bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of Malnutrition and Influence of an Individualized Nutritional Support on the Nutritional Status of Cancer Patients
Authors: Basu Soma , Hemamalini Arambakkam Janardhanam
Published: July 2024

Background: Muscle mass loss, impaired dietary intake, and poor nutritional status are hallmarks of patients with cancer. Cancer-associated malnutrition can lead to several negative consequences, including poor prognosis, reduced survival, increased therapy toxicity, reduced tolerance and compliance to treatment, and diminished response to drugs. The main aim of this study is to understand the prevalence of malnutrition using Global Leadership Initiative on Malnutrition Criteria (GLIM Criteria) and evaluate the impact of tailor-made nutritional intervention on the nutritional status of patients with cancer. Methods and Material: An interventional prospective study was conducted among 100 adult hospitalized cancer patients. The study was based on the Nutrition Care Process model, where nutritional assessment was done using GLIM criteria and Malnutrition Universal Screening Tool (MUST), and muscle mass was assessed using the Handgrip Dynamometer. Nutritional diagnosis was made based on assessment; nutritional intervention was provided through Individualized Nutritional Counseling & Oral Nutritional Support, and nutritional monitoring was done for patients during their stay in hospital using 24-hour daily dietary recall. Nutritional evaluation was done at the time of discharge using GLIM criteria, MUST, and Handgrip Strength (HGS). Data analysis was done using SPSS v24 statistical software (developed by IBM) to find out the Mean and Standard Deviation. Paired t test, Chi-square test, and Regression Analysis were used to analyze the qualitative variables. Statistical significance was defined as P < 0.05. Results: The current study evaluated 100 participants among whom 26% of participants were malnourished as assessed by MUST and 22% participants had poor muscle strength. A paired t-test was performed and it was found that the calorie intake (1504.1 ± 158.7) and the protein intake (56.08±7.01) were almost double after the nutrition intervention. The difference was found to be highly statistically significant with P < 0.01. Thus, nutrition intervention significantly (P < 0.01) improved calorie and protein intake. The overall mean MUST score at baseline was 0.39 which was reduced significantly (P < 0.000) to 0.17 at the end of the study. The HGS improved significantly (P < 0.000) from 10.02 to 25.51 after the nutrition intervention and it was evidenced by 2.5 times increase in HGS (25.51 ± 2.40) by the end of the study. Conclusion: Individualized nutritional support with continuous monitoring and counseling resulted in improvement in nutritional status as evidenced through their improved MUST score and HGS.
Bilateral microsporidial stromal keratitis
Authors: Verma Arti , Venugopal Anitha , Veerangudi Veeramma , Abraham Divyan , Ravindran Meenakshi
Published: July 2024

The purpose of this study was to report a case of bilateral sequential stromal microsporidiosis that was managed with medical treatment. A 12-year-old male presented with a 2-week history of redness, pain, and dense anterior stromal corneal infiltrate. He was successfully managed with 0.02% topical chlorhexidine gluconate two hourly and topical fluconazole 0.3% six times a day and later, 0.5% loteprednol etabonate was given for a total of 12 weeks. There was complete resolution of the infection with corneal nebular scarring with no episodes of recurrence at 6 months of follow-up. The final best corrected visual acuity was 20/30. The diagnosis of microsporidia can be challenging, and repeated corneal scraping should be attempted in cases with a high index of suspicion. Medical therapy can prove successful in selected cases where early detection of causative organism is done.
Non-keratinizing squamous cell carcinoma – A rare variant of sinonasal tract malignancy invading orbit: A case report and review of literature
Authors: Das Barnita , Pandharpurkar Modini
Published: July 2024

This case report presents a rare case of orbital invasion from non-keratinizing squamous cell carcinoma (NKCa) of paranasal sinuses. A male patient presented with painful bleeding from a mass near the left eye, blood-stained discharge from the left nostril, fatigue, and weight loss. There was a heterogenous lesion inferomedial to the left eye, inside the left nostril, and in the oral cavity. Palpable neck lymph nodes, computed tomography scan showing a bone-eroding lesion, histopathology, and immunohistochemistry findings suggested malignancy of the NKCa variant. Immediate chemotherapy showed improvement after the first cycle, and the patient is under regular follow-up.
Bilateral congenital tarsal kink syndrome with clear cornea
Authors: Mishra Aishwarya , Pai H Vijaya
Published: July 2024

Congenital tarsal kink syndrome is a rare disease that causes inward rotation of the upper eyelid, leading to lacrimation, photophobia, blepharospasm, and corneal scarring. Most of the reports in the literature are unilateral cases. We report a 6-month-old male infant with bilateral tarsal kink syndrome without corneal abrasion or keratitis. The defect was corrected with transconjunctival tarsotomy with marginal rotational sutures. The postoperative outcome was satisfactory. Early diagnosis and treatment help to avoid visual complications in the long term. Increased awareness among pediatricians will help in early referral and faster management.
PFCL nightmare: Scleral rupture and novel use of gelatin sponge in repair
Authors: Shah Payal Naresh , Ramanjulu Rajesh , Shanmugam Mahesh P
Published: July 2024

We report a case of scleral rupture that occurred during perfluorocarbon liquid (PFCL) injection in a case of bullous rhegmatogenous retinal detachment (RD), which was managed uniquely using a gelatin sponge. So far, only two case reports of scleral rupture during PFCL injection have been reported. A 69-year-old gentleman presented with complaints of sudden-onset painless blurring of vision in his right eye and was diagnosed with pseudophakia with total bullous RD. During 23-G vitrectomy, PFCL was injected using a single-bore cannula. During FAE, the globe appeared hypotonous with choroidal folds. Scleral rupture with retinal incarceration was noted in the superotemporal quadrant. This case report illustrates further unique management.
Pattern scanning laser photocoagulation in the treatment of recurrent hyphema following gonioscopy-assisted transluminal trabeculotomy
Authors: Espinoza Gustavo , Duarte-Bueno Laura M , Cano Jonathan C
Published: July 2024

Minimally invasive glaucoma surgeries (MIGS) are increasingly used in mild-to-moderate glaucoma cases. Among MIGS, gonioscopy-assisted transluminal trabeculotomy (GATT) is an alternative to conventional glaucoma surgeries. Although GATT is a safe procedure, its potential adverse effects should be considered. The most common complication is hyphema, which is usually transient and resolves spontaneously in the first postoperative week. However, cases of late postoperative hyphema have been reported. We report the case of a patient who developed persistent hyphema after undergoing GATT combined with cataract extraction that was successfully treated with PASCAL photocoagulation, with no further recurrences.
Hemangiopericytoma of the lacrimal sac: A rare case report and review of literature
Authors: Dash Satyabrata , Mohapatra Madan Mohan , Sarangi Sonali , Bidasaria Amit
Published: July 2024

A primary hemangiopericytoma (HPC) of the lacrimal sac in a 40-year-old patient is reported. HPCs are rare soft tissue tumors derived from the pericapillary pericytes with low malignant potential. Only 10 cases of lacrimal sac HPCs have been previously reported. Here, the authors report an additional case that presented clinically with epiphora and painless mass with no recurrence during 36 months of follow-up. The treatment of choice for this neoplasm with frequently unpredictable behavior is total excision with surrounding tissue and long-term follow-up.
Modified reverse Hughes technique for upper eyelid reconstruction – Case report
Authors: Camargo-Parra Katherin , Melo-Murillo Andrea , Salamanca Omar , Martínez-Blanco Alexander , Bonilla-Escobar Francisco J
Published: July 2024

Patients with scarring in the eyelids present a significant surgical challenge, particularly when the scarring results from severe trauma. This case report describes a young female patient with a history of keloid formation who sustained an upper eyelid trauma, resulting in extensive tissue avulsion and damage to the upper canaliculus. An upper eyelid reconstruction was undertaken using the tarsoconjunctival flap advancement procedure (modified reverse Hughes) for both the lower and upper eyelids to reconstruct the defect. This reconstruction facilitated anatomic and functional recovery, including eyelid opening and closing, and appearance.
Macular infarction in a case of acute postoperative endophthalmitis post intravitreal amphotericin B
Authors: Rao Vaishnavi , Dabir Supriya , Mohankumar Arthi , Rajan Mohan
Published: July 2024

To report a case of acute postoperative endophthalmitis that was complicated by macular infarction following intravitreal liposomal amphotericin B injection. A 76-year-old was diagnosed with acute endophthalmitis after uneventful phacoemulsification surgery and underwent pars plana vitrectomy with intravitreal antifungal (voriconazole). We switched to liposomal amphotericin B (5 µg/0.1 mL) from voriconazole in view of non-resolving exudates post vitrectomy. A few hours later, the patient complained of decreased vision, and fundus examination revealed an extensive area of macular infarction. The patient was continued on oral antifungal, and vitreal lavage with intravitreal dexamethasone was done. Optical coherence tomography angiography (OCT-A) at 6 months follow-up showed improved perfusion in the ischemic area, and the patient maintained a visual acuity of 20/80. Retinal toxicity can be a complication while treating post-vitrectomy patients with intravitreal amphotericin B. Early intervention may help in preserving vision by improving vascular perfusion at the macula.
Primary mucinous carcinoma of eyelid skin, a rare finding
Authors: Hernández-Cerdá Jorge , Alegre-Ituarte Víctor , Jaén Martínez Joaquín Miguel , Gornals Montes Gloria
Published: July 2024

Primary mucinous carcinoma of eyelid skin is a rare type of sweat gland carcinoma, with around 300 cases described to date. The most frequent clinical presentation is an asymptomatic nodule with characteristics very similar to those of other benign nodules, so the definitive diagnosis is always histopathological. Although the primary mucinous carcinoma of the skin (PMCS) risk of metastasis is low, its recurrence is much more frequent, so it is critical to expose the cases that we find of this tumor to help a better diagnosis in daily practice. We present the case of a patient with a nodule on the eyelid, and biopsy revealed findings compatible with PMCS.
Doughnut capsulorhexis: Pioneering advancements in cataract surgery to sidestep Argentinian flag sign
Authors: Kumar Badri Praveen , Ramesh Shruthy Vaishali , Ramesh Prasanna Venkatesh
Published: July 2024

Background:

For a successful capsulorhexis, it is crucial to use controlled centripetal and tangential vector forces in the rhexis border to counteract the centrifugal forces of the zonular component. Unfortunately, in hypermature cataracts, these maneuvers do not prove successful due to the raised intralenticular pressure, leading to an Argentinian flag sign. Among several techniques, this method of doughnut capsulorhexis is one such technique to perform successful capsulorhexis in cases with high intralenticular pressure.

Purpose:

In this video, we highlight this new method of capsulorhexis to prevent undue capsule-related complications in hypermature cataracts, as this plays a crucial role in successful surgical outcomes.

Synopsis:

The lens capsule usually experiences centrifugal vector forces exerted by the zonules, but in hypermature cataract cases, there is an additional factor of raised intralenticular pressure. In such cases, the attempts to make a 5 mm capsulorhexis might lead to the propagation of the rhexis to the periphery due to the combined mechanism of the two vector forces. Therefore, the technique of performing a smaller 2 to 3 mm rhexis is performed. This reduces the centrifugal force involved and prevents undue extension of the rhexis. Following this, decompression of the capsular bag is performed by aspirating the liquefied cortex using a bimanual irrigation and aspiration cannula, followed by controlled extension of the rhexis using a cystitome, which is performed for a successful surgical outcome. The second knick is made parallel to the first rhexis,1 mm away from the rhexis border, and a flap is raised. The rhexis can either be completed using a cystitome or a microrhexis forceps.

Highlights:

This technique does not require any additional instrumentation or training. It can be performed using the cystitome and microrhexis forceps. Surgeons of all calibers can efficiently perform it. This series of videos shows the successful outcome of continuous curvilinear capsulorhexis using the Doughnut method.

Video Link:

https://youtu.be/x0dTklOaMqg
A rare case of lipemia retinalis in a 15-day-old neonate
Authors: Sharma Manika , Gupta Kanav , Gupta Brij K , Garg Kritika
Published: July 2024

Lipemia retinalis (LR) is characterized by creamy white discoloration of retinal vessels, a feature of chylomicronemia (triglyceride levels >1000 mg/dL). We report a case of a 15-day-old neonate admitted to the pediatric ward with complaints of breathing difficulty and respiratory distress. Ophthalmological examination revealed a whitish optic disc with diffuse tortuous creamy retinal vessels bilaterally in peripheral and posterior poles and a salmon pink retinal background. A diagnosis of grade-III LR was made. The patient was advised exclusive breastfeeding and followed up.
Traumatic superior oblique tendon rupture with ptosis: A case report
Authors: Qin Yanli , Shen Tao , Ding Lin , Wang Zhonghao , Yan Jianhua
Published: July 2024

The traumatic rupture of the superior oblique tendon with ptosis is extremely rare, and the surgical treatment is very challenging. We reported a case of a 41-year-old man with superior oblique tendon rupture and ptosis due to an iron hook injury. The ocular movement disorders were not obvious except for mild superior oblique underaction but were accompanied by severe extorsion. The distal stump of the superior oblique tendon was shortened and anchored to the periosteum of the supra-nasal orbital margin near the trochlea. Post-operative follow-up revealed the surgical outcome was better than expected, which resulted in significant improvement in binocularity and cosmetic outcomes without complication in the present case. The exploration of the levator palpebral superioris (LPS) in the early post-traumatic stage might not be necessary in circumstances without eyelid laceration. Shortening and anchoring of the ruptured superior tendon could restore almost normal binocularity, decrease the extorsion, and avoid acquired Brown syndrome.
Eyes on the unseen-lung adenocarcinoma presenting as iris and ciliary body metastases: A case report
Authors: Ganesan Suganeswari , Joshi Aditi , Mohan Sujatha , Krishnakumar Subramanian
Published: July 2024

A 65-year-old male was referred for a left-eye irido-ciliary body mass for further evaluation. In the left eye, there was a small, well-circumscribed, white gelatinous, amelanotic mass noted temporally in the angle with a filiform appearance. The ultrasound biomicroscopy showed a large hyperreflective mass at 3 o’clock in the ciliary body, the anterior chamber, angle, iris, and anterior surface of the lens. Iris tissue biopsy was done, and the sample was sent for histopathology with immunohistochemistry. The histopathological examination identified the tumor composed of malignant cells forming glandular structures alongside papillary projections. Immunohistochemical tests showed positive results for CK (AE1/AE3). The diagnosis of a poorly differentiated adenocarcinoma was made. A whole-body PET scan and CT scan were done. The imaging features were suggestive of primary bronchogenic malignancy of the right lung with systemic metastases. The lung biopsy confirmed the diagnosis. Iridociliary mass warrants a detailed evaluation for appropriate management by a multidisciplinary team.
Traumatic subconjunctival phacocele – Rare and sui generis
Authors: Sharma Reena , Yadav Vandana , Maurya Geeta , Singh Sanjeev Kumar
Published: July 2024

Blunt trauma to the globe can result in indirect scleral rupture with dislocation of crystalline lens into the subconjunctival or sub-tenon space and is known as phacocele. Here, we report a case of traumatic subconjunctival phacocele with history of blunt trauma to the globe 1 month back. The case presented with a mass in the inferonasal quadrant with no previous history of myopia, ocular surgery, or connective tissue disorder.
Penetrating eye injuries caused by animal inoculation needle sticks: Two case reports
Authors: Chung Han Y , Ahn Sung H , Lee Tae-Eun
Published: July 2024

We present two cases of ocular injuries caused by animal inoculation needles associated with full-thickness corneal lacerations and traumatic cataracts. Total vitrectomy was performed on the days of the incidents; both retinal holes and retinal hemorrhages were observed. The patients achieved final visual acuities of 20/25 and 20/16, respectively. This report seeks to share treatments that ensure successful outcomes when ocular injuries are caused by animal inoculation needles. We recommend early vitrectomy to prevent endophthalmitis while monitoring any retinal damage.
Compression sutures: A rescue to failed intracameral gas injection in massive non-resolving corneal hydrops of long duration in advanced pellucid marginal corneal degeneration (PMCD)
Authors: Jain Parul , Arora Ritu , Gupta Isha , Sahu Jigyasa , Hariani Avani
Published: July 2024

To describe the application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of pellucid marginal corneal degeneration with a large Descemet membrane (DM) tear. Corneal hydrops is a complication of conditions such as keratoconus (KC), pellucid marginal corneal degeneration (PMCD), and keratoglobus. Intracameral gas injection in the form of sulfur hexafluoride (SF6) or perfluoro propane (C3F8) has been known to shorten the recovery period by tamponading the break. The application of corneal sutures to approximate the widely separated ends of the DM tear may also be performed. All these are management options described for acute hydrops. We report two cases of application of full-thickness compression corneal sutures along with intracameral gas injection in a case of non-resolving long-duration hydrops of more than 2 months duration in PMCD with a large DM tear. Full-thickness corneal compression sutures and intracameral gas injection can restore the imperviousness of posterior stroma after hydrops. This technique is safe and effective for faster resolution of corneal edema post hydrops and early visual rehabilitation.
Phaeoacremonium parasiticum as a cause of postoperative cluster endophthalmitis
Authors: Markan Ashish , Kaur Harsimran , Tekchandani Uday , Thinlass Padma , Singh Ramandeep
Published: July 2024

This case series highlights Phaeoacremonium parasiticum as the cause of postoperative cluster endophthalmitis. We present four cases of fulminant postoperative endophthalmitis following cataract surgery. The mean duration of onset of endophthalmitis-related ocular symptoms was 7.25 ± 0.5 days. Due to fulminant course of infection, the management involved multiple surgical interventions, with three patients requiring explantation of the intraocular lens.
Holmes-Adie syndrome associated with BNT162b2 mRNA COVID-19 vaccine
Authors: Karaca Gulderen , Kabakçı Aslı K
Published: July 2024

Adie’s tonic pupil is a neuro-ophthalmologic disorder with dilation and poor light response. When deep tendon reflex loss accompanies the tonic pupil, it is called Adie syndrome or Holmes-Adie syndrome. The pupillary symptoms result from damage to the ciliary ganglion and the post-ganglionic parasympathetic nerves. Corona virus 2, which causes severe acute respiratory syndrome, has been named corona virus 19 (COVID-19) by the World Health Organization. It has been reported that the coronavirus infection has neurological manifestations including pupillary involvement.[1,2] The cases of two patients with Adie’s tonic pupil 10–15 days after they had BNT16b2b mRNA (Pfizer, BioNTech, Germany) vaccine were reported. One of them had Holmes-Adie syndrome.[3,4] In this case report, we aim to describe two patients who are a married couple with possible coronavirus BNT16b2b mRNA vaccine (Pfizer, BioNTech, Germany)-related Holmes-Adie syndrome.
Ring and flower in the eye – An incidental finding of Wilson disease in a case of diabetic retinopathy: A case report
Authors: Das Daisy R , Singh Ankita , Agarwal Balmukund , Basumatary Jessica
Published: July 2024

This is to report a rare case of Wilson disease (WD) with Kayser–Fleischer (KF) ring with sunflower cataract along with diabetic retinopathy. A 43-year-old male patient presented to the comprehensive clinic with a chief complaint of diminution of vision of both eyes since 8 months. On ocular examination, the cornea showed golden brown color pigment deposition in the Descemet membrane, indicative of KF ring, which is a pathognomonic feature of WD. There was brown plaque or spoke-like radial opacities on the anterior lens capsule in both eyes, which gives sunflower appearance, which is also a feature of WD. The posterior segment revealed diabetic retinopathy in both eyes. Serum ceruloplasmin was reduced, and the bilirubin level was mildly raised. Liver function test was mildly altered. Urine excretory copper levels were raised. Ultrasonography of the abdomen and pelvis revealed liver cirrhosis with portal hypertension, splenomegaly, gross ascites, and gall bladder calculi. This is a rare case of WD with KF ring with sunflower cataract with diabetic retinopathy in both eyes. Slit lamp examination is mandatory to diagnose it as WD in the presence of KF ring.
Optic nerve infiltration as a significant feature in the treatment of a rare secondary intraocular lymphoma derived from a primary breast B-cell lymphoma: A case report
Authors: Fadhila Siti R , Pratomo Tiara G , Herdian Felicia S , Nora Rina L D
Published: July 2024

Intraocular lymphoma (IOL) is a rare form of lymphocytic malignancy which may pose a significant diagnostic challenge as it may masquerade various uveitis entities, with secondary IOL being less common than primary IOL. A 47-year-old woman presented with blurring of the right eye and floaters since 5 months before admission. She had a history of complete remission from primary breast diffuse large B cell lymphoma for five consecutive years. Both eyes had vitreous haziness and several yellowish, thickened retinal lesions with edematous and infiltrated optic nerves. The best-corrected visual acuity was hand movement for the right eye and 6/45 for the left eye. Cytopathologic exam of the vitreous showed a B cell origin lymphoma. Cerebral magnetic resonance imaging revealed new parenchymal lesions suggestive of metastatic lesions. The patient was given multiple rituximab intravitreal injections and systemic chemotherapy. Treatment options for IOL might be influenced by the central nervous system (CNS) involvement, which is signified by infiltration of the optic nerve in this case.
Unusual after cataracts: A case series
Authors: Venkataraman Prasanna , Kumaresan Yamini
Published: July 2024

Posterior capsular opacification (PCO) or “after cataract,” a common complication after cataract surgery, occurs due to abnormal proliferation and differentiation of the residual lens epithelial cells in the capsular bag. It can significantly affect visual acuity and contrast sensitivity. Though it cannot be eliminated, meticulous surgery coupled with appropriate intraocular lens selection can definitely reduce the incidence of PCO, especially in young patients undergoing cataract surgery. A routine neodymium-doped yttrium aluminum garnet (Nd:YAG) capsulotomy can solve the problem easily in most of the patients, but some can have atypical presentations due to angle closure from Soemmering’s ring. The purpose of this report is to present unusual after cataracts and the utility of imaging techniques in the diagnosis of the same.
Spontaneous migration of an intrastromal corneal foreign body
Authors: Sharma Vijay Kumar , Rahul  , Singh Prabhjot , Ambiya Vikas
Published: July 2024

This case report documents the exceptional spontaneous migration of an intrastromal corneal foreign body in a 37-year-old male injured by vegetative matter. Examination revealed a small retained foreign body and surrounding infiltrate. Over 6 weeks of observation and treatment, the foreign body remarkably migrated nearly 3 mm intrastromally with the resolution of infiltrates. Once reaching the anterior chamber, surgical removal was undertaken. This rare occurrence highlights the intricacies of foreign body behavior within the cornea warranting vigilance and further research on underlying biomechanics.
Contrast-induced transient cortical blindness
Authors: Aziz Faradatul Aisyah Abdul , Mat Tuan Hazri Tuan , Buang Nurhamiza , Nor Nor Idahriani Muhd , Hamzah Jemaima Che
Published: July 2024

A 58-year-old Malay man with a history of ischemic heart disease, well-controlled diabetes mellitus, and hypertension presented with sudden loss of vision after he underwent angiogram (cardiac catheterization) with contrast. Post-angiogram, his visual acuity deteriorated gradually to no perception of light bilaterally within 1 h duration. Clinically, there was no new intraocular pathology and neurologic examination was normal. An urgent noncontract computed tomography (CT) scan of the brain showed the presence of contrast in the venous sinuses but no obvious acute intracranial hemorrhage. Bilateral frontal and anterior parietal regions appeared hypodense with loss of gray white matter differentiation and relative effacement of the sulci. CT brain reported that infarction or cerebral edema may represent. Patient’s condition was observed, and after 24 h, his vision recovered to baseline and he was discharged well.
IgG4-related orbital disease presenting as optic neuropathy: A rare presentation and review of literature
Authors: Harirajan Ranjini , Neena R , Pauly Marian , Subramanian Krishnakumar
Published: July 2024

A 74-year-old male presented with a sudden drop of vision in the left eye for 5 days. He had a relative afferent pupillary defect and visual acuity of counting finger at 1 m in the left eye. Fundus showed a hyperaemic disc in the left eye. Ocular movements were full. He had uncontrolled diabetes mellitus. A possibility of anterior ischemic optic neuropathy was considered. The patient was lost for follow-up and came back 2 months later with visual acuity of perception of light in the left eye with features suggestive of orbital apex syndrome. Histopathology was confirmatory of immunoglobulin G4 (IgG4) disease. IgG4 disease presenting as optic neuropathy can be an early manifestation of orbital involvement.
Delayed interface fluid syndrome in a post laser-assisted in situ keratomileusis: A rare complication
Authors: Rao Vaishnavi , Dabir Supriya , Mohankumar Arthi , Nivas Archana , Mohan Sujatha
Published: July 2024

Interface fluid syndrome (IFS) is a rare complication seen post-laser-assisted in situ keratomileusis (post-LASIK). This report describes two unusual cases in which patients underwent ocular surgeries and developed delayed onset interface fluid. Both the patients had undergone uneventful laser-assisted in situ keratomileusis (LASIK) decades ago; case 1 underwent uneventful phacoemulsification and vitrectomy with gas tamponade and case 2 underwent uneventful phacoemulsification with intraocular lens implantation. Possible causes of IFS could be steroid-induced intraocular pressure (IOP) spike, intraocular inflammation, or both. IFS can be seen any time after refractive surgeries and can be a lifelong complication after LASIK surgery. Inaccurate IOP measurement due to underestimation should be borne in mind while measuring IOP in such patients. This report highlights the challenges in diagnosing IFS and the importance of correct IOP measurement in such cases to avoid irreversible vision loss.
Artery of Percheron infarct – An ophthalmologist’s perspective
Authors: Raghunandan Nithya , Tamrakar Varsha , Mehra Ayush
Published: July 2024

Thalamus is an important relay station in diencephalon which receives its blood supply mostly from the posterior cerebral artery. The Artery of Percheron (AOP) arises from the posterior cerebral artery and bifurcates to supply paramedian thalami. AOP infarction, though rare, presents with a triad of clinical features including altered mental status, memory impairment, and supranuclear vertical gaze palsy. Our patient had concurrent manifestation of vertical gaze palsy (both upward and downward) and third cranial nerve palsy in the left eye, which is an interesting clinical amalgamation. Our case report elucidates the quick recognition of the abnormalities in ocular motility through a simple, yet effective nine gaze ocular motility evaluation and thereby enhancing clinical recognition of this entity among the practicing general Ophthalmologists.
Visual and ocular surface rehabilitation with scleral lenses in a patient with limbal stem cell deficiency due to chemical injury – A case report
Authors: Subramanian Madhumathi , Balaji Janani
Published: July 2024

Scleral lenses are widely used for therapeutic purposes. This case report aims to emphasize the advantages of utilizing scleral lenses as a nonsurgical management option and presents evidence of their effectiveness in improving UCVA from 2/60 to 6/12 and reducing the corneal neovascularization and a hazy interface in a patient with partial limbal stem cell deficiency (LSCD) secondary to chemical injury. This case report highlights the potential of the scleral lens if given with an ideal fit and close monitoring for LSCD caused by chemical injury.
Penetrating femtosecond arcuate keratotomy presenting with corneal edema
Authors: Mercer Rachel , Loomba Abhinav , Goel Sid
Published: July 2024

We report a case of full-thickness penetration of an arcuate incision during femtosecond-assisted cataract surgery. A 78-year-old female underwent femto-cataract surgery with femto-arcuate incision. She presented with decreased vision and corneal edema 3 weeks later and was found to have full-thickness penetration of the arcuate incision with an internal wound gape. The patient was managed with closure of the internal wound gape using full-thickness corneal sutures. This resulted in a clear cornea with complete visual recovery. Careful depth setting via optical coherence tomography at the time of femto-cataract surgery is vital for minimizing the risk of this complication.
Cryotherapy of infective foci in metastatic endophthalmitis
Authors: Kandasamy Sindhuja , Chawla Rohan , Asthana Richa
Published: July 2024

A man in his 20s presented with complaints of diminution of vision in both eyes for the past 15 days. He had a history of carcinoma colon for which he underwent hemicolectomy 2 months ago. There was vitritis with white fluffy exudate lesion suggestive of infective foci along the superior arcade, which was noted on fundus examination. A provisional diagnosis of endogenous endophthalmitis was made in both eyes, and pars plana vitrectomy with cryotherapy of infective foci was done. The vision of patient improved at 1-week follow-up. However, it dropped at 1 month due to macular pucker formation at the site of cryotherapy. Cryotherapy should be used with caution in lesions away from the posterior pole and in recalcitrant, nonresolving lesions.
Acanthamoeba epitheliopathy: Atypical presentation of Acanthamoeba keratitis
Authors: Malik Mehvish , Chatterjee Samrat , Agrawal Deepshikha
Published: July 2024

To report clinical features of the epithelial stage of Acanthamoeba keratitis to highlight the impact of an early diagnosis on outcome. A 42-year-old male, with a recurrent history of symptoms and a history of pond water bathing, presented with a linear non-branching epithelial lesion that stained poorly with fluorescein. He was diagnosed with herpes simplex epithelial keratitis and treated with topical acyclovir. However, a ring-like stromal infiltrate developed, and microbiology evaluation revealed Acanthamoeba cysts. Although the disease progressed significantly despite treatment with topical amoebicidal agents, it finally resolved. A 26-year-old male, with an antecedent history of trauma, presented with a ring-like epithelial lesion only, and microbiology evaluation revealed Acanthamoeba cysts. He was treated with topical chlorhexidine 0.02%, and the lesions healed without stromal progression. A delayed diagnosis in the first patient led to a poorer outcome, while an early diagnosis in the second patient led to a better outcome.
Risk Factors of Impediment of the Early Childhood Development in Rural Bengal
Authors: Chattopadhyay Nandita , Mitra Kaninika , Basu Swati , Pal Ranabir , Ghosh Amrita
Published: July 2024

Background:

Early childhood development (ECD) is the foundation of future life starting from conception and depends on biological and environmental factors. Seventy-four percent of these children reside in villages; many are underserved and marginalized. Enabling young children to achieve their full developmental potential is a requisite for sustainable development, but globally, 43% of children are still at risk to do so. The problem of ECD is grave for underprivileged rural population in India.

Objectives:

The objective of the present study was to identify the key risk factors that are prevalent in a marginalized rural community in West Bengal and to observe the impact of these impeding factors on ECD, thereby helping in priority setting in service delivery to optimize ECD promotion.

Methods:

In this community-based cross-sectional observational study, a random sample survey of 609 households with children 0–6 years was conducted in Purulia district, West Bengal, India, using a Multiple Indicator Cluster Survey III-based questionnaire followed by data analysis.

Results:

Lack of stimulatory home environment, poor learning opportunities, and inadequate responsive parental care were major hindrances. The cumulative effect of multiple other health and hygiene factors was also hindering ECD. Most factors were strongly influenced by poor maternal education.

Conclusion:

Education of caregivers, especially parents by dedicated health workers on early learning opportunities, showed the path of applied sciences in pediatric clinical practice. To modulate socioeconomic adversities with responsive parental care, ECD can be fostered.
Transcranial Doppler Sonography in Acute Viral Encephalitis with Special Reference to Dengue Encephalitis
Authors: Verma Nagendra Pratap , Verma Rajesh , Chakraborty Rajarshi , Garg Ravindra Kumar , Malhotra Hardeep Singh , Sharma Praveen Kumar , Kumar Neeraj , Uniyal Ravi , Pandey Shweta , Rizvi Imran
Published: July 2024

Introduction:

Acute viral encephalitis syndrome including dengue encephalitis (DE) is an important tropical illness with a guarded prognosis. The cerebral blood flow may be affected in acute viral encephalitis. Transcranial Doppler (TCD) sonography can quantitatively determine intracranial vascular flow dynamics in acute viral encephalitis.

Aim:

We aimed to investigate the intracranial blood flow characteristics in patients with DE and compare with nondengue acute viral encephalitis patients.

Materials and Methods:

In this prospective study, all the cases of acute viral encephalitis including dengue were enrolled over 18 months and followed up at 3 months. TCD was performed to determine the mean velocity pulsatility index (PI) and resistive index (RI) across the middle cerebral artery, anterior cerebral artery, posterior cerebral artery (PCA), vertebral artery, and basilar artery and compared it among dengue versus nondengue group as well as outcome at 3 months.

Results:

Out of 39 patients, 19 were diagnosed with DE, whereas 20 patients suffered from the nondengue group. The elevated PI and RI in the left PCA were found to statistically significant (P = 0.001 and 0.008, respectively) in the DE group. There was no significant difference in any other TCD indices in any other vessel among both the groups. In addition, an initial low Glasgow Outcome Scale (GOS) and higher brain imaging abnormality were significantly associated with poor GOS of <5 in both the groups.

Conclusion:

An elevated PI and RI of PCA could be an important initial TCD parameter in DE. TCD parameters did not affect the outcome of acute viral encephalitis.
Treatment of Hyperuricemia with Thlaspi Bursa Pastoris 6CH: A Randomized, Open-Label, Equivalence Trial
Authors: Bhar Koushik , Uchat Usha Ghelani , Nayak Chintamani , Saha Sangita , Misra Pankhuri , Ghosh Priyanka , Singh Navin Kumar , Koley Munmun , Saha Subhranil
Published: July 2024

Background:

Hyperuricemia (HU) remains a priority research area in every medical science, including complementary and alternative medicine interventions and homeopathy; however, the research evidence is limited. In homeopathy, Thlaspi bursa pastoris (TBP) is considered to be a potential treatment option in HU.

Methods:

An open-label, randomized, equivalence trial was conducted comparing TBP with individualized homeopathic medicines (IHMs). Serum uric acid (SUA) was the primary outcome; Gout Assessment Questionnaire version 2.0 (GAQ-2) and Measure Yourself Medical Outcome Profile version 2.0 (MYMOP-2) were the secondary outcomes; all measured at baseline and after 6 and 12 weeks. Intention-to-treat analysis was carried out to detect noninferiority and group differences using unpaired t-tests and two-way repeated-measure analysis of variance (ANOVA).

Results:

There were no differences between the groups at baseline. Reduction in SUA after 6 and 12 weeks was similar between groups (P = 0.784). Group differences in the secondary outcomes were also nonsignificant (all P > 0.05). TBP revealed noninferiority against IHMs, both after 6 weeks and 12 weeks in SUA and MYMOP-2 profile scores, but not in GAQ2 scores. Sulfur and Calcarea carbonica were the most frequently prescribed medicines in the IHMs group. There were no harms or serious adverse events reported from either of the groups.

Conclusion:

TBP acted noninferior to IHM in HU and both appeared to be equally effective. Rigorous and larger trials are warranted.

Trial Registration:

This trial was registered in the Clinical Trials Registry – India (CTRI/2018/10/016174; UTN: U1111-1221-8000).
Central Serous Chorioretinopathy Following Symbicort Usage in a 69-year-old Female Patient
Authors: Khamkar Shakib , Rahman Suleman
Published: July 2024

Steroid inhaler usage is the cornerstone of asthma management. This case report describes the development of central serous chorioretinopathy (CSCR) in a 69-year-old female following the use of Symbicort for the management of asthma. The association between inhaled corticosteroids and CSCR is discussed, highlighting the need for awareness among health-care providers. Further research is necessary to establish the pathogenicity of this rare condition and alternatives for patients in whom inhaled corticosteroids are essential to the control of their long-term condition.
Subchronic oral toxicity assessment of Ayurvedic herbo-metallic formulation Mahalaxmi Vilas Rasa in Wistar rats
Authors: Patil Pankaj S. , Wagh Mayuri D. , Mohan Mahalaxmi , Pande Shishir P. , Kulkarni Rajshree A. , Kulkarni Abhay N.
Published: July 2024

BACKGROUND:

Mahalaxmi Vilas (MV) Rasa, a revered Ayurvedic herbo-metallic formulation, holds historical significance for its therapeutic potential. In light of its traditional use, a rigorous evaluation of its safety profile in Wistar rats is imperative for establishing its evidence-based safety. This study aims to contribute valuable insights to the scientific community and healthcare practitioners, facilitating informed decision-making regarding the integration of MV into contemporary medical practices. The findings hold relevance for advancing our understanding of Ayurvedic formulations in the context of safety and efficacy, fostering a bridge between traditional wisdom and modern scientific scrutiny.

METHODS:

In the present study, a total of 24 Wistar rats were randomly divided into four groups as one control vehicle and three dose levels of the test drug MV Rasa. The test drug was made into suspension in a vehicle (honey-to-water ratio, 2:3) and administered orally once a day for 90 consecutive days in three dose levels (51.36, 205.44, and 513.6 mg/kg). Clinical observations, body weight changes, and food and water consumption were noted during the study. Then, on the 91st day, rats were sacrificed humanely, and parameters, such as hematological, biochemical, relative organ weight, and histopathological changes, were studied.

RESULTS:

There was a significant decrease in water intake in high-dose group rats (513.6mg/kg) in the weeks 1, 3, and 4, as compared with control group rats, the observed effect was not treatment related. In addition, MV (51.36, 205.44, and 513.6 mg/kg) produced no significant alterations in any of the hematological and biochemical parameters, except for a significant increase in direct bilirubin in the moderate dose group (205.44 mg/kg). However, no considerable cellular changes were found in the organs analyzed.

CONCLUSION:

MV had no toxic effect in Wistar rats during this repeated dose oral toxicity (90 days) study, even at 10 times the therapeutic dose (513.6 mg/kg). This was evidenced by their normal behavioral, hematological, biochemical, and histopathological examinations.
Evaluation of antibacterial activity of selected plant extracts against Serratia marcescens
Authors: Singh Gagandeep , Parihar Akanksha Singh , Sharma Vishakha , Tandon Smriti , Bhagwat Prateeksha , Yadav Sunanda , Grewal Jyotika , Rawat Hemant , Singh Virendra , Narasimhaji Ch. Venkata , Soni Hemant , Srikanth Narayanam , Acharya Rabinarayan
Published: July 2024

BACKGROUND:

Serratia marcescens is a well-known Gram-negative, rod-shaped bacterium commonly found in soil, animal skin, hospital environment, and plant-based raw materials. It is an opportunistic pathogen that causes serious infections, including pneumonia, bloodstream infection, wound infection, meningitis, and respiratory and urinary tract infections. Due to multiple resistant strains of S. marcescens being identified, new and effective plant-based antimicrobial compounds/drugs against S. marcescens must be searched. The present study is focused to explore the Stem of Neem (Azadirachta indica), Seed of Nirgundi (Vitex negundo) and Clove buds (Syzygium aromaticum) for their antibacterial activity against the isolated S. marcescens.

METHODS:

The S. marcescens was isolated from the garden soil of CARI Jhansi and identified based on various morphological and biochemical tests. We also checked the antibiotic profile of isolated S. marcescens. The ethanolic and methanolic extracts of the selected plant parts were prepared and explored for their antibacterial activity against S. marcescens using the disc diffusion method.

RESULTS:

The antibiotic profile of S. marcescens showed resistance to multiple broad-spectrum antibiotics, including erythromycin, rifampicin, chloramphenicol, and narrow-spectrum antibiotic vancomycin. At the same time, it was sensitive to kanamycin, streptomycin, ciprofloxacin, and ofloxacin. We observed that both methanolic and ethanolic extracts of clove buds were effective, while only the ethanolic extract of Nirgundi seed and Neem stem were found to be effective against S. marcescens.

CONCLUSION:

From this study, we conclude that both methanolic and ethanolic extracts of Clove buds, while only the ethanolic extract of Nirgundi seed and Neem stem, were found effective and showed significant inhibition of growth of S. marcescens.
Mitigation of testicular damage induced by DMBA/TPA through Murraya koenigii (L.) Spreng.: Insights into antioxidant and anti-apoptotic mechanisms
Authors: Kaur Sarvnarinder , Aniqa Aniqa , Kumar Sunil , Sadwal Shilpa
Published: July 2024

BACKGROUND:

7,12-Dimethylbenz[a]anthracene (DMBA) is a known mutagen, teratogen, and toxicant besides being a significant factor responsible for skin carcinogenesis. During carcinogenesis, DMBA and its metabolites produce excessive free radicals and oxidative stress. This oxidative stress further targets various cell organelles. Consequences of the damage by DMBA also influence vital organs, such as the brain, liver, and testis, with complex reactions, such as an increase in mutation, modification in cell membranes, structural proteins, metabolic enzymes, and signaling proteins. Therefore, this study evaluated the possible role of hydroethanolic Murraya koenigii (L.) Spreng. leaves extract (HEMKLE) upon damages incurred in testis tissues against DMBA/12-O-tetradecanoyl phorbol-13-acetate (TPA) in skin tumor-bearing mice.

METHODS:

Forty male LACA mice were segregated into four groups: control, DMBA/TPA, HEMKLE, and HEMKLE + DMBA/TPA. Skin tumors were induced by DMBA (500 nmol/100 μL of acetone) and TPA (1.7 nmol/100 μL of acetone; applied topically).

RESULTS:

The protective response of HEMKLE (200 mg/kg body weight) to testicular damage during skin tumorigenesis was apparent by recovery of endogenous antioxidant enzymes, along with histoarchitecture in the HEMKLE + DMBA/TPA group contrasted with the DMBA/TPA group. Furthermore, in the HEMKLE + DMBA/TPA group, reduced messenger ribonucleic acid and protein expressions of proapoptotic genes (caspase-9 and caspase-3) and enhancement in Bcl-2 were observed, proposing the anti-apoptotic potential of HEMKLE in testicular tissues.

CONCLUSION:

HEMKLE could be used as a nutraceutical or antioxidant drug to protect the body from testicular insults.