Differences in clinical ocular outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix: a systematic review of published literature

2017 ◽  
Vol 102 (7) ◽  
pp. 977-982 ◽  
Author(s):  
Max Carlos Ramírez Soto
Keyword(s):  
Anterior Uveitis ◽  
Vision Loss ◽  
Case Reports ◽  
Posterior Uveitis ◽  
Endogenous Endophthalmitis ◽  
Data Set ◽  
Patient Groups ◽  
Exogenous Endophthalmitis ◽  
Analyse Data ◽  
Poor Outcomes

BackgroundSporotrichosis is an implantation mycosis caused by Sporothrix species prevalent worldwide, which occasionally can also result in intraocular infection presenting as an exogenous or endogenous infection (disseminated sporotrichosis). Knowledge in its clinical recognition and management is limited.AimsTo systematically review and analyse data from published literature with a view to comparing clinical outcomes between exogenous and endogenous endophthalmitis caused by Sporothrix.MethodsCase reports of intraocular sporotrichosis, published from 1960 to 2016, were retrieved from MEDLINE, Embase, Cochrane, LILACS and SciELO databases. The entire data set was divided into two patient groups: (1) exogenous endophthalmitis and (2) endogenous endophthalmitis. Primary outcomes were differences in ocular findings and clinical ocular outcomes between the two groups.ResultsFrom 16 publications retrieved, a total of 8 eyes of 8 patients with exogenous endophthalmitis and 13 eyes of 10 patients with endogenous endophthalmitis were identified. Compared with exogenous endophthalmitis, endogenous endophthalmitis was more common in patients infected with HIV (p=0.001) and those from hyperendemic areas (p=0.036). Anterior uveitis (p=0.015) and posterior uveitis (p=0.04) were more common in the exogenous and endogenous endophthalmitis groups, respectively. The majority of patients with endogenous endophthalmitis had partial or full clinical resolution of ocular lesions with systemic amphotericin B alone or in combination with an oral antifungal, whereas patients with exogenous endophthalmitis had poor outcomes with irreversible vision loss, enucleation and evisceration.ConclusionsAnterior uveitis is more common in exogenous endophthalmitis with worse overall outcomes and complications, compared with endogenous endophthalmitis where posterior uveitis is the most common clinical manifestation, especially in patients infected with HIV and those from hyperendemic areas. Sporothrix infection should be included in the differential diagnosis for ocular inflammation, regardless of the presence or absence of autoimmune comorbidities and whether the patient resides in an endemic area or not. Ophthalmologists should consider intravitreal and systemic antifungal therapy for exogenous and endogenous endophthalmitis caused by Sporothrix.

scholarly journals CLINICAL CASE OF SEVERE INTENSIFICATION OF BLOOD FLOW IN THE CONJUNCTIVA OF THE EYEBALL ONE DAY PRIOR TO THE ONSET OF INTERMEDIATE UVEITIS

2021 ◽  
Vol Volume 2 (Spring,2021) ◽  
pp. 10-12
Author(s):  
Rasim. V.Hajiyev, MD, PhD
Keyword(s):  
Blood Flow ◽  
Anterior Uveitis ◽  
Clinical Case ◽  
Vision Loss ◽  
Posterior Uveitis ◽  
Intermediate Uveitis ◽  
The Right

Purpose: A clinical case is presented of posterior uveitis inapatientwhoreceivedasubconjunctivalinjectionofKenalog. This finding was revealed during the course of adailyassessmentofconjunctivalmicrovascularhemodynamics.Methods:Slitlampbiomicroscopyoftheconjunctivalmicrovasculaturewasperformedbeforeandaftertheemergenceofintermediateuveitisina28-year-oldman.Result: A case of acute vision loss and the occurrence ofintermediate uveitis of the right eye is described in a patientwhopreviouslyreceivedKenalogadministeredsubconjunctivally to treat mild anterior uveitis, which waswithoutvisualimpairment.Dailymonitoringoftheconjunctival microvasculature revealed that the blood flowrate of the right eye considerably increased after Kenalogadministrationthedaybeforepatientvisiondeterioratedand posterioruveitiswithopacityofthevitreousbodyoccurred.The extent of the pronounced intensification ofblood flow wassurprising.Conclusion:The emergence ofacute intermediate uveitisfollowing Kenalog administration was preceded by a severeincrease in bloodcirculation in theconjunctivalvesselsofthe eye, which decreased one day after a severe decrease invisualacuity. It is suggested that this increase in blood flowprecedingpathologymaybeacharacteristicofanyinflammatoryprocessthatoccursinthehumanbody

Massive Intravascular Hemolysis From Clostridium perfringens Septicemia

2013 ◽  
Vol 29 (6) ◽  
pp. 327-333 ◽  
Author(s):  
Tracey G. Simon ◽  
Joanna Bradley ◽  
Adisa Jones ◽  
Gerardo Carino
Keyword(s):  
Clostridium Perfringens ◽  
Patient Survival ◽  
Case Reports ◽  
English Literature ◽  
Case Series ◽  
Surgical Removal ◽  
Chi Square ◽  
Data Set ◽  
Male Mortality ◽  
Time To Death

We describe the case of a patient with hemolysis-associated Clostridium perfringens septicemia and review all similar cases published in the literature since 1990, with specific focus on the relationship between treatment strategy and survival. We searched PubMed for all published cases of C. perfringens-associated hemolysis, using the medical subject terms “clostridia,” “clostridial sepsis,” and/or “hemolysis.” All case reports, case series, review articles, and other relevant references published in the English literature since 1990 were included in this study. There were no exclusion criteria. Each case was examined with respect to presenting features of illness, antibiotic regimen, time-to-antibiotic therapy, additional interventions, complications, and patient survival. These variables were entered into a data set and then systematically analyzed with the aid of a statistician, using serial t tests and chi-square analyses. Since 1990, 50 patients of C. perfringens septicemia with hemolysis have been reported. Median age was 61 years (range 31-84), and 58% were male. Mortality was 74%, with a median time to death of 9.7 hours (range 0-96 hours). Of the patients, 35 (70%) were treated medically, while 15 (30%) received antibiotics and surgery. Surgical intervention was associated with significantly improved survival (risk ratio [RR] 0.23, 95% confidence interval [CI] 0.10, 0.53) as was the use of a combination of penicillin and clindamycin (RR of death 0.46, 95% CI 0.25, 0.83). Four patients utilizing hyperbaric oxygen therapy (HBOT) have been reported, and all patients survived. In cases of clostridial sepsis with hemolysis, strong predictors of survival include early initiation of appropriate antibiotics as well as surgical removal of infected foci. The HBOT may also be associated with survival. The disease often progresses rapidly to death, so rapid recognition is critical for the patient survival.

scholarly journals ‘Failure’ of laser prophylaxis in an eye with stickler syndrome

2021 ◽  
Vol 11 (4) ◽  
pp. 110-111
Author(s):  
Michael P Blair
Keyword(s):  
Vision Loss ◽  
Clinical Course ◽  
Case Reports ◽  
Visual Outcome ◽  
Stickler Syndrome ◽  
Connective Tissue Disorders ◽  
Macular Function ◽  
Giant Retinal Tear ◽  
Case Summary

Background: Stickler syndrome is one of the most common inherited connective tissue disorders and is an important cause of pediatric vision loss due to a high risk of retinal detachment in these patients. Methods: Case report. Case summary: This case reports describes the clinical course of a 10 year old boy with Sticklers Syndrome who underwent bilateral peripheral laser prophylaxis. During routine follow up, he was found to have an asymptomatic giant retinal tear (GRT) with limited sub-retinal fluid expansion due to prior prophylactic laser. He underwent surgery with vitrectomy and scleral buckle with vision remaining at 20/25 at 6 month follow up. Conclusion: Although the utility of laser prophylaxis in Stickler patients is debated, this case demonstrates that after laser prophylaxis, even if GRT develops, expansion can be limited. Laser prophylaxis along with frequent examinations, can prevent development of PVR and complex detachments and preserve macular function with excellent visual outcome.

scholarly journals THE PERFORMANCE OF AFFIRMATIVE ACTION STUDENTS AND ANALYSIS OF SUBJECTS GRADES USING LATENT CLASS AND LATENT BUDGET MODELS

2018 ◽  
Vol 36 (4) ◽  
pp. 827
Author(s):  
Enio Galinkin JELIHOVSCHI
Keyword(s):  
Affirmative Action ◽  
Student Performance ◽  
Latent Class ◽  
Original Performance ◽  
Data Set ◽  
Performance Variables ◽  
Budget Analysis ◽  
The Subject ◽  
Analyse Data ◽  
New Variables

Latent class analysis (LCA) is used to analyse data about performance of students. The original performance variables in the data set are course grade and approval status. However, those variables were not used directly, instead four new variables were calculated from those previous two, variables which are much more informative about the student performance. Coupled with another variable, say afirmative action, the results give light to an understanding about the performance of the divided by afirmative action, yes or no. Besides of showing the results it is also shown how the changing of the original variables by some suitable transformation of the original ones gives more reliable results. The main result is that armative action students have a lower performance than those coming from private schools. The paper also analyses the subjects grades using latent budget analysis (LBA), and it is found that the variables cited above have a real effect in characterizing the subjects. It is also shown that those results can be used in a process of evaluation on how the subject is being taught.

scholarly journals Surgical Treatment of Orbital Blowout Fractures: Complications and Postoperative Care Patterns

2016 ◽  
Vol 9 (4) ◽  
pp. 299-304 ◽  
Author(s):  
Matthew Shew ◽  
Michael P. Carlisle ◽  
GuanningNina Lu ◽  
Clinton Humphrey ◽  
J.David Kriet
Keyword(s):  
Postoperative Complications ◽  
Vision Loss ◽  
Average Length ◽  
Case Reports ◽  
Postoperative Management ◽  
Facial Trauma ◽  
Outpatient Basis ◽  
Retrospective Assessment ◽  
Retrobulbar Hematoma ◽  
Orbital Blowout Fractures

Orbital fractures are a common result of facial trauma. Sequelae and indications for repair include enophthalmos and/or diplopia from extraocular muscle entrapment. Alloplastic implant placement with careful release of periorbital fat and extraocular muscles can effectively restore extraocular movements, orbital integrity, and anatomic volume. However, rare but devastating complications such as retrobulbar hematoma (RBH) can occur after repair, which pose a risk of permanent vision loss if not addressed emergently. For this reason, some surgeons take the precaution of admitting patients for 24-hour postoperative vision checks, while others do not. The incidence of postoperative RBH has not been previously reported and existing data are limited to case reports. Our aim was to examine national trends in postoperative management and to report the incidence of immediate postoperative complications at our institution following orbital repair. A retrospective assessment of orbital blowout fractures was undertaken to assess immediate postoperative complications including RBH. Only patients treated by a senior surgeon in the Department of Otolaryngology were included in the review. In addition, we surveyed AO North America (AONA) Craniomaxillofacial faculty to assess current trends in postoperative management. There were 80 patients treated surgically for orbital blowout fractures over a 9.5-year period. Nearly all patients were observed overnight (74%) or longer (25%) due to other trauma. Average length of stay was 17 hours for those observed overnight. There was one (1.3%) patient with RBH, who was treated and recovered without sequelae. Results of the survey indicated that a majority (64%) of responders observe postoperative patients overnight. Twenty-nine percent of responders indicated that they send patients home the same day of surgery. Performance of more than 20 orbital repairs annually significantly increased the likelihood that faculty would manage patients on an outpatient basis postoperatively ( p = 0.04). For orbital blowout fractures, the number of immediate postoperative complications at our institution is low. In addition, North American trends in postoperative management of orbital blowout fractures may suggest that selected patients can be managed on an outpatient basis, which would have a positive effect on conservation of diminishing healthcare resources.

Better visual outcome associated with early vitrectomy in the management of endophthalmitis

2021 ◽  
pp. bjophthalmol-2020-316846
Author(s):  
Sarah Welch ◽  
Riyaz Bhikoo ◽  
Nancy Wang ◽  
Martin J Siemerink ◽  
William Shew ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Vision Loss ◽  
Endogenous Endophthalmitis ◽  
Health Board ◽  
Surgical Trauma ◽  
District Health ◽  
Early Vitrectomy ◽  
Younger Age ◽  
Severe Vision Loss ◽  
Culture Positive

AimsTo examine the role of early vitrectomy in the management of endophthalmitis from all causes.MethodsRetrospective study of 290 consecutive subjects diagnosed with endophthalmitis at Auckland District Health Board between 1 January 2006 and 31 July 2019. Main outcome measure was visual acuity at 9-month follow-up and proportion of subjects with severe vision loss (≤20/200).ResultsMedian age at presentation was 70.4 years and 151 subjects (52.1%) were women. Cataract surgery was the most common cause of endophthalmitis in 92 subjects (31.7%) followed by intravitreal injection in 57 (19.7%), endogenous endophthalmitis in 48 subjects (16.6%), non-surgical trauma in 42 subjects (14.5%), glaucoma surgery in 24 subjects (8.3%), vitrectomy in 22 subjects (7.6%) and corneal in 5 subjects (1.7%). Culture was positive in 136 (46.9%) with gram-positive organisms most common (76.5%). Early vitrectomy was performed in 82 subjects (28.3%). Median visual acuity at 9 months was 20/100 (IQR 20/30 to light perception), and severe vision loss occurred in 100 (43.5%). Retinal detachment occurred in 35 eyes (12.1%) and 26 eyes were enucleated. On multivariate analysis, younger age, poor presenting visual acuity and culture-positive endophthalmitis were associated with worse outcomes, and early vitrectomy was associated with better outcomes.ConclusionsEarly vitrectomy (within 24 hours) is associated with better visual outcomes at 9 months, while younger age, poor presenting visual acuity and culture-positive endophthalmitis are associated with poorer visual acuity outcomes.

Teleophthalmology for age-related macular degeneration during the COVID-19 pandemic and beyond

2020 ◽  
pp. 1357633X2096063
Author(s):  
Joel Mintz ◽  
Chase Labiste ◽  
Michael V DiCaro ◽  
Evan McElroy ◽  
Reza Alizadeh ◽  
...  
Keyword(s):  
Macular Degeneration ◽  
Vision Loss ◽  
Management Strategies ◽  
Home Monitoring ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Office Visits ◽  
Socioeconomically Disadvantaged ◽  
Age Related ◽  
Poor Outcomes

Introduction COVID-19 has disrupted how ophthalmic practice is conducted worldwide. One patient population that may suffer from poor outcomes during the pandemic are those with age-related macular degeneration (AMD). Many practices are performing some form of teleophthalmology services for their patients, and guidance is needed on how to maintain continuity of care amongst patients with AMD using teleophthalmology. Methods A literature search was conducted, ending 1 August 2020, to identify AMD outcomes and telecare management strategies that could be used during the COVID-19 pandemic Results 237 total articles were retrieved, 56 of which were included for analysis. Four American Academy of Ophthalmology and Center for Disease Control web resources were also included. Discussion Risk-stratification models have been developed that let providers readily screen existing patients for their future risk of neovascular AMD (nAMD). When used with at-home monitoring devices to detect nAMD, providers may be able to determine who should be contacted via teleophthalmology for screening. Telemedicine triage can be used for new complaints of vision loss to determine who should be referred to a retinal specialist for management of suspected nAMD. To increase access and provider flexibility, smartphone fundus photography images sent to a centralized teleophthalmology service can aid in the detection of nAMD. Considerations should also be made for COVID-19 transmission, and teleophthalmology can be used to screen patients for the presence of COVID-19 prior to in-person office visits. Teleophthalmology has additional utility in connecting with nursing home, rural, and socioeconomically disadvantaged patients in the post-pandemic period.

scholarly journals An investigation of transmission control measures during the first 50 days of the COVID-19 epidemic in China

Science ◽  
2020 ◽  
Vol 368 (6491) ◽  
pp. 638-642 ◽  
Author(s):  
Huaiyu Tian ◽  
Yonghong Liu ◽  
Yidan Li ◽  
Chieh-Hsi Wu ◽  
Bin Chen ◽  
...  
Keyword(s):  
Emergency Response ◽  
Case Reports ◽  
Human Movement ◽  
Health Interventions ◽  
Control Measures ◽  
Wuhan City ◽  
Data Set ◽  
Novel Coronavirus ◽  
National Emergency ◽  
And Control

Responding to an outbreak of a novel coronavirus [agent of coronavirus disease 2019 (COVID-19)] in December 2019, China banned travel to and from Wuhan city on 23 January 2020 and implemented a national emergency response. We investigated the spread and control of COVID-19 using a data set that included case reports, human movement, and public health interventions. The Wuhan shutdown was associated with the delayed arrival of COVID-19 in other cities by 2.91 days. Cities that implemented control measures preemptively reported fewer cases on average (13.0) in the first week of their outbreaks compared with cities that started control later (20.6). Suspending intracity public transport, closing entertainment venues, and banning public gatherings were associated with reductions in case incidence. The national emergency response appears to have delayed the growth and limited the size of the COVID-19 epidemic in China, averting hundreds of thousands of cases by 19 February (day 50).

scholarly journals Culture and therapist self-disclosure

2019 ◽  
Vol 12 ◽  
Author(s):  
Peter Phiri ◽  
Shanaya Rathod ◽  
Mary Gobbi ◽  
Hannah Carr ◽  
David Kingdon
Keyword(s):  
Drop Out ◽  
List Type ◽  
Behaviour Therapy ◽  
Data Set ◽  
Self Disclosure ◽  
Psychological Therapies ◽  
Cognitive Behaviour ◽  
Lay Members ◽  
Poor Outcomes ◽  
The Impact

AbstractCognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist’s reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists’ cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training.Key learning aims(1)To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations.(2)To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities.(3)To understand the impact and role of self-disclosure as initiated by patients.(4)To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy.(5)To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that ‘one size does not fit all’.

scholarly journals Vitrectomy for endophthalmitis: 5-year study of outcomes and complications

2020 ◽  
Vol 5 (1) ◽  
pp. e000423 ◽  
Author(s):  
Guy Simon Negretti ◽  
WengOnn Chan ◽  
Carlos Pavesio ◽  
Mahiul Muhammed Khan Muqit
Keyword(s):  
Case Series ◽  
Vitreoretinal Surgery ◽  
Endogenous Endophthalmitis ◽  
Final Visit ◽  
Retrospective Case ◽  
Tertiary Centre ◽  
Early Vitrectomy ◽  
Exogenous Endophthalmitis ◽  
Vitrectomy Surgery

Background/AimsTo analyse the complications and outcomes of vitrectomy surgery for endophthalmitis.MethodsThis was a retrospective case series. All cases that underwent 23-gauge vitrectomy surgery for endophthalmitis at a tertiary centre between 1 February 2013 and 1 February 2018 were included. Main outcome measures were as follows: visual acuity (VA) at final visit and post-vitrectomy complications.Results33 patients were included in the study with 20 men and 13 women, average age 63 years. Main post-surgical causes for endophthalmitis included phacoemulsification (n=9), trabeculectomy (n=5), intravitreal injection (n=5), corneal graft (n=4), vitreoretinal surgery (n=3) and endogenous endophthalmitis (n=6). Average follow-up was 18 months (SD 14). 21/33 (64%) patients had baseline perception of light VA. Analysis of exogenous endophthalmitis cases only demonstrated: mean LogMAR VA improved significantly from 2.68 to 1.66 (p=0.001). At final follow-up, 12% had VA of 6/12 or better, and 28% had VA of 6/36 or better. Vitrectomy within 7 days resulted in improved final VA outcomes (1.49 vs 2.16 LogMAR, p=0.032). Complications included retinal detachment (24.2%), macular hole (3%), hypotony (6%), suprachoroidal haemorrhage (3%) and enucleation/evisceration (6%).ConclusionVitrectomy for endophthalmitis leads to VA gains in some cases. Surgical outcomes may be improved with early vitrectomy performed within 7 days of the initial event for exogenous endophthalmitis. Patients should be advised of the potential risk of severe complications with/and without surgery.

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