Acute Inflammatory Changes Research Articles

Prosthetic stomatitis: treatment and prevention

Relevance. Traumatic prosthodontic stomatitis is the most frequent in clinical prosthetic dentistry, increasing the effectiveness of prevention and treatment of which is considered an urgent problem of practical dentistry. Objective. To study the effectiveness of using various domestic means for oral care in patients suffering from traumatic prosthetic stomatitis. Materials and methods. The study involved 42 elderly patients suffering from denture stomatitis due to the use of removable acrylic dentures. The patients were divided into 2 groups. In the control group after dentures correction they were recommended to use rinses and irrigations of the oral cavity with antiseptic solutions for a week, and later with infusions of medicinal herbs. Patients of the main group during their follow-up used local anti-inflammatory and wound-healing agents produced by thedomestic industry, as well as those improving the fixation of removable dentures. The effectiveness of denture stomatitis treatment and prevention of recurrence was evaluated on the basis of the patient’s complaints and clinical condition of the oral mucosa. Results. . It was established that for effective therapy of denture stomatitis it is necessary to use specially produced anti-inflammatory agents for the oral cavity during the period of acute inflammatory changes in the mucous membrane of the denture bed, and when using removable acrylic dentures it is necessary to recommend ASEPTA denture fixation cream, which has proved itself not only in the aspect of optimization of microbiota and mucosal immunity of the mouth, but also for optimization of psychophysiological state of patients. Their use makes it possible to achieve 81.47% efficacy of prosthetic stomatitis treatment on the 5th day and 100% efficacy of therapy on the 7th day from the beginning of their use by the patient, as well as in the nearest period to provide prevention of this disease recurrence. Conclusion. For secondary prophylaxis of traumatic prosthetic stomatitis, which occurs most often among the complications when patients use removable acrylic dentures, it is advisable to use specially produced by the domestic industry means possessing anti-inflammatory and wound-healing properties, as well as favorably acting on the mucous membrane of the prosthetic bed.

Acute pancreatitis occurring after COVID-19 vaccine: a case report and literature review

BackgroundVaccines are uncommon causes of pancreatitis, and only a few case reports have described COVID-19 vaccine-related pancreatitis.Case presentationA 45-year-old male patient applied to the emergency department due to having serious abdominal pain. Pfizer-BioNTech COVID-19 vaccine, the last dose was administered 1 week ago. One week after vaccination, he experienced abdominal pain. Laboratory tests demonstrated elevated C-reactive protein, amylase, and lipase levels, and Ig G4 levels were normal. Abdominal computer tomography (CT) displayed acute edematous pancreatitis and peripancreatic inflammatory changes. The patient was diagnosed with acute pancreatitis due to the vaccine.ConclusionWe should be aware that acute pancreatitis induced by the vaccine may occur a few days or weeks after the vaccine, especially in patients who have risk factors for acute pancreatitis.

The Current and Novel Imaging Modalities for Ocular Vasculitis in Behcet's Disease: A Review.

Behcet's syndrome is a multisystem inflammatory disorder characterized by a chronic relapsing course and diverse clinical manifestations, prominently affecting young adults along the ancient Silk Road and beyond. The disease pathogenesis involves complex interactions between genetic predisposition, environmental triggers, and dysregulated immune responses, leading to systemic vasculitis and tissue damage. Ocular involvement, a hallmark of Behcet's Disease (BD), significantly impacts morbidity, with uveitis as a common initial presentation that can progress to severe vision-threatening complications like retinal vasculitis and occlusive disease. This review consolidates current knowledge on ocular manifestations in BD, emphasizing the pivotal role of multimodal imaging in diagnostic evaluation and management. Fundus photography serves as a baseline tool for documenting intraocular lesions and monitoring treatment responses. Fluorescein angiography remains the gold standard for detecting acute inflammatory changes and vascular leakage patterns essential for disease staging and prognostication. Recent advancements in imaging, such as ultra-wide field imaging (UWF), indocyanine green angiography (ICGA), Doppler ultrasonography, Optical Coherence Tomography (OCT), OCT angiography (OCTA), adaptive optics (AO), and retinal function imaging (RFI), provide unprecedented insights into microvascular dynamics, structural changes, and functional impairments associated with ocular BD. Integration of these advanced imaging modalities enhances early detection of subclinical disease, facilitates precise localization of inflammatory lesions, guides therapeutic interventions, and monitors treatment efficacy. OCT and OCTA, in particular, offer non-invasive, high-resolution assessments of macular edema, vascular perfusion abnormalities, and choroidal thickness alterations critical for optimizing patient care. In conclusion, multimodal imaging represents the cornerstone in the comprehensive management of ocular manifestations in Behcet's Disease, offering clinicians invaluable tools for accurate diagnosis, treatment planning, and long-term monitoring of disease progression and treatment outcomes.

A new protocol for the induction of chronic mastitis with intramammary infusion of lipopolysaccharide in Balb/c mice

Mastitis is the inflammation of the mammary tissue and is commonly observed in farm animals worldwide. The problem causes severe financial losses in the dairy industry in terms of veterinary costs, milk disposal, and treatment expenses. Bacteria are the main actors in the etiology and cause acute and chronic inflammatory changes in the mammary tissue. Acute inflammatory changes are easily recognized clinically, and treatment is initiated immediately, but subacute inflammation progresses insidiously and leads to chronic inflammation with irreversible fibrotic changes. Standardized experimental models for the induction of acute mastitis in laboratory animals are available, and usually, infusion of bacteria or some bacterial structural components into mammary tissue is easily applied for this purpose. However, there are few studies on the induction of chronic mastitis with fibrotic changes, and the applications are relatively complex. In the submitted study, LPS was infused through the teat duct three times on days 0, 5, and 10 to induce chronic mastitis in mice. Tissues were sampled on days 1, 6, and 15 to evaluate histopathological changes. While severe neutrophil infiltrates, a component of acute inflammation, were observed on day 1, lymphocyte infiltrates increased on day 6, consistent with subacute inflammation. On day 15, lesions representing chronic mastitis, such as fibrosis and lymphocyte infiltration, were observed. A model similar to the lesions in chronic mastitis of dairy cattle was successfully and easily established by LPS infusion in mice.

EP58 - Gangrenous appendicitis in an incarcerated femoral hernia: A rare case of De Garengeot Hernia

Abstract Aims To present a rare case of gangrenous appendicitis within an incarcerated femoral hernia, discussing its clinical background and highlighting the challenges in its diagnosis and surgical management. Methods We detail a 74-year-old female with a painful, non-reducible groin mass. A CT abdomen pelvis revealed a right femoral hernia with acute reactive inflammatory changes, with no comment made on the appendix (Figure 1 and 2). Emergency open femoral hernioplasty and laparoscopic appendectomy were performed. Results Intraoperatively, a femoral hernia with a gangrenous appendicitis were identified. The appendix was reduced into the abdominal cavity to allow for better evaluation of its base. A laparoscopic appendectomy was performed after identifying the healthy base (Figure 3), followed by a femoral hernioplasty. This case sheds light on the rarity not only of the De Garengeot hernia which is defined by the presence of the vermiform appendix within the femoral hernia sac, but also even rarer the finding of a gangrenous appendix within the sac, with a reported incidence from 0.08-0.13% in cases of acute appendicitis. The case emphasizes the importance of considering an acute appendicitis and its complications within a femoral hernia as a differential diagnosis of painful groin masses with raised inflammatory markers. Conclusion Given the scarcity of literature on the surgical management of acute appendicitis in De Garengeot hernias, this case contributes valuable insights. The absence of established guidelines underscores the need for further exploration of optimal surgical strategies in such cases. Our report aims to enhance awareness of this rare presentation and facilitate future discussions on its management.

Comparison of fluorescent antibody test, immunohistochemistry, and PCR testing for diagnostic confirmation of neurolisteriosis in 25 goats.

Neurolisteriosis, a common disease of small ruminants, is most often caused by Listeria monocytogenes. Here we describe 25 cases of caprine neurolisteriosis diagnosed in our laboratory over a 5-y period and compare our fluorescent antibody test (FAT) results with immunohistochemistry (IHC) and polymerase chain reaction (PCR) testing for diagnostic confirmation. Neurohistologic changes consistent with neurolisteriosis affected the pons in all cases, extending rostrally to the mesencephalon in 6 cases, caudally to the medulla oblongata in 6 cases, and/or dorsally to the cerebellum in 4 cases. Acute inflammatory changes were observed in 17 cases, and included neuroparenchymal microabscesses, neuronal necrosis and neuronophagia, axonal swelling, microgliosis and astrogliosis, and perivascular neutrophils with macrophages, lymphocytes, and plasma cells that occasionally extended to the leptomeninges. Subacute-to-chronic changes (8 cases) consisted of neuroparenchymal and perivascular clusters of macrophages with rare neutrophils, lymphocytes, and plasma cells admixed with glial nodules. Bacterial bacilli were observed within neutrophils or macrophages in H&E-stained tissue sections in 4 cases. Gram stain highlighted gram-positive bacilli in 13 cases. Neurolisteriosis was confirmed by FAT in 2 cases, by IHC in 19 cases, and by PCR in 20 cases.

A case of neonatal sepsis, early diagnosis and preventive intensive care

Neonatal sepsis is a pathological process that occurs as a complication of any infectious processes and is a life-threatening condition for newborns. Aim. To inform practitioners with the case of neonatal sepsis, when timely diagnosis and intensive care helped to prevent the development of septic shock and multiple organ failure. Materials and methods. A child was treated in the Department of Anesthesiology and Intensive Care of Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using the hospital equipment. Results. The child with a complicated prenatal history was born by emergency caesarean section for severe pre-eclampsia at 34 weeks’ gestation. On the tenth day of life, the infant developed a worsening intoxication syndrome and febrile temperature. X-ray examinations revealed right-sided pneumonia; clinical blood count showed leukocytosis with acute inflammatory changes, thrombocytopenia, and an elevated procalcitonin level. A day later, the inflammatory changes dramatically deteriorated, and the cerebrospinal fluid cytosis was increased up to 850 cells and dominated by neutrophils. Blood cultures tested positive for Enterobacter cloacae. The child was prescribed antibacterial therapy according to the de-escalation principle (meronem and vancomycin) with subsequent changes according to the results of microbiological examinations, infusion therapy with parenteral nutrition, immunosupportive (intravenous immunoglobulin) and antifungal therapy. As a result of intensive therapy, clinical blood count inflammatory abnormalities were regressed, cerebrospinal fluid was completely restored to health, procalcitonin and C-reactive protein levels were normalized, and pneumonia was resolved within a week. Positive laboratory changes were correlated with the general condition: normalization of body temperature, increased activity, and enteral feeding ability. Conclusions. Timely diagnosis and intensive care of neonatal sepsis caused by gram-negative flora helped to prevent the development of multiple organ failure and septic shock. The use of antibiotic therapy according to the de-escalation principle is justified in newborns at high risk of developing septicaemia.

Lipid Nanoparticle-Mediated Delivery of mRNA Into the Mouse and Human Retina and Other Ocular Tissues.

Lipid nanoparticles (LNPs) show promise in their ability to introduce mRNA to drive protein expression in specific cell types of the mammalian eye. Here, we examined the ability of mRNA encapsulated in LNPs with two distinct formulations to drive gene expression in mouse and human retina and other ocular tissues. We introduced mRNA-carrying LNPs into two biological systems. Intravitreal injections were tested to deliver LNPs into the mouse eye. Human retinal pigment epithelium (RPE) and retinal explants were used to assess mRNA expression in human tissue. We analyzed specificity of expression using histology, immunofluorescence, and imaging. In mice, mRNAs encoding GFP and ciliary neurotrophic factor (CNTF) were specifically expressed by Müller glia and RPE. Acute inflammatory changes measured by microglia distribution (Iba-1) or interleukin-6 (IL-6) expression were not observed 6hours post-injection. Human RPE also expressed high levels of GFP. Human retinal explants expressed GFP in cells with apical and basal processes consistent with Müller glia and in perivascular cells consistent with macrophages. We demonstrated the ability to reliably transfect subpopulations of retinal cells in mouse eye tissues in vivo and in human ocular tissues. Of significance, intravitreal injections were sufficient to transfect the RPE in mice. To our knowledge, we demonstrate delivery of mRNA using LNPs in human ocular tissues for the first time. Ocular gene-replacement therapies using non-viral vector methods are a promising alternative to adeno-associated virus (AAV) vectors. Our studies show that mRNA LNP delivery can be used to transfect retinal cells in both mouse and human tissues without inducing significant inflammation. This methodology could be used to transfect retinal cell lines, tissue explants, mice, or potentially as gene-replacement therapy in a clinical setting in the future.

990 A Rare Case of Adenomyoma in Gastric Pylorus of a Young Adult Female: A Case Report

Abstract Introduction Gastric adenomyoma is a rare benign tumour which occurs 85% in antrum and 15% in pylorus. Although adenomyomas are benign, diagnosis is difficult as they are commonly found alongside with adenocarcinomas. Case report A 20-year-old previously healthy female presented with epigastric pain, gastric outflow obstruction features and weight loss for 3 months. Initial USS was followed by a CECT which, showed intramural mass lesion with necrotic centre arising from the inferior wall of the pre pyloric area of the stomach with acute inflammatory changes of the adjacent omental fat, giving differential diagnosis of GIST or gastrinoma at pyloric region. Subsequent upper GI endoscopy revealed a protruding pyloric mass without mucosal lesions. Unfortunately, the unavailability of EUS and biopsy posed a diagnostic hurdle. Intraoperatively, a mass intricately adhered to the transverse colon and omentum was discovered, leading to a surgical intervention involving distal gastrectomy, gastrojejunostomy, and jejunojejunostomy. Unexpectedly, histological analysis unveiled adenomyoma at the prepyloric area, characterized by Brunner’s glands, dilated glands, and heterotrophic small intestinal tissue. Discussion This rare manifestation of adenomyoma in the gastric pylorus, particularly in a young adult, highlights the challenges in accurate preoperative diagnosis. The favourable postoperative outcome prompts reflection on the potential role of advanced diagnostic tools, emphasizing the significance of EUS and biopsy in steering clear of extensive surgeries. Conclusions This case report underscores the crucial role of personalized diagnostic methods, especially in cases like ours where a rare adenomyoma mimicking other tumours.

Risk factors for PTSD symptoms following PICU admission for childhood septic shock.

ObjectivePaediatric intensive care unit (PICU) admission represents a traumatic event for many children. Follow-up studies have found post-traumatic stress disorder (PTSD) rates of 10-30%, with a particular prevalence following admission for sepsis. Dysregulated inflammatory responses are associated with PTSD. Sepsis involves a marked inflammatory response but the relationship between this and PTSD have not been clearly established. In this study we investigate associations between the inflammatory response, psychosocial risk factors, and PTS symptoms following PICU admission for septic shock.We investigate the outcomes for children aged > 3 years, discharged from one PICU following admission for septic shock between 2010 and 2017. The study was a retrospective analysis of PICU-specific PTS symptoms reported by parents at any time since discharge via the Trauma and Behavior Health screen. Demographics, pre-morbid health characteristics, and exposure to other traumatic events were assessed. Clinical characteristics and blood test results at admission and at 48 h were recorded from clinical records. Multiple linear regression was used to investigate relationships between PTS symptom scores and predictor variables.Data for 65 participants (48% male, median assessment age 8.0 years) was available. Median time since admission was 5.1 years. 30.8% children scored at risk of PTSD at any time since discharge Symptoms were significantly associated with acute CRP rise (p 0.03), other trauma exposures (p = 0.01), and female gender (p =0.04).PTS symptoms in children who have survived septic shock are prevalent. These findings support a possible contribution of acute inflammatory changes, cumulative traumatic exposure, and female gender in post-PICU PTSD development.

Unveiling the Pathological Mechanisms of Death Induced by SARS-CoV-2 Viral Pneumonia.

In this comprehensive study of 15 deceased patients with confirmed SARS-CoV-2 infection, spanning a time frame of 1 to 68 days from confirmation to death, autopsies were meticulously conducted with stringent safety measures. Clinical, laboratory, histopathological, and molecular analyses were integrated, shedding light on diverse pulmonary lesions, including acute inflammatory changes, vascular abnormalities, and aberrant regenerative processes. Immunohistochemical analysis, utilizing various markers, successfully identified the SARS-CoV-2 nucleocapsid antigen within infected tissue cells and also revealed what type of inflammatory cells are involved in COVID-19 pathogenesis. Molecular investigations through rt-qPCR revealed the persistent presence and varying quantities of viral genes, even after 68 days. Moreover, the viral nucleocapsid was present even in patients who died after 50 days of infection onset. Employing statistical analyses such as Chi-square and phi coefficient tests, significant associations among microscopic lesions and their correlation with molecular and immunohistochemical findings were elucidated. We could draw a map of what kind of lesions were a direct consequence of viral invasion and what lesions where secondary to the acute immunological response. This integrative approach enhances our understanding of the intricate relationships between pathological features, providing valuable insights into the multifaceted landscape of COVID-19 pathogenesis.

Knowledge about Acute Respiratory Infection and Home Care Practice among Mothers of Under Five Years Children in Hima Rural Municipality, Jumla, Nepal

Background and Objectives: Acute Respiratory Infection (ARI) is defined as acute infective inflammatory changes in any part of respiratory tract, from the nasal mucosa to the alveoli, with an alteration in the respiratory physiology. ARI is a leading causes of mortality and morbidity in under-five children worldwide. This study aimed to assess knowledge about acute respiratory infection and home care practice among mothers of under-five year’s children and to determine the factors associated with it among mothers of under five children in Hima Rural Municipality, Jumla. Materials and Methods: The community based cross sectional study was conducted. Data was collected using systematic random sampling technique method and face to face interview was conducted using pretested semi-structured questionnaire. Data entry was used Epi-data 4.6 version and analyzed by using SPSS 20.0 version. Results: About 94.9% of the participant’s mother had heard about the ARI and 24.9% participant’s mother had high level of knowledge about ARI. 70.8% participants keep the child in a room with window and door close the room warm. As prevention and control highest percentage of the participants mothers 61.1% preferred to give Tito leaf tea. 59.1% mother were breast feeding than frequently to their ARI babies. Conclusion: The most of the women had knowledge about ARI. More than half of mothers preferred health facility for neighbor child as a choice of treatment. Most of the mothers kept their child in a room with window and door closed to keep the room warm. More than half reduce fever by cold sponge and wrap the child with tight and thick when child had ARI. Most of the ARI cases were treated at home and cured. Among total participants less than half followed health post after not cured at home.

Clinical and Morphological Features of Myocardial Infarction in Patients With a New Coronavirus Infection COVID-19.

Aim To analyze fatal outcomes of myocardial infarction (MI) in patients after COVID-19.Material and methods Data of pathoanatomical protocols and case histories of 612 patients managed in clinics of the Siberian State Medical University from 01.01.2020 through 31.12.2021 were studied. 68 (11%) of these patients were transferred to the clinics from respiratory hospitals for rehabilitation after the novel coronavirus infection. The main condition for hospitalization was a negative polymerase chain reaction (PCR) test for SARS-CoV-2 virus RNA. 544 (89%) of patients had no history of COVID-19. The incidence of MI was 14% (7/68) in patients after COVID-19 and 10% (74/544) in patients who have not had it. In pathoanatomical protocols and case histories of 81 patients diagnosed with MI, macroscopic and histological changes in the heart, pericardial cavity, coronary arteries, and laboratory results were evaluated. Statistical analysis was performed with a STATISTICA version 10.0 software package.Results The patients after COVID-19 had a lower percentage stenosis, more frequent coronary artery thrombosis, and a positive D-dimer. According to our data, MI emerged 10.0 (2.0; 21.0) days after admission to the hospital, had a larger area, always was transmural, and rapidly resulted in death; the time of necrotic changes in all cases did not exceed 24 h. Upon admission to the hospital, the PCR test for SARS-CoV-2 virus RNA was negative, and acute inflammatory changes were stopped at the previous stage of hospitalization.Conclusion The risk of coronary thrombosis in patients after COVID-19 remains after the relief of acute inflammatory response and elimination of the infectious agent, thereby creating a risk of MI, that often leads to a fatal outcome.

Un lésion cérébrale déroutante

A 31-year-old man, with no past medical history, presented with headaches, sudden loss of vision, right exophtalmia, bilateral papilledema, and fever. Brain imaging noted a right basi-temporal lesion. Excision of the lesion was performed. The histological examination noted a glial tissue with acute inflammatory changes and multinucleated giant cells. Within this infiltrate there were septate and branched hyphae consistent with aspergillosis. These filaments were stained with PAS. The patient died post-operatively.

#5127 COMBINED ACTIVITY AND CHRONICITY SCORE FOR PROGNOSTIC ASSESSMENT IN ANCA-ASSOCIATED VASCULITIS WITH GLOMERULONEPHRITIS

Abstract Background and Aims Previous studies have shown that chronic changes on kidney biopsy are useful for stratifying the risk of kidney failure in patients with AAV-GN. We aimed to evaluate the impact of inflammatory activity for the prediction of renal outcomes. Method A retrospective cohort study of MPO- or PR3-ANCA positive patients with AAV and active renal disease. Inflammatory activity was assessed by the Activity Index (AI): a ratio between the number of crescents and/or necrosis and the total number of glomeruli (in percent). We calculated the AI score: 0-5 = 0; 6-10 = 1; 11-15 = 2; 16-20 = 3; 21-25 = 4; 26-37.5 = 5; 37.6-50 = 6; 51-65 = 7; 66-80 = 8; 80-90 = 9; 90-100 = 10. Chronicity was evaluated with the Mayo Clinic Chronicity Score (MCCS). For the combined score, we summed the MCCS and the AI. Results Results. We analyzed 326 patients with kidney biopsies available to score. The biopsies had in median (IQR), 13 glomeruli (9-20), 4 crescents (2-6) and an AI of 28.6% (15.3-47.6). The population was classified according with the risk of progression to kidney failure (KF) in 3 classes as (i) low (0-6) – 114 (35.0%), (ii) intermediate (7-11) – 152 (46.6%), and (iii) high (≥12) – 60 (18.4%). Median eGFR at baseline correlated with the overall risk categories: 42.2 vs. 22.1 vs. 13.4 mL/min/1.73 m2, p<0.0001. The proportion of patients with eGFR< 30 mL/min/1.73 m2 was increased in patients classified as high: 88.3% vs. 66.4% vs. 36.0%, p<0.0001. Renal recovery was more frequent in patients at low risk of progression: 87.7% vs. 64.6% vs. 36.6%, p<0.0001, whereas kidney failure at 12 months and dialysis were more frequent in patients at higher risk (36.7% vs. 12.4% vs. 3.8%, p<0.0001; 35.6% vs. 13.0% vs. 2.9%, p<0.0001, respectively). The combination of AI with MCCS independently predicted the risk of KF at 12 months (HR 1.916, 95%CI 1.210 - 3.033, p = 0.006), particularly increased in patients classified as high risk (HR 3.124, 95%CI 1.224 – 7.970, p = 0.017) and in patients with PR3-ANCA (HR 1.896, 95%CI 1.012 - 3.551, p = 0.046) independently of eGFR at AAV-GN diagnosis and adjusted for severity of renal involvement and age. Conclusion The combined assessment of acute inflammatory activity and chronic changes on kidney histology independently predicted renal outcomes in patients with AAV-GN. The impact of the inflammatory activity is cumulative to the chronic changes.

A 14-year follow-up of ultrasound-detected urinary tract pathology associated with urogenital schistosomiasis in women living in the Msambweni region of coastal Kenya.

Complications of urogenital schistosomiasis include acute inflammatory and chronic fibrotic changes within the urogenital tract. Disease burden of this neglected tropical disease is often underestimated, as only active, urine egg-patent Schistosoma infection is formally considered. Previous studies have focussed on short-term effects of praziquantel treatment on urinary tract pathology, demonstrating that acute inflammation is reversible. However, the reversibility of chronic changes is less well studied. Our study compared, at two time points 14 y apart, urine egg-patent infection and urinary tract pathology in a cohort of women living in a highly endemic area having intermittent praziquantel treatment(s). In 2014 we matched 93 women to their findings in a previous study in 2000. Between 2000 and 2014 the rate of egg-patent infection decreased from 34% (95% confidence interval [CI] 25 to 44) to 9% (95% CI 3 to 14). However, urinary tract pathology increased from 15% (95% CI 8 to 22) to 19% (95% CI 11 to 27), with the greatest increase seen in bladder thickening and shape abnormality. Despite praziquantel treatment, fibrosis from chronic schistosomiasis outlasts the presence of active infection, continuing to cause lasting morbidity. We suggest that future efforts to eliminate persistent morbidity attributable to schistosomiasis should include intensified disease management.

Lyme Disease Associated Orbital Myositis: A Rare Cause of Orbital Swelling

A 61-year-old man presented with a 1-day history of right eye pain, right periorbital swelling, and painful diplopia upon right gaze. He was triaged as having Orbital Cellulitis in the emergency room and was given intravenous metronidazole and ceftriaxone. The patient has a medical history of Type 2 diabetes, right subclavian thrombosis, and Lyme disease, for which he was treated with Doxycycline and Rifampicin. He also has colour blindness and a raised immunoglobulin level, as well as a history of soft tissue thickening and acute inflammatory changes in the right periorbital region. Upon examination, the patient's visual acuity was 6/9 in both eyes, and the right eye showed swelling and tenderness at the superior and inferior margins, chemosis, and restriction of left abduction and upgaze. Blood tests showed elevated CRP levels and a positive rheumatoid factor.

A Study into the Identity, Patterns of Infection and Potential Pathological Effects of Rumen Fluke and the Frequency of Co-Infections with Liver Fluke in Cattle and Sheep

Rumen fluke (RF) are trematode parasites that have increased in prevalence within European ruminant livestock since the 1990s. Morbidity and mortality can result from the development of juvenile flukes in the duodenum, however, evidence for significant impacts of adult fluke in the rumen of the final host is equivocal. The presence of rumen fluke in Scotland had not previously been quantified, so the purpose of this study was to use historical coprological data collected between 2008 and 2018 at the School of Veterinary Medicine in Glasgow to evaluate the frequency of rumen fluke infection and to compare this with the presence of liver fluke. This analysis showed evidence of adult rumen fluke in 6.6% of samples submitted, with a substantial and significant increase in positive diagnoses from 2016, following which positive rumen fluke diagnoses equaled or slightly outnumbered those of liver fluke. A prospective post-mortem examination study was also carried out to determine the presence of rumen and liver fluke in cattle and sheep, to quantify adult rumen fluke burdens and to assess any pathological changes in the reticulorumen and proximal duodenum associated with infection. The presence of rumen fluke in post-mortem cases was 26.9% (n = 18/67), the majority (66.7%, n = 12/18) with burdens of less than 100 adult rumen flukes. There was no significant difference in mean ruminal papillar density and length in animals with and without adult rumen fluke and no significant gross pathology was observed in the rumen or reticulum. Examination of animals with adult rumen fluke provided no evidence of any consistent associations with acute or chronic inflammatory changes in the duodenum. All rumen fluke collected at necropsy were identified by PCR and sequencing as Calicophoron daubneyi.

Critical Care and Postoperative Management of the First Human Long Segment Orthotopic Tracheal Transplantation.

The recipient required reconstruction of a long segment tracheal defect from a previous prolonged intubation. A male donor was chosen for a female recipient to enable analysis of the reepithelialization kinetics using fluorescence in situ hybridization to analyze the source of the new ciliated epithelium. Transplant ICU at the Mount Sinai Hospital, New York, NY. The female recipient was previously intubated for an asthma exacerbation and subsequently developed long segment tracheal stenosis and failed conventional management including dilatation, stenting, and six major surgical procedures rendering her chronically tracheostomy-dependent. The male donor suffered a massive subarachnoid hemorrhage and was subsequently pronounced brain dead. Organ procurement occurred after obtaining appropriate consent from the patient's family. The patient received a deceased donor tracheal allograft that included the thyroid gland, parathyroid glands, and the muscularis of the cervical and thoracic esophagus. Triple therapy immunosuppression (tacrolimus, mycophenolate mofetil, and a corticosteroid taper) was maintained. The patient was initially managed postoperatively with deep sedation on ventilator via armored/reinforced endotracheal tube placed through a small tracheostomy located along the superior tracheal anastomosis. Serial bronchoscopies were performed for graft assessment, pulmonary toilet, and biopsies, which initially showed acute inflammatory changes but no features of acute allograft rejection. A euthyroid state was maintained but hypercalcemia developed. The ICU management of this first long segment orthotopic tracheal transplant required a multidisciplinary approach involving critical care, otolaryngology, transplant surgery, interventional pulmonary, endocrinology, 1:1 nursing throughout the recipient's transplant ICU stay, and respiratory therapy that resulted in the successful establishment of a viable tracheal airway and heralded the end of chronic tracheostomy dependence.

Analysis of laparoscopic cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis-a prospective study

Background: Endoscopic retrograde cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC) remains the cornerstone of treatment worldwide for coexisting CBD and gall bladder calculi. The interval between ERCP and LC is disputed. In our study, LC is performed at or more than 6 weeks after ERCP keeping in view by allowing the gall bladder to recover from the acute inflammatory changes if operated upon earlier.Methods: We conducted a prospective observational study in the postgraduate department of general surgery government medical college Srinagar J and K India over a period of 2 years. The 25 patients above age of 18 years and with cholecysto-choledocholithiasis who underwent ERCP and LC at or more than 6 weeks were included.Results: In our study the mean age was 45.3 years. Male: female ratio was 1:3.2. the distribution of patients as per Nassar grading scale 1 (4%) patient had grade I,12 (48%) patients had grade II, 5 (20%) patients had grade III and 7 (28%) patients had grade IV. In patients with grade I, the mean duration of surgery was 36.0 minutes, in grade II the duration of surgery ranged from 34-60 minutes with mean duration of surgery of 43.4 min (SD±8.9), in grade III duration of surgery ranged from 42-68 minutes with mean duration of surgery of 55.2 min (SD±10.06) and in grade IV duration of surgery ranged from 68-116 minutes with mean duration of surgery of 91.3 min (SD±17.66). We observed a definite relationship between the intraoperative Nassar grading scale and the post ERCP interval, 1 patient of grade I scale operated at 12 weeks post ERCP. 12 patients were between the post ERCP interval of 8-12 weeks (mean 10.1 weeks) and they had grade II. In grade III we had 5 patients with post ERCP interval of 7-11 weeks (mean 9.2 weeks). In grade IV we had 7 patients with post ERCP interval of 6-10 weeks (mean 7.9 weeks). p=0.008.Conclusions: Interval LC after ERCP is safe but challenging, longer the interval time between ERCP and LC lesser the chances of encountering intra-operative complications. We recommend LC more than 6 weeks after ERCP is safe.