Isolated abdominal nocardiosis in a pediatric renal transplant recipient

Nocardia infection after RT is uncommon. The most common modes of exposure are inhalation of dust containing nocardia or contaminated soil/water and surgical instruments. Isolated abdominal nocardiosis following RT has not been reported. We report an 11‐year‐old female who developed nocardia abscesses of the abdomen post‐RT. ESRD was secondary to FSGS and she had received multiple immunosuppressive agents prior to transplant. Induction immunosuppression consisted of thymoglobulin and maintenance was with tacrolimus, mycophenolate, and prednisone. There were construction activities in the hospital ward during her hospital stay. Due to immediate recurrence of FSGS in the allograft, she received plasma exchange, rituximab, and IVIG. Anti‐infective prophylaxis consisted of TMP‐SMX, valganciclovir, and nystatin. She developed multiple loculated fluid collections in the abdomen 6 weeks later. Histology of lesions demonstrated suppurative caseating granulomatous inflammation and the AFB culture showed Nocardia farcinica. With the reduction of immunosuppressive agents along with usage of TMP‐SMX, imipenem‐cilastatin, and linezolid, she had a partial recovery after 9 months with persistent small abscesses but remained asymptomatic clinically. There was no evidence of nocardia infection in lungs and brain. Repeat AFB culture from the lesions was negative. Allograft function remained stable throughout. She remains on oral TMP‐SMX therapy. We postulated that she could have acquired nocardia either from the contaminated air particles in the hospital from the construction activities or reactivation of nocardia from prior colonization. Nocardia infection should be suspected in immunocompromised patients with unexplained fever and abdominal pain.     

Safety and Efficacy of Intravitreal Dexamethasone Implant for Refractory Uveitic Macular Edema in Adults and Children

Purpose: To assess safety and efficacy of intravitreal dexamethasone (DEX) implant in refractory uveitic macular edema (ME).

Methods: We retrospectively analyzed medical records of patients with nonresponsive ME secondary to chronic, noninfectious intermediate or posterior uveitis, treated with intravitreal DEX implants.

Results: A total of 42 eyes of 34 patients (aged 6–67 years) received 56 implants. Mean follow-up was 19.2 ± 2.2 months after DEX implant. The mean visual acuity (0.48 ± 0.06 logMAR to 0.34 ± 0.1 logMAR) and mean central retinal thickness (472.2 ± 35 to 274.7 ± 60.6 µm) improved considerably before and after DEX implant. A total of 11 eyes needed repeat implants after a prolonged time to recurrence (12.6–20.9 months). A total of 10 eyes needed no additional treatment. Oral steroids could be stopped in 40% patients. Intraocular pressure increased in seven and cataract progressed in six eyes.

Conclusion: Intravitreal DEX implant is safe and effective adjunct therapy. It reduces dependence on systemic steroids, immunosuppressives and provides long-term effects.     

DFT exploration of [3 + 2] cycloaddition reaction of 1H-phosphorinium-3-olate and 1-methylphosphorinium-3-olate with methyl methacrylate

A Molecular Electron Density Theory (MEDT) study of the regio- and stereoselectivity of the [3 + 2] cycloaddition (32CA) reaction of 1H-phosphorinium-3-olate and 1-methylphosphorinium-3-olate with methyl methacrylate was carried out using the B3LYP/6-31G(d) method. In order to test the method dependence for the most favorable reaction path leading to the 1H-substituted 6-exo cycloadduct (CA) various functionals using higher basis sets were taken into consideration in the gas phase. An analysis of the energetic parameters indicates that the reaction path leading to 6-exo CA are kinetically as well as thermodynamically favored in the gas phase, THF and ethanol. The calculated energetic parameters of the 32CA reaction of these phosphorus derivatives were compared with those of methyl acrylate and their nitrogen analogues. Investigation of the global electron density transfer at the TSs indicates that these 32CA reactions have non-polar character, while electron localisation function topological analysis of the C–C bond formation along the most favorable reaction path indicates that these 32CA reactions take place through a non-concerted two-stage one-step mechanism, via highly asynchronous TSs.

These phosphorus cycloadducts are kinetically and thermodynamically more favorable than their nitrogen analogues, providing incentives to experimentalists in the quest to synthesise phosphorus containing heterocycles.     

Comparison of three techniques of harvesting full-thickness retinal tissue for large or persistent macular holes

Purpose:To evaluate the success rate of autologous retinal graft (ARG) for the closure of full-thickness macular holes (MHs) and compare the outcomes of three different techniques of harvesting the graft.Methods:Clinic files of all patients who had undergone ARG for MH using intraocular scissors, membrane loop, or retinal punch to harvest retinal tissue were retrospectively reviewed. All patients were evaluated for MH closure, retinal reattachment, and visual improvement.Results:Twenty-two eyes of 22 patients were included. ARG was done for 16 eyes (72.7%) with failed, large persistent MH, and six eyes (27.3%) also underwent simultaneous repair of retinal detachment. The basal diameter of MH was 1103.67 ± 310.09 (range 650–1529) mm. Intraocular scissors were used in 10 eyes (45.5%), a membrane loop in five eyes (22.7%), and a retinal punch in seven eyes (31.8%). Silicone oil tamponade was used in seven (31.8%) eyes and gas in 15 (68.1%) eyes. The follow-up ranged from 6 to 18 months. The hole closure rate was 72.7% (16/22). Visual improvement was noted in 18 eyes (81.8%). Retinal reattachment was seen in all eyes. Good graft integration with the surrounding area was seen in 17 eyes (77.3%). Graft retraction was seen in four eyes (18.18%) and graft loss in one eye (4.55%). No significant differences were noted among the three groups.Conclusion:ARG is successful in closing large, failed MH with and without retinal detachment. A membrane loop and retinal punch are equally useful in harvesting the graft, but scissors are preferable in case the retina is detached. With all three techniques, integration of the graft with the surrounding tissue can be achieved.     

Epileptic manifestations,pathophysiology, and imaging characteristics of non-ketotic hyperglycaemia: a review of the literature and a report of two cases with irreversible cortical vision loss

The purpose of this review is to create more awareness regarding the epileptic manifestations of non-ketotic hyperglycaemia, which are not widely recognised, and to assist understanding of the pathophysiology involved. Given that type II diabetes is one of the common causes of morbidity worldwide, it is important to appreciate the various neurological manifestations of non-ketotic hyperglycaemia.Here, I present two cases and review the existing literature. Both patients developed irreversible vision loss, which is a novel finding because only transient visual defects have previously been reported. The review includes a detailed discussion of the pathophysiology and characteristic magnetic resonance imaging (MRI) findings of patients with defects in cerebral lobar regions, which were associated with a variety of clinical manifestations. These manifestations can be ascribed to epileptic phenomena involving various parts of the cerebrum.Hyperglycaemia can lead to the irreversible loss of vision. Early diagnosis and treatment on the basis of the clinical features and characteristic MRI findings are important to avoid an epilepsia partialis continua-like state and irreversible visual impairment.     

Intravitreal cysticercosis presenting as neovascular glaucoma

We report two cases of intraocular cysticercosis which showed a peculiar presentation of neovascular glaucoma which is hitherto unreported. Two young adults presented with symptoms of raised intraocular pressure due to neovascular glaucoma. On dilated fundus examination both were found to have dead intravitreal cysticercosis. The cysts were removed by a three-port vitrectomy and intracameral injection of bevacizumab was given to help in the regression of rubeosis. Trabeculectomy had to be combined in one case. The intraocular pressure returned to normal. No recurrence of rubeosis was seen even after one year.