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Introduction: Major cause of irreversible blindness is glaucoma which is increasing as a significant global health problem. Knowledge of glaucoma burden and its clinical characteristics in this region is essential. Materials and methods: This was a cross-sectional hospital -based study conducted at Glaucoma unit in CHEERS Hospital, Bhaktapur from August 2015 to July 2019. Patients’ demographic profile, along with comprehensive eye examination findings were reviewed from the records. Data analysis was done with IBM SPSS version 24 and was presented in mean (±SD), frequency and proportions and a chi- square test was applied. P value < 0.05 was considered statistically significant. Results: Total of 310 glaucoma cases were included in this study. The mean age presentation was 61.89±14.4 years, and the majority of patients (52.9%) were in the age group 60-79 years. Most patients had primary open angle glaucoma (171, 55.2%) followed by primary angle closure glaucoma (92, 29.7%). Conclusion: Primary open angle glaucoma is the most common form of glaucoma. The proportion of glaucoma increased with increasing age (> 40 years). Provision of screening programs targeting persons with risk factors and opportunistic eye examinations would be beneficial in detection of glaucoma.

PURPOSE To find out clinical characteristics, therapeutic options, and visual outcome in symptomatic retinal artery macroaneurysm (RAMA) patients. METHOD Newly diagnosed cases of symptomatic RAMA from January 2015 to December 2019 were included. Fifteen eyes of 15 patients with mean age 62.46 years ± 14.89 (SD) fulfilled the inclusion criteria. RESULT Hypertension was present in 66.6% of the patients, and the commonest site was superotemporal (12 eyes, 80%). The most commonly employed treatment was Nd: Yag laser hyaloidotomy in 4 eyes (26.6%). Other treatments were intravitreal bevacizumab in 3 eyes (20%), focal laser with intravitreal bevacizumab in 3 eyes (20%), PPV with focal laser (13.3%) in 2, focal laser only in one (6.6%), PPV with focal and intravitreal bevacizumab in one (6.6%). The mean best-corrected visual acuity (BCVA) at baseline was 1.35 ± 0.84 LogMAR, which improved to 0.39 ± 0.53 LogMAR at the last follow-up. Presenting VA 0.77 (±0.40) improved to 0.20 (±0.17) p value (0.180) in intravitreal bevacizumab only group, 1.29 (±0.35) to 0.75 (±0.15) p value 0.66 in Nd: Yag laser group, 2.67 (±0.58) to 0.46 (±0.28) p value 0.019 in PPV group and did not improve in combined anti-VEGF and focal laser group due to dense hard exudates at the fovea in one and persistent cystoid macular edema in another case. CONCLUSION With regard to its presentation, which can vary tremendously, there are no approved guidelines for its treatment. The present study reinforces the need for a treatment guideline development. Customization of treatment should be considered depending on the clinical presentation of each case.

UNSTRUCTURED Background: Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. As such, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (i.e., detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches, who are individuals with the “lived experience” of recovery who obtain training to be coaches, are increasingly utilized to assist individuals with AUD and may provide a degree of continuity during this transition. We evaluated the feasibility of using an existing care coordination app (“Lifeguard”) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. Methods: The study was conducted on an ASAM Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge received daily prompts to complete a modified version of the Brief Addiction Monitor (BAM). The BAM inquired about alcohol use, risky (e.g., craving) and protective (e.g., 12-step attendance) factors. The coach sent daily motivational texts, appointment reminders, and checked-in if BAM responses were concerning. Follow-up continued for 30 days post-discharge. The following feasibility outcomes were evaluated: 1) proportion of participants engaging with the coach before discharge, 2) proportion of participants and the number of days engaging with the coach after discharge, 3) proportion of participants and the number of days responding to BAM prompts, and 4) the proportion of participants successfully linking with addiction treatment by 30-day follow-up. Results: The 10 participants were all men, averaged 50.5 years old, mostly white (60%), non-Hispanic (90%), and single (80%). Overall, 8 participants (80%) successfully engaged with the coach prior to discharge. Following discharge, 6 participants (60%) continued to engage with the coach, doing so on average 5.3 days (SD 7.3, range 0-20). Five (50%) participants responded to the BAM prompts during the follow-up, doing so on average 4.6 days (SD 6.9, range 0-21). Half (50%) successfully linked with ongoing addiction treatment during the follow-up. Participants who engaged with the coach post-discharge, compared to those who did not, were significantly more likely to link with treatment (83.0% vs 0%, χ2=6.67, P=.01). Conclusions: The results from this proof-of-concept pilot trial demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving post-discharge outcomes. Keywords: Alcohol use disorder; inpatient detoxification; peer recovery coach; smartphone app

Introduction: Ticks are ectoparasites which can lead to various blood borne diseases. Tick bite may resemble pigmented nevi, mole or nodule resulting a diagnostic dilemma. Tick bite in eye lid is rare and this case report describes tick bite in lower eye lid mimicking a traumatized pigmented nodule where the tick was identified only on magnification and was successfully removed mechanically. Case: A 61-year-old man presented to the eye out patient department with a sudden and painful black pigmented lesion on the right lower lid for four days. The tick was manually removed with forceps. Conclusion: This case report explains the need for a high index of suspicion as tick bite in sudden or recent onset pigmented lesions especially in endemic areas.

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Background Glaucoma is increasing as a significant global health problem being the major cause of irreversible blindness worldwide. Early detection and timely management of glaucoma can decrease the burden of blindness worldwide.Methods This was a retrospective hospital -based study conducted at Glaucoma unit in CHEERS Hospital, Bhaktapur from August 2015 to July 2019. Patients demographic profile, along with a comprehensive examination, reviewed from the records. Collected data included: age, sex, race/ethnicity, intraocular pressure, cup/disc ratio, different types of glaucoma, visual field. Data analysis dome with IBM SPSS version 24 and was presented in mean (±SD), frequency and proportions and chi- square test was applied. P value < 0.05 was considered statistically significant.Results Total of 312 glaucoma cases were reviewed and included in this study. The mean age presentation was 61.89±14.4 years, and maximum number (52.6%) was between ages 60-79 years. The majority of patients were primary open angle glaucoma (173, 55.4%) followed by primary angle closure (92, 29.5%). The association between all types of glaucoma and increasing age was statistically significant (P

There is both rapidly growing need, and limited evidence-based guidelines, for the management of opioid use disorders in subacute rehab and other nonaddiction medical settings. Following 2 unintentional opioid overdoses within the Community Living Center (CLC), a VA (Veterans Administration) subacute rehab setting, an interdisciplinary CLC Addictions Task Force was created to address a critical issue: how to best meet the combined neuropsychiatric and medical needs of the opiate use disorder patient through a multifaceted treatment approach. The goals of the task force were to develop and institute educational initiatives for providers; create patient care guidelines; increase safety on the unit; improve provider confidence when caring for this high-risk population; and mitigate the risk of unintentional overdose. The task force divided into 4 working groups to meet these aims. Process and outcomes are discussed. We found that in-services by addiction specialists improved clinician comfort in caring for this high-risk patient group. Specific areas that yielded the greatest clinician satisfaction ratings included didactics on how to identify at-risk patients and techniques on how to manage the patient in a general rehab setting. Utilizing an interdisciplinary approach, and an iterative process, at all stages was critical to the success of the CLC Addictions Task Force, as it improved buy-in and motivation from all disciplines. Improvements have been made to enhance patient safety, improve communication amongst providers, and provide a foundation to improve patient outcomes. Our preliminary work to enhance the identification and management of opioid use disorders at our CLC is an important first step towards a standardized curriculum that could be applied to other VA and non-VA subacute rehab settings.