Induction of anti-SARS-CoV-2 immune reactions in immune compromised patients

The aim of the review is studying the immune response to the new coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus in different populations, including those with immunosuppression due to concomitant diseases or immunosuppressive therapy.The role of T cells in building up the anti-COVID-19 immunity is of special interest, particularly, when comparing T cell and antibody based immunity. A number of studies are focused on the effectiveness of T-cell immunity against SARS-CoV-2 infection, as well as on the resistance to re-infection. The decreased immunity associated with such illnesses as autoimmune diseases, non-autoimmune inflammations, and the effect of immunosuppressive drugs and obviously, different cancers increase the susceptibility to SARS-CoV-2 and COVID-19 development, and exacerbate the course of the disease.Several studies showed that patients with cancer are at risk of impaired immune response associated with a malignant neoplasm. The inefficient immune response was also shown in cancer patients receiving immunomodulatory therapy. However, some studies registered the specific immunogenicity after vaccination in patients with concomitant immunosuppression.Methotrexate is a folate antimetabolite. The drug can be used both in high doses as an antimetabolite in the antitumor therapy, and in low doses as an immunosuppressive agent in patients with autoimmune diseases. Therefore, the review also discusses a study that evaluated the humoral and cellular immune response to the BNT162b2 (PfizerBioNTech) anti-COVID-19 vaccine in patients receiving methotrexate. The rate of antibody production was lower in patients receiving methotrexate, though the level of T-cell response was similar in all groups studied.The review discussed immune compromised patients with cancer and hematological malignancies and patients living with HIV who had COVID-19. Most studies reported no significant differences of COVID-19 outcomes between major population and the patients with suppressed immune system.Hereby, the cell and humoral immune response in immune compromised patients is possible, however, additional studies are required to confirm these data.

Overtreatment in Restorative Dentistry: Decision Making by Last-Year Dental Students

To evaluate the tendency for overdiagnosis and overtreatment upon different clinical situations among last-year students from the degree in dentistry from Valencia University (Spain) during the 2018–2019 course. A questionnaire consisting of 10 case exemplifications examining the diagnosis, treatment, and clinician’s attitude towards different common clinical situations regarding restorative dentistry was designed. Fifty-two students were surveyed, from whom 42 completed the questionnaire (80.77%). Data were analyzed descriptively. A total of 58.8% of the students correctly identified an early carious lesion in the occlusal surface of a molar, while 63.2% would perform unnecessary complementary tests for its diagnosis. The treatment for carious lesions in different evolutive phases with a vital pulp was correct between 51.2 and 92.7% of the cases. The treatment for irreversible pulp pathology and the restoration of the tooth with root canal treatment were adequately selected in 56.1% and 78.3% of the cases, respectively. For the repair of a faulty restoration, an overtreatment was proposed by 87.8% of the students. A tendency to perform unnecessary complementary tests for caries diagnosis was observed. Treatment caries proposals were in accordance with available evidence in the majority of the cases. Students tended to overtreat defective restorations and would perform unnecessary treatments in medically compromised patients.

FUNGAL RHINO SINUSITIS DURING COVID-19 ERA

Fungal rhino sinusitis is a life threating, aggressive, angioinvasive infection caused by a group of fungai called mucormycetes and aspergillus as well1. Spores of these fungai are present in the soil, air decaying material and animal dungs. They are inhaled and swallowed to cause infection. It affects mainly immune compromised patients like uncontrolled diabetes (fungus grows and flourish at high sugar level), organ transplant individuals and patients on long term steroid therapy2. Apart from the Covid-19 the fungal infection is not contagious.

Immune system response to the Covid 19 virus and 3rd boosters

A recent finding that the two-dose vaccination for the Covid-19 virus leads to a rapid loss of protection in many patients within 6 months. Thus the need for a 3rd injection has been found to be mandatory for continuing protection, as well as to highlight the need to monitor immune compromised patients and those with comorbidities particularly in indigenous populations where co-morbidities may be present preventing an adequate response to the initial vaccination. This has also highlighted the problem of lack of vaccines in the less developed parts of the world that requires urgent attention, as this is where new variants arise. The virus must be contained in these countries before we run out of letters in the Greek alphabet. Key words: Covid 19, virus, vaccines, 3rd injection, immunity, mutations, WHO

An Overview of an Invasive Fungal Infection In Covid-19: Mucormycosis

Mucormycosis is an invasive fungal infection of zygomycetes class, comprised the orders of entomophtherales and mucorales which is common infection in immuno compromised patients, especially in stem cell transplantation, hematological malignancy and diabetes mellitus. It is the third invasive fungal infection after aspergillosis and candidiasis both strain belong the class of zygomycetes. Mucormycosis generally transmitted in humans by the inoculation and inhalation of spores in mucous membrane as well as skin. After the deadly outbreak of corona virus, this infection has taken a different form in those patients who suffer from the covid-19 which is categorized as a post covid-19 disease. Aim of this review to highlight the recent awareness about invasive fungal treatment.

Feasibility and outcomes of the removable prosthesis in medically compromised patients

Increasing awareness about providing the necessary care of oral health is essential for patients with a removable prosthesis. The awareness is less interested in dental disorders, being busier with the systemic ones. Planning prosthetic management should only be done after a thorough evaluation of the underlying systemic conditions because the treatment plan might vary accordingly. Previous studies have demonstrated that many systemic diseases are associated with removable prosthesis (RP) procedures. We aim to discuss the feasibility and outcomes of the removable prosthesis for medically compromised patients, including many conditions as diabetes mellitus, cardiovascular, renal, hematological, pulmonary, gastrointestinal disorders and immunocompromised patients. Taking adequate care of oral hygiene practices is recommended for these patients. In addition, it is necessary to have frequent care, but short follow-up visits to make sure that the modalities are still valid for additional use, and to investigate for potential complications and adverse events. Adequate prophylaxis against some diseases might also be the only convenient solution. Therefore, proper management of the medical condition might be associated with the enhanced success of the modality with favorable outcomes and better quality of life. Making unified protocols to deal with these patients is also suggested to enhance the practice among the different clinical settings.