Ocular Mucous Membrane Research Articles

Detection and Isolation of Peste-des-petits Ruminants Virus (PPRV) Infection in Sheep and Goats

PPR also known as goat plague is an acute highly contagious disease of sheep and goats characterized by fever, catarrhal inflammation of ocular and nasal mucous membrane and diarrhea. The present study was conducted for molecular detection and isolation of Peste des petits ruminants (PPR) virus in sheep and goats in Punjab region. A total of 150 samples; ocular (25), nasal (25) and rectal swabs (25) separately from sheep and goats were collected. These samples were subjected to Reverse Transcriptase-PCR for molecular detection of PPR virus. Out of 75 samples from 25 goats, three samples (4%) were found positive for F gene by RT-PCR and all the samples from sheep were negative for PPR virus. PPR virus was isolated from one sample using vero cell line.

A 10-Year Review of the Management of Ocular Mucous Membrane Pemphigoid: A Private Practice Experience.

Ocular mucous membrane pemphigoid (OcMMP) is a rare and potentially blinding condition for which consensus treatment guidelines do not exist. The purpose of this study was to assess the effectiveness and safety of various immunomodulatory agents in the treatment of OcMMP in a private practice setting. We conducted a 10-year retrospective chart review of patients managed with OcMMP (n = 22). The median age at diagnosis was 73 (range: 35-91) years, and 59% (13/22) of patients were female. Visual acuity, Foster stage, and adverse effects (AEs) were documented. Treatment outcomes for each treatment episode were qualified at 3 months as complete response (CR), response (R), or failure (F). After 3 months, CR was then further subqualified as sustained CR, reactivation after initial CR, or AE after initial CR. The Fisher exact test P values were calculated for each outcome in comparison with mycophenolate. Twenty patients were treated with an immunomodulatory agent for a total of 55 treatment episodes. In comparison to dapsone, mycophenolate was more likely to achieve sustained CR (50% vs. 0%, P = 0.022) and R (100% vs. 50%, P = 0.007), and less likely to fail (0% vs. 50%, P = 0.007). Dapsone was also more likely to be discontinued because of AEs than mycophenolate (40% vs. 6%, P = 0.041). Mycophenolate is a superior first-line agent to dapsone in the treatment of OcMMP. Although not statistically significant, mycophenolate trends toward superiority over methotrexate as well. Mycophenolate is very effective when used in combination with rituximab. Azathioprine remains a reasonable second-line agent.

Utility of Direct Immunofluorescence Using Buccal Mucosal Biopsies in Those with Suspected Isolated Ocular Mucous Membrane Pemphigoid

To determine the rate of positivity of immunofluorescence studies in buccal biopsies in patients with cicatrizing conjunctivitis undergoing workup for ocular mucous membrane pemphigoid (MMP)/ocular cicatricial pemphigoid (OCP). Retrospective cohort review. Forty-one patients with cicatrizing conjunctivitis undergoing workup for OCP. A retrospective chart review of direct immunofluorescence (DIF) studies in buccal mucosal biopsies was performed. The primary outcome measure was the rate of positivity of direct and indirect immunofluorescence studies on buccal mucosal biopsies. Twenty-two patients (54%) had a positive buccal mucosal biopsy; 64% of patients (14/22) demonstrated+DIF on initial biopsy and an additional 36% of patients (8/22) on the second biopsy. Eighteen patients underwent conjunctival biopsy. In the 6 patients with a negative conjunctival biopsy, 4 (67%) had a positive buccal biopsy. Buccal mucosal immunofluorescence studies may be positive in patients with OCP even in the absence of extraocular disease. Buccal mucosal biopsy may be considered as an alternative to or attempted before conjunctival biopsy for the diagnosis of OCP, particularly in patients in whom conjunctival biopsy may be difficult or imminently visually threatening.

On the Current Care Situation and Treatment of Ocular Mucous Membrane Pemphigoid in Germany.

Ocular involvement in mucous membrane pemphigoid (MMP) is relatively rare, with a prevalence of 25 cases per million population, equating to approx. 2,100 patients throughout Germany. Diagnosis can be difficult - especially in cases of isolated ocular involvement - and treatment can be complex and lengthy. Immunosuppressants or immunomodulatory drugs are often used. Due to the complexity of diagnosis and treatment, MMP patients are usually referred to specialized centers. The aim of this project was to evaluate the current care situation of patients with ocular MMP in Germany. A paper-based survey was designed and sent to all university eye clinics and other specialized centers in Germany in April 2020. The survey asked about the existence of a specialized outpatient service, the total annual number of patients with MMP, the annual number of newly diagnosed patients, any interdisciplinary collaboration for diagnostic or therapeutic purposes, as well as the local and systemic therapy used. Of a total of 44 clinics, 28 (64%) responded, reporting a total average of 27 ± 42 (0 - 200) patients and 3.6 ± 2.2 (0 - 10) new cases per year. This corresponds to a total of 741patients. Only nine (32%) of the responding clinics offer specialized MMP clinics. 93% of the centers collaborate with the local dermatology department. 79% perform serological and histological diagnostics in-house. About half of the centers (n = 16) apply a standardized treatment regime. Systemic glucocorticoids (66.7%) are most commonly used, followed by mycophenolate mofetil and dapsone (57.1%), rituximab (33.3%), azathioprine and cyclophosphamide (28.6%), as well as methotrexate (19.0%). The least frequently used treatment is intravenous immunoglobulin (14.3%). This survey of German ophthalmology departments obtained data from about one third of the estimated total cohort of all patients with MMP in Germany. These are presumed to be exclusively patients with at least one ocular involvement. The complex care of these patients is usually provided in collaboration with a dermatologist and with the use of systemic anti-inflammatory medication. Currently, an ophthalmological MMP register is being established to better record the epidemiology and care situation of this rare disease in Germany and to improve it in the long term.

OP-10 Gut microbiota dysbiosis as a driver of inflammation in Ocular Mucous Membrane Pemphigoid.

Gut microbiome profiles between OcMMP patients (n=49) and healthy controls (n=40) were compared by extracting DNA from faecal samples and amplified for the V4 region of the 16S rRNA gene followed by Illumina Miseq platform sequencing. Sequencing reads were processed using the bioinformatics pipeline available in the mothur v.1.44.1 software. Using multivariable model and adjustment for participant factors, OcMMP cohort was found to be associated with lower number of operational taxonomic units (OTUs) and Shannon Diversity Index when compared to healthy controls. OcMMP OTUs were found to be significantly correlated with both the bulbar conjunctival inflammation score (p=0.03) and the current use of systemic immunotherapy (p=0.02). Linear discriminant analysis effect size scores found Streptococcus and Lachnoclostridium enriched in OcMMP. By contrast, healthy controls were enriched with Oxalobacter, Clostridia uncultured genus-level group (UCG) 014, Christensenellaceae R-7 group and butyrate-producing bacteria such as Ruminococcus, Lachnospiraceae, Coprococcus, Roseburia, Oscillospiraceae UCG 003, 005, NK4A214 group (Log10 LDA score <2, FDR-adjusted p<0.05). In conclusion, OcMMP patients have gut dysbiosis that correlated with bulbar conjunctival inflammation and the use of systemic immunotherapies. This provides a framework for future longitudinal deep phenotyping studies on the role of the gut microbiome in the pathogenesis of OcMMP. Low L, Suleiman K, Shamdas M, Bassilious K, Poonit N, Rossiter AE, Acharjee A, Loman N, Murray PI, Wallace GR, Rauz S. Gut dysbiosis in ocular mucous membrane pemphigoid. Front. Cell. Infect. Microbiol. 2022;12:780354. https://doi.org/10.3389/fcimb.2022.780354.

Awareness of the Unaizah populations in Al-Qassim province in Saudi Arabia regarding nasal decongestant use for allergic rhinitis and their side effect.

Background:Nasal decongestant drugs are widely used as potent vasoconstrictive agents to reduce congestion of nasal and ocular mucous membranes in disease such as allergic rhinitis. These drugs are easily accessible to the people over the counter without prescription. The ease in access may lead the population in believing that the drugs are risk free and free from side effects. The purpose of this study was to determine the level of awareness of the people in Unaizah Al-Qassim province in Saudi Arabia on the use of nasal decongestants ad their side effects.Methodology:After gaining the Institutional Review Board (IRB) approval, the study was a questionnaire-based cross-sectional study conducted on the people Unaizah Al-Qassim province in Saudi Arabia. It was explorative in nature as such a study has never been done in Unaizah before and hence descriptive statistics was mainly used to establish significance and reference. The questionnaires assessed the demographical characteristics of the population, participants’ history on the usage of nasal decongestants, health condition of the participants, and knowledge on nasal congestion and use nasal decongestants.Results:Out of 385 participants, 54% were male and 46% are female. With regards to age, majority of the participants were between the age of 20 and 40 years 56%, followed by 40--60 years old (33%). 79% of the participants had acquired a baccalaureus level in education. When assessed on the usage of nasal decongestants, 32.5% currently use the decongestants, 64.4% have ever used the drugs now and in the past. In terms of knowledge of the drugs, 16.6% of the participants are aware of the side effects, 25.2% are aware of the medically recommended period to use the drugs, 21.3% have heard of the nasal congestion addiction, and 21.6% are aware of the medication that may cause nasal congestion.Conclusion:The study established that the level of awareness on the use nasal decongestants and the side effects is not significant. There needs to be a sensitization campaign to educate the population on the use of nasal decongestants.

Вирусные конъюнктивиты у детей: особенности течения и лечения

Over the last few years, viral conjunctivitis in children has become a significant challenge. Modern diagnostic techniques facilitate a prompt detection of this disease, assuming that a qualified approach is used by the ophthalmologist for making diagnosis in such cases. As a broad spectrum of drugs is available for the treatment of inflammation of the anterior eye segment, the ophthalmologist can customize medications for each patient with viral conjunctivitis. The key problem of pediatric ophthalmology is associated with the age limits for choosing eye drops and ointments. Besides, most cases of viral conjunctivitis in children occur amid infection of the upper respiratory tract, requiring a comprehensive approach to the management of this health condition. The article describes the most common types of child’s conjunctivitis and provides authors’ own findings for 195 patients, 0–18 years old, including the specific clinical features and the considerations for treatment. In addition, a clinical case report is presented where an incorrect interpretation of symptoms of the anterior eye segment inflammation has led to the inappropriate medication administration and the development of such complications as keratitis and reduced visual acuity. In general, timely diagnosis of the disease and adequate treatment of pediatric patients, in contrast to adults, ensures an uncomplicated clinical outcome, without scarring, uveitis or residual infiltrates. Keywords: viral conjunctivitis, keratitis, adenovirus, herpes, ocular mucous membrane, interferon, para-aminobenzoic acid. For citation: Kazinskaya N.V., Evgraphov V.Yu., Il’inskaya I.A. Viral conjunctivitis in children: the specific clinical features and treatment. Russian Journal of Clinical Ophthalmology. 2022;22(3):191–196 (in Russ.). DOI: 10.32364/2311-7729-2022-22-3-191-196.

Use of Systemic Mycophenolate Mofetil Therapy in Ocular Surface Inflammatory Pathologies at the Initiative and Responsibility of the Ophthalmologist.

The purpose of the study was to evaluate the efficacy and safety of systemic mycophenolate mofetil (MMF) treatment in ocular surface inflammatory diseases. For this retrospective study, patients who were treated with systemic MMF for ocular surface inflammatory diseases between March 2020 and March 2022 were evaluated. Apart from demographic data, examination notes including MMF treatment indication and systemic side effect interrogation and routine laboratory examinations during drug treatment were extracted from the patient records. Detailed staging scores were performed according to the diagnosis including Foster and Mondino for ocular mucous membrane pemphigoid (MMP) and limbal stem cell deficiency scoring for limbal transplantation. For thorough evaluation, anterior segment pictures were used. Fourteen patients were enrolled to the study, with a mean age of 58 ± 12. MMP (6, 42.8%) and limbal allograft transplantation (6, 42.8%) constituted the main indications for the MMF treatment, followed by keratitis-ichthyosis-deafness (KID) syndrome (1, 7.2%) and Mooren's ulcer (1, 7.2%). Five of six patients with MMP regressed according to both staging systems. Only one remained stable which was evaluated as Stage 3. Furthermore, while all limbal transplant groups (6) stabilized and showed regression according to the individualized limbal stem cell deficiency staging system with no rejection during follow-up. Furthermore, patients with Mooren's ulcer and KID syndrome showed control of the inflammation and stabilization after MMF treatment. No significant systemic side effects apart from constipation and nausea (3) were observed in patients whose routine laboratory tests were stable throughout the follow-up. MMF has the potential to be a valuable and safe systemic agent of first choice in the control of ocular surface inflammatory disorders, especially when topical treatment is not effective. With such studies, it is predicted that MMF may reach wider usage areas with the increase in its effectiveness and safety in its use for ocular surface inflammatory pathologies.

Anaphylactic shock with pulmonary eosinophilic infiltration due to honeybee attack in a donkey: case report

ABSTRACT A case of a donkey attacked by Africanized honeybee is reported here with clinical signs of agitation, dehydration, congestion of the ocular mucous membranes, tongue edema, tachycardia and inspiratory dyspnea, and progression to death. At necropsy, diffuse, severe subcutaneous edema at face and cervical regions and severe diffuse pulmonary hyperemia with abundant edema without parenchymal collapse were observed. Microscopically, marked, diffuse deep dermis and panniculus carnosus edema and marked diffuse alveolar edema, with moderate population of eosinophils predominantly around larger caliber vessels were noted. The final diagnosis of anaphylactic shock was supported by history, clinical signs, and anatomic pathology findings. This is the first report of a honeybee attack with pulmonary eosinophilic infiltration in a mammal.

Ocular mucous membrane pemphigoid: novel treatment strategies.

To describe current treatments of ocular mucous membrane pemphigoid (OMMP), including conventional systemic immunosuppression (CIST) and novel biologic agents. CIST remains the main stay therapy for the management of OMMP. The choice of agents is tailored to disease severity - mild disease is treated with dapsone, whereas moderately severe cases are often treated with mycophenolate mofetil or sulfa-based drugs and severe cases are treated with cyclophosphamide. In recalcitrant disease newer biologics such as Rituximab, intravenous immunoglobins and tumour necrosis alpha antagonists have proven to be effective in disease control. Control of inflammation with topical therapy and halting conjunctival fibrosis remain as areas of unmet clinical needs. OMMP is largely treated with CIST. The recent introduction of new biologic agents could shape the way the disease is treated in the near future.

Stevens-Johnson syndrome and herpes simplex reactivation associated with paracetamol use. Case report

Introduction: Stevens-Johnson syndrome (SJS) is a rare disease that affects the skin, as well as the oral, ocular, and urogenital mucous membranes. This condition is caused by drug reactions in more than 50% of cases. Case presentation: A 20-year-old male visited the emergency service of a tertiary care hospital of Popayán due to a 10-day history of asthenia, adynamia, fever (without objective measurement records), cough with scarce whitish sputum, and headache that improved with paracetamol treatment. However, his condition worsened in the last two days, and he developed hyporexia, pharyngeal pruritus, vesicles, and blisters on the corners of the mouth, the oral mucosa, the trunk, and limbs, as well as breathing difficulty and odynophagia, prompting him to seek medical treatment at the ER. At first, disseminated herpes simplex, systemic lupus erythematosus and SJS were suspected, but based on clinical and laboratory findings, the patient was finally diagnosed with SJS with herpes simplex reactivation associated with the use paracetamol. Consequently, the administration of this drug was stopped and management with acyclovir and methylprednisolone was started. The patient progressed satisfactorily and was discharged 10 days after beginning the new treatment, and his general condition was optimal during follow-up appointments. Conclusion: The occurrence of SJS may be associated with the oral administration of paracetamol; nevertheless, its use is not discouraged due to its great overall benefits. In this sense, given that paracetamol is an over-the-counter drug widely used in Colombia, recognizing the clinical manifestations of SJS is essential to provide adequate management and avoid complications in cases such as the one reported here.

Current Evidence of Coryneform Bacteria on The Ocular Surface of Immunocompromised Cats

Monomicrobial and polymicrobial infections may occur on the cornea, conjunctiva and the eyelid of cats.Corynebacterium species are categorized as nonpathogenic bacteria that are regularly detected in the conjunctiva of healthy cats. It has been reported that Corynebacterium species have been shown to be potentially harmful in a variety of tissues including ocular tissues, skin, and mucous membranes. The purpose of the current study was to investigate the presence of Corynebacterium spp. on the ocular surface and its antimicrobial sensitivity and susceptibility pattern. We investigated Corynebacterium species on the ocular surface and reviewed various species of Corynebacterium in terms of their antimicrobial susceptibility and the underlying molecular resistance mechanisms. The risk for Corynebacterium-related ocular infections in cats with low immunity, such as poor nutrition, corneal epithelial damage due to trauma, corneal perforation, lagophthalmos, chronic incurable glaucoma, long-lasting corneal sequestrum, and long-term use of topical steroids have been identified. 64 cats (78 eyes) of different ages and both sexes with various ocular disorders were swabbed. Corynebacterium spp. represented 34.6 % (n=27) of the collected sample and found to be susceptible to common antibiotics. Therefore, the use of antimicrobials for the treatment of ocular infections caused by Corynebacterium species should be a rational and sensible strategy along with provision of immunostimulants.

COVID-19, odontostomatology orofacial findings of interest

The emergence of the coronavirus 2019 (COVID-19) reform a new global strategy for world health and life. Its detection or premature diagnosis has become vital to be able to control its dynamics as a pandemic. This virus is transmitted from human to human through droplets and direct contact with the oral, nasal and ocular mucous membranes, even some studies suggest that it can be airborne through aerosols. This fact encourages epidemiological and clinical researchers to establish highly sensitive case definitions to track all true positive cases; therefore, there is emerging evidence of oral lesions that may be indicative of viral pathology. The purpose of this review article is to provide documentary support that aims to raise awareness among dental professionals that a careful orofacial examination is mandatory, especially when dealing with suspected patients infected with SARS-CoV-2 or not, in order to further enrich the report of possible specific and nonspecific signs and symptoms of the current global pathology and enrich the scientific knowledge for its final control and eradication.

Экспериментальное обоснование предельно допустимой концентрации дихлоргексафторбутена в воздухе рабочей зоны

To date, there have been no exposure standards for air concentrations of 1,4-dichlorohexafluorobutene (DCHF) in the work areas. The study was aimed to assess the toxicity of DCHF and to evaluate health hazard in acute, subacute, and chronic experiments. It was found that the substance was highly hazardous, DL50 in mice after intragastric injection was 79.0 mg/kg, СL50 was 229.0 mg/m3, and in rats these values were 86,0 mg/kg and 670,0 mg/m3. In animals, DCHF had a moderate local irritative effect on animal skin and ocular mucous membranes, as well as the skin resorptive effect. The 18.2 mg/m3 threshold limit concentration for a single inhalation exposure to DCHF was defined based on the changes in behavior responses and blood parameters. The 30-day subacute inhalation experiment revealed the pronounced cumulative effect of the substance. The 4-months chronic inhalation study showed that the exposure of experimental rats to 16.8 mg/m3 concentration of DCHF resulted in impaired function of central nervous system and cardiac activity, altered hematologic, biochemical, acid-base, and blood gas values, as well as in morphological alterations in lungs, which persisted after the 30-day recovery period. The chronic exposure threshold defined for DCHF was 2.2 mg/m3, and the defined no observable effect level was 0.24 mg/m3. Based on the study results, the maximum permissible concentration of DCHF in the air of the working area of 0.2 mg/m3 was confirmed and approved, the substance was assigned hazard class 2, vapor + aerosol + (specific protection of skin and eyes required). Gas chromatographic method using electron-capture detection for determination of DCHF mass air concentration in the work areas has been developed and approved.

Successful rehabilitation of an oiled sea turtle (Lepidochelys olivacea) affected by the biggest oil spill disaster in Brazil

The standardisation of protocols and discussion of therapeutic procedures in the rehabilitation of turtles affected by oil spills are necessary to optimise the recovery time and increase the chances of survival of these animals. This study aimed at reporting the processes adopted for the stabilisation, decontamination, rehabilitation and release of an oiled olive ridley sea turtle (Lepidochelys olivacea), rescued alive on September 23, 2019, at Santa Rita Beach, Extremoz municipality, Rio Grande do Norte, Brazil. Its entire body was covered by oil. At first, the animal was mechanically dry cleaned using a gauze soaked in mineral oil in the keratinised regions (carapace and plastron) and a gauze soaked in vegetable oil was used on the oral, nasal, ocular, and cloacal mucous membranes. The second stage of the oil removal consisted of washing the animal with heated pressurised water (39 °C) and a neutral detergent using a soft foam sponge. The animal received treatment with antitoxins, antibiotics, analgesics, gastrointestinal protectors, and fluid therapy. After 7 days of treatment, the blood count showed that all the parameters were within the normal range. The oil cleaning process and the therapeutic protocol used in the rehabilitation of the olive ridley sea turtle were efficient.

Repository Corticotropin Injection as an Alternative Treatment for Refractory Ocular Mucous Membrane Pemphigoid.

The purpose of this study was to report the clinical course and outcome of patients with refractory ocular mucous membrane pemphigoid (MMP) treated by repository corticotropin injection (RCI). Patients with biopsy-proven ocular MMP treated with RCI from 3 tertiary medical centers were evaluated. Medical records between January 2013 and January 2021 were reviewed and deidentified to retrieve relevant disease-related data. Primary outcome measures included conjunctival inflammatory activity, change in Foster clinical conjunctival scarring staging after RCI treatment, and the development of ocular and systemic complications. Included were 15 patients (10 women and 5 men; 36-95 yrs of age) with a mean follow-up of 4.5 years. Most of the patients (80%) had Foster stage 3 at presentation, and all patients had active MMP. Each patient had failed to respond to at least 1 immunomodulatory drug during the follow-up, and 9 (60%) patients had treatment failure of at least 2 other agents before the use of RCI. The mean duration of RCI treatment was 21 months (range, 3-54 mo). Foster stage did not change in any of the 15 patients at the last follow-up. Nine patients continued RCI therapy at the last follow-up, and in all of them, the disease activity of MMP was well controlled. No serious adverse events because of RCI were documented during the follow-up in any treated patient. RCI may serve as an alternative or an adjunctive treatment in patients with severe and refractory ocular MMP. Treatment with RCI seems to be safe and well-tolerated.

Clinicopathological Effects of Oral Administration of Ethanol Leaf Extract of Charcoal–Tree (Trema Orientalis Linn Blume) in Jamnapari Crossbred Goats

The present study was aimed at evaluating the clinicopathological changes due to oral administration of ethanol leaf extract of Trema orientalis (ELETO) in Jamnapari crossbred goats. The clinical manifestations, gross and histopathological changes in the major vital organs were used as indices of the toxicity. The severity of gross and microscopic changes were evaluated by scoring technique. Twenty goats weighing between 15-20kg were divided into four groups with five goats in each group in a completely randomized design. The test groups I, II, III were administered ELETO at the dosages of 0.5, 1.0 and 2.0g/kg b.wt per os/day respectively, for 14 days while, group IV served as a control. Groups II and III showed decreased appetite whereas, group III showed bilateral congestion of ocular mucous membrane, lacrimation, rectal tenesmus and a significant decrease in body weight compared to control. The main gross and microscopic changes were mild to moderate and included; engorgement of the gall bladder, congestion and icteric liver, hepatocellular degeneration, vacuolation, necrosis and renal congestion observed mainly in group III goats. The results indicate that the ELETO was hepatotoxic and nephrotoxic at continued oral doses equal to or more than 2.0g/kg b.wt in goats but no significant toxicity when used at lowers doses. Therefore, special caution should be taken when keeping goats in areas with T. orientalis.&#x0D; Keywords: Ethanol extract, Trema orientalis, Clinicopathological changes, Goatsv

Concurrent Hepatozoonosis and Transmissible Venereal Tumour in a 10-Year Old German Shepherd Dog In Abeokuta, Nigeria

In this study, a case of hepatozoonosis with concurrent TVT unresponsive to chemotherapy in a 10-year old female German shepherd dog treated with Vincristine for 10 weeks at the State Veterinary Clinic, Abeokuta, was referred to the Veterinary Teaching Hospital, Federal University of Agriculture, Abeokuta, Nigeria. Adiagnosis of hepatozoonosis and TVTwere made based on clinical presentations including protruding mass from the vulva, parasitological technique and cytological evaluation of the tumour mass and bone marrow using optical fine needle aspirate. Pathological changes observed in various organs at post-mortem, following euthanasia were cachexia, pale and icteric ocular and oral mucous membranes, enlarged and oedematous lymph nodes. Histopatholgical lesions were round to oval neoplastic cells from the growth observed in the vagina. There were different developmental stages of the merogony of Hepatozoon canisin the bone marrow. We concluded that concurrent hepatozoonosis and TVT and, possibly, the geriatric state of the patient contributed largely to the problem of unresponsiveness to treatment. To the best of our knowledge this is the first report of concurrent infection of canine hepatozoonosis and TVTin Nigeria&#x0D; Keywords: Dog, hepatozoonosis, TVT, unresponsive to chemotherapy

Real-world experience of using ciclosporin-A 0.1% (Ikervis) in the management of ocular surface inflammatory diseases

PurposeTo report the real-world experience of using topical ciclosporin, Ikervis, in the management of ocular surface inflammatory diseases (OSIDs).MethodsThis was a retrospective study of patients treated with Ikervis for OSIDs...

Single dose etanercept monotherapy for treating Stevens–Johnson syndrome

Stevens–Johnson syndrome (SJS) is a delayed type hypersensitivity reaction to drugs and less commonly infections. The entity represents one end of the spectrum of SJS-TEN (Toxic Epidermal Necrolysis) complex. Together, both conditions contribute to the majority of Severe Cutaneous Drug Reactions (SCARs) with high mortality and morbidity. Clinically, it presents with widespread painful erythematous macules, targetoid lesions, full-thickness or focal epidermal necrosis while mucosal involvement involves oral, genital, and ocular mucous membranes along with preceding prodromal flu like symptoms. While there is no consensus on the treatment of choice, systemic steroids, intravenous immunoglobulin and cyclosporin are most often employed for specific management of SJS-TEN. We report a case of SJS managed with a single dose of etanercept monotherapy.