Thompsonthybo0563
To report our experience with a peculiar case of asynchronous bilateral retinal vascular occlusion in a patient suffering from membranoproliferative glomerulonephritis.
A 57-year-old dialysed male affected by membranoproliferative glomerulonephritis who underwent kidney transplantation complained of a sudden vision loss in his right eye (RE). His best-corrected visual acuity (BCVA) was 20/40 in RE and 20/20 in the left eye (LE); ophthalmological and fluorangiographic examinations revealed unilateral retinal obliterative vasculitis with panuveitis and apparent sparing of contralateral eye. About 6 months later the patient developed a branch retinal vein occlusion associated with a papillary neovascular membrane in LE. Corticosteroid therapy was administered and immunosuppressant dosage was increased with macular oedema reduction in both events.
We report a case of unilateral retinal obliterative vasculitis and subsequent contralateral retinal neovascularization and branch retinal vein occlusion in a patient affected by membranoproliferative glomerulonephritis.
We report a case of unilateral retinal obliterative vasculitis and subsequent contralateral retinal neovascularization and branch retinal vein occlusion in a patient affected by membranoproliferative glomerulonephritis.Moral distress is a negative emotional response that occurs when physicians know the morally correct action but are prevented from taking it because of internal or external constraints. Moral distress undermines a physician's ethical integrity, leading to anger, poor job satisfaction, reduced quality of care and burnout. Scarce literature exists on the ethical aspects of moral distress in medicine. We conducted an ethical analysis of moral distress as experienced by physicians and analysed it from the literature using two predominant ethical theories principlism and care ethics. Finally, we consider the emergence of moral distress in medicine during the COVID-19 pandemic.
To report our surgical experience of deep anterior lamellar keratoplasty (DALK) performed in eyes with scarring resulting from a corneal penetrating wound without tissue loss.
Case series of three eyes of three patients that underwent DALK for poor vision due to a scar resulting from a previous corneal penetrating wound. Surgery was performed at least 1 year after the initial injury. Manual dissection technique was used in all cases. Preoperative and postoperative best correct visual acuity (BCVA), postoperative residual bed thickness, and postoperative endothelial cell count (ECC) were evaluated.
Preoperative BCVA ranged from 1.3 to 1.0 LogMAR. Two eyes were pseudophakic and one eye had a traumatic cataract. Manual DALK was successfully accomplished in all three cases. The mean residual recipient bed thickness was 103 µm (range 68-130 µm). The mean endothelial cell loss at the 6th month of follow-up was 6% (range 3%-11%) with a further 1% decrease at 4 years. One of the patients underwent cataract surgery and limbal relaxing incisions 1 year after DALK having a total endothelial cell loss of 4.8% at 2 years of follow-up. BCVA at 2 years of follow-up was 0.1 LogMAR (range 0.22-0.0 LogMAR). No episode of rejection was recorded, and all grafts remained clear at last follow-up (5 years, range 4-6 years).
Manual DALK should be considered in cases of corneal scars in optical zone resulting from penetrating wound.
Manual DALK should be considered in cases of corneal scars in optical zone resulting from penetrating wound.The current study sought to determine the influence of initial sleep quality and body mass index on the cognitive and mood outcomes of a community-based cardio-dance exercise program. Thirty-two older African Americans who participated in a 5-month cardio-dance exercise program were propensity-matched to 32 no-contact controls. Participants completed neuropsychological tests of attention, executive function, and memory and a self-reported depression measure at baseline and post-test. Among exercise participants, we observed significant improvements in depression (baseline = 6.16 ± 5.54, post-test = 4.66 ± 4.89, ηp2=.12, p = .009) and attention (baseline = 40.53 ± 14.01, post-test = 36.63 ± 13.29, ηp2=.12, p = .009) relative to controls. Improvements in executive function and attention were most pronounced among exercise participants with poor sleep quality (baseline = 7.71 ± 1.25, post-test = 8.29 ± 2.06, ηp2=.41, p = .04) and with obesity (baseline = 38.05 ± 12.78, post-test = 35.67 ± 13.82, ηp2=.30, p = .001), respectively. This study provides novel evidence that exercise has the potential to improve depression in older African Americans. For those with poor sleep quality or obesity, exercise can also improve some cognitive outcomes.
To evaluate outcomes of one muscle surgery for treatment of congenital superior oblique palsy (SOP) with Knapp Class V.
Medical records were retrospectively reviewed for the patients with the congenital SOP type V who underwent surgical treatment through one muscle surgery between July 2015 and September 2020. The surgical procedure was resection-recession on the contralateral inferior rectus muscle of the hypertrophic or paretic eye. Vertical alignment at nine cardinal gaze positions, and resolution of the abnormal head posture were evaluated pre- and postoperatively. The follow-up was scheduled regularly at postoperative day 1, 1 week, 1 month, and followed by 2-month intervals until 18 months.
Twelve patients were included in this study, with a mean age of 6.4 years (range from 3 to 10 years). The mean follow-up period was 10.5 months after surgery (range from 6 to 18 months). The average vertical deviation at primary position was 6.33
± 2.93
preoperatively and 0.75
± 1.14
postoperatively (
< 0.05). The average vertical deviation at downgaze was 23.33
± 4.75
preoperatively and 1.92
± 1.62
postoperatively (
< 0.05). All patients had an abnormal head position preoperatively. Postoperative results indicated that the patients' abnormal head position had been improved significantly.
The surgical procedure of resection-recession on a single inferior rectus muscle is a successful intervention for the correction of superior oblique palsy (SOP) with Knapp Class V.
The surgical procedure of resection-recession on a single inferior rectus muscle is a successful intervention for the correction of superior oblique palsy (SOP) with Knapp Class V.Powered wheelchair standing devices (PWSDs) allow supported standing for activity; however, little is known about their use. To understand factors affecting use of supported standing for participation among boys with Duchenne muscular dystrophy (DMD) and characteristics of successful users, we gathered data over 7 days from boys who had used PWSDs for 24 months, using a smartphone application. We used descriptive statistics to identify factors that affected their participation. Physical/social engagement and independence were motivators for standing in PWSDs. Enablers included positive attitudinal/social environments. Barriers included pain during supported standing and lack of physical environment accessibility. The characteristics of successful users were identified. Supported standing via PWSDs has potential to improve participation for boys with DMD. The disease stage, individual personal factors and environmental supports impact on use. Therapists should carefully consider and manage factors that impact on uptake and sustainability of use.We remember the past in order not to repeat it, but does remembrance of war in fact shape support for military or diplomatic approaches to international conflict? In seven samples from five countries (collected online, total N = 2,493), we examined support for military and diplomatic approaches to conflict during war commemorations (e.g., Veterans Day). During war commemorations in the United States, support for diplomacy increased, whereas support for military approaches did not change. We found similar results in the United Kingdom and Australia on Remembrance Day, but not in Germany, or France, nor in Australia on Anzac Day. Furthermore, support for diplomacy was predicted by concern about loss of ingroup military lives during war, independently of concern about harm to outgroup civilians. These studies expand our understanding of how collective memories of war may be leveraged to promote diplomatic approaches to contemporary geopolitical conflict.
Pharmacotherapies for depression are often ineffective and treatment-resistant depression (TRD) is common across bipolar disorder (BD), major depressive disorder (MDD), and post-traumatic stress disorder (PTSD). Patient genetic information can be used to predict treatment outcomes. Prospective studies indicate that pharmacogenetic (PGX) tests have utility in the treatment of depression. However, few studies have examined the utility of PGX in other diagnoses typified by depression, or in veterans, a cohort with high rates of medical comorbidity, social stress, and suicide.
To determine the efficacy of genetically guided pharmacological treatment of TRD.
We conducted an 8-week, prospective, multisite, single-blind study in 182 veterans with TRD including patients with BD, MDD, and PTSD. Subjects were randomly assigned to PGX-guided treatment in which the clinician incorporated PGX information into decision-making, or treatment as usual (TAU).
Overall, the PGX group improved marginally faster compared to TAU, but the difference was not statistically significant. Secondary analyses revealed that only PTSD patients showed a potential benefit from PGX testing. Patients predicted by PGX testing to have moderate levels of genetic risk showed a significant benefit from the PGX-guided treatment, whereas other risk groups demonstrated no benefit. Clinicians generally found the PGX test was useful, particularly in more depressed patients and/or those with more warnings for significant or serious adverse outcomes. Clinicians more often used the results to select a drug, but only rarely to adjust dosing.
The data reveal possible group differences in the utility of PGX testing in veterans with TRD.ClinicalTrials.gov Identifier NCT04469322.
The data reveal possible group differences in the utility of PGX testing in veterans with TRD.ClinicalTrials.gov Identifier NCT04469322.Access to medical assistance in dying (MAID) is influenced by legislation, health care providers (HCPs), the number of patient requests, and the patients' locations. This research explored the factors that influenced HCPs' nonparticipation in formal MAID processes and their needs to support this emerging practice area. find more Using an interpretive description methodology, we interviewed 17 physicians and 18 nurse practitioners who identified as non-participators in formal MAID processes. Nonparticipation was influenced by their (a) previous personal and professional experiences, (b) comfort with death, (c) conceptualization of duty, (d) preferred end-of-life care approaches, (e) faith or spirituality beliefs, (f) self-accountability, (g) consideration of emotional labor, and (h) future emotional impact. They identified a need for clear care pathways and safe passage. Two separate yet overlapping concepts were identified, conscientious objection to and nonparticipation in MAID, and we discussed options to support the social contract of care between HCPs and patients.
