Comparison of Visual Outcomes of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients with and without Diabetes Mellitus.

PURPOSE: Diabetic patients have a greater risk of nonarteritic anterior ischemic optic neuropathy (NAION) than nondiabetic patients. We compare visual outcomes, prevalence of bilateral/sequential ION, and predictors of visual outcomes in NAION between diabetic and nondiabetic patients. DESIGN: Case-control study. PARTICIPANTS: All 231 patients with NAION seen by the Neuro-Ophthalmology Service, Wilmer Eye Institute, between 2002 and 2011 were screened for study inclusion. METHODS: Patients presenting within 4 weeks of symptom onset (30 with diabetes mellitus, 62 control patients) were included in baseline demographic assessments of vascular risk factors. Interval and final visual outcomes (logarithm of the minimum angle of resolution [logMAR] visual acuity [VA]) were evaluated in the 81 patients in this group with clinical follow-up for ≥3 months, and population average logistic regression models were used to determine risk factors for worse visual outcomes. MAIN OUTCOME MEASURES: Visual acuity at last follow-up. RESULTS: The median follow-up duration was 38.7 weeks in diabetic patients and 52.9 weeks in nondiabetic patients. The majority (92.5%) of patients presented within 2 weeks of symptom onset. In nondiabetic patients, the most prevalent risk factor for NAION was hyperlipidemia (62.9%); for diabetic patients, NAION risk factors included hypertension (83.3%), hyperlipidemia (83.3%), and small cup-to-disc ratio (63.3%). Sequential NAION occurred in 36.8% of diabetic patients and 20.9% of nondiabetic patients. At last follow-up, 48% of diabetic and 62% of nondiabetic patients had VA better than 20/40. Similar proportions of diabetic and nondiabetic patients (8 [27%] diabetic and 14 [22.5%] nondiabetic patients) recorded a final follow-up vision of 1.0 logMAR or worse at a minimum of 3 months. Ischemic heart disease (odds ratio [OR], 7.21; P < 0.001) and greater age (OR, 1.05; P = 0.045) were associated with increased risk for final VA <20/200 in the multiple regression model (OR, 4.35; P = 0.011). CONCLUSIONS: The VA at presentation and at final follow-up in diabetic patients with NAION were not significantly different from nondiabetic controls, although diabetic patients had a higher prevalence of cardiovascular risk factors. Ischemic heart disease and greater age, but not diabetes, independently correlated with worse VA outcome.

Erythema Multiforme in Children and Mycoplasma pneumoniae Aetiology.

Erythema multiforme (EM) in children is understudied and confused with Stevens-Johnson syndrome (SJS) despite their being separate diseases with unique aetiologies and clinical presentations. The goal of this study was to determine the prevalence of Mycoplasma pneumoniae in paediatric patients with EM minor, EM major (EMM), and SJS. This retrospective cohort at The Hospital for Sick Children accrued all cases of EM minor, EMM, and SJS from 1999 to 2013. Sixty-five cases were identified: 20 of EM minor, 23 of EMM, and 22 of SJS. Aetiologies were attributed in 58% of cases: 79% infection and 21% drug aetiology. Sixty-one percent of patients with EMM were M pneumoniae positive, compared with 14% of those with SJS and 22% of those with EM minor (P < .01). M pneumoniae patients were older at presentation (P = .03) and more frequently had sore throat (P < .01) and atypical targets with central blistering (P < .01). These findings suggest that M pneumoniae should be suspected and treated until laboratory confirmation becomes available in patients presenting with atypical target lesions with central blistering.

Creating a Standardized Process to Meet Core Measure Compliance.

A standardized process to improve compliance with venous thromboembolism prophylaxis and hospital-based inpatient psychiatric services Core Measures was developed, implemented, and evaluated by a clinical nurse specialist team. The use of a 1-page tool with the requirements and supporting evidence, combined with concurrent data and feedback, ensured success of improving compliance. The initial robust process of education and concurrent and retrospective review follow-up allowed for this process to be successful.

Biologic therapies associated with development of palmoplantar pustulosis and palmoplantar pustular psoriasis: a systematic review.

BACKGROUND: Palmoplantar pustulosis (PPP) and palmoplantar pustular psoriasis (PPPP) are chronic inflammatory skin conditions characterized by eruptions of sterile pustules on the palms and/or soles. Biologic use has been associated with PPP and PPPP development in the literature. OBJECTIVES: To identify PPP and PPPP associated with biologics and summarize reported treatments and outcomes. METHODS: We systematically searched in MEDLINE and Embase for articles that reported PPP or PPPP during biologic treatment. After a full-text review, 53 studies were included for analysis. RESULTS: We identified 155 patients with PPP/PPPP onset during biologic treatment, with a mean age of 44.1 years and a female preponderance (71.6%). The most frequently reported biologics were adalimumab (43.9%) and infliximab (33.3%). IL-17 inhibitors, secukinumab (7.6%) and brodalumab (1.5%), were reported only in association with PPPP. Overall, 58.8% of patients had complete remission (CR) in 3.6 months and 23.5% had partial remission (PR) in 3.7 months. The most common treatments that led to CR were topical corticosteroids (n = 16) and biologic switching (n = 8). CONCLUSIONS: Clinicians should anticipate PPP or PPPP as potential drug reactions to biologics such as adalimumab and infliximab. Large-scale studies are required to confirm our findings and further explore the pathogenesis for biologic-associated PPP and PPPP.

Comparing bacterial, fungal, and human cell concentrations with rapid adenosine triphosphate measurements for indicating microbial surface contamination.

BACKGROUND: The goal of this study was to test for associations between adenosine triphosphate (ATP) content and microbial concentrations on desk surfaces in school classrooms. METHODS: ATP bioluminescence and quantitative polymerase chain reaction (qPCR) techniques were employed to measure total bacterial, fungal, and human cell concentrations on 66 high-traffic desks spread across 9 schools: 3 in Connecticut (CT) and 6 in Oklahoma (OK). In CT, 6 samples were taken from each desk, 1 precleaning and 5 postcleaning (after 30 minutes, 1 day, 3 days, 7 days, and 21 days). In OK, samples were taken immediately before and after cleaning each desk. RESULTS: Based on simple linear regression analyses, ATP values were good predictors of microbial concentrations (r = 0.8, P = .003) in both CT school postcleaning samples and OK pre- and postcleaning samples (r = 0.7, P = .00002). However, biomass reductions measured after cleaning were 1.5-2 times greater when measured by ATP than by qPCR (P = .007). CONCLUSIONS: Overall, ATP bioluminescence measurements correlate with qPCR-based surface measurements on school desks but may overestimate the physical removal of bacteria and fungi due to cleaning.

Selectively biorefining astaxanthin and triacylglycerol co-products from microalgae with supercritical carbon dioxide extraction.

Clustering behavior of supercritical carbon dioxide, triacylglycerides, and astaxanthin solutes were analyzed using Kamlet-Taft solvatochromic properties of dipolarity/polarizability, π∗, and hydrogen-bond acceptance, ß. Both parameters were decreased for supercritical carbon dioxide with TAG at low densities and with astaxanthin at high densities. These results indicated supercritical carbon dioxide could selectively extract triacylglycerides at low densities followed by astaxanthin at higher densities from microalgae. Accordingly, Haematococcus pluvialis microalgae were subject to a two-stage continuous extraction scheme where a density of 642 mg/ml was employed to extract triacylglycerides followed by a density of 971 mg/ml, by an increase in pressure, to extract astaxanthin. The first, lower density extract yielded over 78% of the total triacylglycerides and was composed of less than 1% astaxanthin. The sequential, higher density extract yielded less than 5% of the total microalgae triacylglycerides, over 70% of the total astaxanthin, and was composed of 60-76% astaxanthin by mass.

Buildings, Beneficial Microbes, and Health.

Bacteria and fungi in buildings exert an influence on the human microbiome through aerosol deposition, surface contact, and human and animal interactions. As the identities and functions of beneficial human microbes emerge, the consequences of building design, operation, and function must be understood to maintain the health of occupants in buildings.

Fracture and dislocation of a glass intraocular lens optic as a complication of neodymium:YAG laser posterior capsulotomy: Case report and literature review.

UNLABELLED: An 83-year-old man presented with a 1-year history of blurry vision in his left eye. Bilateral cataract surgery and ciliary sulcus posterior chamber intraocular lens (IOL) implantation had been performed 11 years earlier. The corrected distance visual acuity (CDVA) was 20/60 in the left eye. Slitlamp examination revealed moderate posterior capsule opacification. Neodymium:YAG laser posterior capsulotomy was performed and complicated by IOL fracture and immediate dislocation of optic fragments into the anterior chamber. An IOL exchange was performed, and the damaged IOL was removed in 7 pieces. A 3-piece acrylic IOL was suture fixated to the posterior iris. Pathologic analysis showed that the damaged IOL was made of glass supported by a polyimide frame. Twelve months after the IOL exchange, the CDVA was 20/60. FINANCIAL DISCLOSURE: Dr. Ahmed is a consultant to Alcon Laboratories, Inc., Abbott Medical Optics, Inc., and Bausch & Lomb. Dr. Mamalis is a consultant to Anew Optics, Inc., and Medennium, Inc. No other author has a financial or proprietary interest in any material or method mentioned.