Outcomes of therapy of immunologically-mediated diseases of the oral mucosa

Immune-mediated diseases (IMDs) can give rise to long standing painful oral mucosal disease which adversely affect oral function and perhaps lessens quality of life. The present series of studies, retrospectively determine the clinical presentation and long-term efficacy and safety of treatment of large groups of patients with oral lichen planus, mucous membrane pemphigoid, pemphigus vulgaris and orofacial granulomatosis. These diseases are some of the challenging disorders to be managed by oral medicine specialists. It was found that patients with oral lichen planus (OLP) rarely have extra-oral manifestations of LP. The symptoms of OLP can generally be controlled with topical corticosteroids and/or tacrolimus. While tacrolimus is not notably better than topical corticosteroids for the management of OLP, it does not seem to increase any risk of malignant transformation. Adverse side effects are uncommon with topical corticosteroids, while 21% of patients with OLP may have adverse side effects with tacrolimus, particularly unpleasant taste. In the present cohort of 49 patients with orofacial granulomatosis (OFG) the onset of disease was characterised by facial swelling in 50% and the long-term behaviour of OFG was characterised by the development of further clinical manifestations with most patients developing orofacial swelling and/or intra-oral ulceration. The response of OFG to therapy was typically remitting and although a lessening of soft tissue swelling oral ulceration could generally be achieved with topical and/or systemic therapy. Complete remission of facial swelling occurred in 50% of patients within 3 years of therapy but may be achieved quicker when intra-lesional corticosteroids are used. Spontaneous remission was rare. Significant adverse side effects to therapy were rare. In a cohort of 62 patients, mucous membrane pemphigoid typically manifested as recurrent oral mucosal ulceration and/or desquamative gingivitis and 32.3% patients had some extra-oral involvement. Treatment generally lessened painful symptoms however gingival lesions rarely resolved. Adverse side effects affected 50% of patients; however in the majority of affected individuals these were minor. In a cohort of 40 patients with pemphigus vulgaris the mouth was often the initial site of involvement but other mucocutaneous sites could be affected. Management necessitated topical and systemic therapy. Adverse side effects occurred in 50% patients and were mainly associated with systemic immunosuppressive agents (e.g. azathioprine). The results of this present study indicate that the long-term treatment of IMDs of the oral mucosal are challenging to both the patients and clinicians. While many patients do experience an improvement in their disease status, many do not. The precise impact of IMDs upon the quality of life of affected individuals remains unclear

The microbiome of diabetic foot ulcers : a comparison of swab and tissue biopsy wound sampling techniques using 16S rRNA gene sequencing

Background: Health-care professionals need to collect wound samples to identify potential pathogens that contribute to wound infection. Obtaining appropriate samples from diabetic foot ulcers (DFUs) where there is a suspicion of infection is of high importance. Paired swabs and tissue biopsies were collected from DFUs and both sampling techniques were compared using 16S rRNA gene sequencing. Results: Mean bacterial abundance determined using quantitative polymerase chain reaction (qPCR) was significantly lower in tissue biopsies (p = 0.03). The mean number of reads across all samples was significantly higher in wound swabs X = 32,014) compared to tissue (X = 15,256, p = 0.001). Tissue biopsies exhibited greater overall diversity of bacteria relative to swabs (Shannon’s H diversity p = 0.009). However, based on a presence/ absence analysis of all paired samples, the frequency of occurrence of bacteria from genera of known and potential pathogens was generally higher in wound swabs than tissue biopsies. Multivariate analysis identified significantly different bacterial communities in swabs compared to tissue (p = 0.001). There was minimal correlation between paired wound swabs and tissue biopsies in the number and types of microorganisms. RELATE analysis revealed low concordance between paired DFU swab and tissue biopsy samples (Rho = 0.043, p = 0.34). Conclusions: Using 16S rRNA gene sequencing this study identifies the potential for using less invasive swabs to recover high relative abundances of known and potential pathogen genera from DFUs when compared to the gold standard collection method of tissue biopsy. SOME OF THE SCIENTIC SYMBOLS CAN NOT BE REPRESENTED CORRECTLY IN THE ABSTRACT. PLEASE READ WITH CAUTION AND REFER TO THE ORIGINAL PUBLICATION

Health care workers safety: screening and immunization: a review

The paper puts forth the need for health care workers safety whilst undertaking their job on a daily basis. Presently there are number of factors that are directly linked to the safety of health care workers. However, Occupational Health is very important and useful for health workers that are exposed to their job hazards. Every year, many lives are lost because of the spread of infections in hospitals. Every hospital’s occupational health departments should ensure that all new staff are vaccinated to protect them against microorganisms carried by other patients, and with vaccinated against preventable diseases. This will help to prevent the health workers from occupational exposure to patients’ blood or any other bodily substances, including injury from sharp objects, and also guarantees that the new employees does not infect the patients with infectious diseases. Furthermore, all the new staff should be screened for blood borne pathogenic diseases

Post-COVID-19 fatigue and health-related quality of life in Saudi Arabia: a population-based study

BackgroundDespite substantial literature on symptoms and long-term health implications associated with COVID-19; prevalence and determinants of post-acute COVID-19 fatigue (PCF) remain largely elusive and understudied, with scant research documenting health-related quality of life (HRQoL). Hence, prevalence of PCF and its associated factors, and HRQoL among those who have survived Covid-19 within the general population of Saudi Arabia (KSA) is the subject under examination in this research.MethodsThis cross-sectional study was conducted on 2063 individuals, selected from the KSA’s general population, using a non-probability sampling approach. An online survey was used to employ a self-administered questionnaire to the participants, which included socio-demographic information, the patient’s COVID-19 infection history, 12-item Short Form Health Survey (SF-12) to assess quality of life, and Chalder Fatigue Scale (CFS) (CFQ 11) to evaluate the extent and severity of fatigue. Data were analyzed using SPSS version 26. A p < 0.05 was considered to be strong evidence against the null hypothesis.ResultsThe median age of participants was 34 (IQR = 22) years, with females comprising the majority (66.2%). According to the SF-12 questionnaire, 91.2% of patients experienced physical conditions, and 77% experienced depression. The prevalence of PCF was 52% on CFQ 11 scale. Female gender, higher levels of education, a pre-existing history of chronic disease, as well as the manifestations of shortness of breath and confusion during acute COVID-19 infection, were identified as independent predictors of fatigue.ConclusionTo facilitate timely and effective intervention for post-acute COVID-19 fatigue, it is essential to continuously monitor the individuals who have recovered from acute COVID-19 infection. Also, it is critical to raise health-education among these patients to improve their quality of life. Future research is required to determine whether COVID-19 survivors would experience fatigue for an extended duration and the impact of existing interventions on its prevalence and severity

An in vitro collagen perfusion wound biofilm model; with applications for antimicrobial studies and microbial metabolomics

BackgroundThe majority of in vitro studies of medically relevant biofilms involve the development of biofilm on an inanimate solid surface. However, infection in vivo consists of biofilm growth on, or suspended within, the semi-solid matrix of the tissue, whereby current models do not effectively simulate the nature of the in vivo environment. This paper describes development of an in vitro method for culturing wound associated microorganisms in a system that combines a semi-solid collagen gel matrix with continuous flow of simulated wound fluid. This enables culture of wound associated reproducible steady state biofilms under conditions that more closely simulate the dynamic wound environment. To demonstrate the use of this model the antimicrobial kinetics of ceftazidime, against both mature and developing Pseudomonas aeruginosa biofilms, was assessed. In addition, we have shown the potential application of this model system for investigating microbial metabolomics by employing selected ion flow tube mass spectrometry (SIFT-MS) to monitor ammonia and hydrogen cyanide production by Pseudomonas aeruginosa biofilms in real-time. ResultsThe collagen wound biofilm model facilitates growth of steady-state reproducible Pseudomonas aeruginosa biofilms under wound like conditions. A maximum biofilm density of 1010 cfu slide-1 was achieved by 30 hours of continuous culture and maintained throughout the remainder of the experiment. Treatment with ceftazidime at a clinically relevant dose resulted in a 1.2 – 1.6 log reduction in biofilm density at 72 hours compared to untreated controls. Treatment resulted in loss of complex biofilm architecture and morphological changes to bacterial cells, visualised using confocal microscopy. When monitoring the biofilms using SIFT-MS, ammonia and hydrogen cyanide levels peaked at 12 hours at 2273 ppb (±826.4) and 138 ppb (±49.1) respectively and were detectable throughout experimentation. ConclusionsThe collagen wound biofilm model has been developed to facilitate growth of reproducible biofilms under wound-like conditions. We have successfully used this method to: (1) evaluate antimicrobial efficacy and kinetics, clearly demonstrating the development of antimicrobial tolerance in biofilm cultures; (2) characterise volatile metabolite production by P. aeruginosa biofilms, demonstrating the potential use of this method in metabolomics studies

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine

[This corrects the article DOI: 10.1186/s13054-016-1208-6.]

Oral manifestations of systemic disease

While the majority of disorders of the mouth are centred upon the direct action of plaque, the oral tissues can be subject to change or damage as a consequence of disease that predominantly affects other body systems. Such oral manifestations of systemic disease can be highly variable in both frequency and presentation. As lifespan increases and medical care becomes ever more complex and effective it is likely that the numbers of individuals with oral manifestations of systemic disease will continue to rise. The present article provides a succinct review of oral manifestations of systemic disease. In view of this article being part of a wider BDJ themed issue on the subject of oral medicine, this review focuses upon oral mucosal and salivary gland disorders that may arise as a consequence of systemic disease

Self-management practices among type 2 diabetes patients attending primary health-care centres in Medina, Saudi Arabia

The purpose of this study was to estimate the frequency of self-management activities among people who have type 2 diabetes in Saudi Arabia. The Arabic version of the Summary of Diabetes Self-care Activities questionnaire was used to identify self-management practices among 210 patients with type 2 diabetes mellitus. Only 15% of participants had a blood glucose level indicative of good glycaemic control (glycosylated haemoglobin = 7 mmol/L). Most reported that they took their medication as prescribed, but many demonstrated low levels of compliance with other self-management practices (overall mean 3.7 days per week). Males and those with lower incomes were less likely to practise self-care activities. Most were given basic advice to undertake self-care activities, but only some were given more detailed information. There are opportunities to improve type 2 diabetes mellitus self-management practices in Saudi Arabia and increase the proportion of patients who achieve good glycaemic control

Pattern of prescription of antibiotics among dental practitioners in Jeddah, KSA: A cross-sectional survey

Background: Inappropriate use of antibiotics by clinicians leads to antibiotic resistance, and is a serious global health concern.Aim: The aim of this study was to determine antibiotic prescription practices of dental practitioners and their adherence to professional guidelines while treating oral health problems among children.Materials and Methods: All the dentists working in Jeddah were invited to participate and 126 dentists consented to be a part of this study. A two-part questionnaire was applied. First section explored the demographics and questions related to antibiotic use for certain dental clinical procedures, whereas the second section used five different clinical case scenarios to elicit the antibiotics prescription practices and adherence to professional guidelines by the dentists.Results: Amoxicillin (73.8%) was the most commonly preferred antibiotic for most of the orofacial infections among the dentists. The overall adherence to the professional guidelines ranged from 9.5 to 45%.Conclusions: A lack of consistency in the antibiotic prescription pattern among dentists in Jeddah and overall low adherence to the professional guidelines was observed.Keywords: Antibiotics, antibiotic abuse, antimicrobial resistance, children, orofacial infectio

Next Generation DNA Sequencing of Tissues from Infected Diabetic Foot Ulcers

We used next generation DNA sequencing to profile the microbiome of infected Diabetic Foot Ulcers (DFUs). The microbiota was correlated to clinical parameters and treatment outcomes to determine if directed antimicrobial therapy based on conventional microbiological cultures are relevant based on genomic analysis. Patients ≥ 18 years presenting with a new Diabetic Foot Infection (DFI) who had not received topical or oral antimicrobials in the two weeks prior to presentation, were eligible for enrolment. Tissue punch biopsies were obtained from infected DFUs for analysis. Demographics, clinical and laboratory data were collected and correlated against microbiota data. Thirty-nine patients with infected DFUs were recruited over twelve-months. Shorter duration DFUs (<six weeks) all had one dominant bacterial species (n = 5 of 5, 100%, p < 0.001), Staphylococcus aureus in three cases and Streptococcus agalactiae in two. Longer duration DFUs (≥six weeks) were diversely polymicrobial (p < 0.01) with an average of 63 (range 19–125) bacterial species. Severe DFIs had complex microbiomes and were distinctly dissimilar to less severe infections (p = 0.02), characterised by the presence of low frequency microorganisms. Nineteen patients (49%) during the study period experienced antimicrobial treatment failure, but no overall differences existed in the microbiome of patients who failed therapy and those who experienced treatment success (p = 0.2). Our results confirm that short DFUs have a simpler microbiome consisting of pyogenic cocci but chronic DFUs have a highly polymicrobial microbiome. The duration of a DFU may be useful as a guide to directing antimicrobial therapy