Diagnosis of limbal stem cell deficiency based on corneal epithelial thickness measured on anterior segment optical coherence tomography

PURPOSE

The purpose of this study is to investigate the epithelial thickness in the cornea and limbus in limbal stem cell deficiency (LSCD) using anterior segment optical coherence tomography (AS-OCT).

METHODS

This was a cross-sectional, comparative study. OCT images of 30 eyes of 19 patients with LSCD collected by AS-OCT were scanned. Corneal epithelial thickness was recorded at the central cornea and the superior, nasal, inferior, and temporal limbus. Measurment of the same region of 30 normal eyes served as control. Epithelial thickness in all locations was measured by 2 independent observers.

RESULTS

The mean epithelial layer thickness was 61.3 ± 2.9 μ in the central cornea and 62.7 ± 4.3 μ in the limbus in the control. The epithelial thickness in LSCD patients was found to be 41.33 ± 2.8 μ. An average reduction of 22.2% in the central cornea and 32.15% in the limbus was found in patients with LSCD (P < 0.05). Epithelial thinning correlated with the severity of LSCD in both cornea and limbus. In eyes with sectoral LSCD, a similar degree of epithelial thinning was also detected in the clinically unaffected limbal regions.

CONCLUSION

Both corneal and limbal epithelia become progressively thinner in LSCD. Epithelial thickness assessment using AS-OCT as a noninvasive tool could be used as a diagnostic measure of LSCD.

An appropriately performed conventional blood culture can facilitate choice of therapy in resource-constrained settings-comparison with BACTEC 9050

Aims:

Comparison of conventional blood culture with BACTEC 9050 for rate and time to detection of microorganisms.

Settings and Design:

A prospective study was carried out in a multispecialty tertiary care teaching hospital.

Subjects and Methods:

A total of 835 paired specimens (797 blood and 38 nonblood specimens) were collected and processed according to standard microbiological procedures by both conventional method as well as by BACTEC 9050 automated culture system. Clinical details of patients were recorded. Data were analyzed for time to detection and isolation rate by the two systems and compared.

Results:

Overall culture positivity for BACTEC 9050 and the conventional system was 32% and 19.88%, respectively. Eighty-five demonstrated concordant growth, 136 specimens were culture positive by BACTEC only, and 38 specimens were culture positive by conventional only. Twelve contaminants in BACTEC and nine contaminants in conventional system were detected. Using BACTEC 9050, higher isolation was observed for Acinetobacter spp., coagulase negative Staphylococcus spp., Streptococcus spp., and Candida spp. A total of 410 patients were on antimicrobial treatment and culture positivity was significantly higher with BACTEC 9050 (P < 0.0001). There was a significant difference in the mean time to detection with BACTEC 9050 recovering 86.8% of isolates within 48 h (P < 0.0001).

Conclusions:

Although BACTEC 9050 demonstrated a significantly higher recovery of microorganisms from blood, an appropriately performed conventional blood culture can facilitate the choice of therapy.

Ocular rhinosporidiosis: a case report from Delhi

Rhinosporidiosis caused by Rhinosporidium seeberii, a protistal microorganism, is endemic in several parts of India. Infection involves mucous membranes of the nose and paranasal sinuses and usually manifests as vascular friable polyps. A few cases of rhinosporidoisis have been reported from Delhi, in patients who were migrants from other states. The present case constitutes the first report of rhinosporidiosis in a Delhi resident; the lesion occurred as polypoidal mass of the palpebral conjunctiva.

Hyperuricaemia induced by ethambutol

Seventy patients with pulmonary tuberculosis and 12 healthy controls were included in a study to observe the effect of ethambutol on serum uric acid level. In ethambutol-treated cases a statistically significant increase in mean serum uric acid levels was observed in the second, third and fourth week of treatment. This increase was independent of dosage of ethambutol. However, 22 of the 52 (42%) ethambutol-treated cases showed no increase. Streptomycin was found not to potentiate the hyperuricaemic action of ethambutol. Hyperuricaemia due to ethambutol was reversed with probenicid but not by salicylates. No patient developed acute gouty arthritis although two developed arthralgia.