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Kulkarni AS, Thool AR, Daigavane S. Fulminant Eye Infection in a Patient With Nephrotic Syndrome: A Case Report. Cureus 2024; 16:e55842. [PMID: 38590483 PMCID: PMC11000746 DOI: 10.7759/cureus.55842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
This case report presents the clinical course of a 53-year-old male farmer with nephrotic syndrome, specifically focal segmental glomerulosclerosis, who developed a fulminant eye infection. While receiving maintenance hemodialysis and immunosuppressive therapy, the patient presented with sudden onset redness, discharge, and decreased vision in his right eye. Initial management with topical antibiotics and steroids failed to halt the progression of the infection, leading to corneal perforation and iris prolapse within a few days. Despite the discontinuation of immunosuppressive medications and initiation of broad-spectrum antimicrobial therapy, the patient's compromised renal function and anaemia precluded surgical intervention. This case underscores the challenges in managing severe ocular infections in immunocompromised patients. It highlights the importance of early recognition, aggressive antimicrobial therapy, and close ophthalmologic monitoring in preventing sight-threatening complications. Despite intensive management, the prognosis for visual recovery in such cases may be poor, emphasizing the need for preventive strategies and careful surveillance in high-risk patient populations.
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Affiliation(s)
- Aditi S Kulkarni
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Archana R Thool
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sachin Daigavane
- Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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2
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Konya I, Iwata H, Hayashi M, Akita T, Homma Y, Yoshida H, Yano R. Effectiveness of weak wiping pressure during bed baths in hospitalized older adults: A single-blind randomized crossover trial. Geriatr Nurs 2021; 42:1379-1387. [PMID: 34583237 DOI: 10.1016/j.gerinurse.2021.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/07/2023]
Abstract
This study evaluated the effectiveness of weak wiping pressure on skin barrier function and patient satisfaction in comparison to ordinary pressure in hospitalized older adults. Forty-seven participants in a general hospital were blindly and randomly assigned a sequence of two bed baths: wiping three times with weak pressure (12-14 mmHg) and ordinary pressure (23-25 mmHg). Transepidermal water loss and stratum corneum hydration were measured before and after the intervention, and patient satisfaction was assessed using a Likert scale. Ordinary pressure significantly decreased skin barrier function compared to weak pressure; however, neither of the pressures caused discomfort. Weak pressure was more effective than ordinary pressure in preventing skin disorders and providing satisfaction. Subgroup cluster analysis showed that ordinary pressure was likely to impair the skin barrier function in older adults with diabetes/dyslipidemia and renal dysfunction. The application of weak pressure during bed baths, especially for these patients, is recommended.
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Affiliation(s)
- Issei Konya
- Graduate School of Health Sciences, Hokkaido University, Hokkaido, Japan
| | - Hiroaki Iwata
- Department of Dermatology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Hokkaido, Japan
| | - Miyuki Hayashi
- Division of Nursing, Hokkaido University Hospital, Hokkaido, Japan
| | - Tamami Akita
- Division of Nursing, Hokkaido University Hospital, Hokkaido, Japan
| | - Yoshie Homma
- Social Welfare Corporation Hokkaido Shakaijigyokyokai Yoichi Hospital, Hokkaido, Japan
| | - Hideaki Yoshida
- Social Welfare Corporation Hokkaido Shakaijigyokyokai Yoichi Hospital, Hokkaido, Japan
| | - Rika Yano
- Faculty of Health Sciences, Hokkaido University, Hokkaido, Japan.
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3
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Blaha T, Nigwekar S, Combs S, Kaw U, Krishnappa V, Raina R. Dermatologic manifestations in end stage renal disease. Hemodial Int 2018; 23:3-18. [PMID: 30520561 DOI: 10.1111/hdi.12689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/29/2018] [Indexed: 01/16/2023]
Abstract
Skin manifestations are commonly seen in end stage renal disease (ESRD). Skin involvement in this population can be extensive and dramatically worsen quality of life. Close observation of the skin and nails of ESRD patients by clinicians allows for timely diagnosis and treatment, which ultimately improves quality of life and reduces mortality. In this article we focus on the cutaneous changes most commonly seen in ESRD patients. PubMed/Medline database search was done for published literature on skin manifestations in ESRD patients. All the available literature was reviewed and relevant articles were used to discuss about clinical features, pathogenesis, histology and treatment of each skin disorder in ESRD patients. Most commonly encountered skin manifestations in patients with ESRD are pruritus, xerosis, pigmentation changes, nail changes, perforating disorders, calcifying disorders, bullous dermatoses and nephrogenic systemic fibrosis. Skin manifestations in ESRD can be difficult to treat and multiple comorbidities in this patient population can exacerbate these disorders. Many of the treatment options are experimental with evidence largely derived from the case reports and small clinical trials. More large-scale trials are needed to firmly establish evidence based treatment guidelines. Prompt evaluation and management of these disorders improve morbidity and quality of life in ESRD patients.
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Affiliation(s)
- Taryn Blaha
- Department of Medicine, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Sagar Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sara Combs
- Department of Medicine, Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Urvashi Kaw
- Department of Dermatology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vinod Krishnappa
- Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, Ohio, USA.,Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Rupesh Raina
- Department of Nephrology, Cleveland Clinic Akron General, Akron, Ohio, USA
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4
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Chinazzo M, Desoubeaux G, Leducq S, Bessis D, Droitcourt C, Mahe E, Goujon E, Bursztejn AC, Phan A, Maruani A. Prevalence of Nail Scabies: A French Prospective Multicenter Study. J Pediatr 2018; 197:154-157. [PMID: 29576324 DOI: 10.1016/j.jpeds.2018.01.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To assess the prevalence of nail involvement in children <16 years old with a confirmed diagnosis of scabies. STUDY DESIGN Observational, prospective study in 7 French dermatology departments between June 2015 and January 2017. Children were included if they had scabies confirmed by dermoscopy and/or microscopy and if nails could be sampled. The first toenails and thumbnails as well as clinically affected nails were systematically sampled for microscopic examination. Individual data were recorded via a standardized questionnaire. RESULTS A total of 47 children with scabies were included (26 females [55.3%], mean age 3.6 ± 4.0 years). Pruritus was present in 42 children (89.3%); the relapse rate was 38.3% (n = 18). In 3 infants (6.4%), Sarcoptes mites were revealed by dermoscopy or microscopy of the first toenails (2 cases) and a thumbnail (1 case), but nails were normal in 2 children. Two of the 3 infants had already received treatment for scabies in the previous weeks. CONCLUSION Prevalence of nail involvement in children with confirmed scabies was 6.4%. Nails should not be overlooked during scabies treatment.
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Affiliation(s)
- Marie Chinazzo
- Pediatric Emergency Department, Centre Hospitalier Régional et Universitaire Tours, Tours, France
| | - Guillaume Desoubeaux
- University François Rabelais Tours, Faculty of Medicine, Tours, France; Department of Parasitology and Mycology, Centre Hospitalier Régional et Universitaire Tours, Tours, France
| | - Sophie Leducq
- University François Rabelais Tours, Faculty of Medicine, Tours, France; Department of Dermatology, Unit of Paediatric Dermatology, Centre Hospitalier Régional et Universitaire Tours, Tours, France
| | - Didier Bessis
- Department of Dermatology, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Catherine Droitcourt
- Department of Dermatology, Centre Hospitalier Universitaire Rennes, Rennes, France
| | - Emmanuel Mahe
- Department of Dermatology, Centre Hospitalier Argenteuil, Argenteuil, France
| | - Elisa Goujon
- Department of Dermatology, Centre Hospitalier Chalon-sur-Saone, Chalon-sur-Saone, France
| | | | - Alice Phan
- Department of Dermatology, Centre Hospitalier Universitaire Lyon, Lyon, France
| | - Annabel Maruani
- University François Rabelais Tours, Faculty of Medicine, Tours, France; Department of Dermatology, Unit of Paediatric Dermatology, Centre Hospitalier Régional et Universitaire Tours, Tours, France.
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Tesauro M, Nisticò S, Noce A, Tarantino A, Marrone G, Costa A, Rovella V, Di Cola G, Campia U, Lauro D, Cardillo C, Di Daniele N. The possible role of glutathione-S-transferase activity in diabetic nephropathy. Int J Immunopathol Pharmacol 2017; 28:129-33. [PMID: 25816416 DOI: 10.1177/0394632015572564] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The most common cause of end stage renal disease is diabetic nephropathy. An early diagnosis may allow an intervention to slow down disease progression. Recently, it has been hypothesized that glutathione-S-transferase (GST) activity may be a marker of severity of chronic kidney disease. In particular, a lower GST activity is present in healthy subjects compared to patients with nephropathy. In the present review we illustrate the scientific evidence underlying the possible role of GST activity in the development of diabetic nephropathy and we analyze its usefulness as a possible early biomarker of this diabetic complication.
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Affiliation(s)
- M Tesauro
- Department of Systems Medicine, Division of Hypertension and Nephrology, University of Rome "Tor Vergata", Rome, Italy
| | - S Nisticò
- Department of Health Sciences, University of Catanzaro 'Magna Graecia', Catanzaro, Italy
| | - A Noce
- Department of Systems Medicine, Division of Hypertension and Nephrology, University of Rome "Tor Vergata", Rome, Italy
| | - A Tarantino
- Department of Systems Medicine, Division of Hypertension and Nephrology, University of Rome "Tor Vergata", Rome, Italy
| | - G Marrone
- Department of Systems Medicine, Division of Hypertension and Nephrology, University of Rome "Tor Vergata", Rome, Italy
| | - A Costa
- Center of Integrated Research, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Rovella
- Department of Systems Medicine, Division of Hypertension and Nephrology, University of Rome "Tor Vergata", Rome, Italy
| | - G Di Cola
- Department of Systems Medicine, Division of Hypertension and Nephrology, University of Rome "Tor Vergata", Rome, Italy
| | - U Campia
- MedStar Cardiovascular Research Network Washington, DC, USA
| | - D Lauro
- Endocrinology Unit, University of Rome "Tor Vergata", Rome, Italy
| | - C Cardillo
- Internal Medicine, Catholic University, Rome, Italy
| | - N Di Daniele
- Department of Systems Medicine, Division of Hypertension and Nephrology, University of Rome "Tor Vergata", Rome, Italy
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Iantorno M, Campia U, Di Daniele N, Nistico S, Forleo GB, Cardillo C, Tesauro M. Gut hormones and endothelial dysfunction in patients with obesity and diabetes. Int J Immunopathol Pharmacol 2014; 27:433-6. [PMID: 25280035 DOI: 10.1177/039463201402700314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Overweight and obesity are the fifth leading risk for global deaths and its prevalence has doubled since 1980. At least 2.8 million adults, worldwide, die each year as a result of being overweight or obese. The deleterious effects of obesity are tightly related to diabetes, as they are often clinically present in combination to confer increased cardiovascular mortality. Thus, patients with diabetes and obesity are known to develop accelerated atherosclerosis characterized by a dysfunctional endothelium and decreased nitric oxide bioavailability. Recent clinical studies support, indeed, the use of incretin-based antidiabetic therapies for vascular protection. Thus, attention has been focusing on gut hormones and their role, not only in the regulation of appetite but also in vascular health. Intervention directed at modulating these molecules has the potential to decrease mortality of patients with diabetes and obesity. This review will cover part of the ongoing research to understand the role of gut hormones on endothelial function and vascular health.
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Affiliation(s)
- M Iantorno
- Critical Care Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | - U Campia
- MedStar Cardiovascular Research Network Washington, DC, USA
| | - N Di Daniele
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - S Nistico
- Department of Health Sciences, University of Catanzaro Magna Grecia, Catanzaro, Italy
| | - G B Forleo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - C Cardillo
- Internal Medicine, Catholic University, Rome, Italy
| | - M Tesauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Mourad B, Hegab D, Okasha K, Rizk S. Prospective study on prevalence of dermatological changes in patients under hemodialysis in hemodialysis units in Tanta University hospitals, Egypt. Clin Cosmet Investig Dermatol 2014; 7:313-9. [PMID: 25419152 PMCID: PMC4235205 DOI: 10.2147/ccid.s70842] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction Chronic hemodialysis patients experience frequent and varied mucocutaneous manifestations in addition to hair and nail disorders. The aim of this study was to evaluate the prevalence of dermatological changes among patients with end-stage renal disease under hemodialysis in a hemodialysis unit in Tanta University hospitals over a period of 6 months, and to evaluate the relations of these dermatological disorders with the duration of hemodialysis as well as with different laboratory parameters in these patients. Patients and methods Ninety-three patients with end-stage renal disease on regular hemodialysis (56 males and 37 females) were selected and included in this cross-sectional, descriptive, analytic study. Their ages ranged from 18–80 years. All patients underwent thorough general and dermatological examinations. Laboratory investigations (complete blood counts, renal and liver function tests, serum parathormone levels, serum electrolytes, alkaline phosphatase, random blood sugar, and Hepatitis C virus (HCV) antibodies) were evaluated. Results This study revealed that most patients had nonspecific skin changes, including xerosis, pruritus, pallor, ecchymosis, hyperpigmentation, and follicular hyperkeratosis. Nail and hair changes were commonly found, especially half and half nail, koilonychia, subungal hyperkeratosis, melanonychia, onychomycosis, and brittle and lusterless hair. Mucous membrane changes detected were pallor, xerostomia, macroglossia, bleeding gums, aphthous stomatitis, and yellow sclera. There was a significant positive correlation between the presence of pruritus and serum parathormone level. There was a significant negative correlation between the presence of mucous membrane changes and hemoglobin level. Conclusion Nonspecific mucocutaneous manifestations are common in patients on hemodialysis, particularly xerosis, dyspigmentation, and pruritus. Early and prompt recognition and treatment of dermatological conditions in patients on dialysis may improve their quality of life.
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Affiliation(s)
- Basma Mourad
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Doaa Hegab
- Dermatology and Venereology Department, Tanta University, Tanta, Egypt
| | - Kamal Okasha
- Internal Medicine Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Caporuscio S, Pranteda G, Nistico S, Maucione T, Canzoni M, Stefani A, Muscianese M, Fanto M, Sorgi M. An incomplete form of childhood Behçet's disease treated with infliximab. Int J Immunopathol Pharmacol 2014; 27:445-8. [PMID: 25280037 DOI: 10.1177/039463201402700316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Behçet's disease (BD) is a multi-systemic vasculitis characterized by the possible presence of cutaneous, ocular, articular and neurological manifestations. In this report, we examine the case of a fifteen-year old boy with an incomplete form of juvenile Behçet's disease which began with joint involvement and developed into a complete form only after several years. The patient showed a rapid response to anti-TNF-alpha (infliximab) with an improvement of mucocutaneous lesions (oral and genital ulcers, pseudofolliculitis) and arthritis.
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Affiliation(s)
- S Caporuscio
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - G Pranteda
- Division of Dermatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - S Nistico
- Unit of Dermatology, University of Catanzaro, Italy
| | - T Maucione
- Sapienza University of Rome, Rome, Italy
| | - M Canzoni
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - A Stefani
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Muscianese
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Fanto
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - M Sorgi
- Division of Rheumatology, Department of Medicine, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
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Specchio F, Carboni I, Cannarozzo G, Tamburi F, Dattola E, Nisticò S. Excimer UV radiation in dermatology. Int J Immunopathol Pharmacol 2014; 27:287-9. [PMID: 25004841 DOI: 10.1177/039463201402700217] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ultraviolet B (UVB 290-320 nm) radiation has been used in the treatment of different skin diseases. Light sources with narrowband UVB output spectrum have been developed with the aim of increasing the rates of beneficial to side effect profile of the treatment. Narrowband UVB phototherapy using fluorescent lamps (TL01, 311∓2nm) has been widely adopted over the past 10 years. Monochromatic Excimer Light (MEL) represents a new source of narrow-band UVB emitting at 308 nm and guarantees a safe and effective approach to different chronic and recurrent skin diseases thanks to its potent and selective immunosuppressant action.
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Affiliation(s)
- F Specchio
- Department of Medicine, University of Rome, Tor Vergata, Italy
| | - I Carboni
- Department of Medicine, University of Rome, Tor Vergata, Italy
| | | | - F Tamburi
- Unit of Dermatology, Complesso Integrato Columbus, Rome, Italy
| | - E Dattola
- Department of Health Sciences, University of Catanzaro Magna Græcia, Italy
| | - S Nisticò
- Department of Health Sciences, University of Catanzaro Magna Græcia, Italy
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