PURPOSE. To investigate the diurnal variations of episcleral venous pressure (EVP) and its relationships with IOP, blood pressure, and heart rate in healthy and systemic hypertension subjects. METHODS. Twenty healthy adults and eight patients taking systemic antihypertensive medications were enrolled. IOP and EVP of both eyes, systolic and diastolic blood pressure (SBP and DBP), and heart rate (HR), were measured at five time points, every two hours from 8 AM to 4 PM. IOP was measured by pneumatonometry, and EVP was assessed using a computer-controlled episcleral venomanometer with video recording and image processing. Changes in measurements at each time point were compared with baseline (8 AM) by using generalized estimating equation models. Correlations between EVP and other variables were determined using linear regression analysis. RESULTS. EVP and IOP were highest in the early morning (8 AM) and lowest in the late afternoon (4 PM), with statistically significant changes (P < 0.05) across all time points compared to baseline in normotensive subjects. Changes in EVP and IOP were correlated at all time points. In treated systemic hypertensive subjects, similar trends were observed, with significant IOP and EVP correlations at multiple time points. No clear pattern of correlation was noted between EVP, SBP, DBP, and HR in all subjects. CONCLUSIONS. IOP and EVP follow a diurnal rhythm with the highest values in the early morning, which gradually decrease throughout the day. The relationship between IOP and EVP suggests that reduction of EVP can be an important target for clinical regulation and stability of IOP.

Diabetes provides an underlying basis for the inability of the body to control infection. Candida albi¬cans has been reported to colonize and cause severe infections in patients with diabetes. This study aimed to evaluate the presence of virulence and antifungal resistance among C. albicans isolates from subjects with type 2 diabetes. Two hundred forty-five and one hundred non-repeat samples were collected from diabetic and non-diabetic subjects, respectively. Cultural and molecular methods were used to confirm the identity of C. albicans isolated from the urine, saliva, and wound samples of the subjects. The presence of virulence factors among the isolated C. albicans and their susceptibility to antifungals were detected using standard microbiological methods. Of the 345 subjects screened in this study, 123 (35.65%) were male, and 222 (64.35%) were female. The prevalence of Candida species was highest among subjects within the 31- 59 years age group. Candida species were recovered from 149 and 49 diabetic and non-diabetic patients, respectively. Apart from C. albicans [n=112 (56.57%)], C. glabrata (n=46 [23.23%]), C. tropicalis [n=13 (6.57%)], and C. krusei [n=5 (2.53%)] also recovered from the subjects. In this study, non-albicans Can¬dida had a lower percentage of virulence factors than C. albicans. Most of the isolates were susceptible to fluconazole and nystatin. There was a correlation between diabetes and C. albicans infections. Candida albicans from diabetic patients were more resistant to the tested antifungals than those from non-diabetic subjects.

Purpose: The goal of this study was to determine changes in best-corrected visual acuity (BCVA), refractive error, and central corneal thickness (CCT) during the first decade after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Outcomes of all consecutive eyes undergoing DSAEK for Fuchs endothelial corneal dystrophy (FECD) were reviewed; eyes with untreatable comorbidities before DSAEK were excluded. DSAEK was performed through a temporal incision and all eyes were pseudophakic postoperatively. Changes in BCVA, manifest spherical equivalent, manifest cylinder (vector analysis), and CCT were assessed by using generalized estimating equation models. Results: BCVA improved between 6 months (0.18 ± 0.12 logarithm of the minimum angle of resolution (logMAR); Snellen equivalent, 20/30) and 5 years (0.10 ± 0.10 logMAR; 20/25; n = 74, P < 0.001) and then remained stable at 10 years (0.09 ± 0.10 logMAR, n = 48, P = 0.22). There was a myopic shift of −0.20 ± 0.51 D between 6 months and 5 years (n = 65, P = 0.002) that remained stable at 10 years (−0.09 ± 0.44 D; 20/25; n = 34, P = 0.33). Manifest cylinder drifted with-the-rule between 6 months and 5 years (n = 65, P < 0.001) and between 5 and 10 years (n = 34, P < 0.001). CCT was stable between 6 months (672 ± 57 μm) and 5 years (677 ± 55 μm, n = 67, P = 0.47), but increased at 10 years (702 ± 60 μm, n = 39, P = 0.001). Conclusions: Excellent BCVA can be achieved during the first decade after DSAEK for FECD, although improvement seems to plateau after 5 years. Changes in manifest refractive error were not clinically significant. The gradual increase in CCT was consistent with longer-term changes found after other types of keratoplasty.

Abstract Background There are no robust data addressing the United States (US) experience with the 0/2 hours (h) European Society of Cardiology (ESC) algorithm using high-sensitivity cardiac troponin T (hs-cTnT). Purpose To evaluate the diagnostic performance of the 0/2h ESC-recommended absolute deltas in a US population. Methods Observational US cohort study of ED patients undergoing 0 and 2 h hs-cTnT measurements. The 99th percentiles upper reference limits (URL) used were 10 ng/L for women and 15 ng/L for men. Diagnostic outcomes were the adjudicated diagnoses of acute myocardial infarction (MI, type 1 or 2). Results A total of 1084 patients met inclusion criteria, amongst which 49% were women. Chest discomfort was reported in 521 (48%) patients. Among patients with a baseline hs-cTnT≤99th URL (n=434), 4 MIs occurred. To rule-out MI, an absolute 0-2h delta change <4 ng/L resulted in a sensitivity of 100% (95% CI: 39.8, 100) and a negative predictive value (NPV) of 100% (95% CI: 99.1, 100). To rule-in MI, an absolute 0-2h delta ≥10 ng/L had a specificity of 99.8 % (95% CI: 98.7, 99.9) and positive predictive value (PPV) of 75% (95% CI: 19.4, 99.4). Among patients with a baseline hs-cTnT >99th URL (n=650), 110 MIs occurred. In these patients, both rule-out (sensitivity 65%, NPV 91%) and rule-in (specificity 7.2%, PPV 11%) were poor using the ESC-recommended absolute deltas. Among patients with modest hs-cTnT increases (99th URL to 100 ng/L) neither the ESC-recommended absolute nor the Fourth Universal Definition of MI (UDMI)-recommended relative deltas provided acceptable performance. Among patients with marked hs-cTnT increases at presentation (>100 ng/L), a relative delta change >20% as recommended by the UDMI resulted in a superior rule-in performance, with a specificity of 92.0% (95% CI 74.0, 99.0) and PPV of 84.6% (57.4, 95.7). Conclusions In our unselected US-cohort of patients undergoing hs-cTnT, the 0/2h ESC algorithm had a good diagnostic performance in patients without myocardial injury at presentation. Conversely, in patients with myocardial injury at baseline, the ESC-recommended absolute deltas performed poorly to determine who had MI. In patients with marked hs-cTnT increases >100 ng/L at presentation, the UDMI recommended 20% relative change showed good rule-in performance.

In 2010 and 2012, between June and October (the peak period of enterovirus circulation in Nigeria), 59 archived enterovirus isolates (recovered as part of the Acute Flaccid Paralysis surveillance program) were randomly selected and typed in this study. All isolates were subjected to RNA extraction, cDNA synthesis and VP1 amplification (nested) and sequencing. Of the 59 isolates, 45 (21 and 24 of the isolates from 2010 to 2012, respectively) had the expected band size (∼350 bp). Forty-three (43) (19 and 24 from 2010 to 2012, respectively) of the amplicons generated were successfully identified and all typed as Enterovirus species B (EV-B) members belonging to twenty (20) different types. The most commonly detected were Echovirus 11 (E11) (9 isolates) and E30 (4 isolates). Many EV-B clades detected show evidence of cross-border transmission in humans within Africa and international spread. Evidence of possible zooanthroponosis/anthropozoonosis between human and nonhuman primates in one EV-B lineage is also reported.

Purpose:To develop a model to predict corneal improvement after Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial corneal dystrophy (FECD) from Scheimpflug tomography. Design:Cross-sectional study. Participants:Forty-eight eyes (derivation group) and 45 eyes (validation group) with a range of severity of FECD undergoing DMEK. Methods:Scheimpflug images were obtained before and after DMEK. Before DMEK, pachymetry map and posterior elevation map patterns were quantified by a special image analysis program measuring tomographic features of edema (loss of regular isopachs, displacement of the thinnest point of the cornea, posterior surface depression). Image-derived novel parameters were combined with instrument-derived parameters, and the relative influences of parameters associated with the change in central corneal thickness (CCT) after DMEK in the derivation group were determined by using a gradient boosting machine learning model. The parameters with highest relative influence were then fit in a linear regression model. The derived model was applied to the validation group. Correlations and agreement were assessed between predicted and observed changes in CCT. Main Outcome Measures:Predictive power (R 2) and mean difference between predicted and observed change in CCT. Results:The gradient boosting machine model identified 4 novel parameters of isopach circularity and eccentricity and 1 instrument-derived parameter (posterior surface radius); preoperative CCT was a poor predictor. In the derivation group, the model strongly predicted the change in CCT after DMEK (R 2 = 0.80; 95% confidence interval [CI], 0.71-0.89) and the mean difference between predicted and observed change was, by definition, 0 μm. When the same 5 parameters were fit to the validation group, the model performed very highly (R 2 = 0.89; 95% CI, 0.84-0.94). When the coefficient estimates from the derivation model were used to predict the change in CCT in the validation group, the predictive power was also high (R 2 = 0.78; 95% CI, 0.68-0.88), and the mean difference was 4 μm (predicted minus observed). Conclusions:Scheimpflug tomography maps of corneas with FECD can predict the improvement in CCT after DMEK, independent of preoperative corneal thickness measurement. The model could be applied in clinical practice or for clinical research of FECD.

The incidence of Candida species has increased among females of child bearing age over the years. There has also been an increase in the resistance of these Candida species to the antifungal drugs used to treat them. This study is aimed at detecting the prevalence of Candida species among patients with urinary tract infections (UTI) attending gynecological unit of Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria. The distribution of pathogenic factors and the antifungal resistance pattern of the isolates were also determined. A total of 61 subjects of different ages and socioeconomic status attending the health facility were enrolled in this study. Samples of high vaginal swab (HVS) were collected from each of the participant and screened. A total of 36 candidal isolates were recovered from the samples out of which 11 (30.5%) were predominantly Candida albican, 5 (13.9%) Candida krusei, 4 (11.1%) Candida glabrata, 2 (5.6%) Candida tropicalis and 14 (38.9%) were not identified beyond the genus level. Ten (27.8%) of the isolates were not able to produce biofilm. Out of those that produce biofilm 17 (47.2%) produced weak biofilm, 5 (8.2%) produced moderate biofilm, while 4 (11.1%) produced strong biofilm. Spectrophotometer was used to quantify those that produce biofilm 9 (25%) produced moderate biofilm while 16 (44.4%) produced strong biofilm. The isolates were subjected to various pathogenicity tests which include haemolysis, catalase, phospholipase and hydrolysis. This test shows that Candida species has the highest percentage to the entire test while none of C. glabrata produced haemolysin and phospholipase. Antifungal assay was then carried out on the entire organisms showed Candida albicans to have low resistance to the azoles drugs while the non-albican Candida shows higher resistance to it. Extremely high prevalence of Candida albicans and Candida species were documented in this study. These findings should be taken into account in further research concerning presence of Candida among patient with sexually transmitted disease in Nigeria.

Purpose: To examine the impact of physician face mask use on the rates and outcomes of postinjection endophthalmitis. Methods: A multicenter retrospective, comparative cohort study comparing endophthalmitis rate and visual acuity of eyes that developed endophthalmitis after antivascular endothelial growth factor injections at Mayo Clinic Rochester (MCR) and at Mayo Clinic Health System sites depending on physician masking. Results: A total of 164,824 injections were performed at MCR and Mayo Clinic Health System sites. Of these, 66,098 injections were in the no mask group and 98,726 injections were in the mask group. Overall, there were no differences in the rates of infectious endophthalmitis in the no mask versus mask cohorts (overall: no mask: 20 cases [0.0303%] vs. mask: 41 cases (0.0415%); P = 0.24; infectious: no mask: 12 cases [0.018%] versus mask: 13 cases [0.0132%]; P = 0.42). At MCR alone, there was a significant reduction in infectious endophthalmitis between the no mask versus mask groups (no mask: 9 cases [0.0297%] versus mask: 2 cases [0.003%]; P < 0.001). Only 2 cases of infectious endophthalmitis occurred at MCR after the face mask policy was implemented (1 in 30,000 injections). At presentation and at 6 months, the average visual acuity was similar for patients who developed endophthalmitis between the no mask versus mask groups. Conclusion: Physician face mask use did not affect the rate or outcome of postinjection endophthalmitis. However, there was a significant reduction at MCR after masking along with other quality improvement measures, including performance of injections in a dedicated procedure room and preparation of patients by nurses, that led to a low rate of endophthalmitis.

The objective is to define the clinical echocardiographic characteristics and cardiovascular outcome in patients with acute heart failure (HF) with versus without diabetes mellitus (DM). Demographic, clinical, laboratory, and echocardiographic data were collected in Olmsted County adults hospitalized for acute HF between 2005 and 2008. Analyses were performed for mortality and acute HF hospitalization outcomes stratified by diabetic status, systolic function, and diastolic function. There were 912 subjects who met inclusion criteria, and mean age was 79 (SD 13.1) years with 53% women. Prevalence of DM was 42% in the study population, and those with DM had worse diastolic function and increased mortality and HF rehospitalization. Among those with DM and acute HF, reduced left ventricular ejection fraction and worse diastolic function conferred increased HF rehospitalization (p = 0.010 and p = 0.022, respectively). In conclusion, DM is common in those hospitalized for acute HF and is associated with worse long-term clinical outcomes. The subgroup of DM with acute HF and left ventricular systolic dysfunction or diastolic dysfunction had worse HF rehospitalization outcomes. (C) 2021 Elsevier Inc. All rights reserved.

Abstract Background Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. Methods In a retrospective study based on a U.S. national registry, we determined the anti–SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti–SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. Results Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti–SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). Conclusions Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti–SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT04338360.)

PURPOSE:To determine if agreement between subjective interpretations of Scheimpflug tomography maps of corneas with Fuchs endothelial corneal dystrophy (FECD) is affected by daily and hourly changes in corneal edema. DESIGN:Reliability analysis. METHODS:Scheimpflug imaging pachymetry and posterior elevation maps of corneas with a range of severity of FECD were evaluated in a randomized manner for the presence of 3 tomographic features of edema. Agreement between interpretations of 1 masked observer was assessed (percentage, and κ-statistic with 95% confidence interval) for images taken within minutes on the same day, for images taken at a similar time on a different day, and for images taken over the course of a morning. Intra- and interobserver agreement was also assessed. RESULTS:Interpretations for individual tomographic features agreed for ≥88% of images (κ ≥ 0.75) taken within minutes on the same day; complete disagreement (ie, disagreement for all 3 tomographic features in an image) occurred in ≤3% of images. Interpretations agreed for ≥77% of images (κ ≥ 0.52) taken at a similar time on a different day; complete disagreement did not occur. Interpretations agreed for ≥81% of images (κ ≥ 0.61) taken over the course of a morning; complete disagreement occurred in ≤6% of images. Intraobserver agreement was ≥93% (κ ≥ 0.83) and interobserver agreement was ≥93% (κ ≥ 0.66); complete disagreement did not occur. CONCLUSIONS:Subjective interpretation of Scheimpflug images in FECD is highly repeatable for disease classification. Although small variations in interpretations resulted from pathophysiologic changes in corneal hydration and other factors, clinically significant disagreements in interpretation were uncommon and therefore unlikely to affect clinical decision-making.

Incidence dandruff among students of a tertiary school was assessed in this study. A standard questionnaire was used to get demographic data while standard microbiological methods were used to identify organisms associated with the infection. Virulence factors and resistance of the isolates to different antifungal agents were also determined. Seventy-eight (65.55 %) out of 119 students sampled had dandruff while dermatophytes were isolated from only 32 (41.07 %). The highest occurrence of dandruff was observed among the age group of 21-25 years with 32 (71.11%) followed by 20 (60.61%) found among 31-35 age group. A total of 108 (90.76 %) of the subjects were single while 9.24 % (n=11) were married. Dry flakes with itching are the highest sign and symptoms among the subject with 71 (91.03 %). A total of 23 (29.29 %) used shampoo as an intervention for dandruff treatment. Two genera of dermatophytes were recovered in this study. The occurrence of Trichophyton was more than Microsporum.The isolates presented different virulence factors. None of the isolates was susceptible to clotrimazole while all Trichophyton were resistant to fluconazole. Nystatin followed by ketoconazole had good inhibitory effects on the isolates. The knowledge of the efficient screening, management, reduction, and treatment of the dermatophytic infection should be fruitful in the future

Disinfection of water is important in the control of waterborne diseases. It is used to kill or inactivate microorganisms in a gradual process that involves a number of physical–chemical and biochemical processes. The effects of sub-lethal gamma irradiation on survival and resistant pattern of two indicator organisms used in assessing water quality: Enterococcus faecalis and Escherichia coli were investigated in this study. Plate count agar and disc diffusion methods were used to determine the load and antibiotics susceptibility pattern of the test organisms respectively before and after exposure to different doses of gamma irradiation in sachet water samples. Survival pattern of the two indicator organisms to gamma- ray showed a decline in the populations of the organisms with time compared to the controls (non-radiated). The effect of the irradiation on the E. coli was dose dependent, it initially responded to the effects of the irradiation in the first 4 days of exposure compared to the control. On exposure to 4 and 5 gy gamma rays a minimum population was reached on the 7th day. At p<0.05 the population of E. coli was significantly different from the control. The survival pattern of Ent. faecalis also followed a similar growth pattern. The application sub-lethal gamma irradiation did reduce the population of the isolates and also affect the antibiotic susceptibility of the isolates.

weight loss candidate drugs may need to have significant and sustained effects on central dopamine systems that mediate food reward to be successful.We have developed a functional screening assay for brain dopamine neurotransmission kinetics as a predictor of weight loss drug efficacy using primary dissociated midbrain dopamine neurons isolated from neonatal rats or mice which we treat in vitro.We also use acute coronal slices containing dopamine terminals from brain sites associated with the encoding of drug reward: nucleus accumbens (Nac), dorsal striatum (DS) and medial prefrontal cortex.We measure dopamine exocytosis in real time by carbon fiber microelectrodes assessing the effects of in vivo drug treatments or to select for drugs that can modulate dopamine kinetics when applied ex-vivo.We have demonstrated evoked dopamine release by brain slices derived from diet-induced obese rats to be significantly attenuated (0.8±0.1 vs 44±11 x10^6 molecules in DS, high fat vs control diet).In BDNF deficient mice, which are obese and hyperphagic, Nac evoked dopamine release was impaired by 64%, consistent with our overall hypothesis of "dopamine deficiency" in obesity.Treatment of Nac slices (mice) with AM251 (3uM), a cannabinoid receptor 1 antagonist with anti-obesity effects, resulted in significant increases of evoked dopamine release (3.8±1.2 vs 21.6±3.6 x10^6 molecules, vehicle vs AM251).As proof of principle, we directly examined whether an overall increase in brain dopamine availability could reduce appetite and body weight.We treated rats with Levodopa (L-DOPA) supplemented in the drinking water (5 mg/ml) for 10 weeks.Resulting body weights were 244.5 ± 4.5 g for L-DOPA vs 264.2 ± 5.9 g for vehicle (p<0.05).Over the course of the study, the L-DOPA treated animals ate approximately 7% less than controls.Electrically evoked dopamine release from the NAc was 275% greater for the L-DOPA treated animals (p

Bioflocculants of microbial origin have the advantage of being safe, biodegradable and harmless to the environment. Production of bioflocculant by two fungi isolates and the factors affecting its production were investigated in this study. Primary screening of fungi for the production of bioflocculants, efficiencies and conditions for the optimum production of the bioflocculants were determined using standard microbiological and chemical methods. Aspergillus flavus MCB 271 and Aspergillus niger MCBF 08 were the best bioflocculant producers among the fourteen fungal isolates screened. Aspergillus flavus optimally produced bioflocculant with glucose and peptone as sole carbon and nitrogen sources respectively. Calcium ions (Ca2+) at 78.4% served as best cation sources for bioflocculant production with optimal pH of 7 and temperature of 40°C. Aspergillus niger MCBF 08 produced bioflocculant optimally when the media had peptone as a nitrogen source and maltose as a sole carbon source. The two species achieved the maximum flocculating activity of 97% (A. flavus MCBF 271) and 86% (A. niger MCBF 08) at pH values of 7 on the 3rd day of the study and caused a reduction in bacterial load of the wastewater samples by 58.73% and 60.85% respectively. These bioflocculants are thus potential replacement for synthetic flocculants conventionally used for wastewater treatment.