Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis

2021 ◽  
pp. 112067212110686
Author(s):  
Weiyan Liang ◽  
Chang Liu ◽  
Xiansen Zhang ◽  
Ling Li ◽  
Zexia Dou ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Therapeutic Effect ◽  
Clinical Symptoms ◽  
Treatment Protocol ◽  
Corneal Stroma ◽  
Fungal Keratitis ◽  
Slit Lamp ◽  
Continuous Administration ◽  
Conventional Medical Treatment

Purpose To evaluate the therapeutic effect of incorporating continuous administration of voriconazole in the treatment of recalcitrant fungal keratitis. Methods In this prospective case study, 5 consecutive patients (5 eyes) with fungal keratitis were treated with a standard protocol after the failing maximal conventional medical treatment. The protocol involved continuous lavage of the ulcer with 1% voriconazole through an irrigator for 2 h, twice a day, combined with local and systemic antifungals. Visual acuity, slit lamp findings of the ulcer, and fungal hyphae density by confocal microscope were documented, respectively. Results In 4 patients, the clinical symptoms and slit lamp examination were significantly improved after only 3 days of treatment. The hyphae were shown to decrease in number and morphologically fragmented in corneal stroma by confocal microscopy. After the infection was controlled, 2 cases required further keratoplasty. In one case, the treatment was deemed ineffective and a conjunctival flap had to be created to help control the infection. In all 5 patients, the best spectacle-corrected visual acuity had improved after treatment. With more than 3 months of follow-up, no recurrence of infection was seen in any cases. Conclusion Our treatment protocol demonstrated improvement in the treatment of clinically resistant fungal keratitis. Continuous lavage of voriconazole is easy to be implemented and well-tolerated by patients. Modification of the current protocol should be further explored to optimize the therapeutic effectiveness in future.

Amavat in pediatric age group (multidisciplinary Ayurvedic approach): a single case study

2020 ◽  
Vol 8 (03) ◽  
Author(s):  
Mayuri Pawar
Keyword(s):  
Clinical Symptoms ◽  
Single Case ◽  
Treatment Protocol ◽  
Oral Intake ◽  
External Application ◽  
Pediatric Age Group ◽  
Patient Reported ◽  
Ayurvedic Treatment

Amavata is a chronic, progressive and crippling disorder caused due to generation of ama and its association with vitiated vata dosha and deposition in shleshma sthana (joints). Clinically resembling with Rheumatoid Arthirtis, it poses a challenge for the physician owing to its chronicity, morbidity and complications. The treasure of Ayurveda therapeutics has laid out detailed treatment line for amavata. A 13years old male patient reported to this hospital with pain and stiffness of metacarpophalangeal joints of right hand followed by pain in corresponding joints of other hand 1 year back. This was succeeded by pain and mild swelling on bilateral wrist, ankle and elbow joints. Based on clinical examination and blood investigations, diagnosis of amavata was made and Ayurvedic treatment protocol was advised with baluka sweda (sudation) as external application, rasnasaptak kashayam and dashmoolharitaki avaleha for oral intake for 30 days. The patient was asked for follow up every 15 days up to total of 45 days. Assessment was done subjectively based on clinical symptoms and blood investigations as objective parameters. There was substantially significant improvement and the patient felt relieved of the pain and inflammation of the joints after the treatment. This case study reveals the potential of Ayurvedic treatment protocol in management of amavata and may form a basis for further detailed study of the subject.

scholarly journals Efficacy of Voriconazole Corneal Intrastromal Injection for the Treatment of Fungal Keratitis

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Chenshuang Li ◽  
Kunpeng Pang ◽  
Liqun Du ◽  
Xinyi Wu
Keyword(s):  
Visual Acuity ◽  
Corneal Stroma ◽  
Fungal Keratitis ◽  
Antifungal Treatment ◽  
Treatment Modalities ◽  
Control Group ◽  
Significant Difference ◽  
The Difference ◽  
Contralateral Eye ◽  
Intrastromal Injection

Purpose. To evaluate efficacy and safety of novel tricyclic corneal stroma injection (TCSI) voriconazole for the treatment of fungal keratitis. Methods. This retrospective cohort study included data of 57 patients (57 eyes) with fungal keratitis. The TCSI group consisted of 27 patients (27 eyes) who were injected voriconazole once via TCSI procedure within one week after enrollment, in addition to conventional antifungal treatment. The control group consisted of 30 patients (30 eyes) who were treated using conventional antifungal treatment modalities. The outcome measures consist of the 3-week and 3-month best-corrected visual acuity (BCVA) values and size of infiltrate or scar, time to re-epithelialization, corneal perforation rate and/or therapeutic penetrating keratoplasty (TPK) requirement, the preoperative and post-TCSI corneal endothelial cell density (ECD), and the intraocular pressure (IOP) of the treated eye and the respective contralateral eye. Results. There were no significant differences in the baseline demographic and clinical characteristics between the two groups. 3 weeks and 3 months after enrollment, the TCSI group exhibited an increase in visual acuity ( P < 0.05 ), and there was no significant difference in the size of infiltrate or scar between two groups ( P > 0.05 ). Time to re-epithelialization was shorter in the TCSI group than in the control group ( P < 0.05 ). There was no statistically significant difference between corneal ECD on the day before and 7 days after TCSI and the IOP of treated and contralateral healthy eyes on the day before and 1 day, 3 days, 7 days, and 1 month after TCSI ( P > 0.05 ). The difference in the risk of perforation and/or TPK requirement was not statistically significant between two groups ( P > 0.05 ). Conclusion. Localized injection of voriconazole using TCSI may be a minimally invasive, safe, and effective adjuvant treatment modality for fungal keratitis.

scholarly journals FUNGAL KERATITIS WITH CORNEAL ULCER IN FARMER

2020 ◽  
Vol 3 (1) ◽  
pp. 58
Author(s):  
Nugraha Wahyu Cahyana
Keyword(s):  
Visual Acuity ◽  
Corneal Ulcer ◽  
Fungal Keratitis ◽  
Eye Drops ◽  
Slit Lamp ◽  
Good Clinical Response ◽  
Specific Diagnosis ◽  
The World ◽  
Corneal Blindness ◽  
Test Result

Fungal keratitis is an important cause of corneal blindness all over the world, especially in developing countries. Fungal Keratitis can diagnosis by slit-lamp biomicroscopic examination and culture is essential for early specific diagnosis and must be taken into consideration to establish the most effective treatment and avoid severe complications. The study was present a case of Fungal Keratitis in Farmer with a corneal ulcer caused by rice seeds corneal corpus allienum. A corneal ulcer is a complication was caused by ineffective therapy especially Steroid topical that should be avoided. The culture test result was C. Albicans and was treated with natamycin 5% Eye drops. Finally, patients have a good clinical response, however with the sequel of decreased visual acuity.  

Ayurvedic management of Myositis Ossificans of Vastus Lateralis Muscle (Urusthamba) - A Case Study

2017 ◽  
Vol 2 (1) ◽  
Author(s):  
Vishnu Mohan ◽  
Gopikrishna BJ ◽  
Avnish Pathak ◽  
Mahesh Kumar ES ◽  
Duradundi G
Keyword(s):  
Heterotopic Ossification ◽  
Myositis Ossificans ◽  
Vastus Lateralis ◽  
Treatment Protocol ◽  
Vastus Lateralis Muscle ◽  
Satisfactory Treatment ◽  
Lateralis Muscle ◽  
Ayurvedic Treatment

Myositis ossificansis characterized by heterotopic ossification (calcification) of muscle of various etiologies. It is most commonly affected in the quadriceps of the thighs. There are many tools available for diagnosis of Myositis ossificans, but lack of satisfactory treatment. So the development of a treatment protocol for Myositis ossificans is the need of today`s era. In Ayurveda, the same can be understood as Urusthamba. The present paper discusses a case of Myositis ossificans of right vastus lateralis muscle and its Ayurvedic treatment.

scholarly journals Brief Eclectic Psychotherapy for Moral Trauma (BEP-MT): treatment protocol description and a case study

2021 ◽  
Vol 12 (1) ◽  
pp. 1929026
Author(s):  
Simone M. de la Rie ◽  
Antoine van Sint Fiet ◽  
Jannetta B. A. Bos ◽  
Nora Mooren ◽  
Geert Smid ◽  
...  
Keyword(s):  
Treatment Protocol ◽  
Eclectic Psychotherapy

scholarly journals Severe Corneal Morphological Alterations after Excimer Laser Surface Ablation for a High Astigmatism

2021 ◽  
pp. 492-496
Author(s):  
Anna M. Roszkowska ◽  
Giovanni W. Oliverio ◽  
Giuseppe A. Signorino ◽  
Mario Urso ◽  
Pasquale Aragona
Keyword(s):  
Excimer Laser ◽  
Corneal Stroma ◽  
Corneal Topography ◽  
Laser Surface ◽  
Slit Lamp ◽  
Slit Lamp Examination ◽  
Morphological Alterations ◽  
Surface Ablation ◽  
Confocal Images

We report long-term alterations of anterior corneal stroma after excimer laser surface ablation for a high astigmatism. The patient claimed progressive visual loss in his right eye (RE) during the last 3 years after bilateral laser-assisted subepithelial keratectomy (LASEK) surgery. His examination comprised visual acuity (UDVA and CDVA), slit-lamp examination, corneal topography and tomography, AS-OCT, and confocal microscopy. The UDVA was 0.1 in his RE and 1.0 in the left eye. The CDVA in the RE was 0.8. The slit-lamp examination showed a stromal lesion in the inferior paracentral corneal zone, with multiple vertical tissue bridges and severe thinning. Corneal topography and tomography showed central flattening with inferior steepening and severe alteration in elevation maps. AS-OCT showed void areas in the anterior stroma with thinning of the underlying tissue, and confocal images were not specific. In this case, progressive corneal steepening and thinning that manifest topographically as inferior ectasia occurred in correspondence to the singular stromal alterations after LASEK.

Beyond exposure therapy: formulation-based therapy treating a fear of urinary incontinence – a case study

2021 ◽  
pp. 1-5
Author(s):  
Torstein Stapley ◽  
Tracey Taylor ◽  
Victoria Bream
Keyword(s):  
Urinary Incontinence ◽  
Treatment Protocol ◽  
Treatment Strategies ◽  
Specific Phobia ◽  
Behaviour Therapy ◽  
Behavioural Treatment ◽  
Subjective Report ◽  
Cognitive Behaviour ◽  
Behavioural Factors

Abstract Background: The current literature on the specific phobia of urinary incontinence is limited, with no specific empirically established model or treatment protocol. Aims: This article consists of a case study of formulation-driven cognitive behaviour therapy (CBT) for phobia of urinary incontinence. Method: Martin attended a total of 12 treatment sessions. The treatment included the development of an idiosyncratic formulation, and the use of well-established cognitive and behavioural treatment strategies from other anxiety disorders. Results: Both outcome measures and Martin’s subjective report indicate that the treatment was effective. Conclusion: This case study contributes to the current limited literature on this phobia, and emphasises the importance of formulation-driven CBT to map for idiosyncratic features and target cognitive and behavioural factors.

Chronic neuroangiostrongyliasis: case study of chronic presentations in Hawaii

Parasitology ◽  
2020 ◽  
pp. 1-6
Author(s):  
Bernard C. Meyer
Keyword(s):  
Clinical Symptoms ◽  
Personal Relationships ◽  
Long Term Outcomes ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Residual Symptoms ◽  
Common Features ◽  
Muscular Pain

Abstract This paper describes chronic features of neuroangiostrongyliasis (NAS), a long-term outcome of the disease that has not been adequately described. Current and past literature is predominantly limited to acute manifestations of NAS, and mention of chronic, ongoing clinical symptoms is usually limited to brief notes in a discussion of severe cases. This study investigated the long-term outcomes in ten individuals who were diagnosed with acute neuroangiostrongyliasis in Hawaii between 2009 and 2017. The study demonstrates a significant number of persons in Hawaii sustain residual symptoms for many years, including troublesome sensory paresthesia (abnormal spontaneous sensations of skin experienced as ‘burning, pricking, pins and needles’; also described as allodynia or hyperesthesia) and extremity muscle pains. As a consequence, employment and economic hardships, domestic relocations, and psychological impairments affecting personal relationships occurred. The study summarizes common features of chronic disease, sensory paresthesia and hyperesthesia, diffuse muscular pain, insomnia, and accompanying emotional distress; highlights the frequently unsuccessful endeavours of individuals struggling to find effective treatment; proposes pathogenic mechanisms responsible for prolonged illness including possible reasons for differences in disease presentation in Hawaii compared to Southeast Asia.

scholarly journals Amnwiotic Membrane Transplantation as a Treatment for Sterile Infiltration and Corneal Melting after Corneal Crosslinking for Keratoconus

2018 ◽  
Vol 9 (1) ◽  
pp. 185-189 ◽  
Author(s):  
Takanori Sasaki ◽  
Takeshi Ide ◽  
Ikuko Toda ◽  
Naoko Kato
Keyword(s):  
Visual Acuity ◽  
Diclofenac Sodium ◽  
Corneal Stroma ◽  
Amniotic Membrane Transplantation ◽  
Eye Drops ◽  
Epithelial Defect ◽  
Persistent Epithelial Defect ◽  
Corneal Crosslinking ◽  
Corneal Epithelial Defect ◽  
Corneal Melting

We report a case of corneal melting through sterile infiltration presumably due to excessive use of nonsteroidal anti-inflammatory eye drops after corneal crosslinking (CXL). It was treated using steroids combined with amniotic membrane transplantation (AMT). A 33-year-old man with progressing keratoconus underwent left eye CXL. We prescribed betamethasone and levofloxacin eye drops 5 times daily and diclofenac sodium eye drops 3 times daily for 3 days. Three days after CXL, there was a persistent epithelial defect and the left corneal stroma was clouded. His visual acuity remained unchanged. We prescribed betamethasone hourly and 20 mg prednisolone daily. At 1 week after CXL, the corneal epithelial defect and infiltration were unchanged. He had not stopped using diclofenac at the prescribed time. On day 17, we performed AMT and his cornea and visual acuity improved. AMT may be effective against persistent epithelial defects and corneal melting after CXL.

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