Chondrosarcoma (CS) is the rare, slowly growing, malignant neoplasm. CS of the sino nasal cavity is extremely rare. It is usually present with common symptoms like nasal obstruction and epistaxis. It rarely present with ocular symptoms. Histopathological examination is useful for confirmation of diagnosis. Surgical excision is the treatment of choice. Radiotherapy is indicated if the tumor involves the vital structures. Here we are reporting a case of recurrent chondrosarcoma. Patient is presented to our department with proptosis of left eye and nasal obstruction since two months. Combined with neurosurgeon bi frontal craniotomy with endoscopic excision of mass done. Post operatively patient received adjuvant radiotherapy. Patient is on regular follow up. Keywords: chondrosarcoma; combined excision; radio therapy

Background: Foot biomechanics undergo age related changes and visual input may be important for postural stability and stance dynamics. This study aimed to investigate how age-related alterations in foot biomechanics and visual input interact to influence postural stability and stance dynamics in children aged 6 to 19 years. Materials and methods: Prospective observational study was conducted after getting permission from Institutional Ethics Committee. Informed consent was obtained before collecting data. OHM3000 used for collecting data. Data was collected for bipedal stance test, stabilometry test with eyes open and eyes closed, and dynamic stance test during walking with predefined protocol. Result: Statistically significant difference in maximum pressure, average pressure, foot area and foot length are exhibited in both feet with higher values in adolescents as compared to pre-adolescents. Maximum lateral deviation was significantly less in adolescent with eyes open toward right feet as compare to preadolescents and the difference was lost with eyes closed. Maximum pressure, average pressure, foot contact area and forefoot maximum pressure in both feet were statistical significance. Conclusion: Increased maximum pressure, average pressure, foot area and foot length indicating physical growth and higher load-bearing capacities in adolescents. Weight distribution over the forefoot and hindfoot remained consistent across age groups even if significant changes shown in foot size and pressure. Visual input significantly improved postural stability in both groups. Adolescents show better postural stability probably due to foot maturation. During walking, adolescents showed increased maximum and average pressures, especially in forefoot. Keywords: foot; clinical anatomy; biomechanics; adolescents; children; postural stability; gait; visual input

Chondromalacia of patella (CMP) is a condition in which cartilages under patella and underlying surface soften and tear resulting in anterior knee pain that worsens especially while flexing and climbing stairs. Conservative treatments can delay or prevent the need of surgical interventions. The prime objective of this paper is to demonstrate the efficacy of certain conservative treatments for symptomatic relief from anterior knee pain due to CMP on a single case. A 45-year-old male diagnosed to have symptomatic CMP of grade-IV with anterior knee pain in both the legs sequentially and difficulty in flexion and climbing stairs has been treated conservatively with nutraceutical supplement, physical rehabilitation, and combined platelet rich plasma (PRP) and hyaluronic acid (HA) intra-articular (IA) injections. Knee flexion angle (KFA) and kneeling ability score (KAS) are considered as clinical evaluation parameters for demonstrating the efficacy of the conservative treatments. The conservative treatments with collagen peptide nutraceutical supplement and rehabilitation exercises for the right knee and the same along with combined PRP and HA IA injections for the left knee sequentially are found to be effective in symptomatic relief from the knee pain to a great extent with significant improvement in the knee joint flexibility as demonstrated on a single case. Thus, the treatments are remarkable for significant alleviation of the knee pain and improvement in the knee joint flexibility. Keywords: Chondromalacia patella; anterior knee pain; conservative treatments; kneeling ability; knee flexion

Introduction: Glaucoma is a progressive optic neuropathy characterized by functional loss or optic nerve dysfunction which is one of the leading causes of irreversible but preventable blindness. The aim of the study was to determine which of the retinal nerve fiber layer and optic nerve head parameters are reliable markers of optic nerve damage in glaucoma suspects. Methods: Observational cross-sectional study of 250 patient’s including147 glaucoma suspect eyes, 103 normal eyes. All subjects underwent complete eye examination and imaging with the spectral domain optical coherence tomography (SD-OCT) cirrus-TM OCT (Carl Zeiss Meditec, Dublin, CA). Retinal nerve fiber layer (RNFL) and optic nerve head (ONH) OCT protocols were used to evaluate all study participants. The main outcome measures were the difference in OCT parameters among groups. Results: Study shows statistically significant difference in the average RNFL thickness, superior, nasal, inferior, temporal quadrants, rim area, cup volume, average cup to disc ratio (CDR), vertical CDR with P value <0.001 between the two groups. Average CDR, vertical CDR and cup volume had significantly greater AROC values (ROC: 0.99, 0.98, 0.95) than RNFL parameters for discriminating glaucoma suspects from normal eyes. Conclusion: Assessment of RNFL, macular and ONH damage with SD-OCT has been proven useful for diagnosing the disease at different levels of severity, as well as for quantifying risk in glaucoma suspects. In our study ONH measurements, as provided by the SD OCT, have more diagnostic value than RNFL parameters in the diagnosis of glaucoma suspects from normal. Keywords: glaucoma suspects; optic nerve head; retinal nerve fiber layer; optical coherence tomography

Diabetic kidney disease (DKD) stands as a prevalent and significant complication in individuals with type 2 diabetes, impacting nearly half of this population. It holds the primary position as the cause of chronic kidney disease and end-stage kidney disease globally, associated with heightened cardiovascular morbidity and mortality. Despite the array of available interventions to prevent and manage DKD, such as regulating blood sugar levels, controlling blood pressure, and inhibiting the renin-angiotensin system, numerous patients continue to grapple with the ongoing decline in kidney function and unfavorable outcomes. This comprehensive review offers an updated exploration of the pathophysiology, diagnosis, prevention, and treatment of DKD. Special attention is devoted to emerging treatment modalities displaying promising outcomes in clinical trials, notably sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, non-steroidal mineralocorticoid receptor antagonists, and innovative agents addressing inflammation and fibrosis. The discourse also delves into the complexities and opportunities associated with integrating these therapies into clinical practice, emphasizing the necessity for personalized and all-encompassing care for DKD patients. The conclusion outlines future directions, urging further research and providing recommendations to advance both understanding and practical approaches in this domain. Keywords: pathophysiology; personalized care; diabetic kidney disease

Background: Rhinosinusitis is defined as a multifactorial disorder with persistence of symptoms caused by inflammation of the sinonasal mucosa for 12 or more weeks with confirmation by diagnostic nasal endoscopy and computed tomography. The main aim of this study is to analyze the neutrophilic or eosinophilic predominance among CRS patients with histopathological examination for appropriate management, and to understand the association between the endotypes of CRS and blood parameters. Materials and methods: A prospective cohort study was conducted on 137 patients over a period of two years at a tertiary centre. Diagnostic nasal endoscopy (DNE), computed tomography of the nose and paranasal sinus (CT PNS), complete haemogram (CBC), absolute eosinophil count (AEC), erythrocyte sedimentation rate (ESR), immunoglobulin E(IgE) was done. Patients were planned for functional endoscopic sinus surgery (FESS) and specimen was sent for histopathological examination. Results: The comparison between DNE and AEC groups showed statistical significance and so did the comparison between CT and IgE. When we compared the groups of CRS with and without polyps with DNE and CT, there was no statistical significance. Also 64.2% of patients had an eosinophilic predominance. Conclusion: It has also been reported that CRS are highly eosinophilic, also have substantial levels of neutrophils. Importantly, tissue neutrophilia has been associated with a poor response to corticosteroid therapy in patients with CRS with nasal polyps. Keywords: nasal polyp; eosinophils; neutrophils; sinusitis; allergy; asthma; inflammation

Alport’s syndrome is a heterogeneous genetic disease involving the basement membrane of the glomeruli, inner ear, retina, and lens capsule. A 30-years-old male patient, recently diagnosed with chronic kidney disease (CKD) stage 5 awaiting for renal transplantation presented to the ophthalmology outpatient department with a complaint of gradual decrease in vision in both eyes since 2 years. Patient has a history of anemia, hypertension for the past 3 years and was on medication for both. On ocular examination, unaided vision was counting fingers (CF)- 2 meters in both eyes with pinhole improvement to 6/60 in both eyes. On slit lamp examination, bilateral anterior lenticonus was seen after pupil dilation. On detailed history taking, the patient has a history of hearing loss since the past 6 months. ENT consultation was done, and the patient was found to have bilateral moderate sensorineural hearing loss. The presence of ocular abnormalities, bilateral sensorineural hearing loss and renal failure is highly suggestive of Alport’s syndrome. When a genetic disorder is identified, it aids in identifying the cause of renal dysfunction in that patient but also enables us to screen other family members for the same before deciding on the potential living donor. Keywords: lenticonus; hematuria; deafness; renal failure; Alport’s syndrome

Background: Systemic lupus erythematosus in children (cSLE) represents 10-20% of all cases of SLE. However, this is still underreported from Assam. In this study, we report our experience with 25 patients of cSLE over the last 3.5 years. Materials and methods: This retrospective study was carried out at the Department of Pediatrics, Gauhati Medical College and Hospital, Guwahati, Assam. Data of patients with cSLE in the records of pediatric rheumatology and immunodeficiency clinic from April 2018 to October 2021 were collected and analysed. Results: In our cohort, the median age at presentation was 10 years (range, 4.6-14 years). The female-to-male ratio was 7:1. Hematological involvement, 21 (84%) was the most common manifestation followed by cutaneous, 19 (76%), and renal involvement, 17 (68%). Five patients also had associated HbE hemoglobinopathy. We had performed renal biopsy in 12/17 patients. Class IV lupus nephritis was the most common type in our patients. Twenty-four out of 25 patients had active disease at the time of the first presentation. There were four deaths in our cohort including two deaths that occurred due to congestive cardiac failure in patients with suspected myocarditis. Seventeen patients in our cohort had completed a median of 10 months (range, 2 – 30 months) follow-up and 6/9 biopsy-proven proliferative nephritis were in remission after a median of 9.5 months (range, 2-27 months) follow-up. Conclusion: Hematological involvement was the commonest manifestation in cSLE at our center. The majority of patients with proliferative LN were in remission with standard treatment. Keywords: hemoglobin E; lupus nephritis; myocarditis; vasculitis

Background: As global birth rates decline and life expectancies rise, the geriatric population is rapidly increasing. The growing geriatric population worldwide necessitates improved vaccination awareness among older adults to mitigate the increased risk of infectious diseases due to immunosenescence - the gradual deterioration of the immune system with age. The main objective of our study was to create awareness, explain the benefits of adult vaccination and brief about the CDC recommended vaccinations and their schedules. Methods: This is a cross-sectional observational study conducted for 3 months on outpatient basis through a pamphlet survey in around 150 patients. Results: 64.6% of patients completed their Signal-to-Noise Ratio (SNR). Secondary level education and out of them 49.3% of them residing in urban areas doesn’t know about adult vaccination. Conclusion: Findings reveal that patients' decisions are influenced by sociocultural factors, access to information, and misconceptions. The results highlight the importance of targeted immunization programs for older adults and implementing National guidelines in a country like India with highest population can prevent vaccine-preventable diseases, reduce healthcare costs, and improve public health outcomes. Enhanced education and healthcare provider engagement are recommended to address vaccine hesitancy and improve vaccination rates among the elderly, especially in underprivileged communities. Keywords: adult vaccination; awareness; immunosenescence

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants have instigated the global COVID-19 pandemic, which unfolded in waves over nearly three years since its emergence in 2019. Variances in host immune responses have resulted in a spectrum of symptoms ranging from asymptomatic to mild, moderate, severe pneumonia-like, or critical conditions. For many individuals, symptomatic conditions exacerbated and posed life-threatening risks, particularly when co-morbidities such as diabetes mellitus, chronic obstructive pulmonary disease (COPD), cardiovascular diseases (CVD), hypertension, malignancies, and HIV were present. This study was aimed to ascertain the co-morbidity trends across the two major waves of COVID-19. Method: In India, COVID-19 patients from the first wave (April 1, 2020 to January 31, 2021) and the second wave (March 1, 2021 to October 1, 2021) were categorized into asymptomatic, moderate, severe, and critical groups, with 100 patients in each category. These patient groups were further subdivided based on co-morbidities and subjected to data analysis. Results: Diabetes mellitus, hypertension, and lung complications were identified as common co-morbidities significantly impacting the quality of life for COVID-19 patients. Conclusions: Our data analysis has highlighted the influence of co-morbidities or multi-morbidities in exacerbating severe and critical conditions during both waves 1 and 2 of COVID-19 infections. Keywords: co-morbidities; COVID-19; diabetes mellitus; hypertension; lung complications