Mucosal Lesions Related to Toombak Dipping in the Sudanese

Background: Mucosal changes related to smokeless tobacco dipping appear to be influenced by many factors; including duration of dipping, frequency of dipping, chemical ingredients of the dipped stuff, in addition to possible genetic and racial factors. In the Sudan the habit of using smokeless tobacco (Toombak) is very common, and it is associated with pathological mucosal changes classified into five distinct clinical presentations: Presentation I; wrinkling with slight discoloration, Presentation II; Café au lait discoloration (Brownish discoloration), Presentation III; smoke-white discoloration, Presentation IV; grizzle discoloration, and Presentation V; cotton-white discoloration. Material and Methods: In this observational prospective study, a survey of oral cancer across 16 different localities was held in the Sudan. A total of 285 Toombak dippers agreed to be examined and of them 161 patients were found to have Toombak dipper-lesions. The clinical presentations of these lesions were identified and recorded into 5 different presentation categories. Furthermore, 64 specimens were cut and stained with Haematoxylin and Eosin (H&E). Microscopic diagnosis was obtained using both WHO-5-Point grading classification and the binary system. The history of the time span was matched with the related clinical and microscopic findings. Results: Regarding the 161 cases; the lower vestibule was the preferred dipping site in 75(46.6%) cases. The average Age of Commencement (AoC) was 24.5 years. The average Estimated Contact Hours (ECH) was 22,338 ± 40,824 hours; equal to 2.55 contact years in lifetime. The dominant mucosal clinical presentation was wrinkling with/without slight discolouration; found in 54 cases, and accounting for 33.6% of the sample. Of the 64 specimens, 51 cases showed hyperkeratosis, 11 cases showed mild dysplasia and the remaining three cases showed severe dysplasia; two cases were cotton- white presentations, and one case was a grizzle presentation. Conclusion: Twenty per cent of Toombak dippers-lesions showed dysplastic cells. The grizzle and the cotton- white clinical presentations are associated with high-risk dysplasia. A significant relationship was found between the clinical presentation and the AoC. No significant relationship was found between the clinical presentation and the Impact of Time Duration (TD), in terms of life-time duration of dipping, number of dippings/day, dip-duration and the Estimated Contact Hours (ECH).

Prominent rash and multisystem inflammatory syndrome in a 29-year-old patient with COVID-19: a case report

Background Adult patients with coronavirus disease present primarily with respiratory symptoms, but children and some adults may display a more systemic inflammatory syndrome with rash, fever, mucosal changes, and elevated inflammatory biomarkers. Case presentation Here, we report the case of a 29-year-old Hispanic patient presenting with significant rash and multisystem inflammation. We describe his clinical course, review dermatological manifestations of coronavirus disease, and summarize the pathophysiology of coronavirus disease-associated multisystem inflammation. Conclusion This case should alert physicians to the atypical nature of presenting rash with minimal respiratory symptoms in coronavirus disease.

The influence of subject learning on the skills of decoding autofluorescent images of the oral mucosa

Background. Despite the ease of implementation, harmlessness, painlessness and speed of the study, the method of autofluorescence does not belong to the routine and often used because of the dependence on the skill of the dentist in interpretation of the resulting visualization. Foreign and domestic researchers speak about the need for thematic training of dentists for the widespread introduction of the autofluorescence method into practice. There is no data proving the influence of training on the skill of interpretation autofluorescence images and showing the dependence of the skill on the duration of training and its frequency.The aim of the study was to conduct a comparative analysis of the results of interpreting autofluorescence images of the oral mucosa by dentists before and after thematic training.Methods. 308 dentists interpreted 20 images of autofluorescence of the oral mucosa before and after the thematic training, 10 of them were of potentially malignant diseases of the oral mucosa, 10 – of benign lesions and paraphysiological anomalies. Correctly identified mucosal changes presented in the autofluorescence image were considered positive results of decoding. The results were evaluated relative to the duration of training and its frequency, taking into account the duration of breaks, according to the average number of positive results.Results. Before the thematic training, dentists on average decoded 8.41 ± 4.89 images, after training – 12.11 ± 3.12 images. The difference before and after the thematic training between the number of positive results of interpretation autofluorescence images is statistically significant (t = –14.1, p˂ 0.001). There was no significant difference in the results of interpretation potentially malignant oral diseases (F = 1.67; p = 0.190) and benign lesions and conditions (F = 0.647; p = 0.524) between the three groups that studied for 6, 12 and 18 hours. There is a correlation to the duration of the interruption of training with positive results of decoding (r = –0.3376; p˂ 0.001). The positive results of interpretation of autofluorescence with regular monthly 6-hour training had significant increasing trends (12.11 ± 3.12 and 13.22 ± 1.76, t = –3.41, p = 0.001; 13.22 ± 1.76 and 14.40 ± 1.81, t = –4.74, p˂ 0.001).Conclusion. Thematic training improves the skill of interpretation autofluorescence images in dentists. The regularity of short-term training is more important for maintaining the interpretation skill than the duration of training.

Lichen Planus

Lichen planus (LP) is a T cell-mediated disease affecting the stratified squamous epithelia of the skin and/or mucus membrane. Histologically, the disease is characterized by a lichenoid inflammatory infiltrate and vacuolar degeneration of the basal layer of the epidermis. LP has three major subtypes: Cutaneous, mucosal and appendageal LP. Rarely, it may affect the nails in the absence of skin and/or mucosal changes. LP may also be induced by several drugs, typically anti-hypertensive medication or be associated with infections, particularly viral hepatitis. The diagnosis is based on the clinical presentation and characteristic histological findings. Although the disease is often self-limiting, the intractable pruritus and painful mucosal erosions result in significant morbidity. The current first-line treatment are topical and/or systemic corticosteroids. In addition, immunosuppressants may be used as corticosteroid-sparing agents. These, however are often not sufficient to control disease. Janus kinase inhibitors and biologics (anti-IL-12/23, anti-IL17) have emerged as novel future treatment options. Thus, one may expect a dramatic change of the treatment landscape of LP in the near future.

EFFECT OF CITRAKADI KSARA LĒPA IN THE MANAGEMENT OF SECOND-DEGREE INTERNAL HAEMORRHOIDS

Background and Objectives: Haemorrhoids are dilated veins within the anal canal in the sub-epithelial region formed by radicles of superior, middle, and inferior rectal veins. It hampers the routine life of an affected person. In India about 50% of the population would have haemorrhoids at some point in their life. Achārya Vāgbhata defines Arsas (haemorrhoids) as an abnormal growth which obstructs the anal canal and troubles continuously like an enemy The objective of the study is to assess the efficacy of citrakādi kṣāra lēpa in the management of second- degree internal haemorrhoids. The study also aims to find out an easy, effective and less complicated procedure for second-degree haemorrhoids. The 15 participants with second degree internal haemorrhoids were selected as per inclusion criteria. After doing all the preoperative procedures, the citrakādi kṣāra lēpa was done in a single sitting. The duration of the study was 30 days. The assessment of reduction of size of haemorrhoids, mucosal changes after the procedure and frequency of bleeding were done before the treatment, on 1st, 3rd, 5th, 7th, 15th, and 30th day using the required assessment tools. The symptoms, constipation and mucous discharge were assessed on the 0th and 30th days. The follow up was done on the 60th day. The statistical analysis of the results was done using non- parametric tests. On analysing, it was found that the Citrakādi kṣāra shows 86.11% of the efficacy in the reduction of both subjective and objective parameters. Key words: Haemorrhoids, Arsas, Citrakādi kṣāra

Gastric Neuroendocrine Tumor Mimicking Gastrointestinal Stromal Tumor: A Case Report

Gastric neuroendocrine tumors (NETs) are rare lesions that arise from enterochromaffin-like cells of the gastric mucosa. Gastric NETs are classified into 3 types of NETs and poorly differentiated neuroendocrine cancers. Most gastric NETs usually present as hemispherical, yellowish, polypoid lesions with a central depression and often as subepithelial tumors (SETs) because they are confined within the submucosal layer. Here, we report a case of gastric NET presenting as SET mimicking a gastrointestinal stromal tumor (GIST). Endoscopy revealed a 2.3-cm-sized SET with intact surface mucosa, and endoscopic ultrasonography showed a homogeneous hypoechoic lesion with a well-circumscribed margin. Typical features of gastric NET, such as yellowish mucosal changes or central ulceration, were not observed. GIST was suspected, and a laparoscopic wedge resection was performed. The final diagnosis was gastric NET with grade 2 differentiation.

Sinus Radiological Findings in General Asymptomatic Populations: A Systematic Review of Incidental Mucosal Changes

Objective To determine the range of incidental mucosal changes in a general sinonasally asymptomatic population on radiology. Data Sources Medline (1996-present) and Embase (1974-present) were searched on March 14, 2020, to identify articles that reported radiological sinus mucosal findings in asymptomatic population groups. Bibliographic search of included studies was conducted to identify additional articles. Review Methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive search strategy was formulated and articles screened to extract data reporting Lund-Mackay (LM) score, presence of mucous retention cysts, and maxillary mucosal thickening. A random-effects model was used in meta-analysis. Results A total of 950 articles were identified, of which 33 manuscripts met the inclusion criteria. The included studies involved 16,966 sinonasally asymptomatic subjects. The mean LM score was 2.24 (95% CI, 1.61-2.87), and an LM score of ≥4 in 14.71% (95% CI, 6.86-24.82%) was present across all general asymptomatic population groups. Mucous retention cysts were noted in 13% (95% CI, 8.33-18.55%) and maxillary mucosal thickening of ≥2 mm in 17.73% (95% CI, 8.67-29.08%). Conclusion The prevalence of incidental mucosal changes in a general asymptomatic population on radiology needs to be considered when making a diagnosis of chronic rhinosinusitis.

Feasibility of balloon-based endobiliary radiofrequency ablation under cholangioscopy guidance in a swine model

Although endobiliary radiofrequency ablation (RFA) has demonstrated considerable potential for the treatment of biliary strictures, conventional catheter RFA has several limitations. This study aimed to evaluate the feasibility of a novel cholangioscopy (CS)-guided balloon-based RFA procedure in vivo using a swine model. CS-guided balloon-RFA was performed under endoscopic retrograde cholangiography guidance at target temperatures of 60 ℃ or 70 ℃, which were maintained for 60 s. We evaluated the technical feasibility, adverse events, and histological effects associated with the procedure. Twelve sites were ablated in seven miniature pigs. The CS-guided balloon-RFA procedure was technically successful in all cases without any hindrance. Mucosal changes could be detected during RFA, and the ablation area was identified on CS. Necropsy was performed in four pigs on the same day as the procedure: the tissue samples showed coagulative necrosis, and the entire internal circumference of the bile duct was uniformly ablated. The mean lengths of the ablation area in the samples ablated at 60 °C and 70 °C were 20.64 and 22.18 mm, respectively, while the mean depths were 3.46 and 5.07 mm, respectively. The other three pigs were reared and euthanized and autopsied 35 days after the procedure. The site to be ablated had replaced the granulation tissue and fibrotic changes. No adverse events were observed in any case. CS-guided balloon-RFA appears to be a promising option for treating biliary strictures. This preliminary study could pave the way for the evaluation of this procedure in future human clinical trials.