Purpose: To report a patient with MEWDS.Patient and findings: A 65-year-old man presented with sudden decrease of vision in his right eye. On ophthalmoscopy of the involved eye, numerous small discrete white lesions were detected superficially and deep in the retina around the disc and macula. On visual field examination, enlargement of the blind spot was detected. Fluorescein angiography was unremarkable. On electroretinography, the a-wave was decreased minimally. The patient was followed and after 2 months, significant improvement of visual acuity and visual field was observed.Conclusion: MEWDS is a rare intraocular inflammatory disease of unknown etiology and in contrast to our patient, more frequent in females. The natural course is generally benign with spontaneous disappearance of the lesions and improvement of vision in 6 to 8 weeks.

Background: Individuals with serious mental illness face challenges in managing their health, leading to the need for integrating their needs and preferences in care decisions. One way to enhance collaboration between users and providers is to improve clinical governance; a shared responsibility between managers and providers, supported by healthcare organizations (HCOs), policies, and standards. We applied the concept of clinical governance to understand (1) how managers and providers can enhance the involvement of users in mental health, (2) the contextual and organizational factors that facilitate user involvement in care, and (3) the users’ perceptions of their involvement in care. Methods: We conducted two, in-depth case studies from two clinical teams in Canada offering outpatient care for users with acute mental illness. A total of 25 interviews were carried out with managers, and four focus groups were held with providers. A measure of patient-reported experience was used to evaluate the users’ perceptions of their involvement in care. Results: The providers used two methods to involve users in the care planning process: encouraging users to identify their life goals and supporting them to define recovery-oriented objectives. To encourage the adoption of collaborative practices, the managers used various practices such as revising care protocols, strengthening providers’ knowledge of best practices and integrating peer-support workers (PSWs) in the team. Compliance with organizational and external commitments/requirements for user involvement, access to specific training and the institutionalization of a culture promoting user involvement facilitated the adoption of collaborative practices. We found that mental health teams that adopt recovery and collaborative practices with users show a high degree of user-perceived involvement in care. Conclusion: This is the first study to apply the concept of clinical governance to understand how managerial and clinical practices, and other organizational and contextual factors, can enhance the involvement of mental healthcare users.

Introduction: Myocardial bridging is a congenital condition in which a segment of a major epicardial coronary artery has an intra myocardial route. Myocardial bridging is usually confined to a single vessel and is typically the mid segment of the left anterior descending artery. Bridging may be associated with chest pain, myocardial infarction, and sudden cardiac death, or usually asymptomatic.Case Report: A 59 year-old women with diabetes mellitus and hypertension presented with dyspnea and chest pain on exercise. Physical exam, electrocardiography and echocardiography were intact. In angiography, we found severe stenosis of left main coronary artery and severe stenosis of three coronary artery (Three Vessel Disease) as well as Multiple myocardial bridges at the end of right coronary artery.Conclusion: Myocardial bridging is a rave condition, however, it be considered in patients facing recurrent chest pain, it has severe complication such as sudden cardiac death.

Purpose: To report a case of severe macular edema following the taking of fingolimod in Multiple sclerosis.Case Report: A 34-year-old woman with a long history of relapsing-remitting Multiple sclerosis presented complaining of blurred vision in the left eye that started 1 week before the presentation. She had been taking fingolimod for 4 months. She was not diabetic and had no history of uveitis but reported an episode of retrobulbar optic neuritis in both eyes. The initial ophthalmic examination, which was performed 2 weeks before initiating fingolimod, revealed a best corrected visual acuity (BCVA) of 20.25 OU and no ocular abnormalities. Upon the recent presentation, BCVA was 20.25 OD and 20.70 OS and there was no afferentpapillary defect. The examination of anterior segment and anterior vitreous was unremarkable. Retinal examination of the left eye revealed cystoid macular edema with no other inflammatory signs or vascular changes. The findings of spectral domain optical coherence tomography (SD-OCT) were compatible with macular edema and indicated that the central macular thickness (CMT) was 605 microns. Fingolimod was discontinued and sinarolac was started three times daily. After 6 weeks, BCVA was 20.25 OD and 20.30 OS.Macular edema was resolved clinically and SD-OCT exhibited a significant reduction in macular edema with a CMT of 277 microns.Conclusion: Fingolimod-associated macular edema is a benign complication of the drug used for Multiple sclerosis and. This complication responds well to the drug discontinuation and topical non-steroidal antiinflammatory administration.