Low CD4 Count or Being Out of Care Increases the Risk for Mpox Hospitalization Among People With Human Immunodeficiency Virus and Mpox

Human immunodeficiency virus (HIV)-associated immunosuppression may increase the risk of hospitalization with mpox. Among persons diagnosed with mpox in the state of Georgia, we characterized the association between hospitalization with mpox and HIV status. People with HIV and a CD4 count <350 cells/mm3 or who were not engaged in HIV care had an increased risk of hospitalization.

HIV and mpox: a rapid review

In this review, we discuss the history and epidemiology of mpox, prevention strategies, clinical characteristics and management, severity of mpox among persons with advanced HIV, and areas for future research relevant to persons with HIV.

Rapid Antiretroviral Therapy Program: Development and Evaluation at a Veterans Affairs Medical Center in the Southern United States

Early HIV viral suppression (VS) improves individual health outcomes and decreases onward transmission. We designed an outpatient clinic protocol to rapidly initiate antiretroviral therapy (ART) in a large Veterans Health Administration (VA) HIV clinic. A pre-post evaluation was performed using a retrospective cohort study design for new diagnoses of HIV infection from January 2012 to February 2020. Time-to-event analyses were performed using the Cox proportional hazards model with the intervention group as the main exposure adjusted for integrase inhibitor usage, baseline viral load, age, gender, and race. Most of the patients were men (historical control: 94.8%, n = 55; Rapid Start: 94.8%, n = 55) and Black or African American persons (historical control: 87.9%, n = 51; Rapid Start: 82.8%, n = 48). More patients initiated treatment with an integrase inhibitor-based regimen in the Rapid Start group (98.3%, n = 57) compared with the historical control group (39.7%, n = 23). Compared with controls, the Rapid Start patients were significantly more likely to achieve VS at any given time during the study period (hazard ratio 2.65; p < 0.001). Median days (interquartile range) from diagnosis to VS decreased from 180.5 (102.5-338.5) to 62 (40-105) (p < 0.001), first appointment to VS decreased from 123 (68.5-237.5) to 45 (28-82) (p < 0.001), referral to first visit decreased from 20 (10-43) to 1 (0-3) (p < 0.001), and from first visit to ART dispense date decreased from 27.5 (3-50) to 0 (0-0) (p = 0.01). Prioritizing immediate ART initiation can compress the HIV care continuum from diagnosis to linkage to VS. Implementation of the Rapid Start Protocol should be considered at all VA facilities providing HIV care.

AEDs at your fingertips: automated external defibrillators on college campuses and a novel approach for increasing accessibility

The use of automated external defibrillators (AEDs) increases survival in cardiac arrest events. Due to the success of previous efforts and free, readily available mobile mapping software, the discussion is to emphasize the importance of the use of AEDs to prevent sudden cardiac arrest-related deaths on college campuses and abroad, while suggesting a novel approach to aiding in access and awareness issues. A user-friendly mobile application (a low-cost iOS map) was developed at Florida State University to decrease AED retrieval distance and time. The development of mobile AED maps is feasible for a variety of universities and other entities, with the potential to save lives. Just having AEDs installed is not enough--they need to be easily locatable. Society increasingly relies on phones to provide information, and there are opportunities to use mobile technology to locate and share information about relevant emergency devices; these should be incorporated into the chain of survival.

A survey of vernal keratoconjunctivitis and other eosinophil-mediated external eye diseases amongst Palestinians

PURPOSE

To determine the morbidity of vernal, atopic and other disease mediated by eosinophils amongst the Palestinian Community of East Jerusalem, West Bank and Gaza Strip.

METHOD

In a prospective outpatient study, 840 people were screened for evidence of eosinophilic external eye disease by history taking and medical examination of the external eye, conjunctiva, nose and paranasal sinuses in the outpatient clinic. The surgical and iatrogenic morbidity of the condition was concurrently estimated, and the prescribing habits of local West Bank ophthalmologists were carefully evaluated. The favoured regime was locally manufactured antihistamine drops, usually in combination with an aminoglycoside antibiotic that characteristically exacerbates the condition. Topical steroids, such as guttae prednisolone forte, were also overused as a modality to treat the condition.

CONCLUSIONS

Since the recent decline of endemic trachoma, vernal eye disease is now the leading cause of outpatient ophthalmic morbidity amongst Palestinians of East Jerusalem. The disease accounts for at least 9. 8% of approximately 74,400 annual outpatient attendances to ophthalmic clinics in East Jerusalem, the West Bank and Gaza. The manifestations of the disease, however, are more protean than this. In the context of poor hygiene and sometimes dubious medical practice, vernal eye disease is often responsible for serious anterior segment and external ophthalmic disease.

Glaucoma: diagnosis and management

Glaucoma is the third most prevalent cause of global blindness, accounting for over 5 million blind. It is common in Western Countries; the estimated prevalence of primary open angle glaucoma rises from a total prevalence of 1.1% to approximately 3% of our population as it ages. Ethnicity affects both the risk of developing glaucoma and the outcome. It is an expensive disease both to detect and to treat. Recent scientific advances include elucidation of the genetic mechanism behind the disease and the study of haemodynamic and biochemical co-factors in the development of glaucomatous optic neuropathy, particularly in relation to the pathogenesis of normal tension glaucoma. Several new types of topical medication have recently been developed for use in glaucoma; both the impact of these therapies and their cost effectiveness remain to be evaluated. There are widely differing regimes which effectively treat glaucoma; some ophthalmologists prefer early surgical intervention whilst others reserve surgery for relatively advanced disease. All methods of current treatment rely on the reduction of intra-ocular pressure; as yet there is no medication which has been definitively proven to be either neuroprotective or to influence favourably optic nerve perfusion. Despite this, most sufferers of glaucoma are able to lead lives of quality. Increased community awareness of glaucoma, and earlier detection of the condition, will doubtless result in decreased morbidity due to glaucoma.

Excimer laser ophthalmic surgery: evaluation of a new technology

The aim of this article is to provide information and an overview of the potential risks and benefits of excimer laser surgery, a new and promising technique in ophthalmic surgery. Although this review concentrates on the use of the laser for refractive purposes, novel therapeutic techniques are also discussed. It is hoped that this will enable general practitioners, optometrists and physicians to provide appropriate advice and counselling for patients.

Age-related macular degeneration

Macular degeneration is now responsible for approximately 95% of blindness and partial sighted registrations in the UK. This review has been written specifically to make the general medical community of the UK aware of the prevalence and clinical manifestations of aged-related macular degeneration. The review encompasses the risk factors, the disabilities and problems experienced by suffers of the condition and current therapeutic options. Age related macular degeneration increases in prevalence in our community from 0% among people under 55 years old to 18.5% among those 85 years or older. There is a marked female preponderance. The exudative form of the disorder is commoner. Treatment remains supportive for most patients with macular degeneration although a minority will benefit from macular laser photocoagulation.

Diabetic retinopathy

Diabetic retinopathy is the commonest cause of blindness amongst individuals of working age. The onset of retinopathy is variable. Regular ophthalmic screening is essential in order to detect treatable lesions early. Retinal laser therapy is highly effective in slowing the progression of retinopathy and in preventing blindness. As the sufferers of diabetes mellitus, the commonest endocrine disorder, now constitute approximately 1-2% of Western populations, concerted multidisciplinary effort must be made towards cost-effective community screening by the medical community.

Surgical management of ophthalmic trauma due to the Palestinian Intifada

PURPOSE

The purpose of the study was to determine the causes, morbidity and visual outcome of 567 Intifada eye injuries which occurred during a 6 year period from December 1987 to December 1993.

METHODS

A prospective study was undertaken of Intifada eye injuries from December 1987 to December 1993 which were treated at the St John Ophthalmic Hospital, Jerusalem, or in private clinics in East Jerusalem, the West Bank and Gaza.

RESULTS

Seventy-five per cent of those injured came from East Jerusalem or the West Bank. The average age of a person injured was 17 years. Male preponderance was 84.7%. The study demonstrates both the high morbidity and the poor visual outcome which characterise Intifada eye injuries. There were 567 eyes in the series, of which 143 (25.2%) lost perception of light and 72 (12.6%) had vision less than or equal to 6/60. Eighty-six eyes (15.1%) required enucleation. In total 43.1% of the series had severe ocular injuries. Rubber or plastic bullets caused 154 injuries. They were the commonest indication for the enucleation of an eye (90.6% of 86 enucleations). There were 3 cases of severe Gram-negative endophthalmitis in the group of patients who presented late to the hospital (0.52%).

CONCLUSIONS

Intifada injuries are associated with far greater morbidity than non-military eye injuries. Rubber or plastic bullet injuries are the leading cause of visual loss and of eye enucleation. Military curfews exacerbate the morbidity of Intifada injuries by prolonging evacuation time.

Lacrimal surgery at St John, Jerusalem

Lacrimal surgery forms a prominent component of a general ophthalmic surgeon's workload at the St. John Ophthalmic Hospital, Jerusalem. The hospital caters for the Palestinian community of East Jerusalem, the West Bank and Gaza, the combined population totaling approximately 2.2 million. The area is under-developed economically and, in addition, the ongoing political conflict, the Intifada, makes the provision of health care difficult. Nonetheless the St. John Ophthalmic Hospital provides a level of surgical care which is notable for the fact that it is consistent and high. Advanced, obstructive lacrimal disease is endemic in the region; in 1993/94 256 operations were performed for lacrimal obstruction at the St John Ophthalmic Hospital. Lacrimal disease on the West Bank and Gaza Strip is the result of well defined causes which have not been previously documented. This paper proves that conventional lacrimal surgery is successful in relieving advanced lacrimal obstruction in the developing community.

Age-related macular degeneration: a leading cause of blindness

Age-related macular degeneration (AMD) is the most common cause of blindness in Australia, rising in prevalence from zero in people aged under 55 years to 18.5% in those aged over 85 years. More women suffer from the disease and it is estimated that 72,220 Australians may have signs of late AMD in one or both eyes. Degenerative processes in the retina include the appearance of abnormal drüsen (the key lesion of AMD); atrophy, retinal-pigment abnormalities and gradual loss of vision (atrophic AMD); and haemorrhage, exudation, scarring and rapid loss of vision (exudative AMD). Although environmental (e.g., smoking) and hereditary factors may possibly play a role in the development of AMD, the principal risk factor is ageing. Treatment remains supportive for most patients, but a few will benefit from macular laser photocoagulation.

Civilian eye casualties in east Jerusalem and the occupied territories

Rapid, unexpected and drastic change characterises the political status quo in the Middle East. The recent upheavals have again focused world attention on the protracted problems of the region. In this paper we review the causes and outcome of 567 Intifada eye injuries which occurred over the six-year period 1987-93, and which were all treated at the St John Ophthalmic Hospital, Jerusalem.

Water deprivation produces an exercise-induced weight loss phenomenon in the rat

Rats given restricted feeding and allowed free access to activity wheels increase activity, decrease food intake, and lose body weight compared to nonexercised controls. The phenomenon is of interest because of the relationship between exercise and anorexia nervosa. This study determined if another factor that energizes behavior in rats, water deprivation, produces similar exercise-induced weight loss. Rats were maintained on a restricted water schedule (10 min/day) combined with free access to running wheels and food; controls had no wheel access or were food deprived only. Both water-deprived groups consumed similar amounts of food and water, with the exercised group losing more body weight. Plasma osmolality, hematocrit, and posterior pituitary vasopressin content were equivalent in the two water-deprived groups, indicating similar hydrational status. It is concluded that the weight loss effect in water-deprived rats is due to excessive voluntary exercise, and that other factors that energize behavior should produce a similar effect.

Rene Laennec: his brilliant life and tragic early death

1. Laennec's lung disease lasted for at least 20 years. Its stigmata included chronic cough, sputum production and intermittent wheeze. 2. Laennec had long term stigmata commonly associated with chronic bronchiectasis, sinusitis, physical frailty, and short stature (5ft 2in). 3. Chronic diarrhoea of at least 20 years duration is not strongly associated with tuberculosis. 4. During Laennec's last illness his physicians equivocated as to whether he had respiratory disease at all. Bronchial breathing at the apex, if indeed present, could have been caused by compensatory emphysema secondary to middle lobe bronchiectasis rather than to active tuberculosis. 5. Laennec did not have haemoptysis in his final illness. 6. Laennec's last illness, a wasting illness characterised by intermittent fevers, cardiac murmur, and persistent tachycardia followed a dental manipulation. The painful "abdominal abscess" noted by Laennec's colleagues may actually have been splenomegaly. These features suggest endocarditis. The cardiac murmurs associated with pulmonary hypertension secondary to bronchiectasis are not usually audible at a remote distance from the patient. Endocarditis was a disease largely unknown to physicians of the early 19th century before Osler clarified its pathology in the 1880s.

Was Frédéric Chopin's illness actually cystic fibrosis?

Since Chopin's death 140 years ago, no one has questioned seriously the theory that he died of tuberculosis, in spite of the knowledge that many of the physicians who treated his illness considered tuberculosis an unlikely cause of his chronic respiratory disease, which was of at least 24 years' duration. Although 170 cm in height, Chopin weighed less than 45 kg throughout his life. He was noticeably emaciated and had a marked tendency to lose weight after respiratory infections and with dietary indiscretion. His exercise tolerance remained far below that of his peers throughout his lifetime. He was affected by a debilitating chronic cough, which was often productive and was worst in the morning. This cough persisted from before 15 years of age until his death of cor pulmonale at 39 years of age. Chopin suffered multiple acute, severe respiratory infections of both the upper and lower respiratory tracts which worsened in winter. He had haemoptysis for 18 years. In later life he grew markedly barrel-chested. He may also have been infertile. Chopin's autopsy revealed gross cardiomegaly and changes in his lungs which were not consistent with cavitating tuberculosis. These features suggest that cystic fibrosis may have been the cause of his ill-health and death. Chopin's sister Emily, died at 14 years of age, possibly also of cystic fibrosis.