Exudative Type Research Articles

A case of bilateral recurrent exudative pleural effusion in a post COVID patient

COVID-19-related pleural effusions are frequently described during the ongoing pandemic. Pleural effusions result from the accumulation of fluid in the pleural space surrounding the lungs. The most common causes of bilateral pleural effusions are due to congestive cardiac failure, nephrotic syndrome, anasarca due to any protein deficiency state or fluid overload, hypothyroidism. Few exudative causes of bilateral pleural effusion also like tuberculosis, primary and metastatic pleural malignancy, bronchogenic Ca, lymphomas, Immunological diseases: Mixed connective tissue disease, long standing cardiac failure or liver failure (on diuretics). Exudative causes of bilateral turbid pleural effusion with recurrent accumulation are very rare without any other associated pathology. The significance of pleural effusions in COVID-19 pneumonia has not been well assessed due to the rarity of the disease limited to case reports/series. A 72-year-old male patient comes to emergency with the complaints increasing shortness of breath for 3 days, Dry cough for same duration, H/O of COVID pneumonia 2 months back with no other comorbidity. A chest computer tomography (CT) radiograph revealed a bilateral pleural effusion, which was further assessed as exudative type. Pleural fluid study reveals exudative hemorrhagic turbid fluid with ADA 71.5 U/L with neutrophilicleukocytosis. Pleural fluid culture reveals moderate growth of pseudomonas species with scanty growth of Candida species. The patient was diagnosed as a case of bilateral complicated recurrent parapneumonic effusion and treated with antibiotic as culture sensitivity with steroids. After 4 times aspiration paracentesis patient was discharged with minimal bilateral pleural effusion. The patient has been followed for 4 months and now he is doing well.
 Bangladesh J Medicine July 2021; 32(2) : 149-155

A COMPARATIVE STUDY BETWEEN PLEURAL FLUID CHOLESTEROLAND LIGHT'S CRITERIA FOR DIFFERENTIATION OF EXUDATIVE AND TRANSUDATIVE PLEURAL EFFUSION

Introduction: Pleural effusion is one of the common clinical disorders encountered in the medical wards. In a patient with pleural effusion diagnosis can be arrived by history, clinical examination and radiological techniques. Pleural effusion is collection of uid in intrapleural space and manifestation of several diseases, both pulmonary and extra pulmonary, often isolated 1. Based on the underlying pathological abnormality and mechanism of formation, effusion may be either transudative or exudative. To nd out etiology, rst step is to differentiate whether the pleural effusion is of exudate or transudate type. Etiology of pleural effusions differ in different parts of the world. Aims And Objectives: The study is conducted to compare between pleural uid cholesterol and Light's criteria for differentiation of transudative and exudative pleural effusion. The sensitivity and specicity of pleural uid cholesterol estimation as an independent biochemical marker in exudative pleural effusion. Methodology: The present work was conducted in the N.R.S. Medical College and Hospital Kolkata(Department of GENERAL MEDICINE ). Study was done from February 2018 to 1st May 2019 i.e., through one year and three month period. 70 patients both male and female Patients admitted in N.R.S MEDICALCOLLEGE with symptoms suggestive of pleural effusion. Result And Analysis: Our study showed that mean serum protein level in tuberculous effusion patients is 6.322 gm/dl. In Para pneumonic effusion cases mean serum protein level is 6.867 gm/dl. Mean serum Protein level in transudative effusion cases is 6.923 gm/dl. In patients with malignant effusion, the mean serum protein level is 6.492 gm. /dl. In empyema patients, mean serum protein level is Summary: Pleural effusion develops in a variety of illnesses. Based on the underlying pathology and mechanism of formation, effusions may be either transudates or exudates. Analysis of pleural effusion is an important diagnostic step to guide further investigations and treatment. Conclusion: Pleural uid cholesterol with a cut-off value of >55 mg/dL is better than Light's criteria in the differentiation of exudative pleural effusions. The sensitivity and specicity of differentiation can be improved by combining pleural uid protein with pleural uid cholesterol. Both these criteria are cost effective than the Light's criteria because it does not require a simultaneous blood sampling for differentiation. So in a country like India where there is maximum nancial constraints, it will be helpful for rural and urban poor patients. In resource-limited settings, pleural uid cholesterol can replace Light's criteria for classication of pleural effusion

Endoscopic features and clinical outcomes of cytomegalovirus gastroenterocolitis in immunocompetent patients

We aimed to investigate the endoscopic features and clinical course of CMV gastroenterocolitis in immunocompetent patients. We reviewed the medical records and endoscopic images of 86 immunocompetent patients with CMV gastroenterocolitis. Immunocompetent patients were defined as those without congenital or acquired immunodeficiency syndrome, use of anti-cancer chemotherapeutic and immunosuppressive agents, and inflammatory bowel diseases. The mean age was 65.5 ± 11.8 years and 53 (61.6%) were male. Sixty-eight (79.1%) patients had comorbidities. Upper gastrointestinal-dominant, small bowel-dominant, and colon-dominant types were observed in 19, 7, and 60 patients, respectively. Endoscopic features could be classified into discrete ulcerative type with/without exudate and diffuse erythematous type with/without exudate. Antiviral treatment with ganciclovir was initiated in 51 patients (59.3%), 40 of whom improved and 1 improved after changing ganciclovir to foscarnet. Thirty-three patients (38.4%) improved without antiviral treatment. Surgery was necessary in two patients because of colon perforation before antiviral treatment. Another two patients underwent surgery because of sigmoid stricture and cecal perforation during antiviral treatment. Endoscopic type was not associated with clinical outcomes, such as surgery and death. CMV gastroenterocolitis in immunocompetent patients mostly occur in older patients with comorbidities, and the endoscopic features vary with no association with clinical outcomes.

Comparison of topical nanocolloidal silver formulation use with eosin 2% solution in management of hard-to-heal ulcers in patients with pemphigus vulgaris.

To examine the effect of a nanocolloidal silver-based gel called SilvoGel (ChitoTech, Iran) versus eosin (prepared by Razi Hospital, Iran) among patients with immunobullous disease. This blind, randomised controlled study was carried out on patients with pemphigus vulgaris who had hard-to-heal ulcers, divided into two equal-sized groups: one treatment group receiving the nanocolloidal silver-based gel and the control group receiving the conventional eosin. A total of 32 patients participated in the study. In both the treatment and control groups, ulcer area, exudate and tissue type improved significantly (p<0.001 for all measures). A significantly higher rate of improvement in ulcer area was observed in the treatment group compared with the control group (p<0.001). Both patient and physician satisfaction were significantly higher in the treatment group compared with the control group (p=0.003 and p=0.01, respectively). The results of this study indicate that use of the nanocolloidal silver-based gel for treating patients with immunobullous disease including pemphigus could potentially increase the rate and quality of wound healing.

Choriocapillaris Flow Deficits and Treatment-Naïve Macular Neovascularization Secondary to Age-Related Macular Degeneration.

PurposeTo evaluate choriocapillaris (CC) flow deficits (FD) in eyes with treatment-naïve macular neovascularization (MNV) and to compare CC FD around exudative versus nonexudative MNV.MethodsTreatment-naïve eyes with a diagnosis of either exudative or nonexudative AMD and type 1 MNV were included. Normal control eyes were age-matched to each AMD eye one to one. En face optical coherence tomography angiograms were analyzed for percentage of CC FD (FD%) in two concentric 500 µm rings, ring 1 and ring 2, surrounding the dark halo around MNV. The mean CC FD% in ring 1 and ring 2 was evaluated for each eye. A secondary analysis was similarly carried out to investigate the differences in CC FD% in exudative versus nonexudative treatment-naïve MNV.ResultsTwenty-three eyes with treatment-naïve MNV were age matched with 23 normal controls. The mean CC FD% was significantly greater in both rings in the MNV versus the normal control group (P < 0.05) and was significantly greater in the inner ring, closer to the lesion, than the outer ring. The mean FD% was also greater in both rings in the exudative versus the nonexudative MNV group, but this difference did not reach statistical significance.ConclusionsThe CC FD% was greater in the area surrounding MNV versus age-matched normal controls and in the ring closer to the MNV lesion. Further, CC FD was greater in eyes with exudative versus nonexudative MNV in both rings surrounding the associated dark halo, although this difference was not statistically significant.

Use of organic exudates from two polar diatoms by bacterial isolates from the Arctic Ocean.

Global warming affects primary producers in the Arctic, with potential consequences for the bacterial community composition through the consumption of microalgae-derived dissolved organic matter (DOM). To determine the degree of specificity in the use of an exudate by bacterial taxa, we used simple microalgae-bacteria model systems. We isolated 92 bacterial strains from the sea ice bottom and the water column in spring-summer in the Baffin Bay (Arctic Ocean). The isolates were grouped into 42 species belonging to Proteobacteria, Bacteroidetes, Actinobacteria and Firmicutes. Forty strains were tested for their capacity to grow on the exudate from two Arctic diatoms. Most of the strains tested (78%) were able to grow on the exudate from the pelagic diatom Chaetoceros neogracilis, and 33% were able to use the exudate from the sea ice diatom Fragilariopsis cylindrus. 17.5% of the strains were not able to grow with any exudate, while 27.5% of the strains were able to use both types of exudates. All strains belonging to Flavobacteriia (n = 10) were able to use the DOM provided by C.neogracilis, and this exudate sustained a growth capacity of up to 100 times higher than diluted Marine Broth medium, of two Pseudomonas sp. strains and one Sulfitobacter strain. The variable bioavailability of exudates to bacterial strains highlights the potential role of microalgae in shaping the bacterial community composition. This article is part of the theme issue 'The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.

Postoperative wound assessment documentation and acute care nurses' perception of factors impacting wound documentation: A mixed methods study.

Wound care documentation is an essential component of best practice wound management in order to enhance inter-disciplinary communication and patient care. However, evidence suggests that wound care documentation is often carried out poorly and sporadically. Determine postoperative wound assessment documentation by acute care nurses and explore their perception of factors constraining adequate nursing documentation. A two-phase sequential exploratory mixed methods design was used. Phase one: A retrospective clinical chart audit of nurses' documentation was undertaken. A random selection of 200 medical records were reviewed over 3months at a provincial hospital in Vietnam. Phase two: semi-structured interviews were conducted with 13 surgical nurses to explore their perceptions of factors influencing appropriate documentation. Inductive qualitative content analysis was applied for qualitative data. This manuscript adheres to COREQ guidelines for reporting the qualitative phase. Phase one: 200 records were audited. Less than 10% of preoperative factors (such as co-morbidities, smoking and nutrition status) related to the risk of delayed wound healing were documented. During the first 5days postoperation, there was no documentation about incision location, wound dimension, wound bed (in wounds healing by secondary intention) or odour. In less than 10% colour and type of exudate were recorded. Phase two: Emerging key categories were: unimportance of nursing documentation, difficulty to change existing practice, and personal factors. This study indicated that surgical wound assessment documentation was insufficient and inconsistent among nurses. Nurses viewed the wound assessment documentation as unimportant. Therefore, extensive exploration of strategies is required to enhance the quality of wound assessment documentation.

Karakteristik Luka Dan Penggunaan Balutan Luka Modern

Abstract&#x0D; The most frequent injuries are chronic wounds, where the number is increasing every year. The most common type of wound is diabetic ulcer and the next is cancerous wound. Each wound has different characteristics, so the treatment of each wound is also different. There are various dressings in modern wound care, where each bandage has different indications according to the characteristics of the wound, it is necessary to do research on the characteristics of the wound and the use of modern wound dressing. The purpose of the study To describe the characteristics of wounds and the use of modern wound dressing in the Salud Wound Care Clinic, Kartasura. Research subjects: patients undergoing wound care at the Salud Wound Care Clinic, a total of 9 respondents. Method: Descriptive analytic. Research Results: The types of wounds treated were diabetic ulcer wounds, postoperative wounds, cancer wounds, and decubitus wounds, wound duration varied from 2 weeks to 1 year. Types of wound dressing used were foam, alginate, and hybrid technology dressing, there was a decrease the size of the wound area with a mean of 14,69 to 11,61, the majority of wounds in stage 2, the basic color of the wound is red, and the type of exudate is serous. Conclusion: There is a reduction in wound size, stage, and the wound exudate, as well as repairing the wound’s basic color with wound care using modern wound dressing.&#x0D; Keywords: modern wound dressing, wound characteristics.

Diagnostic Accuracy of Sonographic Septations in Tuberculous and Malignant Pleural Effusions

Background: Discrimination between tuberculous (TB) and malignant pleural effusions is a real practical challenge because both exist as exudative lymphocytic type. Transthoracic ultrasonography not only identifies and quantifies pleural effusion but also displays sonographic septations, which are frequently seen in TB pleural effusions and can help in differentiation between tuberculosis and malignancy successfully, without any invasive procedure. We designed this study to determine the diagnostic usefulness of these septations for tuberculous and malignant pleural effusions.&#x0D; Material and Methods: This prospective study was conducted in the OPD of Gulab Devi Chest Hospital Lahore, Pakistan, a 1500 bedded tertiary care hospital, from November 2016 to February 2018. Total of 339 consecutive cases, aged 14-83 years with radiological evidence of pleural effusion were included in the study. After detailed history, thorough physical examination, radiological, haematological and biochemical findings were recorded. Pleural fluid macroscopic, cytological, microbiologic and biochemical analysis results were also recorded. Ultrasonography was done, septated and non-septated pleural effusions identified and findings were noted. SPSS-16 was used for statistical evaluation. Fisher Exact test was utilized for comparison between TB and malignant cases with P-value &lt; 0.05 taken as significant. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy and positive likelihood ratio were calculated.&#x0D; Results: Out of total 339 cases, 49 (14.45%) were malignant and 290 (85.55%) were non-malignant. In the malignant group, only 03 cases (6.12%) showed sonographic septations. In the non-malignant group, 259/290 (89.31%) cases showed tuberculous etiology and 187/259 (72.20%) of these cases displayed sonographic septations. By considering septations as predictor of TB, statistical analysis revealed a sensitivity of 79.23%, specificity of 92.85%, PPV of 98.42%, NPV of 44.31% and diagnostic accuracy of 81.29%, respectively.&#x0D; Conclusions: Sonographic septations can be a valuable predictor of tuberculosis, in a population with high prevalence of the disease. We found it to be a useful feature in differentiating between a malignant and tuberculous etiology, in exudative lymphocytic pleural effusions. It can be used with confidence in patients who are unfit for interventional procedures.

Comparative Clinical Study of ‘Panchavalkal Ointment’ &amp; Framycetin Sulfate Cream (Local Application) in the Management of Infected Wound wrt Dushta Vrana

A wound infection is major cause of delayed wound healing. Although there is a huge range of wound care available from Western medicine, their own side effects and increased resistance towards micro-organism leave a substantial space for herbal productwhich can cope-up with the sign and symptom of wound infection as well as accelerate the wound healing. In this clinical study, Group A_Panchavalkal ointment was compared with Group B_Framycetin Sulfate cream, topically, in management of Dushta Vrana (infected wound). Assessment of pain was done by numerical rating scale. However, assessment of objective parameter such as size, depth, edges, undermining, necrotic tissue type, necrotic tissue amount, exudate type, exudate amount, skin color surrounding wound, peripheral tissue edema, peripheral tissue induration, granulation tissue, epithelialization evaluated by Bates-Jensen Wound Assessment Tool. The wound status continuum between the two groups after treatment was compared. In Group A, 30.0% woundachieved tissue health, 36.7% healed, 26.7 regenerated and 6.7% improved. In Group B only 13.3% woundachieved tissue health, 30.0% healed, 43.3% regenerated and 13.3% improved. The clinical analysis of objective parameters showed that both the medicines are effective to control wound infection, but it was observed that control in sign and symptom of wound infection was rapid in Group A and led to wound healing with less time duration in comparison to Group B. The wound assessment revealed that both the groups were markedly efficacious in treating infected wound ; moreover, the outcome was comparatively better in Group A. Hence, it is proved that Panchvalkal ointment was more effective than Framycetin Sulfate Cream in the management of infected wound w.s.r. to Dushta Vrana.&nbsp;&nbsp; How to cite this article: Kulkarni AM, Dwivedi A. Comparative Clinical Study of ‘Panchavalkal Ointment’ &amp; Framycetin Sulfate Cream (Local Application) in the Management of Infected Wound wrt Dushta Vrana. J Adv Res Ayur Yoga Unani Sidd Homeo 2019; 6(3&amp;4): 17-24. DOI: https://doi.org/10.24321/2394.6547.201910

Circadian Rhythms in Exudative Age-Related Macular Degeneration: The Key Role of the Canonical WNT/β-Catenin Pathway.

Age-related macular degeneration (AMD) is considered as the main worldwide cause of blindness in elderly adults. Exudative AMD type represents 10 to 15% of macular degeneration cases, but is the main cause of vision loss and blindness. Circadian rhythm changes are associated with aging and could further accelerate it. However, the link between circadian rhythms and exudative AMD is not fully understood. Some evidence suggests that dysregulation of circadian functions could be manifestations of diseases or could be risk factors for the development of disease in elderly adults. Biological rhythms are complex systems interacting with the environment and control several physiological pathways. Recent findings have shown that the dysregulation of circadian rhythms is correlated with exudative AMD. One of the main pathways involved in exudative AMD is the canonical WNT/β-catenin pathway. Circadian clocks have a main role in some tissues by driving the circadian expression of genes involved in physiological and metabolic functions. In exudative AMD, the increase of the canonical WNT/β-catenin pathway is enhanced by the dysregulation of circadian rhythms. Exudative AMD progression is associated with major metabolic reprogramming, initiated by aberrant WNT/β-catenin pathway, of aerobic glycolysis. This review focuses on the interest of circadian rhythm dysregulation in exudative AMD through the aberrant upregulation of the canonical WNT/β-catenin pathway.

Results of Intravitreal Anti-VEGF Injection in Choroidal Neovascularization Caused by Pathologies Other Than Age-Related Macular Degeneration.

Objectives:The aim of this retrospective study was to evaluate the efficacy of the intravitreal injection of anti-vascular endothelial growth factor (anti-VEGF) agents to treat choroidal neovascularization (CNV) caused by a pathology other than exudative type age-related macular degeneration (AMD).Methods:This was a retrospective study of 43 treatment naive eyes of 35 patients who had been diagnosed with CNV caused by a pathology other than exudative- type AMD and who underwent intravitreal injection of anti-VEGF agents. Primary and secondary outcome measures were the best corrected visual acuity (BCVA) and the central macular thickness (CMT).Results:The mean patient age was 44.6±13.1 years. The mean number of injections was 3.3±1.8. The mean logarithm of minimal angle of resolution BCVA at baseline and the 12th month follow-up was 0.89±0.50 and 0.73±0.57, respectively (p=0.120). In all, 44.2% of the eyes gained ≥15 letters of BCVA, whereas 14% lost ≥15 letters of BCVA. The mean CMT at baseline and the 12th month follow-up was 381±121 and 311±73 microns, respectively (p=0.001).Conclusion:Stabilized functional and improved anatomic outcomes following intravitreal anti-VEGF agent injection for CNV unrelated to AMD were seen at the 12th month of follow-up.

Effects of pure and ozonated sunflower seed oil (Helianthus annuus) on hypergranulation tissue formation, infection and healing of equine lower limb wounds

This study was undertaken to evaluate the therapeutic effects of topical application of pure sunflower seed oil (oil group) and ozonated sunflower seed oil (ozone group) on acute cutaneous wound healing in eight healthy horses. The control group was treated with 0.9% sodium chloride. Two wounds were surgically produced on each horse on the proximal epiphysis of the metacarpus on the dorsal aspect of each forelimb. Wound area and contraction were measured on days 0, 3, 7, 14 and 21. Biopsy samples were taken to evaluate epithelial hyperplasia, inflammation, exuberant granulation tissue, exudate type, angiogenesis, and fibroplasia. Culture swabs were also collected. Wound contraction at 21 days for the oil group was 52.68%, for the ozone group was 72.16%, and for the control group (0.9% sodium chloride) was 34.80%. The ozone group had a significantly smaller wound size and a residual wound area than the control and the oil groups, on days 14 and 21. The control-wounds and oil-wounds had suppurative exudate and the presence of Streptococcus zooepidemicus. Neutrophilic inflammatory infiltrate was observed in all groups. Granulation tissue was observed on day 7 in all groups, but exuberant granulation tissue was observed only in the control group on days 14 and 21. Reepithelialization was observed on day 14 in the ozone group. In conclusion, these results demonstrate that topical application of ozonated sunflower seed oil accelerates acute cutaneous wound repair in horses, preventing hypergranulation tissue and infection, and that it is superior to treatment with pure sunflower seed oil and 0.9% sodium chloride.

Phylloplane Microflora of Potato as influenced by Fungicides

Phylloplane microflora - that included pathogenic fungi as well - changes with the age, variety and location of the crop. Application of fungicides affected the quantity and type of leaf exudates. Besides, fungicides also selectively eliminate the non-target microflora which might resulted in the disease pattern. Effect of fungicides viz., Ridomil MZ, Blitox-50 and Dithane M-45 on the phylloplane microflora of potato was studied. An initial drop of microflora population was observed in most fungicides' treated plants. However, in all cases microbial population increased subsequently. The three fungicides affected microflora differently. Some of the resident fungal species were displaced.

Diagnostic value of procalcitonin in pleural effusion

Background A wide range of diseases can cause pleural effusion. Its diagnosis and management remain a clinical challenge, bearing a significant cost to both patients and health care system. Objective To assess the role of procalcitonin (PCT) level in discriminating transudative from exudative pleural effusion and in differentiation between some types of exudative effusion. Patients and methods A total of 45 patients having pleural effusion were enrolled in this study and were divided into two groups. Group I included 15 patients having transudative pleural effusion. Group II included 30 patients having exudative pleural effusion. This group was subdivided into group IIa, which included 10 patients having tuberculous effusion; group IIb, which included 10 patients having malignant effusion; and group IIc, which included 10 patients having parapneumonic effusion. Quantitative measurement of PCT in both serum and pleural fluid was done using enzyme-linked immunosorbent assay. Results Exudative effusion had significantly higher levels of serum and pleural PCT when compared with transudative one. Regarding serum and pleural PCT levels in different types of exudative effusion, highest level was in parapneumonic followed by malignant, and then tuberculous pleural effusion, and the difference between them was statistically significant. Conclusion Measurement of both serum and pleural PCT may be used to differentiate transudative from exudative type of pleural effusion and may be used also to discriminate parapneumonic from other causes of exudative pleural effusion.

RISK OF AGE-RELATED MACULAR DEGENERATION IN PATIENTS WITH PERIODONTITIS: A Nationwide Population-Based Cohort Study.

Periodontitis is an inflammatory disease that results in loss of connective tissue and bone support. Evidence shows a possible relationship between periodontitis and age-related macular degeneration (AMD). This population-based cohort study was conducted using data from the National Health Insurance Research Database in Taiwan, with a 13-year follow-up, to investigate the risk of AMD in patients with periodontitis. The periodontitis cohort included patients with newly diagnosed periodontitis between 2000 and 2012. The nonperiodontitis cohort was frequency-matched with the periodontitis cohort by age and sex, with a sample size of 41,661 in each cohort. Patients with periodontitis had an increased risk of developing AMD compared with individuals without periodontitis (5.95 vs. 3.41 per 1,000 person-years, adjusted hazard ratio = 1.58 [95% confidence interval, 1.46-1.70]). The risk of developing AMD remained significant after stratification by age (adjusted hazard ratio = 1.48 [1.34-1.64] for age <65 years and 1.76 [1.57-1.97] for age ≥65 years), sex (adjusted hazard ratio = 1.40 [1.26-1.55] for women and 1.82 [1.63-2.04] for men), and presence of comorbidity (adjusted hazard ratio = 1.52 [1.40-1.66] for with comorbidity and 1.92 [1.63-2.26] for without comorbidity). In addition, patients with periodontitis showed an increased incidence for both nonexudative type AMD (5.43 vs. 3.13 per 1,000 person-years) and exudative type AMD (0.52 vs. 0.28 per 1,000 person-years). People with periodontitis could be at a greater risk of developing AMD than those without periodontitis. However, we need more evidence to support this association.

Investigating the Effect of Medicago sativa L. and Trifolium pratense L. Root Exudates on PAHs Bioremediation in an Aged-Contaminated Soil

Polycyclic aromatic hydrocarbons (PAH) are persistent organic compounds of major concern that accumulate in the environment, especially soils, and require remediation. Researches to develop bioremediation and phytoremediation (alternative eco-friendly technologies) are being conducted. First, a bioaccessibility measurement protocol was adapted to a brownfield soil using Tenax® beads in order to compare PAHs bioaccessibility in soil samples. PAHs desorption kinetics were established, described by a site distribution model, and a common extraction time was calculated (48 h). Second, the role of two Fabaceae (Medicago sativa L. or Trifolium pratense L.) root exudates in enhancing PAHs bioaccessibility and biodegradation in the studied soil was evaluated during microcosms experiments (28 °C). The CO2 emissions were significantly higher in presence of T. pratense exudates; the dehydrogenase activities showed improvements of the soil microbial activity in presence of two types of root exudates compared to untreated soil samples; the PAHs residual contents decreased more in untreated samples than in the presence of T. pratense exudates; and M. sativa exudates lowered PAHs bioaccessibility but not residual contents.

Type 1 Choroidal Neovascularization Is Associated with Reduced Localized Progression of Atrophy in Age-Related Macular Degeneration

To investigate the association between the presence of type 1 choroidal neovascularization (CNV) and the localized progression of atrophy in age-related macular degeneration (AMD). Analysis of patients' data collected in the context of 2 noninterventional, prospective studies conducted at the Department of Ophthalmology, University of Bonn, Germany. A total of 98 eyes diagnosed with AMD of 59 patients (40 female, 19 male) with a mean (±standard deviation) age at baseline of 76.60±6.65 years and median (interquartile range) review period of 1.17 years (1.01-1.55) were included. Eyes were subdivided into 3 categories based on multimodal imaging and ocular history: retinal pigment epithelium (RPE) atrophy with treatment-naïve quiescent CNV (n=7), RPE atrophy with a history of exudative CNV (n=10), and RPE atrophy without evidence of coexisting CNV (n=81). Retinal pigment epithelium atrophy was delineated on the basis of serial fundus-autofluorescence and infrared-reflectance images. If CNV was detected by OCT angiography (OCTA), its location and dimension were spatially mapped to RPE atrophy. The localized progression of RPE atrophy in topographic relation to the CNV lesion was then analyzed using mixed-effects logistic regression. The spatial overlap (Dice coefficient) between predicted and observed RPE atrophy progression was evaluated to estimate the model accuracy. Odds ratio (OR) for localized RPE atrophy progression in areas overlying type 1 CNV. The prediction model achieved a high overlap between predicted and observed RPE atrophy progression with a cross-validated Dice coefficient of 0.87 (95% confidence interval [CI], 0.85-0.89) reflecting a high accuracy. The odds for future RPE atrophy involvement were reduced by a factor of 0.21 (95% CI, 0.19-0.24) in the presence of treatment-naïve quiescent type 1 CNV and by a factor of 0.46 (95% CI, 0.41-0.51) in the presence of exudative type 1 CNV. The results indicate that there is markedly reduced RPE atrophy progression in areas co-localizing with quiescent and exudative type 1 CNV. This observation is compatible with a potential protective effect of type 1 CNV on the RPE and overlying neurosensory retina. These results may have relevant clinical implications for the management of CNV and lead to new therapeutic strategies to prevent atrophy progression.

Venöz Ayak Ülser Tedavisinde Güncel Yaklaşımlar

Venöz ayak ülseri alt ekstremite ülserlerin etiyolojisinde en yaygın görülen, açık bir lezyon şeklinde 4 hafta süresince iyileşmeyen ve diz ile ayak bileği arasında gelişen ülserdir. Tüm yaşlar için görülme oranı %1, 65 yaşı üstü kişilerde %3-5 arasındadır. Yaranın tedavisindeki amaç ödemi azaltmak, yara iyileşmesini sağlamak ve tekrarlamasını önlemektir. Yaranın tedavisinden önce; yaranın ilk oluştuğu zaman, yaranın çapı, yeri, sayısı, yatağındaki doku tipi, eksuda türü ve miktarı, yara kenarları ve çevresi cilt durumu, yaranın evresi, ayak bileği kol basıncı indeksi ve ayak lenfödem durumunun değerlendirilmesi gerekir. Venöz ülser tedavisinde ayak elevasyonu, yüksek basınçlı kompresyonlar, pansuman, pentoksifilin, mikronize arıtılmış flavanoid fraksiyonu, topikal işlenmemiş petrol yağı, kalsiyum dobesilat ve aspirin kullanımı önerilmektedir. Sitokin büyüme faktörlerin kullanımı, sklerotherapi ile birlikte kompresyona yönelik çalışmalar mevcuttur. Vakum yardımlı kapama ile hiperbarik oksijen tedavi kombinasyonu için kanıtlar yetersizdir. Yara debridmanı için cerrahi ve mekanik yöntemler önerilmektedir. Altı aydan fazla diğer tedavilere dirençli ve yara çapı &amp;gt; 10 cm² olan ülserlerde pinch ya da mesh greftler kullanılabilir. Tedavi sürecinde aktif planter fleksiyona direnç ve topuk kaldırma egzersizleri, protein ve sıvı ihtiyacının izlenimi, elektrolit ve albümin değerlerinin takibi, düzenli ayak bakımı için hasta-aile eğitimi ve psikososyal destek önem taşımaktadır.

EFFECTIVITY OF INDONESIAN HONEY ON DIABETIC FOOT ULCERS HEALING PROCESS: OBSERVATIONAL CASE STUDY

Background: Diabetic foot ulcers were common diabetes complication that progressively growth globally. The effectivity of Manuka honey in wound healing process was huge published currently. Modern dressing and Manuka honey may not affordable and cost effective since these dressings were not produced originally in Indonesia. In addition, the published study of Indonesian honey is still lack. Therefore, we conducted this study to investigate the effectivity of Indonesian honey in diabetic foot ulcers healing process.&#x0D; Method: This study design was observational case study. This study was conducted among type 2 diabetes with diabetic foot ulcers in Griya Afiat Homecare and ETN Center in Makassar City, Indonesia from March to June 2014. The Bates Wound Assessment Tool (BWAT) were used to collect the score of diabetic foot ulcer healing process regarding wound size, depth, edges, undermining, necrotic tissue type, necrotic amount, granulation, epithelization, exudate type and amount, surrounding skin color, edema and induration. Descriptive, Independent t-test, Analysis of Variance (ANOVA) and Wilcoxon signed rank test were conducted appropriately.&#x0D; Results: In total, 10 type 2 diabetes patients with diabetic foot ulcers were participated. The factors associated with wound healing process were diabetes treatment (t= 2.44, p= 0.041) and primary dressing (t= -2.76, p= 0.025). The effect of honey primary dressing was in reducing wound size (p= 0.043), improving necrotic tissue type (p= 0.041), reducing necrotic tissue amount (p= 0.042), increasing granulation (p= 0.038) and epithelization (p= 0.042). In the counterpart, the effect of modern dressing was in improving necrotic tissue type (p= 0.046) and increasing granulation (p= 0.042).&#x0D; Conclusion: Indonesian honey is beneficial on diabetic foot ulcers healing process.&#x0D; Recommendation: Therefore, findings suggest that honey should be considered as the alternative, cost effective and beneficial wound dressing on the diabetic foot ulcers.