How to find a needle in a haystack: a systematic review on targeting KRAS wild-type pancreatic cancer.

Aim: Pancreatic adenocarcinoma is a very aggressive type of cancer, in which targeted therapies have not yet been fully utilized. KRAS wild-type pancreatic adenocarcinoma tumors are associated with different genomic alterations in comparison to KRAS mutated pancreatic adenocarcinoma. Objective: This systematic review aims to provide a one-stop summary of all these alterations, their proposed targeted treatment and their effect on disease progression. Methods: An electronic search strategy was elaborated in the PubMed database between 2020 and January 2024. Results: 21 studies were included, and we found that the most frequent targetable genomic alterations in KRAS wild-type pancreatic adenocarcinoma were BRAF, EGFR, FGFR, MSI-H/dMMR, Her2/ERBB2 amplification, BRCA1/2 and other HRDs, and gene fusions like ALK, NTRK and NRG1.

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Do ophthalmology residents know how to check the calibration of a Goldmann applanation tonometer?

PURPOSE: The purpose of this observational study was to determine whether ophthalmology residents know how to check Goldmann applanation tonometer (GAT) calibration. METHODS: The step-by-step technique for checking the calibration of a GAT was taken from the manufacturer's manual and developed into a mark sheet. Ophthalmology residents in years 2-8 of training from 11 hospitals were individually observed and assessed checking calibration of a GAT. Participation was voluntary. Contact between participants was minimised to prevent communication about the study. RESULTS: Sixty-eight per cent (n = 30) of eligible ophthalmology residents (years 2-8) from 11 hospitals (three teaching hospitals and eight local general hospitals) were observed checking GAT calibration. Only 33% (n = 10; 95% CI: 16-50%) of ophthalmology residents were able to correctly check GAT calibration. Those participants who were previously taught (p = 0.046) or assessed (p = 0.015) were more likely to be successful in GAT calibration. CONCLUSIONS: Most ophthalmology residents were unable to correctly check GAT calibration. Although better than previously published results, this observational study shows that further training and assessment is required for ophthalmology residents to learn the technique of checking GAT calibration.

Ocular hypertension secondary to high endogenous steroid load in Cushing's disease.

This case report describes a 35-year-old Caucasian man who was referred to the glaucoma clinic with high intraocular pressure (IOP) after routine optometrist assessment. He was diagnosed with ocular hypertension (OHT) and the management plan was for monitoring without treatment. Three months later, he presented to the endocrine clinic with symptoms of Cushing's disease and was diagnosed with an adrenocorticotropic hormone secreting pituitary microadenoma. His symptoms preceded his presentation at both departments by 5 years. He underwent definitive surgical treatment of his adenoma via transsphenoidal resection. At 1-year follow-up in glaucoma clinic, it was noted that his IOP had normalised. Due to his high endogenous cortisol level at diagnosis, long disease duration, the pattern of IOP rise and subsequent normalisation after treatment, it is suggestive that his OHT is secondary to his Cushing's disease. There are infrequent reports of this association in published literature.