[Medico-surgical management of intravitreal hemorrhage in diabetic patients]

Vitreous hemorrhage (VH) is the main complication of proliferative diabetic retinopathy and remains the primary indication for vitrectomy in diabetic patients. The objective of our study is to compare our medical and surgical management of VH with data from the literature and to report the functional results of our series. We studied a series of 284 cases collected over 2 years in two tertiary care centers. In our series, 90.1% of patients had type 2 diabetes, and 70% had glycosylated hemoglobin greater than 7.5%. On fundus examination, 35.2% presented with stage 1 VH, 42.6% with stage 2, 3.6% with stage 3 and 5.2% with stage 4. Ocular ultrasound performed when fundus exam was difficult diagnosed an associated tractional retinal detachment in 8.8% of patients. Medical treatment was sufficient in 77.8% of patients, while 22.2% of our patients underwent vitrectomy, argon laser endophotocoagulation and postoperative anti-VEGF injection. Peeling of tractional fibrovascular membranes and or associated epiretinal membranes was performed in 69.8% of cases. Iatrogenic tears were noted in 11.8% of patients. In this study, 31.5% of patients underwent intraocular gas tamponade, while 23.8% of cases underwent silicone oil tamponade. Postoperative visual acuity improved by at least 2 lines in 60% of our patients, and the VH recurred in 24.2% of cases after surgery.

Detection of Mutations in SARS-CoV-2 Genomic Clades using COVIDSeq-NGS among International Travelers

Introduction/Objective

Numerous SARS-CoV-2 variants/lineages have been identified based on genome sequencing. As of June 15, 2022 almost 11,399,573 whole genome sequences have been deposited in the GISAID-database. Severity and spread of COVID19 is based on their efficiency of infection and to multiply in host. That largely depend upon the structural mutation in spike, ORF and N proteins etc. That happens due to translation of genomic mutations during polypeptide synthesis. Also, the mutations are region/country specific. Specific mutation and combination of mutation causes the emergence of new strains. However, the strains can migrate from one region to other through travelers. The main objective of the current study is profiling of mutations in the genome of SARSCoV2 using Next- Generation-Sequencing (NGS) in international travelers and phylogenetic analysis of the sequences to find out different clades of SARSCoV2.

Methods/Case Report

A total of 557 SARSCoV2 genomes were sequenced on S4-sequencing flow-cell on NovaSeq 6000. For NGS of SARS-CoV-2 genome, Illumina, COVIDSeq kits and the protocols will be used strictly as recommended by the manufacturer. After NGS the analysis was done followed by FASTA sequences retrieval, mutations recording and phylogeny.

Results (if a Case Study enter NA)

This study reports 11 clades (19A, B, 20A, B, C, D, 20E; EU1, 20G, 20H; Beta V2, 20I: Alpha V1, 21D; and Eta) for the first time in international travelers. To best of our knowledge, this is the first report of the COVIDSeq approach for detection of mutation in SARSCoV2 genomic clades. The study revealed some dominants mutations was (Orf1a: P2018Q, K1053R, E176V, Orf1b: A520V, T2165A, S: D1127G, D614G, L18F etc. in other genes).

Conclusion

Profiling of common mutations among travelers could fill some gaps about the existence of SARS-CoV-2 variants information. However, further studies are needed to consolidate these findings before to be utilized for development of a potential therapeutic strategy.

Elucidation of correlation between SARS-CoV-2 RdRp and N gene cycle threshold (Ct) by RT-PCR with age and gender

Background

Coronavirus disease 2019 (COVID19) caused by the new severe acute respiratory syndrome coronavirus 2 (SARSCoV2) is a global public health emergency. Age and gender are two important factors related to the risk and outcome of various diseases. Cycle threshold (Ct) value is believed to have relation with age and gender.

Objective

This study has been conducted to investigates the association between SARS-CoV-2 cycle threshold to age and gender of COVID-19 patients, to investigate whether the population-wide change of SARSCoV2 RTPCR Ct value over time is corelated to the number of new COVID19 cases and to investigate the dynamic of RdRp and N genes.

Methods

72,811 individuals from second wave of COVID19, were observed in current study at Pure Health Lab, Mafraq Hospital, Abu Dhabi, UAE.

Results

15,201/72,811 (21 %) positivity was observed. COVID-19 were more prevalent in males (59.35%) as compared to female (40.65%). The Positivity rate were significantly higher in Male than in Female cases (p-Value = 0.04). The Ct values for both targets of all the samples were ranged from 4.57 to 29.73. Longitudinal analysis showed significant increased during the study period from starting to end as were hypothesized. Interestingly, both the targets (RdRp and N) were present in age < 1 year. Which may indicate that mutated strains are not prevalent in children’s < 1 year.

Conclusion

There was no statistically significant difference in viral loads in between age-groups. Males were tending to higher viral load compared to females. The findings have implications for preventive strategies.

Investigation of wound healing potential of photo-active curcumin-ZnO-nanoconjugates in excisional wound model

Wound healing, being a dynamic process consisting of hemostasis, inflammation, proliferation, and remodeling, involves the complicated interplay of various growth mediators and the cells associated repair system. Current wound healing therapies usually fail to completely regain skin integrity and functionality. Traditionally, curcumin is considered a potent natural wound healing agent as it possesses antibacterial, antioxidant, and anti-inflammatory properties. It is also known that zinc oxide (ZnO) nanoparticles (NPs) have photocatalytic properties, including the generation of reactive oxygen species. ZnO nanoaprticles are also Food and Drug Administration (FDA) approved as safe substances. While ZnO oxide requires illumination with ultraviolet light to become photocatalytically active, dye-sensitized ZnO can be activated by illumination with visible light. In the present study, we explored the wound healing potential of ZnO nanoparticles sensitized with curcumin (Cu+ZnO Nps) and illuminated with visible (blue) light generated by an array of high power LEDs. We studied the antibacterial effect of our conjugates by percentage reduction in bacterial growth and biofilm formation. The wound healing potential was analyzed by percentage wound contraction, biochemical parameters, and histopathological analysis of the wounded site. Additionally, angiogenesis and wound associated cytokines was evaluated by immunohistochemistry of CD31 and gene expression analysis of IL-1β, TNF-α, and MMP-9 after 16 days of post-wound treatment, respectively. Our study suggests that the therapeutic effect of Cu+ZnO NPs with LED illumination increases its wound healing potential by producing an antibacterial and anti-inflammatory effect. Moreover, the treatment strategy of using a nano formulation in combination with LED illumination further increases its efficacy. It was concluded that the anti-inflammatory and bactericidal effects of the LED illuminated Cu+ZnO Np showed accelerated wound healing with increased wound contraction, collagen deposition, angiogenesis, and re-epithelialization.

Effect of drying condition on physicochemical and antioxidant properties of dried Moringa leaf powder

Profile of physicochemical and antioxidant activity of dried Moringa leaves from Bangladesh are presented. Moringa is beneficial for health because it has a lot of nutritional and medicinal values. The leaves were collected and washed with distilled water at different temperatures in an oven dryer, and then the fine powder is taken as a sample by grinding and sieving method. This research was done to compare the changes in physicochemical and antioxidant elements at different temperatures (60°C, 70°C and 80°C) and to find the right temperature at which the nutrient loss will be the lowest. This study showed that as the drying temperature changed, so did the nutrient component of Moringa leaves. Physicochemical parameters (moisture, ash, protein, carbohydrate, fat, color) and antioxidant activity (Total phenol content, DPPH free radical scavenging activity, vitamin C, and ß-carotene) were extracted using a variety of methods. The protein content, carbohydrate content was estimated by the Kjeldahl and phenol sulfuric acid method respectively. Total phenol content (38.30 mg/100g), DPPH (77.79%), and ßcarotene (22.71mg/100g) were measured by the spectrophotometric method. And the colorimeter instrument is used for determining the optical properties. It can be seen that the moisture, ash, protein, carbohydrate, Total phenol content, Vitamin C, DPPH free radical scavenging activity, ß-carotene contents decrease significantly with increasing drying temperature, whereas fat content increases. At 60°C drying temperature the nutrient loss was lowest compared to 70°C and 80°C drying temperature, so it can be concluded that 60°C is the most suitable temperature for drying Moringa leaves.

Effectiveness of a School Based Smokeless Tobacco Intervention: A Cluster Randomized Trial

To assess the effectiveness of intervention in improving knowledge, attitude and perception regarding smokeless tobacco (SLT) use and its harmful effects and intention to quit SLT among school going adolescents. A school-based cluster randomized control trial was carried out in 18 secondary schools targeting male and female students from grades 6 to 10 in Karachi. Primary outcome was knowledge about hazards of smokeless tobacco (SLT) and secondary outcomes were attitude and Perception about hazards of SLT, and intention to quit SLT. We enrolled 738 participants in intervention group and 589 in the control group. Mean score of knowledge significantly improved in intervention as compared to control group (P value < 0.01). Intention to quit was found to be proportionately higher (33%) in the intervention group as compared to control group. Generalized estimating equations were used to assess the association of factors with knowledge regarding harmful effects of SLT use. Significant predictors of increase in knowledge score were found in children: who had seen any anti SLT messages on social media in the past 30 days, who were getting information regarding harmful effects of SLT use in school or textbooks and who had friends using SLT. A school-based intervention was effective in increasing knowledge regarding the harmful effects of SLT use and intention to quit SLT use among school adolescents. Introduction of such educational programmes on a regular basis in schools or as part of school curriculum can have an impact on reducing prevalence of SLT use.Trial Registration NCT03418506. https://register.clinicaltrials.gov/NCT03418506 .

Structural investigation of human dectin-1 receptor; A novel gateway in drug discovery

Stimulation of C-type lectin domain of human dectin-1 receptor by fungal β-glucans causes conformational changes in its cytoplasmic domain which initiates various cellular responses mediated by downstream signaling components. We aimed to build the three-dimensional structures of the cytoplasmic domain as well as C-type lectin domain of human Dectin-1along with their potential ligands through homology modeling.The overall three-dimensional fold of cytoplasmic domain was found to consist of mixed β-sheet whereas,in case of C-type lectin domain antiparallel β-sheets flanked by α-helices were observed. Protein-protein docking strategy was utilized to monitorkey interactions between cytoplasmic domainof dectin-1 receptor and PKCδ, as a prime regulator of Dectin-1 signaling. The interface was observed to have both hydrophilic and hydrophobic amino acid residues maintaining crucial contacts between the two proteins. The given three dimensional structural information can be implicated in structure-based drug designing to discover potential immunomodulators that can interfere with the immune responses and phagocytosis during inflammatory and infectious conditions.

Bergenin loaded gum xanthan stabilized silver nanoparticles suppress synovial inflammation through modulation of the immune response and oxidative stress in adjuvant induced arthritic rats

Bergenin (BG) is a naturally occurring C-glycoside with demonstrated anti-arthritic potential.

Assessment of a modification of Brückner's test as a screening modality for anisometropia and strabismus

BACKGROUND

Current amblyopia screening methods are not cost effective.

AIM

To evaluate the diagnostic capability of a modified Brückner test (MBT) for amblyopiogenic risk factors.

MATERIALS AND METHODS

We applied the MBT using the streak retinoscope to identify anisometropia and strabismus by noting an inter-ocular difference in movement and glow, from children who failed 6/9 Snellen on community vision screening, followed by comprehensive eye examination. STATISITICS: Data were analyzed by 2 × 2 tables for diagnostic test parameters (95% CI).

RESULTS

From 7998 children vision-screened, 392 failed 6/9 VA and were referred. Since 34 failed to reach the centers, and 15 were excluded due to poor/ no glow, data from 343 was analyzed. The prevalence of anisometropia of 0.5D was 17%, of 1D was 11% and of strabismus 5%. For the MBT the accuracy was ≥ 90% (95%CI 89% to 97%) over the three outcomes. The sensitivity, specificity, NPV and +LR for anisometropia of 0.5D were: 0.57 (0.48, 0.64), 0.97 (0.95, 0.98), 0.92 (0.90, 0.93) and 18 (9.7, 35); for 1D: 0.74(0.60, 0.82), 0.95 (0.94, 0.97), 0.97 (0.95, 0.98) and 16 (9.3, 28); and for strabismus: 0.5 (0.32, 0.66), 0.98 (0.97, 0.98), 0.97 (0.96, 0.98) and 20 (9.1, 42).

CONCLUSION

Our data suggests that the MBT is highly accurate and useful for ruling in anisometropia and strabismus in children who fail 6/9 Snellen. The MBT needs further validation, both by different care givers and on differing populations. It offers an affordable, portable, and clinically useful tool to detect anisometropia and strabismus. We suggest that performing an MBT prior to uniocular retinosocpy should be a routine practice.

Incidence of posttrabeculectomy cataract among Arabs in Kuwait

Trabeculectomy was performed in 466 glaucomatous eyes of 342 patients. Of these eyes, 54% appeared to have lens opacities. However, 35% of these cases had the cataract preoperatively and in 19% the cataractous changes appeared to develop postoperatively. The risk of development of posttrabeculectomy cataract seemed to increase with patient age. In addition, our results show that 51% of the patients developing a postoperative cataract had hypotony with a flat anterior chamber, 24.4% had hyphema and 20% had uveitis. Our findings suggest that the main risk factors involved in the posttrabeculectomy development of cataract are age, hypotony, hyphema, uveitis and probably minor trauma to the lens by continuous circulation of the aqueous humor through the surgical fistula.

Intraocular lens implantation following cataract extraction in Fuchs' heterochromic uveitis

Nine patients with cataract secondary to heterochromic uveitis underwent intraocular lens implantation after extracapsular cataract extraction from the posterior chamber, and were followed up for a period ranging from 12 to 36 months (mean 23.3). Visual acuity was restored to 6/9 unaided or better in 5 cases and 6/12 unaided in 3 cases whose reduction of vision was due to massive pigmentation like keratic precipitates (KP) on the implant. A 6/18 unaided visual acuity in the ninth case was due to opacification of the posterior capsule. Postoperative complications included: mild uveitis (2 cases) and massive pigmentation like KP on the lens implant (3 cases). The rest of these patients had mild pigmentation. There were no cases that developed either intraocular pressure or inflammatory pupillary membranes. Additionally, disappearance of KP from the cornea was observed in 2 cases.

Cardiovascular changes induced by large doses of clonidine in mice

Clonidine at doses of 0.5-1.0 mg/kg i.p. produced an initial rise followed by a sustained fall in blood pressure. The initial pressor response became more marked and the onset of hypotensive effect was delayed as the dose was increased to large doses such as 10-50 mg/kg given intraperitoneally. The heart rate was markedly reduced soon after clonidine administration and the bradycardia lasted for more than 2 hours. Both the initial pressor and subsequent hypotensive effects of clonidine were reduced by pretreatment with phentolamine, the initial pressor effects were suppressed by propranolol which did not affect the hypotensive effects. This initial pressor effect was potentiated while the hypotensive effect was reduced after bilateral vagotomy and pretreatment with either 6-hydroxydopamine or atropine. The bradycardia was significantly reduced by propranolol, atropine and bilateral vagotomy. Central sympathetic as well as parasympathetic mechanisms may be involved in cardiovascular changes after large doses of clonidine in urethanized mice.

Possible involvement of a central noradrenergic system in automutilation induced by clonidine in mice

Automutilation induced by a single large dose of clonidine was potentiated by pretreatment with methamphetamine, caffeine and theophyline, while it was inhibited by acute administration of reserpine, alpha-methyl-p-tyrosine, phenoxybenzamine, phentolamine and chlorpromazine. L-Dopa, 5-hydroxytryptophan and p-chlorophenylalanine had no effect on this abnormal behavior. Biochemical studies on brain monoamines revealed that noradrenaline was markedly increased and dopamine slightly so, but 5-hydroxytryptamine was never changed by clonidine. These results suggest that a central noradrenergic system may be involved in automutilation induced by clonidine in mice.

Automutilation induced by clonidine in mice

Clonidine (2-(2,6-dichlorophenylamino)-2-imidazoline hydrochloride, St155, Catapres), after administration of a single large dose, was found to induce automutilation in mice housed individually in the absence of objects to bite. This abnormal behavior was not significantly altered with chronic administration of the drug, and showed no behavior induced by the same drug in mice caged in groups.