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1.
Otolaryngology - Head and Neck Surgery ; 167(1 Supplement):P201, 2022.
Article in English | EMBASE | ID: covidwho-2064416

ABSTRACT

Introduction: Access to specialty care is challenging in rural health environments, and this has been compounded by the COVID-19 pandemic. Routes to establishing care for head and neck cancer patients are especially important. We sought to quantify our referral patterns and processes to identify opportunities for optimization. Method(s): Retrospective review was performed of patients with initial head and neck tumor board presentation between January 1, 2020, through December 31, 2021. Assessed time points were date of referral, biopsy, pathological diagnosis, imaging order, imaging obtained, and initial presentation at head and neck tumor board. Result(s): A total of 429 patients were included. Squamous cell carcinoma (n=350, 81.6%) made up the majority, and most common primary sites were oropharynx (27.4%), oral cavity (20.3%), larynx (16.9%), and cutaneous (16.5%). At time of referral, 37.6% of patients had biopsy proven diagnosis. Average time to tumor board was 22 days, and significantly greater in those undiagnosed at referral (29 vs 14 days). Distance to provider did not correlate with time to tumor board. The period since the onset of the COVID crisis did not appear to affect access to care once in our system. However, there was evidence that patients presented with advanced locoregional disease during COVID-19. Conclusion(s): This study creates an approach to map access to care, evaluating critical time points and opportunities to expedite multiple steps that initiate therapy for head and neck cancer. There are both external (rural geography and the COVID-19 pandemic) and internal aspects that may pose barriers to access. Identification of these barriers allows for improved timely access to care in this susceptible population.

2.
Journal of Pure and Applied Microbiology ; 16(3):1628-1632, 2022.
Article in English | EMBASE | ID: covidwho-2044322

ABSTRACT

Strongyloidiasis is a neglected parasitic disease caused by the intestinal parasite, Strongyloides stercoralis. Most patients with strongyloidiasis are asymptomatic, but few present with varied clinical manifestations such as cutaneous, gastrointestinal, pulmonary, and disseminated disease. It creates a diagnostic dilemma and undue delay in the diagnosis of patients. We report the case of a 79-yearold male who presented with fever and abdominal pain due to strongyloidiasis with no history of immunosuppression. The infection resolved entirely on treatment with ivermectin.

3.
Alergologia Polska - Polish Journal of Allergology ; 9(3):143-149, 2022.
Article in Polish | EMBASE | ID: covidwho-2044116

ABSTRACT

The COVID-19 pandemic, announced by the World Health Organization in March 2020, remains the subject of research and analysis by scientists working in various branches of medicine. Coronavirus-associated disease is most commonly associated with characteristic pulmonary symptoms. Cutaneous manifestations in the course of SARS-CoV-2 as extrapulmonary manifestations of the disease represent a major diagnostic and therapeutic challenge. Diverse clinical aspects of dermatological manifestations hinder correct differentiation and diagnosis. The prevalence of skin lesions associated with COVID-19 is estimated to be over 6% of affected patients. Several clinical patterns strongly associated with COVID-19 have been described, such as pseudo-ulcerative, maculopapular, urticarial, vesicular, and vascular lesions. Cutaneous dermatitis may coexist with mucocutaneous manifestations involving the oral cavity and ocular surface. Cutaneous manifes tations of COVID-19 are classified in the literature according to their clinical features, possible mechanisms of pathogenesis, and prevalence. The pathogenetic mechanism, diagnostic criteria, prognostic significance of these lesions are still being discussed. This review summarizes the current knowledge about the cutaneous manifestations associated with COVID-19. The period of symptom occurrence, severity, need for specific treatment, and prognosis depends on the clinical presentation. Physicians with knowledge of the cutaneous manifestations of COVID-19 can quickly differentiate and then make an accurate diagnosis and implement appropriate treatment.

4.
Bangladesh Journal of Medical Science ; 21(4):676-684, 2022.
Article in English | EMBASE | ID: covidwho-2043413

ABSTRACT

Background: Impacts of primary oncology surgical procedure can impede restoration objectives. Restoring oral function, comfort and aesthetics is a challenge due to limitations in the restorative treatment options. Methodology: Literature review on the responsibilities, role of maxillofacial prosthodontist, materails and retentive aids used for prosthesis, classification of maxillofacial prostheses, recent advancements in MFP and Workflow for the fabrication of obturator prostheses in the COVID-19 pandemic scenario. Case report on the fabrication of Holllow bulb definitive obturator during pandemic crisis. A 47 years old male patient reported for post-surgical evaluation in maxillary posterior region of oral cavity. The patient had partial maxillectomysurgical procedure of squamous cell carcinoma in the palate 5 years back. To replace the gap created, the patient was using interim obturator. He had facial asymmetry and collapse. Prosthodontic rehabilitation with one piece closed hollow bulb obturator was planned & subsequently fabricated for the patient. For our case considering the feasibility & ease of manipulation, heat activated acrylic resin was used for this particular patient for rehabilitation. The method described is easy, simple, time saving & economical. Bulb portion was hollow & made of heat cure resin, so weight was less & less chances of tissue irritation. Results: With the Covid-19 infection protocol measures taken definitive obturator was given to the maxillectomy patient to restore aesthetics, function and comfort as well. After insertion of prostheses mastication, deglutition and phonetics were improved. Breathing problems were resolved and aesthetics was improved. Conclusion: A simplified technical approach for the treatment of a patient with palatal defect of and other supportive structure has been presented in Covid-19 situation following the described infection prevention protocols. The technique presented offers a method of obtaining a detailed impression of the defect and promptly provides the patient with a light weight, easyto-use and flexible tissue-tolerant obturator.

5.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2009570

ABSTRACT

Background: Oral mucositis (OM) is a debilitating side effect of concomitant chemoradiotherapy (CRT) for head and neck cancer (HNC). EC-18 may effectively mitigate OM by minimizing the CRT-induced innate immune response. This Phase II, 2-stage trial evaluated safety, tolerability, and efficacy of EC- 18 in reducing the duration, incidence, and trajectory of severe OM (SOM) in HNC patients. Methods: Patients (n = 105) with pathologically confirmed oral cavity, oropharynx, hypopharynx, or nasopharynx squamous cell cancers who received intensity-modulated radiation therapy (IMRT;with ≥ 55 Gy on ≥ 2 oral sites) and weekly or tri-weekly cisplatin were studied. In Stage 1, 24 patients were randomized (n = 6 per arm) to receive 500, 1000, or 2000 mg of EC-18, or placebo. Following independent Data Safety Monitoring Board review, 81 patients in Stage 2 received EC-18 2000 mg (n = 41) or placebo (n = 40) throughout CRT. WHO OM grade was assessed twice weekly during IMRT and then once weekly for up to 6 weeks post-IMRT. The primary efficacy endpoint was duration of SOM during the active and short-term follow-up (STFU) periods in the compliant per-protocol population (PP). Much of Stage 2 was conducted during peak periods of the COVID-19 pandemic which measurably impacted patient compliance relative to test medication dosing and planned radiation. Consequently, to assess efficacy most accurately, the PP population was analyzed (with at least 4 weeks of study drug dosing, minimum cumulative radiation of 55 Gy, 80% study drug compliance in the first 28 days of dosing, and without using not-allowed-therapy). Results: Patient demographics and baseline characteristics were balanced between groups. Adverse events (AEs) were comparable amongst cohorts without drug-related severe AEs. In the PP, the median duration of SOM from baseline through STFU was 0 day in the EC-18 group (n = 22) v 13.5 days in the placebo group (n = 20). SOM incidence through STFU (45.5% v 70%) and opioid use (time to onset: 32.3 v 26.0 days;and duration: 32.8 v 37.5 days) favored EC-18 v placebo. Results of the covariates analyses suggested that EC-18 favorably impacted SOM incidence in patients who experienced SOM treated with weekly low-dose cisplatin (n = 26;37.5% v placebo 70.0%) and HPV+ tumors (n = 29;35.3% v placebo 66.7%;Table). One-year long-term follow-up for tumor outcomes is ongoing. Conclusions: EC-18 safely mitigated the development and the time course of SOM in CRT-treated HNC patients. In addition, EC-18 may provide substantial benefits to subpopulations of HPV+ HNC patients treated with low dose cisplatin.

6.
Indian Journal of Critical Care Medicine ; 26:S55-S56, 2022.
Article in English | EMBASE | ID: covidwho-2006349

ABSTRACT

Aim and background: Since June 2020, there have been several reports of multisystem inflammatory syndrome in adults (MIS-A). There is a paucity of a description of MIS-A from India. Materials and methods: A 26-year-old, healthy male, with a previous history of COVID-19, without any known history of chronic disease, with clinical characteristics resembling MIS-A was hospitalised on May 30, 2021. Results: Case presentation: The patient presented with 1 week of persistent high-grade fever (102-degree F) with chills and rigor. The concomitant complaints were left-sided pain in the buccal cavity, left facial swelling, intra-orbital pain, and watery eyes. The respiratory rate was 24/minute, SpO2 was 96% on room air. Ever since the recovery from COVID-19 (1 week back), there was severe pain in the throat with difficulty in breathing, generalised weakness, and loss of appetite. BP was 130/80 mm Hg. The hospital course was notable for profound systemic inflammation, requiring ICU admission. MRI revealed discrete subcentimetric bilateral deep cervical lymph nodes. Blood tests at admission revealed, lymphopenia 15.3%, CRP 61.84 mg/L, total leucocyte count 12.93 (1000/μL), neutrophils 78.7%. Red distribution width (RDW) was marginally elevated to 15%. The patient was managed by IV fluids, IV immunoglobulin. Scrub typhus was excluded by IgM ELISA IgM with a negative titre (0.095). Widal test was negative and excluded enteric fever. d-dimer was within normal limits (125 ng/ mL). Borderline elevation of hepatic enzymes was noted. There was a high SARS-CoV-2 IgII titres (12050.4). The patient improved following intravenous immunoglobulin (IVIG), IV ascorbic acid, dexamethasone, supportive care and was discharged on day 4, with methylprednisolone for 1 week. Conclusion: Specific treatment is yet to be determined. However, dexamethasone and IVIG allowed controlling the inflammatory process. MIS-A, as a delayed immune complication, requires early recognition, with a multidisciplinary approach and aggressive therapeutic intervention, to yield favourable outcomes. MIS-A should be considered in adults, during the recovery phase from COVID-19. This is perhaps, the first description of MIS-A from India during the second wave of the COVID-19 pandemic. The role of IVIG needs further exploration.

7.
Indian Journal of Critical Care Medicine ; 26:S51-S52, 2022.
Article in English | EMBASE | ID: covidwho-2006347

ABSTRACT

Introduction: Macroglossia is defined as an enlargement of the tongue in the resting position, protruding beyond the teeth. Many cases have been reported secondary to patient positioning while under anesthesia, post oro-pharyngeal packing, trauma or surgery, and allergic or non-allergic angioedema. However, acute macroglossia in the ICU is a rare situation. In COVID-19 related severe ARDS, endotracheal intubation and prolonged proning is an important part of management of hypoxemic respiratory failure Prone positioning also has the potential to independently cause macroglossia. Awareness of this complication of proning could help mitigate morbidity in patients. Case report: A 53-year-old diabetic, hypertensive overweight female with OSA presented with progressive shortness of breath and productive cough. She was mechanically ventilated in ICU in view of respiratory distress secondary to COVID-19 pneumonia. Intubation was minimally traumatic with minimal oral bleeding settling over few minutes. Though managed with medications as per COVID-19 management protocol, she progressed to severe ARDS hence proned on hospital day 1 for 16 hours - PaO2/FiO2 ratio improved. She was not proned further. Acute macroglossia (3 inches outside the oral cavity) with lower facial edema was noted 4 days post proning. Saline moistened gauze was loosely wrapped around the tongue every hour. Circumferential ecchymosis was noticed around her neck on the 6th day. On day 8, macroglossia did not show signs of resolution. Hence, the tongue was pushed in manually every 2 hourly and the position was maintained manually for 10 minutes. The swelling decreased gradually with the tongue staying in a retracted position on treatment day 2. On day 3, there was a complete resolution of the swelling. However, she had persistent swallowing difficulty causing difficulty in weaning from tracheostomy. MRI of neck and chest showed large pre-vertebral collection from the upper border of C2 inferiorly across the thoracic inlet to the posterior mediastinum with thin linear extension up to the lower border of T4. Mass effect with airway compression, displacement, and compression of esophagus and neck vessels was seen. Trans-oral exploration revealed mucosal rent and bulge in the posterior pharyngeal wall. The hematoma was evacuated by ENT specialists. She was discharged on tracheostomy and feeding tube. Tracheostomy decannulation was done after 1 month. Discussion: In our practice of proning patients with ARDS for >10 years, this is the first case of macroglossia as a complication of proning that we encountered. Other factors that could have contributed to this patient are obesity and mildly traumatic intubation. Development of macroglossia 4 days after proning and resolution over a short period of time is rare and suggests lymphatic and vascular compression as the cause. Later development of ecchymosis and dysphagia may be due to the posterior pharyngeal injury. Conclusion: Proning, especially in obese patients, can be a challenge. Positioning of the face and avoidance of injury to any of the structures is vital to the care of the proned patient. Medical staff involved in patient care should be aware and vigilant to pick up this condition early to avoid further injury.

8.
Journal of General Internal Medicine ; 37:S529-S530, 2022.
Article in English | EMBASE | ID: covidwho-1995833

ABSTRACT

CASE: A 75-year-old man with a history of aortic stenosis status post transcatheter aortic valve replacement (TAVR), compensated cirrhosis in the setting of alcohol use disorder, and osteoarthritis presented with hyper-acute dyspnea and chest pain that awoke him from sleep. Three years prior to admission, an abdominal computed tomography (CT) for his TAVR evaluation revealed a 2 cm, irregular, peripherally-enhancing mass in the right subphrenic space, most concerning for malignancy but stable in size a year later. Further work-up was delayed due to the COVID-19 pandemic. One week prior to this presentation, he returned to care with 6 months of progressive right shoulder pain, pleuritic chest pain, and 5 kg of unintentional weight loss and was found to have growth of the right subphrenic mass to 4.9 cm, for which he underwent interventional radiology-guided aspiration and biopsy from a subxiphoid approach. Pathology on the core biopsy was inconclusive, revealing granulation tissue with chronic inflammatory changes and negative routine cultures. He was hemodynamically stable and discharged home. On admission, he was afebrile, tachypneic to 26, tachycardic to 120, hypotensive to 80/40, and saturating 94% on room air. He was found to have a large pericardial effusion with tamponade physiology, upon which 500 mL of serous fluid was drained via emergent pericardiocentesis. Laparoscopic biopsy of the subphrenic mass revealed a purulent fluid collection. 16S/18S sequencing and MALDI cultures were most consistent with Actinomyces spp. With further history-taking alongside an Italian language interpreter, he was found to have had prior dental abscesses, the likely origin of his Actinomyces infection, although the curious propensity for the subphrenic location remains unknown. Periodontal disease had been diagnosed but not fully treated given lack of insurance coverage and perceived importance. His pericarditis and ensuing tamponade was attributed to irritation and seeding from the subxiphoid approach for attempted fluid aspiration. IMPACT/DISCUSSION: Actinomyces spp. are a part of the normal human gut and oral cavity flora, but when pathogenic, they are often associated with dental, pulmonary, and urinary tract infections. In addition to periodontal disease, this patient's risk factors for Actinomyces abscess formation include cirrhosis (via transient gut translocation from elevated portal pressures) and alcohol use disorder (via increased aspiration risk). There have been several reports of Actinomyces spp. causing pericarditis and tamponade following seeding from liver, lung, and oral cavity abscesses- to our knowledge, however, none from subphrenic abscesses. CONCLUSION: This case highlights the importance of an oral health history in work-up of an indolent growing thoracic mass and the challenges in comprehensive history-taking in patients with limited English proficiency. Increasing coverage of dental services (e.g. a Medicare dental benefit) is key to health and health equity.

9.
Journal of General Internal Medicine ; 37:S362, 2022.
Article in English | EMBASE | ID: covidwho-1995661

ABSTRACT

CASE: Our patient is a 52-year-old female with a history of gastroesophageal reflux and hypertension. 36 hours after receiving the second Pfizer COVID-19 vaccine, she developed lip and tongue swelling, mucosal ulcerations, and respiratory distress. There was no conjunctivitis or genital involvement. She denied taking any new medications, supplements, or food that might have led to the reactions. She initially presented to an outside hospital and required intubation prior to transfer to our facility. A bedside esophagogastroduodenoscopy (EGD) was performed noting extensive Grade D erosive esophagitis and gastric ulcerations with friability. When the endoscope was removed a 34cm section of necrotic esophageal tissue was removed from the airway. Despite intravenous steroid treatment, she continued to have esophageal scarring and was unable to tolerate food by mouth. Therefore, a gastrostomy tube was placed. Since that time, she has required several recurrent EGDs for esophageal dilation due to scarring. It has now been six months from her initial injury, and unfortunately, the patient is still unable to take PO and is dependent on tube feedings. IMPACT/DISCUSSION: The coronavirus pandemic began in December 2019. At the time of this report, SARS-CoV-2 infection has been the cause of 5.48 million deaths worldwide and 836,000 deaths in the United States alone. In addition, this global pandemic has had severe economic and social implications. There are currently three vaccines authorized by the United States Food and Drug Administration for emergency use. I report an extremely uncommon complication of the Pfizer COVID-19 vaccine: a case of Eryethema Multiforme Major that occurred after the second dose vaccine without exposure to any other drug. Eryethema Multiforme is divided into major and minor forms and is regarded as distinct from Stevens- Johnson syndrome and toxic epidermal necrolysis. It is related to infections, usually Herpes Simplex Virus, or less commonly, to medications. In Erythema Multiforme, mucous membrane involvement is absent or mild. Erythema Multiforme Major is an immune mediated skin reaction involving the oral cavity and mucosa that is serious and occasionally life threatening. There have been several reported cases of Erythema Multiforme following COVID-19 vaccination but only one other cases of Erythema Multiforme Major associated with the mRnA-1273 SARS-CoV-2 vaccine (Moderna.) CONCLUSION: This case highlights an extremely rare vaccine consequence. The benefits still greatly outweigh the risks of vaccination, and this case does not diminish the importance of COVID-19 vaccination to effectively control this pandemic.

10.
Journal of Clinical Periodontology ; 49:348, 2022.
Article in English | EMBASE | ID: covidwho-1956767

ABSTRACT

Background: Recent scientific evidence states that a subset of COVID-19 patients have a risk of increased bleeding tendency. This case report presents a 38-year-old woman with periodontitis, generalized stage III, grade C with an abnormal post-operative blood clot formation, who tested positive for COVID-19 5 days after a standard periodontal surgery. nature.com/articles/s41598-020-80010-z. Description of the procedure: After initial periodontal treatment and re-evaluation, we proceeded to the surgical phase including: 1. regenerative procedure with EMD 15 2. regenerative procedure with EMD 44 3. open flap debridement 13-23 4. shortened flap 34-37. Outcomes: Periodontal surgical procedures (1) and (2) proceeded without any complications and were considered standard. On day 1 after the third periodontal surgery (3), the patient was called for post-operative control. The patient had no complaints.On day 2 post-operative, the patient reported by email excess of bleeding in the oral cavity from the operated area, simultaneously with fever and loss of taste. A photo taken by the patient confirmed the abnormal blood clot. On day 3, in compliance with COVID-19 protocols, the patient was seen urgently in our clinic while her COVID-19 symptoms had started to decline. During the appointment, the bleeding tendency was less acute than the day before. Further suturing for precaution was decided. The same day the patient received a COVID-19 PCR test. On day 4 post-operative, the report of the PCR test was confirmatory for COVID-19 and the patient reported no further complaints of intraoral bleeding. Conclusions: After considering the normal response of the initial treatment and the well documented good post-operative healing pattern of the periodontal tissues for this patient, we concluded that the abnormal bleeding tendency was associated with an active phase of COVID-19. Clinicians should be aware that during the first days after a periodontal surgery patients could have bleeding complications due to an active phase of COVID-19. labblog.uofmhealth.org/lab-report/ subset-of-covid-19-patients-have-increased-bleeding-risk.

11.
Journal of Clinical Periodontology ; 49:225, 2022.
Article in English | EMBASE | ID: covidwho-1956765

ABSTRACT

Background and Aim: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV- 2). Recently, some reports indicate that the severity of COVID-19 is associated with periodontal disease. SARS-CoV-2 host cell entry is mediated by viral spike protein binding to the host angiotensinconverting enzyme 2 (ACE2) and its cleavage by transmembrane protease serine 2 (TMPRSS2). ACE2 and TMPRSS2 are expressed in the oral cavity including periodontal pocket epithelium, tongue and saliva glands. Therefore, we hypothesized that inhibiting these two factors may prevent SARS-CoV-2 infections. This study aimed to investigate the inhibitory effects of general ingredients in commercially available toothpaste and mouthwash on SARS-CoV-2 infection. Methods: We evaluated the effects of 30 toothpaste and mouthwash ingredients on the SARS-CoV-2 spike protein-ACE2 interaction and TMPRSS2 protease activity using enzyme-linked immunosorbent assay and an in vitro enzyme activity assay, respectively. We also investigated whether the ingredients were in the presence of saliva. In addition, the binding state of each ingredient to the inhibitor-binding site of ACE2 or TMPRSS2 was evaluated by molecular docking simulation to understand the mechanisms involved. Results: Sodium tetradecene sulfonate, sodium N-lauroyl-N-methyltaurate, sodium N-lauroylsarcosinate, sodium dodecyl sulfate, and copper gluconate inhibited both spike protein-ACE2 interaction and TMPRSS2 activity. Furthermore, these ingredients also showed inhibitory effects on both spike protein-ACE2 interaction and TMPRRS2 activity in the presence of saliva. Molecular docking simulations suggested that these ingredients could bind to the inhibitor-binding site of ACE2. Conclusions: Our findings suggest that five ingredients in commercial toothpaste and mouthwash could inhibit the entry points of SARSCoV- 2 and could help to prevent SARS-CoV-2 infection.

12.
Journal of Clinical Periodontology ; 49:84, 2022.
Article in English | EMBASE | ID: covidwho-1956753

ABSTRACT

The aim is to determine oral manifestations in patients with COVID-19 disease and in the postcovid period. Methods: A special survey (questionnaire) was made in 424 people who had COVID-19 confirmed by RT-PCR, ELISA for specific IgM and IgG antibodies and Chest CT scan (168 people). 123 people had complaints and clinical symptoms in the oral cavity 2-6 months after the illness and they came to the University dental clinic. Laboratory tests have been performed (clinical blood test, blood immunogram, virus and fungal identification). Results: Survey results showed that 16,0% participants had asymptomatic COVID-19, 23,6% - mild and 48,1% moderate disease. 12,3% with severe COVID-19 were treated in a hospital with oxygen support. In the first 2 weeks 44,3% indicated xerostomia, dysgeusia (21,7%), muscle pain during chewing (11,3%), pain during swallowing (30,2%), burning and painful tongue (1,9%), tongue swelling (30,2%), catharal stomatitis (16,0%), gingival bleeding (22,6%), painful ulcers (aphthae) (8,5%) and signs of candidiasis - white plaque in the tongue (12,3%). After illness (3-6 months), patients indicated dry mouth (12,3%), progressing of gingivitis (20,7%) and periodontitis (11,3%). In patients who applied to the clinic we identified such diagnoses: desquamative glossitis - 16 cases, glossodynia (11), herpes labialis and recurrent herpetic gingivostomatitis (27), hairy leukoplakia (1), recurrent aphthous stomatitis (22), aphthosis Sutton (4), necrotising ulcerative gingivitis (13), oral candidiasis (14), erythema multiforme (8), Stevens-Johnson syndrome (2), oral squamous cell papillomas on the gingiva (4) and the lower lip (1). According to laboratory studies, virus reactivation (HSV, VZV, EBV, CMV, Papilloma viruces) was noted in 52 patients (42,3%), immunodeficiency in 96 people (78,0%), immunoregulation disorders (allergic and autoimmune reactions) in 24 people (19,5%). Conclusions: Lack of oral hygiene, hyposalivation, vascular compromise, stress, immunodeficiency and reactivation of persistent viral and fungal infections in patients with COVID-19 disease are risk factors for progression of periodontal and oral mucosal diseases.

13.
Supportive Care in Cancer ; 30:S105-S106, 2022.
Article in English | EMBASE | ID: covidwho-1935789

ABSTRACT

Introduction Osteoradionecrosis (ORN) is a side effect after head and neck radiotherapy (RT) that is difficult to control. Antimicrobial photodynamic therapy (aPDT) promotes bacterial lysis through photosensitization, aiming at stimulating the affected area, promoting healing of the oral mucosa. Methods We performed a retrospective cohort analysis of patients with head and neck cancer, treated with RT, who developed ORN after RT and who underwent the treatment with aPDT concomitant with irrigation with 0.12% chlorhexidine digluconate and surgical debridement. Results Thirty-six patients who had lesions by ORN in the mandible or maxilla, with a mean development time of 30.9 months, were included. Of them, 77.8% were male, with a median age of 58 years. All of them were diagnosed with malignant neoplasms of oral cavity and oropharyx that received local RT as part of cancer treatment. In 22 patients, chemotherapy was used as part of the treatment. The main etiologie of ORN was prosthetic trauma (61.2%). All patients underwent the proposed protocol and 75% of patients were successful in treatment with total healing of the affected area and presented with no symptoms. Conclusions The protocol used suggests successful healing of the area in 75% of cases. The others suffered some complication of the ORN, such as pathological fracture, oro-cutaneous fistula and bucosinusal fistula and 16.6% patients treatment were affected by the COVID-19 pandemic and had the continuity of treatment impaired, still maintaining, a chronic ORN.

14.
Handb. Exp. Pharmacol. ; 275:V-X, 2022.
Article in English | EMBASE | ID: covidwho-1929369
15.
Revista Estomatologica Herediana ; 32(2):203-204, 2022.
Article in Spanish | EMBASE | ID: covidwho-1928975
16.
Journal, Indian Academy of Clinical Medicine ; 23(1-2):77-78, 2022.
Article in English | EMBASE | ID: covidwho-1913158

ABSTRACT

Insertion of nasogastric tube is one of the commonest clinical procedures. However, very rarely, the tube can coil on itself to form something called a Lariat loop. This is a knot that can cause the tube to get stuck inside the pharynx and can precipitate emergencies like laryngeal obstruction or esophageal rupture. A brief discussion of a case along with the causes and prevention of this complication has been done.

17.
New Armenian Medical Journal ; 16(1):43-48, 2022.
Article in English | EMBASE | ID: covidwho-1866096

ABSTRACT

Today, it has been proven that saliva is the main medium through which the new COVID-19 coronavirus infection spreads. Since the oral cavity is the gateway for the SARS-CoV-2 virus, the degree of change in the physicochemical parameters of the saliva of people who have had coronavirus infection compared to people who have not had COVID-19 is of interest. This study involved dental patients of the first and second health groups with a history of chronic generalized periodontitis of moderate degree in the stage of remission. We studied physicochemical parameters of saliva such as pH, surface tension and base buffering capacity. The results of this stage of the study showed saliva acidification, that is a decrease in pH in people who had had a new coronavirus infection compared to the indicators of people from the control group. The average values of the surface tension of saliva in patients of the control group are 30% less than in those who have had COVID-19. This indicates that the saliva of people who have not been sick with the new coronavirus contains more surface-active agents (surfactants). Surfactants provide rinsing and disinfecting functions of saliva, therefore, it can be concluded that these functions are less pronounced in patients who have recovered from COVID-19. The base buffering capacity of the saliva of patients who have had COVID-19 is, on average, 35% higher than that of people from the control group. Thus, the pH and the base buffering capacity are in correlation: the lower the pH value, the higher the acidity of the saliva and the higher the base buffering capacity is. At the second stage of the study, similar physicochemical parameters of patients’ saliva were measured after the application of an oral spray containing a synthetic peptide (ZP2) of the active center of granulo-cyte-macrophage colony-stimulating factor. This spray was used as an antibacterial therapy for the oral cavity after professional hygiene of patients. In 5 minutes after spray irrigation, an increase in saliva pH was observed in all test subjects within the physiological norm. In patients, regardless of their anamnesis, the surface tension of saliva changed in different ways. In a number of people, it increased, which indicates an increase in the concentration of surfactants in saliva, while in others it decreased, which can be explained by the high rate of penetration of surfactants from saliva through the gums into the blood. After the application of the ZP-2 peptide, the base buffering capacity of saliva decreases or remains unchanged. In patients of the control group, the indicators of the base buffering capacity of saliva change less than in patients who have undergone COVID-19. All the studied physicochemical parameters of saliva in patients who had had uncomplicated COVID-19, three months after receiving two negative results for the SARS-CoV-2 virus, remained within the physiological norm.

18.
Przeglad Dermatologiczny ; 108(5):443-444, 2021.
Article in English | EMBASE | ID: covidwho-1766848

ABSTRACT

Lymphangiomas (LG) are uncommon, rare congenital anomalies or acquired lymphatic dilations of a benign flow that can involve the skin [1, 2]. There are main groups of lymphangiomas: 1) a superficial variant, characterized by grouped vesicles (circumscriptum lymphangioma), 2) a deeper variant in the form of a cavernous lymphangioma. The prevalence of LG may be focal or diffuse. Secondary acquired LG with a rarer frequency are known [3, 4]. LG can be one of the manifestations of a symptom complex, for example, Gorham-Stout syndrome, which is characterized by progressive osteolysis [5]. The rare occurrence of LG, clinical diversity, undulating course of congenital forms, the possibility of an acquired nature of the disease causes a high risk of diagnostic errors in establishing the final diagnosis. At the Department of Dermatovenereology, Cosmetology and Additional Professional Education of Smolensk State Medical University for the period from 2018 to 2021, 5 patients (age from 5 to 17 years) with LG were observed. Of these: in four children, the disease existed from birth, in one girl it had an acquired character and developed after covid infection [4]. Gender characteristics: 4 girls (5, 6, 12 and 17 years old) and 1 boy (9 years old). All patients are urban residents. The time to establish the final diagnosis from the moment of seeking medical help ranged from 15 months to 12 (!) years, the average value being 6.5 years. The range of diagnoses of LG 'masks': herpetic infection, molluscum contagiosum, atopic dermatitis, contact dermatitis, epidermolysis bullosa. A frequent change in diagnoses was established in the same patient. Clinical case 1. The boy is 12 years old. The debut of skin lesions from birth and progression to 3 years of age, then spontaneous regression within 4 years (without signs of dermatosis). From 7 years to the present, there has been an increase in the number of rashes. Localization: the skin of the lateral surface of the trunk. Features of the rash: flesh-colored and/or reddish- purple bubbles. A pathognomonic symptom of 'frog calves' is found. The frequent autodestructive effect on the rash provokes its subsequent progression. Family history: his father is a liquidator of the atomic catastrophe in Chernobyl. Previous diagnoses: molluscum contagiosum, herpes zoster. Clinical case 2. The girl is 17 years old. The debut of the disease from birth. Lack of progression up to 5 years of age (up to 5 years of age did not apply to dermatologists). At the age of 5, she began to engage in rhythmic gymnastics (she continues to practice professionally at the present time) and noted an active increase in the number and size of the elements of the rash. She repeatedly consulted dermatologists: diagnoses of molluscum contagiosum (laser removal), herpetic infection (courses of antiherpetic therapy without effect) were assumed. The diagnosis was established 12 years after the moment of seeking medical help. Unilateral location of the rash along the inner surface of the right upper limb with transition to the axillary region;on the right lateral surface of the body, the right inguinal-femoral fold and the inner surface of the right thigh. Focuses of a rash in the form of different sizes of vesicular elements with a tendency to lymphorrhea and oozing, areas of maceration around. Single elements with a hemorrhagic component. The patient notes an increase in the inflammatory response and vesicle lymphorrhea after each workout. Dermatoscopy: yellow-pink lacunae alternating with single dark red lacunae. Histological examination: multiple dilated lymphatic vessels in the papillary and reticular dermis. Clinical case 3. Girl 6 years old. Sick from birth. The diagnosis of LG of the genitals was established at the age of 1, 5 years. Due to the localization of the rash in the external genital area, the girl's parents (at the age of 1 month) consulted an obstetrician-gynecologist, who suggested a hemangioma and referred to a dermatologist. The disease is of a family nature her grandmother (on the maternal side) and her lder brother have similar rashes on the skin of the trunk and in the mouth. The diagnosis was verified by histological examination. The pathological process is localized in the area of the labia majora and labia minora: multiple vesicular rashes with translucent contents, easily traumatized and accompanied by itching, were found. Conclusions: LG is a multidisciplinary problem, which is caused by mimicry of manifestations, varied localization and prevalence of the rash. To verify the diagnosis, the following algorithm should be followed: 1) the debut more often at birth or in the first months of life (with the exception of acquired forms of LG);2) the nature of evolution: a stable state or slow progression in the absence of traumatic factors;3) clinical features: the formation of grouped deep vesicles that resemble 'frog eggs'. The color of the bubbles is transparent or red-purple due to the hemorrhagic component. LG lesions may have hemangioma components. It should be remembered about the frequent localization of LG on the mucous membrane of the cheeks, tongue and floor of the oral cavity, which can manifest itself as bleeding from the elements of the rash when chewing or when providing dental care;4) biopsy reveals dilated lymphatic vessels in the upper layers of the dermis.

19.
Journal of Investigative Medicine ; 70(2):592-593, 2022.
Article in English | EMBASE | ID: covidwho-1706399

ABSTRACT

Case Report A previously healthy 13 year-old female presented with painful, oral mucosal bullae filled with sanguinous fluid. She was initially (mis)diagnosed with angina bullosa haemorrhagica (ABH) and was provided symptomatic treatment. After a CBC demonstrated severe thrombocytopenia, anemia, and leukopenia, the patient was admitted for further workup including Coombs and COVID-19 PCR, which were both positive. Given a remote family history of Lupus and increasing right knee pain, further diagnostic testing was ordered. These results demonstrated a positive ANA, anti-Smith, anti-chromatin, anti-RNP, increased dsDNA and increased SM/RMP, confirming Lupus as the etiology of this patient's presentation. A form of Blistering Systemic Lupus Erythematosus (BSLE) was likely responsible for the patient's oral manifestations. The patient was discharged on Prednisone 30 mg twice per day after receiving 60 g IVIG and 3 days of high dose pulse corticosteroids. Discussion This outlines the case of a thirteen yearold girl with SLE with an initial presentation of blood-filled oral mucosal lesions. The patient's COVID-19 positive status, young age, and atypical presentation added to the intricacy of her case. After presenting with blood-filled bullae in the oral cavity, the patient was initially suspected of having Angina Bullosa Haemorrhagica (ABH). ABH is a rare condition that presents with painful or painless blood-filled oral vesicles or bullae that rupture spontaneously and heal without scarring. The patient's abnormal CBC ruled out ABH and suggested a diagnosis of Evan's syndrome, a disorder in which cytopenias are present in two or more cell lines. Before SLE was determined to be the cause of the patient's cytopenias, the etiology of her Evan's syndrome was attributed to her COVID-19 positive status. Rarely, Lupus has been reported to present with vesicles and bullae in a syndrome known as BSLE. Upon an extensive review of the literature, only four articles mentioned oral bullae in a pediatric patient with SLE and not a single article mentioned hemorrhagic bullae in pediatric SLE patients. Conclusion A deeper understanding of the variety of cutaneous manifestations of SLE is essential for disease diagnosis and management. The present study details the first ever reported case of SLE presenting with blood-filled oral bullae in a pediatric patient. Novel presentations of SLE such as this reinforce the need for a collaborative, inter-specialty approach to diagnosis and treatment of autoimmune disease. This case reinforces the utility of a centralized database for recording unique autoimmune manifestations in order to aid in physicians' diagnosis and expediency of treatment. Lastly, this case should support an increase in a clinician's degree of suspicion for underlying autoimmune disease when dealing with unique cutaneous presentations of autoimmune diseases like SLE.

20.
New Armenian Medical Journal ; 15(4):4-10, 2021.
Article in English | EMBASE | ID: covidwho-1647601

ABSTRACT

Subject. Currently, the impact of coronavirus on the microbiomes of the mouth, lungs and intestines is not well understood. However, research has been done to alter the intestinal micro-biota of pigs infected with the epidemic swine flu virus. The aim of the study is to identify the relationship between the influence of Co-infection of the oral cavity on the course of SARS-COV2. Material and Methods. Totally 201 patients aged 20 to 87 years, with a confirmed diagnosis on admission International classification of diseases (ICD-X: J18.9: coronavirus infection) took part in a clinical study at the Covid Hospital of the Bashkir State Medical University Clinic, Ufa (for 150 beds). The patients were divided into 2 groups: with the appearance of co-infection and with the disappearance of co-infection. Results. The results of this study show that patients with co-infection had a severe course of the disease, more often it was necessary to transfer to non-invasive ventilation;the duration of hospitalization increased;required longer treatment and long-term rehabilitation, aimed at normalizing indicators and normalizing microflora. From this, it can be assumed that if there is an infection in the oral cavity, then the severity of the condition and the course of SARS-CoV-2. This means that the risk of co-infection, secondary infection should be taken into account. Conclusions. In conclusion, it should be noted that the state of the immune system un-doubtedly affects the degree of risk of SARS-CoV-2 disease, as well as the severity of the course of this disease.

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