Indications and types of keratoplasties: Trends in the past 10 years (2011-2020) in Eastern India

Purpose: To observe the trends of various types of keratoplasties in different etiologies over a period of 10 years (2011?2020) in a tertiary eye care center of eastern India. Methods: A retrospective review of patients undergoing keratoplasties from 2011 to 2020 was performed in a tertiary eye care hospital situated in eastern part of India. Apart from demographic data, primary indication for each surgery and type of procedure carried out was recorded. For comparison, data were divided into two time periods: Group I: Jan 2011 to Dec 2015 and Group II: Jan 2016 to Dec 2020. Results: Over a period of 10 years, a total of 2365 (Group I: 902, Group II: 1463) keratoplasties were performed. The average age of patients was 45.8 � 19.9 and 46.9 � 20.9 years in Group I and Group II, respectively. Among all the corneal grafts, 1747 (74%) surgeries were full?thickness. Although optical penetrating keratoplasty (OPK) was most the common indication for full?thickness keratoplasties, Descemet抯 stripping endothelial keratoplasty (DSEK) remained most performed lamellar keratoplasty. Keratitis, corneal scars, and bullous keratopathies remain to be most common indications in both groups. Number of lamellar keratoplasties increased significantly from Group I to Group II for corneal scars (P = 0.02), bullous keratopathies (P = 0.01), and endothelial dystrophies (P = 0.00). Conclusion: With change in time, the indication and technique of keratoplasty has witnessed a changing trend from full?thickness keratoplasty to lamellar keratoplasty. There is rise in trend of lamellar keratoplasties over the period

Isolated tubercular dacryoadenitis in a non-immunocompromised healthy adult

A middle-aged woman presented with a slowly enlarging mass in the right superotemporal orbit and ptosis. The patient had an elevated erythrocyte sedimentation rate, and incisional biopsy showed granulomatous inflammation with Langhan's giant cells suggestive of a tubercular etiology. Tuberculin skin test was negative. The patient responded well to anti-tuberculous therapy. Tubercular dacryoadenitis is a rare presentation of a lacrimal gland mass.

Homologous Assay Development for Detection of Dexamethasone using HRP as Label Enzyme

Background: Dexamethasone is a synthetic corticosteroid similar to cortisol produced naturally by the adrenal glands. As an anti- inflammatory and immunosuppressive agent, it is used in many diseases such as rheumatoid arthritis and allergic anaphylactic shock, and its suppression test to diagnose Cushing's syndrome. Its further use includes its administration before antibiotics in bacterial meningitis, antitumor treatment, for treatment of glucocorticoid resistance, Addison抯 disease, and congenital adrenal hyperplasia. The drug is abused by using it in animal husbandry as a growth promoter and in horse sports to enhance their performance. Methods: In this study, the development of homologous ELISA using Dexamethasone-21-hemisuccinate (DEX-21-HS)-Bovine serum albumin antiserum and Dexamethasone-21-hemisuccinate (DEX-21-HS)-Horseradish peroxidase enzyme conjugate has been done. The n-hydroxysuccinimide ester method was used to prepare the immunogen and enzyme conjugate. Results: The sensitivity 0.25 ng/mL, affinity 2.8x10-8 L/mol and ED50 4.98 ng/mL of the assay were found. The cross-reactivity of the assay was checked and found with three steroids (Corticosterone- 1.13%, Progesterone- 2.25% and Prednisolone- 6.3%) out of 48 structurally related steroids. Then, analytical variables of the developed assay were studied, such as recovery (98.55% to 105.08%), precision (Inter and Intra- assay coefficient of variation <9.28%), correlation (R2= 0.98) by utilizing a commercially available Dexamethasone kit for comparison. Conclusion: This study concluded that low-cost indigenous ELISA for Dexamethasone had been developed, which can give results within 75-80 minutes.

ANAESTHETIC MANAGEMENT OF A PATIENT WITH HYPERHOMOCYSTEINEMIA FOR TOTAL ABDOMINAL HYSTERECTOMY

Hyperhomocysteinemia is a disorder caused by a disruption of any of the enzymes or cofactors involved in the pathways of homocysteine metabolism. The resultant high plasma levels of homocysteine increase the risk for thromboembolic events. These patients are frequently anticoagulated in the perioperative setup. Interruption of anticoagulant therapy may subject the patient to an increased risk of thrombosis, infarction, and death. Neuraxial anaesthesia techniques may be relatively contraindicated in anticoagulated patients and nitrous oxide may exacerbate the condition by inhibiting the conversion of homocysteine to methionine. We describe a case of the anaesthetic management of a unique case of hyperhomocysteinemia with multiple recent thrombotic episodes proposed for total abdominal hysterectomy conducted under general anaesthesia, the intraoperative and postoperative monitoring and considerations.

The effect of social determinants of health on severity of microbial keratitis presentation at a tertiary eye care hospital in Southern India

Purpose: Understanding the association between social determinants of health (SDoHs) and microbial keratitis (MK) can inform underlying risk for patients and identify risk factors associated with worse disease, such as presenting visual acuity (VA) and time to initial presentation. Methods: This was a cross?sectional study was conducted with patients presenting with MK to the cornea clinic at a tertiary care hospital in Madurai, India. Patient demographics, SDoH survey responses, geographic pollution, and clinical features at presentation were collected. Descriptive statistics, univariate analysis, multi?variable linear regression models, and Poisson regression models were utilized. Results: There were 51 patients evaluated. The mean age was 51.2 years (SD = 13.3); 33.3% were female and 55% did not visit a vision center (VC) prior to presenting to the clinic. The median presenting logarithm of the minimum angle of resolution (logMAR) VA was 1.1 [Snellen 20/240, inter?quartile range (IQR) = 20/80 to 20/4000]. The median time to presentation was 7 days (IQR = 4.5 to 10). The average particulate matter 2.5 (PM2.5) concentration, a measure of air pollution, for the districts from which the patients traveled was 24.3 ?g/m3 (SD = 1.6). Age? and sex?adjusted linear regression and Poisson regression results showed that higher levels of PM2.5 were associated with 0.28 worse presenting logMAR VA (Snellen 2.8 lines, P = 0.002). Patients who did not visit a VC had a 100% longer time to presentation compared to those who did (incidence rate ratio = 2.0, 95% confidence interval = 1.3–3.0, P = 0.001). Conclusion: Patient SDoH and environmental exposures can impact MK presentation. Understanding SDoH is important for public health and policy implications to mitigate eye health disparities in India.

Comparative evaluation of effectiveness of twenty versus fifty percent autologous serum eye drops in treatment of dry eye

Purpose: The objective of the study was to compare the efficacy and safety of two concentration of autologous serum (AS) 20% vs 50% in recalcitrant moderate?to?severe dry eye patients. Methods: A double?blind prospective, interventional, and randomized study was done on 44 patients (80 eyes) clinically diagnosed with moderate?to?severe dry eye disease (DED) that was refractory to conventional treatment, and all patients were treated with AS20% or AS50% for 12 weeks. We documented Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), OXFORD corneal staining score (OSS), and Schirmer test (ST) at baseline, 2,4,8, and 12 weeks. These parameters were compared in both groups and between the groups by using Student’s t?test. The study included 11 males and 33 females. Results: Out of 80 eyes, 33 eyes had moderate and 47 had severe DED. The age of patients in AS20% was 44.73 ± 14.37 years, and in AS50% was 46.41 ± 14.47 years. The most common etiology associated with DED was secondary Sjogren syndrome. In moderate DED, both the groups showed significant improvement in both subjective and objective parameters. But in severe DED, the AS20% group failed to show any significant improvement objectively, though subjective improvement was present. Conclusion: In refractory severe DED patients, AS50% is better option for treatment and in moderate DED both concentrations of autologous serum are effective.

Burkholderia Pseudomallei Infection in a Diabetic Patient Presenting as Multiple Splenic Abscesses — A Case Report

Background : Meliodosis is an infection by Burkholderia Pseudomallei, is now endemic in India. It can have varied clinical manifestations. We report a case of Meliodosis in a diabetic patient presented as multiple Splenic Abcesses. Case Report : A 56-year-old male patient, manual labour, diabetic with uncontrolled glycemic levels presented with prolonged Fever and abdominal pain which on evaluation revealed multiple Splenic Abscesses. Culture of aspirate from abscess grew Burkholderia Pseudomallei. He improved with appropriate antibiotic therapy and Splenectomy. Conclusion : The case is presented to highlight the importance of making early clinical and microbiological diagnosis for a better outcome

Socio-Economic Status As An Associate Of Emotional Competence Of Secondary School Students

The study aims to find out the association between socio-economic status (SES) of the family and emotional competence (EC) of secondary school students by taking the construct as a whole and in terms of of its component factors. The cross- sectional study collected data from a stratified random sample of 866 students from the secondary schools of Ernakulam and Thrissur districts (Kerala, India), representing the population of adolescents in the age range 13-15, studying in the secondary classes (Std. VIII to X) of schools affiliated to the Board of Public Examinations, Govt. of Kerala. Data were collected by administering the Emotional Competence Scale for Secondary School Pupils (Rekha & Salim Kumar, 2015) and the Socio-Economic Status Scale (Usha & Vijayan, 2014). Chi-square test of association was employed to analyse the data inferentially. The result revealed the presence of significant association between SES of the family and emotional competence in total and two of the constituent factors of EC, viz., self-awareness and relationship management

Morbidity Pattern among the Farm House Residents in Vijayapur District, Karnataka � A Cross Sectional Study

Background : Agriculture Workers have a multitude of health problems, a fact which is often forgotten because of widespread misconception that occupational health is mainly concerned with industry and industrialized countries. The health problems of workers in agricultural field may be accidents (Snake and insect bites), toxic hazards (chemical exposure and insecticide poisoning), physical hazards (extreme conditions and solar radiation) and respiratory problems (farmer抯 lung and occupational asthma). Objectives : To study the morbidity pattern among the Farm house residents. Material and Methods : A cross sectional study was conducted among the farm house residents in rural areas of Vijayapura district. A Sample of 450 farm house residents were interviewed by pre-structured proferma containing information regarding Socio demographic profile, present and past six months morbidities. In each Taluka, the selection of households was done by considering villages as the Primary Sampling Unit (PSU). PSUs were selected with probability proportional to size sampling and 5 households in a selected PSU were selected by random sampling.All characteristics were summarized descriptively, Chi-square (?2) test was employed to determine the significance of differences between groups for categorical data. Results : The findings of the present study among Farm dwellers in the rural area of vijayapura district revealed that majority at the time of study were having Anaemia followed by Respiratory Infection and majority of Farm dwellers in past six months were having Dental carries as a morbidity followed by Respiratory infection. Conclusion : The present study concludes that overall majority of the Farm house residents presently suffering from Non-communicable Diseases (54%) followed by Communicable Diseases (46%).

Efeito do treinamento pliométrico de curta duração no salto vertical e velocidade de sprint em jogadores de vôlei / Effect of short duration plyometric training on vertical jump and sprint speed in volleyball players

INTRODUÇÃO: O voleibol é um esporte de ritmo acelerado que envolve projeções verticais e horizontais da bola por parte do jogador. O uso de treinamento pliométrico é um método popular para melhorar o desempenho dos jogadores. OBJETIVO: O presente estudo visa verificar o efeito de quatro semanas de treinamento pliométrico em jogadores de voleibol. MÉTODO: Estudo randomizado, controlado, de grupos paralelos. Foram triados 39 participantes para participação no estudo, dos quais 30 foram selecionados seguindo os critérios de inclusão e exclusão da pesquisa. Os critérios de inclusão foram: jogadores de voleibol na faixa etária de 18 a 24 anos, de ambos os sexos, experiência de jogo de no mínimo um ano e disponibilidade para participar. Os critérios de exclusão compreendiam jogadores com histórico de lesão nos últimos seis meses, qualquer distúrbio neurológico ou musculoesquelético e qualquer condição psicológica. Os participantes selecionados foram alocados aleatoriamente no Grupo A e Grupo B usando o método de sorteio. O Grupo A recebeu treinamento pliométrico por três dias em uma semana, e o Grupo B foi solicitado a continuar seus exercícios regulares de rotina. A duração total da intervenção foi de quatro semanas. A medida de resultado para o estudo foi a velocidade do sprint e a altura do salto vertical. A velocidade de sprint foi medida pelo teste de sprint de 20 m e a altura do salto vertical foi medida pelo teste sargent jump. A avaliação foi feita no início e no final de quatro semanas. O teste t não pareado foi usado para analisar as diferenças entre os grupos e o teste t pareado foi usado para analisar as diferenças dentro do grupo nas variáveis de resultado. RESULTADOS: O resultado do estudo mostrou uma melhora significativa na altura do salto vertical (MD= -7,133, IC 95% (-12,657,- 1,609) e nenhuma melhora significativa na velocidade do sprint quando comparações entre grupos foram feitas (MD=0,084, 95% IC (-0,177,-,345) com um tamanho de efeito de 0,75 para a altura do salto vertical. A comparação dentro do grupo foi considerada significativa apenas para a altura do salto vertical no Grupo A, e não houve melhora significativa na velocidade de sprint para ambos Grupo A e B. CONCLUSÃO: Quatro semanas de programa pliométrico é eficaz em melhorar a altura do salto vertical e não a velocidade de sprint em jogadores de voleibol.

INTRODUCTION: Volleyball is a fast-paced sport that involves vertical and horizontal projections of the ball by the player. The use of plyometric training is a popular method to enhance performance in players. OBJECTIVE: The present study aims to see the effect of short-duration plyometric training on vertical jump and sprint speed in volleyball players. METHOD: This study is a parallel group randomized controlled trial. Thirtynine participants were screened for participation in the study, of which 30 were selected following the inclusion and exclusion criteria for the study. The inclusion criteria for the study comprised of volleyball players of age group 18 to 24 years, both males and females, with playing experience of at least one year, and willing to participate. The exclusion criteria for the study included players with a history of injury in the last six months, any reported neurological or musculoskeletal disorder, and any psychological condition. The selected participants were randomly allocated to Group A and Group B using the lottery method. Group A was given plyometric training for three days a week and Group B was asked to continue their regular routine exercises and playing schedule. The total duration of the intervention was four weeks. The outcome measure for the study was sprint speed and vertical jump height. Sprint speed was measured by the 20 m sprint test, and the vertical jump height was measured by the Sargent jump test. The assessment was done at the baseline and at the end of four weeks. An unpaired t-test was used to analyze between-group differences, and paired t-test was used to analyze the within-group differences in the outcome variables. The significance level was set as p<0.05. RESULTS: The result of the study showed a significant improvement in vertical jump height (MD= -7.133, 95% CI-12.657, -1.609) and no significant improvement in sprint speed when between-group comparisons were made (MD=0.084, 95%CI -0.177,-.345) with an effect size of 0.75 for vertical jump height. The within-group comparison was found significant only for vertical jump height in Group A, and there was no significant improvement was found in sprint speed for both Group A and B. FINAL CONSIDERATIONS: The short-duration plyometric training is effective in improving the vertical jump height and not the sprint speed in volleyball players. The specificity of plyometric training is important for optimal improvement in sports performance.

Serum Vitamin D Level in Psoriasis: A Prospective Study in a Tertiary Care Centre of Eastern India

Background: Psoriasis is a systemic, inflammatory, chronic autoimmune disease characterized by multiple discoid plaques over body with silvery scales associated with cardiovascular diseases, obesity, diabetes mellitus, hypertension, and hyperlipidemia. Recently, association between psoriasis and Vitamin D level has also been reported. Our aim of study was to evaluate the association of vitamin D and its association with the severity of Psoriasis Materials and methods: 60 patients diagnosed with psoriasis, in our outpatient department from January 2021 to December 2021, were included the study. 58 age, gender- and skin phototype- matched healthy controls were included in the study. Results: The serum vitamin D level in patients and in the control group ranged from 7 to 24 ng/ml (mean: 13.04 �32 ng/ml) and from 16 to 65 ng/ml (mean: 23.91�08 ng/ml), respectively. The circulating vit D levels were less in patients compared to control. The analysis showed statistical significance (P< 0.05) between the two groups. Conclusion: Our results showed decreased level of vitamin D in patients suffering from psoriasis when compared to healthy controls. Vitamin D supplementation can be useful in psoriasis management.

Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis

Purpose: TO report the corneal manifestations in patients with COVID?19?associated rhino?orbito?cerebral mucormycosis (ROCM). Methods: This study was a retrospective, observational, and record?based analysis of patients of ROCM with corneal involvement. Results: A total of 220 patients were diagnosed with ROCM over a period of 3 months. Thirty?two patients had developed corneal manifestations. The mean age at diagnosis was 52.84 ± 12.8 years. The associated risk factors were systemic mucormycosis, uncontrolled diabetes, recent COVID?19 infection, and injudicious use of systemic steroids. Twenty?nine patients were known diabetics, 32 had recent COVID?19 infection, and 13 gave a history of injudicious use of steroids. The right eye (RE) was affected in nine patients, the left eye (LE) in 20 patients, and both eyes in three patients. Nine patients had a round?oval corneal ulcer. One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis. Three patients each had a corneal melt and inferior conjunctival xerosis with chemosis. Orbital exenteration was performed in six patients. Five patients with corneal ulcers healed. Topical eye drops of amphotericin (0.5 mg/ ml) cycloplegic, antiglaucoma medications, and lubricant eye drops were started along with systemic antifungals. Conclusion: Central corneal ulcer was the most common manifestation of mucormycosis. A concentration as low as 0.5 mg/ml of amphotericin eye drops was effective in the treatment.

Impact of pandemic COVID-19 lockdown on penetrating keratoplasty patients

Purpose: To study the impact of the COVID?19 lockdown on the regular follow?up of keratoplasty patients. Methods: This retrospective interventional case series included 30 patients who had immunological corneal endothelial rejection out of 190 patients who came for post?PKP follow?up between September 15, 2019, and September 30, 2020. The demographics, primary diagnosis, surgical technique, time of presentation, recovery of graft, associated ocular problems, and visual acuity at 1 month were analyzed. Forward stepwise (likelihood ratio) binary logistic regression was used to find significant variables. Results: The study population had 19 males (63.33%) and 11 females (36.67%). The mean age of the study group was 42.83 ± 18.89 (8–80) years. Of 30 patients, 19 (63.3%) presented before and 11 (36.7%) after the COVID?19 lockdown. Overall, 23 (77%) showed a reversal of graft rejection. Logistic regression showed that preoperative indications, large?sized grafts, and deep corneal vascularization were significant risk factors for non?resolution of graft rejection. It was noted that patients who presented to the hospital late had poor recovery (P = 0.002). The delay in the presentation was a significant risk factor for non?resolution of graft rejection (P < 0.01). Z?test for proportions revealed that the difference in the non?resolution of rejection on immediate or delayed treatment in patients presenting during lockdown (P = 0.002) was significant. Conclusion: This article is to highlight the impact of the COVID?19 lockdown on graft rejection recovery of PKP patients due to delays in follow?up. Early treatment helps in the recovery of graft transparency and the reversal of immunological graft rejection. Also, primary diagnosis, deep vascularization, and large?sized grafts were significant risk factors for non?resolution of graft rejection.

Practice patterns and opinions in the treatment of allergic eye disease: A survey among Indian ophthalmologists

Purpose: Management of allergic eye disease is seldom straightforward and often challenging. We conducted an online survey to elicit opinions on the preferred practice pattern in the treatment of allergic eye disease. Methods: An online survey questionnaire was sent to all practicing ophthalmologists using social media platforms. The respondents were asked about their clinical experience and preferred treatment in various scenarios such as mild?moderate vernal keratoconjunctivitis (VKC), chronic VKC, refractory VKC, steroid responders, giant papillae, and shield ulcer. Respondents were asked about the newer molecule (alcaftadine) and reservations regarding systemic immuno?suppressants and ordering allergy tests in their practice. Results: Ninety ? one participants responded to the survey. About 57.1% of ophthalmologists reported coming across more than 10 cases per week in their practice. The most common age group was 5–10 years (61.1%), but adult onset VKC was also reported at 41.6% (1–2 per month), 37.1% (3–5 per month), and 13.5% (more than 10 per month). The disease is perennially present (36.7%), and a mixed form has been reported by 47.8% of ophthalmologists. Dual?acting agents were preferred by 40% in mild?moderate clinical variants. Topical steroids in slow tapering dosage were preferred by 86.7% in their prescription. Tacrolimus 0.03% was preferred by 65.9% and given for at least 3 months of continuous usage by 47.6% of ophthalmologists. High?dose topical steroids were preferred for giant papillae (67.8%) and Shields ulcers (68.3%) in our survey. Supratarsal steroid injection was preferred by 50% in treating refractory VKC in our survey. Conclusion: Allergic eye disease is a common yet annoying disease. The signs and symptoms can vary from subtle, innocuous forms to devastating variants affecting vision and day?to?day work. This survey aims to elicit responses from clinicians spreading across different geographical areas and compares responses based on experience in practice

Assessment of SARS-CoV-2 virus in the tear secretion of conjunctivitis patients during COVID-19 pandemic

Purpose: To determine the presence of SARS?CoV?2 virus in the tear secretion of conjunctivitis patients during the COVID?19 pandemic. Methods: This observational, cross?sectional study was conducted in clinically diagnosed patients with conjunctivitis attending the outpatient services of our institute from July 2021 to December 2021. The tear samples were collected from patients using Schirmer’s strips or capillary tubes to detect the presence of SARS?CoV?2 by real?time PCR assay. COVID?19 vaccination and infection status, visual acuity, and clinical features were documented in all cases. Results: A total of 111 patients with symptoms of conjunctivitis were included during the study period. The mean age was 41.1 ± 13.1 years, and the mean duration of symptoms was 7.1 ± 4.4 days, with 74% males. Conjunctival congestion was mild in 69 (62.1%) patients, moderate in 30 (27%) patients, and severe in 12 (10.8%) patients. All except four had superficial punctate keratitis (SPK). Five (4.3%) patients were positive for SARS?CoV?2 RNA in their tear samples. All had mild–moderate conjunctival congestions with variable papiliofollicular reaction and SPKs, superficial hemorrhages were seen in three and pseudomembrane in one patient. They were followed up with telemedicine and three of them developed mild COVID?19?related symptoms and recovered after in?home quarantine. None of them had a previous history of COVID?19 infection and all had received COVID?19 vaccination within 2 weeks to 2 months. Conclusion: SARS?CoV?2 transmission through ocular secretion of conjunctivitis patients cannot be ignored and appropriate COVID?19?preventive behavior should be followed in ocular settings.

A Study on the Impact of Diabetes Mellitus on the Severity of COVID-19-Associated Mucormycosis

Objectives: Diabetes mellitus (DM) seems the most common predisposing factor for rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to study the impact of DM on the severity of COVID-19-associated ROCM (CAM). Methods:?This was a retrospective analytical study performed over a period of 3 months to assess the impact of DM on the severity of CAM in 100 patients and association of clinical correlates of DM with severity of CAM. Statistical analysis:?The data collected using the study tools were converted into a computer-based spreadsheet and analyzed. The statistical analysis comprised a descriptive analysis that involved calculating means, standard deviations, and proportions. For calculating the significance of the difference of mean between two groups, Student's t-test was applied. In addition, chi-square test (or Fisher's t-test if applicable) was applied to study the significance of association of clinical correlates of DM with severity of CAM for categorical variables and t-test for continuous variables. Results:?The prevalence of DM was 67%. The average presenting blood sugar level was 245.9?±?99.86?mg%. Glycated hemoglobin level between 4.5 and 6.5% was observed in 57 patients and over 6.5% in 43 subjects. A high body mass index (BMI) of 25 and above was noted in 52 patients. A significantly higher level of presenting blood sugar and a longer duration of hospital stay was noted in patients having stage 3b or higher (p?<?0.05) when compared with those having stage 3a or below. No significant correlation was observed in patients in stage 3a or below and those presenting with stage 3b or higher in terms of BMI, waist to hip ratio, or total cholesterol levels. There was a strong correlation between blood sugar level at presentation, severity of DM with the severity of ROCM, and a strong inverse correlation noted between HDL level and severity of ROCM. Conclusion:?A poor metabolic control is associated with a higher risk of a severe disease with intracranial involvement.

Thyroid Abscess After Fine Needle Aspiration with Spontaneous Rupture into the Trachea : A Case Report

Fine needle aspiration (FNA) of the thyroid is a well-tolerated minimally invasive procedure. Thyroid abscess, as a complication of FNA in an immune-competent adult, is extremely rare. Diagnosis requires a high index of suspicion, for which treatment is intravenous antibiotics, drainage, and sometimes surgery. Here we present a case of thyroid abscess in an otherwise healthy man who presented with neck pain, rapidly increasing neck swelling, difficulty in swallowing, and hoarseness of the voice that developed two weeks after diagnostic FNA of a thyroid nodule which had been present for ten months. Despite antibiotic treatment, the abscess ruptured into the trachea, requiring surgical intervention. This highlights the importance of maintaining asepsis during FNA of the thyroid. Timely diagnosis of a thyroid abscess is essential to avoid life-threatening airway complications.

Variations in Azygos Venous System in The Eastern Indian Population: A Cadaveric Study

Background: This study aimed to classify Azygos vein patterns in the Eastern Indian population. Methods: During the routine dissection of MBBS in the 2018–2020 academic year, 20 formalin embalmed cadavers aged 50–70 were used to classify the azygos system. The cadaver’s age was verified by its entry into our institute’s anatomy register. The register confirmed that all cadavers used for dissection were of Indian origin. Though gender was not compared in this study, it was noted for record purposes by identifying the external genitalia and confirming it to the records. These were the exclusion criteria: 1) No major thoracic surgeries; 2) No major thoracic deformities. Azygos, hemiazygos, and accessory hemiazygos veins were also examined. Results: The Anson & McVay system was used to classify the recruited cadavers’ azygos system. The cadavers were classified into Type-1, Type-2, and Type-3. Type 2 was again subdivided into 5 subgroups and Type-3 into2 sub-groups. In one cadaver, Type-1 was observed, 17 cadavers had Type-2 azygos system and 2 cadavers showed Type-3. Of the 17 cadavers of Type-2, 3 and 7 cadavers had Type-2A and -2B, respectively. Similarly, 4 and 1 cadavers had 2C and 2D patterns, respectively. Also, 2 cadavers showed 2E type. Of the 2 cadavers of Type-3, one was Type -3A and one Type-3B. The termination of the azygos vein vertebral level was between T2 and T4, of the hemiazygos vein was T8 to T11, and accessory hemiazygos veins were between T7 and T10. Conclusion: These variations should be well studied to avoid misinterpretation during radiological investigations and surgical interventions.

Feasibility of Indirect immunofluorescence (IIF) alone as a screening method for antinuclear antibody in connective diseases in India's sub-Himalayan region

Background: For the management of connective tissue disorders (CTDs), antinuclear antibody (ANA) testing is essential, both from diagnostic and prognostic points of view. Usually, patterns obtained by ANA-IIF testing correlates to specific autoantibodies as obtained from the test for ENA (by LIA/ELISA, etc.). But to apply these data from western studies, we may need validation in the local population like our subjects in sub-Himalayan (Garhwal region) area where CTDs are common. Also, suppose ANA-IFA pattern's correlation is reliably known in our population, it can minimize the cost of managing CTDs by limiting ENA testing, which is 10 times costlier than ANA-IIF. Hence, this study was undertaken to know the specific autoantibody targets (ENA by LIA) against ANA-IIF patterns in our local population. Materials and Methods: In this retrospective cross-sectional work, serum samples of CTDs were tested for ANA by IIF (Euroimmune AG) and ENA by LIA (Euroline ANA-3G) continuously for 36 months. The manufacturer's kit insert was followed, and results were analyzed applying appropriate statistical methods. Results: Major ANA-IIF patterns were found to be associated with specific autoantibodies, for example, Nuclear homogenous with dsDNA, nucleosomes, histones; speckled pattern with nRNP/Sm, Sm, SSA/Ro-52, SSB; nucleolar pattern with Scl-70, Pm-Scl 100 and centromere pattern with CENP-B. Anticytoplasmic (ACA) are found to be linked with some ANA negative (by IIF) samples, emphasizing the need for careful observation for ACA especially where ANA is not found. Conclusions: In most subjects, specific ENA targets correlated well with ANA-IIF patterns, implying effective cost minimization in CTD management. Similar future prospective studies (with clinical data) can provide a database and reference for our population.

Anti-Biofilm Activity of Monolaurin on Staphylococcus aureus: An in-silico Study

Background: Background: Staphylococcus aureus is a gram-negative bacterium that can build strong biofilms on biotic and abiotic surfaces, quickly acquire drug resistance mechanisms, and cause major issues with the treatment of hospital infections. The creation of new therapeutic options has become important due to the limited supply of new antibacterial medications. One of the main sources of bioactive molecules is medicinal plants, and monolaurin is a naturally occurring substance with a variety of biological functions. In light of this, the goal of this study was to assess monolaurin's antibiofilm activity against S. aureus. Methods: Using the AutoDock programme, a docking study of monolaurin against Clf A (clumping factor A) was carried out, and Pymol software was used to evaluate the generated hydrogen bonds in the docked complex. This study demonstrates the positive potential of monolaurin as an antibacterial product and lends support to upcoming pharmacological research on this molecule with an eye toward its therapeutic use. Results: Research was done to support the theoretical absorption of monolaurin in this work and in silico. It was feasible to forecast if the monolaurin molecule may be produced as a medication based on the values of the physical-chemical parameters evaluated using the online tool Swiss ADME. Conclusion: The compound monolaurin demonstrated good receptor ClfA binding affinity with an estimated binding energy of kcal/mol. Natural anti-staphylococcal chemical monolaurin was used as a possible medicine for treating staphylococcal infections in humans by carrying out drug design studies for S. aureus.