Syphilitic Optic Neuropathy: Re-emerging Cases Over a 2-Year Period

We report 7 cases of syphilitic optic neuropathy during a 2-year period. All patients were newly diagnosed with human immunodeficiency virus (HIV) infection. Six cases (86%) initially presented with swollen optic disc either unilaterally or bilaterally. Blind spot enlargement was the most common type of visual field defect. Final visual acuity of at least 20/25 was achieved together with visual field improvement and resolution of swollen optic disc. Optic nerve involvement can be the first manifestation of syphilis and HIV co-infection. Syphilitic optic neuropathy has an excellent prognosis if the disease diagnosed promptly and treated properly.     

The epidemiology and mutation types of Leber’s hereditary optic neuropathy in Thailand

PurposeLeber’s hereditary optic neuropathy (LHON), the most common mitochondrial optic neuropathy, causes visual loss, especially in young adults. Due to the absence of epidemiological data in Southeast Asia, we aimed to determine Thai LHON patients’ characteristics (demographic data, mutation types, and prognoses) as the first study in this region.MethodsThis retrospective chart review enrolled all Thai LHON patients confirmed by three mitochondrial DNA mutations (G11778A, T14484C, and G3460A) between January 1997 and December 2016. Patients with more than one year of follow-up were included in a visual progression analysis. The Mann–Whitney U-test was applied to compare groups, and prognosis-associated factors were analysed with the generalized estimating equation.ResultsIn all, 229 patients were enrolled, with only nineteen females. Most mutations were of the G11778A type (91%), with T14484C accounting for the remainder. The age at onset of G11778A (21.9 years; interquartile range [IQR] 14.9, 33.5) was younger than that of T14484C (33.0 years; IQR 19.4, 37.5). Of 45 patients, the T14484C group demonstrated good vision recovery, whereas the G11778A group did not improve (difference in logMAR −0.7 and IQR −1.5, −0.2 versus logMAR 0.0 and IQR −0.3, 0.2, respectively; P value .001). The G11778A mutation, male, and older age were related to poor prognoses.ConclusionsThe leading mutation in Thai LHON patients is the G11778A missense, followed by T14484C, while G3460A was not detected. The vast majority of patients were young adult males. The G11778A mutation, older age, and male gender are associated with poor vision outcomes.

Key message

• The G11778A missense mutation is the most common among Thai LHON patients, followed by T14484C, while G3460A was not found. The G11778A mutation, older age, and male gender are associated with poor vision outcomes.

     

Fungicidal and inhibitory efficacy of cinnamon and lemongrass essential oils on Candida albicans biofilm established on acrylic resin: An in vitro study

Statement of problemIt is unclear whether cinnamon and lemongrass essential oils can effectively reduce the Candida-biofilm frequently formed on dental devices made from heat-polymerized polymethyl methacrylate (PMMA) resin that contributes to the development of mild oropharyngeal as well as life-threatening candidiasis in patients wearing the devices.PurposeThe purpose of this in vitro study was to determine the efficacy of cinnamon and lemongrass essential oils in eradicating Candida albicans biofilm on heat-polymerized PMMA specimens and to determine whether they retard the formation of fungal biofilm.Material and methodsThe antifungal effect of cinnamon and lemongrass essential oils was determined by using agar disk diffusion and broth microdilution methods to obtain minimum inhibitory concentrations. The mature C albicans biofilm (48 hours) was pre-established on PMMA specimens before being individually treated with various concentrations (½, 1, 2, 4, 8, 16 times minimum inhibitory concentration) of each tested oil for different exposure times (1, 2, 4, 8, and 24 hours). In another experiment, fungal biofilm was established on the PMMA specimens that were primed individually with various concentrations of the tested oils for different times. The 2,3-bis-(2-methoxy-4-nitro-5-sulfophenyl)-2H-tetrazolium-5-carboxanilide (XTT)-reduction assay was used to quantitate biofilm viability in both experiments. Statistical analysis was performed by using the 1-sample Kolmogorov-Smirnov test and 2-way ANOVA followed by the Tukey multiple comparison test (α=.05).ResultsMinimum inhibitory concentration values of cinnamon and lemongrass essential oils against planktonic C albicans were 0.1 μL/mL (0.01% v/v) and 0.4 μL/mL (0.04% v/v). At 8 times the minimum inhibitory concentration, cinnamon oil (0.8 μL/mL or 0.08% v/v) and lemongrass oil (3.2 μL/mL or 0.32% v/v) eradicated the pre-established fungal biofilm by 99.0% in an exposure time of 1 hour. In contrast, high concentrations of 8 and 16 times the minimum inhibitory concentration of cinnamon oil (0.8 μL/mL or 0.08% v/v) and lemongrass oil (6.4 μL/mL or 0.64% v/v) coated on PMMA specimens for 24 hours were only able to inhibit the formation of fungal biofilm by approximately 70.0%.ConclusionsCinnamon and lemongrass essential oils can eliminate pre-established C albicans biofilm and restrain the formation of fungal biofilm on heat-polymerized PMMA specimens. Both effects of the tested essential oils depended on dose and exposure or priming time.     

Trauma-Associated Leber Hereditary Optic Neuropathy

A 19-year-old man developed visual loss in the left eye 1 day following a martial arts kick to the head. Vision worsened over a week, when visual loss was noted in the right eye without further trauma. The fundus was initially normal, but visual field testing showed temporal depression right eye with diffuse depression left eye, and traumatic chiasmopathy was suspected. Magnetic resonance imaging (MRI) of the brain demonstrated an enlarged chiasm with intrinsic signal abnormality, but no enhancement. Treatment with intravenous corticosteroids and hyperbaric oxygen therapy did not result in visual improvement. Ancillary testing for atypical optic neuritis was negative, but testing for LHON was positive for the 11778 mutation. This case raises the question of trauma as a precipitating factor for LHON and illustrates the rare occurrence of intrinsic signal abnormalities of the chiasm in this disorder.     

Differential induction of surface chemical compositional change on tooth structure by glass ionomer restorative materials

Odontology - Glass ionomer cement (GIC) is a restorative dental material capable of promoting mineral deposition on surrounding tooth substrates. However, it is unclear as to whether...     

Clinical features and etiology of retinal vasculitis in Northern Thailand

Purpose:

To report on the clinical features and etiology of patients with retinal vasculitis (RV).

Materials and Methods:

We reviewed medical records of 47 patients (75 affected eyes) diagnosed with RV. Clinical presentations, ocular complications, associated systemic diseases, and treatment regimens were registered.

Results:

Etiology of RV included infectious causes in 10/47, (21%) while an association with systemic and/or ocular non-infectious disorders was noted in 22/47 (47%). Eales’ disease and Behcet''s disease represented the most common clinical entities in non-infectious group while tuberculosis-associated RV was diagnosed in 6/10 (60%) among those with infectious disorders. RV was bilateral in 28/47 (60%) patients. Retinal veins were most commonly affected (72%, 34/47). Involvement of arteries was present in 12/47 (25%) and was associated with viral infections and Behcet''s disease. Ocular complications developed in 60/75 (80%) eyes. The most common complications were elevated intraocular pressure and/or glaucoma (33/75, 44%). Retinal detachment, vitreous hemorrhage, and cystoid macular edema developed in similar percentages (15%).

Conclusions:

RV in Thailand manifested mostly in male patients, was typically bilateral and involved mostly veins. Involvement of arteries was observed in patients with viral infections and Behcet''s disease. Tuberculosis was the most common infectious cause.