A sialolith observed in the Wharton's duct of a male patient was resected using an Nd:YAG laser. This is the first report on the resection of sialolith using laser. The resected sample was analyzed for structural details using Fourier transform infrared (FTIR), FT-Raman, and fluorescence spectroscopic techniques. Other techniques like energy dispersive X-ray analysis, scanning electron microscopy, and thermal analysis were also used for the analysis of structural details. The major peaks of the vibrational spectra are observed to be due to the vibrations of the phosphate and hydroxyl groups of the inorganic part of the sample and the proteinaceous component of the organic part. The major elements in the sample are identified as calcium and phosphorous in the ratio 7:3. The fluorescence spectra recorded at excitation wavelengths 280, 325, and 410 nm showed emission maxima corresponding to the endogenous fluorescence of structural proteins and amino acids. The inorganic part of the sialolith remained stable even at temperatures up to 1,673 K. The spectroscopic studies indicated that the structure of the sialolith is similar to that of the dentine part of the human teeth. In situ disintegration of the sialolith involves very high temperature. High calcium and phosphorous content in the food may be attributed to one of the reasons for the formation of sialoliths.

Oral cancer is usually preceded by oral potentially malignant disorders (OPMDs) and early detection can downstage the disease. The majority of OPMDs are asymptomatic in early stages and can be detected on routine oral examination. Though only a proportion of OPMDs may transform to oral squamous cell carcinoma (OSCC), they may serve as a surrogate clinical lesion to identify individuals at risk of developing OSCC. Currently, there is a scarcity of scientific evidence on specific interventions and management of OPMDs and there is no consensus regarding their management. A consensus meeting with a panel of experts was convened to frame guidelines for clinical practices and recommendations for management strategies for OPMDs. A review of literature from medical databases was conducted to provide the best possible evidence and provide recommendations in management of OPMDs.

Lemierre's syndrome is a condition characterised by suppurative thrombophlebitis of the internal jugular (IJ) vein following a recent oropharyngeal infection, with resulting septicaemia and metastatic lesions. It is strongly associated with Fusobacterium necrophorum, a Gram-negative bacilli. Key to early diagnosis is awareness of the classical history and course of this illness, and therefore to ask about a history of recent oropharyngeal infections when a young patient presents with fever and rigors. Diagnosis can be confi rmed by showing thrombophlebitis of the IJ vein, culturing F necrophorum from normally sterile sites or demonstrating metastatic lesions in this clinical setting. The cornerstone of management is draining of purulent collection where possible and prolonged courses of appropriate antibiotics. In this article, we review a case study of a young man with Lemierre's syndrome and discuss the condition in more detail.

Background: Hyponatremia (serum Na+ < 135 mmol/L) is the most common electrolyte abnormality detected in clinical practice and an important cause of mortality and morbidity in hospital settings. Hyponatremia in patients with pneumonia is usually mild but is associated with increased risk of intensive care unit (ICU) admission, prolonged hospital stays, and increased mortality rates. The purpose of this study is to understand the impact of varying degrees of hyponatremia and various other inflammatory markers on the severity and outcome of coronavirus disease-19 (COVID-19). Objective: The main objective of this study is to evaluate the prevalence of hyponatremia in COVID-19 patients and to assess the correlation between hyponatremia and severity and outcome of COVID-19. The other objective is to evaluate the correlation between various inflammatory markers and outcome (ICU vs non-ICU admission, discharged vs deceased) in patients with COVID-19 pneumonia. Methods: A total of 113 participants who have been diagnosed with COVID-19 infection by reverse transcriptase-polymerase chain reaction test were included in the study. Epidemiological, demographic, clinical, investigative work-up, and outcome data were extracted from electronic health records using a standard data collection form. Based on serum sodium levels, patients were divided into two groups: normonatremic (serum Na+ ≥ 135 mEq/L) and hyponatremic (serum Na+ < 135 mEq/L). Various clinical, laboratory, and outcome parameters were compared between the two groups. Results: Hyponatremia was present in 50 out of 113 (44%) patients in our study, and it was generally mild. There were more male patients in hyponatremia group ( P = .006), and hyponatremic patients were older than normonatremic patients ( P = .001). Forty (35%) of the 113 patients were transferred to the ICU, and 17 (15%) needed mechanical ventilation during their hospitalization. Interleukin-6 (IL-6) levels were higher in the hyponatremic group ( P = .022). Intensive care unit admissions and oxygen requirement were significantly higher in hyponatremic patients ( P = .001 and .016, respectively). Ferritin, lactate dehydrogenase (LDH), IL-6, total leucocyte count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels were significantly elevated in those patients requiring ICU admission and those who died due to COVID-19. Conclusions: Our study revealed that demography, clinical features, radiographic findings, complications like renal insufficiency, and inflammatory markers like IL-6 play a considerable role in hyponatremic COVID-19 patients. Hyponatremia patients required significantly higher rates of ICU admissions and oxygen support. Our results suggest that monitoring inflammatory markers such as ESR, CRP, total white blood cell (WBC) count, ferritin, LDH, and IL-6 may serve as an early warning system for progression to severe COVID-19.

Malnutrition, inflammation, and atherosclerosis are significant problems in patients on hemodialysis. A prospective, observational study in 100 hemodialysis patients for 2 years was conducted. The primary outcomes were hospitalizations and mortality at the end of 2 years. The mean age was 61 ± 11.3 years and 69% were male. Seven patients did not complete the study (five underwent transplant and two were shifted to other units). Serum albumin was significantly lower in malnourished patients at 6 months from the beginning of the study period (3.58 vs. 3.79 g/dl, P = 0.001). Malnutrition based on subjective global assessment (SGA) was seen in 30 (32%) patients: mild to moderate in 27 (29%) and severe in 3 (3%). Inflammation was seen in 73 (78.5%) patients and intimal-medial thickness of >1.1 mm indicating significant atherosclerosis was seen in 73 (78.5%) patients. Modified SGA score and malnutrition-inflammation score (MIS) were significantly more in the malnourished group. Statistically significant association was seen between hospitalization and mortality in the malnourished population, and the odds ratio of death in malnourished patients was 9.83 (95% confidence interval: 2.8–34.3, P < 0.001). There was a moderate correlation between malnutrition assessed by modified SGA and MIS score (r = 0.54, P < 0.001). Mortality rate was 37% in patients with mild to moderate and 67% in severe malnutrition. Hospital admission was seen in 43 (46%) patients and was significantly more common in malnourished compared to well-nourished patients (77% vs. 32%, P < 0.001). Multiple logistic regression analysis showed that malnutrition by Modified SGA was the only significant variable associated with mortality at 2 years, and addition of MIS score did not improve the predictive ability of the model to modified SGA. We recommend the use of modified SGA and serial serum albumin to monitor nutrition in hemodialysis patients.