Fish and macroinvertebrate assemblages reveal extensive degradation of the world's rivers

Rivers suffer from multiple stressors acting simultaneously on their biota, but the consequences are poorly quantified at the global scale. We evaluated the biological condition of rivers globally, including the largest proportion of countries from the Global South published to date. We gathered macroinvertebrate- and fish-based assessments from 72,275 and 37,676 sites, respectively, from 64 study regions across six continents and 45 nations. Because assessments were based on differing methods, different systems were consolidated into a 3-class system: Good, Impaired, or Severely Impaired, following common guidelines. The proportion of sites in each class by study area was calculated and each region was assigned a Köppen-Geiger climate type, Human Footprint score (addressing landscape alterations), Human Development Index (HDI) score (addressing social welfare), % rivers with good ambient water quality, % protected freshwater key biodiversity areas; and % of forest area net change rate. We found that 50% of macroinvertebrate sites and 42% of fish sites were in Good condition, whereas 21% and 29% were Severely Impaired, respectively. The poorest biological conditions occurred in Arid and Equatorial climates and the best conditions occurred in Snow climates. Severely Impaired conditions were associated (Pearson correlation coefficient) with higher HDI scores, poorer physico-chemical water quality, and lower proportions of protected freshwater areas. Good biological conditions were associated with good water quality and increased forested areas. It is essential to implement statutory bioassessment programs in Asian, African, and South American countries, and continue them in Oceania, Europe, and North America. There is a need to invest in assessments based on fish, as there is less information globally and fish were strong indicators of degradation. Our study highlights a need to increase the extent and number of protected river catchments, preserve and restore natural forested areas in the catchments, treat wastewater discharges, and improve river connectivity.

The impact of sequencing depth and relatedness of the reference genome in population genomic studies: A case study with two caddisfly species (Trichoptera, Rhyacophilidae, Himalopsyche)

Whole genome sequencing for generating SNP data is increasingly used in population genetic studies. However, obtaining genomes for massive numbers of samples is still not within the budgets of many researchers. It is thus imperative to select an appropriate reference genome and sequencing depth to ensure the accuracy of the results for a specific research question, while balancing cost and feasibility. To evaluate the effect of the choice of the reference genome and sequencing depth on downstream analyses, we used five confamilial reference genomes of variable relatedness and three levels of sequencing depth (3.5×, 7.5× and 12×) in a population genomic study on two caddisfly species: Himalopsyche digitata and H. tibetana. Using these 30 datasets (five reference genomes × three depths × two target species), we estimated population genetic indices (inbreeding coefficient, nucleotide diversity, pairwise F ST, and genome-wide distribution of F ST) based on variants and population structure (PCA and admixture) based on genotype likelihood estimates. The results showed that both distantly related reference genomes and lower sequencing depth lead to degradation of resolution. In addition, choosing a more closely related reference genome may significantly remedy the defects caused by low depth. Therefore, we conclude that population genetic studies would benefit from closely related reference genomes, especially as the costs of obtaining a high-quality reference genome continue to decrease. However, to determine a cost-efficient strategy for a specific population genomic study, a trade-off between reference genome relatedness and sequencing depth can be considered.

A global agenda for advancing freshwater biodiversity research

Global freshwater biodiversity is declining dramatically, and meeting the challenges of this crisis requires bold goals and the mobilisation of substantial resources. While the reasons are varied, investments in both research and conservation of freshwater biodiversity lag far behind those in the terrestrial and marine realms. Inspired by a global consultation, we identify 15 pressing priority needs, grouped into five research areas, in an effort to support informed stewardship of freshwater biodiversity. The proposed agenda aims to advance freshwater biodiversity research globally as a critical step in improving coordinated actions towards its sustainable management and conservation.

Establishing the relationship between benthic macroinvertebrates and water level fluctuation in subtropical shallow wetlands

Wetland water level fluctuations often influence benthic macroinvertebrate communities through changes in water quality, substrate, and macrophytes and, hence, affect the structure and function of aquatic ecosystems. However, there is lack of understanding on how water level fluctuations affect the structure and composition of benthic macroinvertebrates in subtropical shallow wetlands in Nepal. Here, we assessed the changes in benthic macroinvertebrate community composition in response to water level fluctuations and identified indicator taxa sensitive to such fluctuations. A study was conducted over 4 seasons covering one annual cycle of water level fluctuation in 4 wetlands of Koshi Tappu Wildlife Reserve, Nepal. The study revealed that benthic macroinvertebrate composition significantly differed across water levels. Dissimilarities in macroinvertebrate community composition were mainly attributed by families Atyidae, Dytiscidae, Baetidae, Planorbidae, Chironomidae, Bithyniidae, Sphaeriidae, and Thiaridae. Taxon specific richness, densities, and biomass varied across the water levels while no difference was documented for overall family richness, density, and biomass. Ephemeroptera and Trichoptera richness decreased when water levels were low while Coleoptera and Diptera richness increased. Medium water level supported high benthic macroinvertebrate diversity. Indicator taxa analysis identified Coleoptera: Hydrophilidae and Dytiscidae, Hemiptera: Pleidae, Diptera: Muscidae and Mollusca: Sphaeriidae, Viviparidae, and Thiaridae, as indicators of low water level. Similarly, Coleoptera: Scirtidae, Hemiptera: Micronectidae and Oligochaeta: Tubificidae as indicators of medium water level, and Trichoptera: Polycentropodidae and Ephemeroptera: Caenidae as indicators of high water level. Redundancy analysis identified water level as one of the most influencing factors in benthic macroinvertebrate community variation. Considering the significant response of benthic macroinvertebrates to water level fluctuations, they are important as ecological indicators in research aimed at developing environmental flow frameworks. Indicator species are likely to be a vital tool in environmental impact assessment and monitoring in relation to hydrological development. The outcomes of this research have important implications to conservation and management of wetlands to preserve the valuable ecosystem functions provided by wetlands.

Ocular manifestations in tuberculosis cases with HIV in Nepal

INTRODUCTION

TB has seen resurgence associated with HIV. Tuberculosis can affect any ocular tissue. The association of HIV with TB is supposed to increase the incidence and plethora of ocular manifestations in tuberculosis.

OBJECTIVES

To study the various ocular manifestations seen in tuberculosis patients with associated HIV infection.

MATERIAL AND METHODS

This hospital based, cross sectional descriptive study was conducted in Tribhuvan University, Teaching Hospital, Maharajgunj, Nepal and Geta Eye Hospital, Kailali from 2010 to 2015. Diagnosed cases of pulmonary and extra pulmonary tuberculosis with HIV co infection were evaluated for ocular manifestations after excluding other opportunistic infections.

RESULTS

Of 70 cases eligible for the study, extra pulmonary tuberculosis was seen in60% of the cases. 5 patients (7.1 %) had ocular manifestations. CD4 counts were <50/mm3 in 3 cases. Ocular involvement was seen in the form of choroidal granulomas, papillitis, cranial nerve palsy, retinal vasculitis and central serous chorioretinopathy.

CONCLUSION

This study demonstrated that ocular involvement is a frequent finding in cases with tuberculosis and HIV. Ocular findings are more common in cases with lesser CD4 counts. As ocular tuberculosis can be visually devastating, we recommend regular ocular evaluation of all patients with HIV and systemic tuberculosis.

Status, distribution, threats, and conservation of the Ganges River Dolphin Platanista gangetica (Mammalia: Artiodactyla: Cetacea) in Nepal

The Ganges River Dolphin Platanista  gangetica  has been classified as Endangered in the IUCN Red List of Threatened Species.  The IUCN changed its status from ‘Vulnerable’ to ‘Endangered’ in 1996 as the species population was declining in its entire distribution range.  It is, however, classified as ‘Critically Endangered’ in Nepal.  Historically, the freshwater cetacean has been documented in the Karnali, Koshi, Narayani, and Mahakali basins.  With their population and distribution range in decline, the Ganges River Dolphin (GRD) is no longer found in the Mahakali River system, which demarcates and traverses the Western border of India and Nepal.  This study examines the status and distribution of the GRD in the river systems of Nepal during the monsoon of 2016.  The national dolphin population survey was conducted in the three largest river basins in Nepal—Karnali, Narayani, and Koshi.  Each of the three basins represent the extreme upstream limit of the GRD distribution in Ganges River basin.  The national population survey included both a boat-based survey and shore-based synchronized counting in each of the three river systems.  Fifty-two (Best-High-Low: 52-61-50) dolphins were counted during the entire nationwide survey, conducted in July–August, 2016.  Researchers gathered social-data from locals residing alongside the observed basin, giving priority to artisanal fishers and those subsisting to some degree from the rivers known to host the river dolphin.  A questionnaire survey of ninety-two residents from riparian villages adjacent to the GRD hotspots sheds light on the local perspectives towards dolphin conservation coupled with an assessment of their socio-economic status; artisanal fishing practices; and their awareness of dolphin conservation.  According to the survey, notable threats to dolphin conservation are prey depletion; non-availability of suitable habitat; habitat fragmentation and a low level of awareness.  Based on the counting outcomes and social survey, recommendations have been put forward for the conservation of this species. 

Scleritis and Takayasu's disease - rare combined presentation

INTRODUCTION

Takayasu's disease (TD) (pulseless disease, aortic arch syndrome) is a rare but potentially life-threatening chronic giant cell vasculitis. The major complications attributed to the disease include Takayasu's retinopathy, secondary hypertension, aortic regurgitation, and arterial aneurysm. The aim of this study is to describe a patient with Takayasu's disease and scleritis and to show its association.

CASE REPORT

We describe a 44-year-old female patient with Takayasu's disease who presented with bilateral anterior scleritis in the form of painful red eye. Patient did not have any associated autoimmune diseases. Patient was diagnosed to have TD and was treated with immunosuppressant.

CONCLUSION

Scleritis though rare can be a vasculitic feature of TD. This is a first report of Takayasu's disease with scleritis, which has been documented in Nepal.

Economic burden of primary compared with recurrent Clostridium difficile infection in hospitalized patients: a prospective cohort study

BACKGROUND

Few studies have investigated the additional healthcare costs of recurrent C. difficile infection (CDI).

AIM

To quantify inpatient treatment costs for CDI and length of stay among hospitalized patients with primary CDI only, compared with CDI patients who experienced recurrent CDI.

METHODS

This was a prospective, observational cohort study of hospitalized adult patients with primary CDI followed for three months to assess for recurrent CDI episodes. Total and CDI-attributable hospital length of stay (LOS) and hospitalization costs were compared among patients who did or did not experience at least one recurrent CDI episode.

FINDINGS

In all, 540 hospitalized patients aged 62±17 years (42% males) with primary CDI were enrolled, of whom 95 patients (18%) experienced 101 recurrent CDI episodes. CDI-attributable median (interquartile range) LOS and costs (in US$) increased from 7 (4-13) days and $13,168 (7,525-24,456) for patients with primary CDI only versus 15 (8-25) days and $28,218 (15,050-47,030) for patients with recurrent CDI (P<0.0001, each). Total hospital median LOS and costs increased from 11 (6-22) days and $20,693 (11,287-41,386) for patients with primary CDI only versus 24 (11-48) days and $45,148 (20,693-82,772) for patients with recurrent CDI (P<0.0001, each). The median cost of pharmacological treatment while hospitalized was $60 (23-200) for patients with primary CDI only (N=445) and $140 (30-260) for patients with recurrent CDI (P=0.0013).

CONCLUSION

This study demonstrated that patients with CDI experience a significant healthcare economic burden attributed to CDI. Economic costs and healthcare burden increased significantly for patients with recurrent CDI.

Climatic and Catchment-Scale Predictors of Chinese Stream Insect Richness Differ between Taxonomic Groups

Little work has been done on large-scale patterns of stream insect richness in China. We explored the influence of climatic and catchment-scale factors on stream insect (Ephemeroptera, Plecoptera, Trichoptera; EPT) richness across mid-latitude China. We assessed the predictive ability of climatic, catchment land cover and physical structure variables on genus richness of EPT, both individually and combined, in 80 mid-latitude Chinese streams, spanning a 3899-m altitudinal gradient. We performed analyses using boosted regression trees and explored the nature of their influence on richness patterns. The relative importance of climate, land cover, and physical factors on stream insect richness varied considerably between the three orders, and while important for Ephemeroptera and Plecoptera, latitude did not improve model fit for any of the groups. EPT richness was linked with areas comprising high forest cover, elevation and slope, large catchments and low temperatures. Ephemeroptera favoured areas with high forest cover, medium-to-large catchment sizes, high temperature seasonality, and low potential evapotranspiration. Plecoptera richness was linked with low temperature seasonality and annual mean, and high slope, elevation and warm-season rainfall. Finally, Trichoptera favoured high elevation areas, with high forest cover, and low mean annual temperature, seasonality and aridity. Our findings highlight the variable role that catchment land cover, physical properties and climatic influences have on stream insect richness. This is one of the first studies of its kind in Chinese streams, thus we set the scene for more in-depth assessments of stream insect richness across broader spatial scales in China, but stress the importance of improving data availability and consistency through time.

Impacted iron nail in the orbit and maxillary sinus through a corneo-scleral perforation: a case report

INTRODUCTION

Open globe injury is one of the commonest ophthalmic emergencies, and when accompanied by intraocular foreign bodies, the condition carries a poorer prognosis.

OBJECTIVE

To report a rare case of perforating injury of the globe with an iron nail which got lodged in the maxillary sinus.

CASE

A ten-year-old boy presented with the history of sudden painful loss of vision in his right eye. He reported that he was hit forcefully by the tail of a cow a day before the presentation. There was no perception of light in that eye. The ocular examination revealed a full thickness corneo-scleral perforation with prolapsed uveal tissue. The X-ray of the right orbit showed an impacted foreign body in the inferior orbit and computed tomography scan of the orbit confirmed the presence of a vertically impacted metal piece in the right orbit and right maxillary sinus. The repair of the perforation and removal of the impacted nail was done in two stages. The globe anatomy was maintained but the vision could not be restored due to the grave nature of the trauma.

CONCLUSION

Perforating globe injury is an important cause of monocular blindness.

Ocular injuries in the people's uprising of April 2006 in Kathmandu, Nepal

INTRODUCTION

In April 2006, the people of Nepal organised mass demonstrations demanding the restoration of democracy in the country. The ocular injuries that resulted during the riots that ensued, their pattern and the visual outcome of the injured have not yet been reported.

OBJECTIVE

To study the demographic profile, type, severity and the visual outcome of ocular injuries that occurred during the 2006 people's uprising in Nepal.

SUBJECTS AND METHODS

This was a retrospective interventional series of cases involving 29 subjects. The main outcome measures were demography, laterality of injury, type of injury and the visual status before and after the trauma.

RESULTS

The age of the victims ranged from 14 to 32 years. Among the victims with eye injuries, 27 (93.1 %) were males, who were unemployed youth, students and construction workers. The left eye was injured more frequently than the right. Non-lethal bullets and explosive tear gas were the commonest agents of the major ocular injuries. The main types of injuries requiring hospitalization were closed globe injuries in eight victims and open globe in six. Surgical intervention was required in 57.2 % (n = 29) of the cases. The visual outcome was poor in cases of open globe injury with posterior segment involvement.

CONCLUSION

Non-lethal bullets and explosive tear gases can cause significant visual impairment. Severe open globe injury with a retained intra-ocular foreign body is associated with significant visual loss.

Outcome of the patients with post-operative cluster endophthalmitis referred to a tertiary level eye care center in Nepal

INTRODUCTION

The causative organism and treatment outcomes of post operative endophthalmitis may vary depending on several factors.

OBJECTIVE

To find out the causative organisms and visual outcome after an outbreak of post-operative endophthalmitis.

MATERIALS AND METHODS

An interventional prospective series of cases of clinically suspected endophthalmitis was studied. Eleven patients who presented within 48 hours after manual cataract surgery on the same day, by a one surgeon in a single center were enrolled in the study. They underwent both anterior chamber and vitreous aspiration and all of them received intravitreal Vancomycin, Amikacin and Dexamethasone. Samples were subjected to microbiological evaluation. All patients were followed up till 8 weeks for clinical and visual outcome.

RESULTS

Of the 11 eyes of suspected endopthalmitis, only one vitreous aspiration showed Gram negative bacilli on Gram stain and 3 vitreous aspirates showed Gram positive cocci. Of the 11 eyes, 3(42.85%) had culture positive on vitreous aspirate. In 2 cases E Coli was isolated and in 1 Staphylococcus aureus was isolated. After 48 hours of intravitreal injection, 10 out of 11 eyes improved and in one, intravitreal injection of vancomycin, amikacin and dexamethasone was repeated. The best corrected visual acuity of 6/9 was achieved in 2 patients, 5 had 6/18, 2 had 6/60 and 2 had 5/60 at the end of eight weeks.

CONCLUSION

Staphylococcus aureus and E coli can cause endophthalmitis immediately on the first day post-operatively. Clinically suspected endophthalmitis treated with antibiotics and steroid intravitreal injection can result in better visual outcome.

Ocular manifestations in herpes zoster ophthalmicus

BACKGROUND

Ocular complications of herpes zoster ophthalmicus (HZO) may lead to substantial visual disability, severe post-herpetic neuralgia and rarely fatal cerebral complications.

AIM

To identify the pattern of ocular manifestation in herpes zoster ophthalmicus.

MATERIALS AND METHODS

A cross-sectional descriptive study was under taken including the clinically diagnosed cases of HZO. All of them underwent a complete ophthalmological evaluation.

RESULTS

Sixty-eight cases of HZO were examined, of which 37 (54.4 %) were male and 31 (45.6%) female. The mean age was 48.7 ± 18.5 years. Most of the patients (64.7 %) were above the age of 40 years. 77.94 % of the patients had some form of ocular involvement. Pain (77.9 %) was the commonest ocular complaint. In young patients less than 35 years, HIV was the most common risk factor (19.3 %).Visual status was good in the majority (73.5 %) of patients at presentation. Lid and adnexal findings (45.8 %) were most common ocular involvement followed by conjunctivitis (41.1 %). Corneal complication was seen in 38.2 % of cases, uveitis in 19.1 % and post-herpetic neuralgia (PHN) and secondary glaucoma each in 5.8 %.

CONCLUSION

Eyelid and ocular adnexal involvement is most commonly found in patients with herpes zoster ophthalmicus followed by corneal complication and uveitis. There needs to be awareness of ocular involvement, which can be sight threatening, among the HZO patients and other medical departments and an increased emphasis on regular ophthalmic examination.

The role of the injection botulinum toxin A in cases of blepharospasm syndrome, hemifacial spasm and Meige's syndrome

BACKGROUND

Benign Essential Blepharospasm Symdrome is a neuropathologic disorder. The cause of blepharospasm is multifactorial. It is unlikely that a single defect in this elusive control centre is the primary cause of this disease.

OBJECTIVES

To evaluate the role of botulinum toxin A in treating cases of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's Syndrome, and to assess orbicularis oculi muscle post treatment, in the patients who attended neuro-ophthalmology clinic and the general outpatient department of BP Koirala Lions Centre for Ophthalmic studies.

METHODS

A prospective, interventional study was carried out on all the patients of Essential Blepharospasm Symdrome, Hemifacial Spasm and Meige's syndrome who underwent treatment with botulinum toxin A in BP Koirala Lions Centre for Ophthalmic studies during a study period of one and half years. Pre- treatment grading of the spasm was done with Jankovic spasm grading and post treatment response was seen with assessment of orbicularis oculi muscle and improvement in functional impairment scale. Relevant findings were noted.

RESULTS

A total of 40 cases were enrolled in the study. The mean Jankovic spasm grading in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 3.61 (+/- Standard deviation 0.50, range 3-4), 3.21 (+/- Standard deviation 0.63, range 2-4) and 3.67 (+/- Standard deviation 0.57, range 3-4) respectively. The mean value for reappearance of significant spasms (in months) in cases of essential blepharospasm, hemifacial spasm and Meige's syndrome was 4.3 (+/- Standard deviation 1.6, range 2.0-6.5), 5.8 (+/- Standard deviation 1.4, range 3-8) and 4.5 (+/- Std.deviation 2.8, range 2.5-6.5) respectively. Blepharoptosis was the commonest complication accounting for 66.6% of the complications.

CONCLUSIONS

The movement disorders like Essential Blepharospasm, Hemifacial Hpasm and Meige's syndrome are treated by different modalities. An acceptable and effective treatment modality has been a long felt need in these cases. Our study has shown that injection of botulinum toxin A has been a safe and effective method of treating these cases in Nepal.

Inflammatory cellular kinetics in sympathetic ophthalmia a study of 29 traumatized (exciting) eyes

An immunohistochemical study was conducted on 29 cases of sympathetic ophthalmia (SO). Monoclonal antibodies against T, B, NK cells, macrophages, and MHC class II antigen (HLA-DR) were used. The choroidal infiltrate in 20 eyes was predominantly T cell while B cell predominated in four cases. All eyes with a B cell predominance came from males. A predominance of B cells was correlated to a longer duration of the disease (> 9 months) and in eyes showing phthisical changes. There was no correlation between a predominance of B cells with age, race, corticosteroid treatment or histological type (typical or atypical). These findings suggest that, although SO is a T cell mediated disease, the predominance of B cells in some cases may represent the end stage of the disease process, or seems a secondary pathological process. The kinetic change in cell populations during the disease may have therapeutic implication.

Ocular Manifestations of Meningitis in Children

Introduction: Meningitis is the most common central nervous system disease affecting children leading to focal neurological deficits and various oculovisual anomalies including blindness in children. The objective of this study was to evaluate the oculovisual anomalies occurring in Nepalese children suffering from different types of bacterial meningitis. Materials and Methods: A Prospective, study was undertaken for 18 months at B.P.Koirala Lion’s Center for ophthalmic studies, TU Teaching Hospital to study the children suffering from bacterial meningitis admitted at Kanti Children’s Hospital for ocular involvement. A through history, anterior and posterior segment ocular examination and investigations like blood, CSF and CT scan were done. Results: A total of 182 cases of bacterial meningitis were screened. Tubercular meningitis cases were 40 (21.97%) and Pyogenic were 142 (78.02%). Oculovisual anomalies were seen in 70 (38.46%) cases. The ocular abnormalities included pupillary changes (34.28%), Cranial Nerve Palsy (22.86%), Fundus changes (35.72%), Cortical Blindness (4.28%), Panophthalmitis and Proptosis (1.43%). Third nerve involvement was seen in 17.14% cases, sixth nerve in 4.29% cases, Papilledema in 11.43 % and Optic atrophy in 22.86 %. Risk factors included late presentation; hydrocephalous and increased CSF cell count and protein level. Conclusion: Oculovisual anomalies formed an important group of clinical manifestations of bacterial meningitis. Incidence of oculovisual anomalies was more frequently seen in Tubercular meningitis (55%).Children with early presentation and intervention had better prognosis. Hence, timely intervention and health education is important. J. Nepal Paediatr. Soc. 32(2) 2012 136-141 doi: http://dx.doi.org/10.3126/jnps.v32i2.5534

Phylogeographic analysis elucidates the influence of the ice ages on the disjunct distribution of relict dragonflies in Asia

Unusual biogeographic patterns of closely related groups reflect events in the past, and molecular analyses can help to elucidate these events. While ample research on the origin of disjunct distributions of different organism groups in the Western Paleartic has been conducted, such studies are rare for Eastern Palearctic organisms. In this paper we present a phylogeographic analysis of the disjunct distribution pattern of the extant species of the strongly cool-adapted Epiophlebia dragonflies from Asia. We investigated sequences of the usually more conserved 18 S rDNA and 28 S rDNA genes and the more variable sequences of ITS1, ITS2 and CO2 of all three currently recognised Epiophlebia species and of a sample of other odonatan species. In all genes investigated the degrees of similarity between species of Epiophlebia are very high and resemble those otherwise found between different populations of the same species in Odonata. This indicates that substantial gene transfer between these populations occurred in the comparatively recent past. Our analyses imply a wide distribution of the ancestor of extant Epiophlebia in Southeast Asia during the last ice age, when suitable habitats were more common. During the following warming phase, its range contracted, resulting in the current disjunct distribution. Given the strong sensitivity of these species to climatic parameters, the current trend to increasing global temperatures will further reduce acceptable habitats and seriously threaten the existences of these last representatives of an ancient group of Odonata.

Organism Isolation in Corneal Ulcer- Utility of Different Techniques

Introduction: Various techniques are available for isolation of microorganism in cases of microbial keratitis including conventional methods of scraping, re-scraping inoculation in different media and corneal biopsy. Methods: This was a cross sectional descriptive study conducted from February 2002 to July 2003. A total of 161 eyes of corneal ulcers were evaluated with scraping inoculation. Re-scraping and corneal biopsy were performed in those cases which did not grow any organism in the first scraping or which did not respond to initial treatment. Results: Microorganisms were isolated in 116 patients (72.04%) after first scraping. S pneumoniae was seen in 50(42%), Fusarium in 21(18%) and Aspergillus in 16(14%) cases. Re-scraping was done in 22 culture negative and non improving cases of which 14 (63.63%) showed isolation of organisms. After re-scraping, Fusarium and Aspergillus were isolated in four patients each (18% each) followed by S. pneumoniae in 3 (14%), S. aureus in 2 (9%), and Penicillium in 1(5%) case.Corneal biopsy was done in 10 cases with isolation of microbial agents in 7 (70%) with Aspergillus and S. aureus in three each, and S. epidermidis in 1(10%). Conclusions: Apart from conventional scraping, other isolation techniques should be considered in the treatment of non-responding and culture negative cases of corneal ulcers. Compared to bacteria, fungi are difficult to isolate in the first scraping and requires more frequent repeat scraping and corneal biopsy. Keywords: Corneal biopsy, corneal scraping, corneal ulcer, microbial keratitis, organismal isolation.

Organism isolation in corneal ulcer: utility of different techniques

INTRODUCTION

Various techniques are available for isolation of microorganism in cases of microbial keratitis including conventional methods of scraping, re-scraping inoculation in different media and corneal biopsy.

METHODS

This was a cross sectional descriptive study conducted from February 2002 to July 2003. A total of 161 eyes of corneal ulcers were evaluated with scraping inoculation. Re-scraping and corneal biopsy were performed in those cases which did not grow any organism in the first scraping or which did not respond to initial treatment.

RESULTS

Microorganisms were isolated in 116 patients (72.04%) after first scraping. S pneumoniae was seen in 50(42%), Fusarium in 21(18%) and Aspergillus in 16(14%) cases. Re-scraping was done in 22 culture negative and non improving cases of which 14 (63.63%) showed isolation of organisms. After re-scraping, Fusarium and Aspergillus were isolated in four patients each (18% each) followed by S. pneumoniae in 3 (14%), S. aureus in 2 (9%), and Penicillium in 1(5%) case. Corneal biopsy was done in 10 cases with isolation of microbial agents in 7 (70%) with Aspergillus and S. aureus in three each, and S. epidermidis in 1(10%).

CONCLUSIONS

Apart from conventional scraping, other isolation techniques should be considered in the treatment of non-responding and culture negative cases of corneal ulcers. Compared to bacteria, fungi are difficult to isolate in the first scraping and requires more frequent repeat scraping and corneal biopsy.

Evaluation of antifungal therapy in patients with candidaemia based on susceptibility testing results: implications for antimicrobial stewardship programmes

BACKGROUND

Definitive antifungal therapy is typically based on Candida species and clinical status, rather than susceptibility reports. Antifungal susceptibility testing is available, but the impact on treatment decisions is unknown. The purpose of this study was to assess antifungal therapy in hospitalized patients with candidaemia during the time period between the start of empirical therapy and after antifungal susceptibility testing reports are available.

METHODS

A retrospective study of 161 hospitalized patients with candidaemia was conducted. Patients who received fluconazole or an echinocandin were evaluated for changes in empirical antifungal therapy prior to and after susceptibility reporting.

RESULTS

One hundred and sixty-one patients aged 59 ± 16 years (male, 54%; Caucasian, 52%; APACHE II score ≥ 15, 48%; and intensive care unit, 50%) were identified, of whom 130 (81%) had fluconazole-susceptible candidaemia. Fifty-eight patients (36%) were initiated on fluconazole and 103 (64%) on an echinocandin. The mean time from culture to the susceptibility report was 5 ± 2 days. Prior to availability of the susceptibility report, 20 fluconazole-initiated patients (34%) were switched to an echinocandin, while 14 echinocandin-initiated patients (14%) were switched to fluconazole. Once a susceptibility report was available, 35 of 89 (39%) patients with fluconazole-susceptible candidaemia on an echinocandin were de-escalated to fluconazole. Eleven patients on fluconazole just prior to a susceptibility report were identified with a fluconazole-resistant Candida species.

CONCLUSIONS

Using antifungal susceptibility testing, patients given fluconazole with fluconazole-resistant Candida species were identified. Less than 40% of echinocandin-treated patients with fluconazole-susceptible organisms were de-escalated to fluconazole. Antifungal susceptibility testing may help to identify patients in need of clinical intervention.

Ocular manifestations in HIV/AIDS cases in Nepal

BACKGROUND

A significant number of patients with HIV/AIDS can have ocular manifestations. Almost every structure in the eyes can be affected in this condition.

OBJECTIVE

To study various ocular manifestations in the cases known to be infected with HIV.

MATERIALS AND METHODS

A cross-sectional descriptive study was carried out including 117 subjects positive for HIV using the purposive sampling method. Their demographic pattern and ocular findings were studied. Findings were recorded in the pro forma developed for the study.

STATISTICS

SPSS ver 14.0 was used for data analysis. The p value of < 0.05 was considered as significant.

RESULTS

A total of 117 HIV infected cases were included in this study. Among them, 76 (64.95%) were male and 41 (35.05%) female. The mean age of the subjects was 30.04 +/- 11.32 years. The duration of HIV detection ranged from 1-5 years. Ocular complaints were present in 26.49% of the subjects. Ocular manifestations were present in 56% of the patients with complaints and in 27.3% of asymptomatic patients. Ocular involvement was seen in 55 (47%) patients. The common anterior segment findings were herpes zoster ophthalmicus (4.27%), anterior uveitis (2.56%), blepharitis (2.56%) and conjunctivitis (1.7%), whereas HIV retinopathy (19.6%), CMV retinitis (5.1%), ocular toxoplasmosis (2.5%) and presumed ocular tuberculosis (0.85%) were common posterior segment findings.

CONCLUSION

Herpes zoster ophthalmicus, anterior uveitis, HIV retinopathy and CMV retinitis are common ocular manifestations associated with HIV infections.

Alport's syndrome

Alport's syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed.

Tearfilm immunoglobulin E (IgE) level in vernal keratoconjunctivitis by ELISA

BACKGROUND

Vernal keratoconjunctivitis (VKC) is recurrent chronic allergic conjunctivitis occurring in the prepubertal age-group with secondary involvement of the cornea and is self-limiting in character. The disease is prevalent worldwide but it shows predominance in the areas with dry and warm climate including the South Asia. VKC represents about 3% of the serious ophthalmic disease in some parts of the world where the prevalence is rate is high.Type I hypersensitivity reaction which is IgE-dependent and type IV hypersensitivity reaction have been implicated for the pathogenesis VKC.

OBJECTIVE

To determine level of immunoglobulin E (IgE) in the tear fi lm of patients with Vernal Keratoconjunctivitis (VKC) attending outpatient department of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS).

MATERIALS AND METHODS

Thirty-four VKC patients and thirty-four controls were included in this study. Tear samples were collected using micro- capillary glass tube method and tear IgE levels were measured using an enzyme - linked immunosorbent assay (ELISA).

RESULTS

There was high concentration of tear IgE level in VKC (95.09IU/ml) than in controls (1.63IU/ml) though the difference was not statistically significant (p=0.16). No statistically significant difference was observed in male and female gender within VKC group and when compared with control group (in male group, p=0.21 and in female group, p=0.26). There was no statistically significant difference observed in tear IgE level in different age groups within VKC group and when compared with control group (p=0.30). The result did not show any significant difference in tear IgE level with respect to the duration of the disease (p=0.23).There was no statistically significant difference in tear IgE level with different episodes of VKC (p=0.69). No statistically significant difference of IgE concentration in tear was seen among different types of VKC (p=0.53) and grades of tarsal and limbal papillae (p=0.72).

CONCLUSION

There was high concentration of tear IgE level observed in VKC.

Ocular evaluation in patients with chronic renal failure--a hospital based study

Chronic renal failure affects every organ system including eye. The aim of this study is to conduct thorough ocular examination in the patients of chronic renal failure and to analyze the findings. 119 cases were collected from Nephrology unit of Tribhuvan University Teaching Hospital between 1st June 2002 to 15th December 2003. This was a cross sectional, descriptive type of study. Sampling technique was consecutive and stratified. Severity of renal disease was classified as mild, moderate, severe and end stage renal disease. Twenty-three percent of total 238 eyes had vision < 6/18. The causes for visual impairment were maculopathy 23 eyes, cataract 14 eyes followed by proliferative diabetic retinopathy, 9 eyes. Twelve percent of total eyes had vision < 6/60. Lid edema was present in 63.0%, conjunctival pallor in 75.6% and corneal calcification in 1.6%. Retinopathy was the most important finding. Hypertensive retinopathy was present in 56 out of total 119 cases (47.1%). It was more prevalent and tended to be more severe as renal disease progressed. This was statistically significant. Diabetic retinopathy was present in 38 out of 43 diabetic cases (88.3%). Although statistically not proven, more severe grades of diabetic retinopathy were detected with increasing severity of the renal disease. There was one case of bilateral serous detachment of the retina relating to chronic renal failure. In this study, 47 out of 56 cases of hypertensive retinopathy and 19 out of 38 cases of diabetic retinopathy were detected for the first time, thus showing the importance of ocular evaluation of the patients of renal insufficiency.

Vernal keratoconjunctivitis: modes of presentation in Nepalese population

OBJECTIVE

To determine pattern of clinical presentation in Vernal Keratoconjunctivitis (VKC) in our context.

METHODS

Thirty-four VKC patients were included in this study.

RESULTS

The study revealed prepubertal onset with male preponderance and most frequently encountered symptom in the study among VKC cases was itching (100%) followed by redness of eyes and discharge (76.5% each) and the commonest sign was tarsal papillae (100%) followed by conjunctival hyperemia (91%) in 68 eyes of 34 cases of VKC.

CONCLUSION

The clinical presentation of VKC cases in our country is very much similar to the findings of other parts of the world.

Association of systemic diseases with retinal vein occlusive disease

Retinal vein occlusion (RVO) is the second commonest vascular disease of the eye, second only to Diabetic Retinopathy. The association of the retinal vein occlusion with other systemic disease likes hypertension, diabetes mellitus and others has been well documented. With the increase in persons being affected from these disorders, patients with retinal vein obstruction are also increasing. Hence, a study was designed to evaluate all cases of RVO to find out its association with systemic disorders. A total of 100 patients (106 eyes) were enrolled in the study. Out of which, 66 cases reported to have Brach Retinal Vein Occlusion (BRVO) and rest 34 cases with Central Retinal Vein Occlusion (CRVO). Among the associated systemic diseases, hypertension and diabetes mellitus accounted for 84% cases. Isolated hypertension (54%) was most commonly seen followed by diabetes mellitus (8%). The prevalence of BRVO was almost twice as compared to CRVO. The high association of various systemic disorder especially Hypertension and diabetes further supports the need of early and periodic eye examination for those suffering from these disorders.

VOGT, KOYANAGI, HARADA (VKH) SYNDROME

ABSTRACT

The Bhaktapur eye study: ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal

AIMS

To determine the incidence of ocular trauma and corneal ulceration in the district of Bhaktapur in Kathmandu Valley, and to determine whether or not topical antibiotic prophylaxis can prevent the development of ulceration after corneal abrasion.

METHODS

A defined population of 34 902 individuals was closely followed prospectively for 2 years by 81 primary eye care workers who referred all cases of ocular trauma and/or infection to one of the three local secondary eye study centres in Bhaktapur for examination, treatment, and follow up by an ophthalmologist. All cases of ocular trauma were documented and treated at the centres. Individuals with corneal abrasion confirmed by clinical examination who presented within 48 hours of the injury without signs of corneal infection were enrolled in the study and treated with 1% chloramphenicol ophthalmic ointment to the injured eye three times a day for 3 days.

RESULTS

Over the 2 year period there were 1248 cases of ocular trauma reported in the population of 34 902 (1788/100 000 annual incidence) and 551 cases of corneal abrasion (789/100 000 annual incidence). The number of clinically documented corneal ulcers was 558 (799/100 000 annual incidence). Of the 442 eligible patients with corneal abrasion enrolled in the prophylaxis study, 424 (96%) healed without infection, and none of the 284 patients who were started on treatment within 18 hours after the injury developed ulcers. Four of the 109 patients (3.7%) who presented 18-24 hours after injury developed infections, and 14 (28.6%) of the 49 patients who presented 24-48 hours subsequently developed corneal ulceration.

CONCLUSIONS

Ocular trauma and corneal ulceration are serious public health problems that are occurring in epidemic proportions in Nepal. This study conclusively shows that post-traumatic corneal ulceration can be prevented by topical application of 1% chloramphenicol ophthalmic ointment in a timely fashion to the eyes of individuals who have suffered a corneal abrasion in a rural setting. Maximum benefit is obtained if prophylaxis is started within 18 hours after injury.

An electromyographic study of masseter muscle activity amongst overdenture and complete denture patients

In recent years the dental profession has extended preventive Dentistry Concept in Prosthodontics by using overdenture. An Overdenture has a number of advantages over ordinary full dentures, including an improved neuromuscular performance. This study was carried out on two groups of patients wearing complete overdenture and conventional complete dentures to find out the masseter muscle activity in different oral condition and how muscle activity of patients with overdentures differ from that of patients with conventional complete denture.

3-(1H-tetrazol-5-yl)-4(3H)-quinazolinone sodium salt (MDL 427): a new antiallergic agent

Syntheses for 3-(1H-tetrazol-5-yl)-4(3H)-quinazolinone sodium salt monohydrate (9; MDL 427) and the related formamido compound, 2-(formylamino)-N-1H-tetrazol-5-ylbenzamide (10), are described. Both compounds are active in the rat passive cutaneous anaphylaxis and passive peritoneal anaphylaxis tests. A 94:6 equilibrium mixture of 9 and ionized 10, respectively, forms in aqueous buffer systems at a pH-dependent rate. In addition, analogues of 3-(1H-tetrazol-5-yl)-4(3H)-quinazolinone (8) bearing substituents on the benzene ring, substituents at the 2-position, and heteroaryl groups at the 3-position other than tetrazole were prepared. These analogue sets demonstrated that an accessible electrophilic center and an acidic functionality were requirements for good antiallergic activity.

Effect of the pH-zero point of charge relationship on the interaction of ionic compounds and polyols with aluminum hydroxide gel

The adsorption of magnesium nitrate, docusate sodium, and mannitol by chloride-containing aluminum hydroxide gel or aluminum hydroxycarbonate gel can be directly related to the surface charge characteristics of the aluminum hydroxide gel as determined by the pH-zero point of charge (ZPC) relationship. Magnesium cation is completely adsorbed under pH conditions where the gel has a negative surface charge, i.e. when the pH is above the ZPC. Docusate sodium is more strongly adsorbed when the pH-ZPC relationship causes the surface charge of aluminum when the pH-ZPC relationship causes the surface charge of aluminum hydroxycarbonate gel to be positive indicating adsorption of the docusate anion. However, adsorption also occurred when the pH was above the ZPC suggesting that adsorption of the hydrophobic portion of docusate anion by van der Waals forces also contributes to the overall adsorption mechanism. Mannitol is adsorbed under all pH conditions. However, greater adsorption occurs when the pH is above the ZPC. Maximum hydrogen bonding is believed to occur when mannitol acts as the proton donor and the negative aluminum hydroxycarbonate gel surface serves as the proton acceptor.

Mechanism of interaction between polyols and aluminum hydroxide gel

IR spectroscopy and changes in the rate of acid neutralization were used to study the interaction between various polyols and aluminum hydroxide. Hydrogen bonding is responsible for this interaction, although structural requirements limit the polyols that interact with aluminum hydroxide. Mannitol and sorbitol, both linear polyols, interacted with sulfate-containing aluminum hydroxide gel and aluminum hydroxycarbonate gel, while inositol, a cyclic polyol, did not interact. The adsorbed polyol has the favorable effect of inhibiting the polymerization reaction that occurs on aging and the negative effect of reducing the rate of acid neutralization. Thus, the specific polyol and concentration must be carefully selected to maximize the desired effect of stabilizing the gel structure. The presence of mannitol in the reaction medium during precipitation did not significantly enhance gel structure stability, probably because the mannitol was desorbed during the washing process as a consequence of the weak adsorption forces.

Effect of adsorbed carbonate on surface charge characteristics and physical properties of aluminum hydroxide gel

A titration procedure was used to determine the zero point of charge of a number of chloride-containing aluminum hydroxide gels and aluminum hydroxycarbonate gels. The surface charge characteristics of aluminum hydroxide gel were determined by both hydroxyls and the surface density of specifically adsorbed carbonate anion. The wide range of zero point of charge values reported for aluminum hydroxide is thought to be due to the presence of specifically adsorbed anions such as carbonate. The effect of ionic strength on the pH of aluminum hydroxide gel is important during washing since the ease of electrolyte removal is related to surface charge. Viscosity and sedimentation characteristics are related to the relationship between the zero point of charge and bulk pH. Maximum possibility was observed when the bulk pH was adjusted to the zero point of charge.