Mucosal Burns Research Articles

Case report: Mixed hydrofluoric and nitric acid mist inhalation poisoning

IntroductionHydrofluoric and nitric acids are strongly acidic substances with strong oxidation and are widely used in industrial production. Chemical pneumonia caused by the inhalation of strong acids has occasionally been reported. Severe chemical pneumonia can lead to acute pulmonary edema and life-threatening acute respiratory distress syndrome. The treatment of chemical pneumonia mainly relies on symptomatic and supportive treatment such as anti-inflammatory and anti-infection.Case descriptionThis study reports three cases of chemical pneumonia caused by the inhalation of a mixed hydrofluoric and nitric acid mist during an occupational exposure accident. After appropriate emergency symptomatic treatment, such as oxygenation and excretion promotion, cough, and difficulty in breathing were alleviated but not completely cleared.DiscussionMost of the literature reports damage caused by hydrogen fluoride on the skin and mucosal burns, and reports on lung damage caused by the inhalation of large amounts of hydrogen fluoride gas are relatively rare. Usually in the early stage of this kind of patients can have elevated blood picture, hypoxemia, pulmonary CT inflammatory plaque changes, so as to have obvious respiratory irritation symptoms. When inhaling a large amount of hydrofluorine mixed nitric acid mist, in addition to considering the occurrence of severe pneumonia, we should also be alert to the occurrence of other organ damage and electrolyte disorder.ConclusionAs occupational hydrogen fluoride gas inhalation poisoning often occurs in groups, improving the safety facilities and standard operations of small- and medium-sized enterprises is necessary. For medical workers, it is necessary to be alert to the occurrence of severe toxic pneumonia and severe fluorosis.

Hepatic Portal Venous Gas (HPVG) after Ingestion of Chlorine Bleach: A Transient Phenomenon.

We present a case involving a 32-year-old man who ingested chlorine bleach with self-defeating intent. The ingestion of bleach can lead to a wide range of consequences, from mild mucosal burns to severe complications, rarely resulting in death. This case highlights the association between chlorine bleach ingestion and the development of hepatic portal venous gas (HPVG), a radiological finding traditionally thought to carry poor prognoses. The HPVG in this case resolved spontaneously within 24 h with conservative management, indicating its transient nature. The exact pathophysiological mechanisms responsible for HPVG after the ingestion of toxic substances .remain only partially understood. One hypothesis suggests that extensive damage to the gastrointestinal wall caused by caustic agent may allow enteric gas to enter the portal system. While HPVG after toxic ingestion is often transient, its consequences and potential risks should be carefully considered. Hyperbaric oxygen therapy is suggested in cases with neurological symptoms. In conclusion, HPVG is not a specific disease but rather a manifestation of various underlying factors, and its development in the context of chlorine bleach ingestion represents an additional insight to its understanding. It can be associated with severe medical conditions, but it is also found in less severe cases that can be managed conservatively.

Oral mucosal burn in a neonate due to accidental wart medicine intake

Caustic ingestion is a problem frequently encountered in children younger than five years of age and mostly in developing countries. It may result in eusophagial, laryngeal, orophanryngeal and oral lesions. An 18 day-old-girl brought to emergency room because she was mistakenly given her fathers’s wart medicine instead of her daily vitamin D medicine. There were severe hyperemia and erosions at her lips, oral mucosa and oropharynx. Her oral nutrition was stopped and intravenous protone pump inhibitor drug has initiated. There were no evidence of gastrointestinal perforation at her abdomen X-ray. Her laboratory test results were completely normal. Endoscopic evaluation was not planned at early period because of her severe oral mucosal lesions. She recieved intravenous methylprednisolone for three days.. An eusophagogastroduedonoscopy was performed on day seven and reported to be normal. She has fully recovered without any sequalea. In this article, incorrect drug use and caustic exposure which are one of the most common household accidents were discussed over a newborn case.

Evaluation of Pediatric Early Warning System and Drooling Reluctance Oropharynx Others Leukocytosis scores as prognostic tools for pediatric caustic ingestion: a two-center, cross-sectional study.

Caustic chemicals are widely distributed in our environment. Exposure to caustic agents is a lifelong problem associated with severe tissue and mucous membrane injuries. In pediatrics, corrosive exposure is the most common cause of nonpharmaceutical exposure presenting to poison control centers. Therefore, this study evaluated the role of the Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) scores as early in-hospital outcome predictors following corrosive ingestion. The current study was a two-center, retrospective, cross-sectional study carried out among pediatric patients diagnosed with acute caustic ingestion during the past 4 years. Most exposure occurred accidentally among boys (59.4%) living in rural areas (51.9%) of preschool age (50% were 2–4 years old). Residence, body temperature, respiratory rate, vomiting, skin and mucosal burns, retrosternal pain, respiratory distress, Oxygen (O2) saturation, Glasgow Coma Scale score, HCO3 level, total bilirubin level, anemia, leukocytosis, and presence of free peritoneal fluid were significant predictors of esophageal injuries (p < 0.05). DROOL and PEWS scoring were the most significant predictors of esophageal injuries with worthy predictive power, where odds ratio (95% confidence interval (CI)) was 1.76 (0.97–3.17) and 0.47 (0.21–0.99) for PEWS and DROOL, respectively. At a cutoff of < 6.5, the DROOL score could predict esophageal injuries excellently, with AUC = 0.931; sensitivity, 91.7%; specificity, 72.5%; and overall accuracy, 91.3%. At a cutoff of > 6.5, PEWS could significantly predict unfavorable outcomes, with AUC = 0.893; sensitivity, 94.4%; specificity, 71.9%; and overall accuracy, 89.3%. However, PEWS better predicted the need for admittance to the intensive care unit (ICU). Pediatric Early Warning System (PEWS) and Drooling Reluctance Oropharynx Others Leukocytosis (DROOL) are potentially useful accurate scorings that could predict the esophageal injuries and ICU admission following corrosive ingestion in pediatrics.

Pengaruh Gel Ekstrak Daun Kenitu (Chrysophyllum cainito L.) terhadap Reepitelisasi pada Penyembuhan Luka Bakar Mukosa Bukal Tikus Wistar

Burn therapy involves elimination of causative factors and symptomatic therapy. Kenitu leaves (Chrysophyllum cainito L.) are known to contain β-amylin acetate, Gallic acid, ursolic acid, quercetin, β-sitosterol, and other substances that have the potential to be antibacterial, antioxidant, and anti-inflammatory. The use of kenitu leaves (Chrysophyllum cainito L.) as an alternative to wound healing has low side effects and is easy to obtain, especially in Jember Regency. The aim of this study was to examine the effect of kenitu leaves (Chrysophyllum cainito L.) leaf extract gel on re-epithelialization in buccal mucosal burns of wistar rats. This type of research is experimental laboratories. This research used 32 samples which divided into four control groups and four treatment groups. Burns are made on the left buccal mucosa. In the control group the CMC placebo gel was given and the treatment group was given 2% leaf extract gel. Euthanasia was performed on days 4, 7, 10, and 13 then histological preparations were made. Measurement using software optilab viewer 2.2 and image raster 3.0. The average yield of epithelial thickness was lowest in the control group on day 4 and highest in the treatment group on day 13. The results of the One Way Anova statistical test showed a significant difference in epithelial thickness between the control group and the treatment group. This study proved that the 2% leaf extract can accelerate the process of reepithelialization in the healing of wistar mucosal mucosal burns.

Effect of Clinacanthus nutans leaf extract on oral mucosal burns and tongue wounds: An in-vivo study

Background: Clinacanthus nutans exhibits antioxidant, anti-inflammatory, antiviral, anticancer, and anti-biofilm activities. Wounds in the oral cavity can affect the quality of life. Wound healing is a complex process to restore functions of injured tissues. The effect of C. nutans on oral mucosal burns and tongue wounds of rats is investigated. Methods: Forty male Sprague Dawley rats were divided into negative control and treatment groups with 25, 50, and 100 mg/mL of C. nutans. Oral mucosal burns and tongue wounds were observed on days 7 and 14 based on the fibroblast count and collagen deposits. Data were analyzed by analysis of variance and post hoc Tukey’s test with P < 0.05. Results: Results revealed that on day 7, the fibroblast count of mucosal burns and tongue wounds increases. The maximum mucosal burns were observed for the 100 mg/mL group, whereas the maximum tongue wounds were observed for the 25 mg/mL group. On day 7, collagen deposits were increased in case of mucosal burns. The number of collagen deposits increased on day 14, the highest mucosal burns were observed for the 100 mg/mL group, and in case of tongue wounds, the highest number was observed for the 50 mg/mL group. Conclusion: Ethanol extracts of C. nutans leaves can increase the fibroblast count on day 7 and collagen deposits on day 14 after injury in case of oral mucosal burns and tongue wounds during the wound healing of Sprague Dawley rats.

Use of “tilapia” as a therapeutic agent in oral mucosal burns: An unprecedented proposal

Water bodies purvey plenty of natural resources that are utilized to manufacture materials or are employed as novel medicines in medical and dental practice. Among sponges, corals, fishes, and other marine life forms, one promising source is the “tilapia fish.” It is principally farmed for the utilization and construction of therapeutic biomaterials. As oral physicians or dental practitioners, we grapple with many oral lesions and wounds in routine practice, “burns” being one of them. Tilapia skin and its collagen are being applied for dermatological burns. Since the branch of medicine encourages innovative ideas and research work in the treatment of challenging oral lesions, this article aims to communicate the idea of its usefulness in oral burns and alike lesions, making tilapia a neoteric healing agent, keeping in mind the remarkable biological properties it possesses.

Allium sativum: Oral mucosal burn

Introduction: Oral medicine practitioner has reported many cases of chemical burn in the oral mucosa. Inappropriate self-treatment with topical application of various therapeutic or non-therapeutic agents often causes chemical burns. Garlic is a century old herb, commonly used in culinary which can cause oral mucosal burns when misused. Case Description: A male patient aged 55 years, reported to the department with a history of tooth pain since one month which had increased in intensity 3 days back. To alleviate the dental pain he had applied crushed raw garlic (Allium sativum) at the site of pain for 60 minutes consecutively for 3 days before visiting the hospital. On intra-oral clinical examination, white pseudo membranous lesion surrounded by erythema was noted on right posterior maxillary and mandibular attach gingiva. At the site of crushed raw garlic application, localized tissue necrosis was observed. The patient was advised to stop self-treatment with raw garlic and was prescribed systemic and topical analgesics to relieve the dental pain. Conclusion: This case report highlights the importance of clinical case history recording. The oral physician should be aware of the herbs like garlic which are commonly used to alleviate pain, which can cause adverse effects like mucosal burn if used inappropriately. Keywords: Chemical burn, garlic, Allium sativum, Oral soft-tissue burns, Mucosal burn.

Use of low-molecular-weight heparin in severe paraquat poisoning: a case report

BackgroundAcute paraquat ingestion remains a leading cause of mortality in developing countries. There is currently no evidence that treatment with high-dose immunosuppressants and antioxidants improves survival in patients with paraquat poisoning, and better options are urgently needed. Here, we describe the unexpected survival and recovery of a patient with a potentially fatal paraquat poisoning.Case presentationAfter ingesting 28 mL of paraquat (20% ion w/v), confirmed by a deep blue color in the urine dithionite test (UDT), a 17-year-old Hispanic Colombian boy was treated according to the hospital protocol with cyclophosphamide, methylprednisolone, N-acetylcysteine, vitamin E and propranolol. Gastrointestinal endoscopy showed extensive ulceration and necrosis. As a novelty, enoxaparin at a single dose of 60 mg was added to his treatment. Despite the evidence of severe mucosal burns in the gastrointestinal tract and high paraquat concentrations found in the UDT, the clinical condition began to improve after 1 day of treatment, with full recovery and discharge from hospital after 21 days.ConclusionsAlthough the amount of paraquat ingested by the patient was large and the UDT indicated severe poisoning with a somber prognosis, unexpected survival of the patient was observed, and the addition of enoxaparin was the only change from the standard treatment.

A Rare Complication of Chlorhexidine: Buccal Mucosal Burn

A 45-year-old woman with a diagnosis of primary hyperparathyroidism was treated by transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). Two days after the surgery, she was diagnosed with buccal mucosal burn due to frequent use of chlorhexidine mouthwash than suggested. The buccal mucosal burn was healed by itself after discontinuing chlorhexidine mouthwash without any special treatment in 10 days.

Biocompatible and degradable Bletilla striata polysaccharide hemostasis sponges constructed from natural medicinal herb Bletilla striata

Medicinal herb Bletilla striata as a traditional Chinese herb has been used to treat alimentary canal mucosal damage, ulcers, bruises, and burns for thousands of years. Despite numerous efforts directed at the development of Bletilla striata products, the challenge of preparing Bletilla striata hemostasis dressings while simultaneously maintaining portability and high hemostasis performance has not yet been addressed. Herein, we describe a Bletilla striata polysaccharide (BSP) sponge with hierarchical aligned porous channels formed via directional freeze technology. The microstructure and mechanical property of the BSP sponges could be controlled by modifying the BSP concentration. Notably, in vivo animal studies indicated that BSP sponges show high biocompatibility and degradation and possess excellent hemostasis capability. In addition, BSP sponges showed accelerated wound healing in comparison to commercial dressings. Thus, our study indicates that the constructed BSP sponges could find potential application in dressings for efficient wound healing.

Effects of vitamin D3 on intestinal mucosal barrier of mice with severe burns

Objective: To explore the effects of vitamin D3 on intestinal mucosal barrier of mice with severe burns. Methods: Forty-two C57BL/6C male mice aged eight to twelve weeks were divided into vitamin D3 vehicle+ sham injury group of seven mice, vitamin D3 vehicle+ burn injury group of fourteen mice, vitamin D3+ sham injury group of seven mice, and vitamin D3+ burn injury group of fourteen mice according to random number table. Mice in vitamin D3 vehicle+ sham injury group and vitamin D3 vehicle+ burn injury group were injected with vehicle of vitamin D3 at a dose of 0.1 mL intraperitoneally at 1, 24, and 48 h before burn experiment. Mice in vitamin D3+ sham injury group and vitamin D3+ burn injury group were injected with vitamin D3 at a dose of 100 ng/kg dissolved in 0.1 mL vehicle intraperitoneally at the same time points. Mice in vitamin D3 vehicle+ burn injury group and vitamin D3+ burn injury group were inflicted with 30% total body surface area full-thickness dermal scald (hereinafter referred to as burn) on the back by 98 ℃ hot water for 3 to 4 seconds. And mice in vitamin D3 vehicle+ sham injury group and vitamin D3+ sham injury were treated with 37 ℃ water on the back for 3 to 4 seconds to simulate injury. Seven mice in vitamin D3 vehicle+ sham injury group and seven mice in vitamin D3+ sham injury group at post injury hour (PIH) 24, and seven mice in vitamin D3 vehicle+ burn injury group and seven mice in vitamin D3+ burn injury group at PIH 6 and 24 were sacrificed respectively to collect mesentery lymph nodes, spleens, livers, and intestinal tissue. The mesentery lymph nodes, spleens, and livers of mice in each group were collected to observe growth of bacteria, and number of bacteria was counted. Intestinal tissue of mice in each group was collected to detect protein expressions of zonal occludin 1 (ZO-1) and occludin by immunohistochemistry staining method, distribution of ZO-1 by immunofluorescence staining method, and expression of occludin by Western blotting. Data were processed with Kruskal-Wallis H test, Nemenyi test, one-way analysis of variance, t test, and Bonferroni correction. Results: (1) At PIH 6 and 24, bacterial counts of mesentery lymph nodes, livers, and spleens of mice in vitamin D3 vehicle+ burn injury group were significantly higher than those of mice in vitamin D3 vehicle+ sham injury group (P<0.05). At PIH 6, bacterial counts of livers and spleens of mice in vitamin D3+ burn injury group were significantly lower than those of mice in vitamin D3 vehicle+ burn injury group (P<0.05). At PIH 24, bacterial counts of mesentery lymph nodes and livers of mice in vitamin D3+ burn injury group were significantly lower than those of mice in vitamin D3 vehicle+ burn injury group (P<0.05). (2) At PIH 6 and 24, expressions of ZO-1 and occludin of intestinal tissue of mice in vitamin D3 vehicle+ burn injury group were significantly lower than those of mice in vitamin D3 vehicle+ sham injury group, and expressions of ZO-1 and occludin of intestinal tissue of mice in vitamin D3+ burn injury group were close to those of mice in vitamin D3+ sham injury group. At PIH 6 and 24, expressions of ZO-1 and occludin of intestinal tissue of mice in vitamin D3+ burn injury group were significantly higher than those of mice in vitamin D3 vehicle+ burn injury group. (3) At PIH 6 and 24, compared with that of mice in vitamin D3 vehicle+ sham injury group, distribution of ZO-1 of intestinal mucosal epithelium of mice in vitamin D3 vehicle+ burn injury group was discontinuous. Distribution of ZO-1 of intestinal mucosal epithelium of mice in vitamin D3+ sham injury group was normal, and the distribution of ZO-1 of intestinal mucosal epithelium of mice in vitamin D3+ burn injury group was with good continuity. (4) At PIH 6 and 24, expressions of occludin of intestinal tissue of mice in vitamin D3 vehicle+ burn injury group were 0.720±0.003, 0.638±0.052 respectively, significantly lower than 0.918±0.003 of mice in vitamin D3 vehicle+ sham injury group (t=57.33, 5.36, P<0.05). At PIH 6 and 24, expressions of occludin of intestinal tissue of mice in vitamin D3+ burn injury group were 0.994±0.058, 1.064±0.060, close to 0.938±0.023 of mice in vitamin D3+ sham injury group (t=0.91, 1.96, P>0.05). At PIH 6 and 24, expressions of occludin of intestinal tissue of mice in vitamin D3 vehicle+ burn injury group were significantly lower than those of mice in vitamin D3+ burn injury group (t=4.75, 5.35, P<0.05). Conclusions: Intestinal bacterial translocation can occur in the early stage of severe burn. And vitamin D3 plays a protective role in the intestinal mucosal barrier post severe burn to reduce the bacterial translocation by protecting tight junction proteins of intestinal epithelium.

DIAGNOSTIC VALUE OF FROZEN SECTION COMPARED TO PERMANENT PATHOLOGY IN CAUSTIC INGESTION

Introduction:-&#x0D; Endoscopy is mandatory for assessment of severity of esophageal and gastric damage after corrosive burns. There are various mucosal damage classifications, which are unreliable for surgical decision making. Confirmation of endoscopic methods of burn depth estimation with pathologic findings is lacking. Faulty resection of burned esophagus and stomach based on mucosal damage also may be done. Second look has its own problem, and diagnostic doubt may still remain because intra-operative findings have not enough validity for decision making. New modality for rapid an accurate assessment of injury depth may be frozen section. &#x0D; Method and materials &#x0D; This is a blinded prospective study to evaluate the accuracy of frozen section in estimation of burn depth. Fifty one patients with grade 2 or 3 mucosal burn due to caustic injury underwent surgical exploration and biopsy taking. Samples reported by two pathologists. Grading of samples either frozen section or permanent compared to each other. Intraoperative judgment of the surgeon compared with pathologic findings. Interrater reliability of examinations compared to each other by the kappa statistic. &#x0D; Results &#x0D; Biopsy samples of fifty one patients with mean age of 33.4 years evaluated and compared to intra-operative findings .Thirty seven patients graded 2 and fourteen were in grade 3 endoscopy. At grade three, only 5 cases had the entire thickness of the stomach burn. Also, from 10 cases of gastrosophagectomy, 5 cases had mucous and under-mucous membranes burn. There were so many variations between pathologic diagnosis of burn depth and judgment of the surgeon (kappa&lt;0.2). &#x0D; Conclusion: &#x0D; Frozen section examination can be an accurate tool for final decision making in corrosive ingestion. Second look surgical exploration can be ignored from the management plan. Intraoperative opinion of a surgeon for estimating necrosis is not accurate. Futile resections are preventable, and Limited resection based on frozen section examination of burn margins will be possible. Limited resection probably made later reconstruction more feasible.

PS01.091: A DANGEROUS FOREIGN BODY IN ESOPHAGUS: ALKALINE BATTERIES

Abstract Background Esophageal foreign bodies are an important clinical condition leading to serious morbidity and mortality. Foreign body swallowing is most common in the group of 6 months to 6 years. Although smooth edges have a lower morbidity in foreign bodies, alkaline batteries are very dangerous. In this study, we aimed to evaluate the results of patients who ingested alkaline batteries. Methods We conducted a retrospective single-center study of 20 patients who were diagnosed with esophageal foreign objects following alkaline battery ingestion between January 2001 and February 2018. All cases were evaluated with posteroanterior chest X-ray and lateral X-ray. Age and sex of the patients, symptoms, localization of foreign body, the method of removing the foreign body, the passing time, length of hospital stay and morbidity and mortality rates were reviewed. Results The cases were 12 males and 8 females. The mean age was 3.2 years (1 month to 14 years). Five cases within 4 hours, 8 cases within 12 hours, 5 cases within 24 hours and 2 cases after 24 hours were referred to our clinic. The foreign body was located in the cervical esophagus in 10 cases, in the midthoracic esophagus in 8 cases, and in distal esophagus in two cases. All cases were quickly taken to the operating room. All cases underwent rigid esophagoscopy under general anesthesia and foreign body was removed. Sixteen cases of esophageal mucosal injury and burns were seen. Perforation and mortality were not observed in any of the cases. Conclusion Severe esophageal injury can occur in a short time after interaction with alkaline battery. Alkaline battery; electrolyte leak, pressure necrosis, mercury toxicity, or alkaline environment. Concentrated potassium hydroxide release has a corrosive effect. In this case, mediastinitis or tracheoesophageal fistula may ocur. Alkaline battery ingestion may result in persistent sequelae with perforation and corrosive esophagitis leading to mediastinitis. For this reason, the battery should be immediately removed by rigid esophagoscopy to prevent the development of these complications. Disclosure All authors have declared no conflicts of interest.

Management of Oral Lesions in Paraquat Poisoning - A Case Report

AbstractParaquat is a herbicide with a good occupational safety record, but a high mortality after intentional ingestion that has proved refractory to treatment. For nearly three decades p concentration–time data have been used to predict the outcome following ingestion, however, none of the published methods has been independently or prospectively validated. However, poisoning is an uncommon entity in India. We report a case of oral lesions associated with poisoning and management of the mucosal burns associated with it along with medical management of poisoning in general.

Circumostial Injection of Mitomycin C (COS-MMC) in External and Endoscopic Dacryocystorhinostomy

To evaluate the safety and efficacy of a new technique of circumostial mitomycin C (COS-MMC) injection in dacryocystorhinostomy (DCR) and to evaluate the outcomes. A prospective, interventional consecutive case series involving 110 DCR surgeries performed over a period of 1 year using the COS-MMC technique were evaluated. All patients were operated by a single surgeon (M.J.A.). After fashioning of the mucosal flaps, all patients underwent an intramucosal injection of 0.02% MMC at 4 points (0.1 ml at each point) along the edges of the freshly created ostium. All patients were intubated, and stent removal was done at 12 weeks following the surgery. All patients underwent regular monitoring of the ostium to look for any complications. A minimum follow up of 6 months after stent removal was considered for final analysis. The outcome measures analyzed were anatomical and functional success, complications, and ostium. The mean age at presentation was 39.91 years. The diagnosis was primary acquired nasolacrimal duct obstruction in 60.9% (67/110) and persistent congenital nasolacrimal duct obstruction in 9.1% (10/110) of the patients. Twenty-six patients were known cases of failed DCR and underwent a revision DCR. Of the total patients, 19.1% (21/110) had a history of acute dacryocystitis, of which, 73% (80/110) of the surgeries were performed by an external approach and 27% (30/110) by endoscopic endonasal route. Anatomical success was noted in 97.3% (107/110) and functional success in 96.4% (106/110). All the 4 failures were due to cicatricial closure of the ostium. None of the patients were noted to have mucosal burns in the area where MMC was injected, and none of the Ostia showed any features of necrosis, infection, or any other complications. COS-MMC is a safe and effective adjunctive modality in DCR. No adverse effects on the ostium were noted. The technique appears to be promising for the success of cases with high risk of failures like revision DCR and traumatic secondary acquired nasolacrimal duct obstruction.

Oral mucosal ulceration caused by the topical application of a concentrated propolis extract.

Propolis is a resinous mixture that is collected by honey bees from tree buds, sap flow, and other botanical sources. Propolis has been extensively used in medicine, dentistry, and cosmetics; however, unwanted effects have been reported. This paper reports a case of oral mucosal burn in a 50-year-old patient, who used an overnight application of concentrated propolis to overcome a throbbing pain in the right upper posterior mucosa. The patient was otherwise healthy and was not receiving any medication. She presented with painful shallow multiple irregular ulcers measuring 0.3–1 cm in diameter that were located on the right buccal mucosa and hard palate mucosa, in addition to the gingival mucosa surrounding tooth 17. Propolis-induced oral mucosal burn was diagnosed. The ulcer cleared after the prescription of tetracycline mouthwash, accompanied with Doloneurobion. The patient was further treated with carbamazepine to address the persistent throbbing pain in the affected area, which was suspected to be trigeminal neuralgia. This report provides another alert to clinicians about the potential adverse effects of propolis use for the treatment of oral diseases, despite its natural origin.

Tobacco use and oral health of inmates in a Nigerian prison

To determine the effect of tobacco use on oral health status of inmates of a federal prison in Enugu, Nigeria. The study involved 230 inmates of the Nigerian Prison in Enugu. An interviewer-administered questionnaire was used to collect data on the demographic characteristics of the participants, oral hygiene methods, and smoking habits. An intra-oral examination to determine their oral health status was done using simplified oral hygiene index (OHI-S) for the oral hygiene status, the modified decayed missing and filled teeth (DMFT) index for caries status, and community periodontal index of treatment needs (CPITN) for the periodontal needs. Statistical Package for Social Sciences software, version 15 was used to analyze data. One hundred and twenty participants (52.2%) were current smokers. Mean DMFT of smokers and nonsmokers were 2.38 ± 0.71 and 2.25 ± 0.83 respectively ( P = 0.508) while mean Community Periodontal Index (CPI) scores of smokers and nonsmokers were 4.71 ± 1.26 and 2.27 ± 0.86, respectively ( P = 0.276). Oral soft tissue lesions such as mucosal burn, oral leukoplakia-like lesions were found mainly in the tobacco users. Tobacco use had a negative effect on the oral health of the participants as smokers had worse oral health profile than non-smokers. They may benefit from counseling programs with the view to educate them on the effect of tobacco use on oral health and by extension, the general health. The full implementation of the Framework Convention on Tobacco Control (FCTC) treaty in Nigeria could help in curtailing these unwanted consequences of tobacco use.

珍稀药用植物白及光合与蒸腾生理生态及抗旱特性

The genus Bletilla,composting about six species,is endemic to Asia with a distribution pattern from N Myanmar and Indochina through China to Japan. The usage of the plants of Bletilla,mainly Bletilla striata( Thunb.) Reichb. f.,includes art( Chinese painting and writing),the production of porcelain,and medicine,as well as vegetable dyes for dyeing cloth in some minority people in Guizhou and Yunnan Province,China. Those species are also commonly used as a horticultural subject covering both indoors and out cultivation in North American and European areas. As the traditional herb medicine using more than 1500 years,pseudobulbs of Bletilla have been widely used in Eastern Asian countries to treat alimentary canal mucosal damage,ulcer,bleeding,bruises and burns. The pseudobulbs also show antibacterial,antiinflammatory,antiphlogistic and demulcent properties,and thus use in treating pneumonophthisis,pneumonorrhagia,tuberculosis and haemorrhage of the stomach or lung. Moreover,it is suggested that cationic polysaccharide from Bletilla strata can serve as a non-viral nucleotide drug delivery vehicle for oligonucleoide or siRNA targeting to immunology system.Apparently,there is a huge potential demand for the pseudobulbs of Bletilla in future. At present,the cultivation of Bletilla is only limited to the temperature areas of North America and Europe for the horticultural purpose,and the using of pseudobulbs of Bletilla for other purpose especially for medicinal purpose is basically based on wild resources.Undoubtedly,the wild resource of Bletilla will rapidly decrease in Eastern Asian Countries due to over collections as well as habitat destruction and fragmentation. The conflict between the great market demand for the pseudobulbs of Bletilla and the decreased wild resource has necessitated the breeding of cultivars for high yields,high concentrations of active components,and high resistance to diseases. Unfortunately,no cultivar has been bred so far and selections of superior individuals meeting the requirements are now underway from field and hybrid progenies. So we strengthened research on ecophysiological characteristics growing development of Bletilla. By using a Li-6400XT portable photosynthesis system,this paper studied the ecophysiological characteristics of photosynthesis-transpiration coupling of Bletilla striata during daily variation. The results showed that:( 1) The diurnal change in photosynthetic active radiation( PAR) and leaf temperature( Tl) are similar to each other,peaking around midday;( 2) Stomatal conductance( Gs),net photosynthetic rate( Pn)and transpiration rate( Tr) presented a bimodal pattern;( 3) Pn shows significant positive linear correlation with Tr( the slopes are 2. 38 and 3. 78,with correlation coefficients of 0. 883**and 0. 954**for sunny and cloudy days,respectively)and presented a good linear coupling with photosynthesis-transpiration of Bletilla striata during daily variation;( 4) The regression lines of PAR-Pn and PAR-Tr,Tl-Pn and Tl-Tr,and Gs-Pn and Gs-Tr are similar to each other,while no significant correlation was observed between Pn and Tl;( 5) Both Pn and Tr showed a positive dependence on PAR,Tl and Gs,with Gs being the main factor affecting Pn and Tr. Bletilla striata is a type of shade perennial plant able to flourish in conditions of low light intensity. The response of the physiological and biochemical indexes in Bletilla striata seedling leaves was compared under simulated drought stress using different concentrations( 0,5,20,40,60g / L) of PEG 6000 solution.The result showed that chlorophyll content takes on a negative correlation( R2= 0. 7854) with the increasing PEG concentration,and relative conductivity takes on a positive correlation( R2= 0. 8755) with the increasing PEG concentration. Under osmotic stress,using different concentrations of PEG 6000 solution,the relative water content of Bletilla striata showed a lower rate of reduction.

Unwitnessed lithium ion disc battery ingestion: case report and review of best practice management of an increasing clinical concern

To describe a case of unwitnessed lithium ion disc battery ingestion, with a review of radiology findings and current best practice management. A three-year-old girl presented following ingestion of a foreign body, which her four-year-old brother claimed was a one pound coin. The patient was managed non-urgently and transferred for specialist ENT assessment 6 hours following the initial ingestion, with no evidence of airway compromise. A corroded battery was removed from the level of the cricopharyngeus after 8 hours, with an associated circumferential mucosal burn. There is increasing concern regarding the acknowledged rising incidence of lithium ion disc battery ingestion. The lack of a high index of suspicion and the inability to recognise subtleties on imaging may lead to suboptimal management with a higher degree of unnecessary immediate and delayed morbidity. The recently published American Academy of Pediatrics Guidelines may guide the approach to managing battery ingestions.