Lichen Planus in Four Clinical Forms.

Lichen planus is an autoimmune disorder which comes under lichenoid reactions. It is T-cell mediated cytotoxic reaction directed against antigen expressed by basal cell layer of the oral mucosa. Autoreactive T-lymphocytes may be of primary importance for the development of oral lichen planus. Lichen planus presentations in the oral cavity are in 6 forms: Reticular, papular, plaque, bullous, erythematous and ulcerative. We present a case report of 4 forms in a patient.

Nocardia asteroides canaliculitis: A case report of uncommon aetiology.

Ocular nocardiosis is an opportunistic infection and is believed to be a rare entity. We describe a rare case report of a patient with culture-positive Nocardia asteroides canaliculitis who presented with complaints of watering, purulent discharge and painful swelling of left lower eye lid. A purulent tenacious material was expressed from the punctum of lower eye lid and subjected to microbiological investigations such as smears and cultures. Smears and culture proved the presence of Nocardia asteroides in the sample collected from punctum.

Epidemiology of bacterial keratitis in a referral centre in South India.

PURPOSE: To study the epidemiological characteristics of bacterial keratitis seen at a tertiary eye care referral centre in south India. METHODS: A retrospective review of medical records of all culture-positive bacterial keratitis which were seen over a 3 years period, from September 1999 through August 2002 was performed. After clinical evaluation corneal scrapings were collected and subjected to culture and microscopy using standard protocols in all patients. RESULTS: Out of 3183 corneal ulcers evaluated, 1043(32.77%) were found to be of bacterial aetiology. A total of 1109 bacterial pathogens were isolated from 1046 eyes with keratitis. The predominant bacterial species isolated was Streptococcus pneumoniae (37.5%). Males were 592(56.76%) and 451(43.24%) were females. There were 564(54.07%) rural residents and 479(45.93%) urban residents; this difference was statistically significant (pp< 0.0001). Co-existing ocular diseases predisposing to corneal ulceration were identified in 703(67.4%) patients, compared to other predisposing risk factors in 340(32.6%) patients. One hundred and seventy seven (16.97%) had corneal injury with soil and/or sand, compared to 115(11.03%) patients who had injury due to other materials and the difference was statistically significant. There was lower incidence of bacterial keratitis from June to September. CONCLUSIONS: The epidemiological characteristics of bacterial keratitis vary geographically. This study describing the features of bacterial keratitis would greatly help the practising ophthalmologist and other medical practitioners in the management of their patients.

Nocardia asteroides keratitis in South India.

PURPOSE: To determine the risk factors, microbiological features, clinical features and other epidemiological characteristics of Nocardia keratitis seen at a tertiary eye care centre in south India. METHODS: We evaluated 31 patients with Nocardia keratitis seen over two years, from September 1999 to September 2001. Corneal scrapings were subjected to microscopy and culture using standard protocols. RESULTS: Out of 2184 corneal ulcers cultured, 31(1.42%) were found to be Nocardia asteroides. All 31(100%) were detected correctly by 10% potassium hydroxide wet mount preparation. The highest percentage of isolates was susceptible to gentamicin(100%) followed by ciprofloxacin(93.55%). Twenty four (77.42%) patients were from rural areas; 22(70.97%) were agricultural workers; 29(93.55%) had history of trauma; 2(6.45%) had previous ocular surgery; 28(90.32%) had ocular injury with soil and sand; and 22(70.97%) had ocular injury while working in the agricultural fields. Ten (32.26%) patients presented at our institute between 15 to 35 days of onset of illness, 26(83.87%) had previous medical treatment, and 15(48.39%) patients had used traditional eye medicines. The average age of the patients was 46.16 years, with a range of 11 to 75 years. No seasonal variation was observed. CONCLUSIONS: A high index of suspicion of Nocardia infection should exist in patients with a history of trauma to the eye by soil or sand. The organisms are sensitive to commonly used topical ocular antibiotics.

Aetiological diagnosis of microbial keratitis in South India - A study of 1618 cases.

PURPOSE: To identify the specific microbial pathogens responsible for corneal ulceration in South India and compare these profiles with other series. METHODS: All patients with infectious keratitis who presented between 20th September 1999 and 31st March 2001 were evaluated. They were examined by slit-lamp biomicroscopy and corneal scrapings were performed for cultures and smears by using standard protocols. RESULTS: In the 18 months period, 1618 patients with corneal ulcerations were evaluated. Corneal cultures were found to be positive in 1126(69.59%) patients. Of the 1618 patients, 566(34.98%) had bacterial growth, 522(32.26%) had fungal growth, 30(1.85%) had mixed bacterial and fungal growth, 8(0.49%) had Acanthamoeba species growth and the remaining 492(30.41%) were found to be culture negative. The predominant bacterial pathogen isolated was Streptococcus pneumoniae representing 41.85%, followed by Pseudomonas aeruginosa 21.25%. The predominant fungal pathogens isolated were Fusarium species (45.85%) followed by Aspergillus species (24.37%). CONCLUSIONS: Bacterial and fungal infections occurred almost with equal frequency, the predominant bacterial and fungal species isolated being Streptococcus pneumoniae and Fusarium species respectively. The findings of our study show that there is a region wise variation in the predominance of corneal pathogens. This has an important public health implication for the initiation of therapy.

Effect of two types of Indian breakfast on bioavailability of cefuroxime axetil.

BACKGROUND & OBJECTIVES: The oral bioavailability of cefuroxime axetil is enhanced by food. This study was done to compare the effect of two types of Indian breakfast on the bioavailability of cefuroxime axetil in healthy volunteers. METHODS: Eight healthy male volunteers participated in the crossover study. Subjects were randomized to receive either one of the two types of breakfast, Diet-A or Diet-B, 10 min before single dose of 500 mg cefuroxime axetil. After a washout period of one week the study was repeated with the other type of diet. Diet-A included idly with chutney. Diet-B included poori and dal-fry. Blood samples for pharmacokinetic analysis were obtained prior to dosing and at 0.25, 0.50, 0.75, 1.0, 1.5, 2.0, 2.5, 3.0, 4.0, 5.0, 6.0 and 8.0 h following dosing and urine collections were done for 8 h. The serum and urine samples were assayed by using HPLC. RESULTS: The AUC and Cmax were significantly increased after oral administration of cefuroxime axetil with Diet-B, when compared to Diet-A (P < 0.01 and P < 0.02 respectively). The values of apparent absorption rate constant, lag-time, Tmax and t1/2 beta for the two regimens were not significantly different. The volume of distribution and plasma clearance for cefuroxime were significantly lower (P < 0.02, P < 0.001 respectively) in the regimen with Diet-B. The 8 h urinary recovery of cefuroxime was 16.59 and 28.44 per cent (P < 0.005) with Diet-A and Diet-B respectively. INTERPRETATION & CONCLUSIONS: The administration of cefuroxime axetil with poori and dal-fry may enhance the bioavailability when compared with idly and chutney.

Central venous catheter related infections.

Infusion therapy carries a substantial risk of producing iatrogenic sepsis, bacteremia or fungemia originating from the device used for vascular access or from the contaminated infusate. This study, a semiquantitative assay of the central venous catheter tips (CVC) was carried out and correlated with the blood culture results to determine the probable cause of sepsis in our post operated patients. One thousand six hundred and thirty one surgeries were performed in the Institute of Cardio-Vascular Diseases from January to December 1997. We received 150 CVC tips which were in place for more than five days for culture. Fifty one (51) CVC tips showed growth in either contents or roll. There was associated blood stream infection in 23 patients. The age groups of patients ranged from two months to 67 years and male to female ratio was 109:41. Children below the age of 12 years were 62 in number. Candida spp. (32.4%) and Staphylococcus spp. (33.9%) formed the predominant isolates from the CVC tips.