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Endoscopy International Open Feb 2020There is growing interest in the endoscopic recognition of infection, and application to routine practice. We present a systematic review of the current literature... (Review)
Review
There is growing interest in the endoscopic recognition of infection, and application to routine practice. We present a systematic review of the current literature regarding diagnosis of during standard (non-magnified) endoscopy, including adjuncts such as image enhancement and computer-aided diagnosis. The Medline and Cochrane databases were searched for studies investigating performance of non-magnified optical diagnosis for , or those which characterized mucosal features associated with infection. Studies were preferred with a validated reference test as the comparator, although they were included if at least one validated reference test was used. Twenty suitable studies were identified and included for analysis. In total, 4,703 patients underwent investigation including white light endoscopy, narrow band imaging, i-scan, blue-laser imaging, and computer-aided diagnostic techniques. The endoscopic features of infection observed using each modality are discussed and diagnostic accuracies reported. The regular arrangement of collecting venules (RAC) is an important predictor of the -naïve stomach. "Mosaic" and "mottled" patterns have a positive association with infection. The "cracked" pattern may be a predictor of an negative stomach following eradication. This review summarizes current progress made in endoscopic diagnosis of infection. At present there is no single diagnostic approach that provides validated diagnostic accuracy. Further prospective studies are required, as is development of a validated classification system. Early studies in computer-aided diagnosis suggest potential for a high level of accuracy but real-time results are awaited.
PubMed: 32010741
DOI: 10.1055/a-0999-5252 -
Journal of Cellular Physiology Jul 2022Pemphigus vulgaris (PV) is a potentially fatal autoimmune blistering disease characterized by cell-cell detachment (or acantholysis) and blister formation. While the... (Review)
Review
Pemphigus vulgaris (PV) is a potentially fatal autoimmune blistering disease characterized by cell-cell detachment (or acantholysis) and blister formation. While the signaling mechanisms that associate with skin/mucosal blistering are being elucidated, specific treatment strategies targeting PV-specific pathomechanisms, particularly kinase signaling, have yet to be established. Hence, the aim of this review was to systematically evaluate molecules in the class of kinases that are essential for acantholysis and blister formation and are therefore candidates for targeted therapy. English articles from PubMed and Scopus databases were searched, and included in vitro, in vivo, and human studies that investigated the role of kinases in PV. We selected studies, extracted data and assessed risk of bias in duplicates and the results were reported according to the methodology outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). The risk of bias assessment was performed on in vivo studies utilizing SYRCLE's risk of bias tool. Thirty-five studies were included that satisfied the pathogenicity criterion of kinases in PV, the vast majority being experimental models that used PV sera (n = 13) and PV-IgG (n = 22). Inhibition of kinase activity (p38MAPK, PKC, TK, c-Src, EGFR, ERK, mTOR, BTK, and CDK2) was achieved mostly by pharmacological means. Overall, we found substantial evidence that kinase inhibition reduced PV-associated phosphorylation events and keratinocyte disassociation, prevented acantholysis, and blocked blister formation. However, the scarce adherence to standardized reporting systems and the experimental protocols/models used did limit the internal and external validity of these studies. In summary, this systematic review highlighted the pathogenic intracellular events mediated by kinases in PV acantholysis and presented kinase signaling as a promising avenue for translational research. In particular, the molecules identified and discussed in this study represent potential candidates for the development of mechanism-based interventions in PV.
Topics: Acantholysis; Autoantibodies; Blister; Humans; Immunoglobulin G; Keratinocytes; Pemphigus; Phosphorylation
PubMed: 35616233
DOI: 10.1002/jcp.30784 -
Frontiers in Immunology 2021CD4 T-cell depletion is pathognomonic for AIDS in both HIV and simian immunodeficiency virus (SIV) infections. It occurs early, is massive at mucosal sites, and is not...
CD4 T-cell depletion is pathognomonic for AIDS in both HIV and simian immunodeficiency virus (SIV) infections. It occurs early, is massive at mucosal sites, and is not entirely reverted by antiretroviral therapy (ART), particularly if initiated when T-cell functions are compromised. HIV/SIV infect and kill activated CCR5-expressing memory and effector CD4 T-cells from the intestinal lamina propria. Acute CD4 T-cell depletion is substantial in progressive, nonprogressive and controlled infections. Clinical outcome is predicted by the mucosal CD4 T-cell recovery during chronic infection, with no recovery occurring in rapid progressors, and partial, transient recovery, the degree of which depends on the virus control, in normal and long-term progressors. The nonprogressive infection of African nonhuman primate SIV hosts is characterized by partial mucosal CD4 T-cell restoration, despite high viral replication. Complete, albeit very slow, recovery of mucosal CD4+ T-cells occurs in controllers. Early ART does not prevent acute mucosal CD4 T-cell depletion, yet it greatly improves their restoration, sometimes to preinfection levels. Comparative studies of the different models of SIV infection support a critical role of immune activation/inflammation (IA/INFL), in addition to viral replication, in CD4 T-cell depletion, with immune restoration occurring only when these parameters are kept at bay. CD4 T-cell depletion is persistent, and the recovery is very slow, even when both the virus and IA/INFL are completely controlled. Nevertheless, partial mucosal CD4 T-cell recovery is sufficient for a healthy life in natural hosts. Cell death and loss of CD4 T-cell subsets critical for gut health contribute to mucosal inflammation and enteropathy, which weaken the mucosal barrier, leading to microbial translocation, a major driver of IA/INFL. In turn, IA/INFL trigger CD4 T-cells to become either viral targets or apoptotic, fueling their loss. CD4 T-cell depletion also drives opportunistic infections, cancers, and comorbidities. It is thus critical to preserve CD4 T cells (through early ART) during HIV/SIV infection. Even in early-treated subjects, residual IA/INFL can persist, preventing/delaying CD4 T-cell restoration. New therapeutic strategies limiting mucosal pathology, microbial translocation and IA/INFL, to improve CD4 T-cell recovery and the overall HIV prognosis are needed, and SIV models are extensively used to this goal.
Topics: Animals; Bacterial Translocation; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Gastrointestinal Microbiome; HIV; HIV Infections; Haplorhini; Host-Pathogen Interactions; Humans; Immunity, Mucosal; Immunocompromised Host; Inflammation Mediators; Intestinal Mucosa; Phenotype; Simian Acquired Immunodeficiency Syndrome; Simian Immunodeficiency Virus; Time Factors
PubMed: 34367156
DOI: 10.3389/fimmu.2021.695674 -
Journal of Maxillofacial and Oral... Jun 2019Dirofilariasis is an endemic disease in tropical and subtropical countries caused by about 40 different species of dirofilari. Dirofilariasis of the oral cavity is... (Review)
Review
BACKGROUND
Dirofilariasis is an endemic disease in tropical and subtropical countries caused by about 40 different species of dirofilari. Dirofilariasis of the oral cavity is extremely rare and is usually seen as mucosal or submucosal nodules. We also present a case of dirofilariasis of the mandibular third molar region submucosally in a 26 year old male patient.
PURPOSE
To identify, enlist and analyze the cases of dirofilariasis in maxillofacial region reported worldwide so as to understand the clinical presentation and encourage the consideration of helminthic infections as a possible differential diagnosis in maxillofacial swellings.
METHODS
Two authors KC and SK independently searched the electronic database of PUBMED, OVID, Google Scholar and manual search from other sources. A general search strategy was planned and anatomic areas of interest identified. The search was made within a bracket of 1 month by the independent authors KC and SK who assessed titles, abstracts and full texts of articles based on the decided keywords. The final selection of articles was screened for the cases that were reported in the maxillofacial region including the age, gender, site of occurrence and region of the world reported in. A geographic distribution of the reported cases was tabulated.
RESULTS
A total number of 265, 97, 1327, 3 articles were identified by PubMed, Ovid, GoogleScholar and manual search respectively. The final articles were manually searched for duplicates and filtered according to the inclusion/exclusion criteria which led to a final list of 58 unique articles that were included in the study. In total 99 cases were identified.
CONCLUSION
Although intraoral dirofilarial infections are extremely uncommon, it should be considered in the differential diagnosis of an intraoral or facial swelling that does not completely respond to routine therapy especially in patients from endemic areas.
PubMed: 30996536
DOI: 10.1007/s12663-018-1139-7 -
Blood Nov 2014Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to... (Meta-Analysis)
Meta-Analysis Review
Childhood immune thrombocytopenia (ITP) is a rare autoimmune bleeding disorder. Most children recover within 6 to 12 months, but individual course is difficult to predict. We performed a systematic review and meta-analysis to identify predictors of chronic ITP. We found 1399 articles; after critical appraisal, 54 studies were included. The following predictors of chronic ITP in children, assessed in at least 3 studies, have been identified: female gender (odds ratio [OR] 1.17, 95% confidence interval [CI] 1.04-1.31), older age at presentation (age ≥11 years; OR 2.47, 95% CI 1.94-3.15), no preceding infection or vaccination (OR 3.08, 95 CI 2.19-4.32), insidious onset (OR 11.27, 95% CI 6.27-20.27), higher platelet counts at presentation (≥20 × 10(9)/L: OR 2.15, 95% CI 1.63-2.83), presence of antinuclear antibodies (OR 2.87, 95% 1.57-5.24), and treatment with a combination of methylprednisolone and intravenous immunoglobulin (OR 2.67, 95% CI 1.44-4.96). Children with mucosal bleeding at diagnosis or treatment with intravenous immunoglobulin alone developed chronic ITP less often (OR 0.39, 95% CI 0.28-0.54 and OR 0.71, 95% CI 0.52-0.97, respectively). The protective effect of intravenous immunoglobulin is remarkable and needs confirmation in prospective randomized trials as well as future laboratory studies to elucidate the mechanism of this effect.
Topics: Adolescent; Child; Child, Preschool; Chronic Disease; Clinical Laboratory Techniques; Female; Humans; Infant; Male; Prognosis; Purpura, Thrombocytopenic, Idiopathic; Risk Factors
PubMed: 25305206
DOI: 10.1182/blood-2014-04-570127 -
South Asian Journal of Cancer Jan 2022Shikha Verma Systemic fluoropyrimidines, both oral and intravenous, are an integral part of colorectal cancer (CRC) management. They can be administered either with... (Review)
Review
Shikha Verma Systemic fluoropyrimidines, both oral and intravenous, are an integral part of colorectal cancer (CRC) management. They can be administered either with curative or palliative intent. This article examines the literature to analyze the efficacy and safety of the oral fixed-dose combination of uracil and tegafur (UFT)/leucovorin (LV) compared with other fluoropyrimidine agents, with an intention to implement the findings into the current treatment algorithms for CRC. An exhaustive systematic literature search was performed for prospective studies using PUBMED, Cochrane Library, and EMBASE database. Studies which met eligibility criteria were shortlisted and grouped into chemotherapy given for curative or palliative intent. Eight trials were shortlisted involving 4,486 patients for the analysis. There was no difference between UFT/LV and other fluoropyrimidines in the primary endpoints-disease-free survival (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.90-.15; = 0.81) and progression-free survival (HR 0.87; 95% CI 0.66-.66; = 0.35) for curative and palliative intent CRC patients, respectively. In secondary analyses, there was no significant difference observed between UFT and other fluoropyrimidines in overall survival in CRC patients with curative intent (HR 1.04; 95% CI 0.88-1.23; = 0.63) and palliative intent (HR 1.02; 95% CI 0.97-1.06; = 0.42) . In the safety analysis, we found significantly lesser patients on UFT/LV had stomatitis/mucositis (odds ratio [OR] 0.20; 95% CI 0.05-0.85; = 0.03), fever (OR 0.46; 95% CI 0.29-0.71; < 0.001), infection (OR 0.42; 95% CI 0.24-0.74; < 0.01), leukopenia (OR 0.04; 95% CI 0.00-0.95; = 0.05), febrile neutropenia (OR 0.03; 95% CI 0.00-0.24; = 0.001), and thrombocytopenia (OR 0.14; 95% CI 0.02-0.79; = 0.03) compared with other fluoropyrimidines. Oral UFT/LV is equally efficacious to other fluoropyrimidines, especially intravenous 5-fluorouracil, in the management of early as well as advanced CRC patients. Importantly, UFT/LV has a superior safety profile compared with other fluoropyrimidines in terms of both hematological and nonhematological adverse events.
PubMed: 35833043
DOI: 10.1055/s-0041-1735650 -
Spartan Medical Research Journal 2021(MP) is a common respiratory pathogen that can result in community-acquired pneumonia (CAP). Approximately 25% of patients diagnosed with MP experience extrapulmonary...
INTRODUCTION
(MP) is a common respiratory pathogen that can result in community-acquired pneumonia (CAP). Approximately 25% of patients diagnosed with MP experience extrapulmonary manifestations. -induced rash and mucositis (MIRM) was coined as a unique disease process in 2014. MIRM has prominent mucositis with or without a characteristic vesiculobullous and/or atypical targetoid eruption. Appropriate identification of this disease is important because it has a milder disease course with low rates of sequelae, and lower mortality compared to Stevens-Johnson syndrome, erythema multiforme, and toxic epidermal necrolysis. The objective of this systematic review was to examine the English literature on -induced rash and mucositis since the establishment of its diagnosis in 2014.
METHODS
The following online databases were used to identify appropriate studies that met the established inclusion and exclusion criteria: Pubmed, Cochrane, MedLine, Health Evidence, EPPI center, Allied Health Evidence. The following MesH search terms were used to further identify articles; " induced rash and mucositis," " rash and mucositis," " rash," " mucositis," "MIRM," " induced rash and mucositis," " rash and mucositis," " rash," and " mucositis." Data was extracted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
RESULTS
One hundred and seventy-five records were initially screened, and nineteen studies were included in the review, leading to a total of 27 patients. Patients had a mean age of 16 years old (Range 4 - 46 years old), with the majority being males (74%). Pulmonary symptoms tended to precede extrapulmonary symptoms on an average of 7.8 days. Extrapulmonary symptoms consisted of oral lesions (96.3%) followed by ocular lesions (92.6%) and genital lesions (59.3%). Female patients were more likely to have genital lesions (71.4%) when compared with male patients (55%). Cutaneous rashes occurred in approximately one-half of the patients, which supports the theory that MIRM is a separate clinical entity from SJS and other related skin disorders.Confirmatory testing for MIRM was performed using IgM/IgG antibody testing or PCR in 19 (66.7%) and 6 (22.2%) patients respectively, although four cases reported the use of both serology and PCR, while five did not report confirmatory testing. Systemic antibiotics were used frequently in treatment 22 patients (77.8%) and 27 (100%) of the patients received various supportive care. Approximately 11 (37%) patients of reported cases used systemic steroids to reduce systemic inflammation. Other systemic treatments were used in six (21.4%) cases, and included intravenous immunoglobulins and cyclosporine A. Only eight patients (22.2%) reported having any lasting sequelae.
CONCLUSION
-induced rash and mucositis is a recently described extra-pulmonary manifestation of infections. To the best of the authors' knowledge, this is the first systematic review of the MIRM literature since the introduction of the diagnosis in 2014. The authors hope that this review can serve to better our current understanding and lead to improved identification, work-up, and treatment of this disease. One notable limitation of this study is the relatively small sample size, which is due to the recent introduction of the term.
PubMed: 34532621
DOI: 10.51894/001c.25284 -
The Journal of Surgical Research Jun 2022Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique.
METHODS
A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy. Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death.
RESULTS
Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1.60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy (RR 7.37 [0.92-59.11]). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation (RR 3.44 [0.39-30.43]) or occurrence of incisional hernias (RR 1.01 [0.11-9.53]). Length of hospital stay (-3.01 h for LP [-8.39 to 2.37 h]) and time to full feeds (-5.86 h for LP [-15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (+0.53 min for LP [-3.53 to 4.59 min]).
CONCLUSIONS
On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative hematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time.
Topics: Abscess; Hematoma; Humans; Incisional Hernia; Infant; Laparoscopy; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Pylorus; Seroma; Surgical Wound Infection
PubMed: 35104694
DOI: 10.1016/j.jss.2021.12.042 -
World Journal of Gastroenterology Dec 2017To critically evaluate previous scientific evidence on Fusobacterium's role in colorectal neoplasia development. (Review)
Review
AIM
To critically evaluate previous scientific evidence on Fusobacterium's role in colorectal neoplasia development.
METHODS
Two independent investigators systematically reviewed all original scientific articles published between January, 2000, and July, 2017, using PubMed, EMBASE, and MEDLINE. A total of 355 articles were screened at the abstract level. Of these, only original scientific human, animal, and in vitro studies investigating and its relationship with colorectal cancer (CRC) were included in the analysis. Abstracts, review articles, studies investigating other colonic diseases, and studies written in other languages than English were excluded from our analysis. Ninety articles were included after removing duplicates, resolving disagreements between the two reviewers, and applying the above criteria.
RESULTS
Studies have consistently identified positive associations between , especially (), and CRC. Stronger associations were seen in CRCs proximal to the splenic flexure and CpG island methylator phenotype (CIMP)-high CRCs. There was evidence of temporality and a biological gradient, with increased DNA detection and quantity along the traditional adenoma-carcinoma sequence and in CIMP-high CRC precursors. Diet may have a differential impact on colonic enrichment; evidence suggests that high fiber diet may reduce the risk of a subset of CRCs that are DNA-positive. Data also suggest shorter CRC and disease-specific survival with increased amount of DNA in CRC tissue. The pathophysiology of enrichment of and other species in colonic tissue is unclear; however, the virulence factors and changes to the local colonic environment with disruption of the protective mucus layer may contribute. The presence of a host lectin (Gal-GalNAc) in the colonic epithelium may also mediate attachment to CRC and precursors through interaction with an protein, fibroblast activation protein 2 (FAP2). The clinical significance of detection or enrichment of in colorectal neoplasia is ambiguous, but data suggest a procarcinogenic effect of , likely due to activation of oncogenic and inflammatory pathways and modulation of the tumor immune environment. This is hypothesized to be mediated by certain strains carrying invasive properties and virulence factors such as FadA and FAP.
CONCLUSION
Evidence suggests a potential active role of , specifically , in CRC. Future prospective and experimental human studies would fill an important gap in this literature.
Topics: Animals; Carcinogenesis; Colon; Colorectal Neoplasms; CpG Islands; Fusobacterium; Fusobacterium Infections; Humans; Intestinal Mucosa; Methylation; Rectum
PubMed: 29358871
DOI: 10.3748/wjg.v23.i48.8626 -
International Journal of Environmental... Oct 2022Antiretroviral therapy (ART) increases the survival of HIV-infected children, but might also bring in oral health-related side effects and increase their risks of oral... (Meta-Analysis)
Meta-Analysis Review
Antiretroviral therapy (ART) increases the survival of HIV-infected children, but might also bring in oral health-related side effects and increase their risks of oral diseases. The review compared the oral health status of children living with HIV (CLWH) undergoing ART with healthy controls. Dual independent screening and study selection from four electronic databases and manual searches, data extraction, risk of bias assessment, and quality-of-evidence evaluation with Grading of Recommendations Assessment Development and Evaluation were performed. Twelve studies were included in qualitative and quantitative analysis. CLWH taking ART had a significantly higher prevalence of periodontal diseases (OR = 3.11, 95% CI 1.62-5.97), mucosal hyperpigmentation (OR = 20.35, 95% CI 3.86-107.39), and orofacial-related opportunistic infections than healthy controls. No significant differences regarding caries prevalence and tooth development were identified. Those with CD4+ T-cell counts below 250 cells/mm were more likely to manifest opportunistic infections, while medication duration had minimal influence on the prevalence of orofacial opportunistic infections. The current findings did not identify HIV and antiretroviral status as predisposing factors to dental caries, but affirmed the associated increased risk of periodontal diseases, mucosal hyperpigmentation and candidiasis.
Topics: Adolescent; Child; Dental Caries; HIV Infections; Humans; Hyperpigmentation; Opportunistic Infections; Oral Health; Periodontal Diseases
PubMed: 36232165
DOI: 10.3390/ijerph191912864