Bilateral Acute Depigmentation of the Iris (BADI) following Covid-19 Infection.

PURPOSE: To present a case of bilateral acute iris depigmentation after covid 19 infection. CASE REPORT: A 55-year-old female presented with binocular pain and blurred vision a month after being diagnosed with severe acute respiratory syndrome - coronavirus-2 (SARS-CoV-2). She presented pigment dispersion in the anterior chamber and pigment depositions on the corneal endothelium. The patient was treated with dexamethasone and during follow-up visits, the pigment dispersion decreased and the symptoms ceased. CONCLUSIONS: Covid-19 infection may be associated with rare ocular disorders such as BADI.

Coriorretinopatía serosa central aguda bilateral tras terapia anticonceptiva de urgencia con acetato de ulipristal / Acute bilateral serous central chorioretinopathy after emergency contraceptive therapy with ulipristal acetate

CASO CLÍNICO: Mujer de 31 años, sin antecedentes de interés, que consulta por diminución de la visión en ambos ojos. Refiere haber consumido un comprimido de acetato de ulipristal 30 mg como anticonceptivo de urgencia 4 días antes de la aparición de los síntomas. A la exploración presenta una mejor agudeza visual corregida de 0,6 en el ojo derecho y de 0,8 en el ojo izquierdo (según test de Snellen) y un desprendimiento seroso macular bilateral. Se decide observación, y a los 15 días presenta una mejoría significativa funcional y anatómica del cuadro. Discusión: El acetato de ulipristal podría desencadenar coriorretinopatía serosa central por su efecto sobre los receptores de progesterona presentes en coroides y epitelio pigmentario de la retina

CASE REPORT The case concerns a 31 year-old woman with no previous history who consulted due to decreased vision in both eyes. She mentioned taking 1 pill of ulipristal acetate (30 mg) as an emergency contraceptive four days before the visual symptoms appeared. In the examination, a better corrected visual acuity of 0.6 was found in the right eye and 0.8 in left eye (by Snellen chart), and bilateral macular serous detachment. It was decided to observe, and 15 days later she showed a functional and anatomical improvement. DISCUSSION: Ulipristal acetate could lead to serous central chorioretinopathy due to its activity on the progesterone receptors present in choroidal and retinal pigment epithelium

Acute bilateral serous central chorioretinopathy after emergency contraceptive therapy with ulipristal acetate. / Coriorretinopatía serosa central aguda bilateral tras terapia anticonceptiva de urgencia con acetato de ulipristal.

CASE REPORT: The case concerns a 31 year-old woman with no previous history who consulted due to decreased vision in both eyes. She mentioned taking 1 pill of ulipristal acetate (30mg) as an emergency contraceptive four days before the visual symptoms appeared. In the examination, a better corrected visual acuity of 0.6 was found in the right eye and 0.8 in left eye (by Snellen chart), and bilateral macular serous detachment. It was decided to observe, and 15 days later she showed a functional and anatomical improvement. DISCUSSION: Ulipristal acetate could lead to serous central chorioretinopathy due to its activity on the progesterone receptors present in choroidal and retinal pigment epithelium.

Clinical characteristics and outcomes of critically ill cancer patients with septic shock.

OBJECTIVE: To evaluate the clinical characteristics and outcomes of critically ill cancer patients with septic shock. DESIGN: Prospective, observational cohort study. METHODS: Medical-surgical intensive care unit (ICU) at the Instituto Nacional de Cancerología located in Mexico City from January 2008 to February 2010. There were no interventions. Eighty-two consecutive cancer patients with septic shock aged over 18 years were prospectively included and evaluated. RESULTS: During the study period, 620 critically ill cancer patients were admitted to ICU. Ninety-four patients were evaluated for septic shock at the request of ward onco-hematologists or surgeon oncologist responsible for the patient. After being evaluated by the intensivists, 82 patients were admitted to the ICU. Of the 82 patients, 56 (68.3%) had solid tumours and 26 (31.7%) had hematological malignancy. The most frequent sites of infection were: abdominal (57.3%) and respiratory (35.8%). Cultures were positive in 41 (50%) patients. The 63.4% of the patients had three or more organ dysfunctions on the day of their admission to the ICU. Cox multivariate analysis identified the Sequential Organ Failure Assessment (SOFA) score [hazard ratio (HR): 1.11; 95% confidence interval (95% CI): 1.02-1.19, P=0.008) and performance status (PS)≥2 (HR: 1.84; 95% CI: 1.03-3.29, P=0.040) as independent predictors of death to 3 months. The ICU mortality rate was 41.5% (95% CI: 31-52%). CONCLUSION: The variables associated with increased mortality were the degree of organ dysfunction determined by SOFA score at ICU admission and PS≥2.

[Limbal relaxing incisions and cataract surgery: our experience]. / Incisiones limbares relajantes y cirugía de la catarata: nuestra experiencia.

PURPOSE: To evaluate the reduction of pre-existing corneal astigmatism at the time of cataract surgery with limbal relaxing incisions (LRIs). METHODS: A prospective study of two groups of patients (treatment and control) with pre-existing astigmatism>or=1D was performed. The 30 patients in the control group had a temporal clear corneal phacoemulsification and the 32 patients of treatment group had combined temporal clear corneal phacoemulsification and LRIs. Holladay analysis was used to assess the efficacy of treatment. An astigmatism distribution and prevalence study in our population is also presented. RESULTS: Three months after surgery, the mean astigmatism change was -0.55D (-0.75 to -0.35) in the treatment group and 0.04D (-0.3 to 0.3) in the control group (p<.0001). CONCLUSIONS: LRI is a simple, safe and effective method not only for reducing pre-existing astigmatism during cataract surgery but in providing good unaided visual acuity.

[Simultaneous botulism in two brothers addicted to cocaine]. / Botulismo simultáneo en dos hermanos cocainómanos.

INTRODUCTION: Botulism is currently an uncommon disease in which the botulinum toxin causes a progressive muscular paralysis that can lead to the death due to a failure of respiratory muscles. CLINICAL CASE: Two brothers, both addicted to cocaine, came to the casualty department because of a decrease of near visual acuity and bilateral mydriasis. Two days later, they developed eyelid ptosis, asymmetric dysfunction of the extraocular muscles and vomiting. DISCUSSION: The presence of a paralysis of accommodation, with bilateral mydriasis that reacts to pilocarpine, makes it necessary to consider botulism as a possible cause.

Incisiones limbares relajantes y cirugía de la catarata: nuestra experiencia / Limbal relaxing incidions and cataract surgery: our experience

Objetivo: Evaluar la reducción del astigmatismo corneal preexistente en la cirugía de catarata mediante incisiones limbares relajantes (ILRs). Método: Estudio prospectivo de dos grupos de pacientes (tratamiento y control) con astigmatismo prequirúrgico ³1D. Los 30 pacientes del grupo control fueron sometidos a facoemulsificación por incisión temporal en córnea clara y los 32 pacientes del grupo tratamiento a ILRs junto a facoemulsificación por incisión temporal en córnea clara. Se usó el test de Holladay para valorar la eficacia del tratamiento. Asimismo, presentamos un pequeño estudio de la prevalencia y distribución del astigmatismo en nuestra población de trabajo. Resultados: El seguimiento promedio de los 62 pacientes fue de 3 meses, con un cambio astigmático medio a los 3 meses de -0.55D (-0,75 a -0,35) en el grupo tratamiento y de 0.04D (-0,3 a 0,3) en el grupo control (p<,000). Conclusiones: Las ILRs son un método sencillo y efectivo para conseguir reducir el astigmatismo previo durante la cirugía de catarata y con ello la dependencia de gafa

Purpose: To evaluate the reduction of pre-existing corneal astigmatism at the time of cataract surgery with limbal relaxing incisions (LRIs). Methods: A prospective study of two groups of patients (treatment and control) with pre-existing astigmatism ³1D was performed. The 30 patients in the control group had a temporal clear corneal phacoemulsification and the 32 patients of treatment group had combined temporal clear corneal phacoemulsification and LRIs. Holladay analysis was used to assess the efficacy of treatment. An astigmatism distribution and prevalence study in our population is also presented. Results: Three months after surgery, the mean astigmatism change was -0.55D (-0.75 to -0.35) in the treatment group and 0.04D (-0.3 to 0.3) in the control group (p<.0001). Conclusions: LRI is a simple, safe and effective method not only for reducing pre-existing astigmatism during cataract surgery but in providing good unaided visual acuity

Botulismo simultáneo en dos hermanos cocainómanos / Simultaneous botulism in two brothers addicted to cocaine

Introducción: El botulismo es poco frecuente en la actualidad. La toxina botulínica produce una parálisis muscular progresiva que puede producir la muerte del paciente por parada de los músculos respiratorios. Caso clínico: Dos pacientes hermanos, adictos a la cocaína, acudieron al Servicio de Urgencias por disminución de la agudeza visual cercana, con midriasis bilateral. A los dos días presentaban, además, ptosis palpebral, disfunción asimétrica de la motilidad ocular extrínseca, y vómito. Discusión: Ante la presencia de una parálisis de la acomodación con una midriasis bilateral que responde a pilocarpina, se debe considerar el botulismo como una posible etiología

Introduction: Botulism is currently an uncommon disease in which the botulinum toxin causes a progressive muscular paralysis that can lead to the death due to a failure of respiratory muscles. Clinical case: Two brothers, both addicted to cocaine, came to the casualty department because of a decrease of near visual acuity and bilateral mydriasis. Two days later, they developed eyelid ptosis, asymmetric dysfunction of the extraocular muscles and vomiting. Discussion: The presence of a paralysis of accommodation, with bilateral mydriasis that reacts to pilocarpine, makes it necessary to consider botulism as a possible cause

Modulation of alpha2beta4 neuronal nicotinic acetylcholine receptors by zinc.

A study was made of the modulation of nicotinic acetylcholine receptors by the divalent cation zinc. Rat neuronal nicotinic receptors (alpha2beta4) were expressed in Xenopus oocytes and membrane currents evoked by acetylcholine (ACh currents) were recorded using a two microelectrode voltage clamp. In non-injected oocytes, or in oocytes expressing alpha2beta4 receptors, Zn2+ by itself (1 microM-4 mM) generated only very small membrane currents. In contrast, in oocytes expressing alpha2beta4 receptors, Zn2+ greatly and reversibly increased the ACh current, without affecting considerably its time course. The ACh current potentiation by Zn2+ was weakly dependent on the membrane potential (2.33+/-0.10 times the control current at -100 mV vs 2.04+/-0.06 at -60 mV, suggesting that Zn2+ interacts with the receptor in the vestibule of the ion channel or at an external domain of the protein. The inward rectification of control and Zn2+-potentiated ACh-currents was similar. We conclude that Zn2+ positively and reversibly modulates neuronal nicotinic receptors in a practically voltage-independent manner and without affecting their rate of desensitization. These results will help to understand better the roles played by Zn2+ in brain functions.