Methanol Induced Optic Neuropathy: Molecular Mysteries, Public Health Perspective, Clinical Insights and Treatment Strategies.

Methanol-induced optic neuropathy (MION) represents a critical public health issue, particularly prevalent in lower socioeconomic populations and regions with restricted alcohol access. MION, characterized by irreversible visual impairment, arises from the toxic metabolization of methanol into formaldehyde and formic acid, leading to mitochondrial oxidative phosphorylation inhibition, oxidative stress, and subsequent neurotoxicity. The pathogenesis involves axonal and glial cell degeneration within the optic nerve and potential retinal damage. Despite advancements in therapeutic interventions, a significant proportion of affected individuals endure persistent visual sequelae. The study comprehensively investigates the pathophysiology of MION, encompassing the absorption and metabolism of methanol, subsequent systemic effects, and ocular impacts. Histopathological changes, including alterations in retinal layers and proteins, Müller cell dysfunction, and visual symptoms, are meticulously examined to provide insights into the disease mechanism. Furthermore, preventive measures and public health perspectives are discussed to highlight the importance of awareness and intervention strategies. Therapeutic approaches, such as decontamination procedures, ethanol and fomepizole administration, hemodialysis, intravenous fluids, electrolyte balance management, nutritional therapy, corticosteroid therapy, and erythropoietin (EPO) treatment, are evaluated for their efficacy in managing MION. This comprehensive review underscores the need for increased awareness, improved diagnostic strategies, and more effective treatments to mitigate the impact of MION on global health.

Uveal metastasis arising from thyroid neoplasms: A case study synthesis.

PURPOSE: We systematically reviewed the case report literature to identify cases of uveal metastases originating from thyroid cancer (TC), evaluate factors and indications in uveal metastases from TC, and provide clinical insights through recent case studies. METHODS: Web of Science, Medline, and Scopus databases were searched for case reports or series reporting uveal metastasis from a thyroid neoplasm. Articles published in any language from inception through November 2022 were searched and screened independently by two reviewers. The quality of the included studies was assessed using the JBI Critical Appraisal Checklist for Case Reports. RESULTS: A total of 1049 records were screened, resulting in the identification of 46 cases from 43 studies. The mean (SD) age at uveal metastases diagnosis was 58.44 (±17.99) years with the median (interquartile range) of 56.5 (29.75) (range, 20-83 years), with 34.8% of cases (16/46) cases reported in elderly patients (>64 years). The sample consisted of 56.5% (26/46) male patients. Uveal metastases were observed in the right eye in 16 cases, the left eye in 19 cases, and both eyes in 11 cases. Choroidal involvement was present in 84.8% of cases (39/46) cases. Papillary carcinoma was the most common thyroid cancer type (34.8%, 16/46), followed by follicular carcinoma (32.6%, 15/46), and medullary carcinoma (21.7%, 10/46). CONCLUSION: Uveal metastases have been observed to appear in metastatic TC, and physicians should approach ocular symptoms cautiously in cases that accompany a neck mass or a history of previous TC.

Could admission level of uric acid predict total diuretic dose in acute heart failure?

BACKGROUND: Recent studies have shown that increases in serum UA levels are associated with adverse clinical outcomes in patients with chronic heart failure (CHF); the aim of this study was to determine the relationship between serum uric acid and total diuretic dose received during hospitalization in hospitalized patients with acute exacerbation of heart failure. The main purpose of this study is to determine the role of uric acid as a biomarker that can be a substitute for pro-BNP in clinical evaluation and the need for diuretics in hospitalized patients with acute heart failure. METHODS: After approving the plan in the Research Council of the Heart Department and obtaining an ethical code from the Regional Committee on Research Ethics (Human Subjects Studies), the researcher referred to the archives of our center, the case of 100 patients diagnosed with acute heart failure. Cardiac patients were selected, and the information required for the study was collected using a pre-prepared data collection form, and the information was entered into SPSS software after categorization and appropriate analysis and statistical tests were performed on it. Were performed and in all statistical tests the statistical significance level was considered 0.05: RESULTS: 100 patients with acute heart failure were included in this study with a mean age of 63.43 ± 14.78 years. 66% of them were men. The mean dose of furosemide in these patients was 680.92 ± 377.47 mg and the mean serum uric acid level in these patients was 8.55 ± 2.50 mg / dL. In the study of the relationship between the variables, there was a significant relationship between the dose of furosemide received with the serum level of serum uric acid (P = 0.017, r = 0.248 and P = 0.009, r = -0.267, respectively). There is also a significant relationship between serum uric acid level and patient mortality (P = 0.013, r = 0.247). However this relationship lost its significance after multivariate analysis. CONCLUSION: There is a significant relationship between serum uric acid level and diuretic use. However, in-hospital mortality is not related to uric acid levels at admission.

Evaluating macular and optic nerve changes during Ramadan fasting by optical coherence tomography angiography-a prospective before-and-after study.

PURPOSE: During Ramadan, millions of Muslims fast from sunrise to sunset. Fasting influences the hormonal system, sympathetic activity, blood circulation, and metabolic pathways. Because of these changes, we employed optical coherence tomography angiography (OCTA) to investigate the effects of fasting on the macula and optic nerve. METHODS: In this prospective before-and-after study, both eyes of 45 participants were examined. Vascular characteristics of the macula and optic nerve head were evaluated in the morning and evening, once before Ramadan and once on the 20th day of Ramadan. RESULTS: Compared to the non-fasting condition, fasting significantly reduced inner parafoveal retinal thickness in both eyes and total foveal retinal thickness in the left eye in the morning and evening. Fasting in the morning also considerably reduced inner foveal retinal thickness in both eyes and total parafoveal retinal thickness in the right eye. Fasting significantly reduced central choroidal flow (1 mm) in both eyes in the evening (all p-values are < 0.05). In the morning, there were significant increases in the foveal avascular zone (FAZ) area (p-value = 0.006) and deep parafoveal vascular density in the left eye (p-value = 0.001). CONCLUSION: Fasting alters both the macular characteristics and the optic nerve head, as seen in OCTA, although it did not affect participants' vision. However, further research is needed before reaching a broad conclusion.

Muscular and hepatosplenic candidiasis in a patient with acute myeloblastic leukemia: A case report and literature review.

Key Clinical Message: Muscular and subcutaneous candidiasis is a rare entity in immunocompromised patients, but it should be kept in mind when we see multiple cystic soft tissue masses in addition to target-shaped hepatosplenic lesions in neutropenic patients. US and MRI are useful imaging modalities for the diagnosis and follow-up of these patients. Abstract: Soft tissue candidiasis is an opportunistic infection in immunocompromised patients and must always be diagnosed and treated as soon as possible. In this case report, the patient is a 14-year-old boy with acute myeloid leukemia M3-type who presented with numerous soft tissue and hepatosplenic candidal abscesses.

Time course study of optical coherence tomography angiography in patients with methanol induced optic neuropathy.

INTRODUCTION: In countries where alcoholic beverages are legally prohibited, methanol toxicity usually occurs due to ingesting homemade alcoholic drinks. The initial ophthalmologic symptoms of methanol toxicity typically appear 6-48 h after ingestion, and the severity of symptoms varies widely from mild and painless decreased vision to no-light perception vision. METHODS: This prospective study examines 20 patients with acute methanol poisoning within 10 days of use. Patients underwent ocular examinations, BCVA (Best Corrected Visual Acuity) recording, and OCTA (Optical Coherence Tomography Angiography) of the macula and optic disc. BCVA measurement and imaging were repeated one month and three months after intoxication. RESULTS: There was a statistically significant reduction in superficial parafoveal vascular density (P-value = 0.026), inner retinal thickness (P-value = 0.022), RNFL (Retinal Nerve Fiber Layer) thickness (P-value = 0.031), and an increase in cup to disc ratio (P-value < 0.001), and central visual acuity (P-value = 0.002) in this time course. However, there was no statistically significant difference in FAZ (Foveal Avascular Zone) area (P-value = 0.309), FAZ perimeter (P-value = 0.504), FD-300 (Foveal density, vascular density within a 300 µm wide region of the FAZ) (P-value = 0.541), superficial vascular density (P-value = 0.187), deep foveal vascular density (P-value = 0.889), deep parafoveal vascular density (P-value = 0.830), choroidal flow area (P-value = 0.464), total retinal thickness (P-value = 0.597), outer retinal thickness (P-value = 0.067), optic disc whole image vascular density (P-value = 0.146), vascular density inside the disc (P-value = 0.864), or peripapillary vascular density (P-value = 0.680) at different times. CONCLUSION: Over time, methanol poisoning can cause changes in retinal layers thickness, vasculature, and optic nerve head. The most important changes include cupping of the optic nerve head, reduction in RNFL thickness, and inner retinal thickness.