Oral lichen planus in children: A systematic review

BACKGROUND

 Oral Lichen Planus is a common chronic inflammatory disease of the oral mucosa. The prevalence in adults ranges between 0.5% and 2%, while in children is reported to be about 0,03%. Clinical features of Oral Lichen Planus could be variable in both adults and children, ranging from painless white hyperkeratotic lesions to painful erythematous atrophic ones. Actually, there are no systematic reviews in the literature on OLP in children, whereby this paper aims to summarize all the pathophysiological aspects and identify all cases described in the literature of Oral Lichen Planus in children, reporting their clinical characteristics.

MATERIAL AND METHODS

 A systematic review of the literature was performed in online databases including PubMed, Scopus, Web of Science, Science Direct, EMBASE. In addition, in order to identify reports not otherwise identifiable, an analysis of the gray literature was performed on google scholar and in Open Gray.

RESULTS

 By literature analysis, it emerged that most cases were reported from India. The mean age at time of diagnosis of the disease was 11 years, ranging from 3 to 17 years. The most frequent pattern was the reticular pattern followed by plaque-like, erosive, atrophic, sclerosus, and bullous. The buccal mucosa was the most involved oral site, followed by the tongue, lips and gingiva.

CONCLUSIONS

Although Oral Lichen Planus in children is rare, it may cause oral discomfort and need to be differentiated from other oral white lesions and/or chronic ulcers.

The role of premorbid transthoracic echocardiogram in identifying adverse clinical outcomes in patients admitted with COVID-19

Background/Introduction

The novel coronavirus disease (COVID-19) inpatient mortality rate is approximately 20% in the United States. Reports have described a wide pattern of abnormalities in echocardiograms performed in patients admitted with COVID-19. The role of premorbid transthoracic echocardiogram (TTE) in the prediction of COVID-19 severity and mortality is yet to be fully assessed.

Purpose

To assess whether a pre-COVID TTE can identify patients at high risk of adverse outcomes who are admitted with COVID-19.

Methods

All patients who underwent a TTE from one year to one month prior to an index inpatient admission for COVID-19 were retrospectively enrolled across five clinical sites. Demographic information, medical history, and laboratory data were included for analysis. Echocardiograms were analyzed by an observer blinded to clinical data. Linear and logistic regressions were performed to detect the association of variables with death, invasive mechanical ventilation, initiation of dialysis, and a composite of these endpoints during the COVID-19 admission. Outcomes were then adjusted for a risk score using inverse propensity weighting incorporating age, sex, diabetes, hypertension, obstructive sleep apnea, history of atherosclerotic cardiovascular disease, atrial fibrillation, diuretic use, and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use.

Results

There were 104 patients (68±15 years old, 49% male, BMI 31.4±9.1kg/m2) who met inclusion criteria (baseline characteristics in Table 1). Mean time from TTE to positive SARS-CoV-2 PCR test was 139±91 days. Twenty-nine (28%) participants died during the index COVID-19 admission. There was no association of pre-COVID echocardiographic measures of systolic ventricular function with any endpoint. Diastolic function, as assessed by LV e', was associated with mortality (Table 2). There were 25 patients (24%) with a normal lateral e' (≥10cm/s); none died. There were 35 (34%) patients with LV e' lateral velocity <8 cm/s, of whom 15 (43%) died. LV e' lateral velocity <8 cm/s was associated with an unadjusted odds ratio of 7.69 (95% confidence interval [CI] 2.26–26.19) for death and 3.25 (95% CI 1.11–9.54) for the composite outcome. The odds ratio for death was 4.76 (95% CI 1.10–20.61) and 3.78 (95% CI 0.98–14.6) for the composite outcome after adjustment for clinical risk factors (Table 2).

Conclusion

In patients with an echocardiogram prior to COVID-19, impaired diastolic function as represented by an abnormal LV e' lateral velocity was associated with both inpatient COVID-19 mortality and a composite outcome of death, mechanical ventilation, and initiation of dialysis, even after adjustment for multiple co-morbidities and medication use. Knowledge of the pre-COVID TTE results may help clinicians identify patients at higher risk of adverse outcomes during an admission for COVID-19.

Funding Acknowledgement

Type of funding sources: None.

Plasma glucose level decreases as collateral effect of fermented papaya preparation use

AIM

Fermented Papaya Preparation (FPP) is a natural healthy drug that has been commercially sold in Japan and Philippines. This nutricetive, bio-normalizer product has antioxidant action, inhibitory effect on oxidative DNA damage and tissue injury, being a potent OH scavanger. The wide use of FPP, expecially by elderly people, made us note an unknown collateral effect, i.e., blood sugar level dropping signs especially in the afternoon. The aim of the present work was to scientifically verify the possibility that individuals, who are taking the nutriceutical FPP, might have a decrease of plasma sugar levels.

MATERIALS AND METHODS

For this purpose, 50 subjects, divided in two groups, were enrolled. The first group was made of 25 patients: 13 females and 12 males affected by type-2 diabetes mellitus under treatment with the oral antidiabetic drug, glybenclamide. The control group included 25 clinically-healthy subjects: 16 females and 9 males, matching in age. All subjects were given 3 grams of FPP daily, during lunch, for two months.

RESULTS

The results of this study confirmed the empirical experience that FPP use can induce a significant decrease in plasma sugar levels in both healthy subjects and type 2 diabetic patients. This hypoglycaemic effect, associated with clinical signs, induced the diabetic patients to reduce the dosage of their antidiabetic oral therapy (in one patient the therapy was really suspended).

CONCLUSIONS

In accordance with these results, the FPP administration is suggested as an adjuvant drug to join the oral antidiabetic therapy in type 2 diabetes meltus.

Do hypertension and diabetes mellitus influence the site of atherosclerotic plaques?

BACKGROUND

The concomitant occurrence of atherosclerotic plaques in carotid, coronary and peripheral vessels has been described in a number of studies. A few studies were, on the contrary, done for determining the role of hypertension and/or type 2 diabetes mellitus for the occurrence of the atherosclerotic plaques in different anatomical sites. Moreover these studies deal with atherosclerotic lesions that are generally considered, without differentiating their morphology as a function of the underlying disease, territory, and risk factors. Primary aim of this study is, thus, to verify whether the two most common causes for atherosclerotic disease, i.e., hypertension and type 2 diabetes mellitus, may influence the site of appearance of the atherosclerotic plaque. A second aim is to verify if the anatomical site of the plaque influences plaque morphology and vulnerability.

PATIENTS AND METHODS

A retrospective study of 244 patients affected with type 2 diabetes mellitus or hypertension was performed; 114 subjects were affected by moderate-severe and drugs-treated hypertension (Group A); 55 were affected by type 2 diabetes mellitus in treatment with oral antidiabetic drugs (Group B); 75 were diagnosed as affected by the association hypertension and diabetes (Group C). The inclusion criteria were: exhaustive images of the cardiovascular system (coronary angiography, colour Doppler ultrasound of lower limb arteries and carotid arteries, transthoracic Doppler echocardiography ) and a serum lipid profile (total serum cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides). Three different anatomical sites: carotid axis, ilio-femoral arteries and coronary district, were considered. In each site a plaque lesion-classification was performed to describe the morphology of the plaque.

RESULTS

In patients with hypertension, carotid district seems to be the preferential site of onset of atherosclerotic plaques even if a statistical significant association between the two conditions was not found. Statistical evaluation didn't show significant association between different risk factors and coronary district too. On the opposite, a significant association (p < 0.001) between diabetes and the presence of atherosclerotic plaques into lower limb district was found. A very significant association (p < 0.001) between type 2-diabetes and the presence of non-ulcerative plaques was found too.

CONCLUSIONS

Our study underlines the relationship between vessel plaques localization and concomitant risk factors for atherosclerosis and suggests a possible difference in plaque morphology and biological behaviour related to different anatomical site.

RNA expression bcl-w, a new related protein Bcl-2 family, and caspase-3 in isolated sertoli cells from pre-pubertal rat testes

Apoptosis has a major role in molding the embryo, in the maintenance of tissue homeostasis, and in the defense against pathogens, while its disgregulation is strongly implicated in cancer as well as in autoimmune and degenerative diseases. The opposite action of anti-apoptotic proteins (Bcl-2 family) and pro-apoptotic proteins (p53, Bax, Bak) regulates the activation of caspases that are the effectors proteases of the cell suicide. Bcl-W is a pro-survival protein, recently discovered, related to the Bcl-2 family. The presence of Bcl-W is fundamental for spermatogenesis in rats. Caspases are cysteine-dependent aspartate-specific proteases, and their over-expression can result in apoptotic cell death. Normally, caspases exist in cells as inactive pro-enzymes and can be activated by 2 distinct mechanisms: the FADD/caspase 8 cascade, and the Apaf-1/caspase 9 cascade. These 2 mechanisms are used extensively by cells for the activation of the effectors caspases: caspase 3, caspase 6, and/or caspase 7. Bcl-W and caspases might have a pivotal role in maintenance of Sertoli cells integrity. In this study, we demonstrate that both Bcl-W mRNA and caspase 3 mRNA are expressed in isolated Sertoli cells of pre-puberal rat testes. This finding might be crucial in clarifying whether Sertoli cells die by an apoptotic mechanism. Further studies are required to understand whether the expression of Bcl-W and caspases is different before and after puberty in rat testis and/or in pathological conditions, that lead to an increased cell apoptosis.

Gadolinium-enhanced 3D MRA of the aortic arch vessels in the detection of atherosclerotic cerebrovascular occlusive disease

PURPOSE

Our goal was to evaluate non-breath-hold Gd-enhanced 3D MR angiography (MRA) for the detection of atherosclerotic occlusive disease of the aortic arch vessels and to compare image quality with two breath-hold techniques.

METHOD

One hundred sixty consecutive patients with known or clinically suspected atherosclerotic cerebrovascular occlusive disease underwent Gd-enhanced 3D MRA of the aortic arch and great vessels. One hundred twenty-six examinations were performed with the body coil after infusion of 40 ml of Gd-DTPA; 89 of these were performed without breath-holding and 37 were acquired during suspended respiration. Thirty-four examinations were performed in a body phased-array coil with breath-holding, a timing examination, and 20 ml of contrast agent by manual (n = 17) or power (n = 17) injection. Images were evaluated for the presence of blurring and ghosting artifacts and venous enhancement. Of the 27 patients who underwent non-breath-hold MRI and digital subtraction angiography (DSA), two readers blinded to the DSA results retrospectively evaluated the MRA examinations for the presence of occlusive disease of the innominate, carotid, subclavian, and vertebral arteries. DSA correlation was not evaluated for the 71 breath-hold studies.

RESULTS

Sensitivity and specificity for arch vessel occlusive disease with non-breath-hold MRA were 38 and 94% for Reader A and 38 and 95% for Reader B. Breath-holding significantly reduced blurring and ghosting artifacts (p < 0.001) when compared with non-breath-hold imaging, and use of 20 ml of contrast medium, with a timing examination, resulted in significantly less venous enhancement than seen with 40 ml (p < 0.001).

CONCLUSION

Non-breath-hold Gd-enhanced 3D MRA is insensitive for detecting arch vessel occlusive disease. Breath-hold imaging, in conjunction with a timing examination and a lower dose of contrast agent, improves image quality, but further studies are needed to assess diagnostic accuracy.

Rapid T2-weighted MR imaging of uterine leiomyoma and adenomyosis

BACKGROUND

To compare three rapid T2-weighted pulse sequences with high-resolution turbo spin-echo (SE) magnetic resonance (MR) imaging for the diagnosis of leiomyoma and adenomyosis.

METHODS

Eighteen patients referred for evaluation of suspected leiomyoma or adenomyosis underwent imaging at 1.5 T with a phased-array multicoil. Non-breath-hold, fat-saturated sagittal images of 4-7 mm, with equivalent voxel size, were obtained through the pelvis with the following three rapid pulse sequences: segmented, half-Fourier single shot turbo SE (HASTE), turboGRASE (TGSE) and turbo SE MR images. Mean acquisition times were 17 s (HASTE), 37 s (TGSE), and 42 s (turbo SE). These images were compared, in a blinded fashion, to high resolution turbo SE MR images, which are considered the "standard" for pelvic MRI.

RESULTS

The three rapid pulse sequences, HASTE, TGSE and turbo SE, provided equivalent diagnostic information when compared with high-resolution turbo SE MR images. There was no significant difference in image quality, detection and localization of leiomyoma or in diagnosis of adenomyosis among the three rapid sequences. HASTE imaging demonstrated the least ghosting.

CONCLUSION

Diagnostic T2-weighted images of benign uterine pathology may be obtained in as little as 17 s.

Ultrasound findings in diffuse granulomatous cystitis in chronic granulomatous disease of childhood

Chronic granulomatous disease (CGD) is a genetically inherited disease of childhood, which is characterized by repeated bacterial and/or fungal infections. The genitourinary tract is rarely involved. We report a case of CGD with involvement of the urinary bladder. Pertinent clinical and sonographic findings of this disease are described.

Bilateral duplex ectopic ureters terminating in the seminal vesicles: sonographic and CT diagnosis

A 15-year-old boy presented with a short history of right-sided flank pain was found to have bilateral duplex renal systems with obstructed upper poles. Sonographic examination and contrast-enhanced delayed computed tomography (CT) performed at the conclusion of the excretory urography (EU) demonstrated termination of both obstructed ureters in the seminal vesicles. These noninvasive studies allowed accurate preoperative diagnosis of this abnormality.

Magnetic resonance imaging of cor triatriatum

Magnetic resonance imaging utilizing spin echo sequences was used to demonstrate cor triatriatum in an 18-year-old boy. Phase map images aided the diagnosis by demonstrating the presence of slowly flowing blood in the accessory atrial chamber. Magnetic resonance is an excellent modality for the noninvasive diagnosis of cor triatriatum.