Activity

To report a case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography.

Case report.

A 61-year-old woman recently immigrated from China presented with round yellow-white retinal lesions in the left eye. The lesions were evaluated with multimodal imaging, including optical coherence tomography angiography (OCT-A). Subsequent serologic testing revealed a positive quantiFERON-TB Gold test while work up for other entities was negative. The patient was diagnosed with presumed intraretinal tuberculosis. She was started on systemic anti-tubercular therapy and the lesions regressed. The regression was documented with OCT-A.

Case reports of primary intraretinal tuberculosis are uncommon. To our knowledge, this is the first case to demonstrate OCT-A findings of presumed intraretinal tuberculosis.

A case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography is reported.

A case of presumed intraretinal tuberculosis evaluated with optical coherence tomography angiography is reported.

To describe a technique of using subretinal air to create and stabilize a neurosensory detachment performed during placement of a subretinal implant.

A case report of an experiment in a live porcine model.

Creation of a neurosensory detachment may be facilitated by instillation of subretinal air. We use a small gauge cannula to infuse approximately 0.1 ml of subretinal air to create a neurosensory detachment. SR1 antagonist datasheet We then expand the bleb using an additional 0.1 to 0.2 cc of subretinal air followed by balanced salt solution, and stabilize it further with installation of viscoelastic. The small gauge retinotomy should be created on the anterior and superior aspect of the bleb so the air can tamponade the retinotomy both during surgery as well as postoperatively.

This technique may be useful for some newer procedures, such as subretinal implants and perhaps administration of subretinal gene therapy or cell therapy, that require access to the subretinal space.

This technique may be useful for some newer procedures, such as subretinal implants and perhaps administration of subretinal gene therapy or cell therapy, that require access to the subretinal space.In the outpatient setting, ambulatory electrocardiography (AECG) is the most frequently used diagnostic modality for the evaluation of patients in whom cardiac arrhythmias or conduction abnormalities are suspected. Proper selection of the device type and monitoring duration is critical for optimizing diagnostic yield and cost-effective resource utilization. However, despite guidance from major professional societies, the lack of systematic guidance for proper test selection in many institutions results in the need for repeat testing, which leads to not only increased resource utilization and cost of care, but also suboptimal patient care. To address this unmet need at our own institution, we formed a multidisciplinary panel to develop a concise, yet comprehensive algorithm, incorporating the most common indications for AECG, to efficiently guide clinicians to the most appropriate test option for a given clinical scenario, with the goal of maximizing diagnostic yield and optimizing resource utilization. The algorithm was designed as a single-page, color-coded flowchart to be utilized both as a rapid reference guide in printed form, and a decision support tool embedded within the electronic medical records system at the point of order entry. We believe that systematic adoption of this algorithm will optimize diagnostic efficiency, resource utilization, and importantly, patient care and satisfaction.

Characterize prevalence of osmotic demyelination syndrome (ODS) in hospitalized patients with cirrhosis.

ODS is a serious complication of rapid serum sodium correction. Patients with cirrhosis experience labile sodium levels related to portal hypertension and diuretic use, often with rapid correction-intentional or unintentional-during hospitalizations.

We used validated International Classification of Diseases, Ninth Revision (ICD-9) codes to identify inpatients 18 years and older with cirrhosis from the 2009-2013 National Inpatient Sample, excluding those with liver transplantation during hospitalization. The primary outcome was ODS (ICD-9 341.8). Baveno IV defined decompensated cirrhosis (stages 3 and 4); Charlson Comorbidity Index identified severe comorbid illness (score >3). Logistic regression modeled factors associated with ODS.

Of 547,544 adult inpatients with cirrhosis, 94 (0.02%) had ODS. Inpatients with versus without ODS were younger (54 vs. 57 y, P=0.0001), and more likely to have alcage, and female gender. ODS is not associated with liver disease severity, specific complications including ascites, or comorbid disease.

Mucinous pancreatic cysts are well reported to transform into pancreatic adenocarcinoma, whereas nonmucinous cysts are mostly benign with low risk for malignant transformation. Nonsurgical methods of differentiating mucinous and nonmucinous pancreatic cysts are challenging and entail a multi investigational approach. Low intracystic glucose levels have been evaluated in multiple studies for its accuracy in differentiating mucinous from nonmucinous cysts of the pancreas.

Multiple databases were searched and studies that reported on the utility of intracystic glucose levels in diagnosing mucinous pancreatic cysts were analyzed. Meta-analysis was conducted using the random-effects model, heterogeneity was assessed by I2%, and pooled diagnostic test accuracy values were calculated.

Seven studies were included in the analysis from an initial total of 375 citations. The pooled sensitivity of low glucose in differentiating mucinous pancreatic cyst was 90.5% [95% confidence interval (CI) 88.1-92.5; I2=0%] and tinous pancreatic cysts.

The aim was to measure bile acids in human saliva using a sensitive ultraperformance liquid chromatography tandem mass spectrometry analysis method to distinguish quantitative differences in refractory gastroesophageal reflux disease (GERD) patients as compared with proton pump inhibitor (PPI) controlled GERD patients and healthy volunteers.

Human saliva samples were analyzed from 2 separate studies. The first a meal-controlled pilot, in which premeal and postmeal saliva samples were analyzed from 20 healthy subjects and 20 patients with GERD symptoms controlled by PPIs. In a subsequent exploratory study, saliva was collected from 34 patients with continuing GERD symptoms despite PPI treatment (refractory GERD), 30 healthy subjects, and 30 PPI-controlled GERD patients at ≥4 hours postmeal.

In the meal-controlled pilot study, both healthy subjects and patients with PPI-controlled GERD, had total saliva bile acid increase for the first hour after consumption of a meal and returned to baseline levels 4 hours later.