Ozanimod-Associated Iatrogenic Kaposi Sarcoma in a Patient With Ulcerative Colitis.

Ozanimod is an oral sphingosine-1-phosphate receptor modulator. Although it can be an effective drug for the induction and maintenance of remission in patients with moderately to severely active ulcerative colitis, there have been a few reported cases of various malignancies after exposure to this small molecule. We describe a unique case of biopsy-proven Kaposi sarcoma of the skin and colon in a patient with biologic-resistant ulcerative colitis after treatment with ozanimod for 2 months. Given the potential risk of malignancy associated with this agent, physicians should be aware of this rare adverse event.

Corneal manifestations and treatment among patients with COVID-19-associated rhino-orbito-cerebral mucormycosis.

Purpose: TO report the corneal manifestations in patients with COVID-19-associated rhino-orbito-cerebral mucormycosis (ROCM). Methods: This study was a retrospective, observational, and record-based analysis of patients of ROCM with corneal involvement. Results: A total of 220 patients were diagnosed with ROCM over a period of 3 months. Thirty-two patients had developed corneal manifestations. The mean age at diagnosis was 52.84 ± 12.8 years. The associated risk factors were systemic mucormycosis, uncontrolled diabetes, recent COVID-19 infection, and injudicious use of systemic steroids. Twenty-nine patients were known diabetics, 32 had recent COVID-19 infection, and 13 gave a history of injudicious use of steroids. The right eye (RE) was affected in nine patients, the left eye (LE) in 20 patients, and both eyes in three patients. Nine patients had a round-oval corneal ulcer. One patient each had a perforated corneal ulcer with uveal prolapse, sealed perforated corneal ulcer, spontaneously healed limbal perforation, diffuse corneal haze with hyphemia, panophthalmitis, diffuse corneal stromal abscess, limbal ischemia, anterior uveitis with posterior synechiae, inferior corneal facet, and filamentary keratitis. Three patients each had a corneal melt and inferior conjunctival xerosis with chemosis. Orbital exenteration was performed in six patients. Five patients with corneal ulcers healed. Topical eye drops of amphotericin (0.5 mg/ml) cycloplegic, antiglaucoma medications, and lubricant eye drops were started along with systemic antifungals. Conclusion: Central corneal ulcer was the most common manifestation of mucormycosis. A concentration as low as 0.5 mg/ml of amphotericin eye drops was effective in the treatment.

Retrospective analysis of the role of retrobulbar amphotericin-B injection in the management of COVID-19 associated rhino-orbito-cerebral-mucormycosis.

Introduction: Rhino-orbito-cerebral-mucormycosis (ROCM) is the most common form of mucormycosis observed during the second wave of COVID-19 where a steep rise in the number of cases was seen. The orbital form is almost always associated with fungal sinusitis. Among the various treatment modalities available, the role of retrobulbar Amphotericin-B injections is under-reported. This study is conducted to determine the role of transcutaneous retrobulbar amphotericin-B (TRAMB) in the management of COVID-19 associated ROCM. Methods: a retrospective analysis of 61 patients of COVID-19 associated ROCM was done, who met the inclusion criteria and presented to a tertiary care center, between May to August 2021. These patients were administered TRAMB (deoxycholate/emulsion form) along-with systemic amphotericin B. All the patients were evaluated for clinical improvement. Results: out of 61 patients, 58 (95.08%) showed overall improvement. 40 patients (65.57%) stabilized or improved clinically and 3 patients succumbed to the illness due to advanced systemic mucormycosis and acute kidney failure. Sixteen out of 58 patients underwent orbital exenteration. Out of remaining 43 patients, 35 showed complete recovery of orbital and ocular disease and the disease stabilized in eight patients. Seven patients demonstrated TRAMB associated ocular complications which however completely resolved in six patients. Conclusion: to the best of the author´s knowledge, regression of orbital mucormycosis with improvement in ptosis, proptosis, ocular motility and stabilization of visual acuity are scarcely reported in literature. Further TRAMB as a globe non-deforming treatment modality is an option available for ROCM.

Anthropometrics by Three-Dimensional Photonic Scanner in Patients with Obesity Before and After Bariatric Surgery.

BACKGROUND: We studied body composition by three-dimensional photonic scanning (3DPS) and metabolic biomarkers in a large ethnically diverse cohort of individuals with severe obesity before and after weight loss by Roux-en-Y gastric bypass (RYGB) or adjustable gastric banding (AGB) surgery. MATERIALS AND METHODS: Male and female participants (n = 95) underwent 3DPS testing in the weeks preceding bariatric surgery (baseline), and 1 year after either RYGB (n = 34) or AGB (n = 9). RESULTS: Principal component analysis showed that A1C and HDL cholesterol clustered with waist-to-hip ratio (WHR). Both RYGB and AGB surgeries led to similar improvements in A1C and lipids after 1 year. RYGB led to greater decreases in body weight, and in most anthropometric measures, compared with AGB at 1 year. However, after accounting for weight loss differences, RYGB and AGB groups did not differ in regional decreases in circumferences or volumes; the exception was a greater reduction in lean mass in RYGB compared with AGB. CONCLUSION: Distribution of weight loss, assessed by 3DPS, did not differ between RYGB and AGB, but surgery type predicted change in lean mass at 1 year.

Coping strategy in persons with low vision or blindness - an exploratory study.

Purpose: Coping strategies employed by people with visual disability can influence their quality of life (QoL). We aimed to assess coping in patients with low vision or blindness. Methods: In this descriptive cross sectional study, 60 patients (25-65 years) with <6/18 best-corrected vision (BCVA) in the better eye and vision loss since ≥6 months were recruited after the institutional ethics clearance and written informed consent. Age, gender, presence of other chronic illness, BCVA, coping strategies (Proactive Coping Inventory, Hindi version), and vision-related quality of life (VRQoL; Hindi version of IND-VFQ33) were recorded. Range, mean (standard deviation) for continuous and proportion for categorical variables. Pearson correlation looked at how coping varied with age and with VRQoL. The analysis of variance (ANOVA) and t-test compared coping scores across categorical variables. Statistical significance was taken at P < 0.05. Results: Sixty patients fulfilled inclusion criteria. There were 33 (55%) women; 25 (41.7%) had low vision, 5 (8.3%) had economic blindness, and 30 (50.0%) had social blindness; 27 (45.0%) had a co-morbid chronic illness. Total coping score was 142 ± 26.43 (maximum 217). VRQoL score (maximum 100) was 41.9 ± 15.98 for general functioning; 32.1 ± 12.15 for psychosocial impact, and 41.1 ± 17.30 for visual symptoms. Proactive coping, reflective coping, strategic planning, and preventive coping scores correlated positively with VRQoL in general functioning and psychosocial impact. Conclusion: Positive coping strategies are associated with a better QoL. Ophthalmologists who evaluate visual disability should consider coping mechanisms that their patients employ and should refer them for counseling and training in more positive ways of coping.

Myxedema Ascites: An Unusual Presentation of Uncontrolled Hypothyroidism.

We describe a case of myxedema ascites in a 64-year-old male with a history of hypothyroidism noncompliant with medical therapy who presented with syncope, hematemesis, melena, and abdominal distension. The patient received intravenous levothyroxine with a good response and improved upon discharge. This case highlights the importance of considering hypothyroidism as an etiology of unexplained ascites. The analysis of ascites from myxedema may not always have a significantly elevated protein (>2.5g/dL). Appropriate diagnosis should also rely on the clinical presentation along with a rapid and positive response to thyroid hormone replacement therapy.

Frozen blastocyst transfer outcomes in immediate versus delayed subsequent cycles following GnRH agonist or hCG triggers.

PURPOSE: The aim of this study is to analyze clinical pregnancy rates (CPR) and ongoing pregnancy rates (OPR) for frozen embryo transfers (FET) performed with blastocysts in the cycle immediately after GnRH agonist (GnRHa) versus human chorionic gonadotropin (hCG) triggers, with outcomes of delayed FET for comparison. METHODS: Retrospective cohort study at a university-affiliated in vitro fertilization (IVF) clinic, including patients undergoing IVF between 2013-16 with a blastocyst FET performed within two menstrual cycles of a previous stimulation cycle and vaginal oocyte retrieval (VOR). FETs included programmed and natural endometrial preparation. Outcome measures were clinical and ongoing pregnancy rates. RESULTS: CPR and OPR for 344 FET cycles were similar when comparing immediate and delayed transfer overall (crude CPR 67.5 versus 76.5%, p = 0.11; OPR 57.5 versus 66.7%, p = 0.13), and after stratifying by cycles following hCG trigger (OPR 62.5 versus 66.3%, p = 0.61) and GnRHa trigger (OPR 55.6 versus 64.5%, p = 0.17). When considering a number of predictors for OPR, an adjusted odds ratio (OR) of 1.74 [95% CI 1.00-3.03] approached significance in favor of delayed FET. CONCLUSIONS: Regardless of trigger modality, patients can be reassured that pregnancy rates with FET are high in immediate and delayed cycles. However, our study suggests a potential benefit in delaying a cycle before proceeding with FET.

Liraglutide-induced Acute Gastroparesis.

We describe a case of liraglutide-induced acute gastroparesis in a 52-year-old man with a history of well-controlled type 2 diabetes who presented with symptoms of gastric outlet obstruction. The patient responded markedly to conservative treatment with gastric suctioning, antiemetic and prokinetic therapy, and discontinuation of liraglutide with a resolution of his symptoms. This case highlights the importance of considering drug-induced gastroparesis as an etiology of unexplained upper abdominal pain, nausea, and early satiety, especially in the absence of mechanical obstruction.

Psychiatric morbidity among patients with oral submucous fibrosis: a controlled study.

AIM: The study aimed to evaluate the association between oral submucous fibrosis (OSF) and psychiatric morbidity in a controlled manner. METHODS: Matched patients were divided into three groups: Those with areca nut chewing habits with OSF (Group 1; n=50); those with areca nut chewing habits without OSF (Group 2; n=50); those without areca habits and with dental problems other than OSF (Group 3; n=50). The Mini International Neuropsychiatric Interview was used to assess psychiatric morbidity. Dependence to areca products was also assessed. RESULTS: Sixteen (32%) Group 1 patients had psychiatric morbidity compared to one (2%) in Group 2 and two (4%) in Group 3 (P<0.001). Further, psychiatric morbidity was significantly higher among patients with advanced stages of OSF. In Groups 1 and 2, 49 (98%) and 47 (94%) patients, respectively, had dependence on areca products. CONCLUSION: This study has suggested the association of substantial psychiatric morbidity among patients with OSF. In addition to mandatory psychiatric management of these patients, future research should be targeted at a prospective evaluation of a cause and effect relationship as well as at psychiatric interventions.

Evaluation of gustatory function in HIV-infected subjects with and without HAART.

BACKGROUND: Alteration in gustatory function among patients with human immunodeficiency virus (HIV) infection is sparsely studied and provides contradictory findings. The objectives of the study were to evaluate taste perversion in HIV-infected subjects and compare taste acuity between patients with and without Highly active antiretroviral therapy (HAART). MATERIALS AND METHODS: Fifty HIV-infected subjects aged 25-55 years were selected and divided into two subgroups: patients with HAART and patients without HAART. Control group included 50 healthy, age-, sex-, gender-, and socioeconomic status-matched individuals. Taste complaints were recorded on a structured questionnaire, and formal taste testing was carried out with triadic forced choice whole-mouth, above-threshold taste test for four tastants - sweet, salt, sour, and bitter. Taste identification, detection threshold, and intensity of tastant were recorded. RESULTS: Twenty-four (48%) among study group complained of taste perversion when compared to none among the control group (P < 0.001). During taste testing, identification and intensity scores were lower, while detection threshold scores for four tastants were higher in study group than in control group (P < 0.05). Among those patients with taste complaints, 16 were with HAART, while eight were without HAART (P = 0.043). Formal taste testing revealed greater taste perversion for sour and bitter tastants among patients with HAART medication. CONCLUSION: The results document significant taste losses in HIV-infected subjects, and HAART contributes considerably to such taste perversion.

Fluoride toxicity and status of serum thyroid hormones, brain histopathology, and learning memory in rats: a multigenerational assessment.

High-fluoride (100 and 200 ppm) water was administered to rats orally to study the fluoride-induced changes on the thyroid hormone status, the histopathology of discrete brain regions, the acetylcholine esterase activity, and the learning and memory abilities in multigeneration rats. Significant decrease in the serum-free thyroxine (FT4) and free triiodothyronine (FT3) levels and decrease in acetylcholine esterase activity in fluoride-treated group were observed. Presence of eosinophilic Purkinje cells, degenerating neurons, decreased granular cells, and vacuolations were noted in discrete brain regions of the fluoride-treated group. In the T-maze experiments, the fluoride-treated group showed poor acquisition and retention and higher latency when compared with the control. The alterations were more profound in the third generation when compared with the first- and second-generation fluoride-treated group. Changes in the thyroid hormone levels in the present study might have imbalanced the oxidant/antioxidant system, which further led to a reduction in learning memory ability. Hence, presence of generational or cumulative effects of fluoride on the development of the offspring when it is ingested continuously through multiple generations is evident from the present study.

Evaluation of fluoride-induced oxidative stress in rat brain: a multigeneration study.

Multigenerational evaluation was made in rats on exposure to high fluoride (100 and 200 ppm) to assess neurotoxic potential of fluoride in discrete areas of the brain in terms of lipid peroxidation and the activity of antioxidant enzyme system. The rats were given fluoride through drinking water (100 and 200 ppm) and maintained subsequently for three generations. Fluoride treatment significantly increased the lipid peroxidation and decreased the activity of antioxidant enzymes viz, catalase, superoxide dismutase, glutathione peroxidase, glutathione S-transferase, and glutathione level in first-generation rats and these alterations were more pronounced in the subsequent second and third-generation rats in both the doses tested. Decreased feed and water consumption, litter size and organ (brain) somatic index, marginal drop in body growth rate and mortality were observed in all three generations. Decreased antioxidant enzyme activity and increased malondialdehyde levels found in the present study might be related to oxidative damage that occurs variably in discrete regions of the brain. Results of this study can be taken as an index of neurotoxicity in rats exposed to water fluoridation over several generations.

Effect of maternal fluoride exposure on developing CNS of rats: protective role of Aloe vera, Curcuma longa and Ocimum sanctum.

Fluoride is toxic to neuronal development and its excessive intake during pregnancy cause adverse effects on neonatal development. The present study examined the presence of oxidative stress during maternal exposure of fluoride and the therapeutic strategy of Aloe vera, Curcuma longa and Ocimum sanctum extracts in functional prevention of fluoride led oxidative stress. The pregnant Wistar rats were exposed to 100 ppm fluoride in drinking water and pups born to them were supplemented with phytoextracts daily. On 21st postpartum day, the pups were sacrificed to analyse fluoride and oxidative stress markers. Fluoride exposure significantly increased its accumulation, lipid peroxidation and decreased the activities of catalase, superoxide dismutase, glutathione peroxidase, glutathione-S-transferase and glutathione levels in discrete regions of the central nervous system (CNS) of pups indicating oxidative stress and inhibited antioxidant defense. The results implied the vulnerability of developing CNS to fluoride toxicity. On phytoextract supplementation, the oxidant devastation was suppressed by regaining antioxidant homeostasis near normal level proving efficacy and therapeutic strategy. Among the phytoextracts supplemented the Ocimum sanctum is found to be more effective.