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Topical cyclosporin as an alternative treatment for vision threatening blepharokeratoconjunctivitis: a case report
Ismail AS, Taharin R, Embong Z
International Medical Case Reports Journal , 2012, DOI: http://dx.doi.org/10.2147/IMCRJ.S29960
Abstract: pical cyclosporin as an alternative treatment for vision threatening blepharokeratoconjunctivitis: a case report Case report (1235) Total Article Views Authors: Ismail AS, Taharin R, Embong Z Published Date June 2012 Volume 2012:5 Pages 33 - 37 DOI: http://dx.doi.org/10.2147/IMCRJ.S29960 Received: 15 January 2012 Accepted: 09 March 2012 Published: 27 June 2012 Abdul-Salim Ismail,1,2 Rohana Taharin,2 Zunaina Embong1 1Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 2Department of Ophthalmology, Hospital Pulau Pinang, Jalan Resindensi, Pulau Pinang, Malaysia Abstract: Here, a case of vision threatening blepharokeratoconjunctivitis that responded well to topical cyclosporin is reported. A 9-year-old Malay girl with a history of bilateral blepharokeratoconjunctivitis was regularly treated with lid scrubbing using diluted baby shampoo, fusidic acid gel, and topical steroids as well as an intermittent course of oral doxycycline for the past year. She developed acute onset bilateral eye redness associated with poor vision in her right eye. Both eyes showed marked diffuse hyperemic conjunctiva with corneal vascularization. The presence of corneal vascularization obscured the visual axis in the right eye. The condition did not improve with regular intensive lid hygiene using diluted baby shampoo, fusidic acid gel, and topical steroids. She was started on topical cyclosporin A 0.5% every 6 hours. There was a dramatic regression of corneal vascularization after 3 days on topical cyclosporin, with marked improvement in visual acuity. This is a single case in which cyclosporin improved the status of the ocular surface. A large cohort study is required to justify its effectiveness in treating blepharokeratoconjunctivitis and to test its potential as an alternative immunosuppressive agent in comparison to conventional corticosteroids.
Topical cyclosporin as an alternative treatment for vision threatening blepharokeratoconjunctivitis: a case report
Ismail AS,Taharin R,Embong Z
International Medical Case Reports Journal , 2012,
Abstract: Abdul-Salim Ismail,1,2 Rohana Taharin,2 Zunaina Embong11Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 2Department of Ophthalmology, Hospital Pulau Pinang, Jalan Resindensi, Pulau Pinang, MalaysiaAbstract: Here, a case of vision threatening blepharokeratoconjunctivitis that responded well to topical cyclosporin is reported. A 9-year-old Malay girl with a history of bilateral blepharokeratoconjunctivitis was regularly treated with lid scrubbing using diluted baby shampoo, fusidic acid gel, and topical steroids as well as an intermittent course of oral doxycycline for the past year. She developed acute onset bilateral eye redness associated with poor vision in her right eye. Both eyes showed marked diffuse hyperemic conjunctiva with corneal vascularization. The presence of corneal vascularization obscured the visual axis in the right eye. The condition did not improve with regular intensive lid hygiene using diluted baby shampoo, fusidic acid gel, and topical steroids. She was started on topical cyclosporin A 0.5% every 6 hours. There was a dramatic regression of corneal vascularization after 3 days on topical cyclosporin, with marked improvement in visual acuity. This is a single case in which cyclosporin improved the status of the ocular surface. A large cohort study is required to justify its effectiveness in treating blepharokeratoconjunctivitis and to test its potential as an alternative immunosuppressive agent in comparison to conventional corticosteroids.Keywords: blepharokeratoconjunctivitis, cyclosporin
Intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage
Abdul-Salim I,Embong Z,ST？Khairy-Shamel,Raja-Azmi MN
Clinical Ophthalmology , 2013,
Abstract: Ismail Abdul-Salim,1 Zunaina Embong,1,2 Sonny-Teo Khairy-Shamel,1,2 Mohd-Noor Raja-Azmi,1,21Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia; 2Universiti Sains Malaysia Hospital, Jalan Raja Perempuan Zainab II, Kubang Kerian, MalaysiaAbstract: Herein, we report our experience in treating extensive traumatic submacular hemorrhage with a single dose of intravitreal ranibizumab. A 23-year-old healthy Malay man presented with a progressive reduction of central vision in the left eye of 2 days’ duration following a history of blunt trauma. Visual acuity was reduced to counting fingers. Examination revealed infero-temporal subconjunctival hemorrhage, traumatic anterior uveitis, and an extensive submacular hemorrhage with suspicion of a choroidal rupture in the affected eye. He was initially treated conservatively with topical prednisolone acetate 1%. The subconjunctival hemorrhage and anterior uveitis resolved but his vision remained poor with minimal resolution of the submacular hemorrhage at 1 week follow-up (day 12 post-trauma). In view of the poor resolution of submacular hemorrhage, he was treated with a single dose of 0.5 mg intravitreal ranibizumab at day 20 post-trauma. At 4 weeks post-intravitreal ranibizumab, there was an improvement in visual acuity (from counting fingers to 6/45) and complete resolution of the submacular hemorrhage with presence of a choroidal rupture scar temporal to the fovea, which was not seen clearly at presentation due to obscuration by blood. His visual acuity further improved to 6/18 at 3 months post-trauma. Although this single case had a favorable outcome, a large population cohort study is needed to establish the effectiveness of intravitreal ranibizumab in treating extensive traumatic submacular hemorrhage.Keywords: trauma, choroidal rupture scar, visual acuity, submacular hemorrhage, anterior uveitis
Intravitreal triamcinolone versus laser photocoagulation as a primary treatment for diabetic macular oedema - a comparative pilot study
Mustapha Norlaili, Shaharuddin Bakiah, Embong Zunaina
BMC Ophthalmology , 2011, DOI: 10.1186/1471-2415-11-36
Abstract: This comparative pilot study consists of 40 diabetic patients with diabetic macular oedema. The patients were randomized into two groups using envelope technique sampling procedure. Treatment for diabetic macular oedema was based on the printed envelope technique selected for every patient. Twenty patients were assigned for IVTA group (one injection of IVTA) and another 20 patients for LASER group (one laser session). Main outcome measures were mean BCVA and mean MEI at three months post treatment. The MEI was quantified using Heidelberg Retinal Tomography II.The mean difference for BCVA at baseline [IVTA: 0.935 (0.223), LASER: 0.795 (0.315)] and at three months post treatment [IVTA: 0.405 (0.224), LASER: 0.525 (0.289)] between IVTA and LASER group was not statistically significant (p = 0.113 and p = 0.151 respectively). The mean difference for MEI at baseline [IVTA: 2.539 (0.914), LASER: 2.139 (0.577)] and at three months post treatment [IVTA: 1.753 (0.614), LASER: 1.711 (0.472)] between IVTA and LASER group was also not statistically significant (p = 0.106 and p = 0.811 respectively).IVTA demonstrates good outcome comparable to laser photocoagulation as a primary treatment for diabetic macular oedema at three months post treatment.ISRCTN05040192 (http://www.controlled-trial.com webcite)Diabetic macular oedema (DME) is the leading causes of blindness in an increasing number of patients with diabetes. Reduction of visual acuity in DME results from accumulation of fluid produced from a rupture of the blood-retinal barrier into the inner nuclear layer of the retina. The thickened macula can be visualized on slit lamp examination using 90 Dioptre or 78 Dioptre lens. The retinal thickness can be measured or quantified by Optical Coherent Tomography (OCT), Confocal laser scanning using Heidelberg Retina Tomography II (HRT II) or Retinal Thickness Analyzer.Scanning laser tomography (SLT) in HRT II is a non-invasive technique which permits the objective, topographic measur
Cerebral venous sinus thrombosis presenting with diplopia in pregnancy: a case report
Munira Yusoff,Sakinah Zakariah,Zunaina Embong
Journal of Medical Case Reports , 2012, DOI: 10.1186/1752-1947-6-336
Abstract: Introduction Cerebral venous sinus thrombosis is a rare condition. The most frequent symptoms and signs are headache, focal seizures with or without secondary generalization, unilateral or bilateral paresis and papilledema. We report a case of transverse sinus and superior sagittal sinus thrombosis that presented with diplopia in a pregnant woman. Case presentation A 34-year-old Malay woman, gravida 3 para 2 at 8 weeks of pregnancy, was admitted for hyperemesis gravidarum, presented with sudden onset of diplopia, blurring of vision and headache. A magnetic resonance scan of her brain showed the presence of cerebral edema with no space occupying lesion, but magnetic resonance venography ultimately revealed right transverse sinus and superior sagittal sinus thrombosis. The patient was treated with anticoagulation for 1 year, after which the patient recovered fully. Conclusion Due to its diverse and varied neurological presentation, cerebral venous sinus thrombosis should be considered in almost any brain syndrome.
Ortner’s syndrome: Focused cardiac ultrasound and rapid ultrasound in shock examination at emergency department unfold the life
Azlan Helmy Abd Samat,Hashim Embong
- , 2018, DOI: 10.1177/1024907918755163
Abstract: Ortner’s syndrome is a rare condition, known as cardiovocal condition as patients present with hoarseness of voice due to cardiovascular causes. We present a case of Ortner’s syndrome secondary to leaking thoracic aortic aneurysm in a patient who came to emergency department with hypotension and hoarseness of voice for 3 months. Focused cardiac ultrasound (FOCUS) and rapid ultrasound in shock (RUSH) were performed which revealed a thoracic aortic arch aneurysm. Focused cardiac ultrasound and rapid ultrasound in shock examination in the emergency department had expedited the diagnosis of this rare condition, hence the subsequent definitive investigation and management. This case highlights the need for high index of suspicion for thoracic aneurysm in patients with unexplained cardiovocal symptoms. It also highlights the importance of point-of-care ultrasound in the emergency department and the significance of utilizing the suprasternal view to look for pathology at the arch of aorta
Ocular Tuberculosis with Multiple Cerebral Abscesses
Saidin Nor-Masniwati,Embong Zunaina,Yaakub Azhany
Case Reports in Ophthalmological Medicine , 2012, DOI: 10.1155/2012/606741
Abstract: A 23-year-old Malay man presented with headache for one-month duration. It was associated with painless blurring of vision of the right eye. He had loss of appetite and reduced weight but no night sweats or hemoptysis. His visual acuity on the right eye was 6/45 and improved to 6/15 with pinhole. Right fundus examination revealed a choroidal tuberculoma located at one disc diameter away from optic disc superiorly with mild vitritis. Systemic examinations revealed no significant finding. Mantoux test reading was 22 mm with erythrocyte sedimentation rate that was 14 mm/h. Other blood investigations were negative with normal chest radiography. The computerized tomography scan of the brain revealed multiple cerebral abscesses. A clinical diagnosis of right ocular tuberculosis with multiple cerebral abscesses was made. He was treated with antituberculosis chemotherapy for one year which divided into intensive phase for three months and maintenance phase for nine months. Cerebral abscesses resolved after three months of antituberculosis drugs and at one-year follow-up, and the choroidal tuberculoma resolved completely with scar formation and significant macular striae.
Purtscher-like retinopathy following valsalva maneuver effect: case report
Saidin Nor-Masniwati, Yaakub Azhany, Embong Zunaina
Journal of Medical Case Reports , 2011, DOI: 10.1186/1752-1947-5-338
Abstract: A 43-year old Malay man presented with a sudden onset of central foggy vision in the left eye after holding his breath for two minutes while catching a falling object. It was not associated with floaters, flashes of light, or head trauma. His vision in the right eye was 6/6, and in his left eye it was finger counting. He had bilateral temporal sub-conjunctival hemorrhages. An examination of his left fundus revealed multiple white cotton wool spots and dot-blot retinal hemorrhages with diffuse retinal edema at the posterior pole. His right fundus was noted to have only mild temporal peri-papillary edema associated with a few dot-blot hemorrhages. Fundus fluorescein angiography showed good arterial perfusion and no evidence of leaking or neo-vascularization. A diagnosis of Purtscher-like retinopathy was made, and the patient was treated with indomethacin tablets for six weeks. At his six-week follow-up examination, his left eye visual acuity had improved to 6/12. His bilateral sub-conjunctival hemorrhage had resolved. His left fundus showed residual multiple cotton wool spots and reduced retinal edema.Treatment with non-steroidal anti-inflammatory drugs seems to be effective in reducing edema in patients with Purtscher-like retinopathy.Purtscher's retinopathy is a rare condition and is noted in cases associated with various types of trauma, including head trauma, seatbelt and airbag pressure, malar bone fracture, crush injury, and chest trauma [1-4]. The fundus characteristics are Purtscher flecken, which are multiple cotton wool spots of varying sizes. The findings in the fundus in patients with Purtscher-like retinopathy are similar, but without any association with trauma. Herein we report the case of a patient with Purtscher-like retinopathy that occurred after the Valsalva maneuver effect.A 43-year old Malay man presented to our hospital with sudden-onset blurring of the vision, which he described as central foggy vision that occurred after he caught a piece of f
Tilt Table Practice Improved Ventilation in a Patient with Prolonged Artificial Ventilation Support in Intensive Care Unit
Asiah M Hashim,Leonard H Joseph,Juleida Embong,Zalila Kasim
Iranian Journal of Medical Sciences , 2012,
Abstract: Patients who are on prolonged ventilator support in critical care unit present wide variety of complications, which range from reduction in oxygen uptake to various musculoskeletal impairments. Early mobilization and rehabilitation are encouraged to manage these complications effectively. Use of tilt table to motivate early mobilization in the intensive care unit for ventilator practices is not a usual practice. However, this new technique has attracted involvements of clinicians and therapists for its therapeutic benefits to the patient. Herein we describe a case of a seventy eight-year-old male patient who suffered Motor car accident, and was on ventilator support in intensive care unit for more than one month. He underwent treatment using a tilt table protocol with other routine treatment, which benefited him based on clinical as well as physiological variables. For practitioners in intensive care units, this report may offer perceptivity into the alternate practice of early mobilization using tilt table, and for investigators it may promote interest for further studies.
Clustering High Dimensional Data Using Subspace and Projected Clustering Algorithms
Rahmat Widia Sembiring,Jasni Mohamad Zain,Abdullah Embong
International Journal of Computer Science & Information Technology , 2010,
Abstract: Problem statement: Clustering has a number of techniques that have been developed in statistics, patternrecognition, data mining, and other fields. Subspace clustering enumerates clusters of objects in allsubspaces of a dataset. It tends to produce many over lapping clusters. Approach: Subspace clusteringand projected clustering are research areas for clustering in high dimensional spaces. In this research weexperiment three clustering oriented algorithms, PROCLUS, P3C and STATPC. Results: In general,PROCLUS performs better in terms of time of calculation and produced the least number of un-clustereddata while STATPC outperforms PROCLUS and P3C in the accuracy of both cluster points and relevantattributes found. Conclusions/Recommendations: In this study, we analyze in detail the properties ofdifferent data clustering method
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