Assessing peptic ulcer risk with the HAMPROW score in the general Chinese population.

The timely identification of individuals at high risk for peptic ulcers (PUs) is vital in preventing gastrointestinal bleeding after antiplatelet therapy. This study was designed to determine PU risk factors and develop a risk assessment model for PU detection in the general Chinese population. In a prospective dataset, clinical data from individuals undergoing gastroscopic evaluation between April 2019 and May 2022 were recorded. PUs were defined as mucosal defects exceeding 5 mm confirmed via gastroscopy. Participants were categorized into development (April 2019 to April 2021) and validation (May 2021 to May 2022) sets based on chronological order. LASSO-derived logistic regression analysis was employed to create a score, which was further validated via temporal validation. A total of 902 patients were ultimately enrolled, 204 (22.6%) of whom had PUs based on endoscopic findings. In the development cohort (n = 631), seven independent risk factors emerged: male sex (OR = 2.35, P = 0.002), white blood cell (WBC) count (OR = 1.16, P = 0.010), red blood cell (RBC) count (OR = 0.49, P < 0.001), globulin level (OR = 0.92, P = 0.004), albumin level (OR = 0.94, P = 0.020), pepsinogen I (PGI) level (OR = 1.01, P < 0.001), and positive Helicobacter pylori (HP) antibody (OR = 2.50, P < 0.001). Using these factors, a nomogram (HAMPROW score [hazard ratio (HP) antibody, albumin, male, PGI, RBC, globulin, and WBC]) was developed for individual PU prediction. The ability of the HAMPROW score to predict survival was confirmed with AUCs of 0.854 (95% CI 0.816-0.891) and 0.833 (95% CI 0.771-0.895) in the development and validation sets, respectively. In conclusion, the HAMPROW score can be used to screen for PUs effectively in the general Chinese population, facilitating personalized early detection of high risk of gastrointestinal bleeding before antiplatelet therapy.

Non-surgical treatment of mild to moderate peri-implantitis with an oscillating chitosan brush or a titanium curette-12-month follow-up of a multicenter randomized clinical trial.

OBJECTIVES: To study clinical and radiographic outcomes after non-surgical treatment of peri-implantitis using either an oscillating chitosan brush (OCB) or titanium curette (TC) and to observe changes in clinical signs of inflammation after repeated treatment. METHODS: Thirty-nine patients with dental implants (n = 39) presented with radiographic bone level (RBL) of 2-4 mm, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly assigned to mechanical debridement with OCB (test) or TC (control). Treatment was performed at baseline and repeated at 3, 6, and 9 months in cases with > 1 implant site with BI ≥ 1 and PPD≥4 mm. Blinded examiners recorded PPD, BI, pus, and plaque. The radiographic bone level change between baseline and 12 months was calculated. A multistate model was used to calculate transitions of BI. RESULTS: Thirty-one patients completed the study. Both groups exhibited a significant reduction in PPD, BI, and pus at 12 months compared to baseline. Radiographic analysis showed stable mean RBL in both groups at 12 months. There was no statistically significant difference in any of the parameters between the groups. CONCLUSIONS: Within the limitations of this 12-month multicenter randomized clinical trial, non-surgical treatment of peri-implantitis with OCB or TC showed no statistically significant differences between the groups. Clinical improvements and, in some cases, disease resolution, was observed in both groups. However, persistent inflammation was a common finding which further puts emphasis on the need for further treatment.

Case report: Purulent transformation of granulocytic sarcoma: An unusual pattern of differentiation in acute promyelocytic leukemia.

RATIONALE: Acute promyelocytic leukemia (APL) is a curable subtype of acute myeloid leukemia. APL is currently treated with combination of all-trans retinoic acid (ATRA) and arsenic trioxide (ATO) resulting in the induction of apoptosis and differentiation of the leukemic cells. Differentiation syndrome (so-called ATRA syndrome) is the main life-threatening complication of induction therapy with these differentiating agents. PATIENT CONCERNS: Herein, we report the case of a 49-year-old woman diagnosed with APL with, concomitantly, a bulky cutaneous lesion of 10 cm diameter with a red-to-purple background and a necrotic center, localized on her abdomen. DIAGNOSES: After 10 days of treatment, the cutaneous lesion became purulent. Fluorescence in situ hybridization (FISH) analysis performed on this pus confirmed the presence of malignant features in the involved granulocytes proving their origin from the differentiation of leukemic APL cells, as all the analyzed nuclei showed 2 promyelocytic leukemia (PML)-retinoic acid receptor-a (RARA) fusions signals. INTERVENTION: The association by ATRA and ATO was continued. OUTCOME: Eventually, the evolution was favorable with healing in three weeks. LESSONS: This case report therefore highlights the differentiation phenomenon of promyelocytic blasts within promyelocytic sarcoma with the ATRA-ATO combination and the efficacy of this drug association in resolving both the malignant sarcoma and a secondary local infection.

Osteonecrosis de los maxilares asociada a denosumab en una paciente con osteoporosis: un caso clínico / Osteonecrosis of the jaw associated with denosumab in a patient with osteoporisis

Desde la comercialización de fármacos que actúan sobre el remodelado óseo se han registrado numerosos casos de osteonecrosis de los maxilares (ONM), pero hasta hace poco solo se habían descrito casos de ONM asociados a la administración de bifosfonatos. Con la introducción de nuevos agentes antirresortivos han aparecido varios casos de ONM asociados a denosumab. Presentamos el caso de una paciente de 84 años con osteoporosis, que presentó osteonecrosis mandibular tras la colocación de 6 implantes 5 meses después de la administración de denosumab. Una ortopantomografía y una TC mostraron pérdida ósea de la cresta mandibular y exposición ósea periimplantar. Tras el tratamiento conservador con antibióticos y la suspensión de denosumab, se inició el tratamiento con teriparatida reduciéndose la infección del hueso necrótico y se observó nueva remodelación ósea. La patogénesis de la ONM por denosumab no está claramente definida, pero parece que la tasa del éxito de curación es superior a la ONM por bifosfonatos (AU)

Since the introduction of drugs acting on bone remodeling, numerous cases of drug-induced osteonecrosis of the jaw (ONJ) have been reported. Until recently these cases were exclusively associated with the administration of bisphosphonates. With the introduction of new antiresorptive agents such as denosumab, several cases of ONJ associated with its treatment have been recently reported. The case is presented of an 84 year-old osteoporotic female patient who developed mandibular osteochemonecrosis after the placement of 6 implants five months after the administration of denosumab. A panoramic radiograph and CT, showed mandibular crestal bone loss and peri-implant exposure. Conservative treatment with antibiotics and discontinuing denosumab, and starting treatment with teriparatide, decreased the necrotic bone infection and new bone remodeling could be observed. The pathogenesis of denosumab-induced ONJ is not clearly defined, but it seems that the success rate in healing after drug discontinuation is higher than in bisphosphonates-induced ONJ (AU)

Predictors of excess cement and tissue response to fixed implant-supported dentures after cementation.

BACKGROUND: The cementation of fixed implant-supported restorations involves the risk of excess cement remaining in the peri-implant tissue that may cause a peri-implant tissue response with attachment loss. PURPOSE: The aim was to study the peri-implant tissue response after cementation and to detect potential predictors of excess cement. MATERIAL AND METHODS: Clinical complications after cementation in several index cases led to a recall of all patients treated with a special methacrylate cement (one hundred five patients with one hundred eighty-eight implants) and systematic reevaluation of 71 patients (68%) with one hundred twenty-six implants (67%). In all cases, suprastructures including abutments were removed, and findings were documented. RESULTS: Implant diameter was significantly associated with the frequency of excess cement. Implant location or system had no significant effect. Excess cement in turn was associated with bleeding on probing, suppuration, and peri-implant attachment loss. In the absence of excess cement 58.8% of implants had no peri-implant attachment loss versus 37.3% when excess cement was present. With increasing retention time of the methacrylate cement, more peri-implant attachment loss was detected. However, the latter association was not significant. CONCLUSION: Larger diameters are significantly associated with excess cement in peri-implant tissue. Consequences of excess cement may be increased bleeding on probing, suppuration, and possibly peri-implant attachment loss.

Pseudohypopyon after Management of Posterior Capsule Rupture Using Intracameral Triamcinolone Injection in Cataract Surgery

No abstract available.

Pyopneumothorax following suicidal kerosene ingestion.

Liquid hydrocarbons derived from petroleum are widely used in household and industry. Many hydrocarbons in kerosene, such as hexane, naphthalene, octane and phenanthrene, are toxic to humans. Pulmonary toxicity is the major cause of morbidity and mortality followed by central nervous-system and cardiovascular complications. As kerosene is a mixture of chemicals, there is no definitive absorption, distribution, metabolism and excretion. The major route of exposure is by inhalation of liquid (aspiration). Kerosene vapours may be mildly irritating to the respiratory system and spray applications of kerosene may provoke signs of pulmonary irritation such as coughing and dyspnoea. Kerosene aspiration leads to inflammation and loss of surfactant. Secondary effects in the lungs include pneumothorax, pneumatocele or bronchopleural fistula. Here, we are presenting a case of pyopneumothorax after kerosene consumption.

The rate of adverse events following BCG vaccination in Poland.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the capacity of the surveillance system to respond to the schedule changes in the view of TB vaccination uptake. Complications of Bacillus Calmette-Guerin (BCG) vaccination in Poland are as elsewhere uncommon. In Poland, BCG vaccination with a vaccine produced with Mycobacterium bovis BCG Moreau has been a part of the National Immunization Program since 1955. In the beginning the immunization schedule involved several BCG revaccinations in children and youths, with the first dose given to neonates up to 1 month old followed by revaccinations at 2, 4, 7, 12, 15, and 18 years of life. In 90s, the number of BCG doses was reduced and since 2006, according to recommendations made by the WHO, a single BCG dose is given to neonates only. METHODS: In the study we have analyzed data on adverse events following BCG vaccination registered within a period of 1994-2010, with attention to the periods before and after 2006, when different BCG vaccination schedules were used for immunization. RESULTS: The frequency of adverse events following BCG vaccination in Poland oscillated within 1994-2000 and 2001-2010 periods around 0.2 per thousand and 0.6 per thousand respectively, and in half consisted of local lesions at the injection sites and in half--appeared in the form of the regional lymphadenopathy. The analysis of surveillance data revealed similar rates of adverse events following BCG vaccination in the periods of different BCG vaccination schedules, eg. before and after 2006. CONCLUSIONS: Improvements in the data collecting manner from passive to active one and the introduction of the routine laboratory confirmation of the infection might evaluate the real prevalence of Mycobacterium bovis BCG infections and improve the treatment of adverse events following BCG vaccination cases.

Safety of intradermal Bacillus Calmette-Guerin vaccine for neonates in Eastern Saudi Arabia.

OBJECTIVE: To evaluate the safety of Bacillus Calmette-Guerin (BCG) in Saudi infants and outline our management for BCG related lymphadenitis. METHODS: The records of infants who developed BCG related complications were retrospectively reviewed from March 2008 to March 2011 at the Maternity and Children Hospital, Dammam, Saudi Arabia for age, gender, birth weight, presentation, and outcome. All our patients were immunized with the BCG vaccine within 48 hours after birth, and the total number of vaccinated newborns was obtained from the vaccination registry. RESULTS: During a 3-year period (March 2008 to March 2011), 26,000 newborns received BCG and 81 (51 males and 30 females) developed complications. This gives an incidence of 3.12 complications/1000 newborns. Their presentations were: left axillary lymphadenitis (n=62), supraclavicular lymphadenitis (n=9), collection at immunization site (n=6), and one each (left cervical lymphadenitis, bilateral axillary lymphadenitis, left arm abscess, left axillary lymphadenitis and collection at immunization site). Two were immunocompromized and 6 with local collection were aspirated. The arm abscess had drainage. Simple lymphadenitis (n=6) were treated expectantly, while those with suppurative lymphadenitis (n=68) had excision (n=65) or incision and drainage (n=3) without anti-tuberculous treatment. CONCLUSION: Bacillus Calmette-Guerin is safe but is associated with a relatively high incidence of suppurative lymphadenitis. Non-suppurative lymphadenitis can be treated conservatively, while suppurative lymphadenitis should be treated with excision. This is safe, avoids rupture, and shortens the recovery period without anti-tuberculous treatment. Although, the use of BCG vaccine may be associated with side effects, the potential morbidity and mortality from tuberculosis outweighs that from BCG related complications.

Dabigatran etexilate.

Dabigatran etexilate is an orally administered prodrug of dabigatran, which is a potent, concentration-dependent inhibitor of thrombus formation and thrombin-induced platelet aggregation. Dabigatran etexilate pharmacokinetics were linear across a wide dosage range. There were no clinically important pharmacokinetic interactions with digoxin (a P-glycoprotein substrate), pantoprazole (a proton-pump inhibitor) or drugs that are substrates and/or inhibitors of hepatic cytochrome P450 enzymes. In two large, randomized, double-blind trials of the prevention of venous thromboembolism (VTE) in patients undergoing total hip or total knee replacement surgery, orally administered dabigatran etexilate 220 mg/day was noninferior to subcutaneous enoxaparin sodium 40 mg/day for the primary composite endpoint of total VTE events or all-cause mortality during the treatment period. There were no significant differences between dabigatran etexilate and enoxaparin sodium in major VTE events and VTE-related mortality. Across trials, < or =0.5% of patients experienced a symptomatic pulmonary embolus or died. Dabigatran etexilate was generally well tolerated. In patients undergoing total hip or total knee replacement surgery, there was no significant difference between dabigatran etexilate and enoxaparin sodium recipients in the incidence of major or minor bleeding.

Left unilateral breast autoinflation and intraprosthetic collection of sterile pus: an unusual operative finding of silicone gel bleed with silicone lymphadenitis.

Implant rupture is a known complication after augmentation mammoplasty. Saline implant failure may present with few diagnosable problems due to the loss of volume. On the other hand, intracapsular silicone gel implant rupture or failure can be silent, asymptomatic, and difficult to diagnose in the absence of loss of breast volume. Silicone leak and migration to regional nodes has been reported but is uncommon and lymph node enlargement can be nonspecific in patients with intact prostheses. Causes, timing, and diagnosis of implant failure sites and mechanisms have been extensively studied and reported in the literature. Implant failure resulting in lymphadenopathy is uncommon. In this article autoinflation of the left breast with regional lymphadenopathy is presented. Upon exploration, the prosthesis was found to be filled with sterile pus, showing an inward movement of a thick creamy material in an otherwise macroscopically intact prosthesis.

Generalized pustular psoriasis and hepatic dysfunction associated with oral terbinafine therapy.

We report a case of 61-yr-old man with stable psoriasis who progressively developed generalized pustular eruption, erythroderma, fever, and hepatic dysfunction following oral terbinafine. Skin biopsy was compatible with pustular psoriasis. After discontinuation of terbinafine and initiating topical corticosteroid and calcipotriol combination with narrow band ultraviolet B therapy, patient's condition slowly improved until complete remission was reached 2 weeks later. The diagnosis of generalized pustular psoriasis (GPP) induced by oral terbinafine was made. To our knowledge, this is the first report of GPP accompanied by hepatic dysfunction associated with oral terbinafine therapy.

Docetaxel-induced onycholysis: the role of subungual hemorrhage and suppuration.

Nail changes are common side effects of taxane chemotherapeutic agents. Docetaxel (Taxotere) is known to cause a great incidence of nail change. Various types of nail changes have previously been reported as a result of treatment with taxanes. We describe 2 cases of severe nail changes induced by docetaxel. The patients had previously been diagnosed with breast cancer and advanced gastric cancer, respectively. During the course of treatment with docetaxel, nail changes became apparent in both patients. Initially, they complained of nail bed purpura. Subungual hematomas with hemopurulent discharge were later observed in several fingers. Drainage of the hemopurulent material occurred spontaneously in our cases, leading to onycholysis. Following drainage, the pain in the nail with subungual hemoprulent material was relieved immediately and spontaneous healing of the patients' nails was noticed after few months. Subungual hemorrhage and suppuration therefore are considered causes of onycholysis and the pain in these patients. Although systemic or topical antibiotics were not used to treat these patients, antibiotics may be also worthwhile to hasten the drainage of the subungual hematomas and suppuration in patients for quick relief of pain.

Generalized Pustular Psoriasis and Hepatic Dysfunction Associated with Oral Terbinafine Therapy

We report a case of 61-yr-old man with stable psoriasis who progressively developed generalized pustular eruption, erythroderma, fever, and hepatic dysfunction following oral terbinafine. Skin biopsy was compatible with pustular psoriasis. After discontinuation of terbinafine and initiating topical corticosteroid and calcipotriol combination with narrow band ultraviolet B therapy, patient's condition slowly improved until complete remission was reached 2 weeks later. The diagnosis of generalized pustular psoriasis (GPP) induced by oral terbinafine was made. To our knowledge, this is the first report of GPP accompanied by hepatic dysfunction associated with oral terbinafine therapy.

Complications associated with the bacille Calmette-Guérin vaccination in Ireland.

INTRODUCTION: BCG vaccination is currently recommended for all newborns in Ireland except where specifically contraindicated. This paper describes a marked increase in the number of referrals of patients with localised complications after vaccination to two Dublin paediatric hospitals. This increase coincided with the introduction of a new strain of BCG vaccine METHODS: A population surveillance study was undertaken to determine the frequency and spectrum of complications associated with the new strain of BCG vaccine introduced in Ireland. Patients were identified though review of the infectious disease service case records and microbiology laboratory culture reports for the two year period from August 2002 to July 2004. Prospectively gathered data were supplemented by retrospective chart review. All infants who had inoculation site abscesses, suppurative adenopathy, or non-suppurative adenopathy with nodes > or =2 cm were included. RESULTS: Fifty eight patients presented a median of 13 weeks post-inoculation: 32 with suppurative adenitis, 17 with inoculation site abscess, three with both inoculation site abscess and suppurative adenitis, and six with non-suppurative adenopathy. The overall complication rate was estimated at 1/931 vaccinees with 1/1543 developing suppurative adenitis. Twenty six infants required surgery. DISCUSSION: This series illustrates the role of hospitals in sentinel surveillance and highlights the importance of having a well functioning and responsive system of adverse event reporting. These events raise a serious question as to the suitability of this vaccine strain for use in a national immunisation programme in a country where the prevalence of tuberculous disease is 10.4/100,000.