CMV retinitis in China and SE Asia: the way forward

AIDS-related CMV retinitis is a common clinical problem in patients with advanced HIV/AIDS in China and Southeast Asia. The disease is causing blindness, and current clinical management, commonly characterized by delayed diagnosis and inadequate treatment, results in poor clinical outcomes: 21% - 36% of eyes with CMV retinitis are already blind at the time the diagnosis is first established by an ophthalmologist. CMV retinitis also identifies a group of patients at extraordinary risk of mortality, and the direct or indirect contribution of extra-ocular CMV disease to AIDS-related morbidity and mortality is currently unmeasured and clinically often overlooked. The obvious way to improve clinical management of CMV retinitis is to screen all patients with CD4 counts < 100 cells/μL with indirect ophthalmoscopy at the time they first present for care, and to provide systemic treatment with oral valganciclovir when active CMV retinitis is detected. Treatment of opportunistic infections is an integral part of HIV management, and, with appropriate training and support, CMV retinitis screening and treatment can be managed by the HIV clinicians, like all other opportunistic infections. Access to ophthalmologist has been problematic for HIV patients in China, and although non-ophthalmologists can perform screening, sophisticated ophthalmological skills are required for the management of retinal detachment and immune recovery uveitis, the major complications of CMV retinitis. CMV retinitis has been clinically ignored, in part, because of the perceived complexity and expense of treatment, and this obstacle can be removed by making valganciclovir affordable and widely available. Valganciclovir is an essential drug for developing successful programs for management of CMV retinitis in China and throughout SE Asia

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Acquired immunodeficiency syndrome and ocular calcification

We report the presence of peculiar nonbanded calcification of the cornea in three patients with acquired immunodeficiency syndrome, discovered on postmortem histological examination of the globes. In one patient, multiple calcium salt precipitates also affected other ocular and orbital structures. Calcium deposits were present in the corneal stroma but spared Bowman's layer, as is usually seen in primary and secondary corneal calcification. The calcified areas were positive to von Kossa, alizarin red, alcian blue, and colloidal iron stains. Electron probe analysis of the three cases showed the presence of calcium and phosphorus in a ratio characteristic for hydroxyapatite. No predisposing factors could be found. The possible role of associated alterations in the mucopolysaccharide content or composition in the calcified areas is unclear

Show me your tail, if you have one! Is inbreeding depression occurring in wildcats (Felis silvestris silvestris) from Italy?

Knowledge of genetic diversity is important to wildlife conservation because genetically depleted populations experience an increased risk of extinction. Mammalian carnivores are characterized by small and fragmented populations and low dispersal, so that genetic erosion can lead to the fixation of deleterious genes relatively quickly, leading to morphological abnormalities. Kinked tails and cowlicks are indicative of inbreeding depression and have been described in two wild cat species so far, the puma (Puma concolor) and the cheetah (Acinonyx jubatus). Here we report the first records of morphological abnormalities in five populations of the European wildcat (Felis silvestris silvestris) in Italy by using (1) camera-trapping and (2) necropsy of road-killed individuals assessed through genetic analysis. We collected 24,055 trap-nights from 251 cameras and recorded 566 wildcat detections, from which we identified 148 wildcats. Among these, 11 individuals had a kinked tail and four displayed brachyuria, whereas three wildcats from Sicily had cowlicks on the thorax. We recovered 28 road-killed wildcats and two of them (from Sicily and Friuli Venezia Giulia) had a kinked tail. Among these, one female with a kinked tail had a male foetus with a kinked tail, which proved that this characteristic was genetically inherited. We are unsure why brachyuria or cowlicks were not detected across all monitored wildcat populations, given we found kinked tails throughout Italy. The frequencies at which we have detected these abnormalities in wildcats are far lower than reports from Florida panthers (Puma concolor). Future research is needed to verify whether these abnormalities are also associated with low genetic diversity or other morphological defects which might lower fitness. We recommend a nationwide effort, using these techniques within a standardized sampling design, to further understand the status of the wildcat in Italy

Show me your tail, if you have one! Is inbreeding depression occurring in wildcats (Felis silvestris silvestris) from Italy?

Knowledge of genetic diversity is important to wildlife conservation because genetically depleted populations experience an increased risk of extinction. Mammalian carnivores are characterized by small and fragmented populations and low dispersal, so that genetic erosion can lead to the fixation of deleterious genes relatively quickly, leading to morphological abnormalities. Kinked tails and cowlicks are indicative of inbreeding depression and have been described in two wild cat species so far, the puma (Puma concolor) and the cheetah (Acinonyx jubatus). Here we report the first records of morphological abnormalities in five populations of the European wildcat (Felis silvestris silvestris) in Italy by using (1) camera-trapping and (2) necropsy of road-killed individuals assessed through genetic analysis. We collected 24,055 trap-nights from 251 cameras and recorded 566 wildcat detections, from which we identified 148 wildcats. Among these, 11 individuals had a kinked tail and four displayed brachyuria, whereas three wildcats from Sicily had cowlicks on the thorax. We recovered 28 road-killed wildcats and two of them (from Sicily and Friuli Venezia Giulia) had a kinked tail. Among these, one female with a kinked tail had a male foetus with a kinked tail, which proved that this characteristic was genetically inherited. We are unsure why brachyuria or cowlicks were not detected across all monitored wildcat populations, given we found kinked tails throughout Italy. The frequencies at which we have detected these abnormalities in wildcats are far lower than reports from Florida panthers (Puma concolor). Future research is needed to verify whether these abnormalities are also associated with low genetic diversity or other morphological defects which might lower fitness. We recommend a nationwide effort, using these techniques within a standardized sampling design, to further understand the status of the wildcat in Ital

Reduced temporal muscle thickness predicts shorter survival in patients undergoing chronic subdural haematoma drainage.

Publication status: PublishedBACKGROUND: Chronic subdural haematoma (CSDH) drainage is a common neurosurgical procedure. CSDHs cause excess mortality, which is exacerbated by frailty. Sarcopenia contributes to frailty - its key component, low muscle mass, can be assessed using cross-sectional imaging. We aimed to examine the prognostic role of temporal muscle thickness (TMT) measured from preoperative computed tomography head scans among patients undergoing surgical CSDH drainage. METHODS: We retrospectively identified all patients who underwent CSDH drainage within 1 year of February 2019. We measured their mean TMT from preoperative computed tomography scans, tested the reliability of these measurements, and evaluated their prognostic value for postoperative survival. RESULTS: One hundred and eighty-eight (122, 65% males) patients (median age 78 years, IQR 70-85 years) were included. Thirty-four (18%) patients died within 2 years, and 51 (27%) died at a median follow-up of 39 months (IQR 34-42 months). Intra- and inter-observer reliability of TMT measurements was good-to-excellent (ICC 0.85-0.97, P < 0.05). TMT decreased with age (Pearson's r = -0.38, P < 0.001). Females had lower TMT than males (P < 0.001). The optimal TMT cut-off values for predicting two-year survival were 4.475 mm for males and 3.125 mm for females. TMT below these cut-offs was associated with shorter survival in both univariate (HR 3.24, 95% CI 1.85-5.67) and multivariate (HR 1.86, 95% CI 1.02-3.36) analyses adjusted for age, ASA grade and bleed size. The effect of TMT on mortality was not mediated by age. CONCLUSIONS: In patients with CSDH, TMT measurements from preoperative imaging were reliable and contained prognostic information supplemental to previously known predictors of poor outcomes