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Investigative Ophthalmology & Visual... Feb 2024Subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) are strongly associated with vasculopathies such as myocardial infarction and ischemic...
PURPOSE
Subretinal drusenoid deposits (SDDs) in age-related macular degeneration (AMD) are strongly associated with vasculopathies such as myocardial infarction and ischemic stroke. This study evaluates ischemic stroke subjects for SDDs to determine whether ocular hypoperfusion from internal carotid artery (ICA) stenosis is associated with ipsilateral SDDs.
METHODS
A cross-sectional study at Mount Sinai Hospital recruited 39 subjects with ischemic stroke (aged 52-90; 18 women, 21 men); 28 completed all study procedures. Computed tomography (CT) of the head and neck evaluated 54/56 ICAs for stenosis criteria: none (n = 33), mild (n = 12), moderate (n = 3), severe (n = 3), and complete (n = 3). Spectral-domain optical coherence tomography (SD-OCT) scans were read to consensus by two masked graders for soft drusen, SDDs and choroidal thickness (CTh; choroidal thinning = CTh < 250 µm). Univariate testing was done with Fisher's exact test. Multivariate logistic regression models tested age, gender, and ICA stenosis as covariates.
RESULTS
Moderate or more ICA stenosis (≥50%-69%) was significantly associated with ipsilateral choroidal thinning (P = 0.021) and ipsilateral SDDs (P = 0.005); the latter were present distal to six of nine stenosed ICAs versus five of 33 normal ICAs. Mild ICA stenosis (≥1%-49%) was not significantly associated with ipsilateral SDDs. Multivariate regression found that older age (P = 0.015) and moderate or more ICA stenosis (P = 0.011) remained significant independent risks for ipsilateral SDDs.
CONCLUSIONS
At least moderate ICA stenosis (≥50%-69%) is strongly associated with ipsilateral SDDs and choroidal thinning, supporting downstream ophthalmic artery and choroidal hypoperfusion from ICA stenosis as the mechanism for SDD formation. SDDs may thus serve as sensitive biomarkers for ischemic stroke and other vascular diseases.
Topics: Male; Humans; Female; Carotid Stenosis; Constriction, Pathologic; Cross-Sectional Studies; Choroid; Ischemic Stroke; Dapsone
PubMed: 38407857
DOI: 10.1167/iovs.65.2.37 -
BMJ Case Reports Jan 2024Methaemoglobinaemia occurs when iron in haemoglobin is oxidised into a form that cannot transport oxygen. At low levels, it is asymptomatic, though at rising levels...
Methaemoglobinaemia occurs when iron in haemoglobin is oxidised into a form that cannot transport oxygen. At low levels, it is asymptomatic, though at rising levels symptoms arise from impaired oxygenation, and it can ultimately be fatal. While uncommon, it is important to consider in hypoxaemic COVID-19 patients, especially if they are not clinically improving on standard treatments and workup for other causes does not explain the ongoing hypoxaemia. It is often diagnosed through a mismatch in peripheral and arterial oxygen, with the former typically less than the latter. We present the case of a COVID-19 patient who was found to have methaemoglobinaemia due to dapsone use for Pneumocystic jirovecii pneumonia (PJP) prophylaxis while on chemotherapy. Dapsone was stopped and supplemental high-flow nasal cannula was provided, and methaemoglobin levels improved over a 5-day period. She was discharged to follow-up with her haematologist in the clinic.
Topics: Female; Humans; Methemoglobinemia; COVID-19; Methemoglobin; Dapsone; Oxygen
PubMed: 38199656
DOI: 10.1136/bcr-2023-256574 -
RSC Advances Jun 2024Heavy metals exist in different water resources and can threaten human health, inducing several chronic illnesses such as cancer and renal diseases. Therefore, this work...
Improvement of hybrid polyvinyl chloride/dapsone membrane using synthesized silver nanoparticles for the efficient removal of heavy metals, microorganisms, and phosphate and nitrate compounds from polluted water.
Heavy metals exist in different water resources and can threaten human health, inducing several chronic illnesses such as cancer and renal diseases. Therefore, this work dealt with the fabrication of highly efficient nanomembranes based on silver nanoparticle (Ag NP)-doped hybrid polyvinyl chloride (PVC) by dapsone (DAP) using an method. Fourier-transform infrared (FT-IR) spectroscopy and X-ray diffraction (XRD) analysis were used to confirm the hybridization of PVC as well as the crystalline structure of hybrid PVC nanocomposites. Three varying proportions of Ag NPs (, 0.1, 0.2, and 0.3%) were used to fabricate hybrid PVC-DAP nanomembranes. The Brunauer-Emmet-Teller (BET) method was used to estimate membrane surface area, porosity and distribution of pore volume. The mechanical strength and antibacterial properties of the cased films notably improved when Ag NPs were added depending on the NP ratio inside the matrix. Results obtained from adsorption experiments of PVC-DAP nanomembranes at 35 °C revealed that the optimum nanomembrane was achieved at 0.2% NPs and its percentage of removal effectiveness ranged from 71 to 95% depending on the ion type. The surface morphology of the PVC-DAP-0.2 Ag NPs before and after the adsorption process of the metal ions was analyzed using SEM-EDX. Moreover, the impact of other parameters such as the initial concentrations, pH media, temperature, and contacting time, on the adsorption efficiency of PVC-DAP-0.2 Ag NPs was also investigated. Furthermore, kinetic and adsorption isotherm models were suggested to describe the adsorption efficiency of the PVC-DAP-0.2 Ag NP membrane, and the uptake mechanism of metal ion removal was studied. The obtained outcomes for these fabricated nanomembranes demonstrated that they could be potential candidates for water purification and other potential purposes including biomedical areas.
PubMed: 38899035
DOI: 10.1039/d4ra03810j -
Indian Journal of Pathology &... 2023Pemphigus herpetiformis (PH) is an autoimmune intraepithelial bullous skin disorder. A 61-year-old female presented with history of multiple pruritic erosions, ulcers...
Pemphigus herpetiformis (PH) is an autoimmune intraepithelial bullous skin disorder. A 61-year-old female presented with history of multiple pruritic erosions, ulcers all over body, and diffuse loss of hair over scalp. Oral and genital mucosas were uninvolved. Subcorneal separation with suprapapillary thinning of epidermis, neutrophilic spongiosis, and elongation of rete ridges were seen on histopathology. Direct immunofluorescence (DIF) revealed IgG deposits in intercellular zone in fish net like pattern and focal linear IgA deposits along basement zone. Indirect immunofluorescence (IIF) revealed antibodies to desmoglein1 (Dsg-1) positive. A final diagnosis of PH was given. The patient responded well to treatment with dapsone and steroids.
Topics: Female; Humans; Middle Aged; Pemphigus; Fluorescent Antibody Technique, Direct; Skin; Autoimmune Diseases; Epidermis
PubMed: 38084547
DOI: 10.4103/IJPM.IJPM_879_20 -
Cureus Jan 2024Acquired methemoglobinemia is a treatable condition that is often clinically subtle and can be missed on routine clinical assessment. We present a 73-year-old male who...
Acquired methemoglobinemia is a treatable condition that is often clinically subtle and can be missed on routine clinical assessment. We present a 73-year-old male who was evaluated in the emergency department with worsening respiratory symptoms requiring oxygen. He tested COVID-19 positive and had new pulmonary emboli evident on his CT chest. The patient was on dapsone therapy as a treatment for bullous pemphigoid. The discrepancy between his oxygen levels on the pulse oximeter and blood gas was noted and was treated with 3% methylene blue for dapsone-induced methemoglobinemia. The patient received treatment for COVID-19 pneumonia and pulmonary emboli. Our case demonstrates that dapsone-induced methemoglobinemia can present concomitantly with other more common causes of acute hypoxic respiratory failure. It is noteworthy for physicians to maintain a high index of suspicion for oxygen level discrepancy in hypoxic patients and consider the possibility of acquired methemoglobinemia. Hence, earlier detection and treatment of the etiology of tissue hypoxia.
PubMed: 38327942
DOI: 10.7759/cureus.51830 -
Acta Dermato-venereologica Jan 2024Epidermolysis bullosa acquisita (EBA) rarely develops in childhood. This study retrospectively recruited paediatric patients with EBA (age ≤ 16 years), diagnosed by...
Epidermolysis bullosa acquisita (EBA) rarely develops in childhood. This study retrospectively recruited paediatric patients with EBA (age ≤ 16 years), diagnosed by clinical and histopathological features and results of immunofluorescence, immunoblotting and enzyme-linked immunosorbent assay (ELISA), and reviews their clinical manifestations, histopathology, immunological features, and responses to various treatments. All 7 included patients presented with inflammatory EBA. Among them, 3 had a bullous pemphigoid-like phenotype. Pathologically, in addition to dermal-epidermal blistering, in all patients, the distribution of neutrophils was superficial perivascular or interstitial, or in the dermal papilla. Mixed neutrophils and eosinophils were detected in 2 of the 3 patients with bullous pemphigoid-like phenotypes. In addition to treatment with glucocorticoids, dapsone was administered in 4 patients, while thalidomide and sulfasalazine were administered in 1 patient. All patients responded to the these therapies. Relapse was mainly due to reduction and cessation of glucocorticoids. In conclusion, EBA in childhood may be unique, and thus distinct from its adult counterpart. Specific treatment and follow-up protocols are required for therapy of this rare autoimmune skin disease in children.
Topics: Adult; Humans; Child; Adolescent; Epidermolysis Bullosa Acquisita; Pemphigoid, Bullous; Retrospective Studies; Autoimmune Diseases; Dapsone; Glucocorticoids
PubMed: 38270257
DOI: 10.2340/actadv.v104.11917 -
MethodsX Dec 2023A new, simple, and sensitive FIA-spectrophotometric method has been developed for evaluating pure amoxicillin and pharmaceutical formulations. The FIA method involves...
A new, simple, and sensitive FIA-spectrophotometric method has been developed for evaluating pure amoxicillin and pharmaceutical formulations. The FIA method involves the reaction of dapsone with sodium nitrite and hydrochloric acid. Subsequently, the diazotized dapsone is coupled with amoxicillin in an alkaline medium, resulting in a stable orange dye with a maximum wavelength of 440 nm. The developed method was validated according to the ICH guidelines and found to have a concentration range of 1-150 µg/mL, a correlation coefficient of 0.9994, a molar extinction coefficient of 0.273 × 10 L/mol.cm, and a detection limit of 0.074 µg/mL. The FIA method was then evaluated using AES, GAPI, and AGREES analytical greenness assessment tools. The FIA method uses dapsone as an eco-friendly reagent, in addition to the FIA method's advantages of reduced sample and reagent usage, reduced waste generation, and cheaper equipment. So, it has been proposed as an excellent eco-friendly method for the determination of AMX in pharmaceutical formulations.
PubMed: 37928107
DOI: 10.1016/j.mex.2023.102437 -
BMC Infectious Diseases Jul 2024Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) that is responsible for deformities and irreversible peripheral nerve damage and has a... (Review)
Review
BACKGROUND
Leprosy is a chronic infectious disease caused by Mycobacterium leprae (M. leprae) that is responsible for deformities and irreversible peripheral nerve damage and has a broad spectrum of clinical and serological manifestations. Leprosy primarily affects the peripheral nerves and rarely presents with central nervous system involvement. Diagnosing leprosy can still be difficult in some cases, especially when the infection involves uncommon clinical manifestations and extracutaneous sites. Delayed diagnosis and treatment of leprosy may lead to irreversible damage and death.
CASE PRESENTATION
We report a case of a 30-year-old female presenting with "repeated high fever with symptoms of headache for 14 days". On the day of admission, physical signs of lost eyebrows and scattered red induration patches all over her body were observed. The patient's diagnosis was based on the clinical characteristics using a combination of metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) and slit-skin smear. After confirming Listeria meningitis and multibacillary leprosy with erythema nodosum leprosum (ENL), a type 2 reaction, she was treated with ampicillin sodium, dapsone, rifampicin, clofazimine, methylprednisolone, and thalidomide. At the 1-year follow-up, the frequency and severity of headaches have significantly decreased and a good clinical response with improved skin lesions was found.
CONCLUSION
This case highlights the importance of considering leprosy, which is a rare and underrecognized disease, in the differential diagnosis of skin rashes with rheumatic manifestations, even in areas where the disease is not endemic, and physicians should be alerted about the possibility of central nervous system infections. In addition, mNGS can be used as a complementary diagnostic tool to traditional diagnostic methods to enhance the diagnostic accuracy of leprosy.
Topics: Humans; Female; Adult; Mycobacterium leprae; High-Throughput Nucleotide Sequencing; Leprosy; Metagenomics; Cerebrospinal Fluid; Leprostatic Agents
PubMed: 38961391
DOI: 10.1186/s12879-024-09473-z -
Research and Reports in Tropical... 2023Dapsone is an antibiotic used in the management of leprosy. Following the worldwide adoption of the dapsone-containing multidrug therapy for treating leprosy, an upsurge...
BACKGROUND
Dapsone is an antibiotic used in the management of leprosy. Following the worldwide adoption of the dapsone-containing multidrug therapy for treating leprosy, an upsurge in the reported frequency of dapsone hypersensitivity syndrome (DHS) has been observed. DHS is associated with a high fatality rate among patients from low-resourced settings and patients with syndrome-associated hepatitis.
CASE PRESENTATION
This is a case of a Ghanaian male who, while being treated for leprosy with the multidrug therapy, developed exfoliative dermatitis and signs of liver damage, 6 weeks after treatment initiation. He was managed for dapsone-related exfoliative dermatitis and infectious causes of liver damage were investigated. However, the patient's condition rapidly deteriorated with a fatal outcome despite discontinuation of dapsone. DHS was only considered as a differential diagnosis postmortem.
CONCLUSION
This case highlights the importance of having a high index of suspicion for DHS in all patients on dapsone and the need for a thorough workup for all leprosy patients who present with exfoliative dermatitis and signs of liver involvement within the latency period of the syndrome, especially in low resource settings. Furthermore, it stresses the need for prompt and appropriate treatment as DHS can quickly become fatal in such settings.
PubMed: 38170098
DOI: 10.2147/RRTM.S434947 -
Indian Journal of Otolaryngology and... Dec 2023Rhinosporidiosis is an endemic condition in India that is difficult to treat when it is disseminated. This condition commonly affects the nasal cavity and nasopharynx...
Rhinosporidiosis is an endemic condition in India that is difficult to treat when it is disseminated. This condition commonly affects the nasal cavity and nasopharynx mucosa, accounting for 75% of the clinical cases. Although rare, rhinosporidiosis can present with only cutaneous involvement without mucosal disease. Symptoms of this condition include complaints of nasal obstruction and episodic nasal bleeding. Diagnosis is achieved through histopathological examination of tissue and demonstration of the sporangium. Rhinosporidiosis tends to recur as it spreads through autoinoculation. Therefore, during endonasal endoscopic excision of the mass, it is essential not to injure the surrounding mucosa. A trial of medical therapy with dapsone is advised, but it is mostly ineffective in cases of disseminated disease. Here, we present a case report of a patient who underwent seven surgeries for the same condition over 12 years but was unable to get rid of the recurrent menace.
PubMed: 37974735
DOI: 10.1007/s12070-023-03964-2