Application of a Dermal Regeneration Matrix for the Surgical Treatment of an Oromaxillary Defect in Medication-Related Osteonecrosis of the Jaw.

Surgical options for managing patients with medication-related osteonecrosis of the jaw are multiple and may range from superficial debridement to vascularized osteocutaneous free flaps. However, some protocols may not be an option in specific cases, and alternative techniques for patients who are not likely candidates for more invasive procedures may represent a suitable solution to treat these patients. Here, we report the case of a 69-year-old man who presented to the Stomatology Department with dysphagia, exposed bone, and mild mandibular pain for the past three months. The patient was diagnosed with stage III medication-related osteonecrosis of the jaw. Surgical debridement with sequestrum removal was performed and the remaining intraoral defect, which was unsuitable for primary closure, was addressed with a dermal regeneration matrix. This system allowed full coverage of the surgical wound. At 10 weeks of follow-up, the intraoral defect had healed completely with no need for active intervention. Dermal regeneration matrixes may represent a surgical approach to cover oromaxillary defects in select patients.

Arrhythmogenic Cardiomyopathy as a Late Complication of COVID-19-Induced Myocarditis.

COVID-19 has become a global health problem. So far, more than 281 million COVID-19 cases have been confirmed. The vast majority of patients diagnosed with COVID-19 infection present only with respiratory signs and symptoms. A small amount of patients, however, show signs and symptoms of cardiovascular involvement like a myocardial injury. Myocarditis is one of the possible complications, and cases of clinically suspected myocarditis have been reported in the setting of COVID-19. Herein, we present a case of inflammatory cardiomyopathy, a different type of arrhythmogenic cardiomyopathy, in a 32-year-old man, 40 days after being diagnosed with COVID-19.

Herpes Zoster Infection in an Immunocompromised Patient: A Case Report and Review of Corticosteroid's Role.

Herpes zoster infection is more frequent and severe in the immunocompromised population. Its incidence is significantly higher in this population when compared to immunocompetent individuals. The authors present a case of an 88-year-old man with a history of arterial hypertension and myelodysplastic syndrome. The patient was evaluated in the emergency department (ED) for edema of the frontal facial region with left periorbital involvement and multiple purulent vesicles. He was diagnosed with viral infection by herpes zoster and was prescribed valaciclovir and deflazacort. He returned two days later due to an increase in the lesions affecting the left hemi-cranium, with decreased visual acuity and painless purulent drainage in the ipsilateral eye. The ophthalmological evaluation revealed exuberant edema with associated chemosis and involvement of the cornea of ​​the affected eye. He was hospitalized and began antiviral therapy with intravenous acyclovir and chloramphenicol with topical ganciclovir. There was a progressive resolution of the skin lesions but no reversal of the loss of vision in the affected eye. Herpes zoster infection is more frequent and severe in the immunocompromised population. The clinical presentation is often similar to that of the immunocompetent population; however, it can have exuberant manifestations. The authors emphasize the need for close clinical monitoring of the immunocompromised patient with herpes zoster infection and review the role of corticosteroids when treating this particular population.

Severe Colchicine Intoxication: A Case Report and Review of Literature in Adults.

Colchicine is used in the treatment of multiple diseases such as gout and auto-immune diseases. Although cases of multiorgan failure have been described in adults with doses usually higher than 0.8 mg/kg, the epidemiology data are scarce and the intoxication mechanisms are not well-known. The authors present the case of a 66-year-old male patient, with a medical history of depression, admitted to the emergency room (ER) due to intentional colchicine ingestion after taking 90 mg (approximately 1.125 mg/kg) 12 hours prior to medical evaluation. Besides some dizziness and sleepiness, he showed no other alteration in the physical examination. After the administration of activated charcoal, he was transferred to the intensive care unit (ICU). The laboratory findings showed mild hepatic dysfunction, acute kidney injury, and metabolic lactic acidosis. Despite treatment, severe clinical worsening with multiorgan failure, including respiratory failure complicated with multiple episodes of cardiac dysrhythmias and finally with persistent cardiac arrest, lead to the patient's death after 13 hours of admission in the ER. Among drug intoxications, high doses of colchicine ingestion can lead to rapid multiorgan dysfunction, and patients with a severe overdose can experience irreversible multiorgan failure without presenting the typical initial gastrointestinal symptoms. Thus, it is necessary for the physicians to be alert to these situations and to be aware of the epidemiological data and clinical profile of this specific poisoning that should be managed in ICU. The authors perform a review of the cases of colchicine poisoning reported in adults between 2017 and 2019 and the differences in clinical management and outcomes.

Raoultella ornithinolytica in MALT-type non-Hodgkin Lymphoma.

Raoultella ornithinolytica is a bacterium that belongs to the Enterobacteriaceae family. The most frequently reported infections are gastrointestinal and hepatobiliary. Urinary tract infections are very rarely reported and bloodstream infections are usually reported without an identified source. This bacterium is responsible for an increasing number of infections, especially in immunocompromised patients. The authors describe the first case ever reported of an immunocompromised patient due to non-Hodgkin lymphoma MALT type and corticotherapy, who developed urinary tract infection and subsequently bacteriemia due to this pathogen. LEARNING POINTS: Raoultella ornithinolytica is a virulent pathogen causing community-acquired and hospital-acquired infection, especially in immunocompromised populations.Although most cases of R. ornithinolytica infection are susceptible to standard antibiotic regimens, multi-drug resistant strains have been reported, which may pose a severe risk to the immunocompromised patient.Physicians should be aware that some treatments may increase immunosuppression, thus enabling infection by opportunistic agents such as R. ornithinolytica.

Occurrence of Guillain-Barre Syndrome During the Initial Symptomatic Phase of COVID-19 Disease: Coincidence or Consequence?

Viral infections are frequently present before the clinical manifestation of Guillain-Barre syndrome (GBS). Multiple studies on coronaviruses have shown that these viruses have neurotropic characteristics, and their molecular mimicry can induce inflammatory demyelinating neuropathy. Herein, we describe a case of a GBS in an 85-year-old patient infected with SARS-CoV-2, manifested with acute progressive symmetric ascending quadriparesis, urinary dysautonomia, and dysphagia, who responded well to treatment with intravenous human immunoglobulin.

Organizing Pneumonia After Exposure to Sodium Hypochlorite: A Case Report.

Organizing pneumonia (OP) is a rare inflammatory lung disease with a difficult diagnosis and sparse mentions in the literature. In most cases, the etiology is unknown but may be associated with infections, systemic disorders, exposure to industrial toxins and environmental pollutants, or even drug toxicity. This report describes a 77-year-old male who presented to the hospital with nonproductive cough, myalgias, fever, and progressive weight loss after prolonged exposure to sodium hypochlorite. The patient was treated with multiple courses of antibiotics with no pathogen isolation. Chest CT revealed condensation foci of all pulmonary lobes. His clinical history, laboratory results, and CT images led to the diagnosis of OP, which was confirmed with a transbronchial lung biopsy. The patient was treated with oral prednisolone with clinical improvement and discharge one week after the beginning of the corticosteroid treatment. OP diagnosis can be challenging and, if not considered, may lead to a delay in providing appropriate treatment to the patients, which can often lead to a prolonged hospital stay and poor outcomes.

Late Hospital Arrival for Thrombolysis after Stroke in Southern Portugal: Who Is at Risk?

BACKGROUND: Delayed hospital arrival remains the main reason for the low rates of thrombolysis in eligible acute ischemic stroke (AIS) patients. The role of socioeconomic and clinical factors for the prehospital delay of AIS remains poor and has never been studied in Portugal. OBJECTIVES: Describe the socioeconomic and clinical factors leading to delayed hospital admission of AIS patients eligible to thrombolysis. METHODS: A case-control study with a consecutive thrombolyzed AIS patients from 2010 to 2015. Controls were patients who did not receive thrombolysis because of late hospital arrival. Logistic regression with stepwise forward regression analysis was used to identify independent predictors of delayed admission to receive thrombolysis with intravenous tissue-type plasminogen activator (rtPA). RESULTS: Of the 1247 patients admitted with AIS, 76 (6%) arrived on-time and received intravenous rtPA. Controls were 65.8% (146/222) of the total number of patients included in the study. Overall, the mean age was 73 years (±11, 61), a minority were below 60 years, and 43.7% were women. Being beneficiary of social insertion income (odds ratio [OR]: .286; .124-.662, P = .003), not having any telephone contact (OR: .145; .039-.536, .004) or having exclusive landline (.055; .014-.210, <.001) and posterior circulation stroke (OR: .266; .087-.811, P = .020) decreased the likelihood of hospital arrive on-time rtPA. The use of prehospital ambulance services increased (OR: 6.478; 2.751-15.254, P < .001) the odds of ER on-time arrival for thrombolysis. CONCLUSIONS: Poverty, lack of stroke awareness, or difficulties in requesting immediate medical help are the main factors implicated in late-hospital admission for thrombolysis in AIS. Stroke awareness campaigns, promotion of activation of national emergency number and stroke code can increase the rate of thrombolysis.

Cardiovascular risk factors: Is the metabolic syndrome related to aging? Epidemiology in a Portuguese population.

AIMS: The primary objective of our study is to determine the prevalence of the metabolic syndrome in the population. The secondary objective is to determine the prevalence of cardiovascular risk factors, anthropometric alterations and the prevalence of target organ damage and their relationship with aging. MATERIAL AND METHODS: The sample for the study was obtained by means of a consecutive population-based demonstration in 803 adults over 18 years of age belonging to the labor force of the company Grupo Delta SA. The study was carried out according to the guidelines of the Declaration of Helsinki. The individuals included in the study voluntarily participated, once informed of the purpose of the study, giving their prior verbal consent, to the company's human resources department, in the case of Delta Group workers. RESULTS: 23.8% of the population has metabolic syndrome more prevalent in males, no smoking, no significant alcohol consumption, sedentary, with a high Body mass index (BMI). Its prevalence increases with age. CONCLUSION: We found that the prevalence of metabolic syndrome increases with age and is present in people of working age, increasing the risk of cardiovascular diseases, work-related absences, and socio-economic costs.

Phenotypic and Molecular Characterization of Salmonella 1,4,[5],12:i:- R-Type ASSuT Isolates from Humans, Animals, and Environment in Portugal, 2006-2011.

The increase in prevalence of Salmonella 1,4,[5],12:i:- related infections over the last few years has been considered a public health issue in many European countries, especially as this serovar may be associated with tetraresistance to ampicillin, streptomycin, sulfonamides, and tetracyclines (R-type ASSuT). Salmonella 1,4,[5],12:i:- isolates (n = 187) obtained by the Portuguese National Laboratory from different sources, including human clinical cases (n = 170), veterinary (n = 10), environmental (n = 6), and food samples (n = 1), were collected from 15 districts between 2006 and 2011. All isolates were serotyped using the slide agglutination method and results were confirmed by multiplex PCR for the monophasic variant. From the confirmed Salmonella 1,4,[5],12:i:-, R-type ASSuT isolates were selected by disc diffusion and minimal inhibitory concentration (MIC) determination for further characterization by pulsed-field gel electrophoresis restriction with XbaI, virulence genes determination by PCR, additional antimicrobial resistance profiling by disc diffusion, and epidemiological distribution evaluation. Out of the 187 serotyped isolates, 133 were confirmed as Salmonella 1,4,[5],12:i:- with a R-type ASSuT occurrence of 61.7%. Distribution among Portuguese districts showed a higher percentage of reported cases in coastal areas, in particular, in Porto (24.8%), Setúbal (13.5%), and Aveiro (12.8%), probably due to the higher population density. Clonality analysis revealed a high diversity of pulsotypes with the majority of human salmonellosis cases being attributed to sporadic events. All isolates harbored 14 out of the 18 virulence genes evaluated and 87.8% of the isolates showed all the resistance genes frequently associated with the European clone, blaTEM+sul2+straA-straB+tetB+. This study shows that Salmonella 1,4,[5],12:i:- resistant isolates are widely distributed in Portugal. This may be related to a selective advantage offered by R-type ASSuT profile, the presence of multiple virulent features, including the ability to form biofilms, which along with a high diversity of pulsotypes may be responsible for the dissemination through the country.

Severe fibrinonecrotic enteritis caused by Pseudomonas aeruginosa in a captive monitor lizard (Varanus niloticus).

Pseudomonas aeruginosa is an important pathogen that has been implicated in a number of serious conditions in humans and animals. Studies regarding the efficacy of antimicrobial drugs against virulent strains of P. aeruginosa in human and animal hosts have demonstrated that common therapeutic options are sometimes ineffective. In captive animals, in particular reptiles, literature on this topic is scarce. In this study, a 6-yr-old monitor lizard, Varanus niloticus, died suddenly without previous symptoms. Postmortem examination and bacteriologic analysis of necropsy samples revealed severe fibrinonecrotic enteritis caused by P. aeruginosa. The isolate presented a typical resistance profile, showing resistance to amoxycillin-clavulanic acid, ampicillin, cephotaxime, and sulphamethoxazole-trimethoprim. Virulence characterization demonstrated that the bacterium was able to express hemolysins, DNases, gelatinases, and lipases and had biofilm-forming ability. This study highlights the importance of surveillance for antimicrobial resistance and virulence traits in captive animals, which may present a challenge to practitioners.

Biofilm formation by Salmonella enterica serovar 1,4,[5],12:i:- Portuguese isolates: a phenotypic, genotypic, and socio-geographic analysis.

Biofilm-forming ability is well established as an important virulence factor. However, there are no studies available regarding biofilm formation of Salmonella Typhimurium 1,4,[5],12:i:-, the new pandemic serovar in Europe. To address this problem, biofilm expression by Salmonella 1,4,[5],12:i:- was evaluated using 133 isolates from clinical, environmental and animal origins, collected in Portugal from 2006 to 2011. Biofilm detection was performed by phenotypic and genotypic methods, such growth characterization in agar and broth medium, optical density determination by microtiter assays and direct observation by fluorescent in situ hybridization. Biofilm-related genes adrA, csgD and gcpA were detected by PCR. A socio-geographic characterization of strains as biofilm producers was also performed. Results showed that biofilm formation in monophasic Salmonella is widely distributed in Portuguese isolates and could be one of the reasons for its dissemination in this country. Biofilm expression varies between locations, showing that isolates from some regions like Lisboa or Ponta Delgada have an increased ability to persist in the environment due to an enhanced biofilm production. Biofilm formation also varies between risk groups, with a higher prevalence in isolates from salmonellosis infections in women. Therefore, the analysis of the socio-geographic distribution of biofilm-forming bacteria should be considered for the establishment of more adequate regulatory measures or therapeutics regimens, especially important due to the continuous increase of infections caused by antimicrobial resistant microorganisms.