Decoding 揼uitar pick sign� in COVID-19朼ssociated mucormycosis: A case series

揋uitar pick sign,� also referred to as posterior globe tenting, is a radiological surrogate marker of tense orbit and profound vision loss. It is seen commonly in traumatic retrobulbar hemorrhage and carotico-cavernous fistula and less frequently in orbital cellulitis, subperiosteal abscess, and invasive fungal infections. We report a case series of Coronavirus disease-19朼ssociated rhino-orbito-cerebral mucormycosis with guitar pick sign, of which none survived, and discuss the causative pathomechanisms, severity grade, and the clinical relevance of this unique radiological finding.

Maternal mortality in a tertiary care hospital: a 10-year review

Epidemiological data pertaining to maternal mortality is valuable in each set up to design interventional programs to favourably reduce the ratio. This study was done to evaluate the maternal mortality rate in our hospital, to assess the epidemiological aspects and causes of maternal mortality, and to suggest recommendations for improvement. This was a 10 year retrospective study. Epidemiological data was collected from the hospital register and maternal mortality ratio, epidemiological factors and causes affecting maternal mortality were assessed. A total of 120 maternal deaths occurred. Most maternal deaths occurred in the age group of 20-24 years, multiparous women [56.66%], women from rural areas [69.16%], illiterate women [65%], unbooked patients [83.33%], and patients of low socioeconomic status [83.33%]. Direct causes accounted for 72.5% of maternal deaths where as 27.5% of maternal deaths were due to indirect causes. There is a wide scope for improvement as a large proportion of the observed deaths are preventable

Evaluation of a novel, non contact, automated focal laser with integrated [NAVILAS[restricted] ] fluorescein angiography for diabetic macular edema

To evaluate the procedural experience and complications of a novel integrated laser delivery system [NAVILAS; OD-OS Teltow, Germany] that combines automated laser delivery with color fundus photography, fluorescein angiography [FA], fundus autofluorescence [FAF] and infrared imaging with a frequency doubled YAG laser. This prospective study evaluated surgical experience with the NAVILAS automated photocoagulation system for the treatment of patients with diabetic macular edema [DME]. Subjective assessment of the accuracy of laser spot placement and postoperative complications were documented. Twelve patients [7 males, 5 females] were enrolled in this pilot study. Five patients were phakic and 7 were pseudophakic. Image overlays and the tracking system allowed accurate delivery of laser spots of varying size, duration and power. None of the patients reported any pain and tolerated the procedure well. No complications were reported in the study. In this pilot study, the NAVILAS system allowed accurate laser spot placement with no complications in patients with DME. However a larger sample with longer follow up is required to determine the safety of this procedure

Evaluation of modified retinopathy of prematurity screening guidelines using birth weight as the sole inclusion criterion

The purpose was to determine if birth weight [BW] alone can be the sole criterion for screening infants at risk for retinopathy of prematurity [ROP]. In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus [AAPOS] Guidelines [1997]. Variables examined included gestational age [GA], birth weight [BW], and a composite variable BWGA Index [[grams x weeks]/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups: Group 1, BW 1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic [ROC] curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance. Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve [AUC] of 0.797 [standard error [SE]=0.0329, P<0.0001]; for GA, AUC was 0.801 [SE=0.0340, P<0.0001] and for the BWGA Index, the AUC was 0.808 [SE=0.0324, P<0.0001]. Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1. Data from our neonatal intensive care unit suggest that birth weight

Incidence of Down syndrome in Dubai, UAE

To describe incidence of Down syndrome in Dubai, United Arab Emirates [UAE]. A total of 63,398 newborn babies in Dubai [24,250 UAE nationals and 39,148 non-UAE] during a 5-year period of 1999-2003 were routinely examined by experienced nurses, neonatologists, pediatricians and/or general practitioners for symptoms of Down syndrome. Those suspected with Down syndrome were referred to the cytogenetic laboratory for karyotyping. A total of 141 cases were confirmed cytogenetically as Down syndrome. Of these, 139 were trisomy 21 and of the remaining 2, 1 was a translocation and the other a mosaic. Theoverall incidence of Down syndrome in Dubai was 1/449 live births [2.2 per 1,000]; 1/319 live births [3.13 per 1,000] among UAE nationals and 1/602 live births [1.66 per 1,000] among non-UAE nationals. The mean maternal age of UAE national mothers was 33.48 ' 8.08, with 41.66% of the mothers being in the advanced maternal age group [>35 years]. The higher incidence of Down syndrome among UAE nationals is comparable to incidences reported for other Arab populations in the Middle Eastern region. Advanced maternal age, with mothers bearing children until their 50s and higher parity, appear to be the major contributing factors for the increased incidence. The study indicates the need to provide efficient genetic counseling and to introduce an effective antenatal screening program and prenatal diagnostic services to reduce the psychological and genetic burden on the families and community

Estimation of number of death associated with exposure to excess ambient PM[10] air pollution

The respirable particle matter [PM10] concentration in urban areas has been a chronic cause concern and principal reason for increased morbidity rate among resident population. The present study aimed at estimating a discrete event like mortality rate associated and attributable to excess particulate matter pollution in the Kathmandu Valley area. The Government of Nepal conducts air monitoring of particulates at its air monitoring site network covering valley area. Adopting the data available with respect to PM10 and with several other considerations like cutoff value for PM10, mean annual concentration, demographic data of valley, exceedance to the reference cutoff value, attributable fraction evolution and computation relative risk attributable to PM10 was computed. Assumption was made about the relative risk of long-term average PM10 exposure on natural mortality estimated and reported from a previous study. The estimation or mortality rate in our case was 0.95% after all these considerations and computation. This implies that 95 deaths out of 10,000 deaths are due to particulate pollution existing in the Kathmandu Valley Area

Ambient air quality of Kathmandu valley as reflected by atmospheric particulate matter concentrations [PM10]

This paper presents the analysis and interpretation of ambient particulate matter concentrations measured as PM10 at a network of six air monitoring stations in Kathmandu valley during the years, 2003 through 2005. The purpose was to understand the pollution trends associated with different areas considering levels particulate matter concentrations representing the ambient air quality of Kathmandu valley. The study indicate that particulate concentrations [PM10] measured are persistently higher at air sampling sites representing roadside areas compared to the background sites. The inter-station network variability with respect the particulate pollution suggests optimizing resources. The comparison of annual average PM10 concentration observed at six air-monitoring sites in Kathmandu Valley with standard annual average concentration prescribed by World Health Organization as well as Europe Union indicates serious PM10 pollution in Kathmandu valley

Estimation of petrol and diesel adulteration with kerosene and assessment of usefulness of selectd automobile fuel quality test parameters

Kerosene is common adulterant utilized for mixing with diesel. Five fuel-adulterant mixtures in different proportions by volume were prepared and individually tested for density and kinematic viscosity. The mixtures were administered to six light cargo vehicles and the tail pipe exhaust emission was tested for opacity value. No appreciable density variation at different levels of adulteration was observed. Density was within the prescribed value even at higher adulteration. Considerable decrease in kinematic viscosity, a departure from prescribed viscosity, was noted at higher adulteration level. The percent opacity value decreased sharply even at small level of adulteration. The probable amount of kerosene present as an adulterant in diesel dispensed at filling stations in Kathmandu city ranged between 35% and 50%. The observations suggest density test is not a good indicator of diesel adulteration. Kinematic viscosity and opacity value are useful diesel adulteration test parameters. Existing diesel adulteration warrants initiation of strict compliance regulation

Limb / pelvis hypoplasia / aplasia [Al-Awadi / Raas-Rothschild] syndrome in three new Kuwaiti patients: Clinical and radiological description

This study describes three new patients in 2 Kuwaiti families having AI-Awadi/Raas-Rothschild syndrome. The cases had intercalary and distal limb reduction malformations, hypoplastic pelvic bones [LPAH syndrome] and unusual facial features. Clinical examination, skeletal survey, echocardiography, ultrasonography of head / abdomen, chromosomal study and FISH technique were done. The patients were 2 males and a female, having prenatal and postnatal growth delay. Two cases had capillary hemangiomata, sparse / brown hair, short nose, dysplastic / flabby ears and retrognathia. Symmetric limb reduction defects, phallus and clitoris enlargement have been found. The 1[st] case had balanced, reciprocal translocation, t [1,3][q32:q21], while the 2[nd] and the 3[rd] cases had normal karyotype. Skeletal survey showed variable limb reduction defects in the three cases. The patients share in common the severe pelvic hypoplasia, symmetric limb reduction defects, normal mentality and recessive mode of inheritance. These 3 new Kuwaiti families are added to the previously reported families in Kuwait Medical Genetics Center [KMGC]

De novo balanced translocation t [6;18] [q16;q23] in a female with bilateral aniridia

A 2.5-year-old female with some dysmorphic features and bilateral aniridia was found to have de nove balanced translocation t[6;18] [q 16; q23] and normal 11p13. Fluorescence in situ hybridization using whole chromosome painting for chromosome 6 confirmed the translocation. DNA sequencing of exon 10 of PAX6 gene at aniridia [AN] locus showed no mutation. In this patient, the presence of AN with normal chromosome 11p13 and PAX6 gene probably indicates involvement of some other loci that influence the functioning of AN gene. A comparison of previously reported cases with breakpoints at 6q16 and 18q23 illustrates the frequent association of ophthalmic abnormalities as well as other clinical abnormalities

Familial pericentric inversion of chromosome 1, inv [1] [p11: q21] associated with inguinal hernia in Bedoum sibs

Inguinal hernia and pericentric inversion of chromosome 1 are described in 2 bedouin sibs. The coexistence support the hypothesis of genetic predisposition

Spatial distribution of homologous chromosomes in metaphase plates of human lymphocytes

The frequency of homologous chromosome association/pairing of chromosomes 1 to 22 and X was analysed in 1000 metaphase plates with colcemid and in 500 plates without colcemid from normal human lymphocyte cells. Statistical analysis revealed that the occurrence of somatic homologous association/pairing is non-random. Chromosomes 1,3,7,16,19 and 20 were found to be associated more frequently The occurrence and significance of such association/pairing is most probably related to the structural and functional organisation of chromosomes. The phenomenon of homologous chromosome pairing is discussed as one of the possible aetiological factors for aneuploidy and/or uniparental disomy