Differential Drug Release Kinetics from Paclitaxel-Loaded Polydioxanone Membranes and Capsules.

BACKGROUND: Drug laden implantable systems can provide drug release over several hours to years, which eventually aid in the therapy of both acute and chronic diseases. The present study focuses on a fundamental evaluation of the influence of implant properties such as morphology, architecture, porosity, surface area, and wettability in regulating the drug release kinetics from drug-loaded polymeric matrices. METHODS: For this, Polydioxanone (PDS) was selected as the polymer and Paclitaxel (Ptx) as the model drug. Two different forms of the matrix implants, viz., reservoir type capsules developed by dip coating and matrix type membranes fabricated by phase inversion and electrospinning, were utilized for the study. Drug release from all the four different matrices prepared by simple techniques was evaluated in vitro in PBS and ex vivo in peritoneal wash fluid for ~4 weeks. The drug release profiles were thereafter correlated with the physicochemical parameters of the polymeric implants. RESULTS: Reservoir-type capsules followed a slow and steady zero-order kinetics, while matrix-type electrospun and phase inversion membranes displayed typical biphasic kinetics. CONCLUSION: It was inferred that the slow degradation rate of PDS polymer as well as the implant properties like porosity and wettability play an important role in controlling the drug release rates.

Radical treatment for blastomycosis following unsuccessful liposomal amphotericin.

Pulmonary blastomycosis is a respiratory disease that is caused by the fungus Blastomyces spp, which is acquired through inhalation of the fungal spores. Blastomycosis is relatively uncommon, with yearly incidence rate of 1-2 cases per 100 000 people. Blastomycosis is a disease that is endemic to the midwest and southern regions of the USA, most commonly affecting immunocompromised patients. About 50% of patients are asymptomatic, but for those who progress to acute respiratory distress syndrome (ARDS) mortality can be as high as 80%. Patients with severe blastomycosis are initially treated with intravenous amphotericin B, followed by long-term itraconazole maintenance therapy. In this Grand Round, we present the case of an immunocompetent 35-year-old man diagnosed with chronic pulmonary blastomycosis who had a poor response to 10 days of intravenous liposomal amphotericin B (L-AmB). He was endotracheally intubated and eventually cannulated for extracorporeal membrane oxygenation (ECMO), due to worsening respiratory function. L-AmB was replaced with a continuous infusion of intravenous amphotericin B deoxycholate (AmB-d). He improved significantly and was decannulated from ECMO on day 9 of AmBd continuous infusion and extubated on day 12 Although L-AmB is considered first-line treatment for blastomycosis, mortality remains high for patients with ARDS associated with blastomycosis. This case highlights the importance of considering AmB-d continuous infusions for patients with severe blastomycosis who might have poor clinical responses to L-AmB.

A Rare Case of Good Outcome of Hodgkin Lymphoma in a Patient with HIV on Antiretroviral Therapy (ART).

BACKGROUND Recent reports have shown an increased incidence of Hodgkin lymphoma (HL) in patients treated with antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection. This report is of a case of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) with a good outcome in a 58-year-old Nigerian HIV-positive man who was being treated with ART. CASE REPORT A 58-year-old HIV-positive man presented to a clinic for evaluation of a left axillary mass. He was diagnosed with HIV in 2005, which was well-controlled by ART. He reported intermittent swelling in the left axillary region for several years. Results of a physical examination were significant for mild tender left anterior axillary lymphadenopathy. He had a computed tomography (CT) scan of the chest and neck, which showed left axillary adenopathy, with the largest measuring 3.5×2.0 cm. A staging positron emission tomography-computed tomography (PET/CT) showed focal uptake in 2 left axillary lymph nodes with no other sites involved. He underwent excision of the left axillary lymph node. Histopathology was consistent with nodular lymphocyte-predominant-type Hodgkin's lymphoma (NLHPL). He underwent radiation therapy with a total dose of 3600 centigray (cGy) according to National Comprehensive Cancer Network (NCCN) guidelines. The 5-month follow-up PET/CT scan showed no evidence of malignancy. CONCLUSIONS We present a case of HIV-associated NLHPL that had an indolent course and a good treatment outcome. This case highlights the importance of regular physical examination in HIV patients while on treatment with ART and accurate diagnosis of the cause of lymphadenopathy to prevent extra-nodal spread in cases of lymphoma.

A Rare Cause of Esophageal Dysphagia - Secondary Esophageal Tuberculosis.

Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. It continues to be one of the most common causes of death in adults across all countries. It is found to be relatively lower in North America. When aerosol droplets that contain Mycobacterium tuberculosis are inhaled, it can deposit in the respiratory tract, particularly in the patient's lungs. Following this deposition, one of the four outcomes can take place. These include clearance of the organism immediately, primary disease, latent infection, and reactivation disease. Unhindered bacterial growth after primary infection can lead to a hematogenous spread of bacilli to produce disseminated TB. Esophageal involvement causing esophageal TB can be primary or secondary esophageal TB. We present a unique case of secondary esophageal TB with symptoms of dysphagia and odynophagia with primary TB focus on the lung. Computed tomography (CT) of the chest noted diffuse bilateral miliary lung disease. TB QuantiFERON gold and sputum culture were positive for TB. Mycobacterial culture for identification with high-performance liquid chromatography showed isoniazid-resistant TB. The patient was started on antitubercular therapy with rifampin, ethambutol, moxifloxacin, and pyrazinamide for a total of nine months. Esophagogastroduodenoscopy (EGD) reported severe ulcerations of the oropharynx and focal ulceration in the proximal to the mid esophagus. Histopathology revealed active ulcerative and granulomatous esophagitis with mycobacterial organisms. After EGD she was started on a full liquid diet and advanced as tolerated. After discharge, she followed with the Health Department and had three negative sputum cultures after the completion of therapy.

Correction: Conductive interface promoted bifunctional oxygen reduction/evolution activity in an ultra-low precious metal based hybrid catalyst.

Correction for 'Conductive interface promoted bifunctional oxygen reduction/evolution activity in an ultra-low precious metal based hybrid catalyst' by Shreya Sarkar et al., Chem. Commun., 2021, 57, 1951-1954, DOI: 10.1039/D0CC08225B.

Conductive interface promoted bifunctional oxygen reduction/evolution activity in an ultra-low precious metal based hybrid catalyst.

Ultra low PtPd alloy deposited on Ni12P5 nanostructures (PtPd/Ni12P5) exhibited enhanced ORR activity (onset: 1.003 V and E1/2:0.95 V) on par with commercial Pt/C and superior OER activity with 81% reduction of the precious metal compared to the commercial catalyst.

How Clean Is the Linen at My Hospital? The Mucorales on Unclean Linen Discovery Study of Large United States Transplant and Cancer Centers.

Mucormycosis outbreaks have been linked to contaminated linen. We performed fungal cultures on freshly-laundered linens at 15 transplant and cancer hospitals. At 33% of hospitals, the linens were visibly unclean. At 20%, Mucorales were recovered from >10% of linens. Studies are needed to understand the clinical significance of our findings.

Preoperative decolonization to reduce infections in urgent lower extremity repairs.

PURPOSE: Medical implants and surgical site infections (SSIs) can be a burden on both patients and healthcare systems with a significant rise in morbidity, mortality and costs. Preoperatively, our practice of a chlorohexidine gluconate (CHG) washcloth bath or solution shower was supplemented with nasal painting using povidone-iodine skin and nasal antiseptic (PI-SNA). We sought to measure the effectiveness in reducing SSIs in patients undergoing repair of lower extremity fractures. METHODS: A retrospective review of trauma patients undergoing orthopedic operations conducted at Conemaugh Memorial Medical Center from 10/1/2012 through 9/30/2016. The intervention period was 10/1/2014 to 9/30/2016 which included the addition of nasal painting with PI-SNA preoperatively. All patients were followed for 1 year prior to January 2013 and 30 or 90 days thereafter for the development of a SSI. RESULTS: The pre-intervention group consisted of 930 cases with a 1.1% infection rate (10 SSIs). The intervention group consisted of 962 cases with a 0.2% infection rate (2 SSIs). This observed difference was statistically significant (P = 0.020). CONCLUSIONS: This retrospective review of a methicillin-resistant Staphylococcus aureus decolonization protocol using CHG bath/shower and PI-SNA nasal painting revealed a significant decrease in the infection rate of patients undergoing lower extremity fracture repairs. We recommend its use without contraindications, but recognize that additional investigations are necessary.