Conjunctival Exophytic Schneiderian-type Papillomas: A Rare Occurrence.

Conjunctival papillomas are common tumors that exhibit an exophytic growth pattern, comprised of multiple filiform fronds of squamous epithelium that contain fibrovascular cores. The inverted (endophytic) variety of papilloma, often termed "Schneiderian," rarely occurs on the conjunctiva, with only 15 cases reported to date. Endophytic and exophytic papillomas are well described arising in the sinonasal Schneiderian epithelium where a low rate of malignant transformation may occur in the endophytic type; malignant transformation in exophytic sinonasal papillomas is exceedingly rare. The authors describe 2 cases of exophytic conjunctival papillomas with the morphology of a sinonasal or Schneiderian-type papilloma. Both were pink, sessile acquired growths in women in the sixth decade of life involving the inferior conjunctival fornix or nasal limbus. Nonkeratinizing squamous epithelium along with numerous goblet cells, intraepithelial mucinous cysts, and microabscesses were present. Immunohistochemistry showed reactivity for cytokeratin 7 and wild-type staining for p16 and p53, paralleling the findings in common conjunctival papillomas; both were also driven by low-risk human papillomavirus.

Epibulbar Subconjunctival Apocrine Hidrocystoma.

Apocrine hidrocystomas are benign cystic tumors derived from apocrine sweat glands; they are most commonly located in the skin of the head and neck regions. Ophthalmic occurrences characteristically appear at the lash line and canthi of the eyelid, although rare instances have been described in the conjunctiva, caruncle, and orbit. The authors describe an exceptional instance of a mobile epibulbar subconjunctival apocrine hidrocystoma in a 57-year-old woman without a history of previous ocular injury or surgery. Histopathology of the excised specimen displayed an empty cyst lined by a double layer of cuboidal epithelium with the inner layer exhibiting periodic acid-Schiff-positive apical decapitation secretion. Confirmatory immunohistochemistry included reactivity with cytokeratin-7, smooth muscle actin, D2-40, and CDGFP-15.

Comparison of in-vitro bioassays for evaluation of the response of different stages of Rhipicephalus sanguineus sensu lato to calcium alginate encapsulated pheromone beads.

Tick sex pheromone (SP), assembly pheromone (AP) and their combination (SP + AP) were encapsulated in calcium alginate beads. In vitro bioassays, namely Petri dish and olfactometer assays, were employed to estimate the level of attraction of the various stages of Rhipicephalus sanguineus sensu lato, namely unfed and engorged (fed) larvae, nymphs, females, and males to the different pheromones. The study revealed that only the Petri dish assay was suitable to evaluate the response of larval stages whereas the olfactometer bioassay could also be used for evaluating the response of all other stages. Attraction to pheromone encapsulated calcium alginate beads of all tick stage was higher in the Petri dish assay than in the olfactometer assay.

The verification of nucleic acid amplification testing (Gen-Probe Aptima Assay) for chlamydia trachomatis from ocular samples.

OBJECTIVE: Chlamydia trachomatis conjunctivitis may present with extended symptoms, and it can have social ramifications as a sexually transmitted disease. For appropriate therapy, C. trachomatis conjunctivitis should be diagnosed definitively. This study presents the verification of nucleic acid amplification testing (NAAT; Gen-Probe Aptima Combo 2 assay) for detection of C. trachomatis ribosomal RNA (rRNA) from direct ocular samples. DESIGN: Retrospective laboratory verification study. SUBJECTS: Patients with infectious conjunctivitis. METHODS: A battery of 25 true-positive specimens (direct ocular specimens from patients with symptoms consistent with C. trachomatis conjunctivitis and with previously demonstrated positive polymerase chain reaction [PCR] results for C. trachomatis DNA by Roche Amplicor) and 25 true-negative specimens (direct ocular specimens with culture-positive results for herpes simplex virus [n = 5], adenovirus [n = 5], Haemophilus influenzae [n = 5], and Streptococcus pneumoniae [n = 5]), and transport medium (n = 5) were tested for C. trachomatis rRNA by NAAT. These true-negative specimens have differential etiologic agents of infectious conjunctivitis. The 25 C. trachomatis specimens with PCR-positive results (obtained May 1994-May 2012) and 20 true-negative infectious ocular specimens (obtained December 2008-August 2013) were collected with soft-tipped applicators and placed in transport medium. All excess specimens were stored at -80°C. All samples were centrifuged at 13,000 rpm for 1 hour at 6°C. For each sample, using the Aptima Unisex collection blue swab, a specimen was collected from the conical apex of the storage tube where a pellet was formed. The Aptima Unisex collection swab was placed in a tube of Aptima swab transport medium for testing. All samples were tested in duplicate. MAIN OUTCOME MEASURES: Detection of C. trachomatis rRNA. RESULTS: Of 25 true-positive samples, 24 (96%) were positive by NAAT, whereas 25 of 25 true-negative samples (100%) showed negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and efficiency were determined to be 96%, 100%, 100%, 96%, and 98%, respectively. CONCLUSIONS: The detection of C. trachomatis in ocular specimens by NAAT was verified for laboratory diagnosis. The test will be evaluated prospectively to determine future test performance precisely.

Control of brown dog tick, Rhipicephalus sanguineus using assembly pheromone encapsulated in natural polymer, chitosan.

In the current study, an attempt was made to encapsulate assembly pheromone using natural polymer, chitosan. Chitosan beads were prepared by incorporating assembly pheromone in conjunction with an acaricide, namely, deltamethrin. In the in vitro bioassay, the test beads attracted and killed 79 % of unfed larvae, 88 % of unfed nymphs and 61 % of unfed adults of the brown dog tick, Rhipicephalus sanguineus, in 24 h of exposure. Field trials were carried out to attract and kill the pre-parasitic environmental stages. The beads were dispersed onto specially designed devices and they were placed in infested kennels. The devices were observed after 10 days.

Neighborhood Environment and Poor Maternal Glycemic Control-Associated Complications of Gestational Diabetes Mellitus.

Introduction: Risk of complications due to gestational diabetes mellitus is increasing in the U.S., particularly among individuals from racial minorities. Research has focused largely on clinical interventions to prevent complications, rarely on individuals' residential environments. This retrospective cohort study aims to examine the association between individuals' neighborhoods and complications of gestational diabetes mellitus. Methods: Demographic and clinical data were extracted from electronic health records and linked to American Community Survey data from the U.S. Census Bureau for 2,047 individuals who had 2,164 deliveries in 2014-2018. Data were analyzed in 2021-2022 using Wilcoxon rank sum test and chi-square test for bivariate analyses and logistic regression for analysis of independent effects. All census tract-based variables used in the model were dichotomized at the median. Results: Bivariate analysis showed that the average percentage of adults earning <$35,000 was higher in neighborhoods where individuals with complications were living than in neighborhoods where individuals without complications were living (30.40%±12.05 vs 28.94%±11.71, p=0.0145). Individuals who lived in areas with ≥8.9% of residents aged >25 years with less than high school diploma had a higher likelihood of complications than those who lived in areas with <8.9% of such residents (33.43% vs 29.02%, p=0.0272). Individuals who lived in neighborhoods that had ≥1.8% of households receiving public assistance were more likely to have complications than those who lived in areas where <1.8% of households received public assistance (33.33% vs 28.97%, p=0.0287). Logistic regression revealed that the odds of deliveries with complications were 44% higher for individuals with obesity (OR=1.44; 95% CI=1.17, 1.77), 35% greater for individuals residing in neighborhoods with higher percentages of households living below the poverty level (OR=1.35; 95% CI=1.09, 1.66), and 28% lower for individuals from neighborhoods where a higher percentage of households had no vehicles available for transportation to work (OR=0.72; 95% CI=0.59, 0.89). Conclusions: Clinical interventions in concert with environmental changes could contribute to preventing maternal and neonatal complications of gestational diabetes mellitus.

Innovative way to dispense pheromones for off-host control of Rhipicephalus sanguineus sensu lato ticks.

Vapour patches dispensing pheromones were evaluated as lures to increase the attractiveness of sticky tick traps for Rhipicephalus sanguineus sensu lato (s.l.). Sex pheromone (SP), assembly pheromone (AP) and a combination of SP + AP at optimal concentrations were impregnated in vapour patches. The responses of the different stages of R. sanguineus s.l. (i.e. larvae, nymphs and adults) to the pheromones were evaluated using a Petri dish bioassay. The impregnated vapour patches were retained as such for a period of two mo and their efficacy was reassessed. In a subsequent field trial, pheromone impregnated vapour patches were placed as lures in bamboo (Bambusa vulgaris) sticky traps designed for the control of ticks in dog kennels. In vitro AP impregnated vapour patches were effective in attracting the different life stages of R. sanguineus s.l. whereas SP was effective in attracting the unfed and fed male stages of R. sanguineus s.l. The field trial revealed that questing and engorged larvae, nymphs and females of R. sanguineus s.l. were attracted more towards AP impregnated vapour patches than SP and AP + SP impregnated vapour patches. Fed and unfed male ticks were lured effectively by SP alone. The combination of SP + AP revealed no potent additive or synergistic effect.

Access to Transportation and Health Care Visits for Medicaid Enrollees With Diabetes.

PURPOSE: Diabetes is a chronic condition that requires frequent health care visits for its management. Individuals without nonemergency medical transportation often miss appointments and do not receive optimal care. This study aims to evaluate the association between Medicaid-provided nonemergency medical transportation and diabetes care visits. METHODS: A retrospective analysis was conducted of demographic and claims data obtained from the Oklahoma Medicaid program. Participants consisted of Medicaid enrollees with diabetes who made at least 1 visit for diabetes care in a year. The sample was predominantly female and white, with an average age of 46.38 years. Two zero-truncated Poisson regression models were estimated to assess the independent effect of transportation use on number of diabetes care visits. FINDINGS: Use of nonemergency medical transportation is a significant predictor of diabetes care visits. Zero-truncated Poisson regression coefficients showed a positive association between the use of transportation and number of visits (0.6563, P < .001). Age, gender, race/ethnicity, area of residence, and presence of additional chronic conditions had independent associations with number of visits. Older enrollees were likely to make more visits than younger enrollees with diabetes (0.02382); controlling for all other factors in the model, rural residents made more visits than urban; women made fewer visits than men (-0.09312; P < .001); and minorities made fewer visits than whites, with pronounced differences for Hispanics and Asians compared to whites. CONCLUSIONS: Findings underscore the importance of ensuring transportation to Medicaid populations with diabetes, particularly in the rural areas where the prevalence of diabetes and complications are higher and the availability of medical resources lower than in the urban areas.

A novel assembly pheromone trap for tick control in dog kennels.

A novel ecofriendly sticky tick trap device for the control of dog tick Rhipicephalus sanguineus using gold nanoparticle assembly pheromone complex as a bait was developed. Assembly pheromones comprising of guanine, xanthine and adenine in the ratio of 25:1:1 was encapsulated in gold nanoparticle. The response of the different stages of unfed R. sanguineus ticks was evaluated using petridish bioassay. Statistical analysis was done using chi-square test. Petridish bioassay with unfed stages of R. sanguineus revealed that 100% of the larvae, nymph and adults were attracted to assembly pheromone nanogold complex within 24h. Of the 952 ticks trapped, ticks of different stages trapped in total by the baited sticky trap device, 543 (57%) were engorged and 409 (43%) were unfed ticks. The study revealed that assembly pheromone baited traps has the potential to control tick infestations in dog kennels.

Response of unfed stages of Rhipicephalussanguineus to subtle variations in the composition of assembly pheromone.

Two combinations of assembly pheromone (AP), with and without hematin were utilized as a lure for the unfed larvae, nymph and adults of Rhipicephalussanguineus ticks. In-vitro trials were carried out with the AP encapsulated in calcium alginate beads and the response of different stages of ticks were recorded. Analysis of results revealed that rapid attraction was evident in unfed larvae exposed to beads containing AP without hematin. In case of unfed nymphal and adult stages, the presence or absence of hematin did not have any impact on arrestment.

Nonemergency medical transportation and health care visits among chronically ill urban and rural medicaid beneficiaries.

Inaccessibility to health care services due to lack of transportation affects the most vulnerable segments of the society. The effect of Medicaid-provided nonemergency medical transportation (NEMT) in Oklahoma on health care visits for the management of chronic illnesses is examined. Analyses of claims data show that African Americans are the highest users of NEMT. Medicaid beneficiaries who use NEMT services are significantly more likely to make the recommended number of annual visits for the management of chronic conditions than those who do not use NEMT. Increased use of NEMT by making the services more accommodating and convenient for beneficiaries is proposed.

A novel approach to control brown dog tick, Rhipicephalus sanguineus using sustained release poly-ɛ-caprolactone-pheromone microspheres.

Control of brown dog tick, Rhipicephalus sanguineus was attempted by utilizing sustained release preparations of synthetic analogues of assembly pheromones. The assembly pheromone, in defined ratio, was encapsulated using poly-ɛ-caprolactone by water-in-oil-in-water double emulsion solvent evaporation technique. In the in vitro bioassay, percent mortality with test microspheres was 95.6, 64 and 44 among the unfed larvae, unfed nymph and unfed adults respectively, 24 hours post-exposure. Field trials were carried out to evaluate the efficacy of microspheres in luring and killing environmental stages of R. sanguineus in dog houses/kennels. Engorged and unfed stages in the environment were found adhered and dead on the specially designed lure.

Infectious crystalline keratopathy predominantly affecting the posterior cornea.

A case of infectious crystalline keratopathy that affects mainly the posterior stroma is presented. Crystalline infiltrates presented after multiple epithelial defects and chronic topical steroid use following a penetrating keratoplasty in this patient. His epithelial defects persisted and given the deep location of the crystalline infiltrates, a penetrating keratoplasty was performed again. Slit-lamp photo demonstrates the crystalline plaque. Confocal microscopy also documents the aggregates of crystal-like structures. Histology slides are also presented that show the disruption of the stromal-Descemet interface and the predominance of pathology confined to the posterior stroma which has been documented in the literature as a rare finding.

Acute corneal edema with subsequent thinning and hyperopic shift following selective laser trabeculoplasty.

UNLABELLED: We report 4 cases of acute corneal edema with subsequent thinning and hyperopic shift following routine selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma. Four women from 3 clinical sites developed acute corneal edema and haze within 2 days of uneventful SLT. In the following weeks to months, all treated corneas thinned to below pre-procedure thicknesses with resultant hyperopic shifts of nearly 2.0 diopters (D) to greater than 6.0 D. All eyes were moderately to highly myopic prior to SLT (spherical equivalent from -5.00 to -12.5 D). The corrected distance visual acuity 6 to 11 months after SLT was within 2 Snellen lines of the pre-procedure acuity in all patients; 2 patients required contact lenses. Corneal edema with subsequent corneal thinning and resultant hyperopic shift is an uncommon but possibly underrecognized complication of SLT, the etiology of which remains unknown but may be associated with moderate to high myopia. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Field trials to attract questing stages of brown dog tick, Rhipicephalus sanguineus using tick pheromone-acaricide complex.

Evaluations were made to assess the efficacy of assembly pheromone, attractant sex pheromone and the kairomone carbon dioxide in attracting the questing larval nymphal and adult stages of the brown ear dog tick, Rhipicephalus sanguineus. Ticks attracted to one location were killed using the acaricide deltamethrin. Initially, simulated field trials were conducted to observe the percentage of attraction of ticks from different distances. Tick lure comprising of carbon dioxide as kairomone and 2,6-dichlorophenol in combination with assembly pheromone and deltamethrin on a thermocol platform was prepared and field trials were conducted in the kennels of Blue Cross Society of India, Velachery, Chennai. The tick lure attracted larval, nymphal and adult stages of R. sanguineus ticks in and around the kennels. Observations were made after 24 h of placing the tick lure. In simulated field out of the 50 ticks used for each distance trials, positive response was exhibited by a total number of 20 (40 %), 17 (34 %) and 14 (28 %) ticks from 0.5, 1 and 1.5 m, respectively. Field trials conducted revealed considerable attraction of larvae and nymph to the tick lure. Few adult ticks (2-5) were also lured to the pheromone impregnated filter paper disc.

Development of a practical complete-kill assay to evaluate anti-Acanthamoeba drugs.

IMPORTANCE: Acanthamoeba keratitis is a debilitating eye disease that requires effective topical drug therapy. Currently, there is no standard in vitro test to evaluate anti-Acanthamoeba drugs. OBJECTIVE: To develop a practical in vitro complete-kill assay to assess anti-Acanthamoeba drugs. DESIGN AND SETTING: Isolates of Acanthamoeba strains (n = 15) evaluated in a clinical laboratory. An in vitro laboratory assay was created to determine whether polyhexamethylene biguanide, 0.02%, chlorhexidine digluconate, 0.02%, hexamidine diisethioonate, 0.1%, and voriconazole, 1.0%, were effective in completely killing 15 different isolates of Acanthamoeba at time points of 24, 48, and 72 hours in comparison with a saline control. Each 0.5-mL volume of drug was inoculated with 0.1 mL of Acanthamoeba cysts (range, 1-3 × 10(6)/mL) (determined with a hemacytometer) and allowed to incubate at 30°C. At the time points listed, 0.05 mL from each treatment group was inoculated onto nonnutrient agar overlaid with Enterobacter aerogenes. The plates were microscopically examined for growth 1 and 2 weeks after inoculation. At 2 weeks, all plates were subcultured onto a fresh medium. At another 7 days, the growth in subculture at each time point was graded "1" for growth and "0" for no growth. MAIN OUTCOMES AND MEASURES: The cumulative grades of 3 time points (range, 0-3) for each drug and isolate were nonparametrically compared to determine differences in growth between the drugs. The "kill" incidence rates over the 3 time points were also compared. RESULTS: In vitro testing determined that antiacanthamoebal efficacy (determined by the median growth grade and the kill incidence rate) was more prominent for hexamidine diisethioonate (median growth grade, 0.0; kill incidence rate, 93% [14 of 15 isolates]) and polyhexamethylene biguanide (median growth grade, 0.0; kill incidence rate, 80% [12 of 15 isolates]) than for chlorhexidine digluconate (median growth grade, 1.0; kill incidence rate, 40% [6 of 15 isolates]), voriconazole (median growth grade, 2.0; kill incidence rate, 13% [2 of 15 isolates]), and saline (median growth grade, 3.0; kill incidence rate, 0% [0 of 15 isolates]). CONCLUSIONS AND RELEVANCE: The complete-kill assay appears to provide separation in the effectiveness of different antiamoebic drug solutions. This assay may be helpful for guiding topical Acanthamoeba therapy and providing a practical method to evaluate and screen new anti-infectives in the treatment of Acanthamoeba keratitis.

Effect of attractant sex pheromone on immature larval stages of ixodid tick species.

Attractant sex pheromone (ASP) 2,6-dichloro phenol was used in the current study to evaluate the percentage attraction and the behavioural responses of the five ixodid tick species namely Rhipicephalus sanguineus, Rhipicephalus microplus (Boophilus microplus), Haemaphysalis bispinosa, Rhipicephalus haemaphysaloides and Hyalomma marginatum using petridish bioassay. Two concentrations of 2,6-DCP (0.1 M and 0.05 M) was used for the larval stages of all five ixodid tick species of which 0.1 M concentration was found to have maximum attraction. Trials with 0.1 M ASP revealed highest per cent of attraction in R. sanguineus larvae (71 %) followed by H. bispinosa (55 %) and R. microplus (55 %). With 0.1 M ASP R. haemaphysaloides and H. marginatum showed least attraction (39 % each). However the per cent of attraction of R. haemaphysaloides was higher (46 %) with 0.05 M ASP. Statistical analysis revealed a highly significant difference in per cent of attraction between the different tick larvae using 0.05 and 0.1 M ASP. The larvae also exhibited behavioural responses such as feeding, probing, resting and questing posture.

Intraperitoneal bladder rupture mimicking acute renal failure.

We describe a patient who presented with acute onset of abdominal pain, oliguria, gross hematuria and uremia. Further examination revealed spontaneous intraperitoneal rupture of the urinary bladder. Upon repair of the rupture, his biochemistry normalized within 24 h. Acute renal failure is characterized by an abrupt decline in glomerular filtration rate (GFR), biochemically reflected by elevation in serum creatinine level. It usually displays multifactorial etiology and can be classified as prerenal, renal and postrenal. In this case report, we describe a situation in which the increase in serum creatinine level was not related to any of these factors and was associated with normal GFR and absorption of urine across the peritoneal membrane following spontaneous rupture of bladder.