Morphologic Mapping of the Sublingual Microcirculation in Healthy Volunteers

PURPOSE

Monitoring the sublingual and oral microcirculation (SM-OM) using hand-held vital microscopes (HVMs) has provided valuable insight into the (patho)physiology of diseases. However, the microvascular anatomy in a healthy population has not been adequately described yet.

METHODS

Incident dark field-based HVM imaging was used to visualize the SM-OM. First, the SM was divided into four different fields; Field-a (between incisors-lingua), Field-b (between the canine-first premolar-lingua), Field-c (between the first-second premolar-lingua), Field-d (between the second molar-wisdom teeth-lingua). Second, we investigated the buccal area, lower and upper lip. Total/functional vessel density (TVD/FCD), focus depth (FD), small vessel mean diameters (SVMDs), and capillary tortuosity score (CTS) were compared between the areas.

RESULTS

Fifteen volunteers with a mean age of 29 ± 6 years were enrolled. No statistical difference was found between the sublingual fields in terms of TVD (p = 0.30), FCD (p = 0.38), and FD (p = 0.09). SVMD was similar in Field-a, Field-b, and Field-c (p = 0.20-0.30), and larger in Field-d (p < 0.01, p = 0.015). The CTS of the buccal area was higher than in the lips.

CONCLUSION

The sublingual area has a homogenous distribution in TVD, FCD, FD, and SVMD. This study can be a description of the normal microvascular anatomy for future researches regarding microcirculatory assessment.

Clinical Outcomes and Independent Risk Factors for 90-Day Mortality in Critically Ill Patients with Respiratory Failure Infected with SARS-CoV-2: A Multicenter Study in Turkish Intensive Care Units

Background:

There are limited data on the long-term outcomes of COVID-19 from different parts of the world.

Aims:

To determine risk factors of 90-day mortality in critically ill patients in Turkish intensive care units (ICUs), with respiratory failure.

Study design:

Retrospective, observational cohort.

Methods:

Patients with laboratory-confirmed COVID-19 and who had been followed up in the ICUs with respiratory failure for more than 24 hours were included in the study. Their demographics, clinical characteristics, laboratory variables, treatment protocols, and survival data were recorded.

Results:

A total of 421 patients were included. The median age was 67 (IQR: 57-76) years, and 251 patients (59.6%) were men. The 90-day mortality rate was 55.1%. The factors independently associated with 90-day mortality were invasive mechanical ventilation (IMV) (HR 4.09 [95% CI: [2.20-7.63], P < .001), lactate level >2 mmol/L (2.78 [1.93-4.01], P < .001), age ≥60 years (2.45 [1.48-4.06)], P < .001), cardiac arrhythmia during ICU stay (2.01 [1.27-3.20], P = .003), vasopressor treatment (1.94 [1.32-2.84], P = .001), positive fluid balance of ≥600 mL/day (1.68 [1.21-2.34], P = .002), PaO₂/FiO₂ ratio of ≤150 mmHg (1.66 [1.18-2.32], P = .003), and ECOG score ≥1 (1.42 [1.00-2.02], P = .050).

Conclusion:

Long-term mortality was high in critically ill patients with COVID-19 hospitalized in intensive care units in Turkey. Invasive mechanical ventilation, lactate level, age, cardiac arrhythmia, vasopressor therapy, positive fluid balance, severe hypoxemia and ECOG score were the independent risk factors for 90-day mortality.

Hemophagocytic lymphohistiocytosis after certolizumab treatment in a patient with rheumatoid arthritis

Hemophagocytic lymphohistiocytosis (HLH) is a rare and life-threatening syndrome that may be triggered by hereditary factors, autoimmune and immunologic disorders, infectious diseases, malignancies and medications. Suspicion of the disease and early treatment is of paramount importance. Since the presentation of HLH with only skin involvement is rare, early diagnosis may be difficult. A pathologically confirmed HLH case that presented with maculopapular skin lesions after certolizumab treatment is being reported in this presentation.

Lumbar spinal chondroma presenting with radiculopathy: case report

Chondroma is a very unusual cartilagenous neoplasm of the spine. Here we are present a case of spinal chondroma with radiculopathy. A 54-year-old female patient consulted with progressive low back pain and left femoral numbness. Lumbar spinal Magnetic resonance (MR) imaging studies showed an extradural mass lesion in the left L2 body. Computerized tomography (CT) did not reveal any osteolytic lesion of the bone. The mass lesion was excised totally by left partial hemilaminectomy and the intradural compartment was also checked. The histopathology of the lesion was confirmed as chondroma. Preoperative evaluation and meticulous pathological analysis are required because of the malignant transformation potential of these rare pathologies.

Rosai Dorfman disease of the parotid and submandibular glands: salivary gland scintigraphy and oral findings in two siblings

Rosai-Dorfman disease (RDD) is an unusual clinical entity characterized by benign pseudolymphomatous proliferation with significant histiocytic infiltration. In the present paper, extranodal RDD of the major salivary glands causing salivary hypofunction and the results of salivary gland scintigraphy and ultrasound are presented in two siblings. Case 1: a 10-year-old boy with bilateral painless masses around the parotid and submandibular glands was referred. Ultrasound examination showed bilateral, well-defined, hypoechoic solid mass lesions within both parotid glands with minimal normal parenchyma in the upper poles. Both submandibular glands were markedly hypoechoic and heterogeneous. Mass lesions within the parotid glands appeared as cold lesions with regular contours on scintigraphy. Dynamic images showed normal uptake and normal response to secretion in the upper poles of the parotid glands, corresponding with ultrasonographically normal parenchyma. Both submandibular glands showed markedly diminished uptake and secretion. Case 2: a 9-year-old boy presented with mass lesions around the submandibular glands. Ultrasound examination showed normal parotid glands and markedly hypoechoic and heterogeneous submandibular glands. Salivary gland scintigraphy showed normal uptake and secretion of parotid glands with markedly diminished uptake and secretion in both submandibular glands. There were severe carious lesions in both patients due to salivary hypofunction. Treatments of the two patients' teeth were performed. Major salivary gland involvement of RDD is important for dentists as it may cause xerostomia and can mimic dental abscess. Functional evaluation of salivary glands with scintigraphy, besides radiological and pathological techniques, will help to explain whether salivary glands are affected or not and improve the diagnostic effectiveness.

The influence of GSTM1 null genotype on susceptibility to in vitro oxidative stress

From epidemiological studies, there is some evidence that genetic variation at the glutathione S-transferase (GST) loci GSTM1 influences individual susceptibility to disease associated with oxidative stress. The aim of this study was to elucidate the role of the GSTM1 genotype in protection against oxidant chemicals by comparing the sensitivity, genotoxicity and cytotoxicity of lymphocytes to benzo(a)pyrene (BaP)- and cumene hydroperoxide (CumOOH)-induced in vitro oxidative challenge. Malondialdehyde and protein carbonyl levels, and oxidation of 2',7'-dichlorofluorescin diacetate were used as biomarkers of oxidative stress in lymphocytes. Following supplementation with BaP or CumOOH, time-dependent increases were observed in the production of all the markers after incubation for 12-48 h. However, we could not find any differences between GSTM1 null and positive genotypes. Furthermore, dose or time response experiments indicated that GSTM1-deficient cells were not more sensitive than control cells to BaP-or CumOOH-induced cell killing and micronucleus formation, although they were hypersensitive to BaP-inhibited cellular growth. The results suggest that lymphocytes from individuals with the GSTM1 null genotype are not abnormally susceptible to in vitro induced oxidant challenge, when exposed to CumOOH.