Vaccination is the time-tested strategy in controlling the infectious diseases. The global scientific community has agreed upon the role of mass vaccination, as a strategy in abating the ongoing COVID pandemic. By immunizing the at-risk population vaccination aims not only to break the chain of spread of disease but also reduces the severity of the disease, hospitalization, and mortality. In the wake of waning immunity and emerging variants, spreading the world over its time to review the evidence of a third dose as a booster.When deciding on the booster dose, availability of the vaccine, type of vaccine, circulating SARS-CoV-2 variants, and emerging variants have to be taken into consideration. Booster dose as the name suggests boosts the waning immunity of the population and when implemented as a public health measure has the potential to increase the antibody level of the population beyond a threshold, thereby mitigating the spread of COVID infection. Cross-protection is likely to the newly emerging SARS-CoV-2 variants by virtue of the enhanced immune response. However, to develop robust recommendations, investigations on the effectiveness and cost-effectiveness of booster doses vaccines are needed in the context of rapidly spreading variant, the omicron.

Objectives: Recently two calcitonin gene-related peptide receptor antagonists (ubrogepant and rimegepant) were approved for the acute attack of migraine. This systematic review and network meta-analysis was performed, so as to evaluate and comprehend the effectiveness of both ubrogepant and rimegepant in alleviating the acute attack of migraine. Materials and Methods: An in-depth search was performed through Cochrane library, Pub Med, and clincialtrials.gov, for the period 2015–2019, using the key words: ubrogepant; rimegepant; and acute migraine. The randomized double-blind phase III clinical trials that explored the efficacy of these drugs were considered for inclusion in this review. The outcomes for this review were considered as the proportion of patients who had to resort to rescue medication within 24 h of taking either of the gepant, and the proportion of patients who had achieved sustained pain freedom and relief. In addition, an indirect meta-analysis was also conducted to establish the comparative effectiveness of these drugs. In addition, risk of bias and heterogeneity among the trials were also assessed to ascertain the strength of the trials. Results: A total of five placebo-controlled RCTs were included in this review. Altogether, both drugs demonstrated well in the parameters assessed. Rimegepant was better than ubrogepant, as a lesser proportion of patients used rescue medication by 3.4%, and a significantly higher number of patients achieved sustained pain freedom by 2.1% at 2–24 h. In sustained pain relief at 2–24 h, rimegepant was slightly better than ubrogepant by 0.5%. Hence, rimegepant 75 mg emerged to be better in all outcomes. Conclusions: Both gepants proved to be efficacious in alleviating the acute attack of migraine. Rimegepant displayed superiority over the ubrgepant.

Metabolic acidosis (MA) is a very common finding in chronic kidney disease (CKD) and in cardiovascular disease due to the close relationship between the two organ systems. It depresses the myocardium; induces CKD; depresses urine acidification, bone mineral disease (CKD-BMD); and its presence reduces the quality of life, as well as increases cardiovascular events and mortality. The diagnostic strategies, patient assessment, treatment, prognostication, and possible patient referral entail good clinical acumen to prevent or limit complications, some of which can be fatal. Chronic metabolic acidosis in CKD is often associated with structural cardiac changes such as increased left ventricular mass and significant intradialysis blood pressure variations.The use of sevelamer, and the inhibitors of aldosterone in these patients could worsen MA; however, bicarbonate in the lower, upper normal, and elevated levels and its replacement could all be associated with various structural and functional cardiovascular changes.

Context: Dental caries remains a major public health problem, affecting 60-90% of school children. The assessment of dental caries and fluorosis in endemic fluoride areas will facilitate in assessing the relation between fluoride concentrations in water with dental caries, dental fluorosis simultaneously. Aims: The aim of the following study is to assess the dental caries and dental fluorosis prevalence among 8–16-year-old school children in Kanpur rural region, Uttar Pradesh. Settings and Design: This was a cross-sectional study. Materials and Methods: School children, residing in the village since childhood, in the age group of 8–16 years were selected from government schools. School children were categorized in five age groups and were examined for oral examination of available 8–16-year-old children fulfilling the inclusion and exclusion criteria was carried out to assess dental caries and fluorosis. Statistical Analysis Used: The influence of demographic characteristics on caries and fluorosis was tested using Chi square test, independent sample t-test and one-way ANOVA wherever applicable. Spearman rank correlation was applied to analyze the relationship between decayed teeth and dental fluorosis. Results: The caries prevalence was found to be 84.7%. Out of 1565 school children, 53.4% were males and 46.5% were females. The prevalence of dental fluorosis was found to be 87.5%.The fluorosis prevalence increased with increasing fluoride concentration with no difference in gender and age distribution. Conclusions: Children and teenagers are the most typically damaged by dental caries and fluorosis, it is necessary for the management of the prevalence of caries and fluorosis.

Background: Headache is a common clinical entity seen among pediatric patients in routine clinical practice. The pressure of two opposing mucosa in the nasal cavity even in the absence of inflammation can be a cause of headache, which is called a rhinogenic contact point headache. Anatomical variations of the nose such as rhinogenic contact point headache may result in headache due to the contact of the nasal mucosa which often missed during the evaluation of the pediatric patients. Objective: The aim of this study is to assess the rhinogenic contact point headache in the pediatric age group. Materials and Methods: This is a prospective study and 112 children with rhinogenic contact point headache enrolled in this study. This study conducted at a tertiary care teaching hospital during September 2018–October 2021. The anatomical variations of the nose were evaluated with help of diagnostic nasal endoscopy and computed tomography (CT) scan. These anatomical variations in rhinogenic contact point headache were treated surgically. Results: Out of 112 children with rhinogenic contact point headache, 31 (27.67%) had deviated nasal septum, 28 (25%) had septal spur, 20 (17.85%) middle turbinate concha bullosa, 11 (9.82%) enlarged ethmoidal bullosa, 11 (9.82%) had hypertrophied inferior turbinate, 7 (6.25%) had hypertrophied super turbinate, and 4 (3.57%) had nasal septal bullosa. Treatment of each child with rhinogenic contact point was personalized for every patient. Conclusion: Headache is a common clinical symptom and is nearly universal in the life of a child. The contact between opposing mucosa in the nasal cavity in the absence of inflammation can result in headache and/or facial pain in the pediatric age group. Endoscopic excision of the contact points of nasal cavity is effective for the treatment of rhinogenic contact point headaches.

Recurrence of disease after surgery for fistula occurs in approximately 30%–40% of patients. Treatment of a recurrent fistula has an increased risk of failure and further recurrence. The aim of this study was to find out the effectiveness of video-assisted anal fistula treatment (VAAFT) in the treatment of recurrent fistula and also to compare the effect of the two adjuvants, fibrin and platelet-rich fibrin (PRF), in reducing recurrence in a recurrent fistula. A retrospective observational study was done on a cohort of patients with fistula-in-ano being treated at our center between 2015 and 2021. Of 85 patients that underwent VAAFT, 36 had recurrent disease and were allotted to two groups, one group receiving fibrin and the other PRF. Details of patients were collected from the hospital database and by telephonic interview. To test the statistical significance of the difference in the proportion of categorical variables between two groups, chi-square test was used and Mann–Whitney U test for the difference in the mean-time of healing between two groups. Recurrence rate following VAAFT in patients with recurrent fistula-in-ano in our series was found to be 25%. A significant reduction in recurrence was noted in patients who received PRF as adjunct when compared to patients who received fibrin glue as adjunct (P = 0.0023). VAAFT is an excellent cost-effective choice for the management of recurrent fistula-in-ano. Use of PRF along with VAAFT improves the outcome of the procedure.

Background: SARS-CoV-2 is being managed rigorously by healthcare professionals (HCPs) making them vulnerable to infection and pose risk for human resource management. Objective: The current study was done to assess the change in seroprevalence, suggesting recent SARS-CoV-2 among HCPs of a tertiary care health facility as per government guidelines. Materials and Methods: Two hospital-based surveys (phase 1: September 2020 to January 2021; phase 2: May to June 2021) were carried out to quantify change in seroprevalence of SARS-CoV-2 infection among HCPs. A total of 1279 and 765 HCPs were assessed in first and second phase accordingly. Out of 765, a total of 412 professionals were assessed for serum IgG antibody. Results: Seroprevalence increases from 12.7% to 31.1% from first to second phase of the study. The adjusted odds ratio (aOR) was found to be significantly high for residents [aOR: 3.57; 95% confidence interval (CI): 1.17–10.89], nurses (aOR: 3.54; 95% CI: 1.20–10.42), administrative (aOR: 8.18; 95% CI: 1.43–46.53), and laboratory staff (aOR: 6.03, 95% CI: 2.97–16.05). Adjusted odds were observed to be significantly more among participants positive for reverse transcriptase–polymerase chain reaction test (aOR: 6.90; 95% CI: 2.97–16.05) and positive for IgG in P1 (aOR: 2.59; 95% CI: 1.32–5.09). Discussion: HCPs mainly residents, nurses, hospital support, and laboratory staff are observed with increased SARS-CoV-2 infection from first to second phase of the study.

Meleney’s gangrene is a rapidly spreading gangrene of skin, subcutaneous tissue, and fascia. It has the highest mortality approximately 40% and more in immunocompromised and diabetic patients. The initial presentation mimics cellulitis and most of the cases are misdiagnosed. Delayed diagnosis and treatment increase mortality by approximately 100%. Our case is initially diagnosed as bull gore injury and underwent treatment of the same. Later patient developed extensive Meleney’s gangrene of the entire anterior abdominal wall and genitalia. Even with extensive wound debridement with antibiotic coverage fails to save the patient life. Therefore, early diagnosis and prompt surgical debridement in boll gore injury will reduce the chance of developing Meleney’s gangrene.

Purple urine bag syndrome (PUBS) is a rare phenomenon, which usually occurs in chronically constipated women having long-term catheters. The underlying pathogenesis is linked to sulfatase producing bacteria in the urinary tract, which react to produce indigo (violet) and indirubin (red) pigment and the mixture gives a purple hue in the presence of alkaline urine. Treatment of the underlying urinary tract infection (UTI), change of catheter, and management of predisposing conditions prevent its recurrence. We report a case of a 74-year-old diabetic man who had Enterobacter cloacae-related UTI with PUBS in acidic urine and managed successfully.

Chemoport, a central venous infusion system, is commonly used in cancer patients for administration of chemotherapy. Dislodgment with subsequent migration of chemoport catheter into the heart is a rare but potentially catastrophic complication. The treatment of choice is immediate retrieval of dislodged part of catheter by either surgery or percutaneous approach. Percutaneous removal is safer and less invasive, making it the standard treatment modality. We herein report the case of a 22-year-old male who was referred to us for the management of a dislodged chemoport catheter used for chemotherapy for Hodgkin’s disease. In this article, we discuss the treatment approach in this particular case as well as review the existing literature.