COVID-19 ASSOCIATED REACTIVATION OF HERPES INFECTION WITH THE DEVELOPMENT OF ENCEPHALITIS: A CASE REPORT.

The etiology of meningoencephalitis with COVID19 is coronavirus and herpetic. Secondary herpes infection is associated with immunological dysregulation or with the use of tocilizumab. Differential diagnosis of the etiology of encephalitis is important, because acyclovir is effective for herpes infection. Case Report: A 38-year-old man with right-sided lower lobe pneumonia COVID-19 was hospitalized in the infectious diseases department. On the 6th day of hospitalization, the patient developed respiratory failure and was transferred to the anesthesiology and intensive care unit. We started noninvasive lung ventilation, which was ineffective, and the patient was intubated and started on MVL. MRI data: encephalitis of the frontal, parietal and occipital lobes on the left. On the 14th day, we detected a herpetic rash on the legs and thighs in the projection of the sciatic nerve. We suspected the patient had a herpes infection and prescribed acyclovir 1000 mg intravenously 3 times a day. On the 32nd day, a blood test by IFA revealed class G antibodies to the Viral Capsid Antigen (VCA) of the Epstein-Barr virus. On the 58th day, he was discharged home in a satisfactory condition. Given the extraordinary strain on healthcare systems amid the pandemic, there are challenges in diagnosing herpes infection in patients with COVID-19. The alertness of doctors about the development of herpes infection and its clinical signs is important. This will allow for early antiherpetic treatment.

[Use of YAG-Selecta laser and argon laser in the treatment of open angle glaucoma]. / Zastosowanie lasera YAG-Selecta i lasera argonowego w leczeniu jaskry otwartego kata.

INTRODUCTION: The falling success rate of ALT (Argon Laser Trabeculoplasty) has raised the interest in some new laser techniques, such as q-switched Nd:YAG laser trabeculoplasty (Coherent Selecta 7000). The "selective" laser trabeculoplasty destroys melanosomes of pigmented trabecular meshwork cells, sparing adjacent non-pigmented cells and tissues. AIM: Our goal was to establish the IOP lowering effect of selective laser trabeculoplasty (SLT--Selecta Laser Trabeculoplasty) in comparison with ALT. MATERIAL AND METHODS: We have examined 27 patients (10 men, 17 women) aged 35-82, with open angle glaucoma and visual field deterioration despite maximal tolerated topical therapy (21 patients--POAG, 3--NPG, 1--pigmentary glaucoma, 1--pseudoexfoliative glaucoma, 1--juvenile glaucoma). One eye of each patient was randomly chosen for SLT, the other eye underwent ALT. In each method 50 burns were applied in 180 degrees angle with power settings of 600-1000 mW for ALT and energy settings of 0.5-1.4 mJ for SLT. The IOP was measured 1 hour before laser treatment and 1, 2, 24 hours and 3 months after treatment. RESULTS: The mean initial IOP in eyes selected for SLT was significantly higher (21.26 +/- 4.82 mm Hg) than in eyes selected for ALT (20.26 +/- 4.01 mm Hg), t-test: p = 0.037. However, there was no statistically significant difference in the IOP lowering effect between eyes treated with SLT and eyes treated with ALT. The mean IOP drop from the pre-treatment values was -2.85 +/- 4.62 mm Hg after SLT and -2.63 +/- 3.60 mm Hg after ALT (t-test, p = 0.84). All values: 2, 24-hours and 3 months after treatment were significantly lower than pre-treatment values in both groups (t-test, p < 0.03). Only in the 1st hour after SLT the IOP drop was not significant. There was a significant correlation between the amount of pigment on the trabecular meshwork and the IOP fall (U Mann-Whitney test). In SLT group 6 patients (21%) developed mild iritis during 1st day after laser treatment, which disappeared after fluorometholon drop therapy. CONCLUSION: Both methods--SLT and ALT--have equivalent IOP lowering effect in short time observation (3 months). Due to entirely novel mode of Selecta laser action, long term results may show significant differences.

[Occurrence of nocturnal arterial hypotension in patients with primary open-angle glaucoma and normal tension glaucoma]. / Wystepowanie nocnej hipotonii tetniczej u chorych na jaskre pierwotna otwartego kata i jaskre z normalnym cisnieniem.

PURPOSE: To investigate the nocturnal blood pressure "dip" in patients with primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). MATERIAL AND METHODS: 46 patients (36 women and 10 men), including 15 patients with POAG (mean age 49.6 +/- 6.8), 20 patients with NTG (mean age 54.5 +/- 14.1) and 11 control subjects (mean age 43.4 +/- 16.3), were studied. Arterial systolic and diastolic blood pressure and heart rate were measured with automated blood pressure monitor MEDILOG DX in 15 minutes intervals during the day and 30 minutes intervals at night. RESULTS: 30.4% of all examined patients showed the nocturnal "dip" of less than 10% (non-dippers). In 41.4% of patients the blood pressure fell at night by 10-20% (dippers) and in 28.2% of patients by more than 20% (big dippers). The percentage distribution of patients with POAG, NTG and control subjects in non-dippers group was 35%, 36% and 29%; in dippers group: 21%, 53% and 26%; in big dippers group: 46%, 46% and 8% respectively. The nocturnal "dip" was significantly larger in NTG group (max. systolic dip 28% +/- 2.9%, mean systolic dip 17% +/- 4.3%, alpha = 0.05) in comparison with POAG and control group. CONCLUSIONS: Large blood pressure "dips" are observed more frequently in patients with glaucoma than in healthy control subjects. The degree of reduction in blood pressure is significantly larger in NTG patients in comparison with POAG patients and control group.