Miracle-dz/UniFAR-FTUs huggingface dataset:
The effect of intravitreal ranibizumab on intraoperative bleeding during pars plana vitrectomy for diabetic traction retinal detachment

Traction retinal detachment (TRD) is an important cause of visual impairment in patients with advanced proliferative diabetic retinopathy (PDR). It is treated surgically and involves removal of fibrovascular membranes and release of the vitreoretinal traction during pars plana vitrectomy (PPV), with special care taken to ensure haemostasis and avoid iatrogenic retinal breaks.1 Based on the promising results using bevacizumab before PPV,2–4 we evaluated the effect of another humanised anti-VEGF-A drug, intravitreal ranibizumab (IVR), on reducing intraoperative bleeding during 23-gauge PPV in 19 consecutive patients with macula-involving TRD of up to 3 months duration secondary to PDR and best-corrected visual acuity between 20/60 and 20/800. Patients were not enrolled if they had vitreous haemorrhage preventing detailed visualisation of the entire posterior retinal pole, previous intraocular surgery except for cataract surgery, any clinical condition that would impair the documentation of the ocular fundus, previous thromboembolic events, known clotting disorders or use of anticoagulant medications except aspirin, or significant and uncontrolled diseases that might interfere with study participation. Patients were randomly assigned to administration of either …
Thalidomide and rituximab in Waldenstrom macroglobulinemia.

Thalidomide enhances rituximab-mediated, antibody-dependent, cell-mediated cytotoxicity. We therefore conducted a phase 2 study using thalidomide and rituximab in symptomatic Waldenstrom macroglobulinemia (WM) patients naive to either agent. Intended therapy consisted of daily thalidomide (200 mg for 2 weeks, then 400 mg for 50 weeks) and rituximab (375 mg/m(2) per week) dosed on weeks 2 to 5 and 13 to 16. Twenty-five patients were enrolled, 20 of whom were untreated. Responses were complete response (n = 1), partial response (n = 15), and major response (n = 2), for overall and major response rate of 72% and 64%, respectively, on an intent-to-treat basis. Median serum IgM decreased from 3670 to 1590 mg/dL (P < .001), whereas median hematocrit rose from 33.0% to 37.6% (P = .004) at best response. Median time to progression for responders was 38 months. Peripheral neuropathy to thalidomide was the most common adverse event. Among 11 patients experiencing grade 2 or greater neuropathy, 10 resolved to grade 1 or less at a median of 6.7 months. Thalidomide in combination with rituximab is active and produces long-term responses in WM. Lower doses of thalidomide (ie, <or= 200 mg/day) should be considered given the high frequency of treatment-related neuropathy in this patient population. This trial is registered at www.clinicaltrials. gov as #NCT00142116.
Seventy years of retinopathy of prematurity

We must admire the enormous amount of work and effort that was needed to put together the paper published in this issue of the British Journal of Ophthalmology by van Sorge et al ( see page 937 ). 1 The numbers, tables and statistics might be overwhelming but essentially reiterate the increased risk of retinopathy of prematurity (ROP) among babies with early gestational age and low birth weight. The other interesting and mixed messages are the relative reduction of visual impairment, presumably as a result of a combination of factors, and yet alarmingly the continued danger of not seeing and treating in time a significant number of babies at risk even in a well-organised healthcare system. This study is of particular relevance as it compares recent data with previous surveys carried out within the same Dutch society over a period of more than 30 years.2–6 Epidemiological studies, and diligent data collection and analysis, have played a pivotal role in advances in the understanding and management of ROP. It is said that if we understand the past we can predict the future. Seventy years ago Terry was the first to document retrolental fibroplasia.7 In the following few years the disease was estimated to affect up …
Abnormalities in the myeloid progenitor compartment in Down syndrome fetal liver precede acquisition of GATA1 mutations.

Down syndrome (DS) children have a high frequency of acute megakaryoblastic leukemia (AMKL) in early childhood. At least 2 in utero genetic events are required, although not sufficient, for DS-AMKL: trisomy 21 (T21) and N-terminal-truncating GATA1 mutations. To investigate the role of T21 in DS-AMKL, we compared second trimester hemopoiesis in DS without GATA1 mutations to gestation-matched normal controls. In all DS fetal livers (FLs), but not marrows, megakaryocyte-erythroid progenitor frequency was increased (55.9% +/- 4% vs 17.1% +/- 3%, CD34(+)CD38(+) cells; P < . 001) with common myeloid progenitors (19.6% +/- 2% vs 44.0% +/- 7%) and granulocyte-monocyte (GM) progenitors (15.8% +/- 4% vs 34.5% +/- 9%) commensurately reduced. Clonogenicity of DS-FL versus normal FL CD34(+) cells was markedly increased (78% +/- 7% vs 15% +/- 3%) affecting megakaryocyte-erythroid ( approximately 7-fold higher) and GM and colony-forming unit-granulocyte, erythrocyte macrophage, megakaryocyte (CFU-GEMM) progenitors. Replating efficiency of CFU-GEMM was also markedly increased. These data indicate that T21 itself profoundly disturbs FL hemopoiesis and they provide a testable hypothesis to explain the increased susceptibility to GATA1 mutations in DS-AMKL and DS-associated transient myeloproliferative disorder.
Colonization With Methicillin Resistant and Methicillin Sensitive Staphylococcus aureus Subtypes in Patients With Atopic Dermatitis and Its Relationship With Severity of Eczema

Background: Studies revealed that severity of atopic dermatitis correlates with colonization by S.aureus and the density of bacteria and antibiotic resistance is one of the factors in S.aureus recolonization. Objectives: We aimed to determine the pattern of colonization with different subtypes of S.aureus in patients with atopic dermatitis and its correlation with SCORAD (Scoring Atopic Dermatitis) index. Materials and Methods: We studied 114 sample cultures from normal skin, nose and active lesions of 38 patients with atopic dermatitis to detection of Staphylococcus aureus colonization and MRSA (methicilin resistance Staphylococcus aureus) subtypes with E test. The severity of the disease was identified by the SCORAD criteria. Logistic regression analysis was used for the evaluation of the coexistence between MRSA colonization and SCORAD index in these patients. Results: We studied 114 sample cultures from 38 children (73% boys, 27% girls) with atopic dermatitis. Mean age of the patients was 19 ± 22.7 months. Mean objective SCORAD was 37.8 + 16.4 (range: 15-80). Twelve patients (31.6%) had mild, 18 patients (47.4%) had moderate and 8 patients (21%) had severe SCORAD. Seventeen patients (44%) were colonized by S. aureus in the nose, 14 (36%) on skin lesions, and 8 (21%) on healthy skin. Among all the cultures, MSSA was noted in 26 (22%) and MRSA was noted in 13 (11%). There was a significant relationship between SCORAD index and colonization of nose and active lesions with Staphylococcus aureus (P value = 0.001). We found MRSA only in patients with moderate SCORAD. Conclusions: This study shows lower rate of S. aureus colonization in atopic dermatitis cases but similar rate of MRSA colonization in comparison with previous studies . A higher rate of MRSA colonization was found in patients with moderate SCORAD.
Unilateral vitelliform maculopathy: a comprehensive phenotype study with molecular screening of BEST1 and PRPH2

Aim To describe the clinical features of a case series of patients with unilateral vitelliform maculopathy and the results of screening BEST1 and PRPH2 for disease-causing mutations. Design/Methods This was a retrospective case series study of six patients ascertained over a 2-year period. Ophthalmological examination, fundus photography, autofluorescence imaging, optical coherence tomography and detailed electrophysiological assessment were undertaken. Blood samples were taken for DNA extraction and mutation screening of BEST1 and PRPH2 was performed. Results Six patients (3 men and 3 women) with unilateral vitelliform maculopathy were identified, ranging in age from 30 to 68 years. Vision in the affected eye ranged from 20/10 to 20/100. There was no clinical, retinal imaging or electrophysiological evidence of fellow eye involvement. Direct sequencing of BEST1 and PRPH2 did not reveal any disease-causing variants. Conclusions A case series of patients is reported with an unusual unilateral vitelliform phenotype, often associated with good visual function. The patients do not have the typical characteristics associated with age-related maculopathy or any inherited macular disorders, such as Best vitelliform macular dystrophy. Molecular screening of the candidate genes BEST1 and PRPH2 revealed no mutations.
Desired family size and contraceptive use in Pakistan.

Although KAP surveys indicate desire to limit family size this indication may not have predictive value with regard to use of family planning. The purpose of this article is to assess the correlation between desired and ideal family size and ever-use of any contraceptive method among married women of fertile age in Pakistan; it is based on cross-sectional data from the 1975 Pakistan Fertility Survey (PFS) and Multiple Classification Analysis (MCA) has been used. In the PFS 84% of women gave either of 2 consistent responses; that is they wanted more children because they had not yet reached their desired family size or they did not want more children because they had. Among the latter 24% had used contraceptives at some time and 12% were current users. Only 3% of the former had ever used contraceptives. After controlling for background variables currently married women who had reached their desired family size were 4 times more likely to have used contraceptives than those who wanted more children because their ideal was equal to or greater than their number of living children (20% vs. 5%). This correlation between the measures of desired fertility and ever-use of contraception was not trivial. (Summaries in ENG FRE).
The effect on quality of life of long-term botulinum toxin A injections to maintain ocular alignment in adult patients with strabismus

Background There is considerable evidence to show that strabismus patients report their quality of life (QoL) as lower than normal controls. While the majority of patients with strabismus are treated with surgery there are a number of cases where surgery is not possible and good long-term ocular alignment can be maintained with repeated injections of botulinum toxin. Methods 65 patients who had undergone over 25 injections of botulinum toxin A for long-term control of their deviation were identified and asked to fill in and return the Adult Strabismus questionnaire (AS-20) to assess their QoL. Results 46 questionnaires were available for analysis. The mean AS-20 score in our patients compared favourably with that reported for normal controls and was much higher than that reported for patients with strabismus. Conclusion Long-term injections with botulinum toxin A is a good treatment for maintaining ocular alignment if squint surgery is not indicated and those patients receiving treatment score near the level of normal controls in QoL terms.
The effect of riboflavin–ultraviolet A-induced collagen cross-linking on intraocular pressure measurement: an experimental study

Purpose To investigate the effect of corneal collagen cross-linking (CCL) on tonopen measurements of intraocular pressure (IOP). Methods CCL with 0.1% riboflavin solution and 30 min of ultraviolet A radiation was performed on the right eye of 15 New Zealand albino adult rabbits (1.8–2.4 kg) (15 eyes). The left eye served as control. IOP was measured by a pressure transducer system (true IOP) and by the tonopen hand-held device (corneal applanation tonometer) before treatment, at 1 week, 1 month and 3 months following CCL. Reference pressure in the globe was increased by increments of 10 mm Hg from 10 to 40 mm Hg, using an anterior chamber infusion on a stand with variable height, and tonopen IOP measurements were recorded for each reference pressure in both eyes. Results Before CCL, tonopen readings were similar between the two eyes (p>0.05). Tonopen underestimated the true IOP in all cases. Following CCL treatment, IOP measurements were significantly higher in the treated eye, at all time intervals (0.005<p<0.03). The most significant difference between true and measured IOP was noted at a reference pressure of 20 mm Hg. Conclusions IOP measurements following CCL are overestimated by the tonopen, probably due to increased stiffness of the treated cornea.
Methadone toxicity in children

Background and aim Poisoning and deaths linked to methadone have risen since the beginning of methadone treatment.1 2 Methadone poisoning is common among children.3 The aim of this review was to explore methadone toxicity cases in children. Methods A systematic literature review was conducted to examine current knowledge regarding methadone toxicity in children. Methadone poisoning cases in the world were reviewed, as well as the number of methadone-related deaths. The databases searched were EMBASE, MEDLINE and PubMed. All relevant titles, abstracts and full articles were obtained and read. Results 38-eight studies were identified which included a total of 62 children (3 weeks–13 years; median=2 years). Of the 62 cases, 26 cases were reported in the USA, 12 cases in the UK, six in France, five in China, four in Canada, two in Germany, one in Switzerland, one in Italy, one in Austria, one in Portugal, one in Poland, one in Slovakia and one in Malaysia. Twenty-nine children died due to methadone toxicity. Methadone plasma/serum concentrations were measured in 27 cases (22 died and 5 survived). The methadone plasma/serum concentrations in the 22 children who died range from 60 to 1200 µg/l (median: 385 µg/l). The plasma/serum concentrations of methadone in the five children who survived ranged from 30 to 360 µg/l (median: 100 µg/l). The common signs and symptoms were central nervous system depression 92% (n=57), respiratory depression 58% (n=36) and miosis 50% (n=31). It is not possible to be certain as to how many children were deliberately poisoned and how many cases were accidental. It is likely that most of the 11 infants (<12 months old) were poisoned deliberately. In three cases, the methadone was a contaminant in an antibiotic suspension. Conclusion Methadone is a dangerous drug for children, because ingestion of tiny amounts can lead to death. A common cause of accidental poisoning of children is careless storage. Methadone toxicity is characterised by respiratory depression, central nervous system depression and miosis. There are overlaps between toxic and fatal concentrations. Accidental poisoning with methadone can be reduced by the education of patients, supervision of methadone consumption, dispensing of methadone doses in resistant bottles for children and storage of methadone in safe places.
Penetrating keratoplasty using femtosecond laser-enabled keratoplasty with zig-zag incisions versus a mechanical trephine in patients with keratoconus

Background/aims This paper will compare the visual outcomes of two different penetrating keratoplasty (PKP) techniques in patients with keratoconus. It is a retrospective comparative surgical case series of 116 keratoconus patients (137 eyes) who had PKP at the Cornea Eye Institute, Beverly Hills, California, USA. Methods 56 keratoconus patients (66 eyes) underwent femtosecond laser-enabled keratoplasty (FLEK) with a zig-zag incision configuration. Their visual parameters were compared with those of 60 patients (71 eyes) who had traditional blade mechanical trephination PKP. The range of follow-up was between 3 and 6 months. The main outcome measures included uncorrected visual acuity and best spectacle-corrected visual acuity (BSCVA), manifest refractive spherical equivalent and topographically determined astigmatism. Results BSCVA was significantly better as early as 3 months postoperatively (p=0.001) in the FLEK group. Visual recovery to 20/40 after 3 months was significantly better in the FLEK group (p<0.001). Topographic astigmatism was lower in the FLEK group, but the difference between the two groups reached significance only at 3 months of follow-up (p=0.001). Postoperative complications noted were not different between the two groups. Conclusions Faster visual recovery and better long-term outcomes were observed in keratoconus patients who had FLEK compared with those who had the mechanical PKP procedure with 6 months of postoperative follow-up.
Keratopigmentation: techniques and results

We read with great interest the article on keratopigmentation by Alio et al , and the letter on the subject by Segal et al. 1 ,2 Corneal tattooing under a lamellar pocket was described more than 25 years ago, but the manual technique described by Alio et al seems to be easier, and when using a femtosecond laser, it is even more surgeon-friendly.3 They published very good results that are undoubtedly related to their adequate technique, but also may be related to the nature of the …
Health expectancy in the Netherlands 1983–1990

Health expectancy is a relatively new indicator for population health, taking account of both mortality and morbidity and/or disability. This integral measure, introduced by Sullivan in the 1970s, is based on the simple idea of subtracting the number of years that may be expected to be spent in poor health from life expectancy. This article presents results of calculations from the Netherlands based on 2 approaches: firstly, disability-free life expectancy and, secondly, healthy life expectancy. In the latter, health is based on a health interview question about self-perceived health. Although the life expectancy at birth of females exceeds that of males by rather more than 6 years, this lead is almost entirely cancelled out by the greater number of years which females spend in poor health. The trend study 1983-1990 revealed some indication of a rise in the healthy life percentage of males albeit that this development was only statistically significant for age 45 years. For females the healthy life percentage appears to be declining. This is in concordance with the results of some trend studies from other countries. They give support to the expansion of morbidity. Recent studies, however, suggest a relative compression of morbidity for severe disability. The analysis of health expectancies by socioeconomic class revealed that in the Netherlands an impressive difference of more than 10% between high and low socioeconomic status also exists, which tallies with findings in Great Britain.
Co-occurring Posttraumatic Stress Disorder and Substance Use Disorder: Recommendations for Management and Implementation in the Department of Veterans Affairs

The recently revised Department of Veterans Affairs (VA) and Department of Defense Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder (PTSD) offers guidance to treat co-occurring PTSD and substance use disorder. The release of the guideline occurred at a time of cultural shifts in recognizing and managing substance use disorders and when major changes were made in the VA to address co-occurring PTSD and substance use disorders. The release also coincided with an increasing number of veterans returning from the wars in Afghanistan and Iraq who were coming to the VA for PTSD treatment. A key augmentation in mental health staffing has brought many new clinicians to the VA and has made it more feasible to address the two disorders in a coordinated way. In this article the authors describe the recommendations in the revised 2010 PTSD clinical practice guideline to address co-occurring PTSD and substance use disorder, review the supporting research evidence behind the recommendations, and examine methods of new VA programs to address the two disorders. A description of what is working and where obstacles still exist is provided. The new recommendations have moved the field forward by offering clinical guidance to practitioners who are working with patients with the commonly observed co-occurring PTSD and substance use disorder.
Efficacy and safety of preservative-free latanoprost eyedrops, compared with BAK-preserved latanoprost in patients with ocular hypertension or glaucoma

Aim To compare efficacy (intraocular pressure (IOP) reduction) and safety of preservative-free latanoprost (T2345) to benzalkonium chloride (BAK)-preserved latanoprost (BPL; Xalatan) in ocular hypertension (OHT) or primary open angle glaucoma (POAG) patients. Methods Prospective, international, multicentre, randomised, investigator-masked, parallel–group trial. After a wash-out period, POAG or OHT patients, previously managed by BPL monotherapy, randomly received T2345 or BPL (one drop into the affected eye(s)) once daily from D0 to D84. Change in IOP was measured at 09:00 (±1 h) from D0 to D84 in the worse eye. Results Mean IOP reduction (D0–D84) was −8.6±2.6 mm Hg (−36%) on T2345 and −9.0±2.4 mm Hg (−38%) on BPL, confirming non-inferiority of T2345 to BPL. Non-inferiority of T2345 was observed from D15. The most frequent ocular adverse event, drug intolerance, was reported in 1 (0.5%) patient on T2345 versus 4 (2.1%) patients on BPL. Moderate to severe conjunctival hyperaemia was less frequent on T2345 than on BPL at D42 (20.2% vs 30.6%; p=0.003) and D84 (21.4% vs 29.1%; p=0.02). Upon instillation, the global subjective ocular symptom score was significantly lower on T2345 than BPL on D42 (0.15 vs 0.41; p=0.001) and D84 (0.18 vs 0.46; p=0.001). Conclusions Preservative-free latanoprost has the same efficacy as BPL, with improved local tolerance.
Is aspirin intake associated with early age-related macular degeneration? The Singapore Indian Eye Study

Background/aims To examine the relationship between aspirin intake and early age-related macular degeneration (AMD) among an Asian population. Methods A population based cross sectional study of 3207 ethnic Indians aged 40 years or older residing in Singapore. AMD signs were graded from retinal images following the modified Wisconsin grading system. Information on aspirin intake was obtained from a standardised questionnaire. Results The prevalence of early AMD was 5.6%. Aspirin use was reported by 11.4% of participants. Early AMD signs were present among 10.9% of aspirin users and 4.9% of non-aspirin users (p<0.001). After adjusting for potential confounders, including age, smoking and previous cataract surgery, aspirin use was associated with early AMD (OR 1.50; 95% CI: 1.01 to 2.22). The association weakened and was not significant after additional adjustment for cardiovascular disease (OR 1.38; 95% CI 0.89 to 2.14). In stratified analysis, aspirin use was significantly associated with early AMD in participants with (adjusted OR 2.64, 95% CI 1.31 to 5.36) but not without (OR 0.73; 95% CI 0.36 to 1.51) a history of cardiovascular disease (interaction term, p=0.011). Conclusions Aspirin intake overall was not associated with early AMD in this sample of Asian Indians, but in those with a history of cardiovascular disease the association between aspirin intake and early AMD might warrant further investigation.