CT Angiographic Evaluation of Pattern and Distribution of Stenosis and its Association with Risk Factors Among Indian Ischemic Stroke Patients.

BACKGROUND: Stroke is the major cause of disability and third major cause of death. Ischemia causes about 80% of stroke cases; stenosis and occlusion are the predominant cause of stroke. Our purpose for this study was to evaluate the pattern and distribution of stenosis and its association with risk factors in Indian ischemic stroke patients and in other countries, for comparison. MATERIAL/METHODS: We evaluated 60 patients after ischemic stroke with CT angiography. The degree of stenosis was measured by the North American Symptomatic Carotid Endarterectomy Trial (NASCET). The results were analyzed by descriptive statistics and chi-square test. RESULTS: Out of 60 cases, 32 cases were positive for significant stenosis and a total number of stenotic segments was 45. Out of 45 stenotic segments, 29 were single stenotic segments (16 intracranial and 13 extracranial) and 16 were multiple stenotic segments (8 intracranial and 8 extracranial). In the total number of stenotic segments (single and multiple), there were 24 (53.33%) intracranial and 21 (46.67%) extracranial. The most commonly involved intracranial stenosis segment was MCA, present in 10 (41.6%) out of 24 intracranial segments. Most commonly involved extracranial stenosis segment was ICA, present in 14 (66.6%) out of 21 extracranial segments. Diabetes is found to be the most common risk factor of intracranial stenosis while hypertension and hypercholesterolemia are the major risk factors of extracranial stenosis. CONCLUSIONS: In the Indian population, intracranial stenosis is more common than extracranial one, anterior circulation stenosis is more common than posterior circulation stenosis; single stenosis is more common than multiple stenosis.

Direct Needle Puncture and Embolization of Splenic Artery Pseudoaneurysm in Case of Chronic Atrophic Calcific Pancreatitis.

BACKGROUND: Gastro-Intestinal bleeding remains a frequent clinical dilemma and common cause of hospitalization, morbidity and mortality. CASE REPORT: We report a case of pseudo aneurysm of splenic artery developed after an episode of acute on chronic pancreatitis which was treated by direct percutaneous puncture of pseudoaneurysm and embolization by coils. CONCLUSIONS: The aim was to preserve the main splenic artery and avoid the complications of splenic artery embolization like infarcts and abscess.

Neuron specific enolase and c-reactive protein levels in stroke and its subtypes: correlation with degree of disability.

Stroke is an emergency which threatens life and third leading cause of death and long term disability in developed countries. The use of biomarkers in diagnosing stroke and assessing prognosis is an emerging and rapidly evolving field. The study aimed to investigate the predictive value of biochemical marker of brain damage neuron-specific enolase (NSE) and systemic inflammatory marker C-reactive protein (CRP) with respect to degree of disability at the time of admission and short term in stroke patients. We investigated 120 patients with cerebrovascular stroke who were admitted within 72 h of onset of stroke in the Department of Neurology at Sri Aurobindo Institute of Medical Sciences, Indore, India. NSE and CRP were analyzed by solid enzyme linked immunosorbent assay using analyzer and micro plate reader from Biorad 680. In all patients, the neurological status was evaluated by a standardized neurological examination and the National Institutes of Health Stroke Scale on admission and on day 7. Serum NSE and CRP concentration were found significantly increased in acute stroke cases as compared to control in present study (<0.05 and <0.001 respectively). The maximum serum NSE and CRP levels within 72 h of admission were significantly higher in patients with greater degree of disability at the time of admission. Both biomarkers were found significantly correlated with neurological disability and short term outcome. Our study showed that serum biomarkers NSE and CRP have high predictive value for determining severity and early neurobehavioral outcome after acute stroke.

Crossed cerebellar Diaschisis in mesial temporal sclerosis: a rare clinical entity.

Crossed cerebellar diaschisis (CCD) is a phenomenon of functional diaschisis that occurs after damage to the cerebral hemisphere and results in decreased activity of the cerebellum outside the primary focus. In this case report, we present the case of a patient admitted for seizures who was diagnosed with CCD due to Mesial temporal sclerosis (MTS). This event is generally observed in ischemic stroke cases and can occur epileptic seizure disorders. However, association of CCD with MTS is very rare. This article provides a comprehensive overview of CCD and related MRI findings to better understand their pathophysiology, clinical implications, and potential therapeutic approaches. The article highlights the importance of MRI in CCD detection and monitoring and discusses its usefulness in different clinical scenarios.

Netting into the Sophoretin pool: An approach to trace GSTP1 inhibitors for reversing chemoresistance.

Chemoresistance, a significant challenge in cancer treatment, is often associated with the cellular glutathione-related detoxification system. The GSTP1 isoenzyme (glutathione S-transferases) plays a critical role in the cytoplasmic inactivation of anticancer drugs. This suggests the identification of GSTP1 inhibitors to combat chemoresistance. We screened Sophoretin (also called quercetin) derivatives for molecular properties, pharmacokinetics, and toxicity profiles. Following that, we conducted molecular docking and simulations between selected derivatives and GSTP1. The best-docked complex, GSTP1-quercetin 7-O-ß-D-glucoside, exhibited a binding affinity of -8.1 kcal/mol, with no predicted toxicity and good pharmacokinetic properties. Molecular dynamics simulations confirmed the stability of this complex. Quercetin 7-O-ß-D-glucoside shows promise as a lead candidate for addressing chemoresistance in cancer patients, although further experimental studies are needed to validate its efficacy and therapeutic potential.

Therapeutic Interventions for Diabetes Mellitus-Associated Complications.

BACKGROUND: Diabetes Mellitus (DM) is an alarming health concern, affecting approximately 537 million people worldwide. As a leading cause of morbidity and mortality, DM demands a comprehensive understanding of its diverse pathophysiological mechanisms and disease progression. METHODS: This traditional review has consolidated literature on the pathogenesis of hyperglycemia, its progression into complications, and advances in optimal treatment strategies. The literature in the last two decades has been reviewed using several keywords, including "diabetes," "diabetes-associated complications", "novel therapeutic interventions for diabetes-associated diseases", "phyto-extracts as antidiabetic drugs", etc. in prominent databases, such as PubMed, Scopus, Google Scholar, Web of Science, and ClinicalTrials.gov. RESULTS: We have discussed macrovascular and microvascular complications, such as atherosclerosis, cardiovascular disease, Peripheral Arterial Disease (PAD), stroke, diabetic nephropathy, retinopathy, and neuropathy, as well as various pharmacological and non-pharmacological interventions that are currently available for the management of DM. We have also focused on the potential of natural products in targeting molecular mechanisms involved in carbohydrate metabolism, insulin production, repair of pancreatic cells, and reduction of oxidative stress, thereby contributing to their antidiabetic activity. Additionally, novel therapeutic approaches, like genetic, stem cell, and immunomodulatory therapies, have been explored. We have also discussed the benefits and limitations of each intervention, emerging research and technologies, and precision medicine interventions. CONCLUSION: This review has emphasized the need for an improved understanding of these advancements, which is essential to enhance clinicians' ability to identify the most effective therapeutic interventions.

Exploring the globoid cell leukodystrophy protein network and therapeutic interventions.

Globoid cell leukodystrophy is a severe rare disorder characterized by white matter degradation, resulting in a progressive loss of physical and mental abilities and has extremely limited therapeutic interventions. Therefore, this study aimed to delve into the Globoid cell leukodystrophy associated intricate network of differentially expressed genes (p < 0.05, |Fc|> 1) to identify potential druggable targets and possible therapeutic interventions using small molecules. The disease-associated neuronal protein circuit was constructed and analyzed, identifying 53 nodes (minimum edge cutoff 1), among which five (FOS, FOSB, GDNF, GFRA1, and JUN) were discerned as potential core protein nodes. Although our research enumerates the potential small molecules to target various protein nodes in the proposed disease network, we particularly underscore T-5224 to inhibit c-Jun activity as JUN was identified as one of the pivotal elements within the disease-associated neuronal protein circuit. The evaluation of T-5224 binding energy (- 11.0 kcal/mol) from docking study revealed that the compound to exhibit a notable affinity towards Jun/CRE complex. Moreover, the structural integrity of complex was affirmed through comprehensive molecular dynamics simulations, indicating a stable hydrophilic interaction between T-5224 and the Jun/CRE complex, thereby enhancing protein compactness and reducing solvent accessibility. This binding energy was further substantiated by free binding analysis, revealing a substantial thermodynamics complex state (- 448.00 ± 41.73 kJ/mol). Given that this investigation is confined to a computational framework, we additionally propose a hypothetical framework to ascertain the feasibility of inhibiting the Jun/CRE complex with T-5224 against Globoid cell leukodystrophy, employing a combination of in vitro and in vivo methodologies as a prospective avenue of this study.

Integration of network pharmacology, molecular docking, and simulations to evaluate phytochemicals from Drymaria cordata against cervical cancer.

Introduction: Cervical cancer is prevalent among women worldwide. It is a type of cancer that occurs in the cells of the cervix, the lower part of the uterus. Mostly, it is observed in developing nations due to limited access to screening tools. Natural products with anticancer properties and fewer side effects have gained attention. Therefore, this study evaluates the potential of Drymaria cordata as a natural source for treating cervical cancer. Methodology: Phytocompounds present in Drymaria cordata were screened for their molecular properties and drug-likeness. The selected compounds were studied using systems biology tools such as network pharmacology, molecular docking, and molecular dynamics simulations, including MMGBSA studies. Results: Through network pharmacology, molecular docking, and molecular dynamics simulations, quercetin 3-O-ß-d-glucopyranosyl-(1→2)-rhamnopyranoside was identified as a hit compound targeting HRAS and VEGFA proteins. These proteins were found to be responsible for the maximum number of pathway modulations in cervical cancer. Conclusion: Drymaria cordata exhibits potential for treating cervical cancer due to the presence of quercetin 3-O-ß-d-glucopyranosyl-(1→2)-rhamnopyranoside. Further validation of these findings through in vitro and in vivo studies is required.

Layered Sheath-Assisted Dissection and Retrieval of Stuck Port Catheters: A Single-Center Experience.

Chemoports are often required for oncological patients requiring repeated blood draws and long-term drug therapy. However, complications such as dislodgement, fracture, thrombosis, and venous occlusion may occur if the ports remain unremoved when not in use. Nonetheless, existing techniques require multiple accesses or release of the stuck catheter tip to retrieve the catheter, making the procedure inconvenient. We present our experience with a technique using the Bard Denali inferior vena cava filter retrieval kit to remove a stuck or fractured chemoport catheter through a single vascular access. The technique was performed in two female patients with satisfactory results (complete retrieval of broken chemoports) and an event-free follow-up period. The entire procedure was completed within 15-30 minutes with fluoroscopic time under two minutes. The technique allows for better case management by simplifying the procedure, reducing radiation, and improving workflow efficiency in the operating room.

A Rare Case of Cystic Artery Pseudoaneurysm because of Cholecystitis Managed with Non-invasive Technique.

Cystic artery pseudoaneurysm due to acute on chronic cholecystitis is very rare in spite of the high incidence of cholecystitis, and very few cases have been reported in the literature. Most of the pseudoaneurysms are symptomatic at the time of diagnosis due to rupture. Very few cases of unruptured cystic artery pseudoaneurysm caused by cholecystitis have been reported in the literature. We present a case of a 41-year-old man who presented in the Intervention Radiology Department with the diagnosis of cholecystitis and cystic artery pseudoaneurysm. Three treatment options are available for such cases. The first approach is surgical clipping of the pseudoaneurysm and cholecystectomy. The second approach is endovascular management of pseudoaneurysm and cholecystectomy. We chose the third approach, endovascular management of the pseudoaneurysm, percutaneous cholecystostomy, and elective laparoscopic cholecystectomy.

Effect of Varying Normal Stiffness on Soft Rock Joints under Cyclic Shear Loads.

The evaluation of changes in shear resistance on soft (or weathered) rock joints under cyclic shear loads with constant normal load (CNL) and constant normal stiffness (CNS) significantly contributes to increasing the safety and stability of rock slopes and underground structures. In this study, a series of cyclic shear tests were conducted on simulated soft rock joints with regular (15°-15°, 30°-30°) and irregular (15°-30°) asperities under different normal stiffnesses (kn). The results indicated that the first peak shear stress increases with the increase in kn up to the normal stiffness of the joints (knj). Beyond knj, no significant change was observed in the peak shear stress. The difference in peak shear stress between regular (30°-30°) and irregular joints (15°-30°) increases as kn increases. The minimum difference of peak shear stress between regular and irregular joints was observed (8.2%) under CNL and the maximum difference was found (64.3%) on knj under CNS. The difference in peak shear stress between the first and subsequent cycles significantly increases as both the joint roughness and kn increases. A new shear strength model is developed to predict peak shear stress of the joints for different kn and asperity angles under cyclic shear loads.

Thrombosis with Thrombocytopenia Syndrome (TTS) After ChAdOx1 nCoV-19 Immunization: An Investigative Case Report.

BACKGROUND Thrombosis with thrombocytopenia syndrome (TTS), including vaccine-induced immune thrombotic thrombocytopenia (VITT), is an extremely rare adverse effect, mostly seen after initial vaccination with the viral vector-based AstraZeneca-Oxford COVID-19 vaccine. It is characterized by mild to severe thrombocytopenia and venous or arterial thrombosis. CASE REPORT Herein, we present a case of an 18-year-old male patient who developed Level 1 TTS (probable VITT) eight days after immunization with the ChADOx1 nCOV-19 vaccine (Covishield; AZ-Oxford). Initial investigations revealed severe thrombocytopenia, hemiparesis, and intracranial hemorrhage, after which the patient was treated conservatively. However, a decompressive craniotomy was performed later due to patient deterioration. One week after surgery, the patient developed bilious vomiting, lower-gastrointestinal bleeding, and abdominal distension. An abdominal CT scan was performed that showed thrombosis of the portal vein with occlusion of the left iliac vein. The patient underwent an exploratory laparotomy followed by resection and anastomosis of the small bowel due to massive gut gangrene. Due to persistent thrombocytopenia after surgery, intravenous immune globulin (IVIG) was administered. The platelet count increased thereafter, and the patient stabilized. He was discharged on the 33rd day after admission and was followed up for a year. No post-hospitalization complications were observed in the follow-up period. CONCLUSIONS Although vaccines have been proven to be highly safe and effective to end the Coronavirus Disease 2019 (COVID-19) caused pandemic, there is still a small risk of developing rare complications, including TTS and VITT. Early diagnosis and prompt intervention are key for patient management.

Targeting Melanoma with a phytochemical pool: Tailing Makisterone C.

BACKGROUND AND OBJECTIVE: According to World Health Organization, melanoma claims the lives of about 48000 people worldwide each year. The purpose of this study was to identify potential phytochemical pool from Diplazium esculentum against proteins that contribute to melanoma development. METHODS: The research was carried to locate potentially bioactive molecules and conduct a theoretical analysis of active ingredients from DE to impact melanoma. Network pharmacology, pharmacokinetics, protein network interaction, gene enrichment, survival, and infiltration analysis were conducted. Furthermore, molecular docking and molecular dynamics simulation was carried out for makisterone C-MAPK1, MAPK3, and AKT1 complexes. RESULTS: The potential phytochemical pool were identified (stigmast-5-en-3-ol, esculentic acid, rutin, and makisterone C) and based on network pharmacology and molecular docking studies, makisterone-C was proposed to be the most promising ingredient. Furthermore, the investigation revealed 14 genes as critical "hubs" involved in combating melanoma that are manipulated by the above-mentioned 4 active ingredients and modulate multiple signaling in melanoma development. CONCLUSION: This study insights into the potential anti-melanoma effects of phytochemical pool from Diplazium esculentum using network pharmacology analysis, molecular docking, and simulation tailing makisterone C as a lead moiety and suggests the need for makisterone C further evaluation in intervening melanoma progression.

Role of MRI and FIGO Staging in Evaluation of Fibroids - A Pictorial Review.

Uterine fibroids are the most common gynaecologic malignancy, but only 20% of women need treatment to relieve their symptoms. The management of fibroids has changed from open to laparoscopic hysterectomy, myomectomy and minimal invasive techniques such as uterine artery embolization and ablation. Magnetic resonance imaging (MRI) is considered the best modality in the diagnosis, characterization and number of fibroids as well as for accessing extrauterine relationships, associated diseases; it also helps in planning, choosing and prognosis of treatment options. Traditionally, uterine fibroids were classified according to their location as submucosal, intramural or subserosal. However, for minimally invasive techniques, the relation of the fibroid with the endometrium, the degree of fibroid extension in the myometrium and the pedunculated nature of the fibroid are required before the procedure. The FIGO classification system was created to describe and classify fibroid locations in a systematic and consistent manner with suitable communication to the referring doctor. We are providing an array of clinical symptoms, MRI images, and surgical approaches on the basis of FIGO classification and associated important points to diagnosis and clinical implications.

The marijuana-schizophrenia multifaceted nexus: Connections and conundrums towards neurophysiology.

Delta-9-tetrahydrocannabinol, a component of marijuana, interacts with cannabinoid receptors in brain involved in memory, cognition, and emotional control. However, marijuana use and schizophrenia development is a complicated and contentious topic. As a result, more investigation is needed to understand this relationship. Through the functional enrichment analysis, we report the delta-9-tetrahydrocannabinol to manipulate the homeostatic biological process and molecular function of different macromolecules. Additionally, using molecular docking and subsequent processing for molecular simulations, we assessed the binding ability of delta-9-tetrahydrocannabinol with the estrogen-related protein, dopamine receptor 5, and hyaluronidase. It was found that delta-9-tetrahydrocannabinol may have an impact on the brain's endocannabinoid system and may trigger the schizophrenia progression in vulnerable people. Delta-9-tetrahydrocannabinol may interfere with the biological function of 18 proteins linked to schizophrenia and disrupt the synaptic transmission (dopamine, glutamine, and gamma-aminobutyric acid). It was discovered that it may affect lipid homeostasis, which is closely related to membrane integrity and synaptic plasticity. The negative control of cellular and metabolic processes, fatty acids binding /activity, and the manipulated endocannabinoid system (targeting cannabinoid receptors) were also concerned with delta-9-tetrahydrocannabinol. Hence, this may alter neurotransmitter signaling involved in memory, cognition, and emotional control, showing its direct impact on brain physiological processes. This may be one of the risk factors for schizophrenia development which is also closely tied to some other variables such as frequency, genetic vulnerability, dosage, and individual susceptibility.

Evaluation of Antioxidant and Anti-Inflammatory Activities, and Metabolite Profiling of Selected Medicinal Plants of Nepal.

This study aimed to evaluate the antioxidant, antiarthritic, and anti-inflammatory properties of extracts from the leaves of twelve different medicinal plants in Nepal. We then evaluated the total phenolic, flavonoid, and tannin contents of the extract using in-vitro assays and characterized it using GC-MS analysis. Results revealed that most of the leaf extracts contained phenolic compounds, flavonoids, tannins, alkaloids, and saponins. Few plants also showed the presence of glycosides, phytate, and vitamin C. Among the studied plants, Neolamarckia cadamba exhibited the highest total phenolic and tannin contents, as 241.53 ± 0.20 µg of gallic acid equivalent/mg and 74.48 ± 1.081 µg of tannic acid equivalent/mg, respectively. Ipomoea batatas exhibited the highest total flavonoid content, as 53.051 ± 1.11 µg of quercetin equivalent/mg. Moreover, Raphanus sativus demonstrated significant ferrous ion chelating, 2,2-diphenyl-1-picrylhydrazyl, hydrogen peroxide scavenging, and total antioxidant activities with IC50 value of 4.76 ± 0.68 µg/mL, 5.84 ± 0.14 µg/mL, 6.89 ± 0.16 µg/mL, and 8.99 ± 0.20 µg/mL, respectively. Similarly, Colocasia esculenta and Cicer arietinum exhibited the highest hydroxyl radical and nitric oxide scavenging activities, measuring IC50 value of 7.22 ± 0.56 µg/mL and 9.06 ± 0.10 µg/mL, respectively. Among all the extracts, Amorphophallus paeoniifolius displayed significant human red blood cell (HRBC) membrane stabilization activity (IC50 = 6.22 ± 0.78 µg/mL). Furthermore, Raphanus sativus, Chenopodium album, Cicer arietinum, and Murraya koenigii exhibited the highest inhibitory activities against protein denaturation with bovine serum albumin, antiarthritic, lipoxygenase inhibitory, and proteinase inhibitory, measuring IC50 of 7.48 ± 0.48 µg/mL, 9.44 ± 1.62 µg/mL, 14.67 ± 1.94 µg/mL, and 28.57 ± 2.39 µg/mL, respectively. In conclusion, this study demonstrated the twelve leaf extracts' significant antioxidant, antiarthritic, and anti-inflammatory activities.

Analysis of conventional and helical soil nails using finite element method and limit equilibrium method.

The infrastructure of roads, bridges, tunnels, subways, etc. is grooming day by day. In the recent era, soil nailing is the developing method for slope stability, road widening projects, and constructing deep foundations. This paper suggests a new and improved helical soil nail (HN) that offers an alternative to conventional soil nail (CN). Till now pullout studies on different model nails in c-Φ soil are still rare. In addition, the stability analysis for conventional soil nails was only studied using FEM analysis, whereas for helical soil nails the estimation of stability of slope is still mysterious. So, the present study includes the behavior of conventional and helical soil nails based on both laboratory and analytical methods in c-Φ soil. The present study also incorporated the use of theoretical equations and finite element analysis (using PLAXIS 2D) for comparing the stability of different profiles of soil nails (e.g., CN and HN) in c-Φ soil, which was unique to this study. By using the finite element method (FEM) and the limit equilibrium method (LEM), a factor of safety was also estimated for both types of nails (CN and HN). According to the experimental, analytical, and numerical findings, it is clear that helical soil nails (HN) exhibit less deformation and more factor of safety than conventional soil (CN) nails under similar loading and soil conditions.

Effect of aqueous extract of barley and wheat grass in stress induced depression in Swiss mice.

BACKGROUND: The consumption of green juice of Barley and wheat grass is widely increases because of its therapeutic benefits. OBJECTIVE: The study aimed to investigate phytochemicals and evaluate the antioxidant and antidepressant activity of aqueous extract of barley and wheat grass. MATERIAL AND METHODS: This study included phytochemical screening, evaluation of antioxidant and antidepressant activities. Four groups consisting of six mice in each group. Negative control with stressed induced mice; imipramine group (100 mg/kg), barley and wheat extract group (400 mg/kg) respectively. Forced swim, tail suspension and elevated plus maize test were carried out to evaluate the antianxiety and antidepressant activity. RESULTS: Phytochemical screening of barley and wheat grass extract showed secondary metabolites such as alkaloids, Saponin, Tannins, Phenolic, Carbohydrate, Glycosides, Flavonoids, and Proteins. The mean total phenolic content of aqueous extract of barley and wheat grass was 160.996 ± 0.656, 135.63 ± 1.184 mg equivalent of GAE/g respectively. The total flavonoid content of aqueous extract of barley and wheat grass was 153.42 ± 0.40, 133.14 ± 0.43 mg equivalent of quercetin/g respectively. The extracts were proved to be an effective radical scavenger in all antioxidant assays. Forced swim and tail suspension test showed a significant (∗p < 0.05 and ∗∗p < 0.01) decrease in an immobility time. In elevated plus maize, there was a significant (∗∗p < 0.01) increase in average time spent on the open arm of the extract-treated group as compared to the negative control. CONCLUSION: It shows that barley and wheat grass extract has antidepressant effect.

Dry Eye Disease among Patients with Glaucoma under Topical Antiglaucoma Agents in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

INTRODUCTION: Dry eye disease is a disorder of the tears and ocular surface that results in various symptoms, such as dryness, grittiness, burning and itching sensation in the eye, excessive tearing, and fluctuating vision. The prevalence of dry eye disease symptoms is increased with long-term topical anti-glaucoma medicine treatment. The objective of this study was to find out the prevalence of dry eye disease in glaucoma patients under topical anti-glaucoma agents in a tertiary care centre. METHODS: A descriptive cross-sectional study was conducted from 9 February 2022 to 5 June 2022 among glaucoma patients under topical anti-glaucoma agents at a tertiary care centre after receiving ethical approval from the Institutional Review Committee (Reference number: UCMS/IRC/028/22). Data were collected using a standard ocular surface disease index questionnaire. The dry eye disease was clinically diagnosed if the ocular surface disease index score was equal to or more than 13. Point estimate and 95% Confidence Interval were calculated. RESULTS: Among 250 glaucoma patients, dry eye disease was found in 180 (72%) (66.43-77.57, 95% Confidence Interval). Mild, moderate, and severe symptoms were present in 50 (27.78%), 68 (37.78%), and 62 (34.44%) of the patients, respectively. The most frequently observed dry eye symptoms were itching and irritation seen in 56 (31.11%), followed by pain in the eye in 41 (22.77%) and redness in the eye in 32 (17.77%) patients. CONCLUSIONS: The prevalence of dry eye disease was higher than other clinical studies done in similar setting. It is extremely concerning and calls for increased focus on managing glaucoma and concurrent dry eye disease.

Imaging findings in invasive rhino-orbito-cerebral mucormycosis in post-COVID-19 patients.

Rhino-orbito-cerebral mucormycosis (ROCM) is a life-threatening addition to the COVID-19 disease spectrum and is caused by an angioinvasive saprophytic opportunistic fungus. Early diagnosis is important to avoid disease spread and mortality. Contrast-enhanced magnetic resonance imaging plays a major role in detection of intraorbital and intracranial extension. We present imaging findings of 15 patients with post-COVID-19 rhino-orbito-cerebral mucormycosis who were diagnosed with invasive sinus mucormycosis at our institution and are currently undergoing treatment. All patients were diabetics, and 80% had a history of steroid intake during the course of COVID-19 treatment. There was a male preponderance (73.3%). The maxillary sinus was most commonly involved (86.7%). Orbital and intracranial invasion was seen in 73.3% and 60% of patients, respectively. The presence of retroantral, facial, infratemporal, and orbital fat stranding was an early sign of extrasinus spread. Other common sites of extrasinus involvement were the orbit and face, followed by the orbital apex, masticator space, pterygopalatine fossa, bone, skull base, cavernous sinus, brain, and internal carotid artery. In conclusion, early detection of extrasinus spread of mucormycosis by imaging is important so that aggressive treatment can be given and mortality can be reduced.