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Heliyon Nov 2023The high incidence and severe clinical manifestations of phlebitis pose a complex and urgent clinical challenge. The rapid and simple establishment of animal phlebitis...
BACKGROUND
The high incidence and severe clinical manifestations of phlebitis pose a complex and urgent clinical challenge. The rapid and simple establishment of animal phlebitis models and the development of preventive strategies are crucial to resolving this problem.
METHODS
In this study, we established such models by mixing vinorelbine ditartrate (VNR) and carbomer to form a sustained-release gel carrier, and then injected it around the veins rather than inside the vessels. Furthermore, we analyzed the efficacy of the carbomer/VNR gel in inducing phlebitis by monitoring the morphology of the veins using HE staining, immunohistochemical and immunofluorescence staining, and western blotting. Reactive oxygen species (ROS) and lipid peroxidation levels were determined using flow cytometry. Finally, we evaluated the inhibitory effect of N-acetylcysteine (NAC) on VNR-induced phlebitis in rabbits and rats.
RESULTS
Our findings suggested that the carbomer/VNR gel rapidly and easily induced phlebitis due to by retention of the gel in situ, wrapping the veins, and the prolonged release of VNR. NAC alleviated the VNR-induced oxidative stress response and expression of inflammatory cytokines by attenuating mitochondrial damage in venous endothelial cells, thereby preventing the occurrence of phlebitis in rabbits and rats.
CONCLUSION
The in situ carbomer/VNR gel provides a rapid and simple method for establishing an animal model to study the pathogenesis of phlebitis. Furthermore, the observed therapeutic effect of NAC highlights its novel and efficacious role in preventing and treating phlebitis.
PubMed: 37942159
DOI: 10.1016/j.heliyon.2023.e21235 -
Heliyon Nov 2023Technetium [99Tc] methylene diphosphonate injection (99Tc-MDP) is widely used for the treatment of rheumatoid arthritis (RA), but there is still insufficient evidence...
Effectiveness and safety of 99Tc-methylene diphosphonate as a disease-modifying anti-rheumatic drug (DMARD) in combination with conventional synthetic (cs) DMARDs in the treatment of rheumatoid arthritis: A systematic review and meta-analysis of 34 randomized controlled trials.
BACKGROUND
Technetium [99Tc] methylene diphosphonate injection (99Tc-MDP) is widely used for the treatment of rheumatoid arthritis (RA), but there is still insufficient evidence for its application. Through the utilization of meta-analysis and systematic reviews, this study aimed to evaluate the effectiveness and safety of 99 TC-MDP in combination with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for RA.
METHODS
This study was registered on PROSPERO in advance (CRD42021220780). A systematic search was conducted in PubMed, Embase, the Cochrane Library, and multiple international public databases from their inception to April 2023 to identify clinical randomized controlled trials exploring the use of 99Tc-MDP combined with csDMARDs in the treatment of RA. Each outcome was subjected to meta-analysis, and the quality of evidence was assessed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The American College of Rheumatology's 50 %/70 % response criteria scores (ACR50/70) scores were utilized as the primary effectiveness outcomes, and risks were measured by assessing the rates of AEs. Moreover, secondary efficacy outcomes were evaluated, including the Disease Activity Score 28 (DAS28) and bone mineral density (BMD) as joint function indicators and the erythrocyte sedimentation rate (ESR) and interleukin-17 (IL-17) as inflammatory indicators.
RESULTS
In this meta-analysis, a total of 34 studies (2296 patients) were included out of 1149 retrieved studies. The summarized results showed that the treatment group treated with the combination of 99Tc-MDP and csDMARDs had significantly higher ACR50 (RR = 1.32, 95 % CI: 1.13-1.55, P = 0.0004) and ACR70 (RR = 1.40, 95 % CI: 1.07-1.82, P = 0.01) scores than the control group receiving csDMARDs alone. In addition, the overall incidence of AEs was lower with the combination of 99Tc-MDP and csDMARDs than with csDMARDs alone (RR = 0.75, 95 % CI: 0.60-0.93, P = 0.009), but the possibility of phlebitis was higher in the treatment group (RR = 4.15, 95 % CI: 1.04-16.50, P = 0.04). In addition, the combination of 99Tc-MDP and csDMARDs had advantages over csDMARDs alone in improving DAS28 (WMD = 1.56, 95 % CI: 0.86-2.25, P < 0.0001), BMD (SMD = 1.12, 95 % CI 0.46-1.78, P = 0.0008), ESR (SMD = 0.71, 95 % CI 0.45-0.97, P < 0.00001), and IL-17 (WMD = 5.82, 95 % CI 3.86-7.77, P < 0.00001). However, the above results might have been influenced by the 99Tc-MDP dosage, csDMARD category, and treatment duration. Combining methotrexate and leflunomide, administering continuous treatment for 24 weeks, or using 3 sets of 99Tc-MDP doses (16.5 mg) may be the optimal 99Tc-MDP treatment plan for RA.
CONCLUSION
Compared with csDMARD therapy alone, the combination therapy with 99Tc-MDP is more effective for RA patients and is associated with a lower overall incidence of adverse events, although the possibility of phlebitis was higher. However, due to the inherent limitations of the included RCTs, high-quality clinical trials are still needed to further assess the effectiveness and safety of this combination therapy.
PubMed: 37942155
DOI: 10.1016/j.heliyon.2023.e21691 -
BMC Infectious Diseases Nov 2023Given the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed...
BACKGROUND
Given the widespread prevalence of the coronavirus disease 2019 (COVID-19), oral and neck examinations tend to be avoided in patients with suspected or confirmed COVID-19. This might delay the diagnosis of conditions such as Lemierre's syndrome, which involves symptoms resembling COVID-19-related throat manifestations.
CASE PRESENTATION
A 24-year-old man without any underlying conditions was diagnosed with COVID-19 7 days before presentation. He was admitted to another hospital 1 day before presentation with severe COVID-19 and suspected bacterial pneumonia; accordingly, he was started on treatment with remdesivir and meropenem. Owing to bacteremic complications, the patient was transferred to our hospital for intensive care. On the sixth day, the patient experienced hemoptysis; further, a computed tomography (CT) scan revealed new pulmonary artery pseudoaneurysms. Successful embolization was performed to achieve hemostasis. In blood cultures conducted at the previous hospital, Fusobacterium nucleatum was isolated, suggesting a cervical origin of the infection. A neck CT scan confirmed a peritonsillar abscess and left internal jugular vein thrombus; accordingly, he was diagnosed with Lemierre's syndrome. The treatment was switched to ampicillin/sulbactam, based on the drug susceptibility results. After 6 weeks of treatment, the patient completely recovered without complications.
CONCLUSION
This case highlights the significance of thorough oral and neck examinations in patients with suspected or diagnosed COVID-19 for the detection of throat and neck symptoms caused by other conditions.
Topics: Humans; Male; Young Adult; Blood Culture; COVID-19; COVID-19 Testing; Delayed Diagnosis; Lemierre Syndrome; Neck
PubMed: 37936077
DOI: 10.1186/s12879-023-08755-2 -
Neurology India 2023Lymphoplasmacyte-rich meningioma (LP meningioma) is a rare form of grade 1 meningioma. It shows dense lymphoplasmacytic infiltrate, mimicking an inflammatory lesion. We...
Lymphoplasmacyte-rich meningioma (LP meningioma) is a rare form of grade 1 meningioma. It shows dense lymphoplasmacytic infiltrate, mimicking an inflammatory lesion. We present a case of Lymphoplasmacyte-rich (LP) meningioma in the left parasagittal region in a 47-year-old female. On histological examination, it showed dense lymphoplasmacytic infiltrate masking the meningothelial component. There was dense fibrosis and numerous IgG4-positive plasma cells (100-120/hpf), admixed with lymphocytes and few histiocytes. The meningothelial component was highlighted by epithelial membrane antigen (EMA) immunostain. The patient had normal serum IgG4 level. This case highlights the morphological overlap between LP meningioma and IgG4-related disease. The presence of fibrosis and increased IgG4-positive plasma cells as a major inflammatory component in LP meningioma, as demonstrated in the present case and some other previous studies raise suspicion of its association with IgG4-related disease. However, this hypothesis requires further detailed studies for confirmation.
Topics: Female; Humans; Middle Aged; Meningioma; Immunoglobulin G4-Related Disease; Plasma Cells; Fibrosis; Immunoglobulin G; Meningeal Neoplasms; Walking
PubMed: 37929445
DOI: 10.4103/0028-3886.388117 -
Phlebology Mar 2024
Topics: Humans; Thrombophlebitis; Ultrasonography, Doppler, Duplex; Anticoagulants
PubMed: 37908099
DOI: 10.1177/02683555231211095 -
Journal of Medical Case Reports Oct 2023Septic pulmonary embolism (SPE), deep vein thrombophlebitis (DVT), and acute osteomyelitis (AOM) form a triad that is rarely seen in children and is usually associated...
BACKGROUND
Septic pulmonary embolism (SPE), deep vein thrombophlebitis (DVT), and acute osteomyelitis (AOM) form a triad that is rarely seen in children and is usually associated with a history of trauma on long bones. Unfortunately, a delay in diagnosis is frequently observed in this syndrome, which places the patient at risk of life-threatening complications. This delay can largely be attributed to the failure to consider osteomyelitis as a potential underlying cause of DVT.
CASE PRESENTATION
In this case report, we present the case of a 16-year-old Arabian male who presented with limb trauma and fever. The patient had a delayed diagnosis of osteomyelitis, which resulted in the formation of an abscess and subsequent joint destruction. Surgical drainage and joint replacement surgery were deemed necessary for treatment.
CONCLUSIONS
persistent fever along with a history of trauma on a long bone with signs of DVT of the limb in a child should raise concern for osteomyelitis and an MRI evaluation of the limb should be obtained.
Topics: Child; Humans; Male; Adolescent; Thrombophlebitis; Pulmonary Embolism; Osteomyelitis; Magnetic Resonance Imaging; Bone and Bones; Acute Disease
PubMed: 37891700
DOI: 10.1186/s13256-023-04172-w -
Frontiers in Immunology 2023IgG4-related digestive diseases encompass a group of chronic inflammatory disorders characterized by autoimmune reactions and fibrosis affecting multiple digestive... (Review)
Review
IgG4-related digestive diseases encompass a group of chronic inflammatory disorders characterized by autoimmune reactions and fibrosis affecting multiple digestive organs. These diseases are identified by elevated serum levels of IgG4 and the presence of IgG4-positive plasma cell infiltration in the affected sites, along with storiform fibrosis, obliterative phlebitis, and eosinophilic infiltration. Although extensive research has been conducted, a comprehensive understanding of these conditions remains elusive. Current clinical diagnosis often relies on the application of integrated diagnostic criteria for IgG4-related diseases, combined with specific organ involvement criteria. Distinguishing them from malignancies poses considerable challenges. Moreover, further investigations are required to elucidate the underlying pathogenic mechanisms and explore potential therapeutic interventions. This review provides a systematic classification of IgG4-related digestive diseases while discussing their diagnostic strategies, clinical presentations, and treatment modalities. The comprehensive insights shared herein aim to guide clinicians in their practice and contribute to the advancement of knowledge in this field.
Topics: Humans; Autoimmune Diseases; Immunoglobulin G4-Related Disease; Immunoglobulin G; Diagnosis, Differential; Fibrosis
PubMed: 37868965
DOI: 10.3389/fimmu.2023.1278332 -
Thrombosis and Haemostasis May 2024The underlying mechanisms of thrombosis in Lemierre's syndrome and other septic thrombophlebitis are incompletely understood. Therefore, in this case control study we...
BACKGROUND
The underlying mechanisms of thrombosis in Lemierre's syndrome and other septic thrombophlebitis are incompletely understood. Therefore, in this case control study we aimed to generate hypotheses on its pathogenesis by studying the plasma proteome in patients with these conditions.
METHODS
All patients with Lemierre's syndrome in the Skåne Region, Sweden, were enrolled prospectively during 2017 to 2021 as cases. Age-matched patients with other severe infections were enrolled as controls. Patient plasma samples were analyzed using label-free data-independent acquisition liquid chromatography tandem mass spectrometry. Differentially expressed proteins in Lemierre's syndrome versus other severe infections were highlighted. Functions of differentially expressed proteins were defined based on a literature search focused on previous associations with thrombosis.
RESULTS
Eight patients with Lemierre's syndrome and 15 with other severe infections were compared. Here, 20/449 identified proteins were differentially expressed between the groups. Of these, 14/20 had functions previously associated with thrombosis. Twelve of 14 had a suggested prothrombotic effect in Lemierre's syndrome, whereas 2/14 had a suggested antithrombotic effect.
CONCLUSION
Proteins involved in several thrombogenic pathways were differentially expressed in Lemierre's syndrome compared to other severe infections. Among identified proteins, several were associated with endothelial damage, platelet activation, and degranulation, and warrant further targeted studies.
Topics: Humans; Lemierre Syndrome; Proteomics; Male; Female; Adult; Case-Control Studies; Middle Aged; Blood Proteins; Sweden; Aged; Proteome; Prospective Studies; Thrombophlebitis; Thrombosis; Tandem Mass Spectrometry; Chromatography, Liquid
PubMed: 37857346
DOI: 10.1055/a-2195-3927 -
Infection Prevention in Practice Dec 2023The COVID-19 pandemic generated high workloads given the high volume of seriously ill patients; conditions that could increase the risk of adverse events (AE). This...
BACKGROUND
The COVID-19 pandemic generated high workloads given the high volume of seriously ill patients; conditions that could increase the risk of adverse events (AE). This study analyzed the frequency of AE in patients with COVID-19 and their effect on mortality, hospital stay and costs.
METHODS
This retrospective cohort study included in-patients with COVID-19 at a single hospital between March 2020-June 2021. Exposure was the occurrence of at least one AE. Hospital stay, costs and death were considered outcomes. Clinical information and direct costs were obtained from medical and billing records. Generalized linear models were used to estimate the association measures.
RESULTS
405 patients were included, 55.8% (n=226) men, median age 56 years (IQR: 41.0-70.0) and with a history of hypertension (26.2%; n=106), diabetes mellitus (13.8%; n=56) and obesity (13.8%; n=56). The incidence of AE was 13.3% (n=54), 29 patients presented more than one AE, for a total of 70 events. Most events (74.3%; n=52) were preventable and the most frequent were healthcare-associated infections (50%; n=35), phlebitis (14.3%; n=10) and pressure ulcers (12.9%; n=9). AE prolonged hospital stay (change rate: 1.57; 95%CI: 1.26-1.95; =0.001) and increased direct healthcare costs (change rate: 1.20; 95% CI: 1.03-1.39, =0.019). Likewise, the risk of death was 56% higher in patients with AE.
CONCLUSION
Pandemics are unexpected events that present challenges to safe healthcare. Improving quality policies, monitoring compliance with protocols and providing ongoing education are strategies to prevent AE such as healthcare-associated infections, which increase hospital costs and stay.
PubMed: 37840847
DOI: 10.1016/j.infpip.2023.100302 -
Medicine Oct 2023Septic thrombophlebitis of the internal jugular vein also known as Lemierre syndrome occurs secondary to an oropharyngeal infection often leading to septic embolisms to...
RATIONALE
Septic thrombophlebitis of the internal jugular vein also known as Lemierre syndrome occurs secondary to an oropharyngeal infection often leading to septic embolisms to distant sites. Anaerobic gram-negative bacillus, Fusobacterium nucleatum and Fusobacterium necrophorum are commonly isolated organisms. Fusobacterium species has also been reported to complicate an intra-abdominal infection leading to septic thrombophlebitis of portal vein also known as pylephlebitis or abdominal variant of lemierre syndrome.
PATIENT CONCERNS
The patient was a middle-aged female patient with chief complaints of abdominal discomfort, intermittent fever and vomiting for one month.
DIAGNOSES
The final diagnosis was septic thrombophlebitis of portal and splenic vein secondary to Fusobacterium nucleatum.
INTERVENTIONS
Patient was managed with broad spectrum intravenous antibiotics with coverage against gram-negative bacilli, anaerobes, and aerobic streptococcus species with therapeutic anticoagulation.
OUTCOMES
Patient gradually improved and was discharged on oral apixaban. She was instructed to follow up with gastrointestinal specialist upon discharge in anticipation of the need for liver transplant in future.
LESSONS
Due to its high mortality and associated long term disease morbidity, clinicians should always strive towards early diagnosis and treatment of the condition with involvement of multidisciplinary teams.
Topics: Middle Aged; Humans; Female; Lemierre Syndrome; Fusobacterium nucleatum; Splenic Vein; Thrombophlebitis; Abdomen; Soft Tissue Infections; Jugular Veins
PubMed: 37832062
DOI: 10.1097/MD.0000000000035622