Severe Bilateral Optic Neuritis: A Rare Presentation of Clinically Isolated Syndrome

Abstract

Multiple sclerosis (MS) is a disabling disease involving the myelin sheath of neurons in the brain and spinal cord. Optic neuritis (ON) is one of the common presentations of MS, and it typically presents as acute unilateral ON. In the absence of a prior history of MS, the first episode of clinically determined acute ON is considered as a clinically isolated syndrome (CIS). CIS presenting with bilateral acute ON resulting in complete vision loss is very rare. We present a case of a young female patient who presented with bilateral progressive vision loss and was ultimately found to have ON in the absence of a prior history of MS. Important differentials were ruled out. Significant improvement was observed in the patient with high doses of intravenous methylprednisolone. As compared to oral prednisone, intravenous steroids have been shown to be more effective in the treatment of ON in the Optic Neuritis Treatment Trial.

Assessment of Adherence to Reporting Guidelines by Commonly Used Clinical Prediction Models From a Single Vendor

“…That these items were rarely reported in the documentation may be unsurprising given that companies have to protect intellectual property such as model architecture details and coefficients, although there is increasing pressure to demonstrate external validation. 19 , 84…”

“…For transparency, we suggest reporting model coefficients, model reproducibility, how to access the data set, and who funded the study, which might be relevant for conflict of interest purposes. That these items were rarely reported in the documentation may be unsurprising given that companies have to protect intellectual property such as model architecture details and coefficients, although there is increasing pressure to demonstrate external validation …”

“…Despite good predictive performance in metrics such as the area under the receiver operating characteristic (AUROC) curve, the use of machine learning models trained on electronic health record data 1 to guide care has not often been demonstrated to translate into measurable clinical gains in the form of better medical care, lower cost, or more equitable outcomes, 2 , 3 , 4 leading to a gap that has been referred to as an “artificial intelligence (AI) chasm.” 5 Some potential reasons for this chasm are that current models are not useful, 4 , 6 , 7 reliable, 8 , 9 or fair. 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 Nevertheless, predictive models have frequently been deployed in health care settings without transparency or independent validation, 19 , 20 and their subsequent failures have occasionally been met with public outcry. 2 , 21 , 22 , 23 …”

Protocol for the Scientific Opinion on the evaluation of the safety in use of hydroxycitric acid and plant preparations containing hydroxycitric acid

“…An overview of the adverse health effects, which have been associated with HCA and HCA in plant preparations in the scientific literature was prepared based on available risk assessments of dietary HCA from various organizations (FDA, 2009; ANSM, 2012; AESAN, 2019; ANSES, 2022) (Appendix C) and reviews (Soni et al, 2004;Onakpoya et al, 2011;Bakhiya et al, 2017;Maunder et al, 2020;Payab et al, 2020;Andueza et al, 2021;Ellis et al, 2022). Several adverse events were identified from case reports and case series (Actis et al, 2007;Elinav et al, 2007;Jones and Andrews, 2007;Fong et al, 2010;Narasimha et al, 2013;Lopez et al, 2014;Araujo and Worman, 2015;Mancano, 2015;Beecheno et al, 2016;Corey et al, 2016;Hendrickson et al, 2016;Lunsford et al, 2016;Wong et al, 2016;Cotovio and Oliveira-Maia, 2017;Crescioli et al, 2018;Kothadia et al, 2018;Nguyen et al, 2019;Nilsson and Duan, 2019;Ferreira et al, 2020;Khetpal et al, 2020).…”

“…The trials compared hibiscus with another tea beverage, a placebo, or a prescribed diet Of the studies, 10 administered hibiscus as a capsule and 7 as a tea beverage. Doses of hibiscus ranged from 15 mg to 9 g/day, and duration of studies ranged from 15 to 90 days Liver damage, hepatitis (Vasques et al, 2008) In a trial involving 60 overweight Brazilian women, randomised into two groups (2400 mg/day of Garcinia gummi-gutta (L.) N.Robson or placebo) for 60 days, liver transaminase analysis and creatinine clearance showed no signs of acute toxicity during treatment; gastric discomfort, increased evacuation and nausea were reported as adverse effects (Vasques et al, 2014) (Actis et al, 2007;Shim and Saab, 2009;Fong et al, 2010;Sharma et al, 2010;Shuster, 2010;Araujo and Worman, 2015;Mancano, 2015;Melendez-Rosado et al, 2015;Corey et al, 2016;Lunsford et al, Case reports, case series More than 20 cases related to the use of dietary supplement containing Garcinia gummi-gutta (L.) N.Robson describreported the development of acute liver injury or hepatic necrosis as the final event in several case series (Steven et al, 2005;Actis et al, 2007;Dara et al, 2008;US FDA, 2009;Shuster et al, 2010 ;Sharma et al, 2010 ;Arujado et al 2015 ;Mancano et al, 2015;Melendez-Rosado et al 2015;Kothadia et al, 2016;Smith et al 2016 ;Smith et al, 2016;Crescioli et al, 2018;Kothadia et al, 2018;Philips and Augustine, 2018;Sharma et al, 2018;Yousaf et al, 2019;Ferreira et al, 2020;Khetpal et al, 2020;ANSES, 2022;…”