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Corneoscleral tunnel infection is a potentially sight threatening complication of cataract surgery. Microbiological investigations are mandatory and early surgical intervention helps in achieving favourable outcomes. Fungal infection of tunnel incisions can pose a diagnostic and therapeutic challenge. We report a case of post-operative tunnel infection with curvularia. Prompt surgical intervention and intensive topical therapy helped attain a good tectonic as well as visual recovery.
ABSTRACT
Identification of Acanthamoeba cysts and trophozoites in cases of keratitis is traditionally done with microbiological techniques such as smear examination with 10% potassium hydroxide (KOH) and culture. Double walled cyst with hexagonal inner wall is characteristic of Acanthamoeba. We report a unique case of a 9 year old boy who presented with dense anterior corneal stromal infltration, which on smear examination showed atypical double walled spherical cysts, leading to a diagnostic dilemma. An 18S rRNA gene-based PCR done on the growth on culture, subsequently identifed a rarely reported species of Acanthamoeba. The patient was advised combination therapy with polyhexamethylene biguanide (PHMB 0.02%) and chlorhexidine (0.02%) eye drops. Three weeks post treatment, the keratitis resolved with scarring and vascularisation and visual acuity improved to 20/60. At 8 weeks follow up Best corrected visual acuity further improved to 20/30 with contact lens.
ABSTRACT
Purpose: To understand trends, awareness, influences and barriers to eye donation in Indian society. Methods: This cross sectional study was conducted in Delhi from March 2017 to February 2018. About 10 hospitals collaborated with the Eye Bank under Human Cornea Retrieval Program (HCRP). Eye Bank recruited Eye Donation Counselors (EDCs) to approach family members of the deceased. A pretested questionnaire was used for this study. Irrespective of whether the next of kin of the deceased consented for eye donation or not, the option of participating in the survey was given. Results: Out of 473 potential donors identified, 407 (86%) next of kin consented to participate in the study. Of these, 388 (95.3%) were males and 19 (4.7%) were females. About 168 (41%) consented for eye donation and were assigned to donor group, while 239 (59%) participants refused eye donation and were assigned to non-donor group. Majority of the participants were siblings 170 (41.8%) of the deceased and the mean age of the deceased was 42.71 ± 17.56 years. The foremost concern before decision-making was transparency in how the cornea would be used (32.25%). The concern with regards to whether the body would remain intact after eye donation significantly decreased the probability of consent for eye donation. Conclusion: The study highlights that barriers to eye donation in India are not cultural or religious but more due to misinformation and proper utilization of the donated tissue. This study also emphasizes the pivotal role of EDC's in facilitating the eye donation movement.
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Background and Objectives: Urban adolescents in the Indian society are exposed to numerous-emotionalissues due to changing socio-economic environment evolving in the urban middle class and lower middleclass societies across the country. This is compounded by the severe competitive ferocity to build theirlivelihood on the basis of academic performance. Performance in academic evaluations in the adolescentperiod forms the basis of entry into professional and vocational programs leading to a career choice. Whilesome students cope with the adversities with fortitude, many students do not have the necessary coping skillsto overcome adversities. Academic resilience is the ability to overcome psychological pressure imposed bysocio-economic adversities and yet perform well in the academic evaluations. This variation in academicresilience determines who continue to thrive despite adversities and those who fall be the way side.Accordingly, there is a need not just to enhance the scholastic skills in adolescents but also work on theiracademic resilience through appropriate counselling methodologies. The objective of this study is to analysethe nature of relationship between academic resilient traits and their actual performance in scholastic tests.The study is carried out in a sample of high school students studying in Public school and come from lowsocio-economic background. This profile of students is highly susceptible to stressful conditions coupledwith low societal support mechanisms to overcome them.Methods: The resilience and scholastic performance are measured using appropriate inventories backed bysecondary data on their school marks. The data has been subjected to statistical analysis to understand thenature of relationship between the variables.Results: The study reveals that there is a significant correlation between level of resilience and the scholasticperformance of students after eliminating the outliers. There is no significant difference between girls andboys with respect their scholastic abilities as well as their resilience attributes. The study reveals that earlyadolescents are less resilient compared to late adolescents. A phenomenological study of the outliers revealsthe impact of environmental protective factors and innate scholastic abilities on their scholastic performance.Conclusion: Based on the outcome of the studies, appropriate counselling interventions can be developedto enhance the resilience capabilities & scholastic skills of adolescents so that their academic performancemay be enhanced leading to their ability to pursue the career of their choice and their capabilities.
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Purpose: The aim of this study is to identify quality indicators of the eye bank and validate their effectivity. Methods: Adverse reaction rate, discard rate, protocol deviation rate, and compliance rate were defined as Quality Indicators of the eye bank. These were identified based on definition of quality that captures two dimensions – “result quality” and “process quality.” The indicators were measured and tracked as part of quality assurance (QA) program of the eye bank. Regular audits were performed to validate alignment of standard operating procedures (SOP) with regulatory and surgeon acceptance standards and alignment of activities performed in the eye bank with the SOP. Prospective study of the indicators was performed by comparing their observed values over the period 2011–2016. Results: Adverse reaction rate decreased more than 8-fold (from 0.61% to 0.07%), discard rate decreased and stabilized at 30%, protocol deviation rate decreased from 1.05% to 0.08%, and compliance rate reported by annual quality audits improved from 59% to 96% at the same time. In effect, adverse reaction rate, discard rate, and protocol deviation rate were leading indicators, and compliance rate was the trailing indicator. Conclusion: These indicators fulfill an important gap in available literature on QA in eye banking. There are two ways in which these findings can be meaningful. First, eye banks which are new to quality measurement can adopt these indicators. Second, eye banks which are already deeply engaged in quality improvement can test these indicators in their eye bank, thereby incorporating them widely and improving them over time.
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Purpose: The purpose of this study is to evaluate the effect of transfer of donor corneal tissue from McCarey朘aufmann (MK) medium to Optisol-GS on corneal endothelium. Methods: This was a prospective, randomized comparative study. Twenty paired human donor corneal tissues of optical quality were retrieved. One tissue of the pair was preserved in Optisol-GS preservative medium (Group A) and other tissue of the pair in MK medium (Group B) at the time of corneoscleral disc excision. Within 12 h of retrieval, each cornea was evaluated using slit-lamp biomicroscopic examination and specular microscopic analysis. Group B corneas were transferred to Optisol-GS medium within 48� h of retrieval. Specular analysis of the paired corneas was repeated 3 h after transferring to Optisol-GS. On day 7 of storage, specular analysis of both the tissues was repeated. Results: The average age of the donor at the time of death was 29 years (16� years). The reduction in endothelial cell count, from baseline, in Groups A and B was 5.5% and 5.8% (P = 0.938) on the 3rd day and 8.2% and 12.6% (P = 0.025) on the 7th day, respectively, postretrieval. The coefficient of variation (CV) increased by 36% (P = 0.021) and hexagonality reduced by 19% (P = 0.007) on day 7. All tissues retained an endothelial cell density higher than the accepted critical level for penetrating keratoplasty. Conclusion: Significant endothelial cell loss was noted while transferring tissues from one medium to another, necessitating the need for reevaluation of transferred tissues before utilization.
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CONTEXT: Rigosertib, a potent, multi-kinase inhibitor that selectively induces mitotic arrest and apoptosis in cancer cells and is non-toxic to normal cells, is being developed for the treatment of solid tumors and hematological malignancies. AIMS: To determine the safety, doselimiting toxicities, and clinical activity of rigosertib administered by 2-, 4-, or 8-hour continuous IV infusion twice-a-week for 3 weeks out of a 4-week cycle in patients with advanced solid tumor or hematological malignancies; and to confirm the safety and tolerability of the recommended phase 2 dose (RPTD). SETTINGS AND DESIGN: Phase 1, open-label, dose-escalation study in men and women ≥18 years of age. MATERIALS AND METHODS: An escalation phase optimized the duration of infusion (2, 4, or 8 hours) of 3200 mg rigosertib twice-a-week for 3 weeks of a 4-week cycle; an expansion phase confirmed the maximum tolerated dose (MTD). STATISTICAL ANALYSIS USED: All data summaries were descriptive. PK parameters were estimated using compartmental analysis. RESULTS: 25 patients (16 male, 9 female, 26- 66 years, all Asian) were treated with rigosertib, 16 in the escalation phase; 9 in the expansion phase. MTD was determined to be 3200 mg as a 4-hour infusion and 2400 mg over 4 hours was declared to be the RPTD. Best response was stable disease in 5 of 14 evaluable patients, with a mean (range) of 90 (43-108) days. CONCLUSIONS: 2400 mg rigosertib as a 4-hour infusion was identified as the RPTD. Five patients achieved stable disease lasting 6-16 weeks.