Purpose To report prevalence, type, and etiology of diplopia in medically and surgically treated glaucoma patients. Design Cohort study Participants 195 adult glaucoma patients treated in a glaucoma referral practice. Methods 195 adult glaucoma patients who had undergone surgical or medical management were prospectively enrolled. Forty-seven patients had undergone glaucoma drainage device (GDD) surgery (Baerveldt 350, Baerveldt 250, and/or Ahmed FP7), 61 had undergone trabeculectomy, and 87 were medically treated. All patients completed the Diplopia Questionnaire to assess diplopia. We defined presence of diplopia as “Sometimes,” “Often,” or “Always” in distance straight ahead and/or reading positions on the Diplopia Questionnaire. A chart review was performed jointly by a strabismus and glaucoma sub-specialist to characterize the type and etiology of the diplopia. Main Outcome Measures Frequency, type, and etiology of diplopia. Results Diplopia was reported in 41 (21%) of 195 medically and surgically treated glaucoma patients. Binocular diplopia attributable to the glaucoma procedure was present in 11 of 47 (23%) post-GDD patients (95% CI; 12%–38%), which was significantly greater than in post-trabeculectomy patients (2 of 61 (3%), 95% CI; 0.4% –11%; P=0.002). The most common type of strabismus associated with binocular diplopia attributable to glaucoma surgery was hypertropia (10 out of 11 GDD patients, 2 out of 2 trabeculectomy patients). Monocular diplopia was found in a similar proportion of medically treated, post-trabeculectomy, and post-GDD (4 of 87 (5%), 4 of 61 (7%), and 2 of 47 (4%) respectively) patients. Binocular diplopia not attributable to surgery was found in similar proportions of GDD, trabeculectomy, and medically treated patients (3 of 47 (6%), 5 of 61 (8%), and 10 of 87 (11%) respectively). Conclusions Diplopia may be under-recognized in medically and surgically treated glaucoma patients and standardization of ascertaining patient symptoms using the Diplopia Questionnaire may be useful in these patients. Diplopia was more commonly seen after GDD than trabeculectomy, typically a non-comitant restrictive hypertropia. The prevalence of monocular diplopia and binocular diplopia unrelated to glaucoma surgery was similar among medical and surgical groups. It is important to counsel patients on the higher occurrence of diplopia associated with GDD surgery.

In patients with P-PHPT or R-PHPT and nonlocalizing imaging studies, sPVS is a sensitive test for localizing the source of PHPT when a positive PTH gradient is present.

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Background Pulmonary vein isolation (PVI) with autonomic modulation may be more successful than PVI alone for atrial fibrillation (AF) ablation and may be signaled by changes in sinus rhythm heart rate (HR) post ablation. We sought to determine if a change in sinus rhythm HR predicted AF recurrence post PVI. Methods Patients who underwent AF ablation from 2000 to 2011 were included if sinus rhythm was noted on ECG within 90 days pre and 7 days post ablation. Basic ECG interval and HR changes were analyzed and outcomes determined. Results A total of 1152 patients were identified (74.3% male, mean age 57 ± 11 years). Mean AF duration was 5.2 ± 5.3 years. Paroxysmal AF was noted in 712 (61.8%) of the patients. Mean EF was 61% ± 6%. Sinus rhythm HR was 61 ± 11 pre‐ablation and 76 ± 13 bpm post‐ablation (27% ± 24% increase, p < .001). The ability of relative HR change post‐ablation to predict AF recurrence was borderline (hazard ratio 0.65 [0.41–1.01], p = .067). With patients separated into quartiles based on the relative HR change, the upper quartile with the largest relative increase in HR had a significantly lower rate of AF recurrence compared to the lowest quartile following multi variable modeling (p = .038). There were significant changes in PR (171 ± 28 to 167 ± 30 ms) and QTc (424 ± 25 to 434 ± 29 ms) intervals (both p < .001) but these were not predictive of outcome. Conclusion Relative changes in HR post AF ablation correlates with AF recurrence. Further prospective studies are needed to confirm this relationship.

Introduction: Glycemic gap (GG), as determined by the difference between glucose and the hemoglobin A1c (HbA1c)-derived estimated average glucose (eAG), is associated with poor outcomes in various clinical settings. There is a paucity of data describing GG and outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Our main objectives were to evaluate the association of admission glycemic gap (aGG) with in-hospital mortality and with poor composite outcome and to compare aGG's predictive value to admission serum glucose. Secondary outcomes were the associations between aGG and neurologic complications including vasospasm and delayed cerebral ischemia following aSAH.Methods: We retrospectively reviewed 119 adult patients with aSAH admitted to a single tertiary care neuroscience ICU. Spearman method was used for correlation for non-normality of data. Area under the curve (AUC) for Receiver Operating Characteristic (ROC) curve was used to estimate prediction accuracy of aGG and admission glucose on outcome measures. Multivariable analyses were conducted to assess the value of aGG in predicting in-hospital poor composite outcome and death.Results: Elevated aGG at or above 30 mg/dL was identified in 79 (66.4%) of patients. Vasospasm was not associated with the elevated aGG. Admission GG correlated with admission serum glucose (r = 0.94, p &lt; 0.01), lactate (r = 0.41, p &lt; 0.01), procalcitonin (r = 0.38, p &lt; 0.01), and Hunt and Hess score (r = 0.51, p &lt; 0.01), but not with HbA1c (r = 0.02, p = 0.82). Compared to admission glucose, aGG had a statistically significantly improved accuracy in predicting inpatient mortality (AUC mean ± SEM: 0.77 ± 0.05 vs. 0.72 ± 0.06, p = 0.03) and trended toward statistically improved accuracy in predicting poor composite outcome (AUC: 0.69 ± 0.05 vs. 0.66 ± 0.05, p = 0.07). When controlling for aSAH severity, aGG was not independently associated with delayed cerebral ischemia, poor composite outcome, and in-hospital mortality.Conclusion: Admission GG was not independently associated with in-hospital mortality or poor outcome in a population of aSAH. An aGG ≥30 mg/dL was common in our population, and further study is needed to fully understand the clinical importance of this biomarker.