Primary care optometry-based diabetic retinopathy review clinics - a new model of care and comparison with virtual diabetic retinopathy clinics.

BACKGROUND: Given the increasing prevalence of diabetes and diabetic retinopathy (DR) in the UK, this study evaluates a novel primary care optometry-based DR review service against traditional hospital-based virtual DR clinics. METHODS: In the hospital-based virtual DR service, patients attended for data capture (visual acuity, fundus photography, macular OCT scanning) with asynchronous review at a later data by a hospital clinician. In the primary care optometry DR review clinic, patients attended an optometry practice for a face-to-face(F2F) review (with imaging) by an optometrist with additional training in DR. Data from both clinic types were analysed. Metrics included DR grading, management plans, grading concordance between primary care optometrists and consultant ophthalmologists, and the assessment of "ungradable" retinopathy referrals. RESULTS: One thousand seven hundred and sixty patients attended the virtual clinic between January 2021 and September 2023. 954 patients attended the primary care review clinic between August 2022 and September 2023. Grading agreements between primary care optometrists and hospital consultants on those patients referred for consultant opinion were significant with Weighted Kappa scores of 0.61(95% CI 0.52-0.69) for DR grade and 0.69(95% CI 0.56-0.82) for diabetic macular oedema (DMO) status. Additionally, the primary care optometry clinic reported a considerably reduced non-attendance rate of 5%, in contrast to 21% in virtual clinics. CONCLUSION: The primary care optometry-based DR service emerges as an efficient, safe alternative to hospital services. It offers notable advantages over virtual clinics and addresses a care gap for those unsuitable for virtual consultations. The results highlight the potential of primary care-based models in managing DR.

Bilateral cystoid macular edema as the presenting feature of chronic myeloid leukemia.

PURPOSE: Ophthalmic disease may rarely be a presenting feature of chronic myeloid leukemia (CML). METHODS: We report a case of a 53-year-old man with type 1 diabetes mellitus who presented with a rapid onset of bilateral blurred vision. RESULTS: He was noted to have bilateral macular edema and was initially treated for presumed diabetic macular edema (DME) with intravitreal alifbercept injections. One month later, there was complete resolution of his macular edema. Review of his history and imaging revealed features atypical for DME, specifically; the rapid onset of bilateral blurred vision over 2-3 weeks, numerous cotton wool spots within the macula, the absence of any exudates, the symmetrical macular edema with a "vaulted ceiling" appearance (more typical of cystoid macular edema) and the dramatic response to a single intravitreal aflibercept injection. One week after his intravitreal injection, the patient was diagnosed with CML following marked leucocytosis on a routine blood test by his general practitioner. Although uncommon, sudden onset bilateral edema in the absence of other chronic diabetic changes should prompt consideration of an underlying haematological cause. CONCLUSION: This case highlights the importance of considering CML as a differential diagnosis in patients presenting with sudden onset, bilateral cystoid macular oedema. Vigilance is especially important in patients with co-existing diabetic retinopathy as the clinical features of leukemic retinopathy can overlap. Furthermore, the diagnosis of CML in a patient with diabetes mellitus should prompt extra observation for accelerated worsening of diabetic retinopathy.

Drought trends projection under future climate change scenarios for Iran region.

The study highlights the potential characteristics of droughts under future climate change scenarios. For this purpose, the changes in Standardized Precipitation Evapotranspiration Index (SPEI) under the A1B, A2, and B1 climate change scenarios in Iran were assessed. The daily weather data of 30 synoptic stations from 1992 to 2010 were analyzed. The HadCM3 statistical model in the LARS-WG was used to predict the future weather conditions between 2011 and 2112, for three 34-year periods; 2011-2045, 2046-2079, and 2080-2112. In regard to the findings, the upward trend of the potential evapotranspiration in parallel with the downward trend of the precipitation in the next 102 years in three scenarios to the base timescale was transparent. The frequency of the SPEI in the base month indicated that 17.02% of the studied months faced the drought. Considering the scenarios of climate change for three 34-year periods (i.e., 2011-2045, 2046-2079, and 2080-2112) the average percentages of potential drought occurrences for all the stations in the next three periods will be 8.89, 16.58, and 27.27 respectively under the B1 scenario. While the predicted values under the A1B scenario are 7.63, 12.66, and 35.08%respectively. The relevant findings under the A2 scenario are 6.73, 10.16, 40.8%. As a consequence, water shortage would be more serious in the third period of study under all three scenarios. The percentage of drought occurrence in the future years under the A2, B1, and A1B will be 19.23%, 17.74%, and 18.84%, respectively which confirms the worst condition under the A2 scenario. For all stations, the number of months with moderate drought was substantially more than severe and extreme droughts. Considering the A2 scenario as a high emission scenario, the analysis of SPEI frequency illustrated that the proportion of dry periods in regions with humid and cool climate is more than hot and warm climates; however, the duration of dry periods in warmer climates is longer than colder climates. Moreover, the temporal distribution of precipitation and potential evapotranspiration indicated that in a large number of stations, there is a significant difference between them in the middle months of the year, which justifies the importance of prudent water management in warm months.

Bilateral, sequential orbital inflammation secondary to relapsing polychondritis.

This report describes a case of a Caucasian man in his 60s with bilateral sequential orbital inflammatory disease associated with relapsing polychondritis (RPC).He first presented with a subclavian vein periphlebitis/thrombosis and swollen left knee. Two weeks later, he developed right orbital inflammation with restricted eye movements. He was treated initially for possible orbital cellulitis. His inflammation failed to respond to antibiotics but rapidly resolved with oral prednisolone. One year later, he presented with left auricular inflammation, a maculopapular rash on his arms and torso and left orbital inflammation. Again, he failed to respond to antibiotics but had rapid resolution of his inflammatory signs following oral prednisolone.Based on his previous inflammatory arthropathy, auricular inflammation, orbital inflammation and response to oral steroids, he was diagnosed with RPC based on the McAdam diagnostic criteria. His steroids were tapered and he was commenced on methotrexate as maintenance therapy.

Can Simvastatin Reduce the Need for Immunomodulatory Drugs to Treat Uveitis?: A Prospective, Randomized, Placebo-Controlled Trial.

Objective: To assess the efficacy of simvastatin 80 mg/day versus placebo in patients with noninfectious nonanterior uveitis receiving prednisolone ≥ 10 mg/day. Design: Randomized, double-masked, controlled trial. Subjects: Adult patients with noninfectious nonanterior uveitis on oral prednisolone dose of ≥ 10 mg/day. Methods: Patients were randomly assigned at a 1:1 ratio to receive either simvastatin 80 mg/day or placebo. A total of 32 patients were enrolled (16 in each arm), all of whom completed the primary end point, and 21 reached the 2-year visit (secondary end points). Main Outcome Measures: The primary end point was mean reduction in the daily prednisolone dose at 12 months follow-up. Secondary end points were mean reduction in prednisolone dose at 24 months, percent of patients with a reduction in second-line immunomodulatory agents, time to disease relapse, and adverse events. Results: Our results show that simvastatin 80 mg/day did not have a significant corticosteroid-sparing effect at 12 months (estimate: 3.62; 95% confidence interval [CI]: -8.15 to 15.38; P = 0.54). There was no significant difference between the groups with regard to prednisolone dose or change in dose at 12 and 24 months. There was no difference between the 2 groups in percent of patients with reduction in second-line agent by 24 months. Among patients who achieved disease quiescence, the median time to first relapse was longer for those receiving simvastatin (38 weeks, 95% CI: 14-54) than placebo (14 weeks, 95% CI: 12-52), although this was not statistically significant. There was no significant difference in adverse events or serious adverse events between the 2 groups. Conclusions: Simvastatin 80 mg/day did not have an effect on the dose reduction of corticosteroids or conventional immunomodulatory drugs at 1 and 2 years. The results suggest that it may extend the time to disease relapse among those who achieve disease quiescence. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Cd(II) and Pd(II) Mixed Ligand Complexes of Dithiocarbamate and Tertiary Phosphine Ligands-Spectroscopic, Anti-Microbial, and Computational Studies.

Mixed ligand complexes of Pd(II) and Cd(II) with N-picolyl-amine dithiocarbamate (PAC-dtc) as primary ligand and tertiary phosphine ligand as secondary ligands have been synthesized and characterized via elemental analysis, molar conductance, NMR (1H and 31P), and IR techniques. The PAC-dtc ligand displayed in a monodentate fashion via sulfur atom whereas diphosphine ligands coordinated as a bidentate mode to afford a square planner around the Pd(II) ion or tetrahedral around the Cd(II) ion. Except for complexes [Cd(PAC-dtc)2(dppe)] and [Cd(PAC-dtc)2(PPh3)2], the prepared complexes showed significant antimicrobial activity when evaluated against Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans and Aspergillus niger. Moreover, DFT calculations were performed to investigate three complexes {[Pd(PAC-dtc)2(dppe)](1), [Cd(PAC-dtc)2(dppe)](2), [Cd(PAC-dtc)2(PPh3)2](7)}, and their quantum parameters were evaluated using the Gaussian 09 program at the B3LYP/Lanl2dz theoretical level. The optimized structures of the three complexes were square planar and tetrahedral geometry. The calculated bond lengths and bond angles showed a slightly distorted tetrahedral geometry for [Cd(PAC-dtc)2(dppe)](2) compared to [Cd(PAC-dtc)2(PPh3)2](7) due to the ring constrain in the dppe ligand. Moreover, the [Pd(PAC-dtc)2(dppe)](1) complex showed higher stability compared to Cd(2) and Cd(7) complexes which can be attributed to the higher back-donation of Pd(1) complex.

The ocular manifestations of relapsing polychondritis.

PURPOSE: Relapsing polychondritis (RPC) is a rare, multi-system, inflammatory disorder. Ocular disease is estimated to occur in 14-67% of patients with RPC, and any ocular structure can be affected. Published case reports and series of RPC were analysed to determine the frequency and nature of the ocular manifestations of RPC, including the age and gender distribution. METHODS: A literature search of the MEDLINE database for case reports and series on RPC was conducted in October 2021 using search terms [relapsing polychondritis (MeSH Major Topic)] OR [relapsing polychondritis (Title/Abstract)]. Articles were included if the diagnosis of RPC was confirmed using established diagnostic criteria and if the paper described the clinical features of patients with RPC. RESULTS: 546 articles (454 case reports and 92 case series) described the clinical features in a total of 2414 patients with RPC. 49% of patients with RPC had ocular involvement, and this was a presenting feature in 21%. The most common ocular manifestations were scleritis (32%), episcleritis (31%) and uveitis (23%). CONCLUSION: Many patients with RPC will be seen by an ophthalmologist during the course of their disease. Knowledge and awareness of RPC and its ocular manifestations is therefore essential to enable the ophthalmologist to make the diagnosis.

Palladium(II) ortho-cyano-aminothiophenolate (ocap) complexes.

A series of Pd(II) complexes containing ortho-cyano-aminothiophenolate (ocap) ligands have been prepared and their molecular structures elucidated. Hg(II) ocap complexes, [Hg{SC6H3XN(CN)}]n (X = H, Me) (1), react with Na2S to afford HgS and Na2[ocap] which reacts in situ with K2[PdCl4] to afford palladium ocap complexes [Pd{SC6H3XN(CN)}]n (2). A second route to these coordination polymers has also been developed from reactions of 2-aminobenzothiazole (abt) complexes, trans-PdCl2(abt)2 (3), with NaOH. We have not been able to crystallographically characterise coordination polymers 2, but addition of PPh3, a range of phosphines and cyclic diamines affords mono and binuclear complexes in which the ocap ligand adopts different coordination geometries. With PPh3, binuclear [Pd(µ-κ2,κ1-ocap)(PPh3)]2 (4) results, in which the ocap bridges the Pd2 centre acting as an S,N-chelate to one metal centre and binding the second via coordination of the cyanide nitrogen. In contrast, with diphosphines, Ph2P(CH2)nPPh2 (n = 1-4), mononuclear species predominate as shown in the molecular structures of Pd(κ2-ocap){κ2-Ph2P(CH2)nPPh2} (5-7; n = 1-3). With 2,2'-bipy and 1,10-phen we propose that related monomeric chelates Pd(κ2-ocap)(κ2-bipy) (9) and Pd(κ2-ocap)(κ2-phen) (10) result but we have been unable to substantiate this crystallographically. Addition of HgCl2(phen) to 9a (generated in situ) affords heterobimetallic Pd(κ2-phen)(µ-κ2,κ1-ocap)HgCl2(κ2-phen) (11), in which Hg(II) is coordinated through the ring sulfur.

Emerging Antibiotic Resistance Patterns Affect Visual Outcome Treating Acute Endophthalmitis.

Background: Examining the effect of antibiotic resistance, use of intravitreal antibiotics and systemic corticosteroids on visual outcome of eyes with acute endophthalmitis. Methods: We included 226 eyes with acute endophthalmitis, treated using a standardized protocol. Visual outcome up to 12 months was assessed related to biopsy results, antibiotics resistance and treatment regimens. Results: Vitreous biopsies were more likely to be culture-positive (41.1%) than anterior chamber biopsies (21.6%, p < 0.0001). Antibiotic resistance for amikacin was found in 19 eyes (24.7%), vancomycin in 29 eyes (31.5%) and moxiflocacin in 14 eyes (16.1%). At presentation 91.53% of eyes had BCVA < 20/40, reducing by 1 month to 69.94% (p < 0.0001) and remaining stable at 12 months. There was no difference in visual outcome for those receiving early systemic corticosteroids. Endophthalmitis following cataract surgery (OR 1.66, 1.04−2.66 95% CI, p = 0.03) and receiving intravitreal vancomycin (OR 3.15, 1.18−8.42 95% CI, p = 0.02) were associated with a greater chance of final BCVA ≥ 20/40. Conclusion: Using vitreous taps with intravitreal antibiotics, despite an increase in resistance to both vancomycin and moxifloxacin, results in a final BCVA > 20/200 in half of eyes and ≥20/40 in a third. Early treatment with intravitreal antibiotics should not be delayed.

Synthesis, structure and reactivity with phosphines of Hg(II) ortho-cyano-aminothiophenolate complexes formed via C-S bond cleavage and dehydrogenation of 2-aminobenzothiazoles.

Addition of 2-aminobenzothiazole (abt) and substituted derivatives to Hg(OAc)2 leads to the high yield formation of ortho-cyano-aminothiophenolate (ocap) complexes [Hg{SC6H3XN(CN)}]n (X = H, Me, Cl, Br, NO2) resulting from dehydrogenation and C-S bond cleavage. The reaction appears to be unique to Hg(OAc)2 and with HgCl2 the product [HgCl2(abt)]n contains an intact abt ligand, but reacts with acetate to afford the ocap complex [Hg{SC6H4N(CN)}]n. Binding of abt to Hg(II) has previously been probed in molecular structures of [Hg(sac)2(abt)L] (L = MeOH, DMSO) and these have been reexamined to understand the perturbation of abt upon coordination. When the reaction of abt and Hg(OAc)2 was carried out at low temperatures the intermediate [Hg(κ2-OAc)(EtOH)(µ-HNCNSC6H4)]2 was isolated resulting from a single ligand deprotonation thus allowing a mechanism for ring-opening to be proposed. Reactions of [Hg{SC6H3XN(CN)}]n with mono- and bidentate phosphines have been studied, affording a series of complexes in which the ocap ligands adopt four different binding modes in the solid state, as shown by a number of crystallographic studies. In all, the ligand chelates to a single mercury centre but spans to the second via either: (i) a simple S,N-chelate, (ii) coordination through nitrogen of the CN group, (iii) the sulfur acting as a thiolate-bridge, (iv) both thiolate bridging and cyanide coordination. With PPh3 two different binding modes are seen in complexes [Hg{SC6H3XN(CN)}(PPh3)]2 being dependant upon the nature of the arene-substituent, while addition of excess PPh3 affords mononuclear [Hg{SC6H3XN(CN)}(PPh3)2]. With dppm, binuclear [Hg{SC6H3XN(CN)}(κ1-dppm)]2 result in which the diphosphine binds in a monodentate fashion. With the more flexible diphosphines, dppe and dppb, coordination polymers [Hg{SC6H3XN(CN)}(κ1,κ1-diphosphine)]n result in which ocap binds in a simple chelate fashion. Somewhat unexpectedly, with dppp, binuclear complexes [Hg2{SC6H3XN(CN)}2(µ,κ1,κ1-dppp)] result in which two diphosphines bridge the Hg2 centre, while with dppf mononuclear chelates are proposed to result. Thus, the simple and high-yielding ring-opening of 2-aminobenzothiazole and substituted derivatives by mercuric acetate provides ready access to a range of novel ortho-cyano-aminothiophenolate complexes, being shown to be a highly versatile ligand that can adopt a number of different coordination modes.

Development and Evaluation of Biocompatible Topical Petrolatum-liquid Crystal Formulations with Enhanced Skin Permeation Properties.

Transdermal administration represents a major advancement over traditional pharmaceutical dosing methods. However, a frequent issue is inadequate penetration of the active medicinal component through the skin. As a result, in the current research, we assessed the utility of newly developed petrolatum-liquid crystal (LC) ointment formulations and characterized their biocompatibility and function in the transdermal drug delivery system. To begin, we made petrolatum-LC formulations using p-aminobenzoic acid (PABA) as a hydrophilic model molecule. The viscosity, small-angle X-ray scattering (SAXS), particle diameters, and z-potential were measured to assess the physicochemical properties of the formulations. A dialysis release technique was used to evaluate medication release from petrolatum-LC formulations. In vitro testing was performed to determine the potential to enhance skin penetration. The biocompatibility of the produced formulations was further tested using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide (MTT) assay and single-cell gel electrophoresis. According to the results, the novel petrolatum-LC formulations are biocompatible and effective in forming hexosomes. PABA skin penetration was significantly enhanced by the new petrolatum-LC formulations. According to this study, petroleum-LC formulations are more efficient than commercial petrolatum in terms of skin permeability improvement and PABA skin concentration.

Rapid resolution of choroidal metastatic tumour secondary to lung cancer following treatment with alectinib.

A 64-year-old man presented with reduced vision in the right eye (visual acuity of 6/24 Snellen). The patient reported having a chronic cough and recent weight loss with difficulty in swallowing and abnormal liver function test 8 months prior to his presentation. He was a chronic smoker for 45 years, having quit a year earlier. Fundus examination showed a unifocal large yellow-brown subretinal mass involving the posterior segment of the eye and associated with subretinal fluid. The patient was diagnosed with a choroidal metastasis and was referred urgently to the oncology team who confirmed the presence of non-small cell lung cancer with distant metastases. He started treatment with alectinib (second-generation tyrosine kinase inhibitor). A few weeks later, his vision improved and, on examination, there was complete resolution of the choroidal mass and the associated subretinal fluid. Alectinib led to rapid resolution of his choroidal secondary and has excellent ocular safety profile.

Cytotoxicity, anti-microbial studies of M(II)-dithiocarbamate complexes, and molecular docking study against SARS COV2 RNA-dependent RNA polymerase.

Ten transition metal dithiocarbamate (DTC)complexes of the type [M(κ 2-Et2DT)2] (1-5), and [M(κ 2-PyDT)2] (6-10) (where M = Co, Ni, Cu, Pd, and Pt; Et2DT = diethyl dithiocarbamate; PyDT = pyrrolidine dithiocarbamate) were synthesized and characterized by different methods. The dithiocarbamate acted as bidentate chelating ligands to afford a tetrahedral complexes with Co(II) ion and square planner with other transition metal ions. The dithiocarbamate complexes showed good activity against the pathogen bacteria species. The results showed the Pt-dithiocarbamate complexes are more active against all the tested bacteria than the Pd-dithiocarbamate complex. The dithiocarbamate complexes displayed the maximum inhibition zone against E. coli bacteria, whereas the lowest activity of the dithiocarbamate against Salmonella typhimurium bacteria. The cytotoxicity of the Pd(II) and Pt(II) complexes was screened against the MCF-7 breast cancer cell line and the complexes showed moderate activity compared with the cis-platin. The results indicated that the MCF7 cells treated with 500 µg\ml of ligands and Pd(II) and Pt(II) complexes after 24 hr exposure showed intercellular space and dead cells. Finally, molecular docking studies were carried out to examine the binding mode of the synthesized compounds against the proposed target; SARS COV2 RNA-dependent RNA polymerase.

Synthesis, anti-bacterial evaluation, DFT study and molecular docking as a potential 3-chymotrypsin-like protease (3CLpro) of SARS-CoV-2 inhibitors of a novel Schiff bases.

New Schiff bases {N'-(phenyl(pyridin-2-yl)methylene) isonicotinohydrazide (L1H), N1 -(naphthalen-1-yl)-N2 -(phenyl(pyridin-2-yl) methylidene) ethane-1,2-diamine (L2H), N-(6-chlorobenzo[d]thiazol-2-yl)-1-phenyl-1-(pyridin-2-yl) methanimine (L3H)}were synthesized by reaction of 2-benzoylpyridine with different amines (2-amino-6-chlorobenzothiazole, isonicotinohydrazide and N 1-(naphthalen-1-yl)ethane-1,2-diamine) and characterized by 1H-NMR, 13C-NMR, IR mass spectroscopy and elemental analysis. The compounds were assayed by the disc diffusion method for anti-bacterial against five pathogenic bacteria species (Staphylococcus aureus, Micrococcus luteus, Staphylococcus pyogenes, Bacillus subtilis, and E. coli). All prepared Schiff bases showed good activity compared to positive control (streptomycin), Moreover the L3H showed the highest activity against S. aureus, and M. luteus than the other compounds and streptomycin. In additional molecular docking studies with 3-chymotrypsin-like protease (3CLpro), the essential enzyme for SARS-CoV-2 proliferation. The rest of compounds have shown promising results as 3CLpro inhibitors interacting with the active sites of the enzymes. Finally, DFT 's estimated electrostatic molecular potential results were used to illustrate the molecular docking findings. The DFT calculations showed that L3H has the highest dipole moment and electrophilicity index. Interestingly, L2H of the largest energy gap ∆E = 2.49 eV, there are several hydrophilic interactions that could facilitate the binding with the receptors. All of these parameters could be shared to significantly affect the protein sites of binding affinity with different extent.

Long-Term Outcomes of Treatment with Biological Agents in Eyes with Refractory, Active, Noninfectious Intermediate Uveitis, Posterior Uveitis, or Panuveitis.

PURPOSE: To examine a large cohort of patients treated with biologic agents for active noninfectious intermediate uveitis, posterior uveitis, or panuveitis (NIPPU) and to compare their efficacy and long-term effect. DESIGN: Retrospective, longitudinal study. PARTICIPANTS: Eighty-two patients (156 eyes) with active NIPPU after failure of treatment with corticosteroids and a second-line immunosuppression drug and treated with biologic agents who were treated at Moorfields Eye Hospital between 2001 and 2016. METHODS: Information was gathered from the clinical notes of all patients. MAIN OUTCOME MEASURES: Time to first disease flare, rate of treatment failure, best-corrected visual acuity, and risk factors for treatment failure. RESULTS: Patients were followed on average for 4.7±0.4 years (724 eye-years). All patients demonstrated active uveitis at baseline, and 34 patients (41.5%) demonstrated a coexisting active systemic disease. Control of ocular inflammation was achieved in 136 eyes (87.2%). The average oral prednisolone dose at baseline was 16.4±1.7 mg/day, and by 6 months reduced to 6.5±0.7 mg/day (P < 0.0001), remaining stable for up to 5 years follow-up. Best-corrected visual acuity at baseline was 0.5±0.1 logarithm of the minimum angle of resolution (logMAR), improved to 0.4±0.1 logMAR (P = 0.008) at 3 months, and remained stable during follow-up. After baseline, 42.3% of eyes experienced flares, and the average number of flares reduced from 1.8±0.1 flares/year to 0.6±0.1 flares/year (P < 0.0001). Median time to first flare was 5.4 years (95% confidence interval [CI], 2.2-5.4 years) with a 5-year survival rate of 58.7%. Treatment failed in 37 eyes (23.7%), with a 5-year survival rate of 68.0% and an estimated time to 75% survival of 2.9 years (95% CI, 2.1-4.4 years). The risk for treatment failure was lower when treatment used adalimumab (odds ratio, 0.4; 95% CI, 0.2-0.9; P = 0.03) but was greater when systemic disease also was active at baseline (odds ratio, 3.2; 95% CI, 1.5-7.1; P = 0.004). CONCLUSIONS: Overall, eyes treated with biologic agents after failure of treatment with corticosteroids and a second-line immunosuppression drug experienced satisfactory disease control (87.2%), reduced use of systemic immunosuppression, stable visual acuity, and a 23.7% risk of disease relapse. After multivariate adjustment, older age, treatment with adalimumab (versus infliximab), and inactive concomitant systemic disease were associated with a lower risk of treatment failure.

Phosphine-promoted ring-opening of benzisothiazolinate ligands at a nickel(ii) centre: a convenient synthesis of Ni(ii)-thiolate complexes.

Phosphines react with the benzisothiazolinate (bit) paddlewheel dimer, [Ni2(µ-bit)4·2H2O], resulting in sulfur-nitrogen bond scission and a series of unexpected transformations leading to novel Ni(ii) complexes containing 2-cyanophenylthiolate and related thiolate ligands.

Serum Angiotensin-Converting Enzyme Has a High Negative Predictive Value in the Investigation for Systemic Sarcoidosis.

PURPOSE: To examine whether measurement of serum angiotensin-converting enzyme (ACE) is useful in diagnosing sarcoidosis in undifferentiated uveitis. DESIGN: Evaluation of a diagnostic test. METHODS: Data collection was performed from 1035 consecutive subjects presenting with uveitis to Moorfields Eye Hospital undergoing measurement of serum ACE as part of baseline investigations for underlying systemic disease. The main outcome measures were sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of elevated serum ACE. RESULTS: Mean age of the sample was 41.7 years and 56.1% of subjects were female. Sarcoidosis was the underlying cause for the uveitis in 110 subjects (10.6%) and was more common in adults, female subjects, black subjects, and subjects with intermediate uveitis or panuveitis. ACE was elevated in 196 subjects (18.9%) and elevated levels were observed in 85 subjects eventually diagnosed with underlying sarcoidosis (true positive 77.3%) and in 111 subjects with an alternate diagnosis (false positive 12.0%). In adult subjects, sensitivity of serum ACE was 78.1%, specificity 90.0%, and PPV 43.6%, but the NPV was 97.0%. The test performed well, with area under curve (AUC) 0.897 (95% confidence interval [CI] 0.854-0.941). Serum ACE performed less well in distinguishing sarcoid uveitis in pediatric subjects, with sensitivity 60.0%, specificity 78.5%, and PPV 10.0%, but again NPV was high at 96.9% and AUC was 0.828 (95% CI 0.571-1.000). CONCLUSIONS: Serum ACE had a very high negative predictive value for sarcoid uveitis, eliminating the need for further screening tests in subjects with normal serum ACE, unless clinical suspicion was high.