The International Transfer of Patients With Positive SARS-CoV-2 Test Using a Framework.

The Japanese Fellowship Program at the U.S. Naval Hospital Yokosuka has served as a liaison with Japanese hospitals during the transfer of acutely ill U.S. Navy patients since 1952. The SARS-CoV-2 pandemic has complicated this process and prompted the creation of a new framework that involves the Public Health Center. We present two international transfer cases of patients with positive SARS-CoV-2. The creation of a framework enabled a safe and smooth transfer process of patients with a favorable outcome. This report can help guide future cases of international transfer, especially for patients who need infectious disease surveillance. To our knowledge, we describe the first report of an international transfer of patients with positive SARS-CoV-2 test using a framework.

Effects of Vectored Thermal Pulsation on Objective Tear Film Measures.

PURPOSE: To assess the effect of vectored thermal pulsation treatment for meibomian gland dysfunction on objective measures of lipid layer thickness (LLT) and tear osmolarity. METHODS: One hundred patients with meibomian gland dysfunction diagnosis were recruited to participate. At their initial visit, baseline study parameters were recorded, and vectored thermal pulsation treatment was administered. At the 2- to 3-month follow-up visit, the study parameters were reevaluated. Subjective symptoms were evaluated using the Ocular Surface Disease Index questionnaire. LLT was measured using an ocular surface interferometer. Tear osmolarity was calculated using impedance measurement of tear fluid collected from the eyelid margin. RESULTS: Ninety-six patients (192 eyes) completed the follow-up. Mean improvement in Ocular Surface Disease Index was 5.6 points (95% confidence interval [CI], -9.0 to -2.1, P = 0.002). There was no significant change in tear osmolarity (mean change -1.6 mOsm/L, 95% CI, -4.7 to +1.3 mOsm/L, P = 0.3). There was no significant change in LLT (mean change -4.3 nm, 95% CI, -9.1 to +0.5 nm, P = 0.08). CONCLUSIONS: The hypothesis that vectored thermal pulsation treatment would decrease tear osmolarity and increase LLT was not substantiated. Although we detected significant improvement in subjective symptoms, the improvement was smaller than the improvements reported in previous studies. Our results suggest that the current understanding of the effects of vectored thermal pulsation treatment is incomplete.

A Case Report of Slug Ingestion Causing Eosinophilic Meningitis, Papilledema, and Pronounced Motor Weakness in a US Marine.

Angiostrongyliasis is the most common cause of eosinophilic meningitis worldwide and is primarily characterized by eosinophilic meningitis, meningoencephalitis, or myelitis. It is caused by ingestion of the nematode Angiostrongylus cantonensis, the rat lungworm (or apple snail). The most common route of infection is by ingestion of parts of the intermediate hosts like mollusks or food contaminated with infective third stage larvae. Following ingestion, the larvae migrate through the intestinal walls into the bloodstream and further into the central nervous system where they cause meningo-encephalo-myelitis and can have a variety of ocular manifestations. We present a case of a Caucasian United States Marine who suffered severe meningo-encephalo-myelitis with papilledema following ingestion of a raw Giant African Snail (Lissachatina lutica) while stationed in Japan. He developed eosinophilic meningoencephalitis, polyneuropathy, motor weakness, and papilledema. We describe the unique clinical features of this disease in our patient.

A comprehensive model for correcting RNFL readings of varying signal strengths in cirrus optical coherence tomography.

PURPOSE: To develop a model for the Cirrus HD-OCT that allows for the comparison of retinal nerve fiber layer (RNFL) thickness measurements with dissimilar signal strengths (SS) and accounts for test-retest variability. METHODS: Retinal nerve fiber layers were obtained in normals using the Cirrus optic disc cube 200 × 200 protocol during a single encounter. Five RNFL scans were obtained with a SS of 9 or 10. Diffusion lens filters were used to degrade SS to obtain five scans at each SS group of 7 or 8, 5 or 6, and 3 or 4. The relationship between average RNFL thickness and SS was established, and an equation was developed to allow for adjustment of an RNFL measurement had it been a SS of 7. Intravisit interclass correlation coefficient (ICC) and coefficient of variation (CV) parameter estimates for each SS group were calculated. Repeatability and upper tolerance limit were calculated as 1.96 × âˆš2 × within-subject standard deviation (Sw) and 1.645 × âˆš2 × Sw, respectively. RESULTS: There was a linear relationship between average RNFL and SS. RNFLadj = RNFL - 1.03*SS + 7.21 allows for the adjustment of RNFL readings to the same SS. Interclass correlation coefficients and CVs were good for all measurements down to SS of 3 or 4. Repeatability and upper tolerance limit were 5.24 and 4.40 µm, respectively. CONCLUSIONS: Our model adjusts RNFL readings based on SS and includes an upper tolerance limit of 5 µm. If validated, this model could improve the detection of real RNFL changes. Further study to validate this model should be performed before widespread use is adopted.