Antimicrobial Resistance: Is There a 'Light' at the End of the Tunnel?

In recent years, with the increases in microorganisms that express a multitude of antimicrobial resistance (AMR) mechanisms, the threat of antimicrobial resistance in the global population has reached critical levels. The introduction of the COVID-19 pandemic has further contributed to the influx of infections caused by multidrug-resistant organisms (MDROs), which has placed significant pressure on healthcare systems. For over a century, the potential for light-based approaches targeted at combatting both cancer and infectious diseases has been proposed. They offer effective killing of microbial pathogens, regardless of AMR status, and have not typically been associated with high propensities of resistance development. To that end, the goal of this review is to describe the different mechanisms that drive AMR, including intrinsic, phenotypic, and acquired resistance mechanisms. Additionally, the different light-based approaches, including antimicrobial photodynamic therapy (aPDT), antimicrobial blue light (aBL), and ultraviolet (UV) light, will be discussed as potential alternatives or adjunct therapies with conventional antimicrobials. Lastly, we will evaluate the feasibility and requirements associated with integration of light-based approaches into the clinical pipeline.

Pattern of astigmatism in a clinical setting in Maldives / Patrón del astigmatismo en un centro clínico de Maldivas

Background: Patterns of refractive errors have never been reported in Maldives. This study aims to dissect astigmatism and provide a general view in context of this island country. Methods: A clinic based cross sectional study was designed with 277 patients, aged ≥3.5 years and with a primary astigmatism of ≥−1.00 diopters (D). They underwent complete eye examination and a vector analysis was done. Results: Mean age was 28.58 (SD 19.15) years. Astigmatic magnitude depended on age (p<0.05) but not on gender (p>0.05). Severity of visual impairment after refractive correction was very less, with only 2.2% having visual acuity ≤6/60. Mean spherical, spherical equivalent and astigmatic refraction were −1.35 (SD 2.94D), −2.40 (SD 3.04) and −2.12 (SD 1.11D), respectively. Between fellow eyes, refractive and corneal astigmatism highly correlated (0.83 and 0.73). Fifty eyes (18.1%) had an astigmatic error of ≥−3.00D which peaked in the second and third decades of life (p<0.0001) and was corneal in origin (p<0.0001). Internal J45 and J0 tended to be more negative with increasing age, showing a trend toward against the rule astigmatism. Correlation between corneal and refractive J0 and J45 were 0.88 and 0.62 (p<0.0001). With the rule astigmatism was more common followed by against the rule and oblique. Conclusion: In conclusion, this study inferred that among patients with relatively higher magnitude of astigmatism attending to the clinics in Maldives, younger patients are affected more, which could possibly link to the environment, genetics and nutrition. The probable association between nutrition and astigmatism needs to be investigated to fill the gap in literature (AU)

Antecedentes: Los patrones de los errores refractivos no han sido reportados nunca en Maldivas. Este estudio trata de analizar minuciosamente el astigmatismo, así como aportar una visión genérica en el contexto de este país insular. Métodos: Se diseñó un estudio clínico transversal que incluyó a 277 pacientes, de edades ≥3,5 años y con astigmatismo primario de ≥-1,00 Dioptrías (D). Se les realizó un examen visual completo y un análisis vectorial. Resultados: La edad media fue de 28,58 años (DE 19,15). La magnitud astigmática dependió de la edad (p<0,05) pero no del sexo (p>0,05). La severidad de la discapacidad visual tras la corrección refractiva fue muy baja, y únicamente el 2.2% reflejó una agudeza visual ≤6/60. La media del defecto esférico, el equivalente esférico y la refracción astigmática fueron de -1,35 (DE 2,94D), -2,40 (DE 3,04) y -2,12 (DE 1,11D), respectivamente. El astigmatismo refractivo y el corneal guardaron una amplia correlación entre ambos ojos (0,83 y 0,73). Cincuenta sujetos (18,1%) reflejaron un valor de error astigmático ≥-3,00D, que se incrementó en la veintena y la treintena (p<0,0001), siendo corneal en origen (p<0,0001). Los vectores J45 y J0 internos tendieron a ser más negativos conforme aumentaba la edad, mostrando tendencias de astigmatismo en contra de la regla. La correlación entre los vectores J0 y J45 corneal y refractivo fue de 0,88 y 0,62 (p<0,0001). El astigmatismo a favor de la regla fue el más común, seguido del astigmatismo contra la regla y el oblicuo. Conclusión: En conclusión, este estudio concluyó que de entre los pacientes astigmáticos de magnitud relativamente mayor que se presentaron en la clínica de Maldivas, los pacientes más jóvenes estaban más afectados, lo que podría estar ligado al entorno, los factores genéticos y la nutrición. Debe investigarse la posible asociación entre la alimentación y el astigmatismo, para llenar el vacío en la literatura al respecto (AU)