Recurrent meningitis and a congenital perilymph fistula.

In any child with recurrent meningitis, the presence of a congenital perilymph fistula must be entertained. All of the patients must have an audiologic assessment, and if a sensorineural loss is demonstrated, CT of the temporal bones should be performed. CT is excellent in identifying malformations within the temporal bones, fistulous tracts, soft tissue densities in the middle ear, and defects in the tegmen tympani. Although MRI may provide superior discrimination of the audiovestibular and facial nerves and cerebellopontine angle, presently it does not offer any distinct advantages over CT in evaluation of the inner ear. When a fistula is suspected, an exploratory tympanotomy is recommended, and any CSF leak is sealed with muscle.     

The effect of pulsating electromagnetic fields on condylar growth in guinea pigs

The purpose of this study was to determine if a simple, noninvasive method could be developed for the application of pulsed electromagnetic fields that would lend itself to future clinical applications. Specifically, the modulation and control of condylar cellular metabolism and the stimulation of cellular proliferation were attempted in order to increase the amount of mandibular condylar growth. A pulsed electromagnetic field with a frequency of 100 hertz was applied for 8 hours per day to the mandibular condylar area of rapidly growing, male, Hartley guinea pigs. Ten guinea pigs were exposed for 10 days and a second group of 10 guinea pigs was exposed for 30 days. In addition, 5 guinea pigs were used as controls for each experimental period. During the experimental period the guinea pigs were placed in specially constructed, plastic animal holders with their heads positioned in an area of uniform magnetic field. After 10 days of pulsed electromagnetic field exposure, there were increases in vascularity, secretion of cartilagenous intercellular matrix, and woven-bone formation in the guinea pig condyle. After 30 days, there were continued but attenuated vascular and calcification responses with an increase noted in marrow hemopoietic elements. An increase in the number of osteoclasts was also noted after 10 days. This effect was transient and was not present at the end of the 30-day experimental period. The application of the pulsed electromagnetic field did not result in a significant increase in the overall anteroposterior or vertical size of the guinea pig mandible compared to controls. The results of this study suggest that it is possible to affect condylar cartilagenous and bony metabolism through the application of a noninvasive, pulsed electromagnetic field.     

Clinical otorhinolaryngological presentation of COVID-19 patients in Saudi Arabia: A multicenter study

Objectives:To assess the otorhinolaryngological (ORL) symptoms, including their prevalence, severity, and early presentations among coronavirus disease-19 (COVID-19) patients in the Saudi population.Methods:This was a multicentric, cross-sectional study carried out on severe acute respiratory syndrome coronavirus-2 positive patients at 3 COVID-19 centres; Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, ALKhobar, Qatif Central Hospital, AlQatif, and Ohud Hospital, Al Madinah Al Munawarah, Saudi Arabia. The validated survey consisted of sociodemographic data, general symptoms of COVID-19, and ORL manifestations.Results:A total of 1734 COVID-19 positive patients were included in the study (mean age: 37.7±11.6 years). Most of the cases were mild (51.8%), followed by moderate (45.6%), and severe (2.6%) cases. Approximately 33.7% were asymptomatic. Severity of symptoms was significantly associated with male gender (p=0.017), higher age-group (p=0.04), and smoking (p<0.001). The most common initial ORL presentations were sore throat (20.9%), anosmia (15.5%), hyposmia (10%), and loss of taste (11.4%). Overall, 79.5% showed ORL symptoms as the initial presenting symptoms for COVID-19, with anosmia and sore throat being the most common symptoms.Conclusion:This study confirmed the prevalence of ORL symptoms among COVID-19 patients in Saudi Arabia. Moreover, these symptoms could also be considered for early detection of COVID-19 as they might appear prior to other symptoms.     

Validación externa de las escalas A2DS2 e ISAN para predecir la infección respiratoria asociada al ictus isquémico

Background and purpose

Pneumonia as a complication of stroke is associated with poor outcomes. The A2DS2 and ISAN scales were developed by German and English researchers, respectively, to predict in-hospital stroke-associated pneumonia. We conducted an external validation study of these scales in a series of consecutive patients admitted to our hospital due to ischaemic stroke.

Snake bites by the jararacucu (Bothrops jararacussu): clinicopathological studies of 29 proven cases in Sao Paulo State, Brazil

The jararacucu, one of the most dreaded snakes of Brazil, southern Bolivia, Paraguay and northeastern Argentina, is a heavily-built pit viper which may grow to a length of 2.2 m. Up to 1000 mg (dry weight) of highly-lethal venom may be milked from its venom glands on a single occasion. It has accounted for 0.8% to 10% of series of snake bites in Sao Paulo State, Brazil. We examined 29 cases of proven jararacucu bites recruited over a 20-year period in two Sao Paulo hospitals. Severe signs of local and systemic envenoming, (local necrosis, shock, spontaneous systemic bleeding, renal failure) were seen only in patients bitten by snakes longer than 50 cm; bites by shorter specimens were more likely to cause incoagulable blood. Fourteen patients developed coagulopathy, six local necrosis (requiring amputation in one) and five local abscesses. Two became shocked and four developed renal failure. Three patients, aged 3, 11 and 65 years, died 18.75, 27.75 and 83 h after being bitten, with respiratory and circulatory failure despite large doses of specific antivenom and intensive-care- unit management. In two patients, autopsies revealed acute renal tubular necrosis, cerebral oedema, haemorrhagic rhabdomyolysis at the site of the bite and disseminated intravascular coagulation. In one survivor with chronic renal failure, renal biopsy showed bilateral cortical necrosis; the patient remains dependent on haemodialysis. Effects of polyspecific Bothrops antivenom were not impressive, and it has been suggested that anti-Bothrops and anti-Crotalus antivenoms should be given in combination.      

Inducible nitric oxide synthase (iNOS) expression in monocytes during acute Dengue Fever in patients and during in vitro infection

 

Mononuclear phagocytes are considered to be main targets for Dengue Virus (DENV) replication. These cells are activated after infection, producing proinflammatory mediators, including tumour-necrosis factor-α, which has also been detected in vivo. Nitric oxide (NO), usually produced by activated mononuclear phagocytes, has antimicrobial and antiviral activities.

Methods

The expression of DENV antigens and inducible nitric oxide synthase (iNOS) in human blood isolated monocytes were analysed by flow cytometry using cells either from patients with acute Dengue Fever or after DENV-1 in vitro infection. DENV-1 susceptibility to iNOS inhibition and NO production was investigated using N^G-methyl L-Arginine (N^GMLA) as an iNOS inhibitor, which was added to DENV-1 infected human monocytes, and sodium nitroprussiate (SNP), a NO donor, added to infected C6/36 mosquito cell clone. Viral antigens after treatments were detected by flow cytometry analysis.

Results

INOS expression in activated monocytes was observed in 10 out of 21 patients with Dengue Fever and was absent in cells from ten healthy individuals. DENV antigens detected in 25 out of 35 patients, were observed early during in vitro infection (3 days), significantly diminished with time, indicating that virus replicated, however monocytes controlled the infection. On the other hand, the iNOS expression was detected at increasing frequency in in vitro infected monocytes from three to six days, exhibiting an inverse relationship to DENV antigen expression. We demonstrated that the detection of the DENV-1 antigen was enhanced during monocyte treatment with N^GMLA. In the mosquito cell line C6/36, virus detection was significantly reduced in the presence of SNP, when compared to that of untreated cells.

Conclusion

This study is the first to reveal the activation of DENV infected monocytes based on induction of iNOS both in vivo and in vitro, as well as the susceptibility of DENV-1 to a NO production.     

Angina e isquemia a los 2 años con armazón vascular bioabsorbible y stents farmacoactivos metálicos. Estudio ESTROFA Isquemia AVB-SFAm

Introduction and objectives

Bioresorbable vascular scaffolds (BVS) have the potential to restore vasomotion but the clinical implications are unknown. We sought to evaluate angina and ischemia in the long-term in patients treated with BVS and metallic drug-eluting stents (mDES).

Photobiomodulation in oral medicine: a review

Photobiomodulation (PBM) or low‐level laser therapy (LLLT) in dentistry is an evolving science, with an increasing number of controlled clinical studies exploring its potential as a treatment modality. The present study provides an outline of the biologic mechanism of PBM and summarizes the findings of clinical studies of PBM for specific applications in oral medicine. Controversies and drawbacks associated with PBM, which require further research, are also identified. Current literature reports the potential of PBM in various applications in oral medicine. Furthermore, well‐documented research confirms its efficacy in certain conditions, such as oral mucositis, recurrent herpes simplex infection, and burning mouth syndrome. The absence of any reported adverse effects is an advantage over conventional therapeutic modalities. While PBM has proved to be effective for some specific applications, it is not a panacea. The paucity in standardized studies, coupled with ambiguity over the laser parameters, has limited its credibility as a therapeutic modality.