Purpose: Following COVID-19 infection a rising count of rhino-orbito-cerebral mucormycosis is observed, requiring orbital exenteration, a disabling lifetime affecting surgery. One of the potential interventions for globe salvage in these patients is retrobulbar injections of amphotericin B. This study was conducted to review protocols, outcomes, and side effects of retrobulbar injection of amphotericin B in patients with COVID-19 associated rhino-orbito-cerebral mucormycosis (CAM). Methods: The PubMed, Scopus, Web of Science, and Embase databases were searched using a comprehensive string of relevant keywords. All English studies with the confirmed diagnosis of CAM infection were included. We excluded all studies in which retrobulbar injection of amphotericin B was not implemented in any of the patients or there was a lack of clarified and detailed data about this procedure among participants. Results: A total of 647 cases had a history of retrobulbar injection(s) of amphotericin B in 13 reviewed studies with 3,132 subjects of CAM. The most common protocol was the retrobulbar injection of 1 ml of 3.5 mg/ml liposomal amphotericin B for 3 doses daily or on alternate days. We discerned that the globe salvage rate was 95.0% in eyes with a history of retrobulbar injection(s). The total rate of orbital exenteration was 14.9%, regardless of the history of retrobulbar injection of the drug. Other outcomes of this intervention were vision salvage and reduced major ophthalmic complaints, including pain, swelling, chemosis, ptosis, and ophthalmoplegia. The side effects of this intervention were not serious, and most of them were transient. They included swelling at the injection site, restriction of ocular motilities, exacerbation of orbital inflammation, and even intensification of visual impairment in a few cases. Conclusions: Retrobulbar injection of amphotericin B should be considered a nearly safe and protective intervention against orbital exenteration in patients with CAM. It may also be effective in saving vision. Since the effectiveness of orbital exenteration in the survival of patients is not ascertained, retrobulbar injections can be considered an alternative intervention.
Introduction Skin pores are enlarged openings of the pilosebaceous follicles that can be affected by age, gender, genetics, exposure to UV light, ethnicity, and sebum secretion. Many treatment modalities reduce facial pores’ count and area, including oral and topical medications as well as different wavelengths of lasers. Finding a safe and cost‐effective treatment protocol is necessary since facial pores are one of the main reasons for cosmetic complaints. Aim This review compares available treatment options for reducing facial pores’ number and area according to the published clinical trials. Methods A search on PubMed and Google Scholar was performed. Nineteen published clinical trials regarding treatment options for facial pores were included and reviewed based on the authors’ clinical experience. Results A total number of 591 cases (83.7% female) aged 18–80 years were included. Three assessment methods including digital imaging, physician assessment, and patient’ satisfaction were used in the studies to evaluate the therapeutic efficacy of each modality. Furthermore, combining different modalities increased the efficacy of reducing pores’ size and number. Mild, reversible burning and erythema were common side effects. Conclusion Multiple sessions and combination therapies improve facial pores’ area and number. In young patients, the focus should be on controlling sebum production, while in older patients, the focus should be on rejuvenation in addition to the control of sebum production.
Background: Acute respiratory distress syndrome (ARDS) following Covid-19 pneumo-nia is a common complication; using non-invasive ventilation (NIV) is one of the best options avai-lable. In the recent Covid-19 pandemic, we have seen a significant increase in barotrauma incidence following the use of NIV in patients with severe Covid-19 pneumonia. We aimed to identify the risk factors of barotrauma in patients with Covid-19 pneumonia under-going NIV. Method: In this retrospective study, all adult patients with severe Covid-19 pneumonia who suffe-red from any form of barotrauma undergoing NIV from July to September 2021 in Afzalipour Hos-pital, Kerman, Iran were evaluated. Lab tests and NIV machine settings were collected from pa-tients' files. A chi-square test and an independent t-test were used for analytical statistics. Results: Twenty patients with barotrauma secondary to severe Covid-19 pneumonia were enrolled. The most common manifestations of barotrauma were pneumomediastinum in 19 patients (95%). No significant relationship was seen between the occurrence of barotrauma and lab tests. The mean ± SD Inspiratory Positive Airway Pressure (IPAP) level in passed-away patients (17.8 ± 1.1) was significantly higher than in recovered patients (13.5 ± 0.5) (p = 0.04). Conclusion: According to the results of the study, using a low level of IPAP in the ventilator ma-chine settings of patients with barotrauma secondary to severe Covid-19 pneumonia will reduce the mortality rate, although its excessive reduction can cause pulmonary collapse and respiratory arrest as a result..
Brimonidine is a vasoconstrictive agent used to treat several dermatologic disorders.Here, we review the uses of brimonidine in different aspects of dermatology. We searched keywords including rosacea, erythema, topical brimonidine, dermatology, and skin disease in PubMed, Cochrane, and Google Scholar to collect the related published articles. In a review of 15 articles, we found topical brimonidine improved the facial erythema of rosacea. In addition, it reduced the erythema associated with alcohol flushing syndrome, intense pulsed light therapy, and photodynamic therapy. Furthermore, topical brimonidine was used as a hemostatic agent in dermatosurgery procedures such as Mohs surgery and nail surgery to reduce intra-operative and postoperative bleeding. Some side effects such as erythema, flushing, and burning were reported in a few patients. Based on our findings, brimonidine is a beneficial drug that can be used in various dermatologic disorders with negligible side effects.
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