RESUMEN
BACKGROUND: Hyperhidrosis (HH) is characterized by exaggerated sweating in a specific region due to hyperfunction of the sweat glands. In the late 2000s, we started treating patients with an anticholinergic, oxybutynin, that was not being used until then. OBJECTIVES: To present, after 12 years of utilizing this medication in our service, the substantial experience obtained with the use of oxybutynin as an initial treatment of HH in a large series of 1,658 patients. METHODS: We analyzed 1,658 patients treated with oxybutynin for HH from May 2006 to June 2018. The patients were divided into four groups according to the main site of HH: the plantar group, the axillary group, the facial group, and the palmar group. To measure the degree of satisfaction, a quality of life (QoL) questionnaire was used. RESULTS: Pre-treatment QoL was poor or very poor in more than 94% of the cases, and the palmar group had the worst quality of life. After treatment, we observed an improvement in the quality of life in 77% of patients. More than 70% of the patients in all groups present moderate or optimal subjective clinical improvement in sweating after treatment. The group with the best result was the facial group. Intense dry mouth was reported in 24.9% of all patients in all groups. CONCLUSIONS: This study included a large number of patients followed for a long period and demonstrated the good effectiveness of treatment with oxybutynin for hyperhidrosis in the main sites of sweating.
Asunto(s)
Hiperhidrosis/tratamiento farmacológico , Ácidos Mandélicos/administración & dosificación , Antagonistas Muscarínicos/administración & dosificación , Calidad de Vida , Xeroftalmia/epidemiología , Administración Oral , Adolescente , Adulto , Axila , Esquema de Medicación , Cara , Femenino , Estudios de Seguimiento , Mano , Humanos , Hiperhidrosis/diagnóstico , Hiperhidrosis/psicología , Masculino , Ácidos Mandélicos/efectos adversos , Persona de Mediana Edad , Antagonistas Muscarínicos/efectos adversos , Satisfacción del Paciente/estadística & datos numéricos , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios/estadística & datos numéricos , Factores de Tiempo , Resultado del Tratamiento , Xeroftalmia/inducido químicamente , Xeroftalmia/diagnóstico , Adulto JovenRESUMEN
BACKGROUND: Sjögren syndrome (SS) is associated with xerostomia and xerophthalmia. Pilocarpine has been shown to stimulate the secretion of saliva. OBJECTIVES: To investigate and compare the efficacy of pilocarpine and artificial saliva as symptomatic treatments for xerostomia and xerophthalmia in patients with SS. METHODS: A double-blind randomized controlled study was performed. A total of 72 patients with SS were assigned randomly to receive 10 drops of pilocarpine (5 mg) or 10 drops of artificial saliva orally, three times daily for 12 weeks. Whole saliva and tear flow were evaluated at baseline and periodically throughout the study to provide a global assessment of dryness and to report any adverse effects. RESULTS: Patients receiving pilocarpine had a statistically significant improvement in their salivary flow (P < 0·001), lacrimal flow (P < 0·001) and their subjective global assessment (P < 0·001), compared with patients who received artificial saliva. The most common side-effects were sialorrhoea and nausea. CONCLUSIONS: Pilocarpine is more effective than artificial saliva for enhancing salivary and lacrimal secretion in patients with SS. This is the first study to compare the efficacy of pilocarpine and artificial saliva for the treatment of xerostomia and xerophthalmia in SS.
Asunto(s)
Agonistas Muscarínicos/administración & dosificación , Pilocarpina/administración & dosificación , Saliva Artificial/administración & dosificación , Síndrome de Sjögren/complicaciones , Xeroftalmia/tratamiento farmacológico , Xerostomía/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Náusea/inducido químicamente , Náusea/epidemiología , Pilocarpina/efectos adversos , Saliva Artificial/efectos adversos , Sialorrea/inducido químicamente , Sialorrea/epidemiología , Síndrome de Sjögren/tratamiento farmacológico , Resultado del Tratamiento , Xeroftalmia/diagnóstico , Xeroftalmia/etiología , Xerostomía/diagnóstico , Xerostomía/etiologíaRESUMEN
PURPOSE:: To identify and evaluate changes in the ocular surface in obese patients with bariatric surgery. METHODS:: The study included 89 randomly selected patients; 81 (91.0%) were women, 35 were preoperative, 32 were included 0-12 months after surgery, and 22 were included >12 months after surgery. All patients completed a dry eye-specific questionnaire and were evaluated by the tear ferning test, tear-film breakup time (BUT), Schirmer's test I, examination of the ocular surface by 1% rose Bengal staining, and impression cytology. Patients were questioned about compliance with nutritional supplementation. RESULTS:: The pre- and postoperative groups did not differ significantly in age (p=0.082), but did differ in body mass index (p<0.001). All test values are within the normal range and there was no statistically significant difference in ocular surface disease index score between the preoperative and postoperative periods. The mean tear-film BUT was lower than that considered normal (10 s) at each time it was tested. No statistically significant group differences were observed in Schirmer's test, BUT, rose Bengal staining, or impression cytology. A high rate of noncompliance with nutritional supplementation was observed. CONCLUSIONS:: No symptoms of xerophthalmia developed in this series of bariatric surgery patients. No changes were observed in any of the specific tests used to evaluate the ocular surface up to 5 years after surgery compared with presurgery results.
Asunto(s)
Cirugía Bariátrica/efectos adversos , Síndromes de Ojo Seco/diagnóstico , Adulto , Estudios Transversales , Síndromes de Ojo Seco/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/cirugía , Resultado del Tratamiento , Xeroftalmia/diagnóstico , Xeroftalmia/etiologíaRESUMEN
ABSTRACT Purpose: To identify and evaluate changes in the ocular surface in obese patients with bariatric surgery. Methods: The study included 89 randomly selected patients; 81 (91.0%) were women, 35 were preoperative, 32 were included 0-12 months after surgery, and 22 were included >12 months after surgery. All patients completed a dry eye-specific questionnaire and were evaluated by the tear ferning test, tear-film breakup time (BUT), Schirmer's test I, examination of the ocular surface by 1% rose Bengal staining, and impression cytology. Patients were questioned about compliance with nutritional supplementation. Results: The pre- and postoperative groups did not differ significantly in age (p=0.082), but did differ in body mass index (p<0.001). All test values are within the normal range and there was no statistically significant difference in ocular surface disease index score between the preoperative and postoperative periods. The mean tear-film BUT was lower than that considered normal (10 s) at each time it was tested. No statistically significant group differences were observed in Schirmer's test, BUT, rose Bengal staining, or impression cytology. A high rate of noncompliance with nutritional supplementation was observed. Conclusions: No symptoms of xerophthalmia developed in this series of bariatric surgery patients. No changes were observed in any of the specific tests used to evaluate the ocular surface up to 5 years after surgery compared with presurgery results.
RESUMO Objetivos: Analisar os resultados dos testes de avialiação da superfície ocular em pacientes com obesidade submetidos à cirurgia bariátrica e identificar a presença e intensidades das alterações oculares após cirurgia bariátrica. Métodos: O estudo foi composto de 89 pacientes, amostra randômica, sendo 81 mulheres (91,0%). Os pacientes foram agrupados com relação à relação da cirurgia bariátrica: pré-operatório (35 pacientes), pós-operatório 0 a 12 meses (32 pacientes) e mais de 12 meses (22 pacientes). Todos os pacientes foram submetidos a seguinte sequencia de exames: questionário olho seco específico, teste de cristalização do filme lacrimal, teste da tempo de ruptura do filme lacrimal, Schirmer teste I, avaliação da superfície ocular usando rosa bengala, citologia de impressão. Os pacientes foram questionados quanto ao uso da suplementação nutricional. Resultados: Não houve diferença estatística entre os grupos quanto à idade (p=0,082). BMI foi significativamente diferente entre os grupos (p<0,001). Quanto ao OSDI, os valores foram normais, sem diferença estatística entre os períodos pré-operatório e pós-operatório. A média do tempo de ruptura do filme lacrimal foi abaixo do considerado normal (10 segundos) em todos os momentos avaliados. Não houve di ferença estatisticamente significante entre os grupos com relação aos exames: teste de Schirmer, BUT, biomicroscopia com rosa bengala 1% e citologia de impressão. Elevada taxa de uso incorreto da suplementação nutricional foi encontrada (73%). Conclusão: Não houve surgimento de sintomas de xeroftalmia nos pacientes submetidos à cirurgia bariátrica e não foram encontrados alterações em nenhum teste utilizado para avaliar a superfície ocular em cinco anos após a cirurgia em comparação com os pacientes antes da cirurgia.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Síndromes de Ojo Seco/diagnóstico , Cirugía Bariátrica/efectos adversos , Síndromes de Ojo Seco/etiología , Xeroftalmia/diagnóstico , Xeroftalmia/etiología , Estudios Transversales , Resultado del Tratamiento , Obesidad/cirugíaRESUMEN
This is a case report of a 14-year-old boy with autism who presented with photophobia. Physical examination was significant for bilateral corneal ulcers. Differential diagnosis of this chief complaint and the management of the suspected condition are discussed. This case was presented at the Section of Emergency Medicine Meeting at the National Conference and Exhibition of the American Academy of Pediatrics in 2012 and was awarded first place in the PEMpix photograph competition.
Asunto(s)
Úlcera de la Córnea/diagnóstico , Deficiencia de Vitamina A/diagnóstico , Xeroftalmia/diagnóstico , Adolescente , Trastorno Autístico/complicaciones , Distinciones y Premios , Úlcera de la Córnea/terapia , Humanos , Masculino , Trastornos Nutricionales , Fotograbar , Deficiencia de Vitamina A/terapia , Xeroftalmia/terapiaAsunto(s)
Deficiencia de Vitamina A/diagnóstico , Xeroftalmia/diagnóstico , Niño , Conjuntiva/patología , Dermatitis Atópica/complicaciones , Diagnóstico Diferencial , Suplementos Dietéticos , Hipersensibilidad a los Alimentos/complicaciones , Humanos , Masculino , Federación de Rusia , Vitamina A/uso terapéutico , Deficiencia de Vitamina A/complicacionesRESUMEN
Sjögren's syndrome (SS) is a chronic inflammatory systemic autoimmune disease affecting the exocrine, salivary and lacrimal glands. The condition occurs more often in adults and is rare in childhood. SS should be considered in the differential diagnosis of recurrent parotitis and keratoconjunctivitis sicca. Oral manifestations include early tooth decay and xerostomia. Treatment consists of operative dentistry and saliva management. This paper reports a case of a 10-year-old Brazilian boy with SS, stressing the oral manifestations, treatment conduct, clinical importance and need for an early diagnosis in order to improve the patient's quality of life.
Asunto(s)
Enfermedades de la Boca/diagnóstico , Síndrome de Sjögren/diagnóstico , Queilitis/diagnóstico , Niño , Caries Dental/diagnóstico , Restauración Dental Permanente , Fluoruros Tópicos/uso terapéutico , Estudios de Seguimiento , Humanos , Masculino , Enfermedades de la Boca/terapia , Parotiditis/diagnóstico , Saliva/metabolismo , Síndrome de Sjögren/terapia , Xeroftalmia/diagnóstico , Xerostomía/diagnósticoRESUMEN
Se realiza una revisión de las bases de datos a las que se puede acceder a través de Internet sobre temas de medicina, así como de las principales revistas y sitios que tratan sobre afecciones reumatológicas buscando los conceptos más actuales que se presentan sobre el síndrome de Sjögren (SS), elementos de su cuadro clínico y complicaciones que pudieran ser útiles para el personal médico que labora en todos los niveles de salud donde se puedan presentar pacientes con esta entidad, logrando recuperar 71 citas de los últimos años útiles para nuestros fines, de las que exponemos los elementos más actuales encontrados en cuanto a los mecanismos etiopatogénicos presentes en su evolución, cuadro clínico, terapéutica y complicaciones más frecuentes(AU)
Authors made a review of databases to which it is possible to enter in Internet on medicine subjects, as well as of leading journals and sites related to Rheumatology affections to search the more updated concepts on Sj÷gren syndrome, elements of its clinical picture and complications that could be useful for medical staff working at all health levels where may be patients presenting with this entity, achieving to recover 71 quotations of past years essential for our aims showing the more updated elements found as regards the etiopathogeny mechanism present in its course, clinical picture, therapeutics and more frequent complications(AU)
Asunto(s)
Humanos , Síndrome de Sjögren/epidemiología , Síndrome de Sjögren/etiología , Xerostomía/diagnóstico , Xeroftalmia/diagnósticoRESUMEN
Se realiza una revisión de las bases de datos a las que se puede acceder a través de Internet sobre temas de medicina, así como de las principales revistas y sitios que tratan sobre afecciones reumatológicas buscando los conceptos más actuales que se presentan sobre el síndrome de Sjögren (SS), elementos de su cuadro clínico y complicaciones que pudieran ser útiles para el personal médico que labora en todos los niveles de salud donde se puedan presentar pacientes con esta entidad, logrando recuperar 71 citas de los últimos años útiles para nuestros fines, de las que exponemos los elementos más actuales encontrados en cuanto a los mecanismos etiopatogénicos presentes en su evolución, cuadro clínico, terapéutica y complicaciones más frecuentes
Authors made a review of databases to which it is possible to enter in Internet on medicine subjects, as well as of leading journals and sites related to Rheumatology affections to search the more updated concepts on Sj÷gren syndrome, elements of its clinical picture and complications that could be useful for medical staff working at all health levels where may be patients presenting with this entity, achieving to recover 71 quotations of past years essential for our aims showing the more updated elements found as regards the etiopathogeny mechanism present in its course, clinical picture, therapeutics and more frequent complications
Asunto(s)
Humanos , Síndrome de Sjögren/epidemiología , Síndrome de Sjögren/etiología , Xeroftalmia/diagnóstico , Xerostomía/diagnósticoRESUMEN
PURPOSE: To evaluate tear film quality by rose bengal staining and its stability by breakup time, relating with palpebral fissure height and exophthalmos in patients with Graves' ophthalmopathy. METHODS: We studied 54 eyes of 27 patients with Graves' ophthalmopathy, either in the inflammatory or in the chronic phase of the disease. The evaluation consisted of tear film qualitative analysis by rose bengal staining using the van Bijsterveld grading scale, tear film stability analysis by breakup time, measurement of palpebral fissure height and exophthalmometry. Qui square test was used to perform statistical analysis. RESULTS: Among 27 studied patients, 77.8% were females and 22.2% males. Mean age was 44.26 years (SD 12.67). Mean disease time was 5.85 years (SD 4.47) and mean ophthalmopathy time was 5.81 years (SD 5.37). Among 54 studied eyes, 37% had positive test by van Bijsterveld's grading scale, 33.3% tear film breakup time lower than 5 seconds, 57.4% palpebral fissure height greater than 11 mm and 55.6% exophthalmometry greater than 19 mm. When relating tear film breakup time lower than 5 seconds with palpebral fissure height greater than 11 mm we found an odds ratio of 11.2 (p=0.0008). The remaining relationships did not show statistical significance. CONCLUSIONS: Dry eye diagnosed by rose bengal staining and tear film breakup time occurs frequently in Graves' ophthalmopathy. Palpebral fissure height correlates with tear film breakup time in Graves' ophthalmopathy. Its increase may lead to tear film instability.
Asunto(s)
Párpados/anatomía & histología , Oftalmopatía de Graves/complicaciones , Lágrimas , Xeroftalmia/etiología , Adulto , Anciano , Distribución de Chi-Cuadrado , Femenino , Colorantes Fluorescentes , Humanos , Masculino , Persona de Mediana Edad , Rosa Bengala , Factores de Tiempo , Xeroftalmia/diagnósticoRESUMEN
OBJETIVO: Avaliar qualidade do filme lacrimal pelo corante rosa bengala e sua estabilidade por meio do tempo de ruptura, relacionando com a largura da fenda palpebral e a exoftalmia em pacientes com oftalmopatia de Graves. MÉTODOS: Foram estudados 54 olhos de 27 pacientes com oftalmopatia de Graves, tanto em fase inflamatória quanto em fase crônica. A avaliação consistiu de análise qualitativa do filme lacrimal pelo corante rosa bengala por meio da classificação de van Bijsterveld, análise da estabilidade do filme lacrimal pelo tempo de ruptura, medida da largura da fenda palpebral e exoftalmometria. A análise estatística foi realizada com o teste do Qui-quadrado. RESULTADOS: Entre os 27 pacientes estudados, 77,8 por cento eram do sexo feminino e 22,2 por cento do masculino. A idade média foi de 44,26 anos (DP 12,67). O tempo médio de doença foi de 5,85 anos (DP 4,47) e o de oftalmopatia foi de 5,81 anos (DP 5,37). Dos 54 olhos em estudo, 37 por cento apresentaram teste positivo pela escala de graduação de van Bijsterveld, 33,3 por cento tempo de ruptura do filme lacrimal menor que 5 segundos, 57,4 por cento largura da fenda palpebral maior que 11 mm e 55,6 por cento exoftalmometria maior que 19 mm. Quando relacionamos o tempo de ruptura do filme lacrimal menor que 5 segundos com a largura da fenda palpebral maior que 11 mm encontramos odds ratio igual a 11,2 (p=0,0008). As demais relações estudadas não mostraram significância estatística. CONCLUSÕES: O olho seco diagnosticado pela coloração com rosa bengala e pelo tempo de ruptura do filme lacrimal ocorre com freqüência na oftalmopatia de Graves. A largura da fenda palpebral correlaciona-se com o tempo de ruptura do filme lacrimal na oftalmopatia de Graves. Seu aumento pode levar à instabilidade do filme lacrimal.
Asunto(s)
Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Párpados/anatomía & histología , Oftalmopatía de Graves/complicaciones , Lágrimas , Xeroftalmia/etiología , Distribución de Chi-Cuadrado , Colorantes Fluorescentes , Rosa Bengala , Factores de Tiempo , Xeroftalmia/diagnósticoRESUMEN
OBJECTIVE: We examined an adult patient who lost one eye due to severe keratomalacia secondary to self-induced vitamin A deficiency. METHODS: This case report provides a clinical, ophthalmologic, and laboratory description in addition to a review of the medical literature. RESULTS: A 33-y-old woman with a 17-y history of an eating disorder presented with bilateral conjunctival xerosis, an infected corneal ulcer in the right eye and a large descemetocele in the left eye. Laboratory and clinical findings were consistent with vitamin A deficiency. Despite a tectonic penetrating keratoplasty, her left eye perforated and had to be eviscerated. In parallel, vitamin A replacement improved her clinical status and the ocular findings in her right eye. CONCLUSIONS: The present report indicates that vitamin A deficiency secondary to eating disorders should be considered in the differential diagnosis of patients with severe dry eye and corneal ulceration.
Asunto(s)
Ceguera/etiología , Úlcera de la Córnea/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Deficiencia de Vitamina A/complicaciones , Vitamina A/uso terapéutico , Adulto , Enfermedades de la Conjuntiva/diagnóstico , Enfermedades de la Conjuntiva/etiología , Úlcera de la Córnea/diagnóstico , Diagnóstico Diferencial , Evisceración del Ojo , Femenino , Humanos , Resultado del Tratamiento , Deficiencia de Vitamina A/diagnóstico , Deficiencia de Vitamina A/tratamiento farmacológico , Xeroftalmia/diagnóstico , Xeroftalmia/etiologíaAsunto(s)
Síndrome CREST/diagnóstico , Anciano , Astenia/diagnóstico , Astenia/etiología , Síndrome CREST/complicaciones , Citocininas/metabolismo , Diagnóstico Diferencial , Mareo/diagnóstico , Mareo/etiología , Disnea/diagnóstico , Disnea/etiología , Edema/diagnóstico , Edema/etiología , Femenino , Fibroblastos/metabolismo , Humanos , Reflejo Anormal , Síndrome de Sjögren/diagnóstico , Linfocitos T/metabolismo , Factores de Crecimiento Transformadores/metabolismo , Xeroftalmia/diagnóstico , Xerostomía/diagnósticoRESUMEN
Se describe un caso de carencia de vitaminas A que resultó en ceguera parcial irreversible ya que la deficiencia no fue considerada entre las hipótesis diagnósticas. El equipo de salud, sobre todo a nivel de atención primaria, debe estar preparado para el tratamiento y prevención de esta carencia nutricional
Asunto(s)
Humanos , Masculino , Preescolar , Deficiencia de Vitamina A/complicaciones , Xeroftalmia/diagnóstico , Errores Diagnósticos , Úlcera de la Córnea/diagnóstico , Deficiencia de Vitamina A/diagnóstico , Xeroftalmia/etiologíaRESUMEN
Conclusäo: É fundamental que se valorizem os sintomas, uma vez que os sintomas do paciente portador de olho seco säo geralmente vagos. Doenças sistêmicas devem ser sempre investigadas. Os testes diagnósticos säo muitos e nenhum pode ser considerado definitivo e único. Ideal seria que pudéssemos de rotina realizar pelo menos o teste de Schirmer I e II, coloraçäo com rosa bengala, pesquisa de drenagem e osmolaridade da lágrima. Porém nem sempre todos estes testes estäo à disposiçäo, de modo que recomenda-se, pelo menos, o teste de Schirmer I e II, coloraçäo com rosa bengala e fluoresceína e a medida do tempo de rotina do filme lacrimal
Asunto(s)
Xeroftalmia/diagnóstico , Xeroftalmia/terapiaAsunto(s)
Deficiencia de Vitamina A/epidemiología , Brasil/epidemiología , Lactancia Materna/estadística & datos numéricos , Preescolar , Femenino , Humanos , Lactante , Alimentos Infantiles , Masculino , Trastornos Nutricionales/epidemiología , Factores de Riesgo , Deficiencia de Vitamina A/complicaciones , Deficiencia de Vitamina A/diagnóstico , Xeroftalmia/diagnóstico , Xeroftalmia/epidemiología , Xeroftalmia/etiologíaRESUMEN
El ojo rojo, constituye una causa muy frecuente de consulta en las emergencias de nuestros hospitales. El propósito de este trabajo es determinar las causas más comunes de ojo rojo. El conocimiento de los microorganismos que generalmente causan infecciones, nos proveen la base para una apropiada investigación de laboratorio, y conducta terapéutica. Para estudiar la etiología de las Conjuntivitis, se tomó muestra para cultivo en 80 pacientes. Se realiza una comparación de los métodos clínicos diagnósticos para ojo seco en 116 pacientes, que presentaban síntomas y/o signos de sequedad ocular
Asunto(s)
Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Humanos , Masculino , Femenino , Xeroftalmia/diagnóstico , Xeroftalmia/terapia , Conjuntivitis , OftalmopatíasRESUMEN
An emaciated alcoholic 52-year-old white woman presented with an old left corneal perforation and bilateral conjunctival and corneal xerosis. The serum vitamin A level was 0 mumol/L. Laboratory and radiologic findings were consistent with the diagnosis of a fat malabsorptive syndrome secondary to chronic alcoholic pancreatitis. Histopathologic evaluation of her enucleated globe revealed conjunctival epidermidalization, corneal perforation with prolapse and loss of intraocular contents, retinal detachment, and massive choroidal hemorrhage. A second patient presented with bilateral conjunctival xerosis, corneal ulcers, and a low serum vitamin A level. Corneal perforation of one ulcer ensued during her hospitalization. Medical investigation revealed hepatic metastases of an unknown primary source. Causes of vitamin A deficiency and its ocular complications as well as medical and surgical management options are discussed.