Trends and patterns in fatal US motorcycle crashes, 2000-2016.

Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics. Methods: We used the Fatality Analysis Reporting System (FARS) database (2000-2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000-2001 and 2007-2008, as well as 2009-2010 and 2015-2016. Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines-before and after the economic recession in 2008-2009. The overall fatality rate ratio between 2000-2001 and 2007-2008 was 1.60 [95% Confidence Interval (CI): 1.51-1.70], and between 2009-2010 and 2015-2016 was 1.09 (95% CI: 1.02-1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18-29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey. Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.

Bilateral acute angle-closure glaucoma following treatment with topiramate for headache.

INTRODUCTION: This case report adds supportive evidence to the development of acute angle-closure glaucoma (AACG), a rare but serious adverse effect following the use of topiramate (TPM) for a severe headache. CASE REPORT: A 25-year-old female reported with severe headache, suspected to be migraine, and was started on TPM 25 mg/day on the first day. However, she presented at the emergency clinic of a hospital with sudden blurring of vision and colored halos 5 days after stopping the drug, i.e., day 8. She was subjected to ophthalmic examination and was diagnosed with AACG. The intraocular pressure (IOP) was found to be elevated and she was hence started on acetazolamide 500 mg instantly, maintained on tablet acetazolamide 250 mg four times a day (QID), pilocarpine 2% eye drops QID, travoprost 0.004% once a day (OD), and dorzolamide 2% eye drops three times a day (TID). After a week's treatment, there was rapid improvement with return of IOP to normal. CONCLUSION: TPM-induced AACG is a rare serious adverse event leading to blindness but is preventable, when diagnosed early and by instituting appropriate treatment.