Intraluminal duodenal “windsock” diverticulum; Case Report and discussion

Intraluminal duodenal diverticulum (IDD) is a rare developmental anomaly usually found in the second portion of the duodenum. The cause appears to be a failure of recanalization of the occluded foregut lumen of the human embryo, resulting in a fenestrated mucosal membrane [1]. A small aperture in this diaphragm will gradually cause it to elongate caudally in response to duodenal peristalsis to form the so called “wind-sock” configuration. Symptoms are nonspecific and generally depend on the degree of duodenal obstruction; 25% of cases are associated with GI bleeding. In most documented cases, IDD was diagnosed radiologically, but the value of endoscopy for diagnosis and treatment has been amply demonstrated.

A Case of Acute Generalized Exanthematous Pustulosis by Cefixime with Oral Mucosal Involvement

Acute generalized exanthematous pustulosis (AGEP) is a rare severe cutaneous adverse reaction characterized by the development of numerous sterile and non-follicular pustules on an erythematous base with no or minimal mucous membrane involvement associated with fever and leucocytosis. Cefixime is a cephalosporin-type beta-lactam antibiotic commonly used for the management of several infections. The Cefixime-induced AGEP cases are known to be rare. Here, we present the case report of a 26-year old female who developed Cefixime-induced AGEP with mucosal membrane involvement. To the best of our knowledge, this is the first case to report the mucosal membrane involvement in Cefixime-induced AGEP. We are presenting this case report to draw the attention on the existence and plethora of symptoms of Cefixime-induced AGEP hoping that the clinicians will reckon these in their differential diagnosis and implement the appropriate management strategies for this rare adverse event in their clinical practice.

Nanoemulsion adjuvantation strategy of tumor-associated antigen therapy rephrases mucosal and immunotherapeutic signatures following intranasal vaccination

BackgroundEmulsion adjuvants are a potent tool for effective vaccination; however, the size matters on mucosal signatures and the mechanism of action following intranasal vaccination remains unclear. Here, we launch a mechanistic study to address how mucosal membrane interacts with nanoemulsion of a well-defined size at cellular level and to elucidate the impact of size on tumor-associated antigen therapy.MethodsThe squalene-based emulsified particles at the submicron/nanoscale could be elaborated by homogenization/extrusion. The mucosal signatures following intranasal delivery in mice were evaluated by combining whole-mouse genome microarray and immunohistochemical analysis. The immunological signatures were tested by assessing their ability to influence the transportation of a model antigen ovalbumin (OVA) across nasal mucosal membranes and drive cellular immunity in vivo. Finally, the cancer immunotherapeutic efficacy is monitored by assessing tumor-associated antigen models consisting of OVA protein and tumor cells expressing OVA epitope.ResultsUniform structures with ~200 nm in size induce the emergence of membranous epithelial cells and natural killer cells in nasal mucosal tissues, facilitate the delivery of protein antigen across the nasal mucosal membrane and drive broad-spectrum antigen-specific T-cell immunity in nasal mucosal tissues as well as in the spleen. Further, intranasal vaccination of the nanoemulsion could assist the antigen to generate potent antigen-specific CD8+ cytotoxic T-lymphocyte response. When combined with immunotherapeutic models, such an effective antigen-specific cytotoxic activity allowed the tumor-bearing mice to reach up to 50% survival 40 days after tumor inoculation; moreover, the optimal formulation significantly attenuated lung metastasis.ConclusionsIn the absence of any immunostimulator, only 0.1% content of squalene-based nanoemulsion could rephrase the mucosal signatures following intranasal vaccination and induce broad-spectrum antigen-specific cellular immunity, thereby improving the efficacy of tumor-associated antigen therapy against in situ and metastatic tumors. These results provide critical mechanistic insights into the adjuvant activity of nanoemulsion and give directions for the design and optimization of mucosal delivery for vaccine and immunotherapy.

Preventive Effects of Mallotus japonicus Cortex Extracts on Dextran Sulfate Sodium-Induced Ulcerative Colitis in C57 BL/6J Mice

Background: The cortex of Mallotus japonicus (Euphorbiaceae) has traditionally been used to treat gastric ulcers, duodenal ulcers, and gastric hyperacidity in Japan. A large number of studies have recently focused on its effects on Inflammatory Bowel Disease (IBD). Objective: The aim of the present study was to examine the effects of M. japonicus (MJ) extracts on large intestinal diarrhea and inflammation using Inflammatory Bowel Disease (IBD) mouse models. Methods: The present study used 3% Dextran Sulfate Sodium (DSS)-treated colitis models. Red blood cell, platelet, and leukocyte counts in addition to hematocrit (Ht), hemoglobin (Hb), and colonic cytokine and chemokine levels were measured in DSS-treated C57BL/6J mice during the experimental period. Results: The Disease Activity Index (DAI) was lower in 3% DSS-treated mice orally administered MJ (200 and 500 mg/kg) than in mice administered 3% DSS only. Furthermore, MJ inhibited decreases in red blood cell and platelet counts as well as Hb and Ht levels in DSS-treated mice. Colon histology using direct fast scarlet staining revealed that MJ prevented mucosal membrane ulceration and eosinophil infiltration of the mucosal membrane induced by the DSS treatment. Increases in colonic Monocyte Chemoattractant Protein 1 (MCP)-1, interleukin (IL)-1β, and Tumor Necrosis Factor (TNF)-α levels in DSS-treated mice were reduced by orally administered MJ extracts. Conclusion: The present results suggest that M. japonicus cortex extracts are an effective treatment for IBD through the inhibition of increases in colonic IL-1β, TNF-α, and MCP-1 levels and eosinophil infiltration of the colon in DSS-treated mice.

Laser Therapy Versus Electromagnetic Field on Mucosal Membrane Thickening in Children With Chronic Rhinosinusitis

Introduction: Rhinosinusitis is a frequent disease in children but may be underdiagnosed, that is to say, several causes of the disease are missed in children. Therefore, it seems essential to provide other modalities to treat chronic health conditions like such cases. This controlled clinical study was conducted to compare the effect of two non-pharmacological, painless, safe modalities; low-level laser therapy (LLLT), with pulsed electromagnetic field (PEMF) on mucosal membrane thickening in children with chronic rhinosinusitis. Methods: Thirty children with chronic sinusitis participated in this study, their ages ranged from 6 to 13 years old, recruited from the outpatients ENT clinic, Kasr Al Aini teaching hospital. They were classified into 2 groups of equal number; study group A (PEMF group) and study group B (LLLT group). These children were evaluated before the starting and after the end of the study through CT scan full examination (coronal and axial) for all children. Results: This study showed that there were statistically significant improvements in mucosal membrane thickness in both groups (P<0.05), while there was no statistically significant difference between groups (P>0.05). Conclusion: From the obtained outcomes it can be concluded that both the laser and electromagnetic field can be used effectively in the management of symptoms in children with chronic rhinosinusitis, while no significant difference between these modalities obtained.

In vitro testing of flash-frozen sublingual membranes for storage and reproducible permeability studies of macromolecular drugs from solution or nanofiber mats

Sublingual drug delivery allows systemic delivery of drug without difficulties connected with the gastrointestinal pathway. We developed a new simple protocol for easy-to-use processing and storage of porcine sublingual mucosal membrane for in vitro studies using “flash freezing” in liquid nitrogen. All the dextrans used as mucosal membrane integrity and permeability markers permeated only slowly through sublingual mucosa illustrating usability both the “fresh” and “flash frozen” sublingual membranes whereas conventional cold storage “frozen” membranes have shown significantly higher permeabilities for macromolecules due to the sustained damage. The permeability values were too low to expect dextrans to be potential carriers at this context. To test albumin as a drug carrier we compared FITC-albumin permeation from solutions vs. nanofiber mats donors. To increase the amounts and prolong the transport, we manufactured nanofiber mats loaded with fluorescently marked albumin using well-scalable electrospinning technology. Nanofiber mats have allowed albumin passage through the sublingual membrane in similar amounts as from the pure artificial saliva solution. Since salivary washout strictly limits the duration of liquid dosages, nanofiber mats may thus permit prolonged sublingual administration.Graphical abstract

CELIAC DISEASE AND CHRONIC ENTERITIS: CLINICAL AND MORPHOLOGICAL PARALLELS (SIMILARITIES AND DIFFERENCES)

Clinical features and the morphofunctional status of the small intestine (SI) have been determined with the help of modern clinical-laboratory and morphological methods of the investigation in 40 children aged 1 to 17 years with suspicion of “celiac disease”. As a result of the study, there were determined criteria to allow made a clear differential diagnosis between non-celiac gluten intolerance and the hyperregenerative form of atrophy of the SI mucosal membrane. In children with the unconfirmed diagnosis of the celiac disease in biopsy specimens of mucosal membrane of SI, a morphological pattern has been established to be determined by the presence of inflammation of different degrees of the severity and the prevalence rate against the background of shortened and dilated villi. The presence of villi subatrophy was shown not to be an occasion to consider this process within the framework of the diagnosis of the hyperregenerative form of atrophy of SI mucosal membrane. The histological picture of the inflammatory process found in these cases in combination with a certain reduction in villi is noted in nonspecific inflammatory processes of the gastrointestinal tract (enteritis, colitis), allergic conditions.