ABSTRACT
Recent advancements in nanotechnology have resulted in improved medicine delivery to the target site. Nanosponges are three-dimensional drug delivery systems that are nanoscale in size and created by cross-linking polymers. The introduction of Nanosponges has been a significant step toward overcoming issues such as drug toxicity, low bioavailability, and predictable medication release. Using a new way of nanotechnology, nanosponges, which are porous with small sponges (below one microm) flowing throughout the body, have demonstrated excellent results in delivering drugs. As a result, they reach the target place, attach to the skin's surface, and slowly release the medicine. Nanosponges can be used to encapsulate a wide range of medicines, including both hydrophilic and lipophilic pharmaceuticals. The medication delivery method using nanosponges is one of the most promising fields in pharmacy. It can be used as a biocatalyst carrier for vaccines, antibodies, enzymes, and proteins to be released. The existing study enlightens on the preparation method, evaluation, and prospective application in a medication delivery system and also focuses on patents filed in the field of nanosponges.Copyright © 2023 The Authors.
ABSTRACT
Background: Cough is a common symptom in cystic fibrosis (CF), and an increase in cough is an important sign of worsening lung disease and pulmonary exacerbation, the most common cause of hospitalization in people with CF. Objective monitoring of cough could be an important outcome measure for clinical trials, especially in children too young to perform pulmonary function tests. There are no accurate, objective methods of quantifying the frequency, severity, and duration of cough. Devices that have been tested to measure cough are neither highly reliable nor user friendly. We developed a mechano-acoustic sensor (MAS): a 4.8- cm- x 2.8-cm- (1 inch) long, thin, lightweight, stretchable, wireless device that adheres easily and securely to the skin surface and is worn at the base of the neck. The devicewas validated in adults being monitored for COVID- 19. This study evaluated usability and acceptability to children and their parents. Method(s): In Cohort 1, a small, flexible, fully wireless accelerometer-based MASwas applied to the suprasternal notch of children with CF using gentle adhesives. Participants were asked to perform activities that included forced coughs while sitting, lying down, and performing activities such as jumping or jogging and other pharyngolaryngeal activities such as swallowing, speaking, and throat clearing. The sessions were an average of about 30 minutes long. In Cohort 2, participants were asked to test the device for a longer period of wearable time (4-6 hours) in various settings, including outpatient clinics, inpatient rooms, and outside clinic and athome environments. Upon completion, all participants from both cohorts were asked to fill out the Acceptability and Usability Questionnaire, which consisted of six questions ranked on a 4-point Likert scale. Result(s): Cohort 1 included 21 children aged 3 to 18 (mean age 9.25 +/- 4.85), and Cohort 2 included 12 children aged 7 to 18 (mean age 12.15 +/- 4.42). On 31 (94%) questionnaires returned, 35.5% of participants strongly agreed and 61.3% agreed with the statement "I [or my child] like(s) wearing the cough sensor." Similarly, most participants found the cough sensor easy to use (74.2% strongly agreed, 25.8% agreed) and comfortable to wear (64.5% strongly agreed, 29.0% agreed), although they found the adhesive sticker difficult to take off and the device too obvious or large. Conclusion(s): Although qualitative and quantitative acceptability and usability data were overall positive, we have redesigned the cough sensor for comfort and are continuing enrollment. The new sensor, 3.5 x 1.6 x 0.8 cm, is smaller and sits lower on the neck so participants can better conceal it underneath clothing (Figure 1). We are providing universal adhesive remover wipes to all participants. Future work includes long-term monitoring (1-2 weeks) of pulmonary exacerbations using the new devices and further assessing usability and acceptability from participants.(Figure Presented) Figure 1. New cough sensor design with a longer neck and a smaller body, allowing it to be better concealed underneath a shirtCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Case report Background: It is well known that chronic spontaneous urticaria (CSU) has an autoimmune etiology in 40% of cases. It is often comorbid with other autoimmune diseases and a wide spectrum of autoantibodies involved in the pathogenesis of CSU is discussed. Objective(s): We share a clinical case of a rare underline autoimmune disease with later onset of CSU and chronic induced urticaria (CIU). Case: A 38-year- old woman was admitted to the hospital with SARS-CoV- 2 infection. At the age of 22, she was diagnosed with Takayasu's disease involving the aorta, the common and external carotid artery, and the left subclavian artery. Surgical interventions were performed twice -angioplasty of the involved vessels, but in both cases restenosis of the affected arteries was observed. Regarding the underlying disease, the patient received 10 mg of methotrexate once a week and 20 mg of prednisone daily. Due to detailed history collection, the patient noted that for the last 4 months she has rashes, bright red in color, rising above the surface of the skin and accompanied by a strong burning and itching dominantly on the upper and lower extremities, trunk. Appearing every day spontaneously, they have a rounded shape (diameter of up to 40-50 mm). While liner scratching the rash has similar contour. Rash elements disappear within a few hours, do not leave traces. During the current hospitalization, a wheal element up to 40 mm in diameter was observed at the wrist area, stayed for a few hours. UAS-7 -42. According to examination: eosinophils 1000 cells/mcl (patient noticed that eosinophilia of the blood has happened before, an examination was conducted, helminthiasis and parasitosis were excluded), total IgE -more than 2000 IU/ml, antibodies to b2-glycoprotein were revealed. Freak test -negative, but the linear wheals were confirmed by retrospective photos. Result(s): In this clinical case, CSU occurs in combination with induced dermographic urticaria. This patient has extremely aggressive urticaria according to its frequency of occurrence despite therapy with systemic GCS and methotrexate. After recovery from coronavirus infection, further examination and consideration of the appointment of biologicals(anti-IgE) is planned.
ABSTRACT
Introduction: Many COVID-19 patients need prolonged artificial ventilation. Skeletal muscle wastes rapidly when deprived of neural activation, and in ventilated patients the diaphragm muscle begins to atrophy within 24 hours (ventilator induced diaphragmatic dysfunction, VIDD). This profoundly weakens the diaphragm, complicating the weaning of the patient off the ventilator, and increasing the risk of complications such as bacterial pneumonia. 40% of the total duration of mechanical ventilation in ITU patients is accounted for by the weaning period, after the initial illness has resolved. Prevention of VIDD would therefore both improve individual outcomes, and also release ITU capacity. We aim to prevent VIDD by exercising the diaphragm with electrical stimulation of the nerves that control it. Evidence suggests that muscle wasting can be prevented by quite low levels of exercise (e.g. 200 contractions per day). Materials / Methods: The diaphragm is activated by the phrenic nerves, formed from branches of the C3-C5 nerve roots in the neck. These nerves may be electrically stimulated in the lower neck. An electrode array is positioned on each side of the neck using surface landmarks. The system automatically determines the best electrode to use in each array. Sensors built into the ventilatory circuit are monitored both to match stimulation to the respiratory cycle and to determine the effects of stimulation. Result(s): We have designed and built a prototype system for unsupervised noninvasive phrenic nerve stimulation. The system delivers one contraction every 7 minutes, synchronised to early inspiration so as not to disrupt ventilation. Electrode impedances are measured before each stimulus, and the closed loop system continuously monitors the effects of stimulation on airflow and adjusts stimulation parameters to compensate for changes in coupling, for example due to head movement. Discussion(s): This stimulator system overcomes several limitations of existing solutions, namely the resource implications and risk profile of invasive electrodes, and the requirement for supervised operation. While invasive systems are applied selectively for these reasons, routine use of our system can be envisaged. This system was inspired by COVID-19 patients but is not limited to them, and has broad applicability to ventilated intensive care patients in general, for example patients with traumatic brain injury. Conclusion(s): Non-invasive stimulation of the phrenic nerves using pressure-free skin surface electrodes is feasible and safe. It offers the potential for prevention of VIDD and thereby faster ventilator weaning and shorter stay on ITU. Clinical trials are planned in 2022. Learning Objectives: After this presentation delegates should be aware of: 1. Ventilation induced diaphragm dysfunction (VIDD) and its importance in patients having lengthy periods of ventilation, as in many cases of COVID-19. 2. The fact that low levels of activity can maintain the condition of skeletal muscles including the diaphragm muscle 3. The potential for noninvasive stimulation of the phrenic nerves to provide 'diaphragm exercise' and prevent VIDD. Keywords: phrenic nerve stimulation, diaphragm, ventilation, COVID-19Copyright © 2022
ABSTRACT
Introduction: The lack of a history of the course of a new coronavirus infection and the lack of data from randomised trials makes it difficult to choose the right treatment tactics and prescribe adequate prophylaxis in patients who have suffered from COVID-19. Comorbid patients with cardiovascular diseases and endothelial dysfunction have a high risk of a severe course of COVID-19 and subsequent thrombotic complications, which manifest clinically as cardiomyopathy;venous thrombo-embolism (deep vein thrombosis and pulmonary embolism);pulmonary thrombosis in situ;stroke;arterial thrombangiitis;rarely, arterial peripheral thrombosis and microvascular thrombosis, in the lungs, liver, kidneys, brain, etc.;and mild disseminated intravascular coagulation syndrome. The role of endothelial dysfunction in the development of severe complications is underestimated. In the pathogenesis of COVID-19, the defeat of the microcirculatory bed plays a crucial role. The SARS-CoV-2 virus causes associated endotheliitis damage to the endothelium due to virus entry and cytokine storm. Endotheliitis leads to the release of tissue factor, which leads to the formation of an excess of thrombin and fibrin;the body tries to cover the virus with these and prevent its spread, which entails negative side effect such as thrombosis Methods: Sixty-six patients who had COVID-19 were examined (42 women and 24 men;mean age 48 years [range 20 – 80 years]). Patients complained of a feeling of paraesthesia, mainly in the lower extremities, a feeling of heaviness, stiffness in the popliteal region, an increased vascular pattern on the entire surface of the skin, a burning sensation in all vessels, and a feeling of weakness. Ultrasound colour duplex scanning showed no signs of thrombosis in the large vessels. Using a high frequency ultrasound Doppler and a 25 MHz sensor, the nailbed of the first finger of the upper limb was examined. The microcirculatory images were analysed by the shape and spectrum of the curves. Twenty patients received prophylaxis with rivaroxaban 10 mg daily (group 1) and 46 patients did not (group 2). The control examination was carried out four weeks after the start of therapy: sulodexide one capsule twice daily. The coagulogram parameters were also studied. Results: A depletion in spectral characteristics was seen in patients after COVID-19 disease, in comparison to microcirculatory images recorded in healthy individuals. Predominantly, the red part of the spectrum was recorded in patients after COVID-19, the lighter part of the spectrum was not recorded. Group 1 patients had higher amplitude parameters than group 2, but they also registered a depletion in spectral characteristics. Soluble fibrin monomer complexes were increased 4 – 5 times, D-dimer 2 – 2.5 times, and antithrombin III 1.5 times. The international normalised ratio, activated partial thromboplastin time, fibrinogen, prothrombin according to Quick, prothrombin time, clotting time, and bleeding time were within the reference intervals both before and after treatment. Upon repeat examination four weeks after the course of sulodexide therapy, the spectral characteristics were normalised, and the coagulogram parameters were also normalised. Conclusion: The red part of the spectrum, according to the Doppler criteria, corresponds to the fastest particles moving in the middle of the stream. The lighter part of the spectrum corresponds to particles moving more slowly. The reduction in spectral characteristics in patients after COVID-19 disease corresponds to parietal stasis and readiness for thrombosis, which was confirmed by the coagulogram data. Examination of the nailbed using high frequency ultrasound Doppler in patients who have COVID-19 allows the identification of stasis of the parietal blood flow, which corresponds to a prethrombotic state. The prescription of sulodexide allows for an improvement in the condition of patients and normalisation of microcirculation indicators
ABSTRACT
Case Report Background : Fixed drug eruption (FDE) is a rare delayed hypersensitivity reaction which is often misdiagnosed. Colchicine is a drug used for gout prophylaxis known to regulate multiple inflammatory pathways. Since 1996 only one case of colchicine-associated FDE has been reported. Case-presentation : A 58-year old man presented at the clinic with recurrent erythematous lesions on the right arm, hand, thighs, chest, and genitals which followed residual hyperpigmentation. First clinical presentation was in 2018 and upon subsequent episodes the lesions appeared on the same skin sites following a tendency to engage larger skin surface and new spots occurred. The patient reported on-demand treatment with colchicine, metamizole, paracetamol, diclofenac for gout arthritis, and acetylsalicylic acid/vitamine C, for Covid-19 prophylaxis. Epicutaneous patch tests with European standard series was performed on healthy skin, and patch testing with colchicine, paracetamol, diclofenac and metamizole was performed on lesional skin. Results were interpreted as positive for: nickel (++), peruvian balm (++), propolis (++), and colchicine (+). The patient did not report intake of food and drugs containing nickel, nor any consumption of honey and propolis-containing products. The patient's history, clinical presentation, and the positive colchicine patch test helped establish the diagnosis of colchicine-induced FDE. Conclusion : We report the second case of colchicine-induced FDE diagnosed for the first time by epicutaneous patch testing on lesional skin. Proper diagnosis might help evade further complications, and the need for oral challenge tests which could be associated with detrimental effects.