Domestic dog ownership in Iran is a risk factor for human infection with Leishmania infantum.

One explanation proposed for the widespread failure to control zoonotic visceral leishmaniasis by culling infected domestic dogs is that wild canids or humans play significant roles in transmission. The aim of this study was to determine the importance of domestic dogs as the reservoir hosts of visceral leishmaniasis in northwest Iran. A random sample of 3,872 children and 199 dogs in 38 villages was surveyed by the direct agglutination test. Dog ownership details among these households were collected by questionnaire. Parasites isolated from 16 patients and 12 dogs were characterized as Leishmania infantum MON-1. Average seroprevalence in dogs (21.6%) was much higher than in children (7%). Child seropositivity increased significantly with village dog density in absolute terms (P < 0.001) and in relation to dog/human ratios (P = 0.028). Dog ownership within villages also was a significant risk factor for child seropositivity (P = 0.003)

Comparison of Three Different Techniques of Inverted Internal Limiting Membrane Flap in Treatment of Large Idiopathic Full-Thickness Macular Hole.

Purpose: To evaluate and compare three different techniques of inverted internal limiting membrane (ILM) flap in the treatment of large idiopathic full-thickness macular hole. Methods: In a comparative interventional case series, 72 eyes from 72 patients with large (\u3e 400 µm) full-thickness macular hole were randomly enrolled into three different groups: group A - hemicircular ILM peel with temporally hinged inverted flap; group B - circular ILM peel with temporally hinged inverted flap; and group C - circular ILM peel with superior inverted flap. Best-corrected visual acuity (BCVA), anatomical closure rate, and ellipsoid zone (EZ) or external limiting membrane (ELM) defects were evaluated preoperatively, at week 1, and months 1, 3 and 6 after surgery. Results: There were 24 eyes in group A, 23 in group B, and 25 in group C. In all three groups, larger diameter macular hole was associated with worse preoperative visual acuity (r=0.625, P\u3c0.001). Mean BCVA improved significantly in all three groups 6 months after surgery (0.91vs 0.55, p\u3c0.001). 6 months after surgery, mean BCVA improved from 0.91 logMAR to 0.52±0.06 in group A, 0.90 to 0.53±0.06 in group B, and 0.91 to 0.55±0.11 in group C. In group A vs. B vs. C, improvement of BCVA was 0.380±0.04 vs. 0.383±0.04 vs. 0.368±0.11 logMAR, with no statistically significant difference between groups (P=0.660). The rate of successful hole closure was 87.5% vs. 91.3% vs. 100%. Although the closure rate was 100% in Group C (circular ILM peel with superiorly hinged inverted flap), this difference was not statistically significant (P=0.115). Conclusion: ILM peel with an inverted flap is a highly effective procedure for the treatment of large, full-thickness macular hole. Different flap techniques have comparable results, indicating that the technique can be chosen based on surgeon preference

Erratum: Inverted ILM Flap Technique in Optic Disc Pit Maculopathy

This article is an Erratum to "Inverted ILM Flap Technique in Optic Disc Pit Maculopathy" . Please download the PDF or view the article HTML.

Inverted ILM Flap Technique in Optic Disc Pit Maculopathy

Purpose: To present the outcome of optic disc pit maculopathy (ODPM) managed successfullywith an inverted internal limiting membrane (ILM) flap over the optic disc. A narrative review ofODPM pathogenesis and surgical management techniques are also provided. Case Report: This prospective interventional case series included three eyes of three adultpatients (25–39 years old) with unilateral ODPM and a mean duration of unilaterally decreasedvisual acuity of 7.33 ± 2.40 months (4–12 months). The pars plana vitrectomy with posteriorvitreous detachment induction was performed on eyes, followed by an inverted ILM flap insertionover the optic disc and gas tamponade. Patients were followed for 7–16 weeks postoperatively;best-corrected visual acuity (BCVA) improved dramatically in one patient from 2/200 to 20/25.BCVA in other patients improved two and three lines – to 20/50 and 20/30, respectively. Asignificant anatomical improvement was achieved in all three eyes, and no complication wasdetected throughout the follow-up period. Conclusion: Vitrectomy with inverted ILM flap insertion over the optic disc is safe and can yieldfavorable anatomical improvement in patients with ODPM

Photodynamic Therapy in Ocular Oncology

Over the past two decades, we have witnessed the increasing use of photodynamic therapy (PDT) in the field of ocular oncology. Based on a review of the literature and our own experience, we herein review the role of PDT for the management of intraocular tumors. The discussion includes two main topics. First, we discuss the application of PDT for benign tumors, including circumscribed choroidal hemangioma, choroidal osteoma, retinal astrocytoma, retinal capillary hemangioma (retinal hemangioblastoma), and retinal vasoproliferative tumor. Second, we assess the role of PDT for malignant tumors, including choroidal melanoma and choroidal metastasis

Urbach-Wiethe Syndrome and the Ophthalmologist: Review of the Literature and Introduction of the First Instance of Bilateral Uveitis

Patients suffering from Urbach-Wiethe syndrome (UWS), also known as lipoid proteinosis or hyalinosis cutis et mucosae, may have an ophthalmologist involved in the diagnosis and management of their disease. Along with moniliform blepharosis as a pathognomonic feature of the disease, an ophthalmologist may encounter other manifestations of UWS in any part of the eye such as cornea; conjunctiva; sclera; trabecular meshwork; iris/pupil; lens and zonular fibers; retina; nasolacrimal duct. This paper provides a review on the pathogenesis and the diverse ocular manifestations seen in UWS patients. Uncommon complications are discussed in this paper (glaucoma; dry eye and epiphora; complications of lens, retina, cornea; iris/pupil and conjunctiva). Moreover, a 27-year-old male UWS patient is described with bilateral diffuse anterior stromal iris atrophy, diffuse keratic precipitates; posterior subcapsular cataract; 1 + vitreous cell in anterior vitreous examination. This case was thought to be the first instance of bilateral uveitis associated with UWS. Overall, ophthalmologists may encounter diverse ocular complications accompanying this syndrome. They should be familiar with well-established ophthalmologic manifestations leading them to cooperate with other specialists in diagnosis and management of the disease

Improvement of container terminal productivity with knowledge about future transport modes : a theoretical agent-based modelling approach

Despite all the achievements in improving container terminal performance in terms of equipment and container stacking systems (CSS), terminal operators are still facing several challenges. One of these challenges is the lack of information about further transportation modes of the container, which leads to extra movements of the container inside the stacking area. Hence, we aimed to examine factors that affect container handling processes and to evaluate a container terminal’s overall equipment effectiveness. This study used data from a container terminal at the Port of Antwerp, Belgium. An agent-based model was developed based on a block-stacking strategy to investigate two scenarios: (1) having information about further transportation modes and (2) a base scenario. The Overall Equipment Effectiveness Index (OEE) was also adopted to evaluate the container terminal’s effectiveness in both scenarios. Results showed that having information on further transportation mode significantly increased the container outflow, and the OEE index improved compared to the base scenario’s results. Therefore, we recommend an integrated data-sharing system where all the stakeholders can share their information with no fear of losing their market share

Fixation of tibial avulsion fractures of the posterior cruciate ligament using pull through suture and malleolar screw

&lt;font face="Times New Roman"&gt;&lt;strong&gt;&lt;span style="font-size: 16pt"&gt;BACKGROUND:&lt;/span&gt;&lt;/strong&gt;&lt;strong&gt;&lt;span style="font-size: 14pt"&gt; &lt;/span&gt;&lt;/strong&gt;&lt;span style="font-size: 14pt"&gt;Tibial avulsion fractures of the posterior cruciate ligament are not infrequent. However, controversies exist between the fixation of the fragments and their reconstruction in the cases with small bony fragments. This prospective study was undertaken to study the results after fixation of the fragments by the malleolar screw and the pull through suture techniques.&lt;span&gt;&amp;nbsp; &lt;/span&gt;&lt;/span&gt;&lt;/font&gt;&lt;font face="Times New Roman"&gt;&lt;strong&gt;&lt;span style="font-size: 16pt"&gt;METHODS:&lt;/span&gt;&lt;/strong&gt;&lt;strong&gt;&lt;span style="font-size: 14pt"&gt; &lt;/span&gt;&lt;/strong&gt;&lt;span style="font-size: 14pt"&gt;From June 2003 to March 2005, 26 patients with acute isolated posterior cruciate ligament avulsion fracture of the tibial attachment were treated surgically at Qhaem and Emam Reza hospitals at Mashhad University of Medical Sciences. The screw fixation was used in 18 cases with large bony fragments and the suturing method for other cases who had small or comminuted fragments. The patients were followed for an average of 14 months; and according to The International Knee Documentation Committee the results were evaluated.&lt;span&gt;&amp;nbsp; &lt;/span&gt;&lt;/span&gt;&lt;/font&gt;&lt;font face="Times New Roman"&gt;&lt;strong&gt;&lt;span style="font-size: 16pt"&gt;RESULTS:&lt;/span&gt;&lt;/strong&gt;&lt;strong&gt;&lt;span style="font-size: 14pt"&gt; &lt;/span&gt;&lt;/strong&gt;&lt;span style="font-size: 14pt"&gt;&lt;span&gt;&amp;nbsp;&lt;/span&gt;All our patients were men and all the avulsion fractures achieved union at an average of 4.8 months (range, 3-8 months). All the patients had sever posterior instability (&amp;gt;10mm) pre-operatively. However, when the union of the fracture was achieved, no one suffered severe instability. &lt;/span&gt;&lt;/font&gt;&lt;p style="margin: 0in 0in 0pt" class="MsoNormal"&gt;&lt;font face="Times New Roman"&gt;&lt;strong&gt;&lt;span style="font-size: 16pt"&gt;CONCLUSIONS:&lt;/span&gt;&lt;/strong&gt;&lt;span style="font-size: 14pt"&gt; Both of these two techniques (especially screw fixation) had satisfactory results. Although the number of our cases was not high enough, it can be claimed that when the bony fragment is small and the screw fixation increases the risk of fragment breakage, the double bundles pull-through suture technique is an effective alternative choice.&amp;nbsp;&lt;span&gt;&amp;nbsp;&lt;/span&gt;&lt;/span&gt;&lt;/font&gt;&lt;/p&gt

Idiopathic macular telangiectasia type 2: A six-year study with multimodal imaging of a presumed unilateral case

Purpose: To present a rare manifestation of macular telangiectasia type 2 (MacTel type 2) followed up for over six years. Methods: A 61-year-old woman with one year history of blurred vision of her left eye was referred. Results: Whereas the funduscopy, spectral-domain optical coherence tomography (SD-OCT), fluorescein angiography (FA), and fundus autofluorescence (FAF) were normal in the right eye, they revealed noticeable findings typical of MacTel type 2 in the left eye. After over six years follow-up, OCT-angiography (OCTA) showed no remarkable difference between the two eyes, and en face OCT showed subtle abnormal change in the right eye as well as typical pathological changes in the left eye. Conclusion: MacTel type 2 can present unilaterally and remain so for a long time. The role of multimodal imaging in diagnosis and follow-up is of utmost importance. Keywords: Unilateral, Macular telangiectasia type 2, Multimodal imagin

Prognostication of uveal melanoma is simple and highly predictive using The Cancer Genome Atlas (TCGA) classification: A review.

Purpose: The cancer genome atlas (TCGA) is a comprehensive project supported by the National Cancer Institute (NCI) in the United States to explore molecular alterations in cancer, including uveal melanoma (UM). This led to TCGA classification for UM. In this report, we review the American Joint Committee on Cancer (AJCC) classification and TCGA classification for UM from the NCI\u27s Center for Cancer Genomics (NCI CCG) (based on enucleation specimens [n = 80 eyes]) and from Wills Eye Hospital (WEH) (based on fine needle aspiration biopsy [FNAB] specimens [n = 658 eyes]). We then compare accuracy and predictability of AJCC versus (vs.) TCGA. Methods: Review of published reports on AJCC and TCGA classification for UM was performed. Outcomes based on AJCC 7th and 8th editions were assessed. For TCGA, UM was classified based on chromosomes 3 and 8 findings including disomy 3 (D3), monosomy 3 (M3), disomy 8 (D8), 8q gain (8qG), or 8q gain multiple (8qGm) and combined into four classes including Class A (D3/D8), Class B (D3/8qG), Class C (M3/8qG), and Class D (M3/8qGm). Outcomes of metastasis and death were explored and a comparison (AJCC vs. TCGA) was performed. Results: In the NCI CCG study, there were 80 eyes with UM sampled by enucleation (n = 77), resection (n = 2), or orbitotomy (n = 1) and analysis revealed four distinct genetic classes. Metastasis and death outcomes were subsequently evaluated per class in the WEH study. The WEH study reviewed 658 eyes with UM, sampled by FNAB, and found Class A (n = 342, 52%), B (n = 91, 14%), C (n = 118, 18%), and D (n = 107, 16%). Comparison by increasing class (A vs. B vs. C vs. D) revealed older mean patient age (P \u3c 0.001), worse entering visual acuity (P \u3c 0.001), greater distance from the optic disc (P \u3c 0.001), larger tumor diameter (P \u3c 0.001), and greater tumor thickness (P \u3c 0.001). Regarding outcomes, more advanced TCGA class demonstrated increased 5-year risk for metastasis (4% vs. 20% vs. 33% vs. 63%,P \u3c 0.001) with corresponding increasing hazard ratio (HR) (1.0 vs. 4.1, 10.1, 30.0,P= 0.01 for B vs. A andP \u3c 0.001 for C vs. A and D vs. A) as well as increased 5-year estimated risk for death (1% vs. 0% vs. 9% vs. 23%,P \u3c 0.001) with corresponding increasing HR (1 vs. NA vs. 3.1 vs. 13.7,P= 0.11 for C vs. A andP \u3c 0.001 for D vs. A). Comparison of AJCC to TCGA classification revealed TCGA was superior in prediction of metastasis and death from UM. Conclusion: TCGA classification for UM is simple, accurate, and highly predictive of melanoma-related metastasis and death, more so than the AJCC classification