scholarly journals Clinical Observation of Allergic Conjunctival Diseases with Portable and Recordable Slit-Lamp Device

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 535 ◽  
Author(s):  
Hiroyuki Yazu ◽  
Eisuke Shimizu ◽  
Shinri Sato ◽  
Naohiko Aketa ◽  
Taiichiro Katayama ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Clinical Observation ◽  
Clinical Signs ◽  
Japanese Patients ◽  
Bulbar Conjunctiva ◽  
Eye Drops ◽  
Slit Lamp ◽  
Rater Agreement ◽  
Palpebral Conjunctiva ◽  
Grading Scale

Background: The incidence of allergic conjunctival diseases (ACDs) is gradually increasing worldwide. Both ophthalmologists and non-ophthalmologists prescribe eye drops to treat ACDs; however, there are many cases which are treated without sufficient examination and diagnosis of the eyes. We have invented a portable, recordable, and smartphone-attachable slit-lamp device—Smart Eye Camera (SEC). The purpose of this study was to compare the diagnostic abilities of ACDs between the SEC and the conventional, non-portable slit-lamp microscope. Methods: This prospective observational study included 32 eyes of 17 Japanese patients (mean age: 21.5 ± 14.8 years; range: 11–51 years; female: 5). The severity of 10 objective signs in the palpebral conjunctiva, bulbar conjunctiva, limbus, and cornea were scored on a grading scale of 0 to 4 (0 = normal; 1+ = mild; 2+ = moderate; 3+ = severe), respectively. First, the conventional slit-lamp microscope was used to examine the grade of the ACDs. Second, another ophthalmologist filmed the eyes using the SEC and two other ophthalmologists evaluated the grades on another day. The correlation and inter-rater reproducibility in total scores among the two devices were determined. Results: Total scores of clinical signs, evaluated by the two approaches, correlated significantly (both eyes: r = 0.918 (95% CI: 0.839 to 0.959; p < 0.001)), with substantial inter-rater agreement (weighted κ value = 0.631 (95% CI: 0.601 to 0.661; p < 0.001)). Conclusions: The SEC is as reliable as the conventional non-portable slit-lamp microscope for assessing ACDs.

scholarly journals Long-term outcomes of 0.1% tacrolimus eye drops in eyes with severe allergic conjunctival diseases

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Hiroyuki Yazu ◽  
Kazumi Fukagawa ◽  
Eisuke Shimizu ◽  
Yasunori Sato ◽  
Hiroshi Fujishima
Keyword(s):  
Medical Information ◽  
Clinical Signs ◽  
University Hospital ◽  
Vernal Keratoconjunctivitis ◽  
Bulbar Conjunctiva ◽  
Eye Drops ◽  
Long Term Outcomes ◽  
Long Term Treatment ◽  
Significant Difference

Abstract Background Because atopic dermatitis does not heal completely, associated severe atopic keratoconjunctivitis (AKC) and vernal keratoconjunctivitis (VKC) often require long-term treatment. This study aims to evaluate the long-term outcomes of using 0.1% tacrolimus eye drops to treat these severe allergic conjunctival diseases. Methods Two-hundred-and-seventy eyes of 135 patients diagnosed with AKC or VKC from April 2004 to April 2014 were screened retrospectively. Patient demographics and objective signs were extracted from the electronic medical records. The severity of 10 objective signs, related to the palpebral and bulbar conjunctiva, limbus, and cornea, and intraocular pressure (IOP) were observed at baseline, at 2 weeks, 1, 2, 3, 6, and 12 months after starting treatment, and every 1 year thereafter (average use period: 8.4 ± 2.9 years). Safety was evaluated based on the incidence and severity of adverse events. Results 12 patients (AKC; 7 cases, VKC; 5 cases) who were treated with 0.1% tacrolimus eye drops were enrolled in this study. The total score of clinical signs significantly decreased after 2 weeks and remained effective thereafter. Tacrolimus eye drops elicited a statistically significant difference in the mean total clinical scores and IOP over the course of treatment (P < 0.001). Elevated IOP was observed in 2 cases and corneal infection in 1 case; these effects were completely controlled with medication. Conclusions Topical tacrolimus may provide effective and long-term improvement in clinical signs of severe AKC and VKC cases that refractory to standard conventional treatment. Trial registration: University Hospital Medical Information Network (UMIN) 000034460.

scholarly journals Evaluation of Nuclear Cataract with Smartphone-Attachable Slit-Lamp Device

Diagnostics ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. 576
Author(s):  
Hiroyuki Yazu ◽  
Eisuke Shimizu ◽  
Sho Okuyama ◽  
Takuya Katahira ◽  
Naohiko Aketa ◽  
...  
Keyword(s):  
Medical Equipment ◽  
Who Classification ◽  
Japanese Patients ◽  
Eye Diseases ◽  
Nuclear Cataract ◽  
Slit Lamp ◽  
Rater Agreement ◽  
Timely Manner ◽  
Age Related ◽  
Healthcare Assistant

Background: Visual impairments and age-related eye diseases need to be detected and treated in a timely manner. However, this is often hampered by lack of appropriate medical equipment. We have invented a portable, recordable, and smartphone-attachable slit-lamp device, called the Smart Eye Camera (SEC). The aim of this study was to compare evaluating nuclear cataract (NUC) between the SEC and the conventional, non-portable slit-lamp microscope. Methods: A total of 128 eyes of 64 Japanese patients (mean age: 73.95 ± 9.28 years; range: 51‒92 years; female: 34) were enrolled. The NUC was classified into four grades (grade 0 to 3) based on three standard photographs of nuclear opacities according to the WHO classification by ophthalmologists. An ophthalmic healthcare assistant (non-ophthalmologist) filmed the eyes in video mode by the SEC and an ophthalmologist graded the NUC. Grade correlation and inter-rater reproducibility were determined. Results: NUC grading by the two approaches correlated significantly (both eyes: r = 0.871 [95%CI: 0.821 to 0.907; p < 0.001]). Inter-rater agreement was high (weighted κ = 0.807 [95%CI: 0.798 to 0.816; p < 0.001]). Conclusions: This study suggests that the SEC is as reliable as the conventional non-portable slit-lamp microscope for evaluating NUC.

scholarly journals Comparison of adherence between fixed and unfixed topical combination glaucoma therapies using Japanese healthcare/pharmacy claims database: a retrospective non-interventional cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chikako Shirai ◽  
Nobushige Matsuoka ◽  
Toru Nakazawa
Keyword(s):  
Cohort Study ◽  
Real World ◽  
Fixed Combination ◽  
Japanese Patients ◽  
Eye Drops ◽  
Combination Therapies ◽  
Real World Data ◽  
Healthcare Database ◽  
Pharmacy Claims ◽  
Persistence Rate

Abstract Background Adherence to chronic therapies is crucial to prevent the progression of disease, such as glaucoma. However, only a limited number of studies have investigated them using real-world data in Japan. This study aimed to evaluate Japanese patients’ adherence to fixed- and unfixed-combination eye drops as a second-line therapy for glaucoma in real-world practice. Methods This retrospective, non-interventional cohort study utilized a commercially available Japanese healthcare database (MinaCare database). Medical/pharmacy claims data were collected from 2011 to 2016. The primary endpoint was adherence to medications, assessed by proportion of days covered (PDC) with medication during a 12-month post-index period. Meanwhile, the secondary endpoints included the persistence rate. Results A total of 738 patients were included in this study: 309 and 329 in the fixed- and unfixed-combination cohorts, respectively. Prostaglandin analog (PG)/β-blocker (BB) was most commonly claimed in 241/309 (78.0%) patients in the fixed-combination cohort. In the unfixed-combination cohort, PG and BB were claimed in 130/329 (39.5%) patients, whereas PG and α2-agonist were claimed in 87/329 (26.4%) patients. Patients were more adherent to the fixed-combination than the unfixed-combinations (mean PDCs [SD], 79.1% [32.1] vs. 62.2% [38.0]; P < 0.0001). The proportion of patients with good adherence (PDC ≥ 80%) was also higher in the fixed-combination cohort (69.6%) than in the unfixed-combination cohort (48.6%) (P < 0.0001). During the 12-month post-index period, the persistence rate was higher in the fixed-combination cohort than in the unfixed-combination cohort (47.6% [95% confidence intervals (CI): 41.9–53.0] vs. 24.9% [95% CI: 20.4–29.7], P < 0.0001). Conclusions Japanese patients with glaucoma preferred the fixed-combination therapies over the unfixed-combination therapies. Hence, fixed-combination therapies would contribute to the improvement of adherence.

scholarly journals LO028: Prospective validation of an iOS app to evaluate tremor in patients with alcohol withdrawal syndrome

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S39-S39 ◽  
Author(s):  
B. Borgundvaag ◽  
S.L. McLeod ◽  
T.E. Dear ◽  
S.M. Carver ◽  
N. Norouzi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Prospective Observational Study ◽  
Alcohol Withdrawal Syndrome ◽  
Research Assistant ◽  
Rater Agreement ◽  
Objective Indicator ◽  
Expert Assessments

Introduction: Ideal management of alcohol withdrawal syndrome (AWS) incorporates a symptom driven approach, whereby patients are regularly assessed using a standardized scoring system (Clinical Institute Withdrawal Assessment for Alcohol-Revised; CIWA-Ar) and treated according to severity. Among the domains assessed by the CIWA-Ar, tremor is the most objective indicator of withdrawal severity, however, the ability of clinicians to reliably quantify tremor is highly dependent on experience. The objective of this study was to prospectively validate an objective, reliable tool to standardize and quantify the severity of alcohol withdrawal tremor using the built-in accelerometer of an iOS application. Methods: A prospective observational study of patients ≥18 years presenting to an academic emergency department in alcohol withdrawal was conducted from Oct 2014 to Aug 2015. Assessments were videotaped by a research assistant and subsequently reviewed by 3 clinical experts, blinded to the primary clinical assessment. Tremor severity was scored using the 8-point CIWA scale (0=no tremor, 7=severe tremor). Accelerometer derived results were compared to expert assessments of each video. Inter-rater agreement was estimated using Cohen’s kappa (k) statistic. Results: 76 patients with 78 tremor recordings were included. Accelerometer derived tremor scores matched exactly with expert assessor scores in 36 (46.2%) cases, within 1 point for 73 (93.6%) cases and differed by ≥ 2 points in 5 (6.4%) cases. The overall kappa for agreement within 1 point for tremor severity was ‘very good’ 0.92 (95% CI: 0.86, 0.99). Conclusion: iOS accelerometer based assessment of the tremor component of the CIWA-Ar score is reliable and has potential to more accurately assess the severity of patients in alcohol withdrawal. We anticipate this resource will be easily disseminated and will impact and improve the care of patients with alcohol withdrawal.

scholarly journals Clinical case of hemolytic disease of the newborn with incompatibility of the blood of the mother and fetus in the “minor” erythrocyte antigen

2019 ◽  
Vol 6 (3) ◽  
pp. 77-82
Author(s):  
E. L. Krivosheina ◽  
T. S. Mikhailova
Keyword(s):  
Blood Cells ◽  
Clinical Observation ◽  
Clinical Signs ◽  
Low Frequency ◽  
Early Diagnostics ◽  
Hemolytic Disease ◽  
Adequate Treatment ◽  
Special Aspect ◽  
Nucleated Red Blood Cells ◽  
Erythrocyte Antigen

Presented a clinical observation of hemolytic disease of the newborn as a result of fetus immunization with low-frequency erythrocyte antigen (Lutheran). The special aspect of the case is the presence of hyperleukocytosis with evident regenerative shift of neutrophils to the left to singular blastic variants, thrombocytopenia, high reticulocytosis (more than 1000 ‰) and a great number of nucleated red blood cells (normoblasts) in the newborn’s hemogram. In myelogram a sharp expansion of erythroid sprout (90 %) and signs of dizerythropoiesis were determinded. Typical clinical signs and isoserological incompatibility of mother and fetus in erythrocyte antigen provided basis for early diagnostics and adequate treatment of hemolytic disease of the newborn.

scholarly journals Delayed splenic rupture and conservative management: case series

2021 ◽  
Vol 8 (11) ◽  
pp. 3407
Author(s):  
Marta A. Silva ◽  
Nídia Moreira ◽  
José Baião ◽  
Carlos E. Costa Almeida
Keyword(s):  
Conservative Management ◽  
Splenic Injury ◽  
Clinical Observation ◽  
Splenic Rupture ◽  
Clinical Signs ◽  
Case Series ◽  
Emergency Rooms ◽  
Abdominal Injuries ◽  
Hemodynamic Stability ◽  
Delayed Splenic Rupture

Splenic injury is frequent in patients with abdominal trauma and delayed splenic rupture yields a poorer prognosis. Patients with hemodynamic stability, despite the grade of splenic anatomical injury, can be safely treated by conservative management (observation or angiography/angioembolization), if no other intra-abdominal injuries are found and a multidisciplinary team (surgeons, interventional radiologists) is available. The conservative approach is an alternative to surgery and its possible complications. In this case series, the authors present three trauma cases very commonly seen in emergency rooms, in whom delayed splenic rupture was diagnosed. All three patients were submitted to conservative management, with no need for surgery or complications.  This case series presents some common clinical signs and diagnostic steps, also showing the safety and efficacy of clinical observation in this setting.

scholarly journals Treatment of conjunctival squamous cell carcinoma: balancing disease eradication with minimising treatment-induced morbidity

2020 ◽  
Vol 2 (4) ◽  
pp. 288-292
Author(s):  
Cameron McLintock ◽  
James McKelvie ◽  
Samer Hamada
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Squamous Cell ◽  
Surgical Excision ◽  
Bulbar Conjunctiva ◽  
Palpebral Conjunctiva ◽  
Buccal Mucosa Graft ◽  
Pigmented Lesion ◽  
Conjunctival Squamous Cell Carcinoma ◽  
The One

A 41-year-old male presented with a large non-pigmented lesion on the ocular surface involving 8 clock hours of limbus, bulbar conjunctiva, and palpebral conjunctiva. Incisional biopsy confirmed poorly differentiated conjunctival squamous cell carcinoma (SCC). It was staged as a T3, N0, M0 lesion. Treatment was with surgical excision, amniotic membrane transplant, and buccal mucosa graft. Three weekly cycles of 0.04% mitomycin C were administered postoperatively. Six months following excision, although there was no evidence of residual conjunctival SCC, the patient suffered from poor vision, significant pain, and diplopia due to severe dry eye, limbal stem cell deficiency, and symblepharon.This case illustrates the difficult clinical decisions which confront the clinician when treating conjunctival SCC, particularly with balancing the need to eradicate the disease to prevent local invasion and metastatic spread on the one hand and minimising ocular morbidity on the other.

Lower Limb Amputation Rates in Patients With Diabetes and an Infected Foot Ulcer: A Prospective Observational Study

2021 ◽  
Vol 67 (7) ◽  
pp. 22-30
Author(s):  
Natasha Chaudhary ◽  
Farhanul Huda ◽  
Ravi Roshan ◽  
Somprakas Basu ◽  
Deepak Rajput ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Clinical Signs ◽  
Foot Ulcer ◽  
Arterial Disease ◽  
Major Amputation ◽  
Lower Extremity Amputation ◽  
Patients With Diabetes ◽  
Peripheral Arterial ◽  
Extremity Amputation

BACKGROUND: Lower extremity amputation is a serious complication of diabetes mellitus and occurs most commonly in persons who have a foot ulcer. PURPOSE: To examine variables that affect the rate of lower extremity amputation in patients with diabetes and infected foot ulcers. METHODS: A prospective observational study was performed including all consecutive patients who were 18 to 65 years, had a diagnosis of diabetes, and a foot ulcer showing clinical signs of infection. Patients were followed for 6 months or until ulcer healing, minor, or major amputation. A total of 81 persons were enrolled. Demographic variables were obtained, and clinical assessments, blood tests, and radiological investigations were performed. Ulcers were categorized using the Perfusion, Extent, Depth, Infection and Sensation classification system. Differences between variables and outcomes were assessed using the Wilcoxon test, Fisher’s exact test, Chi-square test, and t-test. RESULTS: Mean patient age was 54.58 ± 9.04 years, and the majority (61, 75%) were male. After 6 months, 33 (41%) were healed, 2 patients died, and 17 (21%) underwent major and 24 (30%) minor amputations. Major amputation rates were significantly higher in patients with a high Perfusion, Extent, Depth, Infection and Sensation score (6.92 ± 1.36; P = .005), elevated HbA1c (%) (9.43 ± 2.19; P = .049), presence of growth on wound culture (41 [64.1%]; P = .016), culture sensitivity to beta lactam (20 [31.2%]; P = .012), and presence of peripheral arterial disease seen on arterial Doppler ultrasound (P < .001). Minor amputation rates were higher in men (P = .02) and in the presence of peripheral arterial disease (P = .01). CONCLUSION: The presence of the above factors in persons with diabetes and foot ulcer with clinical signs of infection should alert the clinician to the need for focused and individualized treatment to attempt to prevent amputation.

The Efficacy of 0.1% Tacrolimus Eye Drop for Noninfectious, Non-Necrotizing Anterior Scleritis

2019 ◽  
Author(s):  
Hiroyuki Yazu ◽  
Dai Miyazaki ◽  
Hiroshi Fujishima
Keyword(s):  
Intraocular Pressure ◽  
Standard Deviation ◽  
Adverse Events ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Steroid Treatment ◽  
Eye Drops ◽  
Topical Tacrolimus ◽  
Anterior Scleritis ◽  
Clinical Signs And Symptoms

Abstract BACKGROUND: To examine the efficacy of 0.1% tacrolimus eye drops in the treatment of noninfectious, non-necrotizing anterior scleritis. METHODS: This prospective, single-arm study included nine patients (4 males and 5 females; mean age = 59.4 years, standard deviation = 10.5) with anterior scleritis. All patients were first treated with steroids for 1 month and then switched to tacrolimus eye drops alone. We defined baseline as the initiation of steroid or tacrolimus eye drops. Hyperemia and pain were scored before each treatment, at 1 and 2 weeks, and at 1 month after initiation of each treatment by using 5 grades (0 = none; 1+ = mild; 2+ = moderate; 3+ = severe; 4+ = extremely severe). Intraocular pressure (IOP) was also measured from baseline to 6 months after initiating tacrolimus eye drops. Safety was assessed based on the severity and the incidence of adverse events. RESULTS: The scores of hyperemia and pain had significantly decreased from baseline by 1 week after initiating tacrolimus eye drops (both P < 0.05). No significant reduction was observed with steroid treatment throughout the 1-month period in terms of both scores. Tacrolimus eye drops elicited statistically significant differences in mean IOP over the course of treatment (P = 0.02). No additional medications were required to provide relief in any of the patients receiving tacrolimus treatment. No patient had infectious adverse events after initiation of tacrolimus treatment. CONCLUSIONS: Topical tacrolimus may effectively and immediately reduce clinical signs and symptoms of noninfectious, non-necrotizing anterior scleritis. TRIAL REGISTRATION: This trial was prospectively registered on 16/10/2015 under the number (UMIN000034460).

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