Reductions in clinical inflammation and oral neutrophils with improving oral hygiene

Clinical Oral Investigations - This study compared the effects of oral hygiene with a toothpaste formulated with zinc (test) to a fluoride dentifrice (control) for effects on oral polymorphonuclear...     

Unruptured sinus of valsalva aneurysm presenting as acute coronary syndrome

An unusual presentation of sinus of Valsalva aneurysm causing right ventricular outflow tract obstruction and presenting as acute coronary syndrome is reported. A 38-year-old lady presented with ischemic chest pain, probably due to embolization from an unruptured sinus of Valsalva aneurysm.     

Circulatory and hepatic failure at admission predicts mortality of severe scrub typhus patients: A prospective cohort study

Objective: To study the spectrum and outcome of severe scrub typhus in adult patients and to predict the hospital mortality by organ failure on admission.Methods: This was a prospective observational cohort study conducted between July 2017 and October 2020 at the medical emergency centre of PGIMER, Chandigarh, India. One hundred and twenty-six patients aged ≥13 years were diagnosed with scrub typhus. Severe disease was defined as the presence of organ failure based on the Sequential Organ Failure Assessment(SOFA) score on admission.Results: About two-thirds of the patients were from geographic regions outside the endemic sub-Himalayan belt. Fever(99.21%) and dyspnea(79.36%) were the most frequent complaints. Respiratory failure(81.75%) was the most common organ failure, followed by hepatic(52.38%), coagulative(47.62%), circulatory(33.33%), renal(21.43%), and cerebral dysfunction(13.49%). The median(Q1, Q3) SOFA score was 8(6, 9), and 48.41% of the patients had a quick-SOFA score ≥2. Organ supports with invasive ventilation(40.48%), vasopressors(36.51%), and renal replacement therapy(7.14%) were frequently required. The in-hospital mortality was 11.90% and was independently predicted by circulatory and hepatic failures on multivariate logistic regression(OR 11.12, 95% CI 1.73-71.31 and OR 8.49, 95% CI 1.18-61.41, respectively).Conclusions: Most patients had pulmonary dysfunction; circulatory or hepatic failure on admission strongly predicts death.