MR Imaging Spectrum of Neuro Rhino Sino Orbital Fungal Infections in patients treated for COVID

Objectives: To analyse the spectrum of imaging findings of fungal infection as seen in MRI images of priorly treated for COVID. Materials and methods: The different patterns of findings of Neuro Rhino Sino Orbital Fungal Infections as seen in MRI images in 100 patients who received standard treatment for COVID in recent past and presented with suggestive signs and symptoms. Results: No positive MRI findings to suggest any neural tissue, orbital or Sino nasal involvement was seen in 35 % of cases. Only sino nasal involvement noted in 23 % cases. Sino-nasal as well as orbital involvement seen in 21 % cases. Neuro Sino Naso Orbital lesions were seen in 11% cases. Non fungal orbito-facial soft tissue inflammation was seen in 10 % cases. Conclusion: In patients who have received standard treatment for Covid and who later developed signs and symptoms of neural, orbital or Sino nasal involvement; positive imaging findings were noted in 65% cases. Fungal infections were seen more in middle aged population [40-60 years of age]. About 75 % of affected patients were known diabetics. Neural involvement was least common. This study proposes a new staging system [Stage 0, X, I, II, III, IV] for describing the affected region by fungal infection.

The “Vitaminic-strategy” Against the Oral Bacteria S. Mutans and F. Nucleatum, Agents of Caries and Halitosis

BackgroundThe oral cavity is one of the most complex human body environments. Indeed, the continuous variation of this habitat conditions reflects the high dynamism of the resident microbial community. Two key actors in the oral diseases are the bacteria Streptococcus mutans and Fusobacterium nucleatum, both implicated in the formation of oral biofilms and consequently in the generation of common pathologies such as caries and various gingival and soft tissue inflammation diseases. In addition, F. nucleatum is also implicated in the halitosis phenomenon, thanks to its demonstrated ability to produce as second metabolite the hydrogen sulphide (H2S), one of the volatile sulphur compounds (VSCs) that, with methyl mercaptan (CH3SH) and the dimethyl sulphide (CH3SCH3)24, is produced by periodontopathic anaerobic bacteria and causes the awkward bad breath in halitosis patients.MethodsIn this study, the oral preparation Vea® Oris constituted only by vitamin E and capric/caprylic acid was evaluated as a potential treatment of caries and periodontal diseases; the effect of the product at different concentrations on the growth and the ability of both strains to form biofilm was investigated. Regarding to F. nucleatum also the influence of Vea® Oris on the production of H2S was evaluated. ResultsOur in vitro results suggested that the Vea® Oris treatment could considerably reduce the growth and biofilm formation of both S. mutans and F. nucleatum. For F. nucleatum an appreciable reduction of the H2S production can be also obtained. ConclusionsOverall, this study highlighted the potential of Vea® Oris as a more “natural” adjuvant to prevent the biofilm and plaque formation and to reduce the smelly odour of halitosis.

Comparison of photobiomodulation and photodynamic therapy as adjuncts to mechanical debridement for the treatment of peri-implantitis

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the efficacy of photobiomodulation therapy (PBMT) and photodynamic therapy (PDT) as adjuncts to mechanical debridement (MD) for the treatment of peri-implantitis. The present study is based on the null hypothesis that there is no difference in the peri-implant inflammatory parameters (modified plaque index [mPI], modified gingival index [mGI], probing depth [PD]) and crestal bone loss (CBL) following MD either with PBMT or PDT in patients with peri-implantitis. METHODS: Forty-nine patients with peri-implantitis were randomly categorized into three groups. In Groups 1 and 2, patients underwent MD with adjunct PBMT and PDT, respectively. In Group 3, patients underwent MD alone (controls). Peri-implant inflammatory parameters were measured at baseline and 3-months follow-up. P-values < 0.01 were considered statistically significant. RESULTS: At baseline, peri-implant clinicoradiographic parameters were comparable in all groups. Compared with baseline, there was a significant reduction in mPI (P< 0.001), mGI (P< 0.001) and PD (P< 0.001) in Groups 1 and 2 at 3-months follow-up. In Group 3, there was no difference in the scores of mPI, mGI and PD at follow-up. At 3-months follow-up, there was no difference in mPI, mGI and PD among patients in Groups 1 and 2. The mPI (P< 0.001), mGI (P< 0.001) and PD (P< 0.001) were significantly higher in Group 3 than Groups 1 and 2. The CBL was comparable in all groups at follow-up. CONCLUSION: PBMT and PDT seem to be useful adjuncts to MD for the treatment of peri-implant soft-tissue inflammation among patients with peri-implantitis.

Hearing Loss and Teprotumumab

Thyroid eye disease (TED) is an unpredictable autoimmune inflammatory disease which can be sight-threatening, debilitating, and disfiguring. Teprotumumab (IV infusion every 3 weeks x 8 doses) was recently approved as the first and only FDA-approved drug for TED in 2020. Phase 2 and 3 studies showed significant improvement in proptosis, double vision, soft tissue inflammation and quality of life for patients with active moderate to severe TED. Side effects were experienced by 85% of patients on teprotumumab. Hearing loss symptoms were reported in 10% of patients and were reported to be reversible upon stopping the drug. Objective: To explore the incidence of hearing loss symptoms and sensorineural hearing loss in patients treated with teprotumumab. Methods: All patients, followed at one institution, treated with at least 4 infusions of teprotumumab were evaluated. Charts were evaluated for baseline hearing symptoms and hearing symptoms during or after therapy with teprotumumab. Those patients with hearing symptoms were referred for audiogram testing and patulous eustachian tube (PET) testing. Results: Twenty-eight patients were included in this analysis. Thirteen patients (46%) complained of hearing symptoms. The most common symptoms were autophony or an ear plugging sensation and hearing loss or muffled hearing. Hearing symptoms developed after a mean of 3.6 infusions. Of the patients with hearing symptoms, three patients (23%) had sensorineural hearing loss documented on audiogram (n=2) or patulous eustachian tube (n=1) documented on PET testing. To date, the patient with PET has experienced some improvement, but not resolution, of her symptoms. The two patients with documented sensorineural hearing loss have not experienced a significant improvement in hearing, on audiogram, on average 3 months after stopping teprotumumab. Conclusion: Teprotumumab is a promising new therapy for active moderate to severe thyroid eye disease. Providers should consider performing a baseline audiogram with PET testing and performing audiograms with PET testing for patients that develop hearing symptoms during or after therapy. Hearing loss is a concerning adverse event and its mechanism and reversibility should be further studied.

High-Pressure Injection Injuries to the Foot: A Case Report of 2 Patients

Background: High-pressure injections injuries to the extremities can result in significant disability, including amputation of the affected limb. Proprietary mixtures associated with drill mud and hydraulic fracking leads to frequent encounters with varied materials. The physician needs to be aware of the effect of these materials when inadvertent exposure occurs. Injected toxic materials cause extensive soft tissue inflammation and destruction. This puts the foot at risk not only to the cleaning fluid used, generally water, but any contaminant on the boot at the time of injury. This case report is the first known case report involving injection with drill mud contaminant and describes 2 oil field injuries resulting in the gross deep contamination of the foot from a high-pressure washer injury. Case Report: Two patients, a 46-year-old man (patient 1) and a 29-year-old man (patient 2) sustained high-pressure injection injuries to the foot. These patients underwent treatment with immediate broad-spectrum antibiotics and emergent irrigation and debridement on arrival to the treating facility. Neither patient underwent amputation of the affected extremity as a result of their injuries and achieved a full recovery and return to work. Conclusion: High-pressure injection injuries are operative emergencies. Treatment should include tetanus prophylaxis, neurovascular monitoring, broad-spectrum antibiotic coverage, emergent operative debridement for toxic materials. Despite the toxic nature of the injection injuries, aggressive treatment can improve the chance of salvage in these industrial injuries.

Peri-Implantitis - Decontaminating and Regenerative Treatment Protocol

Peri-implant diseases are defined as pathological inflammatory reactions in the tissue surrounding the osseointegrated implants. They are classified into two categories: mucositis - defined as peri-implant soft tissue inflammation and peri-implantitis - bone loss in the peri-implant region. A clinical case of a 61-years-old woman with an implant in the 46 anatomical position and a 5-year follow-up is presented. A probe depth of 5mm and a bone defect length of 35% was observed. The Implacure&reg; Protocol was applied, with the main objective of eliminating the biofilm present on the exposed implant surface. There are multiple approaches to treat peri-implant diseases. While non-surgical treatment is essential for mucositis control, the treatment of peri-implantitis surgical treatment should be considered. Regenerative bone reconstruction promotes bone repair in the defect area and reduces bleeding during probing. To achieve that, autologous fibrin combined with Cerasorb M&reg; was used. The proposed approach in the exposed clinical case involves the application of Implacure&reg; Protocol, whose combination of the physical decontamination technique, together with the use of chlorhexidine and orthophosphoric acid, added with the combination Piperacillin + Tazobactam together with hyaluronic acid, provide a base that allows to regenerate bone using platelet-rich fibrin with Cerasorb M&reg; and increase the survival time of the implant.

Influence of moderate cigarette-smoking on the peri-implant clinicoradiographic inflammatory parameters around cement- and screw-retained dental implants

The aim was to assess the influence of moderate cigarette-smoking on the clinical (bleeding on probing [BoP] and probing depth [PD]) and radiographic (crestal bone resorption [CBR]) around cement- and screw-retained dental implants at 5 years’ follow-up. A questionnaire was used to collect information about age, gender, smoking history, duration of implants in function, jaw location of the implant, and daily toothbrushing and flossing. Peri-implant BoP, PD and CBR were measured in all groups. Group comparisons were performed using one-way analysis of variance and for multiple comparisons, the Bonferroni Post hoc adjustment test was performed. Level of significance was set at P&lt;0.05. Forty-eight patients (25 smokers and 23 non-smokers) had cement-retained dental implants; and 48 (24 smokers and 24 non-smokers) had screw-retained dental implants. Among patients with cement and screw-retained dental implants, PD (P&lt;0.05) and CBR (P&lt;0.05) were significantly higher among smokers than non-smokers. The peri-implant sites that demonstrated BoP were statistically significantly higher among non-smokers (P&lt;0.05) than smokers among patients with cement- and screw-retained dental implants. There was no statistically significant difference in peri-implant PD and CBR among smokers with cement- and screw-retained dental implants. Among non-smokers with cement and screw-retained dental implants, there was no statistically significant difference in BoP, PD and CBR. Cigarette-smoking is associated with an increased PD and CBR around cement- and screw-retained dental implants. Cigarette-smoking increases peri-implant soft tissue inflammation as well as loss of crestal bone and this relationship is independent of the type of implant retention protocol used.The author recommends that cement- and screw-retained dental implants are suitable for prosthesis restoration in non-smokers. Further studies on dual-smokers (individuals smoking cigarettes and other forms of tobacco products) are needed related to the clinicoradiographic inflammatory parameters around cement- and screw-retained dental implants

Effect of Wet Field on the DE Torque Values of Abutment Screws

Screw loosening is amongst the most prevalent mechanical problems in dental implant prosthetics. Clinicians will know if the reverse Detorque values are compromised by contamination of the implant abutment screw hole either by blood , saliva or saline. Research have shown that the drying of the implant cavity may decrease the preload value when the abutment screw is closed and thereafter increase the likelihood of abutment screw loosening. Mobility of the prosthesis, or screw fracture and increase the risk of peri-implant soft-tissue inflammation. This study aims to assess and compare the effect of wet and dry fields while torqueing the abutment screws on the DE torque values. 40 Nobel bio care implant analogues mounted in plaster models were used in this study. The samples were divided into four groups dry abutment screws, artificial saliva, blood and normal saline. All the abutment screws were tightened till 20 Ncm and left aside for 15 minutes. After 15 minutes the abutment screw were DE torqued, and the DE torque values were noted for tall the groups. When analysed using paired sample t-test there was no significant difference with artificial saliva (p=0.269). There was statistical difference with blood (p=0.00) and with saline (p=0.00). Based on this study, the presence of saliva decreases the DE torque values of the abutment screws, whereas Blood and saline increase the DE torque values of the abutment screws. The presence of blood clot might be the reason for the increase in DE torque values which might decrease once the clot disintegrates. Clinicians should prevent contamination of the screw hole by blood and saliva; if contamination arises, sanitation of the infected screw and also the screw hole until final tightening is advised.

Surgical Management of Peri-implantitis

Purpose of Review To provide an overview of current surgical peri-implantitis treatment options. Recent Findings Surgical procedures for peri-implantitis treatment include two main approaches: non-augmentative and augmentative therapy. Open flap debridement (OFD) and resective treatment are non-augmentative techniques that are indicated in the presence of horizontal bone loss in aesthetically nondemanding areas. Implantoplasty performed adjunctively at supracrestally and buccally exposed rough implant surfaces has been shown to efficiently attenuate soft tissue inflammation compared to control sites. However, this was followed by more pronounced soft tissue recession. Adjunctive augmentative measures are recommended at peri-implantitis sites exhibiting intrabony defects with a minimum depth of 3 mm and in the presence of keratinized mucosa. In more advanced cases with combined defect configurations, a combination of augmentative therapy and implantoplasty at exposed rough implant surfaces beyond the bony envelope is feasible. Summary For the time being, no particular surgical protocol or material can be considered as superior in terms of long-term peri-implant tissue stability.

Cytokines and Chemokines in Periodontitis

Periodontitis is a common inflammatory periodontal disease affecting a wide range of population all over the world. The causing bacteria releases chemicals which activate the innate immune system to release proinflammatory cytokines contributing to more progression. This activates the acquired immune system leading to more progression of periodontitis. As the immune response goes on, released cytokines and chemokines can damage the periodontal ligaments, gingiva, and alveolar bone. There are many types of cytokines and chemokines in periodontitis. Cytokines are peptide mediators who are responsible for cell signaling and communication. Chemokines are a large subfamily of cytokines having the ability to coordinate leukocyte recruitment and activation. This paper is a narrative review of the literature.This review ensures that inflammatory mediators in the case of periodontitis can cause a noticeable damage in the whole apparatus of the periodontium. It causes soft tissue inflammation and bone damage affected by the mediators of both innate and acquired immune system.The inflammatory process is accompanied by large network of cytokines and chemokines. There is high expression of proinflammatory cytokines such as interleukin (IL)-1α, IL-1β, IL-6, IL-12, tumor necrosis factor (TNF)-α, and regulatory cytokines such as IL-4, IL-1(RA) receptor antagonist, IL-10, and induced protein (IP)-10. There is also increased production of cytokines IL-10, IL-12, interferon-γ, IP-10, IL-1RA, and IL-4. Cytokines IL-17, IL-6, IL-1β, TNF-α, macrophage colony-stimulating factor, and prostaglandin E2 trigger the osteoclast activity causing bone resorption.