scholarly journals Fusarium infection complicating rheumatic keratitis that acutely progressed to endophthalmitis during regular infusion of tocilizumab: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yusuke Mitsuoka ◽  
Takeshi Soma ◽  
Kazuichi Maruyama ◽  
Kohji Nishida
Keyword(s):  
Filamentous Fungi ◽  
Initial Response ◽  
Rapid Progression ◽  
Human Cornea ◽  
Corneal Epithelial ◽  
Vitreous Opacity ◽  
Increased Risk ◽  
Donor Graft ◽  
Corneal Scraping ◽  
Anti Fungal

Abstract Background Filamentous fungi are ubiquitous in plants, water, and soil. The predominant fungi that infect the human cornea include Fusarium and Aspergillus species. The onset of fungal endophthalmitis is indolent, and typically takes weeks to months to develop after corneal infection. We report a case of Fusarium infection complicating rheumatic keratitis that acutely progressed to endophthalmitis during intravenous tocilizumab therapy. Case presentation A 65-year-old female patient was referred to our department due to pain and decreased vision in her left eye. Slit-lamp examination showed a white focus on the upper peripheral cornea, hypopyon, anterior chamber fibrin formation, marked ciliary hyperemia, and whole corneal epithelial defects. As the corneal scraping smear was positive for filamentous fungi and Fusarium species were detected by aqueous humor polymerase chain reaction, anti-fungal therapy was started. Although the initial response to anti-fungal therapy was good, we observed corneal infiltration, worsening hypopyon, and vitreous opacity after tocilizumab infusion. Given that the infection continued to progress despite conservative therapy, we performed penetrating keratoplasty combined with vitrectomy. After removal of the white focus beneath the intraocular lens, a temporary corneal prosthesis was mounted and the dense vitreous opacity was removed. Finally, a frozen donor graft was sutured in place. The corneal infiltration, hypopyon, and vitreous opacity all disappeared after the operation. Conclusion The rapid progression of Fusarium keratitis to endophthalmitis in a patient who was receiving a regular infusion of tocilizumab demonstrates that ocular condition should be closely monitored during systemic tocilizumab administration due to increased risk of infection.

Real-world analysis of disease progression after CDK 4/6 inhibitor (CDKi) therapy in patients with hormone receptor positive (HR+)/HER2- metastatic breast cancer (MBC).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13030-e13030
Author(s):  
Malinda West ◽  
Andy Kaempf ◽  
Shaun Goodyear ◽  
Thomas Kartika ◽  
Jessica Ribkoff ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cox Regression ◽  
Metastatic Breast ◽  
Molecular Characteristics ◽  
Rapid Progression ◽  
Hormone Receptor Positive ◽  
Her2 Breast Cancer ◽  
Metastatic Setting ◽  
Increased Risk ◽  
Visceral Disease

e13030 Background: CDKi with endocrine therapy (ET) is approved treatment of metastatic HR+/HER2- breast cancer based on PFS benefit vs ET alone. Outcomes data following CDKi discontinuation (dc) is limited, with trials ongoing in this setting. The reported phenomenon of rapid progression within 4 months of CDKi dc raises concern over CDKi impact on HR+/HER2- MBC biology. This study aims to define outcomes after CDKi dc and identify predictors of progression. Methods: This is a retrospective review of women ≥18 years with HR+/HER2- MBC who received CDKi between 4/1/14 and 12/1/19. Patient and tumor characteristics, pre and post CDKi tx, and reason for CDKi dc were collected. Time to event outcomes from date of CDKi dc (primary = PFS, secondary = Overall Survival, OS) were analyzed with Kaplan Meier estimators and Cox regression. Results: Analysis included 140 patients (median age 65 years), with most MBC (84%) arising from earlier stage disease. 51% of MBCs had visceral disease, and 66% received tx prior to CDKi. The most common CDKi was palbociclib (93%); and most common ET were letrozole (52%) and fulvestrant (40%). Median CDKi tx duration was 9 months (3.5 – 17.4) with 80% dc due to progression. Post CDKi txs included chemotherapy (44%), ET (24%), targeted tx (21%), no further tx (7%) and CDKi tx (4%). Median follow up was 12 months. mPFS post CDKi dc were 6.5 months (95% CI: 5.0 – 7.9) and 11.3 months (95% CI: 4.6 – 23.7) in patients who dc CDKi due to progression or other reasons, respectively (HR 1.77, 95%CI: 1.10-2.85). Among 112 patients who progressed on CDKi, estimated 4-month incidence of post CDKi progression or death was 31% (Table ). mOS post CDKi dc was 15.4 months (95%CI: 13.3-19.0) and mOS post CDKi initiation was 26.5 months (95% CI: 23.3 – 34.3). Visceral disease (HR 1.45, 95%CI: 1.01-2.08) and progression as reason for CDKi dc (HR 1.77, 95%CI: 1.1-2.85) were predictors of PFS (p < 0.05). Receiving fulvestrant with CDKi (HR 1.42, 95%CI: 0.96-1.0), prior chemotherapy in the metastatic setting (HR = 1.39, 95% CI: 0.90 – 2.14), and shorter CDKi duration were associated with non-significant increased risk of PFS. Conclusions: Rapid progression or death at 4 months occurred in 31% of MBCs following CDKi dc due to progression. Ongoing studies to define clinical and molecular characteristics of rapidly progressing tumors are underway to develop targeted tx approaches and improve outcomes.[Table: see text]

scholarly journals Novel Haplotype Indicator for End-Stage Renal Disease Progression among Saudi Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Cyril Cyrus ◽  
Shahanas Chathoth ◽  
Chittibabu Vatte ◽  
Nafie Alrubaish ◽  
Othman Almuhanna ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Haplotype Analysis ◽  
Taqman Assay ◽  
Rapid Progression ◽  
High Morbidity ◽  
Glomerular Diseases ◽  
Increased Risk ◽  
Stage Renal Disease ◽  
End Stage

Background. End-stage renal disease (ESRD) is the result of hypertensive nephrosclerosis and chronic glomerular diseases and is associated with high morbidity and mortality. There are strong heritable components in the manifestation of the disease with a genetic predisposition to renal disorders, including focal segmental glomerulosclerosis and arterionephrosclerosis. Recent studies in genetics have examined modifiable risk factors that contribute to renal disease, and this has provided a deep insight into progressive kidney disease. Single-nucleotide polymorphisms at the proximity of SHROOM3, CST3, SLC7A9, and MYH9 genes have been associated with an increased risk of developing CKD and ESRD. Methods. A total of 160 CKD patients and 189 control subjects of Saudi origin participated in the study. Eight polymorphisms (SHROOM3-rs9992101, rs17319721; SLC7A9-rs4805834; MYH9-rs4821480, rs4821481, rs2032487, rs3752462; CST3-rs13038305) were genotyped using TaqMan assay, and the haplotype analysis was done using the HaploView 4.2 software. Results. Haplotype analysis revealed a novel haplotype “E6”-GTTT to be associated significantly with an increased risk for ESRD (p=0.0001) and CKD (p=0.03). Conclusion. CKD is often silent until symptomatic uremia during the advanced stages of the disease. The newly identified haplotype will help recognize patients at risk for a rapid progression of CKD to ESRD. Accurate detection and mapping of the genetic variants facilitates improved risk stratification and development of improved and targeted therapeutic management for CKD.

scholarly journals Posttransplant Metabolic Syndrome

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
M. Shadab Siddiqui ◽  
Richard K. Sterling
Keyword(s):  
Cardiovascular Disease ◽  
Metabolic Syndrome ◽  
Liver Disease ◽  
Liver Transplant ◽  
Cardiovascular Mortality ◽  
Early Recognition ◽  
Health Concern ◽  
Rapid Progression ◽  
Factors Associated ◽  
Increased Risk

Metabolic syndrome (MS) is a cluster of metabolic derangements associated with insulin resistance and an increased risk of cardiovascular mortality. MS has become a major health concern worldwide and is considered to be the etiology of the current epidemic of diabetes and cardiovascular disease. In addition to cardiovascular disease, the presence of MS is also closely associated with other comorbidities including nonalcoholic fatty liver disease (NAFLD). The prevalence of MS in patients with cirrhosis and end-stage liver disease is not well established and difficult to ascertain. Following liver transplant, the prevalence of MS is estimated to be 44–58%. The main factors associated with posttransplant MS are posttransplant diabetes, obesity, dyslipidemia, and hypertension. In addition to developing NAFLD, posttransplant MS is associated with increased cardiovascular mortality that is 2.5 times that of the age- and sex-matched individuals. Additionally, the presence of posttransplant MS has been associated with rapid progression to fibrosis in individuals transplanted for HCV cirrhosis. There is an urgent need for well-designed prospective studies to fully delineate the natural history and risk factors associated with posttransplant MS. Until then, early recognition, prevention, and treatment of its components are vital in improving outcomes in liver transplant recipients.

scholarly journals Infective Keratitis Following Iontophoresis-assisted Corneal Crosslinking (I-CXL): A Case Report

2021 ◽  
Vol 15 (1) ◽  
pp. 1-4
Author(s):  
Noor M. Alqudah ◽  
Hisham M. Jammal
Keyword(s):  
Clinical Examination ◽  
Comparable Efficacy ◽  
Case Description ◽  
Safety And Efficacy ◽  
Corneal Epithelial ◽  
Topical Antibiotics ◽  
Corneal Crosslinking ◽  
Negative Results ◽  
Increased Risk ◽  
The Right

Introduction: The standard corneal crosslinking (S- CXL) technique requires corneal epithelial removal, thus increasing the risk of postoperative complications. Newer technique like iontophoresis-assisted corneal crosslinking (I-CXL) with comparable efficacy as S-CXL but without the increased risk of complications associated with corneal epithelium removal is used. However, being a comparatively newer technique, the safety and efficacy of I-CXL have not been fully explored. Case Description: Here, we present a case of a 28-year-old woman who presented with infective keratitis in one eye after uneventful bilateral I-CXL for keratoconus. Two days after the procedure, the patient presented with decreased vision and pain in the right eye. Clinical examination revealed ciliary injection and central corneal rounded infiltrates measuring 3.0 mm × 3.0 mm with an overlying epithelial defect. Microbiological studies revealed negative results. Based on clinical examination, the patient was managed successfully with fortified topical antibiotics. Conclusion: To the best of our knowledge, we report the first documented case of unilateral infective keratitis following bilateral I-CXL. Ophthalmologists should monitor the possible complications post-I-CXL as it might not be as safe as we expect.

scholarly journals Pathophysiology-based subphenotyping of individuals at elevated risk for type 2 diabetes

2020 ◽  
Author(s):  
Robert Wagner ◽  
Martin Heni ◽  
Adam G. Tabak ◽  
Jürgen Machann ◽  
Fritz Schick ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Fat Distribution ◽  
Elevated Risk ◽  
Liver Fat ◽  
Oral Glucose ◽  
Rapid Progression ◽  
Increased Risk ◽  
Glucose Tolerance Tests ◽  
Definition Of

AbstractThe state of intermediate hyperglycemia is indicative of elevated risk of developing type 2 diabetes1. However, the current definition of prediabetes neither reflects subphenotypes of pathophysiology of type 2 diabetes nor is it predictive of future metabolic trajectories. We used partitioning on variables derived from oral glucose tolerance tests, MRI measured body fat distribution, liver fat content, and genetic risk in a cohort of extensively phenotyped individuals who are at increased risk for type 2 diabetes2,3 to identify six distinct clusters of subphenotypes. Three of the identified subphenotypes have increased glycemia (clusters 3, 5 and 6), but only individuals in clusters 5 and 3 have immanent diabetes risks. By contrast, those in cluster 6 have moderate risk of type 2 diabetes, but an increased risk of kidney disease and all-cause mortality. Findings were replicated in an independent cohort using simple anthropomorphic and glycemic constructs4. This proof-of-concept study demonstrates that pathophysiological heterogeneity exists before diagnosis of type 2 diabetes and highlights a group of individuals who have an increased risk of complications without rapid progression to overt type 2 diabetes.

scholarly journals Case Report: Heparin-induced thrombocytopenia during COVID-19 outbreak: the importance of scoring system in differentiating with sepsis-induced coagulopathy

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 469
Author(s):  
Louisa Fadjri Kusuma Wardhani ◽  
Ivana Purnama Dewi ◽  
Denny Suwanto ◽  
Ade Meidian Ambari ◽  
Meity Ardiana
Keyword(s):  
Scoring System ◽  
Severe Disease ◽  
Scoring Systems ◽  
Pulmonary Infiltrate ◽  
Nasopharyngeal Swab ◽  
Rapid Progression ◽  
Hypoxemic Respiratory Failure ◽  
Heparin Induced Thrombocytopenia ◽  
Heparin Administration ◽  
Increased Risk

Background: COVID-19 disease is accompanied by derangement of coagulation with a risk of fatal thromboembolic formation. COVID-19 patients are among those indicative for heparin treatment. Increased heparin administration among COVID-19 patients increased heparin induced-thrombocytopenia's risk with/without thrombocytopenia. Case presentation: We present a 71-year-old male patient who came to the emergency room (ER) with a COVID-19 clinical manifestation followed by positive PCR nasopharyngeal swab result. He was assessed to have acute respiratory distress syndrome (ARDS), as shown by rapid progression of hypoxemic respiratory failure and bilateral pulmonary infiltrate. He was then treated with moxifloxacin, remdesivir, dexamethasone, unfractionated heparin (UFH) pump, and multivitamins. During admission, his respiratory symptoms got worse, so he transferred to the ICU for NIV support. On the ninth day of admission, he had gross hematuria followed by a rapid fall of platelet count. We used two different scoring systems (4Ts and HEP scoring system) to confirm the diagnosis of heparin-induced thrombocytopenia (HIT). Following the discontinuation of UFH injection, the thrombocyte continued to rise, and hematuria disappeared. Conclusion: Heparin-induced thrombocytopenia is associated with an increased risk of severe disease and mortality among COVID-19 patients. The differential diagnosis of HIT could be difficult as thrombocytopenia can also be caused by the progression of infection. We use two scoring systems (4Ts and HEP scoring) in order to help us managing the patient. These could improve the outcomes, thus avoiding morbidity and mortality.

scholarly journals Bilateral Vocal Cord Carcinoma in a Sarcoidosis Patient during Infliximab Therapy

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Adriane D. M. Vorselaars ◽  
Elisabeth V. Sjögren ◽  
Coline H. M. van Moorsel ◽  
Jan C. Grutters
Keyword(s):  
Vocal Cord ◽  
A Priori ◽  
Tumor Development ◽  
Infliximab Therapy ◽  
Rapid Progression ◽  
Infliximab Treatment ◽  
Sarcoidosis Patient ◽  
Larynx Carcinoma ◽  
Increased Risk

Introduction. Although the role of TNF-αin tumor development is not fully understood, an increased risk of malignancy with TNF-α-inhibitors, such as infliximab, has been suggested.Case Presentation. We present a 54-year-old nonsmoking female sarcoidosis patient. After seven months of infliximab therapy a T1aN0M0 larynx carcinoma of the right vocal cord was found and excised. Within a year, whilst still on treatment, a second larynx carcinoma of the opposite vocal cord appeared.Discussion. A bilateral vocal cord tumor is rare, especially in a never smoker. Evidence on the role of infliximab in carcinogenesis is inconclusive. To date, there are no follow-up studies evaluating malignancy risk of infliximab therapy in sarcoidosis patients. No studies in other diseases focus on laryngeal carcinomas during infliximab use. We argue that infliximab treatment might have attributed to the rapid progression of vocal cord carcinomas in this patient with an a priori low risk tumor profile. This case illustrates that caution remains warranted in patients with previous malignancies when considering initiation of TNF-α-inhibitors.

scholarly journals Human Cadaveric Donor Cornea Derived Extra Cellular Matrix Microparticles for Minimally Invasive Healing/Regeneration of Corneal Wounds

Biomolecules ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 532
Author(s):  
Arun Chandru ◽  
Parinita Agrawal ◽  
Sanjay Kumar Ojha ◽  
Kamalnath Selvakumar ◽  
Vaishnavi K. Shiva ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Tissue Repair ◽  
Rabbit Model ◽  
Human Cornea ◽  
Corneal Epithelial ◽  
Native Tissue ◽  
Ecm Proteins ◽  
Stromal Tissue

Biological materials derived from extracellular matrix (ECM) proteins have garnered interest as their composition is very similar to that of native tissue. Herein, we report the use of human cornea derived decellularized ECM (dECM) microparticles dispersed in human fibrin sealant as an accessible therapeutic alternative for corneal anterior stromal reconstruction. dECM microparticles had good particle size distribution (≤10 µm) and retained the majority of corneal ECM components found in native tissue. Fibrin–dECM hydrogels exhibited compressive modulus of 70.83 ± 9.17 kPa matching that of native tissue, maximum burst pressure of 34.3 ± 3.7 kPa, and demonstrated a short crosslinking time of ~17 min. The fibrin–dECM hydrogels were found to be biodegradable, cytocompatible, non-mutagenic, non-sensitive, non-irritant, and supported the growth and maintained the phenotype of encapsulated human corneal stem cells (hCSCs) in vitro. In a rabbit model of anterior lamellar keratectomy, fibrin–dECM bio-adhesives promoted corneal re-epithelialization within 14 days, induced stromal tissue repair, and displayed integration with corneal tissues in vivo. Overall, our results suggest that the incorporation of cornea tissue-derived ECM microparticles in fibrin hydrogels is non-toxic, safe, and shows tremendous promise as a minimally invasive therapeutic approach for the treatment of superficial corneal epithelial wounds and anterior stromal injuries.

scholarly journals Lethal disseminated tuberculosis in patients under biological treatment – two clinical cases and a short review

2018 ◽  
Vol 46 (7) ◽  
pp. 2961-2969 ◽  
Author(s):  
Elena Dantes ◽  
Doina Ecaterina Tofolean ◽  
Ariadna Petronela Fildan ◽  
Liviu Craciun ◽  
Elena Dumea ◽  
...  
Keyword(s):  
Biological Treatment ◽  
Biological Therapy ◽  
Opportunistic Infections ◽  
Short Review ◽  
Rapid Progression ◽  
Disseminated Tuberculosis ◽  
Increased Risk ◽  
Tnf Α ◽  
Bowel Diseases ◽  
Inflammatory Bowel

Tumour necrosis factor (TNF)-α inhibitors are highly used in Romania for the treatment of autoimmune disorders, such as rheumatoid arthritis (RA), psoriasis, inflammatory bowel diseases, and ankylosing spondylitis. Biological therapy using TNF-α inhibitors is very effective but is associated with an increased risk of opportunistic infections, including active tuberculosis. Here, two cases are presented of patients with RA and psoriasis under biological therapy who developed very aggressive forms of disseminated tuberculosis, with a rapid progression to death. The authors conclude that patients undergoing biological therapy require thorough evaluation prior to initiating treatment, followed by continuous and rigorous monitoring by a multidisciplinary team during biological treatment, particularly in countries with a high incidence of tuberculosis.

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