Epidemiology, economic and humanistic burdens of Ocular Surface Chemical Injury: A narrative review.

Ocular surface chemical injury (OSCI) is a common type of ocular emergency that can potentially cause significant and permanent visual impairment. However, the global prevalence, demographic factors, socioeconomic burden, and psychological impact of OSCI have not been well investigated or reported. This review aims to provide a comprehensive overview of these aspects, highlight gaps in the literature, and advocate key strategies in reducing the incidence of OSCI. OSCI was responsible for 0.1-15% of all ocular emergency presentations, with an estimated incidence of 5.1-50 per 100,000 population-year. Young working adult men were the most at-risk group, though high rates of OSCI were also observed in young children in developed countries, especially from detergent pods. Low- and middle-income countries were noted to have higher proportions of assault-related and pediatric OSCI cases, often with more severe presentations. Direct and indirect costs for some hospitalized patients led to loss of all personal and household income after the injury. Emergency department costs in the United States were estimated at $106.7 million over four years and costs of treating long term complications such as glaucoma were estimated to be as high as $93,003 over five years. Significant negative impacts on visual and health-related quality of life and psychological well-being have been reported after injury, with higher rates of anxiety, depression, and psychological distress compared to the general population.

Human peptidergic nociceptive sensory neurons generated from human epidermal neural crest stem cells (hEPI-NCSC).

Here we provide new technology for generating human peptidergic nociceptive sensory neurons in a straightforward and efficient way. The cellular source, human epidermal neural crest stem cells (hEPI-NCSC), consists of multipotent somatic stem cells that reside in the bulge of hair follicles. hEPI-NCSC and primary sensory neurons have a common origin, the embryonic neural crest. For directed differentiation, hEPI-NCSC were exposed to pertinent growth factors and small molecules in order to modulate master signalling networks involved in differentiation of neural crest cells into postmitotic peptidergic sensory neurons during embryonic development. The neuronal populations were homogenous in regard to antibody marker expression. Cells were immunoreactive for essential master regulatory genes, including NGN1/2, SOX10, and BRN3a among others, and for the pain-mediating genes substance P (SP), calcitonin gene related protein (CGRP) and the TRPV1 channel. Approximately 30% of total cells responded to capsaicin, indicating that they expressed an active TRPV1 channel. In summary, hEPI-NCSC are a biologically relevant and easily available source of somatic stem cells for generating human peptidergic nociceptive neurons without the need for genetic manipulation and cell purification. As no analgesics exist that specifically target TRPV1, a ready supply of high-quality human peptidergic nociceptive sensory neurons could open the way for new approaches, in a biologically relevant cellular context, to drug discovery and patient-specific disease modelling that is aimed at pain control, and as such is highly desirable.

Assessing Patients with Asymptomatic Retinal Emboli Detected at Retinal Screening.

INTRODUCTION: Asymptomatic retinal emboli have been associated with diabetes, the presence of significant carotid artery stenosis (≥70%) and an increased risk of stroke. However, there is no clear guidance on how best to investigate and manage patients found to have asymptomatic retinal emboli. Therefore, this study aimed to assess the incidence of significant carotid artery stenosis in patients found to have asymptomatic retinal emboli at diabetic retinopathy screening, and to examine disease management approaches among these patients. METHODS: Patients with new retinal emboli visible at diabetic retinopathy screening were referred to a medical retinopathy clinic and underwent examinations according to a standardized protocol, including carotid Doppler ultrasound and echocardiography. Case notes of patients referred between January 2013 and April 2014 were reviewed. Results of investigations, medication changes and the number of patients who underwent relevant surgical interventions were noted. RESULTS: Retinal emboli were present in 44 of 13,643 people screened (0.32%). Full data were available for 39 patients. Twenty-two patients (56%) had relevant medication changes. Nine (23%) patients had significant carotid artery stenosis. One underwent carotid endarterectomy, and eight received maximal medical therapy. CONCLUSION: Significant carotid artery stenosis was not uncommon in patients with incident retinal emboli at retinal screening. The referral and investigation protocols identified individuals at risk of cerebrovascular events and led to optimized management. Pathways utilizing Doppler ultrasound and physician referral should be more widely implemented.

Setting appropriate pass or fail cut-off criteria for tests to reflect real life listening difficulties in children with suspected auditory processing disorder.

OBJECTIVE: This paper explores the pass or fail cut-off criteria, the number of test fails, and the nature of tests that are most appropriate in predicting listening difficulties (LiD) in children with suspected APD (SusAPD). METHODS: One hundred and nine English-speaking children (67 males, 42 females) aged between 6 and 11 years with SusAPD were assessed. The Children's Auditory Performance Scale (CHAPS) scores 2 SD below the mean were taken as markers of LiD in different listening conditions. Binary logistic regression analyses were carried out to evaluate the cut-off criterion (2 SD or 1.5 SD or 1 SD below the mean) of failing at least two tests, from the SCAN-C and IMAP test batteries, which significantly predicted LiD. Analyses were also carried out to assess if the group of auditory processing (AP) or cognitive or combination of AP plus cognitive tests were significant in predicting LiD. Receiver Operative Characteristic (ROC) curves were also explored to evaluate how the sensitivity and specificity in confirming LiD varied with the number of test fails. RESULTS: Filtered Words, Competing Words, Competing Sentences, VCV in ICRA noise, Digit Span, Sight Word Reading and the Cued Auditory Attention tests correlated with one or more of the CHAPS domains. Failing at least two of these tests 1.5 SD below the mean significantly predicted (p<.05) CHAPS Ideal scores 2 SD below the mean, and failing at least two of the tests 1 SD below the mean significantly predicted (p<.05) CHAPS Memory and CHAPS Attention scores 2 SD below the mean. The combination of AP plus cognitive tests had significantly higher ability to predict CHAPS Ideal, Memory and Attention scores, compared to the group of AP or cognitive tests separately. ROC curves showed that failing at least two of the tests was associated with the best sensitivity and specificity in predicting LiD. CONCLUSION: Of the different CHAPS domains only the CHAPS Ideal, Memory and Attention correlated with the APD tests. Failing at least two APD tests from a combination of AP and cognitive tests 1 SD and 1.5 SD below the mean, but not 2 SD, is more appropriate in confirming LiD.

Assessment of children with suspected auditory processing disorder: a factor analysis study.

OBJECTIVES: To identify the factors that may underlie the deficits in children with listening difficulties, despite normal pure-tone audiograms. These children may have auditory processing disorder (APD), but there is no universally agreed consensus as to what constitutes APD. The authors therefore refer to these children as children with suspected APD (susAPD) and aim to clarify the role of attention, cognition, memory, sensorimotor processing speed, speech, and nonspeech auditory processing in susAPD. It was expected that a factor analysis would show how nonauditory and supramodal factors relate to auditory behavioral measures in such children with susAPD. This would facilitate greater understanding of the nature of listening difficulties, thus further helping with characterizing APD and designing multimodal test batteries to diagnose APD. DESIGN: Factor analysis of outcomes from 110 children (68 male, 42 female; aged 6 to 11 years) with susAPD on a widely used clinical test battery (SCAN-C) and a research test battery (MRC Institute of Hearing Research Multi-center Auditory Processing "IMAP"), that have age-based normative data. The IMAP included backward masking, simultaneous masking, frequency discrimination, nonverbal intelligence, working memory, reading, alerting attention and motor reaction times to auditory and visual stimuli. SCAN-C included monaural low-redundancy speech (auditory closure and speech in noise) and dichotic listening tests (competing words and competing sentences) that assess divided auditory attention and hence executive attention. RESULTS: Three factors were extracted: "general auditory processing," "working memory and executive attention," and "processing speed and alerting attention." Frequency discrimination, backward masking, simultaneous masking, and monaural low-redundancy speech tests represented the "general auditory processing" factor. Dichotic listening and the IMAP cognitive tests (apart from nonverbal intelligence) were represented in the "working memory and executive attention" factor. Motor response times to cued and noncued auditory and visual stimuli were grouped in the "processing speed and alerting attention" factor. Individuals varied in their outcomes in different tests. Poor performance was noted in different combinations of tests from the three factors. Impairments solely related to the "general auditory processing" factor were not common. CONCLUSIONS: The study identifies a general auditory processing factor in addition to two other cognitive factors, "working memory and executive attention" and "processing speed and alerting attention," to underlie the deficits in children with susAPD. Impaired attention, memory, and processing speed are known to be associated with poor literacy and numeracy skills as well as a number of neurodevelopmental disorders. Individuals with impairments in the "general auditory processing" tests along with tests from the other two cognitive factors may explain the co-occurrence of APD and other disorders. The variation in performance by individuals in the different tests noted was probably due to a number of reasons including heterogeneity in susAPD and less-than ideal test-retest reliabilities of the tests used to assess APD. Further research is indicated to explore additional factors, and consensus is needed to improve the reliability of tests or find alternative approaches to diagnose APD, based on the underlying factors.