Penetrating hypopharyngeal foreign body impalement of the thyroid gland: A case report of rare complication of ingested fish bone.

INTRODUCTION AND IMPORTANCE: Foreign body ingestion complicated by hypopharyngeal perforation is an uncommon but potentially life-threatening condition. Early recognition and appropriate management are crucial to prevent serious complications. We present an extremely rare case highlighting the importance of this clinical entity. CASE PRESENTATION: A 60-year-old female presented with odynophagia 10 days after ingesting fish and chicken. Imaging revealed a linear foreign body penetrating through the left lateral hypopharyngeal wall into the left thyroid lobe, with surrounding inflammatory changes. The patient underwent neck exploration, which identified a sharp fishbone lodged in the postero-medial aspect of the left thyroid lobe, necessitating a left hemithyroidectomy for removal. CLINICAL DISCUSSION: To our knowledge, this is the first reported case of hypopharyngeal perforation by an ingested foreign body penetrating the thyroid gland itself. Despite its rarity, early recognition is crucial to prevent complications like abscess, mediastinitis, and mortality. A high index of suspicion is needed in patients with odynophagia or neck pain after ingesting fish. Advanced imaging and surgical intervention may be required for the management of larger perforations or those involving surrounding structures. CONCLUSION: This unique case highlights an extremely rare presentation of hypopharyngeal perforation with extension into the thyroid gland caused by an ingested fish bone. Prompt diagnosis through appropriate imaging and treatment with surgical exploration and foreign body removal was key to ensuring a positive outcome. Increased awareness of this potential complication is essential among clinicians.

Spondylodiscitis following perforated acute appendicitis in a 14-year-old female: A case report.

INTRODUCTION AND IMPORTANCE: Acute appendicitis is a common surgical emergency, often resulting in perforation and increased morbidity. Up to 55 % of children with complicated appendicitis may experience a complication such as infection, bowel obstruction, or unplanned hospital re-admission (Blakely et al., 2011 [23]). However, the development of infectious spondylodiscitis following appendectomy is an extremely rare complication, particularly in pediatric patients. We present the first reported case of lumbar spondylodiscitis occurring post-perforated appendicitis in a 14-year-old female, highlighting the importance of recognizing and managing uncommon complications. CASE PRESENTATION: A previously healthy 14-year-old female underwent urgent appendectomy for perforated appendicitis. Postoperatively, she developed severe back pain and immobility. Imaging revealed early lumbar discitis, and Pseudomonas aeruginosa was isolated from the surgical site. The patient received multiple antibiotic regimens, including vancomycin, ceftazidime, and meropenem, resulting in clinical improvement. CLINICAL DISCUSSION: Infectious spondylodiscitis is typically hematogenously spread or due to direct inoculation. In this case, the spread from a contiguous focus of infection without vascular insufficiency is suspected. The coexistence of appendicitis and spondylodiscitis poses diagnostic challenges, requiring a multidisciplinary approach for accurate diagnosis and appropriate treatment. CONCLUSION: This unique case highlights the need for vigilance in recognizing rare complications of appendicitis, such as infectious spondylodiscitis. Early diagnosis and tailored antibiotic therapy are crucial for optimal outcomes. Further research is needed to explore the underlying mechanisms and risk factors associated with this rare complication.

Paraduodenal hernias in children: Etiology, treatment, and outcomes of a rare but real cause of bowel obstruction.

INTRODUCTION: Paraduodenal Hernia (PDH) is the most common variant of internal hernia and occurs most often in males during their 4th-6th decades of life. PDH in pediatric age group has rarely been reported in literature with only five cases of age up to 10 years were reported. PDH is a rare cause of intestinal obstruction, which may lead to subsequent strangulation and perforation of the bowel. PRESENTATION OF CASE: We reported a 1.5 year-old male child presented with intestinal obstruction. The patient experienced abdominal pain, vomiting and irritability. Abdominal x-ray showed distal intestinal obstruction which was discovered to be a result of left PDH incidentally during the surgery. In addition, we performed a literature search using PubMed to identify the published cases of PDH. We also compared our case with the characteristics of all reported PDHs in toddlers and children up to 10 years of age in a concise table. DISCUSSION: Despite its congenital origin, PDH has been reported in childhood age group in very rare occasions rendering the accurate incidence of PDH in infancy and childhood unknown. PDHs can be asymptomatic or can present most commonly with recurrent upper abdominal pain. Diagnosis is quite difficult in the absence of symptoms but could be achieved using a computed tomography (CT-scan) in non-emergency symptomatic patients. Surgical repair is mandatory to avoid potential complications. CONCLUSION: As PDH can lead to major and life threatening complications, it must remain in our minds as a possible cause of intestinal obstruction.

Black and white teas as potential agents to combine with amphotericin B and protect red blood cells from amphotericin B-mediated toxicity / Chá preto e branco de Camellia sinensis como potenciais agentes para associar com anfotericina B

Abstract Amphotericin B is a fungicidal substance that is treatment of choice for most systemic fungal infections affecting immunocompromised patients. However, severe side effects have limited the utility of this drug. The aim of this study was to evaluate the antifungal effect of the combination of amphotericin B with black tea or white tea and protective of citotoxic effect. The present study shows that white and black teas have additive effects with amphotericin B against some species Candida. In addition, the combination of white and black tea with amphotericin B may reduce the toxicity of amphotericin B to red blood cells. Our results suggest that white and black tea is a potential agent to combine with amphotericin for antifungal efficacy and to reduce the amphotericin dose to lessen side effects.

Resumo A anfotericina B é o tratamento de escolha para a maioria das infecções fúngicas sistémicas que afetam os doentes imunocomprometidos. No entanto, efeitos secundários graves têm limitado a utilidade desta droga. O objetivo deste estudo foi avaliar o efeito antifúngico da combinação de anfotericina B com chá preto ou chá branco, bem como o efeito citotóxico desta combinação sobre hemáceas. O presente estudo demonstra que o chá branco e preto de Camellia sinensis têm efeitos aditivos com anfotericina B contra algumas espécies de Candida sp. Além disso, a combinação de chá branco e preto com anfotericina B pode reduzir a toxicidade da anfotericina B em hemáceas. Nossos resultados sugerem que o chá branco e preto são agentes potenciais para associação com anfotericina B contribuindo para eficácia antifúngica, bem como redução de toxicidade.

Quercetin and rutin as potential agents antifungal against Cryptococcus spp / Quercetina e rutina: potenciais agentes para terapia antifúngica

Abstract Amphotericin B is a fungicidal substance that is treatment of choice for most systemic fungal infections affecting as cryptococcosis the immunocompromised patients. However, severe side effects have limited the utility of this drug. The aim of this study was to evaluate the antifungal effect of the combination of amphotericin B with quercetin or rutin and as a protective of citotoxic effect. The antifungal activity to amphotericin B, quercetin and rutin alone and in combination was determined in Candida sp and Cryptococcus neoformans strains. Cytotoxicity test on erythrocytes was performed by spectrophotometric absorbance of hemoglobin. The amphotericin B MIC was reduced when used in combination with quercetin or rutin to C. neoformans ATCC strain and reduced when combined with rutin to a clinical isolate of C. neoformans. In addition, the combination of quercetin with amphotericin B may reduce the toxicity of amphotericin B to red blood cells. Our results suggest that quercetin and rutin are potential agents to combine with amphotericin B in order to reduce the amphotericin dose to lessen side effects and improve antifungal efficacy.

Resumo A anfotericina B é uma substância fungicida e é o tratamento de escolha para a maioria das infecções fúngicas sistêmicas que afetam os pacientes imunocomprometidos, como a criptococose. No entanto, as severas reações adversas têm limitado a utilização desta droga. O objetivo deste estudo foi avaliar o efeito antifúngico e o potencial efeito protetor de citotoxicidade da combinação de anfotericina B com quercetina ou rutina. A atividade antifúngica de anfotericina B, quercetina e rutina, isoladamente e em combinação foi determinada em cepas de Candida sp e Cryptococcus neoformans. O teste de citotoxicidade em eritrócitos foi realizado por espectrofotometria, através da determinação da absorbância da hemoglobina. A concentração inibitória mínima da anfotericina B foi reduzida quando utilizada em combinação com a quercetina e rutina em C. neoformans ATCC e reduzida quando combinados com rutina em um isolado clínico de C. neoformans. Além disso, a combinação de quercetina com anfotericina B pode reduzir a toxicidade da droga em eritrócitos. Os resultados sugerem que quercetina e rutina são potenciais agentes para combinação com anfotericina B, a fim de reduzir a dose de anfotericina, diminuindo os efeitos colaterais e melhorando sua eficácia antifúngica.

Antioxidant and antifungal activities of Camellia sinensis (L) Kuntze leaves obtained by different forms of production / Atividade antioxidante e antifúngica das folhas de Camellia sinensis (L) Kuntze, obtidas por diferentes formas de produção

Abstract The antioxidant and anticandidal activities of leaves obtained from Camellia sinensis by non-fermentation (green and white teas), semi-fermentation (red tea) and fermentation method (black tea) were investigated. It was evaluated the total phenolic content by Folin-Ciocalteau assay; antioxidant capacities were evaluated in vitro using DPPH and ABTS radicals, hypochlorous acid and superoxide anion scavenger assays, induced hemolysis, lipid peroxidation by conjugated diene formation and myeloperoxidase activity. Anticandidal activity was performed on three strains of Candida spp. The results showed that non-fermented teas have a higher concentration of phenolic compounds, and then presented the best inhibitory activity of AAPH-induced hemolysis, the best inhibition of conjugated diene formation and more pronounced antioxidant activity in all tests. The highest anticandidal activity was obtained from fermented tea, followed by non-fermented tea. These results indicate that the antioxidant activity demonstrated has no direct relation with the anticandidal activity.

Resumo A atividade antioxidante e antifúngica das folhas obtidas da Camellia sinensis pelos métodos de não-fermentação (chás verde e branco), semi-fermentação (chá vermelho) e fermentação (chá preto) foram investigadas. Foi avaliado o conteúdo total de compostos fenólicos pelo método de Folin-Ciocalteau; a capacidade antioxidante foi avaliada in vitro usando os radicais artificiais DPPH e ABTS, o ácido hipocloroso, ensaios do ânion superóxido, hemólise induzida, peroxidação lipídica por formação de dienos conjugados e atividade da Mieloperoxidase. A atividade antifúngica foi obtida sobre três cepas de Candida spp. Os resultados obtidos mostram que os chás não fermentados apresentam a maior concentração de compostos fenólicos e também, apresentam a melhor atividade inibitória, sobre hemólise induzida por APPH, sobre a formação de dienos conjugados e a mais pronunciada atividade antioxidante sobre todos os testes. A maior atividade antifúngica foi obtida pelo chá fermentado, seguido pelo semi-fermentado e não-fermentados. Os resultados obtidos demonstram que a atividade antioxidante observada não apresenta relação com a atividade antifúngica.

Monitoring of oil pollution at Gemsa Bay and bioremediation capacity of bacterial isolates with biosurfactants and nanoparticles.

Fifteen crude oil-degrading bacterial isolates were isolated from an oil-polluted area in Gemsa Bay, Red Sea, Egypt. Two bacterial species showed the highest growth rate on crude oil hydrocarbons. From an analysis of 16S rRNA sequences, these isolates were identified as Pseudomonas xanthomarina KMM 1447 and Pseudomonas stutzeri ATCC 17588. Gas Chromatographic (GC) analysis of the crude oil remaining in the culture medium after one week at 30°C showed that the optimum biodegradation of crude petroleum oil was demonstrated at 50% in medium containing biosurfactant with two types of nanoparticles separately and two bacterial species. The complete degradation of some different members of polyaromatics and the percentage biodegradation of other polyaromatics increased in microcosm containing two different types of nanoparticles with biosurfactant after 7 days. In conclusion, these bacterial strains may be useful for the bioremediation process in the Gemsa Bay, Red Sea decreasing oil pollution in this marine ecosystem.

Estado nutricional e consumo alimentar de pacientes brasileiros em diferentes estágios da doença de alzheimer: um estudo transversal / Nutritional status and food intake of Brazilian patients at various stages of Alzheimer's disease: a cross-sectional study

A doença de Alzheimer (DA) é caracterizada por distúrbios que podem comprometer a nutrição do paciente e causar perda de peso e deficiências nutricionais durante a doença. O objetivo deste estudo foi avaliar o estado nutricional e o consumo alimentar de pacientes brasileiros com doença de Alzheimer em diferentes estágios da doença. A amostra foi composta por 30 indivíduos, com idade média de 77 anos, de ambos os sexos, com provável DA. Os indivíduos foram avaliados através de dados antropométricos, Mini Avaliação Nutricional (MAN), albumina sérica, Mini Exame do Estado Mental, e recordatório de 24 horas. Embora tenha sido encontrada uma diminuição no peso médio entre os estágios da doença (CDR1: 70,8±15,9 kg; CDR2: 61,4±15,7 kg; CDR3: 56,1± 8,4kg) conforme a progressão da doença, a diferença não foi significativa. Os parâmetros MAN e albumina sérica mostraram uma diminuição entre os estágios da doença (p = 0,042,p = 0,047, respectivamente), sendo que no estágio grave metade dos pacientes estava desnutrida e a outra metade em risco de desnutrição. De acordo com o índice de massa corporal, 23,3% dos pacientes estavam com sobrepeso. O valor nutricional da ingestão alimentar foi similar nos estágios de DA. Em conclusão, a maioria dos pacientes brasileiros com DA neste estudo apresentaram desnutrição, apesar de o consumo alimentar ter sido similar entre os estágios da doença, uma vez que não apresentou associação direta com a progressão da DA...

Alzheimer's disease (AD) is characterized by disorders that can impair the nutrition of the patient and lead to weight loss and nutritional deficits during the course of the disease. The aim of this study was to assess the nutritional status and food intake of Brazilian patients with Alzheimer's disease at 3 different stages of the disease. The sample consisted of 30 subjects of both genders, mean age 77 years, with probable AD. Subjects were assessed by collecting anthropometric data, the Mini Nutritional Assessment (MNA), serum albumin content, Mini Mental State Examination and 24-hour records of food and drink. Although a steady decrease in average weight was observed as the disease progressed (CDR1: 70.8±15.9 kg; CDR2: 61.4±15.7 kg; CDR3: 56.1± 8.4 kg), the differences were not significant. MNA and serum albumin both fell during the progression of the disease (p = 0.042; p = 0.047, respectively) and, at the severe stage, half the patients were found to be undernourished and the other half at risk of undernutrition. According to their body mass index, 23.3% of patients were overweight. The nutritional value of the food consumed was similar across the stages of AD. In conclusion, the majority of Brazilian patients with AD in this study exhibited cognitive decline and malnutrition. However, food intake was similar among the stages of the disease, thus having no direct association with the progression of AD...

Antioxidant activity of Maytenus ilicifolia root bark.

Maytenus ilicifolia is an important plant with potential on cancer treatment and has been largely used in Brazil and other countries. We have evaluated the crude ethanolic extract of M. ilicifolia as a potential antioxidant source using an assay based on the bleaching of the radical monocation 2,2'-azinobis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS(*+)) and by HOCl scavenger capacity. Trolox and uric acid were used as positive controls. The results indicated M. ilicifolia root bark as a great source of antioxidants based on its potential as scavenger of radicals.

Effect of therapeutic plasma concentrations of non-steroidal anti-inflammatory drugs on the production of reactive oxygen species by activated rat neutrophils

The release of reactive oxygen specie (ROS) by activated neutrophil is involved in both the antimicrobial and deleterious effects in chronic inflammation. The objective of the present investigation was to determine the effect of therapeutic plasma concentrations of non-steroidal anti-inflammatory drugs (NSAIDs) on the production of ROS by stimulated rat neutrophils. Diclofenac (3.6 µM), indomethacin (12 µM), naproxen (160 µM), piroxicam (13 µM), and tenoxicam (30 µM) were incubated at 37°C in PBS (10 mM), pH 7.4, for 30 min with rat neutrophils (1 x 10(6) cells/ml) stimulated by phorbol-12-myristate-13-acetate (100 nM). The ROS production was measured by luminol and lucigenin-dependent chemiluminescence. Except for naproxen, NSAIDs reduced ROS production: 58 ± 2 percent diclofenac, 90 ± 2 percent indomethacin, 33 ± 3 percent piroxicam, and 45 ± 6 percent tenoxicam (N = 6). For the lucigenin assay, naproxen, piroxicam and tenoxicam were ineffective. For indomethacin the inhibition was 52 ± 5 percent and diclofenac showed amplification in the light emission of 181 ± 60 percent (N = 6). Using the myeloperoxidase (MPO)/H2O2/luminol system, the effects of NSAIDs on MPO activity were also screened. We found that NSAIDs inhibited both the peroxidation and chlorinating activity of MPO as follows: diclofenac (36 ± 10, 45 ± 3 percent), indomethacin (97 ± 2, 100 ± 1 percent), naproxen (56 ± 8, 76 ± 3 percent), piroxicam (77 ± 5, 99 ± 1 percent), and tenoxicam (90 ± 2, 100 ± 1 percent), respectively (N = 3). These results show that therapeutic levels of NSAIDs are able to suppress the oxygen-dependent antimicrobial or oxidative functions of neutrophils by inhibiting the generation of hypochlorous acid.

Immunopathological studies on guinea pigs experimentally infected with Egyptian strain of Leishmania d. infantum.

Forty Guinea pigs were experimentally infected with Egyptian strain of Leishmania d. infantum. At necropsy, materials for histopathological studies were taken from spleen, liver & lymph nodes and for smears from the same organs and bone marrow as well. Also, serum samples were examined for the elevation of immunoglobulins (IgG., IgM. & IgA.). Amastigotes of Leishmania parasites were demonstrated in the kupffer cells in the liver and in the macrophages in the spleen and lymph nodes as well as the smears of the bone marrow. The immunoglobulins showed varying levels. The IgG increased with the decrease in number of tissue amastigotes. The splenic materials were positive in all the experimentally infected Guinea pigs which means that splenic puncture is the best method of diagnosing VL. However, it may be dangerous in soft spleen. The results were photographed and discussed.

Immune complexes as monitors of cure in Schistosoma mansoni infected mice.

This study was done to assess the use of immune complexes estimated by micro-ELISA as monitors of cure of schistosomiasis mansoni experimentally infected Swiss albino mice which received praziquantel (PZQ) treatment. They were grouped according to duration of infection (4, 8, 12, 16w) and then subgrouped owing to post-treatment life span (4, 6, 8w). It was found that the changes observed in serum level of immune complexes (IC) would provide a good parameter to demonstrate the severity of infection and being an indication of improvement after treatment. The recorded changes confirmed the relationship between schistosomal hepatic affection and serum levels of IC. The study showed the potent anti-schistosomal effect of PZQ. It cured completely when it was given early after infection or improved moderately when given late.

Serum levels of tumour necrosis factor- alpha in schistosomiasis mansoni and their analogous changes in collagen diseases and schistosomal arthropathy.

Serum levels of TNF-alpha was quantitatively estimated by the use of solid enzyme amplified sensitivity immunoassay (EASIA) in different stages of schistosomiasis mansoni, rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and schistosomal arthropathy. Statistically, significant higher levels were detected in the different groups compared to the normal control group. The level was found highest in hepatosplenic schistosomiasis with ascites (group 1c). The difference was significantly higher compared to cases of early S. mansoni infection (group Ia) and insignificant compared to hepatosplenic schistosomiasis without ascites (group 1b). No significant difference was detected comparing groups 1a and 1b, or groups 2a (RA) and 2b (SLE). Cases of schistosomal arthropathy (group 3) showed significantly higher level compared to groups 1a and 1b, although the level in group 1c was still significantly higher compared to group 3, the level was also significantly higher in group 3 compared to cases of RA but not to cases of SLE.

Effect of praziquantel treatment on hepatic pathology of Schistosoma mansoni experimentally infected mice.

In this study we used Schistosoma mansoni (S. mansoni) infected mice were used to assess the pathological changes in the liver at various stages of the disease as well as the effectiveness of Praziquantel (PZQ) treatment on hepatic pathology also at different stages. The S. mansoni infected mice were divided into 7 groups and subgroups according to post infection and/or post treatment periods. The various hepatic pathological changes were recorded and it was concluded that PZQ is an effective yet, safe non hepatotoxic drug and that the earlier the application of treatment in the course of the disease the better cure we can get with minimal or no insult to the liver tissue.

Relationship between schistosomiasis and arthropathy.

This study was carried out to suggest criteria for diagnosing arthritis associated with schistosomiasis. 180 cases were classified into three clinical groups, 120 schistosomal arthritic group (I), 20 schistosomal non-arthritic (II), 20 arthritic non-schistosomal (III) and 20 controls (IV). Four tests were done to exclude other causes of arthritis namely, Erythrocyte sedimentation rate (ESR), Rose-Waaler test (RW) for rheumatoid factor (RF), antinuclear antibody test (ANA) and determination of serum uric acid (SUA) level. A history, clinical examination, urine and stool examination, intradermal test (IDT), indirect haemagglutination test (IHAT), circumoval precipitin test (COPT) and complete blood picture, were performed for all groups. 20 patients were selected randomly from group I and received praziquantel to be followed up 6 months later. Bilharzial ova were found in the excreta of group I and II. The percentage of positive IDT, IHAT and COPT in I & II was 90.8%, 90%, 88.3% and 85% respectively. Blood picture showed mild anaemia and from low to moderate eosinophilia. ESR was moderately raised. RF positivity was 6.6%, 10%, 65% and 5% in the four groups respectively. ANA positivity was 1.6%, 0%, 50% and 0% respectively. There was a marked improvement of arthritic manifestations after praziquantel in 90% of cases.