Corneal Melting Two Weeks after Pterygium Excision with Topical Mitomycin C: Successfully Treated with Lamellar Keratoplasty and Amnion Membrane Transplantation

PURPOSE: To report the management of a case of corneal melting two weeks after pterygium excision with intraoperative topical mitomycin C (MMC). METHODS: Case report. RESULTS: A 57-year-old male was referred to our Department for therapy of rapidly progressive corneal melting two weeks after primary pterygium surgery with MMC (0.2 mg/ml) in September 2009. Initial treatment consisted of topical and systemic immunosuppression along with topical antibiotics. Eight days after presentation, the patient underwent successful lamellar keratoplasty and amnion membrane transplantation. Subconjunctival injection of triamcinolone (40 mg/ml) and topical bevacizumab were used to manage the increased fibrovascular activity around the site of the former pterygium. CONCLUSION: Topical use of MMC during pterygium surgery may be related to serious postoperative complications such as progressive inflammatory corneal melting. The etiology may be multifactorial, which is related to MMC-induced inflammation and/or induced apoptosis. A therapeutic option is the described combination of systemic and local anti-inflammatory treatment along with lamellar keratoplasty and amniotic membrane transplantation. Adjunctive therapy may be needed if recurrence occurs

Degradation and forgone removals increase the carbon impact of intact forest loss by 626%

Intact tropical forests, free from substantial anthropogenic influence, store and sequester large amounts of atmospheric carbon but are currently neglected in international climate policy. We show that between 2000 and 2013, direct clearance of intact tropical forest areas accounted for 3.2% of gross carbon emissions from all deforestation across the pantropics. However, full carbon accounting requires the consideration of forgone carbon sequestration, selective logging, edge effects, and defaunation. When these factors were considered, the net carbon impact resulting from intact tropical forest loss between 2000 and 2013 increased by a factor of 6 (626%), from 0.34 (0.37 to 0.21) to 2.12 (2.85 to 1.00) petagrams of carbon (equivalent to approximately 2 years of global land use change emissions). The climate mitigation value of conserving the 549 million ha of tropical forest that remains intact is therefore significant but will soon dwindle if their rate of loss continues to accelerate

English translation and cross-cultural validation of the patient-reported outcome measurement-haemorrhoidal impact and satisfaction score (PROM-HISS)

Funding Information: The authors would like to thank the following persons for their contribution to the translation of the PROM-HISS: Ms Sadé Assmann, Ms Isabel Senden, Mr Robert Colin Parker, and Mrs Tamara Boerma. The first author of this study was funded by a grant from The Netherlands Organisation for Health Research and Development (ZonMw 852002023).Peer reviewe

Lack of Artemisinin Resistance in Plasmodium falciparum in Uganda Based on Parasitological and Molecular Assays

We evaluated markers of artemisinin resistance in Plasmodium falciparum isolated in Kampala in 2014. By standard in vitro assays, all isolates were highly sensitive to dihydroartemisinin (DHA). By the ring-stage survival assay, after a 6-h DHA pulse, parasitemia was undetectable in 40 of 43 cultures at 72 h. Two of 53 isolates had nonsynonymous K13-propeller gene polymorphisms but did not have the mutations associated with resistance in Asia. Thus, we did not see evidence for artemisinin resistance in Uganda

Ocular neuropathic pain in a real-world patient cohort with dry eye disease:A save sight dry eye registry study

Purpose To compare patient demographics, clinical signs, and questionnaire scores in dry eye disease (DED) patients with and without ocular neuropathic pain. Methods A cross-sectional cohort study was performed using the Save Sight Dry Eye Registry (SSDER). Patients were divided into two groups based on a clinician diagnosis of ocular neuropathic pain and Tear Film and Ocular Surface Society Dry Eye Workshop II definitions. Patient demographics, Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) scores, and DED signs were compared along with Patient Health Questionnaire-4 (PHQ-4) scores, average screen time and treatment compliance. Statistical analyses included descriptive statistics, Mann-Whitney U test, Chi-squared test of independence, and Fisher's exact test. P-values were Bonferroni corrected (p*). Results Data from 298 patients with DED symptoms and signs (26 with ocular neuropathic pain) were analysed. There was no statistical difference in patient demographics (p*>0.0063). Patients with ocular neuropathic pain had worse final, domain, and pain-related question scores for the OSDI (p*<0.0031) and OCI (p*<0.0039) and had higher scores for anxiety and depression for the PHQ-4 (p*<0.0083). Patients with ocular neuropathic pain had a lower rate and severity of meibomian gland dysfunction (p*<0.0063).ConclusionReal-world data from the SSDER demonstrated patient demographics and clinical signs poorly differentiated patients with ocular neuropathic pain within a DED cohort. Patients with ocular neuropathic pain reported significantly worse OSDI and OCI scores, indicating greater symptom severity. While this highlighted symptom differences, further research is required to determine whether OSDI and OCI scores can assist in identifying ocular neuropathic pain in DED

Lack of resistance of Plasmodium falciparum to dihydroartemisinin in Uganda based on parasitogolgical and molecular assays

Artemisinin-­‐based combination therapy is now standard treatment for falciparum malaria. However, this regimen is threatened by resistance to artemisinins, manifest as delayed clearance of parasitemia after therapy, in southeast Asia. Artemisinin resistance in southeast Asia is associated with increased parasitemias in culture, compared to those in sensi0ve parasites, 72 hours a=er a 6 hour pulse with 700 nM dihydroartemisinin (DHA), and with propeller domain polymorphisms in the Plasmodium falciparum kelch (K13; PF3D7_1343700) gene Given that artemether/lumefantrine has been adopted as standard therapy for malaria within the last decade in Uganda, we characterized artemisinin sensiBvity in fresh P. falciparum isolates from Kampala using ex vivo ring-­‐stage survival and IC50 assays. We also assessed the K13 gene for polymorphisms

Ocular neuropathic pain in a real-world patient cohort with dry eye disease:A save sight dry eye registry study

Purpose To compare patient demographics, clinical signs, and questionnaire scores in dry eye disease (DED) patients with and without ocular neuropathic pain. Methods A cross-sectional cohort study was performed using the Save Sight Dry Eye Registry (SSDER). Patients were divided into two groups based on a clinician diagnosis of ocular neuropathic pain and Tear Film and Ocular Surface Society Dry Eye Workshop II definitions. Patient demographics, Ocular Surface Disease Index (OSDI) and Ocular Comfort Index (OCI) scores, and DED signs were compared along with Patient Health Questionnaire-4 (PHQ-4) scores, average screen time and treatment compliance. Statistical analyses included descriptive statistics, Mann-Whitney U test, Chi-squared test of independence, and Fisher's exact test. P-values were Bonferroni corrected (p*). Results Data from 298 patients with DED symptoms and signs (26 with ocular neuropathic pain) were analysed. There was no statistical difference in patient demographics (p*>0.0063). Patients with ocular neuropathic pain had worse final, domain, and pain-related question scores for the OSDI (p*<0.0031) and OCI (p*<0.0039) and had higher scores for anxiety and depression for the PHQ-4 (p*<0.0083). Patients with ocular neuropathic pain had a lower rate and severity of meibomian gland dysfunction (p*<0.0063).ConclusionReal-world data from the SSDER demonstrated patient demographics and clinical signs poorly differentiated patients with ocular neuropathic pain within a DED cohort. Patients with ocular neuropathic pain reported significantly worse OSDI and OCI scores, indicating greater symptom severity. While this highlighted symptom differences, further research is required to determine whether OSDI and OCI scores can assist in identifying ocular neuropathic pain in DED

Examining the relation between bilingualism and age of symptom onset in frontotemporal dementia.

Bilingualism is thought to confer advantages in executive functioning, thereby contributing to cognitive reserve and a later age of dementia symptom onset. While the relation between bilingualism and age of onset has been explored in Alzheimer's dementia, there are few studies examining bilingualism as a contributor to cognitive reserve in frontotemporal dementia (FTD). In line with previous findings, we hypothesized that bilinguals with behavioral variant FTD would be older at symptom onset compared to monolinguals, but that no such effect would be found in patients with nonfluent/agrammatic variant primary progressive aphasia (PPA) or semantic variant PPA. Contrary to our hypothesis, we found no significant difference in age at symptom onset between monolingual and bilingual speakers within any of the FTD variants, and there were no notable differences on neuropsychological measures. Overall, our results do not support a protective effect of bilingualism in patients with FTD-spectrum disease in a U.S. based cohort