Herpes Zoster Ophthalmicus: A Devastating Disease Coming Back with Vengeance or Finding Its Nemesis?

Herpes zoster ophthalmicus is a frequent, painful, and debilitating condition caused by the reactivation of the varicella-zoster virus alongside the ophthalmic branch of the trigeminal nerve. Twenty-five percent of adults will develop the disease during their lifetime with the risk increasing to one in two over the age of 50. Herpes zoster ophthalmicus presents with a plethora of ocular manifestations ranging from the characteristic rash in the distribution of the ophthalmic branch of the fifth cranial nerve to more severe keratouveitis, disciform keratitis, and even retinal necrosis. Up to 20% of affected patients develop post-herpetic neuralgia which can persist for years after the acute episode, resulting in potentially devastating consequences for the patient’s social, financial, and professional circumstances, as well as their quality of life and daily activities. Shingles prevention studies indicated that the herpes zoster vaccine markedly reduces the burden of the disease, as well as the incidence of both infection and post-herpetic neuralgia. Here we review the vaccinations available for herpes zoster, the reasons behind their limited adoption so far, as well as the future perspectives and challenges associated with this debilitating disease in the era of herpes zoster vaccination and coronavirus disease pandemic

Vitamin D supplementation as an adjuvant therapy for patients with T2DM : an 18-month prospective interventional study

Background Vitamin D deficiency has been associated with impaired human insulin action, suggesting a role in the pathogenesis of diabetes mellitus type 2 (T2DM). In this prospective interventional study we investigated the effects of vitamin D3 supplementation on the metabolic profiles of Saudi T2DM subjects pre- and post-vitamin D supplementation over an 18-month period. Methods T2DM Saudi subjects (men, N = 34: Age: 56.6 ± 8.7 yr, BMI, 29.1 ± 3.3 kg/m2; women, N = 58: Age: 51.2 ± 10.6 yr, BMI 34.3 ± 4.9 kg/m2;) were recruited and given 2000 IU vitamin D3 daily for 18 months. Anthropometrics and fasting blood were collected (0, 6, 12, 18 months) to monitor serum 25-hydroxyvitamin D using specific ELISA, and to determine metabolic profiles by standard methods. Results In all subjects there was a significant increase in mean 25-hydroxyvitamin D levels from baseline (32.2 ± 1.5 nmol/L) to 18 months (54.7 ± 1.5 nmol/L; p < 0.001), as well as serum calcium (baseline = 2.3 ± 0.23 mmol/L vs. 18 months = 2.6 ± 0.1 mmol/L; p = 0.003). A significant decrease in LDL- (baseline = 4.4 ± 0.8 mmol/L vs. 18 months = 3.6 ± 0.8 mmol/L, p < 0.001] and total cholesterol (baseline = 5.4 ± 0.2 mmol/L vs. 18 months = 4.9 ± 0.3 mmol/L, p < 0.001) were noted, as well as a significant improvement in HOMA-β function ( p = 0.002). Majority of the improvements elicited were more prominent in women than men. Conclusion In the Saudi T2DM population receiving oral Vitamin D3 supplementation (2000 IU/day), circulating 25-hydroxyvitamin D levels remained below normal 18 months after the onset of treatment. Yet, this “suboptimal” supplementation significantly improved lipid profile with a favorable change in HDL/LDL ratio, and HOMA-β function, which were more pronounced in T2DM females

Chronic endothelin-1 infusion elevates glomerular sieving coefficient and proximal tubular albumin reuptake in the rat

AbstractAimWe have previously found that chronic endothelin-1 (ET-1) infusion in Sprague–Dawley rats increases glomerular permeability to albumin (Palb) as assessed in vitro independent of blood pressure with no observed albuminuria. In this study, we hypothesized that ET-1 increases glomerular albumin filtration with accompanied increase in albumin uptake via the proximal tubule, which masks the expected increase in urinary albumin excretion.Main methodsNonfasting Munich-Wistar Fromter rats were surgically prepared for in vivo imaging (n=6). Rats were placed on the microscope stage with the exposed kidney placed in a cover slip-bottomed dish bathed in warm isotonic saline. Rats were then injected i.v. with rat serum albumin conjugated to Texas Red that was observed to enter capillary loops of superficial glomeruli, move into Bowman's space, bind to the proximal tubular cell brush border and reabsorbed across the apical membrane. Glomerular sieving coefficient (GSC) was calculated as the ratio of conjugated albumin within the glomerular capillary versus that in Bowman's space. Rats were again studied after 2weeks of chronic ET-1 (2pmol/kg/min; i.v. osmotic minipump).Key findingsGlomerular sieving coefficient was significantly increased in rats following chronic ET-1 infusion (0.025±0.005 vs. 0.017±0.003, p<0.05). Mean fluorescence intensity for conjugated albumin within proximal tubules was increased by ET-1 infusion: 118.40±6.34 vs. 74.27±4.45 pixel intensity (p<0.01).SignificanceThese data provide in vivo evidence that ET-1 directly increases glomerular permeability to albumin and that albuminuria is prevented by increased PT albumin uptake in the rat

Developing transcutaneous nanoenabled anaesthetics for eyelid surgery

Purpose: Local anaesthesia in eyelid surgery carries inherent risks, which has spurned ongoing investigation to identify needleless alternatives. Nanomedicines ( particles ranging between 10 nm and 1000 nm in size) have shown promise in the transcutaneous delivery of certain drugs. In this study, we explore the feasibility of nanoenabled lidocaine delivery across an artificial skin analogue. Materials and methods: Three different lidocaineloaded nanocarriers were characterised. Diffusion studies were performed through cellulose membranes using customised Franz cells. The nanocarriers included polymeric micelles (PMs) (Soluplus), solid lipid nanoparticles (SLNs) (Tripalmitin: Lecithin: Labrasol: polysorbate-20: water; 3.33:1:40:1:4.67 w/w) and selfnanoemulsifying drug delivery systems (SNEDDS) (Capryol-90: Transcutol: Labrasol; 1:3:6 w/w). Particles were characterised in terms of size, zeta-potential and morphology. One-way analysis of variance (ANOVA) with post hoc Tukey's tests were used to assess differences in permeation at a significance of p<0.05. Results: Lidocaine loading was highest in SNEDDs (50 ± 2.1 mg/g) compared with PMs (13.4 ± 0.6 mg/mL) and SLNs (2.8 ± 0.5 mg/mL). All particles possessed a size below 150 nm, illustrated good colloidal stability with a negative zeta-potential and a spherical morphology as demonstrated by transmission electron microscopy images. Cumulative lidocaine concentration after 6 h was significant for both PMs (345.7 ± 23.8 mg/ cm2/h) and SNEDDS (224.8 ± 118.2 mg/cm2/h) compared with SLNs (127.3 ± 25.4 mg/cm2/h). However, SLNs provided controlled release of lidocaine with a linear gradient that continued to increase up to 6 h. Discussion: These results highlight the potential capability of nanoparticle lidocaine delivery in eyelid surgery. The achieved flux for all nanomedicines was higher than that reported for currently approved topical lidocaine formulations (including EMLA cream)

Baseline Trachoma Surveys in Kaskazini A and Micheweni Districts of Zanzibar: Results of Two Population-Based Prevalence Surveys Conducted with the Global Trachoma Mapping Project.

PURPOSE: Based on health care records and trachoma rapid assessments, trachoma was suspected to be endemic in Kaskazini A and Micheweni districts of Zanzibar. This study aimed to investigate the prevalence of trachomatous inflammation-follicular (TF), and trachomatous trichiasis (TT) in each of those districts. METHODS: The survey was undertaken in Kaskazini A and Micheweni districts on Unguja and Pemba Islands, respectively. A multi-stage cluster random sampling design was applied, whereby 25 census enumeration areas (clusters) and 30 households per cluster were included. Consenting eligible participants (children aged 1-9 years and people aged 15 years and older) were examined for trachoma using the World Health Organization simplified grading system. RESULTS: A total of 1673 households were surveyed and 6407 participants (98.0% of those enumerated) were examined for trachoma. Examinees included a total of 2825 children aged 1-9 years and 3582 people aged 15 years and older. TF prevalence in 1-9-year-olds was 2.7% (95% confidence interval, CI, 2.7-4.1%) in Kazkazini A and 11.4% (95% CI 6.6-16.5%) in Micheweni. Among people aged 15 years and older, TT prevalence was 0.01% (95% CI 0.00-0.04%) in Kazkazini A and 0.21% (95% CI 0.08-0.39%) in Micheweni. CONCLUSION: Trachoma is a public health problem in Micheweni district, where implementation of all four components of the SAFE strategy (surgery, antibiotics, facial cleanliness, and environmental improvement), including mass drug administration with azithromycin, is required. These findings will facilitate planning for trachoma elimination

Influence of Matrix Polarity on the Properties of Ethylene Vinyl Acetate–Carbon Nanofiller Nanocomposites

A series of ethylene vinyl acetate (EVA) nanocomposites using four kinds of EVA with 40, 50, 60, and 70 wt% vinyl acetate (VA) contents and three different carbon-based nanofillers—expanded graphite (EG), multi-walled carbon nanotube (MWCNT), and carbon nanofiber (CNF) have been prepared via solution blending. The influence of the matrix polarity and the nature of nanofillers on the morphology and properties of EVA nanocomposites have been investigated. It is observed that the sample with lowest vinyl acetate content exhibits highest mechanical properties. However, the enhancement in mechanical properties with the incorporation of various nanofillers is the highest for EVA with high VA content. This trend has been followed in both dynamic mechanical properties and thermal conductivity of the nanocomposites. EVA copolymer undergoes a transition from partial to complete amorphousness between 40 and 50 wt% VA content, and this changes the dispersion of the nanofillers. The high VA-containing polymers show more affinity toward fillers due to the large free volume available and allow easy dispersion of nanofillers in the amorphous rubbery phase, as confirmed from the morphological studies. The thermal stability of the nanocomposites is also influenced by the type of nanofiller

Determination of putative virulence factors among clinical isolates of enterococci isolated from a military hospital in the eastern province of Saudi Arabia

Background: The pathogenic potential of enterococci to produce life-threatening infections is well-documented. The scientific community has, of late, evinced a renewed interest in the putative virulence factors of enterococci. Objective of the study was to determine the putative virulence factors of clinically isolated Enterococcus species from a military hospital and to describe the association between virulence factors and vancomycin susceptibility.Methods: A total of 245 enterococci were isolated from clinical samples collected from KFMMC, a leading military hospital in the eastern province of Saudi Arabia. Following species identification and antimicrobial susceptibility testing using the Vitek 2 system; the isolates were tested for the production of caseinase, gelatinase, biofilm, and presence of haemolysin.Results: Among the enterococcal isolates, 36.7% produced caseinase, 38% produced gelatinase, 24.1% exhibited biofilm formation, and 30.6% were positive for haemolytic activity. A significant association between vancomycin susceptibility patterns and the virulence factors, gelatinase and haemolytic activity, were noted. No significant associations were observed between vancomycin susceptibility patterns and the presence of caseinase or the formation of biofilms.Conclusions: Virulence factors are invariably produced by several clinical isolates of enterococci in our hospital, and some virulence factors are associated with vancomycin susceptibility