scholarly journals Frequent and Persistent Salivary Gland Ectasia and Oral Disease After COVID-19

2021 ◽  
Vol 100 (5) ◽  
pp. 464-471
Author(s):  
E.F. Gherlone ◽  
E. Polizzi ◽  
G. Tetè ◽  
R. De Lorenzo ◽  
C. Magnaghi ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Oral Cavity ◽  
Multivariable Analysis ◽  
University Hospital ◽  
Oral Disease ◽  
Antibiotic Administration ◽  
Oral Manifestations ◽  
Reactive Protein ◽  
Target Organs ◽  
Salivary Gland Cells

The clinical picture of coronavirus disease 2019 (COVID-19) in various target organs has been extensively studied and described. However, relatively little is known about the characteristics of oral cavity involvement. This is surprising, considering that oral mucosal and salivary gland cells are known targets for the direct replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and that the presence of the virus in saliva is a source of transmission of the infection. The aim of our study was to investigate the presence and prevalence of oral manifestations in COVID-19 survivors. We profiled the oral involvement in 122 COVID-19 survivors that were hospitalized and followed up at a single-referral university hospital in Milan, Italy, between July 23, 2020 and September 7, 2020, after a median (interquartile range) time from hospital discharge of 104 (95 to 132) d. We found that oral manifestations, specifically salivary gland ectasia, were unexpectedly common, with oral manifestations being detected in 83.9% while salivary gland ectasia in 43% of COVID-19 survivors. Salivary gland ectasia reflected the hyperinflammatory response to SARS-CoV-2, as demonstrated by the significant relationship with C-reactive protein (CRP) and lactate dehydrogenase (LDH) levels at hospital admission, and with the use of antibiotics during acute disease. Both LDH levels and antibiotic administration survived as independent predictors of salivary gland ectasia at multivariable analysis. Temporomandibular joint abnormalities, facial pain, and masticatory muscle weakness were also common. Overall, this retrospective and prospective cohort study of COVID-19 survivors revealed that residual damage of the oral cavity persists in the vast majority of patients far beyond clinical recovery, and suggests that the oral cavity represents a preferential target for SARS-CoV-2 infection. Further studies are needed to clarify the connection between SARS-CoV-2 infection and oral disorders.

scholarly journals High Specific C-Reactive Protein in Prediction of the Early Outcome of Primary Intra Cerebral Hemorrhage

2021 ◽  
pp. 54-61
Author(s):  
Khaled Eltoukhy ◽  
Mohamed Gomaa ◽  
Yasmin Ibrahim ◽  
Mohamed Saad
Keyword(s):  
Cerebral Hemorrhage ◽  
Hemorrhagic Stroke ◽  
Multivariable Analysis ◽  
University Hospital ◽  
Control Group ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Test Kit ◽  
Hs Crp ◽  
Ct Brain

Background: Primary intra cerebral hemorrhage (ICH) has high rate of disability and death. Many factors was supposed to be predictors of the outcome. The significance of measuring C-reactive protein (CRP) levels to predict the outcome is uncertain, and data have been controversial. The objective of our clinical study was to determine the relationship of hs-CRP levels with bad outcome. The authors tested if (independent of confounding factors) hs-CRP levels was elevated on admission (< 24 hours after ictus). Fifty patients with acute spontaneous hemorrhagic stroke, within 24 hours of onset confirmed by CT brain were admitted at neurology department, Mansoura University Hospital from June 2017 to September 2018. Age and sex cross-matched 50 healthy persons were studied as control group. Patient and control groups were subjected to full history, general and neurological examination, GCS on admission, National Institute of Health Stroke Scale (NIHSS) on admission, ICH score and Canadian scale on admission and after 30 days, Venous Blood samples were taken within 24 hours of onset and tested for routine laboratory investigations (liver function, serum creatinine, CBC and blood glucose) and High Sensitive C-Reactive Protein level using Enzyme Immunoassay Test Kit. Computed tomography (CT) brain was repeated 72 hours later. Multivariable regression analyses were used to evaluate associations of hs-CRP concentration and ICH outcome. Kaplan–Meier analysis was used for survival. Results: This study revealed that Hs-CRP is significantly higher in patient group (9.3 mg/l) when compared to control group (0.68 mg/dl) with p value < 0,001. There was statistically significant correlation between NIHSS and hs-CRP levels but there was no statistically significant correlation between hs-CRP levels and stroke outcome. Conclusion: Taking these covariates into multivariable analysis revealed that there is correlation between hs-CRP and hemorrhagic stroke but it cannot be used as a predictor of its outcome.

scholarly journals Oral cavity manifestations by COVID-19 infections: a review

2021 ◽  
Vol 7 (8) ◽  
pp. 1391
Author(s):  
Santosh Kumar Swain ◽  
Priyanka Debta ◽  
Ansuman Sahu ◽  
Smarita Lenka
Keyword(s):  
Salivary Gland ◽  
Oral Cavity ◽  
Oral Candidiasis ◽  
Review Article ◽  
Primary Site ◽  
Oral Lesions ◽  
Oral Manifestations ◽  
Immunocompromised Patients ◽  
Elderly Age ◽  
Oral Ulcers

<p class="abstract">Coronavirus disease 2019 (COVID-19) is a threat to the global health caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The lungs are the primary site of infection in COVID-19 patient and the symptoms ranges from mild flu like manifestations to fulminant pneumonia and respiratory failure. COVID-19 infection also significantly affects the oral cavity and salivary glands with oral mucosal manifestations. Other than airway manifestations, COVID-19 patients are presenting with oral cavity lesions such as aphthous like ulcers, glossitis, oral mucositis or stomatitis, oral candidiasis and herpetic recurrences. These oral lesions are often associated with immunocompromised patients and elderly age. Direct involvement of the SARS-CoV-2 virus for development of oral ulcers remains uncertain. The salivary gland related symptoms and taste disturbances are highly common in COVID-19 patients. In COVID-19 patient, certain presentations like ulcers or blisters or diffuse reddish lesions affect both keratinized and non-keratinized tissues of the oral cavity. These lesions are found in palate, lip mucosa, buccal mucosa and tongue. The ulceration and blisters of the oral cavity are more often seen. There is still a gap of knowledge related to the oral manifestations of the COVID-19 infections and its impact on the oral cavity. This review article discussed the details of the oral cavity lesions in COVID-19 patients.</p>

Association of High-Sensitivity C-Reactive Protein With Aneurysm Sac Shrinkage in Patients Undergoing Endovascular Abdominal Aneurysm Repair

2021 ◽  
pp. 152660282110677
Author(s):  
Masaki Kano ◽  
Toshiya Nishibe ◽  
Alan Dardik ◽  
Toru Iwahashi ◽  
Hitoshi Ogino
Keyword(s):  
Renal Cyst ◽  
Multivariable Analysis ◽  
Endovascular Aneurysm Repair ◽  
High Sensitivity ◽  
Aortic Aneurysms ◽  
University Hospital ◽  
C Reactive Protein ◽  
Abdominal Aneurysm ◽  
Reactive Protein ◽  
Aneurysm Repair

Purpose: The factors associated with aneurysm sac shrinkage after endovascular aneurysm repair (EVAR) are not well established. As inflammation is implicated in aneurysm pathophysiology, we hypothesized that high-sensitivity C-reactive protein (hsCRP) was associated with aneurysm sac shrinkage after EVAR and compared the preoperative level of hsCRP between patients with and without postoperative aneurysm sac shrinkage after EVAR. Methods: From November 2013 to April 2019, 143 patients undergoing EVAR using Gore C3 Excluder (W. L. Gore & Associates, Inc, Flagstaff, Arizona) at our university hospital were included in this study. Aneurysm sac size was compared between that on baseline preoperative computed tomography (CT) and that on postoperative CT scans. A change in aneurysm sac size ≥5 mm was considered to be significant, whether due to enlargement or shrinkage. Results: Aneurysm sac size showed a significant decrease from 50.6 ± 9.8 mm to 47.1 ± 10.3 mm at 1 year. At 1 year postoperatively, aneurysm sac shrinkage (≥5 mm) was observed in 48 patients (34%), a stable aneurysm sac was noted in 93 patients (65%), and aneurysm sac enlargement was noted in 2 patients (1.4%). The mean preoperative hsCRP was 0.33 ± 0.54 mg/dL. Univariable analysis showed that preoperative hsCRP (p=0.029) and the presence of a renal cyst (p=0.002) were associated with aneurysm sac shrinkage. Multivariable analysis showed that preoperative hsCRP [>0.19mg/dL] (odds ratio [OR] = 0.22; 95% confidence interval [CI] = 0.05–0.96; p=0.042), and the presence of a renal cyst (OR = 0.31; 95% CI = 0.15–0.67; p=0.002) were independent risk factors for aneurysm sac shrinkage after EVAR. Conclusions: The level of preoperative hsCRP was independently associated with aneurysm sac shrinkage after EVAR in patients with abdominal aortic aneurysms. These data suggest that the high level of hsCRP can be a negative predictor for aneurysm sac shrinkage after EVAR.

scholarly journals Early recognition of PIMS-TS: a single centre retrospective review

2021 ◽  
Vol 5 (1) ◽  
pp. e001011
Author(s):  
Roshni Mistry ◽  
Nicola Scanlon ◽  
James Hibberd ◽  
Fionnghuala Fuller
Keyword(s):  
Early Recognition ◽  
Febrile Illness ◽  
Final Diagnosis ◽  
University Hospital ◽  
Single Centre ◽  
Retrospective Case ◽  
Reactive Protein ◽  
Review Reports ◽  
Specific Symptoms

IntroductionResearch into paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) has focused on tertiary level management. This review reports on symptoms and investigations at presentation.MethodsSingle centre retrospective case note analysis of patients fulfilling PIMS-TS diagnostic criteria from March to May 2020 in a London district level university hospital.ResultsSix patients presented in the week prior to their final diagnosis with fever and non-specific symptoms. Raised C-reactive protein (CRP), lymphopenia and hyponatraemia were noted. Kawasaki-like symptoms were under-represented in all patients.InterpretationThe results suggest that a proportion of children with early PIMS-TS present with a non-specific febrile illness and abnormal blood results. Further research is needed to determine the most appropriate identification and follow-up of these children.

scholarly journals AB0619 PROGNOSTIC FACTORS OF PATIENTS WITH ANTI-MDA5 ANTIBODY-POSITIVE DERMATOMYOSITIS COMPLICATED WITH INTERSTITIAL PNEUMONIA -A JAPANESE SINGLE CENTER STUDY-

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1605.1-1605
Author(s):  
A. Umeda ◽  
M. Sawada ◽  
N. Watanabe ◽  
M. Suzuki ◽  
T. Naganawa ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Interstitial Pneumonia ◽  
Serum Ferritin ◽  
Protective Factor ◽  
Detection System ◽  
Ferritin Level ◽  
Multivariable Analysis ◽  
University Hospital ◽  
Rank Test ◽  
Roc Curve Analysis

Background:Anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab)-positive dermatomyositis (DM) is frequently associated with rapidly progressive interstitial pneumonia (RPIP), whose prognosis is assumed to be poor[1]. Although outcome of DM-RPIP has been reported to be improved by early immunosuppressive therapy, we still experience the cases with severe outcome. Only several reports mentioned the prognostic factors and they have not been fully elucidated.Objectives:To identify the predictors of prognosis in patients with anti-MDA5 Ab-positive DM associated with interstitial pneumonia (DM-IP).Methods:Anti-MDA5 Ab-positive DM-IP patients admitted to Fujita Health University Hospital between January 2010 and October 2019 were consecutively included and stratified into 2 groups, the survived and the deceased groups. DM was diagnosed according to the criteria proposed by Bohan and Peter[2]. Clinically amyopathic DM was diagnosed according to the criteria proposed by Sontheimer [3]. Diagnosis of IP was based on findings of high resolution CT scan (HRCT). The definition of RPIP was rapid exacerbation of hypoxemia or HRCT findings in a period of days to one month after the onset. Clinical features and prognosis of the patients were collected retrospectively and compared between groups. Candidates of predictors are extracted by the univariable analysis using Fisher’s exact test for dichotic parameters and Wilcoxon signed-rank test for continuous parameters and multivariable analysis using logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was examined to obtain the cut-off level. Survival was examined using Kaplan-Meier method and Log-rank test.Results:Twenty-one patients were involved. Eight were deceased and 13 were survived. The deceased group had a higher ratio of male (75% versus 25%, p= 0.018). All deceased cases were with RPIP and 67 % in the survived cases. Levels of serum ferritin (4490 versus 646 ng/mL, p = 0.0026), CRP (2.1 versus 0.9 mg/dL, p = 0.0490), CK (1150 versus 290 U/L, p = 0.017), AST (194 versus 108 U/L, p = 0.025) and LDH (674 versus 368 U/L, p = 0.011) were higher in the deceased group. Interestingly, skin ulcers were tended to be more frequent (12.5% versus 87.5%, p= 0.0587), and anti-SS-A antibody was also more frequently detected (14.3% versus 85.7%, p=0.0072) in the survived group. Using ROC analysis cut-off values were 963 ng/mL for serum ferritin level (sensitivity 100%, specificity 83%), 0.7 mg/dL for CRP (sensitivity 75%, specificity 69%), 308 U/L for CK (sensitivity 88%, specificity 77%), 62 U/L for ALT (sensitivity 100%, specificity 62%), and 454 U/L for LDH (sensitivity 88%, specificity 77%). Patients were divided into two groups based on these cut-offs or based on dichotic parameters and survival was examined between 2 groups. Except CRP and anti-SS-A antibody, survival was significantly worse in parameter-positive or higher groups. Interestingly, anti-SS-A antibody-positive group had better outcome compared with those without.Conclusion:In our analysis, novel candidates such as serum CK, AST, and LDH levels were newly extracted and parameters previously reported was also included and those were also associated with the clinical outcome. In addition, anti-SS-A antibody was identified as a novel protective factor associated with a good outcome.References:[1]Nakashima R, Hosono Y, Mimori T. Clinical significance and new detection system of autoantibodies in myositis with interstitial lung disease. Lupus 2016;25:925-33.[2]Bohan A, Peter JB. Polymyositis and dermatomyositis. N Eng J Med 1975;292:344-7.[3]Sontheimer RD. Dermatomyositis: an overview of recent progress with emphasis on dermatologic aspects. Dermatol Clin 2000;20:387-408.Disclosure of Interests:None declared

Primary Surgical Treatment in Very Advanced (T4b) Oral Cavity Squamous Cell Carcinomas

2021 ◽  
pp. 019459982098435
Author(s):  
Evan J. Patel ◽  
Jamie R. Oliver ◽  
Alec Vaezi ◽  
Zujun Li ◽  
Michael Persky ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Propensity Score ◽  
Oral Cavity ◽  
Squamous Cell ◽  
Multivariable Analysis ◽  
Group Versus ◽  
Curative Treatment ◽  
National Cancer Database ◽  
Curative Intent ◽  
Historical Cohort

Objectives To describe patterns of primary surgical treatments in patients with T4b oral cavity squamous cell carcinoma (OCSCC). Study Design Historical cohort study. Setting National Cancer Database. Methods Review of the National Cancer Database between 2004 and 2017 for all T4b OCSCCs. Only patients with curative treatment methods were included in the survival analysis. Surgical and nonsurgical outcomes were compared by multivariable and propensity score matching analysis. Results A total of 1515 cases of T4b OCSCC were identified. A minority of patients (n = 363, 24.0%) underwent curative treatment; among these, 206 (56.7%) underwent primary surgery. Median length of follow-up was 24 months. The 90-day mortality of patients who underwent surgical treatment was 1.0%. The 2-year survival was higher for patients who underwent surgery + chemoradiotherapy (CRT) as compared with CRT (64.6% vs 45.2%, P < .001). On multivariable analysis, surgery + CRT was associated with longer survival. In a propensity score–matched cohort of 312 patients, 2-year survival remained higher in the surgical group versus the nonsurgical group (59.4% vs 45.5%, P = .02). Among patients who underwent surgery + CRT, there was no difference in 2-year survival between clinical T4a and T4b (59% vs 64.6%, P = .20). Conclusions A minority of patients with T4b OCSCC undergo treatments with curative intent. A subset of patients underwent primary surgical treatment, which was associated with longer survival. The T4b classification might entail a heterogenous group, and further studies in revision of this classification might be justified.

scholarly journals Isoproterenol evokes extracellular Ca2+ spikes due to secretory events in salivary gland cells.

1998 ◽  
Vol 273 (17) ◽  
pp. 10806
Author(s):  
Pavel Belan ◽  
Julie Gardner ◽  
Oleg Gerasimenko ◽  
Chris Lloyd Mills ◽  
Ole H. Petersen ◽  
...  
Keyword(s):  
Salivary Gland ◽  
Gland Cells ◽  
Salivary Gland Cells

scholarly journals Coagulopathy and its effect on treatment and mortality in patients with traumatic intracranial hemorrhage

2021 ◽  
Author(s):  
Janne Kinnunen ◽  
Jarno Satopää ◽  
Mika Niemelä ◽  
Jukka Putaala
Keyword(s):  
Intracranial Hemorrhage ◽  
Multivariable Analysis ◽  
International Normalized Ratio ◽  
University Hospital ◽  
Lower Mortality ◽  
Traumatic Intracranial Hemorrhage ◽  
Hemorrhage Volume ◽  
Anticoagulant Medication ◽  
Admission Glasgow Coma Scale

Abstract Background The role of coagulopathy in patients with traumatic brain injury has remained elusive. In the present study, we aim to assess the prevalence of coagulopathy in patients with traumatic intracranial hemorrhage, their clinical features, and the effect of coagulopathy on treatment and mortality. Methods An observational, retrospective single-center cohort of consecutive patients with traumatic intracranial hemorrhage treated at Helsinki University Hospital between 01 January and 31 December 2010. We compared clinical and radiological parameters in patients with and without coagulopathy defined as drug- or disease-induced, i.e., antiplatelet or anticoagulant medication at a therapeutic dose, thrombocytopenia (platelet count < 100 E9/L), international normalized ratio > 1.2, or thromboplastin time < 60%. Primary outcome was 30-day all-cause mortality. Logistic regression analysis allowed to assess for factors associated with coagulopathy and mortality. Results Of our 505 patients (median age 61 years, 65.5% male), 206 (40.8%) had coagulopathy. Compared to non-coagulopathy patients, coagulopathy patients had larger hemorrhage volumes (mean 140.0 mL vs. 98.4 mL, p < 0.001) and higher 30-day mortality (18.9% vs. 9.7%, p = 0.003). In multivariable analysis, older age, lower admission Glasgow Coma Scale score, larger hemorrhage volume, and conservative treatment were independently associated with mortality. Surgical treatment was associated with lower mortality in both patients with and without coagulopathy. Conclusions Coagulopathy was more frequent in patients with traumatic intracranial hemorrhage presenting larger hemorrhage volumes compared to non-coagulopathy patients but was not independently associated with higher 30-day mortality. Hematoma evacuation, in turn, was associated with lower mortality irrespective of coagulopathy.

scholarly journals Biological impact of an enhanced recovery after surgery programme in liver surgery

BJS Open ◽  
2020 ◽  
Vol 5 (2) ◽  
Author(s):  
S Gonvers ◽  
J Jurt ◽  
G -R Joliat ◽  
N Halkic ◽  
E Melloul ◽  
...  
Keyword(s):  
Liver Surgery ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Stress ◽  
Multivariable Analysis ◽  
Albumin Concentration ◽  
Biological Impact ◽  
Reactive Protein ◽  
Before And After ◽  
Major Resection

Abstract Background The clinical and economic impacts of enhanced recovery after surgery (ERAS) programmes have been demonstrated extensively. Whether ERAS protocols also have a biological effect remains unclear. This study aimed to investigate the biological impact of an ERAS programme in patients undergoing liver surgery. Methods A retrospective analysis of patients undergoing liver surgery (2010–2018) was undertaken. Patients operated before and after ERAS implementation in 2013 were compared. Surrogate markers of surgical stress were monitored: white blood cell count (WBC), C-reactive protein (CRP) level, albumin concentration, and haematocrit. Their perioperative fluctuations were defined as Δvalues, calculated on postoperative day (POD) 0 for Δalbumin and Δhaematocrit and POD 2 for ΔWBC and ΔCRP. Results A total of 541 patients were included, with 223 and 318 patients in non-ERAS and ERAS groups respectively. Groups were comparable, except for higher rates of laparoscopy (24.8 versus 11.2 per cent; P &lt; 0.001) and major resection (47.5 versus 38.1 per cent; P = 0.035) in the ERAS group. Patients in the ERAS group showed attenuated ΔWBC (2.00 versus 2.75 g/l; P = 0.013), ΔCRP (60 versus 101 mg/l; P &lt;0.001) and Δalbumin (12 versus 16 g/l; P &lt; 0.001) compared with those in the no-ERAS group. Subgroup analysis of open resection showed similar results. Multivariable analysis identified ERAS as the only independent factor associated with high ΔWBC (odds ratio (OR) 0.65, 95 per cent c.i. 0.43 to 0.98; P = 0.038), ΔCRP (OR 0.41, 0.23 to 0.73; P = 0.003) and Δalbumin (OR 0.40, 95 per cent c.i. 0.22 to 0.72; P = 0.002). Conclusion Compared with conventional management, implementation of ERAS was associated with an attenuated stress response in patients undergoing liver surgery.

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