Long-Term Clinical Outcome of Tacrolimus Skin Ointment (0.03%) for the Treatment of Vernal Keratoconjunctivitis: A Quasi-Experimental Study.

Background Vernal keratoconjunctivitis (VKC) is an allergic conjunctival inflammation with severe ocular complications if left untreated. The current management regimen is plagued with adverse effects, long-term problems, and clinical relapses. Tacrolimus offers an alternative treatment option, and long-term studies are needed to determine its efficacy. Methods A two-year follow-up based study was conducted on moderate to severe VKC patients, who were prescribed tacrolimus skin ointment. The 5-5-5 exacerbation scale was used for the monitoring and grading severity of the disease. Analysis of variance (ANOVA) and intergroup comparisons were conducted on exacerbation scale scores among follow-ups. Results A significant reduction was observed in the total score of severity from baseline (203.17±102.05) to three months' follow-up (69.94±70.54), and it kept reducing for 18 months post therapy. Similar results with statistically significant reduction were observed for all grades of the scale. The relapse rate was 5.71% within a month after therapy cessation, and none of the other patients showed relapse afterward. No significant ocular and systemic complications were observed during the study. Conclusion Tacrolimus is effective in the long-term management of VKC without the complications of conventional steroid-based therapy.

Relation between macrophage inflammatory protein-1 and intercellular adhesion molecule-1 and computed tomography findings in critically-ill saudi covid-19 patients.

BACKGROUND: Several, clinical and biochemical factors were suggested as risk factors for more severe forms of Covid-19. Macrophage inflammatory protein-1 alpha (MIP-1α, CCL3) is a chemokine mainly involved in cell adhesion and migration. Intracellular adhesion molecule 1 (ICAM-1) is an inducible cell adhesion molecule involved in multiple immune processes. The present study aimed to assess the relationship between baseline serum MIP-1α and ICAM-1 level in critically-ill Covid-19 patients and the severity of computed tomography (CT) findings. METHODS: The study included 100 consecutive critically-ill patients with Covid-19 infection. Diagnosis of infection was established on the basis of RT-PCR tests. Serum MIP-1α and ICAM-1 levels were assessed using commercially available ELISA kits. All patients were subjected to a high-resolution computed tomography assessment. RESULTS: According to the computed tomography severity score, patients were classified into those with moderate/severe (n=49) and mild (n = 51) pulmonary involvement. Severe involvement was associated with significantly higher MIP-1α and ICAM-1 level. Correlation analysis identified significant positive correlations between MIP-1α and age, D-dimer, IL6, in contrast, there was an inverse correlation with INF-alpha. Additionally, ICAM-1 showed significant positive correlations with age, D-Dimer,- TNF-α, IL6,while an inverse correlation with INF-alpha was observed. CONCLUSIONS: MIP-1α and ICAM-1 level are related to CT radiological severity in Covid-19 patients. Moreover, these markers are well-correlated with other inflammatory markers suggesting that they can be used as reliable prognostic markers in Covid-19 patients.

One-year Visual and Refractive Outcomes of Deep Anterior Lamellar Keratoplasty (DALK) in Patients with Advanced Keratoconus.

OBJECTIVE: To determine the one-year visual and refractive outcomes of deep anterior lamellar keratoplasty (DALK) in patients with advanced keratoconus (KC) using inexpensive readily available instruments. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, from November 2016 to March 2021. METHODOLOGY: The authors evaluated different types of big bubble (BB) formation and the conversion rate of intended DALK (n=120) to the penetrating keratoplasty (PK) in patients with grade 4 KC. For analysis, only those patients were included in whom DALK was completed. Main outcome measures at 1-year follow-up were best-corrected visual acuity (BCVA), maximum keratometry (Kmax) reading, spherical equivalent (SE), and topographic astigmatism (TA). All the postoperative complications were recorded. RESULTS: Type 1 BB was formed in 68% (n=82) of the patients. An incomplete type 1 BB and type 2 BB were observed in twenty and eighteen patients, respectively. DALK was completed successfully in 102 patients. Whereas, the conversion rate to PK was 15% (n=18). The mean preoperative BCVA improved from 1.11±0.23 logMAR to 0.46±0.20 logMAR, at 1-year follow-up. The mean Kmax, SE, and TA readings reduced from a preoperative value of 62.1±4.60 D, -11.6±2.62 D, and 4.63±1.82 D, respectively, to 49.1±3.10 D, -5.65±0.84 D, and 2.78±1.35 D, respectively, at 1-year follow-up. Stromal rejection was recorded in two patients, but it responded well to topical therapy. CONCLUSION: Inexpensive readily available instruments can be used to perform DALK in patients with advanced KC with favourable visual and refractive outcomes. KEY WORDS: Big bubble, Deep anterior lamellar keratoplasty, Keratoconus, Perforation, Penetrating keratoplasty.

Prognostic Significance of Platelet Activation Marker CD62P in Hospitalized Covid-19 Patients.

BACKGROUND: CD62P is a surface marker for platelet activation. Platelet dysfunction contributes to disproportionate intravascular microthrombosis in SARS-CoV-2. We aimed to assess the clinical significance of CD62P as a biomarker of platelet activation and its correlation to the clinical severity and outcome of COVID-19 infections. METHODS: The study included 80 COVID-19 patients and, in addition, there were 20 age and gender-matched healthy controls. Laboratory measurements included CBC, serum ferritin, LDH, CRP, D-dimer and flow cytometric assessments of the platelet markers CD42b and CD62P. The primary study outcome was patients' survival at the end of study. RESULTS: Among the studied patients, 24 patients (30.0%) died by the end of the study. Survivors had significantly lower CD62P values when compared with non-survivors [median (IQR): 75.5 (73.0 - 91.0) versus 96.0 (93.5 - 97.8), p < 0.001]. Patients with severe disease had significantly higher levels of CD62P levels [median (IQR): 95.5 (92.0 - 97.8) versus 75.0 (72.0 - 76.8), p < 0.001]. Logistic regression analysis identified D-dimer levels [OR (95% CI): 0.14 (0.03 - 0.74) and CD62P levels: OR (95% CI): 0.4 (0.17 - 0.94)] as significant predictors of mortality in multivariate analysis. CONCLUSIONS: CD62P expression on admission may be a useful prognostic maker in hospitalized Covid-19 patients. Its expression is related to other markers of inflammation and coagulopathy.

Peripheral Neuropathy in Beta-Thalassemia: Corneal Confocal Microscopy-Based Study.

Background Peripheral neuropathy is a controversial but serious complication of beta-thalassemia (ß-Th). Although few studies have reported no relationship between neuropathy and thalassemia, many have linked it with increasing age, iron overload, and iron chelator toxicity. This study aims to investigate the presence of neuropathy in ß-Th using corneal nerve fibers. Methodology A cross-sectional study was conducted using corneal confocal microscopy on individuals with intermediate and major ß-Th who were compared to healthy individuals. The main outcome variables were corneal main nerve and branch nerve densities which were calculated using Image J software. The comparison between groups was done using the independent-samples F-test and Bonferroni post-hoc analysis. Results There was reduced corneal main nerve and branch nerve density in ß-Th intermediate and major patients compared to the control group, and the results were statistically significant (p-value <0.05). However, a significant correlation was not observed between serum ferritin levels and corneal nerve parameters. Conclusions The reduction in corneal nerve parameters in ß-Th patients compared to healthy controls can be an indication of peripheral neuropathy in ß-Th. Further work is needed to confirm these findings.

Molecular docking analysis of timepidium with Acetylcholine and lumacaftor with GABA(A) activator.

Epilepsy is a chronic disorder characterized by disturbed tissue related molecular activity within the brain irrespective of age. The cause is very difficult to understand towards a suitable treatment. However, its symptoms like seizures are treated and suppressed by known medications. Moreover, the condition is linked with neuro-transmitters such as GABA (gamma amino butyric acid) and acetylcholine. Therefore, it is of interest to design and develop inhibitors for these targets. Hence, we describe the molecular binding features of timepidium with acetylcholine and lumacaftor with GABA(A) activator using molecular docking based geometric optimization and screening analysis for further consideration.

Panretinal Photocoagulation Plus Intravitreal Bevacizumab Versus Panretinal Photocoagulation Alone for Proliferative Diabetic Retinopathy.

OBJECTIVE: To compare panretinal photocoagulation (PRP) plus intravitreal bevacizumab (IVB) against PRP alone in the treatment of proliferative diabetic retinopathy (PDR) in terms of mean change in best corrected visual acuity (BCVA), neovessels on disc (NVD) and neovessels elsewhere (NVE). STUDY DESIGN: Experimental study. PLACE AND DURATION OF STUDY: Department of Ophthalmology, Benazir Bhutto Hospital, Rawalpindi, from December 2014 to July 2015. METHODOLOGY: Sixty eyes were randomized into two groups with 30 eyes in each. In group A, IVB was given 15 days prior to PRP but in group B only PRP was given. In both groups, BCVA and neovessels status at disc and elsewhere was assessed before and at day 30. NVDs were judged as per percentage of NVD occupying surface of the disc (DD%). NVE were also judged as per reference to diameter of disc surface. RESULTS: The mean age of the study patients was 52.27 ±6.7 years. Mean BCVA (logMAR) in the PRP plus IVB group improved considerably from mean 0.64 ±0.17 to mean 0.49 ±0.21 at 30th day. However, in PRP group, there was no significant change in BCVA 0.64 ±0.16 at baseline to 0.63 ±0.18 at day 30. There were extremely significant changes between the two groups at 4th week (p<0.001). Mean NVE at baseline in PRP plus group was 3.30 ±0.95% at baseline that changes to 1.50 ±1.06% at day 30. While in only PRP group, mean NVE was 3.33 ±0.7% at baseline and 3.17 ±0.7% at one month of follow-up. In PRP plus group, NVD changes from mean 31.27 ±9.8% at baseline to 11.40 ±5.5% at one month of follow-up. In only PRP group, NVD changes from mean 31.13 ±10.23% at baseline to 29.53 ±11.04% at 1 month of follow-up. There were extremely significant changes between two groups at day 30 (p<0.001). CONCLUSION: Intravitreal bevacizumab in short duration is effective as adjunctive treatment to PRP with early and greater rate of regression of retinal neovessel than PRP alone in PDR patients.