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- [Clinical features of ocular symptom in patients with allergic rhinitis]. [English Abstract, Journal Article]
- Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014 Sep; 28(17):1321-5.
To investigate the clinical characteristics of ocular symptoms in patients with allergic rhinitis (AR) and the impact of the ocular symptoms on patients' quality of life.AR patients' history and clinical data were collected and analyzed. One hundred cases were extracted from adult patients with and without ocular symptoms in each group and their quality of life were evaluated using rhino-conjunctivitis quality of life questionnaire (RQLQ).Totally 1119 cases were collected and 859 cases had ocular symptoms. Of the patients with ocular symptoms, 582 cases were mild, 234 cases were moderate, 43 cases were severe. Eye itching was the most common symptom, followed by tears, hyperemia and swelling. Patients with ocular symptoms had longer disease history than non ocular symptom group (P < 0.05). There was a positive correlation between ocular and nasal symptoms (P < 0.01); patients with ocular symptoms had more severe nasal symptoms than patients without ocular problems; while patients with moderate to severe AR had more severe ocular symptoms than mild AR patients (P < 0.01). Female patients had higher incidence (P < 0.05) and ocular symptoms score (P < 0.05) than male. Children less than 10 years old had a relative lower incidence and score of ocular symptoms. While the incidence and score had an increasing trend for patients older than fifty. There was no difference regarding the type and number of allergen in the patients with and without ocular symptom. Moreover, patients with ocular symptoms had higher scores in the domains of non-nose/eye symptoms, practical problems, ocular symptoms, emotional function and total score in RQLQ than patients without ocular symptom.It was common for the AR patients to have ocular symptoms, and ocular symptoms had obvious influence on the patients' quality of life. So controlling of the ocular symptoms should not be ignored during the diagnosis and treatment of AR.
- Outbreak of serotype W135 Neisseria meningitidis in central river region of the Gambia between February and June 2012: A hospital-based review of Paediatric cases. [JOURNAL ARTICLE]
- Niger J Clin Pract 2015 January-February; 18(1):41-47.
Background: Meningitis still accounts for many deaths in children especially during epidemics in countries within the African meningitis belt. Between February and May 2012, the Gambia witnessed an outbreak of meningitis in two of its six regions. This study presents a clinical perspective of this outbreak in central river region of the Gambia. It evaluated the outbreak pattern, clinical features, and mortality among suspected cases that presented to the hospital during the outbreak. Methodology: This is a prospective observational study of suspected cases of meningitis that presented to the pediatric ward of the Bansang Hospital during the outbreak period. Confirmed cases of meningitis were consecutively enrolled, and those with negative blood cultures presenting during the same period were employed as controls. Result: Two hundred and four suspected cases of meningitis presented to the pediatric ward during the outbreak. Ninety were confirmed as meningitis cases. The W135 strain of Neisseria meningitidis was responsible for 89 (98.9%) of meningitis cases seen with an incidence rate of 74.9/100,000 in children (0-14 years) and in-hospital case fatality rate of 7.9%. Highest attack rate was among the 12-49 months age group. Clinical features such as meningeal signs (neck stiffness), conjunctivitis, and joint swelling were seen more in cases than controls. Contact history with relatives, who had fever in previous 2 weeks prior to illness was significantly seen more in cases. Adjusted regression analysis showed 7.5 more likelihood of infection with positive contact history (odds ratio [OR]: 7.2 confidence interval [CI]: [3.39-15.73]). There was no significant difference in death outcome between cases and controls (OR: 0.78 CI: [0.29-2.13]). The double peak wave-like pattern of the epidemic curve noted during this outbreak suggests a disseminated outbreak originating from an index case with propagated spread. Conclusion: There is need for more effective surveillance and incorporation of vaccine against meningitis into the expanded program on immunization schedule of the Gambia and other countries within the meningitic epidemic belt.
- [Diagnosis of streptococcal pharyngotonsillitis in children and adolescents: clinical picture limitations]. [English Abstract, Journal Article]
- Rev Paul Pediatr 2014 Dec; 32(4):285-91.
To assess the utility of clinical features for diagnosis of streptococcal pharyngotonsillitis in pediatrics.A total of 335 children aged 1-18 years old and presenting clinical manifestations of acute pharyngotonsillitis (APT) were subjected to clinical interviews, physical examinations, and throat swab specimen collection to perform cultures and latex particle agglutination tests (LPATs) for group A streptococcus (GAS) detection. Signs and symptoms of patients were compared to their throat cultures and LPATs results. A clinical score was designed based on the multivariate logistic regression analysis and also was compared to throat cultures and LPATs results. Positive throat cultures and/ or LPATs results were used as a reference standard to establish definitive streptococcal APT diagnosis.78 children (23.4%) showed positivity for GAS in at least one of the two diagnostic tests. Coryza absence (odds ratio [OR]=1.80; p=0.040), conjunctivitis absence (OR=2.47; p=0.029), pharyngeal erythema (OR=3.99; p=0.006), pharyngeal exudate (OR=2.02; p=0.011), and tonsillar swelling (OR=2.60; p=0.007) were significantly associated with streptococcal pharyngotonsilitis. The highest clinical score, characterized by coryza absense, pharyngeal exudate, and pharyngeal erythema had a 45.6% sensitivity, a 74.5% especificity, and a likelihood ratio of 1.79 for streptococcal pharyngotonsilitis.Clinical presentation should not be used to confirm streptococcal pharyngotonsilitis, because its performance as a diagnostic test is low. Thus, it is necessary to enhance laboratory test availability, especially of LPATs that allow an acurate and fast diagnosis of streptococcal pharyngotonsilitis.
- Topical Cyclosporine A 1% for the Treatment of Chronic Follicular Conjunctivitis. [JOURNAL ARTICLE]
- Eye Contact Lens 2014 Dec 10.
To evaluate the use of topical cyclosporine A (CSA) 1% in the treatment of chronic follicular conjunctivitis (CFC).Retrospective chart review from 2001 to 2012 identified 12 patients (22 eyes) with CFC (mean±standard deviation [SD] age, 50.2±15.4 years; 75% female; 92% white) treated with CSA. Main outcome measures included inflammation grade, visual acuity, concurrent corticosteroid (CS) therapy, effect on CS taper, and adverse effects.Mean±SD follow-up time was 11.7±9.7 months. Mean±SD time from diagnosis to CSA treatment initiation was 2.4±3.2 months. Mean±SD duration of CSA treatment was 5.8±2.8 months. Four patients (33%) complained of irritation (n=2), redness (n=1), itching (n=1), and burning (n=1) but none discontinued treatment. Concurrent CSs were tapered off in all patients after a mean±SD of 5.0±2.5 weeks. Mean±SD initial vision was 0.078±0.093 logMAR, whereas vision at final examination was 0.056±0.081 logMAR (P=0.02). Mean±SD initial inflammation grade of 1.9±1.0 was significantly reduced to final grade of 0.7±0.9 (P=0.0002). Mean±SD time to initial inflammation control in 9 patients (75%) was 33.2±24.5 days. Two patients (17%) switched to oral CSA because of lack of inflammation control.Topical CSA 1% is an effective and well-tolerated therapy that decreased chronic inflammation and tapered topical CS in patients with CFC. The use of CSA in such patients warrants further investigation.
- Long-term Result of Maintenance Treatment with Tacrolimus Ointment in Chronic Ocular Graft versus Host Disease. [JOURNAL ARTICLE]
- Am J Ophthalmol 2014 Dec 8.
To investigate the efficacy and safety of long-term maintenance treatment with tacrolimus ointment in chronic ocular graft versus host disease (GVHD) with ocular surface inflammation.A Retrospective interventional consecutive case series.Long-term maintenance treatment (≥6 months) with topical 0.02% tacrolimus ointment was applied to patients with chronic ocular GVHD with ocular surface inflammation (at least grade 2 inflammatory score). We evaluated the inflammatory score, steroid score and steroid use period of total duration, and numbers of inflammatory aggravations before and after tacrolimus treatment. The clinical outcomes were assessed by symptom score, ocular surface staining, Schirmer I test, tear break-up time (TBUT), and classification of chronic GVHD conjunctivitis at the initial and final examinations.A 13 patients (24 eyes) were treated with tacrolimus ointment for up to 20 months (average 12.2 months). The ocular surface inflammatory score decreased from 2.8 to 0.6 (P = 0.001) within 2-8 weeks after starting tacrolimus ointment treatment. The numbers of inflammatory aggravation and the need for steroid treatment also decreased after initiating tacrolimus treatment. At the final follow-up, all patients reported improvement in clinical outcomes, compared to initial findings. Except for blurred vision or mild burning sensation, there were no reported side effects.Considering the chronic course of GVHD, long-term maintenance treatment with tacrolimus ointment could be useful and safe to locally treat ocular surface inflammation in chronic ocular GVHD.
- Safety of sublingual immunotherapy Timothy grass tablet in subjects with allergic rhinitis with or without conjunctivitis and history of asthma. [JOURNAL ARTICLE]
- Allergy 2014 Dec 14.
Patients with asthma may be more susceptible to adverse events (AEs) with sublingual immunotherapy tablet (SLIT-tablet) treatment, such as severe systemic reactions and asthma-related events. Using data from 8 trials of grass SLIT-tablet in subjects with allergic rhinitis with/without conjunctivitis (AR/C), AE frequencies were determined in adults and children with and without reported asthma.Data from randomized, double-blind, placebo-controlled trials of Timothy grass SLIT-tablet MK-7243 (2800 BAU/75,000 SQ-T; Merck/ALK-Abelló) were pooled for post hoc analyses. Subjects with uncontrolled and severe asthma were excluded from the trials. Frequencies for treatment-emergent AEs (TEAEs), local allergic swelling (mouth or throat), systemic allergic reactions, and asthma-related treatment-related AEs (TRAEs) were calculated.Among adults (n=3314) and children (n=881), 24% and 31%, respectively, had reported asthma. No serious local allergic swellings or serious systemic allergic reactions occurred in subjects with asthma treated with SLIT-tablet. There was no evidence of increased TEAEs, systemic allergic reactions, or severe local allergic swellings in adults or children with asthma treated with grass SLIT-tablet versus subjects without asthma in or outside of pollen season. There were 6/120 asthma-related TRAEs assessed as severe with grass SLIT-tablet and 2/60 with placebo, without a consistent trend among subjects with and without asthma (5 and 3 events, respectively).In the AR/C subjects with reported well-controlled mild asthma included in these studies, grass SLIT-tablet did not increase TEAE frequency, severe local allergic swelling, or systemic allergic reactions versus subjects without asthma. There was no indication that treatment led to acute asthma worsening. This article is protected by copyright. All rights reserved.
- A practical approach to ocular pain for the non-ophthalmologist. [Journal Article]
- Pain Manag 2014 Nov; 4(6):413-26.
SUMMARY Pain involving the eye has numerous etiologies and is a feared challenge of many clinicians. Between a fear of the patient losing vision and a lack of familiarity with the ophthalmic equipment necessary to diagnose the problem, working up eye pain can be a daunting task. While the ophthalmologist can be indispensable in challenging cases of eye pain, this article will help clarify the unique clinical features of each etiology that can help clinicians narrow down the differential and arrive at a diagnosis.
- Clinical and epidemiological characteristics of kawasaki disease. [Journal Article]
- Jundishapur J Microbiol 2014 Aug; 7(8):e11014.
Kawasaki disease (KD) is an acute multisystem vascular syndrome of unknown etiology that is the leading cause of acquired heart disease in children of developed counties.We aimed to evaluate the epidemiological characteristics and clinical manifestations of KD in children residing in the southwest of Iran.In this retrospective study, we reviewed the medical records of all children with KD who had been admitted to the main children's hospital of Ahvaz, southwest Iran, from March 2000 to March 2010. Data regarding clinical and epidemiological characteristics, management, and the outcome of disease for each patient were obtained. The patients were divided into cardiac and non-cardiac groups based on echocardiographic results.In total, 104 patients with KD (66 boys and 38 girls) were enrolled in this study. The male to female ratio was 1.7:1. The mean ± SD age of the patients was 33.6 ± 24.2 months. Most (87.2%) cases were from urban areas. The disease occurred more frequently during winter and spring. Furthermore, 61.5% of the children had the criteria of classic KD, and 38.5% were labeled as incomplete KD. The mean ± SD of the duration of hospital stay was 6.9 ± 2.4 days. The mean time between illness and admission to the hospital was 6.47 ± 2.6 days. The most common sign was fever, followed by conjunctivitis and oral changes. In total, 20% of the patients had cardiac abnormalities. There was no significant statistical difference between the cardiac and non-cardiac groups according to age, sex, clinical manifestations, laboratory findings, and cessation of fever. The duration of hospital stay and the time between onset of illness and diagnosis were longer in the cardiac group. All patients received intravenous immunoglobulin and aspirin. Only one patient continued to have cardiac abnormalities after 6 months of follow-up.Kawasaki disease is not rare in southwest of Iran. The age, gender distribution and clinical findings are similar to that of other reports. Patients with cardiac abnormalities had delayed treatment and prolonged hospital stays.
- Characteristics of the bacterial flora in the conjunctival sac of cats from Poland. [JOURNAL ARTICLE]
- J Small Anim Pract 2014 Dec 5.
To assess the bacterial flora of the conjunctival sac in clinically healthy cats and cats with signs of conjunctivitis.A total of 324 conjunctival swabs were examined between 2011 and 2012 taken from 60 animals, 30 of which were clinically healthy and 30 with signs of chronic conjunctivitis. The samples were taken three times at 4-week intervals from the clinically healthy cats. The samples from the cats with conjunctivitis were taken before and 4 weeks after cessation of successful therapy. Swabs from both the right and left eye of each cat were subjected to microbiological examination and polymerase chain reaction for the presence of DNA of Chlamydophila felis and Mycoplasma felis.There was no qualitative difference in the eye microflora between the clinically healthy animals and those with signs of conjunctivitis. Staphylococcus epidermidis (21 · 9%) was the most common microorganism isolated and it was more commonly detected in swabs from cats with conjunctivitis (P < 0 · 0001) as was Staphylococcus aureus (P = 0 · 07). The presence of C. felis was significantly correlated with (P < 0 · 0001) signs of conjunctivitis and was detected in 25% of swabs collected from both conjunctival sacs. No DNA of M. felis was detected in any swab. None of the animals had sterile conjunctival sacs in all consecutive bacteriological tests.The conjunctival sac in cats was sterile in over 50% of the clinically healthy cats and 25% of the cats with conjunctivitis. The sterility did not persist for longer than 4 weeks. Positive bacterial cultures occur in cats with and without clinical signs of conjunctivitis.
- External ophthalmomyiasis: A case report. [Journal Article]
- Saudi J Ophthalmol 2014 Oct; 28(4):322-4.
Ophthalmomyiasis is an infestation of the eye with larvae of most common sheep nasal botfly (Oestrus ovis). We describe a case of ophthalmomyiasis in a 50-year-old man who presented with ocular foreign body sensation, redness and tearing. The causative larvae were removed in the emergency room and sent to laboratory for identification. The patient symptoms improved after topical treatment with antibiotics-steroid combination therapy.