Acute Bilateral Ophthalmoparesis with Pupilary Areflexical Mydriasis in Miller-Fisher Syndrome Treated with Intravenous Immunoglobulin

Miller-Fisher syndrome (MFS) is a rare condition characterized by the classical triad of ophthalmoplegia, ataxia, and areflexia (Fisher, 1956). It is considered a variant of Guillain-Barré syndrome (GBS) with which it may overlap, or it can occur in more limited forms. We report a case of a thirty-five-year-old male who presented with a six-day history of diplopia, following a recent chest infection. On examination, he was found to have bilateral sixth nerve palsy, bilateral fourth nerve palsy, bilateral areflexical mydriasis, ataxia and total absence of reflexes. After excluding other conditions, a diagnosis of Miller-Fisher syndrome was made. The patient was administered intravenous immunoglobulin and made an uneventful recovery

Candida albicans keratitis in an immunocompromised patient

H Mohammed J Hassan1, Theocharis Papanikolaou2, Georgios Mariatos1, Amany Hammad3, Hala Hassan41Ophthalmology Department, Barnsley Hospital NHS Foundation Trust, South Yorkshire, England, UK; 2Ophthalmology Department, Cambridge University Hospitals NHS Foundation Trust, England, UK; 3Ophthalmology Department, Rotherham Hospital NHS Foundation Trust, England, UK; 4Corneal and External Disease Service, Moorfields Eye Hospital NHS Foundation Trust, London, England, UKPurpose: When investigating a case of unexplained corneal ulceration, we need to think of fungal infection and any predisposing factors.Methods: A case study of a corneal ulceration in a patient who was HIV positive with a devastating visual outcome.Results: Therapeutic corneal graft was necessary due to corneal perforation. Immunocompromised state of patient was retrospectively diagnosed.Conclusions: Candida albicans keratitis is an opportunistic infection of a compromised cornea, and sometimes unknowingly compromised host, which can be initially misdiagnosed. Despite intensive antifungal therapy, occasionally patients require corneal grafting to improve vision, and before it is possible to establish an accurate diagnosis.Keywords: fungal keratitis, corneal perforation, keratoplasty, human immunodeficiency virus, HI

Evaluation of patients’ adherence in accordance with guidelines for Peripheral Arterial Disease management

Introduction: Peripheral Arterial Disease (PAD) is a serious chronic disease of the lower limb circulatory system as it affects the activity daily living and reduces patients’ quality of life. Usually, patients have low adherence to medication and guidelines. Aim: To access patients’ adherence and attitude, after being given instructions for medication and guidelines on the modifiable risk factors. Methods: It is a descriptive cross-sectional observational study, with a sample of 101 patients, hospitalized in the vascular surgery ward of a tertiary hospital in Crete. Data were collected using a research datasheet that was constructed for the purpose of this study, following the current guidelines for PAD management. Also, the Medication Adherence Self-Efficacy Scale (MASES-R) questionnaire was used. For the statistical analysis, the IBM SPSS 20.0 program was used with a significance level set to p<0,05. Results: Among 101 patients, 78 patients (77,2%) were men. The mean age was 69(+13,5) years. Body Mass Index (BMI) was 29(+5,2). From 72 patients (71,3%) who were smokers, despite of recommendations, 41 (41,8%) were non-compliant and continued smoking. Only 15.8% were fully aware (5/5 correct answers) of their disease. The 52,5% of patients did not take their medication themselves. Intermittent claudication in the first 50 meters of walking was found in 70,4% of the sample. There was a statistically significant correlation between the period (in years) that patients suffered from diabetes mellitus and the occurrence of peripheral neuropathy (p=0,038). A negative correlation between patients’ age and disease awareness was observed (Δ= -0,344. p<0,001 Somers’ d). Conclusions: Adherence to the guidelines deviates significantly from what is recommended, as patients were unable to follow a lot of the instructions given by healthcare professionals. Therefore, nurses should initially focus on adequate patients’ education about their disease. Interventions such as scheduled patient monitoring, weight loss programs and smoking cessation programs should be implemented, to achieve improved adherence, aiming to a greater decrease in morbidity

Evidence for warm and humid Mid-Holocene in the Aegean and northern Levantine seas (Greece, NE Mediterranean).

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