10 Ways to Prevent Genital Herpes

Genital herpes are conditions that are transmitted through sexual contact and are caused by the so-called HSV – 2, or Herpes Simplex Type 2 Many people infected with this virus have no symptoms, but any time may have outbreaks . One in ten people in adulthood may have experienced some type of herpes during their lifetime, so it is a more common condition than it seems. Here we present important things you should know about this genital condition. What is genital herpes? It is an infection that can be found in male and female reproductive organs, also in the hips and in the anal region and is caused by the HSV virus. Genital herpes is a disease that may become more common among people who become sexually active at an early age. It is a highly contagious disease that spreads through contact with an infected person, but can be acquired through oral sex, anal sex and contact with the skin is injured. The risk of acquiring an infection by HSV increase in people who have or have had any sexually transmitted disease. Also fatigue and hormonal and anatomical characteristics of female stress are factors that make a person more risk of getting herpes. It is noteworthy that a person suffering from herpes, has at least twice as likely to acquire HIV. 10 Tips to avoid genital herpes 1. Use a condom every time you have sexual contact so that, if there is an area infected with HSV, does not have direct contact with you.

2. Ask your sexual partner if you have ever had a sexually transmitted disease. 3. Try to have a regular sexual partner; promiscuity may result in the spread of herpes. 4. Ask your partner if you have had many sexual partners before, so you know how big the possibility of contagion. 5. Avoid unprotected sexual contact with a person who has open sores in the genital area. 6. Do not receive oral sex from a person who has herpes sores in the mouth. 7. Together with your partner, become studies to detect infection if you think you have the symptoms of being infected with the virus. 8.

Avoid having sex when under the influence of alcohol or psychoactive substances. 9. If ever you or your partner have had problems with this type of herpes, it is desirable that both follow a treatment and seeking alternate sexual practices that reduce the risk of getting this infection. 10. Be alert to changes you experience a level of health. On many occasions people have genital herpes without knowing it and then visibly manifested; do not ignore any signs that usually occur. Also sure to take a diet rich in nutrients to strengthen your immune system. The list of foods more effective it is in fabulous guide DEFINITIVE PROTOCOL HERPES, Melanie Addington. And not only that: this natural treatment of genital herpes includes home remedies, exercise and other lifestyle habits that pudes apply to prevent herpes ruin your life. Everything is safe, simple and very effective, do not hesitate to check it out. CLICK HERE NOW and you will feel much safer and healthier for your own body will control the herpes! You may also like:

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Jimenez ClínicoCervicovaginitisCastañeda approach mE atient female 28-year-old who attends consulted for persistent fetid leucorrhea transvaginal sparkling greenish yellow and vulvo vaginal itching accompanied by dysuria and dyspareunia two weeks of evolution. It has the following AGO: menarche 12 years with menstrual rhythm 30×4, eumenorrhoea IVSA 18 years with three sexual partners uncircumcised. G2 P2 A0 C0. LMP two weeks ago. IUD family planning method from a year ago. DOC: never. Background heredofamilial and pathological unimportant to the current condition. The EF weight of 52 k, size 1. 50 cm, BMI 23. 11, TA 110/70, FC 80x ‘Temp. 36. 5 ° C.

The EF: Cardiopulmonary without obligation. Abdomen soft depressible not painful on palpation, not visceromegalies normal peristalsis. The speculoscopy with vulvo vaginal edema and erythema, petechiae multiple cervix, presence of yellow-green vaginal discharge fetid. At vaginal examination uterus anteversoflexión of 7x5x3 cm, mobile not painful, normal consistency, regular shape, nonpalpable annexes.  Questions 1 With the above data would be probable diagnosis a) cervicovaginitis by Gardnerella vaginalis b) cervicovaginitis Chlamydia trachomatis c) cervicovaginitis Trichomonas vaginalis d) cervicovaginitis vaginal candidiasis e) cervicovaginitis genital herpes 2 What are the risk factors in this patient? a) frequent douching and intercourse

b) Multiple sexual partners, use of IUDs and transmission by fomites c) Use of oral hormonal, antibiotics, diabetes and pregnancy d) Direct contact with infected secretions, immunosuppressed patients e) Start sexually active before age 20, number of sexual partners and low socioeconomic status 3. What is the treatment? a) Metronidazole 500 mg orally every 12 hours for seven days b) Doxycycline 100 mg orally every 12 hours for seven days c) VO Metronidazole 2 g single dose treatment the couple d) Fluconazole 150 mg PO, single dose e) Acyclovir 400 mg orally every eight hours for 10 days Discussion Question 1.

Correct answer: C Vaginal trichomoniasis are sexually transmitted, can be identified in 30-80% of male sex partners of infected women, this infection increases the risk of HIV transmission. The clinical picture is characterized by the presence of copious, fetid vaginal discharge greenish yellow with vulvo vaginal itching and irritation. A speculoscopy may reveal vaginal erythema generalized with multiple small petechiae, called “strawberry spots”. In the vaginal swab is pH> 4. 5 with increased polymorphonuclear. Fresh examination mobile trichomonas are displayed. Cervicovaginitis by Gardnerella vaginalis is the most common cause of bacterial vaginitis in the sexually mature patient. It is characterized by whitish discharge that smells “fishy” that increases after sexual activity. A vaginal EF is a normal appearance in tissues with presence of abnormal odor colorless homogeneous flow adhering to vaginal walls. In the vaginal discharge pH is greater than 5, there are few leukocytes and lactobacilli. Microscopic examination showed the “key cells” features such as epithelial cells Granular or multiple points are identified. Vaginal candidiasis in 50% of patients are asymptomatic, plus agencies are not sexually transmitted and episodes of candidiasis are not related to the number of sexual partners.

Vaginal discharge is characterized as resembling lumpy white “cottage cheese” usually attached to the vaginal walls, not fetid. With intense dysuria and vaginal itching. The EF is vulvovaginal erythema vaginal fissures. In the vaginal discharge is normal pH, microscopic examination pseudohyphae and mycelia are displayed. Chlamydia occurs among women 15 to 25 years, the most common cause of infection is through sexual transmission. Most women are asymptomatic, but may present mucopurulent cervical discharge, cervicitis, urethritis, pelvic inflammatory disease. A vaginal examination can be found friable cervix but can also be completely normal. The diagnosis is based on laboratory confirmation but Chlamydia can be difficult to grow. The polymerase chain reaction and ligase chain reaction (LCR) methods are highly specific in 99 percent. Genital herpes is caused by herpes virus type 2 genital infection that causes genital ulcers that appear about seven days after virus exposure in vulva, vagina and cervix. They are shallow eroded and very painful, covered by a rough white membrane. They accompanied by inguinal lymphadenopathy. Local symptoms are dysuria, hypersensitivity vulva and vagina, dyspareunia, and sudden increase in flow.

Question 2. Correct Answer: B The Trichomonas vaginalis has a high transmission rate; 70% of men get the disease after a single contact with an infected woman. Approximately 70% of women are asymptomatic. It is transmitted usually by means of coitus; women are the primary reservoir, and the male table, but can also serve as a reservoir. transmission by means of public baths, saunas, swimming pools, bath towels and non-sterile techniques pelvic examination is also possible. This indicates that it is not just a sexually transmitted disease because it is associated with the use of intrauterine devices. Gardnerella vaginalis, has been found in patients with frequent intercourse and the use of douches, by repeated alcanización of the vagina, which triggers a disorder of the normal vaginal flora facilitating the emergence of bacterial vaginosis. Among the predisposing factors for the development of vaginal candidiasis is the use of oral hormonal, pregnancy, diabetes and antibiotics. By a mechanism known as “colonization resistance”, lactobacilli prevent the proliferation of opportunistic fungi. The use of antibiotics disrupts the normal vaginal flora, it decreases the concentration of lactobacilli and other members of the normal flora and therefore allows the proliferation of fungi. Pregnancy and diabetes are accompanied by a qualitative decrease in cell-mediated immunity, resulting in a higher incidence of candidiasis. The herpes virus is spread through direct contact with infected secretions, autoinoculation and immunosuppressed patients as they may be carriers have revival boxes.

Among the predisposing factors for chlamydia present are women under 20 years who exhibit sexually active infection rates two to three times higher than older women. The number of sexual partners and low socioeconomic status are associated with high rates of infection.  Question 3. Correct answer: C The treatment of choice for vaginal trichomoniasis is metronidazole VO 2 g single dose, and as an alternative treatment the multiple dose 500 mg twice daily for seven days. With cure rates close to 95%. You should always be treated sexual partner. In most patients, it can be eradicated with cervical Chlamydia Doxycycline 100 mg orally twice daily for seven days or Tetracycline 500 mg orally four times daily for seven days. When tetracyclines are contraindicated should be used Erythromycin 500 mg four times daily for seven days. Ideally treatment should Gardnerella vaginalis inhibit the growth of anaerobic bacteria but not of vaginal lactobacilli. Therefore the treatment of choice is to Metronidazole 500 mg PO twice daily for seven days. As alternative system consists of a single oral dose of 2 g Metronidazole. The treatment of choice for vaginal candidiasis Fluconazole is administered in a single dose of 150 mg.

Adjunctive treatment with a weak topical steroid, such as hydrocortisone cream 1% may be useful to relieve some symptoms of external irritants. There is no cure for genital herpes infection of the virus. Antiviral use shows a reduction in the frequency of the tables, the duration thereof and its transmission. The antiviral of choice is Acyclovir 400 mg orally every 8 hours for seven to 10 days. Bibliography 1. Guilles RG. Infectious diseases in obstetrics and gynecology. 2nd ed. Barcelona. Salvat. 1985. 2.

Berek J. genitourinary infections and sexually transmitted diseases. Novak Gynecology. 12th ed. Mexico. McGraw Hill Interamericana. nineteen ninety six. 3. DeCherney A. Benign diseases of the vulva and vagina. Gynecoobstetric diagnosis and treatment. 7th ed. Mexico.

Modern manual. 2000. 4. M. Egan Problem Oriented Diagnosis. Diagnosis of vaginitis. American Family Physician. 1 Sep. 2000; 62 (5): 1095-1104. 5. Centers for Disease Control and Prevention 2002 Sexually Transmitted Disease treatment guidelines. MMWR. Morb Mortal Wkly Rep 2002; 51 (RR6): 1-77.

6. Azzam-W M. Vulvovaginitis Caused by Candida spp. and Trichomonas vaginalis in sexually active women. Invest Clin-01-MAR-2002; 43 (1): 3-13. 7. Vazquez JA, Sobel JD. Mucosal Candidiasis. Infect Dis Clin North Am 2002; 16: 793-820. 8. Zeger W, K. Holt Gynecologic infections. Emergency Medicine Clinics of North America.

Volume 21. Number 3. August 2003. 9. LM Hollier. Treatment of sexually transmitted diseases in women. Obstetrics and Gynecology Clinics North Am-01 Dec. 2003; 30 (4): 751-75. 10. Vulvovaginal Candidiasis P. Nyirjesy. Obstet Gynecol Clin North Am-01 Dec. 2003; 30 (4): 671-84.

Specialist in family medicine. Attached to the UMF 7 IMSS

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Chronic fatigue syndrome 27/04/2006 Editor’s note: In addition to the definitions given MedlinePlus, the British called myalgic encephalomyelitis, chronic fatigue syndrome, the Italians. The Belgians have called it Syndrome and Chronic Fatigue Immune Dysfunction and the French, espasmofilia Alternative Names: SFC; Fatigue: Chronic Definition: Chronic fatigue syndrome is a condition that causes fatigue or significant and prolonged (fatigue) exhaustion that is not relieved by rest and is not directly caused by other conditions. To diagnose chronic fatigue syndrome, the degree of fatigue must be important enough to reduce by 50% the ability to perform daily activities. Causes and risk factors the needs of chronic fatigue syndrome (CFS) cause is unknown. Some researchers believe could be caused by a virus, such as Epstein-Barr virus (EBV) or human herpes virus type 6 (HHV-6). However, it has not been identified any specific cause of viral origin. Recent studies showed that chronic fatigue syndrome may be caused by inflammation of pathways in the nervous system, and that this inflammation may be some sort of immune response or autoimmune process. CFS may occur when a viral illness is complicated by inadequate or dysfunctional immune response.

It is also possible influencing factors such as age, prior illness, stress, environment or genetic predisposition. CFS occurs most often in women between 30 and 50 years. The Centers for Disease Control (CDC) describes CFS as a disorder with its own characteristics and specific symptoms and physical signs, based on the exclusion of other possible causes. the number of patients affected by this syndrome is unknown. Symptoms of CFS are similar to those of most of the most common viral infections (muscle aches, headache and fatigue), often they appear in a few hours or days and last for six months or more. Fatigue or tiredness, which had never been so intense in the past (recent onset) with a duration of at least six months and is not relieved by bed rest Fatigue important limiting daily activities (fatigue appears important to make less than half the effort that was made before developing the disease) Other symptoms: Fatigue lasting more than 24 hours after a physical activity that would normally be easily tolerated mild fever (101 ° F [38. 3 ° C] or less) Sore throat Tenderness of lymph nodes in the neck or armpit

muscle weakness throughout the body or in different parts, which is not explained by any known disorder muscle aches (myalgia) Restlessness after sleeping enough Headache, quality, severity and different pattern of previous Joint pain, often moving from joint to joint (migratory arthralgia) without swelling or redness of joints Forgetfulness or other similar symptoms including difficulty concentrating, confusion or irritability Signs and tests Physical examination may confirm the presence of fever, tenderness and swelling of the lymph nodes and other symptoms. There may be redness of the throat, without drainage or pus. The doctor can make a diagnosis of chronic fatigue syndrome only after discarding all other possible known cause fatigue, such as: infections autoimmune or immune disorders tumors

Muscle or nerve diseases (such as multiple sclerosis) endocrine diseases (such as hypothyroidism) psychiatric or psychological illnesses, particularly depression (since this syndrome may be associated with depression, a diagnosis of depression does not exclude the SFC, but should rule that fatigue is related only to diagnose depression SFC) drug Dependence Other diseases (such as heart, kidney or liver disease) To diagnose CFS must have: extreme and prolonged fatigue Absence of other causes of chronic fatigue (excluding depression) At least 4 of the other symptoms listed No specific to confirm the diagnosis of CFS tests, although generally several different studies are performed to exclude other possible causes of symptoms. In studies some typical findings that, while not specific enough to diagnose CFS, systematically appear in patients who then diagnosed with the disorder are observed. Some findings are: Higher levels of specific white blood cells (CD4 T cells) compared to other types of white blood cells (CD8 T cells)

MRI of the brain in which cerebral edema or destruction of nerve cells (demyelination) is observed specific white blood cells (lymphocytes) containing active forms of EBV or HHV-6 Treatment Currently there is no treatment that has proven effective in curing CFS, and what is the symptoms are. Many people with this disorder experience depression and other psychological problems that may improve with treatment. Some of the proposed treatments include: antivirals (such as acyclovir) Drugs to treat “hidden” yeast infections (such as nystatin) Drugs to treat depression (antidepressants) Drugs to treat anxiety (anxiolytics) Drugs to reduce pain, discomfort and fever Some medications can cause adverse reactions or worse than the original symptoms of chronic fatigue syndrome side effects. It is recommended that patients with this syndrome have an active social life; It could also be beneficial to perform light physical activity.

Expectations (prognosis) The long-term expectations for these patients are variable and difficult to predict the onset of the disease. It has been reported that some patients recover completely from six months to a year later. Others may take longer to reach full recovery. Some patients report never returning to the state before the disease. In most studies it reports that patients treated with extensive rehabilitation programs have a better prospect of significant improvement than those untreated. complications Social isolation caused by fatigue Limitations in lifestyle (some people are so fatigued that they are essentially disabled during the course of the disease) Depression (related both to symptoms and lack of diagnosis) Side effects and adverse reactions to medication treatments Call your health care Top Consult your doctor if you experience extreme and persistent fatigue, whether or not you have other symptoms of this disorder.

Updated: 6/22/2004 Source consulted: MedlinePlus

How to Eliminate Cold Sores


How to Eliminate Cold Sores – Some Simple Methods That Work! Often cold sores heal naturally, but usually takes a long time and what you want to know is How to Eliminate Cold Sores quickly. There are many drugs that can accelerate the healing of these wounds, as well as natural remedies home based. You can find the way how to eliminate cold sores, even in the comfort of your own home. You could use ice to reduce swelling, you just rub a cube gently on the sores for several minutes. You can do this every 10 minutes for about an hour. Perhaps there are plants in your backyard as Aloe Vera or sage (or if not, then you can get them). Get some sage extract, and then apply a few drops on the sores. Meat used Aloe Vera for quick relief. Lysine is also effective in inhibiting the virus. 2000MB 3,000 mg of lysine in a day is recommended for people suffering from outbreaks of herpes 2 or 3 times a year. These supplements are available at any grocery store. Moreover, there are medications and creams for these sores can buy at any pharmacy.

You can buy Zovirax, Famvir, Valtrex to shorten the duration of virus infection resulting in rapid relief of pain. Creams as abreva are able to block the outbreak of pain and help the sores heal quickly. There are also gels that are good to relieve pain and itching, as Zilactin, Herpetrol and Aloe gel. These methods How to Eliminate Cold Sores are undoubtedly effective. However, you should keep in mind that they do not stop you from having a herpes outbreak again, because they are not able to eliminate the virus infection. Once the sores heal, the virus remains in the lymph (the end of the nerves) pending the factors that can trigger action again. If you want to get eventually eliminate the virus that causes your cold sores, click here and discover How to Eliminate Cold Sores Forever

What is cold sores and how to treat?


In the presence of “labial fire” is recommended to avoid self-medication, not having contact with people suffering from these injuries and receive immediate medical attention, said the specialist in dermatology Guadalupe Villanueva Quintero. The attached to the Dermatological Institute of Jalisco Dr. Dr. José Barba Rubio, he explained that cold sores is an infectious disease caused by a virus called Herpes Simplex Type 1 affects the face, particularly the facial surface center. When a person suffering from cold sores, also known as “lip fire” kissing others or is in direct contact, you can infecting them, especially when the problem is active, that is, during the first 72 hours that acquired the virus. “This condition is manifested by small blisters grouped on a plate, this disease can appear at any age, both men and women, mainly for having been exposed to the virus or by a previous infection,” warned Dr. Villanueva Quintero. The virus, he said, is more likely to occur in people with low defenses, such as those with diabetes, patients undergoing long treatments such as chemotherapy or patients receiving cortisone. Villanueva Quintero specified that this disease usually occurs in episodes that often vary in the time of onset. The triggers are fever, sun exposure or emotional stress, occurs because there is first an itch or burning generally usually occurs on the lips and then blisters appear. He pointed out that direct contact is the main mode of transmission of this disease, but also carve affected with healthy skin from another patient or partner skin. Also to use some medical or cosmetic instruments where it has a direct contact with discharge and then to another patient or another person applies. “If there is direct contact with discharge that forms during the infectious process is before 72 hours if there is a significant risk of becoming infected or transmitting the disease to another person, acute picture of this virus usually lasts usually up eight days, “he said.

The specialist noted that there is also a second type of herpes virus that usually occurs on the genitals and is transmitted through sexual contact. He noted that 80 percent of cases of herpes presented correspond to type 1, while 20 percent corresponds to Type 2.

Red Eye – UpToDate

Lids / Orbit / lacrimal system Hordeolum / chalazion blepharitis Entropion / ectropion FB / laceration Dacryocystitis / dacryoadenitis Conjunctiva / sclera subconjunctival hemorrhage conjunctivitis Dry eyes pterygium episcleritis / scleritis Preseptal / orbital cellulitis

Cornea FB (including contact lens) keratitis abrasion, laceration ulcer Ant chamber Previous uveitis: iritis, iridocyclitis Angle closure glaucoma Acute Hyphema (blood) hypopyon (pus) Other Trauma Post-op

endophthalmitis (post-op infection) In addressing one eye complaints, always ASSESS visual acuity using history, physical examination, or the Snellen chart, as Appropriate. History: Vs monocular binocular Transient (amaurosis fugax) vs vs acute phase Painless vs painful Foreign body sensation – Suggests active corneal process, objective When FB sensation resistant to patient eye opening; “Scratchy” or “gritty” more suggestive of conjunctivitis. No sensation With FB iritis / glaucoma. Photophobia – corneal process or iritis Trauma Contact lens wearer – Increases suspicion of keratitis Associated symptoms – eg. URTI With viral conjunctivitis.

Physical Exam General observation: opening eyes, in pain / distress, dark glasses, tearing / discharge. Visual acuity: always check best corrected visual acuity, use pinhole vision to help improve increase refractive errors if present. Acuity testing: Snellen chart at 20 feet. = Testing distance / patient smallest line on the chart can read (distance to “normal” person can see) legal blindness: ≤ 20/200 in best eye Near: Rosenbaum / pocket vision at 14 inches. Gross testing: reading vision vs vs perception form only light perception. penlight exam lid, palpebral and bulbar conjunctiva, cornea (foreign body, corneal opacity) Pattern of redness Affecting Both p / b conjunctiva conjunctivitis Suggests ciliary flush around limbus Suggests iritis, keratitis infectious, acute angle closure glaucoma

Suggests subconjunctival hemorrhage hemorrhagic pattern. Fluorescein dye With cobalt blue light – corneal process Hypopyon (white cells in anterior chamber) and hyphema Testing Hierarchy for low vision Snellen acuity (20 / x) counting fingers at a distance Given (CF) hand motion (HM) With projection light perception (LP With projection) light perception (LP) no light perception (NLP) 2 In a patient with a red eye, distinguish Between serious causes (e. g. , keratitis, glaucoma, perforation, temporal arteritis) and non-serious causes (i.

e. , do not assume all red eyes are Caused by conjunctivitis): a) Take an Appropriate history (e. g. , photophobia, Changes in vision, history of trauma). b) Do a physical examination focused (e. g. , pupil size, and visual acuity, slit lamp, fluorescein). conjunctivitis acute Irits Acute Angle-Closure Glaucoma Keratitis (corneal abrasion / ulcer) D / C

Bacteria: purulent Virus: Serous Allergy: Mucous Do not Do not profuse tearing Pain Do not ++ Tend globe +++ With nausea ++ On blinking photophobia Do not

+++ + ++ Blurred Vision Do not ++ +++ Varies Pupil Normal Smaller Fixed in mid-dilation Same or smaller

Injection With limbal conjunctiva pallor ciliary flush Diffuse Diffuse Cornea Normal keratic precipitates Cloudy Infiltrate, edema, epithelial defects intraocular Pressure Normal Varies

Increased Markedly Normal or Increased previous Chamber Normal +++ Cells and flare Shallow Normal Cells and flare or Other Large, tender pre-auricular node if viral posterior synechiae colored halos N / V Pain

While blinking (corneal abrasions / foreign bodies / keratitis) With eye movement (optic neuritis) With headache / nausea (angle-closure glaucoma acute) With brow or temporary pain (temporal arteritis) Photophobia (inflammation of iris \x26amp; middle layer of eye, corneal irritation) “Gritty sensation” (conjunctivitis, corneal abrasion) History of trauma (corneal abrasion) Change in vision Normal vision reassuring (lid disorder, conjunctival process, corneal abrasion, foreign body) With red eye Decreased vision – infectious keratitis, iritis, acute angle glaucoma NB the causes of vision loss are not common That “red eye” culprits: retinal vascular occlusion, papilloedema, retinal detachment, cortical blindness etc. photophobia corneal process, iritis

Keratitis – inflammation of cornea (photophobia, sensation FB) UV keratitis: eg welding or sunlamp, 10. 06 hrs Appears after exposure, bilateral redness, photophobia, tearing. Fluorescein staining punctuate keratitis shows surface. Viral keratitis – herpes Often, can be other (eg adenovirus) – FB sensation, photophobia, watery discharge. Herpes simplex: eyelid edema, can Have Decreased vision. Gray, branching opacity seen dentrite With With fluorescein. Bacterial keratitis – FB sensation, difficulty opening eye, photophobia, mucopurulent discharge, white spot on cornea flurescein With That stains. With high risk wearing contact. Acute Angle Closure Glaucoma Abrupt onset of severe pain, may be frontal or supraorbital headache, redness With ciliary flush, photophobia, Decreased / blurred vision, nausea / vomiting, fixed pupil midposition, hazy (cloudy) cornea, elevated (normal 10-20 mmHg, IOP disease 60 -80mmHg) NO FB sensation! perforation History!

Mechanism of injury (projectile, laceration of eyelid or periorbital area, corneal abrasions occurring hammering metal on metal When, etc). Eye pain visual acuity \x26amp; May be AFFECTED. If you suspect, do not press on globe! And never measure IOP! Slit lamp exam to check for fluorescein With abrasion, laceration, FB, hyphema, iritis, lens dislocation. Signs: flat anterior chamber, pupil asymmetry or irregularity, extrusion of mood – Seidel’s sign. temporal arteritis Headache, jaw claudication, myalgia, fever, anorexia, temporal artery tenderness, TIA / stroke, rapid / visual profound loss (unilaterally INITIALLY), afferent papillary defect. c) Do Appropriate investigations (e. g. , erythrocyte sedimentation rate measurement, tonometry). Bacterial keratitis or conjunctivitis – Swab discharge for C \x26amp; S Angle closure glaucoma Acute – tonometry (dx 60-80 mmHg)

Perforation – slit lamp with fluorescein, palpation around orbital rim, check Extra ocular movements (NB blowout fractures With trauma). Temporal arteritis – ESR or CRP, start prednisone and refer for biopsy of temporal artery if highly suspicious d) Refer the patient Appropriately (if unsure of the diagnosis or if further work-up is needed). REFER: Angle closure glaucoma Acute / Shallow previous emergent Chamberlain – begin treatment to lower IOP – Reducing by acqueous mood – topical BB, alpha-adrenergic agonists, carbonic anhydrase inhibitors, Facilitating outflow of aqueous mood (parasympathomimetic miotic agents), Reducing volume of vitreous mood (IV mannitol) Penetrating trauma / Perforation: Immediately refer emergent- Normal acuity and ocular anatomy can f / u within 48 hours as outpatient Hyphema and hypopyon – referemergently Iritis / uveitis – Optometrist or Ophthalmologist urgent Infectious keratitis (emergent bacterial, viral is urgent)

temporal arteritis Decreased VA, Abnormal pupil, Ocular misalignment, Retinal damage PRIMARY CARE: Stye (hordeoleum), chalazion, blepharitis, subconjunctival hemorrhage Conjunctivitis (bacterial, viral, allergic) Dry eye syndrome episcleritis Corneal abrasion, corneal FB, contact lens Overwear – Refer if not better Within 24-48 hrs. 3 In Patients Presenting With an eye foreign body sensation, correctly diagnose intraocular an foreign body by clarifying the mechanism of injury (eg, high speed, metal on metal, no glasses) and investigating (eg, with computed tomography, X-ray examination) When Necessary. Hx Mechanism of injury important: “metalstrikingmetal” Penetration injury – metal, vegetable With no eye protection Conjunctival abrasions / lacerations – c / o FB scratchy sensation, mild pain, tearing, photophobia and rarely.

Vision preserved UNLESS full-thickness conjunctival laceration. Corneal abrasions / lacerations – c / o FB sensation, photophobia, tearing. Ocular Hx, Drug allergy, tetanus status PEx Do not press on IOP eye globe or check if? globe rupture Inspect for and remove foreign particles. Exam reveals conjunctival injection, tearing, lid swelling. Relief of pain With topical anesthesia diagnosis of corneal abrasion. check Vision Normal VA – less likely to be perforated Reduced VA -? perforated globe, corneal abrasion, lens dislocation, retinal tear

Cornea: abrasion – With fluorescein staining detect and cobalt blue filter using slit lamp Slit lamp exam With fluorescein. Management of Suspected Rupture or penetrating injury Globe – CAN NOT FORGET CT orbits – to ASSESS globe Changes in anatomy or contour of FB Within globe Consult Ophth Ancef ± aminoglycoside IV NPO tetanus Keep head elevated to lower IOP down 4 In Patients With an eye presenting foreign body sensation, evert the eyelids to rule out the presence of a conjunctival foreign body. Evert the eyelids: Have patient look down, use q-tiptohelpevert upper lid. Inspect tarsal conjunctiva.

Remove FB With moist cotton bud. May need penlight or magnification. Have patient look up and return to the normal eyelid With position. FB in or on cornea May Have Associated ring rust if metalic May note symptoms of corneal abrasion Hx: Symptoms of FB / Corneal Abrasion Pain, redness, tearing, photophobia, FB sensation PEx: FB, conjunctival injection, corneal edema, anterior chamber cells / flare de-epithelialized area fluorescein dye stains With With topical anesthetic relieved Pain May cause behind FB lid corneal epithelial Vertical multiple abrasions due to blinking

Tx: Remove under magnification using the local anesthetic and sterile needle or refer to ophthalmology (depends on depth and location) Remove under magnification using the local anesthetic and sterile needle or refer to ophthalmology (depends on depth and location) ABX topical (drops or ointment) Consider topical NSAIDs, cycloplegic (relieves pain and photophobia by paralyzing ciliary muscle) Most abrasions clear spontaneously Within 24-48 hr C / I: infection, ulceration, recurrent erosion, secondary iritis ring rust, abrasion, scarring 5 In neonates With conjunctivitis (not just blocked lacrimal glands or ” gunky ‘eyes), look for a systemic cause and treat it Appropriately (i. e. , with antibiotics). ophthalmia Neonatorum

Newborn conjunctivitis in first month of life Causes \x26amp; Tx Toxic / chemical: silver nitrate, erythromycin Within Resolves as watchful waiting 48hr Infectious: N. gonorrhoeae – most common – presents 2-7 days of life, can cause blindness. bilateral bulbar conjunctival Intense erythema, chemosis, purulent \x26amp; copious discharge. Gram stain of discharge: gram – diplococcic. Prophylaxis With erythromycin ointment at birth Admit \x26amp; Ix disseminated disease – blood / CSF \x26amp; Tx Ceftriaxone 50mg / kg IV x 1 or cefotaxime 50 mg / kg IV q8h chlamydiatrachomatis – 5-14 presents DOL Unilateral or bilateral purulent d / c with intense erythema of eyelid conjunctiva.

Associated With chlamydial pneumonia. Tx: Systemic x 14 days erythromycin. Other bacterial: within 2 wks Presents of birth; much less common. Hyperemia, purulent discharge, and edema. Usual bugs: S. aueus, nontypeable H. influenzae, and S. pneumonia. With Tx topical bacitracin, polymyxin, or neomycin HSV: Presents 6-14 days of life. Bilateral lid edema \x26amp; conjunctival erythema. Suspicious if mucocutaneous lesions Associated With \x26amp; maternal hx of herpes. Fluorescein exam shows keratitis or corneal dendrites.

Requires hospital admission, full sepsis work-up (esp CSF analysis). Tx: Acyclovir 20 mg / kg IV q8h x 14 to 21 days \x26amp; topical antivirals (trifluridine 1%, 0. 1% iododeoxyuridine, vidarabine 3%) Dx using stains \x26amp; Cx Nasolacrimal System Defects Congenital Obstruction of the nasolacrimal duct (not canalization) Usually at 1-2 mo of age Epiphora, crusting, discharge, recurrent conjunctivitis Can Have reflux of mucopurulent materials from lacrimal punctum When pressure is applied over lacrimal sac Tx: lacrimal sac massage over at medial corner of eyelid Most resolve in 9-12 mo, Otherwise Consider referral for duct probing 6 In Patients With conjunctivitis, distinguish by history and physical examination Between allergic and infectious causes (bacterial or viral). conjunctivitis Etiology Infectious: bacterial, viral, chlamydial, fungal, parasitic

Non-infectious: allergic – atopic, seasonal, giant papillary conjunctivitis (Contact lens wearers) Toxic – irritants, dust, smoke, irradiation Secondary to another disorder: Dacryocystitis, dacryoadenitis, cellulitis, Kawasaki’s dz Clinical Features Red eye (conjunctival limbal injection Often With pallor) Chemosis, subepithelial infiltrates Enlarged preauricular / submandibular LN – Suggest infectious etiology (viral or chlamydial) Temporal conjunctival lymphatics drain to preauricular nodes to nodes submandibular \x26amp; nasal Itching, FB sensation, tearing, discharge, crusting of lashes in the morning, lid edema Follicles: pale lymphoid elevations of the conjunctiva in viral \x26amp; chlamydial Papillae: fibrovascularelevationsoftheconjunctivawithcentral network of finely branching vessels (cobblestone appearance)

in allergic and bacterial Type of discharge Allergic: mucoid Viral: Watery Bacterial: purulent Chlamydial: mucopurulent allergic Conjunctivitis atopic Associated With rhinitis, asthma, dermatitis, hay fever Small papillae on lower conjunctival fornix, chemosis, thickened and erythematous swollen lids, corneal neovascularization Seasonal: pollen, grasses, plant allergens Tx: Cool compresses, antihistamine, mast cell stabilizeer: ketotifen, olopatadine Giant Papillary Conjunctivitis

Immune reaction to mucus debris on contact lenses Large papillae form on top palpebral conjunctiva Tx: clean, change or discontinue use of contact lens Vernal Conjunctivitis Large papillae (cobblestones) on top form palpebral conjunctiva With corneal ulcers \x26amp; keratitis Seasonal: warm weather Occurs in children, lasts for 5-10 yr Then Resolves Tx: Consider topical steroid, topical cyclosporine (ophthalmologist) viral Conjunctivitis Painless, Serous / watery discharge, lid edema, follicles Subepithelial corneal infiltrates Maybe be Associated With rhinorrhea – Often Preceded by URTI Often palpable preauricular node and tender

INITIALLY unilateral, Often to the other eye progresses Etiology: mainly due to adenovirus – high contagious for up to 12 d; measles, infleunza, mumps, HSV / HZV On slit lamp, on lower conjunctiva palpebral follicles Tx: Cool compresses, topical lubrication, self-limiting Usually (7-12d), proper hygiene is Very Important bacterial Conjunctivitis Painless, Causing lids Purulent discharge to “stick” on awakening, lid swelling, papillae, conjunctival injection, clear cornea, chemosis Common agents: S aureus, S. pneumoniae, H. influenzae, M catarrhalis LN preauricular except for gonococcal infection absent In neonates / sexually active – MUST CONSIDER: N. gonorrhoeae (cornea to cause keratitis invade) Chlamydia trachomatis is the MOST common cause in neonates

Tx: Topical broad-spectrum antibiotic Systemic antibiotics if indicated, in neonates and children Especially Usually a self-limited course of 10 to 14 d if no Tx and 1-3 d With Tx chlamydial Conjunctivitis Affects neonates (ophthalmia neonatorum) on day 3-5, sexually active Individuals Causes trachmoa \x26amp; inclusion conjunctivitis Trachoma Leading infectious cause of blindness, severe keratoconjunctivitis leads to corneal abrasion, ulceration, and scarring Initially, palpebral conjunctiva follicles on top Tx: topical \x26amp; systemic tetracycline inclusion Conjunctivitis With chronic conjunctivitis subepithelial follicles and infiltrates

Most common cause of conjunctivitis in newborns prevention: erythromycin topical at birth Tx: topical and systemic tetracycline, doxycycline, or erythromycin 7 In Patients Who Have bacterial conjunctivitis and use contact lenses, treatment Provide With That cover for Pseudomonas antibiotics. Soft contact lenses prone Pseudomonas infection Tx: Fluoroquinolone (Ciloxan, Ocuflox) AMG or (Tobrex). 8 Use Only When steroid treatment Indicated (e. g. , to treat iritis, keratitis and conjunctivitis With avoid). Do not use steroids in ocular conjunctivitis due to occult herpetic infection. Should only use on ophthalmologist recommendation 9 In Patients With iritis, Consider and look for underlying systemic causes (e. g.

, Crohn’s disease, lupus, ankylosing spondylitis). The Uveal Tract = Iris + + choroid ciliary body vascularized, pigmented middle layer of the eye, the retina Between sclera \x26amp; Uveitis – May Involve one or all three parts of the tract Anatomically classified as anterior (iritis), intermediate (vitreous) or posterior (choroid / retina) or uveitis Panuveitis Idiopathic or Associated With autoimmune, infectious, granulomatous, malignant causes Anterior uveitis (iritis) Inflammation of iris, Usually With cyclitis (inflammation of ciliary body) Usually unilateral etiology Trauma / large abrasion Systemic Immune-mediateddz / Connectivetissuedz: HLA-B27: Reactivate HLA-B27: reactive arthritis, ankylosing spondylitis, psoriatic arthritis, IBD

Non-HLA-B27: juvenile idiopathic arthritis Crohn’s, UC, vasculitis, MS Infectious: Syphilis, lyme dz, toxoplasmosis, TB, HSV, Herpes Zoster Other: Sarcoidosis, post ocular Sx, ischemia, retinal tear giant, retinoblastoma Clinical Features Hx: Decreased VA photophobia unilateral ocular pain (bilateral if systematic lacrimation, but no discharge systemic symptoms arthritis, urethritis, recurrent GI symptoms PMH of TB, genital herpes, trauma, exposure to welding w / o goggles

PEx: Ciliary flush (perilimbal conjunctival injection), miosis (spasm of sphincter muscle) – poorly reactive tenderness of the globe, brow ache (ciliary muscle spasm) Typically iritis you reduce IOP; however, severe iritis, iritis from HSV / HZV ​​May cause an inflammatory glaucoma (trabeculitis) Slit Lamp: Previous chmaber “cells” (WBC in anterior chamber due to anterior segment inflammation) and “flare” (ppt protein in anterior chamber secondary to inflammation), hypopyon (collection of neutrophilic exudates in the anterior chamber inferiorly) Occasionally keratic precipitate (clumps of cells on corneal endothelium) Tx: Mydriatics: pupil dilates to Prevent formation of posterior synechiae and to decrease pain from spasm ciliary long acting cycloplegic: homatropine or tropicamide Steroids: topical, systemic or sub-tenon Prednisone to reduce inflmmation

Should use only ocular steroids on Ophthal Recommendations (c / i in herpetic / bacterial conjunctivitis) systemic analgesia Extensive medical workup May be Indicated to r / or secondary causes C / I: inflammatory glaucoma posterior synechiae Adhesions of posterior lens capsule to previous iris Indicated by an irregularly shaped pupil Can lead to angle-closure glaucoma Cataracts Macular edema \x26amp; band keratopathy With chronic iritis References: UpToDate 2015

TN2014

1DOC3Cuáles are the symptoms of herpes zoster

Also known as shingles, this disease is caused by the same virus that causes chickenpox. The disease is spread through direct contact with the rash and not through the air. pregnant women and newborns should be completely isolated from people with the disease, it can cause deafness in children. Those who have had chickenpox at some point in his life, no doubt, are candidates to develop shingles. The reason? Once the chickenpox, the virus remains in the body and is housed in nerve cells, it stays there ‘asleep’ unless a low defenses, high levels of stress or taking certain medications activate it. As a sharp pain and burning, shingles affects the nerves, “ie, the body part that facilitates sensitivity, so it is very painful, is a burning type of pain that is burning, it is very annoying, even the touch of clothing. Almost always it occurs in the chest, but can occur in any part of the body and at any age. In adults is more associated with low defenses, because this is an opportunistic virus, ie, pending an alteration in the defenses to appear, “says Juan Felipe Montoya, physician group EMI. Symptoms of Shingles The first signs of the disease are lesions on the skin rash type blisters that evolves grouped linearly, because that is how the nerve is anatomically distributed. Among the first manifestations, warns the National Library of Medicine of the United States, burning or shooting pain and tingling or itching, usually on one side of the body or face are also included. “The pain can be mild or severe.

If shingles appears on the face, can affect vision or hearing. The pain of shingles may last for weeks, months or even years after the blisters have healed. ” This disease is known that can last about a month in the body. Montoya said that once the virus is incubated in 3 or 4 days begin to take the first manifestations, the fifth day the injury occurs and lasts about 10 days. Subsequently, well it has healed, the person can be infectious until 14 days later. “The virus is latent, not die at all, calm and stays living in the nerve. Some patients are left with discomfort, that is known as post-herpetic neuralgia and refers to a burning type pain in the affected area, so the injury is gone, because the nerve is so inflamed left with chronic pain. ” An incurable disease So shingles, however, prompt treatment with antiviral medications and pain management can help. The National Institute of Allergy and Infectious Diseases said that a vaccine can prevent shingles or lessen its effects. The vaccine is recommended for people 60 years or older.

In some cases, doctors may recommend it to people aged 50 to 59 years. Finally, I must say that it is wrong the idea that if the two ends of the shingles meet death comes. What happens is that in the case of the chest, the disease starts back and forth and many think it can turn, which is false, since the nerves on either side of the back are different.

Ophthalmology St. Lucia (Santa Magazine)

Ophthalmology St. Lucia (Santa Magazine) MONOGRAPH herpetic recurrence corneal transplant Dra. Natalia Luciana Chautemps St. Lucia Eye Hospital hospstalucia@speedy. com. ar Introduction The corneal graft is a safe and highly successful for visual, tectonic or therapeutic rehabilitation of corneal diseases common technique.

However, despite the continued progress in both transplant surgical techniques and postoperative care, complications are not uncommon and can threaten the survival of the graft. The three most common causes of graft failure are; rejection (35%), infection (18%) and glaucoma (9%). The purpose of this paper is to distinguish the corneal graft rejection herpetic recurrence, to apply the correct treatment. Not forgetting that recurrence can lead to rejection, so we must find a balance between administered corticosteroids and antivirals to the success of corneal transplant dose. Historical review Since the first successful keratoplasty described in humans by Edward K. Zirm in 1906, several personalities of the ophthalmologic world have contributed to its evolution. Notable names Filatov, Paton, Maurice or Spanish Ramon Castroviejo, not forgetting the creators of current conservation methods, Mc Carey \x26amp; Kaufman. In the last forty years there has been a significant change in terms of penetrating keratoplasty indications, partly because of better medical control of infectious keratopathies, as well as an increase in the number of cataract surgeries. In this regard it has gained great prominence as an indication bullous keratopathy, aphakic and pseudophakic both. Development Indications for corneal transplantation 1- Optics: to improve visual acuity.

2- Tectonics: to restore the corneal structure or prevent a loss of eyeball after drilling. 3- Therapeutic: to act on an active corneal disease, eg persistent infectious keratitis. 4- Cosmetics: if disfiguring corneal opacity without visual expectations. Risk factors for rejection in corneal transplantation: There are many factors associated with a worse prognosis. Some authors classify them into immunological and non-immunological. immunological factors – Deep vascularization – Second keratoplasty – Intervened contralateral eye – Active keratitis – Age of the patient -expression of HLA antigens on the graft.

-queratitis herpetic stromal ulceration with or without perforation (worse prognosis group) non-immunological factors ocular surface disorders from -diseases eyelids conjunctival and limbal -Alterations -fármacos: Latanoprost (proinflammatory) and Dorzolamide (inhibits enzymatic pumping mechanism endothelial cell). Good prognostic factors in corneal transplant  Among the factors of good prognosis in a corneal transplant include Absence of inflammatory activity for at least 6 months prior to the intervention deep vascularization -absence -Use of high doses of corticosteroids in the immediate postoperative -Use interrupted sutures Nylon 10/0 Symptoms of corneal graft rejection

One of the first symptoms are photophobia, followed by pain, blurred vision, conjunctival and episcleral injection and even tearing. Importantly, some patients may present as asymptomatic or have minimal symptoms. Signs of rejection and herpetic recurrence The differential diagnosis between herpetic recurrence and immune rejection can be difficult in some cases, but there are some clinical signs counselors. herpetic recurrence inflammatory conditions in the presence of a dendritic epithelial ulcer, with preferential involvement in the area between the graft and host or endotheliitis with simultaneous involvement of donor and recipient corneal button ring. Graft rejections There are 3 types of graft rejection: endothelial, epithelial and stromal. -The Endothelial rejection is characterized by a progressive or keratic precipitates line (line Khodadoust), sectoral edemas start at the bottom graft respecting receptor ring or minimal reaction with the anterior chamber cells and flare to a strong reaction from the anterior chamber, even with hypopyon. In endothelial rejection, inflammatory reaction is directed against endothelial cells, whose destruction is ultimately the cause of graft rejection. -The Epithelial rejection is characterized by an infiltrator, high and linear or circumferential lesion, which is stained with fluorescence and tends to move toward the center. Since the host epithelium gradually replaces the donor cornea transplants, habitually without producing a line of epithelial rejection, this event does not represent in itself a cause of graft failure. However, it indicates increased immune activity against the graft, and can be a precursor endothelial rejection.

Thus, the epithelial rejection should lead to rapid treatment and close monitoring. -The Stromal rejection comprises subepithelial infiltrates and may also precede or coincide with endothelial rejection it. The primary graft failure occurs when severe edema graft surgery at the end of or during the first postoperative day appears. It is generally due to poor quality of the tissue graft, or significant endothelial damage at the time of surgery. Grafting evidence a marked thickening and has a grayish white opaque appearance, which obscures the view of the anterior segment structures. Diagnosis of rejection The diagnosis is clinical, complementary tests normally are not necessary. Pachymetry of the affected area may be useful to monitor the effectiveness of treatment. Treatment of herpetic recurrence Treatment of herpes keratitis in a graft with topical antiviral agents such as acyclovir 3% five times a day, or oral antivirals, such as acyclovir. The use of oral prophylactic antivirals in the early postoperative is controversial. Some authors recommend the combination of antivirals while corticosteroids are used. Others only in those grafts being treated for rejection with high doses of corticosteroids.

On the other hand, there are published in the literature that there are different recurrence rates that are associated with antivirals or revisions. However, recent studies have found significant differences in the incidence of herpetic recurrence in patients who underwent keratoplasty on postherpetic walleye those treated with acyclovir orally versus patients who were only treated with corticosteroids, just find a lower percentage of rejections . We have also found association between the occurrence of relapse during the first year after surgery or an immune rejection, with a higher percentage of failures in the months after transplantation, although managed to control the initial episode. Oral acyclovir (400 mg, 5 times a day) reaches therapeutic doses in the corneal epithelium and in the aqueous humor. It seems clear that both topically and orally, is capable of inhibiting viral replication in the epithelium in a patient with a stromal keratitis, even if they are treated with corticosteroids. Oral acyclovir use in preventing recurrences of herpetic patients undergoing keratoplasty is based on the characteristics of the corneal innervation after transplantation, and virus release in ocular tissues. The mechanism of recurrence is the transmission of the virus from the trigeminal ganglion, the first branch of the fifth cranial nerve to the cornea and ciliary body. After transplantation, the graft may display a full sensitivity in the central part and at 8 weeks and most patients at 12 months. An alternative route for the arrival of the virus to the tissue may be the tear film. the increased frequency of occurrence of immune rejection is also known after an episode of herpetic recurrence ocular. El acyclovir is more specific than other antivirals, acting on cells infected by the virus, so its toxicity is lower. However, it is not without undesirable systemic effects, the most important but rare renal toxicity. It would therefore be necessary to establish the indications for the use of this drug and to assess its efficacy in preventing recurrences herpéticas.


La dose of 800 mg a day, it seems to be the minimum effective dose, according to a report published in the literature and not It appears to be associated with significant side effects. The time allowed to stay acyclovir orally after surgery is also a fact not solved in the literature, taking into account the risk of recurrence for early discontinuation of treatment against the high cost of antiviral treatment lasted for months, which could not be necessary. Most recurrences occur during the first year after surgery mostly in the first 6 months. Therefore, these results also suggest the need for treatment at least for one year after surgery. This effect was not sustained after cessation of administration. This effect will only last as long as the patient is taking acyclovir. It is believed that oral and topical antivirals are equally effective. Discussion Some authors recommend the combination of antivirals while corticosteroids are used. Others only in those grafts being treated for rejection with high doses of corticosteroids. On the other hand, there are published in the literature that there are different rates of recurrence are associated antivirals or revisions. However, recent studies have found significant differences in the incidence of herpetic recurrence in patients who underwent keratoplasty on postherpetic walleye who were treated with acyclovir orally versus patients who were only treated with corticosteroids, as well as a lower percentage of rejections. We have also found association between the occurrence of relapse during the first year after surgery or an immune rejection, with a higher percentage of failures in the months after transplantation, although managed to control the initial episode.

Acyclovir orally (400 mg, 5 times daily) reaches therapeutic doses in the aftermath of a herpetic stromal keratitis among the most common causes of corneal transplantation. Survival rates for these grafts are between 14 and 61%. The most common cause of failure of these transplants is the recurrence of herpetic keratitis or herpetic iridocyclitis, which take place mostly during the first year after surgery, followed by the second immune rejection. The recurrence rate varies with time tracking and criteria adopted for diagnosis, with values ​​between 6 and 47% in different studies, either immediately after surgery or years later. Rejections frequency ranges from 20 to 76% . The differential diagnosis between herpetic recurrence and immune rejection keratoplasties on one of these can be very difficult in some cases, but there are some clinical signs similar orientadores. Cifras of these complications in patients who received oral acyclovir postoperatively, while those who did receive the anti-viral are below these values ​​for both recurrence, rejections or fracasos. Asimismo in eyes without inflammation without vascularization occurred 16% of immunological rejection to 5 years, but this percentage increased to 30% in corneas with beds vascularizados. El worse prognosis group consists of patients with herpetic keratitis with stromal ulceration with or without perforation. The preferred treatment in these cases is to restore corneal integrity, allowing inflammation subsides for 6 to 12 months and then perform the transplant. The use of oral antiviral postoperatively is controversial. It seems clear that both topically and orally, is capable of inhibiting viral replication in the epithelium in a patient with a stromal keratitis, even if they are treated with corticosteroids. Also, use of acyclovir orally at doses of 800-1000 mg per day has proven effective in preventing recurrences of genital herpes simplex.

Use of oral acyclovir in preventing recurrences of herpetic patients undergoing keratoplasty is based on the characteristics of the corneal innervation after transplantation, and virus release in ocular tissues. The mechanism of recurrence is the transmission of the virus from the trigeminal ganglion, the first branch of the fifth cranial nerve to the cornea and ciliary body. After transplantation, the graft may display a full sensitivity in the central part and at 8 weeks and most patients at 12 months. An alternative route for the arrival of the virus to the tissue may be the tear film. the increased frequency of occurrence of immune rejection is also known after an episode of ocular herpetic recurrence. Acyclovir is more specific than other antivirals, acting on cells infected by the virus, so their toxicity is lower. However, it is not without undesirable systemic effects, the most important but rare renal toxicity. It would therefore be necessary to establish the indications for the use of this drug and assess their effectiveness in preventing recurrences of herpes. The dose used in this study, 800 mg daily, appears to be the minimum effective dose, and does not seem to be associated with significant side effects The time allowed to stay acyclovir orally after surgery is also a fact not solved in the literature, taking into account the risk of recurrence for early discontinuation of treatment against the high cost of antiviral treatment lasted for months, which could not be necessary. Most recurrences occur during the first year after surgery. conclusions Herpetic keratitis is the leading cause of corneal blindness in developed countries.

Corneal transplantation is the only therapeutic alternative in some cases, but are keratoplasties that are considered “high risk” of failure, either by immune rejection or the occurrence of relapses of herpetic disease. There is no agreement on the indication of antiviral oral postoperative of these keratoplasties although some studies suggest that could reduce the incidence of recurrent herpetic disease. the long-term antiviral prophylaxis is preferred and should be considered if economically feasible. It is also important to remember that herpes simplex recurrences can occur even if the patient is receiving prophylaxis and should remain a high suspicion of recurrent disease at all times. Summary Patients receiving oral acyclovir had less postoperative recurrence herpetic episodes, fewer rejects, and fewer failures. So the immediate postoperative prophylaxis with acyclovir would be recommended. Although not reached a unanimous consensus up when necessary, one year of treatment would be a reasonable time. The optimal dose is not notarized, but several papers speak of a minimum dose of 800 mg / day. In other studies consider the topical acyclovir would be a good option considering the systemic toxicity than oral acyclovir to longstanding could produce, especially kidneys. In addition, a high level of suspicion and a constant search for herpetic recurrence and rejection of corneal needed, since both situations give similar symptoms, but not biomicroscopy. Bibliography Langston D.

_Pavan-Herpetic Infections. In Smolin, Thoft RA. Eds. The Cornea. Third edition. Boston: Little, Brown and Company; 1994; 183-199. -barney N, Foster C. A prospective randomized trial of oral acyclovir after penetrating keratoplasty for herpes simplex keratitis. Cornea 1994; 13: 232-236. -Lanier J. Herpes simplex walleye. Surgical considerations. In Brightbill FS.

Eds. Corneal Surgery. Theory, Technique and Tissue. St Louis: Mosby; 1993; 132-137. -Moyes A, Sugar A, et al. Antiviral therapy after penetrating keratoplasty for herpes simplex keratitis. Arch Ophthalmol 1994; 112: 601-607. -Chandler J. Herpes simplex walleye. Results of surgery. In: F. S. Brightbill Eds.

Corneal Surgery. Theory, Technique and Tissue. St Louis: Mosby; 1993; 137-140. -Barron B, L Gee, et al. Herpetic Eye Disease Study. A controlled trial of oral acyclovir for herpes simplex stromal keratitis. Ophthalmology 1994; 101: 1871-1882. -Legmann S, Pavan-Langston D. Long-term oral acyclovir therapy. Effect on recurrent herpes simplex keratitis infectious in Patients With and without grafts. Ophthalmology 1996; 103: 1399-1405. -C. Rapuano, J.

et al Luchs. Anterior Segment. The requirements in Ophthalmology. systemic and immunological processes that affect the cornea. 2001; 183-187. -M. Oliva, H. Taylor et al. impending complications in cornea transplants. Diagnosis and handling- part I. Hightlights of Ophthalmology. 2003; 2-6. -R.

Vajpayee, N. Sharma et al. Cornea transplant. Treatment and Prevention allogeneic corneal graft rejection. Hightlights of Ophthalmology. 2002; 122-127

Herpes In Men: Learn to catch it early!

What are the symptoms of the most common herpes in men? To take action in relation to herpes, you must first know how to detect it. That’s why in this article I want to inform you about herpes in men, what characterizes it, and their symptoms, so you can react just notes that might appear, and thus ensure easily cured. Herpes symptoms in men vary significantly from those infected with HSV-2 virus that causes genital herpes, ranging from the obvious signs of infection, such mild symptoms that may be completely ignored by the affected person. It should be no surprise that the 2010 data of the Center for Disease Control showed that 4 out of every 5 American men infected with HSV-2 are unaware of their condition. This situation becomes even more serious taking into account the results of the report which concluded that up to 11% of the sexually active male population carries the virus. Most infected men find they carry the HSV-2 virus have experienced after an initial outbreak of blisters and painful warts on your genitals or groin. This “primary outbreak” typically occurs between 2-20 days after being first exposed to the virus through sexual encounter. With research showing that less than 40% of newly infected men develop blisters during the initial outbreak, it is critical that men educate themselves about the most common symptoms of herpes, which are mostly ignored. The following list represents the symptoms often ignored and experienced during a primary outbreak of herpes in men: Irritation, itching, burning, tingling sensation on or around the genitals, thighs, buttocks and groin. The sudden appearance similar to those of flu such as fever, fatigue, headaches and chills symptoms. Swelling and pain in the lymph nodes.

muscle aches and pains mysterious groin and lower back. The appearance of these symptoms of herpes in men, after several days of sexual intercourse (especially with a new partner), can be an indicator of newly infected immune system that HSV-2 virus has invaded the body and has begun embedded in the nerves of the site of infection. For men who have previously experienced outbreaks of blisters and warts, these symptoms begin to be recognized as warnings of a new outbreak. However, within the large percentage of men who have never suffered from an outbreak of blisters, these symptoms may be your only indication of infection. If you experience any of these symptoms discussed in this article, it is imperative that you consult a doctor as soon as possible. The virus that causes genital herpes in men is highly contagious, and increases the body’s susceptibility to other sexually transmitted diseases such as HIV. While according to traditional medicine, there is no cure for HSV-2 virus, yes there are effective available that greatly reduce and could cure both severity and duration of the next outbreaks natural treatments. Herpes symptoms in men (type 2 – genital) not only create physical discomfort, but also emotional problems for those who suffer. Therefore, detection and early treatment of HSV-2 infection is vital for those who carry the virus and its nearby people. According to Dr. John Douglas Center for Disease Control, “the message is that herpes is quite common. Symptoms can often be harmless. Many individuals are transmitting herpes to others without even knowing it.

” For his part, Dr. Kevin Fenton, director of the National Center for the Prevention of HIV / AIDS, Viral Hepatitis, STD and TB, adds that “everyone should be aware of these symptoms, risk factors, and measures that can be taken to prevent the spread of the incurable infection. “