scholarly journals Uveitis in spondyloarthritis

2020 ◽  
Vol 12 ◽  
pp. 1759720X2095173
Author(s):  
Judith Rademacher ◽  
Denis Poddubnyy ◽  
Uwe Pleyer
Keyword(s):  
Effective Treatment ◽  
Biological Treatment ◽  
Diagnostic Delay ◽  
Sudden Onset ◽  
Topical Steroids ◽  
Close Collaboration ◽  
Blurred Vision ◽  
Ocular Symptoms ◽  
Referral Strategy ◽  
Necrosis Factor

Uveitis is the most frequent extra-articular manifestation of axial spondyloarthritis (SpA), occurring in up to one-third of the patients. In the majority of patients, uveitis is acute, anterior and unilateral and presents with photosensitivity, sudden onset of pain and blurred vision. Topical steroids are an effective treatment; however, recurrent or refractory cases may need conventional disease-modifying antirheumatic drugs or biological treatment with monoclonal tumor necrosis factor (TNF) inhibitors, thus also influencing treatment strategy of the underlying SpA. Though the exact pathogenesis of SpA and uveitis remains unknown, both seem to result from the interaction of a specific, mostly shared genetical background (among other HLA-B27 positivity), external influences such as microbiome, bacterial infection or mechanical stress and activation of the immune system resulting in inflammation. Up to 40% of patients presenting with acute anterior uveitis (AAU) have an undiagnosed SpA. Therefore, an effective referral strategy for AAU patients is needed to shorten the diagnostic delay of SpA and enable an early effective treatment. Further, the risk for ophthalmological manifestations increases with the disease duration in SpA; and patients presenting with ocular symptoms should be referred to an ophthalmologist. Thus, a close collaboration between patient, rheumatologist and ophthalmologist is needed to optimally manage ocular inflammation in SpA.

scholarly journals Topiramate induced bilateral hypopyon uveitis and choroidal detachment: a report of two cases and review of literature

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mudit Tyagi ◽  
Shashwat Behera ◽  
Sirisha Senthil ◽  
Rajeev R. Pappuru ◽  
Vikas Ambiya ◽  
...  
Keyword(s):  
Sudden Onset ◽  
Acute Angle ◽  
Ocular Inflammation ◽  
Angle Closure ◽  
Topical Steroids ◽  
Review Of Literature ◽  
Case Presentation ◽  
Ocular Symptoms ◽  
Acute Angle Closure ◽  
Acute Angle Closure Glaucoma

Abstract Background Topiramate (TPM) is a drug commonly used by neurophysicians and psychiatrists for a plethora of indications. Topiramate has been reported to induce acute angle closure glaucoma as an adverse effect. However, there is limited literature on Topiramate causing hypopyon uveitis and intense ocular inflammation. It is imperative for ophthalmologists as well as physicians to be aware of the potential sight threatening ocular adverse effects of Topiramate. We report 2 rare consecutive cases of severe hypopyon uveitis and choroidal detachments after using Topiramate. Case presentation Two patients presented with sudden onset of angle closure, bilateral hypopyon uveitis and choroidal detachments. On reassessing a detailed treatment history, it was found that both patient were taking oral Topiramate which had been started 2 weeks before the onset of ocular symptoms. The bilateral hypopyon and angle closure were considered to be induced by Topiramate and the drug was discontinued. The patients were started on oral and topical steroids which led to resolution of hypopyon uveitis and choroidal detachments. The visual acuity improved and the intraocular pressure also got normalised in both the cases. Conclusions Topiramate can lead to a bilateral hypopyon uveitis and severe ocular inflammation. An urgent cessation of topiramate along with topical and systemic steroids is required to prevent serious complications.

Anti-adhesion Molecules in IBD: Does Gut Selectivity Really Make the Difference?

2019 ◽  
Vol 25 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Ferdinando D'Amico ◽  
Giulia Roda ◽  
Laurent Peyrin-Biroulet ◽  
Silvio Danese
Keyword(s):  
Adhesion Molecules ◽  
Biological Treatment ◽  
Current Data ◽  
New Drugs ◽  
Inflammatory Infiltration ◽  
New Class ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Difference ◽  
Necrosis Factor

Inflammatory Bowel Disease is lifetime chronic progressive inflammatory disease. A considerable portion of patients, do not respond or lose response or experience side effect to “traditional” biological treatment such as anti-tumor necrosis factor (TNF)-α agents. The concept that the blockade of T cell traffic to the gut controls inflammation has stimulated the development of new drugs which selectively targets molecules involved in controlling cell homing to the intestine. The result is the reduction of the chronic inflammatory infiltration in the gut. In this regard, anti-adhesion molecules represent a new class of drugs for patients who don’t respond or lose response to traditional therapy. Moreover, some of these molecules such as vedolizumab, offer the advantage to target the delivery of a drug to the gut (gut selectivity) which could increase clinical efficacy and limit potential adverse events. In this article, we will give an overview of the current data on anti-adhesion molecules in Inflammatory Bowel Diseases.

scholarly journals Recurrent keratoconjunctivitis as the sole manifestation of COVID-19 infection: A case report

2021 ◽  
pp. 112067212110065
Author(s):  
Satria Audi Hutama ◽  
Firas Farisi Alkaff ◽  
Ryan Enast Intan ◽  
Citra Dewi Maharani ◽  
Luki Indriaswati ◽  
...  
Keyword(s):  
Case Report ◽  
Foreign Body ◽  
Foreign Body Sensation ◽  
Polymerase Chain Reaction Test ◽  
Nasopharyngeal Swab ◽  
Conjunctival Hyperemia ◽  
Blurred Vision ◽  
Ocular Symptoms ◽  
Body Sensation ◽  
Fluorescence Test

Introduction: Ocular symptoms are uncommon manifestations of coronavirus disease 2019 (COVID-19) infection. Earlier study reported that dry eye, blurred vision, foreign body sensation, tearing, itching, conjunctival secretion, conjunctival congestion, ocular pain, and photophobia are among the ocular symptoms that could be found in COVID-19 patients. However, there are only a few reports available regarding corneal involvement in this disease. Here we report a case of keratoconjunctivitis as the only symptom of COVID-19 infection. Case description: A 27-year-old man who worked as an obstetrics and gynecology resident came to the outpatient clinic with the chief complaints of eye discomfort, foreign body sensation, conjunctival hyperemia, lacrimation, and photophobia in his right eye for the past 3 weeks. Fluorescence test showed a small corneal lesion. The patient was then diagnosed with keratoconjunctivitis. A week after the treatment, all symptoms were resolved. A month later, the patient came to the emergency room with the same eye complaints but with a more severe pain. The fluorescence test showed wider corneal lesion compared to last month. The result from the corneal swab is negative for bacterial or fungal infection, indicating a viral infection. Afterwards, reverse transcriptase polymerase chain reaction test from nasopharyngeal swab was performed and revealed that the patient was positive for COVID-19. Conclusions: This case report showed that keratoconjunctivitis may occur as the only manifestation of COVID-19 infection. Thus, patient presented with unexplainable eye symptoms should be evaluated for COVID-19 infection.

scholarly journals PREVALENCE OF COMPUTER VISION SYNDROME AMONG UNDERGRADUATE PHYSICAL THERAPY STUDENTS

2021 ◽  
Vol 10 (2) ◽  
pp. 63-68
Author(s):  
Farah Deeba
Keyword(s):  
Computer Vision ◽  
Physical Therapy ◽  
Screen Time ◽  
Cross Sectional Study ◽  
Blurred Vision ◽  
Visual Rehabilitation ◽  
Cross Sectional ◽  
Ocular Symptoms ◽  
Computer Vision Syndrome ◽  
Physical Therapy Student

BACKGROUND AND AIM Computers and other digital screens have become an integral part of our life. It raises various ocular problems in the user due to excessive screen time, this study aims to determine the frequency of computer vision syndrome (CVS) in population of under graduate physical therapy student. METHODOLOGY This was cross-sectional study conducted at Ziauddin College of Rehabilitation Sciences; Karachi during June 2019 to September 2020.A total number of 340 candidates of age 22 years ± 1.8 including both genders participated in this study. A questionnaire was designed to collect data which was statistically analyzed on SPSS version 20. Whereas descriptive data was calculated as mean, median, mode and standard deviation using graphical representations. RESULTS 88.5% of the students used mobile phones for study purpose out of which 35.3% use it for 4-7 hour and 33% use for 7 to 10 hours a day. The ocular symptoms that students face was burning of eyes (40%), tearing (55%), eye redness (45.3%), diplopia 31.8%, blurred vision (42.9%), eye dryness (23.8%), while extra ocular symptom that was noticed in the study included headache too was (67.9%). CONCLUSION This study showed that most of the students were found to have a CVS thus screen time guide lines and visual rehabilitation must established.

scholarly journals Cutaneous T-cell lymphoma in the setting of anti-tumor necrosis factor and immunomodulator therapy: A case report and literature review

2020 ◽  
Vol 8 ◽  
pp. 2050313X2093722 ◽  
Author(s):  
James Dotimas ◽  
Manjusha Das ◽  
Daniel Martin
Keyword(s):  
T Cell ◽  
Mycosis Fungoides ◽  
Cell Lymphoma ◽  
Dual Therapy ◽  
T Cell Lymphoma ◽  
Unknown Etiology ◽  
Topical Steroids ◽  
Cutaneous T Cell Lymphoma ◽  
Cutaneous Form ◽  
Necrosis Factor

Immunosuppressive therapy is well recognized as increasing the risk of lymphoma. Mycosis fungoides is a rare cutaneous form of T-cell lymphoma with a largely unknown etiology and not typically associated with immunosuppression. In this article, we describe our encounter with a 24-year-old male with Crohn’s disease in remission on immunotherapy, specifically dual therapy with azathioprine and infliximab, presenting with a facial rash found to be consistent with mycosis fungoides on biopsy. The patient’s rash resolved with treatment of topical steroids. In addition, the decision was made to discontinue his azathioprine to minimize his risks of developing future malignancies.

scholarly journals A Randomized, Controlled Study of the Efficacy and Safety of a New Eyedrop Formulation for Moderate to Severe Dry Eye Syndrome

2016 ◽  
Vol 27 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Frédéric Chiambaretta ◽  
Serge Doan ◽  
Marc Labetoulle ◽  
Nicolas Rocher ◽  
Lamia El Fekih ◽  
...  
Keyword(s):  
Hyaluronic Acid ◽  
Dry Eye ◽  
Keratoconjunctivitis Sicca ◽  
Phase Iii ◽  
Controlled Study ◽  
Efficacy And Safety ◽  
Conjunctival Hyperemia ◽  
Blurred Vision ◽  
Ocular Symptoms ◽  
Global Performance

Purpose This study compared the efficacy and safety of hyaluronic acid (HA)-trehalose, a new eyedrop containing trehalose (a natural bioprotectant) and HA, to an established formulation containing only HA. Methods This was a phase III, randomized, active-controlled, investigator-masked, multicenter study in France and Tunisia. In all, 105 adult patients (≥18 years) with moderate to severe dry eye disease (DED) received either HA-trehalose (n = 52) or HA (n = 53) 3-6 times per day for 84 days. The primary efficacy variable was the Oxford grading score at day 35. A questionnaire on dry eye and symptoms, Schirmer test, tear break-up time, conjunctival hyperemia, and global performance were assessed as secondary efficacy criteria at baseline, day 35, and day 84. Safety assessments were standard. Results Noninferiority of HA-trehalose to HA for keratoconjunctivitis sicca assessed by Oxford grading score was demonstrated at day 35. For the secondary efficacy parameters, reductions in dry eye questionnaire classes of none or mild at day 84, dry eye symptoms of stinging, itching, and blurred vision at day 35, and investigator (days 35 and 84) and patient assessments (day 35) of global performance were significantly better for HA-trehalose. There were no clinically meaningful differences between groups for the other secondary criteria. Both treatments were well-tolerated, and there were fewer ocular symptoms upon instillation and fewer adverse events for HA-trehalose than for HA. Conclusions Hyaluronic acid-trehalose is effective and safe, with better patient satisfaction, than existing HA-only eyedrops particularly from the first month of treatment, and offers a therapeutic advancement in the treatment of moderate to severe DED.

scholarly journals P163 Changes in diagnostic delay in inflammatory bowel diseases over the years: a retrospective single-centre analysis

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S220-S220
Author(s):  
M Di Ruscio ◽  
F Vernia ◽  
A Variola ◽  
G Lunardi ◽  
S Resimini ◽  
...  
Keyword(s):  
Median Time ◽  
Inflammatory Bowel Diseases ◽  
Biological Treatment ◽  
Diagnostic Delay ◽  
Delayed Diagnosis ◽  
Age Related ◽  
Time To Diagnosis ◽  
Bowel Diseases ◽  
Inflammatory Bowel ◽  
The Difference

Abstract Background Delayed diagnosis is common in inflammatory bowel diseases (IBD) and has been reported to be longer for patients with Crohn’s disease (CD) than for those with ulcerative colitis (UC). Aims of study were to assess the median time to diagnosis in IBD patients, to examine whether diagnostic delay (DD) has improved over the years and its impact on biological treatment and need for surgery. Methods A retrospective monocentric study including IBD patients living in the area of Verona (Italy), diagnosed up to 2019 and followed-up for at least 6 months at IRCCS Sacro Cuore—Don Calabria, Negrar, was carried out. DD was defined as the period (months) from symptoms onset to histological diagnosis of IBD and reported as <6 months, 6–12 months and >12 months. Results Six-hundred-six patients (255 CD; 351 UC; 308 males; 298 females) were enrolled. Median DD was 10 (IQR 2–12), 6 (IQR 1–12) and 2 (IQR 1–7) months <2000, between 2001–2010, and >2010, respectively. Median time to diagnosis was not significantly longer in CD than in UC patients (4 vs. 3 months; IQR 1- 12). No sex- or age-related differences in DD were observed. Using the Mann–Whitney test, DD was longer in patients diagnosed <2000 and between 2001–2010, than in those diagnosed >2010 (p = 0.0000 and p = 0.0004). Comparing DD <2000 and >2010, the statistical difference was reported for UC (p = 0.0000) but not for CD (p = 0.2756). Considering the use of biologics over the years, patients diagnosed between 2000–2010, and >2010 were compared (194 CD and 333 UC), reporting a significant increase in their use both for CD (30 vs. 60; p = 0.0008) and UC (28 vs. 43; p = 0.0000). DD did not influence the need for biological treatment in both diseases (p = 0.987 for CD; p = 0.433 for UC). Considering a DD <6, 6–12, and >12 percentages of patients needing biologics were respectively 53.4%, 63.6% and 56.5% for CD and 28.5%, 34.1% and 26.3% for UC. Seventy-two CD and 27 UC patients needed surgery. Analyzing the time to surgery, DD did not influence the rate of resections in CD (p = 0.6559), as well as in UC (p = 0.2792). Conclusion In our cohort, DD has significantly decreased over the last years, more for UC than CD patients. This is probably related to the increased awareness of patients on disease and of general practitioners in sending them to the specialist. Considering the published literature, UC and CD did not differ in DD; moreover age at diagnosis did not affect DD in our patients. DD did not influence the need for biological treatment or surgery rates in both diseases. These results are probably related to the difference in disease extension and severity among the patients enrolled. An analysis on targeted patients at higher risk for bowel damage is presently under way.

scholarly journals Importance of clinical signs leading to the diagnosis in a case of microbiological smear negative ocular microsporidiosis

2019 ◽  
Vol 12 (2) ◽  
pp. e228407
Author(s):  
Prateek Agarwal ◽  
Ivana Romac Coc ◽  
Samuel Edward Navon
Keyword(s):  
Clinical Signs ◽  
Prednisolone Acetate ◽  
Topical Steroids ◽  
Eye Drops ◽  
Blurred Vision ◽  
Days Of Therapy ◽  
History Of ◽  
Smear Negative ◽  
Epithelial Lesions ◽  
Or History

A 28-year-old patient presented to us with multifocal coarse raised epithelial lesions in the left eye associated with pain watering redness and blurred vision with a visual acuity of 20/40 in the left eye. The patient had been managed elsewhere with a course of topical moxifloxacin eye-drops four times a day and topical steroids (prednisolone acetate) 1% three times a day for 2 weeks without any resolution, which was stopped 2 days ago prior to presentation at our centre. Gram stain was negative for bacteria as well as microsporidial spores. 10% KOH was negative for fungal hyphae. Based on strong clinical signs of corneal microsporidiosis, in spite of the negative microbiology smear, the patient was started on voriconazole eye-drops five times a day. The lesions started resolving in 5 days and completely healed after 17 days of therapy. No relevant history pertaining to exposure of contaminated water, swimming or history of trauma could be elicited.

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