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Purpose To describe endogenous endophthalmitis in the setting of Covid-19 pneumonia post recovery. Methods Retrospective review of five patients of endogenous endophthalmitis following Covid-19 disease done. Results All five cases had received systemic corticosteroid for a mean duration of 7 days during severe Covid-19 treatment. Decrease vision was presenting symptom between 1 and 31 days following Covid-19 recovery. All patients had presumed fungal endogenous endophthalmitis based on clinical profile. Four out of five patients subjected to pars plana vitrectomy had microbiologically proven aspergillus species endogenous endophthalmitis on vitreous fluid assessment; two cases each of aspergillus niger and aspergillus fumigates. Four eyes underwent pars plana vitrectomy with silicone oil injection had shown satisfactory anatomical outcome with control of the infection; however, no significant visual gain achieved. Conclusion We reported five cases of aspergillus endogenous endophthalmitis in Covid-19 recovered patients to document the likely presentation of this rising entity and avoid misdiagnosis.

Rhino-orbital-cerebral mucormycosis (ROCM) with intracranial extension is a fatal disease. A case of extensive ROCM, with rare intracranial fungal granuloma, seen in a COVID-19 positive young male is described. A successful therapy consisting of a multidisciplinary approach for sinuses debridement, orbital exenteration, and intracranial granuloma excision was done. Nonseptate hyphae of Mucor and septate filamentous Aspergillus grew concurrently from exenterated orbital specimen.

Introduction: The aim of this study was to determine the role of hyperbilirubinemia as a new diagnostic tool for predictor of gangrenous / perforated appendicitis. Methods: Hospital based prospective study was conducted on 100 patients with perforated/gangrenous appendix Results: In acute appendicitis case out of 84 cases 26 cases bilirubin level was more than 1mg/dl, in gangrenous appendicitis out of 3 cases all cases bilirubin level was more than 1mg/dl and in perforated appendicitis out of 13 cases 12 cases bilirubin level was more than 1mg/dl Conclusion: It is concluded from present study that elevated total serum bilirubin without elevation of liver enzymes is a good indicator of appendicular perforation. Keywords: Perforation, Appendicitis, Bilirubin

Background: Blunt abdominal trauma is a leading cause of morbidity and mortality among all age groups. So we evaluate the spectrum and outcome of blunt trauma. Methods: Hospital based prospective study conducted on 100 patients at department of general surgery. Results: Distribution according to type of injury consisted of maximum cases, 84 (84%) of road traffic accidents, 11% cases were of fall from height. Conclusions: Males were pre-dominantly affected. Road traffic accident was the most common cause of injury. Though conservative management is successful in carefully selected patients, operative management remains the main stay of treatment. Keywords: Blunt abdominal trauma, Liver injury, Perforation, Splenic injury

Proboscis lateralis (PL) is a rare congenital malformation of the craniofacial structure with varied clinical associations. None of the studies documented a discrete review of ophthalmic presentations in PL. The principal aim of the present study is to explore the ophthalmic manifestations of PL. The ancillary goal is to derive a relationship between congenital deformity in PL and various ophthalmic anomalies. Databases were searched in order to obtain articles related to PL. A qualitative systematic analysis of 100 subjects was performed. In PL, eyelid coloboma (32.6%) is the most common ocular feature, followed by hypertelorism (25.3%), iris coloboma (22.4%), lacrimal system abnormality (20.7%), malpositioned eyebrow (14.4%) and retinochoroidal coloboma (12.9%). Sinonasal deformity is the most common systemic abnormality, detected in 87.9% of cases of PL, as compared with central nervous system involvement (56.2%) and other anomalies. The analysis showed a strong significant association between brain abnormalities and hypertelorism (p=0.000) and between brain abnormalities and micro-ophthalmia/anophthalmia (p=0.000). Statistically significant association was noted between cumulative ocular abnormalities and cumulative systemic abnormalities (p=0.001). The present study on PL reviewed the salient features of this rare congenital disorder. The study outcome provides a new aspect to concomitant ocular abnormalities. This study supports the view that other congenital anomalies in cases of PL had significant influence on certain ophthalmic anomalies.

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

A case of X-linked retinoschisis with anatomic and functional issues correlated by a constellation of methods, including spectral-domain optical coherence tomography, microperimeter, electroretinography, and multifocal electroretinography, is described. This case highlights the importance of microperimetry in the presence of normal or subtle abnormalities in full-field electroretinography. The ability of spectral-domain optical coherence tomography in diagnosis and follow-up in cases with X-linked retinoschisis is demonstrated. [Ophthalmic Surg Lasers Imaging 2009;40:71-74.]

Background: This study was undertaken to evaluate the prevalence of idiopathic macular hole in a defined community in Southern India. Methods: In all, 7774 of the 9546 enumerated (81.43%) subjects availed themselves for an ophthalmic assessment which included a detailed ophthalmic examination and fundus photography. All data were entered and stored in a secure computerized database and statistical analysis was performed using spss for Windows. Results: Thirteen subjects comprising six males and seven females were diagnosed with macular holes equating to a risk of 0.17%. Bilateral macular holes were found in two subjects. The mean age of subjects with a macular hole was 67 years. Increasing age and history of cataract surgery was strongly associated with an increased prevalence of macular holes (P

The study was undertaken to evaluate the prevalence of retinitis pigmentosa (RP) in rural and urban South India.Seven thousand seven hundred and seventy four subjects aged 40 years or more from rural and urban Tamil Nadu, underwent comprehensive ophthalmic examination out of 9576 enumerated (81.17%). After a thorough ophthalmic examination, fundus photographs were taken for documentation. Statistical analysis was done using SPSS for Windows (ver 14).7461 (95.9%) subjects had fundus details seen in both eyes. Thirteen subjects (0.17%; 4 males, 9 females) were diagnosed as retinitis pigmentosa. Retinitis pigmentosa in the urban population was seen in approximately 1 in 930 persons, while 1 in 372 of rural subjects had the disorder. This figure is greater than other reports from the western populations and that of the conservative estimate of 1 in 4000. The age and gender adjusted prevalence rate of retinitis pigmentosa to national census 2001 was 0.155%. Eight subjects (61.53%) had visual acuity less than 3/60.Prevalence of RP in South India appears to be alarmingly higher in comparison to those seen in other parts of the world.

Single crystal growth method was applied to determine lactose solubility, growth rate and morphology of lactose crystals grown in model lactose solutions containing various salts and in whey ultrafiltration (UF) permeate solutions. Salts either increased or decreased the lactose crystal growth rate, due to effects on lactose solubility. Addition of LiCl led to a maximum increase in growth rate and a maximum decrease in lactose solubility, while K2HPO4 had opposite effects. Growth rates of individual lactose crystals in whey UF permeate solutions were lower and lactose solubility higher than those in pure lactose solutions.

Solutions (15% protein) of a whey protein concentrate (WPC) at pH 6.8 or 5.0 were subjected to fast, intermediate or slow freezing at −17 °C and −30 °C, with an unfrozen control held at +4 °C for 24 h. After thawing at 20 °C, selected physicochemical and functional properties were compared; these included solubility index, heat stability, viscosity, gel strength, freezing point, as well as observations by cryomicroscopy. It was concluded that there was no major detrimental effect of the freezing process alone on any of the WPC solutions studied at either pH. Minor changes in viscosity, microstructure and possibly heat gel strength observed at pH 5.0 may indicate that long-term storage at this pH could lead to development of quality defects. To assess whether freezing might be a suitable alternative method for preservation of concentrated whey protein solutions, the effects of frozen storage must be studied further.

Dear Editor, We read with interest the article “Combined treatment of intravitreal bevacizumab and intravitreal triamcinolone in patients with retinal vein occlusion: 6 months of follow-up” by Ehrlich et al. [1]. We congratulate the authors for their interesting study and offer our comments. One major advantage we feel that the authors have not adequately highlighted is the much lower re-injection rate of 2±0.81 in their patients compared to previously published reports with bevacizumab monotherapy alone where monthly injections have been proposed in order to maintain a favorable outcome [2]. We postulate that the reason that repeated administration of intravitreal bevacizumab alone could result in a progressive decrease in biological response could be attributed to tachyphylaxis. Schaal et al. [3] proposed that one solution to avoid this decrease in the biologic effect would be to combine drugs with different modes of action. They demonstrated that combining bevacizumab with triamcinolone acetonide partially alleviated the efficacy decrease observed with bevacizumab alone. We propose that this could be one of the mechanisms by which the re-injection rate would be decreased by using combination therapy, compared to monotherapy with anti-VEGF injections alone. Also, nine out of the 16 patients studied in the article had received previous treatment and there is no data provided on whether these eyes behaved differently anatomically or functionally vis-a-vis the treatment naive eyes. It would be of interest to know if prior monotherapy with anti-VEGF agents had any effect on the subsequent course of the disease and whether this subset of patients differed in their response to treatment, recurrence of edema, and visual recovery compared to treatment of naive eyes.