Acute drug reaction to phenylephrine and tropicamide collyrium in a late-preterm newborn: a case report.

BACKGROUND: Collyrium administration is a common procedure in the neonatal ward, both in preterm and at term babies. Various molecules are used to induce mydriasis and cycloplegia: among them, phenylephrine and tropicamide are the most popular, and their administration is generally considered safe. CASE PRESENTATION: A 35 + 2 weeks-old, 2510 g, well-appearing male newborn required an ophthalmologic evaluation after a doubtful red reflex test. A collyrium with 1% phenylephrine and 0.95% tropicamide was administered prior to the consult, one drop per eye. Two minutes after the administration, the baby developed a severe apnea that required tactile stimulation. Moreover, the area around his eyes became visibly pale. Three minutes later, the baby became severely bradycardic (59 bpm), but remained in good general condition, so that resuscitation maneuvers were not required. Bradycardia lasted for almost three hours and then gradually resolved. CONCLUSIONS: Cardiopulmonary manifestations, such as bradycardia and even cardiopulmonary arrest, are severe complications that can happen after phenylephrine collyrium administration in preterm newborns. However, they have been described in babies below 1500 g or with concurrent respiratory manifestations. Our patient, on the other hand, was late preterm, and never required a ventilatory support prior to the collyrium administration. Practitioners who deal with premature babies, even if late preterm, must be aware of these possible complications and administer phenylephrine collyrium carefully, where cardiopulmonary resuscitation equipment and personnel are available.

Ocular nerve growth factor administration counteracts the impairment of neural precursor cell viability and differentiation in the brain subventricular area of rats with streptozotocin-induced diabetes.

The ocular administration of nerve growth factor (NGF) as eye drops (oNGF) has been shown to exert protective effects in forebrain-injured animal models, including adult diabetes induced by a single injection of streptozotocin (STZ) (60 mg/kg body weight). This type 1 diabetes model was used in this study to investigate whether oNGF might extend its actions on neuronal precursors localised in the subventricular zone (SVZ). NGF or saline was administrated as eye drops twice daily for 2 weeks in rats with STZ-induced diabetes and healthy control rats. The expression of mature and precursor NGF and the NGF receptors, tropomyosin-related kinase A and neurotrophin receptor p75, and the levels of DNA fragmentation were analysed by ELISA and western blotting. Incorporation of bromodeoxyuridine was used to trace newly formed cells. Nestin, polysialylated neuronal cell adhesion molecule (PSA-NCAM), doublecortin (DCX) and glial fibrillary acidic protein antibodies were used to identify the SVZ cells by confocal microscopy. It was found that oNGF counteracts the STZ-induced cell death and the alteration of mature/pro-NGF expression in the SVZ. It also affects the survival and differentiation of SVZ progenitors. In particular, oNGF counteracts the reduction in the number of cells expressing PSA-NCAM/DCX (neuroblast type A cells) and the related reductions in the number and distribution of nestin/DCX-positive cells (C-type cells), or glia-committed cells (type B cells), observed in the SVZ of diabetic rats. These findings show that oNGF treatment counteracts the effect of type 1 diabetes on neuronal precursors in the SVZ, and further support the neuroprotective and reparative role of oNGF in the brain.

Antimycotic Activity of Ozonized Oil in Liposome Eye Drops against Candida spp.

Purpose: This study aims to investigate the antifungal activity and mechanism of action of ozonized oil eye drops in liposomes (Ozodrop), commercialized as eye lubricant for the treatment of dry eye syndrome and eye inflammation. The activity was tested against four clinical Candida species: Calbicans,Cglabrata,Ckrusei, and Corthopsilosis. Methods: The antifungal activity of the eye drop solution was ascertained by microdilution method in accordance with EUCAST obtaining the minimum inhibitory concentration for Ozodrop. The mechanism of action was further investigated in Calbicans by measuring cell vitality, intracellular reactive oxygen species production, levels of cellular and mitochondrial (∆Ψm) membrane potential, and the extent of membrane lipid peroxidation. Results: All Candida isolates were susceptible to Ozodrop with minimum inhibitory concentration values ranging from 0.195% (v/v) for Cglabrata to 6.25% (v/v) for Corthopsilosis. After 1 hour of exposure at the minimum inhibitory concentration value about 30% of cells were killed, reaching about 70% at the highest Ozodrop value. After Ozodrop exposure, Calbicans showed cell membrane depolarization, increased levels of lipid peroxidation, depolarized ∆Ψm, and increased reactive oxygen species generation. Conclusions: The significant increases in reactive oxygen species production cause the accumulation of reactive oxygen species-associated damages leading to progressive Candida cell dysfunction. Translational Relevance: The antifungal activity of Ozodrop was demonstrated at concentrations several times lower than the concentration that can be retrieved in ocular surface after its application. The antifungal activity of the eye drops Ozodrop would represent an interesting off-label indication for a product basically conceived as an eye lubricant.

Queixa ocular X condutas nas farmácias de Pelotas, RS: o que mudou em 12 anos / Eye complaints X clerks' conducts in drugstores of Pelotas, RS: changes in twelve years

Introdução: Investigar a conduta dos balconistas de farmácia frente a um caso simulado de olho vermelho e comparar com os resultados de pesquisa similar ocorrida há 12 anos na mesma cidade, bem como avaliar a associação entre a localização do estabelecimento farmacêutico com indicação de consulta médica. Métodos: Através de estudo transversal, investigaram-se 146 farmácias em Pelotas, RS, por meio de um questionário padronizado e pré-codificado. O entrevistador chegava ao estabelecimento com a suposta queixa: “Ao acordar nesta manhã venho sentindo ardência ocular e lacrimejamento, além de perceber o olho vermelho, o que posso fazer?”. Caso a resposta do balconista fosse diversa da orientação da procura de atendimento médico, era feita a seguinte pergunta: “Você acha que devo procurar um médico?”. As associações foram estudadas através do teste qui-quadrado. Resultados: As principais condutas foram: 89 (60,9%) atendentes indicaram o uso de descongestionantes oculares, 17 (11,6%) o uso de lágrima artificial ou soro fisiológico, 12 (8,2%) o uso de colírio antisséptico, 9 (6,2%) o uso de antibióticos. Além disso, 10 (5,8%) atendentes indicaram a procura do médico. Em comparação com estudo similar realizado em 1997, houve significativo aumento na indicação de lágrimas artificiais e diminuição na indicação de descongestionantes e antibióticos. Ademais, o estudo atual demonstrou que uma maior proporção de indicações de procura médica associou-se a farmácias da área central da cidade. Conclusão: Sugerem-se iniciativas que contemplem a fiscalização mais rigorosa do comércio de medicamentos oftalmológicos, fomento à educação populacional e maior acesso aos cuidados básicos de saúde.

Introduction: To investigate the conduct of drugstore clerks in the face of a simulated case of red eyes, and to compare the results with those of a similar research performed 12 years ago in the same city, as well as to evaluate the association between the location of the drugstore and an indication of a medical visit. Methods: In a cross-sectional study we investigated 146 drugstores in South Brazil through a standardized pre-coded questionnaire. The interviewer reached the store and told the clerk: “When I woke up this morning my eyes were burning and tearing and red; what can I do about it?” If the clerk’s response was other than referral to medical care, we asked the following question:” Do you think I should see a doctor?” Associations were studied using the chi–square test. Results: The main suggested courses of action by the clerks were: 89 (60.9%) indicated the use of ocular decongestants, 17 (11.6%) the use of artificial tears or saline, 12 (8.2%) the use of a topical antiseptic, and 9 (6.2%) the use of antibiotics. In addition, 10 (5.8%) clerks advised seeking medical care. Compared with a similar research conducted in 1997, there was a significant increase in the indication of artificial tears and a decrease in the indication of decongestants and antibiotics. Moreover, the current study showed that a higher proportion of indications of seeking medical care was associated with drugstores in the downtown area. Conclusion: We suggest initiatives that provide for a stricter control of the trade of eye care drugs, promotion of population education, and increased access to basic health care.