INTRODUCTION:Long COVID syndrome (LCS) is characterized by persistent neurological, respiratory, and systemic symptoms following SARS-CoV-2 infection, with limited effective treatments available. Viusid is an oral antioxidant and immunomodulatory formulation that may improve chronic inflammatory symptoms. This study evaluated the efficacy of Viusid in patients with LCS. METHODS:This randomized double-blind placebo-controlled clinical trial evaluated the efficacy and safety of Viusid in adults with long COVID syndrome. The primary endpoint was the change in brain fog severity at Day 210. Secondary endpoints included changes in neurological, respiratory, musculoskeletal, digestive, and general symptoms measured using a 23-symptom clinical questionnaire. RESULTS:All participants completed the study. Viusid significantly improved the primary endpoint, brain fog, compared with placebo (MD -1.23; 95% CI -2.41 to -0.005; p < 0.001). Significant improvements favoring Viusid were also observed in anxious-depressive mood (p < 0.001), sleep dis-orders (p = 0.003), fatigue (p = 0.023), dyspnea (p = 0.018), chest pain (p = 0.002), cough (p = 0.004), abdominal pain (p = 0.009), and myalgia (p = 0.025). These effects remained consistent after adjusted analyses. DISCUSSION:The intervention showed potential improvement in long COVID symptoms; however, the small sample size and observational design limit conclusions, warranting further randomized con-trolled studies. CONCLUSIONS:Viusid significantly improved multiple long COVID symptoms, particularly neurological and respiratory manifestations. These findings support its potential as a therapeutic option for long COVID and justify further confirmatory studies.
BACKGROUND:Rickettsial diseases have re-emerged as significant causes of acute febrile illness in India and can occasionally evolve into rickettsial endovasculitis, characterized by widespread endothelial infection and vascular inflammation, leading to increased vascular permeability, tissue ischemia, and multiorgan dysfunction. Early diagnosis remains challenging because the initial clinical presentation is often nonspecific, and rapid diagnostic facilities are not uniformly available in many healthcare settings. CASE PRESENTATION:We describe a 17-year-old previously healthy female who presented after 10 days of fever and rapidly deteriorated, developing Acute Respiratory Distress Syndrome (ARDS), Acute Kidney Injury (AKI), hepatic impairment, and myocardial involvement. Serological testing demonstrated a positive Weil-Felix OX-K titer (OX-K ≥ 1:160), supporting a rickettsial etiology. Despite prompt doxycycline therapy, adjunctive corticosteroids for ARDS, renal replacement therapy, and lung-protective mechanical ventilation, the patient developed refractory hypoxemia (PaO₂ < 60 mmHg despite optimized ventilatory support) and circulatory collapse, resulting in death on the fifth hospital day. This case demonstrates a rapidly progressive, severe vasculitic form of rickettsial disease culminating in severe multiorgan dysfunction (severe ARDS, acute renal impairment, and myocarditis). The lack of classical clinical markers, such as eschar, along with significant overlap with other endemic tropical infections, likely delayed definitive diagnosis. CONCLUSION:In rickettsial-endemic settings, clinicians should retain a high index of suspicion for these infections in patients presenting with undifferentiated febrile illness. Prompt initiation of doxycycline, improved access to rapid diagnostic tools, and early escalation to intensive care are essential strategies to reduce mortality and prevent fatal complications.
Introduction: Toxoplasmosis is a food-borne disease that infects almost all warm-blooded mammals and birds. Birds are considered intermediate hosts for the parasite. The consumption of infected birds by humans and other animals plays a highlight role in the transmission of this parasite. Accordingly, the present review was conducted to find the global seroprevalence of T. gondii in birds. Methods: A comprehensive search of five academic databases (ScienceDirect, PubMed, Web of Science, ProQuest, and Scopus) and Google Scholar was conducted for literature published from 1952 to December 13, 2020. Results: Finally, a total of 211 studies, including 69006 birds (from 61 countries), were incorporated in the present study. The seroprevalence was calculated at 27.96% (95% CI=25.27-30.73) based on the random effect. The pooled seroprevalence rates of T. gondii were in Africa (39.73%), America (34.50%), Asia (23.65%), and Europe (17.46%). Based on these results, the Modified Agglutination Test (MAT) was the most common diagnostic method (122 studies). The weighted prevalence was higher in free-range chickens (37.60%) and domestic chickens (36.93%) than in other bird types. Discussion: Based on the findings of the study, a high seropositivity of T. gondii in birds indicates that they could be a potential food safety risk for humans. Conclusion: The current review has contributed to enhancing the understanding of the relatively high level of T. gondii seroprevalence in birds. The results from this study are useful for policymakers to control T. gondii infection in meat consumption, due to the significant role of poultry in the human diet.
Photodynamic therapy (PDT) has been investigated as a minimally invasive approach that could enhance reproductive health by preserving the reproductive tract microbiome. The disturbances in the reproductive tract microbiome, including the loss of Lactobacillus-dominated communities and the overgrowth of opportunistic or pathogenic bacteria, are associated with infertility. PDT can be used to eliminate specific pathogens or precancerous lesions, and may modulate the microbiome in the female genital tract. Unlike conventional antimicrobial treatments, which may also affect beneficial microorganisms, PDT can selectively inactivate pathogenic microbes through the generation of reactive oxygen species (ROS). Maintaining a balanced cervicovaginal microbiome is of great importance in achieving reproductive success. By reducing pathogenic microbial load and limiting damage to commensal bacteria, PDT may contribute to improving microbial balance in the cervicovaginal environment. In recent years, there has been increasing attention to therapeutic strategies in reproductive medicine that preserve the microbiome, emphasizing the importance of methods that control infection while maintaining a balanced microbial ecosystem. This narrative mini‑review summarizes current findings on the use of PDT for microbial modulation in the female reproductive tract and discusses its relevance in the treatment of infertility associated with reproductive tract microbial dysbiosis.
INTRODUCTION:Saprochaete capitata is a rare opportunistic yeast-like fungus increasingly recognized as a cause of invasive infections, predominantly in immunocompromised hosts. While most cases are reported in patients with hematological malignancies and neutropenia, infections in patients with chronic metabolic and renal disorders are uncommon and often underdiagnosed. Isolation of S. capitata from urine is particularly rare and poses diagnostic challenges in distinguishing colonization from invasive disease. CASE PRESENTATION:We report a fatal case of sepsis associated with Saprochaete capitata isolated from the urine of a 65-year-old male with type 2 diabetes mellitus, chronic kidney disease, and chronic lymphatic filariasis. The patient presented with fever, chills, tachycardia, cellulitis of the right lower limb, and features of systemic inflammatory response syndrome. Laboratory investigations revealed marked leukocytosis, elevated inflammatory markers, and acute-on-chronic renal failure. Despite clinical features of sepsis, repeated bacterial blood and urine cultures were sterile. Urine microscopy showed pyuria, and culture on CLED agar yielded dry, creamy-white, yeast-like colonies. A lactophenol cotton blue mount demonstrated hyaline septate hyphae with rectangular arthroconidia. The isolate was urease-negative and was definitively identified as Saprochaete capitata by MALDI-TOF mass spectrometry. Antifungal susceptibility testing revealed low minimum inhibitory concentrations (MICs) for voriconazole, itraconazole, and posaconazole, with elevated MICs for echinocandins, consistent with known resistance patterns. The patient was treated empirically with broad-spectrum antibacterial agents but did not receive early antifungal therapy. His clinical condition rapidly deteriorated, progressing to septic shock and multi-organ dysfunction syndrome, requiring intensive care support, mechanical ventilation, vasopressors, and hemodialysis. Despite maximal supportive care, the patient succumbed to his illness. CONCLUSION:This case highlights the clinical significance of isolating Saprochaete capitata from urine in high-risk patients presenting with sepsis and negative bacterial cultures. It underscores the need for heightened clinical suspicion, prompt fungal identification using advanced diagnostic methods, and early initiation of appropriate antifungal therapy. Awareness of this rare but aggressive pathogen is crucial for improving outcomes in vulnerable patient populations.
INTRODUCTION:The objective of this study was to develop and optimize a dry powder inhalation formulation of Posaconazole-loaded Chitosan Nanoparticles (POS-CSNPs) using a Quality by Design (QbD) approach. The aim was to enhance pulmonary drug delivery and antifungal efficacy, particularly against Rhizopus oryzae, by improving drug encapsulation, particle dispersion, and lung deposition using leucine as a performance enhancer. METHODS:A Box-Behnken Design (BBD) was employed to evaluate the effects of Chitosan-to- Tripolyphosphate (CS:TPP) ratio, stirring speed, and polymer concentration on particle size, Polydispersity Index (PDI), and Entrapment Efficiency (EE). Nanoparticles were prepared via ionic gelation and spray-dried with varying concentrations of lactose and leucine. Characterization techniques included FTIR for drug-excipient compatibility, Dynamic Light Scattering (DLS) for size and zeta potential, TEM for morphology, and XRD for crystallinity. In vitro drug release, pulmonary deposition using a twin-stage impinger, antifungal activity, and stability under ICH conditions were assessed. RESULTS:The optimized formulation had a particle size of 248.20 ± 6.82 nm, PDI of 0.225 ± 0.010, zeta potential of 21.92 ± 0.84 mV, and EE of 68.17 ± 1.73%. In vitro release showed sustained drug delivery over 48 hours. The Fine Particle Fraction (FPF) reached 68.9% in leucine-based formulations, and antifungal activity was significantly higher compared to the pure drug, with a zone of inhibition of 21 ± 0.5 mm. DISCUSSION:The results demonstrated improved particle characteristics, drug release, and antifungal efficacy. Leucine significantly enhanced dispersibility and deposition. However, scale-up and batch consistency remain challenges. Further in vivo studies are needed to confirm clinical applicability. CONCLUSION:The study successfully developed a stable, effective dry powder POS-CSNP formulation with enhanced pulmonary delivery and antifungal activity, offering potential for improved treatment of pulmonary fungal infections.
INTRODUCTION:The mechanisms of EV-A71 immune evasion and neuroinvasion are poorly understood. Inactivated vaccines provide protective immunity without the dysregulated inflammation and viral persistence caused by active infection. In this bioinformatics-driven study, our objective was to utilize computational transcriptomics to investigate this dichotomy and determine the specific neural cell populations susceptible to enteroviral infection. METHODS:We compared bulk RNA-seq data from THP-1 macrophages infected with active versus inactivated EV-A71 to identify viral hijacking programs. We then applied these systemic findings to the neural environment via an iterative Area Under the Curve (AUC)-based optimization strategy. This process refined the broad bulk-derived candidates into a 10-gene consensus signature, which was projected onto a human spinal cord organoid single-cell RNA-seq atlas to map viral susceptibility across distinct developmental lineages. RESULTS:While active infection with EV-A71 is associated with a wound-healing program defined by the expression of PMEPA1, ALOX5, CCL1, and SPRED3, the administration of an inactivated virus elicits an anti-inflammatory response without activating a similar transcriptional program. In fact, decreased expression of inflammatory factors (ADORA2A, CCR1, CXCL1) marks this wound-healing stage and leads to the development of an immunosuppressive M2 phenotype. By projecting the highly robust 10-gene consensus (comprising ALDH2, SERPINE2, and L1CAM) against the organoid atlas, we have predicted that the cycling neural progenitors could be the most likely reservoir for EV-A71 replication. Using a Wilcoxon rank sum test with Benjamini-Hochberg correction, we observed the only statistically enriched signature in progenitor cells Discussion: Transcriptomic data indicate that EV-A71 might hijack TGF-β/PMEPA1 and ALOX5 signaling pathways to establish EMT-like behavior. The local acquisition of an M2-like immunosuppressive state might help promote early systemic dissemination, immunologic escape, followed by colonization of the proliferative neural niche prior to the development of neurological symptoms. CONCLUSION:Computational identification of a macrophage gene signature provides robust discrimination of EV-A71 infection from vaccine-based protection in vivo. Mapping the signature to the context of human spinal cord organoids indicates that EV-A71 specifically targets proliferative and regenerative programs of neural stem cells.
INTRODUCTION:Chinese essential oils, hydrophobic substances derived from aromatic plants, are widely used in industries such as food, pharmaceuticals, cosmetics, and pest control. This review focuses on their potential as natural therapies for skin conditions like acne and aging, with an emphasis on their antioxidant, antibacterial, and anti-inflammatory properties. METHODS:A literature search was conducted using various databases, including Scopus, PubMed, and Medline, focusing on terms like "essential oils and acne," "tea tree oil and acne," and "essential oils and skin aging." The articles were selected from 1980 to 2025. RESULTS:The findings reveal that Chinese essential oils, particularly tea tree, lavender, and chamomile, have significant anti-inflammatory, antibacterial, and antioxidant effects that may outperform traditional acne therapies. DISCUSSION:These oils also show promise in addressing skin aging. However, while current research highlights their potential, further studies are required to fully understand their mechanisms and opti-mize their therapeutic applications. CONCLUSION:Essential oils could play a key role in future skincare innovations, particularly in acne and anti-aging treatments.
INTRODUCTION:Although sodium bicarbonate (NaHCO3) is still a commonly used treatment for metabolic acidosis, the best dosage methods are still unknown. This study compared the effectiveness of three distinct NaHCO3 regimens for the short-term treatment of moderate-to-severe metabolic acidosis. METHODS:60 adult ICU patients with metabolic acidosis (pH < 7.25) participated in a prospective randomized interventional study. Three groups of twenty patients each were randomly assigned. Over the course of a day, Group A received the calculated total bicarbonate dose. Group C received 30% of the dose as a bolus and 70% as an infusion, whereas Group B received 15% of the dose as an initial bolus and 85% as an infusion. End-tidal CO2 (EtCO₂) and arterial pH were measured at 0, 1, 8, 16, 24, 36, and 48 hours. Additionally, two-day survival was evaluated. RESULTS:Blood pH significantly improved across all groups. With normalization by the sixteenth hour, Group C made the quickest correction. At 24th and 48th hours, Group B revealed the most consistent and sustained correction of pH with less variation. There was no significant ventilation effect, as supported by the gradual increase in EtCO2 levels in all three groups. The 2-day survival rate was slightly higher in Groups B and C (40%) than in Group A (30%), but the difference was not statistically significant. DISCUSSION:Findings from the current investigation help illuminate the extent to which different bicarbonate dosing regimens can raise blood pH and influence the presence of metabolic acidosis over the two-day treatment period. CONCLUSION:All bicarbonate treatment modalities were successful. Group C responded quickly, and Group B was the most consistent. The survival difference is not significant and highlights the need for further studies to improve dosing.
INTRODUCTION:Dental caries is one of the most common health concerns, and the adverse effects of Chlorhexidine have increased the search for safer natural alternatives. This study aimed to compare the antimicrobial effect of a novel 1% Licorice root extract gel with 0.2% Chlorhexidine mouthwash in reducing salivary Streptococcus mutans (S. mutans). METHODS:In this randomized controlled trial, 30 adults with DMFT >2 were randomly divided into two groups to receive 0.2% Chlorhexidine mouthwash (n=15) or 1% Licorice gel (n=15) for seven days. Samples of unstimulated saliva were collected at the beginning and after the intervention. S. mutans colony-forming units per milliliter (CFU/mL) were determined and data were analyzed using SPSS v25.0. RESULTS:Both groups showed significant decreases in S. mutans counts after the intervention (P < 0.001). This reduction in the Chlorhexidine and Licorice gel group was 32.9% and 20.2%, respectively. However, there was no statistically significant difference between the two groups (P = 0.39). DISCUSSION:The 1% Licorice gel showed antimicrobial activity comparable to 0.2% Chlorhexidine, with a more favorable taste and no side effects. These findings support its potential as a tolerable herbal alternative for short-term oral care, especially in individuals intolerant to Chlorhexidine. CONCLUSION:Licorice gel appears to be a safe and effective natural agent for reducing salivary S. mutans levels. Further long-term studies with larger populations are necessary to verify its clinical applicability and sustainable efficacy.
INTRODUCTION:Human Papillomavirus (HPV) is a well-established cause of cancers of the cervix, vulva, and vagina, particularly high-risk types such as HPV-16 and 18. In women living with HIV, impaired immune function reduces viral clearance, leading to persistent infection, faster progression of precancerous lesions, and involvement of multiple sites within the lower genital tract. This phenomenon is often explained by the concept of "field cancerization", where widespread HPV exposure results in synchronous neoplastic changes in adjacent mucosal tissues. CASE PRESENTATION:A 36-year-old HIV-positive woman presented with abnormal vaginal bleeding and post-coital bleeding. Testing revealed infection with multiple high-risk HPV genotypes, including HPV-16, and cervical cytology showed High-grade Squamous Intraepithelial Lesion (HSIL). Histopathological evaluation confirmed two concurrent HPV-related lesions: invasive squamous cell carcinoma of the cervix (FIGO stage IB1) and vulvar HSIL (VIN 3). She underwent a radical hysterectomy with pelvic lymph-node dissection along with wide local excision of the vulvar lesion, followed by adjuvant pelvic radiotherapy. CONCLUSION:This case illustrates the uncommon coexistence of cervical squamous cell carcinoma and vulvar HSIL in an HIV-positive woman, emphasizing the role of immunosuppression in persistent HPV infection and multifocal disease. Thorough evaluation of the entire lower genital tract, along with vigilant follow-up, is crucial for early detection and improved outcomes in this high-risk population.
INTRODUCTION:Epstein-Barr virus (EBV), a widely prevalent member of the herpesvirus family, is linked to a diverse range of clinical outcomes, extending from mild, self-limiting illnesses to serious systemic and hematological disorders. Although India shows a high rate of EBV seropositivity, comprehensive data regarding its clinical presentation and associated complications are still scarce. This study was undertaken to assess the seroprevalence, clinical features, and systemic complications of EBV infection across multiple departments of a tertiary care hospital in Northern India. METHODS:This retrospective study analyzed 168 serologically confirmed EBV IgM-positive cases from January 2018 to December 2023 at a tertiary care centre. Data were collected on demographics, clinical presentation, departmental distribution, laboratory parameters, and complications. EBV IgM was detected using the EBV-VCA IgM ELISA kit, and hematological and biochemical values were interpreted in accordance with WHO and standard clinical definitions. The authors followed the Sex and Gender Equity in Research (SAGER) Guidelines. RESULTS:The median age of patients was 24 years, with a male predominance (56.5%). Generalized weakness (84%), fever (56%), and sore throat (49%) were the most common symptoms. Anemia (79.2%), thrombocytopenia (60.1%), and hepatic dysfunction (69.6%) were the leading complications. Neurological involvement, though less frequent, included encephalitis (6%) and seizures (4.2%). Laboratory values showed marked variability, particularly in liver enzymes and blood counts. DISCUSSION:EBV infection showed significant systemic involvement, with higher rates of hematological and hepatic complications than typically reported. Regional factors may influence this variability, underscoring the need for early diagnosis and targeted management. CONCLUSIONS:EBV infection presents with diverse clinical features and significant systemic complications. Early recognition and multidisciplinary management are essential for improved outcomes in high-burden regions like India.
INTRODUCTION:Odontogenic infections can range from localized abscesses to severe sys-temic conditions originating from teeth and their supporting structures. This review outlines evi-dence-based guidelines for selecting antibiotics and using prophylaxis in odontogenic infections, with a focus on prudent use to combat antimicrobial resistance (AMR). METHODS:A narrative review synthesized guidelines from 2015 to 2024 by searching PubMed/PMC, Scopus, Web of Science, and Google Scholar using terms "odontogenic infection, "dental infection," "antibiotic therapy," "antibiotic resistance", and "antibiotic stewardship." The review included clini-cal guidelines, RCTs, systematic reviews, and consensus statements in English, excluding duplicates, non-English articles, and irrelevant studies. The data were analyzed qualitatively. RESULTS:Antibiotic selection depends on infection severity, patient allergies, comorbidities, and local resistance patterns. For first-line treatment, amoxicillin or phenoxymethylpenicillin is recommended for 3-7 days. For penicillin-allergic patients, clindamycin or a macrolide is recommended. In severe cases, amoxicillin-clavulanate or intravenous options are advised. Prophylaxis is restricted to high-risk cases of Infective Endocarditis (IE). According to ADA, AAOMS, NICE, SDCEP, FDI, and IDA guidelines, narrow-spectrum antibiotics are preferred. DISCUSSION:Primary measures involve source control, such as drainage and extraction, while antibi-otics serve as adjuncts. Antimicrobial resistance (AMR) is driven by overuse, but stewardship pro-grams (ASPs) and Infection Prevention and Control (IPC) help mitigate it through the use of narrow-spectrum antibiotics, diagnostics, and education. There are gaps in rapid diagnostics and resistance surveillance in dentistry. Although guidelines emphasize prudent prescribing, they differ regionally. CONCLUSION:Combining surgical source control with targeted antibiotics enhances outcomes while mitigating AMR. Prophylaxis is designated for patients at high risk of IE. Dentists should follow local antibiograms, educate patients, and implement stewardship to ensure the sustainable manage-ment of odontogenic infections.
INTRODUCTION:Miliary tuberculosis is a severe form of tuberculosis caused by the hematogenous spread of Mycobacterium tuberculosis (MTB). Nontuberculous mycobacteria (NTM) are environmental pathogens that can become aerosolized and cause infections, particularly in immunocompromised individuals. Mycobacterium Abscessus is a rapidly growing NTM that commonly causes pulmonary disease in individuals with preexisting lung conditions. However, its presentation as miliary nodules in an immunocompetent individual is extremely rare. CASE PRESENTATION:A 57-year-old male with well-controlled diabetes presented with progressive dyspnea, chronic dry cough, low-grade fever, and significant weight loss over three months. Chest radiography revealed diffuse miliary opacities, initially suspected to be tuberculosis. Despite receiving standard anti-tubercular therapy, his symptoms persisted. Further investigations, including bronchoalveolar lavage culture and NTM line probe assay, confirmed infection with Mycobacterium abscessus. The patient was treated with a combination of clarithromycin, linezolid, amikacin, and imipenem for the initial three months, followed by clarithromycin and linezolid for a total treatment duration of 15 months, resulting in a favorable outcome. Follow-up high-resolution CT scans showed complete resolution of the miliary lesions, and the patient continues under clinical surveillance for recurrence. CONCLUSION:This case highlights that Mycobacterium Abscessus infection can mimic miliary tuberculosis, even in immunocompetent individuals. Nontuberculous mycobacterial infections should be considered in patients with miliary lung opacities who do not respond to standard anti-tubercular therapy. Early diagnosis and prompt initiation of appropriate antibiotic treatment can result in successful outcomes.
INTRODUCTION:Antibiotic resistance has been identified as one of the most pressing public health issues of our time. This study assessed the knowledge, attitudes, and practices (KAP) regarding antibiotic use and antibiotic resistance, as well as associated factors, among secondary school adolescents. METHODS:A cross-sectional self-survey of secondary school students in Jordan. RESULTS:Students demonstrated limited knowledge of antimicrobial resistance and suboptimal antibiotic use, while attitudes and practices showed variable responses. Knowledge scores were significantly associated with place of residence (p < 0.001), previous education about antibiotic use and resistance (p < 0.001), and ease of access to educational materials (p < 0.001). Positive attitudes were predicted by previous formal education about antibiotic use and resistance (p < 0.001) and ease of access to educational materials (p < 0.001). Better practices were significantly associated with the father's educational level (p < 0.01). DISCUSSION:The findings highlight significant gaps between knowledge, attitudes, and practices regarding antibiotic use among secondary school adolescents, underscoring the need for targeted educational interventions that strengthen practical understanding and individual responsibility toward antimicrobial resistance. CONCLUSION:Formal education, socioeconomic status, and the availability of learning materials were significantly associated with the students' KAP. These findings highlighted various misconceptions and unsafe practices and suggested further interventions.
BACKGROUND:Tenofovir disoproxil fumarate (TDF) is widely used in the treatment of chronic hepatitis B (CHB) due to its high antiviral potency and genetic barrier to resistance. However, long-term use is associated with renal toxicity, bone mineral loss, and high treatment burden. The European Association for the Study of the Liver (EASL) 2017 guidelines allow for cessation of nucleoside analogues (NAs) in well-selected patients, but data on outcomes following TDF withdrawal in Middle Eastern populations remain limited. METHODS:In this prospective cohort study, 44 Iranian patients with CHB who fulfilled the 2017 EASL criteria for safe TDF discontinuation were followed for 12 months. Virological failure was defined as HBV DNA >2000 IU/mL (HBeAg-negative) or >20000 IU/mL (HBeAg-positive). Biochemical failure was defined as alanine aminotransferase (ALT) >2× upper limit of normal (ULN). Patients were assessed quarterly through laboratory testing and imaging. Outcomes, relapse timing, and predictors of failure were evaluated. RESULTS:TDF discontinuation was successful in 22 patients (50%) who maintained both virological suppression and normal ALT without reinitiation of therapy. Relapse occurred in the remaining 22 patients, with most failures (81.8%) occurring within the first 6 months. No cases of hepatic decompensation were reported. Virological relapse was more frequent than biochemical relapse. Serum creatinine significantly improved post-cessation (1.14 ± 0.30 to 1.10 ± 0.28 mg/dL, P=0.05), and liver stiffness remained stable in 97.7% of patients (fibro scan result). Longer HBV infection duration and extended TDF treatment were significant predictors of relapse. CONCLUSION:TDF cessation in appropriately selected Iranian patients with CHB is safe and feasible, with half maintaining remission over 12 months. Relapse predominantly occurred early and was mild, supporting EASL 2017 guideline recommendations. These findings offer valuable insight into TDF discontinuation in genotype D-predominant populations and support the use of finite therapy strategies with careful post-withdrawal monitoring.
INTRODUCTION:Shigella flexneri causes bacillary dysentery by invading the colon epithe-lium, leading to inflammation and tissue damage. The emergence of multidrug-resistant (MDR) Shi-gella strains and the lack of effective vaccines have highlighted the need for alternative treatments. Natural plant compounds have been explored as potential antimicrobial agents. This study evaluates the antibacterial activity of ethanolic (70%-96%) and methanolic (70%-99.9%) extracts of Termi-nalia chebula Retz. against MDR S. flexneri and their effect on bacterial invasion of HeLa cells in vitro. We assessed the anti-MDR S. flexneri activity of these extracts by measuring minimum inhib-itory concentration (MIC) and minimum bactericidal concentration (MBC). MATERIAL AND METHODS:Four Shigella strains belonging to various serotypes and resistant to multiple drugs were used in this study. The invasiveness of S. flexneri was assayed by plaque formation in HeLa cell culture under in vitro conditions. Ethanolic and methanolic extracts of Terminalia chebula Retz. were made in varying concentrations. The antibacterial effects of these extracts against MDR S. flexneri strains were evaluated by determining minimum inhibitory concentration (MIC) and min-imum bactericidal concentration (MBC). RESULT:Plaque-forming assay confirmed that all four S. flexneri serotypes were highly invasive in HeLa cells. All the compounds screened herein were found to be antibacterial (MIC = 0.39-12.5 mg/mL) and (MBC = 0.78-25 mg/mL) against the multidrug-resistant invasive S. flexneri strain, while the MBC/MIC ratio showed both bactericidal and bacteriostatic activity. DISCUSSION:Shigella species are highly infectious and increasingly multidrug-resistant pathogens with significant invasive potential in intestinal cells, as confirmed by our HeLa cell plaque assay results, consistent with prior studies. Our investigation indicates that Terminalia chebula Retz. ex-tracts may exhibit antibacterial activity against multidrug-resistant invasive Shigella isolates. Com-parable research has reported similar antimicrobial effects of T. chebula against various resistant bac-teria, including Shigella sonnei, MRSA, and MDR Escherichia coli. While some studies found other plant extracts, such as Rhus javanica, more potent, bioactive compounds of T. chebula, such as gallic acid derivatives, support its promising role in combating antibiotic-resistant infections. CONCLUSION:These findings suggest that ethanolic and methanolic extracts of Terminalia chebula may have antimicrobial activity against multidrug-resistant and invasive Shigella flexneri. These pre-liminary results indicate that T. chebula extracts warrant further exploration as potential antimicrobial agents against MDR Shigella infections. However, given the limited sample size in this study, further research with larger and more diverse strains is necessary to confirm the therapeutic potential of these plant extracts.
INTRODUCTION:Primary Cutaneous Aspergillosis (PCA) is a rare localized fungal infection resulting from direct skin inoculation of Aspergillus species, often affecting immunocompetent indi-viduals following minor trauma. Unlike systemic forms, which are predominant in immunocompro-mised hosts, PCA frequently mimics benign subcutaneous lesions, leading to diagnostic delays and mismanagement. Case presentation: A total of 3 cases of adult males (aged 55-70 years) were reported: two immuno-competent and one with controlled type 2 diabetes. Lesions presented as painless, mobile subcutane-ous swellings on the left elbow (24 months), shin (6 months), and lower leg (4 months), clinically mimicking lipoma, sebaceous cyst, or olecranon bursitis. Risk factors included repetitive soil expo-sure or superficial abrasion. Fine-Needle Aspiration Cytology (FNAC) with Gomori Methenamine Silver (GMS) staining revealed suppurative inflammation and acute-angle branching septate hyphae. Cultures grew Aspergillus flavus (two cases) and A. fumigatus (one case). For all three cases, wide local excision was planned and performed. Antifungal therapy was administered, which included oral Voriconazole for 8 weeks in two cases and intravenous liposomal Amphotericin B for 14 days fol-lowed by Voriconazole for 6 weeks in the third patient, who was diabetic. No recurrence was ob-served at the 12-month follow-up. CONCLUSION:FNAC with GMS staining is a rapid, low-cost tool that prevents inappropriate surgery and enables early targeted therapy. Clinicians should incorporate FNAC into diagnostic algorithms for atypical subcutaneous swellings with trauma history to avert dissemination and ensure excellent outcomes.
Developing efficient therapies for both acute and chronic wounds requires a thorough un-derstanding of wound healing mechanisms and possible therapeutic approaches. Preclinical research simulates wound healing processes and evaluates the effectiveness of novel medications and treat-ments using a range of experimental models. This review examines and contrasts the main preclinical models-in vitro, in vivo, in silico, explant, and genetically modified models that are employed in wound healing research. While in vivo models offer insights into complex tissue connections and systemic effects in animal subjects, in vitro models facilitate specific cellular and molecular studies to be conducted under controlled settings. The use of in silico models can reduce the requirement for animal testing by supporting predictive analysis and the computational simulation of wound healing processes. Explant models, which bridge the gap between cell cultures and whole-animal models, provide a more complicated environment than in vitro methods by using portions of tissue or organs. Furthermore, targeted research on gene-specific involvement in wound healing is enabled by genet-ically modified models, which are frequently based on animals with particular gene changes. These models' relative advantages and disadvantages are examined, emphasizing their applicability and complementary functions in experimental wound repair studies. This thorough analysis provides a cohesive perspective on each model's suitability, which aids in the development of preclinical ap-proaches for wound healing treatments.
BACKGROUND:Xanthogranulomatous oophoritis (XGO) is a rare chronic inflammatory con-dition that can mimic ovarian malignancy both clinically and radiologically. It is characterized by foamy histiocytes and inflammatory infiltrates, often leading to diagnostic challenges. Few cases have been reported in the literature, and even fewer have noted coexistent endometriosis. CASE PRESENTATION:We present a rare case of XGO in a woman with longstanding endometriosis, highlighting its clinical, radiological, and histopathological correlation. We report a case of a 50-year-old post-menopausal woman with a history of chronic pelvic pain and endometriosis who pre-sented with an adnexal mass. Imaging raised suspicion of ovarian neoplasm. The patient underwent staging laparotomy in view of a persistent, complex adnexal mass with solid-cystic components noted on imaging, and a clinical suspicion of ovarian malignancy. Histopathological evaluation of the ovary post-surgery revealed a fibrocollagenous cyst wall, lined by dense chronic inflammatory infiltrates composed predominantly of foamy histiocytes, lymphocytes, plasma cells, and occasional neutro-phils. Sheets of lipid-laden macrophages with abundant granular cytoplasm were characteristic of xanthogranulomatous inflammation. Foci of fibrosis and hemosiderin-laden macrophages were also identified. CONCLUSION:The final diagnosis was Xanthogranulomatous oophoritis in an endometriotic back-ground. XGO should be considered in the differential diagnosis of adnexal masses, particularly in patients with endometriosis. Accurate diagnosis requires histopathology to avoid overtreatment.
