Do antibiotics prevent recurrent UTI in children with anatomic abnormalities?

Evidence is insufficient to recommend for or against antibiotic prophylaxis to prevent recurrent urinary tract infections (UTI) in children with anatomic abnormalities. Guidelines acknowledge this lack of evidence, but still recommend using prophylactic antibiotics in children with vesiculoureteral reflux (strength of recommendation: B, based on poor-quality or inconclusive cohort and randomized controlled studies). No controlled, prospective studies have examined the effectiveness of prophylactic antibiotics to prevent UTI recurrence or renal scarring

What is the role of tacrolimus and pimecrolimus in atopic dermatitis?

When the standard therapies -- mild topical corticosteroids and moisturizers -- fail in the treatment of atopic dermatitis, patients are left with few proven remedies. The recently introduced topical immunosuppressive treatment --pimecrolimus and tacrolimus -- offer an alternative to topical corticosteroids. Tacrolimus 0.1% (Protopic) appears to be both safe and effective in treating eczema in adults and children (strength of recommendation [SOR]: A). In multiple studies, it has been as effective as potent topical corticosteroids and more effective than mild topical corticosteroids (SOR: A). Pimecrolimus (Elidel) is more effective than placebo but less effective than potent topical corticosteroids (SOR: A). At this time, no data compare pimecrolimus with mild corticosteroids

Vegetal products used in dermatological practice

INTRODUCERE Cel mai mare organ al corpului uman, pielea, menţine un echilibru între diverși parametri ai organismului și este prima barieră care ne apără împotriva agresiunii factorilor externi, cum ar fi agentii infectioși: bacterii, paraziţi, virusuri. SCOPUL LUCRĂRII Cercetarea produselor vegetale, plantelor medicinale și a principiilor active utilizate în practica dermatologică. MATERIALE ȘI METODE Studiul și sinteza articolelor știinţifice privind utilizarea produselor vegetale și plantelor medicinale în practica dermatologică. REZULTATE În practica dermatologică se utilzează pe larg produsele vegetale cu conţinut de poliholozide ce pot fi aplicate local, sub formă de cataplasme, pentru umectarea tegumentelor, ca emolient: Plantaginis majoris folia (Plantago major L.); Lini semina (Linum usitatissimum L.), Echinaceae herba (Echinacea purpurea L.) Produsele vegetale bogate în vitamine au rol de a stimula regenerarea și epitelizarea rănilor, intensifică metabolismul glicoproteidelor, inhibă procesele inflamatorii, infiltraţia leucocitară și cresc activitatea fagocitară: Calendulae flores (Calendula officinalis L.); Bidentis herba (Bidens tripartita L.); Gnaphalii uliginosi herba (Gnaphalium uliginosum L.); Hippophaes rhamnoides fructus (Hippophae rhamnoides L.).Oleum Hippophaes manifestă acţiune antiinflamatoare, iar în asociere cu rostopasca este utilizat în tratamentul dermatozelor și micozelor. Acţiunea cicatrizantă și antiinflamatoare a uleurilor volatile se datorează compușilor care stimulează aparatul reticulo-endotelial prin histamina eliberată din ţesut și proprietăţi antibacterine: Chamomillae flores (Chamomilla recutita L.); Salviae folia (Salvia officinalis L.). Din grupul alcaloizilor, extractele din părţi aeriene de rostopască: Chelidonii herba (Chelidonium majus L.) au efecte cicatrizante și pot fi utilizate în tratarea rănilor, psoriazisului prin coptizină, iar rădăcinile de tătăneasa: Symphyti radices (Symphytum officinale L.) se utilizează ca consolidant și cicatrizant prin conţinut de alantoină. CONCLUZII. Produsele vegetale sunt utilizate în practica dermatologică prin conţinut bogat de mucilagii cu prorpietăţi emoliente, produse vitaminizante regeneratoare, uleiuri volatile cu proprietăţi antihistaminisce și antibacteriene, produse vegetale cu conţinut de alcaloizi cu proprietăţi cicatrizante. Complexitatea leziunilor, precum și multitudinea de soluţii terapeutice disponibile, crează noi provocări cărora farmacistul urmează să le facă faţă.INTRODUCTION The largest organ of the human body, the skin, maintains a balance between various parameters of the body and is the first barrier that protects us against the aggression of external factors, such as infectious agents: bacteria, parasites, viruses. THE AIM OF THE STUDY Research of vegetal products, medicinal plants and active principles used in dermatological practice. MATERIALS AND METHODS Study and synthesis of scientific articles on the use of vegetal products and medicinal plants in dermatological practice. RESULTS In dermatological practice are widely used vegetal products containing polyholosides that can be applied locally, in the form of poultices, to moisturize the skin, as an emollient: Plantaginis majoris folia (Plantago major L.); Flaxseed (Linum usitatissimum L.), Echinaceae herba (Echinacea purpurea L.) Vitamin-rich vegetal products have the role of stimulating wound regeneration and epithelialization, intensifying glycoprotein metabolism, inhibiting inflammatory processes, leukocyte infiltration and increasing phagocytic activity: Calendulae flores (Calendula officinalis L.); Bidentis herba (Bidens tripartita L.); Gnaphalii uliginosi herba (Gnaphalium uliginosum L.); Hippophaes rhamnoides fructus (Hippophae rhamnoides L.). Oleum Hippophaes has an anti-inflammatory action, and in combination with Celandine is used in the treatment of dermatoses and fungal infections. The healing and anti-inflammatory action of essential oils is due to compounds that stimulate the reticuloendothelial apparatus through histamine released from the tissue and antibacterial properties: Chamomillae flores (Chamomilla recutita L.); Salviae folia (Salvia officinalis L.). From the group of alkaloids, extracts from aerial parts of Celandine: Chelidonii herba (Chelidonium majus L.) have healing effects and can be used to treat wounds, psoriasis by coptisyne, and Comfrey roots: Symphyti radices (Symphytum officinale L.) are used as a strengthening and healing remedy thanks to its allantoin content. CONCLUSIONS Vegetal products are used in dermatological practice thanks to their rich content of mucilages with emollient properties, regenerating vitamin products, essential oils with antihistaminic and antibacterial properties, vegetal products with alkaloids with healing properties. The complexity of the lesions, as well as the multitude of therapeutic solutions available, create new challenges that the pharmacist will have to face

A thermoresponsive three-dimensional fibrous cell culture platform for enzyme-free expansion of mammalian cells

A three-dimensional thermoresponsive fibrous scaffold system for the subsequent extended culture and enzyme-free passaging of a range of mammalian cell types is presented. Poly(PEGMA188) was incorporated with poly(ethylene terephthalate) (PET) via blend-electrospinning to render the fibre thermoresponsive. Using primary human corneal stromal stem cells as an therapeutically relevant exemplar, cell adhesion, viability, proliferation and phenotype on this fibrous culture system over numerous thermal enzyme-free passages is described. We also illustrate the versatility of this system with respect to fabricating thermoresponsive fibres from biodegradable polymers and for the culture of diverse mammalian cell types including mesenchymal stem cells, colon adenocarcinoma cells and NIH-3T3 fibroblasts. This thermoresponsive scaffold system combines the advantages of providing a physiologically relevant environment to maintain a desirable cell phenotype, allowing routine enzyme-free passaging and expansion of cultured cells, whilst offering mechanical support for cell growth. The system described in this study presents a versatile platform for biomedical applications and more specifically for the expansion of mammalian cells destined for the clinic

Phytotherapeutic approaches in atopic dermatitis

Skin diseases occur worldwide and affect about 3.5% of the population of all ages, from newborns to elders. Atopic dermatitis is an inflammatory skin condition, which consists of 3 sequential phases: infantile, juvenile and adult, with clinical manifestations and negative effects on patients’ quality of life, and treatment includes both non-pharmacological and pharmacological interventions. Vegetal and phytotherapeutic products are used in the treatment of dermatitis, due to their content of essential oils, vitamins, tannins, mucilages and alkaloids. They account for 1.4% of the number of authorised products and included in the State Nomenclature of Medicinal Products, with a 68% in community drug stores.Bolile de piele apar la nivel mondial și afectează cca 3,5% din populaţia de toate vârstele, de la nou-născuţi până la vârstnici. Dermatita atopică este o afecţiune cutanată inflamatorie, clasificată în 3 faze secvenţiale: infantilă, juvenilă și adultă, care manifestă constatări fizice caracteristice și efecte negative asupra calităţii vieţii pacienţilor, iar tratamentul include atât intervenţiile nefarmacologice, cât și farmacologice. Produsele vegetale și fitoterapeutice sunt utilizate în tratamentul dermatitelor, prin conţinut de ulei volatil, vitamine, substanţe tanante, mucilagii și alcaloizi. Ele deţin o cotă de 1,4% raportate la numărul de produse autorizate și incluse în Nomenclatorul de Stat al Medicamentelor, cu o prezenţă de 68% în farmaciile comunitare

Anterolateral Cervical Kyphoplasty for Metastatic Cervical Spine Lesions

Study Design Retrospective case series. Purpose To evaluate the clinical and radiological efficacy of anterolateral kyphoplasty for cervical spinal metastasis. Overview of Literature Although the spine is the third most common site of tumor metastasis, the cervical spine is the least commonly affected (incidence, 10%–15%). Surgical decompression is highly challenging because of the proximity of neural and vascular elements. Kyphoplasty for cervical spine metastasis has been described in small case reports with promising results. Methods Retrospective analysis of a prospective collected single-center spine metastasis database was done for cervical kyphoplasty cases. Data pertaining to age, sex, primary tumor diagnosis, modified Tokuhashi score, Spinal Instability Neoplastic Score (SINS), preoperative Visual Analog Scale (VAS) score, and analgesic medication were extracted. Postoperative data included VAS score at postoperative day 1, duration of hospitalization, self-reported functional outcome, and VAS score at the last follow-up. Results Eleven patients (mean age, 62.5 years) with cervical spine metastases were treated with 15-level kyphoplasty. Mean Tokuhashi score was 8.1, and mean SINS was 7.85. Mean preoperative pain score was 7.1, and 82% of patients used opioid analgesics. Mean total bleeding volume was 100 mL. Mean complication-free length of stay was 2.6 days with a decrease in postoperative pain (VAS score=2.8, p <0.05). There was a 56% decrease in opioid dosage and the number of consumed analgesics (1.09, p =0.004). Eighty-two percent of the patients reported excellent improvement at the last follow-up self-assessment. Conclusions To our knowledge, this case series represents the largest series of vertebral augmentation using balloon kyphoplasty for cervical spinal metastasis. This technique is associated with low postoperative complications as well as significant decrease in pain, use of opioids, and length of hospital stay. The main indications for vertebral kyphoplasty are lytic lesions of the cervical spine, painful lesions refractory to medical treatment, SINS score of 6–10, and absence of posterior wall defect

Artificial intelligence-based preventive, personalized and precision medicine for cardiovascular disease/stroke risk assessment in rheumatoid arthritis patients: a narrative review

The challenges associated with diagnosing and treating cardiovascular disease (CVD)/Stroke in Rheumatoid arthritis (RA) arise from the delayed onset of symptoms. Existing clinical risk scores are inadequate in predicting cardiac events, and conventional risk factors alone do not accurately classify many individuals at risk. Several CVD biomarkers consider the multiple pathways involved in the development of atherosclerosis, which is the primary cause of CVD/Stroke in RA. To enhance the accuracy of CVD/Stroke risk assessment in the RA framework, a proposed approach involves combining genomic-based biomarkers (GBBM) derived from plasma and/or serum samples with innovative non-invasive radiomic-based biomarkers (RBBM), such as measurements of synovial fluid, plaque area, and plaque burden. This review presents two hypotheses: (i) RBBM and GBBM biomarkers exhibit a significant correlation and can precisely detect the severity of CVD/Stroke in RA patients. (ii) Artificial Intelligence (AI)-based preventive, precision, and personalized (aiP3) CVD/Stroke risk AtheroEdge™ model (AtheroPoint™, CA, USA) that utilizes deep learning (DL) to accurately classify the risk of CVD/stroke in RA framework. The authors conducted a comprehensive search using the PRISMA technique, identifying 153 studies that assessed the features/biomarkers of RBBM and GBBM for CVD/Stroke. The study demonstrates how DL models can be integrated into the AtheroEdge™–aiP3 framework to determine the risk of CVD/Stroke in RA patients. The findings of this review suggest that the combination of RBBM with GBBM introduces a new dimension to the assessment of CVD/Stroke risk in the RA framework. Synovial fluid levels that are higher than normal lead to an increase in the plaque burden. Additionally, the review provides recommendations for novel, unbiased, and pruned DL algorithms that can predict CVD/Stroke risk within a RA framework that is preventive, precise, and personalized. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature

Polygenic Risk Score for Cardiovascular Diseases in Artificial Intelligence Paradigm

Cardiovascular disease (CVD) related mortality and morbidity heavily strain society. The relationship between external risk factors and our genetics have not been well established. It is widely acknowledged that environmental influence and individual behaviours play a significant role in CVD vulnerability, leading to the development of polygenic risk scores (PRS). We employed the PRISMA search method to locate pertinent research and literature to extensively review artificial intelligence (AI)-based PRS models for CVD risk prediction. Furthermore, we analyzed and compared conventional vs. AI-based solutions for PRS. We summarized the recent advances in our understanding of the use of AI-based PRS for risk prediction of CVD. Our study proposes three hypotheses: i) Multiple genetic variations and risk factors can be incorporated into AI-based PRS to improve the accuracy of CVD risk predicting. ii) AI-based PRS for CVD circumvents the drawbacks of conventional PRS calculators by incorporating a larger variety of genetic and non-genetic components, allowing for more precise and individualised risk estimations. iii) Using AI approaches, it is possible to significantly reduce the dimensionality of huge genomic datasets, resulting in more accurate and effective disease risk prediction models. Our study highlighted that the AI-PRS model outperformed traditional PRS calculators in predicting CVD risk. Furthermore, using AI-based methods to calculate PRS may increase the precision of risk predictions for CVD and have significant ramifications for individualized prevention and treatment plans

A Pharmaceutical Paradigm for Cardiovascular Composite Risk Assessment Using Novel Radiogenomics Risk Predictors in Precision Explainable Artificial Intelligence Framework: Clinical Trial Tool

Cardiovascular disease (CVD) is challenging to diagnose and treat since symptoms appear late during the progression of atherosclerosis. Conventional risk factors alone are not always sufficient to properly categorize at-risk patients, and clinical risk scores are inadequate in predicting cardiac events. Integrating genomic-based biomarkers (GBBM) found in plasma/serum samples with novel non-invasive radiomics-based biomarkers (RBBM) such as plaque area, plaque burden, and maximum plaque height can improve composite CVD risk prediction in the pharmaceutical paradigm. These biomarkers consider several pathways involved in the pathophysiology of atherosclerosis disease leading to CVD.This review proposes two hypotheses: (i) The composite biomarkers are strongly correlated and can be used to detect the severity of CVD/Stroke precisely, and (ii) an explainable artificial intelligence (XAI)-based composite risk CVD/Stroke model with survival analysis using deep learning (DL) can predict in preventive, precision, and personalized (aiP3) framework benefiting the pharmaceutical paradigm.The PRISMA search technique resulted in 214 studies assessing composite biomarkers using radiogenomics for CVD/Stroke. The study presents a XAI model using AtheroEdgeTM 4.0 to determine the risk of CVD/Stroke in the pharmaceutical framework using the radiogenomics biomarkers.Our observations suggest that the composite CVD risk biomarkers using radiogenomics provide a new dimension to CVD/Stroke risk assessment. The proposed review suggests a unique, unbiased, and XAI model based on AtheroEdgeTM 4.0 that can predict the composite risk of CVD/Stroke using radiogenomics in the pharmaceutical paradigm