Search

Purpose: The index review aims to provide an update on the role of corticosteroids and steroid-sparing immunomodulatory therapy (IMT) in managing patients with infectious uveitis. Method: Narrative literature review. Results: Corticosteroids and immunomodulatory therapy (IMT) focus on the host defense system instead of the pathogen, adjusting exaggerated inflammatory reactions to reduce potential harm to ocular tissues. Systemic or local corticosteroids are primarily selected as adjunctive medication for infectious uveitis. Concomitant corticosteroids have also been used in cases of paradoxical worsening in ocular tuberculosis and immune recovery uveitis in cytomegalovirus (CMV) retinitis. While there is no well-established evidence to support the use of IMT in infectious uveitis, it is occasionally used in clinical settings to treat persistent inflammation following resolution of infection such as cases of ocular tuberculosis and ocular syphilis where an insufficient response is observed with corticosteroids. Conclusion: There is no consensus on the position of immunomodulatory therapy in the management of infectious uveitis with different etiologies. The index review provides an overview of available adjunctive corticosteroids and IMT options to assist clinicians in managing such disease entities more efficiently. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide OBJECTIVES Coronary artery disease is becoming a major health concern in the young population. Male and female patients may experience different journeys after coronary artery disease events. We aimed to evaluate risk factors and compare outcomes between young male and female patients undergoing coronary artery bypass graft surgery (CABG). METHODS In this registry-based large sample size study, patients undergoing isolated CABG at a young age (premature isolated CABG) between 2007 and 2016 were included and followed up until 2020. Premature was defined as women and men younger than 55 years old. The main end points of the study were 7-year all-cause mortality and 7-year major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS Of a total of 24 428 patients who underwent CABG, 7217 patients (men-to-women ratio ≈4:1) with premature isolated CABG were included. The median follow-up duration was 78.5 months (75.2–81.6 months). The prevalence rates of diabetes mellitus, hypertension, dyslipidaemia and obesity were significantly higher in women than in men (58.3% vs 28.6%, 64.2% vs 38.5%, 69.7% vs 55.3% and 44.7 vs 23.9, respectively; all P s < 0.05). The risk factor burden (mean of the risk factor count per year) was also higher among the female population. Diabetes mellitus was the common mortality predictor between men and women. In the subgroup analysis (interaction analysis in the adjusted model), hypertensive females had a higher rate of MACCE and a higher rate of mortality than hypertensive males; however, this difference was not significant in the non-hypertensive population. Opium addiction was a strong predictor of MACCE and all-cause mortality among men. Female patients had a higher rate of 7-year MACCE (hazard ratio, 1.33; 95% confidence interval, 1.16–1.51) and a higher rate of 7-year all-cause mortality (hazard ratio, 1.23; 95% confidence interval, 0.98–1.53). CONCLUSIONS The risk factor profile and predictors of outcomes were different between our female and male patients. Women carried a higher risk of events and mortality after CABG at a young age. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS. Methods: This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score. Results: Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25-88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus. Conclusion: Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS. [ABSTRACT FROM AUTHOR]

Purpose: To compare the utility of ChatGPT-4 as an online uveitis patient education resource with existing patient education websites., Design: Evaluation of technology., Participants: Not applicable., Methods: The term "uveitis" was entered into the Google search engine, and the first 8 nonsponsored websites were selected to be enrolled in the study. Information regarding uveitis for patients was extracted from Healthline, Mayo Clinic, WebMD, National Eye Institute, Ocular Uveitis and Immunology Foundation, American Academy of Ophthalmology, Cleveland Clinic, and National Health Service websites. ChatGPT-4 was then prompted to generate responses about uveitis in both standard and simplified formats. To generate the simplified response, the following request was added to the prompt: 'Please provide a response suitable for the average American adult, at a sixth-grade comprehension level.' Three dual fellowship-trained specialists, all masked to the sources, graded the appropriateness of the contents (extracted from the existing websites) and responses (generated responses by ChatGPT-4) in terms of personal preference, comprehensiveness, and accuracy. Additionally, 5 readability indices, including Flesch Reading Ease, Flesch-Kincaid Grade Level, Gunning Fog Index, Coleman-Liau Index, and Simple Measure of Gobbledygook index were calculated using an online calculator, Readable.com, to assess the ease of comprehension of each answer., Main Outcome Measures: Personal preference, accuracy, comprehensiveness, and readability of contents and responses about uveitis., Results: A total of 497 contents and responses, including 71 contents from existing websites, 213 standard responses, and 213 simplified responses from ChatGPT-4 were recorded and graded. Standard ChatGPT-4 responses were preferred and perceived to be more comprehensive by dually trained (uveitis and retina) specialist ophthalmologists while maintaining similar accuracy level compared with existing websites. Moreover, simplified ChatGPT-4 responses matched almost all existing websites in terms of personal preference, accuracy, and comprehensiveness. Notably, almost all readability indices suggested that standard ChatGPT-4 responses demand a higher educational level for comprehension, whereas simplified responses required lower level of education compared with the existing websites., Conclusions: This study shows that ChatGPT can provide patients with an avenue to access comprehensive and accurate information about uveitis, tailored to their educational level., Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article., (© 2024 Published by Elsevier Inc. on behalf of the American Academy of Ophthalmology.)

Background: The brain is the most complex and vital organ of the human body. It requires 20-25 % of the total oxygen supply. Because of the limited oxygen and glucose reserves, brain tissue is sensitive to ischemic injury. Indeed, the tolerance of brain tissue for ischemic injury is fragile. Currently, few therapeutic strategies could provide complete neuroprotection. Despite decades of intense research, the beneficial treatment of stroke remains limited. Hence, we aimed to investigate the effect of curcumin on the CA1 region of the hippocampus in a rat model of ischemia/reperfusion (I/R) injury., Materials and Methods: In this experimental research, 24 male Wistar rats were randomly divided into three groups (n=8 per group) as control, I/R, and I/R plus curcumin. All rats underwent bilateral common carotid artery ligation followed by reperfusion. In the treatment group, curcumin (300 mg/kg) was injected 30 minutes before ischemia. Morphological changes of the hippocampus were assessed using Nissl staining, and apoptosis was determined via TUNEL immunohistochemical assays., Results: Nissl staining data showed that the administration of curcumin significantly ameliorated the CA1 pyramidal cell loss due to transient global I/R injury. TUNEL immunohistochemical assays demonstrated that the number of apoptotic cells was significantly lower in the curcumin group than in the I/R groups., Conclusion: Our study demonstrates that curcumin had beneficial activity against ischemia and played a neuroprotective role in the pathogenesis of I/R injury., Competing Interests: The authors declare no conflicts of interest., (Copyright© 2022, Galen Medical Journal.)

Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide. We sought to evaluate the correlation between the severity of coronary artery disease (CAD) and conventional coronary artery risk factors in a large cohort of patients with ACS., Methods: This study included all patients admitted to the coronary care unit with a diagnosis of ACS between 2003 and 2017. The patients were divided into 2 groups: 1) unstable angina and 2) myocardial infarction. The aims of this study were to evaluate the effects of the risk factors and extension of coronary artery stenosis in patients with ACS according to the Gensini score., Results: Of a total 40 319 patients who presented with ACS, 18 862 patients (mean age =60.4±11.14 y, male: 67.2%) underwent conventional coronary angiography and met our criteria to enter the final analysis. The median of the Gensini score was 50 (25-88) in the study population. The multivariable analysis showed that age, sex, diabetes mellitus, hypertension, dyslipidemia, family history, cigarette smoking, opium consumption, and myocardial infarction increased the risk of positive Gensini scores. All the aforementioned risk factors, except cigarette smoking and opium consumption, increased the severity of stenosis in those with positive Gensini scores. The strongest relationship was seen vis-à-vis myocardial infarction, sex, and diabetes mellitus., Conclusion: Our findings suggest that age, sex, diabetes mellitus, dyslipidemia, hypertension, family history, and myocardial infarction have significant effects on the severity of CAD. The obesity paradox in relation to CAD should be taken into consideration and needs further investigation in patients with ACS., (Copyright © 2020 Tehran University of Medical Sciences.)

Background: Hidradenitis suppurativa is a chronic inflammatory disease with multiple inflammatory nodules and abscesses. We aimed to compare split thickness skin graft (STSG) and flaps in bilateral chronic refractory axillary hidradenitis suppurativa., Methods: Thirty patients were investigated from March 21, 2010 to March 20, 2015. Debridement of involved skin and subcutaneous fat was done until deep fascia. The second operation was a reconstructive procedure to cover bilateral axillary wounds with STSG in left side and random fasciocutaneous flaps in the right side., Results: Mean age of patients was 35.2±9.3 years. There were 16 men (53.3%) and 14 women (46.7%). Duration of the disease before trial was 6.5±2.1 years. The association between pain at one-month follow-up for graft or flap sites was not significant. The patients did not have pain at flap and graft sites at three-month, six-month and one-year follow-ups. Twenty-four patients (80.0%) had normal ranges of motion at one-month follow-up. At six-month and one-year follow-ups, all patients had bilateral normal ranges of motion. All patients were satisfied from symmetry of flap and graft sites at six-month and one-year follow-ups. All patients were satisfied from graft and flap donor sites at six-month and one-year follow-ups. At one-month, three-month, six-month and one-year follow-ups, recurrence of hidradenitis suppurativa was not seen., Conclusion: Both STSGs and fasciocutaneous flaps were successful and satisfactory for tissue coverage in patients with axillary hidradenitis suppurativa. We recommend this technique in cases of bilateral axillary hidradenitis suppurativa.