Partial Clearance Research Articles

The Skin-Lightening Power of Tirbanibulin 1% Ointment.

Tirbanibulin 1% ointment has been licensed to treat non-hyperkeratotic actinic keratosis (AK) on the face and scalp in adults. Recent evidence suggests that, besides the antineoplastic effect, tirbanibulin may also confer substantial cosmetic benefits to patients. We report a single-center retrospective study of patients affected by solar lentigines (SLs) and AKs in the context of field cancerization treated with tirbanibulin 1% ointment. Among 42 patients, 35% (n = 15) experienced complete clearance of SLs, while partial clearance was observed in 50% (n = 21) of patients. Regarding AKs, complete and partial clearance were observed in 52% (n = 22) and 40% (n = 17) of patients, respectively. Major study limitations are the small sample size and the absence of a control group. Our results suggest that tirbanibulin 1% ointment may offer the dual benefit of treating AKs while simultaneously lightening aesthetically bothersome and difficult-to-treat lesions like SLs with just 5 days of application.

ThP5.15 - "Unusual Impaction: A Rare Case of Gallstone Ileus''

Abstract Introduction Gallstone-related mechanical gastrointestinal tract obstruction is infrequent, manifesting in only 0.3%-0.5% of cholelithiasis cases. Typically, stones exceeding 2 cm find themselves lodged in the terminal ileum. However, in Bouveret's syndrome which is observed in 1 to 3% of instances the impaction occurs in the duodenum causing gastric outlet obstruction. The epidemiology and prevalence of gallstone impaction in the proximal jejunum remain inadequately documented, making this a rare case. Case Report An 83-year-old patient with known cholelithiasis and choledocholithiasis presented with acute abdominal pain and vomiting a week after undergoing ERCP, sphincterotomy and partial duct clearance. The presence of repeated bilious vomiting prompted investigation with abdominal CT scan. This revealed an approximately 4.5 cm gallstone impacted in the proximal jejunum, prompting emergency laparotomy which confirmed that the stone was impacted 10-15 cm from the dudeno-jejunal junction. Jejunotomy, stone extraction with primary closure was performed. Post-operative recovery was uneventful. Conclusion This case demonstrates gallstone impaction in the proximal jejunum causing bowel obstruction and necessitating emergency intervention. Timely diagnosis and prompt surgical intervention led to a successful outcome. The case highlights the need for awareness and consideration of the entire spectrum of possible gallstone-related complications in the acutely presenting patient with gall stones.

Unsteady vane-rotor secondary flow interaction of the endwall region in a 1.5-stage variable-geometry turbine

Variable-geometry turbines present significant improvements in both off-design cycle efficiency and enhanced engine responsiveness for future adaptive cycle engines. The adjustable vanes regulate the through-flow capacity by varying the installation angle and thus unavoidably require endwall clearance, resulting in profound implications for vane and downstream blade rows. Unsteady numerical simulations are carried out to investigate the vane-rotor flow interaction under the zero and partial clearance type of the adjustable vane in a 1.5-stage variable-geometry turbine. First, specific vortical structures and loss characteristics of upstream adjustable vane leakage flow at turning angles of −5°, 0°, and +5° are described. Then, the basic mechanisms of vane-rotor secondary flow interaction between acquired upstream leakage flow and downstream blade rows secondary flow is explored by the time-resolved method and quantitative detailed analysis method. The results show that adjustable vane vortex core area is the primary cause of internal loss within the vortex, and the mixing and interaction between the leakage vortex and other vortex systems contribute to secondary loss in the vane. Due to the downstream blade shear action caused by different flow velocity on the suction and pressure surfaces, the vane leakage flow fragments upon entering the R1 blade passage and develops downstream of the endwall region. Compared to the vane with zero clearance case at same turning angle, the intensity of the R1 tip leakage vortex at the design turning angle and open turning angle is reduced by 47.4 % and 23.66 % with the upstream partial clearance, respectively. The unsteady vane-rotor secondary flow interaction under different turning angles has large influence on the flow structure and loss characteristics of the downstream blade rows, and results in significant differences in the variation pattern and trend direction of the turbine performance.

Visible Light in the Treatment of Acne Vulgaris.

Acne vulgaris, a prevalent dermatological disorder, frequently affects individuals' self-perception and general psychosocial functioning. The growing demand for home-based light therapy devices prompted a systematic review to assess the efficacy of visible light in acne treatment. Overall, 35 studies were included, representing 1185 cases of acne vulgaris (mean age: 23.7 years; sex: 63% female). A total of 69% of the included studies were level 2 evidence. Overall, 92% of patients achieved partial remission of their acne lesions using visible light therapy. Among the patients who experienced a partial remission of their acne, 46% experienced a reduction of 0% to 50% in their acne lesions, while 33% and 12% experienced reductions of 51% to 74% and 75% to 99%, respectively. Notably, blue light emerged as the predominant treatment modality in this context, used in around 64% of the cases. A total of 95% of the patients who were treated with blue light experienced a partial clearance of acne lesions; 44% experienced a reduction of 0% to 50% in their acne lesions, while 42% and 9% experienced reductions of 51% to 74% and 75% to 99%, respectively. Overall, the average total lesion count improved by 43% at week 4 compared to the baseline. The average number of treatment sessions was 22 (range 1-112 sessions). On average, treated patients responded within a period of 4 weeks. Commonly reported side effects included skin irritation and erythema. This review highlights the potential of visible light therapy in acne treatment. Head-to-head studies are needed to compare the efficacy of visible light compared to existing therapies for the treatment of acne.

Comparison of therapeutic agents' short-term effects on facial and scalp actinic keratosis: A network meta-analysis.

Care for actinic keratosis (AK) can be improved with more knowledge on the relative of effect of indicated therapies. Using network meta-analyses, we quantitatively determined the comparative "short-term" effects of interventions in adults with facial and scalp AK. On February 28, 2023, evidence from the peer-reviewed literature was systematically obtained from OVID, the Cochrane Central Register of Controlled Trials and ClinicalTrials.gov. We analyzed data from studies published in English, of a trial design, and investigating the effect of an actinic keratosis monotherapy. Patient complete clearance, patient partial clearance or lesion-specific clearance across adults were analyzed at 8-12 weeks after therapy. Patient complete clearance pertained to proportion of participants who experienced complete clearance of actinic keratosis lesions; patient partial clearance corresponded to percentage of subjects who achieved at least 75% clearance of actinic keratosis lesions; lesion-specific clearance represented the percentage of all lesions that were cleared. In the main (i.e., base) analyses, nodes were analyzed only at the level of the agent. Data from a total of 84 studies were used-across which 22 active agents were identified. Estimates of interventions' surface under the cumulative ranking curve rankings and (pairwise) relative effects were estimated. Across the three outcomes, fluorouracil 5% was ranked the most effective. Our work is the first to provide information on covariate-adjusted relative effects of actinic keratosis therapies- including the more recently reported treatments-for the face and scalp; this knowledge may help physicians and patients make more informed decisions.

Therapeutic success of tofacitinib in granuloma annulare: A retrospective case series of 15 patients.

Background Granuloma annulare (GA) is a necrobiotic granulomatous disorder that may sometimes be resistant to treatment, especially the generalised form. Tofacitinib has recently shown promise in the treatment of non-infective granulomatous dermatosis. Objectives In this study, we aimed to evaluate the response of generalised GA to oral tofacitinib. Methods This was a retrospective case series in patients of generalised GA who were treated with oral tofacitinib 5 mg twice a day in a tertiary care centre in north India. Baseline clinical details and histopathological findings were reviewed. Treatment response was noted in the form of clearance of lesions (complete or partial) along with the time taken to achieve the maximum response. Results A total of 15 patients of generalised GA were included in this study, amongst whom nine patients were resistant to conventional therapies whilst the remaining were treatment naïve. Complete clearance of lesions was noted in 11 patients at a mean treatment duration of 4.4 ± 2.1 months whereas clearance was partial in four, with a mean follow-up duration post- treatment in patients who had partial clearance, which is 7.3 ± 2.8 month, with a reduction in erythema and infiltration in those lesions. Adverse effects in the form of hyperlipidemia were observed in two patients. Conclusion Tofacitinib, a JAK-STAT inhibitor is beneficial in treating GA, especially in those with generalised and recalcitrant disease.

Pediatric cutaneous Crohn disease: A case series of 89 patients and review.

Cutaneous (or "Metastatic") Crohn disease (CCD) is a rare and underrecognized disease characterized by cutaneous granulomatous inflammation. We describe patient demographics, clinical characteristics, histology, and treatment of 89 pediatric cases of CCD, including 78 previously reported and 11 new cases seen at four academic institutions. We emphasize the efficacy of biologic mono- and dual therapy. PubMed identified cases using keywords including "metastatic Crohn disease" and "cutaneous Crohn disease". Patients were identified by retrospective review of the electronic health record including histopathologic diagnosis consistent with CCD. Chart review collected demographic, clinical, and histologic data. Most pediatric patients with CCD are male 55% (49/89), present with edema (73/89, 82%) and erythema (47/89, 53%) of the genitals (33/49, 67%), and have intestinal Crohn disease (69/89, 78%). Oral corticosteroids (53/75, 71%) and metronidazole (29/75, 39%) are the most frequently prescribed medications. Of the 17 patients treated with tumor necrosis factor (TNF)-blockade, 94% (16/17) had partial or total clearance. Ustekinumab resulted in clearance of cutaneous disease in two patients (2/3, 67%) and partial clearance in one patient (1/3, 33%). Two cases achieved total clearance with the use of dual biologic therapy defined as the use of two biologic therapies with differing mechanisms of action or the use of a biologic therapy and small molecule inhibitor. TNF blockade is an effective treatment for pediatric CCD, and interleukin-12/23 inhibitors may be similarly effective. Consideration of dual biologic therapy may be useful in pediatric patients requiring discordant therapies for their intestinal and cutaneous CD.

The safety and efficacy of blinatumomab in the treatment of B-cell acute lymphoblastic leukemia in children

To explore the safety and efficacy of blinatumomab in the treatment of CD19 positive (CD19+) B-cell acute lymphoblastic leukemia (B-ALL) in children. A retrospective analysis was conducted on the clinical data of pediatric B-ALL patients who received blinatumomab treatment from Hematology & Blood Diseases Hospital of Chinese Academy of Medical Sciences from August 2021 to October 2023. Based on their disease status, the patients were divided into refractory/relapsed(RR) group, minimal residual disease clearance (MC) group, and chemotherapy intolerance (IC) group. Clinical data of the children were collected to evaluate the adverse drug reactions, therapeutic efficacy and survival of the children. In total, 35 patients were included, with 20 males and 15 females, aged from 0.6 to 16.4 (9.9±4.2) years old. There were 10 cases in the RR group, 20 cases in the MC group and 5 cases in the IC group. A total of 56 cycles of infusion were completed, with one cycle in 24 cases, two cycles in 5 cases, three cycles in 2 cases and four cycles in 4 cases. The median infusion time [M (Q1, Q3)] from the first to the fourth cycle was 14 (14, 28) days, 28 (28, 28) days, 28 (28, 28) days and 28 (26, 28) days, respectively. In terms of adverse reactions, the incidence of grade 1-2 cytokine release syndrome(CRS) was 57.1% (32/56), with grade 1 CRS accounting for 84.4% (27/32). The incidence rate of immune effector cell-associated neurotoxicity syndrome(ICANS) (grade 4) was 1.8% (1/56). In the RR group, 6 cases were treated effectively, and minimal residual disease(MRD) turned negative, before treatment, MRD levels were all less than 20%. Among them, 3 cases had MRD turning positive again 14 to 42 days after discontinuation of Belintoumab. Four cases were treated ineffectively, with MRD >20% before treatment. All MRD positive cases in MC group turned negative and all MRD negative cases in the IC group remained negative after treatment. The median follow-up time of RR group was 5.7 (3.8, 9.4) months, and 1 year median survival rate and event-free survival rate were 40.0%±21.9% and 33.3%±19.2%, respectively. The median follow-up time for MC and IC group patients was 6.7 (5.2, 12.5) months and 7.1 (5.1, 7.6) months, respectively, with an event free survival rate of 100%. The safety and efficacy of using belintoumab in partial RR, MRD clearance, and chemotherapy intolerance are good.

Experimental study of flow control on tip leakage flow in variable geometry linear turbine cascades with different pivot layouts

Variable geometry turbines are essential for adjusting operational conditions in industrial gas turbines and variable cycle engines. These adjustments necessitate partial gaps at both ends of the variable guide vanes to alter the turning angle, consequently introducing an aerodynamic performance penalty. Moreover, the pivot layout profoundly influences aerodynamic losses. Research on turbine cascades that considers various partial gap layouts is limited, particularly in terms of experimental studies, which are rarely conducted. This study aims to diminish aerodynamic losses and augment the efficiency of gas turbines by examining the impact of pivot layouts on partial gap clearance and secondary flow. It further investigates the effectiveness of flow control strategies at the blade tip across different pivot configurations within a variable geometry turbine cascade, utilizing pneumatic probe scanning and surface oil flow visualization techniques. The results reveal that employing a cavity at the tip can significantly reduce aerodynamic losses in schemes both with and without a pivot, achieving maximum loss reductions of 15.8% and 3.7%, respectively. Additionally, a narrower squealer width can further decrease these losses. However, with a pivot located at the tip, the resulting separation flow and wake vortex become predominant sources of losses. The presence of the pivot weakens the tip leakage flow rate and the intensity of the tip leakage vortex (TLV), thus diminishing the effectiveness of cavity tip flow control. The cavity moderates TLV and enhances the interaction between TLV and the wake vortex, leading to increased aerodynamic losses.

Quercetin induces senolysis of doxorubicin-induced senescent fibroblasts by reducing autophagy, preventing their pro-tumour effect on osteosarcoma cells

Cellular senescence contributes to ageing and age-related diseases, and multiple therapeutic strategies are being developed to counteract it. Senolytic drugs are being tested in clinical trials to eliminate senescent cells selectively, but their effects and mechanisms are still unclear. Several studies reveal that the upregulation of senescence-associated secretory phenotype (SASP) factors in senescent cells is accompanied by increased autophagic activity to counteract the endoplasmic reticulum (ER) stress. Our study shows that Doxo-induced senescent fibroblasts yield several SASP factors and exhibit increased autophagy. Interestingly, Quercetin, a bioactive flavonoid, reduces autophagy, increases ER stress, and partially triggers senescent fibroblast death. Given the role of senescent cells in cancer progression, we tested the effect of conditioned media from untreated and quercetin-treated senescent fibroblasts on osteosarcoma cells to determine whether senolytic treatment affected tumour cell behaviour. We report that the partial senescent fibroblast clearance, achieved by quercetin, reduced osteosarcoma cell invasiveness, curbing the pro-tumour effects of senescent cells. The reduction of cell autophagic activity and increased ER stress, an undescribed effect of quercetin, emerges as a new vulnerability of Doxo-induced senescent fibroblasts and may provide a potential therapeutic target for cancer treatment, suggesting novel drug combinations as a promising strategy against the tumour.

Tirbanibulin 1% Ointment Effectiveness for Actinic Keratosis Treatment Evaluated by Dynamic Optical Coherence Tomography

Background. Actinic keratosis (AK) is a common premalignant skin condition. Its diagnosis is based on a clinical and sometimes dermoscopic examination, but, in some situations, a skin biopsy may be necessary. Dynamic optical coherence tomography (D-OCT) can often bypass this need, by noninvasive evaluation of skin morphology. Early and effective treatment of AKs is important to prevent the progression to invasive squamous cell carcinoma (iSCC). Tirbanibulin 1% ointment, a new topical field therapy for AKs, has recently been introduced. Objectives. The aim of this study was to evaluate the efficacy and safety of tirbanibulin 1% ointment for the field treatment of nonhyperkeratotic, nonhypertrophic AKs (Olsen grade 1) on the face and/or scalp in adults, using D-OCT technology. Methods. Patients, presenting multiple, mild to moderate AKs on the face and scalp, in treatment with tirbanibulin 1% ointment for five consecutive days of an area measuring 25 cm2, were evaluated with videodermoscopy (V-track Vidix 4.0) and D-OCT (VivoSight Dx, Michelson Diagnostics Ltd., Kent, England, United Kingdom), as normal clinical practice. The lesions were staged according to the Olsen classification, excluding the most aggressive lesions. Results. We retrospectively evaluated 50 patients (27 males and 23 females, mean age 76 ± 7.9 years). At 57 days posttreatment, the complete clearance rate was 68% (n = 34) and partial clearance rate was 76% (n = 38). D-OCT showed markedly improved morphology, including a better recognizable dermal-epidermal junction (DEJ), associated with reduced inflammation. The most common adverse events reported were erythema and scaling, which were mostly mild and self-limiting. Conclusions. This study demonstrated that tirbanibulin may be considered an effective and well-tolerated treatment option for nonhyperkeratotic, nonhypertrophic AKs. It showed a favorable safety profile, with mostly mild adverse events. D-OCT can be considered a useful tool for personalizing AK treatment and monitoring.

Efficacy and tolerability of tirbanibulin 1% ointment in the treatment of cancerization field: a real-life Italian multicenter observational study of 250 patients.

Tirbanibulin 1% ointment is approved for the field treatment of Olsen grade I actinic keratoses (AKs) of the face and scalp. We performed a multicenter retrospective study involving 15 dermatologic units in Italy to investigate the efficacy and tolerability of tirbanibulin in a real-life setting. 250 patients were enrolled. Tirbanibulin, 1% ointment, was applied daily for five consecutive days. The efficacy of treatment was measured with modifications of the Actinic Keratosis Area and Severity Index (AKASI). A satisfactory response was defined by complete (100% reduction in the number of lesions) or partial clearance (75-99%) of treated AKs. Overall, the AKASI score was significantly reduced in the studied population (mean, from 4.1 ± 2.7 to 1.4 ± 1.5; P < 0.001). A satisfactory response was observed in 222 (88.8%) cases. The proportion of satisfactory responses was higher when follow-up was performed after 8 weeks (34/35, 97.1%). The reduction in AKASI was significant in patients with Olsen grade II or III lesions (from 5.3 ± 2.8 to 1.6 ± 1.6; P < 0.001). A satisfactory response was observed in 91/104 (87.5%) cases. AKASI reduction was also significant in patients with trunk or limb AKs (from 7.0 ± 1.3 to 2.0 ± 1.6; P = 0.018) since a satisfactory response was observed in 7/8 (87.5%) cases. Tirbanibulin was well tolerated; all adverse events (AEs) included transient local reactions at the site of treatment. Overall, 231 patients had at least one AE. Only 7 (2.8%) grade 4 AEs were recorded. Our retrospective study confirmed that tirbanibulin 1% ointment is effective and well tolerated in a real-life setting and is also promising for Olsen grade II and grade III AKs and AKs localized on difficult-to-treat areas.

Determinants of Partial Stone Clearance after Mini-PCNL in the Pediatric Population

Abstract: Background: The prevalence of renal stones in pediatric population is increasing in Pakistan, to minimize the adverse outcomes of renal stone disease accurate diagnosis and proper management is necessary. Objective: This study aim to evaluate the risk factors of partial stone clearance after mini-PCNL in the pediatric population of Pakistan. Materials and Methods: This is a retrospective, cross-sectional study conducted at Godhra Hospital, Karachi, during 2021, patients diagnosed with single or multiple renal stones requiring PCNL were enrolled in the study, Guy’s stone score was used as a prediction method for complete clearance. SPSS version 22 was used to analyze the data, chi-square test was used to assess the significance of the data keeping a p-value ≤0.05 as significant. The risk estimation was analyzed with the help of the odds ratio test. Result: A total of 234 participants with mean age of 6.4 ± 4.8 years were enrolled. Stone clearance was reported 203 (86.7%) and 31 (13.2%) residual fragments. 09 (3.8%) out of the residual stone group needed intervention for complete clearance while the remaining were reported as stone free after 4 weeks with METs. The mean residual stone size was 0.7 ± 0.3, upon assessing the determinants maximum patients had Staghorn (&gt; 4) cms stone size with 7 (2.9%) of patients out of 13 (5.5%). The odds of having partial clearance were reportedly positive with 2.34 in staghorn ≥ 4cms stone size and 1.62 in Grade IV Guy’s stone score. Conclusion: Stone size ≥ 4.0 cm and staghorn calculi present in all calyces are independent risk factors for partial stone clearance after Mini-PCNL.

Experimental investigation of secondary flow losses in a variable geometry linear turbine cascade with winglet tip

Variable geometry turbines (VGT) hold a crucial role in gas turbines and variable cycle engines (VCE) by allowing adjustments to different operational conditions. In order to realize the adjustable function of the VGT stator blade, there will be partial gap structure at both ends of the stator blade, which will lead to partial leakage flow and serious secondary flow loss at the blade end that cannot be ignored, especially in a large angle adjustment range. At present, there are few researches on turbine cascades considering the real partial gap structure and winglet tip, and the numerical simulation calculation is mainly used, while the in-depth study using wind tunnel test is rarely seen. Therefore, this study attempts to analyze the internal flow characteristics of variable geometry turbine cascade by using five-hole pneumatic probe scanning and surface oil flow visualization, and discusses the mechanism of controlling partial clearance leakage flow and reducing secondary flow loss in the cascade by using winglet tip flow control technology. The winglet offset distance and the change of the relationship between the pivot and the clearance position on the flow field and flow loss is studied experimentally for the first time. The results show that the influence mechanism of winglet tip applied in VGT partial gap is quite different from that of typical blade tip clearance application, and more consideration should be given to the influence of pivot structure. Reasonable parameter selection can achieve a maximum loss reduction of 13.4 % and 20.2 % with and without pivot, respectively, while the unreasonable flow control scheme may lead to the loss or even increase with pivot. The interaction between the new secondary flow structure induced by pivot in the gap and other gap leakage flows is analyzed to explore the new mechanism of using winglet tip to reduce the loss of gap leakage flow.

Assessment of pancreatic ductal stone density on non-contrast computed tomography for predicting the outcome of extracorporeal shock wave lithotripsy.

Background and study aims The utility of stone density at non-contrast computed tomography (NCCT) for predicting the effectiveness of extracorporeal shock wave lithotripsy (ESWL) in chronic calcific pancreatitis (CCP) is relatively unexplored. Patients and methods This was a prospective observational study of patients with CCP. Hounsfield units (HU) were determined for the largest pancreatic ductal stone during pretreatment NCCT. All patients underwent ESWL until the largest stone was fragmented to <3mm, followed by endoscopic retrograde cholangiopancreatography (ERCP) for stone extraction. The predictive factors following ESWL for successful stone extraction were studied and the receiver operating characteristic (ROC) curve determined the HU optimal cut-point. Results Eighty-two patients with a median (interquartile range) age of 36 years (range, 29-55); majority male 45 (54.9%), were included. Idiopathic CCP was noted in 78 patients (95.1%). The median stone density (SD) was 1095 HU (range, 860.7-1260.7) and the number of ESWL sessions was 2 (range, 2-3). Complete stone removal at index ERCP was achieved in 55 patients (67.1%). Those with partial clearance (n=27) needed a repeat ERCP, which was successful in 26 (96.3%); one patient (3.7%) underwent surgery. There was a significant, positive correlation between number of ESWL sessions and SD (r=0.797; P <0.001). On bivariate analysis, SD and the number of ESWL sessions revealed a significant association with complete ductal clearance. The optimal cut-point for complete stone removal by the ROC curve was 1106.5 HU (Youden index 0.726), with a sensitivity of 93% and a specificity of 80%. Conclusions The SD is a significant predictor of ESWL success followed by ductal clearance at ERCP, and <1106.5 HU is a predictor of good candidates for ESWL therapy.

Efficacy of Retrograde Intrarenal Surgery Versus Percutaneous Nephrolithotomy In Treating Lower Pole Stones of 1-2 cms

Introduction Urologists are always inclined to find techniques with minimal complication and hospital stays with maximum stone-free rates to mitigate not only health concerns but financial burdens too. PCNL is known as the gold standard for large stones, however, RIRS is known for its less invasive and minor complications. Methodology This is a cross-sectional, prospective study conducted at the public hospital of Jamshoro. Patients with renal stones located at the lower pole, measuring 1-2 cm were included. Patients were evaluated before enrollment and detailed history was taken. Intraoperative and post-operative details were documented. SPSS 21 was used to analyze the data, and to assess significance chi-square test was used, a p-value &lt; 0.05 was considered significant. Results The mean age was 42.7 ± 12.8 and 43.2 ± 13.2 in the RIRS and PCNL groups respectively. The RIRS group showed 07 (17.5%) partial clearance cases while PCNL group showed 02 (5%). Hemoglobin drop was measured as minimal (&lt; 2.5ml) and excessive (&gt;2.5ml) after surgery, and only 01 (2.5%) cases of RIRS had excessive blood loss, PCNL group had higher hemoglobin drop cases with 3 (7.5%) cases. Blood transfusion was required in 1 (2.5%) and 2 (5%) cases in the RIRS and PCNL groups respectively. Conclusion RIRS can be beneficial in small stones while PCNL can be an ideal procedure for lower pole renal stones of 1-2 cm size.

Intralesional injection of tuberculin purified protein derivative (PPD) versus measles, mumps, and rubella (MMR) vaccine in treatment of molluscum contagiosum: a comparative study

Molluscum contagiosum (MC) is a skin and mucous membrane infection caused by the molluscum virus (MCV). To evaluate safety and efficacy of intralesional injection of tuberculin purified protein derivative (PPD) antigen injection versus MMR (mumps, measles, rubella) antigen for the treatment of molluscum contagiosum (MC). A total of thirty clinically confirmed patients of molluscum were recruited for this trial. Patients who were divided into three groups (A, B and C). Each group consisted of (30) patients. Group (A) subjects received intralesional MMR injections, group (B) subjects received intralesional PPD injection and group (C) received intralesional saline injection. The results of the present study revealed complete clearance of the injected lesions in 12 patients (80%), partial response in 3 patients (20%) of group (A). In group (B), complete clearance of the treated warts was observed in 11 patients (73.3%) and partial response in 4 (26.7%) of patients. In group (C), the majority of patients 8 (53.3%) demonstrated no response while 7 (46.7%) patients showed only partial clearance. We established a good safety and efficacy profile for tuberculin PPD and MMR antigens in treatment of molluscum contagiosum.

Exploring the impact of CYP2D6 and UGT2B7 gene-drug interactions, and CYP-mediated DDI on oxycodone and oxymorphone pharmacokinetics using physiologically-based pharmacokinetic modeling and simulation

Oxycodone is one of the most commonly used opioids to treat moderate to severe pain. It is metabolized mainly by CYP3A4 and CYP2D6, while only a small fraction of the dose is excreted unchanged into the urine. Oxymorphone, the metabolite primarily formed by CYP2D6, has a 40- to 60-fold higher mu-opioid receptor affinity than the parent compound. While CYP2D6-mediated gene-drug-interactions (GDIs) and drug-drug interactions (DDIs) are well-studied, they only account for a portion of the variability in oxycodone and oxymorphone exposure. The combined impact of CYP2D6-mediated GDIs and DDIs, CYP3A4-mediated DDIs, and UGT2B7 GDIs is not fully understood yet and hard to study in head-to-head clinical trials given the relatively large number of scenarios. Instead, we propose the use of a physiologically-based pharmacokinetic model that integrates available information on oxycodone's metabolism to characterize and predict the impact of DDIs and GDIs on the exposure of oxycodone and its major, pharmacologically-active metabolite oxymorphone. To this end, we first developed and verified a PBPK model for oxycodone and its metabolites using published clinical data. The verified model was then applied to determine the dose-exposure relationship of oxycodone and oxymorphone stratified by CYP2D6 and UGT2B7 phenotypes respectively, and administered perpetrators of CYP-based drug interactions. Our simulations demonstrate that the combination of CYP2D6 UM and a UGT2B7Y (268) mutation may lead to a 2.3-fold increase in oxymorphone exposure compared to individuals who are phenotyped as CYP2D6 NM / UGT2B7 NM. The extent of oxymorphone exposure increases up to 3.2-fold in individuals concurrently taking CYP3A4 inhibitors, such as ketoconazole. Inhibition of the CYP3A4 pathway results in a relative increase in the partial metabolic clearance of oxycodone to oxymorphone. Oxymorphone is impacted to a higher extent by GDIs and DDIs than oxycodone. We predict oxymorphone exposure to be highest in CYP2D6 UMs/UGT2B7 PMs in the presence of ketoconazole (strong CYP3A4 index inhibitor) and lowest in CYP2D6 PMs/UGT2B7 NMs in the presence of rifampicin (strong CYP3A4 index inducer) covering a 55-fold exposure range.

Management of Athlete's foot with topical Zinc Sulphate (15%) Solution versus Clotrimazole (1%) Solution

Background: Athlete's foot (tinea pedis) is by far the commonest fungal infections of the integument in the developed world that usually begins between the toes. Multiple drugs were used for the treatment of athlete's foot and including both; topical and systemic agents.Zinc sulphate has been used as topical antifungal agent. Objective: Comparison the efficacy of 15% zinc sulphate solution topically in the management of tinea pedis with topical clotrimazole solution. Patients and Methods: A therapeutic, single blind, comparative, study of Zinc Sulphate solution (15%) in the management of tinea pedis in comparison with clotrimazole solution (both topically), that conducted in the Unit of Dermatology and Venereology ,Baquba Teaching Hospital, extended from March 2020- July 2021 . Fifty patients, 31 males and 19 females with tinea pedis were registered in this study. Divided to 2 groups of patients included in the study: Group A: Use the topical zinc sulphate solution 15%. Group B: Use the topical 1% Clotrimazole solution. A complete history with examination clinically were done for all patients with tinea pedis involving all the relevant points. All patients were used the medicine twice daily for 30 days, and follow there to be seen every 14 days during the course of treatment and then follow up for two months. The patients were examined clinically; also the scoring of feet odor was done at each visit. Results: Group A: Twenty five patients 9 (36%) females and 16 (64%) males were included in this group were treated by Zinc Sulphate solution , and their ages ranged between 27-73(47.8±12.18) years. and the duration of that illness was ranged from 1-120(43±46.61) months. Clinical response after one month of the treatment was 10(40%) patients with complete clearance, 5(20%) patients had partial clearance while 10(40%) patients showed no response. Group B: Twenty five patients treated by clotrimazole solution, and their ages ranged from 24-65(43.2±11.83) years, and the duration of the illness was ranged from 1-180(30.24±44.9) months. Clinical response after four weeks of treatment was 19(76%) patients with complete response, 2(8%) patients had partial response, while 4(16%) patients have no response. There was no statistical significance difference at two weeks in comparison between group A and B (chi square 5.37 P value =0.07) but was slightly significant at four weeks (chi square 6.65, P value =0.04). Side effects of treatment were mild which included itching and burning sensation in 4(16%) patients of group A and in 1(4%) patients of group B. These side effects did not require discontinuation of the treatment. Conclusion: Clotrimazole solution was superior to15% Zinc sulphate solution as effective as topical treatment for Athlete's foot. Keywords: Tinea pedis, topical zinc sulphate, clotrimazole

Management of Athlete's foot with topical Zinc Sulphate (15%) Solution versus Clotrimazole (1%) Solution

Background: Athlete's foot (tinea pedis) is by far the commonest fungal infections of the integument in the developed world that usually begins between the toes. Multiple drugs were used for the treatment of athlete's foot and including both; topical and systemic agents.Zinc sulphate has been used as topical antifungal agent.&#x0D; Objective: Comparison the efficacy of 15% zinc sulphate solution topically in the management of tinea pedis with topical clotrimazole solution.&#x0D; Patients and Methods: A therapeutic, single blind, comparative, study of Zinc Sulphate solution (15%) in the management of tinea pedis in comparison with clotrimazole solution (both topically), that conducted in the Unit of Dermatology and Venereology ,Baquba Teaching Hospital, extended from March 2020- July 2021 . Fifty patients, 31 males and 19 females with tinea pedis were registered in this study. Divided to 2 groups of patients included in the study:&#x0D; Group A: Use the topical zinc sulphate solution 15%.&#x0D; Group B: Use the topical 1% Clotrimazole solution.&#x0D; A complete history with examination clinically were done for all patients with tinea pedis involving all the relevant points. All patients were used the medicine twice daily for 30 days, and follow there to be seen every 14 days during the course of treatment and then follow up for two months. The patients were examined clinically; also the scoring of feet odor was done at each visit.&#x0D; Results: Group A: Twenty five patients 9 (36%) females and 16 (64%) males were included in this group were treated by Zinc Sulphate solution , and their ages ranged between 27-73(47.8±12.18) years. and the duration of that illness was ranged from 1-120(43±46.61) months. Clinical response after one month of the treatment was 10(40%) patients with complete clearance, 5(20%) patients had partial clearance while 10(40%) patients showed no response.&#x0D; Group B: Twenty five patients treated by clotrimazole solution, and their ages ranged from 24-65(43.2±11.83) years, and the duration of the illness was ranged from 1-180(30.24±44.9) months. Clinical response after four weeks of treatment was 19(76%) patients with complete response, 2(8%) patients had partial response, while 4(16%) patients have no response.&#x0D; There was no statistical significance difference at two weeks in comparison between group A and B (chi square 5.37 P value =0.07) but was slightly significant at four weeks (chi square 6.65, P value =0.04). Side effects of treatment were mild which included itching and burning sensation in 4(16%) patients of group A and in 1(4%) patients of group B. These side effects did not require discontinuation of the treatment. &#x0D; Conclusion: Clotrimazole solution was superior to15% Zinc sulphate solution as effective as topical treatment for Athlete's foot.