Dengue related maculopathy and foveolitis

A 24 year-old Malay lady presented with high grade fever,myalgia,generalized rashes,severe headache and was positive for dengue serology test.Her lowest platelet count was 45×10~9 cells/L.She complained of sudden onset of painlessness,profound loss of vision bilaterally 7 days after the onset of fever.On examination,her right eye best corrected vision was 6/30 and left eye was6/120.Her anterior segment examination was unremarkable.Funduscopy revealed there were multiple retinal haemorrhages found at posterior pole of both fundi and elevation at fovea area with subretinal fluid.Systemic examination revealed normal findings except for residual petechial rashes.She was managed conservatively.Her vision improved tremendously after 2 months.The retinal hemorrhages and foveal elevation showed sign of resolving.Ocular manifestations following dengue fever is rare.However,bilateral visual loss can occur if both fovea arc involved.

Critical pathogenic steps to high risk Helicobacter pylori gastritis and gastric carcinogenesis

Helicobacter pylori(H.pylori)gastritis may progress to high risk gastropathy and cancer.However,the pathological progression has not been characterized in detail.H.pylori induce persistent inflammatory infiltration.Neutrophils are unique in that they directly infiltrate into foveolar epithelium aiming the proliferative zone specifically.Neutrophilic proliferative zone foveolitis is a critical pathogenic step in H.pylori gastritis inducing intensive epithelial damage.Epithelial cells carrying accumulated genomic damage and mutations show the Malgun(clear)cell change,characterized by large clear nucleus and prominent nucleolus.Malgun cells further undergo atypical changes,showing nuclear folding,coarse chromatin,and multiple nucleoli.The atypical Malgun cell(AMC)change is a novel premalignant condition in high risk gastropathy,which may progress and undergo malignant transformation directly.The pathobiological significance of AMC in gastric carcinogenesis is reviewed.A new diagnosis system of gastritis is proposed based on the critical pathologic steps classifying low and high risk gastritis for separate treatment modality.It is suggested that the regulation of H.pylori-induced neutrophilic foveolitis might be a future therapeutic goal replacing bactericidal antibiotics approach.

Ophthalmic complications related to dengue fever: a case report

Two patients aged of 30 and 22(female in cases 1,and male in case 2) both complained of unilateral blurring of vision and scotoma within a week of being diagnosed with dengue fever.No other abnormal findings were found in their anterior segment.Retinal examination revealed blurring of the optic disc margin and several white spots in the posterior in both cases.Optical coherence tomography(OCT)imagery revealed that the white spots were only located in the retinal outer layers.Macular cystic foveolitis were also found in case 1 and diffused macular edema in case 2.In case 1,visual and retinal recovery were seen to resolve spontaneously.In case 2,patient had complete visual recovery two months after onset of the disease after being treated with steroids but central scotomata has continued to persist.