10 research outputs found
Blepharitis
Blepharitis is a very common and under-appreciated
eyelid margin condition which causes non-specific ocular
irritation, significant patient distress. Chronic blepharitis is
often difficult to manage. The true prevalence of blepharitis
is difficult to estimate; figures cited in the literature range
from 12%-79% due to the different ways how blepharitis may
manifest itself and ill-defined diagnostic criteria.peer-reviewe
Sudden bilateral loss of vision in a 19-year-old man
Introduction: Posterior Reversible
Leukoencephalopathy Syndrome (PRES) is caused by
ischaemia commonly affecting the posterior cerebral
vasculature. It presents with sudden decreased vision,
headaches, nausea, vomiting, seizures, and altered
mental status.
Case presentation: A 19-year-old male presented to
the ophthalmic emergency complaining of sudden
bilateral loss of vision, which was down to light
perception He reported headaches, nausea, and
drowsiness since the previous day. He was a known case
of hypertension secondary to IgA nephropathy.
Magnetic resonance imaging (MRI) with STIR and
FLAIR sequences showed foci of hyperintensity within
the occipital lobes bilaterally. This confirmed the
suspected diagnosis of PRES. Discussion: Aetiological factors of PRES include
sudden increase in blood pressure, eclampsia, porphyria,
renal disease, and Cushing syndrome. These lead to
blood-brain barrier injury either by hyper- or hypoperfusion,
endothelial dysfunction, changes in blood
vessel morphology, hypocapnea, or immune system
activation. Histopathological changes in PRES include
activated astrocytes, scattered macrophages and
lymphocytes, often in the absence of inflammation or
neuronal damage.
Conclusion: PRES is usually a reversible neuroophthalmological
condition, however prompt
recognition and appropriate management is important to
prevent permanent brain injury or even death.peer-reviewe
Primary CNS lymphoma with intravitreal metastasis : using vitreous cavity samples to monitor response to therapy
A fifty-eight year old male patient presented to the
ophthalmic department with a 3 day history of reduced
visual acuity, blurred vision and floaters, associated with
recent lethargy, headaches and behavioural changes.
Fundal examination revealed a bilateral vitritis. Steroid
therapy was started. MRI of the brain revealed multiple
hypodense and hyperdense lesions. Vitrectomy was
performed in view of the poor response to steroids. A
biopsy showed non-hodgkin B-Cell lymphoma. The
patient was started on intravenous Methotrexate and
Cytarabine. Repeat vitreous cavity biopsies were
performed in order to assess response to therapy. All
biopsies to date have revealed evidence of on-going
lymphoma.peer-reviewe
Can pterygium excision with mitomycin C leaving bare sclera be salvaged?
Purpose
The aim of this study was to analyze the recurrence rate of pterygium following excision with intra-operative mitomycin C (MMC) and post-operative scraping of the perilimbal conjunctival defect, and the patients’ satisfaction with this technique.
Methods
This is a retrospective analysis of a cohort of 33 eyes of 28 patients with primary or recurrent pterygium who underwent simple excision with MMC. They were followed up after a mean of 27.8 months. The main outcomes considered were the recurrence rate and patient satisfaction. A recurrence was defined as any regrowth of conjunctiva over the limbus and any complications were considered significant. The patients were interviewed with a standard questionnaire and examined.
Results
An objective recurrence was noted in 55% (18 out of 33 eyes). The recurrence rate after excision of primary pterygia was 46% (13 out of 28 eyes), and for recurrent pterygia it was 80% (four out of five eyes). In this study the complications included: six eyes that developed a granuloma, one case of bleeding which persisted for three days post-op, and one eye in which there was a suspected scleral melt at five weeks. 79% of the procedures resulted in a good patient satisfaction (26 out of 33 eyes), and only in 15% (five eyes) was there a subjective recurrence.
Conclusions
This technique in our study resulted in an unacceptably high recurrence rate, especially in the case of recurrent pterygia. However patients still tended to be satisfied with the outcome.peer-reviewe
Young pregnant women's views on the acceptability of screening for chlamydia as part of routine antenatal care
<p>Abstract</p> <p>Background</p> <p>In pregnancy, untreated chlamydia infection has been associated with adverse outcomes for both mother and infant. Like most women, pregnant women infected with chlamydia do not report genital symptoms, and are therefore unlikely to be aware of their infection. The aim of this study was to determine the acceptability of screening pregnant women aged 16-25 years for chlamydia as part of routine antenatal care.</p> <p>Methods</p> <p>As part of a larger prospective, cross-sectional study of pregnant women aged 16-25 years attending antenatal services across Melbourne, Australia, 100 women were invited to participate in a face-to-face, semi structured interview on the acceptability of screening for chlamydia during pregnancy. Women infected with chlamydia were oversampled (n = 31).</p> <p>Results</p> <p>Women had low levels of awareness of chlamydia before the test, retained relatively little knowledge after the test and commonly had misconceptions around chlamydia transmission, testing and sequelae. Women indicated a high level of acceptance and support for chlamydia screening, expressing their willingness to undertake whatever care was necessary to ensure the health of their baby. There was a strong preference for urine testing over other methods of specimen collection. Women questioned why testing was not already conducted alongside other antenatal STI screening tests, particularly in view of the risks chlamydia poses to the baby. Women who tested positive for chlamydia had mixed reactions, however, most felt relief and gratitude at having had chlamydia detected and reported high levels of partner support.</p> <p>Conclusions</p> <p>Chlamydia screening as part of routine antenatal care was considered highly acceptable among young pregnant women who recognized the benefits of screening and strongly supported its implementation as part of routine antenatal care. The acceptability of screening is important to the uptake of chlamydia screening in future antenatal screening strategies.</p
The ProPrems trial: investigating the effects of probiotics on late onset sepsis in very preterm infants
BACKGROUND: Late onset sepsis is a frequent complication of prematurity associated with increased mortality and morbidity. The commensal bacteria of the gastrointestinal tract play a key role in the development of healthy immune responses. Healthy term infants acquire these commensal organisms rapidly after birth. However, colonisation in preterm infants is adversely affected by delivery mode, antibiotic treatment and the intensive care environment. Altered microbiota composition may lead to increased colonisation with pathogenic bacteria, poor immune development and susceptibility to sepsis in the preterm infant.Probiotics are live microorganisms, which when administered in adequate amounts confer health benefits on the host. Amongst numerous bacteriocidal and nutritional roles, they may also favourably modulate host immune responses in local and remote tissues. Meta-analyses of probiotic supplementation in preterm infants report a reduction in mortality and necrotising enterocolitis. Studies with sepsis as an outcome have reported mixed results to date.Allergic diseases are increasing in incidence in "westernised" countries. There is evidence that probiotics may reduce the incidence of these diseases by altering the intestinal microbiota to influence immune function. METHODS/DESIGN: This is a multi-centre, randomised, double blinded, placebo controlled trial investigating supplementing preterm infants born at < 32 weeks' gestation weighing < 1500 g, with a probiotic combination (Bifidobacterium infantis, Streptococcus thermophilus and Bifidobacterium lactis). A total of 1,100 subjects are being recruited in Australia and New Zealand. Infants commence the allocated intervention from soon after the start of feeds until discharge home or term corrected age. The primary outcome is the incidence of at least one episode of definite (blood culture positive) late onset sepsis before 40 weeks corrected age or discharge home. Secondary outcomes include: Necrotising enterocolitis, mortality, antibiotic usage, time to establish full enteral feeds, duration of hospital stay, growth measurements at 6 and 12 months' corrected age and evidence of atopic conditions at 12 months' corrected age. DISCUSSION: Results from previous studies on the use of probiotics to prevent diseases in preterm infants are promising. However, a large clinical trial is required to address outstanding issues regarding safety and efficacy in this vulnerable population. This study will address these important issues. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN012607000144415The product "ABC Dophilus Probiotic Powder for Infants®", Solgar, USA has its 3 probiotics strains registered with the Deutsche Sammlung von Mikroorganismen und Zellkulturen (DSMZ--German Collection of Microorganisms and Cell Cultures) as BB-12 15954, B-02 96579, Th-4 15957
Chlamydia trachomatis Incidence and Re-Infection among Young Women – Behavioural and Microbiological Characteristics
This study aimed to estimate rates of chlamydia incidence and re-infection and to investigate the dynamics of chlamydia organism load in prevalent, incident and re-infections among young Australian women.1,116 women aged 16 to 25 years were recruited from primary care clinics in Australia. Vaginal swabs were collected at 3 to 6 month intervals for chlamydia testing. Chlamydia organism load was measured by quantitative PCR.There were 47 incident cases of chlamydia diagnosed and 1,056.34 person years of follow up with a rate of 4.4 per 100 person years (95% CI: 3.3, 5.9). Incident infection was associated with being aged 16 to 20 years [RR = 3.7 (95%CI: 1.9, 7.1)], being employed [RR = 2.4 (95%CI: 1.1, 4.9)] and having two or more new sex partners [RR = 5.5 (95%CI: 2.6, 11.7)]. Recent antibiotic use was associated with a reduced incidence [RR:0.1 (95%CI: 0.0, 0.5)]. There were 14 re-infections with a rate of 22.3 per 100 person years (95%CI: 13.2, 37.6). The median time to re-infection was 4.6 months. Organism load was higher for prevalent than incident infections (p<0.01) and for prevalent than re-infections (p<0.01).Chlamydia is common among young women and a high proportion of women are re-infected within a short period of time, highlighting the need for effective partner treatment and repeat testing. The difference in organism load between prevalent and incident infections suggests prevalent infection may be more important for ongoing transmission of chlamydia