Background: Shortage of personal protective equipment (PPE), inadequate staff training regarding PPE usage, and confused PPE guidance led to infections and deaths among healthcare workers in many countries. Protection of healthcare workers is needed as they are delivering essential services during the pandemic time. So, the main aim of our study is to evaluate the appropriate use of PPE among healthcare providers (HCPs) during COVID-19 pandemic. Materials and Methods: An observational cross-sectional study was conducted among the HCPs of India during September and October. A 15-item self-administered questionnaire was used, and Excel 2019 and SPPS 24 were used for statistical analysis. A χ² test was performed to determine the role of sociodemographic characteristics on appropriate usage of PPE. Results: One hundred and eighteen HCPs have participated in our study. About 44.9% of the study participants know the proper way of donning the PPE, and 38.9% of the study participants know the proper way of doffing the PPE. About 40.6% of the study participants were aware of place for PPE removal and how to dispose a PPE; 69.49% of the study participants were aware of guidelines of donning and doffing of PPE recommended by the Centers for Disease Control and Prevention and World Health Organization. Conclusion: The prevalence of breathing difficulty, headaches, suffocation, dehydration, hair problems, and skin irritation/maceration among frontline healthcare personnel using PPE during pandemic was seen. Appropriate usage of PPE is vital in safeguarding the HCPs and restriction of the spread of viral infection in the hospital setting.

Aim: The aim of this article is to evaluate the amount of transforming growth factor beta-1 (TGF β-1) released from dentin upon the action of various endodontic irrigants, medicaments, ultrasonic activation, and low-level laser irradiation. Materials and Methods: To assess the effect of endodontic irrigants and medicaments on TGF β-1 release, 200 dentin disks of 1 µm thickness prepared from human mandibular premolars were divided into five groups of 40 each. The specimens in the test groups were treated with four reagents: Group A: (2% chlorhexidine gluconate); Group B: (2.5% sodium hypochlorite); Group C: [calcium hydroxide powder (Ca(OH)₂)]; Group D: [triple antibiotic paste (TAP) (minocycline 100 mg + ciprofloxacin 200 mg + metronidazole 500 mg)]; and one control reagent group, i.e., Group E: (normal saline). Dentin disks were subsequently treated with 10% ethylenediaminetetraacetic acid (EDTA). To assess the effect of ultrasonic activation and low-level laser irradiation on TGF β-1 release, 90 dentin disks of 1 mm thickness obtained from mandibular premolar roots were divided into 6 groups of 15 disks each: Group 1: (10% EDTA +ultrasonic activation), Group 2: [10% citric acid (CA) + ultrasonic activation], Group 3: (10% EDTA + low-level laser), Group 4: (10% CA+ low-level laser), and two control groups, i.e., Group 5 (10% EDTA) and Group 6 (10% CA). Three subgroups were formed among main groups indicating the region from where the specimens were prepared, namely, coronal, middle, and apical thirds. The irrigation solutions from all the above groups were collected, frozen in liquid nitrogen, and stored at −80°C and later thawed and subjected to growth factor quantification by using an enzyme-linked immunosorbent assay test system for TGF β-1. Results: Root canal irrigant 2% chlorhexidine gluconate and intracanal medicament calcium hydroxide both showed an inducing effect on TGF β-1 release, giving a maximum value of 0.741 ng/mL. The least value of 0.0823 ng/mL was given by 2.5% sodium hypochlorite, showing its negative impact on growth factor release. TAP showed a neutral effect similar to that of the control group (normal saline), giving a value of 0.247 ng/mL. Ultrasonic activation and low-level laser irradiation of EDTA and CA have both improved TGF β-1 release from dentin. Conclusion: Chlorhexidine gluconate and calcium hydroxide exerted a positive influence on TGF β-1 release from dentin, whereas sodium hypochlorite retarded its release and TAP gave a neutral impact similar to normal saline. Ultrasonic activation and low-level laser irradiation can enhance TGF β-1 expression. There is no significant difference in the growth factor release among the different regions of root dentin.

Introduction: Tuberculosis (TB), the eighth common cause of disability-adjusted life years in India, is a major problem for public health. Social factors such as economic condition and smoking have been implicated among the risk factors for TB. This paper reports the role of different sociodemographic factors in deciding the burden of TB in India. Materials and Methods: In an ecological approach, data from major national surveys were analyzed: National Family Health Survey 4, Global Adult Tobacco Survey 2, and India: Health of the Nation’s States. Spearman correlation coefficient and multivariate linear regression were used for state-wise analysis. Results: North India seems to be the major contributor to the national TB burden. Several factors such as the use of clean fuel, tobacco use, and economic condition were seen to impact TB burden. On multivariate analysis, only clean fuel was found to be significant (r = −0.540, P = 0.002). Conclusion: A multi-pronged approach for appropriate policy decisions for focussing on sociodemographic factors is the need of the hour for reducing the mortality burden due to TB.

Objective: Adhesive capsulitis (AC) is a pathologic condition characterized by pain and limitation of shoulder movements. Thyroid dysfunction often accompanies musculoskeletal disorders, and undiagnosed hypothyroidism can delay response to treatment outcomes. Early diagnosis and treatment of hypothyroidism in patients with AC of shoulder could help to improve pain and disability. This study was done to assess the association of hypothyroidism with AC of shoulder and to find the correlation of severity of pain and disability in AC with hypothyroidism. Materials and Methods: In this case–control study, patients who attended PMR OPD during a period of 2 years with pain and limitation of shoulder movements satisfying the inclusion and exclusion criteria were included as cases and patients without AC as controls. Fifty-seven patients were selected as cases and 114 patients as controls. Serum thyroid-stimulating hormone (TSH) level and free tetraiodothyronine level were estimated. Shoulder range of motion (ROM) measurement and radiographs were performed in cases, and the TSH values obtained were compared with the severity of ROM restriction, Visual Analog Scale score, and Shoulder Pain and Disability Index Scale (SPADI) score. Statistical analysis was done using IBM SPSS 20 (SPSS Inc., Chicago, IL, USA). Results: Among cases, 8 (14%) patients had hypothyroidism and 16 (28.1%) had subclinical hypothyroidism, and among controls, 4 (3.5%) had hypothyroidism and 9 (7.9%) had subclinical hypothyroidism. Among the 24 patients with elevated TSH, 16 (66.6%) had mild-to-moderate pain and 8 (33.3%) had severe pain. Mean TSH was elevated in patients with severe pain compared with those with mild-to-moderate pain (5.43 ± 2.31 vs. 3.35 ± 2.48 µIU/mL, P = 0.031). TSH levels showed a positive correlation with SPADI pain score (r =0.335, P = 0.011) and SPADI disability score (r = 0.375, P = 0.004), respectively. There was significant restriction in ROM in patients with higher TSH levels (P < 0.001). Conclusion: Patients with AC have higher prevalence of hypothyroidism and subclinical hypothyroidism compared with those who did not. Patients with higher TSH levels had more severe pain, restriction of movement, and overall disability when compared with euthyroid patients. Proper management of hypothyroidism along with the standard measures of management may result in more speedy relief from symptoms and recovery of function in these patients.

Marfan’s syndrome is an autosomal dominant genetic disorder related to a mutation in fibrillin gene type 1 involving mainly the cardiovascular, ocular, skeletal, and pulmonary systems. A 22-year-old female patient presented with cough, blood-stained sputum, and fever for 4 months. The patient was tall and on skeletal examination, high arched palate, arm-span longer than height, positive finger thumb sign, arachnodactyly, asymmetrical chest, and skin striae were present. Family history of Marfan’s syndrome was present. Echocardiography showed large ventricular septal defect with aortic override and severe pulmonary stenosis. CECT thorax showed bronchiectasis changes. Marfan’s syndrome with cardiovascular abnormalities usually has aortic dilatation, aortic regurgitation, aortic aneurysm, mitral valve prolapse, mitral regurgitation, etc. In this case, the patient has Marfan’s syndrome with tetralogy of Fallot (TPF) and bronchiectasis. The association of TOF with Marfan’s syndrome is one of the rarest findings.

Idiopathic hypertrophic cranial pachymeningitis (IHCP) is an extremely rare clinical entity of unknown etiology, characterized by a chronic inflammation causing thickening of the dura mater.^[1] ICHP can produce similar presentation to Tolosa–Hunt syndrome (THS) if it involves cavernous sinus.^[2] THS might represent a focal manifestation of IHCP.^[2] The THS is a rare syndrome with an estimated annual incidence of one case per million per year.^[3] It typically presents with orbital pain associated with palsy of the third, fourth, or sixth cranial nerve. We present an interesting case of a patient with IHCP associated with THS in an elderly female who responded well to high-dose steroids and in a few days had significant improvement in her retro-orbital pain and ocular movements. The importance of appropriate neuroimaging and serological investigation in patients with suspected THS, role of erythrocyte sedimentation rate in follow-up of these patients, and the relationship between IHCP and THS are discussed.

Peroneal neuropathy leading to foot drop is a rare, but preventable, maternal complication following vaginal delivery. Prolonged labor and regional anesthesia during labor are major risk factors for peroneal neuropathy. Obstetric peroneal nerve injury is usually unilateral and is caused by prolonged pressure exerted during full knee flexion in squatting and lithotomy positions while in labor. Bilateral peroneal neuropathies are extremely rare. We report a rare case of bilateral peroneal nerve injury in a 27-year-old primigravida, following spontaneous onset of labor and uncomplicated vaginal delivery.

COVID-19 infection is an established culprit responsible for a multitude of devastating vascular complications such as venous thrombosis of the extremities and other vascular organs. Dislodgment of these thrombi and extension of damage to other organ systems, particularly pulmonary, are quite uncommon. The occurrence of bilateral pulmonary embolism (PE) without concurrent deep vein thrombosis is, however, rare and reported in only a few case reports. Here we are narrating a case of a 40-year-old male, who suffered from novel COVID-19 infection and unfortunately presented with bilateral submassive PE. Our patient was aggressively managed medically and had a splendid recovery in terms of symptoms with an excellent outcome.

Amiodarone is a class III anti-arrhythmic drug which is commonly used in various cardiac arrhythmias. Hypothyroidism is one important complication linked with this drug. Herein, we recount a case of amiodarone-induced hypothyroidism, which presented as atrial fibrillation (AF) with slow ventricular response. A middle-aged gentleman was brought to the casualty in unconscious state. He was a known case of hypertension and on amiodarone treatment for AF for the past 2 years. On presentation, the patient had a slow pulse rate and his electrocardiogram was suggestive of AF with very slow ventricular beat. This was managed medically and a temporary cardiac pacemaker was instituted thereafter. In search of the cause for bradycardia, his thyroid function test depicted hypothyroidism with 2-fold raised thyroid-stimulating hormone and decreased levels of free tetraiodothyronine hormone, but the patient had no other features suggestive of hypothyroidism. Therefore, the patient was started on oral thyroxine hormone, which led to considerable pulse rate improvement.

Ectodermal dysplasia is a rare genetic disorder due to defects in structures derived from ectoderm. It occurs due to mutation in genes that encode proteins involved in the development of ectodermal structures. Males show full expression of the disorder, whereas females show minimal signs of disorder because of the usual X-linked recessive pattern of inheritance. Common defects include hypodontia, onychodysplasia, hypotrichosis, and reduced or absence of sweat glands. The incidence of ectodermal dysplasia is seven in 10,000 live births. It is important to prevent hyperpyrexia, a life-threatening complication in hypohidrotic ectodermal dysplasia patients. Here, we are reporting a rare case of anhidrotic ectodermal dysplasia in a 16-year-old male patient with a positive family history of the same condition.

E-learning has been recognized as an innovative and useful form of learning to the learners and bridges the gap between accessibility and affordability. Even though the number of e-learning courses is mushrooming in the current era, it becomes crucial to ensure that the courses are started after performing a thorough needs assessment and the identification of the potential takers of the course and should have the provision of active engagement of the learners to enhance their learning. A number of strategies have been suggested to ensure that e-learning programs remain interesting and to motivate and involve the learners regardless of their origin. In conclusion, e-learning has emerged as the new face of imparting medical education to students. However, the success and overall utility of the course will depend on the careful planning, involvement of a multidisciplinary team, and active engagement of the learners.