Diagnostic usefulness of triple biopsies (Skin, Muscle and Nerve) in clinically suspected cases of vasculitis in a tertiary care hospital in Gujarat

Introduction: The term vasculitis refers to a heterogeneous group of diseases, all characterized by inflammation and destruction of blood vessel walls leading to ischemic, thrombotic, and hemorrhagic damage to tissues of central and peripheral nervous system. The main indication for triple biopsy (skin, muscle and nerve) is to rule out peripheral vasculitis neuropathy. However, the drawback is that any systemic inflammatory process may show changes in a skin biopsy and hence these changes need to be interpreted with caution. The aim of this study is to establish the diagnostic yield and the usefulness of the triple biopsies in clinically suspected cases of vasculitis. Material and Methods: The present study was conducted in the Department of General Pathology, SBKS MI & RC, Vadodara over a period of one year (1/1/2022 to 31/12/2022). All the clinically suspected cases of vasculitis received at OPD were included in the study. Any case with either muscle, nerve or skin biopsy reported as inadequate were excluded from the study. Results: On evaluation the usefulness of triple biopsies for vasculitis, we found a very low diagnostic yield with only 3.3% of peripheral nerve biopsy and 0.8% of muscle and nerve biopsy showed definite vasculitis. In case of suspected peripheral/systemic vasculitic neuropathy, nerve biopsy was sufficient in the majority of case and has the diagnostic armamentarium for the evaluation of vasculitis. Conclusion: In conclusion, nerve biopsies provide the best yield for the diagnosis of vasculitis, as opposed to muscle and skin biopsies. The role of triple biopsies as a routine protocol for the evaluation of vasculitis is questionable.

Prevention and management of childhood progressive myopia: National consensus guidelines

Myopia is a major public health problem worldwide, including India, with the global prevalence of myopia increasing rapidly over decades. The clinical and socioeconomic impact of myopia is also expected to rise with rising prevalence. Therefore, the focus has now been shifted to prevent the incidence and progression of myopia. However, there is lack of any standardized guidelines for myopia management. This document aims to generate a national-level expert consensus statement on the management of childhood myopia in the Indian scenario. The expert panel of pediatric ophthalmologists consisted of 63 members who met in a hybrid meeting. A list of topics deliberating discussion in the meeting was provided to the experts in advance and they were instructed to provide their opinions on the matter during the meet. The panel of experts then gave their views on each of the items presented, deliberated on different aspects of childhood myopia, and reached a consensus regarding the practice patterns in the Indian scenario. In case of opposing views or lack of a clear consensus, we undertook further discussion and evaluated literature to help arrive at a consensus. A written document is prepared based on recommendations explaining definition of myopia, refraction techniques, components and methods of workup, initiation of anti-myopia treatment, type and timing of interventions, follow-up schedule, and indications for revised or combination treatment. This article formulates evidence-based guidelines for progressing myopes and pre-myopes and also establishes uniformity in the management of childhood myopia in the country.

Expression and sensitivity of immunohistochemical markers SMA, Desmin, CD10 for uterine leiomyomas - A tertiary care centre experience

Introduction: Leiomyoma is the most common benign tumor of the uterus which usually presents with menorrhagia, pain in abdomen or both. In extremely rare cases where uterine leiomyoma can be difficult to distinguish from other uterine smooth muscle tumors, immunohistochemistry is used. This study was aimed to study the expression and sensitivity of immunohistochemical markers SMA, Desmin, CD 10 for uterine leiomyomas and to find average number of mitosis in uterine leiomyomas using Ki 67. Materials and methods: The present study was carried out in the Department of Pathology, Dhiraj General Hospital and Smt. Bhikhiben Kanjibhai Shah Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia. A total 50 cases of uterine leiomyomas after its histological diagnosis were evaluated with immunohistochemical markers SMA, Desmin, CD 10 and Ki 67. Results: SMA expression was seen in all 50 cases of uterine leiomyomas with strong expression in 44 cases (88%). Strong SMA expression was seen more in usual leiomyomas as compared to leiomyomas with secondary changes. Desmin expression was also seen in all the 50 cases of uterine leiomyomas with moderate expression in 26 cases (52%). Weak CD 10 expression was seen in 15 cases of uterine leiomyomas (30%). Ki 67 was expressed very focally in only 3 cases of leiomyomas with mean value of only 0.3% tumor cells. Conclusions: Leimyomas was most frequently seen in the women in 4th decade. The most common clinical presentation was menorrhagia. SMA and Desmin expression was seen in all the cases with strong and moderate immunoreactivity respectively. SMA expression was found to be more specific than Desmin in uterine leiomyoma. Weak CD 10 and focal Ki 67 were expressed only in few cases and were found to be insignificant.

Netarsudil monotherapy as the initial treatment for open-angle glaucoma and ocular hypertension in Indian patients: A real-world evaluation of efficacy and safety

Purpose: Glaucoma is the second leading cause of blindness worldwide, affecting more than 64 million people aged 40–80. The best way to manage primary open?angle glaucoma (POAG) is by lowering the intraocular pressure (IOP). Netarsudil is a Rho kinase inhibitor, the only class of antiglaucoma medications that reorganizes the extracellular matrix to improve the aqueous outflow through the trabecular pathway. Methods: An open?label, real?world, multicentric, observation?based 3?month study was performed for assessing the safety and ocular hypotensive efficacy of netarsudil ophthalmic solution (0.02% w/v) in patients with elevated IOP. Patients were given netarsudil ophthalmic solution (0.02% w/v) as a first?line therapy. Diurnal IOP measurements, best?corrected visual acuity, and adverse event assessments were recorded at each of the five visits (Day?1: screening day and first dosing day; subsequent observations were taken at 2 weeks, 4 weeks, 6 weeks, and 3 months). Results: Four hundred and sixty?nine patients from 39 centers throughout India completed the study. The mean IOP at baseline of the affected eyes was 24.84 ± 6.39 mmHg (mean ± standard deviation). After the first dose, the IOP was measured after 2, 4, and 6 weeks, with the final measurement taken at 3 months. The percentage reduction in IOP in glaucoma patients after 3 months of once?daily netarsudil 0.02% w/v solution use was 33.34%. The adverse effects experienced by patients were not severe in the majority of cases. Some adverse effects observed were redness, irritation, itching, and others, but only a small number of patients experienced severe reactions, as reported in a decreasing order: redness > irritation > watering > itching > stinging > blurring. Conclusion: We found that netarsudil 0.02% w/v solution monotherapy when used as the first?line treatment in primary open?angle glaucoma and ocular hypertension was both safe and effective.

Association of sunlight exposure with visual impairment in an Indian fishing community

Purpose: Indian fishermen belong to a marginalized population and are continuously exposed to extreme occupational hazards and sunlight. A high prevalence of visual impairment (VI) is reported in the coastal fishing community. We aimed to investigate the association between VI and sunlight exposure measurement (SEM). Methods: In this cross?sectional observational study, 270 eyes of 135 participants were enrolled from a coastal fishing village. Participants underwent a comprehensive ophthalmic examination, which included best?corrected visual acuity (BCVA), and anterior and posterior segment examination. Ocular Surface Disease Index (OSDI) and SEM questionnaire were administered to estimate the level of dry eye and ultraviolet?B (UV?B) exposure, respectively. VI was defined as presenting visual acuity worse than 6/12 (logarithm of the minimum angle of resolution [logMAR] > 0.3). Results: The mean age and spherical equivalent were 50.56 ± 11.72 years (range: 18–80 years) and 0.36 ± 1.68 diopters (D) (range: ?7.0 to +3.0 D), respectively. Age, SEM, OSDI, fishing as an occupation, and cataract were significantly associated with higher odds of VI in univariate analysis. Refraction, gender, education level, smoking status, amblyopia, systematic, and other ocular diseases were not significantly associated with VI. In the multivariate analysis, age, SEM, and presence of cataract remained significantly associated with a higher risk for VI. The area under the receiver operating characteristic curve values for age and SEM scores demonstrate a fair index of discrimination for the detection of VI. Conclusion: SEM level is directly associated with a higher risk of VI among fishermen. The fishing community might benefit from regular eye examinations and awareness about the harmful effects of sunlight exposure and preventive measures.

Need of optical aids for schools for blind students in Pune and Nasik districts and compliance of their use

Purpose: To assess the need for spectacles and low?vision aids (LVA) in students attending schools for the blind and study their compliance with use. Methods: Comprehensive ocular evaluation was performed using a hand?held slit lamp and ophthalmoscope. Vision acuity was measured using a logarithm of the minimum angle of resolution (logMAR) chart for distance, as well as for near. Spectacles and LVAs were dispensed after refraction and LVA trial. Follow?up was performed to assess the vision using the LV Prasad Functional Vision Questionnaire (LVP?FVQ) along with compliance with use after 6 months. Results: Of the 456 students examined from six schools, 188 (41.2%) were female; 147 (32.2%) were <10 years of age. In all, 362 (79.4%) were blind since birth. The students dispensed only LVAs were 25 (5.5%), only spectacles were 55 (12.1%), and both spectacle and LVAs were 10 (2.2%). The vision improved using LVAs in 26 (5.7%) and using spectacles in 64 (9.6%). There was a significant improvement in LVP?FVQ scores (P < 0.001). Also, 68/90 students were available for follow?up, of whom 43 (63.2%) were compliant to use. Causes of not wearing spectacles or LVA in 25 were left somewhere or lost 13 (52%), broken 3 (12%), uncomfortable to use 6 (24%), not interested to use 2 (8%), and got operated 1 (4%). Conclusion: Although the dispensing of LVA and spectacles improved the visual acuity and vision function of 90/456 (19.7%) students, nearly a third were not using them after 6 months. Efforts need to be taken to improve the compliance of use

Efficacy and safety analysis of intravitreal bio-similar products of bevacizumab in patients with macular edema because of retinal diseases

Purpose: The purpose of this study was to evaluate retrospectively the efficacy and safety profile of intravitreal injection of bevacizumab bio?similar product Zybev(Z) for macular edema because of retinal diseases. Methods: A retrospective analysis was conducted on patients with macular edema because of retinal diseases, who had been administered intravitreal injections of bio?similar bevacizumab at a tertiary eye care center. Changes in the retinal thickness and visual acuity were evaluated to judge the efficacy, and adverse events were noted for the safety profile over a period of 6 weeks. Results: A total of 104 patients were included in the study. The mean age of the patients was 53 ± 13.5 years. The mean pre?injection best corrected visual acuity (BCVA) was 1.32 ± 0.70 log minimum angle of resolution (logMAR) with a central subfield thickness (CST) of 429.26 ± 204.30 ?m, and the post?injection BCVA at 6 weeks was 1.13 ± 0.71 logMAR with a CST of 302.26 ± 104.50 ?m; this change was statistically significant (P < 0.05) for all groups. The mean average cube thickness (?m) decreased from 11.85 ± 1.96 pre?injection to 10.52 ± 1.75 post?injection, and the mean average cube volume (mm3) decreased from 329.30 ± 54.35 to 302.23 ± 49.56 (P < 0.05). During the follow?up period after injection, no patient had inflammation, endophthalmitis, an increase in intra?ocular pressure, or systemic side effects. Conclusion: This short?term retrospective analysis provides evidence regarding the efficacy and safety of intravitreal injection of bio?similar products of bevacizumab for the treatment of macular edema because of retinal diseases

Argon Beam Coagulation as an Adjuvant for Extended Curettage for Giant Cell Tumors of the Bone: A Study of 50 Cases / Coagulação por plasma de argônio como adjuvante à curetagem estendida em tumores de células gigantes do osso: Um estudo de 50 casos

Abstract Objective Extended curettage with adjuvants of giant cell tumors of bone is associated with a lower rate of recurrence of the tumor while preserving the adjacent joint. The present study was conducted to estimate the recurrence rate and functional outcome after using argon beam as an adjuvant for extended curettage. Methods We selected 50 patients with giant cell tumors, meeting all the inclusion criteria, who underwent extended curettage using high speed burr and argon beam photocoagulation between July 2016 to January 2019. On their follow-up visit, they were assessed for any complaints of pain and signs like tenderness, locally raised temperature, and decreased range of motion of the adjacent joint. Radiologically, the patients were assessed for any increased lucency around the cement mantle and uptake of the subarticular graft. Musculoskeletal Tumor Society Score (MSTS) was administered to the patients, and range of motion of the adjacent joint was compared with the contralateral joint. Results Recurrence was found in 4 patients, that is, an 8% recurrence rate. Twenty-six out of 28 patients with a tumor in the lower limb had a grade-5 weight bearing status 6 months from the surgery, and their range of motion was comparable to contralateral healthy joint with an average MSTS score of 27 (18-30). Conclusion Extended curettage of giant cell tumors using argon beam coagulation is associated with low recurrence rates of the tumor and is an effective modality in the treatment of these tumors besides having a functional outcome comparable to the healthy limb.

Resumo Objetivo A curetagem estendida com adjuvantes de tumores de células gigantes do osso está associada a uma menor taxa de recidiva da neoplasia e à preservação da articulação adjacente. Este estudo foi feito para estimar a taxa de recidiva e o resultado funcional após o uso de plasma de argônio como adjuvante à curetagem estendida. Métodos Cinquenta pacientes com tumores de células gigantes que atendiam a todos os critérios de inclusão foram selecionados para o estudo e submetidos à curetagem estendida com broca de alta velocidade e fotocoagulação com plasma de argônio entre julho de 2016 e janeiro de 2019. À consulta de acompanhamento, os pacientes foram avaliados quanto a quaisquer queixas de dor e sinais como sensibilidade, aumento local da temperatura e diminuição da amplitude de movimento da articulação adjacente. Radiologicamente, os pacientes foram avaliados quanto à presença de qualquer aumento de radiotransparência ao redor do manto de cimento e incorporação do enxerto subarticular. O questionário Musculoskeletal Tumor Society Score (MSTS) foi administrado aos pacientes e a amplitude de movimentação da articulação adjacente foi comparada à articulação contralateral. Resultados Quatro pacientes apresentaram recidiva, o que corresponde a uma taxa de 8%. Seis meses após a cirurgia, 26 de 28 pacientes com tumor no membro inferior tinham capacidade de sustentação de peso de grau 5 e amplitude de movimento comparável à articulação saudável contralateral, com pontuação MSTS média de 27 (intervalo de 18 a 30). Conclusão A curetagem estendida de tumores de células gigantes com coagulação por plasma de argônio está associada a baixas taxas de recidiva da neoplasia; é uma modalidade eficaz no tratamento desses tumores e o resultado funcional é comparável ao do membro saudável.

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.

Phaco-handpiece used as a Fragmatome for managing nucleus drop

Background: Nucleus drop during cataract surgery is a dreaded complication and requires urgent vitreo?retinal intervention which is managed commonly using a fragmatome. However, a fragmatome is not readily available in routine ophthalmology set?ups because its use is very limited. On the other hand, a phaco?probe is commonly available with all surgeons and makes it cost?effective. Purpose: The purpose is to demonstrate the utility of a phaco?probe as an alternative to a fragmatome in managing nucleus drop during cataract surgery, making it cost?effective and less time?consuming and simple. Synopsis: The video shows two cases of complicated cataract surgery in which a nucleus is dropped in the vitreous cavity. The sleeve of the phaco?probe was removed, and infusion was disconnected to make it function as a fragmatome. We noted reduced lenticular repulsion from the phaco?handpiece tip as compared to the fragmatome, and no scleral burns were observed. The cases were completed by secondary placement of an intra?ocular lens in the sulcus in the same sitting. Thus, the phaco?probe can be considered to manage nucleus drop in the absence of a fragmatome. Highlights: A phaco?probe can be used as an alternative to a framgamtome, which is a cost?effective and simple technique.

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.

Disseminated Nasal subtype Extranodal NK/T-cell lymphoma and its diagnostic difficulties in antemortem biopsies

ABSTRACT Extranodal NK/T- cell lymphoma (ENKTCL) is an aggressive lymphoma driven by Epstein-Barr virus (EBV) infection in genetically susceptible individuals. It was historically called a lethal midline granuloma. Due to the angio-destructive nature of ENKTCL, lymphoma cells are often accompanied and masked by necrosis and dense inflammation in the biopsy. Further, the biopsy may show vasculitis, which can mimic granulomatosis with polyangiitis. Due to these masquerades, ENKTCL is often misdiagnosed in the biopsy. Several biopsies may be required to establish the diagnosis. We describe the clinical course and autopsy findings of a young female who presented with a hard-palate ulcer. Antemortem biopsies failed to establish the diagnosis. The autopsy revealed an advanced nasal subtype of Extranodal NK/T-cell lymphoma with dissemination to the kidneys, adrenals, liver, spleen, and small intestine.

Effects of the COVID-19 pandemic on semen quality in male partners of infertile couples: a hospital-based observational study / 亚洲男科学杂志(英文版)

The effects of the coronavirus disease 2019 (COVID-19) pandemic on male fertility have received considerable attention because human testes contain high levels of angiotensin-converting enzyme-2 receptors, through which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can enter. Early studies showed decreases in semen quality during and after recovery from COVID-19. However, no semen quality studies have examined the effects of widespread subclinical and mild disease, as well as changes in lifestyle, psychosocial behavior, intake of dietary supplements, and stress. This cross-sectional study compared semen quality parameters in male partners of infertile couples between men who underwent semen analysis before the COVID-19 pandemic (prepandemic group) and men who underwent semen analysis during the pandemic period (pandemic group); the analysis sought to clarify the overall effects of the pandemic. No participants in the pandemic group had experienced clinically overt disease. Among the 239 participants, mean body weight (P = 0.001), mean body mass index (P < 0.001), median sperm concentration (P = 0.014), total sperm count (P = 0.006), and total percentages of motile (P = 0.013) and abnormal cells (P < 0.001) were significantly greater in the pandemic group (n = 137) than those in the prepandemic group (n = 102). Among abnormal cells, the percentages of cells with excess residual cytoplasm (P < 0.001), head defects (P < 0.001), and tail defects (P = 0.015) were significantly greater in the pandemic group than those in the prepandemic group. With the exception of morphology, the overall semenogram results were better in the pandemic group than those in the prepandemic group.

STUDY OF KNOWLEDGE OF BREAST CANCER AND ITS EARLY DIAGNOSTICS IN FEMALE TERTIARY HEALTH WORKERS

OBJECTIVE- To study the knowledge of breast cancer, early detection methods and whomto consult after detecting abnormality among female tertiary health workers.METHOD- This is a descriptive cross-sectional study of 70 female health workers age groupmore than 20 years carried out at various hospitals after taking consent.RESULT- Being majority of young married doctor respondents, below the age of 40 years(81.4%) study was conducted, almost all the respondents are aware of breast cancer, 69(98.5%). Majority of them got information from media (77.1%), followed by seminars(64.2%) and books (62.8%). Only 15.7% of respondents had a positive family history ofbreast cancer. Most participants were aware of BSE and thinks its useful tool (74.3%) butdoesn’t know about proper timing and method for BSE. They have been taught BSE (58.5%)out of which majority were taught by teachers (51.5%). 41.4% and 60% of respondents knewthat BSE should be done monthly and should start after age of 20 respectively. Onerespondent has discovered an abnormality. Respondents are relatively less aware about BSE28 (40%). 45 (64.3%) and 16 (22.9%) think that BSE should be done by a doctor and trainednurse respectively. The level of awareness of sonomammography was high amongrespondents- 43 (57.1%), but only 8 (11.43%) had undergone sonomammography, because of‘not of proper age’ 27 (38.57%).CONCLUSION- Practice and attitude of breast cancer screening should be promoted amonghealth workers and the general population

Demographic and Clinical Profile of Patients Presenting with COVID-19-Associated Rhino-orbito-cerebral Mucormycosis at a Tertiary Care Center

Objectives?Individuals affected with rhino-orbito-cerebral mucormycosis (ROCM) associated with coronavirus disease 2019 (COVID-19) increased enormously in northern India during the second wave of the novel coronavirus disease. This study determined the demographic and clinical profile including the risk factors in patients presenting to a tertiary care hospital in northern India. Materials and Methods?This is a descriptive study involving patients admitted with COVID-19-associated ROCM and were managed from May 2021 to 20th July 2021. Statistical Analysis?The data was analyzed using SPSS (IBM SPSS Statistics 20, SPSS Inc., Chicago, Illinois, United States) software and Microsoft Excel (Version 16.49). The chi-squared and Fisher's exact tests were used to compare various outcomes. A p-value of less than or equal to 0.05 was considered to be statistically significant. Results?One hundred and seventeen (117) patients (males: 70 [59.8%], females:47 [40.2%]) with the average age of 51.85?±?12.80 years presented with orbital involvement. Diabetes mellitus was noted in 100 (86.2%) patients. Of the available data from the records, oxygen supplementation for the management of COVID-19 was received by 37/108 (34.3%) patients for a median average duration of 11 days. Forty-eight patients of one-hundred-seventeen (60%) patients were treated with corticosteroids with a median duration of steroid administration being 10 days. The duration between onset of symptoms related to mucormycosis and diagnosis of COVID-19 was 0 to 75 days for 48 patients. Intravenous amphotericin B was administered in all cases. External sinonasal debridement was performed in 90 of 114 (78.9%) patients, retrobulbar amphotericin B injection was administered in 56 of 117 (47.9%), and orbital exenteration was performed in 17 of 117 (14.5%) of cases. Conclusion?Administration of corticosteroids and diabetes mellitus seem to be the major underlying causes for the development of COVID-19-associated ROCM. Prompt diagnosis and multidisciplinary management approach are essential for a reduction in mortality.

Bilateral Angle Closure Glaucoma In A Teenage Girl

Primary angle closure glaucoma (PACG) usually presents as unilateral and has acute onset. To the best of our knowledge, chronic PACG in very young age is rare. We share a case report of a teenage girl with advanced glaucomatous changes and, on gonioscopy, had synechia and closed angle of anterior chamber. She was treated by bilateral laser iridotomy and topical glaucoma medication. As patient had poor control of IOP on medications in right eye , she underwent filteration surgery in right eye. The author concludes that, even at very young age, in the absence of predisposing factors for secondary glaucoma, the patient should be investigated for PACG and managed accordingly

Exploring the Clinical Variables among Drug-Dependent HIV-Positive Patients: Implications for Treatment Strategies

This study explored the profile of HIV positive patients seeking treatment at a tertiary care addiction treatment facility. A retrospective study was done to collet detailed information on clinical characteristics: drug use (type, age of initiation, duration), general medical condition and past treatment history. The study included 138 patients with mean (SD) age 30.2 (8.3) years. Opioid dependence with injecting drug use (IDU) was diagnosed in 97% of the patients. The median age of injecting onset was 24.5 years (IQR 20-31 years). The most frequently injected substances were pheniramine (60.1%) and buprenorphine (59.4%). Past treatment seeking was reported by 57% patients and interestingly they were less likely to present any medical condition (2 =69.611, p < 0.001). Variability in the age of onset of drug use indicates the need for broad based approach to prevent IDU and motivation to seek treatment may lead to better health conditions.

Correlation of COVID-19 with Severity of Periodontitis-A Clinical and Biochemical Study

Background: Various conceptual hypotheses have been put forth to link association of COVID?19 with various chronic diseases such as periodontitis. Empirical evidence is still lacking to correlate the severity of COVID?19 with periodontal diseases. Objectives: This study was undertaken with an objective to correlate COVID severity in systemically healthy patients suffering from periodontal diseases. Materials and Methods: 44 systemically healthy patients of both genders with minimum of 20 teeth in their oral cavity in age range of 20 to 50 years suffering from periodontitis were recruited and categorised into four stages as per American Academy of Periodontology (AAP) 2017 classification for periodontitis. Serum C?reactive protein (CRP) levels and periodontal disease parameters of all the patients were measured. Because of COVID?19 and the nationwide lockdown, the dental practice was highly affected. With the help of self?designed online questionnaire information regarding COVID?19 infection and associated symptoms were recorded. Cases were categorized into five groups based on the World Health Organization clinical progression scale of COVID severity. Results: All the patients suffering from COVID disease in moderate and severe forms had increased probing pocket depth, clinical attachment level, and raised serum C?reactive protein levels as compared to patients who were uninfected or suffering from mild COVID disease and the results were statistically significant. Conclusion: Prioritisation and Implementation of periodontal treatment as a preventive measure for COVID?19 should be done. A positive correlation is observed between the severity of periodontitis and COVID?19.

Marital Quality in Middle Aged Women: A Qualitative study

Background: Marital quality is an essential feature of family life that affects one’s wellbeing; higher marital quality is linked to less vulnerability to depression, self-rated health, less physical ailments and subjective well-being and happiness. Cross sectional studies have found low marital satisfaction and happiness in middle aged adults compared to the younger or older adults, whereas cohort studies have revealed that marital quality tends to decrease after the initial of marriage years and into the middle adulthood and then either steadies or continue to decrease after midlife. This study explored marital quality in women and the dimensions that contribute to greater marital quality in midlife stage of marriage. Methodology: The sample consisted of 15 middle aged married women. A semi-structured interview schedule was used to explore their marital quality and the dimensions related to marital quality. The interviews were analysed using content analysis method. Results: The results showed that aspects such as handling problems and disagreements, communication, having an egalitarian approach, making compromises or adjustments, support of extended family were related to better marital quality. Conclusion: The study highlights that marital enrichment programs that focus on communication between partners, problem solving strategies and effective handling of disagreements can increase the marital quality and strengthen the marital relationship.

Mucormycosis and Its Co-Relation with Raised Ferritin Levels

Background: Mucormycosis has emerged as an epidemic within the COVID-19 pandemic due to widespread use of corticosteroids and immune-modulators like Tocilizumab, in the management of COVID-19 pneumonia. It is an invasive fungal disease which spreads by angioinvasion and rapidly spreads to adjacent tissues. If untreated its outcomes are dangerous and often fatal. Uncontrolled diabetes, malignancies and dialysis are predisposing factors. Raised blood iron is an important factor in pathogenesis and rapid progression of fungal invasion that needs to be investigated. Aim: To establish a correlation between raised serum ferritin level and aggressiveness of Mucormycosis. Methodology: Aretrospective study was done from February 2021 to February 2022 of patients diagnosed with mucormycosis by middle meatal biopsy and microscopy along with CT& MRI scan of PNS with brain. They were treated either surgically or conservatively. All the blood parameters including serum ferritin level, were carried out. Acomparison was done on extent of disease in patients in-relation to their serum ferritin level. Results: Our study suggested that higher levels of ferritin are often associated with aggressive form the disease. Zygomycetes are dependent on environmental iron for their growth. Higher the serum ferritin level, more aggressive & widespread is mucormycosis. Conclusion: Serum free iron aggravates mucormycosis. Measures should take to control the serum ferritin in patients under risk for mucormycosis. Iron chelating agents or novel methods like anti-ftr1 immune serum should be developed for controlling the disease at its earlier stages