The Royal College of Paediatrics and Child Health Retinopathy of Prematurity Screening Guidelines (2022): a series of treated infants falling outside the updated criteria.

BACKGROUND/OBJECTIVES: Screening for retinopathy of prematurity (ROP) is a core healthcare intervention in premature babies to avoid preventable sight loss. A variety of screening criteria are in place globally for this purpose. The Royal College of Paediatrics and Child Health recently updated the United Kingdom ROP screening guidelines (March 2022). A key change was the reduction in the gestational age (GA) to warrant retinal screening (from 32 to 31 weeks). SUBJECTS/METHODS: In the course of informal national surveillance during guideline development (2017-2022) and soon after, babies under our care falling outside the updated screening criteria who underwent treatment for ROP were identified. A retrospective case review was carried out. RESULTS: Six babies were identified as having undergone screening and treatment, prior to implementation of the new guidance. Screening and treatment would have been forfeited as per the March 2022 guidelines. All six had numerous systemic risk factors for developing ROP. Specifically, all had documented poor postnatal weight gain. CONCLUSIONS: We present this case series to bring forth an urgent discussion amongst key stakeholders as to whether the new guidance, as it stands, is safe and fit for purpose.

A Case of Morning Glory Disc Associated With Unilateral Retinopathy of Prematurity.

Morning glory disc anomaly is associated with serous retinal detachments, high refractive errors, amblyopia, and strabismus. There have been limited reports of an association between morning glory disc and peripheral retinal non-perfusion. The authors report a case of unilateral morning glory disc anomaly associated with markedly asymmetric retinopathy of prematurity. [J Pediatr Ophthalmol Strabismus. 2022;59(5):e55-e57.].

Ultra-low-dose intravitreal bevacizumab for the treatment of retinopathy of prematurity: a case series.

BACKGROUND: Intravitreal bevacizumab (IVB) has emerged as an effective treatment modality for the management of retinopathy of prematurity (ROP) where the disease is severe and posterior. Despite evidence of systemic vascular endothelial growth factor suppression and concerns about how this might affect the developing neonate, the optimal dose is unknown to date. We report our experience of using ultra-low-dose (0.16 mg) IVB, one-quarter of the 'standard' dose that has widely been reported in the treatment of ROP. METHODS: A retrospective observational case series of consecutive infants who underwent ultra-low-dose IVB injection for the management of ROP at a regional neonatal intensive care unit in the North East of England, between November 2013 and August 2016. RESULTS: 29 eyes of 15 infants underwent IVB injection. We defined 'treatment success' as complete regression of retinopathy and vascularisation into (or laser ablation of) zone 3. Primary success (in response to IVB 0.16 mg alone) was observed in 23/29 eyes (79.3%). Secondary success (where additional treatment was required) was observed in 27/29 eyes (93.1%). One infant died of respiratory disease during follow-up. Retreatment occurred in 6/29 eyes (20.6%). Retreatments occurred at a mean of 9.8 weeks after initial IVB (range 6-15) and at a mean of 44 weeks postmenstrual age (range 40-50). CONCLUSION: 0.16 mg IVB is effective in the treatment of severe and posterior ROP, with no adverse ocular outcomes occurring in our series.

Corneal endothelial dysfunction in Pearson syndrome.

Mitochondrial disorders are associated with well recognized ocular manifestations. Pearson syndrome is an often fatal, multisystem, mitochondrial disorder that causes variable bone marrow, hepatic, renal and pancreatic exocrine dysfunction. Phenotypic progression of ocular disease in a 12-year-old male with Pearson syndrome is described. This case illustrates phenotypic drift from Pearson syndrome to Kearns-Sayre syndrome given the patient's longevity. Persistent corneal endothelial failure was noted in addition to ptosis, chronic external ophthalmoplegia and mid-peripheral pigmentary retinopathy. We propose that corneal edema resulting from corneal endothelial metabolic pump failure occurs within a spectrum of mitochondrial disorders.

Laser-assisted lipolysis: a review.

BACKGROUND: In the United States, liposuction is the most commonly performed cosmetic surgical procedure. Laser lipolysis is the latest adjunct to liposuction. This technique employs laser energy to induce lipolysis and hemostasis and stimulate neocollagenesis. Multiple laser systems have been studied. METHODS: PubMed literature search with the key words laser lipolysis and laser assisted liposuction. Original articles that studied the internal application of laser energy to adipose tissue were reviewed and included. RESULTS: Nineteen manuscripts were reviewed. One double-blind randomized controlled trial compared laser liposuction with tumescent liposuction. Several authors claimed that laser lipolysis offers fewer side effects than "traditional" liposuction performed under general anesthesia. A true objective comparison with tumescent liposuction is missing in the literature. LIMITATIONS: Comparison studies between laser-assisted lipolysis and conventional liposuction are limited, as are comparisons between the different laser systems and wavelengths. Standardization of laser energy settings is lacking. CONCLUSION: Laser-assisted lipolysis is a safe and efficacious procedure that may possess advantages over conventional liposuction. Lipolysis occurs in a dose-response relationship. No advantage over tumescent liposuction has been demonstrated. A specific laser wavelength may prove superior for each clinical application, but more studies are needed.

Immunostaining in Mohs micrographic surgery: a review.

BACKGROUND: With the advent of incorporating the immunoperoxidase staining technique into the processing of frozen tissue, the use of Mohs micrographic surgery (MMS) has been expanded to include several high-risk tumors such as lentigo maligna, malignant melanoma, and dermatofibrosarcoma protuberans. OBJECTIVES: To thoroughly review the English medical literature pertaining to the use of immunohistochemical staining techniques on frozen sections during MMS and to summarize the basic relevant outcomes from the different relevant studies. MATERIALS AND METHODS: Medline search was conducted, with the following words used in the search criteria: "Mohs surgery,""staining,""immunostaining," and "immunoperoxidase." RESULTS Generally, all immunostains showed advantage over the traditional hematoxylin and eosin approach. Studies of MART-1 in melanoma chemosurgery indicated that it is typically crisp and has less background staining than MEL-5 and better staining consistency than HMB-45. In cases of desmoplastic melanomas, S100 is the stain of choice. CONCLUSION: Immunostaining offers an advantage in MMS. Large, randomized, prospective studies comparing the different immunostains are still lacking in the literature. The authors have indicated no significant interest with commercial supporters.

Electron microscopy study of peripheral nerves in the uvulae of snorers and obstructive sleep apnoea patients.

HYPOTHESIS: The pathophysiology of snoring and obstructive sleep apnoea is still unclear. Two theories are proposed. The first is the obstructive theory, which postulates palatopharyngeal muscle hypertrophy leading to airway narrowing; there is no neural role. The second is the neurogenic theory, which postulates neural degeneration due to vibratory stretch trauma, leading to muscle atrophy and collapse. As identification of nerve fibres in the uvula and palate is difficult and time-consuming, all previous studies aiming to differentiate between these two theories have been based on indirect observation of the muscles, rather than direct study of the nerves. METHODS: We conducted a prospective study to directly observe and study nerve fibres in uvular specimens from 10 cases of obstructive sleep apnoea, compared with specimens from 10 cases of simple snoring, using transmission electron microscopy. Five autopsy cases served as controls. RESULTS: Obstructive sleep apnoea was associated with definite degenerative changes in myelinated and unmyelinated nerve endings. These degenerative changes were present to a lesser degree and in a smaller proportion of cases of simple snoring. CONCLUSION: The events postulated by the neurogenic theory of obstructive sleep apnoea appear to play an important role in the pathophysiology of snoring and obstructive sleep apnoea.

Acrodermatitis paraneoplastica responding to topical PUVA treatment.

Acrodermatitis paraneoplastica is a rare paraneoplastic entity that has been associated with multiple neoplasms, most commonly squamous cell carcinoma of the aerodigestive tract. Therapies have focused on treatment of the underlying carcinoma. We report a case of acrodermatitis paraneoplastica successfully treated with PUVA therapy.

Surgical outcome for removal of subfoveal choroidal neovascular membranes in children.

OBJECTIVE: To asses the surgical outcome of subfoveal choroidal neovascular membranes in children. METHODS: Two eyes with Best disease and one with idiopathic subfoveal choroidal neovascular membrane underwent vitrectomy and extraction of the subfoveal neovascular membrane. RESULTS: All the three eyes had significant improvement in their visual acuity and there was no recurrence of choroidal neovascular membrane. CONCLUSION: Surgical removal of subfoveal choroidal neovascular membrane in children carries good visual prognosis in selected cases.

Enhanced flavour formation by combination of selected lactococci from industrial and artisanal origin with focus on completion of a metabolic pathway.

Combinations of lactococcal strains from various origins with divers properties were developed as new starters for new dairy products. Flavour formation by such tailor-made cultures was studied. In some cases, a strongly enhanced flavour was observed. For instance, the combination of B1157 and SK110 strains in milk resulted in a very strong chocolate-like flavour. B1157 produces only a moderate chocolate-like flavour, whereas SK110 alone fails to produce this flavour. Headspace gas chromatography results corroborate the organoleptic evaluations. High levels of branched-chain aldehydes were found when B1157 and SK110 were grown together. The enzyme activities involved in this pathway were studied; both strains contain transaminase activity. Although B1157 had a very high amino acid decarboxylating activity, its release of amino acids from milk protein was limited. SK110 was strongly limited in decarboxylating activity, although this strain is very active in proteolysis. By combining these strains, the substrates released by SK110 can directly be used by the other strain, resulting in the completion of the whole flavour-formation pathway. This opens new avenues for the preparation of tailor-made cultures.

Short-course norfloxacin and trimethoprim-sulfamethoxazole treatment of shigellosis and salmonellosis in Egypt.

In a double-blind clinical study, 109 adult Egyptian patients infected with Shigella spp. and 45 infected with Salmonella spp. were randomly assigned to three treatment groups: 1) norfloxacin in a single 800-mg dose, 2) norfloxacin, 400 mg twice a day for three days, and 3) trimethoprim (160 mg)-sulfamethoxazole (800 mg) (TMP-SMX), twice a day for three days. Among Shigella-infected patients, diarrheal symptoms had resolved in 86-97% and bacteriologic failure (repeat positive stool culture) occurred in only two patients five days after the start of the three treatment regimens. Among Salmonella-infected patients, diarrheal symptoms had resolved in 76-82% of patients and bacteriologic failure was common (18-36%) five days after the start of therapy. These data indicate that short-course therapy with either norfloxacin or TMP-SMX can be effectively used to treat shigellosis in adults in developing countries. However, for uncomplicated Salmonella spp. infection, short-course therapy with norfloxacin and TMP-SMX may not lead to a rapid resolution of symptoms or consistently eliminate this enteropathogen.