No abstract

The coronavirus disease 2019 global pandemic is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Several ophthalmic manifestations have been reported to be associated with SARS-CoV-2 infection, including conjunctivitis, acute sixth nerve palsy, and multiple cranial neuropathies. We present a unique case of unilateral phlyctenular keratoconjunctivitis in a 5-year-old boy in the setting of SARS-CoV-2 infection.

Background. Fungal keratitis is an extremely rare complication of laser vision correction resulting in poor visual outcomes. Amniotic membrane transplantation should be kept in mind in eyes with corneal perforation prior to penetrating keratoplasty. Aim. To assess the outcomes of multilayered fresh amniotic membrane transplantation (MLF-AMT) in patients with severe keratomycosis after laser-assisted in situ keratomileusis (LASIK). Study design. Hospital-based prospective interventional case series. Methods. Five eyes of 5 patients were included in the study. All cases underwent microbiological scrapings from residual bed and intrastromal injections of amphotericin (50 mcg/mL), with flap amputation if needed, followed by topical 5% natamycin and 0.15% amphotericin. MLF-AMT was performed after corneal perforation. Later, penetrating keratoplasty (PK) was performed when corneal opacity compromised visual acuity. The outcome measures were complete resolution of infection, corneal graft survival, and best-corrected visual acuity (BCVA). Results. The mean age of patients was 22±1.2 years with 4/5 (80%) were females. The mean interval between LASIK and symptom onset was 8.8±1 day, and the mean interval between symptom onset and referral was 14±1.4 days. Potassium hydroxide (KOH) smears showed filamentous fungi, and Sabouraud’s medium grew Aspergillus in all cases. Melted flaps were amputated in 4 (80%) cases. MLF-AMT was performed in all cases due to corneal perforation after a mean time of 12.4±1.2 days of antifungals. In all cases, complete resolution of infection was seen 26±1.8 days after MLF-AMT, and optical PK was done at a mean of 2.4 months later. No postoperative complications after MLF-AMT or PK were observed, with a 0% incidence of corneal graft rejection, and a final BCVA ranged from 20/20 to 20/80 after a mean follow-up of 14±1.1 months. Conclusion. MLF-AMT is a safe and valid option to manage corneal perforation during keratmycosis treatment to avoid emergency therapeutic keratoplasty.

Objective: to evaluate the potential clinicopathological involvement of macrophage migration inhibitory factor (MIF) in systemic lupus erythematosus (SLE), and its relationship with lupus nephritis (LN) through measuring serum and urinary MIF levels. Methods: A crosssectional case-control study was carried out on 30 SLE female patients and 30 healthy age-matched females as a control group. SLE activity was assessed by the Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2k) and renal activity was evaluated with the renal-SLEDAI (rSLEDAI-2k). SLE damage was evaluated by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) damage index. Serum MIF (sMIF), urinary MIF (uMIF) levels were assayed and uMIF/creatinine ratio was estimated in all studied subjects. Results: SLE patients had significantly higher levels of sMIF, uMIF and uMIF/ creatinine ratio than the control group (p <0.001 for each).They were also significantly higher in SLE patients with lupus nephritis compared with those without lupus nephritis (p <0.001 for each) and in patients with active nephritis compared with inactive cases (p= 0.007, 0.001, 0.018, respectively). There were significant increase in sMIF, uMIF levels and uMIF/creatinine ratio in association with disease activity assessed by SLEDAI (p =0.005, 0.026, 0.049, respectively). Through regression analysis revealed that sMIF, uMIF, uMIF/creatinine ratio were found to be independent predictors for lupus nephritis development. Conclusion:This study showed that MIF is related to renal disease activity in SLE. Further prospective studies are required to verify whether MIF has a prognostic value in predicting clinical outcomes in SLE patients with different therapeutic regimens.

Our investigation was carried out to assess the protective impact of vitamin E against Moxifloxacin's possible adverse effects. Blood samples were collected at the 1 st , 7 th , 14 th , 21 st day after treatment. Collection of kidneys tissue samples was conducted at the 7 th and 14 th days after treatment. On Day 14 post-treatment with moxifloxacin, our results showed that there was multifocal hepatic necrosis of variable sizes that partially replaced by macrophages and occasionally with giant cells formation. The hepatic blood vessels were moderately congested, and the bile ducts were proliferated with characteristic portal round cells aggregation and portal fibrosis. Examined sections from kidney showed cystic dilatation of few tubules in the medulla and cortex of the kidneys. The renal pelvis revealed focal sloughing and hyperplasic changes in the transitional epithelium. Focal interstitial and perivascular aggregation of round cells and eosinophils were observed. The renal blood vessels were mildly congested. On Day 14 moxifloxacin and vitamin E; sections showed normal hepatic parenchyma with residual portal biliary proliferation and fibrosis. Minute focal hepatic necrotic areas partially replaced by round cells were also seen. Also, there were apparently normal nephron units with mild degenerative changes in some tubular epithelium and cyst dilatation in some renal tubules. Therefore, Vitamin E should be taken with moxifloxacin to decrease its adverse effects.