Fungal keratitis after amniotic membrane placement.

Purpose: We present two cases of fungal keratitis following amniotic membrane transplantation, including Sistotrema biggsiae and Fusarium keratitis. Observations: A 76-year-old female with a history of anterior basement membrane dystrophy referred for reduced vision and left eye pain ten days following AMT at an outside facility. Despite topical management, the patient continued to worsen clinically, with a recalcitrant course of Fusarium keratitis requiring conjunctival flap, cryotherapy, and intracameral and intrastromal injection. The second case involved a 46-year-old male with a history of recurrent corneal erosions referred for blurry vision and pain in his left eye seven days following AMT. He was found to have Sistotrema biggsiae keratitis and had remarkable visual improvement with topical management. Conclusions: Fungal keratitis following amniotic membrane placement has not been reported presenting within ten days after transplantation. This is the first report of Sistotrema biggsiae infection in humans. This case series highlights the risk of severe recalcitrant microbial keratitis presenting within days after AMT placement and recognizing fungal etiologies not previously reported in literature. The risk of keratitis following AMT should be considered with close patient follow up, especially in patients with monocular vision.

Accessibility and Cultural Inclusivity of Online Glaucoma-Based Video Content for Patient Education.

PRCIS: This study is the first to evaluate the ease of access, understandability, and cultural inclusivity of online glaucoma-related video content for patient education. Overall, materials were found to be poorly understandable and not culturally representative. PURPOSE: The purpose of this study is to assess the ease of access, readability, actionability, and cultural inclusivity of glaucoma-specific patient education videos found online. DESIGN: Cross-sectional study. SUBJECTS: Twenty-two glaucoma-based patient education videos were reviewed for this study. METHODS: A survey of glaucoma specialists identified commonly recommended patient education Web sites, which were analyzed for video content. Web sites were reviewed by 2 independent reviewers for glaucoma-based patient education videos. Videos with content designated for medical providers, dedicated to research, or affiliated with private practices were excluded. Videos that were not glaucoma-specific or longer than 15 minutes were also excluded. The Patient Education Materials Assessment Tool was used to score videos for understandability and actionability reviewing content, word choice, organization, layout, and use of visual aids. Videos were also reviewed for cultural inclusivity and accessibility measures including language availability. Agreement analysis with a kappa coefficient (κ) over 0.6 was established with the first 5 videos between 2 independent reviewers and scoring discrepancies were resolved via a third independent reviewer. RESULTS: From 10 recommended Web sites, 22 videos met inclusion criteria for evaluation. The average Patient Education Materials Assessment Tool score was 68.3% (SD = 18.4) for understandability (κ=0.63). Most videos (64%) were accessed within 3 clicks from the homepage. Only 3 videos were available in another language (Spanish). Most actors and images were White individuals (68.9%), followed by Black (22.1%), then Asian (5.7%) and other/ambiguous (3.3%). CONCLUSIONS: There is room for improvement regarding language accessibility, understandability, and cultural inclusivity of glaucoma-based, publicly available patient education video content.

Digital eye strain during the virtual interviews: evidence-based strategies for medical students.

The 2020-2021 residency interview season was the first in which interviews were entirely virtual, and residency interviews may continue to be offered in this format. Digital eye strain can negatively affect applicants' interview experience. We provide an overview of the virtual residency interview experience with a view to providing applicants with solutions that minimize eye strain. Symptoms, contributing factors, and evidence-based interventions for digital eye strain are discussed.

Targeting the Gut Microbiome for Inflammation and Pain Management in Orthopedic Conditions.

The human gut microbiome can be altered with probiotics, prebiotics, synbiotics, and anti-inflammatory foods and spices as part of an evidence-based strategy that targets inflammation and pain in common orthopedic conditions. Implementing these strategies avoids adverse effects associated with nonsteroidal anti-inflammatory drugs and minimizes the potential for opioid use. This review focuses exclusively on human trials studying the effects of gut microbiome alterations to address pain and inflammatory markers in common orthopedic conditions: osteoarthritis, rheumatoid arthritis, fractures/osteoporosis, and bone pain associated with chemotherapy. Individualized supplementation strategies can be further explored with the information in this review. [Orthopedics. 2022;45(5):e226-e234.].

Bilateral nummular infiltrates: An uncommon presentation of Candida keratitis.

PURPOSE: We present a case of misdiagnosed fungal keratitis due to a bilateral nummular presentation. OBSERVATIONS: A 41-year-old female patient, contact lens wearer, presented initially at an optometrist with acute bilateral blurred vision and photophobia. She was found on exam to have multiple round stromal infiltrates bilaterally. She did not have significant ocular surface issues prior and had no history of topical steroid use. Adenovirus testing was negative, and she was started on a topical antibiotic-steroid combination. She did not improve and was referred for further evaluation. We initially suspected a herpetic infection and began treatment with oral antivirals. Cultures came back positive for Candida albicans in the right eye. She was very photophobic and cultures were unable to adequately be obtained from the left eye. She was switched to topical voriconazole drop in both eyes and gradually improved with excellent visual outcome. Urogenital cultures were negative. Contact lens use was discontinued through the course of treatment. CONCLUSIONS: Bilateral Candida keratitis is rare and has not been reported in a nummular pattern and in a patient without significant ocular surface issues or chronic use of steroid drops. Differential diagnosis of nummular keratitis mostly includes viral and inflammatory conditions. This case highlights the need to stay alert to a possible fungal etiology and a potential risk of using topical steroids at initial presentation of nummular keratitis.

Intravenous Drug Use-Associated Infective Endocarditis in Pregnant Patients at a Hospital in West Virginia.

Introduction Due to high levels of intravenous drug use (IVDU) in West Virginia (WV), there are increasing numbers of hospitalizations for infective endocarditis (IE). More specifically, pregnant patients with IE are a uniquely challenging population, with complex management and a clinical course that further affects the health of the fetus, with high morbidity and mortality. Timely recognition and awareness of the most common bacterial causes will provide hospitals and clinicians with valuable information to manage future patients. Methods This retrospective study analyzed the clinical course of pregnant patients admitted with IE and IVDU history presenting at Cabell Huntington Hospital from 2013 to 2018. Inclusion criteria were women between 16 and 45 years of age confirmed to be pregnant by urine pregnancy test and ultrasonography with at least eight weeks gestation, with a first-time diagnosis of endocarditis and an identified history of IVDU. We excluded charts with pre-existing risk factors including a history of valvular disease, rheumatic heart disease, surgical valve repair or mechanical valve replacement, or a diagnosis of coagulopathies. The resulting charts were evaluated for isolated organisms, reported clinical course, and complications of the pregnancy. Results A total of 10 patients were identified, with methicillin-susceptible and methicillin-resistant Staphylococcus aureus, Serratia marcescens, Haemophilus parainfluenza, and Enterococcus faecalis species. Complications included loss of fetus (30%), septic embolization (40%), hemorrhagic stroke (10%), and transfer to outside facilities for cardiothoracic surgical intervention (40%). Discussion IE in pregnancy, while rare, has serious complications. In the context of the IVDU epidemic, it has an increasing impact on WV hospitals. A better understanding of the clinical course may allow for early diagnosis and guide the development of rational empiric therapies. More effective management of IE in pregnant patients can reduce complications and potentially improve maternal and fetal morbidity or mortality.

Primary Cutaneous Cryptococcosis in a Patient on Fingolimod: A Case Report.

Primary cutaneous cryptococcosis is an uncommon condition. Patients with immunosuppression and those of older age are more susceptible to infection, warranting investigations into underlying systemic disease. We report the case of a 49-year-old male with multiple sclerosis in remission on fingolimod who presented with a non-healing skin lesion on his upper thigh for a duration of two years. Skin biopsy showed dermal parasitized histiocytes, and serum antigens for histoplasmosis and Cryptococcus were negative. Further investigation with polymerase chain reaction (PCR) demonstrated cutaneous cryptococcal infection, with no associated systemic signs or symptoms. This case report highlights an uncommon presentation of cutaneous cryptococcosis on an unexposed skin surface with successful and rapid improvement following fluconazole therapy without fingolimod discontinuation.

A role for music in cataract surgery: a systematic review.

PURPOSE: There have been several studies that explore the anxiolytic effects of music during cataract surgery. This is the first systematic review of literature highlighting the effects of music on patients undergoing cataract surgery without pharmacological anxiolytics. METHODS: A systematic review of literature using PRISMA methodology identified randomized controlled trials involving patients undergoing cataract surgery with music as an intervention during the procedure with outcomes measured using at least one assessment of anxiety level, pain score, satisfaction, or vital sign measurements. Studies using pharmacological anxiolytics or additional pain-relieving medications besides local anesthetic were excluded. RESULTS: Three studies, involving 523 patients, were included with patients undergoing cataract surgery with music intervention. Music intervention during cataract surgery has demonstrated use in reducing perceived pain, reducing anxiety, and improving vitals with increased benefit of reduced heart rate and blood pressures with binaural beat embedded music. CONCLUSIONS: The clinical implications of this review identify non-traditional approaches to reducing anxiety intraoperatively for cataract surgeries, offering clinicians alternatives to minimizing benzodiazepine and medication use risks.

Unusual Liver Mass in an Immunocompetent Adult: A Case Report and Literature Review.

A hepatic abscess is a rare disease, especially in developed countries, and usually results from microbial contamination of liver parenchyma via an arterial or portal system or from a direct spread by contiguity. Pyogenic liver abscesses (PLA) are polymicrobial with Staphylococcus aureus accounting for less than 10% of the cases and methicillin-resistant Staphylococcus aureus (MRSA) accounting for even fewer. Colonic and hepatobiliary pathologies are often associated with reported MRSA abscesses. We report a case of MRSA bacteremia and liver abscess in an immunocompetent patient with no significant risk factors. Our patient presented with fever and abdominal pain of four days' duration. Laboratory studies revealed neutrophilic leukocytosis, elevated creatinine, c-reactive protein, and transaminitis. Blood culture was positive for MRSA. Computed tomography (CT) of the abdomen showed multiple areas of hypodensities over the left hepatic lobe that placed malignancy and abscess into the main differentials. A liver biopsy was consistent with liver abscess. Drainage was performed after a month of treatment with intravenous (IV) daptomycin and microbial analysis of the abscess was negative. Our case signifies the association of liver abscess and MRSA bacteremia in a patient with no significant risk factors and highlights the importance of prompt antibiotic treatment as first-line therapy.

A Rare Case of Ixazomib-Induced Cutaneous Necrotizing Vasculitis in a Patient with Relapsed Myeloma.

Ixazomib is the only oral proteasome inhibitor used in relapsed/refractory myeloma. Cutaneous side effects due to ixazomib have been documented in the literature; however, cutaneous necrotizing vasculitis is extremely rare. We describe a case of a 74-year-old man with relapsed multiple myeloma who was started on ixazomib, lenalidomide, and dexamethasone. He developed several skin lesions that were biopsied and revealed cutaneous necrotizing vasculitis. Ixazomib was held with resolution of the vasculitic lesions and restarted with dexamethasone to 20 mg on the day of treatment and 20 mg dose the day after treatment.