👤 Manpreet Bhalla

Spinal TB (STB) is paucibacillary form of disease caused by Mycobacterium Tuberculosis. Late diagnosis of STB can lead to significant disability and morbidity. There is limited data available on diagnostic yield of CT guided biopsy/ultrasonography guided aspiration by various laboratory tests (phenotypic and molecular) used in evaluation STB. Present study was conducted in Department Orthopaedics and Pathology at tertiary care centre in Delhi. Total 68 clinico-radiologically suspected cases undergoing percutaneous aspiration (CT/USG guided) were included in the study. The aspirated tissue/pus was sent for cytology/histopathology/culture/molecular tests. Diagnostic yield of CT/USG guided aspiration for various phenotypic (histopathology/cytology/AFB smear) and molecular tests (CBNAAT/LPA) was calculated alone and in various combination. pvalue <0.05 was considered significant. AFB smear had the lowest diagnostic yield in both USG and CT guided aspirate (28 % and 17.2 % respectively). Histology/cytology combination with molecular method had 100 % diagnostic yield similar to all tests combined. Diagnosis of STB was ascertained in all cases using the combination of molecular methods and phenotypic tests and no single test is effective in ascertaining the diagnosis. The tissue obtained by percutaneous CT guided biopsy/USG guided aspiration technique is adequate to submit tissue to all tests to ascertain diagnosis. Show less

We recently demonstrated the utility of the 'TB Concentration & Transport' kit for bio-safe, ambient-temperature transport of dried sputum samples on Trans-Filter, along with the 'TB DNA Extraction' kit for efficient DNA extraction from Trans-Filter for use in the Line Probe Assay (LPA) for diagnosing drug-resistant tuberculosis (TB). The present study aimed to develop and evaluate a new 'Quick TB DNA Extraction' kit ('Quick DNA' kit) for rapid DNA isolation from Trans-Filter samples and assess its compatibility with LPA for the detection of multidrug-resistant TB (MDR-TB). Consecutive presumptive TB/MDR-TB/XDR-TB patients (n = 1823) were screened using LED-FM and/or TBDetect microscopy at 2 Designated Microscopy Centres associated with the National Institute of Tuberculosis and Respiratory Diseases (NITRD), New Delhi. Smear-positive samples (n = 235) were processed in duplicate using the 'TB Concentration and Transport' kit. Dried sputum on bio-safe Trans-Filters was transported at ambient temperature, along with sputum samples, in a 3-layer packing in cooling conditions to NITRD Hospital (a National Reference Laboratory). DNA was extracted from Trans-Filters using 'Quick DNA' kit and the 'TB DNA Extraction' kit, and from sputum using Hain's GenoLyse® DNA Extraction kit for first-line LPA for MDR-TB detection. Quick Kit-LPA and Kit-LPA (LPA with DNA extracted from Trans-Filter using 'Quick DNA' kit and 'TB DNA Extraction' kit, respectively) showed similar sensitivity of 88.9% (95% CI: 65.3-98.6) and 88.5% (95% CI: 69.9-97.5) and specificity of 100% (95% CI: 98.2-100) and 99.5% (95% CI: 97.3-99.9) for rifampicin and isoniazid resistance detection, respectively against Direct-LPA (LPA with DNA extracted from sputum samples using GenoLyse kit). User feedback obtained from laboratory technicians corroborated that the one-step 'Quick DNA' kit procedure was rapid (5 minutes), easy to perform, seamlessly integrated with LPA testing, and was suitable as a replacement for Kit-LPA or Direct-LPA. The gap between drug-resistant TB detection and treatment initiation can be narrowed through Universal-Drug Susceptibility Testing by implementing (i) bio-safe and ambient temperature transport of sputum from primary healthcare centres to central laboratories, and (ii) by using Quick Kit-LPA over Direct-LPA in patients residing in remote areas. Show less

Trainees are facing isolation and burnout, due to the fear of contracting and transmitting novel coronavirus-19 (COVID-19). There has been a reduction in clinical activities of residents. The purpose of this paper is to measure and compare the psychological well-being of dental versus medical residents during the COVID-19 outbreak. This is a cross-sectional study whereby trainees of a hospital in New York City were sent a questionnaire. Participants were from the dental and medical departments. Psychological measures of depression and post traumatic stress disorder were assessed utilizing the Patient Health Questionnaire-9 (PHQ-9) and The Impact of Event Scale-Revised (IES-R) questionnaire. Other variables compared were age, gender, smoking status, living situation and comorbidities. Data analysis utilized chi-squared (X The survey was sent to 19 dental (Dental) and 171 medical (MD) residents. There were 66 participants. The response rate was 63.16 and 35.09% for the Dental and MD residents, respectively. The mean age for the Dental and MD residents, respectively, was 29.62 ± 2.09 and 34.82 ± 9.32 (P = .014). Eighty-one percent of the Dental respondents were male and 33.3% of the MD respondents were male (P < .001). The mean PHQ-9 score was 18.29 ± 2.88 vs 7.24 ± 7.41 for Dental and MD residents, respectively (P < .001). A higher score represents increased severity of depression. The Dental residents scored 61.9 ± 3.90 on the IES-R vs 30.36 ± 24.67 (P < .001). A higher score indicates a greater frequency of intrusive thoughts and avoidance. Forty-two percent of Dental and 13.3% of MD residents tested positive; 25% of Dental and 28.9% of MD residents self-reported symptoms for COVID-19. Being positive or symptomatic resulted in statistically significant higher IES-R and PHQ-9 scores. Dental residents and being positive or symptomatic for COVID-19 resulted in higher PHQ-9 and IES-R scores. Being aware of the impact of COVID-19 is an important step in providing intervention. Show less

Oroantral communication and fistula are commonly seen complications in the field of oral and maxillofacial surgery. Oral surgeons must be familiar with the diagnosis and proper management including multiple soft and hard tissue approaches to this surgical dilemma. Show less

Implant stability is critical to implant success, and the amount of available bone is vital to achieving that end. Because of low-lying maxillary sinuses, adequate alveolar height on the posterior maxilla is often lacking in many patients in need of implant replacement. This chapter reviews both the traditional lateral sinus lift maxillary approach to achieve vertical augmentation as well as the transcrestal osteotome intraoral approach. A discussion of osseodensification will also be mentioned as an alternative approach. Show less

The US Surgeon General's report Oral Health in America highlighted ways in which oral health and systemic conditions are associated with each other. An oral examination can reveal signs and symptoms associated with systemic diseases. In this article, multiple systemic diseases including but not limited to viral and immune modulated conditions and associated oral symptoms are discussed. Show less

Silent sinus syndrome (SSS) describes enophthalmos and hypoglobus in association with disease of the maxillary sinus. This syndrome has rarely been presented in the dental literature. Many dentists are not familiar with the syndrome and its associated clinical and radiologic features. A 57-year-old female patient presented to the Oral and Maxillofacial Surgery Outpatient Clinic at The Brooklyn Hospital Center for a routine dental examination. During this examination, she indicated that she felt her right eye had been sinking. Routine dental panoramic radiography showed opacification on the right maxillary sinus. Maxillofacial computed tomography showed a small maxillary sinus with retraction of the sinus walls. The floor of the orbit was thinned, causing hypoglobus. Obstruction of the right ostiomeatal complex was noted, with complete opacification of the right maxillary sinus. A diagnosis of SSS was made. SSS usually occurs in individuals in the third to fifth decade of life. It presents with enopthalmos and hypoglobus. On imaging, a small and opacified maxillary sinus is visualized with retraction of the orbital floor and a blocked ostiomeatal complex. Management includes functional endoscopic sinus surgery. The orbital floor can be reconstructed during the same operation, at a later date, or not at all. Knowledge about SSS can lead to prompt diagnosis and treatment recommendations while avoiding unnecessary diagnostic tests. Show less