Microneedle Electroporation for Intralesional Administration of Corticosteroid Treatment of Keloid Scar

Abstract is missing (Short communication)

Corrigendum to "The Effect of Intravenous Autologous Activated Platelet-Rich Plasma Therapy on "Profibrotic Cytokine" IL-1β Levels in Severe and Critical COVID-19 Patients: A Preliminary Study"

[This corrects the article DOI: 10.1155/2021/9427978.].

Photodynamic therapy in the treatment of condyloma acuminata: A systematic review of clinical trials

INTRODUCTION

Condylomata acuminata (CA) is a sexually transmitted infection with a high prevalence associated with psychosexual morbidity in both men and women of various age. Up to now, treatment modalities yield low clearance and recurrence rate (RR) and are also deemed low quality evidence-wise. Photodynamic therapy (PDT) is a novel and promising therapy to effectively cure and prevent CA recurrence.

METHOD

This systematic review was reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and registered to the International Prospective Register of Systematic Review (PROSPERO) (CRD42022332760).

RESULTS

Ten studies were included in this systematic review. A significant value of complete response (CR) ranging from 63-100% in patients with genital warts after receiving several sessions of PDT. A relatively low recurrence rate was seen in all 10 studies, with an RR of less than 17%. Quality assessment of included studies reported mostly high-quality research.

CONCLUSIONS

PDT therapy resulted in a higher CR with significantly lower RR compared to other therapies. Thus, PDT can be an alternative treatment of CA with low RR and minimal side effects. Additional research, especially randomized clinical trials in various countries, is needed to further substantiate this treatment and formulate definitive protocols.

Wound healing in stage IV pressure injury with use of adjunct autologous activated platelet-rich plasma therapy: a case report

INTRODUCTION

Pressure injuries remain a major burden worldwide with associated morbidity and financial implications. Patients in the ICU, such as those with severe COVID-19, are especially susceptible to PI as they remain immobile for extended durations while intubated.

OBJECTIVE

This report examines a case of stage 4 PI in a senior COVID-19 survivor treated with adjunct intravenous and intralesional aaPRP therapy in addition to topical hyaluronic acid/silver sulfadiazine cream and framycetin sulphate dressing.

CASE REPORT

aaPRP therapy was administered via intralesional injection and intravenous infusion 4 times with 2 weeks between therapies, while the aforementioned topical cream and dressing were applied every 2 days between visits. The patient also had controlled diabetes which may affect the wound healing process.

CONCLUSIONS

This report concludes with a discussion of how COVID-19 carries important dynamics in the pathogenesis of PI and how adjunct administration of intravenous and intralesional aaPRP, which is abundant in regenerative proteins, may be beneficial in the management of PI.

Comparison between the world health organization (WHO) and international society of hypertension (ISH) guidelines for hypertension

The global burden of hypertension remains an unsolved problem, especially in low- and middle-income countries (LMICs). For this reason, clinical practice guidelines containing the latest evidence-based recommendations are crucial in the management of hypertension. It is noteworthy that guidelines simply translated from those of high-income countries (HICs) are not the solution to the problem of hypertension in LMICs. Among the numerous guidelines available, those of the World Health Organisation and the International Society of Hypertension are the latest to be published as of the writing of this article. In this review, we conducted both general and specific comparisons between the recommendations supplied by both guidelines. Differences in aspects of hypertension management such as the timing of antihypertensive initiation, assessment of comorbidities and cardiovascular risk factors, pharmacological therapy selection, and blood pressure target and reassessment are explored. Lastly, the implications of the differences found between the two guidelines in both LMICs and HICs are discussed.Key messagesCurrently, with low treatment and control rates, hypertension remains a burden in low- and middle-income countries (LMICs).The lack of customised guidelines for LMICs cannot be solved simply by adopting guidelines from high-income countries.The World Health Organisation (WHO) recently published a clinical guideline for the pharmacological management of hypertension in LMICs. We compare select recommendations from the guidelines to those published by the International Society of Hypertension.

Managing Autism Spectrum Disorder in the Face of Pandemic Using Internet-Based Parent-Mediated Interventions: A Systematic Review of Randomized Controlled Trials

ASD is a neurodevelopmental disorder that is primarily treated with psychosocial intervention. However, it is costly and requires extensive resources to be effective. This inaccessibility is also further worsened by the ongoing COVID-19 pandemic, making the shift to a digital approach a sensible option. Among the available ASD therapies, parent-mediated interventions (PMIs) have a broad application and lower implementation cost. Hence, this systematic review aims to evaluate the potential that telehealth-based PMI holds and explore its feasibility throughout the COVID-19 pandemic. To build up this study, a systematic search through PubMed, Scopus, ProQuest, Wiley, and Cochrane was performed until 14 January 2021. Using the preferred Reporting Items for Systematic Review and Meta-Analysis guidelines, we ultimately included six studies in the review. Each study was evaluated utilizing the Cochrane Risk of Bias (ROB)-2 tool. Generally, parents' outcomes (knowledge, satisfaction, and compliance) were higher in intervention group (E-learning) compared to control (standard treatment or wait-list). Children also showed some improvements in social skill, communication skill, and intelligence after receiving the treatment. In addition, coaching or therapist sessions were found to be crucial as adjuvant to support parents during the intervention. In conclusion, internet-based parent-mediated interventions are promising and recommended for managing ASD patients, in the face of pandemic. However, more variety in study locations is also needed, particularly in low- and middle-income countries, to tackle the knowledge and clinical application gap. Further research should be conducted with a uniform measurement tool to achieve the same perception and reliable pooled analysis.

Therapeutic Effect of Autologous Activated Platelet-rich Plasma Therapy on Mid-dermal to Full-thickness Burns: A Case Series

Although modern medicine has made great strides in the management of burn injuries, associated complications such as pain, infection, dyspigmentation, and scarring have yet to be fully dealt with. Although skin grafting and meshing are routinely performed on burn patients, this method poses a risk for adverse effects. Activated autologous platelet-rich plasma (aaPRP), which is increasingly used in the field of plastic surgery, contains growth factors beneficial for wound regeneration. Seven cases of burns with varying severity and conditions that were treated with intralesional subcutaneous injection and intravenous aaPRP are presented and discussed herein. This case series indicates that subcutaneous and intravenous aaPRP is a safe procedure with the potential to be an alternative when skin grafting cannot be done or as an adjunct treatment to skin grafting.

Evaluation of plasma PDGF and VEGF levels after systemic administration of activated autologous platelet-rich plasma

Introduction and Aim: Activated autologous platelet-rich plasma (aaPRP) is becoming a popular therapy to accelerate healing in the field of plastic surgery. Platelets, which are abundant in aaPRP, can release many growth factors including platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF). This study aims to examine the plasma levels of PDGF and VEGF in healthy subjects after intravenous administration of aaPRP.   Materials and Methods: Nine healthy patients with no prior history of metabolic disease were divided into two groups (control and experiment group). The treatment group which consists of six patients received intravenous aaPRP treatment. The preparation of aaPRP starts with the collection of 24 mL of whole blood in sodium citrate tubes followed a two-step centrifugation procedure and subsequent chemical activation. aaPRP was then administered intravenously to patients. Meanwhile, the control group received no intervention. Venous blood samples were taken before and one week after the treatment and the plasma PDGF and VEGF levels were determined by enzyme-linked immunosorbent assay (ELISA).   Results: The treatment group showed statistically significant increase in VEGF after 7 days compared to before aaPRP administration. However, the change in PDGF levels of the treatment group was unnotable.   Conclusion: The present findings indicate that intravenous administrations of activated aaPRP may increase plasma VEGF level up to 1 week after aaPRP administration.

The Effect of Intravenous Autologous Activated Platelet-Rich Plasma Therapy on "Profibrotic Cytokine" IL-1β Levels in Severe and Critical COVID-19 Patients: A Preliminary Study

INTRODUCTION

Elevated concentration of proinflammatory cytokines followed by hyperinflammation is one of the hallmarks of severe and critical COVID-19. In the short term, this may result in ARDS and lung injury; subsequently, this may cause pulmonary fibrosis-a disease with poor prognosis-in the long run. Among the cytokines, interleukin-1β (IL-1β) is one of the most overexpressed in COVID-19. We speculate that administration of intravenous activated autologous platelet-rich plasma (aaPRP), which contains interleukin-1 receptor antagonist (IL-1RA), would lower IL-1β levels and benefit the severe and critical COVID-19 patients.

METHODS

After acquiring ethical clearance, we recruited 12 adult COVID-19 patients of both sexes from the Koja Regional Hospital (Jakarta, Indonesia) ICU. After selection, seven patients were included and divided into two groups, severe and critical. In addition to three doses of aaPRP, both groups received the same treatment of antiviral, steroid, and antibiotics. Quantification of plasma IL-1β levels was performed by beads multiplex assay a day before the first aaPRP administration and a day after the second and third aaPRP administration. PaO₂/FiO₂ ratio and lung injury scores were evaluated a day before and a day after each aaPRP administration.

RESULTS

Severe and critical patients' initial plasma IL-1β concentration was 4.71 pg/mL and 3.095 pg/mL, respectively. After 2 treatments with aaPRP, severe patients' plasma IL-1β concentration decreased 12.48 pg/mL, while critical patients' plasma IL-1β concentration increased to 18.77 pg/mL. Furthermore, after 3 aaPRP treatments, significant amelioration of patients' PaO₂/FiO₂ ratio from 71.33 mmHg at baseline to 144.97 mmHg was observed (p < 0.05). However, no significant improvement in lung injury score was observed in severe and critical groups. All severe patients and one critical patient recovered.

CONCLUSION

The use of aaPRP may prevent pulmonary fibrosis in severe COVID-19 patients through the reduction of patients' plasma IL-1β concentration and the amelioration of PaO₂/FiO₂ ratio.

Stroke prevention by Non-vitamin K Oral Anticoagulant (NOAC) agents in the absence of atrial fibrillation: meta-analysis of randomized control trials

Background

Anticoagulation to prevent stroke is a mainstay of atrial fibrillation (AF) management. Patients with established cardiovascular disease (CVD) may have conditions that fulfil Virchow's triad for thrombogenesis even in sinus rhythm. Previous investigation into the benefit of warfarin compared to placebo or antiplatelet drug in sinus rhythm found a reduction in stroke rates, but with an increase in bleeding. The efficacy and safety of non-vitamin K oral anticoagulant (NOAC) agents has not been studied.

Purpose

To assess the safety and efficacy of NOAC agents in patients without AF.

Methods

An electronic database search for randomized controlled trials that evaluated a NOAC and control drug (placebo or antiplatelet) in non-AF patients with CVD was conducted up until 1 September 2019. The primary efficacy and safety outcomes were ischemic stroke and major bleeding, respectively. The net clinical benefit (NCB) was calculated as a weighted sum of rate differences of ischemic stroke and major bleeding. Groups were stratified according to intensity of anticoagulation (full vs. low dose NOAC).

Results

Twelve randomized controlled trials were identified with a total of 83,008 patients (50,617 on NOAC, 32391 on control drug; mean age 66±2.7 years). CVD included coronary artery disease (78.3%), hypertension (73.7%), diabetes mellitus (34.7%), peripheral arterial disease (30.3%), previous stroke (21.7%), renal disease (22.9%) and heart failure (18.4%). Over a mean follow-up of 17.3 months, 1347 (1.6%) ischemic strokes occurred. Use of NOAC was associated with 28% reduction in ischemic stroke (odds-ratio [OR] 0.72, 95% confidence-interval [CI] 0.60 to 0.87; 1.1 vs. 1.8 events per 100-person years), with numbers needed to treat of 145 patients to prevent one stroke. Major bleeding was increased nearly 2-fold (OR 1.83, 95% CI 1.46 to 2.29; 2.1 vs. 1.0 events per 100-person years). The NCB demonstrated overall harm with the use of NOAC agents in this patient population (NCB = −0.28, 95% CI: −0.79 to 0.23). Use of full dose NOAC was widely unsafe (NCB = −0.35, 95% CI: −1.25 to 0.54) and low dose NOAC approached null therapeutic safety advantage (NCB = −0.06, 95% CI: −0.47 to 0.35).

Conclusion

Patients with CVD are at increased of ischemic stroke in the absence of AF. The use of NOAC agents in this non-AF population reduces rate of ischemic stroke however overall risk of bleeding exceeds antithrombotic benefit. Low-dose NOACs demonstrate a neutral NCB suggesting a point of clinical equipoise and deserve further scrutiny.

Ischemic stroke vs major bleeding

Funding Acknowledgement

Type of funding source: None

Retrospective cohort study of an enhanced recovery programme in oesophageal and gastric cancer surgery

Introduction Enhanced recovery programmes have been established in some areas of elective surgery. This study applied enhanced recovery principles to elective oesophageal and gastric cancer surgery. Methods An enhanced recovery programme for patients undergoing open oesophagogastrectomy, total and subtotal gastrectomy for oesophageal and gastric malignancy was designed. A retrospective cohort study compared length of stay on the critical care unit (CCU), total length of inpatient stay, rates of complications and in-hospital mortality prior to (35 patients) and following (27 patients) implementation. Results In the cohort study, the median total length of stay was reduced by 3 days following oesophagogastrectomy and total gastrectomy. The median length of stay on the CCU remained the same for all patients. The rates of complications and mortality were the same. Conclusions The standardised protocol reduced the median overall length of stay but did not reduce CCU stay. Enhanced recovery principles can be applied to patients undergoing major oesophagogastrectomy and total gastrectomy as long as they have minimal or reversible co-morbidity.

Day-case peripheral angioplasty using nurse-led admission, discharge, and follow-up procedures: arterial closure devices are not necessary

AIM

To audit the safety of day-case peripheral arterial intervention without the use of arterial-closure devices using nurse-led admission, discharge, and follow-up procedures.

MATERIALS AND METHODS

Patients referred for elective, peripheral vascular intervention were selected for day-case care according to pre-determined criteria using telephone triage. Post-procedure haemostasis was achieved using manual compression. After 3h bed-rest, patients were mobilized and discharged at 5h. Patients were contacted by telephone next working day to audit complications.

RESULTS

One hundred and eighty-three elective day-case peripheral interventions were performed over 2 years, predominantly using 6 F sheaths. No closure devices were used. Five patients (2%) returned to the department because of persistent groin symptoms the next day. One of these had a false aneurysm. Four required no further treatment. A single patient returned at day 6 with a delayed false aneurysm.

CONCLUSION

Day-case peripheral vascular intervention can be safely performed in appropriately selected patients without the use of arterial closure devices. Specialist radiology nurses have a major role in the counselling, care, and follow-up of these patients.

Evaluation of angiography performed by radiographers and nurses

AIM

To evaluate out-patient angiography performed by nurses and radiographers.

MATERIALS AND METHODS

A protocol for out-patient angiography performed by nurses and radiographers was drawn up and approved by the Trust's Risk Management Committee. Following training, two experienced radiographers and one nurse undertook elective peripheral or renal angiography according to the protocol on 187 patients. Angiograms were performed using a 3F catheter introduced into the abdominal aorta from a femoral approach. Patients were discharged after 2 hours and contacted by telephone the following morning.

RESULTS

No patient refused consent for the procedure. One hundred and seventy-two patients underwent successful catheterization without assistance from a radiologist. Radiologist assistance was required with femoral puncture or catheter/guidewire manipulation in 15 cases (8%). Images were considered diagnostic by the reporting radiologist in all but one case. This patient was recalled for further aortogram and pressure measurements. There was a single puncture site complication due to transient stenosis of the common femoral artery at the puncture site. This is thought to have been the result of subintimal injection of local anaesthetic, and it resolved spontaneously over 30 minutes. There were no delayed complications.

CONCLUSION

Experienced nurses and radiographers can rapidly acquire the skills to perform diagnostic angiography safely and efficiently.

Is lactobacillus GG helpful in children with Crohn's disease? Results of a preliminary, open-label study

BACKGROUND

Lactobacillus GG is a safe probiotic bacterium known to transiently colonize the human intestine. It has been found to be useful in treatment of several gastrointestinal conditions characterized by increased gut permeability. In the current study, the efficacy of Lactobacillus GG was investigated in children with Crohn's disease.

METHODS

In this open-label pilot evaluation viewed as a necessary preliminary step for a possible subsequent randomized placebo-controlled trial, four children with mildly to moderately active Crohn's disease were given Lactobacillus GG (10(10) colony-forming units [CFU]) in enterocoated tablets twice a day for 6 months. Changes in intestinal permeability were measured by a double sugar permeability test. Clinical activity was determined by measuring the pediatric Crohn's disease activity index.

RESULTS

There was a significant improvement in clinical activity 1 week after starting Lactobacillus GG, which was sustained throughout the study period. Median pediatric Crohn's disease activity index scores at 4 weeks were 73% lower than baseline. Intestinal permeability improved in an almost parallel fashion.

CONCLUSIONS

Findings in this pilot study show that Lactobacillus GG may improve gut barrier function and clinical status in children with mildly to moderately active, stable Crohn's disease. Randomized, double-blind, placebo-controlled trials are warranted for a final assessment of the efficacy of Lactobacillus GG in Crohn's disease.

The perceived position of the hand in space

This paper reports a series of experiments of the perceived position of the hand in egocentric space. The experiments focused on the bias in the proprioceptively perceived position of the hand at a series of locations spanning the midline from left to right. Perceived position was tested in a matching paradigm, in which subjects indicated the perceived position of a target, which could have been either a visual stimulus or their own fingertip, by placing the index finger of the other hand in the corresponding location on the other side of a fixed surface. Both the constant error, or bias, and the variable error, or consistency of matching attempts, were measured. Experiment 1 showed that (1) there is a far-left advantage in matching tasks, such that errors in perceived position are significantly lower in extreme-left positions than in extreme-right positions, and (2) there is a strong hand-bias effect in the absence of vision, such that the perceived positions of the left and right index fingertips held in the same actual target position in fact differ significantly. Experiments 2 and 3 demonstrated that this hand-bias effect is genuinely due to errors in the perceived position of the matched hand, and not to the attempt at matching it with the other hand. These results suggest that there is no unifying representation of egocentric, proprioceptive space. Rather, separate representations appear to be maintained for each effector. The bias of these representations may reflect the motor function of that effector.

Outpatient angiography: a prospective study of 3 French catheters in unselected patients

Financial constraints and bed shortages led to a re-evaluation of the policy of routine hospital admission for angiography. All patients referred for peripheral and renal angiography over an 8 month period had the procedure performed as an outpatient with a 3 F catheter. Patients were kept supine for 1 h and discharged 2 h after the angiogram. No significant complications resulted from the early mobilization of 219 patients who had outpatient 3 F angiography. It was a safe, well tolerated procedure, resulting in images of consistently adequate quality.

Address of the president. Sir Andrew Huxley, O.M. at the anniversary meeting, 30 November 1984. Award of medals 1984

The Copley Medal is awarded to Professor Subrahmanyan Chandrasekhar, F. R. S., in recognition of his distinguished work in theoretical physics, including stellar structure, theory of radiation, hydrodynamic stability and relativity. Professor Chandrasekhar has been a major figure in astrophysical sciences since the 1930s. His earliest work, on dwarf stars, led to the concept of the Chandrasekhar limit of stability, which later proved to be a central concept in the origin of the natural elements. He subsequently worked on stellar dynamics and the processes of energy transfer through gaseous bodies. The latter work was followed by a detailed and intensive study of convection in buoyant, rotating and conducting systems which has been fundamental to subsequent work in the field. He also studied the stability of rotating fluid masses. His latest work concerns general relativity theory and solutions of the Einstein field equations, in particular singularities and black holes, where he has shown the importance of these solutions and elucidated their mathematical properties.