LONG-TERM OUTCOMES OF SUTURELESS INTRASCLERAL INTRAOCULAR LENS FIXATION IN CHILDREN AND ADULTS: Single-Surgeon Case Series With and Without Haptic Flanging With Up to 11 Years of Follow-Up.

PURPOSE: Report and compare long-term outcomes and complications of sutureless scleral tunnel (SST) and flanged haptic (FH) scleral-fixated intraocular lens, with spontaneous intraocular lens (IOL) dislocation as primary outcome measure. METHODS: Retrospective single-surgeon case series of 95 SST and 458 FH eyes from 2011 to 2022 (553 total eyes). Demographics, surgical indications, ocular history, visual acuity, and complication rates were collected. RESULTS: Reoperation-requiring spontaneous IOL dislocation rate was significantly different ( P = 0.0167) between FH (3.7%) and SST (10.5%). Mean follow-up was 3.31 ± 0.30 versus 1.58 ± 0.07 years for SST and FH, respectively. There was no significant difference between preoperative (20/305 vs. 20/300) or final postoperative (20/77 vs. 20/62) visual acuity. Other complications included any cystoid macular edema (20.0% vs. 25.3%), elevated intraocular pressure (16.8% vs. 9.6%), IOL tilt requiring reoperation (5.3 vs. 0%), haptic exposure (2.1% vs. 3.3%), and reverse pupillary block (4.2% vs. 1.1%). CONCLUSION: Haptic flanging resulted in fewer eyes meeting the primary end point of IOL dislocation. We reported the longest-to-date follow-up of both nonflanged SST IOL fixation and our FH-modified Yamane technique. Our FH-modified Yamane technique represents a safe, durable, and potentially superior option for scleral-fixated intraocular lens.

Intraocular Methotrexate for the Treatment and Prevention of Proliferative Vitreoretinopathy: A Review.

Purpose: To review the current literature on the use of intravitreal methotrexate (IVT MTX) for the treatment and prevention of proliferative vitreoretinopathy (PVR). Methods: All reports of IVT MTX to treat and prevent PVR published in PubMed, Google Scholar, and EBSCOhost were reviewed. The relevant current studies are included in this report. Results: The literature search yielded 32 articles describing the use of MTX in PVR. These included preclinical studies, 1 case report, and several case series. Early studies found that IVT MTX is a promising medication for the treatment and prevention of PVR. MTX works as a potent anti-inflammatory agent through a new mechanism of action different from that of other medications for use in PVR. Few side effects have been reported and were mostly limited to mild reversible corneal keratopathy. There are 2 current ongoing randomized controlled clinical trials to further evaluate the efficacy of MTX for PVR. Conclusions: MTX is a safe and potentially efficacious medication for the treatment and prevention of PVR. Additional clinical trials are needed to further establish this effect.

Intravitreal Rituximab-Associated Retinal Occlusive Vasculitis.

Purpose: To describe a 90-year-old patient who was referred to a private retina specialist with gradually worsening vision and floaters in the left eye. Methods: A retrospective case report is presented. Results: The patient was treated with intravitreal rituximab injections for intraocular lymphoma with resulting vision loss to the level of hand motions from severe granulomatous uveitis and retinal occlusive vasculitis. Conclusions: Retinal occlusive vasculopathy secondary to rituximab intravitreal injections is a rare clinical entity with only a single previous case reported in the literature. However, there are reports of systemic vasculitis after systemic administration of rituximab. Clinicians should be aware of the possibility of ocular hypertension, granulomatous anterior uveitis, and/or retinal occlusive vasculitis after intravitreal rituximab use. Consideration should be given to the inflammatory risk of rituximab intravitreal injections to reduce the potential for treatment-induced vision loss.

Advances in Ophthalmic Epigenetics and Implications for Epigenetic Therapies: A Review.

The epigenome represents a vast molecular apparatus that writes, reads, and erases chemical modifications to the DNA and histone code without changing the DNA base-pair sequence itself. Recent advances in molecular sequencing technology have revealed that epigenetic chromatin marks directly mediate critical events in retinal development, aging, and degeneration. Epigenetic signaling regulates retinal progenitor (RPC) cell cycle exit during retinal laminar development, giving rise to retinal ganglion cells (RGCs), amacrine cells, horizontal cells, bipolar cells, photoreceptors, and Müller glia. Age-related epigenetic changes such as DNA methylation in the retina and optic nerve are accelerated in pathogenic conditions such as glaucoma and macular degeneration, but reversing these epigenetic marks may represent a novel therapeutic target. Epigenetic writers also integrate environmental signals such as hypoxia, inflammation, and hyperglycemia in complex retinal conditions such as diabetic retinopathy (DR) and choroidal neovascularization (CNV). Histone deacetylase (HDAC) inhibitors protect against apoptosis and photoreceptor degeneration in animal models of retinitis pigmentosa (RP). The epigenome represents an intriguing therapeutic target for age-, genetic-, and neovascular-related retinal diseases, though more work is needed before advancement to clinical trials.

Social networks, perceived social support, and HbA1c in individuals with type 2 diabetes mellitus in urban Ghana.

OBJECTIVES: Although links between social relationships and health are well established, few studies have concurrently examined the effects of compositional, structural, and functional dimensions of social networks on glycemic (HbA1c) control in low- and middle-income countries such as Ghana. In these settings where informal social relationships are critical for access to resources, evaluating the links between social network characteristics, social support, and glycemic control may provide clarity about important relationships that facilitate the well-being of individuals with type 2 diabetes mellitus (T2DM). DESIGN: In 2018, we conducted a hospital-based, cross-sectional survey of noninstitutionalized adults with T2DM in Ghana. Using data from 247 study participants, multivariable linear regression models were used to estimate associations between: 1) HbA1c and three social network characteristics (kin composition, household composition, and network density); 2) social support and the three social network characteristics; and 3) HbA1c and social support. We also examined gender differences in these associations and applied mediation techniques to determine if network characteristics operated through social support to affect HbA1c. RESULTS: Findings indicated that higher kin composition and higher household composition were each significantly associated with increased social support. Neither social support nor social network characteristics were significantly related to HbA1c, and there were no gender differences in any of these associations. CONCLUSION: Although family and household members were identified as important sources of social support for diabetes management, the ways in which they influence HbA1c control among Ghanaians require further investigation. Future studies can examine whether changes in social support over time, social support satisfaction, or other dimensions of social relationships improve T2DM outcomes in countries like Ghana.

Rickettsia rickettsii infection as an unusual cause of pediatric retinitis: A case report.

Purpose: To report a case of infectious pediatric retinitis attributed to Rocky Mountain spotted fever which is rarely reported in the United States. Observations: A previously healthy 14-year-old male return traveler from Mexico was admitted to the pediatric ICU with septic shock and a diffuse rash. He subsequently complained of blurry vision and was found to have evidence of retinitis on exam. Infectious workup revealed high titers of rickettsial IgM and IgG antibodies. He was treated successfully with 14 days doxycycline and followed up in clinic with improvement in his visual complaints and retinitis. Conclusions and importance: Rickettsioses are worldwide endemic zoonotic infections caused by Gram negative obligate intracellular bacteria and spread to humans by infected ticks. Rickettsial infections, including Rocky Mountain spotted fever caused by Rickettsia rickettsii, are a cause of infectious retinitis, and atypical and zoonotic infections should remain on the differential diagnosis for patients presenting with rash, systemic illness, and visual complaints, even if the patient's travel or exposure history do not immediately suggest a likely rickettsial infection. In general, the ocular manifestations of rickettsial infection improve with systemic doxycycline treatment of the underlying infection.

Methylation at CpG sites related to growth differentiation factor-15 was not prospectively associated with cardiovascular death in discordant monozygotic twins.

Myocardial infarction patients had decreased methylation at four growth differentiating factor-15 (GDF-15) related CpG sites (cg13033858, cg16936953, cg17150809, and cg18608055). These sites had not been studied for their association with cardiovascular disease (CVD) deaths. Thus, we aimed to assess the associations independent of genes, shared environment, and traditional CVD risk factors. Nineteen white, male, monozygotic twin pairs discordant for CVD deaths were included from the National Heart, Lung and Blood Institute Twin Study (NHLBI) initiated in 1969. Data on vital status was collected through December 31, 2014. Methylation of buffy coat DNA at exam 3 (1986-87) was measured using the Illumina HumanMethylation450 BeadChip. Principal component analysis was used to generate a score representing blood leukocyte composition and baseline CVD risk factors and predominated with natural killer cells, CD4+ T cells, and Framingham risk score. Conditional logistic regression demonstrated that methylation at the four CpG sites was not associated with CVD deaths before (all p > 0.05, bootstrapped p > 0.05) and after adjustment for the score (all p > 0.05). Joint influences of cg16936953 and the score were statistically significant (p < 0.05). In conclusion, joint influences of methylation at the site cg16936953 and the score are prospectively associated with CVD deaths independent of germline and common environment.ClinicalTrials.gov Identifier for NHLBI Twin Study: NCT00005124.

Feasibility, Acceptability, and Potential Cost-Effectiveness of a Novel Mobile Phone Intervention to Promote Human Immunodeficiency Virus Testing Within Social Networks in Tanzania.

ABSTRACT: Among 145 individuals surveyed in Tanzania, 42% indicated willingness to test for human immunodeficiency virus in response to a confidential, phone-based text message. On average, participants were likely to provide contact information for 1.5 members of their social networks, suggesting high feasibility and moderate acceptability of a novel mHealth human immunodeficiency virus testing intervention.

Low socioeconomic status, parental stress, depression, and the buffering role of network social capital in mothers.

BACKGROUND: Pathways underlying the stress-depression relationship in mothers, and the factors that buffer this relationship are not well understood. AIMS: Drawing from the Stress Process model, this study examines (1) if parental stress mediates the association between socioeconomic characteristics and depressive symptoms, and (2) if social support and network capital moderate these pathways. METHOD: Data came from 101 mothers from Montreal. Generalized structural equation models were conducted, with depressive symptoms (CES-D scores) as the outcome, socioeconomic stressors as independent variables, parental stress as the mediator, and social support and network social capital as moderators. RESULTS: Parental stress partially mediated the association between household income and depressive symptoms (indirect effect: ß = -0.09, Bootstrap SE = 0.03, 95% CI = -0.15 to -0.03 p = 0.00). Network diversity moderated the relationship between parental stress and depressive symptoms (ß = -0.25, 95% CI = -0.42 to -0.09, p = 0.00); at high levels of stress, mothers with high compared to low network diversity reported fewer symptoms. CONCLUSION: Findings highlight the role that socioeconomic factors play in influencing women's risk of depression and shaping the benefits that ensue from social resources. Addressing these factors requires interventions that target the social determinants of depression.

The Influence of Religious Participation and Use of Traditional Medicine on Type 2 Diabetes Control in Urban Ghana.

This study examined whether the frequency of participation in religious activities and seeking care from spiritual and other traditional medicine (TM) practitioners were associated with blood glucose (HbA1c) control among urban Ghanaians with type 2 diabetes mellitus (T2DM). Findings revealed that increased frequency of participation in religious activities was significantly associated with decreased HbA1c levels, whereas increased use of TM practitioners was significantly associated with increased HbA1c levels. These findings suggest that strategically integrating religious activities into disease management plans for Ghanaians with T2DM who identify as being religious may be a viable intervention mechanism.

Maternal resources for care are associated with child growth and early childhood development in Bangladesh and Vietnam.

BACKGROUND: Suboptimal child growth and development are significant problems in low- and middle-income countries. Maternal resources for care may help to improve growth and development. This study examined the association of maternal resources for care on child length, motor development and language development of children 12-23.9 months old. METHODS: We used baseline data from the Alive & Thrive household surveys collected in Bangladesh (n = 803) and Vietnam (n = 635). Resources for care were represented by maternal education, knowledge, height, well-nourishment, mental well-being, decision-making, employment, support in chores and perceived support. The regression analyses were adjusted for household wealth and other covariates on households, children and parents and accounted for geographical clustering. RESULTS: Maternal height (Bangladesh ß = 0.150 p < 0.001, Vietnam ß = 0.156 p < 0.001), well-nourishment (Vietnam ß = 0.882 p = 0.007) and mental well-being (Bangladesh ß = 0.0649 p = 0.008, Vietnam ß = 0.0742 p = 0.039) were associated with child length. Well-nourishment (Vietnam ß = 0.670 p = 0.042) and support in chores (Bangladesh ß = 0.0983 p = 0.021) were associated with child motor development. Mental well-being (Vietnam ß = 0.0735 p = 0.013), decision-making autonomy (Bangladesh ß = 0.0886 p = 0.029) and perceived support (Vietnam ß = 0.445 p = 0.003) were associated with child language development. CONCLUSION: Maternal height, well-nourishment, mental well-being, decision-making, support in chores and perceived social support were associated with child outcomes. Interventions that help to improve resources among mothers have potential to foster child growth and development.

Functions of social networks in maternal food choice for children in Mexico.

Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent-child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers' social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants' child-feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio-recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non-household family, community, children's initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision-making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants' mothers and mothers-in-law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child-feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices.

Longitudinal geo-referenced field evidence for the heightened BMI responsiveness of obese women to price discounts on carbonated soft drinks.

There is increasing interest in the effect that food environments may have on obesity, particularly through mechanisms related to the marketing and consumption of calorie-dense, nutrient-poor foods and sugary beverages. Price promotions, such as temporary price discounts, have been particularly effective in the marketing of carbonated soft drinks (CSDs) among consumers. Research has also suggested that the purchasing behavior of consumer groups may be differentially sensitive to price discounts on CSDs, with obese women particularly sensitive. In addition, the intensity of price discount in a person's food environment may also vary across geography and over time. This study examines whether the weight change of obese women, compared to overweight or normal BMI women, is more sensitive to the intensity of price discounts on CSDs in the food environment. This study used longitudinal survey data from 1622 women in the Montreal Neighborhood Networks and Health Aging (MoNNET-HA) Panel. Women were asked to report their height and weight in 2008, 2010 and 2013 in order to calculate women's BMI in 2008 and their change of weight between 2008 and 2013. Women's exposure to an unhealthy food environment was based on the frequency in which their neighborhood food stores placed price discounts on CSDs in 2008. The price discount frequency on CSDs within women's neighborhoods was calculated from Nielsen point-of sales transaction data in 2008 and geocoded to participant's forward sortation area. The prevalence of obesity and overweight among MoNNET-HA female participants was 18.3% in 2008, 19.9% in 2010 and 20.7% in 2013 respectively. Results showed that among obese women, exposure to unhealthy food environments was associated with a 3.25 kilogram (SE = 1.35, p-value = 0.02) weight gain over the five-year study period. Exposure to price discounts on CSDs may disproportionately affect and reinforce weight gain in women who are already obese.

Viscoelastic Hemostatic Assays for Postpartum Hemorrhage.

This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. VHAs are advantageous because they assess the cumulative contribution of all components of the blood throughout the entire formation of a clot, have fast turnaround times, and are point-of-care tests that can be followed serially. Despite these advantages, VHAs are underused due to poor understanding of correct technique and result interpretation, a paucity of widespread standardization, and a lack of large clinical trials. These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.

Social inequalities in accelerated aging among southern U.S. women: an analysis of the biosocial and behavioral pathways linking social determinants to telomere length.

Few studies have examined the biosocial pathways linking socioeconomic status (SES) to accelerated aging in a population-based sample of southern US women. Even fewer have examined the importance of chronic compared to perceived stress in linking SES to women's salivary telomere length (STL). Using data from a probability-based sample of 156 US women and structural equation modeling, we examined three pathways - chronic stress exposure, stress appraisal, and coping behavior - linking SES to STL. SES was positively associated with STL (ßTE = 0.16, p < .05). Everyday discrimination was negatively associated with STL (ßDE = -0.21, p < .05), but perceived stress was positively associated with STL (ßDE = 0.20, p < .05). Current smoking decreased STL (ßDE = -0.19, p < .01). Perceived stress acted to suppress the negative relationship of chronic stress exposure on STL. Given the dearth of STL studies that include measures of both perceived and chronic stress, our study supports the importance of disentangling stress measures and a biosocial approach to the study of accelerated aging.

Tracing the Single and Combined Contributions of Home-Grown Supply and Health Literacy on Fruit and Vegetable Consumption: An Empirical Exploration in Rural India.

Low fruit and vegetable consumption (FVC) remains a global health challenge. Fostering subsistence agriculture through the production and home-grown consumption (HGC) of fruits and vegetables are seen as potential strategies for improving overall FVC, in particular, for developing countries like India. In addition, educational strategies targeting FVC health literacy are also used. Little evidence has documented a connection between these two strategies. We examine the single and combined influence of HGC and health literacy with regard to benefits from fruits and vegetable consumption. Data were collected from 427 rural households in the state of Odisha, India. Three outcomes were examined: FVC, as well as fruit and vegetables separately. Linear and Poisson regression were used to examine the association among home-grown consumption (HGC), FVC health literacy, and the FVC outcomes. Findings show that HGC, but not FVC health literacy, was directly associated with FVC (ß = 0.65, SE = 0.10, p = 0.008) and vegetable consumption (ß = 0.57, SE = 0.11, p = 0.02). However, both HGC (ß = 0.58, SE = 0.05, p < 0.01) and FVC health literacy (ß = -0.07, SE = 0.02, p = 0.001) were associated with fruit consumption. In addition, HGC effect is concentrated among participants who reported low FVC health literacy, especially on overall FVC and vegetables alone. Results are discussed in relation to the beneficial role played by HGC in those particularly vulnerable households who perceived little FVC health literacy. Our results provide insights on novel improved FVC consumption across all population segments. Future research should explore the complex interplay between agricultural policies and educational programs in the design of interventions promoting fruit and vegetable production and consumption.

Addressing social determinants of health in community pharmacy: Innovative opportunities and practice models.

Social determinants of health (SDoH) account for up to 90% of health outcomes, whereas medical care accounts for only 10%-15%; despite this disparity, only 24% of hospitals and 16% of physician practices screen for the 5 social needs. Community-embedded and highly accessible, pharmacies are uniquely positioned to connect individuals to local community and social resources and thereby address SDoH. In this article, we explore novel community pharmacy practice models that address SDoH, provide real-world examples of these models, and discuss pathways for reimbursement and sustainability. A number of innovative community pharmacy practice models that focus on social issues are currently being explored. These include integrating community health workers (CHWs) or SDoH specialists, wherein CHWs are frontline public health workers who can effectively bridge the health care system and their community, whereas SDoH specialists are pharmacy team members trained with substantial SDoH knowledge and how to use it to connect pharmacy patients to community resources. Three community pharmacy networks have implemented pilot programs using either a CHW or SDoH specialist model. An essential component for program success in all cases has been partnership development and increased interdependence between the pharmacies, local community organizations, and the public health sector. New payment models and financial incentives will be necessary to expand and sustain these programs. A potential Approach may be the use of Z codes, a subset of ICD-10-CM codes specific to assessing SDoH. Although opportunities are developing for community pharmacies to play a major role in sustainably addressing SDoH, additional work is needed before there is a widespread acceptance of pharmacies becoming service referral destinations for patients with social needs. Evaluation of these models on a wider scale will be necessary to fully evaluate their effectiveness, costs, and implementation within different community pharmacy settings.

Gendered Intrahousehold Bargaining Power is Associated with Child Nutritional Status in Nepal.

BACKGROUND: Women's intrahousehold bargaining power is an important determinant of child nutrition in Nepal, but a better understanding is needed on how men's bargaining power is related to child nutrition. OBJECTIVES: We examined the relation of women's and men's household bargaining power with child height-for-age z score (HAZ). METHODS: We analyzed cross-sectional data from 2012, collected as an impact evaluation baseline of the Suaahara 1 program. A subsample of households with data on women's and men's intrahousehold bargaining power (n = 2170) with children aged 0-59 mo across Nepal was considered for this analysis. Intrahousehold bargaining power consisted of 4 domains: 1) ownership and control of assets, 2) social participation, 3) time allocation to work activities (workload), and 4) household decision-making control. Using multilevel methods, we analyzed associations between HAZ and 1) women's bargaining power, 2) men's bargaining power, and 3) women's and men's bargaining power, adjusted for individual- and household-level confounding factors and clustering. RESULTS: Women's ownership and control of assets was positively associated with HAZ when women's and men's domains were modeled together (ß: 0.0597, P = 0.026). Men's social participation was positively associated with HAZ in the men's model (ß: 0.233, P < 0.001) and the model with women's and men's domains (ß: 0.188, P = 0.001). Women's workload was negatively associated with HAZ in the women's model (ß: -0.0503, P = 0.014) and in the model with women's and men's domains (ß: -0.056, P = 0.008). Household decision making for women (ß: -0.0631, P = 0.007) and for men (ß: -0.0546, P = 0.017) were negatively associated with HAZ in the gender-specific models. Women's social participation, men's ownership and control of assets, and men's workload were not associated with HAZ. CONCLUSIONS: Women's workload and ownership and control of assets and men's social participation may be important in improving child HAZ in Nepal. Nutrition interventions should address women's intrahousehold bargaining power and promote men's social engagement.