Visual Rehabilitation With Contact Lenses Following Open Globe Trauma.

OBJECTIVES: To describe visual outcomes with various contact lens modalities in patients with a history of ocular trauma who underwent surgical open globe repair. METHODS: Records of all patients with a history of open globe injury and repair at a tertiary care hospital between January 1, 2010, and December 31, 2016, were reviewed. Demographics, type of injury, and visual acuity were assessed before and after contact lens evaluation. RESULTS: Of 214 patients who underwent open globe repair, 29 (13.6%) were evaluated with a contact lens. Visual acuity improved in 97% (28 of 29) of patients from 1.47±0.75 to 0.67±0.71 logarithm of the minimal angle of resolution (logMAR) with manifest refraction to 0.28±0.45 logMAR with contact lenses (n=29; P<0.0001). Corneal opacity was the most common clinical indication (20 of 29) for fitting followed by aphakia (13 of 29). A range of contact lens modalities, including corneal rigid gas-permeable (12 of 28), soft (9 of 28), hybrid (3 of 28), scleral gas-permeable (2 of 28), and piggyback (2 of 28) lenses were prescribed. CONCLUSION: In this study, patients with a history of trauma and open globe repair with good neurosensory visual potential had improvements in visual acuity with contact lens greater than manifest refraction. Soft and gas-permeable lenses were used to improve visual acuity in patients with a history of open globe repair and corneal scarring, aphakia, iris abnormalities, or other ocular sequelae. Although corneal rigid gas-permeable lenses were prescribed most often, additional consideration should be given to other contact lens modalities, including soft, piggyback, hybrid, and scleral gas-permeable lenses.

Early Experience of High-dose Intravenous Mycobacterium w in Critically Ill Patients of COVID-19.

BACKGROUND: Immune dysregulation is one of the main reasons for mortality and morbidity in coronavirus disease 2019 (COVID-19). Mycobacterium w (Mw) is recently approved for gram-negative sepsis. Moreover, it is also found effective in COVID-19 patients in previous studies. The traditional route of administration for Mw is intradermal, which has a limitation of administering 0.1 mL per injection and local injection site reaction. Intravenous (IV) administration of Mw has not been explored in COVID-19. We report the retrospective analysis of six critically ill COVID-19 patients who received Mw (IV). PATIENTS AND METHODS: At baseline, all patients in this case series required O2 supplementation, and their inflammatory biomarkers were elevated. All patients received 0.6 mL Mw (high-dose) in normal saline along with the standard-of-care treatment. RESULTS: After Mw administration, gradual improvement in O2 requirement was observed and patients were discharged from the hospital with no mortality. A reduction in mean C-reactive protein (CRP) (51.48-18.52 mg/dL), interleukin-6 (IL-6) (260.22-14.47 pg/mL), and FiO2 (81.67-43.33) was also observed. No side effects were observed with the use of Mw by IV route. CONCLUSION: Use of 0.6 mL Mw by IV route in this case series was associated with decreased O2 supplementation without any side effects in critically ill patients of COVID-19. HOW TO CITE THIS ARTICLE: Patel PS, Patel S, Shah V, Aswani V, Narwaria M. Early Experience of High-dose Intravenous Mycobacterium w in Critically Ill Patients of COVID-19. Indian J Crit Care Med 2021;25(9):1066-1068.

Development of probiotic yogurt: effect of strain combination on nutritional, rheological, organoleptic and probiotic properties.

Seven combinations of yogurt; C1 [yogurt starter culture (YSC)], T1, [YSC + Lactobacillus acidophilus (LA)], T2 [YSC + Bifidobacterium bifidum (BB)], T3 [YSC + Lactobacillus plantarum (LP)], T4 [YSC + Lactobacillus casei (LC)], T5 [YSC + LA + BB] and T6 [YSC + LP + LC] were developed. Nutritional [proximate and minerals], rheological [total soluble solids (TSS), pH, titratable acidity (TA), water holding capacity, synersis, viscosity] organoleptic and probiotic properties [viability, acid tolerance, bile salt tolerance] were assessed with standard methods. Nutritional composition differed significantly among samples except for the iron and zinc (P < 0.05). Yogurt containing LP as single or in combination with LC resulted in significantly higher ash, protein, calcium and phosphorous level. Probiotic combination also significantly affected the rheological properties of yogurts (P < 0.05). Yogurt with LP and LC as single or in combination lead to significantly higher TSS and viscosity while significantly low syneresis, whereas yogurt with LA as single or in combination resulted in low pH and high TA (P < 0.05). Interestingly, combination of LA and BB increased TSS, reduced pH and syneresis as compare to these bacteria as single probiotic source. Panel experts found yogurt with LP more flavourful. Combination of multi-strain and multi-species probiotic resulted in improved texture but we found no significant difference in overall acceptability. Combination of probiotic strains also resulted in better probiotic potential with multi-species combination found to be even more effective. BB seemed more stable than three other probiotic strains. The present study can be helpful to dairy industry in developing new probiotic products and may provide a rational for selecting a combination of probiotic strains.

Chemosensitization and mitigation of Adriamycin-induced cardiotoxicity using combinational polymeric micelles for co-delivery of quercetin/resveratrol and resveratrol/curcumin in ovarian cancer.

This work looks to improve the efficacy of Adriamycin (ADR) while mitigating its cardiotoxicity using combinations of micellar resveratrol (R): quercetin (Q) (mRQ) or R: curcumin (C) (mRC) in healthy mice and ovarian cancer xenograft models. Ovarian cancer cells, ES2-Luc, or A2780ADR are inoculated in mice (n =4/group) and sorted into eight cohorts. Mice are treated weekly for 4 weeks with ADR, ADR+mRQ, ADR+mRC, or controls (saline, empty micelles, ADR+EM, mRQ, or mRC). To evaluate the degree of cardioprotection, serum is collected to determine the cardiac Troponin I (cTnI). Cardiac tissue is collected for morphological evaluation and evaluation of creatine kinase levels. Our results indicate that mRQ+ADR is statistically significant in tumor reduction in xenograft models. In healthy mice, the left ventricular ejection fraction and fractional shortening in the ADR treated group is most compromised. Co-administration of mRQ with ADR can reduce ADR dosing through chemosensitization while being cardioprotective.

Liposomes produced by microfluidics and extrusion: A comparison for scale-up purposes.

Successful liposomal formulations in the clinic are severely limited due to poor translational capability of the traditional bench techniques to clinical production settings. The gold standard for liposome bench manufacturing is a multi-step and parameter dependent extrusion method. Moreover, these parameters need re-optimization for clinical production. The microfluidics technique utilizes vigorous mixing of fluids at a nanoliter scale to produce liposomes in batches from milliliters to a couple liters. The fine control of process parameters results in improved reproducibility between batches. It is inherently scalable; however, the characteristics of liposomes produced by microfluidics both in vitro and in vivo have never been compared to those produced using extrusion. In this manuscript, we describe the comparison between the traditional extrusion method to microfluidics, the new paradigm in liposome production and scale-up.

A review on laser and light-based therapies for alopecia areata.

Alopecia areata is a form of non-scarring alopecia that results from a hyperactive immune response of T cells against hair follicles. Many patients with visible hair loss experience psychological and emotional distress, as a result of their cosmetic disfigurement, and frequently seek treatment. However, existing treatment methods, such as corticosteroids, topical irritants, sensitizing agents, immunosuppressants, and psoralen plus ultraviolet light A, may result in various adverse effects and often lack efficacy. Laser and light treatments offer a safe and effective alternative. This review aims to provide clinicians with a comprehensive summary of laser and light-based modalities used for the treatment of alopecia areata. Currently, the excimer laser is the most widely studied device and has shown positive results thus far. However, the development of future randomized controlled clinical trials will help determine the appropriate treatment protocols necessary, in order to achieve superior clinical outcomes.

Evaluating the Potential for Delivery of Irinotecan via the Buccal Route: Physicochemical Characterization and In Vitro Permeation Assessment Across Porcine Buccal Mucosa.

Irinotecan (CPT-11) is used to treat advanced colorectal cancer as an intravenous therapy. Depending on pH, CPT-11 exists in either a lactone (active) or carboxylate (inactive) form, or both. In this investigation, the feasibility for systemic delivery of CPT-11 through the buccal route was evaluated. Permeation of CPT-11 across porcine buccal mucosa was studied in vitro using side-by-side flow through diffusion cells at 37°C. Experiments were performed over a pH range from 4 to 9, and the permeability of both the lactone and carboxylate forms of CPT-11 was measured. CPT-11 steady state flux was determined over a range of donor concentrations at pH 4 (0.5, 1, 5, 10, 15, 20 mg/ml) and pH 6.8 (0.5, 5, 10 mg/ml). Steady state flux increased linearly with increasing donor concentration of CPT-11 at pH 4 (r 2 = 0.9935) and at pH 6.8 (r 2 = 0.9886). CPT-11 permeability was independent of pH, although the distribution coefficient increased with increasing pH. Estimates of permeability for the lactone and carboxylate forms were 4.16 × 10-5 cm/s and 2.6 × 10-5 cm/s, respectively. These calculated permeability values were in agreement with the in vitro experimental data. Overall, CPT-11 was found to permeate through porcine buccal mucosa via passive diffusion. CPT-11 permeability was independent of pH, suggesting that the compound was transported mainly via a paracellular route. Overall, the results of this research suggest that the buccal route is a potential extravascular mode of delivery for CPT-11.

Mechanistic Nanotherapeutic Approach Based on siRNA-Mediated DJ-1 Protein Suppression for Platinum-Resistant Ovarian Cancer.

We report an efficient therapeutic modality for platinum resistant ovarian cancer based on siRNA-mediated suppression of a multifunctional DJ-1 protein that is responsible for the proliferation, growth, invasion, oxidative stress, and overall survival of various cancers. The developed therapeutic strategy can work alone or in concert with a low dose of the first line chemotherapeutic agent cisplatin, to elicit a maximal therapeutic response. To achieve an efficient DJ-1 knockdown, we constructed the polypropylenimine dendrimer-based nanoplatform targeted to LHRH receptors overexpressed on ovarian cancer cells. The quantitative PCR and Western immunoblotting analysis revealed that the delivered DJ-1 siRNA downregulated the expression of targeted mRNA and corresponding protein by more than 80% in various ovarian cancer cells. It was further demonstrated that siRNA-mediated DJ-1 suppression dramatically impaired proliferation, viability, and migration of the employed ovarian cancer cells. Finally, the combinatorial approach led to the most pronounced therapeutic response in all the studied cell lines, outperforming both siRNA-mediated DJ-1 knockdown and cisplatin treatment alone. It is noteworthy that the platinum-resistant cancer cells (A2780/CDDP) with the highest basal level of DJ-1 protein are most susceptible to the developed therapy and this susceptibility declines with decreasing basal levels of DJ-1. Finally, we interrogate the molecular underpinnings of the DJ-1 knockdown effects in the treatment of the ovarian cancer cells. By using various experimental techniques, it was revealed that DJ-1 depletion (1) decreases the activity of the Akt pathway, thereby reducing cellular proliferation and migration and increasing the antiproliferative effect of cisplatin on ovarian cancer cells; (2) enhances the activity of p53 tumor suppressor protein therefore restoring cell cycle arrest functionality and upregulating the Bax-caspase pathway, triggering cell death; and (3) weakens the cellular defense mechanisms against inherited oxidative stress thereby increasing toxic intracellular radicals and amplifying the reactive oxygen species created by the administration of cisplatin.

Efficacy of intralesional immunotherapy for the treatment of warts: A review of the literature.

Warts are common epidermal growths caused by human papillomavirus that often cause significant discomfort and embarrassment. Current treatment options include topical therapies, cryotherapy, laser vaporization, and surgical excision. Many of these options are destructive and may result in scarring, while less aggressive approaches can lead to lesion recurrence. Additionally, these local modalities are not practical for patients with a large number of warts. Systemic approaches such as immunotherapy have demonstrated success in treating multiple lesions by combining a targeted approach with upregulation of the host immune system. An extensive literature review was performed to evaluate the various vaccine antigens that have been used intralesionally to treat cutaneous and anogenital warts. The specific intralesional immunotherapies that have been studied include: Candida albicans; measles, mumps, and rubella; Trichophyton; and tuberculin antigens such as purified protein derivative, Mycobacterium w vaccine, and Bacillus Calmette-Guerin. Intralesional vaccine injection represents a safe, effective, and tolerable treatment for warts, including recalcitrant and anogenital warts. This approach has been somewhat overlooked in the past despite substantial evidence of high response rates with a low side effect profile. Large comparative trials are necessary to determine the most effective immunotherapy treatment option as well as the most appropriate dosing parameters.

Utilization of Optical Coherence Tomography in the Evaluation of Cherry Hemangiomas.

Cherry hemangiomas are common vascular proliferative lesions that can be concerning from a cosmetic perspective. Laser therapy is often used to eradicate cherry hemangiomas, but some lesions require multiple treatments or do not resolve at all. The suboptimal response to laser treatment may be due to limitations in penetration depth by vascular lasers such as the pulsed dye laser. Optical coherence tomography is a low-energy, light-based imaging device that can evaluate the depth and extent of vascular lesions such as cherry hemangiomas by allowing visualization of tissue structure and blood vessel architecture, which cannot be appreciated by clinical or dermatoscopic examination alone. We present optical coherence tomography images of a cherry hemangioma to demonstrate the precision and resolution of this imaging modality. Optical coherence tomography provides valuable information that has the potential to predict response to laser therapy without unnecessary attempts. Future prospective studies will determine its value for this purpose.

J Drugs Dermatol. 2016;15(6):713-714.

Laser treatment of congenital melanocytic nevi: a review of the literature.

Congenital melanocytic nevi (CMN) are nevi that are present from birth and occur in approximately 1 % of newborns. CMN may be cosmetically disfiguring and are at risk for malignant transformation. For these two reasons, CMN are frequently treated. A variety of treatment modalities have been utilized with variable efficacy, including excision, dermabrasion, curettage, chemical peels, radiation therapy, cryotherapy, electrosurgery, and lasers. The current treatment of choice for CMN is surgical excision. However, some CMN occur in cosmetically sensitive areas, where a surgical scar is less acceptable, or in inoperable locations. For these reasons, there has been increasing interest in the potential for laser treatment of CMN. The lasers that have been studied to date for the treatment of CMN include pigment-specific lasers, including ruby (694 nm), alexandrite (755 nm), and Nd:yttrium aluminum garnet (YAG) (1064 nm), as well as ablative laser treatment with CO2 laser (10,600 nm) and Er:YAG (2940 nm). To date, ruby lasers have been studied most extensively in the treatment of CMN. Ruby laser has been shown to improve the cosmetic appearance of some CMN and may be cautiously considered for lesions located in cosmetically sensitive areas that are less amenable to surgical excision. For very large CMN, ruby laser has been tried as an alternative to extensive surgical and grafting procedures. Dual treatment with Q-switched ruby laser and normal mode ruby laser may provide the best outcomes; however, multiple treatment sessions should be anticipated. The practicality and expense of multiple treatments should be discussed with the patient prior to initiating treatment. Importantly, because of the persistence of dermal nevus cells, lifelong follow-up is required for all laser-treated CMN, even those with excellent cosmetic effect.

The picosecond laser for tattoo removal.

The prevalence of tattoos continues to grow as modern society's stigma towards this form of body art shifts towards greater acceptance. Approximately one third of Americans aged 18-25 and 40 % of Americans aged 26-40 are tattooed. As tattoos continue to rise in popularity, so has the demand for an effective method of tattoo removal such as lasers. The various colors of tattoo inks render them ideal targets for specific lasers using the principle of selective photothermolysis. Traditional laser modalities employed for tattoo removal operate on pulse durations in the nanosecond domain. However, this pulse duration range is still too long to effectively break ink into small enough particles. Picosecond (10-12) lasers have emerged at the forefront of laser tattoo removal due to their shorter pulse lengths, leading to quicker heating of the target chromophores, and consequently, more effective tattoo clearance. Recent studies have cited more effective treatment outcomes using picosecond lasers. Future comparative studies between picosecond lasers of various settings are necessary to determine optimal laser parameters for tattoo clearance.

Lasers and nevus of Ota: a comprehensive review.

Nevus of Ota is a benign dermal melanocytic nevus that typically affects Asian children and women. The nevus presents as unilateral blue-gray hyperpigmented macules and patches scattered along the first and second divisions of the trigeminal nerve. Individuals with nevus of Ota experience emotional and psychosocial distress related to cosmetic disfigurement and often look for treatment options. Unfortunately, even when treated early, lesions of nevus of Ota are still difficult to treat. The use of lasers for the treatment of nevus of Ota lesions has become helpful in the management of dermal nevi. Currently, Q-switched (QS) lasers have been the most studied and demonstrated positive results for treatment of nevus of Ota. The purpose of this review article is to summarize the clinical efficacy and side effects associated with QS lasers and the treatment of nevus of Ota lesions.

Erythroplasia of Queyrat treated by laser and light modalities: a systematic review.

Erythroplasia of Queyrat (EOQ) is a squamous cell carcinoma in situ most commonly located on the glans penis or prepuce. EOQ accounts for roughly 10 % of all penile malignancies and may lead to invasive squamous cell carcinoma. Standard therapy includes local excision, partial or total penectomy, cryotherapy, and topical cytotoxic agents. Treatment of EOQ has proven to be challenging due to low response rates and recurrence. In addition, radical procedures can significantly affect sexual function and quality of life. Alternative laser treatments and photodynamic therapy (PDT) offer promising results for treating EOQ. A systemic review of the literature was performed for articles discussing laser and light therapy for EOQ. Among the patients treated with the CO2 laser, 81.4 % of cases had complete remission after one session of treatment. Patients treated with PDT presented with more variable results, where 62.5 % of those treated with methyl aminolevulinate photodynamic therapy (MAL-PDT) achieved complete remission. Aminolevulinic acid (ALA-PDT) treatment showed a similar rate of remission at 58.3 %. One study utilized the Nd:YAG laser, which resulted in a recurrence of the lesion in four of the five patients treated. Of the methods reviewed, the CO2 laser offered the most promising results with a cosmetically excellent prognosis. Further studies with larger power and longer follow-up times are needed to determine the optimal treatment regimen for this penile malignancy.

Laser and light-based treatments of venous lakes: a literature review.

Venous lake is a benign vascular malformation commonly seen in elderly patients, typically arising in sun-exposed areas of the body. Patients often seek treatment to prevent recurrent bleeding or because they find the lesion cosmetically unacceptable. Venous lake may negatively affect quality of life, due to the cosmetic disfigurement it can create and the resulting psychological distress. Traditional treatments, such as surgical excision, cryosurgery, sclerotherapy, and electrocoagulation, result in varying degrees of success and can cause discomfort. Laser- and light-based treatment modalities may offer a safe and effective alternative, as numerous studies have shown their benefit in the treatment of venous lakes, particularly with the long-pulsed 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG). Although various types of lasers and lights have been studied, there remains a lack of general consensus as to which one is the superior laser modality. Further studies that establish standardized protocols to compare the results of using different types of laser treatments are warranted.

Assessment of Various Nutritional Parameters in Geriatric Patients Who underwent Different Prosthodontic Treatments.

BACKGROUND: Some relation exists between oral and general health with progressive aging. Certain risk factors are common between oral and systemic diseases. Absence of teeth also affects the oral health by altering the quality of life. Hence, the nutritional changes occurring in elderly patients following prosthodontic rehabilitation are evaluated. MATERIALS AND METHODS: A total of 250 patients who underwent prosthodontic treatment for missing teeth were included for the study. Twice measurement of nutritional parameters was done: Initially at the time of diagnosis and then 5 months following commencement of the prosthodontic treatment. Dental analysis, evaluation of the diet, anthropometric assessment, and analysis of serum biochemical values were done in all the patients and tabulated records were maintained. Independent Student's t test and Tukey's test were done to assess the level of significance. RESULTS: A total of 250 patients were included for the study. The complete denture (CD) group showed the highest alteration in the mean values of the nutritional parameters followed by the removable partial denture group. A significant change was seen in the body mass index, protein, carbohydrate, and iron levels among the different patients who were grouped based on the mode of treatment modality. The CD group showed significantly higher mean change in carbohydrates value compared with mean change in patients receiving fixed treatment. CONCLUSION: Both nutrition and diet form an integral part of the prosthodontic treatment to maintain the health of elderly population. CLINICAL SIGNIFICANCE: With the advancement in the level of edentulism, rehabilitation by prosthetic treatment has become progressively important to restore and improve dietary parameters.

Correlation of Dynamic Surface Tension with Sedimentation of PTFE Particles and Water Penetration in Powders.

The dynamic surface tension of aqueous poly(ethylene oxide)-poly(propylene oxide)-poly(ethylene oxide) [(PEO-PPO-PEO)]-type polymeric surfactant (P103, P105, F108, P123, and F127) solutions were correlated with water penetration in packed Teflon powders, the sedimentation of Teflon suspensions in these solutions, foamability, and contact angle measurements on a Teflon surface. The DST trend with bubble lifetime indicated that the overall slowdown in the diffusion process in aqueous solutions is a function of a higher poly(ethylene oxide) (PEO) molecular weight for a given series of block copolymers containing equal PPO molecular weights, favoring slower diffusion kinetics to the air-water interface caused by preferential partitioning in bulk water. The wettability of poly(tetrafluoroethylene) (PTFE) powder illustrates better water penetration for polymers with low molecular weight and lower HLB values. The wettability of F127 solutions decreases with corresponding increases in concentration resulting from higher viscosity, which restrains the diffusion kinetics at the PTFE-water interface. The foamability decreases drastically with higher PEO molecular weight as attributed by slower diffusion kinetics, leading to a decrease in the effective concentration of molecules at the foam interface. The contact angle on glass and the PTFE surface are in good agreement with assumptions made by other analytical techniques showing a lower value of the contact angle with a lower HLB of the Pluronic, which relates to the higher adsorption of molecules at the interface. It is concluded that the adsorption of molecules at the PTFE-water interface decreases in aqueous Pluronic solutions with corresponding increases in the hydrophilic lipophilic balance (HLB), which is consistent with foaming, water penetration in a packed powder of PTFE, the rate of sedimentation, and DST data. A PTFE dispersion containing P123 showed the maximum wettability and lowest sedimentation among the series of block copolymers introduced, which is attributed to faster diffusion kinetics and a higher PPO contribution fostering faster adsorption at the PTFE surface. The dynamic surface tension of aqueous Pluronic solutions seems to correlate well with the adsorption characteristics at the air-water and PTFE-water interfaces.