COVID-19-Associated Rhino-Orbito-Cerebral Mucormycosis: A Single Tertiary Care Center Experience of Imaging Findings With a Special Focus on Intracranial Manifestations and Pathways of Intracranial Spread.

Background and objective The COVID-19 pandemic and mucormycosis epidemic in India made research on the radiological findings of COVID-19-associated mucormycosis imperative. This study aims to describe the imaging findings in COVID-19-associated mucormycosis, with a special focus on the intracranial manifestations.  Methodology Magnetic resonance imaging (MRI) scans of all patients with laboratory-proven mucormycosis and post-COVID-19 status, for two months, at an Indian Tertiary Care Referral Centre, were retrospectively reviewed, and descriptive statistical analysis was carried out. Results A total of 58 patients (47 men, 81%, and 11 women, 19%) were evaluated. Deranged blood glucose levels were observed in 47 (81%) cases. The intracranial invasion was detected in 31 (53.4%) patients. The most common finding in cases with intracranial invasion was pachymeningeal enhancement (28/31, 90.3%). This was followed by infarcts (17/31, 55%), cavernous sinus thrombosis (11/58, 18.9%), fungal abscesses (11/31, 35.4%), and intracranial hemorrhage (5/31, 16.1% cases). The perineural spread was observed in 21.6% (11/51) cases. Orbital findings included extraconal fat and muscle involvement, intraconal involvement, orbital apicitis, optic neuritis, panophthalmitis, and orbital abscess formation in decreasing order of frequency. Cohen's kappa coefficient of interrater reliability for optic nerve involvement and cavernous sinus thrombosis was 0.7. Cohen's coefficient for all other findings was 0.8-0.9. Conclusions COVID-19-associated rhino-orbito-cerebral mucormycosis has a plethora of orbital and intracranial manifestations. MRI, with its superior soft-tissue resolution and high interrater reliability, as elucidated in this study, is the imaging modality of choice for expediting the initial diagnosis, accurately mapping out disease extent, and promptly identifying and scrupulously managing its complications.

Dislocated Descemet Stripping Endothelial Keratoplasty Lenticule in the Anterior Chamber.

This case report discusses the dislocation of a Descemet stripping endothelial keratoplasty (DSEK) lenticule in a man aged 82 years who underwent DSEK for pseudophakic bullous keratopathy.

Incremental innovations in operation theaters.

Background: The field of ophthalmology has been built upon continuous innovations. COVID-19 pandemic has been an important driving force behind many innovations in ophthalmology and other branches of medicine. Innovations in ophthalmology has been a key to surgical progress. The process of promoting innovation in surgery is imperative in the evolving practice of ophthalmology. Purpose: In this video we demonstrate some incremental innovations in operation theaters which help in increasing the efficiency and improving the performance of a surgeon. These innovations also provide a more comfortable environment for the patient undergoing the surgery. Synopsis: A few incremental innovations that are described in our video also help in preventing the spread of COVID infection during surgery. This video also showcases a few wet lab innovations that help train residents in their surgical skills. Highlights: Use and reuse of simple materials make it cost effective and ecofriendly. These incremental innovations help in the smooth running of operation theaters. Thus, they are small improvements in the existing setup and help in creating a smooth and error free OT flow. Video Link: https://youtu.be/thFLvC-XykE.

A comparative evaluation of micro shear bond strength and microleakage between the resin-modified glass ionomer cement and residual dentin following excavation of carious dentin using Carie CareTM and conventional caries removal in primary teeth: an in vitro study.

Background: The bond between the dentin and restorative material contributes to the success of the restoration. Structural changes associated with prepared dentin may influence the bonding of restorative materials. The present study evaluates the bond between the resin-modified glass ionomer cement (RMGIC) and residual dentin following excavation of carious dentin using Carie Care TM and conventional caries removal in primary teeth. METHODS: 52 primary teeth with dentinal caries were randomly grouped into group I, where caries removal was done using the conventional method, and group II which used Carie Care TM. All the teeth were restored using RMGIC. Micro shear bond strength between the residual dentin and the cement was tested using universal testing machine and the dye penetration method was used for microleakage testing. Independent t-test was performed for intergroup comparison. Pearson chi-square test was carried out to evaluate the microleakage patterns in the enamel and dentin. RESULTS: The mean micro-shear bond strength of group I was 6.03±1.6 and that of group II was 8.54±2.92; this difference was statistically significant with a p-value of 0.012. Microleakage was higher in the test group (1.38±0.51) than the control group (0.77±0.6) and was significant with a p -value of .036. CONCLUSIONS: Papain-based chemomechanical agent Carie Care TM can be used as an alternative method to conventional caries removal. However, further studies need to explore methods to improve the marginal sealing capacity of RMGIC to the residual dentin after chemomechanical caries removal.

Single-Dose Treatment with Rapamycin Preserves Post-Ischemic Cardiac Function through Attenuation of Fibrosis and Inflammation in Diabetic Rabbit.

Robust activation of mTOR (mammalian target of rapamycin) signaling in diabetes exacerbates myocardial injury following lethal ischemia due to accelerated cardiomyocyte death with cardiac remodeling and inflammatory responses. We examined the effect of rapamycin (RAPA, mTOR inhibitor) on cardiac remodeling and inflammation following myocardial ischemia/reperfusion (I/R) injury in diabetic rabbits. Diabetic rabbits (DM) were subjected to 45 min of ischemia and 10 days of reperfusion by inflating/deflating a previously implanted hydraulic balloon occluder. RAPA (0.25 mg/kg, i.v.) or DMSO (vehicle) was infused 5 min before the onset of reperfusion. Post-I/R left ventricular (LV) function was assessed by echocardiography and fibrosis was evaluated by picrosirius red staining. Treatment with RAPA preserved LV ejection fraction and reduced fibrosis. Immunoblot and real-time PCR revealed that RAPA treatment inhibited several fibrosis markers (TGF-ß, Galectin-3, MYH, p-SMAD). Furthermore, immunofluorescence staining revealed the attenuation of post-I/R NLRP3-inflammasome formation with RAPA treatment as shown by reduced aggregation of apoptosis speck-like protein with a caspase recruitment domain and active-form of caspase-1 in cardiomyocytes. In conclusion, our study suggests that acute reperfusion therapy with RAPA may be a viable strategy to preserve cardiac function with the alleviation of adverse post-infarct myocardial remodeling and inflammation in diabetic patients.

Analysis of motivating factors for eye donation among families of eye donors in South India - A questionnaire-based study.

Purpose: To report the factors influencing eye donation among families of successful eye donors in India. Methods: The consenting family members of 434 deceased individuals who donated eyes between April 2019 and March 2020 were retrospectively interviewed via a telephonic questionnaire survey. Details regarding the donors and their families, motivating factors for eye donation, and time taken for tissue recovery were collected and analyzed. Results: The mean age of donors was 66.8 years, and only 13.9% of them had pledged to donate their eyes before death. For 62.3% of donations, children of donors were the primary consenters for eye donation. In 18.8% of donors, there was a previous history of eye donation in the family. Many donations were motivated by a non-governmental organization volunteer (40.5%) or by a grief counselor at the hospital (27.4%). Hospital-based corneal retrieval programs and donations where the first eye bank contact was made through hospital personnel had the greatest percentage of rapid enucleations (performed within 3 h after death) (48.7% and 49.1%, respectively; P = 0.001 and P = 0.02, respectively). Conclusion: Children of donors, typically in the working-age group, most often make the decision for donation, and hence, future awareness programs should focus on this specific population. All types of hospitals should advocate for eye donation as they are a common point of contact for a grieving family, and health-care professionals at all levels should be considered for training as motivators for eye donation.

Traumatic pseudocyst of the lung following blunt trauma to the chest.

Traumatic pseudocysts of the lung are a rare complication following blunt trauma to the chest. Differentiating them from other cystic lesions of the lung is important. Traumatic pseudocysts usually occur in children and young adults who present with haemoptysis and persistent pain. History of trauma and radiological evaluation with a chest radiograph and a CT scan help in making the diagnosis. Follow-up chest radiographs showing resolution of the pseudocyst can confirm thediagnostic confirmation. This is a report of one such patient, a young man who improved after conservative treatment, with spontaneous radiological resolution of the pseudocyst.

Artificial intelligence in glaucoma.

Background: Artificial Intelligence (AI) is an area of computer science that encompasses the creation of intelligent machines that work and react like humans. It deals with the development algorithms that seek to simulate human brain and also mimic cognitive functions typically associated with the human mind such as learning and problem solving. Purpose: Do we need artificial intelligence in Glaucoma? Glaucoma is the second most common cause of blindness in the world. Its prevalence was over 60 million in 2010 and over 80 million by 2020. It is so common, yet so easily overlooked. More importantly, about 50% of patients in developed countries and 90% in developing countries are unaware of having glaucoma. Early detection can delay the progression of glaucoma. Hence the time is ripe to advovate glaucoma screening. Synopsis: The application of AI in ophthalmology mainly concentrates on the diseases with a high incidence, such as diabetic retinopathy, age-related macular degeneration, glaucoma, retinopathy of prematurity, age-related or congenital cataract etc AI involves mainly 1. machine learning that are algorithms with the ability to learn without being explicitly programmed and 2. deep learning in which artificial neural networks adapt and learn from vast amounts of data. But there are limitations to screening - such as disparity between ophthalmologist:patient ratio and also the availability of the specialty services. The large amount of data acquired from patients makes it nearly impossible for ophthalmologists to screen them with equal efficacy and consistency. Highlights: AI in glaucoma aims at including factors such as clinical data, genomic data, life style behaviors, risk factors, and medical history to predict the risk of developing glaucoma, help customise the most appropriate management protocol for a given patient, and estimate prognosis and surgical success. Video Link: https://youtu.be/IwYS7wDMhkY.

Innovative models for vitreoretinal training during COVID-19 times.

Background: Vitreoretinal training has been badly affected during the COVID-19 times. Due to lockdown, the number of patients reaching the hospital has dwindled. Hence we propose two simple cost-effective ways to improve resident training. Purpose: To highlight two simple eye models RETILAPP and RETISURGE, and their use in resident training. This video also highlights how to make and customise laser and surgery eye models and its advantages . Synopsis: : By using 3D printing, two simple, economical and reusable eye models have been proposed to improve resident training especially during COVID-19 times. Highlights: Use of simple easily available materials and 3D printing to make sustainable eye models for practise as against the simulator based learning. Video link: https://youtu.be/dJau9N-sHUE.

Effectiveness of laser fluorescence-based device in detecting the extent of re-mineralisation in primary teeth compared to the conventional method: An In vitro study.

Background: Laser fluorescence (LF)-based clinical device DIAGNOdent™ is at present being used to detect caries. Can the same be used to detect therapeutic remineralisation of early white spot lesions? Aims: To explore the feasibility of using LF-based device in monitoring the changes following remineralisation of demineralised primary teeth. Materials and Method: The sample number for the present experimental in vitro study was 10. The LF based device readings were correlated with surface microhardness (SMH) test values to evaluate its efficiency. SMH analysis was performed using a microhardness tester (Tescol-HT1000AD). All the samples were demineralised, followed by remineralisation using fluoride varnish and pH cycling. The data was analysed using the Statistical Package for the Social Sciences (SPSS) version 17.0 (IBM SPSS®) software. Paired t-test was performed to compare laser fluorescence readings and SMH test result values at baseline, after demineralisation, and after remineralisation. Pearson's correlation was used to compare the relation between the laser fluorescence and SMH test. Results: A good negative correlation was seen between the two methods at the baseline readings even though it was not statistically significant (P = 0.069). A positive correlation between the methods existed following demineralisation which was not significant (P = 0.074). The correlation between the parameters following remineralisation showed a moderate negative correlation but was not significant (P = 0.55). Conclusion: DIAGNOdent™ values at baseline, after demineralisation, and after remineralisation was consistent with SMH values. Thus, DIAGNOdent™ can be explored to provide chairside assistance in identifying remineralisation of white spot lesions.

Is weight regaining significant post laparoscopic Roux-en-Y gastric bypass surgery? - A 5-year follow-up study on Indian patients.

BACKGROUND: Laparoscopic Roux-en-Y gastric bypass (RYGB) has been proven to induce significant weight loss and remission of related co-morbidities in patients with morbid obesity. The long-term follow-up data show weight regain or failure to achieve complete remission of type 2 diabetes mellitus (T2DM) in some patients. In this study, we report weight loss patterns and remission of T2DM in patients with morbid obesity during a 5-year follow-up after RYGB. OBJECTIVE: The objective was to evaluate outcomes during the follow-up on excess weight loss (EWL) and remission of T2DM after laparoscopic RYGB among Indian patients. SETTING: The study was conducted in a tertiary care hospital, Kerala, India. MATERIALS AND METHODS: This is a retrospective study in patients who underwent surgery between 2007 and 2010. The patient demographics, pre- and post-operative body mass index (BMI), co-morbidities and EWL were recorded from the medical records. These data were compared between pre-operative and follow-up intervals till 5 years using statistical approaches. RESULTS: The study included 157 patients (91 males and 66 females) having a mean pre-operative BMI of 47.91 ± 7.01 kg/m2. A significant reduction in the BMI was observed at each follow-up point (P < 0.01) till 5 years after the surgery. The mean percentage of EWL increased from 34.57% ± 12.62% to 71.50% ± 15.41% from 3 months to 5 years after the surgery. Twelve per cent (n = 19) of patients achieved normal BMI (<25 mg/kg2) by 3rd year after the surgery. However, the remission of T2DM was achieved in >50% of patients within a year of surgery. During the 5th year, weight regain (1-22 kg) was observed in 36.70% (n = 58) patients, and recurrence of T2DM was observed in two patients. CONCLUSIONS: The long-term durability of RYGB in the study population was satisfactory with significant weight loss and remission of T2DM.

Seven-Year Outcomes of Laproscopic Sleeve Gastectomy in Indian Patients with Different Classes of Obesity.

BACKGROUND: The aim of the study was to assess the long-term outcome in terms of weight loss and remission of comorbidities among the patients who had undergone LSG in an Indian setting. METHODS: This is a retrospective observational study of patients (BMI > 30 kg/m2) who underwent LSG having a minimum 6 months of follow-up data. Based on preoperative BMI, patients were grouped as class 1, 30 < BMI < 35 kg/m2; class 2, 35 < BMI < 40 kg/m2; and class 3, BMI > 40 kg/m2. Data on BMI and %EWL between three classes and among genders at different follow-up points for 7 years were compared. RESULT: Study included 95 patients (mean age of 33.7 ± 11 years), and the preoperative mean BMI was 40.2 ± 5.1 kg/m2. At one year of surgery, 85.5% patients achieved > 50%EWL. The highest mean %EWL was found in class 1 (66.19%), followed by class 2 (56.73%) and class 3 (46.59%) at the sixth month follow-up. At the seventh year, %EWLs were 85.11% (class 1), 76.69% (class 2), and 62.98% (class 3) and the mean BMIs were 25.13 ± 3.09 kg/m2 (class 1), 26.86 ± 2.12 kg/m2 (class 2), and 31.07 ± 3.39 kg/m2 (class 3) and were significantly different (p < 0.05). At the last follow-up, though, the males showed slight weight regain; however, there were no statistical differences between the genders (p = 0.065). CONCLUSION: Outcome from LSG was better in patients with BMI < 40 kg/m2 compared to the patients with BMI > 40 kg/m2. Remission of obesity-related comorbidities was observed with LSG in all groups and gender did not influence the outcome significantly.