Slit lamp photography for objective assessment of topical eye disorders

Evidence based scientific studies has weightage, when they are presented with quantitative data analysis. Documentation and parametric analysis has become an integral part of present day research. Any publications or write-ups without explanation through standard parameters are not appreciated by the research society. In Ophthalmology assessment of various parameters through photography is a debatable issue. Affordability for higher end diagnostic / OPD instruments may not be feasible for all. In such a scenario, here is an attempt made to standardize the slit lamp photography with a smart phone and its scientific analysis for evaluating clinical conditions like sub-conjunctival hemorrhage, etc. This technique can become a tool for assessment and response of the therapies as well as an important tool to seek help from higher centers. Various add-on benefits in research, limitation and scope for further evaluation also being discussed.

A case of SFTS coinfected with E. coli bacteremia

Background Severe fever thrombocytopenia syndrome virus (SFTSV) is the causative agent of severe fever thrombocytopenia syndrome (SFTS). SFTS is an emerging infectious disease, characterized by high fever, gastrointestinal symptoms, leukopenia, thrombocytopenia, and a high mortality rate. Until now, little importance has been given to the association of SFTS with leukocytosis and bacterial co-infection. Case presentation A 51-year old man visited our hospital with fever and low blood pressure. He was a farmer by occupation and often worked outdoors. He had a Foley catheter inserted due to severe BPH. Laboratory tests revealed thrombocytopenia, elevated liver function, and elevated CRP levels. He had marked leukocytosis, proteinuria, hematuria, and conjunctival hemorrhage. Initially, we thought that the patient was suffering from hemorrhagic fever with renal syndrome (HFRS). However, we confirmed SFTS through PCR and increasing antibody titer. However, his blood culture also indicated E. coli infection. Conclusion SFTS displays characteristics of fever, thrombocytopenia, elevated liver function, and leukocytopenia. We described a case of SFTS with leukocytosis due to coinfection with E. coli. Since patients with SFTS usually have leukocytopenia, SFTS patients with leukocytosis are necessarily evaluated for other causes of leukocytosis. Here, we report the first case of an SFTS with concurrent E. coli bacteremia.

An outbreak of Coxsackievirus A6 infection in adults of a collective unit, China, 2019

Background: Outbreaks/epidemic caused by Coxsackievirus A6 have been reported continuously since 2008. However, outbreaks caused by Coxsackievirus A6 infection in adults of a collective unit have not been reported.Methods: The nasopharyngeal swab specimens were collected to extract the total nucleic acid (DNA/RNA). The pathogen was determined using nucleic acid detection kits for 22 respiratory pathogens. The VP1 gene of this pathogen was amplified and sequenced. Sequence alignment and analysis were performed using Bioedit. The gene phylogenetic tree was constructed with MEGA software.Results: The factory emerged patients in succession from the February 14 and reached the peak on the 18th. The main symptoms were rash, ocular conjunctival hemorrhage, fever and sore throat. A total of 19 workers had symptoms in this factory up to March 31, 2019, giving an attack rate of 8.26%. The laboratory results showed that Coxsackievirus A6 was the main pathogen causing this outbreak. The risk of taking a bath in the bathroom was 7.37 times higher than that of not taking a bath (95% CI: 1.67-32.79).Conclusions: This manuscript further enriched the infection-related information of CVA6, which was helpful to better identify and deal with the epidemic in the future.

An outbreak of Coxsackievirus A6 infection in adults of a collective unit, China, 2019

Background: Outbreaks/epidemic caused by Coxsackievirus A6 have been reported continuously since 2008. However, outbreaks caused by Coxsackievirus A6 infection in adults of a collective unit have not been reported. Methods: The nasopharyngeal swab specimens were collected to extract the total nucleic acid (DNA/RNA). The pathogen was determined using 22 respiratory pathogen nucleic acid detection kits. The VP1 gene of this pathogen was amplified and sequenced. Sequence alignment and analysis were performed using Bioedit. The gene phylogenetic tree was constructed with MEGA software. Results: The factory emerged patients in succession from the February 14 and reached the peak on the 18th. The main symptoms were rash, ocular conjunctival hemorrhage, fever and sore throat. A total of 19 workers had symptoms in this factory up to March 31, 2019, giving an attack rate of 8.26%. The laboratory results showed that Coxsackievirus A6 was the enterovirus type causing this outbreak. The risk of illness was 7.37 times higher taking bath in bathroom than that of not taking bath (95% CI 1.67, 32.79). Conclusions: Epidemiologic and molecular data indicated Coxsackievirus A6 as the etiology of this outbreak of adults in a collective unit, a risk factor for the spread was taking bath in the bathroom of the factory.

Correlation of imatinib plasma trough concentrations with adverse reaction in Chinese gastrointestinal stromal tumors patients.

11034 Background: Imatinib is the standard treatment for patients of Gastrointestinal Stromal Tumors (GISTs), but the intra- and inter-variability of imatinib plasma trough concentration (Cmin) are significant. Few studies investigated the association between Cmin and adverse reaction in Chinese GIST patients. The distribution of imatinib Cmin in different doses and the correlation of imatinib Cmin with adverse reaction in Chinese GIST patients from a high-volume center were evaluated. Methods: From 1 Jul 2017 to 31 Dec 2018, a total of 400 patients who were under imatinib treatment were prospectively studied. All patients’ informed consents were obtained. Steady state plasma samples were obtained from patients at least administrating 1 month treatment who were taking imatinib 100 to 800 mg/d, with continuous similar timing of daily dosage for more than 14 days. The adverse reaction was recorded during regular follow-up at out-patient clinic, and blood sample was collected 22±2 hours to the next dosage of imatinib. Liquid chromatography tandem mass spectrometry was applied to determine the concentration. Adverse reaction grades were referred to CTCAE v4.0. Results: A total of 368 patients who followed the same dose of imatinib with good compliance, and having at least 2 times of tests were investigated. The imatinib Cmin was 384±53 ng/mL, 776±337 ng/mL, 986±327 ng/mL, 1078±498 ng/mL, 1309±712 ng/mL, 1620±469 ng/mL, 2117±597 ng/mL and 3844±987 ng/mL in patients who were administrated with 100 mg/d (n = 3), 200 mg/d (n = 15), 250 mg/d (n = 5), 300 mg/d (n = 80), 400 mg/d (n = 235), 500 mg/d (n = 3), 600 mg/d (n = 22) and 800 mg/d (n = 5), respectively. In correlation analysis, imatinib Cmin was significantly correlated with periorbital and limbs edema (p < 0.01), anemia (p < 0.01) and rush (p < 0.01), correlated with diarrhea and conjunctival hemorrhage but not significant. Much higher Cmin was observed in severe adverse reaction (≥ grade 3) of periorbital and limbs edema and rash. There was no correlation between Cmin with leukopenia, nausea, vomiting, muscle cramp or hepatobiliary disorders. Conclusions: In Chinese GIST patients, imatinib Cmin at steady state was seems higher than Western populations previous reported, especially in higher doses (≥600 mg/d). Imatinib Cmin was correlated with anemia, periorbital and limbs edema, diarrhea and conjunctival hemorrhage, suggesting that imatinib Cmin monitor might be considered when patients were subjected to severe adverse reactions which were caused by excessive imatinib plasma concentration.

Pterygium Excision with Autologous Blood Autograft Fixation: Experience of a District Hospital of Bangladesh

A prospective interventional self-control study to see the outcome of suture less and glue free limbal conjunctival autograft for the management of primary and recurrent pterygium was carried out using patient's own blood as a bio-adhesive to secure the graft in position, in the Department of Ophthalmology, 250 bedded General Hospital Jamalpur from 15.09.16 to 30.11.16 and followed up upto July 2017. A total of 48 cases (44 were primary nasal pterygium and 4 were recurrent pterygium) were included in the study. Regarding type of the pterygium, out of 48 patients 3(6.25%) were grade I, 21(43.75%) were grade II, 13(27.08%) were grade III and 11(22.92%) were grade IV. The mean age of the study population was 32±2 years. The male and female distribution was 18 and 30 respectively. All the eyes followed by bandaging for 24-48 hours and were examined for graft dislodgement, recession, edema sub-conjunctival hemorrhage. Out of 48 eyes only 1 (2.1%) had sub-conjunctival hemorrhage, 2 (4.2%) edema and 3 (6.3%) had graft recession after 24 to 48 hrs of operation. All the complications were resolved 1-2 month. There was no recurrence of pterygium. No recurrence, graft loss or granuloma was recorded. No other complication was noted. Suture less and glue free limbal conjunctival autografting following pterygium excision is an effective and safe option for the management of primary pterygium.Medicine Today 2017 Vol.29(2): 46-50