Purpose: It was the aim of this study to determine any possible correlation between the peaks and changes in intraocular pressure (IOP) of a water drinking test and intravenous methylprednisolone pulse therapy (IVMPT) IOP response. Methods: Patients with rheumatic disorders scheduled for IVMPT with normal ocular examination received a WDT before and after 3 days of IVMPT. The maximum value of IOPs detected during the WDT or IVMPT was regarded as peak IOP, and IOP change was defined as the difference between peak IOP and baseline IOP. Results: The mean ± standard deviation (SD) IOPs on the first (21.9 ± 4.6 mm Hg; p = 0.04), second (21.9 ± 4.1 mm Hg; p = 0.03) and third (21.3 ± 4.2 mm Hg; p = 0.01) days of 20 enrolled patients were greater than that at baseline (19.3 ± 2.8 mm Hg). The mean ± SD of peak IVMPT IOP response was 23.9 ± 3.7 mm Hg, and IVMPT IOP change was 4.6 ± 3.7 mm Hg. These values for the first and second WDTs were 22.9 ± 4.9 and 3.9 ± 4.07 as well as 24.1 ± 4.6 and 3.00 ± 2.9 mm Hg, respectively. A significant correlation was observed between the first WDT and IVMPT IOP changes (r = 0.5, p = 0.007) and peak IOPs (r = 0.6, p = 0.001). Conclusion: WDT, a low-cost and feasible test in clinical practice, may be a useful tool in determining the IOP peak and change following IVMPT.

Spreading COVID-19 disease caused by coronavirus 2 causes tremendous health challenges worldwide. Owing to a high transmission rate, fast-spreading disease, asymptomatic carriers, and high infectivity, we observe a pandemic status that we follow today. Although there are different reports of case fatality rates around the globe, the primary determinant of mortality is age. Symptoms of COVID-19 disease vary from asymptomatic individuals to severe acute respiratory distress syndrome (ARDS) and death. The most common complication of COVID-19 is ARDS. Hyperinflammation due to excessive immune response to coronavirus is the leading cause of severe symptoms seen in the course of COVID-19. The virus enters cells utilizing the S1 subunit through the ACE2 receptor. The innate immune response is the primary immune reaction to virus entry. RNA viruses, including coronavirus, replicate in the cytoplasm, assemble, and then exit by exocytosis. Some suggest that SARS-Cov2 uses cell-cell fusion to infect adjacent cells. Different sensors detect the virus particles in the endosomal compartment and cytoplasm, and infected cells induce an immune response to surrounding cells. As a result, the production of cytokines and chemokines such as interferons (INFs) will be augmented. Since coronavirus uses different means to evade the immune system, it is difficult for immune cells to "sense" them; thus, the coronavirus response is not adequate. It has been showing that even a sufficient level of immunoglobulin response couldn't neutralize virus replication. Therefore, the innate immune response is unable to eradicate SARS-Cov2, causes overexpression of cytokines and chemokines that cannot eliminate the virus. Diminished INFs secretion and apoptosis of regulatory T cells (Treg) are the leading cause of dysregulated immune response in a cytokine storm. Inflammatory cells attack infected and uninfected cells, causing more inflammation How to cite this paper:

Ovarian cancer is the second most common gynecologic cancer after uterine cancer in the United States. Ovarian cancer ranks sixth in cancer deaths among women, accounting for more deaths than other female reproductive system cancers. Breast metastasis in ovarian cancer is a rare presentation and predicts a poor prognosis and challenging management. Our case is a 42-year-old Chinese woman with high-grade serous ovarian carcinoma that presents with metastasis to the breast during the course of her illness. Genetic evaluation of the ovarian tumor showed two BRCA1 pathogenic variants. Germline pathogenic variant of c.2110_2111DelAA and a somatic variant of c.4071_4096+14del40. Our patient was offered different treatment regimens but showed progression of her disease. The low survival rate and high recurrence rate in ovarian cancer show that we still need to investigate our current approved treatments. Our report aims to shed light on the genetic evaluation of ovarian tumors and treatment options available in refractory cases of progressive ovarian cancer. Furthermore, we explain our investigational therapy regimen and the reasoning behind it.