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Gibbons AB, Eberhart C, Li E. Older Woman With Proptosis, Ptosis, and Blurred Vision. JAMA Ophthalmol 2024; 142:262-263. [PMID: 38270967 DOI: 10.1001/jamaophthalmol.2023.6035] [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: 01/26/2024]
Abstract
A woman in her early 70s with a history of coronary artery disease, hypertension, and colon polyps presented to oculoplastic surgery with 1 week of progressive right-sided proptosis, headache, right eyelid ptosis, and blurry vision. Outside magnetic resonance imaging demonstrated an infiltrative mass involving right greater than left orbital apices, the right optic nerve, and right extraocular muscles. What would you do next?
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Affiliation(s)
- Alison B Gibbons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Charles Eberhart
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Emily Li
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Gibbons AB, Niknahad A, Bacorn C, Halawa O, Li E. Subperiosteal and Orbital Abscesses: A Comparison of Clinical Features, Management, and Outcomes. Ophthalmic Plast Reconstr Surg 2024; 40:161-166. [PMID: 37581883 DOI: 10.1097/iop.0000000000002495] [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: 08/16/2023]
Abstract
PURPOSE To compare the clinical features, management, and outcomes between orbital cellulitis patients with subperiosteal abscess (SPA) and those with orbital abscess (OA). METHODS A retrospective study was conducted at a tertiary care center through medical record search to identify patients with orbital cellulitis from January 1, 2000 to December 31, 2022. Charts were screened for those with radiographic evidence of SPA or OA. Demographic data and presenting clinical features were compared between the 2 cohorts. Primary outcomes compared included rates of surgical intervention, reoperation, and readmission; and length of hospital stay and final vision. RESULTS A total of 189 patients, 162 with SPA and 27 with OA, met the criteria. The OA group (mean 46.5 ± 18.6 years) was older than the SPA group (mean 19.1 ± 21.4 years). Comorbid sinusitis was significantly more common in the SPA cohort (95.7% SPA; 70.4% OA; p < 0.001), while OA was more likely to occur with orbital trauma (29.6% vs. 8.0%; p = 0.003), implanted hardware (11.1% vs. 0.6%; p = 0.005), and comorbid diabetes (22.2% vs. 4.3%; p = 0.001). OA patients more often presented with a relative afferent pupillary defect (21.7% vs. 3.9%; p = 0.005), vision worse than 20 of 50 (42.3% vs. 16.2%; p = 0.005), and methicillin-resistant Staphylococcus aureus infection (20.8% vs. 5.8%; p = 0.036). OA was associated with a higher reoperation rate (47.8% vs. 21.3%; p = 0.019), readmission rate (18.5% vs. 5.6%, p = 0.047), and limited extraocular motility at follow-up (4.3% vs. 25%; p = 0.013); while mean length of hospital stay and final visual acuity were similar. CONCLUSION OA may affect an older population with a divergent risk factor profile compared with SPA. OA may cause more severe functional impairment on presentation, warranting more aggressive management to achieve visual outcomes similar to SPA.
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Affiliation(s)
- Alison B Gibbons
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ava Niknahad
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Colin Bacorn
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Omar Halawa
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
| | - Emily Li
- The Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, U.S.A
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Gibbons AB, Huang P, Sklar M, Kim P, Henderson AD. Evaluation of a STAT MRI Protocol for Emergent Ophthalmology Patients. J Neuroophthalmol 2023:00041327-990000000-00521. [PMID: 38051953 DOI: 10.1097/wno.0000000000002053] [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: 12/07/2023]
Abstract
BACKGROUND Evaluating patients with potentially sight-threatening conditions frequently involves urgent neuroimaging, and some providers recommend expediting emergency department (ED) evaluation. However, several factors may limit the practicality of ED evaluation. This pilot study assessed the feasibility and safety of a STAT magnetic resonance imaging (MRI) protocol, designed to facilitate outpatient MRI within 48 hours of referral, compared with ED evaluation for patients with optic disc edema. METHODS A retrospective chart review was performed. Demographics, clinical data, and baseline ophthalmic measures were compared between patients in STAT and ED groups using the t test or Fisher exact test. Multivariate analyses compared changes in visual acuity (VA), visual field mean deviation (VF MD), retinal nerve fiber layer thickness, and edema grade between presentation and follow-up using a mixed-effects model adjusting for age, sex, and baseline measures. RESULTS A total of 70 patients met the study criteria-24 (34.3%) in the STAT MRI cohort and 46 (65.7%) in the ED cohort. Demographic variables were similar between groups. Patients referred to the ED had worse VA ( P < 0.001), larger VF MD ( P < 0.001), and higher edema grade ( P = 0.002) at presentation. Four patients in the ED group and none in the STAT group were found to have space-occupying lesions. Multivariate analyses showed that follow-up measures were significantly associated with their baseline values (all P < 0.001) but not with referral protocol (all P > 0.099). The STAT MRI protocol was associated with lower average patient charges and hospital costs. CONCLUSIONS The STAT MRI protocol did not result in inferior visual outcomes or delay in life-threatening diagnoses. Urgent outpatient evaluation, rather than ED referral, seems safe for some patients with optic disc edema. These findings support continued utilization of the protocol and ongoing improvement efforts.
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Affiliation(s)
- Alison B Gibbons
- Wilmer Eye Institute (ABG, MS, PK, ADH), Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology (PH), Johns Hopkins University School of Medicine, Baltimore, Maryland; and Department of Ophthalmology (PK), University of San Diego Health, San Diego, California
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Gibbons AB, Niknahad A, Bacorn C, Li E. Microbiology and Antibiotic Resistance Profiles of Orbital Subperiosteal Abscesses: A Comparison of Pediatric, Adolescent, and Adult Populations. Ophthalmic Plast Reconstr Surg 2023; 39:583-587. [PMID: 37195825 DOI: 10.1097/iop.0000000000002408] [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: 05/19/2023]
Abstract
PURPOSE The purpose of this study was to compare the microbiology and antibiotic resistance profiles of orbital subperiosteal abscesses (SPA) among 3 age cohorts. METHODS A retrospective study was conducted at a tertiary care center through a medical record search to identify patients with orbital cellulitis and SPA on imaging from January 1, 2000 to September 10, 2022. Patients were categorized into pediatric (<9 years old), adolescent (9-18 years old), and adult (>18 years old) cohorts. Primary outcomes included culture and antibiotic susceptibility results. Secondary outcomes included antibiotic therapy and surgical intervention. RESULTS Of the 153 SPA patients included, 62 (40.5%) were in the pediatric cohort (4 months-8 years, mean 5.0 ± 2.7), 51 (33.3%) were adolescent (9-18 years, 12.7 ± 2.8), and 40 (26.1%) were adult (19-95, 51.8 ± 19.3). Viridians group Streptococci were the most frequent organisms isolated across groups. The anaerobic infection rate was higher in the adult compared to the pediatric group (23.0% vs, 4.0%, p = 0.017), while that of the adolescent did not differ significantly from either. Pediatric patients carried a lower rate of clindamycin resistance than adolescent and adult cohorts, who shared similar rates (0 vs. 27.0% and 28.0%, respectively; p = 0.016). There were progressive increases in duration of intravenous antibiotic therapy ( p < 0.195) and rate of surgical intervention ( p < 0.001) going from younger to older cohorts. CONCLUSION Organisms isolated from orbital SPA from the past 2 decades demonstrate a predominance of Streptococcal species. Older age may be associated with anaerobic infection, clindamycin resistance, and more aggressive management. Adolescent infections are more similar to adult rather than pediatric counterparts but may require less aggressive management than the former.
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Affiliation(s)
- Alison B Gibbons
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Gibbons AB, Farmer C, Shaw JS, Chung JY. Examining the factor structure of the DSM-5 Level 1 cross-cutting symptom measure. Int J Methods Psychiatr Res 2022:e1953. [PMID: 36318494 DOI: 10.1002/mpr.1953] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/12/2022] [Accepted: 10/07/2022] [Indexed: 02/28/2023] Open
Abstract
OBJECTIVES The DSM-5 Level 1 Cross-Cutting Symptom Measure (DSM-XC) was developed by the American Psychiatric Association as a transdiagnostic mental health symptom survey. Despite its promise as a screening tool, few studies have assessed its latent dimensionality or provided guidance on interpreting responses. We examined the factor structure of the DSM-XC in a convenience sample of participants with varying degrees of psychopathology. METHODS Participants (n = 3533) were enrolled in an online study on the mental health impact of COVID-19 (NCT04339790). We used a factor analytic framework with exploratory and confirmatory analyses to evaluate candidate factor solutions. Convergent validity analysis with concurrent study measures was also performed. RESULTS Six-factor and bifactor candidate solutions both had good fit and full measurement invariance across age, sex, and enrollment date. The six-factor solution resulted in constructs labeled as: mood, worry, activation, somatic, thought, and substance use. A general psychopathology factor and two residual factors (mood and anxiety constructs) explained the variance of the bifactor solution. CONCLUSIONS Our analysis supports that the DSM-XC is a multidimensional instrument spanning many mental health symptoms. We provide scoring solutions for two factor structures that capture broader constructs of psychopathology. Use of a convenience sample may limit generalizability of findings.
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Affiliation(s)
- Alison B Gibbons
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland, USA
| | - Cristan Farmer
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland, USA
| | - Jacob S Shaw
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland, USA
| | - Joyce Y Chung
- National Institute of Mental Health, Office of the Clinical Director, Bethesda, Maryland, USA
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Abstract
Although many people think of aggression as a negative or undesirable emotion, it is a normal part of many species' repertoire of social behaviors. Purposeful and controlled aggression can be adaptive in that it warns other individuals of perceived breaches in social contracts with the goal of dispersing conflict before it escalates into violence. Aggression becomes maladaptive, however, when it escalates inappropriately or impulsively into violence. Despite ample data demonstrating that impulsive aggression and violence occurs in both men and women, aggression has historically been considered a uniquely masculine trait. As a result, the vast majority of studies attempting to model social aggression in animals, particularly those aimed at understanding the neural underpinnings of aggression, have been conducted in male rodents. In this review, we summarize the state of the literature on the neurobiology of social aggression in female rodents, including social context, hormonal regulation and neural sites of aggression regulation. Our goal is to put historical research in the context of new research, emphasizing studies using ecologically valid methods and modern sophisticated techniques. This article is part of the Special Issue entitled 'Current status of the neurobiology of aggression and impulsivity'.
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Affiliation(s)
- Laura E Been
- Department of Psychology, Haverford College, Haverford, PA, 19041, USA.
| | - Alison B Gibbons
- Department of Psychology, Haverford College, Haverford, PA, 19041, USA
| | - Robert L Meisel
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, 55455, USA
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Abstract
A case of a multilocular cyst in a sixty-three-year-old woman is reported. The cyst was located in the hilum of a kidney and was distorted but did not involve the renal pelvis or parenchyma. Although unique in location, it fulfilled all the criteria for a multilocular renal cyst.
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