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Fluorescein angiography revealing a focal leak that progressed to an ink blot appearance in the late phase
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Background
Many acute and chronic neurological sequelae from the quinoline derivative antimalarial drug mefloquine, including dizziness and effects on the visual system such as diplopia and blurred vision, may be attributable to focal central nervous system toxicity. Maculopathy has also been reported with use of mefloquine, although the mechanism...
Contexts in source publication
Context 1
... coherence tomography (OCT) revealed serous elevation of his right eye neurosensory retina (Fig. 2). Fluorescein angiography revealed focal leaks of the retinal pigment epithelium within one disc diameter superotemporal to the disc that appeared hyperfluorescent in the arterial phase. One of them acquired an ink blot appearance in the late phase (Fig. 3). A diagnosis of unilateral CSCR was made, and he was referred to an internist for further evaluation. His vital signs were normal, and neurological, musculoskeletal, and psychiatric evaluations were noncon- tributory, although a detailed neuropsychiatric evaluation was not performed. He was asked to discontinue all medicines. His ...
Context 2
... coherence tomography (OCT) revealed serous elevation of his right eye neurosensory retina (Fig. 2). Fluorescein angiography revealed focal leaks of the retinal pigment epithelium within one disc diameter superotemporal to the disc that appeared hyperfluorescent in the arterial phase. One of them acquired an ink blot appearance in the late phase (Fig. 3). A diagnosis of unilateral CSCR was made, and he was referred to an internist for further evaluation. His vital signs were normal, and neurological, musculoskeletal, and psychiatric evaluations were noncon- tributory, although a detailed neuropsychiatric evaluation was not performed. He was asked to discontinue all medicines. His ...
Similar publications
Progress in optical coherent tomography (OCT) has recently provided new insights into varie- ty of chorioretinal disorders. The use of EDI (Enhanced Depth Imaging) during OCT examina- tions and as well as OCT angiography provides a more accurate analysis of the choroid both quantitatively and qualitatively.
„Pachychoroid“ (greek pachy- [παχύ]: thic...
Maculopathy is the excessive damage to macula that leads to blindness. It mostly occurs due to retinal edema (RE), central serous chorioretinopathy (CSCR) or age related macular degeneration (ARMD). Optical coherence tomography (OCT) imaging is the latest eye testing technique that can detect these syndromes in early stages. Many researchers have u...
Purpose:
To describe cases presenting with features of idiopathic macular telangiectasia (MacTel) Type 2 and central serous chorioretinopathy (CSC).
Methods:
Databases from four tertiary retina centers were searched for cases copresenting CSC and MacTel Type 2.
Results:
Five cases were identified (4 men, 1 woman; mean age: 67.2 years). Four pa...
Citations
... [7,8] Many drugs associated with CSC have a propensity to modulate the vascular tone or choroidal blood flow (ChBF) through diverse mechanisms that include actions on the autonomic nervous system, as well as on vascular smooth muscles. [4][5][6][9][10][11][12][13][14][15][16] In our settings, 21% of CSC patients were idiopathic. This prompted us to explore the potential role of other drugs or comorbid conditions in CSC. ...
PURPOSE: To evaluate the role of muscle-relaxants as risk factors for the development of central serous chorioretinopathy (CSC) - the second most common retinopathy in our settings; despite multiple risk factors seen in our patients, 21% were initially labelled as idiopathic.
MATERIALS AND METHODS: Retrospective case-control study at a tertiary hospital in the United Arab Emirates, where we reviewed the medical records of 273 patients with CSC examined between 2010 and 2019 for use of muscle-relaxants including tolperisone/eperisone, carisoprodol and gabapentin/pregabalin within a year of onset/recurrence of the disease. Intake of drugs with known association with CSC (including corticosteroids/sympathomimetics) was also recorded. Two hundred eighty-six subjects with adverse events seen at the same institute during the same study period served as controls. Odds ratios, Chi-Square tests and multivariate logistic regression were carried out to determine any associations with the muscle-relaxants and other pharmacological confounders - corticosteroids/sympathomimetics.
RESULTS: Muscle relaxants may increase the risk of CSC as evident on multivariate regression analysis (OR: 2.55; confidence interval [CI]: 1.208-5.413); the significance was retained on removing the 6 subjects who had corticosteroids/sympathomimetics (OR: 2.30; CI: 1.073–4.939). Univariate analysis yielded an OR of 2.52 for muscle relaxants (CI: 1.2149–5.2276), 2.96 for eperisone/tolperisone (CI: 1.3531–6.5038), and 6.26 for eperisone as an individual agent (CI: 1.8146–21.6252).
CONCLUSION: We found muscle relaxants to be associated factors of CSC regardless of inclusion of corticosteroids/sympathomimetics (P < 0.05). Among individual classes of muscle relaxants in this study, only eperisone/tolperisone posed a significant risk (P < 0.05). The vascular smooth muscle relaxation could be the possible mechanism that affects the choroidal blood flow and indirectly predisposes to CSC.
... Copper (Cu) plays a critical role in the normal biochemical function of the body. It is found as a component of many enzymes and is also used for biological electron transport (Jain, 2006). The groups treated with Artesunate-Amodiaquine, Artesunate-Mefloquine and Dihydroartemisinin -Piperaquine Phosphate indicated a significant reduction in the concentration of serum copper when compared with the positive control. ...
... tadalafil [100] and sildenafil [101]), quinoline (i.e. antimalarial drug like mefloquine [102]), and neuroleptics [103] have shown possible associations with developing CSCR (Table 1). ...
... Quinolines may exert their effects by disrupting connexin 43 within the gap junctions of choroid vessels resulting in hyperpermeability [102]. ...
The pathogenesis of central serous chorioretinopathy (CSCR), a pachychoroid disease, is poorly understood. While choroid hyperpermeability and retinal pigment epithelium dysfunction are cornerstones for developing CSCR, the mechanisms at the retinal, vascular, retinal pigment epithelium, and cellular level continue to be an enigma. A few preclinical studies and the development of small-sized, poorly controlled clinical trials have resulted in limited insight into the disease mechanism. Effective treatments for CSCR are still lacking as current trials have produced inconsistent results for functional and structural gains. Thus, critically evaluating the literature to explore disease mechanisms and provide an up-to-date understanding of pathophysiology can provide valuable information and avenues to new treatments. In this study, a comprehensive summary of the mechanistic insight into CSCR is presented while highlighting the shortcomings of current literature. The mechanism was divided into seven sub-categories including mechanical obstruction, inflammation, oxidative stress, paracrine factors, autonomic dysfunction, mineralocorticoid receptors activation, and medications. We implemented validated tools like the JBI and CAMARADES to objectively analyze the quality of both clinical and preclinical studies, respectively. Overall, our analysis of the literature showed that no single mechanism was populated with a large number of sufficiently sized and good-quality studies. However, compiling these studies gave hints not only to CSCR pathogenesis but also pachychoroid disease in general while providing suggestions for future exploration.
... It has been extensively used in Asia for more than two decades. ASMQ is commonly associated with neuropsychiatric side effects and cardiotoxicity attributed to MQ [100]. In children, the major drug effect of MQ is anorexia, commonly presenting as early vomiting following drug ingestion [101]. ...
Artemisinin-based combination therapy (ACT) has been adopted as a strategy to mitigate multidrug resistance to antimalarial monotherapies. ACT combines the rapid and effective but rather short plasma half-life antimalarial action of an artemisinin derivative with a longer acting partner drug. Although the exact mechanisms of action of artemisinins is not well understood, several studies have proposed multiple cellular targets of artemisinins with involvement of reactive oxygen species (ROS). Most of the currently used ACT partner drugs are also known to involve ROS production in their mechanisms of action. This review gives a brief account of the oxidative stress and redox systems in malaria and discusses the context of antimalarial effectiveness of different ACTs compared to monotherapies of the partner drugs. A final account on the Pros and cons of ACT as a strategy is discussed. This article is protected by copyright. All rights reserved.
According to the 2021 Malaria report, 241 million clinical episodes with 627000 deaths penalty was estimated across the worldwide. However, mutation in the propeller domain of Plasmodium falciparum kelch 13 protein resulted in longer parasite clearance time following an artemisinin-based treatment and had a greater survival rate of ring-stage parasites even after a brief exposure to a high dose of artesunate. Clinical manifestations become more complex and worse with the emerging trend of drug resistance against artemisinin derivatives and the poor effectiveness of malaria vaccination drive. Steroidal lactone (withanolide) moiety (C-28) isolated from methanolic leaf extract Withania somnifera show a greater affinity towards Pfkelch 13 protein in comparison to the artemisinin derivatives (artesunate, artemether). The isolated compound was characterized to be withaferin A with a percentage yield of 29.01% w/w in chloroform fraction, 1.75% w/w in methanolic extract, and 0.29% w/w in raw leaf powder. Structure-based analysis shows that withaferin A (docking score -8.253, -9.802) has a higher affinity for two distinct binding pockets I and II of the Plasmodium falciparum kelch 13 protein than artesunate (docking score -4.470, -3.656). Further, Gibbs binding free energy signifies thermodynamic stability of the docked complex of withaferin A (-43.25, -43.76 Kcal/mol) in comparison to artesunate docked complex (-8.49, -5.75 Kcal/mol). The pharmacokinetic profile of withaferin A shows more drug-likeness characteristics without violating Jorgensen's rule of three, and Lipinski's rule of five. Hence above experimental findings suggest withaferin A could be a suitable therapeutic adjunct for preclinical evaluation of antimalarial potentiality in artemisinin-resistant malaria.
Background
Based on the adverse event reporting system, the authors observed unique occupational and pharmacological trends in central serous chorioretinopathy (CSC); despite being a common condition in the region, there are no large epidemiological studies.
Objective
To describe the clinical profile, risk factors and co-medications of CSC in a multispecialty hospital in UAE.
Methods
Hospital based retrospective, observational study in which all the confirmed cases of CSC (272) seen between 2010 and 2019 were included. Supplementary data was collected on follow up visits or through telephonic calls.
Results
The male: female ratio was 17:1; low socio-economic status was (155; 73.45%), and occupations such as drivers (61; 28.9%) and outdoor laborers (59; 27.96%) were the most commonly affected. The majority (78.05%; 185) were single expatriates. Financial worries (105; 50.72%) constituted the leading cause of stress. The usage of corticosteroids (83; 30.51%), nasal decongestants (14.70%) or both (17; 6.25%) within one year was common; mostly (82; 30.14%) for rhinitis/respiratory states, though grossly under-recognized. Muscle relaxants and psychotropic medications were the other major medications used by 24 (8.82%) and 25 (9.19%) cases prior to CSC. Seven of 15 women had at least one condition that alters the endocrinal milieu: Pregnancy (3), recent child birth (1), erratic oral contraceptive intake (1), menopause with liver dysfunction (1), hormone replacement therapy for menopause and endometriosis (1), ovarian cyst and infertility (1) hypothyroidism (3), and Cushing syndrome (1). Chronic/ recurrent forms were seen in 31.08%. There were too few glaucoma patients despite both CSC and glaucoma being common among our patients.
Conclusions
CSC in Al-Ain predominantly affected males with a specific occupational predisposition. Emotional distress, financial worries, allergic disorders, and endocrinal disorders (among females) were common. Adverse drug events were under-reported compared to the usage of steroid or decongestant users. Suspected pharmacological associations included drugs that modulated the vasomotor tone.
Malaria, as one of the most common human infectious diseases, remains the greatest global health concern, since approximately 3.5 billion people around the world, especially those at subtropical areas, are at the risk of being infected by malaria. Due to the emergence and spread of drug resistance to the current antimalarials, malaria-related mortality and incidence rates have recently increased. To overcome the aforementioned obstacles, nano-vehicles based on biodegradable, natural, and non-toxic polymers have been developed. Accordingly, these systems are considered as a potential drug vehicles, which due to their unique properties such as the excellent safety profile, good biocompatibility, tunable structure, diversity, and the presence of functional groups within the polymer structure, could facilitate covalent attachment of targeting moieties and antimalarials to the polymeric nano-vehicles. In this review, we highlighted some recent developments of liposomes as unique nanoscale drug delivery vehiclesand several polymeric nanovehicles, including hydrogels, dendrimers, self-assembled micelles, and polymer-drug conjugates for the effective delivery of antimalarials.
This book is intended as a guide to help the clinician determine where a visual problem is a drug-induced ocular side effect. We continually review spontaneous case reports from the National Registry of Drug-Induced Ocular Side Effects, the World Health Organization, the US Food and Drug Administration, and the world literature. We have attempted to classify a suspected adverse event with our impression to causality (i.e. certain, probable, unlikely, conditional/unclassified). This chapter discusses anti-infectives including amebicides, anthelmintics, antibiotics, antifungal drugs, antileprosy drugs, antimalarial drugs, antiprotozoal drugs, and antitubercular drugs.
A thirty year old insomniac, an off label user of quetiapine presented with blurring of central vision, eventually diagnosed as Central serous chorioretinopathy. A potential association was suspected based on the drug’s actions on the autonomic nervous system. He had an improvement on drug withdrawal; then he unwittingly resumed quetiapine and had a recurrence. Possible underlying mechanisms that include alteration in choroidal perfusion through serotonin and dopamine receptors are discussed. While retinal vein occlusions and pigment epithelial detachment have been described with quetiapine, to author’s knowledge, this is the first case report of quetiapine associated Central serous chorioretinopathy.
The Side Effects of Drugs Annuals is a series of volumes in which the adverse effects of drugs and adverse reactions to them are surveyed. The series supplements the contents of Meyler's Side Effects of Drugs: the International Encyclopedia of Adverse Drug Reactions and Interactions. This review covers publications made between January 2016 and December 2016 on antiprotozoal drugs, including albendazole, artemether–lumefantrine, dihydroartemisinin–piperaquine, oxantel pamoate–albendazole, primaquine, quinacrine, artesunate, and mefloquine.
