Abstract Aim: The aim of this study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on central corneal thickness (CCT) and corneal endothelial cell density (ECD) in patients undergoing treatment for various systemic conditions. Materials and Methods: This observational study was conducted at a tertiary care center and included a total of 50 patients (100 eyes) receiving HBOT. Inclusion criteria comprised patients aged ≥25 years undergoing HBOT for non ocular systemic indications, with clear corneas, normal baseline endothelial morphology, and no history of prior ocular surgery or corneal pathology. Patients with glaucoma, active ocular infection, corneal dystrophies, contact lens use, and history of prior ocular surgery, including cataract surgery, vitreoretinal surgery, or keratorefractive procedures were excluded. Each participant underwent a comprehensive ophthalmic evaluation. Intraocular pressure (IOP), central corneal thickness, and endothelial cell density were measured immediately before and within 1 hour after a single HBOT session. The HBOT protocol consisted of administration of 100% oxygen at 2.5 atmospheres absolute (ATA) for 90 minutes. Measurements were obtained using standardized non-contact pachymetry and specular microscopy. Statistical analysis was performed using a paired t -test to compare pre- and post-treatment values, with significance set at p < 0.05. Results: A total of 100 eyes from 50 patients were analyzed, including 66% males and 34% females. The mean central corneal thickness decreased from 530.34 ± 40.4 μm pre-HBOT to 520.90 ± 41.5 μm post-HBOT, showing a statistically significant reduction. The mean endothelial cell density showed a slight increase from 2647.81 ± 244.45 cells/mm 2 to 2661.91 ± 220.58 cells/mm 2 , which was not clinically significant. Conclusion: A single session of HBOT induces statistically significant but transient changes in central corneal thickness and intraocular pressure, without adversely affecting corneal endothelial cell density in eyes with healthy endothelium. These findings suggest that short-term HBOT is safe for corneal endothelial integrity in the general population.
[This corrects the article DOI: 10.1016/j.ekir.2025.08.018.].
4154 Background: Advanced gallbladder cancer (GBC) carries a dismal prognosis, with a real-world median overall survival (OS) of 6.8 months. We hypothesized that adding losartan to standard chemotherapy could improve outcomes by modulating the fibrotic tumor microenvironment (TME). Methods: This was a single-arm phase II study conducted at two academic centers between July 2022 and April 2024. Adult patients with histologically confirmed, unresectable or metastatic gallbladder cancer or cholangiocarcinoma received six cycles of gemcitabine and cisplatin with concurrent oral losartan. The primary endpoint was overall survival (OS). Exploratory analysis by whole-exome sequencing (WES) was done on 18 patients. Results: Thirty patients were enrolled. Clinical characteristics are depicted in Table. Median OS was 10.3 months (range 0.5–38.7), with 6-month and 12-month OS rates of 68% and 36%, respectively. Median PFS was 5 months. An objective response was observed in 88% of patients, including five complete responses. Patients with ECOG performance status 2 and those with cholelithiasis had inferior survival. Losartan was well tolerated. Genomic analysis revealed a clear discretion between cohorts (median PFS >, <=6 months). Responders exhibited a "TME-favorable" signature, characterized by genes associated with anti-inflammatory properties, regulated angiogenesis, and cellular stress response. This group was uniquely enriched for variants in ATRX, CHEK2, DNMT3A, EZH2, IDH1, SMARCA4 , and TSC2. Conversely, non-responders (NR) showed a pro-inflammatory profile and oncogenic mutations in the angiogenesis pathway ( AKT2, BRAF, MET, NRAS, SMAD4 ), potentially mediating resistance to losartan-induced vascular normalization. Both groups shared core GBC drivers, including TP53, KRAS, ARID1A , and ERBB2. Conclusions: Losartan improves survival in GBC patients with a specific molecular buildup. The presence of anti-inflammatory genomic signatures and specific variants like SMARCA4 and ATRX may serve as predictive biomarkers for TME-targeted therapy, whereas pro-inflammatory profiles and primary angiogenesis mutations identify a resistant phenotype. Clinical trial information: CTRI/2023/02/049523. Baseline clinical features (n=30). Clinical features n % Age in years Median (range ) 59 (31-75) Gender Male Female 1119 3664 ECOG PS * 1 2 219 7030 Gallstones 12 41 Cholecystectomy 10 34 Jaundice at baseline Present Absent 822 2674 Site Gallbladder Cholangiocarcinoma Intra-hepatic Extra-hepatic distal CBD ** 2613 87310 Weight in Kgs Mean (range ) 58 (41-82) History of weight loss present 15 52 Co-morbidities Diabetes mellitus Hypertension Hypothyroidism 781 23263 Angiotensin receptor blocker Losartan Telmisartan 282 946 ERBB2 positive Received Trastuzumab 22 6100 Immunotherapy(Durvalumab) 5 17 * PS: Performance status, ** CBD: Common bile duct.
Pyomyositis is a serious bacterial infection of the skeletal muscles, usually treated with antibiotics and surgical drainage. The success of medical or surgical treatment is often delayed or less effective when tissue hypoxia is present. Hyperbaric oxygen therapy (HBOT) is currently being studied as a helpful additional treatment for various conditions, especially those involving complications of tissue hypoxia. In this case report, we describe a 29-year-old male who developed chronic pyomyositis and a right lower leg ulcer after failure of multiple surgeries, including fasciotomy, debridements, skin grafts and antibiotics to treat compartment syndrome and tuberculosis of the right knee. HBOT was administered for 80 sessions at 243 kPa (2.4 atmospheres absolute) for 90 minutes. The patient showed significant clinical improvement, as evidenced by the development of healthy granulation tissue, reduction in swelling and discharge, and better mobility. This case highlights the potential of HBOT as an additional treatment option for complex soft tissue infections such as pyomyositis caused by tuberculosis, especially in cases where traditional treatments have been ineffective.
Abstract Introduction: Pregnant women receiving a high- or intermediate-risk result on first-trimester/second-trimester aneuploidy screening often face anxiety, decisional conflict, and confusion. We evaluated whether structured prenatal counseling improves their knowledge, decision-making confidence, anxiety, and uptake of invasive diagnostic testing. Settings and Design: This was a prospective cohort study conducted at a tertiary-level fetal medicine unit in India over 18 months. Materials and Methods: Sixty-seven eligible women with singleton pregnancies (≤22 weeks) and high/intermediate risk screening results underwent a standardized 30–45 min counseling session by a fetal medicine specialist/genetic counselor. Outcomes measured pre- and postcounseling included knowledge (0–10 scale), decisional conflict (Decisional Conflict Scale, 0–100), and anxiety (STAI-State, 0–100). Diagnostic test uptake was also assessed. Statistical analysis was done by Paired t-tests with Cohen’s d effect sizes for pre-/postcomparisons. Results: Knowledge significantly improved (5.93 → 8.86, P < 0.001, d = 5.91). Decisional conflict (43.1 → 23.5, P < 0.001, d = −6.39) and anxiety (49.7 → 36.4, P < 0.001, d = −4.55) decreased substantially. Diagnostic uptake was 94%, identifying 8 aneuploidy cases in the high-risk group. Conclusions: Structured prenatal counseling significantly enhances knowledge, reduces decisional conflict and anxiety, and promotes high uptake of invasive diagnostic testing. Its effectiveness across varying educational backgrounds suggests it is a robust, equitable strategy for supporting informed decision-making in pregnant women with abnormal screening results. It is an effective, scalable intervention with potential for integration into national maternal healthcare strategies.
