Exudative Type Research Articles

Effect of ointment-based egg white on healing of second- degree wound in burn patients: a triple-blind randomized clinical trial study.

Burn wound healing is one of the problems of medical sciences and it is of great importance to find a drug or substance that can heal burn wounds with minimum complications. The present study aimed to evaluate the effect of ointment-based egg white on healing second-degree burn wounds. In the present triple-blind clinical trial, a total of 90 patients from Taleghani hospital, Ahvaz, Iran were selected and randomly divided into two groups based on the inclusion criteria. The intervention group was dressed with egg white formulation + silver sulfadiazine cream and the control group was treated with placebo + silver sulfadiazine cream. The burn wound healing process was evaluated on days 1, 7 and 15 by the Bates-Jensen wound assessment tool. The mean scores of wound healing were decreased (13.75±1.83) in the intervention group when compared to the control (21.51±5.7) on day 15 (p<0.001). The mean duration of wound healing, wound depth, edges, undermining, necrotic tissue, amount of necrosis, exudate type and amount, surrounding skin color, wound induration, peripheral edema, granulation, and epithelialization were significantly decrease in intervention group in comparison with control (p<0.001). The findings of this research showed that egg whites formulation is an appropriate treatment for burn wound healing, reduced above-noted burn wounds' variables. It seems that this treatment, along with the common medicine, improves chronic wound recovery rate and patients' health status.

The role of the intra-abdominal view in complicated intra-abdominal infections

BackgroundThe prognostic role of what a surgeon observes in the abdomen of patients with complicated intra-abdominal infection (cIAI) is largely unknown. The aim of this prospective study was to systemically analyze components of the intra-abdominal view (IAV) and their association to severe complicated intra-abdominal sepsis (SCIAS) or mortality.MethodsThe study cohort consisted of adult patients with cIAI. The operating surgeon filled a paper form describing the intra-abdominal view. Demographics, operative details, and preoperative physiological status were collected. Descriptive, univariate, and multivariate statistical analyses were performed, and a new score was developed based on regression coefficients. The primary outcome was a composite outcome of SCIAS or 30-day mortality, in which SCIAS was defined as organ dysfunctions requiring intensive care unit admission.ResultsA total of 283 patients were analyzed. The primary outcome was encountered in 71 (25%) patients. In the IAV, independent risk factors for the primary outcome were fecal or bile as exudate (odds ratio (OR) 1.98, 95% confidence interval 1.05–3.73), diffuse peritonitis (OR 2.15, 1.02–4.55), diffuse substantial redness of the peritoneum (OR 5.73, 2.12–15.44), and a non-appendiceal source of cIAI (OR 11.20, 4.11–30.54). Based on these factors, an IAV score was developed and its performance analyzed. The area under the receiver operating characteristic for the IAV score was 0.81. The IAV score also correlated significantly with several outcomes and organ dysfunctions.ConclusionsThe extent of peritonitis, diffuse substantial redness of the peritoneum, type of exudate, and source of infection associate independently with SCIAS or mortality. A high IAV score associates with mortality and organ dysfunctions, yet it needs further external validation. Combining components of IAV into comprehensive scoring systems for cIAI patients may provide additional value compared to the current scoring systems.Trial registrationThe study protocol was retrospectively registered on April 4, 2016, right after the first enrolled patient at Clinicaltrials.gov database (NCT02726932).

Analysis of macrophage subtypes and annexin A1 expression in lesions of patients with cutaneous leishmaniasis.

Cutaneous leishmaniasis is caused by protozoa of the genus Leishmania and transmission occurs through the bite of sandflies. It is an infectious disease, which affects skin and mucosa. The aim was to quantify the macrophages M1 and M2 and the annexin A1 expression in the skin lesions of patients with cutaneous leishmaniasis. Skin biopsies from patients (n = 50) were analyzed and classified according to the lesion type as: exudative cellular reaction, exudative granulomatous reaction, exudative necrotic reaction, exudative necrotic-granulomatous reaction. Using the immunofluorescence technique, macrophages were identified by CD163 marker, differentiated by anti-MHCII and anti-CD206 antibodies, and annexin A1 expression was determined by arbitrary unit (a.u.) densitometry. In M1 macrophages, a greater expression of this protein was observed in the exudative cellular reaction type lesions (136.3 ± 2.6 a.u., assuming mean and standard derivation) when compared to the expression in the lesions of exudative granulomatous reaction, exudative necrotic reaction and exudative necrotic-granulomatous reaction patients (108.0 ± 2.3, 121.6 ± 3.2 and 124.7 ± 2.4 a.u., respectively). Regarding M2 macrophages, it was observed that patients with exudative cellular reaction lesion also had a higher expression of this protein (128.8 ± 2.6 a.u.), when compared to the expression in the lesions of exudative granulomatous reaction, exudative necrotic reaction and exudative necrotic-granulomatous reaction patients (105.6 ± 2, 113.9 ± 2.8, 114.3 ± 2.1 a.u., respectively). These data suggest that annexin A1 is assisting macrophages in the phagocytosis process of patients with exudative cellular reaction lesion type.

Composition and concentration of root exudate analogues regulate greenhouse gas fluxes from tropical peat

Tropical peatlands are a significant carbon store and source of carbon dioxide (CO2) and methane (CH4) to the atmosphere. Plants can contribute to these gas emissions through the release of root exudates, including sugars and organic acids amongst other biomolecules, but the roles of concentration and composition of exudates in regulating emissions remains poorly understood. We conducted a laboratory incubation to assess how the type and concentration of root exudate analogues regulate CO2 and CH4 production from tropical peats under anoxic conditions. For CO2 production, substrate concentration was the more important driver, with increased CO2 fluxes following higher addition rates of four out of the six exudate analogues. In contrast, exudate type was the more important driver of CH4 production, with acetate addition associated with the greatest production, and inverse correlations between exudate concentration and CH4 emission for the remaining five treatments. Root exudate analogues also altered pH and redox potential, dependent on the type of addition (organic acid or sugar) and the concentration. Overall, these findings demonstrate the contrasting roles of composition and concentration of root exudate inputs in regulating greenhouse gas emissions from tropical peatlands. In turn this highlights how changes in plant communities will influence emissions through species specific inputs, and the possible impacts of increased root exudation driven by rising atmospheric CO2 and warming.

Development of a simple multidisciplinary arthroplasty wound-assessment instrument: the SMArt Wound Tool

There are currently no validated instruments in the orthopedic literature for assessing the healing of acute surgical wounds. The creation of a simple wound-assessment tool would provide a standardized method of reporting wound outcomes. The objective of this study was to systematically develop a wound-assessment tool that can be used to assess the early healing of arthroplasty incisions. The databases MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane reviews and CINAHL were searched. Articles that described objective assessment of acute incisional wounds were included. Items for the wound-assessment tool were then extracted from eligible studies based on the frequency of reporting. A multidisciplinary panel of wound experts compiled the items into an initial tool to assess key domains of wound healing. The items were reduced through several iterations of panel discussion. Our search strategy yielded 3743 results, which were screened by title and abstract. Thirty-four studies were included in the systematic review for the development of the wound-assessment tool, and 10 domains were extracted based on frequency of reporting. After item reduction, the final version of the wound-assessment tool, the SMArt Wound Tool, contained 3 major domains: blistering, peri-incisional skin colour and exudate type. There is currently a need for a standardized tool to assess the healing of orthopedic surgical incisions. The SMArt Wound Tool provides a simple, objective method of assessing arthroplasty incisions for the presence of early complications.

Management of retinal detachment in retinoblastoma with globe conserving treatment

PurposeTo investigate the features and outcomes of retinoblastoma (Rb) patients complicated by development of retinal detachment (RD) following systemic chemotherapy with or without local focal consolidation treatment and without external beam radiotherapy (EBRT). MethodsA retrospective study of all Rb patients between April 2002 and April 2012 at a tertiary hospital center (Birmingham Children’s Hospital and Birmingham Midlands Eye Centre, United Kingdom). All eyes that had developed RD during or after systemic treatment with or without local focal consolidation treatment were included in the study. The time interval between the type of treatment of Rb, development of RD and relevant surgical intervention were analyzed. Patients with exudative RD were treated conservatively through observation and patients with rhegmatogenous RD were treated with scleral buckling. Final anatomical retinal reattachment rate and visual acuity outcomes were analyzed. ResultsA total of 258 patients were treated for Rb over the 10-year period. One hundred sixty-nine patients were managed with globe conserving treatment. Ten (5.92%) eyes of 10 patients were complicated with RD. Five eyes were exudative or presumed exudative type of RD while the other five eyes were rhegmatogenous or presumed rhegmatogenous RD. In the exudative group, two patients achieved visual acuity (VA) of 0.2 Single Kays (20/32 Snellen), and the other two patients achieved 0.85 and 0.86 Crowded Kays (20/142 and 20/145 Snellen), respectively, after the RD had resolved. The last patient in the group had to be enucleated due to tumor recurrences. The median time for the exudative RD to resolve is 15 weeks (range, 4–36 weeks). In the rhegmatogenous group, 3 of the 4 operated patients achieved retinal reattachment. The final postoperative VA ranged between 0.05 Crowded Kays to 1.84 Crowded Kays (20/22 to 20/1384 Snellen). The other patient was treated conservatively as no retinal breaks were found with previous cryotherapy and thermotherapy. The final VA in this patient was hand movement, and the RD did not reattach. The median time for the rhegmatogenous RD to reattach is 6 weeks (range, 4–8 weeks). There were no intra- and postoperative complications. ConclusionsWith long-term conservative management through observation, exudative Rb after systemic treatment of Rb will tend to resolve by itself. However, supplementary local treatment with cryoretinopexy or laser photocoagulation during the systemic treatment of Rb can lead to an increased risk of rhegmatogenous RD. In these cases, most rhegmatogenous RD are successfully repaired with non-drainage scleral buckling and cryoretinopexy.

Indoor Trichoderma strains emitting peptaibols in guttation droplets.

The production of peptaibols, toxic secondary metabolites of Trichoderma, in the indoor environment is not well-documented. Here, we investigated the toxicity of peptaibols in the guttation droplets and biomass of Trichoderma strains isolated from problematic buildings. Seven indoor-isolated strains of T. atroviride, T. trixiae, T. paraviridescens and T. citrinoviride were cultivated on malt extract agar, gypsum boards and paperboards. Their biomass extracts and guttation droplets were highly cytotoxic in resting and motile boar sperm cell assays and in inhibition of somatic cell proliferation assays. The toxins were identified with HPLC/ESI-MS/MS as trichorzianines, trilongins, trichostrigocins and trichostrigocin-like peptaibols. They exhibited toxicity profiles similar to the reference peptaibols alamethicin, trilongins, and trichorzianine TA IIIc purified from T. atroviride H1/226. Particular Trichoderma strains emitted the same peptaibols in both their biomasses and exudate droplets. The trilongin-producing T. citrinoviride SJ40 strain grew at 37°C. To our knowledge, this is the first report of indoor-isolated Trichoderma strains producing toxic peptaibols in their guttation droplets. This report proves that indoor isolates of Trichoderma release peptaibols in their guttation droplets. The presence of toxins in these types of exudates may serve as a mechanism of aerosol formation for nonvolatile toxins in the indoor air.

Ultrastructure and secretion of glandular trichomes in species of subtribe Cajaninae Benth (Leguminosae, Phaseoleae).

The subtribe Cajaninae of papilionoid legumes has a pantropical distribution and comprises approximately 490 species. These species have diversified throughout dry environments where there are high temperatures and strong light. The subtribe stands out because all its representatives have vesicular glands. In addition, bulbous-based and capitate trichomes are important secretory structures present in all genera of the Cajaninae. We analyzed the ultrastructure and histochemistry of these glandular trichome types in leaflets of the three species of the subtribe. Using transmission electron microscopy and histochemical analyses, we link the glandular secretions to subcellular structures. We here report for the first time the type of exudate and ultrastructure of the glands of subtribe Cajaninae. Terpenoids and phenolics were confirmed by histochemistry tests, and we observed that the organelles responsible for biosynthesis of oils are the most representative in these glands. Each glandular trichome showed particular ultrastructural features compatible with the compounds produced. We suggest that these glandular trichomes, with their respective exudates, act in defense against herbivory and against possible damage by ultraviolet radiation.

Mycoplasma pneumoniae Pneumonia with Worsening Pleural Effusion Despite Treatment with Appropriate Antimicrobials: Case report

Mycoplasma pneumoniae is a common cause of community-acquired pneumonia. As M. pneumoniae pneumonia is usually a mild and self-limiting disease, complications such as pleural effusion occur only rarely. We report a 22-year-old woman who presented to the Emergency Medicine Department of the Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an eight-day history of fever associated with coughing, chills and rigors. She was diagnosed with M. pneumoniae pneumonia, but subsequently developed pleural effusion which worsened despite treatment with appropriate antimicrobials. The pleural effusion required drainage, which revealed that it was of the more severe exudative type. Following drainage, the patient improved dramatically. She was discharged and advised to continue taking antibiotics.

Clinicopathologic Correlation of Aneurysmal Type 1 Neovascularization in Age-Related Macular Degeneration

To correlate multimodal retinal imaging with high-resolution epoxy resin histologic analysis aligned to invivo tomograms in a patient with exudative aneurysmal type 1 (AT1) neovascularization and hemorrhage secondary to age-related macular degeneration (AMD). Case study and clinicopathologic correlation. An 84-year-old man of European descent with AT1 neovascularization secondary to AMD with a 6-year follow-up with combined antiangiogenic and photodynamic therapy. Multimodal imaging from each clinic visit, including fluorescein angiography, indocyanine green angiography, and OCT, was correlated with exvivo OCT and high-resolution histologic images of the donor eye, aligned to the en face images showing hemorrhage and exudation. Location of the branching vascular network and the aneurysmal vascular dilations in angiography, correlated with histologic findings. Clinically, a hemorrhagic detachment of the retinal pigment epithelium (RPE) in the macular area was associated with an AT1 neovascularization extending near the optic nerve head, where the choroid, which was thin overall, was extremely thin. Resolution of the hemorrhage accompanied by progressive macular atrophy and internal changes in the reflectivity of the RPE detachment were observed. Histologic analysis suggested aphysical continuity from a hyalinized choroidal artery to a capillary bed (branching vascular network) in the sub-RPE-basal lamina (BL) space without visualization of aneurysmal dilations. Clinicopathologic correlation of AT1 neovascularization from an intact treated eye with dye-based angiographic and OCT scans supports the proposed nomenclature of AT1 neovascularization over polypoidal choroidal vasculopathy. We described continuity of the sub-RPE-BL branching vascular network with choroidal arteries and histologic correlates of common OCT signatures of neovascular AMD. The thinness of choroid in this patient of European descent contrasts with that reported for Asian populations, in which AT1 neovascularization is associated commonly with pachychoroid disease characteristics. This case reinforces the different manifestations of AT1 neovascularization across and within diverse ethnicities and diseases.

Rhizosphere interactions between copper oxide nanoparticles and wheat root exudates in a sand matrix: Influences on copper bioavailability and uptake

The impact of copper oxide nanoparticles (CuONPs) on crop production is dependent on the biogeochemistry of Cu in the rooting zone of the plant. The present study addressed the metabolites in wheat root exudates that increased dissolution of CuONPs and whether solubility correlated with Cu uptake into the plant. Bread wheat (Triticum aestivum cv. Dolores) was grown for 10 d with 0 to 300 mg Cu/kg as CuONPs in sand, a matrix deficient in Fe, Zn, Mn, and Cu for optimum plant growth. Increased NP doses enhanced root exudation, including the Cu-complexing phytosiderophore, 2'-deoxymugineic acid (DMA), and corresponded to greater dissolution of the CuONPs. Toxicity, observed as reduced root elongation, was attributable to a combination of CuONPs and dissolved Cu complexes. Geochemical modeling predicted that the majority of the solution phase Cu was complexed with citrate at low dosing or DMA at higher dosing. Altered biogeochemistry within the rhizosphere correlated with bio-responses via exudate type, quantity, and metal uptake. Exposure of wheat to CuONPs led to dose-dependent decreases in Fe, Ca, Mg, Mn, and K in roots and shoots. The present study is relevant to growth of a commercially important crop, wheat, in the presence of CuONPs as a fertilizer, fungicide, or pollutant. Environ Toxicol Chem 2018;37:2619-2632. © 2018 SETAC.

KUS121, an ATP regulator, mitigates chorioretinal pathologies in animal models of age-related macular degeneration

Age-related macular degeneration (AMD) is a leading cause of blindness among elderly people. The appearance of drusen is a clinical manifestation and a harbinger of both exudative and atrophic AMD. Recently, antibody-based medicines have been used to treat the exudative type. However, they do not restore good vision in patients. Moreover, no effective treatment is available for atrophic AMD. We have created small chemicals (Kyoto University Substances; KUSs) that act as ATP regulators inside cells. In the present study, we examined the in vivo efficacy of KUS121 in C-C chemokine receptor type 2-deficient mice, a mouse model of AMD. Systemic administration of KUS121 prevented or reduced drusen-like lesions and endoplasmic reticulum stress, and then substantially mitigated chorioretinal pathologies with significant preservation of visual function. Additionally, we confirmed that long-term oral administration of KUS121 caused no systemic complications in drusen-affected monkeys. ATP regulation by KUSs may represent a novel strategy in the treatment of drusen and prevention of disease progression in AMD.

Preferential flow systems amended with biogeochemical components: imaging of a two-dimensional study

Abstract. The vadose zone is a highly interactive heterogeneous system through which water enters the subsurface system by infiltration. This paper details the effects of simulated plant exudate and soil component solutions upon unstable flow patterns in a porous medium (ASTM silica sand; US Silica, Ottawa, IL, USA) through the use of two-dimensional tank light transmission method (LTM). The contact angle (θ) and surface tension (γ) of two simulated plant exudate solutions (i.e., oxalate and citrate) and two soil component solutions (i.e., tannic acid and Suwannee River natural organic matter, SRNOM) were analyzed to determine the liquid–gas and liquid–solid interface characteristics of each. To determine if the unstable flow formations were dependent on the type and concentration of the simulated plant exudates and soil components, the analysis of the effects of the simulated plant exudate and soil component solutions were compared to a control solution (Hoagland nutrient solution with 0.01 M NaCl). Fingering flow patterns, vertical and horizontal water saturation profiles, water saturation at the fingertips, finger dimensions and velocity, and number of fingers were obtained using the light transmission method. Significant differences in the interface properties indicated a decrease between the control and the plant exudate and soil component solutions tested; specifically, the control (θ= 64.5∘ and γ= 75.75 mN m−1) samples exhibited a higher contact angle and surface tension than the low concentration of citrate (θ= 52.6∘ and γ= 70.8 mN m−1). Wetting front instability and fingering flow phenomena were reported in all infiltration experiments. The results showed that the plant exudates and soil components influenced the soil infiltration as differences in finger geometries, velocities, and water saturation profiles were detected when compared to the control. Among the tested solutions and concentrations of soil components, the largest finger width (10.19 cm) was generated by the lowest tannic acid solution concentration (0.1 mg L−1), and the lowest finger width (6.00 cm) was induced by the highest SRNOM concentration (10 mg L−1). Similarly, for the plant exudate solutions, the largest finger width (8.36 cm) was generated by the lowest oxalate solution concentration (0.1 mg L−1), and the lowest finger width (6.63 cm) was induced by the lowest citrate concentration (0.1 mg L−1). The control solution produced fingers with average width of 8.30 cm. Additionally, the wettability of the medium for the citrate, oxalate, and SRNOM solutions increased with an increase in concentration. Our research demonstrates that the plant exudates and soil components which are biochemical compounds produced and released in soil are capable of influencing the process of infiltration in soils. The results of this research also indicate that soil wettability, expressed as (cos θ)1∕2, should be included in the scaling of the finger dimension, i.e., finger width, when using the Miller and Miller (1956) scaling theory for the scaling of flow in porous media.

The impact of decongestive physical therapy and elastic bandaging on the control of pain in patients with venous ulcers.

to evaluate pain in individuals with venous ulcers treated with elastic bandage and decongestant physical therapy. we studied 90 patients, divided into three groups with 30 patients each: a group treated with elastic bandage and decongestant physical therapy; a group treated with elastic bandage; and a group treated only with primary dressing according to tissue type and presence of exudate. We used the Pain Numerical Scale to quantify pain intensity and the McGill Pain Questionnaire for pain qualitative assessment. in the first evaluation, all patients who participated in the study reported intense pain. In the fifth evaluation, the majority of patients treated with elastic bandaging and decongestant physical therapy did not report pain; the majority of patients in the elastic bandage group reported mild pain; and most patients treated only with primary dressing reported mild to moderate pain. During all five assessments using the McGill questionnaire, most patients in the elastic bandaging and primary dressing groups used descriptors of the sensory, affective, evaluative and miscellaneous groups to describe their pain. However, in the fourth and fifth evaluations, most patients who received decongestant physical therapy combined with elastic bandaging treatment did not use any of the descriptors. patients treated with decongestant physical therapy and elastic bandage presented pain improvement from the third evaluation performed on.

The imaging features of optical coherence tomography angiography of complex retinal arterial macroaneurysms

Objective To observe the imaging features of the optical coherence tomography angiography (OCTA) of complex retinal arterial macroaneurysm (RAM). Methods Nineteen eyes of 19 patients with RAM were enrolled in this retrospective study. There were 1 male (1 eye) and 18 females (18 eyes). The patients aged from 62 to 85 years, with the mean age of 71.3 years. The fundus photography examination revealed the tumors were located in the 1 - 3 branch of the artery, which showed focal spindle-shaped or fusiform angiomatous dilatation. The fundus fluorescein angiography revealed the early uniform fluorescence of the tumor, and the tumor was a high-fluorescence leak in the late period. RAM was divided into exudative type and hemorrhagic type according to the literature and based on the ocular fundus appearance. In 19 eyes, 8 eyes were exudative RAM and 11 eyes were hemorrhagic RAM. All eyes were examined by OCTA, and the retinal blood flow images of 3 mm ×3 mm diameter were routinely collected to observe the OCTA imaging features. Results OCTA examination showed that the superficial RAM of all eyes had strong reflection signal connected with retinal artery. B-scan image showed smaller tumors in the lumen with strong reflection of expansion, or large tumor with peak-like uplift and the blood flow signals in the tumor body were abundant. The enface image clearly showed the three-dimensional shape of the tumor. Tumors with exudation or multi-level bleeding could be clearly documented for their bleeding range and boundary. The white signal co-localized with the superficial retinal blood vessels by the function of multi-color fluoroscopy. The pattern of blood flow density can also clearly show the three-dimensional shape of the tumor. Conclusion The complex RAM is a strong reflection signal in the superficial layer of retina, which is connected with the retinal vessels; B-scan images shows small tumors with a small piece of strong reflection and dilation, or large tumors with mountain-like elevation with abundant blood flow signals. En face image can clearly show the three-dimensional shape of the tumor. Key words: Retinal aneurysms/diagnosis; Retinal diseases/diagnosis; Optical coherence tomography; Local blood flow

Multi-mode imaging features of retinal arterial macroaneurysms

Objective To observe the clinical characteristics of multi-mode images of retinal arterial macroaneurysms and provide reference for the accurate diagnostic. Methods The clinic data of 24 patients (25 eyes) with retinal arterial macroaneurysms who were diagnosed in the First Affiliated Hospital of Zhengzhou University from August 2012 to May 2016 were retrospectively analyzed.All patients received ophthalmologic examinations including visual acuity, fundus photography, and fundus fluorescein angiography (FFA). The patients who could not be diagnosed by fundus photography and FFA underwent indocyanine green angiography (ICGA) and spectral-domain optical coherence tomography (SD-OCT) examinations.The visual acuity of the three types of retinal arterial macroaneurysms and the diameters of retinal arterial macroaneurysms based on FFA images was analyzed. Results A single macroaneurysm appeared in all the 25 eyes.Retinal arterial macroaneurysms of 22 eyes were on temporal artery branches and those of 3 eyes were on the nasal artery branches.Sixteen retinal arterial macroaneurysms were determined as hemorrhagic type, 2 were exudative type and the other 7 were quiescent type.The difference of vision acuity in the three types of retinal arterial macroaneurysms was significantly different (χ2=15.117, P=0.001). Retinal arterial macroaneurysms of 20 eyes could be clearly exhibited by FFA, and the retinal arterial macroaneurysms in other 5 eyes which were concealed due to bleeding were displayed by ICGA and OCT.The average diameter of retinal arterial macroaneurysms and normal arteries were (330.65±43.09)μm and (134.70±10.74)μm, respectively, showing a significant difference (t=21.034, P=0.000) and a positive correlation between them (r=0.867, P=0.000). Conclusions Most retinal arterial macroaneurysms can be diagnosed by FFA, moreover, both ICGA and OCT can provide necessary supplement for the concealed retinal arterial macroaneurysms.The larger the diameter of the normal artery is, the larger the diameter of the corresponding retinal arterial macroaneurysms is.The typing of retinal arterial macroaneurysms can offer basis for the evaluation of management. Key words: Retinal artery; Macroaneurysm/diagnosis; Clinical characteristics; Fluorescein angiography; Optical coherence tomography

Clinical Profile of Ascites Based on Presentation and Laboratory Findings: An institutional experience from Kathmandu, Nepal

Introduction: Ascites is the fluid collection in the potential space of the peritoneal cavity. Alcoholic liver disease and intra-abdominal malignancy are two major etiologies behind it. Also, diagnosis of tuberculous ascites should be thought of due to endemicity. Cirrhotic patients at any time during the course of disease, invariably present with ascites which is one of the marker of decompensation. In our context, etiology behind ascites and its correlation with symptoms and clinical findings not yet studied, so present study is conceptualized.&#x0D; Methods:This is a cross-sectional retrospective descriptive hospital based record review of patients presented with ascites in a tertiary center of Kathmandu. One hundred fourteen patients with ascites under regular follow up of Shree Birendra Hospital (SBH) were reviewed. Data regarding presenting complaints, examination findings, relevant investigations during first visit and final diagnosis were retrieved from our own record keeping and recorded information were then evaluated.&#x0D; Results: Patients having ascites have myriad of symptoms and signs, commonest clinical feature being icterus (74, 64.9%). Most of them were anemic at presentation. Forty-two (36.8%) had high blood urea and 36 (31.5%) with high creatinine suggesting approximately 30-40% cases presented with deranged renal function test. Ninety-three (81.5%) had raised total serum bilirubin. Similarly, PT/INR derangements were in 74 (64.9%) and 57 (50%) suggesting deranged liver function. Serum albumin was less than 3.5 gram/deciliter in 83(72.8%) cases. Among the patients studied, 80 (70.1%) had high Serum-Ascites Abumin Gradient (SAAG) suggesting transudative type of ascites and rest 34 had low SAAG suggesting exudative type of ascites. Overall assessment revealed, majority of patients (71.05%) had Chronic liver disease (CLD) as the cause of ascites.&#x0D; Conclusions: Ascites due to chronic liver disease was the main finding with etiology supported by laboratory findings. Significant numbers of the patients had deranged renal function on top of liver function derangement, so these parameters need to be properly taken care of.&#x0D; Key Words: Ascites, liver cirrhosis, serum ascetic albumin gradient.

Comparison of the Effect of Nanosilver Spray and 1% Silver Sulfadiazine Cream on the Healing of Second-Degree Burn Wound

Introduction: Recent scientific advances have led to the availability of silver nanoparticles which can kill microbial agents with their higher power of penetration into them. The present study aimed to compare the effect of nanosilver spray and silver sulfadiazine cream on the healing of second-degree burn wounds. Materials and methods: A clinical trial was conducted in Vasei Hospital of Sabzevar in 2016. For this purpose, 21 patients with a second-degree burn wound of the same depth and size in one or two organs were selected as the sample based on the convenient sampling method. Wounds of patients were divided into two parts; one part was dressed with silver sulfadiazine cream and the other one was dressed with nanosilver spray. The wound dressing was changed every day after washing the wound with normal saline. Wound parameters including size, depth, edges, undermining, necrotic tissue type, necrotic tissue amount, exudate type, exudate amount, skin color surrounding wound, peripheral tissue edema and induration, granulation tissue, and epithelialization were measured on the first, third, seventh, fourteenth, and twenty-first days using Bates-Jensen Wound Assessment Tool. The obtained data were statistically analyzed using the generalized linear model test in SPSS-16. Findings: The mean recovery status at the beginning of the study and on the twenty-first day was 32.05 ± 2.13 and 13.95 ± 1.68 in the nanosilver spray group and 32.24 ± 2.77 and 14.52 ± 2.46 in the silver sulfadiazine group. However, no significant difference was observed between the two groups (p=0.87). Conclusion: Both types of dressing improved the wound and had the same effect on the wound healing. However, since the cost of treatment and pain were lower in dressing with nanosilver, it is more recommended to be used for burn wounds.

Elaboration of an algorithm for wound evaluation and treatment

Objectives: To develop an algorithm for evaluation and treatment of wounds and to test their internal reliability. Method: Crosssectional and descriptive study. For the construction of the algorithm, a review of the literature was realized with databases of health sciences and consultation of books and theses of this area published in the last 10 years, using as descriptors: acute and chronic wounds; wound evaluation; evaluation tools; dressings; nursing evaluation; wound healing and nursing care; and algorithms. Two hundred nurses with at least 12 months of experience in wound care were contacted and 38 of them completed the evaluation questionnaire. The internal consistency of the algorithm was measured by Cronbach’s alpha coefficient. Results: All items evaluated had a “excellent” classification, being: graphic presentation (52.65%), readability (60.5%), sequence of the algorithm (52.6%), description of wound types (56.8%), description of tissue types (52.6%), presentation of types of exudate (57.9%), presentation of signs of infection (57.9%) and products to be used in dressing (50%). The algorithm presented excellent internal consistency (α = 0.911). According to 97.4% of the evaluations, the instrument is able to support health professionals in wounds evaluation. Conclusion: The algorithm showed internal reliability for evaluation and treatment of wounds.

Soyasaponins: A New Class of Root Exudates in Soybean (Glycine max).

Root exudates are plant metabolites secreted from the roots into the soil. These exudates are involved in many important biological processes, including acquisition of nutrients, defense and signaling to rhizosphere bacteria, such as isoflavones of soybean crucial for the symbiosis with rhizobium. Less is known, however, about other types of root exudates. This study shows that soybean roots secrete large amounts of soyasaponins (triterpenoid glycosides) as root exudates. The soyasaponins are classified into four groups, with group A being the most secreted of these compounds, whereas DDMP (2,3-dihydro-2,5-dihydroxy-6-methyl-4H-pyran-4-one) soyasaponins is the group showing greatest accumulation in root tissues, suggesting a selection system for secreted compounds. Time-course experiments showed that the soyasaponin secretion peaked during early vegetative stages. In particular, soyasaponin Ah was the major compound secreted by soybean roots, whereas the deacetylated derivative Af was the major compound secreted specifically during the VE stage. The secretion of soyasaponins containing glycosyl moieties is an apparent loss of photosynthates. This phenomenon has been also observed in other legume species, although the composition of secreted soyasaponins is plant species dependent. The identification of triterpenoid saponins as major metabolites in legume root exudates will provide novel insights into chemical signaling in the rhizosphere between plants and other organisms.