scholarly journals RefractoryScedosporium apiospermumKeratitis Successfully Treated with Combination of Amphotericin B and Voriconazole

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Mohd-Tahir Fadzillah ◽  
Siti-Raihan Ishak ◽  
Mohtar Ibrahim

Aim. To report a case of refractory fungal keratitis caused byScedosporium apiospermum.Methods. Interventional case report.Results. A 47-year-old Malay housewife presented with left eye cornea ulcer as her first presentation of diabetes mellitus. There was no history of ocular trauma, contact lens used, or cornea foreign body.Scedosporium apiospermumwas isolated from the cornea scrapping. Her cornea ulcer initially responded well to topical Amphotericin B within 3 days but subsequently worsened. Repeat cornea scrapping also yieldsScedosporium apiospermum. This refractory keratitis was successfully treated with a combination of topical Amphotericin B and Voriconazole over 6 weeks.Conclusion.Scedosporium apiospermumkeratitis is an opportunistic infection, which is difficult to treat despite tight control of diabetes mellitus and intensive antifungal treatment. The infection appeared to have very quick onset but needed long duration of treatment to completely heal. Surgical debridement always plays an important role as a therapeutic procedure as well as establishes the diagnosis through repeat scrapping.

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
A. Altun ◽  
S. A. Kurna ◽  
T. Sengor ◽  
G. Altun ◽  
O. O. Olcaysu ◽  
...  

Purpose. To present the success of posaconazole in two cases with recalcitrant fugal keratitis that were resistant to conventional antifungal drugs.Method. We presented two cases that were treated with posaconazole after the failure of fluconazole or voriconazole, amphotericin B, and natamycin therapy. Case 1 was a 62-year-old man with a history of ocular trauma. He had been using topical fluorometholone and tobramycin. His best corrected visual acuity (BCVA) was hand motion. He had 5.0 × 4.5 mm area of deep corneal ulcer with stromal infiltration. Case 2 was a 14-year-old contact lens user. He had been using topical moxifloxacin, tobramycin, and cyclopentolate. His BCVA was 20/200. He had a 4.0 × 3.0 mm area of pericentral corneal ulcer with deep corneal stromal infiltration and 2 mm hypopyon.Results. Both patients initially received systemic and topical fluconazole or voriconazole and amphotericin B and topical natamycin that were all ineffective. But the response of posaconazole was significant. After posaconazole, progressive improvement was seen in clinical appearance. BCVA improved to 20/100 in case 1 and 20/40 in case 2.Conclusion. Posaconazole might be an effective treatment option for recalcitrant fusarium keratitis and/or endophthalmitis resistant to conventional antifungal drugs.


2019 ◽  
Vol 6 (5) ◽  
pp. 1549
Author(s):  
Mohammed Hillu Surriah ◽  
Amir Naif Kadum Al-Imari ◽  
Amine Mohammed Bakkour ◽  
Riad Rahman Jallod Al-Asadi

Background: Diabetic foot disease is a foot that exhibits any pathology that results directly from diabetic mellitus or any long-term chronic complication of diabetes mellitus. The aim of the study was to determine the risk factors and indications for amputations among diabetics.Methods: this clinical prospective study includes 120 diabetic foot patients admitted to AL- Karama teaching hospital from 1st January 2015 to 1st January 2019. All patients assessed for age, gender, duration of diabetes, hyperglycemia at admission and control of diabetes, history of smoking, hypertension, assess dominant foot and examination of diabetic foot lesion and classify it according to Meggit-Wagner grading status, indications for amputation and outcome.Results: The male to female ratio was 2:1. Most frequent age group of patients treated by amputation was between 50-80 years. Among patients treated with amputation (68.33%) of patients had diabetes mellitus for 11-20 years. From patients admitted with diabetic foot (53.33%) were smokers. Regarding hypertension (93.33%) of all patients were hypertensive. It was noted that (65%) of patients lesion occur in dominant foot Regarding Wagner's grading system (36.66%) of patients were grade 4 followed by grade 1 (21.66%). regarding mode of treatment (53.33%) of patients treated by amputation and other treated conservatively. Only 3 patients from 60 died while other discharged well after complete treatment.Conclusions: Increasing in age, long duration of diabetes mellitus, poor control of diabetes, smoking and occurrence of lesion in dominant foot all considered as a significant risk factors for increase liability amputation.


2019 ◽  
Vol 6 (5) ◽  
pp. 1372
Author(s):  
Sanjay Parihar ◽  
Rajesh Singh

Background: Depression can be viewed as a modifiable independent risk factor for the development of T2DM and for progression of complications from either type 1 or type 2 diabetes. The recognition and addressal of this association can have profound implications for prevention and treatment of these disorders. Objectives of this study the prevalence of depression among patients with diabetes mellitus type 2.Methods: A semi-structured questionnaire was used to collect the sociodemographic profile and the details of the diabetes and its treatment and history of other chronic diseases. Beck depression inventory (BDS-II) was used for evaluation of depression and 8 item Morisky medication adherence scale (MMAS-8) was used for measurement of patient’s adherence to medication.Results: Majority of the potential cases of depression (33%) were in the age group of 51-60 years. 62% of the patients were male. Majority of the patients (40%) were in the age group of 51-60 years. 73.4% of the married patients were potential cases of depression. 78% of the patients were having family history of type 2 diabetes mellitus. Majority of the patients (72%) were overweight or obese (BMI> 25kg/m2).Conclusion: Duration of diabetes and duration of treatment was 5-10 years in majority of the patients and were significantly associated with prevalence of depression. Prevalence of depression was associated with sex, religion, and family history but was not statistically significant.


Author(s):  
Dr. Nicholas Gaeto, PGY 2, ◽  
Dr. Glenn Goodwin, PGY 2, D.O. ◽  
Mara Seat, OMS III

A 51-year-old female with a past medical history of poorly controlled diabetes mellitus presented to the emergency department with signs of emphysematous cystitis and pyelonephritis with associated Enterococcus faecalis bacteremia and Candida Glabrata (C.Glabrata) fungemia. She was treated with micafungin and amoxicillin with improvement in her symptoms. During her course she underwent repeat imaging which showed improvement in her cystitis and no obstruction in her bladder. She was discharged on home IV micafungin. She returned to the emergency department the next day with acute urinary obstruction and was found to have a completely obstructing mucus ball in her bladder. This was removed cystoscopically and surgical cultures grew C. glabrata. She was successfully treated with intra-vesicular amphotericin B and was discharged.


1970 ◽  
Vol 7 (2) ◽  
pp. 34-38 ◽  
Author(s):  
J Kishan ◽  
K Garg

Introduction: Tuberculosis and Diabetes mellitus are two public health problems which not only often coexist but have serious implications on each other. DM has an impact on symptomatology, radiological presentation, diagnosis and management of TB. TB has a significant impact on DM, causing unmasking of DM and poor control because of stress or because of drug treatment for TB. Present study attempts to assess this coexistence with regard to the age predisposition, sex preponderance, duration and glycemic control of diabetes and the radiological presentations. Materials and Methods: 100 patients presenting to the Department of Tuberculosis and Chest Diseases, Government Medical College, Patiala, who were suffering from both Tuberculosis and Diabetes Mellitus, were studied. Various parameters considered included age, sex, history of diabetes with regard to the duration and the glycemic control and the radiological presentations. Results: It was found that majority were males (61/100). The age group most commonly involved was the 40-60year group (76/100). Majority had their Diabetes diagnosed before the diagnosis of Tuberculosis (57/100), 23 had diagnosis after TB diagnosis, and 20 simultaneously with TB diagnosis. Out of these 57 diagnosed diabetics, 11 patients had controlled diabetes whereas 46 (87.1%) had uncontrolled diabetes. 32 patients had the typical radiological lesions while 68 had atypical presentations with either lower lobe involvement, multi lobe involvement, cavitations or shadows fanning out from the hilum. Conclusion: TB and DM often coexist together and adversely effect each other. Both need to be managed properly in order to achieve favorable treatment outcome. Key Words: TB; DM DOI: 10.3126/saarctb.v7i2.4404SAARC J. TUBER. LUNG DIS. HIV/AIDS 2010 VII(2) 34-38


Author(s):  
Pojala Kumar ◽  
Ravi Shankar K. ◽  
Krishnakanth K. ◽  
Jagadeesh Alla

Background: Diabetes Mellitus (DM) is one of the most challenging public health problems. It is important to know about the awareness level of a disease condition in a population, which plays a vital role in future development, early detection and prevention of disease.Methods: A total of 200 subjects were interviewed and their details were noted in a specially designed data collection form. The questionnaire contained a series of questions related to demographic characteristics and awareness of DM including general knowledge, risk factors and complications of diabetic and non-diabetic patients.Results: Among 150 subjects were diabetic and 50 were non-diabetic. 60 (40%), 14(28%) of diabetics and non- diabetics were between the age of 41-50. 101 (67.3%) were male, 49 (32.6%) were female. 101 (67.3%) of the study participant had family history of diabetes in diabetic. 45 (44.5%) diabetic, 20 (40.81%) non-diabetic male knows the risk factor for diabetes mellitus and 35 (34.6%), 21 (42.8%) were aware of symptoms, 09(8.9%), 03(6.1%) awareness on complication of diabetes. 21 (20.7%), 06 (12.2%) doesn’t know about Risk factors.Conclusions: The present study conclude a current situation of knowledge and awareness of diabetes mellitus and also emphasizes the need for improvement in knowledge and awareness on diabetes mellitus among the diabetic as well as non-diabetic subjects in order to achieve prevention and better control of diabetes risk factors, complications and its management.


2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.


Author(s):  
Mulia Mayangsari

 Individuals who have a family history oftype 2 diabetes mellitus (DM) have a highrisk for type 2 diabetes. Type 2 diabetescan be prevented by improving modifiablerisk factors, supported by self-awareness,perceptions and attitudes of individualswho have a high family history of DM. Thisstudy used a qualitative phenomenologicaldesign. A Purposive Sampling techiniquewas applied to determine individuals whohad parents with type 2 diabetes. Nineindividuals participated in this study. AQualitative content analysis with Collaiziapproach used as a data analysis method.The main themes depicted individuals selfawareness,perceptions, & attitudes were:denials that diabetes caused by heredityfactors; misperception about diabetes;“traditional modalities” as a preventionmeasurement toward type 2 diabetes; andDM is perceived as a “threatening disease”.Further study is needed to examine indepth the themes that have been identifiedon the number of participants are morenumerous and varied.


2019 ◽  
Vol 16 (1) ◽  
pp. 40-46
Author(s):  
Rui Guo ◽  
Ruiqi Chen ◽  
Chao You ◽  
Lu Ma ◽  
Hao Li ◽  
...  

Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.


2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Inés Urrutia ◽  
◽  
Alicia Martín-Nieto ◽  
Rosa Martínez ◽  
J Oriol Casanovas-Marsal ◽  
...  

AbstractThe aim of this study was to estimate the incidence of diabetes mellitus in the Basque Country and the risk factors involved in the disease by reassessing an adult population after 7 years of follow-up. In the previous prevalence study, 847 people older than 18 years were randomly selected from all over the Basque Country and were invited to answer a medical questionnaire, followed by a physical examination and an oral glucose tolerance test. In the reassessment, the same variables were collected and the resulting cohort comprised 517 individuals of whom 43 had diabetes at baseline. The cumulative incidence of diabetes was 4.64% in 7 years and the raw incidence rate was 6.56 cases/1000 person-years (95%CI: 4.11–9.93). Among the incident cases, 59% were undiagnosed. The most strongly associated markers by univariate analyses were age > 60 years, dyslipidaemia, prediabetes and insulin resistance. We also found association with hypertension, obesity, family history of diabetes and low education level. Multivariate analysis adjusted for age and sex showed that a set of risk factors assessed together (dyslipidaemia, waist-to-hip-ratio and family history of diabetes) had great predictive value (AUC-ROC = 0.899, 95%CI: 0.846–0.953, p = 0.942), which suggests the need for early intervention before the onset of prediabetes.


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