SARS-CoV-2 Detection in Gingival Crevicular Fluid

Understanding the pathophysiology of the coronavirus disease 2019 (COVID-19) infection remains a significant challenge of our times. The gingival crevicular fluid being representative of systemic status and having a proven track record of detecting viruses and biomarkers forms a logical basis for evaluating the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The study aimed to assess gingival crevicular fluid (GCF) for evidence of SARS-CoV-2 in 33 patients who were deemed to be COVID-19 positive upon nasopharyngeal sampling. An attempt was also made to comparatively evaluate it with saliva in terms of its sensitivity, as a diagnostic fluid for SARS-CoV-2. GCF and saliva samples were collected from 33 COVID-19-confirmed patients. Total RNA was extracted using NucliSENS easyMAG (bioMérieux) and eluted in the elution buffer. Envelope gene (E gene) of SARS-CoV-2 and human RNase P gene as internal control were detected in GCF samples by using the TRUPCR SARS-CoV-2 RT qPCR kit V-2.0 (I) in an Applied Biosystems 7500 real-time machine. A significant majority of both asymptomatic and mildly symptomatic patients exhibited the presence of the novel coronavirus in their GCF samples. Considering the presence of SARS-CoV-2 RNA in the nasopharyngeal swab sampling as gold standard, the sensitivity of GCF and saliva, respectively, was 63.64% (confidence interval [CI], 45.1% to 79.60%) and 64.52% (CI, 45.37% to 80.77%). GCF was found to be comparable to saliva in terms of its sensitivity to detect SARS-CoV-2. Saliva samples tested positive in 3 of the 12 patients whose GCF tested negative, and likewise GCF tested positive for 2 of the 11 patients whose saliva tested negative on real-time reverse transcription polymerase chain reaction. The results establish GCF as a possible mode of transmission of SARS-CoV-2, which is the first such report in the literature, and also provide the first quantifiable evidence pointing toward a link between the COVID-19 infection and oral health.

Coinfection of H1N1 Influenza and Scrub Typhus-A Review

The H1N1 influenza infection usually coincides with the typical scrub typhus season in North India. This leads to diagnostic difficulties due to their similar and non-specific symptoms. We describe three patients with confirmed co-infection of pandemic (H1N1) influenza and scrub typhus who had presented with acute respiratory distress syndrome. A systematic review of database yielded one case of scrub typhus and H1N1 influenza co-infection reported from South Korea. Co-infection of influenza with tropical infections may not be uncommon in endemic countries and hence a high index of suspicion on the part of physicians coupled with appropriate investigations are needed. The true burden of co-infections needs to be evaluated during outbreaks of influenza in a systematic manner.

Positing a difference between acts and omissions: the principle of justice, Rachels' cases and moral weakness

The difficulty in discovering a difference between killing and letting die has led many philosophers to deny the distinction. This paper seeks to develop an argument defending the distinction between killing and letting die. In relation to Rachels' cases, the argument is that (a) even accepting that Smith and Jones may select equally heinous options from the choices they have available to them, (b) the fact that the choices available to them are different is morally relevant, and (c) this difference in available choices can be used to distinguish between the agents in certain circumstances. It is the principle of justice, as espoused by Aristotle, which requires that equal things are treated equally and that unequal things are treated unequally that creates a presumption that Smith and Jones should be treated differently. The magnitude of this difference can be amplified by other premises, making the distinction morally relevant in practical reality.

Selective inflammatory effect of systemic fluorouracil in actinic keratosis

A selective inflammatory reaction involving actinic keratosis may occur in patients receiving systemic 5-fluorouracil as part of a chemotherapeutic protocol. This may be effectively treated with topical 5-fluorouracil.