Punctal stenosis in 6 dogs following the long-term use of topical neomycin-polymyxin B-dexamethasone

2018 ◽  
Vol 22 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Katelin Quantz ◽  
Jean Stiles
Keyword(s):  
Polymyxin B ◽  
Punctal Stenosis

scholarly journals Impact of the Audit and Intervention of Infectologists in the Use of Antimicrobials in Intensive Care Units

2020 ◽  
Author(s):  
Ravena Melo Ribeiro da Silva ◽  
Ana Cláudia de Brito Câmara ◽  
Ellen Karla Chaves Vieira Koga ◽  
Iza Maria Fraga Lobo ◽  
Wellington Barros da Silva
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Polymyxin B ◽  
Intervention Period ◽  
Post Intervention ◽  
Short Period ◽  
Active Feedback ◽  
The Impact ◽  
Antimicrobial Administration

Abstract Background: Antimicrobials are among the most prescribed drugs in ICUs, where the use of these drugs is approximately 10 times greater than that of other wards. Even so, it is observed that between 30 to 60% of antimicrobial prescriptions performed in these units are unnecessary or inadequate. Thus, surveillance of antimicrobial prescription is a first and essential step to identify potential overuse or misuse, which could be the target of interventions for antimicrobial administration.Methods: This is an observational, analytical, and prospective study conducted in two adult intensive care units (ICU 1 = surgical and ICU 2 = clinic), with 27 beds each. The study period was divided into pre-intervention (January to June 2019) and post-intervention (July to December 2019).Results: Overall, in the pre- and post-intervention period, 91.4% and 90.0%, respectively, of patients received at least one antimicrobial agent. The most frequently prescribed antimicrobial classes were carbapenems (PRE = 26.0% vs POST = 24.9%; p = 0.245) followed by glycopeptides (PRE = 21.0% vs POST = 18.6%; p = 0.056). Overall, there was a significant reduction in the duration of therapy (PRE = 727 LOT / 1000pd vs POST = 680 LOT / 1000pd; p = 0.028). The highest rates regarding the time of use of antimicrobials were observed for carbapenems, followed by glycopeptides, with significant reductions in the time of exposure of glycopeptides (PRE = 284 DOT / 1000pd vs POST = 234 DOT / 1000pd; p = 0.014) and polymyxin B (PRE = 121 DOT / 1000pd vs POST = 88 DOT / 1000pd; p = 0.029), and significant increases for penicillins (PRE = 25 DOT / 1000pd vs POST = 45 DOT / 1000pd; p = 0.009), and tigecycline ( PRE = 3 DOT / 1000pd vs POST = 27 DOT / 1000pd; p = 0.046).Conclusions: In general, the intervention of infectologists in intensive care units had a limited impact on the results evaluated. This may be due to the short period analyzed. Therefore, it is important to monitor the impact of these changes in the long term, drawing a more accurate assessment of the effectiveness of an intervention, with the implementation of active feedback.

scholarly journals Treatment of bilateral punctal stenosis and nasolacrimal duct obstruction in an 11-year-old case with dyskeratosis congenita

2020 ◽  
Vol 3 ◽  
pp. 6
Author(s):  
Fatma Corak Eroglu ◽  
Emine Sen ◽  
Suleyman Ellik
Keyword(s):  
Skin Pigmentation ◽  
Dyskeratosis Congenita ◽  
Nasolacrimal Duct ◽  
Nasolacrimal Duct Obstruction ◽  
Telomere Maintenance ◽  
Long Term Results ◽  
Duct Obstruction ◽  
Silicone Intubation ◽  
Punctal Stenosis

The purpose of this study was to report the external dacryocystorhinostomy (ext-DCR) using silicone intubation in a child with dyskeratosis congenita (DC) who had presented by bilaterally acquired nasolacrimal duct obstruction (NLDO), punctal stenosis, and mucocutaneous changes. We report the 13-month results of an 11-year-old boy with DC who underwent bilateral ext-DCR with silicone stenting under general anesthesia. Ophthalmic examination revealed bilateral punctal stenosis and NLDO with normal fundus examination. He was referred to pediatrics and was diagnosed as DC, based on classic reticular skin pigmentation, nail dystrophy, and oral leukoplakia, without any other systemic involvement. Treatment consisted of bilateral ext-DCR using silicone stenting by 6 months. Management of surgery and post-operative 13-month follow up results was observed. DC is a rare heterogeneous multisystem disorder of telomere maintenance, which may present with ophthalmologic features. Although the lacrimal system abnormalities have been reported most frequently ocular findings in DC, this is the first case to present the management and long-term results of DCR using silicone intubation. This case aims to raise awareness of the various systemic and ocular manifestations and possible complications of DC and to present long-term results of ext-DC in a patient with DC.

scholarly journals A Case of Linezolid Toxicity Presenting as a Sepsis Mimic

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Rashmi Mishra ◽  
Harish Patel ◽  
Bindu Goel ◽  
Trupti Vakde
Keyword(s):  
Lactic Acidosis ◽  
Antimicrobial Agents ◽  
Clinical Status ◽  
Polymyxin B ◽  
Gradual Improvement ◽  
Laboratory Parameters ◽  
Coagulation Profile ◽  
Loss Of Appetite ◽  
Possible Cause

Linezolid is an efficacious and well tolerated antimicrobial but can have serious adverse effects including myelo-suppression, serotonin syndrome, neuropathy, hypoglycemia, liver dysfunction, and lactic acidosis. The side effects are generally duration dependent; linezolid use is not recommended for more than 28 days. Case. A 59-year-old female presented with malaise, loss of appetite, and altered mentation. She had multiple medical comorbidities and required long-term anticoagulation with warfarin for venous thromboembolism. She had multiple medication allergies. Prior to admission, she was on linezolid for cellulitis of foot due to Methicillin-resistant Staphylococcus aureus (MRSA). On physical exam, she was drowsy and required endotracheal intubation for airway protection. Initial laboratory parameters showed lactic acidosis, thrombocytopenia, supra-therapeutic coagulation profile, low blood glucose, and transaminitis. Her altered mentation was due to hypoglycemia. The interaction with warfarin led to altered coagulation profile. She developed shock and vasopressors were initiated. Given her presentation, she was managed as severe sepsis. There were no active infectious foci attributing to decline of her clinical status. Linezolid was discontinued and she was managed with intravenous polymyxin B, aztreonam, and vancomycin. Her hemodynamic status improved within one day. She was extubated on Day 5 of her presentation. Her laboratory parameters showed gradual improvement over 12 days after discontinuation of linezolid. Retrospective evaluation revealed linezolid toxicity as possible cause of presentation. Linezolid toxicity can present as sepsis mimic and should be considered as a differential diagnosis while managing sepsis with other antimicrobial agents.

scholarly journals Clinical efficacy of long-term performance with polymyxin-B immobilized fiber treatment for septic shock

Critical Care ◽  
2008 ◽  
Vol 12 (Suppl 2) ◽  
pp. P461
Author(s):  
N Matumoto ◽  
Y Suzuki ◽  
S Kikuchi ◽  
N Shioya ◽  
S Shibata ◽  
...  
Keyword(s):  
Septic Shock ◽  
Clinical Efficacy ◽  
Polymyxin B ◽  
Fiber Treatment ◽  
Long Term Performance ◽  
Term Performance

scholarly journals Long-Term Compassionate Use of Cefiderocol To Treat Chronic Osteomyelitis Caused by Extensively Drug-Resistant Pseudomonas aeruginosa and Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae in a Pediatric Patient

2019 ◽  
Vol 64 (4) ◽  
Author(s):  
Zain I. Alamarat ◽  
Jessica Babic ◽  
Truc T. Tran ◽  
Susan H. Wootton ◽  
An Q. Dinh ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Klebsiella Pneumoniae ◽  
Chronic Osteomyelitis ◽  
Polymyxin B ◽  
Adolescent Male ◽  
Drug Resistant ◽  
Content Type ◽  
Extensively Drug Resistant ◽  
Extended Spectrum

ABSTRACT We report a 15 year-old Nigerian adolescent male with chronic osteomyelitis caused by an extensively drug-resistant (XDR) Pseudomonas aeruginosa strain of sequence type 773 (ST773) carrying blaNDM-1 and an extended spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae strain. The patient developed neurological side effects in the form of circumoral paresthesia with polymyxin B and asymptomatic elevation of transaminases with aztreonam (used in combination with ceftazidime-avibactam). Cefiderocol treatment for 14 weeks plus bone implantation resulted in apparent cure and avoided amputation.

Acquired External Punctal Stenosis: Surgical Management and Long-Term Follow-Up

Orbit ◽  
2005 ◽  
Vol 24 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Mohsen Bahmani Kashkouli ◽  
Bijan Beigi ◽  
Nick Astbury
Keyword(s):  
Surgical Management ◽  
Long Term Follow Up ◽  
Punctal Stenosis

Incidence of Primary Punctal Stenosis in Adult Patients with Epiphora

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Sheriff Elwan ◽  
Ossama Tarek Nada ◽  
Eman Mohamed Salah Eldeen Madbouli
Keyword(s):  
Outpatient Clinic ◽  
Adult Patients ◽  
University Hospital ◽  
Slit Lamp ◽  
Convenience Sample ◽  
Grade 5 ◽  
Grade 3 ◽  
Grade One ◽  
Punctal Stenosis

Abstract Background Punctal stenosis is one of the etiologies of epiphora, which is caused by an anatomical narrowing or occlusion of the external opening of the lacrimal canaliculi. Punctal stenosis is graded according to punctal sizes examined under slit-lamp biomicroscopy into grade 0 (could not find papilla and punctum), grade 1: Papilla is covered by a membrane (exudative or true membrane), grade 2: Smaller than normal size but recognizable, grade 3: normal, grade 4: Small slit (<2 mm) and grade 5: Large slit (>2 mm). Objective To assess the incidence of punctal stenosis in adult patients with epiphora attending outpatient’s ophthalmology clinic at Ain Shams University Hospital during the months of January and February 2020. Patients and Methods This is an observational study, conducted at the Ophthalmology Outpatient Clinic, Ophthalmology Department, Ain Shams University, using non-probability (convenience) sample. It included all patients above 18 years old who presented to the Ophthalmology Outpatient Clinic during the months of January and February 2020 with tearing, proved to be epiphora on clinical examination. Results Thirty one patients, out of 1800 patients attending the Outpatient Ophthalmology Clinic during the study period had epiphora with incidence of 1.6 %. Incidence of punctal stenosis was reported to be 68.4%. Other reported causes of epiphora were: Canaliculitis (3.5%), chronic dacrocystitis (5.3%), lacrimal sac mucocele (1.8%) and lower lid laxity (21.1%). Punctal stenosis was more common in females (61.5%) with mean age 58.55 years ± 11.67 SD. Punctal stenosis usually presented as bilateral (93.3%). Regarding ocular history 41% of cases were on topical anti glaucoma treatments. Most patients were medically free (54%). Conclusion Incidence of epiphora was 1.6% out of patients attending ASU Ophthalmology Outpatient Clinic. Punctal stenosis incidence was reported to be 68.4%. Most of the cases were females, above 63 years, grade one was the most common, with significant association with the long term use of topical anti-glaucoma medications.

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