Monkeypox, an emergent zoonotic disease caused by an orthopoxvirus, can result in a smallpox-like disease. 1 Predominant signs and symptoms include skin rash, fever, adenopathy, headache, and myalgias. Currently there is no specific treatment except for symptomatic management. We present a rare case of monkeypox in a patient with HIV presenting with conjunctivitis.A 42-year-old man presented with left-eye lacrimation, pain, and photophobia for the past 6 days. On the fifth day since the symptoms started, the patient reported maculopapular lesions on his face (Figure 1) and foot. The patient also had fever and painful cervical adenopathy. He was HIV positive. He denied any recent trip or contact with monkeypox cases. However, his boyfriend works in a sex club and had fever.
Purpose: To evaluate insulin eye drops for persistent epithelial defects (PEDs) that are refractory to usual treatment in clinical practice and to analyze how it may improve epithelization. Methods: A prospective non-randomized hospital-based study was performed. Patients with PEDs that were refractory to conventional treatment were treated with insulin eye drops four times a day. Patients’ demographics, PED etiology, concomitant treatments, and comorbidities were reviewed. The rate of PED closure and epithelial healing time were considered the primary outcome measures. Results: 21 patients were treated with insulin drops (12 females and 9 males; mean age 72.2 years). Mean PED area before treatment was 17.6 ± 16.5 mm2 (median 13.2; range 3.9–70.6). PED comorbidities included seven eyes with infectious keratitis (33%), five eyes with calcium keratopathy (24%), ocular surgery on three eyes (14%), three eyes with lagophthalmos (14%), two eyes with bullous keratopathy (10%), and one patient with herpetic eye disease (5%). The eyes of 17 patients (81%) with refractory PEDs had reepithelized and four patients (19%) had still presented an epithelial defect by the end of the study follow-up period, although it had decreased in size. In patients where PED closure was achieved, mean time until reepithelization was 34.8 ± 29.9 days (median 23; range 7–114). In the remaining patients, a mean area reduction of 91.5% was achieved for the PEDs. Conclusion: Topical insulin can promote and accelerate corneal reepithelization of refractory PEDs. It also offers many other advantages, including excellent tolerance, availability, and cost-effectiveness.
Malingering in children is very frequent. We can make the diagnosis with simple tests. It is not necessary to perform imaging and electrophysiologic testing, thus avoiding unnecessary examinations as well as absenteeism from work for parents and health care costs.
Purpose
To investigate the effect of topical insulin on epithelization in persistent epithelial defects (PED) refractory to usual treatment compared to autologous serum.
Design
Retrospective, consecutive case–control series.
Methods
The charts of 61 consecutive patients with PED treated with topical insulin (case group) and 23 treated with autologous serum (control group) were reviewed. Primary efficacy end points were the percentage of patients in which epithelization was achieved, as well as the rate and time until epithelization. Secondary efficacy point was need for amniotic membrane transplantation (AMT) or other surgeries.
Results
Mean time between PED diagnosis and start of topical insulin was 22.7 ± 18.5 days (range 13–115) and the mean area was 14.8 ± 16.2 mm2 (range 1.1–70.6). In the control group, mean time was 27.9 ± 16.8 days, mean epithelial defect area being 18.6 ± 15.0 mm2 (range 1.7–52.9). No differences in baseline characteristics were found between groups (p > 0.05). Epithelization was achieved in 51 patients (84%) on insulin and 11 patients (48%) on autologous serum (p = 0.002). In those patients, mean time until reepithelization was 32.6 ± 28.3 days (range 4–124) in the insulin group and 82.6 ± 82.4 days (range 13–231) in the autologous serum group (p = 0.011). The need for AMT was significantly lower in the insulin group (p = 0.005). PED recurrence was higher in patients treated on autologous serum (43%) compared with insulin (11%) (p = 0.002).
Conclusions
Topical insulin is an effective treatment and safely promotes healing of PED. In our series, topical insulin presented better epithelization outcomes than autologous serum and could thus be considered as a first‐line treatment.
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