Graves’ Ophthalmopathy Misdiagnosed as Relapsing Conjunctivitis

A 59-year-old female patient presented at the outpatients’ Department of Ophthalmology with epiphora, eyelid swelling, and a foreign body feeling in the right eye. The symptoms were present for 4 months, and the patient was treated as suffering from relapsing conjunctivitis. The slit lamp examination revealed keratitis due to exposure, related with the deficient closure of the eyelids. There was a 2 mm difference in the readings with the Hertel exophthalmometry examination between the eyes. Her medical history was clear, and she was referred for computed tomography of the orbits and brain and biochemical examinations (FT3, FT4, and TSH) to investigate the presence of an intraorbital mass. FT3 was significantly increased and TSH was accordingly low, indicating the diagnosis of Graves’ disease, which presented without other signs and symptoms apart from ophthalmopathy. Computed tomography scan excluded the diagnosis of an intraorbital mass. Therefore, it is important not to underestimate the ocular manifestations of systemic diseases

Vitamin K Deficiency and Vascular Calcification. Is There Any Evidence about Its Impact on Coronary Artery Disease?

Nowadays cardiovascular disease remain globally the leading cause of mortality. Coronary artery disease is the predominant clinical entity related to fatal cardiovascular events, while its development is mostly associated with progressive atherosclerosis of the vessels combined with gradual vascular calcification. It is well described and understood that vascular calcification is strongly associated with the occurrence of CVD and increased mortality rates. Therefore, it is essential to understand the metabolic pathways leading to its formation in order to develop effective therapies. A group of vitamin-k dependent proteins seems to play a significant role on the prevention of the arterial wall. Several past studies have shown that in cases of vitamin-k deficiency the process of vessel calcification is accelerated. Vitamin-k depletion and high levels of uncarboxylated and dephosphorylated forms of the aforementioned proteins are considered as important factors that contribute significantly to this rapid progression. Promising studies are giving the stimulus for further research in the field of vitamin-k supplementation and the suspension of vascular calcification

Episcleritis Related to Drug-Induced Lupus Erythematosus following Infliximab Therapy: A Case Report

Drug-induced lupus erythematosus is defined as a lupus-like syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Herein, we describe a patient with distinct clinical manifestations of anti-TNF-associated DILE related to infliximab therapy. The patient exhibited clinical and laboratory findings of lupus-like illnesses as well as ocular disorders, such as episcleritis. The main message is that the symptoms of DILE should not be overlooked, although sometimes other systematic conditions may underlie them. As a result, it is very important for the clinicians to evaluate the symptoms of DILE and manage appropriately these cases

Study of oxidative stress in patients with diabetes mellitus type II and chronic obstructive pulmonary disease

The aim of our study was to indicate the quantitative differences of oxidative burden between a patient with stage I COPD and a patient with stage I COPD and DM II. As biomarkers of oxidative stress we used serum malonic dialdehyde (serum MDA) and serum carbonylated proteins (serum CP), registering lipid peroxidation and protein carbonylation. 158 people were studied. 32 didn’t suffer from any disease, 34 suffered from stage I COPD and 92 suffered from stage I COPD and DM II. The patients with diabetes mellitus were separated at first in three groups, according to the level of their HbA1c. The first group (30 patients) included diabetics with HbA1c lesser than 7%, the second group (31 patients) diabetics with HbA1c between 7% and 8% and the third group (31 patients) the diabetic patients with HbA1c higher than 8%. After registering the levels of s-MDA and s-CP of all the patients who were studied, we analyzed the results via the statistical method SPSS. This analysis demonstrated statistically significant differences at the levels of both oxidative stress biomarkers between patients with COPD and DM II (the highest levels of s-MDA and s-CP), patients with just COPD (lower levels than the previous group but higher than those without disease) and people with no disease (the lowest levels of s-MDA and s-CP of our study). As far as the 92 diabetic patients are concerned, we saw that those who had HbA1c>8% showed statistically significant increase of s-MDA and s-CP levels in comparison with the diabetics who had HbA1c between 7% and 8% and the diabetics who had HbA1c8%. The statistical analysis revealed statistically significant increase at the levels of both oxidative stress biomarkers in the group of HbA1c>8%. Final conclusions: a) A patient with stage I COPD and DM II suffers from more intense oxidative stress in comparison with a stage I COPD patient,. b) The HbA1c level which is considered as the margin of more intense oxidative stress at patients with stage I COPD and DM II is 8%, as indicated from the levels of serum MDA and the levels of serum CP. c) The intensity of oxidative alteration of proteins and lipids is increased simultaneously in both these two cell components as the oxidative burden increases. This conclusion derives from the fact that irrespective of the existing disease (just COPD or COPD and DM II), s-MDA and s-CP levels increase simultaneously according to the co-existence of COPD and DM II in comparison with just COPD, and the rising of HbA1c levels, presenting intensely positive correlation between them.Σκοπός της μελέτης ήταν να καταδείξουμε τις ποσοτικές διαφορές του οξειδωτικού φορτίου ασθενούς με ΧΑΠ σταδίου Ι και ασθενούς με ΧΑΠ σταδίου Ι και ΣΔ ΙΙ. Ως βιοδείκτες χρησιμοποιήσαμε τη μαλονική διαλδεΰδη (MDA) και τις καρβονυλιωμένες πρωτεΐνες ορού (CP), καταγράφοντας τη λιπιδιακή υπεροξείδωση και την πρωτεϊνική καρβονυλίωση. Μελετήθηκαν 158 άνθρωποι. Οι 32 δεν έπασχαν από νόσο, οι 34 έπασχαν από ΧΑΠ σταδίου Ι και οι 92 έπασχαν από ΧΑΠ σταδίου Ι και ΣΔ ΙΙ. Οι ασθενείς με ΣΔ της μελέτης χωρίστηκαν αρχικά σε τρεις υποομάδες, ανάλογα με την τιμή της γλυκοζυλιωμένης αιμοσφαιρίνης τους (HbA1c). Στην πρώτη υποομάδα (30 ασθενείς) ανήκαν οι ασθενείς με διαβήτη και HbA1c κάτω από 7%, στη δεύτερη υποομάδα (31 ασθενείς) οι ασθενείς με διαβήτη και HbA1c μεταξύ 7% και 8% και στην τρίτη υποομάδα (31 ασθενείς) οι ασθενείς με διαβήτη και HbA1c πάνω από 8%. Αφού καταγράφηκαν οι τιμές των s-MDA και s-CP όλων των ανθρώπων που μελετήθηκαν, έγινε στατιστική ανάλυση των αποτελεσμάτων με τη μέθοδο SPSS. Η ανάλυση αυτή κατέδειξε στατιστικά σημαντικές διαφορές των τιμών και των δύο βιοδεικτών οξειδωτικής καταπόνησης ανάμεσα στους ασθενείς με ΧΑΠ και ΣΔ ΙΙ (οι υψηλότερες τιμές s-MDA και s-CP), στους ασθενείς με ΧΑΠ (μικρότερες τιμές απ’ την προηγούμενη ομάδα αλλά μεγαλύτερες απ’ τα άτομα χωρίς νόσο) και στα άτομα χωρίς νόσο (οι χαμηλότερες τιμές s-MDA και s-CP της μελέτης). Σ’ ότι αφορά τους 92 ασθενείς με διαβήτη που μελετήθηκαν, διαπιστώθηκε ότι όσοι είχαν HbA1c>8%, εμφάνιζαν στατιστικά σημαντική αύξηση των τιμών των s-MDA και s-CP σε σχέση με τους ασθενείς με διαβήτη που είχαν HbA1c μεταξύ 7% και 8% και με τους ασθενείς με διαβήτη που είχαν HbA1c8%. Η στατιστική ανάλυση έδειξε στατιστικά σημαντική αύξηση των τιμών και των δύο βιοδεικτών οξειδωτικής καταπόνησης στην ομάδα της HbA1c>8%. Τελικά συμπεράσματα: α) Ένας ασθενής με ΧΑΠ σταδίου Ι και ΣΔ τύπου ΙΙ εμφανίζει εντονότερη οξειδωτική καταπόνηση συγκριτικά με έναν ασθενή με ΧΑΠ σταδίου Ι. β) Η τιμή της HbA1c που θεωρείται ως όριο εντονότερης οξειδωτικής καταπόνησης σε ασθενείς με ΣΔ τύπου ΙΙ και συνυπάρχουσα ΧΑΠ σταδίου Ι είναι το 8%, όπως καταδεικνύεται από την καταγραφή δύο βιοδεικτών οξειδωτικής καταπόνησης: μαλονική διαλδεΰδη και καρβονυλιωμένες πρωτεΐνες ορού. γ) Η ένταση της πρόκλησης οξειδωτικής διαταραχής στις πρωτεΐνες και στα λιπίδια του οργανισμού, αυξάνεται συγχρόνως και στα δύο αυτά δομικά συστατικά του κυττάρου, αυξανόμενου του οξειδωτικού φορτίου. Αυτό προκύπτει απ’ το ότι ανεξάρτητα απ’ το χαρακτήρα της νόσου που υπάρχει (μόνο ΧΑΠ ή ΧΑΠ και ΣΔ ΙΙ), οι τιμές της s-MDA και των s-CP αυξάνονται ταυτόχρονα αναλογικά με την συνύπαρξη ΧΑΠ και ΣΔ ΙΙ, σε σύγκριση με την ύπαρξη μόνο ΧΑΠ, και με την επιδείνωση των τιμών της ΗbA1c, παρουσιάζοντας έντονα θετική συσχέτιση μεταξύ τους

Hypopyon in the context of tuberculous uveitis

An 86-year-old man presented with blurred vision and pain in the left eye. A slitlamp examination revealed anterior uveitis with hypopyon. During the investigation of the uveitis, the diagnosis of tuberculosis was confirmed. Hypopyon is a rare manifestation of uveitis due to tuberculosis. © 2012 The Authors. Clinical and Experimental Optometry © 2012 Optometrists Association Australia

Rhabdomyolysis Induced by Coadministration of Fusidic Acid and Atorvastatin: A Case Report and Comprehensive Review of the Literature

Statins are among the most widely prescribed medications worldwide. Acute rhabdomyolysis constitutes a potentially life-threatening side effect regardless of whether statins are administered alone or in combination. The potentially fatal combination of a statin and fusidic acid has been well described in the literature. Acute renal failure can be a direct consequence of this drug-drug interaction. We present a case of a 79-year-old woman who presented to our Emergency Department with a one-week history of limb weakness, myalgia, and inability to stand and walk. The patient had been given fusidic acid to treat Methicillin-Sensitive Staphylococcus Aureus (MSSA) positive dermatitis in the 3 weeks prior to admission, while she continued to take her complete therapeutic regimen, which included atorvastatin. Thus, she developed rhabdomyolysis due to the interaction between fusidic acid and atorvastatin. Herein, we report a life-threatening complication of coadministration of fusidic acid and a statin, which is preventable and predictable. The exact mechanism of the interaction is not fully understood, but coadministration of these two medications must be avoided in clinical practice