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Africa
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Dry Eye Syndrome/Keratoconjunctivitis Sicca/Xerophthalmia
Published in Charles Theisler, Adjuvant Medical Care, 2023
The term xerophthalmia means “dry eye” and is a late manifestation of severe vitamin A deficiency that causes abnormal dryness of the conjunctiva and cornea of the eye, associated with inflammation and ridge formation. Xerophthalmia is a major problem in developing countries as a leading cause of preventable blindness.3
The vitamins
Published in Geoffrey P. Webb, Nutrition, 2019
Vitamin A deficiency is very prevalent in Southeast Asia, the Indian subcontinent and several developing countries in Africa and South America. It is the major cause of child blindness in these regions and also causes high child mortality from infections. The WHO have estimated that there may be 6–7 million new cases of xerophthalmia each year with about 10% of these being severe enough to cause corneal damage. More than half of this 10% with ocular damage die within a year and three quarters of the survivors are totally or partially blind. In a meta-analysis of 43 studies that involved over 200,000 children, Mayo-Wilson et al. (2011) estimated that as many as 190 million children under 5 may be vitamin A deficient. Providing supplements of vitamin A reduced mortality rates by around a quarter in vitamin A deficient countries. They estimated that if supplements could be provided to all deprived children then this would have the potential to save 600,000 child deaths each year as well as reducing blindness, measles and diarrhoea.
Ophthalmology
Published in Fazal-I-Akbar Danish, Essential Lists of Differential Diagnoses for MRCP with diagnostic hints, 2017
Blindness in the developing world:1 Infections (trachoma caused by Chlamydia trachomatis; onchocerciasis caused by a parasite, Onchocerca volvulus [known as river blindness]).2 Nutritional deficiency like xerophthalmia caused by vitamin A deficiency.3 Cataract.4 Chronic glaucoma.
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
The prevalence of aseptic meningitis is difficult to establish, because most cases derive from case reports or case series [39]. In the majority of the reports, aseptic meningitis occurred in patients prior to pSS diagnosis [39]. Presenting symptoms were similar to those of idiopathic aseptic meningitis or aseptic meningitis associated with other diseases, with headache, fever, nausea or vomiting, and disturbance of consciousness as predominant features [39]. Of interest is the diagnosis of pSS concomitant with aseptic meningitis. Reports have described the occurrence of xerophthalmia and xerostomia (36%), parotitis (18%), arthritis (15%), and peripheral neuropathy (3%), highlighting the importance of careful clinical investigation [39]. Immunological findings have also been reported, with antinuclear antibodies occurring in 79% of patients, positive anti-Ro/SSA in 79%, and anti-La/SSB in 70% [39]. The majority of the patients (89%) required immunosuppressive treatment and recurrence was observed in 36% of the reports, with a median relapse rate of 2.9 , and an average of 35 month follow-up period [39]. Brain magnetic resonance imaging (MRI) findings are variable. Studies have described findings ranging from normal MRI to the presence of T2 weighted hyperintense inflammatory lesions in the cerebral white matter or cortex and vasculitis [25].
On the continuous (R)evolution of antibody-based and CAR T cell therapies in multiple myeloma: an early 2022 glance into the future
Published in Expert Opinion on Pharmacotherapy, 2022
Vincent Sunder-Plassmann, Osman Aksoy, Judith Lind, Martin Pecherstorfer, Sonia Vallet, Klaus Podar
Besides demonstrating outstanding efficacy in clinical trials, the first real-world data of belamaf in everyday clinical practice have been presented. Belamaf activity similar to clinical trials with a comparable risk profile was demonstrated in heavily pre-treated patients with RRMM. In summary, heavily pre-treated patients with a median of 5–8 prior lines of therapy (triple-refractory 88 to 100%; penta-refractory 54–100%) had an ORR of 33–46% among all analyses [71–74]. Despite the manageable safety profile of belamaf mono- and combination therapy, ocular toxicity, which was mostly reversible, required dose modification, delay or even treatment discontinuation in a majority of patients. A post-hoc analysis at the Mayo Clinic revealed that 79% of patients had any grade ocular toxicity, 74% had any grade keratopathy, 62% a decreased visual acuity, and 38% symptomatic xerophthalmia, despite being instructed to use eye drops and avoid contact lenses as preventive measures. 55.9% of patients had to reduce/delay their next dose or discontinue treatment due to keratopathy [75]. Various additional clinical trials, evaluating belamaf monotherapy [NCT04177823], belamaf-Vd or -Pd [NCT03828292], and belamaf-KRd [NCT04822337] are currently recruiting.
Clinical practice guidance for Sjögren’s syndrome in pediatric patients (2018) – summarized and updated
Published in Modern Rheumatology, 2021
Minako Tomiita, Ichiro Kobayashi, Yasuhiko Itoh, Yuzaburo Inoue, Naomi Iwata, Hiroaki Umebayashi, Nami Okamoto, Yukiko Nonaka, Ryoki Hara, Masaaki Mori
While 98% of adult SS patients complain of sicca symptoms, pediatric patients rarely complain of dryness [3,5,6]. Approximately 30% of cases present with sicca symptoms, which are detected by detailed medical interviews and examinations [24]. To assess dryness of the mouth (xerostomia), medical interviews should be conducted using specific close-ended questions as follows: ‘Do you need to drink water when eating dry foods like bread?’; ‘Are you worried about bad breath?’; ‘Have you ever experienced pain and/or enlargement of the parotid gland?’; ‘Do you have dental caries/stomatitis/ranula?’; ‘Have you noticed a change in your sense of taste?’. Parotid gland enlargement is frequently reported as the earliest symptom of SS [3–5,25]. Dry eye (xerophthalmia or keratoconjunctivitis sicca) symptoms, such as a feeling of dryness, red eyes, sensation of a foreign body, pain, and itchiness, should be checked, in addition to a condition where the patient cannot produce tears even when they might normally cry.