Importance
Acute infectious conjunctivitis is a common ocular condition with major public health consequences.


Objective
To assess regional variations and microbial etiologies of acute infectious conjunctivitis to guide treatment.


Design, Setting, and Participants
In this cross-sectional study, patients with presumed acute infectious conjunctivitis were enrolled in the study at 5 sites (Honolulu, Hawaii; Los Angeles, San Francisco, and San Diego, California; and Petah-Tikva, Israel) from March 2021 to March 2023. Patients with allergic or toxic conjunctivitis were excluded.


Main Outcomes and Measures
Pathogens were identified by unbiased RNA deep sequencing.


Results
In all, 52 patients (mean [range] age, 48 [7-80] years; 31 females [60%]) were enrolled at 5 sites (6 patients from Honolulu, 9 from San Diego, 11 from Los Angeles, 13 from San Francisco, and 13 from Petah-Tikva). RNA deep sequencing detected human adenovirus species D in one-quarter of patients (13 of 52). A wide range of pathogens, including human coronavirus 229E, SARS-CoV-2, and herpes simplex virus type 1, was also identified, as well as several bacteria and fungi. Moreover, 62% (32 of 52) of patients presented with purulent discharge, while only 8% (4 of 52) of patients had confirmed bacterial pathogens.


Conclusion and Relevance
In this cross-sectional study, pathogens associated with acute infectious conjunctivitis varied between all 5 sites in the US and Israel. Purulent discharge was a common presenting sign in this study, with a low specificity for bacteria-associated conjunctivitis, suggesting that further diagnostic workup may be necessary to inform antibiotic stewardship. Additional research on cost-effectiveness of using RNA deep sequencing is needed to ascertain whether it is better to monitor patients clinically until resolution of disease.

Pathogen Surveillance for Acute Infectious Conjunctivitis.

Objective Residency Applicant Assessment Using a Linear Rank Model.

Patient Opinions on Telemedicine Visits in Cleft/Craniofacial Multidisciplinary Team Clinic


 
 Conjunctivitis epidemics and pandemics remain a global burden. This study aims to comprehensively identify pathogens associated with conjunctivitis in Vietnam.
 
 
 
 Patients with acute infectious conjunctivitis who presented to an outpatient clinic in Ho Chi Minh City, Vietnam, were enrolled from September 2022 to March 2023. Swabs were obtained from conjunctiva and anterior nares of all patients. Unbiased RNA deep sequencing (RNA-seq) was used to identify any replicating pathogens in the samples.
 
 
 
 Samples from 35 patients were analyzed. A pathogen was identified in 80% of the patients. In total, 72% (95% confidence interval: 54%–85%) were infected with either human adenovirus (HAdV)-D or HAdV-B. RNA viruses detected were rhinoviruses and human coronavirus 229E. Bacteria etiologies included Streptococcus pneumoniae, Hemophilus influenza, and Pseudomonas spp. One patient had coinfection of rhinovirus A and HAdV-B. Vittaforma corneae, a fungus, was identified in one patient. Corneal subepithelial infiltrates, pseudomembranes, or preauricular lymphadenopathy were not reported in any patient.
 
 
 
 Human adenoviruses are the common circulating pathogens associated with infectious conjunctivitis in Vietnam. HAdV species, however, seem to vary between geographic locations within Vietnam. Other underrecognized pathogens identified in this study, such as RNA viruses, suggest that broader pathogen surveillance may be beneficial.


Pathogen Profiles of Infectious Conjunctivitis in Ho Chi Minh City, Vietnam

Despite having well‐described benefits, diversifying the physician workforce has been an ongoing challenge. Within emergency medicine (EM), multiple professional organizations have identified expanding diversity and inclusion as top priorities. The following is a description of an interactive session held at the SAEM annual meeting addressing recruitment strategies for underrepresented in medicine (URiM) and sexual and gender minority (SGM) students into EM.

Strategies for recruiting underrepresented in medicine and sexual and gender minority students to emergency medicine

Introduction Admissions and selection committees face challenges in identifying and mitigating biases in policies, processes, and discussions. Past bias training has focused on defining bias and presenting the negative impact of bias for committees. Methods This interactive training used committee comments, reflection, and audience response to enhance the contextual recognition of bias in admissions and selection processes and practices. For each bias type, we presented specific mitigation strategies and examples. The workshop was offered at four medical schools between December 2020 and April 2021. Participants were committee members (n = 126), largely medical school faculty, involved in MD, MD/PhD, and residency program selection at participating schools. A paired pre- and postworkshop assessment was conducted for each session to determine effectiveness of the workshop. Results Mean scores for each of the postassessment items ranged from 4.0 to 4.2 and were statistically significantly different from the preassessment scores per respective item. The results of a paired two-way t test found that these pre- to postworkshop assessment score increases were statistically significant across all assessment questions (ps < .001). Participants reported in their comments that the workshop was effective in establishing a safe and judgment-free learning environment to explore and identify biases and build skills and confidence for mitigating them. Discussion Interactive and applied bias training can be an effective strategy to advance committee culture and practice in recognizing and mitigating bias. This workshop provides committees with ongoing tools for equity practice in selection and decision-making.

Bias Breakers: Continuous Practice for Admissions and Selection Committees

SIGNIFICANCE Acute infectious conjunctivitis poses significant challenges to eye care providers. It can be highly transmissible, and because etiology is often presumed, correct treatment and management can be difficult. This study uses unbiased deep sequencing to identify causative pathogens of infectious conjunctivitis, potentially allowing for improved approaches to diagnosis and management. PURPOSES This study aimed to identify associated pathogens of acute infectious conjunctivitis in a single ambulatory eye care center. CASE REPORTS This study included patients who presented to the University of California Berkeley eye center with signs and symptoms suggestive of infectious conjunctivitis. From December 2021 to July 2021, samples were collected from seven subjects (ages ranging from 18 to 38). Deep sequencing identified associated pathogens in five of seven samples, including human adenovirus D, Haemophilus influenzae, Chlamydia trachomatis, and human coronavirus 229E. CONCLUSIONS Unbiased deep sequencing identified some unexpected pathogens in subjects with acute infectious conjunctivitis. Human adenovirus D was recovered from only one patient in this series. Although all samples were obtained during the COVID-19 pandemic, only one case of human coronavirus 229E and no SARS-CoV-2 were identified.

Case Series: Unbiased Deep Sequencing Analysis of Acute Infectious Conjunctivitis in an Ambulatory Eye Center in Berkeley, California

SIGNIFICANCE This case report demonstrates the use of novel imaging techniques and functional tests to longitudinally evaluate retinal structure and function after laser retinal injury. The structural and functional prognosis could be predicted with clinical findings, high-resolution retinal imaging, and functional testing. PURPOSE We present a laser retinal injury case in which an adaptive optics scanning laser ophthalmoscope and adaptive optics–based psychophysics were used to examine and monitor retinal structure and function after accidental exposure to a 1-W infrared laser beam. CASE REPORT A 23-year-old patient was unwittingly exposed to a 1-W, 852-nm continuous-wave laser at work as they noticed a small central blurry spot in the right eye. An initial eye examination was done 1 day after exposure, and the right eye's acuity was 20/25−2. Posterior segment evaluation revealed disrupted outer retina near the right eye's fovea. Adaptive optics imaging 2 weeks after the exposure revealed a 0.50 × 0.75° elliptical area with irregular borders and abnormal cone reflectivity just below the fovea. Starting at 1-month follow-up, structural recovery was observed on optical coherence tomography (OCT). Subsequent adaptive optics imaging showed significant recovery of cone reflectivity. Importantly, adaptive optics microperimetry showed measurable detection thresholds at all affected retinal locations at 6 months. By 10 months, all sites exhibited normal sensitivities. CONCLUSIONS Retinal structure and function from laser injury can be visualized and measured with OCT, adaptive optics imaging, and psychophysics. An intact Bruch's membrane on OCT and measurable retinal sensitivity by adaptive optics microperimetry may serve as good biomarkers for retinal recovery.

Case Report: Multimodal, Longitudinal Assessment of Retinal Structure and Function following Laser Retinal Injury

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Bias Breakers: Continuous Practice for Admissions and Selection Committees

Case Series: Unbiased Deep Sequencing Analysis of Acute Infectious Conjunctivitis in an Ambulatory Eye Center in Berkeley, California

Case Report: Multimodal, Longitudinal Assessment of Retinal Structure and Function following Laser Retinal Injury