Ocular syphilis mimicking Vogt-Koyanagi-Harada syndrome: a diagnostic dilemma.

This case demonstrates the dilemma in the diagnosis of ocular syphilis, as it can mimic many other ocular conditions where initial steroid therapy might complicate the disease course and can worsen the infection. Also, it represents an example of anchoring bias, where a provisional diagnosis resulted in unnecessary treatment that would have worsened her clinical outcomes.

Cross-Sectional Analysis of Instagram Use in American Plastic Surgery Practices.

BACKGROUND: The growth of social media has transformed advertising within plastic surgery. Recent studies have characterized these developments, but objective analysis is needed. METHODS: This is a cross-sectional analysis of online media use by American Society of Plastic Surgeons members who received board certification in 2000, 2005, 2010, 2015, or 2019. Online searches and StatShow revealed social media and website metrics. Metropolitan-based practices were determined using Department of Agriculture continuum codes. Descriptive and quantitative analyses were used to make inferences regarding study aims. RESULTS: This study included 811 surgeons. A total of 58.6 percent had practice websites and 43.9 percent had professional Instagram accounts. Instagram use was widespread across subspecialties and there was no significant difference in the number of followers by subspecialty ( p = 0.34). Year of certification had no significant effect on the number of followers ( p = 0.12); however, recently certified and seasoned members had the fewest. The top 1 percent of surgeons had more followers than the remaining 99 percent combined. Those with metropolitan-based practices had significantly higher website traffic ( p = 0.01) but no difference in the number of followers ( p = 0.88). There was no evidence that the number of followers or posts per month correlated with website traffic ( R 2 = 0.004 and 0.036, respectively). CONCLUSIONS: The study demonstrates findings from a cross-sectional analysis of plastic surgeons from different training backgrounds, regions, and tenure. The use of Instagram in professional practice is widespread but there is no correlation between its use and increased website traffic.

Delayed diagnosis of severe falciparum malaria in a patient presenting with acute gastroenteritis in West Texas.

Falciparum malaria is a life-threatening infection that affects both people in endemic areas and people who travel to endemic areas. Malaria in exceedingly rare in West Texas, but the initial recognition and prompt initiation of antimalarial treatment are crucial in managing malaria. Here we present a case of a 31-year-old woman who was initially diagnosed with acute gastroenteritis and was later found to have cerebral malaria.

Immunological and Clinical Phenotyping in Primary Antibody Deficiencies: a Growing Disease Spectrum.

PURPOSE: Although common variable immunodeficiency (CVID) is considered the most prevalent symptomatic primary antibody deficiency (PAD), there is a population with symptomatic PADs that do not meet criteria for CVID. We analyzed clinical and immunological profiles of patients with different PADs to better understand the differences and similarities between CVID and other PADs. METHODS: We extracted clinical and laboratory data of patients with PADs from electronic medical records. Patients were categorized into CVID, IgG subclass 2 deficiency (IgG2D), IgG deficiency (IgGD), and specific antibody deficiency (sAbD) based on basal immunoglobulin levels and pneumococcal vaccine responses. We compared clinical and immunological characteristics in these groups. RESULTS: All patients, regardless of PAD types, showed similar frequencies of infections, bronchiectasis, and interstitial lung disease (ILD). Hematopoietic malignancies were more frequently found in the CVID than in the IgG2D, IgGD, and sAbD groups, while the latter groups trended towards an increased frequency of connective tissue diseases (CTD). Low counts of natural killer (NK) cells were associated with malignancy, autoimmunity, and ILD in CVID but not in other PAD groups. CONCLUSIONS: Higher frequency of hematopoietic malignancy in CVID than in the other PADs and association of lower NK cell counts with non-infectious complications in CVID suggest a relationship between immune alterations and the development of non-infectious manifestations in PADs.

Assessment of Neuromuscular Function in Patients With Prior Cosmetic Procedures: A Case Report.

Objective: The use of Botulinum toxin type A (Botox) for cosmetic procedures has become so prevalent that many patients do not always consider it to be a past surgical procedure, and it goes excluded from the medical record. Without the knowledge of prior Botox use, interpretation of facial nerve train-of-four testing may be inaccurate. Methods: We describe a 61-year-old woman with a history of multiple cosmetic procedures whose postoperative course was complicated by multiorgan system failure, requiring neuromuscular blockade while on mechanical ventilatory support. Results: Gauged by facial nerve stimulation, adequate neuromuscular blockade was assumed. However, patient-ventilator dyssynchrony motivated the decision to move the peripheral nerve stimulator to the ulnar nerve, where muscle twitches were observed. This indicated inadequate paralysis. Conclusions: This case report highlights the importance of monitoring neuromuscular function with ulnar nerve testing in patients with a history of cosmetic Botox procedures.

Sm-p80-Based Schistosomiasis Vaccine: Preparation for Human Clinical Trials.

Mass antiparasitic drug administration programs and other control strategies have made important contributions in reducing the global prevalence of helminths. Schistosomiasis, however, continues to spread to new geographic areas. The advent of a viable vaccine and its deployment, coupled with existing control efforts, is expected to make significant headway towards sustained schistosomiasis control. In 2016, Science ranked the schistosomiasis vaccine as one of the top 10 vaccines that needs to be urgently developed. A vaccine that is effective against geographically distinct forms of intestinal/hepatic and urinary disease is essential to make a meaningful impact in global reduction of the disease burden. In this opinion article, we focus on salient features of schistosomiasis vaccines in different phases of the clinical development pipeline and highlight the Sm-p80-based vaccine which is now being prepared for human clinical trials.

Development of a schistosomiasis vaccine.

Schistosomiasis is a neglected tropical disease (NTD) of public health importance. Despite decades of implementation of mass praziquantel therapy programs and other control measures, schistosomiasis has not been contained and continues to spread to new geographic areas. A schistosomiasis vaccine could play an important role as part of a multifaceted control approach. With regards to vaccine development, many biological bottlenecks still exist: the lack of reliable surrogates of protection in humans; immune interactions in co-infections with other diseases in endemic areas; the potential risk of IgE responses to antigens in endemic populations; and paucity of appropriate vaccine efficacy studies in nonhuman primate models. Research is also needed on the role of modern adjuvants targeting specific parts of the innate immune system to tailor a potent and protective immune response for lead schistosome vaccine candidates with the long-term aim to achieve curative worm reduction. This review summarizes the current status of schistosomiasis vaccine development.