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Frontiers in Medicine 2024Non-typhoidal (NTS) rarely causes bacteremia and subsequent focal infections as an extraintestinal complication, even in immunocompetent adults. A 25-year-old man was...
Non-typhoidal (NTS) rarely causes bacteremia and subsequent focal infections as an extraintestinal complication, even in immunocompetent adults. A 25-year-old man was hospitalized for several days with difficulty moving due to fever, acute buttock pain, and shivering. He had no recent or current respiratory symptoms and no clear gastrointestinal symptoms. Physical examination revealed mild redness around the left buttock and difficulty raising the left lower extremity due to pain, in addition to which blood tests showed high levels of inflammatory markers. His clinical course and laboratory findings suggested sepsis, and magnetic resonance imaging revealed a high-intensity area in the left piriformis muscle on diffusion-weighted imaging; therefore, acute piriformis pyomyositis was strongly suggested. Cephazolin was started upon hospitalization; however, blood and stool cultures proved positive for NTS, and the antibiotics were changed to ceftriaxone. Follow-up MRI showed a signal in the left piriformis muscle and newly developed left pyogenic sacroiliitis. On the 25th hospital day, a colonoscopy was performed to identify the portal of entry for bacteremia, which revealed a longitudinal ulcer in the sigmoid colon in the healing process. His buttock pain gradually improved, and the antibiotics were switched to oral levofloxacin, which enabled him to continue treatment in an outpatient setting. Finally, the patient completed seven weeks of antimicrobial therapy and returned to daily life without leaving any residual disability. Invasive NTS infection due to bacteremia is rare among immunocompetent adults. Piriformis pyomyositis and subsequent pyogenic sacroiliitis should be added to the differential diagnosis of acute febrile buttock pain. In the case of NTS bacteremia, the entry site must be identified for source control. Additionally, the background of the host, especially in such an immunocompetent case, needs to be clarified; therefore, the patient should be closely examined.
PubMed: 38873212
DOI: 10.3389/fmed.2024.1381555 -
Cell Biochemistry and Biophysics Jun 2024Wound healing involves multiple populations of cells, the extracellular matrix, and soluble mediators' actions like growth factors and cytokines. Wound care was the...
Wound healing involves multiple populations of cells, the extracellular matrix, and soluble mediators' actions like growth factors and cytokines. Wound care was the target of many research, utilizing new therapy techniques and the progression of acute and chronic wound treatments with techniques involving plants to improve healing and decrease the side effects of drugs. When fenugreek is applied to an ulcer, its anti-inflammatory components are released, reducing unnecessary inflammation and accelerating the healing process. Healing is controlled by growth factors that naturally activate and boost the proliferation of cells, such as Ki-67, which is associated with the growth fraction and represents the cell's ability to proliferate. The current study aims to assess the expression of Ki-67 in rat mucosal ulcers treated with fenugreek leave oil. Twenty-four male Wistar albino rats of 350-450 gm weight were used. The rats were grouped as follows; normal group (normal tissue without ulcer induction), control group (tissue with surgical ulcer induction on the right side), and study group (ulcer treated with fenugreek leave oil on the left side), and had been sacrificed at 3- and 7-day healing durations. Thereafter, the tissue specimens were used for immunohistochemical analysis of Ki-67. The obtained outcomes showed that expression of Ki-67 increased in groups where ulcers were induced, with significant differences between control and study groups on the 3rd day. It was concluded that the application of fenugreek oil had an accelerating effect on the healing process of mucosal ulcers, as indicated by the elevated expression level of Ki-67.
PubMed: 38869686
DOI: 10.1007/s12013-024-01347-0 -
Frontiers in Cellular and Infection... 2024Pathogenic and free-living are widely distributed in the environment and have been reported to cause keratitis and universally fatal encephalitis. Primary cutaneous...
Pathogenic and free-living are widely distributed in the environment and have been reported to cause keratitis and universally fatal encephalitis. Primary cutaneous acanthamoebiasis caused by is exceedingly rare and presents as isolated necrotic cutaneous lesions without involvement of the cornea or central nervous system. Cutaneous acanthamoebiasis often occurs in immunocompromised patients and is likely overlooked or even misdiagnosed only by cutaneous biopsy tissue histopathological analysis. Here, we report a HIV-infected 63-year-old female with oral leukoplakia for 4 months and scattered large skin ulcers all over the body for 2 months. The cause of the cutaneous lesions was unclear through cutaneous specimens histopathological analysis, and subsequently were detected by metagenomic next-generation sequencing (mNGS), which may be the cause of cutaneous lesions. Based on the mNGS results, a pathologist subsequently reviewed the previous pathological slides and found trophozoites of so that the cause was identified, and the skin ulcers improved significantly after treatment with multi-drug combination therapy. is also a host of pathogenic microorganisms. The presence of endosymbionts enhances the pathogenicity of , and no other pathogens were reported in this case. mNGS is helpful for rapidly diagnosing the etiology of rare skin diseases and can indicate the presence or absence of commensal microorganisms.
Topics: Humans; Female; High-Throughput Nucleotide Sequencing; Amebiasis; Metagenomics; Middle Aged; Acanthamoeba; HIV Infections; Skin; Treatment Outcome
PubMed: 38863830
DOI: 10.3389/fcimb.2024.1356095 -
Wounds : a Compendium of Clinical... May 2024Marjolin ulcer (MU) is an aggressive cutaneous malignancy that commonly occurs in those with a chronic wound such as post-burn scar. (Review)
Review
BACKGROUND
Marjolin ulcer (MU) is an aggressive cutaneous malignancy that commonly occurs in those with a chronic wound such as post-burn scar.
CASE REPORT
A 20-year-old male who sustained a flame burn over the scalp at 3 months of age developed a nonhealing ulcer over the burn scar 20 years later, which was treated with adequate surgical margins with adjuvant mold brachytherapy. Two months after completion of that treatment, he developed parotid nodal metastasis with positron emission tomography (PET)-positive bilateral cervical, supraclavicular, right suboccipital, and mesenteric lymph nodes that were treated with concurrent chemoradiation. One month later, the patient developed an ulcerative lesion involving the left parotid region with PET showing infiltration of the parotid gland, but with resolution of other previous sites of uptake. The patient was treated surgically with radical parotidectomy with elective neck dissection and reconstruction with locoregional flap. At 6-month follow-up, the patient developed extensive locoregional recurrence and distant metastasis and was started on oral metronomic therapy. The patient was alive with stable disease at 3-month follow-up after initiation of palliative chemotherapy.
CONCLUSION
Despite timely multimodality therapy, MU may present with a hostile clinical course with a short disease-free interval and early recurrence.
Topics: Humans; Male; Brachytherapy; Burns; Combined Modality Therapy; Neck Dissection; Neoplasm Recurrence, Local; Parotid Neoplasms; Plastic Surgery Procedures; Scalp; Skin Neoplasms; Skin Ulcer; Treatment Outcome; Adult
PubMed: 38861212
DOI: 10.25270/wnds/23138 -
IEEE Journal of Biomedical and Health... Jun 2024In the domain of medical diagnostics, precise identification of various skin and oral diseases is vital for effective patient care. In particular, Mpox is a potentially...
In the domain of medical diagnostics, precise identification of various skin and oral diseases is vital for effective patient care. In particular, Mpox is a potentially dangerous viral disease with zoonotic origins, capable of human-to-human transmission, underscoring the urgency of precise diagnostic methods for timely intervention. This paper introduces a novel approach named the Choquet Fuzzy Integral-based Ensemble (CFI-Net) for accurate classification of skin diseases, with a specific emphasis on detecting Mpox, foot ulcers, and various mouth and oral diseases. Our methodology begins with Transfer Learning, enhancing the classification capabilities of base classifiers (DenseNet169, MobileNetV1 and DenseNet201) by incorporating additional layers. Subsequently, we aggregate the prediction scores from each base classifier using the Choquet fuzzy integral (CFI) to derive the final predicted labels, thus ensuring dynamic and robust predictions. Fuzzy measures, a crucial component of this fuzzy integral-based ensemble method, are typically determined through manual experimentation in previous approaches. However, in our study, we have tackled the challenge of manual tuning by employing meta-heuristic optimization algorithm to precisely configure the fuzzy measures for optimal performance. A rigorous evaluation is conducted on four publicly available datasets, encompassing two Mpox datasets, a foot ulcer dataset, and a mouth and oral disease dataset. The experiments reveal the remarkable effectiveness of CFI-Net in significantly improving disease classification accuracy. Additionally, we employ Grad-CAM analysis to provide insights into the decision-making processes of our models. Our findings underscore the exceptional performance of CFI-Net, achieving accuracy rates of 98.06% and 94.81% for Mpox detection, 99.06% for foot ulcer detection, and an impressive 99.61% for mouth and oral disease classification. This research not only contributes to the advancement of disease diagnosis but also demonstrates the effectiveness of ensemble learning techniques coupled with fuzzy integral-based fusion in enhancing diagnostic accuracy.
PubMed: 38857139
DOI: 10.1109/JBHI.2024.3411658 -
Journal of Clinical Medicine Research May 2024Acute myocardial infarction (AMI) in young patients is an important issue because of its impact on health and social life. The mechanisms and disease courses of...
Acute myocardial infarction (AMI) in young patients is an important issue because of its impact on health and social life. The mechanisms and disease courses of ST-elevation myocardial infarction (STEMI) in young individuals may differ from those in the elderly. Behcet disease (BD) is a multisystem autoimmune disorder of unknown etiology. Cardiac involvement is rare, yet it was reported to affect 6% of patients, with 17% of the cases presenting as the first manifestation. We present the case of a 33-year-old male heavy smoker with negative medical history, who presented with acute inferior myocardial infarction. His coronary angiography showed huge thrombosis in proximal right coronary artery. He was treated with primary coronary intervention and implantation of drug-eluting stent, with subsequent intervention and implantation of two more drug-eluting stents due to acute stent thrombosis within 48 h. Rheumatologic assessment revealed the history of four different attacks of oral ulcers and one attack of genital ulcer. His workup showed positive human leukocyte antigen (HLA) allele (B51) which is strongly associated with BD. AMI in young adults due to arterial thrombosis can be attributed to hypercoagulable state related to early manifestation of BD. Increased knowledge of AMI in young adults and its presentation in BD is necessary to reduce morbidity and mortality. Corticosteroids and colchicine may improve cardiac manifestations in BD.
PubMed: 38855780
DOI: 10.14740/jocmr5132 -
Indian Journal of Pathology &... Jun 2024The aim of study is to evaluate the crystallization pattern seen in cupric chloride medium using haemolyzed blood of control, Oral potentially malignant disorders...
AIM
The aim of study is to evaluate the crystallization pattern seen in cupric chloride medium using haemolyzed blood of control, Oral potentially malignant disorders (OPMDs) and oral squamous cell carcinoma (OSCC) patients.
MATERIALS AND METHOD
Study comprise 90 patients including control, OPMDs and OSCC. To create a haemolysed blood, a drop of blood was obtained and distilled water was added. Crystallization test using 0.1 ml of haemolyzed blood and 20% of a 10 ml cupric chloride solution. During 24 to 28 hours, this solution was put in a BOD incubator.
RESULT
Crystallization pattern in control group is eccentric placed nucleus and peripheral radiating lines while in OPMDs and OSCC presence of transverse bar. Crystallization test showed 100% positivity in OSCC while 73.33% seen in control group. 90% sensitivity in OSCC and 76.67% sensitivity in OPMDs.
CONCLUSION
OPMDs lesion convert from white to mixed red and white lesion and OSCC appear as non-healing ulcer or ulcero-proliferative growth increase in number of transverse bars. More number of transverse bars suggestive of high malignant potential.
PubMed: 38847217
DOI: 10.4103/ijpm.ijpm_959_23 -
Scandinavian Journal of Gastroenterology Jun 2024This study aimed to investigate the utility of intensive triamcinolone acetonide (TA) injections after extensive esophageal endoscopic submucosal dissection (ESD).
BACKGROUND
This study aimed to investigate the utility of intensive triamcinolone acetonide (TA) injections after extensive esophageal endoscopic submucosal dissection (ESD).
METHODS
This retrospective study included 27 lesions in 27 consecutive patients who underwent ESD (ulcers encompassing ≥3/4 of the esophageal circumference) and received TA injections without oral steroid administration. Groups A and B included patients undergoing ESD with and without complete circumferential resection, respectively. All patients received TA injections (100 mg/session) immediately after ESD. In Group A, weekly based TA injections were performed until near-complete ulcer epithelialization. In Group B, patients did not receive additional injections or received weekly or biweekly TA injections. The primary outcome was stricture rate, and the secondary outcomes were the proportion of patients requiring endoscopic balloon dilation (EBD) and the number of TA injections.
RESULTS
Group A included 7 lesions, and Group B included 20 lesions. The median (range) tumor lengths were 40 (30-90) and 45 (30-110) mm in Groups A and B, respectively. In Group A, the median circumferential resection diameter was 40 (20-80) mm. The stricture rate and the proportion of patients requiring EBD were 0 (0%) in Group A and 1 (5.0%) in Group B. The number of TA injection sessions was significantly higher in Group A than in Group B (8 [5-25] vs 1.5 [1-3]; < 0.001).
CONCLUSIONS
Intensive weekly or biweekly based TA injections might aid in preventing post-ESD stricture and the need for EBD in patients undergoing extensive resection involving the entire esophageal circumference.
PubMed: 38847135
DOI: 10.1080/00365521.2024.2360557 -
Naunyn-Schmiedeberg's Archives of... Jun 2024Gastric ulcer disease is associated with significant morbidity and mortality rates. The most two common causes of the ulcer are Helicobacter pylori infection and...
Gastric ulcer disease is associated with significant morbidity and mortality rates. The most two common causes of the ulcer are Helicobacter pylori infection and non-steroidal anti-inflammatory drugs. In the past few decades, a significant decrease in the morbidity and mortality rate has been observed probably due to the discovery of proton pump inhibitors. However, the medications used to treat gastric ulcers impose several nauseous side effects. Therefore, recent studies focus on the use of natural products to treat gastric ulcers. In the current study, gastric ulcer was effectively induced using indomethacin, and the protective effect of apigenin, a potent antioxidant flavonoid, was assessed in comparison to omeprazole. The administration of a single oral indomethacin (50 mg/kg) induced gastric ulcer as manifested by hemorrhagic lesions in the gastric mucosa, increased ulcer index, and histopathological alterations. Indomethacin also increased lipid peroxidation, decreased the activities of the antioxidant enzymes superoxide dismutase (SOD) and catalase, increased the immunoreactivity of the inflammatory markers cyclo-oxygenase-2 (COX-2), tumor necrosis factor-alpha (TNF-α), and nuclear factor-kappa B (NF-κB), increased the transcription of the apoptotic marker, Bax, and decreased that of the antiapoptotic Bcl-2. Indomethacin also decreased the immunoreactivity of transforming growth factor-beta 1 (TGF-β1). On the other hand, pretreatment with apigenin (10 and 20 mg/kg) resulted in a dose-dependent improvement in the macroscopic and microscopic features of the gastric mucosa in a manner comparable to that of omeprazole. The gastroprotective effects of apigenin may be attributed to its anti-inflammatory, anti-antioxidant, and anti-apoptotic activities as well as enhancing the expression of TGF-β1. Further experimental and clinical research is required to confirm activity of apigenin as anti-ulcer agent.
PubMed: 38842560
DOI: 10.1007/s00210-024-03200-w -
Frontiers in Genetics 2024Rheumatoid arthritis (RA) frequently presents with oral manifestations, including gingival inflammation, loose teeth, and mouth ulcers; however, the causal connections...
BACKGROUND
Rheumatoid arthritis (RA) frequently presents with oral manifestations, including gingival inflammation, loose teeth, and mouth ulcers; however, the causal connections between these conditions remain unclear. This study aims to explore the genetic correlations and causal relationships between RA and prevalent oral phenotypes.
METHODS
Using summary data from genome-wide association studies of European populations, a cross-trait linkage disequilibrium score regression was conducted to estimate the genetic correlations between RA and six oral phenotypes. Subsequently, a two-sample Mendelian randomization (MR) approach was employed to assess the causal relationships, corroborated by various sensitivity analyses. Heterogeneity was addressed through the RadialMR method, while potential covariates were corrected using the multivariable MR approach.
RESULTS
A significant negative genetic correlation was detected between RA and denture usage (r = -0.192, = 4.88 × 10). Meanwhile, a heterogenous causal relationship between RA and mouth ulcers was observed (OR = 1.027 [1.005-1.05], = 0.016, = 4.69 × 10), which remained robust across sensitivity analyses. After excluding outlier variants, the results demonstrated robustly consistent (OR = 1.021 [1.008-1.035], = 1.99 × 10, = 0.044). However, upon adjusting for covariates such as smoking, alcohol consumption, body mass index, and obesity, the significance diminished, revealing no evidence to support independent genetic associations.
CONCLUSION
Genetically predicted RA increases the risk of mouth ulcers, and a negative genetic correlation is identified between RA and denture use. The observed heterogeneity suggests that shared immunological mechanisms and environmental factors may play significant roles. These findings highlight the importance of targeted dental management strategies for RA patients. Further clinical guidelines are required to improve oral health among vulnerable RA patients.
PubMed: 38836040
DOI: 10.3389/fgene.2024.1383696