ABSTRACT
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by several clinical and immunological manifestations, lacking accurate methods of diagnosis and treatment. This article focuses on the latest research in SLE’s epidemiology, diagnosis methods, and treatment strategies. SLE has a gender-based and ethnicity- based prevalence, with more cases observed in females than males and African population than Caucasians. The diagnosis of SLE is also challenging due to the multifactorial nature of the disease. The diagnosis is generally based on classification rather than diagnostic criteria. Several classification criteria have been proposed, with the most important being ACR-1997, SLICC-2012, and EULAR/ACR-2019. The latest criteria suggested the use of weights linked to different clinical and immunological manifestations. Moreover, several treatment therapies have also been proposed to treat SLE. Anti-malarial drugs are generally regarded as suitable in the earlier stages of SLE. The standard therapy against SLE is mycophenolate mofetil, except for ongoing pregnancy, where azathioprine is used. Currently, different immunosuppressants and immunomodulators are being evaluated in clinical studies against SLE. Anyways, a combination of different therapies might be a holistic approach to the disease, but the heterogenicity of SLE still remains a challenge.

ABSTRACT
Background: Bile duct injury is the most serious complication of laparoscopic cholecystectomy and misidentification is thought to be the most common cause. CVS is a method of exposure of hepatocystic triangle to minimize this injury. Material and methods: This prospective cohort study was conducted in the Surgical Deptt Hayatabad Medical Complex from 1st August 2018 to 31st July 2020. Results: A total of 100 patients were included with 69 females and 31 male patients with age range of 25-70 years and mean age 37 years. The mean procedure time noted was 45 minutes (35-55mins). CVS was achieved in all patients and documented in the form of video or picture as doublet view of hepatocystic triangle. No BDI was noted. Only 01 patient presented with 20ml collection in the gall bladder fossa which was treated conservatively. Conclusion: Achieving CVS during laparoscopic cholecystectomy is a safe way to minimize BDI. Incarporating CVS into our syllabus and guidelines will promote culture of safe laparoscopic cholecystectomy.

ABSTRACT
Tailor is a risky job that impact to low back pain. Low back pain (LBP) can cause a tailor to experience a decrease in the ability to perform daily activities and occupational health problems. One of the low back pain risk factors is individual factors include body mass index (BMI), exercise habits, and working period. This research was observational analytical research with a cross-sectional design conducted at Informal Sector tailor in Solor, Kupang City by filling questioner, body mass index measurement, and direct interview. The sampling technique used was total sampling with 48 samples that fulfilled inclusion and exclusion criteria. The data were analyzed by using the univariate, bivariate with chi-square, and multivariate with logistic regression as well. The bivariate analysis results showed that the results were significant on the variable of body mass index (p=0.012, OR=5.667) and work period (p=0.026). While there was no significant correlation between the variables of exercise habits with the incidence of low back pain (p=0.407).The multivariate analysis results found that the variable of the work period was the variable that had the biggest effect on the incidence of low back pain (OR=0.361). There are correlations between body mass index and work period with low back pain incidence at Informal Sector tailor in Solor, Kupang City in 2019.

ABSTRACT
Background: COVID 19 causes growing numbers of severe diseases with systemic abnormalities like organ dysfunction, thrombosis, and mortality. Disseminated Intravascular Coagulation or DIC is associated with the development of systemic fibrin, which may cause due to increased thrombin expression, concomitant physiological anticoagulant suppression and dysfunctional fibrinolysis. Methods: This study was a retrospective study that was conducted at the department of Clinical Pathology. The study was carried out during the period of September 2021-February, 2022. The total sample size for this study was 50. Result: Most of the respondents 12(24%) were aged from 50-59 years. Most of the respondents 35(70%) were female and 15(30%) were male. D-Dimer findings of most of the patients (44%) were severe. PCT test findings were normal for 34% of the participants, mild for 6%, moderate for 26%, and the remaining 40% had severe PCT levels. Among the 50 cases, both PCT and D-Dimer values were in the normal range for 26% of the participants, while 62% of the participants had raised values (mild, moderate, or severe) in both PCT and D-Dimer tests. Conclusion: From this study, it can be said that levels of D-dimer and PCT are directly linked to the disease severity among the patients with COVID 19.

ABSTRACT
Background: Dehiscence of the facial canal is a matter of great concern for an otologist as one of the most dreaded complications of mastoid surgery is injury to the facial nerve study was carried to determine the intra operative presence of facial canal dehiscence in primary and revision cholesteatoma surgery in a tertiary care centre. And also, our second goal was to identify association between FCD and other intra-operative pathological findings such as labyrinthine fistula, Dural plate dehiscence, sinus plate dehiscence in a group of patients with cholesteatoma surgery. Methods: A retrospective study was carried out in the department of Otorhinolaryngology in a tertiary referral hospital, Gujarat among 302 patients. The study’s inclusion criterion was primary and revision CWU and CWD tympano-mastoidectomy in patients who suffered from (CSOM) with cholesteatoma and exclusion criterion was charts with inadequate documentation. In addition, tympanoplasty cases were excluded as the study evaluated both tympanic and mastoid segments of facial nerve canal. Pre-operative clinical data and intra-operative findings were documented in a formatted questionnaire. Results: It was found that the incidence of FCD in our study of unsafe CSOM surgery was 21.22%. Conclusions: The surgeon should keep in mind during the procedures performed in the middle ear could potentially traumatize or damage the facial nerve at the site of dehiscence. A longer duration and more extensive cholesteatoma increase the chance of finding a dehiscent facial nerve. To this, we can prevent facial nerve paralysis and other complications in post-operative period and reduce the rate of morbidity.

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Purpose: To assess the load of non-urgent and true emergency cases presenting in Emergency department of tertiary eye center in Nepal. Methods: retrospective, descriptive study was done for all emergency visits at Hetauda community eye hospital in 2020. Data on age, gender, address, diagnosis were collected. Diagnosis was classified according to urgency. Results: We had 6526 cases with an average of 18 cases per day. The male to female ratio was 1.47:1. Non-urgent cases comprised of 48% of ED visits. The mean age of patients visiting in ED was 34.18+-19.27 years. Foreign body in cornea was the most common diagnosis while mild conjunctivitis was the commonest cause of non-urgent ED visit. The most common age group to visit as true ocular emergency was 21-30 years with 23.20 %. Males were more likely to visit as true ocular emergency than females. Conclusion: younger males are more likely to use Emergency services. More focus should be done in Triaging, Public education and awareness to reduce non-urgent cases in emergency department.

ABSTRACT
Purpose: The aim of this study was to describe the management of a case of malignant melanoma of the conjunctiva at the National Hospital of Zinder in Niger and review of the literature. Observation: This was a young adult, 46 years old, male, from Agadez, with an unfavorable socioeconomic status, with no particular history referred for an upper left eyelid tumour. On examination, his general condition was preserved. On inspection, a mass hanging from the free edge of the left upper eyelid was noted; resulting in total mechanical ptosis preventing examination of the condition was preserved. On inspection, a mass hanging from the free edge of the left upper eyelid was noted, resulting in total mechanical ptosis preventing examination of the anterior segment. Palpation of the orbital rim did not note anything in particular, the lymph node areas were free. On the ophthalmological examination, on the right the visual acuity from afar without correction was 10/10 with a normal biomicroscopic examination, on the left the visual acuity was counting the fingers at one meter and a biomicroscopy hampered by the ptosis The assessment laboratory was normal, the orbitocerebral computed tomography showed the conjunctival origin of the tumor without notion of extension in the vicinity. Macroscopically complete excision was performed. Histopathological examination of the approximately 5 cm surgical specimen noted a malignant melanoma of the conjunctiva with impregnation of the margins (R1 resection). Adjuvant treatment with mitomycin C was instituted. The postoperative course was simple. After 6 months of postoperative follow-up, the ophthalmological examination was normal and the search for metastases was negative. Conclusion: Malignant melanoma of the conjunctiva is a rare neoplasia that can mimic a palpebral tumor. Histopathological examination remains important for treatment and monitoring.