Interferon is an immunomodulating cytokine used to treat patients with different diseases, such as hepatitis C chronic infection. Pegylated interferon is a new type of interferon, developed to increase the half-life of the drug. Many side effects have been related to its use, including ocular toxicity and retinopathy. The most reported ocular findings are cotton-wool spots and hemorrhages located at the posterior pole and surrounding optic nerve head. We describe one case of pegylated interferon-associated retinopathy with visual loss. The patient had visual acuity improvement four weeks after discontinuation of the medication and the ocular findings became much more subtle.
Presumed toxocara larvae must be included as a potential cause of different inflammatory diseases as a result of its migration through the retinal layers.
Warfarin is a narrow therapeutic range medication with numerous potential factors affecting its' metabolism with consequent fluctuation of the International Normalized Ratio (INR) outside of the therapeutic range. Identifying factors that can be managed by the patient to aid in stabilization of the INR is a key goal of anticoagulation management. In patients who report stable medication usage (both prescription and over-the-counter), dietary intake of vitamin K rich foods, alcohol intake, and stable use of vitamin and herbal preparation supplementation, but who continue to have unstable INRs, the use of vitamin K supplementation has been shown to afford some stabilization of INRs. In each of our practices, from three different settings (a university hospital, a large health maintenance organization and a small rural hospital anticoagulation management service), dietary grade vitamin K supplementation, in doses ranging from 100 to 300 micrograms daily, has been instituted in a small cohort of patients in an effort to achieve INR stabilization. Each patient is on chronic anticoagulation with warfarin and other possibilities of INR fluctuations (co-morbidities, medication changes, compliance, dietary changes, and alcohol ingestion) have been explored as possible contributing factors for unstable INRs. Upon initiation of dietary vitamin K, improvement in INR stabilization did not occur in most cases. Increases in warfarin dose requirements occurred in most cases. Further studies in the use of dietary vitamin K to aid in INR stabilization are required before such adjunct therapy can be broadly recommended.
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