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Early effect of hydroxychloroquine therapy: relationship between cumulative dose and retinal thickness

Agarwal P, Wong YH, Das Gupta E, Agarwal R, Livingstone BI, Ramamurthy S, et al.

Cutan Ocul Toxicol, 2015;34(3):179-84.

PMID: 25068998 DOI: 10.3109/15569527.2014.938751

BACKGROUND: Hydroxychloroquine (HCQ) is widely used for long-term treatment of autoimmune diseases such as rheumatoid arthritis. However, its long-term use is known to be associated with visual changes due to retinal damage. Retinal damage associated with long-term HCQ therapy is preventable if the drug is discontinued early when the patients are still asymptomatic. In view of contrasting reports from previous studies, we investigated the association of prolonged HCQ therapy with retinal thickness in macular area.
METHODS: This study included 48 patients on long-term HCQ therapy and 38 healthy controls. All subjects underwent examination for corrected visual acuity, fundus photography, visual fields and SD-OCT for retinal thickness.
RESULTS: Visual acuity, visual fields, fundus photography and SD-OCT did not reveal changes consistent with diagnosis of established HCQ retinopathy in any of the subjects from HCQ group. Retinal thickness in central, parafoveal and perifoveal areas did not show significant differences between HCQ and control groups. However, we observed negative correlation between cumulative dose and retinal thickness in the parafoveal (p = 0.003) and perifoveal areas (p = 0.019) but not in the central area.
CONCLUSIONS: Correlation of cumulative dose with retinal thickness in parafoveal and perifoveal areas and not the central area is in accordance with the late appearance of HCQ-induced bull's eye retinopathy. Hence screening of asymptomatic patients using OCT seems to be of great importance for early detection of retinal changes.
KEYWORDS: Cumulative dose; OCT; hydroxychloroquine; retinal thickness

Matched MeSH terms: Tomography, Optical Coherence

Complete resolution of type B aortic intramural hematoma with medical treatment

Moorthy PS, Sakijan AS

Asian Cardiovasc Thorac Ann, 2014 Feb;22(2):231.

PMID: 24585805 DOI: 10.1177/0218492312468119

Matched MeSH terms: Tomography, X-Ray Computed

Evaluation of retinal nerve fiber layer thickness in eyes with hypertensive uveitis

Din NM, Taylor SR, Isa H, Tomkins-Netzer O, Bar A, Talat L, et al.

JAMA Ophthalmol, 2014 Jul;132(7):859-65.

PMID: 24789528 DOI: 10.1001/jamaophthalmol.2014.404

IMPORTANCE: Uveitic glaucoma is among the most common causes of irreversible visual loss in uveitis. However, glaucoma detection can be obscured by inflammatory changes.

OBJECTIVE: To determine whether retinal nerve fiber layer (RNFL) measurement can be used to detect glaucoma in uveitic eyes with elevated intraocular pressure (IOP).

DESIGN, SETTING, AND PARTICIPANTS: Comparative case series of RNFL measurement using optical coherence tomography performed from May 1, 2010, through October 31, 2012, at a tertiary referral center. We assigned 536 eyes with uveitis (309 patients) in the following groups: normal contralateral eyes with unilateral uveitis (n = 72), normotensive uveitis (Uv-N) (n = 143), raised IOP and normal optic disc and/or visual field (Uv-H) (n = 233), and raised IOP and glaucomatous disc and/or visual field (Uv-G) (n = 88).

EXPOSURES: Eyes with uveitis and elevated IOP (>21 mm Hg) on at least 2 occasions.

MAIN OUTCOMES AND MEASURES: Comparison of RNFL values between groups of eyes and correlation with clinical data; risk factors for raised IOP, glaucoma, and RNFL thinning.

RESULTS: Mean (SD) global RNFL was thicker in Uv-N (106.4 [21.4] µm) compared with control (96.0 [9.0] µm; P

Matched MeSH terms: Tomography, Optical Coherence

Fulltext Design process of cementless femoral stem using a nonlinear three dimensional finite element analysis

Baharuddin MY, Salleh ShH, Zulkifly AH, Lee MH, Noor AM, A Harris AR, et al.

BMC Musculoskelet Disord, 2014;15:30.

PMID: 24484753 DOI: 10.1186/1471-2474-15-30

Minimal available information concerning hip morphology is the motivation for several researchers to study the difference between Asian and Western populations. Current use of a universal hip stem of variable size is not the best option for all femur types. This present study proposed a new design process of the cementless femoral stem using a three dimensional model which provided more information and accurate analysis compared to conventional methods.

Matched MeSH terms: Multidetector Computed Tomography

Fulltext Coma due to malplaced external ventricular drain

Chai FY, Farizal F, Jegan T

Turk Neurosurg, 2013;23(4):561-3.

PMID: 24101284 DOI: 10.5137/1019-5149.JTN.5724-12.1

Ventriculostomy or external ventricular drain (EVD) placement by free-hand technique has a high malplacement rate. It is a blind procedure that often requires multiple attempts and revisions. To date, no neurological complication due to EVD malplacement has been reported in the literature. In this report, we present the first case of coma induced by a malplaced EVD and the patient regained consciousness after the drain was adjusted. Our discussion focused on various techniques that can improve the accuracy of EVD insertion. EVD insertion under image guidance provides better accuracy with limited disadvantages. We hypothesized that the patient's coma was due to the mass effect and irritation of the malplaced EVD exerted onto the ventral periaqueductal grey matter and the ascending neurons from upper brainstem.

Matched MeSH terms: Tomography, X-Ray Computed

The effect of excision of the posterior arch of C1 on C1/C2 fusion using transarticular screws

Chang KC, Samartzis D, Fuego SM, Dhatt SS, Wong YW, Cheung WY, et al.

Bone Joint J, 2013 Jul;95-B(7):972-6.

PMID: 23814252 DOI: 10.1302/0301-620X.95B7.30598

Transarticular screw fixation with autograft is an established procedure for the surgical treatment of atlantoaxial instability. Removal of the posterior arch of C1 may affect the rate of fusion. This study assessed the rate of atlantoaxial fusion using transarticular screws with or without removal of the posterior arch of C1. We reviewed 30 consecutive patients who underwent atlantoaxial fusion with a minimum follow-up of two years. In 25 patients (group A) the posterior arch of C1 was not excised (group A) and in five it was (group B). Fusion was assessed on static and dynamic radiographs. In selected patients CT imaging was also used to assess fusion and the position of the screws. There were 15 men and 15 women with a mean age of 51.2 years (23 to 77) and a mean follow-up of 7.7 years (2 to 11.6). Stable union with a solid fusion or a stable fibrous union was achieved in 29 patients (97%). In Group A, 20 patients (80%) achieved a solid fusion, four (16%) a stable fibrous union and one (4%) a nonunion. In Group B, stable union was achieved in all patients, three having a solid fusion and two a stable fibrous union. There was no statistically significant difference between the status of fusion in the two groups. Complications were noted in 12 patients (40%); these were mainly related to the screws, and included malpositioning and breakage. The presence of an intact or removed posterior arch of C1 did not affect the rate of fusion in patients with atlantoaxial instability undergoing C1/C2 fusion using transarticular screws and autograft.

Matched MeSH terms: Tomography, X-Ray Computed

A giant mastoid cholesteatoma with posterior cranial extension causing mass effect and obstructive hydrocephalus

Sabir BI, Rahmat K, Bux SI, Rajagopal NS, Looi LM, Sia SF

Clin Neurol Neurosurg, 2013 Oct;115(10):2192-6.

PMID: 23791432 DOI: 10.1016/j.clineuro.2013.05.023

Matched MeSH terms: Tomography, X-Ray Computed

Current status of diagnostic methods for henipavirus

Tamin A, Rota PA

Dev Biol (Basel), 2013;135:139-45.

PMID: 23689891 DOI: 10.1159/000189236

Hendra virus (HeV) and Nipah virus (NiV) are the causative agents of emerging transboundary animal disease in pigs and horses. They also cause fatal disease in humans. NiV has a case fatality rate of 40 - 100%. In the initial NiV outbreak in Malaysia in 1999, about 1.1 million pigs had to be culled. The economic impact was estimated to be approximately US$450 million. Worldwide, HeV has caused more than 60 deaths in horses with 7 human cases and 4 deaths. Since the initial outbreak, HeV spillovers from Pteropus bats to horses and humans continue. This article presents a brief review on the currently available diagnostic methods for henipavirus infections, including advances achieved since the initial outbreak, and a gap analysis of areas needing improvement.

Matched MeSH terms: Electron Microscope Tomography

Fulltext Bilateral atypical optic neuritis associated with tuberculosis in an immunocompromised patient

Jaafar J, Hitam WH, Noor RA

Asian Pac J Trop Biomed, 2012 Jul;2(7):586-8.

PMID: 23569976 DOI: 10.1016/S2221-1691(12)60102-6

A 27 year-old lady, presented with sudden loss of vision in the right eye for a week. It was followed by poor vision in the left eye after 3 days. It involved the whole entire visual field and was associated with pain on eye movement. She was diagnosed to have miliary tuberculosis and retroviral disease 4 months ago. She was started on anti-TB since then but defaulted highly active anti-retroviral therapy (HAART). On examination, her visual acuity was no perception of light in the right eye and 6/120 (pinhole 3/60) in the left eye. Anterior segment in both eyes was unremarkable. Funduscopy showed bilateral optic disc swelling with presence of multiple foci of choroiditis in the peripheral retina. The vitreous and retinal vessels were normal. Chest radiography was normal. CT scan of orbit and brain revealed bilateral enhancement of the optic nerve sheath that suggest the diagnosis of bilateral atypical optic neuritis. This patient was managed with infectious disease team. She was started on HAART and anti-TB treatment was continued. She completed anti-TB treatment after 9 months without any serious side effects. During follow up the visual acuity in both eyes was not improved. However, funduscopy showed resolving of disc swelling and choroiditis following treatment.

Matched MeSH terms: Tomography, X-Ray Computed

Mural nodules in multiple cavernous haemangioma

Nair SR, Rahmat K, Alhabshi SM, Ramli N, Seong MK, Waran V

Clin Neurol Neurosurg, 2013 Jul;115(7):1150-3.

PMID: 23031746 DOI: 10.1016/j.clineuro.2012.09.014

Matched MeSH terms: Tomography, X-Ray Computed

Small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses: a rare case

Tang IP, Singh S, Krishnan G, Looi LM

J Laryngol Otol, 2012 Dec;126(12):1284-6.

PMID: 23084156 DOI: 10.1017/S0022215112002435

We report a rare case of small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses with intracranial extension, and discuss the management of this rare tumour.

Matched MeSH terms: Tomography, X-Ray Computed

Clinical clues for head injuries amongst Malaysian infants: accidental or non-accidental?

Thalayasingam M, Veerakumarasivam A, Kulanthayan S, Khairuddin F, Cheah IG

Injury, 2012 Dec;43(12):2083-7.

PMID: 22424957 DOI: 10.1016/j.injury.2012.02.010

Identifying the differences between infants with non-accidental head injuries (NAHI) and accidental head injuries (AHI) may help alert clinicians to recognize markers of abuse. A retrospective review of infants <1 year of age admitted to a tertiary referral centre in Malaysia over a two year period with a diagnosis of head injury or abnormal computed tomography head scans was conducted to identify the clinical features pointing towards a diagnosis of NAHI by comparing the socio-demographics, presenting complaints, clinical features and the extent of hospital investigations carried out. NAHI infants were more likely to be symptomatic, under a non-related caregiver's supervision, and presented with inconsistent or no known mechanism of injury. Subdural haemorrhages were more common in NAHI infants. The history, mechanism of injury, presenting signs and symptoms as well as the nature of the injuries sustained are all valuable clues as to whether a head injury sustained during infancy is likely to be accidental or not.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Rhino-orbito-cerebral mucormycosis in an immunocompetent patient: case report and review of literature

Shatriah I, Mohd-Amin N, Tuan-Jaafar TN, Khanna RK, Yunus R, Madhavan M

Middle East Afr J Ophthalmol, 2012 Apr-Jun;19(2):258-61.

PMID: 22623872 DOI: 10.4103/0974-9233.95269

Rhino-orbito-cerebral mucormycosis is a fungal infection that can be fatal especially in immunocompromised patients. It is extremely rare in immunocompetent individuals. We describe here an immunocompetent patient who survived rhino-orbito-cerebral mucormycosis due to Saksenaea vasiformis, and provide a literature review of this rare entity.

Matched MeSH terms: Tomography, X-Ray Computed

Velopharyngeal and choanal stenosis after radiotherapy for nasopharyngeal carcinoma

Hussein J, Tan TS, Chong AW, Narayanan P, Omar R

Auris Nasus Larynx, 2013 Jun;40(3):323-6.

PMID: 22652485 DOI: 10.1016/j.anl.2012.05.004

Choanal stenosis is a well recognized late complication of radiotherapy for nasopharyngeal carcinoma. However velopharyngeal stenosis post radiotherapy for nasopharyngeal carcinoma is rare. We present here a case of bilateral choanal stenosis and velopharyngeal stenosis in a patient treated with radiotherapy for nasopharyngeal carcinoma. A 58-year-old woman presented to our otolaryngology clinic with a one year history of nasal obstruction. She was diagnosed to have nasopharyngeal carcinoma 12 years ago for which she received radiotherapy. Clinical examination revealed bilateral choanal stenosis and velopharyngeal stenosis. Treatment of choanal stenosis and velopharyngeal stenosis is challenging due to high incidence of recurrence and patients frequently require multiple procedures. The patient underwent a transnasal endoscopic excision of velopharyngeal scar tissue and widening of posterior choana using Surgitron®, mitomycin-C applied topically to the surgical wound and bilateral stenting under general anesthesia. The stents were kept for two weeks, and 3 years post operation velopharyngeal aperture and posterior choana remained patent. As illustrated in this case velopharyngeal stenosis can occur after radiotheraphy and should not be overlooked. Combine modality of transnasal endoscopic excision of velopharyngeal scar tissue, widening of choanal stenosis with Surgitron® followed by the application of mitomycin-C and stenting has been shown to be an effective option.
Study site: ENT clinic, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia

Matched MeSH terms: Tomography, X-Ray Computed

Extensive facial and orbital infantile hemangiomas associated with high intraocular pressure

Shatriah I, Norazizah MA, Wan-Hitam WH, Wong AR, Yunus R, Leo SW

Pediatr Dermatol, 2013 Jan-Feb;30(1):151-4.

PMID: 22329437 DOI: 10.1111/j.1525-1470.2011.01618.x

High intraocular pressure is a rare ophthalmic condition associated with infantile hemangiomas that involves the orbit, eyelid, or both. Here, we describe a patient with extensive facial and orbital infantile hemangiomas associated with high intraocular pressure in the affected eye. The prompt management of this challenging condition is essential.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext Branch retinal vein occlusion associated with quetiapine fumarate

Yong KC, Kah TA, Ghee YT, Siang LC, Bastion ML

BMC Ophthalmol, 2011;11:24.

PMID: 21867521 DOI: 10.1186/1471-2415-11-24

To report a case of branch retinal vein occlusion in a young adult with bipolar mood disorder treated with quetiapine fumarate.

Matched MeSH terms: Tomography, Optical Coherence

Ultrasonic plaque echolucency and emboli signals predict stroke in asymptomatic carotid stenosis

Topakian R, King A, Kwon SU, Schaafsma A, Shipley M, Markus HS, et al.

Neurology, 2011 Aug 23;77(8):751-8.

PMID: 21849657 DOI: 10.1212/WNL.0b013e31822b00a6

Better methods are required to identify patients with asymptomatic carotid stenosis (ACS) at risk of future stroke. Two potential markers of high risk are echolucent plaque morphology on carotid ultrasound and embolic signals (ES) in the ipsilateral middle cerebral artery on transcranial Doppler ultrasound (TCD). We explored the predictive value of a score based on these 2 measures in the prospective, observational, international multicenter Asymptomatic Carotid Emboli Study.

Matched MeSH terms: Tomography, X-Ray Computed

Fulltext A mimicry of melioidosis by Klebsiella ozaenae infection

Ng TH, How SH, Kuan YC, Adzura, Aziz AA, Fauzi AR

Malays J Pathol, 2009 Dec;31(2):147-50.

PMID: 20514860 MyJurnal

Klebsiella ozaenae is a Gram negative bacillus. It has been described as a colonizer of oral and nasopharyngeal mucosa and is a cause of atrophic rhinitis. Klebsiella ozaenae has seldom been isolated from serious infections. However, several reports have stated that Klebsiella ozaenae may cause invasive infections and even mortality. We report a 55-year-old man with Klebsiella ozaenae infection causing abscesses involving the right eye and left kidney and possibly also in the brain, lungs and prostate. The isolates were sensitive to ceftazidime, ciprofloxacin, chloramphenicol, gentamicin and sulfamethoxazole-trimethoprim but resistant to ampicillin. He responded well to 4 weeks of i.v. ceftazidime and i.v. amoxycillin-clavulanic acid. To our knowledge, such a multiorgan infection has not been reported previously for this organism.

Matched MeSH terms: Tomography, X-Ray Computed

Endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone production as a rare cause of ocular hypertension

Khaw KW, Jalaludin MY, Suhaimi H, Harun F, Subrayan V

J AAPOS, 2010 Aug;14(4):356-7.

PMID: 20637667 DOI: 10.1016/j.jaapos.2010.04.009

Ocular hypertension caused by endogenous Cushing syndrome from an ectopic adrenocorticotropic hormone-producing tumor is rare. We report an 11-year-old boy who presented with intraocular pressures (IOPs) of 50 mm Hg in both eyes. Surgical resection of the tumor was performed with subsequent normalization of serum cortisol and IOP levels.

Matched MeSH terms: Tomography, X-Ray Computed

Pansinusitis causing bilateral optic neuritis in a 9-year-old child

Bashkaran K, Shatriah I, Zunaina E, Bakiah S, Sakinah Z

Orbit, 2009;28(6):377-9.

PMID: 19929663 DOI: 10.3109/01676830903104678

Sinusitis is a rare cause of optic neuritis in children. This case illustrates bilateral optic neuritis in a 9-year-old child caused by pansinusitis. It demands an accurate diagnosis with a prompt management. A proper treatment of sinusitis is essential to prevent this complication.

Matched MeSH terms: Tomography, X-Ray Computed

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