Optociliary shunt vessels in multiple sclerosis.

BACKGROUND/INTRODUCTION: Optociliary shunt vessels develop as a result of chronic retinal venous obstruction. Optic neuritis has never been reported as a causative influence. OBJECTIVE: To determine whether optic neuritis predisposes to the development of optociliary shunts in patients with multiple sclerosis. CASES: This case series follows two patients with multiple sclerosis from August 1st, 2019 to April 24th, 2024, who developed optociliary shunt vessels after attacks of optic neuritis. A 43-year-old female presented with left visual loss and bilateral superior optociliary shunt vessels. Perimetry showed bilateral peripheral visual field loss. Optical coherence tomography showed bilateral retinal thinning and ganglion cell complex loss. Optical coherence tomography angiography showed reduced capillary density bilaterally. We investigated her and eventually diagnosed her with multiple sclerosis. The second, a 49-year-old female, developed right-sided optociliary shunt vessels after an episode of neuroretinitis. Perimetry revealed bilateral central scotomata; optical coherence tomography showed disc and retinal nerve fiber layer edema, and serous retinal detachment; later, ganglion cell complex loss; and reduced capillary density on optical coherence tomography angiography. Neuroimaging revealed demyelination in both, leading to a diagnosis of multiple sclerosis, and therapy was instituted. CONCLUSIONS: We hypothesize, that demyelinating optic neuritis due to multiple sclerosis causes chronic retinal hypoperfusion, leading to subsequent optociliary shunt development in affected eyes. Our case series reveals that eyes with optic neuritis, both previous episodes and fresh cases, can contribute to sufficient retinal vein hypoperfusion to cause the development of optociliary shunts, which should be reported in the literature.

Does optic neuritis in multiple sclerosis cause optociliary shunt vessels? Our case study shows that optociliary shunt vessels have developed in eyes having previous as well as fresh optic neuritis in two multiple sclerosis patients, as demonstrated by examination and investigations. We hypothesize that multiple sclerosis causes decreased retinal perfusion predisposing to the development of optociliary shunts. This will guide neurologists and ophthalmologists in diagnosing this debilitating condition upon the visualization of optociliary shunts; heralding previous or recurrent attacks of optic neuritis. @SanaNadeemS.

Revolutionizing cancer care strategies: immunotherapy, gene therapy, and molecular targeted therapy.

Despite the availability of technological advances in traditional anti-cancer therapies, there is a need for more precise and targeted cancer treatment strategies. The wide-ranging shortfalls of conventional anticancer therapies such as systematic toxicity, compromised life quality, and limited to severe side effects are major areas of concern of conventional cancer treatment approaches. Owing to the expansion of knowledge and technological advancements in the field of cancer biology, more innovative and safe anti-cancerous approaches such as immune therapy, gene therapy and targeted therapy are rapidly evolving with the aim to address the limitations of conventional therapies. The concept of immunotherapy began with the capability of coley toxins to stimulate toll-like receptors of immune cells to provoke an immune response against cancers. With an in-depth understating of the molecular mechanisms of carcinogenesis and their relationship to disease prognosis, molecular targeted therapy approaches, that inhibit or stimulate specific cancer-promoting or cancer-inhibitory molecules respectively, have offered promising outcomes. In this review, we evaluate the achievement and challenges of these technically advanced therapies with the aim of presenting the overall progress and perspective of each approach.

MDM2- an indispensable player in tumorigenesis.

Murine double minute 2 (MDM2) is a well-recognized molecule for its oncogenic potential. Since its identification, various cancer-promoting roles of MDM2 such as growth stimulation, sustained angiogenesis, metabolic reprogramming, apoptosis evasion, metastasis, and immunosuppression have been established. Alterations in the expression levels of MDM2 occur in multiple types of cancers resulting in uncontrolled proliferation. The cellular processes are modulated by MDM2 through transcription, post-translational modifications, protein degradation, binding to cofactors, and subcellular localization. In this review, we discuss the precise role of deregulated MDM2 levels in modulating cellular functions to promote cancer growth. Moreover, we also briefly discuss the role of MDM2 in inducing resistance against anti-cancerous therapies thus limiting the benefits of cancerous treatment.

Unilateral Optic Neuropathy due to a Sphenoid Mucocoele.

Isolated sphenoid sinus mucocoeles are rare; whereas, benign lesions usually discovered incidentally. These may present with headache, diplopia, visual loss or ocular motor nerve palsies, due to slow expansion and mass effects. Prompt endoscopic removal is the key to prevent permanent sequelae. We present the case of a 63-year femele, who presented with sudden loss of vision of the left eye, along with periorbital and retrobulbar pain for the last one month. She was found to have "no light perception" vision in the left eye and optic atrophy. Neuroimaging was performed, which revealed a sphenoid sinus mucocoele, impinging on the left optic nerve. Our ENT Department performed endoscopic sinus surgery and removed it, but her vision did not return at 6-month follow-up. Although very rare, sphenoid sinus mucocoeles should be considered in the differential diagnosis of any patient, who presents with sudden visual loss. Key Words: Sphenoid sinus, Mucocoele, Optic neuropathy, Visual loss.

Evaluation of use of e-Learning in undergraduate radiology education: a review.

PURPOSE: The aim of this review is to investigate the evaluative outcomes present in the literature according to Kirkpatrick's learning model and to examine the nature and characteristics of the e-Learning interventions in radiology education at undergraduate level. MATERIALS AND METHODS: Four databases (PubMed, MEDLINE, Embase, Eric) are searched for publications related to the application of e-Learning in undergraduate radiology education. The search strategy is a combination of e-Learning and Mesh and non Mesh radiology and undergraduate related terms. These search strategies are established in relation to experts of respective domains. The full text of thirty pertinent articles is reviewed. Author's country and study location data is extracted to identify the most active regions and year's are extracted to know the existing trend. Data regarding radiology subfields and undergraduate year of radiology education is extracted along with e-Learning technologies to identify the most prevalent or suitable technologies or tools with respect to radiology contents. Kirkpatricks learning evaluation model is used to categorize the evaluative outcomes reported in the identified studies. RESULTS: The results of this analysis reveal emergence of highly interactive games, audience response systems and designing of wide range of customized tools according to learner needs assessment in radiology education at undergraduate level. All these initiatives are leading toward highly interactive self directed learning environments to support the idea of life-long independent learners. Moreover, majority of the studies in literature regarding e-Learning in radiology at undergraduate level are based on participant satisfaction followed by participant results or outcomes either before or after an intervention or both. There was no research particularly demonstrating performance change in clinical practice or patient outcome as they may be difficult to measure in medical education. Thus clinical competences and performances are highly affected by pretentious learning environments.

Monocular elevation deficiency with associated dextrocardia and situs inversus.

A patient having monocular elevation deficiency with associated dextrocardia and situs inversus is reported. Review of the literature regarding ocular features described in association with dextrocardia is also presented.

Factors associated with breast arterial calcification on mammography.

OBJECTIVE: To determine the frequency of breast arterial calcifications (BAC) as seen on mammographic examination and to determine the association between BAC and hypertension, age, parity and weight of the person. STUDY DESIGN: Cross-sectional analytic study. PLACE AND DURATION OF STUDY: Department of Diagnostic Radiology, Military Hospital, Rawalpindi, from January 2006 to January 2007. METHODOLOGY: Two hundred patients undergoing mammography were studied to evaluate the association of BAC with raised blood pressure, age and parity. Previous history of lactation and the patients' weight were also recorded. Proportions of classes were compared using chi-square test. RESULTS: 13.5% of the subjects (n = 200) were positive for BAC on mammograms. Mean age of the BAC positive subjects was higher than their counterparts found negative for BAC. Women bearing 5 - 6 children showed the highest frequency of BAC. Seventy seven (10.38%) of the BAC positive cases had previous history of lactation, whereas 15.44% (n = 123) had not breast fed their children and showed BAC. No significant association of presence of BAC was noted with the weight of the subjects. CONCLUSION: The frequency of presence of BAC on mammography was associated with systemic hypertension and higher age. It also increased with the reproductive parameters of a woman.