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Nair L, Krishna KJ, Kumar A, Mathews S, Joseph J, James F. 208P Prognostic factors and outcomes of non-seminomatous germ cell tumours of testis: Experience from a tertiary cancer centre in India. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Das T, Agarwal M, Behera U, Bhattacharjee H, Bhende M, Das AV, Dave VP, Dogra A, Ghosh AK, Giridhar S, Joseph J, Kandle K, Karoliya R, Lalitha P, Pathengay A, Sharma S, Therese L. Diagnosis and management of fungal endophthalmitis: India perspective. Expert Review of Ophthalmology 2020. [DOI: 10.1080/17469899.2020.1820322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Taraprasad Das
- L V Prasad Eye Institute, Hyderabad, India (Kallam Anji Reddy Campus; Srimati Kanuri Santamma Centre for Vitreo Retinal Diseases), India
| | - Manisha Agarwal
- India (Retina and Vitreous Department, Dr Shroff’s Charity Eye Hospital, New Delhi, India
| | - Umesh Behera
- L V Prasad Eye Institute, Bhubaneswar, India (Mithu Tulsi Chanrai Campus), India
| | - Harsha Bhattacharjee
- Department of Vitreoretonal diseases, Sri Sankaradev Nethralaya, Guwahati, India
| | - Muna Bhende
- Sankara Nethralaya, Chennai, India (Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation), India
| | - Anthony V. Das
- Department of eyeSmart and EMR, L V Prasad Eye Institute, Hyderabad, India
| | - Vivek P. Dave
- L V Prasad Eye Institute, Hyderabad, India (Kallam Anji Reddy Campus; Srimati Kanuri Santamma Centre for Vitreo Retinal Diseases), India
| | - Avantika Dogra
- L V Prasad Eye Institute, Hyderabad, India (Kallam Anji Reddy Campus; Srimati Kanuri Santamma Centre for Vitreo Retinal Diseases), India
| | - Anup K. Ghosh
- India (Department of Medical Mycology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sneha Giridhar
- Sankara Nethralaya, Chennai, India (Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation), India
| | - Joveeta Joseph
- L V Prasad Eye Institute, Hyderabad, India (Kallam Anji Reddy Campus; Jhaveri Microbiology Centre), India
| | - Kaustubh Kandle
- Sankara Nethralaya, Chennai, India (Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation), India
| | - Roshni Karoliya
- L V Prasad Eye Institute, Hyderabad, India (Kallam Anji Reddy Campus; Jhaveri Microbiology Centre), India
| | - Prajna Lalitha
- India (Department of Microbiology, Aravind Eye Care System, Madurai, India
| | - Avinash Pathengay
- L V Prasad Eye Institute, Vishakhapatnam, India (GMR Varalakshmi Campus), India
| | - Savitri Sharma
- L V Prasad Eye Institute, Hyderabad, India (Kallam Anji Reddy Campus; Jhaveri Microbiology Centre), India
| | - Lily Therese
- L & T Department of Microbiology, Vision Research Foundation, Chennai, India
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Abstract
Abstract
The fourth target of Sustainable Development Goal (SDG) 3 advocates for the promotion of mental health and wellbeing. The Indian state of Kerala is recognized for its gains in health and development but has substantial burden of mental health ailments. Historical analysis is vital to understand the pattern of mental health morbidity. The current study focusses on comparable estimates available from three largescale population-based surveys in India to explore trends in prevalence of mental health disorders over the years and map resources and infrastructure available for mental health care in Kerala.
We undertook a secondary analysis of national demographic surveys from 2002 to 2018 which reported information on mental health and availability of health infrastructure and human resources. Data were collated and descriptive analyses were conducted. We compared the national and state level estimates over the years to study the trend in the prevalence of mental health disability.
The prevalence of mental retardation and intellectual disability in Kerala increased from 194 per hundred thousand persons in 2002 to 300 per hundred thousand persons in 2018, two times higher to the national average. The prevalence of mental illness increased from 272 per hundred thousand people to 400 per hundred thousand people in sixteen years. The prevalence was higher among males (statistical significance was not indicated) in mental illness and mental retardation. 2018 data showed that the public sector had 0.01 hospitals and 5.53 beds per hundred thousand persons available for mental health treatment.
Results showed a substantial increase in mental health illness over the 16-year study period that has affected males and females, as well as all social classes of the state. The current health infrastructure and human resources in the public sector of the state are inadequate to meet the current burden of the problem and to ensure universal access to care for its population.
Key messages
The trend in prevalence of mental health disorders in the state is increasing across the years. There is a mismatch between the extend of the problem and resources available in public sector.
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Affiliation(s)
- J Joseph
- Health Systems, The George Institute for Global Health, New Delhi, India
| | - H Sankar
- Health Systems, The George Institute for Global Health, New Delhi, India
| | - D Nambiar
- Health Systems, The George Institute for Global Health, New Delhi, India
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Sakthivel A, Thangagiri B, Raman N, Joseph J, Guda R, Kasula M, Mitu L. Spectroscopic, SOD, anticancer, antimicrobial, molecular docking and DNA binding properties of bioactive VO(IV), Cu(II), Zn(II), Co(II), Mn(II) and Ni(II) complexes obtained from 3-(2-hydroxy-3-methoxybenzylidene)pentane-2,4-dione. J Biomol Struct Dyn 2020; 39:6500-6514. [PMID: 32794423 DOI: 10.1080/07391102.2020.1801508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Novel macrocyclic Schiff base complexes [[ML]X; where M = Cu(II), Co(II), Ni(II), Zn(II), Mn(II) and VO(IV); L = macrocyclic ligand; X = Cl2 and SO42-] have been synthesized and characterized by microanalytical, 1H, 13C NMR, IR, Mass, UV-Vis, EPR spectral studies, as well as conductivity data. All the complexes exhibit square-planar geometry except vanadium complex. Magnetic susceptibility measurements and high conductance data reveal the monomeric and electrolytic nature of the complexes. Electronic absorption, cyclic voltammetry, viscosity measurements have been carried out on the interaction of the complexes with DNA. The results suggest that the complexes bind to DNA by intercalation via the aromatic ring of the macrocycle into the base pairs of DNA. Using gel electrophoresis experiment in the presence and absence of oxidant (H2O2) the nuclease cleavage activity of the complexes has been performed on plasmid DNA. The results demonstrate that most of the complexes have promising superoxide dismutase (SOD)-mimetic activity. The in vitro cytotoxicity of ligand and its complexes has also been evaluated against human breast and colon carcinoma cells. Binding interactions and energies of ligand and its metal complexes [ML]2+ (M = VO(IV), Mn(II), Co(II), Ni(II), Cu(II), Zn(II)) against the receptors EGFR and HER2 are performed using the Auto dock module. Consequently, it is found that the ligand is strong inhibitor for EGFR and HER2 while [VOL]SO4 is good inhibitor for EGFR and [ZnL]Cl2 is moderate inhibitor for HER2. The antimicrobial activity of the ligand and its complexes against bacteria Salmonella typhi, Staphylococcus aureus, Escherichia coli and Bacillus subtilis and fungi Aspergillus niger, Aspergillus flavus, Candida Albicans and Rhizoctonia bataicola. The complexes have higher activities than the macrocyclic free Schiff base. Interaction of [VOL]SO4 to the binding sites of target protein EGFR (PDB ID: 4HJ0). Research HighlightsMacrocyclic Schiff base and its metal complexes were synthesized.Complexes bind to DNA by intercalation via the aromatic ring of the macrocycle into the base pairs of DNA.Vanadyl complex is a good inhibitor for EGFR.The complexes of copper, zinc and vanadium show efficient antitumor activity.Copper and vanadium complexes have superior antimicrobial activity than the standards.
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Affiliation(s)
- A Sakthivel
- Department of Chemistry, Mepco Schlenk Engineering College, Sivakasi, India
| | - B Thangagiri
- Department of Chemistry, Mepco Schlenk Engineering College, Sivakasi, India
| | - N Raman
- Research Department of Chemistry, VHNSN College, Virudhunagar, India
| | - J Joseph
- Department of Chemistry, Noorul Islam Centre for Higher Education, Kumaracoil, Tamil Nadu, India
| | - Ramu Guda
- Department of Chemistry, Kakatiya University, Warangal, India
| | - Mamatha Kasula
- Department of Chemistry, Kakatiya University, Warangal, India
| | - L Mitu
- Department of Nature Sciences, University of Pitesti, Pitesti, Romania
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105
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Bagga B, Sharma S, Gour RPS, Mohamed A, Joseph J, M Rathi V, Garg P. A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis. Eye (Lond) 2020; 35:1326-1333. [PMID: 32719525 DOI: 10.1038/s41433-020-1109-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare the efficacy of topical voriconazole 1% and the combination therapy of 0.02% polyhexamethylene biguanide (PHMB) and 0.02% chlorhexidine for the treatment of Acanthamoeba keratitis (AK). METHODS This is a prospective, pilot, double-masked randomized comparative study. Twenty-three eyes of 23 patients with microbiologically (smear and/or growth on culture) confirmed AK were randomized to group BG (PHMB 0.02% and chlorhexidine 0.02%) or group VZ (voriconazole 1%). Primary outcome measure was change in geometric mean (GM) of the corneal ulcer size at final visit. Secondary outcome measures were change in visual acuity. RESULTS Out of 71 patients with confirmed AK seen during study period, 23 patients were recruited and 18 patients completed minimum 2 weeks of treatment and further analyzed. Ten patients received BG, whereas eight received VZ. Median ulcer size measured as GM of infiltrate decreased from 5.7 mm (IQR, 5.3-6.5 mm) (p = 0.02) to 1 mm (IQR, 0-4.3 mm) in group BG and from 4.5 mm (IQR, 1.8-5.1 mm) (p < 0.05) to 0.7 mm (IQR, 0-1.6 mm) in VZ group. Median visual acuity improved from 1.79 (IQR, 1.48-2.78) to 1.10 (IQR, 0.48-1.79) in BG group (p = 0.02) and from 1.60 (IQR, 1.00-2.78) to 0.80 (IQR, 0.48-1.30) in VZ group (p = 0.18). CONCLUSION These outcomes suggest that topical VZ as a monotherapy in AK treatment is effective and comparable to BG combination therapy but needs trials with larger sample size and longer follow-up to provide conclusive evidence.
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Affiliation(s)
- Bhupesh Bagga
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | | | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Varsha M Rathi
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Prashant Garg
- The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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106
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Affiliation(s)
- Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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107
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Mundra J, Dhakal R, Mohamed A, Jha G, Joseph J, Chaurasia S, Murthy S. Outcomes of therapeutic penetrating keratoplasty in 198 eyes with fungal keratitis. Indian J Ophthalmol 2020; 67:1599-1605. [PMID: 31546488 PMCID: PMC6786177 DOI: 10.4103/ijo.ijo_1952_18] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose: To study the outcomes of therapeutic penetrating keratoplasty in fungal keratitis. Methods: This retrospective, observational, interventional case series involved an audit of 198 consecutive eyes that underwent therapeutic penetrating keratoplasty (ThPK) for fungal keratitis at L V Prasad Eye Institute between January 2008 and December 2010 was performed. The data on demographics, clinical characteristics, intraoperative, and late postoperative complications were noted. The primary outcome measure was eradication of infection and postoperative anatomical success. Secondary outcome measures were graft survival, risk factors, clinical features, and management of recurrent fungal keratitis post ThPK. Results: Mean follow-up after ThPK was 24 ± 17 months. A total of 178 (89.9%) eyes had complete eradication of fungal infection, whereas 20 (10.1%) eyes developed recurrence. Anatomical restoration was achieved in majority of cases (192 eyes; 97%). Larger infiltrate size was associated with a higher risk of recurrence of infection. The median graft survival rate was 5.9 months. The graft survival was better for grafts <8 mm versus those with >8 mm (P = 0.026) and not found significantly related to the species of fungus. Twenty-seven eyes underwent re-grafting: penetrating keratoplasty in 14 eyes, and Descemet's stripping endothelial keratoplasty in 13 eyes. Conclusion: As larger infiltrate prior to therapeutic keratoplasty had much higher risk of recurrences; timely surgical intervention should be considered in cases not responding to medical therapy. Alternative strategies of management of postoperative inflammation need to be considered to prevent graft failures.
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Affiliation(s)
- Jyothi Mundra
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rohit Dhakal
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Govinda Jha
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Somasheila Murthy
- Cornea and Anterior Segment Services, LV Prasad Eye Institute, Hyderabad, Telangana, India
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108
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Naik P, Singh S, Vishwakarma S, Kaur I, Dave VP, Kumar A, Joseph J. Multidrug-Resistant Pseudomonas aeruginosa Evokes Differential Inflammatory Responses in Human Microglial and Retinal Pigment Epithelial Cells. Microorganisms 2020; 8:microorganisms8050735. [PMID: 32423093 PMCID: PMC7285153 DOI: 10.3390/microorganisms8050735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Increasing incidences of multidrug-resistant (MDR) pathogens causing endophthalmitis threaten our ability to treat this condition, and the modulation of inflammatory responses by MDR bacteria is not known. In this study, using human microglia and retinal pigment epithelial (RPE) cells, we compare the inflammatory responses of sensitive (S-PA) and multidrug-resistant (MDR-PA) clinical isolates of Pseudomonas aeruginosa. Infected cells were subjected to qPCR analysis, enzyme-linked immunosorbent assay (ELISA), and immunostaining to assess the expression of inflammatory mediators. Both microglia and RPE cells, challenged with S-PA and MDR-PA, induced a time-dependent expression of inflammatory cytokines. Significant differences were observed in expression levels of Toll-like receptors (TLR) TLR4, TLR5, and TLR9 in microglia cells challenged with MDR-PA vs. S-PA. Similarly, mRNA levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, Interferon (IFN)-γ, and matrix metalloproteinase (MMP)-9 were also higher in MDR-PA-infected cells. At protein levels, upregulation was observed for IL-10 (p = 0.004), IL-8 (p = 0.0006), IL-1β (p = 0.02), and Granulocyte-macrophage colony-stimulating factor (GM-CSF) (p = 0.0006) in cells infected MDR-PA versus S-PA in both microglia and RPE cells; however, the response was delayed in RPE cells. Heatmap and STRING analysis highlighted the existence of a cross-talk between the inflammatory and cytokine-mediated signaling pathways. Our study highlights a differential inflammatory response evoked by MDR vs. sensitive pathogens in retinal cells during endophthalmitis.
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Affiliation(s)
- Poonam Naik
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India;
- Manipal Academy of Higher Education, Manipal, Karnataka 576104, India;
| | - Sukhvinder Singh
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, Michigan, MI 48201, USA; (S.S.); (A.K.)
| | - Sushma Vishwakarma
- Manipal Academy of Higher Education, Manipal, Karnataka 576104, India;
- Kallam Anji Reddy Molecular Genetics laboratory, Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India;
| | - Inderjeet Kaur
- Kallam Anji Reddy Molecular Genetics laboratory, Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India;
| | - Vivek Pravin Dave
- Smt. Kannuri Santhamma Centre for vitreoretinal diseases. L V Prasad Eye Institute, Hyderabad, Telangana 500034, India;
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, Michigan, MI 48201, USA; (S.S.); (A.K.)
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana 500034, India;
- Correspondence: ; Tel.: +91-40-30612517
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Dave VP, Parmeshwarappa DC, Dogra A, Pappuru RR, Pathengay A, Joseph J, Das T. Clinical Presentations and Comparative Outcomes of Delayed-Onset Low-Grade Endophthalmitis Managed with or Without Intraocular Lens Explantation. Clin Ophthalmol 2020; 14:551-555. [PMID: 32161440 PMCID: PMC7049778 DOI: 10.2147/opth.s243496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the outcomes of delayed-onset low-grade endophthalmitis managed with and without intraocular lens (IOL) explantation. Setting Tertiary eye-care research institute in southern India. Design Retrospective comparative case series. Methods The study included all cases of post-cataract surgery delayed-onset endophthalmitis from January 1990 to January 2019. Time to endophthalmitis, duration of symptoms, presenting visual acuity, time to IOL explantation when performed, resolution after explantation, number of intravitreal injections, and final visual acuity were compared in the IOL non-explanted and IOL explanted groups. Results There were 115 eyes – 61 eyes in the IOL non-explant and 54 eyes in the IOL explant group. Between the two groups there was no statistically significant difference in age (58.37 ± 14.05 and 56.04 ± 14.96 years, respectively; p=0.35), vision at presentation (>20/400 in 29.5% and 29.6% eyes, respectively; p=0.98), and the duration of follow-up (14.38 ± 16.05, median 8.5 months and 7.06 ± 3.55, median 6 months respectively; p=0.43). There was a statistically significant difference between the IOL non-explant and IOL-explant groups in the time to resolution of inflammation (92.70 ± 36.28 and 45.33±11.2 days, respectively; p <0.0001) and the number of intravitreal injections (4.57 ± 0.75, median 5 and 2.79±2.11, median 2 respectively, p=0.005). Persistent/recurrent inflammation at 6 months was recorded in 18.03% and 5.55% in the IOL non-explant and IOL explant eyes, respectively (p=0.04). Favorable functional outcome was seen in 50.81% vs 68.51% in IOL non-explant and explant eyes, respectively (p=0.05). Conclusion IOL explantation in delayed-onset endophthalmitis helps in earlier resolution of inflammation, need for lesser number of intravitreal injections and a trend towards better functional outcomes.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Deepika C Parmeshwarappa
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Avantika Dogra
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Retina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
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110
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Paul M, Karthik S, Joseph J, Sivaprakasam M, Kumutha J, Leonhardt S, Hoog Antink C. Non-contact sensing of neonatal pulse rate using camera-based imaging: a clinical feasibility study. Physiol Meas 2020; 41:024001. [PMID: 32148333 DOI: 10.1088/1361-6579/ab755c] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Neonates and infants are patients who would benefit from less invasive vital sign sensing, especially from fewer cables and the avoidance of adhesive electrodes. Photoplethysmography imaging (PPGI) has been studied for medical applications in recent years: it is possible to assess various vital signs remotely, non-invasively, and without contact by using video cameras and light. However, studies on infants and especially on neonates in clinical settings are still rare. Hence, we conducted a single-center study to assess heart activity by estimating the pulse rate (PR) of 19 neonates. APPROACH Time series were generated from tracked regions of interest (ROIs) and PR was estimated via a joint time-frequency analysis using a short-time Fourier transform. Artifacts, for example, induced by movement, were detected and flagged by applying a signal quality index in the frequency domain. MAIN RESULTS The feasibility of PR estimation was demonstrated using visible light and near-infrared light at 850 nm and 940 nm, respectively: the estimated PR was as close as 3 heartbeats per minute in artifact-free time segments. Furthermore, an improvement could be shown when selecting the best performing ROI compared to the ROI containing the whole body. The main challenges are artifacts from motion, light sources, medical devices, and the detection and tracking of suitable regions for signal retrieval. Nonetheless, the PR extracted was found to be comparable to the contact-based photoplethysmography reference and is, therefore, a viable replacement if robust signal retrieval is ensured. SIGNIFICANCE Neonates are seldom measured by PPGI and studies reporting measurements on darker skin tones are rare. In this work, not only a single camera was used, but a synchronized camera setup using multiple wavelengths. Various ROIs were used for signal extraction to examine the capabilities of PPGI. In addition, qualitative observations regarding camera parameters and noise sources were reported and discussed.
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Affiliation(s)
- M Paul
- Medical Information Technology (MedIT), Helmholtz-Institute for Biomedical Engineering, RWTH Aachen University, Pauwelsstr. 20, Aachen, 52074, Germany
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Abstract
Vision assessments were provided to 297 Head Start children in nine Westchester County, New York programs. An optometrist and an orthoptist administered a protocol which included retinoscopy, visual acuity, fly, cover, motility and convergence tests. Sixty-three children (21.2%) were referred for further evaluation. The visual deficits detected by this screening included decreased acuity, strabismus combined with decreased acuity, astigmatism, and nonspecific visual problems. The protocol used provided a thorough evaluation of the visual system and required only seven minutes per patient.
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Affiliation(s)
- A. R. Morse
- The Jewish Guild for the Blind. 15 W. 65th Street, New York, NY 10023
| | - E. Trief
- The Jewish Guild for the Blind. 15 W. 65th Street, New York, NY 10023
| | - J. Joseph
- The Jewish Guild for the Blind. 15 W. 65th Street, New York, NY 10023
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112
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Kalra P, Ahirwar LK, Mittal R, Ranjith K, Das S, Manjulatha K, Bagga B, Mohamed A, Joseph J, Sharma S. Clinical and Histopathological Evaluation of a Rabbit Model for Pythium insidiosum Keratitis. Curr Eye Res 2020; 45:542-549. [DOI: 10.1080/02713683.2019.1676911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Paavan Kalra
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India
| | - Lalit Kishore Ahirwar
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Ruchi Mittal
- Kanupriya Dalmia Ophthalmic Pathology Laboratory, L V Prasad Eye Institute, Bhubaneswar, India
| | - Konduri Ranjith
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Shilpa Das
- Cornea Service, Nethradhama Superspeciality Eye Hospital, Bangalore, India
| | - Kodiganti Manjulatha
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Bhupesh Bagga
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, India
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113
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Joseph J, Maharaj S. Otorrhoea - a parotid connection. S AFR J SURG 2020; 58:45. [PMID: 32243117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A 36-year-old patient presented with an 18-month history of intermittent right parotid swelling accompanied by otorrhoea. The symptoms started subsequent to a palm leaf injury to the right ear. At right parotidectomy, a fistula connecting the right external auditory canal and the right parotid was demonstrated. A small fibrotic mass probably due to a remnant of the palm leaf was found intraoperatively. The symptoms resolved completely after the mass was excised by superficial parotidectomy, and the fistula closed spontaneously.
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Affiliation(s)
- J Joseph
- Department of Otorhinolaryngology, University of the Witwatersrand, Johannesburg, South Africa
| | - S Maharaj
- Department of Otorhinolaryngology, University of the Witwatersrand, Johannesburg, South Africa
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Abstract
Purpose To report and analyze the outcomes of therapeutic deep anterior lamellar keratoplasty (DALK) in patients with advanced Acanthamoeba keratitis (AK). Methods Medical records of microbiologically confirmed AK, underwent DALK from 2004 to 2017, were reviewed and the data related to early and late outcome including complications were retrieved. Outcome of cases with largest diameter of infiltrate ≥8 mm at the time of surgery (advanced keratitis) were analyzed and compared with those with less severe keratitis (infiltrate size less than 8 mm). Results Out of 23 patients of AK in whom DALK was performed, ten (43.4%) patients had advanced keratitis. Mean age of these patients was 38.7 ± 8.6 years (range, 25 to 56). Median visual acuity at presentation was 2.78 (IQR, 1.79-3.0) that improved to 1.79 (IQR, 0.70-2.78) postoperatively. Early complications included recurrence of AK in 2 (20%), Descemet's membrane detachment in 5 (50%), and persistent epithelial defect in 3 (30%) cases. Overall, 6 (60%) grafts failed, whereas 4 (40%) patients had clear graft at their last follow-up. Median follow-up of these cases was 5 months (IQR, 1.4-11.4). One graft developed stromal rejection, which resolved with increased dose of corticosteroids. In comparison, DALK performed for less severe keratitis (N = 13) had 1 (7.6%) recurrence and 2 (15.8%) grafts failure (OR, 8.25). The probability of one-year graft survival and eradication of infection was 32% and 74.1%, respectively, in advanced cases compared to 91.6% and 83.9% in less severe cases. Conclusion Outcome of DALK in advanced Acanthamoeba keratitis is less favorable compared to those carried out for less severe keratitis cases.
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Affiliation(s)
- Bhupesh Bagga
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Prashant Garg
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, India
| | - Paavan Kalra
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Huang M, Krigstein M, Joseph J, Field A. 46. Classic histological features of gaucher disease: A case report. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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116
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Cashman H, Joseph J, Roberts D. Idarucizumab resistance due to a markedly elevated dabigatran concentration – A case report. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Jacob-Mclimby J, Joseph J, Bannick F, Amoa A. Investigating the common clinical and histopathological features in dysfunctional uterine bleeding. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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118
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Dave VP, Joseph J, Pathengay A, Pappuru RR, Das T. CLINICAL PRESENTATIONS, DIAGNOSIS, AND MANAGEMENT OUTCOMES OF CURVULARIA ENDOPHTHALMITIS AND A REVIEW OF LITERATURE. Retina 2020; 40:370-375. [PMID: 31972808 DOI: 10.1097/iae.0000000000002375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical presentation and management of Curvularia endophthalmitis and compare with previous published literature. METHODS Retrospective interventional comparative case series and literature review. Eight cases with culture-proven Curvularia endophthalmitis from January 2000 to March 2018 underwent vitrectomy/vitreous biopsy, intravitreal antibiotic with or without additional procedures as appropriate. The undiluted vitreous biopsy was subjected to microbiologic evaluation. Pre-existing literature was reviewed, and the current outcomes were compared with them. The mean age at presentation, etiology, number of interventions, interval between inciting event and presentation, type of intravitreal antifungal used, anatomical, and the functional outcomes were reported and compared with pre-existing literature. A favorable anatomical outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. RESULTS In the current series, there were 4 men and 4 women. Mean age at presentation was 34.5 ± 13.51 years (median 30 years). Inciting event was open-globe injury in five cases and cataract surgery, trabeculectomy, and endogenous cause in one case each. Presenting visual acuity was ≥20/400 in 3 cases at presentation and 5 cases at the last visit. One case with staphyloma and endophthalmitis underwent evisceration for a painful blind eye. The patients in the current series were much younger than those described previously. CONCLUSION Presentation and diagnosis of Curvularia can be delayed especially in postoperative cases. Early and appropriate management with multiple interventions can result in an acceptable visual and anatomical outcome.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India; and
| | - Avinash Pathengay
- Retina and Uveitis Department, LV Prasad Eye Institute, Visakhapatnam, India
| | - Rajeev R Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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Joseph J, Hebert K, Ziegelmann M, Habermann E, Gettman M, Viers B. 146 Opioid and Non-Opioid Pain Management Pathways for Male Anterior Urethroplasty: Evidence-Based Approach for Opioid Stewardship. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dave VP, Pappuru RR, Pathengay A, Gupta R, Joseph J, Sharma S, Das T. Aspergillus Endophthalmitis: Clinical Presentations and Factors Determining Outcomes. Asia Pac J Ophthalmol (Phila) 2020; 9:9-13. [PMID: 31990739 PMCID: PMC7004472 DOI: 10.1097/01.apo.0000617928.43993.7e] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to describe the clinical presentations, management and factors determining outcomes of Aspergillus endophthalmitis. DESIGN Retrospective, interventional, multicentric case series. METHODS The study included 91 eyes of 91 patients with culture-proven Aspergillus endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. The data analysis included patient demography, clinical presentations, interventions, and final treatment outcomes. The main outcome measures were the final visual acuity and the globe salvation. The factors determining better visual and/or anatomical outcomes were analyzed. RESULTS The mean age of the patients was 39.71 ± 20.16 years (median 40 years, range 3-76 years). By etiology, the primary event before the endophthalmitis was trauma (42; 46.15%) eyes, cataract surgery (acute-onset: 30; 32.96% and delayed-onset: 6; 6.59%) eyes, endogenous (10; 10.98%) eyes, and cornea surgery (3; 3.29%) eyes. The mean follow up was 5.78 ± 6.74 months (median 3, range 0.5-40 months). The odds of a favorable visual outcome were presenting vision > hand motions [odds ratio (OR) = 3.33, P = 0.02], absence of corneal infiltrate (OR = 5.4, P = 0.03), vitrectomy instead of a vitreous tap only (OR = 4.26, P = 0.03), administration of intravitreal voriconazole (OR = 3.63, P = 0.02), and absence of fungal elements on primary microscopy (OR = 3.42, P = 0.02). CONCLUSIONS Early vitrectomy and intravitreal voriconazole yielded better anatomic and functional outcomes in Aspergillus endophthalmitis. Favorable visual outcome was achieved in a fifth of the eyes and globe was salvaged in two-thirds of the eyes.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Rajeev R. Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Vitreoretina and Uveitis Service, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Rajan Gupta
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Savitri Sharma
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, India
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Joseph J, Maharaj S. Otorrhoea - a parotid connection. S AFR J SURG 2020. [DOI: 10.17159/2078-5151/2020/v58n1a3157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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122
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Bagga B, Kate A, Joseph J, Dave VP. Herpes simplex infection of the eye: an introduction. Community Eye Health 2020; 33:68-70. [PMID: 32395028 PMCID: PMC7205168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Bhupesh Bagga
- Consultant Ophthalmologist: Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Anahita Kate
- Consultant Ophthalmologist: Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Microbiologist: Jhaveri Microbiology Centre, L V Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Consultant Ophthalmologist: Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, L V Prasad Eye Institute, Hyderabad, India
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Patel S, Carter B, Balmes G, Rider H, Joseph J, Zobniw C, Trinh V, Anderson J, Sheth R, Murthy R, Wachter E. A Phase I Study of Percutaneous Oncolytic Rose Bengal Disodium for Metastatic Uveal Melanoma Patients with Hepatic Metastases: A Single-Center Cohort Summary. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz451.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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124
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Dave VP, Joseph J, Jayabhasker P, Pappuru RR, Pathengay A, Das T. Does ophthalmic-grade silicone oil possess antimicrobial properties? J Ophthalmic Inflamm Infect 2019; 9:20. [PMID: 31677008 PMCID: PMC6825108 DOI: 10.1186/s12348-019-0187-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 10/17/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To test the antimicrobial properties of silicon oil (Aurosil 1000 cSt, Aurosil Plus 5000 cSt) on in vitro growth of common microorganisms causing endophthalmitis. Materials and methods Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, multi-drug resistant (MDR) strain of Klebsiella pneumoniae, Escherichia coli, Candida albicans, and Aspergillus flavus were prepared to 0.5 McFarland turbidity. The bacteria and fungi were inoculated into the silicone oils, brain heart infusion (BHI) broth for bacteria and Sabouraud dextrose agar (SDA) broth for fungi, respectively, and cultured aerobically for 30 days. From each sample, 10 μl was plated onto nutrient agar and potato dextrose agar (PDA) for testing growth of bacteria and fungi respectively. Cultures from specimens, overnight incubation, and CFU counting were repeated on days 1, 3, 5, 7, 14, 21, 24, and 30. Negative controls were brain heart infusion and physiologic saline as well as silicone oils without any inoculations. Results All bacteria showed a decrease in CFUs by the fifth day and eliminated between 21 and 30 days in silicone oil. The silicon oil, irrespective of its viscosity, had only fungistatic effect up to 30 days. Colony-forming units of microorganisms remained stable in physiologic saline during the study. In BHI and Sabouraud broth, both bacteria and fungi showed a growth pattern that was compatible with the growth curve of microorganisms. Conclusion Medical-grade silicone oil used in ophthalmology exhibited in vitro bactericidal and fungistatic activity over 30 days. Insertion of silicone oil in vitrectomy for endophthalmitis, when required, could supplement the antimicrobial activities of intravitreal antibiotics in management of endophthalmitis.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Priyanka Jayabhasker
- Jhaveri Microbiology Center, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajeev Reddy Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Avinash Pathengay
- Retina and Uvea Service, GMRV Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
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125
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Joseph J. Commentary: Targeting herpetic keratitis by immunomodulation of IL-27 signaling. Indian J Ophthalmol 2019; 67:1828-1829. [PMID: 31638042 PMCID: PMC6836589 DOI: 10.4103/ijo.ijo_1364_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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126
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McConkey HZR, Marber M, Lee J, Ellis H, Joseph J, Allen C, Rahman H, Patterson T, Scannell C, Pibarot P, Chiribiri A, Redwood S, Prendergast BD. P6484Invasive and non-invasive characterisation of low gradient aortic stenosis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low gradient severe aortic stenosis (LGAS) is associated with unfavourable outcomes when compared to high gradient aortic stenosis (HGAS), yet the contributing pathophysiology is poorly understood.
Methods
Symptomatic LGAS and HGAS patients undergoing trans-catheter aortic valve implantation (TAVI) underwent 3T stress perfusion cardiac magnetic resonance imaging (CMR) pre-(within 24 hours) and post-(4–6 months) TAVI. Left ventricular (LV) contractility and coronary flow/pressure were measured during hyperaemia and rapid pacing, immediately before and after TAVI, using a conductance LV catheter and dual-pressure and Doppler sensor–tipped guidewire in the mid-left anterior descending coronary artery.
Results
24 patients were recruited resulting in 19 suitable datasets (LGAS N=9, HGAS N=10, equally matched for comorbidities and B-natriuretic peptide level). LGAS patients had a smaller LV end diastolic volume index (p=0.035) and lower LV mass index (LVMI) (p=0.037). Pre-TAVI stress global endocardium-epicardium gradient was 0.88±0.09 and global myocardial perfusion reserve (MPR) 2.0±0.48 in 14 patients (6 LGAS and 8 HGAS patients, no difference between groups). Pre-TAVI, baseline coronary data demonstrated lower augmentation pressure (AP, p=0.035) and augmentation index (AIx, p=0.02) in the LGAS group. LGAS patients also exhibited a shorter ejection time (p=0.015), larger forward compression waves during rest, hyperaemia and rapid pacing, and smaller backward expansion waves (BEW) (p=0.001). Lower baseline end systolic pressure (p=0.004), inotropy (dP/dt+, p=0.045), lusitropy (dP/dt-, p=0.069), and stroke work (p=0.019) were observed in the LGAS group. Whilst LV size was smaller the LGAS group, rapid pacing induced a more significant drop in end systolic volume (p=0.045) and ejection fraction (p=0.015) in patients with HGAS. Post-TAVI, the hyperaemic BEW fell sharply (p<0.001), along with coronary VTI (p=0.02), and average pulse velocity (p=0.028), and AP and AIx remained lower (p=0.034 and p=0.031, respectively). The forward expansion wave was reduced in LGAS during rapid pacing. The HGAS group displayed a more profound drop in dP/dt+ (p=0.011) and dP/dt- p=0.014) at rest following intervention. Repeat CMR demonstrated statistically significant reduction in LV size and LVMI (p=0.012 and p<0.001, respectively) with significant increase in 3D global peak radial, circumferential and longitudinal strain (p=0.004, p=0.001 and p=0.018, respectively). Post-TAVI stress global endocardium-epicardium gradient was 0.88±0.13 and MPR 2.46±0.59 (improved from pre-TAVI, p=0.05). There was no difference in remodelling patterns or perfusion between the two groups.
Conclusion
This is the first study detailing the combined invasive and CMR pathophysiological changes in LGAS. Despite invasive parameters indicating a disease of less severe AS, the level of perfusion abnormality is disproportionate which may in part, relate to their adverse prognosis.
Acknowledgement/Funding
This research is funded by a Clinical Research Training Fellowship grant from the British Heart Foundation (FS/16/51/32365).
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Affiliation(s)
- H Z R McConkey
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - M Marber
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - J Lee
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - H Ellis
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - J Joseph
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - C Allen
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - H Rahman
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - T Patterson
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - C Scannell
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - P Pibarot
- Centre de Recherche de lInstitut Universitaire de Cardiologie et de Pneumologie de Quebec, Department of Medicine, Laval University, Quebec, Canada
| | - A Chiribiri
- Kings College London, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom
| | - S Redwood
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
| | - B D Prendergast
- Kings College London, British Heart Foundation Centre of Excellence, The Rayne Institute, London, United Kingdom
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Gandhi J, Jayasudha R, Naik P, Sharma S, Dave VP, Joseph J. Targeted High-Throughput Sequencing Identifies Predominantly Fungal Pathogens in Patients with Clinically Infectious, Culture-Negative Endophthalmitis in South India. Microorganisms 2019; 7:microorganisms7100411. [PMID: 31581465 PMCID: PMC6843429 DOI: 10.3390/microorganisms7100411] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/30/2022] Open
Abstract
To evaluate the clinical utility of high-throughput sequencing (HTS) approach-based analysis of the bacterial and fungal genome in vitreous fluids from patients clinically diagnosed as endophthalmitis, we subjected 75 vitreous fluids from clinically presumed infectious endophthalmitis patients to high-throughput sequencing (Illumina HiSeq 2500) after DNA extraction and amplification of the 16S rRNA for the detection of bacteria, and ITS 2 region for detection of fungal pathogens. As controls, we included vitreous biopsies from 70 patients diagnosed with other non-infectious retinal disorders. Following the construction of the curated microbial genome database and filtering steps to reduce ambiguousness/contaminants from the environment, the paired reads were analyzed. Our HTS reads revealed in almost all cases the same organism that was grown in culture (bacterial-14/15, fungal 3/3) by conventional microbiological workup. HTS additionally diagnosed the presence of microbes in 42/57 (73.7%) patients who were conventionally negative (fungal pathogens in 36/57, bacterial pathogens in 11/57, including five cases that showed the presence of both bacterial and fungal organisms). Aspergillus sp., Fusarium sp., Exserohilum sp., and Candida sp. were the most predominant genera in our cohort of culture-negative endophthalmitis cases. Heat map based microbial clustering analysis revealed that these organisms were taxonomically similar to the species identified by conventional culture methods. Interestingly, 4/70 control samples also showed the presence of bacterial reads, although their clinical significance is uncertain. HTS is useful in detecting pathogens in endophthalmitis cases that elude conventional attempts at diagnosis and can provide actionable information relevant to management, especially where there is a high index of suspicion of fungal endophthalmitis, particularly in tropical countries. Outcome analyses and clinical trials addressing the success and cost savings of HTS for the diagnosis of endophthalmitis are recommended.
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Affiliation(s)
- Jaishree Gandhi
- Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy campus, Hyderabad, Telangana 500034, India.
| | - Rajagopalaboopathi Jayasudha
- Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy campus, Hyderabad, Telangana 500034, India.
| | - Poonam Naik
- Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy campus, Hyderabad, Telangana 500034, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy campus, Hyderabad, Telangana 500034, India.
| | - Vivek Pravin Dave
- Smt. Kannuri Santhamma Centre for vitreoretinal diseases, L. V. Prasad Eye Institute, Kallam Anji Reddy campus, Hyderabad, Telangana 500034, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Prof. Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Kallam Anji Reddy campus, Hyderabad, Telangana 500034, India.
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Naik P, Singh S, Dave VP, Ali MH, Kumar A, Joseph J. Vitreous D-Lactate Levels as a Biomarker in the Diagnosis of Presumed Infectious Culture Negative Endophthalmitis. Curr Eye Res 2019; 45:184-189. [PMID: 31466487 DOI: 10.1080/02713683.2019.1662057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Microbiological investigations of vitreous fluid have often failed to detect the causative agent in infectious endophthalmitis resulting in a clinical dilemma. D-Lactate is a byproduct of bacterial metabolism, and its accumulation in sterile body fluids indicates bacterial infection. The aim of the study was to evaluate the measurement of vitreous fluid D-lactate for the diagnosis of infectious endophthalmitis and to define an optimal D-lactate concentration for the differentiation from non-infectious samples.Methods: Vitreous samples of 41 patients clinically diagnosed as endophthalmitis and 20 patients with non-infectious disorders, as controls, between October 2018 and February 2019 were included in the study. D-lactate levels were determined by a D-lactate colorimetric assay kit (MAK058 Sigma-Aldrich) and the receiver operating characteristic curves (ROC) of D-lactate were calculated. The clinical finding of D-lactate production in bacterial endophthalmitis was also verified in a mouse model of bacterial endophthalmitis.Results: Of the 41 patients included in the infectious group, 25 had culture-positive infections of which 13/25 were gram-positive organisms and 12/25 grew gram-negative bacilli. Based on the ROC curve, the sensitivity of D-lactate was found to be 80% and specificity 100% and a cut-off value of above 47.06 ng/µl for D-lactate was defined as positive or true infectious in vitreous samples for diagnosis of endophthalmitis. In-vivo, a mouse model of bacterial endophthalmitis showed the significant production of D-lactate levels in retina and vitreous. Interestingly the levels were elevated in Gram-negative infections compared to Gram-positive bacterial endophthalmitis.Conclusion: Our clinical and in-vivo mouse model data showed that vitreous fluid D-lactate could be used as a bacterial-specific biomarker in the diagnosis of most infectious endophthalmitis and could be implemented for the evaluation of treatment success.
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Affiliation(s)
- Poonam Naik
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
| | - Sukhvinder Singh
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, Michigan, USA
| | - Vivek Pravin Dave
- Smt. Kannuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India.,Centre for Clinical Epidemiology and Biostatistics, L. V. Prasad Eye Institute, Hyderabad, India
| | - Mohammad Hasnat Ali
- Smt. Kannuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Ashok Kumar
- Department of Ophthalmology, Visual and Anatomical Sciences, Wayne State University, Detroit, Michigan, USA
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
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Guda SJM, Sontam B, Bagga B, Ranjith K, Sharma S, Joseph J. Evaluation of multiplex real-time polymerase chain reaction for the detection of herpes simplex virus-1 and 2 and varicella-zoster virus in corneal cells from normal subjects and patients with keratitis in India. Indian J Ophthalmol 2019; 67:1040-1046. [PMID: 31238404 PMCID: PMC6611321 DOI: 10.4103/ijo.ijo_1700_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To determine the presence of herpes simplex virus and varicella zoster virus (HSV 1 and 2, VZV) in the cornea of normal subjects by multiplex real time quantitative (qPCR) assay and evaluate its utility in the diagnosis of viral keratitis. Methods Corneal epithelial cells from 33 eyes of 22 patients undergoing photorefractive keratectomy surgery (controls) and 50 corneal scrapings from 50 patients with suspected HSV keratitis were analyzed for the presence of HSV1 by conventional PCR and for presence of HSV1 and 2 and/or VZV by multiplex real-time PCR. Corneal scrapings of patients were also tested for HSV1 antigen by immunofluorescence assay (IFA). The results were compared and clinical records reviewed. Results HSV1 and VZV DNA were detected in 8/33 controls (mean-14.3 ± 7.96, range: 3-29.1 copies/mL) and 2/33 controls (mean-10.7 ± 10.9, range 3-18.5 copies/ml) respectively. HSV2 was not detected in any of the controls. Copy numbers above the mean + 1SD of controls were considered significant for viral load in patient samples. Significantly higher number of corneal scrapings (39/50, 78%) from patients were positive for HSV1 (1.2 × 106 copies/mL ± 3.7 × 106 copies/mL) by real time qPCR compared to IFA (11/48, 23%, P value 0.0001) and conventional PCR (20/50, 40%, P value 0.0002). Double infection with HSV-1 (1.5 × 107 copies/ml) and HSV-2 (3.57 × 104 copies/ml) in one case and VZV infection (1.03 × 102 copies/ml) in another was also detected by the multiplex real-time PCR. Conclusion Multiplex real-time PCR reliably detects HSV1 and 2 and VZV DNA and is ideal for the diagnosis of HSV and VZV keratitis in an ocular microbiology laboratory.
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Affiliation(s)
- Sai Jeevana Madhuri Guda
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Bhavani Sontam
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Bhupesh Bagga
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Konduri Ranjith
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Govindaraj V, Joseph J, Kumar BN, Soman R. Isolated left-sided pulmonary artery agenesis with left lung hypoplasia: A report of two cases. J Postgrad Med 2019; 63:262-264. [PMID: 28862244 PMCID: PMC5664872 DOI: 10.4103/jpgm.jpgm_562_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Unilateral absence of pulmonary artery or pulmonary artery agenesis (UAPA) is a rare congenital malformation that can present as an isolated lesion or in association with other cardiac anomalies. Though congenital, presentation in adults are also reported. Most common presentation in adults is of exercise intolerance. The developing lung on the affected side is hypoplastic. Diagnosis of UAPA is established by imaging methods like CT and MRI. There is no specific treatment for this condition. Treatment depends on patients symptomatology, presence of pulmonary hypertension and collateral circulation. Presence of pulmonary hypertension carries a bad prognosis. We present two adult patients with isolated left sided unilateral pulmonary artery agenesis with ipsilateral lung hypoplasia. The diagnosis was confirmed by CT chest and perfusion scan.
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Affiliation(s)
- V Govindaraj
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - J Joseph
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - B Nagamalli Kumar
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R Soman
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Joseph J. Commentary: Dematiaceous fungal keratitis: Importance of ocular microbiology. Indian J Ophthalmol 2019; 67:1053-1054. [PMID: 31238407 PMCID: PMC6611302 DOI: 10.4103/ijo.ijo_359_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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Dave TV, Dave VP, Sharma S, Karolia R, Joseph J, Pathengay A, Pappuru RR, Das T. Infectious endophthalmitis leading to evisceration: spectrum of bacterial and fungal pathogens and antibacterial susceptibility profile. J Ophthalmic Inflamm Infect 2019; 9:9. [PMID: 31098742 PMCID: PMC6522574 DOI: 10.1186/s12348-019-0174-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 05/06/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To describe the spectrum of bacterial and fungal pathogens in cases of endophthalmitis requiring evisceration and report their antimicrobial susceptibilities. Methods Retrospective, consecutive, and descriptive case series of endophthalmitis that underwent evisceration from January 2004 to December 2017. Vitreous samples from all patients had been investigated for bacteria and fungus using institutional protocol. Bacterial isolates were identified using analytical profile index (API) system until 2010 and Vitek-2 compact system (bioMérieux, France), thereafter. The susceptibility of bacterial isolates to a variety of antibiotics was determined by the Kirby-Bauer disk-diffusion method. Results Of 791 cases reviewed, culture positivity was reported in 388 cases (48.92%). Commonest clinical setting of endophthalmitis necessitating evisceration was post-microbial keratitis (58%), followed by post-trauma and post-cataract surgery (14–15%). The commonest isolate was Streptococcus pneumoniae, seen in 68 samples overall (17.52%). One hundred and eighty-three isolates (47.16%) were gram-positive, 86 (22.16%) were gram-negative, and fungi constituted 137 (35.3%) isolates. Streptococcus pneumoniae was the commonest gram-positive bacterial isolate seen in 68/183 samples (37.15%). Among gram-negative organisms, the commonest was Pseudomonas aeruginosa seen in 47/86 (54.65%). Aspergillus spp. formed the commonest fungal isolate, 58/137 (42.33%). The susceptibility of the gram-positive bacteria was highest with vancomycin, 136/147 (92.51%) and for gram-negative bacteria was seen best with imipenem 24/29 (82.75%). Susceptibility to ceftazidime was 31/61 (50.81%) in 31/61. Conclusion Endophthalmitis due to Pneumococci, Aspergillus, and Pseudomonas can be very fulminant and progress to require evisceration in spite of prompt and appropriate treatment.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, KallamAnji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, KallamAnji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India.
| | - Savitri Sharma
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Roshni Karolia
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Retina and Uveitis Department, GMR Varalaxmi Campus, LV Prasad Eye Institute, HanumanthawakaChowk, Visakhapatnam, Andhra Pradesh, 530040, India
| | - Rajeev R Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, KallamAnji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, KallamAnji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
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Joseph J, Ziegelmann M, Savage J, Meng Y, Kohler T, Trost L. 170 6-month Outcomes of RestoreX Penile Traction Therapy in Men with Peyronie's Disease: A Randomized, Controlled Trial. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Panchal B, Tyagi M, Pathengay A, Sharma S, Dave VP, Gandhi U, Balakrishnan D, Pappuru RR, Joseph J, Kekunnaya R, Das T. Endophthalmitis following Suture Removal - Clinical Outcomes and Microbiological Profile. Semin Ophthalmol 2019; 34:115-123. [PMID: 30879381 DOI: 10.1080/08820538.2019.1590605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS To review the clinical profile and report the microbiology and treatment outcomes of endophthalmitis following suture removal. METHODS In this multi-center, retrospective interventional case series, 11 eyes of 11 patients who developed endophthalmitis following suture removal from January 2006 to December 2017 were reviewed. RESULTS Nine of the 11 patients developed a culture-proven, acute onset endophthalmitis [5.3 ± 3.1 days (range 2-10 days)]. Mean age was 15.8 ± 21.2 years (median 7; range, 1-66 years). Presenting visual acuity was extremely low ranging from light perception (PL) to counting fingers close to face (CFCF) at the time of diagnosis of endophthalmitis. Out of the 11 patients, 8 belonged to the pediatric age group; four out of those eight had loose sutures secondary to cataract surgery, two patients had loose sutures secondary to penetrating keratoplasty and 1 case each had loose sutures secondary to corneal tear repair and secondary IOL implantation, respectively. Streptococcus pneumoniae was the most common organism and was identified in seven cases and was susceptible to vancomycin in all these cases. Other bacterial isolates were Haemophilus influenzae and Achromobacter denitrificans. Three out of the 11 eyes had visual outcome of 20/200 or better. Six eyes were phthisical and one eye was eviscerated. Mean follow-up was 26.3 ± 31.2 weeks (range 2-92 weeks). Visual outcomes ranged from 20/40 to no light perception at the last follow-up. CONCLUSIONS Endophthalmitis following suture removal though rare, is observed most commonly in the pediatric population and has an acute and a fulminant course. Streptococcus pneumoniae was the most commonly isolated microorganism. Visual acuity outcomes were poor despite prompt recognition of endophthalmitis and appropriate antibiotic therapy.
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Affiliation(s)
- Bhavik Panchal
- a Vitreo-Retina and Uveitis Services, GMRV Campus , L V Prasad Eye Institute , Visakhapatnam , India
| | - Mudit Tyagi
- b Smt Kanuri Santhamma Center for Vitreo- Retina diseases , Hyderabad , India
| | - Avinash Pathengay
- a Vitreo-Retina and Uveitis Services, GMRV Campus , L V Prasad Eye Institute , Visakhapatnam , India
| | | | - Vivek P Dave
- b Smt Kanuri Santhamma Center for Vitreo- Retina diseases , Hyderabad , India
| | - Uppal Gandhi
- d Jasti V Ramannama Childern's Eye Care Centre , L. V. Prasad Eye Institute , Hyderabad , India
| | - Divya Balakrishnan
- b Smt Kanuri Santhamma Center for Vitreo- Retina diseases , Hyderabad , India
| | - Rajeev R Pappuru
- b Smt Kanuri Santhamma Center for Vitreo- Retina diseases , Hyderabad , India
| | | | - Ramesha Kekunnaya
- d Jasti V Ramannama Childern's Eye Care Centre , L. V. Prasad Eye Institute , Hyderabad , India
| | - Taraprasad Das
- b Smt Kanuri Santhamma Center for Vitreo- Retina diseases , Hyderabad , India
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Sharma P, Sharma N, Mishra P, Joseph J, Mishra DK, Garg P, Roy S. Differential Expression of Antimicrobial Peptides in Streptococcus pneumoniae Keratitis and STAT3-Dependent Expression of LL-37 by Streptococcus pneumoniae in Human Corneal Epithelial Cells. Pathogens 2019; 8:pathogens8010031. [PMID: 30845777 PMCID: PMC6470555 DOI: 10.3390/pathogens8010031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 12/15/2022] Open
Abstract
Streptococcus pneumoniae is the leading cause of bacterial keratitis in the developing world with a growing trend of acquiring resistance against various antibiotics. In the current study, we determined the expression of different antimicrobial peptides (AMPs) in response to S. pneumoniae in patients, as well as in primary and immortalized human corneal epithelial cells. We further focused on LL-37 and determined its expression in human cornea infected with S. pneumoniae and studied the killing ability of LL-37 against S. pneumoniae. The expression of AMPs was determined by quantitative PCR and the phosphorylation of signaling proteins was evaluated by immunoblot analysis. LL-37 expression was also determined by immunofluorescence and Western blot method and the killing ability of LL-37 against S. pneumoniae was determined by colony-forming units. Differential expression of antimicrobial peptides was observed in patients with S. pneumoniae keratitis. Although S. pneumoniae induced expression of the AMPs in human corneal epithelial cells (HCEC), it did not induce AMP expression in U937, a human monocyte cell line. S. pneumoniae also caused activation of nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB)and mitogen activated protein kinase (MAPK) pathways in corneal epithelial cells. LL-37 was found to be effective against both laboratory and clinical strains of S. pneumoniae. LL-37 induction by S. pneumoniae in human corneal epithelial cells was mediated by signal transducer and activator of transcription 3 (STAT3) activation, and inhibition of STAT3 activation significantly reduced LL-37 expression. Our study determines an extensive profile of AMPs expressed in the human cornea during S. pneumoniae infection, and suggests the potential of LL-37 to be developed as an alternative therapeutic intervention to fight increasing antibiotic resistance among bacteria.
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Affiliation(s)
- Prerana Sharma
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India.
- Department of Animal Sciences, University of Hyderabad, Hyderabad 500046, India.
| | - Natalia Sharma
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India.
| | - Priyasha Mishra
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad 500034, India.
| | - Dilip K Mishra
- Pathology Department, LV Prasad Eye Institute, Hyderabad 500034, India.
| | - Prashant Garg
- Tej Kohli Cornea Institute, Hyderabad 500034, India.
| | - Sanhita Roy
- Prof. Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad 500034, India.
- Tej Kohli Cornea Institute, Hyderabad 500034, India.
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Joseph J, Sontam B, Guda SJM, Gandhi J, Sharma S, Tyagi M, Dave VP, Das T. Trends in microbiological spectrum of endophthalmitis at a single tertiary care ophthalmic hospital in India: a review of 25 years. Eye (Lond) 2019; 33:1090-1095. [PMID: 30792523 DOI: 10.1038/s41433-019-0380-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/22/2019] [Accepted: 02/07/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine trends in the microbial spectrum of endophthalmitis over the past 25 years and to review its antibiotic susceptibility patterns over the last 10 years. METHODS Microbiology records of culture-positive endophthalmitis cases from 1991 to 2015 were reviewed. Additionally, data between 2005 and 2015 was also analyzed for trends in antibiotic susceptibility. RESULTS Of the total of 9278 patients, 3319 (35.7%) were culture positive and included bacteria (2840/3319, 85.56%), fungi (387/3319, 11.66%), and mixed cultures (92/3319, 2.7%). Gram-positive bacteria accounted for 67.68% (1922/2840) of the total bacteria seen, with the most prevalent pathogen being Streptococcus pneumoniae and Staphylococcus epidermidis. Among the gram-negative organisms Pseudomonas aeruginosa was the most prevalent while. Aspergillus flavus was the most common fungus isolated and Candida sp. accounted for 6.9% of the total fungi isolated. There was no significant change in the trends of bacteria isolated during the study period. Overall susceptibility patterns showed that gram-positive bacteria were most susceptible to vancomycin (96%) and fluoroquinolones (89%). The resistance to ceftazidime increased from 31% in 2005 to 62% in 2015 (P = 0.006) and amikacin decreased from 36% in 2005 to 33% in 2015 (P = 0.782). Although a significant trend (P < 0.001) toward increasing microbial resistance against cephalosporins and fluoroquinolones was observed, decreasing microbial resistance against glycopeptides and aminoglycosides was also detected. CONCLUSION The spectrum of pathogens causing endophthalmitis at our institute remained similar over the study period. These findings impact the empiric treatment and choice of antibiotics in patients with endophthalmitis.
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Affiliation(s)
- Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India.
| | - Bhavani Sontam
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
| | - Sai Jeevana Madhuri Guda
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
| | - Jaishree Gandhi
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
| | - Taraprasad Das
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
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Sindone J, Day R, Stefani M, Joseph J. Perioperative Management of Antiplatelets in Elective Surgery at a Tertiary Hospital. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Dave VP, Joseph J, Pathengay A, Pappuru RR. Clinical presentations, management outcomes, and diagnostic dilemma in Kocuria endophthalmitis. J Ophthalmic Inflamm Infect 2018; 8:21. [PMID: 30460590 PMCID: PMC6246755 DOI: 10.1186/s12348-018-0163-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023] Open
Abstract
AIM To describe the clinical presentations and management outcomes of Kocuria endophthalmitis and discuss diagnostic dilemmas DESIGN: Retrospective interventional comparative case series INTERVENTION: Eight unilateral cases with culture-proven Kocuria endophthalmitis from January 2013 to December 2017 underwent vitrectomy/vitreous biopsy and intravitreal antibiotic with or without additional procedures. The undiluted vitreous was subjected to microbiologic evaluation. MAIN OUTCOME MEASURES The mean age at presentation, etiology, number of interventions, interval between inciting event and presentation, type of intravitreal antibiotic used, and anatomic and functional outcomes were reported. A favorable anatomic outcome was defined as preservation of the globe, absence of hypotony, attached retina, and absence of active inflammation at the last visit. RESULTS In the current series, there were five males and three females. The mean age at presentation was 31 ± 17.44 years (median 30 years). The inciting event was open globe injury in five cases and one case each following cataract surgery, microbial keratitis, and endogenous cause. Visual acuity was ≥ 20/400 in one case at presentation and ≥ 20/400 in three cases at the last visit. The species identified by Vitek 2, included Kocuria kristinae in three, K. rosea in four and K. varians in one. Follow-up period was 8.25 ± 8.24 months (median 6.5). Six cases (75%) had complete resolution of infection and inflammation at the last visit. Anatomic success was achieved in 75%. CONCLUSIONS Kocuria is a relatively rare cause of endophthalmitis often misdiagnosed as Staphylococcal endophthalmitis. Clinical presentation can be variable but favorable antibiotic susceptibility and appropriate timely management can result in acceptable visual and anatomic outcomes.
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Affiliation(s)
- Vivek Pravin Dave
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India.
| | - Joveeta Joseph
- Jhaveri Microbiology Center, Brien Holden Eye Research Center, LV Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Retina and Uveitis Department, GMR Varalaxmi Campus, LV Prasad Eye Institute, Hanumanthawaka Chowk, Visakhapatnam, Andhra Pradesh, 530040, India
| | - Rajeev R Pappuru
- Smt. Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
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Nair P, Kumar A, Mathews S, Joseph J, Suchetha S, Krishna J, James F. Dysgerminoma ovary: Clinical features and treatment outcome. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Joseph J, Sharma S, Dave VP. Filamentous gram-negative bacteria masquerading as actinomycetes in infectious endophthalmitis: a review of three cases. J Ophthalmic Inflamm Infect 2018; 8:15. [PMID: 30306353 PMCID: PMC6179972 DOI: 10.1186/s12348-018-0157-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/26/2018] [Indexed: 11/28/2022] Open
Abstract
Background To report microbiological diagnostic dilemma posed by observation of unusual morphology of bacteria in the vitreous sample of a series of three cases of bacterial endophthalmitis. Results A non-comparative, descriptive case series is described. All three cases presented to the retina-vitreous clinic with a clinical diagnosis of acute endophthalmitis between January and April 2018. Two patients had a past history of cataract surgery, and one had antecedent trauma within 1–2 days of presentation. As per the institutional protocol, patients underwent pars plana vitrectomy with intraocular antibiotics (vancomycin and ceftazidime) and microbiological investigation of the vitreous sample. Microscopic visualization of the stained vitreous fluid revealed the presence of filamentous organisms suggestive of Actinomycetales. However, the culture showed growth of gram-negative bacilli (Pseudomonas aeruginosa, Klebsiella oxytoca, Morganella morganii) which were identified by ViTEK 2 compact system and biochemical tests. Though a combination antibiotic treatment of vancomycin and ceftazidime was given in all cases in view of the short history, the antibiotic susceptibility testing showed multi-drug resistance pattern in two out of three cases leading to unfavorable clinical outcome. Conclusions Gram-negative bacilli can develop abnormal morphology due to stress or sub-inhibitory antibiotic exposure, and it is important for ocular microbiologists and pathologists to be aware of this phenomenon to avoid misinterpretation that may lead to inappropriate treatment.
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Affiliation(s)
- Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, 500034, India.
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, India
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Deshmukh D, Chakrabarti M, Jayasudha R, Hasnat Ali M, Tyagi M, Sharma S, Joseph J. Elevated cytokine levels in vitreous as biomarkers of disease severity in infectious endophthalmitis. PLoS One 2018; 13:e0205292. [PMID: 30296277 PMCID: PMC6175518 DOI: 10.1371/journal.pone.0205292] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 09/22/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To investigate the immunopathogenesis of endophthalmitis, and determine if cytokine profiles could serve as biomarkers of disease severity in infectious endophthalmitis. Materials and methods Vitreous samples of 46 patients clinically diagnosed as endophthalmitis (of which 25 were culture positive) and 20 non-infectious controls from patients with Retinal Detachment (RD) or diabetic retinopathy were included in the study. The cytokine and chemokine expression patterns of 40 immune mediators including 6 antiinflammatory cytokines, 15 proinflammatory cytokines, 9 Growth factors and 10 proinflammatory chemokines in the vitreous were were analyzed by multiplex cytokine immunoassay. In addition, significant immune mediators were correlated with initial and final visual acuity (VA). Results Our results demonstrated elevated expression of 16 mediators such as GCSF, GRO, IFN-γ, IL-1α, IL-1β, IL-1 RA, IL-6, IL-8, IP-10, MCP-1, MCP-3, MIP-1α, IL-1β, TGF-α, TNF-α in patients with culture positive endophthalmitis. Cytokine profile expression significantly differed between patients with proven endophthalmitis and the non-infectious controls in heat map analysis. PCoA plot indicated five mediators (IL-1RA, IL-6, IL-8, GRO, G-CSF) as biomarkers that could be Independent Predictors of Disease especially in culture negative cases. Correlation of cytokines with VA revealed strong association between the initial VA and intraocular levels of TGF-α, IL-1β and IL-8 but there was no correlation with the severity or visual outcome of infection. Conclusion In comparison to non-infectious ocular conditions, the pathogenesis of infectious endophthalmitis correlates with increased expression levels of IL-1RA, IL-6, IL-8, GRO, G-CSF. Understanding cytokine profiles in culture negative endophthalmitis patients could aid in therapy in non-responders to empirical antibiotic therapy.
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Affiliation(s)
- Dhanshree Deshmukh
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Moumita Chakrabarti
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rajagopalaboopathi Jayasudha
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mohammed Hasnat Ali
- Centre for Clinical Epidemiology and Biostatistics, L. V. Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Smt. Kannuri Santhamma Centre for Vitreoretinal Diseases, L V Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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142
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Joseph J, Chaurasia S, Sharma S. Case Report: Corneal Coinfection with Fungus and Amoeba: Report of Two Patients and Literature Review. Am J Trop Med Hyg 2018; 99:805-808. [PMID: 30014813 DOI: 10.4269/ajtmh.18-0158] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We report two cases of corneal coinfection with Acanthamoeba and Fusarium sp. along with the review of published literature. A 35-year-old woman and 65-year-old man presented to the institute with corneal ulcer refractory for treatment with topical antibiotics. Microbiological examination revealed the presence of Acanthamoeba cysts along with septate, hyaline fungal filaments. After emergency therapeutic penetrating keratoplasty (TPK) in both, the corneal tissue was sent for histopathologic examination, which confirmed the presence of Acanthamoeba and fungal coinfection. One patient had a recurrence of fungal infection after TPK. In subjects with a rapid progression of mycotic ulcer, coinfection with other microorganisms including Acanthamoeba should be suspected. The two cases presented here emphasize the importance of microbiology in making prompt diagnosis and appropriate management of these cases at an early stage.
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Affiliation(s)
- Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
| | - Sunita Chaurasia
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, India
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143
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Abstract
To report a rare case of Cryptococcus neoformans endogenous endophthalmitis with subretinal abscess in a 36-year-old HIV-positive man, referred with progressive blurred vision in his right eye for the last 6 months. Vitreous biopsy followed by intravitreal ganciclovir did not result in significant improvement. Microbiology revealed the presence of C. neoformans, and intravitreal amphotericin B was then administered. The patient was treated aggressively with systemic and intravitreal antifungals but had a poor visual and anatomical outcome. A high degree of clinical suspicion combined with microbiological evaluation helped to arrive at an appropriate diagnosis.
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Affiliation(s)
- Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Raja Narayanan
- Smt. Kanuri Santhamma Centre for Vitreo-Retinal Diseases, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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144
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Nagpal R, Chaurasia S, Joseph J, Tyagi M, Rani PK, Ramappa M, Shah R. Management of Candida glabrata infectious crystalline keratopathy with endophthalmitis following penetrating keratoplasty. Indian J Ophthalmol 2018; 66:1012-1014. [PMID: 29941758 PMCID: PMC6032725 DOI: 10.4103/ijo.ijo_1106_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 33-year-old male underwent an optical keratoplasty elsewhere in the right eye following which he developed endophthalmitis and subsequently underwent a pars plana vitrectomy and lensectomy. At presentation, he had a deep stromal crystalline infiltration along the graft–host junction. A large therapeutic keratoplasty was performed, and the excised corneal button was evaluated. Histopathology revealed gram-positive round-to-oval budding structures and microbiology identified the organism as Candida glabrata. He was treated with antifungals in the postoperative period. At 4 months after therapeutic keratoplasty, the patient developed recurrent endophthalmitis, following stoppage of antifungals. The treatment was reinstituted for another year, and the patient did well with a clear graft at 18-month-follow-up period after the recurrence episode. Management of infectious crystalline keratopathy with endophthalmitis is a challenging situation and requires long-term treatment.
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Affiliation(s)
- Ritu Nagpal
- Cornea and Anterior Segment Services, Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Padmaja Kumari Rani
- Smt. Kanuri Santhamma Centre for Vitreo Retinal Diseases, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Muralidhar Ramappa
- Cornea and Anterior Segment Services, Tej Kohli Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Rikin Shah
- Department of Ophthalmology, Ministry of Health, Al Nahdha Hospital, Muscat, Oman
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145
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Molina R, Agusti C, Mañe JM, Filella X, Jo J, Joseph J, Giménez N, Estapé J, Ballesta AM. Cyfra 21–1 in Lung Cancer: Comparison with Cea, Ca 125, Scc and Nse Serum Levels. Int J Biol Markers 2018; 9:96-101. [PMID: 7523548 DOI: 10.1177/172460089400900206] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CYFRA 21–1, CEA, CA 125, SCC and NSE serum levels were determined in 50 healthy subjects and in 189 patients with primary lung cancer (101 with locoregional disease, 68 with recurrence and 20 patients with no evidence of residual disease (NED). Abnormal CYFRA 21–1 serum levels were found in 53.6% (90/168) of the patients with active cancer. Neither healthy subjects nor NED patients had abnormal serum levels. CYFRa 21–1 serum concentrations were significantly higher in patients with active cancer than in healthy subjects or in NED patients (p < 0.0001). CYFRA 21–1 sensitivity was related to tumor histology with abnormal levels in 64.7% of patients with NSCLC and in 30% of patients with SCLC (P <0.0001). In NSCLC, serum CYFRA 21–1 concentrations were also related to histological type, the highest values being found in squamous cell carcinomas and LCLC and the lowest in adenocarcinomas (p < 0.04). There was also a clear relationship between CYFRA 21–1 and tumor extension, with significantly higher values in patients with metastases than in those without metastases (p < 0.0001). Abnormal CEA values were found in 49.1%, CA 125 in 39%, SCC in 27.8% and NSE in 21.3% of the patients with active cancer. With respect to histological type, CYFRA was elevated in 68.3% of squamous cell carcinomas (CEA: 46.7%, SCC: 50%, CA 125:31.7%, NSE: 11.7%), in 54.8% of adenocarcinomas (CEA: 62%, SCC: 26.2%, CA 125: 59.5%, NSE: 9.5%), in 78.6% of LCLC (CEA: 64.3%, SCC: 28.6%, CA 125: 78.6%, NSE: 7.1%) and in 30% of SCLC (CEA: 37.7%, SCC: 3.8%, CA 125:20.8%, NSE: 45.3%). In summary, CYFRA 21–1 is the most sensitive tumor marker in patients with lung cancer, especially in NSCLC patients.
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Affiliation(s)
- R Molina
- Laboratory of Clinical Chemistry, Hospital Clínic, School of Medicine, Barcelona-Spain
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146
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Molina R, Jo J, Filella X, Zanon G, Grau JJ, Joseph J, Bedini JL, Biete A, Ballesta AM. Mucin-Like Carcinoma-Associated Antigen (MCA) in Tissue and Serum of Patients with Breast Cancer: Clinical Applications in Prognosis and Disease Monitoring. Int J Biol Markers 2018; 8:113-23. [PMID: 8366294 DOI: 10.1177/172460089300800208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mucin-like Carcinoma-associated Antigen (MCA) has been associated with many breast cancers. The aim of this study was to evaluate MCA in tumor tissue and serum as a potential tumor marker for prognosis and disease monitoring. MCA levels were determined in the tissue of 196 patients with primary breast cancer, 25 with metastatic disease and 25 patients with benign diseases, in pellet and/or cytosol. MCA levels were also determined in the serum of 50 patients with benign diseases, 148 with primary breast cancer (Mo), 150 with metastatic breast cancer (MT), and 200 with no clinical evidence of disease (NED). MCA tissue concentrations in pellet and cytosol were similar: 66.7 + 251 U/mg and 41.1 + 53 U/mg, respectively. No relationship between MCA levels and tumor size or nodal involvement was found. Higher MCA levels were observed in patients with ER + or PgR + tumors than in those with ER- or PgR- tumors (p < 0.01). Patients with MCA pellet concentrations lower than 10 U/mg of protein had shorter disease - free intervals (DFI) than those with higher values (p < 0.05). Abnormally high serum levels of MCA were found in 8% of patients with benign diseases, 4% of NED patients, 22% of Mo patients, and in 76% of MT cases. In primary breast cancer MCA values were related to tumor size and nodal involvement. A trend toward a lower DFI in patients with elevated presurgical MCA levels was observed but was of no statistical significance. These differences became statistically significant when patients were subdivided according to nodal status, with shorter DFI in those without nodal invasion (p < 0.05). In metastatic patients, changes in serum MCA were related to the tumor's response to treatment in 82% of cases. The highest MCA values were found in patients with liver or bone metastasis and the lowest values were found in those with locoregional recurrence. In conclusion, although MCA is not a specific tumor marker, it can be useful as a prognostic factor (tissue and serum) and in monitoring metastatic patients.
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Affiliation(s)
- R Molina
- Laboratory of Clinical Biochemistry (Unit for Cancer Research), Hospital Clinico, Medical School, Barcelona, Spain
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147
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Muthiah K, Dunn L, Connor D, Joseph J, Robson D, Macdonald P, Stocker R, Hayward C. Higher Soluble Thrombomodulin and Angiogenic Markers in LVAD Supported Patients Associate with Arteriovenous Malformation and Non-Surgical Bleeding. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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148
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Bagga B, Sharma S, Madhuri Guda SJ, Nagpal R, Joseph J, Manjulatha K, Mohamed A, Garg P. Leap forward in the treatment of Pythium insidiosum keratitis. Br J Ophthalmol 2018; 102:1629-1633. [PMID: 29545414 DOI: 10.1136/bjophthalmol-2017-311360] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/15/2018] [Accepted: 02/24/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pythium insidiosum is a parafungus that causes keratitis resembling fungal keratitis. This study compares outcome in a large cohort of patients with P insidiosum keratitis treated with antifungal drugs, to a pilot group treated with antibacterial antibiotics. METHODS Between January 2014 and December 2016, 114 patients with culture positive P insidiosum keratitis were included in the study. A subset of culture isolates was tested in vitro for response to nine antibacterial antibiotics by disc diffusion and E test. Patients were treated with topical natamycin in 2014, 2015 and up until mid 2016. Thereafter, the patients received a combination of topical linezolid and topical and oral azithromycin. Therapeutic penetrating keratoplasty (TPK) was done for patients not responding to medical therapy. RESULTS In vitro disc diffusion assay showed linezolid to be most effective. The rate of TPK was significantly higher in 2015 compared with 2016 (43/45, 95.6% vs 22/32, 68.8%; p=0.002). Eighteen patients were treated with antibacterial and 14 were treated with antifungal antibiotic in 2016. One patient was lost to follow-up in each group. The rate of TPK was higher and proportion of healed ulcers was lower (p=0.21, Fisher's exact test) in the group on antifungal therapy (TPK-11/13, 84.6%; Healed-2/13, 15.3%) compared with the group on antibacterial therapy (TPK-11/17, 64.7%; Healed-6/17, 35.2%). CONCLUSIONS We report favourable but not statistically significant response of P insidiosum keratitis to antibacterial agents in a pilot series of patients. Further evaluation of this strategy in larger number of patients is recommended.
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Affiliation(s)
- Bhupesh Bagga
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Savitri Sharma
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sai Jeevan Madhuri Guda
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ritu Nagpal
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kodiganti Manjulatha
- Jhaveri Microbiology Centre, Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ashik Mohamed
- Ophthalmic Biophysics, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Prashant Garg
- Tej Kohli Cornea Institute, L V Prasad Eye Institute, Hyderabad, Telangana, India
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149
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Abstract
The purpose of the study is to describe epidemiology, clinical features, diagnosis, and treatment of Acanthamoeba keratitis (AK) with special focus on the disease in nonusers of contact lenses (CLs). This study was a perspective based on authors' experience and review of published literature. AK accounts for 2% of microbiology-proven cases of keratitis. Trauma and exposure to contaminated water are the main predisposing factors for the disease. Association with CLs is seen only in small fraction of cases. Contrary to classical description experience in India suggests that out of proportion pain, ring infiltrate, and radial keratoneuritis are seen in less than a third of cases. Majority of cases present with diffuse infiltrate, mimicking herpes simplex or fungal keratitis. The diagnosis can be confirmed by microscopic examination of corneal scraping material and culture on nonnutrient agar with an overlay of Escherichia coli. Confocal microscopy can help diagnosis in patients with deep infiltrate; however, experience with technique and interpretation of images influences its true value. Primary treatment of the infection is biguanides with or without diamidines. Most patients respond to medical treatment. Corticosteroids play an important role in the management and can be used when indicated after due consideration to established protocols. Surgery is rarely needed in patients where definitive management is initiated within 3 weeks of onset of symptoms. Lamellar keratoplasty has been shown to have good outcome in cases needing surgery. Since the clinical features of AK in nonusers of CL are different, it will be important for ophthalmologists to be aware of the scenario wherein to suspect this infection. Medical treatment is successful if the disease is diagnosed early and management is initiated soon.
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Affiliation(s)
- Prashant Garg
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Paavan Kalra
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Joveeta Joseph
- Jhaveri Microbiology Centre, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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150
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Mohapatra MM, Mulkoju RC, Joseph J, Gochhait D. Atypical lung carcinoid: An unusual presentation. Indian J Cancer 2017; 54:213-214. [PMID: 29199693 DOI: 10.4103/ijc.ijc_150_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M M Mohapatra
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R C Mulkoju
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - J Joseph
- Department of Pulmonary Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - D Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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