Development of Acute Vogt–Koyanagi–Harada-like Syndrome during the Treatment Course with Vemurafenib for Metastatic Melanoma

Purpose: To report on ocular Vogt–Koyanagi–Harada (VKH)-like syndrome under vemurafenib treatment for metastatic melanoma. Design: A case report. Method: Description of clinical and imaging manifestations including fundus photography, fluorescein, and indocyanine green angiography. Results: A 46-year-old Thai female was diagnosed with metastatic melanoma of the skin and had been treated with multiple surgical excisions, radiotherapy, and vemurafenib (initial dose 480 mg orally twice daily, subsequently increased to maximum dose of 960 mg twice daily). After 6 months of vemurafenib use, she complained of bilateral redness and photophobia and was diagnosed with bilateral anterior uveitis, which was topically treated. Two weeks later, her visual acuity (VA) sharply deteriorated to 20/80 and counting fingers. Ocular examination at that stage stronly resembled acute VKH disease. She exhibited intraocular inflammation, and her fundus examination revealed bilateral optic disc swelling and serous retinal detachment. Fluorescein angiogram showed disc leakage and multiple pinpoint hyperfluorescence leakage spots and indocyanine green demonstrated multipl

Primary stabilization of humeral shaft fractures: an experimental study of different osteosynthesis methods

OBJETIVO: Estudo experimental idealizado com o objetivo de se avaliar a estabilização primária das fraturas da diáfise umeral com três diferentes métodos de osteossíntese, representados por uma placa tipo DCP aplicada com técnica em ponte, uma síntese incomum, denominada SPS®, ainda sem similar na literatura, aplicada pela técnica em ponte, e um terceiro método constituído de uma haste intramedular com um método de bloqueio também incomum proporcionado por um parafuso cortical distalmente e por um fio do tipo Ender proximalmente. MATERIAL E MÉTODO: Vinte e um pares de úmeros humanos foram divididos em três grupos, utilizando-se um tipo de material para cada grupo, os quais foram submetidos a osteotomias, aos procedimentos de fixação e a ensaios não destrutivos de flexo-compressão e de torção, com limites de carga de 200N e de 100N, respectivamente e, num mecanismo de "crossing", foram submetidos secundariamente a novos ensaios de torção e de flexo-compressão, amparados por análise estatística. RESULTADOS: O grupo da placa DCP em ponte mostrou boa resistência às cargas aplicadas, o que também ocorreu no grupo do SPS®, que apesar de mostrar maiores índices de deflexão, apresentou grande capacidade elástica. O grupo da haste intramedular mostrou bons resultados nos ensaios de flexo-compressão, devido ao seu mecanismo de tutor, mas não demonstrou resistência às cargas de torção.OBJECTIVE: The purpose of this study was to assess primary stabilization of humeral shaft fractures using three different methods of fixation, represented by a DCP type plate, applied as a bridge plate, an uncommon synthesis material named SPS®, not previously described in literature and also used as a bridge plate, and a third type of material constituted by an intramedullary nail, with an uncommon locking provided by a distal cortical screw and a proximal Ender-type wire. MATERIAL AND METHOD: Twenty-one pairs of human humeri were divided into three groups, each using one type of material for fixation, the bones of which were osteotomized, stabilized and submitted to nondestructive flexion-compression and torsion assays up to 200 N and 100 N respectively, and, in a crossing mechanism, the groups were again submitted to other torsion and flexion-compression assays, supported by statistical analysis. RESULTS: The bridge-DCP group showed good resistance to the applied forces, similarly to the SPS® group, which, although presenting greater deflection, showed great elastic capacity. The intramedullary nail group showed good results in the flexion-compression assay due to the tutor mechanism of the intramedullary nails, but did not show resistance to the torsion forces

Prevalence and Risk Factors for Ocular Complications in New-Onset Uveitis: A Study From a Tertiary Referral Center in Northern Thailand

Atitaya Apivatthakakul,1 Apichat Tantraworasin,2,3 Aniki Rothova,4 Paradee Kunavisarut,1 Kessara Pathanapitoon1 1Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand; 2Department of Surgery, Chiang Mai University, Chiang Mai, Thailand; 3Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 4Department of Ophthalmology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the NetherlandsCorrespondence: Kessara Pathanapitoon, Department of Ophthalmology, Chiang Mai University, Chiangmai, Thailand, Tel +66-53-935512, Email [email protected]: To determine the prevalence and identify risk factors of ocular complications in patients with uveitis.Methods: This retrospective study reviewed of 340 consecutive patients with a first episode of active uveitis from January 2015 to December 2019. Demographic and clinical data, including ocular complications were analyzed.Results: The mean age of the cohort was 47 years. Among them, 75 patients were HIV-positive (74% male), and 265 were HIV-negative (53% male). An Infectious etiology was identified in 52% of cases. Ocular complications, developed in 151 patients (44%), with their type strongly correlate to the anatomical location of uveitis. Multivariate analysis revealed chronic inflammation (risk ratio [RR]=18.9; 95% confidence interval [CI] 6.1– 58.8), recurrent inflammation (RR=20.4; 95%; CI 6.5– 64.3), and poor visual acuity (VA) at presentation (RR=3.6; 95% CI 1.4– 9.2) as significant risk factors for complications.Conclusion: Nearly half of the patients with uveitis developed ocular complications, highlighting the importance of identifying risk factors. Understanding the relationship between the location of inflammation and specific complication patterns is essential for early detection and targeted prevention strategies.Keywords: uveitis, ocular complication, risk factors, blindness, Thailan

Younger Age and Albuminuria are Associated with Proliferative Diabetic Retinopathy and Diabetic Macular Edema in the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study

Purpose: The purpose of the South Indian GeNetics of DiAbeTic Retinopathy (SIGNATR) Study is to identify non-genetic and genetic risk factors associated with diabetic retinopathy (DR). This report examines the non-genetic risk factors for DR in South Indian patients. Methods: Participants with South Indian ancestry and type 2 diabetes (T2D) were included from two sources: the Sankara Nethralaya Diabetic Retinopathy and Molecular Genetics Study (SN-DREAMS) and prospective recruitment at Sankara Nethralaya affiliates. Fundus photography and optical coherence tomography (OCT) were obtained on participants. Fundus images were graded for DR severity and OCTs were graded for center-involved diabetic macular edema (ciDME). Multivariate analyses were performed using stepwise logistic regression to assess effects of the demographic and clinical factors on proliferative DR (PDR) and DME. Results: Among the 2941 participants with DR grading, participants with PDR were more likely to be younger [odds ratio (OR)=0.95], men (OR = 1.83), have a longer duration of diabetes (OR = 1.10), have a higher hemoglobin A1c (OR = 1.12), have albuminuria (OR = 5.83), have hypertension (OR = 1.69), have a higher HDL (OR = 1.02) and a lower total cholesterol (OR = 0.99) (all p < 0.05). Among the 483 participants with gradable OCT scans, participants who had ciDME were more likely to be younger (OR = 0.97), men (OR = 2.80), have a longer duration of diabetes (OR = 1.06), have lower triglycerides (OR = 0.99), and have albuminuria (OR = 3.12) (all p < 0.05). Conclusions: Younger age, male sex, longer duration of diabetes, higher HbA1c, and presence of albuminuria were identified as risk factors for PDR and DME in a South Indian population with T2D

Primary Rhegmatogenous Retinal Detachment Repair by Pars Plana Vitrectomy With and Without Scleral Buckling: A Propensity Score Analysis [Response to Letter]

Pongthep Rajsirisongsri,1 Direk Patikulsila,1 Phichayut Phinyo,2&ndash;4 Paradee Kunavisarut,1 Voraporn Chaikitmongkol,1 Onnisa Nanegrungsunk,1 Atitaya Apivatthakakul,1 Sutheerada Seetasut,1 Yaowaret Tantivit,1 Napatsorn Krisanuruks,1 Apisara Sangkaew,1 Nawat Watanachai,5 Janejit Choovuthayakorn1 1Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Clinical Epidemiology and Clinical Statistics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Department of Biomedical Informatics and Clinical Epidemiology (Bioce), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 4Musculoskeletal Science and Translational Research (MSTR), Chiang Mai University, Chiang Mai, Thailand; 5Department of Ophthalmology, Faculty of Medicine, Mahidol University, Bangkok, ThailandCorrespondence: Janejit Choovuthayakorn, Email [email protected]

Scleritis and episcleritis in patients with idiopathic small fiber neuropathy

Purpose: To report the prevalence of scleritis and episcleritis in patients with idiopathic small fiber neuropathy (SFN). Methods: The Mass General Brigham (MGB) hospital database was queried for patients with SFN, scleritis and episcleritis using diagnostic codes and natural language processing. Electronic medical chart review of patients diagnosed with SFN and episcleritis/scleritis who had at least one ophthalmology visit was conducted. The prevalence of scleritis and episcleritis in patients diagnosed with SFN was compared to those without SFN using logistic regression to adjust for covariates. All statistical analyses were performed in RStudio 4.2.1. Results: From the 2100 SFN patients with an eye exam in the MGB database, 23 patients had episcleritis or scleritis (1.1 %) confirmed by chart review. Ten patients had episcleritis (0.48 %) and thirteen patients had scleritis (0.62 %). Of the episcleritis and scleritis patients, 16 (69.6 %) were women and 7 (30.4 %) were men. Ten (43.5 %) had bilateral ocular disease. The mean age of ocular diagnosis was 51.0 years (range, 22–77 years). Out of the 507,128 controls without SFN in the MGB database, 1481 (0.29 %) had scleritis and 1430 (0.28 %) had episcleritis. Episcleritis and scleritis were more prevalent in patients with SFN than in those without SFN: 0.48 % vs. 0.28 % for episcleritis and 0.62 % vs 0.29 % for scleritis (P values = 0.32 and 0.02, respectively). Conclusions and Importance: There were higher rates of scleritis in SFN patients compared to non-SFN patients. This potential systemic disease association had not been previously reported