Antibiotic lock solutions as adjunct therapy for catheter-related blood stream infections in pediatric hemodialysis patients.

The predominant use of intravenous catheters as primary access type in the pediatric hemodialysis population is associated with an increased risk of catheter related blood stream infections. While strict adherence to catheter placement and long-term care guidelines have helped to decrease the incidence of these infections, blood stream infections remain an infection burden in pediatric patients with long term hemodialysis catheters. The formation of biofilms on the surfaces of these catheters has been shown to be a source of microbes causing blood stream infections. One of the strategies for preventing bacterial colonization, inhibiting microbial multiplication, and suppressing the seeding of these microbes from biofilms upon maturation, has been the use of antibiotic-based lock solutions in-between dialysis treatments. Although clinical guidelines for the use of antibiotic lock solutions are yet to be developed, available evidence suggests a beneficial role of antibiotic lock solutions in the management of catheter related blood stream infections. Additionally, a clear understanding of how biofilms are formed and their role in the pathogenesis of catheter related bloodstream infection will facilitate the development of solutions that can prevent biofilm formation and inhibit their multiplication, maturation and seeding into the bloodstream.

Diversity of human papillomavirus in the anal canal of men: the HIM Study.

Human papillomavirus (HPV) infections are associated with the development of anogenital lesions in men. There are no reports describing the distribution of non-α HPV types in the anal canal of a sexually diverse group of men. The HPV Infection in Men (HIM) Study is a multicentre study on the natural history of HPV infection in Brazil, Mexico, and the USA. At baseline, 12% of anal canal PCR HPV-positive specimens were not typed by the Roche Linear Array, and were considered to be unclassified. Our goals were to characterize HPVs among these unclassified specimens at baseline, and to assess associations with participant socio-demographic and behavioural characteristics. Unclassified HPVs were typed by sequencing of amplified PGMY09/11 products or cloning of PGMY/GP + nested amplicons followed by sequencing. Further analysis was conducted with FAP primers. Of men with unclassified HPV in the anal canal, most (89.1%) were men who have sex with women. Readable sequences were produced for 62.8% of unclassified specimens, of which 75.2% were characterized HPV types. Eighteen, 26 and three different α-HPV, ß-HPV and γ-HPV types were detected, respectively. α-HPVs were more commonly detected among young men (18-30 years) than among older men (45-70 years), whereas ß-HPVs were more frequent among mid-adult men (31-44 years). ß-HPVs were more common among heterosexual men (85.0%) than among non-heterosexual men. All ß-HPVs detected among non-heterosexual men were ß2-HPV types. The high prevalence of ß-HPV in the anal canal of men who do not report receptive anal sex is suggestive of other forms of transmission that do not involve penile-anal intercourse.

Pattern of blindness in a community based hospital of Nepal.

INTRODUCTION: Because of the availability of modern health facilities and moderately easy access to health services in the last 25 years, the blindness due to cataract and trachoma is expected to decline in Nepal. So it is felt that the causes of blindness need to be revised. OBJECTIVE: To regroup the disease pattern leading to permanent blindness in patients attending a suburban multidisciplinary community-based hospital of Nepal. MATERIALS AND METHODS: A cross-sectional, descriptive study was conducted in patients attending Dhulikhel hospital over a period of 12 months, from March 2010. Only the patients with best corrected visual acuity of less than 3/60 were enrolled in the study. A detailed ocular examination was carried out. RESULTS: A total of 76 eyes of 58 patients were analyzed. Of all, 32 were male (55.2 %). The mean age of the patients was 43.03 ± 22.98, with a range of 7 years to 84 years. Retinal diseases had the higher prevalence (23, 39.7 %) followed by amblyopia (10, 17.2 %) and corneal diseases (9, 15.51 %). Anisometropic amblyopia (3.94 %) was the commonest type of amblyopia. Retinitis pigmentosa (9.21 %) and age-related macular degeneration (7.89 %) were common retinal diseases whereas anterior staphyloma (5.26 %) and leucoma (3.94 %) were common corneal diseases. Other important and rare causes of blindness included ethambutol-induced optic neuropathy and vitelliform dystrophy. CONCLUSION: Periodic collection of statistics on the relative frequency of the causes of blindness is important in socioeconomically developing nations like Nepal. This helps to revise the pattern of blinding diseases so that priorities can be redefined.

Outcome of conjunctival autograft transplantation in pterygium surgery in a community based hospital in Nepal.

INTRODUCTION: The mainstay of treatment for pterygium is surgical excision with or without a graft. The most common problem with this intervention is recurrence, for which a multitude of factors have been described. OBJECTIVE: To evaluate the recurrence rate of pterygium in conjunctival autologous graft transplantation after its excision in people living in a hilly region of Nepal Materials and methods: A prospective interventional study was conducted in patients undergoing pterygium excision with conjunctival autologous graft transplantation. The patients were followed up for 20 months. Any recurrence of pterygium was noted during this period. RESULTS: Thirty four patients with an age range of 29 to 65 years (mean 43.88+/-9.19 years) were included. Female predominated (n=21, 61.8%) in the study. Service holders formed a majority of the cases (n=14, 41.2%) followed by farmers (n=10, 29.4%, OR 0.019, 95% CI = 0.002 to 0.209). Ocular discomfort was the main presenting complaint. Dry eye was seen in 30 patients (88.23%). Most of the patients (26, 76.5%) had a grade II pterygium. Graft displacement was the main complication in two (5.88%) patients and recurrence of pterygium was found in three (8.82%). CONCLUSION: Conjunctival autologous transplantation is a safe and effective method for the treatment of pterygium with a minimal recurrence rate.

Ocular trauma in patients presenting to Dhulikhel Hospital.

BACKGROUND: Ocular trauma is an important cause of blindness and ocular morbidity throughout the world. Prevalence studies help to define the target group, plan strategies and thereby lessen trauma related blindness in the country. OBJECTIVE: To identify the risk factors for ocular trauma, those at risk, describe the visual acuity at time of clinical presentation, and assess the nature and severity of ocular trauma in patients presenting to Dhulikhel Hospital emergency department and eye OPD with ocular trauma. METHODS: It is a descriptive and prospective study of all the patients with ocular trauma presenting to Dhulikhel Hospital from December 2009 to December 2010. A complete history and detailed ophthalmologic evaluation was done and noted down. RESULTS: There were 112 subjects with ocular trauma. Mean age was 28.43+/-16.36 years with a range of one year to 74 years. Males predominated with 72.3% frequency (p less than 0.001). Incidence peaked in third decade of life (p less than 0.01). Ocular trauma peaked in months of September and October. Presenting visual acuity better than 6/12 was noted in 83.9% of cases whereas 2.7% of cases had visual acuity of less than 3/60. Household (56.3%, p less than 0.001) was the commonest place of injury with wooden objects (19.6%) being the commonest object of injury. Most of the injuries were mechanical (85.7%, p>0.001). CONCLUSION: Blunt injuries were more common in young males. Household and workplace were common location of ocular injuries. Public awareness and strict legislation to use personal protective devices can help to reduce the occurrence of ocular injury.

Tubercular scleritis.

Scleritis is a severe painful inflammatory process centred in the sclera. A scleritis may be a harbinger of many systemic diseases so that it is important to exclude multisystem disease. We describe a case of unilateral tubercular anterior nodular non-necrotizing scleritis. Anterior nodular non-necrotizing scleritis is relatively an uncommon manifestation of tuberculosis. It may be difficult to diagnose and manage the disease. However, good history, detail clinical evaluation, appropriate and timely management shows a good response to the disease.

Refractive errors and visual anomalies in school children in the Kavrepalanchowk District.

BACKGROUND: Schoolchildren form an important target group for a nation, as any ocular morbidity in this age group has huge physical, psychological and socio-economical implications. Childhood eye disorders can contribute to the burden of blindness in any society. This study aims to highlight the prevalence of ocular morbidity in governmental schools in a sub-urbanised area of Nepal, in relation to ethnic variation. METHODS: A descriptive study, and the study population used were schoolchildren who were examined in their schools and afterwards referred to the hospital if required. Presenting and best corrected visual acuity, refraction, binocularity assessment, anterior and posterior segment evaluation was carried out. Data was analysed statistically using SPSS software, version 14. RESULTS: We examined 1,802 school children. The mean age was 10.78 ± 3.61 years. Ocular abnormality was detected in 11.7%. Low vision and blindness was rare (0.11% and 0.05%). Ocular morbidities were more common in Newar communities (3.71%) followed by Brahamans (3.38%). Lid abnormalities were the most common (3.55%), and morbidities in each ethnicity were followed by refractive errors (3%), conjunctival abnormalities (1.10%), strabismus (0.88%) and amblyopia (0.33%). Refractive errors were most common among Newar communities (1.16%) at almost twice as many Brahamans (0.61%) followed by Mongolians (0.49%). Convergence insufficiency was detected in 2.49% (p less than 0.01). CONCLUSIONS: Ocular morbidities are common in children in Kavhrepalanchowk District with lid abnormalities being the most common issue, probably due to a lack of hygienic practice. Ethnic variation of ocular morbidities is an important observation mostly for refractive error and strabismus.

Etiological pattern of blepharoptosis among patients presenting in teaching hospital.

The purpose of this study was to find out the etiological pattern of blepharoptosis among patients presenting in BPKLCOS, T.U. Teaching Hospital. This was a hospital based descriptive and cross-sectional study conducted from February 2003 to July 2004. A total of 125 patients with ptosis were evaluated. 78 cases (62.4%) were congenital and 47 cases (37.6 %) were acquired. Congenital simple ptosis and congenital complicated ptosis comprised of 58% and 42% respectively. Among the acquired cause, ptosis due to trauma was the commonest 32%, followed by third cranial nerve palsy 25.5%, myasthenia gravis 17%, aponeurotic 10.7%, chronic progressive external ophthalmoplegia 8.5% etc. Aetiology-wise, myogenic ptosis was the commonest (65.6%) which was followed by neurogenic (16.8%), traumatic (12%) and aponeurotic ptosis (5.6%). Congenital ptosis is more common than acquired ptosis. Myogenic ptosis is the most predominant type of ptosis. Among the congenital ptosis, congenital simple ptosis is more common than congenital complicated ptosis. Among the acquired cases trauma, third cranial nerve palsy and myasthenia gravis are the major attendees.

Ocular morbidity in schoolchildren in Kathmandu.

BACKGROUND/AIMS: Any information on eye diseases in schoolchildren in Nepal is rare and sketchy. A programme to provide basic eye screening to schoolchildren with an aim to provide services as well as gather information on ocular morbidity has been started. METHODS: All the children in the schools visited are included in the study. This programme is targeted at poor government schools, which are unable to afford this service. A complete eye examination is given to all the children including slit lamp examination, fundus evaluation and retinoscopy, and subjective refraction. RESULTS: A total of 1100 children from three schools are included in this report. 11% of our schoolchildren have ocular morbidity, 97% (117 out of 121) of which is preventable or treatable. Refractive error is the commonest type of ocular morbidity (8.1%). Myopia is the commonest type of refractive error (4.3%) as opposed to hypermetropia (1.3%). 12.4% of children with refractive error have already developed amblyopia. Strabismus is the second commonest type of ocular disability (1.6%). Alternate divergent squint is the commonest type of strabismus (1.4%). Traumatic eye injuries (0.54%), xerophthalmia (0.36%), and congenital abnormalities (0.36%) are much less common. CONCLUSION: A school eye screening cum intervention programme with periodic evaluation seems to be appropriate for countries like Nepal as most of the eye diseases found are preventable or treatable.

Xerophthalmia among Nepalese children.

A nationwide sample survey was conducted between July 1980 and June 1981 to determine the prevalence of xerophthalmia among Nepalese children. Population proportionate random samples were drawn from the 12 geopolitical subdivisions of the country by employing multistage sampling technique. The survey population was defined as the child population of rural Nepal between the ages of 0 and 14 years. The per cent prevalence of xerophthalmia in Nepal was 1.65 for Bitot's spots, 0.02 for corneal ulcer, and 0.03 for corneal scar. While cases of Bitot's spots were more prevalent in the plains of Nepal, followed by the mountains and the hills, the reverse was true for corneal lesions. Vitamin A deficiency was found to be responsible for one-third of acquired bilateral blindness in preschool children. All corneal cases in the study were accompanied by diarrhea and malnutrition, indicating xerophthalmia to be symptomatic of the whole spectrum of malnutrition.