Type Of Ulcer Research Articles

What do Patients Use for Treating Their Oral Ulcers? And How do these Treatments Affect Their Quality of Life?

Objectives: Oral ulceration forms a major category of oral lesions. Due to its effect on the quality of life, the patients seek treatment using various substances. This study investigated the types of treatments used by a sample of patients having all types of oral ulcers and its positive and negative effects on the patients' lives. Methods: This cross-sectional study included patients having different types of oral ulcers. Participants provided information about their previous treatments, the source of recommendation of its use and side effects linked to them. They filled the oral health impact profile-14 questionnaire to report the change in their quality of life after treatment. The patients' educational and social levels were tested as predictors for the use of non-conventional treatments. Results: Correct pharmaceutical treatments were administered y 34% of the participants; the most effective of which were systemic and topical steroids by ulcerative oral lichen planus patients; and vitamin supplements in recurrent aphthous stomatitis patients. The majority (64.2%) of the previously treated patients used non-conventional treatments, the most widely used of which was Tahini. Half of the patients using non-conventional treatments suffered side effects. The source of information of the self-medication was attributed mainly to the patients themselves, followed by friends and family members. Conclusion: This study reflects the widely spread habit of self-medication in our sample of patients having oral ulcers. It highlights the negative influence of these remedies.

Integrated mRNA-miRNA transcriptome analysis of bladder biopsies from patients with bladder pain syndrome identifies signaling alterations contributing to the disease pathogenesis

BackgroundInterstitial cystitis, or bladder pain syndrome (IC/BPS), is a chronic bladder disorder characterized by lower abdominal pain associated with the urinary bladder and accompanied by urinary frequency and urgency in the absence of identifiable causes. IC/PBS can be separated into the classic Hunner’s ulcerative type and the more prevalent non-ulcerative disease. Our aim was to unravel the biological processes and dysregulated cell signaling pathways leading to the bladder remodeling in non-ulcerative bladder pain syndrome (BPS) by studying the gene expression changes in the patients’ biopsies.MethodsWe performed paired microRNA (miRNA) and mRNA expression profiling in the bladder biopsies of BPS patients with non-Hunner interstitial cystitis phenotype, using comprehensive Next-generation sequencing (NGS) and studied the activated pathways and altered biological processes based on the global gene expression changes. Paired mRNA-miRNA transcriptome analysis delineated the regulatory role of the dysregulated miRNAs by identifying their targets in the disease-induced pathways.ResultsEIF2 Signaling and Regulation of eIF4 and p70S6K Signaling, activated in response to cellular stress, were among the most significantly regulated processes during BPS. Leukotriene Biosynthesis nociceptive pathway, important in inflammatory diseases and neuropathic pain, was also significantly activated. The biological processes identified using Gene Ontology over-representation analysis were clustered into six main functional groups: cell cycle regulation, chemotaxis of immune cells, muscle development, muscle contraction, remodeling of extracellular matrix and peripheral nervous system organization and development. Compared to the Hunner’s ulcerative type IC, activation of the immune pathways was modest in non-ulcerative BPS, limited to neutrophil chemotaxis and IFN-γ-mediated signaling. We identified 62 miRNAs, regulated and abundant in BPS and show that they target the mRNAs implicated in eIF2 signalling pathway.ConclusionsThe bladders of non-ulcerative BPS patients recruited in this study had alterations consistent with a strong cell proliferative response and an up-regulation of smooth muscle contractility, while the contribution of inflammatory processes was modest. Pathway analysis of the integrated mRNA-miRNA NGS dataset pinpointed important regulatory miRNAs whose dysregulation might contribute to the pathogenesis. Observed molecular changes in the peripheral nervous system organization and development indicate the potential role of local bladder innervation in the pain perceived in this type of BPS.

Isolation and Identification of Pathogenic Bacteria from Baime Fish (Mystus armatus) and Evaluation of Antibiotic Susceptibility

Aquaculture products (fish) can harbor pathogenic bacteria which are part of the natural micro-flora of the environment. The current study was carried out for the extraction and identification of fish pathogenic microbes from Baime fish (Mystus armatus). Diseased fresh-water fishes were collected from different water bodies and fish landing centers of two study areas, namely the City area, Jhenaidah region. Bacteria are one of the important causative agents of fish diseases in both wild and cultured fish and are responsible for serious economic losses. Pathogenic bacteria strain was isolated from the infected area of Baime (M. armatus) fish skin. After isolation, isolates were finally identified by their desired morphological, characteristics, and biochemical test. They were gram-negative, rod-shaped bacteria that showed positive reaction for catalase, able to ferment glucose and one is citrate negative and another is citrate positive. After being persuaded above-mentioned test isolates were identified as genus Aeromonas and Pseudomonas. The ulcer type disease of M. armatus, the isolate was tested against several antibiotics’ treatment. Pseudomonas strains isolated from M. armatus is susceptible to penicillin G (10 μg), amoxicillin (10 μg), erythromycin (15 μg), Tetracycline (30 μg), Kanamycin (30 μg), moderately susceptible to Co-trimoxazole (25 μg), and Resistance to ceftazidime (10 μg). Aeromonas strains isolated from M. armatus is susceptible to amoxicillin (10 μg), erythromycin (15 μg), Tetracycline (30 μg), moderately susceptible to ceftazidime (10 μg), and Resistance to Co-trimoxazole (25 μg), penicillin G (10 μg), Kanamycin (30 μg). The results of the present study constitute an advance in the available diagnostic and bacterial pathogens in fish farms.

Two novel CD40LG gene mutations causing X-linked hyper IgM syndrome in Vietnamese patients.

The X-linked hyper IgM syndrome is a primary immunodeficiency disorder (PID) due to mutations in the CD40LG gene. Hyper IgM syndrome is characterized by the absence or decreased levels of IgG and IgA and normal or elevated IgM levels in serum. Affected patients become susceptible to infections such as pneumonia, diarrhea, and skin ulcer types. Hematopoietic stem cell transplantation is the only treatment currently available and ideally performed before the age of 10 years. Early, accurate diagnosis will contribute to the effective treatment for patients with hyper IgM. The patients from different Vietnamese families who have been diagnosed with hyper IgM at The Allergy, Immunology and Rheumatology Department, Vietnam National Hospital Pediatrics, were performed a genetic analysis using whole exome sequencing. The mutations were confirmed by the Sanger sequencing method in patients and their families. The influence of the mutations was predicted with the in silico analysis tools: PROVEAN, SIFT, PolyPhen-2, and MutationTaster. In this study, two novel mutations (p.Thr254fs and p.Leu138Phe) in the CD40LG gene were found in Vietnamese patients with X-linked hyper IgM syndrome. Our results contribute to the general understanding of the etiology of the disease and can help diagnose the different forms of PID.

Anal canal epithelioid sarcoma: Case report and literature review

Soft tissue tumors account for less than 0.1% of colon and rectum malignant neoplasms. Epithelioid sarcoma is a subtype of undifferentiated soft tissue neoplasia that makes up 1% of this category; it is characterized by a slow progression, commonly affecting young male adults, with little or no response to chemotherapy and radiotherapy, leaving surgical resection their main therapeutic option to reduce recurrence. We here present the case of a 71-year-old male patient admitted for major rectorrhagia after evacuations and anal pain. During physical examination, a posterior anal sphincter induration was noted, which extended to the puborectal muscle. Anoscopy was performed where a thrombosed hemorrhoidal bundle was detected adjacent to a mass. In the later biopsy with immunohistochemistry, a proximal ulcer type, histological grade three epithelioid sarcoma was diagnosed. Subsequently, traditional abdominal perineal resection with colostomy was performed, resulting in favorable postoperative evolution and discharge after six days of the procedure. Keywords: soft tissue tumors; epithelioid sarcoma.

Local Management of Malignant and Unresectable Fungating Wounds: PEBO Assessment.

Malignant fungating wounds (MFWs) represent a major problem for public health. The most common symptoms associated with MFWs are pain, exudate, bleeding and odor. The aim of the study was to optimize the local management and dressing of MFWs. We developed a standardized 4- step approach to MFWs based on Pain, Exudate, Bleeding and Odor management in a case series of 24 patients: we call this the PEBO approach. We analyzed etiologies, localization, Quality of Life (QoL), pain and clinical signs and symptoms. We assessed the ulcers at baseline, after two weeks and after one month. In our study, most patients showed an improvement in the QoL using PEBO approach, although some experienced a deterioration in their general clinical conditions. Non-cytolesive cleansing, atraumatic dressings were applied to allow pain relief. Non-adherent dressings were combined with a secondary dressing in the case of exudate. Achieving hemostasis with dressing or medication is a priority in MFW management. Antibacterial dressings and odor absorbent dressings were used for odor absorption. Surgical debridement, adherent dressing and occlusive dressings were avoided. Dressing changes were programmed twice a week for four weeks. PEBO simplified the complex aspects of this type of ulcer, and could help physicians, nurses, and also the rest of the team, including the patients themselves and their family, in the multidisciplinary palliative care of MFWs.

Identifying risk factors for early neurological outcomes following thoracic endovascular aortic repair using the SUMMIT database.

The aim of this study was to assess risk factors for early neurological complications following thoracic endovascular aortic repair (TEVAR) for multiple thoracic aortic diseases using an aggregated dataset. The Study to Assess Outcomes After Endovascular Repair for Multiple Throacic Aortic Disease dataset included data from 6 studies evaluating Zenith thoracic endografts. Post hoc analysis identified early (30-day) neurological complications by TEVAR indication and corresponding risk factors. The study included 594 TEVAR patients (67% male; mean age 66 ± 15 years) with thoracic aortic aneurysm (n = 329), ulcer (n = 56), acute (n = 126) or non-acute (n = 33) type B aortic dissection (TBAD) or blunt injury (n = 50). Overall early stroke rate was 3.5% (n = 21). Overall early paraplegia and paraparesis rates were 1.3% (n = 8) and 2.5% (n = 15), respectively. Multivariable analysis identified acute TBAD [versus others, odds ratio (OR) = 3.47, 95% confidence internal (CI): 1.41-8.52) and longer procedural time (OR = 1.33, CI: 1.02-1.73) as early stroke risk factors. Risk factors for paraplegia or paraparesis included more endografts deployed (OR = 2.43, CI: 1.30-4.55), older age (OR = 1.05, CI: 1.01-1.10) and higher preoperative serum creatinine (OR = 1.31, CI: 1.05-1.64). Endografts landing proximal to the left subclavian artery (LSA) increased stroke rate (versus distal to the LSA; 6.8% vs 2.3%, P = 0.014). Intraoperative LSA revascularization was performed in 20.9% of patients with endografts proximal to the LSA; revascularization did not significantly alter stroke rate (8.1% with revascularization vs 6.4% without, P = 0.72). Acute TBAD and prolonged procedure time increased early stroke risk, while more endografts placed, age and preoperative renal impairment increased early paraplegia or paraparesis risk. For acute TBAD, endograft placement proximal to the LSA, but not LSA patency, increased stroke risk.

Poor local control of ulcerative T1 glottic cancer treated with 2.25-Gy per fraction radiotherapy.

ABSTRACTThe Tokai Study Group for Therapeutic Radiology and Oncology (TOSTRO) started managing T1 glottic cancer using 2.25 Gy/fraction radiotherapy in 2011. The aim was to evaluate the local control (LC) rate and toxicity with 2.25-Gy radiotherapy in clinical practice and identify prognostic factors.The eligibility criteria were T1 glottic squamous cell carcinoma patients with age ≥20 years, treated with 2.25 Gy/fraction without chemotherapy between 2011 and 2017. LC rates were evaluated based on age, performance status, sex, T-category, tumor type (ulcerative or non-ulcerative), presence of anterior commissure invasion, tumor size, X-ray beam energy, and overall treatment time. Acute and late adverse events were evaluated using CTCAE version 4.0. A total of 202 patients were enrolled. The median follow-up period was 34.2 months. The 2- and 4-year LC rates were 93.8% and 93.1%, respectively. There was a significant difference in the LC rate between non-ulcerative type and ulcerative type (95.2% vs. 74.1% at 2 years, 94.4% vs. 74.1% at 4 years; p = 0.01). On univariate analysis, only tumor type was significantly correlated with a poor LC rate (hazard ratio 4.3; 95% confidence interval 1.2–15.4; p = 0.03). Acute grade 3 adverse events occurred in 17 patients. However, no late adverse events of grade 3 or higher have occurred to date. T1 glottic cancer treatment outcomes using hypofractionated radiotherapy with 2.25 Gy/fraction in clinical practice were comparable to previously reported results. However, ulcerative type tumor was associated with a poor LC rate.

A Guide for Identification of Ulcers of the Lower Limb

An ulcer is defined as a breach in the continuity of the skin or a mucous membrane with molecular death of the cells due to underlying inflammation. Figure 1 depicts the different parts of an ulcer. The article describes four different types of ulcers of the lower limb commonly encountered in the surgical wards, with their major characteristics and markers of identification.

Superficial Tissue Swabs Versus Deep Tissue Samples in the Detection of Microbiological Profile of Infected Diabetic Foot Ulcerations.

This study aimed to determine the most accurate microbiological test for the detection of micro-organisms in infected diabetic foot ulcerations in people living with type-2 Diabetes. For 20 eligible patients, a superficial tissue swab and a deep tissue sample were taken during a regular appointment at a Diabetes out-patient's Podiatry Clinic. Two specimens were collected from each wound for microbial culturing after debridement. Infected foot ulcerations were graded according to the Wagner's classification as per clinical protocol. This study found a significant difference [p = 0.028] between the two different samples. The deep tissue sample was found to be more accurate in identifying micro-organisms than the superficial swabs, although the latter is more widely used in clinical practice. Further studies are warranted to provide more evidence to clinicians on the best method to adopt when swabbing different types of diabetic foot ulcerations with different wound classification since, it is clearly still a matter of debate how to detect wound infection.

The Hemostatic and Wound Healing Effect of Chitosan Following Debridement of Chronic Ulcers

Chitosan has been proven to be helpful in wound care as a hemostatic agent. The hemostatic effect is due to the positively charged chitosan interacting with negatively charged red blood cell membranes, initiating the agglutination of red blood cells and platelets. This promotes the activation of thrombin, which activates the clotting pathway, leading to thrombus formation. Based on the properties of chitosan as a rapidly acting hemostatic agent, the authors sought to determine if a chitosan gelling fiber wound dressing could control bleeding of freshly debrided wounds. The effect of the chitosan dressing on overall healing and patient and provider satisfaction was also evaluated. Wounds of any etiology requiring sharp debridement in patients older than 18 years who were capable of consent were eligible. Wounds were sharply debrided by curettage, scalpel, electrosurgery, or a combination of methods. A chitosan dressing was applied to the freshly debrided wound with gentle pressure. The time from application to hemostasis as assessed by non-progression of blood pattern was measured. Other outcome measures also included digital photography, wound surface area, numerical pain scores, and Photographic Wound Assessment Tool (PWAT) scores. Patient and provider satisfaction were measured. Twenty patients with a variety of etiologies and ulcer types were evaluated. After debridement, wound bleeding was rated as mild (n=9), moderate (n=9), or severe (n=2). The mean time to hemostasis was 75 seconds ± 41 SD (range, 28-221 seconds). In 1 week, the mean wound area decreased from 6.9 cm2 ± 7.8 to 6.2 cm2 ± 7.9 and mean PWAT scores decreased from 17.7 ± 4.9 to 11.4 ± 5.0 (lower score indicates wound healing). Pain scores associated with wound debridement were reduced in all but 1 patient evaluated at week 1. Overall, the rating scores from the Patient Reported Acceptance Questionnaire (PRAQ) and Provider Acceptance Questionnaire (PAQ) developed by this research group were high. The mean total PRAQ score was 30.5 ± 3.9 out of 35 (35 being most satisfied). The PAQ score was 15 out of 15 for all but 1 patient (15 being most satisfied). The chitosan gelling fiber wound dressing was simple to use and rapidly promoted hemostasis in fresh sharply debrided wounds. It was safe and easy to use in an outpatient setting and was highly rated by the patients.

A systematic review of ozone therapy for treating chronically refractory wounds and ulcers.

This study aims at evaluating the efficacy and safety of ozone therapy for chronic wounds. The Cochrane Library, PubMed, Ovid Embase, Web of Science, and Chinese Biomedical Literature Database were searched. Randomised controlled trials (RCTs) about participants with chronic wounds were included. Risk of bias assessment was performed by the Cochrane risk‐of‐bias tool. A randomised‐effects model was applied to pool results according to the types of wounds or ulcers. Among 12 included studies, ozone was implemented by topical application (ozone gas bath, ozonated oil, ozone water flushing) and systematic applications including autologous blood immunomodulation and rectal insufflation. The results indicated compared with standard control therapy for diabetic foot ulcers, ozone therapy regardless of monotherapy or combined control treatment markedly accelerated the improvement of the wound area(standardised mean difference(SMD) = 66.54%, 95% confidence interval (CI) = [46.18,86.90], P < .00001) and reduced the amputation rate (risk ration (RR) = 0.36, 95% CI = [0.24,0.54], P < .00001). But there is no improvement in the proportion of participants with completely healed wounds and length of hospital stay. No adverse events associated with ozone treatment have been reported. And the efficacy of ozone therapy for other wound types is still uncertain because of no sufficient studies. More high‐quality randomised controlled trials are needed to confirm the efficacy and safety of ozone therapy for chronic wounds or ulcers.

Opioid Prescribing Patterns for Ulcerative Keratitis.

The purpose of this study was to characterize rates of opioid prescription for different ulcerative keratitis types. This cohort study included patients diagnosed with ulcerative keratitis according to the University of Michigan electronic health record data between September 1, 2014 and December 22, 2020. Ulcerative keratitis was categorized by etiologic type (bacterial, fungal, viral, acanthamoeba, inflammatory, polymicrobial, or unspecified) using rule-based data classification that accounted for billing diagnosis code, antimicrobial or antiinflammatory medications prescribed, laboratory results, and manual chart review. Opioid prescriptions were converted to morphine milligram equivalent and summed over 90 days from diagnosis. Opioid prescription rate and amount were compared between ulcerative keratitis types. Of 3322 patients with ulcerative keratitis, 173 (5.2%) were prescribed at least 1 opioid for pain management within 90 days of diagnosis. More patients with acanthamoeba (32.4%), fungal (21.1%), and polymicrobial (25.0%) keratitis were treated with opioids compared with bacterial (6.7%), unspecified (2.9%), or viral (1.8%) keratitis (all Bonferroni adjusted P < 0.05). For the 173 patients who were prescribed opioids, a total of 353 prescriptions were given within 90 days of diagnosis, with half given within the first week after diagnosis. The quantity of opioid prescribed within 90 days from diagnosis was not significantly different between ulcerative keratitis types (P = 0.6559). Morphine milligram equivalent units prescribed ranged from 97.5 for acanthamoeba keratitis to 112.5 for fungal keratitis. The type of ulcerative keratitis may influence the opioid prescription rate. Providers can better serve patients needing opioids for pain management through improved characterization of pain and development of more tailored pain management regimens.

Oral ulceration and vesiculobullous conditions in the paediatric patient

Deviations from the normal appearance of pale, pink and healthy mucosa require close monitoring or intervention and may be a sign of an underlying systemic disorder. Therefore, it is important that there is timely identification of abnormalities, appropriate management in primary care and onward referral for investigation to specialist services when required. Oral ulceration is the most common soft tissue abnormality in children, with recurrent aphthous stomatitis being the most common type of ulceration. This article discusses the various causes of oral ulceration in addition to vesiculobullous conditions, which may affect the paediatric patient. CPD/Clinical Relevance: It is important that GDPs are aware of the range of causes of ulcers and blisters presenting in children and are aware of when to refer.

Risk prediction and malignant transformation in vocal cord leukoplakia based on electronic laryngoscope

Objective:To investigate the predictive risk factors of vocal fold leukoplakia under electronic laryngoscope and influential factors of malignancy. Methods:A total of 163 cases with vocal cord leukoplakia were analyzed retrospectively. The relationship between the clinical features, including site, size, whether involving the anterior commissure, morphology and pathological grade were analyzed. Then the associations with malignant transformation in vocal cord leukoplakia were evaluated by using multiple Logistic regression analysis. Results:There were one side lesions in 96 cases（58.9%）, and bilateral vocal cord lesions in 67 cases（41.1%）. The vocal cord leukoplakia with extension less than half of the vocal cord was observed in 135 cases（82.8%） and beyond half of the vocal cord was seen in 28 cases（17.1%）. Lesions involving the anterior commissure were 42 cases（25.8%）, without involving the anterior commissure were 121 cases（74.2%）. According to morphological features, 82 patients（50.3%） had a superficial type, followed by exophytic type（n=65, 39.9%）, and ulcerative type（n=16, 9.8%）. The pathological type included squamous epithelial simple hyperplasia in 65 cases（39.9%）, mild hyperplasia in 44 cases（27.0%）, moderate hyperplasia in 31 cases（19.0%）, severe hyperplasia and carcinoma in situ in 23 cases（14.1%）. 140 cases（85.9%） were in low risk group, and 23 cases（14.1%） were in high risk group. The site of the vocal fold leukoplakia was not associated with the pathological grade（P>0.05）, whether the vocal fold leukoplakia range exceeds 1/2 of the total length of the vocal fold, and whether involving the anterior commissure were associated with the pathological grade（both P<0.05）. There were statistically significant differences between the pathological grade and the morphological type（P<0.01）. Ten cases developed larynx cancer, the ratio of malignant transformation was 6.1%. The multiple Logistic regression showed that whether involving the anterior commissure and histopathological classification were the risk factors of malignant transformation in vocal cord eukoplakia. Conclusion:The pathological results of vocal cord leukoplakia can be predicted by laryngoscopy features. Involving of the anterior commissure and histopathological classification are the risk factors of malignant transformation in vocal cord leukoplakia.

A SHOCKING CASE OF DISSEMINATED TB

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: BH is a 41-year-old Nepalese male with a history of ulcerative colitis (recently on adalimumab) and type two diabetes mellitus was transferred for the evaluation of ECMO. He presented to an outside hospital two days prior with a complaint of fevers, hemoptysis, and five-pound weight loss over one month. Despite pre-biologic testing showing indeterminate interferon, negative acid fast culture and a normal chest x-ray, a CT scan of his chest revealed diffuse miliary pattern, consistent with tuberculosis. CASE PRESENTATION: On arrival, the patient was intubated and required norepinephrine, vasopressin and phenylephrine to maintain mean arterial pressures over 65 mmHg. White blood cell count was 5.75 K/uL, lactic acid was 6.5 mmol/L, troponin was 0.5 ng/mL, brain natriuretic peptide was 66,716 pg/mL, ALT of 2827 unit/L and AST greater than 7000 unit/L, concerning for shock. Patient was anuric for which continuous renal replacement therapy was initiated. An echocardiogram showed an ejection fraction of 20-25%. Dobutamine was started due to a rising lactate despite adequate blood pressure. Patient was not a candidate for ECMO given presumed TB infection. Patient was started on Amikacin, Moxifloxacin, Meropenem, Ethambutol and Amphotericin. After a week, he was weaned from pressors and was extubated. He also regained renal function. A repeat echocardiogram two weeks following demonstrated improvement of ejection fraction to 50%. Acid fast bacillus testing confirmed tuberculosis. DISCUSSION: Adalimumab, a TNF-α inhibitor, are among biologic medications that are used in treatment of ulcerative colitis. Although one of its main infectious complications is tuberculosis, there can be other side effects including initiation of heart failure, cytopenia, and elevated transaminases [4]. All mentioned side effects may worsen the clinical picture of septic shock. There are only a handful of cases, some in pediatric literature [3], that conveys the degree of sepsis related to disseminated tuberculosis. Most literature of disseminated tuberculosis are often in the setting of human immunodeficiency virus or in pediatrics [4]. CONCLUSIONS: This case highlights the atypical presentation of disseminated tuberculosis masquerading as septic shock in the setting of recent adalimumab use. Despite the negative screen, it may be possible to develop tuberculosis during biologic therapy. Our case suggests that it may be of utility to retest for tuberculosis during therapy in individuals who may be at high risk for developing tuberculosis or those with indeterminant interferon results. REFERENCE #1: George S, Papa L, Sheils L, Magnussen CR. Septic shock due to disseminated tuberculosis. Clin Infect Dis. 1996 Jan;22(1):188-9. doi: 10.1093/clinids/22.1.188. PMID: 8825004. REFERENCE #2: Hess S, Hospach T, Nossal R, Dannecker G, Magdorf K, Uhlemann F. Life-threatening disseminated tuberculosis as a complication of TNF-α blockade in an adolescent. Eur J Pediatr. 2011 Oct;170(10):1337-42. doi: 10.1007/s00431-011-1501-y. Epub 2011 May 31. PMID: 21625932. REFERENCE #3: Mark S. Godfrey, Lloyd N. Friedman, Tuberculosis and Biologic Therapies: Anti-Tumor Necrosis Factor-α and Beyond, Clinics in Chest Medicine, Volume 40, Issue 4, 2019, Pages 721-739, ISSN 0272-5231, ISBN 9780323682152, https://doi.org/10.1016/j.ccm.2019.07.003.[4] Scheinfeld N. Adalimumab: a review of side effects. Expert Opin Drug Saf. 2005 Jul;4(4):637-41. doi: 10.1517/14740338.4.4.637. PMID: 16011443. DISCLOSURES: No relevant relationships by Saad Ashraf, source=Web Response No relevant relationships by Fiyad Haniff, source=Web Response No relevant relationships by ANDRY VAN DE LOUW, source=Web Response

S3584 Endoscopic Evaluation in a Patient with Post-Bulbar Duodenal Ulcer and Stricture

Introduction: Gastric outlet obstruction (GOO) is the least frequent complication of peptic ulcer disease (PUD) in the US after bleeding and perforation. Ulcers located in the pyloric region and duodenum are most causative of GOO. PUD has decreased since the advent of PPI and eradication of Helicobacter pylori. Although most patients have typical ulcer symptoms prior to the development of complications, asymptomatic ulcers necessitate the need for endoscopic evaluation. Early suspicion and endoscopic evaluation can assist with the prompt management of this complication. Case Description/Methods: 71 year-old white male evaluated for a 5 week history of abdominal pain, nausea, post-prandial vomiting, 35 pound weight loss. Denied the use of non-steroidal anti-inflammatory drugs. Medical history is significant for type 2 diabetes mellitus current tobacco use and hypertension. No prior history of PUD. Physical exam was notable for epigastric tenderness and muscle wasting. Contrasted Abdominopelvic CT showed questionable diverticulum in the second portion of the duodenum and no evidence of pancreatic mass. Endoscopic evaluation showed severe erosive esophagitis, a pinhole stricture in the duodenal bulb with the appearance of a benign peptic stricture. The duodenal stricture was unable to be traversed with a standard gastroscope. With fluoroscopic guidance, the stricture was dilated progressively with a balloon to 6mm, 8mm and 10mm. Biopsies were obtained and the stricture was then traversed with a pediatric scope. After endoscopic evaluation, it was determined that the duodenal stricture was not amenable to durable endoscopic intervention. Pathology, negative for Helicobacter pylori and malignancy. Patient subsequently underwent an exploratory laparotomy and gastrojejunostomy with gastro-jejunal tube placement. Patient continued to improve and was discharged to continue tube feeding at home, outpatient follow up with gastroenterology and surgery. Discussion: Endoscopy plays a critical role in the evaluation and management of patients with symptoms concerning for post bulbar duodenal ulcer, stricture and gastric outlet obstruction. Silent ulcers and complications are more prevalent in older patients. Early detection, evaluation and treatment of GOO could improve disease related morbidity and mortality. Risk modification which consists of tobacco cessation, treating post bulbar ulcers, duodenal ulcers and Helicobacter pylori infection could improve the GOO trends.Figure 1.: Severe Duodenal Stenosis.

Experimental evaluation of preventive action of baladimandura in gastric ulcer based on histopathological reports

Background: Peptic ulcer diseases constitute a major disease that affects the Gastro Intestinal tract. Gastric ulcers are one among the types of Peptic ulcers in which the ulcers are manifested in the lining of gastric mucosa. Annadrava shoola can be correlated with gastric ulcer due to its similarity in symptomatology. Baladimandura is a drug of choice in the management of Amlapitta and Parinamashoola mentioned in Rasakamadhenu. Aims &amp; Objectives: To evaluate the gastric ulcer preventive action of Baladimandura in pyloric ligated albino rats through the histopathology examination of stomach tissue. Methodology: 24 wistar strain albino rats were grouped into 4; all the rats were free access to food and water ad libitum along with standard and test drug to the respective groups for 8 days. On 9th day all the rats were kept for fasting and 10th day pyloric ligation performed followed by sacrificing the rats for taking the stomach tissue for histopathology examination. Results: By comparing the histopathology report of all the rats the test group showed no ulcer formation. However slight inflammation was observed in the test drug group. Discussion &amp; Conclusion: Gastric ulcers are manifested when the gastric mucosal barrier fails to prevent the entry of excess HCL into the cells. Baladimandura acts as Amlapitta hara, Parinama shoola hara and as a powerful ulcer preventive drug due to its gastro protective action.

A Study on Biofilm Production and Its Association with Chronicity in Isolates Obtained From Various Types of Ulcers

A Study on Biofilm Production and Its Association with Chronicity in Isolates Obtained From Various Types of Ulcers

Interstitial cystitis/bladder pain syndrome patient is associated with subsequent increased risks of outpatient visits and hospitalizations: A population-based study.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is not only a chronic urinary bladder pain syndrome but is also associated with multifactorial etiology. Our study aimed to test the hypothesis that IC/BPS is associated with subsequent increased risks of outpatient visits and hospitalizations. Using nationwide database, the diagnoses were based on the International Classification Codes (ICD-9-CM) (595.1) of at least three outpatient services during 2002-2008, (n = 27,990) and cystoscopic finding Hunner type and/or glomerulation with pre-audit criteria. All recruited cases monitored for subsequent outpatient visits and hospitalizations for 2 years, including all-cause and specialty-specific departments, were classified according to medical specialty and age group (<40, 40-60, ≥60 years of age). IC/BPS patients have more overall outpatient department (OPD) visits and an overall adjusted incidence rate ratio (IRR) of 1.64. As for specialty, IRRs were higher in psychiatry (2.75), Chinese medicine (2.01), and emergency medicine (2.00), besides urology and gynecology. The IRRs decreased as age advanced (2.01, 1.71, and 1.44, respectively), except for gynecology (2.42, 2.52, and 2.81). A similar phenomenon happens in hospitalization with IRR of 1.69. Due to claim data characteristics, whether ulcer type IC/BPS findings can be deductive to non-ulcer type remains inclusive. Current results indicate the impacts of healthcare burden in broad spectrum about IC/PBS patients. IC/BPS has been suggested to be associated with lower threshold of healthcare visits and some coexisting disease and is comprised of systemic dysregulation, and is beyond the scope of local bladder-urethra disease. Adequate recognition of associated or comorbid factors and possible recommendation or referral for IC/BPS patients can help provide better healthcare quality.