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2.
Medicine (Baltimore) ; 99(27): e21140, 2020 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-32629750

RESUMEN

INTRODUCTION: Treating blood stasis is effective in treating obesity and metabolic diseases in traditional Korean medicine. The aim of this prospective observational study is to determine the effectiveness of the diagnosis index for metabolic diseases with blood stasis by analyzing clinical data and blood samples. METHODS AND ANALYSIS: We will perform a prospective observational study. Participants who meet the inclusion criteria will be recruited from the Dongguk university Ilsan Oriental hospital. The outcomes are resistin, serum amyloid P component, C-reactive protein, D-dimer, and blood stasis scores. In addition, the blood pressure, ankle-brachial pressure index, brachial-ankle pulse wave velocity, body mass index, waist circumference, and levels of blood lipid will be assessed. DISCUSSION: Through this study, we could collect specific data for diagnosing metabolic diseases with blood stasis. Therefore, the findings of this study will provide a summary of the current state of evidence regarding the effectiveness of the diagnosis index in managing metabolic disease with blood stasis. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Board of the Dongguk University Ilsan Oriental Hospital (DUIOH-2018-09-001-007). The results will be published in a peer-reviewed journal and will be disseminated electronically and in print. TRIAL REGISTRATION NUMBER: Clinical Research Information Service: KCT0003548.


Asunto(s)
Medicina Tradicional Coreana/métodos , Enfermedades Metabólicas/diagnóstico , Enfermedades Metabólicas/terapia , Lengua/irrigación sanguínea , Adulto , Anciano , Índice Tobillo Braquial/métodos , Presión Sanguínea/fisiología , Índice de Masa Corporal , Femenino , Humanos , Lípidos/sangre , Masculino , Enfermedades Metabólicas/complicaciones , Enfermedades Metabólicas/metabolismo , Persona de Mediana Edad , Estudios Prospectivos , Análisis de la Onda del Pulso/métodos , República de Corea/epidemiología , Lengua/patología , Circunferencia de la Cintura/fisiología
4.
Am J Pathol ; 190(6): 1332-1342, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32194051

RESUMEN

The cyclin-dependent kinase inhibitor 2A (CDKN2A)/alternate reading frame (ARF) locus consists of two overlapping tumor suppressor genes, p16INK4a and p14ARF (p19ARF in mice), encoding two unrelated proteins in alternative reading frames. Previous reports suggest that p16INK4a and p14ARF alterations independently exhibit differential roles, and p16INK4a is more closely associated with a poor prognosis in oral cancer. However, the role of p16INK4a-specific loss in oral squamous cell carcinogenesis remains unclear. The authors assessed chemical carcinogen 4-nitroquinoline 1-oxide (4NQO)-induced multistep oral squamous cell carcinogenesis in mice carrying p16INK4a-specific loss with retention of the p19ARF gene (p16INK4a-/-). 4NQO-treated p16-/- mice exhibited a higher incidence and multiplicity of oral squamous cell carcinoma (OSCC) development relative to 4NQO-treated wild-type mice. 4NQO-treated p16INK4a-/- OSCC cells exhibited higher proliferation and up-regulation of Arf, transcription factor E2f1, tumor protein p63 (tp63), and oncogenic ΔNp63, an isoform p63, compared with observations in 4NQO-treated wild-type OSCC cells. Furthermore, the overexpression of oncogenic ΔNp63 was associated with human OSCC. In conclusion, these results in mice indicate the biological significance of p16INK4a-specific loss with retention of p19ARF in oral squamous cell carcinogenesis, and ΔNp63 may be a potential target for OSCC.


Asunto(s)
Inhibidor p16 de la Quinasa Dependiente de Ciclina/genética , Neoplasias de la Boca/genética , Carcinoma de Células Escamosas de Cabeza y Cuello/genética , Lengua/metabolismo , Animales , Inhibidor p16 de la Quinasa Dependiente de Ciclina/metabolismo , Progresión de la Enfermedad , Humanos , Ratones , Ratones Noqueados , Neoplasias de la Boca/metabolismo , Neoplasias de la Boca/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/metabolismo , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Lengua/patología
5.
Dermatol Online J ; 26(1)2020 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-32155030

RESUMEN

Symmetric lipomatosis of the tongue (SLT) is rare and characterized by diffuse growth and unencapsulated lipomas. An 87-year-old man was referred for evaluation of tongue lesions. Intraoral findings showed soft yellowish nodules with a smooth shiny surface diffusely on the lateral border of the tongue, bilaterally. Our clinical diagnosis was multiple tongue lipomas and an incisional biopsy was done. Histopathological examination revealed unencapsulated lobules of mature adipocytes with slight variation in the size and shape, confirming the diagnosis of lipoma. The final diagnosis was SLT. On follow-up at 6 months, the tongue findings were unchanged and no new lesions were observed.


Asunto(s)
Lipomatosis/patología , Neoplasias de la Lengua/patología , Anciano de 80 o más Años , Biopsia , Diagnóstico Diferencial , Humanos , Lipomatosis/diagnóstico , Lipomatosis Simétrica Múltiple/diagnóstico , Masculino , Lengua/patología
7.
J Oral Pathol Med ; 49(3): 219-226, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31782199

RESUMEN

BACKGROUND: Analyze the clinical, demographic, histopathological, and immunohistochemical features of oral lymphoepithelial cyst (OLEC). METHODS: Samples were retrospectively retrieved from five oral pathology services. Clinical and demographic data were collected from patient charts. Histopathological and immunohistochemical (CD3 and CD20) features were evaluated. Data analysis involved descriptive statistics and bivariate analyses (P ≤ .05). RESULTS: Seventy-seven cases were found among a total of 146 150 specimens (0.05%). OLEC was predominantly diagnosed in females (70.1%). Mean patient age was 46.51 years. The lesions arose mainly on the lateral border of the tongue (40.3%), measured up to 1 cm (61.0%), and were asymptomatic (64.9%). Twenty-four lesions (31.2%) were white. Forty-one cases (53.2%) presented lymphocytic inflammatory infiltrate with no specific arrangement. The cystic lining was composed of a non-keratinized stratified epithelium (59.7%) presenting hyperplasia (39.0%). Connection with the surface, epithelium was found in 23 cases (29.9%) and 31 (40.3%) cases had two or more cystic cavities. The lumen content was predominantly desquamated cells (48.1%). Subgemmal neurogenous plaque was found in 11/42 (26.2%) cases involving the tongue. CD20+ cells predominated in 36/63 cases (57.2%), and lymphocytic inflammatory infiltrate was not always continuous around the cystic cavity (52.4%). CONCLUSION: Lymphoepithelial cyst is an uncommon lesion of the oral cavity. The present study offers the largest sample of OLEC for which clinical, demographic, histopathological, and immunohistochemical features were evaluated. The clinical and demographic findings were similar to those described in previous reports, but the microscopic analyses revealed interesting aspects of the cystic epithelium and the lymphocytic inflammatory infiltrate in OLEC.


Asunto(s)
Quistes/patología , Epitelio/patología , Enfermedades de la Boca/patología , Lengua/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
8.
Am J Emerg Med ; 38(1): 109-113, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31843066

RESUMEN

STUDY OBJECTIVE: Endotracheal intubation is frequently performed in emergency departments (EDs). First-pass success is important because repeated attempts are associated with poor outcomes. We sought to identify factors associated with first-pass success in emergency endotracheal intubation. METHODS: We analyzed emergency orotracheal intubations on adult patients in an ED located in South Korea from Jan. 2013 to Dec. 2016. Various operator-, procedure- and patient-related factors were screened with univariable logistic regression. Using variables with P-values less than 0.2, a multiple logistic regression model was constructed to identify independent predictors. RESULTS: There were 1154 eligible cases. First-pass success was achieved in 974 (84.4%) cases. Among operator-related factors, clinical experience (OR: 2.93, 5.26, 3.80 and 5.71; 95% CI: 1.62-5.26, 2.80-9.84, 1.81-8.13 and 2.07-18.67 for PGY 3, 4 and 5 residents and EM specialists, respectively, relative to PGY 2 residents) and physician based outside the ED (OR: 0.10; 95% CI: 0.04-0.25) were independently associated with first-pass success. There was no statistically or clinically significant difference for first-pass success rate as determined by operator's gender (83.6% for female vs. 84.8% for male; 95% CI for difference: -3.1% to 5.8%). Among patient-related factors, restricted mouth opening (OR: 0.47; 95% CI: 0.31-0.72), restricted neck extension (OR: 0.57; 95% CI: 0.39-0.85) and swollen tongue (OR: 0.46; 95% CI: 0.28-0.77) were independent predictors of first-pass success. CONCLUSIONS: Operator characteristics, including clinical experience and working department, and patient characteristics, including restricted mouth opening, restricted neck extension and swollen tongue, were independent predictors of first-pass success in emergency endotracheal intubation.


Asunto(s)
Cuidados Críticos/métodos , Servicio de Urgencia en Hospital , Intubación Intratraqueal , Adulto , Anciano , Anciano de 80 o más Años , Competencia Clínica , Edema , Traumatismos Faciales/fisiopatología , Femenino , Humanos , Internado y Residencia , Masculino , Persona de Mediana Edad , Boca/fisiopatología , Cuello/fisiopatología , República de Corea , Estudios Retrospectivos , Lengua/patología
10.
BMC Dermatol ; 19(1): 16, 2019 12 02.
Artículo en Inglés | MEDLINE | ID: mdl-31787085

RESUMEN

BACKGROUND: Melioidosis is an emerging infection in South Asia caused by Burkholderia pseudomallei with various clinical presentations that include pneumonia, bacteraemia, arthritis, and deep-seated abscesses. Various cutaneous manifestations have been described in association with melioidosis. However Sweet Syndrome secondary to melioidosis has not been reported in the literature. Herein we describe the first case of Sweet syndrome secondary to melioidosis. CASE PRESENTATION: A 53-year-old previously healthy Sri Lankan female presented with high-grade fever, painful oral ulcers, odynophagia and multiple bilateral cervical lymphadenopathies for 1 month. She also had a loss of appetite and weight. She had oral ulcers and bilateral blepharitis. Dermatological examination revealed multiple tender papules with a mamillated appearance and targetoid lesions with a yellowish centre over the face, upper trunk and upper limbs. She also had multiple tender subcutaneous nodules over the extensor aspect of upper limbs. Her inflammatory markers were significantly elevated. Aspirate from a submental lymph node abscess revealed the growth of Burkholderia pseudomallei. Melioidosis antibody titer was > 10,240. The histology of the skin lesions of the face and left forearm showed a prominent neutrophilic infiltrate in the dermis and the morphological features were in favour of Sweet syndrome with panniculitis. She was started on intravenous meropenem 2 g daily and showed rapid clinical improvement with the disappearance of skin lesions as well as a reduction in inflammatory markers. CONCLUSION: Sweet syndrome is an uncommon inflammatory disorder known to be associated with upper respiratory tract and gastrointestinal infections, malignancies and the use of certain drugs. Melioidosis is an emerging infection with various cutaneous manifestations. This is the first case of melioidosis causing the secondary sweet syndrome. It emphasizes the importance of considering melioidosis as a potential aetiology in patients with Sweet syndrome.


Asunto(s)
Melioidosis/complicaciones , Piel/patología , Síndrome de Sweet/etiología , Femenino , Humanos , Persona de Mediana Edad , Síndrome de Sweet/patología , Lengua/patología
11.
Artículo en Inglés | MEDLINE | ID: mdl-31859844

RESUMEN

Although the salivary glands present several functions, there are few studies evaluating these glands in Chagas disease (CD). This study aimed to compare the percentage of collagen, the presence of inflammation, the density of chimase and tryptase mast cells, the area and density of lingual salivary gland acini in autopsied individuals with and without (CD). We analyzed 400 autopsy reports performed in a tertiary public hospital from 1999 to 2015 and selected all the cases in which tongue fragments were collected (27 cases), 12 with chronic CD without megaesophagus (CH) and 15 without CD (non-chagasic - NC). The histological sections of the tongue were stained by Picrosirius red for collagen evaluation and Hematoxylin-eosin for morphometric evaluation of salivary gland acini and inflammation. Anti-chimase and anti-tryptase antibodies were used for the immunohistochemical evaluation of mast cells. The chagasic patients presented higher volume and lower density of salivary glands acini. There was no difference in the collagen percentage, inflammation and density of mast cell chymase and tryptase between the groups. Although we did not observe a significant difference between the groups regarding the collagen percentage, inflammatory process and mast cell density, our results suggest that even without megaesophagus, chagasic patients present hypertrophy of the lingual salivary glands and lower acinar density probably due to mechanisms independent of the esophagus-glandular stimulus.


Asunto(s)
Células Acinares/patología , Enfermedad de Chagas/patología , Glándulas Salivales/patología , Lengua/patología , Anciano , Enfermedad Crónica , Femenino , Humanos , Hipertrofia , Inmunohistoquímica , Masculino
13.
Anal Cell Pathol (Amst) ; 2019: 3563215, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31687322

RESUMEN

Objective: To evaluate the effect of streptozotocin-induced experimental diabetes mellitus on p16, p53, Ki67, and Bcl2 expressions and histopathological changes in the tongue of the rats. Material and Methods: Twenty-two adult female Sprague-Dawley rats were used. The rats were randomly divided into 2 groups (n = 14) as control (C) (n = 8) and diabetic (DM) (n = 6). The rats in the DM group were given streptozotocin as a single intraperitoneal dose for induction of diabetes. Histopathological and immunohistochemical evaluations of formalin-fixed and paraffin-embedded tissue sections of the tongue were used. Results: Significant differences were observed between the DM group and the control group in terms of epithelial thickness, length of filiform papillae, and width of filiform papillae (p = 0.005, p = 0.001, and p = 0.006, respectively). There was no significant difference between the groups in terms of mononuclear inflammatory cell infiltration, capillary proliferation, and dysplasia (p = 0.204, p = 0.244, and p = 0.204, respectively). As a result of immunohistochemical studies, no significant difference was found between the groups in terms of p53, Ki67, and Bcl-2 expressions (p = 0.588, p = 0.662, and p = 0.686, respectively). A significant difference was found between the groups when p16 expression was evaluated (p = 0.006). Conclusions: In our study, streptozotocin-induced experimental diabetes mellitus induced p16 expression but did not show any difference in p53, Bcl-2, and Ki67 levels. It should be considered in the studies that the pathological changes at the early stages of the relationship between DM and oral cancer may be related to p16 expression; however, it may also be linked with p16-related aging process.


Asunto(s)
Envejecimiento/patología , Inhibidor p16 de la Quinasa Dependiente de Ciclina/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patología , Lengua/metabolismo , Lengua/patología , Animales , Epitelio/metabolismo , Epitelio/patología , Masculino , Ratas Sprague-Dawley
14.
BMC Oral Health ; 19(1): 250, 2019 11 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747943

RESUMEN

BACKGROUND: Oral lichenoid reaction (OLR) is a type IV cell-mediated immune response in the oral cavity. There is an established relationship between various dental materials and OLR, but few cases reports reported the occurrence of a lichenoid reaction in association with the use of a Hawley retainer. CASE PRESENTATION: A female patient (twenty years of age) has been complaining of a reddish painful area on the tongue, which started one year ago and has been increasing in size over time. The patient completed orthodontic treatment two years ago and has been using a Hawley retainer for orthodontic retention since then. After performing histological analysis and patch test, the lesion was diagnosed as a lichenoid reaction to the Hawley retainer. Topical corticosteroids were prescribed, and the patient was asked to stop using the retainer and followed for six months. CONCLUSIONS: It is difficult to diagnose lichenoid lesions and even more challenging to differentiate between OLP and OLR, therefore it is essential to do a full intraoral and extraoral examination. OLL can occur in association with Hawley retainer, which we believe could be because it is made of an acrylic based material. Generally, OLL resolves after removal of the cause.


Asunto(s)
Erupciones Liquenoides/diagnóstico , Retenedores Ortodóncicos/efectos adversos , Lengua/patología , Femenino , Humanos , Liquen Plano Oral , Erupciones Liquenoides/inducido químicamente , Adulto Joven
15.
Ned Tijdschr Tandheelkd ; 126(11): 565-570, 2019 Nov.
Artículo en Holandés | MEDLINE | ID: mdl-31730133

RESUMEN

Sometimes it is difficult to diagnose temporal arteritis because the complaints may vary, change in intensity and are not always characteristic. The condition is a cranial form of giant-cell arteritis affecting large and medium-sized arteries. The first manifestation of temporal arteritis can be a sore tongue that does not manifest any abnormalities during a clinical investigation. In a later stage patients sometimes develop ulceration or necrosis of a part of one side of the tongue. Other symptoms can be a recently developed headache, jaw claudication and acute loss of vision. To diagnose temporal arteritis, histological investigation of a biopsy of the temporal artery is carried out. The treatment consists of long-term use of corticosteroids. A patient in your practice with inexplicable pain on one side of the tongue, without clinical abnormalities, or an ulceration of the tongue without an immediately apparent cause may have temporal arteritis.


Asunto(s)
Arteritis de Células Gigantes , Arterias Temporales/patología , Enfermedades de la Lengua , Biopsia , Diagnóstico Diferencial , Arteritis de Células Gigantes/diagnóstico , Humanos , Lengua/patología , Enfermedades de la Lengua/diagnóstico
16.
Cancer Biomark ; 26(3): 375-383, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31594213

RESUMEN

BACKGROUND: p16 has often been found to be overexpressed in patients oral squamous cell carcinoma (OSCC), but its prognostic value between anatomic subsites is still unclear. OBJECTIVE: The aim of this study was to investigate the diagnostic and prognostic values of p16 in OSCC originating from tongue, gingiva or buccal mucosa. METHODS: A total of 147 OSCC patients with tumors arising from the tongue, gingiva or buccal mucosa were enrolled in this study. p16 expression was detected using immunohistochemistry (IHC), and the presence of HPV16 was determined by real-time PCR in p16 positive patients. The correlation of p16 expression with the clinical parameters was evaluated. RESULTS: Only one p16 positive patient with a cut off value of 25% and 75% was HPV16 positive. Although overall survival (OS), recurrence free survival (RFS) and metastasis free survival (MFS) had no significant differences between the p16 positive and negative patients, p16 negative patients (cut off value 25%) had more RFS in the buccal mucosa cancer (p= 0.03) than the p16-positive patients. CONCLUSIONS: The prevalence of HPV16 in Chinese OSCC patients was low. p16 overexpression decoupled from HPV infection was not a prognostic marker for OSCC patients except for patients with the buccal mucosa cancer.


Asunto(s)
Biomarcadores de Tumor/metabolismo , Inhibidor p16 de la Quinasa Dependiente de Ciclina/metabolismo , Neoplasias de la Boca/patología , Carcinoma de Células Escamosas de Cabeza y Cuello/patología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/análisis , Inhibidor p16 de la Quinasa Dependiente de Ciclina/análisis , ADN Viral/aislamiento & purificación , Supervivencia sin Enfermedad , Femenino , Estudios de Seguimiento , Encía/patología , Encía/cirugía , Papillomavirus Humano 16/genética , Papillomavirus Humano 16/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/patología , Mucosa Bucal/cirugía , Neoplasias de la Boca/mortalidad , Neoplasias de la Boca/cirugía , Neoplasias de la Boca/virología , Pronóstico , Reacción en Cadena en Tiempo Real de la Polimerasa , Carcinoma de Células Escamosas de Cabeza y Cuello/mortalidad , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Carcinoma de Células Escamosas de Cabeza y Cuello/virología , Lengua/patología , Lengua/cirugía
17.
An Bras Dermatol ; 94(4): 449-451, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31644619

RESUMEN

Benign migratory glossitis or geographic tongue is a benign condition that usually manifests as asymptomatic erythematous and migratory circinate patches, involving the lateral and dorsal aspects of the tongue. Extra-lingual lesions uncommonly occur and are mainly located on labial and buccal mucosae, lips and floor of the mouth. The present report describes one patient with a geographic lesion on the hard palate associated with lingual lesions and another patient who had multiple geographic lesions both in the hard and soft palate without lingual lesions. We found 64 cases in the English literature of ectopic locations with 22 palate involvement. No case of simultaneous involvement of the hard and the soft palate was found.


Asunto(s)
Glositis Migratoria Benigna/patología , Paladar (Hueso)/patología , Estomatitis/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucosa Bucal/patología , Lengua/patología
19.
Int J Exp Pathol ; 100(4): 244-252, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31577062

RESUMEN

Irinotecan is one of the most important anti-tumour drugs against a broad spectrum of malignancies, but is known to be associated with possible oral complications. The aim of the present study was to evaluate the effect of irinotecan on the tongue mucosa of juvenile male albino rat at adulthood using different histological and immunohistochemical methods. Twenty juvenile male albino rats were divided equally into two groups: control and irinotecan-treated group (single injection of 200 mg irinotecan/kg, then kept for four weeks without treatment). The tongue specimens were processed for light microscopy and scanning electron microscopy. The irinotecan-treated group showed statistically significant shortening and thinning of the lingual papillae. There was loss of the normal appearance of the filiform papillae with focal cell loss alternating with areas of hyperkeratosis. Focal separation of the keratin layer, some nuclear changes and vacuolation of some epithelial cells were detected. Dilated congested blood vessels and mild mononuclear cellular infiltration were encountered. Atrophic fungiform papillae with ill-defined taste bud cells were observed. A statistically significant decrease in the pattern of Ki67 immunohistochemical staining reaction was detected in comparision to the control group. Scanning electron microscopy revealed different signs of atrophy of the tongue papillae. Focal areas of desquamation of lingual papillae were observed revealing some filiform papillae with desquamated surface, bisected tips and evident thinning. Some extravasated red blood cells could be detected. Thus irinotecan caused significant morphological and morphometrical alterations of the tongue mucosa in particularly the filiform papillae.


Asunto(s)
Antineoplásicos/farmacología , Irinotecán/farmacología , Lengua/efectos de los fármacos , Lengua/patología , Animales , Antineoplásicos/efectos adversos , Inmunohistoquímica , Irinotecán/efectos adversos , Antígeno Ki-67 , Masculino , Microscopía Electrónica de Rastreo , Ratas
20.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-31570356

RESUMEN

The case involves a 62-year-old female native of the USA with a history of bipolar disorder and chronic obstructive pulmonary disease who presented with intractable diarrhoea. Prior to the index admission, she was admitted to the intensive care unit and required pericardiocentesis for an idiopathic pericardial effusion with tamponade physiology. Following discharge, she suffered intractable diarrhoea and represented for medical evaluation. She had a painful, swollen tongue as well as persistent hypoglycaemia and required glucose infusions. She had adrenal function testing which revealed adrenal insufficiency. Vitamin testing revealed normal B12 and folate levels but undetectable levels of thiamine, riboflavin and niacin. Her symptoms and signs resolved entirely with appropriate vitamin supplementation. Niacin (vitamin B3) is essential for multiple metabolic pathways, and severe deficiency may cause clinical syndrome of pellagra which is most commonly associated with diarrhoea, delirium and dermatitis. Additional physiological derangements may include adrenal insufficiency, insulin hypersensitivity and pericarditis.


Asunto(s)
Diarrea/etiología , Niacina/deficiencia , Pelagra/diagnóstico , Tiamina/uso terapéutico , Lengua/patología , Complejo Vitamínico B/uso terapéutico , Femenino , Humanos , Persona de Mediana Edad , Pelagra/tratamiento farmacológico , Pelagra/fisiopatología , Recurrencia , Resultado del Tratamiento
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