Bulging Eyes Research Articles

EYE PLASTIC SURGERY FOR SEVERE ORBITOPATHY: RESTORING EYE HEALTH AND QUALITY OF LIFE

Graves' orbitopathy is a complex and debilitating ophthalmological condition often associated with the autoimmune thyroid disease known as Graves' disease. Characterized by inflammation and swelling of the tissues around the eyes, Graves' orbitopathy can lead to a range of serious symptoms, such as proptosis (bulging eyes), diplopia (double vision), eye pain and impaired visual function. Eye plastic surgery emerges as an important therapeutic approach to restore not only ocular health, but also the quality of life of affected patients, aiming to correct the physical and functional deformities associated with the condition. However, critical evaluation of the scientific literature on the topic is essential to understand the effectiveness, safety and results of the different surgical procedures used in this context. Objective: The objective of this systematic review is to analyze studies published in the last 10 years on ocular plastic surgery for Graves' orbitopathy, with the aim of evaluating the effectiveness, safety and results of the different surgical procedures used to treat this condition. Methodology: Using the PRISMA checklist, articles were searched in the PubMed, Scielo and Web of Science databases, published between 2012 and 2020. The descriptors used were "Graves' Orbitopathy", "Ocular Plastic Surgery", "Thyroid Eye Disease" , "Graves' ophthalmopathy" and "eyelid reconstruction". and "eyelid reconstruction". Inclusion criteria: studies in English, evaluating surgical procedures for Graves' orbitopathy, with clinical and quality of life results. Exclusion criteria: duplicate studies, samples unrelated to Graves' orbitopathy and without relevant clinical results. Results: The main topics covered by the studies include surgical techniques, visual results, postoperative complications and impact on patients' quality of life. Conclusion: The systematic review highlights the importance of ocular plastic surgery in the management of Graves' orbitopathy, providing insights into the most effective and safe surgical approaches to restore ocular health and quality of life to affected patients.

Once upon a time in Anatolia: the kings with bulging eyes.

The Hittite Empire, formed by the Hittites who settled in central Anatolia at the beginning of the second millennium BC, has left behind rich archeological remains. In this historical review, statues of the Hittite priest-kings, King Idrimi, King Šuppiluliuma, and King Tarhunza, who ruled in these lands in ancient times, are analyzed. Graves' disease (GD) is the most common cause of hyperthyroidism. Patients with GD are also at risk of developing Graves' orbitopathy (GO). Upper eyelid retraction and exophthalmos (bulging eyes) are common in patients diagnosed with GO. Could the kings who lived in Anatolia at different times in the distant past have suffered from the same disease?

Immunological Processes in the Orbit and Indications for Current and Potential Drug Targets.

Thyroid eye disease (TED) is an extrathyroidal manifestation of Graves' disease (GD). Similar to GD, TED is caused by an autoimmune response. TED is an autoimmune inflammatory disorder of the orbit and periorbital tissues, characterized by upper eyelid retraction, swelling, redness, conjunctivitis, and bulging eyes. The pathophysiology of TED is complex, with the infiltration of activated T lymphocytes and activation of orbital fibroblasts (OFs) and autoantibodies against the common autoantigen of thyroid and orbital tissues. Better understanding of the multifactorial pathogenesis of TED contributes to the development of more effective therapies. In this review, we present current and potential drug targets. The ideal treatment should slow progression of the disease with as little interference with patient immunity as possible. In the future, TED treatment will target the immune mechanism involved in the disease and will be based on a strategy of restoring tolerance to autoantigens.

How patients experience thyroid eye disease.

To determine the impact of thyroid eye disease (TED) on patients in various stages of the disease. TED is a debilitating and potentially sight-threatening inflammatory autoimmune disease that is frequently misdiagnosed. Challenging quality-of-life (QoL) issues can persist long after the active phase of disease has subsided. A 62-question survey was designed as a hypothesis-generating instrument to identify key issues confronting patients ≥18 years old with physician-diagnosed TED. Questions focused primarily on physical and emotional status, and QoL experiences in the 2 months prior to the survey. Data for individual questions are presented as summary statistics. Correlations between questions were determined using χ2 analyses. The 443 respondents were 18 to >80 years old; >90% female, and >80% from the United States. Time since TED diagnosis ranged from <1 year to >10 years. Participants provided >500 free-form responses describing experiences of living with TED. Physical signs/symptoms were experienced by 307/443 (69%) patients. Of those responding to the QoL questions (N = 394), 53 (13%) reported symptoms improving, 73 (19%) reported symptoms worsening, and 255 (65%) reported no change in the 2 months prior to the survey. The most bothersome signs/symptoms were dry/gritty eyes, light sensitivity, bulging eyes, and pressure or pain behind the eyes. Respondents <60 years were significantly (p < 0.0001) more likely to report symptomatic TED than older patients. Of 394 respondents, 179 (45%) reported feeling depressed and/or anxious, 174 (44%) reported concern about their appearance, and 73 (19%) avoided public situations; 192 (49%) reported declines in confidence or feelings of general well-being, and 78 (20%) reported an inability to achieve goals. Activities limited by TED included reading, driving, and socializing. The proportion of respondents experiencing these negative QoL measures was higher when patients reported experiencing >5 symptoms, had been diagnosed within the last 5 years, or were <60 years of age. Physical manifestations of TED impact QoL for patients through all phases of the disease. It is essential that physicians and healthcare professionals become more familiar with patient experiences such as those described here to better help patients manage their disease.

Ablation of myd88 alters the immune gene expression and immune cell recruitment during VHSV infection in zebrafish

Myeloid differentiation primary response protein-88 (MYD88) is an essential adaptor molecule in pathogen-related pattern recognition signaling pathways. Toll-like and interleukin receptors recognize numerous signals and are funneled through MyD88 to express genes responsible for the innate and adaptive immune systems. In the present study, the relevance of MyD88 in viral hemorrhagic septicemia virus (VHSV) was investigated by generating myd88−/− zebrafish. The model was challenged with VHSV, and viral propagation was quantified by evaluating clinical symptoms, mortality, and VHSV copy number. The infected fish showed abnormal morphologies, such as subcutaneous hemorrhages, abdominal swelling, and bulging eyes, which were comparatively more intense in myd88−/− fish than in the wild-type. An injury infection experiment conducted in zebrafish larvae indicated a substantial spread of VHSV in the wound site. The number of neutrophils and macrophages recruited to the wounded area were markedly reduced in myd88−/− fish. According to gene expression analysis, VHSV NP gene expression was considerably upregulated in myd88−/− fish. Substantial gene expression and immune cell marker modulation were observed in the mutant model compared to that in the wild-type. These results suggest that the lack of a significant adaptor protein for immune signal transduction results in enhanced VHSV replication.

The Relationship Between Eye Diseases and Toxic Thyroid Gland: A Concentrated Study

Background: When the thyroid gland becomes overactive or underactive, a variety of health issues may occur, including eye illnesses. Thyroxine (T4) and triiodothyronine (T3) are the two primary hormones produced by the thyroid gland. These hormones are essential for maintaining of proper eye function. When the thyroid gland is hyperactive, it can cause a variety of eye disorders for example Graves' ophthalmopathy. Aim: To explore the potential link between eye disorders and toxic thyroid glands, specifically how hyperthyroidism (an overactive thyroid gland) may contribute to the development of eye conditions like Graves' ophthalmopathy. . The ultimate goal is to enhance patient outcomes through better knowledge and management of these complicated illnesses. Patients and Methods: The second survey questionnaire was completed by 100 patients with thyroid disorders. Several approaches are available to assess the link between ocular problems and toxic thyroid glands. Among these methods are Thyroid Function Tests and a Comprehensive Eye Exam: Thyroid function tests include measuring the plasma levels of TSH, T3, and T4 levels to see if there is an underlying thyroid gland dysfunction which may produce abnormalities in the eyes. Results: The study included 100 patients, with 81% of them being women. Individual ocular problems are more common in male than in female patients. Exophthalmos was reported by about 70% of the men (the most frequently). Patients also frequently reported redness of the eyes (68%), edema or swelling of the eyelids (67%), and ocular dryness (61%). They were less likely to have a hazy vision, but about one-third did. Conclusion: Hyperthyroidism and Graves' disease can lead to eye problems such as bulging eyes, double vision, dry eyes, and sensitivity to light. It is important to have regular eye exams and seek medical attention if any changes occur.

Graves' Ophthalmopathy: A Comprehensive Review of Current Evidence and Management Approaches

Thyroid ophthalmopathy, also known as Graves' ophthalmopathy or thyroid eye disease, is an autoimmune condition that affects the eyes and is often associated with hyperthyroidism, an overactive thyroid gland. It is characterized by inflammation, swelling, and tissue changes in the muscles and tissues around the eyes, leading to a range of symptoms including bulging eyes, double vision, eye pain, redness, and sensitivity to light. The treatment of thyroid ophthalmopathy typically involves managing the underlying thyroid condition, relieving symptoms, and preventing complications. Corticosteroids, such as prednisone, are commonly used to reduce inflammation and swelling in the eye tissues. They can be administered orally or locally through eye drops or injections. Orbital radiotherapy, a form of radiation therapy, may also be used to reduce inflammation in the eye tissues, particularly in cases where corticosteroids are not effective or not well tolerated. In addition to medical treatments, eye protection measures are important in managing thyroid ophthalmopathy. This may include wearing sunglasses to protect the eyes from exposure to sunlight and using lubricating eye ointments at night to alleviate dryness. If eyelid retraction or swelling is present, eyelid management techniques such as lubricating ointments, taping the eyelids closed during sleep, or using moisture chamber glasses may be recommended to protect the cornea and relieve symptoms. Managing the underlying thyroid condition is also crucial in the treatment of thyroid ophthalmopathy. This may involve medications to regulate thyroid hormone levels, radioactive iodine therapy, or surgery to remove the thyroid gland, depending on the individual case. Surgical intervention may also be necessary in severe cases of eye-related complications, such as double vision or optic nerve compression. Surgical options may include decompression surgery, eyelid surgery, or strabismus surgery to realign the eyes. It's important to note that the management of thyroid ophthalmopathy is typically tailored to the specific needs of each patient and may involve a multidisciplinary approach involving endocrinologists, ophthalmologists, and sometimes surgeons. Regular follow-up and monitoring are necessary to assess the effectiveness of the treatment plan and make any necessary adjustments. In conclusion, thyroid ophthalmopathy is an autoimmune condition that affects the eyes and is often associated with hyperthyroidism. Treatment typically involves managing the underlying thyroid condition, relieving symptoms, and preventing complications. Corticosteroids, orbital radiotherapy, eye protection measures, and surgical intervention may be used as part of the management plan. It's important to work closely with a healthcare professional to determine the most appropriate treatment approach for each individual case.&#x0D; &#x0D; Received: 14 January 2023 / Accepted: 26 February 2023 / Published: 20 March 2023

Implementation of Assertive Training to Increase the Ability of Anger Expression in Violent Behavior Patients at RSMM Bogor

Aim: Violent behavior is a feeling of anger, annoyance, emotion, or disappointment that arises and is characterized by a clenched hand, bulging eyes, glaring, loud, and harshly talk that can result in dangerous actions for himself and others, and the environment. Violent behavior can be caused by various factors, both internal and external. One way to deal with violent behavior is by implementing assertive training. Assertive training is an effort to express anger well so that patients can express their annoyance well, ask for help and apologize well. Method: The case study research design involved four subjects chosen based on established inclusion criteria to obtain an overview of the implementation of assertive exercises in increasing the ability to express anger in patients with violent behavior. Result: The main intervention in this paper is the application of assertive exercises for two subjects. After the intervention was carried out three times a day in five days, the result was an increase in ability in assertive training and in expressing anger in patients with violent behavior who implement assertive training. Two patients who did not implement assertive training still had difficulty controlling their anger properly. Conclusion: This case study concludes that assertive training can increase the ability of angry expressions well, such as expressing annoyance well, asking for help well, and rejecting well.

Multiple Eye Disease Detection Using Deep Learning

Human eyes are susceptible to various abnormalities due to aging, trauma, and diseases like diabetes. Glaucoma, cataracts, macular degeneration, and diabetic retinopathy are the leading causes of blindness worldwide. It is crucial to detect and diagnose these eye diseases early to provide timely treatment and prevent vision loss. Multiple eye disease detection through the analysis of medical images can aid in this process. The steps involved in the detection of multiple eye diseases using deep learning include image acquisition, region of interest extraction, feature extraction, and disease classification or detection. In this study, we proposed a model using deep learning algorithms, ResNetand VGG16, to detect eye diseases such as uveitis, glaucoma, crossed eyes, bulging eyes, and cataracts. We achieved a 92% accuracy rate using ResNet50 and 79% accuracy using the VGG16 model. By automating the detection process, we can save time for doctors and increase the accuracy and detection rate. The proposed model can be integrated into the healthcare system to assist in early diagnosis and effective treatment of eye diseases.

Fetalna akranija - prikaz slučaja

Introduction. Acrania is a very rare lethal congenital malformation characterized by an absence of the cranial vault with developed cerebral hemispheres. It is sometimes confused with anencephaly in which both the forebrain and neurocranium are not developed. Although these two conditions principally differ in their morphology and pathogenesis, acrania may be a precursor of the development of anencephaly through the process known as Acrania-exencephaly-anencephaly sequence. Case report. A 27-year-old woman was diagnosed to have a viable fetus with an absent skull vault and uncovered brain directly exposed to amniotic cavity. A diagnosis of acrania was made. A medical abortion was performed in the 14th week of pregnancy. A gross examination of the formalin-fixed fetus revealed a complete absence of the calva and brain tissue. The cranial structures stop abruptly above the orbits and the fetus showed a triangular face with bulging eyes. At the top of the head, a huge defect with a residual thin covering membrane was visible. According to the gross morphology and in correlation with previous ultrasound findings, the pathologist established the diagnosis of secondary anencephaly. Conclusion. This paper suggests that many of the reported anencephaly cases that are diagnosed during the second or third trimester of pregnancy might represent the end of a spectrum that initially appears as isolated acrania. This may be the reason for much higher global incidence of anencephaly compared to acrania.

An Efficient Approach to Predict Eye Diseases from Symptoms Using Machine Learning and Ranker-Based Feature Selection Methods.

The eye is generally considered to be the most important sensory organ of humans. Diseases and other degenerative conditions of the eye are therefore of great concern as they affect the function of this vital organ. With proper early diagnosis by experts and with optimal use of medicines and surgical techniques, these diseases or conditions can in many cases be either cured or greatly mitigated. Experts that perform the diagnosis are in high demand and their services are expensive, hence the appropriate identification of the cause of vision problems is either postponed or not done at all such that corrective measures are either not done or done too late. An efficient model to predict eye diseases using machine learning (ML) and ranker-based feature selection (r-FS) methods is therefore proposed which will aid in obtaining a correct diagnosis. The aim of this model is to automatically predict one or more of five common eye diseases namely, Cataracts (CT), Acute Angle-Closure Glaucoma (AACG), Primary Congenital Glaucoma (PCG), Exophthalmos or Bulging Eyes (BE) and Ocular Hypertension (OH). We have used efficient data collection methods, data annotations by professional ophthalmologists, applied five different feature selection methods, two types of data splitting techniques (train-test and stratified k-fold cross validation), and applied nine ML methods for the overall prediction approach. While applying ML methods, we have chosen suitable classic ML methods, such as Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), AdaBoost (AB), Logistic Regression (LR), k-Nearest Neighbour (k-NN), Bagging (Bg), Boosting (BS) and Support Vector Machine (SVM). We have performed a symptomatic analysis of the prominent symptoms of each of the five eye diseases. The results of the analysis and comparison between methods are shown separately. While comparing the methods, we have adopted traditional performance indices, such as accuracy, precision, sensitivity, F1-Score, etc. Finally, SVM outperformed other models obtaining the highest accuracy of 99.11% for 10-fold cross-validation and LR obtained 98.58% for the split ratio of 80:20.

Strange Creatures of Chu: A Regional Approach to Antlered Tomb Sculptures

Lacquered wooden sculptures of fantastic hybrid beasts adorned with real deer antlers are among the most extraordinary examples of sculpture found in Chu tombs dated from the sixth through the third centuries BCE. Conventionally known as zhenmushou 镇墓兽 or “protecting tomb beasts”, the antlered sculptures have grotesque features, including bulging eyes, fangs, and protruding tongues. In the fourth century BCE, production and use of these sculptures increased and peaked in the Hanxi region of Hubei province. Although most of these figures have been found in tombs in Hanxi (west of the Han River), distinctive variations of antlered tomb sculptures are also documented in regional areas of the Chu polity, including the Nanyang Basin, the Upper Huai, Eastern Hubei, and Jiangnan. Through a systematic regional analysis of Chu antlered sculptures, this paper presents a spatial framework for analyzing this unique genre of Chu funerary sculpture. This approach provides fresh insight into the interregional networks of interaction across the Chu state and beyond, via waterways and the Suizao corridor from the sixth through the third centuries BCE.

ODP615 Emergence of Graves’ Ophthalmopathy in the Setting of Sudden Hypothyroidism: Possible Mechanisms Explored

Abstract Background Ninety percent of thyroid eye disease (TED) patients are hyperthyroid and at least 10% of TED occurs in the setting of euthyroidism or hypothyroidism. When Graves’ hyperthyroidism is diagnosed, 74% may not present with ophthalmopathy. Clinical Case A 58 year old woman diagnosed with Multinodular nontoxic goiter without nodule suspicious for malignancy was carefully monitored. No Levothyroxine treatment started. In 2017, patient had sudden onset of tremors, weight loss and palpitations. There were no signs of thyroid associated orbitopathy. Her TSH was &amp;lt;0. 009 uIU/ml (0.30-4) and FT4 29. 06pmol/L (10-22). Thyroid scan showed elevated 2- and 24-hours RAI uptake (as high as 80%) in both lobes. She was started on Methimazole but developed adverse reactions hence RAI (10 mci) was given. A month after RAI, she was rendered hypothyroid with of TSH 73.48uIU/ml (0.27-3.75), FT4 2.257pmol/L (8.8-44). She was maintained on Levothyroxine and remained euthyroid for four years. One year post RAI, ultrasound showed a small sized thyroid gland (right lobe: 3×0.6×1.5cm and left lobe: 2.2×0.3×1.3cm). May 2021, she followed up due to bulging eyes with scratchy sensation. She was noncompliant with Levothyroxine for several months. TSH was elevated to 46.19 uIU/ml (0.3-4. 00) and FT4 12.35 pmol/L (10.20-22.50). Levothyroxine dose was adjusted and repeat TSH was normal to 0.38 uIU/ml (0.30-4. 00) with FT4 of 22.40 pmol/L (10.20-22.50). Despite euthyroidism, there were progressive eye protrusion, conjunctival redness, pain and blurring of vision. TSHrAb was elevated to 21.62 U/L (N: &amp;lt;1 U/L). TSI was elevated to 6.59 IU/L (N: &amp;lt;0.10). . MRI of the orbit showed findings suggestive of Graves’ ophthalmopathy. She was started on Prednisone 60mg/day. Repeat TSHrAb was 9.85 U/L (&amp;lt;1U/L) after 3 weeks of steroids. Levothyroxine was stopped to check whether she had recurrence of Graves’ disease. When Levothyroxine was discontinued, there was worsening of eye disease and it was confirmed that patient was hypothyroid with TSH of 48.91 uIU/ml (0.55-4.78). Levothyroxine was resumed at 100mcg 1 tablet once daily and continued with Prednisone in tapering doses. Conclusion There were possible mechanisms that can lead to Graves’ ophthalmopathy in patients who had RAI and suddenly became hypothyroid. The rapid and protracted hypothyroidism caused increased secretion of TSH that stimulate antigen production by thyrocytes or induce proliferation in retro-orbital preadipocytes which express the TSH receptor. The protracted hypothyroidism can also be related to fluctuating TSHrAb post RAI. It was suggested that remission of TSH-receptor autoimmunity after RAI is less common. Clinicians should acquire baseline and monitoring of TSHrAb or ophthalmology consultation for all patients undergoing RAI regardless of whether they have eye signs or not. Maintenance of euthyroidism will help prevent emergence of Graves’ ophthalmopathy. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

The controversial case of Cosimo I de’ Medici (1519-1574): reflections on the interaction between anatomy and art (iconodiagnosis vs misdiagnosis)

A recent study maintains to have identified a case of severe Graves’ disease in the bronze statue of Cosimo I de’ Medici forged by Benevenuto Cellini (between 1545 and 1547). We carefully examined the artistic sources, the medical primary sources and the paleopathological findings with the aim of showing that Cosimo I de’ Medici (1519-1574) was not affected by severe Graves’ disease. The artistic analysis of different statues and portraits of the Grand-Duke of Tuscany confirms the medical interpretation. Cosimo I was thick-necked with a well-developed laryngeal prominence of the thyroid cartilage (Adam’s Apple) and slightly bulging eyes. Plagued by obesity, Cosimo I was affected by DISH (diffuse idiopathic skeletal hyperostosis), chronic malaria, and severe osteoarthritis. The Grand Duke had a stroke on February 18th 1568, aged 49, and suffered from the sequelae for six years. Previous scholars proposed chronic cerebral vasculopathy as a possible diagnosis. We surmise that, as in modern day obese patients with DISH, he had increased risk for cardiovascular morbidity. The presence of a familiar thick-neck and a well-developed Adam’s Apple can be observed in several other members of the Medici family such Giovanni dalle Bande Nere, Cosimo I de’ Medici’s father. The same features can also be found in several other predecessors of Cosimo I such as Piero the Gouty and his sons Lorenzo the Magnificent and Giuliano de’ Medici, Pope Leo X, Giuliano de’ Medici, Duke of Nemours and Lorenzo de’ Medici, Duke of Urbino. This paper shows that the combination of literary, artistic, paleopathological sources is fundamental to correctly assess disease manifestation. A constant interaction between anatomy and art is recommended so to avoid over-interpretation of pathologic conditions in personages of the past.

Metonymy to Describe Concept DOUBT in English Artistic Discourse

The article explores the concept of DOUBT from the perspective of an idealized cognitive model of the world and focuses on the conceptual metonymy used to describe the concept. DOUBT has a dual nature and refers to the realm of thinking and the realm of feelings. DOUBT is considered as an emotional concept, since doubt is experienced according to the scheme "cause -&gt; existence of emotion -&gt; expression". Doubt is a mixed state and often includes other emotions such as irritation, restlessness, discomfort, indignation, anger, fear, interest, surprise, fear, regret, guilt, shame, joy, hope. The conceptual metaphor method helps address DOUBT through the basic conceptual metonymy EMOTION EFFECT FOR EMOTION, categorized into expressive, physiological, and behavioral response types. A number of conceptual metonymies highlighted by Z. Kyovechesh are common to emotional concepts and DOUBT, they include FACIAL EXPRESSION MEANS EMOTION, INABILITY TO SPEAK MEANS EMOTION, PHYSICAL EXCITEMENT MEANS EMOTION, INABILITY TO MOVE MEANS FEAR. Expressive metonymies include INTENT AND FIXED LOOK, BULGING EYES, NARROWING OF EYES, EYE BLINK, EYEBROWS MOVEMENT, LIPS MOVEMENT, MOUTH OPEN, MOCKERY, FACIAL EXPRESSION CHANGE for DOUBT. Physiological metonymies include DECREASED HEART-BEAT and INABILITY TO ACT for DOUBT. Behavioral metonyms include SHOULDER SHUG, HEAD SHAKING, BODY TILTING, DISTANCE CHANGE, HOLDING OBJECTS for DOUBT. Behavioral language metonyms include PAUSE, UNINTELLIGIBLE SPEECH, WHISPER and STAMMERING for doubt. It is promising to study other emotional concepts and distinguish their prototypical universal correlates and those specific to a particular linguistic culture.

Quality of Life in Patients with Chronic Thyroid Eye Disease in the United States.

IntroductionThyroid eye disease (TED) is an autoimmune condition producing ocular pain, dysmotility, and ocular structure and function changes. As disease activity changes, redness, swelling, and pain can improve, but eye comfort, appearance, and motility alterations often persist. There are limited data on chronic TED patient-reported outcomes. This study examined chronic US TED patient-reported symptoms and quality of life (QOL).MethodsExisting data from an online survey regarding chronic TED signs/symptoms and patient QOL were retrospectively examined. The Graves’ Ophthalmopathy QOL instrument (GO-QOL; 0–100, 100 = highest QOL) evaluated overall, appearance, and vision-related QOL. Influencing factors were examined by stratifying patients into low (overall QOL ≤ 50), moderate (> 50 and < 75), and high (≥ 75) QOL categories.ResultsOne hundred patients (47 women, 81 Caucasian, 45.2 ± 7.6 years) were included. The duration of inactive TED was 3.0 ± 4.6 years and total duration of TED was 5.8 ± 5.9 years. Patients reported an average of 20 doctor visits/year and high prevalence of anxiety (34%) and depression (28%). Prior TED treatments for the polled population included systemic corticosteroids during active TED (25%), orbital radiation (5%), and surgery (25%). The overall GO-QOL score was 60.5 ± 21.8 (vision-related: 58.6 ± 24.0, appearance-related: 62.3 ± 25.1). Patients with low QOL more frequently reported hypothyroidism, anxiety, and a larger number of chronic TED signs/symptoms (average: 4.2). Compared to high QOL patients, low QOL patients had more pain (39% vs. 13%), blurry vision (30% vs. 17%), and diplopia (27% vs. 3%, all p ≤ 0.025). Additionally, the low QOL group more often had TED-specific surgical history (45% vs. 10%, p = 0.002), more often reported disability/unemployment (21% vs. 3%, p = 0.055), and had a higher number of doctor visits (40 vs. 5 visits/person/year, p < 0.001).ConclusionTED severely impacts patient QOL, despite becoming stable and chronic. Patients reported vision and appearance impairment and psychosocial impact long after acute TED had subsided.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00385-8.

Bapang Mask's Symbolic Power in the Attempt to Break Muri's Record in Malang District

Bapang mask is one of the figures in Malang’s puppet show, which is unique compared to other masks. It has a long nose and a sharp, red-colored face with bulging eyes. It possesses a manly character and enjoys flattery, and is a symbol of the legitimacy of the Malang district government’s power. The symbol of the Bapang mask in MURI’s record-breaking attempt is a practice of power that legitimizes culture in dominating the domain of a discourse struggle (between politics and preserving culture). This study describes Bapang mask’s symbolic power in breaking the MURI’s record in Malang district. This qualitative study used interviews, document analysis, and observations, which were analyzed using a poststructuralist approach through Pierre Bourdieu’s theory of practice. The results of the study revealed that the symbolic system through the discourse of preserving Bapang masks in MURI’s record-breaking attempt is a representation of a symbolic system capable of producing power on political and cultural domination. This symbolic power forms the legitimacy of truth in the attempt to preserve traditional arts using Bapang mask.&#x0D; Keywords: symbolic power, discourse, preserving

Investigating the 2017 Erratic Fishkill Episode in the Jhelum River, Kashmir Himalaya

Globally, the frequency of fishkill episodes is increasing, owing to natural and human-induced modification of aquatic ecosystems. A massive fishkill took place on 22 October 2017 along an approximately 1.5 km stretch of the Jhelum River in Srinagar City, India. Thousands of fish died during this specific event, not lasting more than three hours, creating chaos and panic among the local population and government circles. In this context, affected fish were assessed for three morphological parameters, which include skin color, eye appearance, and skin texture. To back our findings, three critical water-quality parameters, including pH, water temperature, and dissolved oxygen essential for the survival of fishes were assessed in the affected river stretch. This study assumes importance given that water-quality observation stations for monitoring the health of the Jhelum River are lacking in the highly urbanized Srinagar City. The morphological examination of fish samples revealed discoloration, bulging eyes, and rough skin texture, indicating chemical contamination of waters in the affected river stretch. The water quality analysis revealed neutral pH (7.2), normal temperature (15.6 °C), and mildly depleted dissolved oxygen (6 mg L−1) levels. While the morphological examination of the affected fish indicated chemical contamination, the physicochemical parameters exhibited a typical scenario of river water. For avoiding any such further incident and to precisely ascertain the cause of such fishkill episodes in future, it is suggested that a few continuous water-quality monitoring sites along Jhelum River should be set up, supplemented with robust ecological modeling simulations.

Management Practices, Farmers' Knowledge of Diseased Fish, and Their Occurrence in Fish Farms in Nyeri County, Kenya.

In this study, fish farmers' management practices, occurrence, and knowledge of fish diseases in Nyeri County, Kenya, were evaluated. Fish farming management practices for small-scale farmers in Kenya have numerous challenges which have led to disease occurrence and reduced production. Moreover, the impact and association of these challenges to farmers' knowledge of fish diseases and their burden has not been fully studied. A semistructured questionnaire was used to capture farmers' biodata, fish species farmed, and farmers' management practices such as handling of nets, pond fertilization, and disposal of fish waste. Farmers' knowledge of fish diseases was based on their ability to identify independent and dependent variable indicators. Independent variables included clinical signs, decreased feeding, bulging eyes, floating on water, abdominal swelling, bulging eyes, abnormal skin color, reduced growth, and abnormal swimming with fish death as were the dependent variable. A total of 208 farmers were interviewed and included those of tilapia (134), mixed tilapia and catfish (40), catfish (22), rainbow trout, and five dams under cooperative management. Tilapia was the most kept fish species (66.8%) followed by polyculture of tilapia and catfish (20%) and rainbow trout (2%). Most respondents were male (78.5%) over 51 years of age (50%). Fifty percent of the respondents had secondary school education. There was a significant association between deaths and sharing of nets in Kieni East subcounty (p=0.0049, chi-square), while on-farm fish waste disposing appeared to cause higher deaths compared to burning of the waste although not statistically significant (p=0.13). Few respondents observed decreased feed uptake (<20%) and poor growth. Fifty-seven percent of farmers reported mortalities. Fish poor growth, floating in water, and management practices in subcounties had significant effect on fish deaths. The farmers had knowledge of signs of diseased fish, but there was paucity of knowing the specific causes of disease. Farmers need to be empowered on best aquaculture husbandry to avoid disease transmission and specific fish disease signs to enhance proper reporting of disease for subsequent mitigation measures.

Endovascular Embolization of a Paracavernous Arteriovenous Fistula Through a Cortical Venous Access: 2-Dimensional Operative Video.

We present the case of a 62-yr-old female with a right bulging eye and intermittent headaches. A T2 weighted magnetic resonance image revealed a dilated serpiginous vessel in the right orbit and abnormal flow voids lateral to the orbital apex. The right internal carotid contrast injection demonstrated a dural arteriovenous fistula (dAVF) fed by the ophthalmic artery and drainage into the ipsilateral superficial middle cerebral veins (SMCVs) and the basal vein of Rosenthal without opacification of the cavernous sinus. A fistulous pouch was identified anterolateral to the carotid siphon. The venous phase of the left internal carotid injection demonstrated the bilateral cavernous sinuses, suggesting no involvement of the cavernous sinus with the fistula. Concerning the risk of future hemorrhagic events, endovascular treatment was recommended. Considering the robust connection of the cortical draining vein with the superior sagittal sinus (SSS), a transvenous embolization was performed. The lesion was accessed through the SSS and the right SMCV and embolized with platinum coils, resulting in complete fistula obliteration without any complications. The SMCVs can drain into paracavernous venous structure, which independently presents lateral to cavernous sinus.1,2 Because incomplete embolization of this fistula through cavernous sinus can alter the shunt flow toward cerebral veins, we did not get into the fistula site through the cavernous sinus using conventional methods. Transvenous access through a cortical bridging vein is an efficient alternative for endovascular embolization of paracavernous dAVFs. Patient approval and consent was obtained prior to the procedure and for submission of this article.