Bilateral horizontal gaze palsy as an initial presentation of a clinically isolated syndrome: A case report.

Multiple sclerosis (MS) is the most common demyelinating disease affecting the central nervous system. It has a wide range of manifestations and commonly affects the visual system. Many patients with MS report decreased vision, diplopia, nystagmus, and abnormal ocular motility. Nevertheless, bilateral horizontal gaze palsies are exceptionally rarely seen. We present the case of a 24-year-old female who came to our pediatric ophthalmology clinic complaining of bilateral horizontal gaze palsy, photophobia, and eye pain for 2 days. Although the patient had a family history of MS, there was no similar or previous complaint, with an unremarkable past medical and surgical history. During the examination, she was found to have a complete bilateral absence of horizontal saccade and pursuit, with slight limitations in vertical ones. There was no nystagmus or skew deviation, and the rest of the cranial nerves (CNs) were intact. Her ocular vital signs were normal, and her corrected visual acuity was 20/20 with full-color vision. The rest of the physical and neurological examinations were unremarkable. After referral to neurology, the magnetic resonance imaging showed multiple hyperintense lesions in deep white matter, pons, and midbrain. The correlation of imaging findings with clinical presentation confirmed the diagnosis of a clinically isolated syndrome. Extra-ocular motility (EOM) significantly improved after pulse steroid therapy and five sessions of plasma exchange, but the patient developed 35 prism diopter of acquired concomitant esotropia. She underwent a right medial rectus botulinum toxin injection which dramatically improved her condition, and became orthotropic during the last 2 months of follow-up after the injection.

Adherence to Eye Examination Guidelines Among Individuals With Diabetes in Saudi Arabia.

BACKGROUND: Individuals with diabetes are at risk of developing diabetic retinopathy, a vision-threatening complication. Regular eye examinations are crucial for early detection and management. Ensuring adherence to eye examination guidelines is essential to prevent visual impairment and blindness in this at-risk population. METHODS: This was cross-sectional study, and a validated questionnaire was physically administered among adult individuals with diabetes (both males and females) in Saudi Arabia. The data were gathered and analyzed using Statistical Product and Service Solutions (SPSS, version 26.0) software (IBM SPSS Statistics for Windows, Armonk, NY). This study took approximately three months from the period August 2023 to November 2023. RESULTS: This study found that most participants had type 1 diabetes (46.1%, n=83) and had been diagnosed for more than 10 years (49.4%, n=89). The most used management strategy (48.9%, n=88) was lifestyle changes and anti-diabetic medications. Most of the participants (93.3%, n=168) were fully aware of the severe eye complications of diabetes, as well as diabetic retinopathy and its complications (48.9%, n=88). The most common source of information about the importance of eye exams was healthcare professionals (56.7%, n=102). Most of the participants had annual eye exams (58.3%, n=105) and within the previous year, specifically related to their diabetes (62.8%, n=113). Adherence to eye examination guidelines was higher in those who had diabetes for more than 10 years (p=0.009), those who were on lifestyle changes and insulin therapy or anti-diabetic medications (p=0.030), those who were fully aware of severe eye complications and diabetic retinopathy (p=0.017 and p=0.020, respectively), and those with type 2 diabetes (p=0.001). In addition, participants who understood the importance of eye examinations had better glucose control (p=0.017), had eye examinations within the previous year (p=0.001), and had heard about the importance of eye examinations from healthcare professionals (p=0.020). The findings revealed the most common reasons for not getting an eye exam were a lack of awareness (37.8%) and distance from the hospital. CONCLUSION: To summarize, many people with diabetes do not get regular eye exams often because they are unaware of how important these exams are. Long-term diabetics who are aware of the dangers of diabetic retinopathy are more likely to heed this advice. However, adherence was linked to more frequent eye exams and better glucose control. Adherence and wide awareness must be created to improve retinopathy outcomes.

A Systematic Review of Sildenafil Mortality Through the Years.

Sildenafil is a medication used for the treatment of erectile dysfunction. It was approved by the U.S. Food and Drug Administration (FDA) in 1998. Several articles have raised concerns regarding the use of sildenafil and the occurrence of serious adverse events, such as myocardial ischemia, stroke, and even death. Our aim is to systematically review the existing literature on mortality associated with sildenafil use. The method used for this systematic review was completed by searching three databases: PubMed, Scopus, and Web of Science. Articles were screened and assessed for eligibility. This review uses the articles found to address the concerns associated with sildenafil and mortality. A total of 19 reports were used in our systematic review, in which there were 10 case reports, two case series, three systematic reviews, one narrative review, one retrospective study, one article in the British Medical Journal, and one commentary article. One FDA article in particular included case reports and reports to the FDA on the use of sildenafil eight months after its introduction to the market in 1998, with 522 deaths reported. Another retrospective study examined the use of sildenafil on infants below the age of 1 who did not have congenital heart disease but did suffer from severe pulmonary hypertension. The study found a mortality rate of 29%, which increased with sildenafil dosage. A case series examined six deaths related to non-prescription use of sildenafil. All these cases were subjected to autopsies and related to sexual activity. The study suggests that phosphodiesterase 5 inhibitors induced the deaths, and the concentration of sildenafil in the femoral blood was found to be between 0.032and0.087 µg. To conclude, the literature available on this topic is deemed insufficient to provide enough data to establish a direct link of causality between sildenafil and mortality. Although some studies paint sildenafil as the culprit behind these deaths, further studies and research are needed to explain the unexpected deaths following sildenafil use.