Cryptococcal choroiditis in advanced AIDS with clinicopathologic correlation.

PurposeTo describe a case of disseminated cryptococcal meningitis with multifocal choroiditis and provide optical coherence tomography (OCT) findings correlated with described histopathology in a patient with advanced acquired immunodeficiency syndrome (AIDS).ObservationsThe patient was a 54-year-old man with AIDS who presented with dyspnea and headache followed by acute vision loss. OCT demonstrated a lesion with a small area of fluid that was limited by a more prominent and irregular external limiting membrane with underlying nodular choroidal thickening, mild RPE disorganization, and hyperreflectivity of the overlying photoreceptor layer. Patient was found to have disseminated cryptococcal infection and passed away despite aggressive therapy. Autopsy was performed including bilateral enucleation and a Cryptococcus lesion was confirmed on histopathology.Conclusion and importanceThis case highlights the clinical, imaging, and histopathologic findings of cryptococcal choroiditis and provides a review of the updated treatment recommendations for disseminated infection in a patient with advanced AIDS. Although currently fundoscopy has proven most useful in directing the diagnostic algorithm in choroiditis in the setting of advanced immunosuppression, OCT may provide insight into the spread of Cryptococcus within the eye

Efficacy of an Appointment Specialist in Reducing Loss to Follow Up in a Retina Practice

Introduction: Although a new armamentarium has greatly benefitted patients with retinal disease, novel therapeutic approaches require more frequent clinic visits, which may lead to missed treatments and vision loss. This study characterizes patient-reported reasons for missed visits and assesses the efficacy of calling patients for rescheduling missed visits. Methods: This retrospective cohort study included patients who missed an appointment for an intravitreal injection between January 2018 and February 2020 at the Retina Service of Wills Eye Hospital. Two calls were made to each patient by an appointment specialist to reschedule the visit and record a reason for the missed appointment. Reasons were categorized and the efficacy of each round of phone calls was assessed with stratification by sociodemographic information. Multivariate regression analyses were conducted (SPSS). Results: Patients from 8,794 missed intravitreal injection visits received up to two phone calls. The most common patient-reported reasons for missed visits were: Medical Issues (776, 9%) and Hospitalization (720, 8%). On the first call, 1,000/7,667 (13%) patients were rescheduled and 2,456/5,645 (44%) patients were rescheduled on the second call. In multivariate analyses, oldest age quartile [OR 0.70 (CI 0.6-0.8), p\u3c0.001] and 2nd lowest adjusted-gross income quartile [OR 0.83 (CI 0.7-0.9), p=0.004] were significantly associated with worse rescheduling rates, while sex and race were not significantly associated. Discussion: Comorbid medical conditions pose a challenge to patients and physicians managing retinal disease with frequent, in-clinic treatments. Phone calls may be an effective mechanism for rescheduling missed visits, although alternative strategies may be needed to improve rescheduling rates among certain populations

Designing a Summer Transition Program for Incoming and Current College Students on the Autism Spectrum: A Participatory Approach

Students with Autism Spectrum Disorder (ASD) face unique challenges transitioning from high school to college and receive insufficient support to help them navigate this transition. Through a participatory collaboration with incoming and current autistic college students, we developed, implemented, and evaluated two intensive week-long summer programs to help autistic students transition into and succeed in college. This process included: (1) developing an initial summer transition program curriculum guided by recommendations from autistic college students in our ongoing mentorship program, (2) conducting an initial feasibility assessment of the curriculum [Summer Transition Program 1 (STP1)], (3) revising our initial curriculum, guided by feedback from autistic students, to develop a curriculum manual, and (4) pilot-testing the manualized curriculum through a quasi-experimental pre-test/post-test assessment of a second summer program [Summer Transition Program 2 (STP2)]. In STP2, two autistic college students assumed a leadership role and acted as “mentors” and ten incoming and current autistic college students participated in the program as “mentees.” Results from the STP2 pilot-test suggested benefits of participatory transition programming for fostering self-advocacy and social skills among mentees. Autistic and non-autistic mentors (but not mentees) described practicing advanced forms of self-advocacy, specifically leadership, through their mentorship roles. Autistic and non-autistic mentors also described shared (e.g., empathy) and unique (an intuitive understanding of autism vs. an intuitive understanding of social interaction) skills that they contributed to the program. This research provides preliminary support for the feasibility and utility of a participatory approach in which autistic college students are integral to the development and implementation of programming to help less experienced autistic students develop the self-advocacy skills they will need to succeed in college

A survey of practices for the use of electronic health records to support research recruitment

Electronic health records (EHRs) provide great promise for identifying cohorts and enhancing research recruitment. Such approaches are sorely needed, but there are few descriptions in the literature of prevailing practices to guide their use. A multidisciplinary workgroup was formed to examine current practices in the use of EHRs in recruitment and to propose future directions. The group surveyed consortium members regarding current practices. Over 98% of the Clinical and Translational Science Award Consortium responded to the survey. Brokered and self-service data warehouse access are in early or full operation at 94% and 92% of institutions, respectively, whereas, EHR alerts to providers and to research teams are at 45% and 48%, respectively, and use of patient portals for research is at 20%. However, these percentages increase significantly to 88% and above if planning and exploratory work were considered cumulatively. For most approaches, implementation reflected perceived demand. Regulatory and workflow processes were similarly varied, and many respondents described substantive restrictions arising from logistical constraints and limitations on collaboration and data sharing. Survey results reflect wide variation in implementation and approach, and point to strong need for comparative research and development of best practices to protect patients and facilitate interinstitutional collaboration and multisite research

The Role of Microbial Exopolymers in Determining the Fate of Oil and Chemical Dispersants in the Ocean

The production of extracellular polymeric substances (EPS) by planktonic microbes can influence the fate of oil and chemical dispersants in the ocean through emulsification, degradation, dispersion, aggregation, and/or sedimentation. In turn, microbial community structure and function, including the production and character of EPS, is influenced by the concentration and chemical composition of oil and chemical dispersants. For example, the production of marine oil snow and its sedimentation and flocculent accumulation to the seafloor were observed on an expansive scale after the Deepwater Horizon oil spill in the Northern Gulf of Mexico in 2010, but little is known about the underlying control of these processes. Here, we review what we do know about microbially produced EPS, how oil and chemical dispersant can influence the production rate and chemical and physical properties of EPS, and ultimately the fate of oil in the water column. To improve our response to future oil spills, we need a better understanding of the biological and physiochemical controls of EPS production by microbes under a range of environmental conditions, and in this paper, we provide the key knowledge gaps that need to be filled to do so

Scleral Buckling for Primary Retinal Detachment: Outcomes of Scleral Tunnels versus Scleral Sutures

Purpose: There are primarily two techniques for affixing the scleral buckle (SB) to the sclera in the repair of rhegmatogenous retinal detachment (RRD): scleral tunnels or scleral sutures. Methods: This retrospective study examined all patients with primary RRD who were treated with primary SB or SB combined with vitrectomy from January 1, 2015 through December 31, 2015 across six sites. Two cohorts were examined: SB affixed using scleral sutures versus scleral tunnels. Pre- and postoperative variables were evaluated including visual acuity, anatomic success, and postoperative strabismus. Results: The mean preoperative logMAR VA for the belt loop cohort was 1.05 ± 1.06 (Snellen 20/224) and for the scleral suture cohort was 1.03 ± 1.04 (Snellen 20/214, p = 0.846). The respective mean postoperative logMAR VAs were 0.45 ± 0.55 (Snellen 20/56) and 0.46 ± 0.59 (Snellen 20/58, p = 0.574). The single surgery success rate for the tunnel cohort was 87.3% versus 88.6% for the suture cohort (p = 0.601). Three patients (1.0%) in the scleral tunnel cohort developed postoperative strabismus, but only one patient (0.1%) in the suture cohort (p = 0.04, multivariate p = 0.76). All cases of strabismus occurred in eyes that underwent SB combined with PPV (p = 0.02). There were no differences in vision, anatomic success, or strabismus between scleral tunnels versus scleral sutures in eyes that underwent primary SB. Conclusion: Scleral tunnels and scleral sutures had similar postoperative outcomes. Combined PPV/SB in eyes with scleral tunnels might be a risk for strabismus post retinal detachment surgery

USE OF ATHEROGENIC INDICES AS ASSESSMENT METHODS FOR CLINICAL ATHEROSCLEROTIC DISEASES

Accurate assessment of clinical atherosclerotic diseases is essential to guide effective therapeutic interventions, and atherogenic indices have emerged as valuable methods in this setting. The complexity of these pathologies demands approaches that go beyond the simple measurement of total cholesterol, requiring tools that consider the interaction between different lipoproteins and other risk factors. In this context, the use of atherogenic indices appears as a promising approach, providing a more comprehensive and refined assessment of atherosclerotic conditions. Objective: To comprehensively analyze scientific studies published in the last 10 years that investigated the use of atherogenic indices as methods of evaluating clinical atherosclerotic diseases. The review seeks to consolidate the available evidence by examining the effectiveness of these indices in early identification, risk stratification and monitoring the progress of atherosclerotic diseases. Methodology: The systematic review was conducted following the PRISMA guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify relevant studies published in the last 10 years. The descriptors used were "atherogenic indices", "atherosclerotic diseases", "clinical assessment", "lipoproteins" and "cardiovascular risk factors". Inclusion criteria considered original studies that investigated the use of atherogenic indices in clinical populations, while exclusion criteria involved studies with unrepresentative samples and inadequate atherosclerotic assessment methods. Results: The results of the review highlight the diversity of available atherogenic indices and their usefulness in evaluating different aspects of atherosclerotic diseases, including prediction of cardiovascular events, risk stratification and treatment monitoring. The analysis identified indices that proved to be particularly sensitive and specific in different clinical contexts. Conclusion: In summary, the systematic review highlights the relevance of atherogenic indices as valuable tools in the assessment of clinical atherosclerotic diseases. The diversity of these indices and their ability to provide comprehensive information highlights their importance in clinical practice, contributing to a more refined and personalized approach to the management of these conditions.Accurate assessment of clinical atherosclerotic diseases is essential to guide effective therapeutic interventions, and atherogenic indices have emerged as valuable methods in this setting. The complexity of these pathologies demands approaches that go beyond the simple measurement of total cholesterol, requiring tools that consider the interaction between different lipoproteins and other risk factors. In this context, the use of atherogenic indices appears as a promising approach, providing a more comprehensive and refined assessment of atherosclerotic conditions. Objective: To comprehensively analyze scientific studies published in the last 10 years that investigated the use of atherogenic indices as methods of evaluating clinical atherosclerotic diseases. The review seeks to consolidate the available evidence by examining the effectiveness of these indices in early identification, risk stratification and monitoring the progress of atherosclerotic diseases. Methodology: The systematic review was conducted following the PRISMA guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify relevant studies published in the last 10 years. The descriptors used were "atherogenic indices", "atherosclerotic diseases", "clinical assessment", "lipoproteins" and "cardiovascular risk factors". Inclusion criteria considered original studies that investigated the use of atherogenic indices in clinical populations, while exclusion criteria involved studies with unrepresentative samples and inadequate atherosclerotic assessment methods. Results: The results of the review highlight the diversity of available atherogenic indices and their usefulness in evaluating different aspects of atherosclerotic diseases, including prediction of cardiovascular events, risk stratification and treatment monitoring. The analysis identified indices that proved to be particularly sensitive and specific in different clinical contexts. Conclusion: In summary, the systematic review highlights the relevance of atherogenic indices as valuable tools in the assessment of clinical atherosclerotic diseases. The diversity of these indices and their ability to provide comprehensive information highlights their importance in clinical practice, contributing to a more refined and personalized approach to the management of these conditions

RISK FACTORS FOR OPERATIVE WOUND INFECTION IN PATIENTS UNDERGOING PEDIATRIC CARDIAC SURGERY

  Surgical wound infection is a significant complication in patients undergoing pediatric cardiac surgery, which can compromise the postoperative recovery process and increase morbidity. Several risk factors are associated with this condition, including patient characteristics, type of surgical procedure, hospital environment, and postoperative care practices. Understanding these factors is crucial to developing effective prevention strategies and optimizing clinical outcomes in this vulnerable population. Objective: To analyze and synthesize the available evidence on the risk factors for surgical wound infection in patients undergoing pediatric cardiac surgery. The aim is to identify patterns and gaps in the literature, contributing to a more comprehensive understanding of the elements that influence the occurrence of this specific complication. Methodology: The review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify studies published in the last 10 years, using the descriptors "pediatric heart surgery", "operative wound infection", "risk factors", "children" and "prevention ". Three inclusion criteria were established, considering original studies that addressed risk factors in pediatric cardiac surgery, while three exclusion criteria were applied to filter articles that did not meet the specific objectives of the review. Results: Results revealed a variety of risk factors, including patient age, length of surgery, presence of comorbidities, and infection control practices. The review highlighted the importance of specific preventive strategies for the pediatric population undergoing cardiac procedures. Conclusion: This systematic review provides a comprehensive overview of risk factors for surgical wound infection in pediatric cardiac surgery, emphasizing the need for personalized prevention approaches. The conclusions highlight the importance of targeting preventive interventions, adapting them to the unique characteristics of this population, aiming to improve clinical results and reduce the incidence of postoperative infections.  Surgical wound infection is a significant complication in patients undergoing pediatric cardiac surgery, which can compromise the postoperative recovery process and increase morbidity. Several risk factors are associated with this condition, including patient characteristics, type of surgical procedure, hospital environment, and postoperative care practices. Understanding these factors is crucial to developing effective prevention strategies and optimizing clinical outcomes in this vulnerable population. Objective: To analyze and synthesize the available evidence on the risk factors for surgical wound infection in patients undergoing pediatric cardiac surgery. The aim is to identify patterns and gaps in the literature, contributing to a more comprehensive understanding of the elements that influence the occurrence of this specific complication. Methodology: The review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Scielo and Web of Science databases were consulted to identify studies published in the last 10 years, using the descriptors "pediatric heart surgery", "operative wound infection", "risk factors", "children" and "prevention ". Three inclusion criteria were established, considering original studies that addressed risk factors in pediatric cardiac surgery, while three exclusion criteria were applied to filter articles that did not meet the specific objectives of the review. Results: Results revealed a variety of risk factors, including patient age, length of surgery, presence of comorbidities, and infection control practices. The review highlighted the importance of specific preventive strategies for the pediatric population undergoing cardiac procedures. Conclusion: This systematic review provides a comprehensive overview of risk factors for surgical wound infection in pediatric cardiac surgery, emphasizing the need for personalized prevention approaches. The conclusions highlight the importance of targeting preventive interventions, adapting them to the unique characteristics of this population, aiming to improve clinical results and reduce the incidence of postoperative infections

Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

OBJECTIVES: To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. PARTICPANTS AND METHODS: Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. RESULTS: A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. CONCLUSION: This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely