Granulation tissue in the eyelid margin and conjunctiva in junctional epidermolysis bullosa with features of laryngo-onycho-cutaneous syndrome

Eye and adnexal involvement in epidermolysis bullosa can range from symptoms of mild irritation resulting from conjunctival involvement to severe cicatrization of the ocular surface and adnexa. We describe a unique case of granulation tissue in the eyelid margin and conjunctiva in a patient with junctional epidermolysis bullosa. The eyelid granulation tissue resembled granulomas that seen in laryngo-onycho-cutaneous syndrome, which is caused by a mutation in an isoform of the LAMA3 gene, LAMA3a. On investigation, our patient had a combination of a unique mutation in LAMA3 and the mutation I17N in LAMA3a, providing further evidence that laryngo-onycho-cutaneous syndrome is a variant of junctional EB.     

Culture-proven Aspergillus fumigatus infection in a primary hydroxyapatite orbital implant

Hydroxyapatite orbital implants are widely used in enucleation surgery. Infection in this setting is an uncommon but severe complication. Herein a patient with a 3-year history of chronic socket discharge, orbital discomfort, conjunctival breakdown and implant exposure after enucleation and implantation of a hydroxyapatite sphere 7 years previously is reported. Repeated attempts at covering the exposed implant failed. Eventually the implant was removed, and Aspergillus fumigatus was cultured from the explanted material. This is the second reported case of Aspergillus infection of a hydroxyapatite orbital implant, and the first case where fungal cultures were positive.     

Ultraviolet fluorescence photography: patterns in established pterygia

PURPOSE: To investigate established pterygia using our newly developed ultraviolet fluorescence photography (UVFP) system. DESIGN: Prospective observational case series. METHODS: setting: Prince of Wales Hospital, Sydney, Australia. study population: Fourteen patients (both eyes) attending the Ophthalmology Clinic at Prince of Wales Hospital for assessment of their established pterygia. There were eight men and six women, with an age range of 26 to 62 years. A total of 15 (75%) of 20 had primary pterygia, and five (25%) of 20 had recurrent pterygia. There were no specific exclusion criteria. observation procedures: Ultraviolet and standard (control) photographs were taken of the nasal and temporal interpalpebral regions bilaterally. main outcome measures: The presence of established pterygia detected by standard photography and the corresponding presence and patterns of areas of fluorescence detected by UVFP. RESULTS: In the 14 patients, 20 established pterygia were identified on standard photography. On UVFP, four patterns of fluorescence of established pterygia were identified. Of the 20 pterygia, six (30%) of 20 demonstrated fluorescence at the leading edge of the pterygium, seven (35%) of 20 demonstrated fluorescence at the limbus, three (15%) of 20 demonstrated fluorescence at both the leading edge and the limbus, and four (20%) of 20 demonstrated no visible fluorescence. CONCLUSIONS: In this study, we describe patterns of fluorescence in established pterygia by UVFP. We hypothesize that the areas of fluorescence represent areas of cellular activity within the pterygium. The patterns of fluorescence may be useful to further understand of pterygium growth and pathogenesis.     

MCM-based microlaboratory for simultaneous measurement of several biochemical parameters by spectrophotometry

This paper reports on the concept, fabrication and characterization of a multi-chip module microlaboratory. The application is in the spectrophotometric analysis of human physiological fluids in a clinical setting. The system is composed of three stacked parts: (1) a central microfluidic system die containing the microchannels, which is fabricated by applying MEMS techniques to an SU-8 layer, (2) an optical filtering system on the top side, fabricated using a dielectric thin-films multilayer and (3) a detection and readout system on the bottom side, which is fabricated in a CMOS microelectronic process. The system modularity and emphasis on microfabrication provides potential for low unit cost. The application is the simultaneous and quantitative measurement of the concentration of four biochemical parameters in human physiological fluids by spectrally selective optical absorption. The intensity of the light transmitted through the physiological fluid results in an electrical output signal in the form of bit streams, which allows simple computer interfacing. A simple white light source is used for illumination, due to the optical filtering system, which makes the microlaboratory portable. The quantitative measurement of chloride, creatinine, total protein and uric acid in urine is successfully demonstrated.     

Mental Health First Aid guidelines for helping a suicidal person: a Delphi consensus study in India

Background  

This study aimed to develop guidelines for how a member of the Indian public should provide mental health first aid to a person who is suicidal.     

A population-level application of a method for estimating the timing of HIV acquisition among migrants to Australia

Introduction

Australia has set the goal for the virtual elimination of HIV transmission by the end of 2022, yet accurate information is lacking on the level of HIV transmission occurring among residents. We developed a method for estimating the timing of HIV acquisition among migrants, relative to their arrival in Australia. We then applied this method to surveillance data from the Australian National HIV Registry with the aim of ascertaining the level of HIV transmission among migrants to Australia occurring before and after migration, and to inform appropriate local public health interventions.

Methods

We developed an algorithm incorporating CD4⁺ T-cell decline back-projection and enhanced variables (clinical presentation, past HIV testing history and clinician estimate of the place of HIV acquisition) and compared it to a standard algorithm which uses CD4⁺ T-cell back-projection only. We applied both algorithms to all new HIV diagnoses among migrants to estimate whether HIV infection occurred before or after arrival in Australia.

Results

Between 1 January 2016 and 31 December 2020, 1909 migrants were newly diagnosed with HIV in Australia, 85% were men, and the median age was 33 years. Using the enhanced algorithm, 932 (49%) were estimated to have acquired HIV after arrival in Australia, 629 (33%) before arrival (from overseas), 250 (13%) close to arrival and 98 (5%) were unable to be classified. Using the standard algorithm, 622 (33%) were estimated to have acquired HIV in Australia, 472 (25%) before arrival, 321 (17%) close to arrival and 494 (26%) were unable to be classified.

Conclusions

Using our algorithm, close to half of migrants diagnosed with HIV were estimated to have acquired HIV after arrival in Australia, highlighting the need for tailored culturally appropriate testing and prevention programmes to limit HIV transmission and achieve elimination targets. Our method reduced the proportion of HIV cases unable to be classified and can be adopted in other countries with similar HIV surveillance protocols, to inform epidemiology and elimination efforts.     

Negative symptoms and social skills performance in schizophrenia

The present study aimed to determine whether the negative symptoms of patients with schizophrenia were better predictors of social competence than a range of other variables pertaining to demographics, illness, hospitalization, and premorbid functioning. Independent raters assessed social skills performance on a video-taped role-play test and 5 min conversation in 53 inpatients with a DSM-III diagnosis of schizophrenia. Patients' social skills were also assessed by ward nurses. Project clinicians assessed depression, medication side effects and positive and negative symptoms. Multiple-regression analyses demonstrated that, generally, negative symptoms were the best predictors of social skills performance.     

Toxic epidermal necrolysis: a study of 22 cases

Toxic epidermal necrolysis leads to extensive exfoliative epidermal slough, fever, systemic toxic reactions, conjunctivitis and severe mucous membrane involvement. As it evolves many other organs can be affected. Whether or not toxic epidermal necrolysis is the most severe form of erythema multiform is still a subject of discussion. The pathophysiological events involved are not well understood. Indirect evidence suggests a hypersensitivity reaction, but the search for potential immunological mechanisms has resulted in little data to support this hypothesis. Drug reactions remain the most common associated factor. Twenty-two patients, 3-84 years old, have been included in this retrospective study. In 15 patients, clinical evidence points to drugs as the most important cause of toxic epidermal necrolysis. Recent infections were implicated in three patients and ulcerative colitis and lymphoma in one case each. Symptomatic therapy included fluid replacement, nutritional support and local treatment. Steroids were administered in 13 patients, followed by plasmapheresis in three. The mortality rate was approximately 27%. Elderly patients and patients with extensive lesions were at greater risk. Results of immunofluorescence and immunoblot analysis were of no significant interest.