Needlestick injuries among electromyographers

The objective of this study was to determine the self‐reported prevalence of needlestick injuries among practicing electromyographers. In January 2008, an anonymous electronic survey was sent to all active members of the American Association for Neuromuscular and Electrodiagnostic Medicine (AANEM) who provided e‐mail addresses to the Association. Eight hundred and eight members (56% neurologists, 43% physiatrists; 97% practicing physicians, 3% trainees) responded, with a response rate of 22% (808 of 3659). The mean number of years in practice, involving electromyography (EMG) at least 1 day per week, was 16 years. A majority of physicians (64%) reported at least one needlestick injury involving EMG, and 8% reported five or more injuries. Needlestick injuries involving patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis B, and/or hepatitis C occurred in 1 of every 11 electromyographers. Nearly half of all respondents (44%) who experienced a needlestick injury stated that they did not report at least one injury event to official centers. Injuries were most likely to occur during a routine procedure (45%) or when a patient moved (26%). The most common preventable reason for injury was a perceived lack of time. Muscle Nerve 38: 1541–1545, 2008     

Intravitreal concentration and clearance of triamcinolone acetonide in nonvitrectomized human eyes

PURPOSE: To determine the intravitreal concentration and clearance of triamcinolone acetonide at various intervals after intravitreal injection into nonvitrectomized eyes. METHODS: Six participants were administered 4 mg (0.1 cc) of triamcinolone acetonide ophthalmic suspension. All six eyes underwent therapeutic pars plana vitrectomy with membranectomy at various post injection intervals ranging from 1.25 to 5 months from the intravitreal injection. Undiluted specimens of vitreous overlying the macula and of aqueous humor were submitted for analysis. Vitreous and aqueous humor concentrations of triamcinolone were measured by high performance liquid chromatography. RESULTS: Four eyes demonstrated detectable intravitreal concentrations of triamcinolone acetonide between 1.25 and 2.75 months after a single injection. Two eyes had an undetectable level of triamcinolone in both the vitreous and aqueous at 3 and 5 months post single injection. CONCLUSIONS: The intravitreal concentration of triamcinolone acetonide is detectable up to 2.75 months post a single 4 mg injection in nonvitrectomized eyes. A reinjection interval of 3 months may be needed to achieve sustained measurable levels of triamcinolone in nonvitrectomized patients.     

Factors affecting visual outcomes after small-incision phacoemulsification in diabetic patients

PURPOSE: To examine the factors affecting visual outcome after phacoemulsification and evaluate the use of preoperative visual potential in assessing the visual prognosis in diabetic patients. SETTING: Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA. METHODS: In a retrospective chart review of 1345 consecutive patients who had uneventful small-incision phacoemulsification, operated eyes from 106 diabetic and 55 nondiabetic control patients were selected. Data on demographics, level of retinopathy, perioperative glycosylated hemoglobin (HbA(Ic)), surgical duration, preoperative best corrected visual acuity (BCVA), and visual potential were collected. RESULTS: The age, sex, preoperative BCVA, and visual potential in the diabetic and control eyes were comparable. Throughout the postoperative period, BCVA was worse of the diabetic group. At 1 year, BCVA was 20/40 in 82.1% of the diabetic group and 94.7% of the control group (P =.01). The most important factors affecting postoperative BCVA included coexisting diabetes and preoperative level of retinopathy. No correlation was found between perioperative and postoperative BCVA. Diabetic patients were less likely than control patients to achieve a BCVA better than or equal to the preoperative visual potential at 4 years (hazard ratio 0.6; 95% confidence interval, 0.4-0.9; P =.011). Patients with nonproliferative diabetic retinopathy were nearly 5 times less likely (P =.023) and patients with proliferative diabetic retinopathy 30 times less likely (P <.0001) to achieve a postoperative BCVA of 20/40 than diabetic patients without retinopathy. CONCLUSIONS: Although uneventful small-incision phacoemulsification improved visual acuity in diabetic patients, this group had an overall worse visual outcome than nondiabetic patients. The most important predictors of visual outcome were coexisting diabetes and the extent of preoperative retinopathy. Methods used to assess preoperative visual potential provided a reasonable estimate of postoperative BCVA in diabetic patients. Given the inverse association between the level of retinopathy and visual outcome, it may be better to perform cataract extraction in diabetic patients during earlier stages of retinopathy.     

Structure Elucidation and Toxicity Analysis of the Byproducts Formed after Biodegradation of Aflatoxins B1 and B2 Using Extracts of Mentha arvensis

The aqueous extracts of leaves and shoots of Mentha arvensis were checked for their potential to biodegrade aflatoxin B1 and B2 (AFB1; 100 µg/L and AFB2; 50 µg/L) through in vitro assays. Overall, the results showed that leaf extract degrades aflatoxins more efficiently than the shoot extract. First, the pH, temperature and incubation time were optimized for maximum degradation by observing this activity at different temperatures between 25 and 60 °C, pH between 2 and 10 and incubation time from 3 to 72 h. In general, an increase in all these parameters significantly increased the percentage of biodegradation. In vitro trials on mature maize stock were performed under optimized conditions, i.e., pH 8, temperature 30 °C and an incubation period of 72 h. The leaf extract resulted in 75% and 80% biodegradation of AFB1 and AFB2, respectively. Whereas the shoot extract degraded both toxins up to 40–48%. The structural elucidation of degraded toxin products by LCMS/MS analysis showed seven degraded products of AFB1 and three of AFB2. MS/MS spectra showed that most of the products were formed by the loss of the methoxy group from the side chain of the benzene ring, the removal of the double bond in the terminal furan ring and the modification of the lactone group, indicating less toxicity compared to the parent compounds. The degraded products showed low toxicity against brine shrimps, confirming that M. arvensis leaf extract has significant potential to biodegrade aflatoxins.     

Endosonographic features of primary esophageal melanoma

Malignant melanoma most commonly arises in the skin; however, primary melanomas can also arise from the mucosal epithelial lining of the gastrointestinal tract. Primary esophageal melanoma is rare and constitutes only 0.1% of primary esophageal tumors. There are only a few reports on the use of endosonography in this condition. We report here a case of a 45‐year‐old male with a history of painful deglutition and describe the endosonographic features of primary esophageal melanoma.