Intralesional Tetracycline Injection, Pinch Technique, and Canthopexy for the Treatment of Severe Festoons: Preliminary Results

Background Many techniques have been presented for the treatment of lower eyelid festoons, but no singular technique has become dominant. Objectives The authors describe the safety and efficacy of intralesional tetracycline injection, the pinch technique, and canthopexy for the treatment of severe festoons. Methods Institutional board review approval was obtained, and a retrospective chart review was performed on 15 consecutive patients who had received 2% tetracycline injections to treat lower eyelid large festoons between February 2017 and February 2020. Three months after the last injection, a series of patients underwent the surgical procedure: pinch technique and canthopexy bilaterally. Results Clinical and photographic records were reviewed, and 12 patients were included in the analysis. Three patients did not return for follow-up after the injection series. Of the 12 patients, there were 3 male patients and 9 female patients, with an average age of 66.6 years. The mean volume injected in each festoon was 0.43 mL, and the mean follow-up was 313 days. A series of injections with a 3-month time interval were performed for patients with a partial response to the initial injection. There was no evidence of complications at the site of the injection. Three months after the last injection, these 12 patients underwent complementary surgical treatment, which included pinch resection and canthopexy. Conclusions These preliminary results suggest that intralesional injections of tetracycline 2% may offer a safe option to treat lower eyelid festoons. This noninvasive procedure represents adjunct benefits to complementary surgical therapy. Level of Evidence: 4

Efficacy of interrupted cyclic treatment with prednisolone on cancer pain: a randomized crossover study

Background Interrupted cyclic treatment with a low oral dose of prednisolone combined with stepladder analgesics would reduce the pain scores in cancer patients with reported less side effects. Following ethical approval, 39 cancer patients were randomized to receive prednisolone 10 mg every other day or every 4th day for 4 successive weeks followed with tapering prednisolone by 2.5 mg every 4 days over 2 weeks after each interval, primary outcome visual analog score (VAS), and other secondary outcomes such as (A) patient demographics; (B) pain scores; brief pain inventory score (BPI), pain severity score (PSS), pain interference score (PIS), analgesia level score, pain level score (PLS), and pain management index (PMI)); and (C) patient safety (adverse effects) with interrupted cyclic treatment with low-dose prednisolone. Results Compared with baseline values, patients had statistically significant lower VAS and PSS pain scores at 14 and 28 days after starting the 2 days cyclic treatment with prednisolone. Patients had comparative VAS and PSS pain scores during the 4-day cyclic treatment with prednisolone. Compared with the 4-day cyclic treatment, patients in the 2-day cyclic treatment had significant statistically lower VAS pain scores at 28 days. Adverse effects showed no significant statistical differences during both study sequences. Conclusion Interrupted cyclic prednisolone 10 mg combined with stepladder analgesic regimen is effective and safe in terms on improved quality of analgesia for 28 days in cancer patients more when used every 2nd day than every 4th day with appetite improvement during both. Trial registration The study protocol was approved by the local Institutional Board Review Committee on 8-11-2019. The study was prospectively registered with the www.clinicaltrials.gov

773. Hypochlorous Acid Generating Electrochemical Catheter Prototype for Prevention of Intraluminal Infections

Background Central-line associated bloodstream infection (CLABSI) contributes to mortality and cost. While aseptic dressings and antibiotic-impregnated catheters can prevent extraluminal infections, intraluminal infections remain a source of CLABSIs with limited prevention options. Methods In this proof-of-concept study, an electrochemical intravascular catheter (e-catheter) prototype capable of electrochemically generating hypochlorous acid intraluminally on the surface of platinum electrodes polarized at a constant potential of 1.5 VAg/AgCl was developed. After 24h of pre-polarization at 1.5 VAg/AgCl, their activity was tested by inoculating four clinical isolates derived from catheter-related infections, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecium and Escherichia coli. Figure 1. In vitro catheter and e-catheter models. Results E-catheters generated a mean HOCl concentration of 15.86±4.03 μM and had a mean pH of 6.14±0.79. e-catheters prevented infections with all four species, with an average reduction of 8.41±0.61 log10 CFU/mL at 48h compared to controls. Figure 3. Measurement of pH and HOCl at 48 hours in polarized e-catheters. Each dot represents a replicate; bars represent means. Figure 4. Prevention of infection after 48 hours of polarization (24 hours of infections) using e-catheters (polarized and non-polarized) compared to blank catheters. * indicates statistically significant reduction of cell counts in polarized e-catheter compared to blank catheter (p <0.05). Conclusion Polarized e-catheters which generate low amounts of HOCl continuously should be further developed to prevent intraluminal infection. Disclosures Haluk Beyenal, Ph.D, patent (Other Financial or Material Support, HB holds a patent: Beyenal H CD, Fransson BA, Sultana ST. . 2018. Electrochemical reduction or prevention of infections. U.S. patent 20180207301A1, international patent WO/2017/011635.) Robin Patel, MD, 1928 Diagnostics (Consultant)BioFire Diagnostics (Grant/Research Support)ContraFect Corporation (Grant/Research Support)Curetis (Consultant)Hylomorph AG (Grant/Research Support)IDSA (Other Financial or Material Support, Editor's Stipend)Infectious Diseases Board Review Course (Other Financial or Material Support, Honoraria)Mammoth Biosciences (Consultant)NBME (Other Financial or Material Support, Honoraria)Netflix (Consultant)Next Gen Diagnostics (Consultant)PathoQuest (Consultant)PhAST (Consultant)Qvella (Consultant)Samsung (Other Financial or Material Support, Patent Royalties)Selux Diagnostics (Consultant)Shionogi & Co., Ltd. (Grant/Research Support)Specific Technologies (Consultant)TenNor Therapeutics Limited (Grant/Research Support)Torus Biosystems (Consultant)Up-to-Date (Other Financial or Material Support, Honoraria) Robin Patel, MD, BioFire (Individual(s) Involved: Self): Grant/Research Support; Contrafect (Individual(s) Involved: Self): Grant/Research Support; IDSA (Individual(s) Involved: Self): Editor's stipend; NBME, Up-to-Date and the Infectious Diseases Board Review Course (Individual(s) Involved: Self): Honoraria; Netflix (Individual(s) Involved: Self): Consultant; TenNor Therapeutics Limited (Individual(s) Involved: Self): Grant/Research Support; to Curetis, Specific Technologies, Next Gen Diagnostics, PathoQuest, Selux Diagnostics, 1928 Diagnostics, PhAST, Torus Biosystems, Mammoth Biosciences and Qvella (Individual(s) Involved: Self): Consultant

Mayo Clinic Cases in Neuroimmunology

In the past 2 decades, diagnostics and therapeutics in neuroimmunology have rapidly evolved and increased in complexity. Diagnosis is assisted by various laboratory and advanced imaging techniques. Randomized clinical trials in multiple sclerosis and neuromyelitis optica, and smaller studies for rarer autoimmune diseases, have led to distinct immune molecule–targeted and mechanism-specific therapies. The fields of cerebrovascular medicine, neurooncology, and neuroinfectious diseases have not remained static either. All of these gains present a challenge, however, in that early and accurate neurologic diagnosis is more important than ever. In our experience, some diagnostic pitfalls lie in the interpretation of test results and images without reference to the nuances of the clinical history and examination. Although some things change (eg, technology), other things never change (eg, clinical common sense). The 83 case-based chapters focus on key components of the history, examination and test findings, and differential diagnosis, although we also reference treatment approaches extensively throughout. To bring some form to this extensive repertoire of cases, the book is divided into 3 sections covering central nervous system demyelinating disease, autoimmune neurologic disorders, and others. Illustrations include imaging and, where relevant, pathologic images and video material. Board review–style questions are also provided.

Mayo Clinic Neurology Board Review

Neurology is an exciting and rapidly expanding area of medicine. This new edition of Mayo Clinic Neurology Board Review is designed to assist both physicians-in-training who are preparing for the initial American Board of Psychiatry and Neurology (ABPN) certification examination and neurologists who are preparing for recertification. Trainees and other physicians in related specialties such as psychiatry, neurosurgery, or physiatry may also find this book useful in preparation for their own certification examinations. While erring on the side of thoroughness, Mayo Clinic Neurology Board Review, Second Edition, is not intended to replace an in-depth textbook or serve as a guide to the most current therapies. Instead, this book provides a core of essential knowledge of both basic and clinical aspects of neurology. The emphasis is on clinical knowledge related to diagnostic and therapeutic approaches to patient management. In addition, this text has an expansive array of illustrations, pathology, and radiologic images. There are different needs for those who are taking the initial board examination and for those who are recertifying. The first section covers basic sciences and psychiatry, and the remaining portion covers clinical neurology. It is intended that people taking the board examination for the first time would benefit from reviewing all chapters, whereas those recertifying may wish to mainly focus on the clinical section. Throughout the book, high-yield facts and questions have been included for your review.

Heplisav-B in Prior Hepatitis B Vaccine Nonresponders: A Case Series

ABSTRACT Introduction Hepatitis B is a potentially deadly infection that can be acquired by exposure to infectious human blood or body fluids. While service members and others at occupational risk are routinely vaccinated to prevent hepatitis B, non-responders to this vaccine are at continued risk. Heplisav-B is a newer vaccine that may offer additional protection to those at risk. Materials and Methods Cases of hepatitis B vaccine non-responders who were given Heplisav-B after receiving six or more doses of standard hepatitis B vaccine were collected from existing health records within the military health system after Uniformed Services University of the Health Sciences Institutional Review Board review. Results Twelve of thirteen (92%) prior non-responders who were tested at least 1 month after completing the recombinant Heplisav-B vaccine series demonstrated seroprotection against hepatitis B. Conclusions Ideally, all service members and other at-risk workers should be protected from hepatitis B. This case series suggests that prior non-responders are likely to gain protection from hepatitis B with Heplisav-B vaccination. A prospective trial is warranted for further evaluation of this potential indication.