Mitocurcumin (a triphenylphosphonium curcumin derivative) was previously reported as a selective antitumoral compound on different cellular lines, as well as a potent bactericidal candidate. In this study, the same compound showed strong antimicrobial efficacy against different strains of methicillin-resistant Staphylococcus aureus (MRSA). The minimum inhibitory concentration was identical for all tested strains (four strains of MRSA and one strain of methicillin-sensitive Staphylococcus aureus), suggesting a new mechanism of action compared with usual antibacterial agents. All tested strains showed a significant sensitivity in the low micromolar range for the curcumin-triphenylphosphonium derivative. This susceptibility was modulated by the menadione/glutathione addition (the addition of glutathione resulted in a significant increase in minimal inhibitory concentration from 1.95 to 3.9 uM, whereas adding menadione resulted in a decrease of 0.49 uM). The fluorescence microscopy showed a better intrabacterial accumulation for the new curcumin-triphenylphosphonium derivative compared with simple curcumin. The MitoTracker staining showed an accumulation of reactive oxygen species (ROS) for a S. pombe superoxide dismutase deleted model. All results suggest a new mechanism of action which is not influenced by the acquired resistance of MRSA. The most plausible mechanism is reactive oxygen species (ROS) overproduction after a massive intracellular accumulation of the curcumin-triphenylphosphonium derivative.

Orbital apex syndrome (OAS) can be a rare, but severe complication of an odontogenic infection and has high morbidity and mortality. Antibacterial drugs are typically an appropriate treatment choice, but the most severe cases are fungal in nature and pose a tough challenge to the clinician. The aim of this study was to determine the predisposing factors, specific aspects in its management and the appropriate treatment strategy in order to improve patient outcome. A systematic review was conducted using PubMed, PubMed Central, Web of Science, and Scopus up to February 2020, based on the associations between dental extraction or infections and OAS. Of 721 papers found, 18 articles were considered eligible and presented in total 21 cases (13 fungal and eight bacterial infections). The information was organized into a diagnostic and treatment algorithm which included data extracted both from the included cases and updated literature of treatment efficacy studies. Immunosuppression (uncontrolled diabetes mellitus and chemotherapy) was found as an important predisposing factor particularly for fungal infections. In these cases, we suggest that early simultaneous approaches, including aggressive surgical procedures and systemic administration of amphotericin B, result in a better outcome. In conclusion, medical intervention success depends on aggressive treatment and multidisciplinary teamwork.

Background: Peptic ulcer disease (PUD) affects 1-2 per 1000 people annually in the USA, the UK and Europe, and occurs less frequently in children than in adults. PUD in children occurs mainly during the second decade of development. Among risk factors, nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used to manage acute febrile illness or pain in healthy children, is rarely reported to lead to PUD and upper gastrointestinal bleeding. Case presentation: We present a rare case of upper gastrointestinal bleeding following a low dose ibuprofen treatment in a 3-year-old female. The patient with a family history of peptic ulcer was admitted for fever, coffee-ground vomiting and abdominal pain. The clinical examination revealed an altered general health status with a distended and mildly tender abdomen moving normally with respiration as well as normal stool. The initial laboratory test indicated anemia with reticulocytosis. During the first hours of hospitalization, the patient had a second episode of coffee-ground vomiting. An upper digestive endoscopy with biopsy was performed in the following six hours revealing a non-bleeding gastric ulcer at 2 cm from pylorus. Helicobacter pylori testing was negative. The patient was treated with a proton pump inhibitor (esomeprazole 10 mg/day) for 2 months. There were no further gastrointestinal symptoms and hemoglobin values returned to normal, indicating resolution of her gastrointestinal bleeding. Conclusion: The short-term utilization of NSAIDs in the appropriate dosage can lead to PUD, and considering the risk factors before administration can lead to an appropriate management.

Background: Peptic ulcer disease (PUD) affects 1-2 per 1000 people annually in the USA, the UK and Europe, and occurs less frequently in children than in adults. PUD in children occurs mainly during the second decade of development. Among risk factors, nonsteroidal anti-inflammatory drugs (NSAIDs), commonly used to manage acute febrile illness or pain in healthy children, is rarely reported to lead to PUD and upper gastrointestinal bleeding. Case presentation: We present a rare case of upper gastrointestinal bleeding following a low dose ibuprofen treatment in a 3-year-old female. The patient with a family history of peptic ulcer was admitted for fever, coffee-ground vomiting and abdominal pain. The clinical examination revealed an altered general health status with a distended and mildly tender abdomen moving normally with respiration as well as normal stool. The initial laboratory test indicated anemia with reticulocytosis. During the first hours of hospitalization, the patient had a second episode of coffee-ground vomiting. An upper digestive endoscopy with biopsy was performed in the following six hours revealing a non-bleeding gastric ulcer at 2 cm from pylorus. Helicobacter pylori testing was negative. The patient was treated with a proton pump inhibitor (esomeprazole 10 mg/day) for 2 months. There were no further gastrointestinal symptoms, hemoglobin values returned to normal and the follow-up endoscopy confirmed the healing of the ulcer. Conclusion: The short-term utilization of NSAIDs in the appropriate dosage can lead to PUD, and considering the risk factors before administration can lead to an appropriate management.

Glaucoma is a leading cause of irreversible blindness worldwide. Among different types of glaucoma, irreversible bilateral visual impairment is more common in primary angle closure glaucoma (PACG) patients. PACG and cataract often coexist and are both more prevalent among the elderly population, being rare in children and young adults. Here, we discuss the case of a 39-year-old Caucasian woman with unilateral PACG associated with cataract. The patient presented with a several-day history of left sided headache, decreased and blurred vision as well as pain and redness of the left eye (LE). She reported similar episodes in the previous year. Visual acuity (VA) of the LE was limited to counting fingers and intra-ocular pressure (IOP) of the LE was 42 mmHg. Anterior segment examination of the LE revealed: edematous cornea, a peripheral anterior chamber depth corresponding to Van Herick’s grade 0, mid-dilated pupil and lens opacities with visible glaukomflecken. Gonioscopic evaluation revealed iridotrabecular contact for 360º, no visible angle structures and a flat–mild convex iris contour. Spectral domain optical coherence tomography suggested only a thinning of neuro-retinal rim at the lower pole. Following treatment of the initial symptoms, phacoemulsification with intra-ocular lens implant was performed. IOP improved and no IOP-lowering medication was required. The patient was monitored for VA, IOP, field of vision changes, and optic disc evaluation every six months for 2 years and no glaucomatous change occurred. The patient also denied ocular symptoms during this period. This case supports the effectiveness of early phacoemulsification in the IOP control in patients with PACG.