Pancreatic masses clinically diagnosed as tuberculosis: Case reports.

Pancreatic masses are commonly encountered in clinical practice, with concern for the possibility of cancer. Tissue sampling or outright surgical resection may be offered in this setting. However, surgery has been unnecessarily performed in patients with pancreatic masses that proved to be benign. Less invasive options for pancreatic masses that may be benign like tuberculosis should thus be explored. Three adult Filipino patients less than 60 years old presented with symptomatic pancreatic masses suspected of cancer on abdominal imaging studies. Two were smokers without a history of prior tuberculosis. Without any tissue sampling, anti-tuberculosis treatment was eventually given to all three patients due to concomitant diagnoses of extrapancreatic tuberculosis. Endoscopic ultrasound documentation of post-treatment resolution of pancreatic masses was noted in all cases. In endemic regions, although clinical diagnosis of tuberculosis may be possible for pancreatic masses, empiric treatment should still be a last-line option in cases where tissue sampling cannot be done.

Long-term evaluation of clinical success and safety of omadacycline in nontuberculous mycobacteria infections: a retrospective, multicenter cohort of real-world health outcomes.

Infections due to nontuberculous mycobacteria (NTM) continue to increase in prevalence, leading to problematic clinical outcomes. Omadacycline (OMC) is an aminomethylcycline antibiotic with FDA orphan drug and fast-track designations for pulmonary NTM infections, including Mycobacteroides abscessus (MAB). This multicenter retrospective study across 16 U.S. medical institutions from January 2020 to March 2023 examined the long-term clinical success, safety, and tolerability of OMC for NTM infections. The cohort included patients aged ≥18 yr, who were clinically evaluable, and` had been treated with OMC for ≥3 mo without a previous diagnosis of cystic fibrosis. The primary outcome was 3 mo clinical success, with secondary outcomes including clinical improvement and mortality at 6- and 12 mo, persistence or reemergence of infection, adverse effects, and reasons for OMC utilization. Seventy-five patients were included in this analysis. Most patients were female (48/75, 64.0%) or Caucasian (58/75, 77.3%), with a median (IQR) age of 59 yr (49-67). Most had NTM pulmonary disease (33/75, 44.0%), skin and soft tissue disease (19/75, 25.3%), or osteomyelitis (10/75, 13.3%), and Mycobacterium abscessus (60/75, 80%) was the most commonly isolated NTM pathogen. The median (IQR) treatment duration was 6 mo (4 - 14), and the most commonly co-administered antibiotic was azithromycin (33/70, 47.1%). Three-month clinical success was observed in 80.0% (60/75) of patients, and AEs attributable to OMC occurred in 32.0% (24/75) of patients, leading to drug discontinuation in 9.3% (7/75).

Infectious Uveitis after Local Steroid and/or Methotrexate Injections at A Tertiary Referral Center in New Zealand: A Case Series.

AIM: Infectious uveitis is one of the most visually devastating causes of uveitis worldwide and accounts for 19.6% of all cases of uveitis in New Zealand. With the burgeoning use of intravitreal injections, there has been a commensurate increase in the number of injection-related complications and reports of infectious uveitis following their administration in recent years. We present a case series of four patients with infectious uveitis after local injections. METHOD: We retrospectively reviewed the data of four patients (mean age, 67.25 ± 7.58 years) who presented to the department of ophthalmology at Auckland District Health Board with infectious uveitis which occurred or worsened after local triamcinolone acetonide (TA) and/or methotrexate (MTX) injections. RESULTS: Three patients received local TA and one patient received intravitreal MTX. All patients were immunosuppressed prior to treatment. Two patients had toxoplasma chorioretinitis which worsened with local TA and one patient developed cytomegalovirus (CMV) retinitis after intravitreal TA. The last patient had syphilis retinopathy which worsened with intravitreal MTX. There were atypical presentations, as demonstrated by a case of presumed birdshot chorioretinopathy flare which tested positive for toxoplasma chorioretinitis with polymerase chain reaction (PCR). CONCLUSION: Uveitis due to infectious etiologies needs to be carefully excluded prior to the use of local steroid and/or methotrexate injections. Disease presentations may be atypical in the presence of marked immunosuppression following local therapy. Polymerase chain reaction (PCR) can play an important role in the diagnosis in this setting.

Potent antibody-mediated neutralization limits bacteriophage treatment of a pulmonary Mycobacterium abscessus infection.

An 81-year-old immunocompetent patient with bronchiectasis and refractory Mycobacterium abscessus lung disease was treated for 6 months with a three-phage cocktail active against the strain. In this case study of phage to lower infectious burden, intravenous administration was safe and reduced the M. abscessus sputum load tenfold within one month. However, after two months, M. abscessus counts increased as the patient mounted a robust IgM- and IgG-mediated neutralizing antibody response to the phages, which was associated with limited therapeutic efficacy.

Megalocornea, anterior megalophthalmos, keratoglobus and associated anterior segment disorders: A review.

Megalocornea and anterior megalophthalmos (megalocornea spectrum) disorders are typically defined by corneal diameter > 12.5 mm in the absence of elevated intraocular pressure. Clinical features overlap with keratoglobus but are distinct from buphthalmos and severe (globus) keratoconus. Megalocornea spectrum disorders and keratoglobus are primarily congenital disorders, often with syndromic associations; both can present with large and thin corneas, creating difficulty in diagnosis, however, only keratoglobus is typically progressive. Molecular genetics provide significant insight into underlying aetiologies. Nonetheless, careful clinical assessment remains intrinsic to diagnosis. Surgical management can be challenging due to the enlarged ciliary ring and weakened zonules in megalocornea spectrum disorders and the extreme corneal thinning of keratoglobus. In this review, the established literature on measurement of corneal diameter, diagnosis of megalocornea, anterior megalophthalmos and keratoglobus, differentiation from severe keratoconus, recent molecular genetics research and key surgical modalities in the management of these rare disorders are outlined and discussed.

Rubeola keratitis emergence during a recent measles outbreak in New Zealand.

INTRODUCTION Measles is a highly contagious disease caused by the rubeola virus. It can result in ocular complications such as conjunctivitis and keratitis, which will be encountered in general practice. Cases usually resolve without sequelae, but may progress to corneal perforation if left untreated. AIM We present two cases of rubeola keratitis secondary to measles infection. METHODS This report is about a retrospective review of data from two patients who presented to the eye department with rubeola keratitis in the midst of the recent measles outbreak in New Zealand. RESULTS Both patients presented with decreased visual acuity approximately 2 weeks after being diagnosed with measles. One of them was unvaccinated, whereas the other had no documentation of previous vaccination. Both were healthy and immunocompetent individuals. There was no evidence of corneal perforation or retinopathy on examination. Both patients regained their baseline visual acuity after treatment with fluorometholone eye drops. DISCUSSION Despite the existence of a safe and effective vaccine, there were more than 2000 cases of measles in the recent outbreak in New Zealand. The lack of vaccination is one of the primary causes of rubeola keratitis. These cases highlight the effects of measles infection from an ophthalmology perspective and reinforce the paramount importance of getting vaccinated.

Room temperature thiosulfate ion redox reaction-driven synthesis of a robust porous copper-cobalt-sulfur-oxygen nanowire coating on copper foam for highly-efficient and low-cost oxygen evolution reaction.

A robust porous copper-cobalt-sulfur-oxygen nanowire coating (Cu-Co-S-O NWC) was fabricated for the first time on copper foam using a mild thiosulfate ion redox reaction-driven chemical bath synthesis (CBS) strategy. Cu-Co-S-O NWC has a large ECAS, enriched tunnels for gas and electrolyte diffusion and good electron transfer performance from the highly conductive copper foam substrate, and herein, shows improved overall OER activity, outperforming the precious IrO2 catalyst and almost all the as-reported Cu-based or Co-based catalysts, especially at high current density.

Post-surgical versus post-intravitreal injection endophthalmitis: changing patterns in causative flora.

IMPORTANCE: Endophthalmitis is a serious complication of intraocular procedures: knowledge of its causative organisms and outcomes may guide prevention and treatment. BACKGROUND: To determine the outcomes and spectrum of causative organisms in acute post-procedural endophthalmitis. DESIGN: A retrospective observational case series performed at a tertiary referral hospital during the period 1 July 2012 to 31 July 2017. PARTICIPANTS: Two hundred and forty-eight patients diagnosed with acute (≤ 6 weeks post-inciting event) endophthalmitis. METHODS: Chart review of microbiological and clinical data. MAIN OUTCOME MEASURES: The main outcome measure was odds of any improvement in visual acuity (3 months versus presentation). Secondary outcomes included causative organism, likelihood of vitrectomy and likelihood of evisceration. RESULTS: One hundred and ninty cases were post-cataract surgery or post-intravitreal injection (49 and 141, respectively). Causative organisms were identified in 45% of post-cataract surgery and 54% of post-injection cases (OR = 0.69; P = 0.61). Staphylococcus epidermidis was the most frequent causative organism. Streptococcus species accounted for 32% of post-surgical and 7% of culture-positive post-injection cases (OR = 6.63; P = 0.02). At 3 months, 81% of post-surgical and 84% of post-injection cases had improved BCVA over presentation (OR 0.59; P = 0.61). CONCLUSIONS AND RELEVANCE: S. epidermidis is the most common causative organism. In contrast to other studies, we did not find evidence for an increased odds of Streptococcus spp. endophthalmitis following intravitreal injection. This may in turn reflect guideline-driven changes in practice.

Hierarchical Design of NiOOH@Amorphous Ni-P Bilayer on a 3D Mesh Substrate for High-Efficiency Oxygen Evolution Reaction.

Recently, 3d metal phosphide and metal-phosphorus alloy have been intensively studied for the oxygen evolution reaction (OER). Research work has indicated that the presence of phosphorus could lead to the formation of a phosphide/(hydro)-oxide core/shell structure. In this work, we have developed a fabrication technique for a robust NiOOH@amorphous Ni-P bilayer on a zirconia mesh support through the collaboration of electroless deposition and robocasting. During the electroless deposition, a fully amorphous structure can be obtained with a certain phosphorus content (7-8 wt %). Relatively thick films (in the order of 5 µm) had an excellent adhesion on the mesh structure because of the large curvature. A stable Ni oxy/hydroxide surface (∼200 nm) can be formed in bilayer nature (NiOOH/Ni-P) due to preactivation. The combination of catalyst active sites on the surface and high conductivity of metallic body enables good OER performance with an overpotential of 286 mV at a current density of 10 mA cm-2. Together with excellent chemical stability and mechanical strength of the ceramic substrate, this novel combination gives rather excellent adhesion and stability in alkaline solution and provides a different angle for the hierarchical design of corrosion resistant and high-performance OER electrodes for industry.

A biologically inspired, flapping-wing, hybrid aerial-aquatic microrobot.

From millimeter-scale insects to meter-scale vertebrates, several animal species exhibit multimodal locomotive capabilities in aerial and aquatic environments. To develop robots capable of hybrid aerial and aquatic locomotion, we require versatile propulsive strategies that reconcile the different physical constraints of airborne and aquatic environments. Furthermore, transitioning between aerial and aquatic environments poses substantial challenges at the scale of microrobots, where interfacial surface tension can be substantial relative to the weight and forces produced by the animal/robot. We report the design and operation of an insect-scale robot capable of flying, swimming, and transitioning between air and water. This 175-milligram robot uses a multimodal flapping strategy to efficiently locomote in both fluids. Once the robot swims to the water surface, lightweight electrolytic plates produce oxyhydrogen from the surrounding water that is collected by a buoyancy chamber. Increased buoyancy force from this electrochemical reaction gradually pushes the wings out of the water while the robot maintains upright stability by exploiting surface tension. A sparker ignites the oxyhydrogen, and the robot impulsively takes off from the water surface. This work analyzes the dynamics of flapping locomotion in an aquatic environment, identifies the challenges and benefits of surface tension effects on microrobots, and further develops a suite of new mesoscale devices that culminate in a hybrid, aerial-aquatic microrobot.

A 'paperless' wall-mounted surgical safety checklist with migrated leadership can improve compliance and team engagement.

BACKGROUND: Outcome benefits of using the WHO Surgical Safety Checklist rely on compliance with checklist administration. OBJECTIVE: To evaluate engagement of operating room (OR) subteams (anaesthesia, surgery and nursing), and compliance with administering checklist domains (Sign In, Time Out and Sign Out) and checklist items, after introducing a wall-mounted paperless checklist with migration of process leadership (Sign In, Time Out and Sign Out led by anaesthesia, surgery and nursing, respectively). METHODS: This was a pre-post observational study in which 261 checklist domains in 111 operations were observed 2 months after changing the checklist administration paradigm. Compliance with administration of the checklist domains and individual checklist items was recorded, as was the number of OR subteams engaged. Comparison was made with 2013 data from the same OR suite prior to the paradigm change. RESULTS: Data are presented as 2013 versus the present study. The Sign In, Time Out and Sign Out domains were administered in 96% vs 98% (p=0.69), 99% vs 99% (p=1.00) and 22% vs 84% (p<0.001) of cases, respectively. The percentage of relevant checklist items administered in each domain was 60% vs 92%, 84 vs 93% and 80% vs 99%, respectively (p<0.001 for all comparisons). Two-subteam (or better) engagement at Sign In (surgeons usually absent) was 40% vs 94% of cases. Three-subteam (or all staff present) engagement at Time Out and Sign Out was 15% vs 92% and 9% vs 25% of cases, respectively (p<0.001 for all comparisons). CONCLUSIONS: Improvements in team engagement and compliance with administering checklist items followed introduction of migrated leadership of checklist administration and a wall-mounted checklist. This paradigm change was relatively simple and inexpensive.

Comparison of readers' detection of right-sided and left-sided breast cancers and microcalcifications.

INTRODUCTION: Aim of this study was to determine if there is a statistically and clinically significant difference in diagnostic performance (cancer diagnosis) and perceptual performance (microcalcification detection) when detecting left-sided or right-sided breast cancers and microcalcifications. METHODS: Eight radiologist readers (8-20 years experience in radiology, five current BreastScreen readers) read a set of 100 digital mammograms (23/100 had proven malignancies and 52/100 had confirmed microcalcifications) for three reads (random case order in each read). The same mammograms were presented on two reads, serving as the baseline reads. The data from these reads were used to calculate intra-observer variability (presented in an earlier study). The experimental read consisted of left-right mirror images of the original mammograms. In each read, the radiologists were requested to 'clear' or 'call-back' cases and to indicate if any microcalcifications (benign and malignant) were present on the mammograms. Reading conditions were standardised. RESULTS: Comparison of intra-reader performance difference for left-sided versus right-sided breast cancers and microcalcifications with intra-observer variability for breast cancer diagnosis and microcalcification detection, respectively, revealed no clinically significant difference between left-sided and right-sided detections. Per-case analysis showed more left-sided breast cancers and microcalcifications correctly detected. This left-right difference in detection did not reach statistical significance, P-value of 0.28 for cancer diagnosis and 0.74 for microcalcification detection. CONCLUSION: There is no statistically or clinically significant difference between left-sided and right-sided breast cancer diagnosis and microcalcification detection in a group of experienced radiologists. Individual reading patterns do not affect detection rates of left-sided and right-sided cancers and microcalcifications.

Intrareader variability in mammographic diagnostic and perceptual performance amongst experienced radiologists in Australia.

INTRODUCTION: The purpose of this study was, for a group of experienced radiologists, to identify the magnitude of and statistical significance of intrareader variability in mammographic diagnostic performance or cancer diagnosis and mammographic perceptual performance or microcalcification detection. METHODS: Eight radiologist readers (8-30 years experience in radiology, five current BreastScreen readers) read a set of 100 digital mammograms on two separate reads with random case orders. Twenty-three of the 100 had proven malignancies, and 52 of the 100 had confirmed microcalcifications. The same mammograms were presented for both reads. The radiologists were requested to clear or call back cases and to indicate if any benign and malignant microcalcifications were present on the mammograms. Reading conditions were standardised. RESULTS: Intrareader variability in accuracy was demonstrated to be between 0% and 6% for the diagnostic task of breast cancer diagnosis and between 0% and 16% for the perceptual task of microcalcification detection. Intrareader agreement in the group of readers was high; between 75% and 93% (κ=0.36-0.72) for cancer diagnosis and between 77.5% and 93% (κ=0.17-0.77) for microcalcification detection. There was no correlation between reader's experience in radiology or being a BreastScreen reader and level of intrareader variability in cancer diagnosis and microcalcification detection. CONCLUSION: There exists intrareader variability in diagnostic and perceptual performance. Despite this variability, intrareader agreement remains high.

Comparison of 3MP medical-grade to 1MP office-grade LCD monitors in mammographic diagnostic and perceptual performance.

INTRODUCTION: Picture archiving and communication systems images designed to be viewed on high-resolution medical-grade monitors are routinely viewed on office-grade monitors on the wards or at home. This study aimed to determine whether a statistically significant difference in diagnostic (cancer detection) and perceptual (microcalcification detection) performance exists between 3MP grade and 1MP office-grade monitors. METHODS: 3MP Dome medical-grade liquid crystal display (LCD) monitors (Planar, Beaverton, OR, USA) were compared to 1MP Dell office-grade LCD monitors (Dell Inc, Round Rock, TX, USA). Eight radiologists (reader experience 8-30 years) read the same set of 100 mammograms (23/100 with proven cancers and 52/100 with microcalcifications) presented in random order on three occasions separated by two time intervals of 12 weeks. Reads 1 and 3 utilised 3MP monitors and formed the baseline read. Read 2 utilised 1MP monitors and constituted the experimental read. Reading conditions were standardised. Readers were aware of which monitors they were using. Multivariate logistic regression analysis (to account for reader variability and monitor impact) was performed to assess for statistical significance. RESULTS: At α = 5%, confidence intervals analysis comparing the measured parameters between 1MP to 3MP monitors demonstrated no statistically significant difference in diagnostic and perceptual performance for the reader group. In cancer detection (the diagnostic task), reader accuracy remained high irrespective of monitor type. Regression analysis comparing performance with 1MP against 3MP monitors found P values of 0.693 and 0.324 for diagnostic and perceptual performance, respectively. CONCLUSION: There were no statistically and clinically significant differences between 3MP and 1MP monitors in mammographic diagnostic and perceptual performance. Comparable performance may be due to compensatory behaviour by readers.