Peripheral ulcerative keratitis: A review of aetiology and management

Background: Peripheral ulcerative keratitis (PUK) is a severe inflammatory disease of the peripheral cornea that can be caused by local factors or systemic inflammatory disease.Aim: The purpose of this review is to give an overview of the pathophysiology, aetiology, clinical features, diagnosis, and management of PUK.Method: A PubMed search was conducted using the keywords, ‘peripheral ulcerative keratitis’ and ‘Mooren’s ulcer’.Results: The peripheral cornea has unique characteristics the predispose to the development of PUK. These include fine capillary arcades that allow for deposition of immune complexes and subsequent activation of an inflammatory cascade with corneal melt. Several conditions have been implicated in the aetiology of PUK. The most commonly cited causes are rheumatoid arthritis (RA), granulomatosis with polyangiitis (GPA) and various dermatoses. In patients with RA, PUK usually presents in established disease, whereas in GPA, PUK may be the presenting feature in up to 60% of cases. In RA it heralds the onset of a systemic vasculitis with significant associated morbidity and mortality. The management of PUK follows an individualised stepwise approach. All patients require supportive measures to encourage healing and halt the process of keratolysis. Systemic autoimmune conditions need a systemic corticosteroid as a fast-acting agent to halt the inflammatory process while cytotoxic therapy maintains long term disease control. Failure to achieve disease control with CTT, necessitates the use of a biologic agent.Conclusion: Peripheral ulcerative keratitis is a severe inflammatory disease of the peripheral cornea that needs a thorough diagnostic workup and stepwise management approach.

Reconfigurable Intelligent Surfaces for 5G and beyond Wireless Communications: A Comprehensive Survey

With possible new use cases and demanding requirements of future 5th generation (5G) and beyond cellular networks, the future of mobile communications sounds promising. However, the propagation medium has been considered a randomly acting agent between the transmitter and the receiver. With the advent of the digital age of wireless communications, the received signal quality is degrading due to the uncontrollable interactions of the transmitted radio waves with the surrounding artifacts. This paper presents a comprehensive literature review on reconfigurable intelligent surfaces (RISs) and assisted application areas. With the RIS, the network operators can control radio waves’ scattering, reflection, and refraction characteristics by resolving the harmful properties of environmental wireless propagation. Further, the RIS can effectively control the wavefront, such as amplitude, phase, frequency, and even polarization, without requiring complex encoding, decoding, or radio wave processing techniques. Motivated by technological advances, the metasurfaces, reflectarrays, phase shift, and liquid crystals are potential candidates for implementing RIS. Thus, they can be considered the front runner for realizing the 5G and beyond network. Furthermore, the current research activities in the evolving field of wireless networks operated by RIS are reviewed and discussed thoroughly. Finally, to fully explore the potential of RISs in wireless networks, the fundamental research issues to be addressed have been discussed.

Biofilm-Related Infections in Gram-Positive Bacteria and the Potential Role of the Long-Acting Agent Dalbavancin

Infections caused by Gram-positive bacteria are a major public health problem due to their increasing resistance to antibiotics. Staphylococcus and Enterococcus species’ resistance and pathogenicity are enhanced by their ability to form biofilm. The biofilm lifestyle represents a significant obstacle to treatment because bacterial cells become highly tolerant to a wide range of antimicrobial compounds normally effective against their planktonic forms. Thus, novel therapeutic strategies targeting biofilms are urgently needed. The lipoglycopeptide dalbavancin is a long-acting agent for treating acute bacterial skin and skin structure infections caused by a broad range of Gram-positive pathogens. Recent studies have shown promising activity of dalbavancin against Gram-positive biofilms, including methicillin-resistant S. aureus (MRSA), methicillin-resistant S. epidermidis (MRSE), and vancomycin-susceptible enterococci. This review outlines the mechanisms regulating biofilm development in Staphylococcus and Enterococcus species and the clinical impact of biofilm-related infections. In addition, it discusses the clinical implications and potential therapeutic perspectives of the long-acting drug dalbavancin against biofilm-forming Gram-positive pathogens.

Kombinasi Dexmedetomidine – Sevoflurane 0,5 MAC pada Bedah Mikro Reseksi Malformasi Arteri-Vena

Arterio-venous malformation (AVM) is a rare case, particularly among young patients (<40 years old). Maintaining haemodynamic stability and anticipating massive haemorrhage during micro surgery resection of AVM are fundamental for an anaesthetist. Total Intra Venous Anesthesia using propofol is still popular to control intracranial pressure as it is easily titrated and fast acting agent (both in onset and duration). Moreover, general neuruologic evaluation soon after anesthesia terminated is an integral important component of microsurgery of brain MAV. In this case report: a 20-year-old woman suddenly lost her consciousness and left-sided motors strength. Brain angiographic revealed an AVM in right frontal lobe. Microsurgery of brain AVM resection was performed. After 5-minute-preoxygenation, anaesthetic induction was performed by using propofol, fentanyl, rocuronium, and sevoflurane. The surgery went successfully using a combination of dexmedetomidine-sevoflurane 0.5MAC. Post-anaesthesia hemodynamic of this patient was in stable and without new neurologic deficit afterward.

Changes in Red Blood Cell Membrane Properties: The Role of Metabolic Syndrome Components

Metabolic syndrome (MetS) is a cluster of metabolic, hormonal and hemodynamic disorders that contribute to a change in the structural and functional status of erythrocytes and contribute to dysregulation of their cation transport function, where Ca2+ -dependent potassium channels (KCa channels) play an important role. A MetS model was performed using male Wistar rats, which were divided into control and experimental groups. Rats in the control group were fed standard rat chow. Rats in the experimental group were exposed to a high-fat and high-carbohydrate (HFHC) diet for 12 weeks. The data obtained indicate that the HFHC diet led to obesity, high blood pressure, hyperglycemia, impaired glucose tolerance, and dyslipidemia. The level of glutathione (GSH) decreased in the erythrocytes of rats suffering from MetS, but the level of malondialdehyde (MDA) increased. It was shown that the amplitude of the membrane potential of erythrocytes of rats with MetS changed depending on the acting agent: when stimulated with calcium ionophore A23187 it decreased, when the redox system ascorbat –phenazine methosulfate was used, it increased compared to the control group. The data obtained indicate that a HFHC diet leads to changes in the physical and chemical properties of the erythrocyte membrane.

Resistance-associated substitutions and response to treatment in a chronic hepatitis C virus infected-patient: an unusual virological response case report

Background Direct-Acting agents (DAAs) target and inhibit essential viral replication proteins. They have revolutionized the treatment of Hepatitis C virus (HCV) infection reaching high levels of sustained virologic response. However, the detection of basal resistance-associated substitutions (RASs) to DAAs in naïve patients could be important in predicting the treatment outcome in some patients exhibiting failures to DAA-based therapies. Therefore, the aim of this work was to evaluate the presence of RASs as minority variants within intra-host viral populations, and assess their relationship to response to therapy on a multiple times relapser patient infected chronically with HCV. Case presentation A male HCV infected-patient with a genotype 1a strain was evaluated. He had previously not responded to dual therapy (pegylated interferon-α plus ribavirin) and was going to start a direct-acting agent-based therapy (DAAs). He showed no significant liver fibrosis (F0). Viral RNA was extracted from serum samples taken prior and after therapy with DAAs (sofosbubir/ledipasvir/ribavirin). NS5A and NS5B genomic regions were PCR-amplified and the amplicons were sequenced using Sanger and next-generation sequencing (NGS) approaches. RASs were searched in in-silico translated sequences for all DAAs available and their frequencies were determined for those detected by NGS technology. Sanger sequencing did not reveal the presence of RASs in the consensus sequence neither before nor after the DAA treatment. However, several RASs were found at low frequencies, both before as well as after DAA treatment. RASs found as minority variants (particularly substitutions in position 93 within NS5A region) seem to have increased their frequency after DAA pressure. Nevertheless, these RASs did not become dominant and the patient still relapsed, despite perfect adherence to treatment and having no other complications beyond the infection (no significant fibrosis, no drug abuse). Conclusions This report shows that some patients might relapse after a DAA-based therapy even when RASs (pre- and post-treatment) are detected in very low frequencies (< 1%) within intra-host viral populations. Increased awareness of this association may improve detection and guide towards a personalized HCV treatment, directly improving the outcome in hard-to-treat patients.

Synthesis of a Novel PTH1–34 Analog with Increased Human Serum Albumin Affinity

Parathyroid hormone (PTH)1–34 is an effective peptide drug for osteoporosis therapy. However, the half-life of PTH1–34 in vivo is short, leading to the need for frequent injections of this drug during its treatment. To prolong the half-life of PTH1–34, a novel PTH1–34 analog was generated based on fatty acid generation, and its synthesis process included recombinant protein expression, side-chain modification, and peptide decoration. The PTH1–34 variant was expressed in Escherichia coli, with a single Lys (position 27) retained as a modification site. The side chain, –AEEA-γGlu-C18 diacid, was synthesized using 2-chlorotrityl chloride resin as a solid support, and then was conjugated to the PTH1-34 variant to form PTH-Lys27-AGC. Reversed-phase chromatography confirmed a high final purity (>98%) of the target compound; in vitro bioactivity tests showed that PTH-1 receptor potency of PTH-Lys27-AGC was comparable to that of the native PTH1–34. A competitive human serum albumin binding test demonstrated a high albumin affinity of PTH-Lys27-AGC in comparison to PTH1–34. In summary, we developed a novel PTH1–34 analog, PTH-Lys27-AGC, which may be a long-acting agent for osteoporosis treatment in the future.

Mechanism of Drug Resistance in Enterococci and Therapeutic Options - A Review

Enterococci exhibit an array of ways for constitutional and extrinsic resistance to primary antimicrobial agents available for clinical use. Susceptibility of these agents to β lactams, aminoglycosides or glycopeptides antibiotics or low susceptibility to combination of these agents, monomicrobial or polymicrobial nature of the infection, the involvement of heart valves or other endovascular structures affects therapy of Enterococcal infection. Vancomycin-resistant phenotypes A and B are most prevalent among medically important Enterococci isolates. Due to poor uptake of aminoglycosides, moderate level inherent resistance was reported in Enterococci. Gentamicin and Streptomycin are among the aminoglycoside antibiotics recommended for synergistic combination therapy with a cell wall acting agent. Enterococci isolates display inherent resistance to beta-lactam antibiotics due to less affinity penicillin-binding proteins, class B. Resistance to macrolides, due to erm B genotype and efflux proteins are common in Enterococci. Fluoroquinolone resistance due to genetic changes in chromosomal resistance determining regions has been observed in Enterococci isolates. Despite studies on good invitro action of Daptomycin, Linezolid and Tigecycline on Enterococci, their use may be limited due to shortage of clinical data and emergence of drug resistance. Thus optimal therapeutic option for Multidrug-resistant Enterococci infection is based on empirical observation, higher doses and combination therapies. This article reviews the antimicrobial resistance mechanism in Enterococci and available therapeutic options.

Microbial-derived bio-surfactant using neem oil as substrate and its suitability for enhanced oil recovery

The limitation in the formulation and application of synthetic surfactants in petroleum industry is owing to their high cost of production or importation and their associated toxic effect which have been proven to be harmful to the environment. Hence it is vitally imperative to develop an optimum surfactant that is cost-effective, environmentally safe (biodegradable) and equally serves as surface acting agent. This study discusses the production of microbial produced bio-surfactant and its application in enhanced oil recovery. The bacteria Pseudomonas sp. were isolated from urine and allow to feed on neem seed oil as the major carbon source and energy. The crude bio-surfactant produced from the fermentation process was used to prepare three (3) solutions of bio-surfactants at different concentrations of 5 g/500 mL, 10 g/500 mL and 15 g/500 mL, and their suitability for enhanced oil recovery (EOR) was evaluated. Reservoir core samples and crude oil collected from the Niger Delta field were used to evaluate the EOR application of the microbial-derived surfactants. The sets of experimental samples were carried out using core flooding and permeability tester equipment, and the results obtained were compared with conventional waterflooding experiments. The three bio-surfactant concentrations were observed to recover more oil than the conventional waterflooding method for the two core samples used. Optimum performance of the produced microbial-derived surfactant on oil recovery based on the concentrations was observed to be 10 g/500 mL for the two samples used in this study. Therefore, eco-friendly bio-surfactant produced from neem seed oil using Pseudomonas sp. has shown to be a promising potential substance for enhanced oil recovery applications by incremental recoveries of 51.9%, 53.2%, and 29.5% at the concentration of 5, 10, and 15 g/500 mL and 24.7%, 28.7%, and 20.1% at concentration of 5, 10, and 15 g/500 mL for the two core samples, respectively.