A case of severe corneal-conjunctival xerosis caused by long-term local use of inocaine in a patient with viral conjunctivitis (COVID-19)

The article describes a rare case of conjunctivitis in a 25-year-old patient that developed 5 days before the first typical signs of COVID-19 disease appeared, and led to cicatricial changes in the conjunctiva in the form of bilateral partial external symblepharon and mild dry eye syndrome, and later chronic dacryocystitis of the right eyes. Surgical treatment of simblepharon led to its relapse in the right eye with gradual development of severe DES with a significant decrease in visual acuity. The prescribed complex therapy with drops of dexamethasone, restasis, vitabact and tear-suppressing drugs (Oftagel, Vita Pos ointment) for several days, however, led to extensive detachment of the corneal epithelium and the development of a superficial ulcer of the right eye with a keratomalacia area in its lower part. In the process of inpatient treatment recommended to the patient at one of the councils, it suddenly turned out that the patient had been periodically instilling inocaine into his right eye for anesthesia for several months on his own. It was the decrease in sensitivity against the background of prolonged instillations of the local anesthetic inocaine that aggravated the violation of the stability of the tear film, led to a significant decrease in tear secretion and a cytotoxic effect, which gradually led to the development of severe corneal-conjunctival xerosis. The performed inpatient treatment and subsequent outpatient treatment led to the relief of inflammation, epithelialization of the ulcer. Key words: conjunctivitis, COVID-19, complication, simblefaron, inocaine anesthetic, corneal-conjunctival xerosis.

Complicated corneal ulceration in cats: diagnosis and treatment outcomes of 80 cases (2014-2018)

The study describes the most common clinical and endoscopic findings associated with complicated corneal ulcers in cats and evaluates the short-term outcomes after surgical interventions. Eighty client-owned cats of different breeds with corneal ulcers were included. Cats were clinically evaluated to initially determine corneal abnormalities. Endoscopic examination of the corneas was performed to determine anterior and posterior segments’ abnormalities. Non-healing superficial ulcer was treated by superficial keratectomy and deep stromal ulcers were treated using conjunctival flaps. Corneal sequestrum were treated by partial keratectomies and conjunctival flaps. Anterior synechiae were treated via peripheral iridectomy and separation of the adhesion between the iris and the inner cornea. Symblepharon were treated by removal of the adhered conjunctival membrane from the cornea. Unresponsive endophthalmitis was treated surgically by exenteration. Outcomes after surgical managements of selected corneal abnormalities were assessed clinically and endoscopically. Non-healing superficial ulcer, deep stromal ulcer with descemetocele, endophthalmitis, symblepharon, corneal sequestration and anterior synechiae with secondary glaucoma and corneal scarring were the recorded complications of corneal ulcer. FHV-1 was a common etiologic factor of corneal ulceration. Persistent corneal scars of varying shape and size developed in cats with deep stromal ulcer, anterior synechiae, and corneal sequestration. Domestic shorthaired and Persian cats were the most predisposed breeds to FHV-1 infection and subsequent corneal ulceration. Management of patients with corneal ulcer would prevent serious complications. No age or sex predisposition to complicated corneal ulceration in cats was noticed.

Nasal Inflammation and Ulceration Secondary to Repeated Use of an Intranasal Delivery Device in Rabbits

Intranasal administration of drugs is gaining popularity in medicine, and several animal models have been used to test the safety and efficacy of this delivery route. Nevertheless, the nasal anatomy of animals is different from humans, which can lead to pathological changes that stem from the delivery device and not the drug itself. Here, we report on nasal inflammation and ulceration in rabbits, secondary to the repeated trauma caused by the intranasal device. Similar changes were noted in the animals treated with the vehicle and with the tested drug, and therefore, these changes were not attributed to the drug itself. In some animals, superficial ulcer and stromal inflammation were noted in the eyes, secondary to nasal duct obstruction from the nasal inflammation. These observations emphasize the importance of proper interpretation of histopathological changes, attributed to trauma-induced pathological changes related to the handling of the animal and not to the tested product, which is the drug itself and the device that is optimized for clinical (human) use.

COMPLICATION OF THE PRIMARY ANTITUBERCULAR VACCINATION

The aim of the study was to determine the causes and frequency of complications of TB vaccination in newborns, tactics of their treatment and prevention measures. The subject of the study were patients with chronic complications of tuberculosis vaccination: regional lymphadenitis, superficial ulcer, cold abscess, keloid scar, osteo-myelitis. Analysis of morbidity carried out in the Republic of North Ossetia – Alania from 2010 to 2018. A direct correlation of complications with the level of brevemente children with tuberculosis, a decrease in reactivity and change them-munna status of mother and newborn, violation of technology of introduction of the BCG vaccine. The tactics of treatment of each type of complications is defined.

Outcomes of Children Presenting with Button Battery in Esophagus: A Retrospective Review

Introduction Foreign body in esophagus is a common ENT emergency. Button batteries tend to have more grievous outcomes due to caustic mucosal injury to the esophagus. The objective of our study was to review the clinical profile and outcomes of the paediatric population in our center who presented with button battery in esophagus following accidental ingestion. MethodsThis was a retrospective study conducted in Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Hospital records of all the patients who presented with button battery esophagus and underwent rigid oesophagoscopic removal from January 2013 to January 2019 were reviewed and analyzed for patient demographics, time interval between ingestion and presentation, site of impaction, status of oesophageal mucosa at the time of rigid oesophagoscopic removal of the battery, early post-operative complications, outcomes at the time of discharge and on follow-up. ResultsOur final sample size was 11 and all cases were <15 years. The average duration from time of ingestion to presentation to our hospital ranged from 1 day to 2 months. Variable oesophageal mucosal findings such as superficial mucosal erosion, superficial ulcer with slough and granulations with deep discrete ulcer were seen at the site of impaction of the button battery. One case was diagnosed with bilateral abductor palsy on 10th post-operative day following rigid oesophagoscopic removal of the battery. All other cases didn’t develop any significant complications. ConclusionButton battery in esophagus results in oesophageal ulceration and thus warrants an early endoscopic removal. Delayed removal can also cause bilateral abductor palsy from the caustic damage to recurrent laryngeal nerve.

Persistent sore throat: a case of laryngeal mucous membrane pemphigoid

We present a case of a 72-year-old women who presented with a persistent sore throat and productive cough. On flexible nasendoscopy examination, she was found to have a fairly superficial ulcer affecting the laryngeal surface and tip of her epiglottis. On her second microlaryngoscopy and biopsy, direct immunofluorescent staining of the biopsy was analysed and the histological findings were in keeping with a diagnosis of mucous membrane pemphigoid (MMP). MMP is a rare chronic autoimmune condition characterised by the presence of blistering subepithelial lesions that can cause scarring. Laryngeal MMP affects only 1 in 10 million people and can lead to life-threatening airway compromise arising from scarring and stenosis. As there is a large spectrum of disease, it is important to adopt a multidisciplinary approach including dermatologists, otolaryngologists and ophthalmologists for prompt diagnosis and early recognition of potential complications, maximising functional outcomes for patients.

Diagnosis and Treatment of Paracoccidioidomycosis in the Maxillofacial Region: A Report of 5 Cases

Paracoccidioidomycosis is a fungal infection initially described in Brazil in 1908 by Adolfo Lutz. Manifestation of this disease depends on numerous factors, such as microorganism virulence, hormonal profile, genetic predisposition, nutrition, and immune system. It is characterized classically by cutaneous lesions, lymphadenopathy, and pulmonary involvement. It presents male predilection, which can be explained by the protective effect of female hormones. Classic presentation within oral cavity is a superficial ulcer characterized by hemorrhagic dots of moriform aspect. Treatment should be established individually and closely monitored. This manuscript aims at reporting five cases of this pathology.

Bacterial cellulose and bacterial cellulose/polycaprolactone composite as tissue substitutes in rabbits' cornea

ABSTRACT: In order to test the performance of bacterial cellulose/polycaprolactone composite (BC/PCL) and pure bacterial cellulose (BC) as tissue substitutes in rabbits' cornea, a superficial ulcer containing 5mm in diameter and 0.2mm deep was made in the right cornea of 36 rabbits, then a interlayer pocket was created from the basis of this ulcer. Twelve rabbits received BC/PCL membrane and 12 were treated with BC membranes, both membranes with 8mm in diameter. The remaining rabbits received no membrane constituting the control group. The animals were clinically followed up for 45 days. Three animals of each group were euthanized at three, seven, 21, and 45 days after implantation for histological examination of the cornea along with the implant. Clinical observation revealed signs of moderate inflammatory process, decreasing from day 20th in the implanted groups. Histology showed absence of epithelium on the membranes, fibroplasia close to the implants, lymph inflammatory infiltrate with giant cells, collagen disorganization, with a predominance of immature collagen fibers in both groups with implants. Although inflammatory response is acceptable, the membranes used does not satisfactorily played the role of tissue substitute for the cornea during the study period.

Drug-resistant genital tuberculosis of the penis in a human immunodeficiency virus non-reactive individual

The genitourinary tract is the most common site for extrapulmonary tuberculosis (TB). Penile TB is extremely rare comprising less than 1 % of all genital TB cases in males. It most commonly presents either as a superficial ulcer on the glans or around the corona. Diagnosis of penile TB is often difficult because it can mimic numerous other diseases. The association of TB with AIDS, and the increasing incidence of multiple drug resistance has further compounded the problem. The case described herein involves a patient with multidrug-resistant smear-positive penile TB that was undiagnosed initially due to the lack of clinical suspicion of TB, and once diagnosed failed to respond to first line antitubercular drugs because of multiple drug resistance.

Does the Depth of Gastric Ulceration Influence a Modified Dual Therapy with Amoxicilin and Lansoprazole forHelicobacter pylori-Positive Gastric Ulcer?

PURPOSE: To clarify whether the depth of ulceration evaluated by endoscopic ultrasonography (EUS) influences a modified dual therapy with amoxicillin and lansoprazole for the treatment ofHelicobacter pylori-positive patients with gastric ulcer.PATIENTS AND METHODS: Twenty-two consecutive cases of gastric ulcer (nine superficial ulcers and 13 deep ulcers) inH pylori-positive patients were studied. Ten of 22 patients received a two-week eradication therapy with amoxicillin 1500 mg/day, lansoprazole 30 mg/day and a new antiulcer agent with features in common with sucralfate, ecabet sodium, 2.0 g/day. They continued to receive the same doses of lansoprazole and ecabet sodium for the next six weeks. The other 12 patients received the same therapy except for those who underwent the four-week amoxicillin treatment. All patients underwent EUS both at the start of the study and eight weeks later. They then received ecabet sodium alone for the next six months as a maintenance therapy, followed by a six-month interval with no treatment. The final endoscopy was done one year afterH pylorieradication therapy was completed to evaluateH pyloristatus and ulcer recurrence.RESULTS: The rates of endoscopic healing andH pylorieradication in the nine patients with superficial ulcer were 100%, irrespective of the period of amoxicillin treatment. In contrast, the rates of endoscopic evidence of healing andH pylorieradication in the 13 patients with deep ulcer were different for each period of amoxicillin treatment; that is, the rates of reduction in ulcer determined by echo andH pylorieradication in the four patients treated with the two-week amoxicillin course were significantly lower (P=0.03) than those in the nine patients treated with the four-week course.CONCLUSION: Ulcer depth is likely to influence the success of amoxicillin treatment forH pylori-positive patients with gastric ulcer.