bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral diffuse uveal melanocytic proliferation mistaken for nivolumab-induced VKH-like syndrome
Authors: Dallinga Marchien Geesje , Bolhuis Karen , Bins Adriaan , de Hoog Joeri
Published: February 2023

Purpose:

To describe a case of bilateral diffuse melanocytic proliferation (BDUMP) that was mistaken for nivolumab-induced Vogt-Koyanagi-Harada-like syndrome.

Methods:

We present the case of a 58-year-old Caucasian male with metastatic renal clear cell carcinoma for which he was palliatively treated with intravenous nivolumab immunotherapy. Patient developed subacute onset of blurry vision and grey spots in the visual fields of both eyes, macular subretinal fluid, thickening of the RPE and swollen optic nerve heads. Differential diagnosis included nivolumab-induced Vogt-Koyanagi-Harada-disease-like syndrome (nVKH) and patient was initially treated with steroids, which gave no improvement. Investigation showed the development of dark-grey patches in the peripheral retina of both eyes and cataract, which prompted re-evaluation of the diagnosis, deeming BDUMP most likely. The patient was successfully treated with plasmapheresis.

Discussion:

The initial presentation of the case was incorrectly diagnosed as nVKH. Upon repeat studies of the patients’ symptoms and imaging, we concluded we had missed signs of BDUMP.

Conclusion:

The diagnosis BDUMP was missed in the first evaluation. We present this case to discuss the similarities and differences between this disease and nVKH. More importantly, we want to highlight that re-evaluation of the diagnosis upon worsening of a disease was key in this unusual case.
Rate of Endothelial Cell Loss and Graft Survival in Descemet Membrane Endothelial Keratoplasty in Eyes Requiring a Rebubble
Authors: Tapley Jeffrey L. , Hill Jordan R. , Bauer Alex J. , Straiko Megan M. W. , Straiko Michael D. , Terry Mark A.
Published: February 2023

Purpose:

We aimed to compare the rate of 6-month endothelial cell loss (ECL) and 6-month graft survival in eyes that did not require a postoperative rebubble with eyes that did require a postoperative rebubble after Descemet membrane endothelial keratoplasty (DMEK) surgery.

Methods:

A consecutive series of DMEK surgeries performed from September 2013 to March 2020 was retrospectively analyzed. Eyes that did not require a rebubble for graft detachment were compared with eyes with 1 rebubble and eyes with 2 or more rebubbles for 6-month ECL and graft survival. A subanalysis of the rebubble rate for different indications for transplantation was also performed.

Results:

One thousand two hundred ninety-eight eyes were included in this study. The 6-month ECL for eyes with no rebubbles, 1 rebubble, and ≥2 rebubbles was 29.3% ± 16.2% (n = 793), 36.4% ± 18.6% (n = 97, P = 0.001), and 50.1% ± 19.6% (n = 28, P < 0.001), respectively. The 6-month graft survival rate for eyes with no rebubbles, 1 rebubble, and ≥2 rebubbles was 99.5%, 97.8% (P = 0.035), and 81.8% (P < 0.001), respectively. When compared to the rebubble rate for DMEK for Fuchs dystrophy (156/1165 eyes = 13.4%), the rebubble rates were statistically higher for DMEK for failed penetrating keratoplasty (28.5%, P = 0.021) and pseudophakic bullous keratopathy (28.0%, P = 0.036).

Conclusions:

Eyes undergoing any rebubble procedure in the postoperative period after DMEK have an increased risk of endothelial cell loss and graft failure at 6 months postoperative. DMEK in eyes for failed penetrating keratoplasty and failed DMEK had the highest rebubble rate, with the former reaching statistical significance.
Corneal and Whole-Eye Higher Order Aberrations Do Not Correlate With Ocular Residual Astigmatism in Prepresbyopic Refractive Surgery Candidates
Authors: Balparda Kepa , Maya-Naranjo María Isabel , Mesa-Mesa Sara , Herrera-Chalarca Tatiana
Published: February 2023

Purpose:

Ocular residual astigmatism (ORA) is the proportion of manifest astigmatism that is not explained by anterior corneal astigmatism. The role of higher order aberrations (HOAs) in the level of ORA has not been profoundly studied. The purpose of this study was to evaluate the effect of different corneal and whole-eye HOAs on levels of ORA using a multivariate modeling approach.

Methods:

This is a retrospective analytical study including a sample of healthy refractive surgery candidates. One eye of every patient was randomly selected. A total of 294 eyes from an equal number of patients were included. Corneal and whole-eye HOAs were measured with a Pentacam AXL Wave, and subjective manifest refraction was taken. Astigmatism values were converted into power vectors and ORA was calculated. The Spearman rank-order correlation was initially used to explore correlation between HOA and ORA. All variables with a P value under 0.10 were included into a multiple linear regression model to explore this correlation adjusting for confounding variables.

Results:

The mean age was 28.81 ± 5.40 years. Simple bivariate correlation was significant for root mean square (RMS) total, RMS lower order aberrations, RMS HOAs, defocus, and vertical astigmatism. After being included into a multivariate regression model adjusting for confounding variables, the only variable that was significant was RMS total [F(3, 282) = 78.977; P < 0.001; adjusted R2 = 0.451]. For every μm increase in corneal RMS total, ORA increases by 0.135 diopters. About 45% of variability in ORA can be explained by corneal RMS total, corneal J0, and manifest J0. No individual HOA correlated with ORA in the multivariate regression model.

Conclusions:

ORA increases with general corneal irregularity, especially regular astigmatism. Irregular astigmatism expressed by corneal and whole-eye HOAs does not seem to be a significant contributor of ORA in healthy refractive surgery candidates.
Anthropometric Measures and Their Relationship to Steep Cornea in the United States Population
Authors: Valluru Girish , Henick Daniel , Klawe Janek , Liu Bian , Pasquale Louis R. , Ahmad Sumayya
Published: February 2023

Purpose:

The aim of this study was to determine the relationship between anthropometric measures and steep cornea.

Methods:

Participants from the 1999 to 2008 US National Health and Nutrition Examination Survey visual examination were included (20,165 subjects). Cases had a mean dioptric power, averaged across the meridians, ≥ 48.0 diopters (n = 171). Separate multivariable models assessed body mass index, height, and weight in relation to steep cornea. Analyses included both overall and sex-stratified populations.

Results:

A relationship between BMI and steep cornea in the overall population was not detected (P for trend = 0.78). There was a strong inverse relationship between height (adjusted for weight) and steep cornea in the overall population (P for trend <0.0001) and in women (P for trend <0.0001). For every 1-inch increase in height, there was a 16% reduced odds of steep cornea in the overall population (OR, 0.84; 95% CI: 0.77–0.92). A relationship between weight and steep cornea was not detected in the overall population (P for trend = 0.79).

Conclusions:

Greater height was associated with a lower risk of steep cornea.
Etiology-Specific Comparison of the Long-Term Clinical Outcome of Repeat Deep Anterior Lamellar Keratoplasty for Optical Indications
Authors: Yasu-Mimura Ririko , Hirayama Masatoshi , Kasamatsu Hirotsugu , Yamaguchi Takefumi , Shimazaki Jun
Published: February 2023

Purpose:

The aim of this study was to evaluate the etiology-specific clinical outcomes and complications of repeat deep anterior lamellar keratoplasty (DALK) after failed DALK.

Methods:

This retrospective case study included 32 eyes of 27 patients who underwent repeat DALK of 450 cases of DALK performed for optical indications between 1997 and 2013. The patients were divided into 4 etiology-specific subgroups (the corneal dystrophy, ocular surface disease, stromal scar, and others) or those with or without limbal stem cell deficiency (LSCD). The clinical outcomes evaluated were graft survival, best-corrected visual acuity, endothelial cell density, and complications.

Results:

The mean postoperative follow-up duration was 69.6 ± 54.8 months. The 1-, 3-, and 5-year overall graft survival rate were 76.7%, 57.5%, and 38.8% respectively. The graft survival rate was the highest in the corneal dystrophy group (P = 0.0014) and was significantly (P = 0.0010) higher in eyes without LSCD than in eyes with LSCD. There were no significant differences in the graft survival rates between the previous and current DALK groups. The postoperative best-corrected visual acuity of all subjects improved significantly. The postoperative endothelial cell density did not decrease after repeat DALK. There were no significant differences in the incidence of complications between patients with and without LSCD, except the incidence of persistent epithelial defects.

Conclusions:

Repeat DALK had favorable outcomes in all etiology-specific groups, whereas eyes with LSCD required careful assessment of the ocular surface to avoid graft failure due to persistent epithelial defects.
En Bloc Keratolimbal Allograft and Central Penetrating Keratoplasty: A Novel Surgical Technique in Severe Limbal Stem Cell Deficiency
Authors: Karimian Farid , Hassanpour Kiana
Published: February 2023

Purpose:

The purpose of this study was to present a novel surgical technique combining 360-degree keratolimbal allograft (KLAL) and simultaneous central keratoplasty termed en bloc KLAL with the central penetrating keratoplasty (PKP) performed in those cases with total limbal stem cell deficiency (LSCD) and corneal scars.

Methods:

Nine eyes of 9 patients underwent en bloc KLAL and central PKP between 2014 and 2016. All patients had bilateral total LSCD with total corneal opacity due to different etiologies. The exclusion criteria were previous limbal stem cell transplantation and the presence of active and uncontrolled ocular surface inflammation. The same donor globe was used for harvesting 360-degree KLAL and central PKP. The 1-piece integrity of the KLAL and PKP graft was preserved during the described technique. All patients received modified immunosuppressive regimens compatible with the Cincinnati solid organ transplantation protocol.

Results:

The average age of patients was 58.6 ± 18.6 years. The diagnosis was mustard gas keratopathy in 6, herpes simplex keratitis in 1, and severe acid chemical burn in 2 patients. Seven patients were male. An integrated ocular surface without epitheliopathy and a clear cornea was achieved in 8 patients (88.8%) with an average of 6.5 years in follow-up. The average best-corrected visual acuity was 1.89 ± 0.18 (20/1600) preoperatively which improved to 1.02 ± 0.64 (20/200) logMAR in the postoperative period. Endothelial immune rejection episodes were observed in 3 patients. KLAL rejection was not observed in any patient. One patient required repeat PKP due to corneal graft failure.

Conclusions:

En bloc 360-degree KLAL and central PKP could simultaneously be performed in patients with total LSCD and corneal opacification.
Investigating the Link Between Visual Quality and Vision-Related Quality of Life in Patients With Keratoconus
Authors: Schümmer Laura , Kreps Elke O. , Pesudovs Konrad , Berwouts Jesse , Estramil Natalia , Mathysen Danny G. P. , Rozema Jos J.
Published: February 2023

Purpose:

The purpose of the study was to investigate the optical and visual determinants of vision-related quality of life (VR-QoL) in patients with keratoconus.

Methods:

A cross-sectional case–control study was conducted at the Department of Ophthalmology, Antwerp University Hospital, Belgium. Patients previously diagnosed with keratoconus and healthy emmetropic or ametropic volunteers were included. Patients younger than 18 years, with ametropia of more than ±10 D, or with a history of corneal surgery or relevant ocular comorbidity limiting visual acuity were excluded. Assessment included autorefraction, high-contrast visual acuity testing, corneal imaging, intraocular straylight analysis, contrast sensitivity, aberrometry, and the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25). The Rasch-modified visual functioning scale (VFS) and socio-emotional scale were used to quantify VR-QoL. Stepwise linear regression was used to investigate the association between the clinical variables and VR-QoL.

Results:

Seventy-seven patients with keratoconus (77 pairs of eyes) and 77 age-matched and sex-matched controls were included in the study. The scores on the VFS and the SES were significantly lower in patients with keratoconus compared with controls (P < 0.001). Higher-order and lower-order aberrations, high-contrast visual acuity, and contrast sensitivity were poorer in patients with keratoconus (P < 0.001). Bivariate analyses showed that spectacle-corrected high-contrast visual acuity, higher spatial frequency contrast sensitivity, and higher-order aberration metrics were strong predictors of SES (P < 0.001) and of VFS (P < 0.001). Higher-order aberration of the worse eye was the strongest predictor for both SES (b = 0.310, P < 0.001) and VFS (b = 0.638, P < 0.001) on stepwise regression. Contrast sensitivity was not included in the stepwise regression because of insufficient data in the keratoconus group (33/77 patients; 42.9%).

Conclusions:

Both higher and lower aberration showed a strong correlation with VR-QoL, surpassing high-contrast visual acuity. These findings underline the importance of visual quality measures within keratoconus research and clinical care.
Recurrence of Guttae and Endothelial Dysfunction After Successful Descemet Stripping Only in Fuchs Dystrophy
Authors: Kaufman Aaron R. , Bal Sila , Boakye Jeffrey , Jurkunas Ula V.
Published: February 2023

Purpose:

There are limited data about long-term durability of endothelial rejuvenation after Descemet stripping only (DSO). This study reports a case of bilaterally recurrent endothelial dysfunction and guttae formation after initially successful DSO in combination with cataract extraction (DSO-CE).

Methods:

This is a retrospective case report. A 49-year-old man with Fuchs endothelial corneal dystrophy with bilateral visually significant endothelial guttae (predominantly confluent centrally) and concomitant cataract underwent DSO-CE bilaterally. Postoperative course to long-term outcome at 6 years was analyzed.

Results:

Baseline central corneal thickness (CCT) was 568 μm in OD and 582 μm in OS. Preoperatively, both eyes had no countable central endothelial cells but good peripheral endothelial mosaic. In both eyes, the cornea clinically cleared at approximately 1 month postoperatively after DSO-CE. In short-term follow-up (OD postoperative month 6 and OS postoperative month 3), CCT was 556 μm in OD and 561 μm in OS and central endothelial cell density was 1352 cells/mm2 in OD and 880 cells/mm2 in OS. The patient returned to our center in postoperative year 6 OU. At this time, OU had interval formation of guttae within the descemetorhexis, with increased CCT (OD 631 μm and OS 609 μm) and decreased central endothelial cell density (OD 728 cells/mm2 and OS 609 cells/mm2).

Conclusions:

After DSO, progressive endothelial dysfunction with new guttae formation can occur within the descemetorhexis region of repopulated endothelium. Larger analyses with longer follow-up are needed to better characterize long-term outcomes of DSO.
Refractory Keratolimbal Allograft Rejection in Autoimmune Polyglandular Syndrome–Associated Keratopathy Treated With Intravenous Immunoglobulin
Authors: Thakur Shambhawi , Dandar Rachel , Restaino Irene G. , Cheung Albert Y.
Published: February 2023

Purpose:

The aim of this study was to describe the use of intravenous immunoglobulin (IVIG) in the management of a 20-year-old woman with autoimmune polyglandular syndrome–associated keratopathy who developed acute transplant rejection after keratolimbal allograft (KLAL) surgery.

Case:

Nine weeks after KLAL surgery, a 20-year-old woman with autoimmune polyglandular syndrome–related limbal stem cell deficiency presented with graft injection, hemorrhage, and an epithelial rejection line. This was concerning for acute rejection in the setting of triple-agent systemic immunosuppression (albeit nonadherence at times). There was initial reversal of the rejection process with a sub-Tenon's injection of triamcinolone, frequent topical corticosteroids, increase in oral prednisone, and optimization of systemic immunosuppression medications; however, recurrence of the epithelial rejection line and symptoms were noted whenever the prednisone dose was tapered. This was accompanied by ocular surface decompensation (late staining, neovascularization, and persistent epithelial defects). She was found to have weakly positive HLA Class 1 antibodies. The patient was treated with a pulsed corticosteroid infusion and 2 monthly IVIG infusions. This led to resolution of the acute rejection. However, there was a subsequent rejection episode 4 months later after tapering the prednisone. Monthly IVIG for 6 more months led to final resolution with successful prednisone tapering and no further rejection.

Conclusions:

Treatment with prolonged IVIG showed better improvement in a case of acute rejection refractory to traditional treatments, especially in the setting of HLA antibodies. The case demonstrates that close follow-up with a corneal specialist and collaboration with a transplant specialist is important to monitor for postoperative KLAL rejection.
Allogeneic Ocular Surface Stem Cell Transplantation Outcomes With Decreased or No Systemic Immunosuppression in the Elderly
Authors: Cheung Albert Y. , Jeffrey Joseph H. , Govil Amit , Kinosz Elizabeth , Sarnicola Enrica , Denny Matthew R. , Reinisch Cameron B. , Holland Edward J.
Published: February 2023

Purpose:

The aim of this study was to report outcomes after allogeneic ocular surface stem cell transplantation (OSST) for limbal stem cell deficiency in the setting of decreased or no systemic immunosuppression (SI) in the elderly.

Methods:

A retrospective chart review was performed of all eyes that underwent OSST for limbal stem cell deficiency between 2005 and 2020 at CVP Physicians. Inclusion criteria included patients who were (1) at least 70 years at the time of (2) allogeneic OSST. Postoperative SI regimens were assessed. Outcome measures included improvement in visual acuity, ocular surface stability, and adverse effects.

Results:

There were 14 eyes of 14 patients that met the inclusion criteria with mean follow-up of 3.0 (range 0.4–7.0) years. SI was run at a lower level for 6 patients, and 8 patients did not receive any SI. Nine eyes underwent keratolimbal allograft, 1 had a living-related conjunctival limbal allograft, and 4 had combined OSST. Most eyes (85.7%) attained improvement in visual acuity during their follow-up. At the last follow-up, 57.1% maintained a stable ocular surface. Six eyes developed acute rejection or late failure. Minimal adverse events were noted.

Conclusions:

Elderly patients administered less or no SI exhibit overall favorable outcomes after allogeneic OSST. Although not significantly different, surface stability and duration of improved vision was greater with low SI. No SI may be an option that still achieves improved vision in a high proportion for at least part of their follow-up. Decreasing SI after OSST in this population can improve quality of life while minimizing adverse effects.
Microinvasive glaucoma surgeries: critical summary of clinical trial data with and without phacoemulsification
Authors: Aref Ahmad A. , Parker Paul R. , Chen Michael Y.
Published: February 2023

Purpose of review

To critically summarize and examine published data from randomized controlled clinical trials (RCTs) investigating the safety and efficacy of microinvasive glaucoma surgeries (MIGS) with and without cataract surgery versus cataract surgery alone.

Recent findings

Three RCTs with standardized outcomes and rigorous methodology demonstrate superiority of the iStent (Glaukos), CyPass (Alcon), and Hydrus (Alcon) MIGS devices in combination with cataract surgery versus cataract surgery alone. The trials all involved medication washouts at baseline and also after 24 months of follow-up. In each of the trials, a greater proportion of participants randomized to the combined MIGS procedures achieved at least 20% unmedicated intraocular pressure (IOP) lowering compared with cataract surgery alone. With the exception of the CyPass device, which has been voluntarily withdrawn from the market, adverse events associated with MIGS were acceptable and consistent with routine intraocular surgeries. Follow-up studies demonstrate sustained efficacy, greater probabilities of visual field preservation, increased cost-effectiveness, and enhanced quality of life associated with MIGS procedures.

Data related to MIGS platforms for treatment of open-angle glaucoma with or without co-existing cataract supports their continued adoption in clinical practice. Future studies comparing various techniques and devices in a standardized fashion are needed.
Follow-up studies of the classical landmark studies in Glaucoma
Authors: Meier-Gibbons Frances , Töteberg-Harms Marc
Published: February 2023

Purpose of review

It was not until the nineteen nineties that there was scientific evidence for the primary treatment concept of glaucoma, lowering intraocular pressure. The treatment concept of lowering intraocular pressure is now proven by randomized controlled clinical trials (landmark studies). This review provides an overview of the follow-up studies to these landmark studies from the last 18 months.

Recent findings

The 20-year data of the ocular hypertension treatment study showed a 49% incidence of primary open-angle glaucoma. The data of this landmark study was used for developing different machine learning algorithms. Bilateral disease, disc hemorrhages, and higher intraocular pressure (IOP) were risk factors for visual field deterioration in the United Kingdom Glaucoma Treatment Study. The Advanced Glaucoma Intervention Trial and the Collaborative Initial Glaucoma Treatment Study identified demographic factors, comorbidity, and clinical variables associated with visual field damage. Analysis was performed on Chinese subsets from the Laser in Glaucoma and Ocular Hypertension Study (LiGHT). Looking at all the follow-up studies to the tube shunt landmark studies, preoperative IOP, neovascular glaucoma, Ahmed implantation, and younger age were predictors of failure. A follow-up study to the Effectiveness in Angle-Closure Glaucoma in Lens Extraction Study showed that patients were ten times more likely to maintain a drop-free target IOP after lens extraction than after laser iridotomy. A superior location for iridotomy results in significantly more significant angle widening than temporal or nasal locations, as shown by a follow-up study to the Zhongshan Angle Closure Prevention Trial using OCT and gonioscopy.

The number of published follow-up studies to the landmark studies in glaucoma show the ongoing development of clinical questions in management of glaucoma.
Perturbations of the ocular surface microbiome and their effect on host immune function
Authors: Chang Chih-Chiun Jamie , Winn Bryan J.
Published: February 2023

Purpose of review

Current literature describing the ocular surface microbiome and host immunity are reviewed alongside experiments studying perturbations of the microbiome to explore the hypothesis that disruption of a healthy microbiome may predispose the ocular surface to inflammation and infection.

Recent findings

The ocular surface of healthy subjects is colonized by stable, pauci-microbial communities that are tolerant to the host immune response and are dominated by the genera Corynebacterium, Propionibacterium, and Staphylococcus. In animal studies, commensal microbes on the ocular surface interact with toll-like receptors to regulate the immune system through immune cell and inflammatory cytokine production, promoting homeostasis and protecting against infection. Contact lens wear, lens wash solutions, and preserved topical medications can disrupt the native microbiome and alter the relative diversity and composition of microbes on the ocular surface.

The ocular surface microbiome confers protection against pathogenic colonization and immune dysregulation. Disruption of this microbiome by exogenous factors may alter the resistance of the ocular surface to infection. Further study of the relationships between human ocular surface microbiome and the local immune response are needed.
An Update on the Diagnosis and Treatment of Invasive Mold Disease of the Central Nervous System in Children
Authors: Pana Zoi Dorothea , Groll Andreas H. , Lehrnbecher Thomas
Published: February 2023

Epidemiological data of CNS IMD in pediatrics are limited. Aspergillus is the most frequently identified species, followed by other rare molds. Prompt diagnosis is of importance to define the optimal therapeutic management with respect to antifungal agent, dose, and evaluation of surgical intervention. The mortality rate of CNS IMD remains high. In this mini review we summarize the current knowledge on diagnosis and treatment of CNS IMD in pediatrics.
Circulation of Vaccine-derived Rotavirus G1P[8] in a Vulnerable Child Cohort in Rio de Janeiro
Authors: Cunha Denise Cotrim da , Fuller Trevon , Cantelli Carina Pacheco , de Moraes Marcia Terezinha Baroni , Leite José Paulo Gagliardi , Carvalho-Costa Filipe Anibal , Brasil Patricia
Published: February 2023

Background:

The expansion of rotavirus (RV) immunization in several countries reduced the burden of acute diarrheal disease (ADD) and diarrhea-associated mortality. Although community transmission of live attenuated monovalent rotavirus vaccine (G1P[8] RV1) virus has been demonstrated in children and household contacts, fecal shedding of these strains in neonates and infants under six weeks of age has never been demonstrated. The objective of the study was to assess ADD and rotavirus vaccine strain shedding before and after immunization through 24 months of age.

Methods:

This was a prospective cohort study in a low-resource community in which stool samples were collected from neonates from 15 to 45 days of age every 2 weeks, after both doses of G1P[8] RV1, and in subsequent ADD episodes until 2 years of age. RV was detected and genotyped in stool samples by RT-PCR.

Results:

We enrolled 242 participants who were followed for an average of 23 months. The specific prevalence of G1P[8] RV1 virus was 3.3% in neonates and infants less than six weeks of age, 50% after the first dose, and 25.6% after the second dose. Among the 70 participants with ADD, G1P[8] RV1 virus was identified in only one participant (1.4% prevalence).

Conclusions:

In vaccinated children, there were no breakthrough infections with G1P[8] RV1 and ADD was rare supporting high vaccine effectiveness. We observed G1P[8] RV1 virus shedding among neonates and infants before the first vaccine dose, providing evidence of transmission of the vaccine strain from immunized children to those who are not yet vaccinated.
Optimizing the Threshold to Treat Children for Latent Tuberculosis Infection: A North-East England Experience
Authors: Porter George James , Whyte Martin , Walters Elisabetta Ghimenton , Owens Stephen
Published: February 2023

We assessed the impact of the updated guidelines on tuberculin skin test interpretation in the North East of England. Data on 241 children screened for latent tuberculosis infection (LTBI) between January 2011 and July 2018 were analyzed; 12.4% of children screened under the previous guidelines were treated for LTBI, compared to 33.3% under the new ones (P < 0.001).
Household Transmission of SARS-CoV-2 and Long-term Immunity in Children: A Prospective Study in Northern Spain
Authors: García-García Elisa , Calle-Miguel Laura , Pérez-Solís David , Urueña Ignacio Carvajal , Merino Águeda García , Gómez Helena Higelmo , Poladura María Morán , Rodríguez-Pérez Mercedes
Published: February 2023

Background:

The role of children in SARS-CoV-2 transmission and their immune response after infection have been profoundly discussed. Hereby, we analyze both aspects in a Spanish pediatric population.

Methods:

Prospective, multicentre, longitudinal study performed from July 2020 to September 2021 in children up to 14 years old. Venous blood samples were collected every 6 months and serum was analyzed for antibodies against SARS-CoV-2 using a spike (S) and a nucleocapsid (N) protein assays. Household contacts of seropositive children were tested. Household transmission, antibody dynamics, and durability were analyzed.

Results:

Two hundred children were recruited and 28 had SARS-CoV-2 antibodies at the end of the study, resulting in an overall seroprevalence of 16.6% (95% CI: 9.5%–19.6%). Most of children (18/28) were secondary cases. The secondary attack rate (SAR) was lower in households with pediatric index cases than in those with adult index cases (P = 0.023). The median antibody titers in the first positive serology, for the seropositive patients, were 137 BAU/mL (IQR 83.3–427.4) for the S-assay and 132.5 COI (IQR 14.5–170.5) for the N-assay without significant differences between symptomatic and asymptomatic children. The median time between the RT-PCR and the last serology was 7.5 months (IQR 5.2–8.8), and the duration of SARS-CoV-2 antibodies after infection was proven to be at least 18 months. There were no cases of seroreversion.

Conclusions:

(1) Children are not the main drivers of SARS-CoV-2 household transmission. (2) They maintain SARS-CoV-2 antibodies for up to 18 months after infection and the titers are similar between symptomatic and asymptomatic children.
Treatment of Cystic Echinococcosis in Children: A Single Center Experience
Authors: Sheves Asaf , Fuxman Yulia , Gazer Benny , Shmueli Moshe , Van Buren Jacob , Ben-Shimol Shalom , Assi Zaki
Published: February 2023

Background:

Cystic echinococcosis (CE) treatment is complicated, relying on cysts characteristics, host factors and possible treatment adverse events. We assessed childhood CE treatment characteristics.

Methods:

A retrospective cohort study, 2005–2021, which presents our experience with treating children with CE. We compared therapeutic interventions use in association with the location, size and number of cysts. Additionally, we assessed complications rate following those interventions.

Results:

Sixty six children had CE; 97% were Bedouins. Overall, 183 cysts were identified in 74 organs: liver (n = 47, 64%), lungs (n = 23, 31%), brain, para-ovarian, kidney and peritoneum (other-grouped, n = 4, 5%). Mean ± Standard deviation largest cyst size (per patient) was 6.6 ± 3.2 cm. Treatment with albendazole was administered to 94% of CE, while albendazole monotherapy was used in 27% (n = 18, including 4 cases with extra-hepatic cysts). Surgical interventions included drainage/puncture, aspiration, injection and reaspiration (PAIR; n = 20), mainly performed in hepatic-CE (40% vs. 4% in pulmonary-CE, and 0% in other-CE), excision and drainage (n = 34) and complete excision (n = 10), mainly done in other-CE (50% vs. 26% and 4% in pulmonary-CE and hepatic-CE, respectively). Larger cyst size was associated with complete excision compared with albendazole monotherapy. The number of cysts was not associated with the chosen intervention. Fever was recorded following 39% of surgical interventions. Local surgical complications were relatively rare.

Conclusions:

Cysts location and size affected treatment choice among CE patients. Procedures with drainage had relatively higher rate of complications, including recurrence. Albendazole monotherapy may be a viable therapeutic option in selected CE cases.
In vitro Activity of Ceftaroline Against an International Collection of Kingella kingae Isolates Recovered From Carriers and Invasive Infections
Authors: Maher Joshua M. , Mendes Rodrigo E. , Huynh Holly K. , Porsch Eric A. , St. Geme III Joseph W. , Yagupsky Pablo , Bradley John
Published: February 2023

Background:

Improvements in blood culture techniques and molecular-based diagnostics have led to increased recognition of Kingella kingae as an invasive human pathogen causing bacteremia, septic arthritis, osteomyelitis and endocarditis in young children. Serious disease and potentially life-threatening complications of infection due to K. kingae necessitate timely identification and appropriate antimicrobial therapy. Ceftaroline is a fifth-generation broad spectrum cephalosporin that possesses activity against Gram-negative and Gram-positive pathogens similar to third-generation cephalosporins, but also includes methicillin-resistant Staphylococcus aureus. This study reports the in vitro activity of ceftaroline and comparator agents against an international collection of K. kingae isolates.

Methods:

A collection of 308 K. kingae isolates was obtained primarily from children with bacteremia, endocarditis, osteoarticular infections or from asymptomatic pediatric carriers. Isolates were tested for antibiotic susceptibility using Clinical and Laboratory Standard Institute broth microdilution methodology and screened for β-lactamase production using a nitrocefin chromogenic test.

Results:

Ceftaroline inhibited all K. kingae isolates at ≤0.06 mg/L (MIC50/90, 0.015/0.03 mg/L). Ceftaroline MICs were similar to results with ceftriaxone (MIC50/90, 0.015/0.015 mg/L), meropenem (MIC50/90, 0.015/0.015 mg/L) and ampicillin–sulbactam (MIC50/90, 0.06/0.06 mg/L). Ceftaroline MICs were slightly lower than MICs for cefuroxime and amoxicillin/clavulanate (MIC50/90, 0.06/0.12 mg/L). MICs were high for clindamycin (MIC50/90, 2/4 mg/L) and oxacillin (MIC50/90, 4/8 mg/L). Sixteen isolates (5.2%) yielded a positive nitrocefin test indicating production of β-lactamase; ceftaroline demonstrated equivalent MICs against β-lactamase–positive and β-lactamase–negative strains (MIC50/90, 0.015/0.3 mg/L).

Conclusions:

The potent activity of ceftaroline against this large international collection of K. kingae isolates supports further clinical evaluation in children.
Septic Arthritis of the Atlanto-Occipital Joint Caused By S. Intermedius in a 5-Year-Old Girl: A Case Report
Authors: Di Siena Andrea , Passone Eva , Rodofile Federica , Piccinin Giada , Cereser Lorenzo , Merelli Maria , Cogo Paola
Published: February 2023

Septic arthritis of the atlanto-occipital joint caused by Streptococcus intermedius is extremely rare. We present the first case report of this entity in a fully immunocompetent 5-year-old girl. The magnetic resonance imaging and blood tests were consistent with septic arthritis, so she started empirical antibiotic therapy. Septic arthritis should be excluded in children with torticollis, fever and neck pain.
Multisystem Inflammatory Syndrome in American Indian/Alaska Native Children, March 2020–May 2022
Authors: Bornstein Ethan R. , Miller Allison D. , Zambrano Laura D. , Yousaf Anna R. , Apostolou Andria , Weiser Thomas , Campbell Angela P.
Published: February 2023

We describe characteristics, clinical features and outcomes of multisystem inflammatory syndrome in children among American Indian and Alaska Native (AI/AN) persons compared with non-Hispanic white persons. AI/AN patients with multisystem inflammatory syndrome in children were younger, more often obese, and from areas of higher social vulnerability. A greater proportion of AI/AN patients had severe respiratory involvement and shock.
Thirty Years of Experience With Ocular Adnexal T-Cell Lymphoma
Authors: Manta Alexandra I. , Wilson-Pogmore Ario A. , Sullivan Timothy J.
Published: February 2023

Purpose:

To evaluate the disease characteristics and survival of patients with ocular adnexal T-cell lymphoma.

Methods:

A retrospective, observational study of patients with a histopathological diagnosis of T-cell lymphoma of the ocular adnexa seen between 1992 and 2022. Demographic data, clinical presentation, imaging, histology, immunohistochemistry, treatment, and outcomes were reviewed.

Results:

Fifteen patients were included in the study with the mean age at diagnosis of 50 years old (range 7–85). The most common presenting symptoms were ulcerated eyelid skin lesions (40%) followed by eyelid swelling (13.3%), and lacrimal passageways obstruction (13.3%). The anaplastic large cell lymphoma (33%) and primary cutaneous T-cell lymphoma (33%) were the most diagnosed peripheral T-cell lymphoma subtypes, followed by the nasal type natural killer/T-cell lymphoma (27%) and peripheral T-cell lymphoma not otherwise specified (7%). The most prevalent stage of disease progression was stage I and stage IV (Ann Arbor classification) with seven (47%) patients each. Eight (53%) patients succumbed to the disease process of which three (37.5%) deceased in the first six months and six (75%) within the first year of diagnosis. We identified a strong statistical association between stage and disease-related death (p = 0.003).

Conclusions:

Peripheral T-cell lymphoma occurring in the orbit and ocular adnexa is extremely rare. Advanced stage at diagnosis leads to almost certain death from the disease despite aggressive local and systemic treatment. Early diagnosis improves the chances of survival but can be hindered by this condition’s ability to simulate benign inflammatory conditions both clinically and histologically.
Dumbbell-Shaped Congenital Conjunctival Cyst Of The Orbit
Authors: Yazici Bulent , Kiristioglu Omer , Karaman Gulzade
Published: February 2023

Congenital conjunctival cysts often occur in the medial orbit without adjacent bone destruction and have not been previously reported in a dumbbell configuration. A 46-year-old female patient presented with left proptosis and headache. A radiological study revealed a large, cystic, bilobed mass in the orbital-temporal area with an osseous defect in the lateral wall. A histological examination of the excised lesion showed that the cyst wall consisted of non-keratinized stratified epithelium with goblet cells. There was no recurrence during the follow-up. Of the previously reported 54 cases, only 1 had bone erosion due to a recurrent cyst in the frontal bone. Although rare, a primary conjunctival cyst can create a dumbbell-shaped lesion in the lateral orbit and temporal fossa.
Monoclonal Antibodies for the Treatment of Graves Orbitopathy: Precision Medicine?
Authors: Xavier Naiara F. , Lucena Daniela Tavares , Cruz Antonio A.V.
Published: February 2023

Purpose:

To summarize the development, nomenclature, and rationale of the reported use of monoclonal antibodies (Mabs) in Graves Orbitopathy (GO) and to undertake a systematic review of the management of GO with Mabs.

Methods:

The Pubmed and Embase databases and the Federal Brazilian searching site (Periódicos-CAPES) were screened. The authors searched all the keywords “monoclonal antibodies,” “adalimumab,” “belimumab,” “infliximab,” “rituximab,” “teprotumumab,” and “tocilizumab” combined with the terms “Graves Orbitopathy,” “Graves eye disease” and “thyroid eye disease.” All the articles published in English, French, and Spanish from 2000 to May 2022 were screened. Only publications with quantitative data on the activity of orbitopathy, proptosis, or both were included.

Results:

Seventy-six articles of the 954 screened records met the inclusion criteria. Seven Mabs were described for treating GO. The three most reported Mabs were Rituximab, Tocilizumab, and Teprotumumab. Only eight randomized clinical trials compared the effect of these three Mabs and Belimumab with the effect of steroids or placebos. Adalimumab, Infliximab, and K1-70 only appeared in a few case series and case reports. Frequent mild-to-moderate and few major side effects occurred with the three most used Mabs. Relapse rates ranged from 7.4% for Tocilizumab to at least 29.4% for Teprotumumab. No randomized clinical trials compared Mabs head-to-head.

Conclusion:

Considering the lack of head-to-head comparisons between Mabs, the relapse rate, the possibility of severe collateral effects, and the cost of Mabs, it is not clear which Mab is the safest and most useful to treat GO.
Shorter screw lengths in dynamic Dynesys fixation have less screw loosening: From clinical investigation to finite-element analysis
Authors: Hsu Fang-Chi , Chen Chen-Sheng , Yao Yu-Cheng , Lin Hsi-Hsien , Wang Shih-Tien , Chang Ming-Chau , Liu Chien-Lin , Chou Po-Hsin
Published: February 2023

Background:

The dynamic Dynesys Stabilization System preserves lumbar mobility at instrumented levels. This study investigated the effect of screw length on screw loosening (SL) after dynamic Dynesys fixation and screw displacement during lumbar motion, using clinical investigation and finite-element (FE) analysis.

Methods:

Clinical data of 50 patients with degenerative spondylolisthesis treated with decompression and Dynesys fixation in 2011 were analyzed retrospectively. Horizontal sliding displacement and vertical displacement of screw tips at L4 were analyzed postoperatively using displacement-controlled FE analysis at the L4-L5 level with screw lengths 45 (long screw), 36 (median screw), and 27 (short screw), and 6.4 mm in diameter, under flexion, extension, lateral bending, and rotation.

Results:

In 13 patients (13/50, 26%), 40 screws (40/266, 15%) were loose at mean follow-up of 101.3 ± 4.4 months. Radiographic SL at 35, 40, 45, and 50 mm were 7.7%, 10.7%, 12.1%, and 37.5%, respectively, regardless of the fixation level (p = 0.009). FE analysis revealed that the long screw model with corresponding longer lever arm had maximal horizontal sliding displacement under all directions and maximal vertical displacement, except for lateral bending.

Conclusion:

Shorter screws in Dynesys fixation may help avoid dynamic SL. Clinically, 50 mm screws showed the greatest SL and median screw screws demonstrated the least displacement biomechanically.
Self-care Practices of Patients With Heart Failure Using Wearable Electronic Devices
Authors: Patel Harsh A. , Hayden K. Alix , Raffin Bouchal Shelley , King-Shier Kathryn
Published: February 2023

Background

Heart failure (HF) is the fastest growing cardiovascular condition globally; associated management costs and hospitalizations place an immense burden on healthcare systems. Wearable electronic devices (WEDs) may be useful tools to enhance HF management and mitigate negative health outcomes.

Objective

We aimed to perform a systematic review to examine the potential of WEDs to support HF self-care in ambulatory patients at home.

Methods

Five databases were searched for studies published between 2007 and May 2022, including OVID MEDLINE, EMBASE (OVID), APA PsycINFO (OVID), Cochrane Central Register of Controlled Trials (OVID), and CINAHL Plus with Full Text (Ebsco). After 6210 duplicates were removed, 4045 records were screened and 6 were included for review (2 conference abstracts and 4 full-text citations). All studies used WEDs as 1 component of a larger intervention.

Results

Outcome measures included quality of life, physical activity, self-efficacy, self-care, functional status, time to readmission, social isolation, and mood. Studies were of moderate to high quality and mixed findings were reported. Enhanced exercise habits and motivational behavior to exercise, as well as decreased adverse symptoms of fatigue and dyspnea, were identified in 2 studies. However, improvements in exercise capacity and increased motivational behavior did not lead to exercise adherence in another 2 studies.

Conclusions

The findings from this review suggest that WEDs may be a viable health behavior improvement strategy for patients with HF. However, studies of higher quality, with the primary intervention being a WED, and consistent outcome measures are needed to replicate the positive findings of studies identified in this review.
Intrapersonal and Interpersonal Factors Influencing Physical Activity in Arab Americans
Authors: Nahari Ahmed M. , Davis Leslie L. , Wallace Debra C. , Pickett Stephanie , Davis Paul G. , McCoy Thomas P.
Published: February 2023

Background

Many Arab Americans do not meet the physical activity (PA) guidelines despite evidence to support health benefits.

Aims

We aimed to investigate the relationships between PA and sample characteristics, intrapersonal factors, and interpersonal factors and examine to what extent these factors influence PA in Arab Americans. A cross-sectional, descriptive-correlational design using a self-administered questionnaire with 140 Arab Americans was used. Spearman ρ correlation was used to assess the associations between PA and sample characteristics, intrapersonal factors, and interpersonal factors. Three simultaneous gamma regression models were used to assess to what extent these factors jointly influenced PA.

Results

Most participants (58.6%) reported a high level of PA. Significant positive associations were found between PA and health status, religiosity, and PA self-efficacy (rs
= 0.21, P = .019; r
s = 0.19, P = .029; and r
s = 0.28, P = .003, respectively). Multiple regression models revealed that being employed (model 1: Exp[b] = 1.87, P = .030; Model 3: Exp[b] = 1.77, P = .043) and having chronic conditions (model 1: Exp[b] = 1.88, P = .031; model 2: Exp[b] = 1.96, P = .034; model 3: Exp[b] = 1.91, P = .047) were associated with greater PA, when accounting for other sample characteristics, intrapersonal factors, and interpersonal factors.

Conclusion

Presence of chronic health conditions and employment status should be considered when promoting PA in Arab Americans. Future research is needed to explore the relationship between religiosity, PA self-efficacy, and PA in this population.
Age and Marital Status Predict Mild Cognitive Impairment During Acute Coronary Syndrome Admission
Authors: Weddell Joseph , Naismith Sharon L. , Bauman Adrian , Tofler Geoffrey , Zhao Emma , Redfern Julie , Buckley Tom , Gallagher Robyn
Published: February 2023

Background

Mild cognitive impairment (MCI) has been reported after acute coronary syndrome (ACS), but it is uncertain who is at risk, particularly during inpatient admission.

Objective

In this study, we aimed to explore the prevalence and cognitive domains affected in MCI during ACS admission and determine factors that identify patients most at risk of MCI.

Methods

Inpatients with ACS were consecutively recruited from 2 tertiary hospital cardiac wards and screened with the Montreal Cognitive Assessment and the Hopkins Verbal Learning Test. Screening included health literacy (Newest Vital Sign), depressive symptoms (Patient Health Questionnaire-9), and physical activity (Physical Activity Scale for the Elderly). Factors associated with MCI were determined using logistic regression.

Results

Participants (n = 81) had a mean (SD) age of 63.5 (10.9) years, and 82.7% were male. In total, MCI was identified in 52.5%, 42.5% with 1 screen and 10% with both. Individually, the Montreal Cognitive Assessment identified MCI in 48.1%, and the Hopkins Verbal Learning Test identified MCI in 13.8%. In Montreal Cognitive Assessment screening, the cognitive domains in which participants most frequently did not achieve the maximum points available were delayed recall (81.5%), visuospatial executive function (48.1%), and attention (30.9%). Accounting for education, depression, physical activity, and ACS diagnosis, the likelihood of an MCI positive screen increased by 11% per year of age (odds ratio, 1.11; 95% confidence interval, 1.04–1.18) and by 3.6 times for those who are unmarried/unpartnered (odds ratio, 3.61; 95% confidence interval, 1.09–11.89).

Conclusion

An estimated half of patients with ACS screen positive for MCI during admission, with single and older patients most at risk. Multiple areas of thinking were affected with potential impact on capacity for learning heart disease management.