Studi Kasus: Diagnosis dan Pengobatan Stomatitis pada Kucing Domestik

Stomatitis is an inflammation that occurs in the oral mucosal tissue, characterized by ulcers. This case study aims to diagnose and treat stomatitis in a cat. A 7-month-old female domestic cat weighing 2.7 kg with lethargy, lost of appetite, decreased thirst, and was having sores for 2 days was examined. The cat was examined physically include anamnesis, an inspection of body condition and eating behavior, palpation of the skin, hair, and parts of the body that can be palpated, and auscultation of the thorax and abdomen. The blood sample that was examined includes the erythrocyte count, hemoglobin value, leukocytes count, and their differentials. Physical examination results showed hyperemic gingival, swollen submandibular and retropharyngeal lymphoglandula, and there were multiple ulcers on the lips and tongue. Hematological examination showed thrombocytopenia and monocytosis. The stomatitis was diagnosed to the cat with a good prognosis. Therapy was given for 5 consecutive days in the form of intramuscular injection of Amoxycillin 10 mg/kg BW twice daily, intramuscular injection of diphenhydramine HCl 1 mg/kg BW once daily, subcutaneous injection of 0.5 ml vitamin C once daily, oral administration of 0.5 ml multivitamin twice daily, and povidone-iodine for gargle twice a day applied lightly to the lesion area. Stomatitis in this case study was cured within 5 days by treating with amoxicillin, diphenhydramine HCl, vitamin C, multivitamins, and topical povidone-iodine. Keywords: Amoxicillin; Cat; Stomatitis; Vitamin C. Abstrak Stomatitis merupakan radang yang terjadi pada jaringan mukosa mulut yang ditandai adanya ulser. Studi kasus ini bertujuan melakukan diagnosis dan pengobatan stomatitis pada kucing. Studi kasus ini melaporkan seekor kucing domestik betina umur 7 bulan dengan berat badan 2,7 kg dengan keluhan lesu, tidak ada nafsu makan dan minum, serta menderita sariawan sejak 2 hari sebelum diperiksa. Kucing diperiksa secara fisik meliputi anamnesa, inspeksi terhadap kondisi tubuh dan perilaku makan, palpasi terhadap kulit, rambut, dan permukaan tubuh lainnya, serta auskultasi pada daerah thorax dan abdomen. Sampel darah kucing diperiksa terhadap jumlah eritrosit kadar hemoglobin, jumlah leukosit dan diferensialnya. Hasil pemeriksaan fisik menunjukkan limfoglandula submandibula dan retropharingeal bengkak, gingiva hiperemi serta adanya ulser multiple pada bibir dan lidah. Hasil pemeriksaan darah menunjukkan trombositopenia dan monositosis. Berdasarkan hasil pemeriksaan kucing didiagnosis stomatitis dengan prognosis fausta. Kucing diberi terapi selama 5 hari berupa amoxicilin dosis 10 mg/kg BB dua kali sehari secara intramuskuler, dyphenhidramin HCl 1 mg/kg BB satu kali sehari secara intramuskuler, vitamin C sebanyak 0,5 ml satu kali sehari secara subkutan, multivitamin sebanyak 0,5 ml dua kali sehari secara per oral, dan povidone iodine dua kali sehari dioleskan pada lesi stomatitis. Stomatitis pada kasus ini dapat disembuhkan dalam waktu 5 hari dengan pemberian amoxicilin, dipenhidramin HCl, vitamin C, multivitamin secara sistemik dan povidone iodine secara topikal. Kata kunci: Amoksisilin; Kucing; Stomatitis; Vitamin c

A Novel and Simple Method of Managing Thoracic Esophageal Perforation: The “ASSIST” Approach

Introduction Thoracic esophageal perforation (TEP) remains a therapeutic challenge that carries with it a high mortality. Because of its rare occurrence and management is complex, most patients are referred to higher level of care. Management is variable, ranging from a stent placement to an esophagectomy. Unfortunately, stent capabilities may not be readily available and the different surgical approaches can be complex, time-consuming, and demanding on a septic patient. Given these challenges, we conceived a simple 6-step (1) Antibiotics, (2) Suture the cervical esophagus with a 0- chromic, (3) Suture the abdominal esophagus with a 3-0 chromic, (4) Insert nasogastric tube above the sutured cervical esophagus, (5) Support nutrition with a jejunostomy, and (6) Tubes (placement of bilateral chest tubes). Methods Six consecutive septic patients with TEP who underwent an ASSIST approach were evaluated. On day 14, patients were taken to the OR for an esophagogastroduodenoscopy to open the cervical and hiatal esophageal closure. Patients then underwent a repeat barium swallow prior to resuming per oral (PO) intake. Results Sepsis resolved in all patients. One patient died of advanced cirrhosis. None of the living patients required additional surgery and all resumed a normal diet. Conclusions The “ASSIST” method is a viable option for managing septic patients with thoracic esophageal perforation. This novel approach does not require a high level of technical expertise and conceivably be performed by most centers without the need for immediate transfer to specialized facilities.

The Surgical Management of Peptic Ulcer Disease

The treatment of peptic ulcer disease has evolved substantially through the decades since the discovery of acid-reducing agents and helicobacter pylori bacteria. With the success of medical treatment, surgical therapy continues to play a less prominent role in the care of this disease. Operative candidates include the naive patient treated with over-the-counter NSAIDs who are often those with undiagnosed Helicobacter pylori, requiring less complicated initial surgery. With more surgeons graduating with less experience operating on PUD with evolving operative techniques, the question arises as to what constitutes the optimal surgical approach, especially in the elective vs. emergent settings. Recent literature discussing GI bleeding associated with COVID-19 also merits discussion of surgical options in this chapter. Future surgical options may include minimally invasive endoscopic surgeries akin to per-oral endoscopic myotomy of the pylorus; however, this has not yet been described in this disease.

Meloxicam in pain syndrome treatment of comorbid diseases patients

The issue nonsteroidal anti-inflammatory drugs (NSAIDs) use safety is associated with a high frequency of adverse events (AEs) from the gastrointestinal tract and cardiovascular risks. Patients with lower back pain (LBP) and osteoarthritis (OA), as a rule, have comorbid diseases, such as arterial hypertension (AH), coronary heart disease (CHD), gastrointestinal tract (GIT) diseases, which significantly complicates the appointment of NSAIDs. The main guideline in NSAIDs appointment is the selective ability to inhibit cyclooxygenase-1 and -2 (COX). The ratio of the activity of NSAIDs when blocking COX-1/COX-2 allows us to judge their potential toxicity. And, then higher the selectivity of NSAIDs, then lower its toxicity. For example, the ratio of COX-1/COX-2 in meloxicam is 0.33, diclofenac – 2.2, tenoxicam – 15, piroxicam – 33, indomethacin – 107. To the predominantly selective COX-2 NSAIDs include meloxicam, which has little effect on the GIT, the lowest relative risk (RR) of complications from the cardiovascular system (CVS). The therapeutic efficacy of meloxicam is comparable to piroxicam and diclofenac. A number of studies have shown the high efficacy of meloxicam, both with per oral (p/o) administration (7.5–15 mg/d), and with intramuscular (i/m) administration (1.5 ml), and when injected into trigger zones. Both with p/o and the injectable form of meloxicam has minimal GIT AEs and absence local reaction in the injection area. The drug can be recommended both as a combination therapy and prescribed in monotherapy.

Pilot prospective study on formal training in per-oral endoscopic myotomy (POEM) during advanced endoscopy fellowship

Background and study aims Gastroenterology societies have recently proposed core curricula for training in per-oral endoscopic myotomy (POEM) based on expert opinion with limited data on its applicability for advanced endoscopy fellowship (AEF) trainees. We prospectively evaluated the feasibility of a structured POEM training curriculum during a dedicated AEF and the trainee’s performance during independent practice. Methods This was a single-center prospective study evaluating a trainee’s performance of POEM using a structured assessment tool (POEMAT) to assess core cognitive and technical skills. The trainee’s performance was then prospectively assessed during the first 12 months of independent practice. Results The trainee, who had not prior background in submucosal endoscopy, first observed 22 POEM cases followed by 35 hands-on procedures during his advanced endoscopy fellowship. Based on the POEMAT, submucosal entry and mucosal incision closure were the most challenging technical aspects, while cognitive skills were uniformly attained early in training. Overall, the trainee was able to cross the threshold for competence in his POEMAT performance score in 15 of his last 18 cases (83.3 %). The trainee performed 16 POEMs (baseline mean Eckardt 7.2) in his first 12 months of independent practice. Mean procedural time was 79.8 minutes (interquartile range: 67–94 minutes minutes) with no adverse events. Clinical success (Eckardt score < 3) was achieved in 100 % of the cases at a median follow-up of 20 weeks. Conclusions Results from this pilot study support the adoptability of the recently proposed core curricula for POEM training within the context of a dedicated AEF and provide a potential blueprint for future studies of performance in POEM among trainees.

Ovariohysterectomy pada kucing liar

Kucing domestik liar betina dibawa ke klinik dengan tujuan untuk dilakukan serilisasi seksual. Hasil pemeriksaan fisik menunjukkan bahwa kucing tersebut dalam keadaan sehat. Metode sterilisasi yang dilakukan adalah bedah ovariohysterectomy melalui caudal midline. Terapi pasca operasi yang diberikan adalah terapi sistemik berupa injeksi antibiotik Sulfadiazine dan Trimethoprim 30 mg/kg BB serta Dexametasone 0,5 mg/kali melalui rute intramuskular, terapi per oral berupa antiotik Amoxicillin sirup 20 mg/kg BB q8h, serta povidone iodin secara topikal pada luka operasi. Proses penyembuhan luka berjalan dengan baik tanpaa adanya komplikasi. Pada hari ke-11 dilakukan buka jahitan dengan kondisi luka operasi yang telah mengering.