Effect of the SunSafe Student Ambassador Program on the attitudes, knowledge and behaviour of Australian high-school students towards sun safety: a prospective study.

BACKGROUND: The SunSafe Student Ambassador Program (SSSAP) in Australia uses the peer-to-peer learning environment to educate high-school students about sun-safety. AIMS: To assess whether the SSSAP would improve knowledge, attitudes and behaviours towards sun safety in high-school students and whether this would be sustained at 3 months. METHODS: An assessment survey was delivered before, immediately after and 3 months after participation in the SSSAP in 2019. RESULTS: In total, 503 participants completed the pre-presentation survey, 274 completed the post-presentation survey, and 218 completed both. Immediately following presentation, the total composite score for all 18 knowledge questions increased from a mean ± SD of 11.8 ± 3.5 to 13.8 ± 4.7 (P < 0.001). There was strong evidence for an improvement in one attitude-based question 'Is it healthy to have a tan?' (P < 0.01) and one behaviour question about wearing sunscreen daily (P = 0.02). After 3 months, 235 students were matched to their pre-presentation survey. The composite score of all knowledge questions had improved from 11.2 ± 3.5 to 12.1 ± 4.5 (out of a total of 18) (P < 0.01). There was also an improvement in two attitude questions 'Do you feel better when you have a tan?' (P = 0.03) and 'Is it healthy to have a tan?' (very strong evidence: P < 0.001), and evidence for a reduction in time spent outdoors on a weekday (P = 0.04). CONCLUSION: The SSSAP was associated with improvements in knowledge, attitude and behaviour towards sun safety immediately and at 3 months post-presentation. Further research is required to determine whether these positive effects are sustained and whether they ultimately reduce skin cancers.

Panophthalmitis and Orbital Inflammation with Cavernous Sinus Thrombosis Following Cataract Surgery.

BACKGROUND: Panophthalmitis is a severe inflammation of the globe that can result as a rare complication of ophthalmic surgery. In severe cases, it may also be associated with orbital inflammation and cavernous sinus thrombosis. PURPOSE: This case demonstrates a rare and life-threatening post-operative complication of cataract surgery. We also hope to highlight the importance of considering the relevant risk factors associated with developing potential infections after cataract surgery, including the use of corneal sutures, high-risk behaviours such as excessive eye-rubbing, and non-compliance with appointments and post-operative medications. CASE REPORT: We report the case of a 35-year-old female with severe autism and developmental delay who developed panophthalmitis, orbital inflammation and cavernous sinus thrombosis 6 weeks post cataract surgery. The likely cause was corneal suture-related microbial keratitis, and the patient required enucleation due to sepsis. CONCLUSION: Post-surgical panophalmitis is a rapidly progressive disease that is not only sight- but life-threatening and demands urgent and intensive treatment. Consideration of early enucleation may be required to prevent deterioration in such patients.

Viral conjunctivitis: a retrospective study in an Australian hospital.

IMPORTANCE: To update the literature on the current trends of viral conjunctivitis infections in Sydney, Australia. BACKGROUND: To find correlations between viral and patient characteristics on disease outcomes and to assess the rates of antibiotic and steroid use in patients with viral conjunctivitis prior to and after assessment by ophthalmology trainees. DESIGN: Retrospective single-centre case series. PARTICIPANTS: 368 eyes of 224 patients diagnosed with viral conjunctivitis at the Sydney Eye Hospital from 1 st January - 31 st March 2017. METHODS: Patients were identified from hospital records or polymerase chain reaction results. RESULTS: 368 eyes of 224 patients, median age 35.3 (range 7-82) and 59.8% males, were included. 152 (67.9%) patients presented already on antibiotic treatment. Most patients (83.5%) had no previous ocular history aside from 35 (15.6%) who were regular contact lens wearers. PCR was performed in 170 (75.9%) patients, with 92 (54.1%) positive for adenovirus, and 7 (4.1%) for HSV. The average duration of symptoms prior to presentation was 6.3 days. 177 (78.0%) patients presented within 1 week of symptom onset and these patients were more likely to be adenovirus positive on PCR (OR = 2.37). Patients with symptoms of longer duration were more likely to have photophobia (OR = 2.96) and have had steroid treatment (OR = 3.80). CONCLUSIONS AND RELEVANCE: Patients with viral conjunctivitis typically presented within a week of symptom onset, with bilateral disease and on topical antibiotics. Pseudomembranes and a palpable preauricular lymph node were not common. As treatments emerge for viral conjunctivitis patients may need to be encouraged to present earlier.

Evaluating the temperature effects of ice and heat tests on ptosis due to Myasthenia Gravis.

AIMS: The aims of this study are as follows: (1) to describe a standardised methodology for the ice test, and where necessary a heat test; (2) to determine the effects of local cooling vs. heating on ptosis in myasthenia gravis (MG) patients. METHODS: Twenty-three MG patients with ptosis were identified from a tertiary referral neuroimmunology clinic, seventeen with significant ptosis ≥2 mm. Latex party balloons were filled with ice and cold tap water for the ice test, or with water heated to 45 °C for the heat test. Each test was performed for 2 min, with ruler measurement and photographs taken of the palpebral aperture before and immediately after each test. RESULTS: This standardised method was efficient in a clinical setting while maintaining efficacy. In all 23 patients, the mean improvements in ptosis with the ice, rest, and heat tests were 2.3 (±1.5) mm, 1.3 (±1.1) mm, and 0.33 (±1.4) mm respectively. In the 17 patients with significant ptosis, the mean improvements in ptosis with the ice, rest, and heat tests were 2.9 (±1.2) mm, 1.8 (±0.92) mm, and 0.83 (±1.4) mm, respectively. In these 17 patients, the ice test improved ptosis by 1.3 mm more than rest (p < 0.0001). The heat test improved ptosis by 1.1 mm less than rest (p = 0.0013). The ice test improved ptosis by 2.3 mm more than the heat test (p < 0.0001). CONCLUSIONS: The standardised methodology of ice and heat testing was safe, easily reproducible and effective. We confirm that temperature had a significant effect on ptosis in MG, and therefore refute the notion that measured changes are purely due to the associated rest.

Outcomes of single-dose peri-procedural antibiotic prophylaxis for endoscopic ultrasound-guided fine-needle aspiration of pancreatic cystic lesions.

BACKGROUND: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is a technique frequently used to diagnose solid and cystic lesions of the pancreas. Antibiotic prophylaxis has been recommended for EUS-FNA of pancreatic cystic lesions but is not universally observed. The most effective antibiotic and the most efficacious route and regimen of administration are also unknown. OBJECTIVE: This cohort study was undertaken to evaluate whether single-dose piperacillin/tazobactam or ciprofloxacin given at the time of the procedure effectively prevents major adverse events and to audit the adherence to this protocol in the setting of EUS-FNA of pancreatic cystic lesions. DESIGN: Consecutive EUS-FNA procedures of pancreatic cystic lesions were performed at Concord Hospital and significant variables regarding the procedure and adverse events were recorded. Patients were also contacted by telephone to follow-up any subacute adverse events they may have experienced. PATIENTS: Over a 30 month period (January 2010-July 2012), a total of 85 EUS-FNAs of pancreatic cysts were performed on 80 different patients. The mean age was 63.2 years (range 17-89 years; 58% females). INTERVENTIONS: Single-dose piperacillin/tazobactam IVs was administered to 87% of patients, while 12% of patients received ciprofloxacin IVs. RESULTS: No patients developed cyst infection, fever, or sepsis (0%) and one patient (1.2%) was hospitalised for self-limited nausea without adverse sequelae. CONCLUSIONS: Single-dose piperacillin/tazobactam at the time of EUS-FNA of pancreatic cysts is an effective prophylaxis of cyst infection or sepsis and can be conveniently given as a single-dose peri-procedurally without further oral antibiotics.