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Mohamed Karim Sidky, Dina Hosameldin Hassanein, Sherif A Eissa, Yehia M Salah, Nancy M Lotfy Department of Ophthalmology, Faculty of Medicine, Cairo University, Cairo, EgyptCorrespondence: Mohamed Karim SidkyDepartment of Ophthalmology, Faculty of Medicine, Cairo University, Al-Saray Street, El Manial, Cairo 11956, EgyptTel +201 222262629Email mksidky@gmail.comPurpose: To report the prevalence of subclinical keratoconus (KC), and KC suspects, in pediatric Egyptian population with astigmatic error ≥ 2 diopters (D), with the use of CSO Sirius tomographer.Methods: A cross-sectional study that included all the children aged 6– 18 years with an astigmatic error of ≥ 2 D who attended the pediatric ophthalmology clinic for routine checkups during the period between March 2017 and December 2017 was done. All subjects underwent comprehensive ophthalmic examination, and corneal imaging using CSO Sirius instrument, a pentacam with Scheimpflug technology.Results: There were 547 subjects enrolled in our study. Mean age was 11.34 ± 3.03 (range 6– 18) years. There were 278 subjects (50.8%) between 6 and 12 years, and 269 subjects (49.2%) between 12 and 18 years. Males represented 48.4% and females represented 51.6% of patients. Among all the subjects, there were 26 (4.8%) KC patients, 24 (4.4%) KC suspects, and 497 (90.9%) were normal.Conclusion: Prevalence of subclinical KC among pediatric age group with astigmatism is relatively high, hence the importance of corneal tomography screening of children with astigmatic error ≥ 2 D.Keywords: pediatric keratoconus, subclinical keratoconus, astigmatism, Scheimpflug, Sirius, Egypt

Purpose: To study the efficacy of cyclosporin 0.05% eye drops in the management of grade 1 and 2 acquired punctal stenosis and to compare the results with the clinical outcomes of mini-Monoka insertion., Methods: A prospective, controlled, interventional clinical study includes all patients (16 years and older) with symptomatic epiphora and diagnosed with grade 1 or grade 2 acquired punctal stenosis. All patients undergo punctal dilatation, canalicular probing, and nasolacrimal duct irrigation. Afterwards, patients are divided into two groups: Group A: patients receive only medical treatment in the form of topical 0.05% cyclosporin (Restasis®, Allergan Inc.) twice daily for 6 months. Group B: patients receive mini-Monoka stent insertion in the lower canaliculus for 6 weeks. Outcome measures are changes in Munk scoring, grading of the punctum, and functional and anatomical success. Functional success is defined as Munk score 0 to 1 and FDDT grade 0-2. Anatomical success is defined as grade 3 punctum., Results: Forty-two patients are included in the study, with 21 patients in each group. There were no significant differences in the Munk score between the two groups before treatment; however, group B had a significantly higher mean rank at 6 months after treatment. After treatment, the punctal size was significantly larger in group B at 4 weeks and 3 months. However, no significant difference in punctal size was detected at 6 months after treatment between the two groups., Conclusion: Application of cyclosporin 0.05% eye drops is a simple and efficient non-interventional method in the management of grade 1 and 2 acquired punctal stenosis.

Objective: This study aimed to investigate the combined effect of CYP3A5*3, CYP3A4*22, and POR*28 genetic polymorphisms on tacrolimus and cyclosporine dose requirements., Methods: One hundred thirty renal transplant patients placed on either tacrolimus or cyclosporine were recruited, where the effect of CYP3A5*3, CYP3A4*22, and POR*28 genetic polymorphisms on their dose requirements were studied at days 14, 30, and 90 post-transplantations., Results: The POR*28 allele frequency in the studied population was 29.61%. The tacrolimus dose-adjusted trough concentration ratio (C0/D) was significantly lower in the fast metabolizers group ( CYP3A5*1/POR*28(CT/TT ) carriers) than in the poor metabolizers group ( CYP3A5*3/*3/CYP3A4*22 carriers) throughout the study (14, 30, and 90 days) ( P = 0.001, <0.001, and 0.003, respectively). Meanwhile, there was no significant effect of this gene combination on cyclosporine C0/D., Conclusion: Combining the CYP3A5*3, POR*28 , and CYP3A4*22 genotypes can have a significant effect on early tacrolimus dose requirements determination and adjustments. However, it does not have such influence on cyclosporine dose requirements., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The Western Delta Deep Marine Concession (WDDM) in the Eastern Mediterranean Sea is one of northern Africa's most recent petroleum-potential regions for gas and condensate exploration. The present study aims to determine the characteristics of the 15 natural gases and 5 associated condensate samples, using molecular compositions and isotopes from the Miocene reservoir rocks in the various wells located in the WDDM. The results of this study are also used to determine the gas-condensate correlation for their probable source rocks as well as the methane-generating mechanisms (i.e., thermogenic or microbiological). Results highlighted in this research reveal that most of the natural gases in WDDM are mainly thermogenic methane gases, with small contributions of biogenic methane gases that were generated from mainly mixed sources, with a high sapropelic organic matter input for biogenic gases. The thermogenic methane gases were formed from secondary oil and oil/gas cracking at the high maturity stage of the gas window. The biogenic gases are also contributed to the Miocene reservoirs, which are formed from the primary cracking of kerogen at low maturity stage by the action of CO 2 bacterial reduction. In addition, the saturated and aromatic biomarker results show that the condensate samples were generated from clay-rich source rocks. This source unit of the Miocene condensates were deposited in a fluvial deltaic environmental setting, containing mixed kerogen type II/III and accumulated during the Jurassic-Cretaceous, as evidenced by the age dating indicators. The properties of the natural gases and associated condensates in the Miocene reservoir rocks suggest that most of the thermogenic methane gases, together with the condensate, are derived primarily from mature Jurassic-Cretaceous source rocks and formed by secondary oil and oil/gas cracking at the gas generation window, as demonstrated by the 1-D basin modelling results highlighted in the prior works. Therefore, most of the natural gases in WDDM are non-indigenous and migrated from more mature Jurassic-Cretaceous source rocks in the nearby Northern Sinai provinces or the deeper sequences in the offshore Nile Delta provinces., (© 2023. The Author(s).)

Background: Herpes simplex virus (HSV), a cause of many ocular pathologies, may affect the corneal epithelium, stroma, or endothelium, with the epithelium as the most frequently affected location. We aimed to determine the frequency and visual outcomes of HSV keratitis over a 1-year period at Farwaniya Hospital, Kuwait., Methods: This prospective observational case series included patients diagnosed with HSV keratitis who presented to the outpatient or eye casualty department between September 2022 and September 2023. Full history, demographic profile, detailed ocular and slit-lamp examinations, and visual acuity assessments were recorded prior to and after treatment. Baseline corneal sensation was assessed in the four corneal quadrants using the cotton wisp test., Results: Of the 227 patients who presented with infectious keratitis, 72 (31.7%) were diagnosed with HSV keratitis. The mean (SD) age was 45.86 (16.06) years, and 48 (66.7%) patients were male. The subtypes of HSV keratitis were endotheliitis in 27 (37.5%) patients, dendritic ulcer in 22 (30.6%), stromal keratitis with ulceration in 9 (12.5%) and without ulceration in 8 (11.1%), and geographic ulcer in 6 (8.3%). The mean baseline best-corrected distance visual acuity (BCDVA) differed significantly between the HSV keratitis subtypes ( P  < 0.001). Most patients (n = 70, 97.2%) had unilateral eye involvement, were treated within 1 - 2 weeks, and demonstrated improved BCDVA. Despite the improvement in BCDVA in all HSV keratitis subtypes, a significant difference in the median BCDVA remained after treatment ( P  < 0.001). Pairwise comparisons revealed a significantly better BCDVA after treatment in eyes with dendritic epithelial ulcers than in eyes with HSV stromal keratitis with ulceration ( P  = 0.003) or geographic epithelial ulcers ( P  = 0.005). After treatment, corneal haze and neovascularization were detected in 54 (75.0%) and 24 (33.3%) patients, respectively., Conclusions: We detected a substantial frequency of HSV keratitis in one of the governorates of Kuwait, with endotheliitis as the most common manifestation. Timely standard treatment interventions based on valid guidelines resulted in BCDVA improvement in all subtypes of HSV keratitis in our series, indicating the importance of early treatment. However, the BCDVA in eyes with dendritic epithelial ulcers remained substantially better than that in eyes with geographic epithelial ulcers or HSV stromal keratitis with ulceration, signifying the effect of the initial HSV keratitis subtype on visual outcomes. To our knowledge, this is the first study to highlight the frequency of HSV keratitis in a Kuwaiti hospital, and larger-scale research in this region is needed to further understand and manage the condition., Competing Interests: None., (© Author(s).)

Background: Omnigen is a vacuum-dehydrated amniotic membrane transplant. It can be delivered to the eye pre-mounted on a special bandage contact lens (Omnilenz) that enables its application without the need for sutures or glue; the aim of this study is to evaluate the short-term clinical outcomes of Omnilenz-Omnigen complex in eyes with acute chemical injury (CEI)., Methods: A prospective interventional study included patients with different grades of acute CEI attending the casualty between July 2021 and November 2022. All patients received first aid measures followed by the application of Omnilenz-Omnigen within the first 2 days. Patients were followed up for at least 1 month. Primary outcomes include epithelial defect and limbal ischemia. Secondary outcomes include best-corrected visual acuity (BCVA) and tolerability., Results: The study included 23 eyes of 21 patients with acute CEI mostly due to alcohol (34.8%). After the 1 st application, the size of the epithelial defect showed a statistically significant reduction (p = 0.016) with improvement in BCVA (p < 0.001). Restoration of the limbal vascularity was obtained in 56.5% of the eyes. Repeated application of Omnilenz was required in 5 eyes (21.7%). The size of the epithelial defect was reduced after the second application (p = 0.504) with improved BCVA (p = 0.185). After 1 st month, complete epithelial healing was achieved in all the eyes. Mild limbal ischemia persists in 3 (13%) of the eyes. Final BCVA showed statistically significant improvement (p < 0.001). None of the patients develops any serious complications., Conclusion: Omnilenz proved to be easy to apply and well tolerated by patients, with promising clinical outcomes., (© 2023. The Author(s).)

Aim: The aim of this paper is to investigate the need of deferring cataract surgery until treating the co-existing diabetic macular edema (DME) using intravitreal (IVI) anti-vascular endothelial growth factor (anti-VEGF)., Methods: A prospective randomized interventional study included diabetic patients with visually significant cataract and DME. Patients were divided into 2 groups. Group A received three preoperative intravitreal (IVI) aflibercept injections with a monthly interval; the third injection was given intra-operatively. Group B received a single intra-operative injection, and two post-operative injections with a monthly interval. The primary outcome measure was the change in central macular thickness (CMT) at 1st and 6th month post-operative. The secondary outcome measures were best corrected visual acuity (BCVA) at same points and any documented adverse effects., Results: Forty patients were enrolled in the study, 20 patients in each group. Means of CMT at 1 month post-operatively were significantly higher in group B than group A but no statistical difference at 6 months. There was no statistical difference between the 2 groups regarding BCVA at 1 or 6 months post-operatively. Compared with the baseline values, BCVA and CMT improved significantly after 1 and 6 months within both groups., Conclusion: IVI of aflibercept given before cataract surgeries does not seem to have superior effect over postoperative injections in either macular thickness or visual outcomes. Hence, preoperative controlling of DME might not be mandatory in patients undergoing cataract surgery., Clinical Trial Registration: The study is registered in clinical trial. Gov (NCT05731089)., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The Jiza-Qamar Basin is one of the most important exploration sedimentary basins in Yemen. For over a decade, the exploration of hydrocarbons has been occurring in this basin. Late Cretaceous age rocks are the most occurring organic-rich sediments in this basin, including coals, coaly shales, and shales. The studied organic-rich shale beds are from the Late Cretaceous Mukalla Formation and associated with coal seams. These organic-rich shales can serve as source rocks for hydrocarbon generation potential. The current study investigates the geochemical characteristics, including assessing the organic matter (OM) input, sedimentary environmental conditions, and hydrocarbon generation potential of the organic-rich shale within the Mukalla Formation from three well locations in the onshore Jiza-Qamar Basin using organic geochemistry, biomarker, and carbon isotope measurements. The studied shale samples have high OM content with total organic carbon values between 0.74 and 19.48 wt %. Furthermore, they contain mainly hydrogen-poor Types III and IV kerogen, indicating the presence of the gas-prone source rock. The presence of these types of kerogen indicates the abundance of vitrinite and inertinite macerals, as established by microscopic investigation. However, the studied organic-rich shales had biomarker features, including high Ph/Ph ratio between 3.82 and 7.46, high Tm/Ts ratio of more than 7, and high C 29 regular steranes compared to C 27 and C 28 regular steranes. Apart from the biomarker results, the studied Mukalla shales are characterized by the abundance of land-derived OM that deposited in fluvial to fluvial deltaic environments under highly oxic conditions. The finding of the considerable concentration of terrigenous OM is probably confirmed by the bulk carbon isotope and maceral composition data. The maturity indicators show that the examined organic-rich shale samples in the studied wells exhibit low VR values of up to 0.71%, and thereby, they have not been yet reached the high maturity for gas generation. This low maturity level in the studied wells is probably attributed to shallow burial depth, exhibiting depth of up to 2835 m. Therefore, the substantial gas exploration operations from the organic-rich shale source rock system of the Late Cretaceous Mukalla Formation can be recommended in the deeper stratigraphic succession in the offshore Jiza-Qamar Basin., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Background: Shifting to online learning during the coronavirus pandemic has increased the number of individuals symptomatic of digital eye strain (DES). This study aimed to determine the frequency and potential risk factors of DES among university staff members and students in this pandemic era., Methods: A cross-sectional online survey was conducted during the pandemic, in May and June 2020. The online questionnaire was designed to collect data on DES-related ocular and extraocular manifestations. The survey was sent via social media to the previous year's students and staff within the Faculty of Medicine, Tanta University, Tanta, Egypt. The responses were downloaded and analyzed., Results: Of the 412 participants completing the questionnaire, 34 (8.3%) were university staff members with a mean (standard deviation [SD]) age of 36.7 (6.6) years, and 378 (91.7%) were university students with a mean (SD) age of 20.8 (1.8) years. Participants with DES symptoms numbered 294 (71.4%) before the lockdown, increasing to 366 (88.8%) during the last month, with 84 developing new-onset DES. Most participants reported ocular symptoms associated with DES. After the lockdown, both students and staff had a significant prolongation of nighttime digital screen use and TV watching, an increase in the 4-item Patient Health Questionnaire (PHQ-4) severity scale scores, and anxiety and depression, with a reduced duration of daytime reading (all P < 0.05). Students had a significant prolongation of daytime digital screen use and TV watching and an increase in the frequency of eye lubricant use and mean Perceived Stress Scale (PSS)-4 scores (all P < 0.05). Multiple logistic regression analysis revealed that studenthood and increased nighttime screen use were independent risk factors for DES by odds ratios (95% confidence intervals) of 10.60 (2.12 - 53.00) and 3.99 (1.71 - 9.34), respectively (both P < 0.05)., Conclusions: Lockdown and closure of the university, with a shift to online learning, increased the exposure of staff and students to digital screens and the number of individuals with DES. Studenthood and prolonged nighttime digital screen use were independent risk factors for DES. Further studies investigating the prevalence and risk factors of DES, comparing similar data during and after the pandemic, may reveal other aspects of DES caused by virtual reality-based training., Competing Interests: None., (© Author(s).)

Background: Tacrolimus is a widely prescribed immunosuppressant agent for kidney transplantation. However, optimal dosing is challenging due to its narrow therapeutic index, potentially serious adverse effects, and wide inter-individual variability in pharmacokinetics. Cytochrome P450 3A (CPY3A) enzymes metabolize tacrolimus, so allelic variants such as CYP3A4*22 and CYP3A5*3 may contribute to individual differences in pharmacokinetics and therapeutic efficacy of tacrolimus. This study assessed the frequency and influences of CYP3A4*22 and CYP3A5*3 genotypes, alone and combined, on tacrolimus pharmacokinetics and dose requirements in Egyptian kidney transplant patients., Methods: This is a prospective multicenter observational cohort study. Patients were genotyped for the CYP3A4*22 (rs35599367), and CYP3A5*3 (rs776746). Tacrolimus dose (mg), through blood level (ng/ml), and dose-adjusted trough concentration (C0/D) (ng/ml per mg/kg) were recorded during the first and third months post-transplantation and compared among genotype groups., Results: The CYP3A4*22 allele was rare (3.2% of subjects) while the CYP3A5*3 allele was widespread (90.38%) in this cohort. At the third month post-transplantation, median C0/D was significantly higher among CYP3A4*22 carriers than CYP3A4*1/*1 (146.25 [100-380] versus 85.57 [27-370] ng/ml per mg/kg, p = 0.028). Patients harbouring the one copy of the CYP3A4*22 allele and the CYP3A5*3/*3 genotype (n = 5) were classified as poor tacrolimus metabolizers, the CYP3A5*3/*3 plus CYP3A4*1/*1 genotype as intermediate metabolizers (n = 60), and the CYP3A4*1/*1 plus CYP3A5*1/*1 genotype as normal metabolizers (n = 13). During the first month post-transplantation, C0/D was significantly greater in poor metabolizers (113.07 ng/ml per mg/kg) than intermediate and normal metabolizers (90.380 and 49.09 ng/ml per mg/kg) (p < 0.0005). This rank order was also observed during the third month. Acute rejection rate and renal function at discharge did not differ among genotypes., Conclusion: Pharmacogenetics testing for CYP3A4*22 and CYP3A5*3 before renal transplantation may help in the adjustment of tacrolimus starting dose and identify patients at risk of tacrolimus overexposure or underexposure., (© 2022 John Wiley & Sons Ltd.)

The anti-hyperglycemic sodium glucose co-transporter 2 inhibitor Canagliflozin (CFZ) represents a recent antihyperglycemic modality, yet it suffers from low oral bioavailability. The current work aims to formulate CFZ-loaded transdermal nanostructured liquid crystal gel matrix (NLCG) to improve its therapeutic efficiency. Pre-formulation study included the construction of pseudoternary phase diagrams to explore the effect of two conventional amphiphiles against amphiphilic tri-block copolymer in the formulation of NLCG. The influence of different co-solvents was also investigated with the use of monooleine as the oil. Physical characterization, morphological examination and skin permeation were performed for the optimized formulations. The formula of choice was further investigated for skin irritation and chemical stability. Pharmacodynamic evaluation of the successful formula was conducted on hyperglycemic as well as normoglycemic mice. In addition, oral glucose tolerance test was conducted. Results revealed the supremacy of Poloxamer for stabilizing and maximizing liquid crystal gel (LCG) area percentage that reached up to 12.6%. CFZ-NLCG2 isotropic formula showed the highest permeation parameters; maximum flux value of 7460 μg/cm 2  h and Q 24 of 5327 μg/cm 2 . Pharmacodynamic evaluation revealed the superiority of the antihyperglycemic activity of CFZ-NLCG2 in fasting mice and its equivalence in the oral glucose tolerance test (OGTT) compared to the oral one. The obtained results confirmed the success of CFZ-NLCG2 in the transdermal delivery of CFZ in therapeutically effective concentration compared to the oral route, bypassing first pass effect; in addition, eliminates the possible gastrointestinal side effects related to the inhibition of intestinal sodium glucose co-transporter (SGLT) and maximizes its selectivity to the desired inhibition of renal SGLT.

Background: At completion of transepithelial photorefractive keratectomy (t-PRK) surgery, the eye is usually fitted with a bandage contact lens to reduce discomfort and promote epithelial healing. This study aimed to compare the outcomes of eyes fitted with lotrafilcon B versus comfilcon A, silicone hydrogel bandage contact lenses after t-PRK for the correction of low to moderate myopia, with or without astigmatism., Methods: In this comparative, prospective study, patients with myopia < -6 D with or without astigmatism (< 1.75 D), who underwent t-PRK between January and June 2018, were randomly allocated to the lotrafilcon B and comfilcon A groups. Preoperative characteristics, including age, sex, eye treated, uncorrected visual acuity (UCVA), best-corrected visual acuity, mesopic pupil size, central corneal thickness, and refractive error were recorded. Postoperatively, pain score, UCVA, and corneal epithelial defect size on days 1, 4, and 7 were compared between the two groups., Results: Twenty-nine eyes were included in each group. Demographic characteristics and preoperative measurements were similar between the two groups. UCVA was significantly improved on day 7 as compared to day 1 in the comfilcon A group ( P = 0.03), but remained the same in the lotrafilcon B group ( P = 0.70) as on day 1 postoperatively. There was no significant difference in UCVA between the two groups at any follow-up visits (all P > 0.05). The pain score on the first postoperative day was significantly higher in the lotrafilcon B-fitted eyes than in the comfilcon A group ( P < 0.001), but was significantly reduced in both groups compared to day 1 (both P < 0.001). The epithelial defect in the comfilcon A group was significantly greater than in the lotrafilcon B group ( P < 0.001) at day 1 postoperatively, with significant improvement in both groups (both P < 0.001)., Conclusions: Healing responses were better with lotrafilcon B than with comfilcon A bandage contact lenses. The patients had a greater mean pain score with lotrafilcon B than with comfilcon A lenses on the first postoperative day, yet the final outcome was comparable between the two groups. We did not encounter any postoperative complications related to contact lens wear., Competing Interests: None., (© Author(s).)

Background: To report the prevalence of acquired symptomatic external punctal stenosis (EPS) in a tertiary referral center in Kuwait, and to study the associated risk factors, etiologies, and management outcomes., Methods: This prospective interventional hospital-based study was performed at the Farwaniya governmental hospital in Kuwait between November 2018 and November 2019. All patients were referred to the oculoplastic clinic with symptomatic epiphora, age > 18 years, epiphora Munk score ≥ 0, tear film meniscus ≥ 2 mm, and punctum with grade ≤ 2 (smaller than normal size, but recognizable) were included. Eclusion criteria were congenital causes of epiphora, previous eyelid surgeries, and traumatic or neoplastic causes of punctal or canalicular obstruction., Results: A total of 418 patients with symptomatic epiphora, who were referred to our oculoplastic clinic, were enrolled in our study. The prevalence of EPS was 70.3%. Eamination of the puncta revealed different shapes, including tangential, pinpoint, elevated, slit-shaped, horse shoe-shaped, and membranous puncta, with the tangential type accounting for the greatest proportion (65.3%). Bilateral punctal stenosis was observed in 206 patients (70.1%) and unilateral involvement in 88 patients (29.9%). Dilatation and syringing were performed for all puncta upon diagnosis, and repeated dilatation was performed for 225 puncta (32.7%). Placement of a Mini-Monoka tube was performed in 11 puncta (1.6%)., Conclusions: EPS was a common cause of symptomatic epiphora in our study. Aging and female sex were identified as common risk factors. Most etiological factors of EPS were associated with a pathophysiological inflammatory mechanism. For exact estimates of its prevalence, a population-based study is necessary in future., Competing Interests: None., (© Author(s).)

Purpose: We present the KAP levels and the determinants for diabetic retinopathy (DR) screening and management at a private hospital in Riyadh, Saudi Arabia., Methods: A chart review was performed of DM patients to collect the demographics and diabetes related information in June to December 2017. A close ended questionnaire was used that queried knowledge (7), attitude (5) and practice for DR screening (7)., Results: Two hundred participants were interviewed half from endocrinology unit and half from the eye clinic. An excellent knowledge of the ophthalmic effects of diabetes was noted in 91 [45.5% (95% Confidence Interval CI 38.6-52.4) of participants. Thirty-eight [19% (95% CI 13.6-24.4)] participants had a positive attitude. None had an excellent grade of practice and poor practice was noted in 168 [74% (95% CI 78.9-89.1)] participants. Longer duration of DM ( P = 0.07) and systemic complications ( P = 0.06) were associated with good knowledge. Attitude was not significantly associated with any determinants. Good practice was associated with the presence of systemic complications of DM ( P < 0.01) and those recruited to the eye clinic ( P = 0.06). Only 35% of patients had undergone an annual DR screening. Only 4 patients had a history of laser treatment., Conclusion: The KAP of diabetic patients regarding DR screening and management is less than desired. Establishing protocols and public health promotion activities directed at early detection and management are urgently needed in private sectors of Saudi Arabia., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Saudi Journal of Ophthalmology.)

Purpose: Formulation of new drug delivery system as Natamycin (NT)-loaded nanoparticle niosomal formulae mixed in different polymer gel, with the addition of ketorolac tromethamine (KETR). Pharmaceutical and experimental assessments to evaluate their safety and efficacy in treating Aspergillus keratitis. Methods: NT nanoparticle niosomes prepared by reverse-phase evaporation technique were mixed in different polymers, with the addition of KETR. Two formulae are evaluated in this study: F1 [NT-loaded nanoparticle niosomes/0.5% KETR 4% carboxymethyl cellulose (Na.CMC) gel], F2 [NT-loaded nanoparticle niosomes/0.5% KETR 2% hydroxypropylmethyl cellulose (HPMC)-E4 gel], and mixed marketed products (MMP), namely Natamet ® and Ketoroline ® suspension eye drops. NT-loaded nanoparticle niosomes/0.5% KETR were evaluated through viscosity determination, mucoadhesive attractive force, and in vitro NT release studies. The in vivo antifungal evaluation was performed on 45 albino rabbits, Aspergillus species were inoculated in right corneas of all rabbits, and then rabbits were subdivided into 3 groups, 15 rabbits each: Group A: received F1, Group B: received F2, and Group C: received MMP. Daily examination of rabbits was performed for evaluation of corneal infiltration, and signs of iritis. Two weeks later, rabbits were euthanized; their corneas were dissected at the limbus and sent for histopathological evaluation. Results: F1 had a higher viscosity and more mucoadhesive power than F2, and showed better results on corneal infiltration, and level of hypopyon. These results were consistent with the histopathological examination. Conclusion: The formula of NT-loaded nanoparticle niosomes/0.5% KT 4% Na.CMC gel has the best results from all pharmaceutical in vitro evaluations and a better cure percent in experimental application.

Objectives: This study was aimed to develop dual-purpose natamycin (NAT)-loaded niosomes in ketorolac tromethamine (KT) gels topical ocular drug delivery system to improve the clinical efficacy of natamycin through enhancing its penetration through corneal tissue and reducing inflammation associated with Fungal keratitis (FK)., Significance: Nanosized carrier systems, as niosomes would provide great potential for improving NAT ocular bioavailability.NAT niosomal dispersion formulae were prepared and then incorporated in 0.5%KT gels using different mucoadhesive viscosifying polymers., Methods: Niosomes were prepared using the reverse-phase evaporation technique. In vitro experimental, and in vivo clinical evaluations for these formulations were done for assessment of their safety and efficacy for treatment of Candida Keratitis in Rabbits. In vitro release study was carried out by the dialysis method. In vivo and histopathological studies were performed on albino rabbits., Results: NAT niosomes exhibited high entrapment efficiency percentage (E.E%) up to96.43% and particle size diameter ranging from 181.75 ± 0.64 to 498.95 ± 0.64 nm, with negatively charged zeta potential (ZP). NAT niosomal dispersion exhibited prolonged in vitro drug release (40.96-77.49% over 24h). NAT-loaded niosomes/0.5%KT gel formulae revealed retardation in vitro release, compared to marketed-product (NATACYN ®) and NAT-loaded niosomes up to57.32% (F8). In vivo experimental studies showed the superiority for F8 in treatment of candida keratitis and better results on corneal infiltration and hypopyon level. These results were consistent with histopathological examination in comparison with F5 and combined marketed products (NATACYN ® and Ketoroline ® )., Conclusions: This study showed that F8 has the best results from all pharmaceutical in vitro evaluations and a better cure percent in experimental application and enhancing the prolonged delivery of NAT and penetrating the cornea tissues.

Purpose: To compare different macular thickness parameters and peripapillary retinal nerve fiber layer (RNFL) thickness between recently diagnosed cases of multiple sclerosis (MS) without optic neuropathy (ON) and healthy individuals., Methods: This cross-sectional study was performed between June 2014 and June 2015. All subjects underwent ocular and retinal examination. Spectral domain optical coherence tomography (SD-OCT) was used to measure the thickness of different layers of the retina at macular and peripapillary regions and at different quadrants. Between groups comparison was performed with P < 0.05 indicating statistical significance., Results: There were 32 eyes in the MS group and 74 eyes in the control group. The MS group was significantly younger than the control group (P < 0.001). The mean ganglion cell complex (GCL++) thickness in superior macular area was 64.1 ± 8.9 μ in the MS group and 71.1 ± 5.9 μ in the control group. The thickness of the RNFL did not statistically differ in each of the quadrants between groups. Despite controlling for age, the macular thickness parameters were significantly thinner in eyes with MS compared to healthy eyes (P < 0.01)., Conclusion: The macular ganglion cell complex (mGCC) parameters were significantly reduced in recently diagnosed cases of MS as compared to healthy individuals., Competing Interests: None

Introduction: We compared the thickness of the peripapillary retinal nerve fiber layer (RNFL) in patients with diabetic macular edema (DME) and/against the thickness in the normal population., Methods: This cross-sectional study compared the RNFL thickness in patients with DME (DME group) using optical coherence tomography (OCT) to a comparable group of healthy (nondiabetic) patients (control group). Measurements were performed in different/the four peripapillary quadrants and in the macula region for the fovea, parafoveal, and perifoveal areas. The mean RNFL thickness was compared between both groups., Results: There were fifty eyes of fifty nonglaucomatous diabetic patients with DME (29 with nonproliferative diabetic retinopathy [PDR] and 21 with PDR), and fifty eyes in the control group. The macular regions were significantly thicker in the DME group compared to the control group. The central foveal thickness was 149 μ thicker in eyes with DME compared to the control group (P < 0.001). The difference in total RNFL thickness between groups was not significant (4.4 μ [95% confidence interval: -3.1 to +12]). The between-group differences in peripapillary RNFL thickness by age group, glycemic control, history of intravitreal treatments, and refractive errors were not statistically significant (P > 0.05, all comparisons)., Conclusion: Peripapillary RNFL thickness measurements were not significantly influenced by DME. Hence, OCT parameters could be used to monitor/early detect glaucomatous eyes even in the presence of DME.

Purpose: To evaluate the outcomes of argon laser photoablation of benign conjunctival pigmented nevi with different clinical presentations., Patients and Methods: This interventional case series was conducted between July 2014 and January 2015. Patients presenting with benign conjunctival nevi were included. Data were collected on the clinical features at presentation, argon laser photoablation, and follow-up at 8 and 24 weeks. Postoperative photography allowed recording of the success of each case and the overall success rate. Complete removal of conjunctival pigments was considered an absolute success. Partial pigmentation requiring repeat laser treatment was considered a qualified success., Results: There were 14 eyes (four right eyes and ten left eyes) with benign pigmented conjunctival nevi. There were three males and eight females in the study sample. The median age was 36 (25% percentile: 26 years). Three patients had bilateral lesions. The nevi were located temporally in nine eyes, nasally in three eyes, and on the inferior bulbar conjunctiva in two eyes. The mean horizontal and vertical diameters of nevi were 5 ± 2 mm and 4 ± 2.7 mm, respectively. The mean follow-up period was 5 months. Following laser treatment, no eyes had subconjunctival hemorrhage, infection, scarring, neovascularization, recurrence, or corneal damage. The absolute success rate of laser ablation was 79%. Three eyes with elevated nevi had one to three sessions of laser ablation resulting in a qualified success rate of 100%., Conclusions: Argon laser ablation was a safe and effective treatment for the treatment of selective benign pigmented conjunctival nevi in Arab patients.

The aim of the study was to evaluate the usefulness of presepsin as a diagnostic marker of sepsis in intensive care unit (ICU) patients. Presepsin was measured by a rapid method based on a chemiluminescent enzyme immunoassay (PATHFAST). The clinical usefulness of presepsin to diagnose sepsis and septic shock was studied and compared with procalcitonin, C-reactive protein and total leucocytic count. This study was conducted on 53 individuals divided into 3 groups. Group I included 28 adult ICU patients with at least two diagnostic criteria for systemic inflammatory response syndrome (SIRS) as patient group, Group IIa 15 patients admitted to ICU for any medical cause but with no evidence of infection were enrolled as patient control group and further 10 apparently healthy subjects as healthy control group. Patients were further subdivided retrospectively according to the final diagnosis into: patients with sepsis 16 (57.1%) and septic shock 12 (42.9%), from which 17 (59.3%) improved while 11(39.3%) did not survive. The presepsin values were significantly higher in patients with sepsis than the control groups. The area under ROC curve (AUC) for discriminating sepsis from non septic conditions for presepsin was greater than the AUC of PCT, CRP or TLC. This suggests that presepsin has high specificity and sensitivity for sepsis diagnosis. In conclusion, presepsin can be used as a useful biomarker for the diagnosis of sepsis. It is readily available, cost-effective and able to distinguish septic patients in a complex population., (Copyright© by the Egyptian Association of Immunologists.)

A study was planned to examine the insect fauna associated with two hospitals: urban (A) in Cairo and rural (B) in Banha, Egypt with varying hygienic levels and their adjacent residential areas (AC) and (BC), respectively and to investigate the effect of hygienic level on species composition and relative abundance. A total of 22 species belonging to 7 orders and 15 families were reported in the four study areas of which, Dipterous flies were the most common (8/22, 36.36% species). A total of 5257 adults were collected of which Dipterous flies were the abundant (3800, 72.28% insect) and Musca domestica was the most abundant species (3535, 67.24% insect) which was present in all areas where it was more common / predominant species (21.94%-90.91% insect). Moreover, higher densities of M domestica were in (B) and BC than in (A) or (AC). The heavily infested area was AC (54.55% species) followed by (A), (BC) and (B) however, the total number of the collected insects was higher in (BC) and (B) than in (AC) and (A). This was confirmed by finding maximum diversity indices in (AC) and minimum ones in B. In all areas, means of M domestica was more common during summer/autumn and spring than in the winter. Periplaneta americana collected oily during autumn in AC and was more common in autumn in (BC) while Blatella germanica collected only during summer in (AC) and was more common in autumn in (B). The prevalence and higher abundance of the medically important species mainly M domestica, P. americana and B. germanica in rural hospital than in urban one attribute mainly to the lower hygienic level of rural hospital This require a control program based mainly on sanitation supplemented by other measures to overcome the risk of disease transmission by such insects