Some optical principles of the clinical specular microscope.

The clinical specular microscope is used to examine and photograph human endothelial cells in vivo. An optical analysis is presented here in simple form to aid the ophthalmologist or visual scientist in understanding how this instrument can be used in a quantitative manner to measure the size of the magnified endothelial cells and the thickness of the overlying cornea. An error analysis is discussed in order to demonstrate some aspects of the precision of the determination.     

Non-fermentative Gram-negative bacteria

Over the past decade, non-fermenting Gram-negative bacteria have emerged as important opportunistic pathogens in the increasing population of patients who are immunocompromised by their disease or medical treatment. These bacteria are assisted by their ubiquitous distribution in the environment and have a propensity for multiple, intrinsic or acquired drug resistance. The infections that they cause now pose significant problems in terms of treatment and infection control, whilst the commonly observed rapid emergence of bacterial resistance to new antimicrobial compounds raises concerns regarding the clinical lifespan of these agents. Studies are urgently required to assess whether combination therapy can improve the long-term utility of new drugs in the treatment of patients infected with non-fermenters.     

Retinoblastoma--a clinico-pathological study in Ilorin, Nigeria

Retinoblastoma is the commonest childhood primary malignant intraocular neoplasm that is often characterized by spontaneous regression. They display photoreceptor differentiation. This study provides the clinical presentations and histological profiles of retinoblastoma in Ilorin, Kwara-State, in the North Central geo-political zone of Nigeria. A retrospective study of clinically and histologically verified retinoblastoma at the University of Ilorin Teaching Hospital, Ilorin, Kwara-State, Nigeria from January 1989 to December 2000 was undertaken. The clinical and histological features were analyzed using the patient's case folder and surgical pathology records. There were 20 patients, 9 males and 11 females (M:F ratio 1: 1.2), age range from 5 (1/2) months to 6 years with 23 eyeball tumours histologically confirmed retinoblastoma during the study period. Proptosis with chemosis was the most common clinical presentation (84.6 %). Bilaterality was 15 % in this study. Enucleation and Exenteration combined with chemotherapy were offered to 15 (75 %) and 5 (25 %) patients respectively. A poorly differentiated type with extensive areas of tumour necrosis was the commonest histological pattern. Thirteen (65 %) of the patients died before completing the course of chemotherapy.     

Candidaemia in a large teaching hospital: a clinical audit

BACKGROUND: Candidaemias are associated with significant morbidity and mortality. The British Society of Medical Mycology and Infectious Diseases Society of America recently published audit standards, to address the changing epidemiology of candidaemia and to improve outcomes. AIM: To investigate the local epidemiology of candidaemia and the standard of care in a large teaching hospital. DESIGN: Retrospective audit. METHODS: Data were obtained for all candidaemia episodes over the 4-year period ending July 2004, from the medical and nursing notes, laboratory computer and patient administration system. RESULTS: We identified 92 episodes in 90 patients. The main predisposing factors were being on an intensive care unit, having a central venous catheter, and (for neonates) prematurity. Central venous catheters were removed at a mean 1.8 days following candidaemia; 79% (37/47) were removed within 48 h (the audit standard). Identification and susceptibility tests were performed for 94.7% of isolates. All were susceptible to amphotericin B; 87% were susceptible to fluconazole. Antifungal treatment was started within 24 h of a positive blood culture in 84% of episodes. Initial antifungal therapy was appropriate in 95% (61/64) of treated cases. Most patients (81%) who survived or completed their intended course of treatment before death received at least 2 weeks treatment. However, only 45% of those transferred to other hospitals had accompanying guidance on the intended further duration of therapy. Thirty-day mortality was 41%. After adjustment for age, the presence of Candida-related complications was associated with an odds ratio for mortality of 6.5 (95% CI 1.2-36.5, p = 0.03). DISCUSSION: Overall the audit standards set by the BSMM and IDSA were met, and discrepancies did not lead to a change in outcome. Improved intravenous catheter care, a more pro-active approach to searching for complications, and improvement in the inter-hospital transfer process, will assist in reducing morbidity and mortality.