Italiano Farmacia on line: comprare cialis senza ricetta, acquistare viagra internet.

Microsoft powerpoint - ant_seg_inter_grand_runds_rce_allergy_fuchs

Case History
58 y.o. female
CC: “red painful eye”
Tearing
F.B. Sensation
Additional testing:
87% of all RCE occurs in
what part of the cornea?
• Reidy JJ, Pauli MP et al. Cornea 2000 •Recurrent Erosion
Syndrome
Daytime meds?
What about hyperosmotic
Artificial tears PRN
What medications should be
avoided?
Bland Artificial Tear
Doxycycline 100 mg bid x 2 months Ointments
Dursun D. et al. Treatment of recalcitrant recurrent corneal erosions with inhibitors of Eke T et al Recurrent symptoms following
matrix metalloproteinase-9 doxycycline and traumatic corneal abrasion Eye 1999 June
Options for Recalcitrant Cases:
Metalloproteinases which cleave
Bowman’s layer below the
anchoring system
(Hemidesmisones)
Develop through the production
of Leukotrienes
• James Reidy et al. Recurrent erosions of • The remainder had trauma induced causes dystrophy or epithelial basement membrane • 34 y.o. male - professional golf instructor • CC: Burning and can’t go outside because • Periorbital redness, dry skin and crusting • Corneal neovascularization superiorly approx. • People think I have pink-eye and stay away • Has been going on for “years” just much worse • Up to 30% of the US population suffer from some Allergic Eye Disease
• Allergies are the 6th leading cause of chronic • 3.5 Million lost work days each year• Over $6 Billion spent on prescription medications • An immune response to naturally occurring _______________________________• All Type I hypersensitivity reactions • Conjunctivitis may be cicatrizing (scarring, • Swollen eczematous periorbital skin• Superficial punctate keratitis• Superficial corneal infiltrates• Keratoconus• Anterior polar cataracts • Strong family history of Atopic disease (eczema etc.) • Persistent state of mast cells• High concentration of eosinophils• Lymphocyte activation • Chronic Redness, Itching and irritation • Mast cell stabilizers (Alocril, Alamast) • New site-specific steroids (Loteprednol 0.5%) – Blepharitis– Keratoconjunctivitis Sicca– Atopic dermatitis– Eczema of eyelids and periorbital tissue– Ocular allergic response • P.O. Doxycycline 100mg bid x 2-4 weeks – Perhaps after inflammation is under control • 1% hydrocortisone cream after a non-drying • Mast cells play a significant role in multiple • P.O. Antihistamines (Claritin, Allegra, • Protect with topical antibiotics (Quixin, – __________________________– __________________________ – Avoid highly preserved antibiotics (BAK, – Another visually threatening type of the allergic eye • Vascularization present?• Pulsed Steroid Drops (Alrex or Lotemax) • Presents in early spring - lasts until fall • Increased levels of superficial Mast Cells, • Intense itching• Tearing• Hot, tight, sensitive feeling to eyes• Photophobia* Eosinophil levels are not increased in patients with • Th2 cells• H1 and H2 activitation (extreme itching - H1)• Chronic in nature • Severe itching in young patients leads to severe • Steroid drops - pulsed to control inflammation • Associated with contact lenses, ocular prosthetics, • Lotemax (or Pred Forte in severe cases) exposed sutures, cyanoacrylate adhesive, extruded scleral buckles and ocular FBs • Restasis bid - very effective for shield ulcers • Lid discomfort upon lens removal• Increased lens movement • Increased lymphocytes and inflammatory components (cytokines, leukotrienes, prostaglandins) • Early Diagnosis is critical to rapid treatment • Discontinue offending agent (contact lens) for 1-3 • When returning to CL wear consider a different edge • Higher incidence at certain times of the • Perennial allergic conjunctivitis (PAC) – All year– e.g. animal dander, dust,– Indoor allergies • Also burning & tearing• Bilateral – Seasonal Allergic Conjunctivitis every year, – Newer mast stabilizers may only require 4-7 – Patients are not accustomed to seeing a • Best medication for anticipating seasonal – ACUTE Seasonal Allergic Conjunctivitis • Mast-cell stabilizers b.i.d. 1-2 weeks and • Treatment decision depends on signs & • Stimulation of the H1 receptor - ______________ • Stimulation of the H2 receptor - ______________ • Crosslinking of membrane bound IgE molecules • moderate to severe erythema and edema • Release and metabolism of arachidonic acid • “Affecting daily activities or lifestyle” – Alrex 0.2% (perhaps Lotemax 0.5% in severe • M. Abelson• 66 patients on Loteprednol 0.5% for 35 days for • Percentage of patients with an increase in IOP? • Increased Susceptibility to Infections • Loteprednol Etabonte 0.2% used for Seasonal & Perennial • Administered under a University of South Florida College – No patient had worsening of all-ready existing – No reported secondary infectious disease • 159 pts had used loteprednol etabonate 0.2% for more than – No patient developed a clinically significant Ilyas, Slonim, Braswell, Favetta, Schulman. Eye & Contact Len, Vol. 30, No. 1, 2004 • Loteprednol etabonate 0.2% similar to • Ester Steroids are inactivated by naturally – Ketone steroids remain in anterior chamber and • Ketone Steroids are not inactivated and can influence IOP & cataract formation • Post breakdown, ketone metabolites are still activeKetone group in prednisolone is replaced by an – Ester group causes the molecule to be hydrolyzed by tissue esterases to become an • Category III - Significant Systemic Involvement • Rhinitis, itchy throat, cough, sinus congestion• Add Oral medications to topical regimen • Consider consult with allergist depending on severity, • P.O. Claritin, Allegra or Clarinex qd• If sinus congestion is present: • Not recommended with ocular signs/symptoms • P.O. Claritin-D 24-hr or Allegra-D 24 hr - qd • Maintain or increase preservative-free artificial tears • Potentially the most effective treatment for • Poor systemic absorption - few side effects • Vision affected at what time of the day? • Loss of endothelial cells• May be secondary to other factors: – Cataract Surgery stain on compromised – Discoloration of cornea (“Beaten Bronze”) – AC IOL’s (Pseudophakic Bollous Keratopathy) • Eliminate corneal sutures• Eliminate corneal surface incisions – Faster wound healing– Smoother topography– Stronger and more stable eye.
• Remove only diseased endothelium vs. • Creates a deep lamellar corneal pocket• No surface incisions or sutures! • Excise 7.5 - 8.0 mm of diseased tissue • Replace with healthy donor endothelium • Only complication noted in any clinical • Pump function maintains as does natural • Patient has symptoms of blurred vision in • Failed cornea after phaco in first eye

Source: http://www.dcos.org/images/Ant_Seg_Inter_Grand_Rounds.pdf

Microsoft word - syllabus.doc

MARKETING STRATEGY Fall 2005 Professor : Class Times : Tuesday Class Location : Purnell, Room 233A Office Hours : Office Location : 117 Alfred Lerner Hall E-mail : freemand@lerner.udel.edu Course Description BUAD479 provides a capstone experience for marketing majors. As such, the course focuses on devising marketing strategies for real-world business situations. Cou

zetup.ch

ESMO: Chronic Disease AllianceVorzeitiger Morbidität durch chronische Krankheiten den Kampf ansagenGemeinsam mit neun weiteren medizinischen Fachgesellschaften aus ganz Europa hat sich die European Society for Medical Oncology Anfang 2010 zu einer interdisziplinären Allianz mit über 100.000 Fachärzten zusammengeschlossen. Damit soll aufmerksam gemacht werden auf das Problem der schleichend

Copyright © 2010-2014 Drugstore Pdf Search