Ribhi Hazin

Stevens‐Johnson syndrome: Pathogenesis, diagnosis, and management

Cutaneous drug reactions are the most common type of adverse drug reaction. These reactions, ranging from simple pruritic eruptions to potentially life‐threatening events, are a significant cause of iatrogenic morbidity and mortality. Stevens‐Johnson syndrome (SJS) is a serious and potentially life‐threatening cutaneous drug reaction. Although progress has been made in the management of SJS through early detection, prompt hospitalization, and immediate cessation of offending agents, the prevalence of permanent disabilities associated with SJS remains unchanged. Nevertheless, despite being a problem that is global in scope, government and health care agencies worldwide have yet to find a consensus on either diagnostic criteria or therapy for this disorder. Here, we provide the internist and emergency room physician with a brief review the SJS literature and summarize the latest recommended interventions with the hope of improving early recognition of this disease and prevention of permanent sequelae and mortality that frequently complicate SJS.

Teleoncology: current and future applications for improving cancer care globally

Access to quality cancer care is often unavailable in low-income and middle-income countries, and also in rural or remote areas of high-income countries. Teleoncology-oncology applications of medical telecommunications, including pathology, radiology, and other related disciplines-has the potential to enhance access to and quality of clinical cancer care, and to improve education and training. Implementation of teleoncology in the developing world requires an approach tailored to priorities, resources, and needs. Teleoncology can best achieve its proposed goals through consistent and long-term application. We review teleoncology initiatives that have the potential to decrease cancer-care inequality between resource-poor and resource-rich institutions and offer guidelines for the development of teleoncology programmes in low-income and middle-income countries.

Ocular complications of cancer therapy: a primer for the ophthalmologist treating cancer patients.

Purpose of review Cancer patients may develop ocular complications secondary to direct or metastatic involvement with cancer, radiation exposure, or chemotherapy. As many as 1.4 million new cancer cases arise in the United States annually. Recent findings Chemotherapy administration remains a critical aspect of treating many cancers and offers improved prognosis and prolonged survival in many cases; however, these therapies are known to cause a wide range of toxicities. Summary Ocular side effects such as photophobia, cataracts, glaucoma, retinopathy, and other ocular toxicities have been reported following chemotherapy administration. To effectively treat cancer patients, oncologists, primary care clinicians, and ophthalmologists should be aware of the potential ophthalmic toxicities certain widely used chemotherapeutic agents and radiation therapy may pose to their patients, particularly in the setting of preexisting ocular conditions.

Thrombolytic therapy in central retinal artery occlusion: cutting edge therapy, standard of care therapy, or impractical therapy?

Purpose of review Numerous therapeutic options have been suggested for the treatment of central retinal artery occlusion (CRAO) such as ocular massage, anterior chamber paracentesis, physical exercise, and medication-induced reduction of intraocular pressure. Because of the lack of a proven effective treatment for CRAO, there has been a strong effort to develop alternative therapies. Recently, thrombolytic therapy has been suggested as a viable therapy for CRAO. The aim of this review is to provide an update on the progress of thrombolytic therapy for CRAO. Recent findings Although there is no consensus on a standardized treatment regimen for CRAO, emerging evidence suggests that thrombolytic therapy may be effective if administered promptly. Despite the benefit of thrombolytic therapy, on the basis of the results of case reports and case series, randomized controlled studies are necessary to ultimately prove the effectiveness of the treatment. Summary Thrombolytic therapy has yet to be validated as an effective treatment of CRAO. The execution of randomized, controlled trials is greatly needed to establish whether thrombolytic therapy can be considered standard of care therapy for CRAO.

Rhabdomyolysis induced by simvastatin-fluconazole combination.

Rhabdomyolysis is a potential adverse consequence of statin therapy. Here, we report a patient with prostate cancer being treated with simvastatin who developed rhabdomyolysis after coadministration with fluconazole. The rhabdomyolysis promptly resolved after discontinuation of fluconazole, suggesting the possible role of drug interaction in the development of rhabdomyolysis with coadministration of the two medications. Both simvastatin and fluconazole were promptly discontinued, and the patient was admitted to the intensive care unit, where vigorous hydration along with urine alkalinization led to resolution of rhabdomyolysis. Since statins are commonly prescribed treatments for individuals with hyperlipidemia, caution is advised in coadministration with azoles such as fluconazole. Although supportive treatment remains the mainstay of therapy for patients with rhabdomyolysis, fatal consequences can arise from hyperkalemia, cardiac arrhythmia, renal failure and disseminated intravascular coagulation.

Challenges to establishing nationwide diabetic retinopathy screening programs.

Purpose of review To review the results of recently published studies on diabetic retinopathy screening. Recent findings Despite numerous public health campaigns and the existence of guidelines designed to promote annual retinal exams for diabetes patients, an unacceptably high number of patients are not screened for diabetic retinopathy. Current findings suggest the need for novel methods to improve compliance with retinal screening exams among diabetes patients to preserve vision functionality in this population. Summary Diabetic retinopathy represents a major cause of acquired vision loss. The following review addresses the factors that contribute to inadequate retinopathy screenings among diabetes patients and proposes solutions that have the potential to increase the quality and accessibility of screening programs for diabetes patients.

Second malignancies in patients with Ewing Sarcoma Family of Tumors: A population-based study

Abstract Background. Despite significant improvement in the outcome of patients with Ewing Sarcoma Family of Tumors (ESFT), second malignancies remain a problem that may compromise the outcome of some survivors. The Surveillance, Epidemiology and End-Results (SEER) database offers an opportunity to study second malignancies in a population-based cohort of patients. Methods. Cancer incidence rates were compared between the ESFT survivors and the general population using observed-to-expected ratios (O/E). Also, we studied the characteristics of patients with ESFT who developed second malignancies and compared them to those who did not. Results. We studied 1 166 patients with ESFT who were diagnosed from January 1973 to December 2005. Among them, 35 (3%) patients had records of second malignancy. Patients who received radiotherapy as part of their primary therapy had a higher chance of developing a second malignancy (odds ratio, 2.55; 95% CI, 1.09 to 6.00). Most solid tumors (78%) were diagnosed more than 5 years after diagnosis of ESFT while the majority (83%) of lymphatic/hematopoietic malignancies developed within five years of diagnosis. The 5-, 10-, and 20-year probability of developing a second malignancy were 2.1% ± 0.56%, 4.4% ± 0.95% and 8.0% ± 1.7%, respectively. The O/E ratio for developing a second malignancy was 4.10 (95%CI, 2.87 to 5.68) but was higher in children/adolescents (O/E, 9.94; 95%CI, 6.30 to 14.91). Conclusion. Having a second cancer following a diagnosis of ESFT is a known risk that may be increased by current therapies. This modest increase is justified by the benefit of these therapies in the majority of patients with ESFT.

Ocular ischemic syndrome: Recent trends in medical management

Purpose of review To summarize general concepts of ocular ischemic syndrome (OIS), and present current scientific developments in delineating the pathogenesis and treatment of this disorder. Recent findings Recent studies suggest that OIS is associated with a significant risk of cerebrovascular, ocular, and systemic morbidity. Summary OIS is a serious blinding condition that occurs in the setting of carotid artery occlusion. Restoration of arterial perfusion and early diagnosis are critical for preserving visual function and reducing the risk of devastating ocular complications.

Medical and surgical management of facial nerve palsy.

Purpose of review To review the results of recently published studies on the medical management of Bells palsy and highlight strategies in the surgical management of facial nerve palsy. Recent findings Although corticosteroid and antiviral therapy have been proposed for the treatment of Bells palsy for many years, the clinical efficacy of these treatments has been debated in the literature due to the lack of conclusive evidence from large-scale clinical trials. However, recently completed randomized, controlled studies have found that the early administration of corticosteroids improves the chances of full recovery in patients with Bells palsy. But there remains insufficient evidence supporting the routine use of antiviral medications in the treatment of Bells palsy. In addition, improvement in surgical techniques has allowed the introduction of a number of surgical procedures for patients with permanent facial nerve palsy. Summary On the basis of the results of several recently completed randomized, controlled studies, corticosteroid therapy has proven to be efficacious in the treatment of Bells palsy and should be offered to patients presenting within 72 h of symptom onset with consideration to the addition of antiviral therapy for severe cases. Currently available surgical procedures can minimize the complications associated with permanent facial nerve palsy.

Neuromyelitis optica: current concepts and prospects for future management.

Purpose of review To present an overview on the clinical manifestations and an update on the current management of neuromyelitis optica (NMO). Recent findings NMO is associated with a significant risk of neurological, ocular and systemic morbidity. Many cases of NMO assume a relapsing course, which can lead clinicians to mistake the disease for multiple sclerosis. Distinguishing between the two diseases can be accomplished by recognizing the differences in clinical manifestations, observing the clinical course, obtaining serological testing and appreciating the MRI features. It is also important to maintain a high index of suspicion for NMO in the appropriate clinical setting. Summary Clinical features of NMO include visual loss, decreased coordination, widespread asthenia, paraplegia, quadriplegia, and sensory impairment. Severe cases can result in bladder and bowel impairment or fatal respiratory failure. Symptomatic treatment and the currently available therapeutic agents can control the disease in many patients. However, given the lack of a curative treatment, the prognosis of NMO remains poor in some patients underscoring the need for drug development and controlled clinical trials focused on improved treatment strategies.