Search

Agustin L Gonzalez, Nikki Bennett, Rakesh Lakhani Inter American University, School of Optometry, Bayamón, Puerto Rico Abstract: Optometry is recognized as a primary care profession within the health care system. For years, much emphasis has been placed on the core function of optometrists as prescribers for refractive correction, yet little is known about their medication prescribing habits. Optometrists have had the ability to prescribe medications for the last 30 years, and still little information is available about optometric pharmaceutical trends. This study consists of a survey aimed at obtaining self-reported data to depict optometrists' likelihood of prescribing ophthalmic medications during a regular clinic day. We conclude that optometrists are indeed using medications in their clinics, and the trends are very similar to the epidemiological distribution of eye disorders in the general population. Keywords: optometry, prescription drug audit, pharmacoepidemiology

Agustin L Gonzalez, Rakesh Lakhani, Nikki Bennett, Clarissa De Paz School of Optometry, InterAmerican University of Puerto Rico, Bayamon, Puerto Rico Abstract: The traditional role of optometry has been the performance of refractions with the intent to correct vision disorders. In the US, optometry accounts for over two thirds of eye care-related visits. Optometrists have had the privilege of prescribing medications for many years and have been known to manage eye diseases. With no quantitative data known about optometrists’ involvement in managing diseases of the eye, this study describes the trend of ophthalmic drug prescription-writing by optometrists in the US over a 12 quarter period (comprising a 3 year period). Keywords: prescription pattern, optometry, pharmaceutical utilization, ophthalmic medications

The mechanism of thermal decomposition of the metal complexes of sulphamethoxazole (SMZ) viz: [Ag(SMZ)H2O], [Cd(SMZ)2(H2O)2], [VO(SMZ)2(H2O)2], [UO2(SMZ)2]H 2O, [Hg(SMZ)2(H2O)2] and [Co(SMZ)2(H2O)2]H2O has been accomplished on the basis of TG, DTG and DTA studies. The mechanism of thermal decomposition of these complexes conforms to the stoichiometry of the complexes based on elemental analysis. [ABSTRACT FROM AUTHOR]

Purpose: Maxillary sinus carcinomas usually present as a locally advanced disease at the time of diagnosis and it is extremely unusual to have a second primary maxillary carcinoma on the contralateral side after many years of completion of treatment of the first malignancy. We present here a case report of a sphenopalatine artery (SPA) pseudoaneurysm mimicking the second primary maxillary carcinoma., Methods: We reviewed the literature for SPA pseudoaneurysm., Results/case Report: This report describes the case of a 90-year-old man with a background of adenoid cystic carcinoma of the right maxillary sinus, diagnosed and treated with surgery and radiotherapy 14 years ago, who presented with a history of multiple episodes of epistaxis. The radiological evaluation showed a heterogeneously enhancing mass with a central hemorrhagic component and surrounding bony erosions in the left maxillary sinus and the patient was planned for biopsy from the suspicious mass along with SPA ligation. However, on opening the maxillary antrum there was excessive bleeding and it was determined unsafe to proceed further. The patient was subsequently taken to interventional radiology for diagnostic angiography which revealed an SPA pseudoaneurysm that was subsequently embolized successfully., Conclusions: Sphenopalatine artery pseudoaneurysms should be considered as a differential for recurrent epistaxis in patients with a history of sinonasal malignancy. In such cases, endovascular embolization is a viable management option., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: A surgical team works in a high-performance environment and is exposed to stress. Mindfulness practice is evidenced to reduce symptoms of stress, as well as burnout, which is high amongst health workers. The operating theatre is unique, with many job-roles, needs and time-critical tasks. It is plausible that group mindfulness may benefit the surgical team. This evaluates the take-5 theatre brief, consisting of a 'check-in' and short breathwork, when used by two surgical teams as part of the regular theatre team brief., Approach: The take-5 theatre brief was evaluated using domains of acceptability and implementation. Data were collected at two district general hospitals in the United Kingdom using 5-point Likert scales hosted on electronic surveys Thematic analysis was performed of participant voice notes, strategic meeting notes and transcripts of interviews between key informants., Evaluation: There were 17 participants. Ten were from site A (59%), with the remainder being from site B (41%) and covered a range of roles within the theatre team. Participants found the take-5 theatre brief helpful (median Likert 5) and felt that it would benefit themselves (median Likert 5) as well as the team (median Likert 5) and that it fitted into the day easily (median Likert 4). There was a high demand, no financial investment was required and overall it was easy to implement; however, it became challenged in theatre lists that were late to start., Implication: The take-5 theatre brief is an acceptable initiative for these two operating theatre teams., (© 2024 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Objective: Exercise-induced rhinitis (EIR) is a poorly understood condition that can have a massive impact within elite sport. This was epitomized in 2019 when British cyclist and Tour de France winner Chris Froome lost control of his bike at 37 mph while wiping his nose, resulting in an admission to intensive care. We aim to produce a comprehensive resource to guide the assessment and management of rhinitis in athletes., Design: Rhinitis is a common condition which can be broadly divided into allergic rhinitis (AR) and non-AR (NAR), a subset of which is known as vasomotor rhinitis. Exercise-induced rhinitis is an important but understudied subcategory of NAR. The pathophysiology of the disease is broadly believed to be an imbalance of the sympathetic and parasympathetic nervous systems, leading to symptoms of watery rhinorrhea, nasal congestion, and paroxysmal sneezing. Up to 50% of people suffer from some degree of EIR, which impedes their nasal breathing and affects performance. The assessment of the athlete with rhinitis requires consideration of both allergic and vasomotor contributions to ensure optimal management is introduced. There is no clear guidance for the management of EIR, with uncertainty regarding the most effective pharmaceuticals and optimizing the timing of treatment to enable peak performance., Setting: N/A., Patients/participants: N/A., Interventions: N/A., Main Outcome Measures: N/A., Results and Conclusions: Based on expert clinical experience in a busy ear, nose, and throat center and a systematic review of current literature, this article proposes a step-wise, incremental approach to the management of EIR symptoms. In an industry where marginal gains give athletes a competitive edge, optimal management of EIR is crucial., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Melasma is a common chronic, relapsing pigmentary disorder that causes psychological impact. Chemical peels are a well-known therapeutic modality used for accelerating the treatment of melasma., Objective: To review the published evidence on the efficacy and safety of chemical peels in the treatment of melasma., Methods: A systematic review was done. A meta-analysis could not be done due to the heterogeneity of data., Result: The authors conducted a PubMed search and included prospective case series of more than 10 cases and randomized controlled trials (RCTs) that have studied the safety and/or efficacy of chemical peel in melasma. Out of 24 studies, 9 were clinical/comparative trials and 15 were RCTs. The total sample size was 1,075. The duration of the study varied from 8 to 36 weeks. Only 8 studies were split face. All studies used self-assessment, physician global assessment, and Melasma Area and Severity Index (MASI) for quantifying the results. Glycolic acid was found to be the most safe and effective in melasma., Conclusion: Chemical peels were found to be safe and effective in the management of melasma., (Copyright © 2024 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: There are no conflicts of interest.

Introduction There is ambiguity regarding usage of tranexamic acid for melasma in India, be it in its pre-administration evaluation, administration route, dosing or monitoring. Hence, we conducted this study to understand various tranexamic-acid prescribing patterns and provide practical guidelines. Materials and methods A Google-form-based questionnaire (25-questions) was prepared based on the key areas identified by experts from the Pigmentary Disorders Society, India and circulated to practicing dermatologists across the country. In rounds 2 and 3, the questionnaire was re-presented to the same group of experts and their opinions were sought. The results of the practitioners' survey were denoted graphically alongside, to guide them. Consensus was deemed when at least 80% of respondents chose an option. Results The members agreed that history pertaining to risk factors for thromboembolism, cardiovascular and menstrual disorders should be sought in patients being started on oral tranexamic-acid. Baseline coagulation profile should be ordered in all patients prior to tranexamic-acid and more exhaustive investigations such as complete blood count, liver function test, protein C and S in patients with high risk of thromboembolism. The preferred oral dose was 250 mg orally twice daily, which can be used alone or in combination with topical hydroquinone, kojic acid and sunscreen. Repeated dosing of tranexamic-acid may be required for those relapsing with melasma following initial tranexamic-acid discontinuation. Coagulation profile should ideally be repeated at three monthly intervals during follow-up, especially in patients with clinically higher risk of thromboembolism. Treatment can be stopped abruptly post improvement and no tapering is required. Limitation This study is limited by the fact that open-ended questions were limited to the first general survey round. Conclusion Oral tranexamic-acid provides a valuable treatment option for melasma. Frequent courses of therapy may be required to sustain results and a vigilant watch is recommended for hypercoagulable states during the course of therapy.

In order to better understand how the immune system interacts with environmental triggers to produce organ-specific disease, we here address the hypothesis that B and plasma cells are free to migrate through the mucosal surfaces of the upper and lower respiratory tracts, and that their total antibody repertoire is modified in a common respiratory tract disease, in this case atopic asthma. Using Adaptive Immune Receptor Repertoire sequencing (AIRR-seq) we have catalogued the antibody repertoires of B cell clones retrieved near contemporaneously from multiple sites in the upper and lower respiratory tract mucosa of adult volunteers with atopic asthma and non-atopic controls and traced their migration. We show that the lower and upper respiratory tracts are immunologically connected, with trafficking of B cells directionally biased from the upper to the lower respiratory tract and points of selection when migrating from the nasal mucosa and into the bronchial mucosa. The repertoires are characterized by both IgD-only B cells and others undergoing class switch recombination, with restriction of the antibody repertoire distinct in asthmatics compared with controls. We conclude that B cells and plasma cells migrate freely throughout the respiratory tract and exhibit distinct antibody repertoires in health and disease., Competing Interests: SHK receives consulting fees from Northrop Grumman. KBH receives consulting fees from Prellis Biologics. YJ, CC, TGJ and RH are employed by Bristol Myers Squibb. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor has declared past collaborations with one of the authors SHK at the time of this review., (Copyright © 2021 Ohm-Laursen, Meng, Hoehn, Nouri, Jiang, Clouser, Johnstone, Hause, Sandhar, Upton, Chevretton, Lakhani, Corrigan, Kleinstein and Gould.)

Background: Periocular melanosis (POM) due to shadow effect of tear trough deformity (TT) does not respond to the conventional treatment modalities. Hyaluronic acid (HA) fillers are a favurable treatment modality. This area is a high risk for injectables due to its unique anatomy., Aims: To find role of HA fillers in treatment POM due to TT deformity with special emphasis on practical anatomy, patient satisfaction rate, and management of complications. A correlation of the grade of TT, age of the patient, and patient satisfaction was done. A follow-up at 1 year was done to assess longevity of results., Methods: Retrospective study of 60 cases of clinically diagnosed POM (120 TT) due to TT deformity was performed. Each patient was injected with 1 ml, cross-linked HA 22.5 mg/ml in under-eye area using 30 G needle or a 25 G cannula. Follow-up was done at 2 weeks, 4 weeks, and 1 year., Results: Mean age of patients was 36.4 years. Majority of patients, that is, 31 (52%) were in the age group of 30-40. As per Hirmand's classification, 46.6% (28/60) had grade 2 TT which was most common. We graded results in the form of VAS and 80% patients had VAS > 7. There were no major side effects., Conclusion: Hyaluronic acid fillers are promising treatment modality without any major side effects. Both needle and cannula can be used effectively. Patient satisfaction is higher in younger patients with low grade of TT and results persisted in all cases for a minimum of 1 year., (© 2021 Wiley Periodicals LLC.)

The COVID-19 pandemic has forced an unprecedented worldwide change in our daily lives, particularly in healthcare. In response to the lockdown measure it has brought on, some deaneries cancelled planned teaching days, while others had delivered remote smaller scale teaching sessions electronically. Due to significant regional variation, the National Association of Program Directors in ENT (NAPDENT) set up a national educational program, matched to the Intercollegiate Surgical Curriculum Program. This is delivered virtually and for free. This pilot survey evaluates participants' learning experience of the first NAPDENT National Otology Training Day, which was held on 20 April 2020 via Zoom. This is a pilot survey evaluating the first online, national educational program delivered by the NAPDENT in the United Kingdom. In the times of the COVID-19 pandemic, our program has rapidly learnt from this initial experience and continues to build on lessons learnt for future editions. It is feasible to augment the national ENT curriculum with a collaborative, online teaching program. Regional buy-in is required to make this work. This modality allows for access to subject experts across the country. Synchronous delivery allows for participant interaction, while an online repository allows for asynchronous viewing when work or personal commitments do not allow live attendance. The key to participant engagement is adequate structure, appropriate breaks and opportunities for interaction. Even once the COVID-19 pandemic has passed, this teaching modality will remain as an opportunity to educate ENT surgeons of the future., (Copyright © 2020. Published by Elsevier Inc.)