Citations

Background: Eight Global Ophthalmology (GO) fellowship programs are available in the United States, and more than 30 U.S. GO fellows are now alumni. There are no standardized learning objectives for these programs, and fellows’ experiences vary widely between institutions. Purpose: To survey GO fellowship program directors in the United States to elucidate differences in learning objectives, duration of time abroad, funding sources, and other differences between GO fellowships. Methods: All program directors at all institutions with current GO fellowship programs in the United States were sent a 25-question questionnaire via email from October through December 2022. The questionnaire included distinct domains regarding the GO fellowship experience, care delivery, didactics, and best practices. Most questionnaire items were quantitative; 3 were qualitative. Responses to the quantitative and qualitative questions items were summarized descriptively. Results: All 10 program directors from the 8 GO fellowship programs that were current at the time of the survey participated. GO fellowship positions at most (88%) institutions were funded, in part, by the billing of care services provided by the fellows, with 50% of programs receiving supplemental funding from donations and 25% from nongovernmental organizations. Non-GO duties at the program home institutions constituted 29.5% of the time spent during the fellowships, on average. Policy advocacy occupies 2.3% of fellowship time, on average. Specific didactic topics covered in the GO programs and director perspectives on the pragmatic best practices for GO outreach varied considerably; however, inclusion of at least some public health topics and ethics appeared to be consistent among all of the programs. Conclusions: These findings provide insights into the landscape of GO fellowship programs in the United States, highlighting variations in funding, formal educational opportunities, and the allocation of time fellows spent working at the program home institution. Establishing standardized core competencies for fellows is recommended.

Introduction To examine within-class sulfonylurea safety, we compared risks of major adverse cardiovascular events (MACE) and severe hypoglycemia among adults with type 2 diabetes (T2D) and moderate cardiovascular risk following sulfonylurea initiation. Research design and methods We conducted a target trial emulation including adults ≥21 years old with T2D and moderate cardiovascular risk who initiated glimepiride, glipizide or glyburide between 2014 and 2021, using claims data from Optum Labs Data Warehouse and the Medicare fee-for-service 100% sample. Study outcomes were MACE (primary), expanded MACE and its components and emergency department or hospital encounters for hypoglycemia, ascertained during follow-up through 2022. Inverse probability of treatment weighting (IPTW) was applied using propensity scores estimated using the super learner ensemble, and outcomes were examined using IPTW Cox proportional hazards models. Results The weighted study cohort comprised 314 699 patients (mean age 66.9 years, 52.0% men, 76.6% non-Hispanic white). At 1 year, MACE was experienced by 2.5%, 2.7% and 2.8% of patients starting glimepiride, glipizide and glyburide, respectively. Compared with glimepiride, glyburide and glipizide were associated with higher risk of MACE (HR 1.10, 95% CI 1.05 to 1.16 for glyburide; HR 1.05, 95% CI 1.03 to 1.07 for glipizide). At 1 year, severe hypoglycemia was experienced by 0.3%, 0.3% and 0.4% of patients starting glimepiride, glipizide and glyburide, respectively. Glyburide was associated with a greater risk of severe hypoglycemia compared with glipizide (HR 1.43, 95% CI 1.23 to 1.65), while glipizide was associated with a lower risk compared with glimepiride (HR 0.82, 95% CI 0.77 to 0.87). Conclusions Among adults with T2D and moderate cardiovascular risk, glimepiride was associated with lowest risk of MACE and glipizide with lowest risk of severe hypoglycemia. These results can help inform treatment selection if sulfonylureas are used for glucose-lowering.

Objective This longitudinal study evaluated the long-term efficacy and safety of hematopoietic stem cell transplantation (HSCT) in slowing the progression of CSF1R-related disorder (CSF1R-RD).Methods Six symptomatic patients (mean follow-up, 6.6 years) were compared with six matched, untreated controls. The CSF1R Clinical Severity Score (CCSS), Montreal Cognitive Assessment, and Sundal radiological score were used for evaluation.Results Post-HSCT clinical progression slowed significantly from 14.1 to 3.7 CCSS/year, compared with 15.2 CCSS/year in the control group (p<0.01). Cognitive decline was substantially reduced (-1.5 points/year vs. -7.6 points/year), and radiological deterioration slowed (0.4 per year vs. 3.9 per year). Notably, during the observation period, all HSCT patients survived, whereas 50% of the patients in the control group died. No serious transplant-related complications were observed.Conclusion HSCT is a potent disease-modifying therapy for CSF1R-RD that drastically improves survival and slows deterioration. These findings underscore the necessity of early intervention during the symptomatic phase to maximize the preservation of quality of life for affected individuals.

Background: Use of pyrocarbon metacarpophalangeal (MCP) implants in rheumatoid arthritis (RA) patients has been associated with high rates of complications and reoperations. To date, few patient-specific prognostic factors have been identified. This study investigated body mass index (BMI) as a risk factor for RA patients undergoing pyrocarbon MCP arthroplasty. Methods: We included 148 joints (51 patients) that underwent pyrocarbon MCP implantation at our institution from 2000 to 2022. We analyzed survival free from revision, reoperation, and development of postoperative complications using cluster-robust Cox proportional hazard models with restricted cubic splines to plot non linear relationships. Secondarily, we compared survival above and below the World Health Organization cutoff for obesity of ≥ 30 kg/m 2 , adjusting for patient age and sex. Results: The relationship between BMI and risk for complications and revisions was J-shaped, with an increase in risk beyond 29 kg/m 2 . The relationship between BMI and late reoperations was U-shaped, with patients above 27.3 kg/m 2 and below 23.2 kg/m 2 at elevated risk. A BMI ≥ 30 kg/m 2 was associated with a 7.9-times increased risk for revision, 8.3-times increased risk for late reoperations, and 3.7-times increased risk for postoperative complications. Body mass index did not significantly influence risk for early reoperation. Conclusions: Body mass index was associated with pyrocarbon MCP implant failure in a non linear fashion, with overweight patients at risk for complications leading to revisions and late reoperations. Underweight patients may be at increased risk for late reoperations. These findings should inform patient and implant selection and help guide counseling for postoperative expectations.

Neurological conditions associated with air entry into the systemic circulation are rare, particularly when compared with other particles. Patients present with an acute decline in the level of consciousness and new focal neurological deficits, often including new hemiparesis. A single seizure may also be a heralding sign. Patients may progress to deep coma. The first line of action, before anything else, is (1) the immediate positioning of the patient in Trendelenburg and in left lateral decubitus; (2) giving oxygen using a closed face mask (10–15 L/min) or high-flow nasal cannulae (up to 60 L/min). We recommend hyperbaric oxygen therapy if facilities can be reached within an 8-hour window. Awakening from coma, improvement of hemiparesis and good functional outcome may occur, but progress is likely to be slow and protracted. The emphasis of this review is on the recognition, immediate and subsequent treatment of air embolism to the brain.