 days to recover. In the present study 15 patients had died till analysis of data, among the deceased, 73.33% were above 50 year of age with a male preponderance (66.6%). Interestingly, all deceased (100%) had presented with clinical manifestations of COVID-19 and all had underlying multiple co morbid conditions. Majority of patients had early mortality after admission to hospital with two third death account in initial three days. Asymptomatic patients (cases) treated with HCQ recovered early (average recovery time =5.4 days) compared to asymptomatic patients who did not receive any treatment (control group) and had longer recovery time (average recovery time =7.6 days).The varied spectra of COVID-19 mostly affects young adult age group (third to fifth decades of life). Interestingly, early age group was also affected in significant proportion when compared with similar data from other countries. It was observed that male population seemed to be was more prone to getting infected. Majority of COVID-19 positive patients (nearly three-fourth) were asymptomatic (mostly in young age range) at the time of diagnosis, which poses a major challenge for health care workers. Fever, cough, sore throat and shortness of breath were major symptoms that could be detected in such COVID-19 patients. Symptomatic clinical manifestations were more common in old age population. Infectivity was higher in patients that had underlying co morbid disease, especially in patients with multiple co morbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease. Average recovery time from COVID-19 was 8 days with effective treatment. Mortality in COVID-19 was higher in old age population, male gender, symptomatic and co morbid patients as compared to other similarly matched group. Most of mortality was noted within first few days of admission, suggestive of early mortality due to the primary disease process. Treatment with HCQ had early recovery without effectively influencing the overall mortality.

The novel coronavirus (Covid-19) continues to wreck havoc across China, European countries, USA and now seems to gain a strong foothold in India. The aim of this report is to describe the clinical profiles of these Covid-19 infected patients admitted in Sawai Mansingh Hospital(S.M.S), Jaipur ranging from their age, sex, travel history, clinical symptoms, laboratory evaluation, radiological characteristics, treatment provided along with common side effects and the final outcome. The described cases are one of the earliest cases of Covid-19 in the Indian subcontinent.Epidemiological, clinical, laboratory, and radiological characteristics and treatment and outcomes data were obtained with data collection forms from electronic medical records and history given by 21 Covid-19 infected patients admitted in S.M.S., Jaipur. Patients were tested for Covid-19 by real-time reverse transcription polymerase chain reaction (RT-PCR) assay of 2019-nCoVRNA.During the course of this study 21 Covid-19 positive patients were admitted in S.M.S Hospital, Jaipur. Male patients constituted 66.66% of total patients and majority of the patients (80.90%) were below 60 years of age. Most of the patients (71.40%) were either foreigners or had a history of foreign travel suggesting that these cases were not community acquired except for 4 cases from textile producing district Bhilwara (known as Manchester of India), an epicenter of North India. Approximately 33.33% patients were completely asymptomatic and of those who were symptomatic cough was the most common symptom (85.71%) followed by fever (78.57%), myalgia (64.28%), headache (28.57%) and dyspnea (28.57%). Three patients (14.28 %) had underlying co morbidity in the form of hypertension, diabetes mellitus, hypothyroidism, chronic kidney disease or coronary artery disease. 11 patients (52.38%) had lymphopenia in their hemogram during the course of admission. 3 patients (14.28%) had leucocytosis and 4 patients (19.04%) presented with thrombocytopenia. All 4 patients in the severe category had raised FDP, D-Dimer levels and they needed oxygen support. These patients had deranged liver functions and had elevated pro-calcitonin levels, serum ferritin levels and LDH levels. 1 out of the these 4 cases went into ARDS during the course of treatment. 10 patients yielded negative results for Covid-19. The mean duration from admission to getting 1st Covid-19 sample negative was 8.3 days. 18 patients (85.71%) are still under treatment.Clinical investigations in initial Covid-19 patients in the Indian subcontinent reveal lymphopenia as predominant finding in hemogram. Patients with older age and associated comorbid conditions (COPD and diabetes) seem to have greater risk for lung injury thereby requiring oxygen support during the course of disease and these patients also had greater derangement in their biochemical profile.

The present study was undertaken to investigate and quantify the severity of COVID-19 infection on high-resolution chest computed tomography (CT) and to determine its relationship with clinical parameters. This study also aimed to see CT changes with clinical recovery or progression of disease.In an attempt to provide extensive information pertaining to clinical and radiological characteristics of COVID-19, the present study was undertaken in 80 hospitalized patients. The patients were COVID-19 confirmed positive by genomic analysis through RT-PCR at tertiary care center in Jaipur. Initially all patients were evaluated for their clinical parameters and then correlated with HRCT chest after hospitalization. CT findings correlated with duration of disease to assess progress or recovery.A total of 80 patients of laboratory confirmed COVID-19 test by RT-PCR at SMS Hospitals, Jaipur were assessed. Among the confirmed cases, most of patients were young adults in the fifth and sixth decade of age group with mean age of 50.40 years. There was a male preponderance (59% male and 41% female). Out of total analyzed patients, 39 patients (48.75%) were symptomatic, among them fever (79.47%), cough (74.35%), shortness of breath (36%) and sore throat (17.94%) were the most common presenting clinical manifestations. A few patients (12.82%) also had other symptoms like headache, chest pain, pain abdomen, altered sensorium etc. 54% patients had some underlying co morbid disease in sample population. The most prevalent comorbidities were Diabetes mellitus (56%), Hypertension (48.83%), COPD/K-chest (12%), CAD (9.32%) and others (11.62%) like hypothyroidism, anemia, CVA etc. The lung pathological changes were evaluated by HRCT imaging and by assigning CT severity score. We found Typical COVID findings in 50% patients, Indeterminate in 11%, Atypical in 11% and 28% patients had Negative CT chest for COVID. The clinical status of patients correlated with the CT severity score, with mild cases showing score15/25 in 45.83% patients and severe cases showing CT severity score15/25 in 87.50% patients. The CT features varied with duration and course of disease. Proportional GGO was higher (59.37%) in early phase and it was lower (12.5%) in later stage of disease.The varied spectra of COVID-19 presentation included fever, cough, shortness of breath, sore throat etc. Diabetes mellitus, hypertension, COPD/K-Chest and CAD were found as major comorbid conditions. Symptomatic presentation of COVID-19 was observed to be higher in patients with co morbid disease, especially if multiple. HRCT chest in COVID-19 patients had a major diagnostic and prognostic importance as positive CT findings were more prominent in symptomatic patients and co-morbid patients. Clinical symptoms of patients directly correlated with CT severity index. CT imaging was found to be useful in predicting clinical recovery of patients or progression of disease.

Introduction COVID-19 has presented an unprecedented situation to the medical world. With the high infectivity rate, the search for ideal prognostic tests is on. Neutrophil lymphocyte ratio (NLR) has been used as a prognostic marker in several infectious, inflammatory and malignant conditions. We aim to assess the utility of NLR as a prognostic marker in COVID-19. Materials and methods: 142 confirmed COVID-19 patients were included in the study. A detailed clinical Performa was filled. Complete blood count and coagulation parameters were done in each patient. Based on the clinical criteria, the patients were classified as asymptomatic (100) and symptomatic (42). The symptomatic patients were subjected to CT chest examination and were assigned a CT severity index. Using clinical presentation, organ dysfunction, oxygen requirement and CT severity index the patients were classified as mild and severe COVID-19 groups. NLR, coagulation parameters and CT severity index were compared. Results: 46.4 % of males and 17.8 % of females had neutrophilia. 37(38.1 %) males had 14 (31.1 %) females had lymphopenia. NLR was between 1-3.5 in 83 (58.45%) cases and 59 cases (41.5%) had NLR >3.5.Of these 59 cases, 50 had a deranged FDP/D-dimer levels. The Receiver Operating Characteristics (ROC) curve analysis was carried out to indicate the sensivity and specifity of NLR and its respective optimal cut-off value for predicting severity in COVID. NLR >3.5 helped in predicting severity of COVID with a sensitivity of 60% and specificity of 70%. Conclusion: High NLR (>3.5) indicates a severe form of disease. ’What is already known about this topic? Covid 19 is an emerging pandemic and researchers are trying to find the various diagnostic and prognostic parameters. What does this article add? This article tries to assess a new prognostic marker for covid 19

We analyzed the data of 102 confirmed patients with novel Coronavirus 2 infection (COVID-19) during the early period of nationwide lockdown announced in India after the declaration of pandemic. We analyzed epidemiological, clinical characteristics and outcome of hospitalization in 102 patients with positive results for novel corona virus (SARS-CoV-2) RNA testing which were traced on the basis of history of travel, contact with a confirmed COVID-19 case, resident of hotspot areas or presence of symptoms, thus providing an accurate estimate of the proportion of asymptomatic cases in the initial population. Of 102 patients enrolled in the study, 83.3% (85/102) were asymptomatic and 16.67% (17/102) were symptomatic. Seventy-seven (75.49%) were males and 24.50% (25/102) were females. Eighteen (17.6%) patients had associated comorbidities, the most prevalent of which were diabetes mellitus 10.8% (11/102), hypertension 7.8% (8/102), chronic obstructive pulmonary disease (COPD) in 3.92% (4/102), chronic kidney Disease (CKD) 0.98% (1/102), coronary artery Disease (CAD) 0.98% (1/102) and cerebro-vascular disease (CVD) 0.98% (1/102). The clinical spectrum among symptomatic COVID-19 patients varied from dry cough and fever to respiratory failure and multi-organ failure. Twelve (11.76%) patients were kept in intensive care unit (ICU). Ninety-nine (97.05%) patients recovered while three (2.94%) died during hospital stay. With majority of COVID-19 cases in India being asymptomatic, changes in biochemical and inflammatory profile were small and insignificant in asymptomatic patients when compared to symptomatic patients. Elevated NLR, lymphopenia, age and presence of comorbidities were associated with increased severity and poor outcome.

Purpose: The present study was undertaken to investigate imaging features of emerging COVID-19 pneumonia by chest ultrasound (POCUS) and digital radiographs (Ch

Background: Hydroxychloroquine (HCQ) is a well prescribed drug in rheumatological disorders. The repurposed drug HCQ was also used for SARS-CoV-2 as prophylactic and therapeutic strategy in Indian context. The present study aimed to describe that either rheumatological disorder had threatening effect on COVID-19 or advantageous particularly with the use of HCQ. Methods: The present retrospective, observational study included 4100 COVID-19 patients of SMS Medical college and Hospitals, Jaipur, India. The patient’s data (after anonymizing and de-linking) concerning underlying chronic medical illness especially focused on rheumatological disorders was extracted from their medical records. The data from rheumatological patients concerning medical history, clinical manifestation, severity of COVID-19, extension of disease, treatment history and outcome were collected and analyzed. Results: Out of large study cohort of 4100 patients of COVID-19, rheumatological disorders found only in seven patients (0.17%) including rheumatoid arthritis (RA) in four patients, systemic lupus erythematous (SLE) in two patients and Wegener granulomatosis in one patient. All rheumatologic patients of study group had symptomatic presentations with one patient had critical, another one had severe, two had moderate and three patients had mild illness. Only one patient was on hydroxychloroquine (HCQ) treatment (200 mg daily) who presented with mild illness of COVID-19. One patient of SLE with lupus nephritis on glucocorticoids and immunosuppressive agents but not on HCQ, developed critical illness and later on succumbed to life. Conclusion: The present study showed that patients with rheumatological disorders might not be at increased risk of acquiring COVID-19 or a more severe disease. Moreover, HCQ has some protective role against COVID-19 in patients of rheumatological disorders and it also play an important role in reducing the disease severity. Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not for profit sectors. Declaration of Interests: All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential. Ethics Approval Statement: This study approved by ethical and research committee of SMS medical college and Hospital, Jaipur, India.

Purpose: The present study was undertaken to evaluate different management protocols in terms of time duration for seroconversion, hospital stay and severity of COVID-19 infection in COVID-19 patients. Materials and Methods: An attempt was made to appreciate efficacy and safety of defined management protocol so designed according to molecular pathogenic mechanism of SARS-CoV-2 ( Severe Acute Respiratory Syndrome due to Coronavirus 2 ) in two segregated 104 symptomatic COVID-19 positive admitted patients. Patients managed with Hydroxychloroquine along with standard of care belong to Group 1 while patients treated with combination protocol of Hydroxychloroquine, Lopinavir-Ritonavir along with standard of care put in Group 2. Both management protocols were assessed through variables of time duration for seroconversion, severity of disease process and hospital stay. The antecedent inflammatory parameters of C-reactive proteins (CRP), D-dimer, neutrophil/lymphocyte ratio were assayed and comparative evaluation of both management protocols was done. Results: A total of 104 patients were divided into two respective groups of management protocol with 52 patients in each group. In the study population, most of the patients were young adults with mean age of 45.41 (95% CI 45.41 ±4.04) year in Group 1 and 50.8 (95% CI 50.8 ±4.213) years in Group 2. There was a male preponderance with average female to male sex ratio being 0.52 and 0.67 in Group 1 and Group 2, respectively. Mean values of selected inflammatory parameters in serum in Group 1 and Group 2 were observed to be: D-dimer 2.03µg/mL and 3.01µg/mL, C-reactive protein 5.2 mg/L and 5.36 mg/L, neutrophil/lymphocyte ratio 2.47 and 2.78 respectively. The mean time duration for seroconversion of COVID-19 patients in Group 1 and Group 2 was 9.92 days and 7.42 days with 95% CI of 3.54 and 1.45, respectively and P-value of less than 0.0001 (P < 0.0001). Only 15% patients in the group on HCQ and LPRV took more than 10 days for seroconversion while 34.60% patients in group on HCQ alone took more than 10 days for seroconversion. Mean time of hospital stay for groups 1 and 2 were found to be 10.44 days and 8.59 days respectively. 77% patients got discharged from hospital within 10 days in group treated with HCQ and LPRV as compared to that of 60% in those treated with HCQ alone with P-value of 0.0014 (P = 0.0014). Conclusion: The spectrum of COVID-19 had variable output from different treatment regimens. Patients who were treated with combination regimen of HCQ and LPV/r (group 2) took less time in achieving negative seroconversion and were discharged early from hospital as compared to those treated with HCQ alone (group1). Funding Statement: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not for profit sectors. Declaration of Interests: All authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential. Ethics Approval Statement: The authors stated that approval was not required.

To study the clinical profile and magnetic resonance imaging (MRI) features in patients of COVID-19-associated rhino-orbital-cerebral mucormycosis (CA-ROCM) with orbital involvement and perform a clinicoradiological correlation.A cross-sectional study was performed at a tertiary care center in north India from May 2021 to June 2021. Consecutive patients with clinical, nasal endoscopic, and/or microbiological evidence of CA-ROCM underwent MRI of paranasal sinuses, orbit, and brain as per the study protocol. Orbital MRI findings were studied in detail and were correlated with clinical signs.Two hundred and seventy patients were studied. The mean age was 48.4 (± 16.82) years. A male predilection was noted (male:female = 1.77). Orbital involvement was seen in 146 (54%) patients on clinical evaluation and in 184 (68%) patients on MRI. Unilateral orbital involvement was more common (134; 92%). The most common presenting symptom was periorbital and/or facial pain (141; 52.2%) and the most common clinical sign was periorbital edema (116; 43%). The most common MRI finding was suggestive of orbital cellulitis (160; 59%). Orbital compartment syndrome was found in 17 (6.3%) patients. The inter-rater agreement between clinical and radiological assessments to detect the involvement of infraorbital nerve and frontal nerve was found to be 85.56%, (κ 0.621) and 93.70% (κ 0.776), respectively. The diagnostic accuracy, sensitivity, and specificity of MRI to detect medial orbital wall defect were found to be 87.9%, 65%, and 97%, respectively.Orbital imaging features of a cohort of ROCM patients have been presented with clinicoradiological correlation.

Background: Antibody testing against SARS-CoV-2 complimentary to RT-PCR could be an effective method for its detection. Development of immunity against COVID-19 in context of reinfection and herd immunity still remains debatable and needs further elucidation. The present study was conducted to investigate the immunity status against SARS-CoV-2 in terms of IgG antibody positivity in health care workers at a tertiary care center. Methodology: This single center study was conducted at a tertiary care center, that involved 1039 healthcare workers and other staff members. The testing of all subjects was performed using ELIFAST (SARS-CoV-2 IgG ELISA) kits. The sample population was then segregated into RT-PCR positive and negative/status unknown groups. Groups were further segregated on the basis of IgG positivity status and the sensitivity and specificity was also calculated. Results: Among the 1039 enrolled subjects, 179 (17.23%) were RT-PCR positive for SARS-CoV-2 positive and remaining were either RT-PCR negative or status unknown cases. Among 179 COVID-19 recovered subjects, 19 (10.61%) were negative for IgG, whereas 160 (89.39%) came out IgG positive. Out of 860 (82.77%) RT-PCR Negative/Status unknown, 248 (28.84%) came out IgG positive and the remaining 612 (71.16%) were negative for IgG. The overall sensitivity and specificity were 89.39 and 71.16, respectively. Conclusion: A combined approach of testing for COVID-19 using RT-PCR and rapid antibody assays could be more beneficial. Serological studies project a higher antibody response in population that compel us to think about plausibility of herd immunity. However, variability in serological response could be affected by several factors and the underlying complex immune process of COVID-19 is yet to be fully understood.

Background: Chemoradiotherapy plays an important role in management of locally advanced head and neck cancers. This retrospective analysis was done to evaluate and compare acute toxicity profiles and early clinical outcomes in patients treated with conventional and arc techniques. Methods: Fifty-five patients of head and neck cancers were evaluated. Thirty patients received conventional radiotherapy with 6 MV or cobalt 60 and 25 patients were treated with simultaneous integrated boost-volumetric modulated arc radiotherapy (SIB-VMAT) with dose prescription of 66 - 70 Gy. Concurrent chemotherapy was given as cisplatin injection at 40 mg/m 2 weekly or 100 mg/m 2 thrice weekly. Results: The incidence of grade 3-4 mucositis was 56% versus 83.3% with SIB-VMAT and conventional treatments (P = 0.026). The incidence of grade 2-3 xerostomia was 44% versus 80% (P = 0.006) in the two groups. Grade 2 dysphagia was seen in 40% versus 80% (P = 0.008) favoring the arc treatments. Seventeen patients undergoing arc treatment had complete response compared to 14 in the conventional group (P = 0.040). The median disease-free survival (median ± standard error) was 16 months (11 ± 1.987 months) in the conventional and arc groups (P = 0.073). Conclusion: SIB-VMAT shows a better toxicity profile and a trend towards better disease-free survival when compared to conventional radiotherapy in head and neck cancers. World J Oncol. 2017;8(4):117-121 doi: https://doi.org/10.14740/wjon1049w Correction in World J Oncol. 2017;8(5):174-174, https://doi.org/10.14740/wjon1049wc1

This paper reports a 10-month-old spastic quadriplegic male child presenting with severe ulceration of ventral surface of tongue and lower lip due to the presence of mandibular and maxillary primary central incisors. The patient was on antiepileptic medication since birth. The recent development of ulcers aggravated the already deficient dietary intake due to his compromised medical status. After considering various treatment modalities, a conservative approach to cover the mandibular teeth and gum pads with a splint made in a flexible denture material was decided. The appliance incorporated an extraoral wire component for prevention of risk of inadvertent ingestion and to aid in attaching retentive components as and when needed. The challenges faced by the clinicians and the pitfalls influencing the ultimate outcome with this intervention are described. How to cite this article Kapur A, Bhandari S, Goyal A, Gauba K, Jaiswal MA. Factors leading to Nonhealing of severe Lip and Tongue Ulceration in a 10-month-old Infant with Spastic Quadriplegia. J Postgrad Med Edu Res 2017;51(3):140-143.

Fasting and feasting are integral part of many religions and cultures. As the amount of food and fluid intake are markedly altered during these phases, patients with diabetes are prone to higher risk of complications. Even though several guidelines for fasting and feasting are available; Indian specific recommendations are the need of the hour, because of the distinct dietary habits and the diet content (high carbohydrate) of Indians. To fill this void, the current guidelines have been developed by experts from India who extensively reviewed the literature, shared their practical knowledge and ultimately arrived at a consensus.

Cysts, a common occurrence in the jaws, are managed with different conservative and radical approaches. Although surgical excision is usually the treatment of choice, it can result in an open defect that compromises the oronasal seal and affects the patient's quality of life by interfering with daily intake of nutrition. These defects vary in anatomic geometry and extent depending upon etiology and require a prosthodontic intervention in the intermediate phase until a definitive closure is executed. An unconventional obturator design with a helical spring incorporated into a flexible obturator is described to manage 2 patients with challenging anterior maxillary cysts.

To demonstrate glycemic variability in type 2 diabetic patients and consequent control of the same.108 patients with type 2 diabetes with an HbA1c level of 7.5-8.5% were selected for the study. A Freestyle Libre Pro AGP sensor was applied to the patients after explaining the patient about the same. Next, they were called for follow up at 3rd, 7th, 11th and 14th days. Based on the readings and graph obtained, diet and treatment changes were made on various follow-up days. The sensor was removed at the end of 14 days.Out of the 108 subjects, 106 completed the study. There were no adverse device effects. 98 patients had therapy changes while the rest had diet and lifestyle modifications. The mean HbA1c decreased from 7.96% to 7.03% by the end of 15 days. The glycemic variability curves helped in recognizing and treating masked or asymptomatic hypoglycemic events. It also graphically shows intervals of optimal and sub-optimal glycemia.AGP is one of the most recent, innovative developments that are being used to monitor Glycaemic variability in DM patients. AGP is generated from the Flash Glucose Monitoring device which is like a CGM device attached to the patient for a maximum period of 14 days, which checks the ISF glucose at every 15 minutes. We are able to get a Glycaemic variability curve, a median, a modal, various percentiles and statistical data generated through this. AGP study in the patient provides the doctor with an opportunity to have a complete glycemic picture of the patient l. It offers a reliable, predictive, standardized visualization of the glucose data. We were able to not only reduce the Glycaemic variability but were also able to improve their Quality of Life by reducing the frequency of hypos. The data lead to breaking of the clinical inertia and provided a valuable insight into Glycaemic patterns. The achievement of near to normal Glycaemic status at the end of 14 days reflected the use of AGP as an interventional tool.

The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance, and determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding, and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling the genetic epidemiology of SARS-CoV-2.

Objective The aim was to investigate the epidemiological profile and disease trend of nCOVID-19 in Rajasthan, listed among the top five COVID-19-affected states in India. Background The pandemic of coronavirus disease (COVID-19) has created a huge burden on health care system, and every nation, including India, has been struggling to contain the spread of this virus through various measures, including nationwide lockdowns. Methods The present observational descriptive study was performed on available epidemiological data of the state of nCOVID-19, from March 2, 2020, to April 22, 2020, and highlights epidemiological profile and disease trend of nCOVID-19 in the state of Rajasthan. Results Rajasthan in India reported 1918 nCOVID-19 cases with 25 deaths as of April 22, 2020. The nCOVID-19 exhibited a sex bias with a preponderance for male patients (62.7%), with a male: female ratio of 1.68. Individuals in the age group of 16–30 years represented the highest percentage (34.7%) of nCOVID-19 cases. The recovery rate and death rate were 31.8 and 1.5%, respectively. Higher proportion of cases in Rajasthan belonged to districts located in eastern plains and arid western zones. Conclusion Implementation of lockdown, along with mandatory advisory on practices like social distancing, wearing of facial mask, and frequent hand washing in India, remains a crucial step in containment of this pandemic. Moreover, timely and adequate changes of guidelines as issued by Indian Council of Medical Research, India, have led to flattening of the epidemiological curve.

Introduction: Hypertension is a multifactorial disease and is a major risk factor for cardiovascular disease, particularly in patients of diabetes mellitus. Management of hypertension is one of the critical components of comprehensive clinical management of diabetics. Aim: The aim of this study is to evaluate the effect of physical activity on systemic inflammation in patients with hypertension and type 2 diabetes mellitus in patients with hypertension. Methods: A total of 100 participants of either gender aged 40–69 years of Stage 2 essential hypertension were included in the study and assigned to 12 weeks of moderate physical activity (walking 10,000 steps/day). These study participants were further divided into two groups: type 2 diabetic (n =66) and nondiabetic (n = 34) hypertensives. Anthropometric parameters were noted and biochemical variables estimated at baseline and postintervention and evaluated statistically. Results: Twelve weeks of walking resulted in improved levels of inflammatory cytokine tumor necrosis factor-alpha (TNF-α). Systolic and diastolic blood pressure (BP) were reduced from 168.98 ± 3.76 to 154.29 ± 7.48 mmHg and from 103.38 ± 2.46 to 89.08 ± 3.62 mmHg, respectively. Body weight and body mass index were reduced from 69.8 ± 7.09 to 68.3 ± 6.53 kg and 23.21 ± 3.35 to 22.70 ± 3.16 kg/m2, respectively. A significant decrease in glycated hemoglobin (Group 1: 8.36% ± 1.83% vs. 7.74% ± 1.82%; Group 2: 5.56% ± 0.4% vs. 5.09% ± 0.19%) was found. A significant reduction in TNF-α levels in hypertensives with diabetes and a significant (P

Background Diabetes mellitus may be associated with increased severity and enhanced mortality in COVID-19 infections. The present study was undertaken to evaluate the clinical presentation, laboratory parameters, radiological imaging, management, and outcome of COVID-19 infection in patients of diabetes mellitus and its association with glycemic control. Methods The present study was designed to evaluate the difference between uncontrolled and controlled diabetes for COVID-19 manifestations by enrolling 80 admitted COVID-19 patients. Patients were categorized into two groups, where group 1 had patients with uncontrolled diabetes as indicated by HbA1c > 8 g% and group 2 had patients with controlled diabetes as indicated by HbA1c

Background: To share the data of coronavirus 2019 (Covid-19) patients started on lopinavir-ritonavir (lopi/r) in relation to time period from the onset of symptoms.Method: Observational descriptive study of 23 Covid-19 patients admitted in a tertiary care center in India from March 2020 to May 2020. Patients categorized into 2 groups based on the timing of initiation of lopi/r from the onset of symptoms. Group 1 were given the drug early (≤7 days) and group 2 late (>7 days). The clinical events (oxygen requirement days and ICU stay) and outcomes of hospital stay between the two groups were evaluated.Results: Patients were started on lopi/r for a period of 14 days on admission, out of which 12 patients were in group 1 and 11 patients in group 2. Underlying co-morbidities were present in 15 patients (65.21%). The mean duration from onset of symptoms to lopi/r initiation was 4 days and 11.1 days in Group 1 and 2 respectively. Requirement for oxygen support (2.16 versus 6.54 days), mean duration of hospitalization (8.58 versus 11.54 days) and mean duration of obtaining first Covid-19 negative report from the onset of symptoms (10.5 versus 19.57 days) were all significantly lesser in group 1 (p

Background: The present study was undertaken to investigate imaging features of emerging coronavirus disease 2019 (COVID-19) pneumonia by chest ultrasound point-of-care ultrasonography (POCUS) and digital radiographs (chest radiograph [CXR]) and their correlation with clinical manifestation and severity of the disease. Methods: The present ongoing single-center study assessed patients admitted from April 20 to May 15, 2020, with laboratory-confirmed COVID-19 pneumonia at SMS Medical College Hospital, Jaipur, India. The clinical features, laboratory investigations, CXR, and POCUS findings were evaluated and compared. Results: Fifty-two patients with a manifestation of COVID-19 pneumonia were studied. Most of the patients were in the fifth and sixth decade of age group with a mean age of 56.57 years. There was an overall male preponderance (80% men and only 20% women). All pneumonitis patients were symptomatic with fever (88.46%), cough (82.69%), and dyspnea (55.77%) being the major symptoms. Thirty-four patients had underlying comorbid conditions. The digital radiograph-chest findings of 55.77% patients exhibited classic COVID-19 pneumonia findings. The ultrasonography of the chest findings revealed pleural and lungs changes in 94% of patients with COVID-19-positive pneumonia. CURB-65 score for the severity of pneumonia had a positive correlation with POCUS severity score and CXR visual score with P = 0.0013 and 0.0018, respectively. The duration of some major symptoms for COVID-19 pneumonia also had a positive correlation with the POCUS severity score and CXR visual score. Conclusion: The spectrum of COVID-19 pneumonia has a predilection for advancing age and male gender. Although both POCUS and CXR are important tools to detect severity of pneumonia, POCUS has higher sensitivity as compared to that of CXR to detect characteristics of COVID-19 pneumonia, especially interstitial involvement or acute respiratory distress syndrome.

Background: The present study was undertaken to determine the levels of interleukin-6 (IL-6) and evaluate its association with clinical presentation, severity, radiological imaging, management, and outcome in coronavirus disease (COVID-19) infection. Methods: The present study included 132 admitted COVID-19 patients, categorized into three groups. Group 1 had IL-6 within the normal reference range, Group 2 had IL-6 raised up to ten times the upper normal limit (UNL), and Group 3 had IL-6 level raised > ten times the UNL. The patient's data concerning medical history, clinical manifestations, laboratory findings, radiological imaging, management, and outcome were extracted from their medical records for subsequent evaluation, interpretation, and association among the groups. Results: COVID-19 patients with raised IL-6 levels exhibited frequent symptomatic presentations, severity, and critical illness, especially with extremely high IL-6 levels (P

The ever-growing menace of Coronavirus Disease of 2019 (COVID-19) has ravaged mankind the world over. There has been a lot of exploratory work going on to unravel the pathophysiology of the disease and to come up with a rationale and realistic management protocol. Here is one such attempt to present the Government, Societal and Medical measures framed by Tertiary Care Medical College Teaching Hospital of State of Rajasthan, namely, S. M. S. Medical College and Attached Hospitals, Jaipur. These measures were undertaken for the entire state so as to curtail the rise of COVID-19 pandemic to some extent. The combative approach was multi-focal and multi-axial with the aim to address issues from all conceivable angles inclusive of preparative ground-work, fluidic containment, slowing of transmission, and appropriate logistics to ensure steady-state supplies.

Aim: To find out Efficacy of a basal plus regimen. Objectives: 1. To find out the efficacy of basal plus regime by evaluating the changes in HbA1c at 24 weeks. 2. To find out changes in weight and frequency of hypoglycemia after initiation of the basal plus regime. Method: The study was a prospective analysis of 24 weeks after initiation of basal plus regime. Inclusion criteria: T2DM>5 Years; On 3OAD + basal insulin, HbA1c- 7.5-8.5%. Exclusion Criteria: critically ill patients, acute infection, pregnant, T1D. All patients matching the inclusion criteria were analyzed on the basis of SMBG chart to find out their highest glycemic excursion of post prandial and fasting readings. Based on the diet recall and sugar reading charts these patients were initiated on bolus insulin with the largest meal of the day where their post prandial corresponded to the highest reading. They were educated on proper insulin injection techniques and SMBG and asked to follow-up with their sugar readings using telemedicine application every day. Result: We studied 220 patients (F=124 M=96) with HbA1c at baseline 7.5-8.5% (avg-8.0). After addition of bolus insulin at 12 weeks target HbA1c Conclusion: After failure of OADS and basal insulin a basal plus regime with addition of 1 bolus insulin with the largest meal of the day helped achieve the target HbA1c of Disclosure B.D.J. Saboo: None. D. Hasnani: None. H. Chandarana: None. S. Bhandari: None. S. Joshi: None. J. Kesavadev: Advisory Panel; Self; Novo Nordisk India Private Limited. Speaker's Bureau; Self; Novo Nordisk India Private Limited. Advisory Panel; Self; Medtronic. Speaker's Bureau; Self; Medtronic. Advisory Panel; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; MSD. Speaker's Bureau; Self; MSD. Advisory Panel; Self; AstraZeneca. Speaker's Bureau; Self; AstraZeneca. A. Maheshwari: None. H. Thacker: Research Support; Self; Wockhardt LTD.

A case report of a 30-year-old HIV patient presented with features of interstitial lung disease usually misdiagnosed as tuberculosis or PCP and wrongly treated. HRCT of the lung suggestive of interstitial lung disease with no evidence of tumor or Pneumocystis jiroveci . The patient responded to steroids and was continued on antiretroviral treatment.

Objectives. Locoregional recurrence is the predominant pattern of treatment failure in advanced head and neck cancers. Reirradiation is a useful modality to treat inoperable head and neck cancer patients with recurrent disease. The aim of the present study was to analyze the treatment toxicity and early clinical outcomes in patients undergoing reirradiation. Methods. Twenty patients of head and neck cancers with recurrences or second cancers were evaluated. Reirradiation was done using simultaneous integrated boost volumetric modulated arc therapy (SIB VMAT), intensity modulated radiotherapy (IMRT), or conventional radiotherapy using 6MV photons. Dose prescription ranged from 30 to 60 Gy in conventional fractionation. Results. Seventeen males and three females were evaluated in this analysis. The median age of patients under study was 56.5 years. At time of analysis 8 patients (40%) had a complete response, 7 patients (35%) had progressive disease, and 25% had partial response or stable disease. Grade III-IV mucositis, dermatitis, xerostomia, dysphagia, and trismus were seen in 20%, 20%, 50%, 35%, and 45% patients, respectively, during retreatment. Patients receiving a radiotherapy dose less than 45 Gy showed a higher incidence of progressive disease (p=0.01). The median disease-free survival for patients receiving reirradiation dose of ≥46 Gy was 19±3.3 months (median ± S Error) compared to 8±2.61 months for those with a dose prescription less than 45 Gy (p=0.03). At 18-month follow-up 26% of patients undergoing reirradiation were disease-free. Conclusions. Our results show improved tumor control using a prescription of doses ≥46 Gy in retreatment setting.

Intraoral trauma may occur in isolation or in combination with injury of the other parts of the body. Once the life-threatening phase of trauma is over, the primary need for the patient is to restore the form and function of the tissues lost due to trauma. In the oral and maxillofacial region, esthetic consideration does sometimes supersede the need of function. This article briefl y summarizes the scope of prosthodontics in patients with oral and maxillofacial trauma. How to cite this article Bhandari S. Prosthetic Considerations in Oral and Maxillofacial Trauma. J Postgrad Med Edu Res 2014; 48(2):87-90.

India is at risk of Zika virus transmission due to high prevalence of its vector Aedes aegypti. Rajasthan, a state in the north-west region of India, has also high prevalence of Aedes mosquito. First laboratory confirmed case of Zika virus disease in Rajasthan was reported on 21 September 2018 in Jaipur. The Government of Rajasthan quickly implemented a containment strategy to contain the outbreak and prevent further spread of this disease. Strategy included active human and mosquito surveillance, laboratory testing and sequencing of the virus, integrated vector control measures, intersectoral coordination, risk communication and social mobilisation, all in a predefined geographic area around the epicentre. Timely action with appropriate coordination at all levels with multiple stakeholders contained the outbreak successfully. In all, 159 confirmed cases were reported from in and around the 3 km containment zone in Shastri Nagar area of Jaipur City and routine surveillance. Following this, a specially developed laboratory-based surveillance strategy was put in place to ensure that the disease does not spread beyond the containment zone. No fresh case was reported subsequently within or beyond the containment zone.

This article describes the importance of the family in diabetes care. It lists the multiple ways in which the family is related to diabetes: as a cause or culprit of diabetes, as a tool or technique for delivering diabetes care and as a target of diabetes or diabetes-care-related complications. The authors suggest an alliterative ‘Five-I’ approach to guide diabetes care professionals in addressing needs, and utilising strengths, of the family of a person with diabetes. The five ‘I’s stand for: involved independence, iterative information, interactive interviews, inspired introspection and integrated incorporation. This strategy, based upon evidence and experience, is supported by pragmatism and practicality.

Hydatid disease is a parasitic disease caused by the larval stage of Echinococcus granulosus . It mainly affects the liver and lungs and can rarely affect other organs including the brain (Neurohydatidosis). Intracranial hydatid cysts account for 0.5–3% of all the cases of hydatid disease and contribute to 1–2% of all the intracranial space occupying lesions. We report a case of a 26-year-old female patient who presented with seizures and was found to have multiple giant intracranial hydatid cysts.

Dentinogenesis imperfecta (DGI) is one of the most common hereditary disorders of dentin formation. It follows an autosomal dominant pattern of transmission, affecting both the formation and mineralization of dentin. Either or both primary and permanent dentition is affected by it. This paper briefly reviews the manifestations of DGI Type II (DGI1) and presents a case report of a family affected with DGI1 over four generations.

The onset of winter of 2014-2015 saw an alarming spurt in influenza A (H1N1) pdm 09 leading to a significant mortality. Rajasthan was one of the foremost affected state bearing the frontal attack in which majority of deaths occurred early and in the young.To sketch out the mortality profile with respect to demographic and clinical progression with an aim to identify the groups, this virus conspicuously picked up with a perspective to control some of the avoidable factors.We analyzed the epidemiological data in 76 RT-PCR confirmed deaths of H1N1 patients that occurred between 1st January 2015 and 28 February 2015 over a period of 59 days at SMS Medical College Hospital, Jaipur.A total of 412 patients got hospitalized during two months period from 1st January 2015 to 28th February 2015, out of which 76 fatal cases presenting with category C symptoms along with radiological evidence of bilateral pneumonia were analyzed. 48.6% deaths occurred in the 18-40 years of age group. The mean age being 44.01 ± 15.07 years. Females had a marginally increased mortality rate (F: M-1.23:1). The mean time of onset of symptoms to hospitalization was 6.79 ± 4.63 days. Fifty-one (67.1% 0) patients were from urban areas, whereas 25 (32.89%) belonged to rural areas. Only 7.83% patients presented within 24 - 48 hours whereas 46% presented within 5 days of onset of symptoms. 66.9% succumbed within 5 days of hospitalization, despite of starting Oseltamivir in a dose of 150 mg/bd on the day of admission. 64.5% had predisposing risk factors. Bilateral pneumonia was observed in all the 76 patients, septicemia in 21.12%, MODS in 30.26% and AKI in 9.21%.The in-hospital mortality of 17.79% despite of starting Oseltamivir has raised concern about identifying the so called "Rapid Progressors" [66.9% succumbing within 5 days of hospitalization]. As a corollary of this analysis the authors are of the opinion that a rejig of the existing guidelines to identify and treat influenza like illness be made available at the national level. What factors promote rapid progression especially in a group without any predisposing risk condition should form the focus of future studies. As risk group individuals formed a major chunk of deaths, the need to vaccinate this group should form a scaffold on which future directions and interventions have to be built up to combat the morbidity and mortality.

The purpose of this article was to draw attention to a periimplantitis-like clinical presentation of oral malignancy around dental implants, a phenomenon that may develop without any associated risk factors for oral cancer. Such a benign appearance of oral malignancy may lead to delay in the diagnosis and initiation of ensuing treatment. Therefore, chronic nonhealing inflammatory lesions around dental implants should be considered as highly suspicious.

Chemoradiotherapy plays an important role in management of locally advanced head and neck cancers. This retrospective analysis was done to evaluate and compare acute toxicity profiles and early clinical outcomes in patients treated with conventional and arc techniques.Fifty-five patients of head and neck cancers were evaluated. Thirty patients received conventional radiotherapy with 6 MV or cobalt 60 and 25 patients were treated with simultaneous integrated boost-volumetric modulated arc radiotherapy (SIB-VMAT) with dose prescription of 66 - 70 Gy. Concurrent chemotherapy was given as cisplatin injection at 40 mg/mThe incidence of grade 3-4 mucositis was 56% versus 83.3% with SIB-VMAT and conventional treatments (P = 0.026). The incidence of grade 2-3 xerostomia was 44% versus 80% (P = 0.006) in the two groups. Grade 2 dysphagia was seen in 40% versus 80% (P = 0.008) favoring the arc treatments. Seventeen patients undergoing arc treatment had complete response compared to 14 in the conventional group (P = 0.040). The median disease-free survival (median ± standard error) was 16 months (11 ± 1.987 months) in the conventional and arc groups (P = 0.073).SIB-VMAT shows a better toxicity profile and a trend towards better disease-free survival when compared to conventional radiotherapy in head and neck cancers.