Detection of glaucoma-like optic discs in a diabetes teleretinal program.

BACKGROUND: Glaucoma is typically an insidious-onset disease with serious visual consequences that has been positively linked to diabetes mellitus (DM) in several studies. We assessed the sensitivity and specificity of a diabetes teleretinal program to identify the glaucoma-suspicious optic disc. METHODS: Outpatients with DM (N = 1,644) presenting to Veterans Affairs ambulatory clinics participated in a nonmydriatic digital retinal imaging (NMDRI) program. Technicians transmitted digital retinal images electronically to readers for grading and eye care recommendations. Patients were referred for ophthalmic care based on the level of diabetic retinopathy and other ocular findings, including optic nerve changes suspicious for glaucoma. We retrospectively reviewed the electronic medical records of patients labeled as glaucoma suspects (N = 175) and compared them with those of patients from the same imaging pool who were not regarded as glaucoma suspects (N = 175). Ophthalmic data obtained from a comprehensive eye examination after digital retinal imaging was used to determine which patients met predefined criteria for the optic disc suggestive of glaucoma. RESULTS: Assessment of clinical data obtained after NMDRI found that 103 of 175 (59%) glaucoma suspects had glaucoma-suspicious optic discs. In the comparison group, only 7 of 175 (4%) had glaucoma-suspicious optic discs. CONCLUSIONS: Although specificity was high (96%), modifications in diabetes teleretinal imaging programs are needed to improve the sensitivity of detecting the optic disc that is suspicious for glaucoma.     

Seroprevalence of canine heartworm disease in Kerman, southeastern Iran

Canine dirofilariosis is presumed to be enzootic in different parts of Iran but no study has been done regarding the prevalence of canine dirofilariosis in southeastern Iran. In this study, the presence of Dirofilaria immitis circulating antigen was detected using a commercial immunochromatogeraphy kit in the sera of 100 owned dogs, which were referred to Kerman Veterinary Hospital during a 6-month period. Modified knott test and follow-up radiography and electrocardiography were performed to support the heartworm diagnosis in seropositive dogs. At the same period, 98 stray dogs were subjected to post-mortem examination of the heart, pulmonary arteries, thoracic venae cavae, and lungs for detection of adult heartworm infection. The overall seroprevalence of heartworm was estimated at 5% but only two seropositive dogs showed microfilaremia. No stray dog was infected at necropsy and all seropositive dogs were owned. The prevalence of heartworm disease showed an initial increase with age fallowed by a decline in dogs older than 6 years. There were no significant differences among the dogs regarding sex and breed. Seven infected dogs (70%) were symptomatic in physical examination, and a broad spectrum of specific clinical signs of cardiovascular involvement was noticed. Distinctive radiographic signs with varied degrees of severity were seen in 50% of cases. Electrocardiography of seropositive cases revealed specific signs of right-sided cardiomegaly in 30% of cases. In conclusion, Kerman is a low endemic area for canine dirofilariosis but further epidemiological researches are needed to identify the disease distribution and human cases in southeastern Iran.     

Comparison of the Effect of Azithromycin Versus Erythromycin on Antroduodenal Pressure Profiles of Patients with Chronic Functional Gastrointestinal Pain and Gastroparesis

Background  

Current pharmacologic treatments for gastroparesis have been disappointing due to the limited options available. Erythromycin ethylsuccinate is a potent prokinetic agent that stimulates gastric emptying. Recently, erythromycin has been linked to the occurrences of sudden cardiac death due to QT prolongation. Azithromycin is similar to erythromycin in structure but does not have significant drug–drug interactions as seen with erythromycin.     

Genetic relatedness of Enterococcus faecalis isolates with high-level gentamicin resistance from patients with bacteraemia in the south east of Sweden 1994-2001

High-level gentamicin resistant (HLGR) enterococci (Enterococcus faecalis and Enterococcus faecium) have become a substantial nosocomial problem in many countries. In this study, we investigated the prevalence of HLGR enterococci and their genetic relatedness in blood culture isolates from patients with bacteraemia admitted to the 3 hospitals in Osterg?tland, a county in the south east of Sweden, during 1994-2001. 36 of 250 E. faecalis (14%,) and 4 of 106 E. faecium isolates (4%) were shown by PCR to carry the aac(6')-Ie-aph(2")-Ia aminoglycoside modifying gene and these isolates were also classified as HLGR enterococci by the gentamicin antibiotic disk diffusion method. A majority of HLGR E. faecalis isolates (83%) belonged to the same cluster of genetically related isolates, according to the pulsed-field gel electrophoresis (PFGE) patterns, whereas all 4 HLGR E. faecium isolates had unique PFGE patterns. In conclusion, our study showed that in contrast to studies from many other countries, the presence of HLGR enterococci was more common in E. faecalis than in E. faecium and appeared the first time in 1996 and 1999, respectively. Bacteraemia with HLGR enterococci in Osterg?tland was mainly due to the spread of a cluster of related E. faecalis strains.     

Fatal Co-infections with SARS-CoV-2 and Legionella pneumophila,England

Both Legionella pneumophila and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pneumonia. L. pneumophila is acquired from water sources, sometimes in healthcare settings. We report 2 fatal cases of L. pneumophila and SARS-CoV-2 co-infection in England. Clinicians should be aware of possible L. pneumophila infections among SARS-CoV-2 patients.