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AIM: To investigate the clinical features and factors of fundus lesions in patients with acquired immunodeficiency syndrome(AIDS)in Shenyang and the relationship between fundus lesions and CD4+T cell count.METHODS: Retrospective case study. A total of 74 cases with AIDS who were treated in the Central Hospital of Liaoning Electric Power Supply Co., Ltd., from January 2021 to December 2021 were selected. The fundus manifestation and CD4+T cell count of the patients were analyzed.RESULTS: The total detection rate of fundus lesions in AIDS patients was 58%. CD4+T cell count in the patients with fundus lesions was significantly lower than that in the patients with normal fundus [29(6, 55)/μL vs. 76(35, 103)/μL, P<0.01]. The rate of fundus lesions was the highest in the patients with CD4+T cell count ≤ 50/μL(74%). Logistic regression analysis showed that as the CD4+T cell count increased, the incidence of fundus lesions decreased(OR=0.977, 95%CI 0.964～0.991, P<0.01).CONCLUSION: Fundus lesions in AIDS patients related to CD4+T cell count. Decreasing CD4+T cell count was a risk factor of fundus lesions for AIDS patients. Routine fundus examination is important for the early diagnosis of fundus lesions in AIDS patients.
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The data related signs of ocular fundus associated with COVID-19 published in this journal collected from December 2022, while the pandemic of COVID-19 was in a clustering occurrence. The signs of ocular fundus including acute macular neuroretinopathy (AMN), cotton wool spots or Purtscher-like retinopathy, central retinal vein occlusion (CRVO) and macular edema of unknown etiology. The different lesions can be concurrent existence in some cases is one of the clinical characteristics of COVID-19, other characteristics including both eye involved, predominated affected more women, aged from 13 to 56 years. AMN was mentioned recently in most papers on COVID-19, it has been known as deep capillary ischemia. Cotton wool spots is sign infarct in superficial capillary. Retina dots indicated retinal infarct in the outer plexiform layer. CRVO was demonstrated that the blood clot blocks the flow of blood at the level of the lamina cribro, optic disc edema with macular subretinal fluid showed the retina tissue as well as optic head affected. Eye is part of the body, lesions of ocular fundus are identical with body system. Several study proposed different hypothesis for these alterations in acute phase of COVID-19: direct viral endothelial injury, activation of the immune response by a cytokine storm leading to a procoagulant state or transient hypercoagulability. Retina lesions demonstrated a vasculature impairment in several layers of retina and edema in retina and optic disk. We should monitor in the acute phase of COVID-19 the prothrombotic markers and the treatment should consider anti-virus and preventing thrombosis formation.
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A 15-year-old female was referred to the hospital with intermittent fever, where multiple systemic abnormalities were found, such as splenomegaly, secondary hypersplenism, retinitis pigmentosa, and ectodermal dysplasia. Medical history revealed that she had suffered recurrent respiratory infections, blurred vision at night, and dysplasia of teeth and nail beds since childhood. Then she was suspected to be experiencing ROSAH syndrome, a rare disease newly recognized in recent years, which was finally confirmed by gene sequencing results. During a course of treatment with tumor necrosis factor inhibitors, recurrent fever with elevated inflammatory markers reappeared, and the child developed headaches. To guide the comprehensive treatment and improve the patient's quality of life, the multidisciplinary team in Peking Union Medical College Hospital discussed together and directed the following treatment.
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Objective To investigate the correlation of homoeysteine (Hcy) and blood glucose level with type 2 diabetic fundus lesions.Methods Sixty patients with type 2 diabetic fundus lesions were selected and grouped as the diabetic fundus lesions group from February of 2011 to October of 2012,and 40 patients with type 2 diabetes were recruited as the diabetes group,40 healthy volunteer were recruited as the control group.Glycosylated hemoglobin Alc(HbAlc),fasting blood glucose(FBG),homocysteine(Hcy) and total cholesterol (TC),triglyceride (TG),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) of the three groupwere measured and compared.Results Compared with the control group,Hcy in the diabetic fundus lesions group and the diabetic group were significantly higher than the control group ((17.6 ± 4.7) μmol/L,(13.3 ± 2.9) μmol/L vs.(7.3 ± 1.8) μmol/L),and as well as HbA1 c ((11.3 ±2.7)％,(9.2±1.4)％ vs.(4.0±1.1)％),FBG ((11.5 ±3.4) μmol/L,(10.1 ±2.1) μmol/Lvs.(4.2 ±1.7) μmol/L)and TC((6.7 ±1.1) mmol/L,(5.1 ±1.0) mmol/L vs.(4.4±0.8) mmol/L) (F=5.091,5.107,6.017,5.813,P =0.043,0.036,0.032,0.040 respectively).The Hcy,TC,TG,FBG and HbAlc of type 2 diabetic fundus lesions with I stage were the lowest,and the stage of type 2 diabetic fundus lesions was relevant with the level of Hcy,TC,TG,FBG and HbAlc,which were different significantly (F =5.418,5.524,4.971,5.713 respectively,P =0.038,0.041,0.042,0.040 respectively).Conclusion The serum Hcy and blood glucose are risk factors to type 2 diabetic nephropathy.Lowering Hcy concentration and reducing the glucose may be a new way to prevent the occurrence of type 2 diabetic nephropathy.