RESUMO
BACKGROUND: Recent studies suggest that 5α-reductase inhibitors (5ARIs) for benign prostate hyperplasia (BPH) result in abnormal retinal anatomical alteration. OBJECTIVE: To compare age-related macular degeneration (AMD) incidence in BPH patients receiving 5ARIs or tamsulosin. DESIGN: Retrospective, population-based cohort study using new-user and active-comparator design. SETTING: General population. SUBJECTS: Males with BPH, newly receiving 5ARIs or tamsulosin from 2010 to 2018. METHODS: Data were extracted from Taiwan's National Health Insurance Research Database. We used Cox proportional hazards model with 1:4 propensity score (PS) matching, based on intention-to-treat analysis to determine the risk of incident AMD. Sensitivity analyses included an as-treated approach and weighting-based PS methods. We also separately reported the risks of incident AMD in patients receiving finasteride and dutasteride to determine risk differences among different 5ARIs. RESULTS: We included 13 586 5ARIs users (mean age: 69 years) and 54 344 tamsulosin users (mean age: 68.37 years). After a mean follow-up of 3.7 years, no differences were observed in the risk of incident AMD between 5ARIs and tamsulosin users [hazard ratio (HR): 1.06; 95% confidence intervals (95% CI): 0.98-1.15], with similar results from sensitivity analyses. However, increased risk of incident age-related macular degeneration was observed in patients receiving dutasteride [HR: 1.13; 95% CI: 1.02-1.25], but not in those receiving finasteride [HR: 0.99; 95% CI: 0.87-1.12], in the subgroup analyses. CONCLUSIONS: We found no difference between 5ARIs and tamsulosin regarding the incidence of AMD in BPH patients. However, the risk profiles for AMD differed slightly between dutasteride and finasteride, suggesting that the potency of androgen inhibition is a factor related to AMD incidence.
Assuntos
Inibidores de 5-alfa Redutase , Dutasterida , Finasterida , Degeneração Macular , Hiperplasia Prostática , Tansulosina , Humanos , Inibidores de 5-alfa Redutase/efeitos adversos , Inibidores de 5-alfa Redutase/uso terapêutico , Masculino , Idoso , Hiperplasia Prostática/tratamento farmacológico , Hiperplasia Prostática/epidemiologia , Estudos Retrospectivos , Taiwan/epidemiologia , Incidência , Degeneração Macular/epidemiologia , Degeneração Macular/diagnóstico , Degeneração Macular/induzido quimicamente , Dutasterida/uso terapêutico , Dutasterida/efeitos adversos , Tansulosina/uso terapêutico , Tansulosina/efeitos adversos , Finasterida/efeitos adversos , Finasterida/uso terapêutico , Fatores de Risco , Pessoa de Meia-Idade , Medição de Risco , Bases de Dados FactuaisRESUMO
Photodynamic therapy (PDT) has become the first-line treatment of actinic keratosis, superficial basal cell carcinoma, and squamous cell carcinoma in situ (Bowen's disease) in dermatology. The off-label use of PDT has also escalated in recent years owing to its applications in the treatment of various non-neoplastic skin diseases such as acne vulgaris, vascular lesions, rejuvenation, and chronic wounds. Daylight PDT that uses natural sunlight to activate a photosensitizer with advantages such as low cost and reduced pain is widely used in Europe. This chapter reviews the applications and immunogenetic aspects of PDT. However, the studies of immunity and genetic changes in human tissue after PDT are limited.
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Ceratose Actínica , Fotoquimioterapia , Neoplasias Cutâneas , Humanos , Imunogenética , Ceratose Actínica/tratamento farmacológico , Fármacos Fotossensibilizantes/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológicoRESUMO
Photodermatosis is an abnormal skin inflammatory reaction to light. The major classifications of photodermatoses are idiopathic photodermatoses, photodermatoses due to exogenous or endogenous agents, photo-exacerbated dermatoses, and photosensitive genodermatoses. In this chapter, we focus on idiopathic photodermatoses and drug-related photodermatoses and emphasize on the epidemiology and immunogenetic backgrounds. Idiopathic photodermatoses, a spectrum of diseases with abnormal responses to ultraviolet radiation (UVR), include polymorphous light eruption, actinic prurigo, hydroa vacciniforme, chronic actinic dermatitis, and solar urticaria. Young people are more susceptible to most idiopathic photodermatoses except for chronic actinic dermatitis. Interestingly, idiopathic photodermatoses exhibit different characteristics between Caucasians and Asians. For example, the average age of Asian actinic prurigo patients is older than that of Caucasians in which genetic backgrounds or Fitzpatrick skin type might play a role. Drug-induced photodermatoses can be classified into phototoxic and photoallergic drug reactions. Certain drug-induced photodermatoses may mimic other dermatoses. For instance, drug-induced lupus erythematosus (LE) should be considered if an old man is diagnosed with LE but had a poor response to standard treatments.
Assuntos
Transtornos de Fotossensibilidade , Raios Ultravioleta , Adolescente , Humanos , Imunogenética , Masculino , Transtornos de Fotossensibilidade/diagnóstico , Transtornos de Fotossensibilidade/genética , Raios Ultravioleta/efeitos adversosRESUMO
BACKGROUND: Co-trimoxazole, a sulfonamide antibiotic, is used to treat a variety of infections worldwide, and it remains a common first-line medicine for prophylaxis against Pneumocystis jiroveci pneumonia. However, it can cause severe cutaneous adverse reaction (SCAR), including Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug reaction with eosinophilia and systemic symptoms. The pathomechanism of co-trimoxazole-induced SCAR remains unclear. OBJECTIVE: We aimed to investigate the genetic predisposition of co-trimoxazole-induced SCAR. METHODS: We conducted a multicountry case-control association study that included 151 patients with of co-trimoxazole-induced SCAR and 4631 population controls from Taiwan, Thailand, and Malaysia, as well as 138 tolerant controls from Taiwan. Whole-genome sequencing was performed for the patients and population controls from Taiwan; it further validated the results from Thailand and Malaysia. RESULTS: The whole-genome sequencing study (43 case patients vs 507 controls) discovered that the single-nucleotide polymorphism rs41554616, which is located between the HLA-B and MICA loci, had the strongest association with co-trimoxazole-induced SCAR (P = 8.2 × 10-9; odds ratio [OR] = 7.7). There were weak associations of variants in co-trimoxazole-related metabolizing enzymes (CYP2D6, GSTP1, GCLC, N-acetyltransferase [NAT2], and CYP2C8). A replication study using HLA genotyping revealed that HLA-B∗13:01 was strongly associated with co-trimoxazole-induced SCAR (the combined sample comprised 91 case patients vs 2545 controls [P = 7.2 × 10-21; OR = 8.7]). A strong HLA association was also observed in the case patients from Thailand (P = 3.2 × 10-5; OR = 3.6) and Malaysia (P = .002; OR = 12.8), respectively. A meta-analysis and phenotype stratification study further indicated a strong association between HLA-B∗13:01 and co-trimoxazole-induced drug reaction with eosinophilia and systemic symptoms (P = 4.2 × 10-23; OR = 40.1). CONCLUSION: This study identified HLA-B∗13:01 as an important genetic factor associated with co-trimoxazole-induced SCAR in Asians.
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Antibacterianos/efeitos adversos , Anti-Infecciosos Urinários/efeitos adversos , Povo Asiático/genética , Hipersensibilidade a Drogas/genética , Predisposição Genética para Doença , Antígenos HLA-B/genética , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos , Adolescente , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Malásia/epidemiologia , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Taiwan/epidemiologia , Tailândia/epidemiologia , Sequenciamento Completo do Genoma , Adulto JovemRESUMO
AIMS: To investigate the risk of diabetic macular oedema (DMO) associated with the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS: We conducted a retrospective cohort study by analysing a large multi-institutional electronic medical records database in Taiwan. We included adult patients with T2DM without DMO newly receiving either SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists (GLP-1RAs) during the period 2016 to 2018. We used propensity scores with inverse probability of treatment weighting to generate comparable groups. The study outcome was incident DMO, determined by clinical diagnosis during outpatient visits or admissions. We followed patients from the index date to either DMO occurrence, last clinical visit, patient death, or December 31, 2020. We performed Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of DMO. RESULTS: We included 9986 new users of SGLT2 inhibitors (mean [SD] age 59.6 (12.1) years, median [interquartile range {IQR}] glycated haemoglobin [HbA1c] 70 (61-81)mmol/mol, estimated glomerular filtration rate [eGFR] 89.1 [71.4-108.7] mL/min/1.73 m2 and urine albumin-creatinine ratio [UACR] 26.1 [9.7-117.6] mg/g) and 1067 new users of GLP-1RAs (mean [SD] age 58.4 (41.5) years, median [IQR] HbA1c 73 [64-84] mmol/mol, eGFR 91.6 [68.6-114.0] mL/min/1.73 m2 and UACR 37.6 [11.1-153.2] mg/g) with similar baseline characteristics. Lower DMO risks were observed among patients newly receiving SGLT2 inhibitors (7.9/1000 person-years), compared to those receiving GLP-1RAs (10.7/1000 person-years) with an HR of 0.75 (95% CI 0.64-0.88). CONCLUSIONS: Our findings suggest use of SGLT2 inhibitors was associated with lower risk of DMO in T2DM patients in clinical practice, compared to use of GLP-1RAs. Future studies are necessary to confirm this observation.
Assuntos
Diabetes Mellitus Tipo 2 , Edema Macular , Inibidores do Transportador 2 de Sódio-Glicose , Adulto , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Glucose , Humanos , Hipoglicemiantes/efeitos adversos , Lactente , Edema Macular/induzido quimicamente , Edema Macular/epidemiologia , Estudos Retrospectivos , Sódio , Inibidores do Transportador 2 de Sódio-Glicose/efeitos adversos , Taiwan/epidemiologiaRESUMO
BACKGROUND: The increasing use of biologics is accompanied by a risk of hepatitis B (HBV) and C virus (HCV) reactivation. OBJECTIVE: To determine the predictors of HBV and HCV reactivation in patients with psoriasis receiving biologics. METHODS: This study screened 2060 patients with psoriasis (3562 treatment episodes) who were taking biologics from 2009 to 2018. There were 359 patients with psoriasis with HBV (561 treatment episodes) and 61 with HCV infection (112 treatment episodes). RESULTS: During 8809 and 1522 person-months of follow-up, 88 treatment episodes for HBV involved HBV reactivation, and 14 episodes of HCV involved reactivation. The reactivation rate was significantly higher in treatment episodes of chronic HBV infection than in that of occult HBV (34.3% vs 3.2%, P = .001) and resolved HBV (34.3% vs 5.0%, P < .001). The multivariate analysis revealed that being hepatitis B surface antigen seropositive, being hepatitis B e-antigen seropositive, and tumor necrosis factor-α-inhibitor therapy were risk factors for HBV reactivation, whereas antiviral prophylaxis was effective in reducing the risk of HBV reactivation. No predictors were significantly associated with HCV reactivation. LIMITATIONS: Observational design and a lack of a comparison group. CONCLUSION: Patients with psoriasis on biologics have a risk of HBV and HCV reactivations, particularly those who are seropositive for hepatitis B surface antigen and hepatitis B e-antigen and undergoing tumor necrosis factor-α-inhibitor therapy.
Assuntos
Produtos Biológicos/uso terapêutico , Hepacivirus/fisiologia , Vírus da Hepatite B/fisiologia , Psoríase/tratamento farmacológico , Psoríase/virologia , Ativação Viral , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoRESUMO
ABSTRACT: Vascular occlusion causing vision loss is a rare yet one of the most devastating complications of facial esthetic fillers. In this article, we present a case of unilateral blindness and superficial skin necrosis in a 31-year-old woman after the injection of hyaluronic acid for esthetic purposes. The delicate ocular fundal findings of ophthalmic artery occlusion were demonstrated by ophthalmoscopy, optical coherence tomography, and fluorescein angiography. Magnetic resonance imaging also showed subsequent ischemic changes in the optic nerve and posterior scleral wall after ophthalmic artery occlusion. Despite management including intraocular pressure-lowering agents, globe massage, and anticoagulation with acetylsalicylic acid and hyperbaric oxygen therapy, her final vision was not restored. Given the lack of effective treatments, this report depicts the comprehensive ocular fundal findings of an ophthalmic artery occlusion after esthetic hyaluronic acid filler injection, and highlights the importance of a preventive approach to avoid such catastrophic complications.
Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos , Oclusão da Artéria Retiniana , Adulto , Cegueira/induzido quimicamente , Técnicas Cosméticas/efeitos adversos , Preenchedores Dérmicos/efeitos adversos , Feminino , Humanos , Ácido Hialurônico/efeitos adversos , Injeções , Oclusão da Artéria Retiniana/induzido quimicamente , Oclusão da Artéria Retiniana/diagnósticoRESUMO
Daylight photodynamic therapy (dPDT) uses sunlight as a light source to treat superficial skin cancer. Using sunlight as a therapeutic device has been present for centuries, forming the basis of photodynamic therapy in the 20th century. Compared to conventional PDT, dPDT can be a less painful, more convenient and an effective alternative. The first clinical uses of dPDT on skin cancers began in Copenhagen in 2008. Currently, aminolevulinic acid-mediated dPDT has been approved to treat actinic keratosis patients in Europe. In this review article, we introduce the history and mechanism of dPDT and focus on the pros and cons of dPDT in treating superficial skin cancers. The future applications of dPDT on other skin diseases are expected to expand as conventional PDT evolves.
Assuntos
Ácido Aminolevulínico/farmacologia , Antineoplásicos/farmacologia , Ceratose Actínica/radioterapia , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologia , Animais , Doença de Bowen/radioterapia , Carcinoma Basocelular/radioterapia , Queilite/radioterapia , Europa (Continente) , Glucose/química , Glutamina/química , Humanos , Porfirinas/química , Exposição à Radiação , Luz Solar , Fatores de Tempo , Xeroderma Pigmentoso/radioterapiaRESUMO
BACKGROUND: The antihypertensive agent hydrochlorothiazide has been associated with increased risks of non-melanoma skin cancer (NMSC) and possibly some melanoma subtypes. Previous studies were, however, conducted in predominantly Caucasian populations. We therefore examined the association between hydrochlorothiazide and skin cancer risk in an Asian population. METHODS: By using Taiwan's National Health Insurance Research Database (NHIRD), we conducted three separate case-control studies of lip cancer, non-lip non-melanoma skin cancer and melanoma. Cases (n = 29,082) with a first-ever skin cancer diagnoses (2008-2015) were matched 1:10 to population controls. We estimated odds ratios (ORs) associating hydrochlorothiazide use with skin cancer risk by using conditional logistic regression. RESULTS: Hydrochlorothiazide use showed no overall association with any of the three outcomes: ORs for high cumulative use of HCTZ (≥50,000 mg) were 0.86 (95% CI 0.09-7.81) for lip cancer, 1.16 (95% CI 0.98-1.37) for non-lip NMSC and 1.07 (95% CI 0.65-1.76) for melanoma. There was some evidence of a dose-response pattern for non-lip NMSC, with an OR of 1.66 (95% CI 0.82-3.33) for 100,000-149,999 mg of HCTZ. The null findings were robust across subgroup and sensitivity analyses. CONCLUSION: Use of HCTZ appears safe in terms of skin cancer risk in an Asian population.
Assuntos
Anti-Hipertensivos/efeitos adversos , Hidroclorotiazida/efeitos adversos , Neoplasias Labiais/induzido quimicamente , Neoplasias Labiais/epidemiologia , Melanoma/induzido quimicamente , Melanoma/epidemiologia , Neoplasias Cutâneas/induzido quimicamente , Neoplasias Cutâneas/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Risco , Taiwan/epidemiologiaRESUMO
Giant condyloma acuminatum (GCA), also known as Buschke -Löwenstein tumor, is a huge, rapidly growing variant of condyloma found in the anogenital region. Extragenital GCA is rare and, in most cases, affecting the intertriginous area and treated by excision. We described a case of refractory extragenital GCA involving the large part of the left axilla area successfully treated with immunotherapy and podophyllotoxin. Considering the large size and the location, the lesions were not treated by wide excision because it might result in scar contracture with limitation of shoulder movement or axillary web syndrome. Our case illustrates that combination therapy of podophyllotoxin, imiquimod plus weekly cryotherapy may be an effective and less invasive option for treating GCA of the axilla with good cosmetic and functional outcomes.
Assuntos
Axila/patologia , Tumor de Buschke-Lowenstein/terapia , Neoplasias Cutâneas/terapia , Adulto , Tumor de Buschke-Lowenstein/patologia , Terapia Combinada , Crioterapia/métodos , Humanos , Imiquimode/administração & dosagem , Imunoterapia/métodos , Masculino , Podofilotoxina/administração & dosagem , Neoplasias Cutâneas/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Rosai-Dorfman disease is a rare non-Langerhans cell histiocytosis. Ocular involvement is even rarer, mostly involving the orbit and eyelids, although marginal corneal ulcers, uveitis, and epibulbar masses have also been reported, and is characterized by multiple recurrences. However, the disease course and optimal treatment strategies remain undetermined, in light of the rarity of this disease. CASE PRESENTATION: We reported a 36-year-old male patient with the extranodal form of Rosai-Dorfman disease, presenting with scleritis and anterior uveitis in the left eye, who experienced subsequent development of an epibulbar tumor in the same eye. The patient was also complicated by a relapsing facial nodule on the right cheek. After the pathological diagnosis of Rosai-Dorfman disease was obtained, the patient underwent surgical excision of the epibulbar tumor and the facial nodule, accompanied by systemic immunosuppression therapy. At the last follow-up, the patient was asymptomatic without signs of recurrence. CONCLUSIONS: This report highlights the progression of ocular manifestations of Rosai-Dorfman disease and emphasizes the importance of systemic therapy.
Assuntos
Túnica Conjuntiva/patologia , Histiocitose Sinusal/complicações , Esclera/patologia , Esclerite/etiologia , Uveíte Anterior/etiologia , Doença Aguda , Adulto , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Histiocitose Sinusal/diagnóstico , Humanos , Masculino , Esclerite/diagnóstico , Uveíte Anterior/diagnóstico , Acuidade VisualRESUMO
BACKGROUND AND OBJECTIVES: Dissecting folliculitis (DF) or dissecting cellulitis of the scalp is regarded as a rare disease with disfiguring scarring alopecia. This study aimed to analyze the features of DF and to propose a classification to define its severity. PATIENTS AND METHODS: A hospital-based retrospective study was conducted. Patients with a histopathological diagnosis or clinical features leading to diagnosis of DF were included and classified into three stages. RESULTS: Among the 66 patients recruited (63 men / 3 women, mean age 24.9 years), multiple interconnected alopecic nodules involving the vertex scalp were the main feature. Histopathology showed an extensive inflamed granulation abscess forming a dissection plane in the lower dermis/subcutis in the acute stage. Lymphocytic infiltration was predominant in seven of 21 histology specimens. Overweight and obesity were noted in 29 of 45 patients examined. No association with smoking was found. There was comorbidity with acne conglobata in 15 of 66 patients, two of whom had acne inversa. Longer disease duration and greater number of nodules were associated with higher severity of DF (p < 0.05). A complete remission rate of 25 % was achieved by any treatment, and a rate of 37.5 % was achieved with oral isotretinoin alone. CONCLUSIONS: DF is not uncommon in Taiwan. An association with obesity needs to be clarified.
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Celulite (Flegmão)/classificação , Celulite (Flegmão)/diagnóstico , Dermatoses do Couro Cabeludo/classificação , Dermatoses do Couro Cabeludo/diagnóstico , Dermatopatias Genéticas/classificação , Dermatopatias Genéticas/diagnóstico , Abscesso/classificação , Abscesso/diagnóstico , Abscesso/patologia , Acne Vulgar/classificação , Acne Vulgar/diagnóstico , Acne Vulgar/patologia , Adulto , Alopecia/classificação , Alopecia/diagnóstico , Alopecia/patologia , Celulite (Flegmão)/tratamento farmacológico , Celulite (Flegmão)/patologia , Comorbidade , Feminino , Tecido de Granulação/patologia , Humanos , Isotretinoína/uso terapêutico , Linfocitose/classificação , Linfocitose/diagnóstico , Linfocitose/patologia , Masculino , Obesidade/complicações , Sobrepeso/complicações , Estudos Retrospectivos , Couro Cabeludo/patologia , Dermatoses do Couro Cabeludo/tratamento farmacológico , Dermatoses do Couro Cabeludo/patologia , Dermatopatias Genéticas/tratamento farmacológico , Dermatopatias Genéticas/patologia , Resultado do TratamentoRESUMO
BACKGROUND: Previous studies suggested an association between cataract surgery and retinal vascular occlusion. However, the association may be attributable to detection bias because postoperative monitoring may be more frequent for those who receive cataract surgery than for those who do not. DESIGN: Population-based cohort study using target trial emulation framework. METHODS: We included patients with cataract aged 50 years and older receiving cataract surgery or non-surgical interventions identified from the Taiwan National Health Insurance Research Database between 2003 and 2018, matched by propensity score. The primary outcome was retinal vascular occlusion. Cox proportional hazards models were used to compare surgery and control groups. Additional analyses were restricted to patients who had undergone fundoscopic examination within 6 months prior to cataract surgery to address the issue of detection bias. RESULTS: We included 577,129 cataract surgery and control pairs. We found the hazard ratio (HR) for retinal vascular occlusion after cataract surgery was 1.23 (95% confidence interval (CI): 1.17-1.29), compared with the control group. Secondary outcome analyses yielded similar results for retinal artery occlusion (HR: 1.13, 95% CI: 1.02-1.26) and retinal vein occlusion (HR: 1.26, 95% CI: 1.20-1.33). However, no risk of retinal vascular occlusion was observed among patients who had received fundoscopic examinations (HR: 1.06, 95% CI: 0.98-1.15) at baseline. CONCLUSIONS: Our study underscored the importance of conducting complete baseline fundoscopic examinations before cataract surgery to clarify whether postoperative conditions are due to patients' underlying diseases or unintended complications of cataract surgery.
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Tartarato de Brimonidina/uso terapêutico , Carbazóis/uso terapêutico , Propanolaminas/uso terapêutico , Rosácea/tratamento farmacológico , Dermatopatias/tratamento farmacológico , Administração Cutânea , Tartarato de Brimonidina/administração & dosagem , Carbazóis/administração & dosagem , Carvedilol , Temperatura Baixa , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Feminino , Géis , Humanos , Pessoa de Meia-Idade , Necrose/tratamento farmacológico , Necrose/patologia , Propanolaminas/administração & dosagem , Rosácea/patologia , Índice de Gravidade de Doença , Dermatopatias/patologiaAssuntos
Hipotermia Induzida , Infecções por Mycobacterium não Tuberculosas/terapia , Mycobacterium marinum/patogenicidade , Dermatopatias Bacterianas/terapia , Pele/microbiologia , Feminino , Humanos , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/microbiologia , Pele/patologia , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/microbiologia , Resultado do Tratamento , CicatrizaçãoRESUMO
Invasive Candida albicans infection is a significant opportunistic fungal infection in humans because it is one of the most common colonizers of the gut, mouth, vagina, and skin. Despite the availability of antifungal medication, the mortality rate of invasive candidiasis remains ~50%. Unfortunately, the incidence of drug-resistant C. albicans is increasing globally. Antimicrobial photodynamic therapy (aPDT) may offer an alternative or adjuvant treatment to inhibit C. albicans biofilm formation and overcome drug resistance. Rose bengal (RB)-mediated aPDT has shown effective cell killing of bacteria and C. albicans. In this study, the efficacy of RB-aPDT on multidrug-resistant C. albicans is described. A homemade green light-emitting diode (LED) light source is designed to align with the center of a well of a 96-well plate. The yeasts were incubated in the wells with different concentrations of RB and illuminated with varying fluences of green light. The killing effects were analyzed by the plate dilution method. With an optimal combination of light and RB, 3-log growth inhibition was achieved. It was concluded that RB-aPDT might potentially inhibit drug-resistant C. albicans.
Assuntos
Anti-Infecciosos , Fotoquimioterapia , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Antifúngicos/farmacologia , Biofilmes , Candida albicans/fisiologia , Candidíase , Feminino , Humanos , Fotoquimioterapia/métodos , Fármacos Fotossensibilizantes/farmacologia , Rosa Bengala/farmacologiaRESUMO
Background: Phacoemulsification is an effective and widely performed technique in cataract surgery, but the comparative anatomical outcomes, including endothelial cell loss (ECL), central corneal thickness (CCT), and central macular thickness (CMT), between high-flow and low-flow phacoemulsification cataract surgery remain unclear. Methods: This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. Random-effects models were applied to measure pooled mean differences (MD) with 95% confidence intervals (CI) of anatomical outcomes between high-flow and low-flow phacoemulsification cataract surgery. We judged overall certainty of evidence (CoE) based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Results: We included six randomized controlled trials (RCTs) totaling 477 participants. The meta-analysis showed similar changes associated with these two surgery types in both ECL at postoperative days 2-14 (MD: -1.63%; 95% CI: -3.73 to 0.47%; CoE: very low), days 15-42 (MD: -0.65%; 95% CI -2.96 to 1.65%; CoE: very low) and day 43 to month 18 (MD: -0.35%; 95% CI: -1.48 to 0.78%; CoE: very low), and CCT at postoperative day 1 (MD: -16.37 µm; 95% CI: -56.91 to 24.17 µm; CoE: very low), days 2-14 (MD: -10.92 µm; 95% CI: -30.00 to 8.16 µm; CoE: very low) and days 15-42 (MD: -2.76 µm; 95% CI: -5.75 to 0.24 µm; CoE: low). By contrast, low-flow phacoemulsification showed less increase in CMT at postoperative days 15-42 (MD, -4.58 µm; 95% CI: -6.3 to -2.86 µm; CoE: low). Conclusions: We found similar anatomical outcomes, except in CMT, for both high-flow and low-flow phacoemulsification cataract surgery. Future head-to-head RCTs on visual outcomes should confirm our findings. Systematic review registration: PROSPERO, identifier: CRD42022297036.