scholarly journals Pseudoexfoliation Glaucoma and its Systemic Association: A Clinical Study

2022 ◽  
Vol 6 (1) ◽  
Author(s):  
Lakshmi B Ramamurthy ◽  
Sahana Nemmar Chandrashekarabhatta ◽  
Sudheendra B R
Keyword(s):  
Optic Disc ◽  
Care Center ◽  
Tertiary Care ◽  
Visual Fields ◽  
Response To Treatment ◽  
Narrow Angle ◽  
Material Deposition ◽  
Age Related ◽  
Male Preponderance ◽  
Systemic Associations

Pseudoexfoliation [PXF] being a age related elastotic process is a well known entity among all ophthalmologists. PXF is most common form of secondary glaucoma. Objective: To study the clinical presentations and response to treatment of PXF glaucoma and also to throw light on its systemic associations. Methods: A total of 70 eyes of PXF glaucoma was considered for the study in duration of 6 months from june to November 2021 at a tertiary care center. All patients underwent detailed ophthalmic evaluation along with gonioscopy, optic disc assessment, visual fields and intraocular pressure. Based on all these , patients were graded as mild, moderate and advanced glaucoma and treated accordingly either with medical or surgical line of management. Patients were followed up for a duration of 6 months. ECG, echocardiography and dermatological evaluation of all the patients were done. Results: Mean age of 70 patients  was 52.2 years and there was male preponderance .Powdery greyish white pseudoexfoliative material on pupillary margin was seen in 41 eyes[58.5%] and on anterior capsule was seen in 19 eyes[27.1%].   IOP in these 70 patients ranged between 14 to 40mmHg. Gonioscopy showed exfoliative material deposition in 14 eyes[20%] and increased pigmentation of trabecular meshwork in 44 eyes[62.85%]. Also, it revealed narrow angle( grade 1&2) in 6 eyes and open angle (grade 3&4) in rest .Visual filed changes were present in 57 of 70 eyes with PXF glaucoma. Optic disc changes in PXF glaucoma also showed variations with 17 eyes having CD ratio of<0.5,while 38 eyes had a cupping between 0.6-0.8. Eleven eyes showed advanced cupping of >0.8 while 4 eyes had glaucomatous optic atrophy.60 eyes were treated with medical line while 10 eyes were managed surgically. 4 patients had dermal nodules and diastolic dysfunction was noted in 31 patients. Conclusion: PXF confers a significantly higher risk of developing glaucoma in comparison with the general population and needs close monitering. PXF glaucoma and its systemic associations also has to be considered  Keywords: PXF, pseudoexfoliative, ECG

scholarly journals Preferential Hyperacuity Home Testing for Monitoring Intermediate Age-related Macular Degeneration in Routine Clinical Practice

2020 ◽  
Vol 3 ◽  
pp. 9
Author(s):  
Yue Zhao ◽  
Grant Hom ◽  
Thais Conti ◽  
Sumit Sharma ◽  
Alex Yuan ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Macular Degeneration ◽  
Care Center ◽  
Tertiary Care ◽  
Home Monitoring ◽  
Office Visit ◽  
Routine Clinical Practice ◽  
Age Related Macular Degeneration ◽  
Exudative Amd ◽  
Age Related

Objectives: A home monitoring device (ForeseeHome; Notal Vision, Tel Aviv, Israel) detected choroidal neovascularization in age-related macular degeneration (AMD) earlier than home and office monitoring. This study describes device usage in routine clinical practice. Materials and Methods: An Institutional Review Board-approved retrospective chart review of intermediate AMD patients who used the device at a single tertiary care center. Primary outcomes were duration and frequency of usage and outcomes of alerts generated. Results: Sixty-two patients (106 eyes) completed monitoring 4.2 ± 2.1 times per week (avg ± std dev) from February 2015 to February 2019. Forty-five eyes discontinued monitoring after an average of 65 days (range 13–237 days), due to poor quality tests (62%), and false-positive alerts (16%). Eyes that discontinued device monitoring were older and had poorer visual acuity than eyes that continued monitoring (P < 0.01). Fourteen alerts were generated, of which one represented conversion to exudative AMD. Two additional converted eyes were identified by routine office visit and Amsler grid monitoring. Conclusions: Home monitoring has the potential to improve the detection of exudative AMD. Identifying barriers to device utilization are necessary in the AMD population.

scholarly journals Primary Immunodeficiency in Children With Autoimmune Cytopenias: Retrospective 154-Patient Cohort

2021 ◽  
Vol 12 ◽  
Author(s):  
Emma Westermann-Clark ◽  
Cristina Adelia Meehan ◽  
Anna K. Meyer ◽  
Joseph F. Dasso ◽  
Devendra Amre ◽  
...  
Keyword(s):  
Targeted Therapy ◽  
Clinical Features ◽  
Primary Immunodeficiency ◽  
Lymphocyte Subsets ◽  
Care Center ◽  
Tertiary Care ◽  
Response To Treatment ◽  
Evans Syndrome ◽  
Chronic Infections ◽  
Autoimmune Cytopenias

BackgroundPrimary immunodeficiency is common among patients with autoimmune cytopenia.ObjectiveThe purpose of this study is to retrospectively identify key clinical features and biomarkers of primary immunodeficiency (PID) in pediatric patients with autoimmune cytopenias (AIC) so as to facilitate early diagnosis and targeted therapy.MethodsElectronic medical records at a pediatric tertiary care center were reviewed. We selected 154 patients with both AIC and PID (n=17), or AIC alone (n=137) for inclusion in two cohorts. Immunoglobulin levels, vaccine titers, lymphocyte subsets (T, B and NK cells), autoantibodies, clinical characteristics, and response to treatment were recorded.ResultsClinical features associated with AIC-PID included splenomegaly, short stature, and recurrent or chronic infections. PID patients were more likely to have autoimmune hemolytic anemia (AIHA) or Evans syndrome than AIC-only patients. The AIC-PID group was also distinguished by low T cells (CD3 and CD8), low immunoglobulins (IgG and IgA), and higher prevalence of autoantibodies to red blood cells, platelets or neutrophils. AIC diagnosis preceded PID diagnosis by 3 years on average, except among those with partial DiGeorge syndrome. AIC-PID patients were more likely to fail first-line treatment.ConclusionsAIC patients, especially those with Evans syndrome or AIHA, should be evaluated for PID. Lymphocyte subsets and immune globulins serve as a rapid screen for underlying PID. Early detection of patients with comorbid PID and AIC may improve treatment outcomes. Prospective studies are needed to confirm the diagnostic clues identified and to guide targeted therapy.

Treatment of Chronic Cough: Single-Institution Experience Utilizing Behavioral Therapy

2016 ◽  
Vol 156 (1) ◽  
pp. 103-108 ◽  
Author(s):  
Resha S. Soni ◽  
Barbara Ebersole ◽  
Nausheen Jamal
Keyword(s):  
Behavior Modification ◽  
Medical Management ◽  
Chronic Cough ◽  
Behavioral Therapy ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Response To Treatment ◽  
Record System ◽  
Speech Language Pathologist

Objective Chronic cough remains a challenging condition, especially in cases where it persists despite comprehensive medical management. For these particular patients, there appears to be an emerging role for behavior modification therapy. We report a series of patients with refractory chronic cough to assess if there is any benefit of adding behavioral therapy to their treatment regimen. Study Design A case series with planned chart review of patients treated for chronic cough. Setting The review was performed with an outpatient electronic health record system at a tertiary care center. Subjects and Methods The charts of all patients treated for chronic cough by a single laryngologist over a 30-month period were analyzed. Patients’ response to treatment and rate of cough improvement were assessed for those with refractory chronic cough who underwent behavior modification therapy. Results Thirty-eight patients with chronic cough were initially treated empirically for the most common causes of cough, of which 32% experienced improvement. Nineteen patients who did not significantly improve with medical management underwent behavior modification therapy with a speech-language pathologist. Of these patients, 84% experienced resolution or marked improvement of their symptoms. Conclusion Behavioral therapy may be underutilized in practice and could lead to improvement of otherwise recalcitrant cough.

scholarly journals Phosphorylated EGFR (pEGFR T693) as a Novel Predictor of Recurrence in Non-Functioning Pituitary Adenomas

2021 ◽  
Vol 12 ◽  
Author(s):  
Ashutosh Rai ◽  
Liza Das ◽  
Kanchan K. Mukherjee ◽  
Sivashanmugam Dhandapani ◽  
Manjul Tripathi ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Care Center ◽  
Tertiary Care ◽  
Immunohistochemical Analysis ◽  
Tissue Microarrays ◽  
Staining Intensity ◽  
Recurrence Rates ◽  
Male Preponderance ◽  
Non Functioning Pituitary Adenomas

PurposeNon-functioning pituitary adenomas (NFPAs) exhibit high recurrence rates after surgery. However, the determinants of recurrence are inconsistent in the available literature. The present study sought to investigate the association between nuclear phosphorylated EGFR (pEGFR) levels and recurrence of NFPAs.MethodsTissue microarrays from patients undergoing adenomectomy for NFPAs at our tertiary care center from 2003 to 2015 and having a minimum of 60 months of follow-up (n=102) were accessed. Immunohistochemical analysis (IHC) was performed to determine the expression of nuclear pEGFR T693. h-score was calculated as the product of staining intensity and the number of positively staining cells. Radiological surveillance (MRI) was performed to categorize NFPAs as recurrent or non-recurrent on follow-up.ResultsThe mean age of the cohort was 50 ± 11 years with a male preponderance (61.1%). Recurrence was observed in 46.1% of the patients at a median of 123 months (IQR 72-159) of follow-up. pEGFR T693 positivity was higher in a significantly greater number of recurrent NFPAs as compared to non-recurrent NFPAs (95.7% vs 81%, p=0.02). h-scores were also significantly higher in recurrent NFPAs (122.1 ± 6 vs 81.54 ± 3.3, p&lt;0.0001). pEGFR T693 positivity significantly predicted recurrence in NFPAs (HR=4.9, CI 2.8-8.8, p&lt;0.0001). ROC analysis revealed an h-score cutoff of 89.8 as being associated significantly with recurrence (sensitivity 80%, specificity 78%, AUC 0.84, p&lt;0.0001).ConclusionpEGFR T693 was expressed in significantly higher number of recurrent NFPAs. The h-scores were also higher in recurrent NFPAs. Nuclear pEGFR T693 may serve as a predictor of recurrence in NFPAs.

scholarly journals Association between Muscle Mass and Body Mass Index in Elderly Diabetic Patients Attending Tertiary Care Center in Bangalore, India

2016 ◽  
Vol 4 (3) ◽  
pp. 96-99
Author(s):  
Sowbarnika Palanisami ◽  
Vasudha Kulkarni
Keyword(s):  
Body Mass Index ◽  
Muscle Mass ◽  
Body Mass ◽  
Care Center ◽  
Linear Regression Analysis ◽  
Tertiary Care ◽  
Reference Population ◽  
Diabetic Patients ◽  
Age Related ◽  
Increased Risk

Background: Sarcopenia is a disorder causing age-related loss of muscle mass. Its multifaceted nature has been linked to an increased risk of disability and mortality. Equally, obesity is a well-known risk factor for a host of disorders. A combination of sarcopenia and obesity in elderly diabetics can synergistically lead to increased insulin resistance and risk of metabolic syndrome. This study aimed to identify the association between sarcopenia and obesity in elderly diabetic patients by a cost-effective anthropometric method. Methods: A case-control study was conducted from January 2016 to April 2016 at Dr. B. R. Ambedkar Medical College in Bangalore. Height, weight, mid-arm circumference, and triceps skin fold thickness of 112 diabetic patients and 131 healthy adults were measured. Descriptive statistical analysis and multiple linear regression analysis were carried out. Results: 26.8% of male and 76.8% of female diabetic patients were obese (body mass index ≥25 kg/m2). Incidence of sarcopenia (muscle mass one standard deviation smaller than healthy reference population, cut-off value for diabetic males being <9.79 kg/m2 and for diabetic females <8.53 kg/m2) were 12.5% in male diabetic patients and 5.4% in female diabetic patients. Conclusion: Sarcopenia and obesity are co-morbid illnesses which can cause functional and metabolic impairments in elderly diabetic patients. There exists a moderate association between muscle mass and body mass index. Loss of muscle strength (dynapenia), rather than loss of muscle mass (sarcopenia), is closely associated with disabilities in these patients.

scholarly journals Analysis of clinical profile and prescription pattern of malaria in a tertiary care hospital in Karnataka, India

2019 ◽  
Vol 8 (8) ◽  
pp. 1744
Author(s):  
Raghu Murthy N. ◽  
Seema Rai
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Clinical Profile ◽  
Response To Treatment ◽  
Care Hospital ◽  
Peripheral Smear ◽  
Artemisinin Derivatives ◽  
Health Care Center ◽  
Severe Type

Background: Malaria is one of the leading causes of morbidity and mortality in developing countries like India. Plasmodium falciparum and Plasmodium vivax are the commonest species implicated for an increased incidence of malaria in India. The pattern of disease, signs, and symptoms vary from place to place, region to region due to demographic variations. The current study was undertaken to study the differences in the clinical profile of malaria, particularly signs and symptoms, complications and response to treatment in malaria.Methods: A retrospective, single center, surveillance study was carried out at a tertiary health care center in Mangalore. All patients aged above 18 years diagnosed as malaria by peripheral smear method and rapid diagnostic tests were included in the study. The clinical features, complications, and response to treatment were noted.Results: Fifty eight patients diagnosed as malaria were included in the study. Compared to other studies and nationwide incidences, here P. vivax emerged as the leading cause of malaria. All patients presented with fever varying from 3-20 days. About 30 patients complained of headache and 21 patients presented with malaise. In about 6 patient’s complications were seen. Majority of patients received artemisinin derivatives followed by chloroquine for treatment of malariaConclusions: Previous thinking that complications are only seen with P. falciparum has to be changed. Now many complications, mild as well as severe type are seen in P. vivax malaria. Drug resistance is another global problem which needs to be tackled wisely by systematic usage of antimalarials.

scholarly journals Clinical profile of rhinosporidiosis in a tertiary care center of an endemic area

2018 ◽  
Vol 4 (3) ◽  
pp. 659 ◽  
Author(s):  
Suneer R. ◽  
Sivasankari L.
Keyword(s):  
Tamil Nadu ◽  
Endemic Area ◽  
Histopathological Examination ◽  
Care Center ◽  
Tertiary Care ◽  
Granulomatous Inflammation ◽  
Clinical Profile ◽  
Medical College ◽  
Male Preponderance ◽  
A Prospective Study

<p class="abstract"><strong>Background:</strong> Rhinosporidiosis is a chronic granulomatous inflammation caused by <em>Rhinosporidium seeberi</em>. It is water borne disease endemic in Kanyakumari district of South India. The objective of the study was to study the clinical profile of rhinosporidiosis in an endemic area of Kanyakumari district</p><p class="abstract"><strong>Methods:</strong> This is a prospective study of 50 surgically treated cases of rhinosporidiosis carried out in the department of ENT, Kanyakumari Government Medical College from January 2016 to December 2017. All were diagnosed on clinical basis and were treated by excision and electrocautery of the base. The specimens were sent for histopathological examination.  </p><p class="abstract"><strong>Results:</strong> The cases in this study were in the age group between 6 to 70 years. Of these 38 were males and 12 were females indicating a male preponderance. The main presenting symptom was epistaxis in about 80% cases. Nose is the common site involved. Extra nasal spread is common in recurrent cases.</p><p class="abstract"><strong>Conclusions:</strong> The study reflects the endemicity of this disease in Kanyakumari district of Tamil Nadu. High incidence is noted in those bathing in ponds. Extra nasal spread is common in recurrent cases and raising health awareness will go a long way in decreasing its incidence.</p><p class="abstract"> </p>

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