scholarly journals THU0597 CORNEAL MELT - DON’T ALWAYS BLAME RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 540.3-540
Author(s):  
A. Munir ◽  
C. Sheehy
Keyword(s):  
Rheumatoid Arthritis ◽  
Renal Biopsy ◽  
Systemic Vasculitis ◽  
Lower Lobe ◽  
Visual Outcome ◽  
Eye Drops ◽  
Poor Visual Outcome ◽  
Methyl Prednisolone ◽  
History Of ◽  
And Function

Background:Corneal melt is a rare inflammatory disease of the peripheral cornea; it may lead to perforation of the globe and visual failure. Corneal melt can be a manifestation of systemic vasculitis in patients with RA and other conditions, such as cancer. Without early and aggressive treatment it may be associated with a poor visual outcome and a high mortality. It has been reported in patients with stable RA.Objectives:A case report in a patient with long standing but well controlled Rheumatoid Arthritis (RA) and metastatic disease.Methods:A 75 year old male with a background of sero positive Rheumatoid Arthritis for more than 10 years presented to the Eye Casualty with a two week history of a painful left red eye. His other medical history was significant for Stage IIB poorly differentiated cancer of the left lower lobe. Left lower lobectomy with a patch of diaphragm resected. Intratumoural lymphovascular invasion noted. He completed Adjuvant Carboplatin/Vinorelbine chemotherapy September, 2017. He had DVT proximal left leg 22ndof September, 2017. Follow up CT in 2018 demonstrated a right renal upper pole lesion for which he was awaiting biopsy with?metastatic lung disease vs primary renal carcinoma. His RA was well controlled on Methotrexate 10mg weekly. He had been treated by the ophthalmology team for left marginal Keratitis for the prior 2 months with steroid eye drops without significant improvement. On presentation to ED, he described sharp eye pain, waking him from the sleep, associated with watery discharge and photophobia. Examination showed corneal melt in left eye involving 25% of inferior portion of the cornea and spastic entropion with injecting eye lashes. He had no active joints and there were no other signs of vasculitis. CRP was 4.1. He had a negative ANA and ANCA; viral swabs were negative. He was admitted under the medical team. Intravenous Methyl Prednisolone was started. The patient felt better after 5 days of Methyl Prednisolone. Left temporary tarsorrhaphy was done by Ophthalmology. Cyclophosphamide was initiated after discussion with Oncologist pending the result of the renal biopsy. Patient was discharged after 5 days of admission in the hospitalResults:The renal biopsy was positive for metastatic Squamous cell carcinoma of lung. Cyclophosphamide was withdrawn and he was started on Carboplatin/Gemcitabine. The corneal melt improved with complete resolution of his visual symptoms.Conclusion:In this case, although the history of RA was felt by the ophthalmology team to be the most likely association with the corneal melt, we would argue the oncological diagnoses were likely the driving force behind the presentation.References:[1]Sule A, Balakrishnan C, Gaitonde S, Mittal G, Pathan E, Gokhale NS, et al. Rheumatoid corneal melt. Rheumatology (Oxford)2002;41:705–6.[2]S. Yano, K. Kondo, M. Yamaguchi et al., “Distribution and function of EGFR in human tissue and the effect of EGFR tyrosine kinase inhibition,” Anticancer Research, vol. 23, no. 5, pp. 3639–3650, 2003.Disclosure of Interests:None declared

PRO score: predictive scoring system for visual outcomes after rhegmatogenous retinal detachment repair

2021 ◽  
pp. bjophthalmol-2021-320440
Author(s):  
Louis Z Cai ◽  
Jeffrey Lin ◽  
Matthew R Starr ◽  
Anthony Obeid ◽  
Edwin H Ryan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retinal Detachment ◽  
Scoring System ◽  
Rhegmatogenous Retinal Detachment ◽  
Vision Loss ◽  
Visual Outcome ◽  
Visual Outcomes ◽  
Poor Visual Outcome ◽  
History Of ◽  
Endothelial Growth Factor

Background/aimsTo compare risk factors for poor visual outcomes in patients undergoing primary rhegmatogenous retinal detachment (RRD) repair and to develop a scoring system.MethodsAnalysis of the Primary Retinal detachment Outcomes (PRO) study, a multicentre interventional cohort of consecutive primary RRD surgeries performed in 2015. The main outcome measure was a poor visual outcome (Snellen VA ≤20/200).ResultsA total of 1178 cases were included. The mean preoperative and postoperative logMARs were 1.1±1.1 (20/250) and 0.5±0.7 (20/63), respectively. Multivariable logistic regression identified preoperative risk factors predictive of poor visual outcomes (≤20/200), including proliferative vitreoretinopathy (PVR) (OR 1.26; 95% CI 1.13 to 1.40), history of antivascular endothelial growth factor (VEGF) injections (1.38; 1.11 to 1.71), >1-week vision loss (1.17; 1.08 to 1.27), ocular comorbidities (1.18; 1.00 to 1.38), poor presenting VA (1.06 per initial logMAR unit; 1.02 to 1.10) and age >70 (1.13; 1.04 to 1.23). The data were split into training (75%) and validation (25%) and a scoring system was developed and validated. The risk for poor visual outcomes was 8% with a total score of 0, 17% with 1, 29% with 2, 47% with 3, and 71% with 4 or higher.ConclusionsIndependent risk factors were compared for poor visual outcomes after RRD surgery, which included PVR, anti-VEGF injections, vision loss >1 week, ocular comorbidities, presenting VA and older age. The PRO score was developed to provide a scoring system that may be useful in clinical practice.

Corneal perforation from peripheral ulcerative keratopathy in patients with rheumatoid arthritis: epidemiological findings of the British Ophthalmological Surveillance Unit

2017 ◽  
Vol 102 (9) ◽  
pp. 1298-1302 ◽  
Author(s):  
Hannah Mary Timlin ◽  
Hildegard Nikki Hall ◽  
Barny Foot ◽  
Peter Koay
Keyword(s):  
Rheumatoid Arthritis ◽  
Visual Outcome ◽  
Corneal Perforation ◽  
Cyanoacrylate Glue ◽  
Poor Visual Outcome ◽  
Corneal Grafting ◽  
Ocular Morbidity ◽  
Surveillance Unit ◽  
The Uk

Background/AimsThis study quantifies the threat to vision and the survival in patients presenting with peripheral ulcerative keratopathy (PUK) corneal perforation associated with rheumatoid arthritis (RA) in the UK.MethodsNew cases of corneal perforation from PUK in patients with RA were prospectively collected from the UK via the British Ophthalmological Surveillance Unit from July 2012 to June 2014. An initial questionnaire collected data on presentation and the first 2 weeks’ management, and a follow-up questionnaire collected 1-year data on ocular morbidity and mortality.Results30 eyes of 28 patients were identified over 2 years, estimating a UK incidence of 0.234/million/year. 20/27 (74%) were female, with a median age of 68 years (range 41–84). The most common initial management was cyanoacrylate glue with a bandage contact lens, oral steroids, topical and oral antibiotics, and lubricants. Long-term management included corneal grafting in 12/20 (60%) eyes of patients living at 1 year. The 1-year all-cause mortality was 6/25 (24%), which increased to 1/2 (50%) if both eyes had perforated. In the remaining patients alive at 1-year follow-up, there was a 13/20 (65%) poor visual outcome of less than or equal to counting fingers. 8/25 (40%) patients had bilateral PUK, with 2/25 (8%) having bilateral perforation. 5/19 (26%) patients alive at 1-year follow-up were eligible for sight impairment registration.ConclusionThis study highlights the serious ocular morbidity and high mortality associated with corneal perforation from PUK in patients with RA despite treatment. The mortality doubled if both eyes perforated, which should serve as a harbinger of impending serious medical problems.

scholarly journals ANCA-associated vasculitis can present with episodic attacks of joint pain consistent with palindromic rheumatism

2021 ◽  
Vol 14 (4) ◽  
pp. e240913
Author(s):  
Zoe Rutter-Locher ◽  
Bruce Kirkham ◽  
David P D'Cruz
Keyword(s):  
Rheumatoid Arthritis ◽  
Weight Loss ◽  
Renal Biopsy ◽  
Joint Pain ◽  
Small Volume ◽  
Antineutrophil Cytoplasmic Antibodies ◽  
Palindromic Rheumatism ◽  
Anca Associated Vasculitis ◽  
History Of ◽  
New Onset

A 64-year-old man with a 2-year history of palindromic rheumatoid arthritis, presented with recurrent flares of arthritis, weight loss, new onset Raynaud’s phenomenon and one previous episode of small-volume haemoptysis. Investigations, including renal biopsy, revealed antineutrophil cytoplasmic antibodies-mediated vasculitis. This case highlights the need to consider vasculitis in patients in whom there is an atypical history of arthritis.

scholarly journals Possible environmental exposure-associated pulmonary cryptococcosis in a patient with rheumatoid arthritis: a case report and literature review

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096230
Author(s):  
Guangdie Yang ◽  
Junjun Chen ◽  
Jiani Ye ◽  
Yinan Yao ◽  
Zhijie Pan
Keyword(s):  
Rheumatoid Arthritis ◽  
Environmental Exposure ◽  
Opportunistic Infections ◽  
Histopathological Examination ◽  
Serological Test ◽  
Lower Lobe ◽  
Pulmonary Cryptococcosis ◽  
Pulmonary Lesions ◽  
Common Location ◽  
History Of

Patients with rheumatoid arthritis (RA) taking long-term immunosuppressive drugs are more susceptible to opportunistic infections, such as cryptococcosis. A 65-year-old woman was transferred to our hospital for rapidly progressing pulmonary lesions identified by lung computed tomography. She had a 7-year history of RA and had been prescribed methotrexate and glucocorticoids for 10 months. Additionally, our patient had a history of environmental exposure to house renovation lasting approximately 1 week before onset. Her serological test results and histopathological examination confirmed the diagnosis of pulmonary cryptococcosis (PC). The patient recovered well after 6 months of fluconazole treatment. In addition, we summarized 28 reported cases of RA patients with PC and found that older age might be a risk factor for cryptococcal infection in RA patients. The most common location for pulmonary lesions was the lower lobe, and the most common radiologic manifestations were nodules. Detection of cryptococcal capsular polysaccharide antigen was important for diagnosis. Patients undergoing antirheumatic therapy should avoid exposure to Cryptococcus.

Kedudukan dan Fungsi Bahasa dalam Permuseuman

Metahumaniora ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. 54
Author(s):  
Erlina Zulkifli Mahmud ◽  
Taufik Ampera ◽  
Yuyu Yohana Risagarniwa ◽  
Inu Isnaeni Sidiq
Keyword(s):  
Human Life ◽  
Field Research ◽  
Communicative Function ◽  
Language Functions ◽  
The Past ◽  
Library Research ◽  
History Of ◽  
And Function ◽  
Museum Guides ◽  
Bahasa Indonesia

Kedudukan dan fungsi bahasa sebagai alat komunikasi manusia mencakup seluruh bidang kehidupan termasuk ilmu pengetahuan antara lain terkait sejarah peradaban manusia; bagaimana manusia mempertahankan hidupnya, bagaimana manusia memperlakukan alam, bagaimana alam menyediakan segala kebutuhan manusia. Apa yang dilakukan manusia saat ini, saat lampau, dan apa yang dilakukan manusia jauh di masa prasejarah, bagaimana kondisi alam di masa-masa tersebut, apa perubahan dan perkembangannya, dapat didokumentasikan melalui bahasa, divisualisasikan kembali, lalu dipajang sebagai salah satu upaya konversai dan preservasi dalam satu institusi yang disebut museum. Penelitian ini membahas kedudukan dan fungsi bahasa dalam permuseuman. Bagaimana kedudukan dan fungsi bahasa dalam permuseuman baik dalam informasi yang disampaikan oleh pemandu wisata museumnya maupun yang terpajang menyertai benda-benda dan gambar-gambar merupakan tujuan dari penelitian ini. Metode penelitian yang digunakan adalah gabungan antara metode lapangan dan metode literatur. Hasil penelitian menunjukkan bahwa secara umum kedudukan bahasa Indonesia berada pada urutan pertama setelah Bahasa Inggris dan keberadaan kedua bahasa dalam permuseuman ini melibatkan dua fungsi utama bahasa, yakni fungsi komunikatif dan fungsi informatif.The existence and function of language  as a medium of communication covers all fields of human life including knowledge, one of them is the history of human civilization; how humans survived, how human utilized nature for their lives, and how nature provides all the necessities for humans. What humans have been doing now, what they have done in the past and far before that in the pre-history time, how the conditions of the nature at those times were and what changes as well as progresses occurred are documented using language, then re-visualized,  displayed as one of conservation and preservation acts in an institution called museum. This research discusess the existence and function of language in museums. How important the existence of a language in museums and what language functions used in museums both in informations given by the museum guides and on the displays accompanying objects and pictures are the aims of this research. The methods used are the combination between field research and library research. The results show that generally the existence of Indonesian language plays more important role than English and both languages have two main functions; communicative function and informative function.     

John among the Apocalypses

2020 ◽  
Author(s):  
Benjamin E. Reynolds
Keyword(s):  
Gospel Of John ◽  
Central Place ◽  
Reception History ◽  
Genre Theory ◽  
Synoptic Gospels ◽  
Book Of Revelation ◽  
Distinctive Features ◽  
History Of ◽  
Definition Of ◽  
And Function

The central place of revelation in the Gospel of John and the Gospel’s revelatory telling of the life of Jesus are distinctive features of John when compared with the Synoptic Gospels; yet, when John is compared among the apocalypses, these same features indicate John’s striking affinity with the genre of apocalypse. By paying attention to modern genre theory and making an extensive comparison with the standard definition of “apocalypse,” the Gospel of John reflects similarities with Jewish apocalypses in form, content, and function. Even though the Gospel of John reflects similarities with the genre of apocalypse, John is not an apocalypse, but in genre theory terms, John may be described as a gospel in kind and an apocalypse in mode. John’s narrative of Jesus’s life has been qualified and shaped by the genre of apocalypse, such that it may be called an “apocalyptic” gospel. Understanding the Fourth Gospel as “apocalyptic” Gospel provides an explanation for John’s appeal to Israel’s Scriptures and Mosaic authority. Possible historical reasons for the revelatory narration of Jesus’s life in the Gospel of John may be explained by the Gospel’s relationship with the book of Revelation and the history of reception concerning their writing. An examination of Byzantine iconographic traditions highlights how reception history may offer a possible explanation for reading John as “apocalyptic” Gospel.

The Art of Love Poetry

2018 ◽  
Author(s):  
Erik Gray
Keyword(s):  
Popular Culture ◽  
Cultural History ◽  
Literary Tradition ◽  
Love Poetry ◽  
Erotic Love ◽  
Wide Range ◽  
History Of ◽  
And Function ◽  
Meaning And Function ◽  
Comprehensive History

Love begets poetry; poetry begets love. These two propositions have seemed evident to thinkers and poets across the Western literary tradition. Plato writes that “anyone that love touches instantly becomes a poet.” And even today, when poetry has largely disappeared from the mainstream of popular culture, it retains its romantic associations. But why should this be so—what are the connections between poetry and erotic love that lead us to associate them so strongly with one another? An examination of different theories of both love and poetry across the centuries reveals that the connection between them is not merely an accident of cultural history—the result of our having grown up hearing, or hearing about, love poetry—but something more intrinsic. Even as definitions of them have changed, the two phenomena have consistently been described in parallel terms. Love is characterized by paradox. Above all, it is both necessarily public, because interpersonal, and intensely private; hence it both requires expression and resists it. In poetry, especially lyric poetry, which features its own characteristic paradoxes and silences, love finds a natural outlet. This study considers both the theories and the love poems themselves, bringing together a wide range of examples from different eras in order to examine the major structures that love and poetry share. It does not aim to be a comprehensive history of Western love poetry, but an investigation into the meaning and function of recurrent tropes, forms, and images employed by poets to express and describe erotic love.

scholarly journals What Happened to Your College Town: The Changing Relationship of Higher Education and College Towns, 1940–2000

2021 ◽  
Vol 61 (3) ◽  
pp. 320-340
Author(s):  
Kate Rousmaniere
Keyword(s):  
Higher Education ◽  
Higher Education Institutions ◽  
History Of Higher Education ◽  
Campus Housing ◽  
College Towns ◽  
Education Enrollment ◽  
History Of ◽  
To Come ◽  
And Function ◽  
Relationship Of

AbstractThis essay examines the history of what is commonly called the town-gown relationship in American college towns in the six decades after the Second World War. A time of considerable expansion of higher education enrollment and function, the period also marks an increasing detachment of higher education institutions from their local communities. Once closely tied by university offices that advised the bulk of their students in off-campus housing, those bonds between town and gown began to come apart in the 1970s, due primarily to legal and economic factors that restricted higher education institutions’ outreach. Given the importance of off-campus life to college students, over half of whom have historically lived off campus, the essay argues for increased research on college towns in the history of higher education.

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