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Hogerheyde T, Coates D, Walsh L, Zafar S. Biocompatibility and acid resistance of preformed crowns in children: an in vitro study. Eur Arch Paediatr Dent 2024:10.1007/s40368-024-00898-3. [PMID: 38662172 DOI: 10.1007/s40368-024-00898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/13/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE To investigate the in vitro biocompatibility of human gingival fibroblasts with preformed paediatric crowns and resistance to acid exposure at levels that simulate the oral environment. METHODS This laboratory study investigated primary HGFs viability, metabolic activity, cytotoxicity, and apoptotic events on preformed metal crown discs, composite resin-coated wells, and monolithic zirconia fragments at 24, 48, and 72 h using the ApoTox-Glo Triplex assay. The PPCs were also immersed in 0.1% lactic acid, 0.2% phosphoric acid, or 10% citric acid for 7 days at 37 °C to reproduce conditions associated with dietary intake or gastric reflux. Samples were then subject to inductively coupled plasma optical emission spectrometry to quantitate the release of ions. RESULTS The viability of HGFs on stainless steel and CR significantly declined at 48 and 72 h, representing potential cytotoxicity (p < 0.05). Cytotoxicity of HGFs was also higher for stainless steel and ZR compared to control (p < 0.05). PMCs and ZR crowns gave minimal ion release. Meanwhile, significant quantities of metallic ions, including copper (Cu), iron (Fe), nickel (Ni), and zinc (Zn), were present in eluates from veneered-preformed metal crowns. CONCLUSION As PPCs can be exposed to highly acidic environments for many years, thus the release of metallic ions from V-PMCs should form the further investigation in future studies.
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Affiliation(s)
- T Hogerheyde
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, 4006, Australia
| | - D Coates
- Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - L Walsh
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, 4006, Australia
| | - S Zafar
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, 4006, Australia.
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Qousain Naqvi ST, Muhammad SA, Guo J, Zafar S, Ali A, Anderson LJ, Rostad CA, Bai B. Experimental trials of predicted CD4 + and CD8 + T-cell epitopes of respiratory syncytial virus. Front Immunol 2024; 15:1349749. [PMID: 38629077 PMCID: PMC11018974 DOI: 10.3389/fimmu.2024.1349749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Background Respiratory syncytial virus (RSV) is the most common cause of viral lower respiratory tract infections (LRTIs) in young children around the world and an important cause of LRTI in the elderly. The available treatments and FDA-approved vaccines for RSV only lessen the severity of the infection and are recommended for infants and elderly people. Methods We focused on developing a broad-spectrum vaccine that activates the immune system to directly combat RSV. The objective of this study is to identify CD4+ and CD8+ T-cell epitopes using an immunoinformatics approach to develop RSV vaccines. The efficacy of these peptides was validated through in-vitro and in-vivo studies involving healthy and diseased animal models. Results For each major histocompatibility complex (MHC) class-I and II, we found three epitopes of RSV proteins including F, G, and SH with an antigenic score of >0.5 and a projected SVM score of <5. Experimental validation of these peptides on female BALB/c mice was conducted before and after infection with the RSV A2 line 19f. We found that the 3RVMHCI (CD8+) epitope of the F protein showed significant results of white blood cells (19.72 × 103 cells/μl), neutrophils (6.01 × 103 cells/μl), lymphocytes (12.98 × 103 cells/μl), IgG antibodies (36.9 µg/ml), IFN-γ (86.96 ng/L), and granzyme B (691.35 pg/ml) compared to control at the second booster dose of 10 µg. Similarly, 4RVMHCII (CD4+) of the F protein substantially induced white blood cells (27.08 × 103 cells/μl), neutrophils (6.58 × 103 cells/μl), lymphocytes (16.64 × 103 cells/μl), IgG antibodies (46.13 µg/ml), IFN-γ (96.45 ng/L), and granzyme B (675.09 pg/ml). In-vitro studies showed that 4RVMHCII produced a significant level of antibodies in sera on day 45 comparable to mice infected with the virus. 4RVMHCII also induced high IFN-γ and IL-2 secretions on the fourth day of the challenge compared to the preinfectional stage. Conclusion In conclusion, epitopes of the F protein showed considerable immune response and are suitable for further validation.
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Affiliation(s)
| | - Syed Aun Muhammad
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, Pakistan
| | - Jinlei Guo
- School of Intelligent Medical Engineering, Sanquan College of Xinxiang Medical University, Xinxiang, Henan, China
| | - Sidra Zafar
- Institute of Molecular Biology and Biotechnology, Bahauddin Zakariya University, Multan, Pakistan
| | - Amjad Ali
- Atta-ur-Rehman School of Applied Biosciences (ASAB), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Larry J. Anderson
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Christina A. Rostad
- Department of Pediatrics and Children’s Healthcare of Atlanta, Emory University, Atlanta, GA, United States
| | - Baogang Bai
- School of Information and Technology, Wenzhou Business College, Wenzhou, Zhejiang, China
- Engineering Research Center of Intelligent Medicine, Wenzhou, Zhejiang Province, China
- The First School of Medical, School of Information and Engineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Son HS, Chang DF, Li C, Liu L, Zafar S, Lum F, Woreta FA. Visual Acuity Outcomes and Complications after Intraocular Lens Exchange: An IRIS® Registry (Intelligent Research in Sight) Analysis. Ophthalmology 2024; 131:403-411. [PMID: 37858872 DOI: 10.1016/j.ophtha.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE To assess risk factors for worse visual acuity (VA) outcomes after intraocular lens (IOL) exchange, and the most common postsurgical complications. DESIGN Retrospective cohort study. PARTICIPANTS Eyes from patients 18 years of age and older in the IRIS® Registry (Intelligent Research in Sight) that underwent IOL exchange in the United States between 2013 and 2019. METHODS Vision improvement compared with baseline was determined at 1 year after surgery. A multivariable generalized estimating equation model adjusting for demographic factors and baseline vision was used to identify factors associated with VA worse than 20/40 at 1 year. MAIN OUTCOME MEASURES Visual outcomes and postoperative complications after lens exchange. RESULTS A total of 46 063 procedures (n = 41 925 unique patients) were included in the analysis. Overall, VA improved from a mean ± standard deviation (SD) of 0.53 ± 0.58 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/70) before surgery to a mean ± SD of 0.31 ± 0.40 logMAR (Snellen equivalent, 20/40) at 1 year. Among eyes with VA recorded at both baseline and 1 year after surgery, 60.5% achieved VA of 20/40 or better at 1 year. Vision of worse than 20/40 at 1 year was associated with greater age (odds ratio [OR], 1.16 per 5-year increase; 95% confidence interval [CI], 1.14-1.18) and higher logMAR baseline VA (OR, 1.14 per 0.1-logMAR increase; 95% CI, 1.14-1.15), as well as Black or African American (OR, 1.96; 95% CI, 1.68-2.28), Hispanic (OR, 1.82; 95% CI, 1.59-2.08), and Asian (OR, 1.48; 95% CI, 1.21-1.81) race or ethnicity versus White race, Medicaid (OR, 1.78; 95% CI, 1.40-2.25) versus private insurance, smoking history (OR, 1.22; 95% CI, 1.11-1.35), and concurrent anterior (OR, 1.65; 95% CI, 1.51-1.81) and posterior (OR, 1.53; 95% CI, 1.41-1.66) vitrectomy versus no vitrectomy. Female sex was associated with better VA at 1 year. At 1 year, epiretinal membrane (10.9%), mechanical lens complication (9.4%), and dislocation of the replacement lens (7.1%) were the most common complications. CONCLUSIONS In this large national cohort, the annual number of IOL exchanges rose steadily over time. Vision improved in 60.2% of patients; worse visual outcomes were associated with greater age, worse baseline vision, Black race, Hispanic ethnicity, Medicaid insurance, smoking, and concurrent vitrectomy. Epiretinal membrane was the most common complication. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | | | - Charles Li
- American Academy of Ophthalmology, San Francisco, California
| | - Lynn Liu
- American Academy of Ophthalmology, San Francisco, California
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Flora Lum
- American Academy of Ophthalmology, San Francisco, California
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Zafar S, Gonzales A, Cai S. A Case of a Bumpy Retina. JAMA Ophthalmol 2024; 142:384-385. [PMID: 38451506 DOI: 10.1001/jamaophthalmol.2024.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
A 77-year-old male had 3 months of progressive vision decline in the left eye. Dilated fundus examination revealed diffuse hyperpigmented lesions involving the macula and superior fundus that corresponded to areas of nodular retinal pigment epithelium thickening on optical coherence tomography. What would you do next?
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Affiliation(s)
- Sidra Zafar
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anthony Gonzales
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sophie Cai
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Chen A, Dun C, Schein OD, Srikumaran D, Zafar S, Makary M, Woreta F. Endophthalmitis rates and risk factors following intraocular surgeries in the medicare population from 2016 to 2019. Br J Ophthalmol 2024; 108:232-237. [PMID: 37734768 DOI: 10.1136/bjo-2023-323865] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/02/2023] [Indexed: 09/23/2023]
Abstract
AIMS To determine endophthalmitis rates and risk factors following intraocular surgeries in the Medicare population. METHODS Retrospective, cross-sectional study from 2016 to 2019 in Medicare fee-for-service and Medicare Advantage beneficiaries. 100% Medicare claims were used to identify eyes that underwent intraocular surgery. Exclusion criteria included eyes that had intraocular surgery 42 days before or after and eyes in patients with a history of endophthalmitis within 12 months. RESULTS 9 744 400 intraocular surgeries were performed among Medicare beneficiaries from 2016 to 2019. A 42-day postoperative endophthalmitis rate was 0.09%. Endophthalmitis rate by surgery type was 0.43% for corneal transplant, 0.36% for secondary intraocular lens (IOL), 0.24% for retina, 0.16% for glaucoma, 0.11% for cataract combined with other procedures and 0.08% for cataract surgeries alone. On multivariable analysis, the risk of endophthalmitis was increased for all intraocular surgery types when compared with cataract surgeries; adjusted OR (aOR) 5.30 (p<0.01) for corneal transplant, aOR 4.50 (p<0.01) for secondary IOL, aOR 3.00 (p<0.01) for retina, aOR 1.93 (p<0.01) for glaucoma, aOR 1.45 (p<0.01) for combined cataract surgeries. Increased risk of developing endophthalmitis was associated with older age (≥85 vs 65-75 years: aOR 1.36; p<0.01), male sex (aOR 1.20; p<0.001) and greater Charlson Comorbidity Index (≥7 vs 0: aOR 1.79; p<0.01). CONCLUSIONS Postoperative endophthalmitis rate after intraocular surgeries was 0.09% between 2016 and 2019 for Medicare beneficiaries. Endophthalmitis rates were highest for corneal transplant surgeries followed by secondary IOL surgeries and lowest for cataract surgeries. Older age, male gender and higher comorbidity index were associated with risk of endophthalmitis.
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Affiliation(s)
- Ariel Chen
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oliver D Schein
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Zafar S, Ahmed TM, Baig R, Jeeva I, Siddiqui MAR. Accuracy of swept source biometry device in detecting macular diseases compared with swept source OCT. BMC Res Notes 2023; 16:376. [PMID: 38115143 PMCID: PMC10731895 DOI: 10.1186/s13104-023-06641-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023] Open
Abstract
OBJECTIVE To assess the diagnostic accuracy of the IOLMaster 700 foveal scans to detect foveal pathology compared with a standard swept-source optical coherence tomography (SS-OCT) device. RESULTS One hundred seventy eye scans of 95 patients were included in the final analyses. Ninety-nine (58.2%) scans were classified as abnormal by SS-OCT. Mean sensitivity of the biometry device was 67.5% (range: 51-84%) and mean specificity was 69.5% (range: 44-95%). Intra-class correlation coefficients were 0.912 and 0.835, for reader 1 and 2, respectively. Area under the curve for receiver operating curve was 0.726. Foveal scans of the IOLMaster 700 can provide clinically useful information. Clinicians should pay attention to the macular scans when reviewing biometry prior to cataract surgery and standard macular OCT should ideally be supplemented in suspicious cases.
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Affiliation(s)
- Sidra Zafar
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Taha Muneer Ahmed
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Rashid Baig
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Irfan Jeeva
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - M A Rehman Siddiqui
- Department of Ophthalmology and Visual Sciences, Aga Khan University Hospital, Karachi, Pakistan.
- Shahzad Eye Hospital, Shahzad Eye Hospital, Gulshan-e-Iqbal, A-16, Karachi, Pakistan.
- The Eye Centre, South City Hospital, Karachi, Pakistan.
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Masood M, Walsh LJ, Zafar S. Oral complications associated with metal ion release from oral piercings: a systematic review. Eur Arch Paediatr Dent 2023; 24:677-690. [PMID: 37581705 PMCID: PMC10657282 DOI: 10.1007/s40368-023-00831-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 08/01/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE This systematic review explored dental complications associated with metal ion release from oral piercings using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. METHODS Item retrieval from October 2022 to December 2022 from databases, such as Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Scopus and Web of Science, using predefined search terms was undertaken by two independent reviewers. Data were extracted and risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. From 1509 identified studies, 25 were included for analysis. RESULTS Of the 25 studies, 20 included both clinical examination and questionnaire-based data. The remaining five studies were deemed low quality based on the Joanna Briggs Institute criteria. The average time piercings were worn ranged between 5 and 48 months. Most studies did not investigate complications from metal ion release. Only two studies examined the direct effects of metal ion release and showed that metal ions may cause hypersensitivity reactions and mucosal changes. Other soft tissue complications were reported, with gingival recession noted in 16 out of 25 studies, especially due to lip piercings. Studies reporting other complications were as follows: swelling (9), pain (8), infection (6), bleeding (6), inflammation (5), alterations to speech, eating and/or swallowing (5), changes to taste or metallic taste (5), and mucosal changes (4). Ten studies reported tooth chipping from tongue piercings. CONCLUSION Oral piercings leach metal ions into surrounding tissues which may cause local mucosal changes. Furthermore, oral piercings cause damage to both soft and hard oral tissues, particularly gingival recession for lip piercings and tooth chipping for tongue piercings. Thus, to prevent such adverse injuries, dental professionals should discourage patients against oral piercings.
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Affiliation(s)
- M Masood
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston Qld, Brisbane, QLD, 4006, Australia
| | - L J Walsh
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston Qld, Brisbane, QLD, 4006, Australia
| | - S Zafar
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston Qld, Brisbane, QLD, 4006, Australia.
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Bakhshi T, Zafar S. Hybrid Deep Learning Techniques for Securing Bioluminescent Interfaces in Internet of Bio Nano Things. Sensors (Basel) 2023; 23:8972. [PMID: 37960671 PMCID: PMC10648166 DOI: 10.3390/s23218972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023]
Abstract
The Internet of bio-nano things (IoBNT) is an emerging paradigm employing nanoscale (~1-100 nm) biological transceivers to collect in vivo signaling information from the human body and communicate it to healthcare providers over the Internet. Bio-nano-things (BNT) offer external actuation of in-body molecular communication (MC) for targeted drug delivery to otherwise inaccessible parts of the human tissue. BNTs are inter-connected using chemical diffusion channels, forming an in vivo bio-nano network, connected to an external ex vivo environment such as the Internet using bio-cyber interfaces. Bio-luminescent bio-cyber interfacing (BBI) has proven to be promising in realizing IoBNT systems due to their non-obtrusive and low-cost implementation. BBI security, however, is a key concern during practical implementation since Internet connectivity exposes the interfaces to external threat vectors, and accurate classification of anomalous BBI traffic patterns is required to offer mitigation. However, parameter complexity and underlying intricate correlations among BBI traffic characteristics limit the use of existing machine-learning (ML) based anomaly detection methods typically requiring hand-crafted feature designing. To this end, the present work investigates the employment of deep learning (DL) algorithms allowing dynamic and scalable feature engineering to discriminate between normal and anomalous BBI traffic. During extensive validation using singular and multi-dimensional models on the generated dataset, our hybrid convolutional and recurrent ensemble (CNN + LSTM) reported an accuracy of approximately ~93.51% over other deep and shallow structures. Furthermore, employing a hybrid DL network allowed automated extraction of normal as well as temporal features in BBI data, eliminating manual selection and crafting of input features for accurate prediction. Finally, we recommend deployment primitives of the extracted optimal classifier in conventional intrusion detection systems as well as evolving non-Von Neumann architectures for real-time anomaly detection.
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Affiliation(s)
- Taimur Bakhshi
- School of Built Environment, Engineering & Computing, Leeds Beckett University, Leeds LS1 3HE, UK
| | - Sidra Zafar
- Department of Computer Science, Kinnaird College for Women, Lahore 54000, Pakistan;
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Ali M, Menard M, Zafar S, Williams BK, Knight OJ, Woreta FA. Sex and Racial and Ethnic Diversity Among Ophthalmology Subspecialty Fellowship Applicants. JAMA Ophthalmol 2023; 141:948-954. [PMID: 37651110 PMCID: PMC10472264 DOI: 10.1001/jamaophthalmol.2023.3853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023]
Abstract
Importance Physician-patient concordance in sex and race is associated with improved patient outcomes. Studies have explored diversity among ophthalmology residents and faculty, but to our knowledge, not among ophthalmology fellows. Objective To assess diversity by sex and race and ethnicity among fellowship applicants in ophthalmology subspecialties and compare match rates by applicants' sex and underrepresented in medicine (URiM) status. Design, Setting, and Participants This cohort study examined ophthalmology subspecialty fellowship data from the 2021 San Francisco Match. Main Outcomes and Measures Applicant characteristics were stratified by sex and URiM status and compared using χ2, Mann-Whitney U, and median tests. For applicants who matched, the percentages of female and URiM applicants were compared among the ophthalmic subspecialties. A multivariable logistic regression model was used to assess the association of applicant characteristics with their match outcomes. Results Included in the sample were 537 candidates who applied for an ophthalmology fellowship using the 2021 San Francisco Match; 224 applicants (42.6%) were female, and 60 applicants (12.9%) had URiM status. Females and males had similar match rates (70.5% [n = 158] and 69.2% [n = 209], respectively; P = .74), but females had a higher median (IQR) US Medical Licensing Examination (USMLE) Step 2 Clinical Knowledge (CK) score (248 [240-258] vs 245 [234-254]; P = .01). The pediatric ophthalmology subspecialty had the highest percentage of female matched applicants (67.5%; 27 of 40 matched applicants), while the retina subspecialty had the highest percentage of males (68.9%; 84 of 122 matched applicants). URiM applicants had lower match rates (55.0%, n = 33) than non-URiM applicants (72.2%, n = 293; P = .007). The URiM applicants had lower median (IQR) scores on the USMLE Step 1 (238 [227-247]) compared with Asian applicants (246 [235-254]) and White applicants (243 [231-252]; P = .04). Additionally, URIM applicants submitted fewer median (IQR) applications (10 [1-23]) than Asian (21 [8-37]) and White (17 [8-32]; P = .001) applicants and completed fewer interviews (median [IQR], 2 [0-11]) than Asian (median [IQR], 12 [3-18]) and White applicants (median [IQR], 8 [1-14]; P = .001). Among matched fellows in each subspecialty, URiM applicants comprised 13.9% (n = 11) in glaucoma, 10% (n = 4) in pediatric ophthalmology, 7.3% (n = 6) in cornea, and 6.6% (n = 8) in retina. Conclusions and Relevance Ophthalmology subspecialty fellowship match rates were lower for URiM vs non-URiM applicants in 2021. Underrepresentation of females exists in the retina subspecialty, while racial and ethnic differences exist in all ophthalmology subspecialty fellowships examined. Monitoring trends in fellowship diversity over time should help inform where targeted efforts could improve diversity.
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Affiliation(s)
- Muhammad Ali
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Maylander Menard
- School of Medicine, Meharry Medical College, Nashville, Tennessee
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Basil K Williams
- Cincinnati Eye Institute, University of Cincinnati School of Medicine, Cincinnati, Ohio
| | - O'Rese J Knight
- Department of Ophthalmology, University of California, San Francisco, San Francisco
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
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Borhany M, Ali MS, Ghias Z, Abid M, Zafar S, Shamsi T. The Impact of ABO Incompatibility on the Outcomes of Hematopoietic Stem Cell Transplantation: A Single-Center Study From Pakistan. Cureus 2023; 15:e45442. [PMID: 37859904 PMCID: PMC10583226 DOI: 10.7759/cureus.45442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background and objective Allogeneic hematopoietic stem cell transplantation (alloHSCT) provides curative treatment for several hematological illnesses. In this study, we evaluated the impact of ABO compatibility and incompatibility on outcomes and complications related to hematopoietic stem cell transplantation (HSCT) performed for various hematological disorders at our center. Methodology This was a retrospective, single-center, cohort study in which patients were categorized according to the ABO match and mismatch status. The mismatch group was further subcategorized into major, minor, and bidirectional groups. Results A total of 117 patients underwent alloHSCT, out of which 82 (70.1%) were male and 35 (30%) were female. The median age of the patients was 9.5 years (range: 46 years). The most common indications for stem cell transplant were beta-thalassemia major (BTM; n=58, 49%) and aplastic anemia (AA; n=42, 35.8%). However, the outcomes in match and mismatch groups showed significant results for positive direct Coombs test (DCT), indicating the occurrence of hemolysis. Despite the increased need for blood transfusions, ABO blood group incompatibility (ABOi) had no negative impact on the clinical results. Conclusion Based on our findings, ABO incompatibility does not affect the outcomes in patients undergoing alloHSCT. Patient monitoring can aid in early detection and treatment, thereby minimizing the frequency of fatal events.
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Affiliation(s)
- Munira Borhany
- Department of Clinical Hematology and Bone Marrow Transplantation, National Institute of blood Diseases, Karachi, PAK
| | - Muhammad Shujat Ali
- Department of Clinical Hematology and Bone Marrow Transplantation, National Institute of Blood Diseases, Karachi, PAK
| | - Zainab Ghias
- Department of Clinical Hematology and Bone Marrow Transplantation, National Institute of Blood Diseases, Karachi, PAK
| | - Madiha Abid
- Research, National Institute of Blood Diseases, Karachi, PAK
| | - Sidra Zafar
- Research, National Institute of Blood Diseases, Karachi, PAK
| | - Tahir Shamsi
- Department of Clinical Hematology and Bone Marrow Transplantation, National Institute of Blood Diseases, Karachi, PAK
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Tomaiuolo M, Woreta FA, Li A, Yonekawa Y, Zhang QE, Sharpe JE, Zafar S, Syed ZA, Ramesh S, Lorch AC, Hall NE, Shah AS, Justin GA, Hyman L. Open-Globe Injury Repairs in the American Academy of Ophthalmology IRIS® Registry 2014 - 2018: Incidence, Risk Factors, and Visual Outcomes. Ophthalmology 2023; 130:812-821. [PMID: 36924850 PMCID: PMC10502180 DOI: 10.1016/j.ophtha.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/15/2023] [Accepted: 03/08/2023] [Indexed: 03/17/2023] Open
Abstract
PURPOSE To estimate incidence and evaluate demographic risk factors and visual acuity (VA) outcomes of open-globe injuries requiring surgical repair in the IRIS® Registry (Intelligent Research in Sight). DESIGN Retrospective cohort study. PARTICIPANTS Patients with open-globe injury repairs (OGRs) were identified by Current Procedural Terminology codes (65275, 65280, 65285, 65286, 65235, 65260, and 65265) from 2014 through 2018 in the IRIS Registry. METHODS Logistic regression models adjusting for age, sex, race, ethnicity, United States region, concurrent and subsequent surgeries, and baseline VA. MAIN OUTCOME MEASURES Outcomes included annual and 5-year incidence rates per 100 000 people and factors associated with OGR, VA better than 20/40, and VA of 20/200 or worse at final follow-up (3-12 months after OGR). RESULTS Thirteen thousand seven hundred sixty-six OGRs were identified; 5-year cumulative incidence was 28.0 per 100 000 patients. Open-globe repair was associated with age 21 to 40 years compared with younger than 21 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.5-1.7]), male sex (OR, 2.8; 95% CI, 2.7-2.9), Black versus White race (OR, 1.3; 95% CI, 1.2-1.4), Hispanic versus non-Hispanic ethnicity (OR, 1.7; 95% CI, 1.6-1.8), and South (OR, 1.4; 95% CI, 1.3-1.5) and West (OR, 1.3; 95% CI, 1.2-1.4) versus Midwest regions and associated inversely with Asian versus White race (OR, 0.6; 95% CI, 0.6-0.7). Visual acuity outcomes, analyzed in a subset of 2966 patients with VA data available, showed vision impairment (VA < 20/40) at final follow-up was associated with VA of 20/200 or worse at presentation (20/200 better than 20/40; OR, 11.1; 95% CI, 8.0-15.7), older age (e.g., > 80 years vs. < 21 years; OR, 5.8; 95% CI, 3.2-10.7), and Black versus White race (OR, 1.8; 95% CI, 1.3-2.6). Risk factors were similar for VA of 20/200 or worse after OGR. Among the 1063 patients undergoing OGR with VA of 20/200 or worse at presentation, VA did not improve to better than 20/200 at follow-up in 35% of patients (1063/2996). CONCLUSIONS Our findings bring to light racial disparities in risk of OGR and poor visual outcomes that warrant further exploration. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Maurizio Tomaiuolo
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander Li
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Yoshihiro Yonekawa
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania; Retina Service, Wills Eye Hospital, Mid Atlantic Retina, Philadelphia, Pennsylvania
| | - Qiang Ed Zhang
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - James E Sharpe
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zeba A Syed
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Sathyadeepak Ramesh
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania
| | - Alice C Lorch
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Nathan E Hall
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts; Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Grant A Justin
- Department of Ophthalmology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Leslie Hyman
- The Vickie and Jack Farber Vision Research Center at Wills Eye, Wills Eye Hospital, Philadelphia, Pennsylvania.
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Munawar Ali R, Abid M, Zafar S, Ali MS, Nadeem R, Ahmed R, Borhany M. Management of Severe Hemophilia A: Low-Dose Prophylaxis vs. On-Demand Treatment. Cureus 2023; 15:e41410. [PMID: 37546069 PMCID: PMC10402932 DOI: 10.7759/cureus.41410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION Prophylactic clotting factor infusion regimens to prevent bleeding and joint deformity has become the standard of care in severe hemophilia A patients. AIM To assess low-dose factor prophylaxis in our population as an alternative approach to managing severe hemophilia A. METHODS A prospective cohort study that included 68 hemophilia A patients divided into two groups, i.e., Prophylaxis and on-demand. The two groups were compared for annualized bleeding rate (ABR), hospitalization, units of factor VIII (FVIII) infused, or plasma products transfused, i.e., fresh frozen plasma (FFP) and cryoprecipitate (CP), and development of FVIII inhibitors. RESULTS Of the 68 patients recruited in this study, 25 (36.7%) were in the prophylaxis group, and 43(63.3%) were in the on-demand group. The on-demand group presented a higher median-IQR ABR [8(20-3) vs. 5(10-1.5), p-value 0.024], several hospitalizations (39.7% vs. 0, p-value 0.001), and inhibitor development (9.3% vs. 0, p-value 0.289) compared to the prophylaxis group. The prophylaxis approach demonstrated a significant negative correlation of ABR with FVIII prophylaxis (r=-0484, p=value=0.014). Moreover, no hospitalizations or inhibitor development was observed in the prophylaxis group. The estimated annual consumption of FVIII was 328 IU/kg/year in the on-demand group and 1662.6 IU/kg/year in the prophylaxis group. However, a highly significant difference in plasma product utilization was observed between the two groups, i.e., p-value <0.001 and 0.038 for FFP and CP, respectively. CONCLUSION Low-dose factor prophylaxis resulted in improved outcomes compared to on-demand treatment in terms of ABR, joint bleeding, hospitalization, and the development of inhibitors. This treatment approach should be adopted as an economically feasible alternative to high-dose Prophylaxis in resource-constrained countries.
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Affiliation(s)
- Rabeea Munawar Ali
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Madiha Abid
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Sidra Zafar
- Research and Development, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Muhammad Shujat Ali
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
| | - Rukhshanda Nadeem
- Physical Medicine and Rehabilitation, Hemophilia Welfare Society, Karachi, PAK
| | - Raheel Ahmed
- Hematology, Haemophilia Welfare Society, Karachi, PAK
| | - Munira Borhany
- Hematology, National Institute of Blood Disease & Bone Marrow Transplantation, Karachi, PAK
- Hematology, Haemophilia Welfare Society, Karachi, PAK
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Butt AJ, Zaidi U, Munawar Ali R, Zafar S, Ali MS, Shamsi T. Reticulated Platelet Count as a Diagnostic Tool in Immune Thrombocytopenia (ITP). Cureus 2023; 15:e41346. [PMID: 37546153 PMCID: PMC10398611 DOI: 10.7759/cureus.41346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
OBJECTIVE This study aimed to compare the reticulated platelet count between patients having thrombocytopenia secondary to autoimmune destruction (immune thrombocytopenia {ITP}), bone marrow failure, and healthy controls who presented to a tertiary care hospital in Karachi, Pakistan. METHODOLOGY A cross-sectional study was conducted from February 2021 to October 2022 in the Department of Hematology, National Institute of Blood Disease (NIBD) Hospital in Karachi, Pakistan, that involved examining three groups: 30 patients with immune thrombocytopenia, 30 patients with thrombocytopenia secondary to reduced production from bone marrow, and 30 healthy controls. The study utilized the Sysmex XN-1000 (Hyogo, Japan: Sysmex Corporation) automated hematology analyzer to perform a complete blood count (CBC) test. Additionally, peripheral blood was stained with Leishman stain and examined under a microscope to eliminate pseudo thrombocytopenia and identify any abnormal cells or dysplasia. The immature platelet fraction (IPF) was then performed on Sysmex XN 1000 after ensuring adequate quality control. Finally, the data were analyzed using DATAtab (Graz, Austria: DATAtab) and SPSS version 25 (Armonk, NY: IBM Corp.). RESULTS Of the ninety participants, the median age was 33 years with a range of 18-71 years. Patients with ITP had a significantly higher median IPF% (median=26.65, IQR=15-39.4) than thrombocytopenia due to bone marrow failure (median=9.25, IQR=4.55-14.30) and healthy controls (median=7, IQR=4.40-9.90), with a p-value of 0.001. The immune thrombocytopenia group demonstrated an increase in IPF% as platelet counts increased, indicating a significant moderate correlation between IPF% and platelets in these patients (r=0.438, p=0.016) and confirming that IPF% was an independent predictor for the detection of ITP. CONCLUSION Reticulated platelet count may be a useful diagnostic tool to differentiate between ITP and thrombocytopenia caused by bone marrow failure. Because of its non-invasive nature, IPF is a valuable tool for expediting the management of thrombocytopenia associated with increased IPF.
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Affiliation(s)
- Aqsa Javed Butt
- Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
| | - Uzma Zaidi
- Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
| | - Rabeea Munawar Ali
- Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
| | - Sidra Zafar
- Research and Development, National Institute of Blood Diseases and Bone marrow Transplantation, Karachi, PAK
| | - Muhammad Shujat Ali
- Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
| | - Tahir Shamsi
- Clinical Hematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, PAK
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Zafar S, Walder A, Virani S, Biggerstaff K, Orengo-Nania S, Chang J, Channa R. Systemic Adverse Events Among Patients With Diabetes Treated With Intravitreal Anti-Vascular Endothelial Growth Factor Injections. JAMA Ophthalmol 2023:2805503. [PMID: 37261816 PMCID: PMC10236327 DOI: 10.1001/jamaophthalmol.2023.2098] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Importance Anti-vascular endothelial growth factor (VEGF) agents are currently the mainstay of treatment for diabetic retinopathy (DR). Although effective, data on their systemic safety remains inconclusive, particularly in high-risk patient groups. Objective To explore the systemic safety of intravitreal anti-VEGF agents among patients with diabetes. Design, Setting, and Participants This was a retrospective, longitudinal population-based analysis of the Corporate Data Warehouse, a large-scale database of patients within the US Veteran Health Affairs. All patients 18 years and older with type 2 diabetes who were seen at any Veterans Affairs health care facility in the US between January 1, 2011, and December 31, 2012, were identified. Data were then extracted on incident systemic adverse events among this patient cohort from January 1, 2013, to December 31, 2017. All individuals with diabetes who did and did not receive anti-VEGF injections were included. Patients with a history of prior systemic adverse events and those who received an intravitreal injection between January 1, 2011, and December 31, 2012, were excluded. Data were analyzed from October 2019 to March 2023. Exposure Anti-VEGF injection. Main Outcomes and Measures Proportion of patients with any incident systemic adverse event, acute myocardial infarction, cardiovascular disease, or kidney disease at 1-, 3-, and 5-year follow-up. Results A total of 1 731 782 patients (mean [SD] age, 63.8 [12.3] years; 1 656 589 [95.7%] male) with type 2 diabetes were included. DR was present in 476 013 (27.5%), and 14 022 (0.8%) received anti-VEGF injections. Of the total number of patients with type 2 diabetes, 321 940 (18.6%) developed systemic adverse events between 2013 and 2017. The 5-year cumulative incidence of any systemic adverse event was 37.0% (5187/14 022) in the injection group vs 18.4% (316 753/1 717 760) in the noninjection group (P < .001). Anti-VEGF injections were independently associated with a higher likelihood of developing any systemic adverse event (odds ratio, 1.8; 95% CI, 1.7-1.9) when controlling for age, race, sex, ethnicity, tobacco use, severity of DR, Deyo-Charlson Comorbidity Index score, mean hemoglobin A1c, total number of injections, and statin use. Conclusion and Relevance In this study, intravitreal anti-VEGF injections were independently associated with a higher likelihood of systemic adverse events among patients with diabetes.
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Affiliation(s)
- Sidra Zafar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Annette Walder
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey, VA Medical Center, Houston, Texas
| | - Salim Virani
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey, VA Medical Center, Houston, Texas
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Kristin Biggerstaff
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Silvia Orengo-Nania
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Jonathan Chang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison
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15
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Zafar S, Staggers KA, Gao J, Liu Y, Patel PJ, Foster PJ, Frankfort BJ, Abramoff M, Minard CG, Warwick A, Khawaja AP, Channa R. Evaluation of retinal nerve fibre layer thickness as a possible measure of diabetic retinal neurodegeneration in the EPIC-Norfolk Eye Study. Br J Ophthalmol 2023; 107:705-711. [PMID: 34952836 PMCID: PMC9460960 DOI: 10.1136/bjophthalmol-2021-319853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Markers to clinically evaluate structural changes from diabetic retinal neurodegeneration (DRN) have not yet been established. To study the potential role of peripapillary retinal nerve fibre layer (pRNFL) thickness as a marker for DRN, we evaluated the relationship between diabetes, as well as glycaemic control irrespective of diabetes status and pRNFL thickness. METHODS Leveraging data from a population-based cohort, we used general linear mixed models (GLMMs) with a random intercept for patient and eye to assess the association between pRNFL thickness (measured using GDx) and demographic, systemic and ocular parameters after adjusting for typical scan score. GLMMs were also used to determine: (1) the relationship between: (A) glycated haemoglobin (HbA1c) irrespective of diabetes diagnosis and pRNFL thickness, (B) diabetes and pRNFL thickness and (2) which quadrants of pRNFL may be affected in participants with diabetes and in relation to HbA1c. RESULTS 7076 participants were included. After controlling for covariates, inferior pRNFL thickness was 0.94 µm lower (95% CI -1.28 µm to -0.60 µm), superior pRNFL thickness was 0.83 µm lower (95% CI -1.17 µm to -0.49 µm) and temporal pRNFL thickness was 1.33 µm higher (95% CI 0.99 µm to 1.67 µm) per unit increase in HbA1c. Nasal pRNFL thickness was not significantly associated with HbA1c (p=0.23). Similar trends were noted when diabetes was used as the predictor. CONCLUSION Superior and inferior pRNFL was significantly thinner among those with higher HbA1c levels and/or diabetes, representing areas of the pRNFL that may be most affected by diabetes.
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Affiliation(s)
- Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Kristen A Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Jie Gao
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA
| | - Yao Liu
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Praveen J Patel
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | - Paul J Foster
- NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, UK
| | | | - Michael Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa city, Iowa, USA
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | | | | | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, Madison, WI, USA
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Zafar S, Dun C, Srikumaran D, Cai CX, Wang P, Schein OD, Makary M, Woreta F. National Physician-Level Endophthalmitis Rates for Cataract Surgery among Medicare Beneficiaries in the United States: 2011-2019. Ophthalmology 2023:S0161-6420(23)00204-X. [PMID: 37030455 DOI: 10.1016/j.ophtha.2023.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023] Open
Affiliation(s)
- Sidra Zafar
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Chen Dun
- The Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Divya Srikumaran
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Cindy X Cai
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Peiqi Wang
- The Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Oliver D Schein
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Martin Makary
- The Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; The Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Fasika Woreta
- The Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
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Masood M, Walsh LJ, Zafar S. Ion release from oral piercings from in vitro acidic challenges. Aust Dent J 2023. [PMID: 36855902 DOI: 10.1111/adj.12954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES This laboratory-based study measured ion release from metallic piercings when exposed to organic acids (lactic, citric) and inorganic acids (phosphoric, hydrochloric) that could be encountered in the oral cavity. METHODS Barbell and ring oral piercings composed of stainless steel, titanium or gold-plated titanium were submerged in 2 mL volumes of 0.1% lactic acid, 10% citric acid, 0.2% phosphoric acid, and 0.1% hydrochloric acid for 7 and 34 days. Ion release into the liquid was measured using inductively coupled plasma optical emission spectroscopy (ICPOES) and expressed in relationship to surface area. Surface changes from baseline were assessed using light and backscatter scanning electron microscopy (SEM). RESULTS ICPOES results showed that hydrochloric and phosphoric acid caused the greatest release of material per surface area. Released elements included (ranked highest to lowest): Fe, P, Ti, Na, Cr, S, Ni, Ca, Mg, K, Si, Al, V, Mn, Ba, and Co. SEM imaging identified qualitative surface changes consistent with corrosion, for most piercing types examined. CONCLUSIONS Under the exposure conditions used, inorganic acids cause greater metal dissolution than organic acids. Inorganic acids could therefore pose a risk of corrosion and leaching of ions from metallic oral piercings.
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Affiliation(s)
- M Masood
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - L J Walsh
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
| | - S Zafar
- School of Dentistry, The University of Queensland, Herston, Queensland, Australia
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Zafar S, Mishra K, Sachdeva MM. SYPHILITIC OUTER RETINOPATHY: A MASQUERADING DIAGNOSIS REVEALED AFTER STEROID-INDUCED PROGRESSION TO PANUVEITIS. Retin Cases Brief Rep 2023; 17:9-12. [PMID: 33323897 DOI: 10.1097/icb.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE To report a case of syphilitic outer retinopathy revealed after progression to panuveitis after a course of oral steroids for suspected poison ivy. METHODS Retrospective case report. RESULTS A 44-year-old diabetic man presented with progressive symptoms of nyctalopia and color vision changes associated with outer retinal disruption on macular imaging but minimal evidence of intraocular inflammation on examination. A short course of oral steroids for an unrelated skin condition induced rapid progression to frank panuveitis with retinal vascular sheathing and retinal whitening. Systemic workup identified syphilis as the etiology. The patient's visual symptoms and disruption of the photoreceptor and retinal pigment epithelial layers on OCT improved after treatment with IV penicillin. CONCLUSION Syphilitic outer retinopathy represents an unusual manifestation of ocular syphilis that can present with minimal examination findings. We present here a case of oral steroid use resulting in the progression of syphilitic outer retinopathy to a more fulminant form of syphilitic uveitis that ultimately revealed the correct diagnosis and prompted the correct intervention. This case highlights the importance of maintaining a high level of suspicion for this treatable condition.
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Affiliation(s)
- Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ali M, Saeed S, Zafar S, Golnik KC, Woreta F. Predictors of matching into an ophthalmology fellowship for international medical graduates: a San Francisco match analysis. Int Ophthalmol 2022; 43:2029-2035. [DOI: 10.1007/s10792-022-02602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022]
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Burton E, Mishra K, Arsiwala LT, Zafar S, Justin GA, Mruthyunjaya P, Woreta FA. Applicant Characteristics Associated with Retina Fellowship Match from 2010-2019. Ophthalmol Retina 2022; 6:1253-1259. [PMID: 35772695 PMCID: PMC9887683 DOI: 10.1016/j.oret.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/18/2022] [Accepted: 06/21/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe trends in the surgical and medical retina fellowship match and applicant characteristics associated with matching in retina fellowship. DESIGN Retrospective study. SUBJECTS Ophthalmology fellowship applicants who applied through the San Francisco (SF) Match. METHODS Publicly available SF Match data were used to describe trends in the number of programs participating and positions offered, filled, and left vacant in the retina fellowship match from 2014 to 2019. Deidentified applicant data for match cycles from 2010 to 2017 were stratified by match status, and characteristics were compared across groups. Trends in matched applicant characteristics were evaluated using linear regression on log-transformed variables. Multivariable logistic regression was used to determine applicant characteristics that were associated with a successful match. MAIN OUTCOME MEASURES Match status. RESULTS From 2014 to 2019, the number of programs participating, positions filled, and positions left vacant in the retina fellowship match increased from 101 to 119 (P = 0.010), 118 to 123 (P = 0.078), and 18 to 37 (P = 0.045), respectively. Compared with unmatched applicants, matched applicants were more likely to have graduated from a top 10 residency program, US residency, or medical school; hold a United States (US) visa (J-1, H-1B, or O1); distribute more applications; complete more interviews; rank more programs; and score higher on the United States Medical Licensing Examination (USMLE) Step examinations 1-3. Matched applicants completed a median of 10 interviews. After controlling for potential covariates, graduating from a US residency (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.48-2.92), a top 10 residency (OR, 1.74; 95% CI, 1.07-2.84), having an allopathic medical degree (MD; OR, 2.39; 95% CI, 1.08-5.33), completing more interviews (OR, 1.28; 95% CI, 1.23-1.33), and scoring higher on USMLE Step 3 (OR, 1.01; 95% CI, 1.01-1.03) were associated with matching into a retina fellowship. CONCLUSIONS Although the number of programs participating and positions offered in the retina fellowship match are increasing, the number of positions filled remained relatively stagnant. Factors associated with matching in both medical and surgical retina included graduating from a US and top 10-ranked residency program, having an MD, completing more interviews, and scoring higher on USMLE Step 3.
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Affiliation(s)
- Eleanor Burton
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kapil Mishra
- Byers Eye Institute, Stanford University, Palo Alto, California
| | - Lubaina T Arsiwala
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Grant A Justin
- Vitreoretinal Surgery Service, Duke Eye Center, Durham, North Carolina
| | | | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Komal M, Afshan K, Zafar S, Firasat S, Qayyum M. Seroprevalence of Fasciola-infection using Enzyme-linked immunosorbent assay in large ruminants from Pakistan. J HELL VET MED SOC 2022. [DOI: 10.12681/jhvms.26436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Fasciolosis, caused by liver fluke species of the genus Fasciola, are well recognized because of its high veterinary impact. Stool examination for Fasciola eggs is not a sensitive method, and limited efforts to find a reliable and cheaper means of detection are available. The present study aimed to develop rapid diagnostic ELISA test against fasciolosis. The excretory/secretory (ES) and somatic (SA) products of Fasciola helminths were analysed using polyacrylamide gel electrophoresis (PAGE). Immunogenicity was evaluated by immunoblotting using hyperimmune sera raised in rabbits and seroprevalence was determined by indirect ELISA. The results of SA antigen of Fasciola species showed polypeptide bands ranged from 10kDa-100kDa, while ES antigen of Fasciola showed bands of 15kDa-55kDa. The immunoblotting results showed the most prominent bands against ES antibodies were 25, 35, 55-70, 100 and 250 kDa and SA antigens showed 10, 15-25, 35, 70, 100 and 250 kDa polypeptide bands. The sensitivity and specificity of developed indirect ELISA for SA antigens was 95.45% and 87.1%, while for ES antigens was 100% and 77.42% respectively. The overall seroprevalence recorded for fascioliasis based on SA antigen was 39.8% and 29.8% for ES antigen. The fasciolosis did not show significant association with host type, sex and age groups of examined animals, however significantly higher infection was found in months of September and October. The result provides sensitive in house immunodetection assay for diagnosis of fasciolosis alternative to commercial kits with high import cost.
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Zafar M, Rehman A, Zafar S. Correction to: “A Novel Blockchain-Based Model for Blood Donation System” [EAI Endorsed Context-aware Syst App (2022), vol. 8]. EAI Endorsed Trans Context Aware Syst App 2022. [DOI: 10.4108/eetcasa.v8i1.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
This article is a correction on:
Zafar, M., Khan, I., Rehman, A. and Zafar, S. 2022. A Novel Blockchain-Based Model for Blood Donation System. EAI Endorsed Transactions on Context-aware Systems and Applications. 8, 1 (Aug. 2022), e8. DOI:https://doi.org/10.4108/eetcasa.v8i1.2546
In the above article, Imran Khan was added as an author of the paper when he had no participation in the research process. Imran Khan requested the removal of his name and all the co-authors agreed with this decision.
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Ahmed R, Tariq F, Ashfaq J, Thakur W, Zafar S, Danish A, Borhany M. The Outcome of Hodgkin Lymphoma With Reference to Prognostic Markers. Cureus 2022; 14:e28421. [PMID: 36176827 PMCID: PMC9512312 DOI: 10.7759/cureus.28421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: This study aimed to determine the impact of prognostic markers on the outcomes of Hodgkin lymphoma. Methods: It is a cross-sectional, single-center study. A total of 60 patients diagnosed with Hodgkin lymphoma were recruited for the study over five years between 2016 to 2020. The study setting was the National Institute of Blood and Bone Marrow Transplant in Pakistan. The Statistical Package for Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Results: In the study population, 63.3% of the patients were male (38/60), and 36.7% were female (22/60). Hodgkin lymphoma was divided into four stages: stage I (18.3%), stage II (18.3%), stage III (46.7%), and stage IV (16.7%). Patients in stage III had a higher value of hemoglobin (Hb) than in other stages of the disease. The erythrocyte sedimentation rate was high in 56.7% of stage III patients than in patients of the other stages. The lactate dehydrogenase (LDH) levels were not under the normal range in 51.6% of patients. Only 20% of patients in stage III had LDH values within the normal range, whereas 26.6% did not. Conclusion: There was a significant impact of prognostic factors on the survival of patients with Hodgkin lymphoma.
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Zafar M, Khan I, Rehman A, Zafar S. A Novel Blockchain-Based Model for Blood Donation System. EAI Endorsed Trans Context Aware Syst App 2022. [DOI: 10.4108/eetcasa.v8i1.2546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In Pakistan, existing blood control systems or blood information management systems are limited in terms of efficient data retrieval of donor to consumer. There is no communication network in place for extra blood in one location to be demanded from a region if blood is limited, resulting in blood wastage. Due to a lack of accessibility and sufficient blood quality testing, blood contaminated with illnesses such as HIV has been used for transfusion in some cases. This study proposes a ledger blood management system to address these challenges. The trail has been represented as a supply-chain management problem following the blood. By trailing the blood stream and donation a single platform for transferring blood and the problem results among blood groups, the proposed system, built on the hyperledger fabric model, adds more traceability toward the blood transfusion process. It also helps to reduce unjustified blood wastage by providing an integrated system for transferring lifeblood and the thing extracts among lifeblood banks. A web app is also designed for accessing the network for simplicity of usage and security is enhanced by implementing block chain hyperfebric ledger system through Key Value System (KVS) system.
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Tsou BC, Eller ZM, Fliotsos MJ, Qiu M, Zafar S, Srikumaran D, Bower K, Woreta FA. Exposure of Ophthalmology Residents to Cornea and Keratorefractive Surgeries in the United States. Journal of Academic Ophthalmology 2022. [DOI: 10.1055/s-0042-1755317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Purpose To describe the cornea and keratorefractive surgeries experience of U.S. ophthalmology residents.
Methods Deidentified case logs of residents graduating in 2018 were collected from ophthalmology residency program directors in the United States. Using Current Procedure Terminology codes, case logs were reviewed in the categories of cornea and keratorefractive surgeries. Accreditation Council for Graduate Medical Education national graduating resident surgical case logs on cornea procedures published from 2010 to 2020 were also analyzed.
Results Case logs were received for 152/488 (31.1%) residents from 36/115 (31.3%) ophthalmology residency programs. The most common procedures logged by residents as primary surgeons were pterygium removal (4.3 ± 4.2) and keratorefractive surgeries (3.6 ± 6.2). Residents logged an average of 2.4 keratoplasties as primary surgeon, performing an average of 1.4 penetrating keratoplasties (PKs) and 0.8 endothelial keratoplasties (EKs). As assistants, the most common procedures logged were keratorefractive surgeries (6.1 ± 4.9), EKs (3.8 ± 3.3), and PKs (3.5 ± 2.3). Medium or large residency class size was associated with higher cornea procedural volumes (odds ratio: 8.9; 95% confidence interval: 1.1–75.6; p < 0.05).
Conclusion The most common cornea surgeries performed by residents include keratoplasty, keratorefractive, and pterygium procedures. Larger program size was associated with greater relative cornea surgery volume. More specific guidelines for logging of procedures could provide a more accurate assessment of resident exposure to critical techniques such as suturing as well as reflect trends in current practice such as the overall increase in EKs.
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Affiliation(s)
- Brittany C. Tsou
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zachary M. Eller
- College of Medicine at Howard University, Washington, District of Columbia
| | - Michael J. Fliotsos
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Qiu
- Department of Ophthalmology and Visual Science, The University of Chicago Pritzker School of Medicine, Chicago, Illinois
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kraig Bower
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika A. Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tsou BC, Aguwa UT, Arsiwala LT, Burton E, Mishra K, Zafar S, Woreta F. Trends in Cornea Fellowship Applications and Applicant Characteristics: A San Francisco Match Analysis. Journal of Academic Ophthalmology 2022. [DOI: 10.1055/s-0042-1756199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Abstract
Purpose We investigate trends in cornea fellowship positions filled over time and applicant characteristics associated with matching into cornea fellowship.
Methods Characteristics of cornea fellowship applicants were assessed using deidentified 2010 to 2017 San Francisco (SF) Match data. Publicly available SF Match cornea fellowship data including the number of participating programs, number of positions offered, number of positions filled, percentage of positions filled, and number of vacancies from 2014 to 2019 were also analyzed as data from 2010 to 2013 were unavailable.
Results From 2014 to 2019, the number of cornea fellowship programs increased by 11.3% (mean 2.3% per year, p = 0.006) and the number of positions offered increased by 7.7% (mean 1.4% per year, p = 0.065). Of 1,390 applicants from 2010 to 2017, 589 (42.4%) matched into cornea. After controlling for potential covariates, graduation from a U.S residency program (odds ratio [OR]: 6.15, 95% confidence interval [CI]: 4.05–9.35, p < 0.001) and a greater number of interviews completed (OR: 1.35, 95% CI: 1.29–1.42, p < 0.001) were associated with increased odds of cornea fellowship match. A greater number of applied programs (OR: 0.97, 95% CI: 0.95–0.98, p < 0.001) was associated with decreased odds of matching into cornea fellowship. The proportion of applicants matching into cornea fellowship increased until 30 applications.
Conclusions The number of cornea fellowship programs and positions increased from 2014 to 2019. Graduation from a U.S residency program and a greater number of interviews completed were associated with an increased likelihood of cornea fellowship match. Unlike applying to any ophthalmology subspecialty fellowship, applying to greater than 30 cornea fellowship programs was associated with decreased odds of matching.
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Affiliation(s)
- Brittany C. Tsou
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ugochi T. Aguwa
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lubaina T. Arsiwala
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleanor Burton
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kapil Mishra
- Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Justin GA, Soleimani M, Zafar S, Cheraqpour K, Green C, Moin M, Prajna NV, Golnik KC, Woreta FA. The Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management. Clin Ophthalmol 2022; 16:2041-2046. [PMID: 35761961 PMCID: PMC9233515 DOI: 10.2147/opth.s354853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 06/07/2022] [Indexed: 12/04/2022] Open
Abstract
Background/Aims To produce an internationally developed rubric to assess surgical competency in open globe management. Methods An international expert panel of seven ophthalmologist educators developed a standardized competency-based rubric. The steps to perform an open globe repair were outlined. Based on a modified Dreyfus model, the experts agreed on the steps of surgery and certain global indices. They then assigned descriptors for the competency expected of a novice, beginner, advanced beginner, and competent surgeon. The tool was then vetted by another panel of ten ophthalmologists. The main outcome measure was the final version of the tool as agreed upon by the expert review panel. Results The steps of open globe repair and key global indices were established. Descriptive wording for each step and global indices for novice, beginner, advanced beginner, and competent surgery were listed. All the expert comments were integrated to establish face and content validity. Conclusion This standardized rubric to evaluate resident competency should be used globally in training programs to assess open globe repair surgical skills. Using a modified Dreyfus model, four different levels of training competency were defined allowing a non-biased, objective, numerical and simple assessment.
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Affiliation(s)
- Grant A Justin
- Department of Vitreoretinal Surgery, Duke Eye Center, Durham, NC, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Correspondence: Grant A Justin, Department of Vitreoretinal Surgery, Duke Eye Center, Durham, NC, USA, Tel +1 609-468-2468, Email
| | - Mohammed Soleimani
- Department of Ocular Trauma and Emergency, Tehran University of Medical Sciences, Tehran, Iran
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins Medical Institute, Baltimore, MD, USA
| | - Kasra Cheraqpour
- Department of Eye Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Catherine Green
- Glaucoma Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - Mohammad Moin
- Department of Ophthalmology, Amee ud Din Medical College, Lahore, Pakistan
| | - N Venkatesh Prajna
- Department of Cornea and Refractive Eye Services, Aravind Eye Hospital, Madurai, India
| | - Karl C Golnik
- Department of Ophthalmology, University of Cincinnati, The Cincinnati Eye Institute, Cincinnati, OH, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins Medical Institute, Baltimore, MD, USA
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Abstract
PURPOSE OF REVIEW In this review, we focus on artificial intelligence (AI) algorithms for diabetic retinopathy (DR) screening and risk stratification and factors to consider when implementing AI algorithms in the clinic. RECENT FINDINGS AI algorithms have been adopted, and have received regulatory approval, for automated detection of referable DR with clinically acceptable diagnostic performance. While these metrics are an important first step, performance metrics that go beyond measures of technical accuracy are needed to fully evaluate the impact of AI algorithm on patient outcomes. Recent advances in AI present an exciting opportunity to improve patient care. Using DR as an example, we have reviewed factors to consider in the implementation of AI algorithms in real-world clinical practice. These include real-world evaluation of safety, efficacy, and equity (bias); impact on patient outcomes; ethical, logistical, and regulatory factors.
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Affiliation(s)
- Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Heba Mahjoub
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nitish Mehta
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | - Amitha Domalpally
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA
| | - Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
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Hogerheyde T, Walsh LJ, Zafar S. Decontamination practices of paediatric crowns: a systematic review. Eur Arch Paediatr Dent 2022; 23:527-535. [PMID: 35608756 PMCID: PMC9338143 DOI: 10.1007/s40368-022-00714-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
Abstract
Purpose A systematic review was conducted into paediatric crown decontamination practices using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Method After database retrieval using predefined search terms, two reviewers independently applied the selection criteria, extracted the data, and assessed for risk of bias. From 92 potentially eligible studies, 10 were included for analysis. Results Steam sterilisation (autoclaving) was used as the gold standard for reducing biological contaminants on paediatric crowns across in vivo studies. However, autoclaving was associated with microstructural changes such as crazing and contour alterations. Furthermore, several tooth coloured crowns were liable to undergo colour changes from steam sterilisation. Conclusion Ambiguous manufacturer guidelines on protocols for reprocessing and reuse after biological exposure raises concerns regarding cross contamination and leaves practitioners open to potential litigation. A better understanding of the compatibility of paediatric crowns and decontamination practices is needed. More research into alternative chairside technologies that use low temperature, such as hydrogen peroxide gas plasma sterilisation, is warranted.
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Affiliation(s)
- T Hogerheyde
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, Brisbane, QLD, 4006, Australia
| | - L J Walsh
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, Brisbane, QLD, 4006, Australia
| | - S Zafar
- School of Dentistry, The University of Queensland, 288 Herston Road, Herston, Brisbane, QLD, 4006, Australia.
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O'Malley M, Zafar S, Wolff T, Gaspar R. Re: medical imaging call centre: a communication success story. A reply. Clin Radiol 2022; 77:558-559. [PMID: 35487780 DOI: 10.1016/j.crad.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022]
Affiliation(s)
- M O'Malley
- University of Toronto, Canada. Martin.O'
| | - S Zafar
- University of Toronto, Canada
| | - T Wolff
- University of Toronto, Canada
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Abaid S, Zafar S, Kruger E, Tennant M. Size estimation of unerupted canines and premolars using various independent variables: a systematic review. J Orofac Orthop 2022; 84:164-177. [PMID: 35420320 DOI: 10.1007/s00056-022-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 02/24/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Prediction of unerupted permanent teeth is an essential part of orthodontic diagnosis and treatment planning. This prediction is done by mixed dentition space analysis based on the estimation of mesiodistal dimensions of unerupted permanent canine and premolars from already erupted permanent teeth. Permanent mandibular incisors are most commonly used for prediction. Recent literature reveals that mandibular incisors are not accurate predictors and other independent variables have been introduced to make a more accurate and precise prediction. The objective of this paper was to evaluate the literature in light of a variety of independent variables and their predictive accuracy. METHODS Electronic databases such as MEDLINE, PubMed, Scopus, Embase, Web of Science, CINAHL Plus were searched to identify articles published until September 2021. RESULTS The search resulted in a total of 1098 articles, of which 24 papers met our inclusion criteria and were included in this review. Articles using permanent mandibular incisors only as a predictor were excluded during the eligibility assessment. The results show that various independent variables including mesiodistal and vestibulo-oral dimensions of permanent maxillary and mandibular incisors and molars, molar basal arch length, intermolar distance, maxillary and mandibular arch and gender have been used as predictors to more accurately determine mesiodistal width of unerupted canine and premolars in different populations. CONCLUSION Ethnic tooth size variations strongly emphasize the need to determine which independent variable gives a more accurate prediction of unerupted permanent teeth to develop a population-specific prediction model. This will play a significant role in managing space problems and developing malocclusions.
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Affiliation(s)
- S Abaid
- School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Perth, WA, Australia.
| | - S Zafar
- School of Dentistry, The University of Queensland, Herston, Australia
| | - E Kruger
- School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Perth, WA, Australia
| | - M Tennant
- School of Human Sciences, The University of Western Australia, 35 Stirling Highway, Crawley, 6009, Perth, WA, Australia
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Borhany M, Abid M, Zafar S, Zaidi U, Munzir S, Shamsi T. Thrombocytopenia in Pregnancy: Identification and Management at a Reference Center in Pakistan. Cureus 2022; 14:e23490. [PMID: 35475097 PMCID: PMC9035312 DOI: 10.7759/cureus.23490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: The study aimed to evaluate the causes of thrombocytopenia in pregnancy and its management along with the outcome in the COVID-19 era. Methods: Recruitment for this prospective, cross-sectional observational study of thrombocytopenia in pregnancy (platelet counts <100x109/L) was done from January 2017 to August 2020 at the National Institute of Blood Diseases (NIBD) after taking the patients’ informed consent. Complete clinical and lab profile of patients was also collected. Results: A total of 150 pregnant women with thrombocytopenia were enrolled, with the mean age being 27.3±4.64 years. Mean platelet counts at baseline were 48.0±24. Main clinical manifestations at baseline included: anemia 65.9%, bruises 23.25%, and edema 9.3%. Causes of thrombocytopenia were gestational thrombocytopenia (GT) 72 (48%), acute fatty liver five (3.3%), pre-eclampsia in 11 (7.3%), and eclampsia seven (4.6%). Causes not specific to pregnancy included 30 (20%) cases of ITP, hepatitis C, and nutritional deficiency was reported in nine (6%) patients each. 72/150 received supportive care treatment to manage thrombocytopenia and were closely monitored and given supplements. Twenty (66.6%) ITP patients received treatment with steroids, with complete response in 70% of them seen. Overall, 38 (25.3%) women with bleeding symptoms and platelet count <50x109/L received platelet transfusions. Conclusion: The study shows that pre-eclampsia and eclampsia are serious conditions with a high risk for complications, while GT is a benign and the most common cause of thrombocytopenia in pregnancy which requires no active treatment. The other causes such as ITP and infections require individualized management.
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Ahmad M, Zhao J, Iftikhar M, Canner JK, Rajaii F, Mahoney N, Zafar S, Woreta F. Epidemiologic Trends in Oculoplastics-Related Emergency Department Visits in the United States, 2006-2015. Ophthalmic Plast Reconstr Surg 2022; 38:199-206. [PMID: 34380999 DOI: 10.1097/iop.0000000000002047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To characterize demographics and trends in oculoplastics-related emergency department (ED) visits. METHODS The authors conducted a retrospective, multiyear study of the nationwide ED sample database. The nationwide ED sample was queried for oculoplastics-related International Classification of Disease-ninth revision codes identified from a comprehensive list and categorized based on anatomic location, urgency, and trauma status. Demographics, clinical characteristics, procedure requirement, and cost data were analyzed. Variables associated with inpatient admission were assessed using univariate and multivariate logistic regression. RESULTS The authors identified an estimated 4.2 million ED visits in the United States with oculoplastics-related primary diagnoses, of which pathology was 80.8% eyelid/adnexal, 17.4% orbital, and 1.74% lacrimal. Overall, 31.3% of the visits were deemed to be nonurgent. Orbital pathology was more likely to be caused by trauma (70.6%), to be urgent (98.0%), and to require a procedure (45.6%) (p < 0.001). While less than 5% of all patients required hospitalization, predictors for inpatient admission were urgent diagnoses (odds ratio, 14.9; CI, 13.7-16.1), presentation to a level 1 trauma center (odds ratio, 3.19; CI, 2.7-3.79), and presence of orbital pathology (odds ratio, 6.09; CI 5.73-6.47). Incidence of ED visits decreased in all categories; however, total inflation-adjusted charges increased. CONCLUSIONS Over half of oculoplastics-related ED visits are for trauma, with orbital pathology being less common but requiring a high level of care. Although trends show a potentially decreasing incidence of oculoplastics-related ED visits, increasing costs and high proportion of nonurgent visits pose an opportunity for mitigating periocular trauma and increasing outpatient access to care, respectively.
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Affiliation(s)
- Meleha Ahmad
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Tian J, Lim JJJ, Moh FKC, Siddiqi A, Zachar J, Zafar S. Parental and training coaches' knowledge and attitude towards dental trauma management of children. Aust Dent J 2022; 67 Suppl 1:S31-S40. [PMID: 35510930 PMCID: PMC9790494 DOI: 10.1111/adj.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to evaluate parental and training coaches' knowledge and attitude towards traumatic dental injuries (TDIs) among children. MATERIAL AND METHODS A 31-item questionnaire was distributed to the parents and training coaches attending local sporting clubs in Brisbane region, Australia. The questionnaire consisted of five parts (i) demographic and professional information; (ii) TDIs in the primary dentition; (iii) fractures and subluxation of permanent teeth (iv) avulsion of permanent teeth, and (v) information and knowledge related to the management of traumatized teeth. The jamovi (Version 1.6.3) and GraphPad Prism were used for data analysis. RESULTS A total of 233 participants were surveyed, 211 parents and 22 coaches. Of all types of injuries, parental knowledge of managing avulsion to permanent teeth was poorest (9.5%), followed by management of injuries of primary teeth (17.5%) and management of fractures or subluxation of permanent teeth (29.4%). Parents in health care occupations had higher satisfaction on self-knowledge in managing TDIs however there was no significant difference in knowledge levels between health care personnel and other professions (P = 0.128). There was a discrepancy between the lack of knowledge and willingness to further self-educate with online platforms being the preferred medium. CONCLUSION The study showed a gap in parents' and training coaches' knowledge regarding the management of TDIs among children.
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Affiliation(s)
- J Tian
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - JJJ Lim
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - FKC Moh
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - A Siddiqi
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia,School of Dentistry and Oral HealthGriffith UniversitySouthportQueenslandAustralia
| | - J Zachar
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
| | - S Zafar
- School of DentistryThe University of QueenslandBrisbaneQueenslandAustralia
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Patel J, Khalil M, Zafar S. Hyperkinetic Choreiform Movements Secondary to Basal Ganglia Calcification and Underlying Developmental Venous Anomaly. Cureus 2022; 14:e22752. [PMID: 35371891 PMCID: PMC8971109 DOI: 10.7759/cureus.22752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 12/03/2022] Open
Abstract
Chorea is irregular, involuntary movements that are associated with a variety of conditions and can encompass a wide differential. Unilateral hyperkinetic choreiform movements represent a rare subset characterized by the acute and sudden onset of progressive, uncontrollable body movements. We present a patient presenting with left-sided arm and leg arrhythmic movements caused by right-sided basal ganglia calcifications associated with an underlying developmental venous anomaly (DVA). To the author’s knowledge, this is only the second reported case of such a presentation, and it should be on the differential in patients presenting with unilateral movement abnormalities.
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Din F, Mellor F, Millard T, Pace E, Khan N, Attygalle AD, Cunningham D, Zafar S, Sharma B. Radiology of Castleman disease: the pivotal role of imaging in diagnosis, staging, and response assessment of this rare entity. Clin Radiol 2022; 77:399-408. [PMID: 35177229 DOI: 10.1016/j.crad.2022.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/12/2022] [Indexed: 11/16/2022]
Abstract
Castleman Disease (CD) is a rare entity that typically presents as an enhancing nodal mass in the mediastinum or head and neck region on computed tomography (CT). It may manifest as unicentric or multicentric regions of lymph node enlargement. A key clinical issue in the context of CD is delayed diagnosis, which contributes adversely to patient outcome, given that accurate diagnosis facilitates earlier treatment of this curable disease. This article will address relevant imaging aspects, with reference to typical and atypical imaging features of CD, illustrated using examples from our specialist centre; the imaging journey for patients with CD; and will provide practical pointers to radiologists in differentiating CD from other benign and malignant causes of enhancing lymphadenopathy, including lymphoma and neoplastic adenopathy. We will also review current classification tools and staging challenges with reference to World Health Organization guidelines, International Working Group guidelines as well as the Lugano classification. Finally, we will discuss the potential role of additional imaging techniques in CD, highlighting novel imaging methods and expanded utilities from our specialist centre.
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Affiliation(s)
- F Din
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - F Mellor
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - T Millard
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - E Pace
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - N Khan
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - A D Attygalle
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - D Cunningham
- The Lymphoma Unit, The Royal Marsden NHS Trust, London, UK
| | - S Zafar
- Department of Radiology, The Royal Marsden NHS Trust, London, UK
| | - B Sharma
- Department of Radiology, The Royal Marsden NHS Trust, London, UK.
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Menard M, Shah YS, Stroh IG, Zafar S, Sriparna M, Zhang N, Agarwal AA, Shekhawat N, Srikumaran D, Woreta F. Microbial Profile and Clinical Outcomes of Fungal Keratitis at a Single-Center Tertiary Care Hospital. Clin Ophthalmol 2022; 16:389-399. [PMID: 35177897 PMCID: PMC8846617 DOI: 10.2147/opth.s346227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/01/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate baseline characteristics, microbiological spectrum, management, and outcomes of patients with culture-proven fungal keratitis. METHODS Retrospective review of all patients with culture-proven fungal keratitis seen over 6 years at a tertiary referral center. RESULTS The present study included 62 eyes from 62 patients. Infection with filamentous organisms was more common than with yeast (66.1% vs 27.4%). The most common filamentous organisms were Fusarium (17.7%) and Aspergillus (16.1%), while the most common yeast was Candida (24.2%). The main predisposing factor for filamentous keratitis was contact lens use. Yeast keratitis is most associated with an immunocompromised host and ocular surface disease. Corneal perforation (20.0%) and surgical interventions (46.8%) were common, with 27.4% of eyes requiring at least one penetrating keratoplasty. Filamentous keratitis is more likely than yeast keratitis to require urgent penetrating keratoplasty or enucleation and to receive more than one topical and systemic antifungal agent. Visual outcomes were poor with nearly half of the eyes remaining at 20/200 or worse upon resolution of infection. Worse visual outcomes were associated with poor vision at presentation and a history of ocular surface disease. Antifungal susceptibility testing was not routinely performed, but it demonstrated a relatively high minimum inhibitory concentration for at least one antifungal drug in 90% of cases when performed (16.1%) and guided the direction of treatment for 80% of the cases. CONCLUSION Fungal keratitis is visually devastating. Infections with filamentous fungi predominated over yeast and were generally treated more aggressively both medically and surgically. Filamentous and yeast keratitis had similar durations of infections and visual outcomes. Antifungal susceptibility testing influenced treatment in 80% of cases in which it was performed.
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Affiliation(s)
| | - Yesha S Shah
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Inna G Stroh
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manjari Sriparna
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Zhang
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ank A Agarwal
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nakul Shekhawat
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika Woreta
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,Correspondence: Fasika Woreta, Division of Cornea and External Disease, Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Wilmer B20, Baltimore, MD, 21287, USA, Tel +410 955-5650, Email
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Hassam UA, Gulzar A, Rasool B, Zafar S, Younis T, Shakeel M, Khan D, Ullah S, Khaliq S, Ahmad SF, Hafeez M. Efficacy of Citrullus colocynthis seed extract on Earias vittella, Fabricius, (Lepidoptera: Noctuidae): environment sustainable approach. BRAZ J BIOL 2022; 84:e254479. [DOI: 10.1590/1519-6984.254479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/25/2021] [Indexed: 11/22/2022] Open
Abstract
Abstract Earias vittellaFabricius, 1794 (Noctuidae: Lepidoptera) is deliberated to be one of the most destructive pests of cotton and okra vegetation in the world including Asia. The pest has established resistance to various synthetic insecticides. The use of bio-pesticide is one of the unconventional approaches to develop a vigorous ecosystem without harming non- target pests and beneficial natural insect fauna. In the present study, the toxicity levels of Citrullus colocynthis seed extract have been evaluated against the populations of E. vittellaunder standardized laboratory conditions. The toxic effects of C. colocynthis on development periods, protein contents and esterase activity of the life stages of E. vittella were also evaluated. The toxicity levels of methanol, ethanol, hexane, water and profenofos were evaluated on the 1st instar larvae of E. vittella. LC30 and LC80 concentrations exhibited the effectiveness of methanol-based C. colocynthis seed extract against 1st instar larvae of E. vitella. The enhanced larval and pupal periods were revealed in treated samples during the comparison with untreated samples. The intrinsic rate of increase, net reproductive rate in the LC30 and LC80 concentrations exposed larvae remained less than the control treatment. Fecundity, the esterase activity and protein contents were declined in LC30 and LC80 treated samples as compared to the control. The present findings suggest that C. colosynthis extracts based botanical insecticides are beneficial, ecosystem sustainable and can be integrated with insect management programs from environment safety perspective.
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Affiliation(s)
- U. A. Hassam
- Pir-Meher Ali Shah Arid Agriculture University, Pakistan
| | - A. Gulzar
- Pir-Meher Ali Shah Arid Agriculture University, Pakistan
| | - B. Rasool
- Government College University Faisalabad, Pakistan
| | - S. Zafar
- University of Education, Pakistan
| | - T. Younis
- Government College University Faisalabad, Pakistan
| | - M. Shakeel
- Pakistan Agricultural Research Council, Pakistan
| | - D. Khan
- Pir-Meher Ali Shah Arid Agriculture University, Pakistan
| | - S. Ullah
- Pir-Meher Ali Shah Arid Agriculture University, Pakistan
| | - S. Khaliq
- Pir-Meher Ali Shah Arid Agriculture University, Pakistan
| | - S. F. Ahmad
- Pir-Meher Ali Shah Arid Agriculture University, Pakistan
| | - M. Hafeez
- Zhejiang Academy of Agricultural Sciences, China
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Zafar S, Wolff T, Gaspar R, O'Malley M. Medical imaging call centre: a communication success story. Clin Radiol 2021; 77:188-194. [PMID: 34916046 DOI: 10.1016/j.crad.2021.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Abstract
AIM To evaluate utilisation of a medical imaging call centre (MICC) at a multi-site, academic radiology department, focusing on communication of critical, urgent, or significant unexpected findings. MATERIALS AND METHODS Institutional research ethics board approval was obtained. All calls made to MICC from 1 January to 31 December 2019 were reviewed retrospectively. The total number of calls, date, and reason of each call, level of report alert, and turnaround time (TAT) were recorded. Level 1, 2, and 3 alerts were defined as "potentially life-threatening new/unexpected findings", "could result in morbidity/mortality", or "not immediately life-threatening or urgent", respectively. TAT was defined as the time from alert request received by the MICC until acknowledgement of receipt by the referring physician, with a desired TAT of 60 min, 3 h, and 3 days for each level, respectively. RESULTS The MICC received 29,799 calls in 2019, on average 2,483 (range 1,989-3,098) calls per month. The most common indications for contacting the MICC were to request imaging reports to be expedited (14,916 calls, 50%) and issuing report alerts to communicate unexpected or urgent findings (7,060 calls, 24%). Average number and range of calls for Level 1, 2, and 3 alerts were 57 (39-80), 345 (307-388), and 187 (127-215) per month, respectively. Average TAT for Level 1, 2, and 3 report alerts were 59 min, 2 h 26 min, and 19 h 39 min, respectively. CONCLUSION The MICC received a large volume of calls and was a successful method for timely communication of unexpected or urgent imaging findings using a three-tiered alert system.
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Affiliation(s)
- S Zafar
- Joint Department of Medical Imaging, University of Toronto, Canada
| | - T Wolff
- Joint Department of Medical Imaging, University of Toronto, Canada
| | - R Gaspar
- Joint Department of Medical Imaging, University of Toronto, Canada
| | - M O'Malley
- Joint Department of Medical Imaging, University of Toronto, Canada. martin.o'
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Shah YS, Stroh IG, Zafar S, Zhang N, Sriparna M, Shekhawat N, Ghos Z, Srikumaran D, Woreta FA. Delayed diagnoses of Acanthamoeba keratitis at a tertiary care medical centre. Acta Ophthalmol 2021; 99:916-921. [PMID: 33583148 DOI: 10.1111/aos.14792] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 01/22/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the prevalence and reasons for delays in diagnosis in patients with Acanthamoeba keratitis (AK) presenting to Wilmer Eye Institute, Baltimore, Maryland. METHODS This retrospective study analysed all patients with culture-positive AK seen between 2012 and 2019 at a tertiary referral centre. Patient demographic information, clinical history, risk factors, symptom duration, referral patterns, slit lamp examination findings, visual acuity and need for surgery were collected. RESULTS The study included 45 eyes of 43 patients. On average, patients were symptomatic for 52.6 days before culture collection. Thirty-one percent of patients were diagnosed within 28 days of symptom onset while 69% were diagnosed after 28 days. Before presentation to a tertiary care centre, 69% of patients were evaluated by an ophthalmologist outside of this institution and 27% were evaluated by a provider other than an ophthalmologist. AK was most commonly misdiagnosed as herpetic keratitis, occurring in 38% of patients. The strongest risk factor for AK was contact lens use. Only 11% of patients presented with the classic ring infiltrate and 82% had pain. Patients with an early versus late diagnosis had a mean Snellen visual acuity (VA) of 20/224 versus 20/296 at presentation (p = 0.33) and a mean Snellen VA of 20/91 versus 20/240 at final visit (p = 0.07). 11% of patients required a therapeutic penetrating keratoplasty. CONCLUSION Delayed diagnosis of AK in our cohort occurred due to a misdiagnosis as herpetic keratitis, non-specific clinical signs including the lack of pain in a number of patients, and a delay in referral to a tertiary care centre. Any contact lens wearer with an atypical keratitis should be referred promptly for Acanthamoeba cultures.
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Affiliation(s)
- Yesha S Shah
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Inna G Stroh
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nancy Zhang
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Manjari Sriparna
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nakul Shekhawat
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zara Ghos
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Division of Cornea and External Disease, Department of Ophthalmology, The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zafar S, Wolff A. M225 A RARE CASE OF EOSINOPHILIC GASTROENTERITIS. Ann Allergy Asthma Immunol 2021. [DOI: 10.1016/j.anai.2021.08.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shah YS, Fliotsos MJ, Alaqeel A, Boland MV, Zafar S, Srikumaran D, Woreta FA. Use of Teleophthalmology for Evaluation of Ophthalmic Emergencies by Ophthalmology Residents in the Emergency Department. Telemed J E Health 2021; 28:858-864. [PMID: 34619063 DOI: 10.1089/tmj.2021.0334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Utilizing telemedicine is one approach to reduce the ever-increasing burden of patients on emergency departments (EDs) and consulting physicians. Utilization of telemedicine services in the ED may also benefit resident education. Materials and Methods: Ten first-year ophthalmology residents were trained to use a Topcon 3D Optical Coherence Tomography (OCT)-1 Maestro to capture OCT images and fundus photos in patients presenting to the ED with urgent ophthalmic concerns. Findings were communicated to the supervising ophthalmologist. Retrospective chart review was conducted to obtain patient characteristics and final ophthalmologist diagnosis. Residents rated ease of use, technical reliability, and educational value through a survey. Results: From December 1, 2019, to December 1, 2020, the device was used in 109 patient encounters, capturing 887 images (average 8.1 images per encounter). Patients on whom the device was used were on average 48.5 years old (±17.2, range 17-90) and 59.6% were female. The imaging device was utilized most commonly for evaluating papilledema (n = 21, 18.6%), new-onset visual acuity/visual field defects (n = 12, 10.6%), retinal detachment/tear (n = 8, 7.1%), and ophthalmic trauma workup (n = 8, 7.1%). Eight residents completed the survey and most (n = 7) agreed or strongly agreed that the device helped them diagnose patients more accurately. Technical issues such as machine malfunction, image artifacts, and problems syncing with the electronic health record and computer were noted by survey respondents. Conclusions: The most common use of teleophthalmology in the ED setting was evaluation of papilledema; the majority of residents perceived an educational benefit from this tool. Efforts should be made to address the technical challenges to increase the utility of this device.
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Affiliation(s)
- Yesha S Shah
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J Fliotsos
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Abdulaziz Alaqeel
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael V Boland
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Sidra Zafar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fasika A Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Tsou B, Fliotsos M, Zafar S, Smith K, Johnson P, Schein O, Woreta F. 380 Evaluating the Use of Advanced Neuroimaging in the Emergency Department for Ocular Complaints. Ann Emerg Med 2021. [DOI: 10.1016/j.annemergmed.2021.09.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chen X, Marsh JD, Zafar S, Gerber EE, Guyton DL. Increasing incidence and risk factors for divergence insufficiency esotropia. J AAPOS 2021; 25:278.e1-278.e6. [PMID: 34582959 DOI: 10.1016/j.jaapos.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/16/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To document the increasing incidence of divergence insufficiency (DI) esotropia and to identify risk factors for DI. METHODS All patients with a diagnosis of esotropia seen by one provider (DLG) over 41 years were identified from the medical record. Patients with onset of strabismus before age 10 years or with prior strabismus surgery were excluded. Cases of esotropia associated with thyroid eye disease, scleral buckles, trauma, neurological diseases, or atypical misalignment were included but not labeled as DI regardless of the distance versus near deviation. The remaining patients, whatever the original diagnosis, were retrospectively categorized as having, or not having, DI, using a uniform criterion: distance esotropia ≥5Δ more than near esotropia. RESULTS The percentage of DI patients among acquired esotropia patients increased significantly between the first and second half of the 41-year period, from 11.8% to 29.4% (P < 0.001). Multivariate logistic regression identified advancing age and the use of progressive addition lenses as risk factors for the development of DI. CONCLUSIONS The incidence of DI is increasing. DI's association with age and progressive addition lenses may help us to understand its etiology and to decrease the prevalence of this condition in the future.
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Affiliation(s)
- Xinyi Chen
- The Zanvyl Krieger Children's Eye Center at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Justin D Marsh
- The Zanvyl Krieger Children's Eye Center at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sidra Zafar
- The Zanvyl Krieger Children's Eye Center at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth E Gerber
- The Zanvyl Krieger Children's Eye Center at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David L Guyton
- The Zanvyl Krieger Children's Eye Center at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Channa R, Lee K, Staggers KA, Mehta N, Zafar S, Gao J, Frankfort BJ, Chua SYL, Khawaja AP, Foster PJ, Patel PJ, Minard CG, Amos C, Abramoff MD. Detecting retinal neurodegeneration in people with diabetes: Findings from the UK Biobank. PLoS One 2021; 16:e0257836. [PMID: 34587216 PMCID: PMC8480885 DOI: 10.1371/journal.pone.0257836] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/11/2021] [Indexed: 01/23/2023] Open
Abstract
Importance Efforts are underway to incorporate retinal neurodegeneration in the diabetic retinopathy severity scale. However, there is no established measure to quantify diabetic retinal neurodegeneration (DRN). Objective We compared total retinal, macular retinal nerve fiber layer (mRNFL) and ganglion cell-inner plexiform layer (GC-IPL) thickness among participants with and without diabetes (DM) in a population-based cohort. Design/setting/participants Cross-sectional analysis, using the UK Biobank data resource. Separate general linear mixed models (GLMM) were created using DM and glycated hemoglobin as predictor variables for retinal thickness. Sub-analyses included comparing thickness measurements for patients with no/mild diabetic retinopathy (DR) and evaluating factors associated with retinal thickness in participants with and without diabetes. Factors found to be significantly associated with DM or thickness were included in a multiple GLMM. Exposure Diagnosis of DM was determined via self-report of diagnosis, medication use, DM-related complications or glycated hemoglobin level of ≥ 6.5%. Main outcomes and measures Total retinal, mRNFL and GC-IPL thickness. Results 74,422 participants (69,985 with no DM; 4,437 with DM) were included. Median age was 59 years, 46% were men and 92% were white. Participants with DM had lower total retinal thickness (-4.57 μm, 95% CI: -5.00, -4.14; p<0.001), GC-IPL thickness (-1.73 μm, 95% CI: -1.86, -1.59; p<0.001) and mRNFL thickness (-0.68 μm, 95% CI: -0.81, -0.54; p<0.001) compared to those without DM. After adjusting for co-variates, in the GLMM, total retinal thickness was 1.99 um lower (95% CI: -2.47, -1.50; p<0.001) and GC-IPL was 1.02 μm lower (95% CI: -1.18, -0.87; p<0.001) among those with DM compared to without. mRNFL was no longer significantly different (p = 0.369). GC-IPL remained significantly lower, after adjusting for co-variates, among those with DM compared to those without DM when including only participants with no/mild DR (-0.80 μm, 95% CI: -0.98, -0.62; p<0.001). Total retinal thickness decreased 0.40 μm (95% CI: -0.61, -0.20; p<0.001), mRNFL thickness increased 0.20 μm (95% CI: 0.14, 0.27; p<0.001) and GC-IPL decreased 0.26 μm (95% CI: -0.33, -0.20; p<0.001) per unit increase in A1c after adjusting for co-variates. Among participants with diabetes, age, DR grade, ethnicity, body mass index, glaucoma, spherical equivalent, and visual acuity were significantly associated with GC-IPL thickness. Conclusion GC-IPL was thinner among participants with DM, compared to without DM. This difference persisted after adjusting for confounding variables and when considering only those with no/mild DR. This confirms that GC-IPL thinning occurs early in DM and can serve as a useful marker of DRN.
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Affiliation(s)
- Roomasa Channa
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, United States of America
- * E-mail:
| | - Kyungmoo Lee
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States of America
| | - Kristen A. Staggers
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Nitish Mehta
- New York University, New York, NY, United States of America
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, United States of America
| | - Jie Gao
- Department of Ophthalmology, Baylor College of Medicine, Houston, TX, United States of America
| | - Benjamin J. Frankfort
- Department of Ophthalmology and Neurosciences, Baylor College of Medicine, Houston, TX, United States of America
| | - Sharon Y. L. Chua
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Anthony P. Khawaja
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Paul J. Foster
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Praveen J. Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust & UCL Institute of Ophthalmology, London, United Kingdom
| | - Charles G. Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Chris Amos
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Michael D. Abramoff
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States of America
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Zafar S, Dun C, Srikumaran D, Wang P, Schein OD, Makary M, Woreta F. Endophthalmitis Rates among Medicare Beneficiaries Undergoing Cataract Surgery between 2011 and 2019. Ophthalmology 2021; 129:250-257. [PMID: 34537285 DOI: 10.1016/j.ophtha.2021.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/21/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To determine national incidence and risk factors associated with developing endophthalmitis after cataract surgery in the United States. DESIGN Retrospective, cross-sectional analysis. PARTICIPANTS Medicare beneficiaries aged ≥65 years undergoing cataract surgery between 2011 and 2019. METHODS Medicare claims were used to identify all patients who underwent ≥1 cataract surgery between 2011 and 2019. Endophthalmitis cases within 90 days of the cataract surgery were identified using diagnostic codes. Patients with a history of endophthalmitis 12 months before their cataract surgery procedure were excluded. Annual and aggregate 9-year incidences were determined for all cataract surgeries and for stand-alone cataract procedures. A stepwise multivariable logistic regression model using generalized estimating equations was used to evaluate factors associated with occurrence of postoperative endophthalmitis. MAIN OUTCOME MEASURES The 90-day postoperative endophthalmitis rate and patient risk factors associated with onset of endophthalmitis after cataract surgery. RESULTS A total of 14 396 438 cataract surgeries were performed among Medicare beneficiaries between 2011 and 2019. The overall 90-day postoperative endophthalmitis rate was 1.36 per 1000 cataract surgeries for all cataract procedures and 1.30 per 1000 cataract surgeries for stand-alone cataract procedures. A decreasing trend was noted for postoperative endophthalmitis rates during the 9-year study period. On multivariable analysis, the risk of endophthalmitis after cataract surgery was increased for cases performed among those aged ≥75 years versus those aged <75 years (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.11-1.18), Blacks (OR, 1.13; 95% CI, 1.07-1.20), Native Americans (OR, 1.43; 95% CI, 1.19-1.73), and eyes with any history of invasive glaucoma surgery (OR, 1.40; 95% CI, 1.18-1.65). Cataract cases combined with retinal surgery (OR, 2.60; 95% CI, 2.15-3.16) and those performed when the Charlson Comorbidity Index (CCI) was greater than 0 also had an increased likelihood of developing endophthalmitis. The risk of endophthalmitis was lower for cases performed on women versus men (OR, 0.89; 95% CI, 0.86-0.92). CONCLUSIONS The overall 90-day postoperative endophthalmitis rate after cataract surgery was 1.36 per 1000 cataract surgeries between 2011 and 2019. Patient age, gender, race, and CCI were associated with risk of endophthalmitis.
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Affiliation(s)
- Sidra Zafar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chen Dun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peiqi Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oliver D Schein
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Martin Makary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Fasika Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Ijaz MU, Majeed SA, Asharaf A, Ali T, Al-Ghanim KA, Asad F, Zafar S, Ismail M, Samad A, Ahmed Z, Al-Misned F, Riaz MN, Mahboob S. Toxicological effects of thimerosal on rat kidney: a histological and biochemical study. BRAZ J BIOL 2021; 83:e242942. [PMID: 34468508 DOI: 10.1590/1519-6984.242942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/17/2021] [Indexed: 11/21/2022] Open
Abstract
Thimerosal is an organomercurial compound, which is used in the preparation of intramuscular immunoglobulin, antivenoms, tattoo inks, skin test antigens, nasal products, ophthalmic drops, and vaccines as a preservative. In most of animal species and humans, the kidney is one of the main sites for mercurial compounds deposition and target organs for toxicity. So, the current research was intended to assess the thimerosal induced nephrotoxicity in male rats. Twenty-four adult male albino rats were categorized into four groups. The first group was a control group. Rats of Group-II, Group-III, and Group-IV were administered with 0.5µg/kg, 10µg/kg, and 50µg/kg of thimerosal once a day, respectively. Thimerosal administration significantly decreased the activities of catalase (CAT), superoxide dismutase (SOD), peroxidase (POD), glutathione reductase (GR), glutathione (GSH), and protein content while increased the thiobarbituric acid reactive substances (TBARS) and hydrogen peroxide (H2O2) levels dose-dependently. Blood urea nitrogen (BUN), creatinine, urobilinogen, urinary proteins, kidney injury molecule-1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) levels were substantially increased. In contrast, urinary albumin and creatinine clearance was reduced dose-dependently in thimerosal treated groups. The results demonstrated that thimerosal significantly increased the inflammation indicators including nuclear factor kappaB (NF-κB), tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6) levels and cyclooxygenase-2 (COX-2) activities, DNA and histopathological damages dose-dependently. So, the present findings ascertained that thimerosal exerted nephrotoxicity in male albino rats.
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Affiliation(s)
- M U Ijaz
- University of Agriculture, Department of Zoology, Wildlife and Fisheries, Faisalabad, Pakistan
| | - S A Majeed
- University of Agriculture, Department of Zoology, Wildlife and Fisheries, Faisalabad, Pakistan
| | - A Asharaf
- Government College University, Department of Zoology, Faisalabad, Pakistan
| | - T Ali
- Government College University, Department of Zoology, Faisalabad, Pakistan
| | - K A Al-Ghanim
- King Saud University, Department of Zoology, College of Science, Riyadh, Saudi Arabia
| | - F Asad
- Government College University, Department of Zoology, Faisalabad, Pakistan
| | - S Zafar
- Government College University, Department of Zoology, Faisalabad, Pakistan
| | - M Ismail
- Government College University, Department of Zoology, Faisalabad, Pakistan
| | - A Samad
- University of Agriculture, Department of Zoology, Wildlife and Fisheries, Faisalabad, Pakistan
| | - Z Ahmed
- Government College University, Department of Zoology, Faisalabad, Pakistan
| | - F Al-Misned
- King Saud University, Department of Zoology, College of Science, Riyadh, Saudi Arabia
| | - M N Riaz
- Texas A&M University, AMU, Brazos, Texas, United States of America
| | - S Mahboob
- King Saud University, Department of Zoology, College of Science, Riyadh, Saudi Arabia
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Burton E, Arsiwala LT, Johnson TV, Srikumaran D, Zafar S, Woreta FA. Applicant Characteristics Associated with Glaucoma Fellowship Match from 2010 to 2017. Ophthalmol Glaucoma 2021; 5:233-240. [PMID: 34455134 DOI: 10.1016/j.ogla.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To describe trends in the glaucoma fellowship match results, glaucoma applicant characteristics, and applicant characteristics associated with matching. DESIGN Retrospective study. PARTICIPANTS Ophthalmology fellowship applicants participating in the San Francisco (SF) Match between 2010 and 2017. METHODS De-identified, individual applicant data provided by the San Francisco (SF) Match were used to describe glaucoma fellowship match trends and applicant characteristics between 2010 and 2017. Publicly available, conglomerate SF Match data were used to determine trends in the number of programs participating in the glaucoma fellowship match, as well as the number of positions offered and filled from 2014 to 2019. All trends analyses were performed using linear regression models on log-transformed response variables. Summary statistics for applicants who matched in glaucoma were compared with those who did not match. A multivariable logistic regression model was used to evaluate factors associated with matching in glaucoma fellowship. MAIN OUTCOME MEASURES Fellowship match status (matched in glaucoma vs. did not match in any ophthalmology subspecialty). RESULTS From 2010 to 2019, the number of matched glaucoma fellowship applicants increased from 54 to 77 (mean 3.3% per year, P = 0.001), and the proportion of applicants to any ophthalmology fellowship who matched in glaucoma increased from 13% to 15.5% (mean, 3% per year; P = 0.041). Compared with applicants who did not match in any specialty between 2010 and 2017, matched glaucoma applicants were more likely to have graduated from a top 10 residency program (10.7% vs. 4.5%, P < 0.001), U.S. medical school (93.1% vs. 39.1%, P < 0.001), or U.S. residency program (95.0% vs. 42.2%, P < 0.001), and complete more interviews (9 vs. 1, P < 0.001). After controlling for potential covariates, factors associated with increased odds of matching in glaucoma included graduating from a U.S. residency program (odds ratio [OR], 9.91; 95% confidence interval [CI], 5.45-18.03), applying to fewer programs (OR, 0.91; 95% CI, 0.88-0.93), and completing a greater number of interviews (OR, 1.49; CI, 1.39-1.60). United States Medical Licensing Examination (USMLE) Step scores were not associated with matching in glaucoma. CONCLUSIONS The number of applicants who matched in glaucoma fellowship increased from 2010 to 2019. Factors associated with matching in glaucoma were graduating from a U.S. residency program and completing more interviews.
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Affiliation(s)
- Eleanor Burton
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lubaina T Arsiwala
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas V Johnson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Mgboji GE, Woreta FA, Fliotsos MJ, Zafar S, Ssekasanvu J, Srikumaran D, Zhao J, Buccino DL, Regan L. Prevalence of incivility between ophthalmology and emergency medicine residents during interdepartmental consultations. AEM Educ Train 2021; 5:e10653. [PMID: 34522830 PMCID: PMC8427183 DOI: 10.1002/aet2.10653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Since incivility is linked to adverse effects in patient care and health care worker well-being, evaluation of the prevalence of incivility during the formative years of residency training is warranted. The aim of this study was to determine the perceived presence and degree of incivility between emergency medicine (EM) and ophthalmology residents during emergency department (ED) consultations. METHODS We conducted a single-site, survey-based study, targeted to ophthalmology and EM residents. The survey we distributed included questions adapted from validated and widely used surveys measuring incivility in the workplace (Workplace Incivility Scale) and incivility within the ED. RESULTS Ophthalmology (13/15, 86.7%) and EM (42/48, 87.5%) residents participated, with an overall response rate of 55 of 63 (87.3%). Most residents (47/55, 85.5%) reported some degree of incivility during consultations, with a greater proportion of females reporting incivility (100%) than males (77.4%, p = 0.033). A total of 52.7% of respondents reported occurrence of incivility on a quarterly basis; 21.8% reported monthly, 10.9% weekly, and none daily. Incivilities were reported most commonly during nonurgent consults (85.5%). The two most common incivilities reported by trainees were when the other party paid little attention to their statements or opinions (80% of residents) or doubted their professional judgment (74.5% of residents). More female trainees reported jokes being told at their expense compared to males (15.8% vs. 0%, p = 0.049). Residents most often attributed incivility to stress (78.2%), loss of empathy/burnout (63.6%), or attempts to shift responsibility to another party (60.0%). Among EM residents surveyed, incivility was identified as occurring most often during consultations with surgical specialties. CONCLUSIONS Incivility during interdepartmental consultations between EM and ophthalmology is commonly reported by physicians-in-training. It occurs more often during consultations deemed as nonurgent and is more commonly reported by females. Given its associations with adverse outcomes, interventions to decrease incivility early in training may be warranted.
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Affiliation(s)
| | - Fasika A. Woreta
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Sidra Zafar
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Joseph Ssekasanvu
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Divya Srikumaran
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Jiawei Zhao
- Wilmer Eye InstituteJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Daniel L. Buccino
- Department of PsychiatryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Linda Regan
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Zafar S, Nazir M, Sabah A, Jurcut AD. Securing Bio-Cyber Interface for the Internet of Bio-Nano Things using Particle Swarm Optimization and Artificial Neural Networks based parameter profiling. Comput Biol Med 2021; 136:104707. [PMID: 34375900 DOI: 10.1016/j.compbiomed.2021.104707] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/08/2021] [Accepted: 07/24/2021] [Indexed: 11/15/2022]
Abstract
Internet of bio-nano things (IoBNT) is a novel communication paradigm where tiny, biocompatible and non-intrusive devices collect and sense biological signals from the environment and send them to data centers for processing through the internet. The concept of the IoBNT has stemmed from the combination of synthetic biology and nanotechnology tools which enable the fabrication of biological computing devices called Bio-nano things. Bio-nano things are nanoscale (1-100 nm) devices that are ideal for in vivo applications, where non-intrusive devices can reach hard-to-access areas of the human body (such as deep inside the tissue) to collect biological information. Bio-nano things work collaboratively in the form of a network called nanonetwork. The interconnection of the biological world and the cyber world of the Internet is made possible by a powerful hybrid device called Bio Cyber Interface. Bio Cyber Interface translates biochemical signals from in-body nanonetworks into electromagnetic signals and vice versa. Bio Cyber Interface can be designed using several technologies. In this paper, we have selected bio field-effect transistor (BioFET) technology, due to its characteristics of being fast, low-cost, and simple The main concern in this work is the security of IoBNT, which must be the preliminary requirement, especially for healthcare applications of IoBNT. Once the human body is accessible through the Internet, there is always a chance that it will be done with malicious intent. To address the issue of security in IoBNT, we propose a framework that utilizes Particle Swarm Optimization (PSO) algorithm to optimize Artificial Neural Networks (ANN) and to detect anomalous activities in the IoBNT transmission. Our proposed PSO-based ANN model was tested for the simulated dataset of BioFET based Bio Cyber Interface communication features. The results show an improved accuracy of 98.9% when compared with Adam based optimization function.
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Affiliation(s)
- Sidra Zafar
- Department of Computer Science, Lahore College for Women University, Lahore, 54000, Punjab, Pakistan.
| | - Mohsin Nazir
- Department of Computer Science, Lahore College for Women University, Lahore, 54000, Punjab, Pakistan.
| | - Aneeqa Sabah
- Department of Physics, Lahore College for Women University, Lahore, 54000, Punjab, Pakistan.
| | - Anca Delia Jurcut
- School of Computer Science, University College Dublin, Dublin, Dublin 4, Ireland.
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