Bloody tears: Ocular pyogenic granuloma inducing hemolacria during pregnancy.

Hemolacria, or bloody tears, is a symptom caused by several ocular disorders ranging from trauma to hormonal changes. We describe a case in which a 21-year-old, 28-week pregnant patient presented to the emergency department (ED) following her second occurrence of nocturnal left eye bleeding in a week. During her examination in the ED, a small abrasion to the lateral edge of the upper left lid was noted. No other injuries, traumatic mechanisms, or relevant past medical history were noted. Due to her pregnancy, the nascent pyogenic granuloma responsible for her hemolacria was managed conservatively. Despite management, the pyogenic granuloma rapidly grew within a few weeks causing ocular irritation and conjunctival injection. Due to concerns about ocular irritation, inability to close the affected eyelid, and decreasing visual acuity, the pyogenic granuloma was removed surgically. This case highlights the difficulty in managing pregnant patients with ocular complaints who initially present to the ED. In this case, the patient's pregnancy complicated her initial treatment plan, requiring more conservative initial management strategies. While conservative first-line treatment options for pregnant patients are recommended, they should be paired with constant risk-benefit assessment for the patient and her fetus.

Pre-stimulus bioelectrical activity in light-adapted ERG under blue versus white background.

To compare the baseline signal between two conditions used to generate the photopic negative response (PhNR) of the full-field electroretinogram (ERG): red flash on a blue background (RoB) and white flash on a white background (LA3). The secondary purpose is to identify how the level of pre-stimulus signal affects obtaining an unambiguous PhNR component. A retrospective chart review was conducted on four cohorts of patients undergoing routine ERG testing. In each group, LA3 was recorded the same way while RoB was generated differently using various luminances of red and blue light. The background bioelectrical activity 30 ms before the flash was extracted, and the root mean square (RMS) of the signal was calculated and compared between RoB and LA3 using Wilcoxon test. Pre-stimulus noise was significantly higher under RoB stimulation versus LA3 in all four conditions for both right and left eyes (ratio RoB/LA3 RMS 1.70 and 1.57 respectively, p < 0.033). There was also no significant difference between the RMS of either LA3 or RoB across protocols, indicating that the baseline noise across cohorts were comparable. Additionally, pre-stimulus noise was higher in signals where PhNR was not clearly identifiable as an ERG component versus signals with the presence of unambiguous PhNR component under RoB in all four groups for both eyes (p < 0.05), whereas the difference under LA3 was less pronounced. Our study suggests that LA3 produces less background bioelectrical activity, likely due to decreased facial muscle activity. As it seems that the pre-stimulus signal level affects PhNR recordability, LA3 may also produce a better-quality signal compared to RoB. Therefore, until conditions for a comparable bioelectrical activity under RoB are established, we believe that LA3 should be considered at least as a supplementary method to evaluate retinal ganglion cell function by ERG.

The influence of arginine supplementation on IGF-1: A systematic review and meta-analysis.

BACKGROUND: Insulin-like growth factor-1 (IGF-1) secretion is thought to be induced by a semi-essential amino acid called arginine (Arg). Existing research on the effect of Arg on IGF-1 levels has provided conflicting results. This systematic review and meta-analysis investigated the efficacy of acute and chronic Arg supplementation on IGF-1 levels. METHODS: PubMed, Web of Science, and Scopus were systematically searched until November 2022. The meta-analysis was performed using random- and fixed-effects models. Sensitivity and subgroup analyses were also carried out. Publication bias was assessed using Begg's test. RESULTS: Nine studies were included in this meta-analysis. Chronic Arg supplementation did not significantly change IGF-1 levels (SMD = 0.13 ng/ml; %95 CI: -0.21, 0.46; p = 0.457). Furthermore, the IGF-1 level was not significantly affected by acute Arg supplementation (SMD = 0.10 ng/mL; CI: -0.42, 0.62; p = 0.713). The meta-analysis results did not change following subgroup analyses based on the duration, dosage, age, placebo, and study population. CONCLUSION: In conclusion, there was no significant effect of Arg supplementation on IGF-1 concentration. The meta-analyses revealed no acute or chronic Arg supplementation impact on IGF-1 levels.

Prolonged Ocular Foreign Body Found on Repeat Visit to a Second Emergency Department.

We describe a case where the patient presented to the emergency department (ED) with ocular irritation in the right eye with concomitant blurry vision that had been persistent for a week. The cause of this patient's ocular irritation and worsening visual acuity was determined to be a retained foreign body of the limbus. The foreign body had been in the patient's eye for about four months before he began to experience these symptoms. The four-month duration was established based on initial symptoms and a prior ED visit with no noted eye injury or foreign body detection, as well as the degree of overlying epithelization. This case highlights the importance of obtaining a thorough history and physical examination while emphasizing the high index of suspicion needed for translucent foreign bodies. Here, an inert foreign body erupted four months after injury. Additionally, this case stresses the importance of transition of care for ophthalmologic conditions. Consideration of any social determinants of health that could prevent as an example.

Selective detection of aspartic acid in human serum by a fluorescent probe based on CuInS2@ZnS quantum dots.

The importance of amino acids identification in biological systems has created expectation to develop a sensitive method for their detection. In this work, an efficient core-shell fluorescent quantum dots (QDs) probe based on CuInS2 (CIS) core and ZnS shell with the formula of CIS@ZnS QDs were synthesised and characterised by FT-IR, UV-Vis, TEM and DLS techniques. The probe was used for detection of Aspartic Acid (Asp) in an aqueous media. The probe shows a remarkable fluorescence response toward Asp over the other amino acids such as valine (Val), glycine (Gly), phenylalanine (Phe), leucine (Leu), alanine (Ala), serine (Ser), isoleucine (Iso), threonine (Thr), methionine (Met), Glutamic acid (Glu), histidine (His), arginine (Arg), cysteine (Cys), asparagine (Asn), glutamine (Gln), citrolline (Cit), sarcosine (Sar) and ornithine (Orn) the fluorescence intensity quenches significantly upon addition of Asp in an aqueous media. The CIS@ZnS QDs probe showed a selective and sensitive response by fluorescence quenching toward Asp in the concentration range of 8.3 × 10-7 M to 3.3 × 10-4 M with the detection limit of 7.8 × 10-8 M. The application of the sensor in determination of Asp in real human serum sample was also investigated. Based on our library search, the all reported fluorescent sensors for detection of Asp, either show a remarkable sensitivity to Glu acid. Luckily, this is the first presented optical probe able to detect just Asp from the solutions containing various amino acids.

Effects of vitamin D supplementation on metabolic parameters, serum irisin and obesity values in women with subclinical hypothyroidism: a double-blind randomized controlled trial.

Purpose: Subclinical hypothyroidism is an early, mild form of hypothyroidism that may progress to overt hypothyroidism if untreated. The current study aimed to assess the effects of vitamin D supplementation on hormonal (thyroid stimulating hormone [TSH], triiodothyronine, thyroxine, and free thyroxine) parameters, lipid profiles, serum irisin, and obesity indices in women with subclinical hypothyroidism. Methods: The present randomized, double-blind, placebo-controlled clinical trial was carried out on 44 women with subclinical hypothyroidism. The participants were allocated to two groups (22 patients in each group) that received vitamin D (50,000 IU/week) or placebo for 12 weeks. Fasting blood samples, anthropometric and body composition measurements, physical activity levels, and dietary intakes were collected at baseline and at the end of the study. Results: Vitamin D supplementation significantly decreased TSH, total cholesterol, and fat mass percentage, and significantly increased serum vitamin D and irisin levels and fat-free mass percentage compared to the control group (all, p<0.05). Changes in thyroid hormones, other lipid profiles, and anthropometric indices were not significantly different between the groups. Conclusion: Our study indicates that vitamin D administration improves serum TSH, total cholesterol, irisin, and body composition in women with subclinical hypothyroidism. More well-designed clinical trials are required to confirm these findings and clarify the effects of vitamin D supplementation on both genders of patients.Clinical trial registration: https://www.irct.ir/trial/57482, Identifier IRCT20100408003664N25.

Bilateral Keratomalacia From Vitamin A Deficiency in Pancreatic Insufficiency.

While vitamin A deficiency is a leading cause of blindness globally, it is uncommon in the developed world. Here we describe the unique presentation of a young man in the United States with keratomalacia from vitamin A deficiency related to pancreatic insufficiency. The patient presented with bilateral blurry vision that persisted for two weeks, significant unintentional weight loss, orthostatic hypotension, and profuse diarrhea. Upon slit-lamp examination, bilateral corneal opacities were appreciated. After completing additional testing, it became clear that the patient's corneal opacities were related to vitamin A deficiency from pancreatic insufficiency.

Lupus-Induced Myopic Shift.

While ophthalmic manifestations of lupus are common, a myopic shift is a rare manifestation of systemic lupus erythematosus (SLE). An acute myopic shift is defined as a progressive worsening of nearsighted vision within a short time frame. Here, we describe the unique presentation of a young woman with a lupus-induced acute myopic shift. The patient presented with blurry vision and bleeding gums with a previous abnormal lymph node biopsy to rule out ocular lymphoma or leukemia. Her baseline prescription prior to coming in was -4.0D in both eyes. Upon exam, she presented with vision worsening: -7.0D in the right eye and -8.2D in the left eye. After completing blood laboratory tests, it became clear that she had pancytopenia, kidney damage, and elevated inflammatory markers pointing towards lupus. A diagnosis of acute binocular myopic shift induced by systemic lupus erythematosus was made.

FRET probe for selective and sensitive detection of vitamin A by cadmium free quantum dots (ZnS).

Vitamin A as a powerful antioxidant plays an important role in human body functions including bone remodeling regulation, healthy immune system and cell growth reproduction. An accurate determination of vitamin A is taken into consideration because of its importance for human health. In this paper, we reported a fluorescence resonance energy transfer (FRET) probe, MPS-capped ZnS QDs, for sensitive and selective detection of vitamin A. The colloidal MPS-capped ZnS QDs were prepared from Zinc acetate and sodium sulfide by employing 3-mercaptopropyltrimethoxysilane (MPS) molecules as the stabilizer or capping agent at the pH condition of 10. The synthesized MPS-capped ZnS QDs were characterized by means of FT-IR, UV-Vis, DLS, and TEM techniques. The sensing behavior of MPS-capped ZnS QDs for selective and sensitive detection of vitamin A, vitamin B2, vitamin B6, vitamin E, vitamin K, vitamin H, vitamin D3 and vitamin C was investigated using fluorescence spectroscopy. The detection mechanism involves photoinduced charge transfer from the surface of ZnS QDs to Vitamin resulting in the fluorescence quenching of ZnS QDs followed by nonradiative fluorescence resonance energy transfer. An excellent selectivity was observed for vitamin A versus other tested species. A linear relationship was observed between the fluorescence intensity of MPS-capped ZnS QDs and the concentration of vitamin A in the range of 3.33-36.66 µM with detection limit of 1.062 µM.

Inter- and intra-examiner agreement of three classification systems of gingival recession.

Background: Several classifications have been proposed for gingival recession defects. Correct diagnosis of the type of gingival recession is necessary for proper treatment planning and assessment of the prognosis. Considering the existing uncertainty regarding the reliability of different classification systems available for gingival recession and their shortcomings, this study sought to assess the reproducibility and reliability of accuracy of three available classifications (Cairo, Mahajan and Miller's classification systems) for gingival recession. Methods: This descriptive study was conducted on 32 patients presenting to the Department of Periodontics, who were selected using convenience sampling. The screening process entailed two sessions and those with a minimum of one site of gingival recession disclosing the cementoenamel junction (CEJ) of the tooth with no adjacent tooth loss at the site of recession were enrolled. Each patient was separately evaluated by three calibrated examiners twice with a minimum of one-week interval. Grading of the gingival recession defects was determined using the Cairo, Mahajan and Miller's classification systems for gingival recession. The gradings of each examiner were separately recorded by a blinded examiner. A total of 120 single recession defects were examined and data were analyzed using intra-class correlation coefficient (ICC) and Spearman's test. Level of agreement was evaluated according to Landis and Koch. Results: The results showed that the reliability of all the three methods was almost perfect (P<0.05), and no significant difference was noted in reliability of the Cairo, Mahajan and Miller's classifications for gingival recession (P=0.7). Conclusion: Based on the results of the study, the highest intra- and inter-observer agreement in the use of the three classifications belonged to the Cairo classification; however, all the three classifications showed high reliability.

Association between vitamin D and urinary tract infection in children.

PURPOSE: The present study aimed to determine the relationship between serum 25-hydroxyvitamin D (25(OH)D) level and Urinary tract infections (UTIs) in children. METHODS: In this case-control study, 70 children with UTI (case group) were compared with 70 healthy children (control group) in terms of serum 25(OH)D levels. The children were between 1 month and 12 years of age. Serum 25(OH)D levels were measured using enzyme-linked immunosorbent assay (ELISA). The results were analyzed and compared between both groups. RESULTS: Among 70 children with UTI (case group), 5 children (7.2%) were male and 65 (92.8%) were female. Among the healthy children (control group), 9 (12.8%) and 61 children (87.2%) were male and female, respectively (P=0.39). The mean±standard deviation of age in the case and control groups were 53.2±35.6 and 36.1±60.2 months, respectively (P=0.24). The mean level of serum 25(OH)D in the case group was significantly higher than that of the control group (20.4±8.6 ng/mL vs. 16.9±7.4 ng/mL, P=0.01). CONCLUSION: This study showed that there was a relationship between serum 25(OH)D levels and UTI in children. It seems that 25(OH)D plays a role in the pathogenesis of UTI.

Cross-tolerance between antinociception induced by swim-stress and morphine in formalin test.

The present study investigated cross-tolerance between antinociception induced by water swim-stress and morphine in the formalin test. Intraperitoneal administration of morphine (3, 6 and 9 mg/kg) induced dose-dependent antinociception in both phases of the formalin test. Mice treated with a lower dose of morphine (25 mg/kg), once daily for 3 days, showed tolerance to antinociception induced by a lower test dose of morphine (3 mg/kg). Similar repeated treatments with a higher dose of morphine (50 mg/kg) produced tolerance to antinociception induced by different test doses of morphine (3, 6 and 9 mg/kg). Exposure to water swim-stress, once daily for 2 or 3 days in order to induce tolerance, also decreased morphine-induced antinociception. Swim-stress exposure for 2 or 3 days also tends to potentiate tolerance induced by a lower dose of morphine. Acute swim-stress of different durations (0.5, 1 and 3 min) induced antinociception in both phases of the formalin test, which was not reduced by naloxone, but showed even more antinociception in the second phase. The response to swim stress was decreased in mice treated with higher doses of morphine, but not those animals that received swimming stress (3 min) once daily for 2-3 days, in order to induce habituation to swim-stress-induced antinociception. The results may indicate a possible cross-tolerance between antinociception induced by morphine and by swim stress.