RESUMO
We report an aggressive fungal keratitis caused by a putatively novel species of Lophotrichus in a patient with traumatic injury to the cornea from a dog paw. The organism was isolated from the patient's necrotic cornea, which perforated despite coverage with hourly fortified broad-spectrum topical antibiotic therapy. This report represents the first case of human infection caused by this species.
Assuntos
Ascomicetos/isolamento & purificação , Úlcera da Córnea/diagnóstico , Úlcera da Córnea/patologia , Micoses/diagnóstico , Micoses/patologia , Animais , Lesões da Córnea/complicações , Úlcera da Córnea/microbiologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Cães , Feminino , Histocitoquímica , Humanos , Técnicas Microbiológicas , Microscopia , Pessoa de Meia-Idade , Dados de Sequência Molecular , Micoses/microbiologia , Análise de Sequência de DNARESUMO
Purpose. The purpose of this study was to report a case of bilateral vitreopapillary traction, previously misdiagnosed as papilledema. Methods. A case report is presented of a 47-year-old woman with a prior diagnosis of papilledema, who is shown to have bilateral vitreopapillary traction rather than true optic disc swelling, confirmed by optical coherence tomography (OCT). Results. OCT showed vitreous traction surrounding the optic discs of both eyes. Fluorescein angiography demonstrated focal leakage of both discs. Conclusion. Bilateral disc elevation caused by vitreous traction can be confused with papilledema. In such cases, OCT can be used to arrive at the correct diagnosis. Although the phenomenon of vitreopapillary traction is well reported, this case indicates that not all ophthalmologists recognize the condition.
RESUMO
In resource-constrained settings, the most frequently cited barrier to optimal antiretroviral therapy (ART) adherence among HIV-infected patients has been the cost of medications. In recent years many subsidized medication programs have been developed to improve ART affordability. A Graduated Cost Recovery program at the largest care center in South India has enrolled 839 eligible patients into four tiers based on an evaluation of their financial information and willingness to pay, of these patients 635 consented to participate in this study. Patients in Tier 1 receive first-line ART at no cost, whereas patients in Tiers 2, 3, and 4 pay 50, 75, and 100%, respectively of the cost of first-line medications based on an assessment of their means. Adherence rates of 95% or greater on 3-day recall were achieved by 84.6% of Tier 1 (n = 156), 71.6% of Tier 2 (n = 141), 72.3% of Tier 3 (n = 242), and 79.2% of Tier 4 (n = 96). These findings suggest patients are highly motivated and that the provision of no-cost ART can promote higher rates of optimal adherence.