Introduction: Dengue fever, commonly known as breakbone fever is the most common arboviral mosquito-borne disease in the world. Aims of the study was to find any correlation of vitamin B₁₂ levels with the degree of thrombocytopenia in dengue patients. Materials and methods: A hospital-based study from January 2019 to June 2020 at the Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur. The study was done on dengue fever patients with severe thrombocytopenia (<50,000 μL and >2 days duration). Results: Mean platelet count in patients with ≤200 pg/mL vitamin B₁₂ was 38,653.06 ± 6362.49 per mL and in patients with >200 pg/mL vitamin B₁₂ was 40,564.35 ± 61.04.78 per mL. Mean platelet recovery in patients with ≤200 pg/mL vitamin B₁₂ was 7.00 ± 1.04 days and in patients with >200 pg/mL vitamin B₁₂ was 4.33 ± 0.59 days. Mean hospital stay in patients with ≤200 pg/mL vitamin B₁₂ was 7.96 ± 0.71 days and in patients with >200 pg/mL, vitamin B₁₂ was 4.49 ± 0.50 days. Conclusion: Vitamin B₁₂ deficiency may be a contributing factor to the development of severe thrombocytopenia in dengue fever, particularly in the Indian population. Vitamin B₁₂ deficiency may prolong the hospital stay and increase the platelet recovery time.

Introduction: The choice of pacing mode in sinus node dysfunction in patients is still up for debate. Patients with atrial pacing (AAI/AAIR) in comparison to ventricular pacing (VVI/VVIR) have fewer chances of developing atrial fibrillation, stroke, and heart failure. Dual-chamber pacing (DDD/DDDR) is also associated with significantly less atrial fibrillation and less heart failure hospitalization, but various trials have failed to show a survival benefit in relation to ventricular pacing alone. We report about the use of AAIR pacemaker implantation for sinus node dysfunction in 15 adult patients and analyze the clinical characteristics and short-term outcomes of these patients. Materials and methods: All adult patients (18 years or above) who underwent AAIR pacemaker implantation for sinus node dysfunction at the Department of Cardiology, Mahatma Gandhi Hospital, Jaipur between 1^st June 2018 and 31^st August 2021 were included in the study for retrospective analysis of clinical characteristics and short-term outcome of these patients. This was a retrospective observational study. Prior approval was taken before the start of the study from the Institute Ethics Committee. Results: In our study, the mean age was 63 years and 66% of patients were females. Hypertension was present in 46% of patients and diabetes was seen in 33% of patients. About 26% of patients were having coronary artery disease (CAD). The mean LVEF in the study was 54%. Regarding the indication of AAIR pacemaker, 26% had inappropriate sinus bradycardia, 53% had significant sinus pause, and 20% had bradycardia-tachycardia syndrome. The procedure-related complication was not reported in our study. No change in the pacing mode was required in all 15 patients. Two patients developed episodes of paroxysmal AF on follow-up. No deaths were reported on short-term follow-up. Conclusion: The development of AV blocks is rare in sinus node dysfunction patients. The optimal choice of pacing in these patients is the atrial (AAI/AAIR) pacemaker. It is the safest and provides the best cost-to-benefit ratio when compared to a dual-chamber pacemaker. Hence, atrial pacing should be preferred in sinus node dysfunction patients in the absence of atrioventricular blocks.

Background and aim: ST Elevation Myocardial Infarction (STEMI) occurs from occlusion of one or more of the coronary arteries due to abrupt disruption of blood flow which is usually due to plaque rupture, erosion, fissuring, or dissection of coronary arteries that results in an obstructing thrombus. Hyponatremia is a common electrolyte disturbance that is seen frequently in clinical practice. It is also common in patients with myocardial infarction. We tried to study the association between hyponatremia and the severity of STEMI. Materials and methods: A hospital-based study was done on patients of STEMI fitting in inclusion and exclusion criteria attending the OPD/IPD of Mahatma Gandhi Hospital, Jaipur, Rajasthan, India. Results: STEMI patients with hyponatremia had reduced ejection fraction as compared to nonhyponatremic patients. Conclusion: This study concluded that in STEMI patients, decreased sodium levels can be an indicator of worse prognosis as compared to patients with normal sodium levels.

Introduction: COVID-19 epidemic caused by SARS-CoV-2 has progressed into a pandemic. The effect of the virus on healthcare workers (HCWs) is immense and they are one of the highest risk groups in terms of exposure to infection. This study was done to understand the severity of disease in HCWs when they do get infected by SARS-CoV-2 so that we can be better prepared for such future outbreaks of infections. Materials and methods: Healthcare workers affected by SARS COVID-19 infection were identified from March 2020 to December 2020, and a questionnaire regarding clinical profile, course of illness, source of infection, pre-exposure prophylaxis, CT value, CTSS score, vaccination-related information, etc., were collected and analyzed. Results: Out of 133 HCWs, 77.4% had mild disease, 18% had moderate disease, and 4.5% had severe disease. All patients with severe disease belonged to the 35–55 years age-group. About 64.4% of HCWs who had got an HRCT-chest done had a CT severity score of less than 8 out of 25, 60.1% HCWs were home quarantined only, 33% of those who required hospital admission were admitted for less than 15 days, 88.7% HCWs did not require any ventilatory supports, 9% of the HCWs were given plasma therapy, post hoc analysis (Bonferroni) indicated a significantly lower mean cycle threshold value (higher viral load) in severe disease than a mild disease in healthcare workers. Conclusion: There was no significant difference in the severity of distribution according to gender, prophylaxis, contact history, duration of hospital stay, ventilatory support, and receiving plasma therapy. CT severity scores positively correlated with disease severity in HCWs.

Introduction: Dengue is a major health threat with epidemic potential and is prevalent in tropical and subtropical regions of the world. This study was aimed at analyzing the circulating dengue serotypes in our region and their correlation with the severity of disease presenting to our hospital. Materials and methods: A hospital-based retrospective study was done on 100 patients with dengue infection who fulfilled the inclusion and exclusion criteria, admitted under the Department of General Medicine of Mahatma Gandhi Medical College and Hospital, Jaipur. Dengue serotype was confirmed by RT-PCR. Results: A total of 100 patients were included in the data analysis. Adult age group (82%) and male gender (54%) were the most commonly affected group. The most common serotypes in circulation were DENV-2 and DENV-3 (60% cases). Severe dengue was maximum in patients with DENV-2 (20.6%). Concurrent infection with two serotypes was present in four cases. The mean duration of hospital stay was maximum in DENV-4 (5.33 ± 2.09 days). The maximum percentage of DENV-1 cases required platelet transfusion. Conclusion: At our hospital, adult age group and male gender are most commonly affected, with DENV-2 being the most common serotype and having maximum severity. Initial serotyping of dengue patients can help monitor the epidemiological and clinical trends of the different serotypes of dengue infection. Co-infection with two serotypes can also occur.

Incisal fracture of the teeth of the anterior segment of the jaw is a relatively more popular form of dental trauma. Various treatment modus operandi for complicated crown fractures are put forward depending on the severity of the fracture in addition to soft tissue damage. The trauma to the teeth can be contemplated as a concern to public health. The amplified occurrence of fracture of anterior tooth necessitates a most cautious approach for the treatment of the same. During the biomechanical preparation of the root canal, there is always a possibility for the instrument to break in the canal itself. It causes a metallic obstruction of the canal which hinders further cleaning and shaping. Our primary goal in these instances should be an attempt for retrieval of the broken instrument and in case it is not possible bypass should be sought. The broken instrument in the canal not only creates anxiety for the clinician but also causes discomfort in the form of pain to the patient. In order to understand the numerous factors leading to the fracture of the instrument, a substantial amount of research has been done to minimize its occurrence. Several methods and techniques are available for the retrieval of the separated instruments from the root canal. The present article portrays the victorious removal of a broken instrument from the root canal of a maxillary central incisor using an H file followed by the management of Ellis 3 fracture in children.

Oral submucous fibrosis is a chronic and disabling disease with obscure etiology that affects the complete oral cavity occasionally with the pharynx, and rarely involving the larynx. It is characterized by blanching and stiffness of the oral mucosa, which causes progressive limitation of mouth opening and intolerance to hot and spicy food. This prospective study evaluates the utility of platysma myocutaneous flap (PMF) in the reconstruction of surgical defects followed by treatment of oral submucous fibrosis (OSMF) in a case report. The purpose of this case report is to examine the experience and result obtained with the use of reconstruction of intraoral defects with platysma myocutaneous flap in this case. Complications that can occur when adopting this technique may be subjected to total or partial necrosis of skin island, fistula, dehiscence, hematoma, and cellulitis with variable rates. We think that the platysma myocutaneous flap is a better option that an extended nasolabial flap in terms of its owning drawbacks for the management of oral submucous fibrosis cases in practice.

Artery of Percheron (AOP) occlusion is a rare cause of ischemic stroke characterized by bilateral paramedian thalamic infarct with or without rostral midbrain infarction. Clinically characterized by a triad of altered mental status, memory impairment, and vertical gaze palsy. Here, we report a case of AOP infarction in a 69-year-old male patient. This case is being reported to highlight the interesting neuroimaging and clinical features of this condition.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening hyperinflammatory syndrome and is classified into primary and secondary HLH. Primary HLH includes monogenic problems that especially have an effect on the perforin-mediated cytotoxicity of cytotoxic T lymphocytes and herbal killer cells. Secondary HLH happens as a difficulty in diverse settings together with infection, malignancy, autoimmune disease, and postallogeneic hematopoietic stem mobileular transplantation. Both primary and secondary HLH are characterized via way of means of out of control hypercytokinemia that affects myelosuppression and vascular endothelium damage. The maximum not unusual place shows of HLH are continual fever refractory to antimicrobial retailers and hyperferritinemia because of hypersecretion of diverse cytokines. To enhance outcome, it is miles critical to discover the problems underlying HLH and offer disorder-suitable treatment.

Awareness of anatomy of root canal and its associated variations is important to ensure successful endodontic treatment. Mandibular first molar generally demonstrates presence of one mesial and distal root with three canals. But in some cases, they depict anatomic variation in terms of number of roots wherein an additional root might be present either buccally [radix paramolaris (RP)] or lingually [radix entomolaris (RE)]. Appropriate diagnosis of such atypical anatomic variation is key to success for root canal therapy. This case report describes endodontic management of a mandibular first molar with radix, variation was identified through clinical examination along with the aid of multiangled radiographs, and was confirmed with the help of a cone-beam computed tomography (CBCT) imaging.

Isolated fallopian tube torsion is a rarely encountered gynecological condition during acute pelvic pain in a female of reproductive age. Its clinical diagnosis is very difficult or almost impossible. On preoperative ultrasound suspicion of isolated fallopian tube, torsion can be given. Magnetic resonance imaging (MRI) may further improve confidence for diagnosis if MRI findings correlate with ultrasonography findings. Laparoscopy is necessary to establish the diagnosis. Isolated fallopian tube torsion should be suspected when a female presents with acute pelvic pain. Isolated fallopian tube torsion requires prompt intervention to save the adnexa.