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Introduction: Bilateral vestibular areflexia is a rare pathological entity whose most frequent etiology is drug ototoxicity. We report an unusual case of bilateral vestibular areflexia complicating acute otitis media through which we raise the difficulties of diagnosis and therapeutic management of this pathology. Case Report: 57-year-old Tunisian patient who consults for a loss balance associated with earache and hearing loss. Initial clinical examination revealed bilateral acute otitis media with a right harmonious vestibular syndrome and normal neurological examination. The diagnosis of post-otitis labyrinthitis was retained. The patient was put on antibiotics and corticosteroids. The evolution was marked by the persistence of instability in darkness and oscillopsia; vestibular explorations concluded with bilateral vestibular areflexia. MRI concluded to posterior labyrinthitis and eliminated central neurological involvement. The patient was kept under betahistine. The tympanic cavity was drained by a tympanic aerator on both sides. Vestibular rehabilitation was started quickly. Gradual improvement was obtained of autonomy with persistent oscillopsia. Conclusion: Bilateral vestibular areflexia poses diagnostic problems based on anamnestic and clinical arguments and vestibular explorations. The therapeutic management is delicate, vestibular reeducation occupies a primordial place.

Purpose: Analyze Microincision Cataract surgery wound using Fourier-Domain optical coherence tomography. Setting: Medical School of Medicine, Catholic University of Brasilia, Brasília, Brazil. Design: Prospective comparative observational study Methods: Forty eyes were included in this prospective study divided in two groups: with contact lens (CL) and without contact lens (WCL). A line scan pattern of the corneal incisions were acquired using a Spectral domain OCT system immediately after the surgery, and at postoperative days 1, 7 and 30. Incisions were analyzed regarding length, location, angle, architecture, and anatomic imperfections. Results: All incisions were located temporal or nasal superiorly. The average wound length was 1.28 + 0.18mm and the mean incision angle was 49 + 9 degrees. The average wound length of the WCL group mean was 1.24 + 0.17 mm and the mean incision angle was 51 + 8 degrees. Comparing groups for the length and the angle, the incisions measurements were not statistically significant. Anatomic imperfections were observed at the first day postoperative in 12 eyes for CL group and in 13 eyes for the WCL group. No patient presented endophthalmitis during the follow-up. Conclusion: Epithelial imperfection was observed in two patients in the WCL group with spontaneous resolution. The CL group had the highest length and lowest angle of corneal incision. Using contact lens to prevent wound construction imperfection appears not to be a good option. Further studies using a greater number of patients with an architectural analysis of clear corneal incisions are needed to confirm these preliminary results.

Coronavirus disease 2019 (COVID-19) which first appeared in China spread gradually all over the world within three months [1]. China was the only country mainly affected by Covid-19 until February 2020, but from the beginning of March, the disease started to spread rapidly to South Korea. It reached Italy in the second week of March and the number of cases increased rapidly in Spain and other European countries in the third week of March then the virus crossed the Atlantic and entered into the United States and other countries in the Americas. WHO declared COVID-19 as a pandemic disease on 11th March 2020 [2]. As of 23rd April 2020, there have been 2,645,785 confirmed cases of COVID-19, with 185,121 deaths and 726,827 recoveries [3]. Slowly, Nepal is also into the scene of the COVID-19 affected countries.

Background: Tongue swelling often presents as an acute upper airway obstruction. Aim: To present a case series of patients presenting with an acute tongue swelling sharing our experience in managing these patients. Subjects and methods: A retrospective analysis of consecutive patients presenting acutely to the emergency department (ED) at two institutions in Scotland. All patients were evaluated by an otolaryngologist for probable causes of tongue swelling. Data were collected on demographics, co-morbidities, clinical history, examination findings, acute airway management and subsequent care the patients needed. Results: A total of 32 patients (mean age ± STD, 61.6 ± 18.8; 65% male) were included in the study from two teaching hospitals. The most common presenting symptoms were difficulty in speaking (30/32, 94%) and dysphagia (27/32, 84%). Breathing difficulty was only observed in 8 of 32 patients (25%). Angiotensin converting enzyme (ACE) inhibitor’s induced angioedema was the most common cause (45%) for acute tongue swelling. Three (9.4%) patients required intubation; 2 (6.3%) on initial presentation. Two patients had emergency tracheostomy for breathing difficulties due to supraglottic swelling on flexible pharyngolaryngoscopy. Conclusion: Acute tongue swelling is a life-threatening condition. The patients on ACE inhibitors would appear to be at higher risk of developing acute tongue swelling. Such patients with potentially compromised airway need to be treated in a facility where emergency intubation and tracheostomy can be performed at a short notice.

Coronavirus disease 2019 (covid-19) pandemic gives rise to a significant number of psychological consequences and health problems. The GP must recognize the feelings generated in their patients and address them. This task includes 4 areas: 1. Knowing and managing the epidemic of anxiety and fear in patients; 2. Assessing possible de-compensation of patients with previous mental problems; 3. Knowing and managing effects of quarantine and social distancing; and 4. Knowing and managing possible truncated mourning. The recommendations for GPs intervention are: 1) In the clinical interview (identify maladaptive thoughts and emotions; comprehensive health); 2) Health information (clear, evidence-based communication); 3) Health education (healthy behaviors); 4) Telecare (support, monitoring and attention over the phone, via WhatsApp or video calls); 5) Crisis interventions (psycho education, cognitive behavioral techniques or referral to specialist); 6) Bibliotherapy (free electronic copies for the public); 7) Special efforts directed at vulnerable populations (infected and sick patients, the elderly, with a compromised immune function and those living or receiving care in congregated settings and people with adverse medical, psychiatric or with substance use problems, their families and caregivers); 8) Psychosocial monitoring (stressors related to COVID-19: exposures to infected sources, infected family members, loss of loved ones and physical distancing, secondary adversities such as economic loss, psychosocial effects such as depression, anxiety, psychosomatic concerns, insomnia, increased use of substances and domestic violence, and vulnerability indicators such as pre-existing physical or psychological conditions); and 9) Follow-up of the “complicated” mourning (“accompaniment” and transmit compassion, love and affection).

Significance: Due to the limited number of reported cases little is known about the characteristics of unilateral retinitis pigmentosa. Information from additional case reports can aid in learning more about the condition. We report a case of retinitis pigmentosa that has remained unilateral for 28 years and review the available literature. Case Report: A 40-year-old Caucasian female presented for an opinion as to the cause of her vision loss. Fundus autofluorescence demonstrated hypoautofluorescence in the midperipheral retina and a hyperautofluorescent ring surrounding the area of preserved photoreceptors in the macula. Optical coherence tomography showed disruption of the ellipsoid zone and the external limiting membrane. Electroretinography (ERG) showed severely reduced rod and cone function monocularly. Discussion: Retinitis pigmentosa is typically bilateral and symmetric. Unilateral retinitis pigmentosa is a rare condition that manifests with only one eye having changes typical of retinitis pigmentosa. The unaffected eye can have no signs of retinitis pigmentosa and must have a normal ERG after long-term follow up. It is critical to rule out inflammatory, traumatic, toxic, and cancer associated retinopathy that can present with retinal pigmentary changes. Unilateral retinitis pigmentosa generally remains unilateral, but long-term follow up with ERG is important. There is currently no treatment that can stop the process of retinitis pigmentosa, but gene therapy shows promise.

Direct rigid pharyngoscopy, laryngoscopy and oesophagoscopy are very common procedures in the Otolaryngology-Head & Neck department, both for diagnostic and therapeutic purposes. The phayngoscopes, laryngoscopes and oesophagoscopes are solid straight metal instruments to facilitate examination and passage of instruments through them. The process of pharyngo-laryngo-oesophagoscopy invariably involves some contact with the upper dentition resulting in some pressure over the teeth and jaw when suspension laryngoscopy is carried out. 

In COVID-19 pandemic we focused on epidemiology and somewhat we neglect the possibility of biochemical influencing of the infection. Therefore we try to find some properties of the virus, which are impressionable by drugs. Droplet infection transmission is mainly (hypochloric acid) by nose and mouth. Diseases of nose and paranasal sinuses are most often of viral or bacterial origin.

Viral transmission of SARS-CoV-2, the virus causing COVID-19 is very high within households despite self isolation [1,2]. Transmission of the virus is thought to be similar to that of influenza. Virus is shed into respiratory secretions which can be transferred through coarse droplets or fine aerosol released when a person coughs, sneezes or talks. These droplets/aerosols may infect another either by direct contact with the mucous membranes or through fomite transmission. 

Introduction: Obesity (BMI ≥ 30 kg m-2) is epidemic globally and is associated with increased risk for a wide range of physical and mental health comorbidities. This is a particular concern for rural residents who have a greater rate of obesity than urban residents, but are disadvantaged in obtaining care because of a shortage of health care professionals. Community health fairs provide an opportunity for rural residents to receive health care services and education at reduced or no cost. Therefore, this study explored the role of community health fairs for providing health services and improving the health of residents in a rural community where obesity is a serious health concern. Methods: This study involved a retrospective longitudinal analysis of data collected during community health fairs conducted in a rural western Nebraska, USA community during 2014, 2015, and 2016 (n = 83). The Planned Approach to Community Health (PATCH) framework was used to target health education in this rural community. This approach involved 1. Mobilizing the community (via health fairs), 2. Collecting and organizing data (from consented attendees), 3. Selecting health priorities (obesity), 4. Developing a comprehensive intervention (nutrition and physical activity education), and 5. Evaluating the effectiveness of the framework (declines in measures of obesity over time). Analyses characterized BMI, percent body fat, visceral fat, and BP and explored differences between genders. The sample was recruited by advertising with flyers for health fairs at the College of Nursing. Most booths provided printouts of results for participants in order for them to keep and track their health information. Once potential participants arrived at the health fair site, there were asked if they would like to participate in the study via an invitation letter. They could then decline or sign the consent. Results: Percent body fat and visceral fat level differed between genders (p = < .001 and .001, respectively). Mean body fat levels (women 39.4%, men 28.8%) were unhealthy. Mean visceral fat level was unhealthy in men (16), but healthy in women (10). BMI and systolic and diastolic blood pressure did not differ between genders. Mean BMI was 31 kg m-2; 33% of participants were overweight, 44% were obese. Mean systolic and diastolic BP were 134 and 78 mg Hg, respectively. Most participants were hypertensive (systolic: men 57%, women 32%; diastolic: men 24%, women 7%) or prehypertensive (systolic: men 21%, women 39%; diastolic: men and women 36%). Conclusion: Obesity and high BP were common in this rural population, supporting the need for effective education and intervention efforts to address these health issues. Health fairs provide a manner in which to reach community persons needing referrals to local clinics, mental health providers and physicians. Education provided at such events is valuable as well and may in fact be the only health care contact they receive. Though community health fairs provide an economical way for individuals to receive screenings and health information, few men participated and few individuals attended in multiple years. The lack of repeat attendees prevented assessment of the efficacy of the education intervention. Means of enhancing participation, particularly by men and previous attendees, need to be explored. Repeatedly attending health fairs enables participants to monitor their progress, seek physical and mental health screenings and discuss any health concerns and helps researchers assess the efficacy of interventions. 

Background: Corneal injuries are significant contributors to blindness. Cornea being the most anterior structure of eye is exposed to various hazards like airborne debris and blunt trauma. By understanding different types of injuries to which cornea is exposed, the practitioner maybe more capable in managing injuries to minimise structural and visual sequelae. Objectives: To study various patterns of corneal injuries and its visual outcome among patients of ocular trauma in a tertiary care hospital. Methods: Study of 100 cases of corneal injuries wherein patients were treated according to injury type and followed up for 4 months. Results: Majority of patients belonged to working population between age groups 21-65 years. Most patients suffered from corneal abrasions while the least common were perforating and lacerating injuries. Alkali injuries were more common than acid injuries. Most patient presented within 24 hours and had only epithelial defects. Therefore, the number of patients receiving conservative management was higher than those receiving surgical intervention. Conclusion: Most common causes of blindness and low vision in our study was full thickness corneal laceration and corneal abrasions, foreign body injuries affecting the pupillary area and involving anterior or mid stroma causing nebular or macular grade opacities hampering vision.

Coronavirus disease 2019 (COVID-19) which originated in China spread progressively all over the world [1]. On 11th March 2020 WHO declared COVID-19 outbreaks as a pandemic [2]. As of 22nd May 2020, there have been more than 5.3 million confirmed cases of COVID-19, with more than 340 thousand deaths and more than 2.2 million recovered [3]. Slowly, South Asia is also entering the ranks of COVID-19 affected regions. This region comprises more than 21% of the world’s population which remains vulnerable to COVID-19 [4].

The Diagnostic Statistical Manual of Mental Disorders volume 5 (DSM-5) is the influential textbook published in 2013, by the American Psychiatric Association, as a guide to psychiatric diagnosis. It helps to ensure that doctors are consistent in their use of diagnostic terms.

Introduction: Rural populations often experience disparities in health and access to and quality of healthcare. Such disparities may differ among subpopulations. Community outreach events provide an opportunity for rural residents to receive health services and education at reduced or no cost. This project builds on our previous experience with community health fairs by providing health events that target specific underserved subpopulations (rural youth, Latinas, and men). Methods: Our first event provided free sports physicals to area students. The second provided free health screenings to men during an annual agricultural event (Bean Day). The third was a cardiovascular health event for Latinas that featured free or reduced cost health screenings and other health-related and culturally appropriate activities. Results: Thirty-five students received sports physicals, enabling them to participate in sports. Twenty-two Bean Day participants, primarily men, received health screenings; four were hypertensive, three were overweight, and 12 were obese. Over 100 women attended Latina Red Dress and received health services and education. For many in these subpopulations, events such as this provide the only healthcare they receive. During all three events, participants received education regarding any health issues of concern and referrals to local health clinics when appropriate (e.g. hypertension, high glucose levels). Conclusion: Community health events such as these provide culturally appropriate and economical means to deliver health services and education, enabling participants to identify and address any health concerns. Targeting events for underserved subpopulations helped engage them in their healthcare. These findings support the need for effective education and intervention efforts to address physical and mental health concerns in this rural area. This was our first contact with these particular populations whom we know need intervention to receive health care. Moving forward through 2020 and beyond we will have future health fairs in the same groups in order to assess if the health fairs are indeed impacting health of these children, men and minority women. 

Background: 188Re-liposome has been used for evaluating the theranostic efficacy on human head and neck squamous cell carcinoma (HNSCC) at preclinical stages. Here we furthercompared the microRNA expressive profile in orthtopic HNSCC tumor model exposed to 188Re-liposome. Methods: A single dose or dual doses of 188Re-liposome was intravenously injected into tumor-bearing mice followed by the Cerenkov luminescent imaging (CLI) for monitoring the accumulation of 188Re-liposome in tumors. The microRNA expressive profile was generated using the Taqman® OpenArray® Human MicroRNA Panel followed by the DIANA mirPath analysis, KEGG signaling pathways prediction, and Kaplan-Meier survival analysis for predicting the prognostic role of 188Re-liposome affected microRNAs. Results: Dual doses of 188Re-liposome exhibited a better tumor suppression than a single dose of 188Re-liposome, including reduced tumor size, Ki-67 proliferative marker, and epithelial-mesenchymal transition (EMT) related factors. The microRNA expressive profiles showed that 22 microRNAs and 19 microRNAs were up-regulated and down-regulated by dual doses of 188Re-liposome, respectively. Concomitantly, these two groups of microRNAs were inversely regulated by a single dose of 188Re-liposome accordingly. These microRNAs influenced most downstream genes involved in cancer related signaling pathways. Further, miR-520e and miR-522-3p were down-regulated whereas miR-186-5p and miR-543 were up-regulated by dual doses of 188Re-liposome, and they separately affected most of genes involved in their corresponding pathways with high significance. Additionally, high expressions of miR-520e and miR-522-3p were associated with lower survival rate of HNSCC patients. Conclusion: MicroRNA expression could be used to evaluate the therapeutic efficacy and regarded prognostic factors using different doses of 188Re-liposome.

Leadership is not just for leaders anymore. Top companies are beginning to understand that sustaining peak performance requires a firm-wide commitment to developing leaders that is tightly aligned to organizational objectives — a commitment much easier to understand than to achieve. Organizations must find ways to cascade leadership from senior management to men and women at all levels. 

Introduction: Intense Pulsed Light (IPL) is the therapeutic tool implemented in the treatment of dry eye, characterized by the emission of waves of 500-1200nm in the region of the upper and lower eyelids. Dry eye is a recurring complaint in ophthalmology offices and has an impact on the patient’s quality of life. It results from dysfunction of the meibomian glands, duct obstruction, and quantitative and qualitative changes in glandular secretion. It is manifested by dryness and irritation, foreign body sensation, burning, tearing, and eye fatigue. The available treatments are short term palliative with unsatisfactory results.

WHO declared the coronavirus disease 2019 (COVID-19) outbreak, caused by SARS-CoV-2, to be a pandemic on March 12, 2020. In Morocco, the first case was reported in March 2nd 2020. The mental health of general population, medical and nursing staff especially has been greatly challenged. The aim of the present article is to explore the stress status of medical and nursing staff associated with exposure to the COVID-19. The medical staff was asked to complete a self-reported questionnaire anonymously. In University Hospital Mohamed VI, in Marrakesh, Morocco. During May 2020. In total, 120 valid questionnaires were collected. Among them, there were 57 residents (47,5%), 30 internes (25%), 22 nurses (19%) and others: medicine students and technical staff. The age was between 23 and 60 years. 15% of professional lived alone, 85% with their family, 74% lived with an old person or with a person having a chronic disease. In our study: the severity of symptoms in 36% of the asked professional, deaths among health professionals in 15%, death of a family member in 14%, the rapid spread of pandemic in 90%, the lack of knowledge in 83%, and finally contamination risk especially if comorbidity associated in 2%. Further risk factors: feelings of being inadequately supported by the hospital in 42%, fear of taking home infection to family members or others in 80%, being isolated, feelings of uncertainty and social stigmatization in 43%. The psychological presentation was the nightmare 19 in %, the insomnia in 48%, the somatization in 18%, the irritability in 22%, the aggressiveness in 14%, the nervousness in 70% and the drowsiness in 5%. During the vulnerability of the individual’s conditions during and after the COVID-19, psychological intervention should be done and a mental health support for the health professional.

The expansion of social media platforms has given birth to a specific professional category in charge of « sanitizing » social media and keeping it free of “inappropriate” content. These content moderators, as a result of being constantly exposed to potentially traumatic images, may be at risk of developing stress-related symptoms. Here we present the case of a social media content moderator who experienced intrusive images, anxiety symptoms and insomnia. Literature about this subject is very scarce, while the need is increasing to assess this phenomenon and set up strategies of monitoring, counseling and treating this category of workers. Key points The expansion of social media platforms has given birth to a specific professional category: content moderators. As a result of being constantly exposed to potentially traumatic images, content moderators may be at risk of developing stress-related symptoms. The need is increasing to assess this phenomenon and set up strategies of monitoring, counseling and treating this category of workers.

Background/Aim: In spite of global initiatives to provide sight for all by the year 2020, many middle-aged to elderly people in the Niger Delta still have significant visual impairment due to uncorrected refractive errors. The aim of this study is to assess the types of refractive anomalies that occur among presbyopic patients in Port Harcourt and determine the demographic pattern of these anomalies based on age and gender characteristics. Methodology: This is a hospital-based descriptive cross-sectional study in which sixty consecutive adult patients for refraction were seen. Every adult patient that came to get glasses during the study period was included in the study except where ocular or systemic contraindications were present. In addition to visual acuity, all patients had a detailed ocular examination and then refraction. The collected data was subsequently analysed using SPSS version 20. Results: The mean age of the patients was 54.4 ± 9.4 years with a range of 35 to 80 years. A total of 60 patients were seen, comprising 30 males and 30 females. The commonest refractive error was presbyopia with hyperopic astigmatism and this accounted for 80% of all cases. Hyperopic presbyopia and presbyopia alone were the least common. Conclusion: There is a high level of cylindrical and spherical errors in Port Harcourt. The full optical correction should always be prescribed to presbyopic patients to fully correct the associated visual impairment and improve the patients’ well-being.