Candida keratitis and endopthalmitis after corneal transplantation; two case reports, a novel regimen and literature overview of therapeutic options

Purpose To evaluate treatment options for candida keratitis and endopthalmitis after corneal transplantation. Methods Case reports and literature review. Results Two patients with keratitis due to Candida glabrata/ parapsilosis after corneal transplantation were successfully treated with a combination of topical voriconazole, intracameral voriconazole and amphotericin B, and systemic treatment with flucytosine. Conclusions Natamycine and voriconazole topically are preferred therapeutic options for the treatment of fungal keratitis. Systemic flucytosine is a useful alternative additive, particularly for countries where natamycine is not registered as a pharmaceutical agent.

The Cough Reflex: The Janus of Respiratory Medicine

In clinical practice, we commonly face adversity when encountering dysfunction of the cough reflex. Similar to ancient Roman deity Janus, it often presents with one of two opposing “faces”. Continual aberrant activation of the cough reflex, also known as chronic cough, can cause great detriment to quality of life and many of these patients are left misdiagnosed and undertreated. In contrast, loss of normal functioning of the cough reflex is the cause of a significant proportion of mortality in the elderly, primarily through the development of aspiration pneumonia. In this review we discuss both hyper- and hypo-activation of the cough reflex and how airway reflux and chronic aspiration may be involved in the aetiology and sequalae of both disease states. We detail the physiological and pharmacological mechanisms involved in cough, and how the recent development of P2X3 receptor antagonists may lead to the first pharmaceutical agent licensed for chronic cough. The treatment and prevention of loss of the cough reflex, which has been largely neglected, is also discussed as novel low-cost interventions could help prevent a number of hospital and domiciliary deaths from both acute and chronic aspiration.

Quantitative determination of the new substance 7-(4-fluorobenzyl)-3-thioxo-2,3-dihydro[1,2,4]triazolo[4,3-a]pyrazin-8(7H)-one as a potential pharmaceutical agent

The article presents results of studies on the development of a quantification method for a substance 7-(4-fluorobenzyl)-3-thioxo-2,3-dihydro-[1,2,4]triazolo[4,3-a]pyrazin-8(7H)-one using the method of nonaqueous potentiometric titration. Validation of the developed method has been carried out confirming the following characteristics: linearity, accuracy and precision that match the acceptance criteria for these measures.

Assessing the Skills of Alberta’s Refracting Opticians: Can Opticians Safely and Independently Refract and Prescribe Optical Appliances?

Alberta is one of three Canadian provinces that permits optician-performed refractions. Recently, the Alberta College and Association of Opticians (ACAO) has requested an expansion of opticians’ scope of practice to include the ability to prescribe optical appliances, an activity currently restricted to optometrists and ophthalmologists. For the remainder of this paper, the term “prescribe” should be interpreted as the prescription of an optical appliance, not a therapeutic pharmaceutical agent. In this paper, we investigate whether designated refracting opticians in Alberta have adequate training and knowledge to safely and independently perform a refraction and prescribe an optical appliance. To answer this research question, we composed a list of 27 skills we deem necessary to safely and independently refract and prescribe. We then evaluated the Northern Alberta Institute of Technology’s (NAIT) opticianry programs and the entry to practice examinations administered by the National Association of Canadian Optician Regulators (NACOR) and the Optometry Examining Board of Canada (OEBC) in terms of their coverage of these 27 skills. Our findings show that NAIT’s optical science programs either do not cover or do not practically assess students on over half (59 percent) of the skills required to safely and independently refract and prescribe, and the NACOR examination fails to cover 77 percent of the skills required to safely refract and prescribe. Based on this information, refracting opticians in Alberta do not possess adequate training and knowledge to safely and independently perform a refraction and prescribe an optical appliance. Granting opticians the legislative authority to independently refract and prescribe may result in a public health issue, as there may be an increase in the number of un-diagnosed or un-detected eye and systemic diseases.

Pistacia lentiscus: From Phytopharmacology to Scientific Explanations on Its Anti-Inflammatory and Antimicrobial Capacity

There is an increasing interest in revisiting plants for drug discovery proving scientifically their role as remedies. Pistacia lentiscus (PL) is a wild-growing shrub rich in terpenoids, which are pharmacological appealing. The more recurrent components in the oil are represented by α-pinene, terpinene, caryophyllene, limonene, and myrcene. High concentration of polyphenols enriches the extracts. PL-extracts showed in vitro and in animal model strong anti-inflammatory and anti-oxidative activities. The anti-inflammatory activity mainly occurs due to inhibition of NF-kB pathway or directly toward the proinflammatory cytokines, or arachidonic acid cascade against COX-2 and LOX. The antimicrobial activity of PL essential oil and extracts includes among others Staphylococcus aureus, Escherichia coli, periodontal bacteria and Candida sp.. In conclusion, the biological properties, and particularly the anti-inflammatory and anti-microbial capacity, propose PL as a new safe pharmaceutical agent.