Hypothalamic-Pituitary-Adrenal axis activity in SARS-CoV-2 infected noncritically ill hospitalized patients / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#This study determined the baseline hormonal levels of the hypothalamic-pituitary-adrenal axis and their associated factors in noncritically ill hospitalized patients with coronavirus disease 2019 (COVID-19).@*Methodology@#This cross-sectional observational study was carried out in 91 noncritical RT-PCR-confirmed COVID-19 patients (18-65 years) recruited consecutively from the COVID unit, of two tertiary care hospitals over a period of six months. After screening for exclusion criteria relevant history and physical examinations were done, and blood was drawn between 07:00 am to 09:00 am in a fasting state to measure serum cortisol and plasma adrenocorticotropic hormone (ACTH) by chemiluminescent microparticle immunoassay.@*Result@#Of 91 patients, 54, 26, and 11 had mild, moderate, and severe disease respectively. Median values of serum cortisol (p=0.057) and plasma ACTH (p=0.910) were statistically similar among the severity groups. Considering cortisol cut-off of 276 nmol/L (<10 μg/dL), the highest percent of adrenal insufficiency was present in severe (27.3%), followed by mild (25.9%) and least in moderate (3.8%) COVID-19 cases. Using the cortisol/ACTH ratio >15, only 6.6% had enough reserve.@*Conclusions@#The adrenocortical response was compromised in a significant percentage of noncritically ill hospitalized patients with COVID-19, which is unrelated to infection severity, with greater percentages present in severely infected cases.

Preemptive pregabalin for postoperative analgesia during minimally invasive hysterectomy: a systematic review and meta-analysis of randomized controlled trials

We aimed to perform a systematic review and meta-analysis of all randomized placebo-controlled trials (RCTs) that examined the analgesic benefits of preemptive pregabalin among patients undergoing minimally invasive hysterectomy. Five major databases were systematically screened from inception until August 29, 2021 Relevant studies were evaluated for risk of bias. Endpoints were analyzed using the random-effects model and pooled as the mean difference or risk ratio with a 95% confidence interval. Four studies with seven treatment arms met the inclusion criteria. The total sample size was 304 patients: 193 and 111 patients were allocated to the pregabalin and placebo groups, respectively. Overall, the included studies revealed a low risk of bias. The summary results revealed that the mean postoperative pain scores at rest were significantly lower in the pregabalin group than in the control group at 0, 2, 4, 6, 12, and 24 hours. Moreover, the mean postoperative pain scores on movement/coughing were significantly lower in the pregabalin group than in the control group at 12 and 24 hours. The rate of patients who were opioid-free postoperatively was significantly higher in the pregabalin group than in the control group. There was no significant difference between the groups in terms of the mean postoperative time to first rescue analgesic and the rates of adverse events. Compared with placebo, preemptive pregabalin was largely safe, and was correlated with superior analgesic effects in terms of lower postoperative pain scores and higher opioid-sparing effects. Additional RCTs are needed to confirm these findings.

Familial Clustering of Nonalcoholic Fatty Liver Disease in Family Members of Nonalcoholic Steatohepatitis Cirrhotic Patients

Background and Aim: Non-alcoholic fatty liver disease (NAFLD) is a multifactorial disorder with combination of environmental, genetic and metabolic factors that play role in the progression of disease. This study is aimed to explore the familial clustering of NAFLD among the family members of NASH cirrhotic patients and the association of insulin resistance, metabolic syndrome and genetic polymorphism with the familial clustering. Methods: This cross-sectional observational study included 50 NASH cirrhosis patient and 81 1st degree relatives. Family members were screened for fatty liver by ultrasonogram. Insulin resistance, metabolic syndrome, PNPLA3 and staging of liver stiffness by fibroscan were done. Results: Among 81 family members 47 (58.02%) were found having fatty liver. Of these 14(17.28%) had significant fibrosis. PNPLA3 polymorphism was higher (80.85%) in fatty liver group than (55.9%) without fatty liver groups. Sons (57.89%) and daughters (51.6%) were affected by fatty liver equally. Multivariate logistic regression analysis revealed that a subject with TG>150 mg/dl had 6.159 times increase in odds having NAFLD. A subject with PNPLA3 polymorphism had 3.33 times increase in odds having NAFLD. A subject with HOMA-IR >1.6 had 4.375 times increase in odds having NAFLD. Conclusion: This study indicates that there is a strong familial clustering of NAFLD along with significant fibrosis among the family members of NASH cirrhosis patients. This findings warrants screening for NAFLD among the family members of NASH cirrhosis patients especially with PNPLA3 polymorphism.

In-silico characterization and structure-based functional annotation of a hypothetical protein from Campylobacter jejuni involved in propionate catabolism

Campylobacter jejuni is one of the most prevalent organisms associated with foodborne illness across the globe causing campylobacteriosis and gastritis. Many proteins of C. jejuni are still unidentified. The purpose of this study was to determine the structure and function of a non-annotated hypothetical protein (HP) from C. jejuni. A number of properties like physiochemical characteristics, 3D structure, and functional annotation of the HP (accession No. CAG2129885.1) were predicted using various bioinformatics tools followed by further validation and quality assessment. Moreover, the protein-protein interactions and active site were obtained from the STRING and CASTp server, respectively. The hypothesized protein possesses various characteristics including an acidic pH, thermal stability, water solubility, and cytoplasmic distribution. While alpha-helix and random coil structures are the most prominent structural components of this protein, most of it is formed of helices and coils. Along with expected quality, the 3D model has been found to be novel. This study has identified the potential role of the HP in 2-methylcitric acid cycle and propionate catabolism. Furthermore, protein-protein interactions revealed several significant functional partners. The in-silico characterization of this protein will assist to understand its molecular mechanism of action better. The methodology of this study would also serve as the basis for additional research into proteomic and genomic data for functional potential identification.

17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that investigated the clinical benefits of 17-alpha hydroxyprogesterone caproate (17OHPC) in the prevention of recurrent preterm birth (PTB) among singleton pregnant women with a previous history of PTB. We searched four major databases up till April 2021 and assessed the risk of bias in the included studies. We meta-analyzed various maternal-neonatal endpoints (n=18) and pooled them as mean difference or risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Six RCTs met the inclusion criteria, comprising 2,573 patients (17OHPC=1,617, control=956). RCTs revealed an overall low risk of bias. The rates of PTB <35 weeks (n=5 RCTs; RR, 0.77; 95% CI, 0.63-0.93; P=0.008), PTB <32 weeks (n=3 RCTs; RR, 0.68; 95% CI, 0.51-0.91; P=0.009), neonates with low birth weight (<2.5 kg) at delivery (n=3 RCTs; RR, 0.63; 95% CI, 0.5-0.79; P<0.001), and neonatal death (n=4 RCTs; RR, 0.41; 95% CI, 0.20-0.84; P=0.02) were significantly reduced in the 17OHPC group compared with the control group. Moreover, 17OHPC treatment correlated with a significantly decreased rate of retinopathy (n=2 RCTs; RR, 0.42; 95% CI, 0.18-0.97; P=0.004). However, there were no significant differences in the rates of neonatal intensive care unit admission, cesarean delivery, and other pretermrelated complications between both the groups. Among singleton pregnant women with a prior history of PTB, 17OHPC may favorably decrease the risks of recurrent PTB and reduce the rate of neonatal death.

Highlights on selected microscopy techniques to study zebrafish developmental biology / 한국실험동물학회지

Bio-imaging is a tedious task when it concerns exploring cell functions, developmental mechanisms, and other vital processes in vivo. Single-cell resolution is challenging due to different issues such as sample size, the scattering of intact and opaque tissue, pigmentation in untreated animals, the movement of living organs, and maintaining the sample under physiological conditions. These factors might lead researchers to implement microscopy techniques with a suitable animal model to mimic the nature of the living cells.Zebrafish acquired its prestigious reputation in the biomedical research field due to its transparency under advanced microscopes. Therefore, various microscopy techniques, including Multi-Photon, Light-Sheet Microscopy, and Second Harmonic Generation, simplify the discovery of different types of internal functions in zebrafish. In this review, we briefly discuss three recent microscopy techniques that are being utilized because they are non-invasive in investigating developmental events in zebrafish embryo and larvae.

Effect of Vitamin D, Calcium and Multiple Micronutrients Supplementation on Lipid Profile in Pre-menopausal Bangladeshi Garment Factory Workers with Hypovitaminosis D.

Elevated total cholesterol and low-density lipoprotein cholesterol in sera are both well-known risk factors of coronary heart disease. Adequate vitamin D status is important for optimal function of many organs and tissues of our body. There is continuing controversy about the effect of adequate vitamin D consumption on serum lipids and lipoproteins. The present study assessed the effect of vitamin D, calcium and multiple micronutrients supplementation on the lipid profile in Bangladeshi young female garment factory workers who have hypovitaminosis D. This placebo-controlled intervention trial conducted over a period of one year randomly assigned a total of 200 apparently healthy subjects aged 16-36 years to 4 groups. The subjects received daily supplements of 400 IU of vitamin D (VD group) or 400 IU of vitamin D+600 mg of calcium lactate (VD-Ca group), or multiple micronutrients with 400 IU of vitamin-D+600 mg of calcium lactate (MMN-VD-Ca group), or the group consuming placebo (PL group). Serum concentrations of lipid and lipoprotein, 25-hydroxyvitamin D (25OHD) and intact parathyroid hormone (iPTH) were measured at baseline and after one year of follow-up. No significant changes in the serum levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), LDL-C/HDL-C ratio were observed in the supplemented groups compared to the placebo group. Supplementation had a positive effect (p<0.05) on very low-density lipoprotein cholesterol (VLDL-C) and triacylglycerol (TAG). A negative correlation between changes in serum iPTH and HDL-C was observed, which indicated that subjects with the greatest decline in S-iPTH had the greatest increase in HDL-C. The results suggest that consumption of adequate vitamin D with calcium or MMN for one-year may have no impact on serum lipid profile in the subjects studied. Longer-term clinical trials with different doses of supplemental vitamin D are warranted in evaluating the effect of intervention.

Incidence of malignant ovarian germ cell tumors [MOGCTs] in Saudi Arabia

Incidence of malignant ovarian germ cell tumors [MOGCTs] in the Saudi Arabian population has not been studied before. Therefore, the primary objective of this study was to define the population-based incidence rates and histopathological types of MOGCTs in the Saudi Arabian population from 1999 to 2008. Our study showed that MOGCTs are a common type of ovarian tumors in the Saudi Arabian population, and the incidence rates and histopathological types are relatively comparable to the international populations with few differences.

Application of pulsed field gel electrophoresis and ribotyping as genotypic methods versus phenotypic methods for typing of nosocomial infections caused by pseudomonas aeruginosa isolated from surgical wards in suez canal university hospital

Background: Pseudomonas aeruginosa is an opportunistic pathogen causing nosocomial infections in many hospitals. The aim of this study was to compare the different epidemiological typing techniques and their effectiveness in typing and discrimination of nosocomial Pseudomonas aeroginosa isolates

Methods: Seventy eight confirmed nosocomial Pseudomonus aeroginosa out of 1520 different sample [nosocomial infections and environmental samples] were collected during a period of one year. Six typing methods were evaluated, utilizing the confirmed 78 Pseudomonas strains, to assess their usefulness as tools to study the bacterial diversity. The methods used were antibiogram, pyocin typing, serotyping, extracellular enzyme typing, automated ribotyping and pulsed field gel electrophoresis [PFGE

Results: The distinctive capacity of four phenotyping methods was determined and compared to PFGE. Resistance to the antibiotics tested was in the 37.2% to 98.7% range; Imipenem was the most effective, whereas augmentin, carbenicillin and ceftazidime were the least effective antibiotics. Antibiogram for 78 isolates discriminate 13 different patterns

Pulsed field gel electrophoresis yielded 56 distinct types of P.aeruginosa with 100% distinction capacity [78/78] as all the strains were typable. Compared to PFGE, the distinctive capacities were 88.5% [69/78] for serotyping, 91% [71/78] for Pyocin typing and 100% [78/78] for automated ribotyping analysis. The results obtained in PFGE, were the easiest to read and interpret and most discriminating [0.99], followed by the pyocin typing [0.96], whereas ribotyping had [0.90] discriminatory power

Conclusion: Our results indicated that P.aeruginosa infections in Suez Canal University Hospital, mainly affect the hospitalized patients in orthopedic wards, surgical wards and burn units and played a great role in hospital associated infections. Imipenem was the best antibiotic as far as bacterial resistance is considered. Although, the lack of major PFGE type confirmed that no P.aeruginosa outbreak, typing results showed that PFGE was the best used typing method regarding high typability, sensitivity and discriminatory power. The used typing methods showed that cross transmission and treatment failure were the two main problems for spread of nosocomial infections inside surgical wards and should be considered to prevent this bacterial infection in medical units

Role of serum eosinophil cationic protein as a biological marker to assess the severity of bronchial asthma

The study was carried out to evaluate the role of serum eosinophil cationic protein [ECP] as a biological marker for the diagnosis and to assess the severity of bronchial asthma. This observational cross-sectional study was conducted among 70 bronchial asthma patients and 45 disease controls [tuberculosis-15, chronic obstructive pulmonary disease-15, interstitial lung disease-15] enrolled from patients attending the outpatient department of the National Institute of Disease of the Chest and Hospital [NIDCH], Dhaka, Bangladesh during July 2010 to June 2011. Global Initiative of Asthma Management and Prevention [GINA] criteria were followed for selection of both atopic and non-atopic patients with intermittent or persistent [mild, moderate and severe] asthma. Serum level of eosinophil cationic protein [ECP], IgE, forced expiratory volume in 1 second [FEV[1]% predicted] and circulatory eosinophil [CE] count were estimated. Mean serum ECP level [28.8 +/- 42.9 vs. 6.82 +/- 3.5 ng/mL; P < 0.001], IgE level [383.59 +/- 225.3 vs. 135 +/- 131.8 IU/mL; P < 0.001] and percent circulatory eosinophil count [9.95 +/- 3.7 vs. 5.95 +/- 1.4; P < 0.024] were all found significantly raised among asthma patients than disease controls but%FEV[1] was equivocal. All grades of persistent asthma patients had significantly [P < 0.025 and P < 0.002] higher mean ECP level than intermittent cases but serum IgE level and CE count did not differ significantly. FEV[1]% predicted correlated well among moderate and severe persistent asthma but was equivocal for intermittent and mild persistent cases. This study has reinforced that serum eosinophil cationic protein is a dependable biological marker with more discriminatory power over other indicators for bronchial asthma and to assess its severity

Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses

To report factors predicting the visual outcome and complications in eyes that underwent pars plana vitrectomy [PPV] to manage dislocated intraocular lenses [IOLs]. A retrospective chart review was performed. Clinical data recorded from the patient charts include, demographic, preoperative, intraoperative, and postoperative, with emphasis on visual acuity, interval between IOL dislocation and pars plana vitrectomy, surgical method and complications. Patients with follow-up of less than three months were excluded. Ninety-four patients were identified, 63 males and 31 females. Age ranged from 2 to 85years [mean 52.6]. The range of follow-up was 3 to 108 months [mean +/- SD 19.4 +/- 17.4months]. The final visual acuity was 20/50 or better in 52 [55.3%] eyes. Our analysis indicated that visual rehabilitation with IOL was significantly associated with better visual acuity as compared with eyes that were left aphakic [P=0.0092]. There was a trend toward a better visual outcome when PPV was performed within two weeks from the diagnosis of the dislocated IOL which was associated with good visual outcome [20/200 or better] in 85.7% of eyes compared with 78.8% of eyes. Management of IOL by interofixation was associated in [90.0%] of eyes with good vision [20/200 or better] compared to 76.1% eyes that had exchange of IOL through the limbus. Postoperative complications include cystoid macular edema in 9 [9.6%], glaucoma in 9 [9.6%], bullous keratopathy in 8 [8.5%], retinal detachments in 6 [6.4%] eyes, and relapsing uveitis in 2 [2%]. In this series, the final visual outcomes were improved and the rate of postoperative complications were low. Eyes that were pseudophakic had significantly good visual outcome compared with eyes that were left aphakic. To the best of our knowledge, this may be the largest study on dislocated IOL removal by PPV with good visual results compared to other studies

Effects of rabeprazole on the pulmonary functions in patients with GERD related asthma

The association between gastroesophageal reflux disease [GERD] and Bronchial asthma has been extensively studied

The Aim of this study was to evaluate the effect of treatment of GERD with rabeprazole, a proton pump inhibitor [PPI] once daily on the pulmonaiy functions in patients with GERD related bronchial asthma

Methods: twenty eight patients [18 males and 10 females] [age range : 18-66 years] with bronchial asthma and history of chronic heartburn and abnormal esophageal acid exposure [by pH monitoring] were evaluated by clinical history and examination in addition to ventillatory functions then were classified into two groups [A] included 14 patients put on rabebrazole once daily for six weeks and their medications of asthma. Group [B] included 14 patients kept on their medications of asthma without treatment of GERD except on demand therapy as antacids. All patients reevaluated by pH monitoring and ventillatory functions after treatment

Results: the results of pH monitoring revealed normalization of esophageal acid exposure in 12 [86%] and 10 [71%] of patients after treatment in upright and supine positions respectively in group A while no significant change in group B. The esophageal acid clearance time improved from [2.2 minutes] before treatment to [1.1 minutes] after treatment in group [A].with no change in group [B]. Regarding pulmonary functions we found a significant improvement in · the mean values for VC, VC%, FVC, FVC%, FEV[1], FEV[1]%, PEF, PEF%, in group [A] with no change in group [B]

Conclusion: there is significant improvement in the esophageal acid exposure and pulmonary functions in patients with GERD related bronchial asthma after treatment of GERD with rabeprazole as a new proton pump inhibitor

Cost analysis of tuberculosis directly observed treatment strategy at chest dispensaries in Egypt

Background: The study aimed to help the National Tuberculosis Control Program in promotion of DOTS strategy in Egypt. The specific objectives were to calculate the annual costs per TB case treated and TB case cured at the chest dispensary service delivery mode

Materials and Methods: The study was conducted in El-Dakahlia governorate at 5 chest dispensaries and the crosssectional analytic research design was utilized to investigate the current research issue. As a prerequisite for the proper research design a survey of literature has been carried out and covered the various methodological approaches of epidemiological and health economics investigations. Also, an exploratory study was carried out during the research-planning phase. Four different types of data collection instruments were used [Clients' Flow, Capital, Recurrent, and Outcome Questionnaires] to collect the required data

Results: Analysis of data revealed that the annual costs per treated TB case and cured TB case were LE 157 +/- 150 and 198 +/- 190 respectively

Conclusion: The study concluded that the implementation of DOTS strategy required more resources than the routinely managed chest cases at the studied units. Recurrent cost was the most important element in the calculation of the final cost per outcome ratios especially those of drugs and chemicals followed by the annualized capital and personnel costs. We recommended the decision makers to conduct more studies at the different geographical areas and service delivery modes to get the full picture of DOTS strategy implementation in Egypt for future development and improvement

Adult intussusception: a clinical problem. How can CT scan solve it?

Abdominal CT scans in 11 adult in tussusceptions were analyzed. Patients were 8 males and 3 females. Their ages ranged from 18-53 years [mean age: 31.5 years]. All were clinically unsuspected and all were confirmed at surgery. In 9 of our 11 patients, there was organic lesion [benign or malignant tumor] while in 2 patients no cause was found at surgery and thus they were considered idiopathic. The surgical management in our cases involved 7 cases of right hemicolectomy, 2 cases of resection anastomosis and 2 cases of reduction and fixation. One of our cases was jejunoileal intussusception, two were ileoileal, 4 were ileocolic and 3 were colocolic. The last of our cases had synchronous multiple jejunojejunal and colocolic] intussusceptions. We reviewed the different reports about the CT findings in adult intussusception in order to put a spotlight on every sign of the disease and to define its significance. We found "target" mass in 5 cases, one of which showed intramural air crescent. "Layering" pattern was found in 3 cases. "Reniform" mass was seen in 2 cases and the last case showed a sausage shaped" mass. Five of our cases felt in stage [1] and 6 were of stage [2]. Our results suggest that the internal anatomical detail of the mass is more important in its staging than its overall shape. We concluded that not only is CT valuable in the diagnosis of adult intussusception but it is also more informative than other techniques. It can detect the early changes of vascular compromise which influences the surgical plan. Moreover, it can occasionally suggest the underlying organic cause of the disease

Study of some biochemical assays in serum and ascitic fluid for differentiation between cirrhotic and malignant ascites

The clinical diagnosis of ascites is an easy task but the etiological diagnosis of the type of ascites is occasionally a different problem. Many studies have investigated the possibility of using a single marker to detect cancer in ascitic patients; but no analysis of ascitic fluid including cytology has been shown to be specific and sufficiently sensitive for either hepatic or extrahepatic cancer. To evaluate the role of various biochemical parameters including cholesterol, LDH, total protein, albumin and glucose for the differentiation of cirrhotic ascites from malignancy related ascites, fifty ascitic patients were classified into three main groups: Group I: included 20 patients with cirrhotic ascites. Group II: included 15 ascitic patients with hepatocellular carcinoma on top of liver cirrhosis. Group III: included 15 ascitic patients with extrahepatic malignancy without liver cirrhosis. All patients were subjected to: clinical history and examination, various imaging, routine laboratory investigations, histopathological examination, cytological examination of ascitic fluid, and biochemical analysis of both serum and ascitic fluid. We found that, although cytological examination of ascitic fluid is specific, it is less sensitive than ascitic fluid biochemical analysis in determining the cause of ascites. The accuracy of ascitic fluid cholesterol LDH, SAAG, A/S LDH ratio, A/S cholesterol ratio, A/S protein ratio, AFTp and ascitic/blood glucose ratio in discrimination of exudative malignant ascites from transudative cirrhotic ascites are [91%, 91%, 91%, 86%, 83%, 83%, 80% and 71%] respectively. Ascitic fluid biochemical analysis may be useful than cytological examination in follow-up of cirrhotic ascitic patients aiming to early detection of complication

Post-gastrojejunostomy entero-gastric reflux: is it always Symptomatic?

Evaluation of the problem of enterogastric reflux in duodenal ulcer patients managed by anterior and posterior truncal vagotomy and simple loop gastrojejunostorny. Between September 1976 and May 1996, 709 duodenal ulcer patients were managed by different surgical techniques. Anterior and posterior truncal vagotomy with simple loop gastrojejunostomy were done for 372 patients [52.5%]. Of the last group, 75 random patients were studied for enterogastric reflux. The mean postoperative period was 6.5 years, the mean age was 43 years, 64 were men and 11 were women. Careful clinical examination, barium meal study and esophagogastroscopy with histological examination of multiple gastric biopsies were done for all patients. Dual channel simultaneous esophageal and gastric 24h pH monitoring was done for 28 patients. Patients were classified into 2 groups, group 1 included 44 patients [58.7%] free of symptoms and group 2 included 30 patients [40%] who complained of one or more symptom of gastritis, however, the classic symptoms of alkaline refiux gastritis were found only in 8 patients [10.7%]. One patient [1.3%] was excluded due to proved ulcer recurrence. Endoscopic evidence of gastritis was found in 50% in group I versus 73.3% in group 2 [P<0.05]. Histopathologic evidence of gastritis was found in 77.3% in group 1 versus 46.7% in group 2 [P=0.007]. PH monitoring revealed alkaline gastric reflux in 50% in group I versus 75% in group 2 [P>0.05] alkaline esophageal reflux in 33.3% in group 1 versus 50% in group 2 [P<0.05] and mixed esophageal reflux [i.e alkaline and acidic] in 16.7% in group 1 versus 18.8% in group 2 [P> 0.05]. Enterogastric refiux is not an infrequent problem after trurcal vagotomy and loop gas trogejunostory. Pathologic alkaline gastric reflux should be proved by endoscopy, histopathology and pH metry before deciding remedial surgery

Diagnostic and therapeutic value of the replica technique in herpetic keratitis

The recommendation of corneal replicas in the management of superficial herpetic keratitis serves a dual purpose. The first purpose is diagnostic to facilitate histopathological examination of the intact corneal epithelium including the herpetic lesions. The second purpose is therapeutic to promote uneventful healing of the corneal ulcer without any complications and perhaps to reduce the recurrence rate. The causes of recurrences may be either due to stromal affections in which the epithelial lesion only was cured. In cases of simple epithelial herpetic keratitis, corneal replicas proved to be effective in healing the condition within 3-5 days without any complications. If the recurrence has occured and it is very low percentage, it may be attributed to insufficient amount of replica or missed diagnosis of significant stromal affection