Allison J. Chen

Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: A chart-verified case-control analysis

BACKGROUND Hidradenitis suppurativa (HS) is a chronic inflammatory disease involving intertriginous skin. Previous epidemiologic studies have been limited by small sample size. OBJECTIVE We sought to describe the prevalence and comorbidities of HS in a large patient care database. METHODS In this retrospective case-control study, we chart-validated all patients within a hospital database who received at least 1 billing code for HS between 1980 and 2013. Verified cases were matched with controls based on age, gender, and race. Prevalences of a priori selected comorbidities were compared between HS and control groups. RESULTS A total of 2292 patients at Massachusetts General Hospital received at least 1 code for HS. A total of 1776 cases had a validated diagnosis of HS, yielding a prevalence of 0.08%. In unadjusted analysis, all comorbidities were diagnosed significantly more in HS compared with control including (in rank order of likelihood): smoking, arthropathies, dyslipidemia, polycystic ovarian syndrome, psychiatric disorders, obesity, drug dependence, hypertension, diabetes, thyroid disease, alcohol dependence, and lymphoma (all P < .01). LIMITATIONS Control subjects were not validated for absence of HS and comorbidity validation was not performed for either group. CONCLUSIONS Our results highlights the high comorbidity burden of patients with HS compared with matched control subjects.

Epidemiology of nonfatal bicycle injuries presenting to United States emergency departments, 2001-2008

OBJECTIVES The purpose of this study was to describe the epidemiology of bicycle-related injuries presenting to United States emergency departments (EDs). METHODS The National Electronic Injury Surveillance System All Injury Program (NEISS-AIP) database was used to derive national, weighted estimates of nonfatal ED visits for bicycle-related injuries by patient age, sex, diagnosis, injured body part, locale of incident, traffic-relatedness of incident, and month of incident. RESULTS Males accounted for 73% of all bicycle-related injury ED visits. Patients aged 10 to 14 years represented the 5-year age interval with the highest rate of bicycle injury visits (488 per 10,000). Fifty-six percent of ED visits for bicycle-related injuries came from cyclists who were riding on the street, with increased street ridership in those who were older than 15 years, and 99.7% of all patient injuries occurring on the street (as opposed to other locations) were related to motor vehicle collisions (MVCs). The head and face were the most injured body parts in the overall population. In addition, the largest proportion of head injuries, relative to total injuries in the age group, occurred in the very young (0 to 4 years) and elderly (65+ years) populations. The leading rider injury diagnoses were contusion, abrasions, and hematomas. The incidence of bicycle-related injuries peaked in the month of July. CONCLUSIONS The study identified the characteristics of bicycle-related injuries across various age groups of riders. This information will aid in developing more effective age-appropriate injury prevention strategies. The frequency of MVC-related injuries deserves attention and suggests the need to examine strategies for limiting interactions between moving vehicles and bicyclists.

Disclosure of Resident Involvement in Ophthalmic Surgery

lated, with cumulative doses exceeding 100 g predisposing to vortex keratopathy, lens opacities, optic neuritis, retinal pigment epithelium abnormalities, crystalline maculopathy, and CME. These findings are less commonly seen in patients receiving lower-dose therapy for breast cancer, although the advent of high-resolution spectral-domain optical coherence tomography has revealed more cases of tamoxifen-associated CME in the absence of crystals. The crystalline retinal deposits are classically confined to the nerve fiber and inner plexiform layers and are hypothesized to represent areas of axonal degeneration. Current treatment for tamoxifen maculopathy is discontinuation of the drug. In our case, severe crystalline maculopathy and florid CME were unchanged 7 months after cessation of tamoxifen. Previous experience treating diffuse diabetic macular edema by inhibiting vascular endothelial growth factor, a potent inducer of vascular permeability, with intravitreal bevacizumab prompted us to initiate therapy for this patient. Bourla et al reported improvement of tamoxifen-induced CME with intravitreal pegaptanib sodium (Macugen), but to our knowledge this is the first case of improved tamoxifenassociated crystalline maculopathy and resolved CME with intravitreal bevacizumab therapy.

Epidemiology of infant ocular and periocular injuries from consumer products in the United States, 2001-2008.

PURPOSE To quantify and characterize eye injuries related to consumer products in the infant population (0-12 months) treated in United States hospital emergency departments during the period from 2001 to 2008. METHODS This study is a descriptive analysis of consumer-product related eye injury data derived from the National Electronic Injury Surveillance System, a probability sample of 100 hospitals nationwide with 24-hour emergency departments. Narrative data were used to assign each case with the consumer products (CPs) causing the eye injury. The proportions of eye injury visits were calculated by age, sex, diagnosis, disposition, locale of incident, and CP categories. We examined the US Consumer Product Safety Commission National Electronic Injury Surveillance System data for all nonfatal eye injuries (853 cases) in the infant population (0-12 months) treated in US emergency departments from 2001 to 2008. These data can be used to project national, annual, weighted estimates of nonfatal injury treated in US emergency departments. RESULTS There were an estimated 21,271 visits to US emergency departments by patients aged 0-12 months for CP-related eye injuries during the study period. Of these, 63% involved infants aged 9-12 months and 54% involved male patients; 78% of all injuries occurred at home. The CPs causing the most eye injuries belonged to the categories of chemical (46%) and household items (24%). Contusions and abrasions were the leading eye injuries diagnoses (37%). CONCLUSIONS This study suggests that most CP-related infant eye injuries in the United States occur at home and are predominantly caused by chemicals and household products.

Ophthalmic Resident Education on Preventable Surgical Errors

Ophthalmic Resident Education on Preventable Surgical Errors An important objective of ophthalmic graduate medical education (GME) is to provide surgical training to residents so they are competent to enter comprehensive ophthalmic practice.1 Training to reduce the risk of surgical errors is central to this objective. Errors involving the wrong patient, wrong site, or wrong procedure can have devastating consequences2,3 and are largely preventable by adherence to specific protocols.4,5 Figure 3. Optical Coherence Tomographic Images and Enhanced Depth Imaging Optical Coherence Tomographic Images

An evaluation of cataract surgery clinical practice guidelines

Purpose This study used the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument to evaluate the methodological quality of clinical practice guidelines (CPG) published by the American Academy of Ophthalmology (AAO), Canadian Ophthalmological Society (COS) and Royal College of Ophthalmologists (RCO) for the management of cataract in adults. Study design An evaluation of the AAO, COS and RCO CPGs using a reliable and validated instrument. Methods Four evaluators independently appraised the three CPGs using the AGREE II Instrument, which covers six domains (Scope and Purpose, Stakeholder Involvement, Rigour of Development, Clarity of Presentation, Applicability and Editorial Independence). The AGREE II includes an Overall Assessment summarising guideline methodological rigour across all domains, using a 7-point scale where perfect adherence equals a score of 7. Results Scores ranged from 36% to 75% for the AAO guideline; 45% to 94% for the COS guideline and 23% to 85% for the RCO guideline. Intraclass correlation coefficients for the reliability of mean scores for the AAO, COS, and RCO were 0.78, 0.74 and 0.80; 95% CIs (0.60 to 0.90), (0.45 to 0.88) and (0.53 to 0.91), respectively. The strongest domains were Scope and Purpose (COS, RCO), Clarity of Presentation (COS, RCO) and Editorial Independence (AAO, COS). The weakest were Stakeholder Involvement (AAO), Applicability (AAO, COS) and Editorial Independence (RCO). Conclusions Cataract surgery practice guidelines can be improved by targeting stakeholder involvement, applicability and editorial independence.

Retinal implants: analysis of the news media perspective.

Author Contributions: Drs Singh and Han had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Singh, Covert, Henry, Bhatia, Han. Acquisition of data: Covert, Henry, Bhatia, Croskrey, Sanchez, Han. Analysis and interpretation of data: Singh, Henry, Bhatia, Han. Drafting of the manuscript: Singh, Han. Critical revision of the manuscript for important intellectual content: All authors. Statistical analysis: Singh, Covert, Henry, Bhatia, Croskrey. Study supervision: Han.

Etanercept-induced generalization of chronic, localized, anogenital bullous pemphigoid in a psoriatic patient

Up to 20% of cases of bullous pemphigoid (BP) show an atypical presentation, exhibiting localized distribution or non-bullous lesions, such as eczematous, urticarial, prurigolike, and erythema multiformelike papules and plaques.1 These atypical presentations can be associated with a delay in diagnosis and thus require a high degree of suspicion. We present a case of recalcitrant BP localized to the anogenital region with subsequent generalization after administration of etanercept, a tumor necrosis factor–alpha (TNF-α) inhibitor. Our review of bibliographic databases did not find any cases with similar distribution and course. TNF-α inhibitors are used in the treatment of pemphigus and pemphigoid. With expanding use of TNF-α inhibitors and longer follow-up periods, there are increasing reports of autoimmune diseases associated with these therapies, including autoimmune bullous disease and systemic lupus erythematosus.2 This case highlights that caution should be exercised when considering anti–TNF-α therapy for autoimmune bullous diseases.

Sudden vision loss and cardiovascular risk factors in African Americans: the Jackson Heart Study.

ABSTRACT Purpose: The prevalence and determinants of sudden vision loss (SVL) are unknown in African Americans (AAs). Since SVL can be cardiovascular disease (CVD)-related and CVD is highly prevalent in AAs, we examined the prevalence of and CVD factors related to self-reported SVL lasting 24 hours or longer in the cohort of AAs enrolled in the Jackson Heart Study (JHS). Methods: The study population comprised 5301 participants enrolled from 2000–2004 in the metropolitan area of Jackson, MS, USA. All participants who responded to the question “Have you ever had any sudden loss of vision or blurring, lasting 24 hours or longer?” on the baseline stroke questionnaire were included in the study. We estimated the prevalence of SVL and used regression modeling to identify CVD factors independently related to SVL. Results: A total of 5262 participants were included, of which 63% (3334/5262) were female. The prevalence of SVL was 3.6% (193/5262) overall (4.4% in females and 2.4% in males), and 8.7% (84/965) in patients with diabetes mellitus. Factors independently related to SVL included coronary heart disease (odds ratio, OR, 1.69, 95% confidence interval, CI, 1.12–2.56), cerebrovascular disease (OR 2.81, 95% CI 1.76–4.47), diabetes (OR 2.85, 95% CI 2.05–3.94), hypertension (OR 1.64, 95% CI 1.09–2.45), female sex (OR 1.82, 95% CI 1.24–2.67), and income less than US

Training in the prevention of surgical errors in ophthalmology: The resident perspective.

50,000 (OR 2.05, 95% CI 1.28–3.30). Conclusions: In this cohort of AAs, self-reported SVL lasting 24 hours or longer was highly prevalent in women and those with diabetes and was independently related to sex, CVD, CVD risk factors and household income.