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Fungal Keratitis Caused by Drechslera spp. Treated with Voriconazole: A Case Report
Margarita I. Echavez,Archimedes Lee D. Agahan,Noel S. Carino
Case Reports in Ophthalmological Medicine , 2013, DOI: 10.1155/2013/626704
Abstract: Objective. To present a case of Drechslera spp. keratitis treated with topical Voriconazole. Method. A case report. Results. A 52-year-old diabetic male presented with a one-week history of foreign body sensation of the left eye, self-medicated with Neomycin, Polymyxin B, and Dexamethasone eye drops, and was diagnosed to have bacterial conjunctivitis, which was treated with Levofloxacin drops. The patient developed a corneal opacity after 2 days and was initially seen with a visual acuity of counting fingers on the left eye, with a 3?mm central corneal ulcer with feathery borders. No hypopyon was noted. The right eye had a visual acuity of 20/20 and had unremarkable findings. Corneal scraping of the ulcer showed no organisms on Gram and Giemsa stain. Cultures were positive for Drechslera spp. and patient was started on Natamycin drops every 15 minutes, Atropine drops 3× a day, and Levofloxacin was continued every 4 hours. The ulcer increased to 4?mm, the infiltrates became deeper involving the midstroma, and there was appearance of a 2?mm hypopyon. Natamycin was shifted to Voriconazole eye drops every 15 minutes. There was note of a decrease in the size of the ulcer and clearing of the infiltrates with the new treatment regimen. Final visual acuity after 29 days of treatment was 20/40 with note of a slight corneal haze in the area of the previous ulcer. Conclusion. Voriconazole may be safe and effective in the treatment of Drechslera keratitis. There was no perforation and there was immediate decrease in the size of the ulcer. This is the first known case of Drechslera keratitis treated with Voriconazole eye drops in the Philippines. 1. Introduction Central microbial keratitis is one of the major causes of ophthalmic morbidity and visual loss. Worldwide, the reported incidence of fungal keratitis is 17% to 36%, caused by fungi, most commonly Fusarium and Aspergillus and other less common species like Candida, Curvularia, and Monosporidium, among others [1]. Organisms belonging to Drechslera species are rare causes of human infection and are considered opportunistic pathogens; however, it has been seen in healthy hosts [2]. Only 10 cases of human infection with these organisms have been reported in the literature [3]. We report the first case of fungal keratitis due to Drechslera spp. treated with topical voriconazole. 2. Case Report A 52-year-old diabetic male presented with a one-week history of foreign body sensation of the left eye. Patient self-medicated with Neomycin, Polymyxin B, and Dexamethasone eye drops. He consulted a private eye doctor and
Long-Term Followup of Laser In Situ Keratomileusis for Hyperopia Using a 213 nm Wavelength Solid-State Laser
Carmina Franz G. Quito,Archimedes Lee D. Agahan,Raymond P. Evangelista
ISRN Ophthalmology , 2013, DOI: 10.1155/2013/276984
Abstract:
Photorefractive Keratectomy with Adjunctive Mitomycin C for Residual Error after Laser-Assisted In Situ Keratomileusis Using the Pulzar 213?nm Solid-State Laser: Early Results
Maya Fe Ng-Darjuan,Raymond P. Evangelista,Archimedes Lee D. Agahan
ISRN Ophthalmology , 2013, DOI: 10.1155/2013/815840
Abstract: Purpose. To evaluate the accuracy, efficacy, stability, and safety of photorefractive keratectomy (PRK) enhancement using the Pulzar 213?nm solid-state laser (SSL) with adjunctive Mitomycin C in eyes previously treated with laser assisted in situ keratomileusis (LASIK) with residual error of refraction. Methods. This is a prospective noncomparative case series of 16 eyes of 12 patients who underwent PRK for residual refractive error after primary LASIK. Mitomycin C 0.02% was used after the PRK to prevent haze formation. Outcomes measured were pre- and postoperative manifest refraction spherical equivalent (MRSE), uncorrected (UDVA) and best-corrected distance visual acuity (CDVA), and slit lamp evidence of corneal complications. Results. The mean UDVA improved from 20/70 preoperatively to 20/30 postoperatively. The average gain in lines for the UDVA was 2.38. After six months of followup, the postoperative MRSE within 0.50?D in 56% (9) of eyes and 94% (15) eyes were within 1.0 diopters of the intended correction. No eyes developed haze all throughout the study. Conclusion. PRK enhancement with adjunctive use of Mitomycin C for the correction of residual error of refraction after LASIK using the Pulzar 213?nm solid-state laser is an accurate, effective, and safe procedure. 1. Introduction Laser eye surgery has been accepted worldwide as a procedure to modify the shape of the cornea and correct myopia, hyperopia, astigmatism, and presbyopia. However, the cornea is not a plastic material that if shaped a certain way would retain that shape forever. The cornea is a living tissue wherein its biomechanical and wound healing properties can restrict the predictability and stability of refractive surgery [1]. These factors contribute to the discrepancies between intended and achieved visual outcomes after laser-assisted in situ keratomileusis (LASIK), surface ablation, and other keratorefractive procedures leading to residual errors. To correct the remaining refractive error, a second refractive laser surgery can be done. In this study, we chose to do photorefractive keratectomy (PRK) with adjunctive Mitomycin C using the 213?nm solid-state laser for the correction of residual error after LASIK. Photorefractive keratectomy (PRK) with adjunctive Mitomycin C has been shown to be safe and effective with the use of the 193?nm excimer lasers. These lasers have been widely used in the past two decades and up to the present [2–4]. With the recent development and introduction of the 213?nm solid-state laser, use of this machine for refractive surgery has been increasing
Long-Term Followup of Laser In Situ Keratomileusis for Hyperopia Using a 213?nm Wavelength Solid-State Laser
Carmina Franz G. Quito,Archimedes Lee D. Agahan,Raymond P. Evangelista
ISRN Ophthalmology , 2013, DOI: 10.1155/2013/276984
Abstract: Purpose. To evaluate the long-term efficacy, accuracy, stability, and safety of hyperopic laser in situ keratomileusis (LASIK) using a 213?nm wavelength solid-state laser. Methods. This prospective noncomparative case series consisted of 34 eyes of 17 patients which underwent hyperopic LASIK using a 213?nm solid-state laser (Pulzar Z1, CustomVis) at an outpatient refractive surgery center in Manila, Philippines. The preoperative and postoperative examinations included uncorrected distance visual acuity (UDVA), subjective manifest refraction, corrected distance visual acuity (CDVA), cycloplegic refraction, slitlamp biomicroscopy, and keratometry ( ). Main Outcome Measures. Accuracy, efficacy, stability, and safety of the refractive procedure. Results. Mean follow-up was months. At the end of follow-up, 26.47% had a UDVA of 20/20 and 94.12% had a UDVA of ≥20/40. Manifest refractive spherical equivalent (MRSE) was within ±0.50?D of the target refraction in 55.88% and within ±1.0?D in 85.30% of the study eyes. Refractive stability was noted in the 1st postoperative month while hyperopic regression was noted after the 3rd postoperative year. No eye lost more than 2 lines of CDVA. Conclusion. Our results show that the 213?nm solid state laser system is safe, effective, accurate, and predictable for the treatment of hyperopia. 1. Introduction Laser in situ keratomileusis is approved by the US Food and Drug Administration (FDA) for the treatment of myopia, hyperopia, and astigmatism and has been a popular choice among refractive surgeons for almost 2 decades now [1, 2]. Hyperopic LASIK consists of an annular zone of ablation to cause a relative flattening of the corneal periphery and a concomitant relative steepening of the center (optical zone) to achieve the desired refractive effect. Early attempts to correct hyperopia included techniques such as hexagonal keratotomy, thermokeratoplasty, keratophakia, and keratomileusis but have met with only limited success. With the advent of the excimer laser technology, reshaping of the corneal surface to a desired contour with submicron precision and reproducibility became a reality [3]. With the prototype ophthalmic excimer lasers, the visual and refractive outcomes of LASIK for hyperopia were less predictable due to challenges arising from the need to use larger ablation diameters and the relative difficulty to deliver uniformly distributed laser energy in ablation zones larger than 6?mm [1]. Newer models have permitted larger ablation diameters and the development of various microkeratomes facilitated the
Prognostic Value of the Ocular Trauma Score in Traumatic Open Globe Injuries in the Philippines: A Five-Year Retrospective Study —Prognostic Value of the Ocular Trauma Score in Open Globe Injuries  [PDF]
Raymond Nelson C. Regalado, Ruben Lim Bon Siong, Archimedes Lee D. Agahan, Anthony F. Felipe
Open Access Library Journal (OALib Journal) , 2018, DOI: 10.4236/oalib.1104224
Abstract:
PURPOSE: To determine the prognostic value of the Ocular Trauma Score (OTS) in patients with traumatic open globe injuries. METHODS: A retrospective chart review of patients with traumatic open globe injuries seen in a tertiary eye center in the Philippines from 2008 to 2013. Patients with traumatic open globe injuries who were at least 18 years of age upon first consult and with documented visual acuity at the first, third and sixth months of follow up were included in the study. The following data were collected: age, sex, occupation, manner of injury, type of injury, location of injury, presence of globe rupture, endophthalmitis, perforation, retinal detachment and afferent pupillary defect, and visual acuity (VA) at presentation, month 1, month 3 and month 6. The OTS was computed from the available data. RESULTS: A total of 114 records were included. Open-globe (OG) injuries were more common in males (86.8%), between 18 - 39 y/o (64.9%) and who were manual workers (74.6%). Most were occupation-related (64%), seen within 1 - 3 days (55.3%), and treated both medically and surgically (92.1%). The most common type of OG injury was a penetrating laceration (82.5%), had an initial VA of 4/200 to light perception (57.9%), had no afferent pupillary defect (APD) (84.2%), and was located at zone I (73.7%). The most common OTS anatomical factor seen, when present, was an APD (15.8%). In all months, there was a significant positive correlation between OTS score and visual acuity. CONCLUSION: The OTS appeared to predict visual outcome as early as the first month post-injury, although correlation still exists at the 3rd and 6th months.
Living Organ Donation, Beneficient Helping, & the Kantian Concept of Partial Self-Murder  [PDF]
Archimedes C. Articulo
Open Journal of Philosophy (OJPP) , 2014, DOI: 10.4236/ojpp.2014.44052
Abstract: This paper deals with the ethical issues concerning living organ donor transplantation in the context of Immanuel Kant’s Ethical Theory. It primarily aims to refute the common perception about Kant’s categorical opposition to organ transplantation as violative to his concept of duty of self-preservation (transplantation as a form of mutilation or partial suicide). In this paper we will argue that: 1) Kantian concept of mutilation, or partial self-murder, should be perceived within the context of Kant’s prohibition of killing oneself; 2) Kant does not prohibit all forms of organ donation as contrary to duty of self-preservation (i.e., duty to maintain quality of life and donation as violative to the strict prohibition against mutilation). Organ donation could hardly be considered as mutilation or contrary to duty of self-preservation if the following conditions are satisfied: 1) the organ to be donated and the surgical procedure involved, would not pose grave risk (e.g. physical disability and death) to the donor; and 2) the moral personality of the donor would not be at risk by donating his organ.
Towards an Ethics of Technology: Re-Exploring Teilhard de Chardin’s Theory of Technology and Evolution  [PDF]
Archimedes C. Articulo
Open Journal of Philosophy (OJPP) , 2014, DOI: 10.4236/ojpp.2014.44054
Abstract: Defining the mechanism of evolution is a controversial issue that, until now, divides the scientific community. Some have argued in the strictest Darwinian terms that evolution’s primary mechanism is necessity—“survival of the fittest”. Other evolutionists followed in the footsteps of Jacques Monod, the French biologist, who argued for a mixture of random chance and necessity. Teilhard de Chardin, it is widely believed, took Monod one step further by asserting that evolution is the fundamental motion of the entire universe, an ascent along a privileged and necessary pathway toward consciousness—thus, evolution was guided chance and necessity. However, if evolution is being guided, what is doing the guiding? And where, ultimately, is it going? His bold answers brought Teilhard to the heart of a widely perceived scientific, as well as religious, heresy. A heresy that was effectively silenced, and soon would re-emerge as the world began witnessing exponential advancements in Science and Technology (specifically, on computing, nano-technology, robotics and genetic engineering). Almost half a century after the publication of Phenomenology of Man, many futurist thinkers have began noticing that the super-fast acceleration in the passage of time for evolution is moving in a very different direction than that for the Universe from which it emerges. This paper puts forward the thesis that the philosophical underpinning of a “human-sponsored variant of evolution” (i.e. evolution towards convergence of biological and non-biological intelligence) finds support and meaning within Teilhard de Chardin’s theory of evolution (i.e. evolution towards consciousness). It specifically covers 1) the implications of advancing technologies in human evolution and consciousness within the context of Teilhard’s theory of evolution; 2) how, after homo sapiens silently emerged around 500,000 years ago (with larger brains, particularly in the area of the highly convoluted cortex responsible for rational thought), and after they develop computing, the story of evolution has progressed exponentially paving the way for the possibility of turning Teilhard’s controversial ideas (such as the Noosphere) more than a poetic image; and 3) how the grandest creations of evolution—consciousness and intelligence—provide for the very tool that may allow homo sapiens to take over the course and direction of their own evolution—without necessarily shedding their desire to search for spiritual truth in a secular universe.
PROPAFENONE, A NEW EFFECTIVE ANTIARRHYTHMIC DRUG. REPORT OF 2 YEARS CLINICAL EXPERIMENT WITH PROPAFENONE (WITH BRIEF REVIEW OF ARTICLES)
IRAJ NAZERY?,ARCHIMEDES SANATY
Acta Medica Iranica , 1986,
Abstract: Propafenone HCI (p), is a relatively new Class IC antiarrhythmic agent. It has been reported to be superior to conventional antiarrhythmics in the control of supraventricular, ventricular and WPW associated tachyarrhythmias. It has been also shown to be well tolerated. In our study protocol, which extends over 2~ years period , we used (p) in 87 patients for management of various types of cardiac arrhythmias (most of whom were resistant to conventmonal antiarrhythmics) . Intravenously administered, (P) was effective in 85% of patients with paroxysmal reentrant supraventricular tachycardia (PRSVT), 75% of those with paroxysmal atrial fibrillation (PAF) , 50% and 42% of those with refractory premature ventricular contractions (PVC) and ventricular tachycardia (V. Tach), respectively. Orally administered, (P) was effective in 73% of those with resistant PVCs and nonsustained ventricular tachycardia (NSV Tach), and 75% of those with resistant sustained ventricular tachycardia (RSVT)
Is the Use of Frozen Section Indispensable in the Surgical Treatment of Endometrial Hyperplasia?  [PDF]
Ceyhun Numanoglu, Dilek Marangoz Chapman, Aysun Fendal Tunca, Aysu Akca, Agahan Han, Volkan Ulker, Ozgur Akbayir
Open Journal of Obstetrics and Gynecology (OJOG) , 2015, DOI: 10.4236/ojog.2015.54032
Abstract:

Objective: To evaluate the reliability and accuracy of frozen section (FS) compared with final pathology and to determine whether they should be obligatory in every patient with atypical endometrial hyperplasia (AEH). Methods: We retrospectively assessed the medical records of 192 patients whose endometrial biopsy results were endometrial hyperplasia and underwent hysterectomy at our center. Results: Twenty-two (11.4%) of the 192 patients in our study had concurrent endometrial carcinoma (EC). Of these, 21 (95.5%) were EC and 1 (4.5%) was non-endome- trioid. Of the 140 patients with AEH, 20 (14.3%) had concurrent EC. Overall, 157 patients had FS. Two (1%) patients’ EC was higher than grade 1B and needed lymphadenectomy. The positive and negative predictive value, specifity and sensitivity of FS were found to be 77.8%, 95.7%, 97% and 70%, respectively. Conclusion: Patients who have AEH without high-risk comorbidities do not have to be referred to oncology centers and can undergo hysterectomy in community hospitals without FS.

Investigation of Chitosan-PVA Composite Films and Their Adsorption Properties  [PDF]
Lewis S. Casey, Lee D. Wilson
Journal of Geoscience and Environment Protection (GEP) , 2015, DOI: 10.4236/gep.2015.32013
Abstract:

Viscous aqueous solutions of chitosan and polyvinyl alcohol (PVA) were blended to enhance miscibility and avoid polymer phase separation. The mixtures were drop-casted and air dried to yield composite film materials that were characterized by equilibrium water uptake, physical stability in aqueous solution, and thermal stability. Chitosan/PVA blends have greater thermal stability, unique morphology, and reduced solubility in acidic solution, thus extending the useful pH range for chitosan as a sorbent material. The uptake properties of the films was investigated using methylene blue (MB) and a p-nitrophenol (PNP) dyes, where it was found that each single component polymer has greater uptake toward MB than PNP. A direct relationship between film composition (chitosan:PVA) with solution pH and the uptake of MB was observed. The results are in agreement with electrostatic interactions and contributions due to the hydrophobic effect for such composite materials.

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