Continuous administration of voriconazole enhances therapeutic effect for recalcitrant fungal keratitis

Purpose To evaluate the therapeutic effect of incorporating continuous administration of voriconazole in the treatment of recalcitrant fungal keratitis. Methods In this prospective case study, 5 consecutive patients (5 eyes) with fungal keratitis were treated with a standard protocol after the failing maximal conventional medical treatment. The protocol involved continuous lavage of the ulcer with 1% voriconazole through an irrigator for 2 h, twice a day, combined with local and systemic antifungals. Visual acuity, slit lamp findings of the ulcer, and fungal hyphae density by confocal microscope were documented, respectively. Results In 4 patients, the clinical symptoms and slit lamp examination were significantly improved after only 3 days of treatment. The hyphae were shown to decrease in number and morphologically fragmented in corneal stroma by confocal microscopy. After the infection was controlled, 2 cases required further keratoplasty. In one case, the treatment was deemed ineffective and a conjunctival flap had to be created to help control the infection. In all 5 patients, the best spectacle-corrected visual acuity had improved after treatment. With more than 3 months of follow-up, no recurrence of infection was seen in any cases. Conclusion Our treatment protocol demonstrated improvement in the treatment of clinically resistant fungal keratitis. Continuous lavage of voriconazole is easy to be implemented and well-tolerated by patients. Modification of the current protocol should be further explored to optimize the therapeutic effectiveness in future.

Paediatric retropharyngeal abscess with potts spine — A rare case

Tubercular retropharyngeal abscess along with potts spine is very rare in children. As there is no specific sign and symptoms of tuberculosis are present and even if present can be masked by features of nretropharyngeal abscess these cases may have delay in diagnosis. Early diagnosis is important to start proper treatment and can prevent the disability and mortality. In this article we report a case where a child presented to our opd with complaint of right sided neck swelling, dysphagia and neck pain with restricted movement. Any symptoms or signs of tuberculosis were not present. Clinical examination and MRI of neck suggested this as a case of retropharyngeal abscess with cervical spine involvement. Intraoral surgical drainage of pus sent for CBNAAT examination and it revealed the diagnosis of tuberculosis. Antitubercular regimen was given for 12 months. During follow up his symptoms gradually improved and after 1 and 2 year follow up child was free from tuberculosis. So in conclusion we can say retropharyngeal abscess in child should be dealt promptly and in case of abcesses refractory to conventional medical treatment, high degree of suspicion of tuberculosis should have present especially in endemic countries in order to reduce morbidities and improve clinical outcome. Early diagnosis and treatment can improve the scenario significantly.

Hyperbaric Oxygen Therapy for Carbon Monoxide Poisoning can Lead a Perfect Result: A Case Report

Carbon monoxide poisoning (COP) is a common emergency worldwide, especially in the wintertime. It is known to cause serious morbidities, resulting in high mortality risk. COP is also reported to result in neurological complications for which hyperbaric oxygen therapy is likely to offer some benefits, which certainly makes it one of the potential treatment modalities. Here, Case in the paper is of a 64-year-old female patient with carbon monoxide poisoning. Her neurological symptoms nearly disappeared after the application of hyperbaric oxygen therapy (HBOT) and conventional medical treatment. Our case guides for the key role of HBOT in the treatment process of a 64-year-old female patient with COP. Our clinical experience revealed that hyperbaric oxygen therapy could successfully reverse the symptoms of delayed neurological findings caused by COP, a serious and preventable health problem.

A Comparative Study between the Efficacy of Intratympanic Steroid Injection and Conventional Medical Treatment in Resistant Cases of Otitis Media with Effusion

Introduction Otitis media with effusion (OME) is a multifactorial disease and the treatment options for it are limited and controversial. The aim of the present study was to compare the efficacy of intratympanic steroid injection and conventional medical treatment in resistant cases of OME with hearing loss. Materials and Methods A comparative study was conducted among 20 patients of OME with hearing loss, resistant to conventional medical treatment between December 2019 to November 2020. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks to one group and the other group continued to receive medical treatment. Hearing was assessed by performing pure tone audiogram before every ITDI and also at 12 weeks follow up after completion of treatment. Results Hearing improvement was found to be better in the group which received ITDI (Mean AC-PTA hearing gain = 22.88 dB) than the group where conventional medical treatment was continued (Mean AC-PTA hearing gain = 6.83 dB). Conclusion Intratympanic dexamethasone injection has significantly better outcome in term of improvement of hearing loss in resistant cases of OME than conventional medical management, and is an effective and safe therapy.

Nutrition Education Toolbox for Hidradenitis Suppurativa

Diet has been shown to influence disease activity in hidradenitis suppurativa (HS). Modification of dietary intake is the most commonly used lifestyle intervention in HS, and patients frequently report HS improvement after implementing dietary changes. Providing nutrition education may be perceived as not feasible within the time constraints of an outpatient office visit, and many physicians may also not feel equipped to do this. In addition, most insurances have limited coverage for nutrition visits. However, dietary changes may be employed as a low-cost adjunctive treatment option that can be combined with conventional medical treatment to mitigate HS symptoms. Though dietary modification has been increasingly recognized as a commonly used and influential factor in HS management, there is no comprehensive HS nutritional guide. Herein, we provide tools for both physicians and patients to facilitate evidence-based nutrition education in HS through collaboration with dermatologists specializing in HS, a registered dietitian, and a culinary specialist.

Spinal cord stimulator for neuropathic pain in a patient with severe disability due to transverse myelitis

Transverse myelitis is an inflammatory disease of the central nervous system that disrupts nerve signals’ conduction. The illness is characterised by weakness in the lower limbs accompanied by paresthesia and urinary and bowel incontinence. The most disabling sequel is the onset of chronic neuropathic pain, which can severely limit the patient’s independence and negatively affect her quality of life. We present the case of a patient who received a spinal neurostimulator after a failure of conventional medical treatment. Masking pain through paresthesia, a mechanism provided by the device significantly reduces pain perception. The treatment success in our patient represents an advance in pain therapy.

Radioprotective natural products as alternative complements in oncological radiotherapy

Humans when exposed to harmful ionising radiations suffer from various pathophysiological disorders including cancer. Radiotherapy is a treatment where these cancerous cells within a tumor are targeted and killed by means of high energy waves. This therapy is very expensive and involves highly sophisticated instruments. In addition to this, most synthetic radioprotectors including Amifostine have been found to possess toxicity. This led researchers to develop a novel, economically viable, and efficient therapeutic alternative to radiation therapy. The last two decades have observed a major shift towards investigating natural products as radioprotectors, as these are immensely effective in terms of their potential bioequivalence relative to many of the established synthetic compounds available. Taking into account the limitations of radiation therapy, an approach ‘Integrative Oncology’ that involves a combination of both traditional and conventional medical treatment are used nowadays to treat patients suffering from cancer and associated mental and psychological disorders.

Effectiveness of ozone therapy in addition to conventional treatment on mortality in patients with COVID-19

Aim In this study, we aimed to investigate the effectiveness of ozone therapy, which is one of the integrative medicine applications that has been used safely for many years, on the prevalence of mortality in patients receiving COVID-19 treatment. Methods This was a prospective, controlled study conducted on patients with COVID-19 who were hospitalized in Health Sciences University, Haydarpasa Numune Training and Research Hospital. In this study, 55 patients were included. The patients were divided into two groups as the ozone group and the control group. Ozone therapy (major autohemotherapy) was applied to 37 patients who were being treated with the appropriate COVID-19 treatment protocol determined by the infectious diseases committee of our hospital. The ozone treatment protocol consisted of seven sessions (1 session/day) of intravenous ozone administration, applied in a volume of 100 mL and a concentration of 30 μg/mL. Only the conventional COVID-19 treatment protocol was applied to 18 patients in the control group. Clinical follow-up was performed until the discharge of the patients from the hospital with successful treatment or until the mortality occurred. Factors affecting mortality were analyzed using univariate regression analysis. Results Intensive care unit (ICU) hospitalization was required in six of 37 patients who were treated with ozone (16.2%), while four of 18 patients in the control group required ICU treatment (22.2%) (p = 0.713). When the mortality rates between the two groups were compared, mortality was lower in the ozone group (p = 0.032). As a result of univariate logistic regression analysis performed to determine the factors affecting mortality, treatment without ozone therapy was determined as a risk factor for mortality (OR:0.149, 95%CI 0.026-0.863, p=0.034). Conclusion In this study, we demonstrated that administration of ozone therapy along with the conventional medical treatment in patients hospitalized for COVID-19 could reduce mortality.

Maintaining access to maternal fetal medicine care by telemedicine during a global pandemic

Objective This study aims to compare a conventional medical treatment model with a telehealth platform for Maternal Fetal Medicine (MFM) outpatient care during the global novel coronavirus pandemic. Methods In this study, we described the process of converting our MFM clinic from a conventional medical treatment model to a telemedicine platform. We compared clinical productivity between the two models. Outcomes were analysed using standard statistical tests. Results We suffered three symptomatic COVID-19 infections among our clinical providers and staff prior to the conversion, compared with none after the conversion. We had a significant decrease in patient visits following the conversion (53.35 visits per day versus 40.3 visits per day, p < 0.0001). However, our average daily patient visits per full-time equivalent (FTE) were only marginally reduced (11.1 visit per FTE versus 7.6 visits per FTE, p < 0.0001), resulting in a relative decrease in adjusted work relative value units (6987 versus 5440). There was an increase in more basic follow-up ultrasound procedures, complexity (current procedural technology [CPT] code 76816 (10.7% versus 19.5%, relative risk [RR] 1.81, 95% CI 1.60–2.05, p < 0.0001)) over comprehensive follow-up ultrasound procedures, CPT code 76805 (17.2% versus 7.8%, RR 0.46, 95% CI 0.39–0.53, p < 0.0001) after conversion. Despite similar proportions of new consults, there was an increase in the proportion of follow-up visits and medical decision-making complexity evaluation and management CPT codes (e.g. 99214/99215) after the conversion (17.2% versus 24.6%, RR 1.43, 95% CI 1.26–163, p < 0.0001). There were no differences between amniocentesis procedures performed between the two time periods (0.3% versus 0.2%, p = 0.5805). Conclusion The rapid conversion of an MFM platform from convention medical treatment to telemedicine platform in response to the novel coronavirus pandemic resulted in protection of healthcare personnel and MFM patients, with only a modest decrease in clinical productivity during the initial roll-out. Due to the ongoing threat from the novel coronavirus-19, an MFM telemedicine platform is a practicable and innovative solution and merits the continued support of CMS and health care administrators.