Demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India

Purpose: To study the demographic details, risk factors, microbiological profile, and clinical outcomes of pediatric infectious keratitis cases in North India. Methods: This retrospective case series included review of medical records of pediatric patients (0–16 years) diagnosed with infectious keratitis in a tertiary care center of North India during December 2011 to January 2017 was done. Demographic details, predisposing factors, microbiological investigations, and clinical outcomes were analyzed. Results: In this time period, 104 eyes of 104 children had a diagnosis of infectious keratitis. Culture was obtained for all 104 eyes and was positive in eighty eight eyes (84.2%). The most common causative factor was trauma, seen in 77 eyes (74%). Bacteria was the most common agent isolated in culture (54.2%) followed by fungi (40.8%) and acanthamoeba (2.1%). Successful healing of the keratitis with appropriate medical treatment occurred in 84 (80.7%) eyes, while 13 (12.5%) eyes required therapeutic keratoplasty. Of the 80 eyes with documentation of both preliminary and final visual acuity, improvement of two lines was seen in 35 eyes (43.7%), stayed the same in and worsened in 17 eyes (21%). Mean time to resolution of infection on medical treatment for bacteria was 23.65 ± 4.78 days, fungi 32 ± 5.19 days, and acanthamoeba 53.67 ± 4.78 days. Conclusion: Gram positive organism is the most common etiological agent of keratitis in children in our study population which is in contrast to pediatric infective keratitis study conducted by Aruljyothi et al. in South India (2011--2013). Though less in number than bacterial keratitis, fungus also remains an important causative agent. Along with early diagnosis and immediate medical intervention, it is important to identify regional profile of organisms and risk factors for good visual and anatomical outcome.

Intraocular amyloidosis with multifocal iris and anterior chamber translucent spherules

Ocular amylodosis, although a rare entity, is known to affect the conjunctiva, extraocular muscles, orbit, lacrimal gland, and skin around the eyes. Intraocular deposition of amyloid mainly confines to the vitreous and cornea. In this report, we describe two cases of intraocular amyloidosis presenting as multiple iris and anterior chamber cysts. Histopathological examination with special stain like Congo Red and Transmission Electron Microscopy confirmed the diagnosis of amyloidosis. Systemic investigations ruled out systemic association confirming the diagnosis of primary ocular amyloidosis.

Eye donation in north India: Trends, awareness, influences and barriers

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.

Quality indicators for eye bank

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.

Effect of transfer of donor corneal tissue from McCarey朘aufmann medium to Optisol-GS on corneal endothelium

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.

Results of simple limbal epithelial transplantation in unilateral ocular surface burn

Purpose: This study aimed to report the long-term outcomes of autologous Simple Limbal Epithelial Transplantation (SLET) performed for unilateral limbal stem cell deficiency (LSCD) following chemical burn at a tertiary eye center in North India. Methods: This was a single-center prospective interventional case series of patients who developed unilateral LSCD after suffering from ocular surface burns and who underwent SLET between October 2012 and May 2016 with a follow-up period of at least 6 months. The primary outcome measure was restoration of a completely epithelized, stable, and avascular corneal surface. The secondary outcome measure was percentage of eyes, which reported visual gain. Results: The study included 30 eyes of 30 patients, 18 adults and 12 children, at a median follow-up of 1.1 years (range: 6 months to 3.5 years), 21 of 30 eyes (70%; 95% confidence interval, 53.6%–86.2%) maintained successful outcome. Visual acuity gain was seen in 71.4% of successful cases. The clinical factors associated with failure were identified as acid injury, severe symblepharon at the time of presentation, and SLET combined with penetrating keratoplasty (PK). Conclusion: Autologous SLET is an effective limbal cell transplantation technique for the treatment of unilateral LSCD. It is especially beneficial for centers where cell cultivation laboratory is unavailable. Presence of severe symblepharon, which requires PK peroperatively , has poor outcome.

Giant primary pulmonary fibrosarcoma.

A rare case of primary fibrosarcoma in a 48-year-old male is described who presented with a huge pulmonary mass on the left side. The diagnosis was established on fine needle aspiration cytology (FNAC) and percutaneous transthoracic lung biopsy, supported by immuno-histochemistry.

A case of carcinoma rete testis: histomorphological, immunohistochemical and ultrastructural findings and review of literature.

A 72-year-old man presenting with a secondary hydrocoel underwent orchidectomy. Gross examination revealed a tumor arising in the region of the rete testis, which on histopathology proved to be a papillary adenocarcinoma. The patient did not have evidence of any other neoplasia elsewhere in the body. The lesion fulfilled the anatomic criteria elucidated by Nochomovitz et al to be labelled as adenocarcinoma of Rete testis. Electron microscopy revealed characteristic nuclear infoldings and microtubules with two different arrangements. The tubules were either seen to form concentric circles or were in irregular groups with filaments interspersed. The lesion on immunohistochemistry was negative for germ cell markers AFP and HCG, and was positive for cytokeratin and epithelial membrane antigen. A review of literature is also presented.

A multicentric evaluation of recombinant DNA hepatitis B vaccine of Cuban origin.

INTRODUCTION: Hepatitis B infection is an important public health problem all over the world. As no specific treatment is available, greatest emphasis is placed on prevention through immunization. OBJECTIVE: To evaluate the immunogenicity (sero-protection rate) and reactogenicity of a novel recombinant DNA hepatitis B vaccine of Cuban origin (Enivac HB). POPULATION AND METHODS: The study was conducted at two independent centres (New Delhi and Jaipur) and 111 healthy volunteers without any symptomatic or serological evidence of HBV infection were administered the vaccine intramuscularly in a dose of 20 ug at day 0, day 30 and day 180. Blood samples were collected for evaluation of sero-protection on days 30, 60, 90 and 210 at both centres and, in addition, at day 120 at New Delhi. All subjects were evaluated for any adverse event for 120 hours subsequent to each dose of the vaccine. RESULTS: The mean age of the volunteers was 24 years and the male:female ratio was 61:50. An overall sero-protection rate of 24.3% was obtained at day 30, 68.5% at day 60, 94.5% at day 90 and 99.1% by day 120. Following the third dose of the vaccine (at day 180), we lost one subject to follow up and further evaluation could be done in a total of 110 volunteers. The sero-protection rate by day 210 was found to be 100% (110/110). The vaccine was well tolerated with no serious adverse reactions. Minor side effects such as injection site tenderness, erythema and/or low grade fever were observed in 4.5% of the subjects. CONCLUSIONS: The recombinant DNA hepatitis B vaccine of Cuban origin is safe, well tolerated and highly immunogenic.

Bacteriology of spirometer tubing and evaluation of methodology to prevent transmission of infection.

Transmission of respiratory infection by a spirometer is a definite risk in countries like India where a majority of respiratory diseases are infective in nature. To assess this problem, scrapings and washing from a spirometer tube in regular use were taken for microbiological studies. Significant bacterial growth on culture included Aspergillus and acid fast bacilli. In order to check contamination, a segregation chamber was attached to the spirometer. Twenty-three patients used the spirometer with or without segregation chamber and a good correlation was shown between the two methods in forced expiratory volume in one second (r = 0.94), forced vital capacity (r = 0.92) and mid maximum expiratory flow rate (r = 0.90). It can be concluded that a spirometer may have significant growth of pathogenic bacteria and a segregation chamber may be used routinely with the spirometer in order to prevent its contamination.

Vasculitis--a complication of hypothyroidism.

A case of hypothyroidism presenting with cutaneous vasculitis is described. Apart from typical findings of hypothyroidism, the patient had hypertension (HT). With thyroxine replacement therapy patient showed an improvement in hypothyroidism, HT and cutaneous vasculitis.

Comparative study of capillary and arterial, blood gas values in plastic and glass syringes at various intervals in normal and asthmatic subjects.

Fifty-six normal healthy subjects and forty-four patients with bronchial asthma were subjected to capillary and arterial blood gas analysis. Arterial blood values were measured immediately and at two and four hours interval after storing the samples between 0-4 degrees C using glass and plastic syringes. It was observed that PO2 of arterial blood was significantly higher (P less than 0.001) than capillary PO2 values, while material of syringe and time interval of analysis did not make any significant alteration. PCO2 and pH values in arterial samples at various intervals and in different syringes were comparable in normal as well as in asthmatic subjects.

Effects of prolactin and LH on the activity of delta5-3beta hydroxy-steroid dehydrogenase, dihydro-orotic dehydrogenase, b-hydroxybutyrate dehydrogenase and glucose-6-phosphate dehydrogenase in the testis of the dwarf mice.

The activity of delta5-3beta Hydroxysteroid hydro-genase, dihydro orotic dehydrogenase, B-Hydroxybutyrate dehydrogenase and glucose-6-phosphate dehydrogenase was studied in the testes of hereditary dwarf mice treated with Prolactin or LH. Two months old dw/dw dwarf mice were injected twice daily, for 14 days, either with 100 mug ovine Prolactin, or 5 mug ovine LH twice a day. Prolactin treatment increased the activity of all the enzymes assessed. Treatment with LH stimulated the activity of all the enzymes as compared to the saline treated animals but less than the Prolactin treated ones. The data bearing that the increased activity of several oxidising enzymes in the testes of hereditary dwarf mice is increased with Prolactin, is consistent with the suggested effect of this hormone on testicular steroidogenesis.