Low-intensity/high-density subthreshold microPulse diode laser for chronic central serous chorioretinopathy.

PURPOSE: To evaluate the visual outcomes and macular thickness change in patients with symptomatic chronic central serous chorioretinopathy after treatment with a subthreshold MicroPulse diode laser. METHODS: In this retrospective, interventional case series, 10 patients were treated with the subthreshold 810-nm diode MicroPulse laser. Selected patients had symptomatic disease that may or may not have involved the foveal center. The MicroPulse laser was applied to the areas of leakage seen on fluorescein angiogram, over the areas of clinical neurosensory detachment, and/or pigment epithelial detachments. Pretreatment and posttreatment vision, change in maximum macular thickness, number of treatment sessions, and number of laser spot applications were recorded. Patients were excluded if they did not attend follow-up, had other confounding macular diseases, were using steroid medications, or application of another treatment modality had been used (i.e., photodynamic therapy or anti-vascular endothelial growth factor medication). RESULTS: Ten patients met the inclusion criteria, with 1 patient treated in both eyes. Three patients were excluded for lack of follow-up, one for the use of systemic steroids, and one for treatment with anti-vascular endothelial growth factor injection. Maximum macular thickness decreased after subthreshold MicroPulse laser treatment between 20 µm and 338 µm (mean = 97 µm decrease, P = 0.0046) in 11 treated eyes. CONCLUSION: Subthreshold diode MicroPulse laser is a potential treatment option for patients with symptomatic chronic central serous chorioretinopathy.

A Complicated Clinical Course of Community-Acquired Staphylococcus aureus Infective Endocarditis.

Infective endocarditis (IE) is an infection of the heart's endocardial surface, heart valves, or implanted cardiac devices, with the most common causative organism being Staphylococcus aureus. The clinical presentation of IE can be variable, with some patients presenting with multisystemic complications, including renal, pulmonary, cutaneous, and neurologic complications. Cerebral infarction is the most common complication of IE. Here we present a case of a young male with S. aureus IE of a native cardiac valve who developed multiple complications during his clinical course.

Entropic analysis of cilia-modulated slip flow of trimetallic nanofluid through electroosmotic corrugated pump in the presence of inclined magnetic field.

An incredible eradication of thermal indulgence is required to enhance the flow and heat transfer enhancement in micro/nanofluidic devices. In addition, the rapid transport and instantaneous mixing of colloidal suspensions of metallic particles at nanoscale are exceptionally crucial at ascendency of inertial and surface forces. To address these challenges, the present work is intended to investigate the role of trimetallic nanofluid comprising of three kinds of nano-sized granules (titanium oxide, Silica and Aluminium dioxide) with pure blood through a heated micropump in the presence of inclined magnetic field and axially implemented electric field. To ensure rapid mixing in unidirectional flow, the pump internal surface is lined-up with mimetic motile cilia with slip boundary. The embedded cilia whip in pattern due to dynein molecular motion controlled by time and produce a set of metachronal waves along the pump wall. The shooting technique is executed to compute the numerical solution. In a comparative glance it is revealed that the trimetallic nanofluid exhibits 10% higher heat transfer efficiency as compared to bi-hybrid and mono nanofluids. Moreover, the involvement of electroosmosis results in almost 17% decrease in the heat transfer rate if it values jumps from 1 to 5. The fluid temperature in case of trimetallic nanofluid is higher and thus keeps the heat transfer entropy and the total entropy lower. Furthermore, involvement of thermal radiated and momentum slip significantly contribute in reducing heat losses.

UNILATERAL ACUTE IDIOPATHIC MACULOPATHY IN A PATIENT WITH HAND-FOOT-MOUTH DISEASE: A CASE REPORT.

PURPOSE: To demonstrate a rare cause of acute, focal chorioretinitis. METHODS: Review of slit-lamp fundoscopy, color fundus photography, spectral-domain optical coherence tomography, and fluorescein angiography. RESULTS: Slit-lamp examination revealed parafoveal microaneurysms, parafoveal intraretinal hemorrhages, and outer segment irregularity in the left eye. Fundus photographs demonstrated retinal hemorrhages and a greyish-whitish sheen in the central parafoveal area. Optical coherence tomography was notable for a small pocket of outer segment and retinal pigment epithelium disruption and irregularity in the central foveal area of the left eye. Fluorescein angiography revealed increased focal macular leakage within a larger central area of leakage and staining. CONCLUSION: Unilateral acute idiopathic maculopathy and, specifically, coxsackievirus-related chorioretinitis should be considered in the differential diagnosis of atypical maculopathy.

Bezold's abscess: A rare complication of suppurative mastoiditis.

Bezold's abscess is a suppurative complication of mastoiditis rarely seen in the current era of antimicrobials. It can lead to seriously sequelae if not diagnosed and treated early. We describe a patient with recurrent bilateral otalgia who had received multiple courses of antimicrobials who presented with severe headache, neck pain and right sided hearing loss. Imaging studies showed chronic mastoiditis and formation of a Bezold's abscess. Drainage was performed but symptoms persisted. Our report highlights the need for further evaluation of patients presenting with complicated mastoiditis and the need for prolonged antimicrobial therapy.

HELLP syndrome: an atypical presentation.

HELLP syndrome without proteinuria or hypertension is rare. We present the case of a 33-year-old primigravid who initially was diagnosed with pulmonary embolism. The patient was readmitted with a diagnosis of subcapsular hematoma and eventually diagnosed with HELLP syndrome with a sequela of hepatic rupture.

Lash ptosis in congenital and acquired blepharoptosis.

OBJECTIVE: To determine the prevalence of lash ptosis (LP) in eyes with congenital and acquired blepharoptosis. METHODS: We retrospectively graded photographs of 228 eyes from 174 patients with congenital or acquired blepharoptosis for LP. We used a 4-point rating scale for LP, in which 0 indicates no LP; 1, minimal; 2, moderate; and 3, severe. A prospective evaluation of LP in 30 eyes from 15 patients without blepharoptosis (control eyes) was also performed. RESULTS: A total of 107 eyes (in 87 patients) demonstrated congenital blepharoptosis and 121 eyes (in 87 patients) had acquired blepharoptosis. A moderate to severe rating of LP (rating, >/= 2) occurred in 60.7% of eyes with congenital blepharoptosis, 28.9% of eyes with acquired blepharoptosis, and 6.7% of control eyes. Lash ptosis (rating, >/= 1) was present in 91.6% of eyes with congenital blepharoptosis, 83.5% of eyes with acquired blepharoptosis, and 33.3% of control eyes. The mean LP rating was 2.1 for eyes with congenital blepharoptosis, 1.3 for eyes with acquired blepharoptosis, and 0.6 for control eyes. CONCLUSIONS: Lash ptosis was common in the patients with blepharoptosis. Moderate to severe LP occurred more commonly in all forms of blepharoptosis compared with normal eyes, with more frequent and more severe LP demonstrated in eyes with congenital blepharoptosis.

Mirror syndrome: a novel approach to therapy with fetal peritoneal-amniotic shunt.

BACKGROUND: Mirror syndrome is a rare entity characterized by maternal disease mimicking fetal hydrops. In mirror syndrome, there is maternal hypertension, edema, and often proteinuria in association with fetal hydrops. The causal link between mirror syndrome and hydrops fetalis remains elusive. CASE: This is a case report of a pregnant woman who developed mirror syndrome associated with fetal hydrops. A fetal pelvic mass resulted in bladder outlet obstruction, subsequent bladder rupture, and massive urinary ascites. The resultant massive ascites caused thoracic and cardiac compression and subsequent hydrops fetalis. Placement of a peritoneal-amniotic shunt resolved the fetal hydrops and maternal mirror syndrome. CONCLUSION: In utero treatment of hydropic fetus can result in the cure of maternal mirror syndrome.

Stability of RNA from the retina and retinal pigment epithelium in a porcine model simulating human eye bank conditions.

PURPOSE: To assess RNA stability after death in a porcine model to simulate current human eye bank techniques. METHODS: Eye bank time interval data were collected from 191 donor specimens: death to refrigeration, enucleation, and tissue processing. A control porcine eye was enucleated, retina and RPE isolated, and specimens frozen (-80 degrees C). Fourteen porcine eyes remained at room temperature for 2 hours and then cooled to 4 degrees C. Retina and RPE were isolated and frozen (-80 degrees C) at 5, 12, 24, 29, 36, 48, and 72 hours. Four globes remained in a moist chamber, five whole and five sectioned globes were immersed in RNAlater (Ambion, Austin, TX) at 5, 12, 24, or 48 hours. RNA was isolated. The 28S and 18S rRNA peaks were analyzed by electrophoresis. RT-PCR was performed on each sample. Messenger RNA for GAPDH, beta-actin, mouse rhodopsin from retina (mRHO), and RPE-65 (from RPE) were analyzed with gel electrophoresis. RESULTS: The average time from death to refrigeration was 4.2 hours, to enucleation 6.4 hours, and to tissue processing 10.7 hours. RT-PCR gel electrophoresis patterns from retinal tissue had bands of similar intensity at each interval from beta-actin, GAPDH, and RHO. Band patterns from RPE demonstrated decay of the RT-PCR gene products after 5 hours. This decay was delayed by at least 24 hours with the use of RNAlater. The 28S rRNA decay was similar for retina and RPE. CONCLUSIONS: Retinal tissue RNA can be analyzed within the time constraints of current eye bank tissue processing, whereas analysis of RPE necessitates either rapid processing or use of RNAlater. These results should aid in future studies in which eye bank tissue is used for RNA analysis.

Acute Retinal Necrosis with Multiple Viral Infections: A Case Report.

A 52-year-old male presented with acute retinal necrosis in his left eye. Slit lamp examination revealed stellate keratic precipitates and cells in the anterior chamber and vitreous. Funduscopy of his left eye revealed multiple yellow deposits. Pathological examination of the vitreous showed both small, reactive lymphocytes and a few macrophages. IL-6 and IFN-γ were elevated in the vitreous. Microdissected macrophages from the vitreous revealed DNAs from multiple viruses. The patient responded to oral valacyclovir. We conclude that multiple viral infections can be involved in the pathogenesis of acute retinal necrosis and that adequate anti-viral therapy has a beneficial effect on disease progression. However, retinal detachment can be a consequence for a poor visual outcome.

Her2+ and b-HCG Producing Undifferentiated Gastric Adenocarcinoma.

A 25-year-old Hispanic female with a history of anemia, schizoaffective disorder, and psychosis was admitted for anemia associated with fatigue, weakness, shortness of breath, night sweats, weight loss, and abdominal and lower back pain for the past two months. On routine management, she was found to have a positive serum b-HCG of 80.4 (0-5 mIU/mL) but the patient denied any sexual activity in her life. During her admission, U/S of the pelvis was noncontributory. CT angiogram of the chest was significant for prominent mediastinal and hilar lymph nodes, diffusely thickened stomach suggesting gastric malignancy with multiple hypoenhancing lesions in the liver and diffuse lytic lesions in the spine and sacrum suspicious for metastatic disease. The MRI of the abdomen confirmed the CT angiogram findings. After these findings, EGD was performed which showed lesions in the antrum, body of the stomach, fundus, and cardia on the lesser curvature of the stomach body correlating with carcinoma. The biopsy was positive for Her2, b-HCG producing poorly differentiated gastric adenocarcinoma. Patient underwent one successful round of chemotherapy with Taxotene, Cisplatin, and 5-FU for Stage IV gastric adenocarcinoma.

Lymphoplasmacytic lymphoma isolated to an extraocular muscle.

A 44-year-old woman presented with a 1-month history of right-sided tearing, redness, and chronic headache. Clinical examination was notable for 4-mm proptosis and decreased visual acuity OD. Orbital CT demonstrated isolated enlargement of the right lateral rectus. Surgical biopsy was undertaken after an unsuccessful trial of oral steroids. Histopathology and immunophenotyping demonstrated a lymphoplasmacytic lymphoma. External beam radiation induced regression of the lymphoma with decreased proptosis and improved visual acuity.