COVID-19: Unilateral Involvement of Transplanted Lung, Sparing Contralateral Fibrotic Lung

Introduction: Organ transplant recipients might be more likely to develop COVID-19, as they receive long-term immunosuppressives and have comorbidities. Case Presentation: Herein, we reported the case of a 32-year-old man with unilateral lung transplantation due to unclassifiable lung fibrosis on pathologic evaluation who presented with cough, fever, and headache. After evaluation with RT-PCR test and chest CT scan, COVID-19 in the previously transplanted lung was diagnosed. However, the other non-transplanted fibrotic lung was not involved. Conclusions: Lack of COVID-19 involvement in the fibrotic lung tissue in our case without any other risk factors might be related to the fact that the lung with underlying diseases was less susceptible to COVID-19 as unhealthy lungs have lower ACE2 receptors, or it might be related to genetic differences between the donor and recipient.

Rete Middle Cerebral Artery Anomaly Presenting with a Large Intracerebral Hemorrhage: A Case Report

Rete MCA anomaly is extremely rare and has been seldomly discussed in literature. Embryologically MCA develops by fusion of multiple twigs which form a single channel. If there is failure to fuse a plexiform network of vessels persists known as rete MCA. This web like network of vessels is at high risk of haemorrhagic stroke and therefore for patients presenting incidentally correct diagnosis is paramount. Here we report a case of rete MCA anomaly in a 35-year-old gentle man who presented with a large haemorrhagic stroke in emergency. DSA showed unilateral involvement of proximal MCA, and otherwise normal intra-cranial vasculature. With this report we aim to correctly diagnose this rare condition and avoid misdiagnosis leading to unnecessary treatments.

Characteristics of Recurrent Cases after Conservative Therapy in Adolescent Lumbar Spondylolysis

Purpose: Occasionally lumbar spondylolysis in adolescents will recur after conservative treatment. The goal of this study was to retrospectively review the conditions in which recurrence transpired in a subset of adolescent patients diagnosed with acute lumbar spondylolysis. Subjects: A retrospective survey was conducted in 152 patients who had been treated for spondylolysis and had obtained bone union. Twenty subjects were selected who had recurrent lumbar spondylolysis after returning to sports activity following the first spondylolysis treatment. There were 18 males and two females with an average age at the time of initial consultation of 13.3 years and 14.1 years at the time of recurrence.Results: The average period of initial treatment was 101 days, and the average time to recurrence after healing was 149 days. There were three cases at L3, two cases at L4 and 15 cases at L5. At recurrence, 18 patients had unilateral involvement and two patients presented with bilateral occurrence. Four cases did not achieve bony union.Discussion: In this study, the recurrence rate was 13.2%. Eighty percent of cases had recurrence within six months after healing. After recurrence, 20% of the cases reached pseudoarthrosis. It is useful to take regular MRI images to detect recurrence within six months after returning to sports.

Emerging problem to health care workers in form of virus and fungus combo: a tertiary care centre experience

Background: Rhino-orbital-cerebral mucormycosis has reached epidemic proportion during second wave of COVID-19 pandemic in India. In this study we aimed to understand the demographics, presentation, temporal sequence, risk factors and outcomes to undertake measures for prevention and treatment and benefit of administering liposomal amphotericin via retrobulbar injection in addition to systemic antifungals in the setting of rhino-orbital-mucormycosis.Methods: Study of patients with COVID-19-associated mucormycosis managed or co-managed by ophthalmologists in our centre from April 2021 to June 2021.Results: Male predominance and more than 75% associated with COVID-19 infection. Common risk factors associated were DM and corticosteroids use. Unilateral involvement was common (82.4%). Most common primary symptom and sign of ROCM is orbital/facial pain (68.4%) and ptosis (84.2 %) respectively. retro bulbar amphotericin B injections had slight improvement in vision (25%), ptosis (37.5%) and extra ocular movement (25%) with few complications. Surgical management were PNS debridement (42.1%), exenteration added in 17.5 % and with above procedure additional maxillectomy needed in 14%. 22.8 % cases were succumbed by disease while 40.1 % of live patients needed orbital exenteration.Conclusions: ROCM has visible signs and symptoms, help us in early diagnosis as compared to mucormycosis at other anatomical sites and should be known to all ophthalmologists. Early diagnosis by involving root level health worker and creation of standard treatment guideline on emerging heath problem is an urgent need.

Case Report: Ocular Manifestations and Treatments of Ciliary Body Involvement by Lymphoma

PurposeTo describe the ocular clinical features, histopathological findings, and treatment outcomes of lymphomas involving the ciliary body.MethodsWe demonstrate three cases of ciliary body involvement by lymphoma from 2013 to 2019 in Peking Union Medical College Hospital (PUMCH). All patients underwent examinations including best corrected visual acuity (BCVA), slit-lamp microscopy, indirect ophthalmoscope, ultrasound biomicroscopy (UBM), and diagnostic vitrectomy. In addition, cytopathology, immunohistochemistry, gene rearrangement, cytometric immunophenotypic, or in-situ hybridization were used for determining the pathological type of lymphoma.ResultsThe patients were a 25-year-old man, a 52-year-old woman, and a 54-year-old man. Two patients had unilateral involvement, and one patient had bilateral involvement. All patients presented with anterior uveitis and elevated intraocular pressure. Ciliary body masses or infiltration were found in 3 patients. Two patients had diffuse large B-cell lymphoma and one patient had natural killer/T-cell lymphoma. All patients received 0.4 mg methotrexate intravitreal injections, and the ciliary body lesions regressed completely.ConclusionLymphomatous involvement of the ciliary body usually presents as an atypical anterior chamber reaction. Vitreous biopsy should be considered in these patients for diagnosis. Methotrexate intravitreal injection combine with chemotherapy or radiotherapy, might extend the survival time and preserve visual acuity for patients with ciliary body involvement by lymphoma.

Ocular Trauma Trends in Indonesia: Poor Initial Uncorrected Visual Acuity Associated with Mechanism of Injury

Objectives: To identify ocular trauma trends and to analyze how initial uncorrected visual acuity (VA) is associated with mechanism of injury (MOI) in a referral hospital in Indonesia. Methods: A five-year medical chart review at the Ophthalmology Emergency Department (OED) Dr. Soetomo General Academic Hospital (DSGAH). The information retrieved included sex, age, laterality involvement, initial uncorrected VA, MOI and management. Sex- and age- adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to evaluate the relationship between poor initial uncorrected VA and MOI, using multivariate logistic regression analysis. Results: A total of 953 patients consisted of 80.3% males and 19.9% females. Ocular trauma predominantly occurred in 21–30 years age group (20.9%). May and November were found to have the highest average number of monthly patients. Closed globe injuries (80.3%) were more prevalent than open globe injuries (17.7%). The most frequent MOIs were sharp objects (311; 32.6%), followed by blunt objects (236; 24.8%). Most cases (89.2%) displayed unilateral involvement and 54.3% cases showed an initial uncorrected VA of better than 6/18. Compared to road dust, blunt object, sharp object and traffic accident were significantly associated with poor initial VA, with adjusted ORs (95% CIs) of 5.24 (2.27-12.10), 4.03 (1.76-9.25) and 8.17 (3.31-20.15), respectively. Conclusions: Initial uncorrected VA and MOI provide earlier information regarding the prognosis. Traffic accident showed a greater tendency to cause a poor initial uncorrected VA. Most ocular trauma is preventable by educating people at risk to avoid common MOIs and to use protection.

Music listening practices of college-going students and their impact on hearing

<p class="abstract"><strong>Background:</strong> A billion youngsters are at risk of recreational noise-induced hearing loss. Motivated by WHO’s campaign ‘Make listening safe’, the objective of this study was to estimate the prevalence of the habit of listening to music at high volumes using Personal Listening Devices (PLDs) among college students and to analyze their audiometric findings.</p><p class="abstract"><strong>Methods:</strong> This cross-sectional study was performed between December 2019 and May 2020 on college-going students with a habit of listening to music using PLDs. PTA was performed on the eligible study subjects. A modified LHQ was given to the selected candidates to answer. </p><p class="abstract"><strong>Results:</strong> The study population comprised 62 boys (24.5%) and 191 girls (75.5%) of the age of 17-24 years. 77.1% of the participants listened to music through PLD, at a scale of &gt;5 on 10 (median PLD volume-7). 26.1% of students listened to music for more than 14 hours a week using their headphones or earphones. Fifteen students (5.93%) had evidence of a 4 kHz dip on PTA out of which 9 patients (3.56%) had bilateral and 6 patients (2.37%) had unilateral involvement.</p><p class="abstract"><strong>Conclusions:</strong> Though many students had some awareness regarding safe volume levels while listening to music, not many were aware of daily sound allowance (DSA). Health education to the target population along with the addition of an in-built app in all PLDs for monitoring device volume and DSA may reduce the impact of music on hearing.</p>

Acquired symptomatic external punctal stenosis: A tertiary referral center study

Background: To report the prevalence of acquired symptomatic external punctal stenosis (EPS) in a tertiary referral center in Kuwait, and to study the associated risk factors, etiologies, and management outcomes. Methods: This prospective interventional hospital-based study was performed at the Farwaniya governmental hospital in Kuwait between November 2018 and November 2019. All patients were referred to the oculoplastic clinic with symptomatic epiphora, age > 18 years, epiphora Munk score ≥ 0, tear film meniscus ≥ 2 mm, and punctum with grade ≤ 2 (smaller than normal size, but recognizable EPS) were included. Exclusion criteria were congenital causes of epiphora, previous eyelid surgeries, and traumatic or neoplastic causes of punctal or canalicular obstruction. Results: A total of 418 patients with symptomatic epiphora, who were referred to our oculoplastic clinic, were enrolled in our study. The prevalence of EPS was 70.3%. Examination of the puncta revealed different shapes, including tangential, pinpoint, elevated, slit-shaped, horse shoe-shaped, and membranous puncta, with the tangential type accounting for the greatest proportion (65.3%). Bilateral punctal stenosis was observed in 206 patients (70.1%) and unilateral involvement in 88 patients (29.9%). Dilatation and syringing were performed for all puncta upon diagnosis, and repeated dilatation was performed for 225 puncta (32.7%). Placement of a Mini-Monoka tube was performed in 11 puncta (1.6%). Conclusions: EPS was a common cause of symptomatic epiphora in our study. Aging and female sex were identified as common risk factors. Most etiological factors of EPS were associated with a pathophysiological inflammatory mechanism. For exact estimates of its prevalence, a population-based study is necessary in future. Keywords: punctal stenosis, dry eye, chronic blepharitis, Mini Monoka, Kuwait, prevalence, epiphora

Relationship between the higher inflammatory cytokines level in the aqueous humor of Fuchs uveitis syndrome and the presence of cataract

Background This study aims to compare the levels of intraocular cytokines between Fuchs uveitis syndrome (FUS) eyes and the senile cataract eyes. The association between inflammatory cytokine levels and cataract severity in FUS is evaluated to find the possible mechanism of cataract in FUS eyes. Methods A retrospective study of 28 eyes with FUS was performed. Auxiliary examinations were performed, including ophthalmic examinations, laser flare-cell photometry, and levels of inflammatory cytokines in the aqueous humor were measured. The control group included 25 eyes with senile cataract. Data on the aqueous humor inflammatory cytokines were compared between the two groups. The association between the aqueous humor cytokine levels and severity of posterior subcapsular cataract was assessed. Results There were 28 eyes with FUS in 27 patients. Unilateral involvement was noted in 26 patients (96.30%). Stellate keratic precipitates (KPs) were noted in 16 eyes (57.14%). Heterochromia was observed in 21.43% of affected eyes. Posterior subcapsular cataract (PSC) was observed in 16 of the 28 eyes. Eyes with FUS had significantly higher aqueous humor (AH) cytokine levels (VEGF, bFGF, IL-6, IL-8 and IL-10) compared with the control eyes (P < 0.05). There was a statistically significant positive correlation between the severity of cataract and IL-6 and IL-8 levels in the AH (τ = 0.664 and 0.634, respectively; P = 0.001, P = 0.002, respectively). Conclusions Expression of VEGF, bFGF, IL-6, IL-8 and IL-10 in the AH of FUS patients was significantly higher than in senile cataract eyes, and the aqueous humor levels of IL-6 and IL-8 were significantly positively associated with the severity of posterior subcapsular cataract. Our results imply that an inflammation mechanism may be involved in the early development of cataract in FUS.

Chest computed tomographic findings of patients with COVID-19-related pneumonia

Background In December 2019, pneumonia cases of unknown cause were announced in Wuhan, China. The causative agent of pneumonia was identified as coronavirus 2 (SARS-CoV-2), and the disease was named coronavirus disease 2019 (COVID-19). Purpose To evaluate the usefulness of computed thoracic tomography (CT) and postero anterior (PA) thoracic radiography in patients with COVID-19. Material and Methods Between March and June 2020, the patients who arrived at our hospital with suspicion of COVID-19 were retrospectively analyzed. Thorax CT findings of the 281 patients (142 females and 139 males; age range 3–91 years) with positive PCR tests were evaluated. Lesions in the lung parenchyma were examined according to their number, localization, and distribution. PA chest radiograms were classified into two groups, positive and negative for the lung parenchymal lesions. Results Of the total 281 patients with PCR-positive COVID-19, CT examinations were normal in 107 (38.1%), and positive CT findings for pneumonia were found in 174 patients (61.9%). Bilateral involvement was observed in 100 (57.5%) of the 174 patients with positive CT findings, and unilateral involvement was observed in 74 (42.5%) of them. According to the localization of the lesions, peripheral subpleural distribution occurred in 160 of the 174 patients (91.9). The most common lesion was the ground glass opacities (GGO). In 77 of 281 PCR-positive patients (27.4), pulmonary lesions were found on PA chest radiograms. Conclusion The presence of bilateral posterior subpleural GGO, nodule, and consolidation in thoracic CT are significant in terms of COVID-19 pneumonia.