Outcomes of Patients With Acute Vogt–koyanagi–harada Disease Treated With Intravenous Corticosteroid Pulse Followed by the Slow Tapering of Oral Corticosteroid Therapy

Abstract Purpose We investigated the treatment outcomes of patients with acute Vogt–Koyanagi–Harada (VKH) disease and assessed the differences between patients with no inflammation worsening and those with persistent or worsening inflammation. Potential factors responsible for eyes with low visual outcomes were also investigated.Methods We retrospectively reviewed the clinical records of patients with acute VKH disease who first visited us between 2009 and 2018 and were followed up for >300 days. Clinical characteristics, treatments, and posttreatment conditions were assessed. Patients were classified into no inflammation worsening (acute–resolved [AR]) and inflammation worsening (chronic–recurrent [CR]) groups based on conditions after 6 months from disease onset.Results This study assessed 62 eyes from 31 patients (mean age: 52.8 years). One patient was treated with topical treatment alone and showed poor visual outcomes. In total, 30 patients were treated with methylprednisolone pulse followed by the slow tapering of oral prednisolone; 73% of them developed AR and 27% CR. Although the total prednisolone dose was higher in patients with CR disease, no significant difference was noted in the final best-corrected visual acuity (BCVA). Among the patients receiving systemic steroid, five eyes had a final BCVA of ≤0.5 due to anisometropic amblyopia, diabetic maculopathy, pre-existing macular hole, epiretinal membrane, and ellipsoid zone loss. Conclusions Patients with acute VKH disease treated with corticosteroid pulse followed by the slow tapering of prednisolone appear to demonstrate good visual outcomes, including patients with CR; most eyes with low visual outcomes have pre-existing conditions that explain low vision.

Download Full-text

Clinical features and visual outcomes of 111 patients with new-onset acute Vogt-Koyanagi-Harada disease treated with pulse intravenous corticosteroids

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-311691 ◽

2018 ◽

Vol 103 (2) ◽

pp. 274-278 ◽

Cited By ~ 9

Author(s):

Makiko Nakayama ◽

Hiroshi Keino ◽

Takayo Watanabe ◽

Annabelle A Okada

Keyword(s):

Clinical Features ◽

Serous Retinal Detachment ◽

Corticosteroid Treatment ◽

Japanese Patients ◽

Systemic Complications ◽

Visual Outcomes ◽

Number Of Patients ◽

Clinical Records ◽

Vkh Disease ◽

New Onset

PurposeTo describe the clinical features, treatment and visual outcomes of Japanese patients with new-onset acute Vogt-Koyanagi-Harada (VKH) disease.MethodsClinical records of 111 patients who presented between 1999 and 2015 to the Ocular Inflammation Service of the Kyorin Eye Center, Tokyo, were reviewed.ResultsOf the 111 patients (68 women, 43 men), 16 had complete, 90 had incomplete and 5 had probable VKH disease. The median follow-up period was 36 months (4–175 months). The mean age at presentation was 41 years (19–74 years). Serous retinal detachment (202 eyes) and optic disc hyperaemia (89 eyes) were observed at presentation. Of the patients tested, 45/48 (93.8%) were human leucocyte antigen-DR4 positive and 63/77 (81.8%) had cerebrospinal fluid pleocytosis. Initial corticosteroid treatment consisted of pulse intravenous therapy in all patients. Sunset glow fundus was observed in 49.5% of eyes, and anterior and/or posterior segment recurrence of inflammation was observed in 25 patients (22.5%). Treatment was transitioned to cyclosporine in 17 patients (15.3%) for steroid sparing (6 patients) or recurrent inflammation (11 patients), with good subsequent control. Ocular complications were observed in 47 of 222 eyes (21.2%) (mostly cataract), and systemic complications were observed in 8.1% of patients (mostly hypertension and diabetes mellitus). Ninety-three percent of eyes (167 of 178 eyes) had a visual acuity of ≥1.0 at 1 year after presentation.ConclusionsAn aggressive corticosteroid treatment strategy in a large number of patients with new-onset acute VKH disease, with transitioning to cyclosporine in selected cases, resulted in excellent visual outcomes and low rates of recurrence.

Download Full-text

Implicit and explicit corrective feedback and feedback exposure conditions

Instructed Second Language Acquisition ◽

10.1558/isla.38113 ◽

2020 ◽

Vol 4 (1) ◽

pp. 3-48

Author(s):

Takehiro Iizuka ◽

Kimi Nakatsukasa

Keyword(s):

Explicit Knowledge ◽

Corrective Feedback ◽

Significant Difference ◽

Oral Corrective Feedback ◽

Post Test ◽

Picture Description ◽

Potential Factors ◽

Implicit And Explicit ◽

Instructional Settings ◽

The Impact

This exploratory study examined the impact of implicit and explicit oral corrective feedback (CF) on the development of implicit and explicit knowledge of Japanese locative particles (activity de, movement ni and location ni) for those who directly received CF and those who observed CF in the classroom. Thirty-six college students in a beginning Japanese language course received either recast (implicit), metalinguistic (explicit) or no feedback during an information-gap picture description activity, and completed a timed picture description test (implicit knowledge) and an untimed grammaticality judgement test (explicit knowledge) in a pre-test, immediate post-test and delayed post-test. The results showed that overall there was no significant difference between CF types, and that CF benefited direct and indirect recipients similarly. Potential factors that might influence the effectiveness of CF, such as instructional settings, complexity of target structures and pedagogy styles, are discussed.

Download Full-text

Cohort study of the overall survival of patients with pancreatic cancer in a hospital of specialties of Quito-Ecuador in the period 2007–2017

Innovative Surgical Sciences ◽

10.1515/iss-2020-0030 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Andrés Moreno Roca ◽

Luciana Armijos Acurio ◽

Ruth Jimbo Sotomayor ◽

Carlos Céspedes Rivadeneira ◽

Carlos Rosero Reyes ◽

...

Keyword(s):

Pancreatic Cancer ◽

Cohort Study ◽

Survival Time ◽

Univariate Analysis ◽

Rank Test ◽

Kaplan Meier ◽

Significant Difference ◽

Icd 10 ◽

The Difference ◽

Clinical Records

Abstract Objectives Pancreatic cancers in most patients in Ecuador are diagnosed at an advanced stage of the disease, which is associated with lower survival. To determine the characteristics and global survival of pancreatic cancer patients in a social security hospital in Ecuador between 2007 and 2017. Methods A retrospective cohort study and a survival analysis were performed using all the available data in the electronic clinical records of patients with a diagnosis of pancreatic cancer in a Hospital of Specialties of Quito-Ecuador between 2007 and 2017. The included patients were those coded according to the ICD 10 between C25.0 and C25.9. Our univariate analysis calculated frequencies, measures of central tendency and dispersion. Through the Kaplan-Meier method we estimated the median time of survival and analyzed the difference in survival time among the different categories of our included variables. These differences were shown through the log rank test. Results A total of 357 patients diagnosed with pancreatic cancer between 2007 and 2017 were included in the study. More than two-thirds (69.9%) of the patients were diagnosed in late stages of the disease. The median survival time for all patients was of 4 months (P25: 2, P75: 8). Conclusions The statistically significant difference of survival time between types of treatment is the most relevant finding in this study, when comparing to all other types of treatments.

Download Full-text

Prophylactic temporary abdominal aortic balloon occlusion for patients with pernicious placenta previa: a retrospective study

BMC Anesthesiology ◽

10.1186/s12871-021-01354-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fei Huo ◽

Hansheng Liang ◽

Yi Feng

Keyword(s):

Placenta Previa ◽

Balloon Occlusion ◽

Artery Embolism ◽

Abdominal Aortic ◽

Significant Difference ◽

Group A ◽

Group B ◽

Clinical Records ◽

Group D ◽

Central Placenta Previa

Abstract Background Pernicious placenta previa (PPP) can increase the risk of perioperative complications. During caesarean section in patients with adherent placenta, intraoperative blood loss, hysterectomy rate and transfusion could be reduced by interventional methods. Our study aimed to investigate the influence of maternal hemodynamics control and neonatal outcomes of prophylactic temporary abdominal aortic balloon (PTAAB) occlusion for patients with pernicious placenta previa. Methods This was a retrospective study using data from the Peking University People’s Hospital from January 2014 through January 2020. Clinical records of pregnant women undergoing cesarean section were collected. Patients were divided into two groups: treatment with PTAAB placement (group A) and no balloon placement (group B). Group A was further broken down into two groups: prophylactic placement (Group C) and balloon occlusion (group D). Results Clinical records of 33 cases from 5205 pregnant women underwent cesarean section were collected. The number of groups A, B, C, and D were 17, 16, 5 and 12.We found that a significant difference in the post-operative uterine artery embolism rates between group A and group B (0% vs.31.3%, p = 0.018). There was a significant difference in the Apgar scores at first minute between group A and group B (8.94 ± 1.43 vs 9.81 ± 0.75,p = 0.037),and the same significant difference between two groups in the pre-operative central placenta previa (29.4% vs. 0%,p = 0.044), complete placenta previa (58.8% vs 18.8%, p = 0.032),placenta implantation (76.5% vs 31.3%, p = 0.015). We could also observe the significant difference in the amount of blood cell (2.80 ± 2.68vs.10.66 ± 11.97, p = 0.038) and blood plasma transfusion (280.00 ± 268.32 vs. 1033.33 ± 1098.20, p = 0.044) between group C and group D. The significant differences in the preoperative vaginal bleeding conditions (0% vs 75%, p = 0.009), the intraoperative application rates of vasopressors (0% vs. 58.3%, p = 0.044) and the postoperative ICU (intensive care unit) admission rates (0% vs. 58.3%, p = 0.044) were also kept. Conclusions PTAAB occlusion could be useful in reducing the rate of post-operative uterine artery embolism and the amount of transfusion, and be useful in coping with patients with preoperative vaginal bleeding conditions, so as to reduce the rate of intraoperative applications of vasopressors and the postoperative ICU (intensive care unit) admission. In PPP patients with placenta implantation, central placenta previa and complete placenta previa, we advocate the utilization of prophylactic temporary abdominal aortic balloon placement.

Download Full-text

Effects of Line Spacing on Reading Performance of Normally Sighted and Simulated Visually-Impaired Subjects: A Pilot Study Using Arabic Words

Global Journal of Health Science ◽

10.5539/gjhs.v9n8p84 ◽

2017 ◽

Vol 9 (8) ◽

pp. 84

Author(s):

Abdullah Z. Alotaibi

Keyword(s):

Visually Impaired ◽

Low Vision ◽

Reading Rate ◽

Reading Performance ◽

White Background ◽

Significant Difference ◽

Line Spacing ◽

The Difference ◽

Letter Size ◽

Visually Impaired Persons

The study aims to evaluate the role of line spacing during reading in normal and visually-impaired persons. A total of 225 normally-sighted participants with mean age of 23.7 years were asked to read Arabic sentences in a randomized order. Each Arabic sentence contains 7 lines with and without simulated cataract. The words were printed with black letters on white background to enhance contrast and fonts were in Times New Roman and of N12 letter size. The reading pages were placed on reading stand situated 25 cm away from the subject’s eyes. The simulated cataract was created by using a Bernell Cling Patch Occluder. This reduced the visual acuity of all subjects to 20/60. Each line of the text was separated by different line spacing namely: single space, 1.5, 2.0, 2.5, 3.0 and 4.0 which represents, 0.5 cm, 0.8 cm, 1.1 cm, 1.4 cm, 1.7 cm and 2.0 cm, respectively. The sheets were presented randomly and participants’ voices were recorded as they read under a controlled time. The tape was analysed later and reading rate was calculated. There was a significant difference (p<0.0001) in reading rates between the normal sighted persons and the visually impaired persons for all line spacing. Modifying the spacing between lines in prints had a significant impact (p<0.0001) on the reading rate of the visually impaired but not in normally-sighted persons (p˃0.05). Intermediate line spacing (2 and 2.5) increased the reading rate of the visually impaired persons significantly more (p<0.001) than other line spacing, but smaller or larger line spacing slowed their reading rate, significantly (p<0.001). The visually-impaired persons reported that they felt the difference in reading prints with larger line spacing as compared with normal sighted participants who did not. It is beneficial to adequately modify the line spacing in prints commonly read by low vision persons. For Arab subjects the optimum line spacing to significantly improve reading in the visually impaired should range from 0.8 to 1.1 cm. This finding may be a useful for publishers of Arab prints targeting the visually impaired persons. Thus, the implication of the study in the field of health is that by establishing the least common line spacing visualized optimally among normal and simulated visually impaired persons would be fixed as default line spacing for Arab printing to achieve better reading performance.

Download Full-text

Direct and Indirect Costs Associated With Non-invasive Treatments in Obesity and Overweight Patients

10.21203/rs.3.rs-251166/v1 ◽

2021 ◽

Author(s):

Saman Maaroufi ◽

Mina Golestani ◽

Mohammad Alizadeh ◽

Ali Imani ◽

Koustuv Dalal

Keyword(s):

Public Health Problem ◽

Indirect Costs ◽

Medical Costs ◽

Herbal Remedies ◽

Direct And Indirect Costs ◽

Non Invasive ◽

Basic Diet ◽

Obesity And Overweight ◽

Significant Difference ◽

Clinical Records

Abstract Background: Obesity and overweight are a global public health problem causing several chronic diseases which can lead to various degrees of morbidity and mortality. These medical conditions cause economic costs and complications. The purpose of the present study to estimate the direct and indirect costs incurred by obese and overweight patients with non-invasive treatments in Tabriz, north-western Iran.Methods: The number of 247 patients were studied by cross-sectional approach and used cost of illness's prevalence approach assessing the total costs (direct and indirect) of obesity and overweight through interview and assessing relevant clinical records. The study conducted over three months from December 2018 to February 2019 in Tabriz, capital of East Azerbaijan province, Iran. Direct costs included hospitalization, para-clinical medications and outpatient visits for treatment of obesity and overweight. Loss of productivity, days of restricted activity and days in bed, cost of wasting time, transportation costs and nursing expenditure were estimated as indirect costs in the present study. For estimating direct and indirect costs, we used the bottom-up costing approach. The foreign exchange rate used in the analysis was 42000 Iranian Rial = 1US$ (December-February 2018).Results: The mean three months cost per patient is 38529697 IRR (equivalent to $91.73 USD), Direct medical costs have a most significant part of total costs with 36765292 IRR (87.53USD) per three months (95%). Direct non-medical costs were 1380484 IRR (3.28USD) per patient (4%) and indirect costs were estimated 383981 IRR ($0.9USD) per patient (1%). The results of the analysis of variance showed that there was a significant difference between the four strategies in three months. Among the therapeutic strategies, the most changes in body mass index (BMI) occurred in patients who used Basic diet with several types of medicines strategy (p<0.001). Tukey post hoc showed BMI Changes in a patient with a Basic diet with herbal remedies was minimum (p<0.001). According to results in the first month, BMI has a significant reduction over three months. Regarding costs, the analysis showed that Patients who used the Basic diet strategy incurred the lowest costs (p<0.001) and the highest costs are related to patients with a Basic diet with several types of medicines (p<0.001).Conclusions: The results of the present study are useful in improving health policymakers and researchers in motivating to do more studies in particular for adopting new policies depending on the level of insurance coverage and their problems which patients deal with during the treatment period.

Download Full-text

High dose, short course prednisolone for acute idiopathic thrombocytopenic purpura (ITP) in children

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20173770 ◽

2017 ◽

Vol 4 (5) ◽

pp. 1705

Author(s):

Aparna Jayaraman ◽

Sarthak Das ◽

Niranjan Biswal ◽

Dillikumar C. G. ◽

Bhavna Ashok Bade

Keyword(s):

Platelet Count ◽

Oral Prednisolone ◽

High Dose ◽

Study Group ◽

Short Course ◽

Significant Difference ◽

Clinically Significant ◽

Acute Itp ◽

Limiting Condition ◽

Dramatic Presentation

Background: Immune thrombocytopenia (ITP) is a relatively benign and self-limiting condition. Though its dramatic presentation with skin or mucosal bleeds could be worrisome, the incidence of serious bleeding like intracranial hemorrhage (ICH) is relatively low (<1%) occurs at a very low count of <20,000 /mm3. The aim of the study was to compare a high dose, short course prednisolone with conventional Prednisolone therapy in the treatment of acute ITP of childhood.Methods: 20 cases and 18 retrospective controls with acute ITP were enrolled. The study group received 5mg/kg/day of oral prednisolone for four days. All the controls had received 2mg/kg/day of oral prednisolone for 14 days, tapered and stopped over the third week.Results: The study group was found to have significant decrease in clinical bleeding, (p=0.02), and significant increase in platelet count by day 3 of treatment (p=0.03) but no significant difference in platelet counts on day 7 of treatment (p=0.07) when compared with the control group.Conclusions: We conclude that the high dose short course oral prednisolone is significantly better than the conventional regimen in reducing clinically significant bleeding and raising the platelet count to safe levels within first 72 hours of therapy.

Download Full-text

Detection Rate and Clinical Impact of PET/CT with 18F-FACBC in Patients with Biochemical Recurrence of Prostate Cancer: A Retrospective Bicentric Study

Biomedicines ◽

10.3390/biomedicines10010177 ◽

2022 ◽

Vol 10 (1) ◽

pp. 177

Author(s):

Luca Filippi ◽

Oreste Bagni ◽

Carmelo Crisafulli ◽

Ivan Cerio ◽

Gabriele Brunotti ◽

...

Keyword(s):

Prostate Cancer ◽

Clinical Management ◽

Biochemical Recurrence ◽

Detection Rate ◽

Major Change ◽

Emission Computed Tomography ◽

Prostate Bed ◽

Pet Ct ◽

Significant Difference ◽

Clinical Records

Our aim was to assess the detection rate (DR) of positron emission computed tomography (PET/CT) with anti-1-amino-3-[18F]-flurocyclobutane-1-carboxylic acid (18F-FACBC) in patients with biochemical recurrence (BCR) from prostate cancer (PC). As a secondary endpoint, we evaluated 18F-FACBC PET/CT’s impact on patients management. Clinical records of 81 patients submitted to 18F-FACBC PET/CT due to PC BCR in two Italian Nuclear Medicine Units were retrospectively assessed. DR was gauged in the whole cohort and stratifying patients by discrete intervals of PSA levels. PET/CT’s impact on clinical management was scored as (1) major if it entailed an intermodality change (e.g., from systemic to loco-regional therapy); (2) minor if it led to an intramodality change (e.g., modified radiotherapy field). PET/CT’s DR resulted in 76.9% in the whole cohort, with a positive predictive value of 96.7%. Stratified by PSA quartile intervals, PET/CT’s DR was 66.7%, 71.4%, 78.9% and 90% for PSA 0.2–0.57 ng/mL, 0.58–0.99 ng/mL, 1–1.5 ng/mL and >1.5 ng/mL without significant difference among groups (p = 0.81). The most common sites of relapse were prostate bed and pelvic lymph nodes (59.3%). PET/CT impacted on clinical management in 33/81 cases (40.7%), leading to a major change in 30 subjects (90.9%). 18F-FACBC PET/CT localized recurrence in patients with BCR, with meaningful DR also at low PSA levels and significantly impacted on clinical management.

Download Full-text

Factors Influencing Surgical Outcomes in Orbital Trapdoor Fracture

10.21203/rs.3.rs-333415/v1 ◽

2021 ◽

Author(s):

Yi-Hua Chen ◽

Yueh-Ju Tsai ◽

I-Shiang Tseng

Keyword(s):

Multivariate Analysis ◽

Surgical Outcomes ◽

Roc Analysis ◽

Operating Characteristic ◽

Younger Patients ◽

Visual Outcomes ◽

Surgical Reduction ◽

Factors Influencing ◽

Significant Difference ◽

Special Subgroup

Abstract This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post- operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p=0.02), muscle incarceration (p=0.01), duration from injury to surgical reduction (p=0.004), and postoperative supra-duction limitation (p=0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.

Download Full-text

Long-Term Efficacy of Dexamethasone Intravitreal Implant in the Treatment of Vogt-Koyanagi-Harada (VKH) Disease Relapsing Posterior Uveitis

10.21203/rs.3.rs-393685/v1 ◽

2021 ◽

Author(s):

Tarek Roshdy Elhamaky

Keyword(s):

Visual Acuity ◽

Posterior Uveitis ◽

Systemic Steroid ◽

Foveal Thickness ◽

Dexamethasone Intravitreal Implant ◽

Central Foveal Thickness ◽

Intravitreal Implant ◽

The Mean ◽

Vkh Disease

Abstract Purpose: To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent VKH disease.Methods: This is a prospective study of 29 eyes of 16 patients with posterior uveitis in chronic recurrent VKH disease. All patients received previous systemic steroid and immunosuppressive regimens. All patients underwent a comprehensive ophthalmic examination, including BCVA (log MAR), IOP, FFA, and SD-OCT. All patients underwent intravitreal injection with sustained-release dexamethasone 0.7 mg implant (Ozurdex®). Primary outcome measures included mean change in best corrected visual acuity (BCVA) and central foveal thickness (CFT) at 24 months follow-up compared to baseline. Results: At 24 months follow-up, the mean BCVA improved from 0.82 ± 0.13 to 0.38 ± 0.06logMAR (P <0.0001). The mean CFT reduced from 505 ± 29 to 244 ± 23 um (P <0.0001). The mean IOP changed from 15.1±2.2 to16.9±3.1 mmHg with no significant value. Twenty-one eyes (72.4%) received one injection, while eight eyes (27.6%) required two injections. The mean number of injections was 1.2± 0.60. The mean follow-up time was 24.75± 0.9months. No serious ocular or systemic adverse events were noted during the follow-up period. Ocular hypertension was recorded in there (10.3%) eyes and controlled by IOP lowering medications. Cataract progression occurred in 11 (37.9%) eyes.Conclusions: Our cohort highlights the beneficial effects of the Dexamethasone implant 0.7 mg in the treatment of VKH disease relapsing posterior uveitis improving visual acuity, reducing macular edema, and minimizing the burden of systemic steroid in this sample study.

Download Full-text