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Gupta B.,Royal Berkshire Hospital NHS Foundation Trust | Agrawal R.,National Healthcare Group Eye Institute | Swampillai A.J.,Royal Devon and Exeter NHS Foundation Trust | Lim R.H.F.,National Healthcare Group Eye Institute | And 3 more authors.
Expert Review of Ophthalmology | Year: 2016

Tuberculosis (TB) remains a major global health burden and has both pulmonary and extra-pulmonary manifestations. One well-recognised and complex extra-pulmonary form is ocular TB, with its diverse extra- and intra-ocular presentations and often without signs of systemic illness. These could be caused directly by Mycobacterium tuberculosis and inflammation or represent a delayed immune response. Epidemiological data on the true prevalence of ocular TB is scanty and varied in different parts of the world. This is due to lack of a uniform diagnostic criteria as well as difficulties in confirming the diagnosis with traditional laboratory methods. A variety of investigations including imaging, blood tests and biopsies can be used to predict and diagnose ocular involvement in tuberculosis. Our expert review seeks to identify key clinical and laboratorial features and provide a literature update that may facilitate diagnosis of intra-ocular tuberculosis. © 2016 Taylor & Francis Source


Habayeb H.,Ashford & St Peters Hospitals NHS Foundation Trust | Sajin B.,Ashford & St Peters Hospitals NHS Foundation Trust | Patel K.,Ashford & St Peters Hospitals NHS Foundation Trust | Grundy C.,Ashford & St Peters Hospitals NHS Foundation Trust | And 2 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2015

A formulary decision was made at a large provider of acute hospital services in Surrey to replace piperacillin/tazobactam with amoxicillin+temocillin for the empiric treatment of severe hospital-acquired pneumonia. This decision was made because the use of broad-spectrum-β-lactam antibiotics is a known risk factor for Clostridium difficile infection (CDI) and for the selection of resistance. After the antibiotic formulary was changed, a retrospective audit was conducted to assess the effect of this change. Data from patients hospitalised between January 2011 and July 2012 for severe hospital-acquired pneumonia and treated empirically with piperacillin/tazobactam or amoxicillin+temocillin were reviewed retrospectively. Clinical characteristics of patients, data related to the episode of pneumonia, clinical success and incidence of significant diarrhoea and CDI were analysed. One hundred ninety-two episodes of severe hospital-acquired pneumonia in 188 patients were identified from hospital records. Ninety-eight patients received piperacillin/tazobactam and 94 amoxicillin+temocillin. At baseline, the two treatment groups were comparable, except that more patients with renal insufficiency were treated with piperacillin/tazobactam. Clinical success was comparable (80 versus 82 %; P = 0.86), but differences were observed between piperacillin/tazobactam and amoxicillin+temocillin for the rates of significant diarrhoea (34 versus 4 %, respectively; P < 0.0001) and for CDI (7 versus 0 %, respectively; P < 0.0028). This preliminary study suggests that the combination amoxicillin+temocillin is a viable alternative to piperacillin/tazobactam for the treatment of severe hospital-acquired pneumonia. This combination appears to be associated with fewer gastrointestinal adverse events. Further studies are needed to evaluate the place of amoxicillin+temocillin as empiric treatment of severe hospital-acquired pneumonia. © 2015, The Author(s). Source


Yusuf I.H.,Royal Berkshire Hospital NHS Foundation Trust | Sahare P.,Royal Berkshire Hospital NHS Foundation Trust | Hildebrand G.D.,Royal Berkshire Hospital NHS Foundation Trust | Hildebrand G.D.,Prince Charles Eye Unit
Journal of AAPOS | Year: 2013

Children treated for toxoplasma retinochoroiditis may experience a range of severe adverse drug responses. Drug reaction with eosinophilia and systemic symptoms syndrome is a life-threatening idiosyncratic drug reaction with a 10% mortality. We present a case of drug reaction with eosinophilia and systemic symptoms syndrome in a child on standard combination treatment with oral sulfadiazine, pyrimethamine, folinic acid, and steroids for toxoplasma retinochoroiditis. Early clinical recognition and appropriate treatment led to a complete recovery and no longterm sequelae. The parents of children during sulfadiazine treatment should be counseled on the potential significance of nonspecific illness. Copyright © 2013 by the American Association for Pediatric Ophthalmology and Strabismus. Source


Yusuf I.H.,Royal Berkshire Hospital NHS Foundation Trust | Sandford V.,Royal Berkshire Hospital NHS Foundation Trust | Hildebrand G.D.,Royal Berkshire Hospital NHS Foundation Trust | Hildebrand G.D.,Prince Charles Eye Unit
Journal of AAPOS | Year: 2013

Pyridoxine-dependent epilepsy (PDE) is a cause of neonatal epileptic encephalopathy not previously known to cause ophthalmic disease. We describe the novel observation of a 5-year-old girl with pyridoxine-dependent epilepsy and bilateral cataracts. PDE is the result of mutations in the ALDH7A1 gene encoding antiquitin, an enzyme protective against cellular dehydration and osmotic stress. Accumulating metabolic precursors in PDE have been shown to be cataractogenic in vitro, and experimental pyridoxine deficiency has been associated with lenticular opacities in vivo. The association of ALDH7A1 haploinsufficiency in PDE and congenital cataract may offer insight into the relationship between osmotic stress and fetal cataract development. Bilateral progression of cataracts in this child suggests ongoing metabolic dysregulation within the crystalline lens despite pyridoxine supplementation at doses sufficient to control seizure activity. Copyright © 2013 by the American Association for Pediatric Ophthalmology and Strabismus. Source


Hill G.N.,Royal Berkshire Hospital NHS Foundation Trust | O'Leary S.T.,Royal Berkshire Hospital NHS Foundation Trust
Knee Surgery, Sports Traumatology, Arthroscopy | Year: 2013

Purpose: The use of patient reported outcome measures has gained increasing prominence in reporting surgical outcomes following primary anterior cruciate ligament reconstruction (ACLR). Many peer-reviewed journals now require 'end-result' outcomes in excess of 24 months following surgery for publication. As such, there is less focus on early recovery when the greatest rate of change is experienced and when key rehabilitation decisions are made relating to restricted activity and return to sports. We sought to examine the early recovery profile of patients following primary ACLR, determine the presence of any plateau effect of recovery and establish a source of reference for future study. Method: One hundred and sixty-five patients undergoing primary ACLR were identified from a prospective database. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was recorded pre-operatively and at the 3-, 6- and 12-month follow-up reviews. Mean scores were developed to plot a standard 'recovery profile' of statistical analysis for the presence of any plateau effect. Results: There were significant improvements in all mean KOOS domains at 12 months following ACLR (P < 0.001) and between each recording point (P < 0.003), discounting any plateau effect. Rates of graft rupture and other surgical complications were low (1.2 and 1.8 %). The recovery profile of mean KOOS scores illustrated a reduced rate of recovery over time with sports/recreation and knee-related quality of life KOOS domains demonstrating the greatest sensitivity to change. Conclusions: This study profiles the early recovery of patients following primary ACLR using the KOOS demonstrating continued recovery of function throughout the full first 12 months with no evidence of a plateau effect. The early results in ACLR have not previously been reported in a study of this size and provide important data upon which key rehabilitation decisions can be based. Level of evidence: Therapeutic study-case series with no comparison group, Level IV. © 2012 Springer-Verlag Berlin Heidelberg. Source

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