Evaluation of 0.3% Gatifloxacin Hydrochloride in Decontamination of Donor Corneas

PURPOSE:: To evaluate demographic, clinical, and microbiological profile of eye donors and efficacy of 0.3% gatifloxacin hydrochloride in microbial decontamination of donor corneas. METHODS:: About 513 donors and 1,026 corneas received at National Eye Bank of a tertiary care hospital during 1-year period were analyzed prospectively in this randomized clinical trial. The donor eyes were graded and treated with 5% povidone-iodine, 0.4% amikacin sulphate, and 0.3% gatifloxacin hydrochloride. The parameters evaluated were death enucleation time (DET), grading of donor corneas, microbiological profile of culture organisms, and their sensitivity to various antibiotics. RESULTS:: Mean DET was 6.29±5.7 hours. Forty one percent eyes were optical grade corneas and the majority of donors (38.5%) had accidental deaths. Good grade eyes were maximum with DET of <1 hour and were comparable between 0-6 hours and 6-12 hours. About 57.6% (591/1026) eyes were culture positive; most common organisms were Pseudomonas spp (53%) and Coagulase-negative Staphylococci (24%). Culture positivity reduced significantly after treatment with povidone iodine and amikacin (P=0.002, right eye; P=0.004; left eye) and decreased further with use of gatifloxacin (P=0.001). Pseudomonas (93%), Coagulase-negative Staphylococci (96.3%), Staphylococcus aureus (90.5%), enterococci and gram-negative bacilli were sensitive to gatifloxacin. Pseudomonas spp which were multidrug-resistant were sensitive to polymyxin-B. CONCLUSIONS:: Gatifloxacin hydrochloride in addition to amikacin sulphate is beneficial for donor eye decontamination. Polymyxin-B may be used for multidrug-resistant Pseudomonas spp.     

What did you think of the hematology/oncology rotation? A survey of internal medicine residents

Background. To evaluate responses of residents to a hematology/oncology rotation.Methods. A self-administered mail survey among internal medicine residents in a university-based training program who were required to complete a hematology/oncology rotation at a comprehensive cancer center.Results. The majority of the residents rated the duration of the rotation as adequate and quality as excellent or good. It had a positive impact on certain knowledge areas, general opinion about hematology/oncology, preparation for board examination, and motivation to pursue this subspecialty, especially among residents who had performed additional electives.Conclusion. A hematology/oncology rotation received a generally positive evaluation from internal medicine residents.     

Myectomy versus anterior transposition for inferior oblique overaction

BACKGROUND: Inferior oblique overaction can be either secondary (as a sequela of ipsilateral superior oblique palsy) or primary (commonly associated with horizontal strabismus). Superior oblique underaction often coexists with both primary and secondary inferior oblique overaction. This retrospective case series compares the efficacy of inferior oblique myectomy versus anterior transposition in improving inferior oblique overaction and superior oblique underaction in eyes with either primary or secondary inferior oblique overaction. METHODS: One hundred twenty eyes of 81 patients were included in this retrospective case series, of which 20 had anterior transposition of the inferior oblique and 100 eyes underwent myectomy. Inferior oblique myectomy was compared with inferior oblique anterior transposition in improving inferior oblique overaction and superior oblique underaction in each diagnostic subgroup. Postoperative outcome was qualitatively and quantitatively assessed. Fisher's exact test was used to compare the outcomes. The quantitative improvement of function in terms of inferior oblique overaction and superior oblique underaction was analyzed by regression analysis. RESULTS: When postoperative inferior oblique overaction was considered, there was no statistically significant difference between myectomy and anterior transposition in both primary and secondary inferior oblique overaction. Myectomy was superior to anterior transposition in improving superior oblique underaction in both primary inferior oblique overaction (OR = 0.14; 95% CI, 0.015-1.45; p = 0.056) and secondary inferior oblique overaction (OR = 0; 95% CI, 0-0.027; p < 0.001). The quantitative improvement of function showed a significant difference between procedures for superior oblique underaction (t-test; p = 0.005; 95% CI, 0.25-1.3) but not inferior oblique overaction (t-test; p = 0.8; 95% CI, -0.67-0.54). CONCLUSIONS: This study demonstrates both inferior oblique myectomy and inferior oblique anterior transposition to be effective in correcting primary and secondary inferior oblique overaction. Myectomy is more effective in improving superior oblique underaction associated with both primary and secondary inferior oblique overaction. On this basis, we feel that inferior oblique myectomy has some advantage over anterior transposition in treating combined inferior oblique overaction and superior oblique underaction and can be considered the procedure of choice.     

Chromosomal breakage in myelodysplatic syndrome.

The myelodysplastic syndrome (MDS) represents a group of clonal hematological disorders characterized by progressive cytopenia reflecting defects in erythroid, myeloid and mega karyocytic maturation. The incidence of MDS is greter in older age groups. Detailed studies on MDS from India are not available. Cytogenetic study using GTG-banding and FISH revealed 54.5% clonal chromosomal abnormalities. We have carried out chromosomal breakage study from peripheral blood cultures induced with mitomycin C, in karyotypically normal MDS (49) and 15 (30.6%) showed significant (p < 0.001) increase in chromosome damage compared to controls. Among 22 occupationally exposed MDS, 6 (27.3%) showed a high frequency of chromosome breakage while in the non-exposure (n=27) group, high chromosome breakage was noted in 9 (33.3% ) MDS patients. Our results suggest that the high chromosome damage may be due to acquired Fanconi anemia which leads to multiple defects in chromosomes and clonal chromosome anomalies.     

Disseminated hydatid disease involving orbit,spleen, lung and liver

Orbital hydatid disease is rare, even in endemic areas. We present a case of disseminated hydatid disease involving the orbit, spleen, lung and liver in a lady aged 35 years. Based on a typical clinical presentation, presence of eosinophilia, a positive indirect haemagglutination test for hydatid disease and presence of similar disseminated, anechoic cystic masses in the liver, lung, spleen and orbit on imaging studies, the diagnosis of hydatid cyst was seriously considered before surgery. Aspiration of the cyst, followed by cryo-extraction of the cyst wall through transconjunctival route was safely performed. Histopathological examination confirmed the diagnosis. In conclusion, multisystemic involvement of liver, lung and spleen in a case of orbital hydatid cyst has never been reported before. The surgical technique adopted in this case is safe and effective.