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Oral Diseases May 2023Cheilitis Glandularis (CG) is an uncommon entity of obscure etiology. A cases series is presented with emphasis on etiopathogenesis.
OBJECTIVES
Cheilitis Glandularis (CG) is an uncommon entity of obscure etiology. A cases series is presented with emphasis on etiopathogenesis.
MATERIALS AND METHODS
Fourteen CG cases were analyzed according to their demographic and clinicopathologic characteristics.
RESULTS
The mean age of the patients with CG was 68.1 years, while a male-to-female ratio of 1.8:1 was observed. One or more potential causative factors were identified for each patient, including long-term smoking (9 cases), xerostomia (4 cases), cosmetic filler injections (2 cases), and actinic cheilitis (1 case). The lesions were located on the lips, buccal mucosa, or both in 7, 2, and 5 cases, respectively. Multiple submucosal nodules with dilated ductal orifices and mucous or purulent discharge were observed in all cases. Histopathologically, ductal ectasia with metaplasia, intraductal mucin, and chronic or mixed inflammation were noted, as well as pools of hyaluronic acid in 2 cases with a history of cosmetic filler injections.
CONCLUSIONS
CG etiopathogenesis is probably multifactorial. Reduced salivary flow rate and increased viscosity of saliva, potentially caused by long-term smoking, diabetes mellitus, and drug-induced xerostomia, may participate in the initial pathogenesis, while local irritants, for example, poor oral hygiene and local trauma, may further contribute to the development and aggravation of the condition.
Topics: Humans; Male; Female; Aged; Salivary Glands, Minor; Cheilitis; Sialadenitis; Xerostomia
PubMed: 35113467
DOI: 10.1111/odi.14144 -
International Medical Case Reports... 2022To report a case series of lacrimal duct obstruction and infection associated with non-traumatic corneal perforation.
PURPOSE
To report a case series of lacrimal duct obstruction and infection associated with non-traumatic corneal perforation.
CASE SERIES
This study included 6 eyes in 6 patients with non-traumatic corneal perforation treated between April 2019 and March 2021. All 6 cases were associated with lacrimal duct obstruction and infection. Purulent discharge caused by lacrimal duct infection was observed in all 6 patients (100%). However, three of the 6 patients (50%) did not show purulent discharge at initial examination and lacrimal duct obstruction was therefore not initially recognized. Dry eye was observed in five of the 6 patients (83%) and may have caused corneal deterioration, increasing susceptibility to perforation. Further, dry eye masks symptoms of lacrimal duct obstruction and infections, such as epiphora and regurgitation of purulent discharge, making the association with lacrimal duct obstruction and infection difficult to determine. All patients were treated for both corneal perforation and lacrimal duct disease, and conditions improved, with no recurrence of either corneal perforation or lacrimal duct disease.
CONCLUSION
In patients with a combination of lacrimal duct disease and corneal perforation, treatment of both diseases resulted in stabilization of patient condition. Dry eyes may mask symptoms of lacrimal duct diseases, such as epiphora and purulent discharge, and lacrimal duct disease may thus be underdiagnosed.
PubMed: 35769810
DOI: 10.2147/IMCRJ.S363034 -
Theriogenology Mar 2024Up to 50 % of dairy cows fail to resolve uterine involution and develop chronic clinical (CE) or subclinical endometritis (SE) 21 days after calving. Clinical...
Up to 50 % of dairy cows fail to resolve uterine involution and develop chronic clinical (CE) or subclinical endometritis (SE) 21 days after calving. Clinical endometritis is associated with purulent discharge, while SE is not associated with overt clinical signs. Along with numerous knowledge gaps related to its pathogenesis, SE does not allow for a straightforward and effective therapy. Therefore, it is crucial to unravel differences in the expression of genes among healthy, CE, and SE cows. This might contribute to the discovery of new drug candidates and, in consequence, a potentially effective treatment. In the present study, cows between 21 and 28 days postpartum (PP) were examined using vaginoscopy for the presence of vaginal discharge and endometrial cytology for the determination of the endometrial polymorphonuclear cell (PMN) percentage. Next, an endometrial biopsy sample was taken to investigate the expression of 13 selected candidate genes by qPCR. Uterine health status was assigned to healthy (absence of abnormal vaginal discharge and ≤5 % PMN, n = 13), SE (absence of abnormal vaginal discharge and >5 % PMN, n = 30), and CE (mucopurulent or purulent vaginal discharge and >5 % PMN, n = 9). At the same time, a blood sample was collected to assess serum progesterone concentration and to categorize cows as low (≤1 ng/mL) or high (>1 ng/mL) in progesterone. High expression of IL1B, IL6, IL17A, CXCL8, PTGES, PTGS1, PTGS2, and INHBA genes and low expression of FST was noted in the endometrium of CE compared to healthy cows. Increased endometrial INHBA expression was observed in both SE and CE compared to healthy cows. Interestingly, greater expression of PTGES and PRXL2B genes and lower expression of PTGS2 were characteristic of SE versus CE or healthy. Among cows with no overt clinical symptoms of uterine disease (healthy and SE), the endometrial expression of IL1 B, CXCL8, and PTGES was greater in cows with high versus low serum progesterone. Several genes were differentially expressed among healthy, SE, and CE cows indicating different pathways for the development of different uterine diseases. In conclusion, we found progesterone-independent SE markers, which suggests that low endometrial PTGS2 expression may be indicative of an inadequate immune response and thus contribute to the pathogenesis of SE.
Topics: Female; Cattle; Animals; Endometritis; Progesterone; Cyclooxygenase 2; Endometrium; Postpartum Period; Prostaglandin-E Synthases; Vaginal Discharge; RNA, Messenger; Cattle Diseases
PubMed: 38183931
DOI: 10.1016/j.theriogenology.2023.12.031 -
Pediatric Emergency Care Mar 2020Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has...
BACKGROUND
Toxic shock syndrome (TSS) is an acute, severe, toxin-mediated disease, characterized by fever, hypotension, and multiorgan system involvement. Toxic shock syndrome has made headlines because of its high associated morbidity and mortality rate in previously healthy young females. Incidence peaked in the early 1980s owing to increased usage of ultra-absorbent tampons. After improved patient education and tampon labeling, the incidence of menstrual TSS has declined.
CASE
A previously healthy 14-year-old girl presented to an urgent care center with a 2-day history of fever, erythematous maculopapular rash, vomiting, diarrhea, and malaise. She was found to be tachycardic and hypotensive. Investigations revealed thrombocytopenia, an elevated white count and lactate, and acute kidney injury, consistent with septic shock. Recent tampon usage with menstruation was reported, and a pelvic examination revealed purulent vaginal discharge. The patient was transferred to a pediatric intensive care unit for antibiotic and vasopressor therapy. Vaginal swabs later tested positive for Staphylococcus aureus and TSS toxin-1.
CONCLUSIONS
Although the incidence of TSS has decreased in recent years, it is crucial that clinicians rapidly recognize and treat this life-threatening condition. Emergency physicians should always have a high index of suspicion for TSS in young females presenting without another obvious cause of shock. A pelvic examination should always be completed in these cases.
Topics: Adolescent; Anti-Bacterial Agents; Bacterial Toxins; Enterotoxins; Female; Humans; Menstrual Hygiene Products; Menstruation; Shock, Septic; Staphylococcal Infections; Staphylococcus aureus; Superantigens
PubMed: 29040243
DOI: 10.1097/PEC.0000000000001310 -
Journal of Family Medicine and Primary... Dec 2020An umbilical cerebrospinal fluid (CSF) fistula following a ventriculoperitoneal (VP) shunt is an extremely rare complication. The shunt can get blocked and infected and...
An umbilical cerebrospinal fluid (CSF) fistula following a ventriculoperitoneal (VP) shunt is an extremely rare complication. The shunt can get blocked and infected and present as purulent umbilical discharge. We report an 11-month-old female infant who presented with recurrent purulent umbilical discharge, 6 months after VP shunt operation for hydrocephalus. After relevant investigations, she underwent exploratory laparotomy which revealed an umbilical CSF fistula with a blocked VP shunt. VP shunt removal was done with excision of the fistulous tract. The post-op period was uneventful and umbilical discharge ceased. She is further planned for endoscopic third ventriculostomy. Umbilical discharge in a neonate may be due to several pathologies. The family physician is the first point of contact in the majority of the cases before they seek a specialist. Hence, recurrent umbilical discharge not responding to conservative management must be evaluated carefully, referred promptly, and the underlying pathology to be treated.
PubMed: 33681077
DOI: 10.4103/jfmpc.jfmpc_814_20 -
Stomatologiia 2022To familiarize dentists with the features of the clinical course of acute purulent mumps occurring in patients with COVID-19.
THE AIM OF THE STUDY
To familiarize dentists with the features of the clinical course of acute purulent mumps occurring in patients with COVID-19.
MATERIAL AND METHODS
Four patients aged 73 to 89 years with acute bilateral purulent mumps, which occurred against the background of COVID-19, were under observation. The patients were treated for COVID-19, and acute purulent mumps was also treated.
RESULTS
As a result of treatment, two patients were discharged in satisfactory condition on the 9th and 10th days under medical supervision at their place of residence. Their mumps phenomena have completely subsided. Two patients died from acute respiratory failure, cerebral edema, septic condition, acute renal and hepatic insufficiency. From the parotid glands, acute inflammatory phenomena subsided.
CONCLUSION
It was found that one of the complications of COVID-19 may be the development of acute bilateral purulent mumps, which aggravated the course of the underlying disease. Inflammation of the parotid glands proceeded according to the type of acute postoperative mumps against the background of a sharp decrease in the secretory activity of the salivary glands according to the type of asialia. Timely comprehensive treatment of acute mumps allows in some cases to avoid a fatal outcome.
Topics: Aged; Aged, 80 and over; COVID-19; Humans; Mumps; Parotid Gland; SARS-CoV-2
PubMed: 35184537
DOI: 10.17116/stomat202210101170 -
Skin Health and Disease Feb 2024Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has...
BACKGROUND
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has significant physical, psychological and financial impact.
OBJECTIVES
This study plans to analyse patient costs associated with HS. Direct costs include prescription items. Indirect or out-of-pocket costs include dressings, analgesia, and healthcare-related travel costs. This study will also assess disease impact on quality-of-life (QOL).
METHODS
Patients with HS diagnosis attending dermatology OPD at our public tertiary centre were invited to participate. Ethical approval was secured, and informed consent was obtained. Participants completed an anonymous survey which was analysed to identify costs associated with HS as well as demographics and QOL impact.
RESULTS
A total of 25 patients completed the survey; median age was 29% and 80% were female. Median time from HS onset to diagnosis was 2 years, with 24% waiting >10 years to be diagnosed. In the past 3 months, 20% spent >€200 in both categories; prescription and non-prescription items. In the non-prescription category, 36% of patients reported expenditure >€100 in the past 3 months. Dressings were the most common out-of-pocket expense (in 15/25 patients), followed by analgesia and protective clothing. Attendance at medical appointments cost 24% of patients €50-€200. Four participants reported difficulty accessing HS treatments due to associated costs. Mean number of absence days from work/education as result of HS was 8.7 in the past 3 months. Two patients reported being on disability allowance, and two on unemployment benefit as result of their skin disorder. In the QOL question; 96% reported disease impact on QOL, and 11 participants reported that it affected their life 'very much'.
CONCLUSIONS
HS is a chronic inflammatory skin condition with significant financial burden alongside the well-analysed biopsychosocial disease impact. Financial burden can be divided into direct prescription costs and indirect costs such as non-prescription items, protective clothing and travel costs which we have explored in this study. Further research is needed in this area to identify and optimise both the financial and QOL implications of HS in acute flares and chronic disease management.
PubMed: 38312251
DOI: 10.1002/ski2.306 -
Annals of Medicine and Surgery (2012) Oct 2022Breast abscess in newborns is an exceedingly rare pyogenic inflammation that usually starts as mastitis neonatorum. Although mastitis can respond to antibiotic therapy...
BACKGROUND
Breast abscess in newborns is an exceedingly rare pyogenic inflammation that usually starts as mastitis neonatorum. Although mastitis can respond to antibiotic therapy in the initial stages, once advanced into a purulent collection, decompression may be indicated either in the form of needle aspiration or even surgical drainage. We present two newborns with breast abscesses managed surgically with successful outcomes.
CASE PRESENTATION
Case 1: A 13-day-old boy presented with swelling and redness over the left breast for a day. Local examination revealed a warm, indurated swelling with redness and fluctuation. Needle aspiration confirmed pus. Intravenous (IV) antibiotics were started right away followed by pus drainage, the culture of which yielded Methicillin-Sensitive (MSSA). Regular wound care subsequently resulted in complete recovery.Case 2: A 15-day-old boy presented with swelling, redness and milky discharge from the right breast for two days. The swelling was erythematous, tender and indurated but not cystic or fluctuant. Ultrasonogram was suggestive of an abscess. Once again, IV antibiotics were administered followed by drainage. Pus yielded MSSA. Following regular wound dressings, satisfactory healing was achieved.
CONCLUSION
Neonatal mastitis and breast abscess are uncommon. Early recognition followed by appropriate antibiotic therapy and drainage of the abscess is the mainstay of treatment.
PubMed: 36268300
DOI: 10.1016/j.amsu.2022.104774 -
Diagnostics (Basel, Switzerland) Nov 2023A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and...
A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and pyrexia. A radiological assessment revealed a possible tubo-ovarian abscess and the incidental diagnosis of ipsilateral renal agenesis. The patient was treated for pelvic inflammatory disease (PID); however, after antibiotic administration and since the symptoms did not resolve, an abdominal MRI was requested, which revealed uterus didelphys with two cervices, an obstructed haemivagina and evidence of haematocolpos. The diagnosis of Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis (OHVIRA) syndrome was confirmed, and the patient underwent the excision of the vaginal septum, the drainage of the haematopyocolpos and the laparoscopic drainage of the tubo-ovarian abscess. She achieved a good recovery.
PubMed: 37958273
DOI: 10.3390/diagnostics13213377 -
The Israel Medical Association Journal... May 2020Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported,... (Review)
Review
BACKGROUND
Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported, and the treatment of this condition is still unclear.
OBJECTIVES
To evaluate the Seldinger technique for treatment of early BBS after PEG insertion.
METHODS
We report two cases of early BBS in two consecutive patients who underwent PEG insertion to maintain oral intake. The first patient was an 83-year-old woman showing Alzheimer type dementia, while the other one was a 76-year-old man who presented with maxillary cancer and treated with radiotherapy followed by left maxillectomy. Post-surgery, he developed progressive difficulty of swallowing due to mouth deformation and treatment related nerve toxicity. The first patient presented with fever and purulent discharge from the gastrostomy insertion site, without ability to rotate or slide the tube through the stoma 10 days after the PEG insertion. The man was admitted to the hospital 5 days following PEG insertion due to a fever of 38°C and peritubal swelling with purulent discharge. In addition, the tube could not rotate or slide through the stoma.
RESULTS
Buried bumper syndrome was demonstrated by computed tomography scan. Gastroscopy and gastrostomy tube replacement was performed successfully according to the Seldinger technique (replacement over guidewire) in both cases. Correct intragastric tube positioning was demonstrated radiographically before resuming tube feeding. The two patients were discharged in good physical condition several days later.
CONCLUSIONS
External replacement over guide wire should be considered in such cases.
Topics: Aged; Aged, 80 and over; Device Removal; Enteral Nutrition; Female; Gastrostomy; Humans; Male; Point-of-Care Systems; Postoperative Complications; Retreatment; Time Factors
PubMed: 32378825
DOI: No ID Found