Mooren’s ulcer
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Marginal corneal ulcer, also known as Mooren's ulcer, is a rare degenerative ulcer that starts at the corneal margin and spreads circumferentially and axially over the cornea. It is a rapidly progressive and painful ulcerative keratitis that can only be diagnosed in the absence of a systemic cause. It must be differentiated from other corneal abnormalities. Benign cases are unilateral, respond well to treatment, and affect elderly people, while malignant cases are bilateral, respond poorly to treatment, and affect younger people in a progressive manner. It is considered an autoimmune disorder associated with infections and various theories about antigen-antibody reactions and molecular mimicry stimulating an autoimmune response.
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This document summarizes several common pediatric eye conditions seen by Dr. Mona Hussein. It discusses conditions such as conjunctivitis (bacterial, viral, allergic), refractive errors, amblyopia, strabismus, and others. For each condition, it provides details on symptoms, signs, investigations, and treatment approaches. The document is intended to inform specialists about evaluating and managing these common eye issues in children.
Postoperative complication of penetrating keratoplasty
This document summarizes various early and delayed postoperative complications that can occur following penetrating keratoplasty (corneal transplant surgery) and their management. Early complications discussed include suture-related problems, wound leaks, epithelial defects, inflammation, iris incarceration, graft failure, glaucoma, and infections. Delayed complications mentioned are graft rejection, infectious crystalline keratopathy, corneal membranes, cataract formation, and recurrence of the original corneal disease. Treatment approaches for each complication are also provided.
Dr.veni priya acute conj 10.02.16
This document discusses the classification and types of acute conjunctivitis. It is classified based on onset (acute, sub-acute, chronic), type of exudate (serous, catarrhal, mucopurulent, purulent, pseudo-membranous), and etiology (infectious, non-infectious). The types discussed include bacterial (purulent, gonococcal, membranous, angular), viral, chlamydial, and ophthalmia neonatorum. For each type, the etiology, clinical features, complications, and treatment are described. Risk factors like dry eye, nutritional deficiencies, and immune deficiencies that can lead to acute conjunctivitis are also summarized
Dr.veni priya acute conj 10.02.16
This document discusses the classification and types of acute conjunctivitis. It is classified based on onset (acute, sub-acute, chronic), type of exudate (serous, catarrhal, mucopurulent, purulent, pseudo-membranous), and etiology (infectious, non-infectious). The types of acute conjunctivitis discussed include bacterial (purulent, gonococcal, membranous, angular), viral, chlamydial, and ophthalmia neonatorum. For each type, the etiology, clinical features, complications, and treatment options are provided.
Dr.veni priya acute conj 10.02.16
This document discusses the classification and types of acute conjunctivitis. It is classified based on onset (acute, sub-acute, chronic), type of exudate (serous, catarrhal, mucopurulent, purulent, pseudo-membranous), and etiology (infectious, non-infectious). The types discussed include bacterial (purulent, gonococcal, membranous, angular), viral, chlamydial, and ophthalmia neonatorum. For each type, the etiology, clinical features, complications, and treatment are described. Risk factors like dry eye, nutritional deficiencies, and immune deficiencies that can lead to acute conjunctivitis are also summarized
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Desquamative gingivitis
This document provides information on various conditions that can present as desquamative gingivitis, including their signs, symptoms, pathogenesis, histopathology and treatment. Oral lichen planus, pemphigoid, pemphigus vulgaris, chronic ulcerative stomatitis, linear IgA disease and lupus erythematosus are discussed in detail. The document also covers erythema multiforme and provides an overview of the differential diagnosis and evaluation of desquamative gingivitis.
Eczema - A Case Presentation (by Dr. Julius King Kwedhi)
Eczema: Come from the Greek name for boiling, a reference to the tiny vesicles (bubbles) that are commonly seen in the early acute stage of the disease
An immune-mediated inflammation of the skin arising from an interaction between genetic (e.g. epidermal barrier function, immune system) and environmental factors (foods, airborne allergens, Staphylococcus aureus colonization on skin due to deficiencies in endogenous antimicrobial peptides, topical products)
The eczemas are a disparate group of diseases, but unified by the presence of itch and, in the acute stages, of oedema (spongiosis) in the epidermis
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This document discusses bacterial keratitis and corneal ulcers. It defines bacterial keratitis as any corneal inflammation caused by bacteria, and a corneal ulcer as bacterial keratitis accompanied by a loss of epithelium. It then lists common bacterial causes and describes characteristics of infections caused by different bacteria. The document provides guidance on diagnosing, treating, and managing bacterial keratitis and corneal ulcers.
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This document summarizes different types of allergic conjunctivitis including acute, seasonal, and perennial allergic conjunctivitis. It also discusses phlyctenular keratoconjunctivitis, vernal keratoconjunctivitis (VKC), atopic keratoconjunctivitis (AKC), non-allergic eosinophilic conjunctivitis, contact allergic blepharoconjunctivitis, and giant papillary conjunctivitis. For each type, it describes the etiology, clinical presentation, signs, complications, and treatment approaches. Management involves identifying and removing allergens, using mast cell stabilizers, antihistamines, NSAIDs, topical
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Ophthalmology 5th year, 3rd lecture (Dr. Bakhtyar)
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1. Imaging plays an important role in the evaluation and management of patients with acute stroke.
2. Different imaging modalities such as CT, CT angiography, CT perfusion, MRI, MR angiography, and MR perfusion have benefits for assessing the brain parenchyma, vasculature, perfusion, and identifying potentially salvageable penumbral tissue.
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Gestational diabetes mellitus
Gestational diabetes (GDM) is glucose intolerance that begins or is first recognized during pregnancy. It can be caused by either pre-existing type 2 diabetes or a new onset of diabetes during pregnancy. The document discusses screening, diagnosis and management of both pre-existing diabetes and GDM during pregnancy. It aims to provide optimal glucose control to support fetal growth while avoiding risks of hyper- and hypoglycemia. Treatment involves medical nutrition therapy, glucose monitoring and may require insulin therapy in some cases. Close monitoring is needed throughout pregnancy and postpartum to support maternal and fetal health.
Gestational trophoblastic diseases
Gestational trophoblastic disease is a heterogeneous group of lesions arising from abnormal placental trophoblast proliferation. It includes premalignant conditions like complete and partial hydatidiform moles, as well as malignant gestational trophoblastic neoplasia (GTN). GTN has varying potential for local invasion and metastasis. While rare, GTN is highly curable even with widespread dissemination. Treatment involves chemotherapy, with single or multi-agent regimens depending on risk factors and disease stage according to the FIGO scoring system. Careful monitoring of beta-hCG levels is important for diagnosis and follow-up.
Heart failure
This document provides an overview of heart failure, including different types (e.g. acute vs chronic, systolic vs diastolic), biomarkers used to monitor patients, standard treatment options like diuretics and ACE inhibitors, newer drugs in development, and management challenges like high treatment costs. It uses the analogy of a donkey to describe escalating medical interventions for heart failure, from initial diuretic use to more aggressive ionotropes or devices like LVADs for end-stage cases. The document highlights biomarkers that can guide discharge decisions and newer biomarkers being explored, as well as newer drugs and devices in development or use such as CRT devices, ECLS, and LVADs.
Scorpion sting
A 14-year-old boy presented to the emergency department with symptoms of an autonomic storm after being bitten by a scorpion. He was diagnosed with scorpion sting in autonomic storm. He was given prazosin, hydrocortisone, and other supportive treatments. His condition stabilized and he was discharged after 6 days. Scorpion stings can cause local effects and a systemic autonomic storm response due to neurotoxins that affect sodium channels and induce catecholamine release. Prazosin is an effective treatment as it blocks alpha receptors and counters the effects of venom.
Sarcoidosis and IgG4
Sarcoidosis and IgG4-related diseases are inflammatory conditions characterized by granuloma formation. Sarcoidosis is a multisystem disorder involving lungs in over 90% of cases and skin, eyes, and liver in about a third of patients each. It is thought to be triggered by an infectious or environmental agent in a genetically susceptible host. IgG4-related disease is a fibroinflammatory condition that can affect virtually any organ, forming tumefactive lesions. Treatment for both conditions typically involves corticosteroids, with immunosuppressants used for chronic or resistant cases.
Neuropathic pain understanding and management
1. The document discusses diabetic neuropathy, including its classification, clinical characteristics, underlying mechanisms, investigations and pharmacological treatment.
2. Key points include that diabetic neuropathy has many subtypes and involves both large and small nerve fibers. The clinical features progress from negative symptoms like loss of sensation to positive symptoms like pain. Investigations include electrodiagnostic testing and skin or nerve biopsies.
3. Treatment involves first-line options like duloxetine, pregabalin and TCAs. Polypharmacy with combinations from different classes may be considered for refractory cases. Factors like comorbidities, side effects, costs and drug interactions must be evaluated when selecting an individual's treatment plan.
Optimizing heart failure management
Cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can help optimize heart failure management. CRT improves symptoms, reduces hospitalizations, and increases survival in patients with reduced ejection fraction, left bundle branch block, and wide QRS duration. ICDs prevent sudden cardiac death in high-risk patients with prior heart failure, low ejection fraction, or history of dangerous arrhythmias. New devices use adaptive and multi-point pacing to better resynchronize the left ventricle. Device therapy improves outcomes when guided by clinical evidence and used in appropriate heart failure patients.
Kawasaki disease
Kawasaki disease is an autoimmune disease that causes inflammation in blood vessels throughout the body. It was first described in 1967 by Dr. Kawasaki in Japan. It most commonly affects children under 5 years old. Without treatment, it can lead to fatal coronary artery aneurysms in some children. The cause is unknown but likely involves genetic and environmental factors such as a viral or bacterial infection. Diagnosis is based on symptoms that include prolonged fever and changes in lips, mouth, hands and feet. Echocardiograms are used to check for heart complications which include aneurysms and heart valve issues.
bedside approach to common congenital heart diseases
This document summarizes common congenital heart diseases, their presentations, and physical exam findings. It discusses how conditions like ventricular septal defect (VSD), atrial septal defect (ASD), patent ductus arteriosus (PDA), pulmonary stenosis (PS), and tetralogy of Fallot (TOF) can present in neonates, infants, children or adolescents with symptoms like cyanosis, heart failure, or murmurs. Physical exam findings for each condition are provided to help determine the location and nature of cardiac lesions.
Atrial fibrillation
This document provides an overview of atrial fibrillation (AF), including its pathogenesis, types, diagnosis, and management. Some key points:
- AF is the most common cardiac arrhythmia, affecting around 6% of those over 65. It increases the risk of stroke.
- It occurs when the normal sinus rhythm is overridden by disorganized electrical impulses, usually originating in the lungs.
- Types include paroxysmal, persistent, and permanent. Symptoms range from none to palpitations, dyspnea, chest pain, and neurological issues.
- Diagnosis is made via ECG showing irregular rhythm without P waves. Workup evaluates for underlying causes and stroke risk factors.
Infective endocarditis
Infective endocarditis is a microbial infection of the heart valves or endocardium. It is characterized by the formation of vegetations composed of platelets, fibrin, microorganisms, and inflammatory cells. It occurs more commonly in males and the elderly. Streptococci and Staphylococcus aureus are the most common causes. Diagnosis involves blood cultures, echocardiography, and applying the Duke criteria. Complications include embolisms, heart failure, and metastatic infections. Treatment involves prolonged antibiotic therapy targeted to the infecting organism. Surgery may be needed for complications or uncontrolled infection. Antibiotic prophylaxis is now restricted to highest risk patients undergoing highest risk procedures.
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Mooren’s ulcer
- 2. It is a rare, degenerative, superficial ulcer, starting at the corneal margin and spreading circumferentially and axially over the whole of this tissue. It is a rapidly progressive, painful, ulcerative keratitis It can be only be diagnosed in the absence of systemic cause and must be differentiated from other corneal abnormlities such as,Terriens degeneration.
- 4. BENIGN /TYPICAL Unilateral Reponds well to treatment Elderly people MALIGNANT Bilateral Very poorly responds to treatment Younger people progressive
- 6. It is an auto immune disorder. Associated with infections- helminthiasis, hepatitisC, herpes simplex and zoster. Various theories The antigen antibody reaction to infectious toxin deposited in the peripheral cornea causes inflammation and ulceration.
- 7. Molecular mimicry may be involved, stimulating an auto immune response. Deposition of immune complex over peripheral cornea Other causes: Physical trauma, foreign bodies, chemical burns, surgeries such as cataract extraction and keratoplasty.
- 8. Auto immune lysis of the epithelium with release of collagenolytic enzymes. Grey infiltrates , which break down, forming small ulcers that spread and coalesce. It destroys the epithelium and superficial stromal lamellae, forming a whitish overhanging edge, while the base quickly becomes vascularised.
- 9. severe and persistent neuralgic pain. Redness Photophobia Lacrimation Decrease in visual acuity due to associated iritis, central corneal involvement and irregular astigmatism.
- 11. CBC with differentials ESR RF Complement fixation ANA,ANCA & circulating immune complexes VDRL, FTA-ABS Urine analysis
- 12. Topical steroids and antibiotics Excision of a 4-7 mm strip of adjacent conjunctiva may prove successful by eliminating conjunctival sources of collagenase , proteoglycanase and other inflammatory mediators. Perforation: ulcer debridement cyanoacrylate adhesive soft contact lenses. Lamellar keratoplasty with i.v methotrexate – halt the process