Virtual front door for new referrals from a Diabetic Eye Screening Programme in England

Diabetic retinopathy (DR) is a leading cause of visual impairment in the UK [1]. Early detection of DR through national diabetic eye screening programme[s] (DESP) has been shown to preserve vision and reduce the necessity for late treatment [2]. Virtual clinics for follow-up DR patients have been increasingly utilised in recent years following the Covid-19 pandemic. We collected evidence relating to compliance with national guidelines relating to waiting times for routine new diabetic referrals, time frame for follow-ups, mean time-to-treatment, and distribution of subsequent face-to-face and virtual follow-up for a new virtual Diabetic Retinopathy Imaging Clinic (DRIC)

Setting the scene: ePortfolios for students in agriculture/agribusiness disciplines

ePortfolios are a collection of digital evidence demonstrating learning over time, and are a high-impact practice for students that can be curated for specific audiences. In multidisciplinary programs, such as agriculture/agribusiness, students often have nuanced learning journeys and graduate with a range of skills and work-integrated learning (WIL) experiences. It can be difficult for both students and potential employers to recognize the depth and breadth of the students’ individual learning journey, and the skills that they possess. Integrating ePortfolios into an agriculture/agribusiness program has the potential to improve outcomes for student, institution and employer by providing an innovative solution to this tension. It can encourage students to develop technological and reflective skills, as well as highlight their specific WIL experiences, knowledge and understanding. However, while ePortfolios can be a powerful tool, there are challenges to successful implementation. These are addressed via a series of research-driven recommendations

Blood cultures for the diagnosis of multidrug-resistant and extensively drug-resistant tuberculosis among HIV-infected patients from rural South Africa: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The yield of mycobacterial blood cultures for multidrug-resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB) among drug-resistant TB suspects has not been described.</p> <p>Methods</p> <p>We performed a retrospective, cross-sectional analysis to determine the yield of mycobacterial blood cultures for MDR-TB and XDR-TB among patients suspected of drug-resistant TB from rural South Africa. Secondary outcomes included risk factors of <it>Mycobacterium tuberculosis </it>bacteremia and the additive yield of mycobacterial blood cultures compared to sputum culture.</p> <p>Results</p> <p>From 9/1/2006 to 12/31/2008, 130 patients suspected of drug-resistant TB were evaluated with mycobacterial blood culture. Each patient had a single mycobacterial blood culture with 41 (32%) positive for <it>M. tuberculosis</it>, of which 20 (49%) were XDR-TB and 8 (20%) were MDR-TB. One hundred fourteen (88%) patients were known to be HIV-infected. Patients on antiretroviral therapy were significantly less likely to have a positive blood culture for <it>M. tuberculosis </it>(p = 0.002). The diagnosis of MDR or XDR-TB was made by blood culture alone in 12 patients.</p> <p>Conclusions</p> <p>Mycobacterial blood cultures provided an additive yield for diagnosis of drug-resistant TB in patients with HIV from rural South Africa. The use of mycobacterial blood cultures should be considered in all patients suspected of drug-resistant TB in similar settings.</p

Genome evolution in the allotetraploid frog Xenopus laevis

To explore the origins and consequences of tetraploidy in the African clawed frog, we sequenced the Xenopus laevis genome and compared it to the related diploid X. tropicalis genome. We characterize the allotetraploid origin of X. laevis by partitioning its genome into two homoeologous subgenomes, marked by distinct families of ???fossil??? transposable elements. On the basis of the activity of these elements and the age of hundreds of unitary pseudogenes, we estimate that the two diploid progenitor species diverged around 34 million years ago (Ma) and combined to form an allotetraploid around 17-18 Ma. More than 56% of all genes were retained in two homoeologous copies. Protein function, gene expression, and the amount of conserved flanking sequence all correlate with retention rates. The subgenomes have evolved asymmetrically, with one chromosome set more often preserving the ancestral state and the other experiencing more gene loss, deletion, rearrangement, and reduced gene expression.ope

Intensive glucose control and the clinical paradox of transient progression of diabetic retinopathy: Prioritising the relevance of eye screening intervals

The paradoxical early worsening of diabetic retinopathy with optimisation of glycaemic control is well recognised. Patients with type 2 diabetes mellitus with R0M0 grading at eye screening with enhanced glycaemic control and progression of diabetic retinopathy may get missed with just biennial monitoring as per the changes to national diabetes eye screening programme guidelines. However, from the perspective of patients with type 1 diabetes mellitus being offered newer hybrid closed-loop systems for insulin delivery, very recent guidance allows for this recommendation of a 24-month screening interval to be adjusted. There is an override option within the screening software to enable an additional 12-month screen following the initiation of the closed-loop system. More frequent screening during pregnancy when glycaemic control is tightened, was established several years ago. Interestingly, no such guidance is currently available for patients being treated with GLP-1RA for T2DM, or in patients following bariatric surgery despite the well-recognised impact that has been observed. With newer incretin mimetic treatments in the horizon, this warrants a review and needs a re-appraisal

Correction of gummy smile: A report of two cases

Cosmetically acceptable smiles show a gingival display of up to 3 mm. Gingival display of greater than 3 mm results in a gummy smile which is often unsightly for the individual and correction is sought. There are a variety of procedures used for surgical crown lengthening. Here, we describe two such cases requiring two different approaches for surgical crown lengthening

Retinal and vitreous metastases from hepatocholangiocarcinoma.

BACKGROUND To report a case of metastatic hepatocholangiocarcinoma to the vitreous and retina. CASE PRESENTATION A 70-year-old male, who was recently diagnosed with hepatocholangiocarcinoma, was complaining of floaters in his right eye over the past 5 months and was referred to the Liverpool Ocular Oncology Centre. On presentation, his visual acuity in the right eye was 6/24. Fundus exam revealed a whitish, unilateral, full-thickness retinal lesion at the inferotemporal arcade of his right eye, with vitreous infiltration and subretinal fluid. The patient underwent 25G pars plana vitrectomy with biopsy, resection of the lesion and intravitreal bevacizumab injection. Histopathology testing of the surgical specimens confirmed the diagnosis of metastatic carcinoma to the eye. Two months postoperatively his visual acuity had improved to 6/7.5 and there was no sign of active disease in his right eye, while 9 months postoperatively his visual acuity decreased to 6/9.5 due to developing nuclear sclerotic cataract in his right eye. CONCLUSION The current report presents the first case of a hepatocholangiocarcinoma metastasis to the vitreous and retina