Quality, Reliability, Readability, and Accountability of Online Information on Leukocoria.

PURPOSE: To evaluate the quality, reliability, and readability of online patient educational materials on leukocoria. METHODS: In this cross-sectional study, the Google search engine was searched for the terms "leukocoria" and "white pupil." The first 50 search outcomes were evaluated for each search term based on predefined inclusion criteria, excluding duplicates, peer-reviewed papers, forum posts, paywalled content, and multimedia links. Sources were categorized as "institutional" or "private." Three independent raters assessed each website for quality and reliability using DISCERN, Health on the Net Code of Conduct (HONcode), and JAMA criteria. Readability was evaluated using seven formulas: Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index, Automated Readability Index (ARI), Linsear Write (LW), Gunning Fog Index (GFI), and Coleman-Liau Index (CLI). RESULTS: A total of 51 websites were included. Quality, assessed by the DISCERN tool, showed a median score of 4, denoting moderate to high quality, with no significant differences between institutional and private sites or search terms. HONcode scores indicated variable reliability and trustworthiness (median: 10, range: 3 to 16), with institutional sites excelling in financial disclosure and ad differentiation. Additionally, institutional and private sites performed well in reliability and accountability, as measured by the JAMA Benchmark criteria (median: 3; range: 1 to 4). Readability, averaging an 11.3 ± 3.7 grade level, did not differ significantly between site types or search terms, consistently falling short of the recommended sixth-grade level for patient educational materials. CONCLUSIONS: The patient educational materials on leukocoria demonstrated moderate to high quality, commendable reliability, and accountability. However, the readability scores were above the recommended level for the layperson. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XX-XX.].

Simvastatin and non-segmental vitiligo: A new potential treatment option?

There is a paucity of data about the impact of systemic statins on vitiliginous lesions in non-segmental vitiligo (NSV) patients. To the best of our knowledge, no other studies have considered the correlation between lipid disturbances in vitiligo and vitiligo disease activity (VIDA) score. We sought in this study to evaluate the influence of simvastatin on vitiliginous lesions in NSV patients with dyslipidemia and study the correlation between VIDA score and lipid profile. This clinical trial started with 120 patients with NSV, 79 patients had dyslipidemia and received simvastatin 80 mg daily (till normalization of lipid profile or for 4 months, which came first) and only 63 patients continued till the end of the study. Lipid profile, vitiligo area severity index and VIDA were assessed before and 6 months after the end of simvastatin use. Serum total cholesterol (TC), triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein, and LDL/HDL ratio showed statistically significant increases in the NSV than in the control group (p Ë‚ 0.001). There was a statistically significant positive correlation between VIDA and serum levels of TC and LDL and with LDL/HDL ratio. Simvastatin significantly improved the lipid profile and significantly decreased VIDA (p < 0.011). Negative moderate correlation was found between the decrease in VIDA and duration of disease (r = -0.562, p < 0.001). Simvastatin 80 mg daily could be a helpful treatment for NSV patients with dyslipidemia, controlling the vitiligo activity and protecting against the hazardous effects of dyslipidemia. Better results can be obtained in patients with short duration of the disease.

Evaluation of plasma exeresis as a new technique for non surgical treatment of dermatochalasis.

BACKGROUND: Dermatochalasis is frequently associated with tissue ageing and leads to multiple functional and cosmetic issues. There are several possible medical and surgical treatments available, such as blepharoplasty and laser therapy. OBJECTIVE: The aim of this work was to evaluate plasma exeresis as a new technique for nonsurgical treatment of dermatochalasis of the upper eyelid. PATIENT AND METHODS: This clinical trial included 40 female patients with dermatochalasis. Each patient received 3 sessions of treatment with the technology of plasma exeresis with one-month interval. Final evaluation was performed three months after the last session by 2 blinded dermatologists and 2 ophthalmologists, lid laxity according to facial laxity rating scale (FLRS), marginal crease distance (MCD) before and after treatment and patient satisfaction score. RESULTS: There was a significant decrease in eye lid laxity (FLRS) after treatment where p < .001; 36 (90%) patients had change and 4 (10%) patients without change in general. There was a significant increase in MCD after treatment (p = .001). CONCLUSION: Plasma exeresis seems to improve appearance of the upper eyelid, without any serious adverse events and could be a valid solution for dermatochalasis especially in mild and moderate cases.

Immunotherapy in cutaneous warts: comparative clinical Study between MMR vaccine, tuberculin, and BCG Vaccine.

BACKGROUND: Warts are common viral infection of the skin. Treating warts are still an ongoing challenge and no general agreement is reached, on the best treatment, despite different therapeutic approaches. Intralesional (IL) immunotherapy has recently been shown to be effective in treating various wart forms. AIMS: To assess the efficacy and safety of IL tuberculin, IL MMR vaccine, and intradermal (ID) BCG vaccination in treating viral warts. PATIENTS AND METHODS: Sixty patients with single or multiple warts were divided equally into three groups. Group A received IL MMR vaccine, and group B received IL tuberculin every 3 weeks (maximum 3 times). Group C received ID BCG vaccination in the arm with one month interval (maximum 3 times). Recurrence was followed up for 6 months. RESULTS: In group A, complete response occurred in 30%, partial response in 5%, and no response in 65%. In group B, complete response occurred in 45%, partial response in 20%, minimal response in 10% and no response in 25%. In group C, complete response occurred in 70%, partial response in 5%, minimal response in 5%, and no response in 20%. No recurrence was observed in group A and B but occurred in one patient in group C with the same lesion. CONCLUSIONS: Immunotherapy by IL tuberculin and ID BCG vaccination are safe, effective, and inexpensive techniques in treating all types of warts even if recalcitrant or multiple but immunotherapy by IL MMR vaccine has shown less effectiveness and less safety technique.

Positive Effect of Helicobacter pylori Treatment on Outcome of Patients With Chronic Spontaneous Urticaria.

OBJECTIVES: The association between Helicobacter pylori and chronic spontaneous urticaria (CSU) is controversial. Therefore, we aimed to directly diagnose H pylori by polymerase chain reaction (PCR) in gastric tissue from patients with CSU and to investigate the association between H pylori eradication therapy and CSU remission. METHODS: Twenty-seven of 72 patients with CSU who were positive for H pylori stool antigen and PCR in gastric biopsy specimens were randomized to receive either anti-H pylori treatment or placebo. RESULTS: Patients with H pylori were found to have significantly lower hemoglobin concentrations with microcytic hypochromic anemia and a significantly higher occurrence of dyspepsia symptoms. All H pylori-treated patients (except two) showed significant improvement of the urticaria itching and red wheals after 2 weeks of therapy compared with the placebo group (P < .001). The response rate to treatment was 85.7% (12 patients; 95% confidence interval, 64.3%-100.0%). The two patients who failed to eradicate H pylori had an H pylori strain resistant to amoxicillin. CONCLUSIONS: An association was observed between CSU and presence of H pylori infection in the gastric tissue. Whether this is a causal relationship or not remains to be discovered, but treatment of H pylori can significantly improve the symptoms of CSU.

Carbon ion fragmentation effects on the nanometric level behind the Bragg peak depth.

In this study, fragmentation yields of carbon therapy beams are estimated using the Geant4 simulation toolkit version 9.5. Simulations are carried out in a step-by-step mode using the Geant4-DNA processes for each of the major contributing fragments. The energy of the initial beam is taken 400 MeV amu(-1) as this is the highest energy, which is used for medical accelerators and this would show the integral role of secondary contributions in radiotherapy irradiations. The obtained results showed that 64% of the global dose deposition is initiated by carbon ions, while up to 36% is initiated by the produced fragments including all their isotopes. The energy deposition clustering yields of each of the simulated fragments are then estimated using the DBSCAN clustering algorithm and they are compared to the yields of the incident primary beam.

Genetic polymorphisms of twelve X-STRs of the investigator Argus X-12 kit and additional six X-STR centromere region loci in an Egyptian population sample.

Recently, many researchers have focused on analysis of different X-chromosomal STRs as they bear the potential to efficiently complement the analysis of autosomal and Y-chromosomal STRs in solving special complex kinship deficiency cases. In the current study we examined a sample of 250 unrelated Egyptian males with the Investigator Argus X-12 kit (Qiagen GmbH, Hilden, Germany) which detects 12 X-STR markers distributed over the entire X-chromosome as four closely linked clusters. Microvariant off ladder alleles as well as null alleles have been detected in some loci. Furthermore, discordant results were observed between the Investigator Argus X-12 and the Mentype(®) Argus X-8 kits (Biotype AG, Dresden, Germany). New primers were designed for loci DXS10101, DXS10146 and DXS10148 to correct the allele drop outs observed in these loci with the Investigator Argus X-12 kit. Additionally, DNA sequence analysis revealed the polymorphisms responsible for the allele drop outs. Furthermore, six additional X-STRs (DXS10161, DXS10159, DXS10162, DXS10163, DXS10164 and DXS10165) located in the centromere region at Xp11.21-Xq11.1 were examined in a single multiplex reaction. Allele and haplotype frequencies as well as different forensic statistical parameters of the 18 X-STR loci tested indicated that they are highly informative in different forensic applications in the Egyptian population. However, some modifications still need to be performed on the Investigator Argus X-12 kit before its use in forensic casework is validated.

Assessment of risk factors for post-rewarming "rebound hyperthermia" in cardiac arrest patients undergoing therapeutic hypothermia.

INTRODUCTION: The outcomes associated with therapeutic hypothermia (TH) after cardiac arrest, while overwhelmingly positive, may be associated with adverse events. The incidence of post-rewarming rebound hyperthermia (RH) has been relatively unstudied and may worsen survival and neurologic outcome. The purpose of this study was to determine the incidence and risk factors associated with RH as well as its relationship to mortality, neurologic morbidity, and hospital length of stay (LOS). METHODS: A retrospective, observational study was performed of adult patients who underwent therapeutic hypothermia after an out-of-hospital cardiac arrest. Data describing 17 potential risk factors for RH were collected. The primary outcome was the incidence of RH while the secondary outcomes were mortality, discharge neurologic status, and LOS. RESULTS: 141 patients were included. All 17 risk factors for RH were analyzed and no potential risk factors were found to be significant at a univariate level. 40.4% of patients without RH experienced any cause of death during the initial hospitalization compared to 64.3% patients who experienced RH (OR: 2.66; 95% CI: 1.26-5.61; p=0.011). The presence of RH is not associated with an increase in LOS (10.67 days vs. 9.45 days; absolute risk increase=-1.21 days, 95% CI: -1.84 to 4.27; p=0.434). RH is associated with increased neurologic morbidity (p=0.011). CONCLUSIONS: While no potential risk factors for RH were identified, RH is a marker for increased mortality and worsened neurologic morbidity in cardiac arrest patients who have underwent TH.

Use of Foley catheter for management of neonatal genital prolapse: case report and review of the literature.

Congenital vaginouterine prolapse is a rare condition occurring in neonates and is usually associated with spinal cord malformations in about 80% of cases. Several modalities of treatment have been described for neonatal genital prolapse (NGP). Conservative treatment in the form of simple digital reduction, usage of a pessary or other self-retaining device is usually sufficient to treat this condition, which is self-limiting and regressive. The authors report a new simple and effective method of conservative treatment that uses a Foley catheter to achieve permanent correction of this condition. A review of the literature regarding this uncommon condition is also provided.

Detection of cotinine in neonate meconium as a marker for nicotine exposure in utero.

Neonate meconium cotinine level was evaluated as a marker of prenatal exposure to nicotine from tobacco smoking by mothers. Mothers admitted to a maternity hospital in Alexandria, Egypt, were divided into 3 groups: 10 active smokers, 10 passive smokers and 10 with no tobacco exposure during pregnancy. Urine and saliva samples were collected from mothers and first-day meconium samples from their neonates. Mean maternal urinary cotinine levels, measured using radioimmunoassay, differed significantly between the 3 groups, as did mean salivary cotinine and mean cotinine levels in meconium. There was a significant positive correlation between cotinine levels in meconium and both maternal urinary and salivary cotinine levels. Meconium is an ideal biological marker for testing direct fetal exposure to tobacco smoke in the neonatal period.

Detection of cotinine in neonate meconium as a marker for nicotine exposure in utero

Neonate meconium cotinine level was evaluated as a marker of prenatal exposure to nicotine from tobacco smoking by mothers. Mothers admitted to a maternity hospital in Alexandria, Egypt, were divided into 3 groups: 10 active smokers, 10 passive smokers and 10 with no tobacco exposure during pregnancy. Urine and saliva samples were collected from mothers and first-day meconium samples from their neonates. Mean maternal urinary cotinine levels, measured using radioimmunoassay, differed significantly between the 3 groups, as did mean salivary cotinine and mean cotinine levels in meconium.There was a significant positive correlation between cotinine levels in meconium and both maternal urinary and salivary cotinine levels. Meconium is an ideal biological marker for testing direct fetal exposure to tobacco smoke in the neonatal period

The mitochondrial genome of the stramenopile alga Chrysodidymus synuroideus. Complete sequence, gene content and genome organization.

This is the first report of a complete mitochondrial genome sequence from a photosynthetic member of the stramenopiles, the chrysophyte alga Chrysodidymus synuroideus. The circular-mapping mitochondrial DNA (mtDNA) of 34 119 bp contains 58 densely packed genes (all without introns) and five unique open reading frames (ORFs). Protein genes code for components of respiratory chain complexes, ATP synthase and the mitoribosome, as well as one product of unknown function, encoded in many other protist mtDNAs (YMF16). In addition to small and large subunit ribosomal RNAs, 23 tRNAs are mtDNA-encoded, permitting translation of all codons present in protein-coding genes except ACN (Thr) and CGN (Arg). The missing tRNAs are assumed to be imported from the cytosol. Comparison of the C.SYNUROIDEUS: mtDNA with that of other stramenopiles allowed us to draw conclusions about mitochondrial genome organization, expression and evolution. First, we provide evidence that mitochondrial ORFs code for highly derived, unrecognizable versions of ribosomal or respiratory genes otherwise 'missing' in a particular mtDNA. Secondly, the observed constraints in mitochondrial genome rearrangements suggest operon-based, co-ordinated expression of genes functioning in common biological processes. Finally, stramenopile mtDNAs reveal an unexpectedly low variability in genome size and gene complement, testifying to substantial differences in the tempo of mtDNA evolution between major eukaryotic lineages.

A comparative genomics approach to the evolution of eukaryotes and their mitochondria.

The Organelle Genome Megasequencing Program (OGMP) investigates mitochondrial genome diversity and evolution by systematically determining the complete mitochondrial DNA (mtDNA) sequences of a phylogenetically broad selection of protists. The mtDNAs of lower fungi and choanoflagellates are being analyzed by the Fungal Mitochondrial Genome Project (FMGP), a sister project to the OGMP. Some of the most interesting protists include the jakobid flagellates Reclinomonas americana, Malawimonas jakobiformis, and Jakoba libera, which share ultrastructural similarities with amitochondriate retortamonads, and harbor mitochondrial genes not seen before in mtDNAs of other organisms. In R. americana and J. libera, gene clusters are found that resemble, to an unprecedented degree, the contiguous ribosomal protein operons str, S10, spc, and alpha of eubacteria. In addition, their mtDNAs code for an RNase P RNA that displays all the elements of a bacterial minimum consensus structure. This structure has been instrumental in detecting the rnpB gene in additional protists. Gene repertoire and gene order comparisons as well as multiple-gene phylogenies support the view of a single endosymbiotic origin of mitochondria, whose closest extant relatives are Rickettsia-type alpha-Proteobacteria.

Heterozygous expression of Lesch-Nyhan syndrome clinical and ultrastructural studies.

The study comprised two cases (male & female sibs) from one family, with Lesch-Nyhan Syndrome. They were subjected to clinical evaluation, pedigree construction, uric acid estimation in blood, urates in urine, metabolic screening of blood and urine for amino acids, examination of oral cavity, histological studies of the gingiva by light and electron microscopy as well as buccal smear for Barr & Y bodies (for the female). The proband, a six years old female presented with self-mutilation, mental retardation, hyperactivity and aggression. She had bitten her index finger causing amputation of its distal phalanx. On family study her younger brother (9 months) was found to have increased uric acid and less severe neurologic involvement. The serum uric acid level of the affected female was higher. Her Barr body showed normal pattern. Oral cavity examination showed no abnormalities. Histological examination of the gingiva showed macrophages around the blood vessels. Ultrastructural studies showed more or less normal epithelium. There was collection of macrophages around the blood vessels in the sub-epithelial layer, the cytoplasm of these macrophages contained stippled cytoplasmic inclusions. The surrounding connective tissue showed thin collagen fibers with sharp delineation between the epithelial and connective tissue layers indicating poor quality of collagen. There was no histological difference between the hemizygous male and the heterozygous female. The present study indicates heterozygous expression of Lesch-Nyhan Syndrome at both the clinical and the ultrastructural levels in favour of extreme lyonization or X-chromosome deletion in the affected female. Our findings also indicate that ultrastructural studies could be sensitive indicators of abnormal uric acid metabolism. Further studies are needed to compare the phenotypic expression of hemizygotes and heterozygotes with Lesch-Nyhan Syndrome at both the clinical and ultrastructural levels.

Oxyphilic granular cell adenoma (oncocytoma)--a histochemical and ultrastructural study.

Oxyphilic granular cell adenoma (oncocytoma) is extremely rare usually benign neoplasm. Specimens from four oncocytomas of the parotid gland were studied by light microscopy using different histochemical stains, and by electron microscopy. The haematoxylin and eosin stained sections revealed large cells with eosinophilic granular cytoplasm. These granules appear blue with phosphotungstic acid haematoxylin stain, purplish blue with mallory aniline blue stain and are moderately reactive to alcian blue and PAS. No elastic fibers could be seen in the intercellular substance using Verhoeff's stain. At the ultrastructural level, the tumour cells were characterized by great numbers of mitochondria. Many of the mitochondria contained glycogen granules. Dividing mitochondria were also observed.

Ultrastructural features of vocal fold nodules and polyps.

Earlier investigation did not show any clear distinctive pathological features that differentiate vocal polyps from vocal nodules. The light microscopic distinctive features between the two lesions point in the direction of a more pronounced epithelial reaction and a more fibrous stromal change in vocal nodules. In the present study, 19 vocal polyps and 11 vocal nodules were subjected to ultrastructural examination aiming at finding distinctive features that may be pathognomic for each of these clinically distinct entities. The study was carried out by EM Philips 400 T. The results demonstrate that nodules showed epithelial changes in the form of gaping of the intercellular junctions and absence of the basal lamina in parts. These changes are less apparent in polyps, whereas the stromal changes are more pronounced and varied. The significance of these results and their interpretation are discussed.