Severe Retinal Hemorrhages Research Articles

Bilateral vitreous and retinal hemorrhage associated with immune thrombocytopenic purpura and systemic lupus erythematosus followed by neovascularization

Abstract Systemic lupus erythematosus (SLE) is known for its diverse clinical manifestations, with hematological problems occasionally overlooked due to mild symptoms. This case report presents a 15-year-old girl with bilateral blurred vision resulting from severe retinal and vitreous hemorrhage secondary to SLE. Following the resolution of hemorrhage, neovascularization developed in one eye and was successfully treated with intravitreous injections of ranibizumab. This case highlights the significance of considering blood dyscrasia disorders in cases of intraocular hemorrhage and underscores the ocular manifestations and potential complications associated with SLE. Timely diagnosis and appropriate management are vital for preserving vision in such cases.

Long-term Follow-up of a Phase 1/2a Clinical Trial of a Stem Cell-Derived Bioengineered Retinal Pigment Epithelium Implant for Geographic Atrophy

PurposeTo report long-term results from a Phase 1/2a clinical trial assessment of a scaffold-based human embryonic stem cell-derived retinal pigmented epithelium (RPE) implant in subjects with advanced geographic atrophy (GA). DesignThe study was a US Food and Drug Administration (FDA)-approved single-arm, open-label Phase 1/2a clinical trial. SubjectsSubjects were between the ages of 69 and 85 at the time of enrollment and were legally blind in the treated eye (best corrected visual acuity (BCVA) of ≤ 20/200) as a result of GA involving the fovea. InterventionThe clinical trial enrolled 16 subjects, 15 of whom were successfully implanted. The implant was administered to the worse-seeing eye with the use of a custom subretinal insertion device. The companion non-implanted eye served as the control. The primary endpoint was at 1 year; thereafter subjects were followed at least yearly. Main Outcome MeasuresSafety was the primary endpoint of the study. The occurrence and frequency of adverse events were determined by scheduled eye exams, including measurement of BCVA, intraocular pressure, and multimodal imaging (fundus photography, optical coherence tomography, and fluorescein angiography). In addition, serum antibody titers were collected to monitor systemic humoral immune responses to the implant cells. ResultsAt a median follow-up of three years, fundus photography revealed no migration of the implant. There were no unanticipated, severe, implant-related adverse events throughout the follow-up period, and the most common anticipated severe adverse event (severe retinal hemorrhage) was eliminated in the second cohort (9 subjects) through the use of improved intraoperative hemostasis. Non-severe, transient retinal hemorrhages were noted either intra-op or post-op in all subjects as anticipated for a subretinal surgical procedure. Throughout the median 3-year follow-up, the results show that implanted eyes were more likely to improve by >5 letters BCVA, and less likely to decrease by >5 letters compared to non-implanted eyes. ConclusionsThis report details the long-term follow-up of the largest study of subjects with GA to receive a scaffold-based stem cell-derived bioengineered RPE implant. Results show that the implant, at a median 3-year follow-up, is safe and well-tolerated in subjects with advanced dry AMD. The safety profile, along with the early indication of efficacy, warrants further clinical evaluation of this novel approach for the treatment of GA.

Кровоизлияния в сетчатку у новорожденных. Клинические особенности и факторы риска

Material and methods. The study included newborns born at the Perinatal Center of St. Petersburg State Pediatric Medical University in the period from July 2021 to October 2022. Anamnestic and other risk factors for the development of retinal hemorrhages were assessed in newborns with and without retinal hemorrhages (RH). Depending on the severity of RH (according to the results of the examination on the RetCam retinal camera), the newborns were divided into groups in which the bilaterality of the RH was assessed, localization in the layers and area of the retina, with an emphasis on the macular region and the optic disk. Results. Of the 75 newborns, 16 had birth-related RH (23.1%). Normal spontaneous vaginal delivery showed the highest association with RH (odds ratio, 5.515; 95% confidence interval, 1.15–26.46, p<0.001). Hemorrhages were more often bilateral (68.8%), intraretinal (87.5%) and localized in the central zone of the retina (81.3%). At the same time, severe RH were more often located in zones I and II, in each newborn they affected the optic nerve or macula, in 6.3% of cases they spread to the vitreous body, and in 25% they were accompanied by Roth’s spots. Conclusion. RH occur in 21.3% of full-term newborns and are largely associated with normal delivery. The main characteristics of hemorrhages in newborns differ notably depending on their severity. Severe retinal hemorrhages in newborns may have negative consequences for the development of visual functions at an older age, which requires further long-term studies. This study confirmed that the digital wide-angle retinal camera is an effective method for examining a large number of newborns with RH. Key words: newborn, retinal hemorrhages, vitreous hemorrhages, Roth’s spots

Retinal hypoperfusion detected by wide-field optical coherence tomographic angiography in a case of retinal racemose hemangioma.

Retinal racemose hemangioma (RRH) is a rare, non-hereditary arteriovenous malformation characterized by the appearance of dilated and tortuous retinal vessels. RRH can develop complications associated with retinal ischemia, such as vitreous hemorrhage, retinal vein occlusion and neovascular glaucoma. Here, we report a case of RRH with retinal hypoperfusion detected by wide-field swept source optical coherence tomography angiography (OCTA), which was not unambiguously illustrated by fluorescein angiography (FA). Case report. A 57-year-old woman was referred to our hospital for the evaluation of severe retinal vascular tortuosity, dilation and retinal hemorrhages in the left eye. Fundus examination revealed arteriovenous communications temporal to the fovea and multiple microaneurysms surrounded by retinal hemorrhages at the midperipheral temporal fundus. In FA, multiple hyperfluorescent lesions with leakage corresponding to microaneurysms were observed in the temporal and lower midperipheral areas; however, non-perfused areas were apparently absent. By contrast, wide-field OCTA clearly showed low-density retinal capillaries in the superotemporal quadrant in comparison with those in the inferotemporal quadrant. Wide-field OCTA detected sparse retinal capillaries, which were not well illustrated by FA, in a patient with RRH. This indicates the presence of low-grade retinal hypoperfusion caused by altered retinal hemodynamics, potentially leading to ischemia-related retinal disorders during a prolonged course, in patients with clinically quiescent RRH.

Examining diagnostic variability among pediatric subspecialists using case examples of infant head injury

BackgroundAlthough there is research regarding the diagnosis and timing of abusive head trauma, there remains practice variation among pediatric subspecialists. ObjectivesTo examine diagnostic variability among pediatric subspecialists using case examples of infant head injury. Secondary objectives were timing variability among subspecialists, and diagnostic and timing variability among Child Abuse Pediatricians (CAPs). Participants and settingPediatric subspecialists were recruited from Child Abuse Pediatrics, Hospital Medicine, Emergency Medicine, Critical Care, and Neurosurgery to complete a research instrument. Participants qualified for the study if they evaluated at least 1 case of possible abusive head trauma during their career. MethodsThis multi-institutional, mixed-methods study used a research instrument with 4 case examples of infant head injury: severe retinal hemorrhages (RH), mass-effect subdural hemorrhage (SDH), SDH membrane formation, and sepsis. The response selected by most CAPs was reference and compared across subspecialties and among CAPs using Chi-square or Fisher's exact tests. A Bonferroni correction (p < 0.01) was used for subspecialty comparisons. ResultsThere were 288 participants who completed at least 1 case example. Diagnostic variability was observed in all case examples. Significantly fewer Hospital Medicine (34.9 % vs. 57.9 %, p < 0.01), Emergency Medicine (28.0 % vs. 57.9 %, p < 0.0001), and Neurosurgery (24.0 % vs. 57.9 %, p < 0.01) participants selected the reference response for the mass-effect SDH case example. Timing variability was statistically significant for all case examples (p < 0.01). Significantly fewer CAPs aged 44–64 years selected the reference response for timing (p < 0.01) for the severe RH case example. ConclusionsAdditional peer review processes and consensus guidelines for challenging issues in abusive head trauma may be beneficial.

Evidence for significant misdiagnosis of abusive head trauma in pediBIRN data

Independently witnessed events are used as a reference standard to robustly categorize accidental or non-abusive head trauma (non-AHT) cases in the pediBIRN data set of acutely symptomatic infants with closed head injuries. Findings in such independently witnessed non-AHT cases are compared to findings in cases that were diagnosed as AHT but were not independently witnessed. The data shows that 14% of independently witnessed non-AHT cases are misdiagnosed as AHT, and that risk factors for misdiagnosis include acute encephalopathy, bilateral or interhemispheric SDH, and/or severe retinal hemorrhages, findings that are commonly associated with AHT. The data also shows that “dense retinal hemorrhages extending to the periphery” are not highly suggestive of AHT, as they also occur in independently witnessed non-AHT cases.

Birth-related retinal hemorrhages: The Soonchunhyang University Cheonan Hospital universal newborn eye screening (SUCH-NES) study.

To report the prevalence, related factors, and characteristics of birth-related retinal hemorrhages (RHs) according to their severity in healthy newborns using a telemedicine network and wide-field digital retinal imaging (WFDRI). Newborns who underwent WFDRI at 61 obstetrics/gynecology hospitals between January 2017 and December 2019 were enrolled. Demographics and related factors were compared among newborns with and without RHs. The newborns' eyes were divided into the minimal, mild, moderate, and severe groups according to the number of RHs, and characteristics like bilaterality, laterality, involved retinal layer, involved zone, macular and/or optic nerve (ON) involvement were compared. Among 56247 newborns, 13026 had birth-related RHs (23.2%). Normal spontaneous vaginal delivery (NSVD) showed the highest association with RHs (odds ratio, 19.774; 95% confidence interval, 18.277-21.393; P < 0.001) on multivariate analysis. Bilateral RHs (8414/13026; 64.59%) were more common than unilateral RHs (4612/13026; 35.41%); however, unilateral RHs (2383/4217; 56.51%) were more common than bilateral RHs (1834/4217; 43.49%) in the minimal group. RHs showed no laterality differences between the two eyes (P = 0.493). Most RHs were intraretinal (18678/21440; 87.12%), and 2328 (31.65%) eyes with preretinal hemorrhage were observed in the severe group. Zone I RHs were common in the minimal (7072/7090; 99.75%), mild (4953/4960; 99.86%), and moderate (2013/2035; 98.92%) groups; zone I and II RHs were common in the severe group (4843/7355; 65.85%); and RHs in zone III were rare (7/21440; 0.03%). Most RHs showed no macular and/or ON involvement in the minimal and mild group; however, this was common in the severe group (7111/7355; 96.68%). Birth-related RHs were common in healthy newborns and were significantly associated with NSVD. RHs were usually bilateral, intraretinal, and distributed posterior to the retina, but severe RHs had unique characteristics. Future long-term and longitudinal studies are required to elucidate the prognosis of severe RHs.

A meta-analysis of prognostic biomarkers in neonatal retinal hemorrhage.

Neonatal retinal hemorrhage (RH) is a frequently occurring neonatal fundus condition and a very common ocular abnormality in neonates. Some of the key factors that influence the rate of RH are the mode of delivery, examination techniques, and time of examination after birth. The prognostic markers of severe RH are poorly known, making it difficult for an efficient diagnosis, prognosis, and treatment. Hence, to better understand the mechanism of disease, its study at the molecular level is required. Prognostic biomarkers are an essential tool for understanding the pathogenesis of the disease. In this paper, we present a meta-analysis of biomarkers to understand disease pathogenesis and support better diagnosis, prognosis, and treatment of neonatal RH. The meta-analysis was carried out by following the recommendation of PRISMA. The relevant articles were crawled using a systematic keyword using MeSH terms from the MEDLINE, PubMed, and Scopus databases, which were subjected to manual screening for reported biomarkers by two independent reviewers. The obtained biomarkers were further analyzed for gene-disease association and functional enrichment analysis. Our meta-analysis suggests that genes ABCC6, Beta-APP, COL2A1, COL4A1, DNM2, ENPP1, IKBKG, ITGB2, IL-6, SELE, TREX1, and VEGFA are potential prognostic biomarkers associated with the neonatal RH. The gene-disease association and functional enrichment analysis suggest that few genes are associated with disease class "Vision"; however, some genes in the list are associated with the disease class "Pharmacogenomic," "Immune," "Renal." The identified prognostic gene biomarkers may help to understand disease pathogenesis and provide a better diagnosis, prognosis, and treatment of neonatal RH.

The "New Science" of Abusive Head Trauma.

Claims that new science is changing accepted medical opinion about abusive head injury have been made frequently in the media, legal publications and in legal cases involving abusive head trauma (AHT). This review analyzes recently published scientific articles about AHT to determine whether this new information has led to significant changes in the understanding, evaluation and management of children with suspected AHT. Several specific topics are examined: serious or fatal injuries from short falls; specificity of subdural hematoma for severe trauma; biomechanical explanations for findings; the specificity of retinal hemorrhages; the possibility of cerebral sinus thrombosis presenting with signs similar to AHT; and whether vaccines can produce such findings. We conclude: a) that the overwhelming weight of recent data does not change the fundamental consensus b) that abusive head trauma is a significant source of morbidity and mortality in children c) that subdural hematomas and severe retinal hemorrhages are commonly the result of severe trauma d) that these injuries should prompt an evaluation for abuse when identified in young children without a history of such severe trauma and e) that short falls, cerebral sinus thrombosis and vaccinations are not plausible explanations for findings that raise concern for abusive head trauma.

Vascular leakage caused by loss of Akt1 is associated with impaired mural cell coverage.

Angiogenesis plays a critical role in embryo development, tissue repair, tumor growth and wound healing. In the present study, we investigated the role of the serine/threonine kinase Akt in angiogenesis. Silencing of Akt1 in human umbilical vein endothelial cells significantly inhibited vascular endothelial growth factor (VEGF)‐induced capillary‐like tube formation. Mice lacking Akt1 exhibited impaired retinal angiogenesis with delayed endothelial cell (EC) proliferation. In addition, VEGF‐induced corneal angiogenesis and tumor development were significantly inhibited in mice lacking Akt1. Loss of Akt1 resulted in reduced angiogenic sprouting, as well as the proliferation of ECs and mural cells. Addition of culture supernatant of vascular smooth muscle cells (VSMCs) in which Akt1 was silenced suppressed tube formation, the stability of preformed tubes and the proliferation of ECs. In addition, attachment of VSMCs to ECs was significantly reduced in cells in which Akt1 was silenced. Mural cell coverage of retinal vasculature was reduced in mice lacking Akt1. Finally, mice lacking Akt1 showed severe retinal hemorrhage compared to the wild‐type. These results suggest that the regulation of EC function and mural cell coverage by Akt1 is important for blood vessel maturation during angiogenesis.

Increased Intracranial Pressure Does Not Cause Retinal Hemorrhages Characteristic of Abuse

In young children, severe retinal hemorrhages are associated with abusive head trauma and can be important in abuse recognition by clinicians, family

Severe preeclampsia with HELLP syndrome with Wilson's disease.

Severe Preeclampsia is characterized by systolic blood pressure ≥ 160 mmHg or diastolic pressure >110 mmHg, protein excretion >5 gm/24 hour or 3+ or more on random samples, oliguria <500 ml/24 hr, platelet count <1,00,000/mm3, hemolysis, elevated alanine aminotransferase and aspartate aminotransferase, cerebral and visual disturbance, persistent severe epigastric pain, retinal hemorrhages, exudates and papilledema, intrauterine growth restriction of the fetus and pulmonary edema. HELLP (Hemolysis, elevated liver enzymes and low platelets) syndrome is the variant of preeclampsia. Definitive treatment of HELLP syndrome is delivery of the baby. Wilson's disease is autosomal recessive disorder of copper metabolism. It is characterized by the toxic accumulation of copper mainly in liver and brain but also in cornea and kidney due to defective biliary excretion of copper. It is one of the major causes of cirrhosis of liver. Excess copper levels are associated with the disorder of the menstrual cycle and infertility. Increased copper levels are also associated with the preeclampsia, intrauterine growth restriction and neurologic damages in the fetus. However Pregnancy is not contraindicated in well treated Wilson's disease. A case of decompensated cirrhosis due to Wilson's disease, presented in third trimester of pregnancy, with Preeclampsia and HELLP syndrome is discussed.

Evaluations for abuse in young children with subdural hemorrhages: findings based on symptom severity and benign enlargement of the subarachnoid spaces.

OBJECTIVE Children who have subdural hematomas (SDHs) with no or minimal neurological symptoms (SDH-mild symptoms) often present a forensic challenge. Nonabusive causes of SDH, including birth-related SDH, benign enlargement of the subarachnoid spaces (BESS), and other proposed causes have been offered as etiologies. These alternative causes do not provide explanations for concomitant suspicious injuries (CSIs). If SDH with mild symptoms in young children are frequently caused by these alternative causes, children with SDH-mild symptoms should be more likely to have no other CSIs than those who have SDH with severe symptoms (SDH-severe symptoms). Additionally, if SDH with mild symptoms is caused by something other than abuse, the location and distribution of the SDH may be different than an SDH caused by abuse. The objectives of this study were to determine the prevalence of other CSIs in patients who present with SDH-mild symptoms and to compare that prevalence to patients with SDH-severe symptoms. Additionally, this study sought to compare the locations and distributions of SDH between the two groups. Finally, given the data supporting BESS as a potential cause of SDH in young children, the authors sought to evaluate the associations of BESS with SDH-mild symptoms and with other CSIs. METHODS The authors performed a 5-year retrospective case-control study of patients younger than 2 years of age with SDH evaluated by a Child Abuse Pediatrics program. Patients were classified as having SDH-mild symptoms (cases) or SDH-severe symptoms (controls). The two groups were compared for the prevalence of other CSIs. Additionally, the locations and distribution of SDH were compared between the two groups. The presence of BESS was evaluated for associations with symptoms and other CSIs. RESULTS Of 149 patients, 43 presented with SDH-mild symptoms and 106 with SDH-severe symptoms. Patients with SDH-mild symptoms were less likely to have other CSIs (odds ratio [OR] 0.2, 95% confidence interval [CI] 0.08-0.5) and less likely to have severe retinal hemorrhages (OR 0.08, 95% CI 0.03-0.3). However, 60.5% of patients with SDH-mild symptoms had other CSIs. There was no difference between the groups regarding the location and distribution of SDH. Of the entire study cohort, 34 (22.8%) had BESS, and BESS was present in 17 (39.5%) of the SDH-mild symptoms group and 17 (16%) of the SDH-severe symptoms group (OR 3.4, 95% CI 1.5-7.6). The presence of BESS was significantly associated with a lower chance of other CSIs (OR 0.1, 95% CI 0.05-0.3). However, 17 patients had BESS and other CSIs. Of these 17, 6 had BESS and SDH-mild symptoms. CONCLUSIONS The high occurrence of other CSIs in patients with SDH-mild symptoms and a similar high occurrence in patients with BESS (including those with SDH-mild symptoms) indicate that such children benefit from a full evaluation for abuse.

Abusive head trauma: primer and mock trial

Severe retinal hemorrhage (RH), folds, and retinoschisis are highly suggestive of abusive head trauma (AHT) in young children. Ophthalmologists may testify about the significance of these findings, yet be faced with alternative hypotheses proposed by defense teams in court. Ophthalmologists should be familiar with strengths and limitations of their own expertise, relevant literature, and the process and challenges of giving court testimony.

Acceptance of Shaken Baby Syndrome and Abusive Head Trauma as Medical Diagnoses

To assess the current general acceptance within the medical community of shaken baby syndrome (SBS), abusive head trauma (AHT), and several alternative explanations for findings commonly seen in abused children. This was a survey of physicians frequently involved in the evaluation of injured children at 10 leading children's hospitals. Physicians were asked to estimate the likelihood that subdural hematoma, severe retinal hemorrhages, and coma or death would result from several proposed mechanisms. Of the 1378 physicians surveyed, 682 (49.5%) responded, and 628 were included in the final sample. A large majority of respondents felt that shaking with or without impact would be likely or highly likely to result in subdural hematoma, severe retinal hemorrhages, and coma or death, and that none of the alternative theories except motor vehicle collision would result in these 3 findings. SBS and AHT were comsidered valid diagnoses by 88% and 93% of the respondents, respectively. Our empirical data confirm that SBS and AHT are still generally accepted by physicians who frequently encounter suspected child abuse cases, and are considered likely sources of subdural hematoma, severe retinal hemorrhages, and coma or death in young children. Other than a high-velocity motor vehicle collision, no alternative theories of causation for these findings are generally accepted.

Pancytopenia related to malnutrition during pregnancy

Pancytopenia during pregnancy secondary to folate deficiency is rare, but is a potentially life-threatening disease with poor fetomaternal prognosis in the absence of accurate diagnosis and optimal treatment [1,2]. In August 2012, a low-risk primigravida aged 26 years presented to Rene Dubos Hospital, Pontoise, France, for a routine consultation at 27 weeks of pregnancy. Persistent fetal bradycardia (100 beats per minute) was recorded. The patient also reported fatigue, dizziness, and recent decreased visual acuity. All previous pregnancy investigations had been normal. Clinical maternal examination revealed severe paleness, oral aphthae, tachycardia (140 beats per minute), and retinal hemorrhage. Ultrasonography indicated intrauterine growth restriction (b5th percentile), oligoamnios, and absent end-diastolic umbilicalflow. Laboratory results showed severe pancytopenia (hemoglobin 1.9 mmol/L; leukocytes 1.49 × 10 per L; platelets 6 × 10 per L). Elevated lactate dehydrogenase (1839 U/L), ferritin (1568.4 pmol/L) and iron values (60 μmol/L) pointed to megaloblastosis with peripheral hemolysis. Serologic investigations excluded recent infections and other diseases. A bone marrow biopsy sample showed severe megaloblastosis, moderate blastosis of the erythroblast line, and absence of a megakaryoblast line with no leukemic population (Table 1, Fig. 1). Diminished levels of vitamin B12 (135 pmol/L), vitamin C (b3.0 μmol/L) and folate (8.73 nmol/L) were subsequently recorded. The patient was diagnosed with pancytopenia secondary to folate and vitamin B12 deficiency. Meticulous anamnesis revealed a particular nutrition pattern characterized by little food intake, no consumption of fruits or vegetables from childhood, and no psychiatric anorexia. The patient was not taking vitamin supplements. Pregnancy was thought to have reduced the patient’s minimal deposits of folate and vitamin B12. The patient received transfusions of seven units of erythrocytes and three units of platelets on the first day, and high daily doses of oral vitamins from the second day (100 IU vitamin B12, 1 g vitamin C, and 45 mg folic acid). The blood counts returned to normal after

Conséquences fatales de l’ouverture d’un « airbag » chez un nourrisson. Un danger méconnu ?

We report the case of an 8-month-old baby killed by the deployment of an airbag. He was correctly positioned, in a safety seat designed for his age class, on the passenger side, and rear-facing. The accident occurred at low speed, on the left front of the car, without provoking any harm to the mother who was driving the vehicle, but the impact led to airbag deployment. A CT scan showed an occipital fracture, hemorrhagic parenchymal contusions, subarachnoid hemorrhage and edema, which quickly led to fatal intracranial hypertension. Severe retinal hemorrhages were also noted. Brain death was declared 24h later. Both direct impact and violent projection of the head are involved in the severity of brain lesions. Retinal hemorrhages are similar to what is observed in shaken-baby syndrome. To our knowledge, this is the first French publication on this topic in childhood. In France, children are allowed to be positioned on the passenger side seat, but the airbag, if present, is supposed to be deactivated, which is not always possible. In recent cars, depowering the airbag is easy, with on/off switches, but these systems are not uniform between models. Moreover, it is very likely that this possibility is ignored by numerous parents. A widespread communication on this topic should be initiated in France to prevent such events. Banning infants from front passenger seats completely does not seem possible. Nevertheless, greater attention on the part of police departments and better information to drivers appear necessary.

Abusive head trauma: past, present, and future.

Abusive head trauma has a robust and interesting scientific history. Recently, the American Academy of Pediatrics has endorsed a change in terminology to a term that is more general in describing the vast array of abusive mechanisms that can result in pediatric head injury. Simply defined, abusive head trauma is "child physical abuse that results in injury to the head or brain." Abusive head trauma is a relatively common cause of childhood neurotrauma, with an estimated incidence of 16 to 33 cases per 100,000 children per year in the first 2 years of life. Clinical findings are variable; AHT should be considered in all children with neurologic signs and symptoms, especially if no or only mild trauma is described. Subdural and retinal hemorrhages are the most common findings. The current best evidence-based literature has identified some features--apnea and severe retinal hemorrhages--that reliably discriminate abusive from accidental injury. Longitudinal studies of outcomes in abusive head trauma patients demonstrate that approximately one-third of the children are severely disabled, one third of them are moderately disabled, and one third have no or only mild symptoms. Abusive head trauma cases are complex cases that require a rigorous, multidisciplinary team approach. The clinician can establish this diagnosis with confidence if he/she maintains a high index of suspicion for the diagnosis, has knowledge of the signs, symptoms, and risk factors of abusive head trauma, and reasonably excludes other etiologies on the differential diagnosis.

Attempted auto-enucleation in two incarcerated young men with psychosis

Auto-enucleation is a sign of untreated psychosis. We describe two patients who presented with attempted auto-enucleation while being incarcerated. This is an observation two-case series of two young men who suffered untreated psychosis while being incarcerated. These young men showed severe self-inflicted ocular trauma during episodes of untreated psychosis. Injuries included orbital bone fracture and dehiscence of the lateral rectus in one patient and severe retinal hemorrhage and partial optic nerve avulsion in the second patient. Auto-enucleation is a severe symptom of untreated psychosis. This urgent finding can occur in a jail setting in which psychiatric care may be minimal.

Toxoplasmosis en pacientes del Hospital Obrero de Lima

Se ha realizado una investigación para detectar anticuerpos específicos para Toxoplasma en 32 pacientes del hospital Obrero de Lima, de los que 13 fueron tomados al azar entre los hospitalizados en Servicios de Medicina General; 15 procedían del Servicio de Oftalmología y presentaban síntomas y/o signos de toxoplasmosis y 4 del Servicio de Obstetricia. Están incluídos 25 hombres y 7 mujeres. Se usó la reacción de fijación del complemento (RFC), según la técnica del 50% de hemólisis de Bozicevich y la reacción de hemaglutinación (RHA), por la técnica del micrométodo en placa. El antígeno de toxoplasma empleado fue proporcionado por el National Communicable Disease Center de Atlanta, Georgia. En 15 (46,87%), la serología fue positiva; de éstos, 8 estaban entre 21 y 30 años de edad y 5 entre 31 y 50, vale decir en la etapa de mayor capacidad de trabajo. De 4 con sintomatología obstétrica, 3 tuvieron serología positiva y de ellas, una refirió 7 embarazos con síntomas de amenaza de aborto, de los que 4 terminaron en aborto y, la otra, 6 embarazos de los que 3 terminaron en aborto; la tercera presentó coriorretinitis y desprendimiento de retina. La serología fue positiva en 5 de los 12 varones con síntomas y/o signos de toxoplasmosis. En 2, se encontró uveítis severa unilateral, hemorragias retinales, nódulos de Koeppe y de Busaca y, en 3 coriorretinitis, desprendimiento retinal y en una estrabismo divergente. En 13 hombres y 3 mujeres que no presentaron síntomas y signo, hubo 7 positivos. Se ha tratado de demostrar no sólo la difusión e importancia clínica y epidemiológica de ésta parasitosis, sino también la gravedad de la patología obstétrica y lesiones oculares que causa entre los asegurados obreros de Lima.