bluuebunny/crossref_metadata_2025 huggingface dataset:
Systems Immunology Analyses of STAT1 Gain-of-Function Immune Phenotypes Reveal Heterogeneous Response to IL-6 and Broad Immunometabolic Roles for STAT1
Authors: Kaviany Saara , Bartkowiak Todd , Dulek Daniel E , Khan Yasmin W , Hayes Madeline J , Schaefer Samuel G , Ye Xiang , Dahunsi Debolanle O , Connelly James A , Irish Jonathan M , Rathmell Jeffrey C
Published: July 2022

Patients with STAT1 gain-of-function (GOF) pathogenic variants have enhanced or prolonged STAT1 phosphorylation following cytokine stimulation and exhibit increased yet heterogeneous susceptibility to infections, autoimmunity, and cancer. Although disease phenotypes are diverse and other genetic factors contribute, how STAT1 GOF affects cytokine sensitivity and cell biology remains poorly defined. In this study, we analyzed the immune and immunometabolic profiles of two patients with known pathogenic heterozygous STAT1 GOF mutation variants. A systems immunology approach of peripheral blood cells from these patients revealed major changes in multiple immune cell compartments relative to healthy adult and pediatric donors. Although many phenotypes of STAT1 GOF donors were shared, including increased Th1 cells but decreased class-switched B cells and plasmacytoid dendritic cell populations, others were heterogeneous. Mechanistically, hypersensitivity for cytokine-induced STAT1 phosphorylation in memory T cell populations was particularly evident in response to IL-6 in one STAT1 GOF patient. Immune cell metabolism directly influences cell function, and the STAT1 GOF patients shared an immunometabolic phenotype of heightened glucose transporter 1 (GLUT1) and carnitine palmitoyl transferase 1A (CPT1a) expression across multiple immune cell lineages. Interestingly, the metabolic phenotypes of the pediatric STAT1 GOF donors more closely resembled or exceeded those of healthy adult than healthy age-similar pediatric donors, which had low expression of these metabolic markers. These results define new features of STAT1 GOF patients, including a differential hypersensitivity for IL-6 and a shared increase in markers of metabolism in many immune cell types that suggests a role for STAT1 in metabolic regulation of immunity.
Human leukocytes antigen HLA-DQB1 determine susceptibility to thyroid disease
Authors: Mohammad Tawfeeq , Al-Kurtas Mohammad , Zalzala Haider , Mahdi Batool , Raouf Hyam , Abid Laheeb , Nehad Zena
Published: July 2022

Background: Thyroid disease is a common disease in women of the reproductive age. This disease arises due to complex interactions between environmental and genetic factors. However, the interactions between genes and environment are yet well defined. Among the main susceptibility genes that have been identified is the HLA-DQB1 gene locus. The major environmental factors include iodine, medications, infection, smoking, and possibly stress. Aim of study: To ascertain the association between HLA-DQB1 alleles and goitrous thyroid disease in a sample of Iraqi Arab Muslims. Patients and methods: A cross sectional case-control comparative study was carried out. Patients with thyroid disorders who attended this hospital in the period from September 2013 to June 2014 for thyroidectomy were studied. HLA-DQB1genotyping was done using a panel of sequence-specific oligonucleotide probes (SSOP) using HLA-DQB1 amplification and hybridization kits (SSO HLA type DQB1 plus and Mastermix for HLA type DQB1 Amp plus) using automated method by AutoLipa-48. Results: There was an increased frequency of HLADQB1*03:01and 0601 in control group compared with patients group (P=0.005, Odds ratio=0.0164, 95% CI: 0.0009-0.2926) and (P=0.01, Odd ratio=0.1667, 95% CI: 0.0412 to 0.6750) respectively. Other alleles like HLA-DQB1* 0202, 03:02, 0501 and 06:02 were detected in the patients' group but not in controls. Conclusions: HLA alleles have an effect on development thyroid disease. HLADQB1* 0301 and 0601 is a protective in Iraqi Arab Muslims individuals.
Experience with diabetic adolescents observing ramadan fasting
Authors: Musleh Afnan , Beshyah Salem , Abu Awad Samar , Kahwatih Marwa , Al Jubeh Jamal
Published: July 2022

Background and Aims: Fasting during the holy month of Ramadan is an obligatory duty for all healthy adult Muslims. Fasting can be a major challenge for adolescents with type 1 diabetes mellitus (T1DM) as they have to keep good glycemic control to avoid complications. Limited data was published regarding the safety of fasting Ramadan in adolescent patients with T1DM. We have therefore conducted this study addressing the question “Can adolescents with T1DM fast safely during the Holy month of Ramadan, without getting significant hypo/hyperglycemia?” Patients and Methods: This is an observational, prospective, single center study, conducted during Ramadan 2013. Twenty-three patients were observed (7 males, 16 females). Median age was 14 years. All of them had T1DM, and were planning to observe the fast during Ramadan. They were provided with dairies to be filled by the parents or the adolescents themselves (with parental supervision), indicating the days they fasted/didn't fast, and the reasons for not fasting e.g. hypoglycemia, hyperglycemia, menstrual period, sickness or other reasons. Patients were also asked to record the blood glucose readings and their insulin doses on daily basis. They were asked to bring their folders back to the Diabetic clinic after Ramadan. Outcome measures obtained included the percentages of the days fasted/not-fasted, the reasons for not fasting, HbA1c changes, and a comparison between patients on multiple daily injections and those on insulin pump. Moreover, we studied the relationship between the number of days not-fasted due to diabetes related issues and the HbA1c before Ramadan. Results: Patients were able to fast 79.9% of the total days eligible for fasting, while 20.1% of the days were not fasted due to either hypoglycemia (29.1%), hyperglycemia (19.4%) or other reasons (51.5%). None of the patients developed severe hypoglycemia or diabetic ketoacidosis. There was a mild increment in mean HbA1c after Ramadan (from 8.3% to 8.5%). The patients on insulin pump tended to fast more days than those taking multiple daily injections (82.8% versus 77.3% out of the total eligible days). Patients who had able to fast more days without diabetes related problems tended to have had a marginally better glycemic control before Ramadan (8.3% versus 8.7%). Conclusions: Adolescent patients with T1DM wishing to fast during the holy month of Ramadan may contemplate doing this under medical supervision. The use of insulin pump therapy may help patients to fast more easily and have better control. Adequate education and good glycemic control prior to Ramadan is associated with better outcome.
Alcohol consumption and atrial fibrillation: Leisure or suffering!
Authors: Sheikh Abdirahim , Khalif Mohamed , Houmsse Mahmoud
Published: July 2022

Atrial fibrillation (AF) is the commonest cardiac arrhythmia and it is associated with a substantial burden to the healthcare system. Among many of the risk factors of AF, excessive alcohol intake stands out as one of the modifiable risk factors. While alcohol consumption is a leisure that many indulge in, the repercussions on both health and the health economy are not to be under estimated. Alcohol intake contributes to AF incidence although there are differing opinions as to the quantity of alcohol ingestion, which causes AF development. This review article highlights evidence from a range of studies that delineate the effects of alcohol consumption on AF occurrence.
An Observational Study on Empathy and Factors Associated with Individual Variations in Empathy Levels Among Youth in Central Kerala
Authors: Sebastian Shaliet Rose , Saji Joyal Alias , Mathew Geethu , Babu Bichu P.
Published: July 2022

Background:

Empathy is a social skill that exerts influence on the quality of social relationships. The importance of being empathetic is not only limited to the health care field. An empathetic person is able to understand the emotions of others, accurately express their feelings, comprehend others’ situations and act appropriately. According to the census data of 2011, one-fifth of India’s population is made up of the youth. Added to the volatile nature of the age, our youth face challenges from social exclusion, gender-based violence, and the lack of access to rights and opportunities.

Aim:

The aim of the study is to measure empathy levels among young adults aged 19–24 years in Central Kerala and to find out the factors associated with individual variations in empathy levels among them.

Materials and Methods:

A cross-sectional survey was conducted among 610 young adults of both gender in Pathanamthitta, Kottayam, Alappuzha, Kollam, and Trivandrum districts in South-central Kerala.

Results:

Good academic performance among study participants was found to be significantly associated with fantasy scale. The personal distress scale among study participants was found to be significantly associated with burnout, medical stream, and involvement in humanitarian acts. Burnout scores of study participants were found to be inversely correlated with fantasy scale, empathic concern, personal distress, and the combined interpersonal reactivity index.

Conclusion:

The present study sheds light on the prevalence of empathy and humanistic values among the youth in Kerala.
Perioperative Allergy and Anaphylaxis
Authors: Karnik Priyanka Pradeep , Shah Harick B. , Dave Nandini Malay , Rawlani Sujata Shivlal
Published: July 2022

Perioperative anaphylactic reactions though rarer than in adults, result in severe morbidity in children. There is a shift in the most commonly implicated agents causing anaphylaxis from neuromuscular blocking agents and latex to antibiotics. The allergy work up for children can be tedious due to the necessity to perform skin prick tests which are the gold standard. Anaesthesia for children with documented hypersensitivity to various foodstuffs and drugs can be fraught with difficulties due to airway hyperreactivity, need to avoid culprit drugs and possibility of biphasic reaction if epinephrine is not administered on time. We describe perioperative management of three cases with history of allergies and their implications.
Impact of Physical Activity on Gouty Arthritis
Authors: Shah Sakshi , Shinde Sandeep Babasaheb
Published: July 2022

Gout is a metabolic disorder characterized by hyperuricemia and abnormal depositions of urate around tissues and in and around joints, that is, tophi. Gout is a progressive disease, which, if not treated effectively, can make a person disable. The aim of this study was to systematically review the literature on impact of gouty arthritis on physical activity. We performed a systematic review for impact of gouty arthritis on physical activity. An inclusion criterion of the review was the physical activity for gouty arthritis. Comorbidities were associated with gouty arthritis and long-term manifestations. Physically active patients have shown significantly low uric acid levels and also have fewer gout flares as compared to physically inactive patients.
Experience as Anesthesia Resident in Intensive Care Unit During COVID-19 Pandemic
Authors: Sathish Anjali , Srinivas Gadde , Nagpal Amit , Roy Raimol , Vyas Varsha
Published: July 2022

Anesthesiologists’ skills are successfully used in the process of distributing care in the COVID-19 pandemic. The first case of COVID-19 in India was reported on January 30, 2020. Since then, this disease placed the entire health system of the world under immense pressure. Approximately 4% of patients with coronavirus disease required ICU admissions. The government had canceled all elective procedures and ordered new ventilators and built new hospitals to meet this unprecedented challenge. The importance and the experience of anesthesiologists were greatly increased as they rose to the occasion and played an important role in handling the crisis. Residents were introduced to this new world of ICU. This time anesthesiologists acted as the specialized physicians with knowledge of the pathophysiology of organ systems both under normal and stress conditions. The virus is known to spread by aerosol or respiratory secretions of symptomatic patients where viral load is higher. So as health professionals, we were also at high risk; no matter how many precautions we took. Personal care of every affected person was very important. Management took proper care in providing us with all necessary paraphernalia for personal protection. The most significant emotional challenge was dealing with the families of the patients and making them understand that everything was done to offer their loved ones the best possible care.
The Curious Case of An Erythematous Plaque on Penis
Authors: Srivastava Prachi R. , Argal Deepak , Vyas Praveen , Saxena Animesh , Dey Vivek K.
Published: July 2022

Penile psoriasis is a rare entity comprising of only 3% of all the psoriatic cases. However, it is one of the most common non-venereal diseases of the genitalia. Due to the location, sexually transmitted diseases are often suspected as the first diagnosis leading to delay in diagnosis and therapy. This causes quality of life impairment of patients along with severe psychosocial disturbances. We hereby present the case of a young immunocompetent male patient with a non-healing lesion on the glans penis of 4 month duration with raised anti-herpes simplex virus 2 immunoglobulin G (IgG) and IgM titres who was previously misdiagnosed as herpes genitalis owing to the location and serology. A biopsy leads to the correct diagnosis of psoriasis. He was then treated with calcipotriol and clobetasol combination with which the lesions healed in a week. We are presenting this case to raise the index of suspicion of psoriasis in patients with isolated penile lesions, as the presentation here is different with the lesions being non-scaly, compared to the other areas of the body. Another aspect is that maybe this case represents Wolf’s isotopic response in relation with “Zoster Sine Herpete” and psoriasis. This is to our knowledge the first time this phenomenon is being reported with psoriasis..
Bilateral corneal drug deposits due to olanzapine
Authors: Jain Parul , Gupta Isha , Bharti Nisha , Ghosh Shilpa
Published: July 2022

A 21-year-man male patient presented for a regular eye check-up. He was a known case of bipolar affective disorder and was on the antipsychotic drug, olanzapine, for 12 years. Slit-lamp examination showed peripheral anterior-mid stromal, bilateral, whitish, diffuse pigmentary deposition. Olanzapine is a second-generation atypical antipsychotic used in the treatment of schizophrenia and bipolar disorders. In this case report, we describe a case of corneal deposits related to another new generation atypical antipsychotic agent, olanzapine.
Intraretinal hyperreflective line in association with acute retinal pigment epithelitis
Authors: Singh Arjan , Beg Haroon , Gaur Ritika , Kothari Akshat , Chugh Manpreet , Gorhe Sukanya , Saurabh Kumar , Roy Rupak
Published: July 2022

Intraretinal hyperreflective line (IHL) is a novel optical coherence tomography (OCT) observation corresponding to the linear or curvilinear pattern of intraretinal hyperreflective foci. A middle aged female complained of recent onset black spot in the right eye visual field and was diagnosed as acute retinal pigment epithelitis (ARPE). On spectral domain (SD) OCT, in addition to features suggestive of ARPE, a vertical linear hyperreflective line was noted. Such IHLs have previously been reported to be present in association with various inflammatory, degenerative, or tractional conditions of macula. This is the first description of IHL in association with ARPE in published literature.
Uveitis-glaucoma-hyphema syndrome secondary to an in-the-bag intraocular lens with capsular fibrosis
Authors: Liu Jiaru , Szigiato Andrei-Alexandru , Matsumoto Rodolpho T , Harasymowycz Paul
Published: July 2022

A patient developed pseudoexfoliative glaucoma and hyphema syndrome with an appropriately placed, in-the-bag single-piece lens. Ultrasound biomicroscopy showed a Soemmering ring, extensive fibrotic bands tethering the capsule to the ciliary body, and localized ciliary body traction. An anterior chamber washout, peeling of the fibrotic bands, and capsular phimosis correction were performed. Uveitis-glaucoma-hyphema syndrome may be caused by a nontilted in-the-bag lens, precipitated by the formation of tractional fibrotic bands, a Soemmering ring, and a predisposition to zonular laxity from pseudoexfoliative syndrome. Surgical peeling of the capsular fibrosis may be the most important factor in preventing recurrent hyphema.
A case report and review of non-accidental bilateral ocular trauma
Authors: Dhar Sanjay K , Mohapatra Tanmay , Singh Prakhar K , Singh Kunal V , Yadav Yogesh
Published: July 2022

A 52-year-old lady presented with a history of stab injury to both eyes due to assault with scissors by her son. Ocular examination showed no perception of light in the right eye and perception of light in the left eye. Under diffuse illumination, the eyes were appearing unsalvageable. Computed tomography (CT) scan was suggestive of loss of right globe architecture but intact left globe and no intracranial injury. Examination under anesthesia (EUA) was suggestive of multiple injuries in both eyes. The right eye was enucleated and underwent a primary ocular implant. The left eye underwent reconstruction of the upper lid and ocular surface. Postoperatively, the left eye had visual acuity of 20/60 and the patient was able to perform her daily activities independently. Non-accidental bilateral ocular trauma is underreported in ophthalmology journals. Optimum management with a multidisciplinary approach will establish better cosmesis in an eye appearing unsalvageable. Better management and prognostication can be done by incorporating such types of injuries into the international trauma classification systems.
Henpecked
Authors: Chakraborti Chandana , Mandal Raktima B , Francis Dew , Kumar Madhurima , Jingar Bharati , Mathew Jijo P
Published: July 2022

Domestic henpecking can cause serious ocular injuries. Here, we report a case of penetrating orbito-cranial injury along with lid laceration and orbital fat prolapse in a two-year-old girl following henpeck injury. The eye ball was spared. Prolapsed fat was relocated and the wound was repaired successfully. Neurosurgery consultation was done and conservative management advised.
Optical coherence tomography angiography of intraretinal neovascularization in an eye with tubercular serpiginous-like choroiditis
Authors: Konana Vinaya Kumar , Babu Kalpana
Published: July 2022

We present a case of a 28-year-old male who was diagnosed with bilateral tubercular multifocal choroiditis with intraretinal neovascularization adjacent to an area of choroiditis in the left eye. We present OCTA features of the neovascular complex before and after 4 months of treatment with anti-tubercular therapy and oral steroids. We speculate that the intraretinal neovascular complex noted in our case may be due to VEGF released by the underlying ischemic choroid.
Netarsudil-associated reticular epithelial edema in a corneal ulcer
Authors: Nair Arjun Velayudhan , Rosette Devi , Rajaraman Revathi
Published: July 2022

Netarsudil is a novel Rho-kinase (ROCK) inhibitor approved for the reduction in intraocular pressure (IOP). Reticular epithelial edema (REE) is a side effect commonly noted in patients on netarsudil with pre-existing corneal edema. We report a case of netarsudil-associated REE in a corneal ulcer with secondary glaucoma. The patient had a recurrence of REE even after debridement, and the resolution was seen only after discontinuing the drug. Netarsudil-associated REE is a side effect previously reported in patients with corneal edema and decompensation. To the best of our knowledge, there are no previous case reports of REE in a corneal ulcer. ROCK inhibitors have additional anti-inflammatory and antifibrotic action, which can lead to delayed healing and scarring in corneal ulcers. In conclusion, ROCK inhibitors should be used judiciously in corneal ulcers.
Intervention of Adie's tonic pupil with iris tinted contact lenses with clear pupil - Case report
Authors: Korani Hiral J , Bhate Karishma , Bhalakia Disha
Published: July 2022

We report the optometric management of a 27-year-old female diagnosed with Adie's tonic pupil who was otherwise systemically stable. This case report is an effort to understand how tonic pupil management with iris tinted clear pupil contact lenses helps to resolve quantitative and qualitative visual disturbances similar to pharmacological treatment (diluted pilocarpine). The case report shows that it is an effective alternative management to overcome visual symptoms for patients with Adie's tonic pupil compared to pilocarpine (0.1%).
Pseudo-reversal of optic disc cupping in a case of pseudo-exfoliation glaucoma following trabeculectomy
Authors: Dodamani Deepakakumar
Published: July 2022

Reversal of glaucomatous cupping is rare in adults. A case of pseudo-reversal of total cupping in an elderly gentleman with pseudo-exfoliation glaucoma who underwent combined trabeculectomy with cataract surgery is reported. Early laser suture lysis to control high post-operative intra-ocular pressure (IOP) led to sudden lowering of IOP with subsequent optic disc edema, which manifested as reversal of cupping, albeit temporarily. Eight months later, the visual field was stable, but the macula had developed an epiretinal membrane, probably secondary to hypotony-associated inflammation, thus highlighting the importance of timing the suture lysis and aggressive control of intra-ocular inflammation.
Bilateral primary intraocular lymphoma in a 24-year old pregnant woman with hepatitis C
Authors: Zisis Dimitrios , Karamaounas Aristotelis , Sideri Anna Maria , Katsimpris Andreas , Papadopoulos Iasonas , Tservakis Ioannis
Published: July 2022

Primary intraocular lymphoma (PIOL) is a rare malignancy affecting primarily elderly patients. In this case report, we present a rare case of bilateral PIOL in a 24-year-old pregnant woman with hepatitis C. The patient presented with blurred vision and floaters in the right eye for a duration of at least 3 weeks and gradual visual loss in the left eye over the course of 14 months. Fundoscopy revealed mild vitritis in the right eye and severe vitritis in the left eye. Moreover, serological testing revealed that the patient was positive for hepatitis C. Due to high clinical suspicion, a diagnostic 23-gauge pars plana vitrectomy was performed in both eyes and cytologic evaluation of the aspirate confirmed the diagnosis of PIOL. Therefore, despite PIOL being of low prevalence, chronic persistent vitritis in young adults should raise suspicion about this malignancy.
A case report of rehabilitation of bilateral inferior field defect with Peli prisms
Authors: Nishanth Shruti , Rehman Alphia , Henry Henderson , Nivean M , Nishanth M , Nivean Pratheebadevi
Published: July 2022

Bilateral inferior visual field loss (BIVFL) is a rare entity, and rehabilitation of such patients can be challenging. Peli prisms are a good option for visual rehabilitation in horizontal homonymous hemianopias. Here we present an interesting case of BIVFL with macular sparing, successfully rehabilitated with a novel vertical orientation of Peli prism.
Brolucizumab-induced retinal vasculitis – An Indian perspective
Authors: Brar Manpreet , Dogra Mangat R , Grewal SPS , Sharma Mansi , Grewal Dilraj
Published: July 2022

The case of retinal vasculitis in a one-eyed elderly diabetic female after use of brolucizumab injection (second dose) for neovascular age-related macular degeneration.
Silicone oil migration into the anterior chamber in a phakic eye
Authors: Al-Kharashi Abdullah S , AlBloushi Abdulrahman F
Published: July 2022

We describe a novel technique to manage silicone oil (SO) migration into the anterior chamber (AC) in a phakic eye. A 57-year-old female patient underwent right lens-sparing pars plana vitrectomy for diabetic tractional retinal detachment with SO tamponade. Postoperatively, a large bubble of SO was detected in the AC. The case was managed with the intraoperative displacement of the SO bubble using an ophthalmic viscoelastic device, phacoemulsification, and insertion of a capsular tension ring with an opening directed toward 6 o'clock position. The insertion of the capsular tension ring in this particular position prevented further migration of SO into the AC.
Refractory bilateral choroiditis due to presumed ocular tuberculosis responding to intravitreal moxifloxacin
Authors: Babu Kalpana , Shah Dhwani , Murthy Krishna R
Published: July 2022

A rare presentation of bilateral refractory choroiditis due to presumed ocular tuberculosis with dramatic response to intravitreal moxifloxacin is described in this report. A 32-year-old lady with a past history of bilateral choroiditis due to presumed ocular tuberculosis and biopsy-proven tubercular lymphadenitis four years ago came to us with reactivation of inflammation refractory to antitubercular therapy, systemic steroids, vitrectomy and intravitreal anti-VEGF injections. The lesions responded dramatically to intravitreal injections of moxifloxacin and dexamethasone. Following this dramatic response, she also received oral moxifloxacin 800 mg/day along with ATT for a year. At two-year follow-up, she is doing well with no further recurrences. To the best of our knowledge, no cases of tubercular choroiditis responding to moxifloxacin have been reported (MEDLINE search). This case highlights the usefulness of intravitreal moxifloxacin in refractory tubercular choroiditis.
Pseudomonas oryzihabitans corneal ulcer
Authors: Choudhary Tripti , Thakur Anchal , Gupta Amit , Angrup Archana , Dhar Supriya
Published: July 2022

We report clinical features, culture-sensitivity profile and outcomes of infectious keratitis caused by Pseudomonas oryzihabitans. A 70 year-old male presented with acute pain, redness and diminution of vision in left eye since 6 days. Clinically, was diagnosed as infectious keratitis and microbiology revealed gram-negative bacilli. Culture showed Pseudomonas oryzihabitans growth. Initiation of appropriate antibiotics with steroids led to the resolution of keratitis. Pseudomonas oryzihabitans causes fulminant keratitis with rapid deep stromal involvement. However, timely intervention with appropriate topical anti-bacterials with steroids may lead to successful outcomes.
Ectopic cilia of the eyelid with ectopic lacrimal gland
Authors: Rajagopal Janani , Das Gopal K
Published: July 2022

Ectopic cilia of the eyelid is a rare congenital anomaly. Here we report a case of a 22-year-old patient with an extra tuft of eyelashes with watering since birth. Excision of the tuft and histopathology revealed a “pilosebaceous unit with ectopic lacrimal gland.” Ectopic cilia are caused by the replacement of meibomian glands with skin glands. Associated lacrimal gland tissue is a choristoma. The typical site of occurrence of ectopic cilia is mostly in the junction of the medial two-third and lateral one-third of the eyelid. Proper preoperative planning with complete surgical excision provides gratifying cosmetic results with no recurrence.
An unusual complication of retropupillary iris claw intraocular lens fixation
Authors: Colaco Roshan G , Menon Meena G , Sajjan Sujata
Published: July 2022

A patient with well enclaved retropupillary iris-claw intraocular lens (IOL) presented 3 months later with spontaneous diminishing of vision to counting fingers at 3 m. On slit-lamp examination, the cornea was clear, the anterior chamber was normal in depth and the IOL was found to have rotated by 90° and was now vertical, perpendicular to the iris and pupillary plane, and the superior site of enclavation was kinked. The edge of the IOL optic was seen protruding out of the pupil; however, not touching the cornea and a fibrosed posterior capsule was noted nasally. The patient was taken for anterior vitrectomy with repositioning of the IOL. The lever effect of the remnant posterior capsule can be the cause of the tilt.
An orbital mass presenting as an eyelid lesion
Authors: Jagannathan Jeevitha , Murugesan Aravind P , Kumar Lalit S , Kumar Rajesh S
Published: July 2022

A 45-year-old man presented with history of painless, slow-growing mass in the medial aspect of right lower eyelid over 2 years. On examination, the mass was noted to be firm, mobile, and nontender. On excision biopsy, histopathologic and immunohistochemistry report was consistent with low-grade non-Hodgkin's B-cell lymphoma. He was then treated with local radiotherapy. Using 6 MeV electrons, a dose of 24 Gy was delivered in 12 cycles over a period of 2 weeks to the right lower lid, with a centimeter bolus. Though non-Hodgkin's lymphoma of the ocular adnexa is rare, it should be considered in differential diagnosis, as they have the potential for rapid systemic involvement and may need treatment that is different from that of other common diseases at the same site.
Ossifying fibroma and its differential diagnosis
Authors: Nivean Pratheeba D , Nivean M , Duraisamy Ramesh , Mohammed Sayee T S
Published: July 2022

Bony lesions of the sinuses can cause disfigurement or functional issues in orbit. Benign bony lesions of the para-nasal sinuses are collectively called as the fibro-osseous lesions. Osteoma, fibrous dysplasia, and ossifying fibroma (OF) are common among them. OF is a rare benign bony tumor occurring in the second to fourth decade. We present this case as juvenile OF is very rare and to discuss the differentials of the bony sinus pathologies.
True muscle transplantation in sensory exotropia – A case series
Authors: Kapoor Smita , Grover Apoorv
Published: July 2022

Management of sensory exotropias is often challenging. In this study, patients who had sensory exotropia >70 prism diopter (PD) were treated with true muscle transplantation. A total of 10 patients with vision <3/60 in one eye were included in the study. All patients underwent transplantation of the medial rectus to the lateral rectus along with a recess–resect procedure. The mean preoperative deviation was 77.5 ± 7.5 PD and postoperative deviation was 6.8 ± 3.2 PD at 1 year. No limitation of movements or lateral incomitance was noted. Thus, this procedure seems to be effective in treating large-angle sensory exodeviations.
The tale of torn Descemet's membrane
Authors: Madan Neha G , Reddy Jagadesh C , Das Sujata , Sahu Srikant K , Priyadarshini Smruti R , Soni Tanvi K
Published: July 2022

To report three cases of late presentations of forceps birth trauma leading to DM tear and their management. Forceps delivery has become a rare method of child delivery in the modern clinical era. However, in the clinics, we still see patients with Descemet's membrane (DM) tear who have had ocular birth trauma with forceps. Most of the time, it is an incidental finding. Forceps injuries are usually unilateral and affect the left eye as the most common fetal head position is left occiput anterior. In the immediate postpartum period, the rupture in the DM leads to corneal edema, which eventually disappears, leaving the visible edges of the break. In the late presentations, patients can have high myopic astigmatism (steep cornea) and secondary amblyopia, which can mimic unilateral keratoconus and, later in life, can lead to corneal endothelial decompensation leading to bullous keratopathy. Here we report three cases of DM tear due to forceps injury with three late presentations. Patient 1 came with bullous keratopathy; patient 2 presented with high myopic astigmatism, amblyopia, and beaten metal appearance in between the torn edges; and patient 3 presented as keratoconus. To conclude, this case series highlights the various clinical features and signs of forceps induced birth injury to the cornea. In this report, the clinical history, ocular examination, and optical coherence tomography scan confirmed the diagnosis. Early rehabilitation with glasses or contact lenses can prevent the development of deep amblyopia. Corneal decompensation can be a presentation later in life; thus, these patients should have a close follow up. Endothelial keratoplasty helps in visual rehabilitation in cases where bullous keratopathy has developed, which can be up to the preoperative amblyopia state.
Development and Psychometric Properties of the Mental Health Literacy Questionnaire (MHLQ) Among Young Iranian Soldiers
Authors: Soleimani-Sefat Erfan , Parandeh Akram , Rahmati Fatemeh , Kamalikhah Tahereh
Published: July 2022

Background:

Prevention of the incidences of mental disorders, psychological problems, or their rapid diagnosis is an important issue that has led to the creation of a mental health literacy concept and the development of standard tools for evaluating them. This study is the first step in the designing and psychometrics of the Mental Health Literacy Questionnaire (MHLQ) in Iran. The purpose of this study was to design the psychometric properties of the MHLQ in soldiers.

Methods:

This study is a methodological study that was designed in three phases: 1) Designing the instrument, 2) Assessing the items, and 3) Psychometric assessment. This study was conducted during 2017-2018, and the soldiers were selected by using a convenience sampling method from different garrisons of Tehran, Iran. To evaluate the content validity of the questionnaire 10 experts, to evaluate the face validity 9 soldiers, and for the pilot study 103 soldiers formed the sample size. Finally, construct validity was assessed among 251 soldiers.

Results:

In the first phase, 78 items were collected and designed. Then, based on the experts’ opinions and preliminary studies, the items were reduced to 52 in the “Assessing the items phase” and then to 42 items in the psychometric phase. In the third phase, 31 items remained in the final version. The CVR and CVI scores of the 52 items were 0.91 and 0.94, respectively. Exploratory factor analysis revealed a 4-factor structure with 31 items of special value that were higher than five that accounted for 55.04 of the total scale variance. The fit indices values indicated that the model is fit for the data. In the total scale, the test–retest reliability and Cronbach's alpha were 0.81 and 0.76, respectively.

Conclusion:

The MHLQ of soldiers has appropriate psychometric properties and can be considered as a suitable tool for evaluation and screening as well as a basis for educational and research interventions.
Prevalence of Tobacco Use in Adults; 2016 Nationally Representative Household Survey in Iran
Authors: Riazi-Isfahani Sahand , Abdi Zhaleh , Sheidaei Ali , Ahmadnezhad Elham
Published: July 2022

Background:

Tobacco use is an established preventable risk factor for many noncommunicable diseases and is considered as an important indicator for monitoring progress towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This study aimed to determine the situation of tobacco use among Iranian adults using 2016 household survey.

Methods:

This is a secondary analysis of the data from 2016 nationally representative STEPwise approach to Surveillance (STEPs) survey with a sample size of 31,050. The data on tobacco consumption was gathered using questions incorporated in the survey questionnaire.

Results:

The prevalence of current tobacco use in Iran was 25.2 % (24.4-25.9) in men versus 4% (3.7-4.3) in women. The prevalence was higher in rural areas and among second wealth group. The prevalence of current daily cigarette smoking was 20.1% (19.4-20.7) in men versus 0.9% (0.8-1.1) in women). Average number of cigarettes per day among current cigarette smokers was 14.5% (14.1-14.9), mean age at start smoking among daily cigarette smokers was 21.6% (21.1-22), and 95.2% (94.4-96) of daily current daily cigarette smokers attempted for cessation during past 12 months. Prevalences of exposure to secondhand cigarette smoke among nonsmokers at homes and workplaces were 23.21% (22.65-23.76) and 18.04% (17.2-18.87), respectively.

Conclusions:

There was a large difference between the prevalence of tobacco use between men and women (25.2% vs. 4%). Higher prevalences of tobacco use in rural areas and among lower wealth quintiles require more equity-based approaches in tobacco combatting actions.
Left Main Coronary Artery Bifurcation Coronary Intervention in a Patient with Achondroplasia with Multivessel Coronary Artery Disease
Authors: Das Debasish , Banerjee Anindya , Kumar Abhinav , Das Tutan , Singh Shashikant , Gupta Jaideep Das , Dixit Manaranjan
Published: July 2022

We report a rare case of critical coronary artery disease in a 62-year-old male with achondroplasia. There is a paucity of case reports of association of achondroplasia with coronary artery disease. Left main coronary artery (LMCA) bifurcation lesion carries the highest risk of mortality out of all types of coronary artery lesions and patients with achondroplasia have two-fold more mortality as compared to the general population. That is why achondroplasia patients may be having more sudden cardiac death with the most catastrophic LMCA bifurcation lesion before they undergo revascularization. It may be the plausible explanation behind no literature description of LMCA bifurcation lesion in patients with achondroplasia. Our case is the first literature description of LMCA bifurcation lesion with successful intervention in achondroplasia. The present case will also provide a detailed insight into the association of achondroplasia with coronary artery disease without the presence of conventional cardiac risk factors.
A novel weight optimized dynamic conformal arcs with TrueBeam™ Linac for very small tumors (≤1 cc) with single isocenter of multiple brain metastases (2≤, ≥4) in stereotactic radiosurgery: A comparison with volumetric modulated arc therapy
Authors: Sağlam Yücel
Published: July 2022

Introduction:

We evaluated whether improved increase delivery efficiency of weight optimized dynamic conformal arc (WO-DCA) therapy in comparison to volumetric modulated arc therapy (VMAT) with single isocenter for SRS treatment of very small volume and multiple brain metastases (BMs).

Materials and Methods:

20 patients having a less than 1 cc volume and 2≤, ≥4 of multiple BMs, redesigned for 20 Gy in 1 fraction using WO-DCA and VMAT techniques with double full coplanar and three partial noncoplanar arcs. Plan qualities were compared using tumor coverage, conformity index (CI), gradient index (GI), V4Gy, V10Gy, and V12Gy volumes of brain, monitor units (MUs), and percent of quality assurance pass rate (QA%).

Results:

Both techniques satisfied clinical requirements in coverage and CI. VMAT had a significantly higher MU and mean GI than WO-DCA (for MUs; 2330 vs. 1991; P < 0.001, and for GI; 4.72 vs. 3.39; P < 0.001). WO-DCA was found significantly lower V4Gy (171.11 vs. 232.80 cm3, P < 0.001), V10Gy (25.82 vs. 29.71 cm3, P < 0.05), and V12Gy (14.35 vs. 17.28 cm3, P < 0.05) volumes than VMAT. WO-DCA was associated with markedly increase QA pass rates for all plans (97.65% vs. 92.64%, P < 0.001).

Conclusions:

WO-DCA may be the first choice compared to the VMAT in reducing the dose in the brain and minimizing small-field dosimetric errors for very small SRS treatment of brain metastases in the range of ≤ 1 cc and 2≤, ≥4.
Usefulness of palliative radiotherapy in reducing the frequency of red blood cell transfusion in patients with malignant tumor bleeding
Authors: Katano Atsuto , Yamashita Hideomi
Published: July 2022

Objective:

We aimed to evaluate the usefulness of palliative radiotherapy in reducing the frequency of red blood cell (RBC) transfusions in patients with malignant tumor bleeding as a quantitative value to evaluate the hemostatic effect.

Materials and Methods:

In this study, we conducted a retrospective review of patients visiting our department between June 2013 and April 2021. All patients underwent RBC transfusions for 30 days before the initiation of radiotherapy. We determined the overall survival (OS) time and RBC transfusion-free (RBCTF) time using statistical tests.

Results:

In total, 21 patients were enrolled in our study, including 13 women and 8 men; the median patient age was 63 years (range: 32–82 years). After radiotherapy, 19 of the 21 patients had a decreased frequency of requirement for RBC transfusion compared to that before radiotherapy. Fourteen patients had achieved an RBCTF state 1 month after radiotherapy. The estimated 1-year OS and RBCTF rates were 36.3% (95% confidence interval [CI]: 14.2%) and 66.7% (95% CI: 42.5%–42.5%), respectively.

Conclusion:

The present study revealed a reduction in RBC transfusion after palliative radiotherapy in patients with malignant tumor bleeding. We believe that reducing the frequency of blood transfusions in patients with terminal conditions would have significant clinical benefits.
Immunotherapy in cancer patients with chronic hepatitis C viral infection
Authors: Zakurdaeva Kristina , Tsimafeyeu Ilya
Published: July 2022

Disease management in challenging patient population with cancer and concomitant serious conditions presents an unmet clinical need. The major gap is the lack of data from properly designed trials that could support clinical decisions. Despite many advances in the fields of oncology, immunology, and infectious diseases, chronic viral infections in cancer patients remain to some extent terra incognita. Therefore, many patients lose the opportunity to receive the most advanced therapy, and physicians are compelled to make treatment decisions without sufficient evidence. In this review, we discuss the utility of immunotherapy in patients with chronic hepatitis C viral infection. Limited data from several studies and case reports support the hypothesis that immune checkpoint inhibitors can be used safely and effectively in this patient population. Available results warrant further investigation of immunotherapy in infected patients. Taking into account the current state of our knowledge, expanding clinical trial eligibility should be considered by investigators and sponsors to allow patient access to novel therapies and better matching of clinical research to the real-world population.
Coexisting ovarian serous cystadenoma with fibroma: A very unusual combination
Authors: Balhara Kirti , Mallya Varuna , Khurana Nita , Tempe Anjali
Published: July 2022

Surface epithelial neoplasms are the most common ovarian tumors, constituting around 60% of all ovarian malignancies. They are classified as benign, borderline, and malignant. Ovarian cystadenomas are common benign epithelial neoplasms which carry an excellent prognosis. Ovarian thecoma-fibroma groups are uncommon sex cord-stromal neoplasms, constituting 1.0%–4.0% of all ovarian tumors. Most of them are benign and often found in postmenopausal patients. Combination tumors in the ovary are known. The most common combination is mucinous cystadenoma which occurs in association with Brenner tumor, mature cystic teratoma, Sertoli-Leydig cell tumor, or even a serous cystadenoma. A combination of surface epithelial and thecoma-fibroma group is very rarely encountered. A case of one such combination of serous cystadenoma and fibroma of the ovary is being presented here in a postmenopausal woman.
Orthostatic Hypotension
Authors: Jain Gunja , Singhal Sunny , Goyal Laxmi Kant , Mathur Ajay
Published: July 2022

Orthostatic hypotension (OH) is defined as a drop of >20 mm Hg of systolic or >10 mm Hg of diastolic blood pressure (BP) within 3 min of standing from lying position. It is a common geriatric syndrome caused by impaired orthostatic response of BP. Its clinical manifestation can range from dizziness to syncope. It is a common cause of recurrent falls and fracture in older adults. Its etiology ranges from neurological causes such as Parkinson and diabetes to hypovolemia. Drugs, especially cardiovascular drugs are also frequently identified as the cause of OH. The management of OH is primarily nonpharmacological including medication review, dietary, and lifestyle modifications. However, in partially responsive or resistant cases, medications such as fludrocortisone, midodrine, droxidopa, etc., are also used.
Approach to the Current Rational Use of Antibiotics among the Albanian Dentist Community
Authors: Kleva Shpati , Elona Kongo , Edit Xhajanka , Anis Thodhorjani , Neada Hysenaj , Suida Kuka
Published: July 2022

Rising antibiotic use is a serious threat to the success of therapy in dentistry for bacterial resistance and side effects to the patients. The dentist community in Albania prescribing too many antibiotics. This survey assesses the mode of antibiotic use among Albanian dentists, with appropriate dosage and regimen, and antibiotic stewardship and their knowledge of relevant guidelines.

Material and Methods:

This survey study was conducted among 180 Albanian dentists. The questionnaire was distributed through e-mail addresses found in the database of the Faculty of Dental Medicine, University of Medicine of Tirana. We assessed 180 dentists out of which 154 (85.56%) completed the entire questionnaire.

Results:

There were 24,870 prescriptions in adult patients from 154 dentists for a period of six months with an average of 1,243 prescriptions per week. The most used antibiotics were fixed combinations of amoxicillin–clavulanic acid (67.43%) and azithromycin (39.3%) for allergic patients to beta-lactams. The results for antibiotic stewardship were incorrect in 37.01% of total providers, and gastrointestinal disorders were reported as side effects.

Conclusion:

This survey conducted among Albanian dentists shows a different trend of using antibiotics than in other countries. To tackle the current antibiotic resistance, dentists must be an important part of the antimicrobial stewardship program of the Public Health Institution in Albania to change individual behavior.
Scoping Review of Six Retrospective Studies
Authors: Sadeq Adel , Elnour Asim Ahmed , Farah Farah Hamad , Ramadan Azza , Don Judit , Fathelrahman Ahmed Ibrahim , Alkaabi Maisoun , Baraka Mohammed , Abubakar Abubakar B. , Suliman Sasha Mohammed Elamin , Al Amoodi Abdulla , Khidir IsraaYousif , Al Kubaisi Khalid Awad , Al Mazroui Nadia
Published: July 2022

Background:

It would be rational to describe the pattern of the clinical characteristics of the survivors and the nonsurvivors during the critical intensive-infection era of coronavirus disease 2019 (COVID-19). The explicit objective of the current scoping review was to delineate the predictive risk factors associated with case fatality rate (CFR).

Methods:

Six retrospective studies of subjects infected with COVID-19 published between December 1, 2020, and March 30, 2020, describing nonsurvivors in Wuhan/Hubei, China, were identified.

Results:

There were 1769 subjects with a mean age of 52 years, and 65.9% were male. The highest comorbidity reported was cardiovascular diseases at 22.2% (393/1769). The overall number of cases admitted to the intensive care unit was 228 (12.9%). The reported overall CFR was 7.7% (136/1769), with the highest at 28.2% (54/191), and the lowest at 1.4% (15/1099). The mean duration of onset until death for nonsurvivors was 15.3 days.

Conclusion:

We have found that older age, male gender, the longer duration from onset till death (days), development of acute respiratory distress syndrome/shock, preexisting diabetes, and preexisting cardiovascular diseases were the major risk factors associated with high CFR.