Predictors of Ophthalmology Resident Performance From Medical Student Application Materials.

OBJECTIVE: To determine whether elements in ophthalmology residency applications are predictors of future resident performance. DESIGN: This multi-institutional, cross-sectional, observational study retrospectively reviewed the residency application materials of ophthalmology residents who graduated from residency from 2006 through 2018. Resident performance was scored by 2 faculty reviewers in 4 domains (clinical, surgical, academic, and global performance). Correlation between specific elements of the residency application and resident performance was assessed by Spearman correlation coefficients (univariate) and linear regression (multivariate) for continuous variables and logistic regression (multivariate) for categorical variables. SETTING: Seven ophthalmology residency programs in the US. PARTICIPANTS: Ophthalmology residents who graduated from their residency program. RESULTS: High-performing residents were a diverse group, in terms of sex, ethnicity, visa status, and educational background. Residents with United States Medical Licensing Examination Step 1 scores higher than the national average for that year had significantly higher scores in all 4 performance domains than those who scored at or below the mean (all domains P < 0.05). Residents who had honors in at least 4 core clerkships and who were members of Alpha Omega Alpha Medical Honor Society also had higher scores in all 4 performance domains (all domains P ≤ 0.04). Step 1 score (ρ=0.26, P < 0.001) and the difference between Step 1 score and the national average for that year (ρ=0.19, P = 0.009) positively correlated with total resident performance scores. Residents who passed the American Board of Ophthalmology Written Qualifying Examination or Oral Examination on their first attempt had significantly higher Step 1/2 scores (P ≤ 0.005), Ophthalmology Knowledge Assessment Program scores (P = 0.001), and resident performance scores (P ≤ 0.004). CONCLUSIONS: In this new landscape of increasing numbers of applicants to residency programs and changing of the Step 1 score to pass/fail, our findings may help guide selection committees as they holistically review applicants to select exceptional future residents in ophthalmology.

CD150-dependent hematopoietic stem cell sensing of Brucella instructs myeloid commitment.

So far, hematopoietic stem cells (HSC) are considered the source of mature immune cells, the latter being the only ones capable of mounting an immune response. Recent evidence shows HSC can also directly sense cytokines released upon infection/inflammation and pathogen-associated molecular pattern interaction while keeping a long-term memory of previously encountered signals. Direct sensing of danger signals by HSC induces early myeloid commitment, increases myeloid effector cell numbers, and contributes to an efficient immune response. Here, by using specific genetic tools on both the host and pathogen sides, we show that HSC can directly sense B. abortus pathogenic bacteria within the bone marrow via the interaction of the cell surface protein CD150 with the bacterial outer membrane protein Omp25, inducing efficient functional commitment of HSC to the myeloid lineage. This is the first demonstration of direct recognition of a live pathogen by HSC via CD150, which attests to a very early contribution of HSC to immune response.

Abuso sexual contra niños, niñas y adolescentes en Lima, Perú: una aproximación general a los patrones de personalidad, características sociodemográficas y el riesgo de violencia de los perpetradores / Sexual abuse of children and adolescents in Lima, Peru: an overview of personality patterns, socio-demographic characteristics and perpetrators' risk of violence / Abuso sexual de crianças e adolescentes em Lima, Peru: uma visão geral dos padrões de personalidade, características sociodemográficas e risco de violência por parte dos perpetradores

El riesgo de abuso sexual contra niños, niñas y adolescentes es un problema generalizado de salud pública y de derechos humanos que enfrentan todos los países. Este estudio tiene como objetivo determinar si las características sociodemográficas, el riesgo de violencia y los patrones de personalidad del perpetrador podrían predecir futuros episodios de abuso sexual infantil. Se realizó un estudio descriptivo transversal-correlacional en 32 personas privadas de la libertad (PPL) en un establecimiento penitenciario en Lima, Perú. Se utilizó la Ficha Sociodemográfica, el Inventario Clínico Multiaxial de Millon II y la Guía de Valoración del Riesgo de Violencia. Los participantes tenían una edad promedio de 41,5 ± 8,50 años; la mayoría mantenía una relación: convivientes (31,3%) y casados (21,9%); y tiene secundaria completa (56,3%). Los trastornos de personalidad predominantes fue-ron el dependiente (56,3%) y el compulsivo (84,4%). El 79% presentó riesgo moderado de violencia futura. Existen correlaciones modera-das y fuertes entre las variables de estudio; y la regresión logística multivariada reveló que la edad y algunos trastornos de personalidad podrían ser predictores del riesgo de abuso sexual infantil. Estos hallazgos son de utilidad para realizar perfiles delictivos de futuros agresores o reincidentes; y contribuyen al diseño de programas de prevención y tratamiento.

The risk of sexual abuse against children and adolescents is a widespread public health and human rights problem facing all countries. This study aims to determine whether socio-demographic characteristics, risk of violence and personality patterns of the perpetrator could predict future episodes of child sexual abuse. A descriptive cross-sectional-correlational study was conducted in 32 persons deprived of liberty (PPL) in a penitentiary establishment in Lima, Peru. The Sociodemographic Form, the Millon's Multiaxial Clinical Inventory II and the Violence Risk Assessment Guide were used. Participants had an average age of 41.5 ± 8.50 years; most were in a relationship: cohabiting (31.3%) and married (21.9%); and had completed secondary school (56.3%). The predominant personality disorders were dependent (56.3%) and compulsive (84.4%). Seventy-nine per cent were at moderate risk of future violence. There are moderate and strong correlations between the study variables; and multivariate logistic regression revealed that age and some personality disorders could be predictors of child sexual abuse risk. These findings are useful for criminal profiling of future offenders or repeat offenders; and contribute to the design of prevention and treatment programmes.

O risco de abuso sexual contra crianças e adolescentes é um problema generalizado de saúde pública e de direitos humanos enfrentado por todos os países. Este estudo visa determinar se as características sociodemográficas, o risco de violência e os padrões de personalidade do perpe-trador poderiam prever futuros episódios de abuso sexual infantil. Um estudo descritivo de corte transversal foi realizado em 32 pessoas privadas de liberdade (PPL) em um estabelecimento pe-nitenciário em Lima, Peru. Foram utilizados o Formulário Sociodemográfico, o Inventário Clínico Multiaxial II da Millon e o Guia de Avaliação de Risco de Violência. Os participantes tinham uma idade média de 41,5 ± 8,50 anos; a maioria estava em uma relação: coabitada (31,3%) e casada (21,9%); e tinha concluído o ensino médio (56,3%). Os distúrbios de personalidade predominantes eram dependentes (56,3%) e compulsivos (84,4%). Setenta e nove por cento estavam em risco moderado de violência futura. Há correlações moderadas e fortes entre as variáveis do estudo; e a regressão logística multivariada revelou que a idade e alguns distúrbios de personalidade poderiam ser preditores do risco de abuso sexual infantil. Estas descobertas são úteis para a caracterização criminal de futuros infratores ou reincidentes; e contribuem para a concepção de programas de prevenção e tratamento.

Community strategies for health promotion and prevention of chronic non-communicable diseases with a focus on physical activity and nutrition: the URO/FOCOS study protocol.

Non-communicable diseases (NCDs) account for 71% of all annual deaths, totaling 41 million people worldwide. The development and progression of these diseases are highly related to the environment and lifestyle choices, among which physical inactivity and excess malnutrition stand out. Currently, in Chile, there is no evidence at the regional and local level on the impact of physical activity and healthy nutrition plans and interventions on health promotion, prevention, and timely treatment of NCDs. The following protocol delineates the URO/FOCOS (Universidad Regional de O'Higgins/FOrtaleciendo COmunidades Saludables- Regional University of O'Higgins/Strengthening Healthy Communities) study, which will assess pilot community intervention strategies using a participatory action research approach by identifying barriers and facilitators on the practice of physical activity and healthy eating habits. In this project, the community from the O'Higgins region will be involved throughout the entire research process to develop strategies that promote regular physical activity and healthy eating practices. We propose three interrelated strategies: (1) Participatory Action Research, (2) Community interventions for promoting physical activity and healthy nutrition practices, and (3) health education. The URO/FOCOS study offers a unique opportunity in the O'Higgins region to develop participatory strategies and interventions based on the community's needs and motivations with regard to physical activity and healthy eating habits. We believe these strategies will help to improve the community's overall health through effective changes in their decision and preferences toward a more active lifestyle and healthier nutrition practices.

Reduced risk of infections with the intravenous immunoglobulin, IgPro10, in patients at risk of secondary immunodeficiency-related infections.

Aim: Patients with secondary immunodeficiency (SID) are at increased risk of infections and may be treated with immunoglobulin replacement therapy (IgRT). Despite growing efficacy evidence for IgRT in infection prevention in SID, treatment guidelines are not aligned. Materials & methods: A retrospective database analysis was conducted to assess treatment patterns and infection rates in patients at risk of SID-related infections, with or without IgRT (IgPro10) exposure, to evaluate real-world effectiveness of IgRT in infection prevention. Results: Of 11,448 patients included, 222 received IgPro10. B-cell malignancies and solid organ transplants were the predominant underlying conditions. Despite being sicker at baseline, the IgPro10 cohort demonstrated fewer infections post-index than the non-IgRT cohort. Conclusion: IgPro10 may be an effective option for infection prevention in SID.

Secondary immunodeficiency (SID) occurs when the immune system is weakened by external factors, including certain medical treatments. It can leave a person with an increased risk of potentially serious or even fatal infections, as they no longer have adequate defenses against bacteria. Some patients with this condition require treatment to boost their immune system, including supplementation of their antibodies, known as immunoglobulin replacement therapy (IgRT). In this study, we explored whether: (1) patients with conditions that are at risk of SID and associated infections received IgRT; and (2) whether receiving the IgRT reduced the incidence of infections. We found that patients who had IgRT were much less likely to experience infections than those who did not receive IgRT, suggesting that IgRT may be an effective treatment option for preventing infections in patients with compromised immune systems caused by SID.

Risk factors for severe infections in secondary immunodeficiency: a retrospective US administrative claims study in patients with hematological malignancies.

Real-world data are lacking to identify patients with secondary immunodeficiency (SID) who may benefit most from anti-infective interventions. This retrospective analysis used the IQVIA PharMetrics® Plus database to assess baseline characteristics associated with risk of severe infections post-SID diagnosis in patients with hematological malignancies. In 4066 patients included, the mean number of any and severe infections per patient in the one-year pre-SID diagnosis period was 9.5 and 0.7, respectively. Post-SID diagnosis, the mean annualized number of any and severe infections was 19.1 and 1.5, respectively. Receiver operating characteristic curve analysis identified a threshold (cutoff) of three bacterial infections at baseline as optimally predictive of severe infections post-SID diagnosis. Multivariate analysis indicated that hospitalizations, infections (≥3), or antibiotic use pre-SID diagnosis were predictive of severe infections post-SID diagnosis. Evaluation of these risk factors could inform clinical decisions regarding which patients may benefit from prophylactic anti-infective treatment, including immunoglobulin replacement if warranted.

Experiencia de padres/madres al cuidado de niños de 5 a 10 años con trastorno del espectro autista / Parent's experience caring for children 5 to 10 years old with autism spectrum disorder / Experiência dos pais a cuidar de crianças dos 5 aos10 anos com desordem do espectro do autismo

INTRODUCCIÓN: El trastorno del espectro autista contempla una serie de trastornos evolutivos comprometiendo diversos ejes. OBJETIVO: Develar experiencias vividas por los padres/madres al cuidado de niños/as de 5-10 años con Trastorno de espectro autista (TEA). METODOLOGÍA: Estudio cualitativo paradigma interpretativo diseño fenomenológico, en el que se recogieron las vivencias a través de entrevistas en profundidad a madres/padres que participan en las fundaciones de Chile, las que fueron grabadas y transcritas textualmente por las investigadoras con previo consentimiento de los participantes. Para el análisis de los discursos se cumplió con el rigor metodológico. RESULTADOS: Tras analizar las entrevistas, se develó un proceso dinámico y continuo de múltiples vivencias que permitieron a los participantes pasar desde la experiencia al cuidado de niños con TEA de alto funcionamiento, hasta las mejoras que se podrían aplicar en salud. CONCLUSIÓN: El hecho de tener un hijo/a con TEA lo convierte en un proceso complejo, el cual genera diversas emociones en los padres/madres, pero que a pesar de ello les ha permitido vivir un proceso de adaptación, mayor conocimiento teórico y práctico de la condición, permitiendo un crecimiento y desarrollo favorable para el niño/niña y las familias.

INTRODUCTION: Autism spectrum disorder contemplates a series of developmental disorderscompromising several axes. OBJECTIVE: To unveil experiences lived by parents caring forchildren aged 5-10 years with a high-functioning Autism Spectrum Disorder. METHODOLOGY: Qualitative study, interpretative paradigm,phenomenological design,the experiences collected through in-depth interviews with parents participating in foundations in Chile, which were recorded and transcribed verbatim by there searchers with the prior consent of the participants.For the analysis of the speeches, the methodological rigor meets. RESULTS: After analyzing the nterviews, a dynamic and continuous process of multiple experiences was revealed, which allowed the participants to go from the experience of caring for children with a high-functioning Autism Spectrum Disorderto the applicable improvements in health.CONCLUSION:The fact of having a child with ASD makes it a complex process, which generates diverseemotions in the parents, but despite this, it has allowed them to live a process of adaptation,greater theoretical and practical knowledge of the condition, allowing a favorable growth anddevelopmentforthechild and the families.

INTRODUÇÃO: A perturbação do espectro autista contempla uma série de perturbações dedesenvolvimento que comprometem vários eixos. OBJETIVO: Revelar experiências vividas por pais que cuidam decrianças dos5-10 anos comTranstorno do Espectro Autista(TEA). METODOLOGIA: Estudo qualitativo fenomenológico, no qualforamrecolhidas experiênciasatravés de entrevistas aprofundadas com mães e pais que participam em fundações no Chile, as quais foram gravadas e transcritas textualmente como consentimento prévio dos participantes.Para a análise dos dados,foi respeitado o rigor metodológico.RESULTADOS: Após análised as entrevistas,foi revelado um processo dinâmico e contínuo de múltiplas experiências,o que permitiua os participantes passar da experiência de cuidar de crianças comTEA de alta funcionalidade para as melhorias que poderiam ser aplicadas na saúde.CONCLUSÃO: Ofacto deter uma criança comTEA é um processo complexo,que gera diversas emoções nos pais,mas que a pesar disso puderam viver um processo de adaptação,maior conhecimento teórico e prático da condição, permitindo um crescimento e desenvolvimento favorável para a criança e para as famílias

Elementos de protección y nivel de contagio de Covid 19 en el personal sanitario que labora en un hospital ecuatoriano / Elements of protection and level of Covid 19 in the sanitary personnel working in an Ecuadorian hospital

INTRODUCCIÓN: el COVID-19 es una afección ocasionada por el SARS COV2 que ha tenido grandes repercusiones en la salud de la población a nivel mundial, principalmente en la población vulnerable, entre los cuales se encuentra el personal de salud, ya que están en la primera línea de atención en las unidades de salud, es por ello que se ven en la necesidad del uso del equipo de protección personal para disminuir el nivel de riesgo de contagio. OBJETIVO: identificar los elementos de protección y el nivel de contagio de COVID-19 en el personal de Salud que labor en los Hospitales Ecuatorianos. MATERIAL Y MÉTODOS: el actual estudio es de alcance descriptivo, enfoque cuantitativo, en un periodo de tiempo determinado, con una muestra del estudio de 218 trabajadores entre médicos, enfermeros y auxiliares a los cuales se les aplico la encuesta virtual. RESULTADOS: el 95.9% recibió mascarilla N95,76.6 % overol, 87.2%zapatones, 86.2 % las gafas, 91.7 % gorro, 93,1% guantes y 56,9% protector facial, el 96.3 % menciona que ha recibido capacitación sobre el uso de Equipo de Protección Personal (EPP) por parte de la institución, el 76.6 %del personal refieren haber presentado signos y síntomas de COVID-19, el 63.1 % de los resultados de prueba rápida fue positivos y la prueba de hisopado nasofaríngeo el 32,7 % tuvieron un resultaron positivo y 45,7% aún se encuentran en espera de los resultados. CONCLUSIONES: los elementos de protección que recibieron por parte de la Institución, en la pandemia de COVID-19 fueron: mascarilla N95, overol, zapatones, gafas, protector facial, gorro y guantes para la atención de los pacientes en el área hospitalaria, además de obtener capacitaciones acerca del uso correcto del EPP. Sin embargo, el nivel de contagio es elevado según las pruebas positivas rápidas e hisopado nasofaríngeo.

INTRODUCTION: COVID-19 is a condition caused by SARS COV2 that has had great repercussions on the health of the population worldwide, mainly on the vulnerable population, among which are health personnel, since they are on the front line. Care in health units, that is why they are in need of the use of personal protective equipment to reduce the level of risk of infection. OBJECTIVE: to identify the protection elements and the level of contagion of COVID-19 in the Health personnel who work at the Ecuadorians Hospitals. MATERIAL AND METHODS: the current study is descriptive in scope, quantitative approach, in a given period of time, with a sample of the study of 218 workers including doctors, nurses and assistants to whom the virtual survey was applied. RESULTS: 95.9% received N95 mask, 76.6% overalls, 87.2% sneakers, 86.2% glasses, 91.7% hat, 93.1% gloves and 56.9% face protector, 96.3% mention that they have received training on the use of Personal Protective Equipment (PPE) by the institution, 76.6% of the staff report having presented signs and symptoms of COVID-19, 63.1% of the rapid test results were positive and the nasopharyngeal swab test was 32, 7% had a positive result and 45.7% are still awaiting the results. CONCLUSIONS: the protection elements received by the Institution in the COVID-19 pandemic were: N95 mask, overalls, shoes, glasses, face shield, hat and gloves for patient care in the hospital area, in addition to obtain training on the correct use o PPE. However, the level of infection is high according to rapid positive tests and nasopharyngeal swab.

Prevalencia de obesidad y dislipidemias, y su relación con la hipertensión arterial en trabajadores universitarios en Ecuador / Prevalence of obesity and dyslipidemias, and their relationship to high blood pressure in university workers in Ecuador

IINTRODUCCIÓN: la hipertensión arteriales una entidad asintomática, cuyos factores de riesgo son el peso corporal, la dieta, el consumo de alcohol y tabaco, el sedentarismo, las dislipidemias, la hiperglicemia y la diabetes. La obesidad como consecuencia de la malnutrición por exceso es un importante problema de la salud pública en el mundo entero, ya que esto representa un alto costo económico y social para las personas y el Estado. Las dislipidemias son enfermedades metabólicas que cursan con concentraciones anormales de lípidos en la sangre, siendo un factor de riesgo para la presentación de enfermedades cardiovasculares. Es muy frecuente la relación entre estas entidades y la HTA. El objetivo del presente trabajo fue identificar la prevalencia de dislipidemias y obesidad y su relación con la presencia de hipertensión arterial en trabajadores universitarios en una región de Ecuador. MATERIAL Y MÉTODOS: la investigación fue observacional, descriptiva, cuantitativa, de corte transversal. Se seleccionaron 60 trabajadores, se tomaron muestras de sangre al igual que se registró su presión arterial. Con los datos de talla y peso se calculó el IMC para el estudio. Los datos se analizaron en SPSS. RESULTADOS: el 36,66% tuvo hipercolesterolemia, el 41,66% hipertrigliceridemia. El 55% tuvo cifras bajas de HDL, y el 18,33% tuvo cifras elevadas de LDL. El 20% presentó dislipidemia mixta. El 10% presentó obesidad, el 53,33% sobrepeso y el 36,66% peso normal. La prevalencia de hipertensión fue de apenas el 18,33%. Existe correlación entre la hipertensión y el consumo de alcohol, así como con los valores de LDL. CONCLUSIONES. Las prevalencias de obesidad, dislipidemias e hipertensión arterial en los trabajadores universitarios estudiados, son similares a las presentadas en la región, a excepción de la obesidad que registra una prevalencia baja. Las dislipidemias, a excepción de la Hiper LDL, no guardan correlación con la HTA.

INTRODUCTION: arterial hypertension is an asymptomatic entity, whose risk factors are body weight, diet, alcohol and tobacco consumption, sedentarism, dyslipidemias, hyperglycemia and diabetes. Obesity as a consequence of overnutrition is a major public health problem worldwide, as it represents a high economic and social cost for individuals and the State. Dyslipidemias are metabolic diseases with abnormal concentrations of lipids in the blood, and are a risk factor for cardiovascular disease. The relationship between these entities and ETS is very frequent. The aim of the present work was to identify the prevalence of dyslipidemias and obesity and its relation with the presence of arterial hypertension in university workers in a region of Ecuador. MATERIAL AND METHODS: the research was observational, descriptive, quantitative, and cross-sectional. Sixty workers were selected, blood samples were taken, and their blood pressure was recorded. With the data of height and weight the BMI was calculated for the study. The datawere analyzed in SPSS. Results: 36.66% had hypercholesterolemia, 41.66% hypertriglyceridemia. 55% had low HDL, and 18.33% had high LDL. 20% had mixed dyslipidemia. 10% presented obesity, 53.33% overweight and 36.66% normal weight. The prevalence of hypertension was only 18.33%. There is a correlation between hypertension and alcohol consumption, as well as with LDL values. CONCLUSIONS: the prevalence of obesity, dyslipidemias and hypertension in the university workers studied, are similar to those presented in the region, except for obesity which has a low prevalence. Dyslipidemias, with the exception of Hyper LDL, are not correlated with ETS.Keywords:dyslipidemias, overweight, obesity, hypertension, correlation.

Orbital Vasculitides-Differential Diagnosis.

PURPOSE OF REVIEW: The orbit is subject to a variety of vascular insults that manifest with both specific and nonspecific patterns of vision compromise. The aim of the following review is to highlight the ophthalmic clinical features of systemic vasculitides that most frequently involve the orbit and differentiate them from the most common non-vasculitic orbital disorders. RECENT FINDINGS: New studies continue to explore the autoimmune nature of vasculitic disease and seek to determine optimal use of newer therapies such as biologic agents. The pattern of ocular involvement in the context of clinical history allows the knowledgeable physician to distill a differential diagnosis into a specific or likely cause. Establishing a diagnosis in a timely fashion allows for a custom-tailored approach to therapy.

Intraosseous Orbital Cavernous Hemangioma with Frontal Extension and Dural Involvement.

Primary intraosseous cavernous hemangiomas are rare skull lesions that are not typically known to involve the orbital bones or the dura. We describe a rare case of a fronto-orbital bone cavernous hemangioma with extension into the dura. A 68-year-old female presented with a one-year history of diplopia with discomfort around her left orbit. Magnetic resonance images demonstrated a mass in the left frontal skull extending into the orbital rim. The patient underwent a craniotomy for tumor resection. Dural invasion was found intraoperatively. Gross total resection and reconstruction were achieved. On the postoperative follow-up, the patient was asymptomatic.  Primary calvarial intraosseous cavernous hemangiomas are most commonly located in the frontal and parietal bones. These lesions typically involve only the outer table of the skull. In lesions involving the orbit and dura, excision with cranioplasty can provide symptomatic relief with good cosmetic outcomes.

Depletion of Complement Enhances the Clearance of Brucella abortus in Mice.

Brucellosis is a bacterial disease of animals and humans. Brucella abortus barely activates the innate immune system at the onset of infection, and this bacterium is resistant to the microbicidal action of complement. Since complement stands as the first line of defense during bacterial invasions, we explored the role of complement in B. abortus infections. Brucella abortus-infected mice depleted of complement with cobra venom factor (CVF) showed the same survival rate as mice in the control group. The complement-depleted mice readily eliminated B. abortus from the spleen and did so more efficiently than the infected controls after 7 days of infection. The levels of the proinflammatory cytokines tumor necrosis factor alpha and interleukin-6 (IL-6) remained within background levels in complement-depleted B. abortus-infected mice. In contrast, the levels of the immune activator cytokine gamma interferon and the regulatory cytokine IL-10 were significantly increased. No significant histopathological changes in the liver and spleen were observed between the complement-depleted B. abortus-infected mice and the corresponding controls. The action exerted by Brucella on the immune system in the absence of complement may correspond to a broader phenomenon that involves several components of innate immunity.

Online Ratings of ASOPRS Surgeons: What Do Your Patients Really Think of You?

PURPOSE: To characterize patient evaluations of American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) surgeons on a popular online physician rating website in an effort to determine which factors play a role in determining the likelihood of a patient recommending an ASOPRS surgeon to family and friends. METHODS: After obtaining approval and access from Healthgrades.com, the website database was searched for 612 U.S.-based ASOPRS members using their name as published on http://www.asoprs.org/ as of May 2015. For each surgeon, the total number of ratings and average ratings were recorded under each category. The evaluator recommendation, defined as the response to the questions of "likelihood of recommending Dr. X to family and friends," constituted the main outcome measure. Variables from each surgeon were compared using unpaired t tests, with statistical significance set at p < 0.05. Correlations were analyzed using Spearman correlation (rs), with coefficients of greater than or equal to 0.40 or less than or equal to -0.40 considered significant. RESULTS: Five-hundred nineteen members (85%) had at least 1 rating while 222 members (36%) had 10 or more ratings. The mean number of ratings for all rated members was 11.4 (range, 1-77; standard deviation [SD] = 11.1) and mean evaluator recommendation score was 4.16 (range, 1-5; SD = 0.79). There was a strong negative correlation between total wait time and evaluator recommendation score (rs = -0.409, p < 0.001). The average number of ratings and rating scores for all categories were not significantly different when comparing male with female members. University-employed members had significantly fewer ratings (8.46; range, 1-52; SD = 9.3) compared with other members (11.9; range, 1-77; SD = 11.3) (p < 0.016). There were no differences in any other rating score when comparing those university-employed members with other members. CONCLUSION: Online patient-reported evaluations of ASOPRS surgeons appear high in many categories. Long wait times correlate strongly with lower recommendation scores. Further study is required to determine how online patient reviews correlate to objective outcome measures, and how these reviews affect surgeon selection by patients.

Upper Eyelid Reconstruction.

Reconstruction of the upper eyelid is complicated because the eyelid must retain mobility, flexibility, function, and a suitable mucosal surface over the delicate cornea. Defects of the upper eyelid may be due to congenital defects or traumatic injury or follow oncologic resection. This article focuses on reconstruction due to loss of tissue. Multiple surgeries may be needed to reach the desired results, addressing loss of tissue and then loss of function. Each defect is unique and the laxity and availability of surrounding tissue vary. Knowing the most common techniques for repair assists surgeons in the multifaceted planning that takes place.

Brucella canis is an intracellular pathogen that induces a lower proinflammatory response than smooth zoonotic counterparts.

Canine brucellosis caused by Brucella canis is a disease of dogs and a zoonotic risk. B. canis harbors most of the virulence determinants defined for the genus, but its pathogenic strategy remains unclear since it has not been demonstrated that this natural rough bacterium is an intracellular pathogen. Studies of B. canis outbreaks in kennel facilities indicated that infected dogs displaying clinical signs did not present hematological alterations. A virulent B. canis strain isolated from those outbreaks readily replicated in different organs of mice for a protracted period. However, the levels of tumor necrosis factor alpha, interleukin-6 (IL-6), and IL-12 in serum were close to background levels. Furthermore, B. canis induced lower levels of gamma interferon, less inflammation of the spleen, and a reduced number of granulomas in the liver in mice than did B. abortus. When the interaction of B. canis with cells was studied ex vivo, two patterns were observed, a predominant scattered cell-associated pattern of nonviable bacteria and an infrequent intracellular replicative pattern of viable bacteria in a perinuclear location. The second pattern, responsible for the increase in intracellular multiplication, was dependent on the type IV secretion system VirB and was seen only if the inoculum used for cell infections was in early exponential phase. Intracellular replicative B. canis followed an intracellular trafficking route undistinguishable from that of B. abortus. Although B. canis induces a lower proinflammatory response and has a stealthier replication cycle, it still displays the pathogenic properties of the genus and the ability to persist in infected organs based on the ability to multiply intracellularly.

Reduction of cytotoxicity of benzalkonium chloride and octenidine by Brilliant Blue G.

The irritative effects of preservatives found in ophthalmologic solution, or of antiseptics used for skin disinfection is a consistent problem for the patients. The reduction of the toxic effects of these compounds is desired. Brilliant Blue G (BBG) has shown to meet the expected effect in presence of benzalkonium chloride (BAK), a well known preservative in ophthalmic solutions, and octenidine dihydrochloride (Oct), used as antiseptic in skin and wound disinfection. BBG shows a significant protective effect on human corneal epithelial (HCE) cells against BAK and Oct toxicity, increasing the cell survival up to 51 % at the highest BAK or Oct concentration tested, which is 0.01 %, both at 30 min incubation. Although BBG is described as a P2x7 receptor antagonist, other selective P2x7 receptor antagonists, OxATP (adenosine 5'-triphosphate-2',3'-dialdehyde) and DPPH (N'-(3,5-dichloropyridin-4-yl)-3-phenylpropanehydrazide), did not reduce the cytotoxicity of neither BAK nor Oct. Therefore we assume that the protective effect of BBG is not due to its action on the P2x7 receptor. Brilliant Blue R (BBR), a dye similar to BBG, was also tested for protective effect on BAK and Oct toxicity. In presence of BAK no significant protective effect was observed. Instead, with Oct a comparable protective effect was seen with that of BBG. To assure that the bacteriostatic effect is not affected by the combinations of BAK/BBG, Oct/BBG and Oct/BBR, bacterial growth inhibition was analyzed on different Gram-negative and Gram-positive bacteria. All combinations of BAK or Oct with BBG hinder growth of Gram-positive bacteria. The combinations of 0.001 % Oct and BBR above 0.025 % do not hinder the growth of B. subtilis. For Gram-negative bacteria, BBG and BBR reduce, but do not abolish, the antimicrobial effect of BAK nor of Oct. In conclusion, the addition of BBG at bacterial inhibitory concentrations is suggested in the ready-to-use ophthalmic preparations and antiseptic solutions.

Expression of extra-cellular levansucrase in Pseudomonas syringae is controlled by the in planta fitness-promoting metabolic repressor HexR.

BACKGROUND: Pseudomonas syringae pv. glycinea PG4180 causes bacterial blight on soybean plants and enters the leaf tissue through stomata or open wounds, where it encounters a sucrose-rich milieu. Sucrose is utilized by invading bacteria via the secreted enzyme, levansucrase (Lsc), liberating glucose and forming the polyfructan levan. P. syringae PG4180 possesses two functional lsc alleles transcribed at virulence-promoting low temperatures. RESULTS: We hypothesized that transcription of lsc is controlled by the hexose metabolism repressor, HexR, since potential HexR binding sites were identified upstream of both lsc genes. A hexR mutant of PG4180 was significantly growth-impaired when incubated with sucrose or glucose as sole carbon source, but exhibited wild type growth when arabinose was provided. Analyses of lsc expression resulted in higher transcript and protein levels in the hexR mutant as compared to the wild type. The hexR mutant's ability to multiply in planta was reduced. HexR did not seem to impact hrp gene expression as evidenced by the hexR mutant's unaltered hypersensitive response in tobacco and its unmodified protein secretion pattern as compared to the wild type under hrp-inducing conditions. CONCLUSIONS: Our data suggested a co-regulation of genes involved in extra-cellular sugar acquisition with those involved in intra-cellular energy-providing metabolic pathways in P. syringae.

Cogan's syndrome and other ocular vasculitides.

The clinical presentation of Cogan's syndrome has been classified as typical and atypical. Like other forms of ocular vasculitis, Cogan's syndrome has been found to have autoimmune origins with antibodies against the cornea, inner ear, and endothelial antigens. Antineutrophil cytoplasmic antibody (ANCA) and rheumatoid factor (RF) have been associated with Cogan's syndrome as well as ocular-involving vasculitides not as strongly associated with the audiovestibular manifestations such as granulomatosis with polyangiitis and rheumatoid arthritis. The mainstay of therapy has been corticosteroids although other methods have been described in recalcitrant disease and to prevent development of systemic sequelae.

Ocular vasculitis.

Vasculitis is the inflammation of blood vessels that leads to loss of perfusion and ischemia with necrosis. When this occurs in the orbit, the consequences are typically very conspicuous and can be devastating with decreased quality of life and loss of vision. Systemic vasculitides are often related to ophthalmic disorders, which can serve as the first diagnostic manifestation of potentially life-threatening disease. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (e.g., granulomatosis with polyangiitis), Behcet's disease, rheumatoid arthritis, sarcoidosis, and systemic lupus erythematosus are a few of the diseases commonly associated with ocular vasculitis. Collaboration between ophthalmologists and rheumatologists is important in the successful diagnosis and treatment of patients with vasculitis.