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2.
Nat Commun ; 10(1): 2538, 2019 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182708

RESUMO

The pathological mechanisms of radiation ulcer remain unsolved and there is currently no effective medicine. Here, we demonstrate that persistent DNA damage foci and cell senescence are involved in radiation ulcer development. Further more, we identify cordycepin, a natural nucleoside analogue, as a potent drug to block radiation ulcer (skin, intestine, tongue) in rats/mice by preventing cell senescence through the increase of NRF2 nuclear expression (the assay used is mainly on skin). Finally, cordycepin is also revealed to activate AMPK by binding with the α1 and γ1 subunit near the autoinhibitory domain of AMPK, then promotes p62-dependent autophagic degradation of Keap1, to induce NRF2 dissociate from Keap1 and translocate to the nucleus. Taken together, our findings identify cordycepin prevents radiation ulcer by inhibiting cell senescence via NRF2 and AMPK in rodents, and activation of AMPK or NRF2 may thus represent therapeutic targets for preventing cell senescence and radiation ulcer.


Assuntos
Proteínas Quinases Ativadas por AMP/metabolismo , Senescência Celular/efeitos dos fármacos , Dano ao DNA/efeitos dos fármacos , Desoxiadenosinas/farmacologia , Fator 2 Relacionado a NF-E2/metabolismo , Lesões Experimentais por Radiação/prevenção & controle , Úlcera/prevenção & controle , Animais , Apoptose , Linhagem Celular , Senescência Celular/efeitos da radiação , Dano ao DNA/efeitos da radiação , Desoxiadenosinas/toxicidade , Fibroblastos , Humanos , Masculino , Camundongos Endogâmicos C57BL , Lesões Experimentais por Radiação/tratamento farmacológico , Lesões Experimentais por Radiação/patologia , Ratos Sprague-Dawley , Úlcera/tratamento farmacológico , Úlcera/patologia , Raios X/efeitos adversos
3.
Gastroenterology ; 157(3): 637-646.e4, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31095949

RESUMO

BACKGROUND & AIMS: Enteropathy and small-intestinal ulcers are common adverse effects of nonsteroidal anti-inflammatory drugs such as acetylsalicylic acid (ASA). Safe, cytoprotective strategies are needed to reduce this risk. Specific bifidobacteria might have cytoprotective activities, but little is known about these effects in humans. We used serial video capsule endoscopy (VCE) to assess the efficacy of a specific Bifidobacterium strain in healthy volunteers exposed to ASA. METHODS: We performed a single-site, double-blind, parallel-group, proof-of-concept analysis of 75 heathy volunteers given ASA (300 mg) daily for 6 weeks, from July 31 through October 24, 2017. The participants were randomly assigned (1:1) to groups given oral capsules of Bifidobacterium breve (Bif195) (≥5 × 1010 colony-forming units) or placebo daily for 8 weeks. Small-intestinal damage was analyzed by serial VCE at 6 visits. The area under the curve (AUC) for intestinal damage (Lewis score) and the AUC value for ulcers were the primary and first-ranked secondary end points of the trial, respectively. RESULTS: Efficacy data were obtained from 35 participants given Bif195 and 31 given placebo. The AUC for Lewis score was significantly lower in the Bif195 group (3040 ± 1340 arbitrary units) than the placebo group (4351 ± 3195) (P = .0376). The AUC for ulcer number was significantly lower in the Bif195 group (50.4 ± 53.1 arbitrary units) than in the placebo group (75.2 ± 85.3 arbitrary units) (P = .0258). Twelve adverse events were reported from the Bif195 group and 20 from the placebo group. None of the events was determined to be related to Bif195 intake. CONCLUSIONS: In a randomized, double-blind trial of healthy volunteers, we found oral Bif195 to safely reduce the risk of small-intestinal enteropathy caused by ASA. ClinicalTrials.gov no: NCT03228589.


Assuntos
Anti-Inflamatórios não Esteroides/efeitos adversos , Aspirina/efeitos adversos , Bifidobacterium breve/crescimento & desenvolvimento , Microbioma Gastrointestinal , Intestino Delgado/efeitos dos fármacos , Intestino Delgado/microbiologia , Probióticos/administração & dosagem , Úlcera/prevenção & controle , Adolescente , Adulto , Endoscopia por Cápsula , Método Duplo-Cego , Feminino , Voluntários Saudáveis , Humanos , Intestino Delgado/patologia , Irlanda , Masculino , Probióticos/efeitos adversos , Fatores de Tempo , Úlcera/induzido quimicamente , Úlcera/microbiologia , Úlcera/patologia , Adulto Jovem
4.
Medicine (Baltimore) ; 98(20): e15701, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096515

RESUMO

BACKGROUND: Endoscopic submucosal dissection (ESD) is a standard procedure for treating gastric neoplasms. However, ESD causes larger artificial ulcers other than mucosal resection methods. We conducted this prospective randomized controlled study to evaluate the effect of stronger acid suppression on ESD ulcers caused by doubling the proton pump inhibitor (PPI) dose and compare the effects of 20-mg (standard dose) and 40-mg (double dose) esomeprazole (EswonampTM, Daewon Pharmaceutical Co., Ltd., Seoul, Korea) on ulcer healing. METHODS: One hundred ninety-seven patients who underwent gastric ESD from July 2017 to December 2017 at Pusan National University Yangsan Hospital were enrolled and randomly assigned to the standard or double-dose group. Change in ulcer size from the day of ESD to 4 weeks after ESD and the scar-change rate were compared between the groups. RESULTS: There were no significant differences in ulcer contraction (84.5% in 20 mg group vs 86.3% in 40 mg group, P = .91) or scar-change rate (30.9% vs 30.6%, P > .99) between the groups. In a multivariate analysis, initial ulcer size [odds ratio (OR) 0.24; 95% confidence interval (CI) 0.11-0.50] and early gastric cancer (OR 0.22, 95% CI 0.08-0.58) were significantly associated with delayed ulcer healing. CONCLUSIONS: Both 40 and 20-mg esomeprazole have similar effects on ESD-induced ulcer area reduction, suggesting that strong acid suppression does not necessarily result in rapid artificial ulcer healing. TRIAL REGISTRATION NUMBER: RCT no.: KCT0002885.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Esomeprazol/uso terapêutico , Neoplasias Gástricas/cirurgia , Úlcera Gástrica/tratamento farmacológico , Ressecção Endoscópica de Mucosa/métodos , Esomeprazol/administração & dosagem , Feminino , Humanos , Masculino , Estudos Prospectivos , Inibidores da Bomba de Prótons/uso terapêutico , Pirróis/administração & dosagem , Pirróis/uso terapêutico , República da Coreia/epidemiologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/patologia , Úlcera Gástrica/patologia , Sulfonamidas/administração & dosagem , Sulfonamidas/uso terapêutico , Úlcera/tratamento farmacológico , Úlcera/patologia , Cicatrização/efeitos dos fármacos
5.
Parasitol Res ; 118(6): 1999-2004, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30972570

RESUMO

In the present article, we report on the identification of Vermamoeba (Hartmannella) vermiformis as the etiological agent of a tissue infection close to the eye of a female patient. Laboratory examination revealed no involvement of any pathogenic bacteria or fungi in the tissue infection. V. vermiformis was identified by cultivation and morphology of trophozoites and cysts as well as phylogenetic analysis of nuclear 18S rDNA. The lesion improved in the course of 4 weeks by application of zinc paste.


Assuntos
Amebíase/diagnóstico , Amebíase/patologia , Hartmannella/patogenicidade , Úlcera/parasitologia , Adulto , Amebíase/parasitologia , Animais , DNA de Protozoário/genética , DNA Ribossômico/genética , Feminino , Hartmannella/classificação , Hartmannella/genética , Humanos , Filogenia , Trofozoítos/classificação , Trofozoítos/crescimento & desenvolvimento , Úlcera/patologia
6.
World J Gastroenterol ; 25(14): 1753-1763, 2019 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-31011259

RESUMO

BACKGROUND: We recently reported on a hereditary enteropathy associated with a gene encoding a prostaglandin transporter and referred to as chronic enteropathy associated with SLCO2A1 gene (CEAS). Crohn's disease (CD) is a major differential diagnosis of CEAS, because these diseases share some clinical features. Therefore, there is a need to develop a convenient screening test to distinguish CEAS from CD. AIM: To examine whether prostaglandin E major urinary metabolites (PGE-MUM) can serve as a biomarker to distinguish CEAS from CD. METHODS: This was a transactional study of 20 patients with CEAS and 98 patients with CD. CEAS was diagnosed by the confirmation of homozygous or compound heterozygous mutation of SLCO2A1. We measured the concentration of PGE-MUM in spot urine by radioimmunoassay, and the concentration was compared between the two groups of patients. We also determined the optimal cut-off value of PGE-MUM to distinguish CEAS from CD by receiver operating characteristic (ROC) curve analysis. RESULTS: Twenty Japanese patients with CEAS and 98 patients with CD were enrolled. PGE-MUM concentration in patients with CEAS was significantly higher than that in patients with CD (median 102.7 vs 27.9 µg/g × Cre, P < 0.0001). One log unit increase in PGE-MUM contributed to 7.3 increase in the likelihood for the diagnosis of CEAS [95% confidence interval (CI) 3.2-16.7]. A logistic regression analysis revealed that the association was significant even after adjusting confounding factors (adjusted odds ratio 29.6, 95%CI 4.7-185.7). ROC curve analysis revealed the optimal PGE-MUM cut-off value for the distinction of CEAS from CD to be 48.9 µg/g × Cre with 95.0% sensitivity and 79.6% specificity. CONCLUSION: PGE-MUM measurement is a convenient, non-invasive and useful test for the distinction of CEAS from CD.


Assuntos
Enteropatias/diagnóstico , Transportadores de Ânions Orgânicos/genética , Ácidos Prostanoicos/urina , Úlcera/diagnóstico , Adulto , Colo/patologia , Doença de Crohn/diagnóstico , Doença de Crohn/urina , Diagnóstico Diferencial , Feminino , Humanos , Íleo/patologia , Enteropatias/genética , Enteropatias/patologia , Enteropatias/urina , Masculino , Pessoa de Meia-Idade , Mutação , Transportadores de Ânions Orgânicos/metabolismo , Prostaglandinas E/metabolismo , Ácidos Prostanoicos/metabolismo , Úlcera/genética , Úlcera/patologia , Úlcera/urina
8.
BMC Gastroenterol ; 19(1): 49, 2019 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943900

RESUMO

BACKGROUND: CMUSE is a rare disease whose diagnosis remains difficult because the lesion is confined to the small bowel. CASE PRESENTATION: Here, we present a case of 43-year-old female patient suffered chronic abdominal pain for 20 years, and finally diagnosed with CMUSE. Capsule endoscopy was performed when general endoscopic investigation failed to find the lesion, but the capsule was stranded in the small intestine. Moreover, capsule retention results in acute intestinal obstruction. Thus, surgery was performed and CMUSE was confirmed. The patient was recovered after partial small intestine resection. CONCLUSIONS: Capsule retention occurred in nearly 60% of patients with CMUSE. Capsule endoscopy should be avoided when the patient is suspected of CMUSE, especially with severe anemia and radiologic finding in the ileum.


Assuntos
Endoscopia por Cápsula/efeitos adversos , Enterite/patologia , Corpos Estranhos/etiologia , Obstrução Intestinal/etiologia , Intestino Delgado/patologia , Úlcera/patologia , Dor Abdominal/etiologia , Adulto , Endoscopia por Cápsula/instrumentação , Dor Crônica/etiologia , Constrição Patológica/diagnóstico , Enterite/diagnóstico , Feminino , Humanos , Úlcera/diagnóstico
9.
Int J Mycobacteriol ; 8(1): 29-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860176

RESUMO

Background: Erythema nodosum leprosum (ENL) classically presents with tender, coppery, evanescent nodules along with constitutional features and visceral involvement. However, uncommon morphological variants of ENL-like erythema nodosum necroticans, erythema multiforme (EM)-like ENL, Sweet's syndrome (SS)-like ENL, Lucio phenomenon, and reactive perforating type of ENL have also been described in the literature. The primary objective of this study was to describe the clinical features of the severe and uncommon morphological variants of ENL. Methods: This was an observational case series with retrospective review of records of all ENL patients with ulceronecrotic lesions admitted in the Department of Dermato-venereo-leprology of a tertiary health center of central India over a period of 2 years. Results: Eighteen patients were included, all of whom had ulceronecrotic lesions. Four out of them had EM like ENL, two had SS-like presentation, and one of them had annular bullous lesions over old infiltrated plaques of leprosy. Conclusions: Uncommon variants of ENL can be very commonly misdiagnosed in patients, especially in those who have not been previously diagnosed with leprosy. Hence, a high index of suspicion is required in such cases to avoid delay in the diagnosis and resulting morbidity.


Assuntos
Eritema Nodoso/diagnóstico , Eritema Nodoso/patologia , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/patologia , Úlcera/etiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Estudos Retrospectivos , Centros de Atenção Terciária , Úlcera/patologia , Adulto Jovem
10.
Digestion ; 99(3): 219-226, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30799389

RESUMO

BACKGROUND/AIMS: The mucosal healing process after endoscopic submucosal dissection (ESD) is mostly scarring change (flat type), but a protruded lesion is occasionally found. We investigated the factors influencing the mucosal healing process, such as the flat and protruded types. METHODS: A total of 2,096 ESD cases were performed from February 2005 to December 2013, and 1,757 underwent follow-up endoscopy after 3 months to check the healing type of the ulceration. We retrospectively reviewed the medical charts to analyze demographic, endoscopic, and pathological findings between the 2 groups. RESULTS: Forty-eight cases were of the protruded type and 1,709 were of the flat type. In univariate analysis, the protruded type was found more in the antrum, anterior wall, and greater curvature (p < 0.001). In protruded types, the Helicobacter pylori (H. pylori) infection rate was lower (p < 0.017), the mean length of ESD specimen was shorter (p < 0.012), the fibrosis rate was lower (p < 0.033), and the mean number of hot biopsy and clips during ESD were less (p < 0.008 and p < 0.001 respectively). CONCLUSIONS: The healing type of mucosal ulceration after ESD seemed to be influenced by location, specimen size, and the presence of an H. pylori infection.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Mucosa Gástrica/patologia , Gastroscopia/efeitos adversos , Complicações Pós-Operatórias/patologia , Neoplasias Gástricas/cirurgia , Úlcera/patologia , Idoso , Ressecção Endoscópica de Mucosa/métodos , Feminino , Mucosa Gástrica/diagnóstico por imagem , Mucosa Gástrica/microbiologia , Mucosa Gástrica/cirurgia , Gastroscopia/métodos , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/microbiologia , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/microbiologia , Estudos Retrospectivos , Úlcera/diagnóstico por imagem , Úlcera/etiologia , Cicatrização
12.
J Forensic Leg Med ; 62: 103-106, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30738288

RESUMO

Strongyloidiasis is an infectious disease affecting approximately 30-100 million people globally. The main human pathogen is Strongyloides stercoralis which may cause a brief period of acute symptoms and signs after the initial infection, and then lapse into a chronic asymptomatic carrier state for decades due to the nematode's unique ability to autoinfect hosts. Immunosuppression from steroid therapy, T-lymphocytic viral (HTLV-1) infections, or a variety of underlying medical conditions may then result in dissemination and the highly lethal and infectious hyperinfection syndrome. Clinical suspicions for the condition are often not high in non-endemic areas, the diagnosis is difficult, and the incidence is increasing, particularly given recent mass population movements. Indications of infection at autopsy include gastrointestinal ulceration and haemorrhage, with pulmonary oedema, congestion, haemorrhage and diffuse alveolar damage.


Assuntos
Estrongiloidíase/diagnóstico , Animais , Portador Sadio , Fezes/parasitologia , Patologia Legal , Hemorragia/parasitologia , Hemorragia/patologia , Humanos , Hospedeiro Imunocomprometido , Enteropatias Parasitárias/parasitologia , Enteropatias Parasitárias/patologia , Larva , Infecções Oportunistas/parasitologia , Edema Pulmonar/parasitologia , Edema Pulmonar/patologia , Escarro/parasitologia , Strongyloides stercoralis/patogenicidade , Strongyloides stercoralis/fisiologia , Úlcera/parasitologia , Úlcera/patologia
13.
BMJ Case Rep ; 12(2)2019 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-30739086

RESUMO

A 42-year-old woman with a history of cholangiocarcinoma on adjuvant chemotherapy with capecitabine presented with painless haematochezia. She was found to have an isolated twenty-five mm ulcer in the ascending colon. Biopsies of the ulceration demonstrated typical cytomegalovirus (CMV) inclusions and her peripheral blood CMV PCR was significantly elevated. This is an unusual case of a solitary proximal colon ulcer. Non-steroidal anti-inflammatory drugs, inflammatory bowel disease and malignancy, are the most frequent causes of isolated ulcers in the proximal colon. Gastrointestinal (GI) CMV disease most commonly causes CMV colitis and is considered rare outside of the transplant population and other severely immunosuppressed patient groups. Patients who have received chemotherapy may also be at risk for GI CMV disease. The diagnosis should be suspected in patients who present with haematochezia or watery diarrhoea within a broad window of time after receiving chemotherapy.


Assuntos
Colite/diagnóstico , Colo Ascendente/patologia , Infecções por Citomegalovirus/diagnóstico , Úlcera/diagnóstico , Adulto , Antimetabólitos Antineoplásicos/efeitos adversos , Antivirais/uso terapêutico , Neoplasias dos Ductos Biliares/tratamento farmacológico , Capecitabina/efeitos adversos , Quimioterapia Adjuvante/efeitos adversos , Colangiocarcinoma/tratamento farmacológico , Colite/complicações , Colite/patologia , Colite/virologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Infecções por Citomegalovirus/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hospedeiro Imunocomprometido/imunologia , Pancreaticoduodenectomia , Fatores de Risco , Úlcera/complicações , Úlcera/patologia , Úlcera/virologia , Valaciclovir/uso terapêutico
14.
Wounds ; 31(3): 85-90, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30720444

RESUMO

INTRODUCTION: Due to being hard to heal, chronic ulcers account for high morbidity. OBJECTIVE: This study compares the safety and efficacy of 2 formulations of cadexomer iodine and standard care for the treatment of chronic ulcers. MATERIALS AND METHODS: This prospective, randomized, open-label clinical trial was conducted at 8 cities across 15 institutions in India from March 2016 to March 2017. After screening a total of 145 patients with chronic, recalcitrant ulcers, 124 were randomized to 1 of 3 treatments: 0.9% cadexomer iodine ointment plus standard care (n = 41), 0.9% cadexomer iodine powder plus standard care (n = 43), and standard care alone (n = 40). All patients completed the maximum treatment period of 12 weeks, with the exception of 8 who discontinued during the study period. At the end of the treatment period, endpoints were assessed. RESULTS: The percentage of reduction in ulcer size from baseline to the primary endpoint of 12 weeks was significantly higher with both formulations of cadexomer iodine ointment (94.3% ± 10.6%) and powder (90.4% ± 14.9%) as compared with standard care alone (67.8% ± 21.8%). The percentage of patients with complete wound healing at the end of the 12 weeks was significantly higher in patients treated with both formulations of cadexomer iodine ointment (65.8%) and powder (58.1%) as compared with standard care alone (20.0%). CONCLUSIONS: These results demonstrate that cadexomer iodine, in comparison with standard care alone, increases the percentage of reduction in ulcer size and promotes complete wound healing in chronic ulcers.


Assuntos
Anti-Infecciosos Locais/uso terapêutico , Doença Crônica/tratamento farmacológico , Iodóforos/uso terapêutico , Úlcera/tratamento farmacológico , Adulto , Anti-Infecciosos Locais/administração & dosagem , Anti-Infecciosos Locais/farmacologia , Desbridamento , Feminino , Humanos , Índia , Iodóforos/administração & dosagem , Iodóforos/farmacologia , Masculino , Pessoa de Meia-Idade , Pomadas , Pós , Estudos Prospectivos , Resultado do Tratamento , Úlcera/patologia , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia , Adulto Jovem
15.
Gastrointest Endosc ; 89(2): 357-363.e2, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30670179

RESUMO

BACKGROUND AND AIMS: Although erosions and ulcerations are the most common small-bowel abnormalities found on wireless capsule endoscopy (WCE), a computer-aided detection method has not been established. We aimed to develop an artificial intelligence system with deep learning to automatically detect erosions and ulcerations in WCE images. METHODS: We trained a deep convolutional neural network (CNN) system based on a Single Shot Multibox Detector, using 5360 WCE images of erosions and ulcerations. We assessed its performance by calculating the area under the receiver operating characteristic curve and its sensitivity, specificity, and accuracy using an independent test set of 10,440 small-bowel images including 440 images of erosions and ulcerations. RESULTS: The trained CNN required 233 seconds to evaluate 10,440 test images. The area under the curve for the detection of erosions and ulcerations was 0.958 (95% confidence interval [CI], 0.947-0.968). The sensitivity, specificity, and accuracy of the CNN were 88.2% (95% CI, 84.8%-91.0%), 90.9% (95% CI, 90.3%-91.4%), and 90.8% (95% CI, 90.2%-91.3%), respectively, at a cut-off value of 0.481 for the probability score. CONCLUSIONS: We developed and validated a new system based on CNN to automatically detect erosions and ulcerations in WCE images. This may be a crucial step in the development of daily-use diagnostic software for WCE images to help reduce oversights and the burden on physicians.


Assuntos
Endoscopia por Cápsula , Doenças do Íleo/diagnóstico , Doenças Inflamatórias Intestinais/diagnóstico , Intestino Delgado/patologia , Doenças do Jejuno/diagnóstico , Redes Neurais (Computação) , Reconhecimento Automatizado de Padrão , Úlcera/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Inflamatórios não Esteroides/efeitos adversos , Área Sob a Curva , Aprendizado Profundo , Úlcera Duodenal/diagnóstico , Úlcera Duodenal/etiologia , Úlcera Duodenal/patologia , Feminino , Humanos , Doenças do Íleo/etiologia , Doenças do Íleo/patologia , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/patologia , Doenças do Jejuno/etiologia , Doenças do Jejuno/patologia , Masculino , Pessoa de Meia-Idade , Úlcera Péptica/induzido quimicamente , Úlcera Péptica/diagnóstico , Úlcera Péptica/patologia , Curva ROC , Sensibilidade e Especificidade , Software , Úlcera/etiologia , Úlcera/patologia
16.
Diabetes Metab Syndr ; 13(1): 30-34, 2019 Jan - Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30641715

RESUMO

STATEMENT OF THE PROBLEM: The rate of diabetes mellitus is increasing globally as a result of increased levels of blood glucose. The elevated blood glucose level results due to impairment in the production and action of insulin. An increase in glycated hemoglobin is associated with higher blood glucose levels that further results in nephropathy, neuropathy, retinopathy, and cardiovascular disease. Therefore, the study has investigated the correlation between HbA1c and creatinine levels among diabetic patients, suffering from foot ulcerations. METHODS: A prospective cohort hospital based-study has retrieved hospital records of patients during January 2009 and February 2015. A total of 192 patients, admitted in the Rajiv Gandhi Centre for Diabetes and Endocrinology, of Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh, India were recruited. RESULTS: It has been examined that there is a positive correlation between ulcer duration and BMI, amputation rate and BMI, gender and BMI, hospital stay and BMI, HbA1c and BMI, Hb and BMI and triglyceride and BMI at 5% level of significance. CONCLUSION: Findings have shown positive association with gender, diabetes duration, ulcer size, grade of ulcer, amputation rate, hospital stay, Hb, SGOT/AST and triglyceride.


Assuntos
Infecções Bacterianas/epidemiologia , Biomarcadores/metabolismo , Creatinina/metabolismo , Diabetes Mellitus/fisiopatologia , Pé Diabético/complicações , Hemoglobina A Glicada/metabolismo , Úlcera/complicações , Adulto , Amputação/estatística & dados numéricos , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Glicemia/análise , Pé Diabético/metabolismo , Pé Diabético/patologia , Feminino , Seguimentos , Humanos , Incidência , Índia/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Fatores de Risco , Úlcera/metabolismo , Úlcera/patologia , Adulto Jovem
17.
Pathol Int ; 69(1): 21-28, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30615240

RESUMO

Methotrexate (MTX) is currently used as first-line anchor drug for rheumatoid arthritis (RA). Therefore, the number of MTX-associated lymphoproliferative disorders, including Epstein-Barr virus-positive mucocutaneous ulcer (EBVMCU), has increased. Some aspects of MTX-associated EBVMCU (MTX-EBVMCU), particularly clinical behavior and treatment for RA after MTX cessation, have not been well described. Herein, we report nine cases of MTX-EBVMCU with clinical information regarding RA. Seven of nine patients showed spontaneous regression (SR) after immunosuppressive (IS) cessation. The other two required cytotoxic chemotherapy. Eventually, all achieved complete remission. No patients experienced EBVMCU relapse. Eight patients had RA flare after IS cessation. To control the RA activity, rituximab was administered to three patients. The remaining patients were treated by other agents. Regarding the RA activity, all were in the status of low disease activity or clinical remission. In conclusion, MTX-associated EBVMCU has an indolent clinical course and SR after IS cessation can be expected. After the withdrawal of MTX, the majority of patients experience RA flare and required treatment. In our series, RA was well controlled without reinitiating MTX. Therefore, to prevent the EBVMCU relapse, it might be advisable to avoid MTX reintroduction, and rituximab might be the more preferable agent for RA treatment.


Assuntos
Artrite Reumatoide/tratamento farmacológico , Infecções por Vírus Epstein-Barr/tratamento farmacológico , Imunossupressores/efeitos adversos , Transtornos Linfoproliferativos/etiologia , Metotrexato/efeitos adversos , Úlcera/etiologia , Idoso , Idoso de 80 Anos ou mais , Infecções por Vírus Epstein-Barr/etiologia , Infecções por Vírus Epstein-Barr/patologia , Infecções por Vírus Epstein-Barr/virologia , Feminino , Herpesvirus Humano 4/isolamento & purificação , Humanos , Imuno-Histoquímica , Imunossupressores/uso terapêutico , Transtornos Linfoproliferativos/patologia , Transtornos Linfoproliferativos/virologia , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Mucosa Bucal/virologia , Rituximab/uso terapêutico , Resultado do Tratamento , Úlcera/patologia , Úlcera/virologia
18.
J Cancer Res Ther ; 14(7): 1660-1664, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30589056

RESUMO

The skin squamous cell carcinoma (SCC) is a kind of malignancy of keratinocytes. SCC was originated within the epidermis or relevant appendages, which commonly occurred on sunlight exposure sites, such as the head and neck. This case report described an 85-year-old female patient with skin SCC at the right frontal, accompanied with skin ulcer. This patient suffered from indications that were not suitable for surgical resection, including old age, Alzheimer's disease (AD), lacunar infarction, hydropericardium, and some other concomitant diseases. In addition, the external beam radiotherapy was rejected by the relatives of this patient. Then, the patient received 125I seeds interstitial brachytherapy guided by bedside ultrasound. The tumor response was evaluated based on the response evaluation criteria in solid tumors version 1.1 criteria. Complete response was achieved 4 months after brachytherapy. No complications and recurrence were observed during 8-month follow-up. As the sole modality, the 125I seeds implantation could be a reasonable and safe alternative for treating skin SCC with ulcer, especially for the elderly patients.


Assuntos
Braquiterapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/radioterapia , Radioisótopos do Iodo , Radioterapia Guiada por Imagem , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/radioterapia , Úlcera/patologia , Idoso de 80 Anos ou mais , Braquiterapia/métodos , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/radioterapia , Feminino , Humanos , Dosagem Radioterapêutica , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
19.
Molecules ; 23(8)2018 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-30065214

RESUMO

Snake venom is a complex cocktail of toxins which induces a series of clinical and pathophysiological manifestations in victims, including severe local tissue damage and systemic alterations. Deinagkistrodon acutus (D. acutus) ranks among the "big four" life-threatening venomous species in China, whose venom possesses strong myotoxicity and hematotoxicity that often lead to permanent disability or muscle atrophy. Varespladib, an inhibitor of mammalian phospholipase A2 (PLA2), has been recently reproposed as an effective antidote against snakebite envenomation. The present study aimed at evaluating the protective role of varespladib on muscle regeneration in envenomed mice. Mice were grouped and subjected to inoculation with D. acutus venom or a mixture of venom and varespladib or control vehicle in the gastrocnemius muscle. Local injuries including hemorrhage, myonecrosis, ulceration, and systemic damages including general dysfunction, visceral failure, and inflammatory responses were observed at 1, 3, 7, 14, and 21 days. The results indicated that most of the muscle myonecrosis and hemorrhage were alleviated by varespladib. Besides, the pretreated mice recovered rapidly with lesser atrophy and muscle fibrosis. In conclusion, the findings of the present study suggested that varespladib is an effective antidote that could neutralize D. acutus venom and allow for earlier and improved rehabilitation outcome.


Assuntos
Acetatos/farmacologia , Antídotos/farmacologia , Venenos de Crotalídeos/antagonistas & inibidores , Indóis/farmacologia , Necrose/tratamento farmacológico , Mordeduras de Serpentes/tratamento farmacológico , Úlcera/tratamento farmacológico , Angiopoietinas/genética , Angiopoietinas/metabolismo , Animais , Venenos de Crotalídeos/isolamento & purificação , Venenos de Crotalídeos/toxicidade , Crotalinae/fisiologia , Regulação da Expressão Gênica , Hemorragia/fisiopatologia , Hemorragia/prevenção & controle , Masculino , Camundongos , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/lesões , Músculo Esquelético/inervação , Proteína MyoD/genética , Proteína MyoD/metabolismo , Miogenina/genética , Miogenina/metabolismo , Necrose/patologia , Fator de Crescimento Neural/genética , Fator de Crescimento Neural/metabolismo , Fosfolipases A2 Citosólicas/antagonistas & inibidores , Fosfolipases A2 Citosólicas/metabolismo , Recuperação de Função Fisiológica/efeitos dos fármacos , Mordeduras de Serpentes/patologia , Úlcera/patologia
20.
Zhonghua Nei Ke Za Zhi ; 57(7): 487-493, 2018 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-29996266

RESUMO

Objective: To investigate the clinical and pathological characteristics of chronic active Epstein-Barr virus associated enteritis (CAEAE) . Methods: The clinical data of 6 CAEAE patients in Peking Union Medical College Hospital were retrospectively analyzed from January 2010 to November 2017, including clinical manifestations, endoscopic, pathological features, medications and clinical outcome. Results: The male∶female ratio was 4∶2 and the average age was 34 years old. All patients did not have personal and family history of immunodeficiency. The common symptoms consisted of fever (6/6), abdominal pain (6/6), hematochezia (6/6) and diarrhea (5/6). The most frequently affected sites were colorectum (5/6), followed by small intestine (3/6). Further serologic tests revealed a high load of serum Epstein-Barr virus(EBV) DNA. The main manifestations under endoscopy were multifocal or diffuse irregular ulcers. There was inflammation in the ulcer bases and surrounding areas, where EBV-encoded small RNA (EBER) was positive by in situ hybridization (6/6). The common complications were massive hemorrhage (3/6) and intestinal perforation (2/6). None of treatment agents including glucocorticoid, ganciclovir, foscarnet sodium and cytotoxic drugs was effective. All patients died within 0.5 to 13 months after diagnosis. Conclusions: CAEAE in immunocompetent individuals is a rare disorder with poor prognosis. It is difficult to differentiate CAEAE from inflammatory bowel disease due to similar clinical and endoscopic manifestations.


Assuntos
Enterite/virologia , Infecções por Vírus Epstein-Barr/patologia , Herpesvirus Humano 4 , Úlcera/virologia , Adulto , Enterite/imunologia , Enterite/patologia , Infecções por Vírus Epstein-Barr/imunologia , Feminino , Febre/etiologia , Humanos , Imunocompetência , Hibridização In Situ , Doenças Inflamatórias Intestinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Úlcera/imunologia , Úlcera/patologia
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