Diagnostic and Therapeutic Challenges

Abstract

A 33-year-old man came to our hospital with gradually progressive blurring of vision in the left eye for 2 months. He complained of micropsia and altered color perception in the left eye for 10 days and pain in the left eye for 5 days to 6 days. He was diagnosed with essential hypertension for the past 1 year and was on treatment (tablet Telmisartan 40 mg once daily orally). His best-corrected vision was 6/6 and 6/9 in the right and left eyes, respectively. The intraocular pressure was 14 mmHg and 15 mmHg in right and left eyes, respectively. Color vision was recorded with Ishihara plates and was 38/38 in both eyes. The anterior chamber angle was open in both the eyes. Slit-lamp examination was normal in both eyes. The right eye fundus was within normal limits and left eye fundus revealed sea-fan neovascularization with feeder vessels in the inferotemporal quadrant with localized tractional retinal detachment ( Figure 1, A-C).Spectral-domain optical coherence tomography (Optovue RT-Vue 100) was done; the fovea in both eyes was normal. An epiretinal membrane was present away from the fovea. Optical coherence tomography through the lesion revealed tractional retinal detachment with an intact retinal pigment epithelium layer. Fluorescein angiography was done revealing leakage and staining (Figure 1, D and E). ultrasound/ultrasonogram (USG) Bscan of both eyes was within normal limits. Visual field testing was done (24-2 and 10-2) and was within normal limits. Systemic investigations revealed positive Mantoux, slightly elevated serum glutamic pyruvic transaminase (SGPT), increased erythrocyte sedimentation rate (ESR) and elevated eosinophils (7.6%), and a platelet count was within normal limits. Plasma homocysteine was elevated (18.9 mmole/L). Sickling phenomenon was negative. Bleeding time (BT), clotting time (CT), prothrombin time (PT), and partial thromboplastin time (PTT) were all within normal limits. USG abdomen pelvis revealed generalized fatty infiltration of the liver with right nephrolithiasis. Magnetic resonance imaging brain with contrast showed no significant brain parenchymal abnormality.This case is presented for discussion of diagnosis and management. Drs. Leanne T. Labriola and Amani A. Fawzi (Los Angeles, California):The authors present an interesting case of a 33-yearold hypertensive man, who developed gradual, progressive vision loss in the left eye for 2 months associated with altered color perception for 10 days and left eye pain for 5 days to 6 days. On examination his visual acuity was reduced to 20/30 in his left eye, but his color vision on Isihara color plates was normal. His ocular examination was unremarkable except for the presence of a sea-fan neovascularization in the periphery of his left eye with localized tractional retinal detachment.Testing revealed no evidence of sickling phenomenon. He had elevation of ESR, SGPT (alanine transaminase), and homocysteine levels but platelet and blood clotting times were normal. The Mantoux test (tuberculin sensitivity test) was positive. Imaging sh...

Ortho‐phenylphenol exposure impairs porcine sperm motility through AMPK/AKT signaling pathway

“…According to several reviews, ion channels play vital roles in sperm motility, such as Ca 2+ channel and CatSper channel (Ren et al 2001;McKnight et al 2014). Additionally, the main metabolic pathway, cAMPdependent PKA pathway, and energy-related pathways are crucial to supply enough energy for sperm, in which oxidative phosphorylation and glycolysis are involved (Garg et al 2012;Piomboni et al 2012). Moreover, Wnt signaling and adenosine 5 0 -monophosphate-activated protein kinase (AMPK) signaling are also reported responsible for the sperm motility (Hurtado de Llera et al 2015;Freitas et al 2017).…”