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This case report aimed to illustrate the management of single tooth replacement in the esthetic region using immediate implant placement, highlighting the importance of interdisciplinary treatment planning and adherence to esthetic principles. A 37‐year‐old female presented with a fractured upper front tooth, necessitating immediate attention to restore esthetic.

For the foreseeable future, vaccines are the cornerstone in the global campaign against the Coronavirus Disease-19 (COVID-19) pandemic. As the number and fatalities due to COVID-19 decline and the lockdown anywise rescinded, we recognize an increase in the incidence of autoimmune disease post-COVID-19 vaccination. However, the causality of the most vaccine-induced side effects is debatable and, at best, limited to a temporal correlation. We herein report a case of a 51-year-old gentleman who developed Anti-Neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis (AAV) 2 week post-COVID-19 vaccination. The patient responded favorably to oral steroids and rituximab. Additionally, we conducted a case-based review of vaccine-associated AAV describing their clinical manifestations and treatment response of this emerging entity.

Eosinophilic peritonitis (EP) is an uncommon complication of peritoneal dialysis, which happens usually secondary to either an underlying bacterial, fungal or tubercular infection or as a reaction to intraperitoneal drugs or constituents of the dialysis system like tubings or solution. We report a case of a middle aged male who was initiated on continuous ambulatory peritoneal dialysis. Because of inadequate inflow and outflow of dialysis fluid, he was given two doses of intraperitoneal streptokinase after ruling out other causes. After the use of intraperitoneal streptokinase, there was turbid effluent with culture showing Staphylococcus aureus. Even after the successful treatment of bacterial peritonitis with intravenous antibiotics, he continued to have turbid effluent, with a predominance of eosinophils in the effluent cell count. A diagnosis of EP was made and he was managed with the antihistaminic drug loratidine, with complete resolution.

Background Ovarian toxicity is a dreaded complication of cyclophosphamide (CYC). With the use of lower cumulative doses of intravenous CYC (modified NIH regimens) and availability of better markers of ovarian toxicity, the incidence of ovarian dysfunction needs reassessment. Lupus disease activity, by itself, is also believed to affect ovarian function negatively. Methods This single-centre prospective cohort study recruited 50 female patients of severe lupus aged 18–40 years. Twenty-five patients each received induction with either monthly intravenous CYC (0.5–0.75 g/m 2 ) for 6–9 months or daily oral mycophenolate mofetil (MMF). Details of menstrual irregularities; serum levels of FSH, LH, estradiol, AMH, and inhibin B; and sonographic assessment of ovarian volume and antral follicular count were done at baseline and 6 months after treatment. Amenorrhoeic patients were re-evaluated at 1 year. Results Mean (SD) age of subjects in the CYC and MMF groups was 31.4 (6.3) and 28.4 (4.4) years, respectively. Mean (SD) SLEDAI at the initiation of therapy was 7.2 (2.5) in the CYC group and 5.8 (3.4) in the MMF group. The mean cumulative dose of CYC used was 4.6 (1.8) g. Three patients in the CYC group (versus none in MMF) had amenorrhoea at 6 months—two of these regained menses within 6 months, while only one (4%) developed sustained amenorrhoea (lasting more than 12 months) at 41 years of age, likely menopause. Serum FSH levels increased ( p  = 0.03), while AMH ( p  = 0.002) and inhibin B ( p  < 0.001) levels decreased significantly with 6 months of CYC therapy. Ovarian volume also reduced significantly ( p  = 0.005) with 6 months of CYC therapy, while antral follicular count reduced numerically ( p  = 0.32). Levels of AMH, inhibin-B, estradiol, ovarian volume, and antral follicular count after 6 months therapy were significantly lesser in the CYC group compared to the MMF group, despite being similar before the start of therapy. Conclusions Ovarian dysfunction with monthly intravenous CYC (modified NIH regimen) was predominantly subclinical, with a negative effect on ovarian reserve. No premature ovarian failure was noted at 1 year. No ovarian dysfunction occurred in the MMF group, despite having patients with severe background lupus. Use of intravenous CYC for induction may thus not be restricted in young lupus females with incomplete families for fear of gonadotoxicity, especially in life- or organ-threatening situations, where the benefits outweigh this subclinical risk.

Marburg virus disease (MVD) is a highly virulent viral hemorrhagic fever with reported case fatality rates of up to 90%. It is part of the same family as the Ebola virus ( ). MVD, originally identified in 1967 in the context of outbreaks associated with African green monkeys, has been reported sporadically in Africa. Recent outbreaks, including those in Equatorial Guinea and Rwanda, underscore the need for robust preparedness systems and global response. This narrative review focuses on the pathogenesis, clinical manifestations, diagnostic challenges and treatment strategies regarding MVD. It also stresses the need for better surveillance, diagnostic capabilities and vaccines to help prepare for future outbreaks. A comprehensive review of clinical data, epidemiological trends, and diagnostic developments was performed by searching relevant literature in , and . The relevant data were extracted from studies on MVD and presented as a narrative review. MVD primarily affects immune and endothelial cells, resulting in a consequent cytokine storm, coagulopathy, and multi‑organ failure. Early symptoms such as fever, headache and myalgia are nonspecific and can delay diagnosis, as they mimic other infections. Monoclonal antibodies and newer antiviral agents are presently being evaluated for the management of MVD. MVD leads to significant morbidity and mortality, and the high fatality rate, along with the absence of targeted therapies, represents a serious global health threat. Collectively, the establishment of infrastructure for diagnostics, global collaboration, and advanced vaccine development will help bolster the response to MVD outbreaks and thus shorten periods of spiking mortality.

This study aimed to comparatively evaluate piezoelectric surgery and conventional surgery for dental implant site preparation, focusing on bone density, implant stability, and peri-implant marginal bone loss, to contribute valuable insights into optimizing dental implant procedures for improved patient care and treatment outcomes. In this randomized controlled clinical trial with a split-mouth design, 30 patients with a mean age of 35.7 (standard deviation [SD] 7.1) with two edentulous sites, at least one of which was in the posterior mandibular region, were treated sequentially at two sites: Site A, where implant placement was conducted using piezoelectric surgery, and Site B, where conventional surgery was employed. Postsurgical evaluations were conducted at 6 and 9 months. Significant differences were observed between the two techniques. Bone density was greater by 0.035 g/cm ( =0.001) in favor of piezoelectric surgery at 9 months, but not at 6 months. Although there were significant changes in stability within the groups, the difference in the change in implant stability at 6 months between piezoelectric surgery and the control site was not significant at 6 months, Site A (piezoelectric surgery) demonstrated significantly higher implant stability quotient (ISQ) values (mean = 76.7) than Site B (mean = 72.8; ≤ 0.001). Patient discomfort was significantly greater in the control group than in the piezoelectric surgery group by 1.3 visual analog scale (VAS) ( -value < 0.001). Piezoelectric surgery demonstrated potential benefits over conventional surgery in terms of implant stability, postoperative discomfort, and bone density. These findings highlight the potential of piezoelectric surgery to enhance clinical outcomes and patient satisfaction in dental implant procedures. Further investigation into long-term implant survival rates and esthetic outcomes is warranted. ClinicalTrials.gov identifier: ISRCTN99951388; 16CNAHMMDS000002/ISRCTN99951388.

Abstract Context Hypothyroidism is associated with reversible decline in kidney function as measured by estimated glomerular filtration rate (eGFR). eGFR and proteinuria are the most important markers for clinical assessment of kidney function. Though hypothyroidism is associated with proteinuria in cross-sectional data, the impact of treatment on proteinuria is unknown. Objective This study explores the effect of thyroid hormone replacement therapy on eGFR and 24-hour urine protein excretion in patients with severe primary hypothyroidism. Design and Participants This study was a prospective, observational cohort study in adults with severe primary hypothyroidism (serum thyrotropin [TSH] > 50 µIU/mL). Individuals with preexisting or past kidney disease, kidney or urinary tract abnormalities, calculi or surgery, diabetes mellitus, or hypertension were excluded. The participants received thyroid hormone replacement therapy. Thyroid functions, eGFR, 24-hour urine protein excretion, and biochemical parameters were measured at baseline and 3 months. Setting This study took place at a single center, a tertiary care referral and teaching hospital. Results Of 44 enrolled participants, 43 completed 3 months of follow-up. At 3 months, serum TSH levels decreased and thyroxine levels increased (P < .001 for both). Significant increases in eGFR (mean difference, 18.25 ± 19.49 mL/min/1.73 m2; 95% CI, 12.25 to 24.25, P < .001) and declines in 24-hour urine protein excretion (mean difference, –68.39 ± 125.89 mg/day; 95% CI, –107.14 to –29.65, P = .001) were observed. Serum cholesterol and low-density lipoprotein levels also significantly decreased (P < .001). Conclusions Thyroid hormone replacement therapy in patients with severe primary hypothyroidism improves eGFR and decreases 24-hour urine protein excretion, thereby suggesting reversible alterations.

BackgroundUnlike adults, primary membranous nephropathy (PMN) comprises only 1–2% of childhood nephrotic syndrome. The clinical behaviour of PMN in children is not explicit and we report upon clinical presentation and outcome.MethodsThis prospective study includes children and adolescents (< 20 years) with biopsy-proven PMN without secondary causes. Anti-PLA2R assessment: before and after completing therapy. Outcome: percentage of patients achieving remission.ResultsStudy cohort included 48 (M:F ratio 1.1:1) patients and median age 17 (IQR 15–18) years, with 35 (72.9%) PLA2R related. Median interval from symptom onset to presentation was 5 months, where median proteinuria, serum albumin and creatinine were 4.9 g/day, 2.1 g/dL and 0.63 mg/dL, respectively. Forty-seven patients received immunosuppressive therapy, with various agents used as first-line therapy: cyclical CYC/GC (53.1%), CNI/GC (21.3%), rituximab (14.9%), prednisolone alone (4.3%), azathioprine (4.3%) and mycophenolate mofetil (2.1%). Median follow-up was 29 (14, 59) months. At 6 months, 11 (24.4%) and 17 (37.7%) had complete remission (CR) or partial remission (PR), while at last follow-up (median 29 months), 20 (45.4%) and 14 (31.8%) had CR and PR respectively. No significant differences in outcome were observed with different agents. A total of 60% patients treated with rituximab as first line/for relapsing disease, and all cases with resistant disease receiving rituximab had CR or PR at last follow-up. PLA2R antibody presence was associated with clinical outcome.ConclusionsThree-quarters of PMN in children and adolescents is PLA2R related and two-thirds respond to immunosuppressive therapy. Rituximab is a promising agent to manage PMN in children. Anti-PLA2R is associated with clinical outcomes.

In this report, we describe a case of a rotated maxillary right central incisor in a 32‐year‐old woman. The patient condition was restored after avoiding orthodontic treatment, which included essential endodontic treatment, core build‐up, adjusting tooth inclination, and restoration with a full ceramic crown. Better microesthetics and high patient satisfaction were observed after this treatment. Restorative esthetic correction.