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Behcet's disease (BD), first described in 1937, is known to be a complex multisystem disease, characterised by oral and genital aphthous ulcers, pustular vasculitic cutaneous lesions and ocular, gastrointestinal and vascular manifestations [1]. This disease is most commonly encountered in Japan, the Middle East and eastern Mediterranean countries [2]. We describe a patient who developed multiple oral aphthous ulcers after a difficult orotracheal intubation. A 26-year-old woman weighing 49 kg was scheduled for hemicolectomy because of BD with gastrointestinal involvement, which was unresponsive to medical treatment. She had been taking colchicine for 14 years. Pre-operative examination and laboratory workup were within normal limits. One healing aphthous ulcer was the only detectable lesion on the tongue. In the operating room, standard monitoring and anaesthetic induction were performed, but the anaesthetists were faced with an unpredicted difficult intubation. The tracheal tube was successfully inserted on the fourth attempt. A laparoscopic-assisted right hemicolectomy was performed and the trachea was extubated after completion of surgery. The operation and the recovery period were uncomplicated and the patient was sent to the surgical ward. On the first postoperative day, aphthous lesions began to appear on the lips, gums, tongue, oral mucosa, tonsils and larynx (Fig. 5). These lesions caused considerable discomfort to the patient and prevented oral intake. The lesions healed in 7 days with thalidomide and azathioprine therapy. The pathogenesis of BD and complex aphthosis is not completely understood but is probably mediated by some factors including immune dysregulation, inflammatory mediators and infection. Circulating immune complex damage, together with enhanced neutrophil migration, may be involved in the mucocutaneous effects of BD [3]. Trauma may lead to major reactions and cause recurrences of cutaneous or mucosal lesions in these patients [4]. The oral ulcers in BD are typically painful and may last between 1 and 4 weeks. These lesions generally heal without scarring [5]. In the anaesthetic literature, there is only a single case of a patient with BD who developed oral aphthous ulcers after anaesthesia [6]. In these patients it is impossible to rule out the contribution of the immune response following surgical trauma or the unpredictable nature of BD itself in which oral lesions may develop spontaneously. Tracheal intubation was difficult in our patient, and laryngoscopy and intubation attempts inevitably caused tissue trauma, which may have led to the generation of aphthous ulcers. It is important to appreciate that any trauma may cause painful cutaneous or mucosal lesions and these contribute to the postoperative morbidity in patients with Behcet's disease.

The purpose of this study was to determine whether the application of Adlerian life style techniques would provide greater understanding of the psychological factors which shaped the life of Ernest Hemingway. Hemingway's birth order position, the dynamics and atmosphere of his family, and the early recollections of his childhood were studied and analyzed for a consistent theme or belief system. Biographies, critical evaluations of his work and selected published writing were utilized to provide a basis for a life style projection. This projection was then found to correlate with observable incidents in his adult behavior.

Successful treatment of major oral aphthous ulcers in HIV-1 infection after highly active antiretroviral therapy

BackgroundBehçet’s disease (BD) is characterised by recurrent oral and/or genital ulcers accompanied by ocular, cutaneous, articular, gastrointestinal, and/or neurologic manifestations. Oral and/or genital aphthous ulcers are often refractory to conventional...

Behcet's disease (BD) is a multisystem inflammatory disease of unknown etiology characterized by chronic recurrent oral aphthous ulcers, genital ulcerations, skin lesions, and eye involvement. Here, we report a case with severe oral aphthous ulcers and face and neck infection resulting from Behcet's disease (BD) activation. Elevated white blood corpuscles count, C reactive protein, and erythrocyte sedimentation rate were consistent with severe infection and inflammatory response. We provided antibiotic, anti-inflammatory, and supportive treatments, and the condition subsided in 5 days. However, after 3 weeks, oral aphthous ulcers relapsed and ulceration appeared in the patient's genital organ. To our knowledge, this is the first case reporting oral aphthous ulcers from BD activation inducing further severe inflammation and infection. This case also revealed that the treatment and control of BD does not merely rely on medical treatment but also on daily control of the disease activation. The daily oral hygiene care and dental treatments may be one of the important daily practices to prevent disease activation in such patients.

Oral aphthosis is a painful inflammatory process of the oral mucosa. Oral aphthous can appear alone or secondary to numerous distinct disease processes. If recurrence occurs frequently, it is called recurrent aphthous stomatitis. The pathophysiology of oral aphthous ulcers remains unclear but various bacteria are part of its microbiology. Three morphological types hold great importance in literature because these types help manage the illness properly. Google Scholar and PubMed databases were used to retrieve the relevant data and information. Different keywords including "Aphthous", "Aphthosis", "Canker sores", "Aphthous stomatitis", "Aphthous ulcer causes", "Aphthous ulcer AND Microbiota" and "Aphthous ulcer AND treatment". The causes for oral aphthous ulcerations are widespread and ranges from localized trauma to rare syndromes, underlying intestinal disease, or even malignant disease processes. A detailed history and thorough examination of systems can assist the physician or dermatologist in defining whether it is related to a systemic disease process or truly idiopathic. Management of oral aphthous ulcers is challenging. For oral aphthous or recurrent aphthous ulcers from an underlying disease, topical medications are preferred due to their minimum side effects. Systemic medications are necessary if the disease progresses. Within the limitation of research and literature provided, it is safe to say that topical corticosteroids are the first line of treatment. Herein, the author discusses the pathophysiology, types, causes, diagnosis, and appropriate treatment ladder of oral aphthous stomatitis as described in the literature.

To investigate the levels of adrenomedullin (ADM) and lipoprotein (a) [Lp(a)] and their correlation and interaction with disease activity in Behcet's disease (BD), we measured the levels of ADM, Lp(a), α 1-antitrypsin (AAT), α 2-macroglobulin (AMG), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in 35 patients (15 men) with BD (15 active) and 20 healthy volunteers (12 men) serving as controls. The disease activity was evaluated by clinical manifestations (oral aphthous ulcer, genital ulceration, skin lesions and uveitis) and by laboratory investigations (ESR and CRP). The levels of ADM, Lp(a), AAT, AMG, ESR, and CRP were found to be increased in patients with BD compared with those of the control group. The mean levels of those parameters in patients with active BD were significantly higher than those of the patients with inactive BD and of the control group. Similarly, the mean values of those parameters in the inactive BD group were higher than those of the control group. There were no statistically significant correlations between age and Lp(a), ADM, ESR, CRP, AAT or AMG levels. A significant positive correlation was present between ADM and CRP (r = 0.774, p < 0.001), ADM and ESR (r = 0.683, p < 0.001), Lp(a) and CRP (r = 0.572, p < 0.001), Lp(a) and ESR (r = 0.495, p < 0.01), Lp(a) and ADM (r = 0.702, p < 0.001). However, no statistically significant correlation was observed between Lp(a) and ADM with AAT or AMG levels.These data show that increases in ADM, Lp(a), ESR, CRP, AAT and AMG are present in patients with BD, that increases in ADM levels might be due to increased Lp(a) levels, and that the plasma ADM and serum Lp(a) levels are useful markers for evaluating the severity of BD.Keywords: ADRENOMEDULLINLIPOPROTEIN ABEHCET'S DISEASE.

Behçet's disease (BD) is a systemic disorder characterized by recurrent attacks of acute inflammation. Major symptoms are oral aphthous ulcers, uveitis, skin lesions, and genital ulcerations. Involvement of vessels, gastrointestinal (GI) tract, and central nervous system (CNS) is less frequent but is associated with a poor prognosis. Pulmonary complications of BD include aneurysms of the aorta, great vessels, or pulmonary arteries; arterial or venous thrombosis; pulmonary parenchymal changes; pleurisy, and intracardiac thrombosis. Hemoptysis caused by pulmonary artery aneurysms may lead to lethal hemorrhage. Recent advances in therapeutic strategies have improved the prognosis. In this review, the salient clinical and histopathological features of BD and treatment strategies are discussed.

Behcet's disease is a chronic multisystemic disease of unknown pathogenesis characterized by four major symptoms: oral aphthous ulcers, skin lesions, ocular symptoms and genital ulcerations. The disease is spread throughout the world, but it is most frequent in Turkey, Japan, Korea and China. Although HLA-Bw51 has been found to predominate in Behcet's cases, the genetic etiology has not yet been clarified. In this study, we investigated the chromosomal abnormalities and sister chromatid exchange rates in patients with Behcet's diseases. Thirty-eight patients with Behcet's disease (diagnosed for the first time) and 30 healthy subjects (as controls) were included in this study. Although numerical and structural chromosomal abnormalities were not detected in our patients, we found an increased rate of sister chromatid exchange in patients over the control groups (P < 0.01). On the basis of these results, we discuss the genetic etiology of Behcet's disease.

A causative role for Helicobacter pylori (H. pylori) in the pathogenesis of oral mucosal ulcerations has been suggested previously. We have adopted the polymerase chain reaction (PCR) as a rapid and sensitive means to detect H. pylori in swabs of recurrent oral aphthous ulcers and in samples of other oral sites. Of the oral aphthous ulcer samples, 32 (71.8%) were found to be positive, while the saliva and plaque samples (most of them taken from the patients with aphthous ulcers) were consistently negative for H. pylori DNA, as detected by the PCR assay. Only two of the swab samples from the tongue (collected at the time of concurrent, H. pylori-positive oral aphthous ulcers) were found to be positive. The data suggest that H. pylori may be associated frequently with recurrent oral aphthous ulcers, and are consistent with previous studies indicating that saliva and plaque are not likely sources of contamination with this microorganism. There was no apparent correlation with HIV status (infection with human immunodeficiency virus). The possible pathogenic significance of Helicobacter pylori in oral ulcerations is discussed.

BackgroundRecurrent aphthous stomatitis (RAS) is the most common form of oral ulcerative disease, whose cause is still unknown. Researchers have found the association of many factors with the occurrence of RAS, and proposed oral bacterial infection could be a cause for this disease.MethodsTo investigate whether the occurrence of RAS is associated with oral bacterial infection, we performed high throughput sequencing analysis of bacterial samples collected from the normal oral mucosa and aphthous ulcers of 24 patients.ResultsFirmicutes, Proteobacteria and Bacteriodetes were the most abundant phyla in the microbiomes analysed. The alpha diversities of the oral mucosa and aphthous ulcer microbiomes were similar, suggesting a similar richness and diversity. The NMDS analysis showed the oral mucosa and aphthous ulcer microbiomes are significantly different. This suggestion is further supported by Anosim, MRPP, and Adonis analyses. More detailed comparison of the two groups of microbiomes suggested that the occurrence of RAS is significantly associated with the increase of Escherichia coli and Alloprevotella, as well as the decrease of Streptococcus.ConclusionsConsidering E. coli is a very common intestinal bacterium, we propose that E. coli colonization could be a cause for RAS, and controlling E. coli colonization could help curing RAS.

BackgroundRecurrent oral aphthous ulcers are the common manifestation of the Behçet's disease, and they are indistinguishable from ulcers of recurrent aphthous stomatitis (RAS). There is no reliable biomarker reflecting disease...

Abstract: BACKGROUND: Although the terms “aphthous ulcers” and “aphthous stomatitis” have been used interchangeably in the past, the latter is now preferable. It is a widespread illness that affects 20% of the general population and 9% of children, according to estimates. Due to the high prevalence, pediatric patients who complain of mouth ulcers frequently present to medical and dental specialists. OBJECTIVES: Hematological assessments of patients with oral aphthous ulcer and comparison with healthy control. MATERIALS AND METHODS: A case–control study of 120 kids was conducted. The study included 100 patients with oral aphthous ulcer (56 male and 44 female) and a group of 20 healthy controls (10 males and 10 females). Data were collected using questionnaires. The questionnaires had two sections. The first section involved personal information. The second section is related to hematological examinations, such as hemoglobin level, serum iron level, folic acid level, Vitamin B12 level, and mean corpuscular volume. Statistical analysis was carried out using the t-test, and the LSD was employed to significantly compare the means. RESULTS: The level of hemoglobin in the control group was statistically highly significantly increased when compared with patients with mean ± standard error (SE) (13.14 ± 0.20) versus mean ± SE (10.39 ± 0.19). Serum iron showed an increased level in the control group compared to patients with statistically showed highly significant correlation with mean ± SE (71.77 ± 5.14) versus mean ± SE (46.76 ± 2.79). A highly significant correlation existed when compared the control group and patients concerning Vitamin B12 levels with mean ± SE (517.02 ± 28.11) versus mean ± SE (367.32 ± 21.25). CONCLUSIONS: Hemoglobin, serum iron, and Vitamin B12 levels of patients are higher than that of controls. It is very important to observe the hemoglobin, folic acid, Vitamin B12, and serum iron levels in patients with oral ulcer before it starts to suggest treatments for oral ulcer.

Behçet's disease (BD) is a chronic multisystemic inflammatory disorder characterized by recurrent oral and genital aphthous ulcers, uveitis and skin lesions. Recurrent aphthous ulcer (RAU) is the most prevalent oral mucosal disease in humans. The pathogenesis and thrombopoiesis of BD and RAU have not been fully clarified. To reveal the haemostatic dysfunctions in the patients with BD and RAU, we evaluated the levels of coagulant, anticoagulant and fibrinolytic parameters in these patients.Factor VIII clotting activity (FVIII:c), protein C antigen (PC:Ag), total protein S antigen (TPS: Ag), tissue-type plasminogen activator antigen (t-PA:Ag), plasminogen activator inhibitor-1 antigen (PAI-1:Ag) and D-dimer were detected in 24 BD, 58 RAU patients and 50 controls. Results showed that levels of PC:Ag, TPS:Ag, PAI-1:Ag and D-dimer were significantly elevated in both BD and RAU patients compared with controls (P<0.01). PAI-1:Ag was even higher in BD patients than in RAU patients (74.99±12.28 vs. 69.57±13.11, P<0.05), whereas the level of t-PA:Ag was significantly reduced in patients with BD and RAU (P<0.01). In patients with RAU, PC:Ag was lower in major aphthous ulcer (MjAU) group than in minor aphthous ulcer (MiAU) group (P<0.05). The expression of FVIII:c was significantly elevated in MiAU patients compared with controls (P<0.01), while no difference was observed between MjAU patients and controls (P>0.05). Our studies showed that there were anticoagulant and fibrinolytic disorders in BD patients, which may be responsible for diminished fibrinolysis in BD. Some haemostatic parameters may be correlated with the severity of RAU.

OBJECTIVE: The objective of this paper was to assess the awareness regarding oral aphthous ulcers and its risk factors among BDS and MBBS students in private institute of Karachi, Pakistan. METHODOLOGY: A cross-sectional survey was conducted at a private institute of Karachi Pakistan for the duration of six months. Medical and dental students of age more than 18 years of either gender were enrolled in the study using non-probability convenience sampling technique. Pre-designed proforma was used to collect data regarding demographics, history of recurrent aphthous stomatitis and knowledge of oral aphthous ulcers and its risk factors. The knowledge score of 4 out of 6 was considered as adequate knowledge. SPSS version 25 was used to analyze data. RESULTS: Of 150 participants, the mean age was reported as 22.94±1.65 years (range: 21-25 years). In those 150 participants 46 were males (30.7%) and 104 were females (69.3%). Overall mean score of knowledge was 4.35±1.29. Wherein 73% had adequate knowledge regarding oral ulceration and its risk factors. The dental students had significantly higher proportion of adequate knowledge regarding oral ulceration than medical students [p=0.024]. CONCLUSION: Overall students had good knowledge of oral ulceration and its risk factors, wherein knowledge of dental students was better than medical students. KEYWORDS: Oral ulcers; Recurrent Aphthous stomatitis; awareness, oral ulceration, risk factors, eating habits