Fifteen-year trends in indications for enucleation from a tertiary care center in South India

Aim:

To analyze the trends in clinicopathologic indications for enucleations over a 15-year period.

Materials and Methods:

Clinicopathologic details of all eyes that underwent enucleation from January 1996 to December 2010 were drawn up from a computerized database. The study was divided into three periods of 5 years each and comparison tables for each cause of enucleation during these periods were generated. Chi-square test was used to compare proportions.

Results:

Out of a total 1467 enucleations performed during the study period, 693 (46%) were attributable to retinoblastoma, 189 (12.5%) to uveal melanoma, 228 (15%) to trauma, and 149 (10%) to phthisis bulbi. Intraocular tumors accounted for more than 63% of all enucleations performed. Over the three time periods, proportion of enucleations secondary to retinoblastoma increased from 38% in the 1^st period to 58% in the 3^rd period (P < 0.001). Enucleations for trauma showed statistically significant reduction in trends over the three periods (24% in the 1^st period vs. 4.4% in the 3^rd period, P < 0.001). Similar trends were also seen in the proportion of enucleations due to intractable glaucoma and chronic uveitis. The absolute number of enucleations secondary to retinoblastoma out of the total cases seen during the study period did not change over the three periods (range 51–60%).

Conclusion:

Intraocular tumors were the commonest indications for enucleation in our patient population despite the availability of globe-conserving treatments such as chemotherapy and radioactive plaques. We observed increasing trends in the proportion of enucleations due to retinoblastoma and reduction of enucleations secondary to trauma, chronic uveitis, and glaucoma.     

Changing Referral Patterns of Infectious Corneal Ulcers to a Tertiary Care Facility in South India - 7-year analysis

Purpose: To report changing trends in referral patterns of microbial keratitis evidenced by laboratory results of culture-positive cases from a tertiary eye-care hospital in south India. Methods: All patients presenting with microbial (nonviral) keratitis to the cornea services of Aravind Eye Hospital from 2003 to 2009 were identified from a computerized database. Microbiologic characteristics were recorded and annual distributions of causative organisms over the 7-year study period were compared. Results: Out of a total of 3059 cases of presumed microbial keratitis, 1756 had positive cultures (57.4%). Among the culture-positive cases, fungal pathogens were isolated from 1224 cases (70%), 488 (27.7%) showed bacterial growth, 18 (1.03%) grew acanthamoeba species and 26 (1.5%) demonstrated mixed bacterial and fungal growth. The percentage of fungal isolates in culture-positive cases increased gradually over the study period from 59% in 2004 to 78% in 2009. This increase in frequency of fungal keratitis was statistically significant (P = 0.023). A proportionally decreasing trend was seen in the number of bacterial isolates ranging from 31% in 2003-2005 to 22% in 2009 (P = 0.04). Conclusions: An incremental increase was seen in the number of fungal keratitis cases referred to our institute during the study period. Bacterial keratitis showed a decline. This disconcerting trend may lead to an increase in the incidence of corneal blindness in the developing world and thus warrants further research.     

Real-world experience of secukinumab treatment for ankylosing spondylitis at the Royal National Hospital for Rheumatic Diseases,Bath

Clinical Rheumatology - We reviewed our experience of treating ankylosing spondylitis patients with the IL-17 inhibitor secukinumab at the Royal National Hospital for Rheumatic Diseases, Bath. A...     

Improving Medication Management Competency of Clinical Trainees in Geriatrics

The authors hypothesized that an interprofessional workshop would improve geriatrics trainees' medication management. The workshop was based on a needs assessment and comprised an interactive session with pharmacists on managing medications in elderly adults. Participants were trainees in their geriatrics rotation at a tertiary care medical center. Trainees completed a medication appropriateness survey for three patients, one of which was their own. After the workshop, trainees reviewed medications of the three patients. Trainees completed online surveys after their rotation and 3 months later. Of 95 trainees rotating through geriatrics, 76 (80%) attended the workshop and completed the worksheet. Trainees' scores on reviewing medication lists improved significantly, from 6.7 ± 2.3 to 7.7 ± 2.0 out of 11 for standardized patient 1 (P < .001) and from 5.7 ± 1.8 to 6.4 ± 1.5 out of 11 for standardized patient 2 (P = .009). Trainees' scores on their own patients' lists also improved significantly, from 5.6 ± 1.5 to 6.6 ± 1.5 out of 10 (P < .001). After the workshop, 95% (71/75) planned to change the medication regimen of the patient they presented, and 93% (68/73) planned to change other patients' medications based on information learned during the workshop. Three months later, 35% (12/34) had made changes to the regimen of the patient they discussed during the workshop, and 71% (15/21) had made changes to other patients' regimens. Seventy‐eight percent (18/23) rated the workshop as the top nonclinical experience of their geriatrics rotation. In conclusion, this interprofessional medication management workshop improved trainees' ability to perform medication reviews accurately and led to change in self‐reported prescribing behavior.