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Soare C, Cozma EC, Celarel AM, Rosca AM, Lupu M, Voiculescu VM. Digitally Enhanced Methods for the Diagnosis and Monitoring of Treatment Responses in Actinic Keratoses: A New Avenue in Personalized Skin Care. Cancers (Basel) 2024; 16:484. [PMID: 38339236 PMCID: PMC10854727 DOI: 10.3390/cancers16030484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/10/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
Non-melanocytic skin cancers represent an important public health problem due to the increasing incidence and the important local destructive potential. Thus, the early diagnosis and treatment of precancerous lesions (actinic keratoses) is a priority for the dermatologist. In recent years, non-invasive skin imaging methods have seen an important development, moving from simple observational methods used in clinical research, to true diagnostic and treatment methods that make the dermatologist's life easier. Given the frequency of these precancerous lesions, their location on photo-exposed areas, as well as the long treatment periods, with variable, imprecise end-points, the need to use non-invasive imaging devices is increasingly evident to complete the clinical observations in the diagnosis and treatment of these lesions, with the aim of increasing accuracy and decreasing the adverse effects due to long treatment duration. This is the first review that brings together all skin imaging methods (dermoscopy, reflectance confocal microscopy, ultrasonography, dermoscopy-guided high frequency ultrasonography, and optical coherence tomography) used in the evaluation of actinic keratoses and their response to different treatment regimens.
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Affiliation(s)
- Cristina Soare
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Elena Codruta Cozma
- Department of Pathophysiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Celarel
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
| | - Ana Maria Rosca
- Department of Dermatology, University Military Hospital “Dr. Carol Davila”, 010825 Bucharest, Romania;
| | - Mihai Lupu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
| | - Vlad Mihai Voiculescu
- Department of Oncological Dermatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.S.); (M.L.); (V.M.V.)
- Department of Dermatology and Allergology, Elias University Emergency Hospital, 011461 Bucharest, Romania;
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2
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Manole CG, Soare C, Ceafalan LC, Voiculescu VM. Platelet-Rich Plasma in Dermatology: New Insights on the Cellular Mechanism of Skin Repair and Regeneration. Life (Basel) 2023; 14:40. [PMID: 38255655 PMCID: PMC10817627 DOI: 10.3390/life14010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
The skin's recognised functions may undergo physiological alterations due to ageing, manifesting as varying degrees of facial wrinkles, diminished tautness, density, and volume. Additionally, these functions can be disrupted (patho)physiologically through various physical and chemical injuries, including surgical trauma, accidents, or chronic conditions like ulcers associated with diabetes mellitus, venous insufficiency, or obesity. Advancements in therapeutic interventions that boost the skin's innate regenerative abilities could significantly enhance patient care protocols. The application of Platelet-Rich Plasma (PRP) is widely recognized for its aesthetic and functional benefits to the skin. Yet, the endorsement of PRP's advantages often borders on the dogmatic, with its efficacy commonly ascribed solely to the activation of fibroblasts by the factors contained within platelet granules. PRP therapy is a cornerstone of regenerative medicine which involves the autologous delivery of conditioned plasma enriched by platelets. This is achieved by centrifugation, removing erythrocytes while retaining platelets and their granules. Despite its widespread use, the precise sequences of cellular activation, the specific cellular players, and the molecular machinery that drive PRP-facilitated healing are still enigmatic. There is still a paucity of definitive and robust studies elucidating these mechanisms. In recent years, telocytes (TCs)-a unique dermal cell population-have shown promising potential for tissue regeneration in various organs, including the dermis. TCs' participation in neo-angiogenesis, akin to that attributed to PRP, and their role in tissue remodelling and repair processes within the interstitia of several organs (including the dermis), offer intriguing insights. Their potential to contribute to, or possibly orchestrate, the skin regeneration process following PRP treatment has elicited considerable interest. Therefore, pursuing a comprehensive understanding of the cellular and molecular mechanisms at work, particularly those involving TCs, their temporal involvement in structural recovery following injury, and the interconnected biological events in skin wound healing and regeneration represents a compelling field of study.
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Affiliation(s)
- Catalin G. Manole
- Department of Cellular and Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Ultrastructural Pathology Laboratory, “Victor Babeș” National Institute of Pathology, 050096 Bucharest, Romania
| | - Cristina Soare
- Department of Oncological Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Laura Cristina Ceafalan
- Department of Cellular and Molecular Biology and Histology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Cell Biology, Neurosciences and Experimental Myology Laboratory, “Victor Babeș” National Institute of Pathology, 050096 Bucharest, Romania
| | - Vlad M. Voiculescu
- Department of Oncological Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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3
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Cozma EC, Banciu LM, Soare C, Găman MA, Voiculescu VM. Vasculitis-Like Hemorrhagic Herpes Zoster and HIV Infections: An Intricate Association. Cureus 2023; 15:e50609. [PMID: 38226125 PMCID: PMC10788595 DOI: 10.7759/cureus.50609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
Herein, we report the case of a 69-year-old patient who presented to our dermatology clinic for a skin eruption characterized by grouped hemorrhagic vesicles and erosions covered by hemorrhagic crusts on an erythematous background located on the lower right limb. The lesions were small, clustered, and variable in size (diameters between one and 10 mm) and located at the level of the L4-L5 dermatomes. The rash had started three to five days after the complete COVID-19 vaccination scheme with the BNT162b2 Pfizer BioNTech vaccine and had been accompanied by a flu-like syndrome. The histopathological examination established the diagnosis of leukocytoclastic vasculitis potentially in the context of a cytopathic zoster phenomenon. The atypical aspect of the zosterian eruption required additional laboratory work-up to identify possible causes of immunosuppression, i.e., screening for the presence of the human immunodeficiency virus (HIV) infection, solid cancers, as well as measurement of serum immunoglobulin concentrations, which revealed that the subject was HIV-positive. Antiviral treatment was started, with a favorable evolution of the lesions, and the patient was referred to an infectious diseases clinic for initiation of antiretroviral therapy (ART).
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Affiliation(s)
- Elena Codruța Cozma
- Pathophysiology, University of Medicine and Pharmacy of Craiova, Craiova, ROU
- Dermatology, Elias Emergency University Hospital, Bucharest, ROU
| | | | - Cristina Soare
- Dermatology, Elias Emergency University Hospital, Bucharest, ROU
| | - Mihnea-Alexandru Găman
- Hematology, Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, ROU
- Hematology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
| | - Vlad Mihai Voiculescu
- Dermatology, Elias Emergency University Hospital, Bucharest, ROU
- Dermatology, Carol Davila University of Medicine and Pharmacy, Bucharest, ROU
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4
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Cozma EC, Banciu LM, Soare C, Cretoiu SM. Update on the Molecular Pathology of Cutaneous Squamous Cell Carcinoma. Int J Mol Sci 2023; 24:ijms24076646. [PMID: 37047618 PMCID: PMC10095059 DOI: 10.3390/ijms24076646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, originating from keratinocytes of the spinous layer. Numerous risk factors have been discovered for the initiation and growth of this type of cancer, such as exposure to UV and ionizing radiation, chemical carcinogens, the presence of immunosuppression states, chronic inflammation, infections with high-risk viral strains, and, last but not least, the presence of diseases associated with genetic alterations. The important socio-economic impact, as well as the difficulty associated with therapy for advanced forms, has made the molecular mechanisms underlying this neoplasia more and more intensively studied, with the intention of achieving a better understanding and advancing the treatment of this pathology. This review aims to provide a brief foray into the molecular, genetic, and epigenetic aspects of this cancer, as well as the treatment methods, ranging from the first used to the latest targeted therapies.
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Affiliation(s)
- Elena-Codruta Cozma
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
- Pathophysiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Laura Madalina Banciu
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Cristina Soare
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
- Surgery Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sanda-Maria Cretoiu
- Department of Cell and Molecular Biology and Histology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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5
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Nicolescu AC, Ionescu S, Ancuta I, Popa VT, Lupu M, Soare C, Cozma EC, Voiculescu VM. Subepidermal Low-Echogenic Band-Its Utility in Clinical Practice: A Systematic Review. Diagnostics (Basel) 2023; 13:diagnostics13050970. [PMID: 36900113 PMCID: PMC10000591 DOI: 10.3390/diagnostics13050970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
High-frequency ultrasonography (HF-USG) is a relatively new imaging method that allows the evaluation in a non-invasive manner of the skin layers and skin appendages. It is a diagnostic tool with increasing usefulness in numerous dermatological pathologies. High reproducibility, non-invasiveness and short diagnostic time make this method an increasingly used tool in dermatological practice. The subepidermal low-echogenic band is a relatively newly described parameter that seems to be a marker not only of intrinsic and extrinsic skin aging, but also of inflammatory processes taking place at the skin level. This systematic review aims to evaluate the role that SLEB has in the diagnosis and monitoring of the treatment of some inflammatory and non-inflammatory dermatological conditions, as well as its utility as a disease marker.
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Affiliation(s)
| | - Sinziana Ionescu
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Department, “Prof. Dr. Al. Trestioreanu” Oncology Institute Bucharest, 022328 Bucharest, Romania
| | - Ioan Ancuta
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Rheumatology Department, “Dr. I. Cantacuzino” Clinical Hospital, 020475 Bucharest, Romania
| | - Valentin-Tudor Popa
- Dermatology Department, Center for Morphologic Study of the Skin MORPHODERM, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Mihai Lupu
- Department of Dermatology, MEDAS Medical Center, 030447 Bucharest, Romania
| | - Cristina Soare
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
| | - Elena-Codruta Cozma
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
- Pathophysiology Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Correspondence:
| | - Vlad-Mihai Voiculescu
- Surgery Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania
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6
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Neffendorf JE, Mare T, Simpson ARH, Soare C, Kirthi V, Sharpe CC, Jackson TL. Effect of intravitreal anti-vascular endothelial growth factor treatment for neovascular age-related macular degeneration on renal function. Nephrol Dial Transplant 2023:7034340. [PMID: 36764668 DOI: 10.1093/ndt/gfad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Affiliation(s)
| | - Tracey Mare
- Synnovis, King's College Hospital, London, UK
| | | | - Cristina Soare
- King's Ophthalmology Research Unit, King's College Hospital, London, UK
| | - Varo Kirthi
- King's Ophthalmology Research Unit, King's College Hospital, London, UK
| | - Claire C Sharpe
- Faculty of Life Sciences and Medicine, King's College London, UK
| | - Timothy L Jackson
- King's Ophthalmology Research Unit, King's College Hospital, London, UK.,Faculty of Life Sciences and Medicine, King's College London, UK
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Mendall J, Soare C, Nowak V. Comment on 'Trainee research network (TRN): a potential global model for promoting research training and outputs among trainees'. Eye (Lond) 2023; 37:193-194. [PMID: 35907943 PMCID: PMC9362434 DOI: 10.1038/s41433-022-02187-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 06/21/2022] [Accepted: 07/14/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
| | - Cristina Soare
- London Ophthalmology trainee Clinical Trials Network, London, UK
| | - Victoria Nowak
- London Ophthalmology trainee Clinical Trials Network, London, UK
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8
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Seguino A, Braun PG, Del-Pozo J, Soare C, Houf K, Baillie S. Evaluation of a Harmonized Undergraduate Catalog for Veterinary Public Health and Food Hygiene Pedagogy in Europe. J Vet Med Educ 2022; 49:721-732. [PMID: 34739357 DOI: 10.3138/jvme-2021-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Current and emerging veterinary public health (VPH) challenges raised by globalization, climate change, and industrialization of food production require the veterinarian's role to evolve in parallel and veterinary education to adapt to reflect these changes. The European Food Hygiene catalog was developed to provide a list of topics relevant to Day One Competencies in VPH. A study was undertaken to ensure that the catalog and teaching practices were pertinent to the work of public health veterinarians. Relevant stakeholders were consulted using questionnaires and semi-structured interviews. A long questionnaire was distributed to 49 academics teaching VPH in European veterinary schools to review topics listed in the catalog. Eighteen responses were received (36.7%), representing 12 European countries. There was general agreement that most topics were appropriate for the undergraduate VPH curriculum. A short questionnaire was distributed to 348 European veterinarians working in the industry. Twenty-four questionnaires (6.7%) were received, representing eight European countries. Despite the low participation rate, topics needing greater emphasis in the undergraduate curriculum included Hazard Analysis Critical Control Points (HACCP), food microbiology, and audits. Seven semi-structured interviews with public health veterinarians working in the UK identified the need for curricular changes including greater practical experience and a shift from a focus on meat inspection to risk management. This may be partly achieved by replacing traditional lectures with authentic case-based scenarios. The study findings can be used to inform the future direction to VPH education for veterinary students across Europe.
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9
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Farwana R, Soare C, Vonica O. Bilateral Giant Fornix Syndrome Associated with Serratia Marcescens. Ocul Immunol Inflamm 2022; 30:2069-2070. [PMID: 34686120 DOI: 10.1080/09273948.2021.1976218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
An 82-year-old woman with macular degeneration receiving intravitreal bevacizumab, presented with 5-months history of muco-purulent blepharo-kerato-conjunctivitis, resistant to multiple topical antibiotics. Visual acuities were 20/25 right and 20/30 left. She had patent nasolacrimal systems, bilateral blepharoptosis, deep superior fornices (21mm right, 22mm left) with muco-purulent discharge, upper tarsal papillae, and punctate keratitis. Bilateral giant fornix syndrome (GFS) was diagnosed, and forniceal swabs grew Serratia marcescens and Pseudomonas aeruginosa, despite current use of intensive topical moxifloxacin. Topical preservative-free Povidone-Iodine 5% twice-daily, two-hourly weaning course of Prednisolone acetate 1% and Ciprofloxacin 250 mg twice-daily were added with complete resolution within 1 week and no recurrence after 3 months. Serratia conjunctivitis has not been previously reported in association with GFS. Conjunctival flora alteration following previous peri-procedural antibiotics and antiseptics, in the setting of a large fornix with redundant, inflamed conjunctiva, may explain the colonization with this opportunistic organism. Topical povidone-iodine 5% appears to be effective for multi-drug resistant opportunistic Serratia conjunctivitis in association with GFS.
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Affiliation(s)
- Reem Farwana
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | - Cristina Soare
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | - Oana Vonica
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
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10
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Soare C, Patel DS, Ionides A. Cataract surgery outcomes in eyes with previous radial keratotomy. Eye (Lond) 2022; 36:1804-1809. [PMID: 34376819 PMCID: PMC9391422 DOI: 10.1038/s41433-021-01716-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study shows the visual and refractive outcomes of cataract surgery in patients with previous radial keratotomy (RK). SUBJECTS/METHODS This is a retrospective case series of 100 eyes (65 patients) with previous RK who had undergone routine cataract surgery with a monofocal intraocular lens implant (IOL) at Moorfields Eye Hospital, London, United Kingdom, between January 2004 and December 2018. RESULTS Mean age at the time of surgery was 59.8 years; 39% eyes had ocular copathology. Best-corrected visual acuity (LogMAR; median, interquartile range) improved from 0.30 (0.22, 0.55) to 0.06 (-0.02, 0.21) in eyes without copathology, and from 0.56 (0.30, 1.00) to 0.20 (0.00, 0.20) in eyes with copathology. Haigis formula (19 eyes) resulted in a median prediction error of -0.31 D (-1.07, +0.05), versus -0.55 D (-1.23, +0.22) for Double-K SRK/T (55 eyes) and +0.93 D (0.20, 2.31) for SRK/T (18 eyes). At the final follow-up, 52.6% eyes were within 0.5 D and 68.4% within 1 D of the predicted spherical equivalent for Haigis, versus 32.7% and 52.7% for Double-K SRK/T, and 27.8% and 38.9% for SRK/T. The most frequent complication was RK incision dehiscence (8%). CONCLUSIONS Although the best-corrected visual acuity outcomes compare with the UK national benchmarks, significantly fewer eyes with previous RK achieved the level of unaided distance visual acuity to allow spectacle independence. Surgeons should be aware of the increased likelihood of wound dehiscence and plan surgery accordingly. Haigis formula tended to have a better predictability of the postoperative spherical equivalent and, since introduced, was the preferred choice for IOL calculation in this group of patients.
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Affiliation(s)
- Cristina Soare
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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11
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Banciu ML, Dobrica EC, Soare C, Malciu AM, Voiculescu VM. Healthcare Disparities in the Management of Indolent Mycosis Fungoides. Cureus 2022; 14:e24098. [PMID: 35573524 PMCID: PMC9106548 DOI: 10.7759/cureus.24098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/18/2022] Open
Abstract
Mycosis fungoides represents the most common cutaneous T-cell lymphoma, clinically manifested with evolving skin lesions, including patches, plaques, tumors, and erythroderma. Early diagnosis remains difficult to establish because it mimics several benign skin conditions, but maintaining a high index of suspicion for the disease is essential in preventing the progression of a potentially fatal disease. We report the case of a 69-year-old female who presented in our dermatology clinic in 2018 with scaly, indurated, itchy erythematous-violaceus patches and plaques, and tumors disseminated throughout the skin evolving for nine years. Skin biopsy supplemented with immunohistochemical staining established the diagnosis of mycosis fungoides. Due to the equivocal clinical presentation and the lack of extracutaneous manifestations, the patient received conventional therapy according to the stage of the disease. The rapidly progressive evolution of the cutaneous lesions in the last year of the disease determined the patient’s death despite instituting systemic chemotherapy. Patient follow-up and a multidisciplinary approach are essential to diagnose and manage this disease in its early stages. This will prevent the progression to a life-threatening malignancy and the use of immunosuppressive therapy, which can cause serious side effects.
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12
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Jackson TL, Soare C, Petrarca C, Simpson A, Neffendorf JE, Petrarca R, Muldrew KA, Peto T, Chakravarthy U, Membrey L, Haynes R, Costen M, Steel DHW, Desai R. Epimacular brachytherapy for previously treated neovascular age-related macular degeneration: month 36 results of the MERLOT randomised controlled trial. Br J Ophthalmol 2022:bjophthalmol-2021-320620. [PMID: 35217515 DOI: 10.1136/bjophthalmol-2021-320620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/17/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM To assess the long-term safety and efficacy of epimacular brachytherapy (EMB) for chronic, active, neovascular age-related macular degeneration (nAMD). METHODS This pivotal, randomised, controlled surgical device trial recruited patients with chronic nAMD receiving intravitreal ranibizumab from 24 UK hospitals. Participants were randomised to either pars plana vitrectomy with 24 Gray EMB and pro re nata (PRN) ranibizumab (n=224) or PRN ranibizumab monotherapy (n=119). Although masking was not possible, masked clinicians assessed best-corrected visual acuity (BCVA) and imaging. After month 24, participants reverted to standard care, with either ranibizumab or aflibercept, returning for a month 36 study visit. RESULTS Of 363 participants, 309 (85.1%) completed month 36. The number of injections was 12.1±8.1 in the EMB group versus 11.4±6.1 in the ranibizumab group (difference 0.7, 95% CI of difference -0.9 to 2.3, p=0.41) between months 1 and 36, and 3.6±3.3 (n=200) versus 3.9±2.7 (n=102) (difference -0.3, 95% CI of difference -1.0 to 0.4, p=0.43) between months 25 and 36 (standard care). Over 36 months, BCVA change was -19.7±18.5 letters in the EMB group and -4.8±12.5 in the ranibizumab group (difference -14.9, 95% CI of difference -18.5 to -11.2, p<0.0001). The month 36 BCVA of 20 EMB-treated participants with microvascular abnormalities (MVAs) at month 24 was similar to EMB-treated participants without MVAs (-21.8 vs -19.4 letters, p=0.65). CONCLUSION EMB does not reduce the number of anti-vascular endothelial growth factor (VEGF) injections, either within or outside of a trial setting, and is associated with worse BCVA than anti-VEGF monotherapy. TRIAL REGISTRATION NUMBER NCT01006538.
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Affiliation(s)
- Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, UK .,King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
| | - Cristina Soare
- King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
| | - Caroline Petrarca
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Andrew Simpson
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
| | - James E Neffendorf
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
| | - Robert Petrarca
- Faculty of Life Sciences and Medicine, King's College London, London, UK.,King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
| | | | - Tunde Peto
- Reading Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Usha Chakravarthy
- NetwORC UK, Central Angiographic Reading Centre, Queen's University Belfast, Belfast, UK
| | - Luke Membrey
- Department of Ophthalmology, Maidstone Hospital, Maidstone, UK
| | - Richard Haynes
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, UK
| | - Mark Costen
- Department of Ophthalmology, Hull Royal Infirmary, Hull, UK
| | - David H W Steel
- Department of Ophthalmology, Sunderland Eye Infirmary, Sunderland, UK.,Biosciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Riti Desai
- King's Ophthalmology Research Unit (KORU), King's College Hospital, London, UK
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Soare C, Garcia-Ara A, Seguino A, Uys M, Thomas LF. Maximising Societal Benefit From the Control of Neglected Zoonoses: Identifying Synergies and Trade-Offs in the Control of Taenia solium. Front Vet Sci 2022; 8:794257. [PMID: 35224073 PMCID: PMC8865387 DOI: 10.3389/fvets.2021.794257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Interventions to control or eradicate neglected zoonoses are generally paid for through the public purse and when these interventions focus on the animal hosts, they are often expected to be performed and financed through the state veterinary service. The benefits of control, however, accrue across the human, animal, and environmental spaces and enhance both public and private interests. Additionally, disease control interventions do not take place in a vacuum and the indirect impacts of our actions should also be considered if the societal benefit of interventions is to be maximised. With the caveat that unintended consequences can and will occur, pre-identifying potential synergies and trade-offs in our disease control initiatives allows for them to be considered in intervention design and monitored during programme roll-out. In this paper, using a One Health approach with the example of Taenia solium control, we identify potential indirect impacts which may arise and how these may influence both our choice of intervention and opportunities to optimise the animal, environmental, and societal benefits of control through maximising synergies and minimising trade-offs.
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Affiliation(s)
- Cristina Soare
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
| | - Amelia Garcia-Ara
- School of Veterinary Medicine and Science, University of Nottingham, Nottingham, United Kingdom
| | - Alessandro Seguino
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
| | - Matthys Uys
- The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Midlothian, United Kingdom
| | - Lian F. Thomas
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, United Kingdom
- International Livestock Research Institute, Nairobi, Kenya
- *Correspondence: Lian F. Thomas
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Neffendorf JE, Kirthi V, Soare C, Jackson TL. The Effect of Intravitreal Ocriplasmin on Hue Discrimination. Optom Vis Sci 2021; 98:1394-1399. [PMID: 34905526 DOI: 10.1097/opx.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE We report 13 patients who received ocriplasmin for symptomatic vitreomacular adhesion. Farnsworth-Munsell 100 (FM 100) hue test total error score (TES) increased from baseline to month 1, before recovering at year 1. Ocriplasmin may alter hue discrimination. PURPOSE This study aimed to determine whether intravitreal ocriplasmin affects hue discrimination. METHODS Thirteen patients with symptomatic vitreomacular adhesion received intravitreal ocriplasmin 125 μg. Patients underwent full ocular examination, optical coherence tomography, and FM 100 hue test at baseline, 1 week, 1 month, and 1 year. RESULTS Mean age was 74.8 years. The median baseline FM 100 TES was similar in the injected and fellow eyes (272 vs. 252, respectively). Median TES in the injected eye increased from 272 to 348 at 1 week (median difference compared with baseline, +52.0; 98.8% confidence interval of difference, -64.0 to 184.0; P = .29), decreased to 324 at 1 month (median difference compared with baseline, -4.0; 98.8% confidence interval of difference, -44.0 to 256.0; P = .40), and decreased to 268 at 1 year (median difference compared with baseline, -108.0; 93.8% confidence interval of difference, -200.0 to 52.0; P = .19). Two patients (15.4%) had anatomic release of vitreomacular adhesion, occurring within 1 month of injection. CONCLUSIONS Ocriplasmin may alter hue discrimination, but larger studies are required to provide sufficient power to detect or exclude a statistically significant effect. Longer follow-up is needed to determine the duration of any effect.
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Affiliation(s)
- James E Neffendorf
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | - Cristina Soare
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
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15
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Swampillai AJ, Nowak VA, Maubon L, Neffendorf JE, Sahota D, Williams O, Lakhani B, Soare C, Sychev I, Ridyard E, Patel PJ, Park JC. Confidence of UK Ophthalmology Registrars in Managing Posterior Capsular Rupture: Results from a National Trainee Survey. Ophthalmol Ther 2021; 11:225-237. [PMID: 34799828 PMCID: PMC8770778 DOI: 10.1007/s40123-021-00425-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction To establish the level of confidence amongst UK ophthalmology specialist registrars (residents) in managing posterior capsule rupture (PCR) during cataract surgery. Methods An online nine-item questionnaire was distributed to all registrars, recruited nationwide via regional representatives. Data collected included stage of training, number of completed cataract operations, cumulative PCR rate, number of PCRs independently managed, understanding of vitrectomy settings and fluidic parameters and access to simulation. Respondents self-evaluated their confidence in managing PCR with vitreous loss. Results Complete responses were obtained from 248 registrars (35% response rate). Mean number of phacoemulsification procedures performed was 386. For senior registrars (OST 6–7), 35 out of 70 (50%) felt confident to manage PCR independently and 55 out of 70 (78.6%) were either quite confident or very confident at deciding when to implant an intraocular lens during PCR management. Lower confidence levels were noted for junior trainees (OST 1–2). Over 65% of survey respondents had access to relevant simulation. Conclusions Our results represent the largest UK survey analysing the confidence of PCR management amongst registrars. Confidence improves with duration of training and increased exposure to management of PCR. However, 50% of senior registrars still lacked confidence to independently manage PCR and vitreous loss. A specific competency-based framework, potentially using a simulator or simulating a PCR event, incorporated into the curriculum may be desirable.
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Affiliation(s)
- Andrew J Swampillai
- Department of Ophthalmology, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, Somerset, UK
| | | | | | | | | | | | | | | | | | | | - Praveen J Patel
- NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Jonathan C Park
- Department of Ophthalmology, Musgrove Park Hospital, Parkfield Drive, Taunton, TA1 5DA, Somerset, UK.
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16
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Soare C, McNeilly TN, Seguino A. A review of potential risk factors linked to shiga toxin-producing Escherichia coli (STEC) in wild deer populations and the practices affecting the microbial contamination of wild deer carcasses with enteric bacteria. Food Control 2021. [DOI: 10.1016/j.foodcont.2021.108128] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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17
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Soare C, Theodorsson M, Sherafat H, Vonica O. Are Telephone Consultations Suitable for Oculoplastics Clinics? Ophthalmic Plast Reconstr Surg 2021; 37:S117-S119. [PMID: 34011906 DOI: 10.1097/iop.0000000000001782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Jackson TL, Soare C, Petrarca C, Simpson A, Neffendorf JE, Petrarca R, Muldrew A, Peto T, Chakravarthy U, Membrey L, Haynes R, Costen M, Steel D, Desai R. Evaluation of Month-24 Efficacy and Safety of Epimacular Brachytherapy for Previously Treated Neovascular Age-Related Macular Degeneration: The MERLOT Randomized Clinical Trial. JAMA Ophthalmol 2021; 138:835-842. [PMID: 32644148 DOI: 10.1001/jamaophthalmol.2020.2309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Importance Although anti-vascular endothelial growth factor (VEGF) treatment offers better outcomes than the natural history of neovascular age-related macular degeneration (ARMD), a less burdensome, less expensive, and more durable treatment is needed. Objective To assess the efficacy and safety of epimacular brachytherapy (EMB) for chronic, active, neovascular ARMD. Design, Setting, and Participants The Macular Epiretinal Brachytherapy vs Ranibizumab (Lucentis) Only Treatment (MERLOT) pivotal device trial was conducted at 24 National Health Service hospitals across the UK. Patients who had neovascular ARMD and received intravitreal ranibizumab were enrolled between November 10, 2009, and January 30, 2012. Eligible patients were randomized 2:1 and were stratified by lens status and angiographic lesion type to receive either EMB plus as-needed ranibizumab or as-needed ranibizumab monotherapy. Participants were followed up monthly for 24 months and then assessed at a final visit at month 36. Masking of participants and clinicians was not possible, but best-corrected visual acuity (BCVA) and imaging were analyzed by masked assessors. Analysis followed the intent-to-treat approach. Interventions Pars plana vitrectomy with 24 Gy EMB plus as-needed ranibizumab vs as-needed ranibizumab monotherapy. Main Outcomes and Measures Coprimary outcomes were the number of as-needed ranibizumab injections and the mean change in Early Treatment Diabetic Retinopathy Study (ETDRS) BCVA with a noninferiority margin of -5 ETDRS letters. Secondary outcomes were the percentage of participants losing fewer than 15 ETDRS letters and gaining 0 or more or 15 or more ETDRS letters and the mean change in angiographic total lesion size, choroidal neovascularization size, and foveal thickness on optical coherence tomography. Results Of 363 participants, 329 (90.6%) completed 24 months of follow-up (222 participants in the EMB group and 107 in the ranibizumab group). The mean (SD) age of the combined groups was 76.5 (7.4) years. The mean (SD) number of ranibizumab injections was 9.3 (6.7) in the EMB group and 8.3 (4.5) in the ranibizumab group, with a difference of 1.0 injection (95% CI, -0.3 to 2.3; P = .13). The mean (SD) BCVA change was -11.2 (15.7) ETDRS letters in the EMB group and -1.4 (10.9) ETDRS letters in the ranibizumab group, with a difference of 9.8 ETDRS letters (95% CI, -6.7 to -12.9). In the EMB group, 65.6% of participants (160 of 244) lost fewer than 15 ETDRS letters vs 86.6% (103 of 119) in the ranibizumab group, with a difference of 21% (95% CI, 12.4%-29.5%; P < .001). Microvascular abnormalities occurred in 20 of 207 eyes (9.7%) in the EMB group and 1 of 97 eyes (1.0%) in the ranibizumab group. These abnormalities occurred outside the foveal center, and there were no unexpected safety concerns. Conclusions and Relevance The MERLOT trial found that despite the acceptable safety of EMB, it did not reduce the number of ranibizumab injections and was associated with worse visual acuity than anti-VEGF treatment alone; these results do not support EMB use as an adjunct treatment for chronic, active neovascular ARMD. Trial Registration ClinicalTrials.gov Identifier: NCT01006538.
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Affiliation(s)
- Timothy L Jackson
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.,Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Cristina Soare
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Caroline Petrarca
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Andrew Simpson
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.,Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - James E Neffendorf
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.,Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Robert Petrarca
- Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom.,Department of Ophthalmology, King's College Hospital, London, United Kingdom
| | - Alyson Muldrew
- NetwORC UK, Central Angiographic Reading Center, Queen's University of Belfast, Belfast, United Kingdom
| | - Tunde Peto
- Reading Center, Moorfields Eye Hospital, London, United Kingdom
| | - Usha Chakravarthy
- NetwORC UK, Central Angiographic Reading Center, Queen's University of Belfast, Belfast, United Kingdom
| | - Luke Membrey
- Department of Ophthalmology, Maidstone Hospital, Maidstone, United Kingdom
| | - Richard Haynes
- Department of Ophthalmology, Bristol Eye Hospital, Bristol, United Kingdom
| | - Mark Costen
- Department of Ophthalmology, Hull and East Yorkshire Eye Hospital, Hull, United Kingdom
| | - David Steel
- Vitreoretinal Unit, Sunderland Eye Infirmary, Sunderland, United Kingdom.,Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Riti Desai
- Department of Ophthalmology, King's College Hospital, London, United Kingdom
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Petrarca R, Soare C, Wong R, Desai R, Neffendorf J, Simpson A, Jackson TL. Intravitreal ranibizumab for persistent diabetic vitreous haemorrhage: a randomised, double-masked, placebo-controlled feasibility study. Acta Ophthalmol 2020; 98:e960-e967. [PMID: 31674134 DOI: 10.1111/aos.14282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the feasibility of a definitive study of intravitreal ranibizumab to promote the clearance of persistent diabetic vitreous haemorrhage and thereby avoid vitrectomy. METHODS This randomised, double-masked, placebo-controlled feasibility study recruited 24 participants with persistent diabetic vitreous haemorrhage listed for pars plana vitrectomy. Participants were randomised to a single 0.5-mg intravitreal ranibizumab injection or a single subconjunctival saline injection. The primary outcome measure was the number of participants requiring pars plana vitrectomy at week 7. RESULTS Eight of 12 participants (66.7%) in the ranibizumab group required vitrectomy at week 7 versus 12 of 12 (100%) in the placebo group (absolute risk reduction 33.3%, 95% confidence interval 2.1-70.7%; p = 0.09). One additional eye in the ranibizumab group required vitrectomy by 12 months. Mean visual acuity letter score at 12 months was 72.7 ± 12.3 in the ranibizumab group and 75.1 ± 10.1 in the placebo group. Safety was similar across groups. CONCLUSION Intravitreal ranibizumab may reduce the likelihood of proceeding to vitrectomy in patients with persistent, dense diabetic vitreous haemorrhage. Further studies appear feasible and justified.
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Affiliation(s)
- Robert Petrarca
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
| | - Cristina Soare
- Department of Ophthalmology King's College Hospital London UK
| | - Roger Wong
- Department of Ophthalmology St. Thomas’ Hospital London UK
| | - Riti Desai
- Department of Ophthalmology King's College Hospital London UK
| | - James Neffendorf
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
| | - Andrew Simpson
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
| | - Timothy L. Jackson
- School of Life Science and Medicine King's College London London UK
- Department of Ophthalmology King's College Hospital London UK
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20
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Soare C, Grimaldi G, Rees A. Late Recurrence of Acute Retinal Necrosis Within Retinal Scars. Ophthalmology 2020; 127:1754. [PMID: 33222778 DOI: 10.1016/j.ophtha.2020.07.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 10/22/2022] Open
Affiliation(s)
- Cristina Soare
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Angela Rees
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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21
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Farwana R, Soare C, Vahdani K. Potential effects of botulinum toxin on Bell's phenomenon and ocular elevation. Orbit 2020; 40:267. [PMID: 33213208 DOI: 10.1080/01676830.2020.1841809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Reem Farwana
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK
| | - Cristina Soare
- Royal Eye Unit, Kingston Hospital NHS Foundation Trust, London, UK.,Moorfields Eye Hospital NHS Foundation Trust, London, UK,
| | - Kaveh Vahdani
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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22
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Soare C, Vonica O. Re: “Panophthalmitis and Visual Loss as a Complication of Acute Dacryocystitis”. Ophthalmic Plast Reconstr Surg 2020; 36:517-518. [DOI: 10.1097/iop.0000000000001758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Affiliation(s)
- C Soare
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - V A Nowak
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - S Osborne
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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24
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Raducu R, Soare C, Chichirez CM, Purcarea MR. Climate Change and Social Campaigns. J Med Life 2020; 13:454-457. [PMID: 33456591 PMCID: PMC7803319 DOI: 10.25122/jml-2020-0173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The impact of climate change on humanity and nature is increasingly evident. The atmosphere and oceans have warmed, leading to rising sea levels, a sharp drop in Arctic sea ice, floods, heatwaves, and fires. Calls to action are getting stronger. Concerns about climate change have become a full social movement, stimulating climate activism from the bottom up to the world, especially among young people. Campaigns are initiated by governments and international organizations, scientists and scientific institutions, organizations, groups, and people in civil society, public intellectuals and political, religious leaders, people of culture and entertainment. These campaigns generally aim to inform, raise awareness and shape public understanding about the science, problems, and policy of climate change, with the hope that, first of all, people will change their attitudes and behavior, and secondly, will mobilize to put pressure on policymakers for effective climate policies.
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Affiliation(s)
- Raluca Raducu
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina Soare
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Cristina-Mihaela Chichirez
- Department of Marketing and Medical Technology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania,* Corresponding Author: Cristina - Mihaela Chichirez, PhD Assist, Department of Marketing and Medical Technology,Carol Davila University of Medicine and Pharmacy,8, Eroilor Sanitari Boulevard, 050474, Bucharest, Romania Phone: +40742814902 E-mail:
| | - Monica Roxana Purcarea
- Department of Nephrology, “Carol Davila” Clinical Nephrology Hospital, Bucharest, Romania
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Abstract
Walker–Warburg syndrome (WWS) is a disorder characterized by ocular and brain malformations, and congenital muscular dystrophy. Retinal malformations are common in WWS; however, bilateral retinal detachment is a rare occurrence. We present a case of a newborn baby delivered at 36+3 weeks, who was the first living child of consanguineous parents of Turkish origin. On antenatal anomaly scans, the fetus had hydrocephalus that had increased throughout pregnancy, and a diagnosis of hydrancephaly was made at 36 weeks of gestation. Hypotonia, cleft lip and palate, poor suck and absent gag reflex were noted at birth. Ophthalmic examination at the age of 2 days revealed bilateral funnel retinal detachment. B-scan ultrasonography confirmed these findings, and magnetic resonance imaging (MRI) of the brain was performed at the age of 13 days to establish a diagnosis. The MRI showed lissencephaly, hydrocephalus and thin rim of brain parenchyma, with a cobblestone appearance of the cortex and pontine and cerebellar hypoplasia, consistent with the diagnosis of WWS. The infant deteriorated and died at 39 days of age from complications associated with the brain anomalies. In summary, bilateral retinal detachment is extremely rare and in association with hydrocephalus and posterior fossa anomalies strongly suggests the diagnosis of WWS.
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Affiliation(s)
- Navid Hakim
- Department of Medicine, Princess Royal University Hospital, Orpington
| | - Cristina Soare
- Department of Ophthalmology, Queen Mary's Hospital Sidcup, Sidcup, UK
| | - Jamil Hakim
- Department of Ophthalmology, Queen Mary's Hospital Sidcup, Sidcup, UK
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26
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Kuehlewein L, Kitiratschky V, Gosheva M, Edwards TL, MacLaren RE, Groppe M, Kusnyerik A, Soare C, Jackson TL, Sun CH, Chee C, Sachs H, Stingl K, Wilhelm B, Gekeler F, Bartz-Schmidt KU, Zrenner E, Stingl K. Optical Coherence Tomography in Patients With the Subretinal Implant Retina Implant Alpha IMS. Ophthalmic Surg Lasers Imaging Retina 2018; 48:993-999. [PMID: 29253302 DOI: 10.3928/23258160-20171130-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 11/01/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The aim of this study was to assess changes in retinal structure and thickness after subretinal implantation of the Retina Implant Alpha IMS (Retina Implant AG, Reutlingen, Germany). PATIENTS AND METHODS Spectral-domain optical coherence tomography (SD-OCT) imaging was performed to assess the structure and thickness of the retina anterior to the microphotodiode array preoperatively, within 6 weeks and 6 months ± 1 month after implantation. Thickness measurements were performed using the distance tool of the built-in software. Three thickness measurements were performed in each of the four quadrants of the retina on the microchip within 6 weeks and 6 months ± 1 month after implantation. RESULTS The mean ± standard deviation change in retinal thickness from within 6 weeks to 6 months ± 1 month after implantation in all four quadrants combined was 24 μm ± 68 μm. None of the tested variables (location, time, or their interaction) had a statistically significant effect on the mean retinal thickness (P = .961, P = .131, and P = .182, respectively; n = 19). CONCLUSION The authors report on qualitative and quantitative findings in retinal structure in 27 patients after subretinal implantation of the Retina Implant Alpha IMS using OCT technology. No significant changes of retinal thickness could be observed in a period of 6 months after surgery. With more patients receiving subretinal implants and with advanced OCT technology, the data set will be extended to study possible changes in retinal structure in finer detail. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:993-999.].
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Abstract
Cell wall-deficient bacteria (CWDB) are pleomorphic bacterial forms. These atypical organisms may occur naturally or they can be induced in the laboratory. Their presence has been known about for over a century, but a definite link to clinical disease outcomes has not been demonstrated. A number of case reports and laboratory studies suggest some disease associations, however. Considerable controversy surrounds the true relevance of CWDB to disease; there is a widespread belief that they may represent a response by the walled organism to adverse extracellular conditions like antibiotic pressure. This review looks at studies published between 1934 and 2003, which were identified by Dialog DataStar using the key words ‘cell wall deficient bacteria and clinical significance and infections’ and by further scanning the reference list at the end of the papers retrieved. We conclude that the evidence for the clinical significance of CWDB in disease is not compelling.
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Affiliation(s)
- M E Onwuamaegbu
- Department of Clinical Cardiology, Royal Brompton Hospital, London, UK.
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28
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Anderson D, Soare C, Bozic J, Ontsouka B, Ahmed T, Diress A, Yorke M, Fluckiger AC, Kirchmeier M. Therapeutic vaccination against glioblastoma multiformae using CMV gB/pp65 eVLPs formulated with GM-CSF. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv514.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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29
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Ghorbani M, Nass T, Azizi A, Soare C, Aucoin S, Giulivi A, Anderson DE, Diaz-Mitoma F. Comparison of antibody- and cell-mediated immune responses after intramuscular hepatitis C immunizations of BALB/c mice. Viral Immunol 2006; 18:637-48. [PMID: 16359230 DOI: 10.1089/vim.2005.18.637] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Current treatments for hepatitis C infection have limited efficacy, and there is no vaccine available. The goal of this study was to compare the immune response to several immunization combinations against hepatitis C virus (HCV). Six groups of mice were immunized at weeks 0, 4, and 8 with different combinations of a candidate HCV vaccine consisting of 100 microg recombinant HCV core/E1/E2 (rHCV) DNA plasmid and/or 25 microg rHCV polyprotein and 50 microL Montanide ISA- 51. Four weeks after the last injection, all groups of mice were sacrificed and blood samples and spleens were collected for measuring the levels of specific HCV antibodies (total IgG, IgG1, and IgG2a). Cell proliferation and intracellular interferon-gamma were also measured. Among the groups of immunized mice, only the mice immunized with rHCV DNA plasmid, rHCV polyprotein, and montanide (group D) and mice immunized with rHCV polyprotein and montanide (group F) demonstrated a significant increase in the total IgG titer after immunization. IgG1 was the predominant antibody detected in both groups D and F. No IgG2a was detected in any of the groups. Proliferation assays demonstrated that splenocytes from group D and group C (rHCV DNA primed/rHCV polyprotein boost) developed significant anti-HCV proliferative responses. The combination of an rHCV DNA plasmid, rHCV polyprotein, and montanide induced a high antibody titer with a predominance of IgG1 antibodies and recognized the major neutralization epitopes in HVR1. In contrast, group C did not show an increase in anti-HCV antibodies, but did show a proliferative response.
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Affiliation(s)
- M Ghorbani
- Division of Virology, Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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Singeorzean P, Prundeanu C, Gordan G, Soare C, Babeş VT. Epidemiological and clinical findings in viral hepatitis. Virologie (Montrouge) 1980; 31:283-8. [PMID: 7257177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An HBsAg prevalence of 17.27% was found in 480 young adult viral hepatitis (VH) patients from semi-closed communities. The evolution of HBsAg positive VH had a seasonal aspect, resembling that of serologically negative forms. Analyzed according to the moment when the communities were set up, HBsAg-negative VH morbidity had a biphasic pattern, suggesting the occurrence of two distinct viral etiologies. The length of the stationary phase, the prevalence of protracted clinical forms, that high frequency of relapses and of the need for corticotherapy point to the increased severity of HBsAg positive VH.
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Steiner N, Petrescu A, Teodosiu O, Mihail A, Mihăilescu M, Steiner G, Berca C, Călina A, Soare C. Influenza vaccination by nasal route in a semi-closed community. Virologie (Montrouge) 1980; 31:117-20. [PMID: 7405010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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