RESUMEN
INTRODUCTION: TB has seen resurgence associated with HIV. Tuberculosis can affect any ocular tissue. The association of HIV with TB is supposed to increase the incidence and plethora of ocular manifestations in tuberculosis. OBJECTIVES: To study the various ocular manifestations seen in tuberculosis patients with associated HIV infection. MATERIAL AND METHODS: This hospital based, cross sectional descriptive study was conducted in Tribhuvan University, Teaching Hospital, Maharajgunj, Nepal and Geta Eye Hospital, Kailali from 2010 to 2015. Diagnosed cases of pulmonary and extra pulmonary tuberculosis with HIV co infection were evaluated for ocular manifestations after excluding other opportunistic infections. RESULTS: Of 70 cases eligible for the study, extra pulmonary tuberculosis was seen in60% of the cases. 5 patients (7.1 %) had ocular manifestations. CD4 counts were <50/mm3 in 3 cases. Ocular involvement was seen in the form of choroidal granulomas, papillitis, cranial nerve palsy, retinal vasculitis and central serous chorioretinopathy. CONCLUSION: This study demonstrated that ocular involvement is a frequent finding in cases with tuberculosis and HIV. Ocular findings are more common in cases with lesser CD4 counts. As ocular tuberculosis can be visually devastating, we recommend regular ocular evaluation of all patients with HIV and systemic tuberculosis.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Virales del Ojo/diagnóstico , Infecciones por VIH/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Adolescente , Adulto , Recuento de Linfocito CD4 , Coriorretinopatía Serosa Central/diagnóstico , Coriorretinopatía Serosa Central/epidemiología , Niño , Enfermedades de la Coroides/diagnóstico , Enfermedades de la Coroides/epidemiología , Enfermedades de los Nervios Craneales/diagnóstico , Enfermedades de los Nervios Craneales/epidemiología , Estudios Transversales , Infecciones Bacterianas del Ojo/epidemiología , Infecciones Virales del Ojo/epidemiología , Femenino , Granuloma/diagnóstico , Granuloma/epidemiología , Infecciones por VIH/epidemiología , Humanos , Huésped Inmunocomprometido , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Neuritis Óptica/diagnóstico , Neuritis Óptica/epidemiología , Vasculitis Retiniana/diagnóstico , Vasculitis Retiniana/epidemiología , Tuberculosis Pulmonar/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: Takayasu's disease (TD) (pulseless disease, aortic arch syndrome) is a rare but potentially life-threatening chronic giant cell vasculitis. The major complications attributed to the disease include Takayasu's retinopathy, secondary hypertension, aortic regurgitation, and arterial aneurysm. The aim of this study is to describe a patient with Takayasu's disease and scleritis and to show its association. CASE REPORT: We describe a 44-year-old female patient with Takayasu's disease who presented with bilateral anterior scleritis in the form of painful red eye. Patient did not have any associated autoimmune diseases. Patient was diagnosed to have TD and was treated with immunosuppressant. CONCLUSION: Scleritis though rare can be a vasculitic feature of TD. This is a first report of Takayasu's disease with scleritis, which has been documented in Nepal.
Asunto(s)
Esclerótica/patología , Escleritis/etiología , Arteritis de Takayasu/complicaciones , Adulto , Biopsia , Femenino , Humanos , Inmunosupresores/uso terapéutico , Enfermedades Raras , Escleritis/diagnóstico , Escleritis/tratamiento farmacológico , Arteritis de Takayasu/diagnóstico , Arteritis de Takayasu/tratamiento farmacológico , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Few studies have investigated the additional healthcare costs of recurrent C. difficile infection (CDI). AIM: To quantify inpatient treatment costs for CDI and length of stay among hospitalized patients with primary CDI only, compared with CDI patients who experienced recurrent CDI. METHODS: This was a prospective, observational cohort study of hospitalized adult patients with primary CDI followed for three months to assess for recurrent CDI episodes. Total and CDI-attributable hospital length of stay (LOS) and hospitalization costs were compared among patients who did or did not experience at least one recurrent CDI episode. FINDINGS: In all, 540 hospitalized patients aged 62±17 years (42% males) with primary CDI were enrolled, of whom 95 patients (18%) experienced 101 recurrent CDI episodes. CDI-attributable median (interquartile range) LOS and costs (in US$) increased from 7 (4-13) days and $13,168 (7,525-24,456) for patients with primary CDI only versus 15 (8-25) days and $28,218 (15,050-47,030) for patients with recurrent CDI (P<0.0001, each). Total hospital median LOS and costs increased from 11 (6-22) days and $20,693 (11,287-41,386) for patients with primary CDI only versus 24 (11-48) days and $45,148 (20,693-82,772) for patients with recurrent CDI (P<0.0001, each). The median cost of pharmacological treatment while hospitalized was $60 (23-200) for patients with primary CDI only (N=445) and $140 (30-260) for patients with recurrent CDI (P=0.0013). CONCLUSION: This study demonstrated that patients with CDI experience a significant healthcare economic burden attributed to CDI. Economic costs and healthcare burden increased significantly for patients with recurrent CDI.
Asunto(s)
Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/economía , Diarrea/economía , Costos de la Atención en Salud , Instituciones de Salud , Hospitalización/economía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Clostridium/epidemiología , Diarrea/epidemiología , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Adulto JovenRESUMEN
INTRODUCTION: In April 2006, the people of Nepal organised mass demonstrations demanding the restoration of democracy in the country. The ocular injuries that resulted during the riots that ensued, their pattern and the visual outcome of the injured have not yet been reported. OBJECTIVE: To study the demographic profile, type, severity and the visual outcome of ocular injuries that occurred during the 2006 people's uprising in Nepal. SUBJECTS AND METHODS: This was a retrospective interventional series of cases involving 29 subjects. The main outcome measures were demography, laterality of injury, type of injury and the visual status before and after the trauma. RESULTS: The age of the victims ranged from 14 to 32 years. Among the victims with eye injuries, 27 (93.1 %) were males, who were unemployed youth, students and construction workers. The left eye was injured more frequently than the right. Non-lethal bullets and explosive tear gas were the commonest agents of the major ocular injuries. The main types of injuries requiring hospitalization were closed globe injuries in eight victims and open globe in six. Surgical intervention was required in 57.2 % (n = 29) of the cases. The visual outcome was poor in cases of open globe injury with posterior segment involvement. CONCLUSION: Non-lethal bullets and explosive tear gases can cause significant visual impairment. Severe open globe injury with a retained intra-ocular foreign body is associated with significant visual loss.
RESUMEN
INTRODUCTION: The causative organism and treatment outcomes of post operative endophthalmitis may vary depending on several factors. OBJECTIVE: To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis. MATERIALS AND METHODS: An interventional prospective series of cases of clinically suspected endophthalmitis was studied. Eleven patients who presented within 48 hours after manual cataract surgery on the same day, by a one surgeon in a single center were enrolled in the study. They underwent both anterior chamber and vitreous aspiration and all of them received intravitreal Vancomycin, Amikacin and Dexamethasone. Samples were subjected to microbiological evaluation. All patients were followed up till 8 weeks for clinical and visual outcome. RESULTS: Of the 11 eyes of suspected endopthalmitis, only one vitreous aspiration showed Gram negative bacilli on Gram stain and 3 vitreous aspirates showed Gram positive cocci. Of the 11 eyes, 3(42.85%) had culture positive on vitreous aspirate. In 2 cases E Coli was isolated and in 1 Staphylococcus aureus was isolated. After 48 hours of intravitreal injection, 10 out of 11 eyes improved and in one, intravitreal injection of vancomycin, amikacin and dexamethasone was repeated. The best corrected visual acuity of 6/9 was achieved in 2 patients, 5 had 6/18, 2 had 6/60 and 2 had 5/60 at the end of eight weeks. CONCLUSION: Staphylococcus aureus and E coli can cause endophthalmitis immediately on the first day post-operatively. Clinically suspected endophthalmitis treated with antibiotics and steroid intravitreal injection can result in better visual outcome.
Asunto(s)
Antibacterianos/uso terapéutico , Extracción de Catarata/efectos adversos , Endoftalmitis/tratamiento farmacológico , Endoftalmitis/microbiología , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/microbiología , Adulto , Anciano , Dexametasona/uso terapéutico , Femenino , Glucocorticoides/uso terapéutico , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Nepal , Estudios Prospectivos , Derivación y Consulta , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Centros de Atención Terciaria , Resultado del TratamientoRESUMEN
INTRODUCTION: Open globe injury is one of the commonest ophthalmic emergencies, and when accompanied by intraocular foreign bodies, the condition carries a poorer prognosis. OBJECTIVE: To report a rare case of perforating injury of the globe with an iron nail which got lodged in the maxillary sinus. CASE: A ten-year-old boy presented with the history of sudden painful loss of vision in his right eye. He reported that he was hit forcefully by the tail of a cow a day before the presentation. There was no perception of light in that eye. The ocular examination revealed a full thickness corneo-scleral perforation with prolapsed uveal tissue. The X-ray of the right orbit showed an impacted foreign body in the inferior orbit and computed tomography scan of the orbit confirmed the presence of a vertically impacted metal piece in the right orbit and right maxillary sinus. The repair of the perforation and removal of the impacted nail was done in two stages. The globe anatomy was maintained but the vision could not be restored due to the grave nature of the trauma. CONCLUSION: Perforating globe injury is an important cause of monocular blindness.
Asunto(s)
Ceguera/diagnóstico por imagen , Lesiones Oculares Penetrantes/diagnóstico por imagen , Cuerpos Extraños/diagnóstico por imagen , Hierro , Seno Maxilar/lesiones , Ceguera/etiología , Niño , Lesiones de la Cornea/complicaciones , Lesiones de la Cornea/diagnóstico por imagen , Lesiones Oculares Penetrantes/complicaciones , Cuerpos Extraños/complicaciones , Artículos Domésticos , Humanos , Masculino , Seno Maxilar/diagnóstico por imagen , Órbita/diagnóstico por imagen , Órbita/lesiones , Radiografía , Esclerótica/diagnóstico por imagen , Esclerótica/lesionesRESUMEN
BACKGROUND: National guidelines recommend oral vancomycin for severe Clostridium difficile infection (CDI) based on results from recent clinical trials demonstrating improved clinical outcomes. However, real-world data to support these clinical trials are scant. AIM: To compare treatment patterns and patient outcomes of those treated for CDI before and after implementation of a severity-based CDI treatment policy at a tertiary teaching hospital. METHODS: This study evaluated adult patients with a positive C. difficile toxin before and after implementation of a policy where patients with severe CDI given metronidazole were switched to oral vancomycin unless contra-indicated. Patients were stratified according to disease severity using a modified published severity score. Treatment patterns based on CDI severity and rates of refractory CDI were assessed. FINDINGS: In total, 256 patients with CDI (mean age 66 years, standard deviation 17, 52% female) were evaluated (before implementation: N = 144; after implementation: N = 112). Use of oral vancomycin for severe CDI increased significantly from 14% (N = 8) to 91% (N = 48) following implementation of the policy (P < 0.0001). Refractory disease in patients with severe CDI decreased significantly from 37% to 15% following implementation of the policy (P = 0.035). No significant differences were noted among patients with mild to moderate CDI. CONCLUSION: A severity-based CDI treatment policy at a tertiary teaching hospital increased the use of oral vancomycin and was associated with decreased rates of refractory CDI.
Asunto(s)
Antiinfecciosos/uso terapéutico , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/patología , Metronidazol/uso terapéutico , Índice de Severidad de la Enfermedad , Vancomicina/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Clostridium/microbiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Política Organizacional , Resultado del TratamientoRESUMEN
BACKGROUND: Tuberculosis (TB) is a widespread disease, and in spite of timely diagnosis and treatment it can permanently compromise lung function. OBJECTIVE: To study the prevalence of pulmonary impairment in cured adult pulmonary TB (PTB) patients. MATERIALS AND METHODS: Adult cured PTB patients were included in the study; those with any other condition or disease affecting lung function were excluded. After detailed history taking and examination, all patients underwent chest X-ray (CXR) and spirometry; 76 patients were investigated for pulmonary hypertension using electrocardiogram and two-dimensional echocardiogram. RESULTS AND DISCUSSION: A total of 264 patients were enrolled in the study. The majority were male and aged between 40 and 50 years. The most common complaint was cough with expectoration. CXR showed varying degrees of lung destruction, with 38% of the patients having Wilcox Grade II involvement. Spirometry was normal in 34 cases, while in the remaining cases varying degrees of obstructive airway disease with restrictive pattern and reversibility were observed. Seventy-two patients had evidence of pulmonary hypertension. These findings are comparable to those reported in the literature. CONCLUSION: PTB patients need long-term follow-up to diagnose and treat functional impairment after cure.
Asunto(s)
Antituberculosos/uso terapéutico , Hipertensión Pulmonar/etiología , Pulmón/fisiopatología , Tuberculosis Pulmonar/complicaciones , Adulto , Ecocardiografía , Electrocardiografía , Femenino , Estudios de Seguimiento , Humanos , Hipertensión Pulmonar/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Radiografía Torácica/métodos , Pruebas de Función Respiratoria , Espirometría , Factores de Tiempo , Tuberculosis Pulmonar/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: Acute renal dysfunction can be used to define severe Clostridium difficile infection (CDI). The Society for Healthcare Epidemiology of America (SHEA) and Infectious Disease Society of America (IDSA) guidelines define acute renal dysfunction as serum creatinine (SrCr) ≥1.5 times the premorbid level. AIM: To determine the ability to assess premorbid SrCr in hospitalized patients with CDI, stratified into community-onset CDI (CO-CDI) and hospital-onset CDI (HO-CDI); and to evaluate differing definitions for premorbid SrCr as a criterion for acute renal dysfunction. METHODS: Hospitalized patients with CDI were stratified into CO-CDI and HO-CDI. The ability to assess premorbid SrCr was determined, and the incidence of acute renal dysfunction and the severity of CDI were compared using varying definitions of premorbid SrCr. FINDINGS: In total, 293 patients with CDI were evaluated; of these, 135 (46%) had CO-CDI and 158 (54%) had HO-CDI. Premorbid SrCr data were not available for 37 (27%) patients with CO-CDI and one (<1%) patient with HO-CDI (P < 0.0001). Depending on the definition of premorbid SrCr used, acute renal dysfunction ranged from 17% to 24% for patients with CO-CDI (P = 0.26), and from 13% to 14% for HO-CDI (P = 0.81). The severity of CDI could not be determined for 43 out of 293 (15%) patients, primarily due to the lack of premorbid SrCr data (N = 38). CONCLUSION: Assessment of acute renal dysfunction and the severity of CDI was not possible for many patients with CO-CDI using the current SHEA/IDSA guidelines. Given the increasing incidence of CO-CDI, an alternative definition of acute renal dysfunction may be required.
Asunto(s)
Infecciones por Clostridium/diagnóstico , Infecciones Comunitarias Adquiridas/diagnóstico , Creatinina/sangre , Infección Hospitalaria/diagnóstico , Insuficiencia Renal/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Infecciones Comunitarias Adquiridas/microbiología , Infección Hospitalaria/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Suero/químicaRESUMEN
INTRODUCTION: Various techniques are available for isolation of microorganism in cases of microbial keratitis including conventional methods of scraping, re-scraping inoculation in different media and corneal biopsy. METHODS: This was a cross sectional descriptive study conducted from February 2002 to July 2003. A total of 161 eyes of corneal ulcers were evaluated with scraping inoculation. Re-scraping and corneal biopsy were performed in those cases which did not grow any organism in the first scraping or which did not respond to initial treatment. RESULTS: Microorganisms were isolated in 116 patients (72.04%) after first scraping. S pneumoniae was seen in 50(42%), Fusarium in 21(18%) and Aspergillus in 16(14%) cases. Re-scraping was done in 22 culture negative and non improving cases of which 14 (63.63%) showed isolation of organisms. After re-scraping, Fusarium and Aspergillus were isolated in four patients each (18% each) followed by S. pneumoniae in 3 (14%), S. aureus in 2 (9%), and Penicillium in 1(5%) case. Corneal biopsy was done in 10 cases with isolation of microbial agents in 7 (70%) with Aspergillus and S. aureus in three each, and S. epidermidis in 1(10%). CONCLUSIONS: Apart from conventional scraping, other isolation techniques should be considered in the treatment of non-responding and culture negative cases of corneal ulcers. Compared to bacteria, fungi are difficult to isolate in the first scraping and requires more frequent repeat scraping and corneal biopsy.
Asunto(s)
Aspergillus/aislamiento & purificación , Úlcera de la Córnea/microbiología , Fusarium/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Técnicas Bacteriológicas , Niño , Preescolar , Úlcera de la Córnea/tratamiento farmacológico , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Micología/métodos , Penicillium/aislamiento & purificación , Staphylococcus aureus/aislamiento & purificación , Adulto JovenRESUMEN
BACKGROUND: Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications. AIM: To identify the pattern of ocular manifestation in herpes zoster ophthalmicus. MATERIALS AND METHODS: A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation. RESULTS: Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %. CONCLUSION: Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination.
Asunto(s)
Conjuntivitis Viral/epidemiología , Herpes Zóster Oftálmico/epidemiología , Queratitis Herpética/epidemiología , Uveítis/epidemiología , Adulto , Distribución por Edad , Anciano , Estudios Transversales , Femenino , Glaucoma/epidemiología , Glaucoma/virología , Humanos , Masculino , Persona de Mediana Edad , Neuralgia Posherpética/epidemiología , Factores de Riesgo , Uveítis/virología , Agudeza VisualRESUMEN
BACKGROUND: Definitive antifungal therapy is typically based on Candida species and clinical status, rather than susceptibility reports. Antifungal susceptibility testing is available, but the impact on treatment decisions is unknown. The purpose of this study was to assess antifungal therapy in hospitalized patients with candidaemia during the time period between the start of empirical therapy and after antifungal susceptibility testing reports are available. METHODS: A retrospective study of 161 hospitalized patients with candidaemia was conducted. Patients who received fluconazole or an echinocandin were evaluated for changes in empirical antifungal therapy prior to and after susceptibility reporting. RESULTS: One hundred and sixty-one patients aged 59â±â16 years (male, 54%; Caucasian, 52%; APACHE II score ≥ 15, 48%; and intensive care unit, 50%) were identified, of whom 130 (81%) had fluconazole-susceptible candidaemia. Fifty-eight patients (36%) were initiated on fluconazole and 103 (64%) on an echinocandin. The mean time from culture to the susceptibility report was 5â±â2 days. Prior to availability of the susceptibility report, 20 fluconazole-initiated patients (34%) were switched to an echinocandin, while 14 echinocandin-initiated patients (14%) were switched to fluconazole. Once a susceptibility report was available, 35 of 89 (39%) patients with fluconazole-susceptible candidaemia on an echinocandin were de-escalated to fluconazole. Eleven patients on fluconazole just prior to a susceptibility report were identified with a fluconazole-resistant Candida species. CONCLUSIONS: Using antifungal susceptibility testing, patients given fluconazole with fluconazole-resistant Candida species were identified. Less than 40% of echinocandin-treated patients with fluconazole-susceptible organisms were de-escalated to fluconazole. Antifungal susceptibility testing may help to identify patients in need of clinical intervention.
Asunto(s)
Antifúngicos/uso terapéutico , Candida/efectos de los fármacos , Candidemia/tratamiento farmacológico , Candidemia/microbiología , APACHE , Anciano , Antifúngicos/administración & dosificación , Caspofungina , Utilización de Medicamentos , Equinocandinas/administración & dosificación , Equinocandinas/farmacología , Equinocandinas/uso terapéutico , Femenino , Fluconazol/administración & dosificación , Fluconazol/uso terapéutico , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Lipopéptidos , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Estudios Retrospectivos , Factores de RiesgoRESUMEN
This prospective study examined bacterial colonization on writing pens touched by healthcare professionals and hospitalized patients with and without cleaning the pen with alcohol-based hand sanitizing agent after each patient visit. A significant reduction in potential healthcare-associated pathogens, especially Gram-positive cocci, was observed in the intervention group.
Asunto(s)
Bacterias/aislamiento & purificación , Fómites/microbiología , Personal de Salud , Pacientes , Alcoholes/farmacología , Desinfectantes/farmacología , Desinfección/métodos , Hospitales , Humanos , Estudios ProspectivosRESUMEN
BACKGROUND: A significant number of patients with HIV/AIDS can have ocular manifestations. Almost every structure in the eyes can be affected in this condition. OBJECTIVE: To study various ocular manifestations in the cases known to be infected with HIV. MATERIALS AND METHODS: A cross-sectional descriptive study was carried out including 117 subjects positive for HIV using the purposive sampling method. Their demographic pattern and ocular findings were studied. Findings were recorded in the pro forma developed for the study. STATISTICS: SPSS ver 14.0 was used for data analysis. The p value of < 0.05 was considered as significant. RESULTS: A total of 117 HIV infected cases were included in this study. Among them, 76 (64.95%) were male and 41 (35.05%) female. The mean age of the subjects was 30.04 +/- 11.32 years. The duration of HIV detection ranged from 1-5 years. Ocular complaints were present in 26.49% of the subjects. Ocular manifestations were present in 56% of the patients with complaints and in 27.3% of asymptomatic patients. Ocular involvement was seen in 55 (47%) patients. The common anterior segment findings were herpes zoster ophthalmicus (4.27%), anterior uveitis (2.56%), blepharitis (2.56%) and conjunctivitis (1.7%), whereas HIV retinopathy (19.6%), CMV retinitis (5.1%), ocular toxoplasmosis (2.5%) and presumed ocular tuberculosis (0.85%) were common posterior segment findings. CONCLUSION: Herpes zoster ophthalmicus, anterior uveitis, HIV retinopathy and CMV retinitis are common ocular manifestations associated with HIV infections.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Virales del Ojo/epidemiología , Infecciones por VIH/epidemiología , VIH , Adulto , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Nepal/epidemiología , Estudios RetrospectivosRESUMEN
Alport's syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed.
Asunto(s)
Nefritis Hereditaria/diagnóstico , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Nepal , Nefritis Hereditaria/cirugíaRESUMEN
BACKGROUND: Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease. OBJECTIVES: To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies. METHODS: A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted. RESULTS: A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 3.61 (+/- Standard deviation 0.50, range 3-4), 3.21 (+/- Standard deviation 0.63, range 2-4) and 3.67 (+/- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 4.3 (+/- Standard deviation 1.6, range 2.0-6.5), 5.8 (+/- Standard deviation 1.4, range 3-8) and 4.5 (+/- Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications. CONCLUSIONS: The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige's syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal.
Asunto(s)
Blefaroespasmo/tratamiento farmacológico , Toxinas Botulínicas Tipo A/uso terapéutico , Espasmo Hemifacial/tratamiento farmacológico , Síndrome de Meige/tratamiento farmacológico , Adulto , Anciano , Parpadeo/efectos de los fármacos , Toxinas Botulínicas Tipo A/administración & dosificación , Femenino , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Factores SocioeconómicosRESUMEN
BACKGROUND: Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent worldwide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC. OBJECTIVE: To determine level of immunoglobulin E (IgE) in the tear fi lm of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS). MATERIALS AND METHODS: Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro- capillary glass tube method and tear IgE levels were measured using an enzyme - linked immunosorbent assay (ELISA). RESULTS: There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically significant (p=0.16). No statistically significant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically significant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any significant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically significant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically significant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p=0.72). CONCLUSION: There was high concentration of tear IgE level observed in VKC.
Asunto(s)
Conjuntivitis Alérgica/inmunología , Inmunoglobulina E/análisis , Lágrimas/inmunología , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Preescolar , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Adulto JovenRESUMEN
Chronic renal failure affects every organ system including eye. The aim of this study is to conduct thorough ocular examination in the patients of chronic renal failure and to analyze the findings. 119 cases were collected from Nephrology unit of Tribhuvan University Teaching Hospital between 1st June 2002 to 15th December 2003. This was a cross sectional, descriptive type of study. Sampling technique was consecutive and stratified. Severity of renal disease was classified as mild, moderate, severe and end stage renal disease. Twenty-three percent of total 238 eyes had vision < 6/18. The causes for visual impairment were maculopathy 23 eyes, cataract 14 eyes followed by proliferative diabetic retinopathy, 9 eyes. Twelve percent of total eyes had vision < 6/60. Lid edema was present in 63.0%, conjunctival pallor in 75.6% and corneal calcification in 1.6%. Retinopathy was the most important finding. Hypertensive retinopathy was present in 56 out of total 119 cases (47.1%). It was more prevalent and tended to be more severe as renal disease progressed. This was statistically significant. Diabetic retinopathy was present in 38 out of 43 diabetic cases (88.3%). Although statistically not proven, more severe grades of diabetic retinopathy were detected with increasing severity of the renal disease. There was one case of bilateral serous detachment of the retina relating to chronic renal failure. In this study, 47 out of 56 cases of hypertensive retinopathy and 19 out of 38 cases of diabetic retinopathy were detected for the first time, thus showing the importance of ocular evaluation of the patients of renal insufficiency.
Asunto(s)
Oftalmopatías/etiología , Fallo Renal Crónico/complicaciones , Estudios Transversales , Oftalmopatías/diagnóstico , Oftalmopatías/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Índice de Severidad de la Enfermedad , Agudeza VisualRESUMEN
OBJECTIVE: To determine pattern of clinical presentation in Vernal Keratoconjunctivitis (VKC) in our context. METHODS: Thirty-four VKC patients were included in this study. RESULTS: The study revealed prepubertal onset with male preponderance and most frequently encountered symptom in the study among VKC cases was itching (100%) followed by redness of eyes and discharge (76.5% each) and the commonest sign was tarsal papillae (100%) followed by conjunctival hyperemia (91%) in 68 eyes of 34 cases of VKC. CONCLUSION: The clinical presentation of VKC cases in our country is very much similar to the findings of other parts of the world.
Asunto(s)
Conjuntivitis Alérgica/epidemiología , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Nepal/epidemiología , PrevalenciaRESUMEN
Retinal vein occlusion (RVO) is the second commonest vascular disease of the eye, second only to Diabetic Retinopathy. The association of the retinal vein occlusion with other systemic disease likes hypertension, diabetes mellitus and others has been well documented. With the increase in persons being affected from these disorders, patients with retinal vein obstruction are also increasing. Hence, a study was designed to evaluate all cases of RVO to find out its association with systemic disorders. A total of 100 patients (106 eyes) were enrolled in the study. Out of which, 66 cases reported to have Brach Retinal Vein Occlusion (BRVO) and rest 34 cases with Central Retinal Vein Occlusion (CRVO). Among the associated systemic diseases, hypertension and diabetes mellitus accounted for 84% cases. Isolated hypertension (54%) was most commonly seen followed by diabetes mellitus (8%). The prevalence of BRVO was almost twice as compared to CRVO. The high association of various systemic disorder especially Hypertension and diabetes further supports the need of early and periodic eye examination for those suffering from these disorders.