Dr. Tushar Kumar discusses the profiling, examination, diagnostic testing, and management of various types of corneal ulcers. Key points include:
1. A thorough history and physical exam is important to categorize ulcers as infectious, non-infectious, and determine etiology. Signs and symptoms provide clues to common infectious causes.
2. Examination includes visual acuity, slit lamp evaluation of the eyelids, conjunctiva, cornea and anterior chamber. Features of the ulcer like size, depth and borders are noted.
3. Diagnostic testing depends on severity and response to initial treatment, and may include cultures, smears, biopsy or imaging to identify organism or guide management
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
This presentation describes the background of the cornea and the corneal diseases in general, also it describes in detailed manner how to manage the corneal ulcer with its different causes
fungal / mycotic corneal ulcer power point presentation for O.A 2nd year stud...Vinitkumar MJ
Belong suborder Acanthopodina and the genus Acanthamoeba
• Family of free-living cyst-forming protozoans that are ubiquitous in air, soil, dust and water.
• 11 species of which A. Castellanii and A. polyphaga are the most common in keratitis
• Life cycle consist of motile trophozoite and cyst dormant stage
fungal / mycotic corneal ulcer power point presentation for O.A 2nd year stud...Vinitkumar MJ
Belong suborder Acanthopodina and the genus Acanthamoeba
• Family of free-living cyst-forming protozoans that are ubiquitous in air, soil, dust and water.
• 11 species of which A. Castellanii and A. polyphaga are the most common in keratitis
• Life cycle consist of motile trophozoite and cyst dormant stage
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
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QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
4. HISTORY TAKING
Talk to patient to find out the Etiology of the ulcer.
Enquire about Pain.
Superficial > Deep
Excruciating: Acanthameoba (Radial Keratoneuritis)
Absent: Fungal
Sudden relief: Perforation
Redness
16. Cornea
Epithelium, including defects and punctate keratopathy,
edema, epithelial movement patterns
Stroma, including ulceration, thinning, perforation,
infiltrate and edema
Endothelium (endothelial plaque)
Foreign body, including sutures
17. Satellite lesions
Signs of corneal dystrophies
Previous corneal inflammation (thinning, scarring, or
neovascularization)
Signs of previous corneal or refractive surgery
28. DIAGNOSTIC TESTS
CULTURES AND SMEARS
Indications
Corneal infiltrate is central, large, and/or is associated with significant
stromal involvement or melting
Infection is chronic or unresponsive to broad-spectrum antibiotic therapy
History of corneal surgeries
Atypical clinical features are present that are suggestive of fungal,
amoebic, or mycobacterial keratitis
Infiltrates are in multiple locations on the cornea
29.
30.
31. CORNEAL BIOPSY & DEEP STROMAL CULTURE
Indications
Response to treatment is poor
Repeated cultures have been negative and the clinical picture continues
to suggest an infective etiology
Infiltrate is located in the mid or deep stroma with overlying
uninvolved tissue
Organisms were identified by culture in 42% of corneal biopsies and
identified on histopathological examination in 40% of cases.
Younger JR, Johnson RD, Holland GN, Page JP, Nepomuceno RL, Glasgow BJ, Aldave AJ, Yu F, Litak J, Mondino BJ, Service UC.
Microbiologic and histopathologic assessment of corneal biopsies in the evaluation of microbial keratitis. American journal of
ophthalmology. 2012 Sep 1;154(3):512-9.
32. CORNEAL IMAGING
Scanning laser confocal microscopy is used to image the various
levels of the cornea from the epithelium through stroma to the
endothelium in vivo.
Optical coherence tomography may also be helpful in
determining depth of involvement
RANDOM BLOOD SUGAR
35. Contd…
Central or severe keratitis (e.g., deep stromal
involvement or an infiltrate larger than 2 mm with
extensive suppuration), a loading dose every 5–15
minutes followed by frequent applications hourly is
recommended.
Fortified topical antibiotics(cefta+ …..) should be
considered for large or visually significant corneal
infiltrates, especially if a hypopyon is present. Also for
eyes non responsive to initital therapy.
36. Corticosteroids:
Advantages:
Suppression of inflammation, which may reduce subsequent
corneal scarring and associated visual loss
Disadvantages:
Recrudescence of infection
Local immunosuppression
Inhibition of collagen synthesis predisposing to corneal
melting
Increased intraocular pressure
37. Contd…
SCUT treatment study found no benefit of concurrent topical
corticosteroid therapy using prednisolone phosphate 1% in
conjunction with broad-spectrum topical antibiotic.*
Benefit for using corticosteroids in Pseudomonas keratitis and in
more severe cases of bacterial keratitis.**
Treatment of Nocardia keratitis with corticosteroids resulted in
poor visual outcomes.**
Srinivasan M, Mascarenhas J, Rajaraman R, Ravindran M, Lalitha P, Glidden DV, Ray KJ, Hong KC, Oldenburg CE, Lee SM, Zegans
ME. Corticosteroids for bacterial keratitis: the Steroids for Corneal Ulcers Trial (SCUT). Archives of ophthalmology. 2012 Feb
1;130(2):143-50.
Lalitha P, Srinivasan M, Rajaraman R, Ravindran M, Mascarenhas J, Priya JL, Sy A, Oldenburg CE, Ray KJ, Zegans ME, McLeod SD.
Nocardia keratitis: clinical course and effect of corticosteroids. American journal of ophthalmology. 2012 Dec 1;154(6):934-9.
*:
**:
38. Conservative approach would avoid prescribing
corticosteroid treatment for presumed bacterial ulcers
until
Organism has been identified
Epithelial defect is healing
Ulcer is consolidating
Cycloplegics: Decrease synechiae formation and pain,
and are indicated when substantial anterior chamber
inflammation is present.
Antiglaucoma drugs( If IOP )
39. FUNGAL ULCER
Topical E/D Natamycin 5% (Fusarium) 1hrly upto 48 hrs
Topical E/D Voriconazole 1-2% / E/D Amphotericin B 0.15%(Candida)
(Treatment to be continued for 3 months)
Oral Antifungals
Indications:
Near Limbus
Suspected Endophthalmitis
Tab Voriconazole 400mg 1 bd x 1 day f/b 200mg 1 bd
Tab Itraconazole 200 mg 1 od
Oral Tetracyclin(Doxycycline 100 mg bd): Anticollagenase
Antigalucoma drugs( If IOP ) )
Intracameral antifungal injection (enlarging endothelial exudation
with stable corneal infiltration)
40. VIRAL ULCERS
Topical E/O Aciclovir 3% 5 times a day
Topical E/O Ganciclovir 0.15% 5 times a day
Debridement (Resistant cases)
Epithelium removed 2mm from the ulcer edge
Oral therapy
Aciclovir 200-400 mg 5 times a day
Valacyclovir 500 md bd 7-10 days
Indications
Immunosuppressed
Children
Ocular surface disease
41. Contd…
Interferon therapy
Monotherapy not beneficial
Combination with debridement or nucleoside antiviral speeds healing
Cycloplegics ( E/D Homide 2%) od/bd
Topical antibiotics variably recommended
IOP control ( Prostaglandin analogues are
CONTRAINDICATED)
42. PARASITIC ULCERS (ACANTHAMOEBA)
Treatment in based on eradication of cysts.
1st Line (Cysticidal):
E/D Chlorhexidine (0.02%) & polyhexamethylene biguanide (0.02%)
(Hourly initially for few days f/b qid for 4-6 wks)
Clinical resistant patients: E/D Chorhexidine 0.04-0.06%
49. SUPERIOR LIMBIC
KERATOCONJUNSTIVITIS OF
THEODORE
Classic sign:
B/L local hyperemia of superior bulbar conjunctiva
which appears keratinized, thickened and redundant
Papillary reaction with hyperemia: Opposing
palpebral conjunctiva
Fine fluoresceine staining +