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Anisocoria Following Uncomplicated Cataract Surgery. 无并发症白内障手术后的失明。
Jennifer Larson, Madeline Arzbecker

Introduction: In this report, we describe a case of anisocoria following uncomplicated cataract surgery. Clinicians should consider postoperative mechanical and tonic pupils when evaluating patients with anisocoria.

Case presentation: A 69-year-old White female underwent uncomplicated cataract surgery of her left eye. No intraoperative pupil expansion devices were used, and no floppy iris or iris prolapse occurred during the surgery. Postoperatively, she was found to have anisocoria. Pharmacologic pupillary testing confirmed a tonic and mechanical left pupil.

Discussion: There have been no reported causes of anisocoria from a tonic pupil after cataract surgery. Based on reports of tonic pupils following other eye surgeries, our case likely occurred from a combination of parasympathetic dysfunction and mechanical trauma.

Conclusions: To our knowledge, this is the first report of a tonic pupil following cataract surgery, thus expanding the literature of causes of anisocoria that may be underrecognized in the clinical setting.

导言:在本报告中,我们描述了一例无并发症白内障手术后的异视。临床医生在评估异视患者时应考虑术后机械性瞳孔和强直性瞳孔:一名 69 岁的白人女性接受了左眼无并发症白内障手术。术中没有使用扩瞳装置,也没有发生虹膜松动或虹膜脱垂。术后发现她有异视。药理瞳孔测试证实左侧瞳孔为强直性机械性瞳孔:讨论:目前还没有关于白内障手术后瞳孔强直导致视物不清的报道。根据其他眼科手术后瞳孔强直的报道,我们的病例很可能是副交感神经功能障碍和机械性创伤共同作用的结果:据我们所知,这是第一例关于白内障手术后瞳孔强直的报告,从而扩大了临床上可能未被充分认识的异视原因的文献范围。
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引用次数: 0
Cranial Nerve VI Palsy Secondary to Herpes Zoster Ophthalmicus: A Case Report and Literature Review. 继发于带状疱疹眼炎的颅神经 VI 麻痹:病例报告和文献综述。
Clara V Kuranz, Jennifer Larson

Introduction: In this report, we describe a rare case of a cranial nerve VI palsy secondary to herpes zoster infection with polyneuropathic involvement.

Case presentation: An 82-year-old male was seen by ophthalmology for acute onset of double vision. Fourteen days before presenting, he was diagnosed with herpes zoster ophthalmicus. He was suspected to have zoster polyneuropathy also involving cranial nerve IX and X given a sore throat that began prior to the characteristic trigeminal dermatomal rash. He was diagnosed with cranial nerve VI palsy secondary to herpes zoster infection.

Discussion: Ophthalmic complications of herpes zoster ophthalmicus are many; however, extraocular nerve palsies secondary to herpes zoster infection and zoster polyneuropathy are documented infrequently in the literature.

Conclusions: Extraocular muscle palsies are a rare complication of herpes zoster infection. This case reviews the most current literature surrounding this condition and discusses the significance of polyneuropathic involvement in varicella zoster virus reactivation.

简介:本报告描述了一例罕见的继发于带状疱疹感染的颅神经VI麻痹病例:在本报告中,我们描述了一例罕见的继发于带状疱疹感染的颅神经VI麻痹病例:一名 82 岁的男性因急性复视到眼科就诊。就诊前 14 天,他被诊断为带状疱疹性眼炎。由于他在出现特征性三叉神经皮疹之前就出现了咽喉痛,因此被怀疑患有带状疱疹多发性神经病,并累及颅神经 IX 和 X。他被诊断为继发于带状疱疹感染的颅神经VI麻痹:讨论:带状疱疹性眼炎的眼部并发症很多,但文献中很少记载继发于带状疱疹感染和带状疱疹多发性神经病的眼外肌麻痹:结论:眼外肌麻痹是带状疱疹感染的罕见并发症。本病例回顾了有关这一病症的最新文献,并讨论了水痘带状疱疹病毒再激活中多神经病变的重要意义。
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引用次数: 0
Making Space. 创造空间
Sophia Neman
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引用次数: 0
Improving Geographical Cohorting of Patients Admitted Under Hospitalist Service. 改善住院医师服务收治病人的地域分组。
Precious Anyanwu, Kavita Naik, Sanjay Bhandari, Pinky Jha, Barbara Slawski
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引用次数: 0
Thriving in Your First Year of Medical Training. 在医学培训的第一年茁壮成长。
Fahad Aziz
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引用次数: 0
Mapping Milwaukee's Blueprint for Peace: Evaluating the Geospatial Reach of a Cure Violence Implementation, 414LIFE. 绘制密尔沃基的和平蓝图:Evaluating the Geospatial Reach of a Cure Violence Implementation, 414LIFE.
Amber Brandolino, Terri A deRoon-Cassini, Peter Nguyen, Ramneet Mann, Sydney Timmer-Murillo, Marc de Moya, Basil Karam, Andrew Schramm, Reggie Moore, Kathleen Williams, Alicia Pilarski, Brady McIntosh, David J Milia

Background: Cure Violence interruption programs are evidence-based interventions aimed at reducing the transmission of gun violence and its related injuries. Assessing the implementation of these programs can include the metric of "reach." This study evaluated one such program - 414LIFE - in Milwaukee, Wisconsin. The evaluation reconceptualized "reach" as a metric for reaching the individuals and neighborhoods at greatest risk for gun violence.

Methods: 414LIFE's reach was analyzed descriptively and geospatially through its program evaluation dataset from May 2019 through September 2020 using a cross-sectional design. Program referral criteria includes patients who sustained a gunshot wound, are less than 36 years old, and a resident of, or injured in, the city of Milwaukee. A choropleth map visualized location of participants' residence, which justified a global Moran's I, and then a local Moran's I calculation to identify statistically significant clustering of referrals.

Results: In the first 1.5 years of the program's partnership with the local level I trauma center and affiliated academic medical institution, 398 patients were referred. Three hundred referrals (75.4%) met program criteria; 53.8% were Black men. Statistically significant clusters were identified and mapped. Half of the top 10 neighborhoods with referrals were the city's identified priority neighborhoods.

Conclusions: 414LIFE successfully reaches its intended population and geographic locations. Geospatial reach should be considered routinely in program evaluations of Cure Violence programs to track growth and reach over time.

背景:制止暴力计划是以证据为基础的干预措施,旨在减少枪支暴力及其相关伤害的传播。评估这些计划的实施情况可以包括 "覆盖范围 "这一指标。本研究评估了威斯康星州密尔沃基市的一项此类计划--414LIFE。该评估将 "覆盖范围 "重新概念化,将其作为一种衡量标准,用于覆盖枪支暴力风险最大的个人和社区。方法:采用横截面设计,通过 2019 年 5 月至 2020 年 9 月的项目评估数据集,对 414LIFE 的覆盖范围进行了描述性和地理空间分析。项目转介标准包括遭受枪伤、年龄小于 36 岁、密尔沃基市居民或在密尔沃基市受伤的患者。通过一幅choropleth地图可以直观地看到参与者的居住地,这证明了全局莫兰 I 值的合理性,然后通过局部莫兰 I 值的计算来确定转诊者在统计学上的显著聚类:在该计划与当地一级创伤中心及附属学术医疗机构合作的头一年半时间里,共有 398 名患者被转诊。300名转诊者(75.4%)符合项目标准;53.8%为黑人男性。已确定并绘制了具有统计意义的群组图。在转诊率最高的 10 个社区中,有一半是该市确定的重点社区:结论:414LIFE 成功地覆盖了目标人群和地理位置。在对 "治愈暴力 "计划进行评估时,应将地理空间覆盖范围作为常规考虑因素,以跟踪随着时间推移的增长和覆盖范围。
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引用次数: 0
The Severe Skin Cancer Consequences of Extended Tanning Bed Use, A Case Report. 病例报告:长期使用日光浴浴床的严重皮肤癌后果。
Jacqueline T Cooper, Melanie A Clark

Introduction: Tanning bed use has been directly correlated with increased risk of melanoma and non-melanoma skin cancers with greater duration and frequency of use. Despite this, complete bans for minors accessing indoor tanning devices are active in less than half of the states in the United States.

Case presentation: A 65-year-old female presented to our Mohs surgery clinic with a history of left temporal T2a melanoma, multiple untreated advanced keratinocyte carcinomas, and innumerable smaller untreated keratinocyte carcinomas on her legs, arms, and back after more than 40 years of weekly tanning bed use.

Discussion: Reports from the literature indicate that first exposure under age 35 to tanning devices increases the risk for melanoma and non-melanoma skin cancers. Several programs currently focus on prevention, education, and legislative change surrounding this topic.

Conclusions: Highlighting such severe cases may provide an effective form of education for the public regarding the potential disease burden that results from indoor tanning.

导言:使用日光浴浴床与黑色素瘤和非黑色素瘤皮肤癌的风险直接相关,而且使用时间越长、频率越高。尽管如此,美国只有不到一半的州完全禁止未成年人使用室内日光浴设备:一名 65 岁的女性到我们的莫氏手术诊所就诊,她患有左颞 T2a 黑色素瘤、多个未经治疗的晚期角质细胞癌,以及腿部、手臂和背部无数个较小的未经治疗的角质细胞癌,此前她每周使用日光浴床长达 40 多年:文献报告显示,35 岁以下首次接触日光浴设备会增加罹患黑色素瘤和非黑色素瘤皮肤癌的风险。目前有几项计划重点关注这一主题的预防、教育和立法改革:强调此类严重病例可为公众提供一种有效的教育形式,使其了解室内日光浴可能导致的疾病负担。
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引用次数: 0
Diagnosis of Chagas Disease by Detecting Species-Specific Repetitive Genomic DNA from Filtered Human Urine Samples. 通过检测过滤人尿样本中的物种特异性重复基因组 DNA 诊断南美锥虫病
Miriam Price, Nilanjan Lodh

Introduction: Chagas disease caused by Trypanosoma cruzi (T cruzi) found in the Americas is often missed during the early stage of infection due to lack of sensitive diagnostic tests. The classic immunological and parasitological tests often fail in the acute phase due to the nonspecific and low antibody level nature of the infection and in the chronic phase due to low levels of trypanosomes in the blood. For successful control strategies, there must be a sensitive and specific diagnostic test.

Objective/methods: We have demonstrated the possibility (proof of concept) of detecting T cruzi-specific repeat DNA via polymerase chain reaction (PCR) by (1) spiking 15 urine samples collected from volunteers free of prior infection with 3 different concentrations of T cruzi (3 strains), Trypanosoma brucei, and Trypanosoma rhodesiense (African strain) genomic DNA and (2) from filtered collected clinical samples from Argentina. Three sets of primers were used.

Results: Our approach detected repeat DNA specific for T cruzi strains from 1 clinical sample by 2 sets of primer and from spiked urine by all 3 sets of primer but not the African species. A serial dilution (spiking) also was performed on T cruzi strains to detect sensitivities of the assay. One set of primers constantly detected satellite DNA for all T cruzi strains from 70 pg/μl to 175 fg/μl.

Conclusions: We were able to demonstrate the feasibility of detecting T cruzi-specific DNA from filtered urine samples by sensitive and specific PCR assay. Besides the evident increased sensitivity and specificity of primers, our approach can be used to explore Chagas prevalence in endemic areas - especially in congenital Chagas newborn screening - and in the acute phase.

导言:在美洲发现的由克鲁斯锥虫(T cruzi)引起的恰加斯病,由于缺乏灵敏的诊断检测,在感染的早期阶段常常被漏诊。在急性期,由于感染的非特异性和低抗体水平,以及在慢性期,由于血液中锥虫水平较低,传统的免疫学和寄生虫学检测常常失效。为了成功实施控制策略,必须有一种敏感而特异的诊断检测方法:我们通过以下方法证明了通过聚合酶链式反应(PCR)检测克鲁兹锥虫特异性重复 DNA 的可能性(概念验证):(1) 在 15 份从没有感染过克鲁兹锥虫(3 株)、布氏锥虫和罗得西亚锥虫(非洲株)的志愿者尿液样本中添加 3 种不同浓度的克鲁兹锥虫基因组 DNA;(2) 从过滤收集的阿根廷临床样本中检测克鲁兹锥虫特异性重复 DNA。使用了三组引物:结果:我们的方法通过两组引物从 1 份临床样本中检测到了特异性克鲁兹锥虫菌株的重复 DNA,通过所有 3 组引物从加标尿液中检测到了特异性克鲁兹锥虫菌株的重复 DNA,但没有检测到非洲菌株。我们还对 T cruzi 菌株进行了序列稀释(加标),以检测检测方法的灵敏度。其中一组引物可持续检测到所有克鲁兹绦虫菌株的卫星 DNA,检测范围从 70 pg/μl 到 175 fg/μl:我们通过灵敏而特异的 PCR 分析证明了从过滤尿液样本中检测 T cruzi 特异性 DNA 的可行性。除了引物的灵敏度和特异性明显提高外,我们的方法还可用于检测恰加斯病流行地区的恰加斯病患病率--尤其是先天性恰加斯病新生儿筛查--以及急性期恰加斯病患病率。
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引用次数: 0
Integrating Artificial Intelligence Into Radiology Resident Training: A Call to Action. 将人工智能融入放射科住院医师培训:行动呼吁。
Nageen Waseem, Muhammad Saad Farooq
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引用次数: 0
Knowledge, Attitudes, and Behaviors Regarding Pneumococcal Vaccines in Adults 65 Years and Older in Primary Care in Wisconsin. 威斯康星州 65 岁及以上接受初级保健的成年人对肺炎球菌疫苗的了解、态度和行为。
Mary F Henningfield, Alice Yuroff, Lisa Sampson, Paul H Hunter

Introduction: Although shared decision-making is highly valued, its implementation in clinical practice is suboptimal. Shared decision-making was included in the Centers for Disease Control and Prevention (CDC) recommendations for the pneumococcal conjugate vaccine 13 valent for older adults. As a first step to develop and test clinician educational resources to facilitate shared decision-making for pneumococcal vaccines for older adults, we completed a needs assessment to identify knowledge gaps, attitudes, and behaviors.

Methods: Primary care clinicians, pharmacists, and patient care staff completed a questionnaire on shared decision-making and pneumococcal vaccines. After the CDC recommended new pneumococcal vaccines and eliminated the role of shared decision-making, a revised questionnaire was distributed to additional clinicians in an effort to increase the sample size.

Results: Knowledge of pneumococcal vaccine recommendations was high among those who responded to knowledge questions (48 of 75 respondents). Although 96% of respondents believed shared decision-making for use of pneumococcal vaccines in adults 65 years or older was feasible, 25% responded that it would be "somewhat difficult" to explain potential harms and benefits of PCV13.

Discussion: Although shared decision-making was reported to be feasible, challenges implementing it are ongoing. Knowledge gaps regarding pneumococcal vaccines were observed, highlighting the need for ongoing medical education with changing vaccine recommendations.

介绍:尽管共同决策受到高度重视,但其在临床实践中的执行情况却不尽如人意。美国疾病控制和预防中心 (CDC) 建议老年人接种 13 价肺炎球菌结合疫苗时纳入共同决策。作为开发和测试临床医生教育资源以促进老年人肺炎球菌疫苗共同决策的第一步,我们完成了一项需求评估,以确定知识差距、态度和行为:方法: 初级医疗临床医生、药剂师和患者护理人员填写了一份关于共同决策和肺炎球菌疫苗的问卷。在美国疾病预防控制中心推荐了新的肺炎球菌疫苗并取消了共同决策的作用后,我们向更多的临床医生分发了修订后的问卷,以增加样本量:回答知识问题的受访者对肺炎球菌疫苗建议的了解程度较高(75 位受访者中有 48 位)。虽然 96% 的受访者认为在 65 岁或以上的成年人中使用肺炎球菌疫苗的共同决策是可行的,但 25% 的受访者回答说解释 PCV13 的潜在危害和益处 "有些困难":讨论:尽管报告称共同决策是可行的,但在实施过程中仍面临挑战。我们观察到了有关肺炎球菌疫苗的知识缺口,这凸显了根据不断变化的疫苗建议持续开展医学教育的必要性。
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引用次数: 0
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WMJ : official publication of the State Medical Society of Wisconsin
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