Case report on heavy eye syndrome

In high myopia, acquired esotropia can be present as strabismus fixus convergence also known as Heavy Eye Syndrome (HES). Although exotropia and hypertropia have been reported, patients typically present with diplopia due to increasing esotropia and hypotropia with limitations on abduction and elevation. We reported two cases of HES based on history and clinical examination, which includes anterior and posterior segment examination and squint evaluation. The MRI of both patients showed displacement of lateral rectus inferiorly and nasal shifting of superior rectus. In both the cases forced duction test (FDT) was positive for affected medial rectus (MR) when performed under local anaesthesia. Subsequently, they underwent loop myopexy of superior rectus (SR) with medical rectus (MR) along with MR recession for affected eye. Postoperatively, Case 1 had a residual esotropia of 18 prism dioptre (PD) and case 2 had 40 PD compare to preoperatively 70 and 80 PD respectively, measured with the krimsky test. Axial length lengthening and herniation of sclera between the SR and LR muscles are the two main contributors to HES. To stop additional herniation, the inter-muscular link must be restored. Loop myopexy is an elegant and effective procedure to achieve good cosmetic and functional results for HES

Multidrug resistant pulmonary tuberculosis treatment regimens and patient outcomes: an individual patient data meta-analysis of 9,153 patients.

Treatment of multidrug resistant tuberculosis (MDR-TB) is lengthy, toxic, expensive, and has generally poor outcomes. We undertook an individual patient data meta-analysis to assess the impact on outcomes of the type, number, and duration of drugs used to treat MDR-TB

A keratin biomaterial gel hemostat derived from human hair: evaluation in a rabbit model of lethal liver injury

Effective hemostatic dressings that are compatible with tissues are needed. Keratins are a class of biomaterials that can be derived by extraction of proteins from human hair. We have recently discovered that keratin biomaterials have hemostatic characteristics and hypothesize that a keratin hydrogel having the ability to absorb fluid and bind cells may be an effective hemostat. The goal of this study was to test a keratin hydrogel and evaluate it compared to current hemostats. Thirty-two New Zealand white rabbits received a lethal liver injury. Eight animals each were assigned to negative control, QuickClot(R), HemCon(R) bandage, and keratin treatment groups. Vital stats and other data were recorded during surgery and all surviving animals were sacrificed after 72 h. Histology was conducted on all surviving animals. Twenty-four-hour survival rates were 0%, 62.5%, 62.5%, and 75% for the negative control, QuickClot, HemCon, and keratin groups, respectively. Other outcomes included blood loss, mean arterial pressure, heart rate, shock index, and liver histology. All of the hemostats were statistically better than the negative control group at late operative time points. The keratin group consistently performed as well as, or better than, the commercial hemostats. Histology showed an interesting healing response at the hemostat-liver interface in the keratin group

Cultures of quarantine : race, U.S. empire, and the biomedical discourse of national security, 1893-1960

This dissertation argues that twentieth century United States imperialism relied on a liberal art of government that viewed the management of life itself--across species and borders--as necessary for managing risk in a globalizing world. Analyzing literary and visual representations of quarantine projects undertaken by U.S. authorities outside of the continental U.S. between 1893 and 1960, the dissertation traces the formation of a biosecurity apparatus that worked to differentiate and incorporate diverse types of patients, research subjects, disease vectors, ecosystems, and territories into the sphere of U.S. state regulation. In the process, the biosecurity apparatus constituted disease, hygiene, and sexuality as objects of knowledge and indicators of racial difference that mapped the risks associated with U.S. territorial expansion, market globalization, world wars, and the Cold War. The study analyzes three biosecurity interventions: first, the segregation of Hansen's disease patients following Hawaiian annexation, which demonstrated both the globalization of public health efforts and the association of Asia-Pacific racial groups with disease, disability, and abnormal intimacy; second, the U.S. military quarantine of suspected sex workers in Panamá during World War II, where anxiety over miscegenation and other perceived threats to the nuclear family led to the criminalization of women's public culture; and third, the establishment of quarantine and breeding operations for research monkeys in Puerto Rico and Africa during the antibiotic revolution, which reflected the displacement of both racial discourse and the material practices of quarantine onto nonhuman bodies during the rise of scientific medicine. As biosecurity expanded state authority and racial power, it also opened new subaltern public spheres, health identities, forms of citizenship, nationalisms, and even resistances by nonhuman life forms. The dissertation follows transnational, multiethnic, and multispecies itineraries of "counter-conduct" that oppose biosecurity interventions by stressing the priorities of the nation, the population, civil society, or even biological life itself over the priorities of the imperial state. These discussions offer a prehistory of contemporary biopolitical configurations, in which knowledge of global pandemics, bioterrorism, and new forms of detention have become central to managing risks and envisioning liberation in a supposedly "global" societ

More-Than-Human and Deeply Human Perspectives on COVID-19

This multi-authored contribution explores what the COVID-19 pandemic demands of critical inquiry with a focus on the more-than-human. We show how COVID-19 is a complex series of multispecies encounters shaped by humans, non-human animals, and of course viruses. Central to these encounters is a politics of difference in which certain human lives are protected and helped to flourish while others, both human and animal, are forgotten if not sacrificed. Such difference encompasses practices of racialisation and racism, healthcare austerity, the circulation of capital, border-making, intervention into non-human nature, wildlife trade bans, anthropocentrism, and the exploitation of animal test subjects. The contributions highlight how COVID-19 provides a needed opportunity to unite new materialist and anti-racist, anti-colonial scholarship as well as reimagine more radically sustainable multispecies futures. This requires embracing anti-colonial humility, confronting debts owed to lab animal frontline workers, and rethinking economic systems that helped unleash COVID-19 and ensured it became a disaster

Timing and Predictors of Subspecialty Career Choice Among Internal Medicine Residents: A Retrospective Cohort Study.

BACKGROUND: Internal medicine residents face numerous career options after residency training. Little is known about when residents make their final career choice. OBJECTIVE: We assessed the timing and predictive factors of final career choices among internal medicine residents at graduation, including demographics, pre-residency career preferences, and rotation scheduling. METHODS: We conducted a retrospective study of graduates of an academic internal medicine residency program from 2014 to 2017. Main measures included demographics, rotation schedules, and self-reported career choices for residents at 5 time points: recruitment day, immediately after Match Day, end of postgraduate year 1 (PGY-1), end of PGY-2, and at graduation. RESULTS: Of the 138 residents eligible for the study, 5 were excluded based on participation in a fast-track program for an Accreditation Council for Graduate Medical Education subspecialty fellowship. Among the remaining 133 residents, 48 (36%) pursued general internal medicine fields and 78 (59%) pursued fellowship training. Career choices from recruitment day, Match Day, and PGY-1 were only weakly predictive of the career choice. Many choices demonstrated low concordance throughout training, and general medicine fields (primary care, hospital medicine) were frequently not decided until after PGY-2. Early clinical exposure to subspecialty rotations did not predict final career choice. CONCLUSIONS: Early career choices before and during residency training may have low predictability toward final career choices upon graduation in internal medicine. These choices may continue to have low predictability beyond PGY-2 for many specialties. Early clinical exposure may not predict final career choice for subspecialties

The Carboxyl-terminal PDZ Ligand Motif of Chemokine Receptor CXCR2 Modulates Post-endocytic Sorting and Cellular Chemotaxis*

Adaptor protein interaction with specific peptide motifs found within the intracellular, carboxyl terminus of chemokine receptor CXCR2 has been shown to modulate intracellular trafficking and receptor function. Efficient ligand-induced internalization of this receptor is dependent on the binding of adaptor protein 2 to the specific LLKIL motif found within the carboxyl terminus (1). In this study we show that the carboxyl-terminal type 1 PDZ ligand motif (-STTL) of CXCR2 plays an essential role in both proper intracellular receptor trafficking and efficient cellular chemotaxis. First, we show that CXCR2 is sorted to and degraded in the lysosome upon long-term ligand stimulation. We also show that receptor degradation is not dependent upon receptor ubiquitination, but is instead modulated by the carboxyl-terminal type I PDZ ligand of CXCR2. Deletion of this ligand results in increased degradation, earlier co-localization with the lysosome, and enhanced sorting to the Rab7-positive late endosome. We also show that deletion of this ligand effects neither receptor internalization nor receptor recycling. Furthermore, we demonstrate that deletion of the PDZ ligand motif results in impaired chemotactic response. The data presented here demonstrate that the type I PDZ ligand of CXCR2 acts to both delay lysosomal sorting and facilitate proper chemotactic response