Ulcerative Lesions Research Articles

Mucoepidermoid carcinoma showing continuity with the surface mucosa of the oral cavity: a report of 14 cases

We aimed to characterize the histology and the clinicodemographic features of mucoepidermoid carcinoma (MEC), showing continuity with the oral surface mucosa. We reviewed 138 cases of intraoral MEC to identify cases that showed continuity with the surface mucosa and compared their clinicodemographic findings with those of MECs not showing continuity. We compared the sex ratio using the 2-sample Z-test and compared the age distribution using the 2-sample Kolmogorov-Smirnov test. Of the 138 cases examined, 14 showed continuity with the surface mucosa. Their histology showed surface mucosa with an apparent transition to an infiltrating tumor with mucous, intermediate, and epidermoid tumor cells growing in solid and cystic patterns. Their clinical appearance ranged from firm submucosal nodules to erythematous to ulcerated lesions. They showed a strong female predilection (6:1) and sharply bimodal age distribution, with sharp peaks in the fourth and seventh decades. Mucoepidermoid carcinomas that show continuity have a demographic pattern distinct from that of conventional MECs, showing a striking female predilection and bimodal age distribution and suggesting a difference in etiology. Pathologists should remain aware that MEC in the oral cavity can have a histologic appearance of surface origin to reach the correct diagnosis.

What lies beneath a maggot infestation of an ulcerated foot wound?

We present here the case of a 55-year-old male patient with a past medical history of HIV infection on appropriate antiretroviral therapy (Bictegravir/Emtricitabine/Tenofovir Alafenamide), previously treated for hepatitis C with sustained viral response, who was diagnosed with squamous cell cancer of his right hand 2 years before, and treated with carboplatin and taxol, and surgery (partial amputation) for cancer progression and recurrent infections. He presented to our emergency department for worsening pain (NRS 10/10) of a suppurative and foul-smelling interdigital ulcerated lesion of his left foot, that had been present for 3 months. He reported 100% adherence to his HIV therapy and denied fever or chills. Initial work-up showed 10,690/mm3 leukocytes (8,240/ mm3 neutrophils, 1,560/mm3 lymphocytes), and a C-reactive protein of 2.89 mg/dL (normal value 0-0.5). CD4 count on presentation was 225 cells/µL. The patient was immediately treated with morphine (10 mg iv) and piperacillin/tazobactam (4.5 gr iv). The lesion presented erythematous ulcerated bleeding surface with serous and fetid secretion on which mobile larvae were found inside (as showed in the video). We removed about 20 maggots with blunt pliers, identified as larvae of Musca domestica (housefly).

Respuesta al tratamiento y características de los pacientes con pioderma gangrenoso atendidos en una institución de referencia en Antioquia, Colombia, entre 2015 y 2021

IntroductionPyoderma gangrenosum (PG) is an autoinflammatory neutrophilic dermatosis that affects mainly in women, and it is associated with other autoimmune such as inflammatory bowel disease and rheumatoid arthritis. Data about its epidemiology in Latin America, and specifically in Colombia, is scarce. MethodologyA characterization of patients with PG through a cross-sectional study was conducted. The patients were attended in the dermatology service in a tertiary level institution, from January 2015 to December 2021. It included the registries of patients with the diagnosis and whose medical records had complete data about autoimmune comorbidity and laboratory. Results22 patients with PG were analyzed, it was found that the mean age of presentation was 50 years and mainly in women, the most common variant was ulcerative, and the most frequent location was the lower limbs. Half of the patients presenting as a single lesion and mostly with ulcerative lesion with undermined edges and less than 10 cm in size. A total of 22.7% of cases were related to autoimmune disease. Patients were managed with topical, systemic steroid and other systemic immunomodulators, with satisfactory response in 77.3% of them. ConclusionsFamily physicians and dermatologists should become familiar with this entity since it has an unpredictable evolution and prognosis. It is of great importance to recognize, diagnose and treat the disease properly and early.

Oral Health and Salivary pH Changes in Menopausal Women: A Cross-sectional Study

Introduction: Menopause is a natural process in life of women often associated with hormonal changes. It affects oral health by influencing the growth of bacteria and plaque, which can cause tooth decay and gum disease. Menopause can alter salivary pH by reducing estrogen levels, which may lead to dry mouth, inflammation, and increased risk of infections. Therefore, it is important for women in menopause to monitor their salivary pH and maintain good oral hygiene habits. However, there is contradictory evidence about the level of salivary pH and oral symptoms. The present study was carried out to assess the oral findings and salivary pH in premenopausal and postmenopausal women. Methods: The study was carried out on 60 patients who reported to the Department of oral medicine and radiology and were divided into two groups consisting of 30 patients each. Group 1: premenopausal women with no known systemic illness and deleterious habits. Group 2: postmenopausal women. Results: Salivary pH is higher in postmenopausal women than in premenopausal women. Both pre and postmenopausal women have oral symptoms such as dry mouth, facial pain, and ulcerative lesions, but they are more frequent in postmenopausal women. Conclusions: Menopause affects the oral health and salivary pH of women. Postmenopausal women are more prone to oral diseases and have lower salivary pH than premenopausal women. Salivary pH may be used as a biomarker for oral health status in postmenopausal women.

Type-I interferons promote innate immune tolerance in macrophages exposed to Mycobacterium ulcerans vesicles.

Buruli ulcer is a chronic infectious disease caused by Mycobacterium ulcerans. The pathogen persistence in host skin is associated with the development of ulcerative and necrotic lesions leading to permanent disabilities in most patients. However, few of diagnosed cases are thought to resolve through an unknown self-healing process. Using in vitro and in vivo mouse models and M. ulcerans purified vesicles and mycolactone, we showed that the development of an innate immune tolerance was only specific to macrophages from mice able to heal spontaneously. This tolerance mechanism depends on a type I interferon response and can be induced by interferon beta. A type I interferon signature was further detected during in vivo infection in mice as well as in skin samples from patients under antibiotics regiment. Our results indicate that type I interferon-related genes expressed in macrophages may promote tolerance and healing during infection with skin damaging pathogen.

Features of the microbial landscape of the stomach in children, feeding through the gastrostomy or nasogastric tube

BACKGROUND: In children with dysphagia, an increase in body weight is observed after the placement of a feeding tube, however, subsequently, a regression of body weight is noted, symptoms of an erosive and ulcerative lesion of the gastrointestinal tract appear.
 AIM: To identify the features of the gastric microbiome in children fed through a gastrostomy or a tube.
 MATERIALS AND METHODS: A study of aspirates of gastric contents in 21 patients was carried out using metagenomic sequencing. The participants were divided into 2 groups: group 1 11 children fed through the gastrostomy for less than 1 year; group 2 10 children, fed through the gastrostomy for more than 1 year.
 RESULTS: In group 1, from 8 to 19 phyla were identified, median 12.0. In the second group from 4 to 13, median 7.5, the differences are statistically significant (p 0.05). The samples of both groups were dominated by the phyla Firmicutes, Proteobacteria, Bacteroidota, Actinobacteria, Fusobacteria. The number of representatives of the Bacteroidia and Fusobacteriia classes was significantly reduced in patients with long-term nutrition through the gastrostomy. At the same time, a small number of classes were observed in patients with a gastrostomy in the stomach for about 80 months, as well as in patients with identified gastric pathology. There were about 66 genera for each specimen. At the same time, in children fed through a gastrostomy for less than 1 year, the median is 69.5 OTU. In children fed through a gastrostomy for more than 1 year, even with its regular replacement, the median is significantly less 41 OTU. A significant decrease in microbial biodiversity was revealed with an increase in the standing time of the gastrostomy, the median value of the Shannon index in group 1 was 1.95, in group 2 1.69 (p 0.05).
 CONCLUSIONS: In patients with a long stay of the feeding tube in the stomach, the number of anti-inflammatory symbionts of the genus Prevotella, Parabacteroides is reduced. The contamination of the stomach with Helicobacter pylori was 50%, which further increased the predisposition of the gastric mucosa to inflammation.

Metabolic Plasticity and Virulence-Associated Factors of Sporothrix brasiliensis Strains Related to Familiar Outbreaks of Cat-to-Human Transmitted Sporotrichosis.

Sporothrix brasiliensis is the main agent of zoonotic sporotrichosis transmitted by domestic cats in South America. In humans, sporotrichosis commonly presents with cutaneous or lymphocutaneous lesions, and in cats, with multiple ulcerated skin lesions associated with enlarged lymph nodes and respiratory signs. Fungal virulence factors may affect the clinical presentation of the mycoses. Sporothrix spp. present some virulence factors. This study aims to compare 24 S. brasiliensis strains from 12 familiar outbreaks of cat-to-human transmitted sporotrichosis. Fungal growth in different substrates, thermotolerance, resistance to oxidative stress, and production of enzymes were evaluated. An invertebrate model of experimental infection was used to compare the virulence of the strains. The strains grew well on glucose and N-acetyl-D-glucosamine but poorly on lactate. Their thermotolerance was moderate to high. All strains were susceptible to hydrogen peroxide, and the majority produced hemolysins but not phospholipase and esterase. There was no significant difference in the putative virulence-associated factors studied among the different hosts. Moreover, strains isolated from a human and a cat from four familiar outbreaks presented a very similar profile of expression of these factors, reinforcing the zoonotic transmission of S. brasiliensis in Brazil and demonstrating the plasticity of this species in the production of virulence factors.

Necrobiosis lipoidica in childhood: a review of literature with emphasis on therapy.

Necrobiosis lipoidica (NL) is a rare chronic granulomatous disease that manifests as sharply demarcated, telangiectatic, brownish-red plaques with atrophic yellowish centers prone to ulceration and occurs predominantly on the shins. In children, NL is extremely rare, but resistance to therapy, troublesome cosmetic appearance, painful ulcerations, and possible development of squamous cell carcinoma in long-persisting lesions are challenges during treatment. Our review includes 29 reports of NL in patients aged <18 years published from 1990 on PubMed, EMBASE, and Medline. The mean age of patients was 14.3years, with a female predominance of 2:1 and a high prevalence of diabetes mellitus (80%). Data showed that potent topical steroids up to twice daily is the first-line treatment. For refractory cases, therapy can be switched to tacrolimus. Ulcerations benefit from phase-adapted wound care and anti-inflammatory medical dressings such as medical honey. Adding hyperbaric oxygenation to local or systemic therapy in difficult-to-treat ulcerated lesions can be considered. Refractory cases may be switched to topical photochemotherapy or systemic treatment with TNF-α inhibitors, systemic steroids (preferably in non-diabetic patients), pentoxifylline, or hydroxychloroquine. Necrobiosis lipoidica in childhood is difficult to treat, with a treatment failure rate of 40%. Therefore, further research through patient registries is recommended.

Secondary Infection of Buruli Ulcer Lesions (lay summary)&amp;nbsp;

Secondary Infection of Buruli Ulcer Lesions (lay summary)&amp;nbsp;

First Experience of Combined Treatment of Corneal and Graft Ulcers in Preschool Children Using Local Ultraviolet Crosslinking (Clinical Cases)

Purpose: to evaluate the results of a new combined method for the treatment of corneal and graft ulcers in preschool children, including local ultraviolet crosslinking (UVA CL) of corneal collagen and amniotic membrane transplantation (AMT).Methods. 1 patient 4 years old with a corneal ulcer and transplant disease after penetrating subtotal keratoplasty and 1 child 6 years old with a corneal ulcer of herpetic etiology was under observation for 1 year. The treatment included 3–5 consecutive procedures of local UVA CL of the cornea lasting 5 min. and amniotic membrane transplantation (AMT) after the first CL procedure. Biomicroscopy with fluorescein test and optical coherence tomography (OCT Spectralis, Heidelberg Engineering, Germany) were used to dynamically monitor the clinical course of corneal and graft ulcers. Local CL was performed using a new Keratolink device (OA Elatomsky Instrument Plant, Russia). Immediately after the 1st CL procedure, a TAM operation was performed under operating conditions under anesthesia, after which 2–4 more local CL procedures were performed sequentially every 3 days.Results. During treatment with each subsequent CL procedure, the clinical condition of the eyes improved: inflammation was relieved, photophobia, lacrimation, blepharospasm disappeared, a gradual increase in the epithelium from the periphery of the cornea with the formation of a gentle translucent opacification was noted, vascular activity decreased, and visual acuity significantly increased. After 2–10 months, in both cases there are no active complaints, the eyes are calm, infiltrates were not determined, in their place a gentle cloud-like translucent opacity formed, including in a child after keratoplasty. Vessels are empty.Conclusion. Combined treatment of corneal and graft ulcers in children (local UVA CL together with TAM) demonstrated high therapeutic efficacy, ensured stable corneal epithelialization in a short time and improved visual functions at the end of the inflammatory process. This method can significantly expand the possibilities of treating ulcerative lesions of the cornea and graft in preschool children.

Swarming magnetic photonic‐crystal microrobots with on‐the‐fly visual pH detection and self‐regulated drug delivery

AbstractSwarming magnetic micro/nanorobots hold great promise for biomedical applications, but at present suffer from inferior capabilities to perceive and respond to chemical signals in local microenvironments. Here we demonstrate swarming magnetic photonic‐crystal microrobots (PC‐bots) capable of spontaneously performing on‐the‐fly visual pH detection and self‐regulated drug delivery by perceiving local pH changes. The magnetic PC‐bots consist of pH‐responsive hydrogel microspheres with encapsulated one‐dimensional periodic assemblies of Fe3O4 nanoparticles. By programming external rotating magnetic fields, they can self‐organize into large swarms with much‐enhanced collective velocity to actively find targets while shining bright “blinking” structural colors. When approaching the target with abnormal pH conditions (e.g., an ulcerated superficial tumor lesion), the PC‐bots can visualize local pH changes on the fly via pH‐responsive structural colors, and realize self‐regulated release of the loaded drugs by recognizing local pH. This work facilitates the development of intelligent micro/nanorobots for active “motile‐targeting” tumor diagnosis and treatment.image

Diagnosis of Epidermoid Carcinoma of the Tongue after Treatment of Epidermoid Carcinoma of the Esophagus

Abstract In the present case report, a patient with esophageal squamous cell carcinoma (SCC) developed a second primary tumor in the tongue at the same time. Stage III middle esophageal SCC was discovered in a 60-year-old Caucasian male patient who was institutionalized, a smoker, and had previously struggled with alcoholism. Following treatment, the patient was admitted to the hospital for 15 days due to dysphagia and malnutrition. According to him, he had mouth pain while in the hospital. An intraoral examination revealed tooth mobility, bacterial plaque, dental calculus, and a 1.3-cm ulcerated lesion on the right lateral edge of the tongue. During the extraoral examination, no palpable lymph nodes were found in the submandibular or cervical regions. The tongue lesion was excisionally biopsied, and the histological evaluation agreed. The patient was advised to seek treatment for tongue SCC. Given that patients with esophageal SCC have a 9.3%–11.4% risk of developing head-and-neck SCC, multiprofessional follow-up of patients with esophageal SCC is critical for early detection of this cancer.

Balaenophilus manatorum in Debilitated and Bycatch-Derived Loggerhead Sea Turtles Caretta caretta from Northwestern Adriatic Sea.

Balenophilus manatorum (Copepoda: Harpaticoida) is one of the few components of the epibiontic fauna of Caretta caretta that show a "true" parasitic association with their host. From rrosive to ulcerative cutaneous lesions may seldom appear as a consequence of the copepod feeding on keratin on turtles' skin. Debilitating Turtle Syndrome (DTS) is the final outcome of a chronic insufficient assumption of nutrients, generally occurring with the impairment of immune functions and high epibiota burdens. In this survey, the presence of B. manatorum in C. caretta from the Northwestern Adriatic Sea was investigated and the relation between infection indices and the co-occurrence of DTS was studied. Clinical examination was performed at the time of rescue, including routine hematological assessment; external parasites were isolated mechanically from turtles' skin and morphologically identified through observation with an optic microscope and SEM. Ten turtles were classified as affected by DTS, all of them being small juveniles with typical clinical and clinicopathological presentation. A higher prevalence, abundance, and density of infection were found in turtles affected by the syndrome. The presence of massive skin coverage by the burrowing barnacle Pletylepas hexastylos prevented a proper evaluation of the pathology associated with B. manatorum in turtles affected by DTS. In any event, eventual skin damages caused by the parasite may represent a port of entry for secondary infections in such immunocompromised animals. Therefore, infection by B. manatorum should not go overlooked in debilitated turtles and should be opportunely treated.

Combined Metronomic Chemo-Immunotherapy in Metastatic Carcinoma of Esophagus in Second Line and Beyond

Background and Aims: Approximately 570,000 new cases are diagnosed with esophageal cancer worldwide annually and approximately 510,000 deaths from this disease per year. There are currently no effective second-line treatments for patients who progress on cisplatin and 5-fluorouracil. Esophageal squamous cell carcinomas and adenocarcinomas have proven to be inherently resistant to systemic treatments as a result of histological, molecular and etiological heterogeneity, with limited responses seen after first line therapy. Methods: We are presenting 3 case reports of 57 year old man, 53 year old man &amp; 47 year old woman who, presented with dysphasia for solid foods, weight loss and dyspepsia since 1 month, 3 months &amp; 1.5 months respectively. Upper gastro oesophageal endoscopy shows ulcerated friable lesion with minimal luminal compromise with biopsy showing poorly differentiated adenocarcinoma (PDAC) and PECT-CT showed FDG avid lesions in gastroesophageal junction, gastric cardia, multiple retroperitoneal lymph nodes and bilateral liver lesions. All 3 were having stage IV disease, with PDAC, squamous cell carcinoma &amp; PDAC respectively. We have started 1st patient on DOX regimen containing Docetaxel, Oxaliplatin and Capecitabine at an interval of 2 weeks and after 4 cycles he was having stable disease in GE junction, liver and slightly increased size of retroperitoneal lymph nodes. Second &amp; 3rd patient was put on Pclitaxel-carboplatil protocol, after 6 cycles both were having partial response &amp; was managed with 6 cycles CAPOX as second line che otherapy. After 5th &amp; 6th months of second line chemotherapy both patients were having progressive disease. Results: In view of radiological progression we started him on Injection, Nivolumab 240mg intravenously every 2 weekly along with low dose capecitabine 500mg twice a day. After 4 cycles of treatment his PET-CT showing complete metabolic response in GE junction, liver and retroperitoneal lesions. Now we are continuing Nivolumab and low dose capecitabine planned to complete for 2 years. Conclusion: So to conclude nivolumab along with metronomic chemotherapy with low dose capecitabine was very well tolerated and exhibited antitumor activity in extensively pretreated patient with metastatic esophageal poorly differentiated adenocarcinoma. Additional studies of Nivolumab and metronomic chemotherapy and immuno-immuno combination therapy in these diseases are ongoin.

Unique Ulcerating Lesion Revealing Adenocarcinoma of the Lung

A 57-year-old man was admitted to our department with a single ulcerated skin lesion on the right lumbar zone. The patient quit smoking 1 years ago, following a history of 35 years of smoking 13 cigarettes per day. There was no evidence of respiratory symptoms, or anorexia.

Study of the antiulcer activity of garden cabbage extract on the chronic acetic ulcer model in rats

The aim of the study was to study the gastroprotective properties of the dry extract of garden cabbage in the model of chronic acetic ulcer in rats.&#x0D; Materials and methods. Chronic ulcerative lesions of the gastric mucosa of rats were modeled by introducing 0.05 ml of a 30 % solution of acetic acid into the subserous layer of the stomach wall. The dry extract of garden cabbage in a conditionally therapeutic dose of 50 mg/kg and reference drugs omeprazole and altan were administered intragastrically for 10 days, starting from the second day of the experiment. When choosing the duration of the course of treatment, we proceeded from the data that the effectiveness of the antiulcer action in the clinic is assessed after 10-12 days of treatment. The percentage of animals with ulcers in the group, the state of the gastric mucosa were evaluated, the ulcer index and antiulcer activity were calculated. To elucidate the possible mechanism of action of the extract, we studied its effect on synthetic processes in terms of the content of RNA and DNA in homogenates of the gastric mucosa by the spectrophotometric method by reaction with perchloric acid.&#x0D; Results. On the model of stomach damage, caused by acetic acid, a pronounced antiulcer activity of the extract (54.26) was established at the level of omeprazole (54.62). The maximum antiulcer activity (72.75) was revealed when using the combination of the extract with omeprazole, which, in terms of ulcerative effect, is superior to monotherapy with the extract, omeprazole and altan (35.08).&#x0D; Reparative regeneration is a component of an adaptive tissue reaction; under conditions of violation of the reparative potencies of the mucosa, chronic diseases of the gastrointestinal tract develop. Since the final goal of antiulcer therapy is the healing of the ulcer, and the basis of this process is reparative regeneration, the reparative properties of the extract have been studied. Under the influence of cabbage extract, the content of RNA and DNA in the mucosa probably increased by 2.8 and 2.4 times, respectively, at the same level with omeprazole. If possible, to activate the synthetic processes of DEGC and omeprazole, altan significantly prevailed.&#x0D; The most pronounced effect of enhancing reparative processes was established with the combined use of the extract and omeprazole, which turned out to be a significant increase in the content of RNA and DNA in the gastric mucosa by 3.2 and 2.9 times compared with the control.&#x0D; Conclusions. On the model of chronic damage to the stomach of rats, cabbage extract showed an antiulcer effect, the severity of which was not inferior to the comparison drug, the proton pump inhibitor omeprazole, and significantly exceeded the phytopreparation - altan. The combined use of the extract and omeprazole showed the highest preventive effect of preventing the negative effects of acetic acid on the gastric mucosa. One of the mechanisms of the gastroprotective action of the extract is its ability to enhance reparative processes in the gastric mucosa. The results obtained indicate the prospects for further research on the antiulcer properties of cabbage extract with a view to its use in the complex therapy of peptic ulcer

Aplasia Cutis Congenita: An Often Isolated Clinical Finding

Aplasia cutis congenita (ACC) is a rare congenital condition characterised by the absence of skin, with or without the absence of underlying structures. Can appear as an isolated lesion or associated with other congenital malformations. The approach can be conservative or surgical.We report a case of a full-term male newborn with two adjacent ulcerated lesions with well-demarcated limits in the upper occipital region (20 and 4-5 mm diameter). Other alterations that could be associated with aplasia cutis were identified at examination, so the patient was referred to several consultations, and other system involvement was excluded. Re-evaluation at the first month of life revealed complete healing and conservative treatment was kept.After identification of ACC should be excluded other associated congenital malformations. Particularly if large skin defects or bone involvement is detected (higher risk of complications and mortality).

Cytoprotectant Doctovit: perspectives of the use at acid-dependent gastroduodenal diseases

The paper presents analysis of publications devoted to the use of cytoprotectant Doctovit at acid‑dependent gastroduodenal diseases and prospects of its use at inflammatory and erosive injuries of the esophagus, stomach and duodenum. A pathogenetic substantiation of the expediency of using the Doctovit (a complex of vitamins U (methylmethionine) and B5 (dexpanthenol)) is presented for cases of erosive and ulcerative (Helicobacter pylori‑associated) gastroduodenal lesions and at NSAID‑gastropathy, as well as at preservation of inflammatory changes in the gastric mucosa after antihelicobacter therapy (posteradication syndrome). The mechanism of action of Doctovit components is described. The review of investigations has been presented that showed normalization of secretory stomach function (in particular due to vitamin U methylation of histamine and its transformation into an inactive form), faster ulcers’ healing, analgesic, gastroprotective, antioxidant and lipotropic effects, which contribute to the stimulation of healing of mucosal erosions and ulcers in the digestive tract, positive dynamics of the histological picture of the gastroduodenal mucosa in patients who received Doctovit as a part of complex therapy. The positive effects included decrease in the severity of inflammatory cellular infiltration of the mucosa own lamina, disappearance of lymphoid follicles due to improvement in the condition of the epithelium due to an increase in its compensatory reparative regeneration, improvement in the condition of the integumentary pit epithelium of the stomach after treatment and strengthening of its mucin‑producing function with improvement in the quality of mucus The expediency of further use of Doctovit in patients with acid‑dependent pathology of the digestive tract is substantiated.&#x0D;

The Predominance of Tobacco Propensities and Tobacco-Related Oral Lesions in Textile Mill Workers of Bhopal: A Cross-Sectional Study.

Low wages, long work hours, and stressful working conditions predominantly affect the oral and general health of industrial workers, which in turn resultin their tobacco consumption. This cross-sectional study examined the prevalence of tobacco use and its associated oral lesions among textile mill workers in Bhopal, India. Oral cancer and premalignant lesions are significantly increased by smoking and chewing tobacco. The study's objective was to assess and record the prevalence of oral mucosal lesions linked to tobacco use in different age groups among Bhopal textile industry workers. A cross-sectional study was conducted among 583 textile mill workers. Data were collected using a questionnaire and the WHO Oral Health Assessment Form 2013. IBM SPSS Statistics for Windows, Version 29 (Released 2022; IBM Corp., Armonk, New York, United States) was used for the statistical analysis. Variables were compared using the mean, percentage, and standard deviation. The chi-square test and Fisher's exact test were used to compare the distribution of gender, tobacco habits, and oral mucosal lesions in different age groups. Males made up 69.1% of the workforce. A clear male preference was noted (P ≤ 0.001). About 64.7% of the workers did not have any tobacco-related habits, 20.8% used smokeless tobacco, 7.9% used a smoking form of tobacco, and 6.7% used both. Older age groups, 31-45 and >46 years old, had a higher proportion of users of smokeless tobacco (P ≤ 0.001). The most commonly reported oral mucosal lesions were ulcerative conditions in 6.9%, followed by oral submucous fibrosis (OSMF), keratotic lesions, and leukoplakia in 5.0%, 4.1%, and 3.6% of the study population, respectively. Leukoplakia and OSMF were prevalent in the 31-45-yearage group, while ulcerative lesions were more prevalent in the 18-30-yearage group (P ≤ 0.001). Workers at textile mills were more likely to use a smokeless form of tobacco. Older age groups had higher rates of smokeless tobacco use as compared to smoking, which was more prevalent in the younger age group. Oral mucosal lesions in older age groups frequently include OSMF and leukoplakia. The main reasons for engaging in the tobacco use habit were stress and a lack of awareness. Oral hygiene was a neglected entity among workers.

Automated algorithm for diagnosing gastrointestinal bleeding

BACKGROUND: Gastrointestinal bleeding (GIB) is a complication of many diseases of the gastrointestinal tract (GIT), including erosive and ulcerative lesions, vascular malformations, diverticula, and tumors. In developed countries, the GIB mortality rate ranges from 5% to 15%, reaching 30%40% in the group of patients with severe recurrent bleeding.&#x0D; AIM: The study aimed to develop an automated diagnostic algorithm for patients with GIB.&#x0D; METHODS: Knowledge engineering is used to extract terms and their relationships from the scientific literature related to the GIT. After agreement with the experts, information on the diagnosis and treatment of patients with GIB was arranged using a MS Excel spreadsheet editor. For building GIB localization rules, the study included data from histories of 280 patients aged 2094 years (61 [44; 74]); of these, 47.5% were women, while all others were men. The patients were diagnosed and treated at the Municipal Clinical Hospital No. 31 between 2008 and 2021. For testing the algorithm, data from histories of 514 patients aged 2096 years (62 [46; 74]) were used; of these, 57% were men, while the rest were women. The patients under study were diagnosed and treated at the Municipal Clinical Hospital No. 17 and the Municipal Clinical Hospital No. 31 between 2008 and 2022. For each study subject, data were available on 37 signs, including 19 clinical, 3 laboratory, and 15 endoscopic signs. Statistical data analysis was performed using the Statistica 13 software package, R Project programming language, and GraphPad online calculator. The software implementation of the algorithm was performed using the JavaScript programming language.&#x0D; RESULTS: Using polynomial logistic regression, an algorithm for differential diagnosis of GIB according to the preliminary localization of the bleeding source was developed. Having the data from 8 clinical and laboratory parameters with probability, a preliminary localization of the bleeding source may be determined. Thus, the probability of bleeding localization in the upper, middle, and lower GIT accounts for 84% (95% CI [78%; 89%]), 84% (95% CI [74%; 91%]), and 75% (95% CI [69%; 80%]), respectively. A final algorithm to support clinical decision-making in the management of patients with GIB (sergisa.smrtp.ru/medical/edit.html) was developed and implemented as a web-service, working with 92.2% efficiency.&#x0D; The sequence of operations of the algorithm for diagnosing GIB is as follows:&#x0D; &#x0D; Obtaining clinical and laboratory signs of a patient with suspected GIB.&#x0D; Determining the nature of bleeding (overt/occult) using literature data, assessing the severity of bleeding (mild/medium/severe) based on Gorbashko classification, and detecting the preliminary localization of bleeding (upper/middle/lower GIT) by regression equation.&#x0D; Providing recommendations for selecting a research method based on production rules and expert opinions.&#x0D; Obtaining endoscopic signs.&#x0D; Determining the localization and source of bleeding using the production rules.&#x0D; Providing recommendations for stopping/preventing GIB based on literature and expert opinions.&#x0D; &#x0D; CONCLUSIONS: An algorithm to support clinical decision-making for the management of patients with GIB, considering the nature of clinical manifestations and the severity and the cause of bleeding based on expert opinions, production rules, and polynomial logistic regression, which allows to assume a preliminary localization of the source of bleeding, was developed for the first time in the Russian Federation. The developed algorithm is implemented as a web-service and may be integrated into the medical information system at the automated workstation of a surgeon, an endoscopist, and a gastroenterologist to support clinical decision-making in the management of patients with GIB.