Indian Journal of Medical and Health Sciences

Renal calculi are a common cause of blood in the urine (hematuria) and pain in the abdomen, flank, or groin. They occur in one in 11 people at some time in their lifetimes with men affected 2 to 1 over women. Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels or excessive urinary acidity. Renal calculi present with excruciating pain and most patients present to the emergency department in agony. A single event does not cause kidney failure but recurrent renal calculi can damage the tubular epithelial cells, which can lead to functional loss of the renal parenchyma.

A cataract is a clouding or opacification of the normally clear lens of the eye or its capsule (surrounding transparent membrane) that obscures the passage of light through the lens to the retina of the eye. This blinding disease can affect infants, adults, and older people, but it predominates the latter group. It can be bilateral and vary in severity. The disease process progresses gradually without affecting daily activities early on, but with time, especially after the fourth or fifth decade, the cataract will eventually mature, making the lens completely opaque to light interfering with routine activities. Cataracts are a significant cause of blindness worldwide. Treatment options include correction with refractive glasses only at earlier stages, and if cataract mature enough to interfere with routine activities, surgery may be advised, which is very fruitful. The WHO/NPCB (National Programme for Control of Blindness) survey has shown that there is a backlog of over 22 million blind eyes (12 million blind people) in India, and 80.1% of these are blind due to cataract. The annual incidence of cataract blindness is about 3.8 million.

The second wave of COVID-19 in early 2021 has caused havoc across the globe and despite a bit flattening curve of SARS-CoV-2 cases in India, another fatal complication known as CAM created chaos in the whole country. An alarmingly high increase in the number of cases led to the healthcare infrastructure inadequacy due to excessive demand for hospital beds, drugs, oxygen, and vaccines. The rhino-orbital-cerebral form is the most common clinical presentation observed. A complex interplay between uncontrolled blood glucose, unjudicial use of corticosteroids and SARS-CoV-2 infection has to an upsurge in CAM cases. The majority of these cases had diabetes as predisposing comorbidity and corticosteroids were administered to treat COVID-19. Probable pathologic mechanisms may involve immunological and inflammatory processes. Diabetes, together with COVID-19 induces systemic immunological alterations, leading to decreased immunity and an augmented risk of secondary infections. Prolonged use of high-dose corticosteroids acts as another risk factor for CAM. The hypoxic conditions in COVID-19, uncontrolled diabetes, steroid-induced hyperglycemia, DKA, and increased ferritin levels due to SARS-CoV-2 mediated immunosuppression provide a perfect environment for the Mucorales spores germination in these patients. The recommended treatment strategies mainly include surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several clinical guidelines focusing on Indian patients have been proposed for accurate diagnosis of infection, identifying clinical presentation, understanding the pathogenesis mechanisms, and tracking the disease course for rapid management of the disease.