Successful Regenerative Therapy of Periodontal Defects Associated With Tongue Piercing: A Clinical Report.

Oral piercing habits are associated with various degrees of complications. Tongue piercing increases the risk of gingival recession and infrabony defects, subsequently leading to localized periodontitis. In the case presented, the patient had persistent swelling and suppuration around her mandibular anterior teeth attributed to tongue piercing jewelry that was placed approximately 12 years prior. Intraoral examinations revealed a localized deep pocket, purulent discharge, swelling, plaque accumulation, bleeding on probing, gingival recession, and teeth mobility. The patient was diagnosed with localized stage III, grade C periodontitis. Following full-mouth debridement and the placement of an extracoronal lingual splint, minimally invasive, papillae-sparing incisions were made, and regenerative therapy with bone allograft and collagen membrane was used to manage the infrabony defects. During the 18-month postoperative follow-up, complete soft-tissue healing was observed along with a significant reduction in pocket depth and the absence of bleeding on probing or suppuration. Radiographic evaluation showed evidence of bone fill. The reported case demonstrates how careful diagnosis and treatment planning are crucial for managing different periodontal defects and emphasizes the importance of proficient periodontal management, which can save teeth that would otherwise be extracted and replaced with implant therapy or fixed bridgework.

Effects of predictive nursing interventions on pressure ulcer in elderly bedridden patients.

The study explores the impact of predictive nursing interventions on pressure ulcers (PUs) in elderly bedridden patients. A total of 120 elderly bedridden patients from the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture between August 2019 and August 2023 were selected as the subjects of the study and were randomly divided into an observation group and a control group using a random number table method. The control group received conventional nursing care, while the observation group received predictive nursing interventions. The study compared the incidence of PUs, Braden scale scores, the onset time of PUs, self-rating anxiety scale (SAS) scores, self-rating depression scale (SDS) scores, and nursing satisfaction between the two groups. In elderly bedridden patients, the application of predictive nursing interventions significantly reduced the incidence of PUs (p < 0.001), significantly lowered the SAS and SDS scores (p < 0.001), and also significantly increased Braden scale scores (p < 0.001) and delayed the onset time of PUs (p < 0.001). Additionally, it improved patients' nursing satisfaction (p = 0.008). Predictive nursing interventions in elderly bedridden patients have good application effects, reducing the occurrence of PUs, delaying the time of onset in patients, improving patients' negative emotions and enhancing nursing satisfaction rates. It is worthy of widespread use.

Assessing peptic ulcer risk with the HAMPROW score in the general Chinese population.

The timely identification of individuals at high risk for peptic ulcers (PUs) is vital in preventing gastrointestinal bleeding after antiplatelet therapy. This study was designed to determine PU risk factors and develop a risk assessment model for PU detection in the general Chinese population. In a prospective dataset, clinical data from individuals undergoing gastroscopic evaluation between April 2019 and May 2022 were recorded. PUs were defined as mucosal defects exceeding 5 mm confirmed via gastroscopy. Participants were categorized into development (April 2019 to April 2021) and validation (May 2021 to May 2022) sets based on chronological order. LASSO-derived logistic regression analysis was employed to create a score, which was further validated via temporal validation. A total of 902 patients were ultimately enrolled, 204 (22.6%) of whom had PUs based on endoscopic findings. In the development cohort (n = 631), seven independent risk factors emerged: male sex (OR = 2.35, P = 0.002), white blood cell (WBC) count (OR = 1.16, P = 0.010), red blood cell (RBC) count (OR = 0.49, P < 0.001), globulin level (OR = 0.92, P = 0.004), albumin level (OR = 0.94, P = 0.020), pepsinogen I (PGI) level (OR = 1.01, P < 0.001), and positive Helicobacter pylori (HP) antibody (OR = 2.50, P < 0.001). Using these factors, a nomogram (HAMPROW score [hazard ratio (HP) antibody, albumin, male, PGI, RBC, globulin, and WBC]) was developed for individual PU prediction. The ability of the HAMPROW score to predict survival was confirmed with AUCs of 0.854 (95% CI 0.816-0.891) and 0.833 (95% CI 0.771-0.895) in the development and validation sets, respectively. In conclusion, the HAMPROW score can be used to screen for PUs effectively in the general Chinese population, facilitating personalized early detection of high risk of gastrointestinal bleeding before antiplatelet therapy.

Streptococcus pneumoniae-associated pneumonia complicated by purulent pericarditis: case series / Pneumonia por Streptococcus pneumoniae complicada por pericardite purulenta: uma série de casos

AbstractObjective: In the antibiotic era, purulent pericarditis is a rare entity. However, there are still reports of cases of the disease, which is associated with high mortality, and most such cases are attributed to delayed diagnosis. Approximately 40-50% of all cases of purulent pericarditis are caused by Gram-positive bacteria, Streptococcus pneumoniae in particular.Methods: We report four cases of pneumococcal pneumonia complicated by pericarditis, with different clinical features and levels of severity.Results: In three of the four cases, the main complication was cardiac tamponade. Microbiological screening (urinary antigen testing and pleural fluid culture) confirmed the diagnosis of severe pneumococcal pneumonia complicated by purulent pericarditis.Conclusions: In cases of pneumococcal pneumonia complicated by pericarditis, early diagnosis is of paramount importance to avoid severe hemodynamic compromise. The complications of acute pericarditis appear early in the clinical course of the infection. The most serious complications are cardiac tamponade and its consequences. Antibiotic therapy combined with pericardiocentesis drastically reduces the mortality associated with purulent pericarditis.

ResumoObjetivo:Na era dos antibióticos, a pericardite purulenta é uma entidade rara. Entretanto, ainda há relatos de casos da doença, associados a alta mortalidade, muitos deles atribuídos ao diagnóstico tardio. Aproximadamente 40-50% de todos os casos de pericardite purulenta são causados por bactérias gram-positivas, particularmente Streptococcus pneumoniae.Métodos:Relatamos quatro casos de pneumonia pneumocócica complicada por pericardite, com diferentes características clínicas e níveis de gravidade.Resultados:Em três dos quatro casos, a principal complicação foi tamponamento cardíaco. A pesquisa microbiológica (teste de antígeno urinário e cultura de líquido pleural) confirmou o diagnóstico de pneumonia pneumocócica grave complicada por pericardite purulenta.Conclusões:Em casos de pneumonia pneumocócica complicada por pericardite, o pronto diagnóstico é de extrema importância para evitar comprometimento hemodinâmico grave. As complicações da pericardite aguda aparecem no início do curso clínico da infecção. As complicações mais graves são tamponamento cardíaco e suas consequências. A antibioticoterapia com pericardiocentese reduz sobremaneira a mortalidade associada à pericardite purulenta.

Meningoencefalitis post estapedotomía: análisis de un caso clínico / Repeated episodes of meningoencephalitis after a stapedotomy: report of one case

Bacterial meningitis of otological origin is caused by the pass of bacteria from a suppurated otitis to the central nervous system. Patients subjected to otological surgery have a higher risk of contracting it. We report a 30 years old female with a history of non progressive long lasting hear loss in the left ear, that suffered two episodes of bacterial meningitis after being subjected to a stapedotomy. Temporal CAT scan revealed a malformation of the inner ear. An exploratory tympanostomy showed a perilymphatic fistula that was repaired.

Infecciones de las heridas medianas transesternales empleadas en cirugia cardiovascular: su tratamiento / Infections of the median transesternal wounds used in cardiovascular surgery: treatment

El trabajo refleja la experiencia en el tratamiento de una complicación quirúrgica infrecuente pero grave la infección de la herida mediana transternal que sirvió de vía de acceso al corazón y a los grandes vasos. Se realizó entre octubre de 1985 y agosto de 1990 en seis centros de cirugía cardiovascular de la ciudad de Buenos Aires. Los comunicantes ponen de relieve las virtudes de un sencillo esquema terapéutico que con ligeras variantes han aplicado a casi todos sus casos. Los rasgos más característicos de ese plan son: el empleo de azúcar como agente detersorio y el uso de colgajos musculares, también como agentes detersorio y simultáneamente como elementos de protección y relleno. Se prodigan consejos sobre su elección y sobre el modo más eficaz y menos dañino de manejarlos. Fueron asistidos 206 pacientes, con resultados muy satisfactorios: mortalidad y morbilidad limitadas y pronta recuperación sin secuelas

Inestabilidad ventilatoria en infecciones agudas del sistema nervioso central / Ventilatory inestability in acute infections of the central nervous system

Se evaluaron en forma retrospectiva 114 pacientes egresados del Hospital "Dr. F.J. Muñiz" con diagnóstico de infecciones agudas del sistema nervioso central. Se utilizó como criterio de inclusión, ausencia de patología pleuropulmonar concomitante, que se interpreta como posible factor desencadenante de un cuadro de insuficiencia respiratoria. Todos los pacientes fueron sometidos a asistencia respiratoria mecánica, por distintos criterios y con diferentes parámetros gasométricos previos. La tasa de letalidad global fue del 44,75 por ciento, hallándose en los pacientes ventilados, gasométricamente normales, previa asistencia respiratoria, el menor índice de letalidad, 13,63 por ciento en contraste con aquellos que fueron sometidos a ventilación mecánica con criterios de insuficiencia respiratoria, cuya mortalidad alcanzó el 61,76 por ciento. A pesar de tratarse de un estudio retrospectivo, se desea hacer hincapié en la necesidad de considerar los mecanismos compensatorios ante la hipertensión endocraneana, la hiperventilación, como una inestabilidad ventilatoria en sí, extremando las precauciones para indicar una asistencia ventilatoria precoz, para asegurar una ventilación alveolar efectiva

Piometra: estudio de evaluación en 15 años en el hospital Loayza / Piometra: evaluation study in 15 years in hospital Loayza

Se revisa en forma retrospectiva nueve casos de piometra ocurridos durante un período de 15 años en el Hospital Arzobispo Loayza, Lima*Perú. El diagnóstico fue establecido clínicamente luego de la observación de material purulento que escapaba a través del orificio cervical en forma espontánea o luego de dilatación del cervix. El promedio de edad fue de 52.5 años. Siete pacientes se encontraban en edad post*menopáusica. El síntoma de flujo vaginal como descarga purulenta fétida se presentó en siete pacientes, cinco de las cuales acudieron con fiebre y compromiso del estado general. En ningún caso se encontró asociación con enfermedad maligna del cervix o útero. En seis casos se encontró útero aumentado de tamaño y, en todos los casos, este fue doloroso a la palpación. El diagnóstico preoperatorio fue hecho en cuatro casos. Los resultados bacteriológicos son limitados por no haberse hecho cultivos para anaerobios. Todas las pacientes recibieron tratamiento médico y quirúrgico, y su evolución fue favorable. Se discute los resultados basados en una revisión bibliográfica actualizada