RESUMEN
Purpose: To evaluate the efficacy of liposomal amphotericin B (L?AMB) for the treatment of fungal keratitis. Methods: Patients with fungal keratitis confirmed by potassium hydroxide (KOH) smear and/ or confocal microscopy were administered topical L?AMB and randomized into three groups treated with three different formulations. The medication was administered two hourly till clinical improvement was achieved, followed by six hourly till complete resolution. The outcome measures were time to clinical improvement, resolution of epithelial defect, stromal infiltrate, hypopyon, extent and density of corneal opacity, neovascularization, and best corrected visual acuity (BCVA) at 3 months. Results: Mean age of the patients was 46.6 ± 14.8 years, and trauma with vegetative matter was the most common predisposing factor. Aspergillus flavus (36%) was the most common fungus cultured, followed by Fusarium (23%). Mean time to clinical improvement, time to resolution of epithelial defect, mean time to resolution of infiltrate, and time to resolution of hypopyon were 3.45 ± 1.38, 25.35 ± 8.46, 37.97 ± 9.94, and 13.33 ± 4.90 days, respectively, and they were comparable among the three groups. There was a significant difference between treatment failure and success cases in terms of days of presentation (P < 0.01), size of the epithelial defect (P?value 0.04), and infiltrate size at presentation (P?value 0.04). At 3 months follow?up, no statistically significant difference was noted in BCVA and mean scar size among groups. Conclusion: L?AMB in a gel form is an effective antifungal agent that promotes the healing of fungal ulcers with notably least vascularization and better tolerance.
RESUMEN
Foreign bodies in the vagina in paediatric population are not commonly suspected. The presentation of such cases is similar to that of pathological diseases of cervix and the vagina like vaginitis and cervicitis which are more common. Infections of young female genital tract are common because of higher pH, relatively low oestrogen level and unfavourable bacterial flora.(1)Foreign bodies in the vagina are usually introduced accidently and history is negative. Patients commonly present with blood stained discharge, foul smelling pus, pain in the abdomen, dysuria or constipation. Symptoms secondary to vaginal foreign body account to 4 % of paediatric population visiting gynaecological OPD as reported by Dahiya et al.(2) In girls <6 years of age, who underwent examination under general anaesthesia, aetiology of vaginal discharge in 45 % of the cases was found to be foreign body. He has suggested that it is becoming important in most settings to organize special gynaecology clinics for pre-pubertal girls in order to develop special knowledge and skills needed in paediatric gynaecology. Here we report a case of pre-pubertal girl with vaginal foreign body not responding to medical line of management (antibiotics), rendering further evaluation for vaginal discharge. Unusual scenario in this report is a simple case which remained undiagnosed for one year. Another issue was absence of mother from the scene and constant denial by father to bring her which raises the suspicion of sexual abuse.