Infectious scleritis (IS) is a rare and severe ocular disorder responsible for approximately 5%-15% of all scleritis cases. It is often associated with a poor prognosis due to its similar clinical presentation to autoimmune scleritis, resulting in a delayed diagnosis and treatment. Therefore, differentiating between infectious and noninfectious entities is critical. Several details extracted from the patient's history and clinical examination can raise suspicion for infection. The most common predisposing factor is previous ocular surgery, especially pterygium, cataract, and vitreoretinal surgeries. Ocular trauma, poor contact lens hygiene, "eye-whitening" procedures, and subtenon triamcinolone injections have also been implicated. Clinical features of infection include the presence of scleral necrosis, hypopyon, unifocal or multifocal scleral abscesses, and mucopurulent discharge. Thorough diagnostic testing is essential before excluding infection as a possibility. Empiric broad-spectrum topical and systemic antibiotic therapy should be initiated while awaiting laboratory results and adjusted accordingly. Most IS cases require both aggressive medical and surgical treatment, and various studies have reported favorable outcomes with this combination. At this time, there is no consensus on the management of this severe ocular condition, and future studies are needed to establish clear treatment guidelines.

As the incidence of heart failure increases, so too has that of biventricular failure. While transplantation remains the gold standard therapy for end-stage heart failure, the limited organ supply has increased the need for durable mechanical circulatory support. We therefore sought to conduct a systematic review of continuous-flow ventricular assist devices in a biventricular configuration (CF-BiVAD). An electronic search of PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases was performed using the keyword “BIVAD.” Studies were reviewed to identify discrete variables, including implant indication, INTERMACs profile, timing of implant, mean age and BMI, and the anticoagulation/antiplatelet regimens employed post implant. Outcomes of interest included mortality and the incidence of thrombus, bleeding, infection, stroke, and renal failure. A total of 25 studies met inclusion criteria. No single variable was consistently reported, with only 4 studies reporting all 5 adverse effects. INTERMACs profile at implant and anticoagulation/antiplatelet regimen were reported in less than 50% of studies. Of those reporting mortality, there was a wide range of follow-up, from less than 6 months to >10 years, and the survival rate was similarly widely variable. Additionally, more than 50% of studies failed to isolate CF-BiVAD from alternative means of biventricular support, such as temporary support platforms, TAH, and pulsatile VADs. Therefore, high-quality quantitative analysis is not possible. In summary, the CF-BiVAD literature has a very heterogenous reporting of data. Standard reporting criteria may allow for future analyses to determine which patient characteristics portend a favorable outcome with CF-BiVAD implantation.

Frailty is associated with poor clinical outcomes in heart failure patients. The impact of frailty on outcomes following left ventricular assist device (LVAD) implantation, however, is less clearly defined. We therefore sought to conduct a systematic review to evaluate current frailty assessment strategies and their significance for patients undergoing LVAD implantation. We conducted a comprehensive electronic search of PubMed, Embase, and CINAHL databases from inception until April 2021 for studies examining frailty in patients undergoing LVAD implantation. Study characteristics, patient demographics, type of frailty measurement, and outcomes were extracted. Outcomes were organized into 5 basic categories: implant length of stay (iLOS), 1-year mortality, rehospitalization, adverse events, and quality of life (QOL). Of the 260 records retrieved, 23 studies involving 4935 patients satisfied the inclusion criteria. Approaches to measuring frailty varied, with the 2 most common being sarcopenia determined by computed tomography and Fried's frailty phenotype assessment. Outcomes of interest were also widely variable, with iLOS stay and mortality being the most frequently reported, albeit with differing definitions of both between studies. The heterogeneity among included studies precluded quantitative synthesis. Narrative synthesis showed that frailty by any measure is more likely to be associated with higher mortality, longer iLOS, more adverse events and worse QOL post-LVAD implant. Frailty can be a valuable prognostic indicator in patients undergoing LVAD implantation. Further studies are needed to determine the most sensitive frailty assessment, as well as the ways in which frailty may serve as a modifiable target to improve outcomes following LVAD implantation.

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