Frothy Saliva Research Articles

Gastrointestinal mucosal damages caused by ingestion of corrosive substances: A case study of hydrochloric acid and sodium hydroxide.

Ingestion of corrosive substances is most common in children, while in adults causes more severe damages. Massive ingestion of corrosive substances results in severe damage to the gastrointestinal tract and oropharynx if not treated properly. Corrosive substances with pH<2 or >12 can result in severe esophageal damage with either colliquative (alkaline) or coagulative (acidic) necrosis and, at the same time various gastrointestinal injuries could lead to late post-corrosive complications. The aim of the case study was to report the gastrointestinal mucosal damages due to hydrochloric acid (HCl) and sodium hydroxide (NaOH) ingestion. A 55-year-old male patient was presented to the emergency room with a chief complaint of vomiting an hour before admission. Continuous vomiting with a volume of approximately 10-20 cc per vomit. The vomit was initially bluish and turned in to blackish brown over time. Other complaints included nausea, rapid breathing, heartburn, and burning mouth and throat, and had weakness and dizziness. The patient accidentally drank floor cleaning liquid containing HCl. The patient was diagnosed with hematemesis due to ulceration of esophageal, gastric, and duodenal mucosa induced by HCl. Tracheoesophageal fistula developed later in the patient as a long-term complication. Another a 22-year-old male patient was presented to the emergency room with chief complaints of nausea and vomiting an hour before admission. Headache and slight tightness were also experienced. The patient mouth felt burned pain in the solar plexus and frothy saliva. An hour earlier, the patient attempted suicide by drinking two bottles of floor cleaning liquid due to economic problems. The patient was diagnosed with erosive mucosal esophagogastroduodenum induced by NaOH. These cases highlight that intoxication with corrosive substances can complicate damage to the gastrointestinal mucosal and damage features depend on the type of substance concentration and quantity of the corrosive substance.

Semaglutide-associated hyposalivation: A report of case series

Rationale: Obesity and diabetes of different types are considered global health risks with rising prevalence. In addition to low-calorie diet and daily exercise, several treatment options have been introduced to help patient in needs. Semaglutide (Ozempic) is one popular agent, which attracted the attention of both physicians and patients due to its positive outcome in improving glucose control and weight loss. However, no reports on the effect of semaglutide use on the oral cavity and specifically xerostomia are available in the literature. We are reporting 3 cases for patients who were using semaglutide and developed secondary xerostomia. Patient concerns: Three female patients with median age of 34 (range 27–46) presented to the oral medicine clinic with chief complaint of xerostomia. All patients were overweight with a mean body mass index of 35.6 (range 35–37) and have been using semaglutide for weight loss for a mean duration of 11.3 weeks (range 6–16). Diagnoses: All 3 patients had severe dryness in the mouth with minimal frothy saliva with mean modified Schirmer test of 9 mL at 3 minutes (range 8–10 mL). Following exclusion of other possible underlying medical problems, the diagnosis of semaglutide-induced hyposalivation was given to all patients. Interventions: The patients’ management varied between discontinuation of the drug, the use of pilocarpine, and conservative symptomatic management. Outcomes: The patients resumed acceptable salivary flow. Lessons: We are reporting for the first time hyposalivation associated with the use of semaglutide. Further prospective, larger studies are warranted to confirm these findings.

COMPREHENSIVE MANAGEMENT OF ORAL FRAILTY IN MULTIPLE SYSTEMIC DISEASES GERIATRIC PATIENT

ABSTRACTBackground Oral frailty is an important geriatric syndrome characterized by decreases in oral function that coincides with declines in cognitive and physical function. Objective: The aim of this case report is to describe the comprehensive management of oral frailty in a medically compromised geriatric patient prior to cardiovascular surgery. Case: A 64-year-old male patient complained of pain in swallowing and sore mouth since two days before. He had multiple systemic diseases, including infective endocarditis, acute kidney injury, type II diabetes mellitus, thrombocytopenia, and electrolyte-fluid imbalance. Extra-oral examination showed lymphadenitis, icteric sclera, and dry-exfoliative lips. Intra-oral examination revealed tongue depapillation, frothy saliva, and dry mucosa with poor oral hygiene. The scraped-off white plaque leaving erythematous area was found on the dorsal and ventral tongue, buccal mucosa, and hard palate. Irregular multiple major ulcers, surrounded by erythema, well-demarcated with yellowish concave base, and covered by thick yellowish-green sputum at the soft palate to the uvula. The diagnosis was exfoliative cheilitis, aphthous-like ulcer, acute pseudomembranous candidiasis, and moderate xerostomia. A D-E-N-T-A-L questionnaire was used to evaluate oral frailty, and the cumulative result was seven. Case Management: The patient was treated with 100% petroleum jelly, 0.12% chlorhexidine digluconate mouthwash, and chlorine dioxide-zinc mouthwash three times a day. The oral lesions showed significant improvement after one week of treatment. Conclusion: Appropriate therapy for oral lesions and eliminating the infection could be considered to minimize the long-term effect of oral frailty. The comprehensive management of oral frailty could be beneficial for improving the quality of life. Keywords: Geriatric, Oral frailty, Oral lesion, Systemic disease

Etiology of Pneumoparotid: A Systematic Review.

Pneumoparotid describes retrogradely insufflated air within the Stensen's duct and/or parotid gland. It is a rare condition with variable causative factors. This study aimed to elucidate the clinical characteristics of pneumoparotid. Reports in all languages were evaluated following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement 2020. A literature search was conducted using electronic medical databases (PubMed, Scopus, Web of Science, EBSCO, Ovid, Google Scholar, SciElo, LILIACS, and others) from 1890 to 30 June 2022. One hundred and seventy patients (mean age; 28.4 years) from 126 studies were reviewed. Common symptoms included swelling (84.7%) and pain (35.9%). Characteristic findings were crepitus in the parotid region (40%) and frothy saliva from the orifice (39.4%). The common etiologies included abnormal habits such as blowing out the cheeks (23.5%), idiopathic (20%), self-induced (15.9%), playing wind instruments such as trumpets or flutes (8.8%), and diseases inducing coughing or sneezing (8.2%). The treatments included antibiotic therapy (30%), behavioral therapy to avoid continuing causative habits (25.9%), psychiatric therapy (8.2%), and surgical procedures (8.2%). Treatment should be individualized and etiology-based. However, the etiology was not identified in 20% of patients. Further detailed data from larger samples are required to clarify and improve the recognition of this entity.

Frothy saliva—A novel indicator to assess stereotypies in sows?

The present study aimed at introducing a reliable and more feasible indicator to evaluate stereotypies in sows in comparison with the ‘Welfare Quality® animal welfare assessment protocol for sows and piglets’. Therefore, the indicators for the assessment of stereotypies of the Welfare Quality® protocol for sows and piglets as the gold standard (sham chewing, tongue rolling, teeth grinding, bar, drinker, trough biting and floor licking) were tested in relation to the potential indicator ‘frothy saliva’ in an on-farm study on farrowing farms. The analysis included the correlation between indicators, their interobserver agreement and test-retest reliability. Therefore, Spearman’s rank correlation coefficient (RS), intraclass correlation coefficient (ICC), smallest detectable change (SDC) and limits of agreement (LoA) were used. As results, the potential indicator ‘frothy saliva’ showed an acceptable correlation with the most observed indicator sham chewing (RS 0.42), which was in turn correlated to the indicator tongue rolling (RS 0.35). ‘Frothy saliva’ showed similar interobserver agreement as the indicators for the assessment of stereotypies, e.g. ‘frothy saliva’ (RS 0.90 ICC 0.93 SDC 0.16 LoA [−0.18;0.14]) and sham chewing (RS 0.96 ICC 0.94 SDC 0.11 LoA [−0.08;0.13]). Concerning its test-retest reliability, the results showed that the potential indicator ‘frothy saliva’ can be used to differentiate between farms (RS 0.61-0.87 ICC 0.74-0.91 SDC 0.20-0.35 LoA [−0.16;0.24]–[−0.46;0.25]), which matched the results of the indicators for the assessment of stereotypies, e.g. sham chewing (RS 0.81-0.93 ICC 0.80–0.91 SDC 0.16-0.23 LoA [−0.22;0.10]–[−0.24;0.21]). Sensitivity, specificity and regarding result parameters confirmed the usefulness of the potential indicator ‘frothy saliva’ on-farm (sensitivity 0.86, specificity 0.62, positive likelihood ratio 2.26, negative likelihood ratio 0.23). However, organic enrichment material can be a confounding factor. So does the currently still unknown relationship between ‘frothy saliva’ and non-stereotypic foraging or eating activities of sows. Besides that, the potential indicator ‘frothy saliva’ proved to be as reliable as the indicators for the assessment of stereotypies and demonstrated higher feasibility. Hence, the use of the potential indicator ‘frothy saliva’ is recommended to assess stereotypies in sows. Thereby, it could contribute to an improvement of the Welfare Quality® protocol for sows and piglets.

CASE REPORT: A DISEASE OUTBREAK OF BOVINE RESPIRATORY SYNCYTIAL VIRUS IN TAIWAN

A dairy farm with 300 Holstein cattle in Hsin-Chu County, Taiwan, had an outbreak of a respiratory disease from the end of September to November, 2013. Adult animals (1–5-year-old) showed clinical symptoms of anorexia, depression, fever, and dropped milk production during the early stage of infection. In severe cases, animals suffered from dyspnea with frothy saliva at the edge of opened mouth. Samples were collected from eight sick animals, amplified in the baby hamster kidney cell-21 (BHK-21), and the cytopathic effect (CPE) was confirmed. Primers specific to Bovine respiratory syncytial virus (BRSV), Bovine viral diarrhea virus (BVDV), Bovine herpesvirus type I (BHV-I), Bovine ephemeral fever virus (BEFV) and Mannheimia haemolytica were used to identify the pathogen responsible for this respiratory disease by polymerase chain reaction (PCR). Results of sequence analysis confirmed that BRSV is the causative pathogen for the respiratory infection. This is, to the best of our knowledge, the first disease case of BRSV reported in Taiwan.

Comparison of Specimens for Detection of Porcine Reproductive and Respiratory Syndrome Virus Infection in Boar Studs

Porcine reproductive and respiratory syndrome virus (PRRSV)-contaminated semen from boars is a route of transmission to females, and early detection of PRRSV infection in boars is a key component in sow farm biosecurity. The purpose of this study was to determine the optimum diagnostic specimen(s) for the detection of acute PRRSV infection in boars. Individually housed boars (n = 15) were trained for semen and oral fluid collection and then vaccinated with a commercial PRRSV modified live virus vaccine. Starting on the day of vaccination and for 14 days thereafter, oral fluid specimens were collected daily from all boars. The 15 boars were subdivided into three groups of 5, and serum, blood swabs and 'frothy saliva' were collected at the time of semen collection on a 3-day rotation. Frothy saliva, derived from the submandibular salivary gland, is produced by aroused boars. Semen was centrifuged, and semen supernatant and cell fractions were tested separately. All samples were randomly ordered and then tested by PRRSV real-time quantitative reverse-transcription polymerase chain reaction assay (rRT-PCR) and PRRSV antibody ELISA. In this study, a comparison of serum, blood swab, and oral fluid rRT-PCR results found no statistically significant differences in the onset of detection or proportion of positives, but serum was numerically superior to oral fluids for early detection. Serum and oral fluid provided identical rRT-PCR results at ≥ 5 day post-vaccination. Likewise, the onset of detection of PRRSV antibody in serum, oral fluid and frothy saliva was statistically equivalent, with serum results again showing a numerical advantage. These results showed that the highest assurance of providing PRRSV-negative semen to sow farms should be based on rRT-PCR testing of serum collected at the time of semen collection. This approach can be augmented with oral fluid sampling from a random selection of uncollected boars to provide for statistically valid surveillance of the boar stud.

A Case of Pneumoparotid: Initially Presented with Viral Parotitis

Parotid gland swellings are usually caused by viral and bacterial infections. Among the causes of non-infectious swellings, pneumoparotid is a rare condition which refers to the pathologic state of air within the parotid gland. This condition has been described in the medical literature under several names such as pneumoparotid, pneumoparotitis, pneumosialadenitis, wind parotitis, and pneumatocele glandulae parotis. The mechanism that causes the air reflux is an excessive increase in intraoral pressure. Patients typically present with painless swelling in the parotid region. There is crepitus on palpation of the gland, and frothy saliva or air bubbles may be observed emanating from Stensen’s duct during massage of the gland. Here, we report an unusual case of pneumoparotid initially presented with viral parotitis in the epidemic area of mumps.

Radiology Quiz Case 3

A 30-YEAR-OLD MAN PRESENTED WITH A long-standing history of bilateral, intermittent facial pain and swelling. He recalled multiple episodes of these symptoms occurring intermittently each year since he was 8 years old. The episodes included bilateral pain and swelling over the cheeks and preauricular areas that typically lasted for hours to days. In addition to the pain and swelling, he stated that during certain episodes he noticed an audible sound of “wind” when he massaged or pressed the area in front of his ear. The number of episodes had increased over the past year, and he had been seen by a primary care physician and an otolaryngologist for his symptoms. The findings of previous imaging had appeared normal according to the patient, and he had been treated with oral antibiotics during previous episodes. He had no history of trauma or dental problems. He had a 15 pack-year history of smoking and occasional alcohol use. He denied weight loss and chronic fevers and had received all childhood immunizations. On physical examination, the areas over the parotid gland and preauricular soft tissue appeared to be full to the touch and tender on both sides, with no erythema noted. Oral cavity examination showed frothy saliva coming from each parotid duct during palpation over the ipsilateral aspect of the cheek, but no purulent drainage. Further palpation over the left parotid gland elicited an audible sound that can be described as a release of gas. A computed tomogram was obtained 2 days after consultation (Figure 1 and Figure 2). What is your diagnosis?

Oral mucosa in children with Prader-Willi syndrome

Prader-Willi syndrome is a genetic disorder. Abnormal saliva secretion, emotional and behaviour problems, may affect the health status of the oral mucousa. To assess the impact of self-destructive behaviour and abnormal saliva secretion on the oral mucosa in children with Prader-Willi syndrome (PWS). Fifteen PWS's children (mean age 9.8 ± 4.4 years) and 15 healthy children (mean age 11.5 ± 3.5 years) were assessed for self-destructive behaviours, such as picking at the skin, physical and chemical saliva characteristics, mycology, and the clinical status of the oral mucosa. Picking at the skin was only in children with PWS (n = 12). In contrast to the control group, the moistening rate of the lower lip mucosa was slower, and the mean pH of the resting saliva was reduced in the affected subjects. Sticky frothy or frothy saliva, decreased secretion rate of the stimulated saliva, and a reduced buffer capacity were more frequently in PWS's children; Candida spp. and oral candidiasis were also more common. Injurious lesions in the oral mucosa were found in one control child, and in eight PWS's subjects. In affected children, the lesions were concurrent with picking at the skin. A statistical correlation was noted between the presence of Candida spp. and oral candidiasis, and unfavourable saliva properties, and between injurious lesions and a slow moistening rate of the lower lip mucosa, and oral candidiasis. Abnormal saliva secretion and self-destructive behaviours in children with Prader-Willi syndrome predispose them to injurious lesions in the oral mucosa, and possibly, to oral candidiosis.

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Cough in specific populations (paediatric patients, elderly patients and patients with underlying disease)

Pneumoparotid: A case report

Pneumoparotid is an unusual condition resulting from air being forced into the parotid ductal system. When it develops, it is a result of increased intraoral air pressure. Diagnosis is based on the etiologic factor, palpatory evidence of tissue emphysema, the escape of frothy saliva from the involved duct, and the sialographic finding of retained ductal air and ductal infection.

The involvement of boar submaxillary salivary gland secretions in boar-induced precocious puberty attainment in the gilt

The involvement of secretions from boar submaxillary salivary glands in mediating the induction of precocious puberty in the gilt was investigated as follows. Forty-eight Large White × (Large White × Landrace) prepubertal gilts from 12 litters were randomly allocated within litters by weight, to four treatment groups of six, in two replicates, at 145 days of age. Treatments commencing at a mean group age of 165 days, were: (1) control (no boar exposure); (2) gilts exposed to a mature sialectomised boar (submaxillary salivary glands were removed at 9 weeks of age); (3) gilts exposed to a mature sham-operated boar; (4) gilts exposed to a mature unoperated boar. Boar exposure occurred for 30 min per day for 75 days, or until pubertal oestrus was observed. Gilts showing pubertal oestrus were removed and slaughtered. Ovaries were examined to confirm reproductive status. Gilts failing to exhibit oestrus by 240 days of age were slaughtered and nominally ascribed a pubertal age of 245 days. Age at puberty was significantly earlier in all three boar-exposed treatments than in the control treatment ( P<0.05 for treatments 2 and 3, P<0.001 for treatment 4; median ages at puberty being 227.0, 203.5 , 202.0 and 179.0 days for treatments 1 to 4 respectively). No frothy saliva was ever produced by the sialectomised boar, and chromatographic analysis of saliva produced by the sham-operated boar during mating revealed very low levels of 16-androstene pheromones, while levels in the unoperated boar's saliva were normal. These results provide further evidence for an important role of boar salivary pheromones in the induction of precocious puberty attainment in the gilt.

Clinical features of neurotoxic snake bite and response to antivenom in 47 children.

Among 47 children admitted to the Chulalongkorn Medical School Hospital for neurotoxic snake bite, the attackers were identified in 15; the cobra (Naja naja) was the snake involved in all cases. Clinical manifestations in all 47 children appeared to follow a similar pattern. Drowsiness heralded the systemic effects in most of the patients. The characteristic systemic signs were those resulting from the neuromuscular effects of the venom and included ptosis, frothy saliva, slurred speech, respiratory failure, and paralysis of the skeletal muscles. These episodes occurred within 8 hours in 94% of the cases, and at the latest 19 hours following the bite. In some cases unconsciousness accompanied respiratory failure. Necrosis in the region of the bite, the prominent local sign, developed in 40% of the cases at the end of the 1st week after the bite. Infusion of specific antivenom was an effective therapeutic measure for the neuromuscular changes. Respiratory assistance was mandatory in cases of respiratory failure. Edrophonium chloride demonstrated a supportive role as a countermeasure against the neuromuscular effects.

Pig courtship behaviour: pheromonal property of androstene steroids in male submaxillary secretion

ABSTRACTThe influence of the odoriferous androstene steroids upon the response and courtship behaviour of gilts has been studied. These steroids are normally present in the submaxillary salivary glands of the boar, and have been shown previously to be an aid in the artificial insemination of gilts. Glands were excised from young boars after weaning, and at 6 months of age the ability of the boars to elicit a standing response from oestrous gilts was compared with that of littermate controls. In addition, a detailed record was made of behavioural activities performed by both gilts and boars, under a standard test procedure.Analysis of the data showed that the presence of the glands was essential for normal behavioural patterns in both the females and the males. When confronted with a treated boar, the gilts were affected in three ways: approaching oestrus, they did not respond as early as they did to the controls; the intensity of their response was reduced; and it was held for a shorter period. The demeanour of the treated males was passive and unconcerned, i n contrast to the easily-aroused aggressive nature of the controls. The characteristic viscous salivary secretion was absent, and the scrotal sac was less pronounced and supported closer to the body.These results suggest that elimination of the white, frothy saliva normally containing and dispersing the androstene steroids not only reduces the boar's ability to command and elicit a full sexual response from oestrous gilts, but it also reduces his own libido. In conjunction with previous work, these studies provide evidence for the pheromonal properties of androstenone and androstenol.

970 Frothing at the mouth: What Arp and Creip left out: Johnson, K. J. (1965). Frothy saliva due to food allergy. Ann. Allergy23, 277

970 Frothing at the mouth: What Arp and Creip left out: Johnson, K. J. (1965). Frothy saliva due to food allergy. Ann. Allergy23, 277