Optical coherence tomography findings in commotio retina

A 16-year-old boy presented with diminished visual acuity of 6/60 following blunt trauma to his right eye with a cricket ball. Fundus examination showed commotio retinae. Optical coherence tomography (OCT) demonstrated increased reflectivity with small optically clear spaces in the area corresponding to the photoreceptor outer segment. At 2-month follow up the visual acuity improved to 6/6. A small area of retinal opacification persisted nasally, and OCT of the corresponding area continued to show increased reflectivity in the area of photoreceptor outer segment. Increased reflectivity on OCT in eyes with commotio retinae probably denotes photoreceptor outer segment disruption and seems to be reversible to a variable extent.     

Observations on aetiology and management of genital fistulas

Methods We evaluated the aetiological factors and outcome of the management of genital fistulas. A review of patients who presented with genital fistulas between January 1998 and June 2002 was performed.Results There were 34 cases of various genital fistulas, including 29 urinary and 5 intestinal fistulas. Among them 14 (41.2%) were attributed to obstetrical causes, 11 (32.3%) to gynaecological surgery, and 9 (26.3%) to other factors like vaginal procedure, coitus, trauma, etc. We had an operation success rate of 85.7% (30 out of 35 repairs). The success rate was 85.71% (24 out of 28) after primary and 83.3% (5 out of 6) after secondary repair (p=1.00). Vaginal repair was done in 28 cases whereas abdominal repair was carried out in 7 cases. The failure rate was 7.14% (2 out of 28) using the vaginal route and 42.8% (3 out of 7) using the abdominal route (p=0.05). The average duration of disease was 11.8±4.9 months vs. 30±10.3 months (p=0.5), the mean size of the fistulas was 1.5±1.0×1.3±0.9 cm vs. 2.4±1.9×2.2±1.8 cm (p=0.02) in successful and failed cases respectively.Conclusion The vaginal repair of fistulas is associated with a higher success rate. Fistulas due to other etiological factors specifically associated with genital malformation, like vaginal procedures and coitus, have the worst prognosis. Larger or longer duration fistulas are associated with poorer prognosis.     

Primary tuberculosis of the thyroid gland: a case report

Tuberculosis of the thyroid gland is an uncommon disease and primary involvement of thyroid is even more rare. It is a rare disease even in countries in which tuberculosis is endemic. The diagnosis is often difficult as the clinical presentation has no distinct characteristics. Clinical course of the disease may resemble toxic goiter or acute thyroiditis or may follow a subacute or chronic growth pattern without specific symptomatology. Histologically presence of necrotizing epithelioid cell granulomas along with langhans type giant cells are the hallmark of thyroid tuberculosis. Demonstration of acid fast bacilli by ZN staining confirms the diagnosis, but this stain is frequently negative in tissue sections.     

Effects of etravirine alone and with ritonavir-boosted protease inhibitors on the pharmacokinetics of dolutegravir

Dolutegravir (DTG) is an unboosted, once-daily integrase inhibitor currently in phase 3 trials. Two studies evaluated the effects of etravirine (ETR) alone and in combination with ritonavir (RTV)-boosted protease inhibitors (PIs) on DTG pharmacokinetics (PK) in healthy subjects. DTG 50 mg every 24 h (q24h) was administered alone for 5 days in period 1, followed by combination with ETR at 200 mg q12h for 14 days in period 2 (study 1) or with ETR/lopinavir (LPV)/RTV at 200/400/100 mg q12h or ETR/darunavir (DRV)/RTV at 200/600/100 mg q12h for 14 days in period 2 (study 2). PK samples were collected on day 5 in period 1 and day 14 in period 2. All of the treatments were well tolerated. ETR significantly decreased exposures of DTG, with geometric mean ratios of 0.294 (90% confidence intervals, 0.257 to 0.337) for the area under the curve from time zero until the end of the dosage interval (AUC(0-τ)), 0.484 (0.433 to 0.542) for the observed maximum plasma concentration (C(max)), and 0.121 (0.093 to 0.157) for the plasma concentration at the end of the dosage interval (C(τ)). ETR combined with an RTV-boosted PI affected the exposure of DTG to a lesser degree: ETR/LPV/RTV treatment had no effect on the DTG plasma AUC(0-τ) and C(max), whereas the C(τ) increased by 28%. ETR/DRV/RTV modestly decreased the plasma DTG AUC(0-τ), C(max), and C(τ) by 25, 12, and 37%, respectively. Such effects of ETR/LPV/RTV and ETR/DRV/RTV are not considered clinically relevant. The combination of DTG and ETR alone should be avoided; however, DTG may be coadministered with ETR without a dosage adjustment if LPV/RTV or DRV/RTV is concurrently administered.