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Fahmeeda Murtaza,1 Dana Toameh,2 Hannah H Chiu,2– 4 Eric S Tam,2– 4 Sohel Somani2– 4 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 2Uptown Eye Specialists, Vaughan, Ontario, Canada; 3Division of Ophthalmology, William Osler Health System, Brampton, Ontario, Canada; 4Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, CanadaCorrespondence: Sohel Somani, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, Canada, Tel +416 292-0330, Fax +416 292-0331, Email s.somani@utoronto.caPurpose: To evaluate the effects of autologous platelet‐rich plasma (PRP) drops for evaporative dry eye (EDE) disease from meibomian gland dysfunction (MGD).Methods: This is a retrospective, consecutive case series of 20 eyes of 10 patients with EDE from MGD treated with PRP drops from November 2020 to November 2021 at a single outpatient clinic in Ontario, Canada. PRP drops were prepared from whole blood using a two-step centrifugation method. Patients were instructed to instill these drops six times daily for 4 weeks. The Canadian Dry Eye Assessment (CDEA) questionnaire score, patient subjective assessment (PSA) score, first and average non-invasive break-up times (f/a NIBUT), tear meniscus height (TMH), bulbar redness (BR), and meibograph grade (MG) were measured before and after the treatment course.Results: Significant improvements in dry eye symptoms and tear film parameters were observed. Dry eye symptoms significantly improved as per the CDEA (mean difference (MD) = − 5.45, 95% confidence interval (CI) = [− 7.9, − 3.1], p< 0.001) and PSA (MD = − 2.6, 95% CI = [− 3.9, − 1.2], p< 0.001). There were significant improvements in tear film parameters including fNIBUT (MD = 3.85s, 95% CI = [1.2, 6.8], p=0.006), aNIBUT (MD = − 6.81s, 95% CI = [5.7, 11.1], p< 0.001) and TMH (MD = 0.08, 95% CI = [0.003, 0.2], p=0.045). There was an improvement in conjunctival injection as measured by BR (MD = − 0.36, 95% CI = [− 0.4, − 0.15], p=0.373). Five eyes experienced a one-grade improvement in MG (p=0.453), and none experienced worsening in MG with treatment. No temporary or permanent adverse effects were noted.Conclusion: Four weeks of PRP therapy resulted in significant functional improvements in dry eye symptoms and tear film quality and quantity. Improvements in conjunctival injection and microstructural improvements in meibomian glands were also observed in some eyes. Overall, PRP is a promising treatment option for patients with EDE from MGD refractory to conventional treatments.Keywords: platelet-rich plasma, dry eye disease, meibomian gland dysfunction, hemoderivatives, ocular surface disease

Mark K Lukewich,1 Fahmeeda Murtaza,1 Sohel Somani,2– 4 Eric S Tam,2– 4 Hannah H Chiu2– 4 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 2William Osler Health System, Brampton, Ontario, Canada; 3Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada; 4Uptown Eye Specialists, Vaughan, Ontario, CanadaCorrespondence: Hannah H Chiu, Uptown Eye Specialists, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, Canada, Tel +1 416 292-0330, Fax +1 416 292-0331, Email hannah.chiu@utoronto.caAim: To compare residual astigmatism prediction errors across Barrett toric calculations using predicted posterior corneal astigmatism (PCA) and PCA measured using the IOL Master 700 with total keratometry (IOLM).Methods: A retrospective cohort study was undertaken on patients with corneal astigmatism and no other ocular comorbidities that underwent uneventful refractive femtosecond laser-assisted cataract surgery with toric IOL implantation between May 2019 and November 2019. Toric calculations were performed using the Barrett toric calculator and the following values: predicted PCA with anterior corneal measurements from Pentacam, IOLM standard keratometry (SK), OPD scan, and median measurements from these devices; predicted PCA with IOLM total keratometry (TK); and measured PCA with IOLM SK or IOLM TK. Residual astigmatism prediction error was calculated for each device and method of calculation at postoperative month 1 and 3 using the astigmatism double angle plot tool.Results: A total of 24 eyes, 10 with-the-rule (WTR), 10 against-the-rule (ATR) and 4 oblique astigmatism, from 24 patients were included in this study. PCA ranged from 0.00 to 0.67 D with a mean of 0.24 ± 0.15 D in all eyes. PCA was significantly greater in WTR eyes (0.32 D) compared to ATR eyes (0.16 D; p < 0.05). In ATR eyes, calculations made using IOLM SK and measured PCA had significantly lower total corneal astigmatism and toric IOL cylinder power compared to calculations made using Pentacam and IOLM TK (p < 0.05). No significant difference in mean absolute or centroid residual astigmatism prediction error was observed across devices or calculation methods. The percentage of eyes with absolute astigmatism prediction errors ≤ 0.5 D was not significantly different across groups.Conclusion: Barrett toric calculations using predicted PCA and PCA measured using IOLM produced comparable residual astigmatism prediction errors. The incorporation of median measurements did not significantly impact calculation accuracy.Keywords: astigmatism measurement, femtosecond laser-assisted cataract surgery, toric intraocular lens calculator, Barrett toric calculator

Fahmeeda Murtaza,1 Dana Toameh,2 Saed Al-Habib,3 Raj Maini,2 Hannah H Chiu,2,4,5 Eric S Tam,2,4,5 Sohel Somani2,4,5 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 2Uptown Eye Specialists, Brampton, Ontario, Canada; 3U Sculpt Plastic Surgery, Vaughan, Ontario, Canada; 4Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; 5William Osler Health System, Brampton, Ontario, CanadaCorrespondence: Sohel SomaniUptown Eye Specialists, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, CanadaTel +1 416 292-0330Fax +1 416 292-0331Email s.somani@utoronto.caBackground: BroadBand light intense pulsed light (BBL-IPL) therapy has shown to reduce hordeolum and blepharitis frequency. This study aims to evaluate the efficacy and safety of BBL-IPL therapy in patients with dry eye disease (DED) from meibomian gland dysfunction (MGD).Methods: This is a retrospective, consecutive case series of 48 patients with DED from MGD who underwent BBL-IPL therapy from October 2016 to January 2019 at a single, outpatient clinic in Ontario, Canada. Clinical outcomes included first and average non-invasive keratograph tear break-up times (NIKBUT), bulbar redness (BR) scores, tear meniscus heights (TMH), visual acuity (VA) and meibograph grades. Patient-reported outcomes included the Canadian dry eye assessment (CDEA) questionnaire and patient subjective assessment (PSA) scores. Outcomes were measured at baseline and after completion of 4 monthly BBL-IPL sessions.Results: The mean severity of dry eye symptoms as measured by the CDEA and PSA decreased significantly from 19.78 ± 9.62 to 12.08 ± 7.40 (p< 0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (p< 0.001), respectively. Twenty-five percent of patients reported no dry eye symptoms after treatment. The meibograph grade improved significantly in both eyes (p< 0.001). Approximately 71.0% and 80.1% of patients had an improved meibograph grade in the right and left eye, respectively. Near-significant improvements were observed for BR scores and VA. There was also a trend towards improved first/average NIKBUT and TMH scores. No adverse events were noted.Conclusion: BBL-IPL appears to be an effective and safe treatment modality in improving dry eye symptoms and meibomian gland function in patients with DED from MGD.Keywords: BroadBand light, intense pulsed light, meibomian gland dysfunction, dry eye disease

Carter W Lim,1– 3 Sohel Somani,3– 5 Hannah H Chiu,3– 5 Raj Maini,3– 5 Eric S Tam3– 5 1Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada; 2Eye Foundation of Canada, Toronto M3N 2V6, Canada; 3William Osler Health System, Brampton L6R 3J7, Canada; 4Uptown Eye Specialists, Brampton L6Y 0P6, Canada; 5Faculty of Medicine, University of Toronto, Toronto M5S 1A8, CanadaCorrespondence: Eric S TamUptown Eye Specialists, 401-7900 Hurontario Street, Brampton L6Y 0P6, ON, CanadaTel +1416-292-0330Email ericstam@gmail.comPurpose: To determine astigmatic changes of intrastromal limbal-relaxing incisions (LRIs) performed during femtosecond laser-assisted cataract surgery (FLACS).Design: Retrospective case series.Patients and Methods: Patients undergoing FLACS with adjunctive astigmatism management with intrastromal LRIs were included. All eyes had preoperative corneal cylinder (Kcyl) ≥ 0.20 D on ocular biometry. An intrastromal LRI nomogram of single, non-paired LRIs placed at the 9 mm optical zone was used. Keratometry was measured preoperatively, and postoperatively at 1 week, 1 month, and 3 months (POM3). Alpins astigmatism analysis was used to calculate target-induced astigmatism (TIA, equivalent to preoperative Kcyl), surgically induced astigmatism (SIA), difference vectors (DV), and correction indices (CI). Secondary analysis included multivariable binary logistic regression to determine clinical factors associated with corrections > 125% (CI > 1.25).Results: A total of 154 eyes (125 patients) were studied. Mean preoperative Kcyl was 0.87± 0.42 D (SD), which did not significantly differ from POM3 Kcyl (0.87± 0.51 D, p=0.470). Only the against-the-rule (ATR) subgroup demonstrated a small but significant reduction in Kcyl from preoperative (0.96± 0.51D) to POM3 (0.89± 0.55D, p=0.032). Sixteen eyes (10.4%) had Kcyl ≤ 0.5 D preoperatively, compared to 46 eyes (29.9%) at POM3 (p< 0.0001). Mean SIA was 0.80± 0.52 D. Mean DV was 0.85± 0.47. Mean CI was 0.79. Fifty-one eyes (33%) had astigmatism correction > 125%. On multivariable regression analysis, ATR astigmatism class (p=0.026) and lower arc lengths (30º) (p=0.005) were associated with correction > 125%. Lower preoperative corneal astigmatism was inversely correlated with CI (p< 0.001).Conclusion: Although intrastromal LRIs can be conveniently performed during FLACS and appear safe, only patients with ATR astigmatism demonstrated a significant reduction in corneal astigmatism 3-months postoperatively under the current nomogram. Areas for future refinements to the nomogram were identified.Keywords: astigmatism, astigmatic keratotomy, refractive laser-assisted cataract surgery

Tzu-Lin Yeh,1,2 Hsin-Hao Chen,1 Hsiao-Hui Chiu,3 Yu-Hua Chiu,4 Lee-Ching Hwang,5,6 Shang-Liang Wu7 1Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; 2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 3Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan; 4Occupational Safety and Health Office, Taipei Veterans General Hospital, Taipei City, Taiwan; 5Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan; 6Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; 7School of Medicine, Griffith University, Gold Coast Campus, QLD, Australia Purpose: To investigate morbidity associated with overweight and obesity in health personnel and compare the differences among work roles.Materials and methods: This retrospective cohort study examined measurements obtained during employee medical checkups between 2007 and 2016 in a Taiwan medical center. BMI was used to define overweight (≥24 and

Tape stripping is a common method for estimating dermal exposure to pesticides because it is relatively noninvasive and easy to use. A major disadvantage is that samples are usually analyzed with gas chromatography, a time-consuming method in terms of sample preparation. In this study, the authors evaluated the feasibility of using Fourier transform infrared spectroscopy (FTIR) to analyze tape stripped samples to provide near real-time dermal exposure estimates. Various exposure scenarios were evaluated, including a single chemical (i.e., chlorpyrifos, a commonly used pesticide) and a mixture of two chemicals (i.e., chlorpyrifos and captan); these were analyzed with or without the human stratum corneum in the samples. Infrared transparent tape was used for sample collection; samples were analyzed using a FTIR spectrometer in the transmittance mode. The partial least squares algorithm was applied to quantify the spectra and the respective R(2) values for calibration, and test samples were larger than 0.99 and 0.90. The percent divergence of this approach was mostly below 10%, except for several low loading samples. The ANOVA test showed that the stratum corneum's influence on the percent divergence was not significant. Although all the samples evaluated in this study were collected from the same human subject, advantages and feasibility of the stripping-FTIR approach were demonstrated. [ABSTRACT FROM AUTHOR]

Background: Admission into medical schools or other health-related professional schools has become increasingly competitive. As a result, many undergraduate students aspiring to become health care professionals volunteer or work in a health care setting to better equip themselves for the challenge. While there have been a number of papers written about the experiences of medical and nursing students, there is limited amount of literature regarding the experience of undergraduate students in clinical practice environments. Insight into their perspectives and roles could promote patient care and research. Goal: The purpose of the present qualitative study was to explore and describe the experience of being a clinical research student in an outpatient palliative radiotherapy clinic. Methods: Students who have worked as clinical research assistants at the palliative radiotherapy clinic were first asked to write responses to two open ended questions that were qualitatively analyzed for general themes. Subsequently, students were interviewed using an interview guide with open-ended questions that were related to the themes that emerged from their initial responses. Analysis of the students' responses followed the grounded theory approach. Results: Of the 10 students who participated, 6 are pursuing careers as a medical doctor, 2 are pursuing health-related careers, 1 is in medical school, and 1 is a doctor. The length of time the students have worked as a clinical research assistant at the clinic ranges from 4 months to 2 years. After analyzing the students' responses, patterns were categorized and 7 themes emerged: (1) the value of patient interaction in inspiring students to pursue medical careers; (2) the changed attitude towards palliative patients and clinical research; (3) the lack of educational preparation for the skills and knowledge needed for this position; (4) the importance of being challenged with opportunities that are unfound outside of an academic hospital; (5) developing an appropriate and realistic emotional response to clinical experiences (e.g., death); (6) gaining insight into doctor and patient relationship, and (7) the initial difficulty at finding a niche in a health care setting where research comes secondary to patient care. Conclusion: Working as a research assistant is more than 'just a job' for many undergraduate students. The students in this study consistently reported that through their smiles and tears while working in a tertiary palliative cancer care setting, they developed skills and gained knowledge that would be inaccessible within the classroom setting. This experiential learning is crucial in shaping the character of a future clinician or researcher. [ABSTRACT FROM AUTHOR]

Goals of Work. To examine if gender differences exist in patient-rated symptoms following whole brain radiotherapy for treatment of brain metastases. Patients and Methods. Patients with brain metastases treated with palliative whole brain radiotherapy were asked to rate their symptoms using the Edmonton Symptom Assessment Scale (ESAS) before, and 1, 2, 4, 8 and 12 weeks following treatment. The mean difference of each ESAS symptom at follow up was compared with the baseline value. Mean differences with a p value < 0.01 were considered statistically significant. Main Results. From January 1999 to January 2002 one hundred and seventy patients (102 female and 68 male) were accrued. The median age for males was 67 years (range 40-82) and 64 years for females (range 33-84). At baseline, there were no significant gender differences in age, symptomatology and Karnofsky Performance score. Following treatment, there was a statistically significant deterioration from the baseline for females in the following ESAS domains: at week 1 in fatigue (1.5) and drowsiness (1.6); week 8 in appetite (3.8) and sense of well being (2.0); and week 12 in fatigue (2.4), nausea (2.5), depression (2.9), drowsiness (2.8), appetite (4.2), and sense of well being (2.8). Males showed deterioration only at week 12 in drowsiness (3.0). Conclusions. Based on the responding patients' evaluated symptoms, significantly more deterioration was seen in women when compared to men following whole brain radiotherapy. Our result showing a gender difference should be considered only as a hypothesis-generating finding. This needs to be confirmed in larger studies. [ABSTRACT FROM AUTHOR]

Investigation of drug-microbial interactions has gained prominence due to the increasing need to study pharmacomicrobiomics. Previous research has revealed the microbiome's role in drug metabolism, influencing efficacy, bioavailability, and toxicity. Several potential interactions have reported between drugs and microbes, including bioaccumulation, biotransformation, and the influence of drugs on microbial growth. To facilitate the investigation of drug-microbial interactions, in this study, we present an integrated platform and procedure for investigating drug-microbial interactions, focusing on biotransformation, bioaccumulation, metabolomics, exometabolomics, lipidomics, and exolipidomics. To illustrate the feasibility of this platform, we examined the interactions between digoxin and Lactiplantibacillus pentosus (L. pentosus), revealing previously unknown interactions. Although the growth of L. pentosus was unaffected by digoxin, metabolomics, exometabolomics, lipidomics, and exolipidomics analyses revealed digoxin's impact on metabolites and lipids inside and outside L. pentosus. Additionally, we utilized a validated liquid chromatography-mass spectrometry quantification platform to evaluate digoxin biotransformation and bioaccumulation levels by L. pentosus. After accurately quantifying digoxin in the supernatant and pellet, we determined that approximately 8.7 % of digoxin was biotransformed by L. pentosus. Exolipidomics analysis further supported digoxin biotransformation, identifying digoxigenin and its metabolites. These findings elucidate the potential impact of L. pentosus on digoxin metabolism, underscoring the importance of considering microbial interactions in pharmacological research. We anticipate that the integrated platform could assist in more pharmacomicrobiomics studies and uncover unknown drug-microbial interactions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Hsiao-Wei Liao reports financial support was provided by Ministry of Science and Technology of Taiwan. Hsiao-Wei Liao reports a relationship with Ministry of Science and Technology of Taiwan that includes: funding grants., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Inconsistent results regarding the risk of relapse and better subjective outcomes of previous antipsychotic dose reduction trials in patients with remitted psychosis have not been verified using therapeutic drug monitoring (TDM). This study examined plasma drug concentrations of a dose-tapering trial which exhibited the potential of successful maintenance under lower antipsychotic dosages., Methods: A 2-year open-label randomized prospective trial recruited remitted patients to undergo guided antipsychotic tapering. Blood samples were collected at baseline, annually, and after each dose reduction. Plasma aripiprazole/dehydroaripiprazole concentrations were determined using LC-MS/MS. The relationship between the dose and serum drug levels was examined using Spearman's correlation. Divided at 120 ng/mL, relapse rate, global function, quality of life, and psychopathology were compared between high- and low- drug level groups., Results: A total of 126 blood samples were collected, after excluding13 samples due of non-adherence. The correlation coefficients between dosage and drug level were 0.853 (aripiprazole) and 0.864 (dehydroaripiprazole), and the dose and concentration plots were parallel along the tapering trajectories, except patients with non-adherence. The concentration-to-dose ratio of aripiprazole in this cohort, 17.79 ± 7.23 ng/mL/mg, was higher than that in Caucasian populations. No significant differences were observed in the clinical outcomes between the high- and low-level groups. Remarkably, 12 of 15 patients maintained remission at plasma aripiprazole concentrations of <120 ng/mL., Conclusions: The lower-than-expected doses reached in our antipsychotic tapering trial were substantiated to provide adequate prophylactic effects by TDM results in a subset of patients treated with aripiprazole, even considering the differences in pharmacogenomics between ethnicities.

Objective: To quantify post-cataract surgery health care utilization caused by dry eye symptoms (DES) and identify preoperative risk factors and mediators of postoperative DES., Setting: An outpatient surgical centre in Toronto, Canada., Design: Retrospective cohort study., Participants: Included patients had cataract surgery between April 2019 and January 2020, completed a preoperative Dry Eye Questionnaire 5 (DEQ5), and were over age 18., Methods: Data collected included DES risk factors, prophylaxis, and intraoperative and postoperative details. DES health care utilization and prevalence were reported as percentages. Risk of DES follow-up with DES prophylaxis use, and within each DEQ5 severity group, were analyzed with χ 2 -square test of independence and odds ratios. Binomial logistic regression assessed for significance of multiple preoperative and intraoperative risk factors, controlling for one another., Results: Of 1074 patients (46% male, mean age: 71, mean DEQ5: 5.12), 18.1% had at least one nonroutine postoperative appointment due to DES. Patients with moderate/severe DEQ5 scores were 1.843 times likelier to have postoperative DES concerns than those with no/mild scores (CI = 1.307-2.599). Preoperative DES prophylaxis did not reduce DES risk in any severity group. Higher DEQ5 score, female sex, bilateral sequential surgeries, and femtosecond laser-assisted cataract surgery had higher likelihood of postoperative DES (B = 0.054; p < 0.001; B = -0.351; p = 0.037; B = 0.695; p = 0.003; B = 0.491; p = 0.003, respectively)., Conclusion: Nearly 1 in 5 patients had DES postcataract surgery, with 1 in 12 requiring one or more nonroutine follow-ups for DES, suggesting substantial health care burden. Current standard preoperative DES treatment may not reduce postoperative DES, and further studies are needed to elucidate why., (Copyright © 2024 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Background/aims: Papilloedema is an important sign of serious neurological disease, but it can be difficult to detect on funduscopy. The purpose of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) and optical coherence tomography (OCT) for detecting papilloedema in children., Methods: This was a prospective observational study at a tertiary care paediatric hospital. Patients were eligible for the study if they underwent a lumbar puncture with opening pressure and had high-quality POCUS and OCT imaging., Results: A total of 63 eyes from 32 patients were included in the study, 41 (65%) with papilloedema and 22 (35%) without. There were statistically significant differences between the groups in the optic disc elevation (ODE) (p<0.001) and optic nerve sheath diameter (ONSD) (p<0.001) on POCUS, and in the average retinal nerve fibre layer (rNFL) thickness on OCT (p<0.001). Average rNFL thickness had the highest diagnostic accuracy with an area under the curve (AUC) of 0.999 and a 100% sensitivity and 95% specificity for papilloedema (threshold value of ≥108 µm). ODE had an AUC of 0.866 and a 93% sensitivity and 55% specificity (threshold value of ≥0.5 mm). ONSD had an AUC of 0.786 and a 93% sensitivity and 45% specificity (threshold value of ≥5.5 mm)., Conclusion: Both OCT and POCUS are potentially useful tools to help diagnose papilloedema in children. Larger studies are needed to further define the role and accuracy of POCUS and OCT in assessing papilloedema in children., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: A target trough concentration (C min ) of teicoplanin ≥ 15-20 mg/L between the fourth and sixth day has been suggested for severe infections or management of febrile neutropenia (FN). Owing to no reports discussing the impact of early target attainment on treatment outcomes, this study aimed to evaluate the dose-C min relationship and clinical outcome and estimate the optimal early target C min for FN in patients with hematological malignancies., Methods: This single-center, prospective study enrolled patients with hematological malignancies who were treated with teicoplanin either as an empirical antibiotic for FN or as targeted treatment for Gram-positive bacteria. Blood samples were collected on day three (48 h) post-loading doses, day 5 (96 h), and day 8 (when applicable) and determined by ultrahigh-pressure liquid chromatography-triple quadruple mass spectrometry. A total of 117 samples from 47 patients with FN (27 men, 20 women) were consecutively analyzed. A two-tailed α value of 0.05 was considered statistically significant., Results: The mean C min values at 48 h, 96 h, and on day 8 were 23.4, 21.4, and 27.8 mg/L, respectively. The patients achieving C min  ≥ 20 mg/L at 48 h had a higher likelihood of treatment success. The areas under the receiver operating characteristic curves were 0.71 for clinical efficacy and the cutoff value of C min at 48 h was 18.85 mg/L (95% confidence interval 0.55-0.87; P = 0.018)., Conclusions: The C min of teicoplanin after completion of loading doses could predict the treatment response, with a target concentration ≥ 18.85 mg/L., (© 2024. The Author(s), under exclusive licence to Springer Healthcare Ltd., part of Springer Nature.)

Patient and family engagement is crucial for a responsive health system and improves patient outcomes. However, few practical resources for purposeful engagement are available to health leaders. Over the past five years, BC Renal, the provincial kidney care network in British Columbia, developed, operationalized, and implemented a framework to enable meaningful patient and family engagement. An advisory committee, comprising patient partners and representatives from health authorities and the community, directs the outreach, resource development, and evaluation of patient and family engagement at BC Renal. Here, we describe how our network-wide patient engagement strategy was developed and expanded upon, and the progress so far. A 2022 survey reports that 95% were satisfied with the engagement opportunities, and narrative feedback suggests network members continue to adopt practical ways to collaborate more effectively. Health leaders, patient partners, and others continue to align operational and strategic activities to advance culture change in kidney care provincially., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To assess pain perception in patients undergoing manual cataract surgery versus femtosecond laser-assisted cataract surgery (FLACS) and pain perception of patients receiving anaesthesia at 2 different time points during the FLACS procedure. We also aimed to assess the factors affecting pain perception in these different study groups., Design: Prospective cohort comparison of patient-selected surgical approach., Participants: Patients undergoing delayed sequential bilateral cataract surgery at an ambulatory surgical centre in Ontario., Methods: Patients were assigned to 3 groups: a manual cataract surgery cohort (n = 30) and 2 FLACS cohorts, those who received neurolept anaesthesia just prior to draping for phacoemulsification (FLACS standard cohort; n = 38) and those who received neurolept anaesthesia prior to the femtosecond laser part of the procedure (FLACS early cohort; n = 35). Outcome metrics included pain scores on the visual analogue scale on postoperative day 0 and at postoperative week 1. Secondary outcome measures included anxiety scores, surgeon or anaesthesiologist patient cooperation scores, ocular metrics, and perioperative systemic vitals., Results: There were no significant differences in pain perception on postoperative day 0 and at postoperative week 1 among the manual cataract surgery and FLACS standard cohorts (p = 0.94 and p = 0.72, respectively) or FLACS early and FLACS standard cohorts (p = 0.76 and p = 0.67, respectively). Patients had higher pain scores during second-eye procedures than first-eye procedures., Conclusions: Cataract surgery technique or timing of anaesthesia for FLACS procedures does not affect pain perception postoperatively. Second-eye procedures are associated with higher pain scores than first-eye procedures., (Copyright © 2023 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the effect of femtosecond laser-assisted cataract surgery (FLACS) and manual cataract surgery (MCS) on proinflammatory cytokine expression in patients with diabetes vs nondiabetic patients., Setting: Outpatient surgical center in Vaughan, Ontario, Canada., Design: Prospective cohort study., Methods: Patients with diabetes and nondiabetic patients undergoing noncomplicated MCS or FLACS were assigned into 4 cohorts: MCS nondiabetic (n = 30), FLACS nondiabetic (n = 42), MCS diabetic (n = 40), and FLACS diabetic (n = 40). Aqueous humor inflammatory mediator concentrations were evaluated at MCS onset and after femtosecond laser treatment. The presence of cystoid macular edema, anterior chamber (AC) inflammation, central retinal thickness, macular volume, and retinal microvascular changes (through optical coherence tomography angiography) were evaluated preoperatively and on postoperative day 1, week 1, month 1 (POM1), and month 3 (POM3)., Results: Patients with diabetes receiving FLACS had a higher concentration of interleukin (IL)-7, IL-13, and interferon-induced protein-10 than MCS diabetic patients; they also demonstrated higher levels of vascular endothelial growth factor and lower levels of interferon (IFN)-γ, granulocyte colony-stimulating factor, and IFN-α2 compared with MCS nondiabetic patients. Macular volume appeared to be significantly higher in MCS diabetic vs MCS non-diabetic patients at POM1 and between FLACS diabetic vs FLACS nondiabetic patients at POM3. There were no other significant differences between the cohorts for any parameter., Conclusions: FLACS use in patients with diabetes demonstrated some differences in AC cytokine expression compared with non-diabetic FLACS or diabetic patients undergoing MCS; however, there was no increase in clinical inflammatory biomarkers. FLACS seems to be a safe technique to use in patients with diabetes., (Copyright © 2023 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Introduction: Artificial intelligence (AI) development has led to improvements in many areas of medicine. Canada has workforce pressures in delivering cataract care. A potential solution is using AI technology that can automate care delivery, increase effectiveness and decrease burdens placed on patients and the healthcare system. This study assesses the use of 'Dora', an example of an AI assistant that is able to deliver a regulated autonomous, voice-based, natural-language consultation with patients over the telephone. Dora is used in routine practice in the UK, but this study seeks to assess the safety, usability, acceptability and cost-effectiveness of using the technology in Canada., Methods and Analysis: This is a two-phase prospective single-centred trial. An expected 250 patients will be recruited for each phase of the study. For Phase I of the study, Dora will phone patients at postoperative week 1 and for Phase II of the study, Dora will phone patients within 24hours of their cataract surgery and again at postoperative week 1. We will evaluate the agreement between Dora and a supervising clinician regarding the need for further review based on the patients' symptoms. A random sample of patients will undergo the System Usability Scale followed by an extended semi-structured interview. The primary outcome of agreement between Dora and the supervisor will be assessed using the kappa statistic. Qualitative data from the interviews will further gauge patient opinions about Dora's usability, appropriateness and level of satisfaction., Ethics and Dissemination: Research Ethics Board William Osler Health System (ID: 22-0044) has approved this study and will be conducted by guidelines of Declaration of Helsinki. Master-linking sheet will contain the patient chart identification (ID), full name, date of birth and study ID. Results will be shared through peer-reviewed journals and presentations at conferences., Competing Interests: Competing interests: SS: speaking honorarium for Allergan, Bayer, Novartis and industry ad board member for Novartis, Consultant Ripple Therapeutics. HHC: ad board member for Bayer, Novartis and Johnson & Johnson. Public and private support: nothing to disclose. AHi, SK, EL and NdP are employees of Ufonia, Limited., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: We determined the clinical characteristics and prevalence of metabolic syndrome among adult Filipinos with overt hypothyroidism., Methodology: This is a cross-sectional study of 151 adults. Patients were recruited by sequential enrollment. Anthropometric and blood pressure measurements were performed followed by blood extraction for metabolic parameters and thyroid function tests. Clinical and laboratory characteristics were compared between patients with and without metabolic syndrome., Results: The prevalence of metabolic syndrome is 40.4% (95%CI: 32.5%, 48.7%). Patients with metabolic syndrome have a waist circumference of 88.4 ± 7.7 cm in females and 93.3 ± 9.0 cm in males. The median fasting blood glucose was 111.4 (52.2) mg/dL, median systolic blood pressure of 120 (30) mm Hg and diastolic blood pressure of 80 (20) mmHg, median serum triglycerides of 174.3 (114.2) mg/dL, median HDL-C of 42.3 (19.2) mg/dL and a proportion of patients with diabetes (23.0%) and hypertension (44.3%), respectively. The presence of increased waist circumference is the most prevalent component seen among hypothyroid patients. There were no differences in terms of age, sex, etiology of hypothyroidism and anti-TPO levels in those with and without metabolic syndrome., Conclusion: The prevalence of metabolic syndrome in adult Filipinos with hypothyroidism is high. Emphasis must be placed on early screening using waist circumference and metabolic parameters among hypothyroid patients who are at high risk of developing metabolic syndrome., Competing Interests: Cecilia Jimeno is the Vice Editor-in-Chief of the JAFES. The rest of the authors declared no conflict of interest., (© 2024 Journal of the ASEAN Federation of Endocrine Societies.)

Metabolomics has become a promising method for understanding pathological mechanisms. Plasma (PLS) is the most common sample type used for metabolomics studies, and dried blood spot (DBS) sampling has been regarded as a good strategy due to its unique characteristics. However, how results obtained from DBS can be correlated to results obtained from PLS remains unclear. To bridge the results and to investigate the feasibility of using DBS to study metabolomics, we performed a comparative study using 64 paired PLS and DBS samples. The number of features extracted from the two different sample types was investigated. The concentration correlations of the identified metabolites between the DBS and PLS were individually studied. Approximately 47 % showed a strong correlation, 19 % showed a moderate correlation, and 34 % showed a low or even negligible correlation. Finally, we applied both PLS- and DBS-based metabolomics to explore the dysregulated metabolites in diabetes mellitus (DM) patients. Thirty-two non-DM subjects and 32 DM patients were enrolled, and 2 significant metabolites were found in both PLS and DBS samples. In summary, detailed correlation information between PLS and DBS metabolites was first explored in this study, and it is anticipated that these results could facilitate future applications in DBS-based metabolomics., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: We aimed to identify factors related to delayed intervention in abdominal trauma patients who underwent diagnostic laparoscopy using a nationwide databank., Methods: From 2017 to 2019, abdominal trauma patients who underwent diagnostic laparoscopy were retrospectively evaluated using the Trauma Quality Improvement Program. Patients who underwent delayed interventions after a primary diagnostic laparoscopy were compared with those who did not. Factors associated with poor outcomes that are usually correlated with overlooked injuries and delayed interventions were also analyzed., Results: Of the 5221 studied patients, 4682 (89.7%) underwent inspection without any intervention. Only 48 (0.9%) patients underwent delayed interventions after primary laparoscopy. Compared with patients receiving immediate interventions during primary diagnostic laparoscopy, patients receiving delayed interventions were more likely to have small intestine injuries (58.3% vs. 28.3%, p < 0.001). Among patients with hollow viscus injuries, a significantly higher probability of overlooked injuries that required delayed intervention was observed in patients with small intestine injuries (small intestine injury: 16.8%; gastric injury: 2.5%; large intestine injury: 5.2%). However, delayed small intestine repair did not significantly affect the risk of surgical site infection (SSI) (p = 0.249), acute kidney injury (AKI) (p = 0.998), or hospital length of stay (LOS) (p = 0.053). In contrast, significantly positive relationships between delayed large intestine repair and poor outcomes were observed (SSI, odds ratio = 19.544, p = 0.021; AKI, odds ratio = 27.368, p < 0.001; LOS, β = 13.541, p < 0.001)., Conclusions: Most examinations and interventions (near 90%) were successful during primary laparoscopy for abdominal trauma patients. Small intestine injuries were easily overlooked. Delayed small intestine repair-related poor outcomes were not observed., (© 2023. The Author(s) under exclusive licence to Société Internationale de Chirurgie.)

Background: Nurses are a high-risk group for overweight and obesity due to high stress, low-labor medical work, irregular diet, and lack of exercise. There is scarce information on relationship between job characteristics and overweight and obesity among nurses. This study aimed to answer the question. Does the nature of the work including job position, seniority relate to overweight and obesity among nurses? Their incidence was also investigated., Methods: We conducted a retrospective cohort study of nurses who underwent annual checkups during 2007 to 2016 in a medical center. Overweight was defined as a body mass index between 24 and 27 kg/m 2 . Obesity was defined as a body mass index higher than 27 kg/m 2 . We calculated the prevalence and incidence of overweight and obesity and estimated relative risks using logistic regression., Results: Overall, 4253 participants were enrolled for the incidence of overweight and obesity. We found that junior staff, administrative directors, working in intensive care units, and old age had a high possibility of overweight. Junior staff, administrative directors, old age, and male sex tend to be obesity. Overweight and obesity occurred rapidly in the first 2 years of their career., Conclusion: Our findings suggest that policies should be set up to achieve the goal of workplace health promotion. Health plans focusing on these factors may help nurses avoid obesity and overweight. The director of the hospital should keep track of the health checkup database to confirm the benefits of its long-term implementation., Competing Interests: Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2023, the Chinese Medical Association.)

Background: The interactive journal club is designed to utilize a new approach in appraising research in order to maximize the benefits of the traditional journal club. In this new approach, the participants are actively involved in a structured process of critical data appraisal rather than just being passive listeners. In this case study, we applied the interactive journal club format and assessed its impact among our endocrinology fellows-in-training. Methods: We conducted four interactive journal club sessions within a four-week span, one per each week via a virtual platform. The 12 participants were the same throughout all sessions. Each session was recorded following informed consent. At the end of all sessions, feedback was obtained, tabulated and compared. Results: Sessions lasted from 59 to 83 minutes (mean, 67.75 minutes). Participants became more active and spontaneous as the sessions progressed. All participants found the format more fun and proactive. This approach allowed more critical thinking and processing of information. Salient features include increased self-esteem and confidence, additional learning from other participants, better retention of information, and utilization in future practice. Conclusions: Traditional approaches are transformed from passive presentations of recent developments in medicine into an interactive discussion while allowing the retention of the spirit and essence of a traditional journal club, as well as exploring new and improved approaches in clinical training and education., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Chiu HH and Isip-Tan IT.)

Background: Treatment with oral anticoagulants (OACs) could prevent stroke in atrial fibrillation (AF), but side effects developed due to OACs may cause patients anxiety during decision making. This study aimed to investigate whether shared decision making (SDM) reduces anxiety and improves adherence to stroke prevention measures in patients with AF., Methods: A one-group pretest-posttest design using a questionnaire survey was applied at the outpatient cardiology clinic between July 2019 until September 2020. A Patient Decision Aid (PDA) tool was used for the completion of the questionnaire survey after health education and counseling. Ten questions were included for patients' recognition of SDM, and a 5-point scoring method was used, where "very much" was scored as 5 points, and "totally not" was scored as 1 point., Results: Fifty-two patients with AF were enrolled. In terms of patients' recognition of SDM, points of more than 4.17 out of 5 were noted, indicating recognition above the level of "very much." The patients' anxiety scores before SDM were 3.56 (1.2), with a decrease of 0.64 points (p < 0.001) to 2.92 (1.3) after SDM. After SDM, the number of patients who decided to take OAC increased from 76.9% to 88.5%, and the 15.4% answering "unclear" decreased to 1.9% (p = 0.006). The patients' anxiety levels after SDM were associated with gender (p = 0.025)., Conclusions: The approach using SDM enhanced our understanding of the pros and cons of OAC treatment and, in patients with AF, decreased anxiety about therapeutic decisions and increased willingness to accept treatment options., (© 2023. BioMed Central Ltd., part of Springer Nature.)

This study reports on the synthesis of Fe 3+ -activated Sr 9 Al 6 O 18 nanophosphors (SAO:Fe NPs) using a simple solution combustion process, which emits a pale green light and possesses excellent fluorescence properties. An in-situ powder dusting method was utilized to extract unique ridge features of latent fingerprints (LFPs) on various surfaces using ultra-violet 254 nm excitation. The results showed that SAO:Fe NPs possess high contrast, high sensitivity, and no background interference, enabling the observation of LFPs for longer periods. Poroscopy, which is the examination of sweat pores on the skin's papillary ridges, is important in the identification process, and the YOLOv8x program based on deep convolutional neural networks was used to study the features visible in FPs. The potential of SAO:Fe NPs to ameliorate oxidative stress and thrombosis was analyzed. The results showed that SAO:Fe NPs have antioxidant properties by scavenging 2,2-diphenylpicrylhydrazyl (DPPH) and normalized the stress markers in NaNO 2 -induced oxidative stress in Red Blood Cells (RBC). In addition, SAO:Fe inhibited platelet aggregation induced by adenosine diphosphate (ADP). Therefore, SAO:Fe NPs may have potential applications in advanced cardiology and forensic sciences. Overall, this study highlights the synthesis and potential applications of SAO:Fe NPs, which can enhance the sensitivity and specificity of fingerprint detection and provide insights into developing novel treatments for oxidative stress and thrombosis., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier B.V.)

This longitudinal cohort study investigated the associations of air pollutant exposures, including CO, NO, NO 2 , NO x , O 3 , PM 10 , PM 2.5 , and SO 2 , with long-term kidney function changes in patients with chronic kidney disease (CKD). We enrolled 447 CKD patients who took part in a universal hospital pre-ESRD care program during 2011-2015. The daily average air pollutant exposures and temperature were estimated for each patient, with different levels of air pollutant concentrations defined by 5-knot and restricted cubic spline function. Predicted annual estimated glomerular filtration (eGFR) slope values by one mixed model were considered as the study outcome. The average age of the study population was 77.1 ± 12.6 years, and the median annual eGFR decreased by 2.1 ml/min/1.73 m 2 per year from 30 ml/min/1.73 m 2 at baseline during a mean follow-up time of 3.4 years. The univariable and multivariable analyses revealed no significant linear and non-linear associations between 5-knot air pollutant concentrations and annual eGFR slope. In addition, the visualized spline effect plots show insignificant variation patterns in annual eGFR slope values with increased air pollutant concentrations. These results encourage more extensive studies to clarify the causal relationships and mechanisms of long-term specific air pollutant exposures and longitudinal kidney function change, especially in CKD populations., (© 2023. The Author(s).)

Simultaneous extraction of various types of biomolecule from a single sample can be beneficial for multiomics studies of unique specimens. An efficient and convenient sample preparation approach must be developed that can comprehensively isolate and extract biomolecules from one sample. TRIzol reagent is widely used in biological studies for DNA, RNA, and protein isolation. This study evaluated the feasibility of using TRIzol reagent for the simultaneous isolation of not only DNA, RNA, and proteins but also metabolites and lipids from a single sample. Through the comparison of known metabolites and lipids obtained using the conventional methanol (MeOH) and methyl-tert-butyl ether (MTBE) extraction methods, we determined the presence of metabolites and lipids in the supernatant during TRIzol sequential isolation. Finally, we performed untargeted metabolomics and lipidomics to examine metabolite and lipid alterations associated with the jhp0417 mutation in Helicobacter pylori by using the TRIzol sequential isolation protocol and MeOH and MTBE extraction methods. Metabolites and lipids with significant differences isolated using the TRIzol sequential isolation protocol were consistent with those obtained using the conventional MeOH and MTBE extraction methods. These results indicated that TRIzol reagent can be used to simultaneously isolate metabolites and lipids from a single sample. Thus, TRIzol reagent can be used in biological and clinical research, especially in multiomics studies., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Hsiao-Wei Liao reports financial support was provided by Ministry of Science and Technology of Taiwan. Hsiao-Wei Liao reports a relationship with Ministry of Science and Technology of Taiwan that includes: funding grants., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Purpose: Intracranial vertebrobasilar artery dissection (iVBD) is a potentially lethal disease, and progression of the dissected vessels is not uncommon. Our report is aimed at providing further clinical experience of the timing of follow-up vascular imaging or endovascular intervention in iVBD patients., Case Report: We report a case of iVBD with silent rapid progression. The 48-year-old woman presented as transient right limbs weakness. Brain MRI showed a small acute infarct over the left cerebellum, and MRA revealed a short segment of dissection over the left distal vertebral artery extending to proximal basilar artery. With no new clinical symptoms and signs, follow-up of vascular imaging within 1 week showed progressive critical narrowing of the dissected vertebrobasilar arteries. The blood flow of the vertebrobasilar system was restored by endovascular stenting., Conclusion: iVBD might progress without clinical manifestations. Early follow-up of vascular imaging should be considered in the patients with high risk for progression.

Although neurological complications after the administration of vaccines against coronavirus disease 2019 (COVID-19) are rare, they might result in long-term morbidity. This study was designed to determine the risk of peripheral nervous system (PNS) adverse events after the administration of mRNA vaccines against COVID-19. Large-scale randomized controlled trials (RCTs) and cohort studies were systematically searched in databases, and 15 cohort studies were included in the synthesis. Among all PNS adverse events, only Bell's palsy and Guillain-Barré syndrome (GBS) had sufficient data and were included for further analysis. Individuals who received mRNA vaccines had a higher risk of Bell's palsy than the unvaccinated group, and the risk of Bell's palsy after BNT162b2 was significantly higher than after mRNA-1273. Regarding GBS, no significant difference in the risk was observed between BNT162b2 and the unvaccinated group, but BNT126b2 introduced a higher risk of post-vaccinated GBS than mRNA-1273. In conclusion, PNS adverse events, especially Bell's palsy, should be carefully observed after mRNA vaccination against COVID-19. With the opportunity of vaccination campaigns on such a large scale, further investigation and surveillance of post-vaccination neurological adverse events should also be established.

Objective: To present a multifaceted approach to ophthalmology undergraduate medical education and to assess the efficacy of an eye dissection laboratory in enhancing medical student learning., Design: Curriculum review, validation, and student feedback evaluations., Participants: Year 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program., Methods: Student feedback evaluations were compiled from the University of Toronto undergraduate medical education student surveys before 2012-2016 and following introduction of the redesigned foundations ophthalmology curriculum at the University of Toronto (2017-2018). Students who participated in the Eye Dissection Lab as part of the newly designed curriculum completed the pre- and postsession satisfaction and overall interest in ophthalmology questionnaires and a knowledge-based test., Results: Analysis of 1640 student evaluations demonstrated an increase in ophthalmology curriculum rating following the launch of the foundations ophthalmology curriculum (p = 0.015). Among the 335 students who completed the eye dissection lab, there was a significant increase in the average scores for the satisfaction questionnaire, knowledge-based test, and level of interest in the field of ophthalmology from before and after the session, with improvements in scores noted in 91%, 42%, and 36% of the educational parameters of the participants, respectively (p < 0.001)., Conclusions: The newly designed foundations ophthalmology curriculum and the eye dissection lab at the University of Toronto serve as effective means for enhancing ophthalmology teaching in medical schools across Canada., (Copyright © 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)