Risk factors for pediatric presumed microbial keratitis: a case-control study.

PURPOSE: To evaluate risk factors for pediatric presumed microbial keratitis and to describe the clinical picture, microbiologic spectrum, treatment modalities, posttreatment sequelae, and visual outcome in cases of pediatric presumed microbial keratitis. METHODS: A case-control study design was used to identify the risk factors associated with pediatric presumed microbial keratitis. Fifty cases of fresh corneal ulceration aged 12 years or younger were compared with 50 controls. The study variables included were age, gender, immunization status, nutritional status (weight for height), and socioeconomic status. The clinical presentation of the cases with corneal ulceration, microbiologic spectrum, and treatment modalities also were evaluated. All the cases were followed up for a minimum of 3 months, and the posttreatment sequelae and visual outcome were analyzed. RESULTS: The mean (+/- standard deviation) age of children with corneal ulceration and controls was 4.8 (+/-3.8) years and 5.1 (+/-2.8) years, respectively. Incomplete immunization status (AOR [95% confidence interval (CI)], 1.34 [0.62-2.9]) and poor nutritional status [AOR (95% CI) 1.06 (0.68-1.6)] were not found to be the predictors of corneal ulceration. Lower socioeconomic status was significantly associated with the occurrence of corneal ulceration [AOR (95% CI) 1.52 (1.1-2.3)]. Corneal trauma (38%) and systemic illness (24%) were the most often associated predisposing factors. Seventy percent of the cases were culture positive. Staphylococcus (70%) species was the most frequently isolated, followed by Pseudomonas aeruginosa (10%). Fungi were isolated in five eyes. Postresolution visual acuity at 3 months could be recorded only in 31 eyes and a visual acuity of 6/18 or better was achieved in 22% of these cases. CONCLUSION: Corneal ulceration in pediatric age group in India is associated with poverty.     

Infectious crystalline keratopathy.

PURPOSE: To review the diagnosis, microbial and pathological features, pathogenesis, and treatment of infectious crystalline keratopathy (ICK). METHODS: We reviewed the literature on infectious crystalline keratopathy. RESULTS AND CONCLUSIONS: ICK is an indolent corneal infection in which needle-like, branching crystalline opacities are seen within the corneal stroma, in the absence of appreciable corneal or anterior segment inflammation. In most cases it occurs as a complication of corneal surgery and keratitis, with an alpha-hemolytic Streptococcus being the cause of infection. Discontinuation of topical steroids with aggressive antibiotic therapy may suffice, but continued infection, vascularization, or scar formation may affect visual acuity and require penetrating keratoplasty.     

Investigation of an outbreak of Japanese encephalitis in Rourkela City (Orissa) during 1989.

An outbreak of Japanese encephalitis (JE) was reported from Rourkela city for the first time in September-November 1989. 41 cases and 15 deaths occurred with a case fatality rate of 36.6 per cent. Most of the cases (66 per cent) were in the age group of 5-19 years. There was no case under 5 years. Female-male ratio of cases was 1:1.7. Serological examination of convalescent cases showed JE specific IgM indicating strong evidence of recent JE infection. Large number of pigs were seen in the affected areas.     

Genetic diversity of HIV type 1 subtype C env gene sequences from India

Considering the severity of the HIV-1 subtype C epidemic, data on the epidemiology and distribution of HIV subtypes in India are relatively sparse. Keeping this in view, 28 env gene sequences from patients were sequenced and analyzed. The samples were collected over a period of 10 years from 1995 to 2004. Assessment of the interisolate genetic distances of the study isolates, which were all subtype C, showed interisolate distances varying from 2 to 19% (mean: 14%) with the maximum diversity observed in the samples collected in 2003-2004. Analysis of the phylogenetic relationships among subtype C env sequences from six different countries and our study isolates revealed an overall star-like phylogeny with almost all sequences from India forming a monophyletic lineage. A lower diversity within the immunodominant epitopes was found. The data generated from this study should prove valuable for the production of vaccine against subtype C.     

Expression of signal transducer and activator of transcription 3 (STAT3) in primary central nervous system diffuse large B-cell lymphoma: a retrospective analysis of 17 cases

Most primary central nervous system lymphomas (PCNSL) occurring in immunocompetent patients are diffuse large B-cell lymphomas (DLBCL), characterized by poor prognosis. An activated B-cell (ABC) origin of PCNSL has been postulated based on bcl-6 and MUM-1 expression by majority of these tumors. ABC DLBCL has been functionally subdivided using gene expression profiling and immunohistochemical analysis into STAT3-high and STAT-3 low subsets. A potentially crucial difference between STAT3-high and STAT3-low ABC DLBCL is in the expression of bcl-2 family members. STAT3-high cases are generally bcl-2 low and STAT3-low cases show higher expression of bcl-2. Further mechanisms such as activation of nuclear factor-kappa B (NF-κB) activation seem to be responsible for upregulation of bcl-2 in ABC subtype of DLBCL with an adverse outcome. As deregulation of STAT-3 pathway is known to play a critical role in ABC DLBCL and majority of the PCNSL are of the ABC subtype we studied the immunohistochemical expression of STAT-3 proteins in PCNSL along with other traditional markers (CD10, bcl-6, MUM-1 and bcl-2) in 17 cases of PCNSL occurring in immunocompetent patients. Despite lack of STAT3 expression in all our cases, majority (70%) of the patients with bcl-2 positive PCNSL had an adverse outcome similar to that reported in systemic lymphomas of ABC subtype. Based on our observations we propose that PCNSL represents a distinct subset of ABC diffuse large B-cell lymphomas with low STAT3 expression and perhaps mechanisms other than interaction of STAT-3 and NF-κB pathways may play a role in upregulation of bcl-2 in PCNSL. To the best of our knowledge expression of STAT-3 protein in PCNSL which represents a distinct anatomical subset of ABC DLBCL with a dismal prognosis has not been studied before.     

Modification in descemet-stripping automated endothelial keratoplasty: "Hitch suture" technique

PURPOSE: To describe a new modification in Descemet-stripping automated endothelial keratoplasty, using a "hitch suture" to unfold the donor lenticule inside the recipient's eye. METHODS: The technique was used in 2 eyes of 2 patients with bullous keratopathy after complicated cataract surgery. A hitch suture was created in both the donor lenticules before inserting the folded graft in the recipient's anterior chamber. The hitch suture was pulled through a limbal stab incision to unfold the donor lenticule in both cases. RESULTS: No intraoperative problems were encountered. The grafts were well centered with corneal edema. The central part of the graft cleared over a period of 10 to 14 days. CONCLUSION: The technique of using a hitch suture to unfold the graft eliminates the problems associated with this difficult step of the surgery. The hitch loop can be easily made at the edge of the graft and can be pulled using a Sinskey hook through 1 of the stab incisions. We believe that this simple modification in this surgery would help simplify the learning curve of the procedure and increase its chances of success.     

Risk factors for perforation in microbial corneal ulcers in north India

AIM: To identify predisposing factors leading to corneal perforation in patients with microbial keratitis. METHOD: Two groups of 60 patients each, with perforated corneal ulcers and healed/healing corneal ulcers, respectively, were recruited in a case-control study conducted in northern India. The cases and controls were matched by age and time of presentation. A standardised proforma was used to identify potential predisposing factors for demographic, social, medical, ocular, and treatment history. All participants underwent a detailed ocular examination. Corneal scrapings were performed where relevant. RESULTS: The characteristics associated with corneal perforation in microbial keratitis were outdoor occupation (p = 0.005), illiteracy (p = 0.02), excessive alcohol use (p = 0.03), history of "something falling into eye" (p = 0.003), trauma with vegetable matter (p = 0.008), vision less than counting fingers at referral (p<0.001), central location of ulcer (p<0.001), lack of corneal vascularisation (p<0.001), delay in starting initial treatment (p<0.001), failure to start fortified antibiotics (p<0.001), and monotherapy with fluoroquinolones (p = 0.002). The lack of corneal vascularisation (OR 6.4, 95% CI 4.2 to 13.5), delay in starting initial treatment (OR 35.6, 95% CI 6.9 to 68.2), and failure to start fortified antibiotics (OR 19.9, 95% CI 2.7 to 64.7) retained significance on a logistic regression model. CONCLUSIONS: This study characterises microbial keratitis cases at increased risk of corneal perforation and reinforces the need for standardised referral and treatment protocols for patients with corneal ulcer on their first contact at primary care level in the developing world.     

Factors affecting eye donation from postmortem cases in a tertiary care hospital

PURPOSE: To evaluate the responses to requests for eye donation from relatives of postmortem cases in a tertiary care hospital in India. METHODS: In a prospective study, the cases brought for postmortem to the Forensic Medicine Department were screened as potential donors by our team. The next of kin of potential donors were approached and counseled in a systematic manner following a standard interview pattern. Responses were noted in a predesigned performa. The religion, level of literacy, socioeconomic status, relationship with the deceased, prior knowledge of eye donation, willingness for eye donation, and reasons for not donating eyes of the deceased were recorded. RESULTS: One hundred fifty-nine potential donors were identified from a total of 721 postmortem cases. There were 119 (74.8%) men and 40 (25.2%) women. None of the deceased had previously pledged their eyes for eye donation. Eighty-eight (55.4%) next of kin were already aware of the concept of eye donation, but 71 (44.7%) families had not heard of it before. Willingness for eye donation was seen in 66 (41.5%), whereas 93 (58.5%) families refused eye donation. Of those already aware of eye donation, 39 (44.3%) gave consent for donation. Prior knowledge of eye donation had no influence on willingness for eye donation (P = 0.424). Similarly, literacy (P = 0.338) and socioeconomic status as estimated by a composite socioeconomic scale based on literacy and family income did not have any influence on willingness for eye donation (P = 0.338). Major reasons for not donating eyes included refusal to discuss the issue and dissuasion by distant relatives, legal problems, and religious beliefs. CONCLUSIONS: In our experience, literacy, socioeconomic status, and prior knowledge of eye donation of next kin had no correlation with donor corneal tissue procurement. Active counseling by a motivated team can be effective even in families with no prior knowledge and low socioeconomic status.