scholarly journals Treatment outcomes of acute poptoperative infectious endophthalmitis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kai-Ling Peng ◽  
Ya-Hsin Kung ◽  
Hui-Shuang Tsai ◽  
Tsung-Tien Wu

Abstract Background Acute postoperative endophthalmitis is one of the most severe complications of modern ophthalmic procedures including cataract surgeries, vitrectomy and intravitreal injection (IVI). We evaluated the treatment outcomes of acute postoperative infectious endophthalmitis. Methods In this retrospective study, we collected data from 82 patients with acute infectious endophthalmitis within 6 weeks after intraocular surgeries, including cataract surgeries, vitreoretinal surgeries, and IVI, from January 2010 to December 2019. We analyzed the pre-treatment, treatment-related and post-treatment factors that affected visual outcomes. Results The mean age was 67.65 ± 9.52 years, the proportion of male patients was 56.1%. The mean baseline vision was 1.92 (Snellen Equivalent SE], counting finger [CF]) ± 0.54 logarithm of the minimum angle of resolution (log MAR) and the mean final vision was 0.71 (SE, 39/200) ± 0.80 logMAR. Visual improvement was significant (P < 0.001). The pre-treatment factors affecting final visual outcomes were diabetes, hemodialysis, baseline vision, signs of vitreous opacity, and different surgeries before endophthalmitis; the treatment-related factors affecting visual outcomes were the choice factors between IVI of antibiotics alone and vitrectomy combined with IVI of antibiotics, and the injection numbers of antibiotics; post-treatment factors affecting visual outcomes were complications such as retinal detachment (RD), glaucoma and macular pucker. Furthermore, prior cataract surgery was associated with a better mean final vision of 0.57 (SE, 54/200) ± 0.67 logMAR while prior vitrectomy resulted in the worst mean final vision of 1.38 (SE, 21/500) ± 0.75 logMAR. Conclusions The important factors that affected the final visual prognosis, included diabetes, hemodialysis, baseline vision, severity of vitritis, treatment strategies and complications. The treatment outcomes revealed better final vision in prior cataract surgery than vitrectomy.

2021 ◽  
Vol 62 (11) ◽  
pp. 1539-1546
Author(s):  
Sang Wook Lee ◽  
Eun Hye Jung

Purpose: To compare the stereoacuity between patients with anisometropic amblyopia who were treated and achieved normal visual acuity (VA) and normal children and evaluate the factors associated with stereoacuity.Methods: We retrospectively reviewed the records of 37 pediatric patients with anisometropic amblyopia who recovered to normal VA with glasses and occlusion treatment (amblyopia group) and 34 normal children (control group). The Worth 4-dot test, Lang II test, Titmus test, and TNO test were performed to measure stereoacuity. Clinical characteristics were compared between the two groups, and factors affecting stereoacuity outcomes were also analyzed in the amblyopic group.Results: The mean age at diagnosis of amblyopia was 5.3 ± 1.4 years, and the mean VAs at diagnosis were 0.41 ± 0.24 and 0.06 ± 0.07 in amblyopic and fellow eyes, respectively. The mean duration of occlusion was 19.00 ± 9.44 months, and VA of amblyopic eyes improved to 0.04 ± 0.04 after occlusion treatment. The patient characteristics did not differ significantly between the two groups, except for the final VA of the amblyopic eye. The final mean logarithm of minimal angle of resolution VA of the amblyopic eye in the amblyopia group was significantly worse than that in the control group. The number of patients with normal stereoacuity was significantly lower in the amblyopia group than in the control group on Lang II, Titmus, and TNO tests. Factors associated with poor stereoacuity were severe amblyopia in the Lang II test and poor post-treatment VA of the amblyopic eye in the Titmus test.Conclusions: Stereoacuity was worse in the amblyopia group than in the control group, despite normal visual development. The depth of amblyopia and post-treatment VA were associated with stereoacuity outcomes. Thus, VA improvement should be closely monitored in the amblyopic eye to obtain good stereoacuity.


2020 ◽  
pp. 112067212096345
Author(s):  
Marco Lupidi ◽  
Ramkailash Gujar ◽  
Alessio Cerquaglia ◽  
Jay Chhablani ◽  
Daniela Fruttini ◽  
...  

Purpose: To quantitatively assess retinal neovascularizations (RNVs) in proliferative diabetic retinopathy (PDR) before and after photocoagulative laser treatment (PLT) using Optical Coherence Tomography Angiography (OCT-A). Methods: Consecutive patients with PDR were examined with fluorescein angiography (FA) and OCT-A before and after PLT. Baseline and after-treatment FA images were quantitatively analyzed to assess both the RNVs area and leakage area. On OCT-A RNVs area, vascular perfusion density (VPD), vessel length density (VLD) and fractal dimension were computed. VPD of the full-retina OCT-A underneath the RNV was determined to evaluate potential laser-induced changes in vascular perfusion. Results: Fifteen eyes of 13 patients with PDR were enrolled. The mean area of the RNVs was 0.47 ± 0.50 mm2 in the baseline OCT-A and 0.32 ± 0.40 mm2 in the post-treatment assessment ( p = 0.0002). The mean RNV VPD of RNV was 2% ± 4% in pre-treatment and 1% ± 1% for the post-treatment ( p = 0.0001). The mean VLD of RNV was 7.26 ± 1.53 at baseline and 6.64 ± 1.65 in the post treatment ( p = 0.0002). A significant difference in terms of mean RNVs area and VPD reduction between eyes that needed additional treatment and those that did not (~40% vs ~20%; p < 0.05), was observed. Mean VPD of full-retinal thickness OCT-angiogram was 55% ± 10% for the pre-treatment and 53% ± 8% for the post treatment scan ( p = 0.02). Conclusion: The quantitative OCT-A assessment of laser-induced changes of RNVs can be a useful non-invasive approach for determining treatment efficacy. A reduction of RNVs area or VPD ⩾ 40% might reveal those eyes that won’t require additional treatment. Retinal perfusion impairment seemed to progress independently from the treatment.


1971 ◽  
Vol 16 (4) ◽  
pp. 224-227 ◽  
Author(s):  
A. Balfour Sclare ◽  
J. K. Grant

A longitudinal study of urinary 17-OHCS in 16 depressive patients showed mean values within the accepted normal range. There were no significant differences between pre-treatment and post-treatment values; only the female patients showed a tendency to have somewhat lower post-treatment levels. 17-KS output was measured in 18 depressive patients. The mean values were within the normal range. There was no significant difference between pre-treatment and post-treatment values although the female patients displayed a tendency towards somewhat lower levels following treatment. DHA and EA excretion were measured in 9 depressive patients. There was a very wide variance in the findings. There was no significant difference between pre-treatment and post-treatment levels. The significance of the above findings is discussed. It is considered that measurements of urinary excretion of corticosteroids in affective disorders constitute a limited source of information.


2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jae Hui Kim ◽  
Joo Yeon Kim ◽  
Dong Won Lee ◽  
Chul Gu Kim ◽  
Jong Woo Kim

Abstract To evaluate the influence of fibrovascular pigment epithelial detachment (FVPED) on treatment outcomes in eyes with subretinal hemorrhage secondary to neovascular age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV). This retrospective study included 83 eyes diagnosed with fovea-involving submacular hemorrhage secondary to neovascular AMD or PCV. All the patients were treated with intravitreal anti-vascular endothelial growth factor. Eyes showing definite FVPED, which involves the subfoveal region, were included in the FVPED group. Eyes without subfoveal PED, shallow irregular PEDs, or serous/hemorrhagic PED were stratified to the non-FVPED group. The best-corrected visual acuity (BCVA) at diagnosis, at 3 months, at 12 months, and lesion re-activation after initial treatment were compared between the two groups. The mean size of hemorrhage was 8.6 ± 7.6 disc diameter areas. In the FVPED group, the mean logarithm of minimal angle of resolution BCVA was 1.11 ± 0.49 at diagnosis, 0.89 ± 0.58 at 3 months, and 1.05 ± 0.63 at 12 months. In the non-FVPED group, the values were 0.97 ± 0.56, 0.56 ± 0.55, and 0.45 ± 0.50, respectively. The BCVA at 3 months (P = 0.036) and at 12 months (P < 0.001) was significantly worse in the FVPED group than in the non-FVPED group. In addition, the incidence of lesion reactivation was greater in the FVPED group (83.3%) than in the non-FVPED group (38.5%) (P < 0.001). The presence of subfoveal FVPED was associated with a high incidence of lesion re-activation and poor treatment outcomes in eyes with subretinal hemorrhage. This result suggests that different treatment strategies are needed between eyes with and without FVPED.


2020 ◽  
Author(s):  
Chin Loon Ong ◽  
Niccolò Giaj Levra ◽  
Luca Nicosia ◽  
Vanessa Figlia ◽  
Davide Tomasini ◽  
...  

Abstract BACKGROUND:Immobilization devices are crucial to minimize patient positioning uncertainties in radiotherapy (RT) treatments. Accurate inter and intra-fraction motions is particularly important for intracranial and stereotactic radiation treatment which require high precision in dose delivery. Recently, a new immobilization device has been developed specifically for the radiation treatment of intracranial malignancies. To date, no data are available on the use of this device in daily clinical practice. The aim of this study is to investigate the intra and inter-fraction variations, patient comfort and radiographer confidence of the immobilization system from two distinct institutions: HagaZiekenhuis, Den Haag, Netherlands and IRCCS Ospedale Sacro Cuore Don Calabria, Negrar, Italy. MATERIAL AND METHOD:Sixteen patients (10 diagnosed with brain metastases and 6 with primary central nervous systemic tumor) from IRCCS Ospedale Sacro Cuore Don Calabria and 17 patients (all diagnosed with brain metastases tumor) from HagaZiekenhuis were included in this study. The median target volume was 436 cc (range 3.2-1628 cc) and 4.58cc (range 0.4-27.19cc) for IRCCS and Haga, respectively. For patients treated in IRCCS Sacro Cuore Don Calabria, the median dose prescription was 30 Gy (range 27-60 Gy) and median number of fractions 10 (range 3-30). In Haga the median dose prescription was 21 Gy (range 8-21 Gy) and the median number of fraction was 1 (range 1-3). The immobilization device was assembled during CT simulation. A short interview to the patient regarding the device’s comfort level was conducted at the end of the simulation procedure. Additionally, simulation setup time and radiographer (RTT) procedures (i.e. mask preparation) were evaluated. Prior to radiation treatment delivery, an automatic rigid match on the cranial bones between cone beam computed tomography (CBCT) and planning-CT was performed. A couch shift was performed subsequently. An extra post-treatment CBCT was acquire after the treatment delivery. This post-treatment CBCT was matched with pre-treatment CBCT to identify any possible intra-fraction motion. All online matches were validated by experienced radiation oncologist or RTT. A total of 126 CBCT’s were analyzed offline by radiation oncologist/medical physicist. The data of the pre-treatment CBCT match was used to quantify inter-fraction motion. The post-treatment CBCT was matched with pre-treatment CBCT to identify any possible intra-fraction motion.RESULTS:During the molding of the mask, all patients responded positive to the comfort. Median time required by the RTTs to assemble the immobilization system was 9 minutes (range 6-12 minutes). In terms of comfort, all patients reported a good-to high level of satisfaction. The RTTs also respond positively towards the use of the locking mechanism and clips. Results of positioning uncertainties were comparable between the two institutes. The mean inter-fraction motion for all translational and rotational directions were <2mm (SD <4mm) and <0.5°(SD < 1.5°), respectively, while the mean intra-fraction motions were <0.4mm (SD < 0.6mm) and 0.3° (SD < 0.5°).CONCLUSIONS:This study demonstrates the efficacy and feasibility of the immobilization device in the intracranial radiation treatment. Both patient comfort and preparation time by RTTs are considered adequate. In combination with online daily imaging procedure, this device can achieve submillimeter accuracy required for intracranial and stereotactic treatments.


Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2867-2867
Author(s):  
Colleen T. Morton ◽  
David J Dries ◽  
Fatima Khan

Abstract Major bleeding among patients receiving oral anticoagulants is common and is reported to occur in up to 6.5% of patients per year. Vitamin K antagonists (VKA) remain the most frequently prescribed class of anticoagulants for conditions such as atrial fibrillation, mechanical heart valves and venous thromboembolism. The products used for the reversal of VKA-associated coagulopathy include Vitamin K, fresh frozen plasma (FFP), activated recombinant factor VII (rFVIIa), and Prothrombin Complex Concentrates (PCC). Kcentra® (CSL Behring Gmbh, Marburg, Germany) is a 4-factor PCC that contains all of the vitamin K-dependent proteins (Factors II,VII, IX, X, Protein C and S). While Kcentra® has been in use in Europe and other parts of the world for several years, it was only recently approved in the United States for warfarin reversal during acute major bleeding (April, 2013) or when there is a need for an urgent invasive procedure (December 2013). We conducted a retrospective study to evaluate the use of 4-factor PCC in a community-based tertiary care center. The efficacy and safety of PCCs has been established in large multi-center trials. However, there is limited data from outside of carefully conducted clinical trials. In particular, there is a paucity of data regarding the use of 4-factor PCC in the community setting, specifically from the United States. We developed protocols for the reversal of warfarin for life-threatening bleeding and emergent surgery. All patients get vitamin K and they receive Kcentra® if the INR is ≥ 2. If the INR is < 2 they receive plasma. The dose of Kcentra® is based on pre-treatment INR (25 u/kg for INR 2 to < 4, 35 u/kg for INR 4-6 and 50 u/kg for INR >6). We identified 33 patients from July 2013 to April 2014 that were treated with 4-factor PCC (18 males and 15 females). The mean age was 71.06 +/- 14.04 years (Range 42-94). Kcentra® was used appropriately, per our institutional protocol for VKA reversal, in 28/33 (84.35%) cases. Four of the patients, who were treated inappropriately, did not have a drug history on admission and were subsequently found to have an elevated INR due to liver dysfunction. The leading indications for PCC use were intracranial hemorrhage (49%), reversal of elevated INR prior to surgery (21%) and gastrointestinal bleeding (15%). 73% of patients had a pre-reversal INR in the range of 2-4, 12% had INR of 4-6 and15% of patients presented with an INR of >6. The indications for warfarin use included atrial fibrillation (50% patients), prosthetic valve (21.4%) and prior deep vein thrombosis and pulmonary embolism in 18% patients. 40% patients were also receiving concomitant antiplatelet therapy. The mean administered dose of Kcentra® was 2461 +/- 825 units (Range 1375-4715). Among patient treated for reversal of VKA-related coagulopathy, the pre-treatment INR was 4.6 (range 2-17) and mean post-treatment INR was 1.32 (range 1.1-1.9). Post-treatment INR of ≤ 1.5 was attained in 24/33 (73%) patients. Post-treatment INR was not available for one patient. There was only one case of thrombosis within 72 hours of treatment (myocardial infarction). 28/33 patients (85%) were alive at 24 hours. Based on experience from our limited number of patients, we have found Kcentra® to be effective in the rapid reversal of INR in the setting of VKA associated coagulopathy. Kcentra® was successfully used for a wide variety of indications in our patient population. Arterial and venous thromboembolic complications have previously been reported in patients receiving 4-factor PCC. We found a low complication rate in our patients with only one patient developing a thrombotic phenomenon (acute coronary event) within 72 hours of administration of Kcentra®. In conclusion, based on our experience, we have found Kcentra® to be a safe and effective agent for reversal of VKA associated coagulopathy. Disclosures No relevant conflicts of interest to declare.


2019 ◽  
Vol 17 ◽  
pp. 205873921984783 ◽  
Author(s):  
Haicheng Wang ◽  
Zhengfang Zhang ◽  
Jiali Sun

This study was designed to analyze the effects of atorvastatin on microcirculation, blood lipids, inflammatory factors, and characteristic markers in patients with diabetic nephropathy. A total of 170 patients with diabetic nephropathy randomly divided into control and study groups with 85 patients in each group. The control group was treated with diet and lifestyle intervention, and hypoglycemic drugs. The study group was additionally treated with atorvastatin. Nitric oxide (NO), endothelin-1 (ET-1), thromboxane-2 (TXB2), 6-ketone-prostaglandin F-1α (6-Keto-PGF-1α), superoxide dismutase (SOD), total cholesterol (TC), triacylglycerols (TGs), low-density lipoprotein (LDL), high-density lipoprotein (HDL), C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin-6 (IL-6), homocysteine (Hcy), cystatin C (CysC), and vascular endothelial growth factor (VEGF) levels were observed for 8 weeks. Post-treatment of atorvastatin, the levels of NO, 6-Keto-PGF-1α, and SOD were significantly higher than pre-treatment in both groups, while the levels of ET-1 and TXB2 were lower than pre-treatment ( P < 0.05). The levels of NO, 6-Keto-PGF-1α, and SOD in the study group post-treatment were significantly higher ( P < 0.05) than the control group, and the levels of ET-1 and TXB2 in the study group were lower than the control group. After 8 weeks, the levels of TC, TG, and LDL were significantly lower, while the level of HDL was significantly higher in the study group. The level of TC was lower in the control group of post-treatment, while the HDL level was higher than pre-treatment ( P < 0.05). The levels of CRP, TNF-α, and IL-6 in the study group of post-treatment were significantly lower than pre-treatment comparing to the control group ( P < 0.05). There was no statistical significance ( P > 0.05) for above-mentioned indicators in control groups of pre- and post-treatment. The levels of VEGF, CysC, and Hcy in the two groups were lower than pre-treatment. Atorvastatin could effectively improve all the study parameters.


2021 ◽  
Vol 68 (1) ◽  
pp. 92-96
Author(s):  
Dena Autry

Mosquito Control programs are utilizing cost-effective long term autocidal gravid traps because they minimize labor needs while targeting the gravid population of container-breeding mosquitoes. This field study compared the efficacy of the In2Care Mosquito Trap and the Centers for Disease Control and Prevention autocidal gravid ovitrap (CDC-AGO). The study consisted of two control and two treatment sites, and each treatment site had either 100 In2Care Mosquito Traps or 100 CDC-AGOs. Aedes aegypti populations in each site were monitored using Biogent (BG) Sentinel 2 mosquito traps and ovitraps. Analysis of pre- and post-treatment data indicated no significant difference in adult mosquito populations detected by BG traps from either the In2Care or CDC-AGO sites. However, the mean number of eggs collected by ovitraps showed significant reduction in both trap type treated areas posttreatment, compared to pre-treatment. Furthermore, the mean number of egg collections from the In2Care mosquito trap treated area was much less than the collection from the CDC-AGO trap treated area post-treatment.


2019 ◽  
Vol 30 (2) ◽  
pp. 187-192
Author(s):  
Ross Harrison ◽  
Hui Zhao ◽  
Charlotte C Sun ◽  
Shuangshuang Fu ◽  
Shannon D Armbruster ◽  
...  

IntroductionSome experts have argued that obesity-related malignancies such as endometrial cancer are a “teachable moment” that lead to meaningful changes in health behaviors. It is unclear if endometrial cancer survivors lose weight following treatment. Our goal with this investigation was to evaluate post-treatment changes in body mass index (BMI) and attitudes towards health behaviors in endometrial cancer survivors.MethodsIncident endometrial cancer cases undergoing surgery between 2009–2015 were identified in the Marketscan Commercial database and linked with BMI data and health behavior questionnaires from the Marketscan Health Risk Assessment database. Patients were excluded for insufficient BMI data. Standard statistical methods, including the two-sample Wilcoxon rank sum test, χ2 test, and McNemar’s test, were used.Results655 patients with a median age of 54 (IQR 49-58) were identified and analyzed. Median duration of follow-up was 595 days (IQR 360–1091). Mean pre- and post-treatment BMI was 35.5 kg/m2 (median 35.0; IQR 27.0–42.3) and 35.6 kg/m2 (median 34.3; IQR 28.0–42.0), respectively. Median BMI change in the entire cohort was 0 kg/m2 (IQR −1.0 to 2.0). Weight gain (n=302; 46.1%) or no change in weight (n=106; 16.2%) was seen in most patients. Among the 302 patients who gained weight, the mean pre-treatment BMI was 34.0 kg/m2 and mean increase was 2.8 kg/m2 (median 2.0; IQR 1.0–3.4). Among the 247 cases who lost weight, the mean pre-treatment BMI was 38.6 kg/m2 and mean decrease was 3.2 kg/m2 (median 2.0; IQR 1.0–4.0). No pre- to post-treatment differences were observed in health behavior questionnaires regarding intention to better manage their diet, exercise more, or lose weight.DiscussionMost endometrial cancer survivors gain weight or maintain the same weight following treatment. No post-treatment changes in attitudes regarding weight-related behaviors were observed. The systematic delivery of evidence-based weight loss interventions should be a priority for survivors of endometrial cancer.


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