Peripheral iridectomy for preventing iris-related complications in glued intraocular lens surgery in children

Purpose: To assess the role of surgical peripheral iridectomy (PI) in preventing iris-related complications associated with glued intraocular lens (GIOL) surgery in children with bilateral ectopia lentis. Methods: Nonrandomized interventional case series of 34 eyes of 17 children (<15 years of age) who underwent pars plana lensectomy (PPL) and GIOL surgery between January 2013 and December 2016. Eyes with surgical PI (January 2013–June 2015) were compared with those without surgical PI (July 2015–December 2016). The primary outcome measure of the role of surgical PI in GIOL surgery was to account for complications such as optic capture, secondary glaucoma, intraocular lens (IOL) dislocation, or repeat surgery. The secondary outcomes were changes in the best-corrected visual acuity (BCVA). Results: The mean age at surgery was 8.8 years (range: 3.5–15 years). Surgical PI was conducted in 15 eyes. Among the 19 eyes without PI, 9 eyes had complications (optic capture –6; rise in IOP –4; IOL subluxation –4; repeat surgery –5). The complications were significantly less in the PI group, P = 0.02. There was a statistically significant improvement in BCVA (P = 0.0001) in all the patients. The mean presenting BCVA was 0.99 (±0.79) logMAR (Snellen ? 20/200) and post BCVA was 0.40 (±0.50) (Snellen ? 20/50). The mean preoperative refraction was ? 9 D (±8D) (range: ?5 D to ?23D) and postoperative was ?1 (±1.15) D. The mean follow-up was 25.4 months. Conclusion: Surgical PI along with GIOL surgery in children undergoing PPL is shown to reduce optic-capture-related complications.

Surgical outcomes, complications and learning curve of glued intraocular lens of a vitreo retinal fellow in training

Purpose: To evaluate surgical outcomes, complications and learning curve of glued intraocular lens surgery by a vitreoretinal (VR) fellow in training. Methods: Analysis of 50 eyes requiring glued intraocular lens (GIOL) surgery for various indications was done. Both the consultant VR surgeon (Group 1) and VR fellow in training (Group 2) operated 25 eyes each. The primary outcome measures were visual acuity at 3 months, and time taken for completion of surgery. Secondary outcome measures were refractive correction, intraocular pressure and intraoperative or postoperative complications. Results: The uncorrected visual acuity (UCVA) improved from log MAR 1.54�56 (Snellen 20/693) to 0.45�26 (Snellen 20/56) and from 1.64�53 (Snellen 20/873) to 0.56�45 (Snellen 20/72) in group 1 and 2, respectively. The best corrected visual acuity (BCVA) improved from log MAR 0.74�61 (Snellen 20/109) to 0.33�26 (Snellen 20/42) and from 1�68 (Snellen 20/200) to 0.40�50 (Snellen 20/50) in group 1 and 2, respectively (P > 0.05). The surgical time was significantly less in group 1 when compared to that of group 2 (64.26 vs 107.16 minutes) P value <0.05). The mean time taken for the initial 10 cases and later 15 cases in group 2 were 131.9 and 91.2 minutes, which was statistically significant. The complication rates in both groups were comparable. Transient hypotony (IOP < 11) was seen in 56% (14/25) of eyes in group 2 and 44% (11/25) in group 1 (P = 0.39). Conclusion: The study results are encouraging for a VR fellow with good short-term visual outcomes and comparable surgical complications. The procedure gives promising results and the learning curve is overcome by a desire to learn and with increasing number of procedures done under supervision.

Evaluation of Antimicrobial Activities of Fractions of Plant Parts of Pterocarpus santalinoides

Aims: The study aims to investigate the antimicrobial activities of the leaves, seeds, bark, and root of Pterocarpus santalinoides plant. Study Design: Agar well diffusion and Agar well dilution methods were used to test the preliminary antimicrobial and minimum inhibitory/bactericidal/fungicidal concentrations respectively of Pterocarpus santalinoides plants. Place and Duration of Study: Department of Pharmaceutical Microbiology and Biotechnology, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Agulu Campus, Nigeria, between February – October, 2017. Methodology: Primary extraction and fractionation of the plant parts were undertaken with methanol, butanol, ethyl acetate, and n-hexane. Agar diffusion method for the primary antimicrobial screening on Muller-Hinton agar (bacteria) and Sabouraud dextrose agar (fungi) were used to assess the antimicrobial activities of the sixteen (16) samples on some microbial isolates namely Salmonella typhi, Escherichia coli, Candida albicans, Aspergillus niger, Microsporon canis, and Trichophyton rubrum. The minimum Inhibitory concentration (MIC), minimum bactericidal/fungicidal concentration (MBC/MFC) and percentage inhibition diameter growth (PIDG) of the samples that yielded positive activity were also evaluated. Results: Twelve (12) samples exhibited inhibitory activity on at least one or more of the test isolates. The MIC range observed for the extracts and fractions that yielded positive activity was 12.5 – 100 mg/ml. The n-hexane fraction of the plant root indicated the best value of 12.5 mg/ml against M. canis. The best MBC/MFC value of 25 mg/ml was observed with the ethyl acetate fraction of the bark (against E. coli and M. canis) and the n-hexane fraction of the root (against M. canis). The result showed S. typhi to be the most sensitive organism to the metabolites of P. santalinoides. Extended-spectrum activity was observed with the ethyl acetate fraction of the bark against three (3) of the test isolates namely S. typhi, E. coli and M. canis. The determination of PIDG values for the test organisms against the plants’ extracts/fractions showed that crude methanol extract (28.57%) and ethyl-acetate fraction (0.14%) of the leaves, butanol fraction (0.14%) of the root (all against S. typhi) were the most potent test samples. Conclusion: The results indicated that the plant parts may have potential medicinal values and confirmed its use in traditional medicine.

Pachydrusen in Indian population: A hospital-based study

Purpose: To report the prevalence of pachydrusen in Indian population and their characteristics in relation to subfoveal choroidal thickness (SFCT), choroidal vascularity index (CVI) in comparison to eyes with soft drusen and subretinal drusenoid deposits (SDD) in age-related macular degeneration (AMD). Methods: The study was a retrospective, cross-sectional study involving patients with a diagnosis of dry AMD in at least one eye. The diagnosis of soft drusen, SDD, and pachydrusen was made on the basis of color fundus photograph and optical coherence tomography (OCT). SFCT and CVI was calculated and compared among the different subtypes of drusen. Results: A total of 169 eyes (143 dry and 26 wet AMD) of 85 patients with a mean age of 67.67 ± 9.57 years were included. In eyes with dry AMD, pachydrusen were seen in 12 eyes (8.4%) with a mean (±SD) SFCT of 289.66 ± 91.01 ?. The difference in SFCT was statistically significant (P = 0.001) using analysis of variance (ANOVA) test. The eyes with pachydrusen had significantly thickened choroid compared to the eyes with SDD (30 eyes; 21.0%) or combination of soft drusen and SDD (29 eyes; 20.3%) but not soft drusen (72 eyes; 50.3%). The difference of CVI in different subgroups was significant (P = 0.03). One eye in wet AMD group had concurrent pachydrusen. Comparison of SFCT and CVI in wet AMD and fellow dry AMD eyes were not significant. Conclusion: In Indian eyes with dry AMD, prevalence of pachydrusen (8.4%) is slightly lower compared to western literature (11.7%) and is associated with thicker choroid and higher CVI.

Antimicrobial Resistance Evaluation of Organisms Isolated from Liquid Herbal Products Manufactured and Marketed in South Eastern Nigeria.

Objective: To determine the susceptibility and resistance pattern of bacteria and fungi isolates obtained from herbal anti-infective liquid preparations manufactured and marketed in South-East Nigeria to conventional antibiotics. Study Design: Experimental Place and Duration of the study: Pharmaceutical Microbiology and biotechnology Laboratory, Faculty of Pharmaceutical Sciences, Nnamdi Azikiwe University, Agulu Campus between October 2011 and March 2012. Methodology: Isolation and characterization of contaminating microorganisms were carried out using standard procedures. A total of forty-nine (49) bacteria and forty (40) fungi isolated from the herbal products were examined for susceptibility to conventional antibiotics using the disc diffusion method. The bacterial isolates were tested against ciprofloxacin, ofloxacin, amoxicillin-clavulanic acid, gentamicin, cefotaxime, ceftazidime, ceftriazone, sulphamethoxazole, tetracycline and ampicillin were employed while fungi isolates were tested against five common antifungal-griseofulvin, nystatin, ketoconazole, fluconazole and clotrimazole. The Multiple Antibiotic Resistance Index (MARI) of each of the isolated bacteria was obtained following the standard method. Result: The antimicrobial susceptibility-resistance profile of the bacteria isolates revealed that most of the bacteria were sensitive to ciprofloxacin, ofloxacin, gentamicin, and ceftriaxone, On the other hand, a good number of the isolates demonstrated high level of resistance to common antibiotics like Ampicillin, amoxycillin-clavulanic acid, trimethoprimsulphamethoxazole, and moderate level of resistance to Tetracycline, and some of the third generation cephalosporins - ceftazidime and cefotazime. Multiple Antibiotic Resistance Index (MARI) evaluation revealed that most of the isolates were resistance to more than fifty percent (50%) of the number of antibiotics used. The fungal isolates were susceptible to nystatin, ketoconazole and clotrimazole, resistance to fluconazole and high resistance recorded against griseofulvin. Conclusion: The results of this study revealed that the herbal medications can serve as a trail of spread of antibiotic-resistance genes.

Knowledge and Use of Disinfection Policy in Some Government Hospitals in South-East, Nigeria.

Aims: This study was carried out to evaluate the knowledge and use of disinfection policy in government hospitals in south-east geopolitical zone of Nigeria and to compare the three categories of government hospitals. Study Design: This was a descriptive, cross sectional study. Place and Duration of Study: Intensive Care Units and Special Care baby Units (SCBU), Departments of Pharmacy (Compounding/Storage Unit), Medical Laboratory Services, Surgery, Obstetrics and Gynecology, between February and May 2012. Methodology: A structured self administered and pre-tested questionnaires were administered to 200 randomly selected healthcare workers which included 40 Pharmacists, 59 Nurses, 55 Resident/General Practice Medical doctors and 46 Medical laboratory scientists, employed full-time in selected government hospitals in southeast geopolitical zone of Nigeria. Results: The sample size and the response rate were 200 and 100% respectively. About 53.3% of the respondents have heard of the policy, but only 24.5% of them actually know what it means. Only about 22% of all the respondents have applied the policy. The study also reveals that the level of knowledge of disinfection policy is not significantly related to the level of its application by the healthcare workers in the southeast (P-value 0.143, for chi-square and 0.49, for Pearson Correlation). Up to 78% of the healthcare workers have an idea about the different levels of disinfection. The University Teaching Hospitals seem to have better knowledge and use of the policy than the Federal Medical Centres and the General Hospitals. Conclusion: The knowledge of disinfection policy among the healthcare workers and its application is poor. This is worst in General Hospitals. There is therefore urgent need for a national policy on disinfection and health workers’ education or training on the policy and its application in all hospitals in the nation.

The Prevalence and Bacteriology of Asymptomatic Bacteriuria among Antenatal Patients in Nnamdi Azikiwe University Teaching Hospital Nnewi; South Eastern Nigeria

Urinary tract infection in pregnancy leads to poor pregnancy outcome. Diagnosis and treatment of asymptomatic bacteriuria markedly improves pregnancy outcome as well as reduce the incidence of acute pyelonephritis. To determine the prevalence and bacteriology of asymptomatic bacteriuria among Antenatal patients in our centre; and to know if routine screening will be justifiable. This was a prospective study carried out between April and August 2008. Sample size was statistically determined.Women who consented were interviewed and mid stream urine samples were collected and processed in the microbiology laboratory; using standard microbiological methods. Out of 357 women studied; 65(18.21) had significant bacteriuria. was the commonest isolate (25.6); while was the least frequent isolate (3.66). Women in third trimester had the highest prevalence (25.68) while those in the first trimester had the least (15.79).Women that had only primary education had the highest prevalence (27.50) while those that had tertiary education had the least prevalence (21.10). The prevalence of significant asymptomatic bacteriuria among the women studied was high. Screening of all the pregnant women and treatment will reduce the incidence and complications of overt urinary tract infection in pregnancy among these women