Pseudoxanthoma elasticum, or Gronblad-Strandberg syndrome, is an inherited disorder that involves multiple organ systems. The characteristic degeneration and calcification of the elastic fibers caused by this disease were first observed by Ferdinand Jean Darrier in 1896. We report a case of a 27-year-old female who was diagnosed with pseudoxanthoma elasticum based on a skin biopsy prior to her presentation to our ophthalmology outpatient clinic. The past ocular history of the patient was unremarkable for any previous eye complaint or surgery. Her ocular and fundus examination showed pigmented grayish irregular post choroidal crack-like linear dehiscence, forming a network-like pattern, originating at the optic disc and extending radially involving the macular area and the posterior pole in both eyes, representing bilateral angioid streaks. There were no clinical or optical coherent tomographic signs of choroidal neovascularization. Periodic follow up for patients with pseudoxanthoma elasticum is recommended to detect choroidal neovascularization which is a sight-threatening complication. Ophthalmologists should be aware of this association as early recognition and treatment are vital to prevent irreversible visual loss.
Macular coloboma is a rare eye condition that affects around 0.5-0.7/10,000 of live births. Macular coloboma appears as a well-demarcated atrophic lesions that could affect one eye or both eyes on fundus examination. This is a case of a 33-year-old male patient who presented to the outpatient clinic with a history of poor vision in the left eye since childhood. He had a history of strabismus surgery for sensory exotropia (XT) in the left eye. Anterior segment examination of both eyes was normal while the fundus examination of both eyes revealed bilateral chorioretinal lesions in the macula which was larger in the left eye (OS) than the right eye (OD), representing bilateral chorioretinal coloboma. Congenital coloboma is a rare eye condition that leads to non-progressive decrease in visual acuity. Optical coherence tomography (OCT) is the modality of choice in diagnosing and describing macular coloboma.
Aim: There is a paucity of research on the factors predicting mortality and prolonged stay in the Intensive Care Unit (ICU) in critically ill patients with a solid malignancy. We aimed to assess the characteristics and outcomes of these patients who admitted to a medical ICU in a tertiary hospital in Saudi Arabia, and determine the predictors of ICU mortality and ICU prolonged stay. Method: Clinical data from patients with solid tumors extracted from a comprehensive prospective ICU registry. We used logistic regression analysis to identify the predictors influencing ICU mortality and ICU prolonged stay. Results: Of 2883 patients admitted to the ICU, 364 patients identified with solid tumor were enrolled in this study. The most common solid tumor types were: breast (15.9%), colorectal (11.5%) and lung (9.9%) cancers. The ICU mortality rate was (32.4%), and there were 50 (13.7%) patients had a prolonged stay of ≥ 21 days. In the multivariate analysis, three factors were the independent predictors for the ICU mortality: Sequential Organ Failure Assessment (SOFA) score (P <.001), mechanical ventilation (P=.004) and inotropic/vasopressor agents (P=.018), and four variables were independent predictors for the prolonged stay in ICU: ICU acquired infection (P<.001), SOFA score (P <.001), mechanical ventilation (P<.001) and bilirubin (P=.049).Conclusion: In patients with solid tumour the ICU mortality is 32.4%, and 13.7% had a prolonged ICU stay. The reported outcome in this study indicate benefit from ICU care in this category of cases The identified predictors of ICU mortality and prolonged stay of patients would help in assessing the potential benefit of ICU admission, and prognostication.
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