Search

Purpose: To investigate the differences in demographics and clinical characteristics of patients diagnosed with ocular toxoplasmosis according to their IgM status. Methods: Retrospective case note analysis was carried out on patients who tested positive for serum Toxoplasma gondii-specific IgM antibodies (IgM+) as well as a comparator group who tested negative for serum IgM (IgM-), but positive for serum IgG. Patient demographics and clinical features were compared between the two groups to evaluate for any significant differences. Results: One hundred and six patients were included in the study between March 2011 and June 2018, consisting of 37 in the IgM +group and 69 in the IgMgroup. Patients in the IgM +group were significantly older (51.1 vs 34.1 years, p<0.0001), more likely to present with central macular lesions (32% vs 12%, p=0.012), and more likely to develop rhegmatogenous retinal detachment (11% vs 1%, p=0.049). In contrast, patients in the IgM-group were more likely present with pain (20% vs 3%, 0.017) and exhibit more severe inflammation of the anterior chamber and vitreous (p<0.05). Overall, retinal lesions were more likely to be superotemporal (55%) and superonasal (31%). Furthermore, age was associated with larger (p=0.003) and more peripheral lesions (p=0.007). Conclusions: This study demonstrated significant differences in clinical characteristics of ocular toxoplasmosis according to serum IgM status. IgM+ patients were older, less likely to report pain, had lower levels of intraocular inflammation, but were more likely to have macular involvement. We also found age to be correlated with larger and more peripheral lesions. [ABSTRACT FROM AUTHOR]

Summary: Many opportunities for patient and public involvement already exist in medical education. Current approaches may not fully harness the educational potential of the patient voice, so it appears that new approaches are worth exploring. This article, co‐written by students and faculty members, describes an educational initiative in which medical students had opportunistic conversations with randomly selected members of the public to explore their priorities regarding health care. Methods: The 'Design my Doctor' project enabled medical students to hear participants' spontaneous responses to the question 'What should our medical school teach your future doctors?' Students experienced the unfiltered patient voice. The 183 responses were recorded in writing, and on video, and were analysed using the nominal group technique. The themes focused on the health care priorities of members of the public. Results: Themes from the public data included 'interpersonal qualities', 'empowering patients', 'medical knowledge' and the 'health system'. Student reflective pieces showed how powerful hearing first‐hand unfiltered feedback can be. Engagement in collecting and interpreting data enhanced the significance of the content and the process for the learners. Students realised that 'medical knowledge', although important, was not the overriding priority for patients. Students identified specific areas for future application and considered how it could be incorporated systematically into their programme. Discussion:As medical educators, we can use interventions like 'Design my Doctor' to facilitate and support students to proactively seek and reflect on patient feedback. [ABSTRACT FROM AUTHOR]

Purpose: A 15-year-old boy with developmental delay presented to the pediatric ophthalmology clinic with bilateral pulverulent cataracts. The family was examined for developmental delay, cataracts and systemic problems. Methods: The parents were consanguineous and originally from Bangladesh. All the children were born in the UK. The mother and 5 children had developmental delay. Three children had global developmental delay, diarrhea and pulverulent cataracts. Two children had microcephaly, developmental delay, constipation and no cataracts. The mother did not have microcephaly, cataracts or gastrointestinal problems. Linkage analysis via autozygosity testing was performed for detection of loci and candidate genes. The patients with cataracts were segregated with homozygous mutations in the CYP27A1 (G to A substitution at position +1 of intron 6). Results: The complex nature of this family’s findings suggested that it had an unusual autosomal dominant condition with variable expression. Autozygosity testing demonstrated that three members had Cerebrotendinous xanthomatosis (CTX), which is inherited in an autosomal recessive manner. The aetiology of the developmental delay in other family members remains unknown. Conclusions: Cerebrotendinous xanthomatosis is a rare autosomal recessive condition that can result in neurological deficits and early death if left untreated. In view of the reversible nature of the condition with appropriate treatment, there needs to be a high level of suspicion of CTX for any child with cataracts and developmental delay even if the pattern of inheritance is not straightforward at initial assessment. [ABSTRACT FROM AUTHOR]

The article presents an audit of the diagnosis or detection and management of childhood squint for prevention of binocular vision.