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Aim: To determine the effect of COVID-19 on eye sight due to increase screen time in undergraduate students of medical school. Study design: Cross-sectional study. Place and duration of study: This survey was carried out from October 2022 to December 2022 in Army Medical College Rawalpindi. Questionnaires were filled in person and also online-based platform was used to distribute the e-questionnaire, developed using the Google Form. The participants were asked to share the e-questionnaire with their friends using Facebook and Messenger. Method(s): Participants were selected for the study using non-probability consecutive sampling. College students of 20-25 years were included in the study. Sample size was 400 according to a study done internationally. Participants with comorbidities (cataract, glaucoma) were excluded from study. Participants having (trouble concentrating on things such as reading the newspaper, books or watching television) were included in the study. Digital eye strain was calculated using validated computer vision syndrome (CVS-Q) questionnaire to measure the symptoms such as eye fatigue, headache, blurred vision, double vision, itching eyes, dryness, tears, eye redness and pain, excessive blinking, feeling of a foreign body, burning or irritation, difficulty in focusing for near vision, feeling of sight worsening, and sensitivity to light. Qualitative data was analyzed using Chi square test. Results A total number of 470 responses were recorded, out of which 257 (54.7%) were males and 213(45.3%) were females. In our study, the most common symptom was headache, affecting 58.1% of the population before COVID 19 which has increased to 83.2% and the P value is less than 0.001.Theother symptoms which also showed P value less than 0.001 were blurred vision while using digital device, irritated or burning eyes, dry eyes and sensitivity to bright light. Conclusion The practical implication of the study is to create awareness among general population about COVID, that eye sight is Bull`s Target to be affected by it and simple preventing measures can be taken. The purpose of this study is to limelight the importance that during COVID 19 lockdown the excessive use of digital devices and their cons on the ocular health among future health care workers.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Introduction: We report a case of drug-induced liver injury (DILI) induced by cannabis gummies containing Corydalis Rhizome. Case Description/Methods: A 37-year-old female presented to her primary care clinic with recurrent fevers, night sweats, and myalgias for 7 weeks accompanied by eye redness, brain fog, headache, nausea, and abdominal pain. She denied rashes, tick-bites, cough, dyspnea, chest pain, joint swelling, or genitourinary symptoms. Past medical history was notable for IBS, migraines, and anxiety. She reported edible marijuana use four times a week, rare alcohol use, and denied tobacco use. She denied a family history of liver disease. Physical exam was notable for tachycardia to 110 and scleral injection with the remainder of vitals and exam unremarkable. Initial labs were notable for AST 61, ALT 44 and CRP of 12. CBC, BMP, urinalysis, ESR, blood cultures, blood smear for parasite screen, tests for Lyme disease, Babesia, Tularemia, Anaplasma, Ehrlichia, Rickettsia, EBV, HIV, RPR, ANA, CMV, parvovirus B19, and chest x-ray were all negative. The patient was referred to infectious disease with further testing for West Nile, Leptospira, lymphocytic choriomeningitis virus, and COVID-19 returning negative. Repeat LFTs showed worsening transaminitis with ALT 979 and AST 712, alkaline phosphatase 88, total bilirubin 0.7, and albumin 4.9. Hepatitis workup including hepatitis A, B, and C, HSV, EBV, VZV serologies, AMA, ASMA, antiLKM Ab, acetaminophen level, INR, iron panel, CPK, TSH, and abdominal ultrasound were all normal. It was later discovered that her marijuana gummies contained Corydalis rhizome extract known to be hepatotoxic. Cessation of this drug was strongly advised. She was discharged with hepatology follow-up and underwent a liver biopsy showing patchy periportal and lobular inflammation with extension across the limiting plate, hepatocyte injury and apoptosis, and increased lipofuscin for age compatible with mild to moderate hepatitis. She had complete recovery after cessation of Corydalis-containing gummies. (Figure) Discussion: Our patient consumed '1906 Midnight', an American cannabis brand containing Corydalis rhizopus 100 mg, advertised to improve sleep, pain, and have a liver protective effect. A Korean systematic review on herbal-induced liver injury reported that Corydalis was the 3rd most frequent causative herb, with 36 cases. Although there are several personal accounts on social networking sites and other websites, there are no American-based publications reported on DILI from Corydalis. (Table Presented).
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Introduction: Autoimmune and inflammatory thyroid diseases have been reported following SARS-CoV-2 infection or vaccination, but thyroid eye disease (TED) post-COVID-19 infection is less common. We describe a case of TED following SAR-CoV-2 infection in a patient with a history of Graves' disease. Case Description: A 59-year-old female with history of Graves' disease status post radioiodine ablation therapy in 2002. She developed post-ablative hypothyroidism which has been stable on levothyroxine 88 mcg daily. In January 2021, the patient's husband and daughter were diagnosed with COVID-19 infection. A few days later, the patient developed an upper respiratory tract infection associated with loss of sense of smell and taste consistent with COVID-19 infection. Three days later, she developed bilateral watery eyes which progressed to eye redness, eyelid fullness, retraction, and pain with eye movement over 1-month duration. Her eye examination was significant for severe periocular soft tissue swelling, lagophthalmos and bilateral exophthalmos. The laboratory workup was consistent with normal TSH 0.388 mIU/L (0.358-3.740 mIU/L) and positive TSI 1.01 (0.0-0.55). The patient was referred to an Ophthalmologist for evaluation of TED. He noted bilateral exophthalmos, no restrictive ocular dysmotility or compressive optic neuropathy (clinical activity score 4/7 points). CT scan of orbit showed findings compatible with thyroid orbitopathy. Based on clinical activity score of 4, treatment with Teprotumumab was recommended pending insurance approval. Discussion(s): Many cases of new-onset Graves' hyperthyroidism have been reported after COVID-19, with only a few associated with TED. Our patient has been in remission for 20 years before she developed COVID-19 infection with occurence of TED.This suggests that COVID-19 infection may have played a role. SARS-CoV-2 may act through several mechanisms, including breakdown of central and peripheral tolerance, molecular mimicry between viral and self-antigens, stimulation of inflammasome with release of type I interferon. In our patient, treatment with Teprotumumab was indicated due to Graves' orbitopathy clinical activity score greater than or equal to 3. In conclusion, it is very uncommon for TED to present after COVID-19 infection. Our case reinforces the speculative hypothesis that SARS-CoV-2 virus could have triggered an autoimmune response against eye antigens. There is a need for increased awareness about the link between COVID-19 and autoimmunity to help better define the management of patients.Copyright © 2023
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Background: Idiopathic inflammatory myopathies (IIM) are a class of long-lasting autoimmune diseases that typically affect the proximal muscles. Dermatomyositis (DM), polymyositis (PM), necrotizing autoimmune myopathy (NAM), and sporadic inclusion body myositis are the most prevalent kinds. Patients usually have subacute to chronic proximal weakness, which presents as difficulty getting out of a chair, getting up the stairs, lifting objects, and brushing their hair. They are distinguished by their clinical presentation, which includes muscular and ex-tramuscular signs. Elevated serum creatine kinase (CK) levels and myositis-specific antibodies may help distinguish clinical phenotypes and confirm the diagnosis. Biopsy of the muscle, on the other hand, is still the gold standard for determining the cause of the problem. These disorders may be cured with proper diagnosis and treatment. The treatment's goals are to reduce inflammation, restore muscle performance, and alleviate pain. Method(s): 36-year-old man K/C/O dermatomyositis came complaints of redness swelling in the right eye for 3 months, dysphagia, easy fatiguability. Patient was neither hypertensive nor diabetic. Result(s): This case describes the severity of NXP2 autoantibody and a potential to be life threatening. Patient was started with immunoglobulins, monoclonal antibodies. After which patient improved from his present condition.Copyright © 2022 Novyi Russkii Universitet. All rights reserved.
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Background: The inflated use of digital screens has completely changed the lives of people physically, mentally and psychologically. The covid-19 pandemic has also compelled people of all age groups to shift to digital media. The average screen time usage is 7-9 hours a day which is alarming. Aim(s): To find out the relation of screen time with ophthalmic problems among medical students. Study Design: Cross-sectional study Place and Duration of Study: Department of Community Medicine, HITEC-IMS Taxila from 1st January 2020 to 30th June 2020. Methodology: One hundred and fifty two medical students were included using non probability convenience sampling technique. An electronic questionnaire was developed and Google forms were used for data registration. Result(s): The relation between screen time duration with difficulty in refocusing (p=0.05) and eye redness (p=0.05). No relation was found between screen duration and headache, eye strain, blurred vision and refractive errors. Conclusion(s): High screen time is found to be related to ophthalmic problems like difficulty refocussing and eye redness which if not addressed properly might result in detrimental effects. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.
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Mucormycosis in people with COVID-19 or who are immunocompromised in any other way has become a worldwide issue, resulting in severe morbidity and mortality. Infection is incapacitating. and deadly, resulting in organ loss and emotional anguish. Mucormycosis is a rare angioinvasive illness that primarily affects immunocompromised people and is caused by the prolife ration of Mucorales. There are no radiographic symptoms. However a diagnosis can be made by microscopically examining materials recovered from necrotizing lesions Because the fungus enters the body through the skin, treatment involves a multidisciplinary approach. The use of the several antifungal medicines available is restricted by resistance and toxicity factors. The lipid formulation of amphotericin-B (liposomal Am-B) is the first-line treatment for mucormycosis in COVID-19 patients. high cost and limited availability have prompted a shift toward surgery, so surgical debridement to remove all necrotic lesions remains the keystone of effective mucormycosis treatment in COVID-19. This study concentrates on the pathophysiology, clinical manifestations, and therapy of HyperglycemiaAndIts Contributing Factors In Patients With Post Covid - 19 Mucormycosis. Copyright © 2022, Anka Publishers. All rights reserved.
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Purpose : Computer Vision Syndrome (CVS) is a form of asthenopia that manifests with symptoms such as eye pain/discomfort, headache, and blurred vision, among others. Early identification of CVS is especially relevant during the COVID-19 pandemic, which has led to an increase in virtual schooling and digital screen time among children worldwide. This study seeks to evaluate differences in etiologies of eye pain, treatment recommendations, and the relationship between refractive errors and eye pain in the pediatric population before and during the COVID-19 pandemic. Methods : After IRB approval, we retrospectively reviewed the records of patients who visited our tertiary care institution between 2018 and 2021 with a chief complaint of eye pain, determined by the encounter's primary ICD-10 code. Patients who visited before 03/11/2020, when the WHO declared COVID-19 a pandemic, were classified as the pre-pandemic group (PPG), while patients who consulted after this date were classified as the during-pandemic group (DPG). Demographics, symptoms, refractive error, treatment, and schooling method were recorded as covariates and analyzed using a Chi-square and Fisher's exact test. Results : 38 patients were included in the study (21 PPG;17 DPG). The mean age was 10.1 ± 3.2 years, and the majority were African American (44.7%). Virtual school attendance for the PPG and DPG was 4.8% and 58.8%, respectively (P<0.05) (Table 1). There was a higher prevalence of reported blurry vision, headaches, eye redness, eye swelling, and rubbing among DPG patients (Table 1). Counseling on screen time minimization was more likely to be documented in the DPG (Table 2). A greater proportion of patients were prescribed new glasses in the DPG though there was no significant relationship between eye pain and refractive error or anisometropia in either group (P>0.05). Conclusions : The increased prevalence of CVS symptoms in the DPG suggests an association between virtual schooling and CVS in children. There is a role for ophthalmologists to improve rates of counseling for the prevention of eye pain-related symptomatology with digital device usage. Further studies will survey parents to assess their awareness of conservative treatments for eye pain such as artificial tears and decreased screen time.
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Introduction The relationship between autoimmunity and SARS-CoV-2 vaccine has explained how thyroid dysfunction developed following vaccination but the onset of thyroid eye disease (TED) is scarcely described. We report a case of Graves' disease (GD) who developed TED after three weeks of BNT162B2 SARS-CoV-2 vaccine (Pfizer-BioNTech) injection. CASE A 54-year-old non-smoking male presented with newonset bilateral eyes redness, proptosis, and diplopia three weeks after receiving the second dose of mRNA BNT162B2 SARS-CoV-2 vaccine. He was diagnosed with GD without TED in 2003 and underwent radioactive iodine ablation in 2020. He subsequently developed hypothyroidism and was started on levothyroxine with stable thyroid function test throughout clinic visits. There were no recent stressful events including COVID-19 infection. On examination, he has bilateral exophthalmos, chemosis, conjunctival injection, swollen eyelids and caruncles, with intact vision. Blood tests revealed normal TSH, free T4, and T3, but elevated TSH-receptor antibodies of 3.60 IU/L (<1.75) and antithyroid peroxidase (TPO) antibodies of >600 IU/ml (0-34). MRI orbit showed bilateral extraocular muscle enlargement and proptosis. Intravenous methylprednisolone was given weekly for 12 weeks. There was significant improvement concerning congestive symptoms and diplopia after the third dose of methylprednisolone. Thyroid eye disease is the extrathyroidal manifestation of GD resulting from the autoimmune and inflammatory process. The temporal relationship of the onset of TED after mRNA SARS-CoV-2 vaccination in our case was suggestive, and there were no other inciting events identified. The postulated mechanisms include immune reactivation, molecular mimicry between the SARS-CoV-2 spike proteins and thyroid proteins, and the autoimmune/ inflammatory syndrome induced by adjuvants present in the mRNA vaccine. Conclusion Patients with autoimmune thyroiditis should be monitored closely after SARS-CoV-2 vaccine as they may develop TED and require treatment.
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Background: The ocular symptoms are common manifestations in coronavirus infectious disease 2019 (COVID-19), which faces secondary complications and therapeutic challenges. Underlying diseases actuate the body to infectious diseases and their related manifestations through the aberration of metabolism and suppressing the immune system. This study aimed to investigate the correlation of underlying diseases and ocular manifestations in COVID-19 patients. Methods: This cross-sectional study was held on 108 hospitalized COVID-19 patients (confirmed by molecular detection) admitted to Rouhani hospital, Babol, Iran. Upon hospitalization, all clinical symptoms and underlying diseases were registered. Detailed clinical examinations regarding ophthalmological protocols were used to investigate the ocular symptoms. All analyses were performed by SPSS, version 25. Results: Our results showed that 26.67% of patients with at least one ocular symptom had hyperlipidemia, while 10.42% of patients without any ocular symptoms had hyperlipidemia (P=0.049). In this study, 97.81% of COVID-19 patients without epiphora had no thyroid disorders (hyper-/hypo-thyroidism), while 82.35% of COVID-19 patients with epiphora had not any thyroid disorders (P=0.012). Also, 75.00% of patients with blurred vision had diabetes mellitus, while 35.00% of patients without blurred vision suffered from diabetes mellitus. This difference was borderline significant (P=0.051). Other results showed that 13.04% of COVID-19 patients with eye redness suffer from myalgia, while 35.29% of patients without eye redness had myalgia (P=0.044). Also, 35.11% of COVID-19 patients without photophobia had myalgia, while none of the patients with photophobia had myalgia (P=0.005). Finally, 70.00% of patients with respiratory distress had at least one ocular symptom, while 43.10% of patients without respiratory distress had at least one ocular symptom (P=0.007). Conclusion: Some underlying diseases, e.g., hyperlipidemia, diabetes mellitus, and thyroid disorders, and some clinical symptoms in hospitalized patients, e.g., myalgia and respiratory distress, are correlated with ocular manifestations in COVID-19 patients.