Diabetic retinopathy (DR) is a microvascular disorder occurring due to the long-term effects of diabetes, leading to vision-threatening damage to the retina. The human body has an elaborate system for managing and regulating the number of key trace metals circulating in the blood and stored cells. Inadequate zinc (Zn) and concurrent excess of copper (Cu) levels are associated with an increased level of oxidative stress, which may aggravate the microvascular lesions in diabetes mellitus. Several studies have revealed a significantly lower serum Zn concentration and increased Cu levels in DR when compared with diabetic patients without retinopathy and normal controls. These abnormalities are correlated with the duration of diabetes and higher levels of HbA1C. Multiple pathological mechanisms are proposed to explain these changes including hyperzincuria associated with polyuria, glycosuria, and proteinuria in diabetic patients, as well as impaired absorption of Zn at the gastrointestinal level. Increased levels of free Cu ions may be attributed to glycation and the release of Cu ions from the Cu-binding sites of proteins. Zn supplements and selective Cu chelators may be useful to alleviate oxidative stress and prevent DR progression.

Myasthenia gravis(MG)is an antibody mediated, T cell dependent autoimmune disease characterized by a disorderof neuromuscular junction with progressive inability to sustain a maintained or repeated contraction of striated muscle. It is represented by antibodies directed against the nicotinic acetylcholine receptors (nAchR) of the post junctional membranes. We present the case of an 82-year-old patient, who was admitted to the hospital for plasmapheresis due to an aggravation of her auto-immune generalized myasthenia. The clinical examination at admission revealed ptosis, dysphagia, a medium effort dyspnea, difficulties in closing the mouth, dysphonia with a nasal voice and limited walking with a bent head and camptocormia, with Osserman score 46/100 (diplopia and bilateral ptosis). The thoracic scanner describes a tissue lesion in the thymus region with a diameter of 35 mm corresponding to a thymoma. The Magnetic Resonance Imaging confirmed the possible thymoma. A thymectomy using video-assisted thoracoscopic surgery (VATS) technique was performed according to the age and general status of the patient. Post-operative histological examination revealed a B2 type thymoma and the TNM staging system classifies the thymoma as being T1bNx.  

Klebsiella pneumoniae has emerged as the predominant pathogenic agent of liver abscess in Asia, and the incidence is increasing worldwide. Hypervirulent strains are associated with septic metastatic dissemination in the eyes, lungs, and central nervous system, causing severe morbidity. We present the case of a 54year old man, with no previous comorbidities, admitted in emergency for the blind red painful eye. Further investigation documented septic endophthalmitis with transscleral extension and orbital cellulitis. Thoraco-abdominal computed tomography evidenced a hepatic abscess as the locus of the primary infection. Intravenous antibiotherapy with cefuroxime, followed by meropenem and vancomycin were efficient for managing the hepatic abscess. However, as the eyeball was perforated at the admission, evisceration was performed. The vitreous sample revealed Klebsiella pneumoniae, with a positive string test as the etiologic agent. The diagnostic and therapeutic management required a permanent collaboration between an ophthalmologist, infectious diseases specialist, surgeon, and radiologist.