Syphilitic scleritis and episcleritis: A review.

Scleritis and episcleritis are rare, but potentially sight-threatening forms of syphilis. To provide a full description of this neglected subset of ocular syphilis, we evaluated the English literature for reports of syphilitic scleritis and episcleritis, recording the demographics, clinical characteristics, serological data, management practices, treatment responses, and visual outcomes. Previously published descriptions of 44 patients with syphilitic scleritis (50 eyes) and 9 patients with syphilitic episcleritis (14 eyes) were identified. The predominant type of scleritis was anterior scleritis, accounting for 92.9% of cases, with nodular anterior scleritis being the most frequent subtype at 58.1%. Almost one-quarter of patients were co-infected with human immunodeficiency virus (HIV). Initial misdiagnosis was common and led to delays in initiating treatment with appropriate antibiotics. Visual outcomes were often good in both scleritis and episcleritis, irrespective of HIV infection status, although complications including scleral thinning, keratitis, and uveitis, along with permanent visual loss and an association with neurosyphilis, were reported. Response to antibiotic treatment was typically rapid, often within 1 week. With the rising global incidence of syphilis, testing patients with scleritis or episcleritis for this infectious disease is important to ensure prompt diagnosis and treatment for best ocular and systemic outcomes.

Systemic disregard, demoralising occupational burnout, protective maturity: The 'lived' experience of nuclear medicine technologists and the impact of COVID-19.

OBJECTIVE: It has been shown that stress in the workplace can contribute to the development or worsening of mental health conditions, as well as having a negative impact on personal relationships and life outside of work. Therefore, prolonged job stress can be damaging to an individual's mental health and wellbeing, potentially leading to burnout. There is limited research surrounding the wellbeing of nuclear medicine technologists practicing globally, and more specifically in Australia. This interpretative phenomenological study seeks the lived experience of nuclear medicine technologists within a large metropolitan city in Australia, how these experiences and COVID-19 has impacted their wellbeing. METHODS: Five participants were recruited who had greater than five years working experience as a nuclear medicine technologist. Data was collected using semi-structured interviews conducted online via Zoom to accommodate COVID-19 restrictions. The data was transcribed and analysed according to interpretative phenomenological analysis (IPA) protocols. RESULTS: One superordinate theme: systemic regard, demoralizing burnout, protective maturity, overarched four subordinate themes: staying physically and psychologically safe; risk of burnout; maturity as protective against burnout; and COVID-19 drain. Pressures both prior to and during COVID-19 leave the participants feeling undervalued, discredited, and at risk of burnout. However, maturity brings confidence to incorporate their strengths in a more holistic view of life. Glimmers of positivity come from choices to alter their career path and the unexpected opportunities to spend time with family through COVID-19 restrictions. DISCUSSION: Overall, the participants of this study expressed a lack of positivity about their own individual experiences within their career. Occupational stress, caused by workplace bullying, increased workload and understaffing increased their risk of burnout. Although as the participants matured, their ability to cope with occupational stressors improved. The recent COVID-19 pandemic exacerbated the participants' risk of burnout. CONCLUSION: Due to a number of contributing workplace factors, exacerbated by the unexpected COVID-19 pandemic, participants in this study appeared to have an increased risk of developing burnout. However, maturity and life experience has helped mitigate this risk.

Agreement Between Dual-Energy X-ray Absorptiometry and Bioelectric Impedance Analysis for Assessing Body Composition in Athletes: A Systematic Review and Meta-Analysis.

OBJECTIVE: To compare dual-energy x-ray absorptiometry (DXA) and bioelectric impedance analysis (BIA) in the assessment of body composition in athletes. DATA SOURCES: A systematic review and meta-analysis was conducted collating peer-reviewed studies that compared BIA with DXA for the assessment of body composition in athletes that indexed in MEDLINE, CINAHL, EMBASE, and PsycINFO databases. MAIN RESULTS: After duplicate removal, 267 articles remained for full-text screening. Sixty-three studies remained for the final inclusion, with 8 focused on athletes (n = 461). Five studies were included in the meta-analysis and were rated as positive after risk of bias assessment, whereas the remaining were neutral. BIA overestimated fat-free mass (FFM) over DXA 2.78 (1.38-4.18) (mean difference ± 95% CI) with an effect size of 3.9( P < 0.001). CONCLUSIONS: BIA was found to overestimate total FFM when compared with DXA. Correlations are high between BIA and DXA; however, the limits of agreement are wide. Hence, BIA may not be a suitable substitute for DXA body composition scanning of athletes. Because of the low level of ionizing radiation exposure, the use of DXA should always be medically justified, and therefore, it is not recommended for repeat, longitudinal measurements in healthy subjects.We recommend that clinicians do not use BIA interchangeably with DXA in the assessment of body composition in athletes. Considerations should be made over the safety and appropriateness of DXA in young healthy adults. For long-term use, BIA can be warranted for athletes.PROSPERO Registration Number: CRD42020183777.

The Impact of Covid-19 on First Year Undergraduate Nuclear Medicine Students' Practical Skills Training.

RATIONALE: Clinical placement is an important component of any undergraduate nuclear medicine program. For first year students, it is an introduction to clinical nuclear medicine which helps them better understand the profession as well as consolidate their learning to date. At The University of Newcastle, Australia part of the clinical placement course includes radiopharmacy laboratory sessions in a simulated environment to develop necessary skills and confidence. Due to the Covid-19 pandemic, restrictions were put in place that meant that clinical placements for first year students were cancelled and time in the radiopharmacy laboratory was reduced from two hours to one hour per session. The aim of this study is to evaluate whether a clinical alternative portfolio in lieu of clinical placement was effective in increasing the students' knowledge and skills in nuclear medicine practice and if specifically developed instructional videos for preparation of the radiopharmacy laboratories compensated for the reduced time. METHODS: A paper-based survey was given to the 50 students enrolled in the first-year professional practice course. This survey containing 56 questions consisted of both open questions and closed Likert-scale questions about the changes to the radiopharmacy laboratories and the clinical alternative portfolio in two separate sections. Quantitative and qualitative analysis was performed on the resulting data. RESULTS: There was a 94% response rate to the survey. The majority of students watched the preparatory radiopharmacy videos at least once and strongly agreeing that each video adequately prepared them for the associated lab session. Just over half (51%) of the students though the reduced time in the lab was sufficient to complete the required tasks. The majority of students agreed that the modules included in the clinical alternative portfolio increased their knowledge of nuclear medicine practice. CONCLUSION: In spite of the restrictions put in place due to Covid-19, the learning outcomes of the first-year nuclear medicine professional practice course were met. The preparatory videos for the radiopharmacy laboratories and the clinical alternative portfolio was positively received and gave the students a good introduction to clinical nuclear medicine.

How to navigate the evolving world of clinical placement: an Australian university collaboration to support clinical supervision.

Clinical placement is an integral part of medical radiation science student learning and development. Clinical placement provides opportunity for students to apply their theoretical knowledge and enable students to prepare for their future professional practice. Clinical supervisors have a significant role in this process to facilitate student learning on clinical placement. However, clinical supervisors often have little formal training to supervising students on placement and will default to their own previous learning experience. There is a need to provide an educational perspective from tertiary education partners to assist medical radiation practitioners in their role of supervising students. This paper is a collaboration between Australian Nuclear Medicine University partners with the aim to support and educate nuclear medicine technologists, and indeed all medical radiation practitioners to competently fulfil their role regarding student supervision and assessment.

Burnout in the disciplines of medical radiation science: A systematic review.

OBJECTIVE: Burnout is seen as an occupational phenomenon related to workplace stress. Professional groups within medical imaging and radiation science have been reported to suffer from burnout in the past, however research into the profession has been limited. This systematic review aims to evaluate literature measuring levels and prevalence of burnout in the professional groups within medical imaging and radiation science (MIRS). These being radiographers (radiological technologists), sonographers, radiation therapists (therapeutic radiographers) and nuclear medicine technologists. METHODS: Electronic databases including Medline, Embase, Psycinfo and CINAHL were searched to locate studies published in English from 2000 that used a questionnaire/survey to measure burnout in the MIRS population. Also included were studies that measured burnout in a larger healthcare group that included MIRS professionals, as long as the MIRS professionals were reported as a separate group. RESULTS: Sixteen articles met the inclusion criteria; two of these articles reported the same data and therefore were combined to leave 15 studies to review. Of the radiation therapy group, seven of the nine studies reported low or moderate burnout amongst their participants. One study reported high levels of burnout in the emotional exhaustion and depersonalisation domains, and another reported high emotional exhaustion levels. Within the other MIRS professions, five of the six studies reported moderate burnout. One group of sonographers had high levels of burnout in the emotional exhaustion domain. CONCLUSION: For the past 20 years, levels of burnout in MIRS professionals has remained relatively steady, with the majority of studies reporting moderate levels of burnout. However, more research is needed in radiographers, sonographers and nuclear medicine technologists. IMPLICATIONS FOR PRACTICE: Even though the review indicates moderate level of burnout, this needs addressing on an organisational and individual level to ensure stress in the workplace is managed before burnout becomes a significant issue.

Bilateral phototherapeutic keratectomy for corneal macular dystrophy in an adolescent: case report and review of the literature.

PURPOSE: Phototherapeutic keratectomy (PTK) with 193-nm excimer laser is a safe and effective procedure for the treatment of superficial corneal pathology. We aimed to review the use of PTK for the treatment of corneal macular dystrophy (MCD). METHODS: Case report and literature review. RESULTS: A 16-year-old boy presented to an ophthalmologist with a 4-year history of reduced vision, glare and photophobia in his left eye. He was diagnosed with corneal macular dystrophy and underwent sequencing of the CHST6 gene. Left excimer PTK with mitomycin C was performed. He remained relapse free until 18 months post procedure when his visual acuity declined and the stroma appeared more "milky". He underwent a penetrating keratoplasty in his left eye 24 month following the initial PTK. CONCLUSION: Phototherapeutic keratectomy is an effective means of visual restoration in patients with macular corneal dystrophy and may delay penetrating keratoplasty. Patients should be counselled regarding the high risk of recurrence. This is the first reported case of a CHST6 gene positive patient with MCD that was treated with phototherapeutic keratoplasty.

When 'glaucomatous fields' are not glaucoma: bilateral calcarine fissure strokes masquerading as glaucoma in a normal tension glaucoma suspect.

A 78-year-old man with vascular risk factors and a family history of glaucoma presents with bilateral superior arcuate visual field loss. MRI brain was reported normal. Intraocular pressure (IOP) and optical coherence tomography of the retinal nerve fibre layer (RNFL) were within normal limits. A tentative diagnosis of normal tension glaucoma was made. Over the next 5 years, IOP remained stable without treatment, serial visual fields noted repeatable bilateral superior depressions with normal RNFL. Referral to a glaucoma subspecialist and subsequently neuro-ophthalmologist prompted repeat MRIs, which demonstrated mild small vessel ischaemia. Standard visual evoked potentials (VEPs) were normal. Multifocal VEPs identified poor response across the entire visual field in both eyes. The combination of visual defects, unremarkable RNFL and reduced multifocal VEPs raised suspicion of bilateral inferior calcarine fissure change. Retrospective review of MRI's in a multidisciplinary meeting confirmed extensive microvascular changes with bilateral inferior calcarine fissure ischaemia.

Acute hypertensive uveitis as the first presentation of multiple sclerosis.

Ophthalmic manifestations of multiple sclerosis are frequent including acute optic neuritis, ocular motor disturbances and intermediate uveitis. We report an unusual case of multiple sclerosis presenting as acute hypertensive uveitis. A 56-year-old man was referred by his family doctor with a 2-week history of right eye pain and decreased vision. Best-corrected visual acuity was Count Fingers on the right and 6/9-2 on the left. Intraocular pressure was 55mmHg and 14 mmHg on the right and left respectively. He had a right relative pupillary defect and a left internuclear ophthalmoplegia. Vitreous cells were present in the right eye and there was peripheral sclerosis and periphlebitis superior temporally. MRI Brain and Spine revealed multiple T2 hyperintense lesions consistent with multiple sclerosis. Multiple sclerosis may present initially with an acute elevation of intraocular pressure and intermediate uveitis.

Parinaud syndrome: a 25-year (1991-2016) review of 40 consecutive adult cases.

PURPOSE: To characterize the clinical features, aetiology and management of ophthalmic symptoms in adult patients with Parinaud syndrome. METHODS: This is a retrospective, non-comparative observational case series. We reviewed 40 consecutive charts of adult patients with the clinical diagnosis of Parinaud syndrome at the Royal Adelaide Hospital Department of Ophthalmology in Adelaide, South Australia, between 1991 and 2016. Charts were reviewed for the following: (1) demographic information, (2) clinical presentation, (3) neuro-ophthalmology signs, (4) aetiology of Parinaud syndrome, and (5) management. Examination findings were collected at initial evaluation, throughout the course of follow-up, and at last follow-up. RESULTS: All the cases were assessed by one of the authors (JLC). The commonest presenting symptoms were diplopia (67.5%) and blurred vision (25%) followed by visual field defect (12.5%), ataxia (7.5%) and manifest squint (7.5%). The commonest presenting signs were vertical gaze palsy (100%), convergence-retraction nystagmus (87.5%) and light-near dissociation (65.0%). Only 65.0% patients had the classical triad of vertical gaze palsy, convergence-retraction nystagmus and light-near dissociation. Midbrain pathologies including haemorrhage (30.0%), infarction (20.0%) and tumour (15.0%) were the commonest aetiology. Pineal region tumours accounted for 30.0% of presentations. Symptoms were managed conservatively in 45% of cases with temporary occlusion, prisms or refractive correction, and observation in 42.5% of cases. Surgical intervention for refractory diplopia was required in 12.5% of cases, of which 80% reported symptom resolution following surgery. CONCLUSION: Our series highlights the variable clinical presentation of Parinaud syndrome. The classic triad of conjugate upgaze paralysis, convergence-retraction nystagmus and light-near dissociation was only present in 65% of cases. Pineal neoplasms remain an important aetiological consideration; however, primary midbrain pathology including infarction and haemorrhage constituted the majority of our cases and should be considered in all patients. Conservative management approaches for ocular symptoms are sufficient in most cases although surgical treatment of upgaze palsy can be a useful option in refractory cases.

Intermediate-Term Cataract Surgery Outcomes from Rural Provinces in Lao People's Democratic Republic.

PURPOSE: Limited data are available about cataract surgery outcomes from developing regions in South-East Asia, but are necessary to monitor the impact of ongoing program delivery as outlined in the World Health Organization Vision 2020 directives. METHODS: We conducted a retrospective cohort study of 488 eyes of 449 patients who had undergone cataract surgery in 2011 in Luang Prabang and Xayaboury provinces of northwestern Lao People's Democratic Republic (Lao PDR). The study included 400 eyes of 361 subjects (80.4% of the target population). The main outcomes were presenting and pinhole visual acuity (VA). RESULTS: Subjects' mean age was 68 years (standard deviation 12.1 years); 52.6% were women. Preoperative presenting VA in the operated eye was <6/60 in all patients where presenting VA data was available (76.4%). Presenting VA in the operated eye was >6/18 in 185/400 eyes (46.3%, 95% confidence interval, CI, 41.4-51.2%), <6/18-6/60 in 177/400 (44.3%, 95% CI 39.4-49.2%) and <6/60 in 38/400 (9.5%, 95% CI 6.6-12.4%). VA improved two or more lines in 61/400 eyes (15.3%, 95% CI 11.7-18.8%) with pinhole. Relative afferent pupillary defect was present in 13/400 eyes (3.3%, 95% CI 1.5-5.0%). CONCLUSION: Presenting postoperative VA did not meet the World Health Organization criteria for good outcomes. Further study is required to determine specific factors contributing to adverse outcomes in this population.

A Case of Acute Bilateral Irvine-Gass Syndrome following Uncomplicated Phacoemulsification, Demonstrated with Optical Coherence Tomography.

PURPOSE: To report a case of acute bilateral Irvine-Gass syndrome. METHODS: This is an observational case report. RESULTS: An 82-year-old man with no significant ocular history developed postsurgical pseudophakic cystoid macular edema (CME; Irvine-Gass syndrome) on consecutive phacoemulsification cataract surgeries. His initial first-eye (left) CME developed 25 days after surgery and was managed with topical preparations of dexamethasone 0.1% and ketorolac 0.4%, in addition to a routine post-cataract surgery drop regime. His left CME resolved completely on optical coherence tomography (OCT) by day 100, and he subsequently (after extensive discussion of CME risks) underwent cataract surgery on his right eye. He was commenced prophylactically on dexamethasone, ketorolac and oral indomethacin 25 mg t.d.s. immediately after surgery; however, he later developed CME (OD) on day 32 postoperatively. Within 6 months, he achieved complete resolution of his CME in both eyes. His clinical course was documented with serial OCT studies. CONCLUSION: Irvine-Gass syndrome remains an important differential diagnosis in the evaluation of blurred vision after cataract surgery, despite decreasing incidence. Those who experience CME following their first cataract operation should be counseled about the risks of developing the condition in the contralateral eye, despite prophylactic measures.

Conjunctival Attachment of a Live Paralysis Tick, Ixodes holocyclus, in a Child: A Case Report.

We describe a rare clinical finding of conjunctival tick attachment in a child. A 10-year-old boy presented to the clinic with right-eye itch. He was found to have a live tick firmly attached to his right temporal conjunctiva. The tick was identified as the larval stage of the paralysis tick, Ixodes holocyclus. The tick was removed completely by conjunctival excision. Although various methods of removing a tick have been described in the literature, the goal of treatment is the safe and complete removal of the tick to prevent further transmission of pathogens, allergens, and toxins to the patient.

Comparison of pinhole and SPECT 99mTc-MIBI imaging in primary hyperparathyroidism.

OBJECTIVE: This study aims to compare dual tracer, dual phase pinhole technetium-99m labelled 2-methoxyisobutylisonitrile (Tc-MIBI) imaging (including oblique imaging), with single photon emission computed tomography (SPECT) and dual phase planar Tc-MIBI images, and combined SPECT, dual phase planar Tc-MIBI images and anterior pinhole thyroid images for the localization of parathyroid adenomas in the neck in primary hyperparathyroidism. METHODS: Sixty-two patients underwent Tc-MIBI dual phase, anterior and anterior oblique pinhole images of the neck, anterior planar images of the neck and chest and early phase neck/chest SPECT followed by [Tc] pertechnetate anterior and anterior oblique pinhole thyroid images. Images were reviewed by consensus in three combinations - dual phase anterior and anterior oblique pinhole Tc-MIBI images and pinhole thyroid images; SPECT and dual phase planar Tc-MIBI images and combined SPECT, dual phase planar Tc-MIBI images and anterior pinhole thyroid images. RESULTS: For 52 parathyroid adenomas in 50 patients, the sensitivity of dual phase anterior and anterior oblique pinhole Tc-images and pinhole thyroid images was 81%. Significantly lower sensitivities were observed with SPECT and dual phase planar Tc-MIBI images (54%, P=0.0005) and combined SPECT, dual phase planar Tc-MIBI images and anterior pinhole thyroid images (65%, P=0.0209). The positive predictive value for all imaging combinations was 88-92%. CONCLUSION: Dual phase anterior and anterior oblique pinhole Tc-MIBI images and pinhole thyroid images are significantly more sensitive than imaging combinations that included SPECT and remains the optimal imaging protocol for the localization of parathyroid adenomas in the neck in primary hyperparathyroidism.