Lupus Erythematosus Tumidus Misdiagnosed as Erythema Nodosum from Coccidioidomycosis.

Introduction: Lupus erythematosus tumidus (LET) is a rare photosensitive dermatosis that is categorized as intermittent cutaneous lupus erythematosus. It shares clinical similarities and histopathological features with other skin disorders, such as erythema nodosum, lymphocytic infiltrate of Jessner, and reticular erythematous mucinosis, thus making diagnosis quite challenging. We present a patient with LET whose diagnosis was confirmed after seeing several doctors. Case Presentation: A 52-year-old Hispanic female presented with tender erythematous nodules on her thighs for approximately 1 month. She was suspected of having erythema nodosum secondary to coccidioidomycosis and was prescribed fluconazole 200 mg for 30 days but showed no improvement. However, histopathological and direct immunofluorescence tests later confirmed a diagnosis of LET. The patient was treated with hydroxychloroquine, and the lesions improved remarkably after 2 weeks. Conclusion: LET is a rare dermatosis that closely resembles other dermatologic conditions such as erythema nodosum, lymphocytic infiltrate of Jessner, and reticular erythematous mucinosis. Diagnosis based on clinical features alone should be avoided, and ideally, treatment should only be initiated after confirmatory histopathological testing.

Effectiveness of m-health technology-enabled physical activity program on physical activity adoption and adherence in people with hypertension in India: A randomized controlled trial protocol.

Background: Exercise and medication have similar benefits in reducing blood pressure (BP); however, hypertension management initiatives primarily focus on medicines. This is due to scarce research on the effectiveness of implementation strategies for optimal exercise adoption and adherence. Smartphones were found to be effective in delivering hypertension care and increase exercise adherence. Despite this, only a small number of research projects in India have used smartphones as a strategy for managing hypertension. Methods: We hypothesized that smartphone application-based care would lead to higher exercise adherence among adults (30-79 years) with hypertension compared to those who receive usual care. It will be a multicentric, randomized controlled, parallel-design, superiority clinical trial. The outcome assessor and data analyst will be blinded to group allocation. Participants in the intervention group will receive mobile application-based care for 6 weeks. Participants in the usual care group will receive a standard intervention. Both groups will receive the same number of follow-ups. Results: The primary outcome is the difference in the proportion of people adherent to the recommended level of physical activity evaluated using an exercise adherence rating scale in the intervention group and the control group. Exercise adoption will be measured as the percentage of eligible participants in each study setting willing to initiate the exercise program. The secondary outcome includes differences in systolic and diastolic BP and self-management (evaluated using the Hypertension Self-Care Profile). The trial outcome will be accompanied by a process evaluation. Conclusions: This research will inform about the comparative effectiveness of conventional and m-health interventions for exercise adoption and adherence in people with hypertension in resource-constrained settings.

Contribution of infection and vaccination to population-level seroprevalence through two COVID waves in Tamil Nadu, India.

This study employs repeated, large panels of serological surveys to document rapid and substantial waning of SARS-CoV-2 antibodies at the population level and to calculate the extent to which infection and vaccination separately contribute to seroprevalence estimates. Four rounds of serological surveys were conducted, spanning two COVID waves (October 2020 and April-May 2021), in Tamil Nadu (population 72 million) state in India. Each round included representative populations in each district of the state, totaling ≥ 20,000 persons per round. State-level seroprevalence was 31.5% in round 1 (October-November 2020), after India's first COVID wave. Seroprevalence fell to 22.9% in round 2 (April 2021), a roughly one-third decline in 6 months, consistent with dramatic waning of SARS-Cov-2 antibodies from natural infection. Seroprevalence rose to 67.1% by round 3 (June-July 2021), with infections from the Delta-variant induced second COVID wave accounting for 74% of the increase. Seroprevalence rose to 93.1% by round 4 (December 2021-January 2022), with vaccinations accounting for 63% of the increase. Antibodies also appear to wane after vaccination. Seroprevalence in urban areas was higher than in rural areas, but the gap shrunk over time (35.7 v. 25.7% in round 1, 89.8% v. 91.4% in round 4) as the epidemic spread even in low-density rural areas.

Does the format of result presentation and type of conclusion in Cochrane plain language summaries matter? A randomised controlled trial.

OBJECTIVES: This study aimed to investigate whether the format and type of conclusion in Cochrane plain language summaries (PLSs) influence readers' perception of treatment benefit and decision-making. DESIGN: An online parallel group, three-arm randomised controlled trial was conducted. SETTING: The study was conducted online. PARTICIPANTS: The participants were physiotherapy students. INTERVENTIONS: The participants read two Cochrane PLSs, one with a positive conclusion (strong evidence of benefit) and another with a negative conclusion (strong evidence of non-benefit). Each participant read the results of both reviews presented in one of three formats: (1) numerical, (2) textual or (3) numerical and textual. MAIN OUTCOME MEASURES: The primary outcome measure was the participants' perception of treatment benefit. RESULTS: All three groups of participants perceived the treatment to have positive effects when the Cochrane PLS had a positive conclusion, regardless of the format of presentation (mean perception of treatment benefit score: textual 7.7 (SD 2.3), numerical 7.9 (SD 1.8), numerical and textual 7.7 (SD 1.7), p=0.362). However, when the Cochrane PLS had a negative conclusion, all three groups of participants failed to perceive a negative effect (mean perception of treatment benefit score: textual 5.5 (SD 3.3), numerical 5.6 (SD 2.7), numerical and textual 5.9 (SD 2.8), p=0.019). CONCLUSIONS: The format of Cochrane PLSs does not appear to significantly impact physiotherapy students' perception of treatment benefit, understanding of evidence, persuasiveness or confidence in their decision. However, participants' perception of treatment benefit does not align with the conclusion when the Cochrane PLS indicates strong evidence of non-benefit from the intervention. TRIAL REGISTRATION NUMBER: CTRI/2022/10/046476.

Correction to: Metformin inhibits cardiometabolic syndrome associated cognitive deficits in high fat diet rats.

[This corrects the article DOI: 10.1007/s40200-022-01074-4.].

In silico analysis of selected nutrition rich fruit of Bunch berry (Lantana camara) constituents as human acetylcholinesterase (hAchE), carbonic anhydrase II (hCA-II) and carboxylesterase 1 (hCES-1) inhibitory agents.

Background: Bunch berry (Lantana camara) is primarily composed of flavonoids and vitamin C; therefore, it has been shown to possess various medical characteristics, including the ability to relieve fever, inflammation, and urinary tract infections. Objective: In this study, we intended to assess twenty chosen constituents of Bunch berry as potent inhibitory agents of human acetylcholinesterase (hAchE), carbonic anhydrase II (hCA-II) and carboxylesterase 1 (hCES-1) employing in silico techniques. Methods: The twenty chosen Bunch berry components were examined about docking behaviour of hAchE, hCA-II and hCES-I by using the Swissdock method. Apart from to docking, Molecular physico-chemical, drug-likeness, ADME (ingesting, dispersing, metabolising, and excreting), and toxicity assessments were also performed utilising the Molinspiration, Swiss ADME, pkCSM, and STITCH web sites, correspondingly. Results: Eight ligands (40 %) have exhibited strict adherence to Lipinski's rule of five (Ro5), according to molecular physico-chemical study. Drug-likeness property analysis has shown that five ligands (25 %) of Bunch berry predicted to exhibit moderate bioactivity score against all the descriptors. ADME analysis has shown that five ligands (25 %) of Bunch berry are predicted to possess high gastrointestinal absorption property Toxicity analysis has shown that six ligands (30 %) of Bunch berry are predicted to have hERG II (Human ether-a-go-go-related gene) inhibition activity. According to the docking analysis, lantic acid has the lowest atomic binding energy for all three target enzymes, hAchE (-6.23 kcal/mol), hCA-II (-4.46 kcal/mol), and hCES-I (-5.99 kcal/mol), respectively. Conclusions: Thus the current find provides an advanced understanding the twenty selected ligands of Bunch berry as potent inhibitory agents of human acetylcholinesterase (hAchE), carbonic anhydrase II (hCA-II) and carboxylesterase 1 (hCES-1).

Wireless CardioS framework for continuous ECG acquisition.

A first-level textile-based electrocardiogram (ECG) monitoring system referred to as "CardioS" (cardiac sensor) for continuous health monitoring applications is proposed in this study to address the demand for resource-constrained environments. and the signal quality assessment of a wireless CardioS was studied. The CardioS consists of a Lead-I ECG signal recorded wirelessly using silver-plated nylon woven (Ag-NyW) dry textile electrodes to compare the results of wired wearable Ag-NyW textile electrode-based ECG acquisition system and CardioS. The effect of prolonged usage of Ag-NyW dry electrodes on electrode impedance was tested in the current work. In addition, electrode half-cell potential was measured to validate the range of Ag-NyW dry electrodes for ECG signal acquisition. Further, the quality of signals recorded by the proposed wireless CardioS framework was evaluated and compared with clinical disposable (Ag-AgCl Gel) electrodes. The signal quality was assessed in terms of mean magnitude coherence spectra, signal cross-correlation, signal-to-noise-band ratio (Sband/Nband), crest factor, low and high band powers and power spectral density. The experimental results showed that the impedance was increased by 2.5-54.6% after six weeks of continuous usage. This increased impedance was less than 1 MΩ/cm2, as reported in the literature. The half-cell potential of the Ag-NyW textile electrode obtained was 80 mV, sufficient to acquire the ECG signal from the human body. All the fidelity parameters measured by Ag-NyW textile electrodes were correlated with standard disposable electrodes. The cardiologists validated all the measurements and confirmed that the proposed framework exhibited good performance for ECG signal acquisition from the five healthy subjects. As a result of its low-cost architecture, the proposed CardioS framework can be used in resource-constrained environments for ECG monitoring.

Abdominal cocoon: A rare case report of a small bowel obstruction.

INTRODUCTION: Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon, is a remarkably rare entity. It consists of a fibrous layer or cocoon-like sac encasing, in most cases, the small bowel. The lack of specific symptoms makes preoperative diagnosis challenging. CASE PRESENTATION: A 50-year-old patient, with no history of abdominal surgery or medical diseases, was admitted for symptoms of small bowel obstruction. On examination, the patient was underweight with a BMI of 18 kg/m2. Vital signs were stable. His abdomen was mildly distended and soft. Abdominal CT scan showed signs in favor of a left paraduodenal hernia with incarcerated small bowel loops. Intraoperatively, the small bowels were encapsulated in a cocoon-like structure formed by thick fibrous tissue associated with multiple adhesions. Careful adhesiolysis with complete resection of the membrane was performed. The postoperative course was uneventful. One year later, the patient was symptom-free. DISCUSSION: SEP is thought to be a persistent inflammatory disorder due to a cause that remains unidentified. It is divided into two categories based on its etiology: primary and secondary. The most common mode of SEP revelation is bowel obstruction. Because there is no clear consensus on SEP management, the therapeutic approach typically follows the management strategy of bowel obstruction. CONCLUSION: SEP is an uncommon cause of bowel obstruction. Preoperative detection can be challenging in the absence of pathognomonic signs. Treatment is based on surgery, specifically entailing complete excision of the cocoon and adhesiolysis.

Use of Oral Empagliflozin to Obtain Optimal Blood Sugar Levels for Conducting 18 F-FDG PET-CT in Patients with Hyperglycemia-A Pilot Study.

Background Flourine-18 fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET-CT) is a well-established imaging modality for the evaluation of patients with oncological and nononcological conditions. The underlying principle of imaging is the preferentially increased glucose consumption by cancer cells, due to overexpression of glucose type 1 receptors that are insulin independent. Thus, one of the factors that leads to decreased sensitivity of an 18 F-FDG PET-CT is elevated blood sugar levels, leading to decreased glucose uptake by cancer cells due to competitive inhibition. A significant percentage of patients scheduled for PET-CT scan has diabetes mellitus type II as a comorbid condition and often has elevated random blood sugar (RBS) precluding an upfront PET-CT evaluation. Such cases must be rescheduled. This causes delay in the evaluation and management of such patients. Empagliflozin is a novel sodium glucose type 2 inhibitor that prevents tubular reabsorption of glucose and increases renal glycosuria resulting in decreased blood sugar. This drug does not cause significant hypoglycemia or increase endogenous insulin secretion. This study was undertaken to evaluate a potential role for empagliflozin in facilitating optimal blood sugar control in patients with hyperglycemia on the day of the scheduled PET scan. Methods This is an interventional prospective study and patients detected to have RBS more than 200 mg/dL on the day of the scheduled scan were included in the study. The patients were administered two tablets of 10 mg empagliflozin and kept under observation. Samples for RBS were taken at approximately 2nd and 4th hour post administration by bedside method. These patients underwent scan on the same day after adequate sugar control and when an RBS of less than 200 mg/dL was achieved. The primary outcome studied was change in RBS values in the patient cohort and evaluation of PET SUV (standardized uptake value) compared with the rest of the patients scheduled on the same day. Secondary outcome was assessment of any side effects in the patients. Results Total of 10 patients were found to have elevated blood sugar (RBS > 200 mg/dL; irrespective of being on medication) and did not meet the evaluation criteria for a PET-CT scan on the scheduled day. Following administration of the drug, all 10 patients were able to attain blood sugar levels and fulfill the criteria for undergoing a PET-CT scan. No obvious side effect was noted in any of the patient. The SUV values of the patient cohort were comparable with the rest of the patient scanned on the day. Conclusion In this pilot study, 20 mg of empagliflozin (2 tablets of 10 mg) appears to be a safe and effective method for achieving optimal decrease in the RBS without causing hypoglycemia or hyperinsulinemia. It can be safely employed in the subset of population with RBS between 201 and 300 mg/dL to adequately bring the sugar levels at acceptable levels RBS less than 200 mg/dl and fulfill the FDG PET-CT criteria as per European Association of Nuclear Medicine (EANM) norms.

Iatrogenic incarcerated diaphragmatic hernia following laparoscopic resection of a diaphragmatic cystic lymphangioma: A case report.

INTRODUCTION: Incarcerated iatrogenic right diaphragm hernia stands as a rare occurrence. Swift diagnosis and timely management are imperative. This article presents a particularly uncommon case of a right diaphragmatic hernia resulting from a neglected defect following the resection of a diaphragmatic lymphangioma and sheds light on the pitfalls that may lead to such a post-operative event. PRESENTATION OF CASE: Our surgical ward admitted a 36-year-old patient presenting symptoms indicative of bowel obstruction. Four months earlier, the patient had undergone laparoscopic resection of a lymphangioma located in the right dome of the diaphragm. Thoracic auscultation yielded hyperactive bowel sounds at the lower lung field and the right costophrenic angle. Abdominal distention was observed without any signs of peritoneal irritation. A thoracic and abdominal CT scan provided confirmation of a right diaphragmatic hernia. Subsequently, an immediate laparotomy was performed. The right colic hepatic flexure was released, and the diaphragmatic breach was sutured. The postoperative course was uneventful. DISCUSSION: Iatrogenic diaphragmatic hernia remains a possible complication of this surgery. It could occur even on the right side where the liver has a cushioning effect. Incarcerated diaphragmatic hernia is a surgical emergency that should be operated on as quickly as possible. A systematic check of the diaphragm's integrity at the end of the surgical procedure could prevent such complications. CONCLUSION: While surgical techniques and laparoscopic instrumentation have witnessed significant advancements in recent years, achieving proficiency and the precise execution of surgical techniques remain of utmost importance.

Transport use limitations and its association with social participation among patients with stroke living in rural India.

PURPOSE: This study aimed to investigate the limitations in transport use among stroke survivors in rural India and examine its impact on their social participation. MATERIALS AND METHODS: A cross-sectional survey assessed transport patterns, post-stroke changes, and limitations among patients with stroke (N = 77). Social participation was measured with the Stroke Impact Scale (SIS 3.0). RESULTS: Following stroke, there was a significant decrease (28-41%) in the proportion of participants who could use various modes of transport unassisted, particularly in driving a motorbike or scooter and using a bus or train. Post-stroke changes in transport use showed that many participants ceased or decreased their use of different modes of transport. Independent users consistently had higher social participation scores than dependent users across all transport modes, indicating better social participation. The mean differences in various transport modes ranged from 6 to 11 points (p < 0.01). CONCLUSIONS: Independent use of different modes of transport, particularly public transportation, reduced among rural Indian stroke survivors. These transport limitations are significantly associated with reduced social participation, highlighting the need for interventions to improve accessibility and fostering greater community engagement for stroke survivors in this population.IMPLICATIONS FOR REHABILITATIONLimited transportation access limits social participation for stroke survivors in rural India.Study results show a significant decrease in independent transport use among stroke survivors, affecting their social participation.Rehabilitation interventions should focus on improving transportation accessibility to enhance social engagement for rural stroke survivors.

Development of cashew nut shell lignin-acrylonitrile butadiene styrene 3D printed core and industrial hemp/aluminized glass fiber epoxy biocomposite for morphing wing and unmanned aerial vehicle applications.

The aim of this study was to develop a lightweight epoxy based biocomposite for morphing wing and unmanned aerial vehicle (UAV) applications. The proposed composite was developed using a 3D printed high stiffness lignin-Acrylonitrile Butadiene Styrene (ABS) core and industrial hemp with aluminized glass fiber epoxy skin. The ABS was reinforced using lignin macromolecule derived from cashew nut shells via twin screw extruder and the core was printed using an industrial grade 3D printer. Furthermore, the composites were prepared by compression moulding with an ABS-lignin core and hemp/aluminized GF surface and characterized according to respective American society of testing and materials (ASTM) standards. The findings indicate that the addition of 30 vol% Al-glass and hemp fiber with lignin strengthened ABS core improved the mechanical properties. The composite material designated as "E2" exhibits the maximum mechanical properties, providing tensile strength, flexural strength, Izod impact, interlaminar shear strength (ILSS), and compression values of, 136 MPa, 168 MPa, 4.82 kJ/m2, 21 MPa, and 155 MPa respectively. The maximal energy absorbed by composite designation "E2," during drop load impact test is 20.6 J. Similarly, the composite designation "E2"gives fatigue life cycles of 33,709, 25,781 and 19,633 for 50 %, 70 % and 90 % of ultimate tensile strength (UTS) and 32.5 (K1c) MPa⋅m and 0.76 (G1c) MJ/m2 in fracture toughness and energy release rate respectively.

Factors influencing physiotherapists implementation of high value care in the management of nonspecific low back pain in Indian healthcare settings: A qualitative study.

BACKGROUND: Non-specific low back pain is a common musculoskeletal condition that often requires the involvement of physiotherapists for effective management. However, there is limited understanding of the factors influencing physiotherapists' implementation of high-value care in the management of non-specific low back pain (NSLBP), particularly in Indian healthcare settings. OBJECTIVE: The aim of this study was to explore the barriers and facilitators of implementation of high-value care in managing NSLBP from the perspective of physiotherapists practicing in Indian healthcare settings. DESIGN: Descriptive qualitative design. METHODS: We adopted a descriptive phenomenological approach and purposefully selected physiotherapists (N = 15) from diverse healthcare settings, encompassing varying years of clinical experience, to capture a broad range of perspectives. Semi-structured face-to-face interviews were conducted via the Zoom video conferencing platform. Each interview lasted on average for 30-45 min, and no follow-up interviews were conducted. Data were analyzed using thematic analysis with an inductive approach. RESULTS: Our analysis revealed three major themes and seven sub-themes uncovering barriers and facilitators of implementation of high-value care. These themes include misconceptions about low back pain and its management among physiotherapists, their perceived lack of autonomy in clinical decision-making due to external influences, and the significance of aligning treatment plans with patient goals while considering evidence-based care. CONCLUSION: The study results provide insights into the unique challenges associated with implementation of high-value care for non-specific low back pain in Indian healthcare settings.

Endogenous fungal endophthalmitis following COVID-19 infection with microbiological and molecular biological correlation - A report of two cases.

This case report describes three eyes of two patients, who were diagnosed to have endogenous fungal endophthalmitis post coronavirus disease 2019 (COVID-19) infection. Both patients underwent vitrectomy with intravitreal anti-fungal injection. Intra-ocular samples confirmed the fungal etiology by conventional microbiological investigations and polymerase chain reaction in both cases. The patients were treated with multiple intravitreal and oral anti-fungal agents; however, vision could not be salvaged.

Novel Application of Hydrodissection in Laparoscopic Cholecystectomy for Gangrenous Gallbladders.

INTRODUCTION: Laparoscopic cholecystectomy (LC) for gangrenous gallbladders (GGBs) can be challenging and represent a significant number of LC cases, necessitating more efficacious surgical techniques. Currently, the standard treatment for GGBs is blunt dissection which can have high iatrogenic complication rates. To our knowledge, this is the first large retrospective study conducted on the novel application of hydrodissection (HD) in LCs for GGBs. METHODS: In this retrospective study of 386 LCs, data were collected for patient demographics, medical comorbidities, operating time (OT), anesthesia time (AT), length of stay (LOS), estimated blood loss, conversion to open procedures, 30-day readmissions, and mortality. Patients were categorized into four groups: (1) Vyas employing HD for GGBs (VHG), (2) non-Vyas group of five surgeons not employing HD for GGBs (NVG), (3) Vyas treating non-GGBs, and (4) non-Vyas group of five surgeons treating non-GGBs. Control groups were age-matched and sex-matched. Statistical analysis used descriptive statistics, Mann-Whitney U testing, and chi-squared testing (α = 0.05). RESULTS: This study demonstrated significantly decreased (P < 0.05) OT (P = 0.001), AT (P < 0.001), LOS (P = 0.015), and conversion to open procedures (P = 0.047) between the VHG and NVG groups, with HD reducing OT by 35.5% compared to blunt dissection. This study did not demonstrate significantly decreased (P > 0.05) estimated blood loss (P = 0.185) and 30-day readmissions (P = 0.531) between the VHG and NVG groups, but they were trending toward significant. There were no mortalities in this study. CONCLUSIONS: HD is associated with improved surgical outcomes of LCs for GGBs demonstrated by reduced OT, AT, LOS, and conversion to open procedures. Further multi-institutional studies are needed to validate HD implementation and further dissemination.

A Signal Processing Framework for the Detection of Abnormal Cardiac Episodes.

MOTIVATION: Cardiologists rely on the long duration Holter electrocardiogram (ECG) recordings in general for assessment of abnormal episodes and such process found to be tedious and time consuming. An automatic abnormal cardiac episode detection algorithm is the need of the hour that needs to be optimized to reduce the manual burden. OBJECTIVE: The current study presents a signal processing framework with a cross-database to detect abnormal episodes in long-term ECG signals. METHODOLOGY: The data was pre-processed to remove power line interference and baseline drift using basis pursuit sparsely decomposed tunable-Q wavelet transform (BPSD-TQWT). A total of 44 features of time domain, frequency domain, and time-frequency domain characteristics were extracted from the ECG signal. This proposed work tested classification performance with support vector machine (SVM), K-nearest neighbour (KNN), decision tree, naïve Bayes, the nearest mean classifier, and the nearest root mean square classifiers. The trained models with open-source data were used to predict the abnormal episodes from the proprietary database and vice versa. Finally, the performance was analysed via recall rate, specificity, precision, F1-score, and accuracy. RESULTS: Among six classification models, SVM performed best. With an open-source database, the SVM model achieved 95.01% accuracy, and detected the abnormal episodes from proprietary database with an accuracy of 99.31%. In addition, with the proprietary database SVM model classified the normal-abnormal cardiac episodes with an accuracy of 99.89% and detected the abnormal episodes from proprietary database with an accuracy of 92.51%. CONCLUSION: When the performance results were compared with the literature, it was observed that the proposed framework performed well. As a result, the proposed framework could be used in an autonomous diagnosis system.

Inter-observer agreement in grading severity of diabetic retinopathy in wide-field fundus photographs.

OBJECTIVE: To examine the inter-observer agreement between two retina specialists in grading diabetic retinopathy (DR) severity in ultra-wide-field fundus photographs. METHODS: Two hundred and seventy patients with diabetes, who visited the vitreoretinal specialty at a tertiary eye care hospital, with or without DR underwent comprehensive ophthalmic examination, dilated retinal exam and Optos ultra-wide-field (UWF) retinal photography. Optos images were graded for DR severity based on the International Clinical Diabetic Retinopathy Disease Severity Scale by two retina specialists with same number of years of experience, masked to the clinical details of the participants. RESULTS: The two graders showed agreement in 229/270 images (84.8%) and disagreement in 41/270 images (15.2%). The unweighted kappa for agreement between graders was k = 0.715, SE = 0.037 and the weighted kappa was k = 0.838, SE = 0.022. No DR was identified in 170/270 (62.9%) patients, mild NPDR in 15/270 (5.6%) patients, moderate NPDR in 35/270 (12.9%) patients, severe NPDR in 4/270 (1.48%) patient and PDR in 5/270 (1.85%) patients by both graders. Disagreement was neither related to the learning curve of graders nor with the patient's age (p = 0.574), gender (p = 0.169), duration of diabetes (0.660) or the lens being phakic or pseudophakic (p = 0.171) on logistic regression. CONCLUSIONS: The impact of disagreement noted between observers in grading DR on UWF fundus photographs should be considered when utilizing UWF system in clinical studies.

Mepolizumab as a Potential Protective Factor of COVID-19 Mortality: A Case Report of Chronic Bronchitis and Asthma in an Elderly Patient.

BACKGROUND Patients with multiple comorbidities who are infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have a higher risk of mortality. However, treatment with mepolizumab may be a key factor in counteracting the risk of these comorbidities. We present a patient who had an uneventful recovery from coronavirus disease 2019 (COVID-19), despite having 5 independent risk factors for severe disease and increased mortality. CASE REPORT A 75-year-old man with a long-standing history of asthma, chronic bronchitis, coronary artery disease, and hypertension presented to the Emergency Department in November 2020 with a 4-day history of fever, chills, shortness of breath, cough, and fatigue. Six months prior to this presentation, the patient was hospitalized for severe chronic bronchitis and acute exacerbation of asthma. His medications included mepolizumab, aclidinium, ramipril, diltiazem, aspirin, albuterol sulfate, and micronized budesonide/micronized formoterol fumarate dihydrate. Physical examination was unremarkable, except for cardiopulmonary distress. Laboratory tests showed leucocytosis. His chest X-ray revealed infiltrates and interstitial edema in the lower lung fields. A PCR test for SARS-CoV-2 was positive. COVID-19 pneumonia was diagnosed, and the patient was admitted to the hospital, where he was treated with acetaminophen, amoxicillin, dexamethasone, and supplemental oxygen. The patient remained stable and was discharged from the hospital the following day. He was free of all symptoms after 21 days. CONCLUSIONS This case of a 75-year-old man who presented with mild COVID-19 supports the findings from other reports of improvement in clinical outcomes for some patients with asthma who received treatment with mepolizumab.