Esophagus thermal injury is a rare case that can be easily overlooked by practitioners. We herein present a case of thermally induced diffuse corrosive esophagitis with complaints of dysphagia and retrosternal chest pain after having steamed pork. A thorough disease course was demonstrated by serials of endoscopy images and video. A comprehensive review of articles and a concise overview of esophageal thermal injury clinical manifestation, disease process, typical endoscopy features, pharmacomanagement option, and outcomes will be conducted in this article.

/pdf/extensive-causative-esophagitis-caused-by-thermal-injury-a-p71zxhh406.pdf

Extensive Causative Esophagitis Caused by Thermal Injury: A Case Report and Review of the Literature

Introduction: Alcohol use disorder has a chronic relapsing course. Various biological, psychological, environmental, and psychosocial factors play a major role in maintaining abstinence and determining relapse in patients. The COVID-19 pandemic has caused significant changes in every person's life. It is important to assess how this situation has determined alcohol use in the patients who had utilized deaddiction services in the past. Aim: The aim of this study is to assess the pattern of alcohol use, perceived stress, and quality of life (QOL) during COVID-19 in patients who had utilized deaddiction services for alcohol use disorder in the preceding 1 year. Materials and Methods: A cross-sectional design was employed in the study. After obtaining consent, telephonic interviewing of patients who had utilized deaddiction services during January–December 2019 was done, and questionnaires including sociodemographic details, Severity of Alcohol Dependence Questionnaire, Brief Substance Craving Scale, Perceived Stress Scale-10, and WHOQOL-BREF scale were administered to assess the pattern of alcohol use, stress levels, and QOL. Comparisons were carried out on different variables using SPSS version 20. Results: A total of 122 patients were inducted into the study. About 70.5% of the relapsed individuals belonged to joint families. There was a significant association between the poor QOL and relapse status of the individuals. High levels of stress were reported among the individuals who have relapsed compared to nonrelapsed individuals. Conclusion: High rates of relapse and higher stress levels were found in our study. This study has helped us to understand the pattern of alcohol use in individuals during this pandemic. It is important to address the factors contributing to relapse in individuals so as to focus on developing and implementing feasible and accessible interventions to help the individuals.

Impact of Covid-19 pandemic on quality of life in persons with alcohol use disorder - A cross-sectional study

Alcoholic liver disease (ALD) is a globally prevalent chronic liver disease caused by chronic or binge consumption of alcohol. The therapeutic efficiency of current therapies for ALD is limited, and there is no FDA-approved therapy for ALD at present. Various strategies targeting pathogenic events in the progression of ALD are being investigated in preclinical and clinical trials. Recently, mesenchymal stem cells (MSCs) have emerged as a promising candidate for ALD treatment and have been tested in several clinical trials. MSC-released factors have captured attention, as they have the same therapeutic function as MSCs. Herein, we focus on current therapeutic options, recently proposed strategies, and their limitations in ALD treatment. Also, we review the therapeutic effects of MSCs and those of MSC-related secretory factors on ALD. Although accumulating evidence suggests the therapeutic potential of MSCs and related factors in ALD, the mechanisms underlying their actions in ALD have not been well studied. Further investigations of the detailed mechanisms underlying the therapeutic role of MSCs in ALD are required to expand MSC therapies to clinical applications. This review provides information on current or possible treatments for ALD and contributes to our understanding of the development of effective and safe treatments for ALD.

/pdf/current-therapeutic-options-and-potential-of-mesenchymal-25mp2bz4.pdf

Current Therapeutic Options and Potential of Mesenchymal Stem Cell Therapy for Alcoholic Liver Disease

Infectious encephalitis is a rapidly progressive encephalopathy caused by a variety of pathogens, most commonly viruses. It is associated with significant mortality and morbidity, often requiring evaluation and treatment in the intensive care unit. This review article discusses the diagnosis of the infectious etiologies, the assessment for differential diagnoses, and the initiation of therapies, and most importantly, it entails the rapid and efficient management of the associated complications. Novel emerging technologies (e.g., metagenomic next-generation sequencing) have the potential to assist in the diagnosis, etiology identification, and treatment of encephalitis. Interventions such as ketogenic diet therapies have been promising in their potential to treat patients with refractory status epilepticus in the setting of infectious encephalitides. Early recognition of encephalitis and appropriate treatment of the primary infection and its complications are essential to increase survival and reduce sequelae. Intensivists are crucial given the high mortality rate of infectious encephalitis in the ICU setting, and their role may significantly impact patients’ outcomes.

/pdf/infectious-encephalitis-in-the-neurocritical-care-unit-39m3h7828a.pdf

Infectious Encephalitis in the Neurocritical Care Unit

Background: Relapse is an important but difficult phase of the management of alcohol dependence syndrome (ADS). Objective: To study the prevalence and characteristics of relapse in patients with ADS. Methods:This is a descriptive cross-sectional study on the patients with ADS presenting at the Department of Psychiatry, Patan Academy of Health Sciences, for the period of one year (June 2016 - May 2017). Data on the demographic and relapse characteristics were collected. Data were entered and analyzed in Microsoft Excel (MS Office 365, Microsoft Corporation, Washington, United States). Numerical variables were summarized with the median (Inter-Quartile Range [IQR]) and the categorical variables with proportions. Results: Altogether, 105 patients with ADS were studied, among which 59 patients had a relapse (56.1%). All of them were male with a median age of 42 years (Interquartile range (IQR) 35 to 52). The majority were married (55, 93.22%), manual labor as an occupation (32, 54.24%), were Janjati by ethnicity (37, 62.71%), and had received secondary education (19, 32.20%). The median age of starting alcohol consumption was 18 years (IQR 15 to 20) and the median duration of consumption was 22 years (IQR 15 to 30). The most common reason for relapse was peer pressure (25, 42.37%). The majority had relapsed once before (26, 44.07%). Mostly relapsed after abstinence of 1 to 3 months (22, 37.29%) and abstinence maintained by self-motivation (30, 50.85%). Comorbidity and family history of substance use was present in higher proportions. Conclusion: A high rate of relapse was found in our patients with peer pressure as the most common reason for the relapse. 

pdf/prevalence-and-characteristics-of-relapse-in-patients-with-39ri7r3p0q.pdf

Prevalence and characteristics of relapse in patients with Alcohol Dependence Syndrome

Introduction In patients with alcoholic liver disease, abstinence from alcohol is an important aspect of treatment. Once abstinence is achieved, the challenge is to avoid relapse of alcohol use. This study aims to analyse the significant risk factors for alcohol relapse thereby identifying the patients with high risk for recidivism to have an early social and medical intervention. Methodology This was an observational and a retrospective type of study. Patients with chronic liver disease and had alcohol use relapse after abstinence were classified into Group A. Patients who did not have relapse after abstinence were classified into Group B. The two groups were compared for various social and personal and disease related factors. Student "t" test was used for raw data and Chi square test was used for consolidated data to find significant difference between variables. Results Overall nine factors were analysed. The factors which were found to be significant for predicting relapse are quantity of alcohol consumption per week, duration of abstinence, associated smoking, marital status, severity of liver disease (Child-Pugh scoring system). The other factors like age of starting alcohol consumption, duration of alcohol consumption, family history of alcohol intake and MELD score were not statistically significant. Conclusion This study identifies the risk factors associated with alcohol relapse in patients with alcoholic liver disease. The data from this study can be used to identify individuals who are high risk for relapse and treat them with pharmacological and psychosocial methods to prevent relapse.

Risk factors for alcohol use relapse after abstinence in patients with alcoholic liver disease.

An 11-year-old boy, first born of non consanguinous marriage and immunized according to national schedule along with one dose of MMR at 15 months of age, was admitted with complains of bilateral parotid swelling 2 weeks ago, associated with low grade fever that settled over next 5 days. Two days later, child developed headache with projectile vomiting and poor oral intake followed by one episode of generalized tonic clonic seizure and postictal vision loss. On examination, child had altered sensorium, bradycardia, hypertension, neck rigidity and papilledema. We suspected mumps meningoencephalitis with raised intracranial pressure; magnetic resonance imaging (MRI) of brain was suggestive of diffuse leptomeningeal enhancement with gyral swelling and subcortical white matter edema. Child was managed in intensive care unit with ventilation and medication to reduce intracranial pressure. Three days later, he developed gross hematuria. Urine examination was suggestive of proteinuria. C3 was low, ASO and ANA were negative, and IgM mumps was strongly positive.

Severe Complications of Mumps.

Candy Cane Appearance of the Esophagus Caused by Acute Thermal Injury

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Risk factors for alcohol use relapse after abstinence in patients with alcoholic liver disease.

Severe Complications of Mumps.

Candy Cane Appearance of the Esophagus Caused by Acute Thermal Injury