Hyperemic Areas Research Articles

Detecting Conjunctival Hyperemia Using an Effective Machine Learning based Method

Among the many complex sensory organs, the human eye stands out. Prevention of eye illnesses is of the utmost importance since irreversible vision loss might result from postponed treatment. Therefore, to manage the continuous course of eye illnesses, early identification and monitoring are vital. Hyperemia, or redness, from increased blood flow, is one sign of conjunctivitis, an eye disorder defined by inflammation of the conjunctiva. Many illnesses and problems are often curable or significantly reducible with the help of the greatest medicines, sophisticated procedures, and early, accurate diagnosis by medical experts. Because there is a severe lack of diagnostic specialists, patients with vision difficulties are often not given the care they need because their conditions are not properly diagnosed. Segmentation approaches are crucial for detecting and quantifying hyperemic areas, which are necessary for diagnosing and evaluating conjunctivitis. This paper presents a very efficient machine learning framework for the detection of eye problems. The system does this by integrating segmentation approaches with feature extraction techniques. The use of the discrete cosine transform (DCT) generates feature vectors from the segmented regions of interest. Random forests and neural networks are two machine learning classifiers that are learned using feature vectors. This approach has a 96% success rate and has potential to assist ophthalmologists in assessing the severity of illnesses in objective and accurate manner. This strategy might be advantageous for adopting ICT-based solutions in public health systems in remote regions.

Key Clinical and Histopathological Features of a Pterygium-Like Induced Lesion in a Rabbit Model.

Surgery is the definitive treatment for pterygium; therefore, reliable animal models are required for translational research. The goal of this investigation was to establish a standardized preclinical model of pterygium-like lesion. A subconjunctival injection of fibroblasts (NIH3T3) and extracellular matrix was administered to 22 New Zealand rabbits. Clinical evaluation was assessed at different points, the severity of the lesion was scored according to four grades and correlated with the area of hyperemia and the histopathological findings on day 23. Thirteen of 22 eyes (60%) developed pterygium-like lesions after 7days and progressed through different grades. Initially, grade 3, characterized by an elevated and fleshiness conjunctiva with tortuous hyperemia, was evident on day 7. By day 15, lesion decreased to grade 2, with less elevation and hyperemia. Subsequent improvement was noted, with grade 1 on day 18. Finally, day 23 was marked by a white‒yellow lesion, classified as grade 4. The area of hyperemia increased from grade 2 to grade 3 (P < 0.05) and decreased from grade 3 to grade 4 (P ≤ 0.05). Histopathological analysis revealed a tendency toward increasing inflammation at grades 2, 3, and 4. There was a correlation between clinical features and the degree of inflammation. Subconjunctival injection of NIH3T3 and extracellular matrix induces a pterygium-like lesion that progresses across four grades, beginning with an acute inflammatory process that evolve a chronic form. This study provides a replicable model for simulating pterygium. The development of a standardized preclinical model of pterygium to evaluate new pharmacological or surgical treatments.

Impaired Microvascular Reactivity in Patients with Chronic Kidney Disease Submitted to Kidney Transplantation: A Prospective Observational Study

Introduction: The effect of kidney transplantation on endothelial dysfunction and autonomic dysfunction in uremia remains controversial, and few studies have evaluated this question. Endothelial dysfunction and autonomic dysfunction, both, be assessed noninvasively using laser Doppler flowmetry (LDF). This study evaluated cutaneous microvascular blood flow and reactivity using LDF in patients undergoing kidney transplantation. Methods: This prospective longitudinal cohort study involved 40 patients with chronic kidney disease (CKD) undergoing kidney transplantation, compared with 40 patients without kidney disease. Using LDF, post-occlusive reactive hyperemia (PORH) (resting flow [RF], peak flow, ratio between peak, and RF, hyperemic area, PORH index), and sympathetic constrictor response to inspiratory breath-hold (mean minimum inspiratory values) were evaluated. Results: RF and sympathetic constrictor response to inspiratory breath-hold (mean minimum inspiratory values), were lower in the CKD group at 1 week and at 3 months after transplantation (p < 0.005). Mean minimum inspiratory values increase in the CKD group, 3 months after transplantation. Conclusion: Compared with controls with no CKD, in CKD patients undergoing kidney transplantation, microcirculation by LDF shows improvement after 3 months.

Arterial function in response to a 50km ultramarathon in recreational athletes.

This study was performed to determine whether prolonged endurance running results in acute endothelial dysfunction and wave-reflection, as endothelial dysfunction and arterial stiffness are cardiovascular risk factors. Vascular function (conduit artery/macrovascular and resistance artery/microvascular) was assessed in 11 experienced runners (8 males, 3 females) before, during and after a 50km ultramarathon. Blood pressure (BP), heart rate (HR), wave reflection, augmentation index (AIx) and AIx corrected for HR (AIx75) were taken at all time points-Baseline (BL), following 10, 20, 30 and 40km, 1h post-completion (1HP) and 24h post-completion (24HP). Flow-mediated dilatation (FMD) and inflammatory biomarkers were examined at BL, 1HP and 24HP. Reactive hyperaemia area under the curve (AUC) and shear rate AUC to peak dilatation were lower (∼75%) at 1HP compared with BL (P<0.001 for both) and reactive hyperaemia was higher at 24HP (∼27%) compared with BL (P=0.018). Compared to BL, both mean central systolicBP and mean central diastolic BP were 7% and 10% higher, respectively, following 10km and 6% and 9% higher, respectively, following 20km, and then decreased by 5% and 8%, respectively, at 24HP (P<0.05 for all). AIx (%) decreased following 20km and following 40km compared with BL (P<0.05 for both) but increased following 40km when corrected for HR (AIx75) compared with BL (P=0.02). Forward wave amplitude significantly increased at 10km (15%) compared with BL (P=0.049), whereas backward wave reflection and reflected magnitude were similar at all time points. FMD and baseline diameter remained similar. These data indicate preservation of macrovascular (endothelial) function, but not microvascular function resulting from the 50km ultramarathon.

The Impact of Cardiorespiratory and Metabolic Parameters on Match Running Performance (MRP) in National-Level Football Players: A Multiple Regression Analysis

The aim of the study was to examine the association between cardiorespiratory and metabolic parameters and match running performance (MRP) in highly trained football players. The sample of participants consisted of 41 national-level football players (aged 23.20 ± 3.40 years, body height 182.00 ± 5.15 cm, and body mass 76.86 ± 6.06 kg) from the Serbian Super league. For the purposes of this research, the following measurements were applied. A maximal multistage progressive treadmill test, with a direct measurement of maximal oxygen consumption (VO2max) (using Fitmate MED, Cosmed, Rome, Italy) was conducted, alongside continuous heart rate monitoring. Capillary blood samples were taken from the hyperemic area using specific test strips, and, after sample collection, lactate concentration was immediately determined using a lactate analyzer. MRP variables were analyzed according to the BioIRC model of motion structure analysis, based on existing standards for profiling movement intensity. The results of multiple regression analysis indicated an association between cardiac parameters and total distance (R2 = 54.3%, p = 0.000), high-speed running (R2 = 46.4%, p = 0.000), and jogging (R2 = 33.6%, p = 0.004). Regression analysis revealed an association between cardiorespiratory parameters and total distance (R2 = 24.8%, p = 0.014), and high-speed running (R2 = 20%, p = 0.039). Meanwhile, no association was found between lactate concentration and running performance. The explanation for these regression analysis results is based on the observation that functional abilities represent significant potential for expressing movement performance, a crucial condition for success in football.

Hug sign in intraprocedural cone-beam-CT to predict short-term response to combined treatment of hepatocellular carcinoma

ObjectivesCombined treatment of ablation and chemoembolization for hepatocellular carcinoma represents a promising therapy to increase treatment efficacy and improve patient survival. The “hug sign” is a recently introduced radiological sign consisting in deposition of beads/contrast agent during transarterial chemoembolization in the hyperemic area surrounding the post-ablation volume, seen during intraprocedural unenhanced cone-beam CT, that may indicate intraprocedural success. Aim of our retrospective study was to analyze the usefulness of the “hug sign” at the intraprocedural unenhanced cone-beam CT as an early predictor of response to combined treatment, based on the hug sign angle.Materials and methodsBetween January 2017 and September 2021 all patients with hepatocellular carcinoma which underwent a combined treatment of thermal ablation followed by chemoembolization were enrolled. All treated patients underwent immediate post-procedural unenhanced cone-beam CT to evaluate the deposition of contrast agent, lipiodol or radiopaque beads and to assess the percentage of coverage of the ablated area with the contrast agent (hug sign angle). Patients with missing pre-procedural, intra-procedural and/or post-procedural data/imaging, or with poor-quality post-procedural cone-beam CT images were excluded.Results128 patients (mean age, 69.3 years ± 1.1 [standard deviation]; 87 men) were evaluated. Our study evidenced that 84.4% (81/85) of patients with a hug sign angle of 360° had no residual tumor at the first 1-/3-months follow-up examination. A hug sign angle of 360° also showed to be an independent protective factor against residual tumor at multivariate analysis.ConclusionUnenhanced cone-beam CT performed at the end of a combined treatment with ablation plus chemoembolization can effectively predict an early treatment response on radiological images, when a hug sign angle of 360° was detected.

Combined surgical and chemotherapy treatment for invasive primary urethral cancer: a case presentation

BackgroundThe European Association of Urology (EAU) defines primary urethral carcinoma (PUC) as a carcinoma that arises in the urethra without a previous diagnosis of carcinoma elsewhere in the urinary system. It is considered as a rare cancer, accounting for less than 1% of all malignant tumors and 5% of malignant tumors of the urinary system. The difficulty in diagnosis and its rarity can lead to delayed diagnosis and decreased survival. We think that a case report to be made in the literature for this rare disease with no consensus on treatment will contribute to disease management.Case presentationIn this article, we describe the diagnosis and treatment process of a 75-year-old patient who was diagnosed with primary urethral cancer and had urethral discharge and difficulty in urination. The biopsy result from the suspected hyperemic area in the urethra in cystourethroscopy was primary urethral cancer. Urethrectomy followed by urethroplasty was performed on the patient's 2-cm primary urethral cancerous tissue. In the postoperative first month, an F-18 FDG whole-body PET scan for oncological evaluation showed increased pathological F-18 FDG uptake in the periphery of the mass in the penile urethra and indistinguishable boundaries from the prostatic urethra. After this, adjuvant gemcitabine and carboplatin therapy was planned by the oncology team.ConclusionsBased on our outcome in this case, we believe that chemotherapy combined with surgery increases the chance of successful treatment in locally advanced urethral cancer.

Evaluation of the efficacy and tolerability of the combination of lidocaine + phenazone in the local therapy of acute otitis media at the doperforative stage in adults

Introduction. Acute otitis media is a widespread multifactorial disease characterized by inflammatory changes in the mucosa of all parts of the middle ear. One of the most important tasks in the early stages of the disease is adequate anesthesia of patients. The article provides a retrospective assessment of the efficacy (speed of analgesia) and tolerability of topical use of Otipax® (lidocaine + phenazone) in adult patients with acute otitis media before perforation, the timing of its use is justified.Aim. To assess the efficacy and tolerability of topical Otipax® in adult patients with pre-perforated acute otitis media prescribed by a physician in routine practice.Materials and methods. Outpatient maps of 50 adult patients with acute otitis media were analyzed.Results. In almost all 50 patients after the use of Otipax®, the analgesic effect occurred after 3 minutes. The analgesic effect remained on average for 35–40 minutes, then the pain gradually resumed, but in dynamics there was a decrease in its intensity. Hearing loss and ear congestion were initially noted in all patients, by the 3rd visit these complaints persisted, but their intensity was significantly lower, on the 10th day of observation there were no subjectively impaired hearing in any of the patients, which corresponded to acumetric and tuning fork data. The anti-inflammatory effect of Otipax® after a day provided a significant decrease in the intensity and area of hyperemia and infiltration of the eardrum. After 10 days, almost all patients had no otoscopic signs of otitis media. No adverse events were reported during the follow-up period.Conclusions. The use of Otipax® (lidocaine + phenazone) ear drops complies with the clinical guidelines of the Ministry of Health of the Russian Federation in 2021 for the treatment of patients with acute otitis media before perforation, effectively and safely, is the method of choice for reducing ear pain in patients already at the primary appointment.

Abstract 15476: Advanced Assessment of Regional Differences in Myocardial Perfusion by Spectral CT in Patients With Acute Myocarditis

Introduction: Spectral CT (SCT) is a valuable tool for assessing coronary anatomy and myocardial damage. Iodine distribution maps (IDM) obtained by SCT serve as surrogates for first-pass myocardial perfusion, exhibiting reduced iodine uptake in ischemic areas and increased uptake in hyperemic areas due to inflammatory injury. Hypothesis: We aimed to determine if SCT data analysis can detect regional differences in first-pass myocardial perfusion reflecting inflammatory injury in acute myocarditis (AM) patients. Methods: We retrospectively searched for acute myocarditis patients admitted to our center who also underwent SCT angiography to rule out CAD. Spectral images (40 keV monoenergetic images and IDM) from a dual-layer CT scanner (Philips Spectral CT 7500) were analyzed using a perfusion tool developed by Philips Research. LV myocardium was segmented following the AHA-17 model, and CT number (HU) and iodine density values (mg/ml) were quantified. Data were normalized using blood pool values. Healthy controls were included for comparison and differences were assessed with a one-way ANOVA. Results: Six patients with myocarditis (median age: 57 [IQR 30-65]; table 1) and 3 controls (median age: 50 [IQR: 47.5-59.5]) were analyzed. Myocarditis patients (figure 1) showed higher normalized median iodine density values (ratio 0.13 vs. 0.11, p&lt;0.001) and similar differences in 40 keV monoenergetic images (ratio 0.16 vs. 0.13, p=0.005). Conclusions: Spectral CT data analysis can detect first-pass myocardial perfusion differences in acute myocarditis patients, likely reflecting hyperemia. Further research is needed to evaluate the clinical benefits of SCT in this context.

Hydroxychloroquine is effective in oral lichen planus: A multicenter, randomized, controlled trial.

This study was aimed to evaluate the safety and benefit of short-term application of hydroxychloroquine in the management of atrophic/erosive/ulcerative oral lichen planus (OLP). This multicenter, randomized, controlled, evaluator-blinded, prospective clinical trial was performed from October 1, 2019, to September 1, 2022. A total of 99 patients were randomized to receive systemic use of hydroxychloroquine (n = 50), or topical use of 0.05% dexamethasone (n = 49) for 4 weeks. The response to both treatment modalities was evaluated according to reticulation, hyperemic, and ulceration (RHU) score and visual analog scale (VAS) score. After 4 weeks of medication, both groups showed substantial reduction in RHU and VAS score (p < 0.05). In hydroxychloroquine group, the average of RHU score was reduced from 10.60 to 7.68 (dropped 27.49%), and the average of VAS score was reduced from 3.74 to 2.47 (dropped 34.09%). There were no differences between the two groups in reduction of RHU score and VAS score (p > 0.05). Single factor analysis found hyperemic area (p = 0.019) and erosive/ulcerative area (p = 0.024) had impacts on drug efficacy of hydroxychloroquine, and logistic regression revealed that no factors (p > 0.05) influenced its efficacy. These findings indicate hydroxychloroquine is a safe and effective agent in treating atrophic/erosive/ulcerative OLP.

Reactive hyperemia half-time response is associated with skeletal muscle oxygen saturation changes during cycling exercise.

We investigated the relationship between muscle microvascular responses during reactive hyperemia as assessed using near-infrared spectroscopy (NIRS) with changes in skeletal muscle oxygen saturation during exercise. Thirty young untrained adults (M/W: 20/10; 23±5years) completed a maximal cycling exercise test to determine exercise intensities performed on a subsequent visit separated by seven days. At the second visit, post-occlusive reactive hyperemia was measured as changes in NIRS-derived tissue saturation index (TSI) at the left vastus lateralis muscle. Variables of interest included desaturation magnitude, resaturation rate, resaturation half-time, and hyperemic area under the curve. Afterwards, two 4-minute bouts of moderate intensity cycling followed by one bout of severe intensity cycling to fatigue took place while TSI was measured at the vastus lateralis muscle. TSI was averaged across the last 60-s of each moderate intensity bout then averaged together for analysis, and at 60-s into severe exercise. The change in TSI (∆TSI) during exercise is expressed relative to a 20W cycling baseline. On average, the ΔTSI was -3.4±2.4% and -7.2±2.8% during moderate and severe intensity cycling, respectively. Resaturation half-time was correlated with the ΔTSI during moderate (r=-0.42, P=0.01) and severe (r=-0.53, P=0.002) intensity exercise. No other reactive hyperemia variable was found to correlate with ΔTSI. These results indicate that resaturation half-time during reactive hyperemia represents a resting muscle microvascular measure that associates with the degree of skeletal muscle desaturation during exercise in young adults.

The effect of Chromolaena odorata on endometriosis implants in mice model of endometriosis

Introduction: Endometriosis is a benign gynecological disease whose pathogenesis mechanism is not fully understood with treatment modality with hormonal and surgical methods aiming to relieve symptoms, suppress progression, and increase fertility. This study aims to observe the differences in the administration of Chromolaena odorata leaf extract on the area of endometriosis implants in the mice model of endometriosis Materials and Methods: This study was an experimental study with a Randomized Separated Pre and Post Test Design research conducted with the control group. Thirty mice (Mus musculus) were injected with 0.2 ml/mice of cyclosporine A. Then endometrial tissue was injected into the peritoneal cavity, followed by 0.1 ml Ethinyl estradiol/mice injections on the 1st and 5th days. Mice were reared for 14 days until the endometriosis model was formed. Mice models of endometriosis were randomly divided into five groups: endometriosis mice that were terminated on day 14 (pretest), then the other groups are endometriosis mice given Aquadest as placebo (P0), endometriosis mice treated with Chromolaena odorata leaf extract at a dose of 400 mg per kilograms of body weigh (mg/kgBW) (P1), 800 mg/kgBW (P2) and 1200 mg/kgBW (P3) for 14 days. On the twenty-eighth day, mice were dissected to examine and assess the extent of endometriosis implantation macroscopically in hyperemic areas by taking samples in the most hyperemic areas of the peritoneal wall. Research data were analyzed using SPSS Version 22. Results: From this study, the average value of endometriosis implant area in the group given Chromolaena odorata leaf extract was 400 mg/kgBW (P1 = 15.60 mm2), 800 mg/kgBW (P2=14.23 mm2) and 1200 mg/kgBW (P3=0.00 mm2) was lower than the pretest group (P=104.72 mm2) and the placebo group (P0 = 153.89 mm2), showing a significant difference (p&lt;0.001). There was a tendency that the area of endometriosis implants was also lower in the group receiving a higher dose of Chromolaena odorata leaf extract 1200 mg/kgBW (P3=0.00 mm2) than the group receiving a dose of 400 mg/kgBW (P1=15.60 mm2) and 800 mg/kgBW (P2=14.23 mm2). Conclusions: It can be concluded that the administration of Chromolaena odorata leaf extract can reduce the area of endometriosis implants in mice models of endometriosis. Higher doses result in the lower endometrial implant area.

Septicemia caused by an emerging pathogen, Elizabethkingia miricola, in a laboratory colony of African dwarf frogs (Hymenochirus curtipes).

An outbreak of morbidity and mortality in an African dwarf frog (Hymenochirus curtipes) colony was reported following arrival at an animal research facility. Animals were found dead on arrival or became moribund shortly thereafter, and additional animals showed clinical signs of lethargy, weight loss, and anorexia over the following 3 weeks. Externally, some affected animals presented with multifocal areas of hyperemia in the inguinal and axillary areas and on the limbs, and mottled tan discoloration along the ventral abdomen. Histologically, lesions were consistent with generalized septicemia, characterized by granulomatous meningitis, otitis media, peritonitis (coelomitis), myocarditis and pericarditis, nephritis, pneumonia, and arthritis. Gram staining identified gram-negative rod-shaped bacteria free within tissues and within macrophages. Culture results of coelomic swabs identified moderate to numerous Elizabethkingia miricola. Testing of water from tanks housing affected animals showed elevated levels of nitrites and ammonia, and the presence of Citrobacter, Aeromonas, Pseudomonas, and Staphylococcus spp. cultured from several tank biofilters. E miricola is a newly recognized and rapidly emerging opportunistic pathogen in anurans and has been reported as a cause of septicemia in humans. This report documents the first occurrence of E. miricola septicemia in African dwarf frogs and illustrates the importance of this potential pathogen in the laboratory setting for amphibian research colonies, as well as those individuals directly working with them.

Acetaminophen-induced hepatotoxicity predominantly via inhibiting Nrf2 antioxidative pathway and activating TLR4-NF-κB-MAPK inflammatory response in mice

To explore the action time and molecular mechanism underlying the effect of acetaminophen (APAP) on liver injury. APAP was used to establish drug-induced liver injury (DILI) model in mice. Mice in the model group were intraperitoneally injected 300 mg/kg APAP for 6, 12, and 24 h respectively, and control group mice were given the same volume of normal saline. The mice were anesthetized through intravenous injection of sodium pentobarbital at 6, 12, and 24 h after APAP poisoning. Analysis of ALT, AST and ALP in serum, liver histopathological observation, oxidative damage and western blot were performed. The livers in APAP exposed mice were pale, smaller, with a rough texture, and poorly arranged cells. Lesions, large areas of hyperemia, inflammation, swelling, poorly cell arrangement, necrosis, and apoptosis of liver cells were obvious in the liver tissue sections. Serum ALT, AST and ALP levels were significantly enhanced at 12 h of APAP adminstration mice than that of in control group mice (P＜0.05). The histopathological alterations and proinflammatory cytokines (IL-1β, TNF-α and IL-6) levels were most severe at 12 h of APAP-induced hepatotoxicity. APAP treatment induced oxidative stress by decreasing hepatic activities of superoxide dismutase (SOD) and glutathione (GSH) (P＜0.05), and enhancing malondialdehyde (MDA) content (P＜0.05). Moreover, APAP inhibited erythroid 2-related factor 2 (Nrf2) antioxidative pathway with decreased of Nrf2 and HO-1 proteins levels. Furthermore, APAP aggravated the activation of NLRP3 inflammasome by increasing of NLRP3, caspase-1, ASC, IL-1β and IL-18 proteins levels. Finally, APAP further significantly activated the toll-like receptor 4 (TLR4), nuclear factor-kappa B (NF-κB) and mitogen-activated protein kinases (MAPKs) signaling pathways. This study demonstrated that APAP-induced hepatotoxicity by inhibiting of Nrf2 antioxidative pathway and promoting TLR4-NF-κB-MAPK inflammatory response and NLRP3 inflammasome activation.

Efficacy of light chain 3-fused protein multi epitope in protection of mice challenged with Mycobacterium tuberculosis.

The new strategy for vaccine development such as the fused protein multi-epitope capable of preventing the reactivation of latent tuberculosis infection (LTBi) can be an effective strategy for controlling tuberculosis (TB) worldwide. This study was conducted to evaluate the immunity of experimentally infected BALB/c mice with Mycobacterium tuberculosis after injection of DNA construct. Nineteen female BALB/c mice were divided into three groups and injected with 0.50 mL of M. tuberculosis. After 3 weeks, lung and spleen samples from the infected mice were examined. The protective effects of light chain 3-fused protein multi-epitope against TB were evaluated for post-exposure and therapeutic exposure. The lungs and spleens of the mice were aseptically removed after death for histopathology analysis. The bacterial colonies were counted, and the cells were stained after 3 weeks of incubation. No significant differences were observed between the post-exposure and therapeutic exposure groups. The pathological changes in the lung tissue of mice in these groups included an increase in the thickness of interalveolar septa, hyperemia, and intraparenchymal pulmonary hemorrhage centers (positive control), scattered hyperemic areas (negative control), and hyperemia in the interstitial tissue, scattered hyperemic areas in the lung parenchyma and lymphocytic infiltration centers (experimental group). Flow cytometry of the post-exposure and therapeutic exposure models showed insignificant changes in all three groups. It seems necessary to develop a post-exposure and therapeutic exposure vaccine strategy that focuses on LTBi to prevent the progression of the active disease. In this regard, multi-epitope vaccines should be designed to induce both cellular and humoral immunity.

​The Downregulation of Pro-inflammatory Cytokine Interleukin-6 after Oral Administration of Lactobacillus plantarum IS-10506 in Mice Model for Endometriosis

Background: As a multi-functional cytokine, interleukin-6 (IL-6) is advanced in endometriosis. Probiotics are known to be able to modulate/regulate immune responses through downregulation of the pro-inflammatory cytokine IL-6. Lactobacillus plantarum IS-10506 (LIS-10506) is a novel probiotics strain derived from curd (a milk product which look like a yogurt) from traditionally made from buffalo milk or usually called by dadih from West Sumatra, Indonesia. This investigation intended to comprehend the impact of LIS-10506 administration on IL-6 expression in the endometrial tissue, serum IL-6 levels and endometriosis implant areas in mice model for endometriosis. Methods: This study conducted at the Animal Laboratory, Professor Nidom Foundation, Surabaya, Indonesia from January to June 2021. This experimental study was conducted on 32 adult female mice 12 weeks old divided into 4 groups in a completely randomized design with a posttest only control group design. LIS-10506 microencapsulation of curd was administered orally at a dose of 109 CFU/mice/day for 7 and 21 days. Serum IL-6 levels were assessed using IL-6 ELISA Kit for mice, IL-6 expression was assessed semi quantitatively according to the Remmele method and implant areas were measured by the area of hyperemia in mice’s peritoneal wall. Result: This investigation revealed that the peritoneal IL-6 expression and implant area experienced a decrease. In summary, the administration of LIS-10506 could downregulate pro-inflammatory cytokine IL-6. This present study has demonstrated the effect of LIS-10506 on one of the pathophysiological pathways in endometriosis.

Emphysematous cystitis as a potential marker of severe Crohn's disease

BackgroundEmphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing organisms. However, EC has also been reported in the setting of infectious colitis suggesting an alternate etiology. We report a rare case of EC in the setting of severe Crohn’s colitis with no clinical evidence of UTI.Case presentationA 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, weight loss of 10 kg and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. An extensive infectious workup was negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia. Immunohistochemistry was negative for CMV. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. Despite appropriate escalation of therapies, the patient developed colonic perforation requiring subtotal colectomy.ConclusionThis is a rare case of EC in a patient with severe Crohn’s colitis. There was no evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC may be a poor prognostic factor.

An Audit of more than a Thousand uppergastrointestinal Endoscopy in a Tertiary Care Teaching Hospital in South India

Background: Esophagogastroduodeno (EGD) scopy is a benchmark in the modern era of medicine. It is a sensitive tool used to evaluate the upper gastrointestinal (GI) symptoms. Application of EGDscopy is not merely restricted to diagnosis but as well used for therapeutic purpose. Aim of the Study: To find out the common indications for EGDscopy and its findings in a large tertiary care hospital attached to Bangalore medical college and research institute (BMCRI), Bengaluru. Materials and Methods: A retrospective study was conducted on 1030 patients either admitted or seen on outpatient basis at the Bowring and Lady Curzon hospital attached to BMCRI, Bengaluru with the upper GI symptoms like dyspepsia, dysphagia, epigastric pain abdomen, hematemesis etc from September 2016 to August 2018 and the data was analyzed using appropriate statistical methods. Results: Out of 1030 patients who underwent EGDscopy 62% were male and 61% were 31-59year old. The major indications for EGDscopy were epigastric abdominal pain (18%), dyspepsia (18%), chronic liver disease (15%), dysphagia (11%) and hematemesis (8%). The common pathological findings in the above mentioned indications were gastritis and esophagitis in patient with both epigastric abdominal pain and dyspepsia, portal hypertensive gastropathy and esophageal varices in chronic liver disease, esophageal growth in dysphagia and esophageal varices (EV) in cases of hematemesis. Conclusions: The following insights/observations were made during the course of our study-dysphagia is not just oropharyngeal or esophageal in origin but H. pylori gastritis can cause similar complaints, eradication of which relieves the symptoms in our observation. Chronic abdominal pain associated with postprandial urgency which is deemed as Inflammatory Bowel Disease-Diarrhea (IBS-D) may actually be H. pylori gastritis with exaggerated gastro-colic reflex which gets relieved with anti- H. pylori treatment; further studies are needed to prove this claim. Mosaic like pattern with focal areas of hyperemia in the gastric body mucosa is not just typical of portal hypertensive gastropathy but also can be seen with H. pylori gastritis. Corrosive acid ingestion as a mode of suicidal attempt is common in this part of India which can lead to morbidity and even mortality in severe cases, legislative measures need to be put in place to check the sale and use of corrosive acid. Diffuse white spots in duodenum were mostly due to chronic nonspecific duodenitis rather than intestinal lymphangiectasia in our study.

Lipoma Removal Surgery in White-Rumped Shama (Kittacincla malabarica macraoura)

Lipoma in birds is a benign tumor of adipose cells that often occurs in the subcutaneous area. White-rumped shama, more than three years old, was rushed to the puskesmas with symptoms of decreased activity and singing ability. The results of the examination were two round, multi-focal masses, firmly demarcated, yellowish in color with a soft, chewy consistency measuring ± 4 x 2 x 1 cm on the chest and ± 1 x 1 x 1 cm. in the abdominal area, firmly attached to the subcutaneous layer since six months ago, and getting bigger. The feathers around the mass are shed and vascularized on the surface of the mass. Surgery was performed because the mass suspected of being a tumor growing rapidly and causing pain. It was fasted two hours before surgery and the anesthetic used was a combination of ketamine HCl and xylazine. Postoperative therapy using the antibiotic enrofloxacin, ketoprofen analgesics, 0.9% NaCl fluid therapy and topical antibiotic gentamicin ointment. The tumor that has been successfully removed is yellowish in color with several areas of hyperemia and an oily surface. The results of histopathological examination characterized by the presence of adipose cells that appeared to proliferate well confirmed that the tumor was a lipoma.

Similar inflammatory response and conduit artery vascular function between sexes following induced inflammation

What is the central question of this study? Are there sex differences in vascular function following induced inflammation when oestrogen is typically similar between sexes? What is the main finding and its importance? The present study suggests no sex differences in conduit artery vascular responses to acutely induced inflammation during the low-oestrogen phase of the menstrual cycle in premenopausal women. However, women exhibit lower microvascular function than men. Overall, the results underpin the role of oestrogen in previously observed sex differences and the importance of reporting the phase in the hormonal cycle when women are studied. Sex differences in cardiovascular disease incidence in premenopausal women and age-matched men have been attributed to the cardioprotective influence of oestrogen. However, limited knowledge exists regarding sex differences following acute inflammation when oestrogen concentrations are lower in women. We evaluated sex differences in vascular responses to induced inflammation when oestrogen concentrations are typically lower in women (early follicular phase or placebo phase of hormonal contraception). In 15 women and 14 men, interleukin-6 (IL-6) concentrations and vascular function [via brachial artery flow-mediated dilatation (FMD)] were assessed at baseline (BL) and 24 (24H) and 48hours (48H) after administration of influenza vaccine. After induction of inflammation, both sexes exhibited an increase in IL-6 concentrations at 24H [mean (SD) BL vs. 24H: women, 0.563 (0.50) vs. 1.141 (0.65) pg/ml; men, 0.385 (0.17) vs. 1.113 (0.69) pg/ml; P<0.05] that returned to near-baseline concentrations by 48H (BL vs. 48H, P>0.05). There were no sex differences in FMD, allometrically scaled FMD or IL-6 concentrations at any time point (P>0.05). Notably, women exhibited significantly lower microvascular function than men at every time point [P<0.05; reactive hyperaemic area under the curve (in arbitrary units): women, BL 35,512 (14,916), 24H 34,428 (14,292) and 48H 39,467 (13,936); men, BL 61,748 (27,324), 24H 75,028 (29,051) and 48H 59,532 (13,960)]. When oestrogen concentrations are typically lower in women, women exhibit a similar inflammatory response and conduit artery function, but lower microvascular response to reactive hyperaemia, in comparison to age-matched men.