Retinal arterial occlusion and patent foramen ovale: A case study-based review.

PURPOSE: To identify all reported cases of retinal artery occlusion (RAO) associated with patent foramen ovale (PFO) in the literature and present a similar case of CRAO from our clinic. METHODS: PubMed database was searched for studies reporting RAO in individuals with PFO. Relevant data were tabulated and reviewed. We estimated each case's Risk of Paradoxical Embolism (RoPE) score. RESULTS: 23 cases of CRAO (n=10; including ours), BRAO (n=10), and CILRAO (n=3) were reviewed. Most cases were under 50 years of age (78.3%). The reported predisposing factors were: hypertension (26.1%), migraine (17.3%), smoking (13.0%), recent immobilization (13.0%), strenuous exertion (8.7%), pregnancy (8.7%), and diabetes (4.3%). A high RoPE score (≥7; suggestive of paradoxical embolism via PFO) was estimated for 71.4% of patients. In most cases, the neurological and cardiovascular examinations, laboratory studies, and imaging were unremarkable, except for the PFO±atrial septal aneurysm (present in 21.7%). In only 28.6% of cases, transthoracic echocardiography (TTE) (± saline contrast) could visualize the PFO; transesophageal echocardiography (TEE) was necessary to detect the PFO in 71.4%. Approximately one-half of the patients underwent percutaneous closure of the PFO; no complications or subsequent acute ischemic events ensued. The visual prognosis was poorer for CRAO than for BRAO or CILRAO. CONCLUSION: Timely diagnosis, acute management, and ensuring urgent initiation of stroke workup in cases with RAO or transient monocular vision loss are crucial. Clues to a possible paradoxical embolism as the cause include the absence of known cardiovascular risk factors, young age, migraine, recent immobility, vigorous exercise, and pregnancy.

Soil microbial improvement using enriched vinasse as a new abundant waste.

This study proposes the use of vinasse, an inexpensive and readily available waste biopolymer, as a fundamental component of a waste culture medium that can enhance the effectiveness and cost-efficiency of the microbial-induced calcite precipitation (MICP) method for sustainable soil improvement. Vinasse enriched with urea, sodium caseinate, or whey protein concentrate is employed to optimize bacterial growth and urease activity of Sporosarcina pasteurii (S. pasteurii) bacterium. The best culture medium is analyzed using Taguchi design of experiments (TDOE) and statistical analysis, considering the concentration of vinasse and urea as effective parameters during growth time. To test the best culture medium for bio-treated soil, direct shear tests were performed on loose and bio-treated sand. The results demonstrate a substantial cost reduction from $0.455 to $0.005 per liter when using the new culture medium (vinasse and urea) compared to the conventional Nutrient Broth (NB) culture medium. Additionally, the new medium enhances soil shear strength, increasing the friction angle by 2.5 degrees and cohesion to 20.7 kPa compared to the conventional medium. Furthermore, the recycling of vinasse as a waste product can promote the progress of a circular economy and reduce environmental pollution. As ground improvement is essential for many construction projects, especially those that require high shear strength or are built on loose soil, this study provides a promising approach to achieving cost-effective and sustainable soil microbial improvement using enriched vinasse.

Intravitreal fasudil monotherapy for treatment of refractory diabetic macular edema: A prospective interventional case series.

BACKGROUND: Suboptimal response to conventional treatments in refractory diabetic macular edema (rDME) encourages efforts to identify new therapeutic options. PURPOSE: To evaluate the effect of three monthly intravitreal injections of a Rho-associated protein kinase (ROCK) inhibitor (Fasudil, Asahi Kasei Pharma Corporation, Tokyo, Japan) in eyes with rDME. METHODS: Ten eyes of 10 patients with DME unresponsive to at least six previous intravitreal bevacizumab (IVB) injections were recruited and underwent 3 consecutive monthly intravitreal injection of 0.025mg/0.05mL Fasudil. Best-corrected visual acuity (BCVA) and central macular thickness (CMT) were evaluated as functional and anatomical response indicators, respectively. RESULTS: The mean age was 60.1±5.1 years (range, 53-68). Five cases responded to treatment, two with both anatomical and functional responses (reduction of CMT from 521 to 395 and from 390 to 301 microns and improvement of BCVA from 0.3 to 0.1 LogMAR and 0.6 to 0.4 LogMAR, respectively) and three with only functional improvement (0.7 to 0.4; 0.7 to 0.4; and 0.3 to 0.1 LogMAR). Of note, cases with no significant change in CMT showed morphologic improvement of the retinal microstructure to some extent. No adverse event was observed during the study period. CONCLUSION: Monotherapy with intravitreal injection of ROCK inhibitors appears to have moderate visual benefits in eyes with DME refractory to IVB. Such effects may be functionally significant without obvious anatomical improvement.

The additive effect of intravitreal dexamethasone combined with bevacizumab in refractory diabetic macular edema.

PURPOSE: To evaluate the short-term structural and visual outcomes and side effects associated with intravitreal dexamethasone (IVD) combined with bevacizumab (IVB) in treating patients with diabetic macular edema (DME) and an inadequate response to anti-vascular endothelial growth factor (anti-VEGF) agents. METHODS: In this prospective interventional case series, a total of 81 eyes of 81 patients with type 2 diabetes mellitus (T2DM) and refractory DME were included and assigned to one of two groups: I) those receiving three monthly intravitreal injections of combined bevacizumab and dexamethasone (IVB+IVD) and II) those receiving three monthly intravitreal injections of bevacizumab alone (IVB). The primary outcome was the inter-group difference in central macular thickness (CMT); secondary outcomes included best-corrected visual acuity (BCVA), baseline optical coherence tomography (OCT) biomarkers, and intraocular pressure (IOP) one month after the last injection. RESULTS: Reduction in CMT and improvement in BCVA were significantly greater in the IVB+IVD group than the IVB group (109.88±156.25 vs. 43±113.67, respectively, P=0.03; and -0.13±0.23 vs. -0.01±0.17, respectively, P=0.008). Presence of neurosensory retinal detachment (NSD) (P<0.001) and complete inner segment/outer segment junction (IS-OS) disruption (P=0.049) on baseline OCT scans were associated with further CMT reductions in response to IVD. Conversely, identifiable epiretinal membrane (ERM) (P=0.002) and multiple hyperreflective foci (>20) (P=0.049) were associated with smaller reductions in CMT. Vitreomacular traction correlated with worse visual outcomes in the IVB+IVD group (P=0.003). The intergroup IOP difference was not clinically significant. CONCLUSION: In patients with refractory DME, addition of IVD to the standard IVB regimen can improve visual and structural outcomes without increasing the risk of endophthalmitis, IOP rise, or intraocular inflammation. Patients with NSD are more likely to respond well to IVD. The presence of ERM may predict poor treatment response.

Endogenous Fungal Endophthalmitis following COVID-19 Hospitalization: Evidence from a Year-Long Observational Study.

PURPOSE: To describe cases of endogenous fungal endophthalmitis (EFE) post-recovery from or hospitalization for coronavirus disease 2019 (COVID-19). METHODS: This prospective audit involved patients with suspected endophthalmitis referred to a tertiary eye care center over a one-year period. Comprehensive ocular examinations, laboratory studies, and imaging were performed. Confirmed cases of EFE with a recent history of COVID-19 hospitalization±intensive care unit admission were identified, documented, managed, followed up, and described. RESULTS: Seven eyes of six patients were reported; 5/6 were male, and the mean age was 55. The mean duration of hospitalization for COVID-19 was approximately 28 days (14-45); the mean time from discharge to onset of visual symptoms was 22 days (0-35). All patients had underlying conditions (5/6 hypertension; 3/6 diabetes mellitus; 2/6 asthma) and had received dexamethasone and remdesivir during their COVID-related hospitalization. All presented with decreased vision, and 4/6 complained of floaters. Baseline visual acuity ranged from light perception (LP) to counting fingers (CF). The fundus was not visible in 3 out of 7 eyes; the other 4 had "creamy-white fluffy lesions" at the posterior pole as well as significant vitritis. Vitreous taps were positive for Candida species in six and Aspergillus species in one eye. Anti-fungal treatment included intravenous amphotericin B followed by oral voriconazole and intravitreal amphotericin B. Three eyes underwent vitrectomy; the systemic health of two patients precluded surgery. One patient (with aspergillosis) died; the others were followed for 7-10 months - the final visual outcome improved from CF to 20/200-20/50 in 4 eyes and worsened (hand motion to LP) or did not change (LP), in two others. CONCLUSION: Ophthalmologists should maintain a high index of clinical suspicion for EFE in cases with visual symptoms and a history of recent COVID-19 hospitalization and/or systemic corticosteroid use - even without other well-known risk factors.

Acetazolamide and bevacizumab combination therapy versus bevacizumab monotherapy in macular edema secondary to retinal vein occlusion.

PURPOSE: To determine and compare the efficacy of intravitreal bevacizumab (IVB) and oral acetazolamide (OA) combination therapy versus IVB monotherapy in patients with macular edema secondary to retinal vein occlusion (RVO). METHODS: This randomized clinical trial included 54 eyes of 52 patients with RVO central macular thickness (CMT) of more than 300µm, and best corrected visual acuity (BCVA) between 20/400 and 20/40. Eligible patients were randomly assigned to two groups: (I) IVB and OA (250mg twice daily) combination therapy or (II) IVB monotherapy. Ocular injections were repeated monthly for up to three months; BCVA and CMT were measured monthly. RESULTS: Both regimens resulted in significant reduction in CMT (534±150µm to 352±90µm in the IVB+OA group, P<0.001; and 580±175µm to 362±90µm in the IVB group, P<0.001); neither showed superiority in this regard. Likewise, BCVA showed significant improvement in both groups (0.87±0.56 to 0.53±0.28 LogMAR in the IVB+OA group, P=0.001; and 0.85±0.62 to 0.46±0.4 LogMAR in the IVB group, P<0.001), with no intergroup difference. CONCLUSION: Addition of oral acetazolamide to IVB in eyes with macular edema secondary to RVO may not result in additional short-term benefits regarding functional and anatomical outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05290948, registered on March 22, 2022. https://clinicaltrials.gov/ct2/show/NCT05290948.

Acute macular neuroretinopathy and COVID-19 vaccination: Case report and literature review.

OBJECTIVE: To review cases of acute macular neuroretinopathy (AMN) after COVID-19 vaccination and add a similar case to the literature. METHODS: A thorough PubMed search was conducted, and data from studies describing AMN after COVID-19 vaccination were extracted, tabulated, pooled, and reviewed. RESULTS: We present a case of AMN in a young woman 5 days after immunization with the BBIBP-CorV (Sinopharm) COVID-19 vaccine. Data from 21 cases were pooled and reviewed. The most frequent vaccines among the cases were recombinant ones (13/21), followed by mRNA-based (6/21) and inactivated vaccines (2/21). Only one patient (5%) was male. Seventeen over twenty-one (81%) were young women, ages 18-33. Most cases (14/21; 67%) reported recent/concurrent use of contraceptive medication. In 90% of cases (19/21), symptoms appeared within 8 days of vaccination. A confined wedge-/oval-shaped lesion morphology was more frequent than a diffuse, semilunar one. Resolution of symptoms took 4 to over 15 weeks. CONCLUSION: Attention should be paid to the history of vaccination and contraceptive use in patients with sudden-onset visual symptoms. Optical coherence tomography is integral to the detection of AMN-related abnormalities.

Ophthalmologic aspects of Dermatofibrosarcoma Protuberans: A systematic review in the context of a rare case of primary orbital involvement.

OBJECTIVE: To provide a systematic review on ophthalmologic presentations of dermatofibrosarcoma protuberans (DFSP) in conjunction with a case report of primary orbital involvement by this tumor. METHODS: A thorough electronic search on PubMed, Medline, Scopus, EMBASE and web of science databases was performed. All available data from reported cases along with our described case were extracted and analyzed. RESULTS: We describe a 66-year-old male with primary orbital DFSP who was managed by total excision of the tumor without recurrence after 18 months of follow-up. In the literature, 14 studies reporting 15 cases were identified and reviewed. Our review topics included epidemiology, clinical presentations, pathologic features, differential diagnosis, imaging, treatment and prognosis. CONCLUSION: Rarely, but crucially, ophthalmologists may encounter DFSP in the orbital or periorbital area. They should be familiar with the pathologic nature and treatment options for this tumor. This diagnosis should be kept in mind when approaching a case with a non-tender, nodular, firm, mass or more rarely an indenting orbital mass.

Micropollutants removal in tertiary moving bed biofilm reactors (MBBRs): Contribution of the biofilm and suspended biomass.

The performance of tertiary moving bed biofilm reactors (MBBRs) was evaluated in terms of micropollutants (MPs) removal from secondary-treated municipal wastewater. After stepwise establishment of a mature biofilm, monitored by scanning electron and confocal microscopies, abiotic and biotic removals of MPs were deeply studied. Since no MPs reduction was observed by the both photodegradation and volatilization, abiotic removal of MPs was ascribed to the sorption onto the biomass. Target MPs i.e. Naproxen, Diclofenac, 17ß-Estradiol and 4n-Nonylphenol, arranged in the ascending order of hydrophobicity, abiotically declined up to 2.8%, 4%, 9.5% and 15%, respectively. MPs sorption onto the suspended biomass was found around two times more than the biofilm, in line with MPs' higher sorption kinetic constants (ksor) found for the suspended biomass. When comparing abiotic and biotic aspects, we found that biotic removal outperformed its counterpart for all compounds as Diclofenac, Naproxen, 17ß-Estradiol and 4n-Nonylphenol were biodegraded by 72.8, 80.6, 84.7 and 84.4%, respectively. The effect of the changes in organic loading rates (OLRs) was investigated on the pseudo-first order degradation constants (kbiol), revealing the dominant biodegradation mechanism of co-metabolism for the removal of Diclofenac, Naproxen, and 4n-Nonylphenol, while 17ß-Estradiol obeyed the biodegradation mechanism of competitive inhibition. Biotic removals and kbiol values of all MPs were also seen higher in the biofilm as compared to the suspended biomass. To draw a conclusion, a quite high removal of recalcitrant MPs is achievable in tertiary MBBRs, making them a promising technology that supports both pathways of co-metabolism and competitive inhibition, next to the abiotic attenuation of MPs.

Studies on influence of process parameters on simultaneous biodegradation of atrazine and nutrients in aquatic environments by a membrane photobioreactor.

A Lab scale algal-bacterial membrane photobioreactor (MPBR) was designed and operated under 12-h light and 12-h dark conditions with a light intensity of 8000lx, in order to investigate the effects of initial concentrations of atrazine, carbon concentration, and hydraulic retention time on the ability of this photobioreactor in simultaneous removal of atrazine and nutrients in the continuous mode. The removal efficiencies of atrazine (ATZ), chemical oxygen demand (COD), phosphorus (PO43--P) and nitrogen (NOx) in optimum condition was more than 95%, 99%, 98% and 97% when the maximum removal rates were 9.5 × 10-3, 99.231, 11.773 and 7.762mg/L-day, respectively. Results showed that the quality of the effluent was reduced by the increase of atrazine concentration. The outcomes on the hydraulic and toxic shocks indicated that the system has a relatively good resistance to the shocks and can return to the stable conditions. Microalgae showed a great deal of interest and capability in cultivating and attaching to the surface of the membrane and bioreactor, and the total biomass accumulated in the system was greater than 6g/L. The kinetic coefficients of atrazine removal were also studied using various kinetic models. The maximum atrazine removal rate was determined by the modified Stover-Kincannon model. The results approved the ability of the MPBR reactor in wastewater treatment and microalgae cultivation and growth. The decline of atrazine concentration in this system could be attributed to the algal-bacterial symbiosis and co-metabolism process. Accordingly, the MPBR reactor is a practical, simple, economical and therefore suitable process for simultaneous biodegradation of chlorinated organic compounds and nutrients removal from aquatic environments.

Sulfate-Mediated End-to-End Assembly of Gold Nanorods.

There is interest in the controlled aggregation of gold nanorods (GNRs) for the production of extended nanoassemblies. Prior studies have relied upon chemical modification of the GNR surface to achieve a desired final aggregate structure. Herein we illustrate that control of electrolyte composition can facilitate end-to-end assembly of cetyltrimethylammonium-bromide-coated (CTAB) GNRs. By adjusting either the sulfate anion concentration or the exposure time it is possible to connect GNRs in chain-like assemblies. In contrast, end-to-end assembly was not observed in control experiments using monovalent chloride salts. We attribute the end-to-end assembly to the localized association of sulfate with exposed quaternary ammonium head groups of CTAB at the nanorod tip. To quantify the assembly kinetics, visible-near-infrared extinction spectra were collected over a predetermined time period, and the colloidal behavior of the GNR suspensions was interpreted using plasmon band analysis. Transmission electron microscopy and atomic force microscopy results support the conclusions reached via plasmon band analysis, and the colloidal behavior is consistent with Derjaguin-Landau-Verwey-Overbeek theory.

Soil heavy metals are associated with the distribution of multiple sclerosis in Isfahan, Iran.

BACKGROUND: Few epidemiological studies have explored the effects of soil pollution on multiple sclerosis (MS) risk in Asia. METHOD: Based on catchment areas, Isfahan province is divided into five regions (Central, North, East, West, and South), and Soil sampling performed in catchment area with the highest range of MS prevalence and incidence. Samples were analyzed for cobalt (Co), lead (Pb), cadmium (Cd), copper (Cu), zinc (Zn), and absorbable forms of Pb, Cd, and Co. Linear regression is used to examine the association of soil heavy metals with prevalence of MS in central part of Isfahan province. RESULT: Multiple sclerosis prevalence ranged from 5.62 to 156.65 in different townships. Based on regression analysis, in case of considering fixed amounts for the rest of elements, a one (SD) increase of absorbable Pb and absorbable Cd are associated with 0.385 (SD) (P < 0.0001) increase and 0.209 (SD) (P < 0.007) decrease in MS prevalence, respectively. CONCLUSION: This study documented a significant association between exposure to absorbable Pb and Cd in soil with prevalence of MS in Isfahan. Further work is warranted to confirm this association and if validated, to understand the mechanisms behind the association.

Characteristics of a novel polymer gel dosimeter formula for MRI scanning: Dosimetry, toxicity and temporal stability of response.

The present study intended to investigate the composition of a new polymer gel dosimeter. The new composition would be more suitable for a wide range of applications in comparison to polyacrylamide gel dosimeter since its extremely toxic acrylamide has been replaced with less harmful monomer i.e. 2-Acrylamido-2-MethylPropane Sulfonic acid (AMPS). To this end, the PAGAT gel dosimeter formula was used as a basis to test the new formulation of polymer gel dosimeter with a different monomer (AMPS) instead of acrylamide by using the %6T and %50C to the formula. The new formulation was named PAMPSGAT (Poly AMPS, Gelatin and THPC) polymer gel dosimeter. Moreover, the MRI response (R2) of dosimeters was analyzed in terms of different dose range as well as post-irradiation time. The results indicated that the dose-response (R2) of AMPS/Bis had a linear trend over a wide dose range. Furthermore, the results showed an acceptable temporal stability for the new polymer gel dosimeter.

IL-1A rs1800587, IL-1B rs1143634 and IL-1R1 rs2234650 polymorphisms in Iranian patients with systemic sclerosis.

Systemic Sclerosis (SSc) is a systemic autoimmune disorder, with ambiguous pathogenesis. Genetic and environmental factors were proved to be correlated with SSc aetiology. Single nucleotide polymorphisms (SNPs) in cytokine genes can alter the structure and function of the cytokines and consequently may increase the susceptibility to a specific disease. In this study, we investigated SNPs of the IL-1 gene cluster in Iranian SSc patients. We obtained blood samples from 170 SSc patients and 213 healthy individuals. Cytokine genotyping results were obtained by polymerase chain reaction with sequence-specific primers (PCR-SSP). IL-1A rs1800587, IL-1B rs1143634 and IL-1R1 rs2234650 were evaluated for SNP study. The frequency of the IL-1B rs1143634 CT genotype was significantly lower in SSc patients compared to the controls (OR = 0.584; 95% CI = 0.385-0.886; P-value = 0.023), so we propose that CT genotype of this allele might be protective. According to our haplotype analysis, CCC haplotype frequency is higher in the control group compared to SSc patients (OR = 1.575; 95% CI = 1.176-2.111; P-value = 0.008) and in contrast, CTC haplotype frequency is lower in the control group compared to SSc patients (OR = 0.152; 95% CI = 0.047-0.484; P-value = 0.002), so they might decrease and increase the susceptibility of having SSc, respectively. In addition, we reported two significant diplotypes frequency differences among SSc patients and healthy individuals. It is highly important that there is not much resemblance between the IL-1 gene cluster polymorphism in different populations, so we can indicate that SNPs may play critical roles when they are combined with other genetic and environmental factors.

Slightly superior performance of bioimpedance spectroscopy over single frequency regression equations for assessment of total body water.

Electrical bioimpedance has been used for several decades to assess body fluid distribution and body composition by using single frequency and bioimpedance spectroscopic (BIS) techniques. It remains uncertain whether BIS methods have better performance compare to single frequency regression equations. In this work the performance of two BIS methods and four different 50 kHz single frequency prediction equations was studied in a data set of wrist-to-ankle tetrapolar BIS measurements (5-1000 kHz) together with reference values of total body water obtained by tritium dilution in 92 patients. Data were compared using regression techniques and Bland-Altman plots. The results of this study showed that all methods produced similarly high correlation and concordance coefficients, indicating good accuracy as a method. Limits of agreement analysis indicated that the population level performance of Sun's prediction equations was very similar to the performance of both BIS methods. However, BIS methods in practice have slightly better predictive performance than the single-frequency equations as judged by higher correlation and the limits of agreement from the Bland-Altman analysis. In any case, the authors believe that an accurate evaluation of performance of the methods cannot be done as long as the evaluation is done using Bland-Altman analysis, the commonly accepted technique for this kind of performance comparisons.

Development and preliminary evaluation of an Android based heart rate variability biofeedback system.

The reduced Heart Rate Variability (HRV) is believed to be associated with several diseases such as congestive heart failure, diabetes and chronic kidney diseases (CKD). In these cases, HRV biofeedback may be a potential intervention method to increase HRV which in turn is beneficial to these patients. In this work, a real-time Android biofeedback application based on a Bluetooth enabled ECG and thoracic electrical bioimpedance (respiration) measurement device has been developed. The system performance and usability have been evaluated in a brief study with eight healthy volunteers. The result demonstrates real-time performance of system and positive effects of biofeedback training session by increased HRV and reduced heart rate. Further development of the application and training protocol is ongoing to investigate duration of training session to find an optimum length and interval of biofeedback sessions to use in potential interventions.