Carlevale and retropupillary iris-claw Artisan intra-ocular lenses (IOLs) treat aphakia without capsular support, but their relative performance is uncertain. PubMed, Embase and the Cochrane Library were searched to March 2025. Primary outcomes: best-corrected visual acuity (BCVA), surgically induced astigmatism (SIA), mean absolute refractive error (MARE) and mean refractive error (MRE). Secondary outcomes: operating time and postoperative complications. Random-effects meta-analysis with I² and incision-type subgroups was performed. Five studies comprising 631 eyes (229 Carlevale, 402 iris-claw) met inclusion criteria. Mean age was 70.1 ± 14.1 years, 61.18
BACKGROUND:Apathy, depression and anhedonia are clinically overlapping constructs, which hinders diagnostic clarity and treatment development. This study aimed to comprehensively characterise these syndromes to identify a core set of non-redundant symptoms that maximally dissociate them and to investigate the psychological nature of key distinguishing features. METHODS:Data from seven datasets (N=4578) of healthy individuals and patients with major depressive disorder were analysed using the Apathy Motivation Index, Beck Depression Inventory and Snaith-Hamilton Pleasure Scale. A machine-learning algorithm identified the most informative, non-redundant items for dissociating 'pure' apathy, depression and anhedonia. The nature of emotional apathy was further investigated with follow-up studies. RESULTS:Although substantial symptom overlap existed, 'pure' syndromes were present. Factor analysis revealed a robust five-factor structure, separating depression, anhedonia and three distinct apathy domains (behavioural, social and emotional). Machine learning identified 10 core symptoms that differentiated the pure syndromes with high accuracy (area under the curve >0.90) and could also identify well the presence of each syndrome in individuals suffering from two or more syndromes. Emotional apathy negatively correlated with depression and was specifically associated with reduced affective empathy and a diminished sensitivity to the intensity of negative facial emotions, rather than with alexithymia or antidepressant-induced emotional blunting. CONCLUSIONS:Apathy, depression and anhedonia are dissociable constructs with distinct symptom signatures. Emotional apathy is a unique dimension which provides a novel target for research. A 10-item Apathy-Depression-Anhedonia Measure developed here provides a pragmatic tool for rapid, precise phenotyping to guide more personalised therapeutic strategies.
Congenital myasthenic syndromes (CMS) are a rare, heterogeneous group of disorders caused by pathogenic variants in genes encoding proteins essential for neuromuscular transmission. DOK7 variants are among the most common causes of CMS and one of the subtypes that may worsen with pyridostigmine. We report two patients who presented in adulthood with fatigable limb girdle weakness, initially diagnosed with seronegative myasthenia gravis, who slowly progressed over time despite escalating treatment and eventually needed intensive care admission. Revisiting the history led to the diagnosis of DOK7 CMS. Both patients improved after stopping immunosuppressants and pyridostigmine and starting salbutamol. These cases highlight the importance of considering CMS in patients with seronegative myasthenia gravis.
TOPIC:Pterygium is a common ocular surface disorder that can impair vision and cause discomfort. Surgical excision with conjunctival autograft (CAG) is the standard treatment. CLINICAL RELEVANCE:Despite the widespread use of CAG, postoperative recurrence and graft-related complications remain significant challenges, affecting patient outcomes and healthcare resource utilization. In primary pterygium surgery, CAG fixation can be achieved using fibrin glue (FG), autologous blood, autologous FG (a_FG), or sutures (Vicryl, nylon, silk), yet the comparative effects of these techniques on recurrence, graft stability, and postoperative complications are not well established. METHODS:A systematic search of PubMed, Embase, Scopus, and Cochrane Library was conducted up to October 22, 2024, to identify randomized controlled trials (RCTs) comparing CAG fixation methods in primary pterygium surgery. Studies evaluating FG, autologous blood, a_FG, nylon, silk, or Vicryl sutures were included. Primary outcomes were recurrence, graft failure, and granuloma formation; secondary outcomes were graft dehiscence, displacement, and retraction. A frequentist network metaanalysis was performed in R, with results expressed as odds ratios (OR) with 95% confidence intervals (CI), and treatment rankings determined using P-scores. Quality assessments were performed using the Cochrane RoB 2 tool, GRADE, funnel plots and Egger 's test. The protocol was registered in PROSPERO (CRD42024611035). RESULTS:We analyzed 35 RCTs including 2501 eyes: FG (n = 681), a_FG (n = 94), autologous blood (n = 797), silk (n = 54), nylon (n = 504) and Vicryl sutures (n = 371). FG significantly reduced recurrence compared to Vicryl (OR: 0.39; 95% CI: 0.22-0.69), nylon (OR: 0.38; 95% CI: 0.18-0.82), and autologous blood (OR: 0.52; 95% CI: 0.28-0.96). a_FG was associated with the highest odds of graft failure versus Vicryl (OR: 51.01; 95% CI: 1.36-1919.74), whereas Vicryl ranked best for minimizing graft failure. For granuloma formation, FG showed lower odds compared to silk (OR: 0.11; 95% CI: 0.01-0.98). Secondary outcomes revealed that Vicryl had favorable graft stability, while autologous blood carried higher risks of displacement and dehiscence. No significant publication bias was detected. CONCLUSION:FG demonstrates the most favorable profile for reducing recurrence, whereas Vicryl provides superior graft stability. Autologous blood may be considered selectively but carries higher graft-related risks. These findings support individualized selection of fixation methods based on patient-specific risk profiles and resource availability in primary pterygium surgery.
Contrast echocardiography encompasses two forms of ultrasound contrast agents. This article focuses on agitated saline (AS-C) contrast, commonly called ‘bubble’ contrast. Its main application is in identifying the presence of a right to left shunt in a number of clinical syndromes, often associated with a patent foramen ovale (PFO). Dependant on the clinical presentation, the presence of a PFO with a likelihood of a causal role may be considered for percutaneous PFO closure. This guideline outlines a structured approach to performing an AS-C transthoracic echocardiogram, including the indications, protocols, and potential pitfalls for performing AS-C transthoracic echocardiography (TTE). It also addresses when to proceed to more advanced imaging modalities and highlights clinical decision-making frameworks such as the RoPE score.
