Management of periorbital hyperpigmentation: An overview of nature‐based agents and alternative approaches

Periorbital hyperpigmentation (POH) is a common dermatological condition that presents as dark periorbital area beneath the lower eyelids, and it is commonly found in females belonging to the age group of 16 to 45 years. The data presented in this review include studies conducted on patients with a clinical/histological diagnosis of POH or melasma. Many diverse topical depigmenting agents comprising an array of naturally obtained actives such as arabinoxylans, α‐arbutin, asiaticoside, azelaic acid, beta‐carotene, boswellic acid, caffeine, chrysin, curcumin, cyanidin‐3‐glucoside, d ‐glucoronic acid, dihydrochalcone, dipalmitoyl‐hydroxyprolene, fucoxanthin, genistein, glabridin, b‐glucogallin, hyaluronic acid, lactic acid, lycopene, niacinamide, pycnogenol, retinol, salidroside, and xymenynic acid demonstrated significant benefits in the management of POH. An exhaustive literature search revealed that other techniques such as blepharoplasty, carboxytherapy, calcium hydroxylapatite fillers, tear trough implant, Q‐switched ruby laser, medicated tattoo, fat transfer, micro‐needling, chemical peels, nitrogen plasma skin regeneration, intense pulsed light, and radiofrequency have been evaluated and reported to be beneficial in the treatment of POH. The use of topical depigmenting agents is the most widely reported method in the clinical management of POH. Of these, α‐arbutin, caffeine, cyanidin‐3‐glucoside, and dihydrochalcone are reported to exhibit significant benefits. Combination products containing a blend of actives are reported to be better than single active containing products. This review aims to provide a comprehensive perspective on the role of several topical actives in the modulation of melanin and tyrosinase biosynthesis pathway involved in the complex pathophysiology of POH. It also presents the advantages of combination products and other alternative therapies used in the management of POH.     

Morphological, electrophysiological, and metabolic characteristics of skeletal muscle in people with end-stage renal disease: a critical review

Purpose: Fatigue is one of the most frequent debilitating symptoms reported by people with end-stage renal disease (ESRD) on haemodialysis (HD) therapy. A wide range of underlying abnormalities, including skeletal muscle weakness, have been implicated as causes of this fatigue. Skeletal muscle weakness is well established in this population, and such muscle weakness is amenable to physical therapy treatment. The purpose of this review was to identify morphological, electrophysiological, and metabolic characteristics of skeletal muscles in people with ESRD/HD that may cause skeletal muscle weakness.Method: Electronic databases were searched for relevant literature from inception to March 2010. Inclusion criteria were English language; adult subjects with ESRD/HD; and the use of muscle biopsy, electromyography, and nuclear magnetic spectroscopy ((31)P-NMRS) techniques to evaluate muscle characteristics.Results: In total, 38 studies were included. All studies of morphological characteristics reported type II fibre atrophy. Electrophysiological characteristics included both neuropathic and myopathic skeletal muscle changes. Studies of metabolic characteristics revealed higher cytosolic inorganic phosphate levels and reduced effective muscle mass.Conclusion: The results indicate an array of changes in the morphological, electrophysiological, and metabolic characteristics of skeletal muscle structure in people with ESRD/HD that may lead to muscle weakness.     

Synthesis of substituted 3,4-dihydroquinazolinones via a metal free Leuckart–Wallach type reaction

The 3,4-dihydroquinazolinone (DHQ) moiety is a highly valued scaffold in medicinal chemistry due to the vast number of biologically-active compounds based on this core structure. Current synthetic methods to access these compounds are limited in terms of diversity and flexibility and often require the use of toxic reagents or expensive transition-metal catalysts. Herein, we describe the discovery and development of a novel cascade cyclization/Leuckart–Wallach type strategy to prepare substituted DHQs in a modular and efficient process using readily-available starting materials. Notably, the reaction requires only the addition of formic acid or acetic acid/formic acid and produces H₂O, CO₂ and methanol as the sole reaction byproducts. Overall, the reaction provides an attractive entry point into this important class of compounds and could even be extended to isotopic labelling via the site-selective incorporation of a deuterium atom.

A novel cascade cyclization/Leuckart–Wallach type strategy to prepare biologically important 3,4-dihydroquinazolinones is presented.     

Laparoscopic Correction of Chronic Uterine Inversion

A 24-year-old woman had chronic uterine inversion after failed manual reversion of acute uterine inversion following a full-term vaginal delivery. After 2 failed attempts at manual reversion under general anesthesia, operative laparoscopy was performed. After infiltration of the pubovesicocervical fascia with dilute adrenaline in saline solution and division of the uterovesical fold, the anterior cervix and uterus were incised vertically, the inversion corrected, and the incision closed in 2 layers with 1-0 polyglactin 910 interrupted sutures. Postoperatively, estradiol valerate was administered for 30 days. Repeat endoscopy 4 months later revealed a normal uterine cavity. Adhesions between the anterior uterine wall and the anterior abdominal wall were divided, and chromopertubation revealed bilaterally patent fallopian tubes bilaterally.