A Pragmatic, Investigator-Driven Process for Disclosure of Amyloid PET Scan Results to ADNI-4 Research Participants.

BACKGROUND: Prior studies of Alzheimer's disease (AD) biomarker disclosure have answered important questions about individuals' safety after learning and comprehending their amyloid PET results; however, these studies have typically employed highly structured disclosure protocols and focused on the psychological impact of disclosure (e.g., anxiety, depression, and suicidality) in homogeneous populations. More work is needed to develop flexible disclosure protocols and study outcomes in ethnoculturally representative samples. METHODS: The Alzheimer's Disease Neuroimaging Initiative (ADNI) is formally incorporating amyloid PET disclosure into the newest protocol (ADNI-4). Participants across the cognitive spectrum who wish to know their amyloid PET results may learn them. The pragmatic disclosure process spans four timepoints: (1) a pre-disclosure visit, (2) the PET scan and its read, (3) a disclosure visit, and (4) a post-disclosure check-in. This process applies to all participants, with slight modifications to account for their cognitive status. In designing this process, special emphasis was placed on utilizing investigator discretion. Participant measures include perceived risk of dementia, purpose in life, and disclosure satisfaction. Investigator assessment of the disclosure visit (e.g., challenges encountered, topics discussed, etc.) is also included. RESULTS: Data collection is ongoing. Results will allow for more robust characterization of the impact of learning amyloid PET results on individuals and describe the perspectives of investigators. CONCLUSION: The pragmatic design of the disclosure process in ADNI-4 coupled with the novel participant and investigator data will inform future disclosure practices. This is especially important as disclosure of biomarker results expands in research and care.

Global Energy Metabolism Deficit in Alzheimer Disease Brain.

BACKGROUND: The understanding of Alzheimer's disease (AD) has been dominated by the amyloid hypothesis. However, therapies targeting beta-amyloid have largely failed, generating interest in other potential pathogenic factors including energy metabolism. OBJECTIVES: To interrogate canonical energy metabolism pathways from human prefrontal cortical tissue samples obtained from necropsy comparing AD and control. DESIGN, SETTING, AND PARTICIPANTS: Postmortem pre-frontal cortical tissue from 10 subjects histologically diagnosed with AD and 10 control (CTRL) subjects was subjected to untargeted metabolomics to interrogate energy metabolism pathways. The samples were matched by age, sex, and post-mortem interval. Metabolite Measurements: Untargeted metabolomics analyses were via Metabolon®. RESULTS: Glucose-derived energy metabolites in the glycolytic and pentose phosphate pathway and the ketone body ß-hydroxybutyrate were uniformly decreased in AD brain vs. CTRL brain. CONCLUSION: This pilot study aimed to identify energy metabolism abnormalities using untargeted brain metabolomics in two independent subject cohorts. Our study revealed a pattern of global energy deficit in AD brain, supporting a growing body of evidence of deficient energy metabolism in AD.

The fellow eye of retinal detachment patients: Vision and clinical presentation.

Background: The fellow eye of a retinal detachment is at risk of developing a retinal detachment and other visually debilitating disease. Aim: To investigate the rate of bilaterality of retinal detachment (RD), the presenting visual acuity (VA), and the presence of ocular morbidity in the fellow eye of patients with RD. Patients and Methods: A multicenter, prospective, cross-sectional study examining the fellow eye of consecutive patients who were diagnosed with different types of RD. The patients were seen within one year and examined in four Nigerian eye hospitals and clinics. Demographics, VA, and clinical findings at the presentation were reported on examination of the fellow eyes. Results: Twenty-seven (11.4%) out of 237 patients (264 eyes) had an RD in the fellow eye. The mean age of all study patients was 46.2 ± 16.8 years, M/F: 161 (67.9%)/76 (32.1%). The rates of bilaterality for rhegmatogenous, exudative, and tractional RDs were 4.2%, 11.1%, and 31.1%, respectively. Diagnosis of RD in an eye was associated with a risk of developing fellow eye rhegmatogenous retinal detachment (RRD) (P < 0.001) and tractional RD (P < 0.001), respectively. RRD in an eye was associated with a 17% risk of developing RD in the fellow eye (ß = -1.6, OR = 0.202, P < 0.001). The BCVA in the fellow eye of the three types of RD varied significantly (P < 0.001). The fellow eye was blind in 25.2% of RRD, 54.1% of tractional retinal detachment (TRD), and 11.1% of exudative retinal detachment (ERD). Bilateral RD eyes were blind in RRD (85.7%), TRD (71.1%), and ERD (50%). One hundred and seven eyes (40.5%) of the total 264 RD eyes studied had other fellow eye events at the presentation. Conclusion: A patient with an RD in one eye is at significant risk of developing a blinding RD in the fellow eye. This risk varies with the type of RD and is highest with TRD. However, RRD, the commonest type of RD, can benefit from prophylactic treatment to the fellow eye RD predisposing lesions.

Low rates of optical coherence tomography utilization in the diagnosis and management of retinovascular diseases in a lower middle-income economy.

Background: Optical coherence tomography (OCT) is widely used as the standard of care in evaluating macular and retinovascular diseases. However, the degree of OCT utilization is yet to be researched in a resource-limited country where wide gaps exist in access to healthcare. Aim: To determine the rate of utilization of the OCT in diagnosis, pre-treatment, and post-treatment evaluation of macular and retinovascular diseases treated with intravitreal anti-vascular endothelial growth factor injection (IVI). Patients and Methods: Retrospective, consecutive, and non-comparative case series of eyes diagnosed and treated from Jan 2017 to Jan 2022 for seven macular and retinovascular diseases in five eye clinics in Nigeria. Data extracted include demographics, indication for IVI, eye treated, use or non-use of OCT at the diagnosis (pre-treatment) and after the last IVI (post-treatment), and central macular thickness (CMT) of pre-treatment OCT scans. Results: Seven hundred and forty two eyes were diagnosed with retinovascular and macular diseases (389 right eyes and 353 left eyes).The male to female ratio was 430: 312 eyes. The mean age was, 63.89 years (SD 12.58). Four hundred and fifty two eyes (60.9%) had a pre-treatment OCT, 235 eyes (31.7%) had a post-treatment OCT, and 190 eyes (25.6%) had both pre- and post-treatment OCTs. The rate of pre-treatment OCT varied with the diagnosis (P = 0.000); DME had the highest rate, 74.4%, and HRVO had the lowest, 40%. Post-treatment OCT rate varied with the diagnosis (P = 0.009); non-AMD CNVM had the highest rate, 49.1%, and PCV had the lowest, 24.6%. Pre-treatment OCT rate was influenced by clinic location (P = 0.000); higher in clinics having an OCT. Post-treatment OCT was not influenced by clinic location (P = 0.37). A CRVO eye had the highest maximum CMT (1031 microns) of all the pre treatment eyes and the lowest minimum CMT of all the pre treatment eyes was in a BRVO eye (138 microns). Mean CMT was highest in HRVO (475.33 microns) and lowest in CNVM (307.62 microns). Conclusion: Though OCT is the standard of care for managing retinovascular and macular diseases, this research quantifies the extent of its use in Nigeria and finds it to be low. A post-treatment OCT rate of 32% suggests that urgent steps are required to improve access to OCT for IVI patients.

Elevated CSF angiopoietin-2 correlates with blood-brain barrier leakiness and markers of neuronal injury in early Alzheimer's disease.

Breakdown of the neurovascular unit in early Alzheimer's disease (AD) leads to leakiness of the blood-brain barrier (BBB), contributing to cognitive decline and disease pathology. Vascular stability depends on angiopoietin-1 (ANGPT1) signalling, antagonised by angiopoietin-2 (ANGPT2) upon endothelial injury. We have examined the relationship between CSF ANGPT2 and CSF markers of BBB leakiness and disease pathology, across three independent cohorts: (i) 31 AD patients and 33 healthy controls grouped according to their biomarker profile (i.e., AD cases t-tau > 400 pg/mL, p-tau > 60 pg/mL and Aß42 < 550 pg/mL); (ii) 121 participants in the Wisconsin Registry for Alzheimer's Prevention or Wisconsin Alzheimer's Disease Research study (84 participants cognitively unimpaired (CU) enriched for a parental history of AD, 19 participants with mild cognitive impairment (MCI), and 21 with AD); (iii) a neurologically normal cohort aged 23-78 years with paired CSF and serum samples. CSF ANGPT2 level was measured by sandwich ELISA. In cohort (i), CSF ANGPT2 was elevated in AD, correlating with CSF t-tau and p-tau181 but not Aß42. ANGPT2 also correlated positively with CSF sPDGFRß and fibrinogen - markers of pericyte injury and BBB leakiness. In cohort (ii), CSF ANGPT2 was highest in MCI. CSF ANGT2 correlated with CSF albumin in the CU and MCI cohorts but not in AD. ANGPT2 also correlated with t-tau and p-tau and with markers of neuronal injury (neurogranin and α-synuclein) and neuroinflammation (GFAP and YKL-40). In cohort (iii), CSF ANGPT2 correlated strongly with the CSF:serum albumin ratio. Increased CSF ANGPT2 and the CSF:serum albumin ratio showed non-significant associations with elevated serum ANGPT2 in this small cohort. Together, these data indicate that CSF ANGPT2 is associated with BBB leakiness in early AD and is closely related to tau pathology and neuronal injury. The utility of serum ANGPT2 as a biomarker of BBB damage in AD requires further study.

Relationship between Glycaemic Control and Oral Immunologic Proteins.

BACKGROUND: Attaining a good glycaemic control is usually the target for therapy in diabetic patients as this is expected to prevent both acute and chronic complications. Oral infections are however very common among diabetic patients despite the presence of many immunologic proteins in the saliva. This study was designed to determine the impact of glycaemic control on levels of these proteins in diabetic patients. METHODS: Salivary lysozyme, histatins, immunoglobulin A and immunoglobulin G were measured in diabetic patients. The levels of these immunologic proteins were compared between patients whose HbA1c were less than 7% and those whose values were greater than or equal to 7%. RESULTS: A total of 95 participants were recruited for this study with 37 (38.9%) of them having a median HbA1c of 6.3% (IQR 5.3- 6.6) and the remaining 58 (61.1%) having a median HbA 1c of 9.1% (IQR 8.1-10.5). There was no significant difference in salivary lysozyme (31.24 vs 33.77 ng/ml; p = 0.69), histatins (9.65 vs 9.17 ng/ml; p = 0.27), IgA (12.79 vs 12.19 µg/ml; p = 0.16) and IgG (31.29 vs 32.49 µg/ml; p = 0.85) between the group with good and those with poor glycaemic control. CONCLUSION: This study showed that glycaemic control does not impact the levels of salivary immunologic proteins in diabetic patients, so quality attention should be given to oral care to avoid the development of oral complications.

CONTEXTE: L'obtention d'un bon contrôle glycémique est généralement l'objectif du traitement des patients diabétiques, car il est censé prévenir les complications aiguës et chroniques. Les infections buccales sont cependant très fréquentes chez les patients diabétiques malgré la présence de nombreuses protéines immunologiques dans la salive. Cette étude a été conçue pour déterminer l'impact du contrôle glycémique sur les niveaux de ces protéines chez les patients diabétiques. MÉTHODES: Le lysozyme, les histatines, l'immunoglobuline A et l'immunoglobuline G salivaires ont été mesurés chez les patients diabétiques. Les niveaux de ces protéines immunologiques ont été comparés entre les patients dont le HbA1c était inférieur à 7 % et ceux dont les valeurs étaient supérieures ou égales à 7 %. RÉSULTATS: Au total, 95 participants ont été recrutés pour cette étude, 37 (38,9 %) d'entre eux ayant une HbA1c médiane de 6,3 % (IQR 5,3- 6,6) et les 58 autres (61,1 %) ayant une HbA1c médiane de 9,1 % (IQR 8,1- 10,5). Il n'y avait pas de différence significative dans le lysozyme salivaire (31,24 vs 33,77 ng/ml ; p= 0,69), les histatines(9,65 vs 9,17 ng/ml ; p= 0,27), les IgA (12,79 vs 12,19 ?g/ml ; p= 0,16) et les IgG (31,29 vs 32,49 ?g/ml ; p= 0,85) entre le groupe avec un bon et celui avec un mauvais contrôle glycémique. CONCLUSION: Cette étude a montré que le contrôle glycémique n'a pas d'impact sur les niveaux de protéines immunologiques salivaires chez les patients diabétiques, une attention de qualité devrait donc être accordée aux soins bucco-dentaires pour éviter le développement de complications orales. Mots clés: Diabète, Contrôle glycémique, Protéines salivaires, Cavité orale, Protéines immunologiques.

Vitreous Hemorrhage, Aetiology and Visual Outcome of Vitrectomy in a Black African Population.

BACKGROUND: Information on the causes and outcome of treatment of vitreous hemorrhage (VH) in sub-Saharan Africa is limited. OBJECTIVES: To determine the causes and postoperative vision after vitrectomy for VH. DESIGN: A retrospective review of records from consecutive eyes, with VH greater than one-month duration, who had vitrectomy and adjunctive treatment in a retina unit in Nigeria. METHODS: We assessed the change between preoperative and postoperative visual acuity, bio data, cause of VH, duration of follow up, and additional treatment. Data was analyzed using SPSS statistical package 17.0 to determine the significance of the change in visual acuity for each cause of VH. A p value <0.05 was considered statistically significant. RESULTS: Of the 221 eyes of 219 patients, the common causes of VH were trauma 43 eyes, (19.7%), proliferative diabetic retinopathy, 37 eyes (17.0%) and proliferative sickle cell retinopathy, 30 eyes (13.8%). There was no association between cause and the presenting preoperative visual acuity. There was a statistically significant association between cause of VH and postoperative visual outcome. Postoperative visual improvement was significant for branch retinal vein occlusion, central retinal vein occlusion, proliferative diabetic retinopathy with VH only, proliferative sickle cell retinopathy, and trauma with VH only, p value = 0.000, 0.002, 0.001, 0.039, and 0.000 respectively. Postoperative visual change was not significant in age-related macular degeneration and polypoidal choroidal vasculopathy (p value = 0.155, 0.428 respectively). CONCLUSION: Significant improvements in visual acuity can be achieved with active treatment of VH in the majority of cases in Nigeria. This information is useful for discussions on prognosis and agrees with previous studies.

CONTEXTE: Les informations sur les causes et les résultats du traitement de l'hémorragie vitréenne (HV) en Afrique subsaharienne sont limitées. OBJECTIFS: Déterminer les causes et la vision postopératoire après une vitrectomie pour une HV. CONCEPTION: Une revue rétrospective des dossiers d'yeux consécutifs, avec une HV de plus d'un mois, qui ont subi une vitrectomie et un traitement d'appoint dans une unité de rétine au Nigeria. MÉTHODES: Nous avons évalué la variation entre l'acuité visuelle préopératoire et postopératoire, les données biologiques, la cause de l'HV, la durée du suivi et le traitement complémentaire. Les données ont été analysées à l'aide du progiciel statistique SPSS 17.0 afin de déterminer la signification du changement d'acuité visuelle pour chaque cause de HV. Une valeur p <0,05 a été considérée comme statistiquement significative. RÉSULTATS: Sur les 221 yeux de 219 patients, les causes les plus fréquentes de l'HV étaient les suivantes : traumatisme, 43 yeux (19,7%), rétinopathie diabétique proliférante, 37 yeux (17,0 %) et rétinopathie drépanocytaire proliférante, 30 yeux (13,8 %). Il n'y avait pas d'association entre la cause et l'acuité visuelle préopératoire. Il y avait une association statistiquement significative entre la cause de l'HV et le résultat visuel postopératoire. L'amélioration visuelle postopératoire était significative pour l'occlusion de la veine rétinienne de branche, l'occlusion de la veine rétinienne centrale, la rétinopathie diabétique proliférante avec HV uniquement, la rétinopathie drépanocytaire proliférante et le traumatisme avec HV uniquement, valeur p = 0,000, 0,002, 0,001, 0,039 et 0,000 respectivement. Le changement visuel postopératoire n'était pas significatif dans la dégénérescence maculaire liée à l'âge et la vasculopathie choroïdienne polypoïde (valeur p = 0,155,0,428 respectivement). CONCLUSION: Des améliorations significatives de l'acuité visuelle peuvent être obtenues avec un traitement actif de l'HV dans la majorité des cas au Nigeria. Cette information est utile pour les discussions sur le pronostic et concorde avec les études précédentes. Mots clés: Rétinopathie diabétique, traumatisme oculaire, rétinopathie diabétique proliférante, rétinopathie drépanocytaire, Afrique subsaharienne, hémorragie vitrée, vitrectomie, acuité visuelle.

Tackling a Major Deficiency of Diversity in Alzheimer's Disease Therapeutic Trials: An CTAD Task Force Report.

As the last opportunity to assess treatment effect modification in a controlled setting prior to formal approval, clinical trials are a critical tool for understanding the safety and efficacy of new treatments in diverse populations. Recruitment of diverse participants in Alzheimer's Disease (AD) clinical trials are therefore essential to increase the generalizability of study results, with diversity broadly described to be representative and inclusive. This representation of study participants is equally critical in longitudinal cohort (observational) studies, which will be key to understanding disease disparities and are often used to design adequately powered AD clinical trials. New and innovative recruitment initiatives and enhanced infrastructure facilitate increased participant diversity in AD clinical studies.

Correlating optical coherence tomography biomarkers with visual acuity in nigerian retinitis pigmentosa patients.

Background: Spectral Domain Optical Coherence Tomography (SD-OCT) has been used for imaging retinitis pigmentosa (RP) eyes and provides useful information on microstructural changes. Aim: To review SD-OCT findings and correlate the central foveal thickness (CFT), outer nuclear layer (ONL), external limiting membrane (ELM), and ellipsoid zone (EZ) with visual function in nonsyndromic RP eyes. Patients and Methods: A multicenter, retrospective review of records from consecutive eyes diagnosed to have RP. Biodata, systemic disease, visual acuity, lens status, intraocular pressure, and SD-OCT images were examined. The CFT was categorized into normal (250-299 microns), atrophic (0-249 microns), and edematous (≥300 microns). The ONL, ELM, and EZ within the subfoveal area was assessed and rated as normal, reduced (if less than normal), or absent (if missing). The status of these biomarkers was correlated with visual acuity and statistical analysis performed using Pearson Chi2, P < 0.05. In addition, the vitreomacular interface was examined for the presence of vitreomacular traction (VMT), vitreomacular adhesion (VMA), and epiretinal membrane (ERM). Results: Fifty-two RP eyes of 27 patients had SD-OCT images that were used for study analysis. There were 17 males and 10 females; 52% of participants were between 31 and 50 years (age range: 22-77 years). An atrophic retina was the most common finding in 42 eyes (81%); the average CFT in the atrophic group was 175 microns (range: 111-245 microns). There were three eyes with cystoid macular edema, and seven eyes were normal. For the OCT biomarkers, a reduction in ONL and ELM occurred in 69% and 46% of eyes, respectively, while an absence was the most common EZ finding (in 50% of eyes). There was a significant correlation between the presence or absence of the three biomarkers and presenting vision: ONL, ELM, and EZ with P values of 0.000, 0.006, and 0.011, respectively. The CFT had no significant correlation with vision; P = 0.522. Other findings on OCT include ERM 17%, VMA 6%, and VMT 2%. Conclusion: This report supports the notion that OCT image reporting on physical retinal structure in RP eyes can be used to predict disease effects on vision. A prospective study to better quantify the degree of structural change and correlate with the degree of functional loss is required for RP gene types in Nigerians and black Africans.

Local anaesthetic techniques in endoscopic sinonasal surgery: a contemporaneous review.

OBJECTIVE: Endoscopic endonasal surgery is a minimally invasive technique that has revolutionised the management of complex neurosurgical, otolaryngological, skull-base and craniofacial lesions. Traditionally performed under general anaesthetic, this study explores the growing role of local anaesthetic techniques. METHOD: A contemporaneous review of modified dental techniques and intraoral anatomy provides a supportive guide for performing endoscopic sinus surgery under local anaesthetic. RESULTS: The practical procedures for four midfacial nerve blocks are described with relevance to endoscopic surgery under local anaesthetic. Anatomy, surgical technique and potential complications are discussed for the incisive foramen block, sphenopalatine ganglion block (via endonasal approach), maxillary nerve block (via the greater palatine foramen and the transoral lateral pterygoid plate approach) and transcutaneous approach to the pterygomaxillary fissure. CONCLUSION: Ultimately, such techniques may extend the safety and efficacy of endoscopic sinus surgery, limit surgical risk and increase satisfaction for patients, surgeons and healthcare managers alike.

Visual Status of Patients with Retinitis Pigmentosa: A Multicenter Study.

AIM: To determine the degree of visual loss associated with retinitis pigmentosa (RP) in Nigerians at first ophthalmic clinic presentation METHODOLOGY: Multicenter, prospective, cross-sectional study in four collaborating retina clinics within Nigeria between January and December 2018. The primary outcome measure was the World Health Organization's visual status classification at presentation. Clinical examination, including a Snellen's visual acuity, refraction, anterior segment examination using a slit lamp biomicroscope, and dilated fundus examination using a +90D or +78D, was done in all consecutive RP patients. We analyzed the data using SPSS (version 22), P < 0.05. RESULTS: Of 8614 patients seen within the study period, fiftyfour eyes of 27 patients diagnosed to have RP with a mean age of 44.1years ± 17.6 years (ranging between 5­73 years) constituted the study population. Eighteen (66.7%) were males and 9 (33.3%) females. The hospital-based prevalence of RP was 0.31%. Ten patients (37.0%) presented with myopia. RP was bilateral in all cases and non-syndromic. Bilateral low vision and blindness were noted in 44.4% and 22.2% of patients respectively. CONCLUSION: About a quarter of patients with RP presenting to the retina clinics would have some degree of visual morbidity. Educating eye care providers and patients about the disease would improve understanding, encourage early clinic visits, manage visual morbidity and enhance rehabilitation when necessary.

OBJECTIF: Déterminer le degré de perte visuelle associée à la rétinite pigmentaire (RP) chez les Nigérians lors de la première présentation en clinique ophtalmique MÉTHODOLOGIE: Étude multicentrique, prospective et transversale dans quatre cliniques de rétine collaboratrices au Nigeria entre janvier et décembre 2018. Le principal critère de jugement était la classification de l'état visuel de l'Organisation mondiale de la santé à la présentation. Un examen clinique, comprenant une acuité visuelle de Snellen, une réfraction, un examen du segment antérieur à l'aide d'un biomicroscope à lampe à fente et un examen du fond d'œil dilaté à l'aide d'un +90D ou +78D, a été effectué chez tous les patients consécutifs atteints de RP. Nous avons analysé les données à l'aide du SPSS (version 22), P < 0,05 RÉSULTATS: Sur les 8614 patients examinés pendant la période d'étude, 54 yeux de 27 patients diagnostiqués comme ayant une RP et âgés en moyenne de 44,1 ans ± 17,6 ans (entre 5 et 73 ans) ont constitué la population étudiée. Dix-huit (66,7 %) étaient des hommes et 9 (33,3 %) des femmes. La prévalence de la RP dans les hôpitaux était de 0,31 %. Dix patients (37,0 %) présentaient une myopie. La RP était bilatérale dans tous les cas et non syndromique. Une basse vision et une cécité bilatérales ont été constatées chez 44,4 % et 22,2 % des patients respectivement. CONCLUSION: Environ un quart des patients atteints de RP se présentant dans les cliniques de la rétine auraient un certain degré de morbidité visuelle. L'éducation des prestataires de soins ophtalmologiques et des patients sur la maladie permettrait d'améliorer la compréhension, d'encourager les visites précoces dans les cliniques, de gérer la morbidité visuelle et d'améliorer la réadaptation si nécessaire. Mots clés: Rétinite pigmentaire, Nigeria, basse vision, cécité.

Polypoidal Choroidal Vasculopathy Amongst Nigerians; A Multicenter Study.

OBJECTIVE: To investigate the prevalence and presentation of polypoidal choroidal vasculopathy (PCV) in Nigerians. METHODS: A cross-sectional, multicenter, hospital-based, descriptive study. Data were collected prospectively between January and December 2018, from consecutive patients diagnosed to have a retina disease at the general outpatient and retinal clinics of four eye departments in Nigeria. All participants had visual acuity, refraction, intraocular pressure, anterior segment examination, and dilated fundus examination. Some patients had fundus fluorescein angiography, optical coherence tomography (OCT), and OCT angiography (OCTA). Systemic comorbidity was determined by medical history and systemic evaluation. Diagnosis of PCV was based on clinical findings, and in some patients using OCT. RESULTS: A total of 8,614 patients were seen and 15 patients (18 eyes) were diagnosed to have PCV giving a yearly hospital-based prevalence of 0.17%. The mean age at presentation was 63.27 ± 11.5 years (range 44-84 years). There were nine females (60%). The male: female ratio was 1.5:1. Twelve (66.7%) of the 18 eyes were blind, 16.7% had severe visual impairment while 11.1% had mild visual impairment. Seven eyes (38.9%) had vitreous hemorrhage. Of the 12 blind eyes, 50% had vitreous hemorrhage (P = 0.463). Nine patients (60%) had systemic hypertensive as comorbidity (P = 0.016). CONCLUSION: PCV is a cause of vision loss among Nigerians. Majority of the eyes were blind and 50% of blind eyes had vitreous hemorrhage. Since Indocyanine Green Angiography is the most appropriate imaging technology and is mostly unavailable in Nigeria, efforts should be made to address this need and improve the diagnostic accuracy.

Are outcomes of surgery for retina detachments from giant tears worse than from other holes and tears in this era of small gauge vitrectomy and perflorocarbon use in Sub-Saharan Africa?

AIMS: To report a comparison of clinical features, visual and anatomic outcomes between patients with retinal detachments from giant retinal tears (GRTs) and those from other types of holes and tears undergoing retina reattachment surgery in the same institution within the same time period in sub-Saharan Africa. MATERIALS AND METHODS: A retrospective noncomparative case series of patients undergoing primary retina detachment (RD) repair for rhegmatogenous retina detachment (RRD) at Eye Foundation Hospital Retina Institute between January 2014 and December 2018 was done. RESULTS: A total of 275 eyes of 275 patients met the inclusion criteria. Ages ranged from 7 to 87 years. And 81 (29.4%) eyes had giant tears were categorized as group A and 194 (70.6%) eyes had other types of tears were categorized as group B. At presentation Visual acuity in 66 eyes (79.6%) in the group A was worse than 3/60, compared to 117 eyes (60.3%) in group B. Primary anatomic success was achieved in 73 eyes (92.4%) in-group A and 157 eyes (86.7%) in group B. Final anatomic success was achieved in 75 eyes (94.9%) in group A and 164 eyes (93.2%) in group B. Good visual outcomes were achieved in 48 eyes (59.3%) in group A and 126 eyes (65.6%) in group B. CONCLUSION: Good anatomic and visual outcomes can be achieved after surgery for RRD secondary to giant tears in a sub-Saharan Africa setting in this era of small gauge vitrectomy and perflourocarbon use, these outcomes are comparable to those from surgery for RRD secondary to other types of holes and tears.

Test, test, test - a complication of testing for coronavirus disease 2019 with nasal swabs.

BACKGROUND: Coronavirus disease 2019, a highly transmissible respiratory infection, has created a public health crisis of global magnitude. The mainstay of diagnostic testing for coronavirus disease 2019 is molecular polymerase chain reaction testing of a respiratory specimen, obtained with a viral swab. As the incidence of new cases of coronavirus disease 2019 increases exponentially, the use of viral swabs to collect nasopharyngeal specimens is anticipated to increase drastically. CASE REPORT: This paper draws attention to a complication of viral swab testing in the nasopharynx and describes the premature engagement of a viral swab breakpoint, resulting in impaction in the nasal cavity. CONCLUSION: This case highlights a possible design flaw of the viral swab when used to collect nasopharyngeal specimens, which then requires an aerosol-generating procedure in a high-risk patient to be performed. The paper outlines a safe technique of nasal foreign body removal in a suspected coronavirus disease 2019 patient and suggests alternative testing materials.

Outcome of vitrectomy for advanced proliferative vitreoretinopathy complicating primary rhegmatogenous retinal detachment among Nigerians.

AIM: To present the anatomical and visual outcome and compare different techniques in the surgical treatment of proliferative vitreoretinopathy (PVR) in Nigerians. METHOD: Comparative retrospective review of PVR grade C and D eyes that had vitreoretinal surgery with silicone oil between April 2005 and December 2012. Data was extracted from consecutive case notes after exclusion of eyes with PVR associated with proliferative diabetic retinopathy (PDR), proliferative sickle cell retinopathy (PSCR) and eyes with nonuse of silicone oil. A comparison of the outcome of vitrectomy alone (Vit.), versus combined with a scleral buckle (Vit.+SB), versus with retinectomy (Vit.+RT), versus with all three procedures (Vit.+SB+RT) was done. Statistical analysis was done using the Statistical Package for Social Sciences version 16 software. Pearson Chi-square test and Fisher's exact T-test were used to determine the effect of relationships. RESULTS: 138 eyes of 138 patients had grades C (100 eyes) and grade D (38 eyes) PVR. Surgery involved vitrectomy and membrane peel in 53% of eyes, additional scleral buckle in 22%, and retinectomy was performed in 17%. Retinal reattachment rate was 86% for PVR C eyes and 87% in PVR D eyes. There was no statistically significant difference in anatomical outcome between vitrectomy alone and the combination surgeries. In the vitrectomy only category, the postoperative vision was noted to improve (> preoperative), in 48% of PVR C and in 31% of PVR D. 33% of PVR C and 44% of PVR D eyes had a worse vision (< preoperative). Visual outcome was similarly poor in the combination surgeries with improved vision noted in 12%, 44%, and 33% of the Vit.+SB, Vit. +RT, and Vit.+SB+RT PVR C eyes, respectively. In PVR D eyes, improved vision was seen in 57% and 12% of Vit.+SB and Vit.+RT eyes, respectively. CONCLUSION: Surgery results in anatomical reattachment and there is nonsuperiority of any technique. Visual outcome is poor as previously reported. Recent trials of pharmacological adjuncts may show promise for improved visual outcomes.

BILATERAL GANGLIONIC HAEMORRHAGIC STROKE COMPLICATING SUSPECTED MENINGOCOCCAEMIA: A CASE REPORT.

Haemorrhagic stroke in pyogenic meningitis is a rare complication accounting for about 2% of all complications1,2. It often results from disseminated intravascular coagulation, which is a complication of bacterial meningitis and portends a poor prognosis. A superimposed intracranial haemorrhage, although extremely rare, is associated with high mortality rate. We report a child who had haemorrhagic stroke during the acute phase of bacterial meningitis. The diagnosis was made during post mortem examination. It was discovered that she had suffered haemorrhagic necrosis of both basal ganglion nuclei. Early imaging is advised in meningitis patient presenting with altered levels of consciousness to detect cerebrovascular complications.

Refractive aim and visual outcome after phacoemulsification: A 2-year review from a Tertiary Private Eye Hospital in Sub-Saharan Africa.

AIM: To review the short-term visual outcome of phacoemulsification in adults with uncomplicated cataracts in Eye Foundation Hospital, Lagos, Nigeria. MATERIALS AND METHODS: A retrospective review of records of patients that had phacoemulsification between January 2012 and December 2013 in Eye Foundation Hospital, Lagos, Nigeria, was done. Preoperative visual acuity, refractive aim, intraoperative complications, postoperative unaided, and best-corrected visual acuity at 1 and 3 months were analyzed. Only eyes of adults that had phacoemulsification for uncomplicated cataracts were included in the study, all pediatric cataracts and eyes with ocular comorbidities were excluded. Common ocular comorbidities excluded were corneal opacity/corneal scar, glaucoma, uveitis, pseudo exfoliation syndrome, moderate and severe nonproliferative diabetic retinopathy, macula edema, proliferative diabetic retinopathy, eye trauma, age-related macular degeneration, previous corneal surgery, glaucoma surgery, and previous or simultaneous vitreoretinal surgery. RESULTS: A total of 157 eyes of 119 patients who met the inclusion criteria were analyzed. There were 60 (50.4%) females and 59 (49.6%) males, with age range from 31 to 91 years and a mean of 65.3 ± 11.10 years. Only eyes with available data were analyzed at 1 and 3 months postoperatively. In 112 eyes (85.7%), the refractive aim was met, 21 eyes (14.3%) did not meet their refractive aim, 20 eyes (12.7%) were excluded, the refractive aim could not be determined from the records as surgeons did not specify, and in 4 eyes, the required information was missing from the case files. An unaided visual acuity of 6/18 and better was achieved in 134 eyes (85.4%) at 1 month and 126 eyes (85.9%) at 3 months whereas best-corrected vision of 6/18 and better was achieved by 145 eyes (92.4%) at 1 month and 146 eyes (98.0%) at 3 months. CONCLUSION: Surgical outcomes after phacoemulsification are comparable with international benchmarks for good outcomes, with 85.4% of eyes achieving within 1 D of spherical equivalent of the refractive aim, 92.4% and 98.0% of eyes also achieving best-corrected visual acuities of 6/18 and better at 1 and 3 postoperative months, respectively. Unaided vision of 6/18 and better was also achieved in 85.4% and 85.9% at 1 and 3 postoperative months, respectively.

Bilateral simultaneous macular infarction with spontaneous visual recovery in genotype ss hemoglobinopathy patient.

To report the rare and dramatic event of bilateral macular infarction in a sickle cell hemoglobinopathy (SS genotype) patient, resulting in bilateral severe reduction in visual acuity. Without any intervention, the patient's vision gradually improved over the follow-up period. Central visual field defects however persisted. A 21-year-old male Nigerian, presented with a 1-week history of bilateral sudden painless loss of vision. His symptom was associated with fever, feeling of heaviness in the chest and head, and a dizzy spell. Visual acuity was reduced to 20/200 in both eyes and near acuity was; right eye: N24, left eye: N36. Funduscopy showed a pale, milky white, thickened retinal patch superotemporal to the fovea in both eyes. Fluorescein Angiograph: revealed features consistent with occlusion of the parafoveal terminal arterioles in both eyes. Although he did not receive any ocular treatment, and exchange blood transfusion was not done, he regained near-normal visual acuity in both eyes over a 17-month follow-up period, central visual field defects persisted in both eyes. Visual recovery in this patient demonstrates that macular function could improve over time following macular ischemia, without any treatment. Patients and caring physicians should be aware of this possibility.

Paediatric airway foreign body - The human factors influencing patient safety in our hospitals.

Foreign bodies in the pediatric airway are an uncommon emergency with a high morbidity and mortality rate. Morbidity ranges from 10 to 20% worldwide and this pathology accounts for up to 7% of accidental deaths in children under 4. Dealing with this emergency safely and effectively is complex, requiring a tight coupling of procedures and processes and optimal anesthetic and operating conditions to prevent errors. These factors are recognized by the World Health Organization as 'Human Factors'. We perform a multi-center assessment of human factors pertinent to this emergency. Specifically, equipment provision and staff training in this emergency. Data was collected from 13 sites in the United Kingdom, using two questionnaires for medical and nursing staff. Information including equipment availability, location of equipment, and surgeon and nursing experience was recorded. Royal Manchester Children's Hospital (RMCH) set the study standard. Our study shows there is huge variability in equipment provision across units. There is a lack of experience, confidence and training amongst middle grade otolaryngology surgeons and emergency theatre staff in handling this emergency. Issues with equipment and inexperience of both middle grade doctors and nursing staff could result in significant patient morbidity and mortality. We suggest a standardized age appropriate equipment list and staff training in use of this equipment. Implementation of these simple changes could reduce preventable error in this rare but serious emergency.