Functional Vision of Pseudophakic Children Attending a Pediatric Ophthalmology Clinic in Southwest Nigeria.

PURPOSE: To determine the functional vision of pseudophakic children attending a child eye health tertiary facility in southwest Nigeria. METHODS: A hospital-based descriptive study of pseudophakic children attending the Pediatric Ophthalmology outpatient clinic of a tertiary facility in southwest Nigeria was conducted between June and November 2021. Details of demography and clinical examination findings were obtained using a semi-structured questionnaire. Information about functional vision was obtained using the Pediatric Eye Questionnaire (PedEyeQ). Data obtained from the PedEyeQ were entered into a Rasch-calibrated PedEyeQ Excel response data sheet. Data analysis was done using Statistical Package for Social Sciences (SPSS) software version 22 (SPSS, Inc). RESULTS: A total of 196 pseudophakic children were recruited. Their ages ranged from 2 to 16 years with a mean of 9.8 ± 3.4 years and there was a male-to-female ratio of 2.2:1. The median functional vision score of pseudophakic children across all age groups was 90.0. The functional vision scores were associated with the laterality of cataract, type of cataract, presence of comorbidities, visual acuity (distance and near) in the better eye, and number of surgeries. CONCLUSIONS: The functional vision scores of pseudophakic children were low. Significant predictors of low functional vision scores include surgery for congenital cataract, low average family income, longer duration of time between surgery and recruitment into the study, and poorer best corrected visual acuity in the better eye. The routine assessment of functional vision should be considered an important aspect of pseudophakic children's eye care with a view toward optimizing psychological and social well-being. [J Pediatr Ophthalmol Strabismus. 2024;61(2):138-146.].

Sodium/Potassium ATPase Alpha 1 Subunit Fine-tunes Platelet GPCR Signaling Function and is Essential for Thrombosis.

Background: Thrombosis is a major cause of myocardial infarction and ischemic stroke. The sodium/potassium ATPase (NKA), comprising α and ß subunits, is crucial in maintaining intracellular sodium and potassium gradients. However, the role of NKA in platelet function and thrombosis remains unclear. Methods: We utilized wild-type (WT, α1+/+) and NKA α1 heterozygous (α1+/-) mice, aged 8 to 16 weeks, of both sexes. An intravital microscopy-based, FeCl3-induced carotid artery injury thrombosis model was employed for in vivo thrombosis assessment. Platelet transfusion assays were used to evaluate platelet NKA α1 function on thrombosis. Human platelets isolated from healthy donors and heart failure patients treated with/without digoxin were used for platelet function and signaling assay. Complementary molecular approaches were used for mechanistic studies. Results: NKA α1 haplodeficiency significantly reduced its expression on platelets without affecting sodium homeostasis. It significantly inhibited 7.5% FeCl3-induced thrombosis in male but not female mice without disturbing hemostasis. Transfusion of α1+/-, but not α1+/+, platelets to thrombocytopenic WT mice substantially prolonged thrombosis. Treating WT mice with low-dose ouabain or marinobufagenin, both binding NKA α1 and inhibiting its ion-transporting function, markedly inhibited thrombosis in vivo. NKA α1 formed complexes with leucine-glycine-leucine (LGL)-containing platelet receptors, including P2Y12, PAR4, and thromboxane A2 receptor. This binding was significantly attenuated by LGL>SFT mutation or LGL peptide. Haplodeficiency of NKA α1 in mice or ouabain treatment of human platelets notably inhibited ADP-induced platelet aggregation. While not affecting 10% FeCl3-induced thrombosis, NKA α1 haplodeficiency significantly prolonged thrombosis time in mice treated with an ineffective dose of clopidogrel. Conclusion: NKA α1 plays an essential role in enhancing platelet activation through binding to LGL-containing platelet GPCRs. NKA α1 haplodeficiency or inhibition with low-dose ouabain and marinobufagenin significantly inhibited thrombosis and sensitized clopidogrel's anti-thrombotic effect. Targeting NKA α1 emerges as a promising antiplatelet and antithrombotic therapeutic strategy.

A Novel Case of Acquired Isolated Left Ventricular Non-compaction in a Primigravida: Revisiting the Diagnostic Criteria of Left Ventricular Non-compaction.

Left ventricular non-compaction (LVNC) is rare cardiomyopathy characterized by the presence of a two-layered myocardium with prominent trabeculations. It has high rates of mortality and morbidity. Clinical presentation could vary from asymptomatic patients to developing ventricular arrhythmias, thromboembolism, heart failure, and even sudden cardiac death. We present a 23-year-old primigravida with a childhood history of dilated cardiomyopathy secondary to post-viral myocarditis presenting at 32 weeks gestation with dyspnea on exertion. Initial 2-D echocardiogram revealed a mildly dilated left ventricle with apical trabeculation and a 2-layer distinction between compacted and noncompacted myocardium indicating non-compaction of the left ventricle. This case presents a peculiar confluence of cardiac genetics, normal physiology, and infection. We describe a rare form of acquired LVNC that transformed from another type of cardiomyopathy to LVNC during pregnancy drawing attention to the causality pathways of LVNC.

Outcome of surgery for traumatic cataract in children in a child eye health tertiary facility, Ibadan, Nigeria.

OBJECTIVE: The objective of this study was to describe the outcome of surgery for traumatic cataract and associated factors in children aged 16 years and below operated in a tertiary facility. METHODS: This was a retrospective review of records of children who had surgery for traumatic cataract between August 2015 and August 2019. Information on biodata, preoperative visual acuity, surgical methods, complications, and postoperative visual acuity were retrieved. Data were analyzed using IBM SPSS Statistics 20.0. RESULTS: Traumatic cataract accounted for 87 (14.7%) of 593 eyes operated for childhood cataract during the period. Of these, a total of 79 records were available for review. There were 56 (70.9%) males with a mean age of 10.11 (±3.39) years. All injuries were unilateral; closed globe injuries accounted for 70 (88.8%) of the cataracts and the left eye was affected in 42 (53.2%) patients. Fifty-two (67.09%) eyes had other ocular injuries apart from cataracts. The morphology of the cataract was membranous in 44 (55.7%) eyes, and 76 (96.2%) eyes had cataract surgery with intraocular lens (IOL) implantation; 39 (51.3%) of these IOLs were implanted within the capsular bag. The preoperative best corrected visual acuity was worse than 6/18 in all 79 (100%) eyes and improved to 6/18 or better in 32 (40.5%) eyes at 3 months postoperatively. CONCLUSION: Traumatic cataract accounted for less than a quarter of all childhood cataracts in our center. Majority of the eyes had successful IOLs implantation during surgery, and the best corrected visual acuity improved in a moderate proportion of these patients.

Aorto-cavitary fistula to the left ventricle with severe aortic regurgitation as a complication of prosthetic valve infective endocarditis: a novel report.

Infective endocarditis can present in different clinical forms and lead to a variety of complications depending on the affected valvular and perivalvular structures. We describe a case of a 74-year-old male who developed an aortic-cavitary fistulous tract as a complication of prosthetic aortic valve infective endocarditis. Transesophageal echocardiography (TEE) revealed an aorto-cavitary fistula (ACF) connecting the aortic root with the left ventricle, creating an intracardiac shunt, which resulted in severe aortic regurgitation physiology. The patient underwent surgery with successful exclusion of the ACF. ACF is an unusual complication of infective endocarditis that creates an abnormal communication between the aortic root and the heart chambers, establishing an intracardiac shunt. This case highlights that physicians should be aware of the possibility of rare cardiac complications in infective endocarditis. TEE is a valid diagnostic test for ACF.

Epithelial Lacrimal Gland Tumours in Nigeria: Clinicopathological Features and Treatment.

Background: Epithelial lacrimal gland tumours are uncommon orbital tumours and are not widely reported among African populations. Objective: This study aimed to describe the clinicopathological features, treatment, and outcomes of epithelial lacrimal gland tumours in Nigeria. Design: Retrospective case series. Setting: Ocular Oncology Unit, Ophthalmology Department and Pathology Department of University College Hospital, Ibadan, Nigeria. Materials and Methods: A review of the medical records of all patients with histopathological diagnoses of epithelial lacrimal gland tumours managed at a tertiary health facility, southwestern Nigeria over 11.5 years was carried out. Results: Eighteen patients with equal numbers of men and women, and mean age at presentation of 42.2 ± 15.7 years (median 42 years, range 17-70 years) were managed. All patients presented with orbital swelling and had nonaxial proptosis with palpable firm to hard mass in the superotemporal quadrant of the orbit. The mean duration of symptoms was 42.2 ± 38.6 months (median 24 months, range 3-120 months). Visual acuity was <3/60 at presentation in eight (44.4%) of the affected eyes. Thirteen (72.2%) patients underwent orbitotomy and tumour excision, while five (27.8%) patients had orbital exenteration, and two of whom (11.1%) had combined orbital exenteration and craniotomy. Histopathological examination of the specimens revealed pleomorphic adenoma in nine (50.0%) patients, low-grade mucoepidermoid carcinoma in three (16.7%) patients, high-grade mucoepidermoid carcinoma in two (11.1%) patients, adenoid cystic carcinoma in three (16.7%) patients, and adenocarcinoma "not otherwise specified" in one (5.6%) patient. Mortality was reported in four (44.4%) of nine patients with malignant tumours, while no mortality was noted in the patients with benign pleomorphic adenoma. The mean follow-up period for the patients was 28.9 months (median, 4.5 months; range, 2-140 months). Conclusion: The main presenting symptom of epithelial lacrimal gland tumours in our patients was an orbital mass and the most common clinical finding, in addition to the orbital mass, was nonaxial proptosis. The tumours were equally divided into benign and malignant lesions in our studied population. Pleomorphic adenoma was the only benign tumour while mucoepidermoid carcinoma was the commonest malignant lesion. Orbital exenteration was performed in a high proportion of our patients and high mortality was noted among patients with malignant tumours.

Contexte: Les tumeurs épithéliales des glandes lacrymales sont des tumeurs orbitales rares et ne sont pas largement rapportées parmi les populations africaines. Objectif: Cette étude visait à décrire les caractéristiques clinico-pathologiques, le traitement et le résultat des tumeurs épithéliales des glandes lacrymales au Nigeria. Conception: Série de cas rétrospectifs. Cadre: Unité d'oncologie oculaire, département d'ophtalmologie et département de pathologie du Collège Hospitalier Universitaire, Ibadan, Nigéria. Méthode: Un examen des dossiers médicaux de tous les patients présentant des diagnostics histopathologiques de tumeurs épithéliales des glandes lacrymales gérées dans un établissement de santé tertiaire du sud-ouest du Nigéria pendant 11,5 ans a été effectué. Résultats: Dix - huit patients avec un nombre égal d'hommes et de femmes et un âge moyen à la présentation de 42,2 ± 15,7 ans (médian de 42 ans, intervalle de 17 à 70 ans) ont été pris en charge. Tous les patients présentaient un gonflement orbital et avait l'exophtalmie non-axiale avec ferme à dur masse palpable dans le quadrant temporel supérieur de l'orbite. La durée moyenne des symptômes était de 42,2 ± 38,6 mois (médiane de 24 mois, intervalle de 3 à 120 mois). L'acuité visuelle était <3/60 à la présentation dans huit (44,4%) des yeux atteints. Treize (72,2%) patients ont subi une orbitotomie et une excision de la tumeur, tandis que cinq (27,8%) patients avaient une exentération orbitaire, dont deux (11,1%) avaient l'exentération orbitale et la craniotomie combinées. L'examen histopathologique des échantillons a révélé un adénome pléomorphe chez neuf (50,0%) patients, un carcinome muco-épidermoïde de bas grade chez trois (16,7%) patients, un carcinome muco-épidermoïde de haut grade chez deux (11,1%) patients, un carcinome adénoïde kystique chez trois (16,7%) patients et adénocarcinome "non autrement spécifié" (NOS) chez un patient (5,6%). La mortalité a été rapportée chez quatre (44,4%) des neuf patients atteints de tumeurs malignes, alors qu'aucune mortalité n'a été notée chez les patients présentant un adénome pléomorphe bénin. La période moyenne de suivi des patients était de 28,9 mois (médiane de 4,5 mois; intervalle de 2 à 140 mois). Conclusion: Le principal symptôme de présentation des tumeurs épithéliales des glandes lacrymales chez nos patients était une masse orbitale et le résultat clinique le plus courant, en plus de la masse orbitale, était une exophtalmie non axiale. Les tumeurs étaient également divisées entre les lésions bénignes et malignes dans notre population étudiée. L'adénome pléomorphe était la seule tumeur bénigne tandis que le carcinome muco-épidermoïde était la lésion maligne la plus courante. Une exentération orbitale a été réalisée chez une forte proportion de nos patients et une mortalité élevée a été notée chez les patients atteints de tumeurs malignes.

Racial Disparities in Malignant Primary Brain Tumor Survival in Texas From 1995 to 2013.

BACKGROUND: Differences among the top five races in Texas will be explored to determine if racial, geographic, and healthcare disparities exist in patients undergoing treatment for a primary malignant brain tumor. METHODS: Data were obtained from the Texas Cancer Registry from 1995 to 2013. SAS 9.3 (SAS Institute, Inc., Cary, NC) and SEER*Stat 8.3.2 (National Cancer Institute, Bethesda, MD) software were used to analyze death from malignant brain tumors and cause-specific survival. Survival rates were compared using Kaplan-Meier curves and Log-Rank tests. Hazard ratios were estimated using the Cox proportional hazards regression model. RESULTS: Median survival was highest among Asians at 92 months (95% CI: 72, 142) and least among Whites at 20 months (95% CI: 19, 21). Patients living in the Upper Gulf Coast region of Texas had the longest survival time at 31 months (95% CI 29-35%), while those patients in the Texas Panhandle had the shortest survival time at 18 months (95% CI 14-23%). Patients with a poverty index of 0-5% had the highest median survival time of 32 months (95% CI 29-35%), as compared to patients with a poverty index of 10-20% who had a median survival of 22 months (95% CI 21-24%). CONCLUSIONS: Ethnic minorities and higher socioeconomic class demonstrated survival advantage. White males had the worst survival of those with primary malignant brain tumors. Other significant factors affecting a patient's survival rate included geographic location, poverty index, sex, and age, thus suggesting a potential genetic and environmental influence.

Factors influencing the uptake of influenza vaccination in African American patients with heart failure: Findings from a large urban public hospital.

BACKGROUND: Evidence suggests that annual influenza vaccination may prevent acute heart failure exacerbation episodes and improve survival. OBJECTIVE: Determine the influenza vaccination rate among African American patients with heart failure and identify predictors of uptake. METHODS: African American patients with heart failure were recruited at Grady Memorial Hospital, Atlanta GA between October 1, 2017 and April 28, 2018 (N = 281). All participants completed a questionnaire. RESULTS: Mean age of the sample was 50.5 ± 11.5 years (58% male). The influenza vaccination rate among the patients was 46% (n = 129/281). Patients who received vaccination information and recommendation from their physician, especially cardiologists, were significantly more likely to be vaccinated than those who did not (P<0.05). Major reasons for declining vaccination included fear of getting sick from influenza vaccine and distrust of the pharmaceutical companies that produce vaccines. CONCLUSIONS: Recommendation of influenza vaccines by physicians during medical consultations and cardiology visits may improve uptake rates in heart failure patients.

Infective endocarditis and brain abscess secondary to Aggregatibacter aphrophilus.

Aggregatibacter aphrophilus is a rare cause of infective endocarditis that was first described in 1940 by Khairat et al. and is now classified under the HACEK group of bacteria (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae). There is limited literature describing the extracardiac complications of infective endocarditis caused by this organism. We report a case of a 53-year-old male with no significant past medical history who developed acute infective endocarditis complicated by a brain abscess caused by A. aphrophilus. The patient underwent aspiration of the abscess and treated with a long course of intravenous antimicrobials. This case represents a rare complication of infective endocarditis caused by A. aphrophilus and to the best of our knowledge, is the second reported case in the literature describing such a complication in a previously healthy patient. Although neurological sequela is associated with higher mortality and may be the presenting symptom of infective endocarditis, it may also be clinically silent - only detected upon imaging.