Spectral Domain Optical Coherence Tomography Allows the Unification of Clinical Decision Making for the Evaluation of Choroidal Neovascularization Activity.

PURPOSE: This prospective observational clinical study investigated the benefits of spectral domain optical coherence tomography for specialists and residents in the management of neovascular age-related macular degeneration (AMD). PROCEDURES: The study involved 49 eyes of 44 patients. Patients were advised to present for reevaluation 4 weeks after the administration of the loading dose of vascular endothelial growth factor (VEGF)-inhibitors (3 intravitreal injections every 4 weeks after diagnosis). They were examined by residents (3-4 years' experience in ophthalmology) and specialists (> 5 years' experience). Each examiner evaluated the clinical situation and the spectral domain optical coherence tomography (SD-OCT) scan. After each evaluation, the examiners independently stated if further anti-VEGF treatment was recommended. The "true outcome" was defined as the specialist decision based on clinical evaluation and SD-OCT. RESULTS: Specialists and residents did not significantly differ in their accuracy in deciding on the correct treatment (p = 0.705 and p = 1), with or without the aid of SD-OCT. Both groups benefited from using SD-OCT to support their recommendations (p = 0.001 and p = 0.0002) and achieved a similar level of accuracy (p = 1 for difference). CONCLUSIONS: Residents benefited more than specialists by using SD-OCT to substantiate their recommendation on how to manage exudative AMD after the administration of the loading dose.

Successful treatment of Fusarium solani anterior chamber involvement secondary to contact lens associated corneal ulcer with intracameral Amphotericin B.

Background: Fusarium spp. are leading fungal pathogenes in contact lens associated keratitis and may evoke endophthalmitis. Since Fusarium spp. are highly resistant to antifungal drugs, globe integrity is threatened. Case: A woman developed fungal anterior chamber involvement after contact lens associated corneal ulcer formation. She presented with a painful eye with hypopyon and a mass presumably of fungal origin growing on the iris and anterior lens capsule. A biopsy confirmed Fusarium solani. Only multiple lavages of the anterior segment with Amphotericin B achieved convalescence. Conclusion: In the initial stage of contact lens associated keratitis, it is often hard to differentiate between etiology. However, keratitis which are treatment resistant to antibacterials are suspicious for fungal origin. For proper treatment, identification of pathogen is crucial. Due to poor tissue penetration of the lipophilic anti-fungal agents and slow fungal replication rate, multiple lavages of the anterior chamber are often required to handle fungal infections.

Safety, tolerability, and immunogenicity after 1 and 2 doses of zoster vaccine in healthy adults ≥60 years of age.

BACKGROUND: Incidence and severity of herpes zoster (HZ) and postherpetic neuralgia increase with age, associated with age-related decrease in immunity to varicella-zoster virus (VZV). One dose of zoster vaccine (ZV) has demonstrated substantial protection against HZ; this study examined impact of a second dose of ZV. METHODS: Randomized, double-blind, multicenter study with 210 subjects ≥60 years old compared immunity and safety profiles after one and two doses of ZV, separated by 6 weeks, vs. placebo. Immunogenicity was evaluated using VZV interferon-gamma (IFN-γ) enzyme-linked immunospot (ELISPOT) assay and VZV glycoprotein enzyme-linked immunosorbent antibody (gpELISA) assay. Adverse experiences (AEs) were recorded on a standardized Vaccination Report Card. RESULTS: No serious vaccine-related AEs occurred. VZV IFN-γ ELISPOT geometric mean count (GMC) of spot-forming cells per 10(6) peripheral blood mononuclear cells increased in the ZV group from 16.9 prevaccination to 49.5 and 32.8 at 2 and 6 weeks postdose 1, respectively. Two weeks, 6 weeks and 6 months postdose 2, GMC was 44.3, 42.9, and 36.5, respectively. GMC in the placebo group did not change during the study. The peak ELISPOT response occurred ∼2 weeks after each ZV dose. The gpELISA geometric mean titers (GMTs) in the ZV group were higher than in the placebo group at 6 weeks after each dose. Correlation between the IFN-γ ELISPOT and gpELISA assays was poor. CONCLUSIONS: ZV was generally well-tolerated and immunogenic in adults ≥60 years old. A second dose of ZV was generally safe, but did not boost VZV-specific immunity beyond levels achieved postdose 1.

Study of the impact of oseltamivir on the risk for pneumonia and other outcomes of influenza, 2000-2005.

CONTEXT: Influenza results in large numbers of secondary complications and hospitalizations. OBJECTIVE: To assess the impact of oseltamivir on influenza-related complications and hospitalizations by analyzing health insurance claims data for 6 influenza seasons. DESIGN: A retrospective cohort study utilizing claims data from the 2000-2005 influenza seasons. SETTING: Claims data were obtained from Thomson Healthcare MarketScan Research Databases. PATIENTS: Patients prescribed oseltamivir within 1 day of influenza diagnosis were compared to those prescribed no antiviral therapy (controls). OUTCOMES: Frequencies of pneumonia, other respiratory illnesses, and otitis media, and rates of hospitalization, were compared for the oseltamivir and no antiviral groups. Expenditure was also analyzed. Relative risk (RR) for each outcome was assessed using Cox proportional hazards regression. RESULTS: Overall, 31,674 patients received oseltamivir and were propensity matched to patients with no antiviral prescription. Oseltamivir reduced the risk of diagnosis of pneumonia by 15% (RR 0.85, 95% confidence interval [CI] 0.73, 0.98), other respiratory illnesses by 20% (RR 0.80, 95% CI: 0.76, 0.83), and otitis media and its complications by 31% (RR 0.69, 95% CI: 0.61, 0.79). The greatest reductions in pneumonia risk, of 57% and 52%, were observed for children aged 6-12 years (RR 0.43, 95% CI: 0.26, 0.71) and 1-2 years (RR 0.48, 95% CI: 0.24, 0.99), respectively. Overall, hospitalization rates were reduced by 38% (RR 0.62, 95% CI: 0.52, 0.74) in the oseltamivir group compared with the no antiviral group. Total adjusted expenditures in the oseltamivir and no antiviral groups were not significantly different. CONCLUSIONS: Oseltamivir reduced the relative risk of influenza-related complications and hospitalization when prescribed immediately upon presentation of influenza.

Mountaineering and climbing techniques in the curriculum of mountain medicine education programs: a survey of the European Courses for Mountain Medicine.

Mountain medicine education programs have been described and discussed from several perspectives. A Union Internationale des Associations Alpinistes-Internationale Kommission für Alpines Rettungswesen-International Society for Mountain Medicine (UIAA-IKAR-ISMM) label was defined and subsequently awarded to courses that comply with certain minimal requirements. These courses can award an international UIAA-IKAR-ISMM diploma to their successful candidates. The need for mountaineering training was listed in those minimal requirements, but no exact recommendations were given. A complete analysis of existing mountain medicine education programs in Europe is done, providing information about the practical mountaineering and climbing techniques taught in the different courses and, if applicable, the practical requirements and examinations to obtain the above-mentioned diploma. The analysis clearly shows the widely varying requirements for proficiency in mountaineering and climbing in European mountain medicine courses.

Personal and professional profile of mountain medicine physicians.

OBJECTIVE: The purpose of this study was to define and describe the personal and professional profile of mountain medicine physicians including general physical training information and to include a detailed overview of the practice of mountain sports. METHODS: A group of physicians participating in a specialized mountain medicine education program filled out a standardized questionnaire. The data obtained from this questionnaire were first analyzed in a descriptive way and then by statistical methods (chi2 test, t test, and analysis of variance). RESULTS: Detailed results have been provided for gender, age, marital status, general training frequency and methods, professional status, additional medical qualifications, memberships in professional societies and alpine clubs, mountain sports practice, and injuries sustained during the practice of mountain sports. CONCLUSIONS: This study has provided a detailed overview concerning the personal and professional profile of mountain medicine physicians. Course organizers as well as official commissions regulating the education in mountain medicine will be able to use this information to adapt and optimize the courses and the recommendations/requirements as detailed by the UIAA-ICAR-ISMM (Union Internationale des Associations Alpinistes, International Commission for Alpine Rescue, International Society for Mountain Medicine).

Mountain sports and total hip arthroplasty: a case report and review of mountaineering with total hip arthroplasty.

Participation in certain sports after total hip arthroplasty (THA) is common. Some high-risk sports such as extreme endurance sports with risks of falls and fractures are often cautioned against, except when the sport was participated in preoperatively and an excellent physical condition is present postoperatively. In this article, current concepts pertaining to this issue in general and in relation to mountain sports are discussed after a description of the activities of a 69-year-old patient who received cementless bilateral THAs in 1987 and 1995 and who resumed, after each rehabilitation, his preoperative sports practice (eg, walking and high-altitude mountaineering [6000+ m]). The patient, who was experienced in alpine and high-altitude mountaineering, was able, after his first operation, to climb classic alpine peaks (4000+ m) as well as participate in difficult and strenuous climbs outside Europe (Kilimanjaro, Elbrus, and Rolwaling trekking). After the second operation and an intensive rehabilitation program, he was able to climb 2 mountains in the range of 6000+ m. With excellent physical training, a long preoperative practice of the sport, and an intensive and careful rehabilitation, patients with a THA are, under specific circumstances, able to perform mountaineering at a very high, even professional level without signs of prosthesis loosening or higher than normal wear of the bearing materials.