Physician attitudes toward sports medicine coverage of mixed martial arts.

BACKGROUND: The popularity of modern Mixed Martial Arts (MMA) has been increasing since 2000s. It has drawn the attention of the media due to higher injury rates compared to other sports, and it is possible that this may have led to a generally negative image of MMA among viewers, including but not limited to, physicians. Therefore, our study aimed to understand the attitudes of physicians toward MMA and being asked to cover MMA events. METHODS: A cross-sectional study with an online survey was answered by 410 physicians from four physician organizations throughout the USA. Demographic data, sports event-related, sports coverage experience, athleticism, and familiarity with MMA answers were analyzed. Wilcoxon, Fisher Exact, and χ2 tests were used to compare the data. The main outcomes was the association between characteristics of physicians and attitude toward MMA coverage. RESULTS: Physician characteristics influenced positive attitudes toward MMA coverage. Those who regularly followed MMA felt more strongly that combat sport events required physician coverage, mainly for boxing (92.4% vs. 73.4%; P<0.001), kickboxing (89.9% vs. 54.7%; P<0.001), and taekwondo (50.6% vs. 38.4%; P=0.046). Doctors who considered themselves athletic or who had covered MMA events in the past were more likely to think that all sporting events should be covered by physicians (97.4% vs. 65.9%; P<0.01; 98.4% vs. 72.8%, P<0.001, respectively). Family medicine (72/139 [51.8%]) and physical medicine and rehabilitation (7/11 [63.6%]) were the specialties more inclined to agree with physician coverage for these events. CONCLUSIONS: Physicians familiar with MMA, either as a previous ringside physician or as a spectator, are more inclined to believe these events should have physician coverage as are those more experienced with sports medicine, such as family medicine and physical medicine and rehabilitation specialists. Therefore, specialized sports medicine training should be provided to allow for appropriate MMA physician coverage. With additional training, MMA event organizers should feel comfortable asking physicians in any specialty to provide sports medicine coverage to improve care for MMA athletes.

Examining the Relationship Between Diabetic Macular Edema, and Obstructive Sleep Apnea.

Purpose: This prospective cohort study examined the relationship between diabetic macular edema (DME), diabetic retinopathy (DR) and obstructive sleep apnea (OSA) in patients after 1 year of treatment with anti-VEGF injection and/or continuous positive airway pressure (CPAP). Patients and Methods: The study included adults with type 1 or 2 diabetes mellitus with diabetic retinopathy. Polysomnography metrics were measured at baseline. Ophthalmologic metrics were measured at baseline, six-month (6m) and twelve-month (12m) follow-up. All DME+ patients received standard care, and all OSA+ patients were advised continuous positive airway pressure (CPAP). Logistic regression between DR severity and OSA severity was performed. Analysis of variance (ANOVA) was performed between subgroups. Results: Seventy-four eyes of 49 patients with DR were included. Prevalence of OSA was significantly higher in the DME+ group (70.7%) than DME- group (42.4%, p < 0.05). A significantly lower average minimum SaO2 was noted in OSA+DME+ (81.74%) than OSA+DME- eyes (88.23%, p < 0.05). Logistic regression analysis of ophthalmological and sleep metrics showed no correlation between DR and OSA severity. CPAP adherence was 20% (6/30) in the OSA+DME+ cohort and 36% (5/14) in the OSA+DME- cohort. At 12m, CPAP-adherent OSA+DME+ showed significantly lower DR severity score (1.00 ± 0.0) than CPAP non-adherent OSA+DME+ (1.36 ± 0.80, p = 0.042). No significant patterns were noted for visual acuity and mean central retinal thickness. Conclusion: DME is associated with the presence of OSA. Minimum SaO2 is a significant OSA clinical variable for DME. DR severity is not associated with OSA severity. CPAP coupled with intravitreal anti-VEGF therapy may be helpful for reducing DR severity in DME+ eyes. Presence of OSA may diminish intravitreal anti-VEGF efficacy on anatomical (mean CRT) and functional (VA) outcomes of DME.

Cutaneous larva migrans in the city.

Cutaneous larva migrans is typically reported in tropical and subtropical regions of the world. However, cutaneous larva migrans cases are spreading and should now be recognized even in urban, nontropical settings.

Factors Associated with the Development of Posterior Capsule Opacification Requiring Yttrium Aluminum Garnet Capsulotomy.

SIGNIFICANCE: Determining risk factors for posterior capsule opacification will allow for further interventions to reduce the risk of development and thus additional procedures. PURPOSE: The purpose of this study was to investigate risk factors associated with development of clinically significant posterior capsule opacification requiring yttrium aluminum garnet (YAG) capsulotomy. METHODS: Medical records of patients (≥18 years) who underwent cataract surgery between January 1, 2011, and March 31, 2014, at Kresge Eye Institute were reviewed. Three hundred eyes requiring YAG capsulotomy up to 3 years after cataract surgery were included in the YAG capsulotomy group. Three hundred eyes not requiring YAG capsulotomy up to 3 years after cataract surgery were selected via age-matched simple randomization (control group). RESULTS: The YAG capsulotomy group included patients with younger age (65.8 ± 11.3 vs. 70.1 ± 10.6 years, P < .001), more men (42.67 vs. 34.67%, P = .04), fewer patients with hypertension (73.00 vs. 83.00%, P < .001), and more patients with hydrophilic intraocular lenses (74.67 vs. 47.00%, P < .001). Logistic regression analysis demonstrated a negative association between YAG capsulotomy and age (coefficient, -0.04; 95% confidence interval [CI], 0.95 to 0.98; P < .001) and hydrophobic intraocular lenses (coefficient, -1.50; 95% CI, 0.15 to 0.33; P < .001), and a positive association with presence of glaucoma (coefficient, 0.88; 95% CI, 1.39 to 4.17; P = .002). Elapsed time to YAG capsulotomy was sooner in patients with a history of uveitis (95% CI, 5.10 to 9.70 months; P = .02) and insertion of hydrophilic intraocular lenses (95% CI, 18.67 to 21.57 months; P < .001). CONCLUSIONS: Results of this study suggest that development of visually significant posterior capsule opacification is associated with younger age, glaucoma, and hydrophilic intraocular lenses, and it occurs earlier among those with hydrophilic intraocular lenses and a history of uveitis.

Comparison of 2 regimens of loteprednol etabonate and bromfenac for cataract surgery.

OBJECTIVE: We aimed to evaluate the safety and effectiveness of 2 dosing regimens of loteprednol etabonate (LE) ophthalmic gel 0.5% and bromfenac ophthalmic solution 0.07% in patients undergoing routine cataract surgery. DESIGN: Six-week prospective, masked, randomized controlled noninferiority study. PARTICIPANTS: One hundred eyes. METHODS: Patients undergoing uncomplicated cataract surgery were selected in a consecutive manner. Patients were randomized to one of 2 groups: LE QID + qD bromfenac (control group) versus LE BID + qD bromfenac (study group). Primary outcome metrics included summed ocular inflammation score (SOIS) and adverse events. Secondary outcome measures included intraocular pressure, visual acuity, central retinal thickness, and subjective symptomology scores measured at 4 study visits. The final visit included a questionnaire addressing compliance, satisfaction, and comfort with the medications. RESULTS: Both groups demonstrated similar effectiveness and safety between dosing regimens. No statistically significant difference was reported between groups regarding SOIS (visit 1 p = N/A, visit 2 p = 0.66, visit 3 p = 0.60, visit 4 p = 0.08). No adverse events were reported relating to the difference in study regimen. A statistically significant difference was not found regarding secondary outcomes (p > 0.05). Control group patients reported a more difficult time remembering their doses for bromfenac but not LE (bromfenac p < 0.05; LE p = 0.15). CONCLUSIONS: Our data suggest that both groups had similar outcomes with respect to control of ocular inflammation with no differences in adverse outcomes. The compliance questionnaire also suggests a patient preference for the dosing regimen with lower frequency of drop application.

Timing and Outcome of Referral to the First Stand-Alone Palliative Care Center in the Eastern Mediterranean Region, the Palliative Care Center of Kuwait.

BACKGROUND: Compared to other regions of the world, palliative care (PC) in the Eastern Mediterranean region is at an earlier stage of development. The Palliative Care Center of Kuwait (PCC-K) was established a few years ago as the first stand-alone PC center in the region. This study was conducted to investigate the timing of referral to the PCC-K and its outcome. METHODS: Retrospective review of referrals to the PCC-K during its first 3 years of action. Late referral was defined as referral during the last 30 days of life. RESULTS: During the 3-year period, 498 patients with cancer were referred to the PCC-K of whom 467 were eligible for analysis. Referral was considered late in 58% of patients. Nononcology facilities were more likely to refer patients late when compared to oncology facilities ( P = .033). The palliative performance scale (PPS) was ≤30 in 59% of late referrals and 21% in earlier referrals ( P < .001). Among 467 referred patients, 342 (73%) were eligible for transfer to the PCC-K, 102 (22%) were ineligible, and 23 (5%) died before assessment by the PCC-K consultation team. From the 342 eligible patients, the family caregivers refused the transfer of 64 (19%) patients to the PCC-K. CONCLUSION: Patients are frequently referred late to the PCC-K. Further research to identify barriers to PC and its early integration in Kuwait is required. The PPS may be useful in identifying late referrals.