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Sulfur and calcific keratopathy associated with retinal detachment surgery and vitrectomy.

We report an unusual case of extensive sulfur and calcium deposition in the cornea after retinal detachment surgery, vitrectomy, and use of topical sulfacetamide. There were no signs of anterior segment ischemia and intraocular silicone oil was not used. Light and electron microscopic examination and x-ray energy dispersive analysis are described. A possible mechanism for the pathogenesis of this condition is presented.

Adult↗

Molecular modeling of hapten structure and relevance to broad specificity immunoassay of sulfonamide antibiotics.

Molecular modeling of hapten structure was used to predict and influence, through appropriate synthetic work, the outcome of an immunization program. Examination of the structures of sulfonamide antibiotics led to the development of a hypothesis and the consequent synthesis of a sulfacetamide-protein immunogen aimed at the generation of broad specificity anti-sulfonamide antibodies. The antisera generated, alongside anti-sulfachlorpyradizine antisera generated at the same time, were characterized for cross-reactions against a range of sulfonamide drugs, and were found to exhibit good but not the desired broad specificity. Discussion is presented as to the reasons for the failure of the hypothesis. Further hypotheses are developed and speculation is made as to the future of molecular modeling in immunochemical research.

Animals↗

Inactivation of HIV-1 nucleocapsid protein P7 by pyridinioalkanoyl thioesters. Characterization of reaction products and proposed mechanism of action.

The synthesis and antiviral properties of pyridinioalkanoyl thioester (PATE) compounds that target nucleocapsid p7 protein (NCp7) of the human immunodeficiency virus type 1 (HIV-1) have been described previously (Turpin, J. A., Song, Y., Inman, J. K., Huang, M., Wallqvist, A., Maynard, A., Covell, D. G., Rice, W. G., and Appella, E. (1999) J. Med. Chem. 42, 67-86). In the present study, fluorescence and electrospray ionization-mass spectrometry were employed to determine the mechanism of modification of NCp7 by two lead compounds, N-[2-(5-pyridiniovaleroylthio)benzoyl]sulfacetamide bromide and N-[2-(5-pyridiniovaleroylthio)benzoyl]-4-(4-nitrophenylsulfonyl )anili ne bromide (compounds 45 and 47, respectively). Although both compounds exhibit antiviral activity in cell-based assays, we failed to detect appreciable ejection of zinc from NCp7 under conditions in which previously described NCp7-active disulfides readily eject zinc. However, upon "activation" by Ag(+), compound 45 reacted with NCp7 resulting in the zinc ejection from both zinc fingers. The reaction followed a two-step mechanism in which zinc was ejected from the carboxyl-terminal zinc finger faster than from the amino-terminal zinc finger. Both compounds covalently modified the protein with pyridinioalkanoyl groups. Compound 45 modified cysteines 36 and 49 of the carboxyl-terminal zinc finger. The results obtained herein demonstrate that PATE compounds can be constructed that selectively target only one of the two zinc fingers of NCp7, thus providing an impetus to pursue development of highly selective zinc finger inhibitors.

Amino Acid Sequence↗

Clinical comparison of topical solutions containing trimethoprim in treating ocular surface bacterial infections.

Thirty-nine patients with bacterial ocular surface infections (conjunctivitis, blepharitis or blepharoconjunctivitis) were evaluated after treatment with a topically applied ophthalmic solution containing trimethoprim. A combination of trimethoprim and polymixin B (TP) produced identical clinical and microbiologic responses when compared to a solution containing, in addition to trimethoprim and polymyxin B, sulfacetamide. The sulfa component was not essential to produce desired clinical and microbiologic results.

Administration, Topical↗

Clinicomicrobiological review of Nocardia keratitis.

PURPOSE: To present the clinical profile, laboratory results, and outcome of treatment in 16 patients with Nocardia keratitis. METHODS: A retrospective review of 16 culture-proven cases of Nocardia keratitis was done. Clinical and microbiologic data were analyzed. RESULTS: Nocardia constituted 1.7% of laboratory-confirmed bacterial keratitis and was seen predominantly in male subjects (13 of 16) with a mean age of 39.1 years. Although the predisposing factor was unknown in the majority, a definite history of trauma was present in four (25%) cases. Patchy stromal infiltrates were seen in 12 patients. Wreath pattern of infiltrates (six of 16) and hypopyon (nine of 16) were notable features. Nocardia was detectable in corneal scrapings of 10 patients with Gram stain and all patients with 1% acid-fast preparation (six of six). Nocardia asteroides was the causative agent in all except one (N. caviae). All isolates were sensitive to gentamicin; however, topical 30% sulfacetamide was the preferred drug for treatment. Favorable outcome (healed scar) was achieved in 11. CONCLUSION: Although Nocardia keratitis is a rare condition, a high index of clinical suspicion should be kept in agricultural workers or in patients with trauma who have patchy stromal infiltrates. Sulfonamides are the initial drug of choice, and gentamicin could be an effective alternative. If recognized early, Nocardia keratitis responds to medical treatment with good visual recovery.

Administration, Topical↗

Comparison of three topical antimicrobials for acute bacterial conjunctivitis.

One hundred fifty-eight patients, 21 years of age or less, presenting with culture-positive (Haemophilus influenzae or Streptococcus pneumoniae) conjunctivitis were treated with trimethoprim-polymyxin B (TP), gentamicin sulfate (GS) or sodium sulfacetamide (SS) ophthalmic solution for 10 days. Clinical response at 3 to 6 days after start of therapy was similar for all test agents: 26 of 55 (47%) patients cured, 25 of 55 (45%) improved for TP; 28 of 57 (49%) cured, 26 of 57 (46%) improved for GS; and 19 of 46 (41%) cured, 22 of 46 (48%) improved for SS. Clinical response at 2 to 7 days after completion of therapy was also similar: 46 of 55 (84%) patients cured, 5 of 55 (9%) improved for TP; 50 of 57 (88%) cured, 5 of 57 (9%) improved for GS; and 41 of 46 (89%) cured, 2 of 46 (4%) improved for SS. Bacteriologic response at 2 to 7 days after completion of therapy was similar for all antimicrobials: 44 of 55 (83%) patients for TP; 39 of 57 (68%) for GS; and 33 of 46 (72%) for SS.

Administration, Topical↗

Refractory Demodex folliculitis in five children with acute lymphoblastic leukemia.

We report five children with acute lymphocytic leukemia on maintenance chemotherapy who had Demodex folliculitis. None experienced complete clearing when treated with permethrin 5% cream. Topical metronidazole helped to lessen the eruption in four, but did not provide full clearing. The one child who was treated with sodium sulfacetamide 10%, sulfur 5% formulation had resolution of the eruption. We suggest that treatment of Demodex folliculitis in children with acute lymphocytic leukemia is more difficult than is suggested in the literature. Newer sodium sulfacetamide/sulfur formulations should be considered when treating this condition, particularly in children with acute lymphocytic leukemia.

Administration, Topical↗

Medical treatment of rosacea with emphasis on topical therapies.

Due to the development and release of newer topical formulations, the diagnosis and treatment of rosacea has received renewed attention over the past 3-5 years both in the literature and at medical symposia. Rosacea is a very common facial dermatosis. In the US, rosacea is estimated to affect > 14 million people, predominantly adults with approximately 60% of cases diagnosed before the age of 50. A frustrating aspect of the disease is its inherent chronicity punctuated with periods of exacerbation and relative remission. A variety of subtypes have been identified which correlate with clinical presentation. Although the pathogenesis of rosacea is poorly understood, multiple topical agents are available. The efficacy of topical therapy for rosacea relates primarily to reduction in inflammatory lesions (papules, pustules), decreased intensity of erythema, a reduction in the number and intensity of flares and amelioration of symptoms, which may include stinging, pruritus and burning. The list of main topical agents utilised for the treatment of rosacea include metronidazole, sulfacetamide-sulfur, azelaic acid and topical antibiotics (clindamycin, erythromycin). Depending on the severity at initial presentation, topical therapy may be combined with systemic antibiotic therapy (e.g., oral tetracycline derivative). Newer therapeutic choices primarily involve improved vehicle formulations, which demonstrate favourable skin tolerability and cosmetic elegance.

Administration, Topical↗

Perioral dermatitis: etiology and treatment.

Ninety-five patients with perioral dermatitis were studied from an epidemiological aspect. Consistent clearing of the eruption was obtained with oral tetracycline in combination with a topical sodium sulfacetamide-sulfur-hydro-cortisone lotion. Comparison of the study group of patients to a group of 50 control patients revealed highly significant quantitative differences in the cosmetic preparations used by the two groups. This latter finding would suggest that lubricating and moisturizing products play some part in the etiology of perioral dermatitis.

Administration, Topical↗

Berberine, a potential drug for trachoma.

The clinical serological response to topical treatment of trachoma with Berberine an indigenous drug has been studied in 32 microbiologically confirmed cases. Efficacy of Berberine 0.2% when compared to sulfacetamide 20% was found to be superior in both the clinical course of trachoma and in achieving a fall in the serum antibody titers (P < 0.05) against chlamydia trachomatis in the treated patients.

Berberine↗

Old drug--in a new system--revisited.

Sodium sulfacetamide, penetrating antibacterial, in combination with hydrocortisone and sulfur, has enjoyed twenty years of remarkable safety, with outstanding efficacy and patient acceptance, in the prescription treatment of pustular acne and severe, refractory seborrheic dermatitis. Recently, this combination has been reported to be highly effective concomitant therapy for perioral dermatitis. Almost paradoxically, it achieves these desired goals without the excessive erythema and discomforting irritation associated with retinoic acid and benzoyl peroxide.

Acne Vulgaris↗

The use of sulfur in dermatology.

Sulfur has antifungal, antibacterial, and keratolytic activity. In the past, its use was widespread in dermatological disorders such as acne vulgaris, rosacea, seborrheic dermatitis, dandruff, pityriasis versicolor, scabies, and warts. Adverse events associated with topically applied sulfur are rare and mainly involve mild application site reactions. Sulfur, used alone or in combination with agents such as sodium sulfacetamide or salicylic acid, has demonstrated efficacy in the treatment of many dermatological conditions.

Acne Vulgaris↗

Topical metronidazole combination therapy in the clinical management of rosacea.

Metronidazole was the first topical agent approved by the U.S. Food and Drug Administration for the treatment of rosacea. Several controlled studies have confirmed the efficacy and safety of topical metronidazole 0.75% gel, lotion and cream and 1% cream for rosacea. At present, little data exists regarding the use of combination topical therapy in rosacea management, although anecdotal evidence and preliminary studies suggest at least some additive benefit when topical metronidazole is used in combination with sulfacetamide 10% /sulfur 5%. In this paper, the results of observational experience evaluating topical metronidazole 0.75% gel used in combination with other topical rosacea therapies and/or subantimicrobial dose doxycycline are reported.

Administration, Topical↗

Topical therapies for rosacea.

Therapeutic options for rosacea include topical agents, oral therapies, laser and light treatments, and surgical procedures. Topical therapies play a critical role in the treatment of patients with papulopustular rosacea and erythematotelangiectatic rosacea, and have the ability to effectively minimize certain manifestations of the disease, including papules, pustules, and erythema. The 3 primary agents for the topical treatment of rosacea are metronidazole, azelaic acid, and sodium sulfacetamide-sulfur. Each of these therapies is approved for the treatment of rosacea and has been validated by multiple studies. Additional topical therapies including benzoyl peroxide, clindamycin, retinoids, topical steroids, calcineurin inhibitors, and permethrin are not approved for the treatment of rosacea and play variable roles in the management of this condition.

Administration, Topical↗

Epidermal growth factor receptor (EGFR) inhibitor associated skin eruption.

EGFR Inhibitors are used to treat Non-Small-Cell Lung Cancer (NSCLC) and colorectal cancer (CRC). A common side effect of EGFR Inhibitors is a follicular/pustular skin eruption. We report a case of gefitinib (Iressa) associated skin eruption. The treatment regimen consisted of triamcinolone 0.1% cream twice daily, clindamycin 1% lotion twice daily and sodium sulfacetamide lotion twice daily. The clinical presentation, etiology, and management options of EGFR Inhibitor associated skin eruptions are discussed.

Aged↗

[A new pyrimidine-series preparation in the treatment of experimental chemical eye burns].

The effectiveness of a substance of a group of pyrimidine derivatives LUS-3 has been studied in 87 rabbits (174 eyes) with chemical burns of the cornea of degree III. In parallel series of experiments, its action was compared with one of traditional methods of treatment of eye burns using sodium sulfacetamide in combination with subconjunctival injections of autologous blood with penicillin as well as with a pyrimidine derivative--methyluracil. The assessment of the effectiveness of the preparations was made by the picture of the clinical course as well as by data of histologic investigations. The results obtained have shown a pronounced effectiveness of the preparation LUS-3: it accelerated regenerative processes, prevented development of secondary infection, and, as a result, conditioned formation of low-intensive opacifications of the cornea.

Animals↗

Trimethoprim-polymyxin B ophthalmic solution in treatment of surface ocular bacterial infections.

A safety and efficacy study comparing the clinical and bacteriologic effectiveness of trimethoprim-sulfacetamide-polymyxin B-neomycin-gramicidin in a group of patients with surface ocular bacterial infections was conducted. The results demonstrated TSP to be as effective as the other solution (both clinically and bacteriologically), with fewer adverse experiences. A second study was conducted comparing TSP with trimethoprim-polymyxin B (TP) and found TP to be superior to TSP in effecting bacteriologic cures. Clinical response was similar in both groups, and the low incidence of mild adverse experiences was approximately the same. It appears that the combination of trimethoprim with polymyxin B is safe and highly efficacious, both clinically and microbiologically, for the treatment of surface ocular bacterial infections.

Adolescent↗

Nocardia asteroides keratitis: a case associated with soft contact lens wear.

Ocular nocardiosis is rare. Most cases of nocardial keratitis have resulted from corneal trauma by objects contaminated with the organism. We describe the first case of Nocardia asteroides keratitis associated with an extended wear soft contact lens. We also describe its successful treatment with topical trimethoprim-sulfamethoxazole in combination sulfacetamide.

Adolescent↗