Mucosal Membrane Research Articles

Integrative single-cell analysis reveals distinct adaptive immune signatures in the cutaneous lesions of pemphigus

Pemphigus, an autoimmune bullous disease affecting the skin and mucosal membranes, is primarily driven by anti-desmoglein (Dsg) autoantibodies. However, the underlying immune mechanisms of this disease remain largely elusive. Here, we compile an unbiased atlas of immune cells in pemphigus cutaneous lesions at single-cell resolution. We reveal clonally expanded antibody-secreting cells (ASCs) that exhibit variable hypermutation and accumulation of IgG4 class-switching in their immunoglobulin genes. Importantly, pathogenic Dsg-specific ASCs are localized within pemphigus lesions and can evolve from both Dsg-autoreactive and non-binding precursors. We observe an altered distribution of CD4+ T cell subsets within pemphigus lesions, including an imbalance of Th17/Th2 cells. Significantly, we identify a distinct subpopulation of Th17 cells expressing CXCL13 and IL-21 within pemphigus lesions, implying its pivotal role in B cell recruitment and local production of autoantibodies. Furthermore, we characterize multiple clonally expanded CD8+ subpopulations, including effector GMZB+ and GMZK+ subsets with augmented cytotoxic activities, within pemphigus lesions. Chemokine-receptor mapping uncovers cell-type-specific signaling programs involved in the recruitment of T/B cells within pemphigus lesions. Our findings significantly contribute to advancing the understanding of the heterogeneous immune microenvironment and the pathogenesis of pemphigus cutaneous lesions, thereby providing valuable insights for potential therapeutic interventions in this disease.

A mucoadhesive nanolipo gel containing Aegle marmelos gum to enhance transdermal effectiveness of linezolid for vaginal infection: In vitro evaluation, in vitro-ex vivo correlation, pharmacokinetic studies

Effective treatment of vaginal infections with conventional antibiotics often faces challenges like unavoidable dose-related side effects with increased risk of bacterial resistance. The study aims to deliver linezolid through natural gum based mucoadhesive nano lipogel to improve therapeutic effectiveness against vaginal infections. The linezolid loaded nanoliposomes (LNLs) were developed by thin film hydration method and were characterized by FTIR, DSC, XRD, FESEM, particle size analysis, zeta potential, drug loading capacity, in vitro release study etc. Selected LNLs was loaded into suitable gel formulation containing Aegle marmelos gum (as the mucoadhesive agent) and evaluated for in vitro, in vivo potentiality. FTIR/DSC test confirmed absence of any major interaction between selected drug and excipients. XRD showed amorphization of the drug encapsulated in NLs. FESEM studies showed spherical LNLs having smooth surface. LNLs had nanosize (51.03 nm), negative surface charge (-25.7 mV), satisfied drug loading capacity (11.5 ± 0.7 %) with sustained drug release. The experimental LNLs loaded lipogel showed desired physico-chemical properties viz. viscosity (37000 cps), spreadability (6.5 gm.cmsec-1), mucoadhesion (21.9 gf) and 61.04 % release of drug across rabbit vaginal mucosal membrane. The nanolipo gel exhibited improved antimicrobial activity against E. coli and C. albicans with respect to the pure linezolid. A good correlation was observed in between in vitro drug release and ex vivo permeation. Improved pharmacokinetic parameters like AUC, AUMC, MRT, Vd was observed for experimental nanolipo gel Vs. marketed formulation. The experimental nanolipo gel could be explored further for futuristic clinical application.

Mucosal membrane pressure injury in intensive care units: A scoping review

AimTo describe published work on the current situation of mucosal membrane pressure injury of patients in the intensive care unit. BackgroundDevice-related pressure injuries in critically ill patients are mostly focused on skin surface injuries, and less attention is paid to mucosal membrane pressure injury. MethodsWe searched PubMed, Embase, Web of Science, CINAHL, and Cochrane Library from database construction until March 1, 2023. Two researchers independently screened and extracted data. ResultsEighteen articles met our criteria and were published in 2014–2023. The included studies showed that the incidence of mucosal membrane pressure injury in critically ill patients ranged from 0.83% to 88.2%, and the prevalence ranged from 0.16% to 55.6%. The most frequently reported site of mucosal injury is the oral mucosa, followed by the nasal mucosa. Ten studies used Braden to assess the risk of mucosal membrane pressure injury, and only six studies reported specific stages of mucosal membrane pressure injury. Thirteen studies described 30 risk factors for mucosal membrane pressure injury, with albumin being the most frequently reported risk factor, followed by the vasoconstrictive drugs use. Thirty risk factors were summarized in six aspects: medical device-related factors, disease-related factors, treatment- related factors, physiological and biochemical parameters, demographic-related factors, and microbial colonisation. ConclusionsThe incidence or prevalence of mucosal membrane pressure injury varies widely, and specific risk assessment tools and standardized staging criteria need to be further determined. The risk factors of mucosal membrane pressure injury involve multiple aspects, and some risk factors have only been explored in few studies and need to be further verified, in order to detect the risk group of mucosal membrane pressure injury early and take targeted preventive measures. Implications for Clinical PracticeWe synthesized the current research status of mucosal membrane pressure injury in critically ill patients, which can provide a valuable reference for the clinical staff to develop preventive and management measures for such patients.

Monitoring Salivary Sialic Acid and Sialidase Activity to Assess Oral Health Status: Results of a Single Site Double-Blind Study

Objective: Sialic acid [SA] represents a critical mucosal membrane component maintaining mucosal integrity. This investigation stratified adult subjects based on clinical parameters of periodontal health to examine salivary sialic acid [SA] as a health measure and develop a corresponding rapid visual chair-side assay. Methods: Adults [n = 90] were enrolled and clinically stratified into healthy [n = 30], gingivitis [n = 29] or periodontitis [n = 31] groups. Saliva from subjects was evaluated for SA using the Ninhydrin method. A novel rapid SA spot test was developed utilizing filter paper discs soaked in a sialidase substrate. Substrate-laden disks were incubated at room temperature with saliva produced a blue color with increasing color intensities due to higher sialidase activity. Subjects were recalled weekly for clinical and salivary assessments. Results: Average baseline salivary SA in healthy, gingivitis and periodontal disease groups were 64, 95 and 102 µg/mL, respectively with significant differences (<0.05). Differences in SA concentrations among control and test groups were maintained throughout the study. Similarly, the differences in the color intensities in the rapid visual chair side spot test were also observed during the entire study period. Conclusions: Increasing levels of salivary SA were observed from healthy to periodontal disease with these differences remaining consistent over the study. These results corresponded with the chair-side visual assay, which is suitable for patient education or monitoring.

Inferior turbinate lateralization

Inferior turbinate lateralization via an endonasal approach is a reliable low-risk procedure to correct inferior turbinate hypertrophy resistant to medical treatment. This well-established technique provides nasal comfort while conserving the mucosal membrane and physiology of the inferior turbinate, minimizing the postoperative complications (empty nose syndrome) besetting turbinoplasty involving mucosal or submucosal reduction.

Haemato-biochemical characterization of equine piroplasmosis asymptomatic carriers and seropositive, real-time PCR negative horses

Equine piroplasmosis (EP) is caused by Theileria equi and Babesia caballi, transmitted by tick vectors. Horses can suffer an acute, subacute, and chronic forms of the disease, with clinical signs such as poor performance, fever, pale mucosal membranes, and jaundice. The diagnosis of EP subclinical cases is complex due to the sensitivity of real-time PCR and the limited parasite load in some carriers, making it challenging to differentiate them from seropositive, PCR negative (S+PCR-) individuals. This study aimed to describe haematological and biochemical changes in asymptomatic EP carriers, EP S+PCR- horses and control horses (EP seronegative and PCR negative). It also investigated potential haemato-biochemical markers to aid in distinguishing true EP carriers alongside molecular and serological tests. A comprehensive haematology and biochemistry profile was conducted on 410 sera and EDTA blood samples, comprising 130 EP positives by real-time PCR and competitive ELISA (cELISA) (carriers), 130 EP negatives by real-time PCR but positive to cELISA (S+PCR-) and 150 EP negative horses to real-time PCR and c-ELISA (controls). Our study confirmed that a haematological and biochemistry profile could help to differentiate between EP carriers/S+PCR- from healthy horses. Carriers and S+PCR- horses showed significant increases in the white blood cell count (WBC), high total proteins (TP) and total globulins (GLOB) concentration, and liver function markers compared to controls. Additionally, the evaluation of uric acid (UA) suggested oxidative stress in carrier horses. However, no useful haemato-biochemical diagnostic markers were identified to aid the challenging differentiation of EP carriers and S+PCR- horses, highlighting the need for improvement in molecular/serological diagnosis for these horses.

Mucoadhesive Alginate/Pectin Films Crosslinked by Calcium Carbonate as Carriers of a Model Antifungal Drug-Posaconazole.

The mucosal membrane of the oral cavity, due to its unique structure and availability, constitutes an appropriate site for the delivery of drugs, both with local and systemic effects. Mucoadhesive buccal films are drug dosage forms that due to their convenience of application, flexibility and size, are characterized by patients' compliance. Sodium alginate and pectin are natural polymers from the polysaccharides group, with mucoadhesive properties, that are widely applied to obtain buccal films. However, their hydrophilic nature and poor water resistance limit their application in sustained drug release formulations. Hence, the aim of this investigation was to design alginate/pectin buccal films by a one-step crosslinking technique-with the application of calcium carbonate. This technique was applied to prepare crosslinked alginate and alginate/pectin mucoadhesive films with a model antifungal drug-posaconazole. The obtained formulations were evaluated for the impact of crosslinking and pectin's presence on their pharmaceutical, mucoadhesive, mechanical and physicochemical properties. Additionally, the antifungal activity of the prepared films against Candida spp. was evaluated. It was shown that pectin's presence in the formulations improved flexibility, mucoadhesion and antifungal activity. The crosslinking process reduced mucoadhesiveness and antifungal activity but significantly enhanced the mechanical properties and stability and enabled prolonged drug release.

Immunization with recombinant LiHyp1 protein plus adjuvant is protective against tegumentary leishmaniasis.

Tegumentary leishmaniasis (TL) is the main clinical manifestation of leishmaniasis, and it can cause the infected hosts to self-healing cutaneous lesions until mutilating scars in mucosal membranes, particularly in the nose and throat. The treatment against disease presents problems, and the diagnosis is hampered by variable sensitivity and/or specificity of the tests. In this context, the development of prophylactic vaccines could be considered as a strategy to control the disease. Previously, we showed that the recombinant LiHyp1 protein plus adjuvant protected mice from infection with Leishmania infantum, which causes visceral leishmaniasis. In the present study, we tested whether rLiHyp1 could induce protection against infection with L. amazonensis, a parasite species able to cause TL. We immunized BALB/c mice with rLiHyp1 plus saponin (rLiHyp1/S) or incorporated in micelles (rLiHyp1/M) as adjuvants and performed parasitological and immunological evaluations before and after infection. Results showed that after in vitro stimulation from spleen cell cultures using rLiHyp1 or a Leishmania antigenic extract (SLA), rLiHyp1/S and rLiHyp1/M groups developed a Th1-type immune response, which was characterized by high levels of IFN-γ, IL-2, TNF-α and IL-12 cytokines, nitrite, and IgG2a isotype antibodies when compared to values found in the control (saline, saponin, micelles alone) groups, which showed higher levels of anti-SLA IL-4, IL-10, and IgG1 antibodies before and after challenge. In addition, mice receiving rLiHyp1/S or rLiHyp1/M presented significant reductions in the lesion average diameter and parasite load in the infected tissue and internal organs. Blood samples were collected from healthy subjects and TL patients to obtain PBMC cultures, which were in vitro stimulated with rLiHyp1 or SLA, and results showed higher lymphoproliferation and IFN-γ production after stimulus using rLiHyp1, as compared to values found using SLA. These results suggest that rLiHyp1 plus adjuvant was protective against experimental TL and could also be considered for future studies as a vaccine candidate against human disease.

Mucoadhesive, Fluconazole-Loaded Nanogels Complexed with Sulfhydryl-β-cyclodextrin for Oral Thrush Treatment.

The objective of this study was to generate fluconazole-loaded mucoadhesive nanogels to address the problem of hydrophobicity of fluconazole (FL). An inclusion complex was formulated with sulfhydryl-β-CD (SH-β-CD) followed by nanogels formation by a Schiff base reaction of carbopol 940 (CA-940) and gelatin (GE). For characterization, PXRD, FT-IR analysis, drug content, and phase solubility studies were performed. Similarly, nanogels were assessed for particle size, zeta potential, organoleptic, and spreadability studies. Moreover, drug contents, rheological, in vitro drug permeation, release kinetics, toxicity, and stability studies of nanogels were performed. Furthermore, mucoadhesive characteristics over the buccal mucosal membrane of the goat were evaluated. The nanogels formulated with a higher amount of CA-940 and subsequently loaded with the inclusion complexes of FL showed promising results. PXRD and FT-IR analysis confirmed the physical complexes by displaying a reduction in the intensity of peaks of FL. The average particle size of nanogels was in the range of 257 to 361 nm. The highest drug content of 88% was encapsulated within the FL-SH-β-CD complex. All formulations at 0.5-1% concentration displayed no toxicity to the Caco-2 cell lines. Nanogels loaded with FL-SH-β-CD complexes showed 18-fold improved mucoadhesion on the buccal mucous membrane of the goat when compared to simple nanogels. The in vitro permeation study exhibited significantly enhanced permeation and first-order concentration-dependent drug release was observed. On the bases of these findings, we can conclude that a mucoadhesive nanogel-based drug delivery system can be an ideal therapy for candidiasis.

Mucosal Vaccines against Bacterial and Viral Pathogens

The mucosal membranes of the human body play a crucial role in the development, maintenance, and regulation of barrier functions and immune homeostasis, representing an integral component of the overall immune system. Mucosal vaccines elicit immune processes in the lymphoid tissue associated with the mucosal membranes. A critical objective of mucosal immunization is the identification of an antigen delivery vector capable of ensuring optimal vaccine efficacy. The authors of this article have conducted extensive research on the probiotic properties of enterococci over an extended period. They employ a safe and beneficial probiotic strain, Enterococcus faecium L3, as a delivery vector for vaccine antigens. Initially, the gene encoding the pathogenicity factor Bac, derived from group B streptococci (Streptococcus agalactiae), was successfully integrated into the genome of the probiotic strain E. faecium L3. Intravaginal, oral, and intranasal mucosal immunization methods utilizing the L3-Bac+ probiotic, which expresses antigenic determinants of pathogenic streptococci, were found to confer protection against bacterial infection in laboratory animals. Subsequently, recombinant technologies were refined, leading to the development of a universal method for incorporating a region of interest from the gene into the structure of the major pili protein gene of E. faecium L3. Using this technology, candidate vaccines against various infections, including Streptococcus pneumoniae, influenza A virus, and SARS-CoV-2 following the onset of the Covid-19 pandemic, have been obtained and tested. In this study, alongside the presentation of our own data, the challenges associated with utilizing recombinant probiotic bacteria as vectors for vaccine antigen delivery are discussed.

Processing and biomedical applications of novel eco-sustainable fluconazole–loaded zinc oxide (ZnO) encapsulated chitosan (CS) biopolymer nanocomposite by inhibiting microbe species against candidiasis

Drug resistance and a lack of effective antifungal treatments have spurred the research and development of novel therapeutics to combat the fungus Candida albicans. Candida is ubiquitous yeast that is often colonized on the skin and mucosal membranes and is implicated in opportunistic fungal disorders all over the globe. In particular, nanoparticles (NPs) made of metals and metal oxides are a novel kind of functional nanohybrids with fascinating physio-chemical characteristics that have potential uses in nanoscience and medicine. In this current novel research attempt, a decisive biocompatible nanocomposite material with conflation of organic and inorganic sources has been successfully developed using a bis-triazole antifungal agent, fluconazol (FCZ)-assimilated zinc oxide (ZnO) as filler, and chitosan (CS) as matrix by a solution-based chemical method for potent biomedical applications. The eco-sustainable biomaterial ZnO NPs has been synthesized with a simple in situ precipitation method, in which the potent antifungal drug FCZ was implemented into the system to improve its strength, and the system was further modified by employing CS biopolymer. CS is an amorphous, translucent organic biopolymer with a structure unit similar to the polysaccharide structure of the extracellular matrix. This may provide mechanical strength to the nanocomposite by creating interfacial bonding between them. Such a novel nanocomposite has been physicochemically characterized using Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD), Ultra violet (UV), Scanning electron microscope (SEM), and particle size distribution (PSD). Additionally, the well diffusion technique was used to evaluate the ZnO-NPs and to develop FCZ-ZnO-CS nanocomposite for antibacterial and antifungal activities against Escherichia coli, Staphylococcus aureus, Candida albicans, and A. niger. The FCZ-ZnO-CS functionalized nanocomposite has excellent antifungal activity against Candida albicans and Aspergillus niger and optimum antibacterial activity against Escherichia coli and Staphylococcus aureus. Cytotoxicity studies demonstrated that the developed nanocomposite material FCZ-ZnO-CS has significant cytotoxicity against the mouse embryonic fibroblast (NIH-3T3) cell line. These results reveal that ZnO-incorporated fluconazole-chitosan (FCZ-ZnO-CS) could be used as an ideal material for candidiasis applications.

Perioperative antibiotic prophylaxis in skin surgery - Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 2: Special indications and situations.

In addition to prevention of surgical site infections after skin surgery, perioperative antibiotic prophylaxis (PAP) aims to prevent the occurrence of other postoperative infectious complications, especially bacterial endocarditis and hematogenous joint prosthesis infections. This article discusses specific indications for the use of PAP. For example, patients who have undergone any type of heart valve replacement, including transcatheter valve replacement or use of prosthetic material to correct the heart valve, or patients who have experienced bacterial endocarditis, require PAP during skin surgery on mucosal membranes or ulcerated tumors. The use of PAP in special situations such as secondary wound healing, septic dermatosurgery or ulcer surgery is also presented and discussed in detail in this paper based on the current scientific literature. This paper represents the second part of the position paper of the Antibiotic Stewardship Working Group of the German Society for Dermatologic Surgery (DGDC) and summarizes evidence-based recommendations for the administration of PAP during skin surgery for special indications and situations. This is particularly important because, as detailed in Part 1 of this position paper, PAP can and usually should be avoided in skin surgery.

GastroPlus- and HSPiP-Oriented Predictive Parameters as the Basis of Valproic Acid-Loaded Mucoadhesive Cationic Nanoemulsion Gel for Improved Nose-to-Brain Delivery to Control Convulsion in Humans.

Oral and parenteral delivery routes of valproic acid (VA) are associated with serious adverse effects, high hepatic metabolism, high clearance, and low bioavailability in the brain. A GastroPlus program was used to predict in vivo performance of immediate (IR) and sustained release (SR) products in humans. HSPiP software 5.4.08 predicted excipients with maximum possible miscibility of the drug. Based on the GastroPlus and HSPiP program, various excipients were screened for experimental solubility, nanoemulsions, and respective gel studies intended for nasal-to-brain delivery. These were characterized by size, size distribution, polydispersity index, zeta potential, morphology, pH, % transmittance, drug content, and viscosity. In vitro drug release, ex vivo permeation profile (goat nasal mucosa), and penetration studies were conducted. Results showed that in vivo oral drug dissolution and absorption were predicted as 98.6 mg and 18.8 mg, respectively, from both tablets (IR and SR) at 8 h using GastroPlus. The predicted drug access to the portal vein was substantially higher in IR (115 mg) compared to SR (82.6 mg). The plasma drug concentration-time profile predicted was in good agreement with published reports. The program predicted duodenum and jejunum as the prime sites of the drug absorption and no effect of nanonization on Tmax for sustained release formulation. Hansen parameters suggested a suitable selection of excipients. The program recommended nasal-to-brain delivery of the drug using a cationic mucoadhesive nanoemulsion. The optimized CVE6 was associated with the optimal size (113 nm), low PDI (polydispersity index) (0.26), high zeta potential (+34.7 mV), high transmittance (97.8%), and high strength (0.7% w/w). In vitro release and ex vivo permeation of CVE6 were found to be substantially high as compared to anionic AVE6 and respective gels. A penetration study using confocal laser scanning microscopy (CLSM) executed high fluorescence intensity with CVE6 and CVE6-gel as compared to suspension and ANE6. This might be attributed to the electrostatic interaction existing between the mucosal membrane and nanoglobules. Thus, cationic nanoemulsions and respective mucoadhesive gels are promising strategies for the delivery of VA to the brain through intransal administration for the treatment of seizures and convulsions.

Evaluation of covalent and supra-molecular interactions in phosphated galacturonic-glucuronic acid for network structure for use in wound dressings

Keeping in view the wound healing properties of sterculia gum (SG) and ceftriaxone in consideration, in the present work, antibiotic drug encapsulated SG and poly(vinylphosphonic acid) [poly(VPA)] based copolymeric hydrogel wound dressings were designed to enhance the wound healing. Copolymers were characterized by FESEM & EDS, AFM, FTIR, 13C NMR, XRD, TGA and biomedical assay of blood compatibility, mucoadhesion and antioxidant properties. AFM analysis revealed 76.5 nm average roughness and XRD analysis showed sharp peaks at 2θ = 21°. FTIR spectrum of copolymer indicated characteristic peaks at 1116 cm−1 due to stretching vibration of P = O groups of poly(VPA) and twin peaks at 985 and 920 cm−1 due to asymmetric and symmetric vibration of P-O respectively and depicted grafting of phosphated polymers onto gum. The hemolysis test (hemolysis index = 3.40 ± 0.18%) revealed biocompatible nature and the adhesion test demonstrated 84 ± 5.00 mN detachment force which was required to detach the copolymer from the mucosal membrane. Hydrogel dressings absorbed 6.0 ± 5.00 (g/g gel) simulated wound fluid to main the moist wound environment. They were found permeable to O2 and impermeable to microbes and also exhibited antioxidant character. The release profile of ceftriaxone elucidated sustained release of encapsulated ceftriaxone drug with non-Fickian diffusion mechanism and was best fitted in first order kinetic model. Covalent and supra-molecular interactions formed in phosphated galacturonic-glucuronic acid of sterculia gum (SG) were found useful for sustained drug delivery and mucoadhesive properties. These biophysical interactions demonstrated the suitability of antibiotic-encapsulated network structures for wound dressing applications.

Review on a Oral Mucoadhesive Drug Delivery System

Since the previous four decades, the idea of mucoadhesion has attracted significant interest across a range of pharmaceutics domains.Because mucosal membranes are relatively permeable, the mucoadhesive drug delivery system is a well-liked innovative drug delivery technique, allowing for the rapid uptake of a medication into the systemic circulation and avoiding the first pass metabolism. Recent years have seen the development of a number of mucoadhesive drug delivery systems for nasal, buccal, oral, vaginal, and rectal routes for both local and systemic effects.The mucus membrane, which covers the mucin molecules and the mucosal epithelial surface, can interact with mucoadhesive drug delivery systems. This interaction increases the dosage form's residence time at the site of absorption, increasing medication bioavailability and effectiveness while also enhancing therapeutic results.

Contamination of Face Masks and Mask Hygiene Amongst Health Care Workers and General Population in Hamidia Hospital Premises- A Comparative Study

Only 44% of Indians were found to be correctly using masks, according to the latest survey.1,2 91.5% of participants did not wash their hands before using the mask, and 97.3% did not wash their hands after removing it.3 People touch their faces about 23 times every hour, and of those touches, 44% make contact with the mucosal membranes. The mucous membrane of the nose, eyes, and mouth can be self-inoculated, which is a significant method of virus transmission.3 To determine the bacterial load and microbial contamination on the mask, this study was designed with the objective: 1. To study the bacterial load and type of microbes growing on masks in Hamidia Hospital premises. 2. To suggest appropriate recommendations according to the study findings. A cross-sectional comparative study was planned in Hamidia Hospital for three months. Two groups were selected one containing 31 healthcare workers and the other constituting 30 general population visiting Hamidia Hospital. Result and conclusion: This study shows that the prolonged use of a mask (>6 hours) increases the risk of self-inoculation in the general population and frequent clinical contact in a healthcare setting adds to the risks for healthcare workers. Reuse of single-use masks, sharing of masks, and fabric masks should be avoided at all costs. Hand hygiene practices and replacing masks once they become damp are of key importance to avoid contamination. Additionally, it is usually advisable to discard medical face masks after each usage, whereas cotton face masks should be carefully cleaned.

Spinal anesthesia in a patient with Darier’s disease: A case report

Darier’s Disease (Darier-White Disease, keratosis follicularis) is a rare genodermatosis characterized by keratinisation defects that affects the skin, nails and mucosal membranes; it is autosomal and dominantly inherited. To the best of our knowledge, only one case has been reported regarding spinal anesthesia management in a patient suffering from Darier’s disease—this was during Cesarean section. Here, we describe a case of spinal anesthesia with standard skin preparation for inguinal hernia surgery in a Darier’s patient. Spinal anesthesia is a safe anesthesia choice when administered in lesion-free areas.

Incidence of medical device-related pressure injuries in the intensive care unit and related risk factors

AimAt present, physicians employ medical devices extensively in the treatment of numerous diseases and in the care and follow-up of patients. However, these medical devices are a potential cause of pressure injuries.The study aimed to investigate the incidence and affecting risk factors of medical device-related pressure injuries (MDRPIs) in an adult intensive care unit. Materials and methodsThis is a longitudinal descriptive/analytical and cross-sectional study. The researchers conducted this study with 213 intensive care patients between 15.06.2021 and 15.12.2021. The skin and mucosa under and around each medical device were observed once a day for MDRPIs during the stay of patients who had been hospitalized in the intensive care unit for at least 24 h. The data were collected using Patient Information Form developed by the researchers based on the literature, Medical Device-Related Pressure Injury Monitoring Form, the Jackson/Cubbin Pressure Area Risk Calculator (Jackson/Cubbin BARHATr)-Turkish Version, the National Pressure Injury Advisory Panel (NPIAP) Pressure Injury Staging System and the Glasgow Coma Scale. ResultsThe incidence of MDRPIs was 28.6% (61/213). The study revealed that 48.4% (46/95) of these injuries were caused by medical devices for respiratory system, 26.3% (25/95) by devices for gastrointestinal and genitourinary system. The study also revealed that 70.5% of MDRPIs occurred on the skin and 29.5% on the mucosal membrane, and that 82.1% of the MDRPIs occurring on the skin were at Stage 1. In terms of anatomical location, 21.1% of these injuries developed on the fingers and 13.7% on the mouth/lip. In multivariate analysis, parenteral + enteral (p = 0.006, OR = 0.083, 95%CI = [0.014–0.497]) and oral nutrition (p = 0.037, OR = 0.210, 95%CI = [0.049–0.908]), a higher number of devices (nine or more) (p = 0.002, OR = 5.387, 95%CI = [1.840–15.772]) and the duration of device wear (p < 0.05) were identified as independent risk factors for the occurrence of MDRPIs. ConclusionsThe study showed that the incidence of MDRPIs was relatively high and was associated with various factors. It is critical for intensive care nurses, who encounter MDRPIs more frequently, to consider these factors while caring for their patients and to take appropriate preventive measures to reduce the incidence of these injuries.

Mitochondrial uncouplers impair human sperm motility without altering ATP content†.

In human spermatozoa, the electrochemical potentials across the mitochondrial and plasma membranes are related to sperm functionality and fertility, but the exact role of each potential has yet to be clarified. Impairing sperm mitochondrial function has been considered as an approach to creating male or unisex contraceptives, but it has yet to be shown whether this approach would ultimately block the ability of sperm to reach or fertilize an egg. To investigate whether the mitochondrial and plasma membrane potentials are necessary for sperm fertility, human sperm were treated with two small-molecule mitochondrial uncouplers (niclosamide ethanolamine and BAM15) that depolarize membranes by inducing passive proton flow, and evaluated the effects on a variety of sperm physiological processes. BAM15 specifically uncoupled human sperm mitochondria while niclosamide ethanolamine induced proton current in the plasma membrane in addition to depolarizing the mitochondria. In addition, both compounds significantly decreased sperm progressive motility with niclosamide ethanolamine having a more robust effect. However, these uncouplers did not reduce sperm adenosine triphosphate (ATP) content or impair other physiological processes, suggesting that human sperm can rely on glycolysis for ATP production if mitochondria are impaired. Thus, systemically delivered contraceptives that target sperm mitochondria to reduce their ATP production would likely need to be paired with sperm-specific glycolysis inhibitors. However, since niclosamide ethanolamine impairs sperm motility through an ATP-independent mechanism, and niclosamide is FDA approved and not absorbed through mucosal membranes, it could be a useful ingredient in on-demand, vaginally applied contraceptives.

Wickham striae on skin appendages: a helpful dermoscopic feature.

Lichen planus (LP) is a chronic inflammatory disease, clinically characterized by purpuric, itchy papules that typically spread on the trunk and extremities. Other body sites can also be affected, including mucosal membranes, nails, and the scalp. The use of dermoscopy is essential in determining the diagnosis of LP, as it may highlight pathognomonic features such as Wickham striae (WS). WS are thin, pearly white structures arranged in a reticular pattern that is observed over LP lesions and histologically correspond to epidermal hypergranulosis. WS is usually most visible on the oral mucosa but can also cover almost every active LP papule. Here, we report two cases of biopsy-proven LP that show WS on dermoscopy in two specific sites: the scalp and proximal nail fold.