Exogenous lipoid pneumonia caused by repeated sesame oil pulling: a report of two cases

Rose geranium in sesame oil nasal spray to improve nasal vestibulitis symptoms: a randomized controlled trial

PURPOSE

The purpose of this phase III randomized double-blinded controlled trial was to investigate the efficacy of a rose geranium in sesame oil (RG) nasal spray compared with an isotonic saline (IS) nasal spray for alleviating nasal vestibulitis symptoms among patients undergoing chemotherapy.

METHODS

Patients undergoing active chemotherapy who reported associated nasal symptoms were randomized 1:1 to receive RG or IS, administered twice daily for 2 weeks. Consenting participants completed nasal symptom questionnaires at baseline and then weekly while on treatment. The proportion of patients experiencing improvements in their nasal symptoms 2 weeks after initiating the nasal spray, using a six-point global impression of change score, was estimated within and between each randomized arm, and compared between arms, using Fisher's exact test. The estimated odds ratio was determined (95% confidence interval).

RESULTS

One hundred and six patients consented to this study; 43 participants in the RG arm and 41 in the IS arm were evaluable for the primary endpoint. Participants had a mean age of 57.8 years (SD 13.9). Demographic characteristics and baseline nasal symptoms were similar between arms. Of the evaluable participants who received RG, 67.4% reported improved nasal symptoms, compared with 36.6% of the participants who received IS (P = 0.009). Adverse events were sparse and did not differ between arms.

CONCLUSION

Rose geranium in sesame oil significantly improves nasal vestibulitis symptoms among patients undergoing chemotherapy.

TRIAL REGISTRATION

NCT04620369.

The effect of oil pulling in comparison with chlorhexidine and other mouthwash interventions in promoting oral health: A systematic review and meta-analysis

OBJECTIVES

A meta-analytic review was performed to critically synthesize the evidence of oil pulling on improving the parameters of gingival health, plaque control and bacteria counts against chlorhexidine and other mouthwash or oral hygiene practices.

METHODS

Databases including Medline, Embase and bibliographies were searched from inception to 1 April 2023. Randomized controlled trials (RCTs) with 7 days or longer duration of oil pulling with edible oils in comparison to chlorhexidine or other mouthwashes or oral hygiene practice concerning the parameters of plaque index scores (PI), gingival index scores (GI), modified gingival index scores (MGI) and bacteria counts were included. Cochrane's Risk of Bias (ROB) tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework were employed to determine the quality of evidence. Two authors independently conducted study selection and data extraction. Meta-analyses of the effect of oil pulling on the parameters were conducted using an inverse-variance random-effects model.

RESULTS

Twenty-five trials involving 1184 participants were included. Twenty-one trials comparing oil pulling (n = 535) to chlorhexidine (n = 286) and non-chlorhexidine intervention (n = 205) were pooled for meta-analysis. More than half of the trials (n = 17) involved participants with no reported oral health issues. The duration of intervention ranged from 7 to 45 days, with half of the trials using sesame oil. When compared to non-chlorhexidine mouthwash interventions, oil pulling clinically and significantly improved MGI scores (Standardized mean difference, SMD = -1.14; 95% confidence interval [CI]: -1.31, -0.97). Chlorhexidine was more effective in reducing the PI scores compared to oil pulling, with an SMD of 0.33 (95% CI: 0.17, 0.49). The overall quality of the body of evidence was very low.

CONCLUSIONS

There was a probable benefit of oil pulling in improving gingival health. Chlorhexidine remained superior in reducing the amount of plaque, compared to oil pulling. However, there was very low certainty in the evidence albeit the clinically beneficial effect of oil pulling intervention.

Evaluation of Anti-inflammatory and Antimicrobial Properties of Mustard Seed Extract-Based Hydrogel: An In Vitro Study

INTRODUCTION

Mustard has been regarded as one of the world's most extensively produced and useful plants as well as one of the oldest condiments ever. The aim of the study was to develop and analyse the anti-inflammatory and antimicrobial properties of mustard seed extract.

METHODS

The extract was prepared by using a double filtration technique and anti-inflammatory properties were checked using egg albumin assay and bovine serum albumin assay and diclofenac sodium was the control. The antimicrobial property was evaluated by the Kirby-Bauer test and chlorhexidine gel was the control. The species included were Staphylococcus aureus, Streptococcus mutans, Enterococcus faecalis and Candida albicans.

RESULTS

The results showed that the anti-inflammatory property of mustard seed extract is comparable to diclofenac sodium whereas the maximum zone of inhibition was seen against C. albicans.

CONCLUSION

 This study discovered that mustard seed extract has potent antimicrobial and anti-inflammatory activity against a variety of oral microorganisms. These findings indicate that this hydrogel was highly active against the tested pathogens and will be effective in the treatment of periodontitis.

Supportive Home Remedies for Orofacial Pain during the Coronavirus Disease 2019 Pandemic: Their Value and Limitations

Background

The coronavirus disease 2019 (COVID-19) pandemic has impeded access to timely dental care, and there is an urgent need for adjuvant therapies that can reduce orofacial pain in emergencies.

Aims

To provide information on the benefits and limitations of eight representative home remedies as palliative care for orofacial pain during the coronavirus disease 2019 (COVID-19) pandemic.

Methods

PubMed and Medline were electronically searched for eight home remedies for orofacial pain that can be used in COVID-19. Papers published in English in the past 30 years were considered. Among the published studies suitable for the research purpose, those in which the abstract and body text were confirmed were targeted, and duplicate studies were excluded. Finally, 86 studies were included.

Results

There is extensive and high-level scientific evidence for the application of tooth brushing and flossing, mouth rinsing with chlorhexidine, use of over-the-counter pain medication, and application of cryotherapy in emergencies. Gargling with salt water, brushing with bamboo salt, gargling with garlic juice, and oil pulling are traditional methods used for centuries. The use of natural products for orofacial pain has a significant empirical effect but has weak scientific evidence.

Conclusions

Knowing the correct application method, effects, and side effects is desirable to use these methods appropriately in emergencies. However, scientific evidence is unclear and generally lacking for home remedies to be the main treatment strategy, and there are clear limitations to their use as a single main treatment.

High-resolution taxonomic examination of the oral microbiome after oil pulling with standardized sunflower seed oil and healthy participants: a pilot study

OBJECTIVES

We aimed at the high-resolution examination of the oral microbiome depending on oil pulling, compared it with saline pulling, and analyzed whether the method is capable of reducing the overall microbial burden of the oral cavity.

MATERIALS AND METHODS

The study was a cohort study with three healthy subjects. Oil pulling samples, saline pulling samples, and saliva samples were microscoped and cultured under microaerophilic and anaerobic conditions; colony-forming units were counted; and cultivated bacteria were identified employing MALDI-TOF MS. The oral microbiomes (saliva) and the microbiota incorporated in oil and saline pulling samples were determined in toto by using 16S rDNA next-generation sequencing (NGS) and bioinformatics.

RESULTS

Microscopy revealed that oral epithelial cells are ensheathed with distinct oil droplets during oil pulling. Oil pulling induced a higher production of saliva and the oil/saliva emulsion contained more bacteria than saline pulling samples. Oil pulling resulted in a significant and transient reduction of the overall microbial burden in comparison to saliva examined prior to and after pulling. Both oil and saline pulling samples mirrored the individual oral microbiomes in saliva.

CONCLUSIONS

Within the limitations of this pilot study, it might be concluded that oil pulling is able to reduce the overall microbial burden of the oral cavity transiently and the microbiota in oil pulling samples are representative to the oral microbiome.

CLINICAL RELEVANCE

Within the limitations of this pilot study, it might be concluded that oil pulling can be considered as an enlargement of standard oral hygiene techniques since it has the characteristic of an oral massage, enwrapping epithelial cells carrying bacteria in oil vesicles and reaching almost all unique habitats in oral cavity.

The efficacy and safety of therapeutic lung lavage for exogenous lipoid pneumonia: A systematic review

INTRODUCTION AND OBJECTIVES

Exogenous lipoid pneumonia (ELP) is a lung inflammatory disease with low prevalence and has the feature of external lipid substances presented in the alveoli. Therapeutic lung lavage (segmental bronchoalveolar lavage and whole lung lavage) has been gradually recognized as an important therapy for the disease. There was no comprehensive summary on its efficacy and safety.

METHODS

We searched PubMed, Embase, Cochrane Library, CNKI, Wanfang Database, clinicaltrials.gov, and the references of included studies. After study selection, data extraction and quality assessment, we performed a qualitative description of current data.

RESULTS

We included 90 ELP patients from 25 case reports and 8 case series studies. Eighty-four (93.3%) patients received segmental bronchoalveolar lavage and six (6.7%) patients received whole lung lavage. Eighty-seven (96.7%) patients got clinical improvement after lavages, while three (3.3%) patients had no improvement and eventually died. The follow-up status was reported in 29 patients, of whom 24 patients remained well without any use of drugs and 4 patients remained well with some periods of corticosteroids. One patient endured recurrence. The radiological change was reported in 72 patients, of whom 41 (56.9%) patients had full resolution until the last follow-up. Two studies reported acute pulmonary edema and transient hypoxemia during lavages.

CONCLUSIONS

Therapeutic lung lavage might be an effective and safe therapy with long-term benefits for ELP. Current studies were all case reports and case series with relatively high risk of bias. Prospective controlled studies are needed to explore the actual efficacy, safety, individualized indications, and optimized treatment procedures of therapeutic lung lavage for ELP.

Oil pulling to relieve medication-induced xerostomia: A randomized, single-blind, crossover trial

OBJECTIVES

To determine the subjective effectiveness of oilpulling on medication-induced xerostomia with regard to symptom relief, quality of life, taste, mucosal moisture and oral parameters.

MATERIALS AND METHODS

In a randomized, single-blind, crossover trial in participants with medication-induced xerostomia (n = 26; mean age 64.71 (standard deviation (SD) 15.60) years), we investigated oilpulling efficacy (sunflower oil) versus mineral water after one-week use. Xerostomic burden (visual analogue scale, VAS), symptom relief and oral examinations (gingivitis index, plaque index, whole stimulated and unstimulated salivation rates) were investigated at baseline and the end of the follow-up.

RESULTS

Oilpulling reduced the xerostomic burden (baseline value 6.46 (SD 1.80), decreasing to 4.93 (SD 2.97)) (p = .003), without difference between oil versus water (p = .067). Baseline values for water were 6.08 (SD 2.17) decreasing to 5.72 (SD 2.17) (p = .124). Compared to water, oil made swallowing easier (p = .031), caused a pleasant mouthfeel (p = .031) and caused less waking up at night (p = .031). Effectiveness (p = .002) and duration (p = .007) of symptom relief showed differences between products in favour of oil.

CONCLUSIONS

Oil pulling alleviated the overall xerostomic burden. In the comparison between oil and water, no difference regarding symptom relief could be shown. Patients should be informed of possibilities and limitations of oilpulling as inexpensive and easy-to-obtain alternative to commercially available products for short-term symptom relief.

The Global Rise and the Complexity of Sesame Allergy: Prime Time to Regulate Sesame in the United States of America?

Sesame allergy is a life-threatening disease that has been growing globally with poorly understood mechanisms. To protect sensitive consumers, sesame is regulated in many countries. There were four research goals for this work on sesame allergy: (i) to map the timeline, and the extent of its global rise; (ii) to dissect the complexity of the disease, and its mechanisms; (iii) to analyze the global regulation of sesame; and (iv) to map the directions for future research and regulation. We performed a literature search on PubMed and Google Scholar, using combinations of key words and analyzed the output. Regulatory information was obtained from the government agencies. Information relevant to the above goals was used to make interpretations. We found that: (i) the reports appeared first in 1950s, and then rapidly rose globally from 1990s; (ii) sesame contains protein and lipid allergens, a unique feature not found in other allergenic foods; (iii) it is linked to five types of diseases with understudied mechanisms; and (iv) it is a regulated allergen in 32 advanced countries excluding the USA. We also provide directions for filling gaps in the research and identify implications of possible regulation of sesame in the USA.

The effect of oil pulling with coconut oil to improve dental hygiene and oral health: A systematic review

Objectives

Coconut oil is a cheap and accessible oil for many people around the world. There are numerous advocates for the practice of oil pulling to prevent common oral diseases. Therefore determining the effectiveness of oil pulling with coconut oil could potentially have monumental benefits. This review aimed to assess the effect of oil pulling with coconut oil in improving oral health and dental hygiene.

Data

We included randomized controlled trials comparing the effect of oil pulling with coconut oil on improving oral health and dental hygiene.

No meta-analysis was performed due to the clinical heterogeneity and differences in the reporting of data among the included studies.

Sources

Six electronic databases were screened: PubMed, Medline, EMBASE, AMED, CENTRAL and CINAHL.

Study selection

Electronic searches yielded 42 eligible studies, of which four RCTs including 182 participants were included. The studies lasted between 7 and 14 days. Significant differences were demonstrated for a reduction in salivary bacterial colony count (p = 0.03) and plaque index score (p=<0.001). One study also demonstrated a significant difference in staining compared to using Chlorhexidine (p = 0.0002). However, data was insufficient for conclusive findings, the quality of studies was mixed and risk of bias was high.

Conclusion

The limited evidence suggests that oil pulling with coconut oil may have a beneficial effect on improving oral health and dental hygiene. Future clinical trials are of merit considering the universal availability of the intervention. Prospective research should have a robust design with rigorous execution to provide a higher quality of evidence.

Clinical significance

Oil pulling with coconut oil could be used as a adjunct to normal preventative regimes to improve oral health and dental hygiene although further studies are needed to determine the level of effectiveness.

The Diagnosis of Exogenous Lipoid Pneumonia Caused by the Silent Aspiration of Vegetable Oil Using a Lipidomic Analysis

We herein report a case of refractory exogenous lipoid pneumonia that was successfully attributed to vegetable oil through a lipidomic analysis of bronchoalveolar lavage fluid (BALF). As a 25-year-old woman diagnosed with lipoid pneumonia experienced repeated exacerbations and improvement, we performed a BALF lipidomic analysis. The major lipid components were oleic acid, linoleic acid, and α-linolenic acid, which are constituents of vegetable oil. She stopped consuming any vegetable oil and has since experienced no instances of lipoid pneumonia relapse. A lipidomic analysis appears to be useful for identifying causative lipids, since patients with lipoid pneumonia are sometimes unaware of aspiration episodes.

Exogenous lipid pneumonia in old people caused by aspiration: Two case reports and literature review

Background

Exogenous lipoid pneumonia is a rare entity, the diagnosis is often missed or delayed.

Objective

To investigate the clinical characteristics of exogenous lipid pneumonia in elderly patients, improve the efficiency of early diagnosis and treatment of this disease.

Methods

Retrospectively analyzed the clinical information and imaging data of these 2 exogenous lipid pneumonia patients, reviewed related literature.

Results

Both of the 2 patients were over 60 with a history of gastrointestinal diseases. The clinical presentation is nonspecific. Chest CT showed many different manifestations. Histopathology analysis revealed the accumulation of lipid carrying macrophages, vacuolar cells and inflammation. A literature review indicated that 25 previous cases of exogenous lipid pneumonia were caused by aspiration. The most common site of the lesion was located in right lung, while mineral oil was the most common substances. We sought to discuss the patient's treatment and the corresponding outcomes.

Conclusion

The diagnosis of lipid pneumonia's mainly depends on medical history and histopathological morphology. The standard treatment for exogenous lipid pneumonia was composed of antibiotics, steroid, bronchoscopic lavage and a regular follow-up.

Rose geranium in sesame oil nasal spray: a treatment for nasal vestibulitis?

OBJECTIVES

As a rose geranium in sesame oil spray product has been anecdotally noted to improve nasal vestibulitis symptoms, this study was designed to assess whether patients with nasal vestibulitis associated with cancer-directed therapy experienced symptomatic improvements from it.

METHODS

Patients with breast cancer, prescribed rose geranium nasal spray, were identified by looking at pharmacy records and patient diagnosis at Mayo Clinic Rochester. Patient medical information, as well as documentation of symptoms, were gleaned from medical charts. Questionnaires were sent to patients regarding their experiences.

RESULTS

Of the 40 patients with breast cancer who were prescribed rose geranium nasal spray, 100% were receiving cancer-directed therapy: 58 % were receiving taxane chemotherapy; others received a variety of cytotoxic and targeted therapy treatments. Twenty patients who had used the spray product returned surveys. Patient-reported nasal symptoms included bleeding (90%), dryness (86%), pain (81%), scabbing (67%) and sores (52%); patients consistently reported symptoms at a higher proportion than did healthcare providers. All patients who used the rose geranium nasal spray reported symptomatic benefit; one reported a little benefit, 11 (55%) reported moderate benefit and eight (40%) reported dramatic or complete resolution of symptoms. The therapy was well tolerated in most patients.

CONCLUSIONS

Rose geranium in sesame oil nasal spray appears to improve patient-reported nasal symptoms associated with cancer-directed therapy.

Comparison of exogenous and endogenous lipoid pneumonia: the relevance to bronchial anthracofibrosis

Lipoid pneumonia, caused by the accumulation of lipids in the alveoli, is classified into two forms (exogenous vs. endogenous) according to the source of the lipid exposure. There are no data directly comparing patients with exogenous and endogenous lipoid pneumonia. All patients who were diagnosed with lipoid pneumonia between January 2008 and December 2016 at Kyungpook National University Hospital, a tertiary referral hospital in South Korea, were retrospectively reviewed. The clinical, radiologic, and bronchoscopic findings for the two forms of lipoid pneumonia were compared. A total of 13 patients who met the criteria for a confirmed diagnosis of lipoid pneumonia were included. Dyspnea at presentation, predominant lower lobes involvement, bronchial anthracofibrosis (BAF), and recurrent episodes were more frequent in patients with the endogenous form than in those with the exogenous form. Of them, a notable finding was that BAF was identified in all five patients with the endogenous form, whereas BAF was observed in only one of the eight patients with the exogenous form (P=0.005). This finding suggests that BAF may be associated with endogenous form. Awareness of this association between endogenous lipoid pneumonia and BAF may help clinicians avoid delaying diagnoses.

False positive 18FDG PET-CT results due to exogenous lipoid pneumonia secondary to oily drug inhalation: A case report

RATIONALE

Exogenous lipoid pneumonia is a rare condition due to abnormal presence of oily substances in the lungs. It is a rarely known cause for false positive FDG PET-CT results and can sometimes lead to invasive investigations. Searching and finding the source of the oily substance is one of the keys to the diagnosis. Inhalation of oily drugs during snorting has rarely been described.

PATIENT CONCERNS

A patient with well controlled HIV infection was referred for an FDG PET-CT to assess extension of Kaposi's disease, recently removed from his right foot. The patient had no particular symptoms.

DIAGNOSES

Abnormal uptake of FDG was found in a suspicious lung nodule. An experienced radiologist thought the nodule was due to lipoid pneumonia.

INTERVENTIONS

Bronchoalveolar lavage fluid did not contain lipid-laden macrophages but bronchoscopy showed violet lesions resembling Kaposi's disease lesions. Lobectomy was performed after a multidisciplinary discussion.

OUTCOMES

Anatomopathological analysis revealed the nodule was due to lipoid pneumonia. The patient's quality of life did not diminish after the operation and he is still in good health. The source of the oily substance causing lipoid pneumonia was found after the surgery: the patient used to snort oily drugs.

LESSONS

The presence of a suspicious lung nodule possibly due to lipoid pneumonia in a patient with known Kaposi's disease was difficult to untangle and lead to invasive surgery. It is possible that if a source of exogenous lipoid pneumonia had been found beforehand, surgery could have been prevented.

Lung diseases associated with hydrocarbon exposure

The human race has been exposed to the potential toxicity of hydrocarbons, whether by the inhaled or ingested route, for thousands of years and the consequent inflammatory reaction in the lungs depends on the degree of exposure, volatility and viscosity of the particular hydrocarbon in question. Heating, lighting, transportation, industry and nature all provide the potential for both inhalation and/or ingestion of hydrocarbons. Some forms, such as those related to petroleum products, e.g. diesel exhaust particles (DEP) and polycyclic aromatic hydrocarbons (PAH) have been shown to cause both malignant and non-malignant respiratory diseases. Accidental ingestion represents another significant exposure risk and we now have increasing evidence that pollutant particles may adsorb allergens to their surface and potentially enhance the allergic response. It seems unlikely that this potential will significantly decrease in the near future and depending on individual socio-economic circumstances, work environment and habitation, the risks of significant lung disease will vary. This review outlines the domestic, outdoor, occupational and natural sources of hydrocarbon exposure and considers the evidence relating to radiological and pathological lung changes in both animals and man. The acute effects of hydrocarbon toxicity are well recognised but the effects of longer term, lower exposure, and the mechanisms of their toxicity, require further research.

Oil pulling and importance of traditional medicine in oral health maintenance

Dental diseases have detrimental effects on the functionality and quality of life of individuals. In addition, a strong relationship has been established between various oral and systemic diseases. In fact, the prevention and treatment of dental caries and periodontal disease have been shown to reduce the risk of diabetes and heart disease significantly. This goes beyond the role of oral health as a means to identify early manifestations of systemic diseases in the oral cavity. It highlights the necessity of maintaining an optimal oral hygiene to significantly modify the risk factors for serious systemic diseases. The use of oil pulling can be frequently found in ancient medical text and is supported by recent studies for its efficacy and long-term use for maintaining and improving oral health. This article provides an overview on the concept of oil pulling or oil swishing, its mechanism of action and a summary of the evidence available, which highlights the role of oil pulling in specific oral diseases. The goal of this review is to highlight the ancient procedure that has the potential to be used as an adjunct to conventional chemical means of dental plaque control, such as mouth rinses. Incorporating oil swishing as a component of daily oral hygiene can significantly improve oral and general health, specifically in lower socioeconomic groups and rural communities that may have interrupted access to health-care services and dental products such as dentifrices and mouth washes due to various factors; availability and affordability being the most important.

A case of lipoid pneumonia caused by inhalation of vaporized paraffin from burning candles

A 66-year-old woman was referred to our hospital for investigation of interstitial lung disease. She had spent most of her time in a shrine, and had always been exposed to vaporized paraffin from burning candles. Chest High-resolution computed tomography (HRCT)showed ground-glass attenuation with thickening of septal lines, wh create the so-called "crazy-paving appearance". Although bronchoalveolar lavage(BAL) and transbronchial biopsy were performed to aid in diagnosis, the findings did not reveal any conclusive information. Improvements on chest radiographs and in the patient's symptoms were observed without any therapeutic intervention; however, one year later, her chest X-ray showed deteriorative changes. Surgical lung biopsy was performed, and the pathological findings were consistent with those of lipoid pneumonia. The patient showed spontaneous remission of the disease. The cause of exogenous lipoid pneumonia was attributed to inhalation of vaporized paraffin from burning candles in the shrine. This is the first case of lipoid pneumonia that was found to develop from exposure to vaporized paraffin.

Comparison of antibacterial efficacy of coconut oil and chlorhexidine on Streptococcus mutans: An in vivo study

AIMS

Streptococcus mutans is the most common organism causing dental caries. Various chemotherapeutic agents are available that help in treating the bacteria, with each having their own merits and demerits. Recent research has shown that coconut oil has anti-inflammatory and antimicrobial action. Therefore, the present was conducted to determine the antibacterial efficacy of coconut oil and to compare it with chlorhexidine.

MATERIALS AND METHODS

A total of fifty female children aged 8-12 years were included in the study. Twenty five children were randomly distributed to each group, i.e., the study group (coconut oil) and the control group (chlorhexidine). The participants were asked to routinely perform oil swishing with coconut oil and chlorhexidine and rinse every day in the morning after brushing for 2-3 minutes. S. mutans in saliva and plaque were determined using a chairside method, i.e., the Dentocult SM Strip Mutans test. Patients were instructed to continue oil swishing for 30 days. S. mutans. counts in plaque and saliva on day 1, day 15, and day 30 were recorded and the results were compared using Wilcoxon matched pairs signed ranks test.

RESULTS

The results showed that there is a statistically significant decrease in S. mutans. count from coconut oil as well as chlorhexidine group from baseline to 30 days. The study also showed that in comparison of coconut oil and chlorhexidine there is no statistically significant change regarding the antibacterial efficacy.

CONCLUSION

Coconut oil is as effective as chlorhexidine in the reduction of S. mutans.

Exogenous lipid pneumonia related to long-term use of Vicks VapoRub® by an adult patient: a case report

Background

Use of petroleum-based over the counter remedies such as Vicks VapoRub to alleviate symptoms of rhinitis is common and can be effective, but carries under-appreciated risks of adverse side effects. In this case report we highlight Exogenous Lipoid Pneumonia (ELP), an uncommon condition that results from accumulation of exogenous lipids in the alveoli, as an adverse side effect of long-term Vicks VapoRub use.

Case presentation

We present the case of an 85-year-old female patient with ELP apparently due to continuous application of Vicks VapoRub® to her nostrils to alleviate chronic rhinitis. She was diagnosed incidentally via chest radiograph and computed tomography (CT) scan done as follow up to finding elevated C-reactive Protein during a routine exam. The CT scan revealed a pulmonary consolidation in the lower lobe of the right lung with fat density combined with low density areas associated with focal ground-glass opacities. The patient was advised to discontinue use of petroleum-based products, and was prescribed intranasal corticosteroids for her rhinitis. Follow up 2 years later showed that the lipid consolidation had diminished in size by approximately 10 %.

Conclusion

Physicians must be aware that ELP can develop as a result of long-term application of petroleum-based oils and ointments to the nose and discourage such use of these products. Patients who have used petroleum-based products in this way should be screened for ELP. CT scan is the best imaging modality for establishing the diagnosis. The treatment of this condition is not well defined, but, as shown in this case, the size of the lipid mass can decrease after use of petroleum based substances is discontinued.

Electronic supplementary material

The online version of this article (doi:10.1186/s12901-016-0032-6) contains supplementary material, which is available to authorized users.

Oil pulling for maintaining oral hygiene - A review

Oil pulling is a traditional folk remedy practiced in ancient India. It is believed to cure more than thirty systemic diseases when practiced regularly and as directed. Due to occurrence of side effects to modern medicines and oral hygiene products, people are increasingly attracted towards complementary and traditional practices. Oil pulling in addition to offering several oral health benefits has also beneficial effects on overall health. The present article attempts to review and discuss this ancient practice.

Effect of oil pulling in promoting oro dental hygiene: A systematic review of randomized clinical trials

AIM

To critically appraise and evaluate the evidence from randomized clinical trials (RCTs) examining the effectiveness of oil pulling on oro dental hygiene.

METHODS

We conducted electronic searches in Medline, Embase, Amed, The Cochrane Library and Cinahl databases from inception to February 2015, and assessed reporting quality using the Cochrane risk of bias criteria. We included RCTs that compared oil pulling using conventional cooking oils with a control intervention. Our primary outcomes were measures of oro dental hygiene using validated scales.

RESULTS

Electronic searches yielded 26 eligible studies, of which five RCTs comprising a total of 160 participants were included. The studies varied in reporting quality, lasted between 10 and 45 days, and compared oil pulling with chlorhexidine, placebo or routine dental hygiene practice. Three studies reported no significant differences in post intervention plaque index scores between oil pulling and control groups (Chlorhexidine mouthwash +/- Placebo): p=0.28, 0.94, and 0.38, respectively. Two studies reported no significant difference in post-intervention modified gingival index score between oil pulling and Chlorhexidine mouthwash groups (p=0.32 and 0.64).

CONCLUSION

The limited evidence to date from clinical trials suggests that oil pulling may have beneficial effects on oro dental hygiene as seen for the short period of time investigated. Given that this is a potentially cost-effective intervention, this practice might be of particular benefit. Future clinical trials should be more rigorous and better reported.

A severe case of acute exogenous lipoid pneumonia treated with systemic corticosteroid

Acute exogenous lipoid pneumonia is a rare disorder in adults. A treatment of choice for lipoid pneumonia has not been established, and systemic corticosteroid use remains controversial. We report the case of a 32-year-old man with schizophrenia who presented with kerosene-induced acute exogenous lipoid pneumonia that was treated with a systemic corticosteroid. In this case, supportive therapy did not improve the patient's condition, so systemic corticosteroid therapy was commenced four days after he ingested the kerosene. After corticosteroid commencement, the patient's symptoms and hypoxia improved within a few days. Although some radiological characteristics of this disorder have been reported previously, the process of radiological improvement of exogenous lipoid pneumonia is not well known. In this case, computed tomography findings changed dramatically after corticosteroid therapy was initiated. Extensive bilateral consolidations that were observed on admission improved. Although pneumatoceles developed two weeks after corticosteroid commencement, they were nearly gone after two months of the treatment. While corticosteroid therapy is not suitable for all cases, it should be considered for severe or refractory cases.