Case series of central retinal artery occlusion in COVID-19-associated rhino-orbital-cerebral mucormycosis

Rhino orbital Mucormycosis caused by filamentous fungus of mucoraceae family was considered a rare disease affecting immunocompromised and diabetics with ketoacidosis until the recent COVID 19 pandemic. We are presenting a series of six cases of Rhino orbital cerebral Mucormycosis with central retinal artery occlusion. All six cases had common history of COVID 19 infection in recent past with sinusitis, proptosis and total ophthalmoplegia with central retinal artery occlusion on presentation. MR imaging showed invasive pan sinusitis with orbital and cerebral involvement. Urgent debridement was done and histopathological examination showed broad, filamentous aseptate fungi suggestive of Mucormycosis. All patients inspite of intravenous Amphotericin B with local debridement did not show any improvement and expired within a week of presentation. Hence our study shows poor prognosis of post covid 19 associated Mucormycosis with central retinal artery occlusion.

Comparing the efficacy of sodium hyaluronate eye drops and carboxymethylcellulose eye drops in treating mild to moderate dry eye disease

Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2?year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8?week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t?test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.

A simple technique of meibography for morphological and functional evaluation of meibomian glands in dry eye conditions

Purpose: Dry eye disease (DED) is because of a decrease in the tear film’s volume or a change in the composition of tears. Evaporative dry eye is the most common type, which is due to meibomian gland dysfunction (MGD). In this study, the morphology of meibomian glands was evaluated in all kinds of dry eyes to look for any loss of meibomian glands, assess the function of remaining glands, and investigate the relationship between anatomy, function, and severity of DED. Methods: A total of 300 patients were included in the study, with 150 eyes in the study group and 150 in the control group. Meibomian gland morphology was assessed by examining the tarsal plate after everting the eyelids. Tear film function was evaluated using tear film break?up time (TBUT) and Schirmer’s test (SCH I and II). Meibomian gland morphology was examined with a slit?lamp under magnification, a transilluminator using a small light emitting diode (LED) bulb, and non?contact meibography using an auto refracto?keratometer (ARK). Results: Females had a higher prevalence of dry eyes in our study. In all, 103 eyes (68.6%) in the study group had evaporative dry eye, making it the most prevalent type. Among the 150 controls, 104 controls with 69.3% had no dry eye symptoms, and in those with symptoms, the evaporative type was the most common, with a 28% prevalence. Conclusion: TBUT should be performed in all patients with detectable MG abnormality. Meibography has high specificity and sensitivity to diagnose MGD and in turn dry eyes and should be considered a routine screening modality.

A comparison of sub-tenon block with peribulbar block in small-incision cataract surgery

Purpose: To compare the efficacy and safety of sub?tenon block to peribulbar block with respect to analgesia, akinesia, and complications. Methods: It is an observational study conducted at a government hospital in Karnataka. Seventy patients who came to the ophthalmology OPD for small?incision cataract surgery (SICS) under local anesthesia were included in the study. The participants were divided into two groups of 35 as per the surgeon. The pain was evaluated at the time of administration of the block, during the surgery, and during the postoperative period of 4 h. Akinesia was noted in both the groups and the time of onset of akinesia was noted. Any complications associated with the block such as chemosis or subconjunctival hemorrhage were also noted. Statistical analysis was done using PSS version 25.0, where P < 0.05 was considered significant. Results: The baseline pain score was higher in the peribulbar group (1.57). The onset of akinesia was faster in sub?tenons (90.34 s). Complete akinesia was achieved in 82.9% of patients after peribulbar block. There was no significant difference in complications in both groups. Conclusion: Sub?tenons block is an effective and safer technique of ocular anesthesia for SICS. It can be considered as an alternative to the conventional peribulbar block for SICS.

Efficacy And Safety Of Radio Frequency Ablation (RFA) In Treatment Of Liver Tumours: A Study Of 52 Patients

Silicosis is an occupational disease reported in silica, stone & mining industry. No proper report on workers in industries using silica in stones and coal has been done from Chhattisgarh till date. Detailed history, lung functions and chest x-ray were done. Diagnosis was made on the basis of radiology & history. Data analysis was done with the help of the statistical package for social sciences software. The Chi-square test was used for determining the relationship between qualitative data and descriptive statistics was used where required. Out of the total 16 reported cases, 13 had respiratory symptoms. Radiological abnormalities were noted in all. Lung functions revealed obstruction in 25%, restriction in 12.5 %, while mixed ventilatory defects in 62.5% subjects. 16 cases of silicosis and silicotuberculosis were reported. They had high respiratory morbidity (81.25%), cough and dyspnea being predominant symptoms. Duration of exposure correlates with radiological findings and increased incidence of silicosis

Pharmacovigilance: a study to evaluate knowledge, attitude, and practices of and impact of educational intervention among doctors in teaching hospital, in rural area of Jalna, India.

Background: According to WHO Pharmacovigilance is “The science and activities which are related to the detection, assessment, understanding, and the prevention of adverse effects or any other drug-related problems.” A majority of India’s population prefers government hospitals when they are in need of health care facilities. The patients also prefer other available free health care facilities. Hence, these hospitals can be a good source for generating an adverse drug reactions database. However, the Herculean task is to foster a culture of reporting among the doctors, especially among the junior doctors, as they are more closely associated with the patient care, hence the present study to assess awareness of pharmacovigilance among the doctors and to evaluate the impact of an educational intervention for improving awareness of pharmacovigilance among doctors in an Indian tertiary care teaching hospital. Methods: A suitable self-administered knowledge, attitude, practice (KAP) survey questionnaire was designed, based on previous studies. An interventional educational activity was organized and the impact of the educational Intervention was evaluated by again administering the similar questionnaire. The statistical analysis was carried for comparing the pre- and post-intervention. Results: It was seen that the KAP of pharmacovigilance among doctors is low. The results also showed that there was an improvement after the educational intervention. Conclusions: The KAP of pharmacovigilance is low among doctors and educational intervention can improve it.

Type 2 diabetes mellitus affects male fertility potential.

Objective: Diabetes is a syndrome that affects all the physiological systems of the body, therefore this study was undertaken to compare the seminogram parameters in diabetics and non- diabetics. Study design: The study was carried out at Male Infertility and Reproductive Physiology unit in the Department of Physiology, MGIMS, Sevagram, Wardha. 25 normozoospermic subjects with type 2 diabetes and 25 normozoospermic non diabetic subjects were recruited in the study. The semen samples were analyzed for sperm concentration, motility and morphology. Results: In diabetic group the sperm concentration was 24.6 millions/ml with the motility of 52.3% and normal morphology 31.5%, while in non-diabetic group the sperm concentration was 42.7 millions/ml with 63.1% motility and 47.2% normal morphology. Conclusion: Thus our observations indicate that there is a detrimental effect of type 2 diabetes mellitus on semen parameters.

Effect of honey on hepatotoxicity induced by antitubercular drugs in albino rats.

Background: Drug-induced hepatotoxicity is a potentially serious adverse effect of antituberculosis treatment (ATT) regimens containing isoniazid, rifampicin and pyrazinamide. Many in vitro and in vivo studies revealed that honey possess antioxidant property and hepotoprotective property but there is no systematic work available to test the effect of honey on antitubercular drugs induced hepatotoxicity in rats. Hence present study was carried out to explore the prophylactic and therapeutic effect of honey with its antioxidant activity against hepatotoxicity induced by antitubercular drugs (Isoniazid, Rifampicin and Pyrazinamide) in albino rats. Methods: Hepatotoxicity in rats treated with antitubercular drugs (Isoniazid, Rifampicin and Pyrazinamide) was studied by assessing parameters such as Serum alanine aminotransferase (ALT), Serum aspartate aminotransferase (AST), Serum total protein, Serum Malondialdehyde (MDA) and Serum Superoxide dismutase activity (SOD). The effect of Honey as co-administration and administration after establishment of hepatotoxicity on above parameter was investigated. These biochemical observations were supplemented by Histopathological examination of liver. Results: Honey significantly reversed changes in serum levels of AST, ALT, MDA, SOD, total protein and also histopathological changes produced by Antitubercular drugs. It was found that honey significantly prevented as well as reversed Antitubercular drugs induced hepatotoxicity and antioxidant activity. Conclusions: The results of present study show that honey has significant prophylactic and therapeutic value against antitubercular drugs induced hepatotoxicity.

Ventilatory strategies and adjunctive therapy in ARDS.

Acute respiratory distress syndrome, a diagnosis based on physiologic and radiological criteria, occurs commonly in critical care setting. A major challenge in evaluating therapies that may improve survival in ARDS is that it is not a single disease entity but, rather, numerous different diseases that result in endothelial injury, where the most obvious manifestation is within the lung resulting in pulmonary oedema. It has been shown that poor ventilatory technique that is injurious to the lungs can propagate systemic inflammatory response and adversely affect the mortality. The current data suggest that high tidal volumes with high plateau pressures are deleterious and a strategy of ventilation with lower tidal volumes and lower plateau pressure is associated with lower mortality. There may be a role for recruitment manoeuvres as well. Other forms of respiratory support still require further research. The present understanding of optimal ventilatory management and other adjunctive therapies are reviewed.

Exudative pleural effusions in patients over forty years of age--an analysis of seventy-six patients.

A prospective study of 76 consecutive patients over the age of 40 years, with exudative pleural effusion, was undertaken to determine the common causes of such a clinical condition. Malignant pleural effusions were the most common in this series, found in 49 patients (64.47%), all but one being metastatic from elsewhere. Forty were secondary to a carcinoma of the bronchus, 3 from carcinoma of the breast, 1 each from carcinoma of the ovary, oesophagus, and larynx; lymphoma accounted for the remaining 2. Infective causes accounted for 24 of the effusions (31.57%). Of the infections, tuberculosis was the most common, accounting for 17 of the 24. Other infective causes included bacterial empyemas in 4, ruptured amoebic liver abscess in 2, and actinomycosis in 1. Pancreatitis, pulmonary thromboembolism, and a post-cardiotomy syndrome were diagnosed in 1 patient each, while the diagnosis remained unknown in the remaining 5 patients. In 2 patients the diagnosis was made on autopsy.