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Revista Da Associacao Medica Brasileira... 2024
Topics: Humans; Sialorrhea; Child
PubMed: 38655996
DOI: 10.1590/1806-9282.20230971 -
Radiology Case Reports Jul 2024Rabies is an acute fatal disease of the central nervous system. Neuroimaging plays an important role, especially in establishing an early diagnosis and distinguishing it...
Rabies is an acute fatal disease of the central nervous system. Neuroimaging plays an important role, especially in establishing an early diagnosis and distinguishing it from other types of encephalitis. This case report aims to give a brief review of this condition and report the less common MRI findings of the disease. We herein report a case of a 61-year-old male bitten by a stray dog who presented with fever, vomiting, headache, sialorrhea, dysarthria, dysphagia, and upper limb weakness which progressed to lower limbs on the next day. T2W and FLAIR images demonstrated subtle bilateral hyperintense signal in the deep gray matter with more apparent increased signal intensity in the white matter of the frontal and parietal lobes which shows mild diffusion restriction but no postcontrast enhancement. The diagnosis of rabies encephalitis was made based on a typical history of exposure, a compatible clinical presentation, and MRI findings. Rabies diagnosis is essentially clinical. It is definitively confirmed by the isolation of the virus from biological samples such as saliva, CSF, hair, or detection of rabies antigens or antibodies. Magnetic resonance imaging (MRI) brain used as one of the modalities of investigation for distinguishing it from other encephalitis. Rabies per se does not have any characteristic features on the MRI brain.
PubMed: 38645944
DOI: 10.1016/j.radcr.2024.03.072 -
Journal of Oral Biology and... 2024The present case report describes the prosthetic management following partial loss of free-fibular osteocutaneous flap in an irradiated patient diagnosed with recurrent...
The present case report describes the prosthetic management following partial loss of free-fibular osteocutaneous flap in an irradiated patient diagnosed with recurrent head and neck cancer. The patient presented with constant drooling of oral fluids due to an anatomically deficient lower lip. Salvage reconstructive surgery was not considered feasible due to past history of recurrence, multiple surgeries and radiotherapy, and financial constraints. An adhesive-retained interim silicone prosthesis was fabricated to alleviate the functional and psychosocial morbidity. The prosthesis served to restore the oro-facial seal to prevent constant drooling of oral fluids. It also aided in providing an excellent aesthetic solution to palliate the psychological suffering experienced by the patient due to lost facial contours.
PubMed: 38645706
DOI: 10.1016/j.jobcr.2024.04.001 -
TheScientificWorldJournal 2024To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay.
OBJECTIVE
To evaluate the profile of patients operated for maxillofacial space infections and associated risk factors for the length of hospital stay.
MATERIALS AND METHODS
We conducted a retrospective study among patients operated for maxillofacial infections at our center from 2010 to 2020. Information collected from the records were age, sex, type and number of spaces involved, clinical signs and symptoms (pain, swelling, toothache, sore throat, otalgia, hoarseness, headache, cough, neck swelling, rancid breath, sialorrhea, gingival swelling, muffled voice, trismus, fever, dysphagia, odynophagia, malaise, lymphadenopathy, dyspnoea, pus discharge), treatment modality, total leukocyte count, evidence of bacterial growth, comorbidities, complications if any and length of hospital stay.
RESULTS
A total of 128 medical records were examined, out of which 59 were female. The mean age was 38.59 ± 19.7 and the length of hospital stay was 7.56 ± 3.8 days. The most commonly involved space was submandibular space (46.1%) and the common symptoms reported were swelling (99.2%), pain (86.7%), and trismus (68%). Four patients had complications like necrotizing fasciitis (1.6%), pneumonia (0.8%), and death in one patient (0.8%). Logistic regression showed that patients more than 36 years of age, male sex, evidence of bacterial growth, and diabetics had higher odds of increased hospital stay (>6 days). Multiple logistic regression analysis showed that age ( = 0.015; OR: 2.98) and evidence of bacterial culture ( = 0.001; OR:6.64) were potential predictors associated with increased hospital stay.
CONCLUSION
Our study showed that the age of the patient and evidence of bacterial culture were potential predictors of prolonged hospital stay among patients operated for maxillofacial space infections.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Middle Aged; Infant, Newborn; Trismus; Retrospective Studies; Risk Factors; Headache; Pain
PubMed: 38633105
DOI: 10.1155/2024/9304671 -
Frontiers in Pediatrics 2024Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammation of the esophagus, characterized by symptoms related to esophageal dysfunction, resulting from...
INTRODUCTION
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammation of the esophagus, characterized by symptoms related to esophageal dysfunction, resulting from severe eosinophilic infiltration of the esophageal mucosa. It is common in atopic subjects and food antigens have been identified as the most common triggers. However, a seasonal variation in EoE prevalence, correlated with air pollen levels, is reported, suggesting that also aeroallergens may play a role. Little is known about the interplay between EoE and concomitant atopy treatment for aeroallergens.
CASE PRESENTATION
We describe the case of an 11-year-old boy who presented dysphagia, vomiting, drooling, and chest pain while eating meat, developed 15 months after receiving sublingual immunotherapy (SLIT) for Alternaria (SUBLIVAC®). He underwent esophagogastroduodenoscopy (EGD) revealing severe eosinophilic predominant inflammation (100 eos/HPF), consistent with the diagnosis of EoE, not improving at the EGDs performed after both omeprazole and topical corticosteroids treatment, despite symptom improvement. Afterward, immunotherapy was switched from sublingual to injective form. At the EGD performed 1 month later, macroscopic examination of the esophageal mucosa was normal and eosinophilic infiltration was significantly decreased (5-10 eos/HPF).
CONCLUSIONS
SLIT may induce EoE by chronic antigenic exposure of oral mucosa in patients with a robust allergic susceptibility: while attenuating the IgE-mediated immune reactions, the progressive contact with the causative allergen might induce a chronic stimulation of the immune system with the consequent activation of tissue eosinophils. Our data suggest monitoring patients receiving SLIT for EoE symptoms and to discontinue SLIT on their earlier appearance, possibly as a first-line treatment.
PubMed: 38567182
DOI: 10.3389/fped.2024.1379162 -
Journal of Stomatology, Oral and... Jun 2024This study aimed to assess the functional and esthetic outcomes of a chimeric innervated buccinator myomucosal-submental island flap (BMM-SIF) for large composite lower...
OBJECTIVE
This study aimed to assess the functional and esthetic outcomes of a chimeric innervated buccinator myomucosal-submental island flap (BMM-SIF) for large composite lower lip reconstruction.
METHODS
This retrospective study included five patients who underwent lower lip tumor resection and BMM-SIF reconstruction at the Hospital of Stomatology, Sun Yat-sen University, between August 2021 and February 2023. Lip function was evaluated using water leakage, cheek puffing tests, and superficial electromyography. Lip appearance was observed using photographs and evaluated through subjective interviews. Donor-site conditions, including facial symmetry and mouth opening, were monitored.
RESULTS
All the BMM-SIFs survived. Drooling was the main complication observed shortly after surgery. The water leakage test showed complete oral competence for liquid holding in the 7th month; however, moderate air leakage was present in two patients. Electromyography revealed myoelectric signals from the innervated buccinator at the recipient site. Facial expression and food intake were typically managed. The shape and projection of the vermilion were harmonious and satisfactory for each patient. Neither microstomia nor mouth opening limitation was observed, with an average inter-incisor distance of 37.25±4.4 mm.
CONCLUSION
Chimeric motor-innervated BMM-SIF effectively reconstructed large full-thickness lower-lip defects with satisfactory functional and esthetic outcomes.
Topics: Humans; Male; Lip Neoplasms; Retrospective Studies; Female; Middle Aged; Lip; Plastic Surgery Procedures; Surgical Flaps; Facial Muscles; Aged; Esthetics; Adult
PubMed: 38561137
DOI: 10.1016/j.jormas.2024.101861 -
Revista Paulista de Pediatria : Orgao... 2024To describe the current state of the art in the therapeutic administration of botulinum toxin with indications, efficacy, and safety profile for children and adolescents... (Review)
Review
OBJECTIVE
To describe the current state of the art in the therapeutic administration of botulinum toxin with indications, efficacy, and safety profile for children and adolescents with cerebral palsy.
DATA SOURCE
An integrative review was conducted. The MEDLINE/PubMed database was searched twice within the last decade using distinct terms, and only studies written in the English language were included. The study population was limited to those aged 0-18 years. Articles that were duplicates or lacked sufficient methodology information were excluded.
DATA SYNTHESIS
We found 256 articles, of which 105 were included. Among the included studies, most were conducted in developed countries. Botulinum toxin demonstrated good safety and efficacy in reducing spasticity, particularly when administered by a multidisciplinary rehabilitation team. It is primarily utilized to improve gait and upper limb function, facilitate hygiene care, reduce pain, prevent musculoskeletal deformities, and even decrease sialorrhea in patients without a functional prognosis for walking.
CONCLUSIONS
The administration of botulinum toxin is safe and efficacious, especially when combined with a multi-professional rehabilitation team approach, which increases the probability of functional improvement. It can also be beneficial for patients with significant functional impairments to help with daily care tasks, such as hygiene, dressing, and reducing sialorrhea. Pediatricians must be familiar with this treatment and its indications to attend to and refer patients promptly when necessary, and to exploit their neuroplasticity. Further research on this topic is required in developing countries.
Topics: Child; Adolescent; Humans; Botulinum Toxins; Sialorrhea; Neuromuscular Agents; Cerebral Palsy; Muscle Spasticity
PubMed: 38537033
DOI: 10.1590/1984-0462/2024/42/2023093 -
International Immunopharmacology Apr 2024To determine the effective and safe intravenous doses of mesenchymal stem cells (MSCs)-derived microvesicles (MVs) and to elucidate the possible causes of death in mice...
OBJECTIVE
To determine the effective and safe intravenous doses of mesenchymal stem cells (MSCs)-derived microvesicles (MVs) and to elucidate the possible causes of death in mice receiving high-dose MVs.
METHODS
MVs were isolated from human MSCs by gradient centrifugation. Mice with collagen-induced arthritis were treated with different doses of intravenous MVs or MSCs. Arthritis severity, white blood cell count, and serum C-reactive protein levels were measured. To assess the safety profile of MSCs and MVs, mice were treated with different doses of MSCs and MVs, and LD50 was calculated. Mouse lungs and heart were assessed by live fluorescence imaging, histopathological measurements, and immunohistochemistry to explore the possible causes of death. Serum concentrations of cTnT, cTnI, and CK-MB were determined by ELISA. With the H9C2 cardiomyocyte cell line, cellular uptake of MVs was observed using confocal microscopy and cell toxicity was assessed by CCK-8 and flow cytometry.
RESULTS
Intravenous treatment with MSCs and MVs alleviated inflammatory arthritis, while high doses of MSCs and MVs were lethal. Mice receiving a maximum dose of MSCs (0.1 mL of MSCs at 10/mL) died immediately, while mice receiving a maximum dose of MVs (0.1 mL of MVs at 10/mL) exhibited tears, drooling, tachycardia, shortness of breath, unbalanced rollover, bouncing, circular crawling, mania, and death. Some mice died after exhibiting convulsions and other symptoms. All mice died shortly after injecting the maximum dose of MSCs. Histologically, mice receiving high doses of MSCs frequently developed pulmonary embolism, while those receiving high doses of MVs died of myocardial infarction. Consistently, the serum levels of cTnT, cTnI, and CK-MB were significantly increased in the MVs-treated group (P < 0.05). The LD50 of intravenous MVs was 1.60 × 10/kg. Further, MVs could enter the cell. High doses of MVs induced cell apoptosis, though low concentrations of MVs induced cell proliferation.
CONCLUSIONS
Appropriate dosages of MVs and MSCs are effective treatments for inflammatory arthritis while MVs and MSCs overdose is unsafe by causing cardiopulmonary complications.
Topics: Mice; Humans; Animals; Flow Cytometry; Cell-Derived Microparticles; Mesenchymal Stem Cells; Arthritis
PubMed: 38531171
DOI: 10.1016/j.intimp.2024.111845 -
Behavioural Neurology 2024Amyotrophic lateral sclerosis (ALS) is the most frequent neurodegenerative disease of the motor system that affects upper and lower motor neurons, leading to progressive... (Review)
Review
Amyotrophic lateral sclerosis (ALS) is the most frequent neurodegenerative disease of the motor system that affects upper and lower motor neurons, leading to progressive muscle weakness, spasticity, atrophy, and respiratory failure, with a life expectancy of 2-5 years after symptom onset. In addition to motor symptoms, patients with ALS have a multitude of nonmotor symptoms; in fact, it is currently considered a multisystem disease. The purpose of our narrative review is to evaluate the different types of pain, the correlation between pain and the disease's stages, the pain assessment tools in ALS patients, and the available therapies focusing above all on the benefits of cannabis use. Pain is an underestimated and undertreated symptom that, in the last few years, has received more attention from research because it has a strong impact on the quality of life of these patients. The prevalence of pain is between 15% and 85% of ALS patients, and the studies on the type and intensity of pain are controversial. The absence of pain assessment tools validated in the ALS population and the dissimilar study designs influence the knowledge of ALS pain and consequently the pharmacological therapy. Several studies suggest that ALS is associated with changes in the endocannabinoid system, and the use of cannabis could slow the disease progression due to its neuroprotective action and act on pain, spasticity, cramps, sialorrhea, and depression. Our research has shown high patients' satisfaction with the use of cannabis for the treatment of spasticity and related pain. However, especially due to the ethical problems and the lack of interest of pharmaceutical companies, further studies are needed to ensure the most appropriate care for ALS patients.
Topics: Humans; Amyotrophic Lateral Sclerosis; Pain Measurement; Quality of Life; Neurodegenerative Diseases; Pain
PubMed: 38524401
DOI: 10.1155/2024/1228194 -
Clinical and Translational Science Mar 2024Sialorrhea or drooling is a common problem in children and adults with neurodevelopmental disorders. It can negatively impact the quality of life due to its physical and...
Sialorrhea or drooling is a common problem in children and adults with neurodevelopmental disorders. It can negatively impact the quality of life due to its physical and psychological manifestations. Providers commonly prescribe atropine eye drops for topical administration to the oral mucosa, as an off-label treatment to manage sialorrhea. However, the off-label use of atropine eye drops can be associated with medication and dosing errors and systemic side effects. To address these limitations of treatment, we developed a mucoadhesive topical oral gel formulation of atropine as an alternative route to off-label administration of atropine eye drops. In this clinical pharmacokinetic (PK) study, we evaluated the safety and PK of atropine gel (0.01% w/w) formulation after single-dose administration to the oral mucosa in 10 healthy volunteers. The PK data showed that after topical administration to the oral mucosa, atropine followed a two-compartment PK profile. The maximum plasma concentration and area under the curve extrapolated to infinite time were 0.14 ng/mL and 0.74 h·ng·mL , respectively. The absorption rate constant calculated by the compartmental analysis was 0.4 h . Safety parameters, such as heart rate, blood pressure, and oxygen saturation, did not significantly change before and after administration of the gel formulation, and no adverse events were observed in all participants who received atropine gel. These data indicate that atropine gel formulation has a satisfactory PK profile, is well-tolerated at the dose studied, and can be further considered for clinical development as a drug product to treat sialorrhea.
Topics: Adult; Child; Humans; Healthy Volunteers; Quality of Life; Sialorrhea; Area Under Curve; Ophthalmic Solutions; Atropine Derivatives; Administration, Oral
PubMed: 38465519
DOI: 10.1111/cts.13753