A retrospective clinicopathological analysis of rhino-orbital mucormycosis in second wave of COVID-19

Background: During the present surge of COVID-19 positive cases, concurrent multifold increase in the incidence of mucormycosis cases has resulted into significant morbidity and mortality. We retrospectively evaluated the clinicopathological features along with microbiological examination findings in histologically diagnosed cases of rhino-orbital mucormycosis. Material and Methods: All the H and E and special stained slides of included mucormycosis cases were retrieved from the records and were evaluated with microbiological findings including screening KOH mount examination and culture results. Results: Out of 16 cases with available details, 10 cases had the previous history of diabetes mellitus. The most frequent single site of involvement was maxillary sinus (7/25) followed by nasal cavity, orbit, ethmoid and sphenoid sinuses. While comparing the histological diagnosis with KOH mount findings and culture results, 15 cases revealed consistent results. Conclusion: A high clinical suspicion, monitoring, early diagnosis, and timely management can improve the morbidity and mortality of this life-threatening complication.

Awareness, perceptions, and attitude towards Coronavirus disease 2019 vaccine among pregnant women in India: A cross-sectional study

Introduction: The present study was conducted to explore the awareness and perception of the coronavirus disease 2019 (COVID-19) vaccine among pregnant women. Material and Methods: A descriptive cross-sectional study was conducted from September 01, 2021, to September 28, 2021, among 301 pregnant women aged 18–35 years at antenatal care outpatient department in a tertiary care hospital of Western Maharashtra. Results: On assessing the knowledge and awareness score, the mean score (± standard deviation) was 7.83 ± 1.2 out of 16. A total of 176 (58.5%) had good scores(?8). There was no statistically significant association between knowledge and awareness scores and the level of education, type of residence, and age or with weeks of gestation. Although the overall awareness of study participants was satisfactory, 177 (58.8%) felt that COVID-19 vaccines should be avoided during the first trimester. Interestingly, 45 (15.3%) felt that vaccines should not be given during menstruation. There were misconceptions about perceived contraindication, with 81(26.9%), 50(16.6%) and 43(14.4%) responding that diabetes, hypertension and heart disease are contradicts respectively. Interestingly, a total of 52 (17.3%) responded as likely when enquired whether the present vaccine can cause infertility. Similarly, about 62% of study participants felt that the vaccine might alter the DNA. Conclusion: The present study revealed good overall knowledge and awareness about the COVID-19 vaccine among pregnant with certain misconceptions. The findings suggest that immediate health education programs, risk communication, and correct information should be disseminated by respective health authorities.

Evaluation of variable p16 immunostaining patterns, Ki-67 indices and HPV status in cervical SILs and squamous cell carcinomas: An institutional experience

Objective: The present study evaluates the immunoexpression of p16 and Ki-67 in cervical squamous intraepithelial lesion (SIL) and carcinomas and correlates their expression with clinicopathological features and HPV-DNA status. Material and Methods: A total 36 included cases of SIL and squamous cell carcinoma (SCC) were subjected to p16 and Ki-67 immunostaining. p16 staining was evaluated depending on grading, distribution, localization pattern, intensity and IHC score. Ki-67 expression was graded based on percentage of positive cells. Results: Incidence of HSIL and SCC cases was found to be significantly increased with parity > 5. p16 grade III diffuse nucleocytoplasmic immunostaining was observed in 62.5% LSIL, 80% HSIL and 87% SCC cases. Significant association of p16 staining intensity, IHC score and Ki-67 indices was noted with increasing grades of SILs and carcinomas. Conclusion: Our experience indicates that a combination of p16 and Ki-67 immunostaining may be useful to determine the severity of dysplastic change.

Pattern of antiepileptic drug utilization in epilepsy patients in outpatient departments of a tertiary care hospital

Background: Epilepsy is one of the common neurological disorders diagnosed early in life. Availability of many antiepileptic drugs (AEDs) makes it difficult to choose the appropriate pharmacotherapy. Aim and Objective: Understanding the pattern of AED prescription to evaluate the rationality of AED prescriptions in epileptic patients. Materials and Methods: This was a retrospective, observational study carried out at new civil hospital, Surat for a duration of 6 months. The study involved collecting data from the case files of all the patients irrespective of age or gender diagnosed with epilepsy and undergoing treatment from any of the outpatient departments of the hospital. Demographic details, clinical diagnosis, and detailed data about the prescribed pharmacotherapy were recorded in a pre-approved data sheet. The WHO prescribing indicators were evaluated for each prescription. Descriptive statistics was used. Results: The average age of the patients was 21.64 ± 10.46 years. A total of 1565 drugs were prescribed in the 331 epilepsy patients’ prescriptions. Out of this, 551 drugs (35.21%) were antiepileptics. Most of the patients received monotherapy (75.53%). The most commonly prescribed drug was sodium valproate (46.10%) followed by phenytoin (30.13%) and carbamazepine (10%). The average AED per prescription was 1.70. Majority of the prescriptions (94.63%) used generic names. There were no injectable used and no fixed dose combinations were prescribed in any of the patients. Conclusion: The prescriptions followed the rational prescribing pattern. Treatment of epilepsy is usually by monotherapy with valproate being the most commonly used AED. Prospective studies to evaluate adverse effects and patient compliance will help in efficient policy-making decisions.

Bilateral Chandler's syndrome: Uncommon entity diagnosed by ultrasound biomicroscopy and confocal microscopy

A 22?year?old female presented with bilateral, progressive diminution of vision. Slit?lamp examination revealed bilateral sectoral corneal edema. Gonioscopy showed broad?based peripheral anterior synechiae and a membrane obscuring angle structure in both the eyes. On ultrasound biomicroscopy (UBM), a membrane extending from corneal endothelium to anterior iris surface causing traction was seen. Confocal microscopy showed an "epithelium?like" transformation of the corneal endothelium. This case demonstrates a bilateral Chandler variant of the iridocorneal endothelial (ICE) syndrome where the diagnosis of Chandler's disease was confirmed by confocal microscopy, after the mechanism of secondary angle closure was demonstrated by the UBM.

Bio-eco-social determinants of Aedes breeding in field practice area of a medical college in Pune, Maharashtra

Background: Major determinant of dengue incidence is interaction between ecology, vector bionomics, and social factors. Objectives: The objective of the study is to find out bio-eco-social determinants of Aedes breeding. Methods: Background, household, entomological, and knowledge, attitude, and practice (KAP) surveys were undertaken post- and premonsoon showers from May to June 2016 in urban and rural practice area of medical college. Results: A total of 181 and 204 households, 131 and 137 individuals, and 1250 and 1268 water-holding containers were included in household survey, KAP survey, and larval survey in urban slum and rural area, respectively. In both locations, maximum water-holding containers were indoors (41.4% and 61.8%, respectively); however, maximum positivity was peridomestic (63.6% and 83.1%, respectively). Pupae per container were 0.9 and 1.9 in respective locations and pupae per person were 1.2 and 2.3, respectively. Container positivity was seen in containers with rain as water source (8.8%) as well as among those who were never used (10.7%). Irregular water supply was significantly more in rural area (P < 0.05). KAP survey revealed that majority (90.1% and 71.5%, respectively) had heard about dengue, with significantly higher knowledge in urban slum, and television was the main source of information. Majority (89% and 83%, respectively) were unaware that peak biting time of Aedes is daytime. Use of mosquito repellent coils was the predominant preventive practice (46.6% and 61.2%, respectively). Pupae were reared; all were found to be Aedes aegypti. Conclusions: Despite enhanced awareness campaigns, an integrated vector management approach is required for prevention of dengue.

Anterior segment dysgenesis and secondary glaucoma in Goldenhar syndrome

A 3-year-old girl presented with a history of watering, haze and increase in the size of the right eye for two months. The child had bilateral preauricular skin tags, limbal dermoid and dermolipoma, consistant with the diagnosis of Goldenhad syndrome. In addition, her right eye manifested enlarged cornea, flat anterior chamber, atrophic iris and elevated intraocular pressure. This case report highlights a possible association of anterior segment dysgenesis and glaucoma with Goldenhar syndrome.

Intraocular pressure reduction in a spectrum of angle closure disease following cataract extraction

Purpose: The purpose is to study the effect of cataract extraction on intraocular pressure (IOP) in patients with angle closure disease (ACD). Methods: In this retrospective study, patients with ACD including medically uncontrolled and advanced primary angle closure glaucoma (PACG) who underwent only cataract surgery were included. The IOP trend was analyzed at postoperative day 1, day 7, 1 month, 3 months, 6 months, 1 year, and final follow-up along with requirement of antiglaucoma medication (AGM)/surgery. Results: A total of 110 eyes of 79 patients [primary angle closure suspect (PACS): 21, PAC: 34, PACG: 55 eyes] were analyzed. Of these patients, 31 eyes had advanced PACG and 20 eyes had medically uncontrolled glaucoma. Best-corrected visual acuity >6/12 was seen in 51 eyes at baseline and 87 eyes at final follow-up. After cataract surgery alone, there was significant reduction (median) in IOP [19.1 ± 18.00% (18.8) in PACS (P < 0.01), 8.55 ± 17.9% (10) in PAC (P = 0.04), 22.82 ± 15.45%(14.3) in PACG (P < 0.01), 18.27 ± 15.99% (14.5) in advanced PACG (P = 0.01) and 36.56 ± 14.58% (28.57) in medically uncontrolled glaucoma (P < 0.01)] and AGM [51.85% (1) in PAC, 32.35% (2) in PACG, 17.71% (2) in advanced PACG, and 40.74% (1.5) in medically uncontrolled PACD] at median follow-up of 1, 2.5, 1, 1.3, and 1 year. Eleven PACG patients, who were on systemic medication preoperatively, were off systemic therapy at final follow-up, while six other PACG eyes (10.9%) required glaucoma surgery. Conclusion: Cataract surgery leads to significant drop in IOP across the spectrum of ACD with visually significant cataract. Cataract surgery may be considered initially for IOP control even in advanced or medically uncontrolled PACG followed by glaucoma surgery later if required.

Iridocorneal endothelial syndrome: Evaluation of patient demographics and endothelial morphology by in vivo confocal microscopy in an Indian cohort

Purpose: To evaluate the patient demographics and morphological characteristics of corneal endothelium by in vivo confocal microscopy (IVCM), in patients with Iridocorneal Endothelial (ICE) Syndrome. Methods: In this retrospective observational series, IVCM acquired endothelial images of patients with ICE syndrome were evaluated. 'ICE cells' morphology was classified as “?” or “+” if they were larger or smaller than contralateral normal endothelium. It was correlated with patient demographics and clinical manifestations. Results: IVCM was performed on 41 eyes of 21 patients, with 13 males (62%) and 8 females (38%). The disease was unilateral in 19 (90.5%) and bilateral but asymmetric in two (9.5%) patients. Total ICE was seen in 91% eyes. Eighty percent patients (12 out of 15) with ICE—cells were males while 83.3% (5 out of 6) patients with ICE + cells were females. Mean age of patients with ICE- cell type and ICE + cell type was 45.8 ± 17.8 years and 40.3 ± 9.2 years respectively (P = 0.02). Both ICE – and ICE + eyes had similar incidence (33.3%) of corneal edema. ICE + eyes had more severe (grades 2/3) glaucoma (n = 5/6 eyes, 83.3%) compared to ICE – eyes (n = 8/15 eyes, 53.3%). Conclusion: A male preponderance, predilection of ICE – and + cell variants for male and female gender respectively, lack of association of the endothelial cell morphology with corneal edema, and apparent association of ICE + phenotype with more severe glaucoma occurring at a relatively younger age, are some novel findings of the present study. In the clinical setting correlation of patient demographics with these IVCM findings may help in better long-term prognostication of eyes with ICE syndrome.

A prospective randomized controlled study of Aurolab aqueous drainage implant versus Ahmed glaucoma valve in refractory glaucoma: A pilot study

Purpose: To study the efficacy of the Aurolab aqueous drainage implant (AADI) compared to Ahmed glaucoma valve (AGV) in patients with refractory glaucoma. Methods: This was a prospective, randomized controlled trial. Thirty-eight adult patients (>18 years) scheduled for a glaucoma drainage device (GDD) were randomized into two groups to receive either AGV or AADI. Primary outcome measures: intraocular pressure (IOP) control and requirement of antiglaucoma medications; secondary outcome measures: final best correct visual acuity (log MAR), visual field (Visual field index [VFI], mean deviation [MD] and pattern standard deviation [PSD]), postoperative complications and additional interventions. Complete success was defined as IOP ?5–?18 mmHg without antiglaucoma medications/laser/additional glaucoma surgery or any vision threatening complications. Results: There were 19 age and sex-matched patients in each group. Both groups had comparable IOP before surgery (P = 0.61). The AGV group had significantly lower IOP compared to AADI group (7.05 ± 4.22 mmHg vs 17.90 ± 10.32 mmHg, P = <0.001) at 1 week. The mean postoperative IOP at 6 months was not significantly different in the two groups (13.3 ± 4.2 and 11.4 ± 6.8 mmHg respectively; P = 0.48). At 6 months, complete success rate according to antiglaucoma medication criteria was 78.94% in AADI and 47.36% in AGV groups. AGV group required 1.83 times more number of topical medications than AADI group. There was no significant difference in early (P = 0.75) and late (P = 0.71) postoperative complications in the AADI and AGV group. The complete success rate was higher in AADI group (68.42%) than AGV group (26.31%) (P = 0.034). Conclusion: In this study, AADI appears to have comparable efficacy versus AGV implant with higher complete success rate at 6 months follow-up.

Evaluation of macular ganglion cell analysis compared to retinal nerve fiber layer thickness for preperimetric glaucoma diagnosis

Purpose: To compare the diagnostic ability of the ganglion cell analysis (GCA) and retinal nerve fiber layer (RNFL) protocol on optical coherence tomography (OCT), to diagnose preperimetric glaucoma. Methods: A prospective, cross-sectional study of 275 adult patients including 47 early glaucoma (mean deviation better than -6.0 D), 150 glaucoma suspects (106 with suspicious discs and 44 ocular hypertensive (OHT), and 78 normal controls was done. Eligible participants were scanned with the spectral domain CirrusTM OCT (Carl Zeiss Meditec, Dublin, CA). Average peripapillary RNFL thickness and GCA measurements were obtained. Area under receiver operating characteristic (AROC) curves were used to evaluate discriminant value of both protocols to diagnose likely preperimetric glaucoma among glaucoma suspects. Results: Average RNFL and GCA were significantly thinner in glaucoma patients compared to glaucoma suspects and normal controls (P < 0.001). The RNFL was 92.26 ± 8.8 ? in normal controls, 87.9 ± 12.12 ? in glaucoma suspects and significantly thinner in POAG (70.29 ± 10.18 ?; P < 0.001). The GCA was 81.94 ± 6.17 ? in normal controls, 77.69 ± 9.03 ? in glaucoma suspects, and significantly thinner in POAG (69.36 ± 11.06 ?; P < 0.001). AROCs for discriminating glaucoma suspects from normal were modest, with no difference in AROC of average RNFL or GCA measurements (DeLong; P = 0.93). Average RNFL thickness had significantly greater AROC values than average GCA for discriminating glaucoma suspects (both suspicious discs and OHT) from glaucoma (P = 0.03 and 0.05, respectively. AROC for diagnosing glaucoma was significantly better (P = 0.02) for RNFL (0.88 ± 0.03) than GCA (0.77 ± 0.04). Conclusion: In the present time, GCA measurements, as provided by the SD-OCT, do not appear to outperform RNFL measurements in the diagnosis of preperimetric glaucoma.

Post‑traumatic endophthalmitis caused by Streptococcus parauberis: First human case report.

A 12‑year‑old boy presented with trauma to left eye with a wooden stick. On examination, there was full thickness corneal laceration with cataractous lens behind the laceration. The laceration was sutured, and intravitreal injections of vancomycin, ceftazidime and clindamycin were administered. Vitreous tap grew Streptococcus parauberis. The isolate was sensitive to amoxicillin, erythromycin and vancomycin, and topical vancomycin was used to treat the infection. We present the first case of human post‑traumatic infective endophthalmitis caused by the rare agent S. parauberis.

Comparison of multiplex RT-PCR with virus isolation for detection, typing and sub-typing of influenza virus from influenza-like illness cases.

Purpose: Infl uenza epidemics and periodic pandemics occur worldwide resulting in signifi cant mortality, morbidity and economic loss. There is need for a sensitive, rapid and cost-effective assay to detect, type and sub-type infl uenza viruses, as cell culture has a long turnaround time. Materials and Methods: Nasopharyngeal swabs were collected from patients presenting with infl uenza-like illness (ILI) at AIIMS OPD and Primary Health Centre Ballabhgarh (Haryana). From June 2007 to January 2009 and then from September to November 2009, of 1567 specimens collected, 544 were randomly selected and were tested by virus culture using Madin-Darby Canine Kidney (MDCK) cells and by reverse transcription polymerase chain reaction (RT-PCR) for infl uenza A using primers for matrix gene and for infl uenza B using non-structural gene (NS) primers. All infl uenza A positives were sub-typed using primers for HA and NA genes of A/H1, A/H3. A separate multiplex RT-PCR having primers from matrix and HA genes of pandemic A (H1N1) pdm09 viruses was carried out on samples collected after September 2009. Results: Of the 544 samples, 136 (25%) were positive for infl uenza by RT-PCR. Further typing analysis revealed 86 (63.2%) were typed as infl uenza A and 47 (34.5%) as infl uenza B viruses and 3 (2%) samples showed dual infection with infl uenza A and B. Of the 86 infl uenza A positive samples 48 (55.8%) were identifi ed as seasonal infl uenza A/H1N1, 22 (25.6%) as A (H1N1) pdm09 and 16 (18.6%) as A/H3N2. Comparison of infl uenza positivity using virus culture revealed that only 97/136 (71.3%) were infl uenza positive. Sensitivity of viral detection was lowest for seasonal A/H1 (26/48; 54%), followed by H3N2 (11/16; 68.7%) and infl uenza B (38/47; 80.8%); all infl uenza A/H1N1pdm09 viruses were detected by both methods. Conclusion: RT-PCR is a sensitive, low cost and rapid screening test for diagnosing infl uenza infection during epidemics and pandemics. mRT-PCR increased the detection rates for infl uenza by 28.6% as compared with virus isolation and thus is a useful assay in both diagnostic and epidemiological settings in resource poor countries.

Intensified Monitoring of Vitamin A Supplementation Programs in Hard-to-Reach Districts and Urban Slums of Pakistan Results in Improved Coverage.

Objectives: Although national coverage of VAS is high in Pakistan (>95%), large pockets of low coverage have been identified. A VAS coverage survey conducted by the Micronutrient Initiative (MI) in 2010 identified the reasons for low coverage as inadequate attention to VAS during training, stock-outs of VAC with frontline workers, and insufficient VAS monitoring. In response, an intensified monitoring and training strategy was initiated in low-coverage areas. This abstract describes this strategy and its results on VAS coverage. Methods: The program was piloted in April and October 2012 rounds of National Immunization Days (NIDs) in 22 hard-to-reach and low coverage districts of Balochistan and Khyber Pakhtoonkhwa and slums of two cities. The strategy comprised of increased attention to VAS during NID training of health workers and managers, enhanced measures to ensure adequate supplies of VAS throughout the supply chain, improved tracking of children missed from VAS dosing (including door markings and addition of VAS-specific columns on tally sheets). A baseline survey (March 2012) and endline survey (November 2012) was conducted to measure VAS coverage. Results: VAS coverage increased from 48% to 59% (baseline) to 90% to 96% (endline) in study sites. The difference in coverage between VAS and polio vaccinations also narrowed during the project period. The incidence of stock-outs of VAS and proportion of parents reporting vaccination teams not visiting their homes also declined. Conclusions: The improvements demonstrated through these strategies in these pilot areas garnered sufficient attention that now they will be adopted in all the provinces/areas by the government of Pakistan.

Streamlining and Standardizing the Collection, Compilation and Use of VAS Program Indicators in the Government HMIS in Indonesia.

Objectives: The current vitamin A supplementation (VAS) program recording and reporting system in Indonesia faces inadequacies in terms of accuracy and completeness. This exercise was implemented to identify the bridge these gaps and inform the design of more accurate and efficient monitoring and reporting system. Methods: A review of existing forms and systems was undertaken and health workers and managers were interviewed to identify gaps. The tools were revised to overcome the gaps and field tested. Results: The key gaps identified were the absence of indicators to track stocks, VAS coverage among postpartum women and tracking of children who received VAS in both semesters. Recording forms also lacked parents’ name, severely limiting health workers’ ability to track children. The forms were revised to overcome these gaps. Errors were also identified in the roll up of numbers from health facility to the national level. In order to empower managers to identify and correct these errors, an easy to use tool was developed. Further, a tool to assess data quality across different dimensions of completeness, accuracy, timeliness and data use was developed. These improvements reportedly limited errors and facilitated the feedback loop toward implementing data and program improvements. The revised monitoring tools and the data quality and accuracy assessments were field tested and found to be easily usable by health personnel. Conclusions: Streamlining the information flow and empowering managers with simple tools can be very useful for them to initiate corrective action. The Government has initiated replication of these tools and methods in additional districts.