MANAGEMENT OF HERPES LABIALIS TRIGGERED BY STRESS

Introduction : Herpes Labialis is the most common form of orofacial herpes, beginning with a feeling of vesicle formation at the vermilion margin of the lips and the surrounding area within 24 hours and then rupture, superficial erosion occurs which is then covered with crusts. Herpes labialis occurs in 50-75% of individuals exposed to HSV-1 infection in the oral cavity and often has a recurrence followed by prodromal symptoms. Reactivation can occur due to triggers in the form of decreased immune conditions due to weather changes, fever, sun exposure, emotional stress, trauma, menstruation, systemic diseases, allergies, and immunosuppression. Case: 22 years old female with a complaint of a wound on the angular lip, initially the patient had a fever for 2 days then a fluid-filled blister appeared which then rupture. Case Treatment: The diagnosis is made using anamnesis, clinical and supporting examination. CBC and Antybody Titer HSV-1 show value under normal for eosinophil and reactive for IgG HSV-1 established. Patient take medicine topical antiinflammation 3 time a day and multivitamins 1 time a day. Discussion: HSV-1 infektion is latent and can reaktivation. Under Stress Condition can caused a reduced circulating population of immune cells such as IL-6, TNFα, Lymphocites B, NK cell, dan Monocytes which HSV-1 Reactivation. Conclucion: Management in case can be successful if the clinician understand HSV-1 Infection Manifestation and added Suporting Examination. In Addition, cooperation from the patien is needed to manage stress so that the disease no more recurrence.

Targeted delivery of protein arginine deiminase-4 inhibitors to limit arterial intimal NETosis and preserve endothelial integrity

Aims Recent evidence suggests that ‘vulnerable plaques’, which have received intense attention as underlying mechanism of acute coronary syndromes over the decades, actually rarely rupture and cause clinical events. Superficial plaque erosion has emerged as a growing cause of residual thrombotic complications of atherosclerosis in an era of increased preventive measures including lipid lowering, antihypertensive therapy, and smoking cessation. The mechanisms of plaque erosion remain poorly understood, and we currently lack validated effective diagnostics or therapeutics for superficial erosion. Eroded plaques have a rich extracellular matrix, an intact fibrous cap, sparse lipid, and few mononuclear cells, but do harbour neutrophil extracellular traps (NETs). We recently reported that NETs amplify and propagate the endothelial damage at the site of arterial lesions that recapitulate superficial erosion in mice. We showed that genetic loss of protein arginine deiminase (PAD)-4 function inhibited NETosis and preserved endothelial integrity. The current study used systemic administration of targeted nanoparticles to deliver an agent that limits NETs formation to probe mechanisms of and demonstrate a novel therapeutic approach to plaque erosion that limits endothelial damage. Methods and results We developed Collagen IV-targeted nanoparticles (Col IV NP) to deliver PAD4 inhibitors selectively to regions of endothelial cell sloughing and collagen IV-rich basement membrane exposure. We assessed the binding capability of the targeting ligand in vitro and evaluated Col IV NP targeting to areas of denuded endothelium in vivo in a mouse preparation that recapitulates features of superficial erosion. Delivery of the PAD4 inhibitor GSK484 reduced NET accumulation at sites of intimal injury and preserved endothelial continuity. Conclusions NPs directed to Col IV show selective uptake and delivery of their payload to experimentally eroded regions, illustrating their translational potential. Our results further support the role of PAD4 and NETs in superficial erosion.

Abstract 15575: The Clonal Hematopoiesis Mutation Jak2 V617F Aggravates NETosis and Endothelial Injury in Mouse Arteries With Erosion-like Intimas

Introduction: In the current era of intense LDL lowering, superficial erosion may be on the rise as a cause of ACS (25-30%). Experimental data on human atheromata support a role for neutrophils and the formation of neutrophil extracellular traps (NETs) in the pathogenesis of superficial erosion and subsequent thrombosis. The common mutation of Janus kinase 2 ( Jak2 V617F ) borne by clones of leukocytes derived from bone marrow stem cells sensitizes neutrophils to undergo NETosis and linked NET formation to increased thrombosis. Jak2 V617F associates with accelerated atherosclerosis and venous thrombosis in patients with myeloproliferative neoplasms (MPN) and in individuals harboring this mutation but without a demonstrable MPN. Hypothesis We hypothesized that i) the Jak2 V617F associated with clonal hematopoiesis and increased atherosclerotic and thrombotic risk in humans, predisposes to NETosis and subsequent endothelial injury and thrombosis at sites of flow disturbance in arteries with erosion-like intimas; and ii) the clinically approved Jak-1,2 inhibitor, ruxolitinib (Rux), can preserve endothelial integrity and reduce thrombosis in mice with myeloid Jak2 V617F . Methods: We generated cohorts of mice harboring Jak2 V617F or wild-type Jak2 . We used a surgical preparation recapitulating features of superficial erosion and assessed endothelial integrity, thrombosis, and NET formation in relation to genotype and in vivo Rux treatment. Results and Conclusions: Evans blue extravasation following introduction of flow disturbance at sites of erosion-prone intimas showed significant impairment of endothelial barrier in the group of mice bearing the Jak2 V617F mutation compared to control (WT) mice ( ** p<0.005). We further observed more thrombosis in mice bearing the Jak2 V617F mutation. Immunohistochemical evaluation of the regions of experimental superficial erosion revealed reduced endothelial continuity and increased NET accumulation in Jak2 V617F vs. WT mice. Rux treatment mitigated the adverse effects of Jak2 V617F on both NET accumulation and endothelial integrity, supporting the translational potential of these observations in individuals with clonal hematopoiesis due to Jak2 V617F and acute coronary syndromes.

Abstract 15700: Targeted Nanoparticle Delivery of a Protein Arginine Deiminase-4 Inhibitor Limits Arterial Intimal Netosis and Preserves Endothelial Integrity in Mouse Arterial Erosion-like Injury

Introduction: Superficial plaque erosion has emerged as a growing cause of residual thrombotic complications of atherosclerosis in an era of effective lipid lowering, anti-hypertensive therapy, and smoking cessation. The mechanisms of plaque erosion remain poorly understood, and we currently lack validated effective diagnostics or therapeutics for superficial erosion. Lesions complicated by erosion have a rich extracellular matrix, sparse lipid, and few mononuclear cells, but do harbor neutrophil extracellular traps (NETs). We recently reported that NETs amplify and propagate the endothelial damage at the site of arterial lesions that recapitulate in mice elements of superficial erosion. We previously showed that genetic loss of protein arginine deiminase (PAD)-4 function inhibited NETosis and preserved endothelial integrity. Hypothesis: We hypothesized that Col IV-targeted NPs (Col IV-NPs) can deliver PAD4 inhibitors selectively to regions of EC sloughing and collagen IV-rich basement membrane exposure, and attenuate the amplification, persistence, and propagation of superficial erosion and consequent thrombosis. Methods: We developed Col IV-NPs to deliver PAD4 inhibitors selectively to regions of endothelial cell sloughing and collagen IV-rich basement membrane exposure using our validated experimental preparation that reproduces in mice some of the conditions ascribed to lesions associated with superficial erosion. Results and Conclusions: We first demonstrated the binding of the targeting ligand in vitro and evaluated Col IV NP targeting towards areas of denuded endothelium in vivo in this mouse preparation. Delivery of the PAD4 inhibitor GSK484 as cargo in these nanoparticles reduced NETs release at sites of eroded areas. Compared to non-targeted NPs, Col IV NPs showed a 1.8-fold increased accumulation at regions of endothelial injury (p<0.0001). When loaded with the PAD4 inhibitor GSK484, Col IV NPs effectively reduced NET accumulation by 2.5 fold at sites of intimal lesions (p<0.01) and preserved endothelial continuity (a 4-fold increase in endothelial continuity percentage, p<0.001). These results indicate the feasibility of using nanotechnology to address the unmet need of specific therapy for superficial erosion.

Actinic cheilitis in a cardiac inpatient at intensive care unit: a case report

Actinic cheilitis (AC) is a oral disorder potentially malignant with dysplastic proliferations of keratinocytes. The lesion has a predilection for the red zone of the lower lip and may be closely related to excessive exposure to sunlight. The aim of this study was to report a clinical case of AC in a cardiac patient, admitted to the intensive care unit. Male patient, leucoderma, 82 years old, with a whitish lesion on the red zone of the lower lip, pedicled and sessile areas, well-marked limits and irregular shape. The incisional biopsy was performed in the intensive care unit bed and sent to the laboratory of pathological analysis in the State of Paraíba (LACEN). Microscopy showed an epidermis thickened by acanthosis, with cells showing nuclear pleomophism and hyperchromism. In the dermis, the presence of vascular ectasia, diffuse lymphocytic infiltrate and basophilic degeneration of elastic fibers, areas with foci of superficial erosion of the lining epithelium covered by a crust of necrotic and fibrinoleucocytic material were also observed. The anatomopathological diagnosis was ulcerated actinic cheilitis. The treatment performed was total surgical excision with monitoring of the healing process until the patient's hospital discharge. It was concluded that the treatment proposed to the patient was decisive. Also the presence of the dentist in a hospital environment facilitated the access and treatment of a oral disorder potentially malignant, favoring the prognosis of the case.

Bioengineering Techniques Adopted for Controlling Riverbanks’ Superficial Erosion of the Simplício Hydroelectric Power Plant, Brazil

Controlling and preventing soil erosion on slope surfaces is a pressing concern worldwide, and at the same time, there is a growing need to incorporate sustainability into our engineering works. This study evaluates the efficiency of bioengineering techniques in the development of vegetation in soil slopes located near a hydroelectric power plant in Brazil. For this purpose, twelve different bioengineering techniques were evaluated, in isolation and in combination, in the slopes (10 m high) of two experimental units (approximately 70 m long each) located next to the Paraíba do Sul riverbanks, in Brazil. High-resolution images of the slopes’ frontal view were taken in 15-day interval visits in all units for the first 90 days after implantation, followed by monthly visits up to 27 months after the works were finished. The images were treated and analyzed in a computer algorithm that, based on three-color bands (red–green–blue scale), helps to assess the temporal evolution of the vegetative cover index for each technique adopted. The results showed that most of the solutions showed a deficiency in vegetation establishment and were sensitive to climatological conditions, which induced changes in the vegetation phytosanitary aspects. Techniques which provided a satisfactory vegetative cover index throughout the investigated period are pointed out.

Characteristics of Endoscopic and Pathological Findings of Amebic Colitis

Backgroud The clinical features of amoebic colitis resemble those of inflammatory bowel Disease(IBD), and therefore the risk of misdiagnosis is very high.Objective The aim of this study was to analyse the characteristics of the endoscopic and pathological findings of amebic colitis and the lessons from our patients, which were useful for diagnosing the amebic colitis timely and avoiding the serious complications.Methods We retrospectively reviewed data of all amebic colitis admitted to Beijing Friendship Hospital from January 2015 to January 2020. Cases were diagnosed by clinical presentation, laboratory examinations, and colonoscopy with biopsy and histological examination. Results 16 patients were diagnosed with amebic colitis by the colonscopy accompanied by biopsy and microscopic examination. At first time, 12 (75%) patients were misdiagnosed as IBD. Cecum was the most common site of amebic colitis(100%), and the caecum and rectum were also involved in many lesions(68.75%). Multiple lesions of erosion and/or ulcer were recognized in all patients(100%).The features of endoscopic findings included multiple irregular shaped ulcers and erosions with surrouding erythema, and the ulcers and erosions were covered by the white or yellow exudates. The intervening mucosae between the ulcers or erosions were normal. The features of rectums can be divided to 2 types: in 6 patients(54.5%), the irregular ulcer or erosions covered with white or yellow exudates were observed in rectum and cecum, and the bloody exudates in rectum were more severe than those in cecum; in other 5 patients(45.5%), rectal lesions were much less severe than those in cecum, the small superficial erosion or reddened mucosa were observed in the rectal ampulla. All patients were diagnosed as detection of amebic trophozoites from HE-stained biopsy specimens. The number of trophozoites ranged from 1 /HPF to ＞50/HPF. Among 16 cases, mild architectural alteration of colon crypt were observed in 10 cases(62.5%), and serious architectural alteration of colon crypt was found which had crypt branch in 1 case(16.7%). Cryptitis was observed in 12 cases(75%) and its severity was mild or moderate. No crypts abscess was observed in all cases. Conclusions The colonoscopy with histological examination are very important to diagnose the amebic colitis. Detect the amoebic trophozoites in the esudates by histological examination is the vital. Sometimes a negative biopsy does not rule out amebiasis, repeated biopsies may be needed to make the diagnosis.

Deslizamento em Uma Vertente do Rio Madeira em Porto Velho – RO: Uma Análise Morfomecânica

Este estudo tem o objetivo de estabelecer o nível piezométrico que a vertente tinha antes do deslizamento, a morfometria e a causa do movimento de massa. Para isto, foi utilizada equação de Equilíbrio-Limite, com o Fator de segurança em 1,49 para estabelecer o nível piezométrico necessário para causar o colapso da encosta, como também, a determinação de propriedades geomecânicas, como coesão, densidade, ângulo de atrito, tensão de cisalhamento, limites de Atterberg, além da granulometria e da morfometria. A vertente apresentava o formato convexo no topo e côncavo na base, ambos seccionados no meio pelos formatos retilíneo e côncavo. A inclinação média era de 35,17° em uma dimensão de 46,01m. A Equação indicou um nível piezométrico mínimo de 18,53 metros de altura para o colapso. Um aspecto que influenciou o deslizamento foi à erosão superficial causada por uma galeria de água pluvial, que uma vez rompida, erodiu o pacote de material superficial, Argilo Siltoso Mosqueado, que serve de proteção para a vertente, pois possui maior coesão e plasticidade. Após a completa erosão do pacote superior, houve a exposição pontual do pacote inferior, que após sofrer forte precipitação pluvial de 32,20 mm, ocorrida no dia 30/09/2013, ocasionou a elevação do nível piezométrico deste material inferior, Silto Arenoso Tangencial, de menor coesão e plasticidade que saturou, comportando-se de maneira semi-líquida. Devido este material ser todo o alicerce da encosta, o seu colapso causou todo o deslizamento rotacional da vertente. Verifica-se a importância de manter o material superior desta margem do Rio Landslide in The Madeira River Slope in Porto Velho - RO: A Morfomechanical analysis ABSTRACTThe aims this paper is establish the piezometric level that the slope had before sliding, morphometry and the cause of mass movement. For this, the Equilibrium-Limit equation was used, with the Safety Factor at 1.49 to establish the piezometric level necessary for collapse of the slope, as well as the determination of geomechanical properties, such as cohesion, density, friction angle , shear stress, Atterberg boundaries, granulometry and morphometry. The strand had the convex shape at the top and concave at the base, both sectioned in the middle by the rectilinear and concave shapes. The average slope was 35.17° in a dimension of 46.01m. Equation indicated a minimum piezometric level of18.53 metershigh for collapse. One aspect that influenced the sliding was the superficial erosion caused by a gallery of rainwater, which once ruptured, eroded the package of surface material, Silt Clay Mottled, which serves as protection for the slope, as it has greater cohesion and plasticity. After complete erosion of the upper package, there was a punctual exposition of the lower package, which after suffering heavy rainfall of32.20 mm, occurred on 09/30/2013, caused the elevation of the piezometric level of this lower material, Sand Silt Tangential, of lower cohesion and plasticity that saturated, behaving in a semi-liquid way. Because this material is the whole foundation of the slope, its collapse caused all the rotational slip of the slope. It’s important to maintain the superior material of the slope, aiming at the reduction of shear forces and erosions.Keywords: Piezometric Level, morphometry, Break Circle.

Angina bullosa haemorragica: report of two cases

<p class="abstract">Angina bullosa hemorrhagica (ABH) is a term used to describe acute, subepithelial oral mucosal blisters filled with blood without any systemic disorder or hemostatic defect. They rupture spontaneously after short time resulting in painless superficial erosion that heals spontaneously within one week without scarring. We report two cases of ABH to create awareness regarding occurrence of this lesion thus avoiding any misdiagnosis<span lang="EN-IN">.</span></p>