Salivary and serum anti-desmoglein 1 and 3 ELISA and indirect immunofluorescence in pemphigus vulgaris: Correlations with serum ELISA, indirect immunofluorescence and disease severity

Anti-desmoglein (anti-Dsg) ELISA and indirect immunofluorescence (IIF) are used for the diagnosis of pemphigus vulgaris (PV). The value of salivary ELISA, serum ELISA, and IIF in the diagnosis of PV, and the correlation of salivary anti-Dsg1 and anti-Dsg3 ELISA with serum ELISA, serum and salivary IIF titers, and disease severity in patients with PV were evaluated. Fifty newly diagnosed patients with PV were enrolled in the study. Demographic data and disease-severity scores were recorded for each patient. Anti-Dsg1 and anti-Dsg3 ELISA and IIF were performed on both serum and salivary samples. Given the cut-off value of 20 RU/mL for Dsg1 and Dsg3, serum Dsg1 and Dsg3 ELISA were positive in 41 (82%) and 40 (80%) patients, and saliva Dsg1 and the Dsg3 ELISA were positive in 2 (4%) and 3 (6%) patients, respectively. Using the cut-off value of 13.4 RU/mL and 7.7 RU/mL for Dsg3 and Dsg1 salivary ELISA, 25 (50%) and 23 (46%) patients tested positive for Dsg3 and Dsg1, respectively. Serum IIF results were positive in 35 (70%) patients, and salivary IIF results were positive in 16 (32%) patients. Salivary anti-Dsg1 and anti-Dsg3 showed moderate correlations with the total pemphigus disease area index (PDAI) score (r=0.466, P&lt;0.001), (r=0.459, P&lt;0.001), respectively. A moderate correlation between serum IIF and salivary IIF was also detected (r=0.413, P&lt;0.001). Salivary anti-Dsg1 and anti-Dsg3 ELISA could be used as a safe and noninvasive method for the diagnosis of PV under certain circumstances, especially in children or elderly patients. Salivary ELISA is superior to salivary IIF. </p

Salivary and serum anti-desmoglein 1 and 3 ELISA and indirect immunofluorescence in pemphigus vulgaris: Correlations with serum ELISA, indirect immunofluorescence and disease severity

Anti-desmoglein (anti-Dsg) ELISA and indirect immunofluorescence (IIF) are used for the diagnosis of pemphigus vulgaris (PV). The value of salivary ELISA, serum ELISA, and IIF in the diagnosis of PV, and the correlation of salivary anti-Dsg1 and anti-Dsg3 ELISA with serum ELISA, serum and salivary IIF titers, and disease severity in patients with PV were evaluated. Fifty newly diagnosed patients with PV were enrolled in the study. Demographic data and disease-severity scores were recorded for each patient. Anti-Dsg1 and anti-Dsg3 ELISA and IIF were performed on both serum and salivary samples. Given the cut-off value of 20 RU/mL for Dsg1 and Dsg3, serum Dsg1 and Dsg3 ELISA were positive in 41 (82%) and 40 (80%) patients, and saliva Dsg1 and the Dsg3 ELISA were positive in 2 (4%) and 3 (6%) patients, respectively. Using the cut-off value of 13.4 RU/mL and 7.7 RU/mL for Dsg3 and Dsg1 salivary ELISA, 25 (50%) and 23 (46%) patients tested positive for Dsg3 and Dsg1, respectively. Serum IIF results were positive in 35 (70%) patients, and salivary IIF results were positive in 16 (32%) patients. Salivary anti-Dsg1 and anti-Dsg3 showed moderate correlations with the total pemphigus disease area index (PDAI) score (r=0.466, P&lt;0.001), (r=0.459, P&lt;0.001), respectively. A moderate correlation between serum IIF and salivary IIF was also detected (r=0.413, P&lt;0.001). Salivary anti-Dsg1 and anti-Dsg3 ELISA could be used as a safe and noninvasive method for the diagnosis of PV under certain circumstances, especially in children or elderly patients. Salivary ELISA is superior to salivary IIF. </p

The Role of Low-Level Laser in Periodontal Surgeries

Treatment protocols with low-level Laser (also called ‘soft laser therapy) have been used in health care systems for more than three decades. Bearing in mind the suitable sub-cellular absorption and the cellular-vascular impacts, low-level laser may be a treatment of choice for soft tissues. Low-level lasers have played crucial and colorful roles in performing periodontal surgeries. Their anti-inflammatory and painless effects have been variously reported in in-vitro studies. In this present review article, searches have been made in Pub Med, Google Scholar, and Science Direct, focusing on the studies which included low-level lasers, flap-periodontal surgeries, gingivectomy, and periodontal graft. The present study has sought to review the cellular impacts of low-level lasers and its role on reducing pain and inflammation following soft tissue surgical treatments.  

Effectiveness of amlexanox and adcortyl for the treatment of recurrent aphthous ulcers

Background: Recurrent aphthous stomatitis (RAS) is a common condition that affects approximately 20% of the general population. The ulcers can interfere with speech and eating and cause significant pain and discomfort. This study aimed to evaluate the efficacy of Amlexanox and Adcortyl in the treatment of aphthous ulcers. Material and Methods: In this randomized double blind clinical trial with sequential patient entry, a total of 40 patients who presented with aphthous ulcers were included. Patients were received Amlexanox or Adcortyl four times daily for 7 days. Patients were evaluated for pain, lesion size, and tingling at one day, three days, five days and seven days follow-ups. The treatment effects were then evaluated using the Wilcoxonâ Mannâ Whitney (WMW) test. Values of p<0.05 were considered significant. Results: No significant differences in pain score, tingling and lesion size were observed on similar days between Amlexanox and Adcortyl groups. In both groups, reduction in the assessed variables was significant between days 1-3, 3-5, and 5-7 (p < 0.001). Conclusions: This study indicated that Amlexanox as well as Adcortyl was effective in relieving pain and reducing the lesion size during the treatment of aphthous ulcers

Analysis of wave scattering from 2D curved metasurfaces using Floquet and Fourier series expansions

An efficient technique for calculating the scattering from curved metasurfaces using the extinction theorem in conjunction with the Floquet and Fourier series expansions is presented. Here, we treat the two-dimensional metasurfaces that have transversal polarizabilities with no variation along the y-axis. The boundary conditions at the metasurface are given by the generalized sheet transition conditions (GSTCs) whose susceptibilities are given in an arbitrary local coordinate system. First, we use the extinction theorem to provide integral equations of the scattering problem. The integral equations involve the Green's functions, tangential electric and magnetic fields and their normal derivatives in regions above and below the metasurface. Then, we employ the Floquet theorem that gives us the analytical periodic Green's functions of each region. Next, we employ the Fourier theorem to expand the tangential fields in terms of unknown Fourier coefficients. The GSTCs and the integral equations provide equations to be solved for the unknowns. The method can calculate scattering from both periodic and non-periodic metasurfaces. The technique is used to analyse different applied problems such as carpet cloaking, illusion, and radar echo width reduction. The method is fast and accurate and can efficiently treat metasurfaces with electrically large curved geometries with dimensions as large as 120 times the wavelength

Review of Predisposing Factors of Cervical Ectopic Pregnancy; an Update

Cervical ectopic pregnancies (CEPs) are rare, comprising less than 1% of ectopic pregnancies. On one hand, the abundant blood supply of the cervix and its incompatibility to keep the pregnancy in progress increases the potential for bleeding following CEP, mortality, complications, and infertility in affected women. CEPs are more difficult to diagnose and get identified at later gestational ages. CEP is one of the rarest forms of ectopic pregnancies and most commonly are a consequence of assisted reproductive technology (ART); while definitive risk factors are not fully known. Possible risk factors include cervical and uterine anomalies, previous curettages or cesarean sections, smoking, tubal factor infertility, or in vitro fertilization (IVF) treatment. Our analysis of literature in 200 patient restricted to retrospective case series , showed that a history of previous C-section, uterine curettage or D&C procedures, and a history of using assisted reproductive technology might be some of the potential risk factors. The increasing application of Hegar dilators was hypothesized as the cause of the rise in CEPs. Dilation and curettage (D&C) might also make the subject vulnerable to CEP development in the future. Previous D&C history could be a potential predisposing factor that is common among CEP patients.  In this review, we critically reviewed these potential risk factors. In conclusion, the risk factors of CEP and their effect on fertility are also not studied properly. The rarity of these cases makes it difficult to predict as well if the risk of their recurrence is elevated

Creatinine Phosphokinase (CPK) Elevation in the Coexistence of Wilson's Disease and Autoimmune Hepatitis with Atypical Presentation: A Diagnostic Dilemma

Background: Wilson's disease (WD) is a genetic disorder with various clinical presentations due to excessive accumulation of copper in the liver and other organs. It can present as acute/chronic hepatitis, liver failure, extrahepatic and neuromuscular manifestations. Autoimmune hepatitis (AIH) is a necroinflammatory disease of the liver, which affects a lot of people particularly the children population. AIH has a broad clinical presentation that is similar to WD. Coexistence of WD with elevated creatinine phosphokinase (CPK) and AIH, may be a diagnostic dilemma. Case Report: We presented a 6 years old boy with dysarthria, aggressive behavior, weak attention, concentration and weight loss with abnormal physical examination. Laboratory, histochemical, genomic studies, muscle/liver biopsy and atomic absorption test confirmed the diagnosis of both WD and AIH in the boy. Conclusion Although CPK and liver enzyme elevation is a rare presentation of chronic hepatitis with dominant feature of WD and AIH; however, simultaneous therapy with immunosuppressive drugs and Penicillamine may have superior benefit with a significant response

Reducing Hospital Congestion Through Improved Inpatient Discharge and Post-Acute Placement: A Stochastic Programming Approach

Hospital congestion is a pervasive problem that causes care delays, frustration for patients and their families, and stressed staff. This could potentially reduce the quality of care and ruin a hospital’s reputation. Hospital congestion also affects new patient admission, mainly through the emergency department (ED). ED overcrowding, which has been a challenge for years, is primarily caused by patients waiting in ED for being admitted to the inpatient unit (IU). The main reason for the delay in ED patient transfer to IU is inpatient bed unavailability, which can also contribute to canceling elective surgeries and rejecting patient admission to intensive care units (ICU). The situation worsens with a pandemic virus outbreak, which boosts demand for ED and ICU beds. Thus, improving access to IU beds helps smooth the patient flow not only from the ED but also from other upstream units such as ICU and post-anesthesia care unit. One efficient way to release IU beds is to improve the discharge process and minimize non-medical inpatient days. This dissertation studies improving hospital discharge in both operational and strategic levels. Discharge planning on the day of discharge is necessary to ensure effective performance. Discharge delay reduces patient satisfaction and increases hospital congestion and length of stay. Patient satisfaction is impacted by adherence to patient preferred discharge time. Preferences arise from many factors including waiting for family, avoiding rush hours, or waiting to feel better. Flow congestion manifests in patient boarding, and length of stay is extended if discharge delay incurs extra overnight stay. These factors are often in conflict, thus, good hospital performance can only be achieved through careful balancing. In the first part of this dissertation, discharge planning problem is formulated as a two-stage stochastic program with uncertainty in discharge processing and bed request times. The objective minimizes a combination of discharge lateness, patient boarding, and deviation from preferred discharge times. Patient boarding is integrated by aligning bed requests with bed releases. The model is solved for different instances generated using data from a large hospital in Texas. Stochastic decomposition is compared with the deterministic equivalent and the L-shaped algorithm. A shortest expected processing time heuristic is also investigated. Computational experiments indicate that stochastic decomposition outperforms the L-shaped algorithm and the heuristic, with a significantly shorter computational time and small deviation from optimal. The L-shaped method solves only small problems within the allotted time budget. Simulation experiments demonstrate that the developed modeling approach improves discharge lateness and patient boarding compared to current practice. In addition to patients being discharged to home, some wait for a transfer to the next level of care. These patients may experience several days of non-medical stay in IU until the hospital finds a post-acute care facility that fits their needs. The second part of this dissertation studies the feasibility of creating a “post-discharge-unit” (PDU) for patients, who are medically ready for discharge but are being delayed for some reason, to improve access to valuable IU beds. We use a multistage stochastic program to address PDU capacity planning and cost-effectiveness issues. The random variable is the number of bed requests from upstream units, including the ED, ICU, direct admissions, etc. Our model takes the impact of PDU on upstream patient flow, e.g., ED congestion and hospital admission into account. We use the stochastic dual dynamic programming algorithm to solve the model. An extensive numerical analysis is carried out using the data from a large hospital in Texas. An analysis of the impact of a variety of parameters, including PDU’s fixed and operational costs, and length of ALC stays, on PDU capacity and cost savings is performed. The results show that a PDU is cost-efficient and improves access to IU beds significantly, even when the ALC population is small, which is counter-intuitive. Another important finding is that PDU size in hospitals with a larger ALC population is more sensitive to increasing the PDU fixed and operational costs. In other words, the PDU size decreases faster when ALC population is larger