Pseudomembrane Formation Research Articles

Co-administration of Ayurvedic medicines Arshogrit and Jatyadi Ghrit, attenuate croton oil-induced hemorrhoids in rat model of recto-anal inflammation by modulating TNF-α and IL-1β levels

Objective To study the efficacy of co-administration of Arshogrit (AG) and Jatyadi Ghrit (JG), two herb-based Ayurvedic medicines, in rat model of croton oil-induced hemorrhoids. Significance Hemorrhoids refer to a pathological condition affecting the recto-anal region causing pain, swelling, bleeding and protrusion. The available therapies for hemorrhoids are symptomatic or invasive but are expensive and associated with adverse effects. Hence, there exists a need for efficacious and safer pharmacotherapies. Methods Ultra high performance liquid chromatography detected nine phytocompounds in AG and seven in JG. Seven fatty acids were additionally identified in JG by Gas Chromatography-Mass Spectrometry analysis. The in-vivo efficacy of the co-administration of AG, which was administered orally at the doses of 20, 60 and 200 mg/kg/day and JG, which was topically applied (100 mg/animal/day) was evaluated in Wistar rats by inducing hemorrhoids development with the application of croton oil preparation (COP) in the recto-anal area. Prednisolone was employed as the standard drug and was administered orally at the dose of 1 mg/kg/day. Results AG and JG were able to attenuate the croton oil-induced macro and microscopic anomalies. Gross pathological observation demonstrated remarkable decrease in croton oil-induced swelling, hemorrhage and formation of pseudomembrane, with the escalating doses of AG. Microscopic observation revealed alleviation in the histopathological lesions (necrosis, inflammation, hemorrhage/congestion, degeneration and dilatation of blood vessels). AG and JG additionally reduced COP-induced increase in the serum levels of pro-inflammatory cytokines. Conclusion This study convincingly demonstrates that co-administration of AG and JG is a potential therapy against hemorrhoids, warranting further investigations.

A bio-inspired Janus hydrogel patch facilitates oral ulcer repair by combining prolonged wet adhesion and lubrication

Oral ulcers, the most common type of mucosal lesion, are both highly prevalent and prone to recurrence. In the persistently moist environment of the oral cavity, current therapeutic patches face challenges such as short adhesion time, disruption by food particles and bacteria, and oral movements. To address these challenges, we develop a Janus patch, named ANSB, inspired by the multi-layered and asymmetric structure of natural mucosa, featuring a long-lasting adhesive layer and a lubricating layer. By eliminating the salivary barrier and leveraging covalent crosslinking between tissue surface amine groups and N-hydroxysuccinimide ester (NHS), the adhesive layer—composed of gelatin and acrylic acid—achieves rapid (≤ 30 s), strong (≥ 45 kPa), and durable (≥ 8 h) adhesion to wet buccal tissues. Furthermore, the efficient lubricating effect (COF = 0.02 ± 0.003) provided by zwitterions renders the lubricating layer of ANSB highly similar to natural mucosal tissue, effectively preventing bacterial invasion, secondary damage, and unintended adhesion. Additionally, the strong interlayer bonding and complementary mechanical properties are confirmed, resulting in a unified performance characterized by rapid wet adhesion, hydration lubrication, and enhanced mechanical strength. Importantly, ANSB treatment demonstrates a long-term protective barrier and superior therapeutic effects in rat oral ulcers, inhibiting pseudomembrane formation and accelerating tissue regeneration without causing secondary damage. Consequently, this distinctive Janus patch, characterized by prolonged adhesion, efficient lubrication, and simple preparation, holds significant potential for clinical oral ulcer treatment. Statement of SignificanceOral ulcers, with healing impeded by secondary injury and bacterial invasion due to the absence of protective barriers, are highly prevalent and recurrent. However, sustaining therapeutic materials and physical barriers in the highly dynamic and moist oral environment poses a considerable challenge. In this study, a Janus patch (ANSB) that integrated a soft wet adhesive layer and a tough lubricating layer was developed to reconstruct a new protective barrier thus preventing external stimuli such as secondary damage and bacterial infiltration. This innovative patch with high therapeutic potential for oral ulcers may offer a new way for ulcer treatment based on barrier protection.

Clostridioides difficile infections: Update and therapeutic guidelines

Clostridioides difficile infection (CDI) represents a significant challenge due to its increasing incidence, severity, and treatment difficulty. Effective management requires a multifactorial approach that includes preventive strategies, prudent antibiotic use, and adapted therapeutic options. Ongoing research and innovation offer promising prospects for improving ICD management, making vigilance and informed practices essential among healthcare professionals. Two main complications of ICD are pseudomembranous colitis (PMC) and toxic megacolon. PMC involves severe colonic inflammation due to C.difficile toxins, leading to pseudomembrane formation. Diagnosis relies on clinical criteria, microbiological tests, and endoscopy. Toxic Megacolon is characterized by severe colonic dilation and systemic toxicity, requiring immediate medical intervention. ICD diagnosis combines clinical signs and microbiological tests. These tests include toxin tests, GDH antigen detection, PCR for toxin genes, and stool culture. Imaging techniques assess colonic inflammation and complications. Combined diagnostic criteria from the American Gastroenterological Association (AGA) and European guidelines emphasize integrating clinical and laboratory findings for accurate diagnosis. ICD treatment involves stopping the implicated antibiotics and starting specific antimicrobial therapy. Common treatments include mainly fidaxomicin and oral vancomycin. Fecal microbiota transplantation (TMF) is recommended for recurrent cases unresponsive to standard treatments. Bezlotoxumab, an antibody targeting C.difficile toxin B, is used to prevent recurrence in high-risk adults. ICD poses a major challenge due to its increasing incidence, severity, and difficulty in treatment. A multifactorial approach involving rigorous preventive strategies, prudent antibiotic management, and adapted therapeutic options is essential for controlling the infection. Ongoing research and innovations in treatment offer promising prospects for improving patient management. Healthcare professionals must remain vigilant and informed to ensure effective practices in combating this infection and utilizing available resources optimally.

Case Report: A 5 Yea kan r Old Girl with Diphtheria

Background: Diphtheria is an acute infectious disease caused by Corynebacterium diphtheriae. It is characterized by the formation of pseudomembranes in the tonsils, pharynx, and/or nasal cavity, which can lead to severe complications such as airway obstruction, myocarditis, and paralysis of the palate muscles. Aims: This study aims to detail the clinical course and treatment of a pediatric diphtheria case, emphasizing the importance of early diagnosis and appropriate therapeutic interventions. Methods: The case of a 5-year-old girl presenting with a 3-day history of fever at K.R.M.T Wongsonegoro Hospital is described. Clinical evaluation, including history, physical examination, and supportive tests, led to a diagnosis of diphtheritic tonsillitis. Findings: The patient exhibited classic symptoms of diphtheria, including sore throat, fever, and the presence of a dirty, greyish-white pseudomembrane on the tonsils. The membrane extended to adjacent structures, causing a condition known as bullneck. The treatment protocol included the administration of diphtheria antitoxin (DAT), antibiotics, antipyretics, corticosteroids, and symptomatic management. Conclusion: Diphtheria remains a serious infectious disease requiring prompt diagnosis and treatment to prevent complications. The case highlights the importance of early intervention, continuous monitoring, and the evaluation of therapeutic efficacy to improve patient outcomes. Implications: This study underscores the necessity of vigilant clinical practices in managing diphtheria cases, particularly in pediatric patients, to reduce morbidity and mortality.

India's Pink-Eye Mystery: Decoding the 2023 Conjunctivitis Outbreak.

The pink eye outbreak in 2023 was caused due to humid weather conditions in most regions of India. The most affected states include Delhi, Gujrat (21% cases), Maharashtra (30%), Himachal Pradesh (4%) and Karnataka (4%). The epidemiological data indicates that males have a high prevalence rate as compared to females; urban areas were most affected, and professionals as well as students were the population group that had the highest prevalence rate. The most common clinical manifestations were the presence of red eye, eye discharge, grittiness, and eyelashes being stuck together. One of the hallmarks of histopathology is a cobblestone formation of flattened nodules with central vascular centers. Conjunctivitis is a virusmediated immune response accompanied by inflammation, which proceeds the immune reaction, giving rise to vasodilation, pseudo membrane formation, and conjunctivital discharge. The gold standard for the diagnosis of Conjunctivitis is the Adenoplus kit using PCR technology; apart from this slit lamp biomicroscope can be used for the evaluation. It is the need of the hour to spread awareness about the Pink Eye disease and the measures to prevent it.

Low-level laser therapy as an adjuvant in the treatment of erythema multiforme of the oral mucosa: a case report

Erythema multiforme is an autoimmune condition that can affect the skin and mucosa. Oral lesions initially present with edema and progress to superficial erosions with pseudomembrane formation. The most recommended treatment is the use of corticosteroids; however, low-level laser therapy can be effective in the treatment of erythema multiforme. We report a case of erythema multiforme in the oral mucosa treated with low-level laser therapy. A 73-year-old woman using alendronate for osteoporosis, losartan, and puran T4 with extensive ulcers on the upper and lower lips. The clinical diagnosis was erythema multiforme. The proposed treatment was 0.05% clobetasol propionate in gel, 3 times a day, and seven sessions of low-level laser therapy on alternate days. Low-level laser therapy significantly improved the erythema multiforme of the oral mucosa, offering the patient a non-invasive approach with no side effects.

Ligneous Conjunctivitis – A Case Report

Purpose: To describe a case of ligneous conjunctivitis, an uncommon type of recurrent, chronic conjunctivitis that mostly affects the tarsal conjunctiva but can also affect other mucous membranes of the body. It is characterized by a firm, fibrin-rich, woody-like pseudo-membrane formation. Case report: We here describe a case of ligneous conjunctivitis in a three and half years old boy presented with bilateral conjunctival masses for more than two years associated with discomfort, discharge, thick upper eyelids without swelling. Conclusion: Ligneous conjunctivitis is a rare form of pseudo-membranous or membranous conjunctivitis, with formation of indurated plaques. Despite repeated abscissions, these lesions recur rapidly. Corneal involvement can turn into vision threatening condition.

Analysis of cases of laryngeal airway diseases in infants

Objective:To analyze the clinical data of laryngeal airway diseases in infants and provide reference for the standardized diagnosis and treatment of the disease. Methods:From June 2022 to August 2023, analyze the clinical data of 4 cases of children with laryngeal airway diseases recently admitted to Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, and summarize the experience and lessons of diagnosis and treatment by consulting relevant literature. Results:Three cases had symptoms such as laryngeal wheezing, dyspnea, backward growth and development, etc. After electronic laryngoscopy, the first case was diagnosed with laryngeal softening （severe, type Ⅱ）, and the angular incision was performed. While cases 2, 3 diagnosed with case 2 and 3 were diagnosed with laryngeal cyst and underwent laryngeal cyst resection. All three cases underwent low-temperature plasma surgery under visual laryngoscope, and the symptoms were relieved after operation. Case 4 was laryngeal wheezing and dyspnea after extubation under general anesthesia. The electronic laryngoscopy showeded early stage of globetic stenosis, and endoscopic pseudomembrane clamping was performed, and the postoperative symptoms were relieved. Conclusion:Infants and young children with laryngeal airway diseases should pay attention to the early symptoms and be diagnosed by electronic laryngoscopy as soon as possible. With good curative effect and few complications, low-temperature plasma surgery under visual laryngoscope is recommended. The formation of pseudomembrane under the gluteal caused by tracheal intubation causes rapid onset and rapid development. The pseudomembrane extraction by clamping is convenient and fast, with good curative effect.

Long-term follow-up in a pediatric patient with Ligneous Conjunctivitis due to PLG gene mutation in topical plasminogen treatment after successful use of ocular prosthesis for aesthetic rehabilitation: a case report

BackgroundLigneous Conjunctivitis (LC) is the most common clinical manifestation of Type I Plasminogen deficiency (T1PD; OMIM# 217090), and it is characterized by the formation of pseudomembranes (due to deposition of fibrin) on the conjunctivae leading to progressive vision loss.In past times, patients with LC were treated with surgery, topical anti-inflammatory, cytostatic agents, and systemic immunosuppressive drugs with limited results (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022, Surv Ophthalmol 48:369-388, 2003, Blood 131:1301-1310, 2018). The surgery can also trigger the development of membranes, as observed in patients needing ocular prosthesis (Surv Ophthalmol 48:369-388, 2003). Treatment with topical purified plasminogen is used to prevent pseudomembranes formation (Blood 108:3021-3026, 2006, Ophthalmology 129:955-957, 2022).Case presentationWe present the case of a sixteen-year-old girl with LC with severe left eye involvement. We reported the clinical conditions of the patient before and after the use of topical plasminogen eye drops and described the treatment schedule allowing the surgical procedure for the pseudomembranes debulking and the subsequent use of ocular prosthesis for aesthetic rehabilitation.ConclusionsThe patient showed a progressive response to the topical plasminogen, with a complete absence of pseudomembrane formation at a twelve-year follow-up, despite using an ocular prosthesis.

Effect of esketamine nasal drops on pain in children after tonsillectomy using low temperature plasma ablation.

To explore the effect of esketamine nasal drops on pain in children after tonsillectomy using low-temperature plasma ablation. 76 children who underwent tonsillectomy between May 2020 and July 2021, were randomly divided into two groups of 38 cases each. Patients in the control group were treated with conventional medication, while those in the study group were treated with esketamine nasal drops, along with the routine drug treatment. Pain levels of children in the two groups were compared within 1-3 days post-surgery, and the pseudomembrane formation and shedding-off time and recovery time were statistically analyzed. The pain level of children in the study group was lower than that of the control group 1-3 days post-surgery. The pseudomembrane formation and shedding-off time and recovery time in the study group were shorter than in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups, and there were no serious adverse reactions in the two groups (P > 0.05). It is safe to use esketamine nasal drops in children after tonsillectomy using low temperature plasma ablation, and this is found to reduce pain and shorten the recovery time.

Pleomorphic adenoma of the tongue: A case report.

Salivary gland tumors account for approximately 3% of all tumors, most of which are benign, with pleomorphic adenomas being the most common, occurring mostly in middle-aged women, mostly originating from the major salivary glands and, to a lesser extent, from the minor salivary glands, with the tongue being a very rare site of occurrence. To date, case reports of pleomorphic adenoma at the root of the tongue are also rare. A 56-year-old male patient with no obvious cause of foreign body sensation in the pharynx, sputum, no pain, no blood in the sputum, no dysphagia, and no difficulty in swallowing and breathing, which was significantly aggravated in the past 2 weeks, with difficulty in swallowing, breath-holding on lying down. computed tomography and magnetic resonance imaging revealed a soft tissue mass at the root of the left tongue, which involved the tongue body in the forward direction. Electronic laryngopharyngoscopy showed a left-sided tongue root mass with a poorly smooth mucosa, covered with a mucous white pseudomembrane and a localized brownish-black crust without active bleeding. The final pathological findings showed a pleomorphic adenoma. Postoperative symptomatic treatment was given, and the patient recovered well. Eight days after surgery, the patient was discharged from the hospital, and the pharyngeal pain basically subsided at the time of discharge, with no fever and no pharyngeal discomfort. Postoperative laryngoscopy showed smooth mucosa of the pharyngeal cavity, good pseudomembrane formation in the operated area, no active bleeding, no purulent secretions, and normal blood routine on recheck. The medical advice after discharge was firstly, full rest for 1 week, secondly, continue the oral anti-inflammatory treatment, 1 week after the operation need to review the outpatient clinic, finally, if there are any uncomfortable symptoms, seek medical attention in time. At present, the patient has been followed up for half a year and has recovered well from the operation without any discomfort. It is very rare to find a pleomorphic adenoma of the tongue, and it occurs mostly in middle-aged women. In clinical diagnosis, it is sometimes difficult to distinguish it from malignant tumor of the tongue.

The effect of povidone-iodine 2% eye drops in the treatment of adenoviral keratoconjunctivitis.

Keratoconjunctivitis is one of the most common pathologies worldwide, caused by several infectious and noninfectious factors. This study aimed to determine the effect of povidone-iodine 2% eye drops in treating adenoviral keratoconjunctivitis. This analytic cross-sectional study was conducted on patients referred to Farabi Eye Hospital Records of patients with adenoviral keratoconjunctivitis, more than 12 years of age, and no allergy to iodine who were treated by povidone-iodine 2% eye drops four times a day were assessed. Data included demographic characteristics, family history of adenoviral keratoconjunctivitis, follicular conjunctivitis, petechial conjunctival hemorrhages, periauricular lymphadenopathy, and the presence of conjunctival pseudomembrane were collected from the records. Discharge decrease, injection decrease, swelling decrease, pseudomembrane formation, periauricular lymphadenopathy, and subepithelial infiltration on the 7thday of assessment by physical examination were reported. Patients with a mean (±standard deviation) age of 33.77 (11.01) years were assessed. At the baseline, 95 (99.0%) follicular conjunctivitis, 94 (97.9%) petechial conjunctival hemorrhages, 29 (30.2%) periauricular lymphadenopathy, and 5 (5.2%) conjunctival pseudomembrane were recorded. On the 7thday of treatment, the discharge decreased in 92.7% of patients, and the injection decreased in 90.6%. The swelling decrease was also detected in 79.2% of patients. Subepithelial infiltration was only seen in 21.9% of the study population. Results showed that 2.1% of patients had periauricular lymphadenopathy, and only 13 out of 96 patients (13.5%) had pseudomembrane formation after 7 days. Based on the safety, availability, and tolerability of povidone-iodine and its promising effects on patients with adenoviral keratoconjunctivitis, further clinical trials assessing the impact of this drug in a longer duration of follow-up can be recommended.

Adenoviral Keratoconjunctivitis in Korea: Serotypes and Clinical Characteristics

Purpose: Human adenoviruses are a major cause of epidemic keratoconjunctivitis. Of over 60 genotypes, subgroup D is associated with epidemic keratoconjunctivitis. There are, however, no data regarding the genotypes of conjunctivitis-causing adenoviruses in Korea. The purpose of this study was to determine the types of adenoviruses causing epidemic keratoconjunctivitis and clinical manifestations in Korea.Methods: From November 2016 to September 2017, 20 conjunctival swab specimens were collected from patients who were clinically suspected to have adenoviral keratoconjunctivitis. Nucleic acids were extracted using a QIAamp Viral mini kit and processed on the QIAcube platform. Genotyping targeted for adenovirus capsid hexon genes was performed by using the polymerase chain reaction and sequencing techniques. Patient ages ranged from 18 days to 69 years (median, 37 years).Results: Of 20 collected specimens, 17 (85.0%) were genotyped. Three samples were not amplified with our primer sets. Eleven samples (64.7%) were adenovirus type 8, five (29.4%) were type 37, and one was type 64. All 17 genotyped patients showed conjunctival injections (100%) and follicles (100%), and 12 (84.6%) showed pseudomembrane formation. In case of patients genotyped type 8, most of them showed corneal manifestations and involvement of cornea by type 37 showed filamentary keratitis.Conclusions: This study showed that the polymerase chain reaction and direct sequencing for adenovirus hexon genes of conjunctival swab samples were effective techniques for genotyping the adenoviruses that cause epidemic keratoconjunctivitis. The most common causes of adenoviral keratoconjunctivitis in Korea were adenovirus types 8 and 37 in this period of time. Conjunctival injection, follicle formation, and pseudomembrane formation were the major manifestations of adenovirus types 8 and 37 infections.

Primary Laryngeal Aspergillosis in the Immunocompetent Patient

Introduction Fungal infections of the larynx are truly rare in immunocompetent people with only a handful of cases reported in the past five decades. Here we present a case series of 3 people (from 2019 to 2021), with no comorbid conditions, who presented with primary laryngeal aspergillosis. Materials and Methods Three patients with primary aspergillosis of the larynx were seen in the ENT outpatient department from 2019 to 2021, aged between 40-50 years of which two were females and one patient was a male. We describe the clinical presentation of each patient. Discussion Aspergillosis of the larynx usually occurs secondary to bronchopulmonary infections in the immunocompromised. The usual etiological factors include prolonged use of inhaled steroids, cytotoxic drugs, radiotherapy, smoking, mucosal injury, and antibiotic abuse. Persistent hoarseness of voice is the most common presenting symptom. Video laryngoscopy reveals erythema, oedema, hyperkeratosis, adherent white plaques, shallow ulcerations, and grey or white pseudo membrane formation over the vocal cords. Definitive diagnosis is done by the demonstration of hyphae either by KOH staining, culture in Sabouraud Dextrose Agar at 28 degrees Celsius, or tissue biopsy. Conclusion Primary aspergillosis of the larynx has occurred more frequently in recent times. Aspergillosis of the larynx can often mimic malignant or premalignant lesions. Persistent hoarseness of voice not responding to treatment should also raise a suspicion of fungal laryngitis, in the clinician and relatively simple treatment be done before significant morbidity occurs.

The Relationship between Clinical Findings and Viral Load in Adenoviral Keratoconjunctivitis.

The aim of this study was to evaluate the relationship between clinical findings and viral load in adenoviral keratoconjunctivitis (Ad-Kc). In this cross-sectional study, 30 eyes of 30 patients with Ad-Kc were assessed. Real-time polymerase chain reaction was performed to detect and quantify adenovirus in all samples. Patients were divided into three subgroups according to baseline viral load (<107, 107-108, >108 human adenovirus [HAdV] copies/mL). The duration of follow-up, HAdV DNA copy number, treatment regimen, and detailed clinical findings, including uncorrected visual acuity, eyelid edema, conjunctival hyperemia, chemosis, follicular reaction, corneal involvement, conjunctival pseudomembrane, and subepithelial infiltrates (SEIs) were recorded. This study showed that a high initial viral load was associated with the development of SEIs and pseudomembrane formation (P < 0.05). The clinical findings and ocular complications of Ad-Kc were similar in the treatment groups at the final examination (P > 0.05). Our results show that a high initial viral load in Ad-Kc may be predictive of inflammatory sequelae. Determining the initial viral load in Ad-Kc may help understand the clinical course of the disease better and prevent complications.

AIRWAY OBSTRUCTION FROM INFECTION-RELATED TRACHEOBRONCHIAL PSEUDOMEMBRANES

AIRWAY OBSTRUCTION FROM INFECTION-RELATED TRACHEOBRONCHIAL PSEUDOMEMBRANES

Necrotizing periodontal disease in a nutritionally deficient patient: A case report

Necrotizing periodontal disease (NPD) is a microbial infectious inflammatory disease of the gingiva and/or periodontium that is characterized by a rapid onset of inflammation, pain, and “punched out” cratered interdental papillae. Although NPD is not very common, diagnosis is mostly based on its unique clinical presentation. Some predisposing factors for developing NPD include poor oral hygiene, smoking, malnutrition, immunosuppression (such as in HIV infection, uncontrolled diabetes, and cancer), and stress. This case report presented a 22-year-old Caucasian female, heavy smoker but otherwise no systemic disease, who suffered from severe inflammation of the gingiva, ulceration, and necrosis of the interdental papillae, and pseudomembrane formation. The patient had been hospitalized for a seizure episode and was diagnosed with malnutrition-induced seizure. NPD was diagnosed and the patient was treated successfully with nonsurgical scaling and root planing and behavioral modifications including smoking cessation and balanced nutrition intake. Disease remission was achieved after treatment. In addition, the present case report reviewed the effect of nutrients on the health of the periodontium.

Management of Seasonal Viral Keratoconjunctivitis with Ganciclovir in a Regional Military Hospital

Introduction: Seasonal keratoconjunctivitis of military personals in Chattogram area causes loss of many working hours with prolonged sufferings. Objective: To explore the outcome of using Ganciclovir in seasonal viral keratoconjunctivitis in Combined Military Hospital, Chattogram. Methods: This prospective study was conducted in department of ophthalmology of Combined Military Hospital (CMH), Chattogram, from January 2013 to September 2018. Diagnosis was made by clinical signs, symptoms and laboratory study of conjunctival smear to exclude bacterial or fungal cause. Initially they were treated with artificial tear and antibiotic to prevent secondary bacterial infection. After three days of complete rest, the cases presented with static or further deteriorated condition were treated with Ganciclovir eye gel five times a day for two weeks. After subsidence of acute redness, topical dexamethasone was also applied for 4 times and then 3 times at one week interval. Follow up periods were 3 days, 1 week, 2 weeks, 4 weeks and 3 months subsequently. Results: A total of 2678 cases were included in our study. About 78% of the patients were male and 22% were female. 95% patients were from age group of young and serving personnel. Ganciclovir was used in 750 (28%) cases. With conventional treatment, recovery of sign symptoms took 3 weeks (SD-3±1 weeks). Recovery was observed within 10 (9±2 day) days in 450 (60%) cases of using Ganciclovir. Short term complications such as pseudomembrane formation were found in 24% cases and corneal ulcer in 1 case. Superficial punctate keratitis (SPK) was found in 22% cases even after 3 months. Conclusion: Treating viral conjunctivitis without long term vision impairing sequel is a challenging job due to nonspecific presentation. Without specific features of bacterial or fungal conjunctivitis, patients of seasonal keratoconjunctivitis treated with Ganciclovir provide prompt resolution which save working hours of serving personnel. JAFMC Bangladesh. Vol 17, No 2 (December) 2021: 29-32

Additive Effect of Parathyroid Hormone and Zoledronate Acid on Prevention Particle Wears-Induced Implant Loosening by Promoting Periprosthetic Bone Architecture and Strength in an Ovariectomized Rat Model.

Implant-generated particle wears are considered as the major cause for the induction of implant loosening, which is more susceptible to patients with osteoporosis. Monotherapy with parathyroid hormone (PTH) or zoledronate acid (ZOL) has been proven efficient for preventing early-stage periprosthetic osteolysis, while the combination therapy with PTH and ZOL has exerted beneficial effects on the treatment of posterior lumbar vertebral fusion and disuse osteopenia. However, PTH and ZOL still have not been licensed for the treatment of implant loosening to date clinically. In this study, we have explored the effect of single or combined administration with PTH and ZOL on implant loosening in a rat model of osteoporosis. After 12 weeks of ovariectomized surgery, a femoral particle-induced periprosthetic osteolysis model was established. Vehicle, PTH (5 days per week), ZOL (100 mg/kg per week), or combination therapy was utilized for another 6 weeks before sacrifice, followed by micro-CT, histology, mechanical testing, and bone turnover examination. PTH monotherapy or combined PTH with ZOL exerted a protective effect on maintaining implant stability by elevating periprosthetic bone mass and inhibiting pseudomembrane formation. Moreover, an additive effect was observed when combining PTH with ZOL, resulting in better fixation strength, higher periprosthetic bone mass, and less pseudomembrane than PTH monotherapy. Taken together, our results suggested that a combination therapy of PTH and ZOL might be a promising approach for the intervention of early-stage implant loosening in patients with osteoporosis.

A novel plasminogen mutation in a child with hereditary periodic syndrome: A case report

AbstractIntroductionPlasminogen (PLG) deficiency is an ultrarare disease. The reported manifestations in literature were linked to pseudomembrane formation and mucosal surfaces inflammation. Recently, PLG, its activators and its receptors have gained more attention in inflammation regulatory processes, including the release of proinflammatory signaling molecules, and thus its role is believed to have clinical implications beyond what has been known.Case ReportWe present a child with recurrent fever who, although managed initially as familial Mediterranean fever, later on, developed a constellation of findings that were not explained by a classified autoinflammatory disease. Genetic testing revealed a novel homozygous PLG mutation (PLG: c.466G&gt;A: p.D156N) and a likely benign heterozygous MEFV gene variant. We propose that the PLG mutation is responsible for the clinical manifestations, which may or may not be exacerbated by the coexistence of the MEFV variant. A relationship between the PLG pathway, inflammation, and FMF severity has been addressed recently in several studies.ConclusionThis report highlights the recently recognized role of the PLG pathway in inflammatory diseases and describes a potentially new presentation of PLG pathogenesis. Further studies are needed to confirm this finding and allow for a more definitive conclusion.