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Corneal Pseudomicrocysts Following Claudin-6 Antibody-Drug Conjugate Infusion
Full text linkPurpose
To report a case of bilateral corneal pseudomicrocysts associated with infusions of a novel antibody-drug conjugate targeting claudin-6, called TORL-1-23.
Observations
A 47-year-old female with a history of advanced recurrent serous ovarian cancer presented to a level 1 tertiary care center with ocular irritation, redness, tearing, and light sensitivity following two infusions of TORL-1-23. Patient\u27s past ocular history was unremarkable. The patient was enrolled in a phase 1 clinical trial for TORL-1-23, an antibody-drug conjugate (ADC). Nine days following the second infusion the patient presented to the ophthalmology clinic complaining of two weeks of bilateral eye discomfort, tearing, and photophobia. On examination, the patient had decreased visual acuity with a surface keratopathy associated with a whorled pattern of epithelial pseudomicrocysts in both eyes. Corneal changes were concentrated between the inferior limbus and central cornea. The remainder of the ophthalmic exam was unremarkable. Collagen and silicone punctal plugs were placed and the patient was started on preservative free artificial tears, topical loteprednol 0.5 %, later replaced with topical prednisolone acetate 1 % drops, and brimonidine 0.2 % in both eyes. The patient developed neuropathy which necessitated a decrease in ADC dosage and the patient\u27s symptoms subsequently improved. However, a decrease in visual acuity and increase in corneal pseudomicrocysts was seen after the fifth infusion. Corneal disease improved with the placement of new collagen punctal plugs and addition of cyclosporine 0.05 % eye drops in both eyes. Ocular symptoms and exam findings waxed and waned with continued infusions of the ADC.
Conclusions and importance
This case reports an incidence of corneal pseudomicrocysts associated with TORL-1-23 treatment, which should be recognized as a potential adverse effect of this novel therapy
An Unusual Chest Lesion With Dual Pathologies
No full textGranuloma faciale (GF) is a rare, benign, chronic inflammatory condition characterized by well-defined reddish-brown papules, nodules, or plaques, often demonstrating follicular accentuation and telangiectasia, which may be termed peau d\u27orange. Typically, GF is localized to the facial area, but extrafacial variants have been reported, particularly on the trunk, scalp, and extremities. We report a 66-year-old male with a history of GF and multiple basal cell carcinomas (BCCs) who presented with a pearly plaque on the chest. Biopsy revealed extrafacial GF with a coincidental BCC, representing a rare case of a collision tumor. GF, typically a facial condition, can present in extrafacial locations, complicating the diagnosis. This case emphasizes the importance of thorough histopathological evaluation to identify concurrent pathologies in atypical skin lesions
Subscapularis CT-Scan Evaluation in Patients with Proximal Humerus Fracture: Reverse Total Shoulder Arthroplasty Versus Hemi-Arthroplasty
No full textBackground/Objectives: Hemiarthroplasty (HA) and Reverse Total Shoulder Arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. The role of the subscapularis tendon is well-defined in HA, whereas it plays a controversial role in RTSA. The purpose of our study is to evaluate its role in patients with proximal humerus fractures treated with HA and RTSA and investigate its association with clinical outcomes. Methods: Sixty-eight consecutive patients with proximal humeral fracture were prospectively enrolled into the study from June 2015 to May 2020 (RTSA = 36; HA = 32). Pre- and postoperative shoulder CT scans were performed to measure the subscapularis muscle cross-sectional area (SMCSA) and the supraspinatus fossa cross-sectional area (SFCSA). The SMCSA/SFCSA ratio was employed to normalize measurements against individual patient anatomy. Patient reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up. Results: The RTSA group demonstrated superior patient-reported outcomes (PROs) and range of motion (ROM) compared to the HA group. Notably, the Constant Score was significantly higher in the RTSA group (58.00 vs. 38.50; p = 0.0001), as well as forward flexion (147.50° vs. 90.00°; p \u3c 0.0001). A postoperative reduction in subscapularis size of \u3e35% occurred more frequently in RTSA patients (55.6%) than in HA patients (25%) (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018). Conclusions: RTSA demonstrated better results compared to HA, providing better ROM and PROs. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition seems to show no correlation with functional outcome in RTSA
Recognizing Skeletal Presentations of Rotator Cuff and Cruciate Ligament Surgical Interventions
No full textForensic anthropologists are commonly tasked with assisting investigators in identifying a decedent from an unknown set of human skeletal remains. When traditional methods are not applicable, medically implanted orthopaedic devices have been shown to aid in positive identification. However, not all orthopaedic surgeries result in surgical hardware that can be traced to a manufacturer or individual. This article presents skeletal case examples of two different rotator cuff repairs and an anterior cruciate ligament reconstruction, both of which are common orthopaedic surgeries that do not typically result in traceable hardware. In each case, the repairs were performed 10 years prior, yet the surgical intervention remained identifiable from the bony modifications and suture and screw placements, thereby corroborating decedent identifications. In two of the cases, the remains were burned, and DNA analyses were not possible. In addition to the skeletal presentation of these repairs, anatomical descriptions of the injuries and clinical approaches are provided. The case examples may help forensic anthropologists recognize and interpret similar skeletal modifications in their casework, contributing to identification efforts. Furthermore, these cases highlight the importance of broad anatomical knowledge and exposure to clinical medicine in medicolegal practices
“There’s a Lot of People Who Love Them, So Why Call \u27em Junkies?”: Clinician and Patient Perspectives About Words Used to Describe People Who Use Drugs
No full textBackground: There is increasing attention in clinician care to the importance of using person-first language. Clinicians\u27 words can reinforce clinicians\u27 pre-existing stigmas and biases. People who use drugs (PWUD) continue to face stigma from clinicians. Person-first language is a way to reduce stigma and perpetuation of bias.
Methods: Through specific structured in-person interviews, we examined the usage of stigmatizing language in the care of PWUD by surveying key clinicians- such as physicians, nurses, and social workers-and patients who self-identified as PWUD at Tufts Medical Center (Boston, MA) between July 2022-September 2022. Interview guides were created using the Consolidated Framework for Implementation Research (CFIR) 2.0 as a framework. We evaluated perceptions of person-first language and barriers to using person-first language amongst participants. Interviews were coded with Dedoose Software and inductive thematic analysis (ITA) methods were used until all themes were captured; CFIR 2.0 determinants used during interview guide creation were used as preliminary themes and modified as needed.
Results: We interviewed thirty-four people, including eleven PWUD at time of interview. Most clinicians agreed that language is important and matters when talking to patients and during documentation. Almost all patients agreed that language was important to them and impacted their relationship with their provider. However, there were responders that felt that person-first language was unnecessary, ineffective, and overly verbose in the medical setting. Major barriers to using person-first language were unawareness, lack of formal training, and perceived generational differences in appropriate language.
Conclusion: Addressing language usage is a critical opportunity to promote inclusion and reduce bias amongst PWUD. As medical charts become increasingly accessible by patients, the use of language by the clinician becomes increasingly important. To create and maintain equitable systems of care, it is important to meet clinicians where they are at and to work with them to address these issues. This can include targeted educational sessions and resources informing clinicians on preferred language use and curriculum for providers-in-training