ABSTRACT
PURPOSE: To analyse predictors of clinical outcome in fungal keratitis. METHODS: Data was collected during a prospective, randomized, controlled, double-masked clinical trial of treatment for fungal keratitis. Clinical features at presentation and demographics were collected at the enrollment visit for all patients. Pre-specified clinical outcomes included 3-month visual acuity and infiltrate/scar size, time to re-epithelialization, and corneal perforation. A separate multivariable model with each outcome as the dependent variable included all predictor variables. RESULTS: Predictors for worse 3-month visual acuity include older age (P=0.024), worse presentation visual acuity (P<0.001), larger infiltrate size at presentation (P<0.001), and pigmented ulcer (P=0.030). Larger infiltrate size at presentation was a significant predictor of worse 3-month infiltrate/scar size (P<0.001). Larger epithelial defect size was a significant predictor of perforation (P=0.0013). Predictors of longer time to re-epithelialization include infiltrate size at presentation (P<0.001) and older age (P=0.025). CONCLUSION: Ulcer severity at presentation is highly predictive of worse outcomes. Presentation of clinical characteristics such as baseline acuity and infiltrate scar can provide important information to clinicians about prognosis, and may help guide management and treatment decisions. Prevention of corneal ulcer remains important, as it is difficult to change the course of the ulcer once it has begun.
Subject(s)
Corneal Ulcer/diagnosis , Eye Infections, Fungal/diagnosis , Administration, Topical , Antifungal Agents/therapeutic use , Corneal Perforation/diagnosis , Corneal Ulcer/drug therapy , Corneal Ulcer/microbiology , Debridement , Double-Blind Method , Eye Infections, Fungal/drug therapy , Eye Infections, Fungal/microbiology , Female , Humans , Male , Natamycin/therapeutic use , Ophthalmic Solutions , Outcome and Process Assessment, Health Care , Prognosis , Prospective Studies , Pyrimidines/therapeutic use , Re-Epithelialization , Risk Factors , Time Factors , Triazoles/therapeutic use , Visual Acuity/physiology , VoriconazoleABSTRACT
AIMS: The purpose of this study was to estimate the duration of treatment necessary for sequential acanthamoeba laboratory tests from corneal scrapings to become negative, and to assess predictors that affect this duration period. METHODS: We included all patients with at least one positive acanthamoeba culture or Giemsa stain at the F.I. Proctor Foundation Microbiology Laboratory from 1996 to 2009. A parametric survival analysis was performed among patients with repeat cultures to assess significant predictors for extended clearance time. Simulations were performed to estimate clearance time in the entire patient population, assuming imperfect sensitivity. RESULTS: Thirty-seven patients with laboratory evidence of acanthamoeba had testing at 69 time points. The median clearance time among eyes with repeat cultures was 42.5 days (interquartile range (IQR) 22.0-82.0 days; unadjusted parametric model). Initial visual acuity was the only predictor significantly associated with clearance time in univariate analyses (P<0.0001). Using initial visual acuity as a predictor for clearance time among the entire patient population, the estimated clearance time decreased to 38.7 days (95% confidence interval (CI) 27.9-53.5 days). When the imperfect sensitivity of the culture technique was also taken into account, the estimated clearance time was 44.1 days (95% CI 31.9-61.0 days). CONCLUSION: The duration of infection with acanthamoeba keratitis undergoing treatment has not been well characterized. In this report we estimate a median clearance time of approximately 6 weeks, with an IQR of 22-82 days.
Subject(s)
Acanthamoeba Keratitis/microbiology , Acanthamoeba/isolation & purification , Acanthamoeba Keratitis/drug therapy , Acanthamoeba Keratitis/physiopathology , Adolescent , Adult , Aged , Aged, 80 and over , Antiparasitic Agents/therapeutic use , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Visual Acuity/physiology , Young AdultSubject(s)
Calcium-Binding Proteins/metabolism , Conditioning, Psychological/physiology , GTP-Binding Proteins/metabolism , Memory/physiology , Oligopeptides/metabolism , Snails/physiology , Animals , Caenorhabditis elegans Proteins , Immunohistochemistry , Potassium Channel Blockers/metabolism , Snails/metabolismABSTRACT
The aim of the study was to estimate the occurrence of low birthweight (LBW) and preterm birth among immigrant and Swedish women in Sweden. Eligible for analysis were all 1,270,407 singleton births in Sweden between 1978 and 1990 to mothers aged between 15 and 44 years, whose own country of birth was known. The mothers of the children were born in Sweden (88.2%), or had immigrated from Finland (4.4%), other Scandinavian countries (1.2%), Western Europe or North America (1.3%), Eastern Europe (1.8%), the Middle East and North Africa (1.7%), Central and South America (0.6%), Asia and the Pacific Islands (0.6%), or Sub-Saharan Africa (0.2%). Multiple logistic regression was used to model LBW and preterm birth categorical outcomes. Each immigrant group was compared with the Swedish group. Odds ratios (ORs) for LBW were 1.13 (95% CI 1.04, 1.22) for Asia and the Pacific Islands, 1.21 (1.05, 1.38) for Sub-Saharan Africa and 0.89 (0.86-0.93) for Finland. Odds ratios for preterm birth were 1.15 (1.08-1.23) for immigrants from Asia and the Pacific Islands and 1.08 (1.04, 1.13) for immigrants from Eastern Europe. Remarkably small differences were found between immigrant women and native Swedish women.
