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BackgroundOrbital roof fractures are a significant cause of morbidity in trauma and are associated with a spectrum of orbital and ocular injuries. This study aims to characterize orbital roof fracture patterns and quantify the rate of acute intervention as compared with non-roof involving orbital wall fractures.MethodsThis study is a retrospective analysis of 340 orbital wall fractures diagnosed by CT imaging from August 2015 to October 2016. Orbital wall fractures were categorized as roof involving (N = 50) and non-roof involving (N = 290). Comparisons were made between these two groups to indicate a statistically significant difference in mechanism of injury, subjective symptoms, CT and exam findings, and final plan of care to include acute ophthalmologic intervention at the time of consultation.ResultsAssault (40.7%) was the most common cause of non-roof-involving fractures while falls from height (20.0%) were associated with a higher rate of roof fractures. Roof-involving orbital wall fractures were associated with a higher prevalence of corneal abrasions (16.3%), lid lacerations (23.4%), and traumatic optic neuropathy (10.4%). A reliable subjective exam on initial ophthalmic consultation was not achieved in a larger proportion of roof fracture patients (30%). Despite this, the rate of acute intervention in this group (34%) was almost double, including lateral canthotomy and cantholysis.ConclusionsConcomitant ocular injury is common in roof-involving orbital wall fractures, and may require more urgent ophthalmologic evaluation and acute intervention. As subjective patient data is often less readily available, a high index of suspicion and thorough investigation is warranted in caring for patients with roof-involving orbital wall fractures.

Bacterial vaginosis-associated bacterium 1 (BVAB1) is an as-yet uncultured bacterial species found in the human vagina that belongs to the family within the order . As its name suggests, this bacterium is often associated with bacterial vaginosis (BV), a common vaginal disorder that has been shown to increase a woman's risk for HIV, , and infections as well as preterm birth. BVAB1 has been further associated with the persistence of BV following metronidazole treatment, increased vaginal inflammation, and adverse obstetrics outcomes. There is no available complete genome sequence of BVAB1, which has made it difficult to mechanistically understand its role in disease. We present here a circularized metagenome-assembled genome (cMAG) of BVAB1 as well as a comparative analysis including an additional six metagenome-assembled genomes (MAGs) of this species. These sequences were derived from cervicovaginal samples of seven separate women. The cMAG was obtained from a metagenome sequenced with long-read technology on a PacBio Sequel II instrument while the others were derived from metagenomes sequenced on the Illumina HiSeq platform. The cMAG is 1.649 Mb in size and encodes 1,578 genes. We propose to rename BVAB1 to \" Lachnocurva vaginae\" based on phylogenetic analyses, and provide genomic and metabolomic evidence that this candidate species may metabolize D-lactate, produce trimethylamine (one of the chemicals responsible for BV-associated odor), and be motile. The cMAG and the six MAGs are valuable resources that will further contribute to our understanding of the heterogeneous etiology of bacterial vaginosis.

This case presents a young male, with a history of high-risk sexual behavior and immunosuppression, admitted with multi-organ dysfunction and pronounced dead within 24 hours of admission. After an extensive investigation, to include post-mortem studies, his symptoms were attributed to secondary syphilis, which was confirmed with high rapid plasma reagin (RPR) titers (1:128) and positive fluorescent treponemal antibody absorption test (FTA-ABS). The patient developed rapid hypoxemia and hemodynamic instability with pulseless electrical activity (PEA) arrest and was unable to be resuscitated after many rounds of cardiopulmonary resuscitation (CPR). An autopsy revealed syphilis spirochetes in the liver, heart, lungs, and brain.

With improving survivorship in chronic lymphocytic leukemia (CLL), the risk of second primary malignancies (SPMs) has not been systematically addressed. Differences in risk for SPMs among CLL survivors from the Surveillance, Epidemiology, and End Results (SEER) database (1973–2015) were compared to risk of individual malignancies expected in the general population. In ~270,000 person-year follow-up, 6487 new SPMs were diagnosed with a standardized incidence ratio (SIR) of 1.2 (95% CI:1.17–1.23). The higher risk was for both solid (SIR 1.15; 95% CI:1.12–1.18) and hematological malignancies (SIR 1.61; 95% CI:1.5–1.73). The highest risk for SPMs was noted between 2 and 5 months after CLL diagnosis (SIR 1.57; 95% CI:1.41–1.74) and for CLL patients between 50- and 79-years-old. There was a significant increase in SPMs in years 2003–2015 (SIR 1.36; 95% CI:1.3–1.42) as compared to 1973–1982 (SIR 1.19; 95% CI:1.12–1.26). The risk of SPMs was higher in CLL patients who had received prior chemotherapy (SIR 1.38 95% CI:1.31–1.44) as compared to those untreated/treatment status unknown (SIR 1.16, 95% CI:1.13–1.19, p < 0.001). In a multivariate analysis, the hazard of developing SPMs was higher among men, post-chemotherapy, recent years of diagnosis, advanced age, and non-Whites. Active survivorship plans and long-term surveillance for SPMs is crucial for improved outcomes of patients with a history of CLL.

Myopia is the most common type of refractive error and can lead to significant visual impairment. The frequency of myopia has risen considerably, and its worldwide prevalence is expected to continue to increase. Myopia is present in an increasing number of Basic Military Trainees upon entry into the United States Air Force. This study aims to demonstrate the prevalence of myopia in newly enlisted members of the United States Air Force. This study is an institutional retrospective analysis of data collected from the United States Air Force candidates entering Basic Military Training from 1 January 2017 to 31 March 2017. A random selection of 767 Air Force Basic Military Trainees were included in the analysis, yielding 1534 total eyes. The primary outcome measure studied is the mean spherical equivalent (MSE) of participants at initial evaluation. A linear regression analysis was performed to identify any associations related to participant demographics. Of participants analyzed, 45% had myopia (<-0.5 D) and 2% high myopia (<-6.0 D) upon entry into the United States Air Force. Myopia was found to be associated with male gender (p = <0.001). Myopia is present in a significant proportion of Basic Military Trainees upon entry into the United States Air Force, regardless of age, gender, race, or ethnicity. The prevalence of myopia presented is higher than previous studies, reflecting a continued trend towards increased myopia prevalence worldwide.

Thromboangitis obliterans or Buerger's disease is a segmental inflammatory condition of small and medium-sized arteries and veins. It is commonly seen in males with age under 45 years and with a current or recent history of tobacco use, and in smokers. It is sporadic in young women. This report describes a primigravida with dry gangrene in both upper and lower limbs because of Buerger’s disease. The primary diagnosis of the disease occurred first time in pregnancy at the 17th week of gestation with the patient reporting dry gangrene and pain in the digits and confirmed with a non-invasive Doppler study. The patient was screened for autoimmune diseases, diabetes mellitus, and the presence of hypercoagulable disorders. Echocardiography and arteriography were performed to rule out any source of emboli. The case report aims to discuss a rare diagnostic and therapeutic dilemma in the case of a pregnant woman presenting with gangrene without any history of tobacco addiction.

Acute acquired comitant esotropia secondary to smart-phone use is a newly described phenomenon. This case report describes a boy with acute acquired comitant esotropia due to prolonged smartphone use who had improvement in binocular function after cessation of near work for several weeks. [J Pediatr Ophthalmol Strabismus. 2018;55:e42–e44.]

Abstract Background and Aims Limited data exist regarding the impact of standardized care on cardiogenic shock (CS) outcomes over time. We aimed to investigate the influence of multidisciplinary management on CS outcomes following implementation of team-based protocols in 2017. Methods A total of 1453 consecutive patients enrolled into a single-centre CS registry were divided into two time periods, 2017–2019 versus 2020–2022. Baseline characteristics, management and outcomes were compared. The primary endpoint was adjusted in-hospital mortality. Multivariable regression analysis was performed to evaluate change in outcomes over time. Results Compared with 2017–2019, more patients with CS were treated in 2020–2022 (930 vs. 523; P < 0.01). They more often presented to the Level 1 centre (52% vs. 45%; P = 0.01), with a higher proportion of heart failure-related CS (72% vs. 58%; P < 0.01) and Society for Cardiovascular Angiography and Interventions B and C CS (64% vs. 49%; P < 0.01). They were less likely to be managed with percutaneous ventricular assist devices (11% vs. 24%; P < 0.01) but more likely to receive veno-arterial extracorporeal membrane oxygenation (14% vs. 4%; P < 0.01) and heart transplantation (9% vs. 4%; P < 0.04). No differences were noted in in-hospital mortality [adjusted odds ratio (aOR) 0.81; 95% confidence interval (CI): 0.56–1.16; P = 0.25], major adverse cardiac and cerebrovascular events (aOR 1.21; 95% CI: 0.87–1.68; P = 0.26), stroke (aOR 1.11; 95% CI: 0.65–1.91; P = 0.71) or renal replacement therapy (aOR 0.95; 95% CI: 0.66–1.37; P = 0.77). Conclusions Standardized care for CS was associated with consistent in-hospital mortality over time despite changes in presentation and management. Further research is needed to identify the optimal care model during the vulnerable post-discharge period. This contemporary North American cardiogenic shock (CS) registry aimed to investigate the influence of team-based care on outcomes over a six-year period of time following implementation of standardized protocols. Despite a two-fold increase in the number of CS patients and changes in presentation and management strategies, no differences in in-hospital mortality and short-term morbidities were noted in 2020–2022 vs. 2017–2019. These findings highlight the merits and sustainability of shock teams and protocols in the acute phase of disease management.

Median arcuate ligament syndrome (MALS) is a rare benign condition typically affecting young females. It usually presents with abdominal symptoms of pain, nausea, and unintentional weight loss. They are usually diagnosed incidentally on CT of the abdomen done for abdominal pain. Here we present a rare case of MALS which presented with an anginal type of chest pain without any abdominal symptoms leading to an extensive workup and incidental diagnosis.