Osteomielite maxilar associada ao COVID-19: mucormicose ou não? Uma série de casos / Maxillary osteomyelitis associated with COVID-19: mucormycosis or not? A series of cases

Aim: A series of cases have been presented involving the oral cavity focusing on the presentation, diagnosis and treatment of mucormycosis that can form a basis for successful therapy. Background: The management of severe coronavirus disease (COVID-19) in conjunction with comorbidities such as diabetes mellitus, hematological malignancies, organ transplants, and immunosuppression have led to a rise of mucormycosis which is an opportunistic infection. Cases Description: The various forms that have been enlisted till date are rhino-cerebral, rhino-orbital, gastrointestinal, cutaneous, and disseminated mucormycosis. From the dentistry and maxillofacial surgery perspective, the cases depicting extension of mucormycosis into the oral cavity have been less frequently recorded and thus, require a detailed study. The patients that reported to our private practice had non-tender swelling, draining sinuses and mobility of teeth. A similarity was observed in the clinical signs both in osteomyelitis and mucormycosis. Thus, a histopathological examination was used to establish the definitive diagnosis. Conclusion: Mucormycosis is a life threatening pathology that requires intervention by other branches to make an early diagnosis and commence the treatment. The characteristic ulceration or necrosis is often absent in the initial stage and thus, histopathological examination and radiographic assessment are required to formulate a definitive diagnosis. Early intervention is a necessity to avoid morbidity. The treatment involves surgical debridement of the necrotic infected tissue followed by systemic antifungal therapy. Mucormycosis has recently seen a spike in its prevalence, post the second-wave of coronavirus pandemic in India. It was seen commonly in patients with compromised immunity, diabetes mellitus, hematological malignancies, or on corticosteroid therapy. Mucormycosis invading the palate mostly via maxillary sinus has been less frequently described. In the post-COVID era the features associated with mucormycosis involving oral cavity, should warrant a possible differential diagnosis and managed appropriately. (AU)

Objetivo: Apresentar uma série de casos com enfâse na apresentação, diagnóstico e tratamento da mucormicose oral, assim como uma revisão sistemática que sirva como base para estabelecimento de terapias de sucesso. Introdução: A forma severa da infecção por coronavirus (COVID-19) associada a diabetes mellitus, doenças hematológicas malignas, transplante de órgãos e imunossupressão levaram a um aumento das infecções oportunistas de mucormicose. Descrição dos Casos: As diversas apresentações clínicas que foram descritas até o momento são a rinocerebral, rino-orbital, gastrointestinal, cutânea e mucormicose disseminada. No que concerne a odontologia e a cirurgia maxillofacial, os casos que apresentam extensão de mucormicose para cavidade oral tem sido menos reportados e assim requerem mais estudos. Os pacientes que compareceram a nossa clínica apresentavam aumento de volume endurecido, drenagem de fluidos dos seios maxilares e mobilidade dentária. Clinicamente tanto a osteomielite quanto a mucormicose apresentaram-se de forma semelhante. Assim, análise histopatológica foi utilizada para estabelecimento do diagnóstico definitivo. Conclusão: A mucormicose é uma patologia grave que requer intervenção precoce para estabelecimento do tratamento. A ulceração e necrose características usualmente estão ausentes nos estágios iniciais da lesão, assim análise histopatológica e radiográfica são necessárias para o diagnóstico final. Intervenção precoce é necessária para diminuir a morbidade. O tratamento envolve o debridamento cirúrgico da área necrosada seguida de terapia antifúngica sistêmica. Recentemente, houve um aumento nos casos de mucormicose, após a Segunda onda da pandemia de COVID-19 na índia. Os casos acometiam principalmente pacientes imunocomprometidos, com diabetes mellitus, doenças hematológicas malignas e em uso de corticosteróides. A mucormicose invadindo o palato pelos seios maxilares foi raramente descrita. Na era pós-COVID a mucormicose envolvendo a cavidade oral deve entrar no painel de diagnósticos diferenciais para que o tratamento adequado possa ser instituído precocemente.(AU)

Hemangioma segmentario de la barba / Segmental Beard Hemangioma

Los hemangiomas infantiles son el resultado de la proliferación de células del endotelio vascular y representan los tumores benignos más frecuentes en la infancia, con una incidencia estimada del 4-10% en bebés caucásicos. Se clasifican según el número, la profundidad y la distribución. Dentro de esta última clasificación se encuentran aquellos denominados segmentarios, que se caracterizan por su distribución extensa en áreas de prolongaciones mesodérmicas embrionarias. Se comunica el caso de una paciente evaluada al mes y medio de vida, con un hemangioma extenso del área mandibular y cuello anterior (hemangioma segmentario de la barba). Se describe la importancia de los estudios complementarios para evaluar el compromiso de órganos subyacentes, para detectar síndromes asociados y definir el tratamiento sobre la base de estos resultados. (AU)

Infantile hemangiomas arise from the proliferation of vascular endothelial cells and represent the most common benign tumors in infancy, with an estimated incidence of 4-10% in Caucasian infants. They vary according to their number, depth, and distribution. Within the latter classification are the so-called segmental ones, which feature an extensive distribution in areas of embryonic mesodermal extensions. We report the case of a patient evaluated at one and a half months of life with an extensive hemangioma of the mandibular area and anterior neck (segmental hemangioma of the beard). We describe the importance of complementary studies for evaluating the involvement of underlying organs, detecting associated syndromes, and defining the treatment based on these findings. (AU)

Plasma cell cheilitis in an elderly female: A case report

Introduction@#Plasma cell cheilitis (PCC) is a rare, chronic inflammatory dermatitis of unknown etiology. Due to the limited number of cases reported, no guidelines have been established for its treatment. We present a case of PCC clinically similar to actinic cheilitis or mucosal lichen planus, and squamous cell carcinoma but showed response to topical tacrolimus 0.1% ointment. @*Case Report@#A 62-year-old female with extreme fondness to piping hot food presented with a solitary painful ulceration with some pustules and bleeding on the lower lip with three (3) months duration. Skin punch biopsy revealed a dense band-like infiltrate of plasma cells which is consistent with Plasma cell cheilitis. The patient was given tacrolimus 0.1% ointment and showed significant improvement after a month of treatment.@*Conclusion@#PCC is a rare condition that should still be considered in patients presenting with persistent cheilitis. Clinical and histological correlation is advised for proper management and prognostication.

Tuberculosis of the tongue: A rare case

Introduction: Tuberculosis mostly affects the lungs, but may also affect the central nervous system, lymphatic system, circulatory system, genitourinary system, bones, joints, and skin. Extrapulmonary involvement in tuberculosis is rare, accounting for just 10 to 15% of cases. The lymph nodes are the second most common site of tuberculosis infection. Oral tuberculosis has long been thought to be an unusual phenomenon. Oral manifestations are thought to occur in just 0.05 to 5% of all tuberculosis cases. Surface ulcers, patches, papillomatous lesions, and indurated soft tissue lesions are the most common oral manifestations. Case Presentation: A 69-year-old man presented to the Department of Ear, Nose, Throat at MGM Hospital in Aurangabad, India, with a painful ulcer and tiny nodules on the tongue’s tip and lateral surface. The ulcer appeared 3–4 weeks ago without any obvious trigger with a prickling feeling and increased soreness over the area., Onintraoral inspection multiple small nodules is measuring about 0.1 cm and multiple circular ulcer measuring about 0.2 x 0.1 cm in diameter at the tip and lateral border of the tongue. A granulomatous center and a whitish, well-defined border with mild elevation characterized the ulcer. Conclusion: Despite the rarity of tuberculosis evidence in the oral cavity, oral tuberculosis should be included in the differential diagnosis of chronic oral lesions. To prevent ineffective oral therapy, accurate diagnosis is crucial for successful care by concentrating on the pathological source.

Common femoral artery doppler findings pre and post hyperbaric oxygen therapy for leg ulceration / Achados de doppler da artéria femoral comum antes e depois da oxigenoterapia hiperbárica para úlcera de perna / Hallazgos de doppler de la arteria femoral común antes y después de la terapia con oxígeno hiperbárico para la ulceración de la pierna

Hyperbaric Oxygen Therapy (HBOT) assumes that high pressure hyperoxygenation causes faster tissue recovery and wound healing. Lower extremity flow rates are affected by leg ulcers that change vasodilation, microcirculation resistance, and local tissue demands; how blood hyper oxygenation influences these factors is still unclear. Peripheral arterial occlusive disease (PAOD) has been mostly associated with HBOT results in the femoral artery than in other arteries. Common femoral artery (CFA) peak systolic velocities (PSV), measured pre and post HBOT, were analyzed to research HBOT hemodynamics. Sixteen patients with leg ulcers who were 65 ± 11 (SD) (38-87) years-old, had HBOT of 90 minutes at 2.6 ATA. Bilateral CFA Doppler velocity waveforms were recorded immediately pre and post HBOT. Ulcerated vs non-ulcerated peak systolic velocity (PSV) data were compared using paired t-test. CFA PSV were significantly equal in the ulcerated and non-ulcerated extremities before HBOT: 114 ± 35 (SD) cm/s vs 116 ± 41 cm/s (p = 0.87 by paired t-test). CFA PSV in the ulcerated extremity increased to 122 ± 35 cm/s after HBOT but were statistically insignificant (p =.19 by one-tailed paired t-test). On the other hand, CFA PSV decreased to 103 ± 28 cm/s (p =.049 by one-tailed paired t-test) in the non-ulcerated extremity and were significantly lower after HBOT, with 103 ± 28 cm/s vs 122 ± 35 cm/s for the ulcerated limb (p =.02 by paired t-test). Blood velocity responses post HBOT showed differences between ulcerated vs non-ulcerated extremities. The non-ulcerated extremity apparently responded to oxygenation more than the ulcerated extremity. Such observation suggests further research on hemodynamic reactions caused by HBOT.

A oxigenoterapia hiperbárica (HbOT) assume que a oxigenação de alta pressão resulta em mais celeridade na recuperação do tecido e na cicatrização de feridas. As taxas de fluxo nas extremidades inferiores são afetadas por úlceras nas pernas que alteram a vasodilatação, a resistência da microcirculação e as demandas locais de tecido; esses fatores podem ser influenciados pela hiperoxigenação sanguínea de maneiras ainda não claramente compreendidas. A doença arterial oclusiva periférica femoral (DAOP) tem sido associada a melhores resultados de HBOT quando comparada a outras artérias. As velocidades sistólicas de pico (PSV) da artéria femoral comum (CFA) medidas antes e depois da HBOT foram analisadas como parte de um projeto de pesquisa da hemodinâmica da HBOT. Dezesseis pacientes com úlceras de perna, com idade 65 ± 11 (DP), 38-87 anos, realizaram HBOT com duração de 90 minutos a 2,6 ATA. As formas de onda de velocidade do Doppler CFA bilateral foram registradas imediatamente antes e depois da HBOT. Os dados de PSV ulcerado vs. não ulcerado foram comparados usando o teste t pareado. Pre HBOT CFA PSV não foi significativamente diferente nas extremidades ulceradas e não ulceradas: 114 ± 35 (DP) cm/s vs 116 ± 41 cm/s (p = 0,87 pelo teste t pareado). O PSV pós HbOT CFA na extremidade ulcerada aumentou para 122 ± 35 cm/s, mas não atingiu significância estatística (p = 0,19 pelo teste t pareado unicaudal). Em contraste, CFA PSV na extremidade não ulcerada diminuiu para 103 ± 28 cm/s (p = 0,049 pelo teste t pareado unicaudal). O pós-HbOT CFA PSV foi significativamente menor no membro não ulcerado, 103 ± 28 cm/s vs 122 ± 35 cm/s para o membro ulcerado (p = 0,02 pelo teste t pareado). As respostas da velocidade do sangue após HbOT mostraram diferenças entre as extremidades ulceradas e não ulceradas. Aparentemente, a extremidade não ulcerada respondeu mais significativamente à oxigenação do que a extremidade ulcerada. Tal observação sugere pesquisas adicionais sobre as reações hemodinâmicas decorrentes da HbOT.

La terapia de oxígeno hiperbárico (HbOT) asume que la hiperoxigenación a alta presión da como resultado una recuperación más rápida de los tejidos y una cicatrización de heridas. Las tasas de flujo de las extremidades inferiores se ven afectadas por úlceras en las piernas que alteran la vasodilatación, la resistencia de la microcirculación y las demandas de los tejidos locales; estos factores pueden verse influenciados por la hiperoxigenación de la sangre, de formas que aún no se han entendido con claridad. La enfermedad oclusiva arterial periférica femoral (PAOD) se ha relacionado con los mejores resultados de HbOT que otras arterias. Las velocidades sistólicas máximas (PSV) de la arteria femoral común (CFA) medidas antes y después de la HbOT se analizaron como parte de un proyecto para investigar la hemodinámica de la HbOT. Dieciséis pacientes con úlceras en pierna, 65 ± 11 (DE) (38-87) años, 12 hombres, 11 diabéticos, tenían HbOT de 90 minutos a 2,6 ATA. Se registraron formas de onda de velocidad de CFA Doppler bilaterales inmediatamente antes y después de la HbOT. Se compararon los datos de la velocidad sistólica máxima (PSV) ulcerada frente a la no ulcerada mediante la prueba t pareada. Pre HbOT CFA PSV no fue significativamente diferente en las extremidades ulceradas y no ulceradas: 114 ± 35 (DE) cm/s vs 116 ± 41 cm/s (p = 0,87 por prueba t pareada). Post HbOT CFA PSV en la extremidad ulcerada aumentó a 122 ± 35 cm/s pero no alcanzó significación estadística (p =.19 por prueba t unilateral pareada). En contraste, CFA PSV en la extremidad no ulcerada disminuyó a 103 ± 28 cm/s (p =.049 por prueba t unilateral pareada). El PSV después de la HbOT CFA fue significativamente menor en la extremidad no ulcerada, 103 ± 28 cm/s frente a 122 ± 35 cm/s para la extremidad ulcerada (p = 0,02 según la prueba t pareada). Las respuestas de velocidad sanguínea post HbOT mostraron diferencias entre las extremidades ulceradas y no ulceradas. Aparentemente, la extremidad no ulcerada respondió más significativamente a la oxigenación que la extremidad ulcerada. Tal observación sugiere una mayor investigación sobre las reacciones hemodinámicas debidas a la HbOT.

Ulceración esofágica por ingestión de doxiciclina / Doxycycline induced esophageal ulceration

La ulceración esofágica por ingestión de doxiciclina es una de las causas más frecuentes de lesión esofágica. Ha sido subdiagnosticada y escasamente reconocida en dermatología. El dolor retroesternal, la odinofagia de aparición brusca y el antecedente de ingesta de doxiciclina u otros fármacos son características que facilitan su diagnóstico. Puede presentar complicaciones serias, como hemorragias, estenosis y mediastinitis.

Esophageal ulceration due to ingestion of doxycycline is one of the most frequent causes of esophageal injury. It has been underdiagnosed and scarcely recognized in dermatology. Retrosternal pain, sudden odynophagia and a history of doxycycline or other drugs intake are some of the characteristics that lead to diagnosis. It may cause severe complications such as bleeding, stenosis and mediastinitis.

Molecular characterization of bacterial microbiota associated with infectious bovine keratoconjunctivitis in Michoacán, Mexico / Caracterización molecular de la microbiota bacteriana asociada con queratoconjuntivitis infecciosa bovina en Michoacán, México / Caracterização molecular da microbiota bacteriana associada à ceratoconjuntivite bovina infecciosa em Michoacán, México

Abstract Background: The most common ocular disease affecting cattle worldwide is infectious bovine keratoconjunctivitis (IBK), which has been associated with Moraxella bovis bacterium. Objective: To report the molecular characterization of the ocular bacterial microbiota and its relation to IBK in cattle in two dairy regions in Michoacán, Mexico. Methods: A total population of 761 bovines were evaluated, of which 17 (2.23%) showed symptoms of IBK. Thirty-eight bacterial isolates from ocular samples of bovines with IBK were characterized by Gram-staining and antimicrobial sensitivity. In addition, isolates were identified by sequence comparisons of the 16S ribosomal gene. Results: The genus Moraxella was one of the most abundant bacteria and M. bovoculi was the most predominant species. Conclusion: The bacterial isolates identified in eye lesions of cattle and associated to IBK are diverse. To the author´s knowledge, this is the first study on the subject in Mexico; therefore, more research is needed to estimate the incidence of IBK and determine its associated microbiota.

Resumen Antecedentes: la enfermedad ocular más común que afecta al ganado en todo el mundo es la queratoconjuntivitis infecciosa bovina (IBK), que se ha asociado con la bacteria Moraxella bovis. Objetivo: reportar la caracterización molecular de la microbiota bacteriana ocular y su relación con IBK en ganado de dos regiones lecheras en Michoacán, México. Métodos: se evaluó una población total de 761 bovinos de los cuales 17 (2,23%) mostraron síntomas de IBK. Se obtuvieron treinta y ocho aislamientos bacterianos de muestras oculares de bovinos con IBK, los cuales se caracterizaron por tinción de Gram y sensibilidad antimicrobiana. Además, los aislamientos se identificaron mediante comparaciones de secuencias del gen ribosomal 16S. Resultados: el género Moraxella fue una de las bacterias más abundantes y M. bovoculi fue la especie más predominante. Conclusión: los aislamientos bacterianos identificados en lesiones oculares de bovinos y asociados a IBK son diversos. Hasta donde sabemos, este es el primer estudio sobre el tema realizado en México; por lo tanto, es necesario ampliar esta investigación para estimar la incidencia de IBK y determinar la microbiota asociada con la misma.

Resumo Antecedentes: a doença ocular mais comum que afeta o gado no mundo é a ceratoconjuntivite bovina (IBK), que tem sido associada à bactéria Moraxella bovis. Objetivo: relatar a caracterização molecular da microbiota bacteriana ocular e sua relação com a IBK em bovinos de duas regiões leiteiras de Michoacán, México. Métodos: foi avaliada uma população total de 761 bovinos, más apenas 17 (2,23%) apresentaram sintomas de IBK. Trinta e oito isolados bacterianos de amostras de olho bovino com IBK foram caracterizados por coloração de Gram e sensibilidade antimicrobiana. Além disso, os isolados foram identificados por comparação de sequências do gene ribossômico 16S. Resultados: a microbiota bacteriana associada à IBK foi diversa, sendo o gênero Moraxella uma das mais abundantes e M. bovoculi a espécie predominante. Conclusão: de acordo com o conhecimento dos autores, este é o primeiro estudo sobre o tema no México até o momento, portanto é necessário expandir essa pesquisa para estimar a incidência de IBK e determinar a microbiota associada à mesma.

Topical corticosteroid induced ulcerated striae

Abstract We report four cases of ulcerated striae following misuse of fixed dose combinations creams containing clobetasol propionate with antifungal and antibacterial agents.

Clinical application of free anterolateral thigh perforator flap in repairing bone exposure of diabetic foot ulcers / 中华内分泌外科杂志

Objective:To investigate the effect of free anterolateral thigh perforator flap on repair of bone exposure of diabetic foot ulcer.Methods:From Sep. 2016 to Dec. 2019, free anterolateral thigh perforator flap was used to repair 19 cases of diabetic foot ulcer with bone exposure. The area of the flap ranged from 5.0 cm×7.0 cm to 10.0 cm×16.0 cm. The donor site of the flap was sutured directly. The patients were followed up regularly by outpatient and telephone.Results:18 of the 19 cases survived completely, in one case, most of the flap were necrotic, healed after second stage skin grafting; 5 flaps developed edema due to low albumin, and healed after stitches removal, dehydration, albumin supplement and secondary suture and antibiotic replacement. Through 6 to 24 months of follow-up study we concluded that flap transfer could functionally and morphologically repair wounds with soft tissue defect and infection.Conclusion:Free anterolateral thigh perforator flap is effective in repairing diabetic foot ulcer and can effectively reduce disability rate.

Clinical diagnosis of oral erosive and ulcerative diseases in children / 浙江大学学报·医学版

Mucosal disease is one of the most common oral cavity diseases in children, among which mucosal erosion and ulceration account for about 50%. Oral mucosal erosion and ulcer diseases in children are mostly acute with obvious pain, affecting speech, eating and swallowing. Some oral mucosal diseases are caused by infection and would result in epidemic among children. The onset age, sites, lesions size and quantity could vary, and some would have recurrence. The detailed medical history and comprehensive physical examination are necessary, some diseases can be diagnosed according to the medical history and clinical manifestations. If diagnosis can not be made, biopsy, blood test and immunofluorescence staining, immunohistochemistry, molecular biology detection, gene diagnosis, tuberculin test and other tests should be considered, and further investigation of systemic diseases should also be carried out if necessary. In some cases, multidisciplinary consultation should be sought. For those who still have no abnormal findings, therapeutic diagnosis can be tried out or secondary biopsy should be performed. In this article, the research progress of oral mucosal diseases in children is reviewed and our own clinical experiences of oral erosive and ulcerative diseases in children are summarized.

Effect and influencing factors of standardized chemotherapy and bronchoscopic intervention in the treatment of tracheobronchial tuberculosis / 中国医师杂志

Objective:To analyze the factors affecting the disappearance time of airway necrosis and repair time of airway scar stenosis in patients with ulceration necrosis tracheobronchial tuberculosis (TBTB Ⅱ) after standardized chemotherapy and bronchoscopic intervention.Methods:The clinical data of 222 TBTB Ⅱ patients admitted to Hunan Chest Hospital from January 2015 to December 2018 were collected, bronchoscopic interventional treatment was performed on time. The texture, blockage of lumen, granulation proliferation, airway stenosis of TBTB patients before treatment, the disappearance time of airway dead objects, scar repair time and stenosis degree after treatment were followed up. The disappearance time of airway necrosis and repair time of airway scar stenosis and its influencing factors were recorded and analyzed.Results:In 222 patients, 508 ulceration necrosis airway lesions were found under bronchoscopy, with a median of 2(1-6); 170(76.6%) cases of airway lesions had different degrees of stenosis before treatment. 79(35.6%) patients had tough necrosis, and 86(38.7%) patients had necrosis blocking the lumen; 132(59.5%) patients had granulomatosis. The disappearance time of airway necrosis after treatment was 1 to 32 weeks, and M( Q1, Q3) was 6(3, 9) weeks; the repair time of airway scar stenosis was 2 to 73 weeks, and M( Q1, Q3) was 14(10, 19) weeks; after treatment, there were 90.5%(201/222) patients with different degrees of scarring in the airways. Cox multiple analysis showed that the risk factor for the disappearance time of airway necrosis was tough tough necrosis ( HR=1.52, 95% CI: 1.10-2.10); the risk factor for the repair time of airway scar stenosis was the disappearance time of airway necrosis 6-9 weeks ( HR=2.73, 95% CI: 1.84-4.05). Conclusions:90.5% of patients with type Ⅱ TBTB developed airway scar stenosis after treatment. The median time for the disappearance of airway necrosis was 6 weeks, and the median time for the repair time of airway scar stenosis was 14 weeks. In the interventional process, attention should be paid to the removal of tough necrosis and the efficiency of necrosis removal to reduce the risk of airway scar stenosis.

Preliminary in-vitro evaluation of marketed formulations for antacid activity

Background: Hydrochloric acid (pH 1.5-3.5) being the major component of gastric acid is produced by parietal cells of stomach. Its secretion is a complex and relatively energetically expensive process. The preservation of acidity of stomach is evidently important because of its implications in peptic and duodenal ulceration.Methods: In the present study, we attempted to compare the activity of 13 (F1-F13) antacid formulations (5-liquid, 4- quick releases and 4- tablets) by using acid-base neutralization studies. Preliminary antacid test (PAT) was performed to define whether the given formulation falls under the category of antacid wherein the pH of the antacid-acid (HCl) solution should be higher than pH of 3.5. The chosen antacids were further subjected to acid neutralizing capacity (ANC) (reaction between the sample of antacid and amount of acid neutralized by the formulation) and acid neutralizing potential (ANP) which explains the time duration during which a given sample of antacid can maintain pH above 3.5).Results: Out of the 13 samples tested, two formulations of pastels (F6, F12) were rejected as per the standard protocol of classifying formulations as antacids after screening for PAT. Sample F5 was found to have the highest ANC. F7 also showed highest ANC among the tablets tested. Also, F13 showed better ANC and ANP as in comparison to other quick releases.Conclusions: Digene products (F5, F7, and F13) showed better antacid properties. This data would provide insights into development of drug, comparison between antacids depending on their chemical formulation and determination of dosage to avoid plausible side effects.

Facial Lazarine Leprosy in Post-elimination Era: A Case Report

Despite leprosy being eliminated worldwide, a reasonable number of new cases are encountered in many countries like India. Reactions in leprosy are quite common which contributes significantly to morbidity and disabilities in patients suffering from leprosy. Two types of reactions can occur in leprosy patients depending on host's immune response against Mycobacterium leprae. Lazarine leprosy is a rare ulcerating form of leprosy which is considered as an exaggerated type 1 reaction. We are reporting a case of facial lazarine leprosy in a normal immunocompetent person without any underlying malnutrition. This case presented with infiltrated, oedematous plaque with ulceration and crusting, features which are suggestive of Lazarine leprosy but can also be indicative of severe type 1 reaction. Aggressive nature of the lesion and ulceration were taken into consideration to diagnose this case as Lazarine leprosy.

Anti-ulcer effect of rhizome of Curcuma longa Linn, by the method of pyloric ligation

Background: Substantial part of the world population has been known for a long time to suffer from peptic ulcer disease. In the present study, Curcuma longa, a plant belonging to the Zingiberaceae family was chosen for investigating its anti-ulcer properties.Methods: The rhizomes of Curcuma longa were collected locally. The extract was prepared by soxhlet extraction with 50% ethanol. Albino rats of Wistar strain (120-200 grams) obtained from the animal house of medical college Thiruvananthapuram were used. Ranitidine was collected from Kerala Sate Drugs and Pharmaceutical LTD Alapuzha. Antiulcer study in rats were done using the method of pyloric ligation.Results: Antiulcer study in rats using the method of pyloric ligation, extract of Curcuma longa in 1000mg/Kg dose levels exhibited significant protection against shay ulceration. The results were comparable to that of standard drug Ranitidine.Conclusions: The present study with extract of Curcuma longa revealed that it has significant anti-ulcer activity.

Altered Neuronal Activity in the Central Nucleus of the Amygdala Induced by Restraint Water-Immersion Stress in Rats / 神经科学通报·英文版

Restraint water-immersion stress (RWIS), a compound stress model, has been widely used to induce acute gastric ulceration in rats. A wealth of evidence suggests that the central nucleus of the amygdala (CEA) is a focal region for mediating the biological response to stress. Different stressors induce distinct alterations of neuronal activity in the CEA; however, few studies have reported the characteristics of CEA neuronal activity induced by RWIS. Therefore, we explored this issue using immunohistochemistry and in vivo extracellular single-unit recording. Our results showed that RWIS and restraint stress (RS) differentially changed the c-Fos expression and firing properties of neurons in the medial CEA. In addition, RWIS, but not RS, induced the activation of corticotropin-releasing hormone neurons in the CEA. These findings suggested that specific neuronal activation in the CEA is involved in the formation of RWIS-induced gastric ulcers. This study also provides a possible theoretical explanation for the different gastric dysfunctions induced by different stressors.

Effects of Celastrol on Accelerated Healing of Skin Wounds of Diabetic Ulceration in Rats and Mechanism Revealed by Nuclear Magnetic Resonance-based Metabonomics / 分析化学

The experimental SD rats were randomly divided into normal control group (Con group),diabetic ulcer model group (DM group) and Celastrol group (Cel group).Except the control group,diabetic ulceration rat models were established by intraperitoneal injection of streptozotocin along with skin scald.And then,each group was treated by spraying the saline solution on the affected skin with (Cel group) or without (Con group and DM group) Cel (q.d.×14 d).Nuclear magnetic resonance (NMR)-based metabonomic analysis was applied to detect metabolic characteristics,accompanied by healing rate calculation and HE and Masson staining to study therapeutic effect of celastrol on accelerated healing of skin wounds of diabetic ulceration rats,which could be used to elucidate therapeutic effects of celastrol on the rat diabetic ulceration and its mechanism.The results showed that celastrol could induce epithelial regeneration of the rat ulcer wound,regulate the infiltration of inflammatory cells and the distribution of collagen fibers,and promote the healing of the ulcer wound.About 20 endogenous potential differential metabolites were screened and identified by partial least square analysis.Metabolic pathway analysis was carried out to show that celastrol can significantly recovery the level of the tricarboxylic acid cycle,promote its energy supply,accelerate the protein synthesis,improve mitochondrial dysfunction and oxidative stress,and accelerate the self-repair ability of skin tissue.Celastrol can promote the healing of ulcers skins of the diabetic rats,which contribute to experimental basis of the drugs for the treatment of diabetic ulcers.

Resolución de úlcera sublingual en paciente con parálisis cerebral: informe de un caso / Resolution of sublingual ulcer in cerebral palsy patient: case report

Male patient, 19 years old, diagnosed with severe mixed tetraparesis, predominantly spastic, secondary to severe perinatal asphyxia, West syndrome and intellectual disability, GMFCS V. october 2012 presents a 1 cm white-colored and painless ulcer on the ventral surface of the tongue, showing indurated borders, and no signs of palpable lymph nodes, compatible with Riga-Fede disease. the patient is referred to the commune hospital. August 2013 attends a dental control presenting the ulcer with similar conditions, awaiting treatment from the hospital. April 2014 he returns for a health control in the same conditions. this time a non invasive intervention is performed, covering the incisal edges of teeth 3.1 and 4.1 with composite resin. A two weeks later control shows a smaller ulceration. By June 2015 the ulcer has healed completely, and stayed healed until january 2016. the mother reports decreased tongue protrusion in frequency and intensity since January 2015. Conclusion: Sublingual traumatic ulcer can be healed by eliminating the cause of the trauma, using a non invasive technique.

Paciente de sexo masculino, 19 años de edad con diagnóstico de tetraparesia mixta severa de predominio espástico, secundaria a asfixia perinatal, síndrome de West y discapacidad intelectual, GMFCS V. En octubre de 2012 presenta úlcera en cara ventral de la lengua, de 1 cm de diámetro aproximadamente, de bordes indurados, fondo de color blanquecino e indolora, sin ganglios palpables, compatible con diagnóstico de enfermedad de Riga Fede. Se deriva en esa oportunidad al hospital de su comuna. En agosto de 2013 asiste nuevamente a control presentando la úlcera con similares condiciones, en espera de tratamiento en el hospital. En abril de 2014 vuelve a control en iguales condiciones. En esta oportunidad se realiza intervención no invasiva, recubriendo superficies incisales de dientes 3,1 y 4,1 con resina compuesta. En control a las dos semanas se observa la úlcera más pequeña. En junio de 2014 se observa ausencia de úlcera, situación que persiste hasta control de enero de 2016. La madre manifiesta que protrusión lingual ha disminuido en frecuencia e intensidad desde enero de 2015. Conclusión: La úlcera sublingual de origen traumático puede ser resuelta eliminando la causa del trauma, de forma no invasiva.

Manifestaciones de la cavidad bucal por infección del virus de la inmunodeficiencia humana: reporte de caso clínico / Oral manifestations of the HIV virus: report of a clinical case

Las manifestaciones orales por la infección del virus de la inmunode-ficiencia humana son en ocasiones el primer signo de la enfermedad yen muchos casos un indicador de la progresión de la infección hacia elsíndrome de inmunodeficiencia adquirida. Las ulceraciones indoloras,diferentes tipos de gingivitis agresivas y la leucoplasia vellosa, se desarrollan muy fácilmente en individuos cuyo sistema inmunológico está comprometido, como el de los pacientes que sufren del virus deinmunodeficiencia adquirida.

Oral manifestations caused by the human immunodefi ciency virusare often the fi rst indication that the person is infected and oftenan indicator of its progression into AIDS. Painless ulcers, assortedtypes of aggressive gingivitis, and hairy leukoplakia develop easilyin individuals whose immune system is compromised, such as thoseinfected with HIV.

Intestinal pathological changes in Behcet's disease:a clinical retrospective study / 复旦学报（医学版）

Objective To analyze the characteristics of Behcet's disease (BD) with intestinal lesions to provides further reference for the diagnosis and treatment.Methods Four hundred and one cases of BD patients' data were collected including basic data,colonoscopy report,pathology diagnosis and hematologic examination.Statistical description of intestinal lesions was applied and analyzed for the differences between the locations and blood examinations of intestinal lesions.Results Within these 401 BD patients,88 (21.95 ％) with intestinal lesions.Intestinal ulcerations,including both active and inactive phase,appeared in 52 cases (12.97％) mostly founded in ileocecum,in which 62.86％ (22/ 401,5.49％ of all BD patients) without the abdominal discomfort.Compared with inactive phase,the active phase intestinal BD patients have higher inflammation indexes with C reactive protein (CRP) increased of statistical significance (P =0.028).Thirty-three cases (8.23 ％) with adenomas were founded,including tubular adenoma,serrated adenoma and villous adenoma.Mostly occurred in rectum,sigmoid colon,especially the sigmoid colon rectum junction.Adenomas were seen in eider patients with statistical significance compared to BD patients without intestinal lesion or with intestinal ulceration (P =0.022,0.000),and exhibited elder changes of lab tests,such as increas in aspartate aminotransferase (AST),gamma-glutamyl transferase (GGT) and uric acid (UA).In addition,2 cases of melanosis coli and 1 case of caecal diverticulum were also founded.Conclusions BD patients with intestinal ulcer or adenoma takes a fairly high ratio,and most intestinal BD and BD with adenoma patients did not complaint related symptoms,so colonoscopy as a screening method for diagnosis and treatment of BD is necessary.

Estomatitis por metotrexate: Breve revisión del tema / Methotrexate stomatitis: A brief review

El empleo de metotrexate como inmunoimodulador y antimetabolito, ha ido en aumento debido a su efectividad terapéutica, bajo costo y su esquema sencillo de dosis única semanal. Sin embargo, recientemente se han reportado efectos adversos graves relacionados con su administración, entre ellos la estomatitis. Las úlceras bucales son el efecto adverso oral más frecuente y se relacionan con la falta de administración complementaria de ácido fólico, iatrogenias ocasionadas por errores en la ingestión o interacciones farmacológicas.

The use of methotrexate as immunomodulator and antimetabolite has been increasing because of its therapeutic effectiveness, low cost, and simple scheme single dose weekly. However, have recently been reported serious adverse effects related to administration, including stomatitis. Mouth ulcers are the most frequent oral adverse effect and relate to the lack of supplemental folic acid, iatrogenic errors caused by ingestion or drug interactions.