Rosacea Topical Treatment and Care: From Traditional to New Drug Delivery Systems

Rosacea is a multifactorial chronic inflammatory dermatosis characterized by flushing, nontransient erythema, papules and pustules, telangiectasia, and phymatous alterations accompanied by itching, burning, or stinging, the pathophysiology of which is not yet fully understood. Conventional topical treatments usually show limited efficacy due to the physical barrier property of the skin that hinders skin penetration of the active ingredients, thereby hampering proper drug skin delivery and the respective therapeutic or cosmetic effects. New advances regarding the physiopathological understanding of the disease and the underlying mechanisms suggest the potential of new active ingredients as promising therapeutic and cosmetic approaches to this dermatosis. Additionally, the development of new drug delivery systems for skin delivery, particularly the potential of nanoparticles for the topical treatment and care of rosacea, has been described. Emphasis has been placed on their reduced nanometric size, which contributes to a significant improvement in the attainment of targeted skin drug delivery. In addition to the exposition of the known pathophysiology, epidemiology, diagnosis, and preventive measures, this Review covers the topical approaches used in the control of rosacea, including skin care, cosmetics, and topical therapies, as well as the future perspectives on these strategies.

The effects of laser procedure in symptomatic patients with haemorrhoids: A systematic review

Purpose

Haemorrhoids are normal structures in the human body, only seen as pathological when symptomatic. Nowadays, new techniques have surfaced using a diode laser which, after locating the target arteries, blocks the blood flow while hitting and shrinking the local mucosa/submucosa at a depth of 4 mm. Our work aimed to give a broad view over this new technique and its consequences in the post-operative follow-up with a systematic review.

Methods

EMBASE and MEDLINE databases were consulted, retrieving clinical trials, which mentioned the use of 980 nm diode laser on the treatment of haemorrhoids.

Results

Ten clinical trials analyzing the post-operative effects of laser haemorrhoidectomy were selected, including 2 randomized controlled clinical trials and 1 controlled clinical trial. The overall quality of the trials was low, indicating a high risk of bias.

Conclusion

The laser haemorrhoidectomy procedure revealed a high therapeutic potential, considering the reduced number of postoperative complaints (bleeding/pain), the high symptom resolution and the reduced recurrence, albeit the high heterogeneity between the studies in terms of reported results. Future investigations with higher quality and controlled double-blinded studies obtaining better-categorized results should be conducted in order to better evaluate this procedure and compare it to the current paradigm.

Encephalitis: A rare complication of mediterranean spotted fever

Mediterranean spotted fever (MSF) is an emerging zoonosis caused by Rickettsia conorii. The MSF typically presents with a triad of fever, generalized cutaneous rash and inoculation eschar, but its clinical spectrum may range from a mild febrile illness to a potentially life-threatening condition, being central nervous system involvement highly rare. We report the clinical case of a 63-year-old male patient with MSF complicated by acute encephalitis and multi-organic failure.

Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission

The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. Transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered, as the virus remains viable in aerosols for at least 3 h and that mask usage was the best intervention to prevent infection. Heating, Ventilation and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, if not correctly used, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, also suggested an airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities with HVAC systems.

Real-world analysis of acute decompensated heart failure outcomes in Portugal

Aims

In Portugal, in the last 5 years, no study has published recent data regarding outcomes of patients with acute decompensated heart failure (ADHF). We aimed to determine the characteristics and outcomes of a large contemporaneous Portuguese cohort of ADHF patients admitted to our emergency department (ED).

Methods and results

We conducted a retrospective, study of all 1024 patients admitted to our ED with a discharge diagnosis of ADHF from November 2016 to December 2017. Baseline clinical data and outcomes {in‐hospital, 30 day, and follow‐up all‐cause mortality, and readmissions; median follow‐up, 5 months; interquartile range [(IQR), 3–11 months]} were determined. Mean age was 78 ± 10 years, and 53% were male; of the 1024 patients, 554 (54%) were hospitalized. The median hospitalization length was 9 (IQR, 5–15) days, and in‐hospital mortality was 12.7%. Hospitalized patients were predominantly men (56% vs. 47%; P < 0.001), younger (77 ± 9 vs. 79 ± 11 years; P = 0.002) and had higher creatinine values and B‐type natriuretic peptide values (P < 0.001) than discharged patients. Patients with prior hospitalization had lower 30 day readmission rate (8% vs. 14%; P = 0.01), same overall readmission rate (30% vs. 32%), and higher 30 day (13% vs. 5%; P < 0.001) and overall mortality rates (28% vs. 15%; P < 0.001).

Conclusions

Approximately half of the patients admitted to the ED were hospitalized. Of these, only 8% were readmitted in the ED within 30 days. The clinical and analytical status in the ED are important predictors of hospitalization.

Macitentan in the treatment of severe digital ulcers

Digital ulcers are one of the earliest and most disabling manifestations of systemic sclerosis (SSc). We report the clinical case of a female patient with SSc and severe digital ulcers, recurrent and refractory to the classic treatments to whom it was prescribed off-label macitentan with complete resolution of the condition.

Early Interaction of Alternaria infectoria Conidia with Macrophages

Fungi of the genus Alternaria are ubiquitous indoor and outdoor airborne agents, and individuals are daily exposed to their spores. Although its importance in human infections and, particularly in respiratory allergies, there are no studies of how Alternaria spp. spores interact with host cells. Our aim was to study the early interaction of Alternaria infectoria spores with macrophages, the first line of immune defense. RAW 264.7 macrophages were infected with A. infectoria conidia, and the internalization and viability of conidia once inside the macrophages were quantified during the first 6 h of interaction. Live cell imaging was used to study the dynamics of this interaction. TNF-α production was quantified by relative gene expression, and the concentration of other cytokines (IL-1α, IL-1β, IL-6, IL-4, IL-10, IL-17, GM-CSF and INF-γ) and a chemokine, MIP-1α, was quantified by ELISA. Conidia were rapidly internalized by macrophages, with approximately half internalized after 30 min of interaction. During the first 6 h of interaction, macrophages retained the ability to mitotically divide while containing internalized conidia. The classical macrophage-activated morphology was absent in macrophages infected with conidia, and TNF-α and other cytokines and chemokines failed to be produced. Thus, macrophages are able to efficiently phagocyte A. infectoria conidia, but, during the first 6 h, no effective antifungal response is triggered, therefore promoting the residence of these fungal conidia inside the macrophages.

Development of a novel adjuvanted nasal vaccine: C48/80 associated with chitosan nanoparticles as a path to enhance mucosal immunity

In a time in which mucosal vaccines development has been delayed by the lack of safe and effective mucosal adjuvants, the combination of adjuvants has started to be explored as a strategy to obtain potent vaccine formulations. This study describes a novel adjuvant combination as an effective approach for a nasal vaccine - the association of the mast cell activator compound 48/80 with chitosan based nanoparticles. It was hypothesized that mucoadhesive nanoparticles would promote the cellular uptake and prolong the antigen residence time on nasal cavity. Simultaneously, mast cell activation would promote a local microenvironment favorable to the development of an immune response. To test this hypothesis, two different C48/80 loaded nanoparticles (NPs) were prepared: Chitosan-C48/80 NP (Chi-C48/80 NP) and Chitosan/Alginate-C48/80 NP (Chi/Alg-C48/80 NP). The potential as a vaccine adjuvant of the two delivery systems was evaluated and directly compared. Both formulations had a mean size near 500nm and a positive charge; however, Chi-C48/80 NP was a more effective adjuvant delivery system when compared with Chi/Alg-C48/80 NP or C48/80 alone. Chi-C48/80 NP activated mast cells at a greater extent, were better internalized by antigen presenting cells than Chi/Alg-C48/80 NP and successfully enhanced the nasal residence time of a model antigen. Superiority of Chi-C48/80 NP as adjuvant was also observed in vivo. Therefore, nasal immunization of mice with Bacillus anthracis protective antigen (PA) adsorbed on Chi-C48/80 NP elicited high levels of serum anti-PA neutralizing antibodies and a more balanced Th1/Th2 profile than C48/80 in solution or Chi/Alg-C48/80 NP. The incorporation of C48/80 within Chi NP also promoted a mucosal immunity greater than all the other adjuvanted groups tested, showing that the combination of a mast cell activator and chitosan NP could be a promising strategy for nasal immunization.

Spectral analyses of systolic blood pressure and heart rate variability and their association with cognitive performance in elderly hypertensive subjects

Systolic hypertension is associated with cognitive decline in the elderly. Altered blood pressure (BP) variability is a possible mechanism of reduced cognitive performance in elderly hypertensives. We hypothesized that altered beat-to-beat systolic BP variability is associated with reduced global cognitive performance in elderly hypertensive subjects. In exploratory analyses, we also studied the correlation between diverse discrete cognitive domains and indices of systolic BP and heart rate variability. Disproving our initial hypothesis, we have shown that hypertension and low education, but not indices of systolic BP and heart rate variability, were independent predictors of lower global cognitive performance. However, exploratory analyses showed that the systolic BP variability in semi-upright position was an independent predictor of matrix reasoning (B = 0.08 ± .03, P-value = 0.005), whereas heart rate variability in semi-upright position was an independent predictor of the executive function score (B = -6.36 ± 2.55, P-value = 0.02). We conclude that myogenic vascular and sympathetic modulation of systolic BP do not contribute to reduced global cognitive performance in treated hypertensive subjects. Nevertheless, our results suggest that both systolic BP and heart rate variability might be associated with modulation of frontal lobe cognitive domains, such as executive function and matrix reasoning.

Candida krusei reservoir in a neutropaenia unit: molecular evidence of a foe?

Candida krusei has been documented as an emerging pathogen causing nosocomial outbreaks. The consecutive isolation of C. krusei strains in three patients admitted to the same hospital department within 2 months lead us to consider the possibility of an outbreak. Additionally, C. krusei isolates were collected from the room surfaces, whereas another isolate had been recovered from the blood of one patient 2 years before. HinfI DNA restriction endonuclease-based analysis of all C. krusei isolates was performed and restriction profiles were compared. Surprisingly, isolates from different patients were unrelated, whereas isolates from biological products of the same patient showed indistinguishable HinfI restriction patterns and were similar to those obtained from the surrounding environment of the respective patients. The study approach revealed the endogenous origin of the C. krusei infectious episodes observed and demonstrated that, subsequent to colonizing a patient, C. krusei can be involved in infectious episodes distant in time. The hypothesis of an outbreak was excluded, although we believe that the methodology employed in the present study represents a valuable tool for diagnostic and epidemiological surveys.

Development of a temporary marker for peptides

3-[(N,N-Dimethylaminophenyl)-4'-diazenyl]benzoic acid was coupled with several amino acid esters and the product acylated further with Boc. The material thus obtained was then submitted to cleavage by electrolysis and nucleophilic attack in order to evaluate the possibility of using this chromophore as a temporary marker.

Evidence for involvement of Saccharomyces cerevisiae protein kinase C in glucose induction of HXT genes and derepression of SUC2

The PKC1 gene in the yeast Saccharomyces cerevisiae encodes protein kinase C that is known to control a mitogen-activated protein (MAP) kinase cascade consisting of Bck1, Mkk1 and Mkk2, and Mpk1. This cascade affects the cell wall integrity but the phenotype of Pkc1 mutants suggests additional targets which have not yet been identified. We show that a pkc1Delta mutant, as opposed to mutants in the MAP kinase cascade, displays two major defects in the control of carbon metabolism. It shows a delay in the initiation of fermentation upon addition of glucose and a defect in derepression of SUC2 gene after exhaustion of glucose from the medium. After addition of glucose the production of both ethanol and glycerol started very slowly. The V(max) of glucose transport dropped considerably and Northern blot analysis showed that induction of the HXT1, HXT2 and HXT4 genes was strongly reduced. Growth of the pkc1Delta mutant was absent on glycerol and poor on galactose and raffinose. Oxygen uptake was barely present. Derepression of invertase activity and SUC2 transcription upon transfer of cells from glucose to raffinose was deficient in the pkc1Delta mutant as opposed to the wild-type. Our results suggest an involvement of Pkc1p in the control of carbon metabolism which is not shared by the downstream MAP kinase cascade.

[Cognitive effects of therapy with topiramate in patients with refractory partial epilepsy]

INTRODUCTION

Multiple studies have demonstrated that antiepileptic drug therapy may have consequences on cognitive function. Topiramate (TPM) is a new antiepileptic drug characterized by several mechanisms of action, which has proved to be clinically effective in the reduction of the quantity of crisis in epileptic patients. Clinical studies frequently report subjective cognitive complains, inconsistently sustained. The main objective of this study was to assess neuropsychological effects attributable to the addition of TPM to the current antiepileptic therapy, in patients with refractory partial epilepsy.

PATIENTS AND METHODS

44 patients were assessed through a cognitive battery applied before beginning of therapy with TPM and 6 months after the dosage had been stabilized. Tests had been chosen to assess verbal and non verbal memory, executive functions, language, visuomotor processing and psychomotor functions. The cognitive study was conducted in parallel with clinical trials TOPMAT-EPAJ-111 and TOP-POR1.

RESULTS

The statistical analysis of results didn t show changes in motor tests, in sustained attention and in logical and visual memory. Deterioration of semantic verbal fluency, verbal learning, work memory and visuomotor skills was observed. Considering the effects of the dosage of topiramate and the total quantity of antiepileptic drugs, major commitment was observed in patients taking more than 400 mg/day.

CONCLUSIONS

Like other antiepileptic drugs, topiramate, used in polytherapy in patients with refractory epilepsy, may have consequences on cognitive functions. These changes may be related with the potentiating action of this drug at the level of neurotransmission system of gamma amino butyric acid (GABA), substance that has inhibitory properties in the fore regions of the brain.

Aspects of glucose uptake in Saccharomyces cerevisiae

A wild-type Saccharomyces cerevisiae strain showed simple saturation kinetics for glucose uptake, with a Km of 4 mM when cells were obtained from exponential growth on glucose, and a similar, single Km of 2 to 8 mM was found under a variety of other growth conditions. Later in growth on glucose, and during ethanol utilization, a second kinetic component was observed, which might reflect either artifacts of membrane alteration or a Km in the molar range.

[A follow-up by telephone of patients wearing a pacemaker--the experience of the Cardiac Pacing Center of the Hospitais de Universidade de Coimbra]

OBJECTIVE

To demonstrate the viability of the transtelephonic follow-up of paced patients, and its economical, human and practical consequences.

SETTING

Pacing center of a central university hospital and departments of cardiology in district hospitals.

INTERVENTIONS

400 patients under transtelephonic follow-up, between April 1983 and December 1992, with a total of 1200 transtelephonic consultations. Analysis of the parameters of the stimulation and of the ECG tracings transmitted by a Transmitter Receptor Medtronic Teletrace 9403.

RESULTS

No technical problems were found in the transtelephonic transmission and clear ECG tracings were recorded. A very substantial decrease in follow-up costs was so obtained.

CONCLUSION

The transtelephonic monitoring of paced patients is a possible, useful and accurate method of follow-up.

Antioxidant effect of calcium antagonists on microsomal membranes isolated from different brain areas

The antioxidant effect of Ca2+ antagonists on sheep brain microsomal membranes and on liposomes prepared with total lipids extracted from the membranes was studied. Microsomal membranes were isolated from three brain areas: frontal cortex, hippocampus and caudate nucleus. Lipid peroxidation was induced by ascorbic acid and measured by malondialdehyde formation. Seven Ca2+ antagonists representative of the major chemical classes (dihydropyridines, benzothiazepines, phenylalkylamines, alkylamines, diphenylpiperazines) were tested for their antioxidant activity over a wide range of concentrations (0-500 microM). The order of antioxidant activity on frontal cortex membrane phospholipids, expressed as 50% inhibition of peroxidation (antioxidant IC50), was: nifedipine (IC50 = 4 microM) greater than flunarizine (IC50 = 48 microM) greater than bepridil (IC50 = 50 microM) greater than verapamil (IC50 = 74 microM). The dihydropyridines, nitrendipine and nimodipine, and the benzothiazepine, diltiazem, did not affect peroxidation even at a concentration of 500 microM. Membrane phospholipids are the substrate for free radical-induced damage since the extent of peroxidation in brain microsomal membranes was equal to that produced in liposomes prepared from membrane lipids. Although the lipophilicity of certain Ca2+ channel antagonists can enhance their antioxidant activity, our data suggest that Ca2+ antagonists inhibit peroxidation of the membrane lipid bilayer by a free radical scavenger effect that may be related to their chemical structure.