Assessment of quality of life in glaucoma patients in a tertiary care center in Eastern India.

Purpose: The aim of this study is to assess the quality of life (QOL) in glaucoma patients and find out the sociodemographic factors predicting QOL. Methods: A cross-sectional study was conducted in a tertiary care center from August 2021 to February 2022. Subjects diagnosed with glaucoma for at least 6 months were enrolled. After taking informed consent, demographic details and detailed history were collected for all patients. Comprehensive eye examination (visual acuity, intraocular pressure, gonioscopy, fundoscopy, visual field assessment, ocular coherence tomogram assessment) was done for all and they were asked to fill the WHOQOL-BREF questionnaire. Data were collected and analyzed using SPSS 21. Results: One hundred and ninety-nine patients were recruited. Mean age of participants was 57.99 ± 10.76 years. Based on various domains and subgroups, QOL values were significant with respect to income (P = 0.016). Gender-wise QOL in females was lower than that of males with respect to all the domains (P = 0.001). While marital status affected both environmental and social domain, literacy affected only the social domain. A variation in intraocular pressure affected the QOL in the psychological domain. QOL was not significantly associated with the severity of the disease. Gender was the most predominant predictor out of all sociodemographic factors. Conclusion: Chronic diseases affect the QOL of individuals in many ways. Glaucoma being a chronic disease hampers patients' vision irreversibly and by extension the various physical, social, and psychological aspects of the patient's life as well. Hence, knowledge of the change in QOL it brings about can help plan the treatment, counseling, and management of these patients.

Challenges in managing glaucoma-related morbidity due to lockdown in a developing country.

Objective: The aim of this study was to assess the ocular morbidity due to delayed presentation in glaucoma patients because of COVID lockdown. Methodology: This was a retrospective study of 15 cases presented to us between October 2020 and February 2021. Cause of glaucoma in our study group was either primary angle closure, pseudoexfoliation, lens-induced glaucoma, or neovascular glaucoma. The cause of delayed presentation was identified and patients were treated with antiglaucoma medications, Nd-Yag laser, and surgery as per the standard treatment protocol. Results: With both medical and surgical intervention, some useful vision was restored in five cases while in rest it was not salvageable. The vision in the affected eye ranged from 6/60 in Snellen's chart to perception of light and projection of rays positive. Better results were achieved in angle, closure, and lens-induced glaucoma cases as compared to neovascular glaucoma cases. Conclusion: The time of presentation in such cases is as important as the etiopathogenesis. We are left with limited treatment options if the presentation is late. The lockdown ended but it unraveled quite a few instances of disease presentation which were totally preventable under normal circumstances. Introspection on finding out newer and proactive methods to reach people suffering from such irreversible but preventable diseases is the need of the day especially when preventable but irreversible diseases like glaucoma are considered.

Bilateral optic disc edema with subconjunctival hemorrhage: Attributed to scrub typhus?

A 15-year-old female patient presented with complaints of headache, blurring of vision, and redness of both eyes for 15 days and fever for 20 days. Her best-corrected visual acuity (BCVA) was 20/40 in both eyes. Anterior segment examination was normal except for subconjunctival haemorrhage in both eyes. Examination of the posterior segment showed disc oedema in both eyes. Her blood investigations revealed platelet count to be 1.5 lakhs per cubic mm, and leucocyte count to be10,700 per cubic mm. CSF culture showed seven cells per microlitre,76% lymphocytes and CSF samples negative for gram stain, acid-fast bacilli, and culture. Further investigation for IgM titre for scrub typhus was positive. She was treated with oral doxycycline. On follow up after three weeks, both the subconjunctival haemorrhage and bilateral disc oedema resolved with BCVA of 20/20 in both eyes. She was kept on follow up and has not presented with any fresh complaints until six months after the initial presentation."

Angle Closure with Patent Laser Peripheral Iridotomy - An Unusual Complication.

A 41-year-old female presented with diminished vision in both eyes with recurrent episodes of pain, redness, and watering. With a provisional diagnosis of primary angle-closure glaucoma in the left eye and primary angle closure in the right eye, anti-glaucoma medications were started in the left eye and laser peripheral iridotomy was done in both eyes. Follow-up showed patent iridotomy in both eyes and dilated fundoscopy revealed total cupping in the left eye. Next day, the patient had angle closure in the right eye. On medical management, symptoms subsided but intraocular pressure (IOP) was still raised. Right eye trabeculectomy with cataract surgery was done. Vision was restored to 6/9 with IOP of 12 mmHg after 2 weeks. The event was considered to be precipitated because of plateau iris configuration which is an anatomical variant of angle in angle-closure patients. This proves patent laser iridotomy is not always a ticket to dilatation and one should be aware of all possible complications.

Sebaceous Gland Carcinoma of Lid: Masquerading as a Recurring Chalazion.

Recurrent chalazion may be associated with bad lid hygiene but can have clinical changes which lead to the suspicion of a more dangerous entity. Particularly in elderly patients, recurrence of chalazion should be suspected to have carcinomatous changes. We present the case of a 52-year-old woman with presentation of recurrent chalazion which turned out to be sebaceous gland carcinoma of the lid. Sebaceous gland carcinoma usually presents as a small firm nodule resembling chalazion, and majority of the premalignant and malignant lesions misdiagnosed as chalazion are primary cases. Hence, the need of histopathological examination in every such case cannot be undermined.

Involvement of Arachis hypogaea Jasmonate ZIM domain/TIFY proteins in root nodule symbiosis.

Jasmonate ZIM domain (JAZ) proteins are the key negative regulators of jasmonate signaling, an important integrator of plant-microbe relationships. Versatility of jasmonate signaling outcomes are maintained through the multiplicity of JAZ proteins and their definitive functionalities. How jasmonate signaling influences the legume-Rhizobium symbiotic relationship is still unclear. In Arachis hypogaea (peanut), a legume plant, one JAZ sub-family (JAZ1) gene and one TIFY sequence containing protein family member (TIFY8) gene show enhanced expression in the early stage and late stage of root nodule symbiosis (RNS) respectively. In plants, JAZ sub-family proteins belong to a larger TIFY family. Here, this study denotes the first attempt to reveal in planta interactions of downstream jasmonate signaling regulators through proteomics and mass spectrometry to find out the mode of jasmonate signaling participation in the RNS process of A. hypogaea. From 4-day old Bradyrhizobium-infected peanut roots, the JAZ1-protein complex shows its contribution towards the rhizobial entry, nodule development, autoregulation of nodulation and photo-morphogenesis during the early stage of symbiosis. From 30-day old Bradyrhizobium infected roots, the TIFY8-protein complex reveals repressor functionality of TIFY8, suppression of root jasmonate signaling, modulation of root circadian rhythm and nodule development. Cellular localization and expression level of the interaction partners during the nodulation process further substantiate the in planta interaction pairs. This study provides a comprehensive insight into the jasmonate functionality in RNS through modulation of nodule number and development, during the early stage and root circadian rhythm during the late stage of nodulation, through the protein complexes of JAZ1 and TIFY8 respectively in A. hypogaea.

Abduction Deficit Mimicking Sixth Nerve Palsy due to Metastasis in Systemic Malignancy: Rare Case Report.

Lateral rectus palsy presenting as abduction deficit resulting in diplopia is attributed to neurogenic causes. Metastasis as a cause of sixth cranial palsy is an extremely rare entity but cannot be overlooked. Cases of metastasis to lateral rectus secondary to lung and breast carcinoma have been reported. Primary adrenocortical carcinoma (ACC) metastasizing to lateral rectus muscle is extremely rare. Here, we report a case of ACC arising from the left adrenal gland that presented with left-sided abduction deficit in a 58-year-old male with vasculopathic risk factors. The case highlights the importance of neuroimaging in cases of isolated nontraumatic sixth nerve palsy or in cases with isolated ocular symptoms with associated systemic findings. The fact that all cases of muscle palsies may not be neurogenic and rare causes such as metastatic muscle involvement must be included as a differential diagnosis in suspected cases has been emphasized.

Assessment of online teaching as an adjunct to medical education in the backdrop of COVID-19 lockdown in a developing country - An online survey.

PURPOSE: The aim of this study was to assess awareness about online classes and to assess if they can aid learning in the field of medicine amid lockdown. METHODS: Online survey comprising a questionnaire related to the aspects of online teaching was undertaken. There were 16 questions, and responses were collected from undergraduates, postgraduates, and the teaching faculties. RESULTS: Online classes were viewed favorably by the vast majority of respondents. Out of 412 respondents 79.9% actively attended the classes. While 42% felt the timings were inappropriate as they clashed with duty hours, a set of 35% had difficulty understanding the content and most of them were undergraduates. Poor internet connection was a main hindrance identified. In total, 69.2% respondents were happy with the feasibility of the classes and believed these classes had the advantage of being economical as they offered exposure to national and international faculty from the comfort of their homes. CONCLUSION: Conducting online classes on a national scale is a herculean task for a developing country because of poor internet connectivity and deficient access to high-speed broadband services. Nevertheless, their popularity among students during the current crisis shows that it is a very pragmatic and feasible teaching option and can definitely supplement traditional classroom teaching.

Hypotony maculopathy: a surgeon's nightmare.

A 14-year-old myopic male patient diagnosed as steroid-induced glaucoma and cataract elsewhere presented to the eye opd with painless and progressive diminution of vision in the right eye (oculus dexter (OD)) for last 6 months. Phacotrabeculectomy was already done in the left eye (oculus sinister (OS)) 1 year ago and he was on topical latanoprost e/d-H.S in OD and brimonidine e/d-BD and dorzolamide e/d-TDS in both eyes (oculus uterque (OU)) postsurgery. Uneventful phacotrabeculectomy was performed in the right eye under 300 mL intravenous injection mannitol. He developed hypotony maculopathy postsurgery which was managed conservatively.

Rare presentation of capillary haemangioma.

Conjunctival capillary haemangiomas are very rare above 40 years of age group, with few cases reported in the literature. Adding to the scanty literature of this uncommon vascular tumour, we present the case of a 45-year-old man who presented with a nodular growth in the conjunctiva without any associated systemic diseases or cutaneous lesion. Excisional biopsy of the mass was done. Histopathological examination showed lobulated capillary haemangioma which is very rare in this age group.

Proteomic analysis of JAZ interacting proteins under methyl jasmonate treatment in finger millet.

Jasmonic acid (JA) signaling pathway in plants is activated against various developmental processes as well as biotic and abiotic stresses. The Jasmonate ZIM-domain (JAZ) protein family, the key regulator of plant JA signaling pathway, also participates in phytohormone crosstalk. This is the first study revealing the in vivo interactions of finger millet (Eleusine coracana (L.) Gaertn.) JAZ protein (EcJAZ) under methyl jasmonate (MJ) treatment. The aim of the study was to explore not only the JA signaling pathway but also the phytohormone signaling crosstalk of finger millet, a highly important future crop. From the MJ-treated finger millet seedlings, the EcJAZ interacting proteins were purified by affinity chromatography with the EcJAZ-matrix. Twenty-one proteins of varying functionalities were successfully identified by MALDI-TOF-TOF Mass spectrometry. Apart from the previously identified JAZ binding proteins, most prominently, EcJAZ was found to interact with transcription factors like NAC, GATA and also with Cold responsive protein (COR), etc. that might have extended the range of functionalities of JAZ proteins. Moreover, to evaluate the interactions of EcJAZ in the JA-co-receptor complex, we generated ten in-silico models containing the EcJAZ degron and the COI1-SKP1 of five monocot cereals viz., rice, wheat, maize, Sorghum and Setaria with JA-Ile or coronatine. Our results indicated that the EcJAZ protein of finger millet could act as the signaling hub for the JA and other phytohormone signaling pathways, in response to a diverse set of stressors and developmental cues to provide survival fitness to the plant.

A potent bidirectional promoter from the monocot cereal Eleusine coracana.

Ragi bifunctional α-amylase-trypsin inhibitor (RBI) of Eleusine coracana (L.) Gaertn. (finger millet) simultaneously inhibits α-amylase and trypsin. In continuation of previous work on the cloning, expression and characterization of RBI, a bidirectional promoter from finger millet was explored on the basis of experimental observations. Two trypsin inhibitors were identified while purifying RBI from a trypsin-Sepharose column eluent. Using an FPLC gel filtration column, these three inhibitors were purified to homogeneity and subjected to MALDI-TOF-TOF-MS/MS analysis and N-terminal sequencing. Both ragi trypsin inhibitors (RTIs) showed the same N-terminal sequence and considerable sequence similarity to RBI, indicating the presence of a multigene protease inhibitor family in finger millet. To gain insight into the evolution of these genes, the upstream region of RBI was explored by Genome Walking. Interestingly, on sequencing, a genome walking product of ∼1 Kb showed presence of an N-terminal RBI specific primer sequence twice but in opposite directions and leaving an intervening region of ∼0.9 Kb. The intervening region was presumed to represent an E. coracana bidirectional promoter (EcBDP), intuitively having a divergent RBI-RTI gene pair at two sides. For assaying the bidirectionality of promoter activity, a dual reporter GUS-GFP vector construct was made for plant expression containing the reporter genes at two ends of EcBDP, which was used to transform Agrobacterium tumefaciens LBA 4404. Transient plant transformation by recombinant Agrobacterium cells was carried out in onion scale epidermal cells and finger millet seedling leaves. Simultaneous expression of GUS and GFP under EcBDP established it as a potent natural bidirectional promoter from monocot origin, thereby potentially having vast application in cereal gene manipulations. In addition, inducibility of the EcBDP by either abscisic acid or cold treatment, as determined by transient transformation in onion, would substantiate more precise control of gene expression to mitigate the effects of adverse environmental conditions.

The ribosome-related protein, SBDS, is critical for normal erythropoiesis.

Although anemia is common in Shwachman- Diamond syndrome (SDS), the underlying mechanism remains unclear. We asked whether SBDS, which is mutated in most SDS patients, is critical for erythroid development. We found that SBDS expression is high early during erythroid differentiation. Inhibition of SBDS in CD34(+) hematopoietic stem cells and early progenitors (HSC/Ps) and K562 cells led to slow cell expansion during erythroid differentiation. Induction of erythroid differentiation resulted in markedly accelerated apoptosis in the knockdown cells; however, proliferation was only mildly reduced. The percentage of cells entering differentiation was not reduced. Differentiation also increased the oxidative stress in SBDS-knockdown K562 cells, and antioxidants enhanced the expansion capability of differentiating SBDS-knockdown K562 cells and colony production of SDS patient HSC/Ps. Erythroid differentiation also resulted in reduction of all ribosomal subunits and global translation. Furthermore, stimulation of global translation with leucine improved the erythroid cell expansion of SBDS-knockdown cells and colony production of SDS patient HSC/Ps. Leucine did not reduce the oxidative stress in SBDS-deficient K562 cells. These results demonstrate that SBDS is critical for normal erythropoiesis. Erythropoietic failure caused by SBDS deficiency is at least in part related to elevated ROS levels and translation insufficiency because antioxidants and leucine improved cell expansion.

Distinct synergistic action of piperacillin and methylglyoxal against Pseudomonas aeruginosa.

The dicarbonyl compound methylglyoxal is a natural constituent of Manuka honey produced from Manuka flowers in New Zealand. It is known to possess both anticancer and antibacterial activity. Such observations prompted to investigate the ability of methylglyoxal as a potent drug against multidrug resistant Pseudomonas aeruginosa. A total of 12 test P. aeruginosa strains isolated from various hospitals were tested for their resistances against many antibiotics, most of which are applied in the treatment of P. aeruginosa infections. Results revealed that the strains were resistant to many drugs at high levels, only piperacillin, carbenicillin, amikacin and ciprofloxacin showed resistances at comparatively lower levels. Following multiple experimentations it was observed that methylglyoxal was also antimicrobic against all the strains at comparable levels. Distinct and statistically significant synergism was observed between methylglyoxal and piperacillin by disc diffusion tests when compared with their individual effects. The fractional inhibitory concentration index of this combination evaluated by checkerboard analysis, was 0.5, which confirmed synergism between the pair. Synergism was also noted when methylglyoxal was combined with carbenicillin and amikacin.