Reactivated herpetic gingivostomatitis with secondary herpes-associated erythema multiforme and oral candidiasis post-COVID infection: A case report.

The presence and reactivation of oral lesions such as herpetic gingivostomatitis, erythema multiforme, and candidiasis in a COVID-19 recovered patient could be related to COVID-19s profound role in immune dysregulation or related therapies.

The Effects of Acute and Chronic Sleep Deprivation on the Immune Profile in the Rat.

BACKGROUND: Acute and chronic sleep deprivation present many health-related problems in modern societies, mainly concerning the immune system. Immune factors, particularly the interleukins, regulate sleep and, therefore, may be altered by sleep deprivation (SD). OBJECTIVES: We aimed to investigate the possible effects of acute and chronic sleep deprivation on selected cytokines, including interleukins (IL-1ß, IL-9, IL-17, and IL-23) and tumor necrosis factor- alpha (TNF-α). METHODS: The animals were grouped into acute sleep-deprived (SD; for 24 hours) and chronic sleep-deprived (8 hours a day for 10, 20, and 30-days). The SD was induced using the multipleplatforms model. The serum levels of cytokines were measured using commercially available ELISA. RESULTS: The serum levels of IL-1ß were significantly reduced after acute SD, whereas they were increased after 20-days of chronic SD. The IL-9 levels were reduced after acute SD, increased after 10-days of SD, and reduced again after 30-days of SD. Conversely, the levels of IL-23 were not changed after acute SD, reduced after 10 days of SD, and increased after 30-days of SD. Levels of TNF-α were not changed after acute SD, whereas they were increased after 20 and 30- days of SD. CONCLUSION: In conclusion, both acute and chronic SD distinctly disturb the immune profile, which might result in the emergence of various pathologies presented during sleep deprivation.

Neo-adjuvant FOLFIRINOX in borderline resectable and locally advanced pancreatic adenocarcinoma.

BACKGROUND: Surgery and systemic therapy provide the best option for long-term cancer control in localized resectable pancreas cancer. The present study assessed the efficacy and safety of neoadjuvant treatment with FOLFIRINOX in patients with borderline resectable (BR) and locally advanced (LA) pancreas cancer (PDAC). METHODS: This was a prospective noninterventional observational trial of neoadjuvant FOLFIRINOX in BR and LA PDAC. The primary objective was the R0/R1 surgical resection rate. Secondary objectives included progression free survival (PFS) and overall survival (OS), tolerability, and toxicity. RESULTS: Forty-nine patients were enrolled between 2013 and 2019; the majority had LA disease (59.2%). Median age was 61 years, and median Ca 19-9 level pretreatment was 523.4 µmol/L. Following neoadjuvant FOLFIRINOX, 11 patients (22.5%) underwent surgical resection, the majority of which were BR at diagnosis (72.7%). Median OS and PFS for the entire group were 25 (95% CI: 17.2-32.8) and 12 months (95% CI: 9.7-13.3), respectively. Median PFS in BR patients was 14 (95% CI: 10.5-17.5) compared to 12 months (95% CI: 5.2-18.8) in patients with LA patients. Median OS and PFS were not reached in patients who underwent surgical resection as compared to 22 (95% CI: 18.6-25.4) and 9 months (95% CI: 4.2-13.9) in those who did not, respectively. Grade 3/4 neutropenia, leukopenia, neuropathy, nausea/vomiting, and diarrhea occurred in 6.3%, 2.1%, 10.4%, 4.2%, and 8.3%, respectively. CONCLUSION: Neoadjuvant FOLFIRINOX is an active regimen for patients with LA/BR PDAC with a resection rate of 22.5%. These results are in line with prior data.

Hyperbaric oxygen exposure alleviate metabolic side-effects of olanzapine treatment and is associated with Langerhans islet proliferation in rats.

Introduction: Olanzapine (OLZ) is one of the second-generation antipsychotics drugs (APDs) used to treat several psychiatric illnesses. Olanzapine treatment is often associated with many metabolic side effects in a dose dependent manner such as obesity, dyslipidemia and insulin resistance, induction of type II diabetes and acute pancreatitis in some patients. Methods: Hyperbaric Oxygen therapy (HBOT) was investigated as a tool to mitigate olanzapine metabolic side effects in rats. Thirty-six female Sprague Dawley (SD) rats were divided into 4 groups; rats on olanzapine treatment either exposed to hyperbaric oxygen therapy (HBOOLZ) or left without exposure (OLZ) then non-treated rats that either exposed to hyperbaric oxygen therapy or left without exposure (control). Rats received Hyperbaric Oxygen therapy for 35 days at 2.4 atmospheres absolute (ATA) for 2.5 h daily followed by intraperitoneal injection of olanzapine at 10 mg/kg or placebo. Results: Rats on either hyperbaric oxygen therapy or olanzapine had a significant loss in body weight. Olanzapine treatment showed a decrease in serum insulin level, triglyceride, highdensity lipoprotein (HDL) cholesterol, and lipase level but an increase in fasting blood sugar (FBS), insulin resistance index (HOMA-IR) and amylase, while rats' exposure to hyperbaric oxygen therapy reversed these effects. The Pancreatic Langerhans islets were up-regulated in both hyperbaric oxygen therapy and olanzapine treatments but the combination (HBOOLZ) doubled these islets number. Discussion: This study advocated that hyperbaric oxygen therapy can be an alternative approach to control or reverse many metabolic disorders (MDs) associatedwith olanzapine treatment. In addition, it seems that hyperbaric oxygen therapy positively affect the pancreatic Langerhans cells activity and architecture.

Conductometric Immunosensor for Escherichia coli O157:H7 Detection Based on Polyaniline/Zinc Oxide (PANI/ZnO) Nanocomposite.

A conductometric immunosensor was developed for the detection of one of the most common foodborne pathogens, Escherichia coli O157:H7 (E. coli O157:H7), by conductometric sensing. The sensor was built based on a polyaniline/zinc oxide (PANI/ZnO) nanocomposite film spin-coated on a gold electrode. Then, it was modified with a monoclonal anti-E. coli O157:H7 antibody as a biorecognition element. The fabricated nanostructured sensor was able to quantify the pathogens under optimal detection conditions, within 30 min, and showed a good detection range from 101 to 104 CFU/mL for E. coli O157:H7 and a minimum detection limit of 4.8 CFU/mL in 0.1% peptone water. The sensor efficiency for detecting bacteria in food matrices was tested in ultra-heat-treated (UHT) skim milk. E. coli O157:H7 was detected at concentrations of 101 to 104 CFU/mL with a minimum detection limit of 13.9 CFU/mL. The novel sensor was simple, fast, highly sensitive with excellent specificity, and it had the potential for rapid sample processing. Moreover, this unique technique for bacterial detection could be applicable for food safety and quality control in the food sector as it offers highly reliable results and is able to quantify the target bacterium.

Assessment of Immune Response and Efficacy of Essential Oils Application on Controlling Necrotic Enteritis Induced by Clostridium perfringens in Broiler Chickens.

Necrotic enteritis (NE) caused by Clostridium perfringens is one of the most important enteric diseases in poultry. The antibacterial activity of two different essential oil (EO) blends against C. perfringens was investigated both in vitro and in vivo. Additionally, the immunological response to EO treatment was assessed. In the in vitro study, the antibacterial activity of EO formulas and commonly used antibiotics was evaluated against C. perfringens using disk diffusion assay, minimum inhibitory concentration (MIC) assay, and minimum bactericidal concentration (MBC) assay. In the in vivo study, NE experimental infection was performed on 440 Ross broiler chicks at 19 days of age for 4 continuous days. The chicks were treated with either EOs or amoxicillin at 22 days of age for 5 continuous days. One day after the end of treatment, the birds' performance was evaluated by calculating the feed conversion ratio. Serum samples from 120 birds were collected to measure the levels of IL-1ß, IFN-γ, IL-8, IL-10, and IL-17. After that, all birds were slaughtered, and their small intestines were subjected to gross and histopathological evaluation. In addition, bacterial counts in the small intestines were evaluated. In the in vitro study, EOs showed higher antimicrobial activities in comparison with antibiotics against C. perfringens. In the in vivo study, birds treated with EOs showed a significant decrease in bacterial counts, a significant decrease in intestinal lesions, and a significant improvement in performance compared with untreated birds (p < 0.05). Moreover, treating birds with EOs directed the immune system toward an anti-inflammatory pathway. None of the treated birds died due to NE compared with the 10% mortality rate in untreated birds. In conclusion, EOs might be an effective and safe alternative to antibiotics in the treatment of chicken NE.

Genomic Analysis of Oral Lichen Planus and Related Oral Microbiome Pathogens.

Oral lichen planus (OLP) is a common chronic inflammatory disease affecting the oral mucosa. The pathogenesis of OLP is incompletely understood but is thought to be related to the immune system. As the oral cavity is a major reservoir and transmission gateway for bacteria, viruses, and fungi, the microbial composition of the oral cavity could play a role in the pathogenesis of OLP. However, limited by analytic technology and knowledge of the microbial community in the oral cavity, it is not yet clear which pathogens are associated with OLP. Next generation sequencing (NGS) is a powerful tool to identify pathogens for many infectious diseases. In this study, we compared the host cell gene expression profiles and the microbial profiles between OLP patients and matched healthy individuals. We identified the activation of the hepatocyte nuclear factor alpha (HNF4A) network in OLP patients and potential pathogens, including Corynebacterium matruchotii, Fusobacterium periodonticum, Streptococcus intermedius, Streptococcus oralis, and Prevotella denticola. Prevotella denticola is capable of activating the HNF4A gene network. Our findings shed light on the previously elusive association of OLP with various diseases like hepatitis, and indicate that OLP is a T-helper type 17 (Th17) mediated mucosal inflammatory process. The identified molecular pathways and microbes could be used to inform future investigations into OLP pathogenesis and to develop novel therapeutics for OLP treatment.

Presentation of intestinal malrotation and midgut volvulus in adults: Case report & literature review.

INTRODUCTION: Malrotation is considered a newborn disease. This case report sheds light on the rare, but possible late presentation of malrotation in adulthood, which if missed, can leave the patient in a detrimental state. PRESENTATION OF CASE: 28-year-old female presented in critical state with acute abdomen. Computed tomography abdomen/pelvis showed midgut volvulus, requiring urgent laparotomy. The patient's bowels were discolored, yet they normalized upon detorsion, except for a small portion, which was equivocal and left for observation. Ladd's bands were excised, and the abdomen was closed with Bogota bag for re-exploration. The patient underwent two more laparotomies to observe the intestinal segment until it was back to normal. Ladd procedure was then completed, and an absorbable mesh was applied. Follow-up of 20 months has been uneventful, except for a small, asymptomatic, incisional hernia. DISCUSSION: Malrotation in adults is often missed due to its subacute, nonspecific presentation. It is often diagnosed by CT abdomen, which shows inversion or vertical positioning of the superior mesenteric vessels. Symptomatic, but stable patients, can undergo laparoscopic Ladd procedure, which carries the benefit of less length of stay. While an incidental malrotation can be prophylactically operated on, correcting asymptomatic malrotation beyond age of 20 is ineffective and possibly harmful. CONCLUSION: Intestinal malrotation presenting in an adult should be on the differential diagnosis when dealing with abdominal pain, especially in the context of small bowel obstruction in a virgin abdomen. It is vital to consider a patient's age prior to prophylactically operate on malrotation discovered incidentally.

Seroprevalence and associated risk factors of Coxiella burnetii (Q fever) in goats and sheep in northern Jordan.

This cross-sectional study aimed to study animal, farm, and within-farm seroprevalence of C. burnetii and to identify associated risk factors in goat and sheep farm in northern Jordan. Questionnaire was developed to collect information about risk factors and farms management practices. Blood samples from 730, ≥ 1-year-old females (goat n = 250; sheep n = 480) were randomly collected from 20 goat herds and 40 sheep flocks. IDEXX ELISA Kit was used to detect C. burnetii antibodies. The overall goat and sheep seroprevalence level was 32.5% (237/730) and was significantly higher in goats (43.3%, 108/250; 95% CI 37-49.6) than sheep (27%, 129/480; 95% CI 29.1-36.2) (χ2 test, p ≤ 0.001). Eighty percent (16/20) of goat herds and 60% (24/40) of sheep flocks had at least one seropositive animal (p ≥ 0.05). The average within goat herds and sheep flock seroprevalence were 36.4% (ranged: 0-91%) and 23.4% (ranged: 0-82%), respectively. Multivariate logistic regression model revealed that seroprevalence increased 1.79 times in goat herds compared with sheep flocks, 3.2 times more in farms containing ≥ 100 animals, and 1.7 times higher in farms with their animals that were ≥ 2 years of age than in farms with their animals that are < 2 years of age. In addition, seroprevalence significantly increased 1.52 times in farms loaning bucks or rams during breeding season and 1.63 times in farms containing cats on premises (p ≤ 0.05). Farm biosecurity measures are essential to prevent introduction and minimize transmission of C. burnetii infection to humans and animals.

Recombinant adenoviral vaccine encoding the spike 1 subunit of the Middle East Respiratory Syndrome Coronavirus elicits strong humoral and cellular immune responses in mice.

BACKGROUND AND AIM: Middle East respiratory syndrome coronavirus (MERS-CoV) has rapidly spread throughout the Middle East since its discovery in 2012. The virus poses a significant global public health threat with potentially devastating effects. In this study, a recombinant adenoviral-based vaccine encoding the spike 1 (S1) subunit of the MERS-CoV genome was constructed, and its humoral, and cellular immune responses were evaluated in mice. MATERIALS AND METHODS: Mice were immunized initially by intramuscular injection and boosted 3 weeks later by intranasal application. Expression of the S1 protein in the lungs and kidneys was detected using conventional polymerase chain reaction (PCR) and immunohistochemistry (IHC) targeting specific regions within the S1 subunit at weeks 3, 4, 5, and 6 after the first vaccination. Antigen-specific humoral and cellular immune responses were evaluated in serum and in cell culture following in vitro stimulation with a specific 9-mer epitope within the S1 protein (CYSSLILDY). RESULTS: S1 protein expression was only detected by IHC in the kidneys of the Ad-MERS-S1 group at week 6 from first immunization, and in both lungs and kidneys of Ad-MERS-S1 group by conventional PCR at weeks 3 and 5 post-prime. The vaccine elicited a specific S1-immunoglobulin G antibody response, which was detected in the sera of the vaccinated mice at weeks 4 and 6 from the onset of the first immunization. There was a significant increase in the amount of Th1-related cytokines (interferon-γ and interleukin [IL] 12), and a significant decrease in the Th2-related cytokine IL-4 in splenocyte cell culture of the vaccinated group compared with the control groups. CONCLUSION: The results of this study suggest that this recombinant adenovirus vaccine encoding the S1 subunit of MERS-CoV elicits potentially protective antigen-specific humoral and cellular immune responses in mice. This study demonstrates a promising vaccine for the control and/or prevention of MERS-CoV infection in humans.

Potential antimicrobial effect of plant essential oils and virulence genes expression in methicillin-resistant Staphylococcus aureus isolates.

AIM: This study aimed to investigate the antibacterial efficacy of eight commercially available essential oil (EO) blends and characterize the effect on the expression of some virulence genes against methicillin-resistant Staphylococcus aureus (MRSA). MATERIALS AND METHODS: In vitro evaluation of the antimicrobial effects of oils against MRSA was performed using the disk diffusion method and by measuring the minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC). The EOs (A-F) were contained (ß-pinene, carvacrol, carvone, dimethyl trisulfide, linalool, limonene, menthol, monoterpene hydrocarbons, and thymol) in different amounts. In addition, a real-time polymerase chain reaction was also used to determine the gene expression of the virulence genes (intercellular adhesion cluster [ica]-9, ica-15, and RNA III) against MRSA (ATCC 43300) after treatment with selected oils. RESULTS: Among the eight EOs evaluated, EO (D), (E), and (A) showed, in general, the greatest antimicrobial activity against MRSA. EO at 1/3 MIC has effectively down-regulated ica-9 and ica-15 of MRSA by 17.83 and 4.94 folds, respectively. Meanwhile, EO (A) has effectively down-regulated RNAIII by 3.74 folds. Our results indicated that some of the EOs exhibit promising antimicrobial effects against MRSA isolates. Moreover, the results of the analyzed virulence genes related to the pathogenicity of MRSA were down-regulated at the sub-MIC concentrations of EOs, indicated that EOs could be successfully used to suppress the virulence factors and, consequently, decreased the pathogenicity of MRSA. CONCLUSION: These encouraging results indicate that some of the EOs used in this study can be utilized as a natural antibiotic for the treatment of MRSA disease.

Sulfamethazine contamination level and exposure assessment in domestic and imported poultry meats in Jordan.

BACKGROUND AND AIM: Sulfamethazine (SMZ) is an important and widely used antibiotic in poultry industry due to its high efficacy in fighting diseases and promoting growth. In addition, SMZ is a possible human carcinogen and has been found in many food types including poultry meat. Accordingly, this study aimed to survey the contamination level and estimated daily intake (EDI) of SMZ in domestic and imported poultry meat samples in Jordan. MATERIALS AND METHODS: A total of 120 samples; 60, 30, and 30 of fresh and frozen domestic and frozen imported poultry samples, respectively, were collected from different cities in Jordan. Poultry samples were analyzed for SMZ incidence rate and contamination level using a competitive enzyme-linked immunosorbent assay technique. EDI values were calculated from the SMZ concentration, average poultry daily consumption rate, and adult body weight (b.w.). RESULTS: Of the 120 surveyed samples, 20 samples (16.7%) were SMZ violative positive and exceeded the European Union maximum limit (100 µg/kg) and accordingly were unfit for human consumption. Whereas, 51 samples (42.5%) were with SMZ concentrations of 10-100 µg/kg. The average SMZ concentration was 235.58 µg/kg, with a range of 11.47-800 µg/kg poultry meat. It is also noteworthy the high EDI of SMZ by Jordanian adults, 0.286 µg SMZ/kg b.w./day. Moreover, results prevailed that the highest SMZ incidence rate and contamination level were for imported poultry samples followed by domestic poultry samples, which may indicate that SMZ contamination in poultry meat is an international issue. CONCLUSION: The current study prevailed high SMZ incidence rate, contamination level, and EDI values, which is likely due to indiscriminate use of SMZ in poultry production. Results also prevailed the high risk that consumers in Jordan may expose due to SMZ residues. Therefore, more strict program and good agricultural practices should be applied to monitor antibiotic withdrawal periods in animals used for human consumption to ensure the legal residue requirements of these antibiotics.

First Genome Sequence of Newcastle Disease Virus of Genotype VIIi from Jordan.

Newcastle disease virus (NDV) was detected by reverse transcriptase PCR (RT-PCR) from total RNA isolated from a chicken spleen of a backyard flock in Jordan. The complete coding genome sequence of NDV/chicken/Jordan/J11-spleen/2018 was obtained with MiSeq (Illumina) sequencing. Phylogenetic analysis of the concatenated coding sequences classified the virus as class II subgenotype VIIi.

Botulinum toxin type A for the treatment of head and neck chronic myofascial pain syndrome: A systematic review and meta-analysis.

BACKGROUND: The authors conducted a systematic review to study the efficacy of botulinum toxin type A (BoTN-A) in the treatment of myofascial pain syndrome. TYPES OF STUDIES REVIEWED: The authors identified randomized, double-masked, placebo-controlled studies on June 1, 2016, from PubMed, Web of Science, and the Cochrane Library. Three of the authors assessed the studies for risk of bias. Outcomes included pain reduction on a visual analog scale, the number of responders, and the posttreatment pain threshold to applied pressure using algometry. RESULTS: The initial search strategy yielded 253 unduplicated references, which the authors reduced to 13 relevant studies. The authors included 11 studies in the meta-analyses as the investigators of those studies had reported similar outcomes. Pooled results showed a nonsignificant improvement in the posttreatment intensity of pain in the BoTN-A group compared with the placebo group at 4 to 6 weeks (standardized difference in means [SDM], -0.110; 95% confidence interval [CI], -0.344 to 0.124; P = .356) and a significant improvement at 2 to 6 months (SDM, -0.360; 95% CI, -0.623 to -0.096; P = .008). The number of study participants who responded to treatment was not statistically significantly different between the groups (risk ratio, 1.346; 95% CI, 0.922-1.964; P = .123) nor was the increase of pain threshold to pressure (algometry) at 2 months (SDM, 0.131; 95% CI, -0.178 to 0.440; P = .405). The study investigators reported no major adverse events. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Pain was reduced significantly in the group that received BoTN-A compared with the placebo group at 2 to 6 months but not at 4 to 6 weeks (with moderate quality of the evidence). Additional studies with larger numbers of participants are needed to confirm these results.

Effect of intravaginal fluorogestone acetate sponges on prolactin levels of Damascus-local cross breed goats.

The effect of intravaginal fluorogestone acetate (FGA) sponges on prolactin levels (PRL) and correlations between PRL and milk somatic cell count (SCC) and steroid hormones levels of Damascus-local cross goats during transitional period to anestrous were investigated in this study. Fifty-six goats were assigned to three groups. Group 1 (FGA, n = 19) was treated with 40 mg FGA and equine chorionic gonadotropin (600 IU, i.m.) at time of sponge withdrawal (day 0). Group 2 (FGA-PGF; n = 19) was treated similar to group 1 but was also injected with dinoprost tromethamine (naturally occurring PGF2α) (10 mg, i.m.) on day 0. Control goats (n = 18) were left untreated. On day 0, five fertile bucks were turned in with all goats. Milk and blood samples were collected on days -13 (day of sponge insertion), -6, 0, 1, 2, 7, 13, and 20. Prolactin levels were at lowest values on day -13 of the study and increased (p < 0.05) from day -6 to day 20 in all groups. A significant positive correlation (p < 0.05) between PRL and progesterone and between PRL and estradiol levels was found in this study. No significant correlation was found between PRL and SCC of all groups during the study except on days 2 and 20 where PRL levels were correlated (p < 0.05) with SCC of left udder halves of FGA group. In conclusion, estrus induction with FGA resulted in significant increase in PRL. A positive correlation was found between PRL and steroid hormones, but there was no correlation between PRL and goat milk SCC.

Challenges in combining antiangiogenic therapy with transarterial chemoembolization for hepatocellular carcinoma.

BACKGROUND: The combination of systemic antiangiogenic therapy and transarterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) is the subject of several ongoing clinical trials. We present a series of patients treated with sorafenib and TACE at our institution, highlighting the technical challenges of combining these two modalities of treatment. METHODS: We retrospectively identified patients with HCC treated with TACE and sorafenib at our institution. RESULTS: Five patients were treated with the combination of TACE and sorafenib given off-protocol based on preliminary reports in the literature. The first four patients started sorafenib 7 days prior to TACE resulting in intratumoral vascular pruning and poor visualization of lesions on angiography. This was managed by either superselective angiography or lobar TACE. The fifth patient stopped sorafenib 7 days prior to TACE with full visualization of multiple hypervascular lesions on angiography prior to embolization. CONCLUSIONS: Our observations suggest that the biologically preferable strategy of continuous antiangiogenic therapy should be weighed against the possibility of suboptimal TACE due to poor visualization of lesions on angiography and safety.

Neutrophil gelatinase-associated lipocalin (NGAL) and insulin-like growth factor (IGF)-1 association with a Mannheimia haemolytica infection in sheep.

This study was aimed at mapping the tissue distribution of some inflammatory parameters associated with a Mannheimia haemolytica (M. haemolytica) infection in sheep. The M. haemolytica was isolated and characterized from the affected lungs of slaughtered animals. Cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-10, insulin-like growth factor (IGF)-1, as well as the acute-phase protein, neutrophil gelatinase-associated lipocalin (NGAL), were identified in the lung tissues, the serum, and the lymph nodes of M. haemolytica infected sheep, by enzyme-linked immunosorbent assay (ELISA). NGAL and IGF-1 pointed to an innate immune response, and epithelial cell repairing, respectively. The adaptive immune response was identified through the type of cytokines present in the affected sheep, as TNF-α represents the pro-inflammatory cytokines, and IL-10 represents the anti-inflammatory cytokines. M. haemolytica isolates were confirmed by polymerase chain reaction (PCR) and DNA sequences. There was a significant difference in the concentrations of NGAL, IGF-1, TNF-α, and IL-10, as observed in the affected sheep when compared to the healthy sheep. This study, for the first time, closely describes the distribution of some key and new inflammatory parameters in the tissue homogenate of affected lungs.

Comparing open and closed techniques of frontalis suspension with silicone rod for the treatment congenital blepharoptosis.

PURPOSE: To compare open and closed methods of the frontalis suspension operation with a silicone rod in the treatment of congenital blepharoptosis. METHODS: Forty-four cases with unilateral or bilateral congenital ptosis with a poor levator function of < 4 mm were divided randomly into two groups. Each group underwent an eyelid crease incision operation (open) or a supralash stab incision (closed). Ptosis was measured by the difference between the upper eyelid margin reflex distance (MRD) of the affected eyelids of the unilateral and bilateral cases. Frequent follow-up examinations were performed up to 12 months post-surgery. RESULTS: Associated ophthalmologic findings showed that amblyopia, strabismus, wound discharge and knot dehiscence problems were present in 36.6%, 27.3%, 8.5% and 8.5% of the patients, respectively. There was no significant difference between the abovementioned associated ophthalmic findings of the two operative methods studied (P = 0.37). The difference in the surgical methods and MRD 3, 6 and 12 months after operation did not reach statistical significance. Similar results for good MRD (3 < MRD < 5) were found in closed (54.5%, 12/22) and open (54.5%, 12/22) methods, while 40.9% (9/22) and 45.5% (10/22) of cases were attributed to the under correction group in the closed and open methods, respectively. In bilaterally operated cases, MRD was more symmetrical than in unilaterally operated eyes. The symmetry of MRD and the eyelid crease was more prevalent in the open technique group. CONCLUSIONS: The frontalis sling operation using a silicone rod exhibited better results, in terms of symmetry, in the open technique in comparison to the closed method.

Therapeutic effects of high-dose intravenous prednisolone in methanol-induced toxic optic neuropathy.

PURPOSE: We evaluated the effects of high-dose steroids for the treatment of methanol optic neuropathy. METHODS: In an interventional case series, 6 patients with a history of sudden visual loss after an ingestion of homemade alcoholic beverages were included in the study. The patients received 250 mg intravenous methyl prednisolone every 6 h for 4 days and continued with oral prednisolone at 1 mg/kg for 10 days. Best-corrected visual acuity (BCVA), optical coherent tomography, fundus photo, and a complete ophthalmologic exam of the patients were taken before the treatment and 3 months after treatment. RESULTS: All the patients were male. The mean age was 26.34±2.7 years. The mean BCVA before the treatment was 0.86±0.08 in the right eye and 0.93±0.1 in the left eye using the logMAR scale. Four patients showed nerve fiber layer edema as a white density in peripapillary area. After treatment, the mean BCVA was 0.33±0.18 in the right eye and 0.29±0.2 in the left eye using the logMAR scale. The differences between before treatment and after treatment were significant (P=0.008 and P=0.003, respectively). The mean macular thickness and cup.to.disc ratio were unchanged. CONCLUSION: Intravenous high-dose methyl prednisolone may have benefits in the treatment of methanol optic neuropathy.

New trends in the management of hepatic Echinococcus granulosus.

The liver is the most commonly involved organ in the body by cystic echinococcosis (CE) secondary to infection with Echinococcus granulosus. In this article, the authors discuss the classification, recent advances in magnetic resonance (MR) imaging for the diagnosis of hepatic CE, and approaches for management of hepatic CE using five therapeutic options that include: antihelminthic chemotherapy, surgery, percutaneous treatment, endoscopic approach, and the "watch and wait" approach.