scholarly journals Treatment of Severe Recalcitrant Fungal Keratitis Using Subconjunctival Fluconazole as an Adjunctive Therapy

2021 ◽  
Vol 37 (2) ◽  
Author(s):  
Ambreen Gull ◽  
Fuad Ahmad Khan Niazi ◽  
Ali Raza
Keyword(s):  
Key Words ◽  
Study Design ◽  
Antifungal Therapy ◽  
Adjunctive Therapy ◽  
Case Series ◽  
Fungal Keratitis ◽  
Systemic Toxicity ◽  
Adjunctive Treatment ◽  
Subconjunctival Injection ◽  
Medical University

Purpose:  To evaluate the safety and effectiveness of 2% subconjunctival injection of Fluconazole as an adjunctive treatment in severe recalcitrant fungal keratitis. Study Design:  Interventional case series. Place and Duration of Study:  Ophthalmology department of Holy family hospital, Rawalpindi medical university, from January 2019 to August 2019. Methods:  The study included 18 eyes of 18 patients with severe resistant fungal corneal ulcer.We excluded those cases who had known hypersensitivities to Fluconazole. These ulcers were refractory toprimary conventional antifungal therapy with topical Natamycin, topical and systemic Fluconazole. Sample for culture was taken with sterile cotton bud and scraping was taken with kimura spatula. All resistant cases were given1.0 ml of 2% subconjunctival Fluconazole injection once a day for at least one week. After that depending upon the condition, the injections were givenonalternate days for 2 weeks. Results:  Average age of the patients was 35.22 years (SD ± 10.42). Among total 18 patients, six (33.33%) were females and 12 (66.67%) were males. Thirteen (72.22%) cases showed absolute response after one week and 5 (27.77%) cases needed more injections. Four (22.22%) of these 5 cases partiallyimproved andone case failed to show improvement. Final vision varied in different cases according to the position of the residual scar. Five cases ended up in keratoplasty. Local or systemic toxicity was not seen in any case. Conclusion:  Subconjunctival injection of 2% Fluconazole can be used as an adjunctive therapy for severe fungal keratitis without any toxic complications. Key Words:  Keratomycosis, Evisceration, Keratoplasty.

β-Blockers and Depression: The More the Murkier?

1998 ◽  
Vol 32 (6) ◽  
pp. 699-708 ◽  
Author(s):  
L Douglas Ried ◽  
Bentson H McFarland ◽  
Richard E Johnson ◽  
Kathleen K Brody
Keyword(s):  
Key Words ◽  
Study Design ◽  
Depressed Mood ◽  
Depressive Symptomatology ◽  
Case Series ◽  
Case Definition ◽  
Number Of Patients ◽  
Adrenergic Antagonist ◽  
Β Blocker ◽  
Β Blockers

OBJECTIVE: To review the literature regarding the purported association between oral ingestion of β-blocker drugs and depressed mood. DATA SOURCE: MEDLINE was searched for published articles using the key words propranolol, atenolol, metoprolol, nadolol, timolol, β-blocker, β-adrenergic antagonist, or β-adrenergic blocker in combination with the key words depression, depressive symptomatology, major depressive disorder, or depressed mood from January 1966 through December 1996. DATA SYNTHESIS: Findings regarding the association are equivocal. Plausible explanations include study design, case definition, and confounding disease states. Most of the evidence supporting an association has used case series and case reports. Findings from cross-sectional observational studies and case–control studies are equivocal. Case definition and measurement instruments may partially explain these inconsistencies. Studies using a diagnosis of depression generally do not support the relationship. Trials using depressive symptoms are about evenly split, but they have generally enrolled a small number of patients and have questionable statistical power. Studies defining antidepressant prescriptions dispensed as a marker for depression generally support the association. Evidence exists both for and against the hypothesis that lipophilic β-blockers cause more depression than do hydrophilic β-blockers. CONCLUSIONS: β-Blockers may have been unjustly associated with depression and their use avoided for that reason. Future studies into the association between depression and β-blocker use should evaluate whether the association is affected by case definition and study design characteristics, including disease, dose–response, bias, measurement error, or ability to precisely measure the length of the exposure.

scholarly journals PREGNANCY OUTCOME IN FEMALES WITH HIGH BODY MASS INDEX (BMI)

2021 ◽  
Vol 31 (03) ◽  
pp. 159-162
Author(s):  
Sadia Zahoor ◽  
Tahira Malik ◽  
Sadia Younas ◽  
Zilla Huma ◽  
Aalia Tayyba ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Key Words ◽  
Pregnancy Outcome ◽  
Body Mass ◽  
Study Design ◽  
Pregnancy Outcomes ◽  
Case Series ◽  
High Body Mass Index ◽  
Pregnant Females ◽  
Age Range

Objective: To determine the various pregnancy outcomes in females with high pre pregnancy BMI. Study Design: Descriptive case series. Setting: Sheikh Zayed Hospital, Rahim Yar Khan. Duration: 30-06-2016 to 31-12-2017. Methodology; In the present study, pregnant females with age of gestation less than 12 weeks presenting with their first ante natal visit falling in the age range of 20-40 years having pre pregnancy BMI > 25 kg/m2  were included. Then these cases were followed for their whole pregnancy to look for various outcomes. Results; In the present study there were 150 subjects enrolled with high pre pregnancy BMI. Mean age of the participants was 28.41±4.67 year and mean BMI was 28.31±3.57 kg/m2. Regarding various outcome the most common one was C section which was seen in 42 (28%) of the cases, followed by PIH seen in 35 (23.34%) of the cases, while pregnancy remained uneventful in only 21 (14%) of the cases. Conclusion: High pre pregnancy BMI leads to various complication, which are seen in almost 8 out of 10 cases and the most common one is C section. Key words: BMI, C section, PIH

scholarly journals Refractory Toxic Shock-Like Syndrome fromStreptococcus dysgalactiaessp.equisimilisand Intravenous Immunoglobulin as Salvage Therapy: A Case Series

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Marjan Islam ◽  
Dennis Karter ◽  
Jerry Altshuler ◽  
Diana Altshuler ◽  
David Schwartz ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Intravenous Immunoglobulin ◽  
Salvage Therapy ◽  
Adjunctive Therapy ◽  
Case Series ◽  
Ivig Therapy ◽  
Mortality Rates ◽  
Invasive Disease ◽  
Streptococcus Dysgalactiae ◽  
Toxic Shock

Infections fromStreptococcus dysgalactiaessp.equisimilis(SDSE) can cause a wide variety of infections, ranging from mild cellulitis to invasive disease, such as endocarditis and streptococcal toxic shock-like syndrome (TSLS). Despite prompt and appropriate antibiotics, mortality rates associated with shock have remained exceedingly high, prompting the need for adjunctive therapy. IVIG has been proposed as a possible adjunct, given its ability to neutralize a wide variety of superantigens and modulate a dysregulated inflammatory response. We present the first reported cases of successful IVIG therapy for reversing shock in the treatment of SDSE TSLS.

scholarly journals Deferiprone as adjunctive treatment for patients with invasive mucormycosis: A retrospective case series

2018 ◽  
Vol 10 (2) ◽  
Author(s):  
Maria N. Chitasombat ◽  
Pimjai Niparuck
Keyword(s):  
Mortality Rate ◽  
Treatment Strategies ◽  
Case Series ◽  
Hematologic Malignancies ◽  
Adjunctive Treatment ◽  
Combination Regimen ◽  
Retrospective Case ◽  
Day Range

Mucormycosis is a life-threatening disease requiring multimodal treatment with antifungals and surgery. The mortality rate remains high, prompting consideration of alternative treatment strategies. Deferiprone has in vitro activity against Mucorales, but its efficacy has never been evaluated in humans. Here, we retrospectively analyzed patients with confirmed mucormycosis who received deferiprone from 2011 to 2017. Five patients had hematologic malignancies and one was diabetic. The sites of infection included sinus-orbit-cerebral (67%), lung (17%), and disseminated infection (17%). Surgery was performed in 83% of cases and achieved local control for 33% of patients. A combination regimen of polyenes plus echinocandins was administered with stepdown treatment using posaconazole. The median duration of antifungal treatment was 86 days (range: 46-435 days) days. Deferiprone was given as adjunctive treatment with a median dose and duration of 100 mg/kd/day (range: 86.2-100 mg/kg/day) and 25 days (range: 15-215 days), respectively. Overall, deferiprone was well-tolerated. Successful outcomes were observed at 12-week follow-up for 67% of patients. The mortality rate at 180- day follow-up was 50%. Adjunctive therapy with deferiprone showed safety and tolerability.

Long-term Outcome for Open and Endoscopically Resected Sinonasal Tumors

2018 ◽  
Vol 160 (5) ◽  
pp. 862-869 ◽  
Author(s):  
Jan Hagemann ◽  
Jana Roesner ◽  
Soenke Helling ◽  
Christian Jacobi ◽  
Johannes Doescher ◽  
...  
Keyword(s):  
Endoscopic Resection ◽  
Study Design ◽  
Chart Review ◽  
Tumor Resection ◽  
Case Series ◽  
Tumor Spread ◽  
Long Term Outcome ◽  
Cox Regression Analysis ◽  
Tumor Stages ◽  
Prospective Study Design

Objective Endoscopic resection of sinonasal cancer has become an alternative to open craniofacial surgery and leads to safe and satisfying results in emerging numbers. Randomized study data comparing outcomes between approaches are missing. Hence, it remains unclear which subgroups of patients might profit most from each technique. We aimed to identify such patient and tumor characteristics and gather information for future prospective study design. Study Design Case series with chart review. Setting Tertiary academic center. Subjects and Methods This study is based on a retrospective chart review of 225 patients undergoing open craniofacial or endoscopic resection for sinonasal malignancy between 1993 and 2015 at Munich University Hospital. Statistical analyses include t test, chi-square, Kaplan-Meier charts, and univariate and multivariate analyses. Results The sample size was similar between the endoscopic and open surgery groups. Tumors were significantly larger in patients who underwent open craniofacial resection. The risk of notable bleeding ( P = .041) was lower and hospital stay shorter ( P = .001) for endoscopic interventions of all tumor stages. Rates of overall ( P = .024) and disease-specific ( P = .036) survival were significantly improved for endoscopic cases; improved recurrence-free survival rates did not achieve statistical significance ( P = .357). For cases matched for tumor size, this improvement was confirmed for T3 tumors ( P = .038). Regional and distant metastatic tumor spread generally worsened survival in both surgical subgroups. Multivariate Cox regression analysis revealed independent prognosticators for overall survival. Conclusion Endoscopic tumor resection remains a suitable option for distinct indications and showed improved outcome in intermediate-stage tumors in our collective. Further randomized studies acknowledging the here-identified factors are needed to improve future therapy guidelines and patient care.

scholarly journals EMBOLIZATION OF RENAL ANGIOMYOLIPOMA: CASE SERIES

2015 ◽  
Vol 1 (2) ◽  
Author(s):  
Ghania Masood ◽  
Iffat Rehman ◽  
Saquib Khawar ◽  
Khurram A Mufti ◽  
Imran K. Niazi
Keyword(s):  
Minimally Invasive ◽  
Key Words ◽  
Case Series ◽  
Invasive Procedure ◽  
Standard Of Care ◽  
Renal Angiomyolipoma ◽  
Minimally Invasive Procedure ◽  
Benign Lesions ◽  
Current Standard ◽  
Spontaneous Haemorrhage

Renal angiomyolipomas (AML) are benign lesions usually left alone. However, lesions larger than 4 cm carry the risk of spontaneous haemorrhage and need treatment. Angiography and embolisation are the current standard of care particularly in patients with high operative risks. Angio-embolisation is a safe, minimally invasive procedure preserving maximum renal parenchyma, with the added advantage of preventing peri-procedural morbidity. Two cases of AML are presented in this case series. Key words: Angiomyolipoma, embolisation, renal 

scholarly journals TRADITIONAL BONESETTERS

2016 ◽  
Vol 23 (06) ◽  
pp. 699-704
Author(s):  
Waqar Alam ◽  
Faaiz Ali Shah ◽  
Ashfaq Ahmed ◽  
Saeed Ahmad ◽  
Abdullah Shah
Keyword(s):  
Compartment Syndrome ◽  
Study Design ◽  
Low Cost ◽  
Cultural Beliefs ◽  
Case Series ◽  
Non Union ◽  
Appropriate Treatment ◽  
Accident And Emergency ◽  
Set Up ◽  
Study District

Objectives: To analyze the reasons for treatment by Traditional Bone Setters(TBS) and the frequency of complications in patients treated by traditional bone setters in our setup. Study Design: Descriptive case series. Place and Duration of Study: District HeadquarterHospital (DHQ) Temargarah & Lady Reading Hospital Peshawar and, Ghurki Trust TeachingHospital, Lahore from Dec 2014 to Nov 2015. Material and Methods: Patients of either genderor all ages received in outpatient department or accident and emergency of DHQ Temargarah,Lady Reading Hospital Peshawar and Ghurki Trust Teaching Hospital, Lahore with history oftrauma followed by treatment by local bonesetters were included in our study. After properhistory, examinations and investigations, appropriate treatment were given and complicationswere noted. Results: We received a total of 267 patients who were treated by Traditional bonesetters.186 were males and 81 were females. Age ranges from 1.5 years to 87 years. In majorityAdvice or pressure from family/friends taking the lead. 77(28.84%) of patients suffer because offamily or friends. 66(24.72%) of patients affected because of socio cultural beliefs, 46(17.23%)because of low cost, 35(13.11%) because of ignorance, 24(8.98%) because of fear of operation,19(7.12%) because of fear of amputation took their treatment from bone setters. The mostfrequent complication we received was malunion were found in 67(25.10%) and non-union in55(20.60%), Conclusion: Pressure from friends and family was the main reason for consultingTraditional Bone Setters for treatment in our set up and complications caused by their treatmentwere frequent and ranged from immediate compartment syndrome and gangrene of the limb tolate onset mal union, non-union and avascular non-union.

scholarly journals EXPERIENCE OF HALOPELVIC TRACTION IN THE TREATMENT OF SEVERE SPINE DEFORMITY: A CASE SERIES

2016 ◽  
Vol 21 (4) ◽  
pp. 295
Author(s):  
Syed Asif Ali ◽  
Asad Ali Ch ◽  
Ahmad Sarfraz Humayun ◽  
Usman Zafar Dar ◽  
Syed Muhammad Awais
Keyword(s):  
Treatment Outcome ◽  
Case Series ◽  
Descriptive Study ◽  
Spine Deformity ◽  
Operative Techniques ◽  
Curve Correction ◽  
Severe Scoliosis ◽  
Traction Device ◽  
Medical University ◽  
Severe Spinal Deformity

AbstractBackground:Severe and rigid scoliosis and kyphosis are difficult to treat but with the advent of new spinal operative techniques and implants, it has become man-ageable in expert hands. However these implants are too expensive for developing countries like us. The Halo-pelvic traction is a relatively cheaper device sys-tem used to treat such deformities. Moreover, rapid curve correction and one stage surgery may lead to permanent neurological deficit.Objective:To evaluate treatment outcome of Halo-pelvic Traction in the treatment of severe scoliosis and kyphosis.Methodology:This descriptive study was conducted in the department of Orthopedics surgery and traumatology unit I, King Edward Medical University, Mayo Hospital Lahore from September 2010 to August 2012. The patients with severe spinal deformity which could not be corrected at a single stage were included. A Performa was made for each patient and results were statistically analyzed by using SPSS version 20.Results:Total no. of 07 patients were treated, out of them 04 scoliosis patients having mean Cobbs angle of 77.25 5.31 before treatment, improved significantly to 45 5.35 after surgery (p?0.0001), 03 kyphosis patients with mean Kyphus angle of 96.67 24.66 improved to 58.33 17.56 (p?0.0001). Two major complications i.e. one paraplegia which recovered incompletely and one had CSF discharge from cranial pin that was also revived thoroughly after changing the position of the pin.Conclusion:Halopelvic traction device can help in treating the patients of severe scoliosis and kyphosis.Keywords:Kyphosis, Halo-Pelvic, Kyphus angle, Cobbs angle.

Fertility and ovarian reserve (Сlinical lecture)

2018 ◽  
pp. 10-13
Author(s):  
V.I. Pyrohova ◽  
◽  
M.T. Ferents ◽  
Keyword(s):  
Key Words ◽  
Ovarian Reserve ◽  
Reproductive System ◽  
Reproductive Function ◽  
The State ◽  
Chronic Endometritis ◽  
National Medical ◽  
Medical University ◽  
The Relationship

Lviv national medical University named Danylo Galitsky The article considers the selected aspects of fertility of women in modern conditions, the relationship between the ovarian reserve, the state of the endometrium and the ability to realize the reproductive function. Key words: fertility, ovarian reserve, endometrium, chronic endometritis, reproductive system.

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