Stromal and endothelial herpes simplex virus keratitis reactivation in the convalescent period of COVID-19 � A case report

A 73?year?old lady presented with a white spot and redness in the left eye for 1 month and had been treated elsewhere as a case of fungal keratitis. She had severe acute respiratory syndrome coronavirus 2 (SARS?CoV?2) viral infection 2 months before. Her past ocular history and examination gave a probable diagnosis of herpetic stromal and endothelial keratitis. She responded to oral acyclovir and topical steroid, leading to resolution of stromal edema and inflammation. Anterior chamber fluid polymerase chain reaction (PCR) confirmed pathogen herpes simplex virus (HSV)?1. HSV ocular reactivation after coronavirus disease 2019 (COVID?19) has been reported currently. The present report will add knowledge about this potential opportunistic ophthalmic infection during the recovery phase of COVID?19 disease

Subbasal corneal nerve damage in patients with bacterial keratitis: in vivo confocal microscopy study / Danos no plexo nervoso subbasal corneano em pacientes com ceratite bacteriana utilizando a microscopia confocal in vivo

ABSTRACT Purpose: To examine subbasal corneal nerve changes in patients with bacterial infectious keratitis using in vivo confocal microscopy. Methods: Thirteen patients (13 eyes) with unilateral bacterial keratitis and 12 healthy controls were prospectively enrolled in the study. In vivo confocal microscopy was performed in all the patients at 2 time points, in the acute phase of infectious keratitis and at 28 ± 0.6 months after resolution of the infection. Results: The subbasal nerve length was 5.15 ± 1.03 mm/mm2 during the acute phase of bacterial keratitis (compared with that of the controls: 19.02 ± 1.78 mm/mm2, p<0.05). Despite the significant corneal nerve regeneration over the interval of 28 months after the resolution of the infection, the nerve density was still significantly reduced as compared with that of the controls (9.73 ± 0.93 mm/mm2, p<0.05). Moreover, in vivo confocal microscopy images showed diffuse high-reflecting areas referring to the scar tissue areas with thin and tortuous nerve branches regenerating toward these areas. Conclusions: A partial corneal nerve regeneration of subbasal nerve plexus during the first 28 months after the acute phase of infectious keratitis was observed. Moreover, the regenerated nerves of the patients remained morphologically altered as compared with those of the healthy controls. These results may be relevant to the clinical follow-up and surgical planning for these patients.

RESUMO Objetivo: Relatar as alterações no plexo nervoso corneano subbasal em pacientes com ceratite infecciosa de origem bacteriana utilizando a microscopia confocal in vivo. Métodos: Treze olhos de 13 pacientes com ceratite bacteriana unilateral e 12 indivíduos saudáveis como grupo controle foram incluídos prospectivamente no estudo. A microscopia confocal in vivo foi realizada em todos os pacientes em 2 momentos: na fase aguda da ceratite infecciosa e após 28 ± 0,6 meses da resolução da infecção. Resultados: A densidade dos nervos no plexo subbasal foi de 5,15 ± 1,03 mm/mm2 na fase aguda da ceratite infecciosa (comparada com o grupo controle: 19,02 ± 1,78 mm/mm2, p<0,05). Apesar de significativa regeneração dos nervos corneanos ao longo de um intervalo de 28 meses após a resolução da infecção, a densidade dos nervos se manteve significativamente reduzida (9,73 ± 0,93 mm/mm2) quando comparada com o grupo controle (19,02 ± 1,78 mm/mm2, p<0,05). Além disso, as imagens obtidas com a microscopia confocal mostraram áreas de hiperreflectividade referente ao tecido corneano cicatricial com ramos de nervos, afinados e tortuosos, se regenerando nessas áreas. Conclusões: Foi observado regeneração parcial dos nervos do plexo corneano subbasal durante os primeiro 28 meses após a resolução da fase aguda da ceratite infecciosa. Além disso, os nervos corneanos regenerados se mantiveram morfologicamente alterados quando comparados ao grupo controle. Esses resultados podem ser relevantes para o acompanhamento clínico e planejamento cirúrgico desses pacientes.

Herpes simplex keratitis revisited / Ceratite por Herpes simples revisitada

ABSTRACT The degree to which viral infection and the host's immune reaction to viral particles participate in the inflammatory process across various forms of herpetic keratitis has remained controversial. This fact has created conflicts regarding the classification of and therapeutic planning for such morbidities. This review aims to stimulate reflection on the classifications' adequacy, nomenclatures, and therapeutic approaches related to these entities.

RESUMO O grau de participação da infecção viral e da reação imunológica do hospedeiro às partículas virais no processo infamatório das diferentes formas de ceratites herpéticas ainda é objeto de controvérsia. Esse fato gera conflitos de classificação e planejamento terapêutico relativos a essas morbidades. Esta revisão visa estimular a reflexão sobre a adequabilidade das classificações, nomenclaturas e abordagens terapêuticas dessas entidades.

Neuralgia del Trigémino, del Glosofaríngeo y Post-herpética en Pacientes del Hospital Universitario San Ignacio (HUSI) Bogota, Colombia

RESUMEN: Determinar las características clínicas, pautas para el diagnóstico, tratamiento y evolución de la neuralgia del trigémino, postherpética y del nervio glosofaríngeo. Se realizó un estudio descriptivo de 119 historias clínicas de pacientes diagnosticados con neuralgia del trigémino, glosofaríngeo y postherpética tratados en el Hospital Universitario San Ignacio, registrando datos de sexo, edad, antecedentes médicos, exámenes complementarios, características clínicas, tratamientos y evolución. Se revisaron 119 historias clínicas, de las cuales 86 pertenecían a mujeres y 33 a hombres, el 84 % correspondían a neuralgias del trigémino, el 11,7 º% a post- herpética, y el 2,5% en el glosofaríngeo. El lado afectado más común fue el lado izquierdo con un 54%, las ramas más afectadas en la neuralgia del trigémino fue la maxilar y mandibular (V2- V3), en la postherpética la oftálmica (V1), la patología concomitante más frecuente hallada en el grupo fue la HTA, el tipo de dolor más frecuente fue el lancinante con un 82,4%. Los medicamentos más utilizados fueron la carbamazepina (60,5%) seguida de pregabalina (29,4%), en tratamientos quirúrgicos la radiofrecuencia fue la más empleada en un 32 %. 30 pacientes presentaron recaídas que en general fueron manejadas con aumento de las dosis de los medicamentos. Este estudio muestra una similitud con la literatura reportada, presentando más casos de neuralgia de trigémino, seguida de la post herpética y por último del glosofaríngeo. Más frecuente en mujeres, con un promedio de edad de 60 años, afectando en mayor proporción la rama mandibular y maxilar en la neuralgia de trigémino y en la postherpética la oftálmica.

ABSTRACT: To determine the clinical characteristics, guidelines for the diagnosis, treatment and evolution of trigeminal neuralgia, postherpetic neuralgia and glossopharyngeal neu- ralgia. A descriptive study of 119 clinical histories of patients diagnosed with Trigeminal Neoplasia, glossopharyngeal and postherpetic treated at the Hospital Universitario San Ignacio, recording data such as: gender, age, medical history, diagnostic exams, clinical features, branches and side of the face affected, treatments and evolution. 86 clinical records of women and 33 of men were evaluated, 100 with trigeminal neuralgia, 14 postherpetic, 3 glossopharyngeal, the most common affected side was the left side with 51%, the most affected branches in trigeminal neuralgia was the V2-V3, postherpetic V1, the most frequent antecedent of the neuralgias was the AHT, the type of pain that was more frequent was the lancinanting with 82.4%. The most commonly used medication was carbamazepine (60.5%) and pregabalin (29.4%); in surgical treatments radiofrequency was the most used in 32%; 30 patients had relapses that were generally managed with increased doses. This study shows a similarity with the reported literature, presenting more cases of trigeminal neuralgia, followed by the herpetic and finally the glossopharyngeal neuralgia, finding more cases in women than in men, with an average age of 60 years, affecting in Greater proportion the mandibular and maxillary branch in the trigeminal neuralgia and in the postherpetic ophthalmic.

Diagnosing Herpetic Genital Ulcers in a Resource-Limited Setting- What Works?

Aims: Globally, viral agents, especially herpes simplex virus (HSV), have overtaken the bacterial causes of genital ulcers. Very few laboratories in India, perform culture techniques and polymerase chain reaction (PCR) for diagnosis of genital ulcers. This study aimed to establish the utility of existing tests, which are cheaper and need less technical expertise, when compared to newer tests such as PCR.Study Design: This cross sectional study was carried out to determine the aetiology of genital ulcers, with emphasis on diagnosis of herpetic ulcers, using newer and more accurate methods of diagnosis and evaluating their performance by comparing against viral culture as gold standard test.Place and Duration of the Study: The study was carried out over a period of one year in the Apex Regional Sexually Transmitted Diseases (STD) Centre at Safdarjung Hospital, New Delhi and the Department of Microbiology, AIIMS, New Delhi.Methodology: Fifty three patients with genital ulcers were included in the study. Specimens from ulcers were taken for various tests, including Giemsa stain, ELISA for HSV-1 & 2, PCR and Viral culture for HSV.Results: HSV was identified in 31 of 53 cases (58.5%), including 03 cases of HSV-1, and 28 cases of HSV-2. Sensitivity and specificity of PCR was 90.0% and 84.85%, respectively. Viral culture positivity was 37.7%.Conclusion: Genital herpes is associated with an increased risk of Human Immunodeficiency Virus (HIV) acquisition, and clinical manifestations are diverse; hence a presumptive diagnosis should be confirmed by reliable laboratory tests. Nucleic acid amplification tests (NAAT) are the most sensitive methods for direct detection of HSV. The extensive validation of these tests allows for their application in routine laboratory settings with consistency and greater diagnostic accuracy. When standardised and used, PCR is a highly reproducible, rapid and labour efficient method for HSV detection.

Queratoplastia penetrante con y sin terapia antiviral en la queratopatía herpética / Penetrating keratoplasty with and without antiviral therapy in herpetic keratopathy

RESUMEN Objetivo: Identificar el resultado óptico o terapéutico de la queratoplastia penetrante en pacientes con queratopatía herpética. Métodos: Se realizó una investigación descriptiva, transversal, donde se expusieron los resultados del alcance de la queratoplastia penetrante por queratopatía herpética, operados en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras", de La Habana. Resultados: La muestra fue de 33 queratoplastias penetrantes. Con fines ópticos sumaron 24 (72,7 por ciento) y tectónicas 9 (27,3 por ciento). En 5 de estas la agudeza visual fue menor o igual a 0,3. En el total de la muestra, 9 opacificaron, 11 sufrieron complicaciones posquirúrgicas, 8 recurrieron en queratoplastias penetrantes ópticas y 6 en queratoplastias penetrantes terapéuticas. Se rechazaron 7 queratoplastias penetrantes ópticas (33,3 por ciento) y 4 queratoplastias penetrantes terapéuticas (4 por ciento). Presentaron complicaciones 5 (25 por ciento) con queratoplastias penetrantes ópticas y 6 (55,6 por ciento) con queratoplastias penetrantes terapéuticas. En el posquirúrgico 22 (66,6 por ciento) tenían agudeza visual mayor o igual a 0,3 (p= 0,0000). Conclusiones: La inactividad de la enfermedad viral corneal beneficia el pronóstico del injerto por queratopatía herpética en las opacidades de las queratoplastias con fines ópticos. Queda demostrado que el uso de antivirales pre y posoperatorios disminuye la recidiva de la enfermedad herpética sobre el injerto y el rechazo, al lograr mejor agudeza visual y mayor viabilidad. La severidad inflamatoria posquirúrgica se asocia con la enfermedad viral activa o afección de origen inmune al realizar el trasplante, conexos a las complicaciones post queratoplastia(AU)

ABSTRACT Objective: Identify the optical or therapeutic outcome of penetrating keratoplasty in patients with herpetic keratopathy. Methods: A descriptive cross-sectional study was conducted in which a presentation was made of the results of the scope of penetrating keratoplasties for herpetic keratopathy performed at Hermanos Ameijeiras Clinical Surgical Hospital in Havana. Results: The sample was 33 penetrating keratoplasties: 24 optical (72.7 percent) and 9 tectonic (27.3 percent). Visual acuity was lower than or equal to 0.3 in 5 of them. Of the total sample, 9 opacified, 11 had postoperative complications, 8 recurred in optical penetrating keratoplasties, and 6 in therapeutic penetrating keratoplasties. Rejection occurred in 7 optical penetrating keratoplasties (33.3 percent) and 4 therapeutic penetrating keratoplasties (4%). Complications were observed in 5 (25 percent) optical penetrating keratoplasties and 6 (55.6 percent) therapeutic penetrating keratoplasties. In the postoperative period 22 (66.6 percent) had a visual acuity greater than or equal to 0.3 (p= 0.0000). Conclusions: Inactivity of corneal viral disease benefits the prognosis of grafting due to herpetic keratopathy in opacities of optical keratoplasties. Pre- and postoperative antivirals were found to reduce the recurrence of herpetic disease on the graft and rejection, achieving better visual acuity and greater viability. Postoperative inflammatory severity is associated to an active viral disease or an immune disorder at the time of the grafting resulting in post keratoplasty complications(AU)

Queratoplastia en perforación corneal / Keratoplasty in corneal perforation

RESUMEN La perforación corneal es una emergencia médica que por su gravedad puede poner en peligro la integridad del globo ocular. Se informan los resultados en una serie de 25 pacientes y sus 25 ojos con perforación corneal de diversas etiologías, los cuales constituyen el mayor porcentaje de pacientes con queratopatía herpética a quienes se les realizó queratoplastias primarias terapéuticas, así como dos retrasplantes ópticos, en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras". El 83,4 por ciento de los ojos fueron conservados con agudeza visual desde 0,05 a 0,8 con corrección óptica(AU)

ABSTRACT Corneal perforation is a medical emergency whose severity may jeopardize the integrity of the eyeball. Results are presented of a series of 25 patients and their 25 eyes with corneal perforation of varying etiologies. This group constitutes the largest percentage of patients with herpetic keratopathy undergoing primary therapeutic keratoplasties. Two of them underwent optical retransplantation at Hermanos Ameijeiras Clinical Surgical Hospital. Of the total eyes, 83.4 percent were preserved, with a visual acuity of 0.05 to 0.8 with optical correction(AU)

A clinical study on the treatment of postherpetic neuralgia with pulsed radiofrequency of the dorsal root ganglion with pain management

@#This study aimed to investigate the clinical efficacy of pulsed radiofrequency (PRF) of the dorsal root ganglion (DRG) with pain management as treatment of post-herpetic neuralgia (PHN). A total of 78 patients with PHN in the thoracolumbar region were randomly divided into two groups (n = 39 for each group): Group A, oral drug treatment only; Group B, DRG PRF of the thoracic spinal nerve combined with oral drug treatment. The numerical rating scale (NRS) scores of both groups were observed before treatment and at 1, 4, 8, and 12 weeks after treatment. The results showed that the NRS scores of both groups were significantly decreased after treatment (P < 0.05). In addition, the NRS score in Group B decreased significantly more than in Group A (P < 0.05). In conclusion, DRG PRF with pain management is a safe and effective treatment for elderly PHN patients, and it can quickly alleviate pain symptoms.

Blockade of IL-27 signaling ameliorates herpes stromal keratitis with upregulated CD4+ Foxp3+ regulatory T cells influx in mice

Purpose: The purpose of this study was to investigate the production of IL-27 p28 and EBI3 in the ocular inflammatory sites, and the role of IL-27 signaling in a model of HSV-1 induced herpetic stromal keratitis (HSK). Methods: The BALB/c mice were injected intraperitoneally (24 h before infection) with anti-IL-27 antibody or IgG antibody as control, infected with HSV-1 via corneal scarification, and then injected intraperitoneally with anti-IL-27 antibody or IgG antibody at 1, 3, and 5 days postinfection. Slit lamp and histopathology were used to assess disease outcome. The levels of IL-27 p28 and EBI3 in corneas were determined by western blotting and immunofluorescence. Furthermore, viral titers were determined, and immune cell infiltrates were collected and analyzed by flow cytometry. Results: We found that the levels of IL-27 p28 and EBI3 in corneas were elevated significantly at the peak of HSK, and both of them were expressed simultaneously in the epithelium, stroma, and endothelium of corneas. In the group of anti-IL-27 treatment, the severity of the corneal lesion and CD4+ T cells infiltration were significantly decreased, and the percentage of CD4+ Foxp3+ Tregs was upregulated markedly in the spleen, DLNs and cornea of HSK mice compared to IgG treatment. Conclusion: These results provided evidence that IL-27 as a pathogenic pro-inflammatory cytokine controlled CD4+ Foxp3+ Tregs production in HSK, which ultimately resulted in promoting the progression of HSK and poor prognosis.

Flores de Bach para el tratamiento de niños con gingivoestomatitis herpética aguda / Bach flowers for the treatment of children with acute herpetic gingivostomatitis

Introducción: La gingivoestomatitis herpética aguda es la forma más común de infección gingival en la niñez. Objetivo: evaluar la efectividad de la terapia floral de Bach en niños con dicha infección. Métodos: Se realizó un estudio de intervención terapéutica en 42 niños de 2 a 6 años de edad, quienes acudieron al Departamento de Estomatología del Hospital General Docente Dr. Juan Bruno Zayas Alfonso, desde el 2016 hasta diciembre del 2018. De forma aleatoria, se distribuyeron en 2 grupos con 21 miembros cada uno: el de estudio (números pares), recibió la aplicación sublingual de terapia floral, y el de control (números impares), fue tratado de la forma habitual con aciclovir en crema sobre las lesiones. Para la recolección de los datos se confeccionó una planilla que incluyó la evolución de los síntomas clínicos y psicológicos valorados en la entrevista a los padres y en el examen clínico. Se utilizó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con una confiabilidad de 95 %. Resultados: En el grupo de estudio se halló una mejoría clínica de los síntomas en más de 50,0 % de los pacientes a las 72 horas de recibir el tratamiento y en 100,0 % de estos al séptimo día; sin embargo, en el grupo de control se logró esta mejoría en 57,1 % de los afectados. Conclusiones: La favorable evolución clínica y psicológica puso de manifiesto la utilidad de esta terapia en los niños con gingivoestomatitis herpética aguda.

Introduction: Acute herpetic gingivostomatitis is the most common form of infection in childhood. Objective: to evaluate the effectiveness of Bach's floral therapy in children with this infection. Methods: A study of therapeutic intervention in 42 children from 2 to 6 years of age who went to the Stomatology Department of Dr. Juan Bruno Zayas Alfonso Teaching General Hospital was carried out, from 2016 to December, 2018. They were distributed in 2 groups in a random way, with 21 members each: that of study (even numbers), received the floral therapy sublingually, and that of control (odd numbers), was treated in the habitual way with acyclovir in cream on the lesions. For the gathering of the data a schedule was made which included the clinical course of the clinical and psychological symptoms evaluated in the interview to the parents and in the clinical exam. Percentage was used as summary measure and the Chi squared statistician with a confidence of 95 %. Results: In the study group there was a clinical improvement of the symptoms in more than 50.0 % of the patients at the 72 hours of receiving the treatment and in 100.0 % of these to the seventh day; however, in the control group this improvement was achieved in 57.1 % of those affected. Conclusions: The favorable clinical and psychological clinical course showed the usefulness of this therapy in the children with acute herpetic gingivostomatitis.

Hospitalizaciones por Herpes zoster en niños

El herpes zoster (HZ) en niños es una patología infrecuente. Objetivo: Describir las hospitalizaciones por HZ en niños. Métodos: Prospectivamente se seleccionaron los menores de 12 años hospitalizados con HZ en Pediatría-Infecciosa-HUC, entre el 2000 y 2015. Se recolectaron datos clínico-epidemiológicos, serologías virales y subpoblación de linfocitos. Completado los años de estudio, se evaluó la recurrencia de HZ y la adquisición de condiciones inmunosupresoras. Resultados: De 8 758 niños hospitalizados, 28 fueron seleccionados, ocho presentaron alguna condición inmunosupresora. La edad promedio fue 6,99 años e ingresaron a los 3,92 días de enfermedad. Ninguno tuvo inmunización contra varicela. Consultaron previo al ingreso 12/28 niños con diagnósticos errados 6/12. El antecedente de varicela in útero o antes del año de edad fue más frecuente en los niños sanos (P=0,04). El dermatoma más afectado fue el del trigémino (36 %). La media de hospitalización fue 7,6 días con complicaciones inherentes al virus en 7/28 niños sin diferencias entre sanos e inmucocomprometidos. Los CD4 fueron reportados en 15/28 niños con valores disminuidos en 2/12 inmunocompetentes y 2/3 inmunocomprometidos (P=0,08). Los inmunocomprometidos con CD4 bajos tuvieron un RR=4 de complicarse. Las serologías para el virus de la inmunodeficiencia humana resultaron negativas. No hubo recurrencias HZ ni la adquisición de inmunosupresión en el seguimiento realizado a 9 pacientes. Conclusiones: HZ es una causa rara de hospitalización en pediatría pudiendo afectar inmunocompetentes e inmunocomprometidos, cursando con complicaciones frecuentes con mayor riesgo en niños inmunocomprometidos con CD4 bajos. El antecedente de varicela antes del año de edad fue el factor predisponente detectado.

Herpes zoster (HZ) in children is an uncommon condition. Objective: To describe children's herpes zoster hospitalization. Methods: children under 12 years of age hospitalized with HZ in Pediatrics-Infectious-HUC between 2000 and 2015 were selected. Clinical and epidemiological data, viral serology and lymphocyte subpopulation were collected. After completing the years of study, viral recurrence and the acquisition of immunosuppressive conditions were evaluated. Results: Of 8 758 hospitalized children, 28 were selected, eight with immunosuppressive status. The mean age was 6.99 years and they were hospitalized at 3.92 days from the onset of the illness. Twelve patients were consulted prior to their admittance and 6 were misdiagnosed. The history of varicella in utero or before the first year was more frequent in healthy children (P=0.04). The most affected dermatome was the trigeminal (36 %). An average hospitalization duration was 7.6 days with complications inherent to virus in 7/28 children with no difference between healthy and immunocompromised ones. None was immunized against varicella. CD4 was reported in fifteen children with low count in 2/12 immunocompetent and 2/3 immunocompromised (P=0.08). Immunocompromised patients with complicated HZ and low CD4 had a RR = 4.1. Serologies for the human immunodeficiency virus came out negative. There were no HZ recurrences nor the acquisition of immunosuppression in the follow-up of nine patients. Conclusions: HZ is a rare cause of hospitalization that may affect immunocompetent children well as immunocompromised ones and frequently presents complications with a greater risk to the immunocompromised group with low CD4. The antecedent of varicella before the first year of age was the predisposing factor detected.

Neuroprotective effect of surround needling combined with acupoint injection on acute herpetic neuralgia / 中国针灸

OBJECTIVE@#To explore the effect and mechanism of surround needling combined with acupoint injection on acute herpetic neuralgia (AHN).@*METHODS@#Ninety-nine patients with T-T segment AHN were randomly divided into 3 groups, 33 cases in each group, including 2 cases dropped off in the surround needling group, 4 cases dropped off in the acupoint injection group, and 3 cases dropped off in the combined group. Oral valacyclovir was given in each group, 0.3 g each time, 2 times a day for 10 days. Oblique insertion of needle used at points around the herpes in the surround needling group, and continuous wave was stimulated to tolerance for 20 min; the same acupoints were selected as the surround needling group, stimulated with the mixture injection of mecobalamin and lidocaine in the acupoint injection group; After the surround needling, acupoint injection was performed in the combined group. The treatment was given once a day, 14 times for a course, and one course was needed in all groups. The skin healing conditions (blistering, crusting, and dislocation time) of each group were compared after treatment. The pain scores, pain area and quality of life scores in each group were observed before and after treatment. The levels of neuron specific enolase (NSE), substance P (SP) and calcitonin gene-related peptide (CGRP) in the local blister fluid were measured before and after treatment in all groups.@*RESULTS@#The blistering, crusting and dislocation time in the combined group were earlier than the other two groups (all <0.05). The pain score and pain area in the each group were significantly lower than those before treatment, and the quality of life score was significantly higher than that before treatment (all <0.05). The improvements of pain score and quality of life score in the combined group were more obvious than the other two groups (all <0.05). After treatment, the levels of NSE, SP and CGRP in the local blister fluid in each groups were significantly lower than those before treatment (all <0.05). The indexes in the combined group were significantly lower than those in the other two groups (all <0.05).@*CONCLUSION@#Both surround needling and acupoint injection have an adjuvant effect on AHN. The combination of the two is better, the skin is healed quickly, the analgesia is significant, and the contents of local NSE, SP and CGRP are significantly decreased. The mechanism of action is to exert neuroprotective effects.

Systematic review and sequential analysis on treatment of herpes zoster pain mainly by fire needle therapy / 针刺研究

OBJECTIVE: To assess the therapeutic effect and safety of fire needle therapy in the treatment of herpes zoster pain. METHODS: We collected randomized controlled trials about treatment of herpes zoster pain mainly by fire needle therapy (published from the date of establishment of each database to Dec 1 of 2018) from databases of CNKI, Wanfang, VIP, Chinese Biomedical Document Service System (SinoMed), PubMed, Embase, Cochrane Library by using key words of "fire needle" "burnt needle" "red-hot needle" "herpes zoster" "postherpetic neuralgia" and "herpetic neuralgia". Then, we conducted Meta-analysis and sequential analysis about the outcomes of studies met our inclusion criteria using RevMan5.3.5 and TSA0.9.10 Beta softwares and employed GRADE profiler 3.6.1 to grade the quality of evidence. RESULTS: A total of 25 studies including 2 024 patients were brought into the present analysis. Outcomes of the qualitative analysis indicated that the fire needle therapy has a higher effective rate than the western medicine group. Meta-analysis showed that after the treatment mainly with fire needle therapy, 1) the VAS score is evidently lower [WMD=-0.96, 95% CI(-1.22, -0.71), P<0.000 01], 2) the duration of 30% pain relief is obviously shorter [WMD=-1.82, 95% CI (-2.46, -1.18), P<0.000 01], 3) the duration of pain is evidently shorter {fire needle combined with electroacupuncture [WMD=-11.53, 95% CI(-14.57, -8.48), P<0.000 01]; fire needle combined with cupping [WMD=-4.75, 95% CI (-7.99, -1.51), P=0.004]; pure fire needle therapy [WMD=-1.82, 95% CI (-2.46, -1.18), P<0.000 01], and 4) the occurrence rate of post-herpetic neuralgia is considerably lower [RR=0.16, 95% CI (0.09, 0.30), P<0.000 01]. The occurrence and management of adverse events were not mentioned in all the included studies, suggesting no safety problem of the therapy, but the publication bias has not been taken seriously. CONCLUSION: In the treatment of herpes zoster pain, fire needle as the main treatment approach can significantly relieve pain, shorten the pain duration, and reduce the incidence of post-herpetic neuralgia.

Effects of Repetitive Transcranial Magnetic Stimulation in Different Frequencies on Post-herpetic Neuralgia / 中国康复理论与实践

Objective:To observe the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in frequencies of 5 Hz and 10 Hz for post-herpetic neuralgia (PHN). Methods:From March, 2017 to March, 2018, 60 PHN patients were randomly divided into groups A (n = 20), B (n = 20) and C (n = 20), who accepted sham rTMS, 5 Hz rTMS and 10 Hz rTMS, respectively, ten times for two weeks. They were assessed with Visual Analogue Scale (VAS) of pain, Pittsburgh Sleep Quality Index (PSQI), Patients' Global Impression of Change Scale (PGIC), medication regulation (MR) and incidence of adverse events, before treatment (T0), immediately after stimulation (T1-T10), one month after treatment (T11) and three months after treatment (T12). Results:Compared with group A, VAS scores reduced in groups B and C at T3-T12 (P < 0.05), and reduced more in group C than in group B at T7-T12 (P < 0.05). The average VAS reduction was less in group B than in group C (χ2 = 5.347, P < 0.05). The PSQI and PGIS scores were less in groups B and C than in group A at T12 (P < 0.05), while it was less in group C than in group B (P < 0.05). There was no significant difference among three groups in MR and the incidence of adverse events. Conclusions:rTMS in either frequencies of 5 Hz or 10 Hz may relieve pain, and improve sleep for PHN patients, while 10 Hz rTMS seems more effective in terms of pain and sleep.

Effects of Repetitive Transcranial Magnetic Stimulation in Different Frequencies on Post-herpetic Neuralgia / 中国康复理论与实践

Objective:To observe the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in frequencies of 5 Hz and 10 Hz for post-herpetic neuralgia (PHN). Methods:From March, 2017 to March, 2018, 60 PHN patients were randomly divided into groups A (n = 20), B (n = 20) and C (n = 20), who accepted sham rTMS, 5 Hz rTMS and 10 Hz rTMS, respectively, ten times for two weeks. They were assessed with Visual Analogue Scale (VAS) of pain, Pittsburgh Sleep Quality Index (PSQI), Patients' Global Impression of Change Scale (PGIC), medication regulation (MR) and incidence of adverse events, before treatment (T0), immediately after stimulation (T1-T10), one month after treatment (T11) and three months after treatment (T12). Results:Compared with group A, VAS scores reduced in groups B and C at T3-T12 (P < 0.05), and reduced more in group C than in group B at T7-T12 (P < 0.05). The average VAS reduction was less in group B than in group C (χ2 = 5.347, P < 0.05). The PSQI and PGIS scores were less in groups B and C than in group A at T12 (P < 0.05), while it was less in group C than in group B (P < 0.05). There was no significant difference among three groups in MR and the incidence of adverse events. Conclusions:rTMS in either frequencies of 5 Hz or 10 Hz may relieve pain, and improve sleep for PHN patients, while 10 Hz rTMS seems more effective in terms of pain and sleep.

Gingivoestomatitis herpética aguda en paciente adulto / Acute herpetic gingivostomatitis in adult patients

Introduction: Herpetic gingivostomatitis is an infection caused by herpes simplex virus, which affects mainly children patients, being uncommon this manifestation in adults. It initially appears with prodromal signs and then local signs show up. The treatment for this disease is only supportive, because there is already a peak of viral replication when it was diagnosed. Objectives: To report a case of herpetic gingivostomatitis and to discuss its clinical characteristics and treatment. Case report: The patient looked for clinic care for presenting painful oral lesions with little time of evolution. With no medical history, the patient reported using antibiotics and antifungals. Oroscopy showed multiple coalescing ulcerative lesions affecting the gum tissue, tongue, lips and hard palate. It has been diagnosed clinically as herpetic gingivostomatitis and has been treated with supportive treatment (analgesics, topical anesthetic and chlorhexidine digluconate 0,12 percent). The patient returned after one week with improvement of the condition. Conclusion: The correct diagnosis, through the evident clinical manifestations, prevents the indiscriminate use of antibiotics, leading to better response of the patient(AU)

Introducción: La gingivoestomatitis herpética es una infección causada por el virus herpes simple, que afecta principalmente a los pacientes infantiles, la cual resulta inusual en adultos. Inicialmente surge con señales prodrómicas y solo después se presentan señales locales. El tratamiento para este cuadro es solo de soporte, pues cuando se diagnostica ya hay un pico de replicación viral. Objetivo: informar un caso de gingivoestomatitis herpética y discutir sus características clínicas y tratamiento. Presentación del caso: El paciente buscó atención clínica por presentar dolorosas lesiones bucales con poco tiempo de evolución. Sin historial médico, informó que estaba usando antibióticos y antifúngicos, sin remisión de la condición. En la oroscopia se observaron múltiples lesiones ulcerativas coalescentes que afectan el tejido de la gingiva, la lengua, los labios y el paladar duro. Se ha diagnosticado clínicamente como gingivoestomatitis herpética y se ha tratado con tratamiento de apoyo (analgésicos, anestésicos tópicos y digluconato de clorhexidina al 0,12 por ciento). El paciente regresó después de una semana con una mejoría de la condición. Conclusion es: El correcto diagnóstico, a través de las manifestaciones clínicas evidentes, previene el uso indiscriminado de antibióticos, lo que lleva a una mejor respuesta del paciente(AU)

Epidemiology, treatment and prevention of herpes zoster: A comprehensive review

Herpes zoster is a major health burden that can affect individuals of any age. It is seen more commonly among individuals aged ≥50 years, those with immunocompromised status, and those on immunosuppressant drugs. It is caused by a reactivation of varicella zoster virus infection. Cell-mediated immunity plays a role in this reactivation. Fever, pain, and itch are common symptoms before the onset of rash. Post-herpetic neuralgia is the most common complication associated with herpes zoster. Risk factors and complications associated with herpes zoster depend on the age, immune status, and the time of initializing treatment. Routine vaccination for individuals over 60 years has shown considerable effect in terms of reducing the incidence of herpes zoster and post-herpetic neuralgia. Treatment with antiviral drugs and analgesics within 72 hours of rash onset has been shown to reduce severity and complications associated with herpes zoster and post-herpetic neuralgia. This study mainly focuses on herpes zoster using articles and reviews from PubMed, Embase, Cochrane library, and a manual search from Google Scholar. We cover the incidence of herpes zoster, gender distribution, seasonal and regional distribution of herpes zoster, incidence of herpes zoster among immunocompromised individuals, incidence of post-herpetic neuralgia following a zoster infection, complications, management, and prevention of herpes zoster and post-herpetic neuralgia.

Clinical Features of Herpes Simplex Keratitis in a Korean Tertiary Referral Center: Efficacy of Oral Antiviral and Ascorbic Acid on Recurrence

PURPOSE: To describe the clinical manifestations of herpes simplex keratitis (HSK) in a tertiary referral center in South Korea and to determine whether ascorbic acid treatment prevents recurrence of herpetic epithelial keratitis. METHODS: This retrospective cohort study included all consecutive patients with herpetic keratitis referred to our center from January 2010 to January 2015. Clinical features, ocular complications, and recurrences were recorded. RESULTS: In total, 149 eyes of the 133 patients (72 male and 61 female) were followed for an average of 24.6 ± 13.2 months. Sixteen (12.0%) patients had bilateral HSK. The most frequent HSK subtype was epithelial keratitis (49.7%), which was followed by stromal keratitis (23.5%). Epithelial keratitis was the most likely subtype to recur. Complications occurred in 122 (81.9%) eyes. The most common complication was corneal opacity. Recurrences were observed in 48 (32.2%) eyes. The recurrence rates were lower in the prophylactic oral antiviral agent group (16 / 48 eyes, 33.3% vs. 49 / 101 eyes, 48.5%) and the ascorbic acid treatment group (13 / 48 eyes, 27.1% vs. 81 / 101 eyes, 70.3%) compared with the groups without medications. Univariate logistic regression analysis revealed that both factors significantly reduced the risk of recurrence (acyclovir: odds ratio, 0.25; 95% confidence intervals, 0.12 to 0.51; ascorbic acid: odds ratio, 0.51; 95% confidence intervals, 0.20 to 0.91). CONCLUSIONS: This retrospective study described the clinical findings of HSK in a tertiary referral center in South Korea. Prophylactic oral antiviral agent treatment and oral ascorbic acid administration may lower the risk of recurrence.

Role of CD160/BTLA-HVEM-LIGHT/LT-α signaling pathway related to herpetic stromal keratitis / 中华实验眼科杂志

Ocular infection of herpes simplex virus-1 (HSV1) can result in herpetic stromal keratitis (HSK),which impairs vision and is a common cause of human blindness.Studies indicated that HSK lesions are mainly orchestrated by CD4+ T cells.Herpesvirus entry mediator (HVEM),a tumor necrosis factor receptor superfamily member,facilitates virus entry through interactions with viral glycoprotein D (gD).HVEM,a widely expressed tumor necrosis factor (TNF) receptor superfamily member with diverse roles in immune signaling.Intriguingly,HVEM has five receptors:two costimulatory molecules (LIGHT and LT-α),two coinhibitory molecules (BTLA and CD160),and the HSV-gD.HVEM is referred to as a molecular switch because of its capacity to deliver costimulatory signals when bound to LIGHT/LT-α and to produce inhibitory signals when bound to BTLA/CD160.In this paper,the researching progress of the five receptors functions of HVEM and CD160/BTLA-HVEM-LIGHT/LT-α signaling pathway in the HSK were reviewed.We have to provide an insight into the pathogenesis of HSK and clinical ideas for the effective treatment of HSK.Through effective clinical intervention,the inflammatory immune response is reduced,thereby achieving therapeutic effects on recurrence of autoimmune diseases and chronic immune diseases.