Focal Choroidal Excavation in Retinal Dystrophies

Aim: To investigate the presence of focal choroidal excavation (FCE) in patients with retinitis pigmentosa (RP), Stargardt’s disease (STGD), and Best disease in the Indian population. Methods: This retrospective consecutive case series included 309 eyes of 157 patients with RP (183 eyes), STGD (93 eyes), and Best disease (33 eyes) with good-quality, enhanced-depth spectral domain optical coherence tomography scans. Comprehensive ophthalmic examination data were collected. Characteristics of FCE, including location of FCE, type (conforming and non-conforming), maximal width, and depth, were noted. Results: FCE was found in 2 out of 33 (6%) eyes with Best disease and no FCE was found in eyes with RP or STGD. The location of the FCE was extrafoveal in both cases. The first case had non-conforming FCE while the second case had the conforming type and the FCE occurred in association with choroidal neovascularization in the second case. The first case maintained good visual acuity of 20/20 over the entire period of follow-up (14 months), while the second case had a visual acuity of 20/200 at the last follow-up (three years) due to scarred choroidal neovascular membranes. The FCE showed no change in both eyes over the entire duration of follow-up. Conclusion: Focal choroidal excavation was found in 6% of eyes with Best disease, which remained stable throughout follow up. Eyes with RP and STGD did not have any FCE. Further studies are required to determine the role of vitelliform material in FCE development in Best disease.     

Diffusion MRI Microstructural Abnormalities at Term-Equivalent Age Are Associated with Neurodevelopmental Outcomes at 3 Years of Age in Very Preterm Infants

BACKGROUND AND PURPOSE:Microstructural white matter abnormalities on DTI using Tract-Based Spatial Statistics at term-equivalent age are associated with cognitive and motor outcomes at 2 years of age or younger. However, neurodevelopmental tests administered at such early time points are insufficiently predictive of mild-moderate motor and cognitive impairment at school age. Our objective was to evaluate the microstructural antecedents of cognitive and motor outcomes at 3 years'' corrected age in a cohort of very preterm infants.MATERIALS AND METHODS:We prospectively recruited 101 very preterm infants (<32 weeks'' gestational age) and performed DTI at term-equivalent age. The Differential Ability Scales, 2nd ed, Verbal and Nonverbal subtests, and the Bayley Scales of Infant and Toddler Development, 3rd ed, Motor subtest, were administered at 3 years of age. We correlated DTI metrics from Tract-Based Spatial Statistics with the Bayley Scales of Infant and Toddler Development, 3rd ed, and the Differential Ability Scales, 2nd ed, scores with correction for multiple comparisons.RESULTS:Of the 101 subjects, 84 had high-quality DTI data, and of these, 69 returned for developmental testing (82%). Their mean (SD) gestational age was 28.4 (2.5) weeks, and birth weight was 1121.4 (394.1) g. DTI metrics were significantly associated with Nonverbal Ability in the corpus callosum, posterior thalamic radiations, fornix, and inferior longitudinal fasciculus and with Motor scores in the corpus callosum, internal and external capsules, posterior thalamic radiations, superior and inferior longitudinal fasciculi, cerebral peduncles, and corticospinal tracts.CONCLUSIONS:We identified widespread microstructural white matter abnormalities in very preterm infants at term that were significantly associated with cognitive and motor development at 3 years'' corrected age.

Premature birth is associated with a significantly increased risk of brain abnormalities and long-term neurodevelopmental impairment. Injuries or maturational delays affecting the WM are observed in 50%–80% of very preterm infants.^1-3 These abnormalities are associated with serious neurodevelopmental impairment.^1,3,4 However, such abnormalities are challenging to detect using conventional MR imaging techniques alone. Fortunately, DTI, a specialized form of MR imaging that can sensitively query the brain''s microstructure, offers a novel approach for identifying these WM injuries. In preterm brains, the evolution of fractional anisotropy (FA) and mean diffusivity (MD), 2 metrics derived from DTI, varies from that of normative populations, and underlying brain injury may lead to neurodevelopmental impairment later in life.^4-6Functional MR imaging with the FMRIB Tract-Based Spatial Statistics (TBSS; http://fsl.fmrib.ox.ac.uk/fsl/fslwiki/TBSS) tool uses observer-independent voxelwise statistical analysis to process the complex information contained within diffusion-weighted images.^4-16 TBSS can be used to identify specific WM tracts and structures in the infant brain that correlate with later developmental outcomes.^8,10,13-15 Previous studies have used TBSS to objectively assess WM microstructure following clinical events such as infection, sports injury, or preterm brain injury (eg, intraventricular hemorrhage) and to relate the associated WM alterations to outcomes.^9,11,16-19 In addition, studies have used TBSS to identify brain regions and tracts in which FA significantly correlates with cognitive and motor outcomes at 2 years of age or younger.^10,13,15 These studies have consistently concluded that higher FA is associated with better motor, cognitive, and language functioning.Past studies emphasizing the value of TBSS correlated DTI parameters with neurodevelopmental outcomes derived from the Bayley Scales of Infant and Toddler Development, 3rd ed (Bayley-III) collected at 2 years of age or younger. Such standardized assessments are administered between 18 and 24 months of age, representing the earliest time point at which cognitive, language, and motor development can be reliably ascertained. However, assessment at these earliest ages is not necessarily predictive of school age outcomes.^20-22 For example, the Bayley-III Motor subscale at 2 years of age significantly underestimates rates of motor impairment at 4 years of age in preterm infants.²² Spencer-Smith et al²³ showed that cognitive delay, as assessed by the Bayley-III administered at 2 years of age, was not strongly associated with cognitive impairment at 4 years of age as assessed by the Differential Ability Scales, 2nd ed (DAS-II).²⁴ We propose that correlating FA from term-equivalent age MR imaging with 3-year outcomes may provide a more robust understanding of the early changes in WM microstructure that are also significantly associated with cognitive development.Our objective was to test the hypothesis that WM microstructure, assessed using TBSS at term-corrected age (CA), is associated with neurodevelopmental performance at 3 years'' CA in a regional cohort of very preterm infants.     

Effect of immunomodulating and antiviral agent of medicinal mushrooms (immune assist 24/7) on CD4+ T-lymphocyte counts of HIV-infected patients

Immune enhancement through the use of natural products is a potentially valuable therapeutic modality in HIV-infected people, especially those who are not good candidates for aggressive ARV therapy. One such immune enhancement, a medicinal mushroom product from the United States, is Immune Assist 24/7. In this study the effect of Immune Assist 24/7, which is a naturally derived immune-modulating and antiviral agent, on CD4+ T-lymphocyte counts was evaluated in 8 HIV-infected patients at the Sunyani Regional Hospital (Ghana). The subjects were administered three tablets of 800 mg Immune Assist 24/7 once daily (2.4 g/day) and peripheral blood samples were drawn at baseline, day 30, and day 60, and the CD4+ count measured. The study revealed that Immune Assist 24/7, used as a sole therapeutic agent without additional ARV drugs, significantly increased CD4+ T-lymphocyte populations in all of the patients. In one patient, the CD4+ T-lymphocyte count went from 4 at the baseline, to 170 cells in 60 days, representing an increase of more than 4000%. In another patient, the CD4+ count went from 88 to 470 cells within the same period. Even in the patients with the highest CD4+ counts of around 800, there was a significant elevation in the CD4+ count noted. This study did not deal with the effect of Immune Assist 24/7 on other immune parameters such as CD3+ T-lymphocyte count, natural killer cells count, or viral load among HIV-infected patients. These initial results are promising, and indicate the potential value of further evaluating the effects of Immune Assist 24/7 on other immune parameters and viral load among HIV patients, administered either as a sole therapeutic agent, as an adjuvant with standard ARV therapy, or in comparison with standard ARV therapy alone.     

Magnetic Resonance Angiography in Patients with Brain Infarction

This study evaluated the role of magnetic resonance angiography (MRA) in detecting extra- or intracranial vascular disease in 118 patients with brain infarction and the accuracy of MRA diagnosis when compared with conventional angiography in patients who had both investigations. Magnet ic resonance angiography ruled out extra- and intracranial large vessel disease in 36% of the patients. MRA also demonstrated extra- or intracranial disease in 56% (probably symptomatic in 31, possibly symptomatic in 18, and asymptomatic in 17 patients), and provided no information in 8% of the 118 patients. Among the 176 major vessels visualized by both MRA and conventional angiography, conventional angiography confirmed the presence of 9/10 extracranial and 32/40 intracranial large vessel abnormalit ies detected on MRA. There were two false-negative findings on MRA: occlusion of a distal branch of middle cerebral artery, and an asymptomatic posterior cerebral artery stenosis. Magnetic resonance angiography is a clinically useful method for screening extra- and intracranial disease in patients with brain infarction and selecting high-yield patients for conventional angiography.     

Usage of Accessibility Options for the iPhone and iPad in a Visually Impaired Population

Purpose: The iPad and iPhone have a number of low-vision accessibility features including Siri Voice Assistant, Large Text, Zoom Magnification, Invert Colors, Voice Over, and Speech Selection. We studied their usage within a low-vision population. Methods: Patients were recruited to participate in an IRB-approved survey regarding their usage of the iPad and/or iPhone. Participants met one of the following criteria: best corrected visual acuity (BCVA) of 20/60 or worse, or significant peripheral visual field defects. Results: Thirty-three low-vision patients agreed to participate (mean age 54.3 years). There were 18 different diagnoses represented and the average visual acuity of respondents was 20/119 in the right eye and 20/133 in the left eye. The most commonly used vision accessibility features were Zoom Magnification and Large Text. Conclusions: Although many patients are using the low-vision accessibility features, few are receiving training or recommendations from their eye care specialist.     

Examining the association between exposure to mass media and health insurance enrolment in Ghana

Although previous studies have explored the National Health Insurance Scheme (NHIS) in Ghana, very little attention is paid to the influence of mass media exposure on NHIS enrolment. Yet, understanding this linkage is important, particularly due to the critical role of mass media in disseminating health information and shaping people's health perceptions and choices. Using data from the 2014 Ghana Demographic and Health Survey, we employed logistic regression analysis to understand the relationship between NHIS enrolment and exposure to print media, radio, and television. Our findings indicate that women with more exposure to radio (OR = 1.23, P < 0.01) and television (OR = 1.24, P < 0.01) were more likely to enroll in the NHIS than those with no exposure. For men, more exposure to print media was associated with higher odds of enrolling in the NHIS (OR = 1.41, P < 0.01). In conclusion, all 3 types of media may be helpful in promoting NHIS enrolment in Ghana. However, given that the relationship between media exposure and enrolment in the NHIS was gendered, we recommend that policymakers should pay attention to these dynamics to ensure effective targeting in NHIS media campaigns for increased enrolment into the scheme.     

Behavioral Change Communications on Malaria Prevention in Ghana

The purpose of this study is to assess the various communications strategies designed to promote insecticide-treated nets (ITN) use among pregnant women and children. This study is an exploratory study into the communications activities by institutions involved in malaria prevention in Ghana. In-depth interviews were conducted and the data were analyzed. We found that most of the interventions are aimed at encouraging the target markets to acquire ITNs, although most messages on malaria prevention are not integrated. Several challenges were noted, including financial constraints, lack of human resources, cultural barriers, negative publicity, and negative perceptions on malaria.     

Why remove all cervical polyps and examine them histologically?

A retrospective analysis of 1366 cervical polyps showed that none had malignant features and 67% were removed from asymptomatic women. A policy removing only cervical polyps from symptomatic women or those with abnormal cervical cytology and limiting histological examination to these polyps would result in significant savings and reduce the small risk of morbidity associated with polypectomy.