Charles C. Lin

Syphilis in China: results of a national surveillance programme

Summary Background After a massive syphilis epidemic in the first half of the 20th century, China was able to eliminate this infection for 20 years (1960–80). However, substantial changes in Chinese society have been followed by a resurgent epidemic of sexually transmitted diseases. Sporadic reports have provided clues to the magnitude of the spread of syphilis, but a national surveillance effort is needed to provide data for planning and intervention. Methods We collected and assessed case report data from Chinas national sexually transmitted disease surveillance system and sentinel site network. Findings In 1993, the reported total rate of cases of syphilis in China was 0·2 cases per 100 000, whereas primary and secondary syphilis alone represented 5·7 cases per 100 000 persons in 2005. The rate of congenital syphilis increased greatly with an average yearly rise of 71·9%, from 0·01 cases per 100 000 livebirths in 1991 to 19·68 cases per 100 000 livebirths in 2005. Interpretation The results suggest that a range of unique biological and social forces are driving the spread of syphilis in China. A national campaign for detection and treatment of syphilis, and a credible prevention strategy, are urgently needed.

China's syphilis epidemic : A systematic review of seroprevalence studies

Objective: The objective of this study was to investigate syphilis prevalence among low- and high-risk groups in China. Goal: The goal of this study was to explore the magnitude of China’s syphilis epidemic. Study Design: A systematic literature review of syphilis seroprevalence studies in China was performed searching PubMed and the Chinese Periodicals Database (CPD). Results: Five and 169 studies were retrieved from PubMed and the CPD, respectively. From 2000 to 2005, select low-risk groups had the following median syphilis prevalence: antenatal women (0.45%), premarital individuals (0.66%), and food and service employees (0.3%). Select high-risk groups had the following median prevalence: incarcerated female sex workers (12.49%), drug users (6.81%), and men who have sex with men (14.56%). In the last decade, prevalence has increased in all groups with the steepest rises seen among high-risk groups. Conclusions: Syphilis infection is increasing among low- and high-risk groups in China, suggesting unsafe sexual behavior that may accelerate HIV transmission and challenge current syphilis prevention and control efforts.

Determinants of Bone and Blood Lead Levels among Minorities Living in the Boston Area

We measured blood and bone lead levels among minority individuals who live in some of Boston’s neighborhoods with high minority representation. Compared with samples of predominantly white subjects we had studied before, the 84 volunteers in this study (33:67 male:female ratio; 31–72 years of age) had similar educational, occupational, and smoking profiles and mean blood, tibia, and patella lead levels (3 μg/dL, 11.9 μg/g, and 14.2 μg/g, respectively) that were also similar. The slopes of the univariate regressions of blood, tibia, and patella lead versus age were 0.10 μg/dL/year (p < 0.001), 0.45 μg/g/year (p < 0.001), and 0.73 μg/g/year (p < 0.001), respectively. Analyses of smoothing curves and regression lines for tibia and patella lead suggested an inflection point at 55 years of age, with slopes for subjects ≥ 55 years of age that were not only steeper than those of younger subjects but also substantially steeper than those observed for individuals > 55 years of age in studies of predominantly white participants. This apparent racial disparity at older ages may be related to differences in historic occupational and/or environmental exposures, or possibly the lower rates of bone turnover that are known to occur in postmenopausal black women. The higher levels of lead accumulation seen in this age group are of concern because such levels have been shown in other studies to predict elevated risks of chronic disease such as hypertension and cognitive dysfunction. Additional research on bone lead levels in minorities and their socioeconomic and racial determinants is needed.

Seasonal trends of microbial keratitis in South India.

Purpose: Previous studies suggest that fungal keratitis is more common in hot humid climates and that bacterial keratitis is independent of seasonal variation. This study analyzes seasonal trends in the incidence of fungal and bacterial keratitis at the Aravind Eye Hospital in southeast India. Methods: Using microbiology records from August 2006 to July 2009, retrospective analyses of infectious keratitis were performed. Bacterial and fungal keratitis incidence data were analyzed for seasonal patterns. Results: Among the 6967 infectious keratitis cases, cultures were performed in 5221 (74.9%) cases; among them, 3028 (58%) were positive. Of the culture-positive cases, 1908 (63%) and 1081 (35.7%) were of fungal and bacterial etiology, respectively. The predominant fungal organism was Fusarium spp (42.3%) and the predominant bacterial organisms were Streptococcus pneumoniae (35.1%), Pseudomonas aeruginosa (24.3%), and Nocardia spp (8.1%). Analyses revealed an uneven distribution of fungal keratitis throughout the year (P < 0.001) with peaks in July and January. No significant seasonal trend was observed for the combined bacterial keratitis group. Conclusions: A higher incidence of fungal keratitis occurs during the months corresponding to the windy and harvest seasons, during which time infection from vegetative corneal injury may be more likely. Robust screening efforts during these periods may mitigate visually debilitating sequelae from infectious keratitis.

Acanthamoeba Keratitis in South India: A Longitudinal Analysis of Epidemics

Purpose: In light of the increased incidence of contact lens associated Acanthamoeba keratitis in recent years, this study analyzed longitudinal trends of its incidence among predominantly non-contact lens wearers in a high-volume referral center in South India. Methods: A retrospective analysis of microbiology laboratory records at the Aravind Eye Hospital from 1988–2009 was performed. The Maximum Excess Events Test (MEET) was used to identify epidemics of Acanthamoeba keratitis. Results: There were a total of 38,529 unique cases of infectious keratitis evaluated over this time period, of which 372 were culture-positive for Acanthamoeba. Only three cases (0.9%) of Acanthamoeba keratitis occurred among contact lens wearers. MEET identified unique Acanthamoeba keratitis epidemics in 1993 and 2002. Conclusion: Discrete epidemics of Acanthamoeba keratitis occurred among a rural, non-contact lens wearing, population in South India in 1993 and 2002.

Scleral Intraocular Pressure Measurement in Cadaver Eyes Pre- and Postkeratoprosthesis Implantation

PURPOSE We correlated scleral IOP to assigned IOP using pneumatonometry in cadaver eyes before and after Boston type I keratoprosthesis (KPro) implantation. METHODS Corneal IOP and scleral IOP at the superonasal, superotemporal, inferotemporal, and inferonasal quadrants were measured using pneumatonometry in six cadaver eyes cannulated with an infusion line with assigned IOP held at 20, 30, 40, and 50 mm Hg. Measurements of scleral IOP at the same location were repeated after a KPro was implanted. Correlations between scleral IOP and assigned IOP were analyzed for the entire group of eyes, and for each individual eye before and after KPro. One eye was tested by another masked grader for interobserver variability. RESULTS Scleral IOP measured higher than corneal IOP by a mean of 13.2 mm Hg. For group analysis, pre-KPro scleral IOP had a positive and linear correlation with assigned IOP in all quadrants (P < 0.00001), and this correlation was preserved after KPro implantation (P < 0.00001). There was strong interobserver agreement in all measurement sites (P < 0.001). In analyses of individual eyes, scleral IOP measured at the inferotemporal quadrant confirmed the strong linear association between scleral IOP and assigned IOP before and after KPro for all study eyes. A Bland-Altman plot showed that the difference in scleral IOP between pre-KPro and post-KPro eyes fell mostly within ± 5 mm Hg. CONCLUSIONS Scleral IOP measured by pneumatonometry may be used to estimate IOP in cadaver eyes with and without keratoprosthesis. This may be a potential modality for assessing IOP for patients with corneal pathology or keratoprosthesis.

Successful DMEK after intraoperative graft inversion

Purpose: Hardiness of a Descemet membrane endothelial keratoplasty (DMEK) graft is not well established. The aim of this study was to report a case of graft survival after intraoperative inversion. Methods: We describe a case of a 76-year-old man with Fuchs corneal dystrophy who underwent DMEK in the left eye. After deployment of the graft and a 15-minute sulfur hexafluoride gas fill, the graft was noted to be inverted. The graft was then reoriented and properly positioned. Results: Because of progressive graft detachment, rebubble was required at 2 weeks after surgery. At 2 months after surgery, the graft was clear and fully adherent. Specular microscopy revealed 27.9% endothelial cell loss of the donor cornea. Conclusions: Despite intraoperative inversion, this DMEK graft remained viable without excessive endothelial cell loss.

Rescue technique for a partially expulsed descemet membrane endothelial keratoplasty (DMEK) graft

Purpose To describe a novel surgical technique to rescue a partially expulsed DMEK graft after insertion. Observations We present a case of a 66-year-old woman with visually significant Fuchs endothelial dystrophy who underwent a DMEK surgery complicated by partial expulsion of the DMEK graft during insertion. To rescue the graft, MicroSurgical Technology (MST) forceps were inserted through a nasal paracentesis to grasp the DMEK graft and redirect it back into the anterior chamber. The surgical technique and postoperative outcomes are described. The partially expulsed graft was centered and attached successfully during surgery. Postoperatively, the patient required two rebubbling procedures, but achieved best-corrected visual acuity of 20/20 vision 1 month after surgery. Conclusions and Importance: We describe an underreported complication and present a novel rescue technique for a partially expulsed DMEK graft that is effective and minimizes manipulation of the graft.

Rapid corneal adrenochrome deposition from topical ibopamine in the setting of infectious keratitis

Rapid corneal adrenochrome deposition from topical ibopamine in the setting of infectious keratitis