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Fulltext A Case of a Large Sub-retinal Abscess Secondary to Klebsiella pneumoniae Endophthalmitis in a Pyelonephritis Patient

Mohd-Ilham I, Zulkifli M, Yaakub M, Muda R, Shatriah I

Cureus, 2019 May 14;11(5):e4656.
PMID: 31316877 DOI: 10.7759/cureus.4656

Endogenous endophthalmitis is an ocular emergency, with severe sight-threatening complications. We report a case of unilateral endogenous Klebsiella pneumonia endophthalmitis with a large sub-retinal abscess in a 39-year-old lady that developed four days after presentation with sepsis secondary to urinary tract infections and pyelonephritis. Despite immediate treatment with intravenous (IV) and intravitreal antibiotics, her eye condition deteriorated. A pars plana vitrectomy was performed, and the sub-retinal abscess was removed, followed by silicone oil tamponade. Subsequently, she regained her vision to 6/36 with complete regression of the intraocular inflammation and sub-retinal abscess.
Fulltext Stage 4 Takayasu Retinopathy With Persistent Neovascularization

Abd Rahman SA, Mohd Khialdin S, Muda R

Cureus, 2021 Jul;13(7):e16640.
PMID: 34462679 DOI: 10.7759/cureus.16640

Takayasu arteritis is a chronic, progressive, autoimmune, granulomatous, medium-to-large vessel-panarteritis. It may cause chronic ocular ischaemia that may be refractory to treatment. We report a case of stage 4 Takayasu retinopathy resistant to conventional treatments. The patient was a 22-year-old woman who was diagnosed with Takayasu arteritis when she first presented with claudication while chewing and swallowing for one month. The patient was found to be hypertensive, with a significant systolic blood pressure difference between the arms and non-palpable bilateral brachial and radial artery pulses. Angiogram imaging revealed abnormalities involving the left subclavian, bilateral common carotid and left internal carotid arteries. She was referred to the ophthalmology clinic, as she experienced bilateral recurrent transient visual loss six months after the diagnosis. Dilated fundus examination showed bilateral stage 2 Takayasu retinopathy, evidenced by the presence of dilated retinal veins with microaneurysms. Her eyes progressed to stage 4 Takayasu retinopathy with proliferative retinopathy within one year of immunomodulatory therapy, largely due to poor compliance. No signs of regression were observed after completion of bilateral pan-retinal photocoagulation (PRP) with ongoing immunosuppressive treatment.
Endogenous endophthalmitis: a 9-year retrospective study at a tertiary referral hospital in Malaysia

Muda R, Vayavari V, Subbiah D, Ishak H, Adnan A, Mohamed SO

J Ophthalmic Inflamm Infect, 2018 Oct 11;8(1):14.
PMID: 30306361 DOI: 10.1186/s12348-018-0158-3

BACKGROUND: The objective of this study was to determine the clinical presentation, systemic risk factors, source of infective microorganism, treatment outcomes, and prognostic indicators of endogenous endophthalmitis at a main tertiary referral hospital for uveitis in Malaysia. A retrospective review of medical records of 120 patients (143 eyes) with endogenous endophthalmitis over a period of 9 years between January 2007 and December 2015 was undertaken.
RESULTS: Identifiable systemic risk factors were present in 79.2%, with the majority related to diabetes mellitus (60.0%). The most common source of bacteremia was urinary tract infection (17.5%). A positive culture from ocular fluid or other body fluids was obtained in 82 patients (68.9%), and the blood was the highest source among all culture-positive results (42.0%). Gram-negative organisms accounted 42 cases (50.6%) of which Klebsiella pneumonia was the most common organism isolated (32.5%). Sixty-nine eyes (48.6%) were managed medically, and 73 eyes (51.4%) underwent vitrectomy. Final visual acuity of counting fingers (CF) or better was achieved in 100 eyes (73.0%). Presenting visual acuity of CF or better was significantly associated with a better final acuity of CF or better (p = 0.001).
CONCLUSIONS: The visual prognosis of endogenous endophthalmitis is often poor, leading to blindness. As expected, gram-negative organisms specifically Klebsiella pneumonia were the most common organisms isolated. Urinary tract infection was the main source of infection. Poor presenting visual acuity was significantly associated with grave visual outcomes. A high index of suspicion, early diagnosis, and treatment are crucial to salvage useful vision.
Fulltext Guidelines from an expert panel for the management of diabetic macular edema in the Malaysian population

Ngah NF, Muhamad NA, Mohamed SO, Abdul Aziz RA, Ma'amor NH, Ahmad Tarmidzi NA, et al.

Int J Ophthalmol, 2023;16(5):712-720.
PMID: 37206185 DOI: 10.18240/ijo.2023.05.07

AIM: To derive a Malaysia guideline and consensus as part of the Malaysia Retina Group's efforts for diagnosis, treatment, and best practices of diabetic macular edema (DME). The experts' panel suggests that the treatment algorithm to be divided into groups according to involvement the central macula. The purpose of DME therapy is to improve edema and achieve the best visual results with the least amount of treatment load.
METHODS: On two different occasions, a panel of 14 retinal specialists from Malaysia, together with an external expert, responded to a questionnaire on management of DME. A consensus was sought by voting after compiling, analyzing and discussion on first-phase replies on the round table discussion. A recommendation was deemed to have attained consensus when 12 out of the 14 panellists (85%) agreed with it.
RESULTS: The terms target response, adequate response, nonresponse, and inadequate response were developed when the DME patients' treatment responses were first characterized. The panelists reached agreement on a number of DME treatment-related issues, including the need to classify patients prior to treatment, first-line treatment options, the right time to switch between treatment modalities, and side effects associated with steroids. From this agreement, recommendations were derived and a treatment algorithm was created.
CONCLUSION: A detail and comprehensive treatment algorithm by Malaysia Retina Group for the Malaysian population provides guidance for treatment allocation of patients with DME.
Fulltext Predicting attitudinal and behavioral responses to COVID-19 pandemic using machine learning

Pavlović T, Azevedo F, De K, Riaño-Moreno JC, Maglić M, Gkinopoulos T, et al.

PNAS Nexus, 2022 Jul;1(3):pgac093.
PMID: 35990802 DOI: 10.1093/pnasnexus/pgac093

At the beginning of 2020, COVID-19 became a global problem. Despite all the efforts to emphasize the relevance of preventive measures, not everyone adhered to them. Thus, learning more about the characteristics determining attitudinal and behavioral responses to the pandemic is crucial to improving future interventions. In this study, we applied machine learning on the multinational data collected by the International Collaboration on the Social and Moral Psychology of COVID-19 (N = 51,404) to test the predictive efficacy of constructs from social, moral, cognitive, and personality psychology, as well as socio-demographic factors, in the attitudinal and behavioral responses to the pandemic. The results point to several valuable insights. Internalized moral identity provided the most consistent predictive contribution-individuals perceiving moral traits as central to their self-concept reported higher adherence to preventive measures. Similar results were found for morality as cooperation, symbolized moral identity, self-control, open-mindedness, and collective narcissism, while the inverse relationship was evident for the endorsement of conspiracy theories. However, we also found a non-neglible variability in the explained variance and predictive contributions with respect to macro-level factors such as the pandemic stage or cultural region. Overall, the results underscore the importance of morality-related and contextual factors in understanding adherence to public health recommendations during the pandemic.
The Psychological Science Accelerator's COVID-19 rapid-response dataset

Buchanan EM, Lewis SC, Paris B, Forscher PS, Pavlacic JM, Beshears JE, et al.

Sci Data, 2023 Feb 11;10(1):87.
PMID: 36774440 DOI: 10.1038/s41597-022-01811-7

In response to the COVID-19 pandemic, the Psychological Science Accelerator coordinated three large-scale psychological studies to examine the effects of loss-gain framing, cognitive reappraisals, and autonomy framing manipulations on behavioral intentions and affective measures. The data collected (April to October 2020) included specific measures for each experimental study, a general questionnaire examining health prevention behaviors and COVID-19 experience, geographical and cultural context characterization, and demographic information for each participant. Each participant started the study with the same general questions and then was randomized to complete either one longer experiment or two shorter experiments. Data were provided by 73,223 participants with varying completion rates. Participants completed the survey from 111 geopolitical regions in 44 unique languages/dialects. The anonymized dataset described here is provided in both raw and processed formats to facilitate re-use and further analyses. The dataset offers secondary analytic opportunities to explore coping, framing, and self-determination across a diverse, global sample obtained at the onset of the COVID-19 pandemic, which can be merged with other time-sampled or geographic data.
Fulltext Author Correction: A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic

Wang K, Goldenberg A, Dorison CA, Miller JK, Uusberg A, Lerner JS, et al.

Nat Hum Behav, 2022 Sep;6(9):1318-1319.
PMID: 36002766 DOI: 10.1038/s41562-022-01441-4
Fulltext A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic

Wang K, Goldenberg A, Dorison CA, Miller JK, Uusberg A, Lerner JS, et al.

Nat Hum Behav, 2021 Aug;5(8):1089-1110.
PMID: 34341554 DOI: 10.1038/s41562-021-01173-x

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 12 May 2020. The protocol, as accepted by the journal, can be found at https://doi.org/10.6084/m9.figshare.c.4878591.v1.
Fulltext In COVID-19 Health Messaging, Loss Framing Increases Anxiety with Little-to-No Concomitant Benefits: Experimental Evidence from 84 Countries

Dorison CA, Lerner JS, Heller BH, Rothman AJ, Kawachi II, Wang K, et al.

Affect Sci, 2022 Sep;3(3):577-602.
PMID: 36185503 DOI: 10.1007/s42761-022-00128-3

The COVID-19 pandemic (and its aftermath) highlights a critical need to communicate health information effectively to the global public. Given that subtle differences in information framing can have meaningful effects on behavior, behavioral science research highlights a pressing question: Is it more effective to frame COVID-19 health messages in terms of potential losses (e.g., "If you do not practice these steps, you can endanger yourself and others") or potential gains (e.g., "If you practice these steps, you can protect yourself and others")? Collecting data in 48 languages from 15,929 participants in 84 countries, we experimentally tested the effects of message framing on COVID-19-related judgments, intentions, and feelings. Loss- (vs. gain-) framed messages increased self-reported anxiety among participants cross-nationally with little-to-no impact on policy attitudes, behavioral intentions, or information seeking relevant to pandemic risks. These results were consistent across 84 countries, three variations of the message framing wording, and 560 data processing and analytic choices. Thus, results provide an empirical answer to a global communication question and highlight the emotional toll of loss-framed messages. Critically, this work demonstrates the importance of considering unintended affective consequences when evaluating nudge-style interventions.