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Maylander Menard,1 Yesha S Shah,2 Inna G Stroh,2 Sidra Zafar,2 Manjari Sriparna,2 Nancy Zhang,2 Ank A Agarwal,2 Nakul Shekhawat,2 Divya Srikumaran,2 Fasika Woreta2 1School of Medicine, Meharry Medical College, Nashville, TN, USA; 2Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USACorrespondence: Fasika Woreta, Division of Cornea and External Disease, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Wilmer B20, Baltimore, MD, 21287, USA, Tel +410 955-5650, Email fworeta1@jhmi.eduPurpose: To evaluate baseline characteristics, microbiological spectrum, management, and outcomes of patients with culture-proven fungal keratitis.Methods: Retrospective review of all patients with culture-proven fungal keratitis seen over 6 years at a tertiary referral center.Results: The present study included 62 eyes from 62 patients. Infection with filamentous organisms was more common than with yeast (66.1% vs 27.4%). The most common filamentous organisms were Fusarium (17.7%) and Aspergillus (16.1%), while the most common yeast was Candida (24.2%). The main predisposing factor for filamentous keratitis was contact lens use. Yeast keratitis is most associated with an immunocompromised host and ocular surface disease. Corneal perforation (20.0%) and surgical interventions (46.8%) were common, with 27.4% of eyes requiring at least one penetrating keratoplasty. Filamentous keratitis is more likely than yeast keratitis to require urgent penetrating keratoplasty or enucleation and to receive more than one topical and systemic antifungal agent. Visual outcomes were poor with nearly half of the eyes remaining at 20/200 or worse upon resolution of infection. Worse visual outcomes were associated with poor vision at presentation and a history of ocular surface disease. Antifungal susceptibility testing was not routinely performed, but it demonstrated a relatively high minimum inhibitory concentration for at least one antifungal drug in 90% of cases when performed (16.1%) and guided the direction of treatment for 80% of the cases.Conclusion: Fungal keratitis is visually devastating. Infections with filamentous fungi predominated over yeast and were generally treated more aggressively both medically and surgically. Filamentous and yeast keratitis had similar durations of infections and visual outcomes. Antifungal susceptibility testing influenced treatment in 80% of cases in which it was performed.Keywords: fungal keratitis, mycotic keratitis, filamentous keratitis, corneal culture

Schizophrenia is a psychiatric condition characterized by dysfunction in thoughts, behavior, and emotions. The illness is typically diagnosed in late adolescence to early adulthood, and generally lasts throughout a patient’s lifetime. This debilitating condition affects approximately 25% of adults aged 55 years old and older. With numbers of elderly adults afflicted by psychiatric illnesses increasing in the future, special precautions need to be taken to address this underserved population. This increase in schizophrenia frequency among elderly populations also has repercussions not just for future healthcare, but health costs as well, with schizophrenia expenses being costly in comparison to other psychiatric ailments. A major theory explaining the genetic and physiological basis of schizophrenia is the dopamine hypothesis, which describes a disruption in the normal transmission of the dopaminergic pathway as well as the mesolimbic system. Current treatments of schizophrenia often involve pharmacological interventions that create heightened side effects in the elderly. There is a need for more research into efficient and effective treatments for the future, especially treatments that can be safe for elderly use such as brain stimulating interventions. Destigmatizing mental health issues and advocating for safer and more efficient therapies are the key to improving outcomes of geriatric schizophrenic patients

Background Research experience is believed to be an important component of the neurosurgery residency application process. One measure of research productivity is publication volume. The preresidency publication volume of U.S. neurosurgery interns and any potential association between applicant publication volume and the match results of top-ranked residency programs have not been well characterized. Objective In this study, we sought to characterize the preresidency publication volume of U.S. neurosurgery residents in the 2018–2019 intern class using the Scopus database. Methods For each intern, we recorded the total number of publications, total number of first or last author publications, total number of neuroscience-related publications, mean number of citations per publication, and mean impact factor of the journal per publication. Preresidency publication volumes of interns at the top-25 programs (based on a composite ranking score according to 4 different ranking metrics) were compared with those at all other programs. Results We found that 82% of neurosurgery interns included in the analysis (190 interns from 95 programs) had at least 1 publication. The average number of publications per intern among all programs was 6 ± 0.63 (mean ± standard error of the mean). We also found that interns at top-25 neurosurgery residency programs tended to have a higher number of publications (8.3 ± 1.2 vs. 4.8 ± 0.7, P = 0.0137), number of neuroscience-related publications (6.8 ± 1.1 vs. 4.1 ± 0.7, P = 0.0419), and mean number of citations per publication (9.8 ± 1.7 vs. 5.7 ± 0.8, P = 0.0267) compared with interns at all other programs. Conclusions Our results provide a general estimate of the preresidency publication volume of U.S. neurosurgery interns and suggest a potential association between publication volume and matching in the top-25 neurosurgery residency programs.

Introduction The emergence and rapid spread of the coronavirus disease 2019 (COVID-19) pandemic have revealed the limitations in current healthcare systems to handle patient records securely and transparently, and novel protocols are required to address these shortcomings. An attractive option is the use of Ethereum smart contracts to secure the storage of medical records and concomitant data logs. Ethereum is an open-source platform that can be used to construct smart contracts, which are collections of code that allow transactions under certain parameters and are self-executable. Methods The present study developed a proof-of-concept smart contract that stores COVID-19 patient data such as the patient identifier (ID), variant, chest CT grade, and significant comorbidities. A sample, fictitious patient data for the purpose of testing was configured to a private network. A smart contract was created in the Ethereum state and tested by measuring the time to insert and query patient data. Results Testing with a private, Proof of Authority (PoA) network required only 191 milliseconds and 890 MB of memory per insertion to insert 50 records while inserting 350 records required 674 milliseconds and similar memory per insertion, as memory per insertion was nearly constant with the increasing number of records inserted. Retrieving required 912 MB for a query involving all three fields and no wildcards in a 350-record database. Only 883 MB was needed to procure a similar observation from a 50-record database. Conclusion This study exemplifies the use of smart contracts for efficient retrieval/insertion of COVID-19 patient data and provides a case use of secure and efficient data logging for sensitive COVID-19 data.

In order to prescribe an antibiotic, a physician must go through a series of decision-making processes that involve both the drug and the host. In this review article, we outline exactly what those decision-making processes are and some of their limitations. Before a medication can be prescribed, a physician has to determine if the antibiotic works against the host pathogen. To do this, basic science techniques are employed including phenotypic methods such as broth dilution methods, Kirby-Bauer susceptibility testing, Epsilometer test (E-test), and genotypic methods such as the new and upcoming automated tests. After determining if a drug has potential to work, the physician must consider the drug's mechanism of action in order to determine a dosing regimen. Some groups of drugs should be administered at high concentrations infrequently, others should be given more frequently in smaller doses, and others lie somewhere between this spectrum. Finally, external factors such as the patient's age, especially for pediatrics and geriatrics patients, need to be considered, as these groups have the highest health care burden but are among the most vulnerable when it comes to the side effects of drugs.

Over the last decade, opioid use around the world has risen considerably and is projected to continue to rise at an alarming rate. As opioid use rises, so too does the number of people who suffer from opioid use disorder (OUD) and opioid overdose-related deaths. As science and medicine progresses, new medications and therapies have arisen in order to help treat patients suffering from addiction. Treatment can be split into two main domains: pharmacological and non-pharmacological. Buprenorphine and methadone, currently the most prescribed medications for patients suffering from OUD, have been shown to be extremely effective in clinical trials but have significant real-world limitations. Geographical disparities between various locations, physician stigma with prescribing these medications, and training required to prescribe medication can make access to these treatments difficult for patients. Non-pharmacological interventions have also been shown to help with limited efficacy when combined with pharmacological interventions. However, the time and resources required to implement these strategies may be a difficult barrier to overcome. In this review, we assess pharmacological interventions, non-pharmacological treatments, examine barriers to treatment for patients, and propose solutions to bypass these barriers.

Ischemic strokes result in the death of brain tissue and a wave of downstream effects, often leading to lifelong disabilities or death. However, the underlying mechanisms of ischemic damage and repair systems remain largely unknown. In order to better understand these mechanisms, TMT-isobaric mass tagging and mass spectrometry were conducted on brain cortex extracts from mice subjected to one hour of middle cerebral artery occlusion (MCAO) and after one hour of reperfusion. In total, 2,690 proteins were identified and quantified, out of which 65% of the top 5% of up- and down-regulated proteins were found to be significant (p < 0.05). Network-based gene ontology analysis was then utilized to cluster all identified proteins by protein functional groups and cellular roles. Although three different cellular functions were identified—organelle outer membrane proteins, cytosolic ribosome proteins, and spliceosome complex proteins—several functional domains were found to be common. Of these, organelle outer membrane proteins were downregulated whereas cytosolic ribosome and spliceosome complex proteins were upregulated, indicating that major molecular events post-stroke were translation-associated and subsequent signaling pathways (e.g., poly (ADP-ribose) (PAR) dependent cell death). By approaching stroke analyses via TMT-isobaric mass tagging, the work herein presents a grand scope of protein-based molecular mechanisms involved with ischemic stroke recovery.

Objective To describe and assess the educational value of a functional neurosurgery clinical shadowing and research tutorial for pre-medical trainees. Design Program participants observed functional neurosurgery procedures and conducted basic science and clinical research in neurosurgery fields. Former participants completed a brief online survey to evaluate their perspectives and experiences throughout the tutorial. Setting Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Participants 15 pre-medical and post-baccalaureate trainees participated in the tutorial. All former tutorial participants were emailed. Results 11/15 former participants responded to the survey. Survey results suggest that the tutorial program increased participants’ understanding of and interest in neurosurgery and related fields in neuroscience. Conclusions The functional neurosurgery medical tutorial provides valuable clinical and research exposure in neurosurgery fields for pre-medical trainees. Our work is a preliminary step in addressing the crucial challenge of training the next generation of neurosurgeon-scientists by providing a pedagogical paradigm for development of formal experiences that integrate original scientific research with clinical neurosurgery exposure.

Cardiovascular Disease (CVD) remains the leading cause of death, worldwide and in the United States. Approximately 30% of global deaths can be attributed to one form of CVD, including conditions such as heart disease, stroke, heart attack, and arrhythmia. In diagnosing CVD, electrocardiograms (ECG) are commonly used to measure and record the electrical activity of the heart. Their non-invasive, informative, and relatively simple nature allows for rapid deployment. However, because analysis of ECGs depends solely on a physician, ECG analysis becomes subjective, adding a potential layer of error to patient healthcare. Studies indicate that physicians often misread ECGs and disagree with each other’s interpretations. In order to develop an accurate and objective method for ECG analysis, this study evaluates various ensemble algorithms to design and create a supervised classification model. Several ensemble models were evaluated to derive one which correctly classifies CVD with sufficiently high accuracy. A boosted decision tree ensemble created to evaluate cardiac condition performs best, with an overall accuracy of 84.6% and an AUC of 0.828.