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Competing Interests: There are no conflicts of interest.

Introduction: Combined immune checkpoint inhibitors can cause gastrointestinal adverse events. Methods: We performed a meta-analysis of pooled colonic, hepatic and pancreatic treatment-related adverse events of combined ICI. Results: 53 trials reporting treatment-related adverse events in 6581 patients. All grade diarrhea was the most common adverse event seen in 25.4% patients, followed by all grade hepatitis in nearly 13% patients and pancreatitis in nearly 7.5% patients. Conclusion: Our study provides pooled data of treatment-related adverse events from different combination immune checkpoint inhibitors use in solid tumors and demonstrates a high incidence of all grades and ≥3 grade gastrointestinal adverse events. Further studies are required to characterize these adverse events and assess their overall impact on treatment course and outcomes.

Objectives: Adult immunisation has recently emerged as an area of emphasis in research and policy. Increasing life expectancy, outbreaks like COVID-19, and the endemic nature of diseases like dengue, malaria have underscored its importance. Therefore, this study was carried out to assess hesitancy and the factors influencing the uptake of vaccines in adults., Methods: A descriptive cross-sectional study was conducted among the medical students and doctors affiliated to a medical college and tertiary care hospital in Delhi, India and their immediate family members in January 2021. Online data collection was done using the Google Form platforms. Data on awareness and perceptions regarding adult vaccination and immunisation status of participants was collected. The dataset was exported in the Microsoft Excel format and analysed with IBM SPSS Version 25 (Armonk, NY: IBM Corp)., Results: A total of 461 adults responded to the survey. The most common reasons for vaccine hesitancy were fear of side effects (51.41%), lack of awareness of vaccines (49.46%), and the lack of national guidelines on adult vaccination (32.97%). Hesitancy for vaccines among those who were informed by healthcare workers of vaccine availability was highest for zoster vaccine (97.80%) and least for tetanus toxoid (57.62%). Significant hesitancy was also observed for pneumococcal, human papillomavirus, influenza and varicella vaccines., Conclusions: Reduced vaccine uptake due to vaccine hesitancy in adulthood is a major health concern. Framing national guidelines for adult vaccination in India and awareness generation to create a public demand for adult vaccination warrants prioritization., Competing Interests: The authors declare that there are no conflicts of interest., (© 2022 The Authors.)

Objective: The purpose of the study was to ascertain Oral Health Related Quality of Life (OHRQOL) and evaluate oralhygiene practices in patients visiting a dental institution during COVID-19 time., Materials and Methods: Face-to face interviews were conducted using a semi-structured close-ended questionnaire,assessing oral hygiene practices and self-reported oral problems perceived in last 6 months, using both Hindi and English version of Oral Health Impact Profile (OHIP-14) Questionnaire. Frequency distribution of oral hygiene practices were obtained, and Descriptive statistics computed the scores of OHIP-14. Kruskal-wallis test and Independent t-test were used to match the association of OHIP-14 with demographic variables. Multiple linear regression analysis was utilized to compute the association of OHIP-14 with independent variables, age and gender., Results: Subjective evaluation of OHRQOL (Oral Health Related Quality of Life) using OHIP-14 Porforma resulted in high score for physical pain and psychological discomfort but subjects expressed less discomfort in connection to functional limitation, physical disability, psychological discomfort, social disability and handicap domains of OHIP-14. With progressive increase in age OHRQOL worsened. Females had poor OHRQOL, with significant difference as compared to males. Gender and marital status observed variance in OHIP-14 with statistically significant difference (P <0.000)., Conclusion: More than two-third subjects preferred cleaning their teeth using toothbrush and toothpaste. Therefore, COVID-19 consequently impacted OHRQOL of the general population., Competing Interests: Conflict of interest statement Authors must fully disclose any existing or potential conflicts of interest of a financial, personal or any other nature that could affect or bias their research. If applicable, authors are also requested to describe the role of the finding source(s) in the study design, data acquisition, analysis and interpretation, and writing of the manuscript. No potential conflicts of interest must also be explicitly stated. The authors declare that they have no competing interest., (©2022 Pacini Editore SRL, Pisa, Italy.)

Introduction: The success rate of inferior alveolar nerve block decreases exorbitantly in teeth with symptomatic irreversible pulpitis. The purpose of this prospective, double-blind, randomized clinical trial was to evaluate the combined effect of oral premedication with ibuprofen and dexamethasone on the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis., Methods: Ninety-four adult patients actively experiencing pain and diagnosed with symptomatic irreversible pulpitis willingly participated in this study. Preoperative pain was recorded on the Heft-Parker visual analog scale. Patients were randomly allocated to 4 different groups and received placebo, 0.5 mg dexamethasone, 800 mg ibuprofen, or a combination of 0.5 mg dexamethasone and 800 mg ibuprofen. One hour after oral premedication, all patients received standard inferior alveolar nerve block containing 2% lignocaine with 1:200,000 adrenaline. Access cavity preparation was initiated 15 minutes after the administration of anesthesia. Pain scores were recorded on VAS after anesthesia, at dentin penetration to pulp chamber opening, and on file placement. Success was defined as no or mild pain (0-54 mm) throughout the procedure., Results: The chi-square test was used for qualitative data comparison. The 1-way analysis of variance test and post hoc Bonferroni test showed a statistically significant difference between the combination of 0.5 mg dexamethasone and 800 mg ibuprofen group and the other 3 groups (P < .001)., Conclusions: Preoperative administration of a combination of dexamethasone and ibuprofen improved the success rate of inferior alveolar nerve block in mandibular molars with symptomatic irreversible pulpitis., (Copyright © 2021 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Sarcina species are anaerobic gram-positive cocci rarely seen in the upper gastrointestinal tract and associated with delayed gastric emptying. We present 3 cases of Sarcina infection with varying clinical presentations including the first reported case of Sarcina in a patient with eosinophilic esophagitis. Although the pathogenesis of Sarcina is unclear, awareness of the bacteria is important as they can usually only be detected on histopathologic examination of upper gastrointestinal biopsies. Treatment in symptomatic patients may prevent severe complications such as emphysematous gastritis and gastric perforation.

Introduction: Laparoscopic hernia repair is in vogue in the present era. Both the operating surgeon and the patient are concerned about the postoperative inguinodynia which has now replaced recurrence as the predominant factor affecting quality of life., Aim: Our study aimed to compare early postoperative outcomes with the standard non absorbablepolypropylene and the newer partially absorbable composite meshes., Materials and Methods: A total of 60 patients with unilateral uncomplicated inguinal hernia were included in the study and randomly divided into two groups, one each for one kind of mesh. Patients underwent Transabdominal Preperitoneal (TAPP) repair of hernia after taking written informed consent. Follow up was done in the immediate postoperative period and at three months. Patients were compared for inguinodynia, sensation of heaviness, seroma/haematoma formation and return to work activities. Standard statistical tests were applied and a p-value <0.05 was taken as significant., Results: Patients in the composite group complain of significantly less pain as compared to those with the non absorbable mesh at three months (p-value 0.003). They also report less sensation of heaviness over the groin area. However, incidence of seroma formation was higher in the composite group (20%) when compared to the non absorbable group (6.67%). An earlier return to work was seen in the patients with composite mesh., Conclusion: Use of composite mesh in TAPP is associated with better patient outcomes in terms of less postoperative pain and an earlier return to work.

Introduction: Gastric volvulus is an uncommon disorder and can present either in the acute or chronic setting with variable symptoms. A robust blood supply of the stomach from different sources does not allow ischemia to develop early. When it occurs in the acute scenario, patients present with severe epigastric pain and retching without vomiting. Together with inability to pass nasogastric tube, they constitute Borchardt's triad., Presentation of Case: We report a case which presented in the emergency department with severe abdominal pain, abdominal distension and vomiting and a previous history of pulmonary tuberculosis. An incidental finding of uterovaginal prolapse was present. A diagnosis of acute gastric volvulus with peritonitis was made and total gastrectomy with Roux-en-Y esophagojejunostomy for gangrenous and perforated stomach was performed., Discussion: Primary gastric volvulus occurs in the absence of any defect in the diaphragm or adjacent organ pathology and may be caused by weakening of gastric supports. We wish to highlight if there is a possible association of primary gastric volvulus with uterovaginal prolapse reflecting a general laxity of body ligaments or with fibrosis of the lung secondary to pulmonary tuberculosis resulting into the twisting of the stomach., Conclusion: Acute gastric volvulus is a surgical emergency requiring early diagnosis and aggressive management, as a delay results into complications like gangrene and perforation which substantially increase the morbidity and mortality in these patients., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Mineral trioxide aggregate is the mainstay of treatment of large internal resorption defects. But its cost may be a deterrent to its use in some patients. The present case report describes the successful endodontic management of an extensive internal resorptive lesion in a mandibular molar with metal reinforced glass ionomer cement.

Purpose: The objective of this analysis was to evaluate the effects of dietary B vitamin intakes on creatinine-adjusted urinary total arsenic concentration among individuals participating in the Health Effects of Arsenic Longitudinal Study (HEALS) cohort in Araihazar, Bangladesh. Arsenic exposure is a major public health problem in Bangladesh, where nearly 77 million people have been chronically exposed to arsenic through the consumption of naturally contaminated groundwater. Dietary factors influencing the metabolism of ingested arsenic may potentially be important modifiers of the health effects of arsenic in this population., Methods: Daily average B vitamin intakes from a validated food frequency questionnaire and laboratory data on drinking water and urinary arsenic concentrations among 9,833 HEALS cohort participants were utilized. Statistical analyses were conducted using generalized estimating equations incorporating knotted spline linear regression., Results: Increasing dietary intakes of thiamin, niacin, pantothenic acid, and pyridoxine were found to significantly increase urinary total arsenic excretion, adjusted for daily arsenic intake from drinking water and other potential confounders., Conclusions: These results suggest that higher intakes of certain B vitamins may enhance the excretion of arsenic from the body. This study offers new insights into modifiable dietary factors that relate to arsenic excretion and thus provides potential avenues for the prevention of arsenic-related health effects.

Background: Body mass index (BMI) (kg/m(2)) has a U- or J-shaped relationship with all-cause mortality in Western and East Asian populations. However, this relationship is not well characterized in Bangladesh, where the BMI distribution is shifted towards lower values., Methods: Using data on 11,445 individuals (aged 18-75 years) participating in the Health Effects of Arsenic Longitudinal Study (HEALS) in Araihazar, Bangladesh, we prospectively examined associations of BMI (measured at baseline) with all-cause mortality during approximately 6 years of follow-up. We also examined this relationship within strata of key covariates (sex, age, smoking, education and arsenic exposure). Cox proportional hazards models adjusted for these covariates and BMI-related illnesses were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for BMI categories defined by the World Health Organization., Results: Low BMI was strongly associated with increased mortality in this cohort (P-trend < 0.0001). Severe underweight (BMI < 16 kg/m(2); HR 2.06, CI 1.53-2.77) and moderate underweight (16.0-16.9 kg/m(2); HR 1.39, CI 1.01-2.90) were associated with increased all-cause mortality compared with normal BMI (18.6-22.9 kg/m(2)). The highest BMI category (> or =23.0 kg/m(2)) did not show a clear association with mortality (HR 1.10, CI 0.77-1.53). The BMI-mortality association was stronger among individuals with <5 years of formal education (interaction P = 0.02)., Conclusions: Underweight (presumably due to malnutrition) is a major determinant of mortality in the rural Bangladeshi population.

Background: Millions of people worldwide are chronically exposed to arsenic through drinking water, including 35-77 million people in Bangladesh. The association between arsenic exposure and mortality rate has not been prospectively investigated by use of individual-level data. We therefore prospectively assessed whether chronic and recent changes in arsenic exposure are associated with all-cause and chronic-disease mortalities in a Bangladeshi population., Methods: In the prospective cohort Health Effects of Arsenic Longitudinal Study (HEALS), trained physicians unaware of arsenic exposure interviewed in person and clinically assessed 11 746 population-based participants (aged 18-75 years) from Araihazar, Bangladesh. Participants were recruited from October, 2000, to May, 2002, and followed-up biennially. Data for mortality rates were available throughout February, 2009. We used Cox proportional hazards model to estimate hazard ratios (HRs) of mortality, with adjustment for potential confounders, at different doses of arsenic exposure., Findings: 407 deaths were ascertained between October, 2000, and February, 2009. Multivariate adjusted HRs for all-cause mortality in a comparison of arsenic at concentrations of 10.1-50.0 microg/L, 50.1-150.0 microg/L, and 150.1-864.0 microg/L with at least 10.0 microg/L in well water were 1.34 (95% CI 0.99-1.82), 1.09 (0.81-1.47), and 1.68 (1.26-2.23), respectively. Results were similar with daily arsenic dose and total arsenic concentration in urine. Recent change in exposure, measurement of total arsenic concentrations in urine repeated biennially, did not have much effect on the mortality rate., Interpretation: Chronic arsenic exposure through drinking water was associated with an increase in the mortality rate. Follow-up data from this cohort will be used to assess the long-term effects of arsenic exposure and how they might be affected by changes in exposure. However, solutions and resources are urgently needed to mitigate the resulting health effects of arsenic exposure., Funding: US National Institutes of Health., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Of seven patients with Barrett's esophagus, two had acute upper gastrointestinal (GI) tract bleeding, two had slow chronic upper GI tract bleeding; and three had dysphagia and weight loss. At upper GI tract endoscopy, 1- to 2-cm ulcers were seen in all seven patients in the distal esophagus. Four of the seven patients also had stricture of varying severity in the distal esophagus. Serial esophageal mucosal biopsy specimens in all seven patients revealed specialized columnar epithelium distal to 28 cm from the incisor teeth. Five of the seven patients were treated with intensive antacid therapy for eight weeks; but the ulcers had not healed after this period of treatment as assessed endoscopically. These five patients and two more then started therapy with cimetidine, 1.2 g per day. Repeat endoscopy four weeks and eight weeks after institution of cimetidine therapy revealed complete healing of the esophageal ulcers in six of the seven patients. One patient needed 16 weeks of cimetidine therapy before his ulcer had healed completely. Cimetidine therapy was not effective in preventing restricture of the esophagus. Two patients underwent biopsy 18 months after successful treatment; gastric epithelium had not reverted to squamous epithelium.

Complete right bundle branch block associated with a normal QRS axis and a normal PR interval was observed in 2.8 percent of 500 consecutive acute myocardial infarction patients admitted to the coronary care unit of a community teaching hospital. This experience and a review of the literature reveals that this unifascicular block complicating acute myocardial infarction is typically associated with (1) an elderly patient population, (2) a hospital mortality rate in excess of 50 percent, and (3) a "new" onset complete right bundle branch block which carries a higher mortality than when this electrocardiographic pattern preexists the acute infarction.

A 61-year old white male, known to have alcoholic cirrhosis, presented with massive fresh bleeding per rectum. Various investigations failed to ascertain the cause of bleeding. Hepatoma of the liver was revealed by selective hepatic and superior mesenteric angiography. Massive lower gastrointestinal bleeding occurred again one month later and was rapidly followed by death from hepatic coma. An extensive hepatoma infiltrating the adjacent hepatic flexure of the colon was found at autopsy, the colonic infiltration explaining the lower gastrointestinal hemorrhage.

In order to consider possible environmental factors related to the development of benign hepatic tumors, all reports of this disorder in the case records of five different hospitals in Rochester, New York, during the past 10 years were reviewed. Seven patients with benign hepatic tumors of the liver and two with peliosis hepatis were identified. Among the seven with a benign hepatic tumor, four were women currently receiving oral contraceptives; one had been receiving this medication in the past, and two had no history of exposure to any steroid whatsoever. The two patients with peliosis hepatis were receiving long-term androgenic anabolic steroids. Dilated, thin-walled vessels and vascular spaces were a more prominent feature of the tumor seen in four patients receiving oral contraceptive pills. It is emphasized in this report that benign hepatic tumors do occur in men and in patients with cirrhotic liver without the use of any kind of steroids.