General physicians' perspectives on SGLT2 inhibitors for heart failure.

BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are novel agents for heart failure (HF) and are now recommended in guidelines. Understanding general physicians' perspectives can help to optimise utilisation of this new medication. AIM: To understand the clinical concerns and barriers from general physicians about prescribing SGLT2is in a general medicine cohort. METHODS: A questionnaire exploring clinicians' experience, comfort level and barriers to prescribing SGLT2is in patients with HF, incorporating two clinical scenarios, was disseminated to Internal Medicine Society of Australia and New Zealand members over a 2-month period. RESULTS: Ninety-eight participants responded to the questionnaire (10.8% response rate). Most respondents (66.3%) were senior medical staff. Most participants worked in metropolitan settings (64.3%) and in public hospital settings (83.7%). For HF with reduced ejection fraction, 23.5% of participants reported prescribing SGLT2is frequently (defined as prescribing SGLT2is frequently over 75% of occasions). For HF with preserved ejection fraction, 57.1% of participants reported prescribing SGLT2is less than 25% of the time. Almost half of the participants (44%) expressed a high level of familiarity with therapeutic knowledge of SGLT2is, while 47% indicated high familiarity with potential side effects. Patient complexity, cost of medications and discontinuity of care were identified as important barriers. Euglycemic diabetic ketoacidosis was the side effect that caused the most hesitancy to prescribe SGLT2is in 48% of the respondents. CONCLUSION: General physicians in Australia and Aotearoa New Zealand are familiar with the therapeutic knowledge and side effects of SGLT2is. Patient complexity, medication cost and discontinuity of care were significant barriers to the use of SGLT2is for HF among general physicians.

Ultrasound biomicroscopy in scleritis.

OBJECTIVE: This study aimed to investigate the usefulness of ultrasound biomicroscopy (UBM) for detecting and following up scleritis and episcleritis. DESIGN: The study design was a case series. PARTICIPANTS: Patients with scleral inflammatory diseases (n = 16) were examined. INTERVENTION: Patient-reported problems and slit-lamp and UBM (50-MHz transducer) findings were compared retrospectively for signs of scleral inflammation. MAIN OUTCOME MEASURES: Thickness, reflectivity, and homogeneity of the sclera and episclera were the criteria for discriminating between the different types of scleritis with the UBM technique. RESULTS: Scleral disease was associated with Wegener disease (n = 3), Cogan disease (n = 1), Hashimoto thyroiditis (n = 1), myositis (n = 1), or panuveitis (n = 1). Initial slit-lamp evaluation showed episcleritis (n = 3), diffuse scleritis (n = 9), nodular scleritis (n = 3), or necrotizing scleritis (n = 1). By means of UBM analysis, the diagnosis of episcleritis or scleritis was in agreement with the slit-lamp findings in 2 of 3 and 6 of 13 cases, respectively. In contrast to the slit-lamp diagnosis, UBM studies excluded scleritis in one patient, disclosed necrosis in four patients with scleritis, and detected nodular scleritis patterns in two further patients with diffuse scleritis. The determination of complete remission, improvement, or progression of disease by slit-lamp and UBM evaluation was in agreement in 11 of the 14 patients examined. However, UBM was superior to slit-lamp examination with respect to detecting scleral necrosis, scleral thinning, or the nodular type of scleritis. CONCLUSIONS: The findings indicate that UBM is helpful in rapidly differentiating scleritis from severe episcleritis, detecting the diverse scleritis types with high accuracy, disclosing minimal disease progression, and judging treatment efficacy.

[Pterygium excision with intra-operative administration of low dosage mitomycin C]. / Pterygiumexzision mit intraoperativer Applikation von niedrig dosiertem Mitomycin C.

Pterygium excision with postoperative instillation of mitoymcin C (MMC, 0.4 mg/ml) is encouraging because of the technical simplicity and low recurrence rates, but serious postoperative complications have been described (scleral necrosis, corneal perforation, glaucoma, cataract). The authors studied the efficacy and safety of pterygium excisions with a single intraoperative application of low-dose MMC (0.2 mg/ml). Pterygium excision (bare sclera technique) was performed in 18 patients with primary or recurrent pterygia. MMC (0.2 mg/ml) was applied intraoperatively (5 min) to the exposed sclera. Patients were followed up for signs of recurrence and complications. There were four recurrences (mean follow-up 13.8 months). Postoperative complications consisted of granuloma formation (n = 2). Delayed conjunctival healing was observed in all cases. Scleral necrosis, corneal complications, cataract, or glaucoma were not seen. Intraoperative application of MMC apparently reduces the recurrence rate after pterygium excision. The use of a 0.2 mg/ml concentration of MMC appears to be safe.

The inability of a diabetogenic virus to induce diabetes mellitus in athymic (nude) mice.

The effect of a known diabetogenic M-strain encephalomyocarditis (EMC)-virus in athymic nude mice (lacking the thymus-dependent lymphocyte system), and in heteroxygous littermates and homozygous normal mice of the background strain (C57/B16) was investigated. While by 3 weeks 4 out of 4 surviving virus-inoculated littermates and 9 out of 9 inoculated normal mice developed diabetes mellitus, none of the 7 surviving virus-inoculated nude mice became diabetic. Virus was isolated from all inoculated animals, including non-diabetic nude mice. It is concluded that it is the response of the thymus-dependent lymphocyte system evoked by the virus rather than the virus itself that leads to damage to the insulin producing cell.