Search

Ramy Awad,1 Alaa Atef Ghaith,2 Khaled Awad,1 Marina Mamdouh Saad,1 Ahmed Ak Elmassry2 1Department of Ophthalmology, Alexandria General Ophthalmology Hospital, Alexandria, Egypt; 2Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, EgyptCorrespondence: Ahmed Ak Elmassry, Ophthalmology Department, Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria, Egypt, Tel +2 0122 215 2435, Email ahmad.elmassry@gmail.comAbstract: Fungal keratitis is one of the major causes of microbial keratitis that may lead to corneal blindness. Many problems related to diagnosis and therapy are encountered in fungal keratitis, including difficulty in obtaining laboratory diagnoses and the availability and efficacy of antifungal medications. Intensive and prolonged use of antifungal topical preparations may not be enough. The use of antifungal medications is considered the main treatment for fungal keratitis. It is recommended to start antifungal therapy after confirmation of the clinical diagnosis with a smear or positive cultures. Topical application of antifungal medications is a mainstay for the treatment of fungal keratitis; however, systemic, intra-stromal, or intra-cameral routes may be used. Therapeutic keratoplasty is the main surgical procedure approved for the management of fungal keratitis with good success rate. Intrastromal corneal injection of antifungal medications may result in steady-state drug levels within the corneal tissue and prevent intervals of decreased antifungal drug concentration below its therapeutic level. In cases of severe fungal keratitis with deep stromal infiltration not responding to treatment, intracameral injection of antifungal agents may be effective. Collagen cross-linking has been proposed to be beneficial for cases of fungal keratitis as a stand-alone therapy or as an adjunct to antifungal medications. Although collagen cross-linking has been extensively studied in the past few years, its protocol still needs many modifications to optimize UV fluence levels, irradiation time, and concentration of riboflavin to achieve 100% microbial killing.Keywords: fungal keratitis, keratomycosis, PACK-CXL, antifungal, voriconazole, intracorneal injection, targeted therapy

Mohammed Iqbal,1 Ahmed Elmassry,2 Amani E Badawi,3 Hesham M Gharieb,4 Omar M Said5 1Department of Ophthalmology, Faculty of Medicine, Sohag University, Sohag, Egypt; 2Department of Ophthalmology, Faculty of Medicine, Alexandria University, Alexandria, Egypt; 3Department of Ophthalmology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 4Department of Ophthalmology, Faculty of Medicine, Ain Shams University, Cairo, Egypt; 5Department of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, EgyptCorrespondence: Omar M SaidDepartment of Ophthalmology, Faculty of Medicine, Fayoum University, Fayoum, EgyptTel +20 100 350 8051Email oms01@fayoum.edu.egPurpose: To analyze the effectiveness and stability of the refractive, topographic and visual outcomes of the standard cross-linking (SCXL) in keratoconus (KC) management.Patients and methods: This study was designed as a retrospective non-comparative study that included 28 KC patients (n=49 eyes) who performed SCXL as a single procedure to treat KC and completed five-year follow-up period. The topographic, refractive and visual data were recorded preoperatively and at 12, 24, 36 and 60 months postoperatively.Results: Forty eyes (81.6%) showed achieved postoperative spherical equivalent (SE) refraction better than the attempted refraction. Ten eyes (20.4%) improved by

Osama Ibrahim,1 Ahmed Elmassry,1 Amr Said,1,2 Moones Abdalla,2 Hazem El Hennawi,1 Ihab Osman1 1Department of Ophthalmology, Alexandria University, Alexandria, Egypt; 2Roayah Vision Correction Center, Alexandria, Egypt Purpose: To assess the safety, predictability, and effectiveness of Keraring intrastromal corneal ring segments (ICRS) insertion assisted by femtosecond laser and corneal collagen cross-linking (CXL) for keratoconus correction. Patients and methods: In this prospective, noncomparative, and interventional case series, 160 eyes of 100 adult keratoconus patients with poor best-corrected visual acuity (BCVA) (less than 0.7) and intolerance to contact lens wear were included. Patients underwent femtosecond laser-assisted placement of ICRS and CXL. All patients were examined for a complete ophthalmological test: uncorrected visual acuity (UCVA), BCVA, spherical equivalent, keratometry (K1-flat and K2-steep), pachymetry, and Scheimpflug imaging with the Pentacam at 1 week and at 1, 3, and 6 months postoperatively. Results: At 6 months, a significant difference was observed (P

BACKGROUND: Tai Chi (TC) controls pain through mind-body exercise and appears to alter inflammatory mediators. TC actions on lipid biomarkers associated with inflammation and brain neural networks in women with knee osteoarthritic pain were investigated. METHODS: A single-center, pre- and post-TC group (baseline and 8 wk) exercise pilot study in postmenopausal women with knee osteoarthritic pain was performed. 12 eligible women participated in TC group exercise. The primary outcome was liquid chromatography tandem mass spectrometry determination of circulating endocannabinoids (eCB) and oxylipins (OxL). Secondary outcomes were correlations between eCB and OxL levels and clinical pain/limitation assessments, and brain resting-state function magnetic resonance imaging (rs-fMRI). RESULTS: Differences in circulating quantitative levels (nM) of pro-inflammatory OxL after TC were found in women. TC exercise resulted in lower OxL PGE1 and PGE2 and higher 12-HETE, LTB4, and 12-HEPE compared to baseline. Pain assessment and eCB and OxL levels suggest crucial relationships between TC exercise, inflammatory markers, and pain. Higher plasma levels of eCB AEA, and 1, 2-AG were found in subjects with increased pain. Several eCB and OxL levels were positively correlated with left and right brain amygdala-medial prefrontal cortex functional connectivity. CONCLUSION: TC exercise lowers pro-inflammatory OxL in women with knee osteoarthritic pain. Correlations between subject pain, functional limitations, and brain connectivity with levels of OxL and eCB showed significance. Findings indicate potential mechanisms for OxL and eCB and their biosynthetic endogenous PUFA precursors that alter brain connectivity, neuroinflammation, and pain. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT04046003.

Abstract Background: Breast cancer (BC) is considered one of the most diversified types of tumors, characterized by a high mutational burden in the tumor milieu and a lack of immune cell makeup. The programmed death receptor-1 (PD -1)/programmed death ligand-1 (PD -L1) axis has been identified as a new target in the field of immunotherapy because, when activated, they worsen the future scenarios of the disease by helping tumor cells (TC) to escape immune surveillance. This study aims to investigate the expression of PD-L1 in BC tissues from Sudanese ladies and correlate its expression with clinicopathological features and the infiltration of CD8+T lymphocytes by immunohistochemistry (IHC). Methods: One hundred and fifty archived BC blocks were collected from National Public Health Laboratory from January 2019 to August 2020. Data regarding age, TNM staging, grade, and hormonal status were considered. Tissue sections were examined using IHC to determine the expression of PD-L1 and CD8. Results: Among one hundred and fifty BC samples, 73 (48.7%) were TNBCs, and 77 (51.3%) were hormone-positive BCs. PD-L1 was significantly associated with BC subtypes, especially TNBCs (P = 0.001), a similar significant association was shown with CD8 infiltration (P = 0.006). None of the clinicopathological features were associated with PD-L1 expression. Conclusion: PD-L1 expression is strongly associated with TNBC's and linked to CD8+ cells infiltration to the tumor milieu. Moreover, no correlation has been observed between the expression of PD-L1 and clinicopathological features in this study.

BackgroundTai Chi (TC) controls pain through mind–body exercise and appears to alter inflammatory mediators. TC actions on lipid biomarkers associated with inflammation and brain neural networks in women with knee osteoarthritic pain were investigated.MethodsA single-center, pre- and post-TC group (baseline and 8 wk) exercise pilot study in postmenopausal women with knee osteoarthritic pain was performed. 12 eligible women participated in TC group exercise. The primary outcome was liquid chromatography tandem mass spectrometry determination of circulating endocannabinoids (eCB) and oxylipins (OxL). Secondary outcomes were correlations between eCB and OxL levels and clinical pain/limitation assessments, and brain resting-state function magnetic resonance imaging (rs-fMRI).ResultsDifferences in circulating quantitative levels (nM) of pro-inflammatory OxL after TC were found in women. TC exercise resulted in lower OxL PGE1 and PGE2 and higher 12-HETE, LTB4, and 12-HEPE compared to baseline. Pain assessment and eCB and OxL levels suggest crucial relationships between TC exercise, inflammatory markers, and pain. Higher plasma levels of eCB AEA, and 1, 2-AG were found in subjects with increased pain. Several eCB and OxL levels were positively correlated with left and right brain amygdala-medial prefrontal cortex functional connectivity.ConclusionTC exercise lowers pro-inflammatory OxL in women with knee osteoarthritic pain. Correlations between subject pain, functional limitations, and brain connectivity with levels of OxL and eCB showed significance. Findings indicate potential mechanisms for OxL and eCB and their biosynthetic endogenous PUFA precursors that alter brain connectivity, neuroinflammation, and pain.Clinical Trial RegistrationClinicalTrials.gov, identifier: NCT04046003.

Key Clinical Message Pemphigus vulgaris is an autoimmune mucocutaneous disease with an involvement in gastrointestinal tract especially in oral cavity and esophagus. Ulcers can be the initial presentation even before visible mucosal or cutaneous lesions. The presenting symptoms will be in accordance with the affected organ such as throat pain, hoarseness, dysphagia, odynophagia, or even bleeding. Here, we report a case of undiagnosed pemphigus vulgaris presenting with epigastric pain whose endoscopy showed oropharyngeal involvement and isolate esophageal ulcer, which failed proton pump inhibitor treatment.

Key Clinical Messages Behçet's disease (BD) or syndrome is a chronic, recurrent, multisystem, inflammatory vasculitis disorder with findings of oral aphthous ulcers, genital ulcers, and uveitis. Gastrointestinal (GI) involvement can be the initial presentation as presented in this case. Abstract Behçet's disease (BD) or syndrome is a chronic, recurrent, multisystem, inflammatory vasculitis disorder of unknown etiology with classical findings of oral aphthous ulcers, genital ulcers, and ocular involvements including chronic anterior, intermediate, posterior, and even panuveitis. Gastrointestinal involvement in BD usually presents with chronic diarrhea, hematochezia as the disease affects ileocecal area which might be similar to presentation of inflammatory bowel diseases. Here, we report a case of undiagnosed BD who presented with chronic diarrhea for 4 months, leading to the diagnosis of BD and responded well to corticosteroid therapy.

Key Clinical Message Gallbladder herniation is a rare phenomenon with risk factors of being female, older age, and previous history of hernias. Imaging modalities can confirm the diagnosis. Cholecystectomy and hernia repair to prevent strangulation may be warranted.

Background: Neuroinflammation and mitochondrial dysfunction have been implicated in the progression of neuropathic pain (NP) but can be mitigated by supplementation with gingerol-enriched ginger (GEG). However, the exact benefits of GEG for each sex in treating neuroinflammation and mitochondrial homeostasis in different brain regions and the colon remain to be determined. Objective: Evaluate the effects of GEG on emotional/affective pain and spontaneous pain behaviors, neuroinflammation, as well as mitochondria homeostasis in the amygdala, frontal cortex, hippocampus, and colon of male and female rats in the spinal nerve ligation (SNL) NP model. Methods: One hundred rats (fifty males and fifty females) were randomly assigned to five groups: sham + vehicle, SNL + vehicle, and SNL with three different GEG doses (200, 400, and 600 mg/kg BW) for 5 weeks. A rat grimace scale and vocalizations were used to assess spontaneous and emotional/affective pain behaviors, respectively. mRNA gene and protein expression levels for tight junction protein, neuroinflammation, mitochondria homeostasis, and oxidative stress were measured in the amygdala, frontal cortex, hippocampus, and colon using qRT-PCR and Western blot (colon). Results: GEG supplementation mitigated spontaneous pain in both male and female rats with NP while decreasing emotional/affective responses only in male NP rats. GEG supplementation increased intestinal integrity (claudin 3) and suppressed neuroinflammation [glial activation (GFAP, CD11b, IBA1) and inflammation (TNFα, NFκB, IL1β)] in the selected brain regions and colon of male and female NP rats. GEG supplementation improved mitochondrial homeostasis [increased biogenesis (TFAM, PGC1α), increased fission (FIS, DRP1), decreased fusion (MFN2, MFN1) and mitophagy (PINK1), and increased Complex III] in the selected brain regions and colon in both sexes. Some GEG dose–response effects in gene expression were observed in NP rats of both sexes. Conclusions: GEG supplementation decreased emotional/affective pain behaviors of males and females via improving gut integrity, suppressing neuroinflammation, and improving mitochondrial homeostasis in the amygdala, frontal cortex, hippocampus, and colon in both male and female SNL rats in an NP model, implicating the gut–brain axis in NP. Sex differences observed in the vocalizations assay may suggest different mechanisms of evoked NP responses in females. [ABSTRACT FROM AUTHOR]

Purpose: To compare the postoperative outcomes following implantation of KERATACx ring segments (Imperial Medical Technologies Europe GmbH) in patients having eccentric keratoconus with three different topographic patterns. Methods: This retrospective cohort study was conducted at Maadi Eye Subspeciality Center, Cairo, Egypt. The study included patients with keratoconus who had implantation of KERATACx ring segments. Three groups were segregated based on topographic keratoconus patterns using the Sirius CSO Topographer (CSO Italia): type I ectasia where the cone coincides with the corneal flat axis, type II ectasia in which the cone coincides with neither the steep nor the flat axis and lies between the two axes, and type II ectasia for cones coinciding with the corneal steep axis. The visual and topographic outcomes were compared preoperatively and postoperatively for the three enrolled groups. Results: This study enrolled 92 eyes of 92 patients and had a mean ± standard deviation follow-up of 16.9 ± 9.2 months. The patients' medical records revealed that night vision complaints and halos around the light were experienced the most by the type III ectasia group (31.25%). For the type III ectasia group, four topographic indices and one visual parameter did not show statistically significant differences between the preoperative and postoperative data (inferior-superior difference at 2- and 4-mm diameter, coma aberration, higher order aberrations, and uncorrected distance visual acuity), contrary to the type I and II ectasia groups, which showed significant improvements in all evaluated parameters. Conclusions: The type III morphological pattern of ectasia is the least likely to benefit from KERATACx ring segments implantation. [J Refract Surg. 2024;40(9):e625–e634.] [ABSTRACT FROM AUTHOR]

Aim The aim of the study was to report on the ocular response analyzer and posterior segment optical coherence tomography findings in refractive surgery candidates. Patients and methods The study was conducted on 100 eyes of 50 (37 females) patients seeking refractive surgery at a private eye center in Alexandria, Egypt. Following detailed history taking, all study participants were subjected to a thorough ophthalmic examination including assessment of uncorrected and best-corrected visual acuity, manifest and cycloplegic refraction, slit-lamp examination, measurement of intraocular pressure (IOP) using Goldmann applanation tonometry, and fundus examination using a high plus auxiliary lens. Optical coherence tomography and corneal biomechanical properties were then studied using the Reichert ocular response analyzer. Results The mean±SD age of the study patients was 25.27±4.9 years and of contact lens wear (24% of study patients) was 2.5±0.9 years. The mean±SD of the manifest refractive error was −5.6±5.2 D sphere and −1.6±1.2 D cylinder and of the best-corrected visual acuity was 0.9±0.2. The mean±SD of the IOPg, IOPcc, corneal hysteresis and cornea resistance factor were 14.9±3.8, 16.5±3.4, 9.3±1.9, and 9.4±2 mmHg, of the Peripapillary Retinal Nerve Fibre Layer (pRNFL) thickness were 68.9±20.5 μ nasal, 113.3±20.7 μ superior, 77.7±16 μ temporal, and 119.3±21.5 μ inferior and of the central macula thickness was 270.8±22.9 μ. Conclusions The corneal biomechanical properties and the macular nerve fiber layer thickness are not correlated with the refractive error of the eye, whereas the peripapillary nerve fiber layer thickness correlates with the refractive error and the visual acuity. Screening of the corneal biomechanical properties and the nerve fiber layers is recommended for refractive surgery candidates.

Purpose The aim of this study was to evaluate the corneal changes after corneal collagen cross-linking (CXL) in progressive keratoconus using anterior segment optical coherence tomography. Patients and methods This prospective interventional noncomparative case-series study was conducted on 30 eyes of 18 patients of both sexes with a mean age of 23.11±4.06 years diagnosed as progressive keratoconus patients with clear central cornea. All eyes underwent epithelium-off accelerated CXL. Anterior segment optical coherence tomography and Scheimpflug camera imaging were done to all cases preoperatively and at 1, 3, and 6 months, postoperatively. Results The demarcation line (DL) was detected in all eyes 1 month postoperatively, and was still detected at 3 and 6 months, postoperatively. However, it was accurately measured until 3 months postoperatively. At 6 months, it was barely visible, so measuring its depth was difficult to be done. There was a statistically significant positive correlation between the thinnest corneal thickness and the central corneal DL depth (r=0.480, P=0.006). There was no statistically significant correlation between the maximum keratometric reading (K-max) and the depth of central corneal DL (r=−0.253, P=0.17). In addition, there was no statistically significant correlation between corneal densitometry and the depth of central corneal DL (r=−0.68, P=0.715). Conclusions The DL is a direct clinical sign of corneal CXL and can be found within 6 months after the treatment, being most clearly visible at 1 month after CXL. However, the line starts to be less visible after 3 months and becomes barely visible after 6 months postoperatively, making it difficult to measure its depth at that time.

Background Intracorneal ring segment (ICRS) implantation in combination with corneal collagen cross-linking (CXL) has shown promising results in improving the visual acuity and reducing refractive errors, but long-term results are lacking. Aim To evaluate the long-term outcomes (>5 years) of simultaneous CXL and femtosecond laser-assisted intracorneal stromal ring segment implantation for management of keratoconus. Design This was a noncomparative, noncontrolled retrospective single-center study. Patients and methods The study included 50 eyes of 37 patients with keratoconus who underwent simultaneous CXL and ICRS implantation and were followed up for at least 5 years regarding visual acuity, refraction, and corneal imaging. Results Best-corrected visual acuity showed statistically significant improvement, with mean changed from 1.07±0.41 to 0.40±0.30 LogMAR. The results showed significant improvement also after 5 years. The spherical equivalent also was significantly improved from a mean of −4.61±4.37 D to a mean of −1.41±−1.49 D. Keratometric readings also showed improvement of both K1 and K2. The mean K1 improved from a mean of 49.6±6.76–47.78±6.17 D, and the mean K2 improved from 55.04±7.34 to 52.67±7.38. The results were stable, with no statistically significant change after 5 years. Conclusions Simultaneous CXL and femtosecond laser-assisted ICRS is effective and stable for both visual outcome and refraction in patients with keratoconus.

Background Accelerated photoactivated chromophore for keratitis–corneal collagen cross-linking (PACK-CXL) was investigated to be effective in the treatment of fungal keratitis in many studies. High-fluence CXL was used effectively in the treatment of progressive keratoconus but not tested in PACK-CXL for fungal infection. Aim To evaluate the antifungal efficacy of high-fluence CXL in the treatment of induced fusarium corneal ulcer in rabbits. Design This is an experimental interventional study. Patients and methods This is an experimental interventional study conducted on 16 eyes of eight rabbits for which fusarium corneal infection was induced by intrastromal corneal injection. The rabbits were divided into two groups: group A received no treatment and was left as a control group. Group B received a single high-fluence PACK-CXL session. All rabbits were followed up for 6 days and then the eyes were enucleated. Culture was performed for seven corneas and histopathology for the remaining cornea. Results There was statistically significant deterioration in group A (P=0.003), while a statistically significant clinical improvement was seen in group B (P

Abstract Purpose To assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus. Methods Prospective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes. Results The mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p

Abstract Background This study aimed to assess visual outcomes, quality of vision and patients’ satisfaction of a trifocal diffractive intraocular lens after cataract surgery with phacoemulsification. Results The study included 36 eyes that underwent implantation of trifocal diffractive intraocular lens (IOL). The residual mean postoperative spherical equivalent was − 0.40 ± 0.29 diopters. Mean Uncorrected distance visual acuity was 0.80 ± 0.16 decimal (snellen equivalent 25 ft) while mean Uncorrected intermediate visual acuity was 0.82 ± 0.31 decimal (snellen equivalent 25 ft) and mean Uncorrected near visual acuity (UCNVA) was 0.87 ± 0.20 decimal (snellen equivalent 23 ft). In defocus curve, there was infinitesimal gradual change between the three foci. Contrast sensitivity was just below the inferior limit of normal. Conclusion Trifocal diffractive IOL created a true intermediate focus proved by VA and defocus curve and better quality of vision assessed by contrast sensitivity and high order aberration. Moreover, it was safe and effective for correcting distance and near vision in these patients. Most of the patients were very satisfied and achieved spectacle independence. Trial registration Registration number and date: NCT04465279 on July 10, 2020.

Pseudomonas aeruginosa is a Gram-negative opportunistic pathogen that causes high morbidity and mortality in cystic fibrosis (CF) and immunocompromised patients, including patients with ventilator-associated pneumonia (VAP), severely burned patients, and patients with surgical wounds. Due to the intrinsic and extrinsic antibiotic resistance mechanisms, the ability to produce several cell-associated and extracellular virulence factors, and the capacity to adapt to several environmental conditions, eradicating P. aeruginosa within infected patients is difficult. Pseudomonas aeruginosa is one of the six multi-drug-resistant pathogens (ESKAPE) considered by the World Health Organization (WHO) as an entire group for which the development of novel antibiotics is urgently needed. In the United States (US) and within the last several years, P. aeruginosa caused 27% of deaths and approximately USD 767 million annually in health-care costs. Several P. aeruginosa therapies, including new antimicrobial agents, derivatives of existing antibiotics, novel antimicrobial agents such as bacteriophages and their chelators, potential vaccines targeting specific virulence factors, and immunotherapies have been developed. Within the last 2–3 decades, the efficacy of these different treatments was tested in clinical and preclinical trials. Despite these trials, no P. aeruginosa treatment is currently approved or available. In this review, we examined several of these clinicals, specifically those designed to combat P. aeruginosa infections in CF patients, patients with P. aeruginosa VAP, and P. aeruginosa–infected burn patients.

Background/Aim: This study examined the effects of tocotrienols (TT) in conjunction with statin on glucose homeostasis, bone microstructure, gut microbiome, and systemic and liver inflammatory markers in obese C57BL/6J mice. Materials and Methods: Forty male C57BL/6J mice were fed a high-fat diet (HFD) and assigned into four groups in a 2 (no statin vs. 120 mg statin/kg diet)×2 (no TT vs. 400 mg TT/kg diet) factorial design for 14 weeks. Results: Statin and TT improved glucose tolerance only when each was given alone, and only statin supplementation decreased insulin resistance. Consistently, only statin supplementation decreased serum insulin levels and HOMA-IR. Pancreatic insulin was also increased with statin treatment. Statin and TT, alone or in combination, reduced the levels of serum IL-6, but only TT attenuated the increased serum leptin levels induced by a HFD. Statin supplementation increased bone area/total area and connectivity density at LV-4, while TT supplementation increased bone area/total area and trabecular number, but decreased trabecular separation at the distal femur. Statin supplementation, but not TT, reduced hepatic inflammatory cytokine gene expression. Neither TT supplementation nor statin supplementation statistically altered microbiome species evenness or richness. However, they altered the relative abundance of certain microbiome species. Most notably, both TT and statin supplementation increased the relative abundance of Lachnospiraceae UCG-006. Conclusion: TT and statin collectively benefit bone microstructure, glucose homeostasis, and microbial ecology in obese mice. Such changes may be, in part, associated with suppression of inflammation in the host. [ABSTRACT FROM AUTHOR]

Background The corneal cross-linking procedure has been proven to be an effective method to treat and stabilize keratoconus progression, but early vision rehabilitation is still needed in patients. Aim The aim was to compare the results of the combined CXL and intrastromal corneal ring segment implantation procedure to that of the cross-linking-alone procedure in terms of visual acuity, refraction, and some corneal topographic parameters in keratoconic patients. Design This was a prospective, comparative, and interventional study. Patients and methods This study was carried out on 44 keratoconic patients (60 eyes) of both sexes who ranged from 18 to 36 years. Thirty eyes were subjected to the CXL-alone procedure and 30 eyes were subjected to the combined procedure. Measurements were performed in all patients preoperatively and at 3, 6 months, and 1 year postoperatively including unaided visual acuity, best-corrected visual acuity, refractive, and topographic outcomes. Results Through the entire study period, both procedures were safe and effective in treating and stabilizing keratoconus progression. Furthermore, the combined group showed additional improvements over the CXL group for the following: UDVA at 3 months (P=0.0028), best-corrected visual acuity at 1 year (P=0.011), refractive and keratometric astigmatism at all follow-up visits and corneal asphericity at 3 months (P=0.013) and 6 months (P=0.0221) of follow-up. No severe intraoperative or postoperative complications were observed during the entire study period in either group. Conclusions The combined procedure is safe and effective for earlier improvement of visual and refractive outcomes in addition to the corneal stabilizing effect.

Background New approaches have been created to raise the chances of achieving big bubble (BB) in deep anterior lamellar keratoplasty (DALK); however, the BB formation is still uncertain in all cases. Other factors likely contribute to the success of bubble formation. Aim To evaluate the effect of preoperative curvature of the cornea on the success of BB formation in DALK for keratoconus. Design A prospective, comparative, nonrandomized study. Patients and methods The study was performed on 50 keratoconus patients. We compared the data of 25 patients who had successful type-1 bubble formation versus another 25 patients in whom the bubble formation failed. Both groups were compared regarding the keratometric readings recorded from the preoperative pentacam. Results The analysis showed statistically significant lower K1, K2, and Km values in the group where BB has been successfully achieved. We also found that lower K1 value was the only significant studied factor after the multivariate analysis. Conclusion Keratoconus patients with preoperative flatter corneas have slightly higher chances for successful BB formation during DALK surgery.

Virulence is a complex mix of microbial traits and host susceptibility that could ultimately lead to disease. The increased prevalence of multidrug resistant infections complicates treatment options, augmenting the need for developing robust computational methods and pipelines that enable researchers and clinicians to rapidly identify the underlying mechanism(s) of virulence in any given sample/isolate. Consequently, the National Center for Biotechnology and Information at the National Institutes of Health hosted an in-person hackathon in Bethesda, Maryland during July 2019 to assist with developing cloud-based methods to reduce reliance on local computational infrastructure. Groups of attendees were assigned tasks that are relevant to identifying relevant tools, constructing pipelines capable of identifying microbial virulence factors, and managing the associated data and metadata. Specifically, the assigned tasks consisted of the following: data indexing, metabolic functions, virulence factors, antimicrobial resistance, mobile elements in enterococci, and metatranscriptomics. The cloud-based framework established by this hackathon can be augmented and built upon by the research community to aid in the rapid identification of microbial virulence factors.

Abstract Background Biofilm is a fundamental bacterial survival mode which proceeds through three main generalized phases: adhesion, maturation, and dispersion. Lactobacilli spp. (LB) are critical components of gut and reproductive health and are widely used probiotics. Evaluation of time-dependent mechanisms of biofilm formation is important for understanding of host-microbial interaction and development of therapeutic interventions. Time-dependent LB biofilm growth was studied in two systems: large biofilm output in continuous flow system (microfermenter (M), Institute Pasteur, France) and electrical impedance-based real time label-free cell analyzer (C) (xCELLigence, ACEA Bioscience Inc., San Diego, CA). L. plantarum biofilm growth in M system was video-recorded, followed by analyses using IMARIS software (Bitplane, Oxford Instrument Company, Concord, MA, USA). Additionally, whole genome expression and analyses of attached (A) and dispersed (D) biofilm phases at 24 and 48 h were performed. Results The dynamic of biofilm growth of L. plantarum was similar in both systems except for D phases. Comparison of the transcriptome of A and D phases revealed, that 121 transcripts differ between two phases at 24 h. and 35 transcripts – at 48 h. of M growth. The main pathways, down-regulated in A compared to D phases after 24 h. were transcriptional regulation, purine nucleotide biosynthesis, and L-aspartate biosynthesis, and the upregulated pathways were fatty acid and phospholipid metabolism as well as ABC transporters and purine nucleotide biosynthesis. Four LB species differed in the duration and amplitude of attachment phases, while growth phases were similar. Conclusion LB spp. biofilm growth and propagation area dynamic, time-dependent processes with species-specific and time specific characteristics. The dynamic of LB biofilm growth agrees with published pathophysiological data and points out that real time evaluation is an important tool in understanding growth of microbial communities.

Abstract Background To compare the visual and refractive outcomes of femtosecond laser assisted cataract surgery (FLACS) using Victus platform (Technolas Bausch and Lomb (B&L), Munich, Germany) and conventional phacoemulsification cataract surgery (CPCS). Methods A retrospective study of 100 eyes operated for cataract. FLACS was performed in 50 eyes and CPCS was done in another 50 eyes. Preoperative and 6 months postoperative visual and refractive evaluation (efficacy, safety, predictability, and surgically induced astigmatism) as well as higher-order aberrations were analyzed. Efficacy index which equals post-operative mean of uncorrected distance visual acuity (UDVA) divided by preoperative mean corrected distance visual acuity (CDVA) was calculated in both groups. Safety index equals post-operative mean of corrected distance visual acuity (CDVA) divided by preoperative mean CDVA. Results Logarithm of the Minimum Angle of Resolution (LogMAR), UDVA improved in both groups after surgery (p

Aim and Objectives To determine whether Internal Limiting Membrane (ILM) peeling has an effect on visual outcomes after vitrectomy for diabetic tractional retinal detachment. Settings and Design A prospective randomized interventional case series. Patients and Methods Pars Plana Vitrectomy (23-Gauge) was performed on 34 cases with diabetic epi-macular traction affecting the vision due to advanced proliferative diabetic retinopathy. The usual steps of vitrectomy were performed. The ILM was randomly chosen to be peeled in 16 cases (group I), or left not peeled in 18 cases (group II). Eventually, either air, Sulphur hexafluoride (SF6) gas or silicone oil tamponade was used. Final visual acuity results were tabulated six months after surgery, and compared between the two groups. Results The mean pre-operative visual acuity (VA) was 0.06 (decimals) and 0.03 in groups I and II respectively. The mean post-operative VA was significantly better: 0.26 and 0.27 in groups 1 and 2 respectively (P=0.001). There were no statistically significant differences between VA gains in both groups (P=0.721). Air tamponade was used in 18.8% and 33.3%, SF6 in 37.5% and 33.3%, and silicone oil in 43.8% and 33.3% in groups I and II respectively. Conclusions ILM peeling had no effect on the final visual outcome after vitrectomy for diabetic tractional retinal detachments.