Dematiaceous Fungal Colonization of the Bandage Contact Lens in a Patient Lost to Follow-up During the COVID-19 Crisis.

We report a rare case of dematiaceous fungus colonization in the therapeutic bandage contact lens (BCL), in an eye with peripheral ulcerative keratitis. Bandage contact lens removal and appropriate treatment resulted in improvement of the visual acuity and prevented the spread of fungus to the underlying ocular structures. Microbiological evaluation of the BCL showed dematiaceous fungal filaments, and the fungus was identified as Bipolaris species. In patients with pigmented plaque-like lesions, with BCL in situ, dematiaceous fungus on the undersurface of the BCL should be kept in mind. Patient education regarding the importance of frequent BCL replacement, proper ocular hygiene, and timely follow-up should be emphasized.

Deep Keratomycosis Following Ahmed Glaucoma Valve Implantation.

PURPOSE: To report an unusual case of deep keratomycosis after Ahmed glaucoma valve (AGV) implantation. METHODS: A 70-year-old male presented with a deep corneal stromal infiltrate, without epithelial involvement, 3 weeks after a successful AGV implantation for neovascular glaucoma. Microscopic examination of the anterior chamber exudates revealed fungal filaments on smear, and white fungal colonies were observed on the Blood agar and Sabouraud dextrose agar. The fungus was identified as Aspergillus flavus. RESULTS: The patient was treated with oral and topical 1% voriconazole. Ten weeks after the treatment, the corneal infiltrate resolved, resulting in a vascularized scar. CONCLUSION: As recalcitrant keratomycosis of the deep corneal layers may occur after AGV implantation, early identification and prompt treatment may help to achieve complete resolution of the infection and salvage the eye.

Aspergillus Flavus Necrotising Scleritis following Pars Plana Vitrectomy.

PURPOSE: To report a case of fungal necrotising scleritis following pars plana vitrectomy. Results: A 65-year-old lady underwent phacoemlsificication with posterior capsular rupture and posteriorly dislocated lens in her left eye. On the same day she underwent 20 gauge pars plana vitrectomy and phacofragmentation. Postoperative period was uneventful for up to 6 weeks when she developed necrotising anterior scleritis with suppurative nodules. Scraping from the suppuration confirmed the presence of Aspergillus flavus. She was treated with topical Voriconazole and oral Itraconazole. Conclusion: We describe the first case of fungal necrotising scleritis without intraocular inflammation following pars plana vitrectomy (PubMed Search). Infection should be kept in the differential diagnosis of post-operative necrotising scleritis even in the absence of risk factors like hypopyon or diabetes. Early recognition improves final outcome. Medical therapy should be continued even after presumed cure to take care of residual fungi and prevent recurrences.

Rapid Prototyping of Two-Dimensional Non-Cartesian K-Space Trajectories (ROCKET) Using Pulseq and Graphical Programming Interface.

Magnetic resonance imaging is a well-established method for diagnostics and/or prognostics of various pathological conditions. Cartesian k-space trajectory-based acquisition is the popular choice in clinical magnetic resonance imaging, owing to its simple acquisition, reconstruction schemes, and well-understood artifacts. However, non-Cartesian trajectories are relatively more time efficient, with involved methods for image reconstruction. In this review, we survey non-Cartesian trajectories from the standpoint of rapid prototyping and/or implementation. We provide examples of two-dimensional (2D) and 3D non-Cartesian k-space trajectories with analytical equations, merits, limitations, and applications. We also demonstrate implementation of three variants of the 2D radial and spiral trajectories (standard, golden angle, and tiny golden angle), using open-source software. For rapid prototyping, pulse sequences were designed with the help of Pulseq. In-vitro phantom and in-vivo brain data were acquired with three variants of radial and spiral trajectories. The obtained raw data were reconstructed using a graphical programming interface. The signal-to-noise ratios of each of these reconstructions were quantified and assessed.

Management of Nocardia Interface Keratitis After Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To report the clinical course and management of graft-host interface Nocardia keratitis after Descemet membrane endothelial keratoplasty (DMEK). METHODS: A 70-year-old man presented with a corneal epithelial defect, stromal edema, graft infiltrate, and graft-host interface infection 5 months after an uneventful DMEK performed for bullous keratopathy in the left eye. Corneal scrapings from the margin of epithelial defect showed gram-positive bacillus, and the organism was identified as Nocardia asteroides. RESULTS: Intensive and appropriate topical and systemic antibiotic therapy resulted in complete resolution of infection. Three months later, the patient underwent a repeat DMEK, which resulted in clearing of corneal edema and improvement in visual acuity. CONCLUSIONS: Nocardia interface keratitis is a rare entity, which can occur after DMEK. Proper clinical evaluation and microbiological workup helped us in accurate diagnosis and management. Repeat DMEK after complete resolution of the infection resulted in good outcomes regarding corneal clarity and vision improvement.

Micrococcus keratitis following microkeratome-assisted laser in situ keratomileusis.

We hereby report a case of infectious keratitis after laser in situ keratomileusis (LASIK) caused by Micrococcus luteus, a commensal, managed successfully in a nonimmunocompromised individual. A 25-year-old healthy male underwent uneventful bilateral simultaneous LASIK for myopia using disposable blades. Postoperatively, topical antibiotic and steroids were advised; he discontinued antibiotic on his own after using for a day. On the 5th postoperative day, he had pain, redness, decreased vision, and white spot in the left eye (LE) for 1-day duration. Uncorrected visual acuity (UCVA) of LE reduced to 20/80 from postoperative 20/20. Slit-lamp biomicroscopy revealed tiny infiltrate in the interface with reticular haze in the flap and stroma. Gram-positive cocci in pairs and tetrads were found on corneal smears that were collected after lifting the flap from infiltrate, stromal bed, and undersurface of the flap. M. luteus was isolated on culture. The infiltrate resolved with scarring with intensive topical antibiotics. UCVA was 20/25. To the best of our knowledge, this is a first case report of post-LASIK infectious keratitis caused by M. luteus.

Pulseq-Graphical Programming Interface: Open source visual environment for prototyping pulse sequences and integrated magnetic resonance imaging algorithm development.

PURPOSE: To provide a single open-source platform for comprehensive MR algorithm development inclusive of simulations, pulse sequence design and deployment, reconstruction, and image analysis. METHODS: We integrated the "Pulseq" platform for vendor-independent pulse programming with Graphical Programming Interface (GPI), a scientific development environment based on Python. Our integrated platform, Pulseq-GPI, permits sequences to be defined visually and exported to the Pulseq file format for execution on an MR scanner. For comparison, Pulseq files using either MATLAB only ("MATLAB-Pulseq") or Python only ("Python-Pulseq") were generated. We demonstrated three fundamental sequences on a 1.5 T scanner. Execution times of the three variants of implementation were compared on two operating systems. RESULTS: In vitro phantom images indicate equivalence with the vendor supplied implementations and MATLAB-Pulseq. The examples demonstrated in this work illustrate the unifying capability of Pulseq-GPI. The execution times of all the three implementations were fast (a few seconds). The software is capable of user-interface based development and/or command line programming. CONCLUSION: The tool demonstrated here, Pulseq-GPI, integrates the open-source simulation, reconstruction and analysis capabilities of GPI Lab with the pulse sequence design and deployment features of Pulseq. Current and future work includes providing an ISMRMRD interface and incorporating Specific Absorption Ratio and Peripheral Nerve Stimulation computations.

Fungal keratitis due to Schizophyllum commune: an emerging pathogenic fungus.

Fungal keratitis due to Schizophyllum commune is very rare. In this study, we report the clinical and microbiological profile of five patients with fungal keratitis due to S. commune. Direct microscopic examination of corneal scrapings from all five patients showed septate branching hyaline fungal filaments. Similarly, in all five patients Sabouraud dextrose agar (SDA) plates inoculated with corneal scrapings showed white, cottony colonies on the second day of incubation. Lactophenol cotton blue stained wet preparation of 7-day-old colonies on SDA revealed clamp connections and no spores. The fungus was identified by its characteristic clamp connections, fan-shaped bracket fruiting body with pinkish-grey longitudinally split-radiating gills. The phenotypic identification of one of the five isolates further conformed by ITS sequencing. Treatment outcome was available for two of the five patients; in these two patients, the keratitis resolved with topical natamycin.

Susceptibility of bacterial isolates to vancomycin and ceftazidime from patients with endophthalmitis: Is there a need to change the empirical therapy in suspected bacterial endophthalmitis?

To review the susceptibility of bacterial isolates to ceftazidime and vancomycin isolated from patients with endophthalmitis. Microbiology records of patients with endophthalmitis between June 2010 and May 2013 were reviewed. Vitreous and AC fluids obtained from patients with endophthalmitis were subjected to direct microscopy examination and culture. Antibiotic susceptibility of the isolates was performed by Kirby Bauer disk diffusion method. Resistant to ceftazidime in Gram negative bacteria (GNB) by disk diffusion method is confirmed by minimum inhibitory concentration using E test. Culture was positive for bacteria/Fungi in 224/356 patients (62.9 %). Out of 224 patients, 191 (85.2 %) patients showed bacterial growth and 33 (14.0 %) showed fungal growth. Mixed bacterial infection was seen in five patients. Among the GNB, 23/123 (18 %) of the isolates were resistant to ceftazidime, and all the Gram positive bacteria 73/73 (100 %) were susceptible to vancomycin. Sixteen of 123 (13 %) GNB were resistant to amikacin. Although there is an increase in resistance to ceftazidime compared to amikacin in GNB, amikacin intravitreal injection is associated with macular toxicity and no single antibiotic has full coverage for all GNB. Combination of vancomycin and ceftazidime empiric therapy can be continued in patients with suspected endophthalmitis and treatment is modified based on clinical response and susceptibility results.

Neonatal Meningitis by Multidrug Resistant Elizabethkingia meningosepticum Identified by 16S Ribosomal RNA Gene Sequencing.

Clinical and microbiological profile of 9 neonates with meningitis by Elizabethkingia meningosepticum identified by 16S ribosomal gene sequencing was studied. All the clinical isolates were resistant to cephalosporins, aminoglycosides, trimethoprim-sulfamethoxazole, ß -lactam combinations, carbapenems and only one isolate was susceptible to ciprofloxacin. All the isolates were susceptible to vancomycin. Six of nine neonates died even after using vancomycin, based on susceptibility results. E. meningosepticum meningitis in neonates results in high mortality rate. Though the organism is susceptible to vancomycin in vitro, its efficacy in vivo is questionable and it is difficult to determine the most appropriate antibiotic for treating E. meningosepticum meningitis in neonates.

Chronic glucolipotoxic conditions in pancreatic islets impair insulin secretion due to dysregulated calcium dynamics, glucose responsiveness and mitochondrial activity.

BACKGROUND: In the progression towards diabetes, glucolipotoxicity is one of the main causes of pancreatic beta cell pathology. The aim of this study was to examine the in vitro effects of chronic glucolipotoxic conditions on cellular responses in pancreatic islets, including glucose and fat metabolism, Calcium mobilization, insulin secretion and insulin content. RESULTS: Exposure of islets to chronic glucolipotoxic conditions decreased glucose stimulated insulin secretion in vitro. Reduced protein levels of Glut2/slc2a2, and decreased glucokinase and pyruvate carboxylase mRNA levels indicated a significant lowering in glucose sensing. Concomitantly, both fatty acid uptake and triglyceride accumulation increased significantly while fatty acid oxidation decreased. This general suppression in glucose metabolism correlated well with a decrease in mitochondrial number and activity, reduction in cellular ATP content and dampening of the TCA cycle. Further, we also observed a decrease in IP3 levels and lower Calcium mobilization in response to glucose. Importantly, chronic glucolipotoxic conditions in vitro decreased insulin gene expression, insulin content, insulin granule docking (to the plasma membrane) and insulin secretion. CONCLUSIONS: Our results present an integrated view of the effects of chronic glucolipotoxic conditions on known and novel signaling events, in vitro, that results in reduced glucose responsiveness and insulin secretion.

Is blood agar an alternative to sabouraud dextrose agar for the isolation of fungi in patients with mycotic keratitis.

To compare the blood agar (BA), sabouraud dextrose agar (SDA) and chocolate agar (CA) for the isolation of fungi in patients with mycotic keratitis. Corneal Scrapings of 229 patients with clinically diagnosed microbial keratitis were inoculated on BA, SDA, CA. The culture media were evaluated for the rate and time taken for the fungal growth. Seventy six of 229 patients had fungal keratitis. Fungus grew on BA in 60/76(78.9 %), on SDA in 76/76 (100 %), on CA in 40/76(52.6 %) patients. The fungi which grew on BA (60/76) also grown on SDA at the same time. The colony morphologies of different fungi were better on SDA than BA/CA. Among the different culture media, SDA is essential for the isolation fungi in patients with mycotic keratitis.

Endogenous endophthalmitis caused by Enterococcus casseliflavus.

Herein, we report a case of endogenous endophthalmitis caused by Enterococcus casseliflavus. The organism was sensitive to gentamicin, vancomycin and chloramphenicol and resistant to cefazolin, ofloxacin, gatifloxacin and ciprofloxacin. The patient was successfully treated with vitrectomy and sensitivity-based intravitreal vancomycin.

Acute postoperative endophthalmitis by Gemella haemolysans.

Endophthalmitis is a rare and serious post-surgical complication. We report a case of acute postoperative endophthalmitis after an uneventful cataract surgery caused by a commensal organism, Gemella haemolysans. The patient was successfully treated with vitrectomy and intravitreal antibiotics like vancomycin, along with topical cefazolin.

In vitro antibiotic susceptibility of rapidly growing nontuberculous mycobacteria isolated from patients with microbial keratitis.

PURPOSE: This study was undertaken to determine the antibiotic susceptibility and minimum inhibitory concentrations (MIC) of amikacin, tobramycin, ciprofloxacin, gatifloxacin, azithromycin, and clarithromycin against rapidly growing nontuberculous mycobacteria isolated from patients with keratitis. METHODS: A total of 15 rapidly growing nontuberculous mycobacteria isolated from corneal scrapings of keratitis patients from January 1999 through December 2007 were subjected to antimicrobial susceptibility testing by the E-Test to amikacin, tobramycin, ciprofloxacin, gatifloxacin, azithromycin, and clarithromycin. RESULTS: Out of 15 isolates, 13 were identified as Mycobacterium chelonae complex and 2 as Mycobacterium fortuitum complex. Based on minimum inhibitory concentration (MIC) cut off, all 15 (100%) isolates were sensitive to amikacin, azithromycin, and clarithromycin, 13 (86%) were sensitive to tobramycin, nine (60%) to gatifloxacin, and only 6 (40%) to ciprofloxacin. The MIC range was 0.25-4 microg/ml for amikacin, 0.5-1 microg/ml for azithromycin, 0.125-1 microg/ml for clarithromycin, 0.5-16 microg/ml for ciprofloxacin, and 0.25-16 microg/ml for tobramycin. MIC(90) for amikacin was 2 microg/ml, azithromycin 1 microg/ml, clarithromycin 0.75 microg/ml, ciprofloxacin 8 microg/ml, gatifloxacin 8 microg/ml, and for tobramycin it was 4 microg/ml. CONCLUSIONS: All the isolates were sensitive to amikacin, azithromycin, and clarithromycin, but the MIC values of clarithromycin and azithromycin were lower than amikacin. Based on in vitro susceptibility results it appears that the topical amikacin in combination with oral clarithromycin or azithromycin is the best treatment option for rapidly growing nontuberculous mycobacterial keratitis.