Topical Prophylaxis Research Articles

Combination of compound screening with an animal model identifies pentamidine to prevent Chlamydia trachomatis infection

Chlamydia trachomatis (Ct) is the most common cause for bacterial sexually transmitted infections (STIs) worldwide with a tremendous impact on public health. With the aim to unravel novel targets of the chlamydia life cycle, we screen a compound library and identify 28 agents to significantly reduce Ct growth. The known anti-infective agent pentamidine-one of the top candidates of the screen-shows anti-chlamydia activity in low concentrations by changing the metabolism of host cells impairing chlamydia growth. Furthermore, it effectively decreases the Ct burden upon local or systemic application in mice. Pentamidine also inhibits the growth of Neisseria gonorrhea (Ng), which is a common co-infection of Ct. The conducted compound screen is powerful in exploring antimicrobial compounds against Ct in a medium-throughput format. Following thorough invitro and invivo assessments, pentamidine emerges as a promising agent for topical prophylaxis or treatment against Ct and possibly other bacterial STIs.

Cost-Effectiveness of Topical Prophylaxis Against Tympanostomy Tube Otorrhea: An Economic Decision Analysis.

To evaluate the cost-effectiveness of various topical prophylaxis strategies against posttympanostomy otorrhea using a break-even analysis. An economic decision analysis of data collected from purchasing records and the literature. An academic center. Costs of various strategies were calculated by querying our institution's pharmacy as well as GoodRX.com drug prices. Posttympanostomy otorrhea rates were acquired from a review of the literature. Costs for treatment of otorrhea were based upon our institution's self-pay patient charges. A break-even analysis was performed to determine the required absolute risk reduction ( ) in otorrhea rate to make prophylactic treatment cost-effective. The most expensive strategy ciprofloxacin/hydrocortisone otic ($626.83) was not cost-effective unless the rate of postoperative otorrhea was greater than 92% or if the cost of otorrhea treatment exceeded $4477.36. The cheapest antibiotic/steroid combination, ciprofloxacin/dexamethasone otic ($72.25) was cost-effective ( 10%). Using a conservative initial otorrhea rate (14%) and weighted cost of treatment ($683.39), the most expensive cost-effective prophylactic intervention possible was $95.67. Prophylaxis against posttympanostomy otorrhea can be cost-effective. Physicians should consider the cost of prophylaxis at their institution as well as the patient's postoperative risk of otorrhea when making treatment decisions.

Australasian Malignant PLeural Effusion (AMPLE)-4 trial: study protocol for a multi-centre randomised trial of topical antibiotics prophylaxis for infections of indwelling pleural catheters

BackgroundMalignant pleural effusion (MPE) is a debilitating condition as it commonly causes disabling breathlessness and impairs quality of life (QoL). Indwelling pleural catheter (IPC) offers an effective alternative for the management of MPE. However, IPC-related infections remain a significant concern and there are currently no long-term strategies for their prevention. The Australasian Malignant PLeural Effusion (AMPLE)-4 trial is a multicentre randomised trial that evaluates the use of topical mupirocin prophylaxis (vs no mupirocin) to reduce catheter-related infections in patients with MPE treated with an IPC.MethodsA pragmatic, multi-centre, open-labelled, randomised trial. Eligible patients with MPE and an IPC will be randomised 1:1 to either regular topical mupirocin prophylaxis or no mupirocin (standard care). For the interventional arm, topical mupirocin will be applied around the IPC exit-site after each drainage, at least twice weekly. Weekly follow-up via phone calls or in person will be conducted for up to 6 months. The primary outcome is the percentage of patients who develop an IPC-related (pleural, skin, or tract) infection between the time of catheter insertion and end of follow-up period. Secondary outcomes include analyses of infection (types and episodes), hospitalisation days, health economics, adverse events, and survival. Subject to interim analyses, the trial will recruit up to 418 participants.DiscussionResults from this trial will determine the efficacy of mupirocin prophylaxis in patients who require IPC for MPE. It will provide data on infection rates, microbiology, and potentially infection pathways associated with IPC-related infections.Ethics and disseminationSir Charles Gairdner and Osborne Park Health Care Group Human Research Ethics Committee has approved the study (RGS0000005920). Results will be published in peer-reviewed journals and presented at scientific conferences.Trial registrationAustralia New Zealand Clinical Trial Registry ACTRN12623000253606. Registered on 9 March 2023.

COVID-19 vaccination and corneal allograft rejection- a review.

To provide a comprehensive literature review on the perceived correlation between COVID-19 vaccination and corneal allograft rejection, and to characterize risk factors, time course, graft outcomes and proposed immunological basis. A literature review was conducted in August 2023 using 4 electronic databases: PubMed, EMBASE, MEDLINE and Scopus. Articles were sourced using key words associated with COVID-19 vaccination and corneal graft. All articles were screened for relevance by abstract review. Duplicates and articles related to COVID-19 infection were excluded. No time limits were set. Additional literature searches regarding cause of corneal graft rejection, rates of graft rejection associated with other vaccines and the cellular mechanism of rejection were also performed. 262 articles were identified from the literature search. 37 papers were included in the analysis based on defined inclusion criteria. This consisted of systematic reviews (n=6), review articles (n=5), retrospective studies (n=3), case series (n=8), letter to the editor (n=1) and case reports (n= 14). The majority of reported allograft rejections were in penetrating keratoplasties. Risk factors for COVID-19 vaccination associated rejection were previous allograft rejection episodes, repeat grafts and penetrating keratoplasty. Most reported rejection episodes were mild and resolved with treatment. Notably, several studies reported nil increase in corneal allograft rejection episodes over the COVID-19 vaccination period. Rejection episodes are associated with a broad spectrum of other vaccines and the complete pathophysiology is undetermined. Corneal allograft rejection appears to be a rare complication of COVID-19 vaccination most frequently observed in high-risk corneal transplants. The true extent of this correlation remains controversial; however, clinician awareness of this risk is essential to its mitigation. Patient counselling around symptom monitoring following vaccination and discussion around topical steroid prophylaxis may be prudent.

Topical antibiotics prophylaxis for infections of indwelling pleural/peritoneal catheters (TAP-IPC): A pilot study.

Indwelling pleural catheter (IPC) and indwelling peritoneal catheter (IPeC) have established roles in the management of malignant pleural and peritoneal effusions but catheter-related infections remain a major concern. Topical mupirocin prophylaxis has been shown to reduce peritoneal dialysis catheter infections. This study aimed to assess the (i) compatibility of IPC with mupirocin and (ii) feasibility, tolerability and compliance of topical mupirocin prophylaxis in patients with an IPC or IPeC. (i) Three preparations of mupirocin were applied onto segments of IPC thrice weekly and examined with scanning electron microscope (SEM) at different time intervals. (ii) Consecutive patients fitted with IPC or IPeC were given topical mupirocin prophylaxis to apply to the catheter exit-site following every drainage/dressing change (at least twice weekly) and followed up for 6 months. (i) No detectable structural catheter damage was found with mupirocin applied for up to 6 months. (ii) Fifty indwelling catheters were inserted in 48 patients for malignant pleural (n = 41) and peritoneal (n = 9) effusions. Median follow-up was 121 [median, IQR 19-181] days. All patients tolerated mupirocin well; one patient reported short-term local tenderness. Compliance was excellent with 95.8% of the 989 scheduled doses delivered. Six patients developed catheter-related pleural (n = 3), concurrent peritoneal/local (n = 1) and skin/tract (n = 2) infections from Streptococcus mitis (with Bacillus species or anaerobes), Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. This first study of long-term prevention of IPC- or IPeC-related infections found topical mupirocin prophylaxis feasible and well tolerated. Its efficacy warrants future randomized studies.

A review of clinical practice guidelines for preventing chlamydial and gonococcal ophthalmia neonatorum

Abstract Objective: The objective of this study is to evaluate and analyze clinical practice guidelines pertinent to the prevention of ophthalmia neonatorum in newborns after delivery. The aim is to offer guidance to medical and nursing staff regarding newborn eye care within the clinical context. Methods: WHO, Guidelines International Network, National Institute for Health and Care Excellence, Scottish Intercollegiate Guidelines Network, Queensland Clinical Guideline, Joanna Briggs Institute, Canada Registered Nurses’ Association of Ontario, New Zealand Guidelines Group, and Chinese Medlive, professional societies focusing on newborn care, and bibliographic databases, such as PubMed, Embase, Web of Science, CNKI, WanFang Database, VIP, and SinoMed, were systematically searched. The International Guidelines Evaluation Screening Tool and Appraising Guidelines Research and Evaluation II were utilized to assess the quality of the guidelines. Content analysis methodology was used for summarization, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to determine the quality of evidence and the strength of recommendations. Results: A total of 8 guidelines pertaining to neonatal ophthalmia were included in the analysis. Among them, guidelines from the National Institute for Health and Clinical Excellence and WHO obtained higher scores (≥80%). Seven guidelines recommended universal topical ocular prophylaxis. In addition, 2 guidelines recommended prescreening and pretreatment of pregnant women at risk of exposure to chlamydia and gonococcus. In total, 17 recommendations were summarized. While the quality of specific evidence ranged from “very low” to “low,” the majority (12/17) of the recommendation strengths were classified as “strong.” Conclusions: In the clinical context, both universal topical ocular prophylaxis for neonates and screening and treatment of pregnant women and their partners for sexually transmitted diseases are recommended.

Steroid Response after Trabeculectomy-A Randomized Controlled Trial Comparing Dexamethasone to Diclofenac Eye Drops.

This prospective randomized controlled trial aimed to compare changes in intraocular pressure in three different anti-inflammatory regimens following trabeculectomy. Sixty-nine patients were randomized to receive either postoperative prophylaxis with topical preservative-free dexamethasone (DEX), diclofenac (DICLO), or their combination (DEX+DICLO). Our main outcome measure was an intraocular pressure (IOP) change of a minimum 4 mmHg following the withdrawal of anti-inflammatory prophylaxis 9 weeks after trabeculectomy. We found that the IOP decreased ≥ 4 mmHg in 18.6% of eyes after cessation of the topical steroid DEX (n = 3/22) and DEX+DICLO (n = 5/21), whereas a decrease in IOP was not observed in the DICLO group. In conclusion, IOP decreased in nearly 1/5 of patients after cessation of topical steroidal anti-inflammatory prophylaxis after trabeculectomy. This points toward a steroid-induced increase in IOP even after trabeculectomy. Thus, increased postoperative IOP may be related to steroid use, and the success or failure of a trabeculectomy cannot be fully evaluated before anti-inflammatory prophylaxis with steroids is stopped or changed to non-steroidal eye drops.

History of diagnosis and treatment of cystoid macular edema

AbstractFollowing the introduction of the ophthalmoscope by Helmholtz in 1851, very early descriptions of macular edema were reported by Jaeger in 1856 and Nettleship in 1872. Macular disease following cataract surgery was described by Hruby in 1950, Irvine in 1953, Chandler in 1954, Nicholls in 1954, and Maumenee in 1957, among others. The introduction of fluorescein angiography by Novotny and Alvis in 1961, with subsequent modifications by David, Sever and Justice, greatly facilitated the diagnosis of this condition. Using fluorescein angiography, Gass and Norton reported 44 patients with “cystoid macular edema” (CME) in 1966, which appears to be the first use of this term. The eponym “Irvine‐Gass syndrome” appears to have been published first in 1971. In 1991, Puliafito and colleagues reported the first use of optical coherence tomography, and published one case of postoperative CME in 1995.Treatments for CME developed as the pathophysiology became better understood. Early reported treatments included oral vasodilators (Laws, 1964), oral prednisone (Gehring, 1968), and pulsed ruby photocoagulation (Zweng and colleagues, 1968). Alternatively, other investigators recommended observation for at least 12 months, including Gass and Norton in 1969 and Jacobson and Dellaporta in 1974. Miyake reported good results with topical indomethacin prophylaxis in 1977; other investigators subsequently reported benefit with topical or oral indomethacin, including Yannuzzi and colleagues in 1979 and Kraff and colleagues in 1982. Various surgical factors, including posterior (rather than anterior) chamber intraocular lenses, were found to be beneficial during the 1980s. Multiple topical medications, including prednisolone acetate, flurbiprofen, ketorolac, diclofenac, and others, were investigated in the 1990s and 2000s. Gaudric and colleagues published treatment of CME with intravitreal triamcinolone acetonide in 2003.At the present time, the use of topical corticosteroids and nonsteroidal anti‐inflammatory agents is widely used in the prophylaxis and treatment of CME, but there is relatively little evidence from randomized clinical trials to support this practice. In both the US and Europe, no agent has achieved regulatory approval for the treatment of postoperative CME; all agents are used “off‐label”.

“Male-supported, female-initiated”

HIV and AIDS remain one of the leading public health challenges in the world, with young women in sub-Saharan Africa bearing the brunt of HIV infection. Female vulnerability to HIV infection is exacerbated by socio-cultural, economic and biological dynamics. Vaginal microbicide, one of the first topical pre-exposure prophylaxis (PrEP) innovations for HIV prevention can offer new hope for women, but an understanding of the local cultural context and its influence on product acceptability is fundamental for effective HIV communication strategies. Critical health communication navigates through the complexities of cultural discourses to create awareness among women in dominant cultural settings. As a means of understanding the key determinants for effective HIV communication, this paper used thematic analysis of data from a study among female students at the University of KwaZulu-Natal regarding their preferences and the acceptability of two microbicide technologies: the tenofovir gel and the dapivirine ring. Keyfindings indicate that microbicides give women more options for self-protection and cater for diverse sexual encounters, and that their covert use empowers women to use the products even if male partners do not support this. However, women felt more empowered with “male-supported, female-initiated” HIV prevention options. The study suggests that in providing HIV preventionoptions to women, culturally appropriate messages must be considered. We suggested that topical PrEP must be communicated as a “male-supported, female-initiated” HIV prevention option in rural KwaZulu-Natal contexts.

Pharmacogenomics of drug transporters for antiretroviral long-acting pre-exposure prophylaxis for HIV.

The use of antiretrovirals (ARVs) as oral, topical, or long-acting pre-exposure prophylaxis (PrEP) has emerged as a promising strategy for HIV prevention. Clinical trials testing Truvada® [tenofovir disoproxil fumarate (TDF)/tenofovir (TFV) and emtricitabine (FTC)] as oral or topical PrEP in African women showed mixed results in preventing HIV infections. Since oral and topical PrEP effectiveness is dependent on adequate drug delivery and availability to sites of HIV infection such as the blood and female genital tract (FGT); host biological factors such as drug transporters have been implicated as key regulators of PrEP. Drug transporter expression levels and function have been identified as critical determinants of PrEP efficacy by regulating PrEP pharmacokinetics across various cells and tissues of the blood, renal tissues, FGT mucosal tissues and other immune cells targeted by HIV. In addition, biological factors such as genetic polymorphisms and genital inflammation also influence drug transporter expression levels and functionality. In this review, drug transporters and biological factors modulating drug transporter disposition are used to explain discrepancies observed in PrEP clinical trials. This review also provides insight at a pharmacological level of how these factors further increase the susceptibility of the FGT to HIV infections, subsequently contributing to ineffective PrEP interventions in African women.

Infection Control With Topical Antimicrobial Prophylaxis for Mucosal Head and Neck Surgery: A Meta-analysis.

To assess for differences in surgical site infection (SSI) rates and bacterial load after major mucosal head and neck surgery between patients who received topical antimicrobial prophylaxis and those who did not. Ovid Medline, Embase, SCOPUS, Cochrane Library, and ClinicalTrials.gov from inception to May 20, 2021, with cross-referencing of retrieved studies per PRISMA guidelines. Inclusion criteria captured clinical trials, cohort studies, and case-control studies with infectious outcomes of adults who underwent major mucosal head and neck surgery and received perioperative topical antimicrobial therapy to the oral cavity and/or pharynx. Studies of dental procedures were excluded. The primary outcome was SSI rate, and the secondary outcome was bacterial load. Two blinded investigators screened each text. Of 265 unique citations, 9 studies of 470 total patients were included. Topical treatments included numerous antibiotics and antiseptics directly applied over mucosa. Pooled SSI rates of 252 patients in the intervention cohort and 218 in the control cohort were 8% (95% CI, 3%-14%; I 2 = 61.2%) and 29% (95% CI, 16%-43%; I 2 = 79.5%), respectively. A meta-analysis of 7 comparative studies totaling 192 patients receiving topical therapy and 218 control patients revealed a pooled relative risk of 0.44 (95% CI, 0.28-0.68; I 2 = 0.0%) in favor of the treatment group. The studies demonstrated a short-term decrease in bacterial counts after topical antimicrobial prophylaxis. Patients who underwent prophylactic topical antimicrobial therapy had less than half the risk of developing SSI after mucosal head and neck surgery when compared with those who received no topical prophylaxis.

Affordable IgY-based antiviral prophylaxis for resource-limited settings to address epidemic and pandemic risks.

BackgroundThe COVID-19 pandemic caused by SARS-CoV-2 exposed a global problem, as highly effective vaccines are challenging to produce and distribute, particularly in regions with limited resources and funding. As an alternative, immunoglobulins produced in eggs of immunized hens (IgY) can be a simple and inexpensive source for a topical and temporary prophylaxis. Here, we developed a method to extract and purify IgY antibodies from egg yolks of hens immunized against viral pathogen-derived proteins using low-cost, readily available materials, for use in resource-limited settings.MethodsExisting protocols for IgY purification and equipment were modified, including extraction from yolks and separation of water-soluble IgY using common household reagents and tools. A replacement for a commercial centrifuge was developed, using a home food processor equipped with a 3D printed adapter to enable IgY precipitation. IgY purification was verified using standard gel electrophoresis and Western blot analyses.ResultsWe developed a step-by-step protocol for IgY purification for two settings in low- and middle-income countries (LMIC): a local laboratory, where commercial centrifuges are available, or a more rural setting, where an alternative for expensive centrifuges can be used. Gel electrophoresis and Western blot analyses confirmed that the method produced highly enriched IgY preparation; each commercial egg produced ~ 90 mg of IgY. We also designed a kit for IgY production in these two settings and provided a cost estimate of the kit.ConclusionIgY purified from eggs of immunized local hens can offer a fast and affordable prophylaxis, provided that purification can be performed in a resource-limited setting. Here, we created a low-cost method that can be used anywhere where electricity is available using inexpensive, readily available materials in place of costly, specialized laboratory equipment and chemicals. This procedure can readily be used now to make an anti-SARS-CoV-2 prophylaxis in areas where vaccines are unavailable, and can be modified to combat future threats from viral epidemics and pandemics.

Efficacy of Gentamicin versus Chlorhexidine as a Sole Prophylactic Oral Decontaminant in Reducing the Incidence of Ventilator Associated Pneumonia: A Randomised Clinical Study

Introduction: Ventilator Associated Pneumonia (VAP) is the second most common nosocomial infection. Aspiration of bacteria from the upper digestive tract is important in the pathogenesis of this infection. Oral decontamination using antiseptic like chlorhexidine reduces the incidence of VAP but not mortality. There is conflicting results about oral decontamination with antibiotics in preventing VAP, some suggesting benefit and others showing no benefit. Aim: To use two different prophylactic oral decontaminant, gentamicin and chlorhexidine, to compare the incidence of VAP, prevalence of bacterial flora, duration of Intensive Care Unit (ICU) stay, and mortality. Materials and Methods: The present study was a randomised, clinical study conducted at Sir Sunder Lal Hospital, Banaras Hindu University, Varanasi, Uttar Pradesh, India from January 2017 to December 2018. Patients intubated within 24 hours of admission and who needed mechanical ventilation with an expected duration of more than 48 hours were included. All the adult patients between age group 18-50 years were included in study. Patients were randomised to receive either Topical Antimicrobial Prophylaxis (TAP) with 2% gentamicin (Group G) or to 2% chlorhexidine (Group C). Patients were followed until extubation or death. Sequential cultures from endotracheal tube were sent on days 3,7,14, and 21, and for oropharyngeal swab culture were sent on days 0, 3,7,14 and 21. VAP was diagnosed with the help of Clinical Pulmonary Infection Score (CPIS). Results: Out of 151 patients, 82 patients were placed in group G (2% gentamicin) and 69 in group C (2% chlorhexidine). On follow-up of various interval among both the groups, CPIS increased with ICU stay but incidence of VAP was comparable between the groups (50% vs 71%, p=0.009). Pseudomonas was found to be most prevalent bacteria among both the groups. Discharge rate from ICU was higher in group G (54.9%) than group C (52.2%) (p-value=0.744). The mortality rate was higher in the group C (43.9%) than group G (44.9%) (p-value=0.744). Conclusion: Prophylactic oral-decontamination with gentamicin or chlorhexidine does not reduce incidence of VAP and outcome among ICU patients. Gentamicin could be a better option for patients on ventilator because it may lead to less colonisation of Pseudomonas in oral cavity along with lower CPIS in the later stages of VAP.

Impact of topical moxifloxacin prophylaxis and povidone iodine on conjunctival bacterial flora in patients receiving intravitreal injections in a tertiary healthcare center in India.

To assess the efficacy of 3 days of topical moxifloxacin in combination with povidone-iodine (PVI) versus moxifloxacin/PVI alone in eliminating conjunctival bacterial flora in patients scheduled to undergo intravitreal injections (IVI). A prospective randomized comparative study in which 120 patients scheduled to undergo IVI at a tertiary care hospital in New Delhi were selected. Study patients were randomized into two groups. Both the groups received self-administration of moxifloxacin for 3 days prior to injection, except in Group B where it was preceded by PVI. Cultures were obtained at different time intervals, such as in Group A before and after applying moxifloxacin (for 3 days) and once again after applying PVI just before the procedure in the operating room, whereas in Group B first two samples were taken before and after applying PVI and the last sample was taken on the day of the procedure after 3 days of moxifloxacin application. A statistical significance was seen between moxifloxacin prophylaxis and resistant coagulase-negative Staphylococcus (CoNS) (P = 0.0001), which implies that frequent use of antibiotic prophylaxis will ultimately lead to the formation of resistant organisms in the conjunctival flora, especially when repeated IVI are given. We could not establish any additional benefits of topical moxifloxacin prophylaxis with regard to a reduction in conjunctival flora when compared with PVI 5%. PVI can be used as an efficient monotherapy in patients undergoing repeated IVI.

NCCN Guidelines® Insights: Squamous Cell Skin Cancer, Version 1.2022.

The NCCN Guidelines for Squamous Cell Skin Cancer provide recommendations for diagnostic workup, clinical stage, and treatment options for patients with cutaneous squamous cell carcinoma. The NCCN panel meets annually to discuss updates to the guidelines based on comments from panel members and the Institutional Review, as well as submissions from within NCCN and external organizations. These NCCN Guidelines Insights focus on the introduction of a new surgical recommendation terminology (peripheral and deep en face margin assessment), as well as recent updates on topical prophylaxis, immunotherapy for regional and metastatic disease, and radiation therapy.

OPHTHALMIA NEONATORUM in Italy: it is time for change

Ophthalmia neonatorum (ON) refers to any conjunctivitis occurring in the first 28 days of life. In the past Neisseria gonorrhoeae was the most common cause of ON. It decreased with the introduction of prophylaxis at birth with the instillation of silver nitrate 2% (the Credè’s method of prophylaxis). Today, the term ON is used to define any other bacterial infection, in particular due to Chlamydia Trachomatis. Currently, the WHO reccomends topical ocular prophylaxis for prevention of gonococcal and chlamydial conjunctivitis for all neonates. On the contrary, several European countries no longer require universal prophylaxis, opting for screening and treatment of pregnant women at high risk of infection. And what about Italy? Have a look on Italian history of prophylaxis, starting by the first decree issued in 1940, signed by Benito Mussolini. In the following decades the law has undergone many changes. At the moment, legislation is unclear, therefore careful consideration is required in order to draft the correct appoach.

A plant-biotechnology approach for producing highly potent anti-HIV antibodies for antiretroviral therapy consideration

Despite a reduction in global HIV prevalence the development of a pipeline of new therapeutics or pre-exposure prophylaxis to control the HIV/AIDS epidemic are of high priority. Antibody-based therapies offer several advantages and have been shown to prevent HIV-infection. Plant-based production is efficient for several biologics, including antibodies. We provide a short review on the work by Singh et al., 2020 who demonstrated the transient production of potent CAP256-VRC26 broadly neutralizing antibodies. These antibodies have engineered posttranslational modifications, namely N-glycosylation in the fragment crystallizable region and O-sulfation of tyrosine residues in the complementary-determining region H3 loop. The glycoengineered Nicotiana benthamiana mutant (ΔXTFT) was used, with glycosylating structures lacking β1,2-xylose and/or α1,3-fucose residues, which is critical for enhanced effector activity. The CAP256-VRC26 antibody lineage targets the first and second variable region of the HIV-1 gp120 envelope glycoprotein. The high potency of this lineage is mediated by a protruding O-sulfated tyrosine in the CDR H3 loop. Nicotiana benthamiana lacks human tyrosyl protein sulfotransferase 1, the enzyme responsible for tyrosine O-sulfation. The transient coexpression of the CAP256-VRC26 antibodies with tyrosyl protein sulfotransferase 1 in planta had restored the efficacy of these antibodies through the incorporation of the O-sulfation modification. This approach demonstrates the strategic incorporation of posttranslational modifications in production systems, which may have not been previously considered. These plant-produced CAP256-VRC26 antibodies have therapeutic as well as topical and systemic pre-exposure prophylaxis potential in enabling the empowerment of young girls and women given that gender inequalities remain a major driver of the epidemic.

Topical Rifamycin Prophylaxis in Gynecological and Obstetric Surgery

OBJECTIVE: Antibiotic prophylaxis is one of the most important steps to reduce surgical site infections. First-generation cephalosporin (cefazolin) is used prophylactically in the majority of operations. Rifamycin is a broad-spectrum semisynthetic antibiotic that is bactericidal against gram (+) and gram (˗) microorganisms. To the best of our knowledge, there are no studies on the use of rifamycin in antibiotic prophylaxis. In this study, we aimed to analyze whether there is a difference between the use of only cefazolin and only rifamycin in terms of surgical site infections. STUDY DESIGN: One hundred patients were included in this case-control study during the last quarter period of 2017. These patients (n=100) were divided into two groups according to their antibiotic use; 50 patients who received only 1 g cefazolin constituted Group 1, 50 patients who received only 250 mg topical rifamycin over the incision line based on surgeon’s preference constituted Group 2. RESULTS: The use of prophylactic topical rifamycin reduced the incidence of wound infection. compared with cefazolin. Surgical site infection was detected in 5 (10%) of the patients who received cefazolin, whereas surgical site infection was not observed in patients who received rifamycin (p=0.022). CONCLUSIONS: The use of topical rifamycin is effective but does not imply that systemic antibiotics should replace prophylaxis. The use of rifamycin would aid in systemic antibiotic prophylaxis.

Visual outcomes after cataract surgery: topical nonsteroidal anti-inflammatory drug prophylaxis compared with prednisolone.

To compare visual outcomes in patients without a history of macular edema after phacoemulsification using combination topical nonsteroidal anti-inflammatory drug plus prednisolone with prednisolone alone. Kaiser Permanente Northern California, USA. Retrospective cohort study. Information was obtained from the electronic health record. The first measure of corrected distance visual acuity (CDVA) recorded during the period 3 weeks to 1 year after phacoemulsification was obtained. Confounding factors and clustering of eyes within patients were adjusted using linear mixed effects regression models for the continuous outcome of CDVA improvement and general estimating equations for the dichotomous outcome of 20/20 or better vs 20/25 or worse. The study included 62 700 health plan members of whom 26,309 (42%) used topical prednisolone alone, whereas 36,391 (58%) used combination treatment. The mean within-person change in CDVA from the preoperative measurement to the postoperative measurement was the same (-0.43 logMAR) for patients in the 2 groups. However, the group that received combination treatment was somewhat more likely to achieve CDVA of 20/20 or better (odds ratio 1.24 with 95% CI, 1.20-1.28). In this large study of cataract surgery patients, a small statistically significant association of combination treatment compared with prednisolone alone was observed.

Drug-Loaded Hydrogels for Intraocular Lenses with Prophylactic Action against Pseudophakic Cystoid Macular Edema.

Pseudophakic cystoid macular edema (PCME), caused by chronic inflammation, is the most common cause of visual impairment in the medium-term after cataract surgery. Therefore, the prophylactic topical administration of combined steroidal and non-steroidal anti-inflammatory drugs is commonly done. Drug-eluting intraocular lenses (IOLs) gained interest as an efficient way to overcome the compliance issues related to the use of ocular drops without the need for additional surgical steps. The incorporation of functional monomers and molecular imprinting were herein applied to design hydrogels suitable as IOLs and able to co-deliver steroidal (dexamethasone sodium phosphate) and non-steroidal (bromfenac sodium) drugs. The incorporation of N-(2-aminopropyl) methacrylamide (APMA) increased the drug uptake and improved the in vitro release kinetics. Imprinting with bromfenac resulted in a decreased drug release due to permanent drug bonding, while imprinting with dexamethasone increased the amount of dexamethasone released after dual-drug loading. The application of a mathematical model to predict the in vivo drug release behavior suggests the feasibility of achieving therapeutic drug concentrations of bromfenac and dexamethasone in the aqueous humor for about 2 and 8 weeks, respectively, which is compatible with the current topical prophylaxis after cataract surgery.