Good functional recovery following intervention for delayed suprachoroidal haemorrhage post bleb needling: a case report

<p>Abstract</p> <p>Introduction</p> <p>Bleb needling is a recognised procedure in the management of patients with failing trabeculectomies. Suprachoroidal haemorrhage can occur as an unusual complication. We report a pseudophakic man who had early surgical intervention for this complication. This intervention may have contributed to the good recovery of his visual acuity and the minimum changes to his visual fields.</p> <p>Case presentation</p> <p>A 79-year-old pseudophakic man with chronic open angle glaucoma presented with further deterioration of his right visual field despite maximum medical therapy and a previous trabeculectomy. The right visual acuity was 6/9 with an intraocular pressure (IOP) of 16 mmHg. Bleb needling with 5-fluouracil was performed in a standard manner. His postoperative IOP was 6 mmHg. Thirty-six hours later the visual acuity was reduced to hand movements and two large choroidal detachments where observed clinically, which progressed to suprachoroidal haemorrhages. Five days after the initial needling, the patient had complex surgery involving anterior chamber reformation, a bleb compression suture and drainage of the haemorrhagic suprachoroidal detachments. Subsequently, the patient had a right vitrectomy with endolaser following a vitreous haemorrhage. The final visual acuity was 6/9 with an intraocular pressure of 8 mmHg on travoprost and brinzolamide. The final visual field showed little change when compared with the pre-suprachoroidal haemorrhage visual field.</p> <p>Conclusion</p> <p>It is important to consider the possibility of delayed suprachoroidal haemorrhage as a complication in bleb needling, and early surgical intervention may be beneficial.</p

Biopsy frequency and complications among lung cancer patients in the United States

Objective: This study aimed to describe the frequency and distribution of biopsy procedures for patients diagnosed and treated for primary lung cancer. Study design: Retrospective cohort study within an administrative database. Materials & methods: This observational study used data from the IBM MarketScan Results: The total number of lung biopsies performed among eligible subjects was 32,814; an average of 1.7 biopsies per patient. Bronchoscopy and percutaneous approaches accounted for 95% of all procedures. Complication rates by procedure are remarkably similar irrespective of biopsy frequency. Conclusion: Nearly half (46%) of patients in this population experienced multiple biopsies prior to diagnosis. Further, biopsy choice or sequence in patients receiving multiple procedures was unpredictable

Rapid serum tube technology overcomes problems associated with use of anticoagulants

Introduction: Failure to obtain complete blood clotting in serum is a common laboratory problem. Our aim was to determine whether snake prothrombin activators are effective in clotting blood and producing quality serum for analyte measurement in anticoagulated patients. Materials and methods: Whole blood clotting was studied in a total of 64 blood samples (41 controls, 20 Warfarin patients, 3 anticoagulated patients using snake venom prothrombin activator (OsPA)) with plain tubes. Coagulation was analysed using a visual assay, Hyland-Clotek and thromboelastography. Healthy control blood was spiked with a range of anticoagulants to determine the effectiveness of OsPa-induced clotting. A paired analysis of a Dabigatran patient and a control investigated the effectiveness of the OsPA clotting tubes. Biochemical analytes (N = 31) were determined for 7 samples on chemistry and immunoassay analysers and compared with commercial tubes. Results: Snake venom prothrombin activators efficiently coagulated blood and plasma spiked with heparin and commonly used anticoagulants. Clotting was observed in the presence of anticoagulants whereas no clotting was observed in BDRST tubes containing 3 U/mL of heparin. Snake venom prothrombin activator enhanced heparinised blood clotting by shortening substantially the clotting time and improving significantly the strength of the clot. Comparison of 31 analytes from the blood of five healthy and two anticoagulated participants gave very good agreement between the analyte concentrations determined. Conclusions: Our results showed that the snake venom prothrombin activators OsPA and PtPA efficiently coagulated recalcified and fresh bloods with or without added anticoagulants. These procoagulants produced high quality serum for accurate analyte measurement

Costs of Biopsy and Complications in Patients with Lung Cancer

PURPOSE: To describe the distribution of diagnostic procedures, rates of complications, and total cost of biopsies for patients with lung cancer. PATIENTS AND METHODS: Observational study using data from IBM Marketscan(®) Databases for continuously insured adult patients with a primary lung cancer diagnosis and treatment between July 2013 and June 2017. Costs of lung cancer diagnosis covered 6 months prior to index biopsy through treatment. Costs of chest CT scans, biopsy, and post-procedural complications were estimated from total payments. Costs of biopsies incidental to inpatient admissions were estimated by comparable outpatient biopsies. RESULTS: The database included 22,870 patients who had a total of 37,160 biopsies, of which 16,009 (43.1%) were percutaneous, 14,997 (40.4%) bronchoscopic, 4072 (11.0%) surgical and 2082 (5.6%) mediastinoscopic. Multiple biopsies were performed on 41.9% of patients. The most common complications among patients receiving only one type of biopsy were pneumothorax (1304 patients, 8.4%), bleeding (744 patients, 4.8%) and intubation (400 patients, 2.6%). However, most complications did not require interventions that would add to costs. Median total costs were highest for inpatient surgical biopsies ($29,988) and lowest for outpatient percutaneous biopsies ($1028). Repeat biopsies of the same type increased costs by 40-80%. Complications account for 13% of total costs. CONCLUSION: Costs of biopsies to confirm lung cancer diagnosis vary substantially by type of biopsy and setting. Multiple biopsies, inpatient procedures and complications result in higher costs

Understanding the patient journey to diagnosis of lung cancer

OBJECTIVE: This research describes the clinical pathway and characteristics of two cohorts of patients. The first cohort consists of patients with a confirmed diagnosis of lung cancer while the second consists of patients with a solitary pulmonary nodule (SPN) and no evidence of lung cancer. Linked data from an electronic medical record and the Louisiana Tumor Registry were used in this investigation. MATERIALS AND METHODS: REACHnet is one of 9 clinical research networks (CRNs) in PCORnet®, the National Patient-Centered Clinical Research Network and includes electronic health records for over 8 million patients from multiple partner health systems. Data from Ochsner Health System and Tulane Medical Center were linked to Louisiana Tumor Registry (LTR), a statewide population-based cancer registry, for analysis of patient\u27s clinical pathways between July 2013 and 2017. Patient characteristics and health services utilization rates by cancer stage were reported as frequency distributions. The Kaplan-Meier product limit method was used to estimate the time from index date to diagnosis by stage in lung cancer cohort. RESULTS: A total of 30,559 potentially eligible patients were identified and 2929 (9.58%) had primary lung cancer. Of these, 1496 (51.1%) were documented in LTR and their clinical pathway to diagnosis was further studied. Time to diagnosis varied significantly by cancer stage. A total of 24,140 patients with an SPN were identified in REACHnet and 15,978 (66.6%) had documented follow up care for 1 year. 1612 (10%) had no evidence of any work up for their SPN. The remaining 14,366 had some evidence of follow up, primarily office visits and additional chest imaging. CONCLUSION: In both cohorts multiple biopsies were evident in the clinical pathway. Despite clinical workup, 70% of patients in the lung cancer cohort had stage III or IV disease. In the SPN cohort, only 66% were identified as receiving a diagnostic work-up

Genomic Analysis of a Novel Antarctic Bacterium, Cryobacterium sp. SO2 Provides Insights into its Genomic Potential for Production of Antimicrobial Compounds

A novel strain of Cryobacterium designated as SO2, was isolated from the Antarctic. Hence, this study was undertaken to gain further insight into the antimicrobial compounds and secondary metabolites produced by Cryobacterium sp. SO2. It was found that strain SO2 is a Gram-positive that exhibits an irregular rod shape, which formed yellow to orange pigmented colonies on semi-solid media. Strain SO2 grows at temperatures ranging from 4 to 25 ºC. It has a complete genomic size of 4.097 Mb. SO2 has a DNA G+C content of 68.43%, and genomic annotation showed that the genome contained 3,862 CDS, 10 rRNA, 55 tRNA and 1 tm-RNA. Phylogenetic and OrthoANI analysis suggested Cryobacterium sp. strains SO1, N22, TMB1-8, LW097, TMN39-1, C. zongtaii TMN-42, C. arcticum PAMC27867 and C. soli GCJ02 as its closest phylogenetic neighbour. Genome annotation shows that strain SO2 confers β-lactamase class A, cephalosporin-C deacetylases, and 27 drug-resistance or efflux coding genes, and allows resistance to ceftazidime. Functional annotation identifies 28.74% of predicted genes are of unknown functions. Genome mining indicates that there are six putative secondary metabolite gene clusters in strain SO2. They are made up of RRE-containing, terpene, beta-lactone, T3PKS, NAPAA, and 2dos. This finding shows strain SO2 harbours genes that may be involved in the production of compounds with antibacterial and antioxidant activities

A Talaromyces fungal species with strong antimicrobial activity from Deception Island, Antarctica

Deception Island is well-known for harboring highly diverse microbial communities due to its unique volcanic environment in Antarctica. Most studies focused on bacteria, and relatively little was known about the fungal species on this island. The present study was aimed to determine the antimicrobial production and nutrient utilization profiles of a soil fungus from Deception Island, designated as Im33. Our findings showed that the strain had maximum mycelial growth and sporulation on malt-extract agar (MEA) medium, but it demonstrated the strongest antimicrobial activity in yeast extract-malt extract broth (YMB) medium. Phylogenetic analysis of the internal transcribed spacer 1 and 2 regions showed that it is a species belonging to the genus Talaromyces. It was resistant to cycloheximide concentrations up to 1,000 mg/L and exhibited broad-spectrum antimicrobial activity against Gram-positive and Gram-negative test pathogens, as well as being able to utilize a variety of carbon sources. This is the first report of a Talaromyces species from Deception Island. The capability of the strain to produce broad-spectrum antimicrobial compounds and various enzymes indicated that Antarctic fungi, like their bacterial counterparts, have adopted various adaptation strategies to compete and survive in the extreme environment

Exile Vol. XXVII No. 1

ANDY ACKER: Four Lane Breakfast 30 MIKE AUGUSTA: The Store 25-27 J. L. FREEMAN: Bobbie 22 Poem 33 JENNIFER E. GARDNER: Photo 3 Deeds Field 9 Photo 21 Photo 23 Photo 24 LAURA GILBERT: Photo 13 Photo 28 Photo 29 Photo 31 Photo 36 KATE GLAZER: Drawing 14 MICHAEL HEINLIN: Reflections 19 DAVE HOGSHIRE: The Life And Times Of General Worm 29 CHAD HUSSEY: Waiting for Anne Sexton 13 JOHN WHITWORTH KROPF: Friends in the Park 30 DANE LAVIN: Story 4-8 LISA LAWRENCE: Poem 17 The Man With The Red Hat 15 JAMES LUNDY: Bonds 10 Photo 30 Photo 34 Twisted Ulna 11 LISA MEAD: Resistance 9 LISA MINACCI: The Drop 33 A. PENCE: The Minstrels 1 Mussels 33 PENELOPE A. RISEBOROUGH: Poem 2 Regent Street Mannequins 2 RICK RORICK: Photo 18 A. K. SESSIONS Nervious Tension 10 SUZIE SNYDER: Photo 16 L. S. VIOLA: Trash Can JOHN ZARCHEN: In Autumn 20 ANONYMOUS: Untitled Article 32 Sandymount Strand 35 Cover drawing by Kate Glaze

Автоматизация процесса ранжирования ис-полнителей на базе системы электронного документооборота DIRECTUM

Цель работы – автоматизация процессов рассмотрения заявок внешних исполнителей и согласования оценок работ подрядчиков по объектам путем разработки веб-приложения для подачи заявок субподрядчиков, прикладного решения в системе электронного документооборота DIRECTUM. В результате исследования разработано веб-приложение для подачи заявок в среде Microsoft Visual Studio, реализован дополнительный функционал в системе электронного документооборота DIRECTUM и создана интеграция веб-приложения с прикладным решением.The object of study consists of business processes for the review of subcontractor’s application and work estimation. The main goal of the research is to automatize business processes and to develop web application for subcontractors, application solution in EDMS DIRECTUM and their integration