Background: Umbilical cord blood (UCB) is a novel treatment of resistant corneal ulcers owing to the unique anti-inflammatory molecules and growth factors it contains. Platelet lysates are a ...potential future alternative. The aim of the present study was to assess the role of human UCB platelet lysate in treating resistant corneal ulcers.
Methods: This was prospective, non-comparative, interventional case series involving 40 eyes of patients aged 6 – 65 years with persistent corneal ulcers from the Mansoura Ophthalmic Center and Mansoura Research Center for Cord Stem Cells. Patients were classified according to the cause of persistent corneal ulcer into four groups: group I, including 14 eyes with dry eye disease; group II, including six eyes post-keratoplasty; group III, including four eyes with corneal chemical burn; and group IV, including 16 eyes with persistent corneal ulcer from other causes. All participants underwent detailed ophthalmic examinations, and baseline and final best-corrected distance visual acuity (BCDVA) were recorded. Eye drops were prepared from UCB platelet lysate and administered to all patients along with detailed meticulous instructions for the method of use. Clinical progression of wound healing was continuously observed. The treatment response was identified as complete healing, improvement, or treatment failure.
Results: BCDVA improved significantly in all studied groups (all P < 0.05). In group I, complete healing, improvement, and treatment failure occurred in 71%, 29%, and 0% of cases. In group II, complete healing, improvement, and treatment failure occurred in 67%, 33%, and 0% of cases. In group III, complete healing, improvement, and treatment failure occurred in 50%, 50%, and 0% of cases. In group IV, complete healing, improvement, and treatment failure occurred in 63%, 12%, and 25% of cases. No adverse events associated with the treatment were observed or subjectively self-reports in the study period.
Conclusions: Eye drops from UCB platelet lysate were a novel therapeutic blood component with unique growth factors and anti-inflammatory compounds that could be an effective and safe treatment option in managing persistent corneal ulcers of different causes. A future randomized clinical trial with a large sample size and a longer follow-up is required to confirm these preliminary outcomes.
Background: Umbilical cord patch (UCP) grafts have been successfully used for glaucoma shunt tube coverage and conjunctival surface reconstruction. In recent years, the technique has emerged as a ...novel alternative for the reconstruction of corneal perforation and descemetocele. This study aimed to evaluate the effectiveness of combined UCP grafting and human amniotic membrane (HAM) transplantation for the management of corneal perforation or descemetocele.
Methods: This prospective, non-comparative, interventional case series included nine eyes of nine patients with corneal descemetoceles and 28 eyes of 28 patients with corneal perforations, all in a clinically quiescent state. UCP grafting and HAM transplantation were combined to treat all patients. We re-examined the patients daily throughout the first week, weekly for 1 month, and then monthly for the first 6 months using slit-lamp examination and anterior segment optical coherence tomography.
Results: We included 37 eyes with descemetocele or corneal perforation in a clinically quiescent state. The mean (standard deviation) ages of patients with corneal descemetocele and corneal perforation were 56.3 (18.8) years and 54.3 (18.1) years, respectively. The male-to-female ratios in patients with corneal descemetocele and corneal perforation were 56% to 44% and 61% to 39%, respectively. Postoperative corneal thickness increased significantly in eyes with descemetocele compared to preoperative values (P < 0.001). Postoperative best-corrected distance visual acuity improved significantly compared to preoperative values in eyes with descemetocele or corneal perforation (both P < 0.001), with relief of accompanying ocular symptoms. We did not observe any recurrence or complications such as rejection, infection, suture-related problems, or severe inflammation and all had a formed anterior chamber up to the final follow-up visit.
Conclusions: Combined UCP grafting and HAM transplantation could be a promising alternative treatment for corneal perforation or descemetocele in clinically quiescent eyes, providing satisfactory reconstruction and functional outcomes. Further studies with robust designs, larger sample sizes, and longer follow-up are needed to verify the efficacy and safety of this modified surgical technique in enhancing vision and restoring anterior segment anatomical integrity in compromised corneas.
Background:
Chemotherapy regimens containing a combination of anti-Her2 antibodies are effective but can be associated with cardiac toxicity.
Objectives:
We evaluate the outcome with a particular ...focus on the cardiac function of patients with Her2 over-expressed breast cancer receiving Chemotherapy regimens combined with Trastuzumab and Pertuzumab in routine clinical practice settings.
Design and methods:
The initial cohort of patients who started Chemotherapy regimens in combination with Trastuzumab and Pertuzumab before September 2019 in four cancer units were reviewed retrospectively. All patients had regular measurements of left ventricular ejection fraction by Doppler ultrasound.
Results:
Sixty-seven patients were identified. Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment were administered in the neoadjuvant and palliative settings in 28 (41.8%) and 39 (58.2%) patients, respectively. All patients underwent left ventricular ejection fraction assessment prior to starting Chemotherapy regimens in combination with Trastuzumab and Pertuzumab treatment and at 3 and 6 months later. Subsequently, left ventricular ejection fraction was measured at 9, 12, 15, 18, 21, and 24 months as long as patients are still receiving any of the treatment components. Compared to baseline, the mean left ventricular ejection fraction was not significantly different at any of the subsequent time points (range; decrease by 0.936% to increase by 1.087%: T-test P value not statistically significant for all comparisons). Trastuzumab and Pertuzumab administration was withheld temporarily for two patients due to clinically suspected cardiac toxicity which was excluded upon further investigations. In the neoadjuvant cohort, 82.3% of patients were relapse free at 3 years. The median progression-free survival was 20 months, and the median overall survival was 41 months in the palliative cohort.
Conclusion:
In this cohort describing our limited initial experience, dual anti-Her2 antibodies (Trastuzumab and Pertuzumab) combined with chemotherapy is effective and not associated with significant cardiac toxicity when the left ventricular ejection fraction is measured every 3 months. This may suggest that previous concerns about cardiotoxicity may have been overemphasized. Further studies investigating less frequent left ventricular ejection fraction monitoring may be warranted.
Background
Febrile neutropenia (FN) is a life-threatening complication of Docetaxel-based chemotherapy regimens (DBRs). Prophylactic granulocyte-colony stimulating factor (G-CSF) can reduce the risk ...of FN. This study investigated the effect of G-CSF on FN in patients receiving DBRs for breast cancer.
Methods
Patients treated between 2015 and 2017 were identified from the hospital’s pharmacy database and their medical records were examined retrospectively. Data from patients’ first four cycles of DBR were collected. FN rate, FN associated length of hospital stay (FN-LOS), and chemotherapy dose modification/delay due to FN were compared between patients who did (G-CSF group) or did not (non-GCSF group) receive prophylactic G-CSF.
Results
Of the 276 included patients, 83.3% received a DBR as adjuvant or neoadjuvant therapy, and 50% received docetaxel as combination therapy. Prophylactic G-CSF was administered with the first cycle of a DBR in 69.9% of patients who were significantly less likely to experience FN compared to the non-G-CSF group (6.2% vs. 15.7%; odds ratio: 0.36 95% CI: 0.16–0.82; p = 0.020). Collectively and after the 4 DBR treatment cycles, FN rate (4.8 vs. 8.5; odds ratio: 0.54 95% CI: 0.30–0.97; p = 0.043) and the mean FN-LOS (3.55 vs. 5.28 days; t = –2.22; p = 0.037) were reduced in the G-CSF group. There was no difference in DBR dose delay/reduction between both groups in cycles 2–4.
Conclusion
In patients receiving DBRs for breast cancer, prophylactic G-CSF significantly reduced both the rate of FN and duration of hospitalization for FN.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Aromatase enzyme activity is predominant in adipose tissue. This has led to speculation that aromatase activity is elevated in obese women and subsequently decreased the clinical activity of adjuvant ...aromatase inhibitors (AIs) in women with estrogen receptor positive (ER+) breast cancer (BC). We investigated the effect of obesity on the outcome of this population.
Records of 320 consecutive post-menopausal (PM) women with ER+ BC starting single agent adjuvant letrozole between years 2005 and 2014 were retrospectively reviewed. Tumour and patients characteristic including body mass index (BMI) on the day of starting letrozole were extracted. Endpoints of main interest were: (1) Frequency of obesity; (2) relapse-free survival (RFS) in nonobese (G1; BMI < 30) and obese (G2; BMI ≥ 30) patients.
Obesity (BMI: 30-34.99) and morbid obesity (BMI ≥ 35) were present in 105/320 (32.8%) and 115/320 (35.9%) women, respectively. Median follow-up of patients was 49 months; RFS at 5 years (G1: 69% versus G2: 78%) and at 8 years (G1: 69% versus G2: 71%). Median RFS is not reached in both groups (Log rank;
= 0.097). There was no correlation between BMI and RFS (correlation coefficient
= 0.075;
= 0.174).
In this cohort, more than two-thirds of PM women starting adjuvant AIs are obese. Obesity did not adversely affect the outcome of women on adjuvant letrozole.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
Breast cancer is the most common malignant tumor among women. The mortality of the patients could be mainly attributed to metastasis and spread of breast cancer to distant sites. The ...objective of the current study is to evaluate and express the role of diffusion-weighted whole body imaging with background body signal suppression (DWIBS) in detection of osseous and soft tissue metastatic lesions in patients with cancer breast.
Results
The current prospective study included 50 female patients with pathologically proven breast cancer. The overall sensitivity of DWIBS and STIR were 97.5% and 92.5%, respectively. DWIBS was the most sensitive sequence with highest negative predictive values. DWIBS and STIR were the most sensitive with the highest negative predictive value. Both DWIBS and STIR detected more vertebral metastatic deposits (100% and 97.8%, respectively) and more soft tissue lesions (94.4% for both) than WB DWI and T1WI.
Conclusion
DWIBS MRI sequence is an effective method for detection of solid organ, bone and lymph node metastasis but not specific for characterization of lesions.
Diabetic retinopathy (DR) is a major public health problem and the leading cause of vision loss in the working age population. This paper presents a novel deep learning system for the detection and ...diagnosis of DR using optical coherence tomography (OCT) images. The input for this system is three-channel local and global information from OCT images. The local high-level information is represented by the thickness channel and the reflectivity channel. The global low-level information is represented by the grey-level OCT original image. The deep learning system processes the three-channel input to produce the final DR diagnoses. Experimental results on 200 OCT images, augmented to 800 images, which are collected by the University of Louisville, show high system performance related to other competing methods. Moreover, 10-fold and leave-one-subject-out (LOSO) experiments are performed to confirm how significant using the fused images is in improving the performance of the diagnoses, by investigating four different CNN architectures. All of the four architectures achieve acceptable performance and confirm a significant performance improvement using the fused images. Using LOSO, the best network performance has improved from 90.1 ± 2% using only the grey level dataset to 97.7 ± 0.5% using the proposed fused dataset. These results confirm the promise of using the proposed system for the detection of DR using OCT images.
Heavy metal ions are discharged into water from several industries. They are carcinogenic and they cause severe environmental hazards. In the present work the ability of removal of copper and lead ...from aqueous solutions has been studied using carboxy methyl β cyclodextrin, poly(ethylene glycol) β cyclodextrin and their magnetic counterparts. Effects of pH, concentration of the metal ion, temperature and contact time have been studied. Equilibrium isotherms for the adsorption of the metals were measured experimentally. Results were analysed at different temperatures and the characteristic parameters for each adsorption isotherm were determined. The adsorption process has been found exothermic in nature and thermodynamic parameters, Gibb’s free energy (ΔG), change in enthalpy (ΔH) and change in entropy (ΔS) have been calculated. The paper also includes results on the kinetic measurements of adsorption of the metal on modified β cyclodextrin and their magnetic nano composites at different temperatures. It was found that poly (ethylene glycol) β cyclodextrin showed better performance than carboxy methyl β cyclodextrin.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
is common pathogen that is associated with many hospital acquired infections. The virulence of
is identified with resistance to antibiotics especially to methicillin. Therefore the aims of the ...present study were to detect the carrier rates of methicillin-resistant
(MRSA) among health care Workers (HCWs) and patients and to compare use of specific chromogenic agar for MRSA culture with PCR for detection of MRSA genes.
Samples obtained were subjected to full microbiological laboratory studies involving culture on specific chromogenic medium and antibiotics susceptibility testing for detection of MRSA and their resistance rates to other commonly used antibiotics. Furthermore multiplex PCR was carried out to detect
genes.
was isolated from 70 (29.9%) of the studied subjects. MRSA isolates (n=28) had high resistance rates for the used antibiotics and the most common resistance was for ciprofloxacin and chloramphenicol (57.1% for each). MRSA was isolated mainly from health care workers (17.02%). The frequency of SCC
was 60.7% for type I, 25% for type III and 14.3% for type II. Chromogenic agar identified correctly MRSA isolates in 92.9%. PCR was positive in all isolates with resistance to cefoxitin disc.
The present study highlights that MRSA carriage is common among health care workers in one Egyptian tertiary care hospital. The major genotype of MRSA is belonging to SCC
type I followed by type III and type II. ChromID medium is an accurrate culture method for detection of MRSA compared to molecular method.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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