Comparing men who have sex with men only and men who have sex with men and women visiting a public STI clinic.

BACKGROUND: Men reporting same-sex behaviors are disproportionately impacted by sexually transmitted infections (STI). Differences in clinical characteristics and STIs in men who have sex with men only (MSMO), with men and women (MSMW), and with women only (MSW) are not well described. METHODS: First visits to two Baltimore City STI clinics 2011-2016 from MSMO and MSMW compared to an age-matched random sample of MSW were analyzed. Acute STI (aSTI) included chlamydia, gonorrhea, nongonococcal urethritis (NGU), and primary or secondary syphilis (PSS). Chi-squared tests and logistic regression examined associations. RESULTS: Among N = 1226 MSMO, N = 491 MSMW and N = 1717 MSW, most identified as Black/African American; mean age (29.8) was similar across groups. 73.5%, 67.2%, and 60.3% of MSMW, MSMO, and MSW reported ≥2 partners in last 6 months. "Always" condom use was reported by 20.4%, 17.4 % and 14.1% of MSMW, MSMO and MSW. Overall HIV prevalence was 13.8%. Among those tested, urogenital chlamydia prevalence was 21.7%, 8.3%, and 3.9% (p ≤ 0.01) in MSW, MSMW, and MSMO. Urogenital gonorrhea prevalence was 11.6%,7.7%, and 8.3% in MSMW, MSW, and MSMO respectively. Extragenital STI (range 2.7-21.9%), NGU (25.2%), and PSS (5.3-5.7%) positivity was similar in MSMW and MSMO. Older age was inversely associated with STI diagnosis in MSW and MSMO only, consistent condom use was protective against aSTI in MSW (aOR:0.60, p < 0.01) and MSMW (aOR:0.54 p = 0.03) only. CONCLUSION: Differences in behaviors and clinical characteristics associated with aSTI suggest that MSMO, MSMW and MSW have diverse sexual health needs and may require tailored interventions to improve sexual health outcomes.

Comparison of 20% SF6 and 6% C3F8 Gas for Anterior Chamber Tamponade in Endothelial Keratoplasty.

PURPOSE: The aim of this study was to compare the rates of rebubbling after Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) between patients who had anterior chamber (AC) graft tamponade with 20% sulfur hexafluoride gas (SF6) and 6% perfluoropropane gas (C3F8). METHODS: The charts of 431 patients undergoing EK from June 8, 2010, to April 16, 2023, were reviewed. Patients undergoing EK alone as well as combined procedures with cataract extraction and intraocular lens implantation were included. Eyes with tube shunts, anterior chamber intraocular lenses, and large peripheral iridotomy with posterior loss of bubble, and patients undergoing cyclophotocoagulation or synechialysis were excluded. All rebubble procedures were performed within 1 month after initial surgery. RESULTS: A total of 346 eyes using SF6 and 167 eyes using C3F8 were analyzed. Overall, 46 eyes (9%) required rebubbling; 33 eyes (10%) in the SF6 group and 13 eyes (8%) in the C3F8 group. For those patients undergoing DMEK, the odds of requiring rebubbling in the C3F8 group were about 22% lower than that of patients in the SF6 group (operating room [OR]: 0.782; P < 0.001). For patients undergoing DSEK, however, the gas type did not significantly affect rebubbling rates ( P = 0.99). CONCLUSIONS: For DMEK, utilization of 6% C3F8 as an AC tamponade was associated with a significantly lower odds of graft rebubbling compared with 20% SF6. Gas type did not result in a significant difference for DSEK. Utilization of 6% C3F8 for graft tamponade could be considered to reduce graft detachment rates in DMEK.

Results of the United States Food and Drug Administration Clinical Trial of the CustomFlex Artificial Iris.

PURPOSE: To evaluate safety and efficacy of a custom-manufactured artificial iris device (CustomFlex Artificial Iris; HumanOptics AG) for the treatment of congenital and acquired iris defects. DESIGN: Multicenter, prospective, unmasked, nonrandomized, interventional clinical trial. PARTICIPANTS: Patients with photophobia, sensitivity secondary to partial or complete congenital or acquired iris defects, or both. METHODS: Eyes were implanted from November 26, 2013, to December 1, 2017, with a custom, foldable artificial iris by 1 of 4 different surgical techniques. Patients were evaluated 1 day, 1 week, and 1, 3, 6, and 12 months after surgery. At each examination, slit-lamp findings, intraocular pressure, implant position, subjective visual symptoms, and complications were recorded. Corrected distance visual acuity (CDVA) and endothelial cell density (ECD) were measured at 3, 6, or 12 months as additional safety evaluations. The 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) was used to assess health-related quality of life affected by vision. The Global Aesthetic Improvement Scale was used to assess cosmetic results. MAIN OUTCOME MEASURES: Photosensitivity, glare, visual symptoms, NEI VFQ-25 score, Global Aesthetic Improvement Scale rating, prosthesis-related adverse events, intraocular lens (IOL)-related adverse events, and surgery-related adverse events 12 months after surgery. RESULTS: At the 12-month postoperative examination, a 59.7% reduction in marked to severe daytime light sensitivity (P < 0.0001), a 41.5% reduction in marked to severe nighttime light sensitivity (P < 0.0001), a 53.1% reduction in marked to severe daytime glare (P < 0.0001), and a 48.5% reduction in severe nighttime glare (P < 0.0001) were found. A 15.4-point improvement (P < 0.0001) in the NEI VFQ-25 total score was found, and 93.8% of patients reported an improvement in cosmesis as measured by the Global Aesthetic Improvement Scale 12 months after surgery. No loss of CDVA of > 2 lines related to the device was found. Median ECD loss was 5.3% at 6 months after surgery and 7.2% at 12 months after surgery. CONCLUSIONS: The artificial iris surpassed all key safety end points for adverse events related to the device, IOL, or implant surgery and met all key efficacy end points, including decreased light and glare sensitivity, improved health-related quality of life, and satisfaction with cosmesis. The device is safe and effective for the treatment of symptoms and an unacceptable cosmetic appearance created by congenital or acquired iris defects.

Accuracy of intraocular lens calculation formulas for flanged intrascleral intraocular lens fixation with double-needle technique.

PURPOSE: To evaluate the refractive prediction error (RPE) of intraocular lens (IOL) calculation formulas in eyes that have undergone the Yamane technique for scleral fixation of IOLs. SETTING: Alkek Eye Center, Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. DESIGN: Retrospective case series from electronic chart review. METHODS: Patients who had undergone scleral fixation of secondary IOLs were selected. The IOL RPEs for 4 IOL prediction formulas-Barrett Universal II, Holladay 1, Hoffer Q, and SRK/T formulas-were obtained by subtracting the predicted spherical equivalent from the postoperative spherical equivalent. The arithmetic mean RPE, mean absolute error (MAE), and percentages of eyes with prediction error of 0.50 diopter (D) or lesser and 1.00 D or lesser were calculated and compared. RESULTS: Forty eyes of 40 patients met inclusion criteria. All formulas produced hyperopic mean arithmetic RPE. MAE values were 0.73 D for Holladay 1, 0.76 D for Barrett Universal II, 0.80 D for SRK/T, and 0.86 D for Hoffer Q formulas. The percentage of eyes with prediction error of 0.50 D or lesser and 1.00 D or lesser with these formulas were 45% (18 eyes) and 75% (30 eyes) for Holladay 1, 38.5% (15 eyes) and 77% (30 eyes) for Barrett Universal II, 32.5% (13 eyes) and 67.5% (27 eyes) for SRK/T, and 27.5% (11 eyes) and 62.5% (25 eyes) for Hoffer Q formulas. There were no statistically significant differences in prediction errors between the 4 formulas. CONCLUSIONS: Refractive outcomes of the Yamane technique were less predictable than those of standard cataract surgery. Arithmetic RPE ranged from hyperopic to predicted values for all formulas tested.

Pharmacokinetics of intravenous and subcutaneous cefovecin in alpacas.

The purpose of this study was to determine the pharmacokinetics of cefovecin after intravenous and subcutaneous dose of 8 mg/kg to alpacas. Bacterial infections requiring long-term antibiotic therapy such as neonatal bacteremia, pneumonia, peritonitis, dental, and uterine infections are a significant cause of morbidity and mortality in this species. However, few antimicrobials have been evaluated and proven to have favorable pharmacokinetics for therapeutic use. Most antimicrobials that are currently used require daily injections for many days. Cefovecin is a long-acting cephalosporin that is formulated for subcutaneous administration, and its long-elimination half-life allows for 14-day dosing intervals in dogs and cats. The properties of cefovecin may be advantageous for medical treatment of camelids due to its broad spectrum, route of administration, and long duration of activity. Pharmacokinetic evaluation of antimicrobial drugs in camelids is essential for the proper treatment and prevention of bacterial disease, and to minimize development of antibiotic resistant bacterial strains due to inadequate antibiotic concentrations. Cefovecin mean half-life, volume of distribution at steady-state, and clearance after intravenous administration were 10.3 h, 86 mL/kg, and 7.07 mL·h/kg. The bioavailability was 143%, while half-life, C(max), and T(max) were 16.9 h, 108 µg/mL, and 2.8 h following subcutaneous administration. In the absence of additional microbial susceptibility data for alpaca pathogens, the current cefovecin dosage regimen prescribed for dogs (8 mg/kg SC every 14 days) may need to be optimized for the treatment of infections in this species.

Bone mass, body composition and vitamin D status of ARV-naïve, urban, black South African women with HIV infection, stratified by CD4 count.

UNLABELLED: This is the first report examining vitamin D status and bone mass in African women with HIV infection using dual-energy X-ray absorptiometry (DXA) with an appropriate HIV-negative control group. Unlike previous publications, it demonstrates no difference in bone mineral density (BMD) or vitamin D status in HIV-positive patients, at different disease stages, vs. HIV-negative subjects. INTRODUCTION: Low bone mass and poor vitamin D status have been reported among HIV-positive patients; suggesting HIV or its treatment may increase the risk of osteoporosis, a particular concern for women in countries with high HIV prevalence such as South Africa. We describe bone mass and vitamin D status in urban premenopausal South African women, who were HIV positive but not on antiretroviral therapy (ARV). METHODS: This study is a cross-sectional measurement of BMD and body composition by DXA and vitamin D status by serum 25-hydroxyvitamin D (25(OH)D) concentration. Subjects were recruited into three groups: HIV negative (n = 98) and HIV positive with preserved CD4 cell count (non-ARV; n = 74) or low CD4 cell counts prior to ARV initiation (pre-ARV; n = 75). RESULTS: The mean (standard deviation (SD)) age of women was 32.1 (7.2) years. Mean CD4 (SD) counts (×10(6)/l) were 412 (91) and 161 (69) in non-ARV and pre-ARV groups (p < 0.0001). Pre-ARV women were significantly lighter and had lower mean BMI than the other two groups (p < 0.002). The pre-ARV group also had significantly less fat and lean mass compared with non-ARV and HIV-negative subjects (p ≤ 0.05). After full adjustment, there were no significant differences in BMD at any site (p > 0.05) between the groups, nor was vitamin D status significantly different between groups (p > 0.05); the mean (SD) cohort 25(OH)D being 60 (18) nmol/l. CONCLUSION: Contrary to previous studies, these HIV-positive women did not have lower BMD or 25(OH)D concentrations than HIV-negative controls, despite the pre-ARV group being lighter with lower BMI.

Catastrophic globe disruption as a result of a TASER injury.

BACKGROUND: Injuries caused by the TASER(®) (TASER International, Inc., Scottsdale, AZ) have been well documented, and both direct and indirect ocular injuries have been reported. We present a case of severe perforating injury to the globe from a TASER dart with central cornea penetration. OBJECTIVES: To describe the presentation and management of a penetrating ocular injury from a TASER dart. CASE REPORT: A 47-year-old woman presented with a TASER dart injury penetrating through the central cornea. The injury resulted in a stellate corneal laceration, which was repaired with a final visual acuity of light perception without projection. CONCLUSION: This is a case of a severe TASER-related ocular injury resulting in significant vision loss. Although mechanical trauma seemed to be the main etiology for vision loss, electrical shock injury may also be contributory. Direct injury to the eye from a TASER dart is similar to other perforating projectile injuries and can have a devastating visual outcome.

Synthesis of calcium-silica composites: a route toward an in vitro model system for calcific band keratopathy precipitates.

Calcific band keratopathy (CBK) is a degenerative condition resulting in the deposition of calcium salts in the superficial layers of the cornea and causing significant visual disturbance and pain of the affected eye. Unfortunately, the amount of CBK precipitates recovered from the affected eye is very small therefore; it would be beneficial to prepare a synthetic material mimicking CBK material to further the development of therapeutics. Analyses of biological samples recovered from patients show the presence of silicon in addition to calcium, as well as a distinctive fused spherical morphology. This prompted us to study the reaction of various sources of silicon (fumed silica, silicic acid, and silicone oil) with CaCO(3) under a range of reaction conditions to gain an understanding of the formation of CBK. A silicon source alone was not found to be responsible for the fused spherical morphology, and a third component, a polar surfactant-like molecule such as sodium dodecyl sulfate or tetradecylphosphonic acid, was also required. The effects of silicon:calcium ratio and reaction time have been studied. The reaction of fumed silica with CaCO(3) in presence of sodium dodecyl sulfate results in the formation of spherical shapes resembling the structures and chemical composition observed in the eye samples, while no such structures were observed in the absence of silicon. Samples closely resembling human samples were also formed from the reaction of silicone oil with CaCO(3) in the presence of tetradecylphosphonic acid. Samples were characterized by SEM, XRD, and XPS and Raman spectroscopy.

Microscopy detection of rectal gonorrhoea in asymptomatic men.

This audit aimed to determine the usefulness of microscopy to detect presumptive rectal gonorrhoea (GC) infection in asymptomatic men. We retrospectively audited more than 400 male patients attending a London genitourinary medicine clinic from January 2005 to March 2007 who tested rectal culture positive for Neisseria gonorrhoeae and compared this with the microscopy detection rate. In total, 123/423 (29%) of culture positive samples were microscopy positive. Of those that tested microscopy negative (300/423), 64 (21%) were symptomatic and 236 (79%) asymptomatic. In addition, a time and motion study examined 81 rectal slides over a two-week period to identify microscopy reading time required to make a presumptive diagnosis of GC. Three slides were positive, resulting in six hours and 45 minutes to detect one positive sample. Given the low sensitivity for rectal microscopy coupled with the length of time required to obtain a presumptive positive rectal GC result, we believe rectal microscopy is no longer a cost-effective tool screening for asymptomatic men, and this report supports the BASHH guideline that it is not recommended in the management of asymptomatic rectal infection.