Early Pars Plana Vitrectomy for Treatment of Acute Infective Endophthalmitis

Purpose: To evaluate the efficacy and safety of early pars plana vitrectomy (PPV) for the treatment of acute infective endophthalmitis, and identify prognostic factors for better visual outcome. Design: Retrospective cohort study. Methods: Consecutive patients who underwent early PPV within 72 hours of presentation for the treatment of acute infective bacterial endophthalmitis and presented to a large tertiary referral center in New South Wales, Australia, between January 2009 and December 2013 were included. Changes in best-corrected visual acuity (VA) from baseline to 1 year were examined. Results: A total of 64 patients were included. The inciting events were cataract surgery (53%), intravitreal injection (36%), trabeculectomy (3%), and endogenous (3%). The mean VA improved from 3.1 logMAR (hand motion) at baseline to 1.02 (approximately 20/200) at 1 year, with 42% achieving final VA equal to or better than 0.477 logMAR (20/60) following early PPV. Positive prognostic factors were negative microbial cultures (P < 0.01) and etiology of post-cataract surgery (P < 0.01). In multivariable analyses adjusting for age and prognostic factors, patients with baseline VA of light perception and hand motion achieved greater visual gains than those with counting fingers, with gains of logMAR of -2.68, -2.09, and -0.85, respectively (P < 0.0001). Conclusions: Most patients who undergo early PPV experience substantial VA improvement. Negative microbial cultures and endophthalmitis after cataract surgery were associated with better final visual outcome. Patients with presenting VA of light perception or hand motion achieved higher visual gains than those with counting fingers, suggesting the possibility that early PPV may be beneficial in both groups

Mister Mary Somerville: Husband and Secretary

Mary Somerville’s life as a mathematician and savant in nineteenth-century Great Britain was heavily influenced by her gender; as a woman, her access to the ideas and resources developed and circulated in universities and scientific societies was highly restricted. However, her engagement with learned institutions was by no means nonexistent, and although she was 90 before being elected a full member of any society (Società Geografica Italiana, 1870), Somerville (Figure 1) nevertheless benefited from the resources and social networks cultivated by such institutions from as early as 1812. A key intermediary between Somerville and these societies was her husband, Dr. William Somerville, whose mediation was vital to her access to knowledge and her subsequent career as a scientific author. In this paper we will consider how spousal cooperation enabled the overcoming of gendered barriers to scientific institutions in the nineteenth century

Dancing with death. A historical perspective on coping with covid-19

In this paper, we address the question on how societies coped with pandemic crises, how they tried to control or adapt to the disease, or even managed to overcome the death trap in history. On the basis of historical research, we describe how societies in the western world accommodated to or exited hardship and restrictive measures over the course of the last four centuries. In particular, we are interested in how historically embedded citizens' resources were directed towards living with and to a certain extent accepting the virus. Such an approach of “applied history” to the management of crises and public hazards, we believe, helps address today's pressing question of what adaptive strategies can be adopted to return to a normalized life, including living with socially acceptable medical, hygienic and other pandemic‐related measures

Why Functional Pre-Erythrocytic and Bloodstage Malaria Vaccines Fail: A Meta-Analysis of Fully Protective Immunizations and Novel Immunological Model

Background: Clinically protective malaria vaccines consistently fail to protect adults and children in endemic settings, and at best only partially protect infants. Methodology/Principal Findings: We identify and evaluate 1916 immunization studies between 1965-February 2010, and exclude partially or nonprotective results to find 177 completely protective immunization experiments. Detailed reexamination reveals an unexpectedly mundane basis for selective vaccine failure: live malaria parasites in the skin inhibit vaccine function. We next show published molecular and cellular data support a testable, novel model where parasite-host interactions in the skin induce malaria-specific regulatory T cells, and subvert early antigen-specific immunity to parasite-specific immunotolerance. This ensures infection and tolerance to reinfection. Exposure to Plasmodium-infected mosquito bites therefore systematically triggers immunosuppression of endemic vaccine-elicited responses. The extensive vaccine trial data solidly substantiate this model experimentally. Conclusions/Significance: We conclude skinstage-initiated immunosuppression, unassociated with bloodstage parasites, systematically blocks vaccine function in the field. Our model exposes novel molecular and procedural strategies to significantly and quickly increase protective efficacy in both pipeline and currently ineffective malaria vaccines, and forces fundamental reassessment of central precepts determining vaccine development. This has major implications fo

Failure of malaria vaccination in mice born to immune mothers. II. Induction of specific suppressor cells by maternal IgG.

Female BALB/c mice were vaccinated against blood stage P. yoelii malaria, infected 2 weeks later and after recovery mated to C57B1/6 males. When their offspring were subsequently vaccinated, the effectiveness of vaccination, as assessed by survival after infection, was significantly impaired until 8 weeks of age. Cell and serum transfer experiments indicated that specific maternally derived IgG interferes with protection in two distinct ways: (1) directly by prevention of priming by the vaccine and (2) indirectly by the induction and maintenance of specific suppressor T cells (TS) which act to inhibit the generation of memory T helper cells involved in IgG production, as measured by the response to TNP-P. yoelii. Furthermore, it is shown that the maternal IgG and the TS cells act in synergy to abolish the protective effect of vaccination